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Sample records for proctalgia fugax mid-term

  1. Hereditary proctalgia fugax and constipation: report of a second family.

    PubMed Central

    Celik, A F; Katsinelos, P; Read, N W; Khan, M I; Donnelly, T C

    1995-01-01

    A second family with hereditary proctalgia fugax and internal anal sphincter hypertrophy associated with constipation is described. Anorectal ultrasonography, manometry, and sensory tests were conducted in two symptomatic and one asymptomatic subjects within the same family and further clinical information was obtained from other family members. The inheritance would correspond to an autosomal dominant condition with incomplete penetration, presenting after the second decade of life. Physiological studies showed deep, ultraslow waves and an absence of internal anal sphincter relaxation on rectal distension in the two most severely affected family members, suggesting the possibility of a neuropathic origin. Both of these patients had an abnormally high blood pressure. After treatment with a sustained release formulation of the calcium antagonist, nifedipine, their blood pressure returned to normal, anal tone was reduced, and the frequency and intensity of anal pain was suppressed. These together improved the quality of the patients' sleep, which had previously been very troubled because of night time attacks of anal pain. PMID:7737568

  2. Proctalgia fugax: demographic and clinical characteristics. What every doctor should know from a prospective study of 54 patients.

    PubMed

    de Parades, Vincent; Etienney, Isabelle; Bauer, Pierre; Taouk, Milad; Atienza, Patrick

    2007-06-01

    This prospective study was designed to describe a typical attack of proctalgia fugax. Patients were recruited from May 2003 to June 2004. Whatever the reason for consultation, they were systematically asked: "Do you ever suffer intermittent and recurring anorectal pain lasting for at least three seconds?" If the answer was yes, they were interviewed with a questionnaire and had a proctologic examination. The criterion for proctalgia fugax was a positive answer with a negative examination. The study included 1,809 patients. Fifty-four of these patients (3 percent) had proctalgia fugax and 83 percent of them had never sought medical advice for this problem. The mean age was 51 (range, 18-87) years. Thirty-seven patients were females (69 percent). The onset of pain was sudden and without a trigger factor in 85 percent of cases. Attacks occurred in the daytime (33 percent) as well as at night (35 percent). The pain was described as cramping, spasm-like, or stabbing in 76 percent of cases. It did not radiate in 93 percent of cases. There were no concomitant symptoms in 81 percent of cases. Attacks stopped spontaneously in 67 percent of cases. The average duration was 15 minutes (range, 5 seconds to 90 minutes). The average annual number of attacks was 13 (range, 1-180). Proctalgia fugax affects twice as many females as males at approximately aged 50 years. Commonly the roughly once-monthly attack occurs as a sudden pain with no trigger factor, diurnally as often as nocturnally. The nonradiating cramp, spasm, or stabbing pain, without concomitant symptoms, is most severe on average after 15 minutes and declines spontaneously.

  3. Amaurosis fugax

    MedlinePlus

    ... amaurosis fugax Images Retina References Bagheri N, Mehta S. Acute vision loss. Prim Care . 2015;42(3):347-361. PMID: 26319342 www.ncbi.nlm.nih.gov/pubmed/26319342 . Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In: Daroff RB, Jankovic J, Mazziotta ...

  4. Epicrania Fugax.

    PubMed

    Cuadrado, María Luz; Guerrero, Angel L; Pareja, Juan A

    2016-04-01

    Epicrania fugax (EF) is a primary headache of recent description. EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Some patients have ocular or nasal autonomic accompaniments, and some have triggers. Between attacks, many patients have continuous or intermittent pain and/or tenderness at the stemming area. Pain frequency is extremely variable and some patients have spontaneous remissions. Preventive therapy is required when the paroxysms are frequent and non-remitting. Neuromodulators, indomethacin, amitryptiline, nerve anesthetic blockades, and trochlear steroid injections have been used in different cases, with partial or complete response.

  5. Linear interictal pain in Epicrania Fugax.

    PubMed

    Pareja, Juan A; Bandrés, Pablo

    2015-01-01

    Epicrania Fugax is a paroxysmal, short-lasting, head pain moving across one hemicranium, describing a linear or zag trajectory, starting and ending in territories of different nerves. Between attacks, patients are usually free of symptoms. We describe an Epicrania Fugax patient complaining of interictal pain. The interictal pain was line-shaped and extended across the usual starting and ending points of the typical Epicrania Fugax paroxysms. Although rarely encountered, persistent linear pain may be a feature of Epicrania Fugax.

  6. LYRA Mid-Term Periodicities

    NASA Astrophysics Data System (ADS)

    Wauters, L.; Dominique, M.; Dammasch, I. E.

    2016-08-01

    The spectra of the PROBA2/LYRA data, similarly to every other solar time series, show predominant periodicities that can be of solar or instrumental origin. In this article, we compare the main periodicities characterizing the LYRA spectrum to those found in the sunspot number, in the 10.7 cm flux, in an X-ray flare index, and in the sunspot area evolution. We focused on the 2010 to 2014 time range, for which the LYRA data are available, although we also briefly address the evolution of the main periodicities in the longer range. The mid-term periodicities at {˜} 28, {˜} 44, {˜} 54, {˜} 59, {˜} 100, {˜} 110, and {˜} 150 days appear as highly significant in several analyzed datasets. The consistency of distinct periodicities between datasets provides characteristics for the global Sun. This consistency also strengthens the reliability of LYRA data.

  7. Ocean Commission mid-term report

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    In its mid-term report issued on 24 September, the U.S. Commission on Ocean Policy paints a bleak picture of the oceans and marine resources. Among the concerns are dramatic increases in population and pollution along shorelines, which indicate that the management of U.S. coastal areas is inadequate. Other problems outlined include outdated and under-utilized ocean and coastal observing and prediction systems, jurisdictional and legal confusion and ambiguity about coastal laws, and a lack of public awareness about threats to oceans.

  8. Electrification: Mid-term (1985 - 2000)

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Electrification, intended to provide a basis for the mid term period of the energy conservation program, was defined as a set of actions and/or policies that leads to an increasing proportion of total energy used in the form of electricity. The important actions within electrification are those with the greatest impacts (coal and nuclear), the greatest technological requirements (peak shaving and transmission) and the greatest response from the decision makers (economic health and growth of utilities in an era of increasing energy costs). The following areas were discussed: increased power generation from coal action, increased use of nuclear power action, improved operation of public utilities action, actions to be taken in industry, transportation and residential/commercial areas. The various ways in which electrification leads to energy conservation were clarified, and a number of specific recommendations relative to electrification were suggested.

  9. Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options

    PubMed Central

    Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

    2011-01-01

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: A recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

  10. Epicrania fugax: 19 cases of an emerging headache.

    PubMed

    Cuadrado, María Luz; Ordás, Carlos M; Sánchez-Lizcano, María; Casas-Limón, Javier; Matías-Guiu, Jordi A; García-García, María Eugenia; Fernández-Matarrubia, Marta; Barahona-Hernando, Raúl; Porta-Etessam, Jesús

    2013-05-01

    Epicrania fugax (EF) is a primary headache of recent description. We aimed to report 19 new cases of EF, and thus contribute to the characterization of this emerging headache. EF is characterized by painful paroxysms starting in a particular area of the head, and rapidly radiating forwards or backwards through the territories of different nerves. The pain is felt in quick motion along a lineal or zigzag trajectory. To date, 47 cases have been published, 34 with forward EF and 13 with backward EF. We performed a descriptive study of all EF cases attending our Headache Unit from April 2010 to December 2012. Demographic and clinical data were recorded with a structured questionnaire. Overall, there were 12 women and 7 men. Mean age at onset was 51.7 ± 16.2. Fourteen patients had forward EF, while 5 patients had backward EF. Painful paroxysms lasted 1-4 seconds. Pain intensity was usually moderate or severe, and pain quality was mostly electric. Four patients had ocular autonomic accompaniments. Pain frequency was extremely variable, and 7 patients identified some triggers. Between attacks, 13 patients had some pain or tenderness in the stemming area. Thirteen patients required therapy for their pain. Neuromodulators, indomethacin, anesthetic blockades, and steroid injections were used in different cases, with partial or complete response. EF appears as a distinct headache syndrome and could be eventually included in future editions of the International Classification of Headache Disorders. © 2013 American Headache Society.

  11. Amaurosis fugax: risk factors and prevalence of significant carotid stenosis

    PubMed Central

    Kvickström, Pia; Lindblom, Bertil; Bergström, Göran; Zetterberg, Madeleine

    2016-01-01

    Purpose The purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF). Method Patients diagnosed with AF and subjected to carotid ultrasound in 2004–2010 in Sahlgrenska University Hospital, Gothenburg (n=302), were included, and data were retrospectively collected from medical records. Results The prevalence of significant carotid stenosis was 18.9%, and 14.2% of the subjects were subjected to carotid endarterectomy. Significant associations with risk of having ≥70% stenosis were male sex (adjusted odds ratio [aOR]: 2.62; 95% confidence interval [CI]: 1.26–5.46), current smoking (aOR: 6.26; 95% CI: 2.62–14.93), diabetes (aOR: 3.68; 95% CI: 1.37–9.90) and previous vasculitis (aOR: 10.78; 95% CI: 1.36–85.5). A majority of the patients (81.4%) was seen by an ophthalmologist prior to the first ultrasound. Only 1.7% of the patients exhibited retinal artery emboli at examination. Conclusion The prevalence of carotid stenosis among patients with AF is higher than has previously been demonstrated in stroke patients. An association with previously reported vascular risk factors and with vasculitis is seen in this patient group. Ocular findings are scarce. PMID:27826182

  12. Resistance to ACCase-inhibiting herbicides in an Asia minor bluegrass (Polypogon fugax) population in China.

    PubMed

    Tang, Wei; Zhou, Fengyan; Chen, Jie; Zhou, Xiaogang

    2014-01-01

    Asia minor bluegrass (Polypogon fugax) is a common annual grass weed of winter crops distributed across China. We conducted a study on the resistance level and the mechanism of resistance to ACCase-inhibiting herbicides in a P. fugax population from China. Whole-plant dose-response experiments in greenhouse showed that the resistant P. fugax population was 1991, 364, 269, 157, and 8-fold resistant to clodinafop-propargyl, fluazifop-p-butyl, haloxyfop-R-methyl, quizalofop-p-ethyl and fenoxaprop-p-ethyl relative to the reference susceptible population, which was susceptible to all the five AOPP herbicides. Much lower R/S values of 3.5, 2.4 and 3.5, respectively, were detected for clethodim, sethoxydim and pinoxaden. Molecular analysis of resistance confirmed that the Ile2041 to Asn mutation in the resistant population conferred resistance to AOPP herbicides, but not to CHD and DEN herbicides. This is the first report of a target site mutation that corresponded to resistance to AOPP herbicides in P. fugax. Proper resistance management practices are necessary to prevent ACCase-inhibiting herbicides from becoming ineffective over wide areas.

  13. Endovascular treatment of penetrating aortic ulcers: mid-term results.

    PubMed

    Dalainas, I; Nano, G; Medda, M; Bianchi, P; Casana, R; Ramponi, F; Stegher, S; Malacrida, G; Inglese, L; Tealdi, D G

    2007-07-01

    The aim of this study was to evaluate mid-term results of endovascular treatment of penetrating aortic ulcers. Between February 2000 and November 2006, 18 consecutive patients underwent endovascular treatment of the descending thoracic aorta (N=16) and abdominal infrarenal aorta (N=2) for penetrating aortic ulcer, in a single University Hospital. Data were prospectively collected and retrospectively analyzed. Mean follow-up was 41 months (range 4 to 77 months). Technical success was achieved in all patients. No perioperative deaths occurred. No conversion to open repair or secondary procedures were required. Two patients died in the follow-up period for reasons not related to penetrating aortic ulcers. One type II endoleak was observed. It was still present, unchanged, twelve months after the procedure. Endovascular treatment of penetrating aortic ulcers of the descending thoracic and infrarenal aorta were safe and effective in the mid-term in this small series of patients.

  14. Mid-Term Probabilistic Forecast of Oil Spill Trajectories

    NASA Astrophysics Data System (ADS)

    Castanedo, S.; Abascal, A. J.; Cardenas, M.; Medina, R.; Guanche, Y.; Mendez, F. J.; Camus, P.

    2012-12-01

    There is increasing concern about the threat posed by oil spills to the coastal environment. This is reflected in the promulgation of various national and international standards among which are those that require companies whose activities involves oil spill risk, to have oil pollution emergency plans or similar arrangements for responding promptly and effectively to oil pollution incidents. Operational oceanography systems (OOS) that provide decision makers with oil spill trajectory forecasting, have demonstrated their usefulness in recent accidents (Castanedo et al., 2006). In recent years, many national and regional OOS have been setup focusing on short-term oil spill forecast (up to 5 days). However, recent accidental marine oil spills (Prestige in Spain, Deep Horizon in Gulf of Mexico) have revealed the importance of having larger prediction horizons (up to 15 days) in regional-scale areas. In this work, we have developed a methodology to provide probabilistic oil spill forecast based on numerical modelling and statistical methods. The main components of this approach are: (1) Use of high resolution long-term (1948-2009) historical hourly data bases of wind, wind-induced currents and astronomical tide currents obtained using state-of-the-art numerical models; (2) classification of representative wind field patterns (n=100) using clustering techniques based on PCA and K-means algorithms (Camus et al., 2011); (3) determination of the cluster occurrence probability and the stochastic matrix (matrix of transition of probability or Markov matrix), p_ij, (probability of moving from a cluster "i" to a cluster "j" in one time step); (4) Initial state for mid-term simulations is obtained from available wind forecast using nearest-neighbors analog method; (5) 15-days Stochastic Markov Chain simulations (m=1000) are launched; (6) Corresponding oil spill trajectories are carried out by TESEO Lagrangian transport model (Abascal et al., 2009); (7) probability maps are

  15. Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia.

    PubMed

    Xue, Ya-Hong; Ding, Shu-Qing; Ding, Yi-Jiang; Pan, Li-Qun

    2017-06-07

    To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups. Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 ± 3.59 mm vs 28.87 ± 4.84 mm, P < 0.05 and 9.67 ± 1.57 mm vs 8.85 ± 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23° ± 1.81° vs 89.94° ± 2.07° in control group, P < 0.05) and straining (88.47° ± 3.32° vs 90.72° ± 1.87° in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23° ± 1.81° vs 88.47° ± 3.32° respectively, P > 0.05). The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

  16. Female sex pheromones of two Japanese saturniid species, Rhodinia fugax and Loepa sakaei: identification, synthesis, and field evaluation.

    PubMed

    Yan, Qi; Kanegae, Akiko; Miyachi, Takashi; Naka, Hideshi; Tatsuta, Haruki; Ando, Tetsu

    2015-01-01

    While 11 species in the family Saturniidae are found in Japan, no sex pheromones of the native species had been investigated previously. We collected larvae of Rhodinia fugax in Nagano and Tottori Prefecture, and of Loepa sakaei in Okinawa Prefecture, and extracted sex pheromones of these two species from virgin female moths. In gas chromatography-electroantennogram detection (GC-EAD) analyses, male antennae of each species responded to one component in the respective pheromone extracts of conspecific females. Chemical analyses of the extracts by GC/mass spectrometry revealed that the EAD-active compounds of R. fugax and L. sakaei were a hexadecadienal and a tetradecadienyl acetate, respectively. The two species belong to the subfamily Saturniinae, and the mass spectra of both were similar to that of the 6,11-hexadecadienyl acetate identified from Antheraea polyphemus, classified in the same subfamily, suggesting the same 6,11-dienyl structure for the C16 aldehyde and a 4,9-dienyl structure for the C14 acetate. Based on this assumption, four geometrical isomers of each dienyl compound were stereoselectively synthesized via acetylene intermediates, compared to the natural products, and tested in the field. Male catches confirmed the pheromone structures of the two Japanese saturniid species as (6E,11Z)-6,11-hexadecadienal for R. fugax and (4E,9Z)-4,9-tetradecadienyl acetate for L. sakaei. The compounds have a characteristic 1,6-dienyl motif common to the pheromones of Saturniinae species.

  17. Facial pain radiating upwards: could the pain of epicrania fugax start in the lower face?

    PubMed

    Cuadrado, María-Luz; Aledo-Serrano, Ángel; Jiménez-Almonacid, Justino; de Lera, Mercedes; Guerrero, Ángel L

    2015-05-01

    Epicrania fugax (EF) is characterized by painful paroxysms starting in a particular area of the head, and rapidly radiating forwards or backwards through the territories of different nerves. In former clinical descriptions, the pain moved between the posterior scalp (C2) and the frontal or periorbital area (V1), either in forward or backward direction. We report 5 patients with a paroxysmal EF-type pain starting in the lower face (V2 or V3) and radiating upwards. In each patient, the pain stemmed from the cheek (n = 1), the upper lip (n = 2) or the chin and mandibular area (n = 2), and then moved up to the forehead or the scalp with linear trajectory. Pain intensity was moderate (n = 1) or severe (n = 4), and pain quality was stabbing (n = 2) or electric (n = 3). The duration of attacks was very brief, lasting 1 to a few seconds. Three patients had ocular or nasal autonomic accompaniments, and 3 had triggers. There seems to be a facial variant of EF. These observations could not only expand the clinical spectrum of EF but also enlarge the differential diagnosis of facial pain. © 2014 American Headache Society.

  18. Epicrania fugax combining forward and backward paroxysms in the same patient: the first four cases

    PubMed Central

    Barón-Sánchez, Johanna; Gutiérrez-Viedma, Álvaro; Ruiz-Piñero, Marina; Pérez-Pérez, Alicia; Guerrero, Ángel Luis; Cuadrado, María L

    2017-01-01

    Background The first description of epicrania fugax (EF) reported brief painful paroxysms that start in posterior regions of the scalp and move forward to reach the ipsilateral forehead, eye, or nose. A backward variation, wherein pain stems from frontal areas and radiates to the posterior scalp, has also been acknowledged. We report four patients with features reminiscent of EF and the coexistence of forward and backward pain paroxysms. Methods We considered all patients attending the headache outpatient office at two tertiary hospitals from March 2008 to March 2016. We enrolled four patients with paroxysms fulfilling criteria for EF and a combination of forward and backward radiations. Results In all cases, pain paroxysms moved both in forward and backward directions with either a zigzag (n=2) or linear (n=2) trajectory. Three patients presented two stemming points, in the occipital scalp and forehead (n=2) or in the parietal area and eye (n=1), whereas the fourth patient only had a stemming point located in the parietal region. Pain quality was mainly stabbing, and its intensity was moderate (n=1) or severe (n=3). The duration of the paroxysms was highly variable (3–30 seconds), and two patients reported autonomic symptoms. Conclusion The clinical picture presented by our patients does not fit with other types of known headache or neuralgia syndromes; we propose it corresponds to a bidirectional variant of EF. PMID:28721087

  19. Teaching about the 2010 Mid-Term Election Using the Internet

    ERIC Educational Resources Information Center

    Risinger, C. Frederick

    2010-01-01

    Mid-term elections, particularly in a president's first term, can be as significant as presidential elections. They can determine whether or not a president and his party can fulfill promises and achieve goals that they set for the nation when elected. In this article, the author recommends websites that can help guide students in understanding…

  20. Teaching about the 2010 Mid-Term Election Using the Internet

    ERIC Educational Resources Information Center

    Risinger, C. Frederick

    2010-01-01

    Mid-term elections, particularly in a president's first term, can be as significant as presidential elections. They can determine whether or not a president and his party can fulfill promises and achieve goals that they set for the nation when elected. In this article, the author recommends websites that can help guide students in understanding…

  1. Mid-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Far Anteromedial Portal Technique

    PubMed Central

    Jeon, Yoon Sang; Choi, Sung Wook; Park, Ju Hyun; Yoon, Jae Sik; Shin, Jung Sub; Kim, Myung Ku

    2017-01-01

    Purpose The purpose of this study was to evaluate the mid-term outcomes of anatomic anterior cruciate ligament (ACL) reconstruction using two anteromedial (AM) portals by comparing with short-term follow-up results. Materials and Methods Fifty patients who were treated by ACL reconstruction using a two AM portal technique were evaluated retrospectively. The follow-up period was at least 5 years. The mean follow-up period was 68.5±13.9 months. The mid-term clinical outcomes were compared with short-term (≥12 months) results. For the assessment of knee stability, anterior tibial translation was evaluated using the Lachman test and the KT-2000. Rotational stability was evaluated using pivot shift test. For clinical assessment, the Lysholm and International Knee Documentation Committee scores were used. Results The average anterior translation was 2.1±1.4 mm at the short-term follow-up and 2.8±1.8 mm at the mid-term follow-up. Stability and midterm clinical outcomes were not significantly improved compared to the short-term follow-up results. At the mid-term follow-up, anteroposterior (AP) instability assessed by the KT-2000 was slightly increased, but still acceptable. On the other clinical physical evaluation, there was no statistically significant difference. Conclusions The short-term and mid-term outcomes of ACL reconstruction using the two AM portal technique were not significantly different except for AP stability although the value was less than 3 mm at both follow-ups. Therefore, this operative technique could be considered a satisfactory alternative for ACL reconstruction. PMID:28231644

  2. Nextgen Technologies for Mid-Term and Far-Term Air Traffic Control Operations

    NASA Technical Reports Server (NTRS)

    Prevot, Thomas

    2009-01-01

    This paper describes technologies for mid-term and far-term air traffic control operations in the Next Generation Air Transportation System (NextGen). The technologies were developed and evaluated with human-in-the-loop simulations in the Airspace Operations Laboratory (AOL) at the NASA Ames Research Center. The simulations were funded by several research focus areas within NASA's Airspace Systems program and some were co-funded by the FAA's Air Traffic Organization for Planning, Research and Technology.

  3. Mid-term outcome after surgical repair of congenital supravalvular aortic stenosis by extended aortoplasty

    PubMed Central

    Bakhtiary, Farhad; Amer, Mohammed; Etz, Christian D.; Dähnert, Ingo; Wilhelm Mohr, Friedrich; Bellinghausen, Wilfried; Kostelka, Martin

    2013-01-01

    OBJECTIVES Congenital supravalvular aortic stenosis (SVAS) is a rare arteriopathy associated with the Williams–Beuren syndrome (WBS) and other elastin gene deletions. Our objective was to review the mid-term outcomes of SVAS repair with extended aortoplasty. METHODS Congenital SVAS repairs from 2001 to 2010 were retrospectively reviewed. The follow-up records, reintervention and reoperation data and most recent echocardiograms were obtained. RESULTS From 2001 to 2010, 21 patients (15 males) underwent surgical repair of SVAS by extended aortoplasty with autologous pretreated pericardium, which is a modification of the Doty technique. The mean age was 3.1 ± 4.2 years. WBS was diagnosed in 14 of the patients. There was no early mortality, but one late death was observed. At the latest follow-up (mean follow-up, 4.3 ± 2.9 years; range, 1–108 months), echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 15 ± 8 mmHg. The majority of the patients had minimal to mild aortic insufficiency. No reoperation or reintervention was required. CONCLUSIONS Extended aortoplasty provides excellent mid-term relief of SVAS and, in addition, reshapes the aortic root geometry to a much more favourable anatomical configuration. It can be performed without any increase in operative risks. The mid-term results are excellent. PMID:23793710

  4. Short- and Mid-term Effects of Irreversible Electroporation on Normal Renal Tissue: An Animal Model

    SciTech Connect

    Wendler, J. J. Porsch, M.; Huehne, S.; Baumunk, D.; Buhtz, P.; Fischbach, F.; Pech, M.; Mahnkopf, D.; Kropf, S.; Roessner, A.; Ricke, J.; Schostak, M.; Liehr, U.-B.

    2013-04-15

    Irreversible electroporation (IRE) is a novel nonthermal tissue ablation technique by high current application leading to apoptosis without affecting extracellular matrix. Previous results of renal IRE shall be supplemented by functional MRI and differentiated histological analysis of renal parenchyma in a chronic treatment setting. Three swine were treated with two to three multifocal percutaneous IRE of the right kidney. MRI was performed before, 30 min (immediate-term), 7 days (short-term), and 28 days (mid-term) after IRE. A statistical analysis of the lesion surrounded renal parenchyma intensities was made to analyze functional differences depending on renal part, side and posttreatment time. Histological follow-up of cortex and medulla was performed after 28 days. A total of eight ablations were created. MRI showed no collateral damage of surrounded tissue. The highest visual contrast between lesions and normal parenchyma was obtained by T2-HR-SPIR-TSE-w sequence of DCE-MRI. Ablation zones showed inhomogeneous necroses with small perifocal edema in the short-term and sharp delimitable scars in the mid-term. MRI showed no significant differences between adjoined renal parenchyma around ablations and parenchyma of untreated kidney. Histological analysis demonstrated complete destruction of cortical glomeruli and tubules, while collecting ducts, renal calyxes, and pelvis of medulla were preserved. Adjoined kidney parenchyma around IRE lesions showed no qualitative differences to normal parenchyma of untreated kidney. This porcine IRE study reveals a multifocal renal ablation, while protecting surrounded renal parenchyma and collecting system over a mid-term period. That offers prevention of renal function ablating centrally located or multifocal renal masses.

  5. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

    PubMed

    Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

    2014-08-01

    Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. Mid-Term Results of Computer-Assisted Cervical Pedicle Screw Fixation

    PubMed Central

    Uehara, Masashi; Mukaiyama, Keijiro; Kuraishi, Shugo; Shimizu, Masayuki; Ikegami, Shota; Futatsugi, Toshimasa; Ogihara, Nobuhide; Hashidate, Hiroyuki; Hirabayashi, Hiroki; Kato, Hiroyuki

    2014-01-01

    Study Design A retrospective study. Purpose The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability. Overview of Literature CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation. Methods Record of 19 patients who underwent cervical and/or upper thoracic (C2-T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated. Results Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p=0.001). The C2-7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%. Conclusions Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system. PMID:25558318

  7. (Mid-term evaluation of the Central America Rural Electrification Support program)

    SciTech Connect

    Perlack, R.D.

    1990-03-30

    Oak Ridge National Laboratory (ORNL) was requested by Regional Office for Central America and Panama (ROCAP) to conduct a mid-term evaluation of the CARES project. Numerous meetings were held with National Rural Electric Cooperative Association (NRECA) staff, ROCAP staff, and local officials in Guatemala, Honduras, and Belize. In general, the CARES project has been quite successful in a number of key areas as well as in soliciting support from utilities and US Agency for International Development (USAID) Missions. Changes were recommended in the area of report writing and some management activities. It was also recommended that any new activities be considered in the light of the availability of local personnel.

  8. Mid term results of Furlong LOL uncemented hip hemiarthroplasty for fractures of the femoral neck.

    PubMed

    Chandran, Prakash; Azzabi, Mohammed; Burton, Dave J C; Andrews, Mark; Bradley, John G

    2006-08-01

    We report the mid-term results of hemiarthroplasty with the Furlong hydroxyapatite coated bipolar prosthesis for displaced (Garden type III and IV) intracapsular hip fracture in 480 patients operated between 1989 and 2000. Three hundred sixty eight (77%) patients were lost to follow-up due to death, dementia or movement away from the area. In the patients followed up there was an 8% reoperation rate for infection, aseptic loosening, periprosthetic fracture and acetabular erosion. One hundred and twelve patients with a mean follow-up of 4 years (3-14) were studied. Eighty eight percent had no or slight pain, 77% could mobilise outdoors and 89% needed either no aid or a single walking stick to mobilise. Radiographic assessment revealed a stable implant with visible osseointegration in 91%. We conclude that hemiarthroplasty with the hydroxyapatite coated bipolar Furlong LOL prosthesis for displaced intracapsular fracture of the neck of the femur gives good mid term results in elderly patients for return to mobility, use of mobility aids and freedom from pain. It avoids the need for cement and provides satisfactory incorporation into the host bone. The use of a modular head makes revision to total hip replacement easier.

  9. Mid-term results of Oxford Phase 3 unicompartmental knee arthroplasty in obese patients.

    PubMed

    Cepni, Serdar Kamil; Arslan, Armağan; Polat, Halil; Yalçin, Atilla; Parmaksizoğlu, Atilla Sancar

    2014-01-01

    The aim of this study was to evaluate the mid-term outcomes of Oxford Phase 3 unicompartmental knee arthroplasty (UKA) in obese patients in terms of prosthesis survival, progression of lateral compartment arthrosis and functional outcomes. The study included 67 patients, with a body mass index over 30, treated with mobile bearing Oxford Phase 3 UKA for isolated medial osteoarthritis between January 2005 and December 2010. Preoperative and postoperative knee range of motion (ROM) and knee scores (Hospital for Special Surgery, HSS and Oxford knee scores) were compared. Additionally, prostheses were evaluated using Oxford radiographic evaluation criteria at the final follow-up. Mean age was 61 years and mean follow-up was 67.5 months. Insert dislocation occurred in 3 patients (4.5%). Postoperative knee ROM, HSS and Oxford knee scores were significantly improved (p<0.05). There was no sign of prosthesis failure or lateral compartment arthrosis in radiographic evaluation at the final follow-up. Oxford Phase 3 UKA with mobile bearing has good mid-term results in obese patients over 60 years of age.

  10. Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System.

    PubMed

    Marczak, Dariusz; Kowalczewski, Jacek; Czubak, Jarosław; Okoń, Tomasz; Synder, Marek; Sibiński, Marcin

    2017-01-01

    The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants. Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.7 years (range 56-83 years) and a mean followup of 5 years (range 3-8 years). Two patients were treated for distal femoral nonunion, five for distal femur periprosthetic fracture and two for periprosthetic joint infection. The mean Knee Society Score: Knee and functional scores were 77.9 and 40 points, respectively. All demonstrated full extension and flexion was at least 90°. Recurrence of infection was present in one patient. No signs of loosening, dislocation, or implant failure were observed. Based on our small series of patients that represent severe cases, GMRS provides relatively good mid-term functional results, pain relief, and good implant survivorship with a low complication rate. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability.

  11. Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair.

    PubMed

    Sandmann, G H; Hahn, D; Amereller, M; Siebenlist, S; Schwirtz, A; Imhoff, A B; Brucker, P U

    2016-06-01

    Proximal hamstring tendon ruptures are commonly associated with a significant loss of function, and operative treatment is recommended in active patients. The objective was to evaluate objective/subjective functional results and return to sports following proximal hamstring tendon repair in the mid-term follow-up. 16 repairs of proximal hamstring ruptures were performed in 15 patients (9 males, 6 females). The average age at the time of injury was 47 years (range, 21-66). All patients were clinically examined at a mean follow-up of 56 months (range, 24-112 months). Validated patient-oriented assessment scores focussing on sports activity including the Lysholm Score, Tegner Activity Score, UCLA Activity Score, adapted WOMAC Score, and the VAS were evaluated as well as the return to sports. Isokinetic strength of both legs was tested using a rotational dynamometer. The Lysholm, Tegner, UCLA Activity Score and the adapted WOMAC demonstrated predominantly a return to a preinjury activity level at follow-up. Functional measurements of the operated leg showed similar results to the uninjured leg in knee extension and flexion strength (p>0.094). In return to sports, no signficant (p>0.05) differences concerning types or frequency were noted. The surgical repair of proximal hamstring tendon ruptures leads to constantly good functional results in the mid-term follow-up, where patients demonstrate similar isokinetic results in the healthy leg. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Mid-term results for metaphyseal sleeves in revision knee surgery.

    PubMed

    Martin-Hernandez, Carlos; Floria-Arnal, Luis Javier; Muniesa-Herrero, Maria Pilar; Espallargas-Doñate, Teresa; Blanco-Llorca, Jose Adolfo; Guillen-Soriano, Melchor; Ranera-Garcia, Miguel

    2016-09-17

    Metaphyseal titanium sleeves have been used to provide cementless fixation in challenging bone defects in revision knee arthroplasty. The aim of this study was to evaluate the mid-term results of radiological and clinical outcomes, for metaphyseal sleeves in type 1B and 2 defects of tibia and femur under the hypothesis that they would provide stable and prolonged fixation. One hundred and thirty-four patients were included in a prospective study to evaluate the outcomes of knee revision with sleeves, together with stems and varus-valgus constrained mobile bearing prosthesis. Median follow-up was 71.5 months (range 36-107). Analysis included American Knee Society Score (KSS), Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), SF12 Health Survey and radiographic assessment. All clinical scores improved significantly in all patients during the follow-up. The median of Knee KSS increased from 33 to 78 and functional KSS from 30 to 80. The median of WOMAC pain index changed from 12 to 4; pre-operative median of WOMAC stiffness and WOMAC function score improved from 5 to 2 and from 45 to 14, respectively. The median of physical SF12 varied from 27 to 44, while mental SF-12 from 43 to 54. Radiological evaluation showed optimal osseous integration in all patients, and neither implant migration nor progressive radiolucency around components was observed. Complications included three cases of end-of-stem pain at tibial side and two revisions due to septic loosening in the first post-operative year. No aseptic loosening was reported. The use of metaphyseal sleeves, in combination with uncemented stems and varus-valgus constrained components with rotating platform, has shown excellent mid-term results allowing osseous ingrowth with no evidence of osteolysis or displacement. This is a promising option for better implant fixation in revision TKA. Case series with no comparison group, Level IV.

  13. Sirolimus for below the knee lesions: mid-term results of SiroBTK study.

    PubMed

    Commeau, Philippe; Barragan, Paul; Roquebert, Pierre O

    2006-11-01

    To assess the safety and efficacy of sirolimus-eluting stents (SESs) in the treatment of severe intermittent claudication and critical limb ischaemia with "below-the-knee" lesions, unsuitable for surgery. Limited published evidence suggests that drug-eluting stents may offer significant improvements in the treatment of infrapopliteal lesions. Thirty consecutive patients with either severe intermittent claudication or critical limb ischemia (CLI), category 3-6 of Rutherford classification, and multivessel disease of infrapopliteal arteries (> or = 2 vessels) were treated with SES. Sixty-two arteries were treated with 106 SES. Mean age was 73.9 years, 77% of patients were male and 36% diabetic. The primary endpoint was clinical improvement and healing of ulcers at short term (1 month) and mid term (7.7 months). The secondary endpoint was primary vessel patency rate (angiographic or duplex assessment). All patients received clopidogrel (75 mg daily) or ticlopidine (150 mg daily) for 2 months or longer. Angiographic and procedural success was achieved in all patients. At 7 months (7.7 +/- 5.8), it was necessary to amputate 1 toe in one patient and 1 mid-foot in another. Limb salvage was obtained in 100% of patients. Other events were: two cardiac deaths unrelated to CLI, one stroke with hemiparesia, one initial reperfusion syndrome, one contralateral CLI, and three recurrent homolateral claudication cases. All surviving patients had a mid-term clinical improvement with 97% of primary patency (56 patent arteries on 58 arteries). Treatment of "below-the-knee" lesions with SES may provide an alternative treatment for patients with CLI. (c) 2006 Wiley-Liss, Inc.

  14. Mid-term results of leaflet augmentation in severe tricuspid functional tethering.

    PubMed

    Pettinari, Matteo; Bertrand, Philippe; Van Kerrebroeck, Christiaan; Vandervoort, Pieter; Gutermann, Herbert; Dion, Robert

    2016-09-01

    Functional tricuspid regurgitation (FTR) is usually managed surgically using various types of annuloplasty. FTR has been reported to recur in up to 45% of patients, with severe leaflet tethering being an important risk factor for recurrence. The aim of this study is to report the clinical and echocardiographic mid-term results after leaflet augmentation in patients with FTR due to severe leaflet tethering. From May 2008 to July 2014, 22 patients were found to have a severe FTR with a tethering height of at least 8 mm; all of them underwent leaflet augmentation: the anterior and part of the posterior leaflet were detached from the anterior annulus; a patch of fresh autologous pericardium was used to generously fill the gap between the anterior annulus and the detached leaflet. A 5/0 Pronova suture locked at every step was used to avoid any purse string effect. In 2 patients, the septal leaflet also needed to be augmented using a comparable technique. In all but one (annular calcification) patient, a semi-rigid ring annuloplasty was added. The mean age was 67.1 ± 13.7 years; it was a redo procedure in 12 cases (54.5%), 11 patients (50%) had right ventricle failure and 3 (23.1%) had renal failure. The median follow-up was 2.1 ± 1.9 years. Thirty-day and 4-year survival averaged at 81.1 ± 8.5 and 71.6 ± 9.8%, respectively. At 4 years, 84 ± 10.6% of the survivors were in NYHA class I or II and only 2 patients had a TR of ≥2 with a global freedom from TR ≥2 of 85.7 ± 13.2%. There was no reintervention. Tricuspid leaflet augmentation combined with annuloplasty is feasible and leads to excellent clinical and echocardiographical mid-term results even in the presence of severe leaflet tethering and right ventricular failure. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Mid-term outcome of a modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem.

    PubMed

    Cossetto, David J; Goudar, Anil

    2012-12-01

    To report the mid-term outcome of a modular, cementless, proximally hydroxyapatitecoated, anatomic femoral stem in total hip arthroplasty (THA). 160 consecutive patients aged 42 to 92 (mean, 70) years underwent 185 cementless THAs for primary osteoarthritis or femoral neck fractures. All procedures were performed by a single surgeon using the same modular, cementless, proximally hydroxyapatite-coated, anatomic femoral stem, regardless of age and bone quality. Clinical evaluation (pain, range of movement, and ability to walk) was based on the Merle d'Aubigne and Postel scores. Radiological assessment was based on criteria by Engh et al. in the 7 Gruen zones with regard to the presence of radiolucent lines, osteolysis, cancellous condensation, cortical hypertrophy or atrophy, reactive lines, and pedestal formation. Failure of the stem was defined as revision or impending revision because of aseptic loosening or pain. Of the 160 patients, 21 died and none were lost to follow-up. In 3 of the 21 patients, the femoral stems were revised for periprosthetic fractures after a fall at 6 weeks, 10 months, and 3.8 years. 138 patients (162 THAs) completed a mean follow-up of 7.8 (range, 5.5-10.4) years. Their overall mean Merle d'Aubigne and Postel scores increased from 7.09 preoperatively to 16.36 postoperatively. The mean Engh score was 24.9 out of 27, with the mean score for femoral stem fixation 10 out of 10 and 14.9 out of 17 for femoral stem stability. No reactive lines at the bone-stem interfaces and no subsidence or osteolysis were evident in any of the radiographs. There were 5 periprosthetic femoral fractures, 2 deep infections, 3 dislocations, and 2 aseptic loosening (one each for the femoral stem and acetabular socket). Survivorship of the femoral stem at 10 years was 99% when revision secondary to only aseptic loosening of the stem was the endpoint. It was 96% when failures due to all causes (infection, periprosthetic fracture, and aseptic loosening) were the

  16. Hip resurfacing arthroplasty: mid-term results in 486 cases and current indication in our institution.

    PubMed

    Ribas, Manuel; Cardenas, Carlomagno; Astarita, Emanuele; Moya, Esther; Bellotti, Vittorio

    2014-10-02

    In the previous decade, metal-on-metal hip resurfacing has been considered an attractive option and theoretically advantageous over conventional total hip arthroplasty, especially in young active patients. Different authors have reported favourable mid-term clinical and functional results with acceptable survival rates. Proper indication and planning, as accurate technical execution have been advocated to be crucial elements for success.Concerns regarding serum metal ion levels and possible clinical implications have led in the last years to a decline in the use of metal-on-metal hip resurfacing and metal-on-metal bearings in general.The aim of this study is to present the results of our first 486 cases of hybrid hip resurfacing arthroplasties with a second generation cementing technique, and to describe our current restricted indication of this type of prosthesis, in the light of recent findings in the literature about the possible complications related to metallosis or improper patient selection. Global survivorship of our series was 97.9% at a mean follow-up of 7.2 years.In the second season of our experience the indication is restrictive. The candidate for a resurfacing hip replacement is a young and active male patient, with good bone quality, that has been made aware of the risks and benefits of this type of prosthesis.

  17. The Bologna-Oxford total ankle replacement: a mid-term follow-up study.

    PubMed

    Bianchi, A; Martinelli, N; Sartorelli, E; Malerba, F

    2012-06-01

    The Bologna-Oxford (BOX) total ankle replacement (TAR) was developed with the aim of achieving satisfactory pain-free movement of the ankle. To date, only one single multicentre study has reported its clinical results. The aim of this study was to conduct an independent review of its mid-term results. We retrospectively reviewed a total of 60 prospectively followed patients in whom 62 BOX TARs had been implanted between 2004 and 2008. We used the American Orthopedic Foot and Ankle Society (AOFAS) score to assess the clinical results. Standardised radiographs taken at the time of final follow-up were analysed by two observers. The overall survival was 91.9% at a mean follow-up of 42.5 months (24 to 71). The mean AOFAS score had improved from 35.1 points (sd 16.6; 4 to 73) pre-operatively to 78.0 (sd 10.7; 57 to 100) at final follow-up (p < 0.01). Tibial radiolucencies < 2 mm in width were seen around 16 TARs. Talar radiolucencies < 2 mm were seen around four TARs. A total of 47 patients (78.3%) were very satisfied or satisfied with the outcome. Five patients required revision for functional limitation or continuing pain.

  18. CEA versus CAS: short-term and mid-term results.

    PubMed

    Felli, M M G; Alunno, A; Castiglione, A; Malaj, A; Faccenna, F; Jabbour, J; Laurito, A; Stavri, D; Gossetti, B

    2012-10-01

    Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term and mid-term results of carotid endarterectomy and stenting. During a three-year period, we enrolled 300 patients with carotid stenosis that fit with Stroke Prevention and Educational Awareness Diffusion (SPREAD) guidelines and we performed 150 carotid endarterectomy operations (CEA) and 150 carotid artery stenting procedures (CAS) with distal protection devices. All patients underwent preoperative and postoperative: neurological examination, ultrasound imaging, magnetic resonance imaging (MRI) and cognitive tests; moreover all patients were submitted to preoperative, intraoperative and postoperative Transcranial Doppler (TCD) monitoring, in order to detect microembolic signals (MES). Mortality was zero; two patients developed myocardial infarction in the CEA group during follow-up. The main post-operative results after endarterectomy versus CAS were respectively: neurological deficit: 1.3% vs. 3.3%, embolic lesions at postoperative MRI: 4% vs. 34% and worsening of cognitive tests: 4% vs. 25.3%. CEA seems to be the treatment of choice for carotid stenosis, due to its low rate of mortality and morbidity, especially in asymptomatic patients; CAS should be carried out only in particular subgroup of cases, such as: restenosis, previous neck surgery or radian therapy, anatomical high bifurcation or extended lesions. Ongoing multicenter randomized trials may give a definitive answer to this matter.

  19. Mid-term Results of Total Knee Arthroplasty Using PFC Sigma RP-F.

    PubMed

    Kim, Jun-Young; Cheon, Sang-Ho; Kyung, Hee-Soo

    2012-12-01

    We compared the mid-term results after total knee arthroplasty (TKA) using PFC Sigma RP-F mobile model with PFC Sigma PS fixed model. We analyzed 45 knees that underwent TKA with PFC Sigma RP-Fn (study group) and 45 knees with PFC Sigma PS (control group). The mean follow-up period was 65 months (range, 60-69 months). The evaluation system of the American knee society was used for clinical and radiological assessment. Also, the maximal knee flexion angle was assessed. The mean maximum flexion angle in the study group (135°) was greater than that in the control group (125°) at the early post-operation & final follow-up period (p=0.033). The range of motion (ROM) in the study group was recovered earlier at the postoperative 6 months, and ROM gain was improved to a greater extent at the final follow-up period (p=0.039). The knee score and function score and radiographic evaluation were no difference between the two groups (p>0.05) at the final follow-up. The two cases of radiolucency in posterior condyle and medial tibial plateau and one case of patellar elongation were seen in the study group. The PFC Sigma RP-F mobile system appears to facilitate greater maximum flexion angle and ROM gain with two cases of radiolucent line.

  20. Indications and early to mid-term results of ulnar head replacement

    PubMed Central

    Shyamalan, G; Balabanidou, E

    2013-01-01

    Introduction The aim of this study was to explore the indications and show the early to mid-term results of ulnar head replacement for the treatment of pathological conditions of the distal radioulnar joint. Methods Our study group comprised 52 patients with a mean age of 64 years who had 56 ulnar head replacements. Seven were implanted to salvage an unstable deletive procedure; the rest were for primary treatment of osteoarthritis, rheumatoid arthritis and trauma. Concomitant procedures along with the ulnar head replacement included wrist arthrodesis, joint replacement and tendon transfers. Results The follow-up duration ranged from 1 year to 11 years (mean: 60 months, median: 60 months). In almost all of the patients, pain improved with a median visual analogue scale score of 2 (mean: 2.2, range: 0–8) and a median DASH (Disabilities of the Arm, Shoulder and Hand) score of 12.5 (mean: 17.9, range: 0–56). Of the 52 patients, 47 reported they would have the same procedure again. Conclusions Ulnar head replacement appears to be a reliable and effective procedure solving several pathological problems of the distal radioulnar joint. We present a large patient group with a short to medium-term follow-up duration. PMID:24025293

  1. Mid-term results after endovascular repair of abdominal aortic aneurysms: a four-year experience.

    PubMed

    Dalainas, I; Nano, G; Casana, R; Tealdi Dg, D g

    2004-03-01

    The purpose of this retrospective, single-institution study is to describe a 4-year experience of examining early and late clinical outcomes after endovascular repair of abdominal aortic aneurysm (AAA). Between October 1998 and January 2003, 455 patients were submitted for AAA treatment, of whom 269 underwent open repair and 186 were treated with an endovascular procedure. All endovascular-treated patients underwent preoperative arteriography, contrast enhanced CT scanning or spiral-CT to define the morphological characteristics of the aneurysm, including precise diameter and length measurements. Technical success was achieved in 182 (98%) of the endovascular procedures, as intraoperative conversions to open repair and/or aborted procedures occurred in four patients. The perioperative (30-day) mortality rate was 1% (two patients). During the follow-up period (9-60 months) CT, duplex ultrasound scanning and plain abdominal X-ray evaluation were performed at 3, 6, 12 months, and annually thereafter. Type I endoleak occurred in 12 patients (6.6%), required a further endovascular procedure (11) or late conversion to open repair (1). Type II endoleak occurred in five patients (3%). In our clinical experience the endovascular repair of AAA is a safe and effective technique with good mid-term results in patients at standard and high risk.

  2. A mid-term clinical outcome study of the Advance Medial Pivot knee arthroplasty.

    PubMed

    Karachalios, Theofilos; Roidis, Nikolaos; Giotikas, Dimitrios; Bargiotas, Konstantinos; Varitimidis, Socrates; Malizos, Konstantinos N

    2009-12-01

    The Advance Medial Pivot Total Knee Arthroplasty (Wright Medical Technology, Arlington, Tennessee, USA) has been designed to reproduce modern ideas of knee kinematics. We report a prospective clinical outcome study of 284 arthroplasties in 225 consecutive patients with a mean follow-up of 6.7 years (range 4 to 9 years). For evaluation, both objective and subjective clinical rating systems and serial radiographs were used. At final follow-up, 10 (4.4%) patients (10 knees) only were lost from follow-up and four (1.8%) patients (five knees) had died for reasons unrelated to the surgery with their knees performing well. There was an 82% compliance in the intervals of follow-up evaluation. All patients showed a statistically significant improvement (p=0.01) in the Knee Society clinical rating system, WOMAC questionnaire, SF-12 questionnaire, and Oxford knee score. The majority of patients (92%) were able to perform age-appropriate activities with a mean knee flexion of 117 degrees (range 85 degrees to 135 degrees) at final follow-up. Survival analysis showed a cumulative success rate of 99.1% at 5 years. Two (0.7%) arthoplasties, in which patient selection and surgical errors were identified, were revised due to aseptic loosening, one due to infection and one due to a traumatic dislocation. This study demonstrates satisfactory mid-term clinical results for this knee design.

  3. Predictors of intra-aortic balloon pump insertion in coronary surgery and mid-term results.

    PubMed

    Ergüneş, Kazim; Yurekli, Ismail; Celik, Ersin; Yetkin, Ufuk; Yilik, Levent; Gurbuz, Ali

    2013-12-01

    We aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support. Between January 2002 and December 2009, 1,657 patients underwent isolated CABG in İzmir Katip Celebi University Atatürk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%). In a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was 38.55±22.70 months and 48.78±25.20 months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively. The patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period.

  4. ["Pit picking" surgery for patients with pilonidal disease : mid-term results and risk factors].

    PubMed

    Iesalnieks, I; Deimel, S; Schlitt, H J

    2015-05-01

    Minimally invasive procedures have increasingly been used to treat pilonidal disease; however, the mid-term and long-term results have not been evaluated extensively yet. All patients underwent "pit picking" surgery. The surgery was performed under local anesthesia. The technique of "pit picking" was: all midline pits were removed by excising a margin of skin of < 1 mm. An incision of 1 cm parallel to one side of the natal cleft opened the chronic abscess cavity. No specific postoperative wound care was given. A total of 153 patients (126 males) underwent "pit picking" surgery between June 2007 and November 2010. Follow-up information was available for 148 patients (97 %). Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second"pit picking" procedure. By multivariate analysis, smoking (hazard ratio [HR] 2.1) and occurrence of an abscess during the course of disease (HR 2.7) were statistically significantly associated with the disease recurrence after "pit picking" surgery. Approximately three quarters of selected patients with pilonidal disease benefit from minimally invasive "pit picking" surgery.

  5. Nonoperatively treated type A spinal fractures: mid-term versus long-term functional outcome.

    PubMed

    Post, R B; van der Sluis, C K; Leferink, V J M; Dijkstra, P U; ten Duis, H J

    2009-08-01

    This study focuses on the mid-term (four years) and long-term (ten years) functional outcome of patients treated nonoperatively for a type A spinal fracture without primary neurological deficit. Functional outcome was measured using the visual analogue scale spine score (VAS) and the Roland-Morris disability questionnaire (RMDQ). The 50 patients included were on average 41.2 years old at the time of injury. Four years post injury, a mean VAS score of 74.5 and a mean RMDQ score of 4.9 were found. Ten years after the accident, the mean VAS and RMDQ scores were 72.6 and 4.7, respectively (NS). No significant relationships were found between the difference scores of the VAS and RMDQ compared with age, gender, fracture sub-classification, and time between measurements. Three (6%) patients had a poor long-term outcome. None of the patients required surgery for late onset pain or progressive neurological deficit. Functional outcome after a nonoperatively treated type A spinal fracture is good, both four and ten years post injury. For the group as a whole, four years after the fracture a steady state exists in functional outcome, which does not change for ten years at least after the fracture.

  6. Mid-term results of an uncemented femoral stem with modular neck options.

    PubMed

    Benazzo, Francesco; Rossi, Stefano M P; Cecconi, Davide; Piovani, Lucio; Ravasi, Flavio

    2010-01-01

    We prospectively assessed the results of 239 primary total hip replacements performed using a conical stem combined with modular necks of different lengths and inclinations (Modulus System, Lima Corporate San Daniele Del Friuli, Udine, Italia) in 222 patients (50 men, 172 women), undergoing surgery between October 2001 and December 2006 and presenting with anatomical deformities of the proximal femur and/or acetabulum, including developmental dysplasia (DDH), ankylosis, and sequelae of osteotomies or fractures. Such conditions can make hip replacement problematic. The mean age at the time of surgery was 57.6 years (22 ÷ 83). No patients were lost to follow-up. 3 femoral components underwent revision. At a mean of 5 years follow-up the Harris Hip Score showed a significant improvement, increasing from 35 preoperatively to a mean of 96.6. Using Kaplan-Meier analysis the survival rate at 5 years was 98.28%. The Modulus stem showed good mid-term results in terms of survival, as well as clinical and radiographic outcome.

  7. Mid-Term Assessment of English 10 Students: A Comparison of Methods of Entry into the Course.

    ERIC Educational Resources Information Center

    Isonio, Steven

    In spring 1992, a mid-term assessment of English 10 students was conducted at Golden West College, in California, in order to compare four course placement methods. English 10, "Writing Essentials," is a nontransferrable course which focuses on paragraph writing and grammar review in order to prepare students for entry into English 100.…

  8. Role of laparoscopic surgery in the treatment of ulcerative colitis; short- and mid-term results.

    PubMed

    Tajti, János; Simonka, Zsolt; Paszt, Attila; Ábrahám, Szabolcs; Farkas, Klaudia; Szepes, Zoltán; Molnár, Tamás; Nagy, Ferenc; Lázár, György

    2015-04-01

    Laparoscopy is used more widely for the surgery of ulcerative colitis. The objective of this study was a comparison of the surgical and 3-year follow-up results of patients treated with conventional and minimally invasive methods. A total of 45 patients received surgery for ulcerative colitis, 16 as emergency and 29 as elective cases. Laparoscopy was used in 23 and a conventional method in 22 cases. No difference was found between the two groups from the aspects of American Society of Anesthesiologists physical status (ASA) class, mean body mass index (BMI) and age. There were 4 emergency cases in the laparoscopy group, and 12 in the open group. Nineteen elective surgeries were performed in the laparoscopy group, and 10 in the open group. There was no significant difference between the groups as concerns the length of hospital or intensive care unit (ICU) stay, the time to bowel function recovery, but the duration of open surgery was significantly shorter. There was no difference between the groups in the rate of early postoperative complications, whereas among potential late complications, the rates of intestinal obstruction (8.7% vs. 45%) and a septic condition (0% vs. 27%) were significantly lower in the laparoscopy group. There was a significant improvement in the quality of life after surgery in both groups, and better cosmetic results were observed in the laparoscopy group. Laparoscopy can be used for ulcerative colitis both emergency and elective cases, it provides a good quality of life and the mid-term rate of complications is lower as compared with open surgery.

  9. The Mid-Term Efficacy and Safety of a Permanent Nitinol IVC Filter (TrapEase)

    PubMed Central

    Liu, Wei Chiang; Choo, Sung Wook; Kim, Dong-Ik; Kim, Young Wook; Kim, Duk-Kyung; Shin, Sung Wook; Park, Kwang Bo; Jeon, Yong Hwan; Choo, In-Wook

    2005-01-01

    Objective 1) To evaluate the mid-term efficacy and safety of a permanent nitinol inferior vena cava (IVC) filter; 2) to evaluate filter effectiveness, filter stability and caval occlusion. Materials and Methods A prospective evaluation of the TrapEase IVC filter was performed on 42 patients (eight men, 34 women) ranging in age from 22 to 78 years (mean age 66 years). All patients were ill with a high risk of pulmonary embolism (PE). Indications for filter placement were: 1) deep vein thrombosis with recurrent thromboembolism; 2) and/or free-floating thrombus with contraindication to anticoagulation; and 3) complications in achieving adequate anticoagulation. Follow-up evaluations (mean: 15.4 months, range: 2 to 28 months) were performed at 6- and 12-month intervals after the procedure and included clinical histories, chart reviews, plain film, Doppler ultrasounds, and contrasted abdominal CT scans. Results In follow-up evaluations, the data analysis revealed no cases of symptomatic PE. There were no cases of filter migration, insertion site thrombosis, filter fracture, or vessel wall perforation. During the study, there was one case of filter thrombosis; early symptomatic thrombosis that was successfully treated in the hospital. Of the 42 subjects, eight died. These deaths were not related to the filter device or the implantation procedure, but to the underlying disease. Conclusion This study demonstrates that the TrapEase permanent IVC filter is a safe and an effective device with low complication rates and is best used in patients with thromboembolic disease with a high risk of PE. PMID:15968150

  10. [Denervation of the patella: influence on mid-term results after total knee arthroplasty].

    PubMed

    Handel, M; Riedt, S; Lechler, P; Schaumburger, J; Köck, F X; Sell, S

    2014-02-01

    The purpose of the study was to determine possible differences in the mid-term results of total knee arthroplasty in patients treated with and without denervation of the patella. This study included 80 total knee replacements in 71 patients who were treated with total knee replacement, either with (n = 40) or without (n = 40) simultaneous denervation of the patella out of a total population with 122 knee replacements in 100 patients. Comparability of both groups was achieved by applying matching criteria. All patients were reviewed by isokinetic tests, physical and radiological examination. The mean follow-up time was 2.2 years. The mean hospital for special surgery (HSS) score revealed no statistically significant differences between both groups (with denervation 77.9 ± 11.1 and without denervation 77.8 ± 11.0, p = 0.976). The isokinetic torque measurements with low angle velocity (60°/s) indicated slightly higher values during extension (60.2 ± 32.2 Nm versus 55.8 ± 25.2 Nm, p = 0.497) and flexion (52.4 ± 28.3 Nm versus 46.1 ± 22.3 Nm, p = 0.272) movements of the affected knee joint. However, the differences did not reach statistical significance. At high angle velocity (180°/s) no differences could be found between both groups. No cases of postoperative necrosis of the patella were observed. Anterior knee pain after denervation was reported in 6 cases (15 %) compared to 10 cases (25 %) in patients who were treated without denervation (p = 0.402). No statistically significant differences could be found between patients with and without denervation of the patella for total knee arthroplasty.

  11. Mid-term results of arthroscopic Bankart repair: A review of 31 cases.

    PubMed

    Tordjman, D; Vidal, C; Fontès, D

    2016-09-01

    The goal of this study was to assess the overall function (Walch-Duplay score), stability, time and because it is time of return to sport and level of return to sport, and satisfaction of patients who underwent an arthroscopic Bankart repair for chronic anterior shoulder instability at 5 years' follow-up. In addition, the potential correlation between the postoperative Walch-Duplay score and the presence of risk factors for recurrence, the ISIS score, associated labral lesions discovered intraoperatively and clinical presentation was determined. This was a retrospective, single-centre study of 30 patients (31 arthroscopic Bankart procedures) operated between January 2003 and December 2012. The Walch-Duplay score, recurrence rate (dislocation or subluxation), return to sports and subjective satisfaction were evaluated. The mean postoperative Duplay score was 77.4 points (100-15)±30.6. At review, 25.8% of patients had recurrence of the preoperative symptoms, including 16.1% glenohumeral dislocation and 9.7% subluxation. Patients requiring revision surgery (Bristow-Latarjet procedure) had no additional instability episodes. Among the athletes, 16 (66.6%) returned to their pre-injury level, four (16.6%) changed to a different sport and four stopped participating (16.6%). The subjective evaluation of the procedure was satisfactory in 75% of cases. No risk factors for recurrence were significantly related to the Walch-Duplay score. Despite satisfactory Walch-Duplay scores and subjective results, this mid-term follow-up study revealed a significant number of patients with recurrent instability after arthroscopic Bankart repair, confirming published data. Careful patient selection is essential prior to proposing this procedure and patients should be informed of the potential risk of revision surgery. Level IV, retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Endovascular treatment of penetrating aortic ulcers: mid-term follow-up.

    PubMed

    Mestres, Gaspar; Rodríguez, Rubén; García-Madrid, Cesar; Montañà, Xavier; Burrel, Marta; Cruz, Luis Fernando; Flores, Carlos; Riambau, Vicente

    2012-01-01

    The aim of this work is to describe the short- and mid-term results of endovascular treatment of penetrating ulcers in the thoracic aorta. Between 1998 and 2010, 22 patients with penetrating ulcers in the thoracic aorta received endografts (mean age 69.8 years, 91% male); 50% were indicated for acute aortic syndrome (8 chest pain, 1 aortic rupture, 1 aortobronchial fistula, 1 distal embolization) and 50% for aortic or ulcer diameter. All preoperative, operative and follow-up data were recorded prospectively and met EUROSTAR criteria. Technical success was 100% with no intraoperative deaths or open conversions; 6 (27.3%) required preoperative supraaortic trunk debranching and 1.3 endografts were used per patient; 27.3% developed complications in-hospital and 9.1% required reintervention prior to discharge. Mortality at 30 days was 4.5%. After a mean 52.3 month follow-up (range 0.1-122), cumulative survival free from complications and reinterventions at 100 months was 61.7% and 79.5% respectively, with 95.5% cumulative survival free from aorta- or procedure-related death. We identified no factors significantly related to poor intra- or postoperative clinical course. Endovascular treatment of penetrating aortic ulcers is both possible and effective despite high patient comorbidity. Although a substantial rate of complications and reinterventions can be expected-especially in-hospital-(38.3% and 20.5% respectively at 100 months), long-term mortality is low (4.5%). Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  13. [Extraarticular Subtalar Arthrodesis with the Grice Procedure in Children with Cerebral Palsy: Mid-Term Results].

    PubMed

    Němejcová, E; Schejbalová, A; Trč, T; Havlas, V

    2016-01-01

    PURPOSE OF THE STUDY The aim of the study was to evaluate, on the basis of radiographic findings and AOFAS scores, the results of the Grice extra-articular subtalar arthrodesis for treatment of planovalgus foot deformity in cerebral palsy patients. MATERIAL AND METHODS A total of 38 patients (50 feet) with cerebral palsy indicated to the Grice procedure for planovalgus foot deformity between 2006 and 2010 were assessed. The group comprised 18 girls and 20 boys, of whom 10 had spastic quadriparesis (four undergoing bilateral surgery), three had triparesis, four had hemiparesis and 21 had diparesis (treated on both sides in eight). The average age at surgery was 12 years (range, 7 years and 2 months to 17 years and 8 months). All patients were evaluated based on the AOFAS scoring system and radiographic findings before and after surgery. RESULTS The average follow-up was 4.5 years. The average AOFAS score increased from 54.9 points pre-operatively to 76.6 points post-operatively. The pre- and post-operative average values for the talocalcaneal angle were 49.8° and 25°, respectively; for the calcaneal inclination angle they were 8.6° and 13.4°, respectively. DISCUSSION The Grice procedure has long been considered a primary surgical treatment for planovalgus foot deformity in patients with cerebral palsy. Recently, calcaneal osteotomy has been used more frequently, but with no evidence of provably better results. CONSLUSIONS The mid-term results of the Grice extra-articular arthrodesis in our group of cerebral palsy children were very good in terms of both radiographic and AOFAS score evaluation; the latter includes objective assessment as well as the patient's subjective evaluation. Grice procedure, extra-articular subtalar arthrodesis, cerebral palsy, planovalgus foot deformity.

  14. Mid-term results of mitral valve repair with autologous pericardium in pediatric patients.

    PubMed

    Takahashi, Hiroaki; Kadowaki, Tasuku; Maruo, Ayako; Yutaka, Okita; Oshima, Yoshihiro

    2014-05-01

    Mitral valve repair to treat mitral regurgitation (MR) in pediatric patients remains challenging because of the complex morphology and fragility of the leaflets. The study aim was to review retrospectively the authors' experience with mitral valve repair using autologous pericardium. Between April 2004 and November 2011, nine pediatric patients (six males, three females; mean age 2.4 +/- 4.5 years) underwent mitral valve repair with an autologous fresh (n = 5) or glutaraldehyde-treated pericardium (n = 4) to treat severe MR. The etiology of the MR was acute endocarditis, acute chordal rupture and congenital disease in three, two, and four patients, respectively. Autologous pericardium was used for valvuloplasty, leaflet extension plasty and commissuroplasty in two, five, and two patients, respectively. Artificial chordal replacement was performed in three patients. No operative deaths or postoperative endocarditis occurred. One patient required mitral valve replacement at three days after the initial mitral repair. The most recent echocardiography findings of the remaining patients after a mean of 6.3 years (range: 1.3-9.0 years) showed that the severity of mitral insufficiency, left ventricular diastolic diameter and fractional shortening were 1.8 +/- 0.6 (grades 0-4), 40.4 +/- 8.4 mm (114.2 +/- 15.8% of normal) and 35.0 +/- 5.0%, respectively. Mitral valve repair using autologous fresh pericardium is associated with mid-term durability and resistance to infection when used for mitral valve repair of active endocarditis in pediatric patients. Augmentation with autologous pericardium could become an alternative to current surgical options.

  15. Short- and mid-term outcome after laparoscopic repair of large incisional hernia.

    PubMed

    Baccari, P; Nifosi, J; Ghirardelli, L; Staudacher, C

    2013-10-01

    To compare the outcome after laparoscopic incisional and ventral herniorrhaphy (LIVH) for fascial defect larger or equal than 15 cm in width with the outcome after LIVH in patients with hernia defect smaller than 15 cm. From 2003 through 2010, 350 patients were submitted to LIVH. In 70 cases, hernia defect was ≥15 cm in width and in 280 was <15 cm. Incisional hernias were often recurrent, double or multiorificial. In the group of larger hernias, the rate of obesity, recurrent hernia and multiorificial hernia was 27.1, 24.2 and 12.8 %, respectively, and in the group of smaller hernias 27.3, 16.1 and 2.8 %, respectively. Patients were interviewed using McGill pain score test to measure postoperative quality of life (QoL) in the mid-term. LIVH for hernia ≥15 cm required longer surgical time (p = 0.034) and postoperative hospital stay (p = 0.0001). Besides, there were higher rate of postoperative prolonged ileus (p = 0.035) and polmonitis (p = 0.001). Overall recurrence rate was 2.6, 8.6 % for larger and 1.1 % for smaller incisional hernias, p = 0.045. Mc Gill pain test revealed no significant difference in the two groups of patients in postoperative QoL within 36 months. Laparoscopic approach seems safe and effective even to repair large incisional hernia, the rate of recurrence was higher, but acceptable, if compared to smaller hernias. To the best of our knowledge, this is the largest reported series of incisional hernias ≥15 cm managed by laparoscopy.

  16. Laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency: Mid-term outcomes.

    PubMed

    Ferreira, Carlos; Brychaert, Pierre-Emannuel; Menard, Johann; Mandron, Eric

    2017-04-01

    To analyze the safety and the mid-term continence rates of laparoscopic implantation of artificial urinary sphincter in women. A total of 52 women with intrinsic sphincter deficiency underwent a laparoscopic artificial urinary sphincter implantation from 2005 to 2015 at Surgical Clinic Du Pré, Le Mans, France. The artificial urinary sphincter was implanted around the bladder neck by a transperitoneal laparoscopic approach to the Retzius space. Urodynamic assessment was carried out. Postoperative functional outcome was defined as success (no leaking, no pad use), improvement (>50% decrease in number of leakages, >50% decrease in number of pads used or use of light protection) or failure (<50% improvement, persistent or increased leaking). Outcome measures also included perioperative and long-term complications. The mean age of the patients was 69.1 years (range 64-82 years). After a mean follow up of 37.5 months (median 24 months; range 1-125 months), 38 (77.6%) patients were considered to be continent (no leakage, no pads), and eight (16.3%) improved their grade of incontinence. Three patients abandoned the follow-up schedule and were excluded. There was no perioperative severe complication. Artificial urinary sphincter revision was needed in 11 (22.4%) patients, requiring a total of seven redo procedures and four permanent sphincter removals. The main reasons for redo procedures were six (11.2%) mechanical problems and one vaginal erosion (2%). Herein we report one of the largest series with the longest follow up evaluating the outcomes of laparoscopic artificial urinary sphincter implantation in female patients. This approach seems to be a safe and effective treatment option for patients with intrinsic sphincter deficiency. © 2017 The Japanese Urological Association.

  17. The NANOS short stem in total hip arthroplasty: a mid term follow-up.

    PubMed

    Ettinger, Max; Ettinger, Peter; Lerch, Matthias; Radtke, Kerstin; Budde, Stefan; Ezechieli, Marco; Becher, Christoph; Thorey, Fritz

    2011-01-01

    A number of short stems for total hip arthroplasty have been introduced during the last decade. We describe our experience with the NANOS prosthesis (Smith and Nephew, Marl, Germany). The potential increase of bone mass around a femoral short stem using bone densitometry may be an indicator for secondary ingrowth. We report the outcome of 72 NANOS short stems in 65 patients between March 2003 and October 2007. The mean follow-up was 5.2±0.7 years and the mean age of the patients was 63±8.3 years. Along with demographic data and co-morbidities, the Harris Hip Score, the Merle d'Aubigné mobility score, and a patient-centred questionnaire were evaluated pre-operatively and during follow-up. The Mean Harris Hip Score increased from 47.3±12.2 pre-operatively to 97.6±0.6 at the final follow-up. The Merle d'Aubigné mobility score increased from 7.6±1.4 pre-operatively to 11.8±0.3 at the final follow-up. None of the 72 stems were revised, providing a survival rate of 100%. Radiolucent lines were visible rasiographically in two patients during follow-up. The NANOS short stem demonstrated a satisfactory outcome at mid term follow-up. The clinical and radiological results support to the principle of metaphyseal anchorage of a short stem prosthesis. Long term evaluation will be of interest to determine if these encouraging trends are reflected by prolonged survivorship.

  18. On Mid-Term Periodicities in Sunspot Groups and Flare Index

    NASA Astrophysics Data System (ADS)

    Mendoza, Blanca; Velasco-Herrera, Víctor Manuel

    2011-07-01

    In this work we study the mid-term periodicities (MTPs), between 1 and 2 years, of the sunspot groups and the flare index (FI), by separating the data into hemispheres and spectral bands (SBs) according to the most significant periodicities presented by these phenomena. We found that the MTP of sunspot groups has a diminished power during the Modern Minimum and an increased power during the Modern Maximum, with the exception of cycle 20. For flares, the MTP has a diminished power during the low activity cycle 20, and an increased power during cycles 21 and 22. Therefore, for both sunspot groups and FI, cycle 20 shows a very diminished power followed by the active and higher-power cycles 21 and 22; cycle 23 shows a weaker power than cycles 21 and 22. It is uncertain whether MTP can be a precursor of a long-term minimum of solar activity or not, as has been previously suggested. Also, there is no one-to-one correlation between the cycle intensity and the importance of MTP. Concerning the quasi-biennial periodicities and the theory of two kinds of dynamos, we notice the tendency that higher-power cycles mean weaker coupling in the model. Concerning the hemispheric north-south asymmetry, for sunspot groups the southern hemisphere dominates in most of the SBs, while for FI the northern hemisphere dominates for all the SBs. Additionally, the time lag found between the two hemispheres indicates that the degrees of coupling in the photosphere for sunspot groups and in the corona for flares are between moderate and strong. Finally, the modulation shown by the MTP time series suggests that these periodicities are the product of chaotic quasi-periodic processes and not of stochastic processes.

  19. Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging

    SciTech Connect

    Schmid, Axel Schmieder, Raphael; Lell, Michael; Janka, Rolf; Veelken, Roland; Schmieder, Roland E.; Uder, Michael; Ott, Christian

    2016-03-15

    Background/AimsRenal denervation (RDN) emerged as a treatment option for reducing blood pressure (BP) in patients with treatment-resistant hypertension (TRH). However, concerns have been raised regarding the incidence of late renal artery stenosis or thromboembolism after RDN. The goal of the current study was, therefore, to conduct a prospective clinical trial on the mid-term vascular integrity of the renal arteries and the perfusion of the renal parenchyma assessed by magnetic resonance imaging (MRI) in the follow-up after catheter-based RDN.MethodsIn our single-centre investigator initiated study, 51 patients with true TRH underwent catheter-based RDN using the Symplicity Flex{sup TM} catheter (Medtronic Inc., Palo Alto, CA). Follow-up MRI was performed at a median of 11 months (interquartile range 6–18 months) after RDN on a 1.5T MR unit. High-resolution MR angiography (MRA) and MRI results were compared to the baseline digital angiography of renal arteries obtained at time of RDN. In case of uncertainties (N = 2) catheter angiography was repeated.ResultsBoth office and 24-h ambulatory BP were significantly reduced 6 and 12 months after RDN. Renal function remained unchanged 6 and 12 months after RDN. In all patients, MRA excluded new or progression of pre-existing low grade renal artery stenosis as well as focal aneurysms at the sites of radiofrequency ablation. In none of the patients new segmental perfusion deficits in either kidney were detected on MRI.ConclusionsNo vascular or parenchymal complications after radiofrequency-based RDN were detected in 51 patients followed up by MRI.

  20. Short and mid-term effects of different biochar additions on soil GHG fluxes

    NASA Astrophysics Data System (ADS)

    Maier, Regine; Soja, Gerhard; Friesl-Hanl, Wolfgang; Dunst, Gerald; Kitzler, Barbara

    2015-04-01

    The application of biochar (BC) to soils may have a positive influence on physico-chemical soil properties and the mitigation of greenhouse gas (GHG) emissions. Furthermore, biochar contributes to a long-term soil carbon sequestration. The aim of this study is to explore short and mid-term effects (one day up to six months) of different BC-compost applications on soil GHG emissions, particularly CO2, CH4, N2O and NOx. In addition, compounds of the nitrogen cycle like NH4+, NO3- and the microbial biomass nitrogen (Nmic) were measured. For this purpose a field experiment in Kaindorf (Styria/Austria, gleyic Cambisol, loamy, 376 m.a.s.l.) with 16 plots and four different treatments was conducted. K = no BC-compost mixture but fertilized (NH4SO4) corresponding to T3 in 2013; T1 = 1 % BC-compost mixture, no addition of N in 2013 and 2014; T2 = 0.5 % BC-compost mixture, + 175 kg N ha-1 in 2013 and 2014; T3 = 1% BC-compost mixture, + 350 kg N ha-1 in 2013. Nitrogen was added as (NH4)2SO4 directly to the freshly produced biochar before mixing it with compost. Greenhouse gas fluxes (CO2, CH4, N2O) were measured monthly from closed chambers in the field over a period of six months, starting 30 days before BC application and ended shortly before harvesting in September. For the analysis of nitric oxide (NO) fluxes intact soil cylinders were taken from each plot and incubated at the laboratory at ambient air temperature. Mineral N contents were measured by the extraction with KCl-solution and the microbial biomass with chloroform-fumigation extraction (CFE). Biochar application to our agricultural soil showed no reduction potential of NO emissions, but N2O fluxes were significantly lower at T1 and T3 compared to treatment K. Gaseous N fluxes of the pure BC-compost mixture and the additional N fertilization with (NH4)2SO4 led to enormous gaseous N losses in form of N2O and NO. However, after application to the soil, fluxes were only higher for a short time period. We suggest

  1. Short-term and mid-term results with the Sorin Freedom Solo aortic valve.

    PubMed

    Ustunsoy, Hasim; Yasim, Alptekin; Deniz, Hayati; Gokaslan, Gokhan; Ozcaliskan, Ozerdem

    2013-03-01

    The study aim was to present the short- and mid-term results for patients who underwent aortic valve replacement (AVR) with the Sorin Freedom Solo third-generation stentless prosthetic valve. AVR with a Sorin Freedom Solo valve was performed in 14 patients between March 2006 and March 2011. Patients aged > or = 60 years (male:female ratio 6:8; mean age 73.28 +/- 5.42 years) who required AVR with the Sorin Freedom Solo valve according to the surgeon's choice were included in the study. The valvular prosthesis was implanted in the supra-annular position, using a single suture line. Eight patients underwent an isolated AVR; combined interventions were carried out in the other patients due to concomitant cardiac disease. One patient died during the immediate perioperative period, and two more during the follow up, from non-cardiac causes. The mean maximum transvalvular gradient of patients with aortic stenosis was 88.1 +/- 20.2 mmHg, and this fell to 26.4 +/- 7.6 mmHg during the early postoperative period. The mean gradient at one year of follow up was further decreased to 19.4 +/- 5.3 mmHg. The left ventricular end-diastolic and end-systolic diameters were also significantly reduced, from 4.8 +/- 0.9 to 4.3 +/- 0.6 cm and from 3.2 +/- 0.6 to 2.8 +/- 5.3 cm, respectively. The average left ventricular ejection fraction was 60.2 +/- 4.9% preoperatively, and 63.2 +/- 2.1% at one year after surgery (p = NS). No paravalvular leakage, endocarditis, prosthesis failure or neurologic events were reported among patients. The Sorin Freedom Solo stentless valve has provided good early and intermediate-term results. Implantation of the prosthesis is straightforward, with low rates of morbidity and mortality. However, these data require further support from larger patient series and long-term follow up.

  2. Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA.

    PubMed

    De Martino, Ivan; De Santis, Vincenzo; Sculco, Peter K; D'Apolito, Rocco; Assini, Joseph B; Gasparini, Giorgio

    2015-10-01

    Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. We wished to determine the mid-term (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system. There have been two reoperations for recurrent infection; at surgery, the two cones showed osseointegration. No evidence of loosening or migration of any implant was noted on the most recent radiographs. Knee Society knee scores improved from a mean of 31 points before surgery to 77 points at latest followup (p < 0.001), and function scores improved from a mean of 22 points to 65 points (p < 0.001). Tantalum cones for reconstruction of massive bone defects in revision knee arthroplasty

  3. PEEK Cages in Lumbar Fusion: Mid-term Clinical Outcome and Radiologic Fusion.

    PubMed

    Schimmel, Janneke J P; Poeschmann, Marcel S; Horsting, Philip P; Schönfeld, Dirk H W; van Limbeek, Jacques; Pavlov, Paul W

    2016-06-01

    Historical cohort analysis. Evaluation of mid-term clinical outcome and radiologic fusion in patients treated with a polyetheretherketone (PEEK) cage. Anterior lumbar interbody fusion can be a good alternative in chronic low back pain when conservative treatment fails. Although titanium alloy cages give good fusion rates, disadvantages are the subsidence of the cage in the adjacent vertebrae and problematic radiologic evaluation of fusion. PEEK cages such as the Synfix-LR cage (Synthes, Switzerland) should overcome this. From December 2004 until August 2007, 95 patients (21 double-level and 74 single-level) with degenerative disk disease from L3-S1 were operated by a single surgeon. The number of reoperations was counted. Radiologic fusion on computed tomography scan was scored with a new scoring system by an independent skeletal radiologist and orthopedic surgeon. Intraobserver agreement and specificity were assessed. Clinical improvement was measured by the Oswestry Disability Index score. The median duration of clinical follow-up was 47.7 months (range 29.9-61.6). In total, 26 patients were reoperated after a median period of 17.6 months (range 6.7-46.9) of the initial surgery. Of the 26 patients, 23 patients (18 single-level and 5 double-level) were reoperated for symptomatic pseudarthrosis. A moderate agreement (κ=0.36) and a specificity of 70% and 37% for the radiologist and orthopedic surgeon, respectively, were found for scoring bony bridging. The Oswestry Disability Index score improved after initial surgery; however, reoperated patients reported a significantly lower improvement. A high number of reoperations after an anterior lumbar interbody fusion procedure with the Synfix-LR cage were found, mainly because of symptomatic pseudarthrosis. The absence of posterior fixation in combination with lower stiffness and the hydrophobic characteristics of PEEK probably lead to insufficient initial stability, creating suboptimal conditions for bony bridging, and

  4. Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty.

    PubMed

    Lee, Y K; Ha, Y C; Yoo, J-I; Jo, W L; Kim, K-C; Koo, K H

    2017-06-01

    We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

  5. Three metal-on-metal hip replacement devices from the same manufacturer--a short- to mid-term survival.

    PubMed

    Kostensalo, Inari; Junnila, Mika; Mokka, Jari; Virolainen, Petri; Vahlberg, Tero; Mäkelä, Keijo T

    2014-06-01

    The aim of this retrospective study was to evaluate short- to mid-term results of three different metal-on-metal hip devices from the same manufacturer. A total of 329 hip operations were performed in a single academic unit between 2004 and 2010 using either Birmingham hip resurfacing or Synergy--Birmingham and Synergy--R3 total hip arthroplasty. The overall survival rate at the end of the follow-up time for Birmingham hip resurfacing was 88%, for Synergy--Birmingham total hip arthroplasty 95%, and for Synergy--R3 total hip arthroplasty 81% (p = 0.036). Five revision operations were performed due to adverse reaction to metal debris. Head sizes > 50 mm had lower revision rates compared to smaller ones. Synergy--R3 had a poor survival already at short-term. The mid-term survival of Birmingham hip resurfacing arthroplasty was inferior compared to previous studies.

  6. HeartWare third-generation implantable continuous flow pump as biventricular support: mid-term follow-up.

    PubMed

    Loforte, Antonio; Monica, Paola Lilla Della; Montalto, Andrea; Musumeci, Francesco

    2011-03-01

    A long-term mechanical biventricular support by HeartWare HVAS third-generation continuous flow pump (HeartWare, Inc, Miramar, FL, USA) was implanted in a Korean patient with a small chest size for treatment of a refractory end-stage heart failure due to an idiopathic dilative cardiomyopathy. We report our experience with a single patient and the early mid-term follow-up results with such a mechanical ventricular support.

  7. Total hip replacement: a systematic review and meta-analysis on mid-term quality of life.

    PubMed

    Shan, L; Shan, B; Graham, D; Saxena, A

    2014-03-01

    Total hip replacement (THR) is one of the most successful and frequently performed operations worldwide. Health-related quality of life (HRQOL) is a key outcome measure of surgery. We investigated mid-term HRQOL after THR in patients with osteoarthritis (OA). A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis using standardised response means. Tau(2) and I(2) values and Funnel plots were analysed. 20 studies were included. Mid-term post-operative HRQOL is superior compared to pre-operative status on qualitative and quantitative analysis. Pooled response means of total Harris Hip Score (HHS) (P < 0.00001) and combined pain (P = 0.00001) and physical function (P < 0.00001) domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and HHS improved markedly up to 7 years. Medical Outcomes Survey Short Form 36 shows physical functioning (PF) (P < 0.00001), bodily pain (BP) (P < 0.00001), role physical (P = 0.001), role emotional (P = 0.04), and social functioning (SF) (P = 0.03) were improved up to 7 years. General health (GH) (P = 0.29), mental health (MH) (P = 0.43), and vitality (P = 0.17) was similar. HRQOL is at least as good as reference populations in the first few years and subsequently plateaus or declines. Patient satisfaction and functional status was favourable. There was significant heterogeneity amongst all studies, but publication bias was low in pooled analysis. THR confers significant mid-term HRQOL benefits across a broad range of health domains. Further studies based on consistent guidelines provided in this review are required. Copyright © 2013 Osteoarthritis Research Society International. All rights reserved.

  8. Endovascular treatment of type B dissection in patients with Marfan syndrome: mid-term outcomes and aortic remodeling.

    PubMed

    Eid-Lidt, Guering; Gaspar, Jorge; Meléndez-Ramírez, Gabriela; Cervantes S, Jorge; González-Pacheco, Hector; Dámas de Los Santos, Félix; Meave-González, Aloha; Ramírez Marroquín, Samuel

    2013-12-01

    To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair. Copyright © 2013 Wiley Periodicals, Inc.

  9. Mid-term evaluation of the NRECA (National Rural Electric Cooperative Association) Central America Rural Electrification Support Program (CARES)

    SciTech Connect

    Perlack, R.D. ); Jones, H.G. ); Garcia, A. III . Dept. of Agricultural Engineering); Flores, E. , Guatemala City )

    1990-09-01

    Oak Ridge National Laboratory was requested by the Regional Office for Central America and Panama to conduct a mid-term evaluation of the Cares Project, which is being implemented by the National Rural Electric Cooperative Association. This evaluation was conducted over a three week period by a four person team. Overall, the project has had numerous successes and is highly valued by local counterpart utilities and USAID Missions. Notwithstanding the significant results of the project, changes can be made in certain operating procedures and in the direction of some programmatic activities that can lead to an even more effective project.

  10. Evaluation of myocardial deformation in patients with Kawasaki disease using speckle-tracking echocardiography during mid-term follow-up.

    PubMed

    Dedeoglu, Reyhan; Barut, Kenan; Oztunc, Funda; Atik, Sezen; Adrovic, Amra; Sahin, Sezgin; Cengiz, Dicle; Kasapcopur, Ozgur

    2017-04-05

    Speckle-tracking echocardiography is a recently developed technique for the evaluation of myocardial deformation or strain. Our objective was to examine strain through a mid-term follow-up of patients with Kawasaki disease.

  11. Percutaneous Transluminal Angioplasty of Hepatic Artery Stenosis in Patients After Orthotopic Liver Transplantation: Mid-term Results

    SciTech Connect

    Jarmila, Lastovickova Jan, Peregrin

    2011-12-15

    Purpose: This study was designed to present our experience with percutaneous treatment of hepatic artery stenosis in orthotopic liver transplant patients and to evaluate the efficacy, technical outcomes, and mid-term clinical results of the procedure. Methods: Twenty-two percutaneous transluminal angioplasties (PTAs) were performed in 19 liver transplant recipients at our institution between 1998 and 2010. Stents were placed into the hepatic/celiac artery in 16 PTAs, but balloon dilatation alone was performed in 6 because of the anatomical condition of the vessel. PTA/stenting was indicated in 17 patients because of elevated liver enzymes; 2 patients were asymptomatic. The objective of treating stenosis was prevention of long-term complications, including thrombosis. Results: Technical success was achieved in all patients. There was only one complication: dissection of the treated artery without any subsequent adverse effects. In all patients, elevated liver enzyme levels improved after treatment. No restenosis was observed in any patient during a mean follow-up of 2.6 years (1 month to 5.5 years). Conclusions: Percutaneous angioplasty/stent placement is a safe method for the treatment of hepatic artery stenosis after orthotopic liver transplantation, with a high technical success rate and promising mid-term results.

  12. Early intra-aortic balloon pumping following perioperative myocardial injury improves hospital and mid-term prognosis.

    PubMed

    Rubino, Antonino S; Onorati, Francesco; Santarpino, Giuseppe; Abdalla, Karim; Caroleo, Santo; Santangelo, Ermenigildo; Renzulli, Attilio

    2009-03-01

    We evaluated the impact of immediate intra-aortic balloon pumping (IABP) on hospital and mid-term outcome of coronary artery bypass graft (CABG) whenever perioperative acute complications developed. We compared clinical, biochemical, echocardiographic in-hospital results and two-year follow-up outcome of 30 low-risk (EuroSCORE<5) CABG (group A) who immediately received perioperative IABP when acute complications were suspected, to a contemporary, uncomplicated case-matched group (30 patients; Group B). Two in-hospital deaths were recorded in group A with no deaths in controls (P=0.492). Group A showed significantly higher lactate only at ICU arrival (P=0.001). Troponin I was always higher, but never reached values diagnostic for myocardial infarction (P<0.001). Worse left ventricular ejection fraction (P<0.001) and wall motion score index (P=0.008) were recorded at ICU arrival in group A, although an almost complete recovery was registered at discharge. Two-year actuarial survival was similar between the two groups (P=0.598). No differences were observed in freedom from acute myocardial infarction (P=0.503) and from overall cardiac complications (P=0.410). Early IABP should be established whenever cardiac complications are suspected, because of its beneficial impact on enzymatic leakage, myocardial recovery at echocardiography, hospital outcome, mid-term follow-up survival and freedom from cardiovascular events.

  13. Mid-term results of endovascular treatment with the Gore TAG device for degenerative descending thoracic aortic aneurysms.

    PubMed

    Yunoki, Junji; Kuratani, Toru; Shirakawa, Yukitoshi; Torikai, Kei; Shimamura, Kazuo; Kin, Keiwa; Sawa, Yoshiki

    2015-01-01

    To confirm the validity of using Gore TAG for degenerative descending thoracic aneurysm repair, we evaluated the mid-term clinical outcomes in our single-center experience. From May 2008 to April 2011, elective thoracic endovascular aortic repair (TEVAR) with Gore TAG without left subclavian artery (LSA) coverage for a degenerative descending thoracic aneurysm was performed in 36 consecutive cases. The procedural success rate was 100%, and no patient died within 30 days of the operation. We observed no cases of paraplegia or stroke. The mean follow-up was 33.2 ± 13.0 months (the maximum follow-up was 58.0 months). The actuarial survival rate was 100, 97.2 and 94.4% at 1, 2 and 3 years. There was no aorta-related death at 3 years. Two (5.6%) late distal Type I endoleaks were observed. Freedom form aortic events rate was 97.2, 97.2, and 97.2% at 1, 2, and 3 years respectively. In six cases with bird-beak configurations at the 2-year follow-up, the bird-beak length and angle had increased gradually. Elective TEVAR using the Gore TAG for degenerative descending thoracic aortic aneurysms without LSA coverage is effective and provides satisfactory early and mid-term outcomes. However, since the bird-beak configurations progressed, a conformable and flexible device for the next generation of procedures will be needed.

  14. Prolonged high-pressure balloon angioplasty of femoropopliteal lesions: Impact on stent implantation rate and mid-term outcome

    PubMed Central

    Rigatelli, Gianluca; Palena, Mariano; Cardaioli, Paolo; dell'Avvocata, Fabio; Giordan, Massimo; Vassilev, Dobrin; Manzi, Marco

    2014-01-01

    Objectives To assess the impact on stent implantation rate and mid-term outcomes of prolonged high pressure angioplasty of femoropopliteal lesions. Methods We retrospectively enrolled 620 consecutive patients from January 2011 to December 2011 (75.6 ± 12.3 years, 355 males, 76.5% in Rutherford class 5–6), referred for critical limb ischemia and submitted to prolonged high-pressure angioplasty of femoropopliteal lesions. The definition of prolonged high-pressure angioplasty includes dilation to at least 18 atm for at least 120 s. Procedural data, and clinical and instrumental follow-up were analyzed to assess stent implantation rate and mid-term outcomes. Results The preferred approach was ipsilateral femoral antegrade in 433/620 patients (69.7%) and contralateral cross-over in 164/620 (26.4%) and popliteal retrograde + femoral antegrade in 23/620 (3.7%). Techniques included subintimal angioplasty in 427/620 patients (68.8%) and endoluminal angioplasty in 193/620 patients (31.2%). The prolonged high pressure balloon angioplasty procedure was successful in 86.2% (minor intra-procedural complications rate 15.7 %), stent implantation was performed in 74 patients (11.9%), with a significant improvement of ankle-brachial index (0.29 ± 0.6 vs. 0.88 ± 0.3, P < 00.1) and Rutherford class (5.3 ± 0.8 vs. 0.7 ± 1.9, P < 0.01), a primary patency rate of 86.7%, restenosis of 18.6 % on Doppler ultrasound and a target lesion revascularization of 14.8% at a mean follow-up of 18.1 ± 6.4 months (range 1–24 months). Secondary patency rate was 87.7%. Conclusions Prolonged high pressure angioplasty of femoropopliteal lesions appears to be safe and effective allowing for an acceptable patency and restenosis rates on mid-term. PMID:25009562

  15. [Mid-term outcomes and survival rates in patients with radical retropubic prostatectomy (RRP) under current Czech healthcare system].

    PubMed

    Safarík, L; Bílek, R; Vísek, J A; Novák, K; Tuíková, J; Pesl, M; Stolz, J; Dvorácek, J

    2009-01-01

    The mid-term results (5 yr) after radical retropubic prostatectomy (RRP) are outlined and compared with pre- and postoperative parameters of patients. While 5 years survival could be expected in as many as 92.4%, relatively higher age (majority over 65) brings a higher risk of complications with it, though fully comparable with international standards. No perioperative mortality was recorded (0%), obstructive symptoms post-operatively developed in 13.4% patients, who were subsequently managed successfully endoscopically. Continence with maximum one pad per 24 hours was recorded in 77.2%, the severe incontinence was only in 3.3%. Spontaneous erection was reported in 4.3%, but except for higher age, the other objective factors were involved.

  16. Short- and mid-term results of plica excision in patients with mediopatellar plica and associated cartilage degeneration.

    PubMed

    Guney, Ahmet; Bilal, Okkes; Oner, Mithat; Halici, Mehmet; Turk, Yildirim; Tuncel, Mehmet

    2010-11-01

    This study aimed to evaluate the short- and mid-term results of plica excision in patients with mediopatellar plica and associated cartilage degeneration. Seventy-six surgically treated patients with mediopatellar plica and associated cartilage degeneration at medial femoral condyle (MFC) and/or medial pole of patella were included. Patients were evaluated at baseline, at 6 weeks and 6 months after the operation for their clinical outcomes and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The frequency of all signs and symptoms, including all pain parameters, and WOMAC scores were significantly improved compared to baseline, at 6 weeks and 6 months after the operation (P < 0.017). Based on mean WOMAC scores, results of most patients were rated as excellent both at 6 weeks (88%) and at 6 months (94%). Surgical excision of mediopatellar plica associated with cartilage degeneration appears to result in substantial clinical improvement, thus it represents an effective treatment modality.

  17. [In hospital and mid-term outcome of patients with NIR stent implantation: multicenter ESPORT-NIR registry].

    PubMed

    Iñiguez, A; García, E; Seabra, R; Bordes, P; Bethencourt, A; Rigla, J

    2001-05-01

    Despite improvements in the results and techniques of catheter-based revascularization, few studies have evaluated the clinical results of the application of new stent designs. We describe the in-hospital and mid-term outcome of patients undergoing a stent NIR implantation. At least 1 Stent NIR was implanted in 1.004 patients (1.136 lesions) recruited from 50 centers in an international, multicenter, prospective, registry (Spain and Portugal NIR stent registry). Inclusion criteria were objective coronary ischemia related to a severe de novo lesion or first restenosis in native vessels with a reference diameter >= 2.75 mm. The primary end-point was the incidence of major adverse cardiac events within the first 7 months of follow-up. The mean age of the patients was 60 years and 82% were male. Angioplasty was indicated due to unstable angina in 61% of the cases. Stent implantation was successfully achieved in 99.6%. Clinical success (angiographic success without in-hospital major events) was achieved in 98.6% of patients. The rate of angiographic restenosis (> 50% stenosis narrowing) was 16% (CI 95%; 11.7-21.2). The accumulated major cardiac adverse event rate at seven months of follow-up was 8.7%: death (0.9%), acute myocardial infarction (1.2%) and target lesion revascularization (6.6%). In the wide setting of the population included in the ESPORT-NIR registry, stent NIR implantation was a highly effective therapy with a good mid-term clinical and angiographic outcome.

  18. Mid-term evaluation of Sorin Soprano bioprostheses in patients with a small aortic annulus

    PubMed

    Vohra, Hunaid A; Whistance, Robert N; Bolgeri, Marco; Velissaris, Theodore; Tsang, Geoffrey M K; Barlow, Clifford W; Ohri, Sunil K

    2010-03-01

    We set to examine the mid-term outcome after aortic valve replacement (AVR) with Soprano pericardial stented bioprosthesis measuring mid-term outcome. Continued follow-up is required to determine the long-term efficacy of the prosthesis.

  19. Mid-term results of self-testing of the international normalized ratio in adults with a mechanical heart valve.

    PubMed

    Azarnoush, Kasra; Dorigo, Enrica; Pereira, Bruno; Dauphin, Claire; Geoffroy, Etienne; Dauphin, Nicolas; D'Ostrevy, Nicola; Legault, Benoit; Camilleri, Lionel

    2014-02-01

    Commonly the frequency of international normalized ratio (INR) monitoring with a conventional laboratory test in stable patients is once a month. When using a dedicated personal device for INR assessment, the frequency may be increased to two or more times a month. To show that INR assessed by self-measurement at home is reliable and feasible in the mid-term and improves medical care. All patients in the study on INR self-measurement (clinical trial.gov: NCT00925197), conducted between 2004 and 2007, were re-contacted for mid-term follow-up. One hundred and seventy eight out of 192 patients who participated in the study answered a questionnaire. The average follow-up time was 4.2 years (±1) for the self-measurement group and 4.9 years (±1) for the laboratory-analyzed control group. Only 26 patients (group A) continued to use INR self-measurement to monitor treatment with vitamin K antagonists (VKA). The main reasons to stop INR self-measurement were its high cost and difficulty in obtaining strips. There were significantly fewer bleeding complications (p=0.04) and complications related to VKA (p=0.01) in self-measured patients compared to the control group. Feelings of security and quality of life were also significantly better (p=0.002) for self-measured patients. Many patients with a mechanical heart valve, who self-measured INR, continue to use this method for their follow-up because of its positive effects on their health and quality of life. © 2013 Elsevier Ltd. All rights reserved.

  20. Early and mid-term outcomes of the aortic arch surgery: experience from the low-volume centre.

    PubMed

    Brat, Radim; Gaj, Jaroslav; Barta, Jiri

    2015-03-10

    The aim of this retrospective study was to examine the early and mid-term outcomes for patients undergoing elective aortic arch surgery over a 13-years period in the single low-volume centre. Results of aortic arch surgery published in the literature are usually results of high-volume centers, but the majority of institutions have much lower caseload. From January 1999 to March 2013 total of 353 surgeries on thoracic aorta were performed in our institution. Only 30 procedures (8.5%) were elective aortic arch surgeries. This group of patients was analyzed. Deep hypothermia alone and hypothermia with ortograde cerebral perfusion was used in 7 (23%) and 23 (77%) patients respectively. Mean core temperature was 22°C (17 - 26°C). Cannulation sites was axillary artery or brachiocephalic trunk in 17 (57%), femoral artery in 8 (27%) and ascending aorta or aortic arch in 5 (16%). Mean hypothermic circulatory arrest time was 39 min (15 - 74 min). There was one death due to multiorgan failure; all-cause mortality at 30 days was 3.3%. The frequency of other complications was permanent neurological deficit in 2 (6.7%), temporary neurological deficit in 2 (6.7%) and renal failure requiring hemodialysis in 2 (6.7%) patients. In the follow-up 13 patients died, remaining 16 are still alive. Despite the lower caseload and technical problems manifested by a higher number of re-operations for bleeding, the all-cause mortality at 30 days as well as mid-term results are comparable with results reported by the high-volume centres.

  1. On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study.

    PubMed

    Hartel, Maximilian J; Mandani, Shahab Maafi; Nuechtern, Jakob; Stiel, Norbert; Lehmann, Wolfgang; Rueger, Johannes M; Grossterlinden, Lars G

    2016-07-01

    At the present time, it is generally recommended to use hip replacement in dislocated fractures to avoid failure after internal fixation. A problem is that previous research has demonstrated that observers have problems in discriminating between dislocated and undislocated fractures. A possible solution to this problem would be to use arthroplasty in the majority of the cases. However, this also means that many fractures with the potential for uneventful healing would be replaced. In the current investigation, the mid-term outcome was recorded for patients with intracapsular hip fractures who were treated with either internal fixation or arthroplasty. A novel treatment algorithm was employed. After careful exclusion of cases with known risk factors for failure after internal fixation, a technique called on-table decision was used to identify suitable patients for internal fixation. A total of 72 patients with intracapsular hip fractures were studied with a median follow-up time of 12 months (IQR 8-15.25 months). Nineteen (19) patients (26 %) were excluded in the selection process, leaving 53 (74 %) for on-table decision-making. Thirty patients (42 %) were identified as suitable for internal fixation and gave anatomically stable closed reductions. Two of these patients (7 %) exhibited non-unions and one (3 %) avascular necrosis. The mid-term outcome after internal fixation is promising. The careful selection process may be helpful in identifying fracture patterns for which internal fixation may be considered as a safe and less invasive alternative to hip arthroplasty.

  2. Mid-term follow up results of subtalar distraction arthrodesis using a double bone-block for calcaneal malunion.

    PubMed

    Chung, Hyung-Jin; Bae, Su-Young; Choo, Ji-Woong

    2014-07-01

    This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° in talo-first metatarsal angle. Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.

  3. Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene.

    PubMed

    Petis, Stephen M; Vasarhelyi, Edward M; Lanting, Brent A; Howard, James L; Naudie, Douglas D R; Somerville, Lyndsay E; McCalden, Richard W

    2016-02-01

    The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan-Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores. A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0-10.6) years for cobalt-chrome and 7.8 (range 2.1-10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%-97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%-99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%-98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%-99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up.

  4. Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion

    PubMed Central

    Chung, Hyung-Jin; Choo, Ji-Woong

    2014-01-01

    Purpose This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. Materials and Methods From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. Results The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° in talo-first metatarsal angle. Conclusion Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis. PMID:24954341

  5. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients.

    PubMed

    Gwon, Dong Il; Ko, Gi-Young; Ko, Heung Kyu; Yoon, Hyun-Ki; Sung, Kyu-Bo

    2013-11-01

    Percutaneous balloon dilation of benign biliary stricture has been the most widely used alternative to endoscopic treatment; however, the rate of recurrence has varied from 15 to 44 %. Recently, several investigators have reported that percutaneous transhepatic placement of retrievable covered stents is feasible for the treatment of benign biliary strictures. However, these studies had only a small number of patients and had short follow-up periods. The purpose of this study was to investigate the mid-term outcomes of a retrievable covered stent for treatment of benign biliary strictures. We retrospectively assessed 68 patients who underwent percutaneous transhepatic placement and removal of a retrievable covered stent between March 2007 and November 2012, for treatment of benign biliary strictures. Forty-two patients had not previously undergone interventional treatment, whereas 26 had recurrent or refractory strictures despite previous percutaneous procedures. Placement of the retrievable covered stents was technically successful in all patients. Stent migration occurred in 11 (16.2 %) patients. The mean indwelling period of drainage catheter and stent were 5.8 months (range, 3-22.5 months) and 3 months (range, 2-6.5 months), respectively. Clinical success was achieved in 59 (86.8 %) patients. During the mean follow-up of 36 months (range, 8.5-65 months), 12 (20 %) of 60 patients had recurrence of clinically significant strictures. The primary patency rates at 1, 2, 3, 4, and 5 years were 91, 89, 76, 68, and 68 %, respectively. Mid-term outcomes suggested that percutaneous treatment of benign biliary strictures using a retrievable covered stent was a clinically effective method.

  6. Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene

    PubMed Central

    Petis, Stephen M.; Vasarhelyi, Edward M.; Lanting, Brent A.; Howard, James L.; Naudie, Douglas D.R.; Somerville, Lyndsay E.; McCalden, Richard W.

    2016-01-01

    Background The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. Methods We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan–Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores. Results A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0–10.6) years for cobalt-chrome and 7.8 (range 2.1–10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%–97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%–99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%–98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%–99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. Conclusion Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up. PMID:26812409

  7. CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

    PubMed Central

    Kim, Hae Jin; Park, Jung Jae; Kim, Chan Kyo

    2016-01-01

    Objective To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Materials and Methods Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Results Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m2 (14.2–142.7 mL/min/1.73 m2) and 72.0 mL/min/1.73 m2 (7.2–112.6 mL/min/1.73 m2), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. Conclusion CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes. PMID:27587966

  8. Aortic arch aneurysm: short- and mid-term results comparing open arch surgery and the hybrid procedure†.

    PubMed

    Cazavet, Alexandre; Alacoque, Xavier; Marcheix, Bertrand; Chaufour, Xavier; Rousseau, Herve; Glock, Yves; Leobon, Bertrand

    2016-01-01

    Open arch surgery for aortic arch aneurysm was historically associated with a high risk of postoperative morbi-mortality. Improved operative techniques have now lowered the incidence of these complications but in parallel, hybrid arch procedures have emerged. Nowadays, very little data are available about their mid-term results compared with open surgery. From January 2002 to January 2014, 46 patients had treatment for an exclusive aortic arch aneurysm including 25 open arch surgeries and 21 type I hybrid arch procedures in our institution. All cases involved arch aneurysms involving at least one carotid artery (Zone 0 and Zone 1). Aneurysms of the distal arch and descending aorta were excluded (Zone 2 and beyond). Results from a retrospective database are reported. There were no patients lost to the follow-up. There was no significant difference in preoperative comorbidities between the two groups. The incidence of in-hospital mortality was similar at 20% (5/25) for open surgery and 19% (4/21) for hybrid procedure (P = 0.830). The incidence of permanent cerebral neurological deficit was comparable at 17.4% (4/23) for open surgery and 21.1% (4/19) for hybrid procedure (P = 1). Median survival was 109.5 months for open surgery and 56.3 months for hybrid procedure. Freedom from all-cause mortality was 78, 63, 63 and 57% at 1, 3, 5 and 7 years, respectively in the open surgical group. Freedom from all-cause mortality was 74, 55, 46 and 28% at 1, 3, 5 and 7 years, respectively in the hybrid group. Survival rates and incidence of major adverse cardiac and cerebro-vascular event between open surgery and hybrid procedure were not statistically different (P = 0.530 and P = 0.325, respectively). However, incidence of reintervention was in favour of open surgery [14.5 vs 44.8% at 7 years, P = 0.045; 95% confidence interval: (0.06-0.97)]. The type I hybrid arch procedure fails to demonstrate better results compared with open surgery, regarding morbi-mortality at the short

  9. Mid-term Clinical Results and Patient Satisfaction After Uterine Artery Embolization in Women with Symptomatic Uterine Fibroids

    SciTech Connect

    Smeets, Albert J.; Lohle, Paul N. M. Vervest, Harry A. M.; Boekkooi, P. Focco; Lampmann, Leo E.H.

    2006-04-15

    Purpose. To evaluate the mid-term clinical results and patient satisfaction following uterine artery embolization (UAE) in women with symptomatic fibroids. Methods. Between August 1998 and December 2002, 135 patients had UAE for symptomatic uterine fibroids. All patients were asked to fill in a questionnaire. Questions were aimed at changes in bleeding, pain, and bulk-related symptoms. Symptoms after UAE were scored as disappeared, improved, unchanged or worsened. Adverse events were noted, such as vaginal dryness and discharge, menopausal complaints or fibroid expulsion. Patient satisfaction after UAE was assessed. Patient satisfaction of women embolized with polyvinyl alcohol (PVA) particles was compared with satisfaction of women embolized with calibrated microspheres. Results. The questionnaire was returned by 110 of 135 women (81%) at a median time interval of 14 months following UAE. In 10 women additional embolization or hysterectomy had been performed. Of the 110 responders, 86 (78%) were satisfied with the result of UAE. The proportion of satisfied women was higher in the group embolized with calibrated microspheres than in women embolized with PVA, although this difference was not statistically significant (p = 0.053). Conclusion. UAE in women with symptomatic uterine fibroids leads to improvement of symptoms and patient satisfaction is good in the vast majority after a median follow-up period of 14 months.

  10. The mid-term efficacy of intra-articular hyaluronic acid injections on joint structure: a nested case control study.

    PubMed

    Oka, Hiroyuki; Akune, Toru; Muraki, Shigeyuki; Tanaka, Sakae; Kawaguchi, Hiroshi; Nakamura, Kozo; Yoshimura, Noriko

    2013-07-01

    Intra-articular (IA) injection of hyaluronic acid (HA) has been shown to relieve osteoarthritis (OA)-related pain and improve joint structure within a 1-year period. We examined the mid-term (2-year) efficacy of IA-HA in Japanese subjects by using a large-scale population-based cohort of the Research on Osteoarthritis/Osteoporosis Against Disability study. We performed a nested case control study of 60 case control pairs matched for age (within 1 year), sex, Kellgren and Lawrence grade, and history of knee pain. The mean follow-up period after IA-HA series was 2.9 years in case patients. We examined the association of IA-HA with knee radiographic severity and knee pain. To estimate radiographic severity of OA, six distinct features--joint space area and the minimum joint space width at medial and lateral sides, osteophyte area, and tibiofemoral angle--were measured using a fully automatic computer-assisted program. Comparison of the radiographic parameters between case patients and controls showed that the medial and lateral joint space areas were significantly bigger in case patients than in controls. After constructing a multivariate logistic regression model to examine the correlation of knee pain, IA-HA, and radiographic features, we found that unlike radiographic features, IA-HA was protectively associated with the presence of pain. IA-HA might effectively improve joint structure and relieve pain in patients with knee OA.

  11. Complications and mid-term outcome after percutaneous patent foramen ovale closure in patients with cryptogenic stroke

    PubMed Central

    Luermans, J.G.L.M.; Post, M.C.; Plokker, H.W.M.; ten Berg, J.M.; Suttorp, M.J.

    2008-01-01

    Background: Percutaneous patent foramen ovale (PFO) closure seems to reduce the risk of recurrent thromboembolism. We report the safety and efficacy of percutaneous PFO closure in our centre. Methods: All patients, >16 years of age, who underwent a percutaneous PFO closure in our centre were included. Reoccurrence of stroke, transient ischaemic attack (TIA) and peripheral thromboembolism were assessed. Periprocedural and midterm complications are reported. Results: Eighty-three consecutive patients (mean age 49±13 years) were included. Indications for PFO closure were cryptogenic stroke (59.0%), TIA (33.7%), peripheral embolism (2.4%) and other (4.8%). For PFO closure, a Cardioseal/Starflex device was used in 63 patients and an Amplatzer PFO occluder device in 20 patients. Stroke recurred in 1.2%, TIA in 3.6%, peripheral embolism in 0% during a mean follow-up of 1.9±1.2 years. Major periprocedural complications occurred in 1.2%. The mid-term complication rate was 2.4% and only consisted of minor complications. During follow-up, a residual right-to-left shunt was present in 5.7% of the patients. No significant difference in outcome, complications or residual shunting could be documented between the two device types. Conclusion: In our centre, the percutaneous closure of a PFO seems to be a safe and effective procedure to prevent recurrence of paradoxical thrombo-embolic events. (Neth Heart J 2008;16:332-6.) PMID:18958256

  12. Transhepatic Balloon Dilatation of Early Biliary Strictures in Pediatric Liver Transplantation: Successful Initial and Mid-Term Outcome

    SciTech Connect

    Belenky, Alexander; Mor, Eytan; Bartal, Gabriel; Atar, Eli; Shapiro, Riki; Bar-Nathan, Nathan; Bachar, Gil N.

    2004-09-15

    Purpose: To evaluate the initial and mid-term outcomes of transhepatic balloon dilatation for the treatment of early biliary strictures in lateral left-segment liver transplants in young children.Methods: Between April 1997 and May 2001, seven children aged 9 months to 6 years with nine benign strictures in left-segment liver grafts were treated percutaneously. Sessions of two or three dilations were performed three or four times at average intervals of 10-20 days. In each session, the biliary stenoses were gradually dilated using balloons of 3-7 mm. Follow-up ranged from 12 to 54 months (mean 27 months, median 12 months). Clinical success was defined as resolution of the stenosis, normalization of liver enzymes and lack of clinical symptoms. Results: Technical success was achieved in all nine strictures. Hemobilia occurred in one patient and was successfully treated. On follow-up, all patients had complete clinical recovery with normalization of liver function and imaging of patent bile ducts. Conclusion: Balloon dilatation is an effective and relatively safe method for the treatment of early biliary strictures in left-segment liver transplantation in young children. We recommend this approach as the initial treatment for early strictures. Metal stents or surgery should be reserved for patients with late appearance of strictures or failure of balloon dilatation.

  13. Early- and mid-term outcomes after transcatheter aortic valve implantation. Data from a single-center registry

    PubMed Central

    Bagienski, Maciej; Dziewierz, Artur; Rzeszutko, Lukasz; Sorysz, Danuta; Trebacz, Jaroslaw; Sobczynski, Robert; Tomala, Marek; Stapor, Maciej; Gackowski, Andrzej; Dudek, Dariusz

    2016-01-01

    Introduction Transcatheter aortic valve implantation (TAVI) is a less invasive treatment option for elderly, high-risk patients with symptomatic severe aortic stenosis (AS) than aortic valve replacement. More importantly, TAVI improves survival and quality of life as compared to medical treatment in inoperable patients. Aim To assess early- and mid-term clinical outcomes after TAVI. Material and methods All consecutive high-risk patients with severe symptomatic AS undergoing TAVI from November 2008 to August 2014 were enrolled. The clinical and procedural characteristics, as well as clinical outcomes including mortality during 12-month follow-up, were assessed. Results A total of 101 consecutive patients underwent TAVI for native aortic valve stenosis (100%). Patients were elderly, with a median age of 81.0 (76.0–84.0) years, 60.4% were female and 83.2% presented with NYHA III/IV. Median baseline EuroSCORE I and STS scores were 14.0 (10.0–22.5)% and 12.0 (5.0–24.0)%, respectively. The main periprocedural and in-hospital complications were minor vascular complications, bleeding requiring blood transfusions, and the need for a permanent pacemaker. In-hospital, 30-day, 6-month and 12-month mortality rates were 6.9%, 10.9%, 15.8% and 17.8%, respectively. Conclusions A mortality rate of < 20% after 12 months seems acceptable given the high-risk population enrolled. PMID:27279871

  14. The fate of target visceral vessels after fenestrated endovascular aortic repair--general considerations and mid-term results.

    PubMed

    Halak, M; Goodman, M A; Baker, S R

    2006-08-01

    To carry out a retrospective analysis of the short and mid-term target vessels (TV) patency following fenestrated endovascular aortic repair (f-EVAR) of abdominal aneurysm (AAA). Seventeen f-EVAR patients were analysed. The Zenith (Cook) fenestrated graft was used in all cases. Bare renal stents were used where good apposition existed between the stent graft and the aortic wall, and covered stents were chosen when this apposition appeared deficient. A total of 35 TV were treated: twenty with small fenestration and 15 with a scallop. Procedural technical success was achieved in 16 out of 17 patients. All TV were perfused at the completion angiography. Access to TV through small fenestrations was achieved in 18 out of 20 vessels. After a mean follow-up of 20.5 months no type I endoleaks were detected. No late complications were observed in any of the stented TV. One patient with perioperative bilateral renal artery occlusion remains on haemodialysis. One non-target renal artery, opposite a scallop was unintentionally covered. One kidney, initially perfused via a un-stented scallop fenestration, was atrophied 14 months post surgery. One patient died from heart failure. f-EVAR is a valid and safe treatment option. Our series and the world literature demonstrates a >90% TV preservation rate. Long-term intensive surveillance is required.

  15. Mid-term results of Bernese periacetabular osteotomy for developmental dysplasia of hip in middle aged patients.

    PubMed

    Zhu, Junfeng; Chen, Xiaodong; Cui, Yiming; Shen, Chao; Cai, Guiquan

    2013-04-01

    To address the question, compared to having hip replacement with latent revision, does Bernese periacetabular osteotomy (PAO) before primary hip replacement occupy a preferable treatment strategy for middle aged (aged 35-54 years) hip dysplasia patients? We assessed the mid-term functional outcome and survivorship of PAO in those patients. Forty-one hips in 36 patients at middle age at the time of surgery (mean age, 39.5 years; range, 35-47 years) were retrospectively identified out of a total PAO cohort of 315 patients. Eleven of the 41 PAO hips also underwent osteochondroplasty at the femoral head-neck junction. Radiographic parameters of lateral centre edge angle, anterior centre edge angle and hip joint medialisation were investigated using the Harris Hip Score (HHS). The average follow-up was 5.1 years (range, two to ten years). Radiographic parameters postoperatively improved into the normal range, whereas no progression was found from preoperative Tonnis osteoarthritis score. Forty hips survived at the last follow-up, with HHS Score improved from 63.7 to 88.4. Compared to the sole PAO group, both postoperative alpha angle and range of joint motion improved in the PAO combined with osteochondroplasty group. However, no difference in HHS score was found. Good survivorship and improved joint function were identified in middle-aged Chinese patients following PAO with or without osteochondroplasty. We prudently suggest PAO as an alternative strategy for treating DDH in those patients.

  16. A Review of Literature on Formative Evaluation of Teachers through Mid-Term Student Feedback and How the Reiser and Dick Instructional Planning Model Can Enhance This Feedback.

    ERIC Educational Resources Information Center

    Hampton, Scott E.

    Research has shown that student mid-term feedback has significantly increased subsequent ratings of teacher effectiveness, student achievement, and student attitudes when the feedback results were accompanied by expert consultation. A gap in the literature is an instrument intended to provide specific feedback on systematic planning and delivery…

  17. Perception of Radiation Risk as a Predictor of Mid-Term Mental Health after a Nuclear Disaster: The Fukushima Health Management Survey.

    PubMed

    Miura, Itaru; Nagai, Masato; Maeda, Masaharu; Harigane, Mayumi; Fujii, Senta; Oe, Misari; Yabe, Hirooki; Suzuki, Yuriko; Takahashi, Hideto; Ohira, Tetsuya; Yasumura, Seiji; Abe, Masafumi

    2017-09-15

    Predictive factors including risk perception for mid-term mental health after a nuclear disaster remain unknown. The purpose of this study was to examine the association between perceived radiation risk and other factors at baseline and mid-term mental health after the Fukushima Daiichi nuclear disaster of 2011 in Japan. A mail-based questionnaire survey was conducted in January 2012 and January 2013. Mental health status was assessed using the K6 scale. Psychological distress over the 2-year period was categorized into the following four groups: chronic, recovered, resistant, or worsened. Most participants (80.3%) were resistant to the disaster. A positive association was found between the radiation risk perception regarding immediate effects and the worsened group in women. Baseline post-traumatic stress disorder (PTSD) or a history of psychiatric disease predicted being in the chronic or worsened group in mid-term course. These results suggest that evacuees who believed that their health was substantially affected by the nuclear disaster were at an increased risk of having poor mid-term mental health in women. Careful assessment of risk perception after a nuclear disaster, including the presence of PTSD or a history of psychiatric disease, is needed for appropriate interventions.

  18. Comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair for abdominal aortic aneurysm

    PubMed Central

    Gottsäter, Anders; Acosta, Stefan

    2014-01-01

    Objective: To evaluate mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and standard endovascular aneurysm repair for abdominal aortic aneurysm. Methods: Consecutive patients treated from 2007 to 2011 with elective fenestrated endovascular aneurysm repair (n = 81) and endovascular aneurysm repair (n = 201) were evaluated concerning age, cardiovascular medication, comorbidities, and mid-term mortality. Results: Patients in the elective fenestrated endovascular aneurysm repair group were younger than the endovascular aneurysm repair group (p = 0.006). In comparison with the endovascular aneurysm repair group, a lower proportion of patients in the elective fenestrated endovascular aneurysm repair group had diabetes (p = 0.013) and anemia (p = 0.003), and a higher proportion had arterial hypertension (p = 0.009). When entering age, endovascular aneurysm repair or fenestrated endovascular aneurysm repair operation, diabetes, anemia, and hypertension in a Cox regression model, only age (hazard ratio: 1.07; 95% confidence interval: 1.03–1.11; p < 0.001) was a risk factor for mid-term mortality. Conclusion: Careful patient selection and medical optimization resulted in comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair. PMID:26770700

  19. [Effectiveness of nano-hydroxyapatite/polyamide 66 cage in anterior spinal reconstruction: a mid-term study].

    PubMed

    Yang, Xi; Song, Yueming; Liu, Limin; Kong, Qingquan; Gong, Quan; Zeng, Jiancheng; Li, Tao; Tu, Chongqi

    2014-01-01

    To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction. There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores. All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees

  20. Mid-term results of Oxford phase-3 medial unicompartmental knee arthroplasty for medial arthritis in Chinese patients.

    PubMed

    Xu, Taotao; Lao, Yangjun; Wang, Jitao; Liu, Fucun; Xiao, Luwei; Tong, Peijian

    2017-04-01

    The purpose of this study was to evaluate the mid-term results of an Oxford phase-3 unicompartmental knee arthroplasty (UKA) for medial arthritis in Chinese patients. The study included 64 patients who underwent a minimally invasive Oxford phase-3 UKA for medial knee arthritis. The patients were clinically evaluated preoperatively and at the final follow-up according to the clinical and functional components of the Knee Society Score (KSS), the Hospital for Special Surgery knee score and range of motion. A Kaplan-Meier survivorship analysis was performed with revision surgery as the end point. The mean preoperative clinical KSSs increased from 63.2 to 91.4 post-operatively, and the mean functional KSSs increased from 54.9 to 86.5 post-operatively. In addition, the mean Hospital for Special Surgery scores increased from 59.5 to 86.4. The mean active knee flexion increased from 109.1° preoperatively to 123.6° post-operatively. A total of six patients (six knees) required revision surgery at the time of the maximum 10-year follow-up. Four conversions to total knee arthroplasty were performed because of arthritis progression in the lateral compartment. One revision to total knee arthroplasty was performed for aseptic loosening, and one liner exchange was performed for wear. The cumulative survival rates at the 6- and 8-year follow-ups were 97% and 93%, respectively. Oxford phase-3 UKA was largely applicable for medial arthritis in Chinese patients. However, the Oxford phase-3 medial UKA selection criteria for young Chinese males need further exploration to obtain the best treatment effect. © 2016 Royal Australasian College of Surgeons.

  1. Mid-term results of bilateral lung transplant with postoperatively extended intraoperative extracorporeal membrane oxygenation for severe pulmonary hypertension.

    PubMed

    Salman, Jawad; Ius, Fabio; Sommer, Wiebke; Siemeni, Thierry; Kuehn, Christian; Avsar, Murat; Boethig, Dietmar; Molitoris, Ulrich; Bara, Christoph; Gottlieb, Jens; Welte, Tobias; Haverich, Axel; Hoeper, Marius M; Warnecke, Gregor; Tudorache, Igor

    2017-07-01

    In severe pulmonary hypertension, diastolic dysfunction of the left ventricle causes significant morbidity and mortality after lung transplantation, which may be successfully reversed using a protocol based on perioperative veno-arterial extracorporeal membrane oxygenation (ECMO) and early extubation. Here, we present echocardiographic data and mid-term outcomes. The records of lung transplanted patients at our institution between May 2010 and January 2016 were retrospectively reviewed. Echocardiography data were collected preoperatively, at discharge, 3 and 12 months after transplantation. During the study period, 717 patients underwent lung transplantation at our institution, 38 (5%) patients being transplanted for severe pulmonary hypertension. All patients underwent bilateral lung transplantation on veno-arterial ECMO cannulated in the groin, through a sternum sparing thoracotomy in 36 (95%) patients. Extubation was performed early, after a median of 2 days, and awake ECMO was extended for at least 5 days after transplantation. The survival at 3 months, 1 year and 5 years was not different in comparison to patients transplanted for other underlying diseases ( P  = 0.45). At 1 year, tricuspid valve regurgitation had disappeared in all patients. The median of the left ventricular end-diastolic dimension improved from 40 (32-44) mm preoperatively to 45 (44-47) mm at 12 months after lung transplantation ( P  < 0.05). The median of the proximal right ventricular outflow diameter decreased to 25 (23-27) mm after 12 months, compared to 48 (43-51) mm preoperatively ( P  < 0.05). The routine application of a prophylactic postoperative veno-arterial ECMO protocol in patients with severe pulmonary hypertension undergoing lung transplantation decreases postoperative mortality and favours achievement of normal cardiac function after 1 year.

  2. Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results.

    PubMed

    Vida, Vladimiro L; Guariento, Alvise; Castaldi, Biagio; Sambugaro, Matteo; Padalino, Massimo A; Milanesi, Ornella; Stellin, Giovanni

    2014-02-01

    The aim of the study was to evaluate our results with pulmonary valve (PV) preservation in selected patients with tetralogy of Fallot (TOF). From January 2007, 69 patients who underwent early transatrial TOF repair were enrolled in the study. The patients were divided into 2 groups: PV preservation by PV annulus balloon dilation (group 1) and PV cusp reconstruction after annular incision (group 2). Thirty-four patients underwent a successful PV annular preservation (49%). Median age at surgery was 113 days (range, 36-521 days) (group-1 vs group-2, P = not significant). Median preoperative PV Z score was -3.15 (range, -0.95 to -5.62) (group-1 vs group-2, P = .03). Median intensive care unit and hospital stays were 3 and 10 days, respectively (group 1 vs group 2, P = not significant). Median follow-up time was 580 days (range, 189-1940 days) (group 1 vs group 2, P = .08). Two patients were reoperated for residual right ventricular outflow tract (RVOT) obstruction (1 in group 1 and 1 in group 2). The remaining patients are alive and well. Median peak RVOT gradient was 25 mm Hg (range, 8-60 mm Hg) (group 1 vs group 2, P = not significant). The degree of PV regurgitation in group 1 was none/mild in 24 patients (80%) and moderate in 6 (20%) and was none/mild in 8 patients (25%), moderate in 11 (34.4%), and severe in 13 (28.6%) in group 2 (P = .001). Median right ventricular fractional area change was 55% (range, 42%-70%) in group 1 and 50% (range, 40%-63%) in group 2 (P = .003). The integrity and function of the PV can be preserved in selected patients during early repair of TOF by concomitant balloon dilation, leading to a better mid-term right ventricular function. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. Balloon angioplasty of coarctation of the aorta: a safe alternative for surgery in adults: immediate and mid-term results.

    PubMed

    Koerselman, J; de Vries, H; Jaarsma, W; Muyldermans, L; Ernst, J M; Plokker, H W

    2000-05-01

    Patients with coarctation of the aorta can be treated either with surgery or with balloon angioplasty. So far, the last method has proved to be successful in children, but results of this treatment in (young) adults are virtually unknown. The aim of this study was to evaluate the immediate and mid-term follow-up results of balloon angioplasty of native coarctation in (mainly young) adults. Coarctation of the aorta was diagnosed by means of ultrasound or angiography, and defined as a stenosis with a pressure gradient greater than 20 mm Hg. The balloon angioplasty-procedure was carried out under complete anesthesia, and was considered to be successful, if the pressure gradient was reduced to less than 20 mm Hg. Nineteen consecutive adults (12 males, 7 females; aged 14-67 years, median 29) with native coarctation were treated from 1995-99. Mean pressure gradient decreased from 49.3+/- 20.8 to 4.8+/-8.2 mm Hg (P<0.0001). One patient showed a suboptimal result with a residual pressure gradient of 28 mm Hg. In one other patient a stent was placed on request of the referring physician. Follow-up was 100% complete and ranged from 3-47 months (mean 20.2+/- 12.9). At 1-year follow-up mean systolic blood pressure was reduced from 159.4+/-19.5 to 132.5+/-17.6 mm Hg (n = 18; P<0.0001), and mean ankle-arm pressure index improved from 0.73+/-0.09 to 0.96+/-0.05 (n = 18; P<0.0001). Anti-hypertensive medication could either be reduced or stopped in 7 patients (53.8%). With ultrasound or angiography or MRI, no patients had signs of aneurysm formation or worsening restenosis during follow-up. In adult patients with uncomplicated native coarctation of the aorta, balloon angioplasty (without stenting) would seem to be an excellent and safe alternative for surgery. In our hospital it has completely replaced surgical correction in such patients.

  4. [Distal fixation prosthesis for unstable intertrochanteric fractures in elderly patients: a mid-term follow-up study].

    PubMed

    Zhang, Zhan-feng; Min, Ji-kang; Zhong, Jian-ming; Wang, Dan

    2016-06-01

    To explore mid-term follow up results of distal fixation prosthesis in treating unstable intertrochanteric fractures in elderly patients. From May 2008 to March 2014,58 elderly patients with unstable intertrochanteric were treated with distal fixation prosthesis, among them, there were 15 males and 43 females aged from 75 to 87 years old with an average of 83.2 years old. Fracture were classified according to Evans classification, 39 cases were type I c and 19 cases were type I d. Surgical risk was evaluated before operation, 9 patients were performed total hip arthroplasty and 49 patients were performed prosthetic replacement hip joint function of patients with different age period, Evans classificaton, prothesis type, fixation method were evaluated respectively by using Harris score. Fifty-six patients were followed up from 13 to 36 months with an average of 21.6 months. Harris score was 83.51 ± 6.40, 5 cases got excellent results, 38 cases good and 13 cases moderate. Harris score of patients aged from 75 to 80 years old was 88.64 ± 2.35, 81.64 ± 6.40 in patients aged more than 80 years old, and had significant differences between two groups; Harris score in patients with type Evans I c was 83.64 ± 6.53, and 83.11 ± 6.08 in type Evans I d, while there was no significant differences between two groups. There was no obvious meaning in Harris score between patients with tension band (83.63 ± 6.15) and without tension band (82.41 ± 6.57). There was no significant meaning in Harris score between patients with normal distal fixation prosthesis (83.34 ± 6.43) and femoral moment reconstruction distal fixation prosthesis (83.92 ± 6.51). There was 1 patient occurred hip joint dislocation on the operative side and re-dislocation after manual reduction, then received open reduction. Two patients occurred femoral osteolysis without clinical symptoms, and treated conservative treatment. Artificial joint replacement for unstable intertrochanteric fractures in elderly

  5. In-hospital and mid-term predictors of mortality after transcatheter aortic valve implantation: data from the TAVI National Registry 2010-2011.

    PubMed

    Sabaté, Manel; Cánovas, Sergio; García, Eulogio; Hernández Antolín, Rosana; Maroto, Luis; Hernández, José María; Alonso Briales, Juan H; Muñoz García, Antonio J; Gutiérrez-Ibañes, Enrique; Rodríguez-Roda, Jorge

    2013-12-01

    The treatment of severe symptomatic aortic stenosis has been revolutionized by the technique of transcatheter valve replacement. The purpose of this study was to present the outcomes and predictors of mortality in patients enrolled between 2010 and 2011 in the Transcatheter Aortic Valve Replacement National Registry. We collected 131 preprocedural, 31 periprocedural, and 76 follow-up variables, and analyzed the immediate implant success rate, the 30-day safety endpoint, and all-cause 30-day and mid-term (mean follow-up, 244 days) mortality. From January 2010 to December 2011, a total of 1416 patients were included: 806 with Edwards valves and 610 with CoreValves. The implant success and 30-day mortality rates were 94% and 8%, respectively, without differences between types of valves and approaches. The 30-day safety endpoint and mid-term mortality rates were 14% and 16%, respectively, which were also similar between groups. The presence of comorbidities (renal failure, peripheral vascular disease, ejection fraction, and atrial fibrillation), the need for conversion to surgery, and at least moderate aortic regurgitation after transcatheter aortic valve implantation were identified as independent predictors of in-hospital and mid-term mortality. The prognosis of valve implant patients could be improved by including comorbidities in patient selection and by minimizing the degree of residual aortic regurgitation to optimize the results of the procedure. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  6. Mid term monitoring of heavy metals content in soils of Mediterranean coastal wetlands. La Albufera de Valencia Natural Park, Spain

    NASA Astrophysics Data System (ADS)

    Pascual-Aguilar, Juan Antonio; Andreu, Vicente; Gimeno-García, Eugenia

    2014-05-01

    Coastal wetlands, in general, and Mediterranean ones, in particular, suffer from differente anthropogenic pressures that may affect their intrinsic environmental and ecological functions. Most, if not all, Mediterranean wetlands are not natural spaces were preservation of habitat and wildlife is the only management policy achieved, bur rather their terriroty is a combination of land units with different activities and influences, such as farming, environmental protection and connectivities with urban and industrial areas. Therefore, the need of periodical monitoring is required whenever pressures and environmental health of wetlands is assessed, particularly of those processes that affect the interconnection of environmental compartiments involving water, soils and biota. In agro-ecological protected wetlands soils play and important role because they are potential sources of pollutants due to farming practices. In this case, presence of heavy metals in soils is and indicator of both environmental health and anthtopogenic direct (farming activities) and indirect (neighbour urban areas) pressures. In this work a mid term (17 year) monitoring of seven heavy metals (Cd, Co, Cr, Cu, Pb, Ni and Zn) in soils of coastal Mediterranean wetlands (La Albufera Natural Park, Spain) are analyzed. Two monitoring campaings were achieved in 1991 and 2008. In both cases the same 20 points were visited which were distributed in the natural park according two four different sectors of potential anthropogenic pressure and land use. At each point two soil samples were collected at differente depths (0 to 20 cm and 20 to 40 cm). The selected metals were analyzed to determine its total and extractable fractions by treatment with EDTA. Atomic Absorption Spectrometry, using graphite furnace when necessary, was used for the determination of metals. In general, there is a reduction of metal contents in the study area in both dates. The trend of metals according to average concentration (mg

  7. Eliminating the limitations of manual crimping in stapes surgery: mid-term results of 90 patients in the Nitinol stapes piston multicenter trial.

    PubMed

    Rajan, Gunesh P; Diaz, Jason; Blackham, Ruth; Eikelboom, Robert H; Atlas, Marcus D; Shelton, Clough; Huber, Alexander M

    2007-07-01

    To present our mid-term results of our multicenter study using the Nitinol self-crimping stapes piston, focusing on the interindividual variations of postoperative air-bone gap closures (ABGC), postoperative hearing results, and postoperative recurrences of conductive hearing loss and to compare these findings with our pilot group of patients. Prospective, multicenter cohort study involving three academic tertiary care referral centers from Australia, Switzerland, and the United States. Ninety patients with otosclerosis undergoing laser-stapedotomy with the Nitinol stapes piston were matched to reference patients from our titanium piston database. The effects of the self-crimping Nitinol piston on the postoperative ABGC, the postoperative interindividual air-bone gap (ABG) variations, and the postoperative hearing results were investigated 3, 6, 12, 18, and 24 months postoperatively. These data were statistically compared with the results of the control patients in our titanium stapes piston database and the results of our previously published pilot study. The mean postoperative ABG and the interindividual variations of the postoperative ABG continue to be significantly smaller in the Nitinol group; the extent of ABGC now is significantly larger in the Nitinol piston group. The postoperative mid-term stability of ABGC was similar in both groups. No adverse reactions occurred during follow-up. Our mid-term results continue to show that the self-crimping shape memory alloy Nitinol stapes piston overcomes the limitations of manual malcrimping in stapedotomy, thus simplifying and optimizing the surgical procedure. This so far has allowed reliable, safe, and consistent ABGC in patients with otosclerosis.

  8. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration.

    PubMed

    Muzaffar, Iqbal; Zula, Pai; Yimit, Yusp; Jaan, Ajim Tuergan; Wen, Hao

    2014-11-01

    To compare the postoperative short-term and mid-term complications in patients who underwent CBD exploration and closure by using T-tube or primary closure. Prospective randomized clinical trial. Hepatobiliary Department of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, from August 2009 to March 2013. A total of 148 consecutive patients with Common Bile Duct Stones (CBDS) and CBD dilation were enrolled in this randomized study to undergo open cholecystectomy with CBD exploration. Pre-operative findings, postoperative short-term complications, postoperative follow-up (mid-term), and hospital stay were recorded and analyzed. A T-tube was inserted in 76 (51.35%) patients and the primary closure was done in 72 (48.64%) patients. There were no differences in the demographic characteristics and clinical presentations between the two groups. Compared with the T-tube group 8.97 ± 1.629 days, the postoperative stay in primary closure 5.34 ± 1.25 days was significantly shorter (p < 0.01). The incidence of overall postoperative short-term complications and mid-term complications were statistically but not significantly lower in the primary closure group (9.7%) than that in T-tube group (17.10%, p=0.189). Complications in the primary closure group were lower than that in T-tube group but there was no significant statistical difference. So during open surgery for CBD stones, primary closure of CBD appeared safe and effective with shorter hospital stays and less complications.

  9. Combined baseline strain dyssynchrony index and its acute reduction predicts mid-term left ventricular reverse remodeling and long-term outcome after cardiac resynchronization therapy.

    PubMed

    Tatsumi, Kazuhiro; Tanaka, Hidekazu; Matsumoto, Kensuke; Miyoshi, Tatsuya; Hiraishi, Mana; Tsuji, Takayuki; Kaneko, Akihiro; Ryo, Keiko; Fukuda, Yuko; Norisada, Kazuko; Onishi, Tetsuari; Yoshida, Akihiro; Kawai, Hiroya; Hirata, Ken-ichi

    2014-04-01

    The objective of this study was to test the hypothesis that combining assessment of baseline radial strain dyssynchrony index (SDI), that expressed both left ventricular (LV) dyssynchrony and residual myocardial contractility, and of acute changes in this index can yield more accurate prediction of mid-term responders and long-term outcome after cardiac resynchronization therapy (CRT). Radial SDI for 75 CRT patients was calculated as the average difference between peak and end-systolic speckle tracking strain from 6 segments of the mid-LV short-axis view before and 8 ± 2 days after CRT. Mid-term responder was defined as ≥ 15% decrease in LV end-systolic volume 6 ± 2 months after CRT. Long-term outcome was tracked over 5 years. Baseline radial SDI ≥ 6.5% is considered predictive of responder and favorable outcome, as previously reported. Acute reduction in radial SDI ≥ 1.5% was found to be the best predictor of mid-term responders with CRT. Furthermore, patients with acute reductions in radial SDI ≥1.5% were associated with a significantly more favorable long-term outcome after CRT than those with radial SDI <1.5% (log rank P < 0.001). An important findings were that baseline radial SDI ≥6.5% and acute reductions in radial SDI ≥ 1.5% in 42 patients were associated with the highest event-free survival rate of 92%, whereas, 21 patients corresponding values of <6.5% and <1.5% were associated with low event-free survival rate of 46% (log rank P < 0.001). Combined assessment of baseline radial SDI and its acute reduction after CRT may have clinical implications for predicting responders and thus patients' care.

  10. Mid-term survival after transcatheter aortic valve implantation: Results with respect to the anesthetic management and to the access route (transfemoral versus transapical)

    PubMed Central

    Gauthier, Caroline; Astarci, Parla; Baele, Philippe; Matta, Amine; Kahn, David; Kefer, Joëlle; Momeni, Mona

    2015-01-01

    Context: Several studies have analyzed the long-term survival after transcatheter aortic valve implantation (TAVI). However, no previous studies have looked at survival beyond 1-year with respect to the type of anesthesia. Aims: The aim was to evaluate the mid-term survival after TAVI with respect to the type of anesthesia (general anesthesia [GA] vs. local anesthesia ± sedation [LASedation]) or the type of procedure (transfemoral [transfem] vs. transapical TAVI) performed. Settings and Design: Retrospective cohort study. Subjects and Methods: This retrospective study included TAVI's between January 2009 and June 2013. Patients were divided into three groups: transfem TAVI under GA, transfem TAVI under LASedation and transapical TAVI. A total of 176 patients were eligible. The following clinical outcomes were evaluated: (1) Mortality, (2) Major cardiovascular complications, (3) Conduction abnormalities and arrhythmias, (4) Acute kidney injury, (5) Aortic regurgitation, (6) Neurologic events, (7) Vascular complications, (8) Pulmonary complications, (9) Bleeding, (10) Infectious complications, (11) Delirium. Statistical Analysis Used: A Kruskal–Wallis test was performed to test significance between the three groups for quantitative variables. Categorical variables were compared using a Chi-square test. Survival was estimated using Kaplan–Meier method. Results: There was no statistically significant difference between the survival of both transfem TAVI's (P = 0.46). The short-term outcome of the transfem TAVI groups was better than the transapical arm, but their mid-term survival did not show any significant difference (P = 0.69 transapical vs. transfem GA; P = 0.07 transapical vs. transfem LASedation). Conclusions: Our results demonstrate that the type of anesthesia and the access route do not influence mid-term survival after TAVI. PMID:26139739

  11. The assessment of treated wastewater quality and the effects of mid-term irrigation on soil physical and chemical properties (case study: Bandargaz-treated wastewater)

    NASA Astrophysics Data System (ADS)

    Kaboosi, Kami

    2017-09-01

    This study was conducted to investigate the characteristics of inflow and outflow wastewater of the Bandargaz wastewater treatment plant on the basis of the data collection of operation period and the samples taken during the study. Also the effects of mid-term use of the wastewater for irrigation (from 2005 to 2013) on soil physical and chemical characteristics were studied. For this purpose, 4 samples were taken from the inflow and outflow wastewater and 25 quality parameters were measured. Also, the four soil samples from a depth of 0-30 cm of two rice field irrigated with wastewater in the beginning and middle of the planting season and two samples from one adjacent rice field irrigated with fresh water were collected and their chemical and physical characteristics were determined. Average of electrical conductivity, total dissolved solids, sodium adsorption ratio, chemical oxygen demand and 5 days biochemical oxygen demand in treated wastewater were 1.35 dS/m, 707 ppm, 0.93, 80 ppm and 40 ppm, respectively. Results showed that although some restrictions exist about chlorine and bicarbonate, the treated wastewater is suitable for irrigation based on national and international standards and criteria. In comparison with fresh water, the mid-term use of wastewater caused a little increase of soil salinity. However, it did not lead to increase of soil salinity beyond rice salinity threshold. Also, there were no restrictions on soil in the aspect of salinity and sodium hazard on the basis of many irrigated soil classifications. In comparison with fresh water, the mid-term use of wastewater caused the increase of total N, absorbable P and absorbable K in soil due to high concentration of those elements in treated wastewater.

  12. Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis.

    PubMed

    van der Straaten, Ellen P J; Rademakers, Leonard M; van Straten, Albert H M; Houterman, Saskia; Tan, M Erwin S H; Soliman Hamad, Mohamed A

    2016-04-01

    The aim of this study was to investigate the mid-term haemodynamic and clinical results after aortic valve replacement (AVR) using the Sorin Freedom Solo (SFS) stentless bioprosthesis, compared with the standard Carpentier Edwards Perimount (CEP) stented bioprosthesis. In this retrospective cohort study of prospectively collected data, 116 patients were included in the SFS group (53 males; median age 74 years, range 56-85 years), and 122 patients in the CEP group (85 males; median age 73 years, range 43-88 years) between July 2007 and January 2013. Echocardiography was performed at 6 weeks after surgery in our centre, and the most recent echocardiography (in our centre or in referring cardiology departments) was requested. Between September 2013 and April 2014, all patients were called by the same researcher to gain clinical follow-up data. Mid-term mortality was 16.4% in the SFS group (19 patients) and 21.3% in the CEP group (26 patients); (P = 0.3). The mean transvalvular gradient was 7.4 ± 3.1 mmHg in the SFS group, and 11.6 ± 3.2 mmHg in the CEP group at 6 weeks postoperatively (P < 0.001). When stratified by labelled valve size, mean gradients were significantly lower in the SFS group for every size (P ≤ 0.03). After 3.3 ± 1.4 years of follow-up, the mean gradient was still significantly lower in the SFS group than that in the CEP group (P < 0.001). Clinical follow-up showed relatively low complication rates. These data suggest that the Sorin Freedom Solo stentless bioprosthesis is as safe as the Carpentier Edwards bioprosthesis, and provides better short- and mid-term haemodynamic performance than the Carpentier Edwards bioprosthesis. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. The assessment of treated wastewater quality and the effects of mid-term irrigation on soil physical and chemical properties (case study: Bandargaz-treated wastewater)

    NASA Astrophysics Data System (ADS)

    Kaboosi, Kami

    2016-05-01

    This study was conducted to investigate the characteristics of inflow and outflow wastewater of the Bandargaz wastewater treatment plant on the basis of the data collection of operation period and the samples taken during the study. Also the effects of mid-term use of the wastewater for irrigation (from 2005 to 2013) on soil physical and chemical characteristics were studied. For this purpose, 4 samples were taken from the inflow and outflow wastewater and 25 quality parameters were measured. Also, the four soil samples from a depth of 0-30 cm of two rice field irrigated with wastewater in the beginning and middle of the planting season and two samples from one adjacent rice field irrigated with fresh water were collected and their chemical and physical characteristics were determined. Average of electrical conductivity, total dissolved solids, sodium adsorption ratio, chemical oxygen demand and 5 days biochemical oxygen demand in treated wastewater were 1.35 dS/m, 707 ppm, 0.93, 80 ppm and 40 ppm, respectively. Results showed that although some restrictions exist about chlorine and bicarbonate, the treated wastewater is suitable for irrigation based on national and international standards and criteria. In comparison with fresh water, the mid-term use of wastewater caused a little increase of soil salinity. However, it did not lead to increase of soil salinity beyond rice salinity threshold. Also, there were no restrictions on soil in the aspect of salinity and sodium hazard on the basis of many irrigated soil classifications. In comparison with fresh water, the mid-term use of wastewater caused the increase of total N, absorbable P and absorbable K in soil due to high concentration of those elements in treated wastewater.

  14. COST Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar:" ongoing research activities and mid-term results

    NASA Astrophysics Data System (ADS)

    Pajewski, Lara; Benedetto, Andrea; Loizos, Andreas; Slob, Evert; Tosti, Fabio

    2015-04-01

    This work aims at presenting the ongoing activities and mid-term results of the COST (European COoperation in Science and Technology) Action TU1208 'Civil Engineering Applications of Ground Penetrating Radar.' Almost three hundreds experts are participating to the Action, from 28 COST Countries (Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Latvia, Malta, Macedonia, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom), and from Albania, Armenia, Australia, Egypt, Hong Kong, Jordan, Israel, Philippines, Russia, Rwanda, Ukraine, and United States of America. In September 2014, TU1208 has been praised among the running Actions as 'COST Success Story' ('The Cities of Tomorrow: The Challenges of Horizon 2020,' September 17-19, 2014, Torino, IT - A COST strategic workshop on the development and needs of the European cities). The principal goal of the COST Action TU1208 is to exchange and increase scientific-technical knowledge and experience of GPR techniques in civil engineering, whilst simultaneously promoting throughout Europe the effective use of this safe and non-destructive technique in the monitoring of infrastructures and structures. Moreover, the Action is oriented to the following specific objectives and expected deliverables: (i) coordinating European scientists to highlight problems, merits and limits of current GPR systems; (ii) developing innovative protocols and guidelines, which will be published in a handbook and constitute a basis for European standards, for an effective GPR application in civil- engineering tasks; safety, economic and financial criteria will be integrated within the protocols; (iii) integrating competences for the improvement and merging of electromagnetic scattering techniques and of data- processing techniques; this will lead to a novel freeware tool for the localization of buried objects

  15. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

    PubMed

    Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

    2016-11-11

    Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

  16. [Amaurosis fugax of cardiac origin].

    PubMed

    Michaux, S; Lebrun, F; Beissel, J

    2005-01-01

    We present the case of a 49 year old woman who was admitted to the emergency department for dyspnoea, transient amaurosis and limbs oedema. During hospitalisation a full workup revealed multisystemic thrombosis and dilated cardiomyopathy in relation with viral myocarditis due to Coxackie B infection. Diagnosis and treatment will be discussed in light of the litterature.

  17. Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.

    PubMed

    Chouillard, Elie; Younan, Antoine; Alkandari, Mubarak; Daher, Ronald; Dejonghe, Bernard; Alsabah, Salman; Biagini, Jean

    2016-10-01

    Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713-723. doi: 10.1016/j.soard.2014.01.016 , 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954-1960 doi: 10.1007/s00464-014-3424-y , 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome. Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series. Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22-59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18-90). Mean body mass index (BMI) was 27.4 kg/m(2) (22-41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections. Despite the lack of long-term follow-up, RYFJ could be

  18. Mid-term clinical outcomes of ABSORB bioresorbable vascular scaffold implantation in a real-world population: A single-center experience.

    PubMed

    Costopoulos, Charis; Crowson, Matthew C; Brown, Adam J; Braganza, Denise M; Bennett, Martin R; Hoole, Stephen P; West, Nick E J

    2015-12-01

    Available data on the use of the ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) in real-world patients is limited. The aim of this study was to assess the mid-term clinical outcomes in a real-world population treated with ABSORB BVS. We retrospectively evaluated all patients treated with ABSORB at Papworth Hospital, Papworth Everard, UK between July 2012 and July 2014. A total of 108 patients (126 lesions) were identified. Clinical follow-up was performed on all subjects by clinic visit or telephone interview. Most patients were male (91.7%) with a relative high incidence of previous myocardial infarction (MI) (40.7%). Clinical presentation was equally divided between stable angina and acute coronary syndrome (ACS) (51.8% vs. 48.2%, p=0.59). Of the ACS patients, 26.9% presented with ST-elevation myocardial MI. Intravascular imaging was used in all cases. Predilatation (92.9%) and postdilatation (82.5%) were frequently performed. Major adverse cardiac event (MACE) rates defined as the composite of all-cause death, follow-up MI and target vessel revascularization were 2.5% at 6-month and 4.5% at 1-year. The 1-year target lesion failure rate, defined as the composite of cardiac death, target-vessel MI and target lesion revascularization was 1.9%. There was 1 case of subacute stent thrombosis. The use of ABSORB BVS in real-world patients appears to be associated with good mid-term clinical outcomes when guided by intravascular imaging. Larger studies are required to evaluate further the role of BVS in routine clinical practice and examine how this compares to metallic devices. Available data on the use of the ABSORB BVS in real-world patients is limited. We retrospectively evaluated all patients treated with ABSORB BVS between July 2012 and July 2014. A total of 108 patients (126 lesions) were identified. Clinical presentation was equally divided between stable angina and acute coronary syndrome (51.8% vs. 48.2%, p=0.59). Predilatation

  19. Coronary chronic total occlusions: mid-term comparison of clinical outcome following the use of the guided-STAR technique and conventional anterograde approaches.

    PubMed

    Godino, Cosmo; Latib, Azeem; Economou, Fotios I; Al-Lamee, Rasha; Ielasi, Alfonso; Bassanelli, Giorgio; Figini, Filippo; Chieffo, Alaide; Montorfano, Matteo; Colombo, Antonio; Carlino, Mauro

    2012-01-01

    There are limited data on the mid-term safety following the use of the guided-subintimal tracking and re-entry (guided-STAR) technique for the treatment of chronic total occlusions (CTO) and concerns have arisen about a potential increased risk of stent thrombosis (ST). The aim of this study was to evaluate the mid-term safety in terms of cardiac death and ST after recanalization using the contrast guided-STAR technique when compared to conventional anterograde CTO recanalization (CA-CTO). This retrospective study analyzed 355 consecutive patients with successful angiographic recanalization (residual stenosis <20% and TIMI flow grade ≥2) of CTO lesion. Seventy-four (20.8%) underwent guided-STAR and 281 (79.2%) had CA-CTO. Survival rates were estimated using the Kaplan-Meier method. Compared to CA-CTO patients, the rate of the following clinical, angiographic, and procedural characteristics were significantly higher in guided-STAR patients: hypercholesterolemia (84 vs. 67%, P = 0.004), previous CABG (41.3 vs. 15.7%, P < 0.0001), three-vessel disease, (62.7 vs. 47%, P = 0.019), right coronary artery CTO (62.7 vs. 41.6%, P = 0.002), stent length (68.15 vs. 54.05 mm, P < 0.0001). A drug-eluting stent was implanted in the majority of cases (89.2% guided-STAR vs. 93.5% CA-CTO). At a median follow-up of 779 days (IQR 495-1035), there were no significant differences in cardiac survival (97.2 vs. 97.5%, Log-rank P = 0.912) and cumulative ARC ST rates (2.8 vs. 1.8%, Log-rank P = 0.610) for guided-STAR and CA-CTO patients, respectively. The rate of restenosis was significantly higher in the guided-STAR group compared to the CA-CTO group (54 vs. 30%, Log-rank P < 0.0001). The adjusted Cox proportional-hazard analysis for procedural technique showed that the only significant independent predictor of restenosis was the stent length (HR, 1.017; 95% CI, 1.008-1.027; P < 0.0001). At mid-term follow-up, the guided-STAR was not inferior to CA-CTO in terms of safety. The only

  20. [Evaluation of mid-term effectiveness of medium-and-long-term programme for prevention and control of schistosomiasis in Anhui Province].

    PubMed

    He, Jia-Chang; Wang, Tian-Ping; Zhang, Shi-Qing; Gao, Feng-Hua; Zhang, Gong-Hua; Yang, Wei-Ping; Wang, Hao; Yu, Bei-Bei

    2011-06-01

    To evaluate the mid-term effectiveness of the medium-and-long-term programme for prevention and control of schistosomiasis in Anhui Province. In the programme, the comprehensive measures were carried out, including the schistosomiasis detection and chemotherapy for residents and livestock, snail control, health education, and infectious source control. The mid-term effectiveness of the programme was observed and evaluated longitudinally. From 2004 to 2009, 750 798 schistosomiasis patients and 547 069 persons with the history of infested water contacting were treated. The number of positive cattle treated was 8 462 cattle-times and the number of cattle with history of infested water contact treated was 117 023 cattle-times. The area with snails control by molluscicides was 30 532.0 hm2, and the area with snails control by environmental modification was 13 979.5 hm2. The number of persons who received health education was 31.73 million person-times. The infectious source control measures were carried out in 40% of endemic villages with human infection rate being more than 1%. Up to 2009, the infection rates of population and cattle, and the incidence rate of acute schistosomiasis reduced to 0.51%, 1.25% and 0.30/100 000, respectively. During the period of 2004-2009, the areas with snails fluctuated from 29 065.4 to 29 740.3 hm2. The densities of living snails and infected snails both showed a declining trend in general. During these years, the whole province reached the criteria of infection control, 4 counties reached the criteria of transmission control, and 4 counties reached the criteria of transmission interruption. The effect of the comprehensive strategy of schistosomiasis control is remarkable.

  1. Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair.

    PubMed

    Huang, C S; Huang, C C; Lien, H H

    2005-05-01

    Two types of anterior tension-free hernioplasty, prolene hernia system (PHS) repair and mesh plug technique (MPT), were introduced to Taiwan in 2001. This study compared the short- to mid-term outcomes following primary groin hernia repair with PHS and MPT. From January 2001 to December 2003, 393 patients with 426 primary groin hernias were operated on by a single surgeon using MPT (n=192) and PHS (n=234). Baseline perioperative details and follow-up information were compared. Demographic characteristics of both groups were similar. The laterality, types of anesthesia, postoperative stay, postoperative wound pain scores, wound complications and days to return to activities of daily life were equally distributed between the two groups. However, the distribution of Gilbert types in the PHS group was shifted a little to the right compared with that of the MPT group. PHS repair had longer operative time (34+/-17 vs 25+/-9 minutes, p<0.01). No recurrence was noted in both groups during the follow-up from 5 to 41 months. Chronic non-disabling groin pains were noted in 2.8% (6/218) of patients in the PHS group and 8.9% (14/175) in the MPT group (p=0.01). Our results show that both PHS and MPT repairs can be performed with short operation time, minor wound pain and quick return to activities of daily life without short- to mid-term recurrences, but postoperatively the MPT group had higher incidence of chronic non-disabling groin pain. Although the MPT is less invasive, the additional protective patch in the preperitoneal space of the PHS may provide a further safeguard against recurrences, especially for those patients with attenuated inguinal floor. Long-term follow-up is needed.

  2. Mid-term results of ponseti method for the treatment of congenital idiopathic clubfoot - (A study of 67 clubfeet with mean five year follow-up)

    PubMed Central

    2011-01-01

    Background Long-term success reports by Dr. Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among pediatric orthopedists. The purpose of this study is to evaluate mid-term effectiveness of Ponseti method for the treatment of congenital idiopathic clubfoot. Material and Methods A total of 49 patients (67 clubfeet) were treated by Ponseti method by single orthopedic surgeon during the period of October 03 to July 07 and were studied prospectively up to July 10 (mean follow up period 5 years, minimum follow-up period of 3 years). Age at the initiation of the treatment, gender, bilaterality, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace and CTEV shoes were examined. Passive range of movements and look of club foot are evaluated with mean 5 years follow-up. Results We followed the functional Ponseti Scoring System and got good to excellent results in 44 patients - 89.79% (58 clubfeet - 86.56%) at mean five year of follow up. Parents of 32 patients (65.30%) accept the look of the clubfoot nearly normal and parents of 12 patients (24.49%) accept the look of clubfoot as normal. Of the 49 patients who responded to initial Ponseti casting, 14 patients - 28.57% (19 clubfeet - 28.35%) had relapse at varying age; out of which 9 patients - 64.29% (10 clubfeet - 52.63%) were corrected by Ponseti casting method, while 5 patients - 35.71% (9 clubfeet - 47.37%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint was thought to be the main cause of failure in these patients. Conclusion Ponseti method is a safe and satisfactory treatment for congenital idiopathic clubfoot with mid- term effectiveness. PMID:21226940

  3. Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients.

    PubMed

    Aalaei-Andabili, Seyed Hossein; Anderson, R David; Petersen, John W; Beaver, Thomas M; Bavry, Anthony A; Klodell, Charles T

    2017-08-01

    We compared stroke occurrence and outcomes between Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), both periprocedural and at follow-up. From March 2012 to December 2014, 391 consecutive patients underwent TAVR (N.=290) or isolated SAVR (N.=101), concomitantly. Patients' data were prospectively collected. TAVR patients had more comorbidities. One (0.34%) TIA and 9 (3.11%) strokes occurred in-hospital following TAVR, but no cerebrovascular event occurred after SAVR (P=0.11). One stroke (0.99%) and one TIA (0.99%) were detected in SAVR group within 30 days. Among TAVR patients, one (0.75%) stroke at 6 months, 2 (1.9%) strokes and 2 (1.9%) TIAs at 12 months were diagnosed. Kaplan-Meier analysis revealed that 96% and 99% 12-month CVA free survival following TAVR and SAVR, respectively (P=0.67). Preoperative mean trans-aortic valve systolic pressure gradient higher than 40 mmHg remained as risk factor for stroke in TAVR patients only, OR: 4.48 (CI: 1.2-16.54, P=0.02). One intraoperative death, and 5 (4 with CVA) in-hospital deaths occurred after TAVR; whereas only one patient died in SAVR group (P=0.49). Thirty-day mortality was 3.8% (11/290) for TAVR and 0.99% (1/101) for SAVR patients. SAVR patients' survival was 99% at 6 months, 97.9% at 12, and 96.4% at 24 months, whereas survival in TAVR was 97.5% at 6, 92% at 12, and 73.6% at 24 months (HR: 8.43 (CI: 2.47-28.73), P<0.001). Even with significant differences in patients' baseline characteristics; in-hospital and mid-term stroke rates are not significantly higher following TAVR than SAVR. Although periprocedural stroke is not uncommon in TAVR, mid-term stroke rate is low.

  4. Anterior Cervical Discectomy and Fusion with Stand-Alone Trabecular Metal Cages as a Surgical Treatment for Cervical Radiculopathy: Mid-Term Outcomes

    PubMed Central

    ElAbed, Khaldoun; Shawky, Ahmad; Ainscow, Donald

    2016-01-01

    Study Design Retrospective case cohort study done between 2002 and 2012. Purpose To assess the mid-term clinical and radiological outcomes of 1-level and 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone trabecular metal cages. Overview of Literature ACDF is the gold standard surgical treatment for cervical degenerative disease. The usual surgical practice is to use an anteriorly placed fusion plate with or without interdiscal cages. Methods Patients between 36 and 64 years of age diagnosed with cervical radiculopathy who underwent ACDF using stand-alone trabecular metal cages with at least 3 years follow-up were included in this study. Recorded clinical outcomes included residual axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity altered sensation. Visual Analogue scores were also recorded. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device at the latest follow-up. Results Ninety patients were included in the study. Fifty-one patients underwent 2-level surgery and 39 patients underwent 1-level surgery. Mean age was 44±10.4 years and mean follow-up time was 4.5±2.6 years. Patients reported excellent or good outcomes (90%), as well as improvements in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity altered sensation (90%). Most patients (90%) progressed to fusion at the 1-year follow-up. The reoperation rate was 3.6%. There was no reported persistent dysphagia, voice complaints, dural tear, or tracheal or oesophageal perforation in any of the patients. One patient developed a deep methicillin-resistant Staphylococcus aureus infectious infarction of the spinal cord, which was treated with antibiotics. Recovery was complete at the 1-year follow up. Conclusions Mid-term results show that surgical treatment with ACDF with trabecular metal cages is a safe and effective treatment of single and 2-level

  5. Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

    PubMed Central

    Thang, Bui Quoc; Furugaki, Tatsuya; Osaka, Motoo; Watanabe, Yutaka; Kanemoto, Shinya; Suetsugu, Fuminaga

    2016-01-01

    Purpose: There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes. Methods: In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively. Results: There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus–Kaye–Stansel (DKS) anastomosis. Six have completed Fontan. Conclusion: Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation. PMID:27725352

  6. The BioSTAR(r) device versus the CardioSEAL(r) device in patent foramen ovale closure: comparison of mid-term efficacy and safety.

    PubMed

    Van den Branden, Ben J; Luermans, Justin G; Post, Martijn C; Plokker, Herbert W; Ten Berg, Jurriën M; Suttorp, Maarten J

    2010-09-01

    To compare the mid-term efficacy and safety of the bioabsorbable BioSTAR(r) device with the non-bioabsorbable CardioSEAL(r) device for percutaneous patent foramen ovale (PFO) closure. All 81 consecutive patients who underwent PFO closure with the CardioSEAL(r) or BioSTAR(r) device between June 2003 and July 2008 were included. The presence of a residual shunt (minimal, moderate or large) was measured in both groups at six months follow-up, using contrast transthoracic echocardiography. Forty-four patients (48.4±11.4 years) received the CardioSEAL(r) device and 37 patients the BioSTAR(r) device (47.9±10.7 years). There were no significant differences in short-term complications. Two patients who received the BioSTAR(r) device developed a recurrent transient cerebral ischaemic event. Overall, atrial arrhythmias occurred in 19%, with no difference between both groups. At six months, a residual shunt was present in 29% (27% minimal, 2% moderate) using the CardioSEAL(r) device compared to 28% (17% minimal, 11% moderate) using the BioSTAR(r) device (p=0.18). A predictor for residual shunt could not be found. There is no difference in safety and efficacy at six months between the CardioSEAL(r) and BioSTAR(r) device used for PFO closure. However, using the BioSTAR(r) device tends to be associated with a higher percentage of moderate shunting.

  7. MedTech Mag-Lev, single-use, extracorporeal magnetically levitated centrifugal blood pump for mid-term circulatory support.

    PubMed

    Nagaoka, Eiki; Fujiwara, Tatsuki; Kitao, Takashi; Sakota, Daisuke; Shinshi, Tadahiko; Arai, Hirokuni; Takatani, Setsuo

    2013-01-01

    Short- to mid-term extracorporeal ventricular assist devices (VADs) are recommended for critical cardiogenic shock patients. We have designed a preclinical, single-use MedTech Mag-Lev VAD for one-month extracorporeal use. The impeller-rotor of the pump was suspended by a two degree-of-freedom active magnetic bearing in a 300 μm fluid gap, where the computational fluid dynamics analysis predicted a secondary flow of about 400-500 ml/min at a pump speed of 1800-2200 rpm. Three eddy current sensors were employed to implement noise- and drift-free magnetic levitation. The pump components were injection molded using polycarbonate for smooth surfaces as well as improved reproducibility, followed by coating with a biocompatible 2-methacryloyl-oxyethyl phosphorylcholine polymer. Chronic animal experiments were performed in nine calves. Three of the nine calves were excluded from analysis for problems with the circuit. Five of the six (83.3%) completed the 60 day duration of the study, while one prematurely died of massive bleeding due to inflow port detachment. The pump did not stop due to magnetic-levitation malfunction. Neither pump thrombosis nor major organ infarction was observed at autopsy. In comparison to machined surfaces, the injection-molded pump surfaces were thrombus-free after 60 day implantation. This study demonstrates the feasibility of MedTech Mag-Lev VAD for 60 day circulatory support.

  8. Mid-term results of joint-preserving procedures by a modified Mann method for big toe deformities in rheumatoid patients undergoing forefoot surgeries.

    PubMed

    Takakubo, Yuya; Takagi, Michiaki; Tamaki, Yasunobu; Sasaki, Akiko; Nakano, Haruki; Orui, Hiroshi; Ogino, Toshihiko

    2010-04-01

    This study aimed to evaluate joint-preserving procedures by a modified Mann method for rheumatoid forefoot deformities and their functional outcomes in the mid-term. Eleven feet in seven patients underwent forefoot surgery using a modified Mann method for the big toe, combined with offset osteotomy or resection arthroplasty of the lesser toes. The mean follow-up period was 3.6 years. The mean score on the Japanese Society for Surgery of the Foot scale for rheumatoid arthritis foot and ankle joints improved from 44.0 to 72.0. The mean hallux valgus angle improved from 39.4 degrees to 20.5 degrees and the mean M1M5 angle improved from 31.1 degrees to 25.8 degrees . However, deformities involving a hallux valgus angle of more than 25.0 degrees recurred in three feet at the latest follow-up, although the patients did not complain of any symptoms from the recurrence. Improvement in the Sharp score for joint space narrowing was observed in the big toe, indicating better congruity of the metatarsophalangeal joint. For restraint of rheumatoid forefoot deformities, a modified Mann method, combined with offset osteotomy or resection arthroplasty, was satisfactory for not only improving the foot function, but also preserving the metatarsophalangeal joint mobility.

  9. Description and mid-term results of the 'over the top' technique for the treatment of the pincer deformity in femoroacetabular impingement.

    PubMed

    Ilizaliturri, Victor M; Joachin, Pedro; Acuna, Marco

    2015-12-01

    Pincer impingement is often treated by surgical labral separation from the acetabular rim and rim reduction. A more recent technique the so-called 'over the top' involves reduction of the bony acetabular rim without separation of the labrum. Our purpose is to report mid-term results of the 'over the top' technique. Between January 2006 and January 2013 a consecutive series of patients with femoroacetabular impingement (FAI) diagnosis, treated with the 'over the top' technique were included, using the lateral approach. The Western Ontario and MacMaster (WOMAC) scores were evaluated. Fifty patients (20 males and 30 females) from the Hip and Knee Joint Reconstructive and hip arthroscopy division were included. The average age was 30.5 years old and the average follow-up was 48 months (range 70-90). Preoperative WOMAC average was 42. Post-operative WOMAC was 81.3 (P = 0.01). One patient required an arthroscopic revision due to adherences, but had a full recovery after the revision surgery. The 'over the top' technique is an excellent choice for the treatment of the pincer deformity in the FAI avoiding the injury of the chondrolabral union.

  10. Children's oral health-related quality of life and associated factors: Mid-term changes after dental treatment under general anesthesia.

    PubMed

    Baghdadi, Ziad D

    2015-02-01

    This study aimed to document the mid-term effects of comprehensive dental treatment under general anesthesia (DTGA) on parent-assessed children's oral health-related quality of life (COHRQoL). A second aim was to examine some epidemiological factors associated with COHRQoL and treatment outcome. A pretest-posttest design was followed in which parents were surveyed using the Child Oral Health Quality of Life Questionnaire before and 6-9 months after their children (age ranges 3-10 years) underwent DTGA. Some clinical conditions and epidemiological factors were examined to assess their association with COHRQoL and changes resulting from treatment. The clinical sample consisted of 80 children-parent dyads. The effect sizes of change following DTGA were large for both the child impact section and family impact section of the COHRQoL. COHRQoL scores after treatment were comparable or lower than those of a cross-matched group of children with no complaints related to oral health. Child's age, pain and number of teeth with pulpal involvement showed significant association with both pretreatment scores and change scores. Children's OHRQoL improved after DTGA as assessed by parents 6-9 months postoperatively. Child's age, pain and number of pulpally-involved teeth can be used as predictors for COHRQoL and change scores. Key words:Quality of life, children, oral health, reliability.

  11. Short- and mid-term oscillations of solar, geomagnetic activity and cosmic-ray intensity during the last two solar magnetic cycles

    NASA Astrophysics Data System (ADS)

    Singh, Y. P.; Badruddin

    2017-04-01

    Short-and mid-term oscillations of the solar activity (sunspot number and 10.7 cm solar flux), geomagnetic activity (Ap index) and cosmic-ray intensity (neutron monitor count rate) are analysed during the past two solar-magnetic cycles (1968-1989 and 1989-2014). We have implemented the wavelet analysis on the daily time resolution data of sunspot number (SSN), 10.7 cm solar flux, geomagnetic Ap index and Oulu neutron monitor count rate. Results suggest that few quasi and intermittent oscillations are observed with remarkable power density in addition to fundamental periods, like 27 day (synodic period), 154 day (Rieger period), semi-annual, annual, 1.3 year, and 1.7 year. We have consistently observed first (27 day), second (13.5 day) and third (9.0 day) solar-rotation harmonics in the geomagnetic Ap-index during both the magnetic cycles. Rieger period is more pronounced in SSN and solar flux during 1980-82 and 1990-92. Semi-annual variation of Ap-index is consistently observed during both the magnetic cycles. The annual and 1.85 year variation are also observed in all the considered parameters with good signatures in CRI.

  12. Effect of preoperative eating patterns and preoperative weight loss on the short- and mid-term weight loss results of sleeve gastrectomy.

    PubMed

    Ruiz-Tovar, Jaime; Boix, Evangelina; Bonete, José María; Martínez, Rosana; Zubiaga, Lorea; Díez, María; Calpena, Rafael

    2015-04-01

    Weight loss depends directly on the adhesion to the postoperative diet in patients undergoing a sleeve gastrectomy. The aim of this study is to evaluate the effect of different preoperative feeding patterns and the adhesion to a preoperative diet on short and mid- term postoperative weight loss. A prospective study of all morbidly obese patients undergoing a laparoscopic sleeve gastrectomy as a bariatric procedure between 2008 and 2012 was performed. Preoperative feeding patterns and weight loss, preoperatively and postoperatively at 12 and 24 months, were evaluated. A total of 50 patients were included, with a mean preoperative BMI of 51,2+7,9 kg/m(2). All the patients presented a feeding pattern of big eaters, 44% of snackers, 40% of sweet eaters and 48% reported regular ingestion of «light» soft drinks. Mean preoperative excess weight loss (EWL) was 13,4% (range 10-31,4%). At 12 months mean EWL was 83,7% and at 24 months 82,4%. Pre and postoperative EWL showed a direct correlation at 12 and 24 months. Mean EWL was significantly lower in snackers, sweet eaters and those drinking «light» soft drinks regularly. Preoperative weight loss correlates directly with postoperative weight loss at 1 and 2 years. Snackers, sweet eaters and «light» soft drink consumers, associated with a big eater pattern, achieve a significantly lower postoperative weight loss. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Early to mid-term results of ceramic-on-ceramic total hip replacement: analysis of bearing-surface-related complications.

    PubMed

    Stafford, G H; Islam, S Ul; Witt, J D

    2011-08-01

    Ceramic-on-ceramic bearings in hip replacement have low rates of wear and are increasingly being used in young adults. Our aim was to determine the incidence of audible phenomena or other bearing-related complications. We retrospectively analysed 250 ceramic-on-ceramic hip replacements in 224 patients which had been implanted between April 2000 and December 2007. The mean age of the patients at operation was 44 years (14 to 83) and all the operations were performed using the same surgical technique at a single centre. At a mean follow-up of 59 months (24 to 94), the mean Oxford hip score was 40.89 (11 to 48). There were six revisions, three of which were for impingement-related complications. No patient reported squeaking, but six described grinding or clicking, which was usually associated with deep flexion. No radiological evidence of osteolysis or migration of the components was observed in any hip. The early to mid-term results of contemporary ceramic-on-ceramic hip replacement show promising results with few concerns in terms of noise and squeaking. Positioning of the acetabular component remains critical in regard to the reduction of other impingement-related complications.

  14. Mid-term efficacy and safety of cervical disc arthroplasty versus fusion in cervical spondylosis: A systematic review and meta-analysis

    PubMed Central

    Zhao, Guo-Sheng; Zhang, Qiao; Quan, Zheng-Xue

    2017-01-01

    Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are the most commonly used procedures in cervical spondylosis. However, only a few published studies exist in the literature comparing these two operation types, particularly its mid-term efficacy and safety. Furthermore, in those studies, even large sample trials, when compared, have elicited controversial results, making it inconvenient for clinicians to refer to them. The aim of the present study was to clarify the advantages and shortcomings of the two procedures. Articles indexed in the PubMed, Web of Science, Cochrane Library, EMBASE, China Biological Medicine and China National Knowledge Infrastructure (CNKI) databases, as of March 2016, that met our criteria were searched. A total of 18 trials involving 3,040 patients were included in our final analysis. The most important results drawn from the present analysis were as follows: Insignificant differences were identified in the blood loss [weighted mean difference (WMD)=6.23; 95% confidence intervals (CI), −0.85 to 13.32; P=0.08], surgical time [standardized mean difference (SMD)=0.40; 95% CI, −0.01 to 0.82; P=0.06], the time of hospital stay (SMD=0.05; 95% CI, −0.28 to 0.37; P=0.77) and the total complications rate [odds ratio (OR)=0.86; 95% CI, 0.66 to 1.131; P=0.28] on a comparison of the two operation methods. By contrast, comparing CDA with ACDF, the CDA had higher Short Form survey (SF-36) scores (WMD=1.65; 95% CI, 0.61 to 2.69; P=0.002), a larger range of motion in the operation level (SMD=6.53; 95% CI, 3.89 to 9.17; P<0.0001), a higher rate of neurological improvement following the operation (OR=1.80; 95% CI, 1.29 to 2.52; P=0.0006), a lower Visual Analog Scale (VAS) score of neck pain (WMD= 0.16; 95% CI, −0.28 to 0.05; P=0.006) and arm pain (WMD= 0.12; 95% CI, −0.24 to −0.01; P=0.04). In addition, in the mid-term following the surgery, CDA had a lower Neck Disability Index (NDI; SMD=0.18; 95% CI, −0

  15. Mid-term efficacy and safety of cervical disc arthroplasty versus fusion in cervical spondylosis: A systematic review and meta-analysis.

    PubMed

    Zhao, Guo-Sheng; Zhang, Qiao; Quan, Zheng-Xue

    2017-02-01

    Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are the most commonly used procedures in cervical spondylosis. However, only a few published studies exist in the literature comparing these two operation types, particularly its mid-term efficacy and safety. Furthermore, in those studies, even large sample trials, when compared, have elicited controversial results, making it inconvenient for clinicians to refer to them. The aim of the present study was to clarify the advantages and shortcomings of the two procedures. Articles indexed in the PubMed, Web of Science, Cochrane Library, EMBASE, China Biological Medicine and China National Knowledge Infrastructure (CNKI) databases, as of March 2016, that met our criteria were searched. A total of 18 trials involving 3,040 patients were included in our final analysis. The most important results drawn from the present analysis were as follows: Insignificant differences were identified in the blood loss [weighted mean difference (WMD)=6.23; 95% confidence intervals (CI), -0.85 to 13.32; P=0.08], surgical time [standardized mean difference (SMD)=0.40; 95% CI, -0.01 to 0.82; P=0.06], the time of hospital stay (SMD=0.05; 95% CI, -0.28 to 0.37; P=0.77) and the total complications rate [odds ratio (OR)=0.86; 95% CI, 0.66 to 1.131; P=0.28] on a comparison of the two operation methods. By contrast, comparing CDA with ACDF, the CDA had higher Short Form survey (SF-36) scores (WMD=1.65; 95% CI, 0.61 to 2.69; P=0.002), a larger range of motion in the operation level (SMD=6.53; 95% CI, 3.89 to 9.17; P<0.0001), a higher rate of neurological improvement following the operation (OR=1.80; 95% CI, 1.29 to 2.52; P=0.0006), a lower Visual Analog Scale (VAS) score of neck pain (WMD= 0.16; 95% CI, -0.28 to 0.05; P=0.006) and arm pain (WMD= 0.12; 95% CI, -0.24 to -0.01; P=0.04). In addition, in the mid-term following the surgery, CDA had a lower Neck Disability Index (NDI; SMD=0.18; 95% CI, -0.28 to -0.07; P=0

  16. Mid-term results of cementless total hip replacement using a ceramic-on-ceramic bearing with and without computer navigation.

    PubMed

    Sugano, N; Nishii, T; Miki, H; Yoshikawa, H; Sato, Y; Tamura, S

    2007-04-01

    We have developed a CT-based navigation system using infrared light-emitting diode markers and an optical camera. We used this system to perform cementless total hip replacement using a ceramic-on-ceramic bearing couple in 53 patients (60 hips) between 1998 and 2001. We reviewed 52 patients (59 hips) at a mean of six years (5 to 8) postoperatively. The mid-term results of total hip replacement using navigation were compared with those of 91 patients (111 hips) who underwent this procedure using the same implants, during the same period, without navigation. There were no significant differences in age, gender, diagnosis, height, weight, body mass index, or pre-operative clinical score between the two groups. The operation time was significantly longer where navigation was used, but there was no significant difference in blood loss or navigation-related complications. With navigation, the acetabular components were placed within the safe zone defined by Lewinnek, while without, 31 of the 111 components were placed outside this zone. There was no significant difference in the Merle d'Aubigne and Postel hip score at the final follow-up. However, hips treated without navigation had a higher rate of dislocation. Revision was performed in two cases undertaken without navigation, one for aseptic acetabular loosening and one for fracture of a ceramic liner, both of which showed evidence of neck impingement on the liner. A further five cases undertaken without navigation showed erosion of the posterior aspect of the neck of the femoral component on the lateral radiographs. These seven impingement-related mechanical problems correlated with malorientation of the acetabular component. There were no such mechanical problems in the navigated group. We conclude that CT-based navigation increased the precision of orientation of the acetabular component and control of limb length in total hip replacement, without navigation-related complications. It also reduced the rate of

  17. Impact of thermodilution-derived coronary blood flow patterns after percutaneous coronary intervention on mid-term left ventricular remodeling in patients with ST elevation myocardial infarction.

    PubMed

    Sumiyoshi, Akinori; Fujii, Kenichi; Fukunaga, Masashi; Shibuya, Masahiko; Imanaka, Takahiro; Kawai, Kenji; Miki, Kojiro; Tamaru, Hiroto; Horimatsu, Tetsuo; Saita, Ten; Nishimura, Machiko; Masuyama, Tohru; Ishihara, Masaharu

    2017-01-01

    We recently reported the coronary thermodilution curve can be evaluated by analyzing the thermodilution curve obtained from a pressure sensor/thermistor-tipped guidewire, and presence of a bimodal-shaped thermodilution curve following primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients was associated with worse outcomes. This study evaluated whether the bimodal-shaped thermodilution curve predicts left ventricular (LV) remodeling after STEMI. The coronary thermodilution curve patterns were evaluated for 75 patients treated by pPCI for their first STEMI using a pressure sensor/thermistor-tipped guidewire, and classified into the three groups according to the thermodilution curve shape: narrow unimodal (n = 39), wide unimodal (n = 26), and bimodal pattern (n = 10). Echocardiography was performed at baseline and 6 months after STEMI. LV remodeling was defined as a >20 % increase in LV end-diastolic volumes (LVEDV). LVEDV at 6-month follow-up was greater in the bimodal group than in the other groups (p < 0.001). The prevalence of LV remodeling was highest in the bimodal group than in the narrow and wide unimodal groups (60, 12, and 15 %, respectively; p = 0.003). Multivariate analysis revealed a bimodal-shaped thermodilution curve as an independent predictor of the prevalence of LV remodeling. A bimodal-shaped thermodilution curve is associated with LV remodeling after STEMI. This easily assessable coronary thermodilution curve pattern is useful to predict mid-term LV remodeling for STEMI patients at the catheterization laboratory.

  18. Anatomic single-bundle anterior cruciate ligament reconstruction using the outside-in femoral tunnel drilling technique: a prospective study and short- to mid-term results.

    PubMed

    Abdelkafy, Ashraf

    2015-03-01

    Anatomic positioning of the femoral and tibial tunnels in the native ACL femoral and tibial footprints requires an independent drilling either via an accessory medial portal (trans-portal drilling) or using an outside-in drilling technique. Conventional trans-tibial drilling (dependant drilling) was found to lack the ability to accurately position the femoral tunnel in the native ACL footprint. The purpose of the current study was to evaluate the functional outcome results of anatomic single-bundle ACLR using the OI femoral tunnel drilling technique. Single surgeon single center prospective case series study. 64 patients having complete ACL tears were included in the current study. Average follow-up was 15.8 months (range 8-25). Objective and subjective IKDC scores, Lysholm knee score, SF-36 score, VAS for patients' satisfaction, VAS for pain and Kellgren and Lawrence (K/L) classification of osteoarthritis were used for follow-up evaluation. Objective IKDC score revealed that 60 patients had grade ''A'' and 4 had grade ''B'', while no single patient had neither grade ''C'' nor ''D''. The average Lysholm Score was 92.4, average subjective IKDC was 91.5. Average SF-36 score was 96.7. The average VAS for operation satisfaction was 9.7. Average VAS for pain was 0.3. Forty-nine patients were classified as normal K/L classification, 7 were grade ''1'', 8 were grade ''2''. Comparing pre-operative and follow-up Objective IKDC, Subjective IKDC, Lysholm, SF-36 and VAS for pain scores revealed statistically significant differences (P value <0.05). Arthroscopic-assisted ACL reconstruction using the outside-in femoral tunnel drilling technique shows a good and satisfactory functional outcome results at short- to mid-term follow-up. Level IV.

  19. Comparison of Short- and Mid-term Efficacy and the Mechanisms of Gastric Bypass Surgeries on Managing Obese and Nonobese Type 2 Diabetes Mellitus: A Prospective Study.

    PubMed

    Zhang, Xiaojuan; Cheng, Zhong; Xiao, Zhu; Du, Xiao; Du, Juan; Li, Yang; Long, Yang; Yu, Hongling; Zhang, Xiangxun; Tian, Haoming

    2015-05-01

    We targeted to investigate the efficacy and the mechanisms of two gastric bypass surgeries, Roux-en-y Gastric Bypass (RYGB) and Billroth II gastrojejunostomy on managing obese patients with T2DM and nonobese T2DM patients, respectively. Seven nonobese T2DM patients with gastric cancer submitted to Billroth II gastrojejunostomy were compared with nine obese T2DM patients undergoing RYGB about their baseline characteristics, weight loss and glycemic control, 3 months and 2 years after surgery. Meanwhile, β-cell function, glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and gastric inhibitory polypeptide (GIP) levels were also investigated. Significant weight loss and improvement of glycemic control were observed in both groups and in the two follow-up periods. Reduction of body mass index was greater in obese patients with T2DM. The efficacy of Billroth II gastrojejunostomy on controlling blood glucose of nonobese T2DM was similar to that of RYGB on managing obese T2DM. Insulin levels and HOMA-IR were decreased in obese T2DM patients, whereas they remained unchanged in nonobese T2DM patients. Generally, levels of GLP-1 and PYY were increased, whereas GIP levels were decreased in both groups. Glycemic control efficacy of Billroth II gastrojejunostomy on managing nonobese T2DM is similar to that of RYGB on treating obese T2DM in the short- and mid-term. The underlying mechanisms of both surgeries may be related to weight loss and gut hormone modulations. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

  20. Validation of transcatheter aortic valve implantation risk scores in relation to early and mid-term survival: a single-centre study

    PubMed Central

    Collas, Valérie M.; Van De Heyning, Caroline M.; Paelinck, Bernard P.; Rodrigus, Inez E.; Vrints, Christiaan J.; Bosmans, Johan M.

    2016-01-01

    OBJECTIVES The aim of this study was to validate recently proposed risk scores for the prediction of mortality up to 1 year after transcatheter aortic valve implantation (TAVI), using a self-expandable valve (CoreValve). METHODS In this single-centre study, 225 consecutive patients with severe symptomatic aortic valve stenosis, who underwent TAVI between December 2007 and January 2015, were included. Conventional surgical risk scores (logistic EuroSCORE, EuroSCORE II and STS score) were calculated as well as newly proposed TAVI risk scores (TAVI2-SCORe, STT Score and OBSERVANT score). Medium-term survival of the patients was assessed up to 1 year after TAVI. RESULTS The median age was 82 (77–86) years and 45.3% were male. Patients were categorized into ‘non-high risk’ or ‘high risk’ according to logistic EuroSCORE >20%, EuroSCORE II >8%, STS score >10%, TAVI2-SCORe >2, STT score >12% and OBSERVANT score >6. Thirty-day and 1-year survival rates were significantly different between ‘non-high-risk’ and ‘high-risk’ patients according to the STS score (1 year: low: 84.4% vs high: 67.0%, P = 0.010) and according to OBSERVANT score (1 year: low: 85.2% vs high: 68.4%, P = 0.005). In contrast, TAVI2-SCORe and STT score did not discriminate ‘non-high-risk’ and ‘high-risk’ patients. This was confirmed by Cox regression analysis [STS score >10%: hazard ratio: 2.484 (1.206–5.115), P = 0.014; OBSERVANT score >6: hazard ratio: 2.532 (1.295–4.952), P = 0.007]. CONCLUSIONS In this single-centre study, OBSERVANT and STS score most accurately predicted early and mid-term survival in patients undergoing TAVI, using a self-expandable valve (CoreValve). PMID:26689444

  1. Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes.

    PubMed

    Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis; Padayachee, Soundrie; Karunanithy, Narayan; Ahmed, Irfan; Zayed, Hany; Katsanos, Konstantinos

    2015-08-01

    To report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery. This was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford-Becker stage 3-6; P1-P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan-Meier (K-M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes. From August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford-Becker stage was five at baseline and 37/50 (74.0%) were chronic total occlusions. Technical success was achieved in all cases (100%). Stented lesion length was 114.2 ± 36.9 mm (range 6-20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2% with an 86.1 ± 5.9% freedom from TLR and 87 ± 5.0% AFS (K-M estimates). The TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

  2. Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up.

    PubMed

    Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

    2017-10-01

    patellofemoral OA progression did not affect the clinical outcomes of OWHTO at mid-term follow-up. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model.

    PubMed

    Haushofer, Marcus; Abusabha, Yousef; Amerini, Andrea L A; Spillner, Jan; Nix, Christoph; Autschbach, Rüdiger; Goetzenich, Andreas; Hatam, Nima

    2013-07-01

    Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO). Eleven sheep (65 kg) were cannulated by a 28-Fr inflow cannula to the right atrium and a 25-Fr outflow cannula through the lateral left atrial wall. Both were connected by a serial combination of a microaxial pump (Impella Elect(®), Abiomed Europe, Aachen, Germany) and a membrane oxygenator (Novalung(®)-iLA membrane oxygenator; Novalung GmbH, Hechingen, Germany). In four animals, three subsequent states were evaluated: normal circulation, apneic hypoxia and increased right atrial after load by pulmonary banding. We focused on haemodynamic stability and gas exchange. All animals reached the end of the study protocol. In the apnoea phase, the decrease in PaO2 (21.4 ± 3.6 mmHg) immediately recovered (179.1 ± 134.8 mmHg) on-device in continuous apnoea. Right heart failure by excessive after load decreased mean arterial pressure (59 ± 29 mmHg) and increased central venous pressure and systolic right ventricular pressure; PaO2 and SvO2 decreased significantly. On assist, mean arterial pressure (103 ± 29 mmHg), central venous pressure and right ventricular pressure normalized. The SvO2 increased to 89 ± 3% and PaO2 stabilized (129 ± 21 mmHg). We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated.

  4. Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

    SciTech Connect

    Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis; Padayachee, Soundrie; Karunanithy, Narayan; Ahmed, Irfan; Zayed, Hany; Katsanos, Konstantinos E-mail: katsanos@med.upatras.gr

    2015-08-15

    PurposeTo report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery.Materials and MethodsThis was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford–Becker stage 3–6; P1–P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan–Meier (K–M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes.ResultsFrom August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford–Becker stage was five at baseline and 37/50 (74.0 %) were chronic total occlusions. Technical success was achieved in all cases (100 %). Stented lesion length was 114.2 ± 36.9 mm (range 6–20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2 % with an 86.1 ± 5.9 % freedom from TLR and 87 ± 5.0 % AFS (K–M estimates).ConclusionThe TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

  5. Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.

    PubMed

    Pecoraro, Felice; Lachat, Mario; Hofmann, Michael; Cayne, Neal S; Chaykovska, Lyubov; Rancic, Zoran; Puippe, Gilbert; Pfammatter, Thomas; Mangialardi, Nicola; Veith, Frank J; Bettex, Dominique; Maisano, Francesco; Neff, Thomas A

    2017-06-01

    with complex thoracic aorta disease is safe and shows promising mid-term results at 3 years. The combination of these techniques could represent an alternative to the standard open surgical repair, especially in older patients or in patients unfit for cardiopulmonary bypass.

  6. Common Anorectal Disorders

    PubMed Central

    Foxx-Orenstein, Amy E.; Umar, Sarah B.; Crowell, Michael D.

    2014-01-01

    Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. This article reviews the most common anorectal disorders, including hemorrhoids, anal fissures, fecal incontinence, proctalgia fugax, excessive perineal descent, and pruritus ani, and provides guidelines on comprehensive evaluation and management. PMID:24987313

  7. High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis: HemiCAP-Wave®.

    PubMed

    Laursen, Jens Ole

    2016-10-06

    The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant is presented with up to a 6-year survival rate, and hypothesised short-to mid-term reduced pain and improved function. Indication for treatment with the HemiCAP-Wave® implant was a symptomatic, large cartilage lesion in trochlea demonstrated by MRI or arthroscopy, which was ICRS grades 3-4 and larger than 4 cm(2). Patients were followed for 2 years with American Knee Society Subjective outcome Scores (AKSS), pain scores and radiographic evaluations and for up to 6 years with complications and reoperations. At the 1- and 2-year follow-up mean AKSS clinical score, the mean AKSS function score and mean pain score improved significantly. Within 6 years, 28 % of the implants were revised to arthroplasty due to the progression of cartilage lesions, osteoarthritis or increased knee pain. The present study demonstrated an improved short- to mid-term clinical outcome and reduced pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients with almost healthy cartilage in the other compartments who are not yet eligible for arthroplasty treatment. IV.

  8. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths.

    PubMed

    Ando, Tomo; Takagi, Hisato; Grines, Cindy L

    2017-09-01

    Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant

  9. Comparison of mid-term clinical outcomes between "complete full-metal jacket strategy" versus "incomplete full-metal jacket strategy" for diffuse right coronary artery stenosis with drug-eluting stents.

    PubMed

    Yamamoto, Kei; Sakakura, Kenichi; Adachi, Yusuke; Taniguchi, Yousuke; Wada, Hiroshi; Momomura, Shin-Ichi; Fujita, Hideo

    2017-06-01

    The optimal strategy for diffuse right coronary artery (RCA) stenosis remains unclear. The objective of this study was to compare the mid-term outcomes of "complete full-metal jacket (c-FMJ) stenting strategy" with "incomplete full-metal jacket (i-FMJ) stenting strategy" for the diffuse long RCA lesion using drug-eluting stents (DES). Between July 2007 and October 2015, 121 patients underwent percutaneous coronary intervention (PCI) for diffuse RCA lesions using DES. Fifty-three patients underwent c-FMJ PCI, whereas 68 patients underwent i-FMJ. Thirty patients received angiographical follow-up in the c-FMJ group, while 34 patients received angiographical follow-up in the i-FMJ group. The primary endpoint was major adverse cardiac events (MACE): cardiac death, stent thrombosis (ST), target lesion revascularization (TLR), and target vessel revascularization (TVR). The incidence of MACE was significantly lower in the c-FMJ group (13.3%) as compared to the i-FMJ group (41.2%) (p=0.013). There was no cardiac death in either group. The incidence of ST was comparable between the i-FMJ group (2.9%) and c-FMJ group (3.3%) (p=1.00), while TLR was significantly less in the c-FMJ group (6.7%) compared to the i-FMJ group (32.4%) (p=0.011). The mid-term MACE was significantly less in the c-FMJ group than in the i-FMJ group, indicating that c-FMJ stenting was a favorable strategy for the diffuse long RCA lesion. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  10. Incidence, Predictors, and Mid-Term Outcomes of Percutaneous Closure Failure After Transfemoral Aortic Valve Implantation Using an Expandable Sheath (from the Optimized Transcatheter Valvular Intervention [OCEAN-TAVI] Registry).

    PubMed

    Nara, Yugo; Watanabe, Yusuke; Kozuma, Ken; Kataoka, Akihisa; Nakashima, Makoto; Hioki, Hirofumi; Kawashima, Hideyuki; Nagura, Fukuko; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Naganuma, Toru; Yamanaka, Futoshi; Yamamoto, Masanori; Hayashida, Kentaro

    2017-02-15

    The aim of this study was to evaluate the incidence, predictors, and outcomes of percutaneous closure device (PCD) failure during transfemoral transcatheter aortic valve implantation (TAVI) with an Edwards Sapien-XT prosthesis using an expandable sheath (eSheath). From October 2013 to April 2016, 1,215 patients who underwent TAVI were prospectively enrolled in the Optimized Transcatheter Valvular Intervention (OCEAN-TAVI) registry. Of these, 478 patients underwent transfemoral TAVI with Sapien-XT prosthesis using an eSheath and percutaneous closure with a Perclose ProGlide system. We evaluated the predictors of PCD failure and whether it affected the clinical outcomes. Patients were aged 85 years (interquartile range 82 to 88 years). PCD failure occurred in 36 patients (8%). Sheath-to-femoral artery ratio (SFAR) (per 1 increase) (odds ratio 5.40, 95% confidence interval 1.28 to 22.92, p = 0.022) predicted PCD failure in a multivariate model. The sensitivity-specificity curves identified an SFAR threshold of 1.03; the area under the curve for SFAR as a predictor of PCD failure was 0.629. The PCD failure group did not have a higher rate of 30-day mortality (0% vs 1%, p = 0.52) or mid-term (365-day) mortality (log-rank test p = 0.85) compared with the PCD success group in the Kaplan-Meier analysis. In conclusion, PCD failures occurred in 8% of the patients and were not associated with 30-day or mid-term mortality rates after percutaneous transfemoral TAVI. The SFAR threshold of 1.03 was useful for predicting PCD failures.

  11. The Present, Mid-Term, and Long-Term Supply Curves for Tellurium; and Updates in the Results from NREL's CdTe PV Module Manufacturing Cost Model (Presentation)

    SciTech Connect

    Woodhouse, M.; Goodrich, A.; Redlinger, M.; Lokanc, M.; Eggert, R.

    2013-09-01

    For those PV technologies that rely upon Te, In, and Ga, first-order observations and calculations hint that there may be resource constraints that could inhibit their successful deployment at a SunShot level. These are only first-order approximations, however, and the possibility for an expansion in global Te, In, and Ga supplies needs to be considered in the event that there are upward revisions in their demand and prices.In this study, we examine the current, mid-term, and long-term prospects of Tellurium (Te) for use in PV. We find that the current global supply base of Te would support <10 GW of annual traditional CdTe PV manufacturing production. But as for the possibility that the supply base for Te might be expanded, after compiling several preliminary cumulative availability curves we find that there may be significant upside potential in the supply base for this element - principally vis a vis increasing demand and higher prices. Primarily by reducing the Tellurium intensity in manufacturing and by increasing the recovery efficiency of Te in Cu refining processes, we calculate that it may prove affordable to PV manufacturers to expand the supply base for Te such that 100 GW, or greater, of annual CdTe PV production is possible in the 2030 - 2050 timeframe.

  12. Multiscale Mathematical Modeling in Dental Tissue Engineering: Toward Computer-Aided Design of a Regenerative System Based on Hydroxyapatite Granules, Focussing on Early and Mid-Term Stiffness Recovery

    PubMed Central

    Scheiner, Stefan; Komlev, Vladimir S.; Gurin, Alexey N.; Hellmich, Christian

    2016-01-01

    We here explore for the very first time how an advanced multiscale mathematical modeling approach may support the design of a provenly successful tissue engineering concept for mandibular bone. The latter employs double-porous, potentially cracked, single millimeter-sized granules packed into an overall conglomerate-type scaffold material, which is then gradually penetrated and partially replaced by newly grown bone tissue. During this process, the newly developing scaffold-bone compound needs to attain the stiffness of mandibular bone under normal physiological conditions. In this context, the question arises how the compound stiffness is driven by the key design parameters of the tissue engineering system: macroporosity, crack density, as well as scaffold resorption/bone formation rates. We here tackle this question by combining the latest state-of-the-art mathematical modeling techniques in the field of multiscale micromechanics, into an unprecedented suite of highly efficient, semi-analytically defined computation steps resolving several levels of hierarchical organization, from the millimeter- down to the nanometer-scale. This includes several types of homogenization schemes, namely such for porous polycrystals with elongated solid elements, for cracked matrix-inclusion composites, as well as for assemblies of coated spherical compounds. Together with the experimentally known stiffnesses of hydroxyapatite crystals and mandibular bone tissue, the new mathematical model suggests that early stiffness recovery (i.e., within several weeks) requires total avoidance of microcracks in the hydroxyapatite scaffolds, while mid-term stiffness recovery (i.e., within several months) is additionally promoted by provision of small granule sizes, in combination with high bone formation and low scaffold resorption rates. PMID:27708584

  13. Multiscale Mathematical Modeling in Dental Tissue Engineering: Toward Computer-Aided Design of a Regenerative System Based on Hydroxyapatite Granules, Focussing on Early and Mid-Term Stiffness Recovery.

    PubMed

    Scheiner, Stefan; Komlev, Vladimir S; Gurin, Alexey N; Hellmich, Christian

    2016-01-01

    We here explore for the very first time how an advanced multiscale mathematical modeling approach may support the design of a provenly successful tissue engineering concept for mandibular bone. The latter employs double-porous, potentially cracked, single millimeter-sized granules packed into an overall conglomerate-type scaffold material, which is then gradually penetrated and partially replaced by newly grown bone tissue. During this process, the newly developing scaffold-bone compound needs to attain the stiffness of mandibular bone under normal physiological conditions. In this context, the question arises how the compound stiffness is driven by the key design parameters of the tissue engineering system: macroporosity, crack density, as well as scaffold resorption/bone formation rates. We here tackle this question by combining the latest state-of-the-art mathematical modeling techniques in the field of multiscale micromechanics, into an unprecedented suite of highly efficient, semi-analytically defined computation steps resolving several levels of hierarchical organization, from the millimeter- down to the nanometer-scale. This includes several types of homogenization schemes, namely such for porous polycrystals with elongated solid elements, for cracked matrix-inclusion composites, as well as for assemblies of coated spherical compounds. Together with the experimentally known stiffnesses of hydroxyapatite crystals and mandibular bone tissue, the new mathematical model suggests that early stiffness recovery (i.e., within several weeks) requires total avoidance of microcracks in the hydroxyapatite scaffolds, while mid-term stiffness recovery (i.e., within several months) is additionally promoted by provision of small granule sizes, in combination with high bone formation and low scaffold resorption rates.

  14. Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model†‡

    PubMed Central

    Haushofer, Marcus; Abusabha, Yousef; Amerini, Andrea L.A.; Spillner, Jan; Nix, Christoph; Autschbach, Rüdiger; Goetzenich, Andreas; Hatam, Nima

    2013-01-01

    OBJECTIVES Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO). METHODS Eleven sheep (65 kg) were cannulated by a 28-Fr inflow cannula to the right atrium and a 25-Fr outflow cannula through the lateral left atrial wall. Both were connected by a serial combination of a microaxial pump (Impella Elect®, Abiomed Europe, Aachen, Germany) and a membrane oxygenator (Novalung®—iLA membrane oxygenator; Novalung GmbH, Hechingen, Germany). In four animals, three subsequent states were evaluated: normal circulation, apneic hypoxia and increased right atrial after load by pulmonary banding. We focused on haemodynamic stability and gas exchange. RESULTS All animals reached the end of the study protocol. In the apnoea phase, the decrease in PaO2 (21.4 ± 3.6 mmHg) immediately recovered (179.1 ± 134.8 mmHg) on-device in continuous apnoea. Right heart failure by excessive after load decreased mean arterial pressure (59 ± 29 mmHg) and increased central venous pressure and systolic right ventricular pressure; PaO2 and SvO2 decreased significantly. On assist, mean arterial pressure (103 ± 29 mmHg), central venous pressure and right ventricular pressure normalized. The SvO2 increased to 89 ± 3% and PaO2 stabilized (129 ± 21 mmHg). CONCLUSIONS We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated. PMID:23543405

  15. Provenance of alluvial fan deposits to constrain the mid-term offsets along a strike-slip active fault: the Elsinore fault in the Coyote Mountains, Imperial Valley, California.

    NASA Astrophysics Data System (ADS)

    Masana, Eulalia; Stepancikova, Petra; Rockwell, Thomas

    2013-04-01

    The lateral variation in rates along a fault and its constancy along time is a matter of discussion. To give light to this discussion, short, mid and long term offset distribution along a fault is needed. Many studies analyze the short-term offset distribution along a strike-slip fault that can be obtained by the analysis of offset features imprinted in the morphology of the near-fault area. We present an example on how to obtain the mid- to long-term offset values based on the composition of alluvial fans that are offset by the fault. The study area is on the southern tip of the Elsinore fault, which controls the mountain front of the Coyote Mountains (California). The Elsinore-Laguna Salada fault is part of the San Andreas fault (SAF) system, extending 250 km from the Los Angeles Basin southeastward into the Gulf of California, in Mexico. The slip-rate on the southern Elsinore fault is believed to be moderate based on recent InSAR observations, although a recent study near Fossil Canyon (southern Coyote Mountains) suggests a rate in the range of 1-2 mm/yr. For this study we processed the airborne LiDAR dataset (EarthScope Southern & Eastern California, SoCal) to map short to mid-term alluvial offsets. We reprocessed the point clouds to produce DEMs with 0.5m and 0.25m grids and we varied the insolation angles to illuminate the various fault strands and the offset features. We identified numerous offset features, such as rills, channel bars, channel walls, alluvial fans, beheaded channels and small erosional basins that varied in displacement from 1 to 350 m. For the mid- to long-term offsets of the alluvial fans we benefited from the diverse petrological composition of their sources. Moreover, we recognized that older alluvium, which is offset by greater amounts, is in some cases buried beneath younger alluvial fan deposits and separated by buried soils. To determine the source canyon of various alluvial elements, we quantified the clast assemblage of each source

  16. Functional anorectal disorders.

    PubMed

    Bharucha, Adil E; Wald, Arnold; Enck, Paul; Rao, Satish

    2006-04-01

    This report defines criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). Functional fecal incontinence is defined as the uncontrolled passage of fecal material recurring for > or =3 months in an individual with a developmental age of > or =4 years that is associated with: (1) abnormal functioning of normally innervated and structurally intact muscles, and/or (2) no or minor abnormalities of sphincter structure and/or innervation insufficient to explain fecal incontinence, and/or (3) normal or disordered bowel habits (ie, fecal retention or diarrhea), and/or (4) psychological causes. However, conditions wherein structural and/or neurogenic abnormalities explain the symptom, or are part of a generalized process (eg, diabetic neuropathy) are not included within functional fecal incontinence. Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include proctalgia fugax (fleeting pain) and chronic proctalgia; chronic proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with > or =2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation).

  17. The formal Darwinism project: a mid-term report.

    PubMed

    Grafen, A

    2007-07-01

    For 8 years I have been pursuing in print an ambitious and at times highly technical programme of work, the 'Formal Darwinism Project', whose essence is to underpin and formalize the fitness optimization ideas used by behavioural ecologists, using a new kind of argument linking the mathematics of motion and the mathematics of optimization. The value of the project is to give stronger support to current practices, and at the same time sharpening theoretical ideas and suggesting principled resolutions of some untidy areas, for example, how to define fitness. The aim is also to unify existing free-standing theoretical structures, such as inclusive fitness theory, Evolutionary Stable Strategy (ESS) theory and bet-hedging theory. The 40-year-old misunderstanding over the meaning of fitness optimization between mathematicians and biologists is explained. Most of the elements required for a general theory have now been implemented, but not together in the same framework, and 'general time' remains to be developed and integrated with the other elements to produce a final unified theory of neo-Darwinian natural selection.

  18. National Security Reform 2010: A Mid-Term Assessment

    DTIC Science & Technology

    2011-08-01

    first met Harvey Sicherman in 1967 when he was a graduate student at the University of Pennsylvania. Harvey stood out then for his sartorial splendor...had a penetrating intelligence, coruscating wit, great charm, and deep passion, a rare combination even then among students of international...and unique relationships between professors and students academically and in research. The Bush School program also offers students opportunities

  19. Texasgulf solar cogeneration program. Mid-term topical report

    SciTech Connect

    Not Available

    1981-02-01

    The status of technical activities of the Texasgulf Solar Cogeneration Program at the Comanche Creek Sulfur Mine is described. The program efforts reported focus on preparation of a system specification, selection of a site-specific configuration, conceptual design, and facility performance. Trade-off studies performed to select the site-specific cogeneration facility configuration that would be the basis for the conceptual design efforts are described. Study areas included solar system size, thermal energy storage, and field piping. The conceptual design status is described for the various subsystems of the Comanche Creek cogeneration facility. The subsystems include the collector, receiver, master control, fossil energy, energy storage, superheat boiler, electric power generation, and process heat subsystems. Computer models for insolation and performance are also briefly discussed. Appended is the system specification. (LEW)

  20. Statistical attribution of mid-term droughts in central Europe

    NASA Astrophysics Data System (ADS)

    Mikšovský, Jiří; Trnka, Miroslav; Brázdil, Rudolf

    2017-04-01

    Occurrence and intensity of meteorological droughts are determined by a number of factors, both anthropogenic and natural. Besides the trend-like components, often attributable to local or global man-induced changes to the climate system, manifestations of internal climate oscillatory modes are also of great importance in establishing the hydrological regime. In this presentation, we focus on identification and quantification of factors responsible for central European drought variability at seasonal time scales. Using multivariable regression analysis applied to predictands reflecting various definitions of meteorological droughts (based on Standardized Precipitation Index, Standardized Precipitation Evapotranspiration Index and Palmer's Z-index, over the 1883-2010 period), components attributable to external and internal climate-forming agents are extracted and evaluated with regard to their statistical significance. Our results confirm presence of strong links of central European droughts to the anthropogenic radiative forcing and to the phase of the North Atlantic Oscillation, but also existence of connections to the climate oscillations originating from the Pacific area. In this context, we demonstrate that prominence of components related to the phase of the Pacific Decadal Oscillation generally surpasses that of El Niño - Southern Oscillation, although the related transfer mechanisms still remain unclear. Finally, it is shown that noteworthy deviations from linearity exist in some of the drought responses, particularly for the effects of the North Atlantic Oscillation.

  1. Maternal and Fetal Death following Group A Streptococcal Meningitis in Mid-Term Pregnancy

    PubMed Central

    Kamaledeen, Abderahman; Law, Penelope

    2014-01-01

    Background. Group A streptococcal (GAS) meningitis is rarely seen in the antenatal period, but it is associated with significant mortality. We present a case of a mid-trimester woman who developed fulminant meningitis following a rapid onset atypical presentation of infection with this organism. Case. A multiparous 23+5-week woman presented with a 10-day history of a non-productive cough associated with pyrexia. Within minutes of her admission she collapsed and lost consciousness; sepsis was suspected and cross-specialty care was initiated. She was managed empirically in extremis with broad-spectrum antibiotics and mannitol with 3% hypertonic saline for suspected infection and raised intracranial pressure, respectively. Despite intensivist management, a CT head revealed diffuse oedema with coning of the cerebellar tonsils. Brainstem death was certified within 19 hours of admission and fetal death ensued. Postmortem bacteriology confirmed GAS meningitis. Conclusion. Through raising awareness of this patient and her disease course, we hope that future policy decisions, primary care, and hospital level management will be informed accordingly for treatment of pregnant women with suspected GAS infection. PMID:24883215

  2. One-step bone marrow-derived cell transplantation in talarosteochondral lesions: mid-term results

    PubMed Central

    BUDA, ROBERTO; VANNINI, FRANCESCA; CAVALLO, MARCO; BALDASSARRI, MATTEO; NATALI, SIMONE; CASTAGNINI, FRANCESCO; GIANNINI, SANDRO

    2013-01-01

    Purpose to verify the capability of scaffold-supported bone marrow-derived cells to be used in the repair of osteochondral lesions of the talus. Methods using a device to concentrate bone marrow-derived cells, a scaffold (collagen powder or hyaluronic acid membrane) for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 64 patients. The mean follow-up was 53 months. Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. We also considered the influence of scaffold type, lesion area, previous surgery, and lesion depth. Results the mean preoperative AOFAS scale score was 65.2 ± 13.9. The clinical results peaked at 24 months, before declining gradually to settle at a score of around 80 at the maximum follow-up of 72 months. Conclusions the use of bone marrow-derived cells supported by scaffolds to repair osteochondral lesions of the talus resulted in significant clinical improvement, which was maintained over time. Level of Evidence level IV, therapeutic case series. PMID:25606518

  3. Space station needs, attributes and architectural options study. Briefing material, mid-term review

    NASA Technical Reports Server (NTRS)

    1982-01-01

    User mission requirements and their relationship to the current space transportation system are examined as a means of assuring the infusion of corporate ideas and knowledge in the space station program. Specific tasks include developing strategies to develop user consistency; determine DOD implication and requirements; and foster industry involvement in the space station. Mission alternatives; accrued benefits; program options; system attributes and characteristics; and a recommended plan for space station evolution are covered.

  4. Phase 3 study of selected tether applications in space, mid-term review

    NASA Technical Reports Server (NTRS)

    1986-01-01

    Topics addressed include: guidelines for the Space Transportation System (STS) payload deployer design; mini-orbital maneuvering vehicle (MOMV) design: shuttle tether deployer systems (STEDS); cost modeling; tethered platform analysis; fuel savings analysis; and STEDS control simulation.

  5. Economic 5-megajoule heavy-ion driver for mid-term fusion goals

    SciTech Connect

    Martin, R.L.; Arnold, R.C.; Burke, R.J.

    1980-01-01

    Design concepts for heavy-ion drivers with lower costs are presented which are adapted to the needs of ICF development in the next decade, rather than power plants. Four 5-MJ drivers are compared, whose repetition rates range from 0.5 Hz to 20 Hz. Three use synchrotrons, and their costs are estimated to be competitive with any other existing driver technology.

  6. Tri-component, mobile bearing, total ankle replacement: mid-term functional outcome and survival.

    PubMed

    Dhawan, Rohit; Turner, Jake; Sharma, Vikas; Nayak, Ramesh K

    2012-01-01

    Tri-component, mobile bearing, uncemented, total ankle replacements were introduced after the high failure rates of cemented, highly constrained, first-generation, total ankle replacement implants. A total of 30 primary total ankle replacements in 29 patients (20 males and 9 females) were followed up in the present retrospective study for up to 13 (mean 5.1 ± 4) years. The postoperative functional and radiographic outcomes were measured. Failure was defined as revision of either of the components for any reason or conversion of the total ankle replacement to arthrodesis because of debilitating pain that did not resolve after surgery. Of the 29 patients, 2 underwent revision and 1 underwent arthrodesis. All 3 patients had the malpositioned talar implant revised. The mean American Orthopaedic Foot and Ankle Society score was 81 at 1 year postoperatively. Revision of the tibial or talar component for any reason or conversion of the ankle replacement to arthrodesis was considered failure for the survival analysis. Kaplan-Meier analysis showed a 5-year survival rate of 87.6%. The last failure occurred 23.3 months after surgery.

  7. Return to sporting activity after Birmingham hip resurfacing arthroplasty: Mid term results

    PubMed Central

    Sandiford, Nemandra; Muirhead-Allwood, SK; Skinner, JA

    2015-01-01

    Background: Hip resurfacing arthroplasty (HRA) is primarily indicated for young, active patients with disabling coxarthrosis who wish to remain active and return to sports after surgery. Relatively few prospective studies have assessed return to sporting activity and impact of gender and age on this. Materials and Methods: Seventy-nine consecutive patients treated with HRA were included. Patients were reviewed clinically and radiologically. Function was assessed using the modified University of California Los Angeles (UCLA) activity score. The Oxford, Harris and WOMAC hip scores were calculated. Results: Average age at the time of surgery was 54.9 years (range 34.5–73.6 years). Average preoperative and postoperative UCLA scores were 4 and 7.6 respectively. Patients were involved in 2 (0–4) sporting activities preoperatively and 2 (0–5) postoperatively. Preoperative and postoperative Oxford Hip Scores, Harris Hip Score and WOMAC scores were 40, 46 and 51 and 16, 94 and 3 respectively (P < 0.0001). Patients returned to sports at an average of 3 months postoperatively. Conclusion: Patients were able to return to sports by 3 months and perform the same number of activities at preoperative intensity. Activity levels are maintained up to the medium term with few complications. PMID:26806965

  8. [Laparoscopic pyeloplasty in adults--mid-term results in 32 laparoscopic pyeloplasties during 2003-2008].

    PubMed

    Safarík, L; Novák, K; Pesl, M; Fogel, K; Sedlácek, J; Macek, P; Dvorácek, J

    2009-03-01

    Pyeloureteric iunction obstruction is the most common inborn error of the upper urinary pathways. In the time of routine prenatal ultrasound examination, this disease is discovered in the child's age, when it is treated most frequently. Publication summarizes the results of modern laparoscopic management in the adults, who had not been diagnosed previously and symptoms occurred many years after their birthdate. The surgical treatment has been changed in the approach, but not the goal of desobtruction. The results in the adults are influenced not only by the operation technique, but also by the length of time the obstruction lasted and by the number and severity of the inflammatory changes.

  9. Forest Dragon 2: Mid-Term Results Of The European Partners

    NASA Astrophysics Data System (ADS)

    Schmullius, C.; Reiche, J.; Leiterer, R.; Cartus, O.; Santoro, M.; Wegmuller, U.; Li, Z. Y.; Tian, X.; Ling, F. L.

    2010-10-01

    One of the main objectives of the Forest DRAGON 2 project is the evaluation of the Forest DRAGON 1 large area forest growing stock volume (GSV) maps generated for Northeast and Southeast China, based on ERS-1/2 tandem coherence data from the mid 1990s. A special cross-comparison design mainly based on freely available Earth Observation products has been developed in consequence of lack of extensive in situ measurements. A reasonable agreement above 70 % between the forest GSV maps and the EO products in terms of forest/ non-forest could be achieved for NE and SE China. The assessment of forest cover and structure changes in China from the mid 1990s into the current decade is addressed by a pilot study at the regions of Daxinganling and Xiaoxinganling. A one-year stack (2007) of Envisat ASAR GMM data has been processed at 1-km pixel size with the BIOMASAR algorithm to obtain continuous GSV. Accordingly, the ERS-1/2 tandem data has been reprocessed to 1 km to allow an intercomparison of the two products, which in turn allowed observing scaling effects on the forest GSV. Preliminary results show plausible detection of forest cover changes.

  10. Mid term results of total hip arthroplasty using polyethylene-ceramic composite (Sandwich) liner.

    PubMed

    Wang, Tao; Sun, Jun-Ying; Zha, Guo-Chun; Dong, Sheng-Jie; Zhao, Xi-Jiang

    2016-01-01

    Ceramic-on-ceramic (COC) couplings are an attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in total hip arthroplasty (THA) remains one of the major concern regarding the risk of fracture. The present study aims at reporting the fracture rate of bearings in a series of COC THAs with the use of a sandwich liner and attempt to detect the relative risk factors, the possible cause and assess the clinical results. We retrospectively evaluated 153 patients (163 hips) using the sandwich liner COC THA between 2001 and 2009. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index (BMI). All patients were evaluated clinically and radiographically or using computed tomography viz-a-viz dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture. Three ceramic sandwich liners fracture (1.84%) were observed at an average of 7.3 years' followup. The factors which were found to be non-significant to the ceramic liner fracture, included age (P = 0.205), weight (P = 0.241), gender (P = 0.553), BMI (P = 0.736), inclination (P = 0.199) and anteversion (P = 0.223). The overall survival was 91.4% at 12-year with revision as the endpoint. Other complications included osteolysis in 4 (2.45%), dislocation in one and periprosthetic fracture in one. In no hip aseptic loosening of the implants was seen. Our experience with the ceramic-polyethylene sandwich liner acetabular component has been disappointing because of the high rate of fracture and osteolyis. We have discontinued the use of this device and recommend the same.

  11. Lost Opportunities: The Civil Rights Record of the Bush Administration Mid-Term.

    ERIC Educational Resources Information Center

    Liss, Susan M., Ed.; Taylor, William L., Ed.

    This study of the civil rights policies and practices of the Bush Administration reviews the first 2 years of that administration's actions, presents recommendations for the future, and offers a series of working papers prepared by experts in the civil rights field. Part 1 of two major parts presents the actual report of the Citizen's Commission…

  12. CardiaMed mechanical valve: mid-term results of a multicenter clinical trial.

    PubMed

    Nazarov, Vladimir M; Zheleznev, Sergey I; Bogachev-Prokophiev, Alexandr V; Afanasyev, Alexandr V; Nemchenko, Eugene V; Jeltovskiy, Yuri V; Lavinyukov, Sergey O

    2014-01-01

    Prosthesis choice is a major concern in valvular surgery. A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study. The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1%  ± 3.7%; 86.1%  ± 4.8% and 84.4%  ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9%  ± 3.7% and 94.5%  ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8%  ± 3.1% and 93.8%  ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

  13. Isolation and characterization of a somatomedin-binding protein from mid-term human amniotic fluid.

    PubMed

    Póvoa, G; Enberg, G; Jörnvall, H; Hall, K

    1984-10-15

    Human amniotic fluid is rich in a binding protein for somatomedins. This binding protein competes with human placenta membranes for labelled somatomedin A. Consequently, the placenta radioreceptorassay for somatomedin can be used for detection of the binding protein. The protein was isolated from human amniotic fluid by a three-step procedure: First, stepwise ammonium sulphate precipitation; second, hydrophobic chromatography (phenyl-Sepharose); and third, anion-exchange chromatography (fast protein liquid chromatography). The total recovery of binding protein calculated with the placenta radioreceptorassay was 50%. Polyacrylamide gel electrophoresis under native and denaturating conditions of the isolated protein disclosed a single band. The relative molecular mass was 35000, determined by exclusion chromatography, and 32000 under denaturating conditions in sodium dodecyl sulphate/polyacrylamide gel electrophoresis. The isoelectric point was 4.3 according to chromatofocusing and the amino acid composition also disclosed a high content of acidic/amidated residues. The N-terminal amino acid sequence was Ala-Pro-Trp-Gln-Cys-Ala-Pro-Cys-Ser-Ala.

  14. Mid-term results of ankle fractures with and without syndesmotic rupture.

    PubMed

    Veen, Egbert J D; Zuurmond, Rutger G

    2015-03-01

    This study investigated the effect of short term removal of syndesmotic screws on the ankle function after 6 years, as there still exists controversy on the duration of screw stabilization. Patients with an ankle fracture who received surgery between 1998 and 2004 were reviewed. One group was composed of patients with an ankle fracture needing a syndesmotic repair with screws. The second was composed of operated patients that did not need syndesmotic repair. The primary scoring used was the Olerud-Molander Ankle Score (OMAS). A total of 59 patients were studied with comparable characteristics, with no significant difference on the OMAS after 6 years between the repair group (81.9) and the non-repair group (90.4). On additional clinical scoring groups remained the same. Joint degeneration was seen in both groups (86.7% vs. 55.5%). Patients with ankle fractures using syndesmotic repair and screw removal after 8 weeks and operated patients without syndesmotic injury have comparable results after 6 years. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  15. Mid Term Progress Report: Desertification Assessment and Monitoring in China Based on Remote Sensing

    NASA Astrophysics Data System (ADS)

    Gao, Zhihai; del Barrio, Gabriel; Li, Xiaosong; Wang, Wengyu; Puigdefabregas, Juan; Sanjuan, Maria E.; Bai, Lina; Wu, Junjun; Sun, Bin; Li, Changlong

    2014-11-01

    The objective of Dragon 3 Project 10367 is the development of techniques research for desertification assessment and monitoring in China using remote sensing data in combination with climate and environmental-related data. The main achievements acquired since 2012 could be summarized as follows:(1) Photosynthetic vegetation (PV) and non-photosynthetic vegetation (NPV) fraction were retrieved separately through utilizing Auto Monte Carlo Unmixing technique (AutoMCU), based on BJ-1 data and field measured spectral library.(2) The accuracy of sandy land classification was as high as 81.52% when the object-oriented method and Support Vector Machine (SVM) classifiers were used.(3) A new Monthly net primary productivity (NPP) dataset from 2002 to 2010 for the whole China were established with Envisat-MERIS fraction of absorbed photosynthetically active radiation (FPAR) data.(4) The 2dRUE proved to be a good indicator for land degradation, based on which, land degradation status in the general potential extent of desertification in China (PEDC) was assessed preliminarily.

  16. Mid Term Progress Report: Desertification Assessment and Monitoring in China Based on Remote Sensing

    NASA Astrophysics Data System (ADS)

    Gao, Zhihai; del Barrio, Gabriel; Li, Xiaosong; Wang, Bengyu; Puigdefabregas, Juan; Sanjuan, Maria E.; Bai, Lina; Wu, Junjun; Sun, Bin; Li, Changlong

    2014-11-01

    The objective of Dragon 3 Project 10367 is the development of techniques research for desertification assessment and monitoring in China using remote sensing data in combination with climate and environmental-related data. The main achievements acquired since2012could be summarized as follows: (1)Photosynthetic vegetation(PV)and non-photosynthetic vegetation(NPV)fraction were retrieved separately through utilizing Auto Monte Carlo Unmixing technique (AutoMCU), based on BJ-1 data and field measured spectral library. (2) The accuracy of sandy land classification was as high as81.52%when the object-oriented method and Support Vector Machine (SVM) classifiers were used. (3) A new Monthly net primary productivity (NPP)dataset from 2002 to 2010 for the whole China were established with Envisat-MERIS fraction of absorbed photosynthetically active radiation (FPAR) data. (4) The 2dRUE proved to be a good indicator for land degradation, based on which, land degradation status in the general potential extent of desertification in China(PEDC) was assessed preliminarily.

  17. [Mid-term results after complete surgical correction of transposition of the great arteries].

    PubMed

    Parezanović, Vojislav; Mrdjen, Mirko; Illić, Slobodan; Vulićević, Irena; Djukić, Milan; Jovanović, Ida; Stefanović, Igor; Illisić, Tamara; Kalanj, Jasna; Mimic, Branko; Milovanović, Vladimir

    2014-01-01

    Arterial switch operation (ASO) is a cardiosurgical method of choice for complete anatomical correction of transposition of great arteries. Improvement of this procedure has made considerably improved the outcome and long-term prognosis of children born with this complex congenital heart disease. The aim of this study was to estimate the success rate of ASO through retrospective analysis of mortality and late complications. This study included 57 children operated from 1st January 2005 until 31st December 2009. Parameters that could influence the outcome of surgery were investigated. The following late complications were investigated: neopulmonary artery stenosis, neoaortic stenosis and regurgitation, as well as clinical signs of heart failure. Early postoperative mortality was 15.8% (9/57 patients). During follow-up (8 to 72 months, average 36.5 months) there were no lethal outcomes. On the last echocardiography examination, 73.2% patients had neoaortic regurgitation and 67.4% patients had neopulmonary regurgitation, but all of them were mild in intensity. Neopulmonary stenosis had 32.6% of patients, but only two had moderate or severe stenosis. No one had ischemic ECG changes. Three reinterventions were performed due to serious residual problems: surgical correction of neoaortic stenosis, surgical correction of neopulmonary stenosis and transcatether balloon dilatation for aortic recoarctation. At the end of the follow-up period, only one of 46 consistently followed patients had signs of heart failure which required therapy (2.2%), while the majority of patients were without any symptoms and with good effort tolerance. Arterial switch operation has been successfully performed at our institution, with acceptable perioperative mortality and excellent late outcome.

  18. Mid-term outcome of total elbow replacement for rheumatoid arthritis.

    PubMed

    Williams, H; Madhusudhan, T; Sinha, A

    2016-08-01

    To review the outcome of total elbow replacement (TER) in 21 patients after a mean of 64 months. Records of 12 women and 9 men aged 32 to 78 (mean, 59.1) years who underwent 22 TERs for rheumatoid arthritis by a single surgeon were reviewed. Functional outcome was assessed using the disability of the arm, shoulder and hand (DASH) questionnaire. The range of movement and Kaplan- Meier survival curve was determined. Adequacy of cementation was assessed on immediate postoperative radiographs. Aseptic loosening was assessed on radiographs using the Mayo clinic scoring system. After a mean follow-up of 64 (range, 10-145) months, the mean DASH score improved from 72.3 to 46.8, mean flexion improved from 96.9º to 128.1º, and mean extension lag from 37.3º to 24.0º. The 5-year survival rate with symptomatic aseptic loosening as the end point was 100%, and the revision rate for all reasons was 69%. Cement mantle was adequate in 17, marginal in 4 (most lacked cement around the prosthesis tip), and inadequate in one who was clinically asymptomatic. At the latest follow-up, 4 patients had a type-1 radiolucent line and one had a type-2 radiolucent line of both components; all remained clinically asymptomatic. Two patients developed transient radial nerve neuropraxia. One patient underwent revision for peri-operative fracture. One patient underwent a 2-stage revision for deep infection. One patient underwent revision for bilateral periprosthetic fracture. One patient underwent revision for symptomatic aseptic loosening. No patient had elbow dislocation. TER is a viable option for pain relief and functional improvement in patients with rheumatoid arthritis.

  19. Application of Classification Methods for Forecasting Mid-Term Power Load Patterns

    NASA Astrophysics Data System (ADS)

    Piao, Minghao; Lee, Heon Gyu; Park, Jin Hyoung; Ryu, Keun Ho

    Currently an automated methodology based on data mining techniques is presented for the prediction of customer load patterns in long duration load profiles. The proposed approach in this paper consists of three stages: (i) data preprocessing: noise or outlier is removed and the continuous attribute-valued features are transformed to discrete values, (ii) cluster analysis: k-means clustering is used to create load pattern classes and the representative load profiles for each class and (iii) classification: we evaluated several supervised learning methods in order to select a suitable prediction method. According to the proposed methodology, power load measured from AMR (automatic meter reading) system, as well as customer indexes, were used as inputs for clustering. The output of clustering was the classification of representative load profiles (or classes). In order to evaluate the result of forecasting load patterns, the several classification methods were applied on a set of high voltage customers of the Korea power system and derived class labels from clustering and other features are used as input to produce classifiers. Lastly, the result of our experiments was presented.

  20. The Education for All Global Monitoring Report: A Mid-Term Assessment

    ERIC Educational Resources Information Center

    Packer, Steve

    2008-01-01

    The Education for All (EFA) Global Monitoring Report is six years old and seven reports have been produced (UNESCO, 2000-2008). It is a product of the outcomes of the World Education Forum in Dakar held in 2000. It is designed to track progress towards the realization of the six EFA goals and to hold governments and the international community to…

  1. The Soviet Shift in Emphasis from Nuclear to Conventional. Volume 2. The Mid-Term Perspective

    DTIC Science & Technology

    1983-06-01

    in Soviet strategic capabilities over the five-year plan 1966-70 simply accentuated the doctrinal trends of the decade’s first half. There were two...Third World crisis management, the accent beginning in 1966 was put on conventional forces. Bloc armed forces, it was now said, have "to be in

  2. One-step bone marrow-derived cell transplantation in talarosteochondral lesions: mid-term results.

    PubMed

    Buda, Roberto; Vannini, Francesca; Cavallo, Marco; Baldassarri, Matteo; Natali, Simone; Castagnini, Francesco; Giannini, Sandro

    2013-01-01

    to verify the capability of scaffold-supported bone marrow-derived cells to be used in the repair of osteochondral lesions of the talus. using a device to concentrate bone marrow-derived cells, a scaffold (collagen powder or hyaluronic acid membrane) for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 64 patients. The mean follow-up was 53 months. Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. We also considered the influence of scaffold type, lesion area, previous surgery, and lesion depth. the mean preoperative AOFAS scale score was 65.2 ± 13.9. The clinical results peaked at 24 months, before declining gradually to settle at a score of around 80 at the maximum follow-up of 72 months. the use of bone marrow-derived cells supported by scaffolds to repair osteochondral lesions of the talus resulted in significant clinical improvement, which was maintained over time. level IV, therapeutic case series.

  3. Mid-term clinical outcome of radial shortening for kienbock disease

    PubMed Central

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Vahedi, Ehsan; Kachooei, Amir Reza

    2015-01-01

    Background: To evaluate the intermediate-term outcomes of radius shortening as a treatment for Kienbock's disease. Materials and Methods: In a historical cohort, 16 skeletally mature patients (9 men and 7 women) with Kienbock disease, who were treated with radial shortening osteotomy between 2002 and 2012, were reviewed in our study. The mean age of our patients was 30 (range 18-43) years old. According to Litchman staging, there were 7 wrists at stage II and 9 wrists at stage III (6 at stage IIIA and 3 at stage IIIB). The data of grip strength, pain (visual analog scale (VAS) score), wrist range of motion (ROM), ulnar variance (according to Palmer method), and the Lichtman stage were gathered before and after surgery. We evaluated overall wrist function using the Mayo Wrist score and disabilities of the arm shoulder and hand (DASH) score before surgery and at the last follow-up. Results: The average of follow-up was 7 years (range from 5 to 9 years). Preoperative ulnar variance was −1.3 mm (range from 2.5 to 1) preoperatively. The mean postoperative ulnar variance was 1 mm positive (range from 0.5 to 1.5). The VAS pain score, the mean arc of wrist flexion and extension, and grip strength improved significantly preoperatively compared to after recovery from surgery. The Lichtman stage was unchanged in nine patients, one grade worse in six patients, and one grade better in one patient. The mean DASH and Mayo scores improved significantly postoperatively compare with preoperation. Comparing preoperative positive, neuter, and negative ulnar variance, there was no significant difference in terms of VAS, DASH, and Mayo scores as well as ROM and grip strength. Conclusion: Our study shows that radius shortening surgery improves pain and disability regardless of ulnar variance. PMID:25983766

  4. U.S. Natural Gas Markets: Mid-Term Prospects for Natural Gas Supply

    EIA Publications

    2001-01-01

    This service report describes the recent behavior of natural gas markets with respect to natural gas prices, their potential future behavior, the potential future supply contribution of liquefied natural gas and increased access to federally restricted resources, and the need for improved natural gas data.

  5. Mid-term evaluation of USAID Sudan Energy Planning and Management Project (650-0059)

    SciTech Connect

    Jones, D.W.; Stovall, J.P.; Raby, J.G.; Younger, D.R.; Pryor, C.A.

    1987-07-01

    The Energy Planning and Management (EPM) Project was designed to increase reliability of the Blue Nile Grid and to bolster the management and operation of the National Electricity Corporation (NEC) and the General Petroleum Corporation (GPC), and to help develop the National Energy Administration (NEA) as a national energy planning institution. Two major successes are already in evidence at NEC at mid-project. The Blue Nile Grid reliability has improved from a low of 74% in 1983 to 94% currently; although the EPM project has not been the only influence, its maintenance activities have been partly responsible for this improvement. Accomplishments of NEA and NEC are described.

  6. Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries.

    PubMed

    Kamara, Lidija; Lydon, Patrick; Bilous, Julian; Vandelaer, Jos; Eggers, Rudi; Gacic-Dobo, Marta; Meaney, William; Okwo-Bele, Jean-Marie

    2013-01-01

    Within the overall framework set out in the Global Immunization Vision and Strategy (GIVS) for the period 2006-2015, over 70 countries had developed comprehensive Multi-Year Plans (cMYPs) by 2008, outlining their plans for implementing the GIVS strategies and for attaining the GIVS Goals at the midpoint in 2010 or earlier. These goals are to: (1) reach ≥90% and ≥80% vaccination coverage at national and district level, respectively; and (2) reduce measles-related mortality by 90% compared with the 2000 level. Fifty cMYPs were analysed along the four strategic areas of the GIVS: (1) protecting more people in a changing world; (2) introducing new vaccines and technologies; (3) integrating immunization, other health interventions and surveillance in the health system context; and (4) immunizing in the context of global interdependence. By 2010, all 50 countries planned to have introduced hepatitis B (HepB) vaccine, 48 the Haemophilus influenzae type B (Hib) vaccine and only a few countries had firm plans to introduce pneumococcal or rotavirus vaccines. Countries seem to be inadequately prepared in terms of cold-chain requirements to deal with the expected increases in storage that will be required for vaccines, and in making provisions to establish a corresponding surveillance system for planned new vaccine introductions. Immunization contacts are used to deliver other health interventions, especially in the countries in the World Health Organization (WHO) Africa Region. The cost for the planned immunization activities will double to U$27 per infant, of which U$5 per infant is the expected shortfall. Global Alliance for Vaccines and Immunization (GAVI) funding is becoming the largest contributor to immunization programmes.

  7. Pretransplant and protocol biopsies may help in defining short and mid-term kidney transplant outcome.

    PubMed

    Esposito, C; Migotto, C; Torreggiani, M; Maggi, N; Manini, A; Castoldi, F; Grosjean, F; Mangione, F; Abelli, M; Scaramuzzi, M L; Catucci, D; Dal Canton, A

    2012-09-01

    Although many variables may affect long-term graft survival no biomarker is available to identify donor kidney with poor quality and with inadequate short and long-term outcome. While in marginal donors pre-transplant renal biopsies are commonly performed to establish if donor kidneys are suitable for transplantation they are not performed in standard donors. In this study we assessed the relevance of pre-transplant morphological features on post-transplant renal function and evaluated the association between perioperative parameters with posttransplant histological and clinical findings. Kidney transplant recipients undergone pre-transplant and post transplant protocol biopsies at 1, 6, and 12 months were enrolled in the study. Perioperative and posttransplant clinical and biochemical parameters were recorded. Semiquantitative analysis of PAS stained kidney sections was used to determine the degree of lesions. Glomerular volume was measured by computed morphometry. A strong inverse correlation was found between donor age and renal graft function at 1, 6, and 12 months after transplantation. A prompt functional recovery was associated with a better renal function at 6 months and one year. Kidneys with higher glomerular volume demonstrated a lower serum creatinine at 1 month. Higher tubulo-interstitial grading at protocol biopsies was associated with a poor renal function at 1 month. Our findings confirm the importance of donor age in kidney transplant long-term outcome and demonstrate that pretransplant and protocol biopsies are valid options to determine graft outcome and to define therapeutic strategies and tailor immunosuppressive regimen for each patient.

  8. [Use of the anatomical cemented femoral stem SAS I: mid-term results].

    PubMed

    Mikláš, M; Pink, M; Valoušek, T

    2015-01-01

    PURPOSE OF THE STUDY In view of increasing interest in a relationship between the surface of an implant and its behaviour and longevity in total hip arthroplasty (THA), the aim of this study is to present the clinical and radiographic results, as well as complications, of hip replacement surgery using the cemented femoral stem SAS I. MATERIAL AND METHODS A total of 298 cemented femoral stems SAS I were implanted in 275 patients at our department between 1996 and 2005. The patient average age was 72.1 years, with the range from 64 to 92 years. The pre-operative diagnoses were as follows: primary osteoarthritis in 179 (30.1%); post-dysplastic osteoarthritis in 41 (13.7%); femoral neck fracture in 44 (14.8%); avascular necrosis of the femoral head in 23 (7.7%); rheumatoid arthritis in nine (3%) and other causes in two (0.7%) patients. Of the 275 patients who had the surgery, 186 (204 THAs) underwent clinical and X-ray examination at an average follow-up of 11.5 years (range, 8 to 17 years). The clinical results were used to calculate the Harris hip score and radiographic evaluation was based on antero-posterior views. RESULTS The group of 186 assessed patients (204 THAs) comprised 106 women and 80 men, who were on average 85.4 years old on evaluation (range, 72 to 92 years). Of the remaining patients, 62 patients (64 THAs) died from causes unrelated to the surgery and 27 patients (30 THAs) were lost to follow-up. The functional outcome of surgery assessed by the Harris hip score was excellent in 61 (32.8%), good in 94 (50.5%), satisfactory in 26 (14%) and poor in five (2.7%) patients. The 93.1% SAS I stem longevity was recorded in relation to aseptic loosening; reimplantation for this indication was performed in 14 THAs. No revision surgery for failure due to valgus/varus deviations of the stem was carried out. Of the 204 hips, 188 had femoral stems aligned in neutral, 12 (5.9%) in valgus and four (2%) in varus positions. DISCUSSION The anatomical femoral stem SAS I is an implant made to fit the proximal femur anatomy. Its highly polished surface allows for optimal fitting with the supporting bone and for even distribution of weight bearing. This results in a low rate of THA failure. In accordance with the relevant literature, the acetabular components is considered to be the weakest element in total hip replacement in terms of aseptic loosening and implant failure. At present, the SAS I stem has no Morse Eurocone taper and this is the chief obstacle hindering its more frequent use in endoprosthetics. CONCLUSIONS The results of our study are in agreement with those of other successfully implanted polished cemented femoral components. Key words: anatomical cemented femoral component, surface adjustment of the femoral stem, complications.

  9. Apophis: No impact risks for the mid-term, but after?

    NASA Astrophysics Data System (ADS)

    Prado, J.-Y.; Bancelin, D.; Colas, F.; Hestroffer, D.; Thuillot, W.

    2011-05-01

    Apophis will come back very close to the Earth on April 13, 2029. Its heliocentric orbit will gain energy from the gravitational pull from the Earth and, depending on its actual pass geometry, it will be placed on a new nominal orbit of period around 422 days. Even if impact possibilities are excluded for the years 2036 (corresponding to a new period for Apophis of 426.15 days) and 2037 (period of 417.23 days), the actual value of the post 2029 period can be in resonance with the orbit period of the Earth and leads to a new close encounter in the next decades. Apophis should be visible from ground-based observatories at some time intervals between 2011 and 2013, with a reasonable expectation that radar measurements from Arecibo can be performed in 2013. Furthermore, space astrometry by Gaia mission will also give accurate measurements in the 2013-2017 period. Then it will be possible to characterize the nongravitational forces, starting with the Yarkovsky effect and propagate the orbit solutions up to April 2029 in order to refine the further impact risk probabilities. It will be possible to check the correctness of the 2029 pass in 2021 when again Apophis can be observed from the Earth. Finally, on April 13, 2029, Apophis will be tracked at least by ground-based observatories and it can be expected that the determination of its orbit relative to the Earth will be accurate to the meter level. Then, it will be known with a high confidence if the key holes that would lead to a collision of Apophis with the Earth have been missed or not. Each of these observations periods (2013, 2021, 2029) will be highly scrutinized by astronomers who will have to report to the public opinion and the decision makers on the observation and ephemeris activities, and impact risk at least for the decades to come. It is of prime interest for the NEO community to show them that the observation campaigns of Apophis will provide an incremental improvement of the threat assessment.

  10. Mid-Term Progress Report on the Development of Army Closed Cycle Circulator (CCC) System.

    DTIC Science & Technology

    1979-09-20

    installation of the rotor assembly. The compressor shaft is sealed with a Crane Type 28 Kinetic Wedge gas seal for positive static sealing. A unitized...Pressure ratio 1.91 Horsepower 134 R (Molecular weight 18.67) 82.76 The compressor is fitted with a Crane Packing Company Type 28 gas seal. This seal...simply reading a digital voltmeter which is hooked up to the anemometer. The only preparation that the anemometer requires is that the operating

  11. Application of pulsed electromagnetic fields after microfractures to the knee: a mid-term study.

    PubMed

    Osti, Leonardo; Del Buono, Angelo; Maffulli, Nicola

    2015-07-01

    Pulsed electromagnetic fields (PEMFs) may improve clinical outcomes following microfractures and prevent their decline over time. Sixty-eight patients who underwent partial medial meniscectomy and microfractures to the medial femoral condyle for management of grade III-IV cartilage lesions were randomly divided into two groups using a block randomization procedure. After surgery, 34 patients underwent PEMFs application in the I-ONE group; 34 patients underwent placebo treatment in the placebo group. All patients had the same postoperative rehabilitation protocol. Sixty patients (28 in the I-ONE group, 32 in the placebo group) were assessed at an intermediate follow-up of two years and a minimum follow-up of five years after surgery. The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow up of two years. At two years, IKDC and Lysholm and Constant scores were significantly improved compared to baseline in both groups with no significant inter-group differences. At the last follow up (minimum five years), clinical and functional outcomes were decreased in both the groups, with significant better outcomes in the I-ONE group. At five years, the percentage of patients still active at the same level they were pre-operatively was greater in the I-ONE group (82% vs 68%, P = 0.28). At radiographic assessment, at the latest evaluation, six patients (21.4%) in the I-ONE group and nine (28.1%) in the placebo group demonstrated grade I-II degenerative changes according to Fairbank grading system (Χ = 0.36, P = 0.55). PEMFs application can improve the effectiveness of microfracture in the long term.

  12. Mid-term effects of mine soil reclamation by use of aided phytostabilization

    NASA Astrophysics Data System (ADS)

    Zornoza, Raúl; Faz, Ángel; Martínez-Martínez, Silvia; Acosta, Jose Alberto; Gómez, María Dolores; Yanardag, Ibrahim

    2014-05-01

    Abandoned tailing ponds show environmental and human health hazards by the transfer of heavy metals through erosion or leaching. To reduce these hazards, a reclamation strategy has been developed on a tailing pond based on aided phytostabilization. In 2011 marble mud and pig slurry were applied on the tailing pond surface. In spring 2012 thirteen native vegetal species were introduced. During two years (2012-2013) the evolution of different soil properties and the bioavailable fraction of the heavy metals Cd, Pb and Zn has been monitored. Results showed that pH, aggregates stability, organic carbon, nitrogen and cation exchange capacity increased with the application of the amendments and the development of vegetation, while the bioavailable fraction of the heavy metals drastically decreased (90-99%). Thus, the strategy followed resulted positive to reduce the availability of heavy metals, improving soil quality and fertility. These results are promising in areas with extractive activity of carbonated materials, since the generated wastes can be used for reclamation of soils affected with heavy metals, turning a waste into a by-product. Key words: amendments, geochemistry, heavy metals, mining, tailing pond. Acknowledgements: This work has been funded by the European Union LIFE+ project MIPOLARE (LIFE09 ENV/ES/000439).

  13. Triple pelvic osteotomy: Report of our mid-term results and review of literature

    PubMed Central

    Mimura, Tomohiro; Mori, Kanji; Kawasaki, Taku; Imai, Shinji; Matsusue, Yoshitaka

    2014-01-01

    A wide variety of pelvic osteotomies have been developed for the treatment of developmental dysplasia of the hip (DDH). In the present paper, we present a detailed review of previous studies of triple osteotomy as an alternative treatment for DDH. We also report our experience treating 6 adult cases of DDH by triple osteotomy in order to highlight the various aspects of this procedure.The mean age of our patients was 31.2 years with a mean follow-up period of 6 years. We assessed range of motion, center-edge angle, acetabular index angle, Sharp angle, acetabulum head index, head lateralization index, Japanese Orthopedic Association score, Harris hip score, patient satisfaction, and the difference between lower limb lengths before and after the procedure. At final follow-up, clinical scores were significantly improved and radiographic parameters also showed good correction of acetabulum. PMID:24649410

  14. The Generation of Situational Awareness within Autonomous Systems - A Near to Mid term Study - Analysis

    DTIC Science & Technology

    2006-07-01

    Programmability. The bottleneck issue centres on the capacity to communicate with the robot once deployed, and thus change its behaviour . This issue...robotic systems. This appendix formally presents this framework, and the way that it can be applied to generate insights. The discussion is organised ...capacity to communicate with the robot once deployed, and thus change its behaviour . This issue weighs into the balance of autonomy solutions against

  15. Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers

    PubMed Central

    Arakawa, Takashi; Abe, Hiroshi; Abe, Shinichi; Cho, Baik Hwan; Murakami, Gen; Sugihara, Kenichi

    2012-01-01

    Purpose We recently demonstrated the morphology of the anococcygeal ligament. As the anococcygeal ligament and raphe are often confused, the concept of the anococcygeal raphe needs to be re-examined from the perspective of fetal development, as well as in terms of adult morphology. Materials and Methods We examined the horizontal sections of 15 fetuses as well as adult histology. From cadavers, we obtained an almost cubic tissue mass containing the dorsal wall of the anorectum, the coccyx and the covering skin. Most sections were stained with hematoxylin and eosin or Masson-trichrome solution. Results The adult ligament contained both smooth and striated muscle fibers. A similar band-like structure was seen in fetuses, containing: 1) smooth muscle fibers originating from the longitudinal muscle coat of the anal canal and 2) striated muscle fibers from the external anal sphincter (EAS). However, in fetuses, the levator ani muscle did not attach to either the band or the coccyx. Along and around the anococcygeal ligament, we did not find any aponeurotic tissue with transversely oriented fibers connecting bilateral levator ani slings. Instead, in adults, a fibrous tissue mass was located at a gap between bilateral levator ani slings; this site corresponded to the dorsal side of the ligament and the EAS in the immediately deep side of the natal skin cleft. Conclusion We hypothesize that a classically described raphe corresponds to the specific subcutaneous tissue on the superficial or dorsal side of the anococcygeal ligament. PMID:22665356

  16. Immediate and mid-term effects of pyrimethanil toxicity on microalgae by simulating an episodic contamination.

    PubMed

    Shinn, Cândida; Delello-Schneider, Danieli; Mendes, Lucas B; Sanchez, André L; Müller, Ruth; Espíndola, Evaldo L G; Araújo, Cristiano V M

    2015-02-01

    Since pesticides can represent a threat for non-target aquatic communities, including microalgae, we looked at the effects of the fungicide pyrimethanil on the growth of the freshwater green microalgae Selenastrum capricornutum. Additionally, attenuation of the toxicity of pyrimethanil due to its dissipation in the water was assessed. Pyrimethanil-contaminated samples were taken from outdoor mesocosms one (1.4 mg L(-1) of pyrimethanil) and ten (0.78 mg L(-1) of pyrimethanil) days after pyrimethanil application. Different dilutions were prepared using both nutrient-rich culture medium (LC Oligo) and non-contaminated mesocosm samples, and cell growth inhibition was assessed. Reference mesocosm samples were also diluted with LC Oligo in order to verify how the nutrient concentration in the LC Oligo could improve cell growth. Comparing cell growth of population exposed to pyrimethanil-treated sample taken at day 1 with cells growing in reference sample and LC Oligo, the growth inhibition was 80% (± 6.5) and 95% (± 2.0), respectively. The toxicity of samples taken from contaminated mesocosms at day 10 was attenuated to 34% (± 15) (when compared with reference sample) and 88% (± 3.0) (when compared with LC Oligo), as pyrimethanil concentrations in the mesocosms decreased. In conclusion, (i) pyrimethanil can be an environmental disturber for the microalgae; (ii) the toxicity of pyrimethanil in water was reduced almost 2.4 times (when compared with the reference sample) at as short a period as 10d if assuming that pesticide entrance is not continuous; (iii) toxicity of an environmental sample could be underestimated if the sample/medium used in dilution presents different nutrient levels. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Mid-term result of ceramic bearings in total hip arthroplasty.

    PubMed

    Tozun, Ismail Remzi; Ozden, Vahit Emre; Dikmen, Goksel; Beksac, Burak

    2014-10-01

    The purpose of this study was to evaluate our clinical experience with ceramic-on-ceramic cementless total hip arthroplasty (THA) and complications after an average follow-up of more than eight years. From January 2001 to December 2008, 540 THA with ceramic-on-ceramic bearings were performed in 448 patients (92 bilateral, 54 of which were operated simultaneously) with a mean age 49.9 years (range 18-84) by a senior surgeon. Pre-operative aetiological reasons were developmental dysplasia of the hip (DDH) in 205 hips, degenerative arthritis in 157 hips, avascular necrosis in 51 hips, rheumatoid diseases in 40 hips, posttraumatic arthritis in 40 hips, other reasons in 25 hips and revision surgery in 22 hips. Patients were evaluated with Harris hip score (HSS), and radiological findings of acetabular and femoral component loosening or osteolysis with ceramic bearing related complications like squeaking, liner and head fractures were recorded. The average duration of follow-up time was 8.2 years (range, five to 13.2). The main Harris hip score increased from 42.4 points preoperatively to 94.9 points at the time of last follow-up. We had one fracture of the ceramic head, 11 clicking and four squeaking; one of them was revised because of terrible squeaking due to acetabular liner fracture, the other three were seldom audible from the outside and followed conservatively. We did not observed loosening or osteolysis due to ceramic bearings at the time of the final follow-up. Our study has demonstrated that ceramic-on-ceramic bearings can be used safely in different etiological problems. Incidences of noisy hips are becoming less frequent.

  18. Mid-Term Results of Terrain Measurements in the Dragon-3 Program

    NASA Astrophysics Data System (ADS)

    Liao, Mingsheng; Zhang, Lu; Balz, Timo; Li, Deren

    2014-11-01

    In the project 10569 under the theme “Terrain Measurement” within the ESA-MOST Dragon-3 program, our research focused on topographic mapping and deformation measurements with SAR data acquired by ESA missions as well as third party missions. SAR data was used to map topography in mountainous area using interferometry and stereoscopy. Deformations due to slow landslide movements and urban ground subsidence were measured by PSI and offset tracking techniques. In this paper an overview of the studies undertaken is given and the achievements are summarized.

  19. Mid-Term Results of Terrain Measurements in the Dragon-3 Program

    NASA Astrophysics Data System (ADS)

    Liao, Mingsheng; Zhang, Lu; Balz, Timo; Li, Deren

    2014-11-01

    In the project 10569 under the theme “Terrain Measurement" within the ESA-MOST Dragon-3 program, our research focused on topographic mapping and deformation measurements with SAR data acquired by ESA missions as well as third party missions. SAR data was used to map topography in mountainous area using interferometry and stereoscopy. Deformations due to slow landslide movements and urban ground subsidence were measured by PSI and offset tracking techniques. In this paper an overview of the studies undertaken is given and the achievements are summarized.

  20. Presacral abscess as a rare complication of sacral nerve stimulator implantation.

    PubMed

    Gumber, A; Ayyar, S; Varia, H; Pettit, S

    2017-03-01

    A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

  1. Anorectal and Pelvic Pain.

    PubMed

    Bharucha, Adil E; Lee, Tae Hee

    2016-10-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  2. Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.

    PubMed

    Armañanzas, Laura; Arroyo, Antonio; Ruiz-Tovar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

    2015-01-01

    Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles.

    PubMed

    Dodi, G; Bogoni, F; Infantino, A; Pianon, P; Mortellaro, L M; Lise, M

    1986-04-01

    In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature (23 degrees C). In 16 volunteers (Group A) and 21 patients (Group B) anorectal manometry was then performed while the anus was immersed in water at varying temperatures (5 degrees C, 23 degrees C, and 40 degrees C). In ten volunteers (Group A') and ten patients (Group B') resting pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40 degrees C. In all subjects (at least P less than 0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40 degrees C, but remained unchanged in all subjects after immersion at 5 degrees C and 23 degrees C. In Group A', anal canal pressures remained significantly reduced for 15 minutes (P less than 0.02). In Group B', significant reduction in resting pressure lasted 30 minutes (P less than 0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain.

  4. Anorectal and Pelvic Pain

    PubMed Central

    Bharucha, Adil E.; Lee, Tae Hee

    2016-01-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis. PMID:27712641

  5. MCI patients declining and not-declining at mid-term follow-up: FDG-PET findings.

    PubMed

    Pagani, M; Dessi, B; Morbelli, S; Brugnolo, A; Salmaso, D; Piccini, A; Mazzei, D; Villavecchia, G; Larsson, S A; Rodriguez, G; Nobili, F

    2010-06-01

    Patients with Mild Cognitive Impairment (MCI) not converted to dementia at one to three years follow-up represent a heterogeneous group across studies, by including 'late converters' but also patients without any neurodegenerative disease. We tested the hypothesis that the combination of memory and brain metabolic assessment could identify subgroups of memory decliners (MCI/Decl) and non-decliners (MCI/noDecl) before a long follow-up time is available. From twenty-nine patients with amnestic MCI (aMCI) at baseline, three groups were identified at follow-up: 10 patients who converted to AD (MCI/AD); 10 patients either showing episodic memory worsening or reaching the floor effect on memory and declining in other key tests (MCI/Decl) and 9 patients showing no memory worsening or even improvement (MCI/noDecl). They were compared with a group of fourteen elderly controls (CTR) by means of basal FDG-PET voxel-based analysis (SPM2). Two hypometabolic clusters were found in MCI/AD versus CTR, including the bilateral posterior cingulate cortex, the left parietal precuneus and the left fusiform gyrus. MCI/AD showed also a large hypometabolic region, mainly including the left medium and superior temporal gyri and inferior parietal lobule, when compared to MCI/noDecl. The MCI/Decl showed a hypometabolic region in the left medial temporal lobe versus both CTR (hippocampus) and MCI/noDecl (parahippocampal gyrus and hippocampus). No significant difference was found in the comparison between CTR and MCI/noDecl, neither in the comparison between MCI/Decl and MCI/AD. Thus, non converter MCI patients comprised a sub-group of 'decliners' with AD-like metabolic and cognitive patterns, likely including 'late converters', and a sub-group lacking this pattern, with stable or improving memory function and a brain metabolic picture similar to that in healthy controls. Combining neuropsychological and FDG-PET information could be used for prognostic purposes in aMCI patients at medium-term follow-up.

  6. Treating Epiphora in Adults With the Wilhelm Plastic Nasolacrimal Stent: Mid-Term Results of a Prospective Study

    SciTech Connect

    Ciampi, Juan J. Lanciego, Carlos; Navarro, Sofia; Cuena, Rafael; Velasco, Javier; Perea, Miguel; Garcia-Garcia, Lorenzo

    2011-02-15

    The objective of the present study was to evaluate, in a prospective, single-center study, the effectiveness of the Wilhelm-type stent used in interventional radiology for the management of epiphora. Patients (n = 104; mean age 64 [range 25-88]; 33 male and 71 female) with severe epiphora had the stents inserted (135 stents in 115 eyes) to treat obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 83 cases, chronic dacryocystitis in 31, cases and postsurgical status in 1 case. The overall technical success rate of stent placement was near 94%. Resolution of epiphora was complete in 105 cases and partial in 3 cases. During a mean 13-month follow-up (range 1 week to 28 months), the median duration of primary patency was 11 months, and the percentage of patency at 6 months was 60.8%, at 1 year was 39.6%, and at 2 years was 25%. Stents malfunctioned in 54 cases, and all were easily withdrawn except in 1 case. Of these 27 cases, patency recovered spontaneously in 9 and by way of a second stent in 18. Secondary patency was 50%. Factors presdisposing to lower primary patency are inflammatory etiology and location of the obstruction. The benefit of stent deployment is clear with respect to the resolution of epiphora in candidate patients for percutaneous treatment. Technical and/or design improvements would be welcomed.

  7. Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

    SciTech Connect

    Torres-Blanco, Álvaro Edo-Fleta, Gemma; Gómez-Palonés, Francisco; Molina-Nácher, Vicente; Ortiz-Monzón, Eduardo

    2016-03-15

    PurposeThe purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI).MethodsPatients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan–Meier estimation and predictors of restenosis/occlusion with Cox analysis.ResultsThirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76 %, whereas estimated primary and secondary patency rates were 41 and 79 %, respectively.ConclusionsEndovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.

  8. Is the tantalum Strecker stent suitable for TIPS creation? short- and mid-term results in 20 consecutive patients

    SciTech Connect

    Ugolotti, Ugo; Larini, Pietro; Marcato, Carla; Saccani, Andrea; Puccianti, Franca; Pedretti, Giovanni

    1997-01-15

    Purpose. To assess the suitability of tantalum Strecker stents for transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods. TIPS was performed with Strecker balloon-expandable stents in the first 20 patients of our series. A total of 26 prostheses were utilized (average 1.3 per patient). Results. Immediate technical success was achieved in all 20 cases. Nine patients (45%) died during follow-up. The overall average follow-up period was 18.9 months; the 11 survivors were followed for a mean period of 29.8 months. In 4 patients (20%) the stent dislodged towards the hepatic vein during withdrawal of the balloon catheter, and difficulties in recatheterizing the shunt for routine control portal phlebography were frequently encountered. Rebleeding occurred in 5 cases and aggravation of pre-existing encephalopathy occurred in 2 cases. Shunt occlusions or stenosis required further intervention in 4 and 9 patients, respectively. Conclusion. In our opinion the tantalum Strecker stent is not particularly suitable for TIPS. Although it has evident advantages, such as high radiopacity and minimal shortening after deployment, the tendency of the device to dislodge and the difficulty in recatheterization during portal phlebography were important drawbacks. Furthermore, the atraumatic ends of the device did not seem to reduce shunt-related complications, which were comparable to those occurring with other types of stent.

  9. Endovascular Repair of Abdominal Aortic Aneurysms: Analysis of Aneurysm Volumetric Changes at Mid-Term Follow-Up

    SciTech Connect

    Bargellini, Irene Cioni, Roberto; Petruzzi, Pasquale; Pratali, Alessandro; Napoli, Vinicio; Vignali, Claudio; Ferrari, Mauro; Bartolozzi, Carlo

    2005-05-15

    Purpose. To evaluate the volumetric changes in abdominal aortic aneurysms (AAA) after endovascular AAA repair (EVAR) in 24 months of follow-up. Methods. We evaluated the volume modifications in 63 consecutive patients after EVAR. All patients underwent strict duplex ultrasound and computed tomography angiography (CTA) follow-up; when complications were suspected, digital subtraction angiography was also performed. CTA datasets at 1, 6, 12, and 24 months were post-processed through semiautomatic segmentation, to isolate the aneurysmal sac and calculate its volume. Maximum transverse diameters (Dmax) were also obtained in the true axial plane, Presence and type of endoleak (EL) were recorded. A statistical analysis was performed to assess the degree of volume change, correlation with diameter modifications, and significance of the volume increase with respect to ELs. Results. Mean reconstruction time was 7 min. Mean volume reduction rates were 6.5%, 8%, and 9.6% at 6, 12, and 24 months follow-up, respectively. Mean Dmax reduction rates were 4.2%, 6.7%, and 12%; correlation with volumes was poor (r = 0.73-0.81). ELs were found in 19 patients and were more frequent (p = 0.04) in patients with higher preprocedural Dmax, The accuracies of volume changes in predicting ELs ranged between 74.6% and 84.1% and were higher than those of Dmax modifications. The strongest independent predictor of EL was a volume change at 6 months {<=}0.3% (p = 0.005), although 6 of 19 (32%) patients with EL showed no significant AAA enlargement, whereas in 6 of 44 (14%) patients without EL the aneurysm enlarged. Conclusion. The lack of volume decrease in the aneurysm of at least 0.3% at 6 months follow-up indicates the need for closer surveillance, and has a higher predictive accuracy for an endoleak than Dmax.

  10. Graft Distortion After Endovascular Repair of Abdominal Aortic Aneurysm: Association with Sac Morphology and Mid-Term Complications

    SciTech Connect

    Gould, Derek Alan; Edwards, Richard David; McWilliams, Richard Gregory; Rowlands, Peter Christopher; Martin, Janis; White, Donagh; Fear, Simon; Bakran, Ali; Brennan, John; Gilling-Smith, Geoffrey; Harris, Peter Lyon

    2000-09-15

    Purpose: To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.Methods: EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.Results: Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p= 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.Conclusion: There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions.

  11. Conversion of failed hemiarthroplasty to total hip arthroplasty: A short to mid-term follow-up study

    PubMed Central

    Pankaj, Amite; Malhotra, Rajesh; Bhan, Surya

    2008-01-01

    Background: The conversion of hemiarthroplasty (unipolar or bipolar) of the hip to total hip replacement has been reported to be associated with very high rates of intra- and postoperative complications. We present a prospective analysis of the outcome of conversion surgery in patients with failed hemiarthroplasty. Materials and Methods: Forty-four cases, 30 women and 14 men, average age 62 years (range 42-75 years) of failed hemiarthroplasty were converted to total hip replacement between January 1998 and December 2004. Groin pain was the main presenting complaint in the majority of the patients (24 out of 44). Six patients had infection and were operated with staged procedure. All acetabular and the majority (86.5%) of femoral components used in our series were uncemented. Results: After an average follow-up of 6.4 years (range, two to nine years) Harris hip scores improved from 38 (range 15-62) preoperatively to 86 (range 38 to 100) and 22 (50%) patients were community ambulators without support while 17 (38%) needed minimal support of cane. Fifteen out of 18 (83%) patients who had isolated groin pain preoperatively experienced no pain postoperatively while three patients (17%) reported only partial improvement. Intraoperative and postoperative complications included iatrogenic fracture of the femur in two, femoral perforation in two, partial trochanteric avulsion in two, fracture of the acetabular floor in three hips, and postoperative dislocation in one. None of these complications resulted in a poor long-term outcome. The rate of loosening in our series was 2.3% (one out of 44) after a mean follow-up of 6.4 years with a mean survival of 97.4% at 72 months. Conclusion: Conversion of symptomatic hemiarthroplasty to total hip arthroplasty is a safe option that gives good functional results, with marginally higher rates of intra-operative complications. The patients should be warned of the possibility of incomplete relief of groin pain postoperatively. PMID:19753155

  12. Early to mid-term results of fixed-bearing total ankle arthroplasty with a modular intramedullary tibial component.

    PubMed

    Adams, Samuel B; Demetracopoulos, Constantine A; Queen, Robin M; Easley, Mark E; DeOrio, James K; Nunley, James A

    2014-12-03

    There has been a continuing increase in the use of total ankle arthroplasty for the treatment of end-stage ankle arthritis. Our aim was to determine the clinical, radiographic, and functional outcomes of total ankle arthroplasties done with a prosthesis with a modular intramedullary stem and intramedullary referencing to align the tibia. A consecutive series of patients who underwent total ankle arthroplasty with the INBONE Total Ankle Replacement from June 2007 to December 2010 were enrolled in this study. Pain and patient-reported function were assessed with use of a visual analog scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health Survey. Objective function was measured with assessment of walking speed, the Timed Up and Go (TUG) test, the Sit-to-Stand (STS) test, and the Four Square Step Test (4SST). Standardized weight-bearing radiographs obtained preoperatively and after total ankle arthroplasty were evaluated. We analyzed clinical, functional, and radiographic measurements with a series of repeated-measures analyses of variance (ANOVAs) with post-hoc testing to assess differences between preoperative, one-year postoperative, and most recent follow-up data. On the basis of the number of statistical comparisons, a Bonferroni correction was completed (alpha < 0.003). We identified 194 primary INBONE total ankle arthroplasties with a mean duration of clinical follow-up of 3.7 years (range, 2.2 to 5.5 years). Patients demonstrated a significant improvement (p < 0.003) in VAS pain, AOFAS, SMFA, and SF-36 scores at the time of final follow-up, compared with preoperative values, and in walking speed, STS time, TUG time, and 4SST time at two years postoperatively, compared with preoperatively. The mean coronal tibiotalar angle for varus and valgus ankles significantly improved postoperatively and was maintained until the time of final follow-up. The prevalence of unstable subsidence leading to impending failure was 5%, and the prevalence of revision was 6%. Patients who underwent total ankle arthroplasty with the INBONE Total Ankle Replacement demonstrated significant improvement in radiographic, functional, and patient-reported outcome scores at a mean of 3.7 years postoperatively. The overall implant survival rate was 89%. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

  13. THE POTENTIAL MID-TERM ROLE OF NUCLEAR POWER IN THE UNITED STATES: A SCENARIO ANALYSIS USING MARKAL

    EPA Science Inventory

    With all nations facing enormous challenges related to energy security, sustainability and environmental quality, nuclear power is likely to play an increasingly important role in the future. In particular, the life-cycle emissions of criteria pollutants and greenhouse gases (GHG...

  14. THE POTENTIAL MID-TERM ROLE OF NUCLEAR POWER IN THE UNITED STATES: A SCENARIO ANALYSIS USING MARKAL

    EPA Science Inventory

    With all nations facing enormous challenges related to energy security, sustainability and environmental quality, nuclear power is likely to play an increasingly important role in the future. In particular, the life-cycle emissions of criteria pollutants and greenhouse gases (GHG...

  15. [Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching].

    PubMed

    Hernández-Elena, J; de la Red-Gallego, M Á; Garcés-Zarzalejo, C; Pascual-Carra, M A; Pérez-Aguilar, M D; Rodríguez-López, T; Alfonso-Fernández, A; Pérez-Núñez, M I

    2015-01-01

    An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Mid-term and scaling effects of forest residue mulching on post-fire runoff and soil erosion.

    PubMed

    Prats, Sergio Alegre; Wagenbrenner, Joseph W; Martins, Martinho António Santos; Malvar, Maruxa Cortizo; Keizer, Jan Jacob

    2016-12-15

    Mulching is an effective post-fire soil erosion mitigation treatment. Experiments with forest residue mulch have demonstrated that it increased ground cover to 70% and reduced runoff and soil loss at small spatial scales and for short post-fire periods. However, no studies have systematically assessed the joint effects of scale, time since burning, and mulching on runoff, soil loss, and organic matter loss. The objective of this study was to evaluate the effects of scale and forest residue mulch using 0.25m(2) micro-plots and 100m(2) slope-scale plots in a burnt eucalypt plantation in central Portugal. We assessed the underlying processes involved in the post-fire hydrologic and erosive responses, particularly the effects of soil moisture and soil water repellency. Runoff amount in the micro-plots was more than ten-fold the runoff in the larger slope-scale plots in the first year and decreased to eight-fold in the third post-fire year. Soil losses in the micro-plots were initially about twice the values in the slope-scale plots and this ratio increased over time. The mulch greatly reduced the cumulative soil loss measured in the untreated slope-scale plots (616gm(-2)) by 91% during the five post-fire years. The implications are that applying forest residue mulch immediately after a wildfire can reduce soil losses at spatial scales of interest to land managers throughout the expected post-fire window of disturbance, and that mulching resulted in a substantial relative gain in soil organic matter. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Joining of ceramics for high performance energy systems. Mid-term progress report, August 1, 1979-March 31, 1980

    SciTech Connect

    Smeltzer, C E; Metcalfe, A G

    1980-10-06

    The subject program is primarily an exploratory and demonstration study of the use of silicate glass-based adhesives for bonding silicon-base refractory ceramics (SiC, Si/sub 3/N/sub 4/). The projected application is 1250 to 2050/sup 0/F relaxing joint service in high-performance energy conversion systems. The five program tasks and their current status are as follows. Task 1 - Long-Term Joint Stability. Time-temperature-transformation studies of candidate glass adhesives, out to 2000 hours simulated service exposure, are half complete. Task 2 - Environmental and Service Effects on Joint Reliability. Start up delayed due to late delivery of candidate glass fillers and ceramic specimens. Task 3 - Viscoelastic Damping of Glass Bonded Ceramics. Promising results obtained over approximately the same range of glass viscosity required for joint relaxation function (10/sup 7.5/ to 10/sup 9.5/ poise). Work is 90% complete. Task 4 - Crack Arrest and Crack Diversion by Joints. No work started due to late arrival of materials. Task 5 - Improved Joining and Fabrication Methods. Significant work has been conducted in the area of refractory pre-glazing and the application and bonding of high-density candidate glass fillers (by both hand-artisan and slip-spray techniques). Work is half complete.

  18. Mid-term outcome after curettage with polymethylmethacrylate for giant cell tumor around the knee: higher risk of radiographic osteoarthritis?

    PubMed

    van der Heijden, Lizz; van de Sande, Michiel A J; Heineken, Adriaan C; Fiocco, Marta; Nelissen, Rob G H H; Dijkstra, P D Sander

    2013-11-06

    It has been suggested that, when a patient has a giant cell tumor, subchondral bone involvement close to articular cartilage and a hyperthermic reaction from polymethylmethacrylate (PMMA) are risk factors for the development of osteoarthritis. We determined the prevalence, risk factors, and clinical relevance of osteoarthritis on radiographs after curettage and application of PMMA for the treatment of giant cell tumors around the knee. This retrospective single-center study included fifty-three patients with giant cell tumor around the knee treated with curettage and PMMA between 1987 and 2007. The median age at the time of follow-up was forty-two years (range, twenty-three to seventy years). There were twenty-nine women. Radiographic evidence of osteoarthritis was defined, preoperatively and postoperatively, as Kellgren and Lawrence grade 3 or 4 (KL3-4). We studied the influence of age, sex, tumor-cartilage distance, subchondral bone involvement (≤3 mm of residual subchondral bone), subchondral bone-grafting, intra-articular fracture, multiple curettage procedures, and complications on progression to KL3-4. Functional outcomes and quality of life were assessed with the Short Form-36 (SF-36), Musculoskeletal Tumor Society (MSTS) score, and Knee injury and Osteoarthritis Outcome Score (KOOS). After a median duration of follow-up of eighty-six months (range, sixty to 285 months), six patients (11%) had progression to KL3, two (4%) had progression to KL4, and one had preexistent KL4. No patient underwent total knee replacement. The hazard ratio for KL3-4 was 9.0 (95% confidence interval [CI] = 2.0 to 41; p = 0.004) when >70% of the subchondral bone was affected and 4.2 (95% CI = 0.84 to 21; p = 0.081) when the tumor-cartilage distance was ≤3 mm. Age, sex, subchondral bone-grafting, intra-articular fracture, multiple curettage procedures, and complications did not affect progression to KL3-4. Patients with KL3-4 reported lower scores on the KOOS symptom subscale (58 versus 82; p = 0.01), but their scores on the other KOOS subscales, the MSTS score (21 versus 24), and the SF-36 (76 versus 81) were similar to those for the patients with KL0, 1, or 2 (KL0-2). Seventeen percent of patients with giant cell tumor around the knee had radiographic findings of osteoarthritis after treatment with curettage and PMMA. A large amount of subchondral bone involvement close to articular cartilage increased the risk for osteoarthritis. The function and quality of life of the patients with KL3-4 were comparable with those for the patients with KL0-2, suggesting that radiographic findings of osteoarthritis at the time of intermediate follow-up had a modest clinical impact. Treatment with curettage and PMMA is safe for primary and recurrent giant cell tumors, even large tumors close to the joint. Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

  19. Looking Forward with LIFE: Literacy Initiative for Empowerment. Global LIFE Mid-Term Evaluation Report 2006-2011

    ERIC Educational Resources Information Center

    Hanemann, Ulrike

    2012-01-01

    The United Nations Educational, Scientific and Cultural Organization (UNESCO) launched the Literacy Initiative for Empowerment (2006-2015)--LIFE--to tackle the literacy challenge. This is a collaborative effort to accelerate literacy efforts in thirty five of the world's most challenged countries and thereby to unlock progress to reach all of the…

  20. Probabilistic seismic hazard at Mt. Etna (Italy): The contribution of local fault activity in mid-term assessment

    NASA Astrophysics Data System (ADS)

    Azzaro, R.; D'Amico, S.; Peruzza, L.; Tuvè, T.

    2013-02-01

    In this work, we tackle the problem of seismic hazard at Etna deriving from the recurrent seismogenic activity of local faults, by adopting two independent methods based on probabilistic approaches. We assess the hazard in terms of macroseismic intensity and represent the occurrence probability calculated for different exposure times both on maps and at fault scale. Seismic hazard maps obtained by applying the "site approach" through the SASHA code and a new probabilistic attenuation model, indicate the eastern flank of the volcano as the most hazardous, with expected intensity (Iexp) in 50 years (i.e. the standard exposure time adopted in the seismic regulations) ranging from degrees IX to X EMS. In shorter exposure periods (20, 10, 5 years), values of Iexp up to IX are also reached in the same area, but they are clearly determined by the earthquakes generated by the Timpe fault system. In order to quantify the contribution of local seismogenic sources to the hazard of the region, we reconstruct the seismic history of each fault and calculate with SASHA the probability that earthquakes of a given intensity may be generated in different exposure times. Results confirm the high level of hazard due to the S. Tecla, Moscarello and Fiandaca faults especially for earthquakes of moderate intensity, i.e. VI ≤ I0 ≤ VII, with probabilities respectively exceeding 50% and 20% in 10 years, and 30% and 10% in 5 years. Occurrence probability of major events (I0 ≥ VIII) at the fault scale has also been investigated by statistics on intertimes. Under stationary assumptions we obtain a probability of 6.8% in 5 years for each structure; by introducing the time-dependency (time elapsed since the last event occurred on each fault) through a BPT model, we identify the Moscarello and S. Tecla faults as the most probable sources to be activated in the next 5 years (2013-2017). This result may represent a useful indication to establish priority criteria for actions aimed at reducing seismic risk at a local scale.

  1. Mid-term results of interventional closure of patent foramen ovale with the Occlutech Figulla(®) Flex II Occluder.

    PubMed

    Neuser, Jonas; Akin, Muharrem; Bavendiek, Udo; Kempf, Tibor; Bauersachs, Johann; Widder, Julian D

    2016-11-10

    Patients with a patent foramen ovale (PFO) who suffered from stroke, TIA or peripheral paradoxical embolism are at substantial risk for recurrent neurologic events and in need for secondary prevention. Interventional closure of PFO has been performed for over 20 years. Numerous devices have been developed and used for treatment. We investigated PFO closure with the third generation Occlutech Figulla(®) Flex II Occluder device. Between 2012 and 2015 57 patients (mean age 47.3 ± 1.5 years) who had suffered from a thromboembolic event of unknown cause underwent transcatheter PFO closure with the Occlutech Figulla(®) Flex II Occluder at our department. 68.4 % of all patients had suffered from cryptogenic stroke, while TIA had occurred in 28.1 %. Almost all patients were diagnosed with an atrial septum aneurysm (90.9 %) and a severe right-to-left shunt grade 3: >20 microbubbles (92.0 %). Follow-up was done 6 months post intervention by clinical examination and transesophageal contrast echocardiography. No major periprocedural or in-hospital complication occurred. Closure was sufficient with no residual right-to-left shunt in 94.4 % of all patients at 6 months post implantation and only minimal residual shunt in three cases. There were no thrombotic formations associated to the occluder device. Atrial fibrillation occurred in one patient and a recurrent cerebral ischemic event was seen in one patient, who suffered from another TIA. The Occlutech Figulla(®) Flex II Occluder device and its delivery system is safe and provides sufficient closure of PFO in patients who suffered from cryptogenic stroke, TIA or paradoxical peripheral embolism.

  2. A novel design biodegradable stent for use in congenital heart disease: mid-term results in rabbit descending aorta.

    PubMed

    Veeram Reddy, Surendranath R; Welch, Tré R; Wang, Jian; Richardson, James A; Forbess, Joseph M; Riegel, Matthew; Nugent, Alan W

    2015-03-01

    This study evaluates the feasibility of delivery and deployment of low and medium molecular weight (LMW and MMW, respectively) double-opposing helical (DH) poly-l-lactic acid biodegradable stent (BDS) in rabbit descending aorta (DAO). Secondary objectives were to assess patency and inflammation of stented vessels at 9 months and to investigate safety following intentional embolization of stent fragments in DAO. A BDS that will relieve aortic obstruction and disappears as the child grows older allowing for preservation of aortic wall elasticity and natural growth of aorta will be ideal to treat Coarctation (CoA). BDS have never been evaluated in the DAO. Seven New Zealand white rabbits underwent implantation of DH-LMW (n = 7), DH-MMW (n = 3), and metal stents (n = 7) in DAO. BDS fragments were intentionally embolized into DAO in two rabbits. All stents were deployed via a 6-French sheath. Five BDS covered the origin of major DAO side branches. Angiography and intravascular ultrasound showed good stent apposition to the wall of DAO with minimal luminal loss at 9 months follow-up. All stents had minimal neointimal hyperplasia on histopathology. Adverse events included 1 death, 1 aortic aneurysm, and lower extremity ulceration due to self-mutilation in an embolization rabbit. Pilot study confirms the feasibility of delivery and deployment of up to 6-millimeter diameter DH BDS in rabbit DAO. Stent integrity with DH design was maintained at 9 months with minimal vessel inflammation. Potential morbidity due to embolized BD fragments cannot be ruled out and needs further evaluation. © 2014 Wiley Periodicals, Inc.

  3. Mid-term coral-algal dynamics and conservation status of a Gorgona Island (Tropical Eastern Pacific) coral reef.

    PubMed

    Zapata, Fernando A; Rodríguez-Ramírez, Alberto; Caro-Zambrano, Carlos; Garzón-Ferreira, Jaime

    2010-05-01

    Colombian coral reefs, as other reefs worldwide, have deteriorated significantly during the last few decades due to both natural and anthropogenic disturbances. The National Monitoring System for Coral Reefs in Colombia (SIMAC) was established in 1998 to provide long-term data bases to assess the changes of Colombian coral reefs against perturbations and to identify the factors responsible for their decline or recovery. On the Pacific coast, data on coral and algal cover have been collected yearly during seven consecutive years (1998-2004) from 20 permanent transects in two sites at La Azufrada reef, Gorgona Island. Overall, coral cover was high (55.1%-65.7%) and algal cover low (28.8%-37.5%) and both exhibited significant changes among years, most notably on shallow areas. Differences between sites in both coral and algal cover were present since the study began and may be explained by differences in sedimentation stress derived from soil runoff. Differences between depths most likely stem from the effects of low tidal sub-aerial exposures. Particularly intense sub-aerial exposures occurred repeatedly during January-March, 2001 and accounted for a decrease in coral and an increase in algal cover on shallow depths observed later that year. Additionally, the shallow area on the Northern site seems to be negatively affected by the combined effect of sedimentation and low tidal exposure. However, a decrease in coral cover and an increase of algal cover since 2001 on deep areas at both sites remain unexplained. Comparisons with previous studies suggest that the reef at La Azufrada has been more resilient than other reefs in the Tropical Eastern Pacific (TEP), recovering pre-disturbance (1979) levels of coral cover within a 10 year period after the 1982-83 El Niño, which caused 85% mortality. Furthermore, the effects of the 1997-98 El Niño, indicated by the difference in overall live coral cover between 1998 and 1999, were minor (< 6% reduction). Despite recurrent natural disturbances, live coral cover in 2004 was as high as that existing before 1982 at La Azufrada, and one of the highest observed on healthy coral reefs in the TEP region.

  4. Long- and Mid-Term Variations of the Soft X-ray Flare Type in Solar Cycles

    NASA Astrophysics Data System (ADS)

    Chertok, I. M.; Belov, A. V.

    2017-10-01

    Using data from the Geostationary Operational Environmental Satellites (GOES) spacecraft in the 1 - 8 Å wavelength range for Solar Cycles 23, 24, and part of Cycles 21 and 22, we compare mean temporal parameters (rise and decay times, and duration) and the proportion of impulsive short-duration events (SDE) and gradual long-duration events (LDE) among C- and ≥ M1.0-class flares. It is found that the fraction of the SDE ≥ M1.0-class flares (including spikes) in Cycle 24 exceeds that in Cycle 23 in all three temporal parameters at the maximum phase and in the decay time during the ascending cycle phase. However, Cycles 23 and 24 barely differ in the fraction of the SDE C-class flares. The temporal parameters of SDEs, their fraction, and consequently the relationship between the SDE and LDE flares do not remain constant, but reveal regular changes within individual cycles and during the transition from one cycle to another. In all phases of all four cycles, these changes have the character of pronounced, large-amplitude "quasi-biennial" oscillations (QBOs). In different cycles and at the separate phases of individual cycles, such QBOs are superimposed on various systematic trends displayed by the analyzed temporal flare parameters. In Cycle 24, the fraction of the SDE ≥ M1.0-class flares from the N- and S-hemispheres displays the most pronounced synchronous QBOs. The QBO amplitude and general variability of the intense ≥ M1.0-class flares almost always markedly exceeds those of the moderate C-class flares. The ordered quantitative and qualitative variations of the flare type revealed in the course of the solar cycles are discussed within the framework of the concept that the SDE flares are associated mainly with small sunspots (including those in developed active regions) and that small and large sunspots behave differently during cycles and form two distinct populations.

  5. Protocol liver biopsy is the only examination that can detect mid-term graft fibrosis after pediatric liver transplantation.

    PubMed

    Sanada, Yukihiro; Matsumoto, Koshi; Urahashi, Taizen; Ihara, Yoshiyuki; Wakiya, Taiichi; Okada, Noriki; Yamada, Naoya; Hirata, Yuta; Mizuta, Koichi

    2014-06-07

    To assessed the clinical significance of protocol liver biopsy (PLB) in pediatric liver transplantation (LT). Between July 2008 and August 2012, 89 and 55 PLBs were performed in pediatric patients at two and five years after LT, respectively. We assessed the histopathological findings using the Metavir scoring system, including activity (A) and fibrosis (F), and we identified factors associated with scores of ≥ A1 and ≥ F1. Our results clarified the timing and effectiveness of PLB. The incidences of scores of ≥ A1 and ≥ F1 were 24.7% and 24.7%, respectively, at two years after LT and 42.3% and 34.5%, respectively, at five years. Independent risk factors in a multivariate analysis of a score of ≥ A1 at two years included ≥ 2 h of cold ischemic time, no acute cellular rejection and an alanine amino transaminase (ALT) level of ≥ 20 IU/L (P = 0.028, P = 0.033 and P = 0.012, respectively); however, no risk factors were identified for a score of ≥ F1. Furthermore, no independent risk factors associated with scores of ≥ A1 and ≥ F1 at five years were identified using multivariate analysis. A ROC curve analysis of ALT at two years for a score of ≥ A1 demonstrated the recommended cutoff value for diagnosing ≥ A1 histology to be 20 IU/L. The incidence of scores of ≥ A2 or ≥ F2 at two years after LT was 3.4% (three cases), and all patients had an absolute score of ≥ A2. In contrast to that observed for PLBs at five years after LT, the incidence of scores of ≥ A2 or ≥ F2 was 20.0% (11 cases), and all patients had an absolute score of ≥ F2. In all cases, the dose of immunosuppressants was increased after the PLB, and all ten patients who underwent a follow-up liver biopsy improved to scores of ≤ A1 or F1. PLB at two years after LT is an unnecessary examination, because the serum ALT level reflects portal inflammation. In addition, immunosuppressive therapy should be modulated to maintain the ALT concentration at a level less than 20 IU/L. PLB at five years is an excellent examination for the detection of early reversible graft fibrosis because no serum markers reflect this finding.

  6. The Freedom SOLO valve: mid-term clinical results with a stentless pericardial valve for aortic valve replacement.

    PubMed

    Horst, Michael; Easo, Jerry; Hölzl, Philipp P F; Eichstaedt, Harald C; Kronberg, Kay; Nordmeyer, Peter; Dapunt, Otto E

    2011-11-01

    The study aim was to evaluate the Freedom SOLO pericardial stentless valve prosthesis implanted in a subcoronary or supra-annular position, using a single running suture, over a follow up period of up to five years. The clinical data obtained after aortic valve replacement (AVR) were analyzed retrospectively for validation. Between April 2004 and September 2009, a total of 143 patients (81 males, 62 females; mean age 71 +/- 7 years; range: 41-87 years) underwent primary AVR using the Freedom SOLO valve, implanted with a supra-annular subcoronary technique. Isolated AVR was performed on 120 patients, while 23 patients required additional surgery that included coronary artery bypass grafting (n = 5), ascending aorta replacement (n = 1), atrial fibrillation surgery (n = 9), and mitral valve repair (n = 1). Clinical investigations were performed before, during and after surgery; the follow up was 100% complete. A subgroup of patients (70%) was investigated echocardiographically during the follow up period to analyze the hemodynamic performance of the prosthesis. For all procedures the mean ischemia time was 66 +/- 15 min, and the mean cardiopulmonary bypass (CPB) time 88 +/- 20 min. For isolated AVR, the mean cross-clamp time was 65 +/- 14 min, and the mean CPB time 85 +/- 17 min. The predominant implanted valve size was 25 mm (42%). Operative mortality was 4.9% (7/143), with an overall mortality of 10.5% (15/143) at 4.7 years of follow up. The mean follow up was 1.8 +/- 1.4 years, and the total follow up 257 patient-years. At postoperative follow up the mean valve gradient was 10.6 mmHg, while the effective orifice area was 1.9 +/- 0.6 cm2 at one month and 1.9 +/- 0.6 cm2 at 12 months. The Freedom SOLO valve was implanted in a cohort of patients, using a simplified, supra-annular subcoronary technique, with no technical problems. Subsequently, the valve demonstrated an excellent clinical performance for up to five years. Further long-term follow up will be required to confirm the performance of the prosthesis with regards to structural and nonstructural valve stability.

  7. The mid-term and long-term solar quasi-periodic cycles and the possible relationship with planetary motions

    NASA Astrophysics Data System (ADS)

    Tan, Baolin; Cheng, Zhuo

    2013-02-01

    This work investigates the solar quasi-periodic cycles with multi-timescales and the possible relationships with planetary motions. The solar cycles are derived from long-term observations of the relative sunspot number and microwave emission at frequency of 2.80 GHz. A series of solar quasi-periodic cycles with multi-timescales are registered. These cycles can be classified into three classes: (1) the strong PLC (PLC is defined as the solar cycle with a period very close to the ones of some planetary motions, named as planetary-like cycle) which is related strongly with planetary motions, including nine periodic modes with relatively short period ( P<12 yr), and related to the motions of the inner planets and of Jupiter; (2) the weak PLC, which is related weakly to planetary motions, including two periodic modes with relatively long period ( P>12 yr), and possibly related to the motions of outer planets; (3) the non-PLC, for which so far there has been found no clear evidence to show the relationship with any planetary motions. Among the planets, Jupiter plays a key role in most periodic modes due to its sidereal motion or spring tidal motions associated with other planets. Among planetary motions, the spring tidal motion of the inner planets and of Jupiter dominates the formation of most PLCs. The relationships between multi-timescale solar periodic modes and the planetary motions will help us to understand the essential nature and prediction of solar activities.

  8. A thorough analysis of the short- and mid-term activity-related variations in the solar acoustic frequencies

    NASA Astrophysics Data System (ADS)

    Santos, A. R. G.; Cunha, M. S.; Avelino, P. P.; Chaplin, W. J.; Campante, T. L.

    2017-02-01

    The frequencies of the solar acoustic oscillations vary over the activity cycle. The variations in other activity proxies are found to be well correlated with the variations in the acoustic frequencies. However, each proxy has a slightly different time behaviour. Our goal is to characterize the differences between the time behaviour of the frequency shifts and of two other activity proxies, namely the area covered by sunspots and the 10.7-cm flux. We define a new observable that is particularly sensitive to the short-term frequency variations. We then compare the observable when computed from model frequency shifts and from observed frequency shifts obtained with the Global Oscillation Network Group (GONG) for cycle 23. Our analysis shows that on the shortest time-scales, the variations in the frequency shifts seen in the GONG observations are strongly correlated with the variations in the area covered by sunspots. However, a significant loss of correlation is still found. We verify that the times when the frequency shifts and the sunspot area do not vary in a similar way tend to coincide with the times of the maxima of the quasi-biennial variations seen in the solar seismic data. A similar analysis of the relation between the 10.7-cm flux and the frequency shifts reveals that the short-time variations in the frequency shifts follow even more closely those of the 10.7-cm flux than those of the sunspot area. However, a loss of correlation between frequency shifts and 10.7-cm flux variations is still found around the same times.

  9. Outcome of Kienbök’s disease in twelve cases: a mid-term follow-up study

    PubMed Central

    Gupta, Ravi; Pruthi, Manish; Kumar, Amit; Garg, Sudhir

    2014-01-01

    INTRODUCTION No single study has established the superiority of one treatment of Kienböck’s disease over the other. Pooled outcome data is presently considered the best way to add to the knowledge and understanding of Kienböck’s disease. METHODS A total of 12 patients (9 male and 3 female) with Kienböck’s disease were included in the present case series. The mean age of the 12 patients was 28 years. One patient presented in Lichtman stage I, five in Lichtman stage II, five in Lichtman stage IIIa, and one in Lichtman stage IV. Univariate and multivariate analyses of the obtained data were performed to identify any correlations. RESULTS The mean follow-up time was 62 months, and the mean modified Mayo wrist score improved from the preoperative value of 29.5 to the final value of 89.6. Lichtman stage at presentation showed moderate positive correlation with the duration of symptoms (r = 0.56), and a strong negative correlation with the preoperative and final modified Mayo scores (r = –0.89 and r = –0.77, respectively). The final modified Mayo score showed moderate negative correlation with the duration of the symptoms (r = –0.55). There was a significant difference in the preoperative modified Mayo scores of patients who presented in stage II and those of patients who presented in stage IIIa (p = 0.03). However, the difference in the final modified Mayo scores of the patients in these stages was not significant (p = 0.14). CONCLUSION Lichtman’s stage is moderately related to the duration of symptoms, suggesting natural progression of the disease. The final outcomes of stages II and IIIa were the same irrespective of the surgical treatment (radial shortening and/or vascularised bone grafting). PMID:25631969

  10. [A mid-term review of the Millennium Development Goals: where are we with the goals on health?].

    PubMed

    Kaddar, Miloud

    2009-01-01

    The eight Millennium Development Goals (MDGs) are the expressed commitment by world leaders to combat the most obvious forms of social inequality in the world: poverty, illiteracy and disease. The MDGs set health priorities and serve as markers of the most fundamental problems to solve: the maternal and child health high mortality, and the fight against major endemic diseases. Thus, health appears in three of the eight goals, and plays a decisive role in achieving the other MDGs such as the eradication of poverty and hunger, promotion of education and gender equality. While progress has been made in various domains and in numerous countries, enormous gaps and lack of funding remain. This is the case for infant mortality and HIV/AIDS, and even more so in the area of maternal mortality reduction especially in sub-Saharan Africa and Southeast Asia. The recent proliferation of forums and international partnerships for health have put at the forefront the targeted health-related MDG, increased financial resources for the benefit of poor countries but have made the architecture of global health even more fragmented and complex. Attempts to align on country priorities, needs and national health plans, and also to harmonize donors and partners' actions and funding according to the 2005 Paris Declaration principles, were difficult to actually materialize. The revitalization of primary health care and the strengthening of health systems are now back on the international and national health agenda.

  11. Does Previous Hip Surgery Effect the Outcome of Tönnis Triple Periacetabular Osteotomy? Mid-Term Results.

    PubMed

    Konya, Mehmet Nuri; Aydn, Bahattin Kerem; Yldrm, Timur; Sofu, Hakan; Gürsu, Sarper

    2016-03-01

    Hip dysplasia (HD) is 1 of the major reasons of coxarthrosis. The goal of the treatment of HD by Tönnis triple pelvic osteotomy (TPAO) is to improve the function of hip joint while relieving pain, delaying and possibly preventing end-stage arthritis. The aim of this study is to compare the clinical and radiological results of TPAO to determine if previous surgery has a negative effect on TPAO.Patients operated with TPAO between 2005 and 2010, included in this study. Patients divided into 2 groups: primary acetabular dysplasia (PAD) and residual acetabular dysplasia (RAD). Prepostoperatively, hip range of motion, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) hip score, visual analog scores (VAS), impingement tests, and also the presence of Trendelenburg sign (TS) were investigated for clinical evaluation. For radiological analysis pre-postoperative, anterior-posterior (AP) pelvis and faux profile radiographs were used. Acetabular index, lateral center edge (LCE) angle, and Sharp angles were measured by AP pelvis; anterior center edge (ACE) angle were measured by faux profile radiography. All the clinical and radiological data of the groups were analyzed separately for the pre-postoperative scores also the amount of improvement in all parameters were analyzed.SPSS20 (SPSS Inc., Chicago, IL) was used for statistical analysis. Wilcoxon test, McNemar test, paired t tests, and Mann-Whitney U tests were used to compare the groups. P < 0.05 were defined as statistically significant.Study included 27 patients: 17 patients were in PAD and 10 patients were in RAD. The mean follow-up period was 6.2 years (5.2-10.3 years). In all patients, the radiological and the clinical outcomes were better after TPAO except the flexion of the hip parameter. When the patient groups were evaluated as pre-postoperatively, more statistically significant parameters were found in the PAD group when compared with RAD group. Extension, impingement, TS, VAS, HHS, WOMAC score parameters in clinical outcome and LCE, ACE, Sharp angle, coverage ratio in radiological results were significantly better in PAD group postoperatively but in RAD group; only extension, VAS, HHS, and WOMAC parameters were clinically and LCE and Coverage ratio were significantly different compared with the preoperative measurements. The change of the parameters that used for the evaluation of clinical and radiological results did not show a significant difference between groups.Our data suggest that TPAO can be performed on patients with HD for both groups. Although there were fewer parameters which changed significantly after TPAO in RAD patients; the improvement of radiological and clinical results was similar for groups. Further long-term follow-up studies with large number of patients are needed to determine the proper results of TPAO.

  12. Mid-term evaluation of USAID (US Agency for International Development) Sudan Energy Planning and Management Project (650-0059)

    SciTech Connect

    Jones, D.W.; Stovall, J.P.; Raby, J.G.; Younger, D.R.; Pryor, C.A.

    1988-06-01

    In 1984, the United States Agency for International Development's mission in Sudan implemented the Energy Planning and Management Project to strengthen several key institutions in the energy sector of Sudan. One component of the project focused on improving management, billing and collection, pricing, purchasing and stores, and vehicle operation and maintenance in the National Electricity Corporation. The other major component was devoted to strengthening the capability of the National Energy Administration to conduct national energy planning studies, including the analysis of energy issues and policies and the recommendation of policies. Originally the planned date for the midterm evaluation of this project was early 1986, but because political turmoil and other events impeded implementation of the project, that evaluation was only conducted in January and February 1987. ORNL, at the request of the Sudan Mission and the office of Energy of AID, fielded a team in January 1987 to evaluate the progress of the project to that date and make recommendations for the remainder of the project's implementation. This study reports the findings and recommendations of the evaluation team regarding the Sudan Energy Management and Planning Project. 84 refs., 2 figs., 6 tabs.

  13. Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression.

    PubMed

    Romeo, Bruno; Choucha, Walid; Fossati, Philippe; Rotge, Jean-Yves

    2015-12-15

    Among treatments currently assessed in major depression, ketamine, has been proposed of great interest, especially because of its very rapid action. However, the time-course of the antidepressive action of ketamine remained unclear. In the present meta-analysis, we provided a clear and objective view regarding the putative antidepressive effect of ketamine and its time-course. We searched the MEDLINE and PsycINFO databases through December 2013, without limits on year of publication, using the key words ketamine and synonyms for mood disorder or episode. Six randomized, double-blind and placebo-controlled trials of ketamine in major depression (n=103 patients) were thus identified. Authors were contacted and they all provided original data necessary for this meta-analysis. Standardized mean differences (SMD) were calculated between the depression scores in ketamine and placebo groups at days 1, 2, 3-4, 7 and 14. Ketamine showed an overall antidepressive efficacy from day 1 to day 7. However, the maintenance of its efficacy over time failed to reach significance in bipolar depression after day 3-4. Significant SMDs were not explained by demographic or clinical characteristics of included samples. The present meta-analysis provides a high level of evidence that ketamine has a rapid antidepressive action during one week, especially in unipolar disorder.

  14. Modified semicircular constricting annuloplasty (Sagban's annuloplasty) in severe functional tricuspid regurgitation: alternative surgical technique and its mid-term results.

    PubMed

    Goksin, Ibrahim; Yilmaz, Arif; Baltalarli, Ahmet; Goktogan, Tayfun; Karahan, Nagihan; Turk, Ufuk Ali; Kara, Hakan; Sagban, Mansur

    2006-01-01

    De Vega annuloplasty is one of the most effective methods used in surgical correction of functional tricuspid regurgitation (FTR). Physiologic annular motions are protected by De Vega annuloplasty. However, recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon may be seen after De Vega annuloplasty as a result of gliding (jiggle) effect. The aim of this new annuloplasty was to prevent Bowstring phenomenon seen in De Vega annuloplasty. Twenty-five patients with severe FTR secondary to the left-sided valvular heart disease were included in this study. Modified semicircular constricting annuloplasty (Sagban's annuloplasty): The procedure is performed utilizing 0 and 2-0 polypropylene sutures. At first, 0 and 2-0 polypropylene sutures are fixed and knotted at anteroseptal and posteroseptal comissural regions (named as anchoring points). 2-0 Polypropylene sutures which come from anchoring points in clockwise and counterclockwise direction are used to encircle the free wall annulus as well as 0 polypropylene sutures in spiral fashion (spiral annulary suture technique). When both sutures get to the anteroposterior comissural region (tying point), they are passed through plastic snares. After the annuloplasty is completed, with the heart beating and the pulmonary artery clamped, competency of the valve is tested by injecting saline into the right ventricular chamber before the adjusting suture is tied. In this annuloplasty, 0 polypropylene sutures are used for reduction and constriction, 2-0 polypropylene sutures are used for the fixation of 0 polypropylene sutures in annular level. FTR improved totally in 16 patients (66.7%), 4 patients (16.7%) had first degree, 3 patients (12.5%) had second degree, and only 1 patient (4.2%) had third degree residual tricuspid regurgitation in an average follow-up period of 17.8 months. One patient died from low cardiac output in early postoperative period. There is no risk of recurrent regurgitation secondary to Bowstring phenomenon in this alternative annuloplasty technique and this annuloplasty is cost-effective and performed easily.

  15. [Mid-term evaluation on schistosomiasis control effect in Lushan earthquake-stricken areas in Sichuan Province].

    PubMed

    Liu, Yang; Xu, Bao-hua; Chen, Lin; Wu, Zi-song; Xiao, Zhi-yong; Wang, Chao-fu; Xie, Ming-kang; Zhang, Yi; Lu, Ding; Xu, Liang; Mao, Yong; Li, Rong-zhi; Yang, Yuh; Xu, Jia; Wan, Jia-jia; Qiu, Dong-chuan; Zhong, Bo

    2013-10-01

    To evaluate the effect of schistosomiasis control in Lushan earthquake-stricken areas in Sichuan Province, so as to provide the evidence for formulating appropriate measures for schistosomiasis prevention and control. According to the data of historical schistosomiasis prevalence, 5 villages were selected as research sites and field investigations were conducted. The average density of Oncomelania hupensis snails was 0.41 snails/0.1 m2, and there were no schistosome-infected snails. There were no acute schistosomiasis cases in these five villages. For local residents, the health education leaflets were more suitable than warning signs, and for migrant population, they were more concerned about the warning signs. After the implementation of effective prevention and control works, the epidemic risks of schistosomiasis have been controlled. However, the health education, surveillance, and prevention measures for schistosomiasis still need to be persisted in.

  16. Mid-term clinical results of total hip arthroplasty using a Wagner standard cup for dysplastic hip

    PubMed Central

    Maezawa, Katsuhiko; Nozawa, Masahiko; Yuasa, Takahito; Aritomi, Kentaro; Ogawa, Seiki; Maruyama, Yuichiro; Kaneko, Kazuo

    2014-01-01

    Background The outcome of cementless total hip arthroplasty depends on many factors. We must not forget fundamental things those are design of outer surface of the component, that leads bone ingrowth into the prosthesis, better initial stability, and better insertional techniques. The purpose of this study was to review our experience with metal-on-metal total hip arthroplasty with a Wagner standard cup for patients who had acetabular dysplasia. Patients and methods Fifty-four patients with 55 hips underwent primary metal-on-metal total hip arthroplasty (Metasul prosthesis) with a Wagner standard cup (44–48 mm in outer diameter) and were followed for a minimum of 10 years. All patients received the same type of cementless femoral component (Natural hip stem) and femoral head (28 mm in diameter). Results Seventeen of the 55 Wagner standard cups (30.9%) showed aseptic loosening over a mean period of 3.6 years after surgery, and there were no bone anchors on the outer surface of the 16 retrieved cups. Conclusion From our experience, the small Wagner standard cup does not achieve sufficient osteointegration and we do not recommend the use of this cup, especially for patients with acetabular dysplasia and/or those with a small stature. PMID:25561751

  17. Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up

    PubMed Central

    Breu, Anna-Katharina; Hauser, Till-Karsten; Ebner, Florian H.; Bischof, Felix; Ernemann, Ulrike; Seeger, Achim

    2016-01-01

    Flow diverters (FDs) are designed for the endovascular treatment of complex intracranial aneurysm configurations. From February 2009 to March 2013 28 patients (22 females, 6 males) were treated with FD; mean age was 57 years. Data, including aneurysm features, clinical presentation, history of previous bleeding, treatment, and follow-up results, are presented. Early postinterventional neurological deficits (transient: n = 3/enduring: n = 1) appeared in 4/28 patients (14%), and early improvement of neurological symptoms was observed in 7 patients with previous restriction of cranial nerve function. The overall occlusion rate was 20/26 (77%; 59% after 3 months). 77% achieved best results according to O'Kelly-Marotta score grade D with no contrast material filling (70% of those after 3 months). In 4/6 patients who did not achieve grade D, proximal and/or distal stent overlapping ≥5 mm was not guaranteed sufficiently. During follow-up we did not detect any aneurysm recurrence or haemorrhage. In-stent stenosis emerged as the most frequent complication (4/27; 15%) followed by 2 cases of vascular obliteration (AICA/VA). In conclusion endovascular reconstruction using a FD represents a modern and effective treatment in those aneurysms that are not suitable for conventional interventional or surgical treatment. The appearance of severe complications was rare. PMID:27006830

  18. Nutrition transition in Chile revisited: mid-term evaluation of obesity goals for the period 2000-2010.

    PubMed

    Vio, Fernando; Albala, Cecilia; Kain, Juliana

    2008-04-01

    To analyse the nutritional status component of the nutrition transition in Chile in relation to the evolution of obesity rates in all age groups until 2005, comparing these with the goals established by the Ministry of Health for the period 2000-2010. A descriptive study which includes data on the nutritional status of the Chilean population categorised by age. The data originate from: (1) institutions which administer nutritional programmes - the National Board for Day-Care Centres (JUNJI) and the National Board for School Assistance and Scholarships (JUNAEB); (2) the Ministry of Health and the National Institute of Statistics; and (3) epidemiological studies which include adolescents and the elderly. The prevalence of obesity in pre-school children attending JUNJI was 10.6% in 2005; by age group, it was 6% in 2-year-olds, 11% in 3-year-olds and 14% in 4-year-olds. Among schoolchildren in first grade, obesity prevalence was 18.5%. In pregnant women, obesity has increased from 12% in 1987 to 33% in 2004. For adults, the 2003 National Health Survey showed that the prevalence of obesity (body mass index (BMI) > or = 30 kg m-2) was 22% and of morbid obesity (BMI > or = 40 kg m-2), 1.3%. Obesity varied according to gender and educational level, being higher among women (25% vs. 19% in men) and adults from low socio-economic levels. In the elderly there was a high prevalence of obesity in the 60-64 years age group for both men (35.6%) and women (44.1%), decreasing to 18% and 26%, respectively, in those aged 75 years and older. The goals for the decade (2000-2010) consider a reduction of obesity rates from 10% to 7% in pre-school children attending JUNJI, and from 16% to 12% in schoolchildren attending first grade. For pregnant women, the goal is to reduce the prevalence from 32% to 28%. Despite the implementation of initiatives in nutrition and physical activity, these have been insufficient to shift the rising trend in obesity. The explanation could be that after a rapid rise in obesity in children and pregnant women between 1987 and 2000, a stabilisation period or a 'plateau' is observed. In that situation, very effective interventions are required to reduce obesity, because it is extremely difficult to reverse the trend. Some positive experiences are being implemented in Chile, but government priorities are not focused in health promotion. A comprehensive State Policy in health promotion, that includes the public and private sectors related with obesity, is needed to reverse this trend.

  19. Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women.

    PubMed

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Tomas, Andres; Llavero, Carolina; Arroyo, Antonio; Calero, Alicia; Martinez-Blasco, Amparo; Calpena, Rafael

    2012-05-01

    Despite routine supplementation of vitamins and minerals after bariatric surgery, an important number of patients suffer from deficiencies. Little is still known about the novel restrictive procedure, sleeve gastrectomy. A retrospective study of 30 morbidly obese patients undergoing a laparoscopic sleeve gastrectomy, between May 2008 and September 2010, was performed. Baseline albumin, ferritin, iron, zinc, calcium, vitamin D, parathormone (PTH), vitamin B12, and folic acid were obtained before operation and postoperative determinations 1, 3, 6, 9, 12, 18, and 24 months after surgery. Before surgery, 96.7% of the patients presented vitamin D deficiency, 20% had elevated PTH, 3.3% hypoalbuminemia, and 3.3% folic acid deficiency. One year after surgery, only one patient (3.3%) presented vitamin D deficiency and had elevated PTH. The rest of parameters were within normal range. The second year after surgery, the results remain similar. A significant difference was obtained when comparing preoperative vitamin D values and postoperative determinations 12 months after surgery (increase of 51.9 ng/dl, 95% confidence interval (CI) (41.8-61.3); p < 0.001). A significant difference was determined when comparing preoperative PTH values and postoperative determinations 3 months after surgery (decrease of 16.6 pg/ml, 95% CI (2.6-30.6); p = 0.03). A significant inverse correlation was observed between weight loss and vitamin D increase at the third month after surgery (Pearson correlation coefficient -0.948; p = 0.033). Postoperative values of vitamin D show a progressive increase, while PTH ones present a significant reduction, without any impact on serum calcium levels. We have demonstrated an inverse correlation between weight loss and vitamin D increase at the third month after surgery.

  20. What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

    PubMed

    Grammatopoulos, George; Wales, Jeremy; Kothari, Alpesh; Gill, Harinderjit S; Wainwright, Andrew; Theologis, Tim

    2016-05-01

    The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle < 25° and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software. The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54). Factors that influenced survival included joint congruency (100% versus 78%; 95% CI, 61%-96%; p = 0.03) and acetabular orientation correction achieved (AIpostoperative < 15° [100% versus 65%; 95% CI, 43-88; p < 0.001] and CEApostoperative 20° to 40° [100% versus 71.9%; 52.8-100; p < 0.001]). Better WOMAC scores were seen if postoperative AI < 15° (7 versus 25, p = 0.005) and CEA between 20° and 40° (7 versus 23, p = 0.005) were achieved. The chances of obtaining acetabular correction within this range improved after the 20(th) procedure (30% versus 70%, p = 0.008). This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. Level III, therapeutic study.

  1. The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up

    PubMed Central

    Pearsall, Albert W; Ibrahim, Khalid A; Madanagopal, Sudhakar G

    2007-01-01

    Background To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears. Methods Fifty-two patients underwent "mini-open" or all arthroscopic repair of a full thickness tear of the rotator cuff. Patients who complained of shoulder pain and/or weakness and who had failed a minimum of 6 weeks of physical therapy and had at least one sub-acromial injection were surgical candidates. Pre and post-operative clinical evaluations included the following: 1) demographics; 2) Simple Shoulder Test (SST); 3) University of California, Los Angeles (UCLA) rating scale; 4) visual analog pain assessment (VAS); and 5) pre-op SF12 assessment. Descriptive analysis was performed for patient demographics and for all variables. Pre and post outcome scores, range of motion and pain scale were compared using paired t-tests. Analysis of variance (ANOVA) was used to evaluate any effect between dependent and independent variables. Significance was set at p is less than or equal to 0.05. Results There were 31 females and 21 males. The average follow-up was 50.6 months (27 – 84 months). The average age was similar between the two groups [arthroscopic x = 55 years/mini-open x = 58 years, p = 0.7]. Twenty-seven patients underwent arthroscopic repair and 25 underwent repair with a mini-open incision. The average rotator cuff tear size was 3.1 cm (range: 1–5 centimeters). There was no significant difference in tear size between the two groups (arthroscopic group = 2.9 cm/mini-open group = 3.2 cm, p = 0.3). Overall, there was a significant improvement from pre-operative status in shoulder pain, shoulder function as measured on the Simple Shoulder test and UCLA Shoulder Form. Visual analog pain improved, on average, 4.4 points and the most recent Short Shoulder Form and UCLA scores were 8 and 26 respectively. Both active and passive glenohumeral joint range of motion improved significantly from pre-operatively. Conclusion Based upon the number available, we found no statistical difference in outcome between the two groups, indicating that either procedure is efficacious in the treatment of small and medium size rotator cuff tears. Level of Evidence Type III PMID:18053153

  2. DEBLICOM: Deaf-Blind Communication and Control Systems. Mid-Term Progress Report. Sept. 1, 1976 - Feb. 28, 1977.

    ERIC Educational Resources Information Center

    Kafafian, Haig; Gouge, James

    Described is the Deaf Blind Communications System (DEBLICOM), a somesensory coded information transfer system in which information is received cutaneously and transmitted kinesthetically. Reported is a pilot study done with 15 normal Ss (13- to 21-years-old) which compared communicative effectiveness of conventional temporal Morse code, spatial…

  3. Information Requirements for Supervisory Air Traffic Controllers in Support of a Mid-Term Wake Vortex Departure System

    NASA Technical Reports Server (NTRS)

    Lohr, Gary W.; Williams, Daniel M.; Trujillo, Anna C.; Johnson, Edward J.; Domino, David A.

    2008-01-01

    A concept focusing on wind dependent departure operations has been developed the current version of this concept is called the Wake Turbulence Mitigation for Departures (WTMD). This concept takes advantage the fact that cross winds of sufficient velocity blow wakes generated by "heavy" and B757 category aircraft on the downwind runway away from the upwind runway. Supervisory Air Traffic Controllers would be responsible for authorization of the Procedure. An investigation of the information requirements necessary to for Supervisors to approve monitor and terminate the Procedure was conducted. Results clearly indicated that the requisite information is currently available in air traffic control towers and that additional information was not required.

  4. Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients

    SciTech Connect

    Brandt, Michael Walluscheck, Knut P.; Jahnke, Thomas; Attmann, Tim; Heller, Martin; Cremer, Jochen; Mueller-Huelsbeck, Stefan

    2006-10-15

    Purpose. To analyze our experience with endovascular stent-grafting of descending aortic aneurysms in high-risk patients. Methods. Nineteen patients underwent endovascular stent-graft repair of descending aortic aneurysms using the Talent Stent Graft System (Medtronic). All patients were considered high-risk for open surgical repair due to their age, requirement for emergency surgery, and comorbidities. Computed tomography and/or MR tomography were performed at 3, 6 and 12 months postoperatively and thereafter every 12 months. Results. Secondary technical success was 100%. Thirty-day mortality was 5%. Incidence of postoperative stroke and paraplegia were 5% each. One patient required a second stent-graft due to a type I endoleak during the same hospital stay (primary technical success 95%). All patients have been followed for a median of 20 months. No migration, wire fractures or endoleak appeared during follow-up. Conclusion. Endovascular stent-grafting had a low 30-day mortality and morbidity in high-risk patients. One patient developed an aortoesophageal fistula 40 days after stent implantation. Stent-graft repair is a valuable supplement to surgical therapy in high-risk patients.

  5. Cutting Balloon Angioplasty Versus Standard Balloon Angioplasty for Failing Infra-inguinal Vein Grafts: Comparative Study of Short- and Mid-Term Primary Patency Rates

    SciTech Connect

    Vikram, Raghunandan; Ross, Rose A.; Bhat, Rajesh; Griffiths, Gareth D.; Stonebridge, Peter A.; Houston, J. Graeme; Chakraverty, S.

    2007-07-15

    Purpose. To evaluate the results of a recent change in practice in our institution using cutting balloon angioplasty instead of standard balloon angioplasty as the primary treatment for failing infra-inguinal vein bypass grafts. Methods. In this nonrandomized cohort study with a historical control, failing infra-inguinal vein grafts were identified at duplex surveillance or clinical examination. Patients had confirmatory arteriography and balloon angioplasty at the same attendance. Interventions proximal or distal to the graft itself and prosthetic grafts were not included. Patients were entered into a duplex graft surveillance program. Initial assessment of technical success was duplex or improvement 4-6 weeks after the primary angioplasty. Results. Twenty-seven consecutive patients were treated with standard balloon angioplasty, then 11 consecutive patients were treated with cutting balloon angioplasty. Initial technical success was 74% for the standard balloon versus 82% for the cutting balloon. The primary patency rate at 6 months was 16/26 (62%) for standard balloon angioplasty and 8/10 (80%) for cutting balloon angioplasty (p = 0.44). The primary patency rate at 12 months was 9/25 (36%) for standard balloon angioplasty and 5/10 (50%) for cutting balloon angioplasty (p = 0.47). Conclusion. The use of cutting balloons for primary angioplasty of infra-inguinal vein grafts offers no definite advantage over standard balloon angioplasty in this institution or compared with patency rates after standard balloon angioplasty reported elsewhere. Larger multicenter studies would be required to demonstrate whether there was any real difference between the two techniques.

  6. Monitoring and evaluation of the PAHO/WHO cooperation project, the Mais Médicos (More Doctors) Program: a mid-term assessment.

    PubMed

    Molina, Joaquín; Tasca, Renato; Suárez, Julio

    2016-09-01

    Working relations between the Pan- American Health Organization/World Health Organization (PAHO/WHO) and Brazilian health institutions accumulated a long history of cooperation with mutual benefits, which in many cases were shared with other nations under various cooperation frameworks among countries for health development. A milestone in this relationship is the technical cooperation provided by PAHO/WHO to the More Doctors Program (Programa Mais Médicos - PMM). This cooperation has added both strategic value in reducing gaps in health equality and has capitalized on the unique nature of the Cuba-Brazil South-South cooperation experience, triangulated through PAHO/WHO. This paper discusses PAHO/WHO's role in the evaluation of its technical cooperation within PMM. A Monitoring and Evaluation (M&E) Framework has been developed in order to progressively identify the advances in coverage and quality of primary health care provided by the Unified Health System (Sistema Único de Saúde - SUS) through the PMM. Special attention was given to identify best practices in health services, to analyze results and impacts of the PMM, and to manage and share knowledge that has been produced by its implementation, through a web-based knowledge platform. Some relevant results of PMM are briefly presented and discussed.

  7. Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft.

    PubMed

    Beirer, Marc; Banke, Ingo J; Harrasser, Norbert; Crönlein, Moritz; Pförringer, Dominik; Huber-Wagner, Stefan; Biberthaler, Peter; Kirchhoff, Chlodwig

    2017-03-29

    Treatment of clavicular non- and malunion is still challenging. Current surgical procedures often result in frustrating functional outcome along with high-grade subjective impairment and increased rates of revision surgery. However, the combination of biological augmentation with vital bone graft and a biomechanically sufficient fixation system seems to be a promising concept of treatment. In this retrospective study, 14 patients with a mean age of 44 years (26-67 years) suffering from non-union (n = 11) and/or malunion (n = 3) of the clavicle were enrolled. All patients were surgically treated using an anatomical precontoured locking compression plate (LCP) and autologous iliac crest bone graft. Functional outcome was assessed using the age- and sex-specific relative Constant Score. Mean follow-up was 27 months (range 12-44 months). The relative Constant Score significantly improved from preoperative 61 ± 8 (43-72) to 82 ± 10 (65-100) points at the final follow-up examination (p < 0.05). All patients showed bony union radiographically. One patient presented with a re-fracture of the clavicle nearly 3 years after revision surgery and 5 weeks after implant removal. Secondary fractures at the donor site of the anterior superior iliac spine were recorded in two patients. Iliac crest bone graft and anatomic locking plate fixation allow for a safe and adequate stabilization and radiographical bony union in non- and malunions of the clavicle with a high degree of patient satisfaction. However, secondary fractures of the anterior superior iliac spine constitute relevant complications and the time of hardware removal should be considered carefully.

  8. Mid-term Clinical Outcomes of Stand-alone Posterior Interbody Fusion with Rectangular Cages: A 4-year-minimum Follow-up

    PubMed Central

    Cho, Kyung Rae; Lee, Sun-Ho; Kim, Eun Sang

    2013-01-01

    Objective We sought to determine minimum 4 years of clinical outcomes including fusion rate, revision rate and complications of patients who underwent placement of rectangular stand-alone cages. Methods Thirty-three cases of degenerative spine that had been followed for at least 4-years were reviewed retrospectively. Cages were inserted at L4-L5 level or L5-S1 in 27 or in 6 cases respectively. Visual analogue scale (VAS), Odom's criteria, fusion rate, intervertebral disc height and lumbar lordosis were determined pre- and post-operatively on standing x-rays. Amount of intra- and postoperative blood loss, total volume transfused, duration of surgery and perioperative complications were also evaluated. Results The mean VAS score of back pain and sciatica were improved from 8.0 and 7.0 points to 3.4 and 2.4 during 1 years follow-up visit and the scores was raised gradually. Also, during the follow-up, 94% of patients showed excellent or good outcomes by the Odom's criteria. Intervertebral disc height was increased from 8.2±1.4mm to 9.2±1.9mm at the first year of follow-up, however, found to be decreased and stabilized to 8.3±1.8mm after 2 years. The fusion rate was approximately 91% after 4 year postoperative. The segmental angle of lordosis was increased significantly by two years but it was not maintained after four years. A statistically insignificant change in total lumbar lordosis was also observed. Three patients (9%) had experienced perioperative complications. Conclusion The use of rectangular stand-alone cages for posterior lumbar interbody fusion (PLIF) resulted in a various degree of subsidence and demonstrate very low complication rate, high functional stability and improved clinical outcomes in patients with degenerative lumbar disc disease. PMID:24757473

  9. Class III Mid-Term Project, "Increasing Heavy Oil Reserves in the Wilmington Oil Field Through Advanced Reservoir Characterization and Thermal Production Technologies"

    SciTech Connect

    Scott Hara

    2007-03-31

    The overall objective of this project was to increase heavy oil reserves in slope and basin clastic (SBC) reservoirs through the application of advanced reservoir characterization and thermal production technologies. The project involved improving thermal recovery techniques in the Tar Zone of Fault Blocks II-A and V (Tar II-A and Tar V) of the Wilmington Field in Los Angeles County, near Long Beach, California. A primary objective has been to transfer technology that can be applied in other heavy oil formations of the Wilmington Field and other SBC reservoirs, including those under waterflood. The first budget period addressed several producibility problems in the Tar II-A and Tar V thermal recovery operations that are common in SBC reservoirs. A few of the advanced technologies developed include a three-dimensional (3-D) deterministic geologic model, a 3-D deterministic thermal reservoir simulation model to aid in reservoir management and subsequent post-steamflood development work, and a detailed study on the geochemical interactions between the steam and the formation rocks and fluids. State of the art operational work included drilling and performing a pilot steam injection and production project via four new horizontal wells (2 producers and 2 injectors), implementing a hot water alternating steam (WAS) drive pilot in the existing steamflood area to improve thermal efficiency, installing a 2400-foot insulated, subsurface harbor channel crossing to supply steam to an island location, testing a novel alkaline steam completion technique to control well sanding problems, and starting on an advanced reservoir management system through computer-aided access to production and geologic data to integrate reservoir characterization, engineering, monitoring, and evaluation. The second budget period phase (BP2) continued to implement state-of-the-art operational work to optimize thermal recovery processes, improve well drilling and completion practices, and evaluate the geomechanical characteristics of the producing formations. The objectives were to further improve reservoir characterization of the heterogeneous turbidite sands, test the proficiency of the three-dimensional geologic and thermal reservoir simulation models, identify the high permeability thief zones to reduce water breakthrough and cycling, and analyze the nonuniform distribution of the remaining oil in place. This work resulted in the redevelopment of the Tar II-A and Tar V post-steamflood projects by drilling several new wells and converting idle wells to improve injection sweep efficiency and more effectively drain the remaining oil reserves. Reservoir management work included reducing water cuts, maintaining or increasing oil production, and evaluating and minimizing further thermal-related formation compaction. The BP2 project utilized all the tools and knowledge gained throughout the DOE project to maximize recovery of the oil in place.

  10. Osteochondritis dissecans of the elbow: excellent mid-term follow-up results in teenage athletes treated by arthroscopic debridement and microfracture

    PubMed Central

    Bojanić, Ivan; Smoljanović, Tomislav; Dokuzović, Stjepan

    2012-01-01

    Aim To extend the microfracture procedure, which has been proven successful on osteochondritis dissecans (OCD) lesions in the knee and ankle, to OCD lesions in the elbow. Methods Nine young patients were treated by arthroscopic debridement and microfracture by a single surgeon. The average age at operation was 15.0 years (median 15; range 12-19). The average length of the follow-up was 5.3 years (median 5; range 2-9). The follow-up included physical examination and patient interview with elbow function scoring. Success of treatment was determined according to pre-operative and follow-up Mayo Elbow Performance Index scores and the patients’ return to sports. Results Eight patients scored excellent results on the follow-up and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. Conclusions We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum. PMID:22351577

  11. Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience

    PubMed Central

    Briganti, Francesco; Leone, Giuseppe; Ugga, Lorenzo; Marseglia, Mariano; Macera, Antonio; Manto, Andrea; Delehaye, Luigi; Resta, Maurizio; Resta, Mariachiara; Burdi, Nicola; Nuzzi, Nunzio Paolo; Divenuto, Ignazio; Caranci, Ferdinando; Muto, Mario; Solari, Domenico; Cappabianca, Paolo; Maiuri, Francesco

    2017-01-01

    Background Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device. Methods 40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed. Results Complete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths. Conclusions Endovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis. PMID:27439887

  12. The Incidence and Predictors of Early- and Mid-Term Clinically Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients.

    PubMed

    Bosmans, Johan; Bleiziffer, Sabine; Gerckens, Ulrich; Wenaweser, Peter; Brecker, Stephen; Tamburino, Corrado; Linke, Axel

    2015-07-21

    Transcatheter aortic valve replacement (TAVR) enables treatment of high-risk patients with symptomatic aortic stenosis without open-heart surgery; however, the benefits are mitigated by the potential for neurological events. This study sought to determine the timing and causes of clinically relevant neurological events after self-expandable TAVR. We enrolled 1,015 patients, of whom 996 underwent TAVR with a self-expandable system at 44 TAVR-experienced centers in Europe, Colombia, and Israel. Neurological events were evaluated for 3 distinct time periods: periprocedural (0 to 1 days post TAVR); early (2 to 30 days); and late (31 to 730 days). In this real-world study, neurological events were first referred to the site neurologist and then reviewed by an independent neurologist. The overall stroke rate was 1.4% through the first day post-procedure, 3.0% at 30 days, and 5.6% at 2 years. There were no significant predictors of periprocedural stroke or stroke/transient ischemic attack (TIA) combined. Significant predictors of early stroke were acute kidney injury (p = 0.03), major vascular complication (p = 0.04), and female sex (p = 0.04). For stroke/TIA combined, prior atrial fibrillation (p = 0.03) and major vascular complication (p = 0.009) were predictive. Coronary artery bypass graft surgery was the only significant predictor of late stroke (p = 0.007) or late stroke/TIA (p = 0.06). Treatment of high-risk patients with aortic stenosis using a self-expandable system was associated with a low stroke rate at short- and long-term follow-up. Multivariable predictors of clinically relevant neurological events differed on the basis of the timing after TAVR. (CoreValve Advance International Post Market Study; NCT01074658). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation.

    PubMed

    Firestone, Rebecca; Rivas, Jorge; Lungo, Susana; Cabrera, Alejandra; Ruether, Susan; Wheeler, Jennifer; Vu, Lung

    2014-12-04

    Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program's effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks. PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage. Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10). PASMO's strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.

  14. Mid-Term Outcomes and Complications with Cementless Distal Locking Hip Revision Stem with Hydroxyapatite Coating for Proximal Bone Defects and Fractures.

    PubMed

    Carrera, Lluis; Haddad, Sleiman; Minguell, Joan; Amat, Carles; Corona, Pablo S

    2015-06-01

    We revised the first 100 revision total hip arthroplasties using a cementless distal locking revision stem conducted in our referral centre. Average follow-up was 9.2 years (range: 5.5-12 years). Harris Hip Score improved from 42.5 to 81.6, and none had thigh pain at last follow-up. No significant stress shielding, osteolysis, or radiologic loosening was found. All patients showed radiological evidence of secondary implant osseointegration. Overall survival was 97% with three patients being revised: two stem ruptures and one subsidence. We could trace these complications to technical errors. These findings suggest that a diaphyseal fixation of the revision stem with distal locking can provide the needed primary axial and rotational stability of the prosthesis. This would allow further bony ingrowth, enhanced by the hydroxyapatite coating.

  15. Mid-term results of small-sized St. Jude Medical Regent prosthetic valves (21 mm or less) for small aortic annulus.

    PubMed

    Mizoguchi, Hiroki; Sakaki, Masayuki; Inoue, Kazushige; Iwata, Takashi; Tei, Keikou; Miura, Takuya

    2013-11-01

    Prosthesis-patient mismatch (PPM) is always of concern when performing aortic valve replacement (AVR) in patients with a small aortic annulus. Although bioprosthetic AVR is preferred in patients older than 65 years, we have experienced cases in elderly patients with a small aortic annulus whereby we could not implant small-sized bioprosthetic valves. We have implanted St. Jude Medical Regent (SJMR) mechanical valves (St. Jude Medical, St. Paul, MN, USA) as necessary, even in elderly patients with no aortic annulus enlargement. We investigated our experiences of AVR with SJMR mechanical valves of 21 mm or less in size. Between January 2006 and December 2009, 40 patients underwent AVR with SJMR mechanical valves ≤21 mm in size: 9 patients received 21-mm valves, 19 received 19-mm valves, and 12 received 17-mm valves. The mean age was 65.9 ± 9.5 years, and 25 patients (62.5 %) were 65 years or older. We evaluated the clinical outcome and the echocardiographic data for each valve size. There was no operative or hospital mortality. The mean duration of clinical follow-up was 31.2 ± 17.6 months. During follow-up, there were no hospitalizations due to heart failure. The cumulative valve-related event-free survival was 93 % at 33 months, and the cumulative hemorrhagic event-free survival was 93 % at 33 months and 84 % at 43 months, using the Kaplan-Meier method. At follow-up, the mean values of the measured effective orifice area (EOA) for the 21-, 19-, and 17-mm prostheses were 2.00 ± 0.22, 1.74 ± 0.37, and 1.25 ± 0.26 cm(2), and the mean measured EOA index (EOAI) were 1.17 ± 0.12, 1.11 ± 0.21 and 0.90 ± 0.22 cm(2)/m(2), respectively. A PPM (EOAI ≤0.85) was documented in 5 patients, all of whom had received a 17-mm SJMR valve. AVR with SJMR valves of 21 mm or less in size appears to show satisfactory clinical and hemodynamic results.

  16. Mid-term variation of vertical distribution of acid volatile sulphide and simultaneously extracted metals in sediment cores from Lake Albufera (Valencia, Spain).

    PubMed

    Hernández-Crespo, Carmen; Martín, Miguel

    2013-11-01

    Lake Albufera is one of the most eutrophic bodies of water in Spain due to point and diffuse pollution over past decades, and its sediments are likely to be anoxic because of high organic matter flux. Hence, sulphides can play an important role in limiting the mobility of heavy metals. This study aimed to study the vertical variation of acid volatile sulphide (AVS) and simultaneously extracted metals (SEM) in sediment cores collected from Lake Albufera; other sediment characteristics, such as organic matter, biochemical oxygen, demand or total metals, were also studied. Three sites were selected, and four sampling campaigns were performed to study spatial and temporal variation as well as to obtain information regarding historical variation in the composition of sediments. AVS and SEM were analysed by the purge-and-trap method. The vertical distribution of AVS and SEM varied depending on the sampling site-concentrations of AVS and SEM were higher at sites close to mouths of inflowing channels. A decreasing trend of AVS has been found at these sites over time: In the two first samplings, AVS increased with depth reaching maximum concentrations of 40 and 21 μmol g(-1), but from then on AVS were lower and decreased with depth. SEM decreased with depth from 3 μmol g(-1) in surface layers to approximately 1 μmol g(-1) at deeper segments at these sites. However, the central site was more uniform with respect to depth as well as with time; it presented lower values of SEM and AVS (mean 0.9 and 2.0 μmol g(-1) respectively), and the maximum value of AVS (7 μmol g(-1)) was found at the top layer (0-3 cm). According to the (SEM-AVS)/fOC approach, every site, and throughout the cores, can be classified as containing nontoxic metals because the values were <130 μmol g(-1).

  17. Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study

    PubMed Central

    Albers, Anthony; Carli, Alberto; Routy, Bertrand; Harvey, Edward J.; Séguin, Chantal

    2015-01-01

    Background Nontraumatic osteonecrosis of the femoral head (ONFH) is a progressive disease in young adults producing substantial morbidity and frequently resulting in total hip arthroplasty. Although hip-preserving surgical procedures represent the current mainstay of treatment for early disease, medical therapies targeting specific pathways in the ONFH pathogenesis could help prevent disease progression while producing less morbidity. Acetylsalicylic acid (ASA) is a promising alternative to other therapies for ONFH owing to its anti-inflammatory and antithrombotic mechanisms of action and its relatively benign side effect profile. Methods We followed a prospective cohort of 10 patients (12 hips) with precollapse ONFH who were given ASA to prevent disease progression. Their outcomes were compared with those of a historic control group taken from the literature. Results Progression occurred in 1 of 12 (8%) patients taking ASA compared with 30 of 45 (66.6%) controls (p = 0.002) at a mean follow-up of 3.7 years. Patients taking ASA also tended to exhibit decreased femoral head involvement at the end of therapy. Conclusion This hypothesis-generating study leads us to believe that ASA may be a simple and effective treatment option for delaying disease progression in patients with early-stage ONFH. PMID:26011853

  18. An emerging view of the crust and mantle of tectonic North America from EMScope: a mid- term progress review of Earthscope's magnetotelluric program

    NASA Astrophysics Data System (ADS)

    Schultz, A.; Bedrosian, P.; Evans, R.; Egbert, G.; Kelbert, A.; Mickus, K.; Livelybrooks, D.; Park, S.; Patro, P.; Peery, T.; Wannamaker, P.; Unsworth, M.; Weiss, C.; Woodward, B.

    2008-12-01

    EMScope, the MT component of the Earthscope project has completed its final year of infrastructure construction, and its third annual campaign of regional magnetotelluric array operations in the western USA. Seven semi-permanent "backbone" MT observatories have been installed in California, Oregon, Montana, New Mexico, Minnesota, Missouri and Virginia, designed through installation in 2 m deep, insulated underground vaults and with long, buried electric dipole detectors using stable electrodes, to provide extremely long-period magnetotelluric data meant to provide a set of regional, deep structural "anchor points" penetrating into the mid-mantle, in which a series of denser and more uniform regional, transportable MT networks can be tied. A total of 160 "transportable array" MT stations have been occupied in Oregon, Washington, Idaho, northernmost-California, and Montana. These were located on a 70 km quasi-regular grid, with coverage of Cascadia, parts of the Basin and Range, the Rockies and the Snake River Plain, the zone above a putative mantle plume that is hypothesized to serve as the magma source for both the Yellowstone supervolcano and a chain of volcanic features extending westward into Oregon. It is anticipated that in 2009 the transportable array will sweep eastward through the Yellowstone region, following which a set of regional transects at sites of special geodynamic interest will be staged. The transportable array stations are typically occupied for three weeks, providing MT response functions extending from 2-10,000 s or in cases as great as 20,000 s period. These stations are anchored at longer periods (extending as close to 100,000 s periods as possible) by the network of 7 backbone stations, to be operated continuously for up to five years. We present an initial set of 3-d inverse models from the EMScope data sets There is substantial coherence between the resulting 3-d conductivity model and the known boundaries of major physiographic provinces, as well as seismically delineated mid-to-lower crustal and upper mantle features. A combination of telemetry from backbone stations and frequent batch transmission of data from the transportable array field sites, followed by rapid data quality control procedures and generation of MT response functions provides a data set of use to all interested researchers. All EMScope data are made available freely through the IRIS Data Management Center or via the EMScope data portal. For transportable array sites these data are available typically within two weeks of acquisition.

  19. The Mid-Term Clinical Follow-Up Using Drug-Eluting Balloons on Tibial Artery "De Novo" Lesions in Patients With Critical Limb Ischemia: A Cohort Study.

    PubMed

    Tolva, Valerio; Casana, Renato; Huibers, Anne; Parati, Gianfranco; Bianchi, Paolo; Cireni, Lea; Ferrero, Emanuele; Halliday, Allison

    2016-07-01

    Restenosis due to intimal hyperplasia (IH) is a major clinical issue that affects the success of lower limb endovascular surgery. After 1 year, restenosis occurs in 40% to 60% of the treated vessels. The possibility to reduce IH using local antiproliferative drugs, such as taxols, has been the rationale for the clinical applications of drug-eluting stents and drug-eluting balloons (DEBs). The purpose of this study was to evaluate the clinical and instrumental efficacy of DEBs versus simple percutaneous transluminal angioplasty (PTA) in patients affected by chronic limb ischemia (CLI) with tibial artery "de novo" lesions. A retrospective analysis was performed and included all consecutive patients who underwent endovascular treatment for CLI in our centers between January 2011 and March 2013. Inclusion criteria were (1) "de novo" tibial artery stenosis and (2) Rutherford class >4. Lesions were further divided by TransAtlantic Inter-Societal Consensus (TASC) classification into groups A, B, C, and D. Between January 2010 and March 2013, a total of 138 patients underwent simple PTA or DEB for CLI, and the groups were clinically and demographically homogenous. We decided to use DEBs in 70 cases. An improvement in the Rutherford Scale in cumulative and single TASC lesions classification was better in the DEB group (74% vs 51%; P = .024) at 24 months than in the PTA group. In the DEB group, the increase in ankle-brachial index was significantly higher than in the PTA group (P = .039). Our experience in addition to the existing literature supports the use of DEB in patients with CLI Rutherford class >3. © The Author(s) 2016.

  20. Radiofrequency ablation of the great saphenous vein with the ClosureFAST™ procedure: mid-term experience on 400 patients from a single centre.

    PubMed

    Tolva, Valerio S; Cireni, Lea V; Bianchi, Paolo G; Lombardo, Almarosa; Keller, Guido C; Casana, Renato M

    2013-07-01

    Endovascular obliteration of the great saphenous vein (GSV) has been proposed as an alternative to conventional extirpative treatment of varicose veins. This report reviewed the initial experience with the ClosureFAST™ procedure in 407 legs over a one-year period. Occlusion of the GSV was seen on 98 % of completion scans and in all patients within 1 week of the procedure. Persistent occlusion was documented in all cases. One had paresthesias and one had skin pigmentation. Three patients had transient superficial thrombophlebitis in a treated segment of a superficial collateral of the GSV. One patient was found to have extension of an asymptomatic, nonocclusive thrombus into the common femoral vein 1 week after the procedure. Radiofrequency ablation of the GSV appears to be a safe alternative to conventional stripping and ligation. Randomised clinical trials and longer follow-up periods are required to establish the overall superiority of the procedure in comparison to conventional stripping.

  1. Prospective Developments in Western Europe and in the Northwest Indian-Ocean Region. A Study of Selected Mid-Term Problems in U.S. Foreign Policy,

    DTIC Science & Technology

    1975-02-01

    they are not simply interdisciplinary In the conventional sense of the term, that is, taking account of separate political, economic, psychological ...F-2 T in psychological processes and expressed In interpersonal relations, insti- tutional patterns and rriterial, aesthetic and intellectual...But, whereas Italy has few, if any, political and psychological inhibitions about accepting official financial assistance from other OECD countries

  2. New Challenges: The Civil Rights Record of the Clinton Administration Mid-Term. Report of the Citizens' Commission on Civil Rights.

    ERIC Educational Resources Information Center

    Yu, Corrine M., Ed.; Taylor, William L., Ed.

    This report is the work of the Citizens' Commission on Civil Rights, a bipartisan group of former federal officials with responsibility for equal opportunity. Part 1 contains three chapters: (1) "Introduction"; (2) "Executive Summary and Review"; and (3) "Recommendations of the Commission." Part 2 contains the…

  3. Mid-Term Outcomes of Single-Port versus Conventional Three-Port Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

    PubMed Central

    Jung, Hanna; Oh, Tak Hyuk; Cho, Joon Yong; Lee, Deok Heon

    2017-01-01

    Background The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. Methods Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. Results The mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. Conclusion No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP. PMID:28593154

  4. Acute kidney injury after cardiac surgery is associated with mid-term but not long-term mortality: A cohort-based study

    PubMed Central

    Ferreiro, Alejandro

    2017-01-01

    Acute kidney injury (AKI) in cardiac surgery is associated with complications, early and late mortality and increased health care expenditures. The overall dynamic comorbidity-adjusted contributions of an episode of AKI on mortality during long-term follow-up have not been fully explored. A longitudinal cohort of 7075 adult patients admitted for cardiac surgery were enrolled in the study. Follow-up data were obtained through telephonic survey after 1, 5, 10, and 15 years or from the National Mortality Registry. All-cause mortality was assessed at five time intervals: I) 30 days after surgery to 1 year; II) 1 to 3 years; III) 3 to 5 years; IV) 5 to 10 years; and V) 10 to 15 years. For the adjustment of mortality for comorbidity and pre-, intra- and postoperative variables, Cox proportional hazard regression models were conducted within each period. The overall incidence of AKI was 36.1%. AKI was an independent predictor of death only during the first five years after surgery (30 days to 1 year: HR 1.834, 95% CI 1.459 to 2.306; 1 to 3 years: HR 1.285, 95% CI 1.023 to 1.610; and 3 to five years: HR 1.330, 95% CI 1.123 to 1.750). Only age, diabetes mellitus and CHF were associated with increased risk of death over the entire follow-up period. Our study demonstrates a transient association of AKI with long-term mortality that progressively decreases and vanishes five years after surgery. The knowledge of this dynamic is crucial to understanding this complex association, planning health care and allocating resources. PMID:28700753

  5. Low Educational Status and Childhood Obesity Associated with Insufficient Mid-Term Weight Loss After Sleeve Gastrectomy: a Retrospective Observational Cohort Study.

    PubMed

    Dilektasli, Evren; Erol, Mehmet Fatih; Cayci, Haci Murat; Ozkaya, Guven; Bayam, Mehmet Emrah; Duman, Ugur; Tihan, Necdet D; Erdogdu, Umut; Kisakol, Gurcan

    2017-01-01

    Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: <%50EWL (insufficient WL) and group 2: ≥%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed. In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 ± 15.4 and 58.2 ± 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045). Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population.

  6. Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using (90)Yttrium resin-microspheres.

    PubMed

    Jakobs, Tobias F; Hoffmann, Ralf-T; Poepperl, Gabriele; Schmitz, Anna; Lutz, Jürgen; Koch, Walter; Tatsch, Klaus; Lubiensky, Andreas; Reiser, Maximilian F; Helmberger, Thomas

    2007-05-01

    The purpose was to determine the response and survival and to analyse the feasibility of single-session, whole-liver SIRT in patients with non-resectable, otherwise non-responding liver cancer. Thirty-nine patients qualified for SIRT. Eighteen patients suffered from colorectal-cancer metastases (CRC), breast-cancer metastases (MBC, 7), HCC (5) and other tumours (9). Response was assessed by tumour-markers and CT-imaging. At 2-4, 5-7 and 8-9 months follow-up in 3/17, 5/15 and 5/10 of CRC-patients CEA-levels were higher than before. In the MBC group 1-3 and 4-6 months after SIRT tumour-marker-levels were higher in 2/6 and 3/3 patients, respectively. In all HCC-patients AFP-levels dropped 1-3 months after SIRT. Using RECIST, in the CRC-group progressive liver disease (PD) was found in 4/17, 2/12, 2/10 and 2/5 patients at 2-4, 5-8, 9-10 and 12-14 months follow-up. Concerning MBC, after 3 months 7/7 patients presented with stable-disease (SD) or partial-response (PR). At 5-6 months, 1/5 patients showed PD. All HCC-patients showed SD/PR at 2-3 months with no PD at 5-8 months. In the mixed-group 5/6 patients presented with SD/PR at 3-4 months and with SD in 2/3 patients at 5-6 months. The median time-to-PD was 6.5, 8.5 and 8 months for the CRC-, MBC- and mixed-group, respectively. SIRT is a promising, liver-targeted approach for patients with otherwise treatment-refractory liver tumours.

  7. The short- to mid-term symptom prevalence of dumping syndrome after primary gastric-bypass surgery and its impact on health-related quality of life.

    PubMed

    Emous, Marloes; Wolffenbuttel, Bruce H R; Totté, Eric; van Beek, André P

    2017-04-28

    Early and late dumping are complications of gastric bypass surgery. Early dumping occurs within an hour after eating, when the emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and the release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs between 1 and 3 hours after carbohydrate ingestion and is caused by an exaggerated insulin release, resulting in hypoglycemia. Almost no data are currently available on the prevalence of early and late dumping or their impact on health-related quality of life (QoL). To study the prevalence of early and late dumping in a large population of patients having undergone a primary Roux-en-Y gastric bypass (RYGB) and its effect on QoL. Cross-sectional study at a single bariatric department in the Medical Center Leeuwarden, The Netherlands between 2008 and 2011. In 2013, this descriptive cohort study approached by email or post all patients who underwent a primary RYGB in the setting between 2008 and 2011 in one hospital. These patients were asked to fill in standardized questionnaires measuring their QoL (RAND-36), anxiety and depression (HADS), fatigue (MFI-20) and any disease specific indicators of early and late dumping syndrome. The questionnaire was completed and returned by 351 of 613 patients (57.1%) and 121 nonobese volunteers. Participants were mostly female (80%), aged 42 (40-54 years), with an excess weight loss of 76.8% [IQR 61-95] after RYGB surgery 2.3 [ IQR 1.6-3.4] years earlier. Self-reported complaints of moderate to severe intensity suggestive of early and late dumping were present in 18.8% and 11.7% of patients, respectively. Patients with early and late dumping demonstrated significantly lower scores on the RAND-36 and HADS compared with patients without dumping. No differences were seen in the MFI-20 scores between patients with or without early and late dumping. In this descriptive cohort, self-reported complaints suggestive of early and late dumping of moderate-to-severe intensity were, respectively, 18.8% and 11.7% in a cohort after primary gastric bypass surgery. These complaints were associated with markedly reduced health-related QoL. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Assessment of mid-term growth assumptions and learning rates for comparative studies of CSP and hybrid PV-battery power plants

    NASA Astrophysics Data System (ADS)

    Breyer, Christian; Afanasyeva, Svetlana; Brakemeier, Dietmar; Engelhard, Manfred; Giuliano, Stefano; Puppe, Michael; Schenk, Heiko; Hirsch, Tobias; Moser, Massimo

    2017-06-01

    The main objective of this research is to present a solid foundation of capex projections for the major solar energy technologies until the year 2030 for further analyses. The experience curve approach has been chosen for this capex assessment, which requires a good understanding of the projected total global installed capacities of the major solar energy technologies and the respective learning rates. A literature survey has been conducted for CSP tower, CSP trough, PV and Li-ion battery. Based on the literature survey a base case has been defined for all technologies and low growth and high growth cases for further sensitivity analyses. All results are shown in detail in the paper and a comparison to the expectation of a potentially major investor in all of these technologies confirmed the derived capex projections in this paper.

  9. Does Family Make a Difference? Mid-Term Effects of a School/Home-Based Intervention Program to Enhance Reading Motivation

    ERIC Educational Resources Information Center

    Villiger, Caroline; Niggli, Alois; Wandeler, Christian; Kutzelmann, Sabine

    2012-01-01

    This study examined the effects of a school/home-based intervention program designed to enhance the reading motivation and comprehension of Swiss fourth graders (N = 713). In order to identify the specific contribution of the home environment, the program was implemented in one group "without" (N = 244) and in one group "with"…

  10. Arthroscopic release of iliopsoas tendon in patients with femoro-acetabular impingement: clinical results at mid-term follow-up

    PubMed Central

    Mardones, Rodrigo; Via, Alessio Giai; Tomic, Alexander; Rodriguez, Claudio; Salineros, Matias; Somarriva, Marcelo

    2016-01-01

    Summary Background The iliopsoas tendon is a recognized cause of extra-articular hip pain, and tenotomy has been described as an effective treatment in patients who do not respond to conservative treatments. Endoscopic release showed higher success rate, lower recurrence, fewer complications compared to open surgery. The aim of the study is to report the results at a mean of 4 years follow-up of a series of patients affected by femoroacetabular impingement (FAI) and an associated iliopsoas tendinopathy, treated with hip arthroscopy and transcapsular tendon release. Methods Fifteen patients were retrospectively reviewed. Assessment of radiographic signs of FAI was performed, the alpha angle, the femoral head-neck offset and the lateral center edge angle (LCEA) were collected. Osteoarthritis was assessed from the AP pelvic and graded according to the Tönnis classification. Modified Harris Hip Score (mHHS), VAIL score and VAS score were administered to all patients before surgery, at follow-up at 1 year (T1) and final follow-up (T2). Results We found a statistical significant improvement in functional scores (mHHS and VAIL score) from the baseline to T2. According to VAS score, a statistical significant improvement was also found from T0 to T2, from a median of 5.5 (range 3–7) to 0 (range 0–5) (P<0.001). Two patients referred a recurrence of pain one year after surgery who were treated conservatively. No other complications have been reported. Conclusion Iliopsoas tendinopathy can be associated to FAI in some patients, and failure in diagnosing and treating may be the reason of poor results and a revision surgery. Arthroscopic iliopsoas tendon release seems to produce good clinical outcome, reducing pain and the rate of a revision surgeries. Level of evidence: IV case series. PMID:28066744

  11. MID TERM RESULTS AFTER OPEN HEART SURGERY IN HEMODIALYSIS PATIENTS AWAITING KIDNEY TRANSPLANT: DOES CARDIOVASCULAR SURGICAL INTERVENTION PRIOR TO TRANSPLANTATION PROLONG SURVIVAL?

    PubMed

    Ozbek, C; Sever, K; Demirhan, O; Mansuroglu, D; Kurtoglu, N; Ugurlucan, M; Sevmis, S; Karakayali, H

    2015-12-01

    The aim of this study was to compare the mid and long term postoperative outcomes between the hemodialysis-dependent patients awaiting kidney transplantat who underwent open heart surgery in our department during the last five years, and those who did not receive a renal transplant, to determine the predictors of mortality, and assess the possible contribution of post heart surgery kidney transplantation to survival. The patients were separated into two groups: those who underwent a transplantation after open heart surgery were included in the Tp+ group, and those who did not in the Tp- group Between June 2008 and December 2012, 127 dialysis dependent patients awaiting kidney transplant and who underwent open heart surgery were separated into two groups. Those who underwent transplantation after open heart surgery were determined as Tp+ (n=33), and those who did not as Tp- (n=94). Both groups were compared with respect to preoperative paramaters including age, sex, diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), obesity, smoking, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), left ventricle ejection fraction (EF), Euroscore; operative parameters including cross clamp time, perfusion time, number of grafts, use of internal mammary artery (IMA); postoperative parameters including revision, blood transfusion, ventilation time, use of inotropic agents, length of stay in the intensive care unit and hospital, and follow up findings. Problems encountered during follow up were recorded. Predictors of mortality were determined and the survival was calculated. Among the preoperative parameters, when compared with the Tp- group, the Tp+ group had significantly lower values in mean age, presence of DM, obesity, PVD, and Euroscore levels, and higher EF values. Assessment of postoperative values showed that blood transfusion requirement and length of hospital stay were significantly lower in the Tp+ group compared to the Tp- group, whereas the length of follow up was significantly higher in the Tp+ group. The use of inotropic agents was significantly higher in the Tp- group. A logistic regression analysis was made to determine the factors affecting mortality. Revision (p=0.013), blood transfusion (p=0.017), ventilation time (p=0.019), and length of stay in the intensive care unit (p=0.009) were found as predictors of mortality. Survival rates at years 1, 2 and 3 were 86.1%, 81%, 77.5% in the Tp- group, and 96.0%, 96.3%, 90.4% in the Tp+ group. Median survival rate was 41.35±2.02 in the Tp- group, and 49.64±1.59 in the Tp+ group which was significantly higher compared to the Tp- group (p=0.048). Chronic renal failure is among the perioperative risk factors for patients undergoing open heart surgery. Transplantation is still an important health issue due to insufficiency of available transplant organs. Patients with chronic renal failure are well known to have higher risks for coronary artery disease. A radical solution of the cardiovascular system problems prior to kidney transplantation seems to have a significant contribution to the post transplant survival.

  12. Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience.

    PubMed

    Briganti, Francesco; Leone, Giuseppe; Ugga, Lorenzo; Marseglia, Mariano; Macera, Antonio; Manto, Andrea; Delehaye, Luigi; Resta, Maurizio; Resta, Mariachiara; Burdi, Nicola; Nuzzi, Nunzio Paolo; Divenuto, Ignazio; Caranci, Ferdinando; Muto, Mario; Solari, Domenico; Cappabianca, Paolo; Maiuri, Francesco

    2017-01-01

    Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device. 40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed. Complete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths. Endovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Effect of mid-term drought on Quercus pubescens BVOCs' emission seasonality and their dependency on light and/or temperature

    NASA Astrophysics Data System (ADS)

    Saunier, Amélie; Ormeño, Elena; Boissard, Christophe; Wortham, Henri; Temime-Roussel, Brice; Lecareux, Caroline; Armengaud, Alexandre; Fernandez, Catherine

    2017-06-01

    Biogenic volatile organic compounds (BVOCs) emitted by plants represent a large source of carbon compounds released into the atmosphere, where they account for precursors of tropospheric ozone and secondary organic aerosols. Being directly involved in air pollution and indirectly in climate change, understanding what factors drive BVOC emissions is a prerequisite for modeling their emissions and predict air pollution. The main algorithms currently used to model BVOC emissions are mainly light and/or temperature dependent. Additional factors such as seasonality and drought also influence isoprene emissions, especially in the Mediterranean region, which is characterized by a rather long drought period in summer. These factors are increasingly included in models but only for the principal studied BVOC, namely isoprene, but there are still some discrepancies in estimations of emissions. In this study, the main BVOCs emitted by Quercus pubescens - isoprene, methanol, acetone, acetaldehyde, formaldehyde, MACR, MVK and ISOPOOH (these three last compounds detected under the same m/z) - were monitored with a PTR-ToF-MS over an entire seasonal cycle during both in situ natural and amplified drought, which is expected with climate change. Amplified drought impacted all studied BVOCs by reducing emissions in spring and summer while increasing emissions in autumn. All six BVOCs monitored showed daytime light and temperature dependencies while three BVOCs (methanol, acetone and formaldehyde) also showed emissions during the night despite the absence of light under constant temperature. Moreover, methanol and acetaldehyde burst in the early morning and formaldehyde deposition and uptake were also punctually observed, which were not assessed by the classical temperature and light models.

  14. Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease

    PubMed Central

    Shalganov, Tchavdar Nikolov; Paprika, Dora; Vatasescu, Radu; Kardos, Attila; Mihalcz, Attila; Kornyei, Laszlo; Szatmari, Andras; Szili-Torok, Tamas

    2007-01-01

    Background Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction. Methods A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram. Results Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation. Conclusion Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease. PMID:17352821

  15. [Mid-term radiographic results in Th12 and L1 fractures after anterior column reconstruction with tibial shaft bone allograft].

    PubMed

    Wendsche, P; Kočiš, J; Chmelová, J; Kelbl, M; Stursa, V

    2013-01-01

    Frozen tibial shaft bone allografts filled with autologous cancellous bone chips were used for anterior column reconstruction in Th12 and L1 fractures. The aim of this retrospective study was to evaluate the five-year results of the treatment on the basis of radiographic findings. Twenty-six patients treated in 2005 and 2006 for isolated Th12 or L1 fractures, with no neurological deficit, were evaluated. In all patients, the spine was stabilised from an isolated anterior approach or through a combined posterior and anterior approach, and angle-stable implants were used. On radiographic examination the loss of correction and lateral compression of the segment involved were measured on standard X-ray views. Data on bone union at graft-bone interfaces were obtained from spiral CT scans. For assessment of the stage of bone healing, a scale of 0-25-50-75-100 % was established, and each patient was evaluated by two independent radiologists. Based on the average results, bone union was defined as non-union, 0-24 %; incomplete union, 25-74 %; complete union, 75-100 %. The average loss of correction measured by Beck's method was 0.77 degree. In four patients, the lateral compression angle deteriorated on the average by 1.1 degree (range, 0.7°-1.8°) during the treatment. The proximal graft-bone interface showed complete union in 19 patients (73 %), and the distal interface was completely healed in 20 patients (77 %). Incomplete bone union at the proximal and the distal interface was found in seven (27 %) and six (23 %) patients, respectively. Nonunion was not recorded. No complications occurred. The use of tibial shaft bone allografts filled with autologous cancellous bone chips resulted in stable reconstruction of the anterior column of the thoracolumbar spine which showed a low loss of correction and good bone union.

  16. Uncemented total hip arthroplasty in osteoarthritis of hip secondary to low and high dislocated hips: A mid-term follow-up study

    PubMed Central

    Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric

    2016-01-01

    Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2™ at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. PMID:27433063

  17. Snare coupling of the pre-pectoral pacing lead delivery catheter to the femoral transseptal apparatus for endocardial cardiac resynchronization therapy : mid-term results.

    PubMed

    Patel, Mehul B; Worley, Seth J

    2013-04-01

    Limitations imposed by the coronary sinus venous anatomy triggered the transseptal approach for endocardial LV lead placement. The alignment of the interatrial septum (IAS) and its neighborhood anatomy does not favor transseptal puncture from the pre-pectoral area. Locating and advancing a pre-pectoral LV lead delivery catheter (PDC) through an opening created in the IAS via femoral transseptal puncture (FTP) is time consuming and technically difficult. We describe a method where the PDC is snare coupled to the femoral transseptal apparatus (FTA). When the FTA is advanced into the left atrium (LA) the coupled PDC follows. The catheter of a 25-mm loop snare kit is replaced with the PDC (SelectSite®). The snare loop is positioned in the right common iliac vein from the pre-pectoral access. The PDC is coupled to the FTA by advancing the transseptal apparatus through the open snare loop. After conventional FTP, the FTA is withdrawn back into the right atrium (RA) over an extra support wire positioned in the LA. The PDC with open snare loop is pulled over the FTA up to the RA. The PDC is advanced to close the snare loop on the extra support wire immediately distal to the tip of the dilator close to the puncture site. The PDC is deflected to align with the FTA. The snare coupled catheters are gently advanced across the IAS into the LA. The PDC is released from the FTA by advancing the snare and opening the loop; the snare is then removed from the PDC. The PDC is deflected and advanced into the left ventricle (LV). After positioning the 4.1 Fr lumen less LV lead, the PDC is sliced and removed. The PDC snare coupled to the FTA was advanced into the LA in all five patients, however, access was lost during catheter manipulation in the one right-sided case. Endocardial LV lead was successfully positioned in all five patients. Snare coupling the pre-pectoral SelectSite® catheter to the FTA is technically simple, reliable and a safe method for transseptal endocardial LV lead placement for left pre-pectoral implantation.

  18. A mid-term follow-up of Koutsogiannis’ osteotomy in adult-acquired flatfoot stage II and “early stage III”

    PubMed Central

    Arvinius, Camilla; Manrique, Elena; Urda, Antonio; Cardoso, Zulema; Galeote, Jose Enrique; Marco, Fernando

    2017-01-01

    Introduction: Koutsogiannis’ osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. Methods: We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis’ osteotomy due to adult-acquired flatfoot stage II and “early stage III”: a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. Results: Sixteen cases were “early stage III” and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and “early stage III”. Five cases presented a mild dysesthesia but only one patient needed neurolysis. Conclusions: We consider the Koutsogiannis’ osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and “early stage III” adult-acquired flatfoot. PMID:28304274

  19. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    PubMed Central

    Huang, De-Yong; Zhang, Liang; Zhou, Yi-Xin; Zhang, Chun-Yu; Xu, Hui; Huang, Yong

    2016-01-01

    Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures. PMID:27064033

  20. Mid-term outcomes of floating platform mobile-bearing total knee arthroplasty under navigational guidance with a minimum 4-year follow-up.

    PubMed

    Lee, Dae-Hee; Lee, Dong-Ki; Shin, Young-Soo; Han, Seung-Beom

    2013-12-01

    We evaluated 106 knees that underwent primary total knee arthroplasty (TKA) with the navigation-assisted gap balancing technique using an e.-motion cruciate retaining floating platform (FP) mobile-bearing prosthesis to prospectively assess the survival of the e.-motion FP system after a minimum follow-up of 4 years. There was no evidence of any complications, including dissociation or breakage of the polyethylene liner or component loosening at last follow up (5.1 ± 0.6 years). Four knees, however, required re-operation, three for distal femoral fracture, and one for infection. The estimated 5-year prosthesis survival rates without revision for any reason and for prosthesis-associated problems were 96.2% and 100%, respectively. The e.-motion floating platform, with a cruciate retaining design under navigation guidance, demonstrated excellent clinical results and 5-year survival rate.

  1. A deeper look at the response of oxygenated and non oxygenated VOC to mid-term drought over the seasonal cycle: the case study of a drought-resistant species

    NASA Astrophysics Data System (ADS)

    Saunier, Amelie; Ormeño Lafuente, Elena; Wortham, Henri; Temime-Roussel, Brice; Fernandez, Catherine

    2015-04-01

    At the end of this century, climatic models plan an intensification of summer drought in the Mediterranean area due to a 30% rain reduction and a temperature rise of 3.4 °C. Plants respond to drought by modifying their primary (growth) and their secondary metabolism, the later being partly represented by volatile organic compound (VOC) emissions, such as terpenes. With drought, oxygenated and non oxygenated terpene emissions have been observed to increase, decrease or remain unchanged according to drought severity and vegetal model. By contrast, the response of non-terpenic oxygenated compounds to drought has been poorly studied. The aim of this study is to determine the potential impact of a two-year drought period on the full screen of VOC released by Q. pubescens, with a focus on both isoprene and methanol, issued from plant anabolism , and the numerous highly volatile oxygenated VOC, issued from plant catabolism (i.e. issued from oxidation of isoprene or methanol). A 70 years-old Downy oak forest (Quercus pubescens), highly resistant to drought stress, was selected as model ecosystem since it is well widespread in Southern France occupying 321 000 ha. Downy oak also represents the major source of isoprene emissions in the Mediterranean area and, unlike the other major Quercus sp. of the region (i.e. Quercus ilex, a monoterpene emitter) the impact of watering withholding over years has never been tackled. The study was performed at the experimental platform of O3HP (Oak Observatory at Observatoire de Haute Provence) in Southern France which is equipped with both a rain exclusion (by 30 %) and a rain addition structure (simulating the rainiest years of the region), allowing for comparison with naturally watered trees. Using dynamic enclosure chambers at the branch level and PTR-MS-Q-ToF, we screened the anabolic VOC (isoprene, methanol) and the catabolic VOC (e.g. methacrolein, methyl vinyl ketone, C6 aldehydes and carboxylic acids) of trees located under the three watering treatments during the three seasons of the vegetation period (spring, summer and autumn). Concomitantly, water stress was characterized by monitoring the ecophysiological plant parameters such as predawn leaf water potential, photosynthesis, stomatal conductance as well as VOCanabolic/VOCCcatabolic ratios indicators of oxidation within the cell. Differences among the three watering treatments were slight or absent depending on the season and the compound. This response was attributed to Downy Oak resistance to rain exclusion as reflected by the maintenance of the photosynthetic machinery activity and leaf water levels.

  2. EU-FP7-iMARS: analysis of Mars multi-resolution images using auto-coregistration, data mining and crowd source techniques: A Mid-term Report

    NASA Astrophysics Data System (ADS)

    Muller, J.-P.; Yershov, V.; Sidiropoulos, P.; Gwinner, K.; Willner, K.; Fanara, L.; Waelisch, M.; van Gasselt, S.; Walter, S.; Ivanov, A.; Cantini, F.; Morley, J. G.; Sprinks, J.; Giordano, M.; Wardlaw, J.; Kim, J.-R.; Chen, W.-T.; Houghton, R.; Bamford, S.

    2015-10-01

    Understanding the role of different solid surface formation processes within our Solar System is one of the fundamental goals of planetary science research. There has been a revolution in planetary surface observations over the last 8 years, especially in 3D imaging of surface shape (down to resolutions of 10s of cms) and subsequent terrain correction of imagery from orbiting spacecraft. This has led to the potential to be able to overlay different epochs back to the mid-1970s. Within iMars, a processing system has been developed to generate 3D Digital Terrain Models (DTMs) and corresponding OrthoRectified Images (ORIs) fully automatically from NASA MRO HiRISE and CTX stereo-pairs which are coregistered to corresponding HRSC ORI/DTMs. In parallel, iMars has developed a fully automated processing chain for co-registering level-1 (EDR) images from all previous NASA orbital missions to these HRSC ORIs and in the case of HiRISE these are further co-registered to previously co-registered CTX-to-HRSC ORIs. Examples will be shown of these multi-resolution ORIs and the application of different data mining algorithms to change detection using these co-registered images. iMars has recently launched a citizen science experiment to evaluate best practices for future citizen scientist validation of such data mining processed results. An example of the iMars website will be shown along with an embedded Version 0 prototype of a webGIS based on OGC standards.

  3. Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up.

    PubMed

    Musella, Mario; Susa, Antonio; Manno, Emilio; De Luca, Maurizio; Greco, Francesco; Raffaelli, Marco; Cristiano, Stefano; Milone, Marco; Bianco, Paolo; Vilardi, Antonio; Damiano, Ivana; Segato, Gianni; Pedretti, Laura; Giustacchini, Piero; Fico, Domenico; Veroux, Gastone; Piazza, Luigi

    2017-05-31

    In recent years, several articles have reported considerable results with the Mini/One Anastomosis Gastric Bypass (MGB/OAGB) in terms of both weight loss and resolution of comorbidities. Despite those positive reports, some controversies still limit the widespread acceptance of this procedure. Therefore, a multicenter retrospective study, with the aim to investigate complications following this procedure, has been designed. To report the complications rate following the MGB/OAGB and their management, and to assess the role of this approach in determining eventual complications related especially to the loop reconstruction, in the early and late postoperative periods, the clinical records of 2678 patients who underwent MGB/OAGB between 2006 and 2015 have been studied. Intraoperative and early complications rates were 0.5 and 3.1%, respectively. Follow-up at 5 years was 62.6%. Late complications rate was 10.1%. A statistical correlation was found for perioperative bleeding both with operative time (p < 0.001) or a learning curve of less than 50 cases (p < 0.001). A statistical correlation was found for postoperative duodenal-gastro-esophageal reflux (DGER) with a preexisting gastro-esophageal-reflux disease (GERD) or with a gastric pouch shorter than 9 cm, (p < 0.001 and p = 0.001), respectively. An excessive weight loss correlated with a biliopancreatic limb longer than 250 cm (p < 0.001). Our results confirm MGB/OAGB to be a reliable bariatric procedure. According to other large and long-term published series, MGB/OAGB seems to compare very favorably, in terms of complication rate, with two mainstream procedures as standard Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG).

  4. Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty: mid-term results of a randomised controlled trial.

    PubMed

    van der Veen, H C; Reininga, I H F; Zijlstra, W P; Boomsma, M F; Bulstra, S K; van Raay, J J A M

    2015-11-01

    We compared the incidence of pseudotumours after large head metal-on-metal (MoM) total hip arthroplasty (THA) with that after conventional metal-on-polyethylene (MoP) THA and assessed the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large head (38 mm to 60 mm) cementless MoM THA with conventional head (28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males, 20 females, mean age of 64 years, standard deviation (sd) 4) and 55 MoP (25 males, 30 females, mean age of 65 years, sd 5) were recruited after a mean follow-up of 50 months (36 to 64). The incidence of pseudotumours, measured using a standardised CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP THA. Women with a MoM THA were more likely to develop a pseudotumour than those with a MoP THA (15 vs 7, odds ratio (OR) = 13.4, p < 0.001). There was a similar incidence of pseudotumours in men with MoM THAs and those with MoP THAs (7 vs 5, OR = 2.1, p = 0.30). Elevated cobalt levels (≥ 5 microgram/L) were only associated with pseudotumours in women with a MoM THA. There was no difference in mean Oxford and Harris hip scores between patients with a pseudotumour and those without. Contrary to popular belief, pseudotumours occur frequently around MoP THAs. Women with a MoM THA and an elevated cobalt level are at greatest risk. In this study, pseudotumours had no effect on the functional outcome after either large head MoM or conventional MoP THA.

  5. Impact on mid-term kidney graft outcomes of pretransplant anti-HLA antibodies detected by solid-phase assays: Do donor-specific antibodies tell the whole story?

    PubMed

    Malheiro, Jorge; Tafulo, Sandra; Dias, Leonídio; Martins, La Salete; Fonseca, Isabel; Beirão, Idalina; Castro-Henriques, António; Cabrita, António

    2017-09-01

    The detrimental impact of preformed anti-HLA donor-specific antibodies (DSA) is well defined, contrarily to non-donor-specific antibodies (NDSA). We sought to evaluate their clinical impact in a cohort of 724 kidney graft recipients in whom anti-HLA antibodies were thoroughly screened and identified in pre-transplant sera by solid-phase assays. NDSA or DSA were detected in 100 (13.8%) and 47 (6.5%) recipients respectively, while 577 (79.7%) were non-allosensitized (NaS). Incidence of antibody-mediated rejection at 1-year was 0.7%, 4.0% and 25.5% in NaS, NDSA and DSA patients, respectively (NaS vs. NDSA P=0.004; NaS vs. DSA P<0.001; NDSA vs. DSA P<0.001). Graft survival was lowest in DSA (78.7%), followed by NDSA (88.0%) and NaS (93.8%) recipients (NaS vs. NDSA P=0.015; NaS vs. DSA P<0.001; NDSA vs. DSA P=0.378). Multivariable competing risk analysis confirmed both NDSA (sHR=2.19; P=0.025) and DSA (sHR=2.87; P=0.012) as significant predictors of graft failure. The negative effect of NDSA and DSA on graft survival was significant in patients receiving no induction (P=0.019) or an anti-IL-2 receptor antibody (P<0.001), but not in those receiving anti-thymocyte globulin (P=0.852). The recognition of the immunological risk associated with preformed DSA but also NDSA have important implications in patients' risk stratification, and may impact clinical decisions at transplant. Copyright © 2017 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

  6. School restrictions on outdoor activities and weight status in adolescent children after Japan's 2011 Fukushima Nuclear Power Plant disaster: a mid-term to long-term retrospective analysis.

    PubMed

    Nomura, Shuhei; Blangiardo, Marta; Tsubokura, Masaharu; Ochi, Sae; Hodgson, Susan

    2016-09-28

    Radiation fears following Japan's 2011 Fukushima nuclear disaster affected levels of physical activity in local children. We assessed the postdisaster versus predisaster weight status in school children and evaluated to what extent school restrictions on outdoor activities that were intended to reduce radiation exposure risk affected child weight. We considered children aged 13-15 years from 4 of the 5 secondary schools in Soma City (n=1030, 99.1% of all children in the city), located in 35-50 km from the Fukushima nuclear plant, postdisaster (2012 and 2015) and predisaster (2010). Weight status, in terms of body mass index (BMI), percentage of overweight (POW) and incidence of obesity and underweight (defined as a POW ≥20% and ≤-20%, respectively) were examined and compared predisaster and postdisaster using regression models. We also constructed models to assess the impact of school restrictions on outdoor activity on weight status. After adjustment for covariates, a slight decrease in mean BMI and POW was detected in females in 2012 (-0.37, 95% CI -0.68 to -0.06; and -1.97, 95% CI -3.57 to -0.36, respectively). For male children, obesity incidence increased in 2012 (OR for obesity: 1.45, 95% CI 1.02 to 2.08). Compared with predisaster weight status, no significant weight change was identified in 2015 in either males or females. School restrictions on outdoor activities were not significantly associated with weight status. 4 years following the disaster, weight status has recovered to the predisaster levels for males and females; however, a slight decrease in weight in females and a slight increase in risk of obesity were observed in males 1 year following the disaster. Our findings could be used to guide actions taken during the early phase of a radiological disaster to manage the postdisaster health risks in adolescent children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Metabolic consequences of the incorporation of a Roux limb in an omega loop (mini) gastric bypass: evaluation by a glucose tolerance test at mid-term follow-up.

    PubMed

    Himpens, Jacques M; Vilallonga, Ramon; Cadière, Guy-Bernard; Leman, Guido

    2016-07-01

    In the technique used in our department, Roux-en-Y gastric bypass (RYGB) anatomically only differs from the mini- or omega loop gastric bypass (OLGB) by the incorporation of an isolated alimentary limb, called the Roux limb. The metabolic consequences of the incorporation of a Roux limb are unknown. To evaluate differences in glucose and insulin dynamics between RYGB and OLGB in normoglycemic patients, by submitting them to a glucose challenge after stabilization of their weight. Nondiabetic patients who had undergone OLGB 4 years earlier were matched with nondiabetic patients who had undergone RYGB around the same time and with healthy controls. Participants underwent oral (OGTT) and intravenous glucose tolerance test (IVGTT). Endpoints of the study were: progression of plasma glucose and insulin, changes in their concentration [calculated by area under the curve (AUC)] at OGTT and IVGTT, incretin effect and incidence of hypoglycemia. Each of the three groups comprised 14 participants. At OGTT, plasma glucose and insulin incremental values were comparable after OLGB and RYGB, and substantially higher than in controls. Overall glucose concentration, however, did not vary across the three groups. Thirty-minute and overall insulin plasma concentration, indicators of early and total insulin secretion, respectively, was significantly higher in both bypass groups than in controls, and was greatest in OLGB. Severe hypoglycemia occurred in one out of two patients in both bypass groups. At IVGTT, no differences were registered across the three groups and no participant experienced hypoglycemia. The incretin effect was higher after OLGB than after RYGB, but the difference was not statistically significant. The incorporation of a Roux limb in a loop gastric bypass appears to create a statistically nonsignificant tendency toward reducing insulin hypersecretion observed at OGTT after OLGB, and consequently toward tapering the incretin effect.

  8. Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results.

    PubMed

    Miscusi, Massimo; Polli, Filippo Maria; Forcato, Stefano; Ricciardi, Luca; Frati, Alessandro; Cimatti, Marco; De Martino, Luca; Ramieri, Alessandro; Raco, Antonino

    2015-05-01

    OBJECT Spinal metastasis is common in patients with cancer. About 70% of symptomatic lesions are found in the thoracic region of the spine, and cord compression presents as the initial symptom in 5%-10% of patients. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, with the aim of decreasing the morbidity associated with more traditional open spine surgery; furthermore, the recovery time is reduced after MISS, such that postoperative chemotherapy and radiotherapy can begin sooner. METHODS Two series of oncological patients, who presented with acute myelopathy due to vertebral thoracic metastases, were compared in this study. Patients with complete paraplegia for more than 24 hours and with a modified Bauer score greater than 2 were excluded from the study. The first group (n = 23) comprised patients who were prospectively enrolled from May 2010 to September 2013, and who were treated with minimally invasive laminotomy/laminectomy and percutaneous stabilization. The second group (n = 19) comprised patients from whom data were retrospectively collected before May 2010, and who had been treated with laminectomy and stabilization with traditional open surgery. Patient groups were similar regarding general characteristics and neurological impairment. Results were analyzed in terms of neurological recovery (American Spinal Injury Association grade), complications, pain relief (visual analog scale), and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and EORTC QLQ-BM22 scales) at the 30-day follow-up. Operation time, postoperative duration of bed rest, duration of hospitalization, intraoperative blood loss, and the need and length of postoperative opioid administration were also evaluated. RESULTS There were no significant differences between the 2 groups in terms of neurological recovery and complications. Nevertheless, the MISS group showed a clear and significant improvement in terms of blood loss, operation time, and bed rest length, which is associated with a more rapid functional recovery and discharge from the hospital. Postoperative pain and the need for opioid administration were also significantly less pronounced in the MISS group. Results from the EORTC QLQ-C30 and QLQ-BM22 scales showed a more pronounced improvement in quality of life at follow-up in the MISS group. CONCLUSIONS In the authors' opinion, MISS techniques should be considered the first choice for the treatment for patients with spinal metastasis and myelopathy. MISS is as safe and effective for spinal cord decompression and spine fixation as traditional surgery, and it also reduces the impact of surgery in critical patients. However, further studies are needed to confirm these findings.

  9. School restrictions on outdoor activities and weight status in adolescent children after Japan’s 2011 Fukushima Nuclear Power Plant disaster: a mid-term to long-term retrospective analysis

    PubMed Central

    Nomura, Shuhei; Blangiardo, Marta; Hodgson, Susan

    2016-01-01

    Objective Radiation fears following Japan's 2011 Fukushima nuclear disaster affected levels of physical activity in local children. We assessed the postdisaster versus predisaster weight status in school children and evaluated to what extent school restrictions on outdoor activities that were intended to reduce radiation exposure risk affected child weight. Participants We considered children aged 13–15 years from 4 of the 5 secondary schools in Soma City (n=1030, 99.1% of all children in the city), located in 35–50 km from the Fukushima nuclear plant, postdisaster (2012 and 2015) and predisaster (2010). Methods Weight status, in terms of body mass index (BMI), percentage of overweight (POW) and incidence of obesity and underweight (defined as a POW ≥20% and ≤−20%, respectively) were examined and compared predisaster and postdisaster using regression models. We also constructed models to assess the impact of school restrictions on outdoor activity on weight status. Results After adjustment for covariates, a slight decrease in mean BMI and POW was detected in females in 2012 (−0.37, 95% CI −0.68 to −0.06; and −1.97, 95% CI −3.57 to −0.36, respectively). For male children, obesity incidence increased in 2012 (OR for obesity: 1.45, 95% CI 1.02 to 2.08). Compared with predisaster weight status, no significant weight change was identified in 2015 in either males or females. School restrictions on outdoor activities were not significantly associated with weight status. Conclusions 4 years following the disaster, weight status has recovered to the predisaster levels for males and females; however, a slight decrease in weight in females and a slight increase in risk of obesity were observed in males 1 year following the disaster. Our findings could be used to guide actions taken during the early phase of a radiological disaster to manage the postdisaster health risks in adolescent children. PMID:27683520

  10. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial

    PubMed Central

    Thom, Howard; West, Nicholas E J; Hughes, Vikki; Dyer, Matthew; Buxton, Martin; Sharples, Linda D; Jackson, Christopher H; Crean, Andrew M

    2014-01-01

    Objectives To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting Regional cardiothoracic referral centre in the east of England. Participants 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration ISRCTN 47108462, UKCRN 3696. PMID:24508847

  11. Use of Proktis-M suppositories in patients undergoing neoadjuvant radiochemotherapy for adenocarcinoma of the rectum.

    PubMed

    Montrone, S; Gonnelli, A; Cantarella, M; Sainato, A

    2015-12-01

    Generally speaking, the negative side of radiation treatment of the pelvic district is the toxicity that may compromise the patient's quality of life and lead to temporary suspension of treatment with possible negative effects on its effectiveness. In neoadjuvant radiochemotherapy for locally advanced rectal cancer (LARC), the toxicity that is most frequently observed is proctitis, usually treated with topical corticosteroids or mesalazine. Hyaluronic acid's function is to restore the regular trophism and elasticity of the connective tissues leading to faster repair of the damage, and this could represent a viable option for the control of actinic proctitis. Since March 2012, a neoadjuvant radiochemotherapy protocol has been active at the Pisa Universitary Hospital for patients with LARC; 23 patients have been enrolled up to the present. Treatment involves an induction chemotherapy phase according to the FOLFOXIRI + Bevacizumab regimen for 6 cycles, followed by chemotherapy (capecitabina + Bevacizumab) concomitant with radiotherapy (5040 cGy in 28 fractions). Surgery is scheduled 6-8 weeks after the end of RTCT. During the course of associated treatment (RTCT), 12/23 patients received topical therapy with hyaluronic acid (Proktis-M suppositories) for the prevention of proctitis. All 23 patients enrolled in the study completed the induction chemotherapy phase. In the first 11 enrolled patients who did not receive prior Proktis-M suppositories, intense rectal toxicity was observed. Proctalgia of grade G1-2 and G3-4 presented respectively in 64% and 36% of cases, with consequent interruption of treatment which, in 45% of patients, lasted longer than 10 days. In the remaining 12 patients who underwent prior treatment with Proktis-M suppositories, the percentage of rectal toxicity was lower. In those cases where it did present, onset was later and its intensity and duration lower. 25% of patients did not develop proctalgia, 33% developed proctalgia of grade G1 and 42

  12. Microaggregates: Experimental and Clinical Aspects - Symposium on Microaggregates, Held at Letterman Army Institute of Research on 20-21 June 1977,

    DTIC Science & Technology

    1980-06-01

    pain thershold and ECG changes associated with angina pectoris (57). It has also been found not to reduce the frequency of diminished pulses following...1972. 57. Frishman, W.H., Christodoulou, J., Seksler, B. et al.: Aspirin therapy in angina pectoris : Effects on platelet aggregation, exercise...infarction 4. Stable angina 5. Amaurosis fugax 6. Nephrotic syndrome 7. Diabetes mellitus 8. Hyperbetalipoproteinemia 9. Acute arterial insufficiency 10

  13. White Paper on School-Lunch Nutrition.

    ERIC Educational Resources Information Center

    Center for Science in the Public Interest, Washington, DC.

    Recommendations are made on how school lunch programs can provide better nutrition and promote healthier eating habits. Recommendations consist of goals with both short-term and mid-term objectives. The short-term objectives should be implemented over the next 2 to 4 years; the mid-term objectives should be implemented by the year 2000 or sooner…

  14. White Paper on School-Lunch Nutrition.

    ERIC Educational Resources Information Center

    Center for Science in the Public Interest, Washington, DC.

    Recommendations are made on how school lunch programs can provide better nutrition and promote healthier eating habits. Recommendations consist of goals with both short-term and mid-term objectives. The short-term objectives should be implemented over the next 2 to 4 years; the mid-term objectives should be implemented by the year 2000 or sooner…

  15. Temporal arteritis: an approach to suspected vasculitides.

    PubMed

    Harder, Natasha

    2010-12-01

    Temporal arteritis, also known as giant cell arteritis, is the most common vasculitis in adults. Classic symptoms include polymyalgia rheumatica, new-onset headache, jaw claudication, and visual symptoms such as diplopia and amaurosis fugax. Elevated erythrocyte sedimentation rate is a common laboratory finding in temporal arteritis, and abnormalities on temporal artery biopsy are the gold standard for diagnosis. Rapid treatment with steroids can prevent permanent vision loss, which is the worst ischemic complication of the disease. It is important for primary care physicians to be able to recognize the signs and symptoms of this disease and begin treatment rapidly. Copyright © 2010. Published by Elsevier Inc.

  16. 'Crescendo' transient ischemic attacks: clinical and angiographic correlations.

    PubMed

    Rothrock, J F; Lyden, P D; Yee, J; Wiederholt, W C

    1988-02-01

    Forty-seven consecutive patients presenting acutely with repetitive symptoms indicative of anterior circulation ischemia ("crescendo" transient ischemic attacks) were evaluated to identify clinical features that might reliably predict the presence of significant stenosis, ulceration, or both in the presumably symptomatic internal carotid artery. Angiographic or intraoperative correlation was obtained in all patients, and 26 (55%) were found to have anatomically significant disease. Of 20 patients with signs or symptoms suggestive of cortical ischemia, amaurosis fugax, or both, 17 (85%) had "positive" angiograms; of 18 with numbness/weakness only, 9 (50%) had positive angiograms; of 9 whose symptoms suggested lacunar ischemia, none had positive angiograms.

  17. Horsfield's hawk-cuckoo nestlings simulate multiple gapes for begging.

    PubMed

    Tanaka, Keita D; Ueda, Keisuke

    2005-04-29

    Nestlings of some brood parasitic birds evict hosts' eggs and young soon after hatching, thereby avoiding discrimination by hosts while monopolizing parental care. Eviction carries a cost, however, because lone parasitic nestlings attract a reduced provisioning rate. Here we describe a form of visual signaling used by the evicting Horsfield's hawk-cuckoo (Cuculus fugax) to obtain sufficient food. The chick displays a gape-colored patch on the wing to the host parents as they deliver food, simulating the gaping display of more than one nestling.

  18. Deglutition syncope: a manifestation of vagal hyperactivity following carotid endarterectomy.

    PubMed

    Endean, Eric D; Cavatassi, William; Hansler, Joseph; Sorial, Ehab

    2010-09-01

    A 61-year-old man with left amaurosis fugax and bilateral >80% internal carotid artery stenoses underwent a left carotid endarterectomy. On the first postoperative day, he developed hypotension, bradycardia, and chest pain with food ingestion. He was diagnosed as having deglutition syncope and was treated with oral anticholinergics. Similar symptoms occurred when he underwent a right carotid endarterectomy. Deglutition syncope is a neurally mediated situational syncope resulting from vagus nerve over-activity. This is the first report of deglutition syncope associated with carotid endarterectomy. It is important to recognize and differentiate these symptoms from other causes of postendarterectomy hemodynamic instability.

  19. Leucosiid crabs (Crustacea: Decapoda: Brachyura) from Taiwan, with three new records.

    PubMed

    Shih, Yi-Jia; Ho, Ping-Ho; Chan, Tin-Yam

    2015-12-01

    Four leucosiid species from Taiwan are presented. Ebalia nudipes Sakai, 1963, with its male first gonopod figured for the first time. Galilia petricola Komai & Tsuchida, 2014, is recorded on the basis of a larger specimen, and distinguishing features with its only congener, G. narusei Ng & Richer de Forges, 2007, reappraised. Nursia rhomboidalis (Miers, 1879), previously known only from Japan, Korea, and mainland China, is also recorded from Taiwan. Myra fugax (Fabricius, 1798) is now formally recorded from Taiwan, and female characters identified to help separate the three known Taiwanese species of Myra.

  20. Goals for limited strategic defenses

    SciTech Connect

    Canavan, G.H.

    1989-05-01

    This report reviews the nature of near and mid-term accidental, third-country, and limited threats, discusses the technologies available to defend against them, and examines the development programs required. 22 refs.

  1. Advanced batteries for electric vehicle applications: Nontechnical summary

    NASA Astrophysics Data System (ADS)

    Henriksen, G. L.

    This paper provides an overview of the performance characteristics of the most prominent batteries under development for electric vehicles (EV's) and compares these characteristics to the USABC Mid-Term and Long-Term criteria, as well as to typical vehicle-related battery requirements. Most of the battery performance information was obtained from independent tests, conducted using simulated driving power profiles, for DOE and EPRI at Argonne National Laboratory. The EV batteries are categorized as near-term, mid-term, and long-term technologies based on their relative development status, as well as our estimate of their potential availability as commercial EV batteries. Also, the performance capabilities generally increase in going from the near-term to the mid-term and on to the long-term technologies. To date, the USABC has chosen to fund a few selected mid-term and long-term battery technologies.

  2. 76 FR 40336 - Availability of Seats for the Florida Keys National Marine Sanctuary Advisory Council

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    .... DATES: Applications are due by August 5, 2011. ADDRESSES: Application kits may be obtained from Lilli... changed to provide for staggered expiration dates or member resignation mid term. Authority: 16...

  3. 40 CFR Table 4 to Subpart Ttttt of... - Continuous Compliance With Emission Limits

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... CATEGORIES (CONTINUED) National Emissions Standards for Hazardous Air Pollutants for Primary Magnesium... least twice during each term of your title V operating permit (at mid-term and renewal). 2. Magnesium...

  4. Cutting Balloon Angioplasty of Bilateral Renal Artery Stenosis Due to Takayasu Arteritis in a 5-Year-Old Child with Midterm Follow-Up

    SciTech Connect

    Gumus, Burcak Cevik, Halime; Vuran, Can; Omay, Oguz; Kocyigit, Ozgen Ilgaz; Turkoz, Riza

    2010-04-15

    The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.

  5. A Systems Engineering Analysis of Unmanned Maritime Systems for U.S. Coast Guard Missions

    DTIC Science & Technology

    2013-06-01

    respective system architectures provide a design concept for near- to mid-term (5-10 year) acquisition . Finally, feasibility analysis reviews key system...alternatives and their respective system architectures provide a design concept for near- to mid-term (5-10 year) acquisition . Finally, feasibility...Security RACON Radar Beacon Transponder ROV Remotely Operated Vehicle SAR Search and Rescue SE Systems Engineering TRL Technology Readiness Level UAV

  6. Association of intracellular pro- and anti-inflammatory cytokines in peripheral blood with the clinical or ultrasound indications for carotid endarterectomy in patients with carotid atherosclerosis

    PubMed Central

    Profumo, E; Buttari, B; Tosti, M E; Siracusano, A; Ortona, E; Margutti, P; Capoano, R; Salvati, B; Riganò, R

    2008-01-01

    Early non-invasive diagnostic information would be useful in identifying patients at risk of progressive carotid atherosclerosis, despite an apparently harmless plaque on ultrasound imaging. In this study, we assessed the possible association of intracellular cytokines in peripheral blood with the ultrasound (stenosis ≥ 70%) and clinical indications (transient ischaemic attack, amaurosis fugax or stroke) for carotid endarterectomy (CEA) in patients. Intracellular cytokine expression was determined in 106 patients (67 undergoing and 39 not undergoing CEA). Cells primed for the proinflammatory cytokines tumour necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-1β, IL-6, IL-8 and the anti-inflammatory cytokines IL-4 and IL-10 were found in significantly higher percentages in patients undergoing CEA than in patients who were not (P < 0·05). Intracellular cytokine expression was significantly higher in patients undergoing CEA who had stenosis ≥ 70% (TNF-α, IFN-γ, IL-1β, IL-6, IL-4 and IL-10), with previous stroke (IFN-γ, IL-1β, IL-6, IL-8, IL-4 and IL-10) and with amaurosis fugax (IFN-γ, IL-6, IL-4 and IL-10) than in patients not undergoing CEA. Increased intracellular cytokines in patients' peripheral blood might be a warning signal indicating progressive atherosclerosis. If so, intracellular cytokine monitoring could help in selecting patients at high risk of future clinical cardiovascular events and therefore most likely to benefit from CEA or adjustment of pharmacological therapy. PMID:18307518

  7. Visual-evoked potentials in patients with brain circulatory problems.

    PubMed

    Pojda-Wilczek, Dorota

    2015-04-01

    The aim of this study was to find out if local brain circulatory problems may influence visual-evoked potentials (VEP). Thirty-eight patients were divided into the following groups: (I) those with hemianopsia or quadrantanopsia and hemiparesis after brain stroke; (II) those with hemianopsia or quadrantanopsia without paresis after brain stroke; and (III) those with amaurosis fugax. The control group consisted of 38 patients. The VEP pattern (PVEP) and flash VEP (FVEP) were examined monocularly using two electrodes placed at O1 and O2. Latency and amplitude of the N75, P100 and N2, P2 waves were measured. The Newman-Keuls test was used for statistical analysis. In PVEP, no differences between the groups were observed. In FVEP, the mean P2 latency was significantly longer in group I than in group III, and the P2 amplitude was significantly lower in all examined groups when compared with the control group. PVEP and FVEP revealed differences in P latency over 3 ms between brain hemispheres and differences in P amplitude over 30% in all examined groups. In the control group, there were no differences in latency between brain hemispheres and only a small difference in amplitude. Local brain circulatory problems that may lead to brain ischemia cause differences in VEP amplitude and latency between brain hemispheres. Changes in VEPs observed in patients with amaurosis fugax may be considered the result of recurrent brain ischemia.

  8. Right ventricular relative wall thickness as a predictor of outcomes and of right ventricular reverse remodeling for patients with pulmonary hypertension.

    PubMed

    Sano, Hiroyuki; Tanaka, Hidekazu; Motoji, Yoshiki; Fukuda, Yuko; Mochizuki, Yasuhide; Hatani, Yutaka; Matsuzoe, Hiroki; Hatazawa, Keiko; Shimoura, Hiroyuki; Ooka, Junichi; Ryo-Koriyama, Keiko; Nakayama, Kazuhiko; Matsumoto, Kensuke; Emoto, Noriaki; Hirata, Ken-Ichi

    2017-03-01

    Mid-term right ventricular (RV) reverse remodeling after treatment in patients with pulmonary hypertension (PH) is associated with long-term outcome as well as baseline RV remodeling. However, baseline factors influencing mid-term RV reverse remodeling after treatment and its prognostic capability remain unclear. We studied 54 PH patients. Mid-term RV remodeling was assessed in terms of the RV area, which was traced planimetrically at the end-systole (RVESA). RV reverse remodeling was defined as a relative decrease in the RVESA of at least 15% at 10.2 ± 9.4 months after treatment. Long-term follow-up was 5 years. Adverse events occurred in ten patients (19%) and mid-term RV reverse remodeling after treatment was observed in 37 (69%). Patients with mid-term RV reverse remodeling had more favorable long-term outcomes than those without (log-rank: p = 0.01). Multivariate logistic regression analysis showed that RV relative wall thickness (RV-RWT), as calculated as RV free-wall thickness/RV basal linear dimension at end-diastole, was an independent predictor of mid-term RV reverse remodeling (OR 1.334; 95% CI, 1.039-1.713; p = 0.03). Moreover, patients with RV-RWT ≥0.21 showed better long-term outcomes than did those without (log-rank p = 0.03), while those with RV-RWT ≥0.21 and mid-term RV reverse remodeling had the best long-term outcomes. Patients with RV-RWT <0.21 and without mid-term RV reverse remodeling, on the other hand, had worse long-term outcomes than other sub-groups. In conclusions, RV-RWT could predict mid-term RV reverse remodeling after treatment in PH patients, and was associated with long-term outcomes. Our finding may have clinical implications for better management of PH patients.

  9. Hyperbaric oxygen in the treatment of radiation-induced optic neuropathy

    SciTech Connect

    Guy, J.; Schatz, N.J.

    1986-08-01

    Four patients with radiation-induced optic neuropathies were treated with hyperbaric oxygen. They had received radiation therapy for treatment of pituitary tumors, reticulum cell sarcoma, and meningioma. Two presented with amaurosis fugax before the onset of unilateral visual loss and began hyperbaria within 72 hours after development of unilateral optic neuropathy. Both had return of visual function to baseline levels. The others initiated treatment two to six weeks after visual loss occurred in the second eye and had no significant improvement of vision. Treatment consisted of daily administration of 100% oxygen under 2.8 atmospheres of pressure for 14-28 days. There were no medical complications of hyperbaria. While hyperbaric oxygen is effective in the treatment of radiation-induced optic neuropathy, it must be instituted within several days of deterioration in vision for restoration of baseline function.

  10. Rheumatoid vasculitis: early presentation of rheumatoid arthritis.

    PubMed

    Abdulqader, Yasir; Al-Ani, Muhsen; Parperis, Konstantinos

    2016-11-08

    Rheumatoid vasculitis is a rare and late complication of rheumatoid arthritis and may affect small-to-medium-sized vessels. Here, we report a case of a 49-year-old man who presented with amaurosis fugax in the left eye, symmetric polyarthritis, Raynaud's symptoms and paraesthesia in both lower extremities. The patient subsequently experienced right foot drop, nail fold infracts and gangrene of his right second toe. He was found to have a high titre of rheumatoid factor and treatment with rituximab and high dose of corticosteroids led to significant improvement of his symptoms. This is rare case describing the early onset of rheumatoid vasculitis in a patient with rheumatoid arthritis. 2016 BMJ Publishing Group Ltd.

  11. An Important Clue in the Sonographic Diagnosis of Internal Carotid Artery Agenesis: Ipsilateral Common Carotid Artery Hypoplasia

    PubMed Central

    Kaya, Omer; Yilmaz, Cengiz; Gulek, Bozkurt; Soker, Gokhan; Cikman, Gokalp; Inan, Ibrahim; Demirduzen, Selahaddin

    2014-01-01

    A 42-year-old female patient, who had been diagnosed with an occlusion of her left internal carotid artery (ICA) following Doppler ultrasonographic (US) and digitally-subtracted angiographic (DSA) examinations performed in an outer healthcare center in order to eliminate the underlying cause of her complaint of amorosis fugax, later applied to our hospital with the same complaint. At Doppler US performed in our hospital's radiology department, her right common carotid artery (CCA) was normal, but her left CCA was hypoplastic. The right internal artery (ICA) was validated as normal. At the left side, however, the ICA was apparent only as a stump and it did not demonstrate a continuity. The diagnosis of ICA agenesis was confirmed by the utilization of Doppler US, CT, and DSA imaging, and it was concluded also that ipsilateral CCA hypoplasia could be evaluated as an important clue to the diagnosis of ICA agenesis. PMID:25097789

  12. Visual claudicatio: diagnosis with 64-slice computed tomography.

    PubMed

    Cademartiri, Filippo; Maffei, Erica; Palumbo, Alessandro; Mollet, Nico R; van der Lugt, Aad; Crisi, Girolamo

    2007-06-01

    We present a case of a 78-year-old male referred presented to our institution with amaurosis fugax after walking 20 steps ("visual claudicatio"). Duplex ultrasound was not able to visualize the carotid arteries. Multislice computed tomography (Sensation 64 Cardiac, Siemens, Germany) of the cerebro-vascular circulation was performed from its origin at the level of the aortic arch to the circle of Willis. The investigation demonstrated a complete occlusion of both common carotid arteries at their origin and a severe origo stenosis of both vertebral arteries. An important collateral circulation of the vertebral arteries through the minor vessels of the neck was also displayed. Both comunicans posterior arteries were small but patent. The intra-cranial arteries were patent. Multislice CT of the cerebro-vascular circulation is an optimal tool for a comprehensive evaluation when duplex ultrasound fails.

  13. Obstetrical management of patients with extra-anatomic vascular bypass grafts due to Takayasu arteritis.

    PubMed

    Miyasaka, Naoyuki; Egawa, Makiko; Isobe, Mitsuaki; Inoue, Yoshinori; Kubota, Toshiro

    2016-12-01

    Little is known about the obstetrical management of patients with Takayasu arteritis (TA) who have undergone extra-anatomic vascular bypass (EAVB). We describe two cases of EAVB. Case 1 underwent EAVB due to renovascular hypertension associated with stenosis of the abdominal aorta, and Case 2 due to amaurosis fugax episodes associated with stenosis of the brachiocephalic and left common carotid arteries. Pregnancy outcomes were favorable for both cases, though the original symptoms recurred during the third trimester in each case, possibly due to increased blood flow to the pregnant uterus. Neither bypass occlusion nor anastomotic aneurysm formation was observed. Pregnancy outcomes of patients with EAVB due to TA are favorable, although pregnancies of patients with TA who have cardiovascular complications are associated with an increased risk of maternal and fetal morbidity. The obstetrical management of these patients, however, should include monitoring for complications related to the EAVB.

  14. The requirements for batteries for electric vehicles

    NASA Technical Reports Server (NTRS)

    Schwartz, H. J.

    1976-01-01

    Analysis of automobile use patterns shows that the battery requirements for an urban car can be met by mid-term battery technology. The far-term technology potentially offers greater range but does not proportionately increase the usefulness of the vehicle. This suggests that emphasis should be shifted toward more modest energy density goals, if such a shift would ease technical problems and allow the use of lower cost materials and construction methods. A technology diffusion model indicates that the impact of the mid-term batteries by the year 2000 would be greater than that of the far-term batteries because of their earlier introduction and nearly equal market potential. From the standpoint of maximizing both the cumulative impact and the benefits derived in the year 2000, however, a strategy of early introduction of near-term and mid-term cars followed by the far-term vehicle would produce the optimum results.

  15. FY 1979 Unit Cost Analysis for the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    A unit cost analysis for fiscal year (FY) 1979 was conducted by the Illinois Community College Board using mid-term enrollment data and uniform accounting information from each of the state's 51 community colleges. Unit costs for instructional areas were determined at three incremental levels: (1) net instructional cost (NIC), which includes…

  16. The Effect of Context and Input Conditions on Oral and Written Development: A Study Abroad Perspective

    ERIC Educational Resources Information Center

    Perez-Vidal, Carmen; Juan-Garau, Maria

    2011-01-01

    This article aims at describing and explaining the effects of a period of Study Abroad spent in the target language country (SA) on foreign language development. Such effects are analysed in the short- and mid-term and in contrast with the impact of a period of formal instruction (FI) previously spent in the home country (AH). It is hypothesised…

  17. Metacognitive Monitoring in University Classes: Anticipating a Graded vs. a Pass-Fail Test Affects Monitoring Accuracy

    ERIC Educational Resources Information Center

    Barenberg, Jonathan; Dutke, Stephan

    2013-01-01

    Three field studies tested the hypothesis that anticipating a graded test as opposed to a pass-fail test enhances metacognitive monitoring. Participants were teacher candidates who completed a mid-term and a final test in psychology courses. Each participant chose whether the result of the final test should be evaluated with one of five grades or…

  18. Evaluating Knowledge, Attitudinal, and Behavioral Change Effects from a Multinational HIV/AIDS Education Program for Youth

    ERIC Educational Resources Information Center

    Hardre, Patricia L.; Garcia, Fe; Apamo, Peter; Mutheu, Lucy; Ndege, Monica; Bois, Iderle

    2010-01-01

    This project tracked the mid-term evaluation processes, practices, and products of a multinational program to reduce at-risk behaviors for HIV/AIDS among children in Kenya, Tanzania, and Haiti. It focused on participant and community perceptions; program effectiveness in promoting abstinence and monogamy decisions; and factors supporting ongoing…

  19. Students' Confusions with Reciprocal and Inverse Functions

    ERIC Educational Resources Information Center

    Kontorovich, Igor'

    2017-01-01

    These classroom notes are focused on undergraduate students' understanding of the polysemous symbol of superscript (-1), which can be interpreted as a reciprocal or an inverse function. Examination of 240 scripts in a mid-term test identified that some first-year students struggle with choosing the contextually correct interpretation and there are…

  20. Resilience and Learning: A Conspectus for Environmental Education

    ERIC Educational Resources Information Center

    Lundholm, Cecilia; Plummer, Ryan

    2010-01-01

    There has been an increasing interest in how environmental education contributes to sustainability dating from the 1977 UNESCO conference in Tbilisi to the current Decade of Education for Sustainable Development, which in 2009, reached mid term. There is also a growing interest and concern in the complexity, uncertainty and changing nature of…

  1. Evolutionary Theories of Detection

    SciTech Connect

    Fitch, J P

    2005-04-29

    Current, mid-term and long range technologies for detection of pathogens and toxins are briefly described in the context of performance metrics and operational scenarios. Predictive (evolutionary) and speculative (revolutionary) assessments are given with trade-offs identified, where possible, among competing performance goals.

  2. Coping with historic drought in California rangelands

    USDA-ARS?s Scientific Manuscript database

    The current drought in California is of historic proportion, both in its intensity and its effect on agriculture. Although storms of the 2015-16 winter rainfall season have provided modest drought relief, their effects on alleviating the multi-year drought are unknown. Short- and mid-term forecasts...

  3. GIS Pedagogy, Web-Based Learning and Student Achievement

    ERIC Educational Resources Information Center

    Clark, Andrew M.; Monk, Janice; Yool, Stephen R.

    2007-01-01

    The authors evaluate impacts of web-based learning (WBL) for a geographic information system (GIS) course in which self-paced interactive learning modules replaced lectures to prepare students for GIS laboratory activities. They compare student laboratory, mid-term, final exam and overall scores before and after introduction of WBL, analyzing for…

  4. A United Nations Decade of Education for Sustainable Development (2005-14): What Difference Will It Make?

    ERIC Educational Resources Information Center

    Mula, Ingrid; Tilbury, Daniella

    2009-01-01

    The launch of the United Nations Decade of Education for Sustainable Development (DESD) (2005-2014) was accompanied by a series of high-profile events and celebratory activities across the globe, which raised awareness about the Decade's objectives. Now, as the DESD approaches its mid-term, many stakeholders are asking these questions: What will…

  5. Enhancing Student Performance through Cooperative Learning in Physical Sciences

    ERIC Educational Resources Information Center

    Gupta, Madan L.

    2004-01-01

    Students in a physical sciences course were introduced to cooperative learning at the University of Queensland, Gatton Campus. Groups of four to five students worked together in tutorial and practical sessions. Mid-term and practical examinations were abolished and 40% of total marks were allocated to the cooperative learning activities. A peer-…

  6. 31 CFR 50.74 - Collecting the Surcharge.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Collecting the Surcharge. 50.74 Section 50.74 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE..., mid-term, and audit premiums for a policy term are subject to the Surcharge in effect on the...

  7. The National Security Mission of the U.S. Border Patrol: A Question of Collective Bargaining Exemption

    DTIC Science & Technology

    2015-06-12

    until the mid-term elections where the Republicans gained a majority in the Senate did the Act receive passage in both chambers . Interestingly, the...These victories provided sufficient numbers in both chambers of Congress for passage of the Act in November of 2002. The Act (figure 2) as passed...

  8. Top Tips for Buying Telecommunication Services.

    ERIC Educational Resources Information Center

    Linder, Jeff

    2001-01-01

    Examines top regulatory issues and other unique issues resulting from this regulatory overlay when negotiating for corporate telecom services. Issues cover such topics as tariffs, rate negotiation, exclusivity provisions, revenue commitments, mid-term negotiations, service-level agreements, and dispute resolution. (GR)

  9. Do Those Who Benefit the Most Need it the Least? A Four-Year Experiment in Enquiry-Based Feedback

    ERIC Educational Resources Information Center

    Adcroft, Andy; Willis, Robert

    2013-01-01

    The aim of this paper is to report on an ongoing experiment in an enquiry-based approach to feedback. Over the course of four years, almost 1800 students have studied a final-year undergraduate module involving a mid-term assignment and end of module examination. Feedback on the assignment is delivered through a process which involves the…

  10. New Technology Trends in Education: Seven Years of Forecasts and Convergence

    ERIC Educational Resources Information Center

    Martin, Sergio; Diaz, Gabriel; Sancristobal, Elio; Gil, Rosario; Castro, Manuel; Peire, Juan

    2011-01-01

    Each year since 2004, a new Horizon Report has been released. Each edition attempts to forecast the most promising technologies likely to impact on education along three horizons: the short term (the year of the report), the mid-term (the next 2 years) and the long term (the next 4 years). This paper analyzes the evolution of technology trends…

  11. Economic analysis of the unified heliostat array

    SciTech Connect

    Not Available

    1980-06-13

    Viewgraphs for the mid-term review outline the contract objectives and project details, give optical performance assumptions and constraints, and diagram the methodologies for the performance determination. The method of calculating performance is outlined. The flux distribution over the heliostat field is computed and graphed. (LEW)

  12. Maintenance Crisis vs Solutions.

    ERIC Educational Resources Information Center

    Haggard, Susie

    Industrial maintenance in Northeast Georgia is facing an acute crisis. Contributing factors are economic development that is depleting the work force, aging of the population, downsizing of the military, and lack of technical school graduates. Solutions to the crisis fall into three categories: short-term, mid-term, and long-term. For short-term…

  13. 78 FR 18429 - Cost Recovery for Permit Processing, Administration, and Enforcement

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... review of the permit, permit renewals, and the transfer, assignment, or sale of rights to an existing... rights of an existing permit, or any new application or action that OSM might require to be submitted in... request to transfer, assign or sell rights to an existing permit; 4. A mid-term review; 5. A request to...

  14. National Electric Sector Cybersecurity Organization Resource (NESCOR)

    SciTech Connect

    None, None

    2014-06-30

    The goal of the National Electric Sector Cybersecurity Organization Resource (NESCOR) project was to address cyber security issues for the electric sector, particularly in the near and mid-term. The following table identifies the strategies from the DOE Roadmap to Achieve Energy Delivery Systems Cybersecurity published in September 2011 that are applicable to the NESCOR project.

  15. Students' Confusions with Reciprocal and Inverse Functions

    ERIC Educational Resources Information Center

    Kontorovich, Igor'

    2017-01-01

    These classroom notes are focused on undergraduate students' understanding of the polysemous symbol of superscript (-1), which can be interpreted as a reciprocal or an inverse function. Examination of 240 scripts in a mid-term test identified that some first-year students struggle with choosing the contextually correct interpretation and there are…

  16. The Effect of Context and Input Conditions on Oral and Written Development: A Study Abroad Perspective

    ERIC Educational Resources Information Center

    Perez-Vidal, Carmen; Juan-Garau, Maria

    2011-01-01

    This article aims at describing and explaining the effects of a period of Study Abroad spent in the target language country (SA) on foreign language development. Such effects are analysed in the short- and mid-term and in contrast with the impact of a period of formal instruction (FI) previously spent in the home country (AH). It is hypothesised…

  17. Resilience and Learning: A Conspectus for Environmental Education

    ERIC Educational Resources Information Center

    Lundholm, Cecilia; Plummer, Ryan

    2010-01-01

    There has been an increasing interest in how environmental education contributes to sustainability dating from the 1977 UNESCO conference in Tbilisi to the current Decade of Education for Sustainable Development, which in 2009, reached mid term. There is also a growing interest and concern in the complexity, uncertainty and changing nature of…

  18. 29 CFR 4022.81 - General rules.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... after May 1998, the applicable federal mid-term rate (as determined by the Secretary of the Treasury pursuant to section 1274(d)(1)(C)(ii) of the Code) for that month (or, where the rate for a month is not... which the rate is available) based on monthly compounding; and (ii) For May 1998 and earlier months,...

  19. 29 CFR 4022.81 - General rules.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... after May 1998, the applicable federal mid-term rate (as determined by the Secretary of the Treasury pursuant to section 1274(d)(1)(C)(ii) of the Code) for that month (or, where the rate for a month is not... which the rate is available) based on monthly compounding; and (ii) For May 1998 and earlier months,...

  20. Community Analysis for the Pitkin County Library.

    ERIC Educational Resources Information Center

    Kirwin, Florence M.

    This document analyzes the social and demographic characteristics of Pitkin County, Colorado (population 12,000) and the Pitkin County Library located in Aspen (24,000 volumes). The report contains statistics gathered from the 1978 Mid-Term U.S. Bureau Census of Pitkin County, as well as other statistics from local, state, and federal sources; the…

  1. Maintenance Crisis vs Solutions.

    ERIC Educational Resources Information Center

    Haggard, Susie

    Industrial maintenance in Northeast Georgia is facing an acute crisis. Contributing factors are economic development that is depleting the work force, aging of the population, downsizing of the military, and lack of technical school graduates. Solutions to the crisis fall into three categories: short-term, mid-term, and long-term. For short-term…

  2. Extracorporeal shock wave lithotripsy in infants less than 12-month old.

    PubMed

    Turna, Burak; Tekin, Ali; Yağmur, İsmail; Nazlı, Oktay

    2016-10-01

    There is a lack of literature on children compared to adults regarding the long-term effects of extracorporeal shock wave lithotripsy (SWL), specifically in infants. The aim of the present study was to analyze the efficacy and safety of SWL in infants and also evaluate its potential adverse effects in the mid-term. Between May 1999 and December 2013, 36 infants with 39 renal units underwent SWL treatment for kidney stones with an electrohydraulic lithotripter (Dornier MPL 9000/ELMED Multimed Classic). All children were less than 12-month old. The mid-term effects of SWL were examined at the last follow-up by measuring arterial blood pressure, random blood glucose level and ipsilateral kidney size. Evaluation of treatment and its consequences was based on clinical examination, blood tests and conventional imaging (plain abdominal radiography and ultrasound). Overall stone-free rate was 84.6 % after 3-month follow-up without any major complications. Mid-term follow-up was available in 20 of 36 children with a mean follow-up of 3.2 ± 2.8 years (range 0.5-15.3). None of the infants were found to develop new onset of hypertension or diabetes. All treated infant kidneys' sizes were in the normal percentile range. SWL for management of infant kidney stones is effective and safe in the mid-term.

  3. Development of an Academic Alert and Advisement System Using a Participational Governance Structure.

    ERIC Educational Resources Information Center

    Mackin, Sara Lee

    Due to the implementation of new standards for academic progress in Fall 1978 and the resultant suspension of or imposition of credit limitations upon students not meeting these standards, Miami-Dade Community College developed and tested an academic alert program in which computer-generated letters were sent to students at mid-term to provide an…

  4. EFA Mid-Decade Assessment Meeting Report. Annual EFA Coordinators Meeting/EFA Mid-Decade Assessment Planning Meeting (7th, Bangkok, Thailand, October 24-29, 2005)

    ERIC Educational Resources Information Center

    Tung, Ko-Chih

    2006-01-01

    Six Education For All (EFA) goals were agreed to in the World Education Forum in Dakar, Senegal in 2000. Since then, UNESCO Bangkok, UNICEF and the Regional Thematic Working Group on EFA have been jointly assisting countries in conducting assessment of progress and gaps towards the EFA goals and mid-term review of policies and reforms. In October…

  5. A United Nations Decade of Education for Sustainable Development (2005-14): What Difference Will It Make?

    ERIC Educational Resources Information Center

    Mula, Ingrid; Tilbury, Daniella

    2009-01-01

    The launch of the United Nations Decade of Education for Sustainable Development (DESD) (2005-2014) was accompanied by a series of high-profile events and celebratory activities across the globe, which raised awareness about the Decade's objectives. Now, as the DESD approaches its mid-term, many stakeholders are asking these questions: What will…

  6. Incorporating Multiple-Choice Questions into an AACSB Assurance of Learning Process: A Course-Embedded Assessment Application to an Introductory Finance Course

    ERIC Educational Resources Information Center

    Santos, Michael R.; Hu, Aidong; Jordan, Douglas

    2014-01-01

    The authors offer a classification technique to make a quantitative skills rubric more operational, with the groupings of multiple-choice questions to match the student learning levels in knowledge, calculation, quantitative reasoning, and analysis. The authors applied this classification technique to the mid-term exams of an introductory finance…

  7. Fetal growth of the anal sinus and sphincters, especially in relation to anal anomalies.

    PubMed

    Arakawa, Takashi; Hwang, Si Eun; Kim, Ji Hyun; Wilting, Joerg; Rodríguez-Vázquez, José Francisco; Murakami, Gen; Hwang, Hong Pil; Cho, Baik Hwan

    2016-03-01

    The anal sinuses, small furrows above the pectinate line, sometimes form perianal abscesses in adults. We examined the pattern of fetal growth of the anal sinus and sphincters using 22 mid-term (8-18 weeks) and 6 late-stage (30-38 weeks) fetuses. In mid-term fetuses, the external and internal sphincters gradually increased in thickness, depending on specimen size (from 0.2 to 1.5 mm), whereas the anteroposterior diameter of the anal canal at the epithelial junction was relatively stable (0.5-1.0 mm) irrespective of specimen size. Anal canal diameter increased less than twofold between mid-term and late-stage fetuses, from 0.5-1.0 to almost 2 mm, whereas sphincter thickness increased over tenfold, from 0.2-1.5 to almost 3.5 mm. The anal sinus often showed balloon-like enlargement when the sphincter muscle bundles were tightly packed in mid-term, but not in late-stage fetuses. Large concentric mechanical stress from the sphincters in late-stage fetuses apparently prevented the anal sinus from expanding in a balloon-like manner. Conversely, to avoid anal stenosis, the growing sinuses maintained a luminal space of the anal canal in response to stress from rapidly growing sphincters. The inferiorly extending sinus usually provided temporal double canals separated by a thick column. In the presence of double lumens, anal canal duplication is likely to develop without any abnormalities of the anal epithelium and sphincters.

  8. Cyclic Nucleotide-Gated Channels, Calmodulin, Adenylyl Cyclase, and Calcium/Calmodulin-Dependent Protein Kinase II Are Required for Late, but Not Early, Long-Term Memory Formation in the Honeybee

    ERIC Educational Resources Information Center

    Matsumoto, Yukihisa; Sandoz, Jean-Christophe; Devaud, Jean-Marc; Lormant, Flore; Mizunami, Makoto; Giurfa, Martin

    2014-01-01

    Memory is a dynamic process that allows encoding, storage, and retrieval of information acquired through individual experience. In the honeybee "Apis mellifera," olfactory conditioning of the proboscis extension response (PER) has shown that besides short-term memory (STM) and mid-term memory (MTM), two phases of long-term memory (LTM)…

  9. Plant community composition after 75 years of sustained grazing intensity treatments in shortgrass steppe

    USDA-ARS?s Scientific Manuscript database

    Plant community responses to livestock grazing lack conformity across studies, even those conducted within similar ecosystems. Variability in outcomes is often related to the strong influences of short-term weather patterns, mid-term climatic cycles, differences in the timing and intensity of grazin...

  10. New Technology Trends in Education: Seven Years of Forecasts and Convergence

    ERIC Educational Resources Information Center

    Martin, Sergio; Diaz, Gabriel; Sancristobal, Elio; Gil, Rosario; Castro, Manuel; Peire, Juan

    2011-01-01

    Each year since 2004, a new Horizon Report has been released. Each edition attempts to forecast the most promising technologies likely to impact on education along three horizons: the short term (the year of the report), the mid-term (the next 2 years) and the long term (the next 4 years). This paper analyzes the evolution of technology trends…

  11. Do Those Who Benefit the Most Need it the Least? A Four-Year Experiment in Enquiry-Based Feedback

    ERIC Educational Resources Information Center

    Adcroft, Andy; Willis, Robert

    2013-01-01

    The aim of this paper is to report on an ongoing experiment in an enquiry-based approach to feedback. Over the course of four years, almost 1800 students have studied a final-year undergraduate module involving a mid-term assignment and end of module examination. Feedback on the assignment is delivered through a process which involves the…

  12. Course Syllabus: Minds and Robots.

    ERIC Educational Resources Information Center

    Goldman, Steven L.

    1985-01-01

    Describes and outlines the general syllabus of a philosophy course entitled, "Minds and Robots." Lists the assigned readings and explains the issues addressed in the 14-week course. Essay questions that are used for the mid-term and final exams are also included. (ML)

  13. Medial pivot knee in primary total knee arthroplasty.

    PubMed

    Atzori, Francesco; Salama, Wael; Sabatini, Luigi; Mousa, Shazly; Khalefa, Abdelrahman

    2016-01-01

    Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.

  14. 26 CFR 1.483-4 - Contingent payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... December 31, 1996, the short-term applicable Federal rate is 4 percent, compounded annually, and the mid-term applicable Federal rate is 5 percent, compounded annually. (ii) Treatment of noncontingent payment... December 31, 1996, the short-term applicable Federal rate is 4 percent, compounded annually. M and N are...

  15. Left ventricular assist device support with a centrifugal pump for 2 months in a 5-kg child.

    PubMed

    Inoue, Takafumi; Nishimura, Takashi; Murakami, Arata; Itatani, Keiichi; Takaoka, Tetsuhiro; Kitahori, Kazuo; Umeki, Akihide; Takezoe, Toshiko; Kashiwa, Koichi; Kyo, Shunei; Ono, Minoru

    2011-09-01

    The mid-term and long-term results of left ventricular assist device (LVAD) implantation for small children are still unsatisfactory. There have been few reports of LVAD implantation for more than a month in children weighing under 5 kg. We report the case of a 4-month-old female infant who survived for 2 months after being diagnosed with dilated cardiomyopathy (DCM) with extracorporeal centrifugal pump support. In recent years, although pumps designed for small children have been introduced and are used as a bridge to transplantation or recovery, mid-term or long-term mechanical support for small children with heart failure is still difficult. We managed to successfully provide support for a low-body-weight child with a centrifugal pump over a mid-term period. We achieved acceptable control of thrombosis, but eventually the infant died of sepsis. Autopsy revealed no prominent thrombosis in the perfusion cannula, drainage cannula, the pump, or the left ventricle. This is the first case report of LVAD support with the centrifugal pump, ROTAFLOW(®) (Maquet, Rastatt, Germany), for 2 months in a child weighing under 5 kg. Our method may potentially save severe heart failure children who need mid-term LVAD support.

  16. Cyclic Nucleotide-Gated Channels, Calmodulin, Adenylyl Cyclase, and Calcium/Calmodulin-Dependent Protein Kinase II Are Required for Late, but Not Early, Long-Term Memory Formation in the Honeybee

    ERIC Educational Resources Information Center

    Matsumoto, Yukihisa; Sandoz, Jean-Christophe; Devaud, Jean-Marc; Lormant, Flore; Mizunami, Makoto; Giurfa, Martin

    2014-01-01

    Memory is a dynamic process that allows encoding, storage, and retrieval of information acquired through individual experience. In the honeybee "Apis mellifera," olfactory conditioning of the proboscis extension response (PER) has shown that besides short-term memory (STM) and mid-term memory (MTM), two phases of long-term memory (LTM)…

  17. English Teaching in South Africa: Languages, Literacies and Politics.

    ERIC Educational Resources Information Center

    Farrell, Lesley; Homer, David; Patterson, Annette

    1998-01-01

    Uses three addresses given at a mid-term International Federation for the Teaching of English at the University of Witwatersrand to outline workplace realities for South African teachers. Summarizes the addresses which deal with (1) the role of intellectuals in Africa; (2) the problems of school and social reconstruction; and (3) the political…

  18. Development of PCK for Novice and Experienced University Physics Instructors: A Case Study

    ERIC Educational Resources Information Center

    Jang, Syh-Jong; Tsai, Meng-Fang; Chen, Ho-Yuan

    2013-01-01

    The current study assessed and compared university students' perceptions' of a novice and an experienced physics instructor's Pedagogical Content Knowledge (PCK). Two college physics instructors and 116 students voluntarily participated in this study. The research model comprised three workshops, mid-term and final evaluations and instructor…

  19. English Teaching in South Africa: Languages, Literacies and Politics.

    ERIC Educational Resources Information Center

    Farrell, Lesley; Homer, David; Patterson, Annette

    1998-01-01

    Uses three addresses given at a mid-term International Federation for the Teaching of English at the University of Witwatersrand to outline workplace realities for South African teachers. Summarizes the addresses which deal with (1) the role of intellectuals in Africa; (2) the problems of school and social reconstruction; and (3) the political…

  20. FY 1979 Unit Cost Analysis for the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    A unit cost analysis for fiscal year (FY) 1979 was conducted by the Illinois Community College Board using mid-term enrollment data and uniform accounting information from each of the state's 51 community colleges. Unit costs for instructional areas were determined at three incremental levels: (1) net instructional cost (NIC), which includes…

  1. Cuisenaire Daily Calendar of a Primary One Teacher. How-I-Did-It.

    ERIC Educational Resources Information Center

    Loomis, Challie

    A teacher's daily record of activities and strategies for teaching arithmetic to a class of first grade students exclusively through the use of Cuisenaire rods is described. Worksheets and the mid-term test are included. A short evaluation of the results of the instructional method concludes the paper. (DT)

  2. Predicting Pre-Service Classroom Teachers' Civil Servant Recruitment Examination's Educational Sciences Test Scores Using Artificial Neural Networks

    ERIC Educational Resources Information Center

    Demir, Metin

    2015-01-01

    This study predicts the number of correct answers given by pre-service classroom teachers in Civil Servant Recruitment Examination's (CSRE) educational sciences test based on their high school grade point averages, university entrance scores, and grades (mid-term and final exams) from their undergraduate educational courses. This study was…

  3. Energy Frontier Research Center, Center for Materials Science of Nuclear Fuels

    SciTech Connect

    Todd R. Allen

    2011-12-01

    This is a document required by Basic Energy Sciences as part of a mid-term review, in the third year of the five-year award period and is intended to provide a critical assessment of the Center for Materials Science of Nuclear Fuels (strategic vision, scientific plans and progress, and technical accomplishments).

  4. Incorporating Multiple-Choice Questions into an AACSB Assurance of Learning Process: A Course-Embedded Assessment Application to an Introductory Finance Course

    ERIC Educational Resources Information Center

    Santos, Michael R.; Hu, Aidong; Jordan, Douglas

    2014-01-01

    The authors offer a classification technique to make a quantitative skills rubric more operational, with the groupings of multiple-choice questions to match the student learning levels in knowledge, calculation, quantitative reasoning, and analysis. The authors applied this classification technique to the mid-term exams of an introductory finance…

  5. 75 FR 11988 - Notice of Request for Approval To Collect New Information: Collection of Safety Culture Data

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ...: The survey will be conducted twice either as a mid-term or end-of-study evaluation. Total Annual... Research and Innovative Technology Administration Notice of Request for Approval To Collect New Information: Collection of Safety Culture Data AGENCY: Bureau of Transportation Statistics (BTS), Research and Innovative...

  6. Identifying Functional Requirements for Flexible Airspace Management Concept Using Human-In-The-Loop Simulations

    NASA Technical Reports Server (NTRS)

    Lee, Paul U.; Bender, Kim; Pagan, Danielle

    2011-01-01

    Flexible Airspace Management (FAM) is a mid- term Next Generation Air Transportation System (NextGen) concept that allows dynamic changes to airspace configurations to meet the changes in the traffic demand. A series of human-in-the-loop (HITL) studies have identified procedures and decision support requirements needed to implement FAM. This paper outlines a suggested FAM procedure and associated decision support functionality based on these HITL studies. A description of both the tools used to support the HITLs and the planned NextGen technologies available in the mid-term are presented and compared. The mid-term implementation of several NextGen capabilities, specifically, upgrades to the Traffic Management Unit (TMU), the initial release of an en route automation system, the deployment of a digital data communication system, a more flexible voice communications network, and the introduction of a tool envisioned to manage and coordinate networked ground systems can support the implementation of the FAM concept. Because of the variability in the overall deployment schedule of the mid-term NextGen capabilities, the dependency of the individual NextGen capabilities are examined to determine their impact on a mid-term implementation of FAM. A cursory review of the different technologies suggests that new functionality slated for the new en route automation system is a critical enabling technology for FAM, as well as the functionality to manage and coordinate networked ground systems. Upgrades to the TMU are less critical but important nonetheless for FAM to be fully realized. Flexible voice communications network and digital data communication system could allow more flexible FAM operations but they are not as essential.

  7. [Admission to medical education at the School of Medical Sciences of the National University of La Plata: its effectiveness].

    PubMed

    Albizu, Enrique Pérez; Urrutia, María I

    2005-01-01

    The present paper, based on studies carried out as from the year 1972 at the Department of Anatomy "C" of the Medical Sciences School of the National University of La Plata, analyzes the performance of students who entered the aforementioned School with and without entrance examination. To evaluate the performance achieved by the students, considering for the analysis a cross section of two groups, those who entered the School between the years 1985 and 1988 and those who did it between 1992 and 1999, without and with entrance examination respectively. The following variables were evaluated: Dropout average percentage. Average percentage of students who passed in November, December and March. Average percentage of students who passed the mid-term tests. Mid-term tests average mark. The performance records of each student in the department were audited: personal information, assistance, mid-term tests marks, homework, familiarity with topic of the day, interest in the practical activity and student overall impression. The statistical analysis evaluated whether there were any particular differences between the groups compared. Dropout average percentage: without admissibility*: 27,15%, with admissibility: 7,91% Average percentage of students who passed in November, December and March: without admissibility: 50,75%, with admissibility: 90,43% Average percentage of students who passed the mid-term tests: without admissibility: 68,75%, with admissibility: 93,29% Mid-term tests average mark: without admissibility: 6,63%, with admissibility: 6,86% *Admissibility = entrance examination The overall performance of the students with entrance selection surpasses the one of those who entered directly.

  8. Bevacizumab, Capecitabine, Amifostine, and Preoperative Hypofractionated Accelerated Radiotherapy (HypoArc) for Rectal Cancer: A Phase II Study

    SciTech Connect

    Koukourakis, Michael I.; Tsoutsou, Pelagia; Chloropoulou, Pelagia A.; Manolas, Kostantinos; Sivridis, Efthimios

    2011-06-01

    Purpose: Bevacizumab has established therapeutic activity in patients with metastatic colorectal cancer, and anti-vascular endothelial growth factor therapy enhances the activity of radiotherapy in experimental models. We assessed the feasibility and efficacy of preoperative radiochemotherapy combined with bevacizumab in patients with rectal cancer. Methods and Materials: Nineteen patients with radiologic T3 and/or N+ rectal carcinoma were treated with preoperative conformal hypofractionated accelerated radiotherapy (3.4 Gy in 10 consecutive fractions) supported with amifostine (500-1,000 mg daily), capecitabine (600 mg/m{sup 2} twice daily, 5 days per week), and bevacizumab (5 mg/kg every 2 weeks for 2 cycles). Surgery followed 6 weeks after the end of radiotherapy. A cohort of 14 sequential patients treated with the same regimen without bevacizumab was available for comparison. Results: Grade 2 or 3 diarrhea was noted in 7 of 19 patients (36.8%), which was statistically worse than patients receiving the same regimen without bevacizumab (p = 0.01). A higher incidence of Grade 2 or 3 proctalgia was also noted (21.1%) (p = 0.03). Bladder and skin toxicity was negligible. All toxicities regressed completely within 2 weeks after the end of therapy. Pathologic complete and partial response was noted in 7 of 19 cases (36.8%) and 8 of 19 cases (42.1%). Within a median follow-up of 21 months, none of the patients has had late complications develop and only 1 of 18 evaluable cases (5.5%) has had locoregional relapse. Conclusions: Bevacizumab can be safely combined with hypofractionated radiotherapy and capecitabine as a preoperative radiochemotherapy regimen for patients with rectal cancer. The high pathologic complete response rates urges the testing of bevacizumab in randomized studies.

  9. Pudendal nerve decompression in perineology : a case series

    PubMed Central

    Beco, Jacques; Climov, Daniela; Bex, Michèle

    2004-01-01

    Background Perineodynia (vulvodynia, perineal pain, proctalgia), anal and urinary incontinence are the main symptoms of the pudendal canal syndrome (PCS) or entrapment of the pudendal nerve. The first aim of this study was to evaluate the effect of bilateral pudendal nerve decompression (PND) on the symptoms of the PCS, on three clinical signs (abnormal sensibility, painful Alcock's canal, painful "skin rolling test") and on two neurophysiological tests: electromyography (EMG) and pudendal nerve terminal motor latencies (PNTML). The second aim was to study the clinical value of the aforementioned clinical signs in the diagnosis of PCS. Methods In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between 1995 and 2002. To accomplish the first aim, the patients sample was compared before and at least one year after surgery by means of descriptive statistics and hypothesis testing. The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs: prolapse, anal incontinence, perineodynia, dyschesia and history of pelvi-perineal surgery. Results When bilateral PND was the only procedure done to treat the symptoms, the cure rates of perineodynia, anal incontinence and urinary incontinence were 8/14, 4/5 and 3/5, respectively. The frequency of the three clinical signs was significantly reduced. There was a significant reduction of anal and perineal PNTML and a significant increase of anal richness on EMG. The Odd Ratio of the three clinical signs in the diagnosis of PCS was 16,97 (95% CI = 4,68 – 61,51). Conclusion This study suggests that bilateral PND can treat perineodynia, anal and urinary incontinence. The three clinical signs of PCS seem to be efficient to suspect this diagnosis. There is a need for further studies to confirm these preliminary results. PMID:15516268

  10. Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study.

    PubMed

    Karaduman, Mert; Okkaoglu, Mustafa Caner; Sesen, Hakan; Taskesen, Anil; Ozdemir, Mahmut; Altay, Murat

    2016-03-01

    To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique. A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements. VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength. The PRP seems to be better for pain relief and functionality in the short and mid-term periods.

  11. The requirements for batteries for electric vehicles

    NASA Technical Reports Server (NTRS)

    Schwartz, H. J.

    1976-01-01

    The paper reassesses the role of electric vehicles in the modern transportation system and their potential impact on oil consumption. Three major factors determining the size of this impact are discussed: the market potential, the date of introduction, and the rate of consumer acceptance. The strategy of selecting the battery type for an urban car to introduce in coming years is analyzed. The results of the analysis suggest that the research and development emphasis should be placed on near- and mid-term battery technology. From the standpoint of maximizing both the cumulative impact and the benefits derived in the year 2000, however, a strategy of early introduction of near-term and mid-term cars followed by the far-term vehicles seems to produce the optimum result.

  12. Techno-economic analysis of corn stover fungal fermentation to ethanol

    SciTech Connect

    Meyer, Pimphan; Tews, Iva J.; Magnuson, Jon K.; Karagiosis, Sue A.; Jones, Susanne B.

    2013-11-01

    This techno-economic analysis assesses the process economics of ethanol production from lignocellulosic feedstock by fungi in order to identify promising opportunities and the research needed to achieve them. Based on literature derived data, four different ethanologen strains are considered in this study: native and recombinant Saccharomyces cerevisiae, the natural pentose-fermenting yeast, Pichia stipitis and the filamentous fungus Fusarium oxysporum. Organism performance and technology readiness are split into three groups: near-term (<5 years), mid-term (5-10 years) and long-term (>10 years) process deployment. Processes classified as near-term could reasonably be developed in this shorter time frame, as suggested by recent literature. Mid-term technology process models are based on lab-scale experimental data, and yields near the theoretical limit are used to estimate long-term technology goals. Further research and economic evaluation on the integrated production of chemicals and fuels in biorefineries are recommended.

  13. Acute Iliac Artery Rupture: Endovascular Treatment

    SciTech Connect

    Chatziioannou, A.; Mourikis, D.; Katsimilis, J.; Skiadas, V. Koutoulidis, V.; Katsenis, K.; Vlahos, L.

    2007-04-15

    The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.

  14. Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study

    PubMed Central

    Karaduman, Mert; Okkaoglu, Mustafa Caner; Sesen, Hakan; Taskesen, Anil; Ozdemir, Mahmut; Altay, Murat

    2016-01-01

    Purpose To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique. Method A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements. Results VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength. Conclusion The PRP seems to be better for pain relief and functionality in the short and mid-term periods. PMID:26955228

  15. The requirements for batteries for electric vehicles

    NASA Technical Reports Server (NTRS)

    Schwartz, H. J.

    1976-01-01

    The paper reassesses the role of electric vehicles in the modern transportation system and their potential impact on oil consumption. Three major factors determining the size of this impact are discussed: the market potential, the date of introduction, and the rate of consumer acceptance. The strategy of selecting the battery type for an urban car to introduce in coming years is analyzed. The results of the analysis suggest that the research and development emphasis should be placed on near- and mid-term battery technology. From the standpoint of maximizing both the cumulative impact and the benefits derived in the year 2000, however, a strategy of early introduction of near-term and mid-term cars followed by the far-term vehicles seems to produce the optimum result.

  16. How to Awaken an Appreciation for the Value of Practicing Learning Skills in an Environment of Poverty, Theft, Destruction and Violent Behavior

    ERIC Educational Resources Information Center

    Fish, James C.

    2011-01-01

    A first-year teacher thrust mid-term into a mixed-grade geometry class in a tough high school struggles to sort out what works and does not work to engage the 120 students in meaningful learning. The students are largely from low-income urban families and demonstrate a broad range of abilities and motivation. The purpose of this study is to…

  17. Evaluation, Analysis, and Documentation Support for the 10kW Signature Suppressed Lightweight Electric Energy Plant (SLEEP)

    DTIC Science & Technology

    1988-03-14

    Energy Plant,ý ~{ ~ LF &E Mobile Electric Power,’ Engine Generators,’ Free PPiston Stirling Engine," Kinematic Stirling Engine;(Continued) k19. ABTAT...Kinematic Stirling technologies are projected to be excellent candidates for development. Stirling is a mid-term technologyI that is projected to meet all...for the Signature Suppressed, Lightweight Electric Energy Plant (SLEEP). The SLEEP requirement identifies a family of lightweight, compact, mobile

  18. An Effect of Unstructured Evaluation on Academic Integrity.

    ERIC Educational Resources Information Center

    Marsh, Robert

    An attempt was made to determine whether student honesty is affected by a take-home test, referred to as an unstructured evaluation. A group of 27 students in a history class at a university was given a teacher-made take-home test as a mid-term examination. A second group of 27 students was given the same examination in class. Unknown to the…

  19. Socialization and Participation: A Research Agenda for the 21st Century.

    ERIC Educational Resources Information Center

    Gans, Curtis B.

    If one counts both the mid-term and presidential elections, the United States has had the lowest voter turnout of any democracy in the world. In the 1986 election, only 16.6% of the eligible 18-24 year olds voted, and although final census surveys for that year are not yet published, it is unlikely that the turnout for that age group would have…

  20. Efforts and Programs of the Department of Defense Relating to the Prevention, Mitigation, and Treatment of Blast Injuries

    DTIC Science & Technology

    2007-01-01

    therapy into patients requiring reconstructive surgery of limbs or tissues damaged in the battlefield or for patients with vascular disease in need...follow-on cosmetic surgery and novel strategies to repair and restore oral, dental, and craniofacial tissues, including the eye. Additionally, new...and DoD Live Fire Test and Evaluation Program • Mid-term Outcomes Following Wartime Extremity Vascular Injuries: A Report from the 59th MDW: This

  1. Support of a pathway to a hydrogen future

    SciTech Connect

    Hoffman, A.R.

    1997-12-31

    This paper consists of viewgraphs which outline the content of the presentation. Subjects addressed include: hydrogen research program vision; electricity industry restructuring -- opportunities and challenges for hydrogen; transportation sector -- opportunities for hydrogen; near-term and mid-term opportunities for hydrogen; and hydrogen production technologies from water. It is concluded that the global climate change challenge is the potential driver for the development of hydrogen systems.

  2. Rare associations of tetralogy of Fallot with anomalous left coronary artery from pulmonary artery and totally anomalous pulmonary venous connection.

    PubMed

    Sen, Supratim; Rao, Suresh G; Kulkarni, Snehal

    2016-06-01

    We describe the cases of two patients with tetralogy of Fallot, aged 4 years and 8 months, who were incidentally detected to have concomitant anomalous left coronary artery from pulmonary artery and total anomalous pulmonary venous connection, respectively, on preoperative imaging. They underwent surgical correction with good mid-term outcomes. In this study, we discuss the embryological basis, physiological effects, and review the literature of these two unusual associations. Awareness of these rare associations will avoid missed diagnoses and consequent surgical surprises.

  3. Classroom Life

    ERIC Educational Resources Information Center

    Miller, Karl

    2014-01-01

    In this reflective piece, Karl Miller looks down the lens at an ancient world, once his own. He does so with the help of a memoir, "Rebecca's Vest," which he published much later, in the mid-1990s: a mid-term report in which he describes how he became a reader and about what he read. With the end of the term approaching, he offers a…

  4. Misogyny in heart disease?

    PubMed

    Silva, Rafael C; Lemos, Pedro A

    2015-04-01

    Overall, mid-term outcomes of edge-to-edge mitral valve repair with the MitraClip system do not seem to be markedly affected by gender. Nevertheless, there seems to be subtle differences in the results of men and women treated with MitraClip, which might affect patient selection and therapeutic strategy. Further studies with larger sample sizes are required to fully assess the potential differences in specific subsets.

  5. Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: clinical and imaging results.

    PubMed

    Koh, Jieun; Kim, Man Deuk; Jung, Dae Chul; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Kwang Hun

    2012-10-01

    The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) in the management of diffuse uterine leiomyomatosis with mid-term follow-up. All patients who underwent UAE between 2008 and 2010 for symptomatic fibroids were analyzed. Among 360 cases, a total of 7 patients with diffuse uterine leiomyomatosis diagnosed based on MRI were included in this retrospective study. Patient ages ranged from 29 to 38 (mean 32.7) years. The median follow-up period was 16 (range; 6-31) months. The embolic agent was non-spherical polyvinyl alcohol particles. All patients underwent follow-up MRI at 3 months after UAE. Uterine volumes were calculated using MRI. Menorrhagia symptom changes were assessed at mid-term follow-up. There were no technical failures to catheterize the uterine artery and no adverse events requiring therapy after UAE. Contrast-enhanced MRI showed complete necrosis of the leiomyomatous nodules in 5 patients (71%) 3 months after embolization. Two patients (28%) showed mostly leiomyomatous nodules that were necrotized, some of which were still viable. All 7 patients with menorrhagia had improvement of symptoms at the mid-term follow-up. The initial mean uterine volume was 601.30 ± 533.92 cm(3) and was decreased to a mean of 278.81 ± 202.70 cm(3) at 3 months follow-up, for a mean uterus volume reduction rate of 50.1% (p<0.05). One patient became pregnant 5 months after UAE treatment. UAE was a highly effective treatment for diffuse uterine leiomyomatosis with mid-term durability and may be a valuable alternative to hysterectomy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. [Evaluation of aortic valve replacement involving small severely calcified aortic annulus in elderly patients].

    PubMed

    Iwahashi, M; Nishimura, Y; Hiramatsu, K; Komori, S; Shibata, M; Yuzaki, M; Okamura, Y

    2006-04-01

    We performed aortic valve replacement in 24 patients aged over 70 with small calcified valves. The surgical management of such patients remains controversial as the extensive calcification compromises implantation. Hence, we used an ultrasonic debridement instrument to remove calcium and selected a small prosthesis with the largest possible orifice without enlargement of the aortic annulus. Echocardiography showed significant reductions in left ventricular mass index compared with preoperative values. Early and mid-term prognosis has been relatively good.

  7. Frequency stability of maser oscillators operated with cavity Q. [hydrogen and rubidium masers

    NASA Technical Reports Server (NTRS)

    Tetu, M.; Tremblay, P.; Lesage, P.; Petit, P.; Audoin, C.

    1982-01-01

    The short term frequency stability of masers equipped with an external feedback loop to increase the cavity quality factor was studied. The frequency stability of a hydrogen and a rubidium maser were measured and compared with theoretical evaluation. It is shown that the frequency stability passes through an optimum when the cavity Q is varied. Long term fluctuations are discussed and the optimum mid term frequency stability achievably by small size active and passive H-masers is considered.

  8. Report on activities of the Sub-Working Group 1 "Precession/Nutation" of the IAU/IAG Joint Working Group on Theory of Earth Rotation.

    NASA Astrophysics Data System (ADS)

    Getino, J.; Escapa, A.

    2015-08-01

    This is the mid-term report of the Sub-WG1 of the IAU/IAG Joint Working Group on Theory of Earth Rotation (JWG ThER). The main objectives are (1) to provide some feasible enhancements of current precession/nutation model; (2) to give a list of potential future improvements of that model provided by the contributors of the subgroup, and (3) to raise out some open questions which should be discussed within the JWG ThER.

  9. Russia and the European Union: The Sources and Limits of "Special Relationships"

    DTIC Science & Technology

    2007-02-01

    Russia, 2002, 2003, 2005. 43. EBRD Transition Reports; and Cynthia Roberts and Thomas Sherlock , “Bringing the Russian State Back In,” Comparative...April 2006, pp. 69-82, at p. 69. 104 146. Chris Holmes , “Atlantic Basin, Mideast Adequate to Supply Europe, US in Mid-Term,” Oil and Gas Journal’s...Limits of Partial Integration.” Aktualnye problemy Evropy (Urgent Problems of Europe). Vol. 4, 2004, pp. 87-113. _______ and Thomas Sherlock

  10. Argon plasma coagulation for flexible endoscopic Zenker's diverticulotomy.

    PubMed

    Rabenstein, T; May, A; Michel, J; Manner, H; Pech, O; Gossner, L; Ell, C

    2007-02-01

    The increasing use of flexible endoscopy to treat symptomatic Zenker's diverticulum is only partially supported by data on safety and benefits. This retrospective study reports the mid-term results of argon plasma coagulation (APC) for flexible endoscopic therapy of Zenker's diverticulum. Between January 2002 and July 2006, 41 patients (27 men, 14 women, mean age +/- standard deviation [SD] 73 +/- 11 years) were treated by means of APC flexible endoscopic Zenker's diverticulotomy. Technical and immediate clinical success (on a 3-month control examination) was assessed for the entire group. Mid-term follow-up data were obtained for patients treated until December 2005 (n = 34) with a mean +/- SD follow-up period of 16 +/- 5 months. Technical success was achieved in all 41 patients, with a mean +/- SD of 3 +/- 2 treatment sessions during one or two hospitalizations (1-3 sessions for 78% patients, > 3 sessions for 22% patients). Immediate clinical success was achieved in 95% of cases. Fever occurred in seven patients (17%), lasting less than 24 hours in three patients (7%) and associated with clinical infections in four (10%); one perforation occurred, which was managed conservatively. In the patients for whom we had mid-term follow-up data, 5/34 experienced recurrence and achieved a successful clinical outcome after retreatment with APC. APC treatment of Zenker's diverticulum is safe and effective in the short term, with a mean of three treatment sessions. Recurrence rates of around 15% have to be expected on mid-term follow-up. The relative value of APC vs. needle-knife techniques can only be clarified in a prospective randomized study.

  11. U.S.-Mexican Security Cooperation: the Merida Initiative and Beyond

    DTIC Science & Technology

    2010-07-29

    politicians, and civilians. On June 28, 2010, drug traffickers assassinated a popular gubernatorial candidate in Tamaulipas, capping off mid-term...in order to regain popular support for its security policies, the Calderón government will have to show success in dismantling the DTOs, while also...Estados Unidos en Seguridad ? Mexico City : National Autonomous University of Mexico, 2009. 29 Ibid; see the chapters by Mario Cruz Cruz, Juan Pablo Prado

  12. U.S.- Mexican Security Cooperation: The Merida Initiative and Beyond

    DTIC Science & Technology

    2010-07-29

    politicians, and civilians. On June 28, 2010, drug traffickers assassinated a popular gubernatorial candidate in Tamaulipas, capping off mid-term...in order to regain popular support for its security policies, the Calderón government will have to show success in dismantling the DTOs, while also...Estados Unidos en Seguridad ? Mexico City : National Autonomous University of Mexico, 2009. 29 Ibid; see the chapters by Mario Cruz Cruz, Juan Pablo Prado

  13. Hydrocarbon Boost Technology for Future Spacelift

    DTIC Science & Technology

    2012-02-02

    Demonstration Program IVHM/ EHM MondaloyTM ALREST Combustion Stability Mid Term Implementation 3GRB Risk Reduction 3GRB Demo (Subscale) Far Term...the development of the next generation of rocket engine technology – Drive towards model driven development – Strong emphasis on Systems Engineering...Critical tech for high performance domestic ORSC liquid rocket engine – Program goals defined by DoD, NASA and industry partnership – Strong focus

  14. Classroom Life

    ERIC Educational Resources Information Center

    Miller, Karl

    2014-01-01

    In this reflective piece, Karl Miller looks down the lens at an ancient world, once his own. He does so with the help of a memoir, "Rebecca's Vest," which he published much later, in the mid-1990s: a mid-term report in which he describes how he became a reader and about what he read. With the end of the term approaching, he offers a…

  15. Brain Structure-Function Couplings: Year 2 Accomplishments and Programmatic Plans

    DTIC Science & Technology

    2013-06-01

    performance through individual-specific neurotechnologies and enhance Soldier protection technologies to minimize neural injury. The long-term vision of this...envision pathways that enable our basic science accomplishments to foster development of revolutionary Soldier neurotechnologies and Soldier protection...improve Soldier-system performance with Soldier-specific neurotechnologies . We expect mid-term impact with models linking structure and function that can

  16. A Crude Reality; Exploring the Interdependencies of Energy (Oil), the Macro-Economy, and National Security

    DTIC Science & Technology

    2012-04-11

    imported oil rather than on the more stable and available domestic energy resources such as coal, natural gas, hydroelectric , nuclear, and renewable...This is difficult to determine with certainty. Wide variations are reported, and politicians from all persuasions use statistics and terms to suit...attractive, have the potential to speed along the transformation. Like it or not, our economy is tied to oil for the near- and mid-term future. The

  17. Climate observing system studies: An element of the NASA Climate Research Program: Workshop report

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Plans for NASA's efforts in climatology were discussed. Targets for a comprehensive observing system for the early 1990's were considered. A program to provide useful data in the near and mid-term, and a program to provide for a feasibility assessment of instruments and methods for the development of a long-term system were discussed. Climate parameters that cannot be measured from space were identified. Long-term calibration, intercomparison, standards, and ground truth were discussed.

  18. 2011 Army Strategic Planning Guidance

    DTIC Science & Technology

    2011-03-25

    TESI ) of 22,000 Soldiers, the Army’s total force by the end of the mid-term period is programmed to be 520K (AC). We will achieve a more...dwell ratios, extending TESI authority to adequately man deploying units and sustain the All-Volunteer Force, right-sizing the generating force, and... TESI Temporary End-Strength Increase WMD Weapons of Mass Destruction 2011 ARMY STRATEGIC PLANNING GUIDANCE Page 19 2011

  19. International Intelligence Forum 2005, Africa: Perspectives on Multinational Intelligence Cooperation in Africa

    DTIC Science & Technology

    2005-06-01

    AT THE FIELD LEVEL Intelligence in the field filters through the Joint Operations Centre (JOC) and the Joint Mission Analysis Cell ( JMAC ), a newly...established concept in peacekeeping. While the JOC is providing the watch and emergency response capacity in military terms, the JMAC provides for the...and diplomatic sources. As a mission tool, the JMAC should be capable of providing in-depth current and mid-term analysis on issues affecting the

  20. WE Are the Interagency: Exercising a Comprehensive Approach to Crisis Action and Conflict Termination and Stabilization.

    DTIC Science & Technology

    2010-12-01

    CapabilitiesRequired: Water/sanitation, shelter, food , health, security, access, logistics, communication • Risk: JTF medical assets becomefocus for medical...supplyat the expense of HN infrastructure • Duration: Major combat ops or follow-on security ops Mid-TermEffort: • Lead: HN ( MOH , Ministryof Refugees...Internally DisplacedPersons) • Supporting Effort: Donors, NGOs, IGOs, JTF • CapabilitiesRequired: Water/sanitation, shelter, food , health, security

  1. Do carotid surface irregularities correlate with the development of cerebrovascular symptoms? An analysis of the supporting studies, the opposing studies, and the possible pathomechanism.

    PubMed

    Liapis, Christos D; Paraskevas, Kosmas I

    2006-01-01

    Carotid plaque surface morphology appears to play a controversial role in the occurrence of cerebrovascular symptoms, that is, amaurosis fugax, transient ischemic attacks, and episodes of stroke. A number of researchers favor a strong association between the morphologic abnormalities of the carotid plaque surface and the development of cerebrovascular symptoms. The supporters of this theory have demonstrated that surface contour irregularities not only are important potential sources of flow abnormalities but also contribute significantly to the development of ischemic neurologic symptoms through plaque fragmentation, microthrombi formation, and atheroembolism. However, opposers of this theory also exist. The main arguments for and against this theory, as well as the possible underlying pathomechanism linking the morphology of the carotid plaque surface with the development of cerebrovascular symptoms, are outlined. Detection of carotid surface abnormalities with the aid of angiography or color-flow duplex ultrasonography should play a major role in the early identification of patients at increased risk, this way aiding prompt correction of these usually clinically silent but potentially hazardous lesions.

  2. The CHAT classification of stroke.

    PubMed

    Bernstein, E F; Browse, N L

    1989-02-01

    Current terminology for clinical episodes relating to stroke is inconsistent and unclear, does not permit inclusion of data regarding the location and magnitude of extracranial and intracerebral arterial disease, does not coincide with existing classifications in Europe, and characterizes a hemispheric entity only, as opposed to a global description including prior symptoms in both hemispheres. A new classification system (CHAT) has been designed to deal with these problems, including the current clinical presentation, historical clinical episodes, the site and pathologic type of arterial disease, and information regarding abnormalities of the brain. Using this system, a retrospective review of 480 consecutive carotid endarterectomies is presented, demonstrating the advantages of the CHAT classification. Data include a significant difference in the probability of survival after carotid endarterectomy for asymptomatic stenosis in patients with prior symptoms on the opposite side, as well as a significant difference in the probability of stroke-free survival between patients with amaurosis fugax and those with prior carotid cortical symptoms (TIAs) as the presenting clinical condition. The CHAT classification is suggested as a significant advance in the reporting of all surgical cerebrovascular disease experience, and has particular implications for the current randomized trials between medical and surgical therapy for carotid artery disease.

  3. Digital cameras with designs inspired by the arthropod eye.

    PubMed

    Song, Young Min; Xie, Yizhu; Malyarchuk, Viktor; Xiao, Jianliang; Jung, Inhwa; Choi, Ki-Joong; Liu, Zhuangjian; Park, Hyunsung; Lu, Chaofeng; Kim, Rak-Hwan; Li, Rui; Crozier, Kenneth B; Huang, Yonggang; Rogers, John A

    2013-05-02

    In arthropods, evolution has created a remarkably sophisticated class of imaging systems, with a wide-angle field of view, low aberrations, high acuity to motion and an infinite depth of field. A challenge in building digital cameras with the hemispherical, compound apposition layouts of arthropod eyes is that essential design requirements cannot be met with existing planar sensor technologies or conventional optics. Here we present materials, mechanics and integration schemes that afford scalable pathways to working, arthropod-inspired cameras with nearly full hemispherical shapes (about 160 degrees). Their surfaces are densely populated by imaging elements (artificial ommatidia), which are comparable in number (180) to those of the eyes of fire ants (Solenopsis fugax) and bark beetles (Hylastes nigrinus). The devices combine elastomeric compound optical elements with deformable arrays of thin silicon photodetectors into integrated sheets that can be elastically transformed from the planar geometries in which they are fabricated to hemispherical shapes for integration into apposition cameras. Our imaging results and quantitative ray-tracing-based simulations illustrate key features of operation. These general strategies seem to be applicable to other compound eye devices, such as those inspired by moths and lacewings (refracting superposition eyes), lobster and shrimp (reflecting superposition eyes), and houseflies (neural superposition eyes).

  4. Fourier-Transform Raman and Fourier-Transform Infrared Spectroscopy (An Investigation of Five Higher Plant Cell Walls and Their Components).

    PubMed Central

    Sene, CFB.; McCann, M. C.; Wilson, R. H.; Grinter, R.

    1994-01-01

    Infrared and Raman spectra of sequentially extracted primary cell walls and their pectic polymers were obtained from five angiosperm plants. Fourier-transform Raman spectrometry was shown to be a powerful tool for the investigation of primary cell-wall architecture at a molecular level, providing complementary information to that obtained by Fourier-transform infrared microspectroscopy. The use of an extraction procedure using imidazole instead of cyclohexane trans-1,2-N,N,N[prime],N[prime]-diaminotetraacetate allows the extension of the infrared spectral window for data interpretation from 1300 to 800 cm-1, to 2000 to 800 cm-1, and allows us to obtain Raman spectra from extracted cell-wall material. Wall constituents such as pectins, proteins, aromatic phenolics, cellulose, and hemicellulose have characteristic spectral features that can be used to identify and/or fingerprint these polymers without, in most cases, the need for any physical separation. The Gramineae (rice [Oryza sativa], polypogon [Polypogon fugax steud], and sweet corn [Zea mays]) are spectroscopically very different from the nongraminaceous monocotyledon (onion [Allium cepa]) and the dicotyledon (carrot [Daucus carota]); this reflects differences in chemical composition and cross-linking of the walls. The possibility of a taxonomic classification of plant cell walls based on infrared and Raman spectroscopies and the use of spectral fingerprinting for authentication and detection of adulteration of products rich in cell-wall materials are discussed. PMID:12232436

  5. Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients.

    PubMed

    García-Carrasco, M; Galarza, C; Gómez-Ponce, M; Cervera, R; Rojas-Rodríguez, J; Espinosa, G; Bucciarelli, S; Gómez-Puerta, J A; Bové, A; Escárcega, R O; Font, J

    2007-01-01

    The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.

  6. [Hypercoagulable workup in ophthalmology. When and what].

    PubMed

    Muñoz-Negrete, F J; Casas-Lleras, P; Pérez-López, M; Rebolleda, G

    2009-07-01

    Most ophthalmologic disorders secondary to hypercoagulabe state are due to the confluence of congenital and adquired factors. A systematic workup is mandatory. Most of congenital coagulation disorders cause venous trombosis and are inherited autosomal dominantly. In order of frequency these are factor V Leiden mutation (activated protein C resistance), G20210A mutation of the prothrombin gen and protein C, protein S, and antithrombin III deficiencies. Sickle cell anemia can determine arerial and venous thrombosis. In relation with arterial occlusion, the markers most frequently involved are homcysteine fasting levels and the markers of antiphospholipid antibody syndrome. Both of them can also determine venous thrombosis. Several acquired factors can lead to hypoercoagulable state, especially hyperhomocysteinemia, antiphospholipid antibody syndrome, hepatic disease, alcohol and tobacco intake, oral contraceptives, immobilization, surgeries and malignancies. In central venous occlusion is only necessary to rule out hyperhomocysteinemia and antiphospholipid antibody syndrome in young patients without known risk factors. In central artery occlusion, hypercoagulable workup is only recommended for patients less than 50 years-old with unknown emboli source. In this cases protein C, protein S, and antithrombin III deficiencies, homocystein, sickle cell disease and antiphospholipid antibody syndrome will ruled out. In non arteritic ischemic optic neuropathy hypercoagulable work up is not necessary. In amaurosis fugax without known emboli source, it is recommended to rule out etiologies of arterial occlusion, especially antithrombin III deficiencies, homocystein, sickle cell disease and antiphospholipid antibody syndrome.

  7. Varied presentations of moyamoya disease in a tertiary care hospital of north-east India.

    PubMed

    Borah, Papori; Sharma, Vikas; Basumatary, Lakshya Jyoti; Das, Marami; Goswami, Munindra; Kayal, Ashok K

    2014-07-01

    Moyamoya disease is a chronic progressive cerebrovascular disorder, characterized by stenosis or occlusion of bilateral internal carotid arteries (ICAs), anterior cerebral arteries (ACAs) and middle cerebral arteries (MCAs), accompanied by a collateral network of vessels formed at the base of the brain. Ischemia and intracranial hemorrhage are the common typical manifestations. However moyamoya disease has been associated with atypical presentations like headache, seizures and involuntary movements. Although frequently reported from Asian countries like Japan, China and Korea, only few studies reported on clinical manifestations of moyamoya disease from India. To study the varied presentations of moyamoya disease in a tertiary care hospital of north-east India. Relevant investigations were done to rule out other causes of moyamoya syndrome. We report 6 cases of moyamoya disease with varied presentations from a tertiary care referral government hospital. Case 1, 2 and 6 presented with alternating hemiparesis. Case 3 had amaurosis fugax. Case 4 had history suggestive of ischemic stroke and presented with hemichorea. Case 4 had focal seizure as the only manifestation. Cases 4 and 5 notably had stenosis of posterior cerebral artery (PCA) in addition to stenosis of bilateral ICAs, ACAs and MCAs. Owing to its low incidence in India, moyamoya disease is easily overlooked as a possible diagnosis. However, because of its progressive nature, it is imperative to diagnose this disease early and offer surgical treatment to the patients.

  8. No evidence that severity of stroke in internal carotid occlusion is related to collateral arteries

    PubMed Central

    Mead, G E; Wardlaw, J M; Lewis, S C; Dennis, M S

    2006-01-01

    Background/Aim The neurological effects of internal carotid artery (ICA) occlusion vary between patients. The authors investigated whether the severity of symptoms in a large group of patients with ipsilateral or/and contralateral ICA occlusion at presentation with ocular or cerebral ischaemic symptoms could be explained by patency of other extra or intracranial arteries to act as collateral pathways. Methods The authors prospectively identified all patients (n = 2881) with stroke, cerebral transient ischaemic attack (TIA), retinal artery occlusion (RAO), and amaurosis fugax (AFx) presenting to our hospital over five years, obtained detailed history and examination, and examined the intra and extracranial arteries with carotid and colour‐power transcranial Doppler ultrasound. For this analysis, all those with intracranial haemorrhage on brain imaging and cerebral events without brain imaging were excluded. Results Among 2228/2397 patients with brain imaging (1713 ischaemic strokes, 401 cerebral TIAs, 193 AFx, and 90 RAO) who underwent carotid Doppler, 195 (9%) had ICA occlusion. Among those patients with cortical events, disease in potential collateral arteries (contralateral ICA, external carotid, ipsilateral or contralateral vertebral or intracranial arteries) was equally distributed among patients with severe and mild ischaemic presenting symptoms. Conclusion The authors found no evidence that the clinical presentation associated with an ICA occlusion was related to patency of other extra or intracranial arteries to act as collateral pathways. Further work is required to investigate what determines the clinical effects of ICA occlusion. PMID:16488923

  9. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events.

    PubMed

    Glueck, Charles J; Wang, Ping

    2014-08-01

    There are similar time intervals between starting testosterone therapy (TT) and development of thrombotic (~4.5 months) or cardiovascular (CVD) events (~3 months) which may, speculatively, reflect a shared pathophysiology. We have described thrombotic events 5 months (median) after starting TT in 38 men and 4 women, including 27 with deep venous thrombosis-pulmonary embolism, 12 with osteonecrosis, 1 with central retinal vein thrombosis, 1 with amaurosis fugax, and 1 with spinal cord infarction. In 8 men whose TT was continued, second thrombotic events occurred despite adequate anticoagulation with Coumadin in 8 men, 3 of whom had a third thrombotic event. Of these 42 cases, 40 had measures of thrombophilia-hypofibrinolysis, and 39 were found to have previously undiagnosed thrombophilia-hypofibrinolysis. Before beginning TT, especially in men with previous history of thrombotic events, we suggest that, at a minimum, measurements be made for the Factor V Leiden and Prothrombin mutations, Factors VIII and XI, and homocysteine, to identify men who should not receive TT. We need prospective data focused on whether there should be pre-TT screening based on history of previous venous thromboembolism or for all subjects for major gene thrombophilias. To better resolve questions about TT and all cause and cardiovascular morbidity and mortality and thrombosis, a long term, prospective, randomized, blinded study following the example of the Women's Health Initiative is needed. While we wait for prospective placebo-controlled TT outcome data, TT should be restricted to men with well-defined androgen deficiency syndromes.

  10. Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study

    PubMed Central

    Crowson, Cynthia S.; Makol, Ashima; Ytterberg, Steven R.; Saitta, Antonino; Salvarani, Carlo; Matteson, Eric L.; Warrington, Kenneth J.

    2016-01-01

    Objective To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. Methods A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. Results The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. Conclusion In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects. PMID:26901431

  11. [Changes introduced into the recent International Classification of Headache Disorders: ICHD-III beta classification].

    PubMed

    Belvis, Robert; Mas, Natàlia; Roig, Carles

    2015-01-16

    Introduccion. La Sociedad Internacional de Cefaleas (IHS) ha publicado la tercera edicion de la Clasificacion Internacional de las Cefaleas (ICHD-III beta), la guia diagnostica de las cefaleas mas utilizada en el mundo. Objetivo. Revisar las recientes aportaciones de la guia, explicando las nuevas entidades que en ella aparecen y comparando las entidades que han matizado sus criterios con sus criterios de la edicion precedente. Desarrollo. Hemos registrado multitud de matices en los criterios de practicamente todas las cefaleas y neuralgias de la clasificacion, pero las entidades que han experimentado mas matizaciones trascendentales son la migraña cronica, la cefalea asociada exclusivamente a la actividad sexual, las cefaleas neuralgiformes unilaterales de breve duracion, la cefalea diaria persistente de novo, la cefalea por abuso de medicacion sintomatica, el sindrome de cefalea y deficits neurologicos transitorios con pleocitosis linfocitaria. Las entidades nuevas mas destacables que se han incorporado son las cefaleas por presion externa, las cefaleas por crioestimulo, la cefalea numular, la cefalea atribuida a vuelos de avion y la cefalea atribuida a disreflexia autonomica. Tambien cabe destacar las nuevas cefaleas, aun no consideradas como entidades, que se incorporan al apendice, entre las que destacan la epicranea fugax, la migraña vestibular y los colicos infantiles. Conclusiones. La IHS recomienda utilizar ya la nueva clasificacion (ICHD-III beta), prescindiendo de la anterior clasificacion, en la asistencia, la docencia y la investigacion, asi como hacer la maxima difusion de esta nueva guia.

  12. The modified operative technique of partial eversion carotid endarterectomy.

    PubMed

    McBride, Richard; Porter, Johnathan; Al-Khaffaf, Haytham

    2017-01-01

    We report a modified operative technique termed partial eversion carotid endarterectomy (PECE). During a 9-year period (2006-2015), 352 patients underwent PECE. Indications for surgery, intraoperative details, and outcomes were recorded. The initial 185 patients had carotid duplex ultrasound imaging at 6 weeks and then at 6, 12, and 24 months. Subsequent patients had carotid imaging at 4 to 6 weeks. Indications included stroke (76), transient ischemic attack (153), and amaurosis fugax (33); 58 patients were asymptomatic, and 32 patients had surgery before cardiac surgery. Median clamp time was 14 minutes (interquartile range, 11.5-17 minutes). Median total operation time was 41 minutes (interquartile range, 31-72 minutes). Outcomes included four transient ischemic attacks (1.2%), five strokes (1.4%), and two deaths at 30 days (0.5%). No significant cranial nerve injuries or carotid restenosis was detected during follow-up. PECE is technically straightforward, with outcomes comparable to those of current operative techniques. Its advantages included reduced operative and carotid clamping time. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Clinical results of carotid artery stenting versus carotid endarterectomy

    PubMed Central

    Akinci, Tuba; Derle, Eda; Kibaroğlu, Seda; Harman, Ali; Kural, Feride; Cınar, Pınar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.

    2016-01-01

    Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (≥70%) or symptomatic stenosis (≥50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility. PMID:27744460

  14. Comparison of real-world clinical outcomes between Cypher- and Taxus-eluting stents: the GARA-GARA study.

    PubMed

    Fukumoto, Atsushi; Otsuji, Satoru; Takiuchi, Shin; Ikushima, Masashi; Asano, Katsuaki; Terasoma, Kunihiko; Hasegawa, Katsuyuki; Yabuki, Masanori; Higashino, Yorihiko

    2011-09-01

    To evaluate real-world outcomes of PCI in unselected individuals using sirolimus-eluting (SESs) or paclitaxel-eluting stents (PESs) in a single-center randomized trial. Eight hundred consecutive patients (919 lesions) with coronary artery disease were randomized to receive SES or PES implantation. In-hospital, mid-term, and 1-year clinical and angiographical outcomes in both groups were compared. MACEs were defined as cardiac death, myocardial infarction, CABG and target vessel revascularization (TLR). Follow-up angiography was performed in 80.7% of patients. The baseline clinical characteristics were similar in both groups. Pre- and postprocedural reference vessel diameter, minimum length diameter, and diameter stenosis (%DS) were similar in both groups, as was incidence of in-hospital and mid-term MACEs. SESs significantly reduced the risk of TLR, compared with PESs (SES = 5.5%, PES = 10.5%). The superiority of SESs for TLR was also demonstrated with regard to small vessel lesions (stent diameter <2.5 mm) (SES = 6.0%, PES = 15.9%), whereas larger vessel (stent diameter >2.5 mm) lesions did not differ between groups (SES = 5.3%, PES = 8.4%). The safety and efficacy of both DESs were nearly equivalent. SESs, however, were superior to PESs in reducing mid-term TLR, particularly in the small vessel lesion subsets.

  15. Highly potent stem cells from full-term amniotic fluid: A realistic perspective.

    PubMed

    Hamid, Adila A; Joharry, Muhammad Khair; Mun-Fun, Hoo; Hamzah, Siti Nurusaadah; Rejali, Zulida; Yazid, Mohd Nazri; Karuppiah, Thilakavathy; Nordin, Norshariza

    2017-03-01

    Amniotic fluid (AF) is now known to harbor highly potent stem cells, making it an excellent source for cell therapy. However, most of the stem cells isolated are from AF of mid-term pregnancies in which the collection procedure involves an invasive technique termed amniocentesis. This has limited the access in getting the fluid as the technique imposes certain level of risks to the mother as well as to the fetus. Alternatively, getting AF from full-term pregnancies or during deliveries would be a better resolution. Unfortunately, very few studies have isolated stem cells from AF at this stage of gestation, the fluid that is merely discarded. The question remains whether full-term AF harbors stem cells of similar potency as of the stem cells of mid-term AF. Here, we aim to review the prospect of having this type of stem cells by first looking at the origin and contents of AF particularly during different gestation period. We will then discuss the possibility that the AF, at full term, contains a population of highly potent stem cells. These stem cells are distinct from, and probably more potent than the AF mesenchymal stem cells (AF-MSCs) isolated from full-term AF. By comparing the studies on stem cells isolated from mid-term versus full-term AF from various species, we intend to address the prospect of having highly potent amniotic fluid stem cells from AF of full-term pregnancies in human and animals.

  16. Evaluating the effectiveness of presenting introductory chemistry prelaboratory information and assessment on-line with WebCT(TM)

    NASA Astrophysics Data System (ADS)

    McKelvy, George Michael

    This study evaluated the use of web-based videos and quizzes in conjunction with a printed general Chemistry laboratory manual on achievement as well as students' perceptions regarding the use of the web in aiding their success in Chemistry laboratory work. Differences in the effects of the treatment based on gender were also examined. Previous research involving video information for laboratory work has been with regard to video cassette players and televisions and not to on-line presentations. The research involving on-line quizzes and manuals did not utilize a single package for presentation of both. This research incorporated videos, quizzes, and instructor-generated information along with other material in one commercially available web based program known as WebCT(TM) (Web Course Tools). Data focused on the first half of a one semester Introductory Chemistry course involving a generally freshman population in a state technological institution in the southeastern United States which required students to purchase and use a personal computer. Statistical analysis comparing the two groups showed no significant difference in achievement at the mid-term point of the semester with regard to gender. In addition, there was no significant interaction between genders and methods of preparation in achievement at the mid-term. However, there was significant difference between the use of WebCT(TM) and traditional means for preparation. The primary indicator for the significant difference in preparation revolved around the large standard deviation of those grades involving WebCT(TM) with respect to those using traditional means. This would seem to indicate a wide range of achievement levels and possibly a wide degree of acceptance of the computer for prelaboratory work. Female students tended to score higher than their male counterparts on their prelaboratory assessment and laboratory report grades, but lower on the mid-term examination. Due in part to the weighting of

  17. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial.

    PubMed

    Panés, Julián; García-Olmo, Damián; Van Assche, Gert; Colombel, Jean Frederic; Reinisch, Walter; Baumgart, Daniel C; Dignass, Axel; Nachury, Maria; Ferrante, Marc; Kazemi-Shirazi, Lili; Grimaud, Jean C; de la Portilla, Fernando; Goldin, Eran; Richard, Marie Paule; Leselbaum, Anne; Danese, Silvio

    2016-09-24

    in the placebo group) and proctalgia (five vs nine). Cx601 is an effective and safe treatment for complex perianal fistulas in patients with Crohn's disease who did not respond to conventional or biological treatments, or both. TiGenix. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. ACUTE RETINAL ARTERIAL OCCLUSIVE DISORDERS

    PubMed Central

    Hayreh, Sohan Singh

    2011-01-01

    The initial section deals with basic sciences; among the various topics briefly discussed are the anatomical features of ophthalmic, central retinal and cilioretinal arteries which may play a role in acute retinal arterial ischemic disorders. Crucial information required in the management of central retinal artery occlusion (CRAO) is the length of time the retina can survive following that. An experimental study shows that CRAO for 97 minutes produces no detectable permanent retinal damage but there is a progressive ischemic damage thereafter, and by 4 hours the retina has suffered irreversible damage. In the clinical section, I discuss at length various controversies on acute retinal arterial ischemic disorders. Classification of acute retinal arterial ischemic disorders These are of 4 types: CRAO, branch retinal artery occlusion (BRAO), cotton wools spots and amaurosis fugax. Both CRAO and BRAO further comprise multiple clinical entities. Contrary to the universal belief, pathogenetically, clinically and for management, CRAO is not one clinical entity but 4 distinct clinical entities – non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO associated with giant cell arteritis (GCA) and transient non-arteritic CRAO. Similarly, BRAO comprises permanent BRAO, transient BRAO and cilioretinal artery occlusion (CLRAO), and the latter further consists of 3 distinct clinical entities - non-arteritic CLRAO alone, non-arteritic CLRAO associated with central retinal vein occlusion and arteritic CLRAO associated with GCA. Understanding these classifications is essential to comprehend fully various aspects of these disorders. Central retinal artery occlusion The pathogeneses, clinical features and management of the various types of CRAO are discussed in detail. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual

  19. Nature and nurture: a case of transcending haematological pre-malignancies in a pair of monozygotic twins adding possible clues on the pathogenesis of B-cell proliferations.

    PubMed

    Hansen, Marcus C; Nyvold, Charlotte G; Roug, Anne S; Kjeldsen, Eigil; Villesen, Palle; Nederby, Line; Hokland, Peter

    2015-05-01

    We describe a comprehensive molecular analysis of a pair of monozygotic twins, who came to our attention when one experienced amaurosis fugax and was diagnosed with JAK2+ polycythaemia vera. He (Twin A) was also found to have an asymptomatic B-cell chronic lymphocytic leukaemia (B-CLL). Although JAK2-, Twin B was subsequently shown to have a benign monoclonal B-cell lymphocytosis (MBL). Flow cytometric and molecular analyses of the B-cell compartments revealed different immunoglobulin light and heavy chain usage in each twin. We hypothesized that whole exome sequencing could help delineating the pattern of germline B-cell disorder susceptibility and reveal somatic mutations potentially contributing to the differential patterns of pre-malignancy. Comparing bone marrow cells and T cells and employing in-house engineered integrative analysis, we found aberrations in Twin A consistent with a myeloid neoplasm, i.e. in TET2, RUNX1, PLCB1 and ELF4. Employing the method for detecting high-ranking variants by extensive annotation and relevance scoring, we also identified shared germline variants in genes of proteins interacting with B-cell receptor signalling mediators and the WNT-pathway, including IRF8, PTPRO, BCL9L, SIT1 and SIRPB1, all with possible implications in B-cell proliferation. Similar patterns of IGHV-gene usage to those demonstrated here have been observed in inherited acute lymphoblastic leukaemia. Collectively, these findings may help in facilitating identification of putative master gene(s) involved in B-cell proliferations in general and MBL and B-CLL in particular.

  20. Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study.

    PubMed

    Caruso, Diego; Perez Akly, Manuel; Costantini, Pablo Daniel; Fridman, Sebastian; Esnaola, Maria Martha

    2015-01-01

    Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire. We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression. Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21). These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions. © 2015 S. Karger AG, Basel.

  1. Dabigatran: Experience in standard clinical practice.

    PubMed

    Álvarez-Otero, J; de la Fuente-Aguado, J; Arias-Castaño, J C; González-González, L; Puerta-Louro, R; Araújo-Fernández, S

    2015-10-01

    Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. Tai Chi for improving cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

    PubMed

    Guo, Jia-Bao; Chen, Bing-Lin; Lu, Yue-Mei; Zhang, Wen-Yi; Zhu, Zhao-Jin; Yang, Yu-Jie; Zhu, Yi

    2016-08-01

    To examine the effect of Tai Chi on cardiopulmonary function and quality of life in chronic obstructive pulmonary disease. Cochrane Library, PUBMED, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang database. Articles on randomized controlled trials comparing Tai Chi with other treatments or no treatment were identified. A random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI). Fifteen articles involving 1354 participants were included. Compared with the control group, Tai Chi was more effective in improving exercise capacity on 6-minute walking distance (short term: MD = 16.02, 95% CI 2.86 to 29.17; mid term: MD = 30.90, 95% CI 6.88 to 54.93; long term: MD = 24.63, 95% CI 2.30 to 46.95), as well as pulmonary functions on forced expiratory volume in the first second (mid term: MD = 0.10; 95% CI 0.01 to 0.19), and forced vital capacity (mid term: MD = 0.20; 95% CI 0.04 to 0.36). Concerning quality of life, we found Tai Chi was better than the control group for the Chronic Respiratory Disease Questionnaire dyspnoea score (short term: MD = 0.90; 95% CI 0.51 to 1.29), fatigue score (short term: MD = 0.75; 95% CI 0.42 to 1.09), and total score (short term: MD = 1.92; 95% CI 0.54 to 3.31). Tai Chi may improve exercise capacity in the short, mid, and long terms. However, no significant long term differences in pulmonary function and quality of life were observed for patients with chronic obstructive pulmonary disease. © The Author(s) 2015.

  3. Titanium-nitride-oxide-coated coronary stents: insights from the available evidence.

    PubMed

    Karjalainen, Pasi P; Nammas, Wail

    2017-06-01

    Coating of stent surface with a biocompatible material is suggested to improve stent safety profile. A proprietary process was developed to coat titanium-nitride-oxide on the stent surface, based on plasma technology that uses the nano-synthesis of gas and metal. Preclinical in vitro and in vivo investigation confirmed blood compatibility of titanium (nitride-) oxide films. Titanium-nitride-oxide-coated stents demonstrated a better angiographic outcome, compared with bare-metal stents at mid-term follow-up; however, they failed to achieve non-inferiority for angiographic outcome versus second-generation drug-eluting stents. Observational studies showed adequate clinical outcome at mid-term follow-up. Non-randomized studies showed an outcome of titanium-nitride-oxide-coated stents comparable to - or better than - first-generation drug-eluting stents at long-term follow-up. Two randomized controlled trials demonstrated comparable efficacy outcome, and a better safety outcome of titanium-nitride-oxide-coated stents versus drug-eluting stents at long-term follow-up. Evaluation by optical coherence tomography at mid-term follow-up revealed better neointimal strut coverage associated with titanium-nitride-oxide-coated stents versus drug-eluting stents; yet, neointimal hyperplasia thickness was greater. Key messages Stents coated with titanium-nitride-oxide demonstrated biocompatibility in preclinical studies: they inhibit platelet and fibrin deposition, and reduce neointimal growth. In observational and non-randomized studies, titanium-nitride-oxide-coated stents were associated with adequate safety and efficacy outcome. In randomized trials of patients with acute coronary syndrome, titanium-nitride-oxide-coated stents were associated with a better safety outcome, compared with drug-eluting stents; efficacy outcome was comparable.

  4. Unilateral Versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion: A Monocentric Study of 215 Patients With a Minimum of 4-Year Follow-up.

    PubMed

    Liu, Fubing; Feng, Zhenzhou; Zhou, Xiaogang; Liang, Yun; Jiang, Chun; Li, Xilei; Li, Zheng; Jiang, Xiaoxing; Dong, Jian

    2017-07-01

    A retrospective clinical study. This study sought to retrospectively compare the mid-term to long-term outcomes between unilateral pedicle screw (UPS) and bilateral pedicle screw (BPS) augmented transforaminal lumbar interbody fusion (TLIF) in lumbar degenerative diseases. Recently, UPS fixation has been applied in TLIF, for its satisfactory clinical outcome, less implants and less invasiveness. However, only short-term outcome has been reported, the mid-term to long-term outcome has not been well characterized. From June 2007 to February 2011, 215 of 348 consecutive patients suffering from lumbar degenerative diseases were operated in our hospital and accomplished a minimum of 4-year follow-up. These patients were divided into 2 groups according to the operative techniques: UPS group (n=109), and bilateral pedicle screw group (n=106). Operative time, blood loss, length of hospital stay, hospital bill, fusion status, and complications were recorded and analyzed statistically. Visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores were used to assess the preoperative and postoperative pain and functional outcome. The mean follow-up duration was 52.2 months. A significant decrease occurred in operative time, blood loss, and hospital bill in unilateral group, compared with bilateral group (P<0.05). The average postoperative visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores improved significantly in each group than the preoperative counterparts (P<0.05); however, there were no significant difference between groups at any follow-up time point (P>0.05). No statistically difference was detected regarding fusion rate and complication rate between the 2 groups (P>0.05), except the cage migration rate (P<0.05). UPS fixation could achieve satisfactory clinical outcome similar to bilateral fixation in TLIF at a mid-term to long-term follow-up. To avoid cage migration, bullet-shaped cages should not

  5. Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.

    PubMed

    Potenza, V; Caterini, R; Farsetti, P; Bisicchia, S; Ippolito, E

    2010-07-01

    We report the short- and mid-term results in six patients (seven feet) affected by markedly comminuted intra-articular calcaneal fractures (Sanders type IV), treated by primary subtalar arthrodesis. The average age at surgery was 40 years. In all patients, arthrodesis of the subtalar joint was performed using a limited lateral approach to the calcaneus; it was stabilised with two or three cannulated screws. No patient had a preliminary reduction and internal fixation of the fracture. The time from injury to surgery averaged 20 days because all of the patients had associated visceral and/or other skeletal injuries. All of the patients were followed up clinically and radiographically 2 times, at an average of 12 months and 53 months after surgery. At the short-term follow-up, the mean AOFAS score was 70 points; the X-rays showed a complete fusion of the subtalar joint in all seven feet, without any sign of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints. In all cases, an altered shape of the calcaneus was present. At the mid-term follow-up, the mean AOFAS score increased to 85 points; in one patient, radiographic signs of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints were present and, in another patient, only talo-navicular joint was present, although both patients were free from pain. The difference between the two AOFAS scores was statistically significant. We believe that primary subtalar arthrodesis performed for markedly comminuted Sanders type IV calcaneal fractures yielded good mid-term results, and it is especially indicated when surgical treatment is delayed for whatever reason. A preliminary open reduction and internal fixation to restore the normal height of the calcaneus before performing the subtalar arthrodesis, as suggested by several authors, does not seem indispensable to obtain good clinical results. 2009 Elsevier Ltd. All rights reserved.

  6. Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy.

    PubMed

    Khoueiry, Z; Albenque, J-P; Providencia, R; Combes, S; Combes, N; Jourda, F; Sousa, P A; Cardin, C; Pasquie, J-L; Cung, T T; Massin, F; Marijon, E; Boveda, S

    2016-09-01

    Pulmonary vein isolation is the mainstay of treatment in catheter ablation of paroxysmal atrial fibrillation (AF). Cryoballoon ablation has been introduced more recently than radiofrequency ablation, the standard technique in most centres. Pulmonary veins frequently display anatomical variants, which may compromise the results of cryoballoon ablation. We aimed to evaluate the mid-term outcomes of cryoballoon ablation in an unselected population with paroxysmal AF from an anatomical viewpoint. Consecutive patients with paroxysmal AF who underwent a first procedure of cryoballoon ablation or radiofrequency were enrolled in this single-centre study. All patients underwent systematic standardized follow-up. Comparisons between radiofrequency and cryoballoon ablation (Arctic Front™ or Arctic Front Advance™) were performed regarding safety and efficacy endpoints, according to pulmonary vein (PV) anatomical variants. A total of 687 patients were enrolled (376 radiofrequency and 311 cryoballoon ablation). Baseline characteristics and distribution of PV anatomical variants were generally similar in the groups. After a mean follow-up of 14 ± 8 months, there was no difference in the incidence of relapse (17.0% cryoballoon ablation vs. 14.1% radiofrequency, P = 0.25). We observed no interaction of PV anatomical variants on mid-term procedural success. Our findings suggest that mid-term outcomes of cryoballoon ablation for paroxysmal AF ablation are similar to those of radiofrequency, regardless of PV anatomy. The presence of anatomical variants of PVs should not discourage the referral of patients with paroxysmal AF for cryoballoon ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  7. Fixed bearing lateral unicompartmental knee arthroplasty--short to midterm survivorship and knee scores for 101 prostheses.

    PubMed

    Smith, James R A; Robinson, James R; Porteous, Andrew J; Murray, James R D; Hassaballa, Mohammad A; Artz, Neil; Newman, John H

    2014-08-01

    Isolated unicompartmental knee arthritis is less common laterally than medially. Lateral unicompartmental knee arthroplasty (UKA) constitutes only 1% of all knee arthroplasty performed. Use of medial UKA is supported by several published series showing good long-term survivorship and patient satisfaction, in large patient cohorts. Results of lateral UKA however have been mixed. We present the short and mid-term survivorship and 5-year clinical outcome of 101 lateral UKAs using a single prosthesis. Over a 9 year period, 100 patients who satisfied inclusion criteria underwent a lateral fixed-bearing unicompartmental arthroplasty. American Knee Society (AKSS), Oxford Knee (OKS) and modified Western Ontario McMaster Universities Arthritis Index (WOMAC) scores were completed preoperatively and at 1, 2 and 5 years postoperatively. Kaplan-Meier survival analysis was used to determine the 2-year and 5-year survivorship, using revision for any cause as end point. Survivorship was 98.7% and 95.5% at 2 and 5 years respectively. 1 knee was revised for subsidence of the tibial component and 1 knee for progression of medial compartment osteoarthritis. Of a possible 35 knees in situ at 5 year follow-up, 33 knees were fully scored. Median AKSS, OKS and modified WOMAC scores were 182, 41, and 16 respectively. The mid-term survivorship and outcome scores at 5-years suggest that lateral unicompartmental knee arthroplasty provides a valuable alternative to total joint replacement in selected patients with isolated lateral tibio-femoral arthritis at mid-term follow-up. Level II evidence. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients.

    PubMed

    Mauri, Giovanni; Michelozzi, Caterina; Melchiorre, Fabio; Poretti, Dario; Pedicini, Vittorio; Salvetti, Monica; Criado, Eva; Falcò Fages, Joan; De Gregorio, Miguel Ángel; Laborda, Alicia; Sonfienza, Luca Maria; Cornalba, Gianpaolo; Monfardini, Lorenzo; Panek, Jiri; Andrasina, Tomas; Gimenez, Mariano

    2016-11-01

    To assess mid-term outcome of biodegradable biliary stents (BBSs) to treat benign biliary strictures refractory to standard bilioplasty. Institutional review board approval was obtained and patient consent was waived. 107 patients (61 males, 46 females, mean age 59 ± 16 years), were treated. Technical success and complications were recorded. Ninety-seven patients (55 males, 42 females, aged 57 ± 17 years) were considered for follow-up analysis (mean follow-up 23 ± 12 months). Fisher's exact test and Mann-Whitney U tests were used and a Kaplan-Meier curve was calculated. The procedure was always feasible. In 2/107 cases (2 %), stent migration occurred (technical success 98 %). 4/107 patients (4 %) experienced mild haemobilia. No major complications occurred. In 19/97 patients (18 %), stricture recurrence occurred. In this group, higher rate of subsequent cholangitis (84.2 % vs. 12.8 %, p = 0.001) and biliary stones (26.3 % vs. 2.5 %, p = 0.003) was noted. Estimated mean time to stricture recurrence was 38 months (95 % C.I 34-42 months). Estimated stricture recurrence rate at 1, 2, and 3 years was respectively 7.2 %, 26.4 %, and 29.4 %. Percutaneous placement of a BBS is a feasible and safe strategy to treat benign biliary strictures refractory to standard bilioplasty, with promising results in the mid-term period. • Percutaneous placement of a BBS is 100 % feasible. • The procedure appears free from major complications, with few minor complications. • BBSs offer promising results in the mid-term period. • With a BBS, external catheter/drainage can be removed early. • BBSs represent a new option in treating benign biliary stenosis.

  9. Increased Carotid Artery Intima-Media Thickness in Pregnant Women with Gestational Diabetes Mellitus

    PubMed Central

    Yousefzadeh, Gholamreza; Hojat, Hashem; Enhesari, Ahmad; Shokoohi, Mostafa; Eftekhari, Nahid; Sheikhvatan, Mehrdad

    2012-01-01

    Background: Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness (IMT) in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. Methods: This cross-sectional study carried out at Afzalipour Hospital (Kerman, Iran) between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test (OGCT) as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of mid-term pregnancy (20 to 24 weeks) and full-term pregnancy (36 to 38 weeks) on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls (near and far walls) at four different angles was assessed. Results: An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term (0.65 ± 0.07 vs. 0.59 ± 0.06 mm; p value = 0.002) and full-term (0.65 ± 0.05 vs. 0.59 ± 0.04 mm; p value < 0.001) pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group (p value > 0.05). Conclusion: Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women. PMID:23323075

  10. Increased carotid artery intima-media thickness in pregnant women with gestational diabetes mellitus.

    PubMed

    Yousefzadeh, Gholamreza; Hojat, Hashem; Enhesari, Ahmad; Shokoohi, Mostafa; Eftekhari, Nahid; Sheikhvatan, Mehrdad

    2012-11-01

    Pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders. The current study evaluated carotid intima-media thickness (IMT) in pregnant women with gestational diabetes at two time points of mid-term and full-term pregnancy to determine whether gestational diabetes mellitus causes increased IMT. This cross-sectional study carried out at Afzalipour Hospital (Kerman, Iran) between 2009 and 2010, recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test (OGCT) as screening for gestational diabetes. B-mode ultrasound scans were performed at baseline and at two time points of mid-term pregnancy (20 to 24 weeks) and full-term pregnancy (36 to 38 weeks) on all the participants. The mean IMT of common carotids and internal carotid arteries from two walls (near and far walls) at four different angles was assessed. An overall comparison between the impaired OGCT test group and the control group revealed significant differences in carotid IMT in the mid-term (0.65 ± 0.07 vs. 0.59 ± 0.06 mm; p value = 0.002) and full-term (0.65 ± 0.05 vs. 0.59 ± 0.04 mm; p value < 0.001) pregnancy; however, the trend of the changes in carotid IMT during mid to full-term pregnancy was insignificant in each group (p value > 0.05). Carotid IMT was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters. This finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women.

  11. Therapeutic fasting in patients with metabolic syndrome and impaired insulin resistance.

    PubMed

    Stange, Rainer; Pflugbeil, Christine; Michalsen, Andreas; Uehleke, Bernhard

    2013-01-01

    In this study, we evaluated whether a short- to mid-term fasting therapy (7-18 days) might improve insulin resistance according to the homeostasis model assessment for insulin resistance (HOMA-IR), measured during mid-term (80 days) follow-up observation in patients with metabolic syndrome. In this open label observational study in inpatients, criteria of metabolic syndrome were defined. Before medically controlled Buchinger fasting, a wash-out period for hypoglycemic agents was conducted. Further evaluation was carried out on day 80. 25 patients (13 males, 12 females, mean age 61.3 years) were included in this study (mean fasting duration 11.5 days). Out of 16 inpatients with type 2 diabetes, 4 had been treated with metformin, 3 with insulin, and 1 with glimepiride before the intervention. After therapy, body mass index (BMI), fasting insulin, fasting glucose, and HOMA-IR were all significantly reduced. Compared to baseline, HOMA-IR decreased by 33% in all patients, by 38% in patients with type 2 diabetes, and by 23% in patients without diabetes. At day 80, BMI further improved, while other parameters showed complete (insulin) or partial (glucose, HOMA-IR) rebound. At this time, HOMA-IR values showed an only insignificant improvement in 15% of all patients, in 20% of patients with type 2 diabetes, and in 6% of patients without diabetes. There was no correlation between change in BMI and change in HOMA-IR (r(2) = 0.008, baseline minus day 80). No serious side effects were observed. Fasting as a safe and acceptable procedure may cause short- and mid-term improvement of increased insulin resistance (HOMA-IR). Patients with type 2 diabetes benefit more than those without diabetes. A possible clinical significance of this effect should be explored in larger and controlled clinical trials. © 2014 S. Karger GmbH, Freiburg.

  12. Final report for next generation multi-scale quantum simulation software for strongly correlated materials

    SciTech Connect

    Jarrell, Mark

    2014-11-18

    The goal of this project was to develop a new formalism for the correlated electron problem, which we call, the Multi Scale Many Body formalism. This report will focus on the work done at the Louisiana State University (LSU) since the mid term report. The LSU group moved from the University of Cincinnati (UC) to LSU in the summer of 2008. In the last full year at UC, only half of the funds were received and it took nearly two years for the funds to be transferred from UC to LSU . This effectively shut down the research at LSU until the transfer was completed in 2011, there were also two no-cost extensions of the grant until August of this year. The grant ended for the other SciDAC partners at Davis and ORNL in 2011. Since the mid term report, the LSU group has published 19 papers [P1-P19] acknowledging this SciDAC, which are listed below. In addition, numerous invited talked acknowledged the SciDAC. Below, we will summarize the work at LSU since the mid-term report and mainly since funding resumed. The projects include the further development of multi-scale methods for correlated systems (1), the study of quantum criticality at finite doping in the Hubbard model (2), the description of a promising new method to study Anderson localization with a million-fold reduction of computational complexity!, the description of other projects (4), and (5) a workshop to close out the project that brought together exascale program developers (Stellar, MPI, OpenMP,...) with applications developers.

  13. Moderate patient-prosthesis mismatch predicts cardiac events and advanced functional class in young and middle-aged patients undergoing surgery due to severe aortic stenosis.

    PubMed

    Hernandez-Vaquero, Daniel; Garcia, Jose M; Diaz, Rocio; Calvo, David; Khalpey, Zain; Hernández, Ernesto; Rodriguez, Víctor; Morís, César; Llosa, Juan C

    2014-03-01

    The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population. All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area ≤ 0.85 cm(2) /m(2) . We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis. Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR=1.45; 95% CI=0.65-3.22; p=0.36), although it had a negative impact on cardiac events (HR=11.52; 95% CI=5.25-25.24; p<0.001) and functional class (RR=7.55; 95% CI=2.59-22.03; p<0.001). Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality. © 2013 Wiley Periodicals, Inc.

  14. Acquired aortic atresia: Catheter therapy using covered stents.

    PubMed

    Momenah, Tarek S; Khan, Muhammad A; Qureshi, Shakeel; Hijazi, Ziyad M

    2015-11-15

    To maintain aortic continuity, aortic arch interruption is usually treated surgically. We present our experience of aortic arch reconstruction using percutaneous implantation of covered stents and mid-term follow-up. To describe the feasibility, safety, and effectiveness using percutaneous placement of covered stents for functional aortic atresia and mid-term follow-up. Nine patients (7 males), mean age of 30.8 ±16.2 years (range 13-58 years) and mean body weight of 65.7± 14.9 kg (range 52-95 kg), were investigated for systemic hypertension and found to have functional aortic interruption. All were treated with percutaneous perforation, combined with balloon dilation and implantation of covered stents. After stent implantation, control angiograms were performed. All the patients had functional aortic interruption and continuity was established by perforating the atretic segment with trans-septal Brockenbrough needle or the stiff end of a guide wire. A covered Cheatham-Platinum CP stent was used to establish the luminal continuity of the aortic arch. Angiograms after stent deployment showed good forward flow through the stent and hemodynamic assessment revealed minimal gradients across the stent. The mean invasive descending aortic systolic blood pressure before stenting was 86.6 ± 14.3 mm Hg, which increased to 116.5 ± 16.3 mm Hg, after stenting (P = 0.004). The mean invasive descending aortic diastolic blood pressure before stenting was 63.6 ± 8.1 mm Hg, which increased to 79.7 ± 13.3 mm Hg after stenting (P = 0.002). Percutaneous treatment of functional aortic atresia with covered stents is feasible, safe, and effective alternative to surgery with excellent short- and mid-term results. © 2015 Wiley Periodicals, Inc.

  15. [Stenting in superficial femoral artery and usCRP: Multicentric study SAFE in 255 patients].

    PubMed

    Beregi, Jean-Paul; Lehalle, Bertrand; Cardon, Jean-Marie; Pillet, Jean-Christophe; Chabanier, Alain; Sibé, Maxime; Aubry, Pascal; de Cassin, Patrice; Raffin, Jean-Bernard; Lecointre, Bruno; Vernhet, Hélène

    2010-12-01

    To evaluate mid-term primary patency of the femoral artery stenting in correlation with usCRP level and characteristics of the population, morphological aspect of the lesions and interventional techniques. Patients were prospectively included in a multicenter study (18 centers in France) after stenting (SMART, Cordis Johnson & Johnson, Issy-les-Moulineaux, France) of the superficial femoral artery (SFA). Inclusion and exclusion criteria were based on recommendations and every day practice of the centers. Thus 255 patients (183 men; mean age: 69 years; range 44-92) were included. Technical success of the SFA stenting was 100% without any complications and primary angiographic success 97%. usCRP level increased significantly (p < 0.05) between before and 24h after SFA stenting. In the subgroup of patients without initial inflammation (n = 157), usCRP increased significantly (p < 0.05) in the group of patient with initial thrombosis and additional intervention (graft, amputation, angioplasty on other arterial bed) in the same procedure compared to the remaining patients. Restenosis rate was 12.4% (26/209 patients) at 7 ± 2 months. Before stenting, usCRP level was not predictive of a restenosis, whereas after stenting, an increase of the 24h usCRP level was significantly higher in the subgroup of patient with an occlusion at mid-term (8 patients; p < 0.05). This study demonstrated good patency at 7 months of SFA stenting with nitinol SMART with an increase of the usCRP level 24h after stenting in favour of the presence of an occlusion at mid-term follow-up. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  16. Long-Term Echocardiographic Response to Cardiac Resynchronization Therapy in Initial Nonresponders.

    PubMed

    Burns, Kevin V; Gage, Ryan M; Curtin, Antonia E; Bank, Alan J

    2015-12-01

    The aim of this study was to investigate the frequency and clinical implications of a delayed echocardiographic response to cardiac resynchronization therapy (CRT). Long-term prognosis for CRT patients is routinely based on the assessment of echocardiograms after 6 to 12 months of therapy. Some patients, however, may require a longer period of therapy before echocardiographic improvements are detectable. This observational study included all patients with heart failure (HF) receiving a CRT device at a single center from 2003 to 2011. Eligible patients met current indications and had technically adequate echocardiograms from before implantation, approximately 1 year after implantation (mid-term), and ≥3 years after implantation (long-term). A positive echocardiographic response to CRT was defined as a reduction in left ventricular end-systolic volume ≥15%. All-cause mortality was compared for patients in 3 response groups: mid-term responders, long-term responders, and nonresponders. During this study, 294 patients met the study criteria. Of the 120 patients who were nonresponders after 1 year, 52 (43%) experienced a delayed positive response. Delayed, long-term responders had mortality and hospitalization rates similar to mid-term responders and significantly lower than nonresponders. Among patients surviving at least 3 years after implantation of a CRT device and with echocardiographic follow-up, a significant portion of nonresponders after 1 year of CRT experience a delayed echocardiographic response after a longer period of time. Survival and hospitalization rates were similar for all echocardiographic responders, regardless of the time at which the response occurred. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Monitoring the Heavens, Today, and Tomorrow

    NASA Technical Reports Server (NTRS)

    Johnson, Nicholas L.

    2006-01-01

    The current Earth satellite population in LEO for all sizes is relatively well-established by a combination of deterministic and statistical means. At higher altitudes, the population of satellites with diameters of less than 1 m is not well defined. Although a few new sensors might become operational in the near- to mid-term, no major improvement in environment characterization is anticipated during this period. With the increasing deployment of micro- and pico-satellites and with the continued growth of the small debris population, a need exists for better space surveillance to support spacecraft design and operations.

  18. Expedition Seven Lu with EMU in Quest airlock

    NASA Image and Video Library

    2003-09-05

    ISS007-E-14473 (5 September 2003) --- Astronaut Edward T. Lu, Expedition 7 NASA ISS science officer and flight engineer, performs routine maintenance on an Extravehicular Mobility Unit (EMU) space suit in the Quest airlock on the International Space Station (ISS). The work represents a mid-term checkout and included emptying and refilling the suit’s water tank and loops, cycling relief valves, checking sensors and collecting data, a leak check and running the suit’s fan for two hours to lubricate it.

  19. Expedition Seven Lu with EMU in Quest airlock

    NASA Image and Video Library

    2003-09-05

    ISS007-E-14472 (5 September 2003) --- Astronaut Edward T. Lu, Expedition 7 NASA ISS science officer and flight engineer, performs routine maintenance on an Extravehicular Mobility Unit (EMU) space suit in the Quest airlock on the International Space Station (ISS). The work represents a mid-term checkout and included emptying and refilling the suit’s water tank and loops, cycling relief valves, checking sensors and collecting data, a leak check and running the suit’s fan for two hours to lubricate it.

  20. Expedition Seven Lu with EMU in Quest airlock

    NASA Image and Video Library

    2003-09-05

    ISS007-E-14469 (5 September 2003) --- Astronaut Edward T. Lu, Expedition 7 NASA ISS science officer and flight engineer, performs routine maintenance on an Extravehicular Mobility Unit (EMU) space suit in the Quest airlock on the International Space Station (ISS). The work represents a mid-term checkout and included emptying and refilling the suit’s water tank and loops, cycling relief valves, checking sensors and collecting data, a leak check and running the suit’s fan for two hours to lubricate it.

  1. Expedition Seven Lu with EMU in Quest airlock

    NASA Image and Video Library

    2003-09-05

    ISS007-E-14470 (5 September 2003) --- Astronaut Edward T. Lu, Expedition 7 NASA ISS science officer and flight engineer, performs routine maintenance on an Extravehicular Mobility Unit (EMU) space suit in the Quest airlock on the International Space Station (ISS). The work represents a mid-term checkout and included emptying and refilling the suit’s water tank and loops, cycling relief valves, checking sensors and collecting data, a leak check and running the suit’s fan for two hours to lubricate it.

  2. Outcomes of total cavopulmonary connection for single ventricle palliation

    PubMed Central

    Zou, Minghui; Wang, Yanfei; Cui, Hujun; Ma, Li; Yang, Shengchun; Xia, Yuansheng; Chen, Weidan

    2016-01-01

    Background The aim of this study was to review the early and mid-term outcomes of the total cavopulmonary connection (TCPC) procedure and evaluate risk factors for prolonged pleural effusions. Methods The clinical records of 82 consecutive patients, who underwent a TCPC operation between January 2008 and December 2013, were reviewed for incidence of prolonged pleural effusions, duration of ventilation time and pleural drainage, length of intensive care unit (ICU) stay, and early and mid-term morbidity and mortality. Results The median age at surgery was 3.0 years. The main single ventricle diagnoses included 18 cases of a double-inlet single ventricle, 17 cases of heterotaxy, 16 cases of tricuspid atresia, 4 cases of mitral atresia, 12 cases of unbalanced complete atrioventricular canal (CAVC), 5 cases of double-outlet right ventricle (DORV) combined with ventricular septal defect (VSD) and pulmonary stenosis (PS), 4 cases of transposition of the great arteries (TGA) combined with VSD and PS, 4 cases of corrected transposition of great arteries (cTGA) combined VSD and PS, and 2 cases of criss-cross heart. Preoperative mean pulmonary artery pressure (mPAP) was 13.66±2.21 mmHg with 23.2% (n=19) higher than 15 mmHg. A total of 61 (74.4%) patients underwent a fenestration. The perioperative mortality was 4.9%. The median duration of pleural effusion was 10 days (range, 3−80 days), and prolonged pleural effusions occurred in 16 (19.5%) patients. Multivariable analysis revealed that mPAP >15 mmHg was independently associated with prolonged pleural effusions (OR, 8.33; 95% CI, 2.33−29.74; P=0.001), and creation of a fenestration was associated with decreased odds of effusion (OR, 0.21; 95% CI, 0.06−0.74; P=0.015). Five-year estimated Kaplan-Meier survival of two-stage TCPC was significantly higher than that of one-stage group(96.7% vs. 79.7%, P=0.023). Patients with heterotaxy or obstructed totally anomalous pulmonary venous connection (TAPVC) had significantly

  3. Emerging Community Noise Reduction Approaches

    NASA Technical Reports Server (NTRS)

    Envia, Edmane

    2012-01-01

    An overview of the current NASA research portfolio in the area of aircraft noise reduction is presented. The emphasis of the research described herein is on meeting the aggressive near- and mid-term national goals for reducing aircraft noise emissions, which NASA internal studies have shown to be feasible using noise reduction technologies currently being developed in-house or in partnership with NASA s industry and academic partners. While NASA has an active research effort in airframe noise reduction, this overview focuses on propulsion noise reduction only.

  4. Two proteins with ribosome-inactivating, cytotoxic and abortifacient activities from seeds of Luffa cylindrica roem (Cucurbitaceae).

    PubMed

    Ng, T B; Wong, R N; Yeung, H W

    1992-07-01

    Two immunologically distinct glycoproteins, with a molecular weight of 28,000 and 28,500 respectively, were isolated from seeds of Luffa cylindrica using a procedure that involved acetone precipitation, gel filtration on Sephadex G-75 and ion exchange chromatography on CM-Sepharose CL-6B. The proteins differed in the content of aspartic acid, threonine, proline and alanine but were otherwise similar in amino acid composition. The proteins were capable of inducing mid-term abortion in mice, inhibiting protein synthesis in a cell-free system and suppressing thymidine uptake by human choriocarcinoma cells.

  5. Advanced Cryo-Tanks Structural Design Investigated in CHATT

    NASA Astrophysics Data System (ADS)

    Sippel, Martin; Kopp, Alexander; Mattsson, David; Koussios, Sotiris

    2014-06-01

    An EU-funded study called CHATT (Cryogenic Hypersonic Advanced Tank Technologies) has been initiated early 2012 and recently passed its mid-term milestone. The project CHATT is part of the European Commission's Seventh Framework Programme and run on behalf of the Commission by DLR-SART in a multinational collaboration. One of the core objectives is to investigate Carbon Fiber Reinforced Plastic (CFRP) cryogenic pressure tanks. Four different subscale CFRP-tanks are planned to be designed, manufactured, and tested.The paper outlines the study logic of CHATT, gives a presentation of the technology development tasks, and summarizes available research results on the liner testing and CFRP-tank manufacturing.

  6. Advanced In-Space Propulsion: "Exploring the Solar System"

    NASA Technical Reports Server (NTRS)

    Johnson, Les

    2003-01-01

    This viewgraph presentation reviews a number of advanced propulsion technologies for interplanetary spacecraft. The objective of the In Space Propulsion Technology Projects Office is to develop in-space propulsion technologies that can enable and/or benefit near and mid-term NASA science missions by significantly reducing cost, mass, and/or travel times. The technologies profiled are divided into several categories: High Priority (aerocapture, next generation ion propulsion, solar sails); Medium Priority (advanced chemical propulsion, solar electric propulsion, Hall thrusters); Low Priority (solar thermal propulsion); and High Payoff/High Risk (1 g/sq m solar sails, momentum exchange tethers, and plasma sails).

  7. NEMS industrial module documentation report

    SciTech Connect

    Not Available

    1994-01-01

    The NEMS Industrial Demand Model is a dynamic accounting model, bringing together the disparate industries and uses of energy in those industries, and putting them together in an understandable and cohesive framework. The Industrial Model generates mid-term (up to the year 2010) forecasts of industrial sector energy demand as a component of the NEMS integrated forecasting system. From the NEMS system, the Industrial Model receives fuel prices, employment data, and the value of output of industrial activity. Based on the values of these variables, the Industrial Model passes back to the NEMS system estimates of consumption by fuel types.

  8. Business aspects and sustainability for healthgrids - an expert survey.

    PubMed

    Scholz, Stefan; Semler, Sebastian C; Breitner, Michael H

    2009-01-01

    Grid computing initiatives in medicine and life sciences are under pressure to prove their sustainability. While some first business model frameworks were outlined, few practical experiences were considered. This gap has been narrowed by an international survey of 33 grid computing experts with biomedical and non-biomedical background on business aspects. The experts surveyed were cautiously optimistic about a sustainable implementation of grid computing within a mid term timeline. They identified marketable application areas, stated the underlying value proposition, outlined trends and specify critical success factors. From a general perspective of their answers, they provided a stable basis for a road map of sustainable grid computing solutions for medicine and life sciences.

  9. Technology Development Plan for the Baseline Detector System of the X-Ray Microcalorimeter Spectrometer (XMS) of the International X-Ray Observatory (IXO)

    NASA Technical Reports Server (NTRS)

    Kilbourne, C. A.; Boriese, W. B.

    2010-01-01

    The primary purpose of this document is to present the technology development plan for the XMS detector system. It covers the current status (including assessment of the Technology Readiness Level, TRL, and a justification of the level assigned), the roadmap to progress to a level between TRL 5 and TRL 6 by the middle of 2012, and an assessment of the associated cost. A secondary purpose of this document is to address the Action Items raised at the XMS Phase-A Study Mid-Term Review that pertain to the detector system (AI #4, #8, and #9).

  10. Intervertebral disc transplantation: a biological approach to motion preservation.

    PubMed

    Luk, Keith D K; Ruan, D K

    2008-12-01

    Intervertebral disc transplantation was developed in a bipedal animal model through the stages of autograft, fresh allograft and fresh frozen allograft. Results showed that the allografts were able to survive through a deep freezing protocol and maintain cell viability after transplantation without significant immunoreaction. Although degeneration of the allograft appeared to be inevitable, it was able to maintain stability and mobility of the functional spinal unit. These findings were similarly reproduced in the human clinical trial with excellent mid-term clinical results at 5 years. The process of evolution and findings were summarized in this review.

  11. Activities of the Oil Implementation Task Force, December 1990--February 1991; Contracts for field projects and supporting research on enhanced oil recovery, April--June 1990

    SciTech Connect

    Tiedemann, H.A. )

    1991-03-01

    The Oil Implementation Task Force was appointed to implement the US DOE's new oil research program directed toward increasing domestic oil production by expanded research on near- or mid-term enhanced oil recovery methods. An added priority is to preserve access to reservoirs that have the largest potential for oil recovery, but that are threatened by the large number of wells abandoned each year. This report describes the progress of research activities in the following areas: chemical flooding; gas displacement; thermal recovery; resource assessment; microbial technology; geoscience technology; and environmental technology. (CK)

  12. In-Space Propulsion Solar Electric Propulsion Technology Overview

    NASA Astrophysics Data System (ADS)

    Dankanich, John W.

    2006-12-01

    NASA’s In-space Propulsion Technology Project is developing new propulsion technologies that can enable or enhance near and mid-term NASA science missions. The solar electric propulsion technology area has been investing in NASA’s Evolutionary Xenon Thruster (NEXT), the High Voltage Hall Accelerator (HiVHAC), lightweight reliable feed systems, wear testing and thruster modeling. These investments are specifically targeted to increase planetary science payload capability, expand the envelope of planetary science destinations, and significantly reduce the travel times, risk and cost of NASA planetary science missions. Current status and expected capabilities of the solar electric propulsion technologies will be discussed.

  13. The `advanced DIR-MCFC development' project, an overview

    NASA Astrophysics Data System (ADS)

    Kortbeek, P. J.; Ottervanger, R.

    An overview is given of the approach and mid-term status of the joint European `Advanced DIR-MCFC Development' project, in which BCN, BG plc, GDF, ECN, Stork, Schelde and Sydkraft co-operate. Hospitals are identified as an attractive initial market for cogeneration direct internal reforming-molten carbonate fuel cell (DIR-MCFC) systems in the size of 400 kWe. Innovative system and stack design concepts are being developed for this application. The `SMARTER' system, based on DIR stacks, combines high electric efficiency and a wide operational window with optimal system simplicity and low cost.

  14. Propulsion Noise Reduction Research in the NASA Advanced Air Transport Technology Project

    NASA Technical Reports Server (NTRS)

    Van Zante, Dale; Nark, Douglas; Fernandez, Hamilton

    2017-01-01

    The Aircraft Noise Reduction (ANR) sub-project is focused on the generation, development, and testing of component noise reduction technologies progressing toward the NASA far term noise goals while providing associated near and mid-term benefits. The ANR sub-project has efforts in airframe noise reduction, propulsion (including fan and core) noise reduction, acoustic liner technology, and propulsion airframe aeroacoustics for candidate conventional and unconventional aircraft configurations. The current suite of propulsion specific noise research areas is reviewed along with emerging facility and measurement capabilities. In the longer term, the changes in engine and aircraft configuration will influence the suite of technologies necessary to reduce noise in next generation systems.

  15. Development of Ductile Cr-Re Alloys for High Temperature Application in Aggresive Atmosphere

    DTIC Science & Technology

    2007-11-02

    to 1600°C) – Joining and welding – Resistance to propellant – Thermomechanical fatigue The demonstration alloys Cr-35ReCr-18Re Manufacturing method... Heating kinetics of 500 K/s (700 cycles) Materials history 1960 Cobalt base 800 °C 1970 Nickel base 1000 °C 1990 Platinum base 1700 °C Investigated...Powder Metallurgy VS Ingot Metallugy – Short to mid term: Ingot Metallurgy · Prototype alloys by Arc Melting · Production by Induction Melting and

  16. Enterprise Risk Management: The Way Ahead for DRDC within the DND Enterprise

    DTIC Science & Technology

    2010-03-01

    organisationnelle , en vue d’atteindre les objectifs généraux d’une organisation. Il s’agit souvent d’une perspective de haut niveau du processus général de la...planning and performance management processes in the short- to mid- term. Incorporating ERM into whole-life cycle of a technology concept from idea to...hide” in the meeting-room protected by outer office staffs. Risk management should be tied to performance management with the aim to increase the

  17. Aortic valve reimplantation for large root aneurysm and high-grade aortic regurgitation: incidence and implications of additional cusp and commissure repair.

    PubMed

    Kari, Fabian A; Siepe, Matthias; Rylski, Bartosz; Kueri, Sami; Beyersdorf, Friedhelm

    2015-05-01

    Large-sized root aneurysm and high-grade aortic regurgitation (AR) might be contraindications for a valve-sparing aortic root replacement procedure (V-SARR) and aortic valve repair. The impact of a combination of root reimplantation and additional cusp/commissure repair on valve sufficiency in this setting was investigated with respect to early- and mid-term functional outcome. Out of a cohort of 220 patients treated with V-SARR, 73 with an aneurysm size ≥ 55 mm were identified. As a cut-off for high-grade preoperative AR, a grade of ≥ 3 was defined. End points were absolute early and mid-term aortic regurgitation grades, new incidence of AR and AR progression. The mean echocardiographic follow-up time was 3.8 years. T-tests, Kaplan-Meier and log-rank calculations were employed. Within the studied cohort of large aneurysms ≥ 55 mm [total, n = 73; mean age, 56 ± 14 years; female, n = 22 (30%); Marfan, n = 9 (12%); bicuspid valve n = 6 (8%)], 21 (29%) individuals had AR grades ≥ 3+. The rest had lower grade AR (63%) and 6 (8%) had a normally functioning aortic valve. The incidence rate of additional cusp procedures was 27% (n = 20) and included cusp plication, Trussler Stitch, cusp shaving and commissure resuspension. Incidence of additional cusp/commissure repair was 2 (9.5%) among patients with higher grade AR ≥ 3+, while it was 18 (30%) among patients with lower grade AR or a normally functioning valve (P = 0.03). The mean early postoperative AR was 0.5 (median, 1.0). The rate of freedom from early failure, valve replacement and AR ≥ 2 was 96%. The rate of freedom from AR progression was 96% and from new onset AR was 100%. The setting of a large proximal thoracic aortic aneurysm size and high-grade AR does not result in a higher need for cusp/commissure procedures in order to achieve a satisfactory mid-term functional outcome. Large aneurysm size and high-grade AR per se do not increase the complexity of repair. The choice of reimplantation technique

  18. Grammont inverted prosthesis for the treatment of cuff tear arthropathy: a 6-year follow-up study.

    PubMed

    de Cupis, Vincenzo; Chillemi, Claudio; Marinelli, Mario

    2008-05-01

    This study evaluated mid-term functional results of the Grammont inverted prosthesis for the treatment of shoulder osteoarthritis associated with massive cuff rupture. Twenty-eight patients with a minimum of 6 years of follow-up were evaluated. Clinical evaluation was performed on all patients preoperatively and at follow-up using the Constant score. Radiologic assessment included radiographs and magnetic resonance imaging preoperatively and radiographs at follow-up. Constant score improved from 27.4 preoperatively to 64.6 postoperatively. The inverted prosthesis is attractive and remains one of the options for treating cuff tear arthropathy. However, glenoid loosening remains a serious problem.

  19. Upper stage alternatives for the shuttle era

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The status and general characteristics of Space Shuttle upper stages now in use or in development, as well as new vehicle possibilities are examined. Upper stage requirements for both civil and Department of Defense missions, categorized generally into near-term (early and mid-1980's), mid-term (late 1980's to mid-1990's), and far-term (late 1990's and beyond) are discussed. Finally, the technical, schedule and cost impact of alternative ways in which these requirements could be met are examined, and a number of conclusions and recommendations are reached.

  20. Electrolysis: Information and Opportunities for Electric Power Utilities

    SciTech Connect

    Kroposki, B.; Levene, J.; Harrison, K.; Sen, P.K.; Novachek, F.

    2006-09-01

    Recent advancements in hydrogen technologies and renewable energy applications show promise for economical near- to mid-term conversion to a hydrogen-based economy. As the use of hydrogen for the electric utility and transportation sectors of the U.S. economy unfolds, electric power utilities need to understand the potential benefits and impacts. This report provides a historical perspective of hydrogen, discusses the process of electrolysis for hydrogen production (especially from solar and wind technologies), and describes the opportunities for electric power utilities.

  1. [Control situation and primary task of key parasitic diseases in China].

    PubMed

    Lei, Zheng-long; Wang, Li-ying

    2012-02-29

    In the "11th Five-year Plan" period, China unveiled a mid-term planning on the control of the key parasitic diseases, including schistosomiasis, malaria, echinococcosis (hydatid disease), as well as some other parasitic diseases. It clarifies the goals on the control of the major parasitic diseases in the national control program during the "12th Five-year' Plan" period (2011-2015) , formulates current main tasks based on analyzing the progress of the national control program on key parasitic diseases, in order to meet the challenges appearing in the future implementation.

  2. Utilization of the aortic flap above the facing commissure in arterial switch operations.

    PubMed

    Chiu, I S; Chou, T F; Lin, S F; Wu, M H; Wang, J K; Chu, S H

    1996-01-01

    The aortic flap above the facing commissure after removal of the coronary button from the aortic sinus can be utilized for reconstruction in an arterial switch operation. The free flap was used to reconstruct the coronary artery in two cases, as a medially based trapdoor. A rotational flap was inserted into the cut-open right pulmonary artery to augment the neopulmonary arterial anastomotic site in another case. All patients are doing well at mid term follow-up. The indications of each method and reported tricks to avoid coronary artery kinking during an arterial switch operation are discussed.

  3. An Overview of the VHITAL Program: A Two-Stage Bismuth Fed Very High Specific Impulse Thruster with Anode Layer

    NASA Technical Reports Server (NTRS)

    Sengupta, Anita; Marrese-Reading, Colleen; Capelli, Mark; Scharfe, David; Tverdokhlebov, Sergey; Semenkin, Sasha; Tverdokhlebov, Oleg; Boyd, Ian; Keidar, Michael; Yalin, Azer; hide

    2005-01-01

    The Very High Isp Thruster with Anode Layer (VHITAL) is a two stage Hall thruster program that is a part of NASA's Prometheus Program in NASA's New Exploration Systems Mission Directorate (ESMD). It is a potentially viable low-cost alternative to ion engines for near-term NEP applications with the growth potential to support mid-term and far-term NEP missions... This paper will present an overview of the thruster fabrication, pre-existing TAL 160 demonstration, feed system development, lifetime assessment, contamination assessment, and mission study activities performed to date.

  4. In-Space Propulsion Solar Electric Propulsion Program Overview of 2006

    NASA Technical Reports Server (NTRS)

    Baggett, Randy M.; Hulgan, Wendy W.; Dankanich, John W.; Bechtel, Robert T.

    2006-01-01

    The primary source of electric propulsion development throughout NASA is implemented by the In-Space Propulsion Technology Project at the NASA MSFC under the management of the Science Mission Directorate. The Solar Electric Propulsion technology area's objective is to develop near and mid-term SEP technology to enhance or enable mission capture while minimizing risk and cost to the end user. Major activities include developing NASA s Evolutionary Xenon Thruster (NEXT), implementing a Standard Architecture, and developing a long life High Voltage Hall Accelerator (HiVHAC). Lower level investments include advanced feed system development, advanced cathode testing and xenon recovery testing. Progress on current investments and future plans are discussed.

  5. An Overview of the VHITAL Program: A Two-Stage Bismuth Fed Very High Specific Impulse Thruster with Anode Layer

    NASA Technical Reports Server (NTRS)

    Sengupta, Anita; Marrese-Reading, Colleen; Capelli, Mark; Scharfe, David; Tverdokhlebov, Sergey; Semenkin, Sasha; Tverdokhlebov, Oleg; Boyd, Ian; Keidar, Michael; Yalin, Azer; Markusic, Tom; Polzin, Kurt

    2005-01-01

    The Very High Isp Thruster with Anode Layer (VHITAL) is a two stage Hall thruster program that is a part of NASA's Prometheus Program in NASA's New Exploration Systems Mission Directorate (ESMD). It is a potentially viable low-cost alternative to ion engines for near-term NEP applications with the growth potential to support mid-term and far-term NEP missions... This paper will present an overview of the thruster fabrication, pre-existing TAL 160 demonstration, feed system development, lifetime assessment, contamination assessment, and mission study activities performed to date.

  6. Tokamak burn control

    SciTech Connect

    Sager, G.T.

    1988-06-01

    Research of the fusion plasma thermal instability and its control is reviewed. General models of the thermonuclear plasma are developed. Techniques of stability analysis commonly employed in burn control research are discussed. Methods for controlling the plasma against the thermal instability are reviewed. Emphasis is placed on applications to tokamak confinement concepts. Additional research which extends the results of previous research is suggested. Issues specific to the development of control strategies for mid-term engineering test reactors are identified and addressed. 100 refs., 24 figs., 10 tabs.

  7. Advanced batteries for electric vehicle applications

    SciTech Connect

    Henriksen, G.L.

    1993-08-01

    A technology assessment is given for electric batteries with potential for use in electric powered vehicles. Parameters considered include: specific energy, specific power, energy density, power density, cycle life, service life, recharge time, and selling price. Near term batteries include: nickel/cadmium and lead-acid batteries. Mid term batteries include: sodium/sulfur, sodium/nickel chloride, nickel/metal hydride, zinc/air, zinc/bromine, and nickel/iron systems. Long term batteries include: lithium/iron disulfide and lithium- polymer systems. Performance and life testing data for these systems are discussed. (GHH)

  8. Drug-Coated Balloons: Current Outcomes and Future Directions.

    PubMed

    Kondapalli, Ananya; Danek, Barbara A; Khalili, Houman; Jeon-Slaughter, Haekyung; Banerjee, Subhash

    2017-04-01

    Paclitaxel-coated drug-coated balloons have significantly improved short-term and mid-term clinical outcomes in patients with symptomatic femoropopliteal peripheral artery disease. However, long-term results are awaited. Furthermore, the clinical success of drug-coated balloons in the infrapopliteal peripheral arteries has been more modest and overall similar to traditional balloon angioplasty, and remains an area of unmet clinical need. This article provides an overview of the clinical evidence for paclitaxel-coated balloons in the femoropopliteal and infrapopliteal peripheral artery distributions and future directions in this area.

  9. [Implantation of an automatic cardioverter-defibrillator in small children--two case reports].

    PubMed

    Przybylski, Andrzej; Kucińska, Beata; Grabowski, Krzysztof; Sterliński, Maciej; Wróblewska-Kałuzewska, Maria; Szwed, Hanna

    2004-07-01

    Implantation of an automatic cardioverter-defibrillator (ICD) in children may be challenging due to the increased risk of periprocedural and long-term complications. ICD was implanted in two boys with hypertrophic cardiomyopathy, aged 6 and 9 years, with of a body weight of 20 and 25 kg, respectively. In one patient an ICD was implanted due to a history of ventricular fibrillation whereas the second patient underwent prophylactic ICD implantation due to a family history of sudden cardiac death. No short- or mid-term complications were recorded. Difficulties and risks of ICD implantation in children are discussed.

  10. Multiple left ventricular aneurysms in a young female.

    PubMed

    Raval, Abhishek P; Shukla, Anand; Garg, Rajiv; Rana, Yashpal; Shah, Komal

    2016-02-01

    Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. The State of the Corona During the Weak Solar Cycle 24: the View from LASCO Images

    NASA Astrophysics Data System (ADS)

    Barlyaeva, T.; Lamy, P.; Llebaria, A.; Boclet, B.

    2016-04-01

    The LASCO-C2 coronagraph onboard SOHO continues its white-light imaging of the corona from 1.5 to 6.0 solar radii, thus allowing investigating the consequences of the weak Solar Cycle 24 on the corona and comparing it to the previous cycle (23). Temporal variations of the global radiance of the corona are presented. We pay particular attention to the mid-term variations which are distinctly different between the two cycles and highlight the similarities and differences. Finally, we rely on our ARTEMIS II catalog of coronal mass ejections (CMEs) to compare their global rates during these two cycles.

  12. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  13. The quality of Achilles tendon repair five to eight years after percutaneous tenotomy in the treatment of clubfoot: clinical and ultrasonographic findings.

    PubMed

    Maranho, D A; Leonardo, F H L; Herrero, C F; Engel, E E; Volpon, J B; Nogueira-Barbosa, M H

    2017-01-01

    Our aim was to describe the mid-term appearances of the repair process of the Achilles tendon after tenotomy in children with a clubfoot treated using the Ponseti method. A total of 15 children (ten boys, five girls) with idiopathic clubfoot were evaluated at a mean of 6.8 years (5.4 to 8.1) after complete percutaneous division of the Achilles tendon. The contour and subjective thickness of the tendon were recorded, and superficial defects and its strength were assessed clinically. The echogenicity, texture, thickness, peritendinous irregularities and potential for deformation of the tendon were evaluated by ultrasonography. The appearance of the Achilles tendon was slightly abnormal, with more thickening and less conspicuous contours than a normal tendon. Its strength was grossly normal, with no insufficiency of the triceps surae. Ultrasonographic findings revealed a mild fusiform thickening in 12 children (80%). The tissue at the site of the repair had a slightly hypoechoic, fibrillar quality with hyperechoic striation and the anterior contour was irregular and blurred. There was a focal narrowing within the healing tissue in two children. This mid-term evaluation of the ability of the Achilles tendon to repair after division suggests a combination of intrinsic and extrinsic mechanisms. There were minor abnormalities which did not appear to affect function. Cite this article: Bone Joint J 2017;99-B:139-44. ©2017 The British Editorial Society of Bone & Joint Surgery.

  14. An interplanetary mission to Neptune System I: Analysis of trajectories to Neptune using gravity assists

    NASA Astrophysics Data System (ADS)

    Solórzano, C.; Sukhanov, A.; Prado, A.

    At the present time the search for the knowledge of our Solar System continues effective So in July 1st 2004 the international Cassini-Huygens Mission spacecraft entered into orbit around the planet Saturn and in January 2005 send data from the Huygens probe which is studing Saturn s largest moon Titan On January 19 2006 occurred the launch of the New Horizons spacecraft to Pluto and Charon NASA s Solar System Exploration theme listed a Neptune mission as one of its top priorities for the mid-term 2008-2013 The gravity assist is a proven technique in interplanetary exploration as exemplified by the missions Voyager Galileo Cassini etc Here a mission to Neptune for the mid-term 2008-2020 is proposed with the goal of studiyng several schemes for the mission A direct transfer to Neptune is considered and also Venus Earth Jupiter and Saturn gravity assists are used for the transfer to Neptune which represent new contributions for a possible real mission We show several schemes with and without braking near Neptune in order to find a good compromise between the Delta V and time of flight to Neptune Besides taking advantage of asteroid flyby opportunities when the spacecraft passes through the asteroid belt To incorporta as asteroid flyby we first need to optimize a trajectory to Neptune with planetary flybys and then search for asteroids that pass close to this trajectory to finally reoptimize the trajectory including one or more asteroid flybys

  15. Peripheral Applications of Drug-Coated Balloons: Past, Present and Future

    SciTech Connect

    Krokidis, Miltiadis Spiliopoulos, Stavros Katsanos, Konstantinos Sabharwal, Tarun

    2013-04-15

    Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offer valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.

  16. Woven Endobridge (WEB) device for endovascular treatment of complex unruptured aneurysms-a single center experience.

    PubMed

    Lescher, Stephanie; du Mesnil de Rochemont, Richard; Berkefeld, Joachim

    2016-04-01

    The introduction of the Woven Endobridge (WEB) device increases the feasibility of endovascular treatment of wide-neck bifurcation aneurysms with limitations given by currently available sizes and shapes of the device. Parallel to other studies, we used the new device for selected patients who were no optimal candidates for established techniques like neurosurgical clipping or endovascular coiling. We aimed to report the angiographic and clinical results of WEB implantations or combinations between WEB and coiling or intracranial stents. We reviewed the records of n = 23 interventions in 22 patients with unruptured wide-neck aneurysms (UIA) who were assigned for aneurysm treatment with the use of the WEB or adjunctive techniques. Interventional procedures and clinical and angiographic outcomes are reported for the periprocedural phase and in mid-term FU. Of the included 22 patients, six patients needed additional coiling, intracranial stenting, or implantation of a flow diverter. WEB implantation was technically feasible in 22 out of the 23 interventions. Follow-up angiographic imaging proved total or subtotal occlusion of the aneurysm in 19 of 22 cases. Two minor recurrences remained stable during a period of 15 months. One patient with a partially thrombosed giant MCA aneurysm had a major recurrence and was retreated with a second WEB in combination with coiling. Despite of unfavorable anatomic conditions, broad-based and large UIA endovascular treatment with the WEB and adjunctive techniques was feasible with a low risk of complications and promising occlusion rates in mid-term follow-up.

  17. [Treatment of subclinical congenital toxoplasmosis by sulfadiazine and pyrimethamine continuously during 1 year: apropos of 46 cases].

    PubMed

    Kieffer, F; Thulliez, P; Brézin, A; Nobre, R; Romand, S; Yi-Gallimard, E; Voyer, M; Magny, J F

    2002-01-01

    In France, most of children suffering from congenital toxoplasmosis have an infraclinic or moderate type at birth. This study aimed at evaluating, on the mid term, tolerance and results of postnatal treatment previously given in severe toxoplasmosis. A retrospective study considered 46 children with a mild or moderate congenital toxoplasmosis treated over 12 months with sulfadiazine-pyrimethamine and treatment was completed since three months. Five children suffered from a lesion of chorioretinitis during treatment and two after. After a mean follow-up of 27.1 months, ten children (21.7% 95%CI [12.1-35.9]) had at least one ocular injury. Specific IgG titers and immune load were diminished to become almost non-existent at the end of the year of treatment (respectively p < 10(-5) and p = 0.0005). No thrombocytopenia was observed. Twenty-three children (50%) had at least one episode of neutropenia < 1000/mm3, 14 had only one, nine presented two or more installment. None was followed by an infection. This therapeutic pathway is more demanding but shorter than those usually offered when associating pyrimethamine-sulfadiazine. Yet, it does give identical result on the mid term. Longer follow-up is needed to appreciate. Active molecule on cysts should be introduced.

  18. Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience☆

    PubMed Central

    Thakkar, Bhavesh; Patel, Nehal; Shah, Shaunak; Poptani, Vishal; Madan, Tarun; Shah, Chirag; Shukla, Anand; Prajapati, Vaishali

    2012-01-01

    Objectives To evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants. Background Surgical closures of large mVSD in infants represent a challenge with significant morbidity. Methods Between August 2008–2010, perventricular closure was attempted in 24 infants of 6.01 ± 2.37 months age and 4.27 ± 0.56 kg weight under TEE guidance. Results The device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 ± 1.46 mm (6.1–12 mm). Mean procedure time was 28.8 ± 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 ± 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis. Conclusion Perventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance. PMID:23253407

  19. Implication of Paris Agreement in the context of long-term climate mitigation goals.

    PubMed

    Fujimori, Shinichiro; Su, Xuanming; Liu, Jing-Yu; Hasegawa, Tomoko; Takahashi, Kiyoshi; Masui, Toshihiko; Takimi, Maho

    2016-01-01

    The Paris Agreement confirmed the global aim to achieve a long-term climate goal, in which the global increase in mean temperature is kept below 2 °C compared to the preindustrial level. We investigated the implications of the near-term emissions targets (for around the year 2030) in the context of the long-term climate mitigation goal using the Asia-Pacific Integrated Model framework. To achieve the 2 °C goal, a large greenhouse gas emissions reduction is required, either in the early or latter half of this century. In the mid-term (from 2030 to 2050), it may be necessary to consider rapid changes to the existing energy or socioeconomic systems, while long-term measures (after 2050) will rely on the substantial use of biomass combined with carbon capture and storage technology or afforestation, which will eventually realize so-called negative CO2 emissions. With respect to the policy context, two suggestions are provided here. The first is the review and revision of the nationally determined contributions (NDCs) in 2020, with an additional reduction target to the current NDCs being one workable alternative. The second suggestion is a concrete and numerical mid-term emissions reduction target, for example to be met by 2040 or 2050, which could also help to achieve the long-term climate goal.

  20. Degradation of Kidney and Psoas Muscle Proteins as Indicators of Post-Mortem Interval in a Rat Model, with Use of Lateral Flow Technology

    PubMed Central

    Lee, Dong-Gi; Yang, Kyeong Eun; Hwang, Jeong Won; Kang, Hwan-Soo; Lee, Seung-Yeul; Choi, Seoyeon; Shin, Joonchul; Jang, Ik-Soon; An, Hyun Joo; Chung, Heesun; Jung, Hyo-Il; Choi, Jong-Soon

    2016-01-01

    We investigated potential protein markers of post-mortem interval (PMI) using rat kidney and psoas muscle. Tissue samples were taken at 12 h intervals for up to 96 h after death by suffocation. Expression levels of eight soluble proteins were analyzed by Western blotting. Degradation patterns of selected proteins were clearly divided into three groups: short-term, mid-term, and long-term PMI markers based on the half maximum intensity of intact protein expression. In kidney, glycogen synthase (GS) and glycogen synthase kinase-3β were degraded completely within 48 h making them short-term PMI markers. AMP-activated protein kinase α, caspase 3 and GS were short-term PMI markers in psoas muscle. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was a mid-term PMI marker in both tissues. Expression levels of the typical long-term PMI markers, p53 and β-catenin, were constant for at least 96 h post-mortem in both tissues. The degradation patterns of GS and caspase-3 were verified by immunohistochemistry in both tissues. GAPDH was chosen as a test PMI protein to perform a lateral flow assay (LFA). The presence of recombinant GAPDH was clearly detected in LFA and quantified in a concentration-dependent manner. These results suggest that LFA might be used to estimate PMI at a crime scene. PMID:27552165

  1. Intramyocardial Delivery of Mesenchymal Stem Cell-Seeded Hydrogel Preserves Cardiac Function and Attenuates Ventricular Remodeling after Myocardial Infarction

    PubMed Central

    Mathieu, Eva; Lamirault, Guillaume; Toquet, Claire; Lhommet, Pierre; Rederstorff, Emilie; Sourice, Sophie; Biteau, Kevin; Hulin, Philippe; Forest, Virginie; Weiss, Pierre

    2012-01-01

    Background To improve the efficacy of bone marrow-derived mesenchymal stem cell (MSC) therapy targeted to infarcted myocardium, we investigated whether a self-setting silanized hydroxypropyl methylcellulose (Si-HPMC) hydrogel seeded with MSC (MSC+hydrogel) could preserve cardiac function and attenuate left ventricular (LV) remodeling during an 8-week follow-up study in a rat model of myocardial infarction (MI). Methodology/Principal Finding Si-HPMC hydrogel alone, MSC alone or MSC+hydrogel were injected into the myocardium immediately after coronary artery ligation in female Lewis rats. Animals in the MSC+hydrogel group showed an increase in cardiac function up to 28 days after MI and a mid-term prevention of cardiac function alteration at day 56. Histological analyses indicated that the injection of MSC+hydrogel induced a decrease in MI size and an increase in scar thickness and ultimately limited the transmural extent of MI. These findings show that intramyocardial injection of MSC+hydrogel induced short-term recovery of ventricular function and mid-term attenuation of remodeling after MI. Conclusion/Significance These beneficial effects may be related to the specific scaffolding properties of the Si-HPMC hydrogel that may provide the ability to support MSC injection and engraftment within myocardium. PMID:23284842

  2. Transcatheter Embolisation of Proximal Type 1 Endoleaks Following Endovascular Aneurysm Sealing (EVAS) Using the Nellix Device: Technique and Outcomes

    SciTech Connect

    Ameli-Renani, S. Morgan, R. A.

    2015-10-15

    AimTo evaluate the technical success and mid-term outcomes following transcatheter embolisation of type 1a endoleak after Nellix endovascular aneurysm sealing (EVAS).Materials and MethodsSeven patients (5 men; mean age 83; range 79–90) underwent transcatheter embolisation between July 2013 and August 2014. The average time from EVAS to embolisation was 136 days (range 6–301) and from endoleak diagnosis to embolisation was 20 days (range 2–50). Embolisation was performed with coils and Onyx in six cases and Onyx only in one case. Technical success, imaging and clinical outcomes of embolisation were reviewed. Technical success was defined as elimination of the endoleak on completion angiography and first imaging follow-up. Clinical success was defined as unchanged or decreased aneurysm sac size on subsequent follow-up (average 8 months; range 103–471 days).ResultsAll cases were technically successful. One patient required a second endovascular procedure following Onyx reflux into the Nellix endograft and another patient required surgical closure of a brachial puncture site. All patients are endoleak free with stable sac size on the latest available follow-up imaging.ConclusionIf a type 1 endoleak occurs after EVAS, embolisation using Onyx with or without coils is feasible and effective with high technical success and freedom from endoleak recurrence at mid-term follow-up.

  3. Cardiac myxoma: preoperative diagnosis using a multimodal imaging approach and surgical outcome in a large contemporary series.

    PubMed

    Rahmanian, Parwis B; Castillo, Javier G; Sanz, Javier; Adams, David H; Filsoufi, Farzan

    2007-08-01

    Diagnosis of cardiac myxoma is typically suggested in the presence of symptoms and echocardiographic findings of an intracardiac mass and confirmed histologically. Coronary angiography (CA) and cardiac magnetic-resonance-imaging (MRI) may provide specific additional information which could lead to a precise preoperative diagnosis. Herein we report a series of 28 patients who underwent excision of myxoma between 1998 and 2005. Data analysis included patient demographics, clinical presentation, imaging modalities, and operative outcome. Echocardiography revealed an intra-atrial mass in all patients but did not differentiate between myxoma and other formations such as thrombi. CA showed neovascularization suggestive of cardiac tumor in 12 (53%) patients. MRI demonstrated specific characteristics of myxomatous tissue in all cases. Surgical removal was performed with no hospital mortality or major complications. Mid-term survival was similar to that of the general population. In patients with a cardiac mass, echocardiography remains the first diagnostic imaging modality but does not allow definite discrimination between cardiac tumors and thrombi. CA shows neovascularization in 50% and has, therefore, a low sensitivity and specificity in distinguishing the nature of the mass. MRI shows specific tissue characteristics facilitating the diagnosis of myxoma preoperatively. Surgery should be performed promptly and this can provide excellent early and mid-term results.

  4. Urgent carotid endarterectomy in patients with acute neurological ischemic events within six hours after symptoms onset.

    PubMed

    Gajin, P; Radak, Dj; Tanaskovic, S; Babic, S; Nenezic, D

    2014-06-01

    To analyze the outcome of urgent carotid endarterectomy (CEA) performed within less than six hours in patients with crescendo transient ischemic attack (TIA) and stroke in progression. From January 1998 to December 2008, 58 urgent CEAs were done for acute neurological ischemic events--46 patients with crescendo TIA and 12 patients with stroke in progression. Brain computed tomography (CT) was done prior and after the surgery. Disability level was assessed prior to and after urgent CEA using modified Rankin scale. Median follow-up was 42.1 ± 16.6 months. In the early postoperative period stroke rate was 0% for the patients in crescendo TIA group while in patients with stroke in progression group 3 patients (25%) had positive postoperative brain CT, yet neurological status significantly improved. Mid-term stroke rate was 2.2% in crescendo TIA group and 8.3% in stroke in progression group. In the early postoperative period there were no lethal outcomes, mid-term mortality was 8.3% in stroke in progression while in crescendo TIA group lethal outcomes were not observed. In conclusion, based on our results urgent CEA is a safe and effective treatment option for patients with crescendo TIA and stroke in progression with acceptable rate of postoperative complications.

  5. Degradation of Kidney and Psoas Muscle Proteins as Indicators of Post-Mortem Interval in a Rat Model, with Use of Lateral Flow Technology.

    PubMed

    Lee, Dong-Gi; Yang, Kyeong Eun; Hwang, Jeong Won; Kang, Hwan-Soo; Lee, Seung-Yeul; Choi, Seoyeon; Shin, Joonchul; Jang, Ik-Soon; An, Hyun Joo; Chung, Heesun; Jung, Hyo-Il; Choi, Jong-Soon

    2016-01-01

    We investigated potential protein markers of post-mortem interval (PMI) using rat kidney and psoas muscle. Tissue samples were taken at 12 h intervals for up to 96 h after death by suffocation. Expression levels of eight soluble proteins were analyzed by Western blotting. Degradation patterns of selected proteins were clearly divided into three groups: short-term, mid-term, and long-term PMI markers based on the half maximum intensity of intact protein expression. In kidney, glycogen synthase (GS) and glycogen synthase kinase-3β were degraded completely within 48 h making them short-term PMI markers. AMP-activated protein kinase α, caspase 3 and GS were short-term PMI markers in psoas muscle. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was a mid-term PMI marker in both tissues. Expression levels of the typical long-term PMI markers, p53 and β-catenin, were constant for at least 96 h post-mortem in both tissues. The degradation patterns of GS and caspase-3 were verified by immunohistochemistry in both tissues. GAPDH was chosen as a test PMI protein to perform a lateral flow assay (LFA). The presence of recombinant GAPDH was clearly detected in LFA and quantified in a concentration-dependent manner. These results suggest that LFA might be used to estimate PMI at a crime scene.

  6. Cost and surface optimization of a remote photovoltaic system for two kinds of panels' technologies

    NASA Astrophysics Data System (ADS)

    Avril, S.; Arnaud, G.; Colin, H.; Montignac, F.; Mansilla, C.; Vinard, M.

    2011-10-01

    Stand alone photovoltaic (PV) systems comprise one of the promising electrification solutions to cover the demand of remote consumers, especially when it is coupled with a storage solution that would both increase the productivity of power plants and reduce the areas dedicated to energy production. This short communication presents a multi-objective design of a remote PV system coupled to battery and hydrogen storages systems simultaneously minimizing the total levelized cost and the occupied area, while fulfilling a constraint of consumer satisfaction. For this task, a multi-objective code based on particle swarm optimization has been used to find the best combination of different energy devices. Both short and mid terms based on forecasts assumptions have been investigated. An application for the site of La Nouvelle in the French overseas island of La Réunion is proposed. It points up a strong cost advantage by using Heterojunction with Intrinsic Thin layer (HIT) rather than crystalline silicon (c-Si) cells for the short term. However, the discrimination between these two PV cell technologies is less obvious for the mid term: a strong constraint on the occupied area will promote HIT, whereas a strong constraint on the cost will promote c-Si.

  7. Features and impacts of five multidisciplinary community-university research partnerships.

    PubMed

    King, Gillian; Servais, Michelle; Forchuk, Cheryl; Chalmers, Heather; Currie, Melissa; Law, Mary; Specht, Jacqueline; Rosenbaum, Peter; Willoughby, Teena; Kertoy, Marilyn

    2010-01-01

    Despite the increasing number of multidisciplinary community-university research partnerships designed to address real-world issues, little is known about their nature. This article describes the features and impacts of five research partnerships addressing health or social service issues, which constituted a convenience sample from the province of Ontario, Canada. The article describes their characteristics, ways of operating, outputs, types of requests received from community members and mid-term impacts. Requests directed to partnerships were tracked over a 10-month period in 2003 to 2004, using a research contact checklist, and 174 community members later completed an impact questionnaire capturing perceptions of the impacts of the partnerships on personal knowledge and research skill development, organisational/group access to and use of information, and community and organisational development. The data indicated that partnerships had similar priorities and magnitudes of mid-term impacts, yet differed in the scope of their partnering, realm of intended influence and the number of mechanisms used to engage and communicate with target audiences. The partnerships produced different types of outputs and received different types of requests from community members. The findings inform researchers about partnership diversity and help to establish more realistic expectations about the magnitude of partnerships' impacts.

  8. Minimally invasive surgery (MIS) for total knee replacement; medium term results with minimum five year follow-up.

    PubMed

    Unwin, Olivia; Hassaballa, Mohammed; Murray, James; Harries, William; Porteous, Andrew

    2017-03-01

    MIS TKA has been shown to offer a reduced in-patient stay, but no clinical difference at two years. Whilst there may be a benefit from earlier discharge, we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA. To report the mid-term result from a prospective randomised controlled trial (RCT) comparing MIS-TKA with standard approach for TKA. Using knee score questionnaires, we collected patient reported outcome measures (PROMs) regarding pain and function. Sixty-six patients (from an eligible cohort of 83 patients) completed the mid-term postal follow-up. There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs. Mean MIS and standard group improvement was: AKSS 53 and 51 (p=0.7644), OKS 15 and 16 (p=0.2341) or WOMAC 15 and 15 (p=0.9900) respectively. Both groups showed improvement in pain and function with no significant difference between groups. There was no difference between groups for revision due to malalignment at a mean six year follow-up. In addition to the early benefits regarding hospital stay and complications, we have found that at a mean of six years there was no increase in malalignment, pain or function with MIS techniques. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Stability analysis of large electric power systems

    SciTech Connect

    Elwood, D.M.

    1993-01-01

    Modern electric power systems are large and complicated, and, in many regions of the world, the generation and transmission systems are operating near their limits. Ensuring the reliable operation of the power system requires engineers to study the response of the system to various disturbances. The responses to large disturbances are examined by numerically solving the nonlinear differential-algebraic equations describing the power system. The response to small disturbances is typically studied via eigenanalysis. The Electric Power Research Institute (EPRI) recently developed the Extended Transient/Mid-term Stability Program (ETMSP) to study large disturbance stability and the Small Signal Stability Program Package (SSSP) to study small signal stability. The primary objectives of the work described in this report were to (1) explore ways of speeding up ETMSP, especially on mid-term voltage stability problems, (2) explore ways of speeding up the Multi-Area Small-Signal Stability program (MASS), one of the codes in SSSP, and (3) explore ways of increasing the size of problem that can be solved by the Cray version of MASS.

  10. A Systems Approach to Developing an Affordable Space Ground Transportation Architecture using a Commonality Approach

    NASA Technical Reports Server (NTRS)

    Garcia, Jerry L.; McCleskey, Carey M.; Bollo, Timothy R.; Rhodes, Russel E.; Robinson, John W.

    2012-01-01

    This paper presents a structured approach for achieving a compatible Ground System (GS) and Flight System (FS) architecture that is affordable, productive and sustainable. This paper is an extension of the paper titled "Approach to an Affordable and Productive Space Transportation System" by McCleskey et al. This paper integrates systems engineering concepts and operationally efficient propulsion system concepts into a structured framework for achieving GS and FS compatibility in the mid-term and long-term time frames. It also presents a functional and quantitative relationship for assessing system compatibility called the Architecture Complexity Index (ACI). This paper: (1) focuses on systems engineering fundamentals as it applies to improving GS and FS compatibility; (2) establishes mid-term and long-term spaceport goals; (3) presents an overview of transitioning a spaceport to an airport model; (4) establishes a framework for defining a ground system architecture; (5) presents the ACI concept; (6) demonstrates the approach by presenting a comparison of different GS architectures; and (7) presents a discussion on the benefits of using this approach with a focus on commonality.

  11. Overview of NASA Electrified Aircraft Propulsion Research for Large Subsonic Transports

    NASA Technical Reports Server (NTRS)

    Jansen, Ralph H.; Bowman, Cheryl; Jankovsky, Amy; Dyson, Rodger; Felder, James

    2017-01-01

    NASA is investing in Electrified Aircraft Propulsion (EAP) research as part of the portfolio to improve the fuel efficiency, emissions, and noise levels in commercial transport aircraft. Turboelectric, partially turboelectric, and hybrid electric propulsion systems are the primary EAP configurations being evaluated for regional jet and larger aircraft. The goal is to show that one or more viable EAP concepts exist for narrow body aircraft and mature tall-pole technologies related to those concepts. A summary of the aircraft system studies, technology development, and facility development is provided. The leading concept for mid-term (2035) introduction of EAP for a single aisle aircraft is a tube and wing, partially turbo electric configuration (STARC-ABL), however other viable configurations exist. Investments are being made to raise the TRL level of light weight, high efficiency motors, generators, and electrical power distribution systems as well as to define the optimal turbine and boundary layer ingestion systems for a mid-term tube and wing configuration. An electric aircraft power system test facility (NEAT) is under construction at NASA Glenn and an electric aircraft control system test facility (HEIST) is under construction at NASA Armstrong. The correct building blocks are in place to have a viable, large plane EAP configuration tested by 2025 leading to entry into service in 2035 if the community chooses to pursue that goal.

  12. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip.

    PubMed

    Heywang-Köbrunner, S H; Amaya, B; Okoniewski, M; Pickuth, D; Spielmann, R P

    2001-01-01

    Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1% mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain.

  13. Intraoperative flow measurement in composite Y arterial grafts.

    PubMed

    Speziale, G; Ruvolo, G; Coppola, R; Marino, B

    2000-05-01

    Total arterial myocardial revascularization may be achieved by using the 'Y-graft' techniques with different free arterial conduits anastomosed off the side of an in situ internal thoracic artery to reach distal coronary segments. This study was assessed to measure intraoperative graft flow, resistance and clinical outcomes. Seventy-six patients who underwent coronary artery bypass grafting during a time period of 27 months were enrolled in this prospective study. All patients received sequential grafting by using both internal thoracic arteries, inferior epigastric and right gastroepiploic artery joined as a composite Y graft. Intraoperative graft flow, resistance and derived variables were measured. All patients except one showed good flow (ml/min and waveform) in either branch of composite graft. In one case, a low-flow situation through the graft was registered requiring surgical correction. Temporary occlusion of either branch did not significantly affect flow in the other side of the arterial Y. Mid-term follow-up (3 and 15 months) and angiographic studies showed a high graft patency rate. Composite arterial grafts provide excellent early and mid-term clinical results. Flow reserve of the left internal thoracic artery did not affect blood flow and resistance on either branch of the Y graft when temporary occlusion on the other side of the arterial Y was performed.

  14. Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting.

    PubMed

    Kim, Taehwan; Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

    2016-07-01

    To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.

  15. Temperature-related mortality estimates after accounting for the cumulative effects of air pollution in an urban area.

    PubMed

    Stanišić Stojić, Svetlana; Stanišić, Nemanja; Stojić, Andreja

    2016-07-11

    To propose a new method for including the cumulative mid-term effects of air pollution in the traditional Poisson regression model and compare the temperature-related mortality risk estimates, before and after including air pollution data. The analysis comprised a total of 56,920 residents aged 65 years or older who died from circulatory and respiratory diseases in Belgrade, Serbia, and daily mean PM10, NO2, SO2 and soot concentrations obtained for the period 2009-2014. After accounting for the cumulative effects of air pollutants, the risk associated with cold temperatures was significantly lower and the overall temperature-attributable risk decreased from 8.80 to 3.00 %. Furthermore, the optimum range of temperature, within which no excess temperature-related mortality is expected to occur, was very broad, between -5 and 21 °C, which differs from the previous findings that most of the attributable deaths were associated with mild temperatures. These results suggest that, in polluted areas of developing countries, most of the mortality risk, previously attributed to cold temperatures, can be explained by the mid-term effects of air pollution. The results also showed that the estimated relative importance of PM10 was the smallest of four examined pollutant species, and thus, including PM10 data only is clearly not the most effective way to control for the effects of air pollution.

  16. Modified team-based learning strategy to improve human anatomy learning: A pilot study at the Universidad del Norte in Barranquilla, Colombia.

    PubMed

    Martínez, Emilio G; Tuesca, Rafael

    2014-01-01

    As part of an institutional program sponsored by the Centre for Teaching Excellence at the Universidad del Norte, Barranquilla, Colombia, we developed an educational research study on two sessions of human anatomy in which we combined team-based learning (TBL) and the use of iPads. Study data included the TBL, assessments applied during the course, student's grades on mid-term examinations and students' perceptions of their experiences. Students reported a positive attitude toward the use of the TBL sessions, and the results showed a significant improvement in their learning between the first and second sessions. Significantly positive correlations (P < 0.05) were obtained between (a) the individual students' readiness test performance 1 and mid-term examination 1, (b) the individual readiness test performances from Session 1 to Session 2, and (c) the group readiness test performances from the first and second sessions. These results point to positive learning experiences for these students. Analyses of the students' reflections on their activities also pointed toward future challenges.

  17. Comparison of artificial graft versus autograft in anterior cruciate ligament reconstruction: a meta-analysis.

    PubMed

    Jia, Zhen-Yu; Zhang, Chen; Cao, Shi-Qi; Xue, Chen-Chen; Liu, Tian-Ze; Huang, Xuan; Xu, Wei-Dong

    2017-07-19

    Critically evaluation and summarization for the outcomes between autografts and artificial grafts using in anterior cruciate ligament (ACL) reconstruction have not been performed currently. The purpose of this study is to compare the clinical outcomes between artificial ligaments and autografts at a short- to mid-term follow-up. A computerized search of the databases was conducted including Medline, Embase, and the Cochrane library. Only prospective or retrospective comparative studies with a minimum 2-year follow-up and a minimum sample size of 15 for each group were considered for inclusion. Two independent reviewers performed data extraction and methodological quality assessment. A Mantel-Haenszel analysis was used for pooling of results. Sensitivity analysis was performed in order to maintain the stability of results. Seven studies were included in this study. The total sample size was 403 (autograft group: 206 patients; synthetic graft group: 197 patients). Four studies were randomized controlled trials. Two studies were retrospective comparative studies and one study was non-randomized prospective comparative study. In terms of instrumented laxity, patient-oriented outcomes and complications, no significant difference was occurred between new artificial ligaments and autografts. But the results of IKDC grades and instrumented laxity were worsen in early artificial ligaments compared to autografts. The outcomes of new generation of artificial ligaments are similar to autografts at a short- to mid-term follow-up. However, the early artificial ligaments are not suggested for ACL reconstruction compared to autografts.

  18. Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

    PubMed Central

    Lee, Youngok; Cho, Joon Yong; Kwon, O Young; Jang, Woo Sung

    2016-01-01

    Background Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes. Methods We retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA. Results Four anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality. Conclusion In situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair. PMID:27733992

  19. Tightly Coupled Inertial Navigation System/Global Positioning System (TCMIG)

    NASA Technical Reports Server (NTRS)

    Watson, Michael D.; Jackson, Kurt (Technical Monitor)

    2002-01-01

    Many NASA applications planned for execution later this decade are seeking high performance, miniaturized, low power Inertial Management Units (IMU). Much research has gone into Micro-Electro-Mechanical System (MEMS) over the past decade as a solution to these needs. While MEMS devices have proven to provide high accuracy acceleration measurements, they have not yet proven to have the accuracy required by many NASA missions in rotational measurements. Therefore, a new solution has been formulated integrating the best of all IMU technologies to address these mid-term needs in the form of a Tightly Coupled Micro Inertial Navigation System (INS)/Global Positioning System (GPS) (TCMIG). The TCMIG consists of an INS and a GPS tightly coupled by a Kalman filter executing on an embedded Field Programmable Gate Array (FPGA) processor. The INS consists of a highly integrated Interferometric Fiber Optic Gyroscope (IFOG) and a MEMS accelerometer. The IFOG utilizes a tightly wound fiber coil to reduce volume and the high level of integration and advanced optical components to reduce power. The MEMS accelerometer utilizes a newly developed deep etch process to increase the proof mass and yield a highly accurate accelerometer. The GPS receiver consists of a low power miniaturized version of the Blackjack receiver. Such an IMU configuration is ideal to meet the mid-term needs of the NASA Science Enterprises and the new launch vehicles being developed for the Space Launch Initiative (SLI).

  20. [Bernese periacetabular osteotomy for the treatment of severe hip dysplasia].

    PubMed

    Huang, Ye; Zhang, Hong; Liu, Qing; Jiang, Zeng-hui; Dou, Yong

    2010-02-15

    To analyze the mid-term clinical and radiographic results obtained with the Bernese periacetabular osteotomy for the treatment of severe hip dysplasia. From October 1997 to December 2002 20 hips of 18 patients were classified as having severe acetabular dysplasia (Severin classification Grade IVb). Preoperatively, all patients had hip pain, and sufficient hip joint congruency on functional radiographs. All 20 hips underwent Bernese periacetabular osteotomy. Postoperatively, the hips were assessed radiographically on center edge angle (CE), acetabular roof obliquity and the progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 6.2 years follow-up. Comparison of preoperative and follow-up radiographs demonstrated significant improvements in the lateral CE angle, the anterior CE angle, and roof obliquity. The average Harris hip score improved from 78.5 points preoperatively to 91.1 points at the time of the latest follow-up. Fourteen of 18 patients were satisfied with the result of the surgery, and 16 of 20 hips had a good or excellent clinical result. Under-correction occurred in 5 hips. The Bernese periacetabular osteotomy is an effective procedure for surgical correction of the severe dysplastic hip. This osteotomy can predictably obtain major reorientation of the acetabulum in all planes. The clinical results in the mid-term follow-up are encouraging.