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Sample records for presurgical focus localization

  1. Electrical source imaging of interictal spikes using multiple sparse volumetric priors for presurgical epileptogenic focus localization.

    PubMed

    Strobbe, Gregor; Carrette, Evelien; López, José David; Montes Restrepo, Victoria; Van Roost, Dirk; Meurs, Alfred; Vonck, Kristl; Boon, Paul; Vandenberghe, Stefaan; van Mierlo, Pieter

    2016-01-01

    Electrical source imaging of interictal spikes observed in EEG recordings of patients with refractory epilepsy provides useful information to localize the epileptogenic focus during the presurgical evaluation. However, the selection of the time points or time epochs of the spikes in order to estimate the origin of the activity remains a challenge. In this study, we consider a Bayesian EEG source imaging technique for distributed sources, i.e. the multiple volumetric sparse priors (MSVP) approach. The approach allows to estimate the time courses of the intensity of the sources corresponding with a specific time epoch of the spike. Based on presurgical averaged interictal spikes in six patients who were successfully treated with surgery, we estimated the time courses of the source intensities for three different time epochs: (i) an epoch starting 50 ms before the spike peak and ending at 50% of the spike peak during the rising phase of the spike, (ii) an epoch starting 50 ms before the spike peak and ending at the spike peak and (iii) an epoch containing the full spike time period starting 50 ms before the spike peak and ending 230 ms after the spike peak. To identify the primary source of the spike activity, the source with the maximum energy from 50 ms before the spike peak till 50% of the spike peak was subsequently selected for each of the time windows. For comparison, the activity at the spike peaks and at 50% of the peaks was localized using the LORETA inversion technique and an ECD approach. Both patient-specific spherical forward models and patient-specific 5-layered finite difference models were considered to evaluate the influence of the forward model. Based on the resected zones in each of the patients, extracted from post-operative MR images, we compared the distances to the resection border of the estimated activity. Using the spherical models, the distances to the resection border for the MSVP approach and each of the different time epochs were in

  2. Electrical source imaging of interictal spikes using multiple sparse volumetric priors for presurgical epileptogenic focus localization

    PubMed Central

    Strobbe, Gregor; Carrette, Evelien; López, José David; Montes Restrepo, Victoria; Van Roost, Dirk; Meurs, Alfred; Vonck, Kristl; Boon, Paul; Vandenberghe, Stefaan; van Mierlo, Pieter

    2016-01-01

    Electrical source imaging of interictal spikes observed in EEG recordings of patients with refractory epilepsy provides useful information to localize the epileptogenic focus during the presurgical evaluation. However, the selection of the time points or time epochs of the spikes in order to estimate the origin of the activity remains a challenge. In this study, we consider a Bayesian EEG source imaging technique for distributed sources, i.e. the multiple volumetric sparse priors (MSVP) approach. The approach allows to estimate the time courses of the intensity of the sources corresponding with a specific time epoch of the spike. Based on presurgical averaged interictal spikes in six patients who were successfully treated with surgery, we estimated the time courses of the source intensities for three different time epochs: (i) an epoch starting 50 ms before the spike peak and ending at 50% of the spike peak during the rising phase of the spike, (ii) an epoch starting 50 ms before the spike peak and ending at the spike peak and (iii) an epoch containing the full spike time period starting 50 ms before the spike peak and ending 230 ms after the spike peak. To identify the primary source of the spike activity, the source with the maximum energy from 50 ms before the spike peak till 50% of the spike peak was subsequently selected for each of the time windows. For comparison, the activity at the spike peaks and at 50% of the peaks was localized using the LORETA inversion technique and an ECD approach. Both patient-specific spherical forward models and patient-specific 5-layered finite difference models were considered to evaluate the influence of the forward model. Based on the resected zones in each of the patients, extracted from post-operative MR images, we compared the distances to the resection border of the estimated activity. Using the spherical models, the distances to the resection border for the MSVP approach and each of the different time epochs were in

  3. Local Functional Connectivity as a Pre-Surgical Tool for Seizure Focus Identification in Non-Lesion, Focal Epilepsy

    PubMed Central

    Weaver, K. E.; Chaovalitwongse, W. A.; Novotny, E. J.; Poliakov, A.; Grabowski, T. G.; Ojemann, J. G.

    2013-01-01

    Successful resection of cortical tissue engendering seizure activity is efficacious for the treatment of refractory, focal epilepsy. The pre-operative localization of the seizure focus is therefore critical to yielding positive, post-operative outcomes. In a small proportion of focal epilepsy patients presenting with normal MRI, identification of the seizure focus is significantly more challenging. We examined the capacity of resting state functional MRI (rsfMRI) to identify the seizure focus in a group of four non-lesion, focal (NLF) epilepsy individuals. We predicted that computing patterns of local functional connectivity in and around the epileptogenic zone combined with a specific reference to the corresponding region within the contralateral hemisphere would reliably predict the location of the seizure focus. We first averaged voxel-wise regional homogeneity (ReHo) across regions of interest (ROIs) from a standardized, probabilistic atlas for each NLF subject as well as 16 age- and gender-matched controls. To examine contralateral effects, we computed a ratio of the mean pair-wise correlations of all voxels within a ROI with the corresponding contralateral region (IntraRegional Connectivity – IRC). For each subject, ROIs were ranked (from lowest to highest) on ReHo, IRC, and the mean of the two values. At the group level, we observed a significant decrease in the rank for ROI harboring the seizure focus for the ReHo rankings as well as for the mean rank. At the individual level, the seizure focus ReHo rank was within bottom 10% lowest ranked ROIs for all four NLF epilepsy patients and three out of the four for the IRC rankings. However, when the two ranks were combined (averaging across ReHo and IRC ranks and scalars), the seizure focus ROI was either the lowest or second lowest ranked ROI for three out of the four epilepsy subjects. This suggests that rsfMRI may serve as an adjunct pre-surgical tool, facilitating the identification of the seizure focus in

  4. Lateralization and Localization of Epilepsy Related Hemodynamic Foci Using Presurgical fMRI

    PubMed Central

    Zhang, Clara Huishi; Lu, Yunfeng; Brinkmann, Benjamin; Welker, Kirk; Worrell, Gregory; He, Bin

    2014-01-01

    Objective The aim was to develop a method for the purpose of localizing epilepsy related hemodynamic foci for patients suffering intractable focal epilepsy using task-free fMRI alone. Methods We studied three groups of subjects: patients with intractable focal epilepsy, healthy volunteers performing motor tasks, and healthy volunteers in resting state. We performed spatial independent component analysis (ICA) on the fMRI alone data and developed a set of IC selection criteria to identify epilepsy related ICs. The method was then tested in the two healthy groups. Results In seven out of the nine surgery patients, identified ICs were concordant with surgical resection. Our results were also consistent with presurgical evaluation of the remaining one patient without surgery and may explain why she was not suitable for resection treatment. In the motor task study of ten healthy subjects, our method revealed components with concordant spatial and temporal features as expected from the unilateral motor tasks. In the resting state study of seven healthy subjects, the method successfully rejected all components in four out of seven subjects as non-epilepsy related components. Conclusion These results suggest the lateralization and localization value of fMRI alone in presurgical evaluation for patients with intractable unilateral focal epilepsy. Significance The proposed method is noninvasive in nature and easy to implement. It has the potential to be incorporated in current presurgical workup for treating intractable focal epilepsy patients. PMID:24856460

  5. Determination of epileptic focus side in mesial temporal lobe epilepsy using long-term noninvasive fNIRS/EEG monitoring for presurgical evaluation

    PubMed Central

    Rizki, Edmi Edison; Uga, Minako; Dan, Ippeita; Dan, Haruka; Tsuzuki, Daisuke; Yokota, Hidenori; Oguro, Keiji; Watanabe, Eiju

    2015-01-01

    Abstract. Noninvasive localization of an epileptogenic zone is a fundamental step for presurgical evaluation of epileptic patients. Here, we applied long-term simultaneous functional near-infrared spectroscopy (fNIRS)/electroencephalogram (EEG) monitoring for focus diagnosis in patients with mesial temporal lobe epilepsy (MTLE). Six MTLE patients underwent long-term (8–16 h per day for 4 days) fNIRS/EEG monitoring for the occurrence of spontaneous seizures. Four spontaneous seizures were successfully recorded out of the six patients. To determine oxy-Hb amplitude, the period-average values of oxy-Hb across 20 s from the EEG- or clinically defined epileptic onset were calculated for both hemispheres from the simultaneously recorded fNIRS data. The average oxy-Hb values for the temporal lobe at the earlier EEG- or clinically defined epileptic onsets were greater for the epileptic side than for the contralateral side after EEG activity suppression, spike train, and clinical seizure in all four cases. The true laterality was determined based on the relief of seizures by selective amygdalo-hippocampectomy. Thus, oxy-Hb amplitude could be a reliable measure for determining the epileptic focus side. Long-term simultaneous fNIRS/EEG measurement serves as an effective tool for recording spontaneous seizures. Cerebral hemodynamic measurement by fNIRS would serve as a valuable supplementary noninvasive measurement method for presurgical evaluation of MTLE. PMID:26158007

  6. Germ line polymorphisms as predictive markers for pre-surgical radiochemotherapy in locally advanced rectal cancer: a 5-year literature update and critical review.

    PubMed

    Pezzolo, Elisa; Modena, Yasmina; Corso, Barbara; Giusti, Pietro; Gusella, Milena

    2015-05-01

    Locally advanced rectal cancer is currently treated with pre-surgical radiotherapy and chemotherapy. Approximately one-half of patients obtain a relevant shrinkage/disappearance of tumour, with major clinical advantages. The remaining patients, in contrast, show no benefit and possibly need alternative treatment. To provide the best therapeutic option for each individual patient, predictive markers have been widely researched. This review was undertaken to evaluate recent progress made in this field. A systematic literature search was performed using PubMed and Scopus database, focused on germ line gene polymorphisms as biomarkers and response and toxicity as outcomes. Because an exhaustive previous review was available describing findings up to 2008, we restricted our analysis to the last 5 years. Ten original research articles were found, reporting promising results for some candidate genes in drug metabolism (TYMS, MTHFR), DNA repair (XRCC1, OGG1, CCND1) and inflammation (SOD2, TGFB1)/immunity (IL13) pathways, but with no firm conclusion. All the studies had small sample size and were defined as exploratory. This review highlights pivotal molecular, clinical, genetic and statistical issues in the investigation of genetic polymorphisms as outcome predictors for rectal cancer and offers suggestions for future development. What emerges is a clear need for new proposals, especially in view of the increasing evidence for tumour-host and gene-gene interactions during anticancer treatment, together with stronger adherence to proper methodological requirements.

  7. Presurgical language localization with visual naming associated ECoG high- gamma modulation in pediatric drug-resistant epilepsy.

    PubMed

    Arya, Ravindra; Wilson, J Adam; Fujiwara, Hisako; Rozhkov, Leonid; Leach, James L; Byars, Anna W; Greiner, Hansel M; Vannest, Jennifer; Buroker, Jason; Milsap, Griffin; Ervin, Brian; Minai, Ali; Horn, Paul S; Holland, Katherine D; Mangano, Francesco T; Crone, Nathan E; Rose, Douglas F

    2017-04-01

    This prospective study compared presurgical language localization with visual naming-associated high-γ modulation (HGM) and conventional electrical cortical stimulation (ECS) in children with intracranial electrodes. Patients with drug-resistant epilepsy who were undergoing intracranial monitoring were included if able to name pictures. Electrocorticography (ECoG) signals were recorded during picture naming (overt and covert) and quiet baseline. For each electrode the likelihood of high-γ (70-116 Hz) power modulation during naming task relative to the baseline was estimated. Electrodes with significant HGM were plotted on a three-dimensional (3D) cortical surface model. Sensitivity, specificity, and accuracy were calculated compared to clinical ECS. Seventeen patients with mean age of 11.3 years (range 4-19) were included. In patients with left hemisphere electrodes (n = 10), HGM during overt naming showed high specificity (0.81, 95% confidence interval [CI] 0.78-0.85), and accuracy (0.71, 95% CI 0.66-0.75, p < 0.001), but modest sensitivity (0.47) when ECS interference with naming (aphasia or paraphasic errors) and/or oral motor function was regarded as the gold standard. Similar results were reproduced by comparing covert naming-associated HGM with ECS naming sites. With right hemisphere electrodes (n = 7), no ECS-naming deficits were seen without interference with oral-motor function. HGM mapping showed a high specificity (0.81, 95% CI 0.78-0.84), and accuracy (0.76, 95% CI 0.71-0.81, p = 0.006), but modest sensitivity (0.44) compared to ECS interference with oral-motor function. Naming-associated ECoG HGM was consistently observed over Broca's area (left posterior inferior-frontal gyrus), bilateral oral/facial motor cortex, and sometimes over the temporal pole. This study supports the use of ECoG HGM mapping in children in whom adverse events preclude ECS, or as a screening method to prioritize electrodes for ECS testing. Wiley Periodicals, Inc.

  8. Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy.

    PubMed

    Zhang, Jing; Liu, Weifang; Chen, Hui; Xia, Hong; Zhou, Zhen; Mei, Shanshan; Liu, Qingzhu; Li, Yunlin

    2014-01-01

    Intracranial EEG (icEEG) monitoring is critical in epilepsy surgical planning, but it has limitations. The advances of neuroimaging have made it possible to reveal epileptic abnormalities that could not be identified previously and improve the localization of the seizure focus and the vital cortex. A frequently asked question in the field is whether non-invasive neuroimaging could replace invasive icEEG or reduce the need for icEEG in presurgical evaluation. This review considers promising neuroimaging techniques in epilepsy presurgical assessment in order to address this question. In addition, due to large variations in the accuracies of neuroimaging across epilepsy centers, multicenter neuroimaging studies are reviewed, and there is much need for randomized controlled trials (RCTs) to better reveal the utility of presurgical neuroimaging. The results of multiple studies indicate that non-invasive neuroimaging could not replace invasive icEEG in surgical planning especially in non-lesional or extratemporal lobe epilepsies, but it could reduce the need for icEEG in certain cases. With technical advances, multimodal neuroimaging may play a greater role in presurgical evaluation to reduce the costs and risks of epilepsy surgery, and provide surgical options for more patients with drug-resistant epilepsy.

  9. Indication of pre-surgical radiochemotherapy enhances psychosocial morbidity among patients with resectable locally advanced rectal cancer.

    PubMed

    Bencova, V; Krajcovicova, I; Svec, J

    2016-01-01

    Patients with cancer experience stress-determined psychosocial comorbidities and behavioural alterations. Patients expectation to be cured by the first line surgery and their emotional status can be negatively influenced by the decision to include neoadjuvant long-course radiotherapy prior to surgical intervention. From the patient's perspective such treatment algorithmindicates incurability of the disease. The aim of this study was to analyse the extent and dynamics of stress and related psychosocial disturbances among patients with resectable rectal cancer to whom the neoadjuvant radiochemotherapy before surgery has been indicated.Three standardised assessment tools evaluating psychosocial morbidity of rectal cancer patients have been implemented: The EORTC QLQ C30-3, the EORTC QLQ CR29 module and the HADS questionnaires previously tested for internal consistency were answered by patients before and after long-course radiotherapy and after surgery and the scores of clinical and psychosocial values were evaluated by means of the EORTC and HADS manuals. The most profound psychosocial distress was experienced by patients after the decision to apply neoadjuvant radiotherapy and concomitant chemotherapy before surgical intervention. The involvement of pre-surgical radiotherapy into the treatment algorithm increased emotional disturbances (anxiety, feelings of hopelessness) and negatively influenced patient's treatment adherence and positive expectations from the healing process. The negative psychosocial consequences appeared to be more enhanced in female patients. Despite provided information about advances of neoadjuvant radiotherapy onto success of surgical intervention, the emotional and cognitive disorders improved only slightly. The results clearly indicate that addressed communication and targeted psychosocial support has to find place before pre-surgical radiochemotherapy and as a standard part through the trajectory of the entire multimodal rectal cancer

  10. Localization of Epileptogenic Zone on Pre-surgical Intracranial EEG Recordings: Toward a Validation of Quantitative Signal Analysis Approaches.

    PubMed

    Andrzejak, Ralph G; David, Olivier; Gnatkovsky, Vadym; Wendling, Fabrice; Bartolomei, Fabrice; Francione, Stefano; Kahane, Philippe; Schindler, Kaspar; de Curtis, Marco

    2015-11-01

    In patients diagnosed with pharmaco-resistant epilepsy, cerebral areas responsible for seizure generation can be defined by performing implantation of intracranial electrodes. The identification of the epileptogenic zone (EZ) is based on visual inspection of the intracranial electroencephalogram (IEEG) performed by highly qualified neurophysiologists. New computer-based quantitative EEG analyses have been developed in collaboration with the signal analysis community to expedite EZ detection. The aim of the present report is to compare different signal analysis approaches developed in four different European laboratories working in close collaboration with four European Epilepsy Centers. Computer-based signal analysis methods were retrospectively applied to IEEG recordings performed in four patients undergoing pre-surgical exploration of pharmaco-resistant epilepsy. The four methods elaborated by the different teams to identify the EZ are based either on frequency analysis, on nonlinear signal analysis, on connectivity measures or on statistical parametric mapping of epileptogenicity indices. All methods converge on the identification of EZ in patients that present with fast activity at seizure onset. When traditional visual inspection was not successful in detecting EZ on IEEG, the different signal analysis methods produced highly discordant results. Quantitative analysis of IEEG recordings complement clinical evaluation by contributing to the study of epileptogenic networks during seizures. We demonstrate that the degree of sensitivity of different computer-based methods to detect the EZ in respect to visual EEG inspection depends on the specific seizure pattern.

  11. Monotherapy trials: presurgical studies.

    PubMed

    Pledger, G

    2001-05-01

    Presurgical evaluation of patients with refractory partial seizures provides a unique opportunity to perform a placebo-controlled, monotherapy trial. Some patients undergoing presurgical evaluations must have all of their antiepileptic drugs (AEDs) tapered in order to induce seizures and therefore such patients are possible candidates for a placebo-controlled monotherapy trial. Often, EEG monitoring is continued throughout the trial period, thus patients either receiving placebo or whose seizures do not completely respond to the active drug are still evaluated to determine whether or not surgery is feasible, supporting the validity of a trial in this setting. In addition, all patients are, in general, eligible to receive the study drug after the blinded period of the trial, and can therefore be assured of the possible therapeutic benefits of the study. Presurgical inpatients studies have been carried out using felbamate, gabapentin and oxcarbazepine. All patients randomised in these trials were refractory to previous treatment and the studies themselves were short-term and placebo-controlled. These presurgical studies are designed to elucidate AED activity and show statistically significant differences between active and control treatments during short-term therapy, and are therefore of use in fulfilling regulatory requirements. However, these measures of efficacy are distinctly different from those determined during chronic treatment and are therefore not necessarily predictive of clinical usefulness.

  12. [The presurgical evaluation of epilepsies].

    PubMed

    Bartolomei, F; Guye, M; Gavaret, M; Régis, J; Wendling, F; Raybaud, C; Chauvel, P

    2002-05-01

    In this article, we present an overview of the principles, practices and procedures of the presurgical evaluation of the epilepsies in use in our center and in the majority of French teams. Surgery for epilepsy is offered to patients presenting with severe epilepsy with partial seizures. Its aim is to stop the seizures, or to significantly reduce their frequency. To do that, the epileptogenic zone should theoretically be removed and/or the propagation pathways of the seizures should be cut. Discussion of these indications inevitably includes prior assessment of the functional sequels (sensory, motor, cognitive or behavioral) which surgery is liable cause. The presurgical evaluation involves a multidisciplinary approach involving epileptologists, neurophysiologists, neuroradiologists, neuropsychologists and neurosurgeons and is carried out in two phases. The phase I is based on non-invasive investigations, including functional and structural neuroimaging, neuropsychological assessment, source localization of interictal spike and video-EEG recordings of seizures. The phase II is often required and is aimed to precisely define the anatomical localization of the epileptogenic zone and the relationships with a structural lesion. This invasive phase is mainly based on stereoelectroencephalography (SEEG). Finally, the surgical procedure must be adapted according to the distribution and dynamics of the anatomical and functional abnormalities which individually define each case of epilepsy.

  13. [Presurgical functional magnetic resonance imaging].

    PubMed

    Stippich, C

    2010-02-01

    Functional magnetic resonance imaging (fMRI) is an important and novel neuroimaging modality for patients with brain tumors. By non-invasive measurement, localization and lateralization of brain activiation, most importantly of motor and speech function, fMRI facilitates the selection of the most appropriate and sparing treatment and function-preserving surgery. Prerequisites for the diagnostic use of fMRI are the application of dedicated clinical imaging protocols and standardization of the respective imaging procedures. The combination with diffusion tensor imaging (DTI) also enables tracking and visualization of important fiber bundles such as the pyramidal tract and the arcuate fascicle. These multimodal MR data can be implemented in computer systems for functional neuronavigation or radiation treatment. The practicability, accuracy and reliability of presurgical fMRI have been validated by large numbers of published data. However, fMRI cannot be considered as a fully established modality of diagnostic neuroimaging due to the lack of guidelines of the responsible medical associations as well as the lack of medical certification of important hardware and software components. This article reviews the current research in the field and provides practical information relevant for presurgical fMRI.

  14. Presurgical window of opportunity trial design as a platform for testing anticancer drugs: Pros, cons and a focus on breast cancer.

    PubMed

    Maugeri-Saccà, Marcello; Barba, Maddalena; Vici, Patrizia; Pizzuti, Laura; Sergi, Domenico; Catenaro, Teresa; Di Lauro, Luigi; Mottolese, Marcella; Santini, Daniele; Milella, Michele; De Maria, Ruggero

    2016-10-01

    The high attrition rate is a major issue in anticancer drug development. Among the alternative trial designs, presurgical window of opportunity trials envision a short course treatment in the time window between diagnostic biopsy and surgery in a moderately-sized patient population. This approach allows testing therapeutics when pre- and post-treatment tumor tissues are available for comprehensive molecular analyses. The emerging evidence may help define the ability of a given agent to modulate its target(s) and help obtain a broader picture of the molecular changes operated by the treatment. The resulting gain may outweigh the potential harms for patients in the early disease setting. Window of opportunity trials have been extensively applied to breast cancer. Overall, a wider use of these trial designs might lead to the identification of potential responders, ineffective drugs or combinations, and ultimately contribute to enhance the efficiency of the clinical developmental process.

  15. Environmental Flux and Locally Focused College Writing

    ERIC Educational Resources Information Center

    Shepley, Nathan

    2014-01-01

    This article reviews insights from place-based education and ecological models of writing to show how these theories can work together to shape locally focused composition pedagogies. From place-based education, the researcher takes an emphasis on physical specificity, and from ecological models of writing, the researcher takes an emphasis on…

  16. EEG Source Imaging in Partial Epilepsy in Comparison with Presurgical Evaluation and Magnetoencephalography

    PubMed Central

    Park, Chae Jung; Seo, Ji Hye; Kim, Daeyoung; Abibullaev, Berdakh; Kwon, Hyukchan; Lee, Yong-Ho; Kim, Min-Young; An, Kyung-min; Kim, Kiwoong; Kim, Jeong Sik; Joo, Eun Yeon

    2015-01-01

    Background and Purpose The aim of this study was to determine the usefulness of three-dimensional (3D) scalp EEG source imaging (ESI) in partial epilepsy in comparison with the results of presurgical evaluation, magnetoencephalography (MEG), and electrocorticography (ECoG). Methods The epilepsy syndrome of 27 partial epilepsy patients was determined by presurgical evaluations. EEG recordings were made using 70 scalp electrodes, and the 3D coordinates of the electrodes were digitized. ESI images of individual and averaged spikes were analyzed by Curry software with a boundary element method. MEG and ECoG were performed in 23 and 9 patients, respectively. Results ESI and MEG source imaging (MSI) results were well concordant with the results of presurgical evaluations (in 96.3% and 100% cases for ESI and MSI, respectively) at the lobar level. However, there were no spikes in the MEG recordings of three patients. The ESI results were well concordant with MSI results in 90.0% of cases. Compared to ECoG, the ESI results tended to be localized deeper than the cortex, whereas the MSI results were generally localized on the cortical surface. ESI was well concordant with ECoG in 8 of 9 (88.9%) cases, and MSI was also well concordant with ECoG in 4 of 5 (80.0%) cases. The EEG single dipoles in one patient with mesial temporal lobe epilepsy were tightly clustered with the averaged dipole when a 3 Hz high-pass filter was used. Conclusions The ESI results were well concordant with the results of the presurgical evaluation, MSI, and ECoG. The ESI analysis was found to be useful for localizing the seizure focus and is recommended for the presurgical evaluation of intractable epilepsy patients. PMID:25749824

  17. Use of magnetoencephalography in the presurgical evaluation of epilepsy patients.

    PubMed

    Shibasaki, Hiroshi; Ikeda, Akio; Nagamine, Takashi

    2007-07-01

    Magnetoencephalography (MEG) is used twofold for presurgical evaluation of patients with medically intractable partial epilepsy; to identify epileptogenic focus and to investigate functions of cortical areas at or near the epileptogenic focus or structural lesion. For the precise localization of the current source of epileptic discharge, the question as to whether MEG is superior to electroencephalography (EEG) is often addressed. To answer this question, so many factors, both biologically and technically related, have to be taken into consideration. The biological factors include the magnitude of epileptic discharge, its distribution over the cortex, depth of its source from the head surface, and the proportion of large pyramidal neurons tangentially oriented with respect to the head surface within the cortical area. The technical factors include the quality of the recording instrument such as the number of sensors and the use of gradiometer vs. magnetometer, the employed method of source analysis, and availability of experts in each institute. As far as the importance of ictal recording is emphasized, long-term video/EEG monitoring is of utmost importance. Thus, it is concluded that, once the epileptogenic focus is identified by the video/EEG monitoring, then MEG is superior to EEG in order to precisely localize the current source of the interictal epileptic discharge. Another question often addressed is whether MEG can replace the invasive intracranial EEG recording or not. In addition to the above-described factors, different coverage of the cortical areas by MEG vs. invasive intracranial EEG recording has to be taken into account to explain some of the recent reports related to this question. MEG can be effectively applied to the investigation of cortical functions near the epileptogenic focus. It is especially so when combined with other non-invasive studies like functional magnetic resonance imaging (fMRI). In addition to the source analysis of magnetic

  18. Localizing and Assessing Amputee Pain with Intense Focused Ultrasound

    DTIC Science & Technology

    2016-10-01

    ig-iFU device uses ultrasound imaging to locate neuromas, nerves, and tissue, and individual, short pulses of high- intensity ultrasound to...AWARD NUMBER: W81XWH-15-1-0291 TITLE: Localizing and Assessing Amputee Pain with Intense Focused Ultrasound PRINCIPAL INVESTIGATOR: Pierre D...patient pain. 2. KEYWORDS:  Image-guided intense focused ultrasound (ig-iFU)  Intense focused ultrasound (iFU)  Targeted muscle Reinnervation

  19. Comparative study of presurgical hand hygiene with hydroalcoholic solution versus traditional presurgical hand hygiene.

    PubMed

    López Martín, M Beatriz; Erice Calvo-Sotelo, Alejo

    To compare presurgical hand hygiene with hydroalcoholic solution following the WHO protocol with traditional presurgical hand hygiene. Cultures of the hands of surgeons and surgical nurses were performed before and after presurgical hand hygiene and after removing gloves at the end of surgery. Cultures were done in 2different days: the first day after traditional presurgical hand hygiene, and the second day after presurgical hand hygiene with hydroalcoholic solution following the WHO protocol. The duration of the traditional hand hygiene was measured and compared with the duration (3min) of the WHO protocol. The cost of the products used in the traditional technique was compared with the cost of the hydroalcoholic solution used. The variability of the traditional technique was determined by observation. Following presurgical hand hygiene with hydroalcoholic solution, colony-forming units (CFU) were detected in 5 (7.3%) subjects, whereas after traditional presurgical hand hygiene CFU were detected in 14 subjects (20.5%) (p < 0.05). After glove removal, the numbers of CFU were similar. The time employed in hand hygiene with hydroalcoholic solution (3min) was inferior to the time employed in the traditional technique (p < 0.05), its cost was less than half, and there was no variability. Compared with other techniques, presurgical hand hygiene with hydroalcoholic solution significantly decreases CFU, has similar latency time, a lower cost, and saves time. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  20. Depressed mood and memory impairment in temporal lobe epilepsy as a function of focus lateralization and localization.

    PubMed

    Helmstaedter, Christoph; Sonntag-Dillender, Markus; Hoppe, Christian; Elger, Christian E

    2004-10-01

    Memory disorders and depressed mood are prominent psychological symptoms of temporal lobe epilepsies (TLEs). We examined the interaction of depressive mood and memory as a function of focus localization. One hundred fifty-two TLE patients with right mesial (n=37, RTLE-AHS), right lateral (n=31, RTLE-LAT), left mesial (n=42, LTLE-AHS), and left lateral (n=42, LTLE-LAT) lesions and epilepsies underwent comprehensive presurgical evaluation and neuropsychological assessment of mood and memory. Univariate and multivariate analyses of covariance (ANCOVAs) and partial correlation analyses were performed to reveal interactions of depression and memory as a function of focus localization. No differences between the study groups were revealed for depression, indicating a general risk of 30% for depressed mood (BDI>12) in patients with TLE. ANCOVAs revealed significant main effects of focus side (left: verbal learning deficits; right: figural learning deficits) and site (mesial at disadvantage) on learning and memory scores. Correlation analyses revealed interactions between memory and mood only in LTLE-LAT patients. Although the data provide evidence that side and site of the epileptogenic region differentially affect material specific memory performance, there was no evidence of a specific temporal target region for depressive mood. In the majority of the patients, depressed mood and memory impairment appeared as independent rather than as related symptoms of TLE. In LTLE-LAT, however, mood was significantly related to verbal and figural memory performance. Epilepsy-driven pathological left temporofrontal circuits are discussed as a prerequisite for the coupling of mood disorders and memory impairment in this specific patient subgroup which is also known from the psychiatric major depression syndrome.

  1. Ictal Magnetic Source Imaging in Presurgical Assessment.

    PubMed

    Badier, Jean-Michel; Bénar, Christian-George; Woodman, Michael; Cruto, Catarina; Chauvel, Patrick; Bartolomei, Fabrice; Gavaret, Martine

    2016-01-01

    Ictal MEG recordings constitute rare data. The objective of this study was to evaluate ictal magnetic source localization (MSI), using two algorithms: linearly constrained minimum variance (LCMV), a beamforming technique and equivalent current dipole (ECD). Ictal MSI was studied in six patients. Three of them were undergoing post-operative re-evaluation. For all patients, results were validated by the stereoelectroencephalographic (SEEG) definition of the epileptogenic zone (EZ). EZ was quantified using the epileptogenicity index (EI) method, which accounts for both the propensity of a brain area to generate rapid discharges and the time for this area to become involved in the seizure. EI values range from 0 (no epileptogenicity) to 1 (maximal epileptogenicity). Levels of concordance between ictal MSI and EZ were determined as follows: A: ictal MSI localized the site whose value EI = 1, B: MSI localized a part of the EZ (not corresponding to the maximal value of EI = 1), C: a region could be identified on ictal MSI but not on SEEG, D: a region could be identified on SEEG but not on MSI, E: different regions were localized on MSI and SEEG. Ictal MEG pattern consisted of rhythmic activities between 10 and 20 Hz for all patients. For LCMV (first maxima), levels of concordance were A (two cases), B (two cases) and E (two cases). For ECD fitted on each time point separately (location characterized by the best goodness-of-fit value), levels of concordance were A (one case), B (one case), D (three cases) and E (one case). For ECD calculated for the whole time window, levels of concordance were A (two cases) and D (four cases). Source localization methods performed on rhythmic patterns can localize the EZ as validated by SEEG. In terms of concordance, LCMV was superior to ECD. In some cases, LCMV allows extraction of several maxima that could reflect ictal dynamics. In a medial temporal lobe epilepsy case, ictal MSI indicated an area of delayed propagation and was non

  2. Local tissue displacements induced by a focused ultrasound beam

    NASA Astrophysics Data System (ADS)

    Deng, Cheri

    2002-11-01

    The acoustic radiation force generated by an ultrasound beam in a medium where energy density gradient exists as the result of absorption or reflection can induce local tissue movement. Through energy absorption, an ultrasound beam can also cause local temperature rise in tissue, which can induce thermoelastic displacement because of thermal expansion. The radiation-force deformation is related to tissue elasticity and has been investigated for tumor detection in ultrasonic imaging and for monitoring therapeutic lesion size and location in high intensity focused ultrasound (HIFU) applications. In our study, theoretical and numerical models are developed to simulate the displacements induced by a focused ultrasound beam such as a HIFU beam and an imaging pulse, including both the radiation force deformation and thermoelastic displacement. Temperature rise resulted from the beam is computed using a 3D finite-difference algorithm that evaluates the bioheat equation. Thermoelastic displacements are obtained from the temperature rise. Radiation-force displacements are computed using finite-difference algorithm that solves the equations of motion subjected to such internal body force. The mechanical and thermal effects are compared and studied to elucidate how tissue displacements are related to factors including exposure characteristics and tissue properties such as absorption coefficients and Young's modulus.

  3. Focused ultrasound as a local therapy for liver cancer.

    PubMed

    Fischer, Krisztina; Gedroyc, Wladyslaw; Jolesz, Ferenc A

    2010-01-01

    Conventional surgical treatments of liver cancer are invasive (including minimally invasive) with a high incidence of new metastasis and poor success, even after multiple resections or ablations. These limitations motivated research into new, less invasive solutions for liver cancer treatment.Focused ultrasound surgery (FUS), or high-intensity focused ultrasound, has been recognized as a noninvasive technology for benign and malignant tumor treatment. Previously, FUS was guided with ultrasound that has limited target definition and monitoring capability of the ablation process. Combining magnetic resonance imaging (MRI) with multiple-element phased-array transducers to create MRI-guided focused ultrasound thermal therapy provides more accurate targeting and real-time temperature monitoring. This treatment is hindered by the ribcage that limits the acoustic windows to the liver and the respiratory motion of the liver. New advances in MRI and transducer design will likely resolve these limitations and make MRI-guided FUS a powerful tool in local liver cancer therapy. This article reviews this technology and advances that can expand its use for cancer treatment in general and liver cancer in particular.

  4. Presurgical Mapping of the Language Network Using Resting State Functional Connectivity

    PubMed Central

    Tanaka, Naoaki; Stufflebeam, Steven M.

    2016-01-01

    Resting-state functional magnetic resonance imaging (Resting-state fMRI) is a tool for investigating the functional networks that arise during the resting-state of the brain. Recent advances of the resting-state fMRI analysis suggest its feasibility for evaluating language function. The most common clinical application is for presurgical mapping of cortex for a brain tumor or for resective epilespy surgery. In this article, we review the techniques and presurgical applications of resting-state fMRI analysis for language evaluation, and discuss the use in the clinical setting, focusing on planning for neurosurgery. PMID:26848557

  5. Presurgical Mapping of the Language Network Using Resting-state Functional Connectivity.

    PubMed

    Tanaka, Naoaki; Stufflebeam, Steven M

    2016-02-01

    Resting-state functional magnetic resonance imaging (resting-state fMRI) is a tool for investigating the functional networks that arise during the resting state of the brain. Recent advances of the resting-state fMRI analysis suggest its feasibility for evaluating language function. The most common clinical application is for presurgical mapping of cortex for a brain tumor or for resective epilespy surgery. In this article, we review the techniques and presurgical applications of resting-state fMRI analysis for language evaluation, and discuss the use in the clinical setting, focusing on planning for neurosurgery.

  6. Localized Harmonic Motion Imaging for Focused Ultrasound Surgery Targeting

    PubMed Central

    Curiel, Laura; Hynynen, Kullervo

    2011-01-01

    Recently, an in vivo real-time ultrasound-based monitoring technique that uses localized harmonic motion (LHM) to detect changes in tissues during focused ultrasound surgery (FUS) has been proposed to control the exposure. This technique can potentially be used as well for targeting imaging. In the present study we evaluated the potential of using LHM to detect changes in stiffness and the feasibility of using it for imaging purposes in phantoms and in vivo tumor detection. A single-element FUS transducer (80 mm focal length, 100 mm diameter, 1.485 MHz) was used for inducing a localized harmonic motion and a separate ultrasound diagnostic transducer excited by a pulser/receiver (5 kHz PRF, 5 MHz) was used to track motion. The motion was estimated using cross-correlation techniques on the acquired RF signal. Silicon phantom studies were performed in order to determine the size of inclusion that was possible to detect using this technique. Inclusions were discerned from the surroundings as a reduction on LHM amplitude and it was possible to depict inclusions as small as 4 mm. The amplitude of the induced LHM was always lower at the inclusions as compared with the one obtained at the surroundings. Ten New Zealand rabbits had VX2 tumors implanted on their thighs and LHM was induced and measured at the tumor region. Tumors (as small as 10 mm in length and 4 mm in width) were discerned from the surroundings as a reduction on LHM amplitude. PMID:21683514

  7. Localized harmonic motion imaging for focused ultrasound surgery targeting.

    PubMed

    Curiel, Laura; Hynynen, Kullervo

    2011-08-01

    Recently, an in vivo real-time ultrasound-based monitoring technique that uses localized harmonic motion (LHM) to detect changes in tissues during focused ultrasound surgery (FUS) has been proposed to control the exposure. This technique can potentially be used as well for targeting imaging. In the present study, we evaluated the potential of using LHM to detect changes in stiffness and the feasibility of using it for imaging purposes in phantoms and in vivo tumor detection. A single-element FUS transducer (80 mm focal length, 100 mm diameter, 1.485 MHz) was used for inducing a localized harmonic motion and a separate ultrasound diagnostic transducer excited by a pulser/receiver (5 kHz PRF, 5 MHz) was used to track motion. The motion was estimated using cross-correlation techniques on the acquired radio-frequency (RF) signal. Silicon phantom studies were performed to determine the size of inclusion that was possible to detect using this technique. Inclusions were discerned from the surroundings as a reduction on LHM amplitude and it was possible to depict inclusions as small as 4 mm. The amplitude of the induced LHM was always lower at the inclusions compared with the one obtained at the surroundings. Ten New Zealand rabbits had VX2 tumors implanted on their thighs and LHM was induced and measured at the tumor region. Tumors (as small as 10 mm in length and 4 mm in width) were discerned from the surroundings as a reduction on LHM amplitude.

  8. Ectonucleotidases in the digestive system: focus on NTPDase3 localization.

    PubMed

    Lavoie, Elise G; Gulbransen, Brian D; Martín-Satué, Mireia; Aliagas, Elisabet; Sharkey, Keith A; Sévigny, Jean

    2011-04-01

    Extracellular nucleotides and adenosine are biologically active molecules that bind members of the P2 and P1 receptor families, respectively. In the digestive system, these receptors modulate various functions, including salivary, gastric, and intestinal epithelial secretion and enteric neurotransmission. The availability of P1 and P2 ligands is modulated by ectonucleotidases, enzymes that hydrolyze extracellular nucleotides into nucleosides. Nucleoside triphosphate diphosphohydrolases (NTPDases) and ecto-5'-nucleotidase are the dominant ectonucleotidases at physiological pH. While there is some information about the localization of ecto-5'-nucleotidase and NTPDase1 and -2, the distribution of NTPDase3 in the digestive system is unknown. We examined the localization of these ectonucleotidases, with a focus on NTPDase3, in the gastrointestinal tract and salivary glands. NTPDase1, -2, and -3 are responsible for ecto-ATPase activity in these tissues. Semiquantitative RT-PCR, immunohistochemistry, and in situ enzyme activity revealed the presence of NTPDase3 in some epithelial cells in serous acini of salivary glands and mucous acini and duct cells of sublingual salivary glands, in cells from the stratified esophageal and forestomach epithelia, and in some enteroendocrine cells of the gastric antrum. Interestingly, NTPDase2 and ecto-5'-nucleotidase are coexpressed with NTPDase3 in salivary gland cells and stratified epithelia. In the colon, neurons express NTPDase3 and glial cells express NTPDase2. Ca(2+) imaging experiments demonstrate that NTPDases regulate P2 receptor ligand availability in the enteric nervous system. In summary, the specific localization of NTPDase3 in the digestive system suggests functional roles of the enzyme, in association with NTPDase2 and ecto-5'-nucleotidase, in epithelial functions such as secretion and in enteric neurotransmission.

  9. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite.

    PubMed

    Liao, Yu-Fang; Chiu, Yu-Ting; Huang, Chiung-Shing; Ko, Ellen Wen-Ching; Chen, Yu-Ray

    2010-12-01

    It has long been claimed that presurgical orthodontics is crucial to the outcome of surgical-orthodontic treatment for dentofacial deformity. However, in the literature, the effect of presurgical orthodontics on the treatment outcome remains controversial. The purpose of the study was therefore to investigate the effect of presurgical orthodontics on the treatment outcome in terms of facial aesthetics, occlusion, stability, and efficiency. Thirty-three adult patients with skeletal class III open bite corrected by Le Fort I posterior impaction and bilateral sagittal split osteotomy were included. The patients were divided into two groups: 13 received presurgical orthodontics, and 20 did not. Cephalometric radiographs and study models were used to evaluate the treatment outcome. There were no between-group differences in facial aesthetics, overbite, or Peer Assessment Rating score. Overjet was larger in the no-presurgical orthodontics group than in the presurgical orthodontics group, but both were within normal limits. Both groups had similar maxillary and horizontal mandibular stability. Although the vertical mandibular stability was worse in the no-presurgical orthodontics group than in the presurgical orthodontics group, the direction of instability was favorable for open bite correction. Finally, longer treatment time was required in the presurgical orthodontics group compared with the no-presurgical orthodontics group (512±103 days versus 342±127 days; p<0.001). The results suggest that in surgical-orthodontic correction of skeletal class III open bite, presurgical orthodontics has no clinically significant effects on facial aesthetics, occlusion, or stability. However, presurgical orthodontics has a significant adverse effect on efficiency. Patients receiving presurgical orthodontics undergo longer treatment time than those receiving no presurgical orthodontics.

  10. Neuroimaging and presurgical evaluation of symptomatic epilepsies.

    PubMed

    Otsuki, Taisuke

    2004-06-01

    The goal of presurgical evaluation of intractable epilepsy is to identify epileptogenic regions in the brain. From our experience of 38 cases of resective epilepsy surgery from the last 3 years, ictal SPECT was considered the most sensitive at detecting focal changes relating to seizures compared to other neuroimaging modalities, such as MRI, FDG-PET, SPECT and MEG. At interictal state, on the other hand, FDG-PET was most sensitive, especially in cases with focal cortical dysplasia, which is often MRI-invisible. In dysplastic tumors, MRI showed the highest concordance rate to clinically verified epileptogenic regions. Activation studies using functional neuroimaging such as PET and fMRI is useful to evaluate brain functions at epileptogenic regions presurgically. The role of functional brain imaging in epilepsy surgery is considered to be: (i). case selection for resective surgery, (ii). case selection for invasive EEG monitoring, and (iii). navigation of electrode placement and cortical resection.

  11. Modeling of space-time focusing of localized nondiffracting pulses

    NASA Astrophysics Data System (ADS)

    Zamboni-Rached, Michel; Besieris, Ioannis M.

    2016-10-01

    In this paper we develop a method capable of modeling the space-time focusing of nondiffracting pulses. These pulses can possess arbitrary peak velocities and, in addition to being resistant to diffraction, can have their peak intensities and focusing positions chosen a priori. More specifically, we can choose multiple locations (spatial ranges) of space and time focalization; also, the pulse intensities can be chosen in advance. The pulsed wave solutions presented here can have very interesting applications in many different fields, such as free-space optical communications, remote sensing, medical apparatus, etc.

  12. The Role of Functional Neuroimaging in Pre-Surgical Epilepsy Evaluation

    PubMed Central

    Pittau, Francesca; Grouiller, Frédéric; Spinelli, Laurent; Seeck, Margitta; Michel, Christoph M.; Vulliemoz, Serge

    2014-01-01

    The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy. PMID:24715886

  13. Chitosan in Mucoadhesive Drug Delivery: Focus on Local Vaginal Therapy

    PubMed Central

    Andersen, Toril; Bleher, Stefan; Flaten, Gøril Eide; Tho, Ingunn; Mattsson, Sofia; Škalko-Basnet, Nataša

    2015-01-01

    Mucoadhesive drug therapy destined for localized drug treatment is gaining increasing importance in today’s drug development. Chitosan, due to its known biodegradability, bioadhesiveness and excellent safety profile offers means to improve mucosal drug therapy. We have used chitosan as mucoadhesive polymer to develop liposomes able to ensure prolonged residence time at vaginal site. Two types of mucoadhesive liposomes, namely the chitosan-coated liposomes and chitosan-containing liposomes, where chitosan is both embedded and surface-available, were made of soy phosphatidylcholine with entrapped fluorescence markers of two molecular weights, FITC-dextran 4000 and 20,000, respectively. Both liposomal types were characterized for their size distribution, zeta potential, entrapment efficiency and the in vitro release profile, and compared to plain liposomes. The proof of chitosan being both surface-available as well as embedded into the liposomes in the chitosan-containing liposomes was found. The capability of the surface-available chitosan to interact with the model porcine mucin was confirmed for both chitosan-containing and chitosan-coated liposomes implying potential mucoadhesive behavior. Chitosan-containing liposomes were shown to be superior in respect to the simplicity of preparation, FITC-dextran load, mucoadhesiveness and in vitro release and are expected to ensure prolonged residence time on the vaginal mucosa providing localized sustained release of entrapped model substances. PMID:25574737

  14. Corneal Injury from Presurgical Chlorhexidine Skin Preparation.

    PubMed

    Bever, Gregory J; Brodie, Frank L; Hwang, David G

    2016-12-01

    Chlorhexidine skin preparation has been shown to provide highly effective antimicrobial presurgical skin cleansing. However, there is a significant risk of ocular toxicity when it is used in periocular areas. We describe 2 cases of significant corneal damage resulting from 4% chlorhexidine gluconate preoperative skin cleanser, despite the use of protective occlusive dressing over the eyes. Because of the potential for severe corneal toxicity resulting from use of chlorhexidine, alternative agents such as 10% povidone-iodine should be considered for skin preparation near periocular areas whenever possible. If chlorhexidine gluconate must be employed near periocular areas, great care must be exercised to avoid contact with the eyes, and additional protective measures (e.g., absorbent eye pads along with tightly occlusive dressings) must be used whenever possible. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Functional neuro-imaging as a pre-surgical tool in epilepsy.

    PubMed

    Haneef, Zulfi; Chen, David K

    2014-03-01

    Functional neuro-imaging techniques are helpful in the pre-surgical evaluation of epilepsy for localization of the epileptogenic zone as ancillary tools to electroencephalography (EEG) and magnetic resonance imaging (MRI) or when other localization techniques are normal, non-concordant or discordant. Positron emission tomography (PET) and ictal single photon emission computed tomography (ictal SPECT) imaging are traditional tests that have been reported to have good sensitivity and specificity although the results are better with more expertise as is true for any technique. More recently magnetoencephalogram/magnetic source imaging (MEG/MSI), diffusion tensor imaging and functional magnetic resonance imaging (fMRI) have been used in localization and functional mapping during the pre-surgical work-up of epilepsy. Newer techniques such as fMRI-EEG, functional connectivity magnetic resonance imaging and near infra-red spectroscopy, magnetic resonance spectroscopy and magneto nanoparticles hold promise for further development that could then be applied in the work-up of epilepsy surgery. In this manuscript, we review these techniques and their current position in the pre-surgical evaluation of epilepsy.

  16. Functional neuro-imaging as a pre-surgical tool in epilepsy

    PubMed Central

    Haneef, Zulfi; Chen, David K.

    2014-01-01

    Functional neuro-imaging techniques are helpful in the pre-surgical evaluation of epilepsy for localization of the epileptogenic zone as ancillary tools to electroencephalography (EEG) and magnetic resonance imaging (MRI) or when other localization techniques are normal, non-concordant or discordant. Positron emission tomography (PET) and ictal single photon emission computed tomography (ictal SPECT) imaging are traditional tests that have been reported to have good sensitivity and specificity although the results are better with more expertise as is true for any technique. More recently magnetoencephalogram/magnetic source imaging (MEG/MSI), diffusion tensor imaging and functional magnetic resonance imaging (fMRI) have been used in localization and functional mapping during the pre-surgical work-up of epilepsy. Newer techniques such as fMRI-EEG, functional connectivity magnetic resonance imaging and near infra-red spectroscopy, magnetic resonance spectroscopy and magneto nanoparticles hold promise for further development that could then be applied in the work-up of epilepsy surgery. In this manuscript, we review these techniques and their current position in the pre-surgical evaluation of epilepsy. PMID:24791091

  17. Task-free presurgical mapping using functional magnetic resonance imaging intrinsic activity

    PubMed Central

    Liu, Hesheng; Buckner, Randy L.; Talukdar, Tanveer; Tanaka, Naoaki; Madsen, Joseph R.; Stufflebeam, Steven M.

    2013-01-01

    Object Low-frequency components of the spontaneous functional MR imaging signal provide information about the intrinsic functional and anatomical organization of the brain. The ability to use such methods in individual patients may provide a powerful tool for presurgical planning. The authors explore the feasibility of presurgical motor function mapping in which a task-free paradigm is used. Methods Six surgical candidates with tumors or epileptic foci near the motor cortex participated in this study. The investigators directly compared task-elicited activation of the motor system to activation obtained from intrinsic activity correlations. The motor network within the unhealthy hemisphere was identified based on intrinsic activity correlations, allowing distortions of functional anatomy caused by the tumor and epilepsy to be directly visualized. The precision of the motor function mapping was further explored in 1 participant by using direct cortical stimulation. Results The motor regions localized based on the spontaneous activity correlations were quite similar to the regions defined by actual movement tasks and cortical stimulation. Using intrinsic activity correlations, it was possible to map the motor cortex in presurgical patients. Conclusions This task-free paradigm may provide a powerful approach to map functional anatomy in patients without task compliance and allow multiple brain systems to be determined in a single scanning session. PMID:19361264

  18. Comprehensive presurgical functional MRI language evaluation in adult patients with epilepsy.

    PubMed

    Szaflarski, Jerzy P; Holland, Scott K; Jacola, Lisa M; Lindsell, Christopher; Privitera, Michael D; Szaflarski, Magdalena

    2008-01-01

    Functional magnetic resonance imaging (fMRI) has the potential to replace the intracarotid amobarbital procedure (IAP) in presurgical evaluation of patients with epilepsy. In this study, we compared fMRI verb generation (VG) and semantic decision/tone decision (SDTD) tasks and the IAP in their ability to localize language functions in patients with epilepsy undergoing presurgical evaluation. We enrolled 50 healthy controls to establish normal language activation patterns for VG and SDTD tasks at 3 or 4 T, and to design language regions of interest (ROIs) that were later applied to 38 patients with epilepsy (28 of 38 also underwent the IAP). We calculated laterality indices (LIs) for each task for each subject based on the ROIs, and we used general linear modeling to analyze the fMRI data. All healthy and epileptic subjects activated language areas with both fMRI tasks. We found significant correlations in language lateralization between the fMRI tasks (r=0.495, P<0.001) and between VG and IAP (r=0.652, P<0.001) and SDTD and IAP (r=0.735, P<0.001). The differences in LIs between SDTD and VG tasks were small and not affected by age, gender, epilepsy status, handedness, or performance. SDTD and VG tasks combined explained approximately 58.4% in the variability of the IAP/language. In the general linear modeling, only the SDTD task significantly contributed to the determination of language lateralization in patients with epilepsy undergoing presurgical evaluation. Results indicate a moderate convergent validity between both fMRI language tasks and between IAP and fMRI tasks. The results of this study indicate that either of these fMRI tasks can be used for language lateralization in patients with epilepsy undergoing presurgical evaluation, but that the SDTD task is likely to provide more information regarding language lateralization than the VG task.

  19. Critical role of bevacizumab scheduling in combination with pre-surgical chemo-radiotherapy in MRI-defined high-risk locally advanced rectal cancer: results of the branch trial

    PubMed Central

    Avallone, Antonio; Pecori, Biagio; Bianco, Franco; Aloj, Luigi; Tatangelo, Fabiana; Romano, Carmela; Granata, Vincenza; Marone, Pietro; Leone, Alessandra; Botti, Gerardo; Petrillo, Antonella; Caracò, Corradina; Iaffaioli, Vincenzo R.; Muto, Paolo; Romano, Giovanni; Comella, Pasquale; Budillon, Alfredo; Delrio, Paolo

    2015-01-01

    Background We have previously shown that an intensified preoperative regimen including oxaliplatin plus raltitrexed and 5-fluorouracil/folinic acid (OXATOM/FUFA) during preoperative pelvic radiotherapy produced promising results in locally advanced rectal cancer (LARC). Preclinical evidence suggests that the scheduling of bevacizumab may be crucial to optimize its combination with chemo-radiotherapy. Patients and methods This non-randomized, non-comparative, phase II study was conducted in MRI-defined high-risk LARC. Patients received three biweekly cycles of OXATOM/FUFA during RT. Bevacizumab was given 2 weeks before the start of chemo-radiotherapy, and on the same day of chemotherapy for 3 cycles (concomitant-schedule A) or 4 days prior to the first and second cycle of chemotherapy (sequential-schedule B). Primary end point was pathological complete tumor regression (TRG1) rate. Results The accrual for the concomitant-schedule was early terminated because the number of TRG1 (2 out of 16 patients) was statistically inconsistent with the hypothesis of activity (30%) to be tested. Conversely, the endpoint was reached with the sequential-schedule and the final TRG1 rate among 46 enrolled patients was 50% (95% CI 35%–65%). Neutropenia was the most common grade ≥3 toxicity with both schedules, but it was less pronounced with the sequential than concomitant-schedule (30% vs. 44%). Postoperative complications occurred in 8/15 (53%) and 13/46 (28%) patients in schedule A and B, respectively. At 5 year follow-up the probability of PFS and OS was 80% (95%CI, 66%–89%) and 85% (95%CI, 69%–93%), respectively, for the sequential-schedule. Conclusions These results highlights the relevance of bevacizumab scheduling to optimize its combination with preoperative chemo-radiotherapy in the management of LARC. PMID:26320185

  20. Figuring of plano-elliptical neutron focusing mirror by local wet etching.

    PubMed

    Yamamura, Kazuya; Nagano, Mikinori; Takai, Hiroyuki; Zettsu, Nobuyuki; Yamazaki, Dai; Maruyama, Ryuji; Soyama, Kazuhiko; Shimada, Shoichi

    2009-04-13

    Local wet etching technique was proposed to fabricate high-performance aspherical mirrors. In this process, only the limited area facing to the small nozzle is removed by etching on objective surface. The desired objective shape is deterministically fabricated by performing the numerically controlled scanning of the nozzle head. Using the technique, a plano-elliptical mirror to focus the neutron beam was successfully fabricated with the figure accuracy of less than 0.5 microm and the focusing gain of 6. The strong and thin focused neutron beam is expected to be a useful tool for the analyses of various material properties.

  1. Partial resection of presurgical fMRI activation is associated with a postsurgical loss of language function after frontal lobe epilepsy surgery.

    PubMed

    Labudda, Kirsten; Mertens, Markus; Kalbhenn, Thilo; Schulz, Reinhard; Woermann, Friedrich G

    2017-09-27

    We describe five patients with frontal lobe epilepsy who underwent electrocortical stimulation (ES) for language localization and language functional magnetic resonance imaging (fMRI) prior to epilepsy surgery. Six months after surgery, three patients suffered from a drop of verbal fluency. In all of them, frontal areas with presurgical language fMRI activity were resected. Our results suggest that resection in regions of areas with presurgical fMRI activation is not without risk for a postsurgical loss of function, even when ES results were negative for language function in these areas. Using fMRI activations might be specifically helpful to plan the resection when ES delivered inconclusive results.

  2. A case of pathological excitability located with navigated-TMS: presurgical evaluation of focal neocortical epilepsy.

    PubMed

    Schmidt, Sein; Holst, Eric; Irlbacher, Kerstin; Oltmanns, Frank; Merschhemke, Martin; Brandt, Stephan A

    2010-01-01

    The quality of presurgical evaluation in focal extratemporal epilepsy surgery is highly dependent on precise structural and functional identification of the epileptic focus. Navigated transcranial magnetic stimulation (nTMS) is a tool that combines the spatial information of high-resolution magnetic resonance imaging (MRI) with the functionality of non-invasive cortical stimulation. The non-invasive character of nTMS suggests that it could be a promising tool for presurgical evaluation of cortical excitability. Presurgical nTMS evaluation was performed on an 8-year-old boy with left-sided intractable focal epilepsy, somatosensory auras and epilepsia partialis continua. In line with standardized procedures, motor evoked potentials were sought in both hemispheres over perirolandic cortex during simultaneous belly-tendon surface recordings of the first dorsal interosseus muscles. One singular motor-evoked potential (MEP) could be elicited in the unaffected hemisphere. In contrast, in the affected hemisphere MEPs could be elicited over a large area of the cortex even after the stimulation strength was reduced by at least 44%. Latency stratification in the affected hemisphere differentiated a motor from a sensory region of interest. Stimulation over the sensory region induced a sensory aura. The sensory site was concordant with a previous transient diffusion restriction found in an MRI two years prior to nTMS. NTMS can locate pathological excitability with high spatial precision. Future studies should compare nTMS with direct cortex stimulation, as well as the combination of nTMS with electroencephalography (EEG) in a larger patient-collective.

  3. Response of malignant scalp dermatofibrosarcoma to presurgical targeted growth factor inhibition.

    PubMed

    Mattox, Austin K; Mehta, Ankit I; Grossi, Peter M; Cummings, Thomas J; Adamson, D Cory

    2010-05-01

    Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive, malignant cutaneous tumor that sparingly presents on the scalp. Dermatofibrosarcomas often result from the formation of a fusion oncogene on translocated or supernumerary ring chromosomes 17 and 22, causing the overexpression of PDGFRbeta driven by the COL1A1 promoter. Because of uncertainty surrounding appropriate treatment of aggressive scalp DFSP, the authors performed an extensive review of the available data from a MEDLINE (Ovid) search to describe the clinical presentation and treatment options for this rare tumor. Their search identified 39 different cases, including the illustrative case presented in this study. Adjuvant therapy for this malignant lesion is not universally established in the literature. In the present case, the authors successfully treated a locally invasive scalp DFSP with presurgical therapy that specifically inhibited the PDGFbeta receptor. Imatinib significantly shrank the DFSP tumor mass, reduced hypervascularity, reduced metabolic activity on PET scanning, and permitted a safe gross-total resection. Although wide excision and Mohs micrographic surgery remain the standard surgical treatments for DFSP, the authors illustrate that presurgical chemotherapeutic treatment by imatinib provides a critical adjunct to traditional therapy.

  4. High-intensity focused ultrasound: noninvasive treatment for local unresectable recurrence of osteosarcoma.

    PubMed

    Yu, Wenxi; Tang, Lina; Lin, Feng; Yao, Yang; Shen, Zan; Zhou, Xiaohui

    2015-03-01

    Local unresectable recurrence of osteosarcoma is one of the most challenging tumors to treat. High-intensity focused ultrasound (HIFU) is a new, noninvasive technique with potential to ablate and inactivate tumors. Treatment of solid tumors with HIFU has been reported. In this study, we assessed safety and efficacy of HIFU in treating local unresectable recurrence of osteosarcoma. We performed a retrospective analysis of 27 patients who had local unresectable recurrence of osteosarcoma from 2006 to 2010. Changes of biochemical markers and pain rating, response rate, disease control rate, local disease progression-free survival, progression-free survival (PFS) and overall survival (OS) were used to evaluate efficacy of HIFU treatment. HIFU resulted in a significant change in alkaline phosphatase and lactic acid dehydrogenase and a remarkably relief in pain rating, without severe side effects. According to MRI examination 4-6 weeks after HIFU treatment, 2 (7.4%) patients had complete response (CR), 12 (44.4%) had partial response (PR), 9 (33.3%) had stable disease (SD) and 4 (14.8%) had progression disease (PD). The response rate was 51.8% and the local disease control rate was 85.2%. The 1-, 2-, and 3-year local disease control rates were 59.2%, 40.7% and 33.1%, respectively. The median local disease progression-free time was 14 months, the median progression-free time was 13 months and the median over-all survival time was 21 months. Patients without pulmonary metastasis had a better local disease control rate at 1-,2-,3-year and a longer local disease progression-free time, progression-free time, over-all survival time than patients with pulmonary metastasis. HIFU is a safe and noninvasive treatment for local unresectable recurrence of osteosarcoma, with good local control and without severe complications. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. [18F] fluorodeoxyglucose-positron-emission tomography and MR imaging coregistration for presurgical evaluation of medically refractory epilepsy.

    PubMed

    Lee, K K; Salamon, N

    2009-11-01

    Epilepsy is a chronic disorder affecting approximately 1% of the population of the world. Approximately one third of patients with epilepsy remain refractory to medical therapy. For these patients, surgery is a curative option. In order for surgery to be considered, precise localization of the structural abnormality is needed. When MR imaging findings are normal, more sensitive techniques such as positron-emission tomography (PET) can help find the abnormality. Combining MR imaging and PET information increases the sensitivity of the presurgical evaluation. In this review, we discuss the clinical applications of coregistration of [(18)F] fluorodeoxyglucose (FDG)-PET with MR imaging for medically refractory epilepsy. Because FDG-PET/MR imaging coregistration has been a routine component of the presurgical evaluation for patients with epilepsy at our institution since 2004, we also included cases from our data base that exemplify the utility of this technology to obtain better postsurgical outcomes.

  6. Local search methods based on variable focusing for random K -satisfiability

    NASA Astrophysics Data System (ADS)

    Lemoy, Rémi; Alava, Mikko; Aurell, Erik

    2015-01-01

    We introduce variable focused local search algorithms for satisfiabiliity problems. Usual approaches focus uniformly on unsatisfied clauses. The methods described here work by focusing on random variables in unsatisfied clauses. Variants are considered where variables are selected uniformly and randomly or by introducing a bias towards picking variables participating in several unsatistified clauses. These are studied in the case of the random 3-SAT problem, together with an alternative energy definition, the number of variables in unsatisfied constraints. The variable-based focused Metropolis search (V-FMS) is found to be quite close in performance to the standard clause-based FMS at optimal noise. At infinite noise, instead, the threshold for the linearity of solution times with instance size is improved by picking preferably variables in several UNSAT clauses. Consequences for algorithmic design are discussed.

  7. Pre-Surgical Integration of fMRI and DTI of the Sensorimotor System in Transcortical Resection of a High-Grade Insular Astrocytoma

    PubMed Central

    Ekstrand, Chelsea L.; Mickleborough, Marla J. S.; Fourney, Daryl R.; Gould, Layla A.; Lorentz, Eric J.; Ellchuk, Tasha; Borowsky, Ron W.

    2016-01-01

    Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis. PMID:27013996

  8. A Simulation Model for Local Harmonic Motion Monitoring of Focused Ultrasound Surgery

    SciTech Connect

    Heikkilae, Janne; Curiel, Laura; Hynynen, Kullervo

    2009-04-14

    A computational model for local harmonic motion (LHM) imaging-based monitoring of high-intensity focused ultrasound surgery (FUS) is presented. LMH technique is based on a focused ultrasound radiation force excitation, which induces local mechanical vibrations at the focal region. These pulse-echo imaged vibrations are then used to estimate the mechanical properties of the sonication region. LHM has been proven to be feasible for FUS monitoring because changes in the material properties during the coagulation affect the measured displacements. The presented model includes separate models to simulate acoustic fields, sonication induced temperature elevation and mechanical vibrations, and pulse-echo imaging of the induced motions. These simulation models are based on Rayleigh integral, finite element, and spatial impulse response methods. Simulated temperature rise and vibration amplitudes have been compared with in vivo rabbit experiments with noninvasive MRI thermometry.

  9. A rapid method for the presurgical cleansing of hands.

    PubMed

    Decker, L A; Gross, A; Miller, F C; Read, J A; Cutright, D E; Devine, J

    1978-01-01

    A new rapid method of presurgical cleansing of the hands has been evaluated in a clinical setting. The effectiveness of a 90 second jet wash has been compared with a standard 10-minute presurgical scrub. Bacteriologic cultures were obtained from the fingertips of interns, residents, and staff of the Department of Obstetrics and Gynecology of the Walter Reed Army Medical Center before and after 90-second jet washings and 10-minute conventional scrubs. The results showed that the 90-second jet wash was more effective in degerming the hands than the 10-minute standard brush scrub. Other advantages of the new method, such as the amount of time saved, the standardization of cleansing, and reduced skin irritation are discussed.

  10. Presurgical prosthetic management of the periodontal patient--a modern adhesive approach.

    PubMed

    Scharf, J

    1994-01-01

    The comprehensive management of the periodontal prosthetic patient requires that treatment be provided in a logical sequence; initial therapy, presurgical prosthetic management, surgical management of hard and soft tissue lesions, post-surgical prosthetics, followed by maintenance therapy. This article focuses on some of the most perplexing challenges encountered during the presurgical prosthetic management phase of periodontal diagnosis and therapy, including the stabilization of mobile teeth, the immediate replacement of teeth that require removal due to advanced attachment loss, and the correction of visual defects created by soft tissue loss. A number of creative treatment modalities are described that utilize silane-treated etched-glass fiber ropes and tapes (GlasSpan, GlasSpan, Inc.) for the internal reinforcement of periodontal splints and for the attachment of composite and natural tooth pontics as transitional tooth replacements. Gingival-colored composite (Gingiblend, Jeneric Pentron) and its importance as a diagnostic aid during the early stages of periodontal therapy and as an esthetic permanent restorative material are also examined.

  11. High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment

    PubMed Central

    Alkhorayef, Mohammed; Mahmoud, Mustafa Z.; Alzimami, Khalid S.; Sulieman, Abdelmoneim; Fagiri, Maram A.

    2015-01-01

    Summary Background High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period. PMID:25806099

  12. The value of EEG-fMRI and EEG source analysis in the presurgical setup of children with refractory focal epilepsy.

    PubMed

    Elshoff, Lydia; Groening, Kristina; Grouiller, Frédéric; Wiegand, Gert; Wolff, Stephan; Michel, Christoph; Stephani, Ulrich; Siniatchkin, Michael

    2012-09-01

    In the presurgical evaluation of children and juvenile patients with refractory focal epilepsy, the main challenge is to localize the point of seizure onset as precisely as possible. We compared results of the conventional electroencephalography-functional magnetic resonance imaging (EEG-fMRI) analysis with those obtained with a newly developed method using voltage maps of average interictal epileptiform discharges (IEDs) recorded during clinical long-term monitoring and with the results of the electric source imaging (ESI). Simultaneous EEG-fMRI was recorded in nine patients (ages 1.5-17.5 years) undergoing presurgical evaluation. The postoperative outcome and resected area were compared with the following: the localizations of blood oxygen-level dependent (BOLD) signal changes associated with IEDs, which were identified by visual inspection changes using SPM5 software (Analysis I); BOLD signal changes related to IED topography, which was characterized using spike-specific voltage maps of average IED recorded outside the MR scanner during clinical long-term monitoring (Analysis II); as well as results of EEG source analysis based on the distributed linear local autoregressive average (LAURA) algorithm using the Cartool software by Denis Brunet (Analysis III). All nine patients had postoperative outcome Engel class I-IIb (postoperative time 6-26 months). The analysis I revealed an IED-related area of activation within the resection area in 3 (33%) of 9 patients, analysis II was able to reliably localize the source of epileptic activity in 4 (44%) of 9 patients, and analysis III rendered results concordant with the postoperative resection site in all nine patients. The localization of seizure onset based on EEG-fMRI may be a useful adjunct in the preoperative evaluation but also has some deficits that impair the reliability of results. In contrast, EEG source analysis is clearly a more credible method for epileptic focus localization in children with refractory

  13. Noninvasive measurement of local thermal diffusivity using backscattered ultrasound and focused ultrasound heating.

    PubMed

    Anand, Ajay; Kaczkowski, Peter J

    2008-09-01

    Previously, noninvasive methods of estimating local tissue thermal and acoustic properties using backscattered ultrasound have been proposed in the literature. In this article, a noninvasive method of estimating local thermal diffusivity in situ during focused ultrasound heating using beamformed acoustic backscatter data and applying novel signal processing techniques is developed. A high intensity focused ultrasound (HIFU) transducer operating at subablative intensities is employed to create a brief local temperature rise of no more than 10 degrees C. Beamformed radio-frequency (RF) data are collected during heating and cooling using a clinical ultrasound scanner. Measurements of the time-varying "acoustic strain", that is, spatiotemporal variations in the RF echo shifts induced by the temperature related sound speed changes, are related to a solution of the heat transfer equation to estimate the thermal diffusivity in the heated zone. Numerical simulations and experiments performed in vitro in tissue mimicking phantoms and excised turkey breast muscle tissue demonstrate agreement between the ultrasound derived thermal diffusivity estimates and independent estimates made by a traditional hot-wire technique. The new noninvasive ultrasonic method has potential applications in thermal therapy planning and monitoring, physiological monitoring and as a means of noninvasive tissue characterization.

  14. High intensity focused ultrasound (HIFU) focal spot localization using harmonic motion imaging (HMI)

    NASA Astrophysics Data System (ADS)

    Han, Yang; Hou, Gary Yi; Wang, Shutao; Konofagou, Elisa

    2015-08-01

    Several ultrasound-based imaging modalities have been proposed for image guidance and monitoring of high-intensity focused ultrasound (HIFU) treatment. However, accurate localization and characterization of the effective region of treatment (focal spot) remain important obstacles in the clinical implementation of HIFU ablation. Harmonic motion imaging for focused ultrasound (HMIFU) is a HIFU monitoring technique that utilizes radiation-force-induced localized oscillatory displacement. HMIFU has been shown to correctly identify the formation and extent of HIFU thermal ablation lesions. However a significant problem remains in identifying the location of the HIFU focus, which is necessary for treatment planning. In this study, the induced displacement was employed to localize the HIFU focal spot inside the tissue prior to treatment. Feasibility was shown with two separate systems. The 1D HMIFU system consisted of a HIFU transducer emitting an amplitude-modulated HIFU beam for mechanical excitation and a confocal single-element, pulse-echo transducer for simultaneous RF acquisition. The 2D HIFU system consists of a HIFU phased array, and a co-axial imaging phased array for simultaneous imaging. Initial feasibility was first performed on tissue-mimicking gelatin phantoms and the focal zone was defined as the region corresponding to the  -3dB full width at half maximum of the HMI displacement. Using the same parameters, in vitro experiments were performed in canine liver specimens to compare the defined focal zone with the lesion. In vitro measurements showed good agreement between the HMI predicted focal zone and the induced HIFU lesion location. HMIFU was experimentally shown to be capable of predicting and tracking the focal region in both phantoms and in vitro tissues. The accuracy of focal spot localization was evaluated by comparing with the lesion location in post-ablative tissues, with a R2 = 0.821 at p  <  0.002 in the 2D HMI system. We demonstrated

  15. High intensity focused ultrasound (HIFU) focal spot localization using harmonic motion imaging (HMI).

    PubMed

    Han, Yang; Hou, Gary Yi; Wang, Shutao; Konofagou, Elisa

    2015-08-07

    Several ultrasound-based imaging modalities have been proposed for image guidance and monitoring of high-intensity focused ultrasound (HIFU) treatment. However, accurate localization and characterization of the effective region of treatment (focal spot) remain important obstacles in the clinical implementation of HIFU ablation. Harmonic motion imaging for focused ultrasound (HMIFU) is a HIFU monitoring technique that utilizes radiation-force-induced localized oscillatory displacement. HMIFU has been shown to correctly identify the formation and extent of HIFU thermal ablation lesions. However a significant problem remains in identifying the location of the HIFU focus, which is necessary for treatment planning. In this study, the induced displacement was employed to localize the HIFU focal spot inside the tissue prior to treatment. Feasibility was shown with two separate systems. The 1D HMIFU system consisted of a HIFU transducer emitting an amplitude-modulated HIFU beam for mechanical excitation and a confocal single-element, pulse-echo transducer for simultaneous RF acquisition. The 2D HIFU system consists of a HIFU phased array, and a co-axial imaging phased array for simultaneous imaging. Initial feasibility was first performed on tissue-mimicking gelatin phantoms and the focal zone was defined as the region corresponding to the -3dB full width at half maximum of the HMI displacement. Using the same parameters, in vitro experiments were performed in canine liver specimens to compare the defined focal zone with the lesion. In vitro measurements showed good agreement between the HMI predicted focal zone and the induced HIFU lesion location. HMIFU was experimentally shown to be capable of predicting and tracking the focal region in both phantoms and in vitro tissues. The accuracy of focal spot localization was evaluated by comparing with the lesion location in post-ablative tissues, with a R(2) = 0.821 at p < 0.002 in the 2D HMI system. We demonstrated the

  16. Localized conductive patterning via focused electron beam reduction of graphene oxide

    SciTech Connect

    Kim, Songkil; Henry, Mathias; Kulkarni, Dhaval D.; Zackowski, Paul; Jang, Seung Soon; Tsukruk, Vladimir V.; Fedorov, Andrei G.

    2015-03-30

    We report on a method for “direct-write” conductive patterning via reduction of graphene oxide (GO) sheets using focused electron beam induced deposition (FEBID) of carbon. FEBID treatment of the intrinsically dielectric graphene oxide between two metal terminals opens up the conduction channel, thus enabling a unique capability for nanoscale conductive domain patterning in GO. An increase in FEBID electron dose results in a significant increase of the domain electrical conductivity with improving linearity of drain-source current vs. voltage dependence, indicative of a change of graphene oxide electronic properties from insulating to semiconducting. Density functional theory calculations suggest a possible mechanism underlying this experimentally observed phenomenon, as localized reduction of graphene oxide layers via interactions with highly reactive intermediates of electron-beam-assisted dissociation of surface-adsorbed hydrocarbon molecules. These findings establish an unusual route for using FEBID as nanoscale lithography and patterning technique for engineering carbon-based nanomaterials and devices with locally tailored electronic properties.

  17. Grains unchained: local fluidization of a granular packing by focused ultrasound.

    PubMed

    Lidon, Pierre; Taberlet, Nicolas; Manneville, Sébastien

    2016-02-28

    We report experimental results on the dynamics of a granular packing submitted to high-intensity focused ultrasound. Acoustic radiation pressure is shown to remotely induce local rearrangements within a pile as well as global motion around the focal spot in an initially jammed system. We demonstrate that this fluidization process is intermittent for a range of acoustic pressures and hysteretic when the pressure is cycled. Such a first-order-like unjamming transition is reproduced in numerical simulations in which the acoustic pressure field is modeled by a localized external force. Further analysis of the simulated packings suggests that in the intermittent regime unjamming is not associated with any noticeable prior structural signature. A simple two-state model based on effective temperatures is proposed to account for these findings.

  18. Site-selective local fluorination of graphene induced by focused ion beam irradiation.

    PubMed

    Li, Hu; Daukiya, Lakshya; Haldar, Soumyajyoti; Lindblad, Andreas; Sanyal, Biplab; Eriksson, Olle; Aubel, Dominique; Hajjar-Garreau, Samar; Simon, Laurent; Leifer, Klaus

    2016-01-29

    The functionalization of graphene remains an important challenge for numerous applications expected by this fascinating material. To keep advantageous properties of graphene after modification or functionalization of its structure, local approaches are a promising road. A novel technique is reported here that allows precise site-selective fluorination of graphene. The basic idea of this approach consists in the local radicalization of graphene by focused ion beam (FIB) irradiation and simultaneous introduction of XeF2 gas. A systematic series of experiments were carried out to outline the relation between inserted defect creation and the fluorination process. Based on a subsequent X-ray photoelectron spectroscopy (XPS) analysis, a 6-fold increase of the fluorine concentration on graphene under simultaneous irradiation was observed when compared to fluorination under normal conditions. The fluorine atoms are predominately localized at the defects as indicated from scanning tunneling microscopy (STM). The experimental findings are confirmed by density functional theory which predicts a strong increase of the binding energy of fluorine atoms when bound to the defect sites. The developed technique allows for local fluorination of graphene without using resists and has potential to be a general enabler of site-selective functionalization of graphene using a wide range of gases.

  19. Site-selective local fluorination of graphene induced by focused ion beam irradiation

    PubMed Central

    Li, Hu; Daukiya, Lakshya; Haldar, Soumyajyoti; Lindblad, Andreas; Sanyal, Biplab; Eriksson, Olle; Aubel, Dominique; Hajjar-Garreau, Samar; Simon, Laurent; Leifer, Klaus

    2016-01-01

    The functionalization of graphene remains an important challenge for numerous applications expected by this fascinating material. To keep advantageous properties of graphene after modification or functionalization of its structure, local approaches are a promising road. A novel technique is reported here that allows precise site-selective fluorination of graphene. The basic idea of this approach consists in the local radicalization of graphene by focused ion beam (FIB) irradiation and simultaneous introduction of XeF2 gas. A systematic series of experiments were carried out to outline the relation between inserted defect creation and the fluorination process. Based on a subsequent X-ray photoelectron spectroscopy (XPS) analysis, a 6-fold increase of the fluorine concentration on graphene under simultaneous irradiation was observed when compared to fluorination under normal conditions. The fluorine atoms are predominately localized at the defects as indicated from scanning tunneling microscopy (STM). The experimental findings are confirmed by density functional theory which predicts a strong increase of the binding energy of fluorine atoms when bound to the defect sites. The developed technique allows for local fluorination of graphene without using resists and has potential to be a general enabler of site-selective functionalization of graphene using a wide range of gases. PMID:26822900

  20. More attentional focusing through binaural beats: evidence from the global-local task.

    PubMed

    Colzato, Lorenza S; Barone, Hayley; Sellaro, Roberta; Hommel, Bernhard

    2017-01-01

    A recent study showed that binaural beats have an impact on the efficiency of allocating attention over time. We were interested to see whether this impact affects attentional focusing or, even further, the top-down control over irrelevant information. Healthy adults listened to gamma-frequency (40 Hz) binaural beats, which are assumed to increase attentional concentration, or a constant tone of 340 Hz (control condition) for 3 min before and during a global-local task. While the size of the congruency effect (indicating the failure to suppress task-irrelevant information) was unaffected by the binaural beats, the global-precedence effect (reflecting attentional focusing) was considerably smaller after gamma-frequency binaural beats than after the control condition. Our findings suggest that high-frequency binaural beats bias the individual attentional processing style towards a reduced spotlight of attention.

  1. Design techniques and analysis of high-resolution neural recording systems targeting epilepsy focus localization.

    PubMed

    Shoaran, Mahsa; Pollo, Claudio; Leblebici, Yusuf; Schmid, Alexandre

    2012-01-01

    The design of a high-density neural recording system targeting epilepsy monitoring is presented. Circuit challenges and techniques are discussed to optimize the amplifier topology and the included OTA. A new platform supporting active recording devices targeting wireless and high-resolution focus localization in epilepsy diagnosis is also proposed. The post-layout simulation results of an amplifier dedicated to this application are presented. The amplifier is designed in a UMC 0.18µm CMOS technology, has an NEF of 2.19 and occupies a silicon area of 0.038 mm(2), while consuming 5.8 µW from a 1.8-V supply.

  2. In Vivo application and localization of transcranial focused ultrasound using dual-mode ultrasound arrays.

    PubMed

    Haritonova, Alyona; Liu, Dalong; Ebbini, Emad S

    2015-12-01

    Focused ultrasound (FUS) has been proposed for a variety of transcranial applications, including neuromodulation, tumor ablation, and blood-brain barrier opening. A flurry of activity in recent years has generated encouraging results demonstrating its feasibility in these and other applications. To date, monitoring of FUS beams has been primarily accomplished using MR guidance, where both MR thermography and elastography have been used. The recent introduction of real-time dual-mode ultrasound array (DMUA) systems offers a new paradigm in transcranial focusing. In this paper, we present first experimental results of ultrasound-guided transcranial FUS (tFUS) application in a rodent brain, both ex vivo and in vivo. DMUA imaging is used for visualization of the treatment region for placement of the focal spot within the brain. This includes the detection and localization of pulsating blood vessels at or near the target point(s). In addition, DMUA imaging is used to monitor and localize the FUS-tissue interactions in real time. In particular, a concave (40 mm radius of curvature), 32-element, 3.5-MHz DMUA prototype was used for imaging and tFUS application in ex vivo and in vivo rat models. The ex vivo experiments were used to evaluate the point spread function of the transcranial DMUA imaging at various points within the brain. In addition, DMUA-based transcranial ultrasound thermography measurements were compared with thermocouple measurements of subtherapeutic tFUS heating in rat brain ex vivo. The ex vivo setting was also used to demonstrate the capability of DMUA to produce localized thermal lesions. The in vivo experiments were designed to demonstrate the ability of the DMUA to apply, monitor, and localize subtherapeutic tFUS patterns that could be beneficial in transient blood-brain barrier opening. The results show that although the DMUA focus is degraded due to the propagation through the skull, it still produces localized heating effects within a sub

  3. In Vivo Application and Localization of Transcranial Focused Ultrasound Using Dual-Mode Ultrasound Arrays

    PubMed Central

    Haritonova, Alyona; Liu, Dalong; Ebbini, Emad S.

    2015-01-01

    Focused ultrasound (FUS) has been proposed for a variety of transcranial applications, including neuromodulation, tumor ablation, and blood brain barrier opening. A flurry of activity in recent years has generated encouraging results demonstrating its feasibility in these and other applications. To date, monitoring of FUS beams have been primarily accomplished using MR guidance, where both MR thermography and elastography have been used. The recent introduction of real-time dual-mode ultrasound array (DMUA) systems offers a new paradigm in transcranial focusing. In this paper, we present first experimental results of ultrasound-guided transcranial FUS (tFUS) application in a rodent brain, both ex vivo and in vivo. DMUA imaging is used for visualization of the treatment region for placement of the focal spot within the brain. This includes the detection and localization of pulsating blood vessels at or near the target point(s). In addition, DMUA imaging is used to monitor and localize the FUS-tissue interactions in real-time. In particular, a concave (40-mm radius of curvature), 32-element, 3.5 MHz DMUA prototype was used for imaging and tFUS application in ex vivo and in vivo rat model. The ex vivo experiments were used to evaluate the point spread function (psf) of the transcranial DMUA imaging at various points within the brain. In addition, DMUA-based transcranial ultrasound thermography measurements were compared with thermocouple measurements of subtherapeutic tFUS heating in rat brain ex vivo. The ex vivo setting was also used to demonstrate the DMUA capability to produce localized thermal lesions. The in vivo experiments were designed to demonstrate the ability of the DMUA to apply, monitor, and localize subtherapeutic tFUS patterns that could be beneficial in transient blood brain barrier opening. The results show that, while the DMUA focus is degraded due to the propagation through the skull, it still produces localized heating effects within sub

  4. Computing network-based features from intracranial EEG time series data: Application to seizure focus localization.

    PubMed

    Hao, Stephanie; Subramanian, Sandya; Jordan, Austin; Santaniello, Sabato; Yaffe, Robert; Jouny, Christophe C; Bergey, Gregory K; Anderson, William S; Sarma, Sridevi V

    2014-01-01

    The surgical resection of the epileptogenic zone (EZ) is the only effective treatment for many drug-resistant epilepsy (DRE) patients, but the pre-surgical identification of the EZ is challenging. This study investigates whether the EZ exhibits a computationally identifiable signature during seizures. In particular, we compute statistics of the brain network from intracranial EEG (iEEG) recordings and track the evolution of network connectivity before, during, and after seizures. We define each node in the network as an electrode and weight each edge connecting a pair of nodes by the gamma band cross power of the corresponding iEEG signals. The eigenvector centrality (EVC) of each node is tracked over two seizures per patient and the electrodes are ranked according to the corresponding EVC value. We hypothesize that electrodes covering the EZ have a signature EVC rank evolution during seizure that differs from electrodes outside the EZ. We tested this hypothesis on multi-channel iEEG recordings from 2 DRE patients who had successful surgery (i.e., seizures were under control with or without medications) and 1 patient who had unsuccessful surgery. In the successful cases, we assumed that the resected region contained the EZ and found that the EVC rank evolution of the electrodes within the resected region had a distinct "arc" signature, i.e., the EZ ranks first rose together shortly after seizure onset and then fell later during seizure.

  5. Epileptic Focus Localization Using Discrete Wavelet Transform Based on Interictal Intracranial EEG.

    PubMed

    Chen, Duo; Wan, Suiren; Bao, Forrest Sheng

    2017-05-01

    Over the past decade, with the development of machine learning, discrete wavelet transform (DWT) has been widely used in computer-aided epileptic electroencephalography (EEG) signal analysis as a powerful time-frequency tool. But some important problems have not yet been benefitted from DWT, including epileptic focus localization, a key task in epilepsy diagnosis and treatment. Additionally, the parameters and settings for DWT are chosen empirically or arbitrarily in previous work. In this work, we propose a framework to use DWT and support vector machine (SVM) for epileptic focus localization problem based on EEG. To provide a guideline in selecting the best settings for DWT, we decompose the EEG segments in seven commonly used wavelet families to their maximum theoretical levels. The wavelet and its level of decomposition providing the highest accuracy in each wavelet family are then used in a grid search for obtaining the optimal frequency bands and wavelet coefficient features. Our approach achieves promising performance on two widely-recognized intrancranial EEG datasets that are also seizure-free, with an accuracy of 83.07% on the Bern-Barcelona dataset and an accuracy of 88.00% on the UBonn dataset. Compared with existing DWT-based approaches in epileptic EEG analysis, the proposed approach leads to more accurate and robust results. A guideline for DWT parameter setting is provided at the end of the paper.

  6. Information flow and application to epileptogenic focus localization from intracranial EEG.

    PubMed

    Sabesan, Shivkumar; Good, Levi B; Tsakalis, Konstantinos S; Spanias, Andreas; Treiman, David M; Iasemidis, Leon D

    2009-06-01

    Transfer entropy ( TE) is a recently proposed measure of the information flow between coupled linear or nonlinear systems. In this study, we suggest improvements in the selection of parameters for the estimation of TE that significantly enhance its accuracy and robustness in identifying the direction and the level of information flow between observed data series generated by coupled complex systems. We show the application of the improved TE method to long (in the order of days; approximately a total of 600 h across all patients), continuous, intracranial electroencephalograms (EEG) recorded in two different medical centers from four patients with focal temporal lobe epilepsy (TLE) for localization of their foci. All patients underwent ablative surgery of their clinically assessed foci. Based on a surrogate statistical analysis of the TE results, it is shown that the identified potential focal sites through the suggested analysis were in agreement with the clinically assessed sites of the epileptogenic focus in all patients analyzed. It is noteworthy that the analysis was conducted on the available whole-duration multielectrode EEG, that is, without any subjective prior selection of EEG segments or electrodes for analysis. The above, in conjunction with the use of surrogate data, make the results of this analysis robust. These findings suggest a critical role TE may play in epilepsy research in general, and as a tool for robust localization of the epileptogenic focus/foci in patients with focal epilepsy in particular.

  7. Focused Impedance Method (FIM) and Pigeon Hole Imaging (PHI) for localized measurements - a review

    NASA Astrophysics Data System (ADS)

    Siddique-e Rabbani, K.

    2010-04-01

    This paper summarises up to date development in Focused Impedance Method (FIM) initiated by us. It basically involves taking the sum of two orthogonal tetra-polar impedance measurements around a common central region, giving a localized enhanced sensitivity. Although the basic idea requires 8 electrodes, versions with 6- and 4-electrodes were subsequently conceived and developed. The focusing effect has been verified in 2D and 3D phantoms and through numerical analysis. Dynamic stomach emptying, and ventilation of localized lung regions have been studied successfully suggesting further applications in monitoring of gastric acid secretion, artificial respiration, bladder emptying, etc. Multi-frequency FIM may help identify some diseases and disorders including certain cancers. FIM, being much simpler and having less number of electrodes, appears to have the potential to replace EIT for applications involving large and shallow organs. An enhancement of 6-electrode FIM led to Pigeon Hole Imaging (PHI) in a square matrix through backprojection in two orthogonal directions, good for localising of one or two well separated objects.

  8. Local harmonic motion monitoring of focused ultrasound surgery--a simulation model.

    PubMed

    Heikkilä, Janne; Curiel, Laura; Hynynen, Kullervo

    2010-01-01

    In this paper, a computational model for localized harmonic motion (LHM) imaging-based monitoring of high-intensity focused ultrasound surgery (FUS) is presented. The LHM technique is based on a focused, time-varying ultrasound radiation force excitation, which induces local oscillatory motions at the focal region. These vibrations are tracked, using pulse-echo imaging, and then, used to estimate the mechanical properties of the sonication region. LHM is feasible for FUS monitoring because changes in the material properties during the coagulation process affect the measured displacements. The presented model includes separate models to simulate acoustic sonication fields, sonication-induced temperature elevation and mechanical motion, and pulse-echo imaging of the induced motions. These 3-D simulation models are based on Rayleigh-Sommerfield integral, finite element, and spatial impulse response methods. Simulated-tissue temperature elevation and mechanical motion were compared with previously published in vivo measurements. Finally, the simulation model was used to simulate coagulation and LHM monitoring, as would occur with multiple, neighbouring sonication locations covering a large tumor.

  9. Global, local and focused geographic clustering for case-control data with residential histories

    PubMed Central

    Jacquez, Geoffrey M; Kaufmann, Andy; Meliker, Jaymie; Goovaerts, Pierre; AvRuskin, Gillian; Nriagu, Jerome

    2005-01-01

    Background This paper introduces a new approach for evaluating clustering in case-control data that accounts for residential histories. Although many statistics have been proposed for assessing local, focused and global clustering in health outcomes, few, if any, exist for evaluating clusters when individuals are mobile. Methods Local, global and focused tests for residential histories are developed based on sets of matrices of nearest neighbor relationships that reflect the changing topology of cases and controls. Exposure traces are defined that account for the latency between exposure and disease manifestation, and that use exposure windows whose duration may vary. Several of the methods so derived are applied to evaluate clustering of residential histories in a case-control study of bladder cancer in south eastern Michigan. These data are still being collected and the analysis is conducted for demonstration purposes only. Results Statistically significant clustering of residential histories of cases was found but is likely due to delayed reporting of cases by one of the hospitals participating in the study. Conclusion Data with residential histories are preferable when causative exposures and disease latencies occur on a long enough time span that human mobility matters. To analyze such data, methods are needed that take residential histories into account. PMID:15784151

  10. Presurgical nasal moulding in a neonate with cleft lip

    PubMed Central

    Deshpande, Anshula; Shah, Dixit; Macwan, Chirag S

    2014-01-01

    The concept of presurgical nasoalveolar moulding (PNM) was developed to improve the aesthetic result of surgically corrected cleft lip. This paper presents the method of fabrication of PNM appliance and the case of a 30-day-old neonate with unilateral cleft lip in whom nasal moulding was performed. Treatment was initiated at 30 days and continued for 60 days after which the surgical correction of cleft lip was performed. Significant improvement in aesthetics and symmetry of the nose was achieved at the end of the treatment. PMID:24928928

  11. Stereoscopic virtual reality presurgical planning for cerebrospinal otorrhea.

    PubMed

    Shen, Ming; Zhang, Xiao-Luo; Yang, De-Lin; Wu, Jin-Song

    2010-07-01

    We present a complicated case of spontaneous cerebrospinal otorrhea, which had not been cured despite undergoing 5 surgical interventions in the past. The disability to identify the location of the fistula was the main crux of the past failures. On this occasion, stereoscopic virtual reality presurgical planning was applied to identify the exact location of the fistula and a surgical simulation was performed, and was later confirmed during the actual operation. Interactive manipulation in a stereoscopic virtual environment makes the decision making process easier in the treatment of cerebrospinal otorrhea.

  12. Predictors of seizure occurrence in children undergoing pre-surgical monitoring.

    PubMed

    Harini, Chellamani; Singh, Kanwaljit; Takeoka, Masanori; Parulkar, Isha; Bergin, Ann Marie; Loddenkemper, Tobias; Kothare, Sanjeev V

    2013-10-01

    Long-Term-Monitoring (LTM) is a valuable tool for seizure localization/lateralization among children with refractory-epilepsy undergoing pre-surgical-monitoring. The aim of this study was to examine the factors predicting occurrence of single/multiple seizures in children undergoing pre-surgical monitoring in the LTM unit. Chart review was done on 95 consecutive admissions on 92 children (40 females) admitted to the LTM-unit for pre-surgical workup. Relationship between occurrence of multiple (≥ 3) seizures and factors such as home seizure-frequency, demographics, MRI-lesions/seizure-type and localization/AED usage/neurological-exam/epilepsy-duration was evaluated by logistic-regression and survival-analysis. Home seizure-frequency was further categorized into low (up-to 1/month), medium (up-to 1/week) and high (>1/week) and relationship of these categories to the occurrence of multiple seizures was evaluated. Mean length of stay was 5.24 days in all 3 groups. Home seizure frequency was the only factor predicting the occurrence of single/multiple seizures in children undergoing presurgical workup. Other factors (age/sex/MRI-lesions/seizure-type and localization/AED-usage/neurological-exam/epilepsy-duration) did not affect occurrence of single/multiple seizures or time-to-occurrence of first/second seizure. Analysis of the home-seizure frequency categories revealed that 98% admissions in high-frequency, 94% in the medium, and 77% in low-frequency group had at-least 1 seizure recorded during the monitoring. Odds of first-seizure increased in high vs. low-frequency group (p=0.01). Eighty-nine percent admissions in high-frequency, 78% in medium frequency, versus 50% in low-frequency group had ≥ 3 seizures. The odds of having ≥ 3 seizures increased in high-frequency (p=0.0005) and in medium-frequency (p=0.007), compared to low-frequency group. Mean time-to-first-seizure was 2.7 days in low-frequency, 2.1 days in medium, and 2 days in high-frequency group. Time

  13. Improved highly accurate localized motion imaging for monitoring high-intensity focused ultrasound therapy

    NASA Astrophysics Data System (ADS)

    Qu, Xiaolei; Azuma, Takashi; Sugiyama, Ryusuke; Kanazawa, Kengo; Seki, Mika; Sasaki, Akira; Takeuchi, Hideki; Fujiwara, Keisuke; Itani, Kazunori; Tamano, Satoshi; Takagi, Shu; Sakuma, Ichiro; Matsumoto, Yoichiro

    2016-07-01

    Visualizing an area subjected to high-intensity focused ultrasound (HIFU) therapy is necessary for controlling the amount of HIFU exposure. One of the promising monitoring methods is localized motion imaging (LMI), which estimates coagulation length by detecting the change in stiffness. In this study, we improved the accuracy of our previous LMI by dynamic cross-correlation window (DCCW) and maximum vibration amount (MVA) methods. The DCCW method was used to increase the accuracy of estimating vibration amplitude, and the MVA method was employed to increase signal-noise ratio of the decrease ratio at the coagulated area. The qualitative comparison of results indicated that the two proposed methods could suppress the effect of noise. Regarding the results of the quantitative comparison, coagulation length was estimated with higher accuracy by the improved LMI method, and the root-mean-square error (RMSE) was reduced from 2.51 to 1.69 mm.

  14. Focused impedance measurement (FIM). A new technique with improved zone localization.

    PubMed

    Rabbani, K S; Sarker, M; Akond, M H; Akter, T

    1999-04-20

    Conventional four-electrode impedance measurements (FEIM) cannot localize a zone of interest in a volume conductor. On the other hand, the recently developed electrical impedance tomography (EIT) system offers an image with reasonable resolution, but is complex and needs many electrodes. By placing two FEIM systems perpendicular to each other over a common zone at the center and combining the two results, it is possible to obtain enhanced sensitivity over this central zone. This is the basis of the proposed new method of focused impedance measurement (FIM). Sensitivity maps in both 2D and 3D show the desired improvement. A comparison of stomach-emptying studies also indicates the improvement achieved. This new method may be useful for impedance measurements of large organs like stomach, heart, and lungs. Being much simpler in comparison to EIT, multifrequency systems can be simply built for FIM. Besides, FIM may have utility in other fields like geology where impedance measurements are performed.

  15. Noise focusing in neuronal tissues: Symmetry breaking and localization in excitable networks with quenched disorder

    NASA Astrophysics Data System (ADS)

    Orlandi, Javier G.; Casademunt, Jaume

    2017-05-01

    We introduce a coarse-grained stochastic model for the spontaneous activity of neuronal cultures to explain the phenomenon of noise focusing, which entails localization of the noise activity in excitable networks with metric correlations. The system is modeled as a continuum excitable medium with a state-dependent spatial coupling that accounts for the dynamics of synaptic connections. The most salient feature is the emergence at the mesoscale of a vector field V (r ) , which acts as an advective carrier of the noise. This entails an explicit symmetry breaking of isotropy and homogeneity that stems from the amplification of the quenched fluctuations of the network by the activity avalanches, concomitant with the excitable dynamics. We discuss the microscopic interpretation of V (r ) and propose an explicit construction of it. The coarse-grained model shows excellent agreement with simulations at the network level. The generic nature of the observed phenomena is discussed.

  16. Pre-surgical language mapping with functional magnetic resonance imaging.

    PubMed

    Bookheimer, Susan

    2007-06-01

    Patients with lesions in or near eloquent cortex typically undergo one of several invasive techniques to prevent loss of function following surgery. One of the most promising potential clinical applications of functional magnetic resonance imaging (fMRI) is to map these functions as part of the pre-surgical work-up to identify patients at-risk, guide the surgical entry, or tailor the surgical procedure to prevent deficits. While motor and sensory mapping are relatively straightforward, language mapping is far more complex. The language system is variable in location across individuals and in many cases may reorganize partially or completely to the contralateral hemisphere. In addition, multiple regions of the brain contribute to language functioning including essential regions that must not be removed in surgery, and contributory regions that may result in transient or insignificant impairments post-surgery. Despite these challenges, an increasing number of studies have supported the use of fMRI for pre-surgical language mapping in a variety of disorders. This article reviews the literature from three disorders for which patients benefit from preoperative language mapping: epilepsy, brain tumors, and arteriovenous malformations. Each disorder presents unique challenges to language mapping. Specific case studies are presented highlighting the both the potential benefits of preclinical fMRI for language mapping as well as the potential risks and pitfalls.

  17. Presurgical cleft lip and palate orthopedics: an overview

    PubMed Central

    Alzain, Ibtesam; Batwa, Waeil; Cash, Alex; Murshid, Zuhair A

    2017-01-01

    Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term. PMID:28615974

  18. Combined EEG/MEG Can Outperform Single Modality EEG or MEG Source Reconstruction in Presurgical Epilepsy Diagnosis

    PubMed Central

    Aydin, Ümit; Vorwerk, Johannes; Dümpelmann, Matthias; Küpper, Philipp; Kugel, Harald; Heers, Marcel; Wellmer, Jörg; Kellinghaus, Christoph; Haueisen, Jens; Rampp, Stefan; Stefan, Hermann; Wolters, Carsten H.

    2015-01-01

    We investigated two important means for improving source reconstruction in presurgical epilepsy diagnosis. The first investigation is about the optimal choice of the number of epileptic spikes in averaging to (1) sufficiently reduce the noise bias for an accurate determination of the center of gravity of the epileptic activity and (2) still get an estimation of the extent of the irritative zone. The second study focuses on the differences in single modality EEG (80-electrodes) or MEG (275-gradiometers) and especially on the benefits of combined EEG/MEG (EMEG) source analysis. Both investigations were validated with simultaneous stereo-EEG (sEEG) (167-contacts) and low-density EEG (ldEEG) (21-electrodes). To account for the different sensitivity profiles of EEG and MEG, we constructed a six-compartment finite element head model with anisotropic white matter conductivity, and calibrated the skull conductivity via somatosensory evoked responses. Our results show that, unlike single modality EEG or MEG, combined EMEG uses the complementary information of both modalities and thereby allows accurate source reconstructions also at early instants in time (epileptic spike onset), i.e., time points with low SNR, which are not yet subject to propagation and thus supposed to be closer to the origin of the epileptic activity. EMEG is furthermore able to reveal the propagation pathway at later time points in agreement with sEEG, while EEG or MEG alone reconstructed only parts of it. Subaveraging provides important and accurate information about both the center of gravity and the extent of the epileptogenic tissue that neither single nor grand-averaged spike localizations can supply. PMID:25761059

  19. Combined EEG/MEG can outperform single modality EEG or MEG source reconstruction in presurgical epilepsy diagnosis.

    PubMed

    Aydin, Ümit; Vorwerk, Johannes; Dümpelmann, Matthias; Küpper, Philipp; Kugel, Harald; Heers, Marcel; Wellmer, Jörg; Kellinghaus, Christoph; Haueisen, Jens; Rampp, Stefan; Stefan, Hermann; Wolters, Carsten H

    2015-01-01

    We investigated two important means for improving source reconstruction in presurgical epilepsy diagnosis. The first investigation is about the optimal choice of the number of epileptic spikes in averaging to (1) sufficiently reduce the noise bias for an accurate determination of the center of gravity of the epileptic activity and (2) still get an estimation of the extent of the irritative zone. The second study focuses on the differences in single modality EEG (80-electrodes) or MEG (275-gradiometers) and especially on the benefits of combined EEG/MEG (EMEG) source analysis. Both investigations were validated with simultaneous stereo-EEG (sEEG) (167-contacts) and low-density EEG (ldEEG) (21-electrodes). To account for the different sensitivity profiles of EEG and MEG, we constructed a six-compartment finite element head model with anisotropic white matter conductivity, and calibrated the skull conductivity via somatosensory evoked responses. Our results show that, unlike single modality EEG or MEG, combined EMEG uses the complementary information of both modalities and thereby allows accurate source reconstructions also at early instants in time (epileptic spike onset), i.e., time points with low SNR, which are not yet subject to propagation and thus supposed to be closer to the origin of the epileptic activity. EMEG is furthermore able to reveal the propagation pathway at later time points in agreement with sEEG, while EEG or MEG alone reconstructed only parts of it. Subaveraging provides important and accurate information about both the center of gravity and the extent of the epileptogenic tissue that neither single nor grand-averaged spike localizations can supply.

  20. Localization and characterization of fatigue cracks around fastener holes using spherically focused ultrasonic probes

    NASA Astrophysics Data System (ADS)

    Hopkins, Deborah; Datuin, Marvin; Aldrin, John; Warchol, Mark; Warchol, Lyudmila; Forsyth, David

    2017-02-01

    Results are presented from laboratory experiments and simulations that demonstrate the ability to localize fatigue cracks around fastener holes using spherically focused ultrasonic probes for shear-wave inspections. For the experiments, fatigue cracks were created in aluminum plates in a testing frame under cyclic loading. With the exceptions of one specimen with a mid-bore crack and another with a "through" crack, the remaining specimens contain surface-breaking cracks. All of the specimens were inspected for the cracks intersecting the back wall, and some were flipped over and re-inspected with the crack intersecting the front surface. Parameter and variable sensitivity studies were performed using CIVA Simulation Software. In contrast to C-scans where detection and localization of small cracks can be very difficult, modeling and initial experimental results demonstrate that cracks can be accurately located in "True" B-scans (B-scans projected in the part along the beam path). Initial results show that small-amplitude diffracted/scattered signals from the crack tips and edges are essential in obtaining clear crack traces in the True B-scans. It is important therefore that experimental data be acquired with sufficient gain to capture the diffracted/scattered signals. In all of the cases studied here, saturating the high-amplitude specular reflections from the fastener hole and crack enhanced the crack trace in the True B-scans.

  1. Focused ultrasound treatment of VX2 tumors controlled by local harmonic motion.

    PubMed

    Curiel, Laura; Huang, Yuexi; Vykhodtseva, Natalia; Hynynen, Kullervo

    2009-06-07

    The purpose of this study was to evaluate the feasibility of using localized harmonic motion (LHM) to monitor and control focused ultrasound surgery (FUS) in VX2 tumors in vivo. FUS exposures were performed on 13 VX2 tumors implanted in nine rabbits. The same transducer induced coagulation and generated a localized oscillatory motion by periodically varying the radiation force. A separate diagnostic ultrasound transducer tracked motion by cross-correlating echo signals at different instances. A threshold in motion amplitude was instituted to cease exposure. Coagulation was confirmed by T2-weighted MR images, thermal dose obtained through MR thermometry and histological examinations. For tumor locations achieving coagulation, the LHM amplitude was 9% (p = 0.04) to 57% (p < 0.0001) lower than that before exposure. Control was successful for 74 (69%) out of 108 cases, with 52 (48%) reaching the threshold and achieving coagulation and 22 (21%) never reaching threshold nor coagulating. For the 34 (31%) unsuccessful exposures, 16 (15%) never reached the threshold but coagulation occurred, and 18 (16%) reached threshold without coagulation confirmed. Noise or radio-frequency signal changes explained motion over- or underestimation in 24 (22%) cases; the remaining 10 (9%) had other causes of error. The control was generally successful, but sudden change or noise in the acquired echo signal caused failure. Coagulation after exposure could be validated by comparing amplitudes before and after exposure.

  2. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer.

    PubMed

    Rebillard, Xavier; Gelet, Albert; Davin, Jean Louis; Soulie, Michel; Prapotnich, Dominique; Cathelineau, Xavier; Rozet, François; Vallancien, Guy

    2005-01-01

    The literature concerning the efficacy and safety of transrectal high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer still comprises a relatively small number of articles. The main studies have been published by four teams using an apparatus available in Europe for several years. The recently presented results of the European Multicentre Study and the study by Gelet and associates based on 242 patients with a follow-up of more than 1 year show that HIFU is a valid alternative for the management of welldifferentiated and moderately differentiated localized prostate cancer with an initial PSA 10 years. In two studies, the combination of transurethral resection of the prostate and HIFU limited the risk of postoperative urinary retention without inducing a higher complication rate. In a series of patients presenting recurrence after external-beam radiotherapy, HIFU was found to be a useful therapy, with >80% negative biopsies. The best indications for HIFU are men over the age of 65, those who are not candidates for radical prostatectomy, obese patients, or patients with comorbidities likely to make surgery more difficult. The learning curve for this technique is relatively short, between 10 and 15 patients, for urologists experienced in transrectal ultrasonography. One of the advantages of HIFU is that it can be repeated in the case of recurrence or to re-treat a prostatic site, it involves no radiation, and patients do not suffer from long-term irritative urinary symptoms.

  3. Seahorses in focus: local ecological knowledge of seahorse-watching operators in a tropical estuary.

    PubMed

    Ternes, Maria L F; Gerhardinger, Leopoldo C; Schiavetti, Alexandre

    2016-11-08

    Seahorses are endangered teleost fishes under increasing human pressures worldwide. In Brazil, marine conservationists and policy-makers are thus often skeptical about the viability of sustainable human-seahorse interactions. This study focuses on local ecological knowledge on seahorses and the implications of their non-lethal touristic use by a coastal community in northeastern Brazil. Community-based seahorse-watching activities have been carried out in Maracaípe village since 1999, but remained uninvestigated until the present study. Our goal is to provide ethnoecological understanding on this non-extractive use to support seahorse conservation and management. We interviewed 32 informants through semi-structured questionnaires to assess their socioeconomic profile, their knowledge on seahorse natural history traits, human uses, threats and abundance trends. Seahorse-watching has high socioeconomic relevance, being the primary income source for all respondents. Interviewees elicited a body of knowledge on seahorse biology largely consistent with up-to-date research literature. Most informants (65.5 %) perceived no change in seahorse abundance. Their empirical knowledge often surpassed scientific reports, i.e. through remarks on trophic ecology; reproductive aspects, such as, behavior and breeding season; spatial and temporal distribution, suggesting seahorse migration related to environmental parameters. Seahorse-watching operators were aware of seahorse biological and ecological aspects. Despite the gaps remaining on biological data about certain seahorse traits, the respondents provided reliable information on all questions, adding ethnoecological remarks not yet assessed by conventional scientific surveys. We provide novel ethnobiological insight on non-extractive modes of human-seahorse interaction, eliciting environmental policies to integrate seahorse conservation with local ecological knowledge and innovative ideas for seahorse sustainable use. Our study

  4. Conducting focus groups in developing countries: skill training for local bilingual facilitators.

    PubMed

    Maynard-Tucker, G

    2000-05-01

    Many countries of the world are characterized by the use of two or more languages, and qualitative research is usually conducted in indigenous languages; however, bilingual facilitators often do not have any experience in research studies or in conducting focus group discussions. This article presents a 4-day skill-training workshop for local facilitators in which they learn the role of moderator, recorder, and observer and acquire research skills during role playing and during a pretest of the study population. Developed over several years of field experience, this technique has proven successful in collecting reliable data in situations when time is limited, when participants speak indigenous languages, and when bilingual facilitators have no background in research and lack focus group skills. The advantages of this training are that it is low cost and fast and permits a careful translation of the data. Moreover, because facilitators are involved in the collecting and analyzing of the data, their input provides the investigator with a valuable understanding of the findings from an emic perspective.

  5. Stimulus-evoked potentials contribute to map the epileptogenic zone during stereo-EEG presurgical monitoring.

    PubMed

    Boido, Davide; Kapetis, Dimos; Gnatkovsky, Vadym; Pastori, Chiara; Galbardi, Barbara; Sartori, Ivana; Tassi, Laura; Cardinale, Francesco; Francione, Stefano; de Curtis, Marco

    2014-09-01

    Presurgical monitoring with intracerebral electrodes in patients with drug-resistant focal epilepsy represents a standard invasive procedure to localize the sites of seizures origin, defined as the epileptogenic zone (EZ). During presurgical evaluation, intracerebral single-pulse electrical stimulation (SPES) is performed to define the boundaries of eloquent areas and to evoke seizure-associated symptoms. Extensive intracranial exploration and stimulation generate a large dataset on brain connectivity that can be used to improve EZ detection and to understand the organization of the human epileptic brain. We developed a protocol to analyse field responses evoked by intracranial stimulation. Intracerebral recordings were performed with 105-162 recording sites positioned in fronto-temporal regions in 12 patients with pharmacoresistant focal epilepsy. Recording sites were used for bipolar SPES at 1 Hz. Reproducible early and late phases (<60 ms and 60-500 ms from stimulus artefact, respectively) were identified on averaged evoked responses. Phase 1 and 2 responses recorded at all and each recording sites were plotted on a 3D brain reconstructions. Based on connectivity properties, electrode contacts were primarily identified as receivers, mainly activators or bidirectional. We used connectivity patterns to construct networks and applied cluster partitioning to study the proprieties between potentials evoked/stimulated in different regions. We demonstrate that bidirectional connectivity during phase 1 is a prevalent feature that characterize contacts included in the EZ. This study shows that the application of an analytical protocol on intracerebral stimulus-evoked recordings provides useful information that may contribute to EZ detection and to the management of surgical-remediable epilepsies.

  6. Multicentric oncologic outcomes of high-intensity focused ultrasound for localized prostate cancer in 803 patients.

    PubMed

    Crouzet, Sebastien; Rebillard, Xavier; Chevallier, Daniel; Rischmann, Pascal; Pasticier, Gilles; Garcia, Gregory; Rouviere, Olivier; Chapelon, Jean-Yves; Gelet, Albert

    2010-10-01

    High-intensity focused ultrasound (HIFU) is an emerging treatment for select patients with localized prostate cancer (PCa). To report the oncologic outcome of HIFU as a primary care option for localized prostate cancer from a multicenter database. Patients with localized PCa treated with curative intent and presenting at least a 2-yr follow-up from February 1993 were considered in this study. Previously irradiated patients were excluded from this analysis. In case of any residual or recurrent PCa, patients were systematically offered a second session. Kaplan-Meier analysis was performed to determine disease-free survival rates (DFSR). Prostate-specific antigen (PSA), clinical stage, and pathologic results were measured pre- and post-HIFU. A total of 803 patients from six urologic departments met the inclusion criteria. Stratification according to d'Amico's risk group was low, intermediate, and high in 40.2%, 46.3%, and 13.5% of patients, respectively. Mean follow-up was 42+/-33 mo. Mean PSA nadir was 1.0+/-2.8 ng/ml with 54.3% reaching a nadir of < or =0.3 ng/ml. Control biopsies were negative in 85% of cases. The overall and cancer-specific survival rates at 8 yr were 89% and 99%, respectively. The metastasis-free survival rate at 8 yr was 97%. Initial PSA value and Gleason score value significantly influence the DFSR. The 5- and 7-yr biochemical-free survival rates (Phoenix criteria) were 83-75%, 72-63%, and 68-62% (p=0.03) and the additional treatment-free survival rates were 84-79%, 68-61%, and 52-54% (p<0.001) for low-, intermediate-, and high-risk patients, respectively. PSA nadir was a major predictive factor for HIFU success: negative biopsies, stable PSA, and no additional therapy. Local control and DFSR achieved with HIFU were similar to those expected with conformal external-beam radiation therapy (EBRT). The excellent cancer-specific survival rate is also explained by the possibility to repeat HIFU and use salvage EBRT. Copyright 2010 European

  7. Low-intensity focused ultrasound mediated localized drug delivery for liver tumors in rabbits.

    PubMed

    Gong, Yuping; Wang, Zhigang; Dong, Guifang; Sun, Yang; Wang, Xi; Rong, Yue; Li, Maoping; Wang, Dong; Ran, Haitao

    2016-09-01

    To explore the antitumor effects of low-intensity focused ultrasound (LIFU) mediated localized drug delivery of adriamycin-microbubble-PLGA nanoparticle complexes on rabbits VX2 liver tumor. ADM-NMCs were prepared by covalent linking of ADM-PLGA nanoparticles (ADM-NPs) to the shell of the microbubbles. A fixed water bag filled with microbubbles was subjected to LIFU and non-focused ultrasound respectively, and the ultrasound images of which were recorded before and after ultrasonication. A total of 54 VX2 liver tumor-burdened rabbits were divided into six groups randomly, including control, ADM-NPs combined with LIFU, microbubbles combined with LIFU, ADM-NPs and microbubbles combined with LIFU, ADM-NMCs combined with LIFU and ADM-NMCs combined with Non-FUS. The tumor volume and volume inhibition rate (VIR) of tumor progression were calculated and compared. Apoptotic cells were labeled by terminal deoxyuridine nick end. Proliferating cell nuclear antigen was detected by immunohistochemistry. The median survival time of the animals were recorded and compared. ADM-NMCs were successfully prepared with an average diameter of 1721 nm. The highest VIR and apoptotic index (AI) were found in the group of ADM-NMCs combined with LIFU while the lowest proliferating index (PI) was simultaneously observed in this group. The median survival time of the rabbits in the ADM-NMCs combined with LIFU group was the longest (71days) among all groups. ADM-NMCs combined with LIFU could inhibit the rabbits VX2 liver tumor progress by delaying the tumor proliferation and accelerating apoptosis, which presents a novel process for liver tumor targeting chemotherapy.

  8. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons.

    PubMed

    Verwilghen, Denis; Grulke, Sigrid; Kampf, Günter

    2011-07-01

    To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques. Survey of veterinary surgical specialists. Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS). An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates. A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution. Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps. © Copyright 2011 by The American College of Veterinary Surgeons.

  9. IN VIVO MONITORING OF FOCUSED ULTRASOUND SURGERY USING LOCAL HARMONIC MOTION

    PubMed Central

    Curiel, Laura; Chopra, Rajiv; Hynynen, Kullervo

    2009-01-01

    The present study established the feasibility of a technique for monitoring FUS lesion formation in vivo using localized harmonic motion (LHM) measurements. Oscillatory motion (frequencies between 50 and 300 Hz) was generated within tissues by induction of a periodic radiation force with a focused ultrasound (FUS) transducer. The harmonic motion was estimated using cross-correlation of RF ultrasonic signals acquired at different instances during the motion by using a confocal diagnostic ultrasound transducer. The technique was evaluated in vivo in rabbit muscle (14 locations) in an MR imager for simultaneous ultrasound harmonic motion tracking and MR thermometry. The measured maximum amplitude of the induced harmonic motion before and after the lesion formation was significantly different for all the tested motion frequencies and decreased between 17 and 81% depending on the frequency and location. During the FUS exposure a drop in the maximum amplitude value was observed and a threshold value could be associated to the formation of a thermal lesion. A series of controlled sonications was performed by stopping the exposure when the threshold value in LHM amplitude was reached and the presence of a thermal lesion was confirmed by MR imaging. LHM measurements were also used to perform a spatial scan of the tissues across the exposure region and the thermal lesions could be detected as a reduction in the maximum motion amplitude value at the sonication region. PMID:18805626

  10. Focused Ultrasound Surgery Control Using Local Harmonic Motion: VX2 Tumor Study

    NASA Astrophysics Data System (ADS)

    Curiel, Laura; Chopra, Rajiv; Goertz, David; Hynynen, Kullervo

    2009-04-01

    The objective of this study was to develop a real-time method for controlling focused ultrasound surgery using ultrasound imaging. The approach uses measurements of localized harmonic motion (LHM) in order to perform controlled FUS exposures by detecting changes in the elastic properties of tissues during coagulation. Methods: Nine New Zealand rabbits with VX2 tumors implanted in the thigh were used for this study. LHM was generated within the tumors by periodic induction of radiation force using a FUS transducer (80-mm focal length, 100-mm diameter, 20-mm central hole, 1.485-MHz). Tissue motion was tracked by collecting and cross-correlating RF signals during the motion using a separate diagnostic transducer (3-kHz PRF, 5-MHz). After locating the tumor in MR images, a series of sonications were performed to treat the tumors using a reduction in LHM amplitude to control the exposure. Results: LHM was successfully used to control the sonications. A LHM amplitude threshold value was determined at which changes were considered significant and then the exposure was started and stopped when the LHM amplitude dropped below the threshold. The appearance of a lesion was then verified by MRI. The feasibility of LHM measurements to control FUS exposure was validated.

  11. In vivo monitoring of focused ultrasound surgery using local harmonic motion.

    PubMed

    Curiel, Laura; Chopra, Rajiv; Hynynen, Kullervo

    2009-01-01

    The present study established the feasibility of a technique for monitoring focused ultrasound (FUS) lesion formation in vivo using localized harmonic motion (LHM) measurements. Oscillatory motion (frequencies between 50 and 300 Hz) was generated within tissues by induction of a periodic radiation force with a FUS transducer. The harmonic motion was estimated using cross correlation of RF ultrasonic signals acquired at different instances during the motion by using a confocal diagnostic ultrasound transducer. The technique was evaluated in vivo in rabbit muscle (14 locations) in an magnetic resonance (MR) imager for simultaneous ultrasound harmonic motion tracking and MR thermometry. The measured maximum amplitude of the induced harmonic motion before and after the lesion formation was significantly different for all the tested motion frequencies, and decreased between 17 and 81% depending on the frequency and location. During the FUS exposure a drop in the maximum amplitude value was observed and a threshold value could be associated to the formation of a thermal lesion. A series of controlled sonications was performed by stopping the exposure when the threshold value in LHM amplitude was reached and the presence of a thermal lesion was confirmed by MR imaging. LHM measurements were also used to perform a spatial scan of the tissues across the exposure region and the thermal lesions could be detected as a reduction in the maximum motion amplitude value at the sonication region.

  12. Localized Ablation of Thyroid Tissue by High-Intensity Focused Ultrasound: an Alternative to Surgery?

    NASA Astrophysics Data System (ADS)

    Esnault, Olivier; Franc, Brigitte; Chapelon, Jean-Yves; Lacoste, Francois

    2006-05-01

    PURPOSE: The aim of this study was to evaluate the feasibility of using a High-intensity focused ultrasound (HIFU) device to obtain a localised destruction of the thyroid with no damage to adjacent tissues. MATERIALS AND METHODS: The ewe model was used because its thyroid gland is easily accessible with ultrasound. The animals were anaesthetised with 10 mg / kg IV injection of Penthothal. The HIFU pulses were generated by a 3-MHz spherical transducer under ultrasound guidance. Macroscopic and microscopic tissue lesions were identified after formalin fixation of the anterior part of the ewe's neck. RESULTS: After determining the optimal instrument settings to obtain localized thyroid ablation, the repeatability of the method was evaluated using a HIFU prototype designed specifically for human use: in 13 ewes (26 treated lobes), an average of 20 (range: 14-27) ultrasound pulses (pulse duration: 3 s) per lobe covering a mean volume of 0.5 cm3 (range: 0.3-0.7 cm3) were delivered. The ewes were sacrificed 2-5 weeks after treatment delivery. No damage to the nerves, trachea, esophagus or muscle was observed. Only 3 ewes suffered superficial skin burns. The desired thyroid lesions were obtained in 25/26 treated lobes, as demonstrated by fibrotic tissues, which replaced necrotic areas. CONCLUSION: These results obtained in the ewe model show that thyroid lesions of defined volume can be induced safely and suggest that the HIFU device is now ready for human trials.

  13. Presurgical satisfaction with facial appearance in orthognathic surgery patients.

    PubMed

    van Steenbergen, E; Litt, M D; Nanda, R

    1996-06-01

    Orthognathic surgery and orthodontic therapy are most often performed to improve the patient's appearance. However, not all patients are satisfied with the result though the procedure may be considered successful by the orthodontist and the maxillofacial surgeon. It has been suggested that the patient's satisfaction with his or her facial appearance before the surgery can predict later satisfaction with orthognathic procedures. The present study examined the role of several potential predictor variables in satisfaction with facial appearance before orthognathic treatment. The variables, identified in previous research, included severity of facial disharmony, self-concept, psychological distress, gender, age, and socioeconomic status. Questionnaires were gathered from 54 patients in 10 orthodontic practices in Connecticut and New York. Contrary to expectations, gender, age and socioeconomic status failed to predict patients' presurgical satisfaction with appearance. Self-concept, psychological distress, and orthodontists' ratings of total facial appearance (from a lateral view) were bivariate predictors of satisfaction. When all variables were analyzed with a multiple regression analysis, however, only self-concept emerged as a significant independent predictor of satisfaction with appearance. This accounted for 15% of the variance in satisfaction. Orthodontists' ratings of facial views, considered here objective measures of disharmony, were predictive neither of satisfaction with appearance nor of self-concept. It is suggested that self-concept may be a predictor of postsurgical as well as presurgical satisfaction with appearance and that self-concept itself may be unaffected by severity of facial disharmony, at least in young adults. Orthodontists may need to pay special attention to those patients with poor self-concept, because these patients may be more likely to report unsatisfactory surgical outcomes.

  14. Locally Appropriate Energy Strategies for the Developing World: A focus on Clean Energy Opportunities in Borneo

    NASA Astrophysics Data System (ADS)

    Shirley, Rebekah Grace

    This dissertation focuses on an integration of energy modeling tools to explore energy transition pathways for emerging economies. The spate of growth in the global South has led to a global energy transition, evidenced in part by a surge in the development of large scale energy infrastructure projects for the provision of reliable electricity service. The rational of energy security and exigency often usher these large scale projects through to implementation with minimal analysis of costs: social and environmental impact, ecological risk, or opportunity costs of alternative energy transition pathways foregone. Furthermore, development of energy infrastructure is inherently characterized by the involvement of a number of state and non-state actors, with varying interests, objectives and access to authority. Being woven through and into social institutions necessarily impacts the design, control and functionality of infrastructure. In this dissertation I therefore conceptualize energy infrastructure as lying at the intersection, or nexus, of people, the environment and energy security. I argue that energy infrastructure plans and policy should, and can, be informed by each of these fields of influence in order to appropriately satisfy local development needs. This case study explores the socio-techno-environmental context of contemporary mega-dam development in northern Borneo. I describe the key actors of an ongoing mega-dam debate and the constellation of their interaction. This highlights the role that information may play in public discourse and lends insight into how inertia in the established system may stymie technological evolution. I then use a combination of power system simulation, ecological modeling and spatial analysis to analyze the potential for, and costs and tradeoffs of, future energy scenarios. In this way I demonstrate reproducible methods that can support energy infrastructure decision making by directly addressing data limitation barriers. I

  15. Use of stationary focused ultrasound fields for characterization of tissue and localized tissue ablation

    NASA Astrophysics Data System (ADS)

    Winey, Brian Andrew

    Ultrasound-induced blood stasis has been observed for more than 30 years. The physical understanding of the phenomenon has not been fully explored. Analytical descriptions of the acoustic interaction with spheres in suspension have been derived but the physical implications and limitations have not been demonstrated. The analytical expressions will be tested against physical observations using numerical simulations. The simulations will begin with stationary spheres and continue with the inclusion of moving spheres and a moving suspending fluid. To date, experimental observations of acoustically induced blood stasis have been either in vitro or invasive. We demonstrate ultrasound-induced blood stasis in murine normal leg muscle versus tumor-bearing legs, observed through noninvasive measurements of optical spectroscopy, and discuss possible diagnostic uses for this effect of ultrasound. We derive the optimal optical wavelengths for measuring the effects of the ultrasound at small source detector separations. Using optical oximetry performed at the optimal wavelengths, we demonstrate that effects of ultrasound can be used to differentiate tumor from normal leg muscle tissue in mice. To provide a statistical analysis of the experiments, we propose a novel diagnostic algorithm that quantitatively differentiates tumor from nontumor with maximum specificity 0.83, maximum sensitivity 0.79, and area under receiver-operating-characteristics curve 0.90. Ultrasound has long been known to cause tissue heating when applied in high intensities. More recently, interest has arisen in the area of High Intensity Focused Ultrasound (HIFU) for localized tissue heating effects, specifically thermal ablation. All present techniques employ focused traveling high intensity acoustic waves to create a region of elevated temperature. Such high intensity traveling waves can be damaging to normal tissue in the vicinity of the focal region, and have demonstrated surface burns and caused

  16. Noninvasive, localized, and transient brain drug delivery using focused ultrasound and microbubbles

    NASA Astrophysics Data System (ADS)

    Choi, James J.

    In the United States, Alzheimer's disease (AD), Parkinson's disease (PD), and brain cancer caused 72,432, 19,566 and 12,886 deaths in 2006, respectively. Whereas the number of deaths due to major disorders such as heart disease, stroke, and prostate cancer have decreased since 2006, deaths attributed to AD, PD, and brain cancer have not. Treatment options for patients with CNS disorders remain limited despite significant advances in knowledge of CNS disease pathways and development of neurologically potent agents. One of the major obstacles is that the cerebral microvasculature is lined by a specialized and highly regulated blood-brain barrier (BBB) that prevents large agents from entering the brain extracellular space. The purpose of this dissertation is to design a noninvasive, localized, and transient BBB opening system using focused ultrasound (FUS) and determine ultrasound and microbubble conditions that can effectively and safely deliver large pharmacologically-relevant-sized agents to the brain. To meet this end, an in vivo mouse brain drug delivery system using a stereotactic-based targeting method was developed. FUS was applied noninvasively through the intact skin and skull, which allowed for long-term and high-throughput studies. With this system, more than 150 mice were exposed to one of 31 distinct acoustic and microbubble conditions. The feasibility of delivering a large MRI contrast agent was first demonstrated in vivo in both wild-type and transgenic Alzheimer's disease model (APP/PS1) mice. A wide range of acoustic and microbubble conditions were then evaluated for their ability to deliver agents to a target region. Interestingly, the possible design space of parameters was found to be vast and different conditions resulted in distinct spatial distributions and doses delivered. In particular, BBB opening was shown to be dependent on the microbubble diameter, acoustic pressure, pulse repetition frequency (PRF), and pulse length (PL). Each set of

  17. Methods of Knowledge Exchange and Learning Focused on Local Authorities' Experiences of Flood Science Communication

    ERIC Educational Resources Information Center

    Stokes, Alison; Roberts, Carolyn; Crowley, Kate; McEwen, Lindsey

    2015-01-01

    Devastating floods in 2007 across western England resulted in legislative changes which have placed increased responsibility on local government for managing and mitigating local flood risk. For these changes to be effective, professional stakeholders need to understand fundamental concepts in flood science of which they may have no prior…

  18. Comparison of blocked and event-related fMRI designs for pre-surgical language mapping.

    PubMed

    Tie, Yanmei; Suarez, Ralph O; Whalen, Stephen; Radmanesh, Alireza; Norton, Isaiah H; Golby, Alexandra J

    2009-08-01

    Language functional magnetic resonance imaging (fMRI) is a promising non-invasive technique for pre-surgical planning in patients whose lesions are adjacent to or within critical language areas. Most language fMRI studies in patients use blocked experimental design. In this study, we compared a blocked design and a rapid event-related design with a jittered inter-stimulus-interval (ISI) (or stochastic design) for language fMRI in six healthy controls, and eight brain tumor patients, using a vocalized antonym generation task. Comparisons were based on visual inspection of fMRI activation maps and degree of language lateralization, both of which were assessed at a constant statistical threshold for each design. The results indicated a relatively high degree of discordance between the two task designs. In general, the event-related design provided maps with more robust activations in the putative language areas than the blocked design, especially for brain tumor patients. Our results suggest that the rapid event-related design has potential for providing comparable or even higher detection power over the blocked design for localizing language function in brain tumor patients, and therefore may be able to generate more sensitive language maps. More patient studies, and further investigation and optimization of language fMRI paradigms will be needed to determine the utility and validity of this approach for pre-surgical planning.

  19. Diffusion Tensor Tractography in the Presurgical Assessment of Cerebral Gliomas

    PubMed Central

    Farshidfar, Zahra; Faeghi, Fariborz; Mohseni, Mostafa; Seddighi, Afsoun; Kharrazi, Homayoun Hadizadeh; Abdolmohammadi, Jamil

    2014-01-01

    Summary Glioma is the most common intra-axial brain tumor characterized by invasion into the surrounding white matter (WM) tracts. These tumors are usually diagnosed by conventional MRI, but this method is unable to describe the relationship between tumor and neighboring WM tracts. Diffusion tensor tractography (DTT) is a new imaging modality which can solve this problem. The current study evaluated the application of DTT imaging in the presurgical assessment of gliomas, and introduces this new modality and its importance to physicians and imaging centers in Iran. Ten patients with intra-axial brain tumor and suspicion of glioma underwent conventional brain MRI pulse sequences and DTT imaging between December 2011 and February 2013 with a 1.5 Tesla system using 64 independent diffusion encoding directions. Acquired images were assessed by the neuroradiologist and neurosurgeon. The treatment strategies were recognized and compared using data before and after the tractography. On the basis of DTT data, the treatment strategy changed from radiotherapy to the craniotomy in seven patients, and in one patient, the neurosurgeon preferred to avoid surgery. In one patient, the treatment technique did not change, and in the last one radiosurgery was replaced by craniotomy. As we can infer from this study, based on the tractography results, the treatment strategy may be changed, and the treatment technique could be devised more accurately and may lead to fewer postoperative neurological deficits and better outcomes. PMID:24571836

  20. Social representations of climate change in Swedish lay focus groups: local or distant, gradual or catastrophic?

    PubMed

    Wibeck, Victoria

    2014-02-01

    This paper explores social representations of climate change, investigating how climate change is discussed by Swedish laypeople interacting in focus group interviews. The analysis focuses on prototypical examples and metaphors, which were key devices for objectifying climate change representations. The paper analyzes how the interaction of focus group participants with other speakers, ideas, arguments, and broader social representations shaped their representations of climate change. Climate change was understood as a global but distant issue with severe consequences. There was a dynamic tension between representations of climate change as a gradual vs. unpredictable process. Implications for climate change communication are discussed.

  1. ACAL National Conference (Sydney, Australia, October 9-11, 1992). Conference Papers, Vol. 3, Workshops with a Local NSW Focus.

    ERIC Educational Resources Information Center

    Literacy & Numeracy Exchange, 1992

    1992-01-01

    This third of three volumes of the 1992 Australian Council for Adult Literacy (ACAL) Conference Papers is a special edition of "Literacy and Numeracy Exchange." It includes nine papers from workshops with a more local New South Wales focus. "Literacy, Language, and Numeracy in the Workplace in the Context of Industry…

  2. Cloning, localization and focus formation at DNA damage sites of canine XRCC4.

    PubMed

    Koike, Manabu; Yutoku, Yasutomo; Koike, Aki

    2017-01-10

    Various chemotherapies and radiation therapies are useful for killing cancer cells mainly by inducing DNA double-strand breaks (DSBs). Uncovering the molecular mechanisms of DSB repair processes is crucial for developing next-generation radiotherapies and chemotherapeutics for human and animal cancers. XRCC4 plays a critical role in Ku-dependent nonhomologous DNA-end joining (NHEJ) in human cells, and is one of the core NHEJ factors. The localization of core NHEJ factors, such as human Ku70 and Ku80, might play a crucial role in regulating NHEJ activity. Recently, companion animals, such as canines, have been proposed to be a good model in many aspects of cancer research. However, the localization and regulation mechanisms of core NHEJ factors in canine cells have not been elucidated. Here, we show that the expression and subcellular localization of canine XRCC4 changes dynamically during the cell cycle. Furthermore, EYFP-canine XRCC4 accumulates quickly at laser-microirradiated DSB sites. The structure of a putative human XRCC4 nuclear localization signal (NLS) is highly conserved in canine, chimpanzee and mouse XRCC4. However, the amino acid residue corresponding to the human XRCC4 K210, thought to be important for nuclear localization, is not conserved in canine XRCC4. Our findings might be useful for the study of the molecular mechanisms of Ku-dependent NHEJ in canine cells and the development of new radiosensitizers that target XRCC4.

  3. Cloning, localization and focus formation at DNA damage sites of canine XLF.

    PubMed

    Koike, Manabu; Yutoku, Yasutomo; Koike, Aki

    2017-01-20

    Understanding the molecular mechanisms of DNA double-strand break (DSB) repair processes, especially nonhomologous DNA-end joining (NHEJ), is critical for developing next-generation radiotherapies and chemotherapeutics for human and animal cancers. The localization, protein-protein interactions and post-translational modifications of core NHEJ factors, such as human Ku70 and Ku80, might play critical roles in controlling NHEJ activity. XRCC4-like factor (XLF) is a core NHEJ factor and plays a key role in the Ku-dependent NHEJ repair process in human cells. Recently, companion animals, such as canines, have been proposed to be a good model for many aspects of cancer research, including the development of chemotherapeutics. However, the localization and regulation of core NHEJ factors in canine cells have not been elucidated. Here, we show that the localization of canine XLF changes dynamically during the cell cycle. EYFP-canine XLF localizes in the nuclei of interphase cells and accumulates immediately at microirradiated DSB sites. The structure of a putative human XLF nuclear localization signal (NLS) and a putative 14-3-3 binding motif are evolutionarily conserved in canine, chimpanzee and mouse XLF. However, the putative β-TRCP-recognizable degron of human XLF is not conserved in canine and mouse. Additionally, some vital human XLF phosphorylation sites, including the ATM major phosphorylation site (S251), are not conserved in canine XLF. Our findings might be useful for the study of the molecular mechanisms of NHEJ in canine cells and for the development of new radiosensitizers that target XLF.

  4. Presurgical Multimodality Neuroimaging in Electroencephalographic Lateralized Temporal Lobe Epilepsy

    PubMed Central

    Knowlton, Robert C.; Laxer, Kenneth D.; Ende, Gabriele; Hawkins, Randall A.; Wong, Stephen T. C.; Matson, Gerald B.; Rowley, Howard A.; Fein, George; Weiner, Michael W.

    2009-01-01

    The purpose of this study was to compare 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), hippocampal volumetry (HV), T2 relaxometry, and proton magnetic resonance spectroscopic imaging (1H-MRSI) in the presurgical neuroimaging lateralization of patients with nonlesional, electroencephalogram (EEG)-defined unilateral temporal lobe epilepsy (TLE). Twenty-five patients were prospectively studied, along with age-matched controls. T2 relaxometry examinations were performed in 13 patients. Comparison of FDG-PET, HV, and 1H-MRSI was possible in 23 patients. FDG-PET lateralized 87% of patients, HV 65%, N-acetyl aspartate (NAA)/(choline [Cho] + creatine [Cr]) 61%, and [NAA] 57%. Combined HV and NAA/(Cho + Cr) results lateralized 83% of the patients, a value similar to PET. Of 10 patients with normal magnetic resonance imaging (MRI) scans, 2 were lateralized with HV, 6 with FDG-PET, 4 with NAA/(Cho + Cr), and 3 with [NAA]. T2 relaxometry lateralized no patients without hippocampal atrophy. Bilateral abnormality was present in 29 to 33% of patients with 1H-MRSI measures and 17% with HV. Only hippocampal atrophy correlated with postoperative seizure-free outcome. FDG-PET remains the most sensitive imaging method to correlate with EEG-lateralized TLE. Both FDG-PET and 1H-MRSI can lateralize patients with normal MRI, but only the presence of relative unilateral hippocampal atrophy is predictive of seizure-free outcome. Bilaterally abnormal MRI and 1H-MRSI measures do not preclude good surgical outcome. PMID:9403474

  5. Presurgical nasoalveolar moulding in unilateral cleft lip and palate.

    PubMed

    Zuhaib, Mohammed; Bonanthaya, Krishnamurthy; Parmar, Renu; Shetty, Pritham N; Sharma, Pradeep

    2016-01-01

    Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Prospective study. A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Student's t-test for paired comparisons. Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.

  6. Cloning, localization and focus formation at DNA damage sites of canine Ku70.

    PubMed

    Koike, Manabu; Yutoku, Yasutomo; Koike, Aki

    2017-03-23

    Understanding the molecular mechanisms of DNA double-strand break (DSB) repair machinery, specifically non-homologous DNA-end joining (NHEJ), is crucial for developing next-generation radiotherapies and common chemotherapeutics for human and animal cancers. The localization, protein-protein interactions and post-translational modifications of core NHEJ factors, might play vital roles for regulation of NHEJ activity. The human Ku heterodimer (Ku70/Ku80) is a core NHEJ factor in the NHEJ pathway and is involved in sensing of DSBs. Companion animals, such as canines, have been proposed to be an excellent model for cancer research, including development of chemotherapeutics. However, the post-translational modifications, localization and complex formation of canine Ku70 have not been clarified. Here, we show that canine Ku70 localizes in the nuclei of interphase cells and that it is recruited quickly at laser-microirradiated DSB sites. Structurally, two DNA-PK phosphorylation sites (S6 and S51), an ubiquitination site (K114), two canonical sumoylation consensus motifs, a CDK phosphorylation motif, and a nuclear localization signal (NLS) in the human Ku70 are evolutionarily conserved in canine and mouse species, while the acetylation sites in human Ku70 are partially conserved. Intriguingly, the primary candidate nucleophile (K31) required for 5'dRP/AP lyase activity of human and mouse Ku70 is not conserved in canines, suggesting that canine Ku does not possess this activity. Our findings provide insights into the molecular mechanisms of Ku-dependent NHEJ in a canine model and form a platform for the development of next-generation common chemotherapeutics for human and animal cancers.

  7. Cloning, localization and focus formation at DNA damage sites of canine Ku70

    PubMed Central

    KOIKE, Manabu; YUTOKU, Yasutomo; KOIKE, Aki

    2017-01-01

    Understanding the molecular mechanisms of DNA double-strand break (DSB) repair machinery, specifically non-homologous DNA-end joining (NHEJ), is crucial for developing next-generation radiotherapies and common chemotherapeutics for human and animal cancers. The localization, protein-protein interactions and post-translational modifications of core NHEJ factors, might play vital roles for regulation of NHEJ activity. The human Ku heterodimer (Ku70/Ku80) is a core NHEJ factor in the NHEJ pathway and is involved in sensing of DSBs. Companion animals, such as canines, have been proposed to be an excellent model for cancer research, including development of chemotherapeutics. However, the post-translational modifications, localization and complex formation of canine Ku70 have not been clarified. Here, we show that canine Ku70 localizes in the nuclei of interphase cells and that it is recruited quickly at laser-microirradiated DSB sites. Structurally, two DNA-PK phosphorylation sites (S6 and S51), an ubiquitination site (K114), two canonical sumoylation consensus motifs, a CDK phosphorylation motif, and a nuclear localization signal (NLS) in the human Ku70 are evolutionarily conserved in canine and mouse species, while the acetylation sites in human Ku70 are partially conserved. Intriguingly, the primary candidate nucleophile (K31) required for 5’dRP/AP lyase activity of human and mouse Ku70 is not conserved in canines, suggesting that canine Ku does not possess this activity. Our findings provide insights into the molecular mechanisms of Ku-dependent NHEJ in a canine model and form a platform for the development of next-generation common chemotherapeutics for human and animal cancers. PMID:28163277

  8. Skin Localization of Lipid Nanoparticles (SLN/NLC): Focusing the Influence of Formulation Parameters.

    PubMed

    Amasya, Gulin; Sandri, Giuseppina; Onay-Besikci, Arzu; Badilli, Ulya; Caramella, Carla; Bonferoni, Maria C; Tarimci, Nilufer

    2016-01-01

    In this study, fluorescein labeled SLN and NLC formulations were prepared for improving the dermal distribution of the hydrophilic active ingredients and for enhancing the skin penetration. To determine skin distribution of the lipid nanoparticles ex-vivo penetration/ permeation experiments were performed using full thickness rat skin by means of Franz diffusion cells. Studies on the localization of fluorescence labeled nanoparticles were performed by confocal laser scanning microscopy (CLSM). Cellular uptake studies were performed on human keratinocyte cell line (HaCaT) and visualized by fluorescence microscope. Both tissue and cell uptake were also quantitatively determined by means of fluorimetric method in the skin extract or cell extract. Both imaging and quantification studies suggest that the dermal localization of the lipid nanoparticles depends on their dimensions and particle size distribution. The CLSM images clearly show that the Tripalmitin based lipid nanoparticles have higher accumulation in the skin. It is possible to overcome the stratum corneum barrier function with T-NLC05 coded lipid nanoparticle formulation. Additionally cellular uptake of this NLC formulation is time dependent. Conclusıon: It can be concluded that this formulation is promising for treating local skin disorders without systemic side effects. On the other hand obtained results suggest that optimum formulation (T-NLC05) might be an interesting option even for novel cosmetic products.

  9. Gamma knife treatment for refractory epilepsy in seizure focus localized by positron emission tomography/CT★

    PubMed Central

    Bai, Xia; Wang, Xuemei; Wang, Hongwei; Zhao, Shigang; Han, Xiaodong; Hao, Linjun; Wang, Xiangcheng

    2012-01-01

    A total of 80 patients with refractory epilepsy were recruited from the Inner Mongolia Medical College Affiliated Hospital. The foci of 60% of the patients could be positioned using a combined positron emission tomography/CT imaging modality. Hyper- and hypometabolism foci were examined as part of this study. Patients who had abnormal metabolism in positron emission tomography/CT imaging were divided into intermittent-phase group and the seizure-phase group. The intermittent-phase group was further divided into a single-focus group and a multiple-foci group according to the number of seizure foci detected by imaging. Following gamma knife treatment, seizure frequency was significantly lower in the intermittent-phase group and the seizure-phase group. Wieser’s classification reached Grade I or II in nearly 40% of patients. Seizure frequency was significantly lower following treatment, but Wieser’s classification score was significantly higher in the seizure-phase group compared with the intermittent-phase group. Seizure frequency was significantly lower following treatment in the single-focus group, but Wieser’s classification score was significantly higher in the single-focus group as compared with the multiple-foci group. PMID:25317147

  10. Chronic unlimited recording electrocorticography-guided resective epilepsy surgery: technology-enabled enhanced fidelity in seizure focus localization with improved surgical efficacy.

    PubMed

    DiLorenzo, Daniel J; Mangubat, Erwin Z; Rossi, Marvin A; Byrne, Richard W

    2014-06-01

    Epilepsy surgery is at the cusp of a transformation due to the convergence of advancements in multiple technologies. Emerging neuromodulatory therapies offer the promise of functionally correcting neural instability and obviating the need for resective or ablative surgery in select cases. Chronic implanted neurological monitoring technology, delivered as part of a neuromodulatory therapeutic device or as a stand-alone monitoring system, offers the potential to monitor patients chronically in their normal ambulatory setting with outpatient medication regimens. This overcomes significant temporal limitations, pharmacological perturbations, and infection risks inherent in the present technology comprising subacute percutaneous inpatient monitoring of presurgical candidates in an epilepsy monitoring unit. As part of the pivotal study for the NeuroPace Responsive Neurostimulation (RNS) System, the authors assessed the efficacy of the RNS System to control seizures in a group of patients with medically refractory epilepsy. Prior to RNS System implantation, these patients were not candidates for further resective surgery because they had temporal lobe epilepsy with bilateral temporal sources, frontal lobe reflex epilepsy with involvement of primary motor cortex, and occipital lobe epilepsy with substantial involvement of eloquent visual cortex. Without interfering with and beyond the scope of the therapeutic aspect of the RNS System study, the authors were able to monitor seizure and epileptiform activity from chronically implanted subdural and depth electrodes in these patients, and, in doing so, they were able to more accurately localize the seizure source. In 5 of these study patients, in whom the RNS System was not effective, the notion of resective surgery was revisited and considered in light of the additional information gleaned from the chronic intracranial recordings obtained from various permutations of electrodes monitoring sources in the frontal, temporal

  11. A Nanoscale-Localized Ion Damage Josephson Junction Using Focused Ion Beam and Ion Implanter.

    PubMed

    Wu, C H; Ku, W S; Jhan, F J; Chen, J H; Jeng, J T

    2015-05-01

    High-T(c) Josephson junctions were fabricated by nanolithography using focused ion beam (FIB) milling and ion implantation. The junctions were formed in a YBa2Cu3O7-x, thin film in regions defined using a gold-film mask with 50-nm-wide (top) slits, engraved by FIB. The focused ion beam system parameters for dwell time and passes were set to remove gold up to a precise depth. 150 keV oxygen ions were implanted at a nominal dose of up to 5 x 10(13) ions/cm2 into YBa2Cu3O7-x microbridges through the nanoscale slits. The current-voltage curves of the ion implantation junctions exhibit resistive-shunted-junction-like behavior at 77 K. The junction had an approximately linear temperature dependence of critical current. Shapiro steps were observed under microwave irradiation. A 50-nm-wide slit and 0-20-nm-thick buffer layers were chosen in order to make Josephson junctions due to the V-shape of the FIB-milled trench.

  12. Optical characterization of locally and compositionally mixed superlattices using conventional and focused ion beam implantation

    SciTech Connect

    Choo, A.G.

    1992-01-01

    Spatially resolved Raman scattering and low temperature photoluminescence have been utilized to investigate implantation-induced lattice damage and compositional disordering in multiple quantum well (MQW) structures prepared using by ion beam (conventional and focused) implantation and subsequent rapid thermal annealing (RTA). The RTA of 10 sec at 950[degrees] for short period MQW and 10 sec at 1000[degrees]C for long period MQW are appropriate thermal annealing condition. Focused on beam (FIB) implantation induces more damage than conventional ion beam (CIB) implantation for the whole dose range. The highest dose FIB induces significant damage compared to the CIB. The degree of FIB implantation-induced intermixing increases with increasing ion dose. As RTA time increases, additional enhanced intermixing does not occur in MQW channel waveguide structure. The donor-to-acceptor transition from PL is dominant in the ion-implanted samples. The multiple scan FIB and the CIB shows more compensation than the single scan FIB. The spatial scanning of Raman scattering is demonstrated to characterize MQW channel waveguide structure.

  13. Localized Delivery of Low-Density Lipoprotein Docosahexaenoic Acid Nanoparticles to the Rat Brain using Focused Ultrasound

    PubMed Central

    Mulik, Rohit S.; Bing, Chenchen; Ladouceur-Wodzak, Michelle; Munaweera, Imalka; Chopra, Rajiv; Corbin, Ian R.

    2016-01-01

    Focused ultrasound exposures in the presence of microbubbles can achieve transient, non-invasive, and localized blood-brain barrier (BBB) opening, offering a method for targeted delivery of therapeutic agents into the brain. Low-density lipoprotein (LDL) nanoparticles reconstituted with docosahexaenoic acid (DHA) could have significant therapeutic value in the brain, since DHA is known to be neuroprotective. BBB opening was achieved using pulsed ultrasound exposures in a localized brain region in normal rats, after which LDL nanoparticles containing the fluorescent probe DiR (1,1′-Dioctadecyl-3,3,3′,3′-Tetramethylindotricarbocyanine Iodide) or DHA were administered intravenously. Fluorescent imaging of brain tissue from rats administered LDL-DiR demonstrated strong localization of fluorescence signal in the exposed hemisphere. LDL-DHA administration produced 2× more DHA in the exposed region of the brain, with a corresponding increase in Resolvin D1 levels, indicating DHA was incorporated into cells and metabolized. Histological evaluation did not indicate any evidence of increased tissue damage in exposed brain regions compared to normal brain. This work demonstrates that localized delivery of DHA to the brain is possible using systemically-administered LDL nanoparticles combined with pulsed focused ultrasound exposures in the brain. This technology could be used in regions of acute brain injury or as a means to target infiltrating tumor cells in the brain. PMID:26790145

  14. Localized delivery of low-density lipoprotein docosahexaenoic acid nanoparticles to the rat brain using focused ultrasound.

    PubMed

    Mulik, Rohit S; Bing, Chenchen; Ladouceur-Wodzak, Michelle; Munaweera, Imalka; Chopra, Rajiv; Corbin, Ian R

    2016-03-01

    Focused ultrasound exposures in the presence of microbubbles can achieve transient, non-invasive, and localized blood-brain barrier (BBB) opening, offering a method for targeted delivery of therapeutic agents into the brain. Low-density lipoprotein (LDL) nanoparticles reconstituted with docosahexaenoic acid (DHA) could have significant therapeutic value in the brain, since DHA is known to be neuroprotective. BBB opening was achieved using pulsed ultrasound exposures in a localized brain region in normal rats, after which LDL nanoparticles containing the fluorescent probe DiR (1,1'-Dioctadecyl-3,3,3',3'-Tetramethylindotricarbocyanine Iodide) or DHA were administered intravenously. Fluorescent imaging of brain tissue from rats administered LDL-DiR demonstrated strong localization of fluorescence signal in the exposed hemisphere. LDL-DHA administration produced 2 × more DHA in the exposed region of the brain, with a corresponding increase in Resolvin D1 levels, indicating DHA was incorporated into cells and metabolized. Histological evaluation did not indicate any evidence of increased tissue damage in exposed brain regions compared to normal brain. This work demonstrates that localized delivery of DHA to the brain is possible using systemically-administered LDL nanoparticles combined with pulsed focused ultrasound exposures in the brain. This technology could be used in regions of acute brain injury or as a means to target infiltrating tumor cells in the brain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. A single bout of meditation biases cognitive control but not attentional focusing: Evidence from the global-local task.

    PubMed

    Colzato, Lorenza S; van der Wel, Pauline; Sellaro, Roberta; Hommel, Bernhard

    2016-01-01

    Recent studies show that a single bout of meditation can impact information processing. We were interested to see whether this impact extends to attentional focusing and the top-down control over irrelevant information. Healthy adults underwent brief single bouts of either focused attention meditation (FAM), which is assumed to increase top-down control, or open monitoring meditation (OMM), which is assumed to weaken top-down control, before performing a global-local task. While the size of the global-precedence effect (reflecting attentional focusing) was unaffected by type of meditation, the congruency effect (indicating the failure to suppress task-irrelevant information) was considerably larger after OMM than after FAM. Our findings suggest that engaging in particular kinds of meditation creates particular cognitive-control states that bias the individual processing style toward either goal-persistence or cognitive flexibility.

  16. Alternative-based thresholding with application to presurgical fMRI.

    PubMed

    Durnez, Joke; Moerkerke, Beatrijs; Bartsch, Andreas; Nichols, Thomas E

    2013-12-01

    Functional magnetic reasonance imaging (fMRI) plays an important role in pre-surgical planning for patients with resectable brain lesions such as tumors. With appropriately designed tasks, the results of fMRI studies can guide resection, thereby preserving vital brain tissue. The mass univariate approach to fMRI data analysis consists of performing a statistical test in each voxel, which is used to classify voxels as either active or inactive-that is, related, or not, to the task of interest. In cognitive neuroscience, the focus is on controlling the rate of false positives while accounting for the severe multiple testing problem of searching the brain for activations. However, stringent control of false positives is accompanied by a risk of false negatives, which can be detrimental, particularly in clinical settings where false negatives may lead to surgical resection of vital brain tissue. Consequently, for clinical applications, we argue for a testing procedure with a stronger focus on preventing false negatives. We present a thresholding procedure that incorporates information on false positives and false negatives. We combine two measures of significance for each voxel: a classical p-value, which reflects evidence against the null hypothesis of no activation, and an alternative p-value, which reflects evidence against activation of a prespecified size. This results in a layered statistical map for the brain. One layer marks voxels exhibiting strong evidence against the traditional null hypothesis, while a second layer marks voxels where activation cannot be confidently excluded. The third layer marks voxels where the presence of activation can be rejected.

  17. Engineering, global health, and inclusive innovation: focus on partnership, system strengthening, and local impact for SDGs.

    PubMed

    Clifford, Katie L; Zaman, Muhammad H

    2016-01-01

    The recent drafting of the Sustainable Development Goals challenges the research community to rethink the traditional approach to global health and provides the opportunity for science, technology, engineering, and mathematical (STEM) disciplines, particularly engineering, to demonstrate their benefit to the field. Higher education offers a platform for engineering to intersect with global health research through interdisciplinary partnerships among international universities that provide excellence in education, attract nontraditional STEM students, and foster a sense of innovation. However, a traditional lack of engineering-global health collaborations, as well as limited faculty and inadequate STEM research funding in low-income countries, has stifled progress. Still, the impact of higher education on development efforts holds great potential. This value will be realized in low-income countries through strengthening local capacity, supporting innovation through educational initiatives, and encouraging the inclusion of women and minorities in STEM programs. Current international university-level partnerships are working towards integrating engineering into global health research and strengthening STEM innovation among universities in low-income countries, but more can be done. Global health research informs sustainable development, and through integrating engineering into research efforts through university partnerships, we can accelerate progress and work towards a healthier future for all.

  18. Engineering, global health, and inclusive innovation: focus on partnership, system strengthening, and local impact for SDGs

    PubMed Central

    Clifford, Katie L.; Zaman, Muhammad H.

    2016-01-01

    The recent drafting of the Sustainable Development Goals challenges the research community to rethink the traditional approach to global health and provides the opportunity for science, technology, engineering, and mathematical (STEM) disciplines, particularly engineering, to demonstrate their benefit to the field. Higher education offers a platform for engineering to intersect with global health research through interdisciplinary partnerships among international universities that provide excellence in education, attract nontraditional STEM students, and foster a sense of innovation. However, a traditional lack of engineering–global health collaborations, as well as limited faculty and inadequate STEM research funding in low-income countries, has stifled progress. Still, the impact of higher education on development efforts holds great potential. This value will be realized in low-income countries through strengthening local capacity, supporting innovation through educational initiatives, and encouraging the inclusion of women and minorities in STEM programs. Current international university-level partnerships are working towards integrating engineering into global health research and strengthening STEM innovation among universities in low-income countries, but more can be done. Global health research informs sustainable development, and through integrating engineering into research efforts through university partnerships, we can accelerate progress and work towards a healthier future for all. PMID:26790462

  19. Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients.

    PubMed

    Marek, Ryan J; Ben-Porath, Yossef S; Dulmen, Manfred H M van; Ashton, Kathleen; Heinberg, Leslie J

    2017-03-01

    Psychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent. Examine associations between presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory-2 - Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes. Cleveland Clinic Bariatric and Metabolic Institute METHODS: 446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical BMI was 49.14 kg/m(2) [SD = 9.50 kg/m(2)]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling. Older patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes. Preoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  20. Relations between perceptual and conceptual scope: how global versus local processing fits a focus on similarity versus dissimilarity.

    PubMed

    Förster, Jens

    2009-02-01

    Nine studies showed a bidirectional link (a) between a global processing style and generation of similarities and (b) between a local processing style and generation of dissimilarities. In Experiments 1-4, participants were primed with global versus local perception styles and then asked to work on an allegedly unrelated generation task. Across materials, participants generated more similarities than dissimilarities after global priming, whereas for participants with local priming, the opposite was true. Experiments 5-6 demonstrated a bidirectional link whereby participants who were first instructed to search for similarities attended more to the gestalt of a stimulus than to its details, whereas the reverse was true for those who were initially instructed to search for dissimilarities. Because important psychological variables are correlated with processing styles, in Experiments 7-9, temporal distance, a promotion focus, and high power were predicted and shown to enhance the search for similarities, whereas temporal proximity, a prevention focus, and low power enhanced the search for dissimilarities. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

  1. Focusing "upstream" to Address Maternal and Child Health Inequities: Two Local Health Departments in Washington State Make the Transition.

    PubMed

    Storey-Kuyl, Marni; Bekemeier, Betty; Conley, Elaine

    2015-11-01

    Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother-child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways. The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities. Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities. With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities.

  2. Localized spin-wave modes in a triangular magnetic element studied by micro-focused Brillouin light scattering

    NASA Astrophysics Data System (ADS)

    Hwang, S.; Kwon, J.-H.; Grünberg, P.; Cho, B. K.

    2017-09-01

    Localized spin-wave modes, which were thermally excited at a specific position in a triangular magnetic element, were investigated using micro-focused Brillouin light scattering in two saturated states, the buckle and Y-states, with an applied magnetic field of 0.24 T parallel and perpendicular to the basal edge, respectively. The measured frequency spectrum at a specific beam spot position, rather than an integrated spectrum, was analyzed by comparing it with the simulation data at a precisely selected position within the beam spot area. The analyzed results were used to plot a two-dimensional intensity map and simulation spatial profile to verify the validity of the analysis. From the analysis process, two localized spin-wave modes in a triangular magnetic element were successfully identified near the apex region in the buckle state and near the basal edge region in the Y-state.

  3. Optimization of spoiled gradient-echo phase imaging for in vivo localization of a focused ultrasound beam.

    PubMed

    Chung, A H; Hynynen, K; Colucci, V; Oshio, K; Cline, H E; Jolesz, F A

    1996-11-01

    The parameters of a spoiled gradient-echo (SPGR) pulse sequence have been optimized for in vivo localization of a focused ultrasound beam. Temperature elevation was measured by using the proton resonance frequency shift technique, and the phase difference signal-to-noise ratio (SNR delta phi) was estimated in skeletal muscle and kidney cortex in 10 rabbits. Optimized parameters included the echo time equivalent to T2* of the tissue, the longest repetition time possible with a 20-s sonication, and the flip angle equivalent to the Ernst angle. Optimal SPGR phase imaging can detect a sonication beam with a peak phase difference of 0.55 radian, which corresponds to a temperature elevation of 7.3 degrees C. The sonication beam can be localized within one voxel (0.6 x 0.6 x 5 mm3) at power levels that are below the threshold for thermal damage of the tissue.

  4. Effect of focused ultrasound stimulation at different ultrasonic power levels on the local field potential power spectrum

    NASA Astrophysics Data System (ADS)

    Yuan, Yi; Lu, Cheng-Biao; Li, Xiao-Li

    2015-08-01

    Local field potential (LFP) signals of the rat hippocampus were recorded under noninvasive focused ultrasound stimulation (FUS) with different ultrasonic powers. The LFP mean absolute power was calculated with the Welch algorithm at the delta, theta, alpha, beta, and gamma frequency bands. The experimental results demonstrate that the LFP mean absolute power at different frequency bands increases as the ultrasound power increases. Project supported by the National Natural Science Foundation of China (Grant No. 61273063), China Postdoctoral Science Foundation (Grant No. 2013M540215), and the Natural Science Foundation of Hebei Province, China (Grant No. F2014203161).

  5. Lommel pulses: an analytic form for localized waves of the focus wave mode type with bandlimited spectrum.

    PubMed

    Sheppard, Colin J R; Saari, Peeter

    2008-01-07

    A criticism of the focus wave mode (FWM) solution for localized pulses is that it contains backward propagating components that are difficult to generate in many practical situations. We describe a form of FWM where the strength of the backward propagating components is identically zero and derive special cases where the field can be written in an analytic form. In particular, a free-space version of "backward light" pulse is considered, which moves in the opposite direction with respect to all its spectral constituents.

  6. [Analysis of non-surgical candidates after presurgical evaluation for epilepsy surgery].

    PubMed

    Lin, Hua; Wang, Yu-ping; Li, Li-ping; Wu, Xun; Li, Yong-jie; Zhang, Guo-jun

    2010-08-17

    To investigate the causes of non-surgical candidates after presurgical evaluation for epilepsy surgery. A retrospective review was conducted for the clinical data of 112 non-surgical candidates after presurgical evaluation for epilepsy surgery. Potential surgical candidates were identified through a detailed seizure and medical history, physical examination, and uses of video electroencephalography and neuroimaging. The common causes of non-surgical candidates after presurgical evaluation for epilepsy surgery were patients and their families giving up intracranial electrode positioning for various reasons (42/112, 37.5%), multifocal epileptogenic zones (29/112, 25.9%), generalized seizures (15/112, 13.4%), pseudoseizure or slight seizure (10/112, 8.9%; 7/112, 6.3%), epileptogenic zone in functional areas (6/112, 5.4%) and so on. Epilepsy surgery is less likely in patients with a history of severe encephalitis and perinatal brain injury and diffuse, multiple, bilateral abnormality on cranial MRI. Unnecessary presurgical evaluation can be avoided by distinguishing generalized seizures, pseudoseizure and progressive brain disease. Patients and their families still have doubts about the surgical risks, costs and effects. It is important to inform the patients of the potential risks and benefit of surgery.

  7. MRI contrast variation of thermosensitive magnetoliposomes triggered by focused ultrasound: a tool for image-guided local drug delivery.

    PubMed

    Lorenzato, Cyril; Cernicanu, Alexandru; Meyre, Marie-Edith; Germain, Matthieu; Pottier, Agnès; Levy, Laurent; de Senneville, Baudouin Denis; Bos, Clemens; Moonen, Chrit; Smirnov, Pierre

    2013-01-01

    Improved drug delivery control during chemotherapy has the potential to increase the therapeutic index. MRI contrast agent such as iron oxide nanoparticles can be co-encapsulated with drugs in nanocarrier liposomes allowing their tracking and/or visualization by MRI. Furthermore, the combination of a thermosensitive liposomal formulation with an external source of heat such as high intensity focused ultrasound guided by MR temperature mapping allows the controlled local release of the content of the liposome. MRI-guided high-intensity focused ultrasound (HIFU), in combination represents a noninvasive technique to generate local hyperthermia for drug release. In this study we used ultrasmall superparamagnetic iron oxide nanoparticles (USPIO) encapsulated in thermosensitive liposomes to obtain thermosensitive magnetoliposomes (TSM). The transverse and longitudinal relaxivities of this MRI contrast agent were measured upon TSM membrane phase transition in vitro using a water bath or HIFU. The results showed significant differences for MRI signal enhancement and relaxivities before and after heating, which were absent for nonthermosensitive liposomes and free nanoparticles used as controls. Thus, incorporation of USPIO as MRI contrast agents into thermosensitive liposomes should, besides TSM tumor accumulation monitoring, allow the visualization of TSM membrane phase transition upon temperature elevation. In conclusion, HIFU under MR image guidance in combination with USPIO-loaded thermosensitive liposomes as drug delivery system has the potential for a better control of drug delivery and to increase the drug therapeutic index.

  8. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in infancy and early childhood.

    PubMed

    Cossu, Massimo; Schiariti, Marco; Francione, Stefano; Fuschillo, Dalila; Gozzo, Francesca; Nobili, Lino; Cardinale, Francesco; Castana, Laura; Russo, Giorgio Lo

    2012-03-01

    The authors report on the use of stereoelectroencephalography (stereo-EEG) in the presurgical electroclinical evaluation of infants and very young children with focal drug-resistant epilepsy. Fifteen patients (9 girls and 6 boys, mean age 34.1 ± 7.3 months, range 21-45 months), potentially candidates to receive surgical treatment for their focal drug-resistant epilepsy, were evaluated using stereo-EEG recording for a detailed definition of the epileptogenic zone. Stereoelectroencephalography was indicated because neuroradiological (brain MRI) and video-EEG data failed to adequately localize the epileptogenic zone. Stereotactic placement of multicontact intracerebral electrodes was preceded by the acquisition of all pertinent anatomical information from structural and functional MRI and from brain angiography, enabling the accurate targeting of desired structures through avascular trajectories. Stereoelectroencephalography monitoring attempted to record habitual seizures; electrical stimulations were performed to induce seizures and for the functional mapping of eloquent areas. Stereoelectroencephalography-guided microsurgery, when indicated, pointed to removal of the epileptogenic zone and seizure control. Brain MRI revealed an anatomical lesion in 13 patients (lobar in 2 cases, multilobar or hemispheric in 11 cases) and was unremarkable in 2 patients. One patient underwent 2 stereo-EEG studies. The arrangement of the intracerebral electrodes was unilateral in all but 1 case. One patient died the day following electrode placement due to massive brain edema and profound hyponatremia of undetermined cause. In 8 cases intracerebral electrical stimulations allowed mapping of functionally critical areas; in 3 other cases that received purposeful placement of electrodes in presumably eloquent areas, no functional response was obtained. Of the 14 patients who completed stereo-EEG monitoring, 1 was excluded from surgery for multifocality of seizures and 13 underwent

  9. Importance of presurgical breast MRI in patients 60 years of age and older.

    PubMed

    Destounis, Stamatia V; Arieno, Andrea L; Morgan, Renee C

    2014-01-01

    To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI) in women 60 years of age and older. Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results. Of 1268 exams performed in this population, 272 (21.5%) patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%), benign findings in 127 (47%), and atypia in 31 (11%). Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy. Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268) and atypia in 2.4% (n = 31/1268). A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268). These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.

  10. High-Intensity Focused Ultrasound for the Treatment of Localized and Locally Advanced Hormone-Resistant Prostate Cancer: 2,5 Year Outcome

    NASA Astrophysics Data System (ADS)

    Solovov, V. A.; Dvoynikov, S. Y.; Vozdvizhenskiy, M. O.

    2011-09-01

    Introduction & Objectives: High-Intensity Focused Ultrasound (HIFU) has been shown to be a successful treatment for localised prostate cancer (PC). Here we have explored the effectiveness of the HIFU treatment for hormone-resistant prostate cancer (HRPC). Materials & Methods: 341 patients were treated in our center between September 2007 and December 2009; all of them showed treatment failure following hormone ablation. The median time before hormone-resistance was 20 (3-48) months. In the group with localised PC: number of patients 237, Gleason score ≤7, stage T1-2N0M0, age 69 (60-89) years, mean PSA before treatment 40,0 (5,8-92,9) ng/ml, mean prostate volume—39,3 (28-92) cc; in the group with locally advanced PC: number of patients 104, Gleason score ≤9, stage T2-3N0M0, age 72 (52-83) years, PSA before treatment 30,3 (20,1-60) ng/ml, mean prostate volume—41,2 (25-198) cc. HIFU was delivered under spinal anesthesia using the Ablatherm HIFU device (EDAP, France). Pre HIFU transurethral resection of the prostate (TURP) was performed for all patients. Mean follow-up time 18 months (3-30). Results: The median PSA level 12 months after HIFU treatment was 0,04 (0-2,24) ng/ml—localised PC, and for locally advanced disease—0,05 (0-48,4) ng/ml, at 18 months after HIFU treatment this was 0,2 (0,02-2,0) ng/ml for localised PC, and for locally advanced disease 0,18 (0,04-7,45) ng/ml. Patients with localised PC has 4,5% recurrence, those with locally advanced PC 20%. Kaplan-Meir analyses of the total group indicated that the risk of recurrence after 1 year follow-up was 10%, the risk of recurrence was 19% after 2 years of follow-up. Conclusions: Our initial experience shows that ultrasound ablation is safe, minimally invasive and effective as a treatment for localised and locally advanced hormone-resistant prostate cancer.

  11. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound.

    PubMed

    Napoli, Alessandro; Anzidei, Michele; Marincola, Beatrice Cavallo; Brachetti, Giulia; Ciolina, Federica; Cartocci, Gaia; Marsecano, Claudia; Zaccagna, Fulvio; Marchetti, Luca; Cortesi, Enrico; Catalano, Carlo

    2013-06-01

    The objectives of this study were to evaluate the efficacy in pain management of magnetic resonance (MR)-guided focused ultrasound for the primary treatment of painful bone metastases and to assess its potential for local control of bone metastases. This was a prospective, single-arm research study with approval from the institutional review board. Eighteen consecutive patients (female, 8; male, 10; mean [SD] age, 62.7 [11.5] years) with painful bone metastases were enrolled. The patients were examined clinically for pain severity and pain interference in accordance with the Brief Pain Inventory-Quality of Life criteria before and at each follow-up visit. Computed tomography and MR imaging were performed before and at 1 and 3 months after the magnetic resonance-guided focused ultrasound treatment. The nonperfused volume (NPV) was calculated to correlate the extension of the ablated pathological tissue in the responder and nonresponder patients. No treatment-related adverse events were recorded during the study. The evaluation of pain palliation revealed a statistically significant difference between baseline and follow-up values for pain severity and pain interference (P = 0.001, both evaluations). In the evaluation of local tumor control, we observed increased bone density with restoration of cortical borders in 5 of the 18 patients (27.7%). In accordance with the MD Anderson criteria, complete and partial responses were obtained in 2 of the 18 patients (11.1%) and 4 of the 18 patients (22.2%), respectively. Nonperfused volume values ranged between 20% and 93%. Mean NPV values remained substantially stable after the treatment (P = 0.08). There was no difference in the NPV values between the responder and nonresponder patients (46.7% [24.2%] [25%-90%] versus 45% [24.9%] [20%-93%]; P = 0.7). Magnetic resonance-guided focused ultrasound can be safely and effectively used as the primary treatment of pain palliation in patients with bone metastases and has a potential

  12. Adaptive Localization of Focus Point Regions via Random Patch Probabilistic Density from Whole-Slide, Ki-67-Stained Brain Tumor Tissue

    PubMed Central

    Alomari, Yazan M.; MdZin, Reena Rahayu

    2015-01-01

    Analysis of whole-slide tissue for digital pathology images has been clinically approved to provide a second opinion to pathologists. Localization of focus points from Ki-67-stained histopathology whole-slide tissue microscopic images is considered the first step in the process of proliferation rate estimation. Pathologists use eye pooling or eagle-view techniques to localize the highly stained cell-concentrated regions from the whole slide under microscope, which is called focus-point regions. This procedure leads to a high variety of interpersonal observations and time consuming, tedious work and causes inaccurate findings. The localization of focus-point regions can be addressed as a clustering problem. This paper aims to automate the localization of focus-point regions from whole-slide images using the random patch probabilistic density method. Unlike other clustering methods, random patch probabilistic density method can adaptively localize focus-point regions without predetermining the number of clusters. The proposed method was compared with the k-means and fuzzy c-means clustering methods. Our proposed method achieves a good performance, when the results were evaluated by three expert pathologists. The proposed method achieves an average false-positive rate of 0.84% for the focus-point region localization error. Moreover, regarding RPPD used to localize tissue from whole-slide images, 228 whole-slide images have been tested; 97.3% localization accuracy was achieved. PMID:25793010

  13. Adaptive localization of focus point regions via random patch probabilistic density from whole-slide, Ki-67-stained brain tumor tissue.

    PubMed

    Alomari, Yazan M; Sheikh Abdullah, Siti Norul Huda; MdZin, Reena Rahayu; Omar, Khairuddin

    2015-01-01

    Analysis of whole-slide tissue for digital pathology images has been clinically approved to provide a second opinion to pathologists. Localization of focus points from Ki-67-stained histopathology whole-slide tissue microscopic images is considered the first step in the process of proliferation rate estimation. Pathologists use eye pooling or eagle-view techniques to localize the highly stained cell-concentrated regions from the whole slide under microscope, which is called focus-point regions. This procedure leads to a high variety of interpersonal observations and time consuming, tedious work and causes inaccurate findings. The localization of focus-point regions can be addressed as a clustering problem. This paper aims to automate the localization of focus-point regions from whole-slide images using the random patch probabilistic density method. Unlike other clustering methods, random patch probabilistic density method can adaptively localize focus-point regions without predetermining the number of clusters. The proposed method was compared with the k-means and fuzzy c-means clustering methods. Our proposed method achieves a good performance, when the results were evaluated by three expert pathologists. The proposed method achieves an average false-positive rate of 0.84% for the focus-point region localization error. Moreover, regarding RPPD used to localize tissue from whole-slide images, 228 whole-slide images have been tested; 97.3% localization accuracy was achieved.

  14. Focused acoustic beam imaging of grain structure and local Young's modulus with Rayleigh and surface skimming longitudinal waves

    SciTech Connect

    Martin, R. W.; Sathish, S.; Blodgett, M. P.

    2013-01-25

    The interaction of a focused acoustic beam with materials generates Rayleigh surface waves (RSW) and surface skimming longitudinal waves (SSLW). Acoustic microscopic investigations have used the RSW amplitude and the velocity measurements, extensively for grain structure analysis. Although, the presence of SSLW has been recognized, it is rarely used in acoustic imaging. This paper presents an approach to perform microstructure imaging and local elastic modulus measurements by combining both RSW and SSLW. The acoustic imaging of grain structure was performed by measuring the amplitude of RSW and SSLW signal. The microstructure images obtained on the same region of the samples with RSW and SSLW are compared and the difference in the contrast observed is discussed based on the propagation characteristics of the individual surface waves. The velocity measurements are determined by two point defocus method. The surface wave velocities of RSW and SSLW of the same regions of the sample are combined and presented as average Young's modulus image.

  15. Dynamic modulation of electronic properties of graphene by localized carbon doping using focused electron beam induced deposition.

    PubMed

    Kim, S; Russell, M; Henry, M; Kim, S S; Naik, R R; Voevodin, A A; Jang, S S; Tsukruk, V V; Fedorov, A G

    2015-09-28

    We report on the first demonstration of controllable carbon doping of graphene to engineer local electronic properties of a graphene conduction channel using focused electron beam induced deposition (FEBID). Electrical measurements indicate that an "n-p-n" junction on graphene conduction channel is formed by partial carbon deposition near the source and drain metal contacts by low energy (<50 eV) secondary electrons due to inelastic collisions of long range backscattered primary electrons generated from a low dose of high energy (25 keV) electron beam (1 × 10(18) e(-) per cm(2)). Detailed AFM imaging provides direct evidence of the new mechanism responsible for dynamic evolution of the locally varying graphene doping. The FEBID carbon atoms, which are physisorbed and weakly bound to graphene, diffuse towards the middle of graphene conduction channel due to their surface chemical potential gradient, resulting in negative shift of Dirac voltage. Increasing a primary electron dose to 1 × 10(19) e(-) per cm(2) results in a significant increase of carbon deposition, such that it covers the entire graphene conduction channel at high surface density, leading to n-doping of graphene channel. Collectively, these findings establish a unique capability of FEBID technique to dynamically modulate the doping state of graphene, thus enabling a new route to resist-free, "direct-write" functional patterning of graphene-based electronic devices with potential for on-demand re-configurability.

  16. Highly Localized Acoustic Streaming and Size-Selective Submicrometer Particle Concentration Using High Frequency Microscale Focused Acoustic Fields.

    PubMed

    Collins, David J; Ma, Zhichao; Ai, Ye

    2016-05-17

    Concentration and separation of particles and biological specimens are fundamental functions of micro/nanofluidic systems. Acoustic streaming is an effective and biocompatible way to create rapid microscale fluid motion and induce particle capture, though the >100 MHz frequencies required to directly generate acoustic body forces on the microscale have traditionally been difficult to generate and localize in a way that is amenable to efficient generation of streaming. Moreover, acoustic, hydrodynamic, and electrical forces as typically applied have difficulty manipulating specimens in the submicrometer regime. In this work, we introduce highly focused traveling surface acoustic waves (SAW) at high frequencies between 193 and 636 MHz for efficient and highly localized production of acoustic streaming vortices on microfluidic length scales. Concentration occurs via a novel mechanism, whereby the combined acoustic radiation and streaming field results in size-selective aggregation in fluid streamlines in the vicinity of a high-amplitude acoustic beam, as opposed to previous acoustic radiation induced particle concentration where objects typically migrate toward minimum pressure locations. Though the acoustic streaming is induced by a traveling wave, we are able to manipulate particles an order of magnitude smaller than possible using the traveling wave force alone. We experimentally and theoretically examine the range of particle sizes that can be captured in fluid streamlines using this technique, with rapid particle concentration demonstrated down to 300 nm diameters. We also demonstrate that locations of trapping and concentration are size-dependent, which is attributed to the combined effects of the acoustic streaming and acoustic forces.

  17. Investigation of artificial domains realized by local gallium focused ion-beam modification of Pt/Co/Pt trilayer structures

    NASA Astrophysics Data System (ADS)

    Aziz, A.; Bending, S. J.; Roberts, H.; Crampin, S.; Heard, P. J.; Marrows, C. H.

    2006-04-01

    We present the results of experimental investigations of magnetic switching and magnetotransport in a generation of magnetic devices containing artificially patterned domains. Our devices are realized by locally reducing the coercive field of a perpendicularly magnetized Pt(3.5 nm)/Co(0.5 nm)/Pt(1.6 nm) trilayer structure using a gallium focused ion beam. Artificial domain walls are created at the interfaces between dosed and undosed regions when an external magnetic field switches the former but not the latter. We have exploited this property to create stripelike domains with widths down to submicron length scales, separated by undosed regions. Using the extraordinary Hall effect to monitor the local magnetization we have investigated the reversal dynamics of these artificial domains by measuring major and minor hysteresis loops. The coercive field of regions irradiated with identical doses systematically increases as their size decreases. In the lower branch of minor loops, reversal is seen to occur via a few large Barkhausen events. Preliminary measurements of transport across domain walls reveal a positive domain-wall resistance, that does not change sign from 4.2 to 300 K.

  18. Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients.

    PubMed

    Rischmann, Pascal; Gelet, Albert; Riche, Benjamin; Villers, Arnauld; Pasticier, Gilles; Bondil, Pierre; Jung, Jean-Luc; Bugel, Hubert; Petit, Jacques; Toledano, Harry; Mallick, Stéphane; Rouvière, Olivier; Rabilloud, Muriel; Tonoli-Catez, Hélène; Crouzet, Sebastien

    2017-02-01

    Up to a third of patients with localized prostate cancer have unilateral disease that may be suitable for partial treatment with hemiablation. To evaluate the ability of high intensity focused ultrasound (HIFU) to achieve local control of the tumor in patients with unilateral localized prostate cancer. The French Urological Association initiated a prospective IDEAL multi-institutional study (2009-2015), to evaluate HIFU-hemiablation as a primary treatment. Multiparametric magnetic resonance imaging and biopsy were used for unilateral cancer diagnosis and control, and HIFU-hemiablation. Primary: absence of clinically significant cancer (CSC) on control biopsy at 1 yr (CSC: Gleason score ≥ 7 or cancer core length>3mm regardless of grade or > 2 positive cores). Secondary: presence of any cancer on biopsy, biochemical response, radical treatment free survival, adverse events, continence (no pad), erectile function (International Index of Erectile Function-5 ≥ 16), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C28) questionnaires. One hundred and eleven patients were treated (mean age: 64.8 yr [standard deviation 6.2]; mean prostate-specific antigen: 6.2 ng/ml [standard deviation 2.6]; 68% low risk, 32% intermediate risk). Of the 101 patients with control biopsy, 96 (95%) and 94 (93%) had no CSC in the treated and contralateral lobes, respectively. Mean prostate-specific antigen at 2 yr was 2.3 ng/ml (standard deviation 1.7). The radical treatment-free survival rate at 2 years was 89% (radical treatments: six radical prostatectomies, three radiotherapies, and two HIFU). Adverse events were Grade 3 in 13%. At 12 mo continence and erectile functions were preserved in 97% and 78%. No significant decrease in quality of life score was observed at 12 mo. One limitation is the number of low-risk patients included in this study. At 1 yr, HIFU-hemiablation was efficient with 95% absence of clinically significant cancer associated with

  19. Focal therapy for localized unifocal and multifocal prostate cancer: A prospective development study using real time MR guided focused ultrasound

    NASA Astrophysics Data System (ADS)

    Napoli, A.; Caliolo, G.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    To assess safety and feasibility of non-invasive high intensity 3T MR guided focused ultrasound (MRgFUS) treatment of localized prostate cancer in an exploratory designed study. Men aged 45-80 years were eligible for this prospective study if they had low-risk localized prostate cancer (prostate specific antigen [PSA] ≤10 ng/mL, Gleason score ≤ 3 + 3), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI (Discovery 750, GE; Gd-Bopta, Bracco) and have a spinal anesthetic. Patients underwent focal therapy using real time MR guided high intensity focused ultrasound (MRgFUS), delivered to all known cancer lesions, with a margin of normal tissue. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. 8 men were recruited between June 2011 and June 2012. After treatment, one man was admitted to hospital for acute urinary retention. Another patient had self-resolving, mild, intermittent dysuria (median duration 5.0 days). Urinary tract infection was not reported. Urinary debris occurred in 6 men (75%), with a median duration of 12 days. Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 6 to 12 months (p=0.060), as were median IIEF-15 scores for intercourse satisfaction (p=0.433), sexual desire (p=0.622), and overall satisfaction (p=0.256). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 6 to 12 months (p=0.026). All 8 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. No histological evidence of cancer was identified in 7 of 8 men biopsied at 6 months (87,5%); overall, the entire population (8 patients) was free of clinically significant cancer and had no evidence of disease on multi-parametric MRI at 6 to 12 months. MR guided Focused

  20. Source reconstruction based on subdural EEG recordings adds to the presurgical evaluation in refractory frontal lobe epilepsy.

    PubMed

    Ramantani, Georgia; Cosandier-Rimélé, Delphine; Schulze-Bonhage, Andreas; Maillard, Louis; Zentner, Josef; Dümpelmann, Matthias

    2013-03-01

    In presurgical investigations of refractory frontal lobe epilepsy, subdural EEG recordings offer extensive cortical coverage, but may overlook deep sources. Electrical Source Localization (ESL) from subdural recordings could overcome this sampling limitation. This study aims to assess the clinical relevance of this new method in refractory frontal lobe epilepsy associated with focal cortical dysplasia. In 14 consecutive patients, we retrospectively compared: (i) the ESL of interictal spikes to the conventional irritative and seizure onset zones; (ii) the surgical outcome of cases with congruent ESL and resection volume to cases with incongruent ESL and resection volume. Each spike type was averaged to serve as a template for ESL by the MUSIC and sLORETA algorithms. Results were superimposed on the corresponding pre and post-surgical MRI. Both ESL methods were congruent and consistent with conventional electroclinical analysis in all patients. In 7 cases, ESL identified a common deep source for spikes of different 2D localizations. The inclusion of ESL in the resection volume correlated with seizure freedom. ESL from subdural recordings provided clinically relevant results in patients with refractory frontal lobe epilepsy. ESL complements the conventional analysis of subdural recordings. Its potential in improving tailored resections and surgical outcomes should be prospectively assessed. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Using 3-dimensional printing to create presurgical models for endodontic surgery.

    PubMed

    Bahcall, James K

    2014-09-01

    Advances in endodontic surgery--from both a technological and procedural perspective-have been significant over the last 18 years. Although these technologies and procedural enhancements have significantly improved endodontic surgical treatment outcomes, there is still an ongoing challenge of overcoming the limitations of interpreting preoperative 2-dimensional (2-D) radiographic representation of a 3-dimensional (3-D) in vivo surgical field. Cone-beam Computed Tomography (CBCT) has helped to address this issue by providing a 3-D enhancement of the 2-D radiograph. The next logical step to further improve a presurgical case 3-D assessment is to create a surgical model from the CBCT scan. The purpose of this article is to introduce 3-D printing of CBCT scans for creating presurgical models for endodontic surgery.

  2. The use of cone-beam computed tomography and virtual reality simulation for pre-surgical practice in endodontic microsurgery.

    PubMed

    Suebnukarn, S; Rhienmora, P; Haddawy, P

    2012-07-01

    To design and evaluate the impact of virtual reality (VR) pre-surgical practice on the performance of actual endodontic microsurgery.   The VR system operates on a laptop with a 1.6-GHz Intel processor and 2 GB of main memory. Volumetric cone-beam computed tomography (CBCT) data were acquired from a fresh cadaveric porcine mandible prior to endodontic microsurgery. Ten inexperienced endodontic trainees were randomized as to whether they performed endodontic microsurgery with or without virtual pre-surgical practice. The VR simulator has microinstruments to perform surgical procedures under magnification. After the initial endodontic microsurgery, all participants served as their own controls by performing another procedure with or without virtual pre-surgical practice. All procedures were videotaped and assessed by two independent observers using an endodontic competency rating scale (from 6 to 30). A significant difference was observed between the scores for endodontic microsurgery on molar teeth completed with virtual pre-surgical practice and those completed without virtual presurgical practice, median 24.5 (range = 17-28) versus median 18.75 (range = 14-26.5), P = 0.041. A significant difference was observed between the scores for osteotomy on a molar tooth completed with virtual pre-surgical practice and those completed without virtual pre-surgical practice, median 4.5 (range = 3.5-4.5) versus median 3 (range = 2-4), P = 0.042. Pre-surgical practice in a virtual environment using the 3D computerized model generated from the original CBCT image data improved endodontic microsurgery performance. © 2012 International Endodontic Journal.

  3. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651.

    PubMed

    Goorin, Allen M; Schwartzentruber, Douglas J; Devidas, Meenakshi; Gebhardt, Mark C; Ayala, Alberto G; Harris, Michael B; Helman, Lee J; Grier, Holcombe E; Link, Michael P

    2003-04-15

    Successful therapeutic interventions to prevent disease progression in patients with nonmetastatic osteosarcoma have included surgery with adjuvant chemotherapy. Presurgical chemotherapy has been advocated for these patients because of putative improvement in event-free survival (EFS). The advantages of presurgical chemotherapy include early administration of systemic chemotherapy, shrinkage of primary tumor, and pathologic identification of risk groups. The theoretic disadvantage is that it exposes a large tumor burden to marginally effective chemotherapy. The contribution of chemotherapy and surgery timing has not been tested rigorously. Between 1986 and 1993, we conducted a prospective trial in patients with nonmetastatic osteosarcoma who were assigned randomly to immediate surgery or presurgical chemotherapy. Except for the timing of surgery (week 0 or 10), patients received 44 weeks of identical combination chemotherapy that included high-dose methotrexate with leucovorin rescue, doxorubicin, cisplatin, bleomycin, cyclophosphamide, and dactinomycin. One hundred six patients were enrolled onto this study. Six were excluded from analysis. Of the remaining 100 patients, 45 were randomly assigned to immediate chemotherapy, and 55 were randomly assigned to immediate surgery. Sixty-seven patients remain disease-free. At 5 years, the projected EFS +/- SE is 65% +/- 6% (69% +/- 8% for immediate surgery and 61% +/- 8% for presurgical chemotherapy; P =.8). The treatment arms had similar incidence of limb salvage (55% for immediate surgery and 50% for presurgical chemotherapy). Chemotherapy was effective in both treatment groups. There was no advantage in EFS for patients given presurgical chemotherapy.

  4. Presurgical biopsychosocial variables predict medical, compensation, and aggregate costs of lumbar discectomy in Utah workers' compensation patients.

    PubMed

    DeBerard, M Scott; Wheeler, Anthony J; Gundy, Jessica M; Stein, David M; Colledge, Alan L

    2011-05-01

    Elective lumbar discectomy among injured workers is a prevalent spine surgery that often requires a lengthy rehabilitation. It is important to determine presurgical biopsychosocial predictors of compensation and medical costs in such patients. To determine if presurgical biopsychosocial variables are predictive of compensation and medical costs in a cohort of Utah patients who have undergone open or microlumbar discectomy that are receiving workers' compensation. A retrospective cohort study consisting of a review of presurgical medical records and accrued medical and compensation costs. A consecutive sample of 266 compensated workers from Utah who had undergone either open discectomy or microlumbar discectomy from 1994 to 2000. All patients were at least 2 years postsurgery at the time of follow-up. Total accrued medical, compensation, and aggregate costs. A retrospective review of presurgical biopsychosocial variables and total accrued medical, compensation, and aggregate costs. Presurgical variables were statistically significantly correlated with medical and compensation costs. Multiple linear regression models accounted for 31% of variation in compensation costs, 32% in medical costs, and 43% in total aggregate costs. Presurgical biopsychosocial variables are important predictors of compensated lumbar discectomy costs. Medical cost control programs might benefit from identifying biopsychosocial variables related to increased costs. Published by Elsevier Inc.

  5. Presurgical symptom profiles predict quality of life 2 years after surgery in women with breast cancer.

    PubMed

    Chen, Mei-Ling; Liu, Li-Ni; Miaskowski, Christine; Chen, Shin-Cheh; Lin, Yung-Chang; Wang, Jong-Shyan

    2016-01-01

    Higher symptom burden in oncology patients is associated with poorer quality of life (QOL). However, the long-term predictive relationship between pre-treatment symptom profiles and QOL is unknown. The aim of this study was to identify subgroups of breast cancer patients based on their presurgical symptom profiles and to examine the predictive effect of group membership on QOL 2 years after surgery. Data were analyzed from a longitudinal study of women's (N = 198) symptoms after breast cancer surgery. Patient subgroups were identified by latent class analysis based on presurgical severity of five symptoms (i.e., attentional and physical fatigue, sleep disturbance, depression, and anxiety). Among these 198 women, quality of life 2 years after surgery was available for 97. Group differences in QOL were examined by general linear models. We identified four distinct patient groups. Group A (All Low) had low levels of all symptoms. Group B (Low Fatigue and Moderate Mood) was characterized by low attentional and physical fatigue but moderate sleep disturbance, depression, and anxiety. Group C (All Moderate) was characterized by moderate levels of all five symptoms. Group D was characterized by moderate attentional and physical fatigue and severe sleep disturbance, depression, and anxiety (Moderate Fatigue and High Mood). Group D had significantly lower overall QOL scores 2 years after surgery than Group A (p = 0.002). Breast cancer patients' presurgical symptom profile had a long-term predictive effect on QOL. Routine assessment of patients' pre-treatment symptom is suggested to identify high risk group.

  6. Pre-Surgical fMRI Data Analysis Using a Spatially Adaptive Conditionally Autoregressive Model.

    PubMed

    Liu, Zhuqing; Berrocal, Veronica J; Bartsch, Andreas J; Johnson, Timothy D

    2016-06-01

    Spatial smoothing is an essential step in the analysis of functional magnetic resonance imaging (fMRI) data. One standard smoothing method is to convolve the image data with a three-dimensional Gaussian kernel that applies a fixed amount of smoothing to the entire image. In pre-surgical brain image analysis where spatial accuracy is paramount, this method, however, is not reasonable as it can blur the boundaries between activated and deactivated regions of the brain. Moreover, while in a standard fMRI analysis strict false positive control is desired, for pre-surgical planning false negatives are of greater concern. To this end, we propose a novel spatially adaptive conditionally autoregressive model with variances in the full conditional of the means that are proportional to error variances, allowing the degree of smoothing to vary across the brain. Additionally, we present a new loss function that allows for the asymmetric treatment of false positives and false negatives. We compare our proposed model with two existing spatially adaptive conditionally autoregressive models. Simulation studies show that our model outperforms these other models; as a real model application, we apply the proposed model to the pre-surgical fMRI data of two patients to assess peri- and intra-tumoral brain activity.

  7. Effects of presurgical and post-surgical irradiation on the healing process of Medpor in dogs.

    PubMed

    Kim, S G; Kim, Y U; Park, J C; Oh, Y K

    2001-10-01

    The purpose of this study was to determine the effect of irradiation on the healing process and the effect on the contact surface of Medpor and bone. Eighteen dogs were studied. The animals were divided into three groups. Six non-irradiated dogs served as controls (Group 1). Twelve dogs irradiated on the left femur, before and after implantation of Medpor, were studied. The dogs were euthanized 4 and 8 weeks after Medpor was implanted in presurgical irradiation subgroup animals (Group 2) and after the completion of irradiation in post-surgical irradiation subgroup animals (Group 3). Light microscopic and scanning electron microscopic examinations were performed. The appearance of osteoblasts and bone matrix formation were remarkably late and manifest slight reactions in post-surgical irradiation group compared to the control group presenting the osteoblasts at 4 weeks, and those osteoblasts were not visible in presurgical irradiation group in both the 4-week and 8-week observation. We concluded that the bone remodeling was delayed in the irradiated bone, especially in the presurgical group.

  8. A novel technique for presurgical nasoalveolar molding using computer-aided reverse engineering and rapid prototyping.

    PubMed

    Yu, Quan; Gong, Xin; Wang, Guo-Min; Yu, Zhe-Yuan; Qian, Yu-Fen; Shen, Gang

    2011-01-01

    To establish a new method of presurgical nasoalveolar molding (NAM) using computer-aided reverse engineering and rapid prototyping technique in infants with unilateral cleft lip and palate (UCLP). Five infants (2 males and 3 females with mean age of 1.2 w) with complete UCLP were recruited. All patients were subjected to NAM before the cleft lip repair. The upper denture casts were recorded using a three-dimensional laser scanner within 2 weeks after birth in UCLP infants. A digital model was constructed and analyzed to simulate the NAM procedure with reverse engineering software. The digital geometrical data were exported to print the solid model with rapid prototyping system. The whole set of appliances was fabricated based on these solid models. Laser scanning and digital model construction simplified the NAM procedure and estimated the treatment objective. The appliances were fabricated based on the rapid prototyping technique, and for each patient, the complete set of appliances could be obtained at one time. By the end of presurgical NAM treatment, the cleft was narrowed, and the malformation of nasoalveolar segments was aligned normally. We have developed a novel technique of presurgical NAM based on a computer-aided design. The accurate digital denture model of UCLP infants could be obtained with laser scanning. The treatment design and appliance fabrication could be simplified with a computer-aided reverse engineering and rapid prototyping technique.

  9. Twelve years' experience with high-intensity focused ultrasound (HIFU) using sonablate™ devices for the treatment of localized prostate cancer

    NASA Astrophysics Data System (ADS)

    Uchida, Toyoaki; Nakano, Muyura; Shoji, Sunao; Nagata, Yoshihiro; Usui, Yukio; Terachi, Toshiro

    2012-10-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Patients with clinical Stage T1c-T3N0M0, biopsy proven, localized prostate cancer, with a serum prostate specific antigen (PSA) level of <30 ng/ml, any Gleason score were included. All patients underwent HIFU using the Sonablate™ (S) device and were required to have a minimal follow-up of 2 years after the last HIFU session to be included in this analysis. Four different generation HIFU devices, S200, S500, S500 version 4 and S500 TCM, have been used for this study. Biochemical failure was defined according to the Phoenix definition (PSA nadir+2ng/ml). Seven hundred and fifty-three men with prostate cancer were included. The patients were divided into two groups: in the Former group, 421 patients were treated with S200 and 500 from 1990 to 2005; in the Latter group, 332 patients were treated with S500 ver. 4 and TCM from 2005 to 2009. The mean age, PSA, Gleason score, operation time, and follow-up period in the Former and Latter groups were 68 and 67 years, 11.3 and 9.7 ng/ml, 6.2 and 6.6, 167 and 101 min, and 49 and 38 months, respectively. The biochemical disease-free rate (BDFR) in the groups at 5 years was, respectively, 67% and 53%, and was 50% at 10 years in the Former group (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Former group at 5 and 10 years were 68% and 65%, 52% and 48%, and 43% and 40%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Latter group at 5 years were 83%, 76%, and 42% (p<0.0001). The negative prostate biopsy rate in the Former and Latter groups was 81% and 93%, respectively. Postoperative erectile dysfunction was noted in 45%, 38%, and 24% of patients at 6 months, 12 months, and 2 years after HIFU. The results after long-term follow-up have indicated that HIFU is an efficient and safe treatment for patients with

  10. Correlation of sensorimotor activation with functional magnetic resonance imaging and magnetoencephalography in presurgical functional imaging: a spatial analysis.

    PubMed

    Kober, H; Nimsky, C; Möller, M; Hastreiter, P; Fahlbusch, R; Ganslandt, O

    2001-11-01

    In this study we investigated the spatial heterotopy of MEG and fMRI localizations after sensory and motor stimulation tasks. Both methods are frequently used to study the topology of the primary and secondary motor cortex, as well as a tool for presurgical brain mapping. fMRI was performed with a 1.5T MR system, using echo-planar imaging with a motor and a sensory task. Somatosensory and motor evoked fields were recorded with a biomagnetometer. fMRI activation was determined with a cross-correlation analysis. MEG source localization was performed with a single equivalent current dipole model and a current density localization approach. Distances between MEG and fMRI activation sites were measured within the same anatomical 3-D-MR image set. The central region could be identified by MEG and fMRI in 33 of 34 cases. However, MEG and fMRI localization results showed significantly different activation sites for the motor and sensory task with a distance of 10 and 15 mm, respectively. This reflects the different neurophysiological mechanisms: direct neuronal current flow (MEG) and secondary changes in cerebral blood flow and oxygenation level of activated versus non activated brain structures (fMRI). The result of our study has clinical implications when MEG and fMRI localizations are used for pre- and intraoperative brain mapping. Although both modalities are useful for the estimation of the motor cortex, a single modality may err in the exact topographical labeling of the motor cortex. In some unclear cases a combination of both methods should be used in order to avoid neurological deficits.

  11. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    PubMed

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium

  12. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI

    PubMed Central

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R. G.; Meier, Dominik S.; Ngo, Long H.; Hshieh, Tammy T.; Callahan, Amy E.; Fong, Tamara G.; Schmitt, Eva; Dickerson, Bradford C.; Press, Daniel Z.; Marcantonio, Edward R.; Jones, Richard N.; Inouye, Sharon K.

    2016-01-01

    Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium

  13. The use of PROMIS CAT Physical Function Pre-surgical Scores to Predict Recovery and Establish Pre-surgical Cut-off Values

    PubMed Central

    Papuga, Owen; Voloshin, Ilya; Nicandri, Gregg; Goldblatt, John P.; Bronstein, Robert D.; Rouse, Lucien M.; Maloney, Michael D.

    2017-01-01

    Objectives: There is a lack of standardized outcome measures or methods to study the effects of treatment and to effectively monitor and document patient outcomes. We have used Patient Reported Outcome Measurement Information System (PROMIS) computed adaptive testing questionnaires collected during routine office visits to describe the pre-surgical and postsurgical physical function scores and to assess the ability of pre-surgical scores to predict scores at 6 month after surgery. Methods: A retrospective analysis of 619 patients undergoing ACL reconstructive surgery at a large academic medical system was conducted to compare the predictive value of baseline PROMIS physical function scores to predict those scores after surgery. Patients with PROMIS physical Function scores within 1 standard deviation of the normal population at baseline were compare to those who fell below that score. Longitudinal comparisons of PROMIS scores between subsets was then made to identify any significant differences. PROMIS scores were assessed for discriminatory ability using receiver operating characteristic (ROC) curve analyses, with overall accuracy summarized using the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were used for each measurement at similar time points. Results: As shown in figure 1 average PROMIS physical function scores at later timepoints were comparable to those who had higher baseline scores. An ANOVA general linear (GROUP x TIME) model found statically significant (p<. 001) differences between the two groups at earlier time points. Further, ROC curve analysis demonstrated that PROMIS physical function scores have moderate to strong predictive ability (AUC>0.826). Using the ROC analysis an “optimal” cut-off pre-surgical score was determined to be a T-Score of 42.6. Conclusion: If fully utilized, these outcome measures can help inform physicians in individual surgical cases, as well as be used to show overall

  14. Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study.

    PubMed

    Zhou, Yang; Li, Zili; Wang, Xiaoxia; Zou, Bingshuang; Zhou, Yanheng

    2016-02-01

    In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion. Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery. Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups. Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  15. Location of residual cancer after transrectal high-intensity focused ultrasound ablation for clinically localized prostate cancer.

    PubMed

    Boutier, Romain; Girouin, Nicolas; Cheikh, Alexandre Ben; Belot, Aurélien; Rabilloud, Muriel; Gelet, Albert; Chapelon, Jean-Yves; Rouvière, Olivier

    2011-12-01

    What's known on the subject ? and What does the study add? Transrectal High-Intensity Focused Ultrasound (HIFU) ablation has been used as a minimally invasive treatment for localized prostate cancer for 15 years. Five-year disease-free survival rates of 66-78% have been reported, challenging the results of external-beam radiation therapy. Usually, a 6-mm safety margin is used in the apex to preserve the urinary sphincter and potency. The influence of this 6-mm margin on the results of the treatment has never been assessed. This retrospective study of a cohort of 99 patients who underwent systematic biopsy 3-6 months after HIFU ablation for prostate cancer (with a 6-mm safety margin in the apex) shows that post-HIFU residual cancer is found more frequently in the apex. Therefore, new strategies improving the prostate destruction at the apex while preserving the urinary continence need to be found. • To evaluate whether the location (apex/midgland/base) of prostate cancer influences the risk of incomplete transrectal high-intensity focused ultrasonography (HIFU) ablation. • We retrospectively studied 99 patients who underwent prostate cancer HIFU ablation (Ablatherm; EDAP, Vaulx-en-Velin, France) with a 6-mm safety margin at the apex, and had systematic biopsies 3-6 months after treatment. • Locations of positive pre- and post-HIFU sextants were compared. • The present study included two analyses. First, sextants negative before and positive after treatment were recoded as positive/positive, hypothesizing that cancer had been missed at pretreatment biopsy. Second, patients with such sextants were excluded. • Pre-HIFU biopsies found cancer in all patients and in 215/594 sextants (36.2%); 55 (25.6%) positive sextants were in the apex, 86 (40%) in the midgland and 74 (34.4%) in the base. • After treatment, residual cancer was found in 36 patients (36.4%) and 50 sextants (8.4%); 30 (60%) positive sextants were in the apex, 12 (24%) in the midgland

  16. Augmented corticotomy-assisted presurgical orthodontics of class III malocclusions: a cephalometric and cone-beam computed tomography study.

    PubMed

    Wang, Bo; Shen, Guofang; Fang, Bing; Yu, Hongbo; Wu, Yong

    2013-11-01

    The purpose of this study was to evaluate mandibular incisor decompensation and the surrounding periodontal status with augmented corticotomy-assisted presurgical orthodontics of class III patients. Fifty-six surgical class III patients were enrolled in this study, 26 of whom chose augmented corticotomy-assisted presurgical orthodontics (G1), and 30 chose conventional procedures (G2). Cone-beam computed tomography images and lateral cephalograms were obtained from each patient before and after presurgical orthodontics. Measurements of variables were compared using Student t tests and separate variance estimation t tests. The amount of mandibular incisor decompensation and the increase in labial alveolar bone thickness in G1 were greater than those in G2 during presurgical orthodontics (P < 0.001), however, root resorption (P < 0.001), the decrease in lingual alveolar bone thickness (P < 0.001), and vertical alveolar bone loss on both labial (P < 0.05) and lingual sides (P < 0.001) were less in G1 than in G2. Sufficient mandibular incisor decompensation and better periodontal preservation were achieved with augmented corticotomy-assisted presurgical orthodontics for class III patients compared with traditional procedures.

  17. Increased long-term remission after adequate medical cortisol suppression therapy as presurgical treatment in Cushing's disease.

    PubMed

    van den Bosch, O F C; Stades, A M E; Zelissen, P M J

    2014-02-01

    In the last decade, pre-operative medical cortisol suppression therapy has frequently been used in Cushing's disease to normalize cortisol concentrations pre-operatively. Our aim was to assess the efficacy of presurgical medical cortisol suppression therapy in Cushing's disease. We retrospectively assessed the medical files of all patients with Cushing's disease that received presurgical cortisol suppression therapy with ketoconazole or metyrapone and underwent subsequent transsphenoidal surgery between 1990 and 2010 at our centre. We retrieved the pretreatment regimen, adequacy of pretreatment, early postoperative serum cortisol levels, adverse effects and long-term remission status. Nineteen of 33 patients (58%) obtained long-term remission after pituitary surgery without additional postoperative therapy. Thirteen of 16 patients with adequate presurgical cortisol suppression therapy had postoperative cortisol concentrations <50 nmol/l. The 16 patients with adequate presurgical cortisol suppression had a higher long-term remission rate after primary surgery compared with the 13 patients with borderline or inadequate pretreatment (81% vs 38%; P < 0·05). Adequate presurgical cortisol suppression treatment with ketoconazole or metyrapone in Cushing's disease seems to be associated with suppressed postoperative cortisol concentrations and an increased long-term remission rate. © 2013 John Wiley & Sons Ltd.

  18. Relations between Perceptual and Conceptual Scope: How Global versus Local Processing Fits a Focus on Similarity versus Dissimilarity

    ERIC Educational Resources Information Center

    Forster, Jens

    2009-01-01

    Nine studies showed a bidirectional link (a) between a global processing style and generation of similarities and (b) between a local processing style and generation of dissimilarities. In Experiments 1-4, participants were primed with global versus local perception styles and then asked to work on an allegedly unrelated generation task. Across…

  19. Relations between Perceptual and Conceptual Scope: How Global versus Local Processing Fits a Focus on Similarity versus Dissimilarity

    ERIC Educational Resources Information Center

    Forster, Jens

    2009-01-01

    Nine studies showed a bidirectional link (a) between a global processing style and generation of similarities and (b) between a local processing style and generation of dissimilarities. In Experiments 1-4, participants were primed with global versus local perception styles and then asked to work on an allegedly unrelated generation task. Across…

  20. Pre-surgical cortical activation to food pictures is associated with weight loss following bariatric surgery.

    PubMed

    Ness, Abigail; Bruce, Jared; Bruce, Amanda; Aupperle, Robin; Lepping, Rebecca; Martin, Laura; Hancock, Laura; Patrician, Trisha; Malley, Steve; Selim, Niazy; Savage, Cary R

    2014-01-01

    Recent research suggests that preintervention functional magnetic resonance imaging (fMRI) data may predict weight loss outcomes among patients who participate in a behavioral weight loss plan. No study has examined whether presurgical brain activation can predict outcomes following bariatric surgery. The aim of the present study was to determine if brain activations during a presurgical fMRI food-motivation paradigm are associated with weight loss 3 and 6 months following laparoscopic adjustable gastric banding (LAGB). Nineteen participants viewed food and nonfood pictures from a well-established food motivation paradigm during an fMRI scanning session before LAGB surgery. Weight was assessed presurgery and 3 and 6 months postsurgery; data for all participants was available at each time point. fMRI data were analyzed using the BrainVoyager QX statistical package. Whole brain voxelwise correlations of presurgery (food-nonfood) brain activation and weight, corrected for multiple comparisons, were performed to analyze the relationship between presurgical brain activation and subsequent weight loss. The settings were a medical university brain imaging center and 2 surgical weight loss centers in a major metropolitan area. Increased activity in frontal regions associated with cognitive control (medial, middle, superior frontal gyrus) and posterior cingulate cortex was associated with weight loss following LAGB. We found that neural activity in previously established regions associated with cognitive and behavioral self-regulation predicts weight loss following bariatric surgery. These preliminary findings highlight the role of neural circuitry in the success and maintenance of weight loss and suggest a possible future use of fMRI in screening LAGB surgery candidates. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. Resting state BOLD fMRI for pre-surgical planning

    PubMed Central

    Kamran, Mudassar; Hacker, Carl D; Allen, Monica G; Mitchell, Timothy J; Leuthardt, Eric C; Snyder, Abraham Z; Shimony, Joshua S

    2014-01-01

    SYNOPSIS Resting state functional MRI (rsfMRI) measures spontaneous fluctuations in the BOLD signal and can be used to elucidate the brain’s functional organization. It can be used to simultaneously assess multiple distributed resting state networks. Unlike task fMRI, rsfMRI does not require task performance and thus can be performed in any subject that can obtain an MRI scan. In this article we present a brief introduction of rsfMRI processing methods followed by a detailed discussion on the use of rsfMRI in pre-surgical planning. Example cases are provided to highlight the strengths and limitations of the technique. PMID:25441506

  2. A New Classification System for Unilateral Cleft Lip and Palate Infants to assist Presurgical Infant Orthopedics.

    PubMed

    Daigavane, P S; Hazarey, P V; Niranjane, P; Vasudevan, S D; Thombare, B R; Daigavane, S

    2015-01-01

    The proposed advantages of pre-surgical naso-alveolar moulding (PNAM) are easy primary lip repair which heals under minimum tension reducing the scar formation and improving the aesthetic results in addition to reshaping of alar cartilage and improvement of nasal symmetry.However, the anatomy and alveolar morphology varies for each cleft child; the procedure for PNAM differs accordingly. In an attempt to categorize unilateral cleft lip and palate cases as per anatomical variations, a new classification system has been proposed. This classification aims to give an insight in unilateral cleft morphology based on which modification in PNAM procedure could be done.

  3. Presurgical management of unilateral cleft lip and palate in a neonate: a clinical report.

    PubMed

    Avhad, Rajendra; Sar, Ranjukta; Tembhurne, Jyoti

    2014-09-01

    A cleft lip and palate consists of fissures of the upper lip and/or palate, and is the most commonly seen orofacial anomaly that involves the middle third of the face. Early treatment of patients with a cleft lip and palate is important because of esthetic, functional, and psychological concerns. Nasoalveolar molding provides excellent results when started immediately after birth. This clinical report describes the presurgical management of an infant with a complete unilateral cleft of the soft palate, hard palate, alveolar ridge, and lip. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  4. Parental Satisfaction With Pediatric Preoperative Assessment and Education in a Presurgical Care Center.

    PubMed

    Delaney, Dolores; Bayley, Elizabeth W; Olszewsky, Patricia; Gallagher, Jean

    2015-08-01

    The aim of this study was to evaluate parental satisfaction with preoperative assessment and education in a pediatric presurgical care center (PSCC) as well as parental use of a computer instructional video, EMMI, which is a product of Emmi Solutions (Chicago, IL), a health information company for patients. A prospective, exploratory, comparative, and correlational descriptive design was implemented. A 23-item questionnaire was completed by 542 parents or legal guardians at the end of their child's PSCC visit. Very high overall satisfaction was seen with the visit. Highest overall satisfaction was seen related to nurse practitioner and registered nurse behaviors and lowest satisfaction to operational aspects. This study validates parents' perceptions of the high value of nurses' explanations, respect shown, and response to questions during preoperative assessment of the child and education of the family anticipating surgery. Identification of less satisfying aspects of the presurgical experience provides opportunities for improvement. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  5. [Pre-surgical worries: an empirical study in the child and adolescent population].

    PubMed

    Quiles Sebastián Mf; Méndez Carrillo, F; Ortigosa Quiles, J

    2001-08-01

    To analyze presurgical worries in children and adolescents and to examine differences according to gender and prior surgical experience. The child sample included 1,311 subjects, aged 7-10 years old, and the (pre)adolescent sample included 1,488 subjects, aged 11-14 years old. The child sample filled in the child version of the Surgical worries Questionnaire (CPCI-N; Quiles, Ortigosa and Méndez, 1998), with 17 items and a three-point rating scale, and the adolescent sample filled in the adolescent version (CPCI-A, Quiles, Méndez and Ortigosa, 1998), with 22 items and a five-point rating scale. Student's t-test was carried out to analyze the main worries and an analysis of variance was used to examine the effect of gender. Children's and adolescents' main worries concerned the surgical process, the negative results of surgery and the negative consequences of illness. However, the younger children showed other significant worries such as having a needle in the arm for a long time or separating from their parents. In both samples, girls and subjects without previous experience of surgery showed higher levels of pre-surgical worries. We discuss the implications of these results for the development of programs of psychological preparation for children and adolescents about to undergo surgery.

  6. Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

    PubMed Central

    Niranjane, P. Priyanka; Kamble, R. H.; Diagavane, S. Pallavi; Shrivastav, S. Sunita; Batra, Puneet; Vasudevan, S. D.; Patil, Pushkar

    2014-01-01

    Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results. PMID:25593413

  7. Health Technology Assessment report on the presurgical evaluation and surgical treatment of drug-resistant epilepsy.

    PubMed

    Marras, Carlo Efisio; Canevini, Maria Paola; Colicchio, Gabriella; Guerrini, Renzo; Rubboli, Guido; Scerrati, Massimo; Spreafico, Roberto; Tassi, Laura; LoRusso, Giorgio; Tinuper, Paolo

    2013-10-01

    Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option in patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug-resistant epilepsy to assess their suitability for surgical intervention. Health Technology Assessment (HTA) represents a modern approach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy surgery including clinical, ethical, social, and economic features. The present study includes an analysis of the diagnostic and surgical workup performed at the Italian centers for the diagnosis and treatment of drug-resistant epilepsy (DRE). The study includes the following issues: (1) social, ethical impact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom-up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow-up. The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short-term follow-up increases the overhead to €22,291 at the first year

  8. Focusing of the lowest-order antisymmetric Lamb mode behind a gradient-index acoustic metalens with local resonators

    NASA Astrophysics Data System (ADS)

    Zhao, Jinfeng; Bonello, Bernard; Boyko, Olga

    2016-05-01

    We have investigated the focusing of the lowest-order antisymmetric Lamb mode (A0) behind a positive gradient-index (GRIN) acoustic metalens consisting of air holes drilled in a silicon plate with silicon pillars erected on one face of the lens. We have analyzed the focusing in the near field as the result of the coupling between the flexural resonant mode of the pillars and the vibration mode of the air/silicon phononic crystal. We highlight the role played by the polarization coherence between the resonant mode and the vibration of the plate. We demonstrate both numerically and experimentally the focusing behind the lens over a spot less than half a wavelength, paving a way for performance of acoustic lenses beyond the diffraction limit. Our findings can be easily extended to other types of elastic wave.

  9. Decentralization in Educational Governance and Its Challenges in Korea: Focused on Policy Conflicts between Central and Local Government in Education

    ERIC Educational Resources Information Center

    Cha, Sung-Hyun

    2016-01-01

    Decentralization of educational governance is characterized by the recent education reform in Korea. With the election of progressive superintendents and local council members, educational policy conflicts have often occurred and deepened in the process of decision-making and implementation of policies such as School Violence Prevention, National…

  10. Disentangling Stability, Variability and Adaptability in Human Performance: Focus on the Interplay between Local Variance and Serial Correlation

    ERIC Educational Resources Information Center

    Torre, Kjerstin; Balasubramaniam, Ramesh

    2011-01-01

    We address the complex relationship between the stability, variability, and adaptability of psychological systems by decomposing the global variance of serial performance into two independent parts: the local variance (LV) and the serial correlation structure. For two time series with equal LV, the presence of persistent long-range correlations…

  11. Public Transit Equity Analysis at Metropolitan and Local Scales: A Focus on Nine Large Cities in the US

    PubMed Central

    Griffin, Greg Phillip; Sener, Ipek Nese

    2016-01-01

    Recent studies on transit service through an equity lens have captured broad trends from the literature and national-level data or analyzed disaggregate data at the local level. This study integrates these methods by employing a geostatistical analysis of new transit access and income data compilations from the Environmental Protection Agency. By using a national data set, this study demonstrates a method for income-based transit equity analysis and provides results spanning nine large auto-oriented cities in the US. Results demonstrate variability among cities’ transit services to low-income populations, with differing results when viewed at the regional and local levels. Regional-level analysis of transit service hides significant variation through spatial averaging, whereas the new data employed in this study demonstrates a block-group scale equity analysis that can be used on a national-scale data set. The methods used can be adapted for evaluation of transit and other modes’ transportation service in areas to evaluate equity at the regional level and at the neighborhood scale while controlling for spatial autocorrelation. Transit service equity planning can be enhanced by employing local Moran’s I to improve local analysis. PMID:28638236

  12. Public Transit Equity Analysis at Metropolitan and Local Scales: A Focus on Nine Large Cities in the US.

    PubMed

    Griffin, Greg Phillip; Sener, Ipek Nese

    2016-01-01

    Recent studies on transit service through an equity lens have captured broad trends from the literature and national-level data or analyzed disaggregate data at the local level. This study integrates these methods by employing a geostatistical analysis of new transit access and income data compilations from the Environmental Protection Agency. By using a national data set, this study demonstrates a method for income-based transit equity analysis and provides results spanning nine large auto-oriented cities in the US. Results demonstrate variability among cities' transit services to low-income populations, with differing results when viewed at the regional and local levels. Regional-level analysis of transit service hides significant variation through spatial averaging, whereas the new data employed in this study demonstrates a block-group scale equity analysis that can be used on a national-scale data set. The methods used can be adapted for evaluation of transit and other modes' transportation service in areas to evaluate equity at the regional level and at the neighborhood scale while controlling for spatial autocorrelation. Transit service equity planning can be enhanced by employing local Moran's I to improve local analysis.

  13. Decentralization in Educational Governance and Its Challenges in Korea: Focused on Policy Conflicts between Central and Local Government in Education

    ERIC Educational Resources Information Center

    Cha, Sung-Hyun

    2016-01-01

    Decentralization of educational governance is characterized by the recent education reform in Korea. With the election of progressive superintendents and local council members, educational policy conflicts have often occurred and deepened in the process of decision-making and implementation of policies such as School Violence Prevention, National…

  14. PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy.

    PubMed

    Fernández, S; Donaire, A; Serès, E; Setoain, X; Bargalló, N; Falcón, C; Sanmartí, F; Maestro, I; Rumià, J; Pintor, L; Boget, T; Aparicio, J; Carreño, M

    2015-03-01

    We aimed to investigate the usefulness of coregistration of positron emission tomography (PET) and magnetic resonance imaging (MRI) findings (PET/MRI) and of coregistration of PET/MRI with subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) (PET/MRI/SISCOM) in localizing the potential epileptogenic zone in patients with drug-resistant epilepsy. We prospectively included 35 consecutive patients with refractory focal epilepsy whose presurgical evaluation included a PET study. Separately acquired PET and structural MRI images were coregistered for each patient. When possible, ictal SPECT and SISCOM were obtained and coregistered with PET/MRI. The potential location of the epileptogenic zone determined by neuroimaging was compared with the seizure onset zone determined by long-term video-EEG monitoring and with invasive EEG studies in patients who were implanted. Structural MRI showed no lesions in 15 patients. In these patients, PET/MRI coregistration showed a hypometabolic area in 12 (80%) patients that was concordant with seizure onset zone on EEG in 9. In 7 patients without MRI lesions, PET/MRI detected a hypometabolism that was undetected on PET alone. SISCOM, obtained in 25 patients, showed an area of hyperperfusion concordant with the seizure onset zone on EEG in 7 (58%) of the 12 of these patients who had normal MRI findings. SISCOM hyperperfusion was less extensive than PET hypometabolism. A total of 19 patients underwent surgery; 11 of these underwent invasive-EEG monitoring and the seizure onset zone was concordant with PET/MRI in all cases. PET/MRI/SISCOM coregistration, performed in 4 of these patients, was concordant in 3 (75%). After epilepsy surgery, 13 (68%) patients are seizure-free after a mean follow-up of 4.5 years. PET/MRI and PET/MRI/SISCOM coregistration are useful for determining the potential epileptogenic zone and thus for planning invasive EEG studies and surgery more precisely, especially in

  15. An Examination of the Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

    ERIC Educational Resources Information Center

    Montez-Ray, Natasha Dawn

    2011-01-01

    As patients prepare for total-knee arthroplasty surgery, they have numerous expectations related to their long-term recovery and function. This research discerned whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective…

  16. The Contribution of Functional Near-Infrared Spectroscopy (fNIRS) to the Presurgical Assessment of Language Function in Children

    ERIC Educational Resources Information Center

    Gallagher, Anne; Beland, Renee; Lassonde, Maryse

    2012-01-01

    Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic,…

  17. An Intelligibility Assessment of Toddlers with Cleft Lip and Palate Who Received and Did Not Receive Presurgical Infant Orthopedic Treatment.

    ERIC Educational Resources Information Center

    Konst, Emmy M.; Weersink-Braks, Hanny; Rietveld, Toni; Peters, Herman

    2000-01-01

    The influence of presurgical infant orthopedic treatment (PIO) on speech intelligibility was evaluated with 10 toddlers who used PIO during the first year of life and 10 who did not. Treated children were rated as exhibiting greater intelligibility, however, transcription data indicated there were not group differences in actual intelligibility.…

  18. An Intelligibility Assessment of Toddlers with Cleft Lip and Palate Who Received and Did Not Receive Presurgical Infant Orthopedic Treatment.

    ERIC Educational Resources Information Center

    Konst, Emmy M.; Weersink-Braks, Hanny; Rietveld, Toni; Peters, Herman

    2000-01-01

    The influence of presurgical infant orthopedic treatment (PIO) on speech intelligibility was evaluated with 10 toddlers who used PIO during the first year of life and 10 who did not. Treated children were rated as exhibiting greater intelligibility, however, transcription data indicated there were not group differences in actual intelligibility.…

  19. The Contribution of Functional Near-Infrared Spectroscopy (fNIRS) to the Presurgical Assessment of Language Function in Children

    ERIC Educational Resources Information Center

    Gallagher, Anne; Beland, Renee; Lassonde, Maryse

    2012-01-01

    Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic,…

  20. An Examination of the Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

    ERIC Educational Resources Information Center

    Montez-Ray, Natasha Dawn

    2011-01-01

    As patients prepare for total-knee arthroplasty surgery, they have numerous expectations related to their long-term recovery and function. This research discerned whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective…

  1. Magnetic resonance guided focused ultrasound surgery (MRgFUS) of bone metastases: From primary pain palliation to local tumor control

    NASA Astrophysics Data System (ADS)

    Napoli, A.; Leonardi, A.; Andrani, F.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    Purpose: To evaluate the clinical performance of MRgFUS in primary pain palliation of painful bone metastases and in local tumor control. Materials and Methods: We enrolled 26 consecutive patients (female/male 12/14; age: 64.7±7.5yrs) with painful bone metastases. Before and 3 months after MRgFUS treatment pain severity and pain interference scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria and patients underwent both CT and MRI. Local tumor control was evaluated according to lesion size, density and perfusion at CT, dynamic contrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and metabolic activity at PET or scintigraphy. Patients were classified as responders or non-responders. Results: No treatment-related adverse events were recorded during the study. As statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (p<0.05). Increased bone density was observed in 9/26 (34.6%) patients. Non-Perfused Volume values ranged between 20% and 92%. There was no difference in NPV values between responders and non-responders (46.7±24.2% [25 - 90 %] vs. 45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary cancer) there was nearly absence of metabolic activity after treatment (mean SUV=1.2). Conclusion: MRgFUS can be safely and effectively used as the primary treatment for pain palliation in patients with painful bone metastases; moreover our experience demonstrated also a potential role for the MRgFUS in local tumor control.

  2. Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: focus on 5% lidocaine-medicated plaster

    PubMed Central

    Casale, Roberto; Mattia, Consalvo

    2014-01-01

    Within the broad definition of neuropathic pain, the refinement of clinical diagnostic procedures has led to the introduction of the concept of localized neuropathic pain (LNP). It is characterized by consistent and circumscribed area(s) of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features (currently lacking in guidelines and treatment recommendations) in patients for whom topical targeted treatment with 5% lidocaine-medicated plaster is suggested as first-line therapy. Few epidemiologic data are present in the literature but it is generally estimated that about 60% of neuropathic pain conditions are localized, and therefore identifiable as LNP. A mandatory clinical criterion for the diagnosis of LNP is that signs and symptoms must be present in a clearly identified and defined area(s). Cartographic recordings can help to define each area and to assess variations. The diagnosis of LNP relies on careful neurological examination more than on pain questionnaires, but it is recognized that they can be extremely useful for recording the symptom profiles and establishing a more targeted treatment. The most widely studied frequent/relevant clinical presentations of LNP are postherpetic neuralgia, diabetic neuropathy, and neuropathic postoperative pain. They successfully respond to treatment with 5% lidocaine-medicated plaster with equal if not better pain control but with fewer side effects versus conventional systemic treatments. Generally, the more localized the pain (ie, the area of an A4 sheet of paper) the better the results of topical treatment. This paper proposes an easy-to-understand algorithm to identify patients with LNP and to guide targeted topical treatments with 5% lidocaine medicated plaster. PMID:24790451

  3. The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity.

    PubMed

    Choi, Jong Woo; Lee, Jang Yeol; Yang, Sung Joon; Koh, Kyung Suk

    2015-03-01

    Orthognathic surgery with presurgical and postsurgical orthodontic treatment is the most widely accepted method for the correction of skeletal or dentoalveolar malocclusion. However, recent advancements in presurgical orthodontic simulations and postsurgical orthodontic treatments using miniscrews have shown remarkable stability and control of the occlusion after orthognathic surgery. Thus, we have adopted a surgery-first orthognathic approach without presurgical orthodontic treatment, based on a novel presurgical simulation process using a dental model. We hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. This prospective study investigated intervention outcomes in 24 standard and 32 surgery-first approaches for patients with skeletal class III dentofacial deformity. The patients underwent orthognathic surgery between December 2007 and July 2010. In the surgery-first approach, a dental model was created and a novel preoperative orthodontic simulation of the standard presurgical orthodontic treatment was performed to determine the final occlusion between the maxilla and mandible. Changes in cephalometric landmarks were compared between the standard and surgery-first groups in the preoperative, immediate postoperative, and postoperative periods. The Student t test, Kruskal-Wallis test, and a linear mixed model were used for statistical analysis. The follow-up period ranged from 12 to 36 months (average, 20.5 months). The average age of the patients was 22.4 years, with 16 male and 40 female patients. We found that a surgery-first approach without presurgical orthodontic treatment is possible and can give similar results to standard orthognathic surgery. The statistical analysis showed that changes in skeletal cephalometric landmarks were similar between the surgery-first and standard approach groups, according to each period. However, the cephalometric landmarks relating to the dental component showed

  4. Local resistance patterns to antimicrobials in internal medicine: a focused report from the REGIMEN (REGistro Infezioni in MEdicina INterna) study.

    PubMed

    Cei, Marco; Pardelli, Riccardo; Sani, Spartaco; Mumoli, Nicola

    2014-02-01

    The treatment for infections in hospitalized patients can be summarized in the timely start of empirical therapy, followed by adjustment on the basis of isolates and microbial susceptibilities. Initial therapy may be based on international guidelines. However, to know local frequencies of bacterial and fungal strains together with patterns of drug resistance should be a better approach to therapy. REGIMEN is a retrospective observational study of all consecutive recorded bacterial and fungal isolates, collected between October 2009 and August 2011 from patients admitted in a 53-bedded ward of internal medicine of a non-teaching Italian hospital. We investigated type of samples and of microorganisms, patterns of susceptibility and resistance to antibiotics, and in-hospital mortality. A total of 504 samples were examined (244 from urine, 189 from blood and 71 from skin and various exudates). Participants were old (mean age, 83 years), and so overall mortality was high (20 %). There were high frequencies of drug resistance; only 27.9 % of urinary gram-negatives and 52.6 % of blood gram-negatives were susceptible to levofloxacin. Susceptibility profiles compatible with the presence of extended-spectrum beta-lactamases were present in 64.2 % of gram-negative strains, and 10.1 % were also resistant to carbapenems. ESKAPE organisms account for a third of all bacterial infections. Local patterns of drug resistance should influence empirical antibiotic therapy for patients admitted in internal medicine wards, where mortality is high.

  5. Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with (18)F-Fluorocholine PET/CT.

    PubMed

    Hocevar, M; Lezaic, L; Rep, S; Zaletel, K; Kocjan, T; Sever, M J; Zgajnar, J; Peric, B

    2017-01-01

    A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ultrasound are most often used localization modalities with reported sensitivity of 54-100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with (18)F-Fluorocholine PET/CT (FCh-PET) in patients with PHP. A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma and a classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. Intraoperative failure experienced 2/22 patients (9,1%). In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used and one experienced intraoperative failure. A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing.

  6. Pre-seizure architecture of the local connections of the epileptic focus examined via graph-theory.

    PubMed

    Vecchio, Fabrizio; Miraglia, Francesca; Vollono, Catello; Fuggetta, Filomena; Bramanti, Placido; Cioni, Beatrice; Rossini, Paolo Maria

    2016-10-01

    Epilepsy is characterized by unpredictable and sudden paroxysmal neuronal firing occurrences and sometimes evolving in clinically evident seizure. To predict seizure event, small-world characteristic in nine minutes before seizure, divided in three 3-min periods (T0, T1, T2) were investigated. Intracerebral recordings were obtained from 10 patients with drug resistant focal epilepsy examined by means of stereotactically implanted electrodes; analysis was focused in a period of low spiking (Baseline) and during two seizures. Networks' architecture is undirected and weighted. Electrodes' contacts close to epileptic focus are the vertices, edges are weighted by mscohere (=magnitude squared coherence). Differences were observed between Baseline and T1 and between Baseline and T2 in theta band; and between Baseline and T1, Baseline and T2, and near-significant difference between T0 and T2 in Alpha 2 band. Moreover, an intra-band index was computed for small worldness as difference between Theta and Alpha 2. It was found a growing index trend from Baseline to T2. Cortical network features a specific pre-seizure architecture which could predict the incoming epileptic seizure. Through this study future researches could investigate brain connectivity modifications approximating a clinical seizure also in order to address a preventive therapy. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Clinical Application of Spatiotemporal Distributed Source Analysis in Presurgical Evaluation of Epilepsy

    PubMed Central

    Tanaka, Naoaki; Stufflebeam, Steven M.

    2014-01-01

    Magnetoencephalography (MEG), which acquires neuromagnetic fields in the brain, is a useful diagnostic tool in presurgical evaluation of epilepsy. Previous studies have shown that MEG affects the planning intracranial electroencephalography placement and correlates with surgical outcomes by using a single dipole model. Spatiotemporal source analysis using distributed source models is an advanced method for analyzing MEG, and has been recently introduced for analyzing epileptic spikes. It has advantages over the conventional single dipole analysis for obtaining accurate sources and understanding the propagation of epileptic spikes. In this article, we review the source analysis methods, describe the techniques of the distributed source analysis, interpretation of source distribution maps, and discuss the benefits and feasibility of this method in evaluation of epilepsy. PMID:24574999

  8. Clinical application of spatiotemporal distributed source analysis in presurgical evaluation of epilepsy.

    PubMed

    Tanaka, Naoaki; Stufflebeam, Steven M

    2014-01-01

    Magnetoencephalography (MEG), which acquires neuromagnetic fields in the brain, is a useful diagnostic tool in presurgical evaluation of epilepsy. Previous studies have shown that MEG affects the planning intracranial electroencephalography placement and correlates with surgical outcomes by using a single dipole model. Spatiotemporal source analysis using distributed source models is an advanced method for analyzing MEG, and has been recently introduced for analyzing epileptic spikes. It has advantages over the conventional single dipole analysis for obtaining accurate sources and understanding the propagation of epileptic spikes. In this article, we review the source analysis methods, describe the techniques of the distributed source analysis, interpretation of source distribution maps, and discuss the benefits and feasibility of this method in evaluation of epilepsy.

  9. Tailored disconnection based on presurgical evidence in catastrophic epilepsy: report of 2 cases.

    PubMed

    Park, Jun T; Manjila, Sunil V; Tangen, Rachel B; Cohen, Mark L; Shahid, Asim M; Sweet, Jennifer A; Tuxhorn, Ingrid E; Miller, Jonathan P

    2016-06-01

    Catastrophic epilepsy in infants, often due to extensive cortical dysplasia, has devastating consequences with respect to brain development. Conventional lobar, multilobar, or hemispheric resection in these infants is challenging, carrying an increased operative risk compared with that in older children. Removing a larger tissue volume versus removing or disconnecting the epileptogenic region does not always guarantee better seizure outcome. The authors describe 2 infants with catastrophic epilepsy who benefited from individually tailored disconnections based on a hypothesized epileptogenic zone following intensive presurgical evaluation. Two infants with catastrophic epilepsy and epileptic spasms underwent leukotomies between 3 and 12 months of age. They were followed up postoperatively for 19-36 months. Both patients had 90%-100% seizure reduction and a significantly improved neurodevelopmental outcome without postoperative complication. Cortical malformation was seen in both patients. Modifications of established surgical disconnection techniques, tailored to each patient's specific epileptogenic zone, optimized seizure and neurodevelopmental outcomes while minimizing the risks associated with more extensive resections.

  10. Pre-surgical Pulmonary Rehabilitation in Asthma Patients Undergoing Bariatric Surgery.

    PubMed

    Türk, Yasemin; van Huisstede, Astrid; Hiemstra, Pieter S; Taube, Christian; Braunstahl, Gert-Jan

    2017-08-22

    This pilot study was performed to investigate the feasibility of pre-surgical pulmonary rehabilitation (PR) in morbidly obese patients with uncontrolled asthma, undergoing bariatric surgery. Four morbidly obese female patients with asthma participated in a 12-week PR program (exercise, diet, and psychological intervention) before undergoing bariatric surgery, and the outcomes were compared to a matched group of seven female controls (bariatric surgery only). In patients who participated in PR, asthma control and asthma quality of life improved dramatically after 3 months of PR. Besides, asthma control was better at the moment of surgery. The results of this pilot study show that PR is feasible in morbidly obese asthmatics and should be considered for a selected group of patients with uncontrolled asthma before undergoing bariatric surgery.

  11. Functional MRI in clinical practice: Assessment of language and motor for pre-surgical planning

    PubMed Central

    Azar, Ramyar; Shoar, Majid Haghighat; Hooshmand, Sina; Mahdavi, Arash; Kharrazi, Homayoon Hadizadeh

    2015-01-01

    Functional magnetic resonance imaging (fMRI) has been widely used for pre-neurosurgical planning and may eventually become a routine pre-surgical imaging modality. The validity of fMRI for clinical application depends on various factors such as proper task selection, correct statistical analysis and threshold setting with appropriate patient cooperation. This study was performed on 40 patients with different types of brain mass lesions or hippocampal sclerosis to assess the role of appropriate patient selection for achieving a reliable fMRI result. Accurate and reproducible fMRI strongly depends on the patient’s cooperation. In this study we observed that a pre-test mock fMRI session held by a radiologist may help to predict which patients are more or less suitable candidates for fMRI. PMID:26443298

  12. Presurgical treatment with sunitinib for renal cell carcinoma with a level III/IV vena cava tumour thrombus.

    PubMed

    Horn, Thomas; Thalgott, Mark K; Maurer, Tobias; Hauner, Katharina; Schulz, Stephan; Fingerle, Alexander; Retz, Margitta; Gschwend, Jürgen E; Kübler, Hubert R

    2012-05-01

    The feasibility and safety of a presurgical treatment approach with sunitinib for renal cell carcinoma (RCC) with level III/IV tumour thrombus in the inferior vena cava (IVC) were to be evaluated and its potential ability to reduce the surgical morbidity explored. In our institution, we treated five consecutive patients with suspected RCC and a level III/IV IVC tumour thrombus with preoperative sunitinib (50 mg, 4 weeks on, 2 weeks off). Side dose effects were assessed and the effect on the tumour size and the dependent surgical approach documented with a computed tomographic scan before and after the treatment. The data were analyzed retrospectively. The overall tolerability to presurgical sunitinib was good. All procedures were carried out without perioperative complications. In four patients, a reduction in tumour size was observed, which resulted in avoidance of a bicavital surgical approach with cardiopulmonary bypass in one patient. This patient was diagnosed with papillary renal cancer; the other four patients had clear cell carcinomas. Presurgical treatment with sunitinib is able to ease surgery for RCC tumour thrombi regardless of the histological subtype in selected patients. In our series, surgery was possible without additional morbidity. Two courses of a presurgical therapy with sunitinib seems to be an appropriate duration. In accordance with previously published data, presurgical sunitinib treatment may become more widely used in RCC with level III/IV IVC tumour thrombi but administered with restraint in cases of level I/II thrombi. The effects on the risk of recurrence and survival remain to be evaluated prospectively.

  13. Measuring the biological effect of presurgical metformin treatment in endometrial cancer

    PubMed Central

    Sivalingam, V N; Kitson, S; McVey, R; Roberts, C; Pemberton, P; Gilmour, K; Ali, S; Renehan, A G; Kitchener, H C; Crosbie, E J

    2016-01-01

    Background: Preclinical studies in endometrial cancer (EC) show that metformin reduces cellular proliferation by PI3K-AKT-mTOR inhibition. We tested the hypothesis that short-term presurgical metformin reduces cellular proliferation in atypical endometrial hyperplasia (AEH) and endometrioid EC, and assessed the feasibility of using phosphorylated PI3K-AKT-mTOR proteins as tissue end points. Methods: Women with AEH or EC received metformin 850 mg twice a day or no drug in the presurgical window between diagnosis and hysterectomy. Before and after the window, tissue samples were obtained; serum markers of insulin resistance (e.g. homeostasis model of assessment of insulin resistance index) were determined; and anthropometrics measured (e.g. BMI). Cell proliferation (Ki-67) and PI3K-AKT-mTOR phosphostatus were assessed by immunohistochemistry and scored blinded to treatment. Results: Twenty-eight metformin-treated and 12 untreated patients, well matched for age and BMI, completed the study. Metformin treatment (median 20 days, range 7–34) was associated with a 17.2% reduction in tumour Ki-67 (95% CI −27.4, −7.0, P=0.002), in a dose-dependent manner. Tumour PI3K-AKT-mTOR protein phosphostatus varied but the effects were not significant after adjusting for changes in controls. Conclusions: Short-term metformin was associated with reduced Ki-67 expression in EC. Changes in tumour PI3K-AKT-mTOR protein phosphostatus were seen in both groups. Future studies should address the variability attributed to different sampling techniques including devascularisation of the uterus at hysterectomy. PMID:26794276

  14. Effect of Presurgical Iodine-Based Disinfection on Bacterial Colonization of the Equine Peripodal Region.

    PubMed

    Johnson, Jessica; Messier, Serge; Meulyzer, Michael; Vinardell, Tatiana; Marcoux, Marcel; David, Florent

    2015-08-01

    To compare bacterial colonization after diluted iodine tincture or povidone iodine solution for presurgical disinfection of the equine peripodal region. Complete block design. Five horses. Disinfection protocols using iodine tincture or povidone iodine solutions were tested on 5 pairs (n = 10) equine front feet. Iodine tincture was applied to the left feet and povidone iodine to the right feet. Fixed surfaces of the sole, frog, hoof wall, and peripodal skin were swabbed pre-preparation (T0), after a standard pre-disinfection step (T1), after short disinfection with a 4-minute application of 0.5% iodine tincture or povidone iodine (T2), and after long disinfection with 12-hour soaking in 0.25% iodine tincture or povidone iodine (T3). Quantitative bacteriology was performed on each swab. The frog and sole were the most contaminated sites compared to hoof wall and skin at T0. Bacterial counts were significantly decreased at T2 for both solutions. Bacterial counts did not change significantly with iodine tincture at T3 but increased with povidone iodine compared to T2. Skin abrasions were detected on almost all feet but were subjectively more severe on iodine tincture-treated feet. Soaking for 12 hours with either iodine tincture or povidone iodine is not recommended as these solutions damaged the skin and bacterial recolonization was noted with povidone iodine. Four-minute disinfection using either iodine tincture or povidone iodine (0.5% available iodine) is appropriate for presurgical preparation of the equine peripodal region. © Copyright 2015 by The American College of Veterinary Surgeons.

  15. Artificial domain structures realized by local gallium focused Ion-beam modification of Pt /Co/Pt trilayer transport structure

    NASA Astrophysics Data System (ADS)

    Aziz, A.; Bending, S. J.; Roberts, H.; Crampin, S.; Heard, P. J.; Marrows, C. H.

    2005-12-01

    We demonstrate that a high-resolution Ga focused ion beam can be used to introduce artificial domain structures in Pt(1.6nm )/Co(0.5nm)/Pt(3.5nm) trilayer transport structures. We have used thin SiO2 overlayers to control the effective energy and dose of Ga ions at the Pt /Co interface. The extraordinary Hall effect (EHE) was used to characterize the magnetic properties of the patterned films. Using 30keV Ga ions and SiO2 overlayer thicknesses in the range of 0-24nm, we achieve complete control of the coercive field of our Pt /Co/Pt trilayer structures. The magnetization reversal mechanism for an artificial domain of size of 3×0.5μm2 is investigated using EHE.

  16. Studying Coxiella burnetii Type IV Substrates in the Yeast Saccharomyces cerevisiae: Focus on Subcellular Localization and Protein Aggregation

    PubMed Central

    Rodríguez-Escudero, María; Cid, Víctor J.; Molina, María; Schulze-Luehrmann, Jan; Lührmann, Anja; Rodríguez-Escudero, Isabel

    2016-01-01

    Coxiella burnetii is a Gram-negative obligate parasitic bacterium that causes the disease Q-fever in humans. To establish its intracellular niche, it utilizes the Icm/Dot type IVB secretion system (T4BSS) to inject protein effectors into the host cell cytoplasm. The host targets of most cognate and candidate T4BSS-translocated effectors remain obscure. We used the yeast Saccharomyces cerevisiae as a model to express and study six C. burnetii effectors, namely AnkA, AnkB, AnkF, CBU0077, CaeA and CaeB, in search for clues about their role in C. burnetii virulence. When ectopically expressed in HeLa cells, these effectors displayed distinct subcellular localizations. Accordingly, GFP fusions of these proteins produced in yeast also decorated distinct compartments, and most of them altered cell growth. CaeA was ubiquitinated both in yeast and mammalian cells and, in S. cerevisiae, accumulated at juxtanuclear quality-control compartments (JUNQs) and insoluble protein deposits (IPODs), characteristic of aggregative or misfolded proteins. AnkA, which was not ubiquitinated, accumulated exclusively at the IPOD. CaeA, but not AnkA or the other effectors, caused oxidative damage in yeast. We discuss that CaeA and AnkA behavior in yeast may rather reflect misfolding than recognition of conserved targets in the heterologous system. In contrast, CBU0077 accumulated at vacuolar membranes and abnormal ER extensions, suggesting that it interferes with vesicular traffic, whereas AnkB associated with the yeast nucleolus. Both effectors shared common localization features in HeLa and yeast cells. Our results support the idea that C. burnetii T4BSS effectors manipulate multiple host cell targets, which can be conserved in higher and lower eukaryotic cells. However, the behavior of CaeA and AnkA prompt us to conclude that heterologous protein aggregation and proteostatic stress can be a limitation to be considered when using the yeast model to assess the function of bacterial effectors

  17. Studying Coxiella burnetii Type IV Substrates in the Yeast Saccharomyces cerevisiae: Focus on Subcellular Localization and Protein Aggregation.

    PubMed

    Rodríguez-Escudero, María; Cid, Víctor J; Molina, María; Schulze-Luehrmann, Jan; Lührmann, Anja; Rodríguez-Escudero, Isabel

    2016-01-01

    Coxiella burnetii is a Gram-negative obligate parasitic bacterium that causes the disease Q-fever in humans. To establish its intracellular niche, it utilizes the Icm/Dot type IVB secretion system (T4BSS) to inject protein effectors into the host cell cytoplasm. The host targets of most cognate and candidate T4BSS-translocated effectors remain obscure. We used the yeast Saccharomyces cerevisiae as a model to express and study six C. burnetii effectors, namely AnkA, AnkB, AnkF, CBU0077, CaeA and CaeB, in search for clues about their role in C. burnetii virulence. When ectopically expressed in HeLa cells, these effectors displayed distinct subcellular localizations. Accordingly, GFP fusions of these proteins produced in yeast also decorated distinct compartments, and most of them altered cell growth. CaeA was ubiquitinated both in yeast and mammalian cells and, in S. cerevisiae, accumulated at juxtanuclear quality-control compartments (JUNQs) and insoluble protein deposits (IPODs), characteristic of aggregative or misfolded proteins. AnkA, which was not ubiquitinated, accumulated exclusively at the IPOD. CaeA, but not AnkA or the other effectors, caused oxidative damage in yeast. We discuss that CaeA and AnkA behavior in yeast may rather reflect misfolding than recognition of conserved targets in the heterologous system. In contrast, CBU0077 accumulated at vacuolar membranes and abnormal ER extensions, suggesting that it interferes with vesicular traffic, whereas AnkB associated with the yeast nucleolus. Both effectors shared common localization features in HeLa and yeast cells. Our results support the idea that C. burnetii T4BSS effectors manipulate multiple host cell targets, which can be conserved in higher and lower eukaryotic cells. However, the behavior of CaeA and AnkA prompt us to conclude that heterologous protein aggregation and proteostatic stress can be a limitation to be considered when using the yeast model to assess the function of bacterial effectors.

  18. Comparative Local Quality Assessment of 3D Medical Image Segmentations with Focus on Statistical Shape Model-Based Algorithms.

    PubMed

    Landesberger, Tatiana von; Basgier, Dennis; Becker, Meike

    2016-12-01

    The quality of automatic 3D medical segmentation algorithms needs to be assessed on test datasets comprising several 3D images (i.e., instances of an organ). The experts need to compare the segmentation quality across the dataset in order to detect systematic segmentation problems. However, such comparative evaluation is not supported well by current methods. We present a novel system for assessing and comparing segmentation quality in a dataset with multiple 3D images. The data is analyzed and visualized in several views. We detect and show regions with systematic segmentation quality characteristics. For this purpose, we extended a hierarchical clustering algorithm with a connectivity criterion. We combine quality values across the dataset for determining regions with characteristic segmentation quality across instances. Using our system, the experts can also identify 3D segmentations with extraordinary quality characteristics. While we focus on algorithms based on statistical shape models, our approach can also be applied to cases, where landmark correspondences among instances can be established. We applied our approach to three real datasets: liver, cochlea and facial nerve. The segmentation experts were able to identify organ regions with systematic segmentation characteristics as well as to detect outlier instances.

  19. Comparison between high-intensity focused ultrasound devices for the treatment of patients with localized prostate cancer

    NASA Astrophysics Data System (ADS)

    Kim, Hakushi; Tomonaga, Tetsuro; Shoji, Sunao; Uchida, Toyoaki

    2017-03-01

    To evaluate the association between long-term clinical outcomes and morbidity of patients with prostate cancer who underwent high-intensity focused ultrasound (HIFU). We included 918 patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate™ (SB) devices during 1999-2012 and followed-up for >2 years. Risk stratification and complication rates were compared between the treatment groups. The 10-year overall and cancer-specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival (bDFS) rates in the SB200/500, SB500 version 4, and SB500 tissue change monitor groups were 48.3%, 62.3%, and 82.0%, respectively (p < 0.0001). In the low-, intermediate-, and high-risk categories, the 10-year bDFS rates for all patients were 63%, 52%, and 32%, respectively (p < 0.0001), whereas the 5-year bDFS rates in the tissue change monitor group were 95%, 84%, and 72%, respectively (p = 0.0134). The overall negative biopsy rate was 87.3%. Multivariate analysis showed pre-treatment serum prostate-specific antigen levels, neoadjuvant hormonal therapy, and devices as significant predictors (p < 0.0001). Urethral stricture, epididymitis, and urinary incontinence were observed in 19.7%, 6.2%, and 2.3% of the cases, respectively. Long-term follow-up with HIFU demonstrated improved clinical outcomes owing to technical, imaging, and technological advancements.

  20. A local consensus process making use of focus groups to enhance the implementation of a national integrated health care standard on obesity care.

    PubMed

    Derksen, R E; Brink-Melis, W J; Westerman, M J; Dam, J J M Ten; Seidell, J C; Visscher, T L S

    2012-04-01

    Recent guidelines on obesity management promote integrated care. There is little knowledge about local opportunities and barriers, faced by health care professionals and patients, that affect implementation of an integrated national health care standard in a local setting. Our aim is to understand experiences and expectations of health care professionals and patients as part of the local implementation process. Eight focus groups and two interviews have been conducted among 24 patients (60+) and 29 professionals from seven different care disciplines. Both patients and professionals have identified serious barriers to implement the national standard: older adults do not feel taken seriously and experience lacking support from professionals. Professionals give contradictory advice and recommendations do not match needs of older adults. Professionals actually feel reluctant to discuss weight-related topics due to several reasons: they do not consider obesity being a chronic disease, lack of qualifications to support self-management and perceived lack of awareness and motivation among patients. Focus groups have proven their value to ascertain the opportunities and barriers older adults and professionals foresee while improving obesity care in order to meet the standards as required in a national guideline. Our research provides an emerging picture of health care professionals and patients having contradictory views and expectations about 'the others' role and their notions on the capability to intervene on patient's weight problems. Without this emerging picture, we would have missed important information on barriers to overcome. The likelihood of successful implementation would then have been small.

  1. High-Intensity Focused Ultrasound (HIFU) Using Sonablate® Devices for the Treatment of Benign Prostatic Hyperplasia and Localized Prostate Cancer: 18-year experience

    NASA Astrophysics Data System (ADS)

    Uchida, Toyoaki

    2011-09-01

    From 1993 to 2010, we have treated 156 patients benign prostatic hyperplasia (BPH) and 1,052 patients localized prostate cancer high-intensity focused ultrasound (HIFU). Four different HIFU devices, SonablateR-200, SonablateR-500, SonablateR-500 version 4 and Sonablate® TCM, have been used for this study. Clinical outcome of HIFU for BPH did not show any superior effects to transurethral resection of the prostate, laser surgery or transurethral vapolization of the prostate. However, HIFU appears to be a safe and minimally invasive therapy for patients with localized prostate cancer, especially low- and intermediate-risk patients. The rate of clinical outcome has significantly improved over the years due to technical improvements in the device.

  2. What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study.

    PubMed

    Vatcharavongvan, Pasitpon; Hepworth, Julie; Lim, Joanne; Marley, John

    2014-02-01

    This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.

  3. Formation and microstructural properties of locally distributed ZnSiO3 nanoparticles embedded in a SiO2 layer by using a focused electron beam.

    PubMed

    Shin, J W; No, Y S; Kim, T W; Choi, W K

    2008-10-01

    Locally distributed crystalline ZnSiO3 nanoparticles embedded in a SiO2 layer inserted between the ZnO thin film and the Si substrate were formed using transmission electron microscopy (TEM) with a focused electron beam irradiation process. High-resolution TEM (HRTEM) images and energy dispersive X-ray spectroscopy (EDS) profiles showed that ZnSiO3 nanocrystals with a size of approximately 6 nm were formed in the SiO2 layer. The formation mechanisms of the ZnSiO3 nanocrystals in the SiO2 layer are described on the basis of the HRTEM images and the EDS profiles.

  4. Three-dimensional intracranial EEG monitoring in presurgical assessment of MRI-negative frontal lobe epilepsy

    PubMed Central

    Yang, Peng-Fan; Shang, Ming-Chao; Lin, Qiao; Xiao, Hui; Mei, Zhen; Jia, Yan-Zeng; Liu, Wei; Zhong, Zhong-Hui

    2016-01-01

    Abstract Magnetic resonance imaging (MRI)-negative epilepsy is associated with poor clinical outcomes prognosis. The present study was aimed to assess whether intracranial 3D interictal and ictal electroencephalography (EEG) findings, a combination of EEG at a different depth, in addition to clinical, scalp EEG, and positron emission tomography–computed tomography (PETCT) data help to predict outcome in a series of patients with MRI-negative frontal lobe epilepsy (FLE) after surgery. Patients with MRI-negative FLE who were presurgically evaluated by 3D-intracranial EEG (3D-iEEG) recording were included. Outcome predictors were compared in patients with seizure freedom (group 1) and those with recurrent seizures (group 2) at least 24 months after surgery. Forty-seven patients (15 female) were included in this study. MRI was found normal in 38 patients, whereas a focal or regional hypometabolism was observed in 33 cases. Twenty-three patients (48.9%) were seizure-free (Engel class I), and 24 patients (51.1%) continued to have seizures (12 were class II, 7 were class III, and 5 were class IV). Detailed analysis of intracranial EEG revealed widespread (>2 cm) (17.4%:75%; P = 0.01) in contrast to focal seizure onset as well as shorter latency to onset of seizure spread (5.9 ± 7.1 s; 1.4 ± 2.9 s; P = 0.016) and to ictal involvement of brain structures beyond the frontal lobe (21.8 ± 20.3 s; 4.9 ± 5.1 s; P = 0.025) in patients without seizure freedom. The results suggest that presurgical evaluation using 3D-iEEG monitoring lead to a better surgical outcome as seizure free in MRI-negative FLE patients. PMID:27977572

  5. Anchor Plate Efficiency in Postoperative Orthodontic Treatment Following Orthognathic Surgery via Minimal Presurgical Orthodontic Treatment

    PubMed Central

    Jeong, Tae-Min; Kim, Yoon-Ho; Song, Seung-Il

    2014-01-01

    Purpose: The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes. Methods: The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods. Results: The mean skeletal change was posterior movement by 13.87±4.95 mm based on pogonion from T0 to T1, and anterior movement by 1.54±2.18 mm from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P <0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P <0.05). Conclusion: This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative

  6. Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate

    PubMed Central

    Attiguppe, Prabhakar Ramasetty; Karuna, Y. M.; Yavagal, Chandrashekar; Naik, Saraswathi V.; Deepak, B. M.; Maganti, Rekhamani; Krishna, Chaithanya G.

    2016-01-01

    Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM) technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral) which underwent PNAM treatment and gave an excellent surgical prognosis. PMID:27994432

  7. Presurgical motor, somatosensory and language fMRI: Technical feasibility and limitations in 491 patients over 13 years.

    PubMed

    Tyndall, Anthony J; Reinhardt, Julia; Tronnier, Volker; Mariani, Luigi; Stippich, Christoph

    2017-01-01

    To analyse the long-term feasibility and limitations of presurgical fMRI in a cohort of tumour and epilepsy patients with different MR-scanners at 1.5 and 3.0 T. Four hundred and ninety-one consecutive patients undergoing presurgical fMRI between 2000 and 2012 on five different MR-scanners using established paradigms and semi-automated data processing were included. Success rates of task performance and BOLD-activation were determined for motor and somatosensory somatotopic mapping and language localisation. Procedural success, failures and imaging artifacts were analysed. MR-field strengths were compared. Two thousand three hundred fifteen of 2348 (98.6 %) attempted paradigms (1033 motor, 1220 speech, 95 somatosensory) were successfully performed. 100 paradigms (4.3 %) were repetition runs. 23 speech, 6 motor and 2 sensory paradigms failed for non-compliance and technical issues. Most language paradigm failures were noted in overt sentence generation. Average significant BOLD-activation was higher for motor than language paradigms (95.8 vs. 81.6 %). Most language paradigms showed significantly higher activation rates at 3 T compared to 1.5 T, whereas no significant difference was found for motor paradigms. fMRI proved very robust for the presurgical localisation of the different motor and somatosensory body representations, as well as Broca's and Wernicke's language areas across different MR-scanners at 1.5 and 3.0 T over 13 years. • Standardised presurgical motor and language fMRI is robust across various MRI platforms. • Motor fMRI is less dependent on field strength than language fMRI. • fMRI task failures are relatively low and are reduced by paradigm repetition.

  8. Environmental education with a local focus: The development of action competency in community leaders through participation in an environmental leadership program

    NASA Astrophysics Data System (ADS)

    Cairns, Karen Jean

    2001-07-01

    This dissertation is a historical and theoretical examination of environmental education to promote community leadership in local environmental issues. It begins with an overview of the history of environmental education, historical perspectives of the beginning of the field, ongoing differences in perspectives of practitioners, and its relationship to the larger field of education. Using a prevalent definition of environmental education as education with an aim of promoting actions, which are environmentally responsible and careful, I examine a variety of educational approaches and their results in achieving this objective. Reasons for using a local focus in terms of promotion of community sustainability are explored, and the literature review ends with a discussion of the value of community action through participatory democratic processes. The dissertation is divided into five chapters, covering an introduction to the purpose and significance of the study, literature review, methodology, results and analysis, and conclusion and implications of the research. Two programs, one at a city or urban level and one at a state level, and outcomes for their participants are explored and compared through data collected from interviews, field observation, and program documents. Findings demonstrated the value of a local focus for environmental education programs, plus the importance of experiential learning, or learning through some sort of personal connection and involvement. Examples of the types of experiential learning involved are tours or field trips, role-playing, and games illustrating concepts. Results emphasized the importance of educational process over content, information, or factual knowledge. The urban leadership program demonstrated the value of a local focus and experiential process in increasing motivation for action. The state program demonstrated the value of education of environmental leaders in democratic processes, especially collaboration, inclusion

  9. Presurgical orthodontic decompensation alters alveolar bone condition around mandibular incisors in adults with skeletal Class III malocclusion

    PubMed Central

    Sun, Boyang; Tang, Jun; Xiao, Ping; Ding, Ying

    2015-01-01

    This study is to use cone beam computed tomography (CBCT) to acquire accurate radiographic images for alveolar bone in lower incisors and the change after presurgical orthodontic treatment. Seventeen patients with skeletal Class III malocclusion, ten normal occlusion subjects, and fifteen patients treated with orthodontic treatment and orthognathic surgery were included. CBCT images were obtained. The labial and lingual inclinations of mandibular incisors, the thickness of alveolar bone, the vertical alveolar height and root length were measured. Alveolar bone thickness at the apex in patients with skeletal Class III malocclusion was thinner than normal subjects. The vertical alveolar bone heights at labial and lingual sides in patients with skeletal Class III malocclusion were both reduced compared with normal subjects, especially at the labial side. There were statistically significant correlations between lower incisor inclination and alveolar bone morphology. After orthodontics, the incisors root apex was closer to the lingual side of alveolar bone. The alveolar bone thickness at apex was not statistically changed. The vertical alveolar bone heights at the labial and lingual sides were both significantly reduced especially the lingual side after presurgical orthodontic treatment. The root length was not significantly changed. In conclusion, the alveolar bone thickness at apex is thinner and the vertical alveolar height is reduced at the labial side. Forward movement of lower incisors during presurgical orthodontic treatment can render the lower incisors root apex closer to the lingual side and the vertical alveolar height is reduced. PMID:26550202

  10. Evaluation of pre-surgical models for uterine surgery by use of three-dimensional printing and mold casting.

    PubMed

    Sayed Aluwee, Sayed Ahmad Zikri Bin; Zhou, Xiangrong; Kato, Hiroki; Makino, Hiroshi; Muramatsu, Chisako; Hara, Takeshi; Matsuo, Masayuki; Fujita, Hiroshi

    2017-04-12

    We propose an approach to supporting pre-surgical planning for the uterus by integrating medical image analysis and physical model generation based on 3D printing. With our method, we first segment the patient-specific anatomy and lesions of the uterus on MR images; then, we create a 3D physical model, an exact replica of the patient's uterus in terms of size and softness, with transparency for easy observation of the internal structures of the uterus. In our experiments, we created pre-surgical models of hysterectomy for five patients who had been diagnosed to have uterine endometrial cancer. An experienced radiologist, the surgeons, and all of the patients cooperated in our experiment for carrying out subjective evaluations of the usefulness of our model. The accuracy of the physical models was evaluated quantitatively by comparison between the MR images of the patients and the CT images of the models. The results showed that the mean values of the errors in gap ranged from 1.19 to 2.22 mm, which was satisfactory for the surgeons. The feedback from both surgeons and patients demonstrated the usefulness and convenience of the models for efficient patient explanation understanding and pre-surgical planning by surgeons.

  11. Assessing Locally Focused Stability Operations

    DTIC Science & Technology

    2014-01-01

    AND TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM... Science ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Review of Assessment Tools...can ensure that their methodological perspectives are synchronized to support their objectives, rather than simply being a science project that

  12. Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: prognostic value of prostate MRI.

    PubMed

    Rouvière, O; Sbihi, L; Gelet, A; Chapelon, J-Y

    2013-07-01

    To assess the prognostic value of magnetic resonance imaging (MRI) before salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after external-beam radiotherapy (EBRT). Forty-six patients who underwent prostate MRI before salvage HIFU for locally recurrent prostate cancer after EBRT were retrospectively studied. HIFU failure was defined as a prostate-specific antigen (PSA) value >nadir + 2 ng/ml (Phoenix criteria) or positive follow-up biopsy or initiation of any other salvage therapy. The following prognostic parameters were assessed: neoadjuvant hormone therapy, clinical stage and Gleason score of recurrence, PSA level and velocity at HIFU treatment, and six MRI-derived parameters (prostate volume, tumour volume, extracapsular extension, seminal vesicle invasion, tumour extension into the apex or anterior to the urethra). Two factors were significant independent predictors of salvage HIFU failure: the PSA level at HIFU treatment (p < 0.012; risk ratio: 1.15, 95% CI: 1.03-1.29) and the tumour extension anterior to the urethra, as assessed by MRI (p = 0.046, risk ratio: 2.51, 95% CI: 1.02-6.16). The location of cancer recurrence anterior to the urethra on MRI is an independent significant predictor of salvage HIFU failure for locally recurrent prostate cancer after EBRT. Therefore, MRI may be useful for patient selection before post-EBRT salvage HIFU ablation. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  13. A Bayesian non-parametric Potts model with application to pre-surgical FMRI data.

    PubMed

    Johnson, Timothy D; Liu, Zhuqing; Bartsch, Andreas J; Nichols, Thomas E

    2013-08-01

    The Potts model has enjoyed much success as a prior model for image segmentation. Given the individual classes in the model, the data are typically modeled as Gaussian random variates or as random variates from some other parametric distribution. In this article, we present a non-parametric Potts model and apply it to a functional magnetic resonance imaging study for the pre-surgical assessment of peritumoral brain activation. In our model, we assume that the Z-score image from a patient can be segmented into activated, deactivated, and null classes, or states. Conditional on the class, or state, the Z-scores are assumed to come from some generic distribution which we model non-parametrically using a mixture of Dirichlet process priors within the Bayesian framework. The posterior distribution of the model parameters is estimated with a Markov chain Monte Carlo algorithm, and Bayesian decision theory is used to make the final classifications. Our Potts prior model includes two parameters, the standard spatial regularization parameter and a parameter that can be interpreted as the a priori probability that each voxel belongs to the null, or background state, conditional on the lack of spatial regularization. We assume that both of these parameters are unknown, and jointly estimate them along with other model parameters. We show through simulation studies that our model performs on par, in terms of posterior expected loss, with parametric Potts models when the parametric model is correctly specified and outperforms parametric models when the parametric model in misspecified.

  14. Ictal/postictal SPECT in the pre-surgical localisation of complex partial seizures.

    PubMed

    Duncan, R; Patterson, J; Roberts, R; Hadley, D M; Bone, I

    1993-02-01

    Single photon emission computed tomography (SPECT) used in conjunction with HM-PAO (Ceretec-Amersham International) was used to image regional cerebral blood flow (rCBF) in 28 patients with medically intractable complex partial seizures during or soon after a seizure, and interictally. Changes from interictal rCBF were seen in 26/28 (93%) patients. The main findings were; 1) During the seizure--hyperperfusion of the whole temporal lobe; 2) Up to 2m postically--hyperperfusion of the hippocampus with hypoperfusion of lateral temporal structures; 3) From 2-15m postically--hypoperfusion of the whole temporal lobe. When compared with EEG and MRI data, correct localisation to one temporal lobe was obtained in 23 patients. In one further patient bilateral temporal foci, and in a further two patients frontal foci, were correctly identified. There were no disagreements between EEG and SPECT localisation. Temporal lobe surgery was successful (by the criterion of at least 90% reduction in seizure frequency) in all but one of the 23 patients operated on. It is concluded that ictal/postictal SPECT is a reliable technique for the presurgical localisation of complex partial seizures. The data indicate a likely sequence of changes in rCBF during and after complex partial seizures of temporal lobe origin.

  15. A Bayesian Non-Parametric Potts Model with Application to Pre-Surgical FMRI Data

    PubMed Central

    Johnson, Timothy D.; Liu, Zhuqing; Bartsch, Andreas J.; Nichols, Thomas E.

    2013-01-01

    The Potts model has enjoyed much success as a prior model for image segmentation. Given the individual classes in the model, the data are typically modeled as Gaussian random variates or as random variates from some other parametric distribution. In this manuscript we present a non-parametric Potts model and apply it to an FMRI study for the pre-surgical assessment of peritumoral brain activation. In our model we assume that the Z-score image from a patient can be segmented into activated, deactivated and null classes, or states. Conditional on the class, or state, the Z-scores are assumed to come from some generic distribution which we model non-parametrically using a mixture of Dirichlet process priors within the Bayesian framework. The posterior distribution of the model parameters is estimated with a Markov chain Monte Carlo algorithm and Bayesian decision theory is used to make the final classifications. Our Potts prior model includes two parameters, the standard spatial regularization parameter and a parameter that can be interpreted as the a priori probability that each voxel belong to the null, or background state, conditional on the lack of spatial regularization. We assume that both of these parameters are unknown, and jointly estimate them along with other model parameters. We show through simulation studies that our model performs on par, in terms of posterior expected loss, with parametric Potts models when the parametric model is correctly specified, and outperforms parametric models when the parametric model in misspecified. PMID:22627277

  16. Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly.

    PubMed

    Losa, Marco; Bollerslev, Jens

    2016-06-01

    The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and treatment individualized accordingly. The issue of SSA pre-treatment to improve surgical outcome is yet to be settled and further methodologically sound studies are probably necessary to clarify this point.

  17. Simplified enrollment for autologous transfusion: automatic referral of presurgical patients for assessment for autologous blood collections.

    PubMed

    Moore, S B; Swenke, P K; Foss, M L; Rand, J A; Cabanela, M E; Kavanagh, B; Taswell, H F

    1992-04-01

    We implemented a pilot program at our institution for automatic referral of patients for presurgical assessment for preoperative and intraoperative collection of autologous blood. Although patients and clinicians support the use of autologous transfusion, often a request for collection of autologous blood is not initiated. During 11 months, 269 patients (82%) of three orthopedic surgeons entered the program, and 218 underwent operation and were dismissed from the hospital. A total of 940 units of autologous blood (675 preoperatively and 265 intraoperatively) was collected from these 218 patients, and 84% of the units were transfused. Throughout hospitalization, 86% of the patients received only autologous blood, whereas 14% received various proportions of homologous and autologous blood. In contrast, only 26% of a concomitant control group of 220 consecutive orthopedic surgical patients not participating in the automatic-referral program received only autologous blood. Thus, the automatic-referral program increased the percentage of elective orthopedic surgical patients who received only autologous blood from 26% to 86% (P less than 0.001). This study also showed that the same amount of blood was used for autologous transfusions as was routinely used for homologous transfusions in similar cases. The automatic-referral system was convenient for physicians and patients and offered the benefits of reduction of transfusion-associated risks and amelioration of patient anxieties.

  18. Psychosocial Moderators of Presurgical Stress Management for Men Undergoing Radical Prostatectomy

    PubMed Central

    Gilts, Chelsea D.; Parker, Patricia A.; Pettaway, Curtis A.; Cohen, Lorenzo

    2013-01-01

    Objective It is important to identify factors that predict who will benefit the most from psychosocial interventions in cancer populations. Methods This study examines the moderating effect of baseline social support (Social Support, SS; Dyadic Adjustment DA), distress (Brief Symptom Inventory, BSI; Impact of Event Scale, IES), and coping style (Brief COPE) on quality of life outcomes (SF-36 Physical Component Summary scores(PCS)) 1 year post surgery derived from a presurgical cognitive behavioral stress management program (SM; n = 23), supportive attention (SA; n = 37), or standard care (SC; n = 29). Results Moderation analyses indicated that men who reported low baseline social support (SS) and were in SM had increased PCS one year after surgery compared to men with low SS in the SC group (β = −0.39, p < .01), with SA having a non-significant intermediate effect. Men who reported high distress (BSI) at baseline and were in the SA group had increased PCS one year after surgery compared to those in the SC group (β = 24.80, p = .01), with SM having a non-significant intermediate effect. Mediation analyses suggested that neither SM nor SA improved QOL simply by increasing social support or decreasing general distress. Conclusions Distressed individuals may benefit more from unstructured discussion of distress whereas those low in social support may benefit more from a structured approach to learning coping skills. PMID:23088178

  19. Evaluation of the factors influencing brain language laterality in presurgical planning.

    PubMed

    Batouli, Seyed Amir Hossein; Hasani, Nafiseh; Gheisari, Sara; Behzad, Ebrahim; Oghabian, Mohammad Ali

    2016-10-01

    Brain lesions cause functional deficits, and one treatment for this condition is lesion resection. In most cases, presurgical planning (PSP) and the information from laterality indices are necessary for maximum preservation of the critical functions after surgery. Language laterality index (LI) is reliably estimated using functional magnetic resonance imaging (fMRI); however, this measure is under the influence of some external factors. In this study, we investigated the influence of a number of factors on language LI, using data from 120 patients (mean age=35.65 (±13.4) years) who underwent fMRI for PSP. Using two proposed language tasks from our previous works, brain left hemisphere was showed to be dominant for the language function, although a higher LI was obtained using the "Word Generation" task, compared to the "Reverse Word Reading". In addition, decline of LIs with age, and lower LI when the lesion invaded brain language area were observed. Meanwhile, gender, lesion side (affected hemisphere), LI calculation strategy, and fMRI analysis Z-values did not statistically show any influences on the LIs. Although fMRI is widely used to estimate language LI, it is shown here that in order to present a reliable language LI and to correctly select the dominant hemisphere of the brain, the influence of external factors should be carefully considered. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. [Quality guidelines for presurgical epilepsy diagnosis and operative epilepsy therapy: 1st revised version].

    PubMed

    Rosenow, F; Bast, T; Czech, T; Hans, V; Helmstaedter, C; Huppertz, H-J; Seeck, M; Trinka, E; Wagner, K

    2014-06-01

    In patients with pharmacorefractory epilepsy, preoperative epilepsy evaluation and subsequent epilepsy surgery lead to a significant improvement of seizure control, proportion of seizure-free patients, quality of life and social participation. The aims of preoperative epilepsy evaluation are to define the chance of complete seizure freedom and the likelihood of inducing new neurological deficits in a given patient. As epilepsy surgery is an elective procedure quality standards are particularly high. As detailed in the first edition of these practice guidelines, quality control relates to seven different domains: (1) establishing centres with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuing medical education of employees, (4) surveillance by trained personnel during the video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures and (7) cooperation of epilepsy centres. In the first edition of these practice guidelines published in 2000 it was defined which standards were desirable and that their implementation should be aimed for. These standards related especially to the certification required for different groups of medical doctors involved and to the minimum numbers of procedures required. In the subsequent decade quite a number of colleagues have been certified by the trinational Working Group (Arbeitsgemeinschaft, AG) for Presurgical Epilepsy Diagnosis and Operative Epilepsy Treatment (http://www.ag-epilepsiechirurgie.de) and therefore, on 8 May 2013 the executive board of the AG decided to now make these standards obligatory.

  1. SECOT-GEDOS consensus on pre-surgical pain management in knee and hip arthrosis.

    PubMed

    Ruiz Ibán, M A; Maculé, F; Torner, P; Gil Garay, E; Oteo-Álvaro, A; López Millán, J M; Díaz Heredia, J; Loza, E

    2015-01-01

    To develop recommendations, based on best evidence and experience, on pain management in patients undertaking total knee or hip replacement. Nominal group methodology was followed. A group of experts was selected (5 orthopedics, 1 anesthesiologist), who defined the scope, users, topics, preliminary recommendations, and 3 systematic reviews: efficacy and safety of pre-surgical analgesia regarding to post-surgical pain, efficacy and safety of pre-emptive analgesia and pre-operative factors of post-operative pain. The level of evidence and grade of recommendation was established using the Oxford Centre for Evidence Based Medicine, and the level of agreement with the Delphi technique (2 rounds). The Delphi was extended to 39 orthopedics and anesthesiologists. The whole document was reviewed by all the experts. A total of 21 recommendations were produced. They include specific pharmacological treatment, as well as the evaluation and monitoring of patients on this treatment, and post-operative pre-emptive treatment. Agreement above 70% was reached in 19 recommendations. In patients undergoing total knee or hip replacement, a proper evaluation, follow-up, pharmacological and non-pharmacological treatment of predictors of poor surgical outcomes should be performed, especially those related to pre-operative pain. This can improve post-operative pain and surgery outcomes. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  2. Effective retropulsion and centralization of the severely malpositioned premaxilla in patients with bilateral cleft lip and palate: a novel modified presurgical nasoalveolar molding device with retraction screw.

    PubMed

    Li, Wanshan; Liao, Lishu; Dai, Jingbo; Zhong, Yuxiang; Ren, Leixi; Liu, Yutao

    2014-12-01

    A novel, modified presurgical nasoalveolar molding (MPNAM) device with retraction screw was designed and used in patients with bilateral complete cleft lip and palate (BCCLP) to rapidly retract and centralize the protuberant and malpositioned premaxilla and correct the nasolabial and palatal deformities. The orthopedic effects and possible complications were evaluated. Nine patients with BCCLP who met the inclusion criteria were selected. After the maxillary model was obtained, the new MPNAM device with retraction screw was designed and worn until cheilorrhaphy. Changes in local deformities and complications were observed continuously, and the orthopedic effect was evaluated. All patients quickly adapted to the MPNAM appliance, and the treatment was finished after 5-8 return visits. The columella was significantly prolonged, the nasal tip was elevated, and the collapsed nasal dome was obviously improved. Simultaneously, the premaxilla was rapidly retracted and rotated, and gradually centralized; the clefts were gradually reduced and closed, and a nearly normal dental arch was formed. Although there were some complications, the orthopedic treatment was continued until cheiloplasty. The MPNAM device with retraction screw can simultaneously correct nasolabial and palatal deformities and also rapidly retract and centralize the premaxilla. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  3. Dual-color multiple-particle tracking at 50-nm localization and over 100-µm range in 3D with temporal focusing two-photon microscopy

    PubMed Central

    Ding, Yu; Li, Chunqiang

    2016-01-01

    Nanoscale particle tracking in three dimensions is crucial to directly observe dynamics of molecules and nanoparticles in living cells. Here we present a three-dimensional particle tracking method based on temporally focused two-photon excitation. Multiple particles are imaged at 30 frames/s in volume up to 180 × 180 × 100 µm3. The spatial localization precision can reach 50 nm. We demonstrate its capability of tracking fast swimming microbes at speed of ~200 µm/s. Two-photon dual-color tracking is achieved by simultaneously exciting two kinds of fluorescent beads at 800 nm to demonstrate its potential in molecular interaction studies. Our method provides a simple wide-field fluorescence imaging approach for deep multiple-particle tracking. PMID:27867724

  4. Presurgical nasoalveolar molding orthopedic treatment improves the outcome of primary cheiloplasty of unilateral complete cleft lip and palate, as assessed by naris morphology and cleft gap.

    PubMed

    Sasaki, Hiroyoshi; Togashi, Shinji; Karube, Rei; Yanagawa, Toru; Nakane, Shizuo; Tabuchi, Katsuhiko; Ishibashi, Naomi; Shinya, Yoshiko; Ito, Hiroyuki; Yamagata, Kenji; Onizawa, Kojiro; Adachi, Koji; Sekido, Mitsuru; Bukawa, Hiroki

    2012-11-01

    We evaluated the effects of presurgical nasoalveolar molding (NAM) with an orthopedic appliance and compared them with a passive orthopedic method (Hotz plate, HP), focusing on the naris morphology and width of the alveolar and palate cleft gap. The subjects were 28 unilateral complete cleft lip and palate patients treated with primary cheiloplasty at Tsukuba University Hospital from 2004 to 2011. Thirteen patients were treated preoperatively with NAM (NAM group), and 15 with HP (HP group). The surgical outcome was assessed according to left-right naris symmetry, as measured by the area ratio, perimeter ratio, aspect a/u ratio (aspect ratio of the affected side/aspect ratio of the unaffected side), and Hausdorff distance. In addition, the alveolar and palate cleft width was measured at the times of orthopedic plate setting and primary cheiloplasty. The aspect ratio was significantly smaller in the NAM group than in the HP group before the operation. In both groups, the aspect ratio, perimeter ratio, and Hausdorff distance were significantly smaller after the operation than before. The width of the alveolar and palate cleft gap was significantly narrowed in the NAM group, and the cleft gap at the initiation of NAM correlated significantly with the Hausdorff distance after cheiloplasty. We found that NAM improved the form of the naris after primary cheiloplasty and decreased the palate cleft gap more effectively than HP and that the width of the palate cleft gap was correlated with the surgical outcome of the naris.

  5. Activation of signaling pathways following localized delivery of systemically administered neurotrophic factors across the blood-brain barrier using focused ultrasound and microbubbles

    NASA Astrophysics Data System (ADS)

    Baseri, Babak; Choi, James J.; Deffieux, Thomas; Samiotaki, Gesthimani; Tung, Yao-Sheng; Olumolade, Oluyemi; Small, Scott A.; Morrison, Barclay, III; Konofagou, Elisa E.

    2012-04-01

    The brain-derived neurotrophic factor (BDNF) has been shown to have broad neuroprotective effects in addition to its therapeutic role in neurodegenerative disease. In this study, the efficacy of delivering exogenous BDNF to the left hippocampus is demonstrated in wild-type mice (n = 7) through the noninvasively disrupted blood-brain barrier (BBB) using focused ultrasound (FUS). The BDNF bioactivity was found to be preserved following delivery as assessed quantitatively by immunohistochemical detection of the pTrkB receptor and activated pAkt, pMAPK, and pCREB in the hippocampal neurons. It was therefore shown for the first time that systemically administered neurotrophic factors can cross the noninvasively disrupted BBB and trigger neuronal downstream signaling effects in a highly localized region in the brain. This is the first time that the administered molecule is tracked through the BBB and localized in the neuron triggering molecular effects. Additional preliminary findings are shown in wild-type mice with two additional neurotrophic factors such as the glia-derived neurotrophic factor (n = 12) and neurturin (n = 2). This further demonstrates the impact of FUS for the early treatment of CNS diseases at the cellular and molecular level and strengthens its premise for FUS-assisted drug delivery and efficacy.

  6. Non-inductive current built-up by local electron cyclotron heating and current drive with a 28 GHz focused beam on QUEST

    NASA Astrophysics Data System (ADS)

    Onchi, Takumi; Idei, Hiroshi; Hasegawa, Makoto; Ohwada, Hiroaki; Zushi, Hideki; Hanada, Kazuaki; Kariya, Tsuyoshi; Mishra, Kishore; Shikama, Taichi; Quest Team

    2016-10-01

    The plasma current can be driven solely by injecting electron cyclotron waves (ECWs) in spherical tokamak (ST) configuration. A system of 28 GHz gyrotron (maximum power: 270 kW) is renewed and reinstalled on QUEST. A focused ECW beam, whose diameter is about 5 cm at the second harmonic resonance, is injected for local ECW heating and current drive. The local power density at resonance exceeds 75 MW/m2 at an injection power of 150 kW. The incident ECW polarization can be adjusted employing the phase shifter consisting of two corrugated plates. During 1.25 second pulse of ECH, plasma current is built up to Ip = 70 kA fully non-inductively with a core electron density of ne > 1018 m-3. The closed flux in such ST plasma is determined at the inboard limiter on the center stack. Energetic electrons are also responsible for the pressure and equilibrium. This work is supported by JSPS KAKENHI (15H04231, 15K17800), NIFS Collaboration Research program (NIFS13KUTR085, NIFS11KUTR069, NIFS16KUTR114).

  7. Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis

    PubMed Central

    Yamazaki, Hideya; Nakamura, Satoaki; Nishimura, Takuya; Yoshida, Ken; Yoshioka, Yasuo; Koizumi, Masahiko; Ogawa, Kazuhiko

    2014-01-01

    With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment. PMID:25204643

  8. Localized delivery of doxorubicin in vivo from polymer-modified thermosensitive liposomes with MR-guided focused ultrasound-mediated heating

    PubMed Central

    Ta, Terence; Bartolak-Suki, Elizabeth; Park, Eun-Joo; Karrobi, Kavon M.; McDannold, Nathan J.; Porter, Tyrone M.

    2014-01-01

    Thermosensitive liposomes have emerged as a viable strategy for localized delivery and triggered release of chemotherapy. MR-guided focused ultrasound (MRgFUS) has the capability of heating tumors in a controlled manner, and when combined with thermosensitive liposomes can potentially reduce tumor burden in vivo. However, the impact of this drug delivery strategy has rarely been investigated. We have developed a unique liposome formulation modified with p(NIPAAm-co-PAA), a polymer that confers sensitivity to both temperature and pH. These polymer-modified thermosensitive liposomes (PTSL) demonstrated sensitivity to focused ultrasound, and required lower thermal doses and were more cytotoxic than traditional formulations in vitro. A set of acoustic parameters characterizing optimal release from PTSL in vitro was applied in the design of a combined MRgFUS/PTSL delivery platform. This platform more effectively reduced tumor burden in vivo when compared to free drug and traditional formulations. Histological analysis indicated greater tumor penetration, more extensive ECM remodeling, and greater cell destruction in tumors administered PTSL, correlating with improved response to the therapy. PMID:25151982

  9. Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy.

    PubMed

    Bostock, Emmanuelle C S; Kirkby, Kenneth C; Garry, Michael I; Taylor, Bruce V M

    2017-01-01

    Bipolar disorder (BD) and temporal lobe epilepsy (TLE) overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Comparison of cognitive function in both disorders may indicate temporal lobe mediated processes relevant to BD. This systematic review examines neuropsychological test profiles in euthymic bipolar disorder type I (BD-I) and pre-surgical TLE and compares experimental designs used. A search of PubMed, PsychINFO, and Scopus using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Inclusion criteria were comparison group or pre- to post-surgical patients; reported neuropsychological tests; participants aged 18-60 years. Fifty six studies met criteria: 27 BD-I; 29 TLE. Deficits in BD-I compared to healthy controls (HC) were in executive function, attention span and verbal memory. Deficits in TLE compared to HC were in executive function and memory. In the pre- to post-surgical comparisons, verbal memory in left temporal lobe (LTL) and, less consistently, visuospatial memory in right temporal lobe (RTL) epilepsy declined following surgery. BD-I studies used comprehensive test batteries in well-defined euthymic patients compared to matched HC groups. TLE studies used convenience samples pre- to post-surgery, comparing LTL and RTL subgroups, few included comparisons to HC (5 studies). TLE studies typically examined a narrow range of known temporal lobe-mediated neuropsychological functions, particularly verbal and visuospatial memory. Both disorders exhibit deficits in executive function and verbal memory suggestive of both frontal and temporal lobe involvement. However, deficits in TLE are measured pre- to post-surgery and not controlled at baseline pre-surgery. Further research involving a head-to-head comparison of the two disorders on a broad range of neuropsychological tests is needed to clarify the nature and extent of cognitive deficits and

  10. Pre-surgical evaluation and surgical treatment in children with extratemporal epilepsy.

    PubMed

    Centeno, Ricardo Silva; Yacubian, Elza Marcia; Sakamoto, Americo Ceiki; Ferraz, Antonio Fernando Patriani; Junior, Henrique Carrete; Cavalheiro, Sergio

    2006-08-01

    This review summarizes some patterns of pre-surgical evaluation and surgical treatment of extratemporal epilepsy in pediatric patients with medically refractory seizures, whose ictal behavior is variable. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone (the area of ictal onset and initial seizure propagation). This might be risky, though, in the case of a widespread lesion, sometimes encroaching one or more lobes, given the risk to the functional cerebral cortex. An anterior temporal lobectomy might prove more effective then in preventing seizures with fewer potential complications. If partial extratemporal epilepsy is associated with pharmaco-resistant seizures, the preoperative evaluation and operative strategy are determined according to the epileptogenic zone and to the relationship between a substrate-directed disorder and eloquent areas. The pediatric treatment of extratemporal epilepsy is aimed at controlling the seizures, avoiding morbidity, and improving the patient's quality of life through psychosocial integration. Since the immature brain is more plastic than when mature, the recovery of functions after surgery is greater in children than in adults. Early surgery is recommended for children with intractable epilepsy, and is now accepted as an important therapeutic modality also for children with chronic epilepsy. Technological advances in the last two decades, mainly in neuroimaging, have led many medical centers to consider surgical treatment of epilepsy, accuracy being granted by MRI-based neuronavigation systems-an interface between the lesion seen in the preoperative magnetic resonance imaging (MRI) and the operative field, often invisible to the surgeon.

  11. [Pre-surgical simulation of microvascular decompression for hemifacial spasm using 3D-models].

    PubMed

    Mashiko, Toshihiro; Yang, Qiang; Kaneko, Naoki; Konno, Takehiko; Yamaguchi, Takashi; Watanabe, Eiju

    2015-01-01

    We have been performing pre-surgical simulations using custom-built patient-specific 3D-models. Here we report the advantageous use of 3D-models for simulating microvascular decompression(MVD)for hemifacial spasms. Seven cases of MVD surgery were performed. Two types of 3D-printers were used to fabricate the 3D-models:one using plaster as the modeling material(Z Printer®450, 3D systems, Rock Hill, SC, USA)and the other using acrylonitrile butadiene styrene(ABS)(UP! Plus 3D printer®, Beijing Tiertime Technology, Beijing). We tested three types of models. Type 1 was a plaster model of the brainstem, cerebellum, facial nerve, and the artery compressing the root exit zone of the facial nerve. Part of the cerebellum was digitally trimmed off to observe "the compressing point" from the same angle as that used during actual surgery. Type 2 was a modified Type 1 in which part of the skull was opened digitally to mimic a craniectomy. Type 3 was a combined model in which the cerebellum and the artery of the Type 2 model were replaced by a soft retractable cerebellum and an elastic artery. The cerebellum was made from polyurethane and cast from a plaster prototype. To fabricate elastic arteries, liquid silicone was painted onto the surface of an ABS artery and the inner ABS model was dissolved away using solvent. In all cases, the 3D-models were very useful. Although each type has advantages, the Type-3 model was judged extremely useful for training junior surgeons in microsurgical approaches.

  12. Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates.

    PubMed

    Losa, Marco; Mortini, Pietro; Urbaz, Laura; Ribotto, Paolo; Castrignanó, Tristana; Giovanelli, Massimo

    2006-06-01

    The question of whether preoperative therapy with somatostatin analogs can improve surgical outcome in acromegaly has not been definitively answered. In this paper, the authors report the effects of preoperative treatment with somatostatin analogs in a large sample of patients with acromegaly. Between 1990 and 2003, 399 consecutive patients with acromegaly underwent surgery at the Istituto Scientifico San Raffaele. Thirty-three patients who had previously undergone surgery or radiation treatment, 48 patients treated with somatostatin analogs for fewer than 3 months, and patients who had stopped therapy for too long a time before surgery were excluded from the study. One hundred forty-three patients who had received somatostatin analogs prior to surgery (Group 1) were randomly matched to 143 patients who had never been treated with somatostatin analogs (Group 2). Matching criteria were tumor size and invasiveness into the cavernous sinus. Before surgery, Group 1 patients showed reduction of growth hormone levels to less than 50% of baseline in 64% of cases, but insulin-like growth factor-I was normalized in only 19.5%. Surgical remission occurred in 81 Group 1 patients (56.6%) and in 91 Group 2 patients (63.6%; p = 0.28). No significant difference in the remission rate was observed when cases were analyzed according to tumor size or invasiveness. Logistic regression analysis confirmed that pretreatment with somatostatin analogs was not associated with surgical outcome. Surgical morbidity was mild and similar in Group 1 and Group 2 patients (7 and 5.6%, respectively; p = 0.81). Surgical remission and complication rates in patients with acromegaly who received treatment with somatostatin analogs prior to surgery were not significantly different from those of matched patients who did not receive these agents. At present, the routine use of presurgical therapy with somatostatin analogs for patients with acromegaly cannot be recommended.

  13. Automated analysis of seizure semiology and brain electrical activity in presurgery evaluation of epilepsy: A focused survey.

    PubMed

    Ahmedt-Aristizabal, David; Fookes, Clinton; Dionisio, Sasha; Nguyen, Kien; Cunha, João Paulo S; Sridharan, Sridha

    2017-10-09

    Epilepsy being one of the most prevalent neurological disorders, affecting approximately 50 million people worldwide, and with almost 30-40% of patients experiencing partial epilepsy being nonresponsive to medication, epilepsy surgery is widely accepted as an effective therapeutic option. Presurgical evaluation has advanced significantly using noninvasive techniques based on video monitoring, neuroimaging, and electrophysiological and neuropsychological tests; however, certain clinical settings call for invasive intracranial recordings such as stereoelectroencephalography (SEEG), aiming to accurately map the eloquent brain networks involved during a seizure. Most of the current presurgical evaluation procedures focus on semiautomatic techniques, where surgery diagnosis relies immensely on neurologists' experience and their time-consuming subjective interpretation of semiology or the manifestations of epilepsy and their correlation with the brain's electrical activity. Because surgery misdiagnosis reaches a rate of 30%, and more than one-third of all epilepsies are poorly understood, there is an evident keen interest in improving diagnostic precision using computer-based methodologies that in the past few years have shown near-human performance. Among them, deep learning has excelled in many biological and medical applications, but has advanced insufficiently in epilepsy evaluation and automated understanding of neural bases of semiology. In this paper, we systematically review the automatic applications in epilepsy for human motion analysis, brain electrical activity, and the anatomoelectroclinical correlation to attribute anatomical localization of the epileptogenic network to distinctive epilepsy patterns. Notably, recent advances in deep learning techniques will be investigated in the contexts of epilepsy to address the challenges exhibited by traditional machine learning techniques. Finally, we discuss and propose future research on epilepsy surgery assessment

  14. Interactive presurgical simulation applying advanced 3D imaging and modeling techniques for skull base and deep tumors.

    PubMed

    Oishi, Makoto; Fukuda, Masafumi; Yajima, Naoki; Yoshida, Kenzo; Takahashi, Machiko; Hiraishi, Tetsuya; Takao, Tetsuro; Saito, Akihiko; Fujii, Yukihiko

    2013-07-01

    In this paper, the authors' goal was to report their novel presurgical simulation method applying interactive virtual simulation (IVS) using 3D computer graphics (CG) data and microscopic observation of color-printed plaster models based on these CG data in surgery for skull base and deep tumors. For 25 operations in 23 patients with skull base or deep intracranial tumors (meningiomas, schwannomas, epidermoid tumors, chordomas, and others), the authors carried out presurgical simulation based on 3D CG data created by image analysis for radiological data. Interactive virtual simulation was performed by modifying the 3D CG data to imitate various surgical procedures, such as bone drilling, brain retraction, and tumor removal, with manipulation of a haptic device. The authors also produced color-printed plaster models of modified 3D CG data by a selective laser sintering method and observed them under the operative microscope. In all patients, IVS provided detailed and realistic surgical perspectives of sufficient quality, thereby allowing surgeons to determine an appropriate and feasible surgical approach. Surgeons agreed that in 44% of the 25 operations IVS showed high utility (as indicated by a rating of "prominent") in comprehending 3D microsurgical anatomies for which reconstruction using only 2D images was complicated. Microscopic observation of color-printed plaster models in 12 patients provided further utility in confirming realistic surgical anatomies. The authors' presurgical simulation method applying advanced 3D imaging and modeling techniques provided a realistic environment for practicing microsurgical procedures virtually and enabled the authors to ascertain complex microsurgical anatomy, to determine the optimal surgical strategies, and also to efficiently educate neurosurgical trainees, especially during surgery for skull base and deep tumors.

  15. Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review.

    PubMed

    Baert, I A C; Lluch, E; Mulder, T; Nijs, J; Noten, S; Meeus, M

    2016-02-01

    The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  16. The Use of Susceptibility-Weighted Magnetic Resonance Imaging to Characterize the Safety Window of Focused Ultrasound Exposure for Localized Blood—Brain-Barrier Disruption

    NASA Astrophysics Data System (ADS)

    Liu, Hao-Li; Hsu, Po-Hong; Wai, Yau-Yau; Chen, Jin-Chung; Yen, Tzu-Chen; Wang, Jiun-Jie

    2009-04-01

    High-intensity focused ultrasound has been discovered to be able to locally and reversibly increase the permeability of the blood—brain barrier (BBB), which can be detected using magnetic resonance imaging (MRI). However, side effects such as microhemorrhage, erythrocyte extravasations, or even extensive hemorrhage can also occur. Although current contrast-enhanced T1-weighted MRI can be used to detect the changes in BBB permeability, its efficacy in detecting tissue hemorrhage after focused-ultrasound sonication remains limited. The purpose of this study was to determine the feasibility of using MR susceptibility-weighted imaging (SWI) to identify tissue hemorrhage associated with the process of BBB permeability increase and characterize the safety window of acoustic pressure level. Brains of 42 Sprague-Dawley rats were subjected to 107 sonications either unilaterally or bilaterally. Contrast-enhanced T1-weighted images, together with SWI were performed. Tissue damage and hemorrhage were analyzed histologically with light microscopy and staining by Evan's blue, HE staining as well as TUNEL staining. Our results showed that contrast-enhanced T1 weighted imaging is sensitive to the presence of the BBB disrupture, but was unable to differentiate from extensive tissue damage such as hemorrhage. Also, SWI proved to be a superior tool for the realtime monitoring of the presence of hemorrhage, which is essential to the clinical concerns. The safety operation window in vivo in our study indicated a pressure of 0.78 to 1.1 MPa. to increase the BBB permeability successfully without hemorrhage. Potential applications such as drug delivery in the brain might be benefited.

  17. Advances in spike localization with EEG dipole modeling.

    PubMed

    Rose, Sandra; Ebersole, John S

    2009-10-01

    EEG interpretation by visual inspection of waveforms, using the assumption that activity at a given electrode is a representation of only the activity of the cortex immediately beneath it, has been the traditional form of EEG analysis since its inception. The relatively recent advent of digital EEG has allowed more advanced analysis of EEG data and has shown that the simple visual inspection described above is a simplistic form of analysis. This is especially true when one is attempting to localize an epileptogenic focus using EEG spikes or seizure onset data. Spatiotemporal analysis of scalp voltage fields has allowed for improved localization of likely cerebral origins of such waveforms. Equivalent dipole source modeling is one such technique and, although not perfect, provides improved characterization of spike and seizure sources as compared to previous methods when properly interpreted. The use of other modern techniques, such as 3D MRI reconstructions and realistic head models, can further improve accuracy of dipole localization and allow for the synthesis of EEG and imaging data, which may be invaluable, especially in cases of pre-surgical epilepsy evaluation.

  18. Description of Ictal HFO Mapping in Patients with Both Temporal and Extratemporal Seizure Focus

    PubMed Central

    Rusyniak, Walter G.

    2016-01-01

    Objective. Review presurgical use of ictal HFO mapping to detect ictal activation areas with dual seizure focus in both the temporal and extratemporal cortex. Methods. Review of consecutive patients admitted to the University of South Alabama Epilepsy Monitoring Unit (SouthCEP) between January 2014 and October 2015, with suspected temporal lobe epilepsy and intracranial electrode recording. Ictal HFO localization was displayed in 3D reconstructed brain images using the patient's own coregistered magnetic resonance imaging (MRI) and computed tomography (CT) with the implanted electrodes. Results. Four of fifteen patients showed evidence of extratemporal involvement at the onset of the clinical seizures. Ictal HFO mapping involving both frontal and temporal lobe changed the surgical resection areas in three patients where the initial surgical plan included only the temporal lobe. Resection of the ictal HFO at the onset of the seizure and the initial propagation region was associated with seizure freedom in all patients; follow-up period ranged from 12 to 25 months. Significance. Extratemporal ictal involvement may not have clinical manifestations and may account for surgical failure in temporal lobe epilepsy. Ictal HFO mapping is useful to define the ictal cortical network and may help detect an extratemporal focus. PMID:28018675

  19. Localized Down-regulation of P-glycoprotein by Focused Ultrasound and Microbubbles induced Blood-Brain Barrier Disruption in Rat Brain

    PubMed Central

    Cho, HongSeok; Lee, Hwa-Youn; Han, Mun; Choi, Jong-ryul; Ahn, Sanghyun; Lee, Taekwan; Chang, Yongmin; Park, Juyoung

    2016-01-01

    Multi-drug resistant efflux transporters found in Blood-Brain Barrier (BBB) acts as a functional barrier, by pumping out most of the drugs into the blood. Previous studies showed focused ultrasound (FUS) induced microbubble oscillation can disrupt the BBB by loosening the tight junctions in the brain endothelial cells; however, no study was performed to investigate its impact on the functional barrier of the BBB. In this study, the BBB in rat brains were disrupted using the MRI guided FUS and microbubbles. The immunofluorescence study evaluated the expression of the P-glycoprotein (P-gp), the most dominant multi-drug resistant protein found in the BBB. Intensity of the P-gp expression at the BBB disruption (BBBD) regions was significantly reduced (63.2 ± 18.4%) compared to the control area. The magnitude of the BBBD and the level of the P-gp down-regulation were significantly correlated. Both the immunofluorescence and histologic analysis at the BBBD regions revealed no apparent damage in the brain endothelial cells. The results demonstrate that the FUS and microbubbles can induce a localized down-regulation of P-gp expression in rat brain. The study suggests a clinically translation of this method to treat neural diseases through targeted delivery of the wide ranges of brain disorder related drugs. PMID:27510760

  20. Site-Specific Preparation of Intact Solid-Liquid Interfaces by Label-Free In Situ Localization and Cryo-Focused Ion Beam Lift-Out.

    PubMed

    Zachman, Michael J; Asenath-Smith, Emily; Estroff, Lara A; Kourkoutis, Lena F

    2016-12-01

    Scanning transmission electron microscopy (STEM) allows atomic scale characterization of solid-solid interfaces, but has seen limited applications to solid-liquid interfaces due to the volatility of liquids in the microscope vacuum. Although cryo-electron microscopy is routinely used to characterize hydrated samples stabilized by rapid freezing, sample thinning is required to access the internal interfaces of thicker specimens. Here, we adapt cryo-focused ion beam (FIB) "lift-out," a technique recently developed for biological specimens, to prepare intact internal solid-liquid interfaces for high-resolution structural and chemical analysis by cryo-STEM. To guide the milling process we introduce a label-free in situ method of localizing subsurface structures in suitable materials by energy dispersive X-ray spectroscopy (EDX). Monte Carlo simulations are performed to evaluate the depth-probing capability of the technique, and show good qualitative agreement with experiment. We also detail procedures to produce homogeneously thin lamellae, which enable nanoscale structural, elemental, and chemical analysis of intact solid-liquid interfaces by analytical cryo-STEM. This work demonstrates the potential of cryo-FIB lift-out and cryo-STEM for understanding physical and chemical processes at solid-liquid interfaces.

  1. Noninvasive localized delivery of Herceptin to the mouse brain by MRI-guided focused ultrasound-induced blood-brain barrier disruption

    NASA Astrophysics Data System (ADS)

    Kinoshita, Manabu; McDannold, Nathan; Jolesz, Ferenc A.; Hynynen, Kullervo

    2006-08-01

    Antibody-based anticancer agents are promising chemotherapeutic agents. Among these agents, Herceptin (trastuzumab), a humanized anti-human epidermal growth factor receptor 2 (HER2/c-erbB2) monoclonal antibody, has been used successfully in patients with breast cancer. However, in patients with brain metastasis, the blood-brain barrier limits its use, and a different delivery method is needed to treat these patients. Here, we report that Herceptin can be delivered locally and noninvasively into the mouse central nervous system through the blood-brain barrier under image guidance by using an MRI-guided focused ultrasound blood-brain barrier disruption technique. The amount of Herceptin delivered to the target tissue was correlated with the extent of the MRI-monitored barrier opening, making it possible to estimate indirectly the amount of Herceptin delivered. Histological changes attributable to this procedure were minimal. This method may represent a powerful technique for the delivery of macromolecular agents such as antibodies to treat patients with diseases of the central nervous system. brain tumor | microbubble

  2. Localized Down-regulation of P-glycoprotein by Focused Ultrasound and Microbubbles induced Blood-Brain Barrier Disruption in Rat Brain

    NASA Astrophysics Data System (ADS)

    Cho, Hongseok; Lee, Hwa-Youn; Han, Mun; Choi, Jong-Ryul; Ahn, Sanghyun; Lee, Taekwan; Chang, Yongmin; Park, Juyoung

    2016-08-01

    Multi-drug resistant efflux transporters found in Blood-Brain Barrier (BBB) acts as a functional barrier, by pumping out most of the drugs into the blood. Previous studies showed focused ultrasound (FUS) induced microbubble oscillation can disrupt the BBB by loosening the tight junctions in the brain endothelial cells; however, no study was performed to investigate its impact on the functional barrier of the BBB. In this study, the BBB in rat brains were disrupted using the MRI guided FUS and microbubbles. The immunofluorescence study evaluated the expression of the P-glycoprotein (P-gp), the most dominant multi-drug resistant protein found in the BBB. Intensity of the P-gp expression at the BBB disruption (BBBD) regions was significantly reduced (63.2 ± 18.4%) compared to the control area. The magnitude of the BBBD and the level of the P-gp down-regulation were significantly correlated. Both the immunofluorescence and histologic analysis at the BBBD regions revealed no apparent damage in the brain endothelial cells. The results demonstrate that the FUS and microbubbles can induce a localized down-regulation of P-gp expression in rat brain. The study suggests a clinically translation of this method to treat neural diseases through targeted delivery of the wide ranges of brain disorder related drugs.

  3. EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy.

    PubMed

    Coan, Ana C; Chaudhary, Umair J; Frédéric Grouiller; Campos, Brunno M; Perani, Suejen; De Ciantis, Alessio; Vulliemoz, Serge; Diehl, Beate; Beltramini, Guilherme C; Carmichael, David W; Thornton, Rachel C; Covolan, Roberto J; Cendes, Fernando; Lemieux, Louis

    2016-06-01

    Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome. 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during video-EEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection. The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (χ(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively. The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  4. A randomized control trial investigating the effect of presurgical orthopedics on feeding in infants with cleft lip and/or palate.

    PubMed

    Masarei, A G; Wade, A; Mars, M; Sommerlad, B C; Sell, D

    2007-03-01

    To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate. Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized. The North Thames Regional Cleft Centre. Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment. At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: -0.45 (95% confidence interval [-1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [-0.95, 4.91]). None of the differences were statistically significant at either age. Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.

  5. Cerebrovascular reactivity mapping in patients with low grade gliomas undergoing presurgical sensorimotor mapping with BOLD fMRI.

    PubMed

    Zacà, Domenico; Jovicich, Jorge; Nadar, Sreenivasan R; Voyvodic, James T; Pillai, Jay J

    2014-08-01

    (i) to validate blood oxygenation level dependent (BOLD) breathhold cerebrovascular reactivity (BH CVR) mapping as an effective technique for potential detection of neurovascular uncoupling (NVU) in a cohort of patients with perirolandic low grade gliomas undergoing presurgical functional MRI (fMRI) for sensorimotor mapping, and (ii) to determine whether NVU potential, as assessed by BH CVR mapping, is prevalent in this tumor group. We retrospectively evaluated 12 patients, with histological diagnosis of grade II glioma, who performed multiple motor tasks and a BH task. Sensorimotor activation maps and BH CVR maps were compared in two automatically defined regions of interest (ROIs), ipsilateral to the lesion (i.e., ipsilesional) and contralateral to the lesion (i.e., contralesional). Motor task mean T-value was significantly higher in the contralesional ROIs (6.00 ± 1.74 versus 4.34 ± 1.68; P = 0.00004) as well as the BH mean T-value (4.74 ± 2.30 versus 4.09 ± 2.50; P = 0.009). The number of active voxels was significantly higher in the contralesional ROIs (Z = 2.99; P = 0.03). Actual NVU prevalence was 75%. Presurgical sensorimotor fMRI mapping can be affected by NVU-related false negative activation in low grade gliomas (76% of analyzed tasks). © 2013 Wiley Periodicals, Inc.

  6. Cerebrovascular reactivity mapping in patients with low grade gliomas undergoing presurgical sensorimotor mapping with BOLD fMRI

    PubMed Central

    Zacà, Domenico; Jovicich, Jorge; Nadar, Sreenivasan R.; Voyvodic, James T.; Pillai, Jay J.

    2013-01-01

    Purpose i) to validate Blood Oxygenation Level Dependent (BOLD) breath hold cerebrovascular reactivity mapping (BH CVR) as an effective technique for potential detection of neurovascular uncoupling (NVU) in a cohort of patients with perirolandic low grade gliomas undergoing presurgical functional magnetic resonance imaging (fMRI) for sensorimotor mapping, and ii) to determine whether NVU potential, as assessed by BH CVR mapping, is prevalent in this tumor group. Materials and Methods We retrospectively evaluated 12 patients, with histological diagnosis of grade II glioma, who performed multiple motor tasks and a BH task. Sensorimotor activation maps and BH CVR maps were compared in two automatically defined regions of interest (ROIs), ipsilateral to the lesion (i.e., ipsilesional) and contralateral to the lesion (i.e., contralesional). Results Motor task mean T-value was significantly higher in the contralesional ROIs (6.00±1.74 vs 4.34±1.68, p=0.00004) as well as the BH mean T-value (4.74±2.30 vs 4.09±2.50, p=0.009). The number of active voxels was significantly higher in the contralesional ROIs (Z=2.99, p=0.03). Actual NVU prevalence was 75%. Conclusion Presurgical sensorimotor fMRI mapping can be affected by NVU-related false negative activation in low grade gliomas (76% of analyzed tasks). PMID:24338845

  7. A novel active intraoral appliance for presurgical orthopaedic treatment in patients with complete bilateral cleft lip and palate.

    PubMed

    Kiya, Koichiro; Oyama, Tomoki; Sone, Yumiko; Ishii, Nobuyuki; Hosokawa, Ko

    2015-05-01

    Management of the protruding/deviated premaxilla in patients with complete bilateral cleft lip and palate is a challenging problem for surgeons and orthodontists. Various passive and active methods have been developed for the presurgical orthopaedic treatment. However, most of these treatments are complicated and laborious for the patient's parents and clinicians. Here, we describe our original active intraoral appliance comprising two components, that is, the premaxillary and palatine process plates, connected with two elastic chains, and we assess its therapeutic efficacy. We retrospectively evaluated 15 patients treated using this appliance during 2006-2012, followed up for an average of 60.3 months (range, 18-97 months). We analysed the cleft widths and maxillary size, obtained pretreatment, post-treatment and pre-palatoplasty. Cleft widths and premaxillary protrusion were significantly decreased post treatment; however, the transverse dimensions were not significantly altered. In all cases, the protruding/deviated premaxilla was set into a suitable position within 1 month, and we could perform one-stage cheiloplasty using the modified Mulliken method with low tension. Our appliance is technically simple to use, less invasive to the skin and bone and cost-effective, with reliable and predictable outcomes. In the follow-up period, we observed no detrimental growth of the maxilla or dentition. Therefore, we consider our appliance to be useful for application in presurgical orthopaedic treatments of complete bilateral cleft lip and palate. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. High-intensity focused ultrasound (HIFU) using Sonablate{trade mark, serif} devices for the treatment of localized prostate cancer: 13-year experience

    NASA Astrophysics Data System (ADS)

    Uchida, Toyoaki; Tomonaga, Tetsuro; Shoji, Sunao; Kim, Hakushi; Nagata, Yoshihiro

    2012-11-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Eight hundred and eighty-four men with prostate cancer treated with Sonablate® (SB) devices were included. All patients were followed for more than 2 years. The patients were divided into three groups: in the first group, 419 patients were treated with SB200/500 from 1999 to 2006; in the second group, 263 patients were treated with SB 500 ver. 4 from 2005 to 2009: in the third group, 202 patients were treated with SB 500 TCM from 2007 up to present. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/ml). The mean age, PSA, Gleason score, operation time, and follow-up period in each group were 68, 66 and 67 years, 11.2, 9.7 and 9.3 ng/ml, 6.2, 6.6 and 6.7, 167, 101 and 106 min, and 56, 48 and 36 months, respectively. The biochemical disease-free rate (bDFR) in each group at 5 years was, respectively, 54%, 61% and 84%, and was 50% at 10 years in the SB200/500 group (p<0.0001). The bDFR in patients in the low-, intermediate-, and high-risk groups in all patients at 10 years were 72% and 58%, 44%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the SB500 TCM group at 5 years were 97%, 83%, and 74% (p=0.0056). The negative prostate biopsy rates in 3 groups were 81%, 92% and 88%, respectively. As post HIFU complications, urethral stricture, acute epididymitis and urinary incontinence were noted in 18.0%, 6.2% and 1.9%, respectively. Rectourethral fistula was occurred in 0.6% in the first HIFU cases, Postoperative erectile dysfunction was noted in 27% of patients at 2 years after HIFU. HIFU therapy appears to be minimally invasive, efficacious, and safe for patients with localized prostate cancer. Technological advances as well as cultural and economic vectors have caused a shift from to minimally invasive techniques.

  9. Ten-year Biochemical Disease-free Survival After High-intensity Focused Ultrasound (HIFU) for Localized Prostate Cancer: Comparison with Four Different Generation Devices

    SciTech Connect

    Uchida, T.; Nakano, M.; Shoji, S.; Omata, T.; Harano, Y.; Nagata, Y.; Usui, Y.; Terachi, T.

    2010-03-09

    HIFU has been recognized as a minimally invasive treatment option for localized prostate cancer. The purpose of the study was to assess with a long-term outcome of HIFU for prostate cancer. From January 1999, a total of 657 patients who had HIFU with at least 2 year follow-up were treated with four different types of Sonablate registered (Focus Surgery, Indianapolis, USA) devices. Thirty-three patients were treated with Sonablate registered 200 (S200) from 1999 to 2001, 406 patients with Sonablate registered 500 (S500) from 2001 to 2005, 200 patients with Sonablate registered 500 version 4 (V4) from 2005-2008 and 19 patients with Sonablate registered 500 TCM (TCM) from 2007. Biochemical disease-free survival rate (bDFS) in all patients was 59% in 8 years. bDFS in 8 years in patients with S200 and S500 groups were 55% and 56%, and bDFS in 4 and 2 years in patients with V4 and TCM group were 72% and 84%, respectively. bDFS in low, intermediate, and high risk groups were 75%, 54%, and 43% in S200/S500 and 93%, 72%, and 58% in V4/TCM group. Negative prostate biopsy rate after HIFU was 97% in S200, 79% in S500, 94% in V4 and 100% in TCM group. HIFU as primary therapy for prostate cancer is indicated in patients with low- and intermediate-risk (T1-T2b N0M0 disease, a Gleason score of <=7, a PSA level of <20 ng/mL) and a prostate volume of less than 40 mL. The rate of clinical outcome has significantly improved over the years due to technical improvements in the device.

  10. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions.

    PubMed

    Weston, Matthew; Weston, Kathryn L; Prentis, James M; Snowden, Chris P

    2016-01-01

    The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training-which involves brief bouts of intense exercise interspersed with longer recovery periods-the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential

  11. Clinical and histopathological effects of presurgical treatment with sunitinib for renal cell carcinoma with inferior vena cava tumor thrombus at a single institution.

    PubMed

    Ujike, Takeshi; Uemura, Motohide; Kawashima, Atsunari; Nagahara, Akira; Fujita, Kazutoshi; Miyagawa, Yasushi; Nonomura, Norio

    2016-11-01

    To evaluate the clinical and histopathological effects of presurgical treatment with sunitinib on inferior vena cava (IVC) tumor thrombus. Between 2010 and 2014, we treated seven patients with renal cell carcinoma and IVC tumor thrombus presurgically with sunitinib. We retrospectively evaluated primitive tumor size, the level of tumor thrombus according to Novick's classification, its distance above the renal vein, thrombus diameter at its widest segment, and histopathological change after sunitinib treatment. Three patients were diagnosed histologically. Percutaneous biopsy of the renal mass before sunitinib treatment was performed in two patients. One patient was diagnosed after sunitinib treatment following nephrectomy. The primitive tumors shrank upon sunitinib therapy in four cases; however, although the caval thrombus was downstaged (from level II to I) in one patient, the level of caval thrombus did not change in five patients and increased in one patient (from level III to IV). We evaluated the histopathological effects in two patients. In one patient, the IVC tumor thrombus was mostly replaced with necrotic tissue, but its thrombus level was not downstaged. In the other patient, the IVC tumor thrombus was downstaged, but tumor thrombus was not replaced with necrotic tissue and viable tumor cells remained. Presurgical treatment with sunitinib for renal cell carcinoma with IVC tumor thrombus appears to have limited effect on IVC tumor thrombus, in contrast to its effects on primitive tumor shrinkage. In the absence of evidence of presurgical benefits from prospective studies, this treatment may not be systematically advisable.

  12. Presurgical orthopaedic nasoalveolar molding in cleft lip and palate infants: a comparative evaluation of cases done with and without nasal stents.

    PubMed

    Punga, Rohit; Sharma, S M

    2013-09-01

    Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2-3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.

  13. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research.

    PubMed

    van der Heijden, Perry; Dijkstra, Pieter U; Stellingsma, Cees; van der Laan, Bernard F; Korsten-Meijer, Astrid G W; Goorhuis-Brouwer, Sieneke M

    2013-01-01

    In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term. A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch. The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects. Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding. Therapeutic, III.

  14. Surgeons’ Assessment of Presurgical Clefts and Predicted Surgical Outcome in Patients Treated with and without Nasoalveolar Molding

    PubMed Central

    Rubin, Marcie S.; Clouston, Sean; Ahmed, Mohammad M.; Lowe, Kristen; Shetye, Pradip R.; Broder, Hillary L.; Warren, Stephen M.; Grayson, Barry H.

    2014-01-01

    Obtaining an aesthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging due to tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons’ assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n=10) and BCLP (n=10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM and five did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid email addresses responded to the survey. For patients with UCLP, surgeons reported that for NAM-prepared patients 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM to non-NAM prepared patients showed statistically significant differences (p < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared to patients not prepared with NAM. PMID:25534051

  15. Comparing Stability of Mandibular Setback Versus 2-Jaw Surgery in Class III Patients With Minimal Presurgical Orthodontics.

    PubMed

    Larson, Brent E; Lee, Nam-Ki; Jang, Moon-Jung; Yun, Pil-Young; Kim, Jong-Wan; Kim, Young-Kyun

    2017-06-01

    The aim of this study was to compare treatment time and skeletal stability between mandibular setback surgery (MS) and 2-jaw surgery (2J) with minimal presurgical orthodontics (MPO) in patients with skeletal Class III. One hundred ninety-five patients who underwent orthognathic surgery were enrolled in this retrospective cohort study. Consecutive patients were selected based on standardized inclusion criteria: Class III malocclusion with mandibular prognathism, surgery type, and presurgical orthodontics with non-extraction for less than 6 months (MPO). Lateral cephalograms were taken before surgery (T0), 1 month after surgery (T1), and at debonding (T2). To evaluate surgical changes (T0 to T1) and postsurgical changes (T1 to T2) in skeletodental tissue, linear, angular, and dental measurements were analyzed using paired t test and independent t test. Thirty-one patients were allocated to the MS-MPO group (n = 16) and the 2J-MPO group (n = 15). The 2J-MPO group showed a shorter duration of postsurgical orthodontic and total surgical and orthodontic treatment than the MS-MPO group. Although the 2J-MPO group exhibited advancement and superior impaction of the maxilla from T0 to T1, posterior movement with clockwise rotation of the mandible between the 2 groups did not show a statistical difference. In addition, from T1 to T2, the MS-MPO and 2J-MPO groups presented forward and upward movement and counterclockwise rotation of the mandible, but no intergroup difference was found. The MS-MPO and 2J-MPO groups showed similar horizontal and vertical mandibular stability. However, the 2J-MPO group presented a shorter surgical and orthodontic treatment time than the MS-MPO group. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Presurgical evaluation of pediatric epilepsy patients prior to hemispherotomy: the prognostic value of (18)F-FDG PET.

    PubMed

    Traub-Weidinger, Tatjana; Weidinger, Philip; Gröppel, Gundrun; Karanikas, Georgios; Wadsak, Wolfgang; Kasprian, Gregor; Dorfer, Christian; Dressler, Anastasia; Muehlebner, Angelika; Hacker, Marcus; Czech, Thomas; Feucht, Martha

    2016-12-01

    OBJECTIVE The objective of this study was to investigate whether fluorine-18 fluorodeoxyglucose PET ((18)F-FDG PET) can help to predict seizure outcome after hemispherotomy and therefore may be useful in decision making and patient selection. METHODS Children and adolescents less than 18 years of age who underwent (18)F-FDG PET studies during presurgical evaluation prior to hemispherotomy and had follow-up data of at least 12 months after surgery were included. Seizure outcome was classified according to the recommendations of the International League Against Epilepsy. PET data were reevaluated by two specialists in nuclear medicine blinded to clinical data and to MRI. MRI studies were also reinterpreted visually by an experienced neuroradiologist blinded to clinical data and PET findings. RESULTS Thirty-five patients (17 girls) with a median age of 5 years (range 0.4-17.8 years) were evaluable. Of the 35 patients, 91.4% were seizure free after surgery, including 100% of those with unilateral (18)F-FDG-PET hypometabolism compared with only 75% of those with bilateral hypometabolism. With respect to MRI, seizure freedom after surgery was observed in 96.4% of the patients with unilateral lesions compared with only 71.4% in those with bilateral MRI lesions. The best seizure outcomes were noted in patients with unilateral findings in both PET and MRI (100% seizure freedom) whereas only 50% of those with bilateral findings in both imaging techniques were seizure free. Furthermore, 100% of the patients with unilateral PET hypometabolism and bilateral MRI findings were also seizure free, but only 87.5% of those with bilateral PET hypometabolism and unilateral MRI findings. CONCLUSIONS According to these results, candidate selection for hemispherotomy can be optimized by the use of (18)F-FDG PET as part of a multimodal presurgical evaluation program, especially in patients with inconsistent (bilateral) MRI findings.

  17. Single-session primary high-intensity focused ultrasonography treatment for localized prostate cancer: biochemical outcomes using third generation-based technology.

    PubMed

    Pinthus, Jehonathan H; Farrokhyar, Forough; Hassouna, Magdy M; Woods, Edward; Whelan, Kaitlyn; Shayegan, Bobby; Orovan, William L

    2012-10-01

    What's known on the subject? and What does the study add? The experience with HIFU as a minimally invasive treatment for localized prostate cancer is relatively new and most reports are from European centres. Our study is unique in five regards: 1. Data was collected prospectively. 2. All patients were treated with contemporary technology. 3. Outcomes are reported after a single HIFU session using two definitions of biochemical failure that have the ability to predict longer-term clinical failure after primary ablative therapies for prostate cancer (Stuttgart definition for HIFU and Horwitz definition for radiation). 4. All patients were treated in a single centre. 5. No patients underwent peri-HIFU TURP. The present study represents the largest North American prospective cohort of primary HIFU for prostate cancer with mid-term oncological outcome data. To assess 4-year biochemical failure (BCF) rates in patients after high-intensity focused ultrasonography (HIFU) treatment using the Horwitz and Stuttgart definitions. A total of 447 consecutive patients were treated with a single session of HIFU between May 2005 and December 2010. Follow-up included prostate-specific antigen (PSA) measurement every 3 months during the first year and every 6 months thereafter. Patients who had previously received radiation, androgen deprivation or HIFU therapy, and patients with <2 consecutive PSA measurements were excluded. BCF was reported using the Stuttgart (PSA nadir + 1.2 ng/mL rising) and the Horwitz (two consecutive increases of at least 0.5 ng/mL) definitions. In all, 402 patients met the inclusion criteria and the median (range) follow-up was 24 (6-48) months. Of these patients, 183 (45.5%) had low and 219 (54.5%) had intermediate D'Amico's risk stratification disease. Mean and median absolute PSA nadir levels were 0.36 ± 0.69 and 0.1 ng/mL (Q(1):0, Q(3):0.37), respectively and these were achieved in median time of 3 months. Overall 4-year mean (range) BCF-free rates were

  18. Collaboration of local government and experts responding to increase in environmental radiation level due to the nuclear disaster: focusing on their activities and latest radiological discussion.

    PubMed

    Iimoto, T; Nunokawa, J; Fujii, H; Takashima, R; Hashimoto, M; Fukuhara, T; Yajima, T; Matsuzawa, H; Kurosawa, K; Yanagawa, Y; Someya, S

    2015-11-01

    Activities were introduced in Kashiwa city in the Tokyo metropolitan area to correspond to the elevated environmental radiation level after the disaster of the Fukushima Daiichi nuclear power plant. These were based on a strong cooperation between local governments and experts. Ambient dose rate and radioactivity of foodstuff produced inside of the city have been monitored. Representative ambient dose rates around living environments have almost already become their original levels of the pre-accident because of the decontamination activity, natural washout and effective half-lives of radioactivity. The internal annual dose due to radioactive cesium under the policy of 'Local Production for Local Consumption' is estimated as extremely low comparing the variation range due to natural radioactivity. Systematic survey around a retention basin has been started. All of these latest monitoring data would be one of the core information for the policy making as well as a cost-benefit discussion and risk communication.

  19. A novel model evaluation approach focusing on local and advected contributions to urban PM2.5 levels - application to Paris, France

    NASA Astrophysics Data System (ADS)

    Petetin, H.; Beekmann, M.; Sciare, J.; Bressi, M.; Rosso, A.; Sanchez, O.; Ghersi, V.

    2014-07-01

    Aerosol simulations in chemistry transport models (CTMs) still suffer from numerous uncertainties, and diagnostic evaluations are required to point out major error sources. This paper presents an original approach to evaluate CTMs based on local and imported contributions in a large megacity rather than urban background concentrations. The study is applied to the CHIMERE model in the Paris region (France) and considers the fine particulate matter (PM2.5) and its main chemical constituents (elemental and organic carbon, nitrate, sulfate and ammonium), for which daily measurements are available during a whole year at various stations (PARTICULES project). Back-trajectory data are used to locate the upwind station, from which the concentration is identified as the import, the local production being deduced from the urban concentration by subtraction. Uncertainties on these contributions are quantified. Small biases in urban background PM2.5 simulations (bias of +16%) hide significant error compensations between local and advected contributions, as well as in PM2.5 chemical compounds. In particular, winter time organic matter (OM) imports appear strongly underestimated while local OM and elemental carbon (EC) production is overestimated all along the year. Erroneous continental wood burning emissions and missing secondary organic aerosol (SOA) pathways may explain errors on advected OM, while the carbonaceous compounds is likely to be related to errors in emissions and dynamics. A statistically significant local formation of nitrate is also highlighted from observations, but missed by the model. Together with the overestimation of nitrate imports, it leads to a bias of +51% on the local PM2.5 contribution. Such an evaluation finally gives more detailed insights on major gaps in current CTMs on which future efforts are needed.

  20. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    NASA Astrophysics Data System (ADS)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  1. US Public Health Agency involvement in youth-focused illicit drug policy, planning, and prevention at the local level, 1999-2003.

    PubMed

    McBride, Duane C; Terry-McElrath, Yvonne M; VanderWaal, Curtis J; Chriqui, Jamie F; Myllyluoma, Jana

    2008-02-01

    We examined local public health agencies' involvement in community illicit drug policy advocacy and provision related to youths to determine the extent to which public health agencies were involved in local drug policy activities and could potentially provide an infrastructure for policy alternatives. We conducted telephone interviews from 1999 to 2003 with 1793 US public health agencies in 804 communities surrounding schools participating in the Monitoring the Future study. Respondents reported public health agency planning, priorities, and involvement in alternative drug policy advocacy and prevention activities. We examined results for variance by site sociodemographic characteristics. Most students lived where public health agencies provided resources for community- and school-based drug use prevention. More than one third resided where public health agencies advocated for drug policy alternatives and more than one quarter where public health agencies were involved in juvenile drug court programs. Such activities were significantly higher in urban communities, in the West, and in sites where the proportion of African Americans was above the national average. Although local public health agencies could increase participation levels in drug policy alternatives, current involvement suggests that agencies may provide a base for supporting the development of public health alternatives to deterrence-based drug policies. Such a base may be more likely in communities with the highest need for such policies and services.

  2. Cross-correlation focus method with an electrostatic sensor array for local particle velocity measurement in dilute gas-solid two-phase flow

    NASA Astrophysics Data System (ADS)

    Wang, Chao; Zhang, Jingyu; Gao, Wenbin; Ding, Hongbing; Wu, Weiping

    2015-11-01

    The gas-solid two-phase flow has been widely applied in the power, chemical and metallurgical industries. It is of great significance in the research of gas-solid two-phase flow to measure particle velocity at different locations in the pipeline. Thus, an electrostatic sensor array comprising eight arc-shaped electrodes was designed. The relationship between the cross-correlation (CC) velocity and the distribution of particle velocity, charge density and electrode spatial sensitivity was analysed. Then the CC sensitivity and its calculation method were proposed. According to the distribution of CC sensitivity, it was found that, between different electrode pairs, it had different focus areas. The CC focus method was proposed for particle velocity measurement at different locations and validated by a belt-style electrostatic induction experiment facility. Finally, the particle velocities at different locations with different flow conditions were measured to research the particle velocity distribution in a dilute horizontal pneumatic conveying pipeline.

  3. An in silico approach for pre-surgical evaluation of an epileptic cortex.

    PubMed

    Sinha, Nishant; Dauwels, Justin; Wang, Yujiang; Cash, Sydney S; Taylor, Peter N

    2014-01-01

    Clinical evidence indicates that a third of patients with epilepsy are refractory to anti-epileptic drug treatment. For some of these patients better seizure control can be achieved by surgical treatment in which the seizure focus is localised and resected while avoiding injury to crucial cortical tissues. In this paper, non-seizure (interictal) epoch of electrographic recording was used to calculate the functional synchrony between different cortical regions. This synchrony measure was then used as the connectivity parameter in a computational model of transitions to a seizure like state. The seizure focus was localised using this model and the surgical intervention procedure was simulated. It was shown that the in silico removal of a subset of seizure focus can decrease the likelihood of a seizure in the model. The in silico results were also compared with the clinical outcomes and a convincing agreement was shown for five out of six patients; sixth being a counter-example. These methods may aid in the identification of the seizure onset zone using the interictal electrographic data. Moreover, it may facilitate neurosurgeons to investigate alternative cortical tissues to operate on if the seizure focus cannot be operated.

  4. Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: a clinical report.

    PubMed

    Kamble, Vaibhav D; Parkhedkar, Rambhau D; Sarin, Soumil P; Patil, Pravinkumar G; Kothari, Bhavesh

    2013-07-01

    A 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention. The alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate. As a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM. Copyright © 2013 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  5. Diagnostic techniques to detect the epileptogenic zone: Pathophysiological and presurgical analysis of epilepsy in dogs and cats.

    PubMed

    Hasegawa, Daisuke

    2016-09-01

    The use and availability of magnetic resonance imaging (MRI) and other neurosurgical devices is rapidly increasing in the field of veterinarian medicine. Coincident with these technological advances, there is an increased expectation to treat drug resistant epilepsy in dogs and cats by epilepsy surgery. However, the presurgical evaluation of epileptic animals, by using methodologies to detect the epileptogenic zone for example, have yet to become established in common practice. The epileptogenic zone, defined as the minimum amount of cortex to produce seizure freedom, consists of five conceptual cortical abnormal 'zones': symptomatogenic, irritative, seizure-onset, structurally abnormal (epileptogenic lesion) and functional deficit. These zones can now be detected by suitable modalities including ictal video monitoring, interictal non-invasive or invasive electroencephalography (EEG), ictal video-EEG, magnetoencephalography, structural and functional MRIs, or nuclear imaging. These diagnostic techniques are essential for selecting both appropriate patients and surgical techniques, and are also important in understanding the pathophysiology of epilepsy. This review describes the diagnostic techniques available for detecting each abnormal zone while considering the current veterinary status to realise future surgery for canine and feline epilepsy. Copyright © 2016 The Author. Published by Elsevier Ltd.. All rights reserved.

  6. Effects of presurgical exercise training on quality of life in patients undergoing lung resection for suspected malignancy: a pilot study.

    PubMed

    Peddle, Carolyn J; Jones, Lee W; Eves, Neil D; Reiman, Tony; Sellar, Christopher M; Winton, Timothy; Courneya, Kerry S

    2009-01-01

    The aim of this study was to explore the effects of presurgical exercise training on quality of life (QOL) in patients with malignant lung lesions. Using a single-group prospective design, patients were enrolled in supervised aerobic exercise training for the duration of surgical wait time (mean 59.7 days). Participants completed assessments of cardiorespiratory fitness (peak oxygen consumption) and QOL using the Functional Assessment of Cancer Therapy-Lung scales, including the trial outcome index (TOI) and the lung cancer subscale (LCS) at baseline, immediately presurgery, and postsurgery (mean, 57 days). 9 participants provided complete data. Repeated-measures analysis indicated a significant effect for time on TOI (P = .006) and LCS (P = .009). Paired analysis revealed that QOL was unchanged after exercise training (ie, baseline to presurgery), but there were significant and clinically meaningful declines from presurgery to postsurgery in the LCS (-3.6, P = .021) and TOI (-8.3, P = .018). Change in peak oxygen consumption from presurgery to postsurgery was significantly associated with change in the LCS (r = 0.70, P = .036) and TOI (r = 0.70, P = .035). Exercise training did not improve QOL from baseline to presurgery. Significant declines in QOL after surgery seem to be related to declines in cardiorespiratory fitness. A randomized controlled trial is needed to further investigate these relationships.

  7. An intelligibility assessment of toddlers with cleft lip and palate who received and did not receive presurgical infant orthopedic treatment.

    PubMed

    Konst, E M; Weersink-Braks, H; Rietveld, T; Peters, H

    2000-01-01

    A randomized, prospective, clinical study was performed investigating the effects of presurgical infant orthopedic treatment (PIO) in children with unilateral cleft lip and palate (UCLP). The influence of PIO on speech intelligibility was evaluated with two groups, each consisting of 10 children with UCLP. One group used PIO during the first year of life, whereas the other group did not use the device. Eight children without cleft served as a second control group. Intelligibility was assessed by lay listeners using two methods: transcription and listener rating. The ratings proved to be reliable and to have sufficient validity, but they did not completely reflect intelligibility defined as the proportion of words understood by the listener. Children in the treatment group were rated as exhibiting greater intelligibility than those in the nontreatment group. However, data obtained by means of transcriptions indicated that, in fact, there were no group differences in actual intelligibility. Only in comparison with their noncleft peers were the children with cleft lip and palate significantly less well understood.

  8. Long-Term Treatment Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate

    PubMed Central

    Clark, Stacey L.; Teichgraeber, John F.; Fleshman, Ruth G.; Shaw, Joi D.; Chavarria, Carmen; Kau, Chung-How; Gateno, Jaime; Xia, James J.

    2015-01-01

    Purpose The purpose of this study was to evaluate the long-term effectiveness of presurgical nasoalveolar molding (PNAM) in patients with unilateral cleft lip and palate (UCLP). Methods Twenty-five patients with UCLP treated by either PNAM or non-PNAM therapy between 1998 and 2003 were recruited in the study. During the clinical examination and data analysis, the evaluators were blinded to which patients received PNAM. The patients were reviewed clinically, and their facial morphology was captured with a three-dimensional scanner. Their dental arch configuration and occlusion were recorded by plaster dental models. After the patient evaluations and measurements were completed, the patient list was unblinded. There were 20 patients in the PNAM group and 5 patients in the non-PNAM group. Fisher exact tests and Wilcoxon rank sum tests were used to compare the outcomes. Results Clinically, the improvement in the PNAM group was most evident in nasal and lip anatomy. However, there were no statistically significant differences between the 2 groups on each of the measurements on three-dimensional facial images and dental models. Conclusions Our study suggests a trend toward a long-term clinical improvement in nasal and lip anatomy of UCLP patients treated with PNAM. However, these improved results were not confirmed by three-dimensional stereophotography. There was no statistically significant difference in the long-term three-dimensional anthropometric measurements and dental model analysis between the PNAM group and the non-PNAM group. PMID:21239929

  9. Clinical recommendation for treatment planning of sinus augmentation procedures by using presurgical CAT scan images: a preliminary report.

    PubMed

    Kutkut, Ahmad M; Andreana, Sebastiano; Kim, Hyeong-Ll; Monaco, Edward

    2011-12-01

    To propose a clinical recommendation based on anatomy of maxillary sinus before sinus augmentation procedure using presurgical computerized axial tomography (CAT) scan images. CAT scan images were randomly selected from previous completed implant cases. Proposed area for the lateral window osteotomy was outlined on the panorex image of the CAT scan. Sagittal section on the CAT scan that was in the center of the outlined window was selected for sinus measurement analysis. On CAT scan, 2 lines were drawn to measure the dimensions of sinus. One line measured the horizontal width and the other line measured the vertical height. Based on the measurement data, a classification of the maxillary sinus anatomy was proposed. Narrow sinus cavity indicates favorable type anatomy in terms of bone regeneration healing and wide sinus cavity as less favorable anatomy for patient treatment planning. A narrow sinus and greater exposure to the blood supply should require shorter healing times after grafting. Conversely, wider sinus cavities and less exposure to the blood supply would require a longer healing time before implant placement.

  10. Perception of local inhabitants regarding the socioeconomic impact of tourism focused on provisioning wild dolphins in Novo Airão, Central Amazon, Brazil.

    PubMed

    Alves, Luiz C P S; Zappes, Camilah A; Oliveira, Rafael G; Andriolo, Artur; Azevedo, Alexandre de F

    2013-01-01

    Botos (Inia geoffrensis) are currently provisioned for use in tourist attractions in five sites in the Brazilian Amazon. Despite the known negative effects associated with human-wild dolphin interactions, this activity has been regulated and licensed in the Anavilhanas National Park in Novo Airão, Amazonas State, Brazil. We present an updated evaluation of the perception of the local community concerning the possible socioeconomic impacts of this tourism in Novo Airão. In April 2011, 45 interviews were conducted with inhabitants. A small segment of Novo Airão perceives currently itself as being economically dependent on the botos feeding tourism. Despite that, the economic benefits of this controversial activity apparently are not shared among most inhabitants, and botos feeding tourism is perceived as generating diverse negative effects. We conclude that if the activity was banned or modified into a less impacting tourist activity, this action would probably not majorly affect the lives of the general population.

  11. Local control of magnetic damping in ferromagnetic/non-magnetic bilayers by interfacial intermixing induced by focused ion-beam irradiation

    SciTech Connect

    King, J. A.; Burn, D. M.; Sallabank, E. A.; Hindmarch, A. T.; Atkinson, D. E-mail: abarman@bose.res.in; Ganguly, A.; Pal, S.; Barman, A. E-mail: abarman@bose.res.in; Hase, T. P. A.

    2014-06-16

    The influence of interfacial intermixing on the picosecond magnetization dynamics of ferromagnetic/non-magnetic thin-film bilayers was studied. Low-dose focused-ion-beam irradiation was used to induce intermixing across the interface between a 10 nm Ni{sub 81}Fe{sub 19} layer and a 2–3 nm capping layer of either Au or Cr. Time-resolved magneto-optical Kerr effect was used to study magnetization dynamics as a function of ion-beam dose. With an Au cap, the damping of the un-irradiated bilayer was comparable with native Ni{sub 81}Fe{sub 19} and increased with increasing ion dose. In contrast, for Ni{sub 81}Fe{sub 19}/Cr the damping was higher than that for native Ni{sub 81}Fe{sub 19}, but the damping decreased with increasing dose.

  12. Biochemical diagnosis, localization and management of pheochromocytoma: focus on multiple endocrine neoplasia type 2 in relation to other hereditary syndromes and sporadic forms of the tumour.

    PubMed

    Pacak, K; Ilias, I; Adams, K T; Eisenhofer, G

    2005-01-01

    Approximately 50% of patients with multiple endocrine neoplasia (MEN) 2A or 2B develop pheochromocytoma. These tumours are almost exclusively benign and localized in the adrenal glands. About one-third are bilateral at initial diagnosis. Amongst patients with pheochromocytoma, those with MEN 2A have subtler symptoms compared to those with sporadic disease. Since pheochromocytomas in patients with MEN 2 often secrete catecholamines episodically (but metabolize them continuously to metanephrines), the first choice for biochemical diagnosis is the measurement of free metanephrines in plasma, with urinary fractionated metanephrines being the second choice. In patients with pheochromocytomas that produce exclusively normetanephrine, MEN 2 can be excluded. In patients with biochemically proven MEN 2-related pheochromocytoma, anatomical imaging of the adrenals (with either computerized tomography or magnetic resonance) should be obtained next. Functional imaging with specific ligands (e.g. scintigraphy with [(123)I]-metaiodobenzylguanidine or, if available, positron emission tomography with [(18)F]-fluorodopamine, [(18)F]-dihydroxyphenylalanine, [(11)C]-adrenaline or [(11)C]-hydroxyephedrine) may then be particularly useful in patients with distorted anatomy from previous surgery, in cases of equivocal biochemical data despite high clinical suspicion for a tumour, to rule out multifocal disease, or where there is suspicion of metastatic disease (e.g. tumours larger than 5 cm). Laparoscopic surgery is the treatment of choice and subtotal (cortical-sparing) adrenalectomy is the procedure of choice in bilateral pheochromocytomas.

  13. Ion focusing

    DOEpatents

    Cooks, Robert Graham; Baird, Zane; Peng, Wen-Ping

    2017-01-17

    The invention generally relates to apparatuses for focusing ions at or above ambient pressure and methods of use thereof. In certain embodiments, the invention provides an apparatus for focusing ions that includes an electrode having a cavity, at least one inlet within the electrode configured to operatively couple with an ionization source, such that discharge generated by the ionization source is injected into the cavity of the electrode, and an outlet. The cavity in the electrode is shaped such that upon application of voltage to the electrode, ions within the cavity are focused and directed to the outlet, which is positioned such that a proximal end of the outlet receives the focused ions and a distal end of the outlet is open to ambient pressure.

  14. Ion focusing

    SciTech Connect

    Cooks, Robert Graham; Baird, Zane; Peng, Wen-Ping

    2015-11-10

    The invention generally relates to apparatuses for focusing ions at or above ambient pressure and methods of use thereof. In certain embodiments, the invention provides an apparatus for focusing ions that includes an electrode having a cavity, at least one inlet within the electrode configured to operatively couple with an ionization source, such that discharge generated by the ionization source is injected into the cavity of the electrode, and an outlet. The cavity in the electrode is shaped such that upon application of voltage to the electrode, ions within the cavity are focused and directed to the outlet, which is positioned such that a proximal end of the outlet receives the focused ions and a distal end of the outlet is open to ambient pressure.

  15. An Evaluation of Hemi-Ablation Therapy Using High-Intensity Focused Ultrasound in the Treatment of Localized Adenocarcinoma of the Prostate

    NASA Astrophysics Data System (ADS)

    Ahmed, Hashim Uddin; Freeman, Alex; Allen, Clare; Kirkham, Alex; Illing, Rowland; Emberton, Mark

    2007-05-01

    The current choice for men with localised prostate cancer lies between active surveillance and radical therapy. The best evidence for the difference between these two extremes of care is 5% in terms of cancer-related absolute mortality at 8 years. It is generally accepted that this small difference will decrease for men diagnosed in the PSA-era. Therein lays a dilemma for men. If they choose active surveillance they accept anxiety of living with a cancer diagnosis and risk of under-treatment in the long term. On the other hand, radical therapy carries significant toxicity (incontinence, impotence, rectal problems) because it treats the whole gland and damages surrounding structures in up to half of men. With increasing PSA screening practices men are diagnosed younger with lower risk disease — early stage, lower Gleason grade and lower volume of cancer. Many have unifocal or unilateral disease. We propose a new concept whereby only the tumour focus and a margin of normal tissue is treated. With emerging techniques that can accurately localise tumour in the gland and technology that can treat to within millimetre accuracy, focal therapy of prostate cancer is now possible. By treating focally, the psychological burden of active surveillance is avoided. Equally, it is proposed that toxicity will decrease whilst at the same time retaining effective cancer control.

  16. Modulation of the interstitial fluid pressure by high intensity focused ultrasound as a way to alter local fluid and solute movement: insights from a mathematical model.

    PubMed

    Sassaroli, E; O'Neill, B E

    2014-11-21

    High intensity focused ultrasound (HIFU) operated in thermal mode has been reported to reduce interstitial fluid pressure and improve the penetration of large macromolecules and nanoparticles in tumor and normal tissue. Little is understood about how the interstitial fluid pressure and velocity as well as the interstitial macromolecule transport are affected by HIFU exposure. A mathematical model is presented here which sheds light on the initial biophysical changes brought about HIFU. Our continuum model treats tissue as an effective poro-elastic material that reacts to elevated temperatures with a rapid drop in interstitial elastic modulus. Using parameters from the literature, the model is extrapolated to derive information on the effect in tumors, and to predict its impact on the convective and diffusive transport of macromolecular drugs. The model is first solved using an analytical approximation with step-wise changes at each boundary, and then solved numerically starting from a Gaussian beam approximation of the ultrasound treatment. Our results indicate that HIFU causes a rapid drop in interstitial fluid pressure that may be exploited to facilitate convection of macromolecules from vasculature to the exposed region. However, following a short recovery period in which the interstitial fluid pressure is normalized, transport returns to normal and the advantages disappear over time. The results indicate that this effect is strongest for the delivery of large molecules and nanoparticles that are in the circulation at the time of treatment. The model may be easily applied to more complex situations involving effects on vascular permeability and diffusion.

  17. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.

    PubMed

    Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam

    2016-08-01

    The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  18. Youth Violence: Developing Local and State Solutions. Hearings before the Subcommittee on Youth Violence of the Committee on the Judiciary. United States Senate, One Hundred Fourth Congress, Second Session on Focusing on Youth Violence and Developing Local and State Solutions (Memphis and Nashville, TN, February 15 and 16, 1996).

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Committee on the Judiciary.

    This hearing focused on youth violence and the importance of developing local and state solutions. Senator Fred Thompson made an introductory statement. This was followed by four panels on each of 2 days of testimony. Day one's first panel included involved students and business people from Memphis, TN. The second panel included two Tennessee…

  19. High Avidity CD8+ T Cells Efficiently Eliminate Motile HIV-Infected Targets and Execute a Locally Focused Program of Anti-Viral Function

    PubMed Central

    Foley, Maria Hottelet; Forcier, Talitha; McAndrew, Elizabeth; Gonzalez, Michael; Chen, Huabiao; Juelg, Boris; Walker, Bruce D.; Irvine, Darrell J.

    2014-01-01

    stationary secretory phase to control local viral infection. PMID:24551068

  20. Air quality monitoring in communities of the Canadian Arctic during the high shipping season with a focus on local and marine pollution

    NASA Astrophysics Data System (ADS)

    Aliabadi, A. A.; Staebler, R. M.; Sharma, S.

    2014-11-01

    repeating seasonal patterns in air quality due to shipping, local pollution, and long-range transport.

  1. Air quality monitoring in communities of the Canadian Arctic during the high shipping season with a focus on local and marine pollution

    NASA Astrophysics Data System (ADS)

    Aliabadi, A. A.; Staebler, R. M.; Sharma, S.

    2015-03-01

    in air quality due to shipping, local pollution, and long-range transport.

  2. High avidity CD8+ T cells efficiently eliminate motile HIV-infected targets and execute a locally focused program of anti-viral function.

    PubMed

    Foley, Maria Hottelet; Forcier, Talitha; McAndrew, Elizabeth; Gonzalez, Michael; Chen, Huabiao; Juelg, Boris; Walker, Bruce D; Irvine, Darrell J

    2014-01-01

    sustained stationary secretory phase to control local viral infection.

  3. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer.

    PubMed

    Branca, Jacopo J V; Pacini, Stefania; Ruggiero, Marco

    2015-10-01

    A woman, mother of one at the age of 19 years, was diagnosed with mammary adenocarcinoma in the right breast in 1985 at the age of 37 years. The patient underwent surgery (quadrantectomy), lymphadenectomy and radiotherapy. In 1999, an adenocarcinoma was diagnosed in the left breast, followed by adequate resection, radiotherapy and anti-oestrogen receptor treatment for 6 years. In March 2014, an infiltrating adenocarcinoma was diagnosed in the remaining part of the right breast that had been operated on and irradiated in 1985. The pre-surgical biopsy, showed weak positivity for progesterone receptor (PgR) (<1%), high positivity for oestrogen receptor (ER) (90%), high positivity for human epidermal growth factor receptor (HER2) (>10%, score 2+), and high positivity for the nuclear protein Ki67 (30%). In the three weeks between diagnosis and operation, when no other treatment had been planned, the patient decided to self-administer high doses of oral vitamin D3 (10,000 IU/day), and to follow a strict ketogenic diet. Following right mastectomy, analysis of the surgical specimen showed no positivity for HER2 expression (negative, score 0), and significant increase in positivity of PgR (20%). Positivity for ER and Ki67 were unaltered. This observation indicates that a combination of high-dose vitamin D3 and ketogenic diet leads to changes in some biological markers of breast cancer, i.e. negativization of HER2 expression and increased expression of PgR. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. Presurgical orthopedics by drink plates does not significantly normalize deglutition in infants with cleft lip and palate.

    PubMed

    Knösel, Michael; Fendel, Christine; Jung, Klaus; Sandoval, Paulo; Engelke, Wilfried G

    2016-03-01

    To test the null hypothesis of no significant difference between intraoral pressure characteristics in infants with cleft lip and palate (CLP) with or without presurgical orthopedic (PSO) plates (groups CLP and CLP-PSO), compared with noncleft infants. Intraoral atmospheric pressure assessments were performed on 17 subjects with preoperative CLP (m/f, 11/6; mean/SD, 4.76/0.92 months) and a matched control group (n = 24; m/f, 15/9; mean/SD, 4.88/0.9 months), for 200 seconds, simultaneously at the vestibulum (vestibular space [VS]) and at the palate (subpalatal space [SPS]), using a prepared pacifier connected to a digital manometer. Areas under the pressure curves (AUC), frequencies, durations, and magnitudes of swallowing peaks and pressure resting plateaus were compared between trial groups and locations (VS, SPS) using a two-factor analysis of variance for repeated measures, Kruskal-Wallis test, and Mann-Whitney U-test (α = .05). The null hypothesis was rejected: Globally, there were statistically significant differences in intraoral pressure characteristics between groups CLP, CLP-PSO, and control (all P < .01), with significantly higher negative pressures (AUC) in the control subjects compared with those of CLP or CLP-PSO. There were significant effects by the location of pressure recordings (VS, SPS) and their interaction with all treatment groups. Differences between noncleft and CLP subjects were more pronounced in the VS than in the SPS. There was no significant effect by PSO. PSO does not improve deviated swallowing characteristics during suction in CLP infants.

  5. Functional MRI mapping of visual function and selective attention for performance assessment and presurgical planning using conjunctive visual search

    PubMed Central

    Parker, Jason G; Zalusky, Eric J; Kirbas, Cemil

    2014-01-01

    Background Accurate mapping of visual function and selective attention using fMRI is important in the study of human performance as well as in presurgical treatment planning of lesions in or near visual centers of the brain. Conjunctive visual search (CVS) is a useful tool for mapping visual function during fMRI because of its greater activation extent compared with high-capacity parallel search processes. Aims The purpose of this work was to develop and evaluate a CVS that was capable of generating consistent activation in the basic and higher level visual areas of the brain by using a high number of distractors as well as an optimized contrast condition. Materials and methods Images from 10 healthy volunteers were analyzed and brain regions of greatest activation and deactivation were determined using a nonbiased decomposition of the results at the hemisphere, lobe, and gyrus levels. The results were quantified in terms of activation and deactivation extent and mean z-statistic. Results The proposed CVS was found to generate robust activation of the occipital lobe, as well as regions in the middle frontal gyrus associated with coordinating eye movements and in regions of the insula associated with task-level control and focal attention. As expected, the task demonstrated deactivation patterns commonly implicated in the default-mode network. Further deactivation was noted in the posterior region of the cerebellum, most likely associated with the formation of optimal search strategy. Conclusion We believe the task will be useful in studies of visual and selective attention in the neuroscience community as well as in mapping visual function in clinical fMRI. PMID:24683515

  6. Pre-surgical Psychological and Neuroendocrine Predictors of Psychiatric Morbidity Following Major Vascular Surgery: A Prospective Longitudinal Study

    PubMed Central

    King, Anthony P.; Abelson, James L.; Gholami, Bardia; Upchurch, Gilbert R.; Henke, Peter; Graham, Linda; Liberzon, Israel

    2015-01-01

    Objective Major life stressors, including major surgeries, are often followed by psychiatric symptoms and disorders. Prior retrospective work found abdominal-aortic aneurysm (AAA) repair is followed by increased psychiatric morbidity, which may adversely influence physical and functional recovery. Identifying risk factors prior to surgery, such as dysregulation in stress response systems, might be useful to improving preventative intervention. Methods Two hundred and sixteen patients receiving open AAA or aortofemoral bypass (AFB) surgeries, endovascular AAA repair (EVAR), or nonsurgical AAA treatment were recruited from two vascular surgery services. Psychiatric symptoms and salivary cortisol measures (waking, 4 pm, and 11 pm, before and after low-dose dexamethasone) were obtained at intake and 3 and 9 month followups. Results Following open surgeries, 18% of patients had new psychiatric disorders, compared to 4% of patients receiving EVAR or nonsurgical treatment (odds ratio = 6.0, 95% CI 1.6 - 22.1, p=.007). Having a history of major depression predicted onset of new disorders in surgical patients. Pre-surgical cortisol levels were associated with both baseline (r=.23, p<.05) and 9 month (r=.32, p<.01) psychiatric symptoms (cortisol B=1.0, SE=0.48, p<.05 in repeated measures mixed model). Conclusion Open AAA repair surgery is prospectively linked to development of psychiatric morbidity, and history of depression elevates risk. Cortisol measures prior to surgery are associated with current and future psychological functioning, suggesting potential neurobiological mechanisms that may contribute to vulnerability. These results can help identify surgical patients at risk, and point to potential targets for risk reduction interventions. PMID:26461854

  7. Proteomics, and metabolomics: magnetic resonance spectroscopy for the presurgical screening of thyroid nodules.

    PubMed

    Minuto, Michele N; Shintu, Laetitia; Caldarelli, Stefano

    2014-06-01

    We review the progress and state-of-the-art applications of studies in Magnetic Resonance Spectroscopy (MRS) and Imaging as an aid for diagnosis of thyroid lesions of different nature, especially focusing our attention to those lesions that are cytologically undetermined. It appears that the high-resolution of High-Resolution Magic-Angle-Spinning (HRMAS) MRS improves the overall accuracy of the analysis of thyroid lesions to a point that a significant improvement in the diagnosis of cytologically undetermined lesions can be expected. This analysis, in the meantime, allows a more precise comprehension of the alterations in the metabolic pathways induced by the development of the different tumors. Although these results are promising, at the moment, a clinical application of the method to the common workup of thyroid nodules cannot be used, due to both the limitation in the availability of this technology and the wide range of techniques, that are not uniformly used. The coming future will certainly see a wider application of these methods to the clinical practice in patients affected with thyroid nodules and various other neoplastic diseases.

  8. Measures against increased environmental radiation dose by the TEPCO Fukushima Dai-ichi NPP accident in some local governments in the Tokyo metropolitan area: focusing on examples of both Kashiwa and Nagareyama cities in Chiba prefecture.

    PubMed

    Iimoto, T; Fujii, H; Oda, S; Nakamura, T; Hayashi, R; Kuroda, R; Furusawa, M; Umekage, T; Ohkubo, Y

    2012-11-01

    The accident of the Fukushima Dai-ichi nuclear power plant of Tokyo Electric Power Cooperation (TEPCO) after the great east Japan earthquake (11 March 2011) elevated the background level of environmental radiation in Eastern Japan. Around the Tokyo metropolitan area, especially around Kashiwa and Nagareyama cities, the ambient dose equivalent rate has been significantly increased after the accident. Responding to strong requests from citizens, the local governments started to monitor the ambient dose equivalent rate precisely and officially, about 3 months after the accident had occurred. The two cities in cooperation with each other also organised a local forum supported by three radiation specialists. In this article, the activities of the local governments are introduced, with main focus on radiation monitoring and measurements. Topics are standardisation of environmental radiation measurements for ambient dose rate, dose mapping activity, investigation of foodstuff and drinking water, lending survey meters to citizens, etc. Based on the data and facts mainly gained by radiation monitoring, risk management and relating activity have been organised. 'Small consultation meetings in kindergartens', 'health consultation service for citizens', 'education meeting on radiation protection for teachers, medical staffs, local government staffs, and leaders of active volunteer parties' and 'decontamination activity', etc. are present key activities of the risk management and restoration around the Tokyo metropolitan area.

  9. The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy.

    PubMed

    Schmeiser, B; Zentner, J; Steinhoff, B J; Brandt, A; Schulze-Bonhage, A; Kogias, E; Hammen, T

    2017-10-01

    After surgery for intractable mesiotemporal lobe epilepsy (mTLE) seizures recur in 30-40%. One predictor for seizure recurrence is the distribution of seizure onset and interictal epileptiform discharges (IED). Our study focused on lateralization and extent of epileptiform activity regarding postoperative seizure persistence and the effect of reoperation. This study comprises 426 consecutive patients operated for intractable mTLE. Impact of preoperative seizure onset and IED on the persistence of seizures and results of reoperation were analyzed. One year after surgery, 27% of patients with mTLE experienced persistent seizures (Engel II-IV). Preoperative bilateral seizure onset in EEG was predictive for postoperative seizure recurrence (Engel II-IV: 64%). Seizure foci and IED exceeding the temporal lobe in the ipsilateral hemisphere were not found to be associated with worse seizure outcome (Engel I: 72% and 75%) compared to patients with seizure foci confined to the ipsilateral temporal lobe (Engel I: 75% and 76%). Moreover, IED exceeding the affected temporal lobe in the ipsilateral hemisphere or even bilateral IED did not negatively affect seizure freedom if seizure onset was strictly limited to the affected temporal lobe (Engel I: 85% and 65%, respectively). 60% of patients reoperated in the ipsilateral temporal lobe for persistent seizures became seizure free. Preoperative bilateral ictal foci are a negative predictor for seizure outcome. Contrarily, IED exceeding the affected temporal lobe in the ipsilateral hemisphere or even bilateral IED had favorable seizure outcome if seizure onset is strictly limited to the affected temporal lobe. Reoperation for seizure persistence constitutes a promising therapeutic option. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  10. Herbal medicine: a survey of use in Nigerian presurgical patients booked for ambulatory anaesthesia

    PubMed Central

    2012-01-01

    Background Utilization of herbal medicines in the preoperative period by Nigerian patients booked for day case surgery has not been explored. Methods Cross-sectional survey of 60 patients presenting for day-case surgery at a tertiary healthcare institution over a 3-week period in August 2011 was conducted. Using a structured questionnaire, inquiries were made concerning use of herbal medicines in the immediate preoperative period. Socio-demographic characteristics, information on use of concurrent medical prescriptions, types of herbs used, reasons for use, perceived side effects and perceived efficacy were obtained. Data were evaluated using descriptive statistics and Chi-square. Results Fifty-two (86.7%) were American Society of Anesthesiologists (ASA) class 1 while 8 (13%) were ASA 2. Most patients (86.7%) had their procedures done under local infiltration with monitored anaesthesia care (MAC), while 5.0% and 8.3% had their procedures done under regional and general anaesthesia, respectively. About 48.3% of respondents were on concurrent medical prescriptions while 51.7% were not. Forty percent (40%) of patients admitted to use of herbal medicine, all by the oral route, in the immediate perioperative period; 87.5% did not inform their doctor of their herbal use. Types of herbs used included ‘dogonyaro’, ‘agbo’, ‘nchanwu’, and Tahitian noni. Treatment of malaria was commonest reason for use in 29.2% of patients, while cough and concurrent surgical condition were reasons given by 12.5% of patients, respectively. Seventy-nine percent (79.2%) of patients considered their herbal medications effective. Perceived side effects of herbal medication (16.6%) included fever, waist pain and intoxication. There were no variations in use between ASA 1 and ASA 2 patients and none between respondents on conventional medication against those that were not. Variables such as age less than 35 years, female gender, being married and being an urban dweller did not show

  11. Tsunami focusing

    NASA Astrophysics Data System (ADS)

    Spillane, M. C.; Titov, V. V.; Moore, C. W.; Aydin, B.; Kanoglu, U.; Synolakis, C. E.

    2010-12-01

    Tsunamis are long waves generated by impulsive disturbances of the seafloor or coastal topography caused by earthquakes, submarine/subaerial mass failures. They evolve substantially through three dimensional - 2 spatial+1 temporal - spreading as the initial surface deformation propagates. This is referred to as its directivity and focusing. A directivity function was first defined by Ben-Menahem (1961, Bull. Seismol. Soc. Am. 51, 401-435) using the source length and the rupture velocity. Okal (2003, Pure Appl. Geophys. 160, 2189-2221) discussed the details of the analysis of Ben-Menahem (1961) and demonstrated the distinct difference between the directivity patterns of landslide and earthquake generated tsunamis. Marchuk and Titov (1989, Proc. IUGG/IOC International Tsunami Symposium, July 31 - August 3, 1989, Novosibirsk, USSR. p.11-17) described the process of tsunami focusing for a rectangular initial deformation combining positive and negative surface displacements. They showed the existence of a focusing point where abnormal tsunami wave height can be registered. Here, first, we describe and quantify numerically tsunami focusing processes for a combined positive and negative - N-wave type - strip source representing the 17 July 1998 Papua New Guinea and 17 July 2006 Java events. Specifically, considering field observations and tsunami focusing, we propose a source mechanism for the 17 July 2006 Java event. Then, we introduce a new analytical solution for a strip source propagating over a flat bottom using the linear shallow-water wave equation. The analytical solution of Carrier and Yeh (2005, Computer Modeling In Engineering & Sciences, 10(2), 113-121) appears to have two drawbacks. One, the solution involves singular complete elliptic integral of the first kind which results in a self-similar approximate solution for the far-field at large times. Two, only the propagation of Gaussian shaped finite-crest wave profiles can be modeled. Our solution is not only

  12. Adiabatic Focuser

    SciTech Connect

    Chen, P.; Oide, K.; Sessler, Andrew M.; Yu, S.S.

    1989-08-01

    Theoretical analysis is made of an intense relativistic electron beam. such as would be available from a linear collider, moving through a plasma of increasing density, but density always less than that of the beam (underdense). In this situation. the plasma electrons are expelled from the beam channel and the electrons are subject to an ever-increasing focusing force provided by the channel ions. Analysis is made on the beam radiation energy loss in the classical, the transition, and the quantum regimes. It is shown that the focuser is insensitive to the beam energy spread due to radiation loss. Furthermore, because of the different scaling behaviors in the nonclassical regimes, the radiation limit on lenses (the Oide limit) can be exceeded. The sensitivity of the system to the optic mismatch and the nonlinearity is also analyzed. Examples are given with SLC-type and TLC-type parameters.

  13. Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions.

    PubMed

    Bailey, Paul D; Zacà, Domenico; Basha, Mahmud Mossa; Agarwal, Shruti; Gujar, Sachin K; Sair, Haris I; Eng, John; Pillai, Jay J

    2015-01-01

    To determine whether lesion to activation distance (LAD) on presurgical blood-oxygen-level-dependent functional magnetic resonance imaging (fMRI) and degree of white matter involvement by primary or metastatic brain lesions predict perioperative motor and language deficits. We retrospectively evaluated 76 patients with intra-axial brain lesions referred for presurgical fMRI and diffusion tensor imaging (DTI). We measured expressive, receptive, global language and motor LAD and assessed degree of involvement of the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF). We performed a Wilcoxon rank-sum test to determine whether the LAD and the degree of CST/SLF involvement were statistically significantly different between patients with and without preoperative or postoperative neurological deficits. In preoperatively symptomatic patients, motor and expressive language LAD were significantly lower (z = -3.78, P = .0002, and z = -2.51, P = .01, respectively) than in asymptomatic patients. No significant difference was noted in LAD between postoperative symptomatic and asymptomatic patients, except for a trend level effect for motor LAD (P = .07). The degree of CST involvement was significantly different between symptomatic and asymptomatic patients (z = 3.40, P = .0007 and z = 2.97, P = .003, respectively, for pre- and postoperative motor deficits).The degree of SLF involvement was significantly different between preoperatively (but not postoperatively) symptomatic and asymptomatic patients (z = 2.85, P = .004). Presurgical motor and expressive language LAD as well as degree of tract involvement on DTI are predictive of preoperative but not postoperative deficits, except for CST DTI and (trend level) motor LAD; inability of language LAD to predict postoperative deficits suggests that preoperative fMRI is valuable to neurosurgeons in avoiding resection of eloquent cortex. Copyright © 2015 by the American Society of Neuroimaging.

  14. Public Engagement. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1996

    1996-01-01

    This newsletter includes six articles that examine key issues facing public schools and communities related to accountability, bilingual education, immigrant education, school finance, and school choice. In addressing these issues, articles focus on the importance of community involvement and input in local school reform efforts aimed at achieving…

  15. [Presurgical treatment of axitinib reduced operation risk by downsizing the vena cava tumor thrombus in advanced renal cell carcinomas: two case reports].

    PubMed

    Hamada, Akihiro; Yamasaki, Toshinari; Negoro, Hiromitsu; Kobayashi, Takashi; Terada, Naoki; Sugino, Yoshio; Matsui, Yoshiyuki; Inoue, Takahiro; Kamba, Tomomi; Yoshimura, Koji; Ogawa, Osamu

    2014-12-01

    In cases of advanced renal cell carcinoma with inferior vena cava (IVC) thrombus, surgical resection of both tumor and thrombus contributes to the improvement of patient's prognosis, but the risk of perioperative complication is still high. We experienced two cases of advanced renal tumors with IVC tumor thrombus down-sized by presurgical treatment of axitinib. Axitinib treatment showed a marked tumor reduction effect without any severe adverse event. We could remove both tumor and thrombus without perioperative complications. In these two cases, downsizing of IVC thrombus enabled us to reduce the extent of the surgery.

  16. Electrophoretic Focusing

    NASA Technical Reports Server (NTRS)

    Snyder, Robert S.

    2001-01-01

    Electrophoretic focusing is a new method of continuous flow electrophoresis that introduces precision flow control to achieve high resolution separations. The electric field is applied perpendicular to an incoming sample lamina and buffer but also perpendicular to the broad faces of the thin rectangular chamber. A uniform fluid cross-flow then enters and exits the separation chamber through the same broad faces which are porous. A balance is achieved by adjusting either the electric field or the cross-flow so the desired sample fraction with its specific migration velocity encounters an opposing flow of the same velocity. Applying an electric field transverse to the incoming sample lamina and opposing this field with a carefully configured buffer flow, a sample constituent can be selected and focused into a narrow stream for subsequent analysis. Monotonically changing either electric field or buffer cross-flow will yield a scan of all constituents of the sample. Stopping the scan increases the collection time for minor constituents to improve their analysis. Using the high voltage gradients and/or cross-flow to rapidly deflect extraneous sample through the porous screens and into either of the side (purge) chambers, the selected sample is focused in the center plane of the separation chamber and collected without contact or interaction with the separation chamber walls. Results will be presented on the separation of a range of materials including dyes, proteins, and monodisperse polystyrene latexes. Sources of sample dispersion inherent in other electrokinetic techniques will be shown to be negligible for a variety of sample concentrations, buffer properties and operating conditions.

  17. Clinical management of critically ill patients with Cushing's disease due to ACTH-secreting pituitary macroadenomas: effectiveness of presurgical treatment with pasireotide.

    PubMed

    Cannavo, S; Messina, E; Albani, A; Ferrau, F; Barresi, V; Priola, S; Esposito, F; Angileri, F

    2016-06-01

    The management of critically ill Cushing's disease (CD) patients is extremely challenging. Pasireotide is indicated for the treatment of CD patients when pituitary surgery is unfeasible or has not been curative, but no data are available about the use of this drug as pre-operative treatment in critically ill patients. We report the effects of presurgical pasireotide therapy in CD patients in whom hypercortisolism caused life-threatening hypokalemia, alkalosis, and cardio-respiratory complications precluding surgical approach. Clinical, biochemical, and radiological data of two critically ill patients with ACTH-secreting pituitary macroadenoma, before and during first-line presurgical pasireotide treatment (600 μg s.c. bid). During the first 21 days of treatment, pasireotide therapy induced a rapid, partial decrease of plasma ACTH, serum cortisol, and urinary free cortisol levels, with the consequent normalization of serum potassium concentration and arterial blood gases parameters, in both the patients. They did not experience unmanageable side effects and underwent endoscopic transsphenoidal surgery after 4 weeks of effective treatment. Pre-operative MRI evaluation did not show pituitary tumor shrinkage. Surgical cure of CD was obtained in the first patient, while debulking allowed the pharmacological control of hypercortisolism in the second case. We suggest that pasireotide can induce a rapid improvement of clinical and metabolic conditions in critically ill CD patients in whom surgical approach is considered hazardous and need to be delayed.

  18. A systematic investigation of the invariance of resting-state network patterns: is resting-state fMRI ready for pre-surgical planning?

    PubMed Central

    Kollndorfer, K.; Fischmeister, F. Ph. S.; Kasprian, G.; Prayer, D.; Schöpf, V.

    2013-01-01

    Objectives: Measurements of resting-state networks (RSNs) have been used to investigate a wide range of diseases, such as dementia or epilepsy. This raises the question whether this method could also serve as a pre-surgical planning tool. Generating reliable functional connectivity patterns is of crucial importance, particularly for pre-surgical planning, as these patterns may directly affect the outcome. Methods: This study investigated the reproducibility of four commonly used resting-state conditions: fixation of a black crosshair on a white screen; fixation of the center of a black screen; eyes-closed and fixation of the words “Entspann dich!” (Engl., “relax”). Ten healthy, right-handed male subjects (mean age, 25 years; SD 2) participated in the experiment. The spatial overlap for different RSNs across the four conditions was calculated. Results: The spatial overlap across all four conditions was calculated for each seed region on a single subject and at the group level. Activation maps at the single-subject and group levels were highly stable, especially for the reading network (RNW). The lowest consistency measures were found for the visual network (VIN). At the single-subject level spatial overlap values ranged from 0.31 (VIN) to 0.45 (RNW). Conclusion: These findings suggest that RSN measurements are a reliable tool to assess language-related networks in clinical settings. Generally, resting-state conditions showed comparable activation patterns, therefore no specific conditions appears to be preferable. PMID:23532457

  19. A systematic investigation of the invariance of resting-state network patterns: is resting-state fMRI ready for pre-surgical planning?

    PubMed

    Kollndorfer, K; Fischmeister, F Ph S; Kasprian, G; Prayer, D; Schöpf, V

    2013-01-01

    Measurements of resting-state networks (RSNs) have been used to investigate a wide range of diseases, such as dementia or epilepsy. This raises the question whether this method could also serve as a pre-surgical planning tool. Generating reliable functional connectivity patterns is of crucial importance, particularly for pre-surgical planning, as these patterns may directly affect the outcome. This study investigated the reproducibility of four commonly used resting-state conditions: fixation of a black crosshair on a white screen; fixation of the center of a black screen; eyes-closed and fixation of the words "Entspann dich!" (Engl., "relax"). Ten healthy, right-handed male subjects (mean age, 25 years; SD 2) participated in the experiment. The spatial overlap for different RSNs across the four conditions was calculated. The spatial overlap across all four conditions was calculated for each seed region on a single subject and at the group level. Activation maps at the single-subject and group levels were highly stable, especially for the reading network (RNW). The lowest consistency measures were found for the visual network (VIN). At the single-subject level spatial overlap values ranged from 0.31 (VIN) to 0.45 (RNW). These findings suggest that RSN measurements are a reliable tool to assess language-related networks in clinical settings. Generally, resting-state conditions showed comparable activation patterns, therefore no specific conditions appears to be preferable.

  20. Is 11C-flumazenil PET superior to 18FDG PET and 123I-iomazenil SPECT in presurgical evaluation of temporal lobe epilepsy?

    PubMed Central

    Debets, R M; Sadzot, B; van Isselt, J W; Brekelmans, G J; Meiners, L C; van Huffelen, A O; Franck, G; van Veelen, C W

    1997-01-01

    OBJECTIVE: To determine the contribution of 18FDG PET, 11C-flumazenil PET, and 123I-iomazenil SPECT to the presurgical evaluation of patients with medically intractable complex partial seizures. METHODS: Presurgical evaluation was performed in 23 patients, who were considered candidates for temporal lobe resective surgery (14 females and nine males with a median age of 34 (range 13 to 50) years). The presurgical diagnosis was based on seizure semiology as demonstrated with ictal video recording, ictal and interictal scalp EEG recordings, and MRI. RESULTS: Eighteen patients had convergent findings in clinical semiology, interictal and ictal EEG with scalp and sphenoidal electrodes, and MRI that warranted surgery without depth EEG (DEEG). In five patients with insufficient precision of localisation, DEEG with intracerebral and subdural electrodes was performed. MRI showed abnormalities in 22 out of 23 patients. Of these 22, 18 had mesial temporal sclerosis. This was limited to the mesial temporal lobe in four and more widespread in the temporal lobe in 14 patients. In one patient only enlargement of the temporal horn was found and in three others only white matter lesions were detected. 18FDG PET showed a large area of glucose hypometabolism in the epileptogenic temporal lobe, with an extension outside the temporal lobe in 10 of 23 patients. Only in one of these patients DEEG showed extratemporal abnormalities that were concordant with a significant extratemporal extension of hypometabolism in 18FDG PET. 18FDG PET was compared with the results of scalp EEG: in none of the patients was an anterior temporal ictal onset in scalp EEG related to a maximum hypometabolism in the mesial temporal area. By contrast, the region of abnormality indicated by 11C-flumazenil PET was much more restricted, also when compared with DEEG findings. Extension of abnormality outside the lobe of surgery was seen in only two patients with 11C-flumazenil and was less pronounced compared with

  1. Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures.

    PubMed

    Grisius, Thomas M; Spolyar, John; Jackson, Ian T; Bello-Rojas, Gustavo; Dajani, Khaled

    2006-05-01

    The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).

  2. A technique for the presurgical simulation of the position of computer-assisted, template-based, planned implants: a clinical report.

    PubMed

    Villa, Roberto

    2014-11-01

    Computer-assisted oral implant surgery offers several advantages over the traditional approach. However, several unexpected procedure-linked adverse events during guided implant placement indicate that the clinical demands on the surgeon are no less than those observed during conventional placement. The aim of this report was to present a novel technique for the presurgical simulation of the position of computer-assisted, template-based, planned implants immediately before surgery. The presented technique could increase the clinician's confidence and the safety of the surgical procedures, which allows changes to the original plan if needed. The potential benefits of the present method should be confirmed by randomized clinical studies. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  3. Pre-surgical assessment of mandibular bone invasion from oral cancer: comparison between different imaging techniques and relevance of radiologist expertise.

    PubMed

    Silva, Mario; Zambrini, Eleonora I; Chiari, Gianfranco; Montermini, Ilaria; Manna, Carmelinda; Poli, Tito; Lanfranco, Davide; Sesenna, Enrico; Thai, Elena; Sverzellati, Nicola

    2016-09-01

    To compare diagnostic performance between computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone infiltration from oral cancer, and to test interobserver agreement between radiologists with different expertises. Pre-surgical CT and MRI were reviewed independently by two radiologists with different expertises in head and neck oncology. A third radiologist reviewed CT and MRI simultaneously. Interobserver agreement was calculated by Cohen test. Association between radiological evidence of bone infiltration and histological reference was tested by Fisher's exact test or Chi-squared test, as appropriate. Receiving operator curve was calculated and area under the curve (AUC) was compared between CT, MRI, and both methods together. Interobserver agreement was moderate: the trainee under-reported periosteal reaction on CT and inferior alveolar canal involvement on MRI. Imaging findings associated with histologic evidence of bone infiltration were: periosteal reaction and cortical erosion on CT; bone marrow involvement, contrast enhancement within bone; and inferior alveolar canal involvement on MRI. Sensitivity of MRI alone (74 %) was higher than CT (52 %). Simultaneous review of CT and MRI showed the highest specificity (91 %), with the increase of diagnostic performance in the subgroup of subjects with positive MRI (AUC = 0.689; p = 0.044). Higher expertise allows pre-surgical detection of clinically relevant signs of bone infiltration sensitivity of MRI alone is higher than CT for the detection of bone infiltration from oral cancer. In MRI positive cases, diagnostic integration with combined review of CT and MRI is suggested for optimal diagnostic performance.

  4. Virtual reality presurgical planning for cerebral gliomas adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural MRI and DTI tractography.

    PubMed

    Qiu, Tian-ming; Zhang, Yi; Wu, Jin-Song; Tang, Wei-Jun; Zhao, Yao; Pan, Zhi-Guang; Mao, Ying; Zhou, Liang-Fu

    2010-11-01

    Resection of gliomas invading primary motor cortex and subcortical motor pathway is difficult in both surgical decision-making and functional outcome prediction. In this study, magnetic resonance (MR) diffusion tensor imaging (DTI) data were used to perform tractography to visualize pyramidal tract (PT) along its whole length in a stereoscopic virtual reality (VR) environment. The potential value of its clinical application was evaluated. Both three-dimensional (3-D) magnetic resonance imaging (MRI) and DTI datasets were obtained from 45 eligible patients with suspected cerebral gliomas and then transferred to the VR system (Dextroscope; Volume Interactions Pte. Ltd., Singapore). The cortex and tumor were segmented and reconstructed via MRI, respectively, while the tractographic PTs were reconstructed via DTI. All those were presented in a stereoscopic 3-D display synchronously, for the purpose of patient-specific presurgical planning and surgical simulation in each case. The relationship between increasing amplitude of the number of effective fibers of PT (EPT) at affected sides and the patients' Karnofsky Performance Scale (KPS) at 6 months was addressed out. In VR presurgical planning for gliomas, surgery was aided by stereoscopic 3-D visualizing the relative position of the PTs and a tumor. There was no significant difference between pre- and postsurgical EPT in this population. A positive relationship was proved between EPT increasing amplitude and 6-month KPS. 3-D stereoscopic visualization of tractography in this VR environment enhances the operators to well understand the anatomic information of intra-axial tumor contours and adjacent PT, results in surgical trajectory optimization initially, and maximal safe tumor resection finally. In accordance to the EPT increasing amplitude, surgeon can predict the long-term motor functional outcome.

  5. PreSurgMapp: a MATLAB Toolbox for Presurgical Mapping of Eloquent Functional Areas Based on Task-Related and Resting-State Functional MRI.

    PubMed

    Huang, Huiyuan; Ding, Zhongxiang; Mao, Dewang; Yuan, Jianhua; Zhu, Fangmei; Chen, Shuda; Xu, Yan; Lou, Lin; Feng, Xiaoyan; Qi, Le; Qiu, Wusi; Zhang, Han; Zang, Yu-Feng

    2016-10-01

    The main goal of brain tumor surgery is to maximize tumor resection while minimizing the risk of irreversible postoperative functional sequelae. Eloquent functional areas should be delineated preoperatively, particularly for patients with tumors near eloquent areas. Functional magnetic resonance imaging (fMRI) is a noninvasive technique that demonstrates great promise for presurgical planning. However, specialized data processing toolkits for presurgical planning remain lacking. Based on several functions in open-source software such as Statistical Parametric Mapping (SPM), Resting-State fMRI Data Analysis Toolkit (REST), Data Processing Assistant for Resting-State fMRI (DPARSF) and Multiple Independent Component Analysis (MICA), here, we introduce an open-source MATLAB toolbox named PreSurgMapp. This toolbox can reveal eloquent areas using comprehensive methods and various complementary fMRI modalities. For example, PreSurgMapp supports both model-based (general linear model, GLM, and seed correlation) and data-driven (independent component analysis, ICA) methods and processes both task-based and resting-state fMRI data. PreSurgMapp is designed for highly automatic and individualized functional mapping with a user-friendly graphical user interface (GUI) for time-saving pipeline processing. For example, sensorimotor and language-related components can be automatically identified without human input interference using an effective, accurate component identification algorithm using discriminability index. All the results generated can be further evaluated and compared by neuro-radiologists or neurosurgeons. This software has substantial value for clinical neuro-radiology and neuro-oncology, including application to patients with low- and high-grade brain tumors and those with epilepsy foci in the dominant language hemisphere who are planning to undergo a temporal lobectomy.

  6. Quantum focusing conjecture

    NASA Astrophysics Data System (ADS)

    Bousso, Raphael; Fisher, Zachary; Leichenauer, Stefan; Wall, Aron C.

    2016-03-01

    We propose a universal inequality that unifies the Bousso bound with the classical focusing theorem. Given a surface σ that need not lie on a horizon, we define a finite generalized entropy Sgen as the area of σ in Planck units, plus the von Neumann entropy of its exterior. Given a null congruence N orthogonal to σ , the rate of change of Sgen per unit area defines a quantum expansion. We conjecture that the quantum expansion cannot increase along N . This extends the notion of universal focusing to cases where quantum matter may violate the null energy condition. Integrating the conjecture yields a precise version of the Strominger-Thompson quantum Bousso bound. Applied to locally parallel light-rays, the conjecture implies a novel inequality, the quantum null energy condition, a lower bound on the stress tensor in terms of the second derivative of the von Neumann entropy. We sketch a proof of the latter relation in quantum field theory.

  7. Focused crossed Andreev reflection

    NASA Astrophysics Data System (ADS)

    Haugen, H.; Brataas, A.; Waintal, X.; Bauer, G. E. W.

    2011-03-01

    We consider non-local transport mediated by Andreev reflection in a two-dimensional electron gas (2DEG) connected to one superconducting and two normal metal terminals. A robust scheme is presented for observing crossed Andreev reflection (CAR) between the normal metal terminals based on electron focusing by weak perpendicular magnetic fields. At slightly elevated temperatures the CAR signature can be easily distinguished from a background of quantum interference fluctuations. The CAR-induced entanglement between electrons can be switched on and off over large distances by the magnetic field.

  8. Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - analysis from the @-Registry.

    PubMed

    Ganzer, Roman; Robertson, Cary N; Ward, John F; Brown, Stephen C W; Conti, Giario N; Murat, Francois J; Pasticier, Gilles; Rebillard, Xavier; Thuroff, Stefan; Wieland, Wolf F; Blana, Andreas

    2011-10-01

    •To determine if the prostate-specific antigen (PSA) nadir after high-intensity focused ultrasound (HIFU) can be used as a predictor of the biochemical disease-free survival rate (DFSR). •Patient data were derived from the multicentre-based @-Registry, the largest registry to report outcomes in patients with localized prostate cancer after Ablatherm® HIFU. •PSA level was measured at 3-month intervals. Patients were stratified into four PSA nadir groups: group 1, ≤0.2 ng/mL; group 2, 0.21-0.5 ng/mL; group 3, 0.51-1 ng/mL; and group 4, >1 ng/mL. •Biochemical treatment failure was defined according to the Stuttgart definition (PSA nadir + 1.2 ng/mL) and the Phoenix definition (PSA nadir + 2 ng/mL). •Biopsy was performed at 3-6 months post-HIFU or if a PSA level was recorded that was considered clinically relevant. •The present study included 804 patients. Biochemical treatment success rates at 5 years according to the Stuttgart definition for the four PSA nadir sub-groups were as follows: 84, 64, 40 and 30% for groups 1-4, respectively. •The equivalent 5-year biochemical success rates using the Phoenix definition were 94, 74, 66 and 47%, respectively. •Significantly more patients had a negative biopsy in the lowest PSA nadir group than in the other sub-groups (91.6 vs 73.1%; P < 0.001). •The present study is limited by its retrospective nature and variations in clinical practice across participating centres. •This multicentre analysis confirms that PSA nadir after HIFU predicts biochemical DFSR in a statistically significant manner. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  9. Local Foods, Local Places

    EPA Pesticide Factsheets

    The Local Foods, Local Places technical assistance program protects human health and the environment, spurs revitalization, increases access to healthy foods, and creates economic opportunities by promoting local foods.

  10. Subsurface contaminants focus area

    SciTech Connect

    1996-08-01

    The US Department of Enregy (DOE) Subsurface Contaminants Focus Area is developing technologies to address environmental problems associated with hazardous and radioactive contaminants in soil and groundwater that exist throughout the DOE complex, including radionuclides, heavy metals; and dense non-aqueous phase liquids (DNAPLs). More than 5,700 known DOE groundwater plumes have contaminated over 600 billion gallons of water and 200 million cubic meters of soil. Migration of these plumes threatens local and regional water sources, and in some cases has already adversely impacted off-site rsources. In addition, the Subsurface Contaminants Focus Area is responsible for supplying technologies for the remediation of numerous landfills at DOE facilities. These landfills are estimated to contain over 3 million cubic meters of radioactive and hazardous buried Technology developed within this specialty area will provide efective methods to contain contaminant plumes and new or alternative technologies for development of in situ technologies to minimize waste disposal costs and potential worker exposure by treating plumes in place. While addressing contaminant plumes emanating from DOE landfills, the Subsurface Contaminants Focus Area is also working to develop new or alternative technologies for the in situ stabilization, and nonintrusive characterization of these disposal sites.

  11. Presurgical functional transcranial Doppler sonography (fTCD) with intravenous echo enhancing agent SonoVue enables determination of language lateralization in epilepsy patients with poor temporal bone windows.

    PubMed

    House, Patrick M; Brückner, Katja E; Lohmann, Hubertus H

    2011-03-01

    Presurgical determination of language lateralization is important for planning and outcome estimation of neurosurgical interventions in patients with drug-refractory epilepsy. Functional transcranial Doppler sonography (fTCD) provides an established measure for language lateralization using the temporal bone windows for continuous recording of the cerebral blood flow velocity (CBFV) in both middle cerebral arteries (MCAs). However, because of insufficient temporal bone windows, fTCD cannot be applied properly in every patient. Here, we established stable and sufficient CBFV signals in both MCAs using continuous intravenous application of echo-enhancing agent SonoVue in 7 of 10 patients with poor temporal bone windows and were thus able to determine language lateralization. We conclude that the application of SonoVue can solve one principal disadvantage of fTCD and improves the applicability of the technique as a presurgical functional language lateralization procedure.

  12. Diffusiophoretic Focusing of Suspended Colloids

    NASA Astrophysics Data System (ADS)

    Shi, Nan; Nery-Azevedo, Rodrigo; Abdel-Fattah, Amr I.; Squires, Todd M.

    2016-12-01

    Using a microfluidic system to impose and maintain controlled, steady-state multicomponent p H and electrolyte gradients, we present systems where the diffusiophoretic migration of suspended colloids leads them to focus at a particular position, even in steady-state gradients. We show that naively superpositing effects of each gradient may seem conceptually and qualitatively reasonable, yet is invalid due to the coupled transport of these multicomponent electrolytes. In fact, reformulating the classic theories in terms of the flux of each species (rather than local gradients) reveals rather stringent conditions that are necessary for diffusiophoretic focusing in steady gradients. Either particle surface properties must change as a function of local composition in solution (akin to isoelectric focusing in electrophoresis), or chemical reactions must occur between electrolyte species, for such focusing to be possible. The generality of these findings provides a conceptual picture for understanding, predicting, or designing diffusiophoretic systems.

  13. WE-EF-BRA-12: Magnetic Resonance- Guided High-Intensity Focused Ultrasound for Localized Ablation of Head and Neck Tissue Structures: A Feasibility Study in An Animal Model

    SciTech Connect

    Partanen, A; Ellens, N; Noureldine, S; Tufano, R; Burdette, E; Farahani, K

    2015-06-15

    Purpose: High-intensity focused ultrasound (HIFU) ablation is feasible in the head and neck [1]. This study aims to expand upon these findings to assess the feasibility of treatment planning and monitoring via magnetic resonance imaging (MRI) guidance using a clinical MR-guided HIFU platform. Methods: Two 31 kg pigs were anaesthetized, shaved, and positioned prone on the HIFU table (Sonalleve, Philips Healthcare, Vantaa, Finland). The necks were acoustically coupled to the integrated transducer using gel pads and degassed water. MR imaging verified acoustic coupling and facilitated target selection in the thyroid and thymus. Targets were thermally ablated with 130–200 W of acoustic power over a period of 16 s at a frequency of 1.2 MHz while being monitored through real-time, multi-planar MR-thermometry. Contrast-enhanced MR imaging was used to assess treatment efficacy. Post-treatment, animals were euthanized and sonicated tissues were harvested for histology assessment. Results: MR-thermometry, post-contrast-imaging, and gross pathology demonstrated that the system was capable of causing localized thermal ablation in both the thyroid and the thymus without damaging the aerodigestive tract. In one animal, superficial bruising was observed in the ultrasound beam path. Otherwise, there were no adverse events. Analysis of the tissue histology found regions of damage consistent with acute thermal injury at the targeted locations. Conclusion: It is feasible to use a clinical MR-guided HIFU platform for extracorporeal ablation of porcine head and neck tissues. MR guidance and thermometry are sufficient to target and monitor treatment in the thyroid region, despite the presence of the inhomogeneous aerodigestive tract. Further study is necessary to assess efficacy and survival using a tumor model, and to examine what modifications should be made to the transducer positioning system and associated patient positioning aids to adapt it for clinical head and neck targets

  14. Clinical value of the first dedicated, commercially available automatic injector for ictal brain SPECT in presurgical evaluation of pediatric epilepsy: comparison with manual injection.

    PubMed

    Kim, Sunhee; Holder, Deborah L; Laymon, Charles M; Tudorascu, Dana L; Deeb, Erin L; Panigrahy, Ashok; Mountz, James M

    2013-05-01

    The most challenging technical problem in ictal brain SPECT for localization of an epileptogenic focus is obtaining a timely injection of a radiopharmaceutical. In our institution, the first dedicated commercially available, remotely controlled automatic injector has been used in the pediatric epilepsy unit in conjunction with 24-h video and electroencephalogram monitoring. The goal of this study was to demonstrate the improved success rate of ictal injection by use of the automatic injector in the pediatric population. Eighty-four pediatric patients and eighty-four (99m)Tc-ethylcysteinate dimer ((99m)Tc-ECD) ictal brain SPECT studies were retrospectively analyzed in a masked manner. The group with manual injection consisted of 45 studies performed from 2004 to 2010 before the introduction of the automatic injector. The group with automatic injection consisted of 39 studies performed from 2010 to 2011 after the introduction of the automatic injector. The 2 groups were comparable in the total duration of seizure, injected dose, and time from the injection to the image acquisition. The latency time from the seizure onset to the initiation time of injection, the ratio of latency time to total duration of seizure (L/T), the number of patients with repeated studies, the number of days of additional hospitalization for each study, and the localization rate for identifying a single focus in each study were compared between the groups. The median latency time in the group with automatic injection (8 s) was significantly lower than that of the group with manual injection (18 s) (P < 0.05). Also there was a statistically significant decrease in the number of patients with repeated studies in the group with automatic injection (2/39 [5%]), compared with the group with manual injection (14/45 [31%]) (P < 0.05). The median number of days of additional hospitalization in the group with manual injection (range, 0-7) was statistically significantly different, compared with the

  15. Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note.

    PubMed

    Mullin, Jeffrey P; Smithason, Saksith; Gonzalez-Martinez, Jorge

    2016-06-13

    SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients who are deemed appropriate candidates for invasive recordings, the decision to monitor is made between the subdural grids versus SEEG. Invasive neuromonitoring for epilepsy is pursued in patients with complex, medically refractory epilepsy. The goal of invasive monitoring is to offer resective surgery with the hope of allowing seizure freedom. SEEG's advantages include access to deep cortical structures, an ability to localize the epileptogenic zone (EZ) when subdural grids have failed to do so, and in patients with non-lesional extra-temporal epilepsies. In this manuscript, we present a succinct historical overview of the SEEG and report on our experience with frameless stereotaxy under robotic. An imperative step of SEEG insertion is planning the electrode trajectories. In order to most effectively record ictal activity via SEEG trajectories should be planned based upon a hypothesis of where the seizure activity originates the presumed epileptogenic zone (EZ). The EZ hypothesis is based on a standardized preoperative workup including video-EEG monitoring, MRI (magnetic resonance imaging), PET (positron emission tomography), ictal SPECT (Single-photon emission computed tomography), and neuropsychological assessment. Using a suspected EZ, SEEG electrodes can be placed minimally invasively yet maintain accuracy and precision. Clinical results showed the ability to localize the EZ in 78% of difficult to localize epileptic patients.(1).

  16. Maxillary growth after the use of protraction head gear in conjunction with presurgical orthopedics and gingivoperiosteoplasty for complete bilateral cleft lip and alveolus patients.

    PubMed

    Kobayashi, Shinji; Hirakawa, Takashi; Fukawa, Toshihiko; Maegawa, Jiro

    2013-09-01

    Maxillary development is often inadequate in bilateral cleft patients. The use of presurgical orthopedics (PSO) and gingivoperiosteoplasty (GPP) may promote bone formation at the alveolar cleft, but can also have detrimental effects on maxillary development. Our objective was to investigate the effect of PSO and GPP on maxillary development in bilateral cleft lip and alveolus (BCLA) patients. We had 3 complete BCLA patients who had received PSO. All patients underwent cheiloplasty and GPP simultaneously. At 4 years, maxillary protraction head gear was used as part of the protocol. They were evaluated by cephalometric analysis at 4 and 8 years of age, and by CT imaging at 5 years of age. At 4 years of age, patients with all BCLA had anterior crossbite of deciduous central incisors. As a result of maxillary protraction, jaw development at 8 years was good. Among all patients, only one showed bone formation at the alveolar cleft sufficient to avoid alveolar bone grafting (ABG). All patients presented anterior crossbite in the premaxillary region, but had good maxillary growth at 8 years old as a result of maxillary protraction. The combination of PSO and GPP can potentially eliminate the need for ABG and does not significantly retard maxillary development. PSO with GPP and protraction head gear may be an option, but long-term growth is not known.

  17. Comparison between functional magnetic resonance imaging at 1.5 and 3 Tesla: effect of increased field strength on 4 paradigms used during presurgical work-up.

    PubMed

    Tieleman, Ann; Vandemaele, Pieter; Seurinck, Ruth; Deblaere, Karel; Achten, Eric

    2007-02-01

    We sought to evaluate the benefit of 3 T compared with 1.5 T during presurgical functional magnetic resonance imaging. Six participants performed a motor, a visual, and 2 language paradigms both at 1.5 and 3 T. The number of activated voxels, mean t-value, and assessment of language dominancy were compared between both field strengths. Group analysis was performed to evaluate the influence of field strength on the cortical language activation patterns. The number of activated voxels and mean t-values were significantly higher at 3 T for all paradigms. Using the same statistical threshold, language activation was significantly less lateralized, and more activation zones were depicted at 3 T compared with 1.5 T. Sensitivity associated with visual, motor and language functional magnetic resonance imaging increased significantly at 3 T. Additional cortical areas were depicted during language processing at 3 T. For assessment of language dominancy, usage of more stringent statistical thresholds at 3 T is suggested.

  18. Motion tracking to enable pre-surgical margin mapping in basal cell carcinoma using optical imaging modalities: initial feasibility study using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Duffy, M.; Richardson, T. J.; Craythorne, E.; Mallipeddi, R.; Coleman, A. J.

    2014-02-01

    A system has been developed to assess the feasibility of using motion tracking to enable pre-surgical margin mapping of basal cell carcinoma (BCC) in the clinic using optical coherence tomography (OCT). This system consists of a commercial OCT imaging system (the VivoSight 1500, MDL Ltd., Orpington, UK), which has been adapted to incorporate a webcam and a single-sensor electromagnetic positional tracking module (the Flock of Birds, Ascension Technology Corp, Vermont, USA). A supporting software interface has also been developed which allows positional data to be captured and projected onto a 2D dermoscopic image in real-time. Initial results using a stationary test phantom are encouraging, with maximum errors in the projected map in the order of 1-2mm. Initial clinical results were poor due to motion artefact, despite attempts to stabilise the patient. However, the authors present several suggested modifications that are expected to reduce the effects of motion artefact and improve the overall accuracy and clinical usability of the system.

  19. Presurgical mapping of basal cell carcinoma or squamous cell carcinoma by confocal laser endomicroscopy compared to traditional micrographic surgery: a single-centre prospective feasibility study.

    PubMed

    Schulz, Alexandra; Daali, Samira; Javed, Mehreen; Fuchs, Paul Christian; Brockmann, Michael; Igressa, Alhadi; Charalampaki, Patra

    2016-12-01

    At present, no ideal diagnostic tools exist in the market to excise cancer tissue with the required safety margins and to achieve optimal aesthetic results using tissue-conserving techniques. In this prospective study, confocal laser endomicroscopy (CLE) and the traditional gold standard of magnifying glasses (MG) were compared regarding the boundaries of in vivo basal cell carcinoma and squamous cell carcinoma. Tumour diameters defined by both methods were measured and compared with those determined by histopathological examination. Nineteen patients were included in the study. The CLE technique was found to be superior to excisional margins based on MG only. Re-excision was required in 68% of the cases following excision based on MG evaluation, but only in 27% of the cases for whom excision margins were based on CLE. Our results are promising regarding the distinction between tumour and healthy surrounding tissue, and indicate that presurgical mapping of basal cell carcinoma and squamous cell carcinoma is possible. The tool itself should be developed further with special attention to early detection of skin cancer.

  20. EDITORIAL: Focus on Plasmonics FOCUS ON PLASMONICS

    NASA Astrophysics Data System (ADS)

    Bozhevolnyi, Sergey; García-Vidal, Francisco

    2008-10-01

    Plasmonics is an emerging field in optics dealing with the so-called surface plasmons whose extraordinary properties are being both analyzed from a fundamental point of view and exploited for numerous technological applications. Surface plasmons associated with surface electron density oscillations decorating metal-dielectric interfaces were discovered by Rufus Ritchie in the 1950s. Since the seventies, the subwavelength confinement of electromagnetic fields as well as their enhancement inherent to the surface plasmon excitation has been widely used for spectroscopic purposes. Recent advances in nano-fabrication, characterization and modelling techniques have allowed unique properties of these surface electromagnetic modes to be explored with respect to subwavelength field localization and waveguiding, opening the path to truly nanoscale plasmonic optical devices. This area of investigation also has interesting links with research on photonic band gap materials and the field of optical metamaterials. Nowadays, plasmonics can be seen as a mature interdisciplinary area of research in which scientists coming from different backgrounds (chemistry, physics, optics and engineering) strive to discover and exploit new and exciting phenomena associated with surface plasmons. The already made and forthcoming discoveries will have impacts in many fields of science and technology, including not only photonics and materials science but also computation, biology and medicine, among others. This focus issue of New Journal of Physics is intended to cover all the aforementioned capabilities of surface plasmons by presenting a current overview of state-of-the-art advances achieved by the leading groups in this field of research. The below list of articles represents the first contributions to the collection and further additions will appear soon. Focus on Plasmonics Contents Nanoantenna array-induced fluorescence enhancement and reduced lifetimes Reuben M Bakker, Vladimir P Drachev

  1. Focus group research.

    PubMed

    Traynor, Michael

    2015-05-13

    A focus group is usually understood as a group of people brought together by a researcher to interact as a group. Focus group research explicitly uses interaction as part of its methodology. This article summarises the practice of running focus groups, explores the nature of focus group data and provides an example of focus group analysis.

  2. "Only" and Focus.

    ERIC Educational Resources Information Center

    Vallduvi, Enric

    The relationship of the word "only," one of a class of words known as scalar particles, focus adverbs, focus inducers, or focus-sensitive particles, with the "focus" of the sentence is examined. It is suggested, based on analysis of discourse structure, that this "association with focus" is not an inherent property of…

  3. [Value of the ictal video EEG recording in the presurgical evaluation of temporal lobe epilepsy. Semiology and EEG patterns].

    PubMed

    Parra, J; Iriarte, J

    The surgical treatment of epilepsy has gained increased acceptance in the last decade, especially for temporal lobe seizures. Its success is based upon a strict selection of the candidates, which combines clinical, neurophysiological, neuropsychological and neuroimaging criteria. The video-EEG recording of the seizures still plays an important role in this selection process, as it provides enough amount of interictal activity, demonstrates the existence of different seizure types and enables to perform an adequate electroclinical correlation. It also helps recognizing patients with concomitant non-epileptic events. The widespread use of ictal video-EEG has allowed the validation of several clinical signs, such as the dystonic posturing of the limb or the postictal speech disturbance among others, as being quite useful in the process of localization and lateralization. In fact, with the proper analysis of the ictal behavior it is possible to achieve confident lateralizing information in the majority of patients with temporal lobe epilepsy. This knowledge, gathered through the analysis of the semiology is complementary to that obtained with the simultaneous recording of the EEG. When a meaningful electroclinical correlation is possible, and it is also concordant with the data provided by the MRI and neuropsychological testing, a surgical procedure can be warranted without the use of intracranial electrodes.

  4. Localization of pediatric seizure semiology.

    PubMed

    Vendrame, Martina; Zarowski, Marcin; Alexopoulos, Andreas V; Wyllie, Elaine; Kothare, Sanjeev V; Loddenkemper, Tobias

    2011-10-01

    The aim of this study was to evaluate the relationship between semiology of seizures in children and adolescents to the corresponding EEG localization. Charts of 225 consecutive pediatric epilepsy patients undergoing Video-EEG monitoring (VEM) over 2 years were reviewed. Seizure semiology recorded during VEM was classified according to ILAE seizure semiology terminology and EEG localization, and analyzed based on onset as defined by the EEG data (generalized, frontal, temporal, parietal, occipital or multilobar). A total of 1008 seizures were analyzed in 225 children (mean age 8.5 years, range 0-20), with 50% boys. Auras and seizures with automatisms arose predominantly from the temporal lobes (p<0.001). Tonic, clonic and tonic-clonic seizures had most commonly generalized onset (p<0.001). Hypomotor seizures were most frequently seen from the frontal lobes (p<0.001). Hypermotor seizures had most commonly temporal lobe or multiple lobe onset (p<0.001 and p<0.05 respectively). Atonic, myoclonic seizures and epileptic spasms had almost exclusively a generalized onset (p<0.001). Different seizure semiologies relate to specific brain regions, with overlap between focal and generalized semiological seizure types, as identified electrographically. Semiology of seizures can provide important information for epilepsy localization, and should not be overlooked, especially in patients undergoing pre-surgical evaluation. Separation of clinical seizure description and EEG findings may be useful, in particular when only incomplete information is available. i.e. during the first office visit. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Frontal lobe seizures: from clinical semiology to localization.

    PubMed

    Bonini, Francesca; McGonigal, Aileen; Trébuchon, Agnès; Gavaret, Martine; Bartolomei, Fabrice; Giusiano, Bernard; Chauvel, Patrick

    2014-02-01

    Frontal lobe seizures are difficult to characterize according to semiologic and electrical features. We wished to establish whether different semiologic subgroups can be identified and whether these relate to anatomic organization. We assessed all seizures from 54 patients with frontal lobe epilepsy that were explored with stereoelectroencephalography (SEEG) during presurgical evaluation. Semiologic features and concomitant intracerebral EEG changes were documented and quantified. These variables were examined using Principal Component Analysis and Cluster Analysis, and semiologic features correlated with anatomic localization. Four main groups of patients were identified according to semiologic features, and correlated with specific patterns of anatomic seizure localization. Group 1 was characterized clinically by elementary motor signs and involved precentral and premotor regions. Group 2 was characterized by a combination of elementary motor signs and nonintegrated gestural motor behavior, and involved both premotor and prefrontal regions. Group 3 was characterized by integrated gestural motor behavior with distal stereotypies and involved anterior lateral and medial prefrontal regions. Group 4 was characterized by seizures with fearful behavior and involved the paralimbic system (ventromedial prefrontal cortex ± anterior temporal structures). The groups were organized along a rostrocaudal axis, representing bands within a spectrum rather than rigid categories. The more anterior the seizure organization, the more likely was the occurrence of integrated behavior during seizures. Distal stereotypies were associated with the most anterior prefrontal localizations, whereas proximal stereotypies occurred in more posterior prefrontal regions. Meaningful categorization of frontal seizures in terms of semiology is possible and correlates with anatomic organization along a rostrocaudal axis, in keeping with current hypotheses of frontal lobe hierarchical organization

  6. Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital.

    PubMed

    Gupta, C; Czubatyj, A M; Briski, L E; Malani, A K

    2007-01-01

    The antiseptic effectiveness and acceptability of a commercial alcohol-based waterless (ABWL) and an alcohol-based water-aided (ABWA) scrub solution were compared with a brush-based iodine solution (BBIS) under conditions encountered in community hospital operating rooms. This randomized partially blinded study was based on guidelines from the American Society for Testing and Methods. The three scrub solutions were compared for antimicrobial efficacy, using criteria within the Food and Drug Administration's Tentative Final Monograph for Healthcare Antiseptic Products (FDA-TFM), and for participants' acceptance of the products. Volunteer surgical staff that worked daily in the same operating room for the entire duration of the study were enrolled. In total, 1126 surgical scrub procedures were performed over the duration of the study. Only the ABWL met all of the FDA-TFM criteria. The BBIS performed better than both of the alcohol-based solutions at the end of Day 1 (P=0.03), but the ABWL was more efficacious than the ABWA and the BBIS at the end of Days 2 and 5 (P=0.02 and 0.01, respectively). When colony-count reductions were compared over the entire duration of the study, there was no significant difference between the three solutions (P=0.2). The participants found the ABWL easiest to use (P<0.001), with the fewest adverse effects on skin (P=0.007), and it was their preferred product (P<0.001). Although both of the commercially available alcohol-based solutions may be considered as acceptable alternatives to the BBIS for presurgical antisepsis, the ABWL was found to have significantly higher user acceptability.

  7. Maxillary growth after maxillary protraction: Appliance in conjunction with presurgical orthopedics, gingivoperiosteoplasty, and Furlow palatoplasty for complete bilateral cleft lip and palate patients with protruded premaxilla.

    PubMed

    Kobayashi, Shinji; Hirakawa, Takashi; Fukawa, Toshihiko; Maegawa, Jiro

    2015-06-01

    In bilateral cleft lip and palate (BCLP) with premaxillary protrusion, a good outcome with adequate maxillary development is difficult to achieve. The purpose of this article is to evaluate the maxillary growth after using presurgical orthopedics (PSO), gingivoperiosteoplasty (GPP), Furlow palatoplasty, and maxillary protraction appliance (MPA) for BCLP with premaxillary protrusion. Seven patients with complete BCLP with premaxillary protrusion were treated by PSO, cheiloplasty, GPP, and Furlow palatoplasty. MPA was used as part of the protocol for 6 months to 1 year for postoperative retardation of maxillary growth cases. Maxillary growth was evaluated by cephalometric analysis at 4 and 10 years of age, and bone formation at the alveolar cleft was evaluated by computed tomography (CT) imaging at 5 years of age. At 4 years of age, three of seven patients had apparent retardation of maxillary growth. The maxillary growth at 10 years of age was equivalent to the average value of normal Japanese after using MPA in three cases. At 5 years of age, only two of seven patients showed sufficient bone formation at the alveolar cleft to avoid alveolar bone grafting (ABG). Subsequently, ABG was performed in five patients. Although three of seven patients had apparent crossbite at 4 years of age, the maxillary growth of all patients at 10 years of age was approximately equivalent to the average value of normal Japanese after using MPA. A treatment protocol based on PSO, GPP, Furlow palatoplasty, and MPA may be an option, but long-term growth is unknown. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. Exploring effects of presurgical weight loss among women with stage 0–II breast cancer: protocol for a randomised controlled feasibility trial

    PubMed Central

    Tsuruta, Yuko; Rogers, Laura Q; Krontiras, Helen; Grizzle, William E; Frugé, Andrew D; Oster, Robert A; Umphrey, Heidi R; Jones, Lee W; Azrad, Maria; Demark-Wahnefried, Wendy

    2016-01-01

    Introduction Obesity is a known risk factor for postmenopausal breast cancer and is associated with poorer prognosis for premenopausal and postmenopausal patients; however, the aetiological mechanisms are unknown. Preclinical studies support weight loss via caloric restriction and increased physical activity as a possible cancer control strategy, though few clinical studies have been conducted. We undertook a feasibility trial among women recently diagnosed with stage 0–II breast cancer hypothesising that presurgical weight loss would be feasible, safe and result in favourable changes in tumour markers and circulating biomarkers. Methods and analysis A two-arm randomised controlled trial among 40 overweight or obese women, newly diagnosed with stage 0–II breast cancer and scheduled for surgery was planned. The attention control arm received upper body progressive resistance training and diet counselling to correct deficiencies in nutrient intake; the experimental arm received the same plus counselling on caloric restriction and aerobic exercise to achieve a weight loss of 0.68–0.919 kg/week. In addition to achieving feasibility benchmarks (accruing and retaining at least 80% of participants, and observing no serious adverse effects attributable to the intervention), we will explore the potential impact of an acute state of negative energy balance on tumour proliferation rates (Ki-67), as well as other tumour markers, serum biomarkers, gene expression, microbiome profiles and other clinical outcomes (eg, quality of life). Outcomes for the 2 study arms are compared using mixed models repeated-measures analyses. Ethics and dissemination Ethics approval was received from the University of Alabama at Birmingham Institutional Review Board (Protocol number F130325009). Study findings will be disseminated through peer-reviewed publications. Given that this is one of the first studies to investigate the impact of negative energy balance directly on tumour biology in

  9. Virtual MRI endoscopy: detection of anomalies of the ventricular anatomy and its possible role as a presurgical planning tool for endoscopic third ventriculostomy.

    PubMed

    Rohde, V; Krombach, G A; Struffert, T; Gilsbach, J M

    2001-11-01

    Many anatomical anomalies have the potential to impair the efficacy of endoscopic third ventriculostomy (ETV) and increase the surgical morbidity. By virtual magnetic resonance imaging (MRI) endoscopy, the real endoscopic view into the ventricular system can be simulated. It was the objective of the present study to investigate if this simulation is sensitive enough to detect anatomical anomalies of the ventricular system. In 18 hydrocephalic patients, first neuronavigationally guided ETV, then virtual MRI endoscopy were performed. This study design allowed for selection of a path for virtual MRI endoscopy, which was identical to that used during surgery, making the real and the virtual view on anatomical structures of the ventricular system highly comparable. It was investigated whether the intra-operatively identified anatomical anomalies could likewise be depicted on virtual MR endoscopic images. Seven anatomical variants (not enlarged interventricular foramen n=2, atrophic corpus callosum and split fornical bodies n=1, narrow retroclival space n=1, prominent basilar tip n=1, opaque and thick/atypically declining third ventricular floor n=2) were encountered in 5 of the 18 patients during surgery. The five variants of the non-membraneous structures were identified by virtual MRI endoscopy (sensitivity 71%), whereas the anatomical variants of the third ventricular floor were missed. Both the normal as well as the variant third ventricular floor could not be visualised and appeared as a defect. Through this artefact, the anatomy of the major vessels in the interpeduncular cistern could be assessed. The sensitivity of virtual MRI endoscopy for detection of anatomical variants of the ventricular system is low. Its potential usefulness as a presurgical planning tool inspite of this low sensitivity rate is discussed.

  10. Fifteen-Year Follow-Up Results of Presurgical Orthopedics Followed by Primary Correction for Unilateral Cleft Lip Nose in Program SEHATI in Indonesia.

    PubMed

    Sulaiman, Farida Kamil; Haryanto, Inge Gustiningsih; Hak, Syafrudin; Nakamura, Norifumi; Sasaguri, Masaaki; Ohishi, Masamichi

    2013-03-01

    Objective : To assess long-term effects of nasal correction in infancy on nasal form and growth in patients with unilateral cleft lip, alveolus, and palate (UCLP). Design : Retrospective longitudinal study. Patients : Seventeen patients with complete UCLP treated in Program SEHATI in Harapan Kita Children and Maternity Hospital, Indonesia, and followed for approximately 15 years were enrolled. Interventions : Subjects received presurgical orthopedics using a Hotz's plate and simultaneous primary lip and nose repair in which the lower lateral cartilage was repositioned through a reverse-U incision. Main Outcome Measures : Preoperative and postoperative nasal forms, including the nostril height and width ratio, the ratio of the height of the top of the alar groove, and the ratio of nostril surface areas were analyzed using color photos taken serially. One-way analysis of variance was used for statistical analyses. Results : The nostril height and width ratio and the height of the alar groove were significantly improved postoperatively and maintained for 15 years. The mean ratio of nostril surface areas was 1.01 ± 0.12 fifteen years postoperatively, and there was no significant difference from the ratio 1 year postoperatively. The major persistent deformities were septal deviation and a small skin web on the nostril rim. Conclusions : Our primary cleft lip nose correction has provided an acceptable nose form and absence of disturbance of the nasal growth in patients with UCLP. However, the repositioning of the nasal cartilage at infancy might not eliminate the need for secondary correction after puberty.

  11. Fast presurgical magnetic resonance imaging of meniscal tears and concurrent subchondral bone marrow lesions. Study of dogs with naturally occurring cranial cruciate ligament rupture.

    PubMed

    Olive, J; d'Anjou, M-A; Cabassu, J; Chailleux, N; Blond, L

    2014-01-01

    Meniscal tears and subchondral bone marrow lesions have both been described in dogs with cranial cruciate ligament rupture, but their possible concurrence has not been evaluated. In a population of 14 dogs exhibiting signs of stifle pain with surgically confirmed cranial cruciate ligament rupture, a short presurgical 1.5T magnetic resonance (MR) imaging protocol including dorsal proton density, dorsal T1-weighted gradient recalled echo, and sagittal fat-saturated dual echo sequences was tested to further investigate these features and illustrate meniscal tears. Interobserver agreement for detection of medial meniscal tears (k=0.83) and bone marrow lesions (k=0.87) was excellent. Consensus MR reading allowed detection of nine out of 12 surgically confirmed medial meniscal tears and there was no false positive. All dogs had cruciate ligament enthesis-related bone marrow lesions in the tibia, femur or both bones. Additionally, among the 12 dogs with confirmed medial meniscal tears, subchondral bone marrow lesions were present in the caudomedial (9 dogs) and caudoaxial (11 dogs) regions of the tibial plateau, resulting in odds ratios (13.6, p=0.12, and 38.3, p=0.04, respectively) that had large confidence intervals due to the small group size of this study. The other two dogs had neither tibial bone marrow lesions in these locations nor medial meniscal tears. These encouraging preliminary results warrant further investigation using this clinically realistic preoperative MR protocol. As direct diagnosis of meniscal tears remained challenging in dogs even with high-field MR, identification of associated signs such as subchondral bone marrow lesions might indirectly allow suspicion of an otherwise unrecognized meniscal tear.

  12. Localization Value of Magnetoencephalography Interictal Spikes in Adult Nonlesional Neocortical Epilepsy

    PubMed Central

    Jeong, Woorim; Kim, June Sic

    2012-01-01

    Few studies have included magnetoencephalography (MEG) when assessing the diagnostic value of presurgical modalities in a nonlesional epilepsy population. Here, we compare single photon emission computed tomography (SPECT), positron emission tomography (PET), video-EEG (VEEG), and MEG, with intracranial EEG (iEEG) to determine the value of individual modalities to surgical decisions. We analyzed 23 adult epilepsy patients with no abnormal MRI findings who had undergone surgical resection. Localization of individual presurgical tests was determined for hemispheric and lobar locations based on visual analysis. Each localization result was compared with the ictal onset zone (IOZ) defined by using iEEG. The highest to the lowest hemispheric concordance rates were MEG (83%) > ictal VEEG (78%) > PET (70%) > ictal SPECT (57%). The highest to lowest lobar concordance rates were ictal VEEG = MEG (65%) > PET (57%) > ictal SPECT (52%). Statistical analysis showed MEG to have a higher hemispheric concordance than that of ictal SPECT (P = 0.031). We analyzed the effects of MEG clustered-area resection on surgical outcome. Patients who had resection of MEG clusters showed a better surgical outcome than those without such resection (P = 0.038). It is suggested that MEG-based localization had the highest concordance with the iEEG-defined IOZ. Furthermore, MEG cluster resection has prognostic significance in predicting surgical outcome. PMID:23166423

  13. Mesial temporal lobe morphology in intractable pediatric epilepsy: so-called hippocampal malrotation, associated findings, and relevance to presurgical assessment.

    PubMed

    Leach, James L; Awwad, Reem; Greiner, Hansel M; Vannest, Jennifer J; Miles, Lili; Mangano, Francesco T

    2016-06-01

    .33); however, this was not significant when hippocampal sclerosis cases were excluded. HIMAL findings were more prevalent and MTL scores were higher in patients with resections involving the temporal lobes. On group analysis, HIMAL findings did not predict eventual surgical side and did not predict outcome, although the numbers are small. In 4 patients the abnormally rotated hippocampus was resected and showed hippocampal sclerosis and/or dysplastic changes on histopathology. All of these patients had a good outcome after surgery. CONCLUSIONS While increased in prevalence in children with intractable epilepsy, imaging findings of HIMAL did not have preoperative lateralizing utility in this group. Findings of HIMAL (including round hippocampus, architectural blurring, and vertical collateral sulcus) did not predict outcome after surgery, although the small number of patients with these findings limits evaluation. In the small number of patients in which the malrotated hippocampus was removed, outcome was good. Further research is needed to continue to define this association in children with intractable epilepsy, focusing on a temporal lobe cohort.

  14. Extensive Lesions in the Gustatory Cortex in the Rat Do Not Disrupt the Retention of a Presurgically Conditioned Taste Aversion and Do Not Impair Unconditioned Concentration-Dependent Licking of Sucrose and Quinine

    PubMed Central

    2014-01-01

    Although damage to gustatory cortex (GC) in the rat has been reported to severely impair, if not eliminate, retention of a presurgically conditioned taste aversion (CTA), it has equivocal effects on taste preference as measured by intake tests. Because intake tests can be influenced by nongustatory (e.g., postingestive) factors, we employed the brief-access taste test to assess the effects of ibotenic acid–induced lesions targeting the GC on unconditioned licking to a sucrose and then a quinine concentration series in a specialized lickometer. As a functional lesion assessment, a presurgical CTA to 0.1M NaCl was established in thirsty rats by following 15-min intake with intraperitoneal administration of either LiCl (or NaCl for control) on 2 occasions. Both conditioned sham-operated (SHAM) rats and rats with histologically confirmed extensive damage to the GC (GCX) avoided a NaCl concentration series relative to unconditioned controls in a postsurgical brief-access CTA test, with no difference between the surgical groups in their responses to NaCl or similar concentrations of KCl. GCX rats also did not differ from SHAM rats in the EC50 of concentration–response functions for sucrose or quinine. Clearly, the critical cortical area required for the retention of a presurgical CTA falls outside of the extensive area of damage, which was well centered within the conventionally defined gustatory zone of the insular cortex. The absence of an effect on unconditioned responsiveness to sucrose and quinine suggests that the damaged region is also unnecessary for the normal expression of affective licking responses to tastants. PMID:24226296

  15. Light focusing in the Anderson regime

    NASA Astrophysics Data System (ADS)

    Leonetti, Marco; Karbasi, Salman; Mafi, Arash; Conti, Claudio

    2014-07-01

    Anderson localization is a regime in which diffusion is inhibited and waves (also electromagnetic waves) get localized. Here we exploit adaptive optics to achieve focusing in disordered optical fibres in the Anderson regime. By wavefront shaping and optimization, we observe the generation of a propagation-invariant beam, where light is trapped transversally by disorder, and show that Anderson localizations can be also excited by extended speckled beams. We demonstrate that disordered fibres allow a more efficient focusing action with respect to standard fibres in a way independent of their length, because of the propagation-invariant features and cooperative action of transverse localizations.

  16. Presurgical brain mapping of the language network in patients with brain tumors using resting-state fMRI: Comparison with task fMRI.

    PubMed

    Sair, Haris I; Yahyavi-Firouz-Abadi, Noushin; Calhoun, Vince D; Airan, Raag D; Agarwal, Shruti; Intrapiromkul, Jarunee; Choe, Ann S; Gujar, Sachin K; Caffo, Brian; Lindquist, Martin A; Pillai, Jay J

    2016-03-01

    To compare language networks derived from resting-state fMRI (rs-fMRI) with task-fMRI in patients with brain tumors and investigate variables that affect rs-fMRI vs task-fMRI concordance. Independent component analysis (ICA) of rs-fMRI was performed with 20, 30, 40, and 50 target components (ICA20 to ICA50) and language networks identified for patients presenting for presurgical fMRI mapping between 1/1/2009 and 7/1/2015. 49 patients were analyzed fulfilling criteria for presence of brain tumors, no prior brain surgery, and adequate task-fMRI performance. Rs-vs-task-fMRI concordance was measured using Dice coefficients across varying fMRI thresholds before and after noise removal. Multi-thresholded Dice coefficient volume under the surface (DiceVUS) and maximum Dice coefficient (MaxDice) were calculated. One-way Analysis of Variance (ANOVA) was performed to determine significance of DiceVUS and MaxDice between the four ICA order groups. Age, Sex, Handedness, Tumor Side, Tumor Size, WHO Grade, number of scrubbed volumes, image intensity root mean square (iRMS), and mean framewise displacement (FD) were used as predictors for VUS in a linear regression. Artificial elevation of rs-fMRI vs task-fMRI concordance is seen at low thresholds due to noise. Noise-removed group-mean DiceVUS and MaxDice improved as ICA order increased, however ANOVA demonstrated no statistically significant difference between the four groups. Linear regression demonstrated an association between iRMS and DiceVUS for ICA30-50, and iRMS and MaxDice for ICA50. Overall there is moderate group level rs-vs-task fMRI language network concordance, however substantial subject-level variability exists; iRMS may be used to determine reliability of rs-fMRI derived language networks. © 2015 Wiley Periodicals, Inc.

  17. A comprehensive study of clinical, biochemical, radiological, vascular, cardiac, and sleep parameters in an unselected cohort of patients with acromegaly undergoing presurgical somatostatin receptor ligand therapy.

    PubMed

    Annamalai, Anand K; Webb, Alison; Kandasamy, Narayanan; Elkhawad, Maysoon; Moir, Samantha; Khan, Fakhar; Maki-Petaja, Kaisa; Gayton, Emma L; Strey, Christopher H; O'Toole, Samuel; Ariyaratnam, Shaumya; Halsall, David J; Chaudhry, Afzal N; Berman, Laurence; Scoffings, Daniel J; Antoun, Nagui M; Dutka, David P; Wilkinson, Ian B; Shneerson, John M; Pickard, John D; Simpson, Helen L; Gurnell, Mark

    2013-03-01

    Attainment of safe GH and IGF-1 levels is a central goal of acromegaly management. The aim of this study was to determine the extent to which reductions in GH and IGF-1 concentrations correlate with amelioration of radiological, metabolic, vascular, cardiac, and respiratory sequelae in a single unselected patient cohort. This was a prospective, within-subject comparison in 30 patients with newly diagnosed acromegaly (15 women and 15 men: mean age, 54.3 years; range, 23-78 years) before and after 24 weeks of lanreotide Autogel (ATG) therapy. Reductions in GH and IGF-1 concentrations and tumor volume were observed in all but 2 patients (median changes [Δ]: GH, -6.88 μg/L [interquartile range -16.78 to -3.32, P = .000001]; IGF-1, -1.95 × upper limit of normal [-3.06 to -1.12, P = .000002]; and pituitary tumor volume, -256 mm(3) [-558 to -72.5, P = .0002]). However, apnea/hypopnea index scores showed highly variable responses (P = .11), which were independent of ΔGH or ΔIGF-1, but moderately correlated with Δweight (R(2) = 0.42, P = .0001). Although systolic (P = .33) and diastolic (P = .76) blood pressure were unchanged, improvements in arterial stiffness (aortic pulse wave velocity, -0.4 m/s [-1.2 to +0.2, P = .046]) and endothelial function (flow mediated dilatation, +1.73% [-0.32 to +6.19, P = .0013]) were observed. Left ventricular mass index regressed in men (-11.8 g/cm(2) [-26.6 to -1.75], P = .019) but not in women (P = .98). Vascular and cardiac changes were independent of ΔGH or ΔIGF-1 and also showed considerable interindividual variation. Metabolic parameters were largely unchanged. Presurgical ATG therapy lowers GH and IGF-1 concentrations, induces tumor shrinkage, and ameliorates/reverses cardiac, vascular, and sleep complications in many patients with acromegaly. However, responses vary considerably between individuals, and attainment of biochemical control cannot be assumed to equate to universal complication control.

  18. Long-term care insurance and market for aged care in Japan: focusing on the status of care service providers by locality and organisational nature based on survey results.

    PubMed

    Kubo, Makoto

    2014-09-01

    The purpose of this paper is to examine the status of care service providers by locality and organisational nature. Questionnaires were sent to 9505 home-based care service providers registered in the databases of 17 prefectures. The prefectures were selected according to population size. Numerous for-profit providers have newly entered the aged care service market and are operating selectively in Tokyo, a typical example of a metropolitan area. Furthermore, both for-profit and non-profit providers have suffered from a shortage of care workers and difficult management conditions, which tend to be more pronounced in Tokyo. The market under long-term care insurance was successful in terms of the volume of services, but most providers were sceptical as to whether competition in the market could facilitate quality care services. © 2013 The Author. Australasian Journal on Ageing © 2013 ACOTA.

  19. EDITORIAL: Focus on Graphene

    NASA Astrophysics Data System (ADS)

    Peres, N. M. R.; Ribeiro, Ricardo M.

    2009-09-01

    Graphene physics is currently one of the most active research areas in condensed matter physics. Countless theoretical and experimental studies have already been performed, targeting electronic, magnetic, thermal, optical, structural and vibrational properties. Also, studies that modify pristine graphene, aiming at finding new physics and possible new applications, have been considered. These include patterning nanoribbons and quantum dots, exposing graphene's surface to different chemical species, studying multilayer systems, and inducing strain and curvature (modifying in this way graphene's electronic properties). This focus issue includes many of the latest developments on graphene research. Focus on Graphene Contents Electronic properties of graphene and graphene nanoribbons with 'pseudo-Rashba' spin-orbit coupling Tobias Stauber and John Schliemann Strained graphene: tight-binding and density functional calculations R M Ribeiro, Vitor M Pereira, N M R Peres, P R Briddon and A H Castro Neto The effect of sublattice symmetry breaking on the electronic properties of doped graphene A Qaiumzadeh and R Asgari Interfaces within graphene nanoribbons J Wurm, M Wimmer, I Adagideli, K Richter and H U Baranger Weak localization and transport gap in graphene antidot lattices J Eroms and D Weiss Electronic properties of graphene antidot lattices J A Fürst, J G Pedersen, C Flindt, N A Mortensen, M Brandbyge, T G Pedersen and A-P Jauho Splitting of critical energies in the n=0 Landau level of graphene Ana L C Pereira Double-gated graphene-based devices S Russo, M F Craciun, M Yamamoto, S Tarucha and A F Morpurgo Pinning and switching of magnetic moments in bilayer graphene Eduardo V Castro, M P López-Sancho and M A H Vozmediano Electronic transport properties of graphene nanoribbons Katsunori Wakabayashi, Yositake Takane, Masayuki Yamamoto and Manfred Sigrist Many-body effects on out-of-plane phonons in graphene J González and E Perfetto Graphene zigzag ribbons, square

  20. Focus Curriculum Manual; A Focus Dissemination Project.

    ERIC Educational Resources Information Center

    Human Resource Associates, Inc., Hastings, Minn.

    This training manual is for use in preparing staff members to use the Focus Model, which is a "school within a school" for disaffected high school students. The material is designed to be used as a resource aid following participation in an in-service workshop. Information is presented to help implement a contracting system to establish…

  1. Prostate Focused Ultrasound Therapy.

    PubMed

    Chapelon, Jean-Yves; Rouvière, Olivier; Crouzet, Sébastien; Gelet, Albert

    2016-01-01

    The tremendous progress in engineering and computing power coupled with ultrasound transducer technology and imaging modalities over the past 20 years have encouraged a revival of clinical interest in ultrasound therapy, mainly in High-Intensity Focused Ultrasound (HIFU). So far, the most extensive results from HIFU obtained in urology involve transrectal prostate ablation, which appears to be an effective therapeutic alternative for patients with malignant prostate tumors. Prostate cancer (PCa) is one of the most frequently diagnosed cancers in men. Several treatment options with different therapeutic approaches exist, including HIFU for localized PCa that has been in use for over 15 years. Since the early 2000s, two systems have been marketed for this application, and other devices are currently in clinical trials. HIFU treatment can be used either alone or in combination with (before- or after-) external beam radiotherapy (EBRT) (before or after HIFU) and can be repeated multiple times. HIFU treatment is performed under real-time monitoring with ultrasound or guided by MRI. Two indications are validated today: Primary care treatment and EBRT failure. The results of HIFU for primary care treatment are similar to standard conformal EBRT, even though no randomized comparative studies have been performed and no 10-year follow up data is yet available for HIFU. Salvage HIFU after EBRT failure is increasing with oncological outcomes, similar to those achieved with surgery but with the advantage of fewer adverse effects. HIFU is an evolving technology perfectly adapted for focal treatment. Thus, HIFU focal therapy is another pathway that must be explored when considering the accuracy and reliability for PCa mapping techniques. HIFU would be particularly suited for such a therapy since it is clear that HIFU outcomes and toxicity are relative to the volume of prostate treated.

  2. COS NUV Focus Sweep

    NASA Astrophysics Data System (ADS)

    Sahnow, David

    2017-08-01

    Program 13530 performed an NUV focus sweep during Cycle 21 in order to determine whether the COS focus has changed since it was originally measured in Program 11469 during SMOV. Nineteen NUV exposures of NGC188-41 were obtained during a single orbit while the OSM1 focus was moved over the range from -200 to +200 steps. The focus was found to be close to the initial value.

  3. Focus Intonation in Bengali

    ERIC Educational Resources Information Center

    Hasan, Md. Kamrul

    2015-01-01

    This work attempts to investigate the role of prosody in the syntax of focus in Bangla. The aim of this study is to show the intonation pattern of Bangla in emphasis and focus. In order to do that, the author has looked at the pattern of focus without-i/o as well as with the same. Do they really pose any different focus intonation pattern from…

  4. Alternating phase focused linacs

    DOEpatents

    Swenson, Donald A.

    1980-01-01

    A heavy particle linear accelerator employing rf fields for transverse and ongitudinal focusing as well as acceleration. Drift tube length and gap positions in a standing wave drift tube loaded structure are arranged so that particles are subject to acceleration and succession of focusing and defocusing forces which contain the beam without additional magnetic or electric focusing fields.

  5. Tsunami Amplification due to Focusing

    NASA Astrophysics Data System (ADS)

    Moore, C. W.; Kanoglu, U.; Titov, V. V.; Aydin, B.; Spillane, M. C.; Synolakis, C. E.

    2012-12-01

    Tsunami runup measurements over the periphery of the Pacific Ocean after the devastating Great Japan tsunami of 11 March 2011 showed considerable variation in far-field and near-field impact. This variation of tsunami impact have been attributed to either directivity of the source or by local topographic effects. Directivity arguments alone, however, cannot explain the complexity of the radiated patterns in oceans with trenches and seamounts. Berry (2007, Proc. R. Soc. Lond. A 463, 3055-3071) discovered how such underwater features may concentrate tsunamis into cusped caustics and thus cause large local amplifications at specific focal points. Here, we examine focusing and local amplification, not by considering the effects of underwater diffractive lenses, but by considering the details of the dipole nature of the initial profile, and propose that certain regions of coastline are more at-risk, not simply because of directivity but because typical tsunami deformations create focal regions where abnormal tsunami wave height can be registered (Marchuk and Titov, 1989, Proc. IUGG/IOC International Tsunami Symposium, Novosibirsk, USSR). In this work, we present a new general analytical solution of the linear shallow-water wave equation for the propagation of a finite-crest-length source over a constant depth without any restriction on the initial profile. Unlike the analytical solution of Carrier and Yeh (2005, Comp. Mod. Eng. & Sci. 10(2), 113-121) which was restricted to initial conditions with Gaussian profiles and involved approximation, our solution is not only exact, but also general and allows the use of realistic initial waveform such as N-waves as defined by Tadepalli and Synolakis (1994, Proc. R. Soc. Lond. A 445, 99-112). We then verify our analytical solution for several typical wave profiles, both with the NOAA tsunami forecast model MOST (Titov and Synolakis, 1998, J. Waterw. Port Coast. Ocean Eng. 124(4), 157-171) which is validated and verified through

  6. The focused ethnographic study 'assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old' and its use in three countries.

    PubMed

    Pelto, Gretel H; Armar-Klemesu, Margaret; Siekmann, Jonathan; Schofield, Dominic

    2013-01-01

    The concept of a focused ethnographic study (FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts (Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children (IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements (LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. © 2012 Blackwell Publishing Ltd.

  7. Recognizing focus in noise filled sentences

    NASA Astrophysics Data System (ADS)

    Xu, Ching X.; Xu, Yi

    2003-04-01

    This study is designed to help identify the intrinsic constituents of focus. Twelve four-word Mandarin sentences were recorded by a native speaker five times, each time either with focus on one of the words, or without any focus. Then, one, two or three words in each sentence produced by the speaker were replaced by pink noise. The noise-filled sentences were presented to subjects along with the text. The subjects' task was to determine if the sentence had a focus, and if yes, on which word. Ten native Mandarin speakers participated as subjects. Their performance was compared across noise replacement conditions. It was found that, when both on-focus and post-focus words were present, focus could be recognized consistently. When only the focused word was present, focus could be recognized fairly well unless the focus position was sentence final, in which case it was not very distinct from no focus. When post-focus word(s) was(were) left intact while focused words were replaced by noise, focus could still be detected successfully, but its exact localization was sometimes judged wrong. These results seem to support the dual-component hypothesis about focus. Further implications of the findings will be discussed.

  8. Localization of focal epileptic discharges using functional connectivity magnetic resonance imaging

    PubMed Central

    Stufflebeam, Steven M.; Liu, Hesheng; Sepulcre, Jorge; Tanaka, Naoaki; Buckner, Randy L.; Madsen, Joseph R.

    2011-01-01

    Object In patients with medically refractory epilepsy the accurate localization of the seizure onset zone is critical for successful surgical treatment. The object of this study was to investigate whether the degree of coupling of spontaneous brain activity as measured with functional connectivity MR imaging (fcMR imaging) can accurately identify and localize epileptic discharges. Methods The authors studied 6 patients who underwent fcMR imaging presurgical mapping and subsequently underwent invasive electroencephalography. Results Focal regions of statistically significant increases in connectivity were identified in 5 patients when compared with an ad hoc normative sample of 300 controls. The foci identified by fcMR imaging overlapped the epileptogenic areas identified by invasive encephalography in all 5 patients. Conclusions These results suggest that fcMR imaging may provide an effective high–spatial resolution and noninvasive method of localizing epileptic discharges in patients with refractory epilepsy. PMID:21351832

  9. Pre-surgical radiologic identification of peri-prosthetic osteolytic lesions around TKRs: a pre-clinical investigation of diagnostic accuracy

    PubMed Central

    Kurmis, Timothy P; Kurmis, Andrew P; Campbell, David G; Slavotinek, John P

    2008-01-01

    Background Emerging longitudinal data appear to demonstrate an alarming trend towards an increasing prevalence of osteolysis-induced mechanical failure, following total knee replacement (TKR). Even with high-quality multi-plane X-rays, accurate pre-surgical evaluation of osteolytic lesions is often difficult. This is likely to have an impact on surgical management and provides reasonable indication for the development of a model allowing more reliable lesion assessment. The aim of this study, using a simulated cadaver model, was to explore the accuracy of rapid spiral computed tomography (CT) examination in the non-invasive evaluation of peri-prosthetic osteolytic lesions, secondary to TKR, and to compare this to conventional X-ray standards. Methods A series of nine volume-occupying defects, simulating osteolytic lesions, were introduced into three human cadaveric knees, adjacent to the TKR implant components. With implants in situ, each knee was imaged using a two-stage conventional plain X-ray series and rapid-acquisition spiral CT. A beam-hardening artefact removal algorithm was employed to improve CT image quality. After random image sorting, 12 radiologists were independently shown the series of plain X-ray images and asked to note the presence, anatomic location and 'size' of osteolytic lesions observed. The same process was repeated separately for review of the CT images. The corresponding X-ray and CT responses were directly compared to elicit any difference in the ability to demonstrate the presence and size of osteolytic lesions. Results Access to CT images significantly improved the accuracy of recognition of peri-prosthetic osteolytic lesions when compared to AP and lateral projections alone (P = 0.008) and with the addition of bi-planar oblique X-rays (P = 0.03). No advantage was obtained in accuracy of identification of such lesions through the introduction of the oblique images when compared with the AP and lateral projections alone (P = 0

  10. Focus, 2000-2001.

    ERIC Educational Resources Information Center

    Focus, 2001

    2001-01-01

    These three issues of 2000-2001 "Focus" present a collection of papers focusing on issues related to poverty. The first issue discusses child support enforcement policy and low-income families, highlighting such issues as fragile families and child wellbeing; low-income families and the child support enforcement system; child support…

  11. Microfabricated particle focusing device

    DOEpatents

    Ravula, Surendra K.; Arrington, Christian L.; Sigman, Jennifer K.; Branch, Darren W.; Brener, Igal; Clem, Paul G.; James, Conrad D.; Hill, Martyn; Boltryk, Rosemary June

    2013-04-23

    A microfabricated particle focusing device comprises an acoustic portion to preconcentrate particles over large spatial dimensions into particle streams and a dielectrophoretic portion for finer particle focusing into single-file columns. The device can be used for high throughput assays for which it is necessary to isolate and investigate small bundles of particles and single particles.

  12. FOCUS: Sustainable Mathematics Successes

    ERIC Educational Resources Information Center

    Mireles, Selina V.; Acee, Taylor W.; Gerber, Lindsey N.

    2014-01-01

    The FOCUS (Fundamentals of Conceptual Understanding and Success) Co-Requisite Model Intervention (FOCUS Intervention) for College Algebra was developed as part of the Developmental Education Demonstration Projects (DEDP) in Texas. The program was designed to use multiple services, courses, and best practices to support student completion of a…

  13. Focus, 2000-2001.

    ERIC Educational Resources Information Center

    Focus, 2001

    2001-01-01

    These three issues of 2000-2001 "Focus" present a collection of papers focusing on issues related to poverty. The first issue discusses child support enforcement policy and low-income families, highlighting such issues as fragile families and child wellbeing; low-income families and the child support enforcement system; child support…

  14. Focused ultrasound in ophthalmology.

    PubMed

    Silverman, Ronald H

    2016-01-01

    The use of focused ultrasound to obtain diagnostically significant information about the eye goes back to the 1950s. This review describes the historical and technological development of ophthalmic ultrasound and its clinical application and impact. Ultrasound, like light, can be focused, which is crucial for formation of high-resolution, diagnostically useful images. Focused, single-element, mechanically scanned transducers are most common in ophthalmology. Specially designed transducers have been used to generate focused, high-intensity ultrasound that through thermal effects has been used to treat glaucoma (via ciliodestruction), tumors, and other pathologies. Linear and annular transducer arrays offer synthetic focusing in which precise timing of the excitation of independently addressable array elements allows formation of a converging wavefront to create a focus at one or more programmable depths. Most recently, linear array-based plane-wave ultrasound, in which the array emits an unfocused wavefront and focusing is performed solely on received data, has been demonstrated for imaging ocular anatomy and blood flow. While the history of ophthalmic ultrasound extends back over half-a-century, new and powerful technologic advances continue to be made, offering the prospect of novel diagnostic capabilities.

  15. Focused ultrasound in ophthalmology

    PubMed Central

    Silverman, Ronald H

    2016-01-01

    The use of focused ultrasound to obtain diagnostically significant information about the eye goes back to the 1950s. This review describes the historical and technological development of ophthalmic ultrasound and its clinical application and impact. Ultrasound, like light, can be focused, which is crucial for formation of high-resolution, diagnostically useful images. Focused, single-element, mechanically scanned transducers are most common in ophthalmology. Specially designed transducers have been used to generate focused, high-intensity ultrasound that through thermal effects has been used to treat glaucoma (via ciliodestruction), tumors, and other pathologies. Linear and annular transducer arrays offer synthetic focusing in which precise timing of the excitation of independently addressable array elements allows formation of a converging wavefront to create a focus at one or more programmable depths. Most recently, linear array-based plane-wave ultrasound, in which the array emits an unfocused wavefront and focusing is performed solely on received data, has been demonstrated for imaging ocular anatomy and blood flow. While the history of ophthalmic ultrasound extends back over half-a-century, new and powerful technologic advances continue to be made, offering the prospect of novel diagnostic capabilities. PMID:27757007

  16. Flat Focusing Mirror

    PubMed Central

    Cheng, Y. C.; Kicas, S.; Trull, J.; Peckus, M.; Cojocaru, C.; Vilaseca, R.; Drazdys, R.; Staliunas, K.

    2014-01-01

    The control of spatial propagation properties of narrow light beams such as divergence, focusing or imaging are main objectives in optics and photonics. In this letter, we propose and demonstrate experimentally a flat focusing mirror, based on an especially designed dielectric structure without any optical axis. More generally, it also enables imaging any light pattern in reflection. The flat focusing mirror with a transversal invariance can largely increase the applicability of structured photonic materials for light beam propagation control in small-dimension photonic circuits. PMID:25228358

  17. Inertial focusing in microfluidics.

    PubMed

    Martel, Joseph M; Toner, Mehmet

    2014-07-11

    When Segré and Silberberg in 1961 witnessed particles in a laminar pipe flow congregating at an annulus in the pipe, scientists were perplexed and spent decades learning why such behavior occurred, finally understanding that it was caused by previously unknown forces on particles in an inertial flow. The advent of microfluidics opened a new realm of possibilities for inertial focusing in the processing of biological fluids and cellular suspensions and created a field that is now rapidly expanding. Over the past five years, inertial focusing has enabled high-throughput, simple, and precise manipulation of bodily fluids for a myriad of applications in point-of-care and clinical diagnostics. This review describes the theoretical developments that have made the field of inertial focusing what it is today and presents the key applications that will make inertial focusing a mainstream technology in the future.

  18. Focusing corner cube

    DOEpatents

    Monjes, J.A.

    1985-09-12

    This invention retortreflects and focuses a beam of light. The invention comprises a modified corner cube reflector wherein one reflective surface is planar, a second reflective surface is spherical, and the third reflective surface may be planar or convex cylindrical.

  19. Focus: Surface Characterization.

    ERIC Educational Resources Information Center

    Winograd, Nicholas

    1985-01-01

    The 38th Annual Summer Symposium on Analytical Chemistry (June 18-20, 1985) focused on the surface characterization of catalytic and electronic materials. Highlights of the symposium are provided, including presentations that considered lasers and microscopy. (JN)

  20. Facility Focus: Food Service.

    ERIC Educational Resources Information Center

    College Planning & Management, 2002

    2002-01-01

    Describes the Hawthorn Court Community Center at Iowa State University, Ames, and the HUB-Robeson Center at Pennsylvania State University. Focuses on the food service offered in these new student-life buildings. Includes photographs. (EV)

  1. Inertial Focusing in Microfluidics

    PubMed Central

    Martel, Joseph M.; Toner, Mehmet

    2015-01-01

    When Segré and Silberberg in 1961 witnessed particles in a laminar pipe flow congregating at an annulus in the pipe, scientists were perplexed and spent decades learning why such behavior occurred, finally understanding that it was caused by previously unknown forces on particles in an inertial flow. The advent of microfluidics opened a new realm of possibilities for inertial focusing in the processing of biological fluids and cellular suspensions and created a field that is now rapidly expanding. Over the past five years, inertial focusing has enabled high-throughput, simple, and precise manipulation of bodily fluids for a myriad of applications in point-of-care and clinical diagnostics. This review describes the theoretical developments that have made the field of inertial focusing what it is today and presents the key applications that will make inertial focusing a mainstream technology in the future. PMID:24905880

  2. Focus Group Guide

    DTIC Science & Technology

    2017-07-01

    Time/Date: Unit: Session #: Focus Group Location: Number of Participants: Group Rank Makeup: Demographics (# by race, sex ): Use separate...Sexual Harassment (C) Sex Harassment Retaliation (D) Discrimination - Sex (E) Discrimination - Race (F) Discrimination - Disability (G

  3. Focus on Preservation.

    ERIC Educational Resources Information Center

    Wyly, Mary; And Others

    1985-01-01

    Three articles focus on preservation of library materials: profile of Bonnie Jo Cullison, book conservationist at Newberry Library (Chicago, Illinois); planning for preservation (administration, conservation training, microreproduction, library binding, environmental control, research and development, educating public); preservation guide for…

  4. Facility Focus: Food Service.

    ERIC Educational Resources Information Center

    College Planning & Management, 2002

    2002-01-01

    Describes the Hawthorn Court Community Center at Iowa State University, Ames, and the HUB-Robeson Center at Pennsylvania State University. Focuses on the food service offered in these new student-life buildings. Includes photographs. (EV)

  5. Final focus test beam

    SciTech Connect

    Not Available

    1991-03-01

    This report discusses the following: the Final Focus Test Beam Project; optical design; magnets; instrumentation; magnetic measurement and BPM calibration; mechanical alignment and stabilization; vacuum system; power supplies; control system; radiation shielding and personnel protection; infrastructure; and administration.

  6. Final focus nomenclature

    SciTech Connect

    Erickson, R.

    1986-08-08

    The formal names and common names for all devices in the final focus system of the SLC are listed. The formal names consist of a device type designator, microprocessor designator, and a four-digit unit number. (LEW)

  7. High harmonics focusing undulator

    SciTech Connect

    Varfolomeev, A.A.; Hairetdinov, A.H.; Smirnov, A.V.; Khlebnikov, A.S.

    1995-12-31

    It was shown in our previous work that there exist a possibility to enhance significantly the {open_quote}natural{close_quote} focusing properties of the hybrid undulator. Here we analyze the actual undulator configurations which could provide such field structure. Numerical simulations using 2D code PANDIRA were carried out and the enhanced focusing properties of the undulator were demonstrated. The obtained results provide the solution for the beam transport in a very long (short wavelength) undulator schemes.

  8. New NLC Final Focus

    SciTech Connect

    Raimondi, P.

    2004-10-11

    A novel design of the Final Focus has recently been proposed [1] and has been adopted now for the Next Linear Collider [2]. This new design has fewer optical elements and is much shorter, nonetheless achieving better chromatic properties. In this paper, the new final focus system is briefly discussed stressing one particular characteristic of the new design--its multi TeV energy reach.

  9. Electron beam focusing system

    SciTech Connect

    Dikansky, N.; Nagaitsev, S.; Parkhomchuk, V.

    1997-09-01

    The high energy electron cooling requires a very cold electron beam. Thus, the electron beam focusing system is very important for the performance of electron cooling. A system with and without longitudinal magnetic field is presented for discussion. Interaction of electron beam with the vacuum chamber as well as with the background ions and stored antiprotons can cause the coherent electron beam instabilities. Focusing system requirements needed to suppress these instabilities are presented.

  10. Plutonium focus area

    SciTech Connect

    1996-08-01

    To ensure research and development programs focus on the most pressing environmental restoration and waste management problems at the U.S. Department of Energy (DOE), the Assistant Secretary for the Office of Environmental Management (EM) established a working group in August 1993 to implement a new approach to research and technology development. As part of this new approach, EM developed a management structure and principles that led to the creation of specific Focus Areas. These organizations were designed to focus the scientific and technical talent throughout DOE and the national scientific community on the major environmental restoration and waste management problems facing DOE. The Focus Area approach provides the framework for intersite cooperation and leveraging of resources on common problems. After the original establishment of five major Focus Areas within the Office of Technology Development (EM-50, now called the Office of Science and Technology), the Nuclear Materials Stabilization Task Group (EM-66) followed the structure already in place in EM-50 and chartered the Plutonium Focus Area (PFA). The following information outlines the scope and mission of the EM, EM-60, and EM-66 organizations as related to the PFA organizational structure.

  11. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors

    PubMed Central

    Hou, Bob L.; Bhatia, Sanjay; Carpenter, Jeffrey S.

    2016-01-01

    For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., > 20 mm) of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52%) the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52%) the distances between the task-determined and anatomically determined hand areas were > 20 mm; and in 16 of 25 cases (i.e., 64%) the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities. PMID:27069871

  12. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials

    PubMed Central

    2017-01-01

    Background Non-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy. Objective To investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence. Search methods Search without restrictions, together with hand searching, until May 2016. Selection criteria Randomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances. Data collection and analysis Following study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. Results Finally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low. Conclusions The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further

  13. Quantitative comparisons on hand motor functional areas determined by resting state and task BOLD fMRI and anatomical MRI for pre-surgical planning of patients with brain tumors.

    PubMed

    Hou, Bob L; Bhatia, Sanjay; Carpenter, Jeffrey S

    2016-01-01

    For pre-surgical planning we present quantitative comparison of the location of the hand motor functional area determined by right hand finger tapping BOLD fMRI, resting state BOLD fMRI, and anatomically using high resolution T1 weighted images. Data were obtained on 10 healthy subjects and 25 patients with left sided brain tumors. Our results show that there are important differences in the locations (i.e., > 20 mm) of the determined hand motor voxels by these three MR imaging methods. This can have significant effect on the pre-surgical planning of these patients depending on the modality used. In 13 of the 25 cases (i.e., 52%) the distances between the task-determined and the rs-fMRI determined hand areas were more than 20 mm; in 13 of 25 cases (i.e., 52%) the distances between the task-determined and anatomically determined hand areas were > 20 mm; and in 16 of 25 cases (i.e., 64%) the distances between the rs-fMRI determined and anatomically determined hand areas were more than 20 mm. In just three cases, the distances determined by all three modalities were within 20 mm of each other. The differences in the location or fingerprint of the hand motor areas, as determined by these three MR methods result from the different underlying mechanisms of these three modalities and possibly the effects of tumors on these modalities.

  14. Focused local anesthesia and analgesia for head and neck surgery.

    PubMed

    Herlich, Andrew

    2012-01-01

    Facility in the use of head and neck regional blocks will provide excellent perioperative analgesia and patient satisfaction. The scope of ambulatory surgical care for head and neck surgery will undoubtedly increase as expertize in these blocks expand in the face of strict criteria for patient selection. Supplemental sedation will be more precise with the intended result of less hangover and nausea and vomiting.

  15. Decontamination & decommissioning focus area

    SciTech Connect

    1996-08-01

    In January 1994, the US Department of Energy Office of Environmental Management (DOE EM) formally introduced its new approach to managing DOE`s environmental research and technology development activities. The goal of the new approach is to conduct research and development in critical areas of interest to DOE, utilizing the best talent in the Department and in the national science community. To facilitate this solutions-oriented approach, the Office of Science and Technology (EM-50, formerly the Office of Technology Development) formed five Focus AReas to stimulate the required basic research, development, and demonstration efforts to seek new, innovative cleanup methods. In February 1995, EM-50 selected the DOE Morgantown Energy Technology Center (METC) to lead implementation of one of these Focus Areas: the Decontamination and Decommissioning (D & D) Focus Area.

  16. Sagittal focusing Laue monochromator

    DOEpatents

    Zhong; Zhong , Hanson; Jonathan , Hastings; Jerome , Kao; Chi-Chang , Lenhard; Anthony , Siddons; David Peter , Zhong; Hui

    2009-03-24

    An x-ray focusing device generally includes a slide pivotable about a pivot point defined at a forward end thereof, a rail unit fixed with respect to the pivotable slide, a forward crystal for focusing x-rays disposed at the forward end of the pivotable slide and a rearward crystal for focusing x-rays movably coupled to the pivotable slide and the fixed rail unit at a distance rearward from the forward crystal. The forward and rearward crystals define reciprocal angles of incidence with respect to the pivot point, wherein pivoting of the slide about the pivot point changes the incidence angles of the forward and rearward crystals while simultaneously changing the distance between the forward and rearward crystals.

  17. NICMOS focus monitor

    NASA Astrophysics Data System (ADS)

    Schneider, Glenn

    1997-07-01

    This proposal is used to determine and monitor the optimal focus and tilt settings for all three NICMOS cameras. It is derived from SM2/NIC 7041, but is structurally quite a bit different. This proposal is built to run NIC1/2 focus sweeps on a weekly basis, and NIC3 focus sweeps twice a week during SMOV {following the "interim" runs of the 7150}. 7043 will run for as long as it is deemed necessary to keep track of the camera focii and to monitor the dewar anomaly. After the discussion on 20/3/96, this proposal is written to run 4 complete 1-week iterations starting 3 days after the last run of the 7150 {NICMOS COARSE OPTICAL ALIGNMENT, PART 2}.

  18. Electrolysis and isoelectric focusing

    NASA Astrophysics Data System (ADS)

    Choi, Y. S.; Lui, Roger; Yu, Xun

    1994-01-01

    This paper consists of two parts. In the first part, the authors prove the existence of steady-state solutions for a three-species electrolyte. The species are subject to both dissociation-association reactions inside the electrolyte and electrochemical reactions at the boundary electrodes. This is a common occurrence in electrolysis. In the second part, the authors investigate how to use this model to describe isoelectric focusing, which is a common technique used to separate large protein molecules. In particular, the isoelectric focusing point for a particular type of protein molecule is calculated using formal perturbation analysis.

  19. [Focused musculoskeletal sonography].

    PubMed

    Horn, Rudolf

    2015-09-16

    Even in emergent situations, focused musculoskeletal sonography must not be overlooked. It has a place in traumatology no less valuable than its place in internal medicine. It can be used to identify traumatic joint effusions, occult fractures and fissures, joint inflammation, muscle and tendon rupture; it can differentiate soft tissue swelling, locate a foreign body, or identify the location of fractures. Focused ultrasound should be performed by the attending physician directly at the patient’s bedside, in order to answer these specific questions.

  20. Focus on Research Methods.

    ERIC Educational Resources Information Center

    Manson, Spero M.

    A brief review of the papers presented at the Symposium on Research and Evaluation Methodology highlights some of the major issues of research in Indian Country. There is a need to translate research results into terms that are meaningful at the local level, yet the act of doing this reveals tensions between scientific objectivity and advocacy.…

  1. Localization of dense intracranial electrode arrays using magnetic resonance imaging

    PubMed Central

    Doyle, Werner K.; Halgren, Eric; Carlson, Chad; Belcher, Thomas L.; Cash, Sydney S.; Devinsky, Orrin; Thesen, Thomas

    2013-01-01

    Intracranial electrode arrays are routinely used in the pre-surgical evaluation of patients with medically refractory epilepsy, and recordings from these electrodes have been increasingly employed in human cognitive neurophysiology due to their high spatial and temporal resolution. For both researchers and clinicians, it is critical to localize electrode positions relative to the subject-specific neuroanatomy. In many centers, a post-implantation MRI is utilized for electrode detection because of its higher sensitivity for surgical complications and the absence of radiation. However, magnetic susceptibility artifacts surrounding each electrode prohibit unambiguous detection of individual electrodes, especially those that are embedded within dense grid arrays. Here, we present an efficient method to accurately localize intracranial electrode arrays based on pre- and post-implantation MR images that incorporates array geometry and the individual's cortical surface. Electrodes are directly visualized relative to the underlying gyral anatomy of the reconstructed cortical surface of individual patients. Validation of this approach shows high spatial accuracy of the localized electrode positions (mean of 0.96 mm±0.81 mm for 271 electrodes across 8 patients). Minimal user input, short processing time, and utilization of radiation-free imaging are strong incentives to incorporate quantitatively accurate localization of intracranial electrode arrays with MRI for research and clinical purposes. Co-registration to a standard brain atlas further allows inter-subject comparisons and relation of intracranial EEG findings to the larger body of neuroimaging literature. PMID:22759995

  2. Focus on First Graders.

    ERIC Educational Resources Information Center

    Schwartz, Shari S.

    The result of a collaboration between the El Paso, Texas, school district and community agencies, the Focus on First Graders program provides early intervention and prevention using a comprehensive approach to providing a variety of services at the school to at-risk first graders from low income families. Teachers and parents were surveyed to…

  3. Focus on Bilingual Education.

    ERIC Educational Resources Information Center

    Mayo, Donald S., Ed.

    1982-01-01

    This collection of essays focuses on issues in bilingual education. First, Elizabeth Flynn examines different kinds of bilingual programs; efforts made towards cultural pluralism in a number of countries; national benefits to be derived from bilingualism; the needs of American ethnic groups, new immigrants, and foreign students; and the pros and…

  4. Youth Leadership. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1995

    1995-01-01

    This theme issue focuses on motivating young people to learn by providing leadership opportunities in school. "Coca-Cola Valued Youth Program: Assessing Progress" (Josie Danini Supik) examines the program's success. This program, which trains high-risk middle and high school students as tutors of younger children, has dramatically…

  5. Policy Update. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1995

    1995-01-01

    This theme issue focuses on the drastic revision of the Texas education code undertaken during the 1995 state legislative session. "Education Policy Reform: Key Points for Districts" (Albert Cortez, Mikki Symonds) outlines critical issues in the legislation that have an impact on educational quality: charter schools exempt from state…

  6. Focused on Student Success

    ERIC Educational Resources Information Center

    California Community Colleges, Chancellor's Office, 2014

    2014-01-01

    In January 2011, the California Community Colleges Board of Governors formed a task force to chart a roadmap for system-wide focus on student success. The task force identified best practices and designed evidence-based recommendations to ensure student success is a driving theme in colleges. This comprehensive plan, known as the Student Success…

  7. Instructional Technology. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1997

    1997-01-01

    This theme issue includes five articles that focus on implementing instructional technology in ways that benefit all students, including limited-English-proficient, minority, economically disadvantaged, and at-risk students. "Cruising the Web with English Language Learners" (Laura Chris Green) presents three scenarios using the World…

  8. School Reform. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue addresses school reform, focusing on accountability, attrition, public-supported private education, equitable education, and schoolwide reform. "School-Student Performance and Accountability" (Jose A. Cardenas) discusses what constitutes good performance in school; the shifting emphasis among the input, output, and…

  9. Bilingual Education. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue focuses on instructional practices, evaluation, and the state of bilingual education. "Effective Implementation of Bilingual Programs: Reflections from the Field" (Abelardo Villarreal, Adela Solis) describes the key characteristics of successful bilingual programs: vision and goals; program leadership; linkage to central…

  10. Focusing on the Invisible

    ERIC Educational Resources Information Center

    Haley, Tim R.

    2008-01-01

    This article seeks to answer the question of whether or not the design and development of an educational laboratory really changes when the focus is on nanotechnology. It explores current laboratory building trends and the added considerations for building a nanotechnology laboratory. The author leaves the reader with additional points to consider…

  11. [Focus: Family Communication].

    ERIC Educational Resources Information Center

    Barnes, Richard E., Ed.

    1977-01-01

    This issue of the "Journal of the Wisconsin Communication Association" focuses on family communication and contains the following articles: "Marital Typologies: An Alternative Approach to the Study of Communication in Enduring Relations" by Mary Anne Fitzpatrick, "Intimate Communication and the Family" by Marilyn D. LaCourt, and "A Study in…

  12. A FOCUS On Students.

    ERIC Educational Resources Information Center

    Fletcher, Susan

    1998-01-01

    William McKinley Middle School in Cedar Rapids, Iowa, has a parent volunteer program called FOCUS that targets average students who are not doing well academically. Program goals are to improve students' organizational skills, help them complete homework assignments, and reteach and preview lessons to increase understanding, so that students will…

  13. Focus on Distance Education.

    ERIC Educational Resources Information Center

    Grenzky, Janet; Maitland, Christine

    2001-01-01

    As a followup to a survey of distance education faculty, the National Education Association conducted two 3-hour focus groups with 12 higher education faculty members in June 2000. The purpose of the groups was to gain more understanding of the complexity of feelings and opinions expressed in a telephone survey conducted in March 2000. The…

  14. Focusing laser scanner

    NASA Technical Reports Server (NTRS)

    Callen, W. R.; Weaver, J. E.

    1979-01-01

    Economical laser scanner assembled from commercially available components, modulates and scans focused laser beam over area up to 5.1 by 5.1 cm. Scanner gives resolution comparable to that of conventional television. Device is highly applicable to area of analog and digital storage and retrieval.

  15. Focus on Godard.

    ERIC Educational Resources Information Center

    Brown, Royal S., Ed.

    This Film Focus series presents selected information about the respected and controversial French filmmaker Jean-Luc Godard and his films. Information is documented through reports of interviews, reviews, essays, and commentaries. Included are filmographies of Godard's films, beginning in 1954 and continuing through 1972. Also, there is a selected…

  16. Focus on Godard.

    ERIC Educational Resources Information Center

    Brown, Royal S., Ed.

    This Film Focus series presents selected information about the respected and controversial French filmmaker Jean-Luc Godard and his films. Information is documented through reports of interviews, reviews, essays, and commentaries. Included are filmographies of Godard's films, beginning in 1954 and continuing through 1972. Also, there is a selected…

  17. Focus on Basics, 1997.

    ERIC Educational Resources Information Center

    Focus on Basics, 1997

    1997-01-01

    Together, these four newsletters contain 36 articles devoted to adult literacy research and practice and the relationship between them. The following articles are included: "A Productive Partnership" (Richard J. Murnane, Bob Bickerton); "Welcome to 'Focus on Basics'" (Barbara Garner); "Applying Research on the Last Frontier" (Karen Backlund, Kathy…

  18. Theme: Focus on Teaching.

    ERIC Educational Resources Information Center

    Connors, James J.; And Others

    1996-01-01

    Includes "The More Things Change..." (Connors); "Students--Bored of Education?" (Earle); "Yesterday, Today and Tomorrow" (Wesch et al.); "Attitude and the Value of Environment" (Foster); "Fins, Feathers and Fur" (Crank); "Greenhouse as a Focus for Agriscience" (Hurst); and "Agricultural and Environmental Education at Milton Hershey School"…

  19. Focus on Phase Electives.

    ERIC Educational Resources Information Center

    Jones, Victor H., Ed.

    1976-01-01

    In this thematic issue, articles focus on the use of phase electives in the English classroom. Discussions include "Death in the Classroom,""Soapbox Operas in the English Classroom,""Language and History in Phase-Elective Programs,""Phase Electives and the Problem of Composition," and "Phase Electives and College Preparation.""Phase Electives Are…

  20. Focus on Grandparents.

    ERIC Educational Resources Information Center

    Murphy, Linda; Della Corte, Suzanne

    1990-01-01

    Following the birth of a handicapped child, both parent and grandparent experience similar feelings of consternation, shock, and grief. The grandparents' reaction is double, however, as they suffer not only for the newborn but for their own child's pain as well. This article focuses on dealing with grief and its stages, including numbness, denial,…

  1. ENC Focus Review.

    ERIC Educational Resources Information Center

    Thorson, Annette, Ed.

    The mission of the Eisenhower National Clearinghouse (ENC) is to identify effective curriculum resources, create high-quality professional development materials, and disseminate useful information and products to improve K-12 mathematics and science teaching and learning. This issue of "ENC Focus" contains articles related to mathematics teaching…

  2. Homework. Focus On

    ERIC Educational Resources Information Center

    Rahal, Michelle Layer

    2010-01-01

    Homework has been an integral part of the educational system for over 100 years. What likely began as simple memorization tasks has evolved into complex projects and sparked an increasingly heated debate over the purpose and value of homework assignments. This "Focus On" examines the purpose of homework, how to create homework that has value,…

  3. Equity. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue focuses on equity in children's literature, public funding for private schools, women in educational fields, female dropouts, and the relationship between school violence and family and community violence. "Violence in Our Schools" (Bradley Scott) explores reasons for school violence (media violence, isolation from…

  4. Focus on Refugees. Transcript.

    ERIC Educational Resources Information Center

    Brandel, Sarah; And Others

    This is the transcript of the "Focus on Refugees," proqram conducted by the Overseas Development Council. Remarks from the following participants are included: (1) Sarah Brandel, Associate Fellow at the Overseas Development Council; (2) Gary Perkins, Chief of Mission of the Washington Office of the United Nations High Commissioner for Refugees…

  5. Focus on Efficient Management.

    ERIC Educational Resources Information Center

    Kentucky State Dept. of Education, Frankfort. Office of Resource Management.

    Compiled as a workshop handbook, this guide presents information to help food service program administrators comply with federal regulations and evaluate and upgrade their operations. Part I discusses requirements of the National School Lunch Program, focusing on the "offer versus serve" method of service enacted in 1976 to reduce waste.…

  6. Immigrant Education. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1996

    1996-01-01

    This newsletter includes five articles on immigrant education that focus on successful school programs and educational policy issues. In "Immigrant Education from the Administrators' Perspective" (Pam McCollum, Juanita Garcia), three principals of south Texas secondary schools with successful immigrant programs discuss their views on the…

  7. Lifelong Learning. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1995

    1995-01-01

    This theme issue focuses on the need for adult literacy programs, as well as recent innovations in literacy education. "Adult Literacy and Leadership: Current Innovations" (Aurelio M. Montemayor) describes an adult literacy outreach program in Texas, and discusses the importance of family literacy for parents' involvement in their…

  8. Young Children. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue includes five articles that focus on educational, cognitive, and brain research with implications for early childhood educators, including those who work with limited-English-proficient, minority, and economically disadvantaged children. "Coming to Grips with Reading Instruction at the Early Grades" (Christie L. Goodman)…

  9. Neocortical focus: experimental view.

    PubMed

    Timofeev, Igor; Chauvette, Sylvain; Soltani, Sara

    2014-01-01

    All brain normal or pathological activities occur in one of the states of vigilance: wake, slow-wave sleep, or REM sleep. Neocortical seizures preferentially occur during slow-wave sleep. We provide a description of neuronal behavior and mechanisms mediating such a behavior within neocortex taking place in natural states of vigilance as well as during seizures pointing to similarities and differences exhibited during sleep and seizures. A concept of epileptic focus is described using a model of cortical undercut, because in that model, the borders of the focus are well defined. In this model, as in other models of acquired epilepsy, the main factor altering excitability is deafferentation, which upregulates neuronal excitability that promotes generation of seizures. Periods of disfacilitation recorded during slow-wave sleep further upregulate neuronal excitability. It appears that the state of neurons and neuronal network in the epileptic focus produced by deafferentation are such that seizures cannot be generated there. Instead, seizures always start around the perimeter of the undercut cortex. Therefore, we define these areas as the seizure focus. In this zone, neuronal connectivity and excitability are moderately enhanced, lowering the threshold for seizure generation.

  10. [Focus: Family Communication].

    ERIC Educational Resources Information Center

    Barnes, Richard E., Ed.

    1977-01-01

    This issue of the "Journal of the Wisconsin Communication Association" focuses on family communication and contains the following articles: "Marital Typologies: An Alternative Approach to the Study of Communication in Enduring Relations" by Mary Anne Fitzpatrick, "Intimate Communication and the Family" by Marilyn D. LaCourt, and "A Study in…

  11. Homework. Focus On

    ERIC Educational Resources Information Center

    Rahal, Michelle Layer

    2010-01-01

    Homework has been an integral part of the educational system for over 100 years. What likely began as simple memorization tasks has evolved into complex projects and sparked an increasingly heated debate over the purpose and value of homework assignments. This "Focus On" examines the purpose of homework, how to create homework that has value,…

  12. Focus on Rashomon.

    ERIC Educational Resources Information Center

    Richie, Donald S., Ed.

    This Film Focus series is a collection of reviews, essays, and commentaries on the Japanese film Rashomon. The plot consists of an attack, a rape, and a robbery, all of which probably occurred during the Middle Ages. Each character relates his own version of what happened, or might have happened, revealing the outward and inner driving forces,…

  13. Focusing educational initiatives

    NASA Technical Reports Server (NTRS)

    Parks, George K.

    1990-01-01

    The United States will soon be facing a critical shortage of aerospace scientists and engineers. To address this problem, Space Grant Colleges can assist in focusing interest in existing educational initiatives and in creating new educational opportunities, particularly for women and underrepresented minorities.

  14. Focus on the President.

    ERIC Educational Resources Information Center

    Optometric Education, 1996

    1996-01-01

    In an interview, the incoming president of the Association of Schools and Colleges of Optometry (ASCO), Thomas L. Lewis, discusses his goals for the association, the challenges facing optometric education in the next decade, cooperation between ASCO and other professional organizations in optometry, his mentors in the profession, his focus as a…

  15. Focus on the President.

    ERIC Educational Resources Information Center

    Optometric Education, 2000

    2000-01-01

    An interview with the new president of the Association of Schools and Colleges of Optometry, John Schoessler, considers issues the president wishes to focus on during his presidency, changes in optometry students over the years, people who influenced his educational ideas, and research currently being conducted at Ohio State University College of…

  16. Education Policy. IDRA Focus.

    ERIC Educational Resources Information Center

    IDRA Newsletter, 1998

    1998-01-01

    This theme issue includes five articles that focus on educational policy in the Texas legislature in relation to student retention, Internet access, and sexual harassment. "1999 Texas Legislative Session--End of an Era?" (Albert Cortez, Maria Robledo Montecel) examines educational equity issues facing legislators: school funding,…

  17. Focus: International Economics.

    ERIC Educational Resources Information Center

    Lynch, Gerald J.; Watts, Michael W.; Wentworth, Donald R.

    The "Focus" series, part of the National Council on Economic Education's (NCEE) EconomicsAmerica program, uses economics to enhance learning in subjects such as history, geography, civics, and personal finance, as well as economics. Activities are interactive, reflecting the belief that students learn best through active, highly…

  18. Theme: Focus on Teaching.

    ERIC Educational Resources Information Center

    Connors, James J.; And Others

    1996-01-01

    Includes "The More Things Change..." (Connors); "Students--Bored of Education?" (Earle); "Yesterday, Today and Tomorrow" (Wesch et al.); "Attitude and the Value of Environment" (Foster); "Fins, Feathers and Fur" (Crank); "Greenhouse as a Focus for Agriscience" (Hurst); and "Agricultural and Environmental Education at Milton Hershey School"…

  19. Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe.

    PubMed

    Mouthaan, Brian E; Rados, Matea; Barsi, Péter; Boon, Paul; Carmichael, David W; Carrette, Evelien; Craiu, Dana; Cross, J Helen; Diehl, Beate; Dimova, Petia; Fabo, Daniel; Francione, Stefano; Gaskin, Vladislav; Gil-Nagel, Antonio; Grigoreva, Elena; Guekht, Alla; Hirsch, Edouard; Hecimovic, Hrvoje; Helmstaedter, Christoph; Jung, Julien; Kalviainen, Reetta; Kelemen, Anna; Kimiskidis, Vasilios; Kobulashvili, Teia; Krsek, Pavel; Kuchukhidze, Giorgi; Larsson, Pål G; Leitinger, Markus; Lossius, Morten I; Luzin, Roman; Malmgren, Kristina; Mameniskiene, Ruta; Marusic, Petr; Metin, Baris; Özkara, Cigdem; Pecina, Hrvoje; Quesada, Carlos M; Rugg-Gunn, Fergus; Rydenhag, Bertil; Ryvlin, Philippe; Scholly, Julia; Seeck, Margitta; Staack, Anke M; Steinhoff, Bernhard J; Stepanov, Valentin; Tarta-Arsene, Oana; Trinka, Eugen; Uzan, Mustafa; Vogt, Viola L; Vos, Sjoerd B; Vulliémoz, Serge; Huiskamp, Geertjan; Leijten, Frans S S; Van Eijsden, Pieter; Braun, Kees P J

    2016-05-01

    In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  20. A sharp-focusing schlieren optical deflectometer

    NASA Technical Reports Server (NTRS)

    Alvi, F. S.; Settles, G. S.; Weinstein, L. M.

    1993-01-01

    A new instrument capable of localized, nonintrusive turbulence measurements is developed by combining a focusing schlieren system with an optical deflectometer. This instrument records the fluctuating light intensity at a point in the focused schlieren image. Its capability is verified by making benchmark measurements of Kelvin-Helmholtz vortices produced in a low-speed axisymmetric mixing layer. The sharp-focusing effect is demonstrated both visually and quantitatively. The results show that the instrument is capable of optical turbulence measurements within a 4 mm depth-of-field.

  1. Focused ion beam system

    DOEpatents

    Leung, K.; Gough, R.A.; Ji, Q.; Lee, Y.Y.

    1999-08-31

    A focused ion beam (FIB) system produces a final beam spot size down to 0.1 {mu}m or less and an ion beam output current on the order of microamps. The FIB system increases ion source brightness by properly configuring the first (plasma) and second (extraction) electrodes. The first electrode is configured to have a high aperture diameter to electrode thickness aspect ratio. Additional accelerator and focusing electrodes are used to produce the final beam. As few as five electrodes can be used, providing a very compact FIB system with a length down to only 20 mm. Multibeamlet arrangements with a single ion source can be produced to increase throughput. The FIB system can be used for nanolithography and doping applications for fabrication of semiconductor devices with minimum feature sizes of 0.1 m or less. 13 figs.

  2. Focused ion beam system

    SciTech Connect

    Leung, K.; Gough, R.A.; Ji, Q.; Lee, Y.Y.

    1999-08-31

    A focused ion beam (FIB) system produces a final beam spot size down to 0.1 {mu}m or less and an ion beam output current on the order of microamps. The FIB system increases ion source brightness by properly configuring the first (plasma) and second (extraction) electrodes. The first electrode is configured to have a high aperture diameter to electrode thickness aspect ratio. Additional accelerator and focusing electrodes are used to produce the final beam. As few as five electrodes can be used, providing a very compact FIB system with a length down to only 20 mm. Multibeamlet arrangements with a single ion source can be produced to increase throughput. The FIB system can be used for nanolithography and doping applications for fabrication of semiconductor devices with minimum feature sizes of 0.1 m or less. 13 figs.

  3. Focused Bessel beams

    SciTech Connect

    Adamson, P V

    2000-04-30

    The diffraction broadening of a focused beam with a Bessel amplitude distribution is examined. Calculations are reported not only of the traditional differential characteristics (radial distributions of the electric-energy densities and of the axial total electromagnetic energy flux in the beam), but also of integral quantities characterising the degree of transverse localisation of the radiation in a tube of specified radius within the beam. It is shown that in a large-aperture Bessel beam only a very small fraction of the total beam power is concentrated in its central core and that a focal point is also observed on intense focusing of the Bessel beam. This spot is not in the geometric-optical focal plane but is displaced from the latter by a certain distance. (laser applications and other topics in quantum electronics)

  4. Focused ion beam system

    DOEpatents

    Leung, Ka-Ngo; Gough, Richard A.; Ji, Qing; Lee, Yung-Hee Yvette

    1999-01-01

    A focused ion beam (FIB) system produces a final beam spot size down to 0.1 .mu.m or less and an ion beam output current on the order of microamps. The FIB system increases ion source brightness by properly configuring the first (plasma) and second (extraction) electrodes. The first electrode is configured to have a high aperture diameter to electrode thickness aspect ratio. Additional accelerator and focusing electrodes are used to produce the final beam. As few as five electrodes can be used, providing a very compact FIB system with a length down to only 20 mm. Multibeamlet arrangements with a single ion source can be produced to increase throughput. The FIB system can be used for nanolithography and doping applications for fabrication of semiconductor devices with minimum feature sizes of 0.1 .mu.m or less.

  5. Dense Plasma Focus Modeling

    SciTech Connect

    Li, Hui; Li, Shengtai; Jungman, Gerard; Hayes-Sterbenz, Anna Catherine

    2016-08-31

    The mechanisms for pinch formation in Dense Plasma Focus (DPF) devices, with the generation of high-energy ions beams and subsequent neutron production over a relatively short distance, are not fully understood. Here we report on high-fidelity 2D and 3D numerical magnetohydrodynamic (MHD) simulations using the LA-COMPASS code to study the pinch formation dynamics and its associated instabilities and neutron production.

  6. Focused on Robert E

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This image, taken by the microscopic imager on the Mars Exploration Rover Opportunity, shows a geological feature dubbed 'Robert E.' Light from the top is illuminating the feature, which is located within the rock outcrop at Meridiani Planum, Mars. Several images, each showing a different part of 'Robert E' in good focus, were merged to produce this view. The area in this image, taken on Sol 15 of the Opportunity mission, is 2.2 centimeters (0.8 inches) across.

  7. Particle Accelerator Focus Automation

    NASA Astrophysics Data System (ADS)

    Lopes, José; Rocha, Jorge; Redondo, Luís; Cruz, João

    2017-08-01

    The Laboratório de Aceleradores e Tecnologias de Radiação (LATR) at the Campus Tecnológico e Nuclear, of Instituto Superior Técnico (IST) has a horizontal electrostatic particle accelerator based on the Van de Graaff machine which is used for research in the area of material characterization. This machine produces alfa (He+) and proton (H+) beams of some μA currents up to 2 MeV/q energies. Beam focusing is obtained using a cylindrical lens of the Einzel type, assembled near the high voltage terminal. This paper describes the developed system that automatically focuses the ion beam, using a personal computer running the LabVIEW software, a multifunction input/output board and signal conditioning circuits. The focusing procedure consists of a scanning method to find the lens bias voltage which maximizes the beam current measured on a beam stopper target, which is used as feedback for the scanning cycle. This system, as part of a wider start up and shut down automation system built for this particle accelerator, brings great advantages to the operation of the accelerator by turning it faster and easier to operate, requiring less human presence, and adding the possibility of total remote control in safe conditions.

  8. Asking questions with focus

    NASA Astrophysics Data System (ADS)

    Liu, Fang; Xu, Yi

    2004-05-01

    This study investigates how different interrogative meanings interact with focus in determining the overall F0 profile of a question. We recorded eight native speakers of Mandarin producing statements, yes-no questions with and without a question particle, wh questions, incredulous questions, and confirmation questions. In each sentence, either the initial, medial, final, or no word was focused. The tonal components of the sentences are all high, all rising, all low, or all falling. F0 contours were extracted by measuring every complete vocal period in the initial, medial, and final disyllabic words in each sentence. Preliminary results show that in both statements and questions, the pitch range of the focused words is expanded and that of the postfocus words suppressed (compressed and lowered). However, postfocus pitch-range suppression seems less extensive in questions than in statements, and in some question types than in others. Finally, an extra F0 rise is often observed in the final syllable of a question unless the syllable is the question particle which has the neutral tone. This is indicative of a high or rising boundary tone associated with the interrogative meaning, which seems to be superimposed on the tone of the sentence-final syllable. [Work supported by NIDCD DC03902.

  9. Findings: LANL outsourcing focus groups

    SciTech Connect

    Jannotta, M.J.; McCabe, V.B.

    1996-12-31

    In March 1996, a series of 24 3-hour dialog focus groups were held with randomly selected Laboratory employees and contractors to gain their perceptions regarding potentials and problems for privatization and consolidation. A secondary goal was to educate and inform the workforce about potentials and issues in privatization and consolidation. Two hundred and thirty-six participants engaged in a learning session and structured input exercises resulting in 2,768 usable comments. Comments were categorized using standard qualitative methods; resulting categories included positive and negative comments on four models (consolidation, spin offs, outsourcing, and corporate partnering) and implications for the workforce, the Laboratory, and the local economy. Categories were in the areas of increasing/decreasing jobs, expertise, opportunity/salary/benefits, quality/efficiency, and effect on the local area and economy. An additional concern was losing Laboratory culture and history. Data were gathered and categorized on employee opinion regarding elements of successful transition to the four models, and issues emerged in the areas of terms and conditions of employment; communication; involvement; sound business planning; ethics and fairness; community infrastructure. From the aggregated opinion of the participants, it is recommended that decision-makers: Plan using sound business principles and continually communicate plans to the workforce; Respect workforce investments in the Laboratory; Tell the workforce exactly what is going on at all times; Understand that economic growth in Northern New Mexico is not universally viewed as positive; and Establish dialog with stakeholders on growth issues.

  10. NICMOS Optimum Coronagraphic Focus Determinaton

    NASA Astrophysics Data System (ADS)

    Schneider, Glenn

    1997-07-01

    This test will ascertain the optimum position of the PAM for maximizing the local contrast ratios in coronagraphic images. Because of the forward motion of the NICMOS optical bench and dewar, the nominal operational position for the PAM is set {for each camera} to achieve diffraction limited focus at the image plane formed at the detector. As a result of the forward motion of the camera 2 detector, hard images are no longer formed coincidentally at the field divider mirror surface {where the coronagraphic hole is located} and at the detector. This will lead to an increase in the diffracted energy in the wings of a PSF from a target placed inside of the coronagraphic hole as the image plane will fall behind the surface of the FDA mirror. The contrast in a coronagraphic image might be enhanced by placing the focus to form an image at either image planes {FDA or detector} or at a place in-between. This is highly dependent on scattering and must be ascertained by direct measurement.

  11. Needs Assessment: A Focus for Curriculum Development.

    ERIC Educational Resources Information Center

    English, Fenwick W.; Kaufman, Roger A.

    This booklet focuses on needs assessment, a process for identifying and defining valid curriculum, instructional, and management objectives. It also presents a means for establishing controls over curriculum development at the local level, whether it be a school district or an individual school. Part 1 explains the (a) fundamentals, (b) rationale,…

  12. Mechanisms Regulating Protein Localization.

    PubMed

    Bauer, Nicholas C; Doetsch, Paul W; Corbett, Anita H

    2015-10-01

    Cellular functions are dictated by protein content and activity. There are numerous strategies to regulate proteins varying from modulating gene expression to post-translational modifications. One commonly used mode of regulation in eukaryotes is targeted localization. By specifically redirecting the localization of a pool of existing protein, cells can achieve rapid changes in local protein function. Eukaryotic cells have evolved elegant targeting pathways to direct proteins to the appropriate cellular location or locations. Here, we provide a general overview of these localization pathways, with a focus on nuclear and mitochondrial transport, and present a survey of the evolutionarily conserved regulatory strategies identified thus far. We end with a description of several specific examples of proteins that exploit localization as an important mode of regulation.

  13. Local aspects of sleep: observations from intracerebral recordings in humans.

    PubMed

    Nobili, Lino; De Gennaro, Luigi; Proserpio, Paola; Moroni, Fabio; Sarasso, Simone; Pigorini, Andrea; De Carli, Fabrizio; Ferrara, Michele

    2012-01-01

    Human sleep is considered a global phenomenon, orchestrated by central specialized neuronal networks modulating the whole-brain activity. However, recent studies point to a local regulation of sleep. Sleep disorders, such as sleepwalking, suggest that electroencephalographic (EEG) features of sleep and wakefulness might be simultaneously present in different cerebral regions. Recently, intracranial EEG recording techniques, mainly applied for the presurgical evaluation of drug-resistant epileptic patients, have provided new and interesting information on the activity of different cortical and subcortical structures during sleep in humans. In particular, it has been observed that the thalamus, during the transition between wake and sleep undergoes a deactivation process that precedes the one occurring within the cortex, with extensive cortical territories maintaining an activated pattern for several minutes after the thalamic deactivation. Very recent intracerebral EEG studies have also shown that human NREM sleep can be characterized by the coexistence of wake-like and sleep-like EEG patterns in different cortical areas. Moreover, unit-firing recordings in multiple brain regions of neurosurgical patients evidenced that most sleep slow waves and the underlying active and inactive neuronal states do occur locally. These findings add a new dimension to the concept of local sleep regulation and opens new perspectives in the interpretation of the substrates underlying behavioral states of vigilance. The implications for sleep medicine are also discussed.

  14. Transverse field focused system

    DOEpatents

    Anderson, Oscar A.

    1986-01-01

    A transverse field focused (TFF) system for transport or acceleration of an intense sheet beam of negative ions in which a serial arrangement of a plurality of pairs of concentric cylindrical-arc electrodes is provided. Acceleration of the sheet beam can be achieved by progressively increasing the mean electrode voltage of successive electrode pairs. Because the beam is curved by the electrodes, the system can be designed to transport the beam through a maze passage which is baffled to prevent line of sight therethrough. Edge containment of the beam can be achieved by shaping the side edges of the electrodes to produce an electric force vector directed inwardly from the electrode edges.

  15. Obesity in focus.

    PubMed

    Pavlik, V; Fajfrova, J

    2011-01-01

    Obesity has become the most frequent metabolic disease as a result of life conditions and lifestyle which have resulted in a positive energetic balance. However, at the end of the 20th century it reached the dimension of the global epidemic as a result of constantly increasing energy intake without an adequate increase in energy expenditure. The article describes the 11th International Congress on Obesity which took place in Stockholm in July 2010. The delegates discussed recommended diagnostics and treatments in obesitology. A large number of presentations were focused on nutrition and dietary management. The Congress showed that it is necessary to keep paying obesity due attention.

  16. Focus on 'Rue Legendre'

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Annotated image of PIA04196 Focus on 'Rue Legendre'

    Spirit used its microscopic imager to take this mosaic of the rock 'Haussmann' on martian day, or sol, 563 (August 3, 2005). The specific target is nicknamed 'Rue Legendre.' The rounded nature of the pebbles indicates that they were eroded on the surface before being embedded into the Haussmann rock. The size of the larger of the two pebbles is approximately 3 centimeters (1.2 inches). The rock probably formed from impact ejecta, consistent with other rocks Spirit discovered during its climb to the summit of 'Husband Hill.'

  17. Dielectrophoretic columnar focusing device

    DOEpatents

    James, Conrad D.; Galambos, Paul C.; Derzon, Mark S.

    2010-05-11

    A dielectrophoretic columnar focusing device uses interdigitated microelectrodes to provide a spatially non-uniform electric field in a fluid that generates a dipole within particles in the fluid. The electric field causes the particles to either be attracted to or repelled from regions where the electric field gradient is large, depending on whether the particles are more or less polarizable than the fluid. The particles can thereby be forced into well defined stable paths along the interdigitated microelectrodes. The device can be used for flow cytometry, particle control, and other process applications, including cell counting or other types of particle counting, and for separations in material control.

  18. Teaching Local History.

    ERIC Educational Resources Information Center

    Singer, Alan, Ed.

    2003-01-01

    This Social Science Docket theme issue focuses on teaching local history and included theme and non-themed articles, lesson plans, learning activities, and book, movie, and museum reviews designed for K-12 social studies teachers. Articles and materials in this issue are: "Editing Is Not Censorship" (Alan Singer); "Teachers Respond…

  19. Global and Local Textuality.

    ERIC Educational Resources Information Center

    Campbell, B. G.

    Coherence and cohesion are fundamental considerations of the composing process that help to define the global and local components of texuality. Global text coherence centers on those aspects of the familiar rhetorical situation. Coherence operates at the paragraph and essay levels, answering questions about focus, tone, mode, topic, and thesis.…

  20. Global and Local Textuality.

    ERIC Educational Resources Information Center

    Campbell, B. G.

    Coherence and cohesion are fundamental considerations of the composing process that help to define the global and local components of texuality. Global text coherence centers on those aspects of the familiar rhetorical situation. Coherence operates at the paragraph and essay levels, answering questions about focus, tone, mode, topic, and thesis.…

  1. Isoelectric focusing in space

    NASA Technical Reports Server (NTRS)

    Bier, M.; Egen, N. B.; Mosher, R. A.; Twitty, G. E.

    1982-01-01

    The potential of space electrophoresis is conditioned by the fact that all electrophoretic techniques require the suppression of gravity-caused convection. Isoelectric focusing (IEF) is a powerful variant of electrophoresis, in which amphoteric substances are separated in a pH gradient according to their isoelectric points. A new apparatus for large scale IEF, utilizing a recycling principle, has been developed. In the ground-based prototype, laminar flow is provided by a series of parallel filter elements. The operation of the apparatus is monitored by an automated array of pH and ultraviolet absorption sensors under control of a desk-top computer. The apparatus has proven to be useful for the purification of a variety of enzymes, snake venom proteins, peptide hormones, and other biologicals, including interferon produced by genetic engineering techniques. In planning for a possible space apparatus, a crucial question regarding electroosmosis needs to be addressed To solve this problem, simple focusing test modules are planned for inclusion in an early Shuttle flight.

  2. Presurgical evaluation for partial epilepsy: Relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG

    SciTech Connect

    Engel, J. Jr.; Henry, T.R.; Risinger, M.W.; Mazziotta, J.C.; Sutherling, W.W.; Levesque, M.F.; Phelps, M.E.

    1990-11-01

    One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidal ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology.

  3. Focus awards 2002.

    PubMed

    Davis, Naomi

    2003-03-22

    The dental team at Zetland House Clinic are a particularly innovative group. As a result of their parent hospital being the first to complete a whole organization clinical governance programme run by the NHS Modernization Agency, they were consequently the first dental team to do so. Now the clinic is a better place to work where the staff are proud of their clinic and the work that they do. The changes that resulted through their experiences of the program have benefited the patients and staff alike, and was such a success story that they have been taken as an example for the Modernisation Agency website to illustrate good practice in clinical governance. These changes and the way they approached their involvement in the program also earned the Zetland House team a place on the finalist list of the 2002 Focus Awards.

  4. Focus on granular segregation

    NASA Astrophysics Data System (ADS)

    Daniels, Karen E.; Schröter, Matthias

    2013-03-01

    Ordinary fluids mix themselves through thermal motions, or can be even more efficiently mixed by stirring. In contrast, granular materials such as sand often unmix when they are stirred, shaken or sheared. This granular segregation is both a practical means to separate materials in industry, and a persistent challenge to uniformly mixing them. While segregation phenomena are ubiquitous, a large number of different mechanisms have been identified and the underlying physics remains the subject of much inquiry. Particle size, shape, density and even surface roughness can play significant roles. The aim of this focus issue is to provide a snapshot of the current state of the science, covering a wide range of packing densities and driving mechanisms, from thermal-like dilute systems to dense flows.

  5. Capillary Isoelectric Focusing

    NASA Astrophysics Data System (ADS)

    Markuszewski, Michał J.; Bujak, Renata; Daghir, Emilia

    Capillary isoelectric focusing (CIEF) is a widespread technique for the analysis of peptides and proteins in biological samples. CIEF is used to separate mixtures of compounds on the basis of differences in their isoelectric point. Aspects of sample preparation, capillary selection, zone mobilization procedures as well as various detection modes used have been described and discussed. Moreover CIEF, coupled to various types of detection techniques (MALDI or LIF), has increasingly been applied to the analysis of variety different high-molecular compounds. CIEF is considered as a highly specific analytical method which may be routinely used in the separation of rare hemoglobin variants. In addition, the application of CIEF in proteomic field have been discussed on the examples of analyses of glycoproteins and immunoglobins due to the meaning in clinical diagnostic.

  6. Alliance-focused training.

    PubMed

    Eubanks-Carter, Catherine; Muran, J Christopher; Safran, Jeremy D

    2015-06-01

    Alliance-focused training (AFT) aims to increase therapists' ability to recognize, tolerate, and negotiate alliance ruptures by increasing the therapeutic skills of self-awareness, affect regulation, and interpersonal sensitivity. In AFT, therapists are encouraged to draw on these skills when metacommunicating about ruptures with patients. In this article, we present the 3 main supervisory tasks of AFT: videotape analysis of rupture moments, awareness-oriented role-plays, and mindfulness training. We describe the theoretical and empirical support for each supervisory task, provide examples based on actual supervision sessions, and present feedback about the usefulness of the techniques from trainees in our program. We also note some of the challenges involved in conducting AFT and the importance of maintaining a strong supervisory alliance when using this training approach.

  7. Focusing on customer service.

    PubMed

    1996-01-01

    This booklet is devoted to a consideration of how good customer service in family planning programs can generate demand for products and services, bring customers back, and reduce costs. Customer service is defined as increasing client satisfaction through continuous concern for client preferences, staff accountability to clients, and respect for the rights of clients. Issues discussed include the introduction of a customer service approach and gaining staff commitment. The experience of PROSALUD in Bolivia in recruiting appropriate staff, supervising staff, soliciting client feedback, and marketing services is offered as an example of a successful customer service approach. The key customer service functions are described as 1) establishing a welcoming atmosphere, 2) streamlining client flow, 3) personalizing client services, and 4) organizing and providing clear information to clients. The role of the manager in developing procedures is explored, and the COPE (Client-Oriented Provider-Efficient) process is presented as a good way to begin to make improvements. Techniques in staff training in customer service include brainstorming, role playing, using case studies (examples of which are provided), and engaging in practice sessions. Training also leads to the development of effective customer service attitudes, and the differences between these and organizational/staff-focused attitudes are illustrated in a chart. The use of communication skills (asking open-ended questions, helping clients express their concerns, engaging in active listening, and handling difficult situations) is considered. Good recovery skills are important when things go wrong. Gathering and using client feedback is the next topic considered. This involves identifying, recording, and discussing customer service issues as well as taking action on these issues and evaluating the results. The booklet ends by providing a sample of customer service indicators, considering the maintenance of a

  8. Local entrainment of oscillatory activity induced by direct brain stimulation in humans

    PubMed Central

    Amengual, Julià L.; Vernet, Marine; Adam, Claude; Valero-Cabré, Antoni

    2017-01-01

    In a quest for direct evidence of oscillation entrainment, we analyzed intracerebral electroencephalographic recordings obtained during intracranial electrical stimulation in a cohort of three medication-resistant epilepsy patients tested pre-surgically. Spectral analyses of non-epileptogenic cerebral sites stimulated directly with high frequency electrical bursts yielded episodic local enhancements of frequency-specific rhythmic activity, phase-locked to each individual pulse. These outcomes reveal an entrainment of physiological oscillatory activity within a frequency band dictated by the rhythm of the stimulation source. Our results support future uses of rhythmic stimulation to elucidate the causal contributions of synchrony to specific aspects of human cognition and to further develop the therapeutic manipulation of dysfunctional rhythmic activity subtending the symptoms of some neuropsychiatric conditions. PMID:28256510

  9. Local Publications.

    ERIC Educational Resources Information Center

    Wilson, Yvonne; And Others

    1994-01-01

    Annotates 30 local government publications that describe local community efforts to improve policing; find alternative ways of dealing with violence; attract businesses; preserve neighborhoods and buildings; provide open space; and improve employment opportunities. Several publications' statistics were based on 1990 census data. (KRN)

  10. Local gravitomagnetism

    NASA Astrophysics Data System (ADS)

    Shahid-Saless, Bahman

    1990-10-01

    In a simple two-body system, the gravitomagnetic components of the metric in the local quasi-inertial frame of one of the bodies is calculated. The local geometry in this frame which is freely falling along the geodesic but is directionally fixed with respect to distant stars is primarily defined by the gravitomagnetic components of the local metric. This metric serves to track down the various contributions from the local and distant source and thus provides further insight to the nature of gravitomagnetism. As a result it is shown that in the quasi-inertial frame geodetic precession is a gravitomagnetic phenomenon. Furthermore a connection between local gravitomagnetic effects and Einstein's principle of equivalence is established.

  11. Focusing on flu

    PubMed Central

    Short, Mary B; Middleman, Amy B

    2014-01-01

    Introduction: To describe adolescents' perspectives regarding the use of school-located immunization programs (SLIP) for influenza vaccination. More importantly, adolescents were asked what factors would make them more or less likely to use a SLIP offering influenza vaccine. Results: Participants were generally found to be knowledgeable about influenza and to have positive attitudes toward receiving the vaccine via SLIP. Students were more willing to participate in a SLIP if it were low cost or free, less time-consuming than going to a doctor, and if they felt they could trust vaccinators. Overall, high school and middle school students ranked the benefits of SLIP similarly to each other. Methods: Focus groups using nominal group method were conducted with middle and high school students in a large, urban school district. Responses were recorded by each school, and then, responses were ranked across all participating schools for each question. Conclusions: A wide range of issues are important to middle and high school students when considering participation in SLIPs including convenience, public health benefits, trust in the program, program safety, and sanitary issues. Further research will be needed regarding the generalizability of these findings to larger populations of students. PMID:24018398

  12. COMPRENDO: Focus and Approach

    PubMed Central

    Schulte-Oehlmann, Ulrike; Albanis, Triantafyllos; Allera, Axel; Bachmann, Jean; Berntsson, Pia; Beresford, Nicola; Carnevali, Daniela Candia; Ciceri, Francesca; Dagnac, Thierry; Falandysz, Jerzy; Galassi, Silvana; Hala, David; Janer, Gemma; Jeannot, Roger; Jobling, Susan; King, Isabella; Klingmüller, Dietrich; Kloas, Werner; Kusk, Kresten Ole; Levada, Ramon; Lo, Susan; Lutz, Ilka; Oehlmann, Jörg; Oredsson, Stina; Porte, Cinta; Rand-Weaver, Marian; Sakkas, Vasilis; Sugni, Michela; Tyler, Charles; van Aerle, Ronny; van Ballegoy, Christoph; Wollenberger, Leah

    2006-01-01

    Tens of thousands of man-made chemicals are in regular use and discharged into the environment. Many of them are known to interfere with the hormonal systems in humans and wildlife. Given the complexity of endocrine systems, there are many ways in which endocrine-disrupting chemicals (EDCs) can affect the body’s signaling system, and this makes unraveling the mechanisms of action of these chemicals difficult. A major concern is that some of these EDCs appear to be biologically active at extremely low concentrations. There is growing evidence to indicate that the guiding principle of traditional toxicology that “the dose makes the poison” may not always be the case because some EDCs do not induce the classical dose–response relationships. The European Union project COMPRENDO (Comparative Research on Endocrine Disrupters—Phylogenetic Approach and Common Principles focussing on Androgenic/Antiandrogenic Compounds) therefore aims to develop an understanding of potential health problems posed by androgenic and antiandrogenic compounds (AACs) to wildlife and humans by focusing on the commonalities and differences in responses to AACs across the animal kingdom (from invertebrates to vertebrates). PMID:16818253

  13. Focusing on flu

    PubMed Central

    Middleman, Amy B.; Short, Mary B.; Doak, Jean S.

    2012-01-01

    School-located immunization programs (SLIP) will only be successful if parents consent to their children's participation. It is critical to understand parent perspectives regarding the factors that make them more or less likely to provide that consent. Organizations creating SLIPs will be able to capitalize on the aspects of SLIPs that parents appreciate, and address and correct issues that may give rise to parent concerns. This study involved five focus groups among the parents of school students in a large, urban school district. Findings highlight the broad range of concepts important to parents when considering participation in a SLIP. The safety and trust issues regarding vaccines in general that are so important to parents are also important to parents when considering participation in a SLIP. Effective communication strategies that include assurances regarding tracking of information and the competence and experience of immunizers will be helpful when addressing parents regarding SLIPs. In addition, parents were very cognizant of and positive regarding the public health benefits associated with SLIPs. Further study among larger populations of parents will further refine these ideas and aid in the development of successful influenza vaccine SLIPs that directly address and communicate with parents about the issues most important to them. PMID:23095868

  14. Current and Emerging Potential of Magnetoencephalography in the Detection and Localization of High-Frequency Oscillations in Epilepsy.

    PubMed

    Tamilia, Eleonora; Madsen, Joseph R; Grant, Patricia Ellen; Pearl, Phillip L; Papadelis, Christos

    2017-01-01

    Up to one-third of patients with epilepsy are medically intractable and need resective surgery. To be successful, epilepsy surgery requires a comprehensive preoperative evaluation to define the epileptogenic zone (EZ), the brain area that should be resected to achieve seizure freedom. Due to lack of tools and methods that measure the EZ directly, this area is defined indirectly based on concordant data from a multitude of presurgical non-invasive tests and intracranial recordings. However, the results of these tests are often insufficiently concordant or inconclusive. Thus, the presurgical evaluation of surgical candidates is frequently challenging or unsuccessful. To improve the efficacy of the surgical treatment, there is an overriding need for reliable biomarkers that can delineate the EZ. High-frequency oscillations (HFOs) have emerged over the last decade as new potential biomarkers for the delineation of the EZ. Multiple studies have shown that HFOs are spatially associated with the EZ. Despite the encouraging findings, there are still significant challenges for the translation of HFOs as epileptogenic biomarkers to the clinical practice. One of the major barriers is the difficulty to detect and localize them with non-invasive techniques, such as magnetoencephalography (MEG) or scalp electroencephalography (EEG). Although most literature has studied HFOs using invasive recordings, recent studies have reported the detection and localization of HFOs using MEG or scalp EEG. MEG seems to be particularly advantageous compared to scalp EEG due to its inherent advantages of being less affected by skull conductivity and less susceptible to contamination from muscular activity. The detection and localization of HFOs with MEG would largely expand the clinical utility of these new promising biomarkers to an earlier stage in the diagnostic process and to a wider range of patients with epilepsy. Here, we conduct a thorough critical review of the recent MEG literature that

  15. Current and Emerging Potential of Magnetoencephalography in the Detection and Localization of High-Frequency Oscillations in Epilepsy

    PubMed Central

    Tamilia, Eleonora; Madsen, Joseph R.; Grant, Patricia Ellen; Pearl, Phillip L.; Papadelis, Christos

    2017-01-01

    Up to one-third of patients with epilepsy are medically intractable and need resective surgery. To be successful, epilepsy surgery requires a comprehensive preoperative evaluation to define the epileptogenic zone (EZ), the brain area that should be resected to achieve seizure freedom. Due to lack of tools and methods that measure the EZ directly, this area is defined indirectly based on concordant data from a multitude of presurgical non-invasive tests and intracranial recordings. However, the results of these tests are often insufficiently concordant or inconclusive. Thus, the presurgical evaluation of surgical candidates is frequently challenging or unsuccessful. To improve the efficacy of the surgical treatment, there is an overriding need for reliable biomarkers that can delineate the EZ. High-frequency oscillations (HFOs) have emerged over the last decade as new potential biomarkers for the delineation of the EZ. Multiple studies have shown that HFOs are spatially associated with the EZ. Despite the encouraging findings, there are still significant challenges for the translation of HFOs as epileptogenic biomarkers to the clinical practice. One of the major barriers is the difficulty to detect and localize them with non-invasive techniques, such as magnetoencephalography (MEG) or scalp electroencephalography (EEG). Although most literature has studied HFOs using invasive recordings, recent studies have reported the detection and localization of HFOs using MEG or scalp EEG. MEG seems to be particularly advantageous compared to scalp EEG due to its inherent advantages of being less affected by skull conductivity and less susceptible to contamination from muscular activity. The detection and localization of HFOs with MEG would largely expand the clinical utility of these new promising biomarkers to an earlier stage in the diagnostic process and to a wider range of patients with epilepsy. Here, we conduct a thorough critical review of the recent MEG literature that

  16. Agriculture and Locality Interrelationships: Perspectives of Local Officials and Farmers.

    ERIC Educational Resources Information Center

    Moxley, Robert L.; Liles, James

    The focus of this study is the impact of urban activities (such as industry) and local governments on agriculture and the impact of agriculture on localities. This report is based on a qualitative study of an agricultural county, and interviews with community and county officials and farmers. The perceptions and opinions of officials are compared…

  17. Trastuzumab Benefits Women with Locally Advanced or Inflammatory

    Cancer.gov

    Women treated with trastuzumab (Herceptin) and chemotherapy before surgery and trastuzumab again after surgery had a reduced risk of the disease recurring or progressing compared with women who received pre-surgical chemotherapy but no trastuzumab, accord

  18. Stress wave focusing transducers

    SciTech Connect

    Visuri, S.R., LLNL

    1998-05-15

    Conversion of laser radiation to mechanical energy is the fundamental process behind many medical laser procedures, particularly those involving tissue destruction and removal. Stress waves can be generated with laser radiation in several ways: creation of a plasma and subsequent launch of a shock wave, thermoelastic expansion of the target tissue, vapor bubble collapse, and ablation recoil. Thermoelastic generation of stress waves generally requires short laser pulse durations and high energy density. Thermoelastic stress waves can be formed when the laser pulse duration is shorter than the acoustic transit time of the material: {tau}{sub c} = d/c{sub s} where d = absorption depth or spot diameter, whichever is smaller, and c{sub s} = sound speed in the material. The stress wave due to thermoelastic expansion travels at the sound speed (approximately 1500 m/s in tissue) and leaves the site of irradiation well before subsequent thermal events can be initiated. These stress waves, often evolving into shock waves, can be used to disrupt tissue. Shock waves are used in ophthalmology to perform intraocular microsurgery and photodisruptive procedures as well as in lithotripsy to fragment stones. We have explored a variety of transducers that can efficiently convert optical to mechanical energy. One such class of transducers allows a shock wave to be focused within a material such that the stress magnitude can be greatly increased compared to conventional geometries. Some transducer tips could be made to operate regardless of the absorption properties of the ambient media. The size and nature of the devices enable easy delivery, potentially minimally-invasive procedures, and precise tissue- targeting while limiting thermal loading. The transducer tips may have applications in lithotripsy, ophthalmology, drug delivery, and cardiology.

  19. Climate adaptation: Cultural knowledge and local risks

    NASA Astrophysics Data System (ADS)

    Strauss, Sarah

    2015-07-01

    A focus on African American communities on the Eastern Shore of Maryland highlights the ways that local cultural knowledge differs from place to place, developing understanding of local climate risks and resources for adaptation.

  20. Focus on sustainability.

    PubMed

    Thompson, R J; Godiksen, L; Hansen, G; Gustafson, D J; Brinkerhoff, D W; Ingle, M D; Rounds, T; Wing, H

    1990-01-01

    In recent years, sustainability has become one of the most critical concepts in international development and is having a dramatic impact on the way development is conceptualized and carried out. The US Agency for International Development (USAID) is incorporating this concept into its programs and projects. Factors encouraging sustainability of projects and programs include host government policies that support or constrain program objectives, national and/or local commitment to project goals, managerial leadership that helps shape improved policies, collaboration at all staff levels in program management, financial resources that cover program operational costs, appropriate program technology, integration of the program with the social and cultural setting of the country, community involvement in the program, sound environmental management, technical assistance oriented to transferring skills and increasing institutional capacity, perception by the host country that the project is "effective," training provided by the project to transfer skill needed for capacity-building, integration of the program into existing institutional framework, and external political, economic and environmental factors. Impediments to sustainability are often inherent in the donor agency's programming process. This includes the implicit assumption that program objectives can be accomplished in a relatively short time frame, when in fact capacity-building requires a lengthy commitment. USAID professionals are pressured to show near-term results which emphasize outputs rather than purpose and goal-level accomplishments achievable only after extensive effort. The emphasis on obligating money and on the project paper as a sales document leads project designers to talk with a great deal more certainty about project results than is warranted by the complex development situation. Uncertainty and flexibility should be designed into projects so activities and objects can change as more

  1. Localized Scleroderma

    MedlinePlus

    ... form of scleroderma which affects internal organs, called systemic sclerosis or, often incorrectly stated, as systemic scleroderma. Localized ... condition and to explain how it differs from systemic sclerosis, which is quite different and affects internal organs ...

  2. Local theory for Mott-Anderson localization

    NASA Astrophysics Data System (ADS)

    Sen, Sudeshna; Terletska, Hanna; Moreno, Juana; Vidhyadhiraja, N. S.; Jarrell, Mark

    2016-12-01

    The paramagnetic metallic phase of the Anderson-Hubbard model (AHM) is investigated using a nonperturbative local moment approach within the framework of dynamical mean-field theory with a typical medium. Our focus is on the breakdown of the metallic phase near the metal-insulators transition as seen in the single-particle spectra, scattering rates, and the associated distribution of Kondo scales. We demonstrate the emergence of a universal, underlying low-energy scale, TKpeak. This lies close to the peak of the distribution of Kondo scales obtained within the metallic phase of the paramagnetic AHM. Spectral dynamics for energies ω ≲TKpeak display Fermi liquid universality crossing over to an incoherent universal dynamics for ω ≫TKpeak in the scaling regime. Such universal dynamics indicate that within a local theory the low to moderately low-energy physics is governed by an effective, disorder renormalized Kondo screening.

  3. Monosized dripping mode of axisymmetric flow focusing.

    PubMed

    Cruz-Mazo, Francisco; Montanero, J M; Gañán-Calvo, A M

    2016-11-01

    We identify and analyze the perfectly regular dripping mode of flow focusing. This mode occurs within narrow intervals of injected flow rates and applied pressure drops and leads to homogeneous-size droplets with diameters similar to or smaller than that of the discharge orifice. The balance between the local acceleration of the fluid particle and the applied pressure drop yields the scaling law for the droplet diameter. This scaling law is validated experimentally with excellent accord.

  4. Muscle and eye movement artifact removal prior to EEG source localization.

    PubMed

    Hallez, Hans; Vergult, Anneleen; Phlypo, Ronald; Van Hese, Peter; De Clercq, Wim; D'Asseler, Yves; Van de Walle, Rik; Vanrumste, Bart; Van Paesschen, Wim; Van Huffel, Sabine; Lemahieu, Ignace

    2006-01-01

    Muscle and eye movement artifacts are very prominent in the ictal EEG of patients suffering from epilepsy, thus making the dipole localization of ictal activity very unreliable. Recently, two techniques (BSS-CCA and pSVD) were developed to remove those artifacts. The purpose of this study is to assess whether the removal of muscle and eye movement artifacts improves the EEG dipole source localization. We used a total of 8 EEG fragments, each from another patient, first unfiltered, then filtered by the BSS-CCA and pSVD. In both the filtered and unfiltered EEG fragments we estimated multiple dipoles using RAP-MUSIC. The resulting dipoles were subjected to a K-means clustering algorithm, to extract the most prominent cluster. We found that the removal of muscle and eye artifact results to tighter and more clear dipole clusters. Furthermore, we found that localization of the filtered EEG corresponded with the localization derived from the ictal SPECT in 7 of the 8 patients. Therefore, we can conclude that the BSS-CCA and pSVD improve localization of ictal activity, thus making the localization more reliable for the presurgical evaluation of the patient.

  5. Fused multivariate empirical mode decomposition (MEMD) and inverse solution method for EEG source localization.

    PubMed

    Khosropanah, Pegah; Ramli, Abdul Rahman; Lim, Kheng Seang; Marhaban, Mohammad Hamiruce; Ahmedov, Anvarjon

    2017-07-22

    EEG source localization is determining possible cortical sources of brain activities with scalp EEG. Generally, every step of the data processing sequence affects the accuracy of EEG source localization. In this paper, we introduce a fused multivariate empirical mode decomposing (MEMD) and inverse solution algorithm with an embedded unsupervised eye blink remover in order to localize the epileptogenic zone accurately. For this purpose, we constructed realistic forward models using MRI and boundary element method (BEM) for each patient to obtain results that are more realistic. We also developed an unsupervised algorithm utilizing a wavelet method to remove eye blink artifacts. Additionally, we applied MEMD, which is one of the recent and suitable feature extraction methods for non-linear, non-stationary, and multivariate signals such as EEG, to extract the signal of interest. We examined the localization results using the two most reliable linear distributed inverse methods in the literature: weighted minimum norm estimation (wMN) and standardized low resolution tomography (sLORETA). Results affirm the success of the proposed algorithm with the highest agreement compared to MRI reference by a specialist. Fusion of MEMD and sLORETA results in approximately zero localization error in terms of spatial difference with the validated MRI reference. High accuracy results of proposed algorithm using non-invasive and low-resolution EEG provide the potential of using this work for pre-surgical evaluation towards epileptogenic zone localization in clinics.

  6. Localized scleroderma.

    PubMed

    Laxer, Ronald M; Zulian, Francesco

    2006-11-01

    Localized scleroderma, also known as morphoea, has a variety of clinical manifestations that can include systemic involvement. Early recognition, diagnosis and treatment may improve the long-term outcome. A large multicentre study coordinated by the Pediatric Rheumatology European Society has yielded important information on the epidemiology and clinical manifestations of juvenile localized scleroderma, especially as it pertains to systemic manifestations. Previous results using methotrexate and corticosteroids have been confirmed. Studies on phototherapy have also demonstrated efficacy. A new immunomodulator, imiquimod, has shown promise in an initial case series. Studies over the past year highlight the wide range of extracutaneous manifestations and different forms of localized scleroderma and suggest that treatment may be beneficial.

  7. Local Acausality

    NASA Astrophysics Data System (ADS)

    Wüthrich, Adrian

    2014-06-01

    A fair amount of recent scholarship has been concerned with correcting a supposedly wrong, but wide-spread, assessment of the consequences of the empirical falsification of Bell-type inequalities. In particular, it has been claimed that Bell-type inequalities follow from "locality tout court" without additional assumptions such as "realism" or "hidden variables". However, this line of reasoning conflates restrictions on the spatio-temporal relation between causes and their effects ("locality") and the assumption of a cause for every event ("causality"). It thus fails to recognize a substantial restriction of the class of theories that is falsified through Bell-type inequalities.

  8. Dual focus diffractive optical element with extended depth of focus

    NASA Astrophysics Data System (ADS)

    Uno, Katsuhiro; Shimizu, Isao

    2014-09-01

    A dual focus property and an extended depth of focus were verified by a new type of diffractive lens displaying on liquid crystal on silicon (LCoS) devices. This type of lens is useful to read information on multilayer optical discs and tilted discs. The radial undulation of the phase groove on the diffractive lens gave the dual focus nature. The focal extension was performed by combining the dual focus lens with the axilens that was invented for expanding the depth of focus. The number of undulations did not affect the intensity along the optical axis but the central spot of the diffraction pattern.

  9. Focusators for laser-branding

    NASA Astrophysics Data System (ADS)

    Doskolovich, L. L.; Kazanskiy, N. L.; Kharitonov, S. I.; Uspleniev, G. V.

    A new method is investigated for synthesis of computer-generated optical elements: focusators that are able to focus the radial-symmetrical laser beam into complex focal contours, in particular into alphanumeric symbols. The method is based on decomposition of the focal contour into segments of straight lines and semi-circles, following corresponding spacing out of the focusator on elementary segments (concentric rings or sectors) and solution of the inverse task of focusing from focusator segments into corresponding elements of the focal contour. The results of numerical computing of the field from synthesized focusators into the letters are presented. The theoretical efficiency of the focusators discussed is no less than 85%. The amplitude masks and the results of operational studies of synthesized focusators are presented.

  10. Public Participation Guide: Focus Groups

    EPA Pesticide Factsheets

    A focus group is a small group discussion with professional leadership. Focus groups are used to find out what issues are of most concern for a community or group when little or no information is available.

  11. Local Color.

    ERIC Educational Resources Information Center

    National Education Association, Washington, DC. Association of Classroom Teachers.

    Twenty-four local projects which are intended to serve as sources of ideas for professional group action are described in this pamphlet. The projects are reported within the framework of four areas of improving teaching. Under "professional development" projects are portrayed concerning the use of student tutors and the improvement of…

  12. Localized scleroderma.

    PubMed

    Kreuter, Alexander

    2012-01-01

    Localized scleroderma (also called morphea) is a term encompassing a spectrum of sclerotic autoimmune diseases that primarily affect the skin, but also might involve underlying structures such as the fat, fascia, muscle, and bones. Its exact pathogenesis is still unknown, but several trigger factors in genetically predisposed individuals might initially lead to an immunologically triggered release of pro-inflammatory cytokines, resulting in a profound dysregulation of the connective tissue metabolism and ultimately to induction of fibrosis. To date, there are no specific serological markers available for localized scleroderma. Within the last years, several validated clinical scores have been introduced as potential outcome measures for the disease. Given the rarity of localized scleroderma, only few evidence-based therapeutical treatment options exist. So far, the most robust data is available for ultraviolet A1 phototherapy in disease that is restricted to the skin, and methotrexate alone or in combination with systemic corticosteroids in more severe disease that additionally affects extracutaneous structures. This practical review summarizes relevant information on the epidemiology, pathogenesis, clinical subtypes and classifications, differential diagnoses, clinical scores and outcome measures, and current treatment strategies of localized scleroderma. © 2012 Wiley Periodicals, Inc.

  13. Local Heroes.

    ERIC Educational Resources Information Center

    Uehling, Barbara

    1996-01-01

    As critics complain about higher education's shortcomings, trustees may need to communicate their institution's economic, cultural, and intellectual contributions to the local community. The most obvious and easily understood benefit is purchasing power, but it also contributes to small business growth, individual quality of life, the social,…

  14. Near-infrared spectroscopic study and the Wada test for presurgical evaluation of expressive and receptive language functions in glioma patients: with a case report of dissociated language functions.

    PubMed

    Sato, Yosuke; Uzuka, Takeo; Aoki, Hiroshi; Natsumeda, Manabu; Oishi, Makoto; Fukuda, Masafumi; Fujii, Yukihiko

    2012-02-29

    Near-infrared spectroscopy (NIRS) has proven to be useful for the evaluation of language lateralization in healthy subjects, infants, and epileptic patients. This study for the first time investigated the expressive and receptive language functions separately, using NIRS in presurgical glioma patients. We also describe a special case with dissociated pattern of language functions. Ten glioma patients were examined. Using NIRS, the hemodynamic changes during a verb generation task or story listening task were measured in the cerebral hemisphere on either side covering the language areas. Following the NIRS study, the Wada test was performed in all the patients. The NIRS study revealed increases of oxyhemoglobin and decreases of deoxyhemoglobin in the language areas elicited by both tasks. In 9 patients, who were all right-handed, the expressive and receptive language functions were lateralized to the left hemisphere. The results of the NIRS study were completely consistent with those of the Wada test. In the remaining 1 patient with a right sided insular glioma, who was right-handed, the NIRS study revealed stronger activation of the right inferior frontal region during the verb generation task, and stronger activation of the left superior temporal region during the story listening task. This dissociated language function was validated by the Wada test and the postoperative neurological course. These results demonstrate that a NIRS study using our technique is extremely valuable for preoperative assessment of the language functions and exemplifies how a preoperative NIRS study can allow detection of unforeseen language lateralization. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

    PubMed

    Szaflarski, Jerzy P; Gloss, David; Binder, Jeffrey R; Gaillard, William D; Golby, Alexandra J; Holland, Scott K; Ojemann, Jeffrey; Spencer, David C; Swanson, Sara J; French, Jacqueline A; Theodore, William H

    2017-01-24

    To assess the diagnostic accuracy and prognostic value of functional MRI (fMRI) in determining lateralization and predicting postsurgical language and memory outcomes. An 11-member panel evaluated and rated available evidence according to the 2004 American Academy of Neurology process. At least 2 panelists reviewed the full text of 172 articles and selected 37 for data extraction. Case reports, reports with <15 cases, meta-analyses, and editorials were excluded. The use of fMRI may be considered an option for lateralizing language functions in place of intracarotid amobarbital procedure (IAP) in patients with medial temporal lobe epilepsy (MTLE; Level C), temporal epilepsy in general (Level C), or extratemporal epilepsy (Level C). For patients with temporal neocortical epilepsy or temporal tumors, the evidence is insufficient (Level U). fMRI may be considered to predict postsurgical language deficits after anterior temporal lobe resection (Level C). The use of fMRI may be considered for lateralizing memory functions in place of IAP in patients with MTLE (Level C) but is of unclear utility in other epilepsy types (Level U). fMRI of verbal memory or language encoding should be considered for predicting verbal memory outcome (Level B). fMRI using nonverbal memory encoding may be considered for predicting visuospatial memory outcomes (Level C). Presurgical fMRI could be an adequate alternative to IAP memory testing for predicting verbal memory outcome (Level C). Clinicians should carefully advise patients of the risks and benefits of fMRI vs IAP during discussions concerning choice of specific modality in each case. © 2017 American Academy of Neurology.

  16. Endoscopic Localization of Colon Cancer Is Frequently Inaccurate.

    PubMed

    Nayor, Jennifer; Rotman, Stephen R; Chan, Walter W; Goldberg, Joel E; Saltzman, John R

    2017-08-01

    Colonoscopic location of a tumor can influence both the surgical procedure choice and overall treatment strategy. To determine the accuracy of colonoscopy in determining the location of colon cancer compared to surgical localization and to elucidate factors that predict discordant colon cancer localization. We conducted a retrospective cross-sectional study of colon cancers diagnosed on colonoscopy at two academic tertiary-care hospitals and two affiliated community hospitals from 2012 to 2014. Colon cancer location was obtained from the endoscopic and surgical pathology reports and characterized by colon segment. We collected data on patient demographics, tumor characteristics, endoscopic procedure characteristics, surgery planned, and surgery performed. Univariate analyses using Chi-squared test and multivariate analysis using forward stepwise logistic regression were performed to determine factors that predict discordant colon cancer localization. There were 110 colon cancer cases identified during the study period. Inaccurate endoscopic colon cancer localization was found in 29% (32/110) of cases. These included 14 cases (12.7%) that were discordant by more than one colonic segment and three cases where the presurgical planned procedure was significantly changed at the time of surgery. On univariate analyses, right-sided colon lesions were associated with increased inaccuracy (43.8 vs 24.4%, p = 0.04). On multivariate analysis, right-sided colon lesions remained independently associated with inaccuracy (OR 1.74, 95% CI 1.03-2.93, p = 0.04). Colon cancer location as determined by colonoscopy is often inaccurate, which can result in intraoperative changes to surgical management, particularly in the right colon.

  17. Use of resting-state fMRI in planning epilepsy surgery.

    PubMed

    Chiang, Sharon; Haneef, Zulfi; Stern, John M; Engel, Jerome

    2017-01-01

    Epileptic seizures result from abnormal neuronal excitability and synchronization, affecting 0.5-1% of the population worldwide. Although anti-seizure drugs are often effective, a significant number of patients with epilepsy continue to experience refractory seizures and are candidates for surgical resection. Whereas standard presurgical evaluation has relied on intracranial electroencephalography (icEEG) and direct cortical stimulation to identify epileptogenic tissue and areas of cortex for which resection would produce clinical deficits, the invasive nature and limited spatial extent of icEEG has led to the investigation of less invasive imaging modalities as adjunctive tools in the presurgical workup. In the past few decades, functional connectivity MRI has emerged as a promising approach for presurgical mapping, leading to a surge in the number of proposed methods and biomarkers for identifying epileptogenic tissue. This review focuses on recent advances in the use of functional connectivity MRI toward its application for presurgical planning, including epilepsy localization and eloquent cortex mapping.

  18. Focus vernier for optical lithography

    NASA Astrophysics Data System (ADS)

    Arnold, William H.; Barouch, Eytan; Hollerbach, Uwe; Orszag, Steven A.

    1993-08-01

    As the depth of focus of optical steppers grows smaller, it becomes more important to determine the position of best focus accurately and quickly. This paper describes the use of phase-shifted mask technology to form a focus vernier: a phase pattern on the stepper reticle which, when imaged in resist, can give both the magnitude and the direction of the focus error. In this, the focus vernier structure is analogous to 3overlay verniers. Thus the determination of focus error can be treated as an alignment problem in the z-axis. This technique is an improvement on previous schemes for the determination of best focus from resist images as it can indicate both the magnitude of the error and its direction in a single exposure.

  19. Making the Localism Vision a Reality

    ERIC Educational Resources Information Center

    Minter, Chris

    2010-01-01

    A focus on adult learning has been quietly driving an increase in local activism among those who traditionally have had the least "voice". It is precisely this kind of grassroots activity that will enable the vision of local democracy and the Big Society to be implemented. In this article, the author hopes to show how a focus on adult…

  20. EDITORIAL: Focus on Quantum Control

    NASA Astrophysics Data System (ADS)

    Rabitz, Herschel

    2009-10-01

    represent two-photon power spectra of arbitrarily and adaptively shaped broadband laser pulses M A Montgomery and N H Damrauer Accurate and efficient implementation of the von Neumann representation for laser pulses with discrete and finite spectra Frank Dimler, Susanne Fechner, Alexander Rodenberg, Tobias Brixner and David J Tannor Coherent strong-field control of multiple states by a single chirped femtosecond laser pulse M Krug, T Bayer, M Wollenhaupt, C Sarpe-Tudoran, T Baumert, S S Ivanov and N V Vitanov Quantum-state measurement of ionic Rydberg wavepackets X Zhang and R R Jones On the paradigm of coherent control: the phase-dependent light-matter interaction in the shaping window Tiago Buckup, Jurgen Hauer and Marcus Motzkus Use of the spatial phase of a focused laser beam to yield mechanistic information about photo-induced chemical reactions V J Barge, Z Hu and R J Gordon Coherent control of multiple vibrational excitations for optimal detection S D McGrane, R J Scharff, M Greenfield and D S Moore Mode selectivity with polarization shaping in the mid-IR David B Strasfeld, Chris T Middleton and Martin T Zanni Laser-guided relativistic quantum dynamics Chengpu Liu, Markus C Kohler, Karen Z Hatsagortsyan, Carsten Muller and Christoph H Keitel Continuous quantum error correction as classical hybrid control Hideo Mabuchi Quantum filter reduction for measurement-feedback control via unsupervised manifold learning Anne E B Nielsen, Asa S Hopkins and Hideo Mabuchi Control of the temporal profile of the local electromagnetic field near metallic nanostructures Ilya Grigorenko and Anatoly Efimov Laser-assisted molecular orientation in gaseous media: new possibilities and applications Dmitry V Zhdanov and Victor N Zadkov Optimization of laser field-free orientation of a state-selected NO molecular sample Arnaud Rouzee, Arjan Gijsbertsen, Omair Ghafur, Ofer M Shir, Thomas Back, Steven Stolte and Marc J J Vrakking Controlling the sense of molecular rotation Sharly Fleischer

  1. Local Group

    NASA Astrophysics Data System (ADS)

    Mateo, M.; Murdin, P.

    2000-11-01

    Not long after EDWIN HUBBLE established that galaxies are `island universes' similar to our home galaxy, the MILKY WAY, he realized that a few of these external galaxies are considerably closer to us than any others. In 1936 he first coined the term `Local Group' in his famous book The Realm of the Nebulae to identify our nearest galactic neighbors. More than 60 yr later, the galaxies of the Loca...

  2. Localized scleroderma.

    PubMed

    Tuffanelli, D L

    1998-03-01

    Localized scleroderma can be divided into three main subtypes: morphea, linear scleroderma, and generalized morphea. Plaque morphea usually has a good prognosis. Variants of morphea, including guttate morphea and atrophoderma of Pasini and Pierini, are seen. Linear scleroderma, whether involving an extremity or the face, is often associated with serological abnormalities. Cosmetic and functional prognosis may be poor. Therapy is usually ineffective. Generalized morphea may be difficult to differentiate from systemic scleroderma. However, progression to systemic scleroderma is uncommon.

  3. Focus Groups Help To Focus the Marketing Strategy.

    ERIC Educational Resources Information Center

    Ashar, Hanna; Lane, Maureen

    1996-01-01

    A university-based degree completion program for adults conducted focus group research to refine market positioning and promotion. Focus groups averaged five current students and recent graduates who reflected, demographically, the current student population. Results gave insight into reasons for selecting the university, aspects of the program…

  4. Localization of sleep spindles, k-complexes, and vertex waves with subdural electrodes in children.

    PubMed

    Pinto, Anna L R; Fernández, Iván S; Peters, Jurriaan M; Manganaro, Sheryl; Singer, Jedediah M; Vendrame, Martina; Prabhu, Sanjay P; Loddenkemper, Tobias; Kothare, Sanjeev V

    2014-08-01

    To describe for the first time in children the localization of sleep spindles, K-complexes, and vertex waves using subdural electrodes. We enrolled children who underwent presurgical evaluation of refractory epilepsy with subdural grid electrodes. We analyzed electroencephalogram data from subdural electrodes and simultaneous recording with Cz scalp electrode. Sleep spindles, K-complexes, and vertex waves were identified and localized based on their morphology on the subdural electrodes. Sixteen patients (9 boys; age range, 3-18 years) were enrolled in the study. The inter-rater reliability on identification and localization of maximal amplitude was high with an intraclass correlation coefficient of 0.85 for vertex waves, 0.94 for sleep spindles, and 0.91 for K-complexes. Sleep spindles presented maximum amplitude around the perirolandic area with a field extending to the frontal regions. K-complexes presented maximum amplitude around the perirolandic area with a field extending to the frontal regions. Vertex waves presented maximum amplitude around the perirolandic areas. In our series of pediatric patients, sleep spindles, K-complexes, and vertex waves were localized around the perirolandic area.

  5. Focused RF hyperthermia using magnetic fluids.

    PubMed

    Tasci, T Onur; Vargel, Ibrahim; Arat, Anil; Guzel, Elif; Korkusuz, Petek; Atalar, Ergin

    2009-05-01

    Heat therapies such as hyperthermia and thermoablation are very promising approaches in the treatment of cancer. Compared with available hyperthermia modalities, magnetic fluid hyperthermia (MFH) yields better results in uniform heating of the deeply situated tumors. In this approach, fluid consisting of superparamagnetic particles (magnetic fluid) is delivered to the tumor. An alternating (ac) magnetic field is then used to heat the particles and the corresponding tumor, thereby ablating it. However, one of the most serious shortcomings of this technique is the unwanted heating of the healthy tissues. This results from the magnetic fluid diffusion from the tumor to the surrounding tissues or from incorrect localization of the fluids in the target tumor area. In this study, the authors demonstrated that by depositing appropriate static (dc) magnetic field gradients on the alternating (ac) magnetic fields, focused heating of the magnetic particles can be achieved. A focused hyperthermia system was implemented by using two types of coils: dc and ac coils. The ac coil generated the alternating magnetic field responsible for the heating of the magnetic particles; the dc coil was used to superimpose a static magnetic field gradient on the alternating magnetic field. In this way, focused heating of the particles was obtained in the regions where the static field was dominated by the alternating magnetic field. In vitro experiments showed that as the magnitude of the dc solenoid currents was increased from 0 to 1.8 A, the specific absorption rate (SAR) of the superparamagnetic particles 2 cm apart from the ac solenoid center decreased by a factor of 4.5, while the SAR of the particles at the center was unchanged. This demonstrates that the hyperthermia system is capable of precisely focusing the heat at the center. Additionally, with this approach, shifting of the heat focus can be achieved by applying different amounts of currents to individual dc solenoids. In vivo

  6. Focused RF hyperthermia using magnetic fluids

    PubMed Central

    Tasci, T. Onur; Vargel, Ibrahim; Arat, Anil; Guzel, Elif; Korkusuz, Petek; Atalar, Ergin

    2009-01-01

    Heat therapies such as hyperthermia and thermoablation are very promising approaches in the treatment of cancer. Compared with available hyperthermia modalities, magnetic fluid hyperthermia (MFH) yields better results in uniform heating of the deeply situated tumors. In this approach, fluid consisting of superparamagnetic particles (magnetic fluid) is delivered to the tumor. An alternating (ac) magnetic field is then used to heat the particles and the corresponding tumor, thereby ablating it. However, one of the most serious shortcomings of this technique is the unwanted heating of the healthy tissues. This results from the magnetic fluid diffusion from the tumor to the surrounding tissues or from incorrect localization of the fluids in the target tumor area. In this study, the authors demonstrated that by depositing appropriate static (dc) magnetic field gradients on the alternating (ac) magnetic fields, focused heating of the magnetic particles can be achieved. A focused hyperthermia system was implemented by using two types of coils: dc and ac coils. The ac coil generated the alternating magnetic field responsible for the heating of the magnetic particles; the dc coil was used to superimpose a static magnetic field gradient on the alternating magnetic field. In this way, focused heating of the particles was obtained in the regions where the static field was dominated by the alternating magnetic field. In vitro experiments showed that as the magnitude of the dc solenoid currents was increased from 0 to 1.8 A, the specific absorption rate (SAR) of the superparamagnetic particles 2 cm apart from the ac solenoid center decreased by a factor of 4.5, while the SAR of the particles at the center was unchanged. This demonstrates that the hyperthermia system is capable of precisely focusing the heat at the center. Additionally, with this approach, shifting of the heat focus can be achieved by applying different amounts of currents to individual dc solenoids. In vivo

  7. Localism: The Changing Picture for Adult Learning

    ERIC Educational Resources Information Center

    Lamb, Penny

    2012-01-01

    The rapidly changing picture on localism and the government's focus on local economic growth have significant implications for adult learning and skills providers in England. Government now sees a sense of place as key to economic growth and recognises the need for a renewed debate on how business and state interact with localities. There is a…

  8. Localism: The Changing Picture for Adult Learning

    ERIC Educational Resources Information Center

    Lamb, Penny

    2012-01-01

    The rapidly changing picture on localism and the government's focus on local economic growth have significant implications for adult learning and skills providers in England. Government now sees a sense of place as key to economic growth and recognises the need for a renewed debate on how business and state interact with localities. There is a…

  9. Policies, Local Control, and Other Antiquities.

    ERIC Educational Resources Information Center

    Davies, Daniel R.; And Others

    1988-01-01

    This bulletin focuses on the views of four authors. The first, Daniel R. Davies, describes the rise and fall of local control and local school board policies and predicts how the vacuum will be filled. Specifically, he analyzes the concomitant waning of local control and school board policymaking power and forecasts stages in the transition from…

  10. Automated detection of ocular focus.

    PubMed

    Hunter, David G; Nusz, Kevin J; Gandhi, Nainesh K; Quraishi, Imran H; Gramatikov, Boris I; Guyton, David L

    2004-01-01

    We characterize objectively the state of focus of the human eye, utilizing a bull's eye photodetector to detect the double-pass blur produced from a point source of light. A point fixation source of light illuminates the eye. Fundus-reflected light is focused by the optical system of the eye onto a bull's eye photodetector [consisting of an annulus (A) and a center (C) of approximately equal active area]. To generate focus curves, C/A is measured with a range of trial lenses in the light path. Three human eyes and a model eye are studied. In the model eye, the focus curve showed a sharp peak with a full width at half maximum (FWHM) of +/-0.25 D. In human eyes, the ratio C/A was >4 at best focus in all cases, with a FWHM of +/-1 D. The optical apparatus detects ocular focus (as opposed to refractive error) in real time. A device that can assess focus rapidly and objectively will make it possible to perform low-cost, mass screening for focusing problems such as may exist in children at risk for amblyopia.

  11. CTE's Focus on Continuous Improvement

    ERIC Educational Resources Information Center

    Foster, John; Kelley, Patricia; Pritz, Sandy; Hodes, Carol

    2011-01-01

    Just one of the ways career and technical education (CTE) is revamping its image is through increased attention to data-driven instructional techniques as a means of improving and focusing instruction on what matters most. Accountability and data have increasingly become a core focus of research, news, and commentary about education in recent…

  12. Production and Perception of Tone 3 Focus in Mandarin Chinese

    PubMed Central

    Lee, Yong-Cheol; Wang, Ting; Liberman, Mark

    2016-01-01

    This study uses production and perception experiments to explore tone 3 focus in Mandarin Chinese. Overall, contrastive focus in Mandarin is clearly marked with increased duration, intensity, and pitch range: in the experiments, listeners identified focused syllables correctly more than 90% of the time. However, a tone 3 syllable offers a smaller capacity for pitch range expansion under focus, and also yields less intensity increase; in addition, local dissimilation increases the duration, intensity, and pitch range of adjacent syllables within the same phrase as a focused tone 3 syllable. As a result, tone 3 focus was less well identified by listeners (77.1%). We suggest that the relatively poor identification of tone 3 focus is due to the smaller capacity for pitch range expansion, the confusion from within-phrase local dissimilatory effects, and the relatively weak intensity of tone 3. This study demonstrates that even within a language where purely prosodic marking of focus is clear, the location of prosodic focus can be difficult to identify in certain circumstances. Our results underline the conclusion, established in other work, that prosodic marking of focus is not universal, but is expressed through the prosodic system of each language. PMID:27507951

  13. Presurgical Botulinum Toxin A Treatment Increases Angiogenesis by Hypoxia-Inducible Factor-1α/Vascular Endothelial Growth Factor and Subsequent Superiorly Based Transverse Rectus Abdominis Myocutaneous Flap Survival in a Rat Model.

    PubMed

    Park, Tae Hwan; Lee, Song Hyun; Park, Yun Joo; Lee, Young Seok; Rah, Dong Kyun; Kim, Sung Young

    2016-06-01

    To date, there have been several experimental studies to assess tissue viability of transverse rectus abdominis myocutaneous (TRAM) flaps. Botulinum toxin A (BoTA) has gained popularity in many clinical fields, for a variety of therapeutic and aesthetic purposes. In addition, there have been reports regarding the positive effect of BoTA on flap survival by various mechanisms. In this study, we hypothesized that pretreatment with BoTA could augment the survival of TRAM flaps via increased hypoxia-inducible factor (HIF)1α/vascular endothelial growth factor (VEGF)-dependent angiogenesis.Twenty-four Sprague-Dawley rats were randomly divided into 2 groups: a control group and a BoTA group. Five days before superiorly based TRAM flap elevation, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Gross flap survival rates were assessed, and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) and Western blotting were performed for the evaluation of angiogenesis-related factors (CD34, HIF-1α, and VEGF).In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral (92.78.3 ± 5.05% vs 86.8 ± 3.88%, P = 0.009) and contralateral (91.57 ± 5.79% vs 74.28 ± 11.83%, P < 0.001) sides.The relative mRNA expression of CD34 and VEGF was significantly higher in the BoTA group than that in the control group in every zone, whereas the relative mRNA expression of HIF-1α was significantly higher in the BoTA group than that in the control group on contralateral sides. The relative protein expression of CD34, VEGF, and HIF-1α was significantly higher in the BoTA group than that in the control group in every zone.In conclusion, we demonstrate that presurgical BoTA treatment might increase angiogenesis by HIF-1α/VEGF, subsequently increase superiorly based TRAM flap survival in a rat model.

  14. High-resolution MEG source imaging approach to accurately localize Broca's area in patients with brain tumor or epilepsy.

    PubMed

    Huang, Charles W; Huang, Ming-Xiong; Ji, Zhengwei; Swan, Ashley Robb; Angeles, Anne Marie; Song, Tao; Huang, Jeffrey W; Lee, Roland R

    2016-05-01

    Localizing expressive language function has been challenging using the conventional magnetoencephalography (MEG) source modeling methods. The present MEG study presents a new accurate and precise approach in localizing the language areas using a high-resolution MEG source imaging method. In 32 patients with brain tumors and/or epilepsies, an object-naming task was used to evoke MEG responses. Our Fast-VESTAL source imaging method was then applied to the MEG data in order to localize the brain areas evoked by the object-naming task. The Fast-VESTAL results showed that Broca's area was accurately localized to the pars opercularis (BA 44) and/or the pars triangularis (BA 45) in all patients. Fast-VESTAL also accurately localized Wernicke's area to the posterior aspect of the superior temporal gyri in BA 22, as well as several additional brain areas. Furthermore, we found that the latency of the main peak of the response in Wernicke's area was significantly earlier than that of Broca's area. In all patients, Fast-VESTAL analysis established accurate and precise localizations of Broca's area, as well as other language areas. The responses in Wernicke's area were also shown to significantly precede those of Broca's area. The present study demonstrates that using Fast-VESTAL, MEG can serve as an accurate and reliable functional imaging tool for presurgical mapping of language functions in patients with brain tumors and/or epilepsies. Published by Elsevier Ireland Ltd.

  15. Local Allergic Rhinitis.

    PubMed

    Campo, Paloma; Salas, María; Blanca-López, Natalia; Rondón, Carmen

    2016-05-01

    This review focuses on local allergic rhinitis, a new phenotype of allergic rhinitis, commonly misdiagnosed as nonallergic rhinitis. It has gained attention over last decade and can affect patients from all countries, ethnic groups and ages, impairing their quality of life, and is frequently associated with conjunctivitis and asthma. Diagnosis is based on clinical history, the demonstration of a positive response to nasal allergen provocation test and/or the detection of nasal sIgE. A positive basophil activation test may support the diagnosis. Recent studies have demonstrated that allergen immunotherapy is an effective immune-modifying treatment, highlighting the importance of early diagnosis.

  16. Plutonium focus area: Technology summary

    SciTech Connect

    1996-03-01

    To ensure research and development programs focus on the most pressing environmental restoration and waste management problems at the U.S. Department of Energy (DOE), the Assistant Secretary for the Office of Environmental Management (EM) established a working group in August 1993 to implement a new approach to research and technology development. As part of this approach, EM developed a management structure and principles that led to creation of specific focus areas. These organizations were designed to focus scientific and technical talent throughout DOE and the national scientific community on major environmental restoration and waste management problems facing DOE. The focus area approach provides the framework for inter-site cooperation and leveraging of resources on common problems. After the original establishment of five major focus areas within the Office of Technology Development (EM-50), the Nuclear Materials Stabilization Task Group (NMSTG, EM-66) followed EM-50`s structure and chartered the Plutonium Focus Area (PFA). NMSTG`s charter to the PFA, described in detail later in this book, plays a major role in meeting the EM-66 commitments to the Defense Nuclear Facilities Safety Board (DNFSB). The PFA is a new program for FY96 and as such, the primary focus of revision 0 of this Technology Summary is an introduction to the Focus Area; its history, development, and management structure, including summaries of selected technologies being developed. Revision 1 to the Plutonium Focus Area Technology Summary is slated to include details on all technologies being developed, and is currently planned for release in August 1996. The following report outlines the scope and mission of the Office of Environmental Management, EM-60, and EM-66 organizations as related to the PFA organizational structure.

  17. EDITORIAL: Focus on Molecular Electronics FOCUS ON MOLECULAR ELECTRONICS

    NASA Astrophysics Data System (ADS)

    Scheer, Elke; Reineker, Peter

    2008-06-01

    The notion 'molecular electronics' has been used more frequently since the 1970s and summarizes a series of physical phenomena and ideas for their application in connection with organic molecules, oligomers, polymers, organic aggregates and solids. The properties studied in this field were connected to optical and electrical phenomena, such as optical absorption, fluorescence, nonlinear optics, energy transport, charge transfer, electrical conductance, and electron and nuclear spin-resonance. The final goal was and is to build devices which can compete or surpass some aspects of inorganic semiconductor devices. For example, on the basis of organic molecules there exist rectifiers, transistors, molecular wires, organic light emitting diodes, elements for photovoltaics, and displays. With respect to applications, one aspect of the organic materials is their broad variability and the lower effort and costs for their processability. The step from microstructures to the investigation of nanostructures is a big challenge also in this field and has lead to what nowadays is called molecular electronics in its narrow sense. In this field the subjects of the studies are often single molecules, e.g. single molecule optical spectroscopy, electrical conductance, i.e. charge transport through a single molecule, the influence of vibrational degrees of freedom, etc. A challenge here is to provide the techniques for addressing in a reproducible way the molecular scale. In another approach small molecular ensembles are studied in order to avoid artefacts from particular contact situations. The recent development of the field is presented in [1-8]. In this Focus Issue we present new results in the field of 'molecular electronics', both in its broad and specialized sense. One of the basic questions is the distribution of the energy levels responsible for optical absorption on the one hand and for the transport of charge on the other. A still unanswered question is whether the Wannier

  18. Compact electron beam focusing column

    SciTech Connect

    Persaud, Arun; Leung, Ka-Ngo; Reijonen, Jani

    2001-07-13

    A novel design for an electron beam focusing column has been developed at LBNL. The design is based on a low-energy spread multicusp plasma source which is used as a cathode for electron beam production. The focusing column is 10 mm in length. The electron beam is focused by means of electrostatic fields. The column is designed for a maximum voltage of 50 kV. Simulations of the electron trajectories have been performed by using the 2-D simulation code IGUN and EGUN. The electron temperature has also been incorporated into the simulations. The electron beam simulations, column design and fabrication will be discussed in this presentation.

  19. FOCUSing on Innovative Solar Technologies

    SciTech Connect

    Rohlfing, Eric; Holman, Zak, Angel, Roger

    2016-03-02

    Many of ARPA-E’s technology programs seek to break down silos and build new technological communities around a specific energy challenge. In this video, ARPA-E’s Deputy Director for Technology Eric Rohlfing, discusses how the Full-Spectrum Optimized Conversion and Utilization of Sunlight (FOCUS) program is bringing together the photovoltaic (PV) and concentrated solar power (CSP) communities to develop hybrid solar energy systems. This video features interviews with innovators from the FOCUS project team made up by Arizona State University and the University of Arizona, and showcases how the FOCUS program is combining.

  20. FOCUSing on Innovative Solar Technologies

    ScienceCinema

    Rohlfing, Eric; Holman, Zak, Angel, Roger

    2016-07-12

    Many of ARPA-E’s technology programs seek to break down silos and build new technological communities around a specific energy challenge. In this video, ARPA-E’s Deputy Director for Technology Eric Rohlfing, discusses how the Full-Spectrum Optimized Conversion and Utilization of Sunlight (FOCUS) program is bringing together the photovoltaic (PV) and concentrated solar power (CSP) communities to develop hybrid solar energy systems. This video features interviews with innovators from the FOCUS project team made up by Arizona State University and the University of Arizona, and showcases how the FOCUS program is combining.