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Sample records for shockwave treatment compared

  1. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

    PubMed Central

    Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

    2013-01-01

    OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

  2. Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

    PubMed

    Cole, R S; Shuttleworth, K E

    1988-12-01

    Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

  3. Side effects of high-energy shockwaves in the human kidney: first experience with model comparing two shockwave sources.

    PubMed

    Roessler, W; Wieland, W F; Steinbach, P; Hofstaedter, F; Thüroff, S; Chaussy, C

    1996-12-01

    The side effects of high-energy shockwaves (HESW) from two different sources on kidney parenchyma obtained from 10 patients treated by radical nephrectomy for renal cell carcinoma were examined. Immediately after nephrectomy, the kidneys were perfused with cold HTK solution and kept in hypothermia (8 degrees C) for a maximum of 4 hours. In five cases, the tumor-free parenchyma was treated at the upper or lower renal pole with 2000 shocks, energy output 21 kV, in an experimental electromagnetic shockwave system (Siemens Co., Erlangen). In the other five cases, the upper or lower poles were treated with 2000 shocks, energy output 24 kV, in an electrohydraulic spark gap system (MFL 5000; Dornier Medizintechnik, Germering). The resulting tissue defects were analyzed by histologic examinations. Changes after treatment with the electromagnetic system were found mainly in the tubules and midsized blood vessels in a well-defined focal area. Treatment with the electrohydraulic system was followed by tubular and glomerular lesions combined with vessel defects in a patchy pattern. The model is able to define the side effects of HESW in the human kidney and to test the side effects of different lithotripters.

  4. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature.

    PubMed

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.

  5. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature☆

    PubMed Central

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  6. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid.

    PubMed

    Notarnicola, A; Moretti, L; Tafuri, S; Gigliotti, S; Russo, S; Musci, L; Moretti, B

    2010-08-01

    The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves

  7. [Trigger points - Diagnosis and treatment concepts with special reference to extracorporeal shockwaves].

    PubMed

    Gleitz, M; Hornig, K

    2012-02-01

    The 70-year-old trigger point theory has experienced a growing scientific confirmation and clinical significance as a consequence of recent muscle pain research. The trigger point pain formation is caused by high levels of vasoneuroactive substances. Depending on intensity and duration of the muscle stimulus the central pain processing is modified and leads to characteristic referred pain patterns. The most effective conventional forms of treatment are aimed at a direct mechanical manipulation of the trigger point as are new forms of therapy with focused and radial shockwaves. By using high pressures the focused shockwaves in particular are suitable to provoke local and referred pain and thus simplify the trigger point diagnosis. The empirically found therapeutic effect of shockwaves on muscles is hypothetical and can be explained in analogy with validated reactions of shockwaves in non-muscle tissues. Overall, the shockwave therapy on muscles represents a confirmation and extension of the existing trigger point therapy. It seems to be suitable for treating functional muscular disorders and myofascial pain syndromes within the locomotor system.

  8. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed Central

    Rickford, J. K.; Speedy, H. M.; Tytler, J. A.; Lim, M.

    1988-01-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group. PMID:3044238

  9. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.

    PubMed

    Ramon, Silvia; Gleitz, Markus; Hernandez, Leonor; Romero, Luis David

    2015-12-01

    Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes in the absence of evident local nociception such as myogelosis, muscle hardening, myalgia, muscular rheumatism, fibrositis or myofascial trigger point with or without referred pain. If it persists over six months or more, it often becomes therapy resistant and frequently results in chronic generalized pain, characterized by a high degree of subjective suffering. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibers, known as myofascial trigger points (MTP), and fascial constrictions. Fibromyalgia (FM) is a chronic condition that involves both central and peripheral sensitization and for which no curative treatment is available at the present time. Fibromyalgia shares some of the features of MPS, such as hyperirritability. Many treatments options have been described for muscle pain syndrome, with differing evidence of efficacy. Extracorporeal Shockwave Treatment (ESWT) offers a new and promising treatment for muscular disorders. We will review the existing bibliography on the evidence of the efficacy of ESWT for MPS, paying particular attention to MTP (Myofascial Trigger Point) and Fibromyalgia (FM).

  10. Laser induced shockwaves on flexible polymers for treatment of bacterial biofilms.

    PubMed

    Navarro, Artemio; Taylor, Zachary D; Beenhouwer, David; Haake, David A; Gupta, Vijay; Grundfest, Warren S

    2011-01-01

    Bacterial biofilm-related infections are a burden on the healthcare industry. The effect of laser generated shockwaves through polycarbonate, a flexible polymer, is explored for its ability to generate high peak stresses, and also for its ability to conform to complex wound surfaces. Shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 60 MPa was measured which should provide sufficient pressure to kill bacteria.

  11. Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

    PubMed Central

    Malliaropoulos, Nikos; Jury, Rosanna; Pyne, Debasish; Padhiar, Nat; Turner, Jennifer; Korakakis, Vasileios; Meke, Maria; Lohrer, Heinz

    2016-01-01

    Introduction Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery. Study design This case series is a retrospective cohort study. Purpose The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit). Methods A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed. Results Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019). Conclusion This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect. PMID:27843364

  12. Original hypothesis: Extracorporeal shockwaves as a homeostatic autoimmune restorative treatment (HART) for Type 1 diabetes mellitus.

    PubMed

    Craig, Kenneth; d'Agostino, Cristina; Poratt, Daniel; Walker, Marjorie

    2014-09-01

    Mononuclear invasion of Langerhans islet and the ensuing insulitis triggers signal-transduction for the autoimmune mediated pancreatic beta-cell (β-cell) apoptosis that severely disrupts insulin production resulting in hyperglycemia associated with Type-1 diabetes (T1DM). Today extensive global research is being conducted to eliminate the need for insulin, and even prevent or find a cure for T1DM. The multifactorial combination of autoimmune dysfunction, Langerhans islet hypoxia, and bio-chemical disruption are seen to be contributory factors for β-cell destruction and the consequential disruption to insulin production. Regeneration of β-cells back to physiological levels may restore homeostatic insulin levels, reversing T1DM. Evidence suggests that there are still functioning pancreatic β-cells even in long standing T1DM providing the potential for their regeneration. Although the exact mechanism of extracorporeal shockwaves (ESW) is yet to be fully elucidated, it is seen to influence a complex spectrum of bio-chemical, cellular and neuronal functions (i.e. suppression of pro-inflammatory immune response, improved tissue hemodynamics, anti-microbial properties, and the induction of progenitor cell expression including proangiogenic factors and nitric oxide syntheses). The rationale for the use of ESW as a therapeutic modality in this instance is attributed to its restorative properties and safety profile demonstrated in urology, cardiology, chronic wounds, osteogenesis, complex pain syndromes, and tendinopathies. ESW may restore autoimmune homeostasis creating a suitable environment for pancreatic β-cell proliferation which in-turn may significantly increase or normalize endogenous insulin secretion reducing or totally eliminating dependency of exogenous insulin. The devastating complications, morbidity and mortality associated with T1DM warrants the exploration of homeostatic autoimmune restorative treatment (HART) modalities that may partially or fully

  13. Diagnostic features of relief formations on the nanostructured titanium VT1-0 surface after laser shock-wave treatment

    NASA Astrophysics Data System (ADS)

    Lytvynenko, I. V.; Lupenko, S. A.; Maruschak, P. O.; Panin, S. V.; Hats, Yu I.

    2017-02-01

    A new class of diagnostic features for conducting morphological analysis of relief formations induced by laser shock-wave treatment on the surface of the nanostructured titanium VT1-0 alloy is proposed. They are the coefficients of series expansions of statistical estimates for the orthogonal basis of Chebyshev, Laguerre, Kravchuk discrete polynomials and trigonometric functions. Based on the criterion of the minimum number of the diagnostic features in the above-mentioned bases, the Chebyshev one was selected as the most appropriate to solve this problem.

  14. Osteogenic effects of low-intensity pulsed ultrasound, extracorporeal shockwaves and their combination - an in vitro comparative study on human periosteal cells.

    PubMed

    Tam, Kam-Fai; Cheung, Wing-Hoi; Lee, Kwong-Man; Qin, Ling; Leung, Kwok-Sui

    2008-12-01

    Our previous studies have shown that on human periosteal cells, low-intensity pulsed ultrasound (LIPUS) has an immediate stimulatory effect whereas extracorporeal shockwaves (ESW) have an delayed stimulatory effect. Therefore, we hypothesized that a combined ESW and LIPUS treatment might provide additive or synergistic effects on periosteal cells, by using ESW to trigger a biological activity while using LIPUS to maintain the stimulated activity. Human periosteal cells were subjected to a single session of ESW treatment on day 0 and/or daily LIPUS treatments or no treatment (control). The cell viability, proliferation, and alkaline phosphatase activity on day 6 and day 18 as well as matrix mineralization on day 35 were measured. Results revealed that LIPUS alone had early positive effects on the activities on day 6 only. In contrast, ESW alone had an early destructive effect but exerted delayed stimulatory effects on the cellular activities on day 18. The combined treatment of ESW plus LIPUS produced effects that were comparable to the ESW treatment alone. Although these findings suggest that ESW and LIPUS stimulate the periosteal cells in two different ways and at different times, their additive or synergistic effects could not be proven.

  15. The use of low-energy radial shockwave in the treatment of entrapment neuropathy of the medial calcaneal nerve: a pilot study.

    PubMed

    Barrett, Stephen L; Reese, Matthew M; Tassone, John; Buitrago, Maria

    2008-08-01

    Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

  16. The effect of shockwaves on mature and healing cortical bone.

    PubMed

    Forriol, F; Solchaga, L; Moreno, J L; Canãdell, J

    1994-10-01

    It has been proposed that high energy shockwaves could be used to create microfractures in cortical bone. This quality might be exploited clinically to perform closed osteotomies and promote healing in nonunion (15). However, no study has previously documented the effect of shockwaves on cortical bone "in vivo". We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.

  17. Extracorporeal shockwave lithotripsy in pediatrics.

    PubMed

    D'Addessi, Alessandro; Bongiovanni, Luca; Sasso, Francesco; Gulino, Gaetano; Falabella, Roberto; Bassi, Pierfrancesco

    2008-01-01

    Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all

  18. The efficacy of performing shockwave lithotripsy before retrograde intrarenal surgery in the treatment of multiple or large (≥1.5 cm) nephrolithiasis: A propensity score matched analysis

    PubMed Central

    Shim, Myungsun; Park, Myungchan

    2017-01-01

    Purpose To investigate the effect of performing shockwave lithotripsy (SWL) before retrograde intrarenal surgery (RIRS) on the treatment outcomes of patients with nephrolithiasis. Materials and Methods The data of 189 patients with renal stones who underwent RIRS from July 2007 to July 2014 was reviewed retrospectively. Patients with stones larger than 1.5 cm were recommended to undergo SWL before RIRS. Patients were divided into 2 groups based on whether the preoperative SWL was performed (group 1, n=68) or not (group 2, n=121). The cohorts of the 2 groups cohorts were matched 1:1 using propensity score analysis. Patient, stone characteristics, operative parameters, and stone-free rates were compared. Results Patients in groups 1 and 2 were matched with respect to stone size, number, and location, leaving 57 patients in each group. After matching, no differences were identified between the 2 groups regarding age, body mass index, sex, stone composition, density and multiplicity. Compared to group 2 patients, patients in group 1 had fewer number of procedures performed (1.10 vs. 1.26, p=0.045) and higher stone-free rate (89.4% vs.73.6%, p=0.039). In multivariate analysis, Non lower calyceal location (odd ratio [OR], 8.215; 95% confidence interval [CI], 1.782–21.982; p=0.041), stone size (OR, 6.932; 95% CI, 1.022–18.283; p<0.001), and preoperative SWL (OR, 2.210; 95% CI, 1.058–7.157; p=0.019) were independent factors predicting a stone-free state after RIRS. Conclusions Performing SWL before RIRS may favor stone eliminations during surgery and increase the stone-free rate in selected patients. PMID:28097265

  19. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  20. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5.

    PubMed

    Hausdorf, Jörg; Lemmens, Marijke A M; Kaplan, Suleyman; Marangoz, Cafer; Milz, Stefan; Odaci, Ersan; Korr, Hubert; Schmitz, Christoph; Maier, Markus

    2008-05-01

    Application of extracorporeal shockwaves to the musculoskeletal system can induce long-term analgesia in the treatment of chronic painful diseases such as calcifying tendonitis of the shoulder, tennis elbow and chronic plantar fasciitis. However, the molecular and cellular mechanisms underlying this phenomenon are largely unknown. Recently it was shown that application of extracorporeal shockwaves to the distal femur of rabbits can lead to reduced concentration of substance P in the shockwaves' focal zone. In the present study we investigated the impact of extracorporeal shockwaves on the production of substance P within dorsal root ganglia in vivo. High-energy shockwaves were applied to the ventral side of the right distal femur of rabbits. After six weeks, the dorsal root ganglia L5 to L7 were investigated with high-precision design-based stereology. The application of extracorporeal shockwaves caused a statistically significant decrease in the mean number of neurons immunoreactive for substance P within the dorsal root ganglion L5 of the treated side compared with the untreated side, without affecting the total number of neurons within this dorsal root ganglion. No effect was observed in the dorsal root ganglia L6 and L7, respectively. These data might further contribute to our understanding of the molecular and cellular mechanisms in the induction of long-term analgesia by extracorporeal shockwave application to the musculoskeletal system.

  1. Effects of extracorporeal shockwaves on the stability of the interface between bone and polymethylmethacrylate: an in vitro study on human femoral segments.

    PubMed

    Braun, W; Claes, L; Rüter, A; Paschke, D

    1992-02-01

    The increasing number of revision procedures for failed total arthroplasty requiring difficult cement removal has led to various developments of new instruments and techniques to facilitate this procedure. In this in vitro study the effect of extracorporeal shockwaves on the bone-cement interface was investigated. At first the pressure reduction caused by the passage of shockwaves through compounds consisting of cortical bone-polymethyl-methacrylate and cancellous bone-polymethylmethacrylate by means of a needle pressure probe was measured. Secondly, the mechanical and morphological effects of extracorporeal shockwaves on the polymethylmethacrylate-bone interface of human femoral segments was tested. Using bone cement, stainless steel rods were implanted into cadaveric femoral segments and the polymethylmethacrylate-bone interface was treated with extracorporeal shockwaves. When comparing the treatment and control groups mechanically, radiologically, and microscopically it was not possible to demonstrate evidence of disruption of the interface caused by extracorporeal shockwaves. Instead it was shown that intravasation of bone marrow can be induced by shockwaves. Considering these facts, shockwaves seems not to be good clinical adjunct in revision surgery of failed arthroplasty.

  2. Extracorporeal shockwave therapy in musculoskeletal disorders

    PubMed Central

    2012-01-01

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders. PMID:22433113

  3. [Percutaneous nephrolitholapaxy combined with extracorporeal shockwave lithotripsy in the treatment of staghorn lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Castillo Rodríguez, M; Hernández Silverio, D; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1990-05-01

    From December, 1988 to July, 1989, 41 patients with renal or juxtapyelic ureteral calculi were submitted to percutaneous litholapaxy (PCN) at the Stone Center of the Hermanos Amerijeiras Hospital in Havana. This series comprise our early experience utilizing this procedure. PCN was initially limited to pelvic and juxtapyelic ureteric calculi with dilated renal cavities. It was subsequently used in combination with extracorporeal lithotripsy (ESWL) in the treatment of staghorn stones. The present study analyzed the results achieved with PCN in 30 patients with staghorn calculi; 21 (70%) incomplete staghorns and 9 (30%) complete staghorns. Posteriorly, 6 additional borderline staghorns were completely removed by PCN and are not included in the present study. PCN was performed to reduce stone mass and for placement of a large renal drain to permit subsequent ESWL. At two months following treatment, 86.6% of the patients were completely stone-free. The remaining 13.4% with stone remnants presented anatomic and functional renal conditions that allow us to predict complete elimination within a short period of time. Since 6 months had not elapsed in these cases, these were not considered as residual fragments. One patient presented massive absorption of fluids. This was the only observed major and non-lethal complication. Episodes of fever were observed in 23% post-PCN. No patient presented severe sepsis. In our view, PCN combined with ESWL is one of the currently available therapeutic options in the treatment of staghorn calculi. This approach permits adequate resolution of cases that would have otherwise required surgery.

  4. Improving the antioxidant functionality of Citrus junos Tanaka (yuzu) fruit juice by underwater shockwave pretreatment.

    PubMed

    Kuraya, Eisuke; Nakada, Shina; Touyama, Akiko; Itoh, Shigeru

    2017-02-01

    Citrus junos Tanaka (yuzu) has a strong characteristic aroma, and hence, yuzu juice is used in a number of Japanese foods. We herein evaluated the functional compounds of yuzu juice to investigate whether underwater shockwave pretreatment affects its functionality. Employing the shockwave pretreatment at an increased discharge and energy of 3.5kV and 4.9kJ, respectively, resulted in an increase in the flavanone glycoside content and oxygen radical absorbance capacity (ORAC). The ORAC value of yuzu juice cultivated in Rikuzentakata increased approximately 1.7 times upon underwater shockwave pretreatment. The treatment method proposed herein exhibited reliable and good performance for the extraction of functional and antioxidant chemicals in yuzu fruits, and was comparable with traditional squeezing methods. The high applicability and reliability of this technique for improving the antioxidant functionality of yuzu fruit juice was demonstrated, confirming the potential for application to a wide range of food extraction processes.

  5. Shock-wave behavior of structural nitrogen-bearing steel after heat treatment under various conditions

    NASA Astrophysics Data System (ADS)

    Meshcheryakov, Yu. I.; Divakov, A. K.; Zhigacheva, N. I.; Konovalov, G. V.; Barakhtin, B. K.; Kalinin, G. Yu.; Mushnikova, S. Yu.; Fomina, O. V.

    2014-10-01

    04Kh20G11N6M2AFB steel is subjected to shock tests in the following two states: after high-temperature mechanical treatment (HTMT) and after HTMT followed by quenching. The dynamic yield strength, the spall strength, and the structural transition threshold induced by shock loading are determined. It is shown that these parameters weakly depend on the shock loading rate in the steel after HTMT and increase slightly in the steel quenched from a temperature of 1100°C. In both cases, the mass velocity defect at a compression pulse plateau increases sharply beginning from a certain threshold strain rate, which indicates a high energy absorption ability of the steel.

  6. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  7. Bacterial biofilm disruption using laser generated shockwaves.

    PubMed

    Taylor, Zachary D; Navarro, Artemio; Kealey, Colin P; Beenhouwer, David; Haake, David A; Grundfest, Warren S; Gupta, Vijay

    2010-01-01

    A system was built to test the efficacy of bacterial biofilm disruption using laser generated shockwaves. The system is based on a Q-switched, ND:YAG pulsed laser operating at a rep rate of 10 Hz with 1500 mJ pulses centered at 1064 nm. The laser pulses were used to create shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 50 MPa was measured. These stress pulses were coupled to bacteria grown to confluence on agar plates and cell death as a result of shockwave stress was assessed. The results show a 55% reduction in the number living bacteria between shocked and control samples. This type of biofilm disruption method could prove useful in the treatment of infected wounds where standard treatment methods such as debridement and topical antibiotics have proven to be ineffectual or harmful.

  8. The Chelyabinsk airburst shockwave

    NASA Astrophysics Data System (ADS)

    Popova, O.; Shuvalov, V.; Rybnov, Y.; Jenniskens, P.; Kharlamov, V.; Usoltseva, O.; Glazachev, D.; Podobnaya, E.; Dyagilev, R.; Trubetskaya, I.

    2014-07-01

    The Chelyabinsk airburst of 15 February 2013 was exceptional because of the large kinetic energy of the impacting body and because the airburst that was generated created significant damage and injuries in a densely populated area. The butterfly-shape of the damaged area (Popova et al., 2013) is explained from the fact that the energy was deposited over a range of altitudes. Some uncertainty remains about the source energy of the airburst, because it is not known precisely at what pressure glass is expected to break. Reasonable results were obtained for energies of 300--520 kt TNT and over pressures of 500--1000 Pa, assuming that the time dependence of the energy release followed the meteor lightcurve (Popova et al. 2013). Additional information about the airburst characteristics may be extracted from the arrival times of the shockwave at various locations and from pressure records. Arrival times of the shock wave were derived from video observations. From the analysis of these shock wave arrival times, a range of altitudes of energy deposition was derived (Popova et al. 2013). The observed arrival times were compared with model estimates, taking into account the real wind and atmospheric conditions. Results of the numerical simulations were compared with recorded sound signals, which were often quite complex. Borovicka et al. (2013) suggested that subsequent acoustic arrivals corresponded to separate fragmentation events. This hypothesis is tested. There were no instrumental records of overpressure in the damaged area. However, seismic records exist from locations surrounding a coal mine at Korkino, situated in the damage area close to the meteoroid trajectory, almost immediately below the region of highest energy deposition. Its seismic control system to monitor land slides recorded the blast wave from the meteoroid entry indirectly due to coupling to the ground. This is the only instrumental record of the airburst close to the meteoroid trajectory. An analysis

  9. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL. PMID:23304627

  10. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy.

    PubMed

    Francis, Nathan C; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S; Taylor, Zach D

    2015-03-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications.

  11. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy

    PubMed Central

    Francis, Nathan C.; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S.; Taylor, Zach D.

    2015-01-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications. PMID:25798307

  12. Current concepts of shockwave therapy in stress fractures.

    PubMed

    Leal, Carlos; D'Agostino, Cristina; Gomez Garcia, Santiago; Fernandez, Arnold

    2015-12-01

    Stress fractures are common painful conditions in athletes, usually associated to biomechanical overloads. Low risk stress fractures usually respond well to conservative treatments, but up to one third of the athletes may not respond, and evolve into high-risk stress fractures. Surgical stabilization may be the final treatment, but it is a highly invasive procedure with known complications. Shockwave treatments (ESWT), based upon the stimulation of bone turnover, osteoblast stimulation and neovascularization by mechanotransduction, have been successfully used to treat delayed unions and avascular necrosis. Since 1999 it has also been proposed in the treatment of stress fractures with excellent results and no complications. We have used focused shockwave treatments in professional athletes and military personnel with a high rate of recovery, return to competition and pain control. We present the current concepts of shockwave treatments for stress fractures, and recommend it as the primary standard of care in low risk patients with poor response to conventional treatments.

  13. Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children.

    PubMed

    Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut

    2009-04-01

    In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the

  14. A Supernova's Shockwaves

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Supernovae are the explosive deaths of the universe's most massive stars. In death, these volatile creatures blast tons of energetic waves into the cosmos, destroying much of the dust surrounding them.

    This false-color composite from NASA's Spitzer Space Telescope and NASA's Chandra X-ray Observatory shows the remnant of one such explosion. The remnant, called N132D, is the wispy pink shell of gas at the center of this image. The pinkish color reveals a clash between the explosion's high-energy shockwaves and surrounding dust grains.

    In the background, small organic molecules called polycyclic aromatic hydrocarbons are shown as tints of green. The blue spots represent stars in our galaxy along this line of sight.

    N132D is located 163,000 light-years away in a neighboring galaxy called, the Large Magellanic Cloud.

    In this image, infrared light at 4.5 microns is mapped to blue, 8.0 microns to green and 24 microns to red. Broadband X-ray light is mapped purple. The infrared data were taken by Spitzer's infrared array camera and multiband imaging photometer, while the X-ray data were captured by Chandra.

  15. Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series

    PubMed Central

    Pavone, Vito; Di Stefano, Antonio; Testa, Gianluca; Costarella, Luciano; Sessa, Giuseppe

    2016-01-01

    Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70%) males and 12 (30%) females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from 800 shots in each one (4 Hz, 14 KeV), together with eccentric exercises. Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score were recorded. Results. At the 12-month follow-up, 26 (65.0%) patients did not complain about pain (VAS < 2), 11 (27.5%) patients got back to normal activities despite residual pain (VAS 2–4), and 3 (7.5%) of the patients still complained about pain (VAS > 4). There was no significative improvement in both scores after eccentric exercises alone. Mean VAS improvement was 5.8 ± 1.3 SD points (P < 0.001). Mean AOFAS Hindfoot score improvement was 19.8 ± 5.0 SD points (P < 0.001). Conclusions. ESWT is recommended, in combination with an eccentric exercise program, in patients with chronic Achilles tendinopathy being both insertional and not. PMID:27843949

  16. Development and Preclinical Testing of Laser-Generated Shockwave Therapy for Infected Wounds

    NASA Astrophysics Data System (ADS)

    Francis, Nathan Craig

    The goal of this thesis is to translate laser-generated shockwave (LGS) therapy from a bench-top, research system into a portable, clinical system for in vivo animal trials. Prior research along this topic was completed using a benchtop system, in a physical setup dissimilar to the clinical setup. So the technology required re-engineering in order to apply it to animal studies. This began with the construction of a portable LGS therapy system, mobile enough to transport from laboratory to clinical settings. Included in the portable system is a 2D scanning system to consistently treat wound areas of varying geometries with shockwaves of 3 mm diameter spot sizes. The shockwaves generated by the portable laser system were characterized, along with the varying shockwave-generating substrates possible for clinical application. A final material selection of black polyimide was chosen because of its complete absorption of laser light and its ability to conform to tight wound geometries. Since shockwaves have never been demonstrated to delaminate biofilm from a tissue surface, a proof-of-concept study was completed successfully delaminating Staphylococcus epidermidis from wounded ex vivo pigskin. Through false-colored SEM imaging, biofilm area reduction between treated and non-treated samples were calculated. A 53% reduction in biofilm area and signifcant biofilm fragmentation was seen. An in vivo safety study was conducted next to observe potential physiological effects of LGS on healthy dermal tissue. Treated subjects were observed over a 3 day period, and no physiological or inflammatory effects were seen in the histological analysis. Finally, a pilot wound healing study was com- pleted on excisional wound healing model in rats, with S. epidermidis as the infectious agent, to measure the effect of LGS on wound healing area and rate compared to other treatments. After 9 days of wound healing, no treatment or controls showed a significant difference in wound healing rate

  17. Interaction of lithotripter shockwaves with single inertial cavitation bubbles.

    PubMed

    Klaseboer, Evert; Fong, Siew Wan; Turangan, Cary K; Khoo, Boo Cheong; Szeri, Andrew J; Calvisi, Michael L; Sankin, Georgy N; Zhong, Pei

    2007-01-01

    The dynamic interaction of a shockwave (modelled as a pressure pulse) with an initially spherically oscillating bubble is investigated. Upon the shockwave impact, the bubble deforms non-spherically and the flow field surrounding the bubble is determined with potential flow theory using the boundary-element method (BEM). The primary advantage of this method is its computational efficiency. The simulation process is repeated until the two opposite sides of the bubble surface collide with each other (i.e. the formation of a jet along the shockwave propagation direction). The collapse time of the bubble, its shape and the velocity of the jet are calculated. Moreover, the impact pressure is estimated based on water-hammer pressure theory. The Kelvin impulse, kinetic energy and bubble displacement (all at the moment of jet impact) are also determined. Overall, the simulated results compare favourably with experimental observations of lithotripter shockwave interaction with single bubbles (using laser-induced bubbles at various oscillation stages). The simulations confirm the experimental observation that the most intense collapse, with the highest jet velocity and impact pressure, occurs for bubbles with intermediate size during the contraction phase when the collapse time of the bubble is approximately equal to the compressive pulse duration of the shock wave. Under this condition, the maximum amount of energy of the incident shockwave is transferred to the collapsing bubble. Further, the effect of the bubble contents (ideal gas with different initial pressures) and the initial conditions of the bubble (initially oscillating vs. non-oscillating) on the dynamics of the shockwave-bubble interaction are discussed.

  18. Developing Multimedia Courseware for the Internet's Java versus Shockwave.

    ERIC Educational Resources Information Center

    Majchrzak, Tina L.

    1996-01-01

    Describes and compares two methods for developing multimedia courseware for use on the Internet: an authoring tool called Shockwave, and an object-oriented language called Java. Topics include vector graphics, browsers, interaction with network protocols, data security, multithreading, and computer languages versus development environments. (LRW)

  19. Shockwave Interactions with Argon Glow Discharges

    DTIC Science & Technology

    2006-03-01

    SHOCKWAVE INTERACTIONS WITH ARGON GLOW DISCHARGES THESIS Nicholas S. Siefert, Lieutenant, USAF AFIT/GAP/ENP/06-18 DEPARTMENT OF THE AIR FORCE AIR...the United States Government. AFIT/GAP/ENP/06-18 SHOCKWAVE INTERACTIONS WITH ARGON GLOW DISCHARGES THESIS Presented to the Faculty Department of...APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED AFIT/GAP/ENP/06-18 SHOCKWAVE INTERACTIONS WITH ARGON GLOW DISCHARGES Nicholas S. Siefert, BS

  20. Delayed stimulatory effect of low-intensity shockwaves on human periosteal cells.

    PubMed

    Tam, Kam-Fai; Cheung, Wing-Hoi; Lee, Kwong-Man; Qin, Ling; Leung, Kwok-Sui

    2005-09-01

    We investigated the effect of shockwaves on cells explanted from normal human periosteum to study the potential mechanisms of their responses and to determine suitable treatment settings. The cells were subjected to one shockwave treatment with systematic combinations of energy intensities (range, 0.05-0.5 mJ/mm) and number of shocks (range, 500-2000) whereas control cells received no treatment. The immediate effect on cell viability and the long-lasting effect on proliferation, viable cell number at Day 18, and mineralization at Day 35 were assessed. We observed an immediate dose-dependent destructive effect of shockwaves. Energy intensity and number of shocks contributed equally to viability. Total energy dose (intensity x number of shocks) was a better reference for determining the shockwave effect. We also found a long-term stimulatory effect on proliferation, viable cell number, and calcium deposition of human periosteal cells. At the same total energy dose, low-intensity shockwaves with more shocks (0.12 mJ/mm at 1250 shocks) were more favorable for enhancing cellular activities than high-intensity waves with fewer shocks (0.5 mJ/mm at 300 shocks). These findings document some of the biochemical changes of periosteal cells during shockwave treatments.

  1. Superconductivity of Mg/MgO interface formed by shock-wave pressure

    NASA Astrophysics Data System (ADS)

    Sidorov, N. S.; Palnichenko, A. V.; Shakhrai, D. V.; Avdonin, V. V.; Vyaselev, O. M.; Khasanov, S. S.

    2013-05-01

    A mixture of Mg and MgO has been subjected to a shock-wave pressure of ≈170 kbar. The ac susceptibility measurements of the product has revealed a metastable superconductivity with Tc ≈ 30 K, characterized by glassy dynamics of the shielding currents below Tc. Comparison of the ac susceptibility and the dc magnetization measurements infers that the superconductivity arises within the interfacial layer formed between metallic Mg and its oxide due to the shock-wave treatment.

  2. Shock-wave measurement using a calibrated interferometric fiber-tip sensor.

    PubMed

    Koch, C; Molkenstruck, W; Reibold, R

    1997-01-01

    The results of shock-wave measurements using a calibrated fiber-tip sensor based on a Michelson interferometer are presented. A transfer function, obtained by an independent experiment that describes the properties of the sensor system, was used to correct the measured shock-wave data in the Fourier frequency domain. The phase of the transfer function was determined from its amplitude by a fitting procedure using minimum-phase terms. As an example of application, the acoustic output field of an electromagnetic lithotriptor was investigated, and the shock-wave source was reliably characterized. The measured data provide a basis for estimating the hazard to which a patient is exposed during shock-wave treatment and for optimizing a lithotriptor system to produce a sharply localized and effective acoustic field.

  3. Interaction of lithotripter shockwaves with single inertial cavitation bubbles

    PubMed Central

    Klaseboer, Evert; Fong, Siew Wan; Turangan, Cary K.; Khoo, Boo Cheong; Szeri, Andrew J.; Calvisi, Michael L.; Sankin, Georgy N.; Zhong, Pei

    2008-01-01

    The dynamic interaction of a shockwave (modelled as a pressure pulse) with an initially spherically oscillating bubble is investigated. Upon the shockwave impact, the bubble deforms non-spherically and the flow field surrounding the bubble is determined with potential flow theory using the boundary-element method (BEM). The primary advantage of this method is its computational efficiency. The simulation process is repeated until the two opposite sides of the bubble surface collide with each other (i.e. the formation of a jet along the shockwave propagation direction). The collapse time of the bubble, its shape and the velocity of the jet are calculated. Moreover, the impact pressure is estimated based on water-hammer pressure theory. The Kelvin impulse, kinetic energy and bubble displacement (all at the moment of jet impact) are also determined. Overall, the simulated results compare favourably with experimental observations of lithotripter shockwave interaction with single bubbles (using laser-induced bubbles at various oscillation stages). The simulations confirm the experimental observation that the most intense collapse, with the highest jet velocity and impact pressure, occurs for bubbles with intermediate size during the contraction phase when the collapse time of the bubble is approximately equal to the compressive pulse duration of the shock wave. Under this condition, the maximum amount of energy of the incident shockwave is transferred to the collapsing bubble. Further, the effect of the bubble contents (ideal gas with different initial pressures) and the initial conditions of the bubble (initially oscillating vs. non-oscillating) on the dynamics of the shockwave–bubble interaction are discussed. PMID:19018296

  4. Laser-induced shockwave propagation from ablation in a cavity

    SciTech Connect

    Zeng Xianzhong; Mao Xianglei; Mao, Samuel S.; Wen, S.-B.; Greif, Ralph; Russo, Richard E.

    2006-02-06

    The propagation of laser-induced shockwaves from ablation inside of cavities was determined from time-resolved shadowgraph images. The temperature and electron number density of the laser-induced plasma was determined from spectroscopic measurements. These properties were compared to those for laser ablation on the flat surface under the same energy and background gas condition. A theoretical model was proposed to determine the amount of energy and vaporized mass stored in the vapor plume based on these measurements.

  5. Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

    PubMed

    Palfrey, E L; Bultitude, M I; Challah, S; Pemberton, J; Shuttleworth, K E

    1986-12-01

    Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

  6. Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder

    PubMed Central

    Vahdatpour, Babak; Taheri, Parisa; Zade, Abolghasem Zare; Moradian, Saeed

    2014-01-01

    Background: Frozen shoulder has always been considered important because of the impact on the quality-of-life and long period of illness. Therefore, the use of noninvasive and safe techniques that can speed up the healing process of the disease is important. Methods: This study was a randomized clinical trial study on patients suffering from frozen shoulder who were referred to Isfahan University of Medical Sciences hospitals in 2011 and 2012. A total of 36 patients were enrolled in the study. Eligible patients were allocated into two groups. Intervention group received extracorporeal shockwave therapy (ESWT) once a week for 4 weeks. The control group received sham shockwave therapy once a week for 4 weeks. On the follow-up period, changes in individual performance and the amount of pain and disability were assessed by the Shoulder Pain and Disability Index (SPADI) questionnaire and the range of motion changes were assessed by a goniometer. Data obtained were analyzed using SPSS software. Results: Variance analysis revealed a difference in the mean pain and disability score of the SPADI questionnaire, flexion, extension, and abduction, external rotation of involved shoulder between two groups before and after the shockwave therapy (P < 0.05). Improvement was more satisfactory in the intervention group, but the mean internal rotation did not differ significantly in two groups (P > 0.05). Conclusions: The use of ESWT seems to have positive effects on treatment, quicker return to daily activities, and quality-of-life improvement on frozen shoulder. PMID:25104999

  7. Shockwave Engine: Wave Disk Engine

    SciTech Connect

    2010-01-14

    Broad Funding Opportunity Announcement Project: MSU is developing a new engine for use in hybrid automobiles that could significantly reduce fuel waste and improve engine efficiency. In a traditional internal combustion engine, air and fuel are ignited, creating high-temperature and high-pressure gases which expand rapidly. This expansion of gases forces the engine’s pistons to pump and powers the car. MSU’s engine has no pistons. It uses the combustion of air and fuel to build up pressure within the engine, generating a shockwave that blasts hot gas exhaust into the blades of the engine’s rotors causing them to turn, which generates electricity. MSU’s redesigned engine would be the size of a cooking pot and contain fewer moving parts—reducing the weight of the engine by 30%. It would also enable a vehicle that could use 60% of its fuel for propulsion.

  8. Shockwaves Cause Synaptic Degeneration in Cultured Neurons

    DTIC Science & Technology

    2009-11-02

    constructed of delrin. A piezoresistive pressure sensor (Endevco Model 8530C) was mounted flush with the plate, coaxial with the center of the gene gun ...biolostic gene gun to deliver shockwaves to cultured hippocampal or cortical neurons. These cultured cells form abundant synapses in vitro, and after a 24-48...neurons, we used a biolostic gene gun to deliver shockwaves to cultured hippocampal or cortical neurons. These cultured cells form abundant synapses in

  9. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    PubMed

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  10. A shockwave approach for web-based clinical motion analysis.

    PubMed

    Lemaire, Edward

    2004-01-01

    Advances in Internet connectivity and personal multimedia computing have created opportunities for integrating simple motion analysis into clinical practice. The Macromedia Shockwave environment provides tools for creating media-rich software that runs within a Web browser. For this project, clinical motion analysis software was created using Shockwave that can load digital video clips of a client's motion, step/shuttle/play through the clip, superimpose a grid over the video image, measure relative joint angles, scale to a linear factor, measure distances, and measure average velocities. After installing the Shockwave and Quicktime video plug-ins, the Motion Analysis Tools-Shockwave program runs directly from a Web page hyperlink. Program testing involved comparing angle measurements, linear distances, stride length, and walking speed among six video clips. The first three clips were of a transtibial prosthesis being carried through the field of view (640 x 480, 320 x 240, 320 x 240 enlarged to 640 x 480). The second set of three clips was of a metal square carried through the field of view. Average root mean square errors were 2.0 degrees for angle measures and 1.2 cm for length measures. Stride length standard deviation was 4.6 cm (mean length = 212.1 cm). Average walking speed standard deviation was 0.015 m/s (mean speed = 1.15 m/s). The test results were consistent with video motion analysis results and within an acceptable range for clinical design-making. This Web-based motion analysis approach provides a useful tool for ubiquitous, quantitative, clinical gait analysis.

  11. Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans

    PubMed Central

    Hsi, Ryan S.; Sorensen, Mathew D.; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Bailey, Michael; Harper, Jonathan D.

    2015-01-01

    Abstract Introduction: In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans. Materials and Methods: Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points. Results: Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05). Conclusion: Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected. PMID:26239232

  12. Blood clot disruption in vitro using shockwaves delivered by an extracorporeal generator after pre-exposure to lytic agent.

    PubMed

    Goldenstedt, Cedric; Birer, Alain; Cathignol, Dominique; Lafon, Cyril

    2009-06-01

    The standard methods for recanalyzing thrombosed vessels are vascular stenting or administration of thrombolytic drugs. However, these methods suffer from uncertain success rate and side-effects. Therefore, minimally-invasive ultrasound methods have been investigated. In this article, we propose to use shockwaves after pre-exposure to fibrinolytic agent for disrupting thrombus. Shockwaves were delivered by an extracorporeal piezocomposite generator (120 mm in diameter, focused at 97 mm, pulse length = 1.4 micros). In vitro blood clots, made from human blood, were placed at the focal point of the generator. The clots were exposed to shockwaves either with or without prior immersion in a solution of streptokinase. The percentage of lysed clot was determined by weighing the clot before and after treatment. The proportion of lysed clot increased with the pressure at the focus and with the number of shocks. A mean clot reduction of 91% was obtained for 42 MPa in 4-min treatment duration only, without using streptokinase. For a treatment of 2 min at 29 MPa, the clot reduction increased significantly (p < 0.01) from 47% without streptokinase to 82% when streptokinase was used prior to shockwaves. These results also showed no significant damage to streptokinase due to exposure to shockwaves. This study suggests that extracorporeal shockwaves combined with streptokinase is a promising pharmaco-mechanical method for treating occlusive thrombus, and should be confirmed by in vivo trials. Additional studies must also be conducted with other fibrinolytic agents, whose abilities to penetrate clots are different.

  13. Shockwave Consolidation of Nanostructured Thermoelectric Materials

    NASA Technical Reports Server (NTRS)

    Prasad, Narasimha S.; Taylor, Patrick; Nemir, David

    2014-01-01

    Nanotechnology based thermoelectric materials are considered attractive for developing highly efficient thermoelectric devices. Nano-structured thermoelectric materials are predicted to offer higher ZT over bulk materials by reducing thermal conductivity and increasing electrical conductivity. Consolidation of nano-structured powders into dense materials without losing nanostructure is essential towards practical device development. Using the gas atomization process, amorphous nano-structured powders were produced. Shockwave consolidation is accomplished by surrounding the nanopowder-containing tube with explosives and then detonating. The resulting shock wave causes rapid fusing of the powders without the melt and subsequent grain growth. We have been successful in generating consolidated nano-structured bismuth telluride alloy powders by using the shockwave technique. Using these consolidated materials, several types of thermoelectric power generating devices have been developed. Shockwave consolidation is anticipated to generate large quantities of nanostructred materials expeditiously and cost effectively. In this paper, the technique of shockwave consolidation will be presented followed by Seebeck Coefficient and thermal conductivity measurements of consolidated materials. Preliminary results indicate a substantial increase in electrical conductivity due to shockwave consolidation technique.

  14. 1D GAS-DYNAMIC SIMULATION OF SHOCK-WAVE PROCESSES VIA INTERNET

    SciTech Connect

    Khishchenko, K. V.; Levashov, P. R.; Povarnitsyn, M. E.; Zakharenkov, A. S.

    2009-12-28

    We present a Web-interface for 1D simulation of different shock-wave experiments. The choosing of initial parameters, the modeling itself and output data treatment can be made directly via the Internet. The interface is based upon the expert system on shock-wave data and equations of state and contains both the Eulerian and Lagrangian Godunov hydrocodes. The availability of equations of state for a broad set of substances makes this system a useful tool for planning and interpretation of shock-wave experiments. As an example of simulation with the system, results of modeling of multistep shock loading of potassium between polytetrafluoroethylene and stainless steel plates are presented in comparison with experimental data from Shakhray et al.(2005).

  15. Superconductivity of Al/Al2O3 interface formed by shock-wave pressure

    NASA Astrophysics Data System (ADS)

    Palnichenko, A. V.; Shakhrai, D. V.; Avdonin, V. V.; Vyaselev, O. M.; Khasanov, S. S.

    2015-05-01

    A mixture of Al and α -Al2O3 has been subjected to a shock-wave pressure of ≃ 170 kbar, followed by vacuum-encapsulating and quenching of the product to liquid nitrogen. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc ≈ 37 K, characterized by glassy dynamics of the shielding currents below Tc . Comparison of the ac susceptibility and the dc magnetization measurements infers that the superconductivity arises within the interfacial granular layer formed between metallic Al and its oxide due to the shock-wave treatment.

  16. Superconductivity of Cu/CuOx interface formed by shock-wave pressure

    NASA Astrophysics Data System (ADS)

    Shakhray, D. V.; Avdonin, V. V.; Palnichenko, A. V.

    2016-11-01

    A mixture of powdered Cu and CuO has been subjected to shock-wave pressure of 350 kbar with following quenching of the vacuum-encapsulated product to 77 K. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc ≈ 19 K, characterized by glassy dynamics of the shielding currents below Tc . Comparison of the ac susceptibility and the DC magnetization measurements infers that the superconductivity arises within the granular interfacial layer formed between metallic Cu and its oxides due to the shock-wave treatment.

  17. Superconductivity of Al/Al2O3 interface formed under shock-wave conditions

    NASA Astrophysics Data System (ADS)

    Shakhray, D. V.; Avdonin, V. V.; Palnichenko, A. V.; Vyaselev, O. M.

    2015-11-01

    A mixture of powdered Al and Al2O3 has been subjected to a shock-wave pressure of ≈ 170 kbar, followed by vacuum-encapsulating and quenching of the product to liquid nitrogen. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc ≈ 37 K, characterized by glassy dynamics of the shielding currents below Tc. Comparison of the ac susceptibility and the dc magnetization measurements infers that the superconductivity arises within the interfacial granular layer formed between metallic Al and its oxide due to the shock-wave treatment.

  18. Superconductivity of Cu/CuOx interface formed by shock-wave pressure

    NASA Astrophysics Data System (ADS)

    Palnichenko, A. V.; Sidorov, N. S.; Shakhrai, D. V.; Avdonin, V. V.; Vyaselev, O. M.; Khasanov, S. S.

    2014-03-01

    A mixture of powdered Cu and CuO has been subjected to a shock-wave pressure of ≃350 kbar with following quenching of the vacuum-encapsulated product to ≈77 K. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc≈19.5 K, characterized by glassy dynamics of the shielding currents below Tc. Comparison of the ac susceptibility and the dc magnetization measurements infers that the superconductivity arises within the granular interfacial layer formed between metallic Cu and its oxides due to the shock-wave treatment.

  19. Shockwaves induce osteogenic differentiation of human mesenchymal stem cells through ATP release and activation of P2X7 receptors.

    PubMed

    Sun, Dahui; Junger, Wolfgang G; Yuan, Changji; Zhang, Wenyan; Bao, Yi; Qin, Daming; Wang, Chengxue; Tan, Lei; Qi, Baochang; Zhu, Dong; Zhang, Xizheng; Yu, Tiecheng

    2013-06-01

    Shockwave treatment promotes bone healing of nonunion fractures. In this study, we investigated whether this effect could be due to adenosine 5'-triphosphate (ATP) release-induced differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells. Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase activity, osteocalcin production, and calcium nodule formation. Expression of P2X7 receptors and c-fos and c-jun mRNA was determined with real-time reverse transcription polymerase chain reaction and Western blotting. P2X7-siRNA, apyrase, P2 receptor antagonists, and p38 MAPK inhibitors were used to evaluate the roles of ATP release, P2X7 receptors, and p38 MAPK signaling in shockwave-induced osteogenic hMSCs differentiation. Shockwave treatment released significant amounts (≈ 7 μM) of ATP from hMSCs. Shockwaves and exogenous ATP induced c-fos and c-jun mRNA transcription, p38 MAPK activation, and hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists, or blockade of p38 MAPK with SB203580 prevented osteogenic differentiation of hMSCs. Our findings indicate that shockwaves release cellular ATP that activates P2X7 receptors and downstream signaling events that caused osteogenic differentiation of hMSCs. We conclude that shockwave therapy promotes bone healing through P2X7 receptor signaling, which contributes to hMSC differentiation.

  20. Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

    PubMed Central

    Vergunst, H; Terpstra, O T; Brakel, K; Laméris, J S; van Blankenstein, M; Schröder, F H

    1989-01-01

    Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results. PMID:2684058

  1. Use of shock-wave heating for faster and safer ablation of tissue volumes in high intensity focused ultrasound therapy

    NASA Astrophysics Data System (ADS)

    Khokhlova, V.; Yuldashev, P.; Sinilshchikov, I.; Partanen, A.; Khokhlova, T.; Farr, N.; Kreider, W.; Maxwell, A.; Sapozhnikov, O.

    2015-10-01

    Simulation of enhanced heating of clinically relevant tissue volumes using nonlinear ultrasound waves generated by a multi-element HIFU phased array were conducted based on the combined Westervelt and bio-heat equations. A spatial spectral approach using the fast Fourier transform algorithm and a corresponding analytic solution to the bioheat equation were used to optimize temperature modeling in tissue. Localized shock-wave heating within a much larger treated tissue volume and short, single HIFU pulses within a much longer overall exposure time were accounted for in the algorithm. Separation of processes with different time and spatial scales made the calculations faster and more accurate. With the proposed method it was shown that for the same time-average power, the use of high peak power pulsing schemes that produce high-amplitude shocks at the focus result in faster tissue heating compared to harmonic, continuous-wave sonications. Nonlinear effects can significantly accelerate volumetric heating while also permitting greater spatial control to reduce the impact on surrounding tissues. Such studies can be further used to test and optimize various steering trajectories of shock-wave sonications for faster and more controlled treatment of tissue volumes.

  2. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    PubMed

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  3. Causality violation, gravitational shockwaves and UV completion

    NASA Astrophysics Data System (ADS)

    Hollowood, Timothy J.; Shore, Graham M.

    2016-03-01

    The effective actions describing the low-energy dynamics of QFTs involving gravity generically exhibit causality violations. These may take the form of superluminal propagation or Shapiro time advances and allow the construction of "time machines", i.e. spacetimes admitting closed non-spacelike curves. Here, we discuss critically whether such causality violations may be used as a criterion to identify unphysical effective actions or whether, and how, causality problems may be resolved by embedding the action in a fundamental, UV complete QFT. We study in detail the case of photon scattering in an Aichelburg-Sexl gravitational shockwave background and calculate the phase shifts in QED for all energies, demonstrating their smooth interpolation from the causality-violating effective action values at low-energy to their manifestly causal high-energy limits. At low energies, these phase shifts may be interpreted as backwards-in-time coordinate jumps as the photon encounters the shock wavefront, and we illustrate how the resulting causality problems emerge and are resolved in a two-shockwave time machine scenario. The implications of our results for ultra-high (Planck) energy scattering, in which graviton exchange is modelled by the shockwave background, are highlighted.

  4. Three lectures: NEMD, SPAM, and shockwaves

    NASA Astrophysics Data System (ADS)

    Hoover, Wm. G.; Hoover, Carol G.

    2011-03-01

    We discuss three related subjects well suited to graduate research. The first, Nonequilibrium molecular dynamics or "NEMD", makes possible the simulation of atomistic systems driven by external fields, subject to dynamic constraints, and thermostated so as to yield stationary nonequilibrium states. The second subject, Smooth Particle Applied Mechanics or "SPAM", provides a particle method, resembling molecular dynamics, but designed to solve continuum problems. The numerical work is simplified because the SPAM particles obey ordinary, rather than partial, differential equations. The interpolation method used with SPAM is a powerful interpretive tool converting point particle variables to twice-differentiable field variables. This interpolation method is vital to the study and understanding of the third research topic we discuss, strong shockwaves in dense fluids. Such shockwaves exhibit stationary far-from-equilibrium states obtained with purely reversible Hamiltonian mechanics. The SPAM interpolation method, applied to this molecular dynamics problem, clearly demonstrates both the tensor character of kinetic temperature and the time-delayed response of stress and heat flux to the strain rate and temperature gradients. The dynamic Lyapunov instability of the shockwave problem can be analyzed in a variety of ways, both with and without symmetry in time. These three subjects suggest many topics suitable for graduate research in nonlinear nonequilibrium problems.

  5. Shockwave-induced deformation of organic particles during laser shockwave cleaning

    NASA Astrophysics Data System (ADS)

    Hoon Kim, Tae; Cho, Hanchul; Busnaina, Ahmed; Park, Jin-Goo; Kim, Dongsik

    2013-08-01

    Although the laser shockwave cleaning process offers a promising alternative to conventional dry-cleaning processes for nanoscale particle removal, its difficulty in removing organic particles has been an unexplained problem. This work elucidates the physics underlying the ineffectiveness of removing organic particles using laser shock cleaning utilizing polystyrene latex particles on silicon substrates. It is found that the shockwave pressure is high enough to deform the particles, increasing the contact radius and consequently the particle adhesion force. The particle deformation has been verified by high-angle scanning electron microscopy. The Maugis-Pollock theory has been applied to predict the contact radius, showing good agreement with the experiment.

  6. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis

    PubMed Central

    Mangone, Giuseppe; Veliaj, Altin; Postiglione, Marco; Viliani, Tamara; Pasquetti, Pietro

    2010-01-01

    The objective of the study is to evaluate the effectiveness of Radial Extracorporeal Shock-wave Therapy (RESWT) compared with High Power LASER Therapy (HPLT) for the treatment of patients with Rotator Cuff Calcific Tendinosis (RCCT). RCCT is widely diffused, it is painful and invalidating. It is an important public health problem with social and economic implications. The most common therapeutic approach is a physiotherapic one. Both HPLT and RESWT give positive results. There is a debate on which is to be preferred. Therefore there is need to obtain scientific evidence to support either case. An observational study was carried out in the period between October 2008 and September 2009 in our outpatient clinic with 62 patients, divided into 3 groups: group A 36 patients treated only with RESWT, group B 26 patients treated only with HPLT and group C 16 patients with only short term improvement with HPLT retreated with RESWT. Patients were evaluated with Constant-Murley scale before and after treatment (immediately, 1 month and 3 months) for mean constant score, pain and range of movement. Data were examined statistically with SPSS. Criteria for inclusion and exclusion were defined. Patients treated with HPLT have shown good clinical results but have returned to original syndrome 1 month after treatment. RESWT has given improvement after treatment extended in time (3 months) in terms of pain and recover of functionality with a limited number of applications. The evidence collected indicates that RESWT is the method of choice. PMID:22460011

  7. Acute and chronic bioeffects of single and multiple doses of piezoelectric shockwaves (EDAP LT.01).

    PubMed

    Ryan, P C; Jones, B J; Kay, E W; Nowlan, P; Kiely, E A; Gaffney, E F; Butler, M R

    1991-02-01

    Piezoelectric second generation lithotriptors are an established means of administering extracorporeal shockwave lithotripsy (ESWL) enabling treatment to be performed without anaesthesia or analgesia, but higher shockwave doses and multiple or staged treatment are frequently required. The bioeffects of this modality of ESWL, therefore, require further assessment. Seven experimental groups of adult male rabbits were treated using the EDAP LT.01 in order to determine the acute and chronic bioeffects of clinical dose, excess dose, divided excess dose, high frequency and multiple treatment (X10) piezoelectric shockwaves (PSW). Renal function was measured before and after treatment using mercaptoacetyltriglycine (MAG 3) scans. Gross and histological morphological changes were assessed at one and 30 days following application of PSW. Application of single clinical dose PSW was not associated with any significant functional or morphological renal injury. Excess dose PSW caused transient gross renal contusion, which resolved in the majority of animals with no persistent microscopic abnormality. Divided excess dose PSW resulted in no gross or microscopic damage. High frequency PSW was associated with mild histological abnormality. Multiple PSW treatments caused small discrete fibrotic lesions in all cases, without any change in renal function.

  8. Reynolds number effects on shock-wave turbulent boundary-layer interactions - A comparison of numerical and experimental results

    NASA Technical Reports Server (NTRS)

    Horstman, C. C.; Settles, G. S.; Vas, I. E.; Bogdonoff, S. M.; Hung, C. M.

    1977-01-01

    An experiment is described that tests and guides computations of a shock-wave turbulent boundary-layer interaction flow over a 20-deg compression corner at Mach 2.85. Numerical solutions of the time-averaged Navier-Stokes equations for the entire flow field, employing various turbulence models, are compared with the data. Each model is critically evaluated by comparisons with the details of the experimental data. Experimental results for the extent of upstream pressure influence and separation location are compared with numerical predictions for a wide range of Reynolds numbers and shock-wave strengths.

  9. Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons.

    PubMed

    Murata, Ryo; Ohtori, Seiji; Ochiai, Nobuyasu; Takahashi, Norimasa; Saisu, Takashi; Moriya, Hideshige; Takahashi, Kazuhisa; Wada, Yuichi

    2006-07-30

    Although extracorporeal shockwave has been applied in the treatment of various diseases, the biological basis for its analgesic effect remains unclear. Therefore, we investigated the dorsal root ganglion neurons of rats following shockwave exposure to the footpad to elucidate its effect on the peripheral nervous system. We used activating transcription factor 3 (ATF3) and growth-associated phosphoprotein (GAP-43) as markers for nerve injury and axonal regeneration, respectively. The average number of neurons immunoreactive for ATF3 increased significantly in the treated rats at all experimental time points, with 78.3% of those neurons also exhibiting immunoreactivity for GAP-43. Shockwave exposure induced injury of the sensory nerve fibers within the exposed area. This phenomenon may be linked to the desensitization of the exposure area, not the cause of pain, considering clinical research with a particular absence of painful adverse effect. Subsequent active axonal regeneration may account for the reinnervation of exposed area and the amelioration of the desensitization.

  10. Shockwaves increase T-cell proliferation and IL-2 expression through ATP release, P2X7 receptors, and FAK activation.

    PubMed

    Yu, Tiecheng; Junger, Wolfgang G; Yuan, Changji; Jin, An; Zhao, Yi; Zheng, Xueqing; Zeng, Yanjun; Liu, Jianguo

    2010-03-01

    Shockwaves elicited by transient pressure disturbances are used to treat musculoskeletal disorders. Previous research has shown that shockwave treatment affects T-cell function, enhancing T-cell proliferation and IL-2 expression by activating p38 mitogen-activated protein kinase (MAPK) signaling. Here we investigated the signaling pathway by which shockwaves mediate p38 MAPK phosphorylation. We found that shockwaves at an intensity of 0.18 mJ/mm(2) induce the release of extracellular ATP from human Jurkat T-cells at least in part by affecting cell viability. ATP released into the extracellular space stimulates P2X7-type purinergic receptors that induce the activation of p38 MAPK and of focal adhesion kinase (FAK) by phosphorylation on residues Tyr397 and Tyr576/577. Elimination of released ATP with apyrase or inhibition of P2X7 receptors with the antagonists KN-62 or suramin significantly weakens FAK phosphorylation, p38 MAPK activation, IL-2 expression, and T-cell proliferation. Conversely, addition of exogenous ATP causes phosphorylation of FAK and p38 MAPK. Silencing of FAK expression also reduces these cell responses to shockwave treatment. We conclude that shockwaves enhance p38 MAPK activation, IL-2 expression, and T-cell proliferation via the release of cellular ATP and feedback mechanisms that involve P2X7 receptor activation and FAK phosphorylation.

  11. Minimizing masses in explosively driven two-shockwave physics applications

    NASA Astrophysics Data System (ADS)

    Buttler, William; Cherne, Frank; Furlanetto, Michael; Payton, Jeremy; Stone, Joseph; Tabaka, Leonard; Vincent, Samuel

    2015-06-01

    We have experimentally investigated different two-shockwave high-explosives (HE) physics package designs to maximize the variability of the second shockwave peak stress, while minimizing the total HE load of the physics tool. A critical requirement is to also have a large radial diameter of the second shockwave to maintain its value as an HE driven two-shockwave drive. We have previously shown that we could vary the peak-stress of the second-shockwave with a 76 mm diameter HE lens driving different composite boosters of PBX 9501 and TNT. Here we report on our results with a 56- and 50-mm diameter HE lens driving Baritol. The results indicate that the 56-mm diameter HE lens works well, as does the Baritol, giving total HE loads of about 250 mg TNT equivalent explosives.

  12. Experimental Results on Shock-Wave Interaction on Compression Ramps

    NASA Astrophysics Data System (ADS)

    Passaro, A.; Fantoni, G.; Biagioni, L.; Cardone, G.

    2005-02-01

    A set of new experimental tests was carried out with intrusive and non-intrusive measurements related to Shock-Wave Boundary-Layer Interaction (SWBLI) on a 15 deg compression ramp model in a Mach 6 flow with total enthalpy of 1.8-2.5 MJ/kg. The facility was the modified High Enthalpy Arc-heated Tunnel at Alta, Pisa, Italy, with improved performance and diagnostics, in order to provide good control on the actual properties of the tunnel flow. The model shape and test conditions were the same of the previous test campaign carried out during the FESTIP programme. The new results confirmed a good agreement between intrusive and non-intrusive measurements and were also compared with success with numerical predictions, eventually explaining the discrepancy on wall heat flux that was found on the previous test campaign.

  13. Comparative Analysis of Treatment Costs in EUROHOPE.

    PubMed

    Iversen, Tor; Aas, Eline; Rosenqvist, Gunnar; Häkkinen, Unto

    2015-12-01

    This study examines the challenges of estimating risk-adjusted treatment costs in international comparative research, specifically in the European Health Care Outcomes, Performance, and Efficiency (EuroHOPE) project. We describe the diverse format of resource data and challenges of converting these data into resource use indicators that allow meaningful cross-country comparisons. The three cost indicators developed in EuroHOPE are then described, discussed, and applied. We compare the risk-adjusted mean treatment costs of acute myocardial infarction for four of the seven countries in the EuroHOPE project, namely, Finland, Hungary, Norway, and Sweden. The outcome of the comparison depends on the time perspective as well as on the particular resource use indicator. We argue that these complementary indicators add to our understanding of the variation in resource use across countries.

  14. Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces

    SciTech Connect

    James A. Smith; Jeffrey M. Lacy; Barry H. Rabin

    2014-07-01

    12. Other advances in QNDE and related topics: Preferred Session Laser-ultrasonics Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces 41st Annual Review of Progress in Quantitative Nondestructive Evaluation Conference QNDE Conference July 20-25, 2014 Boise Centre 850 West Front Street Boise, Idaho 83702 James A. Smith, Jeffrey M. Lacy, Barry H. Rabin, Idaho National Laboratory, Idaho Falls, ID ABSTRACT: The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) which is assigned with reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU. The new LEU fuel is based on a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to complete the fuel qualification process, the laser shock technique is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. The Laser Shockwave Technique (LST) is being investigated to characterize interface strength in fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However the deposition of laser energy into the containment layer on specimen’s surface is intractably complex. The shock wave energy is inferred from the velocity on the backside and the depth of the impression left on the surface from the high pressure plasma pulse created by the shock laser. To help quantify the stresses and strengths at the interface, a finite element model is being developed and validated by comparing numerical and experimental results for back face velocities and front face depressions with experimental results. This paper will report on initial efforts to develop a finite element model for laser

  15. New developments in shockwave technology intended for meat tenderization: Opportunities and challenges. A review.

    PubMed

    Bolumar, Tomas; Enneking, Mathias; Toepfl, Stefan; Heinz, Volker

    2013-12-01

    Meat tenderness is an important quality parameter determining consumer acceptance and price. Meat tenderness is difficult to ensure in the global meat chain because the production systems are not always aiming at this purpose (ex.: cattle derived from milk production) and by the existence within the carcass of "tough" primals. Different methods can be used by the meat industry to improve meat tenderness each with its advantages and drawbacks. The application of hydrodynamic pressure or shockwaves has showed outstanding improvements by reducing the Warner Bratzler Shear Force by 25% or more. However, the technology has not penetrated into the market as first systems were based on the use of explosives and further developments seemed to lack the robustness to fulfill industrial requirements. The present paper describes the main challenges to construct a prototype for the continuous treatment of meat by shockwaves based on electrical discharges under water. Finally, improvements on the tenderness of meat by using the novel prototype are presented.

  16. [A 10-month experience with extracorporeal shockwave therapy of urolithiasis].

    PubMed

    García Sisamón, F; Ferrer Roda, J; Tudela Bañuls, O; Ferrer Bosch, L

    1990-01-01

    From November 1987 treatment of urinary lithiasis regardless location was initiated in our Service of extracorporal renal lithofragmentation using shockwaves. Up until August 1988 (10 months), 411 patients have been treated representing a total of 590 lithiasis and 699 sessions on which the present communication is based; treatment included calculus of various chemical composition, as well as different sizes and locations. Also the relationship between sex, age, number of waves, use of analgesia, hospital stay, etc, has been considered. Results obtained after a 2.5 months follow-up are: 60.34% fragments-free and 39.41% in expulsion stage. Monotherapy was chosen in 98% cases and multiple drug therapy in the remaining 2%. There has been no case of complementary open surgical therapy. Thus, we consider extracorporal renal lithofragmentation as the ideal treatment for urinary lithiasis, as long as the indication is correct. And we believe it to be the ideal treatment since it is a simple procedure, highly effective and with few complications.

  17. Detecting cavitation in vivo from shock-wave therapy devices

    NASA Astrophysics Data System (ADS)

    Matula, Thomas J.; Yu, Jinfei; Bailey, Michael R.

    2005-04-01

    Extracorporeal shock-wave therapy (ESWT) has been used as a treatment for plantar faciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other indications where conservative treatments have been unsuccessful. However, in many areas, the efficacy of SW treatment has not been well established, and the mechanism of action, particularly the role of cavitation, is not well understood. Research indicates cavitation plays an important role in other ultrasound therapies, such as lithotripsy and focused ultrasound surgery, and in some instances, cavitation has been used as a means to monitor or detect a biological effect. Although ESWT can generate cavitation easily in vitro, it is unknown whether or not cavitation is a significant factor in vivo. The purpose of this investigation is to use diagnostic ultrasound to detect and monitor cavitation generated by ESWT devices in vivo. Diagnostic images are collected at various times during and after treatment. The images are then post-processed with image-processing algorithms to enhance the contrast between bubbles and surrounding tissue. The ultimate goal of this research is to utilize cavitation as a means for optimizing shock wave parameters such as amplitude and pulse repetition frequency. [Work supported by APL internal funds and NIH DK43881 and DK55674.

  18. [The history of extracorporeal shockwave lithotripsy in Spain].

    PubMed

    Ruíz Marcellán, Francisco Javier; Ibarz Servio, Luis

    2007-10-01

    We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

  19. Influence of shockwave profile on ejecta

    SciTech Connect

    Zellner, Michael B; Dimonte, Guy; Germann, Tim C; Hammerberg, James E; Rigg, Paulo A; Buttler, William T; Stevens, Gerald D; Turley, William D

    2009-01-01

    This effort investigates the relation between shock-pulse shape and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of shocked Sn targets. Two shock-pulse shapes are considered: a supported shock created by impacting a Sn target with a sabot that was accelerated using a powder gun; and an unsupported or Taylor shockwave, created by detonation of high explosive that was press-fit to the front-side of the Sn target. Ejecta production at the back-side or free-side of the Sn coupons were characterized through use of piezoelectric pins. Assay foils, optical shadowgraphy, and x-ray attenuation.

  20. Does extracorporeal shockwave lithotripsy cause hypertension?

    PubMed

    Montgomery, B S; Cole, R S; Palfrey, E L; Shuttleworth, K E

    1989-12-01

    Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

  1. Improved interval estimation of comparative treatment effects

    NASA Astrophysics Data System (ADS)

    Van Krevelen, Ryne Christian

    Comparative experiments, in which subjects are randomized to one of two treatments, are performed often. There is no shortage of papers testing whether a treatment effect exists and providing confidence intervals for the magnitude of this effect. While it is well understood that the object and scope of inference for an experiment will depend on what assumptions are made, these entities are not always clearly presented. We have proposed one possible method, which is based on the ideas of Jerzy Neyman, that can be used for constructing confidence intervals in a comparative experiment. The resulting intervals, referred to as Neyman-type confidence intervals, can be applied in a wide range of cases. Special care is taken to note which assumptions are made and what object and scope of inference are being investigated. We have presented a notation that highlights which parts of a problem are being treated as random. This helps ensure the focus on the appropriate scope of inference. The Neyman-type confidence intervals are compared to possible alternatives in two different inference settings: one in which inference is made about the units in the sample and one in which inference is made about units in a fixed population. A third inference setting, one in which inference is made about a process distribution, is also discussed. It is stressed that certain assumptions underlying this third type of inference are unverifiable. When these assumptions are not met, the resulting confidence intervals may cover their intended target well below the desired rate. Through simulation, we demonstrate that the Neyman-type intervals have good coverage properties when inference is being made about a sample or a population. In some cases the alternative intervals are much wider than necessary on average. Therefore, we recommend that researchers consider using our Neyman-type confidence intervals when carrying out inference about a sample or a population as it may provide them with more

  2. Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs.

    PubMed

    Leeman, J J; Shaw, K K; Mison, M B; Perry, J A; Carr, A; Shultz, R

    2016-10-15

    Supraspinatus tendinopathy (ST) and biceps tendinopathy (BT) are common causes of forelimb lameness in large-breed dogs and have historically been treated with conservative management or surgery. Extracorporeal shockwave therapy (ESWT) and therapeutic exercise (TE) are thought to be treatment options for these conditions. The objectives of this study were to report the clinical presentations of dogs treated with ESWT for shoulder tendinopathies, to determine the association between shoulder lesion severity identified on ultrasonography or MRI and outcome, and to compare the outcomes of dogs treated with ESWT with and without TE. Medical records of 29 dogs diagnosed with shoulder tendinopathies and treated with ESWT were reviewed, and 24 dogs were diagnosed with either unilateral BT or BT and ST. None were found to have unilateral ST. Five dogs were diagnosed with bilateral disease. Eighty-five per cent of dogs had good or excellent outcomes determined by owner assessment 11-220 weeks after therapy. Outcomes were found to be better as tendon lesion severity increased (P=0.0497), regardless if ESWT was performed with or without TE (P=0.92). ESWT should be considered a safe primary therapeutic option for canine shoulder tendinopathies. Larger controlled prospective studies are needed to adequately assess these findings.

  3. Extracorporeal shockwave lithotripsy without radiation: Ultrasound localization is as effective as fluoroscopy

    PubMed Central

    Smith, Hazel Elizabeth; Bryant, David Alistair; KooNg, Jenny; Chapman, Richard Alexander; Lewis, Gareth

    2016-01-01

    Context: Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). Aim: The aim of this study is to compare stone free rates (SFR) using two techniques. Methods: This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. Results: Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm2) in the US group of 103 (0–233) and 2113 (241–7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. Conclusions: Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients. PMID:28057991

  4. Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

    PubMed

    Ferreira, U; Claro, J de A; Rodrigues Netto, N; Denardi, F; Figueiredo, J F; Riccetto, C L

    1995-02-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Handbook of Comparative Treatments for Adult Disorders.

    ERIC Educational Resources Information Center

    Janzen, Troy; Janzen, Henry L.

    1994-01-01

    Describes and evaluates text providing background, conceptual understanding, and treatment options for major adult disorders. Strengths include comprehensiveness, treatment comparisons, and a process emphasis. Weaknesses center on biases toward psychoanalytic, behavioral, and pharmacological treatments while neglecting cognitive and "cutting edge"…

  6. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

    PubMed Central

    Ellis, R; Jenkins, A; Thompson, R; Ede, R

    2000-01-01

    BACKGROUND—Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
AIMS—To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
METHODS—Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
RESULTS—Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
CONCLUSION—Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.


Keywords: lithotripsy; bile duct calculi; extracorporeal lithotripsy PMID:11034593

  7. Time Resolved Shadowgraph Images of Silicon during Laser Ablation:Shockwaves and Particle Generation

    SciTech Connect

    Liu, C.Y.; Mao, X.L.; Greif, R.; Russo, R.E.

    2006-05-06

    Time resolved shadowgraph images were recorded of shockwaves and particle ejection from silicon during laser ablation. Particle ejection and expansion were correlated to an internal shockwave resonating between the shockwave front and the target surface. The number of particles ablated increased with laser energy and was related to the crater volume.

  8. Cloud cavitation effects in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim; Tanguay, Michel

    2003-10-01

    Cavitation has already been identified as an important damage mechanism in the comminution of kidney stones in shockwave lithotripsy (SWL). However, the precise conditions that maximize the damage caused by the collapsing bubbles are still unknown. Numerical simulations are used to investigate shock propagation and the consequent growth and collapse of a bubble cloud in the focal region of a lithotripter. In the simulations, a continuum two-phase flow model for the ensemble-averaged macroscale is coupled to a Gilmore model for individual spherical bubble dynamics at the microscale. The simulations show agreement with experimental pressure measurements and high-speed photography of the bubble cloud. At void fractions commensurate with experiments, it is found that the collective collapse of the bubble cloud provides a significant increase to the energy available for comminution (beyond what a single bubble would produce). Relatively small increases in the pressure at the center of the cloud in advance of collapse (two orders of magnitude smaller than the initial shock) can more than double the energy of the collapsing bubble.

  9. Shockwave Absorption using Network-forming Ionic glass

    NASA Astrophysics Data System (ADS)

    Lee, Jaejun; Yang, Ke; Moore, Jeffrey; Sottos, Nancy; MURI SWED Collaboration

    2015-06-01

    Network-forming ionic glasses composed of di-ammonium cations and citrate anions exhibit significant potential for dissipation of shock wave energy. The long alkyl side chains in the di-ammonium cation form a soft matrix, while the negatively charged heads of anions segregate into hard nanophase domains. Similar to polyurea, which has microphase separation of soft and hard domains, we hypothesize that shock wave dissipation of the ionic glass occurs by bond breaking in the hard domains and/or pressure-induced phase transition. By employing size-tunable alkyl side chains in the cations, we examine the effect of the relative soft domain size on energy dissipation. A series of thin film (ca. 50 μm) ionic glass specimens are subjected to laser-induced compressive stress waves and the transmitted response measured interferometrically. Structural changes of the ionic glass due to shock wave impact are characterized by x-ray diffraction. When compared directly to polyurea films of identical thickness and geometry, the ionic glass showed superior shock-wave mitigating performance. ONR MURI program.

  10. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    SciTech Connect

    Lacy, Jeffrey M. Smith, James A. Rabin, Barry H.

    2015-03-31

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.

  11. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    NASA Astrophysics Data System (ADS)

    Lacy, Jeffrey M.; Smith, James A.; Rabin, Barry H.

    2015-03-01

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.

  12. Shock-wave dynamics during oil-filled transformer explosions

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Utkin, A. V.

    2016-08-01

    This paper presents a numerical and experimental study of the shock-wave processes evolving inside a closed vessel filled with mineral oil. Obtained experimental Hugoniot data for oil are compared with the corresponding data for water. It is found that compression of mineral oil and water can be described by approximately the same Hugoniot over a wide pressure range. Such similarity allows the use of water instead of mineral oil in the transformer explosion experiments and to describe the compression processes in both liquids using similar equations of state. The Kuznetsov equation of state for water is adopted for a numerical study of mineral oil compression. The features of the evolution of shock waves within mineral oil are analyzed using two-dimensional numerical simulations. Numerical results show that different energy sources may cause different scenarios of loading on the shell. The principal point is the phase transition taking place at relatively high temperatures for the case of high-power energy sources. In this case, a vapor-gaseous bubble emerges that qualitatively changes the dynamics of compression waves and the pattern of loads induced on the shell. Taking into account the features of the process together with the concept of water-oil similarity, the present work presents a new approach for experimental modeling of transformer shell destruction using an explosion with given characteristics in a water-filled shell.

  13. High-efficiency shock-wave generator for extracorporeal lithotripsy.

    PubMed

    Broyer, P; Cathignol, D; Theillère, Y; Mestas, J L

    1996-09-01

    In extracorporeal lithotripsy, the electro-acoustic efficiency of electrohydraulic generators is limited by the inductance of the electrical discharge circuit. A new shock-wave generator is described that uses a coaxial discharge line enabling electro-acoustic efficiency to be greatly increased. The line is built using a para-electric ceramic with a relative dielectric constant of 1700, manufactured for use in high-voltage impulse mode. A coaxial spark gap, with minimal inductance, has been developed to obtain the triggered breakdown of the discharge line. Shock waves are created with a coaxial electrode plugged directly into the spark gap and immersed in an electrolyte of degassed saline. Electrode gap and electrolyte resistivity are adjusted to match the resistivity of the electrolyte volume between the underwater electrodes to the characteristic impedance of the line. The discharge line generates in the medium a rectangular current pulse with an amplitude of about 6000 A and a rise time of 50 ns. Compared with conventional generators, measurements of the expansive peak pressure pulse show an increase of 105% at 10 kV, 86.5% at 12 kV and 34.5% at 14 kV charging voltage. Electro-acoustic efficiency is found to be 11% instead of 5.5% for a conventional discharge circuit.

  14. Shock-Wave Acceleration of Protons on OMEGA EP

    NASA Astrophysics Data System (ADS)

    Haberberger, D.; Froula, D. H.; Pak, A.; Link, A.; Patel, P.; Fiuza, F.; Tochitsky, S.; Joshi, C.

    2016-10-01

    The creation of an electrostatic shock wave and ensuing ion acceleration is studied on the OMEGA EP Laser System at the Laboratory for Laser Energetics. Previous work using a 10- μm CO2 laser in a H2 gas jet shows promising results for obtaining narrow spectral features in the accelerated proton spectra. Scaling the shock-wave acceleration mechanism to the 1- μm-wavelength drive laser makes it possible to use petawatt-scale laser systems such as OMEGA-EP, but involves tailoring of the plasma profile. To accomplish the necessitated sharp rise to near-critical plasma density and a long exponential fall, an 1- μm-thick CH foil is illuminated on the back side by thermal x rays produced from an irradiated gold foil. The plasma density is measured using the fourth-harmonic probe system, the accelerating fields are probed using an orthogonal proton source, and the accelerated protons and ions are detected with a Thomson parabola. These results will be presented and compared with particle-in-cell simulations. This material is based upon work supported by the Department of Energy National Nuclear Security Administration under Award Number DE-NA0001944 and LLNL's Laboratory Directed Research and Development program under project 15-LW-095.

  15. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  16. Sonoporation of erythrocytes by lithotripter shockwaves in vitro.

    PubMed

    Miller, D L; Williams, A R; Morris, J E; Chrisler, W B

    1998-08-01

    Sonoporation of red blood cells was examined in relation to cavitation-induced hemolysis. FITC-dextran at 580,000 MW was added to suspensions of canine erythrocytes and the mixture was exposed to lithotripter shockwaves. Exposure at 5% or 50% hematocrit in PBS or 50% in plasma yielded not only hemolysis but also FITC-dextran uptake in surviving cells. Hemolysis increased with increasing numbers of shockwaves. The numbers of cells with fluorescent dextran uptake remained roughly constant for 250-1000 shockwaves, but this represented an increasing percentage of the surviving cells. In addition, fluorescent microspheres formed spontaneously in samples with hemolysis. An air bubble was needed in the chamber to obtain substantial effects, implicating the cavitation mechanism. The exposure-response trends could be modeled by simple theory for random interaction of the cells with bubbles.

  17. Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

    PubMed

    Pode, D; Shapiro, A; Verstandig, A; Pfau, A

    1987-01-01

    Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

  18. Extreme shockwave systems in problems of external supersonic aerodynamics

    NASA Astrophysics Data System (ADS)

    Uskov, V. N.; Chernyshov, M. V.

    2014-01-01

    The stationary shockwave systems (the sequences of shocks, isentropic expansion and compression waves), which arise at a planar supersonic flow of perfect inviscid gas around the bodies are investigated theoretically. The domains of the existence of shockwave systems under consideration are found analytically and numerically for the model problems of supersonic aerodynamics (the flow around a single plate, the plate with the frontal shield, polygonal profiles), the parameters of systems are determined, which provide the extrema of the force and thermal loadings as well as of the aerodynamic coefficients of streamlined bodies.

  19. Cavitation in ultrasound and shockwave therapy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim

    2014-11-01

    Acoustic waves, especially high-intensity ultrasound and shock waves, are used for medical imaging and intra- and extra-corporeal manipulation of cells, tissue, and urinary calculi. Waves are currently used to treat kidney stone disease, plantar fasciitis, and bone nonunion, and they are being investigated as a technique to ablate cancer tumors and mediate drug delivery. In many applications, acoustic waves induce the expansion and collapse of preexisting or newly cavitating bubbles whose presence can either mediate the generation of localized stresses or lead to collateral damage, depending on how effectively they can be controlled. We describe efforts aimed at simulating the collapse of bubbles, both individually and in clusters, with the aim to characterize the induced mechanical stresses and strains. To simulate collapse of one or a few bubbles, compressible Euler and Navier-Stokes simulations of multi-component materials are performed with WENO-based shock and interface capturing schemes. Repetitive insonification generates numerous bubbles that are difficult to resolve numerically. Such clouds are also important in traditional engineering applications such as caveating hydrofoils. Models that incorporate the dynamics of an unresolved dispersed phase consisting of the bubble cloud are also developed. The results of several model problems including bubble collapse near rigid surfaces, bubble collapse near compliant surfaces and in small capillaries are analyzed. The results are processed to determine the potential for micron-sized preexisting gas bubbles to damage capillaries. The translation of the fundamental fluid dynamics into improvements in the design and clinical application of shockwave lithotripters will be discussed. NIH Grant PO1-DK043881.

  20. Molecular changes after shockwave therapy in osteoarthritic knee in rats

    NASA Astrophysics Data System (ADS)

    Wang, C.-J.; Sun, Y.-C.; Wu, C.-T.; Weng, L.-H.; Wang, F.-S.

    2016-01-01

    This study investigated the molecular changes of DKK-1, MMP13, Wnt-5a and \\upbeta -catenin after extracorporeal shockwave therapy (ESWT) in anterior cruciate ligament transected (ACLT) osteoarthritic (OA) knee in rats. 27 male Spraque-Dawley rats were divided into three groups. Group I was the control one and received sham knee arthrotomy but no ACLT or ESWT. Group II underwent ACLT, but no ESWT. Group III underwent ACLT and received ESWT. The animals were killed at 12 weeks, and the harvested knee specimens were subjected to histopathological examination and immunohistochemical analysis. Radiographs of the knees were obtained at 0 and 12 weeks. At 12 weeks, radiographs of group II showed more arthritic changes with formation of osteochondral fragments, whereas very subtle arthritis was noted in groups I and III. In histopathological examination, group II showed a significant increase of Mankin score and a decrease of subchondral bone as compared to groups I and III. Group III showed a significant decrease of Mankin score and an increase of subchondral bone, with the data comparable to group I. In immunohistochemical analysis, group II showed significant increases of DKK-1 and MMP13 and decreases of Wnt-5a and \\upbeta -catenin in articular cartilage and subchondral bone as compared to groups I and III. Group III showed significant decreases of DKK-1 and MMP13 and increases of Wnt-5a and \\upbeta -catenin, with the data comparable to group I. In conclusion, the application of ESWT causes molecular changes that are consistent with the improvement in subchondral bone remodeling and chondroprotective effect in ACLT OA knees in rats.

  1. Extracorporeal shockwave therapy in osteonecrosis of femoral head

    PubMed Central

    Zhang, Qingyu; Liu, Lihua; Sun, Wei; Gao, Fuqiang; Cheng, Liming; Li, Zirong

    2017-01-01

    Abstract Background: Osteonecrosis is an incapacitating disorder with high morbidity. Though extracorporeal shockwave therapy (ESWT) provides a noninvasive treatment option, controversial subjects still exist about its effectiveness, indications, and mechanism of action. Methods: An electronic databases search was performed using PubMed, Embase, and the Cochrane library to collect clinical trials, case reports, and cases series on this topic and then useful data were extracted and appraised by experienced clinicians. We evaluated the quality of included evidences by using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. Results: A total of 17 articles including 2 case reports, 9 open label trials, 2 cohorts, and 6 randomized controlled trials were considered to be eligible for this systematic review. Visual analog scale (VAS), Harris hip scores, and the imaging results were the frequently-used outcome estimates of included studies. Conclusion: By systematically analyzing these evidences, we could conclude that ESWT could act as a safe and effective method to improve the motor function and relieve the pain of patients with osteonecrosis of femoral hip, especially those at early stage. Imaging revealed that bone marrow edema was significantly relieved, but the necrotic bone could not be reversed after ESWT. This technique could slow or even block the progression of ONFH and therefore reduce the demand for surgery. Collaboration with other conservative modalities would not improve the curative benefits of ESWT. Meanwhile, ONFH with various risk factors showed similar reaction to this noninvasive treatment method. However, these conclusions should be interpreted carefully for the low-quality of included publications and further studies are requisite to validate the effect of ESWT in ONFH. PMID:28121934

  2. Computation of sharp-fin-induced shockwave/turbulent boundary layer interactions

    NASA Technical Reports Server (NTRS)

    Horstman, C. C.

    1986-01-01

    Solutions of the Reynolds-averaged Navier-Stokes equations are presented and are compared with a family of experimental results for the three-dimensional interaction of a sharp-fin-induced shock wave with a turbulent boundary layer. The solutions predict most of the essential features of the flow fields for various shock-wave strengths. However, some features of the measured flow fields, such as secondary separation and size of the largest separated zones were not accurately computed. The computed flow fields, aided by particle tracing techniques, display a prominent vortical structure which can be correlated with the observed surface phenomena.

  3. [Biliary extracorporeal shock-wave lithotripsy].

    PubMed

    Jakobeit, C; Greiner, L

    1992-07-14

    Since 1985/86, more than 200 patients with problematic intra- and extrahepatic bile duct stones were treated with ESWL. Results are excellent and comparable with ESWL's success-story in urinary stone disease, abandoning widely open surgery for bile duct stones. In gallbladder-stone treatment, ESWL (always combined with bile acid litholysis) is only promising or successful in a carefully selected subset (10 to 15%) of all symptomatic patients (with good gallbladder contractility, limited stone volume and sonolucent stones).

  4. Neurodevelopmental treatment after stroke: a comparative study

    PubMed Central

    Hafsteinsdottir, T; Algra, A; Kappelle, L; Grypdonck, M; on, b

    2005-01-01

    Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. Methods: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was "poor outcome", defined as Barthel index <12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. Results: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. Conclusions: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach. PMID:15897499

  5. Influence of shockwave profile on ejection of micron-scale material from shocked Sn surfaces: an experimental study

    SciTech Connect

    Zellner, Michael B; Byers, Mark E; Hammerberg, James E; Germann, Tim C; Dimonte, Guy; Rigg, Paulo A; Buttler, William T

    2009-01-01

    This effort experimentally investigates the relationship between shock-breakout pressure and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of Sn targets shocked with a supported shockwave. The results are compared with an analogous set derived from HE shocked Sn targets, Taylor shockwave loading. The supported shock-pulse was created by impacting a Sn target with a Ti64 (Ti-6Al-4V) impactor that was accelerated using a powder gun. Ejecta production at the free-surface or back-side of the Sn targets were characterized through use of piezoelectric pins and Asay foils, and heterodyne velocimetry verified the time of shock release and the breakout pressure.

  6. Structural Changes in Alloys of the Al-Cu-Mg System Under Ion Bombardment and Shock-Wave Loading

    NASA Astrophysics Data System (ADS)

    Ovchinnikov, V. V.; Gushchina, N. V.; Romanov, I. Yu.; Kaigorodova, L. I.; Grigor'ev, A. N.; Pavlenko, A. V.; Plokhoi, V. V.

    2017-02-01

    To confirm the hypothesis on the shock-wave nature of long-range effects upon corpuscular irradiation of condensed media presumably caused by emission and propagation of post-cascade shock waves, comparative experiments on ion beam modification and mechanical shock-wave loading of specimens of VD1 and D16 alloys of the Al-Cu-Mg system are performed. Direct analogy between the processes of microstructural change of cold-deformed VD1 and D16 alloys under mechanical shock loading and irradiation by beams of accelerated Ar+ ions (E = 20-40 keV) with low fluences (1015-1016 cm-2) is established. This demonstrates the important role of the dynamic long-range effects that have not yet been considered in classical radiation physics of solids.

  7. Effects of high-energy shockwaves on normal human fibroblasts in suspension.

    PubMed

    Kaulesar Johannes, E J; Sukul, D M; Bijma, A M; Mulder, P G

    1994-12-01

    To gain insight in the effects of shockwaves on human cells the relationship between the energy density and the number of shockwaves as well as their effect on suspensions of normal cells was studied. At energy densities of 0.37, 0.6, 0.78, and 1.20 mJ/mm2 fibroblasts were subjected to 50, 100, 250, 500, and 1,000 shockwaves. Each test was performed three times and one sample was used as control. A decrease in viability related to the logarithm of both the number (P = 0.0000) and the energy density (P = 0.001) of the shockwaves was statistically demonstrable 1 hr after the shockwave application. The energy density of the shockwaves has less influence on the viability than the number of applied shockwaves. Seeding of viable cells 1 hr after the shockwave application showed that the decrease in the 48-hr growth potential was statistically dependent of the number of applied shockwaves only (P = 0.0007). After 24 hr no difference in the 48-hr growth potential could be demonstrated between viable shockwave-treated cells and control cells. The literature as well as our own investigations in vitro and in vivo indicate that shockwaves have a logarithmic dose-dependent destructive effect on cells in suspension, but they also seem to have a dose-dependent stimulating influence on the healing process in damaged tissues. Due to the logarithmic relationship between the viability and both the number and energy density of the applied shockwaves it might be expected that even excessive numbers of high-energy-density shockwaves don't soon lead to total destruction of all cells in the suspension.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Large-Eddy Simulation of Shock-Wave Boundary Layer Interaction and its Control Using Sparkjet

    NASA Astrophysics Data System (ADS)

    Yang, Guang; Yao, Yufeng; Fang, Jian; Gan, Tian; Lu, Lipeng

    2016-06-01

    Large-eddy simulation (LES) of an oblique shock-wave generated by an 8° sharp wedge impinging onto a spatially-developing Mach 2.3 turbulent boundary layer and their interactions has been carried out in this study. The Reynolds number based on the incoming flow property and the boundary layer displacement thickness at the impinging point without shock-wave is 20,000. The detailed numerical approaches are described and the inflow turbulence is generated using the digital filter method to avoid artificial temporal or streamwise periodicity. Numerical results are compared with the available wind tunnel PIV measurements of the same flow conditions. Further LES study on the control of flow separation due to the strong shock-viscous interaction is also conducted by using an active control actuator “SparkJet” concept. The single-pulsed characteristics of the control device are obtained and compared with the experiments. Instantaneous flowfield shows that the “SparkJet” promotes the flow mixing in the boundary layer and enhances its ability to resist the flow separation. The time and spanwise averaged skin friction coefficient distribution demonstrates that the separation bubble length is reduced by maximum 35% with the control exerted.

  9. Working mechanism of extracorporeal shockwave therapy in non-urological disciplines

    NASA Astrophysics Data System (ADS)

    Schaden, Wolfgang

    2005-04-01

    For 32 years of extracorporeal shockwave lithotripsy (ESWL) only the mechanical strength of shockwaves were of clinical interest. For use in orthopaedics, the absence of dangerous long term effects (malignant degeneration, etc.) is the only important message. The mechanical model tries to explain the effect of shock waves by the provocation of microleasions in the tissue stimulating repairing processes. First doubts on this mechanical model came up when Schaden (2001) could show, that less energy is more efficient in the treatment of non-unions. Due to the basic research of the last years knowledge increased about the microbiological effects. Under the influence of shock waves the change of permeability of cell membranes and the liberation of free radicals was reported. Also the production of nitric oxide (NO) and different growth factors like vascular endothelial growth factor (VEGF), bone morphogenetic proteins (BMP), transforming growth factor-beta 1 (TGF-b1), insulin-like growth factor-I (IGF-I) etc. was observed. The biological model tries to explain the effect of shock waves by stimulating the ingrowth of blood vessels and liberation of growth factors. Under the influence of shock waves, biological tissues seem to be able to produce important substances to initiate healing processes.

  10. Contraction ratio effect on boundary layer separation induced by shockwave boundary layer interactions

    NASA Astrophysics Data System (ADS)

    Im, Seongkyun; di Cristina, Giovanni; Do, Hyungrok

    2016-11-01

    Boundary layer separations induced by shockwave boundary layer interaction at various contraction ratios were investigated at a Mach 4.5 flow. Stagnation pressure and temperature condition of 10 bars and 295 K were used, and a high-speed schlieren system visualized the flow features. A shockwave generator with 12 degree wedge generated an impinging shockwave onto a laminar boundary layer on a flat plate. The contraction ratio of the flow was varied by changing the distance between the shockwave generator and the flat plate. The location of the shockwave impingement was fixed while the contraction ratios were changed. Flow visualization showed that the flow separation and its size were influenced by the contraction ratio although overall flow features were similar. At higher contraction ratio, stronger impinging shockwave and more severe flow separation were observed.

  11. Thermodynamic parameters of heterogeneous materials under shock-wave loading in presentation of equilibrium model

    NASA Astrophysics Data System (ADS)

    Maevskii, K. K.; Kinelovskii, S. A.

    2016-11-01

    The results of numerical experiments on modeling of shock wave loading of solid and porous heterogeneous materials on the example of molybdenum and some alloys included molybdenum as a component are presented. A thermodynamically equilibrium model is applied to describe the behavior of solid and porous materials. This model ensures good compliance with the experiment in a wide range of pressures. The gas in pores, which is a component of the medium, is taken into account in this model. The equation of state of the Mie-Grüneisen type with allowance for the dependence of the Grüneisen coefficient on temperature is used for condensed phases. The applied model allows the behavior of the molybdenum with porosity from 1 to 3 to be calculated under shock-wave loading at pressures above 5 GPa in the one-velocity and one-temperature approximations, as well as on the assumption of equal pressures for all the phases. Computational results are compared with the well-known experimental results obtained by different authors. The model permits the shock-wave loading of solid and porous alloys with molybdenum in their composition to be described reliably solely by using species parameters.

  12. Shockwave-turbulent boundary layer interaction control using magnetically driven surface discharges

    NASA Astrophysics Data System (ADS)

    Kalra, Chiranjeev S.; Zaidi, Sohail H.; Miles, Richard B.; Macheret, Sergey O.

    2011-03-01

    This study demonstrates the potential for shockwave-turbulent boundary layer interaction control in air using low current DC constricted surface discharges forced by moderate strength magnetic fields. An analytical model describing the physics of magnetic field forced discharge interaction with boundary layer flow is developed and compared to experiments. Experiments are conducted in a Mach 2.6 indraft air tunnel with discharge currents up to 300 mA and magnetic field strengths up to 5 Tesla. Separation- and non-separation-inducing shocks are generated with diamond-shaped shockwave generators located on the wall opposite to the surface electrodes, and flow properties are measured with schlieren imaging, static wall pressure probes and acetone flow visualization. The effect of plasma control on boundary layer separation depends on the direction of the Lorentz force ( j × B). It is observed that by using a Lorentz force that pushes the discharge upstream, separation can be induced or further strengthened even with discharge currents as low as 30 mA in a 3-Tesla magnetic field. If shock-induced separation is present, it is observed that by using Lorentz force that pushes the discharge downstream, separation can be suppressed, but this required higher currents, greater than 80 mA. Acetone planar laser scattering is used to image the flow structure in the test section and the reduction in the size of recirculation bubble and its elimination are observed experimentally as a function of actuation current and magnetic field strength.

  13. [Extracorporeal shockwave lithotripsy of stones in lower calices of kidney].

    PubMed

    Martov, A G; Peniukova, I V; Moskalenko, S A; Peniukov, V G; Peniukov, D V; Balykov, I S

    2013-01-01

    The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74.4%) patients. Residual stone fragments (> or = 5 mm) were identified in 73 (25.6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P = 0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p = 0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a

  14. Mesoscale simulations of shockwave energy dissipation via chemical reactions.

    PubMed

    Antillon, Edwin; Strachan, Alejandro

    2015-02-28

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials that undergo volume-reducing chemical reactions under shockwave-loading conditions. We find that such chemical reactions can attenuate the shockwave and characterize how the parameters of the chemical model affect this behavior. The simulations show that the magnitude of the volume collapse and velocity at which the chemistry propagates are critical to weaken the shock, whereas the energetics in the reactions play only a minor role. Shock loading results in transient states where the material is away from local equilibrium and, interestingly, chemical reactions can nucleate under such non-equilibrium states. Thus, the timescales for equilibration between the various degrees of freedom in the material affect the shock-induced chemistry and its ability to attenuate the propagating shock.

  15. Raman study of the shockwave effect on collagens.

    PubMed

    Cárcamo, José J; Aliaga, Alvaro E; Clavijo, R Ernesto; Brañes, Manuel R; Campos-Vallette, Marcelo M

    2012-02-01

    The Raman spectra (1800-200 cm(-1)) of isolated dried collagen types I and III were recorded at different times after shockwave (SW) application in aqueous media. SWs were applied in a single session. One week after the SW application the vibrational data analysis indicates changes in the conformation of the collagens; orientational changes are also inferred. During the next three weeks collagens tended to recover the conformation and orientation existing before SW application.

  16. Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.

    PubMed

    Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

    2013-11-01

    The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ≤ 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment.

  17. Shock-wave therapy for tennis and golfer's elbow--1 year follow-up.

    PubMed

    Krischek, O; Hopf, C; Nafe, B; Rompe, J D

    1999-01-01

    Thirty patients with chronic medial epicondylitis were treated with low-energy shock waves. They received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. At 1 year follow-up examinations were performed. According to the Verhaar criteria, only seven patients reached excellent or good results. In eight cases a fair outcome was recorded, and in 14 patients the outcome was poor. Only six patients were satisfied with the treatment. The average relief of pain was 32%. These data were significantly worse than for identically treated patients with chronic tennis elbow. Thus, the question arises as to whether extracorporal shock-wave therapy is indicated in medial epicondylitis.

  18. Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

    ERIC Educational Resources Information Center

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

    This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were…

  19. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    PubMed

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  20. On the use of shockwave models in laser produced plasma expansion

    NASA Astrophysics Data System (ADS)

    de Posada, E.; Arronte, M. A.; Ponce, L.; Rodríguez, E.; Flores, T.; Lunney, J. G.

    2011-01-01

    Interaction of medium to high peak power laser pulses with solid materials produces a plasma that expands supersonically. Expansions of such plasmas have been studied and several models have been proposed to describe it. This work presents a study of the expansion of laser produced plasmas in both vacuum and gas environment by using Langmuir probe and photography. It compares some of the most used models to identify that which better describes the expansion process. In vacuum, such process is properly described by the Anisimov model. However when expanding in a background gas it is found that the Sedov-Taylor model fits properly the position of generated shockwave but overestimates both kinetic energy and pressure of the expanding plasma. Such problem is solved by using a modification of the Freiwald-Axford model. Finally it is demonstrated that after the plasma stopping distance the plasma inters in a diffusive regime.

  1. Bacterial biofilm disruption using laser-generated shockwaves

    NASA Astrophysics Data System (ADS)

    Navarro, Artemio; Taylor, Zachary D.; Matolek, Anthony Z.; Weltman, Ahuva; Ramaprasad, Vidyunmala; Huang, Sean; Beenhouwer, David O.; Haake, David A.; Gupta, Vijay; Grundfest, Warren S.

    2012-03-01

    Bacterial related infections are a burden on the healthcare industry. A system was built to test the efficacy of laser generated shockwaves on S. epidermidis biofilms (RP62A) grown on polystyrene surfaces. The system is based on a Qswitched, ND:YAG pulsed laser with an output wavelength of 1.064 μm that ablates titanium-coated soda-lime glass. Results show that the system is capable of generating stress profiles that can effectively delaminate biofilm structures from polymer surfaces.

  2. Laboratory Simulations of Supernova Shockwave Progagation and ISM Interaction

    SciTech Connect

    Hansen, J F; Edwards, M J; Robey, H F; Miles, A R; Froula, D; Gregori, G; Edens, A; Ditmire, T

    2003-08-29

    High Mach number shockwaves were launched in laboratory plasmas to simulate supernova shockwave propagation. The experiments were carried out at inertial fusion facilities using large lasers. Spherical shocks were created by focusing laser pulses onto the tip of a solid pin surrounded by ambient gas. Ablated material from the pin would rapidly expand and launch a shock through the surrounding gas. Planar shocks were created by ablating material from one end of a cylindrical shocktube. Laser pulses were typically 1 ns in duration with ablative energies ranging from <1 J to >4 kJ. Shocks were propagated through various plasmas, and observed at spatial scales of up to 5 cm using optical and x-ray cameras. Interferometry techniques were used to deduce densities, and emission spectroscopy data were obtained to infer electron temperatures. Experimental results confirm that spherical shocks are Taylor-Sedov, and that radiative shocks stall sooner than non-radiative shocks. Unexpected results include the birth of a second shock ahead of the original, stalling shock, at the edge of the radiatively preheated region. We have begun experiments to simulate the interaction between shocks and interstellar material (ISM), and the subsequent turbulent mixing. Comparisons between experimental data and numerical simulations of shock evolution, stall, second shock birth, and interstellar material (ISM) interaction will be presented.

  3. [Lithotripsy of gallbladder calculi with extracorporeal shockwaves].

    PubMed

    Nogueira, C E; Martins, F P; Dani, R

    1991-01-01

    Two hundred and sixty two patients with gallbladder stones were prospectively evaluated at the Biliary Lithiasis Treatment Unit of the Mater Dei Hospital, Belo Horizonte, MG., and 45 (17.5%) were selected for extracorporal shock wave lithotripsy (ECSWL). From these, 32 were submitted to the procedure. One stone was present in 30 patients, 2 stones in another and 1 patient had 3 stones. The mean diameter was 14.7 mm ranging from 8 to 28 mm. ECSWL was preceded by 1 week course of ursodeoxycholic acid (8 to 10 mg/dk/day) and this medication was continued after the procedure. ECSWL was done with the Lithosthar-Plus apparatus (Siemens). Meperidine (up to 100 mg) IM and pirazolene IV was given when necessary. The intensity of the shock waves was gradually increased to a maximum (9 bar) whenever tolerated. The treatment was well succeeded in 22 cases (71%) with pulverization in 12 (38.7%). In 9 patients (29%) remaining fragments were greater than 4 mm. From these, 3 were submitted to a second session of ECSWL. In 1 patient the stone could not be properly positioned for lithotripsy. The mean number of shock waves was 2,591, ranging from 801 to 4,411. The mean duration of the sessions was 80 min, ranging from 45 to 150 min. In 3 patients, a complete disappearance of fragments was observed in intervals of 1 to 6 months after the procedure. One patient had severe pain during ECSWL and developed acute cholecystitis. One patient had sinus bradycardia. One patient with total stone pulverization, become jaundiced 1 month after ECSWL and a gallbladder carcinoma was found at surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Shockwave Propagation in Nonequilibrium Air Plasma

    DTIC Science & Technology

    2006-07-01

    V cm-1), the observed B3Πg – A3Σu+ intensity jumps by at least 20% compared to the steady state in 2 μs. This requires a rate of change of the...S.E.Ponomareva, V.M.Shibkov, High Temp. 29, 468 (1990) 5. Y.Z. Ionikh, N. V . Chernysheva, A . V . Meshchanov, A . P. Yalin and R.B. Miles, Phys. Lett. A 259...Cathode Anode 15 Figure 2a -15 -10 -5 0 m V 1.51.00.50.0 mS 20 15 10 5 m

  5. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study.

    PubMed

    Sørlie, Tore; Nergård, Jens-Ivar

    2005-06-01

    Treatment, treatment satisfaction and recovery in Saami and Norwegian patients treated in a psychiatric hospital were compared. Although half of the Saami patients preferred to speak Saami with their therapists, only one patient did. The extensive use of traditional helpers was only partly recognized. Despite no differences in type and amount of treatment or symptom-change during the hospital stay, the Saami patients showed less satisfaction with all investigated treatment parameters including contact with staff, treatment alliance, information and global treatment satisfaction. There was less agreement between the ratings of the therapists and the Saami patients. Suggestions for improvements are made.

  6. Shock-wave heating model for chondrule formation: Hydrodynamic simulation of molten droplets exposed to gas flows

    NASA Astrophysics Data System (ADS)

    Miura, Hitoshi; Nakamoto, Taishi

    2007-05-01

    Millimeter-sized, spherical silicate grains abundant in chondritic meteorites, which are called as chondrules, are considered to be a strong evidence of the melting event of the dust particles in the protoplanetary disk. One of the most plausible scenarios is that the chondrule precursor dust particles are heated and melt in the high-velocity gas flow (shock-wave heating model). We developed the non-linear, time-dependent, and three-dimensional hydrodynamic simulation code for analyzing the dynamics of molten droplets exposed to the gas flow. We confirmed that our simulation results showed a good agreement in a linear regime with the linear solution analytically derived by Sekyia et al. [Sekyia, M., Uesugi, M., Nakamoto, T., 2003. Prog. Theor. Phys. 109, 717-728]. We found that the non-linear terms in the hydrodynamical equations neglected by Sekiya et al. [Sekiya, M., Uesugi, M., Nakamoto, T., 2003. Prog. Theor. Phys. 109, 717-728] can cause the cavitation by producing negative pressure in the droplets. We discussed that the fragmentation through the cavitation is a new mechanism to determine the upper limit of chondrule sizes. We also succeeded to reproduce the fragmentation of droplets when the gas ram pressure is stronger than the effect of the surface tension. Finally, we compared the deformation of droplets in the shock-wave heating with the measured data of chondrules and suggested the importance of other effects to deform droplets, for example, the rotation of droplets. We believe that our new code is a very powerful tool to investigate the hydrodynamics of molten droplets in the framework of the shock-wave heating model and has many potentials to be applied to various problems.

  7. Effects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability.

    PubMed

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-01-01

    [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams' exercises and McKenzie's exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients' dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA.

  8. Comparative Review of the Treatment Methodologies of Carotid Stenosis

    PubMed Central

    Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

    2015-01-01

    The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

  9. Laser Shockwave Technique For Characterization Of Nuclear Fuel Plate Interfaces

    SciTech Connect

    James A. Smith; Barry H. Rabin; Mathieu Perton; Daniel Lévesque; Jean-Pierre Monchalin; Martin Lord

    2012-07-01

    The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process. Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.

  10. Shock-Wave Consolidation of Nanostructured Bismuth Telluride Powders

    NASA Astrophysics Data System (ADS)

    Beck, Jan; Alvarado, Manuel; Nemir, David; Nowell, Mathew; Murr, Lawrence; Prasad, Narasimha

    2012-06-01

    Nanostructured thermoelectric powders can be produced using a variety of techniques. However, it is very challenging to build a bulk material from these nanopowders without losing the nanostructure. In the present work, nanostructured powders of the bismuth telluride alloy system are obtained in kilogram quantities via a gas atomization process. These powders are characterized using a variety of methods including scanning electron microscopy, transition electron microscopy, and x-ray diffraction analysis. Then the powders are consolidated into a dense bulk material using a shock-wave consolidation technique whereby a nanopowder-containing tube is surrounded by explosives and then detonated. The resulting shock wave causes rapid fusing of the powders without the melt and subsequent grain growth of other techniques. We describe the test setup and consolidation results.

  11. Laser shockwave technique for characterization of nuclear fuel plate interfaces

    SciTech Connect

    Perton, M.; Levesque, D.; Monchalin, J.-P.; Lord, M.; Smith, J. A.; Rabin, B. H.

    2013-01-25

    The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process. Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.

  12. Thermal loading of laser induced plasma shockwaves on thin films in nanoparticle removal

    SciTech Connect

    Varghese, Ivin; Zhou Dong; Peri, M. D. Murthy; Cetinkaya, Cetin

    2007-06-01

    Damage concerns, such as substrate/film material alterations, damage, and delamination of thin films, have become a central problem in sub-100 nm particle removal applications. In the laser induced plasma (LIP) removal technique both LIP shockwave and radiation heating are potential sources of thermomechanical damage. The specific objective of current study is to conduct a computational investigation of the LIP shockwave effect on the thermoelastic response of a thin chromium (Cr) film deposited on a quartz substrate and to identify the conditions leading to the onset of plastic film deformations. The experimentally characterized shockwave pressure and temperature (approximated from gas dynamic relations) were prescribed as boundary conditions in the computational analysis. From the shockwave arrival times for different travel distances, the shockwave radius as well as the velocity were obtained as a function of the shockwave propagation time. Radial (and circumferential) stresses, caused by thermal expansion of the Cr film, were most dominant and, hence, of damage concern. It is determined that the resultant temperature rise utilizing a 1064 nm Nd:yttrium-aluminum-garnet (YAG) laser (450 mJ) due to the film-shockwave interactions was not sufficiently high to initiate film and/or substrate damage. No material alteration/damage of the Cr film is predicted due to the temperature and pressure of LIP shockwaves at the firing distance of 2 mm, with a high strain rate gain factor of two (minimum), though damage was observed experimentally for 1064 nm Nd:YAG laser at the pulse energy of 370 mJ. Reported results indicate that the leading cause of observed thin film damage during nanoparticle removal is almost certainly radiation heating from the LIP core.

  13. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Coleman, A. J.; Leighton, T. G.; White, P. R.; Hurrell, A. M.

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  14. Comparing Biofouling Control Treatments for Use on Aquaculture Nets

    PubMed Central

    Swain, Geoffrey; Shinjo, Nagahiko

    2014-01-01

    Test panels comprised of uncoated, copper coated and silicone coated 7/8'' (22 mm) mesh knitted nylon net were evaluated to compare their properties and the effectiveness to prevent biofouling. This paper describes test procedures that were developed to quantify the performance in terms of antifouling, cleanability, drag and cost. The copper treatment was the most effective at controlling fouling, however, the silicone treated nets were the easiest to clean. The drag forces on the net were a function of twine diameter, twine roughness and fouling. After immersion, the uncoated nets had the most drag followed by the silicone and copper treatments. The cost of applying silicone to nets is high; however, improved formulations may provide a non-toxic alternative to control fouling. PMID:25474085

  15. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    SciTech Connect

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  16. Comparative tolerability and efficacy of treatments for impotence.

    PubMed

    Meinhardt, W; Kropman, R F; Vermeij, P

    1999-02-01

    treatment studies are very diverse so efficacy data can only be assessed in comparative studies. However, long term comparison studies have not been performed. Safety demands must be set very high for this type of treatment since the disorders being treated present no threat to the patient's health.

  17. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

    PubMed

    Panah, A; Patel, S; Bourdoumis, A; Kachrilas, S; Buchholz, N; Masood, J

    2013-10-01

    Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

  18. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children.

    PubMed Central

    Frick, K. D.; Lietman, T. M.; Holm, S. O.; Jha, H. C.; Chaudhary, J. S.; Bhatta, R. C.

    2001-01-01

    OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective. PMID:11285663

  19. Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods.

    PubMed

    Gray, R J; Quayle, A A; Hall, C A; Schofield, M A

    1994-04-09

    Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

  20. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    PubMed

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

  1. Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

    NASA Astrophysics Data System (ADS)

    Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

    1997-05-01

    Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

  2. Dynamics of plasma expansion and shockwave formation in femtosecond laser-ablated aluminum plumes in argon gas at atmospheric pressures

    SciTech Connect

    Miloshevsky, Alexander; Harilal, Sivanandan S.; Miloshevsky, Gennady Hassanein, Ahmed

    2014-04-15

    Plasma expansion with shockwave formation during laser ablation of materials in a background gasses is a complex process. The spatial and temporal evolution of pressure, temperature, density, and velocity fields is needed for its complete understanding. We have studied the expansion of femtosecond (fs) laser-ablated aluminum (Al) plumes in Argon (Ar) gas at 0.5 and 1 atmosphere (atm). The expansion of the plume is investigated experimentally using shadowgraphy and fast-gated imaging. The computational fluid dynamics (CFD) modeling is also carried out. The position of the shock front measured by shadowgraphy and fast-gated imaging is then compared to that obtained from the CFD modeling. The results from the three methods are found to be in good agreement, especially during the initial stage of plasma expansion. The computed time- and space-resolved fields of gas-dynamic parameters have provided valuable insights into the dynamics of plasma expansion and shockwave formation in fs-pulse ablated Al plumes in Ar gas at 0.5 and 1 atm. These results are compared to our previous data on nanosecond (ns) laser ablation of Al [S. S. Harilal et al., Phys. Plasmas 19, 083504 (2012)]. It is observed that both fs and ns plumes acquire a nearly spherical shape at the end of expansion in Ar gas at 1 atm. However, due to significantly lower pulse energy of the fs laser (5 mJ) compared to pulse energy of the ns laser (100 mJ) used in our studies, the values of pressure, temperature, mass density, and velocity are found to be smaller in the fs laser plume, and their time evolution occurs much faster on the same time scale. The oscillatory shock waves clearly visible in the ns plume are not observed in the internal region of the fs plume. These experimental and computational results provide a quantitative understanding of plasma expansion and shockwave formation in fs-pulse and ns-pulse laser ablated Al plumes in an ambient gas at atmospheric pressures.

  3. Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

    DOE PAGES

    Shan, Tzu -Ray; Wixom, Ryan R.; Thompson, Aidan P.

    2016-08-01

    In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed bymore » coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.« less

  4. Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

    NASA Astrophysics Data System (ADS)

    Shan, Tzu-Ray; Wixom, Ryan R.; Thompson, Aidan P.

    2016-08-01

    In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed by coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. The formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

  5. High-speed imaging optical techniques for shockwave and droplets atomization analysis

    NASA Astrophysics Data System (ADS)

    Slangen, Pierre R.; Lauret, Pierre; Heymes, Frederic; Aprin, Laurent; Lecysyn, Nicolas

    2016-12-01

    Droplets atomization by shockwave can act as a consequence in domino effects on an industrial facility: aggression of a storage tank (projectile from previous event, for example) can cause leakage of hazardous material (toxic and flammable). As the accident goes on, a secondary event can cause blast generation, impacting the droplets and resulting in their atomization. Therefore, exchange surface increase impacts the evaporation rate. This can be an issue in case of dispersion of such a cloud. The experiments conducted in the lab generate a shockwave with an open-ended shock tube to break up liquid droplets. As the expected shockwave speed is about 400 m/s (˜Mach 1.2), the interaction with falling drops is very short. High-speed imaging is performed at about 20,000 fps. The shockwave is measured using both overpressure sensors: particle image velocimetry and pure in line shadowgraphy. The size of fragmented droplets is optically measured by direct shadowgraphy simultaneously in different directions. In these experiments, secondary breakups of a droplet into an important number of smaller droplets from the shockwave-induced flow are shown. The results of the optical characterizations are discussed in terms of shape, velocity, and size.

  6. Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

    SciTech Connect

    Shan, Tzu -Ray; Wixom, Ryan R.; Thompson, Aidan P.

    2016-08-01

    In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed by coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

  7. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  8. All-atom Molecular-level Computational Simulations of Planar Longitudinal Shockwave Interactions with Polyurea, Soda-lime Glass and Polyurea/Glass Interfaces

    DTIC Science & Technology

    2014-01-01

    All-atom molecular-level computational simulations of planar longitudinal shockwave interactions with polyurea, soda-lime glass and polyurea/glass...sandwich structures under dynamic-loading conditions involving propagation of planar longitudinal shockwaves . Design/methodology/approach – The problem...of shockwave generation, propagation and interaction with material boundaries is investigated using non-equilibrium molecular dynamics. The results

  9. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.

    PubMed

    Sermeus, Loic; Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

  10. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report

    PubMed Central

    Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Abstract Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available. PMID:28078329

  11. Use of the Hugoniot elastic limit in laser shockwave experiments to relate velocity measurements

    NASA Astrophysics Data System (ADS)

    Smith, James A.; Lacy, Jeffrey M.; Lévesque, Daniel; Monchalin, Jean-Pierre; Lord, Martin

    2016-02-01

    The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. This fuel-cladding interface qualification will ensure the survivability of the fuel plates in the harsh reactor environment even under abnormal operating conditions. One of the concerns of the project is the difficulty of calibrating and standardizing the laser shock technique. An analytical study under development and experimental testing supports the hypothesis that the Hugoniot Elastic Limit (HEL) in materials can be a robust and simple benchmark to compare stresses generated by different laser shock systems.

  12. DSMC study of oxygen shockwaves based on high-fidelity vibrational relaxation and dissociation models

    NASA Astrophysics Data System (ADS)

    Borges Sebastião, Israel; Kulakhmetov, Marat; Alexeenko, Alina

    2017-01-01

    This work evaluates high-fidelity vibrational-translational (VT) energy relaxation and dissociation models for pure O2 normal shockwave simulations with the direct simulation Monte Carlo (DSMC) method. The O2-O collisions are described using ab initio state-specific relaxation and dissociation models. The Macheret-Fridman (MF) dissociation model is adapted to the DSMC framework by modifying the standard implementation of the total collision energy (TCE) model. The O2-O2 dissociation is modeled with this TCE+MF approach, which is calibrated with O2-O ab initio data and experimental equilibrium dissociation rates. The O2-O2 vibrational relaxation is modeled via the Larsen-Borgnakke model, calibrated to experimental VT rates. All the present results are compared to experimental data and previous calculations available in the literature. It is found that, in general, the ab initio dissociation model is better than the TCE model at matching the shock experiments. Therefore, when available, efficient ab initio models are preferred over phenomenological models. We also show that the proposed TCE + MF formulation can be used to improve the standard TCE model results when ab initio data are not available or limited.

  13. Shock-induced bubble collapse in a vessel: Implications for vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran; Colonius, Tim

    2014-11-01

    In shockwave lithotripsy, shocks are repeatedly focused on kidney stones so to break them. The process leads to cavitation in tissue, which leads to hemorrhage. We hypothesize that shock-induced collapse (SIC) of preexisting bubbles is a potential mechanism for vascular injury. We study it numerically with an idealized problem consisting of the three-dimensional SIC of an air bubble immersed in a cylindrical water column embedded in gelatin. The gelatin is a tissue simulant and can be treated as a fluid due to fast time scales and small spatial scales of collapse. We thus model the problem as a compressible multicomponent flow and simulate it with a shock- and interface-capturing numerical method. The method is high-order, conservative and non-oscillatory. Fifth-order WENO is used for spatial reconstruction and an HLLC Riemann solver upwinds the fluxes. A third-order TVD-RK scheme evolves the solution. We evaluate the potential for injury in SIC for a range of pressures, bubble and vessel sizes, and tissue properties. We assess the potential for injury by comparing the finite strains in tissue, obtained by particle tracking, to ultimate strains from experiments. We conclude that SIC may contribute to vascular rupture and discuss the smallest bubble sizes needed for injury. This research was supported by NIH Grant No. 2PO1DK043881 and utilized XSEDE, which is supported by NSF Grant No. OCI-1053575.

  14. Comparison of hydrodynamic simulations with two-shockwave drive target experiments

    NASA Astrophysics Data System (ADS)

    Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

    2015-11-01

    We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number A --> - 1 of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments. This work was supported in part by the (U.S.) Department of Energy (DOE) under Contract No. DE-AC52-06NA2-5396.

  15. Comparison of hydrodynamic simulations with two-shockwave drive target experiments

    NASA Astrophysics Data System (ADS)

    Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

    2015-11-01

    We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number (A --> - 1) of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments.

  16. Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study

    PubMed Central

    2016-01-01

    Objective To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA). Methods A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). Results The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT. Conclusion It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site. PMID:27847716

  17. Experimental studies of hypersonic shock-wave boundary-layer interactions

    NASA Technical Reports Server (NTRS)

    Lu, Frank K.

    1992-01-01

    Two classes of shock-wave boundary-layer interactions were studied experimentally in a shock tunnel in which a low Reynolds number, turbulent flow at Mach 8 was developed on a cold, flat test surface. The two classes of interactions were: (1) a swept interaction generated by a wedge ('fin') mounted perpendicularly on the flat plate; and (2) a two-dimensional, unseparated interaction induced by a shock impinging near an expansion corner. The swept interaction, with wedge angles of 5-20 degrees, was separated and there was also indication that the strongest interactions prossessed secondary separation zones. The interaction spread out extensively from the inviscid shock location although no indication of quasi-conical symmetry was evident. The surface pressure from the upstream influence to the inviscid shock was relatively low compared to the inviscid downstream value but it rose rapidly past the inviscid shock location. However, the surface pressure did not reach the downstream inviscid value and reasons were proposed for this anomalous behavior compared to strongly separated, supersonic interactions. The second class of interactions involved weak shocks impinging near small expansion corners. As a prelude to studying this interaction, a hypersonic similarity parameter was identified for the pure, expansion corner flow. The expansion corner severely damped out surface pressure fluctuations. When a shock impinged upstream of the corner, no significant changes to the surface pressure were found as compared to the case when the shock impinged on a flat plate. But, when the shock impinged downstream of the corner, a close coupling existed between the two wave systems, unlike the supersonic case. This close coupling modified the upstream influence. Regardless of whether the shock impinged ahead or behind the corner, the downstream region was affected by the close coupling between the shock and the expansion. Not only was the mean pressure distribution modified but the

  18. Comparative assessment of water treatment using polymeric and inorganic coagulants

    NASA Astrophysics Data System (ADS)

    Manda, Innocent K. M.; Chidya, Russel C. G.; Saka, John D. K.; Biswick, Timothy T.

    2016-06-01

    Portable water plays a vital role in improving human life, particularly in controlling the spread of diseases. However, problems associated with lack of potable water are still common especially in developing countries including Malawi. Until now little information exists on the effectiveness of available commercial coagulants used by national water boards in Malawi. Therefore, this study was undertaken in Southern Region Water Board (SRWB) to investigate the efficiency of polymeric coagulants (sufdfloc 3850 and algaefloc 19s) in turbidity reduction comparative with inorganic coagulant (aluminium sulphate) at Zomba, Liwonde, Mangochi, Chikwawa and Mulanje Treatment plants. The jar test method was used to determine the effectiveness of the water coagulants. The results revealed that sudfloc 3850 was most effective in reducing turbidity at Mangochi (99.4 ± 0.06%) and Liwonde (97.2 ± 0.04%) using 0.4 mg L-1 flocculant dose. The Zomba, Mulanje and Chikwawa plants gave 19.56 ± 0.03%, 29.23 ± 0.02% and 9.43 ± 0.02% total reductions respectively. Algaefloc 19s afforded the highest turbidity reduction at Liwonde and Mangochi plants (98.66 ± 0.06 and 97.48 ± 0.05% at a dose of 0.4 and 0.6 mg L-1 respectively), while Chikwawa provided the lowest (9.52 ± 0.01%). At the Zomba and Mulanje plants 20.5 ± 0.03% and 28.4 ± 0.04% reductions were obtained respectively. The inorganic flocculant, alum provided a 99.0 ± 0.05% and 98.6 ± 0.04% reduction at a dose of 4.0 mg L-1 and 6.0 mg L-1 at Zomba and Liwonde plants respectively. The lowest reductions in turbidity were achieved at Chikwawa (7.50 ± 0.01%), Mangochi (12.97 ± 0.02%) and Mulanje (25.00 ± 0.02). The best and optimum pH ranges for polymeric and inorganic coagulants were 7.20-7.80 and 7.35 to 7.57 respectively. The results further revealed that sudfloc 3850 and algaefloc 19s achieved faster formation of heavy flocs than alum. At 0.4 mg L-1 flocculant dosage sudfloc 3850 and algaefloc 19s required ten times

  19. A comparative analysis of odour treatment technologies in wastewater treatment plants.

    PubMed

    Estrada, José M; Kraakman, N J R Bart; Muñoz, Raúl; Lebrero, Raquel

    2011-02-01

    Biofiltration, activated sludge diffusion, biotrickling filtration, chemical scrubbing, activated carbon adsorption, regenerative incineration, and a hybrid technology (biotrickling filtration coupled with carbon adsorption) are comparatively evaluated in terms of environmental performance, process economics, and social impact by using the IChemE Sustainability Metrics in the context of odor treatment from wastewater treatment plants (WWTP). This comparative analysis showed that physical/chemical technologies presented higher environmental impacts than their biological counterparts in terms of energy, material and reagents consumption, and hazardous-waste production. Among biological techniques, the main impact was caused by the high water consumption to maintain biological activity (although the use of secondary effluent water can reduce both this environmental impact and operating costs), biofiltration additionally exhibiting high land and material requirements. From a process economics viewpoint, technologies with the highest investments presented the lowest operating costs (biofiltration and biotrickling filtration), which suggested that the Net Present Value should be used as selection criterion. In addition, a significant effect of the economy of scale on the investment costs and odorant concentration on operating cost was observed. The social benefits derived from odor abatement were linked to nuisance reductions in the nearby population and improvements in occupational health within the WWTP, with the hybrid technology exhibiting the highest benefits. On the basis of their low environmental impact, high deodorization performance, and low Net Present Value, biotrickling filtration and AS diffusion emerged as the most promising technologies for odor treatment in WWTP.

  20. Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee

    PubMed Central

    Wang, Ching-Jen; Cheng, Jai-Hong; Chou, Wen-Yi; Hsu, Shan-Ling; Chen, Jen-Hung; Huang, Chien-Yiu

    2017-01-01

    We assessed the pathological changes of articular cartilage and subchondral bone on different locations of the knee after extracorporeal shockwave therapy (ESWT) in early osteoarthritis (OA). Rat knees under OA model by anterior cruciate ligament transaction (ACLT) and medial meniscectomy (MM) to induce OA changes. Among ESWT groups, ESWT were applied to medial (M) femur (F) and tibia (T) condyles was better than medial tibia condyle, medial femur condyle as well as medial and lateral (L) tibia condyles in gross osteoarthritic areas (p<0.05), osteophyte formation and subchondral sclerotic bone (p<0.05). Using sectional cartilage area, modified Mankin scoring system as well as thickness of calcified and un-calcified cartilage analysis, the results showed that articular cartilage damage was ameliorated and T+F(M) group had the most protection as compared with other locations (p<0.05). Detectable cartilage surface damage and proteoglycan loss were measured and T+F(M) group showed the smallest lesion score among other groups (p<0.05). Micro-CT revealed significantly improved in subchondral bone repair in all ESWT groups compared to OA group (p<0.05). There were no significantly differences in bone remodeling after ESWT groups except F(M) group. In the immunohistochemical analysis, T+F(M) group significant reduced TUNEL activity, promoted cartilage proliferation by observation of PCNA marker and reduced vascular invasion through observation of CD31 marker for angiogenesis compared to OA group (P<0.001). Overall the data suggested that the order of the effective site of ESWT was T+F(M) ≧ T(M) > T(M+L) > F(M) in OA rat knees. PMID:28367081

  1. Summary of comparative results integrated nonthermal treatment and integrated thermal treatment systems studies

    SciTech Connect

    1996-12-01

    In July 1994, the Idaho National Engineering Laboratory (INEL), under a contract from U.S. Department of Energy`s (DOE) Environment Management Office of Science and Technology (OST, EM-50) published a report entitled {open_quotes}Integrated Thermal Treatment System Study - Phase 1 Results{close_quotes} (EGG-MS-11211). This report was the culmination of over a year of analysis involving scientists and engineers within the DOE complex and from private industry. The purpose of that study was {open_quotes}to conduct a systematic engineering evaluation of a variety of mixed low level waste (MLLW) treatment system alternatives.{close_quotes} The study also {open_quotes}identified the research and development, demonstrations, and testing and evaluation needed to assure unit operability in the most promising alternative system.{close_quotes} This study evaluated ten primary thermal treatment technologies, organized into complete {open_quotes}cradle-to-grave{close_quotes} systems (including complete engineering flow sheets), to treat DOE MLLW and calculated mass balances and 20-year total life cycle costs (TLCC) for all systems. The waste input used was a representative heterogenous mixture of typical DOE MLLW. An additional study was conducted, and then, based on response to these studies, additional work was started to investigate and evaluate non-thermal treatment options on a footing comparable to the effort devoted to thermal options. This report attempts to present a summary overview of the thermal and non-thermal treatment technologies which were examined in detail in the process of the above mentioned reviews.

  2. Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

    ERIC Educational Resources Information Center

    Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory

    2010-01-01

    Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…

  3. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    ERIC Educational Resources Information Center

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  4. [Comparative evaluation of clinical effectiveness of treatment of giardiasis].

    PubMed

    2014-09-01

    Giardia is the most common causes of protozoan diarrhea that leads to significant morbidity and mortality worldwide. The purpose of this study was to determine the clinical efficiency of different scheme of therapy giardiasis with new original plant preparation "Sausalin" (Kazakhstan). We conducted open clinical trial with participation of 93 patients with giardiasis. According the method of treatment the patients were divided into three groups.  Group I - Sausalin at the dose 300 mg/day; group II - Metronidazole at 750 mg/ day; group III - combination of Sausalin 300 mg/day and Metronidazole 750 mg/ day. The treatment was conducted during 10 days. The protozoal clearance rate and clinical symptoms were assessed. There were no significant differences in the efficiency of treatments in group I and group II. The protozoal clearance rate was 68% in group I (Sausalin); in group II -  42,1% (metronidazole). In group III - 83,2% (combination therapy) (р=0.001; 95% CI 54,6-89,7). There was no negative effect on clinical and biochemical blood analysis. We detected statistically significant differences in the dynamics of clinical symptoms (defecation disorders, dyspepsia, abdominal pain, asthenia) of giardiasis in a group of patients receiving Sausalin.The scheme with new drug Sausalin can be used as alternative treatment of Giardiasis. Moreover, the use of the Sausalin is improved the clinical symptoms and safety of therapy.

  5. High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease)

    PubMed Central

    2012-01-01

    Background Plantar fibromatosis is a benign disease creating nodules on the medial plantar side of affected patients. While surgical removal is regarded as the therapeutic mainstay, recurrence rates and impairment of daily activities remains substantial. High-energy focussed extracorporeal shockwave therapy has been suggested to be potentially effective in plantar fibromatosis in terms of pain reduction. Hypothesis High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis. Findings A total number of six patients (5 males, 58±4 years) were included with plantar fibromatosis (Ledderhose’s disease) associated with pain. Three patients were operated on previously, one had concomitant Dupuytren’s contracture. High-energy focussed ESWT was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm2) in two sessions with 7 days between. Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted. Conclusions High-energy focussed extracorporeal shockwave energy reduces pain in painful plantar fibromatosis (Morbus Ledderhose). Further large-scale prospective trials are warranted to elucidate the value of high-energy focussed extracorporeal shockwave therapy (ESWT) in plantar fibromatosis in terms of recurrence and efficacy. PMID:23031080

  6. A solid-phase mechanism of shock-wave formation of dust particles of heavy metals

    NASA Astrophysics Data System (ADS)

    Lin, E. E.; Mikhailov, A. L.; Khvorostin, V. N.

    2016-08-01

    The possibility of formation of dust particles in solid as a result of shock-wave destruction of the initial crystalline material structure and subsequent coalescence of atomic clusters (nanoparticles), which leads to the aggregation of mesocrystalline particles (grains) in the shocked layer, is discussed.

  7. Ultrafast Time Response Pressure-Sensitive Paint for Unsteady Shock-Wave Research

    NASA Astrophysics Data System (ADS)

    Numata, Daiju; Asai, Keisuke

    Pressure-Sensitive Paint (PSP) is an optical pressure measurement technique widely used in aerodynamic experiments, and has been applied to unsteady shock-wave phenomena [1, 2]. However, one of the largest problems to apply PSP to high-speed and unsteady phenomena is the response time of PSP.

  8. Inactivation of Ascaris eggs in soil by microwave treatment compared to UV and ozone treatment.

    PubMed

    Mun, Sungmin; Cho, Shin-Hyeong; Kim, Tong-Soo; Oh, Byung-Taek; Yoon, Jeyong

    2009-09-01

    This study reports on the effect of microwave radiation for inactivation of Ascaris lumbricoides eggs in 25 g of soil compared to ultraviolet irradiation and ozone expose. Microwave radiation at 700 W with 14% water content (w/w) achieved approximately 2.5 log inactivation of eggs in soil within 60s. On the other hand, UV irradiation at 3 mW cm(-2) with and without shaking soil for 3600 s achieved approximately 0.32 and 0.01 log inactivation of eggs, respectively. In ozone treatment, 0.13 log inactivation of eggs was achieved with 5.8+/-0.7 mg L(-1) of dissolved ozone dose for 30 min in a continuous diffusion reactor. In addition, the inactivation of eggs by three disinfection techniques was conducted in water in order to compare the inactivation efficiency of eggs in soil. The inactivation efficiency of microwave radiation was found to be no significant difference between in soil and water. However, the inactivation efficiency of UV irradiation was significantly increased in water while in ozone expose there was no significant difference between in soil and water. Microwave treatment thus proved to be the most efficient method in controlling A. lumbricoides eggs in soil.

  9. Treatment/Comparative therapeutics: cancer of the larynx and hypopharynx.

    PubMed

    McMullen, Caitlin P; Smith, Richard V

    2015-07-01

    This article reviews the management of laryngeal and hypopharyngeal squamous cell carcinoma. Available therapies for early and late stage cancers are discussed, and the literature is reviewed. The indications and outcomes of surgical and nonsurgical modalities are discussed and compared.

  10. RESEARCH PAPERS : Shock-wave equation of state of rhyolite

    NASA Astrophysics Data System (ADS)

    Anderson, William W.; Yang, Wenbo; Chen, George; Ahrens, Thomas J.

    1998-01-01

    We have obtained new shock-wave equation of state (EOS) and release adiabat data for rhyolite. These data are combined with those of Swegle (1989, 1990) to give an experimental Hugoniot which is described by Us = 2.53(+/-0.08) + 3.393(+/-0.37)Up for Up ≪ 0.48 km s-1 , Us = 3.85(+/-0.05) + 0.65(+/-0.03)Up for 0.48 <= Up ≪ 2.29 km s-1 , Us = 1.52(+/-0.08) + 1.67(+/-0.02)Up for 2.29 <= Up ≪ 4.37 km s-1 , and Us = 3.40(+/-034) + 1.24(+/-0.06)Up for Up ≫= 4.37 km s-1 , with ρ0 = 2.357 +/- 0.052 Mg m-3 . We suggest that the Hugoniot data give evidence of three distinct phases-both low- and high-pressure solid phases and, possibly, a dense molten phase. EOS parameters for these phases are ρ0 = 2.494 +/- 0.002 Mg m-3 , KS0 = 37 +/- 2 GPa, K' = 6.27 +/- 0.25, and Γ = 1.0(V/V0 ) for the low-pressure solid phase; ρ0 = 3.834 +/- 0.080 Mg m-3 , KS0 = 128 +/- 20 GPa, K' = 3.7 +/- 1.4, and Γ = 1.5 +/- 0.5 for the solid high-pressure phase; and ρ0 = 3.71 +/- 0.10 Mg m-3 , KS0 = 127 +/- 25 GPa, K' = 2.1 +/- 1.0, and Γ = 1.5 +/- 1.0 for the dense liquid. Transition regions of the Hugoniot cover the ranges of 9-34 GPa for the low-pressure-high-pressure solid transition and 90-120 GPa for the high-pressure solid-liquid transition. Release paths from high-pressure states, calculated from the EOS parameters, suggest that the material remains in the high-pressure solid phase upon release. Release paths from both the high-pressure solid and liquid fall above the Hugoniot until the Hugoniot enters the low-pressure-high-pressure mixed phase region, when the release paths then cross the Hugoniot and fall below it, ending at significantly higher zero-pressure densities than that of the low-pressure phase. The low-pressure release paths fall very close to the Hugoniot. Estimates of residual heat deposition, based on shock-release path hysteresis, range from 20 to 60 per cent of the shock Hugoniot energy.

  11. Clinical experience with shock-wave lithotripsy using the Siemens Modularis Vario lithotripter

    PubMed Central

    Hassouna, Mohamed E.; Oraby, Samir; Sameh, Wael; El-Abbady, Ahmed

    2011-01-01

    Purpose To assess the effectiveness of a lithotripter (Modularis Vario; Siemens, AG Healthcare, Munich, Germany) in the management of renal and ureteric stones. Patients and methods In all, 1146 adult patients with renal or ureteric stones were treated at one urological centre using the latest model of the Modularis Vario lithotripter. The effectiveness of lithotripsy and re-treatment rate were assessed. Data were obtained on stone location, stone size, shock wave usage, success rate, and complications. Results Between May 2007 and November 2009, 698 patients with renal stones and 448 with ureteric stones underwent extracorporeal shock-wave lithotripsy (ESWL). The mean (SD) renal stone size was 12.8 (3.8) mm; a mean of 1.36 sessions was required, with a mean (SD) number of 3744 (1961) shocks delivered per renal stone. After 3 months, the success rate defined as the patient being stone-free or with residual fragments of <4 mm; for renal stones the rate was 91.1%, with a 6.9% complication rate in the form of steinstrasse and severe renal colic. The mean (SD) ureteric stone size was 10.4 (2.7) mm. A mean of 1.37 sessions was required, with a mean (SD) of 4551 (2467) shocks delivered for each ureteric stone. The success rate for ureteric stones was 89.5%, with a 5.6% complication rate. The overall efficiency quotient was 0.66. Conclusion The Siemens Modularis Vario lithotripter is a safe and effective machine for treating renal and ureteric stones. PMID:26579276

  12. Comparative environmental analysis of waste brominated plastic thermal treatments

    SciTech Connect

    Bientinesi, M. Petarca, L.

    2009-03-15

    The aim of this research activity is to investigate the environmental impact of different thermal treatments of waste electric and electronic equipment (WEEE), applying a life cycle assessment methodology. Two scenarios were assessed, which both allow the recovery of bromine: (A) the co-combustion of WEEE and green waste in a municipal solid waste combustion plant, and (B) the staged-gasification of WEEE and combustion of produced syngas in gas turbines. Mass and energy balances on the two scenarios were set and the analysis of the life cycle inventory and the life cycle impact assessment were conducted. Two impact assessment methods (Ecoindicator 99 and Impact 2002+) were slightly modified and then used with both scenarios. The results showed that scenario B (staged-gasification) had a potentially smaller environmental impact than scenario A (co-combustion). In particular, the thermal treatment of staged-gasification was more energy efficient than co-combustion, and therefore scenario B performed better than scenario A, mainly in the impact categories of 'fossil fuels' and 'climate change'. Moreover, the results showed that scenario B allows a higher recovery of bromine than scenario A; however, Br recovery leads to environmental benefits for both the scenarios. Finally the study demonstrates that WEEE thermal treatment for energy and matter recovery is an eco-efficient way to dispose of this kind of waste.

  13. Criticality and characteristic neutronic analysis of a transient-state shockwave in a pulsed spherical gaseous uranium-hexafluoride reactor

    NASA Astrophysics Data System (ADS)

    Boles, Jeremiah Thomas

    The purpose of this study is to analyze the theoretical criticality of a spherical uranium-hexafluoride reactor with a transient, pulsed shockwave emanating from the center of the sphere in an outward-radial direction. This novel nuclear reactor design, based upon pulsed fission in a spherical enclosure is proposed for possible use in direct energy conversion, where the energy from fission products is captured through the use of electrostatic fields or through induction. An analysis of the dynamic behavior of the shockwave in this reactor is the subject of this thesis. As a shockwave travels through a fluid medium, the characteristics of the medium will change across the shockwave boundary. Pressure, temperature, and density are all affected by the shockwave. Changes in these parameters will affect the neutronic characteristics of a fissile medium. If the system is initially in a subcritical state, the increases in pressure, temperature, and density, all brought about by the introduction of the shockwave, will increase the reactivity of the nuclear system, creating a brief super critical state that will return to a subcritical state after the shockwave dissipates. Two major problems are required to be solved for this system. One is the effects of the shockwave on the gas, and the second is the resulting effects on system criticality. These problems are coupled due to the unique nature of the speed of the expanding shockwave in the uranium-hexafluoride medium and the energy imparted to the system by the shockwave with respect to the fissile uranium-hexafluoride. Using compressible flow and shockwave theories, this study determines the properties of the gaseous medium for reference points before, during, and behind the shockwave as it passes through the fissile medium. These properties include pressure changes, temperature changes, and density changes that occur to the system. Using the parameters calculated from the shockwave, the neutron transport equation is

  14. Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: an experiment in animals

    PubMed Central

    2014-01-01

    Introduction This study investigated the effectiveness of extracorporeal shockwave therapy (ESWT) in osteoporotic (OP) osteoarthritis (OA) of rat knee. Methods Fifty-six rats were divided into seven groups including sham, OA, OP, OA + OP, OA + ESWT, OP + ESWT, and OA + OP + ESWT groups. The evaluations included gross pathology, bone mineral density (BMD), micro-computed tomography (micro-CT) scan, bone-strength test, histopathologic examination, and immunohistochemical analysis. Results On gross pathology, group OA + OP showed larger areas of osteoarthritic changes than did groups OA and OP, as compared with the sham group. BMD and bone strength significantly decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly improved BMD and bone-strength changes. On micro-CT scan, the subchondral plate thickness significantly decreased, and the bone porosity increased in groups OA, OP, and OA + OP, and ESWT significantly improved the changes in subchondral-plate thickness and bone porosity. In histopathologic examination, Mankin score and safranin O score significantly increased in groups OA and group OA + OP, but not in group OP relative to the sham group, and ESWT significantly improved the changes. In immunohistochemical analysis, Dickkopf-1 (DKK-1) significantly increased, but vessel endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and bone morphogenetic protein 2 (BMP-2) decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly reversed the changes. Conclusions Osteoporosis increased the severity of cartilage damage in osteoarthritis of the knee. ESWT showed effectiveness in the reduction of osteoporotic osteoarthritis of the knee in rats. PMID:24994452

  15. A cumulative shear mechanism for tissue damage initiation in shock-wave lithotripsy

    PubMed Central

    Freund, Jonathan B.; Colonius, Tim; Evan, Andrew P.

    2007-01-01

    Evidence suggests that inertial cavitation plays an important role in the renal injury incurred during shock-wave lithotripsy. However, it is unclear how tissue damage is initiated, and significant injury typically occurs only after a sufficient dose of shock waves. While it has been suggested that shock-induced shearing might initiate injury, estimates indicate that individual shocks do not produce sufficient shear to do so. In this paper, we hypothesize that the cumulative shear of the many shocks is damaging. This mechanism depends upon whether there is sufficient time between shocks for tissue to relax to its unstrained state. We investigate the mechanism with a physics-based simulation model wherein the the basement membranes that define the tubules and vessels in the inner medulla are represented as elastic shells surrounded by viscous fluid. Material properties are estimated from in vitro tests of renal basement membranes and documented mechanical properties of cells and extracellular gels. Estimates for the net shear deformation from a typical lithotripter shock (~ 0.1%) are found from a separate dynamic shock simulation. The results suggest that the larger interstitial volume (~ 40%) near the papilla tip gives the tissue there a relaxation time comparable to clinical shock delivery rates (~ 1Hz), thus allowing shear to accumulate. Away from the papilla tip, where the interstitial volume is smaller (≲ 20%), the model tissue relaxes completely before the next shock would be delivered. Implications of the model are that slower delivery rates and broader focal zones should both decrease injury, consistent with some recent observations. PMID:17507147

  16. Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

    PubMed

    Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

    2016-04-01

    Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.

  17. Posthospitalization Outcomes for Psychiatric Sex Offenders: Comparing Two Treatment Protocols.

    PubMed

    Stinson, Jill D; McVay, Lee Ann; Becker, Judith V

    2016-05-01

    This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n= 58) and RP (n= 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings.

  18. Tenderization of chicken and turkey breasts with electrically produced hydrodynamic shockwaves.

    PubMed

    Claus, J R; Schilling, J K; Marriott, N G; Duncan, S E; Solomon, M B; Wang, H

    2001-07-01

    Eighty early deboned (45 min, post mortem) postrigor chicken breasts were exposed (24 h post mortem) to two levels (number of pulse firing networks, PFN; 45% energy) of electrically produced hydrodynamic shockwaves (HSW). In addition, 21 turkey breasts (72 h post mortem) were HSW treated (two PFN, 72% energy). Samples were water cooked in bags (78°C internal). Two PFN's were required to decrease (P<0.05) chicken Warner-Bratzler shear (WBS) force by 22% from the control (4.67 kg). WBS force of the HSW treated turkey breast decreased (P<0.05) by 12% from the control (3.20 kg). Cooking loss was higher (P<0.05) in the turkey breast portions but not in the chicken breasts. The electrically produced shockwave process has the potential to provide chicken processors with the ability to early debone and produce tender breasts and to provide turkey processors with tenderness-enhanced fillets.

  19. Laser plasma shockwave cleaning of SiO 2 particles on gold film

    NASA Astrophysics Data System (ADS)

    Ye, Yayun; Yuan, Xiaodong; Xiang, Xia; Dai, Wei; Chen, Meng; Miao, Xinxiang; Lv, Haibing; Wang, Haijun; Zheng, Wanguo

    2011-04-01

    A Nd:YAG laser (1064 nm) induces optical breakdown of the airborne above the gold-coated K9 glass surface and the created shockwave removes the SiO2 particles contaminated on the gold films. The laser cleaning efficiency has been characterized by optical microscopy, dark field imaging, ultraviolet-visible-near infrared spectroscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy and the Image-pro software. The relationships between removal ratio and particle position and laser gap distance have been studied in the case of single pulse laser cleaning. The results show that the 1064 nm laser induced plasma shockwave can effectively remove the SiO2 particles. The removal ratio can reach above 90%. The effects of particle position and laser gap distance on the cleaning efficiency are simulated for the single pulse laser cleaning. The simulated results are consistent with the experimental ones.

  20. Shock-wave equation-of-state studies at Los Alamos

    SciTech Connect

    Morris, C.E.

    1990-01-01

    A history of the shock-wave equation-of-state (EOS) studies at Los Alamos is given. Particular emphasis is placed on the pioneering research in the 1950s where many of the experimental techniques and methods of analysis were developed, which we now take for granted. A brief review of shock-wave physics is given, which illustrates important hydrodynamic and thermodynamic concepts. Recent studies on the EOS of Ti are presented with emphasis on the {alpha}-to-{omega} phase transition. VISAR wave profiles on polycrystalline Ni and single-crystal Ni are presented to determine the strengths of these materials at pressure. Low-density polystyrene foam Hugoniot experiments are described and results analyzed. 21 refs., 14 figs.

  1. Shock-Wave and Plasma-Pinch Mechanisms of Galactic Cosmic-Ray Production

    SciTech Connect

    Trubnikov, B.A.

    2005-07-01

    Based on recent discoveries, we show that it is appropriate to complement the standard shock-wave model for the production of galactic cosmic rays by a plasma-pinch model. The latter describes well the production of high-energy cosmic rays, yields a simple formula for their intensity, and allows the threshold pattern of the knee-type kink in the secondary particle spectrum and a number of unusual phenomena observed above the threshold to be explained.

  2. Elastomeric Polymer-by-Design for Blast-Induced Shock-Wave Management

    DTIC Science & Technology

    2015-06-01

    ORGANIZATION . REPORT DATE (DD-MM-YYYY) 01-06-2015 2. REPORT TYPE Final Technical Performance Report 3. DATES COVERED (From - To) September 1...2009 - November 30, 2014 4. TITLE AND SUBTITLE Elastomerie Polymer -by-Design for Blast-Induced Shock-Wave Management [ONR BRC Program] 5a. CONTRACT...NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Regents of UC San Diego Department of Mechanieal and Aerospace

  3. A VISAR Velocity Interferometer System at MRL for Slapper Detonator and Shockwave Studies

    DTIC Science & Technology

    1991-12-01

    VISAR schematic diagram. 8 The transmitted fraction of the beam enters the modified Michelson -type interferometer where it is first split into equal...Thus the phase difference will be 1 2 (A.12) 30 39 2n 2If-1A.13) In the arrangement of the Michelson interferometer used for length measurements, A2...A VISAR Velocity Interferometer L System at MRL for Slapper Detonator and Shockwave Studies David J. Hatt MRL Technical Report MRL-TR-91-42 Abstract

  4. International shock-wave database project : report of the requirements workshop.

    SciTech Connect

    Aidun, John Bahram; Lomonosov, Igor V.; Levashov, Pavel R.

    2012-03-01

    We report on the requirements workshop for a new project, the International Shock-Wave database (ISWdb), which was held October 31 - November 2, 2011, at GSI, Darmstadt, Germany. Participants considered the idea of this database, its structure, technical requirements, content, and principles of operation. This report presents the consensus conclusions from the workshop, key discussion points, and the goals and plan for near-term and intermediate-term development of the ISWdb. The main points of consensus from the workshop were: (1) This international database is of interest and of practical use for the shock-wave and high pressure physics communities; (2) Intermediate state information and off-Hugoniot information is important and should be included in ISWdb; (3) Other relevant high pressure and auxiliary data should be included to the database, in the future; (4) Information on the ISWdb needs to be communicated, broadly, to the research community; and (5) Operating structure will consist of an Advisory Board, subject-matter expert Moderators to vet submitted data, and the database Project Team. This brief report is intended to inform the shock-wave research community and interested funding agencies about the project, as its success, ultimately, depends on both of these groups finding sufficient value in the database to use it, contribute to it, and support it.

  5. Thermodynamic parameters of mixtures with allowance for phase transition components under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Kinelovskii, S. A.; Maevskii, K. K.

    2017-02-01

    The shock-wave synthesis and compaction using powder mixtures are the one of perspective directions of new materials creation. The results of numerical experiments on modeling of shock wave loading of mixtures with allowance for phase transition components in their composition are presented. The significant change in volume in the region of phase transition components included in the mixtures allows us to expand the range of variation of thermodynamic parameters of the mixtures under shock wave loading. The calculation model is based on the assumption that all components of mixture under shock-wave loading are in thermodynamic equilibrium (model TEC). The model TEC allows us to describe the region of the polymorphic phase transition, considering the material in the region of phase transition as a mixture of low-pressure phase and high-pressure phase. The good agreement of these model calculations with the data of different authors defined on the basis of experiments is obtained. Thermodynamic parameters of the nitrides mixture, solid and porous mixtures with quartz as component were reliably described. This model is useful for determining the compositions and volume fractions of the components of the mixture to obtain the specified parameters of solid and porous materials under shock-wave loading.

  6. Simulation of shock-induced bubble collapse with application to vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran

    Shockwave lithotripsy is a noninvasive medical procedure wherein shockwaves are repeatedly focused at the location of kidney stones in order to pulverize them. Stone comminution is thought to be the product of two mechanisms: the propagation of stress waves within the stone and cavitation erosion. However, the latter mechanism has also been implicated in vascular injury. In the present work, shock-induced bubble collapse is studied in order to understand the role that it might play in inducing vascular injury. A high-order accurate, shock- and interface-capturing numerical scheme is developed to simulate the three-dimensional collapse of the bubble in both the free-field and inside a vessel phantom. The primary contributions of the numerical study are the characterization of the shock-bubble and shock-bubble-vessel interactions across a large parameter space that includes clinical shockwave lithotripsy pressure amplitudes, problem geometry and tissue viscoelasticity, and the subsequent correlation of these interactions to vascular injury. Specifically, measurements of the vessel wall pressures and displacements, as well as the finite strains in the fluid surrounding the bubble, are utilized with available experiments in tissue to evaluate damage potential. Estimates are made of the smallest injurious bubbles in the microvasculature during both the collapse and jetting phases of the bubble's life cycle. The present results suggest that bubbles larger than one micrometer in diameter could rupture blood vessels under clinical SWL conditions.

  7. Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL).

    PubMed

    Ngee-Ming, Goh; Tamsin, Drake; Rai, B P; Somani, B K

    2014-06-01

    Shock wave lithotripsy (SWL) is an established treatment for renal stones. Although non-invasive, it can cause significant pain and anxiety during the procedure. Our purpose was to review the literature to look at the effect of complimentary therapy in patients undergoing SWL and whether it led to a reduction in the requirement of analgesics and anxiolytics. A systematic review was performed on the use of acupuncture, auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and music during SWL. Only prospective randomized controlled trials were selected. Two reviewers independently extracted the data from each study. Outcomes relating to analgesia requirement, anxiety and stone-free rates (SFR) were compared. Seven papers were identified reporting on 591 patients (acupuncture-3, TENS-1 and music-3). Pain control/analgesia requirement was significantly better in four studies (music-2, acupuncture-1, TENS-1). Significantly lower anxiety was noted in one study with music and two using acupuncture. No difference in SFR was noted with the use of complementary therapy. No major or minor side effects were noted. Complementary therapy for SWL can help lower analgesia requirement and the anxiety associated with it. However, it does not have any effect on the SFR.

  8. Incident shock-wave characteristics in air, argon, carbon dioxide, and helium in a shock tube with unheated helium driver

    NASA Technical Reports Server (NTRS)

    Miller, C. G., III; Jones, J. J.

    1975-01-01

    Incident shock-wave velocities were measured in the Langley 6-inch expansion tube, operated as a shock tube, with air, argon, carbon dioxide, and helium as test gases. Unheated helium was used as the driver gas and most data were obtained at pressures of approximately 34 and 54 MN/sq m. A range of pressure ratio across the diaphragm was obtained by varying the quiescent test-gas pressure, for a given driver pressure, from 0.0276 to 34.5 kN/sq m. Single- and double-diaphragm modes of operation were employed and diaphragms of various materials tested. Shock velocity was determined from microwave interferometer measurements, response of pressure transducers positioned along interferometer measurements, response of pressure transducers positioned along the driven section (time-of-arrival gages), and to a lesser extent, measured tube-wall pressure. Velocities obtained from these methods are compared and limitations of the methods discussed. The present results are compared with theory and the effects of diaphragm mode (single or double diaphragm), diaphragm material, heating of the driver gas upon pressurization of the driver section, diaphragm opening time, interface mixing, and two-dimensional (nonplanar) flow are discussed.

  9. Bubble Proliferation or Dissolution of Cavitation Nuclei in the Beam Path of a Shock-Wave Lithotripter

    NASA Astrophysics Data System (ADS)

    Frank, Spencer; Lautz, Jaclyn; Sankin, Georgy N.; Szeri, Andrew J.; Zhong, Pei

    2015-03-01

    It is hypothesized that the decreased treatment efficiency in contemporary shock-wave lithotripters is related to tensile wave attenuation due to cavitation in the prefocal beam path. Utilizing high-speed imaging of the beam path and focal pressure waveform measurements, tensile attenuation is associated with bubble proliferation. By systematically testing different combinations of pulse-repetition frequency and gas concentration, we modulate the bubble-dissolution time to identify which conditions lead to bubble proliferation and show that reducing bubble proliferation in the beam path significantly improves acoustic transmission and stone comminution efficiency in vitro. In addition to experiments, a bubble-proliferation model is developed that takes gas diffusion across the bubble wall and bubble fragmentation into account. By aligning the model with experimental observations, the number of daughter bubbles produced after a single lithotripter bubble collapse is estimated to be in the range of 253 ˜510 . This finding is on the same order of magnitude with previous measurements of an isolated bubble collapse in a lithotripter field by Pishchalnikov, McAteer, and Williams [BJU Int. 102, 1681 (2008), 10.1111/j.1464-410X.2008.07896.x], and this estimate improves the general understanding of lithotripsy bubble dynamics in the beam path.

  10. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

    PubMed Central

    Vahdatpour, Babak; Kianimehr, Lida; Ahrar, Mohmmad Hossein

    2016-01-01

    Background: Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF. Materials and Methods: Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment. Results: Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115). Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term. PMID:27274499

  11. Comparing Treatment Policies with Assistance from the Structural Nested Mean Model

    PubMed Central

    Lu, Xi; Lynch, Kevin G.; Oslin, David W.; Murphy, Susan

    2015-01-01

    Summary Treatment policies, also known as dynamic treatment regimes, are sequences of decision rules that link the observed patient history with treatment recommendations. Multiple, plausible, treatment policies are frequently constructed by researchers using expert opinion, theories and reviews of the literature. Often these different policies represent competing approaches to managing an illness. Here we develop an “assisted estimator” that can be used to compare the mean outcome of competing treatment policies. The term “assisted” refers to the fact estimators from the Structural Nested Mean Model, a parametric model for the causal effect of treatment at each time point, are used in the process of estimating the mean outcome. This work is motivated by our work on comparing the mean outcome of two competing treatment policies using data from the ExTENd study in alcohol dependence. PMID:26363892

  12. Focal Adhesion Kinase Signaling Mediated the Enhancement of Osteogenesis of Human Mesenchymal Stem Cells Induced by Extracorporeal Shockwave

    NASA Astrophysics Data System (ADS)

    Hu, Jun; Liao, Haojie; Ma, Zebin; Chen, Hongjiang; Huang, Zhonglian; Zhang, Yuantao; Yu, Menglei; Chen, Youbin; Xu, Jiankun

    2016-02-01

    Extracorporeal shockwave (ESW) has been shown of great potential in promoting the osteogenesis of bone marrow mesenchymal stem cells (BMSCs), but it is unknown whether this osteogenic promotion effect can also be achieved in other MSCs (i.e., tendon-derived stem cells (TDSCs) and adipose-derived stem cells (ADSCs)). In the current study, we aimed not only to compare the osteogenic effects of BMSCs induced by ESW to those of TDSCs and ADSCs; but also to investigate the underlying mechanisms. We show here that ESW (0.16 mj/mm2) significantly promoted the osteogenic differentiation in all the tested types of MSCs, accompanied with the downregulation of miR-138, but the activation of FAK, ERK1/2, and RUNX2. The enhancement of osteogenesis in these MSCs was consistently abolished when the cells were pretreated with one of the following conditions: overexpression of miR-138, FAK knockdown using specific siRNA, and U0126, implying that all of these elements are indispensable for mediating the effect of ESW. Moreover, our study provides converging genetic and molecular evidence that the miR-138-FAK-ERK1/2-RUNX2 machinery can be generally activated in ESW-preconditioned MSCs, suggesting that ESW may be a promising therapeutic strategy for the enhancement of osteogenesis of MSCs, regardless of their origins.

  13. Focal Adhesion Kinase Signaling Mediated the Enhancement of Osteogenesis of Human Mesenchymal Stem Cells Induced by Extracorporeal Shockwave

    PubMed Central

    Hu, Jun; Liao, Haojie; Ma, Zebin; Chen, Hongjiang; Huang, Zhonglian; Zhang, Yuantao; Yu, Menglei; Chen, Youbin; Xu, Jiankun

    2016-01-01

    Extracorporeal shockwave (ESW) has been shown of great potential in promoting the osteogenesis of bone marrow mesenchymal stem cells (BMSCs), but it is unknown whether this osteogenic promotion effect can also be achieved in other MSCs (i.e., tendon-derived stem cells (TDSCs) and adipose-derived stem cells (ADSCs)). In the current study, we aimed not only to compare the osteogenic effects of BMSCs induced by ESW to those of TDSCs and ADSCs; but also to investigate the underlying mechanisms. We show here that ESW (0.16 mj/mm2) significantly promoted the osteogenic differentiation in all the tested types of MSCs, accompanied with the downregulation of miR-138, but the activation of FAK, ERK1/2, and RUNX2. The enhancement of osteogenesis in these MSCs was consistently abolished when the cells were pretreated with one of the following conditions: overexpression of miR-138, FAK knockdown using specific siRNA, and U0126, implying that all of these elements are indispensable for mediating the effect of ESW. Moreover, our study provides converging genetic and molecular evidence that the miR-138-FAK-ERK1/2-RUNX2 machinery can be generally activated in ESW-preconditioned MSCs, suggesting that ESW may be a promising therapeutic strategy for the enhancement of osteogenesis of MSCs, regardless of their origins. PMID:26863924

  14. Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy

    PubMed Central

    Freund, J. B.; Shukla, R. K.; Evan, A. P.

    2009-01-01

    Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid “tissue.” A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves. PMID:19894850

  15. The Comparative Effectiveness of Outpatient Treatment for Adolescent Substance Abuse: A Meta-Analysis

    PubMed Central

    Tanner-Smith, Emily E.; Wilson, Sandra Jo; Lipsey, Mark W.

    2012-01-01

    Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment-comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre-post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre-post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use. PMID:22763198

  16. Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

    ERIC Educational Resources Information Center

    Lindsay, William R.; Michie, Amanda M.; Steptoe, Lesley; Moore, Fhionna; Haut, Fabian

    2011-01-01

    Background: Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method:…

  17. Comparing drinking water treatment costs to source water protection costs using time series analysis.

    EPA Science Inventory

    We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reductio...

  18. A Comparative Evaluation of Minimal Therapist Contact and 15-Session Treatment for Female Orgasmic Dysfunction.

    ERIC Educational Resources Information Center

    Morokoff, Patricia J.; LoPiccolo, Joseph

    1986-01-01

    Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…

  19. Comparative Evaluation of Medical vs. Social Treatment of Alcohol Withdrawal Syndrome.

    ERIC Educational Resources Information Center

    McGovern, Mark P.

    1983-01-01

    Compared medical and social setting detoxification treatments of alcohol withdrawal syndrome regarding the degree to which each involved alcoholics (N=200) in ongoing rehabilitative efforts. Results showed highly significant differences between treatment models, with the social setting model showing significantly greater rates of commitment to…

  20. Long-Term Outcome and Factors Affecting Prognosis of Extracorporeal Shockwave Therapy for Chronic Refractory Achilles Tendinopathy

    PubMed Central

    2017-01-01

    Objective To investigate the factors affecting prognosis of extracorporeal shockwave therapy (ESWT) for chronic refractory Achilles tendinopathy (AT). Methods Thirty-six patients (48 consecutive feet) with chronic AT (>6 months) and who underwent ESWT for ‘poor’ or ‘fair’ grade in Roles-Maudsley Score (RMS) after unsuccessful conservative treatment were included in the present study. A maximum of 12 sessions of ESWT were conducted until treatment success: RMS reached ‘good’ or ‘excellent’. Termination of ESWT for no response, or ‘poor’ or ‘fair’ grade was regarded as treatment failure. Immediate outcome, long-term outcome (telephone interview after mean 26 months), and factors affecting treatment success were analyzed. Results Numeric Rating Scale was significantly decreased at immediate and long-term follow-up. Success rate was 71.1% and 90.3%, respectively. Univariate logistic regression identified that immediate treatment success was associated with retrocalcaneal enthesophyte on X-ray (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01–0.28), pretreatment abnormal ultrasonography echogenicity within Achilles tendon (OR, 18.89; 95% CI, 2.08–171.96), mean duration of ‘post-treatment soreness’ (OR, 0.55; 95% CI, 0.33–0.94), and duration of ‘post-treatment soreness after first ESWT’ (OR, 0.06; 95% CI, 0.01–0.34). The duration of ‘post-treatment soreness after first ESWT’ was found to be the only factor associated with long-term success (OR, 0.32; 95% CI, 0.10–0.99). Conclusion ESWT appears to be effective in achieving long-term success in chronic refractory AT. Immediate success was associated with absence of retrocalcaneal enthesophyte on X-ray, presence of pretreatment abnormal ultrasonography echogenicity, shorter mean duration of ‘post-treatment soreness’, and shorter duration of ‘post-treatment soreness after first ESWT’. The shorter duration of ‘post-treatment soreness after first ESWT’ was

  1. Shockwave turbulent boundary layer interaction control using magnetically driven surface discharges

    NASA Astrophysics Data System (ADS)

    Kalra, Chiranjeev Singh

    The dissertation demonstrates the potential for shockwave-turbulent boundary layer interaction control in air using low current DC constricted surface discharges forced by moderate strength magnetic fields. Experiments are conducted in a Mach 2.6 indraft air tunnel with discharge currents up to 300 mA and magnetic field strengths up to 5 Tesla. Separation and non-separation inducing shocks are generated with diamond shape shockwave generators located on the wall opposite to the surface electrodes, and flow properties are measured with schlieren imaging, static wall pressure probes and acetone flow visualization. Also, an efficient, time dependent, two-dimensional Navier-Stokes numerical code for shockwave boundary layer interaction in air is developed. To replicate the experiments done at high Reynolds number, the code is divided into time independent and time dependent regimes to significantly reduce computation time. The effect of plasma control on boundary layer separation depends on the direction of the Lorentz force ( j d16 xB d16 ). It is observed that by using a Lorentz force that pushes the discharge upstream, separation can be induced or further strengthened even with discharge currents as low as 30 mA in a 3 Tesla magnetic field. If shock induced separation is present, it is observed that by using a Lorentz force that pushes the discharge downstream, separation can be suppressed, but this required higher currents, greater than 80 mA. Acetone planar laser scattering is used to image the flow structure in the test section and the reduction in the size of recirculation bubble and its elimination are observed experimentally as a function of actuation current and magnetic field strength. Computational results are in good agreement with experiments in terms of the flow structure as shown by Schlieren imaging, acetone planar laser scattering, and the static pressure profile on the test section wall.

  2. Extracorporeal shockwave therapy for chronic proximal plantar fasciitis.

    PubMed

    Strash, Walter W; Perez, Richard R

    2002-10-01

    Although much enthusiasm surrounds applying extracorporeal shock wave therapy for various musculoskeletal conditions, its effects are not well understood and warrant continued study. Certain body tissues or organs may be damaged either acutely or chronically by ESWT; however, it is unequivocal that lung tissue may be damaged. It is theorized that neovascularization is responsible for improvement in symptoms of plantar fasciitis. Neovascularization is the direct effect of macrophage stimulation through cytokines. ESWT has effects at the cellular level--does it interfere with metabolic activity or enhance it? The noninvasive nature and minimal complications of appropriately applied ESWT are its primary advantages. Symptoms may continue to improve for three weeks to six months after treatment; the effects of shock wave therapy seem to be time dependent. ESWT is an effective form of treatment for proximal insertional plantar fasciitis after exhaustive, conservative forms of treatment have failed.

  3. [Extracorporeal shock-wave lithotripsy in horseshoe kidney].

    PubMed

    Blasco Casares, F J; Ibarz Servio, L; Ramón Dalmau, M; Ruiz Marcellán, F J

    1994-05-01

    Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.

  4. Femtosecond-laser-induced shockwaves in water generated at an air-water interface.

    PubMed

    Strycker, B D; Springer, M M; Traverso, A J; Kolomenskii, A A; Kattawar, G W; Sokolov, A V

    2013-10-07

    We report generation of femtosecond-laser-induced shockwaves at an air-water interface by millijoule femtosecond laser pulses. We document and discuss the main processes accompanying this phenomenon, including light emission, development of the ablation plume in the air, formation of an ablation cavity, and, subsequently, a bubble developing in water. We also discuss the possibility of remotely controlling the characteristics of laser-induced sound waves in water through linear acoustic superposition of sound waves that results from millijoule femtosecond laser-pulse interaction with an air-water interface, thus opening up the possibility of remote acoustic applications in oceanic and riverine environments.

  5. [Effects of shock-wave lithotripsy (ESWL) on electrolytic and hormonal balance in nephrolithiasis patients].

    PubMed

    Dzhavad-Zade, S M; Abdullaev, S Sh

    1998-01-01

    Blood concentrations of parathyroid hormone, aldosterone, hydrocortisone, Na+, K+, Ca2+, 24-h urine concentration of Ca2+, blood pressure were measured on day 3 and 7 after extracorporeal shock-wave lithotripsy. A total of 54 patients with nephrolithiasis (NL) were examined. In NL patients with hypertension the above lithotripsy led to a fall in pressure by 15-20%, to correction of initial hormonal and electrolytic unbalance. There were marked changes in the levels of parathyroid hormone, total Ca2+ in the blood and 24-h urine.

  6. Laser-Induced Shockwave Paired with FRET: A Method to Study Cell Signaling

    PubMed Central

    GOMEZ-GODINEZ, VERONICA; PREECE, DARYL; SHI, LINDA; KHATIBZADEH, NIMA; ROSALES, DERRICK; PAN, YIJIA; LEI, LIE; WANG, YINGXIAO; BERNS, MICHAEL W.

    2015-01-01

    Cells within the body are subject to various forces; however, the details concerning the way in which cells respond to mechanical stimuli are not well understood. We demonstrate that laser-induced shockwaves (LIS) combined with biosensors based on fluorescence resonance energy transfer (FRET) is a promising new approach to study biological processes in single live cells. As “proof-of-concept,” using a FRET biosensor, we show that in response to LIS, cells release intracellular calcium. With the parameters used, cells retain their morphology and remain viable. LIS combined with FRET permits observation of the cells immediate response to a sudden shear force. PMID:25639252

  7. Shock-wave processes evolution in fused quartz under intense energy action

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Yakovenko, I. S.

    2016-11-01

    The paper considers gas-dynamical processes evolving as a result of laser action in fused quartz. A conventional approach is used to construct a model for equation of state which provides an adequate description of the silica state at high densities of energy typical for local optical silica damage. Shock-wave processes generated in the medium due to the local laser energy deposition are calculated using fully conservative numerical technique. The obtained results provide relatively accurate description of the process in a wide range of parameters and allow further research to get clear interpretation of high-speed propagation of the laser absorbing front through the silica optical fiber.

  8. Experimental study of dynamic properties of porous materials under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Zubareva, A. N.; Efremov, V. P.; Mochalova, V. M.; Utkin, A. V.

    2016-11-01

    The paper presents new experimental data on properties of porous media under shock-wave loading. We considered materials with different nature of porosity. The porosity in the silicone rubber and the epoxy resin was produced by glass microspheres filler. Open porosity was realized in a fibrous material made from glass fibers with corundum. It was shown that two-wave configuration was formed in materials with closed porosity. Such structure of the pulse with a precursor was not observed in samples with open porosity. As a result of analysis of experimental data, Hugoniots for the investigated materials were obtained.

  9. EXTRACORPOREAL SHOCKWAVE TERAPY TO TREAT CHRONIC MUSCLE INJURY

    PubMed Central

    Astur, Diego Costa; Santos, Bruno; de Moraes, Eduardo Ramalho; Arliani, Gustavo Gonçalves; dos Santos, Paulo Roberto Dias; Pochini, Alberto de Castro

    2015-01-01

    ABSTRACT Objective: To evaluate the low energy extracorporeal shock waves therapy (ESWT) associated with physical therapy in the treatment of chronic muscle injuries classified as grades 2 and 3 in the lower limbs of amateur athletes. Methods: Eight athletes presenting with lower limb muscle injury for more than three weeks were treated with physiotherapy and ESWT. We evaluated the following parameters during treatment: palpable gap, muscle strength, pain, and Tegner score, as well as ultrasound image features and the ability to return to sports practice. Results: The average time of the first evaluation of the injury was 8.75 weeks. All patients presented muscle strength grade V after eight weeks. The pain score evolved from 5.75 to 0.5 points of the visual analogue scale (VAS), at the end of the treatment. The Tegner score after treatment was six points on average. Patients returned to sports practice after 8.14 weeks. Conclusion: ESWT associated with physical therapy proved to be effective to treat long-term muscle injury, with good performance and the ability to return to sport practice for all patients. Level of Evidence IV, Case Series, Prospective Study. PMID:26981031

  10. Effects of extracorporeal shockwave therapy on nanostructural and biomechanical responses in the collagenase-induced Achilles tendinitis animal model.

    PubMed

    Yoo, Seung Don; Choi, Samjin; Lee, Gi-Ja; Chon, Jinmann; Jeong, Yong Seol; Park, Hun-Kuk; Kim, Hee-Sang

    2012-11-01

    The aim of this study was to quantitatively investigate the effects of extracorporeal shockwave therapy (ESWT) on the nanostructure and adhesion force of collagen fibrils in a rat model of collagenase-induced Achilles tendinitis (CIAT) using histology and atomic force microscopy. A total of 45 rats were divided into experimental groups of three rats each: a control group, 27 CIAT rats with nine time points, and 15 ESWT rats with five time points. Progressive changes in nanostructure including the fibrillary diameter and D-periodicity, and biomechanical properties including the fibrillary adhesion forces in each healing phase were investigated over a 5-week period after collagenase injection. On postoperative day 3, CIAT rats showed granulomatous tissue associated with subacute inflammation, and a deterioration in nanostructure and mechanical properties compared to controls. On postoperative day 12, the ESWT group showed increased vascularity, fibroblastic activity, lymphocyte and plasma cell infiltration, dense histocytes, and disorganization of the fibers compared to the CIAT group. The ESWT group showed and improvement in nanostructure and mechanical properties compared to controls, while the CIAT group showed a deterioration in nanostructure and mechanical properties compared to controls. On postoperative day 26, the ESWT group showed 30% inflamed tissue and 70% fibrotic tissue, while the CIAT group showed chronic inflammation. By the end of the experiments, in both groups the changes had reversed and the tissues were similar in appearance to those in the control group. Following ESWT the deformed and irregular collagen network returned to a well-aligned normal collagen network nanostructure. These results suggest that ESWT may promote the healing response in Achilles tendinitis.

  11. Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial.

    PubMed

    Radinmehr, Hojjat; Nakhostin Ansari, Noureddin; Naghdi, Soofia; Olyaei, Gholamreza; Tabatabaei, Azadeh

    2017-03-01

    Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm(2), 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T0), immediately after treatment (T1) and one hour after the end of the treatment (T2). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T1, but there was no significant effect on Hmax/Mmax ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.

  12. Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

    PubMed Central

    Kim, Jung Kwon; Ha, Seung Beom; Jeon, Chan Hoo; Oh, Jong Jin; Cho, Sung Yong; Oh, Seung-June; Kim, Hyeon Hoe; Jeong, Chang Wook

    2016-01-01

    Purpose Shock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms. Materials and Methods From March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction. Results The SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences. Conclusions We constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making. PMID:26890006

  13. Fetotoxicity and teratogenesis of SWL treatment in the rabbit.

    PubMed

    Frankenschmidt, A; Heisler, M

    1998-02-01

    The potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the

  14. Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause

    PubMed Central

    Brandi, Hugo; Gomez, Valentin; Luque, Daniel

    2016-01-01

    Objectives The objective of this prospective comparative cohort study was to establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for genitourinary syndrome of menopause and to compare it with an established topical estriol treatment. Methods Fifty patients with genitourinary syndrome of menopause were divided into two groups. The estriol group received a treatment of 0.5 mg estriol ovules for 8 weeks and the laser group was first treated for 2 weeks with 0.5 mg estriol ovules 3 times per week to hydrate the mucosa and then received three sessions with 2,940 nm Er:YAG laser in non‐ablative mode. Biopsies were taken before and at 1, 3, 6, and 12 months post‐treatment. Maturation index, maturation value and pH where recorded up to 12‐months post‐treatment, while the VAS analysis of symptoms was recorded up to 18 months post‐treatment. Results Statistically significant (P < 0.05), reduction of all assessed symptoms was observed in the laser group at all follow‐ups up to 18 months post‐treatment. Significant improvement in maturation value and a decrease of pH in the laser group was detected up to 12 months after treatment. The improvement in all endpoints was more pronounced and longer lasting in the laser group. Histological examination showed changes in the tropism of the vaginal mucosa and also angiogenesis, congestion, and restructuring of the lamina propria in the laser group. Side effects were minimal and of transient nature in both groups, affecting 4% of patients in the laser group and 12% of patients in the estriol group. Conclusions Our results show that Er:YAG laser treatment successfully relieves symptoms of genitourinary syndrome of menopause and that the results are more pronounced and longer lasting compared to topical estriol treatment. Lasers Surg. Med. 49:160–168, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. PMID:27546524

  15. Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

    PubMed

    Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

    2013-06-01

    Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange.

  16. Generation of Shock-Wave Disturbances at Plasma-Vapor Bubble Oscillation

    NASA Astrophysics Data System (ADS)

    Kuznetsova, N. S.; Yudin, A. S.; Voitenko, N. V.

    2015-11-01

    The complex physical and mathematical model describing all steps of plasma-vapor bubble evolution in the system of the water-ground condensed media is presented. Discharge circuit operation, discharge plasma channel expansion, its transformation into the vapor-plasma bubble and its pulsation, pressure wave generation and propagation of the mechanical stress waves in the ground are self-consistently considered in the model. The model allows investigation of the basic laws of stored energy transformation into the discharge plasma channel, next to the plasma-vapor bubble and transformation of this energy to the energy of pressure wave compressing the surrounding ground. Power characteristics of wave disturbances generated by gas-vapor bubble oscillation in liquid depending on the circuit parameters are analyzed for the prediction of the ground boundary displacement. The dynamics of the shock-wave propagation in water-ground condensed media depending on the rate of the plasma channel energy release is investigated. Simulation of the shock-wave phenomena at a plasma-vapor bubble oscillation in condensed media consecutively describes the physical processes underlying technology for producing piles by electro-discharge stuffing. The quantitative model verified by physical experimental tests will allow optimization of pulse generator parameters and electrode system construction of high-voltage equipment.

  17. Dosimetric feasibility of cone-beam CT-based treatment planning compared to CT-based treatment planning

    SciTech Connect

    Yoo, Sua . E-mail: sua.yoo@duke.edu; Yin, F.-F.

    2006-12-01

    Purpose: Cone-beam computed tomography (CBCT) images are currently used for positioning verification. However, it is yet unknown whether CBCT could be used in dose calculation for replanning in adaptive radiation therapy. This study investigates the dosimetric feasibility of CBCT-based treatment planning. Methods and Materials: Hounsfield unit (HU) values and profiles of Catphan, homogeneous/inhomogeneous phantoms, and various tissue regions of patients in CBCT images were compared to those in CT. The dosimetric consequence of the HU variation was investigated by comparing CBCT-based treatment plans to conventional CT-based plans for both phantoms and patients. Results: The maximum HU difference between CBCT and CT of Catphan was 34 HU in the Teflon. The differences in other materials were less than 10 HU. The profiles for the homogeneous phantoms in CBCT displayed reduced HU values up to 150 HU in the peripheral regions compared to those in CT. The scatter and artifacts in CBCT became severe surrounding inhomogeneous tissues with reduced HU values up to 200 HU. The MU/cGy differences were less than 1% for most phantom cases. The isodose distributions between CBCT-based and CT-based plans agreed very well. However, the discrepancy was larger when CBCT was scanned without a bowtie filter than with bowtie filter. Also, up to 3% dosimetric error was observed in the plans for the inhomogeneous phantom. In the patient studies, the discrepancies of isodose lines between CT-based and CBCT-based plans, both 3D and IMRT, were less than 2 mm. Again, larger discrepancy occurred for the lung cancer patients. Conclusion: This study demonstrated the feasibility of CBCT-based treatment planning. CBCT-based treatment plans were dosimetrically comparable to CT-based treatment plans. Dosimetric data in the inhomogeneous tissue regions should be carefully validated.

  18. Weighted log-rank statistic to compare shared-path adaptive treatment strategies.

    PubMed

    Kidwell, Kelley M; Wahed, Abdus S

    2013-04-01

    Adaptive treatment strategies (ATSs) more closely mimic the reality of a physician's prescription process where the physician prescribes a medication to his/her patient, and based on that patient's response to the medication, modifies the treatment. Two-stage randomization designs, more generally, sequential multiple assignment randomization trial designs, are useful to assess ATSs where the interest is in comparing the entire sequence of treatments, including the patient's intermediate response. In this paper, we introduce the notion of shared-path and separate-path ATSs and propose a weighted log-rank statistic to compare overall survival distributions of multiple two-stage ATSs, some of which may be shared-path. Large sample properties of the statistic are derived and the type I error rate and power of the test are compared with the standard log-rank test through simulation.

  19. Cost-effectiveness of bazedoxifene compared with raloxifene in the treatment of postmenopausal osteoporotic women.

    PubMed

    Hiligsmann, Mickael; Ben Sedrine, Wafa; Reginster, Jean-Yves

    2013-04-01

    Bazedoxifene is a novel selective estrogen receptor modulator (SERM) for the prevention and treatment of osteoporosis. In addition to the therapeutic value of a new agent, evaluation of the cost-effectiveness compared with relevant alternative treatment(s) is an important consideration to facilitate healthcare decision making. This study evaluated the cost-effectiveness of bazedoxifene compared with raloxifene for the treatment of postmenopausal women with osteoporosis. The cost-effectiveness of treatment for 3 years with bazedoxifene was compared with raloxifene using an updated version of a previously validated Markov microsimulation model. Analyses were conducted from a Belgian healthcare payer perspective and, the base-case population was women (aged 70 years) with bone mineral density T-score ≤ -2.5. The effects of bazedoxifene and raloxifene on fracture risk were derived from the 3-year results of a randomized, double-blind, placebo-controlled and active-controlled study, including postmenopausal women with osteoporosis. The cost-effectiveness analysis based on efficacy data from the overall clinical trial indicated that bazedoxifene and raloxifene were equally cost-effective. When the results were examined based on the subgroup analysis of women at higher risk of fractures, bazedoxifene was dominant (lower cost for higher effectiveness) compared with raloxifene in most of the simulations. Sensitivity analyses confirmed the robustness of the results, which were largely independent of starting age of treatment, fracture risk, cost, and disutility. In addition, when the cost of raloxifene was reduced by one-half or when incorporating the raloxifene effects on reducing breast cancer, bazedoxifene remained cost-effective, at a threshold of €35,000 per quality-adjusted life-years gained, in 85% and 68% of the simulations, respectively. Under the assumption of improved antifracture efficacy of bazedoxifene over raloxifene in women with high risk of fractures

  20. [Extracorporeal shockwave lithotripsy in patients with coagulation disorders].

    PubMed

    Ruiz Marcellán, F J; Mauri Cunill, A; Cabré Fabré, P; Argentino Gancedo Rodríguez, V; Güell Oliva, J A; Ibarz Servio, L; Ramón Dalmau, M

    1992-03-01

    During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.

  1. Additional treatment of wastewater reduces endocrine disruption in wild fish--a comparative study of tertiary and advanced treatments.

    PubMed

    Baynes, Alice; Green, Christopher; Nicol, Elizabeth; Beresford, Nicola; Kanda, Rakesh; Henshaw, Alan; Churchley, John; Jobling, Susan

    2012-05-15

    Steroid estrogens are thought to be the major cause of feminization (intersex) in wild fish. Widely used wastewater treatment technologies are not effective at removing these contaminants to concentrations thought to be required to protect aquatic wildlife. A number of advanced treatment processes have been proposed to reduce the concentrations of estrogens entering the environment. Before investment is made in such processes, it is imperative that we compare their efficacy in terms of removal of steroid estrogens and their feminizing effects with other treatment options. This study assessed both steroid removal and intersex induction in adult and early life stage fish (roach, Rutilus rutilus). Roach were exposed directly to either secondary (activated sludge process (ASP)), tertiary (sand filtrated (SF)), or advanced (chlorine dioxide (ClO(2)), granular activated charcoal (GAC)) treated effluents for six months. Surprisingly, both the advanced GAC and tertiary SF treatments (but not the ClO(2) treatment) significantly removed the intersex induction associated with the ASP effluent; this was not predicted by the steroid estrogen measurements, which were higher in the tertiary SF than either the GAC or the ClO(2). Therefore our study highlights the importance of using both biological and chemical analysis when assessing new treatment technologies.

  2. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder.

    PubMed

    Pollack, Mark H; Simon, Naomi M; Worthington, John J; Doyle, Alicia L; Peters, Patricia; Toshkov, Fany; Otto, Michael W

    2003-09-01

    Despite the widespread application of combined selective serotonin reuptake inhibitors (SSRI) and benzodiazepine treatment for panic disorder, there has been relatively little systematic assessment of the safety and efficacy of this therapeutic strategy. Although the limited number of studies to date suggest a more rapid onset of benefit with combined treatment, this study is the first to address the critical question of whether continued combined treatment confers superior efficacy. This study is a randomized, double-blind, three-arm study in patients with panic disorder (n = 60), comparing the efficacy and safety of paroxetine and placebo (PP), paroxetine coadministered with clonazepam followed by a tapered benzodiazepine discontinuation phase (PC-D), and ongoing combination treatment (PC-M). All treatment groups demonstrated significant improvement by endpoint. There was a significant advantage for the combined treatment groups early in treatment but, subsequently, outcome in all three groups was similar. A trend towards greater achievement of endpoint remission status for the PC-D group was attenuated when variability in baseline severity was considered. The results of this study should be interpreted in the context of a relatively moderate sample size and higher rates of early dropout. Combined treatment with paroxetine and clonazepam resulted in more rapid response than with the SSRI alone, but there was no differential benefit beyond the initial few weeks of therapy. Initiating combined treatment followed by benzodiazepine taper after a few weeks may provide early benefit while avoiding the potential adverse consequences of long-term combination therapy.

  3. Meta-analysis Comparing Different Behavioral Treatments for Late-Life Anxiety

    PubMed Central

    Thorp, Steven R.; Ayers, Catherine R.; Nuevo, Roberto; Stoddard, Jill A.; Sorrell, John T.; Wetherell, Julie Loebach

    2009-01-01

    Objective To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety [cognitive-behavioral therapy (CBT) alone, CBT with relaxation training (RT), and RT alone]. Method We compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing post-treatment and pre-treatment scores) and effects relative to control conditions on both anxiety and depressive symptoms. Results Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not appear to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. Conclusion Results suggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies. PMID:19155744

  4. Explosively driven two-shockwave tools with application to ejecta formation at the Los Alamos National Laboratory Proton Radiography Facility

    NASA Astrophysics Data System (ADS)

    Buttler, William

    2013-06-01

    We present the development of an explosively driven physics tool to generate two mostly uniaxial shockwaves. The tool is being used to extend single shockwave ejecta models to a subsequent shockwave event separated by a time interval on the order of a few microseconds. We explore the possibility of varying the amplitude of both the first and second shockwaves, and we apply the tool in experimental geometries on Sn with a surface roughness of Ra = 0 . 8 μ m. We then evaluate the tool further at the Los Alamos National Laboratory Proton Radiography (pRad) Facility in an application to Sn with larger scale perturbations of wavelength 550 μ m, and various amplitudes that gave wave-number amplitude products of η0 2 π / λ = { 3 / 4 , 1 / 2 , 1 / 4 , 1 / 8 } , where the perturbation amplitude is η0, and the wave-number k = 2 π / λ . The pRad data and velocimetry imply it should be possible to develop a second shock ejecta model based on unstable Richtmyer-Meshkov physics. In collaboration with David Oro, Fesseha Mariam, Alexander Saunders, Malcolm Andrews, Frank Cherne, James Hammerberg. Robert Hixson, Christopher Morris, Russell Olson, Dean Preston, Joseph Stone, Dale Tupa, and Wendy Vogan-McNeil, Los Alamos National Laboratory,

  5. Comparing drinking water treatment costs to source water protection costs using time series analysis

    NASA Astrophysics Data System (ADS)

    Heberling, Matthew T.; Nietch, Christopher T.; Thurston, Hale W.; Elovitz, Michael; Birkenhauer, Kelly H.; Panguluri, Srinivas; Ramakrishnan, Balaji; Heiser, Eric; Neyer, Tim

    2015-11-01

    We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reduction in the watershed rather than pay for treatment on site. To illustrate, we use daily observations from 2007 to 2011 for the Bob McEwen Water Treatment Plant, Clermont County, Ohio, to understand the relationship between treatment costs and water quality and operational variables (e.g., turbidity, total organic carbon [TOC], pool elevation, and production volume). Part of our contribution to understanding drinking water treatment costs is examining both long-run and short-run relationships using error correction models (ECMs). Treatment costs per 1000 gallons (per 3.79 m3) were based on chemical, pumping, and granular activated carbon costs. Results from the ECM suggest that a 1% decrease in turbidity decreases treatment costs by 0.02% immediately and an additional 0.1% over future days. Using mean values for the plant, a 1% decrease in turbidity leads to $1123/year decrease in treatment costs. To compare these costs with source water protection costs, we use a polynomial distributed lag model to link total phosphorus loads, a source water quality parameter affected by land use changes, to turbidity at the plant. We find the costs for source water protection to reduce loads much greater than the reduction in treatment costs during these years. Although we find no incentive to protect source water in our case study, this framework can help DWTPs quantify the trade-offs.

  6. A model for traumatic brain injury using laser induced shockwaves

    NASA Astrophysics Data System (ADS)

    Selfridge, A.; Preece, D.; Gomez, V.; Shi, L. Z.; Berns, M. W.

    2015-08-01

    Traumatic brain injury (TBI) represents a major treatment challenge in both civilian and military medicine; on the cellular level, its mechanisms are poorly understood. As a method to study the dysfunctional repair mechanisms following injury, laser induced shock waves (LIS) are a useful way to create highly precise, well characterized mechanical forces. We present a simple model for TBI using laser induced shock waves as a model for damage. Our objective is to develop an understanding of the processes responsible for neuronal death, the ways in which we can manipulate these processes to improve cell survival and repair, and the importance of these processes at different levels of biological organization. The physics of shock wave creation has been modeled and can be used to calculate forces acting on individual neurons. By ensuring that the impulse is in the same regime as that occurring in practical TBI, the LIS model can ensure that in vitro conditions and damage are similar to those experienced in TBI. This model will allow for the study of the biochemical response of neurons to mechanical stresses, and can be combined with microfluidic systems for cell growth in order to better isolate areas of damage.

  7. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.

    PubMed

    Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

    2011-02-01

    The purpose of this study was to determine and compare the efficacy of kinesio tape and physical therapy modalities in patients with shoulder impingement syndrome. Patients (n = 55) were treated with kinesio tape (n = 30) three times by intervals of 3 days or a daily program of local modalities (n = 25) for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping (20, 40, and 50, respectively) group were statistically significantly lower (p values were 0.001, 0.01, and 0.001, respectively) at the first week examination as compared with the physical therapy group (50, 70, and 70, respectively). However, there was no significant difference in the same parameters between two groups at the second week (0.109, 0.07, and 0.218 for rest, night, and movement median pain scores, respectively). Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

  8. Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

    PubMed

    Ottaviani, F; Marchisio, P; Arisi, E; Capaccio, P

    2001-10-01

    Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

  9. A comparative analysis of standard and alternative antidepressants in the treatment of human immunodeficiency virus patients.

    PubMed

    Wagner, G J; Rabkin, J G; Rabkin, R

    1996-01-01

    Our research group has conducted clinical trials of standard (imipramine, fluoxetine, and sertraline) and alternative antidepressants (dextroamphetamine and testosterone replacement therapy) in the treatment of clinical depression among patients with human immunodeficiency virus (HIV) illness. This report presents secondary analyses of data pooled from these trials with the purpose of comparing the antidepressant efficacy of these various agents. In all trials, a DSM-III-R depressive disorder was the primary criterion for study entry, and each treatment resulted in significant improvement after both 2 and 6 weeks of treatment according to the Hamilton Depression Rating Scale (HDRS). Response rates for standard antidepressants ranged from 70% to 74%, with similar, high response rates found in trials of dextroamphetamine (93%) and testosterone (81%). The response rate of each active drug treatment was superior to that of placebo (33%). Each treatment was well-tolerated in terms of side effects, and there was essentially no effect of any treatment on CD4 cell count. Differences in trial design, entrance criteria, and measurements require that caution be used in interpreting these results; nonetheless, each of the five treatments studied demonstrated strong efficacy and possessed relatively unique benefits, providing health care providers with valuable treatment options in addressing individual needs of patients.

  10. RANS Modeling of Benchmark Shockwave / Boundary Layer Interaction Experiments

    NASA Technical Reports Server (NTRS)

    Georgiadis, Nick; Vyas, Manan; Yoder, Dennis

    2010-01-01

    This presentation summarizes the computations of a set of shock wave / turbulent boundary layer interaction (SWTBLI) test cases using the Wind-US code, as part of the 2010 American Institute of Aeronautics and Astronautics (AIAA) shock / boundary layer interaction workshop. The experiments involve supersonic flows in wind tunnels with a shock generator that directs an oblique shock wave toward the boundary layer along one of the walls of the wind tunnel. The Wind-US calculations utilized structured grid computations performed in Reynolds-averaged Navier-Stokes mode. Three turbulence models were investigated: the Spalart-Allmaras one-equation model, the Menter Shear Stress Transport wavenumber-angular frequency two-equation model, and an explicit algebraic stress wavenumber-angular frequency formulation. Effects of grid resolution and upwinding scheme were also considered. The results from the CFD calculations are compared to particle image velocimetry (PIV) data from the experiments. As expected, turbulence model effects dominated the accuracy of the solutions with upwinding scheme selection indicating minimal effects.!

  11. Brazilian Green Propolis Compared to Miconazole Gel in the Treatment of Candida-Associated Denture Stomatitis

    PubMed Central

    Capistrano, Hermínia Marques; de Assis, Eliene Magda; Leal, Rosana Maria; Alvarez-Leite, Maria Eugênia; Brener, Sylvie; Bastos, Esther Margarida Alves Ferreira

    2013-01-01

    Aim. To evaluate the efficacy of Brazilian green propolis in comparison to miconazole gel in the treatment of Candida-associated denture stomatitis. Methods. Forty-five denture stomatitis patients, with palatal mucosa erythema levels classified according to Newtons's criteria and with positive culture to Candida spp., were randomly divided into three treatment groups: 15 received miconazole gel 2%, 15 received propolis gel 2,5%, and 15 received propolis 24% for mouthwash. After four daily use lasting two weeks, they were reexamined for the denture stomatitis degree and for a second culture of Candida. The Wilcoxon's test was applied to compare the results of clinical classification of the denture stomatitis and the Candida spp. colonies numbers, before and after each treatment. The Kruskall-Wallis's test was used to compare efficacy among the three treatment groups. Results. There were a significant reduction or complete remission of denture stomatitis (P < 0.05) and a significant decrease of Candida colonies for the three groups (P < 0.05). There was no difference in the efficacy among the treatment groups (P > 0.05). Conclusion. Brazilian green propolis has a similar effect as miconazole in the treatment of Candida-associated denture stomatitis being an alternative in the therapeutics of this condition. PMID:23737855

  12. DUI/DWAI Offenders Compared to Clients Seen in an Outpatient Alcohol-Treatment Facility.

    ERIC Educational Resources Information Center

    Packard, Michele A.

    1987-01-01

    Examined client records to compare 50 subjects admitted to a drinking-driver program and 50 subjects admitted to an outpatient alcohol treatment clinic. Highly significant differences were found between groups on 10 of 12 drinking indices, suggesting that clients referred for alcohol-related traffic offenses represent a population different from…

  13. Treatment Gain for Sexual Offenders against Children Predicts Reduced Recidivism: A Comparative Validity Study

    ERIC Educational Resources Information Center

    Beggs, Sarah M.; Grace, Randolph C.

    2011-01-01

    Objective: To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. Method: We compared 3…

  14. Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

    ERIC Educational Resources Information Center

    Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

    2016-01-01

    Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

  15. Comparing Cognitive Behavior Therapy, Problem Solving Therapy, and Treatment as Usual in a High Risk Population

    ERIC Educational Resources Information Center

    Stewart, Carment D.; Quinn, Andrea; Plever, Sally; Emmerson, Brett

    2009-01-01

    Cognitive behavior therapy (CBT), problem-solving therapy (PST), or treatment as usual (TAU) were compared in the management of suicide attempters. Participants completed the Beck Hopelessness Scale, Beck Scale for Suicidal Ideation, Social Problem-Solving Inventory, and Client Satisfaction Questionnaire at pre- and posttreatment. Both CBT and PST…

  16. Comparing the Effects of Four Instructional Treatments on EFL Students' Achievement in Writing Classified Ads

    ERIC Educational Resources Information Center

    Khodabandeh, Farzaneh

    2016-01-01

    The current study set out to compare the effect of traditional and non-traditional instructional treatments; i.e. explicit, implicit, task-based and no-instruction approaches on students' abilities to learn how to write classified ads. 72 junior students who have all taken a course in Reading Journalistic Texts at the Payame-Noor University…

  17. COMPARING RBF WITH BENCH-SCALE CONVENTIONAL TREATMENT FOR PRECURSOR REDUCTION

    EPA Science Inventory

    The reduction of disinfection by-product (DBP) precursors upon riverbank filtration (RBF) at three drinking water utilities in the mid-Western United States was compared with that obtained using a bench-scale conventional treatment train on the corresponding river waters. The riv...

  18. Comparing Spoken Language Treatments for Minimally Verbal Preschoolers with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Paul, Rhea; Campbell, Daniel; Gilbert, Kimberly; Tsiouri, Ioanna

    2013-01-01

    Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in…

  19. Comparative effectiveness of imaging modalities to determine metastatic breast cancer treatment response.

    PubMed

    Lee, Christoph I; Gold, Laura S; Nelson, Heidi D; Chou, Roger; Ramsey, Scott D; Sullivan, Sean D

    2015-02-01

    We performed a systematic review to address the comparative effectiveness of different imaging modalities in evaluating treatment response among metastatic breast cancer patients. We searched seven multidisciplinary electronic databases for relevant publications (January 2003-December 2013) and performed dual abstraction of details and results for all clinical studies that involved stage IV breast cancer patients and evaluated imaging for detecting treatment response. Among 159 citations reviewed, 17 single-institution, non-randomized, observational studies met our inclusion criteria. Several studies demonstrate that changes in PET/CT standard uptake values are associated with changes in tumor volume as determined by bone scan, MRI, and/or CT. However, no studies evaluated comparative test performance between modalities or determined relationships between imaging findings and subsequent clinical decisions. Evidence for imaging's effectiveness in determining treatment response among metastatic breast cancer patients is limited. More rigorous research is needed to address imaging's value in this patient population.

  20. Counteraction between overshadowing and degraded contingency treatments: support for the extended comparator hypothesis.

    PubMed

    Urcelay, Gonzalo P; Miller, Ralph R

    2006-01-01

    Four experiments using rats in a Pavlovian lick-suppression preparation investigated the effects of combining 2 treatments known for their response-decrementing effects, namely, overshadowing and degraded contingency. Contrary to most contemporary learning theories, the extended comparator hypothesis predicts that these 2 treatments will counteract each other, and therefore, less of a decrement in conditioned responding should be observed than with either treatment alone. Experiments 1 and 2 confirmed this prediction in first-order conditioning and sensory preconditioning preparations, respectively. Experiment 3 demonstrated that posttraining extinction of the training context resulted in a recovery from degraded contingency and reversed the counteractive effect on overshadowing. Finally, Experiment 4 demonstrated that posttraining extinction of the overshadowing stimulus resulted in recovery from simple overshadowing and also reversed the counteractive effect on degraded contingency. These results are consistent with the extended comparator hypothesis but not traditional or recent acquisition-focused models.

  1. Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India.

    PubMed

    Prinja, Shankar; Kaur, Gunjeet; Malhotra, Pankaj; Jyani, Gaurav; Ramachandran, Raja; Bahuguna, Pankaj; Varma, Subhash

    2017-03-01

    Recent innovations in treatment of multiple myeloma include autologous stem cell transplantation (ASCT) along with high dose chemotherapy (HDC). We undertook this study to estimate incremental cost per quality adjusted life year gained (QALY) with use of ASCT along with HDC as compared to conventional chemotherapy (CC) alone in treatment of multiple myeloma. A combination of decision tree and markov model was used to undertake the analysis. Incremental costs and effects of ASCT were compared against the baseline scenario of CC (based on Melphalan and Prednisolone regimen) in the patients of multiple myeloma. A lifetime study horizon was used and future costs and consequences were discounted at 5%. Consequences were valued in terms of QALYs. Incremental cost per QALY gained using ASCT as against CC for treatment of multiple myeloma was estimated using both a health system and societal perspective. The cost of providing ASCT (with HDC) for multiple myeloma patients was INR 500,631, while the cost of CC alone was INR 159,775. In the long run, cost per patient per year for ASCT and CC arms was estimated to be INR 119,740 and INR 111,565 respectively. The number of QALYs lived per patient in case of ASCT and HDC alone were found to be 4.1 and 3.5 years respectively. From a societal perspective, ASCT was found to incur an incremental cost of INR 334,433 per QALY gained. If the ASCT is initiated early to patients, the incremental cost for ASCT was found to be INR 180,434 per QALY gained. With current mix of patients, stem cell treatment for multiple myeloma is not cost effective at a threshold of GDP per capita. It becomes marginally cost-effective at 3-times the GDP per capita threshold. However, accounting for the model uncertainties, the probability of ASCT to be cost effective is 59%. Cost effectiveness of ASCT can be improved with early detection and initiation of treatment.

  2. A mixed treatment comparison to compare the efficacy and safety of botulinum toxin treatments for cervical dystonia.

    PubMed

    Han, Yi; Stevens, Andrea L; Dashtipour, Khashayar; Hauser, Robert A; Mari, Zoltan

    2016-04-01

    A systematic pair-wise comparison of all available botulinum toxin serotype A and B treatments for cervical dystonia (CD) was conducted, as direct head-to-head clinical trial comparisons are lacking. Five botulinum toxin products: Dysport(®) (abobotulinumtoxinA), Botox(®) (onabotulinumtoxinA), Xeomin(®) (incobotulinumtoxinA), Prosigne(®) (Chinese botulinum toxin serotype A) and Myobloc(®) (rimabotulinumtoxinB) have demonstrated efficacy for managing CD. A pair-wise efficacy and safety comparison was performed for all toxins based on literature-reported clinical outcomes. Multi-armed randomized controlled trials (RCTs) were identified for inclusion using a systematic literature review, and assessed for comparability based on patient population and efficacy outcome measures. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was selected as the efficacy outcome measurement for assessment. A mixed treatment comparison (MTC) was conducted using a Bayesian hierarchical model allowing indirect comparison of the interventions. Due to the limitation of available clinical data, this study only investigated the main effect of toxin treatments without explicitly considering potential confounding factors such as gender and formulation differences. There was reasonable agreement between the number of unconstrained data points, residual deviance and pair-wise results. This research suggests that all botulinum toxin serotype A and serotype B treatments were effective compared to placebo in treating CD, with the exception of Prosigne. Based on this MTC analysis, there is no significant efficacy difference between Dysport, Botox, Xeomin and Myobloc at week four post injection. Of the adverse events measured, neither dysphagia nor injection site pain was significantly greater in the treatment or placebo groups.

  3. [Comparative assessment of conservative treatment of chronic prostatitis with application of complex unit andro-gin].

    PubMed

    Golubchikova, V A; Alekseev, M Ia; Sitnikov, N V; Kochetov, A G; Podgornyĭ, V F

    2000-01-01

    The Andro-Gin unit used in combined treatment of 78 patients with chronic prostatitis (CP) and 16 women with chronic interstitial cystitis with inflammation in the internal genitalia (56.5% of the patients had sexual and spermatogenesis disorders) employed effects of simultaneous exposure to local magnetic field, electrostimulation of the small pelvis organs and prostate with introduction of contact rectal electrode, neurostimulation of pathogenic zones, low-intensity laser and light-diode radiator and color impulse therapy. Control group consisted of 85 patients with CP who received conventional physiotherapy. The comparative analysis has shown high efficiency of the unit Andro-Gin in the treatment of CP and its complications. Laboratory and clinical convalescence and persistent remission was registered in 98% of the patients of the study group. Combined treatment using Andro-Gin is twice more effective than other treatments.

  4. Comparative Effects of Gamma Irradiation and Ozone Treatment on Hygienic Quality of Korean Red Ginseng Powder

    NASA Astrophysics Data System (ADS)

    Byun, Myung-Woo; Yook, Hong-Sun; Kang, Il-Jun; Chung, Cha-Kwon; Kwon, Joong-Ho; Choi, Kang-Ju

    1998-06-01

    For the purpose of improving hygienic quality of Korean red ginseng powder, the comparative effects of gamma irradiation and ozone treatment on the microbial and physicochemical properties were investigated. Gamma irradiation at 7.5 kGy resulted in sterilization of total aerobic bacteria, molds and coliforms below detective levels, while ozone treatment for 8 hours up to 18 ppm did not sufficiently eliminate the microorganisms of the red ginseng powder. Physicochemical properties including compositions of the red ginseng saponin (ginsenosides) and fatty acids, pH and hydrogen doanting activity were not significantly changed by gamma irradiation, whereas, ozone treatment caused significant changes in fatty acid compositions, TBA value, pH, acidity and hydrogen donating activity. The results from this study led us to conclude that gamma irradiation was more effective than ozone treatment both for the improvement of hygienic quality and for the maintenance of physicochemical quality of red ginseng powder.

  5. Automatic identification of comparative effectiveness research from Medline citations to support clinicians’ treatment information needs

    PubMed Central

    Zhang, Mingyuan; Fiol, Guilherme Del; Grout, Randall W.; Jonnalagadda, Siddhartha; Medlin, Richard; Mishra, Rashmi; Weir, Charlene; Liu, Hongfang; Mostafa, Javed; Fiszman, Marcelo

    2014-01-01

    Online knowledge resources such as Medline can address most clinicians’ patient care information needs. Yet, significant barriers, notably lack of time, limit the use of these sources at the point of care. The most common information needs raised by clinicians are treatment-related. Comparative effectiveness studies allow clinicians to consider multiple treatment alternatives for a particular problem. Still, solutions are needed to enable efficient and effective consumption of comparative effectiveness research at the point of care. Objective Design and assess an algorithm for automatically identifying comparative effectiveness studies and extracting the interventions investigated in these studies. Methods The algorithm combines semantic natural language processing, Medline citation metadata, and machine learning techniques. We assessed the algorithm in a case study of treatment alternatives for depression. Results Both precision and recall for identifying comparative studies was 0.83. A total of 86% of the interventions extracted perfectly or partially matched the gold standard. Conclusion Overall, the algorithm achieved reasonable performance. The method provides building blocks for the automatic summarization of comparative effectiveness research to inform point of care decision-making. PMID:23920677

  6. [Effectiveness of treatment of varicose veins assessed by epidemiological comparative studies].

    PubMed

    Górski, Grzegorz; Kielar, Maciej; Porzycki, Piotr; Sobański, Paweł; Noszczyk, Wojciech

    2004-07-01

    Effectiveness of varicose veins (VV) management, due to high prevalence of this condition, is an important medical, social and economical issue. The aim of the study was to compare cost effectiveness of VV treatment by comparison of the results of two epidemiological surveys performed in Warsaw Bródno population, in 1982-1984 (group I, n=4997) and 1998-2000 (group 11, n=3556). Analysis compared prevalence of varicose veins, venous ulcers, deep vein thrombosis (DVT) in relation to number of VV procedures performed, and cost of conservative and surgical treatment, subjective patients' assessment of treatment results. Varicose veins prevalence has not changed significantly in group I was 15.7% (men 9.3%, women 20.1%) vs. 13.7% (men 8.7%, women 15.9%) in group II. Similarly, prevalence of venous ulcers (0.76% vs 0.73%), and previous DVT among VV patients (8.9% vs 8.9%) have not changed in both groups. Percentage of patients treated surgically in relation to all VV patients (19.7% vs 26.1%), as well as treated conservatively (45.2% vs 48.8%) increased, the latter mainly due to significant increase of ratio of patients treated with phlebotropic drugs. Patients'assessment of conservative and surgical treatment has improved dramatically, cost of treatment remained similar. Despite significant surgical and conservative treatment efforts, prevalence of essential venous diseases in hospital catchment area remained unchanged. Amount of patients satisfied both with surgical and conservative treatment increased, perhaps mainly due to better efficacy of phlebotropic drugs and better access to specialist care. On the other hand, significant amount of patients doesn't start any treatment at all. We conclude that preventive varicose veins surgery during early stage of disease may not diminish prevalence of serious venous complications.

  7. Comparative efficacy and safety of mavacoxib and carprofen in the treatment of canine osteoarthritis

    PubMed Central

    Payne-Johnson, M; Becskei, C; Chaudhry, Y; Stegemann, M R

    2015-01-01

    A multi-site, masked, randomised parallel group study employing a double dummy treatment design was performed in canine veterinary patients to determine the comparative efficacy and safety of mavacoxib and carprofen in the treatment of pain and inflammation associated with osteoarthritis for a period of 134 days. Treatments were administered according to their respective summaries of product characteristics. Of 139 dogs screened, 124 were suitable for study participation: 62 of which were dosed with mavacoxib and 62 with carprofen. Both treatments resulted in a very similar pattern of considerable improvement as indicated in all parameters assessed by both owner and veterinarian. The primary efficacy endpoint ‘overall improvement’ was a composite score of owner assessments after approximately six weeks of treatment. Both drugs were remarkably effective, with 57/61 (93.4 per cent) of mavacoxib-treated dogs and 49/55 (89.1 per cent) of carprofen-treated dogs demonstrating overall improvement and with mavacoxib's efficacy being non-inferior to carprofen. The treatments had a similar safety profile as evidenced by documented adverse events and summaries of clinical pathology parameters. The positive clinical response to treatment along with the safety and dosing regimen of mavacoxib makes it an attractive therapy for canine osteoarthritis. PMID:25433056

  8. Bayesian sample sizes for exploratory clinical trials comparing multiple experimental treatments with a control.

    PubMed

    Whitehead, John; Cleary, Faye; Turner, Amanda

    2015-05-30

    In this paper, a Bayesian approach is developed for simultaneously comparing multiple experimental treatments with a common control treatment in an exploratory clinical trial. The sample size is set to ensure that, at the end of the study, there will be at least one treatment for which the investigators have a strong belief that it is better than control, or else they have a strong belief that none of the experimental treatments are substantially better than control. This criterion bears a direct relationship with conventional frequentist power requirements, while allowing prior opinion to feature in the analysis with a consequent reduction in sample size. If it is concluded that at least one of the experimental treatments shows promise, then it is envisaged that one or more of these promising treatments will be developed further in a definitive phase III trial. The approach is developed in the context of normally distributed responses sharing a common standard deviation regardless of treatment. To begin with, the standard deviation will be assumed known when the sample size is calculated. The final analysis will not rely upon this assumption, although the intended properties of the design may not be achieved if the anticipated standard deviation turns out to be inappropriate. Methods that formally allow for uncertainty about the standard deviation, expressed in the form of a Bayesian prior, are then explored. Illustrations of the sample sizes computed from the new method are presented, and comparisons are made with frequentist methods devised for the same situation.

  9. Anaerobic treatment of methanol condensate from pulp mill compared with anaerobic treatment of methanol using mesophilic UASB reactors.

    PubMed

    Badshah, Malik; Parawira, Wilson; Mattiasson, Bo

    2012-12-01

    The feasibility of anaerobic treatment of methanol condensate from pulp and paper mill in UASB reactor was investigated and compared with the anaerobic treatment of methanol. The UASB reactor treating methanol condensate was operated for 480 days with minimum problems of overload. COD removal from methanol condensate and methanol under normal operating conditions ranged from 84-86% to 86-98%, respectively. Under optimal conditions (OLR=5.0 g COD L(-1)day(-1), COD(influent)=11.40 g L(-1)) a methane yield of 0.29 NL CH(4) per g COD(removed) (at standard temperature and pressure) was achieved during the treatment of methanol condensate. The recovery time of the microorganisms after several overloads was decreasing each time probably due to the adaptation to methanol condensate. These findings indicate that methanol condensate can be efficiently treated in a UASB reactor with the benefit of biogas production. As a bonus effect of the treatment, much of the smell of the feed was eliminated.

  10. Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy.

    PubMed

    Sun, Dongmei; Shehata, Nadine; Ye, Xiang Y; Gregorovich, Sandra; De France, Bryon; Arnold, Donald M; Shah, Prakesh S; Malinowski, Ann Kinga

    2016-09-08

    Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 × 10(9)/L vs corticosteroids 77 × 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 × 10(9)/L and 18 (9%) had platelet counts <50 × 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 × 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP.

  11. Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status

    PubMed Central

    2014-01-01

    Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico. PMID:25074067

  12. Comparative assessment of the environmental sustainability of existing and emerging perchlorate treatment technologies for drinking water.

    PubMed

    Choe, Jong Kwon; Mehnert, Michelle H; Guest, Jeremy S; Strathmann, Timothy J; Werth, Charles J

    2013-05-07

    Environmental impacts of conventional and emerging perchlorate drinking water treatment technologies were assessed using life cycle assessment (LCA). Comparison of two ion exchange (IX) technologies (i.e., nonselective IX with periodic regeneration using brines and perchlorate-selective IX without regeneration) at an existing plant shows that brine is the dominant contributor for nonselective IX, which shows higher impact than perchlorate-selective IX. Resource consumption during the operational phase comprises >80% of the total impacts. Having identified consumables as the driving force behind environmental impacts, the relative environmental sustainability of IX, biological treatment, and catalytic reduction technologies are compared more generally using consumable inputs. The analysis indicates that the environmental impacts of heterotrophic biological treatment are 2-5 times more sensitive to influent conditions (i.e., nitrate/oxygen concentration) and are 3-14 times higher compared to IX. However, autotrophic biological treatment is most environmentally beneficial among all. Catalytic treatment using carbon-supported Re-Pd has a higher (ca. 4600 times) impact than others, but is within 0.9-30 times the impact of IX with a newly developed ligand-complexed Re-Pd catalyst formulation. This suggests catalytic reduction can be competitive with increased activity. Our assessment shows that while IX is an environmentally competitive, emerging technologies also show great promise from an environmental sustainability perspective.

  13. Quality of Life in 807 Patients with Vestibular Schwannoma: Comparing Treatment Modalities.

    PubMed

    Soulier, Géke; van Leeuwen, Bibian M; Putter, Hein; Jansen, Jeroen C; Malessy, Martijn J A; van Benthem, Peter Paul G; van der Mey, Andel G L; Stiggelbout, Anne M

    2017-03-01

    Objective In vestibular schwannoma treatment, the choice among treatment modalities is controversial. The first aim of this study was to examine the quality of life of patients with vestibular schwannoma having undergone observation, radiation therapy, or microsurgical resection. The second aim was to examine the relationship between perceived symptoms and quality of life. Last, the association between quality of life and time since treatment was studied. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods A total of 1208 patients treated for sporadic vestibular schwannoma between 2004 and 2014 were mailed the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and additional questions on symptoms associated with vestibular schwannoma. Total and domain scores were calculated and compared among treatment groups. Propensity scores were used, and results were stratified according to tumor size to control for potential confounders. Correlations were calculated to examine the relationship between self-reported symptoms and quality of life, as well as between quality of life and time since treatment. Results Patients with small tumors (≤10 mm) under observation showed a higher PANQOL score when compared with the radiation therapy and microsurgical resection groups. A strong negative correlation was found between self-reported symptoms and quality of life, with balance problems and vertigo having the largest impact. No correlation was found between PANQOL score and time since treatment. Conclusion This study suggests that patients with small vestibular schwannomas experience better quality of life when managed with observation than do patients who have undergone active treatment.

  14. Comparative analysis of 11 different radioisotopes for palliative treatment of bone metastases by computational methods

    SciTech Connect

    Guerra Liberal, Francisco D. C. E-mail: adriana-tavares@msn.com; Tavares, Adriana Alexandre S. E-mail: adriana-tavares@msn.com; Tavares, João Manuel R. S.

    2014-11-01

    Purpose: Throughout the years, the palliative treatment of bone metastases using bone seeking radiotracers has been part of the therapeutic resources used in oncology, but the choice of which bone seeking agent to use is not consensual across sites and limited data are available comparing the characteristics of each radioisotope. Computational simulation is a simple and practical method to study and to compare a variety of radioisotopes for different medical applications, including the palliative treatment of bone metastases. This study aims to evaluate and compare 11 different radioisotopes currently in use or under research for the palliative treatment of bone metastases using computational methods. Methods: Computational models were used to estimate the percentage of deoxyribonucleic acid (DNA) damage (fast Monte Carlo damage algorithm), the probability of correct DNA repair (Monte Carlo excision repair algorithm), and the radiation-induced cellular effects (virtual cell radiobiology algorithm) post-irradiation with selected particles emitted by phosphorus-32 ({sup 32}P), strontium-89 ({sup 89}Sr), yttrium-90 ({sup 90}Y ), tin-117 ({sup 117m}Sn), samarium-153 ({sup 153}Sm), holmium-166 ({sup 166}Ho), thulium-170 ({sup 170}Tm), lutetium-177 ({sup 177}Lu), rhenium-186 ({sup 186}Re), rhenium-188 ({sup 188}Re), and radium-223 ({sup 223}Ra). Results: {sup 223}Ra alpha particles, {sup 177}Lu beta minus particles, and {sup 170}Tm beta minus particles induced the highest cell death of all investigated particles and radioisotopes. The cell survival fraction measured post-irradiation with beta minus particles emitted by {sup 89}Sr and {sup 153}Sm, two of the most frequently used radionuclides in the palliative treatment of bone metastases in clinical routine practice, was higher than {sup 177}Lu beta minus particles and {sup 223}Ra alpha particles. Conclusions: {sup 223}Ra and {sup 177}Lu hold the highest potential for palliative treatment of bone metastases of all

  15. MD simulation of steady shock-wave fronts with phase transition in single-crystal iron

    NASA Astrophysics Data System (ADS)

    Zhakhovsky, V. V.; Migdal, K. P.; Inogamov, N. A.; Anisimov, S. I.

    2017-01-01

    Overdriven shock waves propagating in main crystallographic directions of single-crystal bcc iron were studied with moving-window molecular dynamics (MD) technique. To simulate correctly the shock-induced bcc-to-hcp phase transition in iron a new EAM potential fitted to the cold pressure curves and pressure transition at 13 GPa was developed with the stress matching method. We demonstrate that structure of shock fronts depends on orientation of crystal. A peculiar structure of steady shock-wave front in [100] direction is observed. While the ultra-fast α → ɛ transition initiated in uniaxially compressed crystal along [100] in elastic zone transforms bcc completely to hcp phase, transformation in other directions is performed only partially with production of metastable composition of nanometer-sized bcc-hcp-fcc grains.

  16. Study of shockwave method for diagnosing the radiation fields of laser-driven gold hohlraums

    NASA Astrophysics Data System (ADS)

    Li, Yongsheng; Lan, Ke; Huo, Wenyi; Lai, Dongxian; Gao, Yaoming; Pei, Wenbing

    2013-11-01

    Besides the routinely used broad-band x-ray spectrometer (Dante or SXS), ablative shock-wave method is often used to diagnose the radiation fields of laser-driven Hohlraums. The x-ray ablation process of Aluminum and Titanium is studied numerically with a 1-D radiation hydrodynamic code RDMG [F. Tinggui et al., Chin. J. Comput. Phys. 16, 199 (1999)], based on which a new scaling relation of the equivalent radiation temperature with the ablative shock velocity in Aluminum plates is proposed, and a novel method is developed for determining simultaneously the radiation temperature and the M-band (2-4 keV) fraction in laser-driven gold Hohlraums.

  17. Shock-wave compression of silica gel as a model material for comets

    NASA Astrophysics Data System (ADS)

    Arasuna, Akane; Okuno, Masayuki; Chen, Liliang; Mashimo, Tsutomu; Okudera, Hiroki; Mizukami, Tomoyuki; Arai, Shoji

    2016-07-01

    A shock-wave compression experiment using synthesized silica gel was investigated as a model for a comet impact event on the Earth's surface. The sample shocked at 20.7 GPa showed considerable structural changes, a release of water molecules, and the dehydration of silanol (Si-OH) that led to the formation of a new Si-O-Si network structure containing larger rings (e.g., six-membered ring of SiO4 tetrahedra). The high aftershock temperature at 20.7 GPa, which could be close to 800 °C, influenced the sample structure. However, some silanols, which were presumed to be the mutually hydrogen-bonded silanol group, remained at pressures >20.7 GPa. This type of silanol along with a small number of water molecules may remain even after shock compression at 30.9 GPa, although the intermediate structure of the sample recovered was similar to that of silica glass.

  18. The Shock-Wave Patterns on a Cranked-Wing Configuration

    NASA Technical Reports Server (NTRS)

    Sammonds, Robert I.

    1960-01-01

    The shock-wave patterns of a complex configuration with cranked cruciform wings and a cone-cylinder body were examined to determine the interaction of the body bow wave with the flow field about the wing. Also of interest, was the interaction of the forward (760 sweptback) wing leading-edge wave with the rear (600 sweptback) wing leading-edge wave. The shadowgraph pictures of the model in free flight at a Mach number of 4.9, although not definitive, appear to indicate that the body bow wave crosses the outer wing panel after first being refracted either by the leading-edge wave of the 600 sweptback wing or by pressure fields in the flow crossing the wing.

  19. CHARADE: A characteristic code for calculating rate-dependent shock-wave response

    SciTech Connect

    Johnson, J.N.; Tonks, D.L.

    1991-01-01

    In this report we apply spatially one-dimensional methods and simple shock-tracking techniques to the solution of rate-dependent material response under flat-plate-impact conditions. This method of solution eliminates potential confusion of material dissipation with artificial dissipative effects inherent in finite-difference codes, and thus lends itself to accurate calculation of elastic-plastic deformation, shock-to-detonation transition in solid explosives, and shock-induced structural phase transformation. Equations are presented for rate-dependent thermoelastic-plastic deformation for (100) planar shock-wave propagation in materials of cubic symmetry (or higher). Specific numerical calculations are presented for polycrystalline copper using the mechanical threshold stress model of Follansbee and Kocks with transition to dislocation drag. A listing of the CHARADE (for characteristic rate dependence) code and sample input deck are given. 26 refs., 11 figs.

  20. Quantum molecular dynamics simulation of shock-wave experiments in aluminum

    SciTech Connect

    Minakov, D. V.; Khishchenko, K. V.; Fortov, V. E.; Levashov, P. R.

    2014-06-14

    We present quantum molecular dynamics calculations of principal, porous, and double shock Hugoniots, release isentropes, and sound velocity behind the shock front for aluminum. A comprehensive analysis of available shock-wave data is performed; the agreement and discrepancies of simulation results with measurements are discussed. Special attention is paid to the melting region of aluminum along the principal Hugoniot; the boundaries of the melting zone are estimated using the self-diffusion coefficient. Also, we make a comparison with a high-quality multiphase equation of state for aluminum. Independent semiempirical and first-principle models are very close to each other in caloric variables (pressure, density, particle velocity, etc.) but the equation of state gives higher temperature on the principal Hugoniot and release isentropes than ab initio calculations. Thus, the quantum molecular dynamics method can be used for calibration of semiempirical equations of state in case of lack of experimental data.

  1. [Comparative study of the efficiency of itraconazole and ketoconazole in the treatment of experimental paracoccidioidomycosis].

    PubMed

    Negroni, R; Finquelievich, J L; Gosis, A S

    1987-01-01

    A comparative study between ketoconazole and itraconazole in the prophylactic and curative treatment of experimental paracoccidioidomycosis in rats and guinea pigs was carried out. Ninety seven Wistar rats were inoculated intracardiacally with the yeast-phase of P. brasiliensis with the purpose of evaluating the prophylactic treatment. Eighty one guinea pigs were injected intratesticularly with the same microorganism with the aim of studying the healing treatment. Both drugs were administered by gavage once a day. The prophylactic treatment started 3 days before the challenger inoculation and the healing treatment begun 10 days after the challenger inoculation. The animals were divided in four groups: I), control animals to which only the solvents of both drugs were administered; II), those which received ketoconazole 40 mg/kg/day; III), those treated with the same drug 80 mg/kg/day, and IV), animals treated with itraconazole 8 mg/kg/day. Seven to 30 days after starting the healing and prophylactic treatments the results were evaluated. Itraconazole seems to be as effective as ketoconazole at 5 fold lower dosage.

  2. A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients.

    PubMed

    De Luis, D A; Becerra, A; Lahera, M; Botella, J I; Valero; Varela, C

    2000-01-01

    Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 microg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.

  3. The isolated perfused kidney: an in vitro test system for evaluation of renal tissue damage induced by high-energy shockwaves sources.

    PubMed

    Bergsdorf, Th; Thüroff, S; Chaussy, Ch

    2005-09-01

    Most of our knowledge of shockwave-induced renal damage is based on animal experiments and clinical observation. We developed a tissue model using isolated porcine kidneys perfused with Berliner Blau dye in physiologic saline using a Ureteromat Perez-Castro peristaltic pump connected to the renal artery. Reproducible results were obtained under a variety of experimental conditions. Further refinements of the model might consist of interposition of tissue layers in the shockwave path or simulation of ventilatory movements.

  4. In Vitro Comparative Assessment of Mechanical Blood Damage Induced by Different Hemodialysis Treatments

    PubMed Central

    Lodi, Carlo Alberto; Sconziano, Sara Antonia; Beck, Werner; Bosch, Juan P.

    2015-01-01

    Abstract Gradual deterioration of red blood cells (RBCs) due to mechanical stress (chronic hemolysis) is unavoidable during treatments that involve extracorporeal blood circulation, such as hemodialysis (HD). This effect is generally undetectable and does not generate any acute symptoms, but it leads to an increase in plasma free hemoglobin (fHb). There are no absolute safety levels for fHb increase, indicating the need for an empirical evaluation using comparative testing. The increase in fHb levels was investigated in vitro by applying double‐needle double‐pump HD (HD‐DNDP), a new modality in which arterial and venous pumps both run continuously. fHb was measured during typical and worst‐case simulated dialysis treatments (double‐needle single‐pump HD [HD‐DNSP], hemodiafiltration [HDF‐DN], single‐needle double‐pump HD [HD‐SNDP], and HD‐DNDP) performed in vitro using bovine blood for 4 h. Hemolysis‐related indices (fHb%; index of hemolysis, IH; and normalized IH) were calculated and used for comparison. The increase in fHb during either HDF‐DN or HD‐SNDP with Artis and AK200 dialysis machines was similar, while the fHb at the maximum real blood flow rate (Qbreal) at the completion of the HD‐DNDP treatment on Artis was higher than that for HD‐DNSP using a Phoenix dialysis machine (fHb % = 1.24 ± 0.13 and 0.92 ± 0.12 for the Artis machine with HD‐DNDP at Qbreal = 450 mL/min and Phoenix with HD‐DNSP at Qbreal = 500 mL/min, respectively). However, the fHb levels increased linearly, and no steep changes were observed. The increases observed during HD‐DNDP were the same order of magnitude as those for widely used bloodlines and treatment modes for delivering dialysis treatments. The observed results matched literature findings, and thus the measured fHb trends are not predicted to have clinical side effects. HD‐DNDP treatment with Artis does not merit any additional concern regarding mechanical stress

  5. Granular biochar compared with activated carbon for wastewater treatment and resource recovery.

    PubMed

    Huggins, Tyler M; Haeger, Alexander; Biffinger, Justin C; Ren, Zhiyong Jason

    2016-05-01

    Granular wood-derived biochar (BC) was compared to granular activated carbon (GAC) for the treatment and nutrient recovery of real wastewater in both batch and column studies. Batch adsorption studies showed that BC material had a greater adsorption capacity at the high initial concentrations of total chemical oxygen demand (COD-T) (1200 mg L(-1)), PO4 (18 mg L(-1)), and NH4 (50 mg L(-1)) compared to GAC. Conversely the BC material showed a lower adsorption capacity for all concentrations of dissolved chemical oxygen demand (COD-D) and the lower concentrations of PO4 (5 mg L(-1)) and NH4 (10 mg L(-1)). Packed bed column studies showed similar average COD-T removal rate for BC with 0.27 ± 0.01 kg m(-3) d(-1) and GAC with 0.24 ± 0.01 kg m(-3) d(-1), but BC had nearly twice the average removal rate (0.41 ± 0.08 kg m(-3) d(-3)) compared to GAC during high COD-T concentrations (>500 mg L(-1)). Elemental analysis showed that both materials accumulated phosphorous during wastewater treatment (2.6 ± 0.4 g kg(-1) and 1.9 ± 0.1 g kg(-1) for BC and GAC respectively). They also contained high concentrations of other macronutrients (K, Ca, and Mg) and low concentrations of metals (As, Cd, Cr, Pb, Zn, and Cu). The good performance of BC is attributed to its macroporous structure compared with the microporous GAC. These favorable treatment data for high strength wastewater, coupled with additional life-cycle benefits, helps support the use of BC in packed bed column filters for enhanced wastewater treatment and nutrient recovery.

  6. A computational model of drug delivery through microcirculation to compare different tumor treatments.

    PubMed

    Cattaneo, L; Zunino, P

    2014-11-01

    Starting from the fundamental laws of filtration and transport in biological tissues, we develop a computational model to capture the interplay between blood perfusion, fluid exchange with the interstitial volume, mass transport in the capillary bed, through the capillary walls and into the surrounding tissue. These phenomena are accounted at the microscale level, where capillaries and interstitial volume are viewed as two separate regions. The capillaries are described as a network of vessels carrying blood flow. We apply the model to study drug delivery to tumors. The model can be adapted to compare various treatment options. In particular, we consider delivery using drug bolus injection and nanoparticle injection into the blood stream. The computational approach is suitable for a systematic quantification of the treatment performance, enabling the analysis of interstitial drug concentration levels, metabolization rates and cell surviving fractions. Our study suggests that for the treatment based on bolus injection, the drug dose is not optimally delivered to the tumor interstitial volume. Using nanoparticles as intermediate drug carriers overrides the shortcomings of the previous delivery approach. This work shows that the proposed theoretical and computational framework represents a promising tool to compare the efficacy of different cancer treatments.

  7. A Comparative Study of Oral Cyclosporine and Betamethasone Minipulse Therapy in the Treatment of Alopecia Areata

    PubMed Central

    Jang, Yong Hyun; Kim, Sang Lim; Lee, Kyou Chae; Kim, Min Ji; Park, Kyung Hea; Lee, Weon Ju; Lee, Seok-Jong

    2016-01-01

    Background Various systemic agents have been assessed for the treatment of alopecia areata (AA); however, there is a paucity of comparative studies. Objective To assess and compare cyclosporine and betamethasone minipulse therapy as treatments for AA with regard to effectiveness and safety. Methods Data were collected from 88 patients who received at least 3 months of oral cyclosporine (n=51) or betamethasone minipulse therapy (n=37) for AA. Patients with ≥50% of terminal hair regrowth in the alopecic area were considered responders. Results The responder of the cyclosporine group was 54.9% and that of the betamethasone minipulse group was 37.8%. In the cyclosporine group, patients with mild AA were found to respond better to the treatment. Based on the patient self-assessments, 70.6% of patients in the cyclosporine group and 43.2% of patients in the betamethasone minipulse group rated their hair regrowth as excellent or good. Side effects were less frequent in the cyclosporine group. Conclusion Oral cyclosporine appeared to be superior to betamethasone minipulse therapy in terms of treatment effectiveness and safety. PMID:27746635

  8. Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity.

    PubMed

    Ommerborn, Michelle A; Schneider, Christine; Giraki, Maria; Schäfer, Ralf; Handschel, Jörg; Franz, Matthias; Raab, Wolfgang H-M

    2007-02-01

    The impact of an occlusal splint (OS) compared with cognitive-behavioral treatment (CBT) on the management of sleep bruxism (SB) has been poorly investigated. The aim of this study was to evaluate the efficacy of an OS with CBT in SB patients. Following a randomized assignment, the OS group consisted of 29, and the CBT group of 28, SB patients. The CBT comprised problem-solving, progressive muscle relaxation, nocturnal biofeedback, and training of recreation and enjoyment. The treatment took place over a period of 12 wk, and the OS group received an OS over the same time period. Both groups were examined pretreatment, post-treatment, and at 6 months of follow-up for SB activity, self-assessment of SB activity and associated symptoms, psychological impairment, and individual stress-coping strategies. The analyses demonstrated a significant reduction in SB activity, self-assessment of SB activity, and psychological impairment, as well as an increase of positive stress-coping strategies in both groups. However, the effects were small and no group-specific differences were seen in any dependent variable. This is an initial attempt to compare CBT and OS in SB patients, and the data collected substantiate the need for further controlled evaluations, using a three-group randomized design with repeated measures to verify treatment effects.

  9. Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna.

    PubMed

    Patigaroo, Suhail Amin; Mehfooz, Nazia; Patigaroo, Fozia Amin; Kirmani, Masood H; Waheed, Arafat; Bhat, Shakura

    2012-07-01

    The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30-40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2-3 months should be discussed with each patient and was found to be as good as intralesional steroids.

  10. Structural Equation Analyses of Clinical Subpopulation Differences and Comparative Treatment Outcomes: Characterizing the Daily Lives of Drug Addicts.

    ERIC Educational Resources Information Center

    Aiken, Leona S.; And Others

    1994-01-01

    Used structural equation modeling for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. Evaluated effect of early period of treatment on daily lives of 486 clients in 2 drug abuse treatment modalities (methadone maintenance and outpatient counseling).…

  11. Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

    PubMed

    Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

    2015-01-01

    Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting

  12. Comparative evaluation between hypericin (hypiran) and fluoxetine in treatment of companion dogs with tail chasing

    PubMed Central

    Mosallanejad, Bahman; Najafzadeh Varzi, Hossein; Avizeh, Reza; Pourmahdi, Mahdi; Khalili, Fatemeh

    2015-01-01

    The aim of the present study was to compare the effects of hypericin and fluoxetine in the treatment of companion dogs with tail chasing in Ahvaz district. In the present survey, eighteen dogs with tail chasing were assigned into three equal groups for a three-year period. The dogs were randomly classified based on different treatment groups. During 15 weeks, dogs of group A were given 0.05 mg kg-1 hypericin orally and dogs of group B received 1 mg kg-1 fluoxetine, orally. The group C was the control group. Changes in signs of tail chasing were weekly reported by the owners or a veterinarian. Treatment periods were assessed in five intervals: weeks 1-3, 4-6, 7-9, 10-12 and weeks 13-15, respectively. Hypericin (group A) was significantly more effective in the treatment of tail chasing compared with fluoxetine (group B), (p = 0.043). Statistical analysis revealed a significant difference in each group between weeks 1-3 (X2 = 8.8, p = 0.01), 4-6 (X2 = 9.1, p = 0.01), 7-9 (X2 = 7.4, p = 0.03), 10-12 (X2 = 10.4, p = 0.005) and 13-15 (X2 = 12.5, p = 0.002). Improvement of behavior in the dogs of group A was significant compared with group B, between weeks 10-12 (X2 = 5.4, p = 0.02) and 13-15 (X2 = 7.2, p = 0.007). In conclusion, our survey showed that hypericin was more effective than fluoxetine in controlling signs of tail chasing. PMID:26261714

  13. Comparative Effectiveness of Tocilizumab with either Methotrexate or Leflunomide in the Treatment of Rheumatoid Arthritis

    PubMed Central

    Narváez, Javier; Díaz-Torné, César; Magallares, Berta; Hernández, Maria Victoria; Reina, Delia; Corominas, Héctor; Sanmartí, Raimon; de la Serna, Arturo Rodriguez; Llobet, Josep Maria; Nolla, Joan M.

    2015-01-01

    Objective In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting. Methods We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile. Results Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively. Conclusion Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ. PMID:25830224

  14. Impact of ablator thickness and laser drive duration on a platform for supersonic, shockwave-driven hydrodynamic instability experiments

    NASA Astrophysics Data System (ADS)

    Wan, W. C.; Malamud, G.; Shimony, A.; Di Stefano, C. A.; Trantham, M. R.; Klein, S. R.; Soltis, J. D.; Shvarts, D.; Drake, R. P.; Kuranz, C. C.

    2017-03-01

    We discuss changes to a target design that improved the quality and consistency of data obtained through a novel experimental platform that enables the study of hydrodynamic instabilities in a compressible regime. The experiment uses a laser to drive steady, supersonic shockwave over well-characterized initial perturbations. Early experiments were adversely affected by inadequate experimental timescales and, potentially, an unintended secondary shockwave. These issues were addressed by extending the 4x1013 W/cm2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 μm to 500 μm. We present data demonstrating the performance of the platform.

  15. Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis--a systematic review.

    PubMed

    Huisstede, Bionka M A; Gebremariam, Lukas; van der Sande, Renske; Hay, Elaine M; Koes, Bart W

    2011-10-01

    Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data and assessed the methodological quality. Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective (moderate evidence) than placebo in mid-term. For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or high-ESWT versus placebo, each other, or other treatments. This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis.

  16. Comparative study of wastewater treatment and nutrient recycle via activated sludge, microalgae and combination systems.

    PubMed

    Wang, Liang; Liu, Jinli; Zhao, Quanyu; Wei, Wei; Sun, Yuhan

    2016-07-01

    Algal-bacterial synergistic cultivation could be an optional wastewater treatment technology in temperate areas. In this study, a locally screened vigorous Chlorella strain was characterized and then it was used in a comparative study of wastewater treatment and nutrient recycle assessment via activated sludge (AS), microalgae and their combination systems. Chlorella sp. cultured with AS in light showed the best performance, in which case the removal efficiencies of COD, NH3-N and TP were 87.3%, 99.2% and 83.9%, respectively, within a short period of 1day. Algal-bacterial combination in light had the best settleability. Chlorella sp. contained biomass, could be processed to feed, fertilizer or fuel due to the improved quality (higher C/H/N) compared with sludge. PCR-DGGE analysis shows that two types of rhizobacteria, namely, Pseudomonas putida and Flavobacterium hauense were enriched in sludge when cultured with algae in light, serving as the basics for artificial consortium construction for improved wastewater treatment.

  17. [Parenteral S-adenosylmethionine compared to placebos in the treatment of alcoholic liver diseases].

    PubMed

    Diaz Belmont, A; Dominguez Henkel, R; Uribe Ancira, F

    1996-01-01

    The improvements in the knowledge of the action of ethanol over the hepatic cell, its direct action over the cell, and the intracytoplasmatic structures membranes, point out the possibilities of use of sulfo-adenosil-L-metionina (SAMe); as an util drug inn the treatment of the altered metilation reactions, that take place in those membranes, facilitating their physiological functions. The primary end point in this study was to demonstrate the therapeutic worth os SAMe, by parenteral route in 45 patients with alcoholic liver disease, which were determined by clinical laboratory and hepatic function test, label qith 32 points or more of the discriminatory function index. Divided into two groups, placebo-SAMe, randomized, double blind. As well as total plasmatic and reduced glutation and lipoperoxidation index, indirect form as malondehaldehyde. Were determined at the first visit anf after 8 and 15 days of treatment. Comparing the results of both groups there were a significative favorable results for the group treatment with SAMe and this confirms the utility of this drug in the treatment of patients with alcoholic liver disease with a discriminatory function index (Maddrey index), of 32 points or more.

  18. A retrospective study to compare improvement of implant maintenance by Medical Treatment Model

    PubMed Central

    Maruo, Katsuichiro; Singh, Kamleshwar; Shibata, Sadahiko; Sugiura, Go; Kumagai, Takashi; Tamaki, Katsushi; Jain, Jyoti

    2016-01-01

    Background: Study comparing the improvement of implant maintenance is limited. Clinicians must be aware of implant maintenance to improve long-term success of implant. Aims: The aim of this retrospective study was to evaluate whether the Medical Treatment Model (MTM), which is a comprehensive treatment, includes initial risk assessment, lifestyle instructions, such as diet and habits, and a customized maintenance program to improve implant prognosis. Materials and Methods: Patients who were comprehensively treated were included and divided into two groups, test and control groups. The test group included patients who started treatment with MTM, whereas control group included patients who started treatment without MTM introduction. Moreover, subsequently, compliance with maintenance, occurrence of biological complications, and implant failure were evaluated. Results: About 199 patients with 515 implants were analyzed in the control group and 38 patients with 59 implants in the test group. In the control and test groups, the percentages of patients in the four compliance categories were, respectively, 73.9% and 89.5% for excellent compliance, 7.0% and 7.9% for good compliance, 14.6% and 0% for fair compliance, and 4.5% and 2.6% for poor compliance. There was a statistically significant difference in the compliance with periodontal and implant maintenance between the test and control groups (P = 0.029). Conclusions: Within the limitation of this study, MTM significantly enhanced the compliance of patients treated with implants. PMID:27994406

  19. Comparative trial of permethrin 5% versus lindane 1% for the treatment of scabies.

    PubMed

    Goldust, Mohamad; Babae Nejad, Shahla; Rezaee, Elham; Raghifar, Ramin

    2013-01-20

    Objective: Treatment of scabies is an important issue in infectious dermatology. The aim of this study was to specify whether permethrin is effective for the treatment of human scabies and to compare its effectiveness with that of 1% lindane by topical application. Methods: 220 patients with scabies with the mean age of 44 ± 12/24 attended the study. Patients were divided into two groups randomly. The first group and their family contacts received 5% permethrin cream and the other received 1% lindane lotion. Treatment was evaluated at intervals of 2 and 4 weeks. Results: Of 254 patients, 220 completed the study. 110 in the group treated with lindane and 110 in the group treated with permethrin. Permethrin provided an improvement rate of 92 (83.6%) after 2 weeks, whereas lindane was effective only in 54 (49%) of patients. After 4 weeks improvement rate was 96.3% (106 of 110) in permethrin group since it was only 69.1% (76 of 110) in lindane group. Conclusion: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study. There were no adverse effects with either permethrin or lindane.

  20. Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones

    PubMed Central

    Galal, Ehab Mohamad; Anwar, Ahmad Zaki; Fath El-Bab, Tarek Khalaf; Abdelhamid, Amr Mohamad

    2016-01-01

    ABSTRACT Background: We analyzed the outcome and complications of rigid (R-URS) and flexible (F-URS) ureteroscopic lithotripsy for treatment of proximal ureteric stone (PUS). Subjects and methods: Retrospective data of 135 patients (93 males and 42 females) submitted to R-URS and F-URS for treatment of PUS in the period between July 2013 and January 2015 were investigated. (R-URS, group 1) was performed in 72 patients while 63 patients underwent (F-URS, group 2).We compared the 2 groups for success, stone characteristics, operative time, intraoperative and postoperative complications. Results: The overall stone free rate (SFRs) was 49/72 (68%) in group 1 and 57/63 (91%) patients in group 2, (P=0.005). The operative time was shorter in group 1 in comparison to group 2 with statistically significant difference (P=0.005). There was not any statistically significant difference between 2 groups in complication rate (P=0.2). Conclusıon: Both R-URS and F-URS could be a feasible option for treatment of PUS. R-URS is less successful for treatment of PUS and should be used cautiously and with availability of F-URS. PMID:27622276

  1. Periradicular repair after two-visit endodontic treatment using two different intracanal medications compared to single-visit endodontic treatment.

    PubMed

    Silveira, Adriana M Vieira; Lopes, Hélio P; Siqueira, José F; Macedo, Sérgio B; Consolaro, Alberto

    2007-01-01

    The number of appointments necessary to treat infected root canals is one of the most controversial issues in endodontics. This study evaluated, in dogs, the response of the periradicular tissues to the endodontic treatment of infected root canals performed in a single visit or in two visits, using different interappointment dressings. Periradicular lesions were induced by inoculating Enterococcus faecalis in the root canals. After confirming that a periradicular lesion developed, the root canals were treated within one or two visits, using either ozonized oil or calcium hydroxide in camphorated paramonochlorophenol (CMCP) as an intracanal medication. After 6 months, the animals were sacrificed and the specimens were processed for histological and histobacteriological analysis. The root canals treated in a single visit showed a success rate of 46%. When a calcium hydroxide/CMCP-based interappointment intracanal medication was used, 74% of the cases were categorized as success. In cases where ozonized oil was used as the intracanal medication, a success rate of 77% was observed. These results of the present study demonstrated that the two-visit treatment offered a higher success rate compared to one-visit therapy. In addition, ozonized oil may potentially be used as an intracanal medication.

  2. Meso-scale Computational Investigation of Shock-Wave Attenuation by Trailing Release Wave in Different Grades of Polyurea

    NASA Astrophysics Data System (ADS)

    Grujicic, Mica; Snipes, J. S.; Ramaswami, S.; Yavari, R.; Ramasubramanian, M. K.

    2014-01-01

    Over the past several years, considerable research efforts have been made toward investigating polyurea, a segmented thermoplastic elastomer, and particularly its shock-mitigation capacity, i.e., an ability to attenuate and disperse shock-waves. These research efforts have clearly established that the shock-mitigation capacity of polyurea is closely related to its chemistry, processing route, and the resulting microstructure. Polyurea typically possesses a nano-segregated microstructure consisting of (high glass transition temperature, T g) hydrogen-bonded discrete hard domains and a (low T g) contiguous soft matrix. While the effect of polyurea microstructure on its shock-mitigation capacity is well-established, it is not presently clear what microstructure-dependent phenomena and processes control its shock-mitigation capacity. To help identify these phenomena and processes, meso-scale simulations of the formation of nano-segregated microstructure and its interaction with a leading shock-wave and a trailing release-wave is analyzed in the present work. The results obtained revealed that shock-induced hard-domain densification makes an important contribution to the superior shock-mitigation capacity of polyurea, and that the extent of densification is a sensitive function of the polyurea soft-segment molecular weight. In particular, the ability of release-waves to capture and neutralize shock-waves has been found to depend strongly on the extent of shock-induced hard-domain densification and, thus, on the polyurea soft-segment molecular weight.

  3. New sonic shockwave multi-element sensors mounted on a small airfoil flown on F-15B testbed aircraft

    NASA Technical Reports Server (NTRS)

    1996-01-01

    An experimental device to pinpoint the location of a shockwave that develops in an aircraft flying at transonic and supersonic speeds was recently flight-tested at NASA's Dryden Flight Research Center, Edwards, California. The shock location sensor, developed by TAO Systems, Hampton, Va., utilizes a multi-element hot-film sensor array along with a constant-voltage anemometer and special diagnostic software to pinpoint the exact location of the shockwave and its characteristics as it develops on an aircraft surface. For this experiment, the 45-element sensor was mounted on the small Dryden-designed airfoil shown in this illustration. The airfoil was attached to the Flight Test Fixture mounted underneath the fuselage of Dryden's F-15B testbed aircraft. Tests were flown at transonic speeds of Mach 0.7 to 0.9, and the device isolated the location of the shock wave to within a half-inch. Application of this technology could assist designers of future supersonic aircraft in improving the efficiency of engine air inlets by controlling the shockwave, with a related improvement in aircraft performance and fuel economy.

  4. New Alternatives for Autoimmune Disease Treatments: Physicochemical and Clinical Comparability of Biosimilar Etanercept.

    PubMed

    Miranda-Hernández, Mariana P; López-Morales, Carlos A; Perdomo-Abúndez, Francisco C; Salazar-Flores, Rodolfo D; Ramírez-Ibanez, Nancy D; Pérez, Nestor O; Molina-Pérez, Aarón; Revilla-Beltri, Jorge; Flores-Ortiz, Luis F; Medina-Rivero, Emilio

    2016-01-01

    Etanercept is a recombinant fusion protein approved for the treatment of TNF-α mediated diseases such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, and ankylosing spondylitis. Herein, we present an evaluation of the physicochemical and biological properties of a biosimilar etanercept and its reference product followed by a clinical study in patients diagnosed with RA intended to demonstrate comparability of their immunomodulatory activity. Identity analyses showed a total correspondence of the primary and higher-order structure between the two products. In regard to intrinsic heterogeneity, both products showed to be highly heterogenous; however the biosimilar etanercept exhibited similar charge and glycan heterogeneity intervals compared to the reference product. Apoptosis inhibition assay also showed that, despite the high degree of heterogeneity exhibited by both products, no significant differences exist in their in vitro activity. Finally, the clinical assessment conducted in RA-diagnosed patients did not show significant differences in the evaluated pharmacodynamic markers of both products. Collectively, the results from the comparability exercise provide convincing evidence that the evaluated biosimilar etanercept can be considered an effective alternative for the treatment of RA.

  5. New Alternatives for Autoimmune Disease Treatments: Physicochemical and Clinical Comparability of Biosimilar Etanercept

    PubMed Central

    Miranda-Hernández, Mariana P.; López-Morales, Carlos A.; Perdomo-Abúndez, Francisco C.; Salazar-Flores, Rodolfo D.; Ramírez-Ibanez, Nancy D.; Pérez, Nestor O.; Molina-Pérez, Aarón; Revilla-Beltri, Jorge; Flores-Ortiz, Luis F.; Medina-Rivero, Emilio

    2016-01-01

    Etanercept is a recombinant fusion protein approved for the treatment of TNF-α mediated diseases such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, and ankylosing spondylitis. Herein, we present an evaluation of the physicochemical and biological properties of a biosimilar etanercept and its reference product followed by a clinical study in patients diagnosed with RA intended to demonstrate comparability of their immunomodulatory activity. Identity analyses showed a total correspondence of the primary and higher-order structure between the two products. In regard to intrinsic heterogeneity, both products showed to be highly heterogenous; however the biosimilar etanercept exhibited similar charge and glycan heterogeneity intervals compared to the reference product. Apoptosis inhibition assay also showed that, despite the high degree of heterogeneity exhibited by both products, no significant differences exist in their in vitro activity. Finally, the clinical assessment conducted in RA-diagnosed patients did not show significant differences in the evaluated pharmacodynamic markers of both products. Collectively, the results from the comparability exercise provide convincing evidence that the evaluated biosimilar etanercept can be considered an effective alternative for the treatment of RA. PMID:27382576

  6. Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules.

    PubMed

    Bernardi, Stella; Dobrinja, Chiara; Fabris, Bruno; Bazzocchi, Gabriele; Sabato, Nicoletta; Ulcigrai, Veronica; Giacca, Massimo; Barro, Enrica; De Manzini, Nicolò; Stacul, Fulvio

    2014-01-01

    Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA). This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient or in a short-stay surgical regimen. Efficacy, tolerability, and costs were compared. The contribution of final pathology was also taken into account. Results. RFA reduced nodular volume by 70% after 12 months and it was an effective method for treating nodule-related clinical problems, but it was not as effective as surgery for the treatment of hot nodules. RFA and surgery were both safe, although RFA had less complications and pain was rare. RFA costed €1,661.50, surgery costed €4,556.30, and short-stay surgery costed €4,139.40 per patient. RFA, however, did not allow for any pathologic analysis of the nodules, which, in 6 patients who had undergone surgery (8%), revealed that the nodules harboured malignant cells. Conclusions. RFA might transform our approach to benign thyroid nodules.

  7. Radiofrequency Ablation Compared to Surgery for the Treatment of Benign Thyroid Nodules

    PubMed Central

    Bernardi, Stella; Dobrinja, Chiara; Fabris, Bruno; Bazzocchi, Gabriele; Sabato, Nicoletta; Ulcigrai, Veronica; Giacca, Massimo; Barro, Enrica; De Manzini, Nicolò; Stacul, Fulvio

    2014-01-01

    Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA). This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient or in a short-stay surgical regimen. Efficacy, tolerability, and costs were compared. The contribution of final pathology was also taken into account. Results. RFA reduced nodular volume by 70% after 12 months and it was an effective method for treating nodule-related clinical problems, but it was not as effective as surgery for the treatment of hot nodules. RFA and surgery were both safe, although RFA had less complications and pain was rare. RFA costed €1,661.50, surgery costed €4,556.30, and short-stay surgery costed €4,139.40 per patient. RFA, however, did not allow for any pathologic analysis of the nodules, which, in 6 patients who had undergone surgery (8%), revealed that the nodules harboured malignant cells. Conclusions. RFA might transform our approach to benign thyroid nodules. PMID:25045352

  8. Levocloperastine in the treatment of chronic nonproductive cough: comparative efficacy versus standard antitussive agents.

    PubMed

    Aliprandi, P; Castelli, C; Bernorio, S; Dell'Abate, E; Carrara, M

    2004-01-01

    The medical and social impact of cough is substantial. Current antitussive agents at effective doses have adverse events such as drowsiness, nausea and constipation that limit their use. There is also recent evidence that standard antitussive agents, such as codeine, may not reduce cough during upper respiratory infections. Therefore, there is a need for more effective and better-tolerated agents. The efficacy of levocloperastine, a novel antitussive, which acts both centrally on the cough center and on peripheral receptors in the tracheobronchial tree in treating chronic cough, was compared with that of other standard antitussive agents (codeine, levodropropizine and DL-cloperastine) in six open clinical trials. The studies enrolled patients of all ages with cough associated with various respiratory disorders including bronchitis, asthma, pneumonia and chronic obstructive pulmonary disease. Levocloperastine significantly improved cough symptoms (intensity and frequency of cough) in all trials, and improvements were observed after the first day of treatment. In children, levocloperastine reduced nighttime awakenings and irritability, and in adults it was effective in treating cough induced by angiotensin-converting enzyme inhibitors. When compared with other antitussive agents, levocloperastine had improved or comparable efficacy, with a more rapid onset of action. Importantly, no evidence of central adverse events was recorded with levocloperastine, whereas drowsiness was reported by a significant number of patients receiving codeine. Levocloperastine is an effective antitussive agent for the treatment of cough in patients of all ages. It has a more rapid onset of action than standard agents with an improved tolerability profile.

  9. Comparative study of 15% TCA peel versus 35% glycolic acid peel for the treatment of melasma

    PubMed Central

    Puri, Neerja

    2012-01-01

    Background: Chemical peels are the mainstay of a cosmetic practitioner's armamentarium because they can be used to treat some skin disorders and can provide aesthetic benefit. Objectives: To compare 15% TCA peel and 35% glycolic acid peel for the treatment of melasma. Material and Methods: We selected 30 participants of melasma aged between 20 and 50 years from the dermatology outpatient department and treated equal numbers with 15% TCA and 35% glycolic acid. Results: Subjective response as graded by the patient showed good or very good response in 70% participants in the glycolic acid group and 64% in the TCA group. Conclusions: There was statistically insignificant difference in the efficacy between the two groups for the treatment of melasma. PMID:23130283

  10. How comparative effectiveness research can help advance 'personalized medicine' in cancer treatment.

    PubMed

    Ramsey, Scott D; Veenstra, David; Tunis, Sean R; Garrison, Louis; Crowley, John J; Baker, Laurence H

    2011-12-01

    The use of biomarkers to "personalize" cancer treatment--identifying discrete genes, proteins, or other indicators that can differentiate one type of cancer from another and enable the use of highly tailored therapies--offers tremendous potential for improved outcomes and lower treatment costs. However, the rapid development of cancer biomarker, or genomic, tests--combined with a paucity of evidence to support the effectiveness of the tests--presents a challenge for patients, clinicians, and other stakeholders. In this article we propose that comparative effectiveness research be used to strengthen what is now a haphazard process for developing and marketing cancer biomarker tests. We suggest novel funding approaches and a systematic process for moving from regulatory approval to the generation of evidence that meets the needs of stakeholders and, ultimately, patients.

  11. Comparative LCA of decentralized wastewater treatment alternatives for non-potable urban reuse.

    PubMed

    Opher, Tamar; Friedler, Eran

    2016-11-01

    Municipal wastewater (WW) effluent represents a reliable and significant source for reclaimed water, very much needed nowadays. Water reclamation and reuse has become an attractive option for conserving and extending available water sources. The decentralized approach to domestic WW treatment benefits from the advantages of source separation, which makes available simple small-scale systems and on-site reuse, which can be constructed on a short time schedule and occasionally upgraded with new technological developments. In this study we perform a Life Cycle Assessment to compare between the environmental impacts of four alternatives for a hypothetical city's water-wastewater service system. The baseline alternative is the most common, centralized approach for WW treatment, in which WW is conveyed to and treated in a large wastewater treatment plant (WWTP) and is then discharged to a stream. The three alternatives represent different scales of distribution of the WW treatment phase, along with urban irrigation and domestic non-potable water reuse (toilet flushing). The first alternative includes centralized treatment at a WWTP, with part of the reclaimed WW (RWW) supplied back to the urban consumers. The second and third alternatives implement de-centralized greywater (GW) treatment with local reuse, one at cluster level (320 households) and one at building level (40 households). Life cycle impact assessment results show a consistent disadvantage of the prevailing centralized approach under local conditions in Israel, where seawater desalination is the marginal source of water supply. The alternative of source separation and GW reuse at cluster level seems to be the most preferable one, though its environmental performance is only slightly better than GW reuse at building level. Centralized WW treatment with urban reuse of WWTP effluents is not advantageous over decentralized treatment of GW because the supply of RWW back to consumers is very costly in materials and

  12. Randomized, double-blind, comparative study of oral metronidazole and tinidazole in treatment of bacterial vaginosis

    PubMed Central

    Raja, Indu M.; Basavareddy, Asha; Mukherjee, Deepali; Meher, Bikash Ranjan

    2016-01-01

    Objective: To compare the efficacy and tolerability of oral metronidazole and tinidazole in patients with bacterial vaginosis (BV) using Amsel's criteria. Patients and Methods: This was a randomized double-blind study, conducted by the Departments of Pharmacology and Gynecology of a tertiary care teaching hospital. Patients diagnosed with BV received either tablet metronidazole 500 mg twice daily for 5 days or tablet tinidazole 500 mg once daily + one placebo for 5 days and instructed to come for follow-up at the 1st week and 4th week. They were categorized as cured, partially cured, and not cured based on Amsel's criteria at the end of the study and compared between two groups using Chi-square test. Results: A total 120 women were enrolled in the study, of which 114 completed the study. The treatment arms were comparable. The cure rate with low-dose tinidazole was significantly more compared to metronidazole at 4th week (P = 0.0013), but not at 1st week (P = 0.242). The adverse drug reactions were less with tinidazole compared to metronidazole. Conclusion: Tinidazole at lower dose offers a better efficacy than metronidazole in long-term cure rates and in preventing relapses with better side effect profile. PMID:28066102

  13. [Comparative analysis of the treatment results of the nasal obstruction using septoplasty and septokonchoplasty].

    PubMed

    Balcerzak, Jarosław; Łukawska, Izabela; Grzanka, Antoni; Niemczyk, Kazimierz

    2014-01-01

    The nasal septal deviation coexistent with turbinate hypertrophy is considered one of the most common causes of nasal patency disorders. There is no doubt that septoplasty in most such cases is a proper treatment method. It is more difficult to clearly identify indications and predict the consequences of septoconchoplasty. The main aim of this study is to compare the impact of each of these procedures on subjective and objective measures of nasal patency. The authors retrospectively reviewed 132 medical records of patients treated in the Department of Otolaryngology, Medical University of Warsaw in the period from March 2012 to January 2013 due to nasal obstruction. Each patient had septoplasty or septoconchoplasty performed. Before treatment, each patient responded to questions in a standardized questionnaire SNOT 20. In addition, each patient was performed upon for anterior rhinomanometry before and after shrinking the nasal mucosa. Finally, the study involved a group of 30 people - 15 after septoplasty (group A) and the same number after septoconchoplasty (group B), who attended control examination carried out by the same scheme 6 weeks and 6 months after surgery. SNOT 20 poll was repeated 6 months after surgery. Analysis of the rhinomanometry results showed no statistically significant differences between the two treatment groups. Average values of the nasal resistance after surgery as compared to their baseline values in all measurements were smaller in each of the groups but the differences were also not statistically significant. However, comparing the results of the subjective assessment of nasal patency and associated signs and symptoms showed statistically significant differences between pre and postoperative results in both groups and the patients of group B felt more improvement than patients in group A. The study authorizes the conclusion that in justified cases septoconchoplasty gives better results than septoplasty.

  14. Energy implications of mechanical and mechanical–biological treatment compared to direct waste-to-energy

    SciTech Connect

    Cimpan, Ciprian Wenzel, Henrik

    2013-07-15

    Highlights: • Compared systems achieve primary energy savings between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste.} • Savings magnitude is foremost determined by chosen primary energy and materials production. • Energy consumption and process losses can be upset by increased technology efficiency. • Material recovery accounts for significant shares of primary energy savings. • Direct waste-to-energy is highly efficient if cogeneration (CHP) is possible. - Abstract: Primary energy savings potential is used to compare five residual municipal solid waste treatment systems, including configurations with mechanical (MT) and mechanical–biological (MBT) pre-treatment, which produce waste-derived fuels (RDF and SRF), biogas and/or recover additional materials for recycling, alongside a system based on conventional mass burn waste-to-energy and ash treatment. To examine the magnitude of potential savings we consider two energy efficiency levels (state-of-the-art and best available technology), the inclusion/exclusion of heat recovery (CHP vs. PP) and three different background end-use energy production systems (coal condensing electricity and natural gas heat, Nordic electricity mix and natural gas heat, and coal CHP energy quality allocation). The systems achieved net primary energy savings in a range between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste}, in the different scenario settings. The energy footprint of transportation needs, pre-treatment and reprocessing of recyclable materials was 3–9.5%, 1–18% and 1–8% respectively, relative to total energy savings. Mass combustion WtE achieved the highest savings in scenarios with CHP production, nonetheless, MBT-based systems had similarly high performance if SRF streams were co-combusted with coal. When RDF and SRF was only used in dedicated WtE plants, MBT-based systems totalled lower savings due to inherent system losses and additional energy costs. In scenarios without heat

  15. Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study.

    PubMed Central

    Thorens, J; Froehlich, F; Schwizer, W; Saraga, E; Bille, J; Gyr, K; Duroux, P; Nicolet, M; Pignatelli, B; Blum, A L; Gonvers, J J; Fried, M

    1996-01-01

    BACKGROUND: Gastric and duodenal bacterial overgrowth frequently occurs in conditions where diminished acid secretion is present. Omeprazole inhibits acid secretion more effectively than cimetidine and might therefore more frequently cause bacterial overgrowth. AIM: This controlled prospective study compared the incidence of gastric and duodenal bacterial overgrowth in patients treated with omeprazole or cimetidine. METHODS: 47 outpatients with peptic disease were randomly assigned to a four week treatment regimen with omeprazole 20 mg or cimetidine 800 mg daily. Gastric and duodenal juice were obtained during upper gastrointestinal endoscopy and plated for anaerobic and aerobic organisms. RESULTS: Bacterial overgrowth (> or = 10(5) cfu/ml) was present in 53% of the patients receiving omeprazole and in 17% receiving cimetidine (p < 0.05). The mean (SEM) number of gastric and duodenal bacterial counts was 6.0 (0.2) and 5.0 (0.2) respectively in the omeprazole group and 4.0 (0.2) and 4.0 (0.1) in the cimetidine group (p < 0.001 and < 0.01; respectively). Faecal type bacteria were found in 30% of the patients with bacterial overgrowth. Basal gastric pH was higher in patients treated with omeprazole compared with cimetidine (4.2 (0.5) versus 2.0 (0.2); p < 0.001) and in patients with bacterial overgrowth compared with those without bacterial overgrowth (5.1 (0.6) versus 2.0 (0.1); p < 0.0001). The nitrate, nitrite, and nitrosamine values in gastric juice did not increase after treatment with either cimetidine or omeprazole. Serum concentrations of vitamin B12, beta carotene, and albumin were similar before and after treatment with both drugs. CONCLUSIONS: These results show that the incidence of gastric and duodenal bacterial overgrowth is considerably higher in patients treated with omeprazole compared with cimetidine. This can be explained by more pronounced inhibition of gastric acid secretion. No patient developed signs of malabsorption or an increase of N

  16. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments

    NASA Astrophysics Data System (ADS)

    Ma, L.; Kwok, Y.; Chin, L. S.; Yu, C.; Regine, W. F.

    2005-11-01

    Dedicated linac-based radiosurgery has been reported for trigeminal neuralgia treatments. In this study, we investigated the dose fall-off characteristics and setup error tolerance of linac-based radiosurgery as compared with standard Gamma Knife radiosurgery. In order to minimize the errors from different treatment planning calculations, consistent imaging registration, dose calculation and dose volume analysis methods were developed and implemented for both Gamma Knife and linac-based treatments. Intra-arc setup errors were incorporated into the treatment planning process of linac-based deliveries. The effects of intra-arc setup errors with increasing number of arcs were studied and benchmarked against Gamma Knife deliveries with and without plugging patterns. Our studies found equivalent dose fall-off properties between Gamma Knife and linac-based radiosurgery given a sufficient number of arcs (>7) and small intra-arc errors (<0.5 mm) were satisfied for linac-based deliveries. Increasing the number of arcs significantly decreased the variations in the dose fall-off curve at the low isodose region (e.g. from 40% to 10%) and also improved dose uniformity at the high isodose region (e.g. from 70% to 90%). As the number of arcs increased, the effects of intra-arc setup errors on the dose fall-off curves decreased. Increasing the number of arcs also reduced the integral dose to the distal normal brain tissues. In conclusion, linac-based radiosurgery produces equivalent dose fall-off characteristics to Gamma Knife radiosurgery with a high number of arcs. However, one must note the increased treatment time for a large number of arcs and isocentre accuracies.

  17. Comparative study of actinic keratosis treatment with 3% diclofenac sodium and 5% 5-fluorouracil*

    PubMed Central

    Segatto, Majoriê Mergen; Dornelles, Sérgio Ivan Torres; Silveira, Vera Bauer; Frantz, Gabriela de Oliveira

    2013-01-01

    BACKGROUND Actinic keratosis is a frequent lesion which occurs in sunlight exposed areas. Diclofenac sodium and 5-Fluorouracil are effective, non-invasive and easy-to-apply topical treatment options. OBJECTIVES To assess and compare the effectiveness of 3% diclofenac sodium associated with 2.5% hyaluronic acid and of 5% 5-Fluorouracil for the treatment of actinic keratosis, as well as the patient's degree of satisfaction and tolerability. METHODS 28 patients with a clinical diagnosis of actinic keratosis were randomized to receive diclofenac sodium or 5-Fluorouracil and were clinically assessed before and after treatment as well as 8 weeks after the end of treatment. Modified versions of the Investigator and Patient Global Improvement Scores were used. RESULTS The average number of lesions in the diclofenac sodium group before and after treatment was 13.6 and 6.6 (p<0,001), respectively, while it was 17.4 and 3.15 (p<0.001) in the 5-Fluorouracil group. There was a significant reduction in the number of lesions in the 5-Fluorouracil group in relation to the diclofenac sodium group (p<0.001). To the non-blinded physician, there was a higher satisfactory therapeutic response in the 5-Fluorouracil group (p<0.001); to the blinded physician, there was a higher satisfactory response in this same group, although not statistically significant (p=0.09). There was a high degree of satisfaction in both groups (73% in the diclofenac sodium group and 77% in the 5-Fluorouracil group; p=0.827). Regarding adverse effects, the diclofenac sodium group presented a higher degree of satisfaction (93.3% vs 38.4%; p=0.008). Erythema, edema, crusts and itching were significantly higher in the 5-Fluorouracil group. CONCLUSION We concluded that 5-Fluorouracil was more effective; however, it showed lower tolerability than diclofenac sodium. PMID:24173178

  18. Use of treatment services in a comparative effectiveness study of bipolar disorder.

    PubMed

    Sylvia, Louisa G; Iosifescu, Dan; Friedman, Edward S; Bernstein, Emily E; Bowden, Charles L; Ketter, Terence A; Reilly-Harrington, Noreen A; Leon, Andrew C; Calabrese, Joseph R; Ostacher, Michael J; Rabideau, Dustin J; Thase, Michael E; Nierenberg, Andrew A

    2013-11-01

    OBJECTIVE Bipolar disorder is a severe, chronic mental illness with a high incidence of medical and psychological comorbidities that make treatment and prevention of future episodes challenging. This study investigated the use of services among outpatients with bipolar disorder to further understanding of how to maximize and optimize personalization and accessibility of services for this difficult-to-treat population. METHODS The Lithium Treatment-Moderate Dose Use Study (LiTMUS) was a six-month multisite, comparative effectiveness trial that randomly assigned 283 individuals to receive lithium plus optimized care-defined as personalized, guideline-informed care-or optimized care without lithium. Relationships between treatment service utilization, captured by the Cornell Service Index, and demographic and illness characteristics were examined with generalized linear marginal models. RESULTS Analyses with complete data (week 12, N=246; week 24, N=236) showed that increased service utilization was related to more severe bipolar disorder symptoms, physical side effects, and psychiatric and general medical comorbidities. Middle-aged individuals and those living in the United States longer tended to use more services than younger individuals or recent immigrants, respectively. CONCLUSIONS These data suggest that not all individuals with bipolar disorder seek treatment services at the same rate. Instead, specific clinical or demographic features may affect the degree to which one seeks treatment, conveying clinical and public health implications and highlighting the need for specific approaches to correct such discrepancies. Future research is needed to elucidate potential moderators of service utilization in bipolar disorder to ensure that those most in need of additional services utilize them.

  19. Peritoneal dialysis compared with hemodialysis in the treatment of end-stage renal disease.

    PubMed

    Alloatti, S; Manes, M; Paternoster, G; Gaiter, A M; Molino, A; Rosati, C

    2000-01-01

    Whether to use peritoneal dialysis (PD) or hemodialysis (HD) is a major decision in terms of clinical outcome and management implications; the final choice is difficult because of the conflicting results of comparisons reported in the literature. A review of studies comparing survival shows either superiority of HD, or superiority of PD, or equivalence of the two techniques, but an analysis of the comparisons as a whole brings to light two clear phases in the survival curves. In the first, residual renal function (RRF) gives PD an advantage, or at least puts it on the same level as HD. In the second phase, the reduction in Kt/V as RRF declines gives PD a potential risk. After a few years of PD treatment a sharp watch is therefore necessary to detect signs of under-dialysis promptly and to shift the patient to HD. In patients without RRF it is more difficult to control hypertension with PD and they are more prone to hyperhydration. Despite a widespread belief in the Eighties that PD was the treatment modality of election for diabetics, HD is in fact preferable in these patients, except younger ones. High-turnover and low-turnover bone lesions are more frequent respectively in HD and PD patients. Anemia is better controlled with PD. Blood lipids and nutritional indices are less well controlled with PD. Despite poor technical survival, the "pool" of patients treated with PD frequently reaches 20-30% because it is indicated as first treatment in a large proportion. PD preserves renal function better than HD and is useful while awaiting renal transplantation, with faster postoperative restoration of diuresis. The quality of life with PD as home treatment is usually better than with HD. In conclusion, dialytic centers should establish an integrated PD/HD programme as the two methods are not competitive but are different tools for the treatment and rehabilitation of uremic patients.

  20. Comparative effect and safety of verapamil in keloid and hypertrophic scar treatment: a meta-analysis

    PubMed Central

    Li, Zhouna; Jin, Zhehu

    2016-01-01

    Background Keloids and hypertrophic scars are the most common types of pathological scarring. Traditionally, keloids have been considered as a result of aberrant wound healing, involving excessive fibroblast participation that is characterized by hyalinized collagen bundles. However, the usefulness of this characterization has been questioned. In recent years, studies have reported the appropriate use of verapamil for keloids and hypertrophic scars. Methods Searches were conducted on the databases Medline, Embase, Cochrane, PubMed, and China National Knowledge Infrastructure from 2006 to July 2016. State12.0 was used for literature review, data extraction, and meta-analysis. Treatment groups were divided into verapamil and nonverapamil group. Nonverapamil group includes steroids and intense pulsed light (IPL) therapy. Total effective rates include cure rate and effective rate. Cure: skin lesions were completely flattened, became soft and symptoms disappeared. Efficacy: skin lesions subsided, patient significantly reduced symptoms. Inefficient definition of skin was progression free or became worse. Random-effects model was used for the meta-analysis. Results Six studies that included 331 patients with keloids and hypertrophic scars were analyzed. Analysis of the total effective rate of skin healing was performed. The total effective rates in the two groups were 54.07% (verapamil) and 53.18% (nonverapamil), respectively. The meta-analysis showed that there was no difference between the two groups. We also compared the adverse reactions between the verapamil treatment group and the steroids treatment group in two studies, and the result indicated that the verapamil group showed less adverse reactions. Conclusion There were no differences between the application of verapamil and nonverapamil group in keloids and hypertrophic scars treatment. Verapamil could act as an effective alternative modality in the prevention and treatment of keloid and hypertrophic scars. A

  1. Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research.

    PubMed

    Steel, Amie; Sundberg, Tobias; Reid, Rebecca; Ward, Lesley; Bishop, Felicity L; Leach, Matthew; Cramer, Holger; Wardle, Jon; Adams, Jon

    2017-02-01

    In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.

  2. [Levofloxacin and macrolides in chronic bronchitis exacerbation: comparative analysis of the treatment efficacy and nonrelapsing periods].

    PubMed

    Dvoretskiĭ, L I; Dubrovskaia, N V; Grudinina, S A; Filimonova, O Iu; Sidorenko, S V; Iakovlev, S V

    2007-01-01

    Clinical and bacteriological efficacies of levofloxacin versus clarithromycin and azithromycin were evaluated in 41 patients with chronic bronchitis infectious exacerbation in the Respiratory-Recovery Centre of Polyclinic No. 7. The effect of the drugs on the nonrelapsing period was estimated as well. With the use of levofloxacin there was observed a more rapid elimination of the clinical signs of the exacerbation as compared to the use of the macrolides. Levofloxacin provided a more pronounced and stable eradication of the main pathogens of the exacerbation as compared to the macrolide antibiotic. Long-term monitoring for 12 months after discontinuation of the treatment showed that the nonrelapsing period in the patients treated with levofloxacin was higher and the frequency of the relapses and their intensity were lower in comparison to the group of the patients treated with the macrolides.

  3. Meta-Analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-Wilderness Treatment Programs

    ERIC Educational Resources Information Center

    Gillis, Harold L.; Speelman, Elizabeth; Linville, Noelle; Bailey, Emily; Kalle, Ashley; Oglesbee, Nathan; Sandlin, James; Thompson, Lauren; Jensen, Jennifer

    2016-01-01

    Background: Monitoring youth treatments requires outcome instruments sensitive to change. The Y-OQ and the Y-OQ-SR measure behavioral change during psychological treatment. Objective: The focus of this study was to compare treatment progress of youth in studies using the Youth Outcome Questionnaire (YOQ) or the Youth Outcome Questionnaire Self…

  4. Comparative trial of sodium cromoglycate enemas with prednisolone enemas in the treatment of ulcerative colitis.

    PubMed Central

    Grace, R H; Gent, A E; Hellier, M D

    1987-01-01

    A double blind multicentre study comparing sodium cromoglycate (600 mg/100 ml) by enema with prednisolone (20 mg/100 ml) by enema is reported. The study was conducted over a nine week period in the treatment of 70 patients with ulcerative colitis. Analysis of symptoms showed significant decreases in scores for patients in both groups, both at four and eight weeks; the only difference between the two groups was a significantly greater improvement in the reduction of rectal bleeding after four weeks in the prednisolone group. On sigmoidoscopy, both treatment groups showed a highly significant improvement after four and eight weeks with no significant differences being seen between the groups. Histology of the rectal biopsies showed a significant improvement in the inflammation of the mucosa for both treatment groups after four and eight weeks with no differences being observed between the groups. There were no significant changes in eosinophils from baseline and no difference between the groups at four and eight weeks. PMID:3102323

  5. Operative compared to non-operative treatment of displaced intra-articular calcaneal fractures

    PubMed Central

    Nouraei, Mohammad Hadi; Moosa, Farhad Mostafa

    2011-01-01

    BACKGROUND: The aim of this study was to compare outcomes of open reduction and rigid internal fixation of displaced calcaneal fractures with that of non operative treatment. METHODS: Seventy two consecutive patients with displaced intra-articular calcaneal fractures were selected regarding inclusive and exclusive criteria and then were randomly allocated to surgical and non surgical groups. First group underwent open reduction and internal fixation with reconstruction plate and screws fixation and the other group were treated with closed reduction and cast immobilization. Data were collected by clinical observation and a check list. Data was analyzed by chi-square and student's t-test. RESULTS: The results showed significant difference between outcomes of surgical treatment and nonsurgical method (p = 0.001). There were some differences between two methods in terms of decreasing pain [Odd Ratio (OR): 6.72, p = 0.001], swelling (OR: 6.80, p = 0.001), increased range of motion of the joints (p = 0.001), decreased late osteoarthritis (OR: 2.33, p = 0.22) in favor of surgical group. CONCLUSIONS: Open reduction and internal fixation of displaced calcaneal fractures in absence of open fracture, severe osteoporosis, or comminution, poor general condition may be the preferred method of treatment. PMID:22279476

  6. Mixed-waste treatment -- What about the residuals? A comparative analysis of MSO and incineration

    SciTech Connect

    1993-06-01

    This report examines the issues concerning final waste forms, or residuals, that result from the treatment of mixed waste in molten salt oxidation (MSO) and incinerator systems. MSO is a technology with the potential to treat a certain segment of the waste streams at US Department of Energy (DOE) sites. MSO was compared with incineration because incineration is the best demonstrated available technology (BDAT) for the same waste streams. The Grand Junction Projects Office (GJPO) and Oak Ridge National Laboratory (ORNL) prepared this report for the DOE Office of Environmental Restoration (OER). The goals of this study are to objectively evaluate the anticipated residuals from MSO and incineration, examine regulatory issues for these final waste forms, and determine secondary treatment options. This report, developed to address concerns that MSO residuals present unique disposal difficulties, is part of a larger effort to successfully implement MSO as a treatment technology for mixed and hazardous waste. A Peer Review Panel reviewed the MSO technology in November 1991, and the implementation effort is ongoing under the guidance of the MSO Task Force.

  7. Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center.

    PubMed

    Wilson, Robin J; Looman, Jan; Abracen, Jeffrey; Pake, Donald R

    2013-03-01

    Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

  8. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study.

    PubMed

    Livingstone, V; Stringer, L J

    1999-09-01

    Sore, cracked nipples are commonly experienced by breastfeeding mothers. We have previously reported a strong correlation between sore, cracked nipples and S. aureus colonization. A prospective, randomized clinical trial was performed to compare four treatment regimes for S. aureus infected sore nipples. Eighty-four breastfeeding mothers were enrolled in the study. After 5 days to 7 days of treatment, only 8% of mothers showed improvement in the "optimal breastfeeding technique alone" group, 16% improved with topical mupiricin, 29% improved with topical fusidic acid, yet 79% improved with oral antibiotics (p < .0001). Optimal breastfeeding techniques and topical antibiotics ointment failed to heal most infected, sore, cracked nipples. Mastitis developed in 12% to 35% of mothers not treated with systemic antibiotics compared to 5% of mothers treated with systemic antibiotics (p < .005). In conclusion, S. aureus infected sore, cracked nipples should be diagnosed as a potentially widespread impetigo vulgaris and treated aggressively with systemic antibiotics in order to improve healing and decrease the risk of developing mastitis due to an ascending lactiferous duct bacterial infection.

  9. Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder.

    PubMed

    Nikvarz, Nikvarz; Alaghband-Rad, Javad; Tehrani-Doost, Mehdi; Alimadadi, Abbas; Ghaeli, Padideh

    2017-01-01

    Introduction: This study was aimed to compare the efficacy and side effects of memantine, an antagonist of the NMDA receptor of glutamate, with risperidone given the fact that glutamate has been noted for its possible effects in the pathogenesis of autism. Risperidone, an atypical antipsychotic, has been approved by FDA for the management of irritability associated with autism. Methods: 30 children, aged 4-17 years, entered an 8-week, randomized trial. Patients were randomly assigned to receive either risperidone or memantine. Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Clinical Global Impressions - Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S) scales were used to assess behavioral symptoms of the patients. Results: Both risperidone and memantine reduced the scores of 4 subscales of ABC as well as the 10-item and the total score of CARS significantly. However, differences between the 2 drugs in the scores of each evaluating scale were not found to be significant. Relatively, larger number of patients on risperidone showed "very much improvement" when assessed by CGI-I scale when compared with those on memantine. Discussion and conclusion: The present study suggests that memantine may have beneficial effects in the treatment of many core symptoms of autism. Therefore, memantine may be considered as a potential medication in the treatment of those autistic children who do not respond or cannot tolerate side effects of risperidone.

  10. Comparative efficacy of nicardipine hydrochloride and atenolol in the treatment of chronic stable angina

    PubMed Central

    Logan, R. L.; Ikram, H.; Webster, M. W.; Guppy, W.

    1986-01-01

    1 The efficacy and safety of nicardipine, 30 mg three times a day, were compared with atenolol, 100 mg once daily in a randomised, double-blind, 11-week, crossover study of 46 patients with stable angina pectoris. 2 Both drugs significantly decreased the frequency of angina and improved total exercise time, time to angina, and time to 1 mm ST-segment depression. No statistically significant differences were observed between nicardipine and atenolol in clinical responses or treadmill performance. 3 At maximum workload, the double product decreased significantly in patients taking atenolol and did not change in those using nicardipine. 4 During treatment with atenolol, statistically significant decreases were observed in heart rate and QTc interval; these parameters increased minimally on nicardipine. 5 The incidence and severity of adverse experiences associated with each treatment were similar and did not interfere with the study. The two major adverse experiences, myocardial infarction and sudden death, occurred only in patients receiving atenolol. 6 Nicardipine therapy compared favourably with atenolol therapy in patients with angina pectoris.

  11. Energy implications of mechanical and mechanical-biological treatment compared to direct waste-to-energy.

    PubMed

    Cimpan, Ciprian; Wenzel, Henrik

    2013-07-01

    Primary energy savings potential is used to compare five residual municipal solid waste treatment systems, including configurations with mechanical (MT) and mechanical-biological (MBT) pre-treatment, which produce waste-derived fuels (RDF and SRF), biogas and/or recover additional materials for recycling, alongside a system based on conventional mass burn waste-to-energy and ash treatment. To examine the magnitude of potential savings we consider two energy efficiency levels (state-of-the-art and best available technology), the inclusion/exclusion of heat recovery (CHP vs. PP) and three different background end-use energy production systems (coal condensing electricity and natural gas heat, Nordic electricity mix and natural gas heat, and coal CHP energy quality allocation). The systems achieved net primary energy savings in a range between 34 and 140 MJprimary/100 MJinput waste, in the different scenario settings. The energy footprint of transportation needs, pre-treatment and reprocessing of recyclable materials was 3-9.5%, 1-18% and 1-8% respectively, relative to total energy savings. Mass combustion WtE achieved the highest savings in scenarios with CHP production, nonetheless, MBT-based systems had similarly high performance if SRF streams were co-combusted with coal. When RDF and SRF was only used in dedicated WtE plants, MBT-based systems totalled lower savings due to inherent system losses and additional energy costs. In scenarios without heat recovery, the biodrying MBS-based system achieved the highest savings, on the condition of SRF co-combustion. As a sensitivity scenario, alternative utilisation of SRF in cement kilns was modelled. It supported similar or higher net savings for all pre-treatment systems compared to mass combustion WtE, except when WtE CHP was possible in the first two background energy scenarios. Recovery of plastics for recycling before energy recovery increased net energy savings in most scenario variations, over those of full

  12. The retina dose-area histogram: a metric for quantitatively comparing rival eye plaque treatment options

    PubMed Central

    2013-01-01

    Purpose Episcleral plaques have a history of over a half century in the delivery of radiation therapy to intraocular tumors such as choroidal melanoma. Although the tumor control rate is high, vision-impairing complications subsequent to treatment remain an issue. Notable, late complications are radiation retinopathy and maculopathy. The obvious way to reduce the risk of radiation damage to the retina is to conform the prescribed isodose surface to the tumor base and to reduce the dose delivered to the surrounding healthy retina, especially the macula. Using a fusion of fundus photography, ultrasound and CT images, tumor size, shape and location within the eye can be accurately simulated as part of the radiation planning process. In this work an adaptation of the dose-volume histogram (DVH), the retina dose-area histogram (RDAH) is introduced as a metric to help compare rival plaque designs and conformal treatment planning options with the goal of reducing radiation retinopathy. Material and methods The RDAH is calculated by transforming a digitized fundus-photo collage of the tumor into a rasterized polar map of the retinal surface known as a retinal diagram (RD). The perimeter of the tumor base is digitized on the RD and its area computed. Area and radiation dose are calculated for every pixel in the RD. Results The areal resolution of the RDAH is a function of the pixel resolution of the raster image used to display the RD and the number of polygon edges used to digitize the perimeter of the tumor base. A practical demonstration is presented. Conclusions The RDAH provides a quantitative metric by which episcleral plaque treatment plan options may be evaluated and compared in order to confirm adequate dosimetric coverage of the tumor and margin, and to help minimize dose to the macula and retina. PMID:23634152

  13. Comparative analysis of collagen membranes for the treatment of implant dehiscence defects.

    PubMed

    Oh, Tae-Ju; Meraw, Stephen J; Lee, Eun-Ju; Giannobile, William V; Wang, Hom-Lay

    2003-02-01

    Guided bone regeneration (GBR) evolved from the concept of guided tissue regeneration (GTR) and has been used for reconstructing sites with bone deficiencies associated with dental implants. For GBR, the use of absorbable collagen membranes has been increasing, but, at present, scientific information on the use of collagen membranes for GBR is limited. This study was aimed to clinically and histomorphometrically compare two collagen membranes, Bio-Gide(R) and BioMend ExtendTM, for the treatment of implant dehiscence defects in eight mongrel dogs. Implant dehiscence defects were surgically created in edentulous ridges, followed by the placement of three endosseous implants bilaterally in the mandible. Each implant dehiscence defect was randomly assigned to one of three treatment groups: (1) control (no membrane), (2) porcine dermis collagen barrier (Bio-Gide) or (3) bovine tendon collagen barrier (BioMend Extend). Dogs were sacrificed at 4 and 16 weeks (four dogs each) after treatment. Histomorphometric analysis included percentage linear bone fill (LF), new bone-to-implant contact (BIC) and area of new bone fill (BF). The results of the study revealed no significant differences among groups for any parameter at 4 weeks. However, at 16 weeks, more LF, BIC, and BF were noted in the membrane-treated groups than controls. BioMend Extend-treated defects demonstrated significantly greater BIC than control (P < 0.05) at this time point. BIC at 16 weeks was significantly greater than 4-week BIC (P < 0.05). Membrane exposure occurred in 9 out of 15 sites examined, resulting in significantly less LF and BIC than the sites without membrane exposure (P < 0.05). The results of this study indicate that: (1) GBR treatment with collagen membranes may significantly enhance bone regeneration, manifested at late stage (16 weeks) of healing; and (2) space maintenance and membrane coverage were the two most important factors affecting GBR using bioabsorbable collagen membranes.

  14. Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.

    PubMed

    Przekop, Peter; Przekop, Allison; Haviland, Mark G

    2016-10-01

    Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p < .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p < .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results.

  15. Cardiac shockwave therapy improves myocardial function in patients with refractory coronary artery disease by promoting VEGF and IL-8 secretion to mediate the proliferation of endothelial progenitor cells

    PubMed Central

    CAI, HONG-YAN; LI, LIN; GUO, TAO; WANG, YU; MA, TIE-KUN; XIAO, JIAN-MING; ZHAO, LING; FANG, YIN; YANG, PING; ZHAO, HU

    2015-01-01

    Cardiac shockwave therapy (CSWT) is a potential and effective remedy to promote revascularization in the ischemic myocardium of patients with refractory coronary heart disease (CHD). The technique is both safe and non-invasive; however, the underlying molecular mechanism remains unclear. The aim of this study was to evaluate the efficacy of CSWT in treating CHD patients and investigate a potential mechanism. A total of 26 patients with CHD were enrolled in the study, and CSWT was performed over a 3-month period. The efficacy of CSWT was assessed using several clinical parameters. Peripheral blood (PB) was collected prior to and following treatment. The number of circulating endothelial progenitor cells (EPCs) in the PB was counted using a flow cytometer, and the levels of vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), stromal cell-derived factor 1 and matrix metalloproteinase 9 in the PB were analyzed. Mononuclear cells were isolated from the PB and cultured in vitro. The EPCs and EPC-colony forming units (EPC-CFUs) in the PB mononuclear cell culture were counted using an inverted phase contrast microscope. Following CSWT, the tested clinical parameters were significantly improved. The levels of circulating EPCs, VEGF and IL-8 in the PB were significantly increased, as were the EPCs and EPC-CFUs from the PB mononuclear cell culture. We suggest that EPC proliferation, mediated by VEGF and IL-8 secretion, may be among the potential mechanisms associated with CSWT. PMID:26668649

  16. Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats.

    PubMed

    Shan, Hai-Tao; Zhang, Hai-Bo; Chen, Wen-Tao; Chen, Feng-Zhi; Wang, Tao; Luo, Jin-Tai; Yue, Min; Lin, Ji-Hong; Wei, An-Yang

    2017-01-01

    Stem cell transplantation and low-energy shock-wave therapy (LESWT) have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups: the diabetic group (n = 6), the LESWT group (n = 6), the bone marrow-derived mesenchymal stem cell (BMSC) transplantation group (n = 15), and the combination of LESWT and BMSC transplantation group (n = 15). One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed: the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone.

  17. Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats

    PubMed Central

    Shan, Hai-Tao; Zhang, Hai-Bo; Chen, Wen-Tao; Chen, Feng-Zhi; Wang, Tao; Luo, Jin-Tai; Yue, Min; Lin, Ji-Hong; Wei, An-Yang

    2017-01-01

    Stem cell transplantation and low-energy shock-wave therapy (LESWT) have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups: the diabetic group (n = 6), the LESWT group (n = 6), the bone marrow-derived mesenchymal stem cell (BMSC) transplantation group (n = 15), and the combination of LESWT and BMSC transplantation group (n = 15). One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed: the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone. PMID:27427555

  18. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial.

    PubMed

    Panahi, Yunes; Taghizadeh, Mohsen; Marzony, Eisa Tahmasbpour; Sahebkar, Amirhossein

    2015-01-01

    Rosmarinus officinalis L. is a medicinal plant with diverse activities including enhancement microcapillary perfusion. The present study aimed to investigate the clinical efficacy of rosemary oil in the treatment of androgenetic alopecia (AGA) and compare its effects with minoxidil 2%. Patients with AGA were randomly assigned to rosemary oil (n = 50) or minoxidil 2% (n = 50) for a period of 6 months. After a baseline visit, patients returned to the clinic for efficacy and safety evaluations every 3 months. A standardized professional microphotographic assessment of each volunteer was taken at the initial interview and after 3 and 6 months of the trial. No significant change was observed in the mean hair count at the 3-month endpoint, neither in the rosemary nor in the minoxidil group (P > .05). In contrast, both groups experienced a significant increase in hair count at the 6-month endpoint compared with the baseline and 3-month endpoint (P < .05). No significant difference was found between the study groups regarding hair count either at month 3 or month 6 (> .05). The frequencies of dry hair, greasy hair, and dandruff were not found to be significantly different from baseline at either month 3 or month 6 trial in the groups (P > .05). The frequency of scalp itching at the 3- and 6-month trial points was significantly higher compared with baseline in both groups (P < .05). Scalp itching, however, was more frequent in the minoxidil group at both assessed endpoints (P < .05). The findings of the present trial provided evidence with respect to the efficacy of rosemary oil in the treatment of AGA.

  19. Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax.

    PubMed

    Moreno-Merino, Sergio; Congregado, Miguel; Gallardo, Gregorio; Jimenez-Merchan, Rafael; Trivino, Ana; Cozar, Fernando; Lopez-Porras, Marta; Loscertales, Jesus

    2012-07-01

    Primary spontaneous pneumothorax is a pathology mainly affecting healthy young patients. Clinical guidelines do not specify the type of pleurodesis that should be conducted, due to the lack of comparative studies on the different techniques. The aim of this study was to compare talc poudrage and pleural abrasion in the treatment of spontaneous pneumothorax. A retrospective comparative study was performed, including 787 patients with primary spontaneous pneumothorax. The 787 patients were classified into two groups: Group A (pleural abrasion) n = 399 and Group B (talc pleurodesis) n = 388. The variables studied were recurrence, surgical time, morbidity and in-hospital length of stay. Statistical analysis was done by an unpaired t-test and Fisher's exact test (SSPS 18.0). Statistically significant differences were observed in the variables: surgical time (A: 46 ± 12.3; B: 37 ± 11.8 min; P < 0.001); length of stay (A: 4.7 ± 2.5; B: 4.3 ± 1.8 days; P = 0.01); apical air camera (A: 25; B: 4; P < 0.001); pleural effusion (A: 6; B: 0; P = 0.05). Talc poudrage shows shorter surgical times and length of stay, and lower re-intervention rates. Morbidity is lower in patients with talc poudrage. Statistically significant differences were not observed in recurrence, persistent air leaks, atelectasis and haemothorax.

  20. High-energy shockwaves and extracorporeal high-intensity focused ultrasound.

    PubMed

    Madersbacher, Stephan; Marberger, Michael

    2003-10-01

    We review the physical interactions of focused ultrasound with tissue, describe technical features of current high-energy shockwave (HESW) and extracorporeal high-intensity focused ultrasound (HIFU) devices, and summarize the experimental and human data available to date. Tissue destruction by extracorporeal HIFU is not new: the first clinical attempts were made almost half a century ago for ablating brain tissue. Despite recent progress in the knowledge of the interactions between HIFU and tissue and significant device modifications, this technique is still in its infancy. The most promising targets for this kind of therapy in the field of urology are the kidney, bladder, and testis. The largest clinical experience with HIFU therapy currently available is for benign prostatic enlargement and prostate cancer using transrectal HIFU devices, which are not the topic of this summary. In parallel with HIFU, HESW therapy has been tested in numerous experimental and preclinical settings. This technique is currently not in routine clinical use. Theoretically, in parallel with HIFU, any organ accessible to conventional diagnostic ultrasound examination is a potential target for this kind of therapy.

  1. Loosening detection of the femoral component of hip prostheses with extracorporeal shockwaves: a pilot study.

    PubMed

    Rieger, Johannes S; Jaeger, Sebastian; Kretzer, Jan Philippe; Rupp, Rüdiger; Bitsch, Rudi G

    2015-02-01

    The diagnosis of aseptic loosening of hip implants is often challenging. A vibrational analysis of the bone-implant interface could be an alternative method to analyze the fixation of endoprostheses. We assessed an innovative and new approach for excitation by using extracorporeal shockwaves in this study. In three cadaver specimens total hip arthroplasty was performed bilaterally. Four different states of implant loosening were simulated. Three accelerometers were fixed at the medial condyle, the greater trochanter, and the crest of the ilium. The bone-implant compound was excited with highly standardized extracorporeal shock waves. Resonance spectra between 100 Hz and 5000 Hz were recorded. This technique permitted a good adaptation to varying soft tissue conditions. The main resonance frequency of the hip joints occurred at about 2000 Hz. The analysis of the measured spectra showed an interrelation between the state of loosening and the frequency values of the resonances. In case of a stem loosening, there were significant shifts of the resonance into the lower frequency area between 386 Hz and 847 Hz. With this novel technique the degree of stem loosening could be assessed in a soft tissue considering configuration. This study forms a first step for future establishment of a non-invasive, non-radiological and fast applicable diagnostic procedure for early detection of endoprostheses loosening before manifest presence of clinical signs.

  2. Shooter position estimation with muzzle blast and shockwave measurements from separate locations

    NASA Astrophysics Data System (ADS)

    Grasing, David

    2016-05-01

    There are two acoustical events associated with small arms fire: the muzzle blast (created by bullets being expelled from the barrel of the weapon), and the shockwave (created by bullets which exceed the speed of sound). Assuming the ballistics of a round are known, the times and directions of arrival of the acoustic events furnish sufficient information to determine the origin of the shot. Existing methods tacitly assume that it is a single sensor which makes measurements of the times and direction of arrival. If the sensor is located past the point where the bullet goes transonic or if the sensor is far off the axis of the shot line a single sensor localization become highly inaccurate due to the ill-conditioning of the localization problem. In this paper, a more general approach is taken which allows for localizations from measurements made at separate locations. There are considerable advantages to this approach, the most noteworthy of which is the improvement in localization accuracy due to the improvement in the conditioning of the problem. Additional benefits include: the potential to locate in cases where a single sensor has insufficient information, furnishing high quality initialization to data fusion algorithms, and the potential to identify the round from a set of possible rounds.

  3. In vitro study of the mechanical effects of shock-wave lithotripsy.

    PubMed

    Howard, D; Sturtevant, B

    1997-01-01

    Impulsive stress in repeated shock waves administered during extracorporeal shock-wave lithotripsy (ESWL) causes injury to kidney tissue. In a study of the mechanical input of ESWL, the effects of focused shock waves on thin planar polymeric membranes immersed in a variety of tissue-mimicking fluids have been examined. A direct mechanism of failure by shock compression and an indirect mechanism by bubble collapse have been observed. Thin membranes are easily damaged by bubble collapse. After propagating through cavitation-free acoustically heterogeneous media (liquids mixed with hollow glass spheres, and tissue) shock waves cause membranes to fail in fatigue by a shearing mechanism. As is characteristic of dynamic fatigue, the failure stress increases with strain rate, determined by the amplitude and rise time of the attenuated shock wave. Shocks with large amplitude and short rise time (i.e., in uniform media) cause no damage. Thus the inhomogeneity of tissue is likely to contribute to injury in ESWL. A definition of dose is proposed which yields a criterion for damage based on measurable shock wave properties.

  4. Dislocation-kinetic analysis of FCC and BCC crystal spallation under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Malygin, G. A.; Ogarkov, S. L.; Andriyash, A. V.

    2015-09-01

    Within the dislocation-kinetic model of the formation and propagation of shock waves in crystals under their intense shock-wave loading, the crystal spallation mechanism at micro- and macrolevels has been discussed taking into account published empirical data. It has been shown that the spallation time t f for Cu, Ni, α-Fe, and Ta crystals in the time interval of 10-6-10-9 s at the macroscopic level changes with variations in the wave pressure σ as , where = is the plastic strain rate according to the Swegle-Grady relation; K f , K σ, and ɛ f = K f K σ ≈ 3-5% are the pressure-independent spallation coefficients and strain, respectively; and E is the Young's modulus. At the microlevel, the dislocation-kinetic calculation of plastic zones around pore nuclei as stress concentrators and plastic strain localization regions at the shock wave front has been performed. It has been shown that the pore coalescence and spall fracture formation result from the superposition of shear stresses and plastic deformations in interpore spacings when the latter decrease to a size of the order of two pore sizes.

  5. A Comparative Dosimetric Analysis of the Effect of Heterogeneity Corrections Used in Three Treatment Planning Algorithms

    NASA Astrophysics Data System (ADS)

    Herrick, Andrea Celeste

    (AAA) and Collapsed Cone Convolution (CCC) have been shown to be much better than earlier heterogeneity correction algorithms (such as modified Batho), they still fail to agree to a significant degree to ensure agreement between the recommended planning and delivery of better than 2% (Loevinger & Loftus, 1977). For lung plans, average minimum PTV dose was seen to be as much as 285 cGy (4.3% of the prescription dose) less than the same plan calculated without heterogeneity corrections applied. Average maximum PTV dose was seen to be as much as 680 cGy (10.3% of the prescription dose) higher than the same plan calculated with heterogeneity corrections turned off. When different heterogeneity correction algorithms are compared, average differences of up to 747 cGy in minimum PTV dose (11.3% of the prescription dose) can be seen. These results highlight the importance of careful considerations of the limitations of treatment planning algorithms under certain conditions of clinical use.

  6. Specific Phobias in Youth: A Randomized Controlled Trial Comparing One-Session Treatment to a Parent-Augmented One-Session Treatment

    PubMed Central

    Ollendick, Thomas H.; Halldorsdottir, Thorhildur; Fraire, Maria G; Austin, Kristin E.; Noguchi, Ryoichi J. P.; Lewis, Krystal M.; Jarrett, Matthew A.; Cunningham, Natoshia R.; Canavera, Kristin; Allen, Kristy B.; Whitmore, Maria J.

    2015-01-01

    Objective Examine the efficacy of a parent-augmented One Session Treatment (A-OST) in treating specific phobias (SP) in youth by comparing this novel treatment to child-focused OST, a well-established treatment. Method A total of 97 youth (ages 6–15, 51.5% female, 84.5% white) who fulfilled diagnostic criteria for SP were randomized to either A-OST or OST. SPs were assessed with semi-structured diagnostic interviews, clinician improvement ratings, and parent and child improvement ratings. In addition, measures of treatment satisfaction and parental self-efficacy were obtained. Blind assessments were completed pretreatment, post-treatment, and 1-month and 6-months following treatment. Analyses were undertaken using mixed models. In addition, gender, age, internalizing/externalizing problems, parent overprotection, and parent anxiety were examined as potential predictors and moderators of treatment outcome. Results Both treatment conditions produced similar outcomes with approximately 50% of youth in both treatments diagnosis free and judged to be much or very much improved at post-treatment and 1-month follow up. At 6-month follow up, however, the treatments diverged with OST resulting in marginally superior outcomes to A-OST, contrary to predictions. Only age of child predicted treatment outcome across the two treatments (older children did better); unexpectedly, none of the variables moderated treatment outcomes. Conclusions Parent augmentation of OST produced no appreciable gains in treatment outcomes. Directions for future research are highlighted. PMID:25645164

  7. Effect of shock-wave loading on mechanical and thermomechanical characteristics of shape-memory alloys 45Ti-45Ni-10Nb and 43Ti-46Ni-8Nb-3Zr

    NASA Astrophysics Data System (ADS)

    Popov, N. N.; Lar'kin, V. F.; Ogorodnikov, V. A.; Presnyakov, D. V.; Lar'kina, Yu. A.; Aushev, A. A.; Sysoyeva, T. I.; Suvorova, E. B.; Kostyleva, A. A.

    2016-09-01

    This work was performed to study the behavior of 45Ti-45Ni-10Nb and 43Ti-46Ni-8Nb-3Zr (at %) shape-memory alloys (SMAs) under the effect of severe dynamic deformation to use the obtained results to develop technologies based on SMAs. Cast alloys were used for the tests. The elemental and phase compositions of the alloys in the initial state, as well as the phase composition, kinetics, and temperatures of phase transformations after heat treatment (annealing in a vacuum at 850°C for 4 h, furnace cooling) have been determined. The mechanical and thermomechanical characteristics of these alloys before and after shock-wave loading have been determined.

  8. Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

    PubMed Central

    Brokmann, Jörg C; Conrad, Clemens; Rossaint, Rolf; Bergrath, Sebastian; Beckers, Stefan K; Tamm, Miriam; Czaplik, Michael

    2016-01-01

    Background Prehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues. Objective The objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS. Methods After approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician–staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed. Results Teleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007). Conclusions Telemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was

  9. [Comparative characteristics of the open and endovascular methods of treatment for carotid artery stenoses].

    PubMed

    Krotovskiĭ, G S; Uchkin, I G; Shugushev, Z Kh; Zudin, A M; Kagdasarian, A G

    2010-01-01

    The article is dedicated to the problem concerning treatment for stenoses of the extracranial portions of carotid arteries. From March 2004 to November 2009 at the Department of Vascular Surgery No 2 of the N. A. Semashko Central Clinical Hospital No 2 we treated a total of 364 patients presenting with stenotic lesions of the extracranial portion of the carotid arteries. Of these, 176 patients underwent revascularization of the carotid basin: 120 patients endured open carotid endarterectomy (CEAE), 56 patients sustained carotid angioplasty and stenting (CAS), with a total of 128 CEAE and 67 CAS interventions performed. The following conclusion was made: with high skill of surgeons and broad experience in carrying out revascularization of the carotid basin, the CEAE and CAS procedures possess comparable efficacy and safety with CEAE possessing reliable advantage in terms of the parameters of the patient's quality of life.

  10. Pharmaceutical Innovation in the Treatment of Schizophrenia and Mental Disorders Compared with Other Diseases

    PubMed Central

    MacEwan, Joanna P.; Seabury, Seth; Kamat, Siddhesh; van Eijndhoven, Emma; Francois, Clement; Henderson, Crystal; Citrome, Leslie

    2016-01-01

    Objectives: The objectives of this study were to assess the level of private and public investment in research and development of treatments for schizophrenia and other mental disorders compared to other diseases in order to present data on the economic burden and pharmaceutical innovation by disease area, and to compare the level of investment relative to burden across different diseases. Design: The levels of investment and pharmaceutical innovation relative to burden across different diseases were assessed. Disease burden and prevalence for mental disorders (schizophrenia, bipolar disorder, and major depressive disorder); cancer; rheumatoid arthritis; chronic obstructive pulmonary disorder; diabetes; cardiovascular disease; and neurological disorders (dementia and epilepsy) were estimated from literature sources. Setting: Pharmaceutical treatment innovation was measured by the total number of drug launches and the number of drugs launched categorized by innovativeness. Research and development expenditures were estimated using published information on annual public and domestic private research and development expenditures by disease area. Lastly, investment relative to disease burden was measured among the set of disease classes for which all three measures were available: schizophrenia, bipolar disorder, major depressive disorder, cancer, rheumatoid arthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and neurology (dementia and epilepsy combined). Results: The level of investment and pharmaceutical innovation in mental disorders was comparatively low, especially relative to the burden of disease. For mental disorders, investment was $3.1 per $1,000 burden invested in research and development for schizophrenia, $1.8 for major depressive disorder, and $0.4 for bipolar disorder relative to cancer ($75.5), chronic obstructive pulmonary disease ($9.4), diabetes ($7.6), cardiovascular disease ($6.3), or rheumatoid arthritis ($5

  11. Comparative gastroprotective effect of post-treatment with low doses of rutin and cimetidine in rats.

    PubMed

    Olaleye, Mary Tolulope; Akinmoladun, Afolabi Clement

    2013-04-01

    The anti-ulcerogenic potentials of low doses of rutin and cimetidine in ethanol-, acetic acid-, and stress-induced ulcers in rats have been evaluated and compared in this study. In each model, male Wistar rats were randomly divided into six groups (I-VI). Groups II-VI were administered 1 mL/100 g ethanol orally, 0.05 mL of 20% acetic acid submucosally or kept in a cold chamber for 6 h to induce ulcer in the ethanol-, acetic acid-, and stress-induced ulceration model, respectively. Thereafter, group III was post-treated with 300 mg/kg cimetidine and groups IV-VI with 20, 40, and 80 mg/kg rutin, respectively, while the control (group I) received distilled water in Tween 20. One hour after post-treatment, all groups were killed and the gastric ulcer index was calculated. Malondialdehyde (MDA) level, vitamin C content, and glutathione peroxidase (GPx) activity were evaluated in the gastric mucosa of animals. Post-treatment with rutin significantly reduced ulcerogen-induced gastric damage in all models. This effect was significant at all dose levels compared with the ulcer-induced groups. Rutin significantly reduced the MDA levels but increased the vitamin C content and GPx activity. Ulcer index and MDA level were highest in the ethanol-induced ulcer model while vitamin C content and GPx activity were lowest in the stress-induced ulcer model. The study showed that all three models of ulceration appeared to be linked to oxidative stress and also ascribed significant anti-ulcerogenic potential to rutin especially at lower doses of 20-80 mg/kg.

  12. Comparative Effectiveness of Pleural Drainage Procedures for the Treatment of Complicated Pneumonia in Childhood

    PubMed Central

    Shah, Samir S.; Hall, Matthew; Newland, Jason G.; Brogan, Thomas V.; Farris, Reid W. D.; Williams, Derek J.; Larsen, Gitte; Fine, Bryan R.; Levin, James E.; Wagener, Jeffrey S.; Conway, Patrick H.; Myers, Angela L.

    2011-01-01

    Objective To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (i.e., complicated pneumonia). Design Multicenter retrospective cohort study. Setting 40 children’s hospitals contributing data to the Pediatric Health Information System. Participants Children with complicated pneumonia requiring pleural drainage. Main Exposures Initial drainage procedures were categorized as chest tube without fibrinolysis, chest tube with fibrinolysis, video-assisted thoracoscopic surgery (VATS), and thoracotomy. Main Outcome Measures Length of stay (LOS), additional drainage procedures, readmission within 14 days of discharge, and hospital costs. Results Initial procedures among 3,500 patients included chest tube without fibrinolysis (n=1,762), chest tube with fibrinolysis (n=623), VATS (n=408), and thoracotomy (n=797). Median age was 4.1 years. Overall, 716 (20.5%) patients received an additional drainage procedure (range, 6.8%–44.8% across individual hospitals). The median LOS was 10 days (range, 7–14 days across individual hospitals). The median readmission rate was 3.8% (range, 0.8%–33.3%). In multivariable analysis, differences in LOS by initial procedure type were not significant. Patients undergoing initial chest tube placement with or without fibrinolysis were more likely to require additional drainage procedures. However, initial chest tube without fibrinolysis was the least costly strategy. Conclusion There is variability in the treatment and outcomes of children with complicated pneumonia. Outcomes were similar in patients undergoing initial chest tube placement with or without fibrinolysis. Those undergoing VATS received fewer additional drainage procedures but had no differences in LOS compared with other strategies. PMID:21374798

  13. Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect

    PubMed Central

    Chen, Qiang; Cao, Hua; Chen, Zhao-yang; Zhang, Gui-Can; Chen, Liang-wan; Xu, Fan; He, Jia-jun

    2017-01-01

    Abstract The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect. From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy. In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05). Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device. PMID:28296745

  14. Comparative study on the osseointegration of implants in dog mandibles according to the implant surface treatment

    PubMed Central

    2016-01-01

    Objectives This study compared the impact of implant surface treatment on the stability and osseointegration of implants in dog mandibles. Materials and Methods Six adult dogs received a total of 48 implants that were prepared using four different surface treatments; resorbable blast media (RBM), hydroxyapatite (HA), hydrothermal-treated HA, and sand blasting and acid etching (SLA). Implants were installed, and dogs were separated into 2- and 4-week groups. Implant stability was evaluated via Periotest M, Osstell Mentor, and removal torque analyzers. A histomorphometric analysis was also performed. Results The stability evaluation showed that all groups generally had satisfactory values. The histomorphometric evaluation via a light microscope revealed that the HA surface implant group had the highest ratio of new bone formation on the entire fixture. The hydrothermal-treated HA surface implant group showed a high ratio of bone-to-implant contact in the upper half of the implant area. Conclusion The hydrothermal-treated HA implant improved the bone-to-implant contact ratio on the upper fixture, which increased the implant stability. PMID:28053904

  15. Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions

    PubMed Central

    Terplan, Mishka; Ramanadhan, Shaalini; Locke, Abigail; Longinaker, Nyaradzo; Lui, Steve

    2016-01-01

    Background Illicit drug use in pregnancy is a complex social and public health problem. The consequences of drug use in pregnancy are high for both the woman and her child. Therefore, it is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial interventions in drug treatment but it is unclear whether they are effective in pregnant women. This is an update of a Cochrane review originally published in 2007. Objectives To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programmes on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance? Search methods We conducted the original literature search in May 2006 and performed the search update up to January 2015. For both review stages (original and update), we searched the Cochrane Drugs and Alcohol Group Trial's register (May 2006 and January 2015); the Cochrane Central Register of Trials (CENTRAL; the Cochrane Library 2015, Issue 1); PubMed (1996 to January 2015); EMBASE (1996 to January 2015); and CINAHL (1982 to January 2015). Selection criteria We included randomized controlled trials comparing any psychosocial intervention vs. a control intervention that could include pharmacological treatment, such as methadone maintenance, a different psychosocial intervention, counselling, prenatal care, STD counselling and testing, transportation, or childcare. Data collection and analysis We used standard methodological procedures expected by the Cochrane Collaboration. We performed analyses based on three comparisons: any psychosocial intervention vs. control, contingency management (CM) interventions vs. control, and motivational interviewing based (MIB) interventions vs. control. Main results

  16. Bayesian network meta-analysis comparing five contemporary treatment strategies for newly diagnosed acute promyelocytic leukaemia.

    PubMed

    Wu, Fenfang; Wu, Di; Ren, Yong; Duan, Chongyang; Chen, Shangwu; Xu, Anlong

    2016-07-26

    Acute promyelocytic leukemia (APL) is a curable subtype of acute myeloid leukemia. The optimum regimen for newly diagnosed APL remains inconclusive. In this Bayesian network meta-analysis, we compared the effectiveness of five regimens-arsenic trioxide (ATO) + all-trans retinoic acid (ATRA), realgar-indigo naturalis formula (RIF) which contains arsenic tetrasulfide + ATRA, ATRA + anthracycline-based chemotherapy (CT), ATO alone and ATRA alone, based on fourteen randomized controlled trials (RCTs), which included 1407 newly diagnosed APL patients. According to the results, the ranking efficacy of the treatment, including early death and complete remission in the induction stage, was the following: 1. ATO/RIF + ATRA; 2. ATRA + CT; 3. ATO, and 4. ATRA. For long-term benefit, ATO/RIF + ATRA significantly improved overall survival (OS) (hazard ratio = 0.35, 95%CI 0.15-0.82, p = 0.02) and event-free survival (EFS) (hazard ratio = 0.32, 95%CI 0.16-0.61, p = 0.001) over ATRA + CT regimen for the low-to-intermediate-risk patients. Thus, ATO + ATRA and RIF + ATRA might be considered the optimum treatments for the newly diagnosed APL and should be recommended as the standard care for frontline therapy.

  17. The Efficacy of Nasal Steroids in Treatment of Otitis Media with Effusion: A Comparative Study

    PubMed Central

    El-Anwar, Mohammad Waheed; Nofal, Ahmad Abdel-Fattah; Khazbak, Alaa Omar; Sayed, Ahmad Ebrahim El; Hassan, Mohammad Ramadan

    2015-01-01

    Introduction Otitis media with effusion (OME) continues to be an important pediatric clinical problem, and more studies are needed to decide the proper treatment for it. Objective To assess the efficacy of nasal steroids in the management of OME by comparing its results with that of oral steroid and that of nasal saline spray as placebo. Methods This study was carried on 60 patients with OME who were divided into three groups: in group 1, 20 patients received mometasone furoate spray, one puff in each nostril daily, for 3 months; in group 2, 20 patients received oral prednisolone, 5 mg three times per day for the first 3 weeks; in group 3, 20 patients received nasal saline spray, one puff in each nostril daily for 3 months. Results A highly significant difference between systemic or topical (nasal spray) steroid therapy and saline nasal spray was detected (p < 0.001), and the difference between systemic and topical steroid was nonsignificant (p > 0.05). Conclusion Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid. Further studies are needed to investigate its use for longer duration and in recurrent cases. PMID:26491474

  18. Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures

    PubMed Central

    Yeganeh, Ali; Taghavi, Roozbeh; Moghtadaei, Mehdi

    2016-01-01

    Introduction: Dynamic Hip Screw fixation is currently considered as a standard treatment for pre-trochanteric fractures; however, due to the long-term hospitalization and some other complications, some researchers have proposed intramedullary nailing as the alternative surgical treatment. The aim of this study was to compare and examine the consequences of the using intramedullary nailing method versus Dynamic Hip Screw. Methods: In this study 114 patients with unstable Intertrochanteric fracture refer to Rasoul Akram hospital during 2011 to 2013 has been selected. After reduction, fixation surgery with PFN nail (60 patients) and Dynamic Hip Screw (54 patients) has been performed. All patients were screen during surgery and six months after surgery and some parameters like, bleeding, union, as well as complications such as collapse, varus and medialization of the distal fragment were record and patients. Results: About some parameters like cutting length, surgery duration, bleeding there were significant differences between two groups. In six months follow up period 2 patinas from nail and 8 patients from DHS group had non-union. Also from the point of radiologic and clinical parameters, like anterior thigh pain, cut out, medialization of the distal fragment, collapse of the neck, walking recovery and daily activities were significant between two groups. Conclusion: Due to the reduced hospital stay in intramedullary nailing method and the necessity of doing repeated surgery and applying intramedullary nailing when the patients are not treated with external fixation, the researchers recommend intramedullary nailing as the first option in treating such patients. PMID:26980933

  19. Treatment of congenital leg length discrepancies in children using an Ilizarov external fixator: a comparative study.

    PubMed

    Bukva, Bojan; Vrgoc, Goran; Brdar, Radivoj; Ducić, Sinisa; Gulan, Gordan; Jurdana, Hari

    2014-12-01

    The purpose of this study was to evaluate the influence of intramedullary (IM) alignment used in combination with an Ilizarov external fixation on the healing index (HI) and lengthening index (LI) in the treatment of congenital leg length discrepancies (LLD). This study included 35patients aged from 3.5 to 19 (average age 10.73) who underwent thl egalisation procedure using an Ilizarov external fixator. We compared the duration of the external fixator application, LLD, HI and LI between two groups of children: children in Group I underwent limb lengthening by the conventional llizarov technique using an Ilizarov external fixator alone, and children in Group II underwent a combination of Ilizarov technique and intramedullary alignment with two Kirschner wires, introduced through two mini-incisions. We found significant differences between the two groups of patients for duration of external fixator application and HI. Patients with congeni- tal LLD treated with combined method of treatment had benefit from intramedullary alignment due to its better outcome.

  20. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne.

    PubMed

    Bassett, I B; Pannowitz, D L; Barnetson, R S

    1990-10-15

    Tea-tree oil (an essential oil of the Australian native tree Melaleuca alternifolia) has long been regarded as a useful topical antiseptic agent in Australia and has been shown to have a variety of antimicrobial activities; however, only anecdotal evidence exists for its efficacy in the treatment of various skin conditions. We have performed a single-blind, randomised clinical trial on 124 patients to evaluate the efficacy and skin tolerance of 5% tea-tree oil gel in the treatment of mild to moderate acne when compared with 5% benzoyl peroxide lotion. The results of this study showed that both 5% tea-tree oil and 5% benzoyl peroxide had a significant effect in ameliorating the patients' acne by reducing the number of inflamed and non-inflamed lesions (open and closed comedones), although the onset of action in the case of tea-tree oil was slower. Encouragingly, fewer side effects were experienced by patients treated with tea-tree oil.

  1. Comparing complementary alternative treatment for chronic shoulder pain of myofascial origin

    PubMed Central

    Pan, Ru-Yu; Hsu, Yung-Chi; Wong, Chih-Shung; Lin, Shinn-Long; Li, Tsung-Ying; Cherng, Chen-Hwan; Ko, Shan-Chi; Yeh, Chun-Chang

    2016-01-01

    Abstract The aim of this study was to compare the short-term outcomes between 2 different treatments for unilateral chronic shoulder pain of myofascial origin, that is, local tender area related meridians (LTARMs) treatment and collateral meridian therapy (CMT), which were performed 6 times over a period of 4 weeks. Seventy patients with unilateral shoulder pain of chronic myofascial origin were enrolled. The patients were randomly assigned to 2 different treatment groups: 1 group received CMT (n = 35) and the other received LTARM (n = 35). Before and after the 2 treatment processes, all patients rated their overall pain intensity on a visual analogue scale (VAS) and a validated 13-question shoulder pain and disability index (SPADI) questionnaire was used to measure shoulder pain and functional impairment after therapy for 4 weeks. After CMT, the pain intensity was reduced after CMT. VAS score is reduced from 5.90 ± 2.07 (a mean of 5.90 and standard deviation of 2.07) to 3.39 ± 1.2. This was verified by the SPADI pain subscale scores (from 0.58 ± 0.193 to 0.33 ± 0.14). The pain-relief effect of CMT was significantly better than that of LTARM (VAS score from 5.78 ± 1.64 to 4.58 ± 1.40; P < 0.005; SPADI pain subscale score from 0.58 ± 0.16 to 0.45 ± 0.14, P < 0.001). In addition, the VAS scores of patients changed considerably in the CMT group after 4 weeks of treatment, where 63% of patients felt no or mild pain, whereas the VAS scores for moderate pain were even higher in the LTARM group in 75% of patients (P < 0.001). Moreover, the SPADI disability subscale scores improved significantly in the CMT group because of their greater mobility associated with shoulder impairment (disability score: from 0.58 ± 0.20 to 0.35 ± 0.14) than those in the LTARM group (disability score: from 0.55 ± 0.17 to 0.44 ± 0.14, P < 0.001). CMT may be more effective in reducing chronic shoulder pain of

  2. Comparative study of low-energy ultrasonic and alkaline treatment on biosludge from secondary industrial wastewater treatment.

    PubMed

    Li, Dongzhe; Tan, Youming; Zhou, Yan; Pathak, Santosh; Sendjaja, Antonius Yudi; Abdul Majid, Maszenan; Chowdhury, Prannoy; Ng, Wun Jern

    2015-01-01

    In this study, low-energy ultrasonic (3 and 6 kJ/g volatile solids of feed biomass (FB) which was lower than the heat value of the FB), alkaline, and ultrasonic-alkaline pretreatments were applied on FB, a biosludge from secondary industrial wastewater treatment. Biochemical methane potential (BMP), particle size distribution, Biomass Stress Index (BSI™), soluble chemical oxygen demand (SCOD), protein, carbohydrate, and size-exclusion chromatography (SEC) fingerprints were used to comparatively study the mechanisms of these pretreatment methods. The results indicated that low-energy ultrasonication and alkali exhibited significantly different impacts on the FB. After ultrasonication with energy input of 6 kJ/g-VS, the average particle size of FB was reduced from 102.6 to 19.4 µm. However, ultrasonication had no obvious effect on microbial cells rupture, solubilization of protein and carbohydrate, and SEC fingerprint. Consequently, low-energy ultrasonication could not enhance methane generation. However, after alkaline pretreatment with dosage of 0.3 g-NaOH/g-VS, SCOD, soluble protein, and soluble carbohydrate concentration of FB increased from 0.66, 0.00, 0.07 to 2.83, 0.83, 0.47 g/L, respectively. At the same time, BSI™ increased from 5.3% to 96.8%, and the SEC fingerprint changed significantly. Consequently, the methane generation in the BMP test increased from 68.9 to 135.0 mL. Ultrasonic-alkaline pretreatment was similar to alkaline pretreatment in terms of methane generation. Based on this study, alkaline pretreatment is recommended over both low-energy ultrasonic and low-energy ultrasonic-alkaline pretreatment to enhance the biodegradability of FB.

  3. A Randomized Controlled Study to Compare Conventional and Evidence Based Treatment Protocols in Fresh Compound Fractures

    PubMed Central

    Mahajan, Kanika; Singh, Girish Kumar; Kumar, Santosh; Avasthi, Sachin

    2016-01-01

    Introduction A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George’s Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). Aim To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. Materials and Methods This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. Statistical Analysis Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. Results Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). Conclusion EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture

  4. Balance Sheets versus Decision Dashboards to support patient treatment choices: A comparative analysis

    PubMed Central

    Dolan, James G.; Veazie, Peter J.

    2015-01-01

    Background Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision making. The use of tabular balance sheets to support clinical decision making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive a deeper understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. Method The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision making. Two separate surveys were conducted: one for the control group and one for the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and asked to choose between three hypothetical drug treatments that varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief washout period, members of the control group made a second treatment choice after reviewing the balance sheet again while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices participants rated their degree of confidence in their choice on a 1–10 scale. Results Members of the dashboard intervention group were more likely to change their choice of preferred drug, (10.2% vs. 7.5%, p=0.054) and had a larger increase in decision confidence than the control group: 0.67 vs. 0.075, p<0.03. There were no statistically significant between group differences in decisional conflict or decision aid acceptability. Conclusion These findings suggest that clinical

  5. Comparable quality attributes of hepatitis E vaccine antigen with and without adjuvant adsorption-dissolution treatment

    PubMed Central

    Zhang, Yue; Li, Min; Yang, Fan; Li, Yufang; Zheng, Zizheng; Zhang, Xiao; Lin, Qingshan; Wang, Ying; Li, Shaowei; Xia, Ningshao; Zhang, Jun; Zhao, Qinjian

    2015-01-01

    Most vaccines require adjuvants for antigen stabilization and immune potentiation. Aluminum-based adjuvants are the most widely used adjuvants for human vaccines. Previous reports demonstrated the preservation of antigen conformation and other antigen characteristics after recovery from adjuvanted Hepatitis B and human papillomavirus vaccines. In this study, we used a combination of various physiochemical and immunochemical methods to analyze hepatitis E vaccine antigen quality attributes after recovery from adjuvants. All biochemical and biophysical methods showed similar characteristics of the p239 protein after recovery from adjuvanted vaccine formulation compared to the antigen in solution which never experienced adsorption/desorption process. Most importantly, we demonstrated full preservation of key antigen epitopes post-recovery from adjuvanted vaccine using a panel of murine monoclonal antibodies as exquisite probes. Antigenicity of p239 was probed with a panel of 9 mAbs using competition/blocking ELISA, surface plasmon resonance and sandwich ELISA methods. These multifaceted analyses demonstrated the preservation of antigen key epitopes and comparable protein thermal stability when adsorbed on adjuvants or of the recovered antigen post-dissolution treatment. A better understanding of the antigen conformation in adjuvanted vaccine will enhanced our knowledge of antigen-adjuvant interactions and facilitate an improved process control and development of stable vaccine formulation. PMID:26018442

  6. Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis.

    PubMed

    Liang, Zhen; Chen, Ya-Ping; Yang, Chun-Sheng; Guo, Wen; Jiang, Xiao-Xiao; Xu, Xi-Feng; Feng, Shou-Xin; Liu, Yan-Qun; Jiang, Guan

    2016-01-01

    Penicillin is the gold standard for treating syphilis. However, allergic reactions, poor drug tolerance and limited efficacy in patients remain a challenging problem. The objective of this meta-analysis was to compare the efficacy of ceftriaxone and penicillin based on data obtained from published randomised controlled trials (RCTs). The Cochrane Library, Medline, EBSCO, EMBASE and Ovid databases were searched for RCTs of ceftriaxone vs. penicillin for the treatment of syphilis. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were used to investigate the following outcome measures: 3-month response rate; 6-month response rate; 12-month response rate; relapse rate; serofast rate; and failure rate. Seven RCTs involving 281 participants (159 patients who received ceftriaxone and 122 patients who received penicillin) were included in the meta-analysis. There were no significant differences in 3-month response rate (RR=1.12, 95% CI 0.89-1.42), 6-month response rate (RR=1.02, 95% CI 0.75-1.38), 12-month response rate (RR=1.04, 95% CI 0.82-1.32), relapse rate (RR=0.91, 95% CI 0.45-1.84), serofast rate (RR=0.69, 95% CI 0.22-2.12) or failure rate (RR=0.66, 95% CI 0.03-15.76) in patients treated with ceftriaxone compared with those treated with penicillin. In conclusion, there is no evidence in the literature that ceftriaxone is less efficient than penicillin.

  7. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns.

    PubMed

    Malik, Kamran Ishaque; Malik, M A Nasir; Aslam, Azhar

    2010-10-01

    Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns.

  8. Comparative evaluation of natural antioxidants spirulina and aloe vera for the treatment of oral submucous fibrosis

    PubMed Central

    Patil, Santosh; Al-Zarea, Bader Kureyem; Maheshwari, Sneha; Sahu, Rohit

    2015-01-01

    Aim Oral submucous fibrosis (OSMF) is a high risk premalignant condition predominantly seen in the Indian subcontinent. The aim of the present study was to compare the efficacy of spirulina and aloe vera in the management of OSMF. Material and methods 42 subjects with clinico-pathologically diagnosed OSMF were included in the study and divided equally in 2 groups, Group A (spirulina group) and Group B (aloe vera group). Group A was administered 500 mg spirulina in 2 divided doses for 3 months and Group B was given 5 mg aloe vera gel to be applied topically thrice daily for 3 months. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Chi-square test. P-value <0.05 was considered to be statistically significant. Results The patients in Group A showed significant clinical improvement in mouth opening and ulcers/erosions/vesicles (p < 0.05). However, there was no significant improvement in burning sensation (p = 0.06) and pain associated with the lesion (p = 0.04) among the 2 groups. Conclusion Both the drugs showed improvement in the condition; however spirulina can bring about significant clinical improvements in the symptoms like mouth opening and ulcers/erosion/vesicles. Thus, spirulina appears to be more promising when compared to aloe vera for the treatment of OSMF. PMID:25853042

  9. Comparing two books and establishing probably efficacious treatment for low sexual desire.

    PubMed

    Balzer, Alexandra M; Mintz, Laurie B

    2015-04-01

    Using a sample of 45 women, this study compared the effectiveness of a previously studied (Mintz, Balzer, Zhao, & Bush, 2012) bibliotherapy intervention (Mintz, 2009), a similar self-help book (Hall, 2004), and a wait-list control (WLC) group. To examine intervention effectiveness, between and within group standardized effect sizes (interpreted with Cohen's, 1988 benchmarks .20 = small, .50 = medium, .80+ = large) and their confidence limits are used. In comparison to the WLC group, both interventions yielded large between-group posttest effect sizes on a measure of sexual desire. Additionally, large between-group posttest effect sizes were found for sexual satisfaction and lubrication among those reading the Mintz book. When examining within-group pretest to posttest effect sizes, medium to large effects were found for desire, lubrication, and orgasm for both books and for satisfaction and arousal for those reading the Mintz book. When directly comparing the books, all between-group posttest effect sizes were likely obtained by chance. It is concluded that both books are equally effective in terms of the outcome of desire, but whether or not there is differential efficacy in terms of other domains of sexual functioning is equivocal. Tentative evidence is provided for the longer term effectiveness of both books in enhancing desire. Arguing for applying criteria for empirically supported treatments to self-help, results are purported to establish the Mintz book as probably efficacious and to comprise a first step in this designation for the Hall book.

  10. 90Y radioembolization versus chemoembolization in the treatment of hepatocellular carcinoma: an analysis of comparative effectiveness.

    PubMed

    Xing, Minzhi; Kokabi, Nima; Camacho, Juan C; Kooby, David A; El-Rayes, Bassel F; Kim, Hyun S

    2013-07-01

    Locoregional catheter-based therapies for unresectable hepatocellular carcinoma (HCC) include conventional transarterial chemoembolization (cTACE), drug-eluting bead chemoembolization and yttrium-90 ((90)Y) radioembolization. Although current guidelines recommend cTACE for inoperable HCC, comparative effectiveness of drug-eluting bead chemoembolization and (90)Y radioembolization in the management of HCC remains undefined due to the lack of data evaluating safety and effectiveness among these therapies. A comprehensive search of the literature was carried out for studies examining comparative effectiveness of cTACE and (90)Y based on objective tumor response and overall patient survival. Further data on efficacy, safety, toxicity and cost-effectiveness was also examined. The National Cancer Institute Levels of Evidence for Cancer Treatment Studies provided a useful framework for the critical understanding and stratification of current evidence on locoregional therapy for unresectable HCC. Based on current retrospective cohort studies, evidence for similar efficacy and safety between cTACE and (90)Y radioembolization was demonstrated. Further prospective, randomized studies are required to validate these observations and to analyze cost-effectiveness of these interventions in unresectable HCC patients for definitive recommendations to be made.

  11. Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax†

    PubMed Central

    Moreno-Merino, Sergio; Congregado, Miguel; Gallardo, Gregorio; Jimenez-Merchan, Rafael; Trivino, Ana; Cozar, Fernando; Lopez-Porras, Marta; Loscertales, Jesus

    2012-01-01

    Primary spontaneous pneumothorax is a pathology mainly affecting healthy young patients. Clinical guidelines do not specify the type of pleurodesis that should be conducted, due to the lack of comparative studies on the different techniques. The aim of this study was to compare talc poudrage and pleural abrasion in the treatment of spontaneous pneumothorax. A retrospective comparative study was performed, including 787 patients with primary spontaneous pneumothorax. The 787 patients were classified into two groups: Group A (pleural abrasion) n = 399 and Group B (talc pleurodesis) n = 388. The variables studied were recurrence, surgical time, morbidity and in-hospital length of stay. Statistical analysis was done by an unpaired t-test and Fisher's exact test (SSPS 18.0). Statistically significant differences were observed in the variables: surgical time (A: 46 ± 12.3; B: 37 ± 11.8 min; P < 0.001); length of stay (A: 4.7 ± 2.5; B: 4.3 ± 1.8 days; P = 0.01); apical air camera (A: 25; B: 4; P < 0.001); pleural effusion (A: 6; B: 0; P = 0.05). Talc poudrage shows shorter surgical times and length of stay, and lower re-intervention rates. Morbidity is lower in patients with talc poudrage. Statistically significant differences were not observed in recurrence, persistent air leaks, atelectasis and haemothorax. PMID:22514256

  12. Extracorporeal shockwaves (ESWs) enhance the osteogenic medium-induced differentiation of adipose-derived stem cells into osteoblast-like cells.

    PubMed

    Catalano, Maria Graziella; Marano, Francesca; Rinella, Letizia; de Girolamo, Laura; Bosco, Ornella; Fortunati, Nicoletta; Berta, Laura; Frairia, Roberto

    2017-02-01

    Human adipose-derived stem cells (hASCs) are a promising cell type for bone tissue engineering, given their potential to differentiate into osteoblast-like cells. Interactions among biochemical and mechanical signals result in bone formation and repair. In this process stem cells have a crucial role. Extracorporeal shockwaves (ESWs) are acoustic waves capable of enhancing bone regeneration, suggesting that ESWs may induce some signals for mesenchymal progenitor maturation. The aim of the present work is to investigate the effects of ESW treatment on the differentiation of hASCs into osteoblast-like cells and to better clarify the mechanisms involved. The hASCs were treated with ESWs and osteogenic medium, and the effects in terms of gene expression, alkaline phosphatase (ALP) activity and calcium deposition were then evaluated. Moreover, to investigate the mechanisms of ESW action, reactive oxygen species (ROS) production, extracellular-signal-regulated kinase (ERK) and small 'mothers against' decapentaplegic (Smad) phosphorylation, and bone morphogenetic protein 2 (BMP2) expression were assessed. The ESW treatment increased Runt-related transcription factor 2 (Runx2), ALP and BMP2 expression, as well as ALP activity and calcium deposits with respect to untreated cells. Moreover ESWs induced ROS formation, and both ERK and Smad phosphorylation. The present study shows the effects of ESWs on osteogenic differentiation in an in vitro model using hASCs and defines the mechanisms involved in this process. The observations suggest that the combination of autologous hASCs and ESW treatment may improve bone tissue repair in tissue engineering procedures. Copyright © 2014 John Wiley & Sons, Ltd.

  13. Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study.

    PubMed

    Shaheen, Maha Adel; Salem, Samar Abdallah M; Fouad, Dina Adel; El-Fatah, Abeer Aly Abd

    2015-01-01

    Intralesional purified protein derivative (PPD) or mumps, measles, rubella (MMR) were not previously compared regarding their efficacy or mechanism of action in treatment of warts. We aimed to compare their efficacy in treatment of multiple warts and investigate their effect on serum interleukin (IL)-4 and IL-12. Thirty patients with multiple warts were included (10 treated with PPD, 10 with MMR, and 10 with normal saline (control)). Injection was done every 3 weeks until clearance or maximum of three treatments. Clinical response of target and distant warts was evaluated. Serum ILs-4 and -12 were assessed before and after treatment. A significantly higher rate of complete response was found in target and distant warts with PPD (60% each) and MMR (80%, 40%, respectively) compared with controls (0%), with no significant difference between both treatments. After treatment, the control group showed the lowest serum IL-12 and IL-4 levels compared with the MMR- and PPD-treated groups with statistically significant difference in between. MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreat-ment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection.

  14. Determining, Ranking and Comparing Treatment Stressors in Children and Adolescents with Cancer in Tehran

    PubMed Central

    Azizi, Narges; Mansour, Ladan; Tahmassian, Karineh; Mosavi, Farideh

    2012-01-01

    Background Studies show that cancer treatment procedures could increase stress in children and adolescents diagnosed with cancer. This study was conducted to determine the frequency of stressors in children and adolescents with cancer, and to compare it in boys and girls. Methods Relevant information was collected via a structured interview with 70 children and their mothers. Subjects were divided into four age groups of 0-3; 4-7; 8-12; 13-18. Stressors in physical, social and psychological aspects were determined and ranked. The main question asked was: "During the period of your disease, what has caused you the most suffering?" Whilst interviewing the mothers, this question was altered to:" During the period of your child's disease, what caused him/her to suffer the most?" The answers were reflected back to the respondents, and were categorized in a validated check list after their confirmation. Results The most stressing items in the 0 to 3 age group were found to be worry, pain due to treatment procedures, and separation from their immediate family. In 4 to 7 age group, they were procedural pain, worry and fatigue. For the 8 to 12 age group, pain, separation from family and worry were the most stressing items. For the 13 to 18 age group, the main stressors were worry, pain, and parting from friends and losing them. Analysis by "Mann-Whitney U test" showed no significant differences in stressors between girls and boys. Conclusion Our findings revealed that worry and procedural pain are the most common stressors in children treated for malignancy. Caregivers need to be aware of this fact and should take appropriate steps to relieve these stressors. PMID:25628833

  15. The comparative efficacy of trazodone and imipramine in the treatment of depression.

    PubMed Central

    Patten, S B

    1992-01-01

    OBJECTIVE: To review published clinical trials comparing the efficacy of trazodone with that of tricyclic antidepressant medication. DATA SOURCES: MEDLINE was searched for relevant articles published from 1983 to 1991. The bibliography of a review article was searched for further references. STUDY SELECTION: In all, 25 clinical trials were found. Six of these met the methodologic assessment criteria (adapted from the McMaster guidelines for the evaluation of clinical trials), which included the stipulation of a score of 18 or more on the Hamilton depression rating scale and a 50% reduction in that score as an outcome measure. DATA EXTRACTION: All six studies compared trazodone with imipramine. Data describing response to the treatments were extracted, and post-hoc power estimates were calculated. The analysis also involved statistical tests of a modified null hypothesis, the generation of confidence intervals (CIs) and a meta-analysis. DATA SYNTHESIS: All the studies found no significant difference in the efficacy of trazodone and imipramine. However, the statistical power of most of them was less than 50% and often less than 10%; thus there was a low probability that differences would be detected. The results of statistical tests of the modified null hypothesis, inspection of the CIs and the results of the meta-analysis all suggested that trazodone, and imipramine are equally efficacious. CONCLUSION: The application of various techniques for the analysis of equivalence data suggests that trazodone and imipramine are of approximately equivalent efficacy. The data are compatible with small differences in efficacy, but the differences are of a magnitude such that they are unlikely to be of clinical significance. PMID:1532532

  16. Supersonic, shockwave-driven hydrodynamic instability experiments at OMEGA-EP

    NASA Astrophysics Data System (ADS)

    Wan, Willow

    2016-10-01

    Hydrodynamic instabilities play a dominant role in the transport of mass, momentum, and energy in nearly every plasma environment, governing the dynamics of natural and engineering systems such as solar convective zones, magnetospheric boundaries, and fusion experiments. In past decades, limitations in our understanding of hydrodynamic instabilities have led to discrepancies between observations and predictions. Since then, significant improvements have been made to our available experimental techniques, diagnostics, and simulation capabilities. Here, we present a novel experimental platform that can sustain a steady, supersonic flow across a precision-machined, well-characterized material interface for unprecedented durations We applied this platform to a series of Kelvin-Helmholtz instability experiments. The Kelvin-Helmholtz instability generates vortical structures and turbulence at an interface with shear flow. In a supersonic flow, the growth rate is inhibited and the instability structure is altered. The data were obtained at the OMEGA-EP facility by firing three laser beams in sequence to produce a 12 kJ, 28 ns stitched laser pulse. The ablation pressure sustained a steady shockwave for 70 ns over a foam-plastic, single-mode or dual-mode interface. A spherical crystal imager was used to measure the evolution of these modulations with high-resolution x-ray radiography using Cu Kα radiation at 8.0 keV. The observed structure was reproduced with 2D hydrodynamic simulations. Supported by the U.S. DOE, through NNSA Grants DE-NA0002956 (SSAA) and DE-NA0002719 (NLUF), by the LLE under DE-NA0001944, and by the LLNL under subcontract B614207 to DE-AC52-07NA27344.

  17. Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis.

    PubMed

    Rosenschein, U; Yakubov, S J; Guberinich, D; Bach, D S; Sonda, P L; Abrams, G D; Topol, E J

    1992-11-15

    Successful experimental and clinical experience with thrombus ablation has been attained with high-power acoustic energy delivered in a catheter. The goal of this study was to investigate the feasibility of noninvasive thrombus ablation by focused high-power acoustic energy. The source for high-power acoustic energy was a shock-wave generator in a water tank equipped with an acoustic lens with a fixed focal point at 22.5 cm. Thrombus was prepared in vitro, weighed (0.24 +/- 0.08 g), and inserted in excised human femoral artery segments. The arterial segments wer ligated, positioned at the focal point and then randomized into either test (n = 8) or control (n = 7). An x-ray system verified the 3-dimensional positioning of the arterial segment at the focal point. A 5 MHz ultrasound imaging system continuously visualized the arterial segment at the focal point before, during and after each experiment. The test segments were exposed to shock waves (1,000 shocks/24 kv). The arterial segment content was then flushed and the residual thrombus weighed. The arterial segment and thrombus were fixed and submitted to histologic examination. The test group achieved a significant ablation of thrombus mass (0.25 +/- 0.15 vs 0.07 +/- 0.003 g; p = 0.0001) after application of shock waves. Arterial segments showed no gross or microscopic damage. Ultrasound imaging revealed a localized (1.9 +/- 0.5 cm2), transient (744 +/- 733 ms), cavitation field at the focal point at the time of application of focused shock waves. Thus, focused high-power acoustic energy can effect noninvasive thrombus ablation without apparent damage to the arterial wall.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. A Theoretical Investigation of Radial Lateral Wells with Shockwave Completion in Shale Gas Reservoirs

    NASA Astrophysics Data System (ADS)

    Shan, Jia

    As its role in satisfying the energy demand of the U.S. and as a clean fuel has become more significant than ever, the shale gas production in the U.S. has gained increasing momentum over recent years. Thus, effective and environmentally friendly methods to extract shale gas are critical. Hydraulic fracturing has been proven to be efficient in the production of shale gas. However, environmental issues such as underground water contamination and high usage of water make this technology controversial. A potential technology to eliminate the environmental issues concerning water usage and contamination is to use blast fracturing, which uses explosives to create fractures. It can be further aided by HEGF and multi-pulse pressure loading technology, which causes less crushing effect near the wellbore and induces longer fractures. Radial drilling is another relatively new technology that can bypass damage zones due to drilling and create a larger drainage area through drilling horizontal wellbores. Blast fracturing and radial drilling both have the advantage of cost saving. The successful combination of blast fracturing and radial drilling has a great potential for improving U.S. shale gas production. An analytical productivity model was built in this study, considering linear flow from the reservoir rock to the fracture face, to analyze factors affecting shale gas production from radial lateral wells with shockwave completion. Based on the model analyses, the number of fractures per lateral is concluded to be the most effective factor controlling the productivity index of blast-fractured radial lateral wells. This model can be used for feasibility studies of replacing hydraulic fracturing by blast fracturing in shale gas well completions. Prediction of fracture geometry is recommended for future studies.

  19. Structure, phase content and mechanical properties of aluminium with hard particles after shock-wave compaction

    NASA Astrophysics Data System (ADS)

    Kulkov, S.; Vorozhtsov, S.; Turuntaev, I.

    2015-04-01

    The possibilities to combine metal and metal oxide powders in various compositions open a broad range of mechanical and thermal behavior. When using in nanostructured components the resulting materials might exhibit even more interesting properties, like product effectiveness, tensile strength, wear resistance, endurance and corrosion resistance. Intermetallics like TiAl could be obtained as TiAlx in a quality similar to that obtained from melting where only eutectic mixture can be produced. Similar effects are possible when compacting nanoceramic powders whereas these can be combined with intermetallics. Currently, it is very difficult to produce wires and special shaped parts from high temperature superconducting materials. The compacting by explosives could solve this problem.The present paper uses explosion compacting of Al nanoparticles to create nanocomposite with increased physico-mechanical properties. Russian civil explosive Uglenit was chosen as high energy material (HEM) for shock-wave compaction. The different schemes and conditions were suggested to run the explosion process. Al nanoparticles as produced by electric wire explosion contain 8-10% of aluminum oxide. That aluminum oxide can serve as strengthening material in the final nanocomposite which may be generated in various compositions by explosive compacting. Further modifications of nanocomposites were obtained when including nanodiamonds into the mixture with aluminum nanoparticles with different percentages. The addition of nanodiamonds results in a substantial strengthening effect. The experiments with compacting aluminum nanoparticles by explosives are described in detail including the process variations and conditions. The physico-mechanical properties of the nanocomposites are determined and discussed by considering the applied conditions. Especially, microstructure and phases of the obtained nanocomposites are analyzed by X-ray diffraction.

  20. A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis

    PubMed Central

    2015-01-01

    Purpose With the increasing prevalence of orthodontic treatment in adults, clear aligner treatments are becoming more popular. The aim of this study was to evaluate the effect of orthodontic treatment on periodontal tissue and to compare orthodontic treatment with fixed appliances (FA) to clear aligner treatment (CAT) in periodontitis patients. Methods A total of 35 patients who underwent orthodontic treatment in the Department of Periodontology were included in this study. After periodontal treatment with meticulous oral hygiene education, patients underwent treatment with FA or CAT, and this study analyzed patient outcomes depending on the treatment strategy. Clinical parameters were assessed at baseline and after orthodontic treatment, and the duration of treatment was compared between these two groups. Results The overall plaque index, the gingival index, and probing depth improved after orthodontic treatment (P<0.01). The overall bone level also improved (P=0.045). However, the bone level changes in the FA and CAT groups were not significantly different. Significant differences were found between the FA and CAT groups in probing depth, change in probing depth, and duration of treatment (P<0.05). However, no significant differences were found between the FA and CAT groups regarding the plaque index, changes in the plaque index, the gingival index, changes in the gingival index, or changes in the alveolar bone level. The percentage of females in the CAT group (88%) was significantly greater than in the FA group (37%) (P<0.01). Conclusions After orthodontic treatment, clinical parameters were improved in the FA and CAT groups with meticulous oral hygiene education and plaque control. Regarding plaque index and gingival index, no significant differences were found between these two groups. We suggest that combined periodontal and orthodontic treatment can improve patients’ periodontal health irrespective of orthodontic techniques. PMID:26734489

  1. Comparing Client Outcomes for Two Evidence-Based Treatment Consultation Strategies.

    PubMed

    Funderburk, Beverly; Chaffin, Mark; Bard, Elizabeth; Shanley, Jenelle; Bard, David; Berliner, Lucy

    2015-01-01

    Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.

  2. Comparing the dynamic performance of wastewater treatment systems: A metafrontier Malmquist productivity index approach.

    PubMed

    Molinos-Senante, María; Hernández-Sancho, Francesc; Sala-Garrido, Ramón

    2015-09-15

    The assessment of productivity change of wastewater treatment plants (WWTPs) is essential to improve the performance over time of the facilities evaluated. This study assessed and compared the productivity growth of WWTPs operating with non-homogeneous technologies. The metafrontier Malmquist productivity index (MMPI) was computed for a sample of 99 WWTPs encompassing 4 alternative technologies: activated sludge (AS), aerated lagoon (AL), trickling filter (TF) and rotating biological contactor (BD). The results indicated that, on average, WWTPs with AS and BD exhibited better performance over time than WWTPs with AL and TF. The MMPI indicates that, over the period 2007-2009, the productivity rose by 0.9% and 0.3% for AS and BD technologies, respectively, whilst for the AL and TF processes, the productivity decreased by 0.5% and 2.2%, respectively. The decomposition of the MMPI into efficiency change (EC) and technical change (TC) illustrated that EC was a positive driver of productivity change for WWTPs that use AS, whilst TC contributed positively to the productivity growth of WWTPs using AL and BD. Several policy implications to help managers make informed decisions were drawn from our empirical analysis.

  3. A comparative study of clonal selection algorithm for effluent removal forecasting in septic sludge treatment plant.

    PubMed

    Chun, Ting Sie; Malek, M A; Ismail, Amelia Ritahani

    2015-01-01

    The development of effluent removal prediction is crucial in providing a planning tool necessary for the future development and the construction of a septic sludge treatment plant (SSTP), especially in the developing countries. In order to investigate the expected functionality of the required standard, the prediction of the effluent quality, namely biological oxygen demand, chemical oxygen demand and total suspended solid of an SSTP was modelled using an artificial intelligence approach. In this paper, we adopt the clonal selection algorithm (CSA) to set up a prediction model, with a well-established method - namely the least-square support vector machine (LS-SVM) as a baseline model. The test results of the case study showed that the prediction of the CSA-based SSTP model worked well and provided model performance as satisfactory as the LS-SVM model. The CSA approach shows that fewer control and training parameters are required for model simulation as compared with the LS-SVM approach. The ability of a CSA approach in resolving limited data samples, non-linear sample function and multidimensional pattern recognition makes it a powerful tool in modelling the prediction of effluent removals in an SSTP.

  4. Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients.

    PubMed Central

    Gómez-Jiménez, J; Ribera, E; Gasser, I; Artaza, M A; Del Valle, O; Pahissa, A; Martínez-Vázquez, J M

    1993-01-01

    We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h) for their efficacy and safety in treating spontaneous bacterial peritonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic characteristics were similar in both groups. Ceftriaxone-susceptible strains were isolated on 44 occasions (94%), and cefonicid-susceptible strains were isolated on 43 occasions (91.5%). The antibiotic concentration in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100% of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid group and 30% in the ceftriaxone group (P was not significant). The time that elapsed between the initiation of treatment and the patient's death was shorter in the cefonicid group patients (5.3 +/- 3.90 days) than in the ceftriaxone group patients (11.8 +/- 9.15 days) (P < 0.05). None of the patients presented with superinfections, and only two patients treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans. Ceftriaxone and cefonicid are safe and useful agents for treating cirrhotic spontaneous bacterial peritonitis, although the pharmacokinetic characteristics of ceftriaxone seem to be more advantageous than those of cefonicid. PMID:8215267

  5. Patient satisfaction with treatment for alcohol use disorders: comparing patients with and without severe mental health symptoms

    PubMed Central

    McCallum, Stacey L; Andrews, Jane M; Gaughwin, Matthew D; Turnbull, Deborah A; Mikocka-Walus, Antonina A

    2016-01-01

    Background Previous studies suggest patients with co-occurring alcohol use disorders (AUDs) and severe mental health symptoms (SMHS) are less satisfied with standard AUD treatment when compared to patients with an AUD alone. This study compared patient satisfaction with standard AUD treatment among patients with and without SMHS and explored how standard treatment might be improved to better address the needs of these patients. Methods Eighty-nine patients receiving treatment for an AUD either at an inpatient hospital, outpatient clinic, inpatient detoxification, or residential/therapeutic community services were surveyed. Patient satisfaction with treatment was assessed using the Treatment Perception Questionnaire (range: 0–40). Patients were stratified according to their score on the Depression Anxiety Stress Scale. Forty patients scored in the extremely severe range of depression (score >14) and/or anxiety (score >10) (indicating SMHS) and 49 patients did not. An inductive content analysis was also conducted on qualitative data relating to areas of service improvement. Results Patients with SMHS were found to be equally satisfied with treatment (mean =25.10, standard deviation =8.12) as patients with an AUD alone (mean =25.43, standard deviation =6.91). Analysis revealed that being an inpatient in hospital was associated with reduced treatment satisfaction. Patients with SMHS were found to be significantly less satisfied with staffs’ understanding of the type of help they wanted in treatment, when compared to patients with AUDs alone. Five areas for service improvement were identified, including staff qualities, informed care, treatment access and continuity, issues relating to inpatient stay, and addressing patients’ mental health needs. Conclusion While findings suggest that AUD treatment services adequately meet the needs of patients with SMHS in treatment, patients with SMHS do feel that staff lack understanding of their treatment needs. Findings have

  6. Is Tuberculosis Treatment Really Free in China? A Study Comparing Two Areas with Different Management Models

    PubMed Central

    Zhang, Simin; Peng, Xianzhen; Zheng, Xianzhi; Xu, Guisheng; Wang, Min; Wang, Jianming; Lu, Hui

    2015-01-01

    Objective China has implemented a free-service policy for tuberculosis. However, patients still have to pay a substantial proportion of their annual income for treatment of this disease. This study describes the economic burden on patients with tuberculosis; identifies related factors by comparing two areas with different management models; and provides policy recommendation for tuberculosis control reform in China. Methods There are three tuberculosis management models in China: the tuberculosis dispensary model, specialist model and integrated model. We selected Zhangjiagang (ZJG) and Taixing (TX) as the study sites, which correspond to areas implementing the integrated model and dispensary model, respectively. Patients diagnosed and treated for tuberculosis since January 2010 were recruited as study subjects. A total of 590 patients (316 patients from ZJG and 274 patients from TX) were interviewed with a response rate of 81%. The economic burden attributed to tuberculosis, including direct costs and indirect costs, was estimated and compared between the two study sites. The Mann-Whitney U Test was used to compare the cost differences between the two groups. Potential factors related to the total out-of-pocket costs were analyzed based on a step-by-step multivariate linear regression model after the logarithmic transformation of the costs. Results The average (median, interquartile range) total cost was 18793.33 (9965, 3200-24400) CNY for patients in ZJG, which was significantly higher than for patients in TX (mean: 6598.33, median: 2263, interquartile range: 983–6688) (Z = 10.42, P < 0.001). After excluding expenses covered by health insurance, the average out-of-pocket costs were 14304.4 CNY in ZJG and 5639.2 CNY in TX. Based on the multivariable linear regression analysis, factors related to the total out-of-pocket costs were study site, age, number of clinical visits, residence, diagnosis delay, hospitalization, intake of liver protective drugs and use of

  7. Treatment of superficial thrombophlebitis. A comparative trial between placebo, Hirudoid cream and piroxicam gel.

    PubMed

    Bergqvist, D; Brunkwall, J; Jensen, N; Persson, N H

    1990-01-01

    A prospective randomized trial on the treatment of superficial thrombophlebitis has been performed in 68 patients randomized to either Hirudoid cream, piroxicam gel or placebo. Both spontaneous and infusion thrombophlebitis were included. Treatment effect was evaluated using the status of thrombophlebitis, the thrombophlebitic area, pain intensity with a visual analogue scale, and side effects were registered. Both in the treatment groups and the placebo group there was a significant decrease of signs and symptoms during the treatment period. There was no statistical difference between the treatment groups and no difference between spontaneous and infusion thrombophlebitis.

  8. Comparing recidivism rates of treatment responders/nonresponders in a sample of 413 child molesters who had completed community-based sex offender treatment in the United kingdom.

    PubMed

    Beech, Anthony R; Mandeville-Norden, Rebecca; Goodwill, Alasdair

    2012-02-01

    Analysis of psychometric data from a sample of 413 child molesters who had completed a U.K. probation-based sex offender treatment program was carried out to assess (a) the effectiveness of therapy in the short term and (b) the longer term implications of treatment in relation to sexual recidivism. It was found that 12% (51 offenders) of the sample had recidivated within 2 to 4 years. Of these recidivists, 86% (44 offenders) had been reconvicted for a sexually related offense. One hundred thirty-five offenders (33%) demonstrated a treated profile (i.e., demonstrated no offense-specific problems and few, or no, socioaffective problems at the posttreatment stage). This group was compared with a sample of offenders deemed as not responding to treatment, matched by their levels of pretreatment risk/need. It was found that a significantly smaller proportion (n = 12, 9%) of treatment responders had recidivated, compared to the treatment nonresponders (n = 20, 15%), indicating a 40% reduction in recidivism in those who had responded to treatment (effect size = .18). Matching length of treatment to the offenders' level of pretreatment risk/need (i.e., higher risk/treatment-need offenders typically undertook longer treatment) reduced the rate of recidivism among this group to the level of recidivism observed among the lower risk/need offenders.

  9. Treatment choices in breast cancer: a comparative analysis of mastectomy patients and radiation patients

    SciTech Connect

    Williams, J.

    1985-01-01

    This descriptive-exploratory study identified factors that distinguished women on the basis of the treatment they chose for breast cancer. A semi-structured interview and questionnaire was administered to 30 respondents who received mastectomy and 31 who received lumpectomy with radiation. The variables investigated as potential predictors of treatment choice were (1) participation in treatment planning, (2) knowledge of illness and treatment alternatives, (3) health locus of control, (4) sex-role identification, (5) body image, (6) social support and (7) age. As perceptions of the outcome of treatment influence attitudes about treatment choice, five variables relating to perceived treatment consequences were also examined. These were (1) social support, (2) body image, (3) satisfaction with medical care, (4) satisfaction with treatment and (5) general well-being. The major findings in regard to the predictor variables included a profile of the characteristics of each group. The radiation group had more knowledge, participated in planning to a greater extent, investigated treatment options more often and typically made their own decisions about treatment. The mastectomy group was older, attributed locus of control to chance and demonstrated nonsignificant trends toward locus of control in powerful others and toward a feminine sex-role identification; 50% cited Surgeon's Advice as the basis of their choice.

  10. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

    PubMed

    Johns, Claire; Seav, Susan M; Dominick, Sally A; Gorman, Jessica R; Li, Hongying; Natarajan, Loki; Mao, Jun James; Su, H Irene

    2016-04-01

    Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

  11. Comparing Nigella sativa Oil and Fish Oil in Treatment of Vitiligo

    PubMed Central

    Ghorbanibirgani, Alireza; Khalili, Ali; Rokhafrooz, Darioush

    2014-01-01

    Background: Vitiligo is one of the autoimmune skin diseases that destroy the melanocytes of the skin. Moreover, its prevalence varies in different countries and regions. Objectives: The aim of this study was to compare the effect of Nigella sativa and fish oil on vitiligo lesions of the patients referred to a dermatology clinic. Materials and Methods: This randomized, double blind clinical trial was conducted in the dermatology clinic of the Imam Khomeini Hospital Ahvaz, Iran, from June to December 2011. We used a randomized simple sampling. From 96 patients with vitiligo, 52 eligible patients were selected and allocated to two groups with equal size. The study medications were applied twice a day by patients on their lesions. After six months, the improvement rate of lesions was assessed by the Vitiligo Area Scoring Index (VASI). Data were analyzed using SPSS v. 15; P value < 0.05 was considered as statistically significant. Results: After six months, a mean score of VASI decreased from 4.98 to 3.75 in patients applying topical Nigella sativa and from 4.98 to 4.62 in those using topical fish oil. Most of the percent improvement observed in upper extremities, trunk, head, and neck of those who received Nigella sativa and head, neck, trunk, and feet of those who received fish oil. No adverse effect was reported by the patients. Conclusions: Nigella sativa oil and fish oil were effective in reduction the size of patient’s lesions; however, Nigella sativa was more effective in comparison to the fish oil. Therefore, using Nigella sativa with the major drugs in the treatment of vitiligo is recommended. PMID:25068060

  12. Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer

    PubMed Central

    Sigounas, Dimitrios E; Krystallis, Christoforos; Couper, Graeme; Paterson-Brown, Simon; Tatsioni, Athina

    2016-01-01

    Background Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used. Objective The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy. Methods Single centre, retrospective analysis of all patients (n = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n = 160) or APC (n = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan–Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test. Results Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13–1.65 of SEMS over APC, p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p = 0.02 and 0.05 respectively). Conclusions APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results.

  13. Proteomic Profiling Comparing the Effects of Different Heat Treatments on Camel (Camelus dromedarius) Milk Whey Proteins.

    PubMed

    Benabdelkamel, Hicham; Masood, Afshan; Alanazi, Ibrahim O; Alzahrani, Dunia A; Alrabiah, Deema K; AlYahya, Sami A; Alfadda, Assim A

    2017-03-28

    Camel milk is consumed in the Middle East because of its high nutritional value. Traditional heating methods and the duration of heating affect the protein content and nutritional quality of the milk. We examined the denaturation of whey proteins in camel milk by assessing the effects of temperature on the whey protein profile at room temperature (RT), moderate heating at 63 °C, and at 98 °C, for 1 h. The qualitative and quantitative variations in the whey proteins before and after heat treatments were determined using quantitative 2D-difference in gel electrophoresis (DIGE)-mass spectrometry. Qualitative gel image analysis revealed a similar spot distribution between samples at RT and those heated at 63 °C, while the spot distribution between RT and samples heated at 98 °C differed. One hundred sixteen protein spots were determined to be significantly different (p < 0.05 and a fold change of ≥1.2) between the non-heated and heated milk samples. Eighty protein spots were decreased in common in both the heat-treated samples and an additional 25 spots were further decreased in the 98 °C sample. The proteins with decreased abundance included serum albumin, lactadherin, fibrinogen β and γ chain, lactotransferrin, active receptor type-2A, arginase-1, glutathione peroxidase-1 and, thiopurine S, etc. Eight protein spots were increased in common to both the samples when compared to RT and included α-lactalbumin, a glycosylation-dependent cell adhesion molecule. Whey proteins present in camel milk were less affected by heating at 63 °C than at 98 °C. This experimental study showed that denaturation increased significantly as the temperature increased from 63 to 98 °C.

  14. Environmental impact of recycling nutrients in human excreta to agriculture compared with enhanced wastewater treatment.

    PubMed

    Spångberg, J; Tidåker, P; Jönsson, H

    2014-09-15

    Human excreta are potential sources of plant nutrients, but are today usually considered a waste to be disposed of. The requirements on wastewater treatment plants (WWTPs) to remove nitrogen and phosphorus are increasing and to meet these requirements, more energy and chemicals are needed by WWTPs. Separating the nutrient-rich wastewater fractions at source and recycling them to agriculture as fertiliser is an alternative to removing them at the WWTP. This study used life cycle assessment methodology to compare the environmental impact of different scenarios for recycling the nutrients in the human excreta as fertiliser to arable land or removing them in an advanced WWTP. Three scenarios were assessed. In blackwater scenario, blackwater was source-separated and used as fertiliser. In urine scenario, the urine fraction was source-separated and used as fertiliser and the faecal water treated in an advanced WWTP. In NP scenario, chemical fertiliser was used as fertiliser and the toilet water treated in an advanced WWTP. The emissions from the WWTP were the same for all scenarios. This was fulfilled by the enhanced reduction in the WWTP fully removing the nutrients from the excreta that were not source-separated in the NP and urine scenarios. Recycling source-separated wastewater fractions as fertilisers in agriculture proved efficient for conserving energy and decreasing global warming potential (GWP). However, the blackwater and urine scenarios had a higher impact on potential eutrophication and potential acidification than the WWTP-chemical fertiliser scenario, due to large impacts by the ammonia emitted from storage and after spreading of the fertilisers. The cadmium input to the arable soil was very small with urine fertiliser. Source separation and recycling of excreta fractions as fertiliser thus has potential for saving energy and decreasing GWP emissions associated with wastewater management. However, for improved sustainability, the emissions from storage and

  15. Comparing the Effects of Fuel Treatments and Wildfire on Small Catchment Runoff and Sediment Yield at Two Spatial Scales

    NASA Astrophysics Data System (ADS)

    Robichaud, P. R.; Wagenbrenner, J. W.; Storrar, K. A.; Elliot, W. J.

    2014-12-01

    The role of wildfire in the Rockies continues to be a major concern—especially fire's effect on water quantity and quality, thus protection of water resources is of great management importance as wildfire occurrence and water needs increase. Since high burn severity wildfires often affect soils, vegetation, and hydrologic processes, fuel treatments are often implemented to reduce the risk of high severity fires. The effects of fuel treatments and wildfire on runoff and sediment yields are often examined separately at the hillslope scale but few studies compare the effects of fuel treatments directly to those of wildfire or allow upscaling effects to the small catchment scale. We studied hillslope scale (0.01 ha) sediment yields and catchment scale (2 to 9 ha) runoff and sediment yields at seven fuel treatment sites and one high severity wildfire site in the northern Rockies. The fuel treatments consisted of thinning or timber harvest followed by low to moderate severity prescribed fire. Mean runoff rates from snowmelt and summer rainfall were often similar between the fuel treatments and wildfire catchments, sediment yields were two to three orders of magnitude higher in the wildfire site than in the fuel treatment sites, and much of the sediment was produced during summer rainfall. Comparing results across scales, sediment yields from the fuel treatments and wildfire sites decreased exponentially with increasing area. These results suggest that fuel treatments that reduce the risk of wildfire do not cause significant erosion.

  16. Drugs for treatment of vulvovaginal candidiasis: comparative efficacy of agents and regimens.

    PubMed

    Doering, P L; Santiago, T M

    1990-11-01

    Various agents are available for the treatment of vulvovaginal candidiasis. Imidazole agents (clotrimazole, miconazole, butoconazole, and terconazole) are preferred because of their greater efficacy, shorter treatment regimens, and ease of administration. Although the various imidazole compounds are equally efficacious, different treatment schedules are recommended depending on clinical situations. Additionally, different formulations are available that provide clinicians and patients with the opportunity to select the most appropriate agent.

  17. A comparative study of epicillin and chloramphenicol in the treatment of enteric fever.

    PubMed

    Hassau, A; Sippel, J; Farid, Z; Tadros, S S; Brian, M

    1977-01-01

    One hundred patients with acute enteric fever were randomly assigned to treatment with either chloramphenicol 50 mg/kg body-weight or epicillin 1 g six hourly. Eighty-one patients had a positive blood culture for typhoid or paratyphoid bacilli and nineteen had a positive stool culture with a significant Widal titre. All fifty patients in the group treated with chloramphenicol responded, however there was one relapse with bacteraemia. In the group treated with epicillin, six from the total of fifty patients were considred treatment failures. Treatment was considred as a failure if the patient was febrile after ten days treatment or if there was a deterioration despite antibiotic therapy.

  18. Numerical simulations of shock-wave interaction with a boundary layer in the plane supersonic flows with jet injection

    NASA Astrophysics Data System (ADS)

    Beketaeva, A. O.; Moisseyeva, Ye. S.; Naimanova, A. Zh.

    2016-03-01

    A supersonic air flow in a plane channel with a transverse turbulent jet of hydrogen injected through a slot on the bottom wall is simulated. The algorithm for solving the Favre-averaged Navier-Stokes equations for the flow of a perfect multispecies gas on the basis of the WENO scheme is proposed. The main attention is paid to the interaction of the shock-wave structure with the boundary layers on the upper and lower duct walls under the conditions of an internal turbulent flow. Namely, a detailed study of the structure of the flow is done, and separation and mixing depending on the jet slot width are investigated. It is found that in addition to well-known shock-wave structures produced by the interaction of the free stream with the transverse jet and the bow shock interaction with the boundary layers near the walls, an additional system of shock waves and the flow separation arise on the bottom wall downstream at some distance from the jet. The comparison with the experimental data is performed.

  19. Power to Detect Differences between Alternative Treatments in Comparative Psychotherapy Outcome Research.

    ERIC Educational Resources Information Center

    Kazdin, Alan E.; Bass, Debra

    1989-01-01

    Drew 85 outcome studies from 9 journals from 1984 through 1986. Examined data in each article to provide estimates of effect sizes and to evaluate statistical power at posttreatment and follow-up. Findings indicated that power of studies to detect differences between treatment and no treatment was generally quite adequate given relatively large…

  20. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD

    DTIC Science & Technology

    2011-06-01

    subjects consented to study participation and 45 met all of the inclusion and none of the exclusion criteria and were randomized to treatment. The...additional 100 referrals for treatment have been received, 72 subjects consented to study participation and 39 of those met all of the inclusion and none of the exclusion criteria and were randomized.

  1. Comparative Assessment of Health Benefits of Praziquantel Treatment of Urogenital Schistosomiasis in Preschool and Primary School-Aged Children

    PubMed Central

    Gwisai, Reggis; Mduluza, Takafira; Woolhouse, Mark E. J.; Mutapi, Francisca

    2016-01-01

    Schistosomiasis is a major public health problem in Africa. However, it is only recently that its burden has become recognised as a significant component impacting on the health and development of preschool-aged children. A longitudinal study was conducted in Zimbabwean children to determine the effect of single praziquantel treatment on Schistosoma haematobium-related morbidity markers: microhaematuria, proteinuria, and albuminuria. Changes in these indicators were compared in 1–5 years versus 6–10 years age groups to determine if treatment outcomes differed by age. Praziquantel was efficacious at reducing infection 12 weeks after treatment: cure rate = 94.6% (95% CI: 87.9–97.7%). Infection rates remained lower at 12 months after treatment compared to baseline in both age groups. Among treated children, the odds of morbidity at 12 weeks were significantly lower compared to baseline for proteinuria: odds ratio (OR) = 0.54 (95% CI: 0.31–0.95) and albuminuria: OR = 0.05 (95% CI: 0.02–0.14). Microhaematuria significantly reduced 12 months after treatment, and the effect of treatment did not differ by age group: OR = 0.97 (95% CI: 0.50–1.87). In conclusion, praziquantel treatment has health benefits in preschool-aged children exposed to S. haematobium and its efficacy on infection and morbidity is not age-dependent. PMID:27631011

  2. Comparative Assessment of Health Benefits of Praziquantel Treatment of Urogenital Schistosomiasis in Preschool and Primary School-Aged Children.

    PubMed

    Wami, Welcome M; Nausch, Norman; Midzi, Nicholas; Gwisai, Reggis; Mduluza, Takafira; Woolhouse, Mark E J; Mutapi, Francisca

    2016-01-01

    Schistosomiasis is a major public health problem in Africa. However, it is only recently that its burden has become recognised as a significant component impacting on the health and development of preschool-aged children. A longitudinal study was conducted in Zimbabwean children to determine the effect of single praziquantel treatment on Schistosoma haematobium-related morbidity markers: microhaematuria, proteinuria, and albuminuria. Changes in these indicators were compared in 1-5 years versus 6-10 years age groups to determine if treatment outcomes differed by age. Praziquantel was efficacious at reducing infection 12 weeks after treatment: cure rate = 94.6% (95% CI: 87.9-97.7%). Infection rates remained lower at 12 months after treatment compared to baseline in both age groups. Among treated children, the odds of morbidity at 12 weeks were significantly lower compared to baseline for proteinuria: odds ratio (OR) = 0.54 (95% CI: 0.31-0.95) and albuminuria: OR = 0.05 (95% CI: 0.02-0.14). Microhaematuria significantly reduced 12 months after treatment, and the effect of treatment did not differ by age group: OR = 0.97 (95% CI: 0.50-1.87). In conclusion, praziquantel treatment has health benefits in preschool-aged children exposed to S. haematobium and its efficacy on infection and morbidity is not age-dependent.

  3. How study designs influence comparative effectiveness outcomes: the case of oral versus long-acting injectable antipsychotic treatments for schizophrenia.

    PubMed

    Alphs, Larry; Schooler, Nina; Lauriello, John

    2014-07-01

    This article reviews key methodological considerations for clinical trials that utilize explanatory and pragmatic trial designs and relates these contrasting approaches to the interpretation of results from comparisons of oral versus long-acting injectable (LAI) antipsychotics in schizophrenia. Explanatory randomized controlled trials (RCTs) generally measure the efficacy of a treatment in a homogeneous population with intensive, frequent, and often clinical trial-specific assessments. In contrast, pragmatic trials measure effectiveness in routine clinical practice and frequently aim to inform choices between treatments. Comparative effectiveness outcomes with pragmatic designs in naturalistic settings for schizophrenia treatments are of increasing interest to healthcare providers because outcomes of treatment (both efficacy and safety) may vary significantly when identified in an explanatory setting compared with a naturalistic pragmatic setting. Indeed, it has been suggested that the inconsistent outcomes observed in trials comparing oral and LAI antipsychotic medications may be a function of the use of explanatory or pragmatic trial designs. In practice, clinical trial designs are seldom purely explanatory or pragmatic. To identify the predominant orientation of a trial, one must consider multiple features. This paper reviews the relative impact of these features when comparing LAI and oral antipsychotic treatments and makes recommendations for improving these comparative designs.

  4. Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis

    PubMed Central

    Shih, Vanessa; ten Ham, Renske M.; Bui, Christine T.; Tran, Dan N.; Ting, Jie; Wilson, Leslie

    2015-01-01

    Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed. PMID:26171248

  5. A comparative study of the clinical efficacy of nedocromil sodium and placebo. How does cromolyn sodium compare as an active control treatment?

    PubMed

    Schwartz, H J; Blumenthal, M; Brady, R; Braun, S; Lockey, R; Myers, D; Mansfield, L; Mullarkey, M; Owens, G; Ratner, P; Repsher, L; van As, A

    1996-04-01

    Nedocromil sodium and cromolyn sodium are the only two currently available nonsteroid anti-inflammatory agents for treatment of asthma. Clinical differences between the two agents remain under continuous investigation with reports differentiating the two on the basis of atopy of the patient and reversibility of bronchoconstriction. This study investigated the efficacy of nedocromil sodium (4 mg, qid) for treatment of mild-to-moderate asthma in comparison to placebo using cromolyn sodium (2 mg, qid) as an active control treatment. Patients were primarily allergic asthmatics (with at least 15% reversibility) previously maintained on a regimen of regular bronchodilator therapy. During a 2-week run-in period, the patient's slow-release theophylline therapy was removed, and the patients were randomized to treatment after deterioration of asthma control (asthma symptom summary score of 3 for 7 of the 14 days). After 8 weeks of treatment, patients were returned to as occasion requires bronchodilator therapy, as per the 2-week baseline period. The results demonstrate that patients treated with nedocromil sodium showed statistically significant improvements during the primary time period (mean weeks 3 through 8) over placebo-treated patients as evidenced by all indexes of asthma symptoms, pulmonary function measures, and decreased bronchodilator reliance (p<0.05). Patients treated with cromolyn sodium demonstrated similar improvements over placebo-treated patients. Comparisons between nedocromil sodium and cromolyn sodium showed the two agents to be comparable in this group of primarily allergic patients with reversible disease. Between-group differences were noted for 3 of the 13 variables (nighttime asthma, FEV1, and forced expiratory flow rate between 25 % and 75% of the FVC) in favor of cromolyn sodium when the data were pooled during the primary time period. The number of patients missing 1 or more days from work/school/regular activity due to asthma was significantly

  6. [No free water in the treatment of "hyperosmolar diabetic coma": treatment control by comparing serum and CSF (author's transl)].

    PubMed

    Irsigler, K; Kaspar, L; Bruneder, H; Lageder, H

    1977-11-18

    Some serum and CSF concentrations were measured in five patients with severe hyperosmolar coma (mean blood sugar = 58.9 mmol/l; osmolarity = 406 mosmol/l). A gradual decrease of serum osmolarity prevented the development of an osmotic gradient between CSF and extracellular space. Insulin treatment (1-20 IU/h) with a motor infusion pump and infusion of hypertonic solutions decreased serum osmolarity by 2-4 mosmol/l X h. The faster fall of glucose in the extracellular space was compensated by hypertonic saline infusions (up to 365 mosmol/l). All patients survived.

  7. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009) - a Randomized Trial

    PubMed Central

    2010-01-01

    Background Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Methods/Design Study design: Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Analysis: Intention-to-treat. Outcome parameters: a) Photonumeric severity scale, b) Nürnberger Score, c) circumference measurements, d) capillary blood flow, e) tissue oxygen saturation, f) postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. Control group: Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training

  8. Household water treatment in developing countries: comparing different intervention types using meta-regression.

    PubMed

    Hunter, Paul R

    2009-12-01

    Household water treatment (HWT) is being widely promoted as an appropriate intervention for reducing the burden of waterborne disease in poor communities in developing countries. A recent study has raised concerns about the effectiveness of HWT, in part because of concerns over the lack of blinding and in part because of considerable heterogeneity in the reported effectiveness of randomized controlled trials. This study set out to attempt to investigate the causes of this heterogeneity and so identify factors associated with good health gains. Studies identified in an earlier systematic review and meta-analysis were supplemented with more recently published randomized controlled trials. A total of 28 separate studies of randomized controlled trials of HWT with 39 intervention arms were included in the analysis. Heterogeneity was studied using the "metareg" command in Stata. Initial analyses with single candidate predictors were undertaken and all variables significant at the P < 0.2 level were included in a final regression model. Further analyses were done to estimate the effect of the interventions over time by MonteCarlo modeling using @Risk and the parameter estimates from the final regression model. The overall effect size of all unblinded studies was relative risk = 0.56 (95% confidence intervals 0.51-0.63), but after adjusting for bias due to lack of blinding the effect size was much lower (RR = 0.85, 95% CI = 0.76-0.97). Four main variables were significant predictors of effectiveness of intervention in a multipredictor meta regression model: Log duration of study follow-up (regression coefficient of log effect size = 0.186, standard error (SE) = 0.072), whether or not the study was blinded (coefficient 0.251, SE 0.066) and being conducted in an emergency setting (coefficient -0.351, SE 0.076) were all significant predictors of effect size in the final model. Compared to the ceramic filter all other interventions were much less effective (Biosand 0.247, 0

  9. [Comparative characteristic of methods for operative treatment of patients suffering varicocele].

    PubMed

    Boĭko, M I; Pasiechnikov, S P; Boĭko, O M

    2014-04-01

    Efficacy and security of treatment of varicocele constitute a complex issues in urology, necessitating the additional investigations conduction. The results of surgical treatment of 280 patients, suffering left-sided varicocele and operated using three different methods--retroperitoneal varicocelectomy, laparoscopic varicocelectomy and subinguinal microsurgical varicocelectomy (SMV)--were analyzed. The advantages and faults of these methods were estimated, basing on the recurrence rate, complications by hidrocele occurrence and changes in the patients quality of life. SMV was determined as most effective and secure method of varicocele correction. The data obtained may be useful for choice of tactics for the disease treatment.

  10. [Comparative analysis of the combined treatment efficacy of the Chernobyl accident clean-up workers with essential hypertension].

    PubMed

    Habulavichene, Zh M

    2012-12-01

    It was shown the results of comparative evaluation of combined treatment in 111 clean-up workers of Chernobyl accident with essential hypertension (EH). This treatment consist of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers in combination with calcium channel blockers and diuretics. The follow-up period lasted 12 months. It was found that combined therapy provides comparable and reliable blood pressure (BP) control during 24-hour, significant reduction of average daily BP, daytime and nighttime BP, an index of time of the BP, BP variability. Despite on achieved target blood pressure level, 4 weeks treatment is not enough for regression of left ventricular hypertrophy (LVH). Significant regress of LVH was found if treatment lasted during a year under the condition that BP remained at the target level. It was revealed the advantage of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers intake combined with a diuretic on regress of left ventricular hypertrophy and dysfunction.

  11. Urgent need for basic treatment data to make precipitation manipulation experiments comparable

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Differences in ecosystem process responses between experiments imposing the same manipulation remain attributable to differences in the perceived magnitude of the treatment as well as to differences in biological factors. Conversely, similar responses across sites could either indicate similar proce...

  12. A comparative study on the membrane based palm oil mill effluent (POME) treatment plant.

    PubMed

    Ahmad, A L; Chong, M F; Bhatia, S

    2009-11-15

    The discharge of palm oil mill effluent (POME) causes serious pollution problems and the membrane based POME treatment is suggested as a solution. Three different designs, namely Design A, B and C distinguished by their different types and orientations of membrane system are proposed. The results at optimum condition proved that the quality of the recovered water for all the designs met the effluent discharge standards imposed by the Department of Environment (DOE). The economic analysis at the optimum condition shows that the total treatment cost for Design A was the highest (RM 115.11/m(3)), followed by Design B (RM 23.64/m(3)) and Design C (RM 7.03/m(3)). In this study, the membrane system operated at high operating pressure with low membrane unit cost is preferable. Design C is chosen as the optimal design for the membrane based POME treatment system based on the lowest total treatment cost.

  13. Trimethopim-sulfamethoxazole compared with benzathine penicillin for treatment of impetigo in Aboriginal children: a pilot randomised controlled trial.

    PubMed

    Tong, Steven Y C; Andrews, Ross M; Kearns, Therese; Gundjirryirr, Rosalyn; McDonald, Malcolm I; Currie, Bart J; Carapetis, Jonathan R

    2010-03-01

    We conducted a pilot randomized controlled trial comparing trimethoprim-sulfamethoxazole to benzathine penicillin for treatment of impetigo in Aboriginal children. Treatment was successful in 7 of 7 children treated with trimethoprim-sulfamethoxazole and 5 of 6 treated with benzathine penicillin. Trimethoprim-sulfamethoxazole achieved microbiological clearance and healing of sores from which beta-hemolytic streptococci and community-associated methicillin-resistant Staphylococcus aureus were initially cultured.

  14. Subjective response to antipsychotic treatment and compliance in schizophrenia. A naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study)

    PubMed Central

    García-Cabeza, Ignacio; Gómez, Juan-Carlos; Sacristán, Jose A; Edgell, Eric; González de Chavez, Manuel

    2001-01-01

    Background In order to compare the effectiveness of different antipsychotic drugs in the treatment of schizophrenia it is very important to evaluate subjective response and compliance in patient cohorts treated according to routine clinical practice. Method Outpatients with schizophrenia entered this prospective, naturalistic study when they received a new prescription for an antipsychotic drug. Treatment assignment was based on purely clinical criteria, as the study did not include any experimental intervention. Patients treated with olanzapine, risperidone or haloperidol were included in the analysis. Subjective response was measured using the 10-item version of the Drug Attitude Inventory (DAI-10), and treatment compliance was measured using a physician-rated 4 point categorical scale. Results A total of 2128 patients initiated treatment (as monotherapy) with olanzapine, 417 with risperidone, and 112 with haloperidol. Olanzapine-treated patients had significantly higher DAI-10 scores and significantly better treatment compliance compared to both risperidone- and haloperidol-treated patients. Risperidone-treated patients had a significantly higher DAI-10 score compared to haloperidol-treated patients. Conclusion Subjective response and compliance were superior in olanzapine-treated patients, compared to patients treated with risperidone and haloperidol, in routine clinical practice. Differences in subjective response were explained largely, but not completely, by differences in incidence of EPS. PMID:11835695

  15. Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders.

    PubMed

    Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N; Crum, Rosa M

    2014-02-01

    Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 U.S. National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders.

  16. Comparative study of ground water treatment plants sludges to remove phosphorous from wastewater.

    PubMed

    Bal Krishna, K C; Aryal, Ashok; Jansen, Troy

    2016-09-15

    Alum- and iron-based sludge obtained from water treatment plant produced during a unit treatment process (coagulation and flocculation) have been widely tested as a low-cost adsorbent to remove phosphorous (P) from wastewater. However, the effectiveness of iron-based sludge generated from the oxidation of iron which naturally occurs in the ground water has not been investigated. Moreover, influences of dominant metals ions comprised in the treatment plants sludges on P adsorption capacity and rate from wastewater are not yet known. This study, therefore, employed four different groundwater treatment plants sludges iron-based (from the oxidation of iron) and alum-based (from coagulation and flocculation process) to determine their P adsorption capacities and adsorption rates from the synthetic wastewater (SWW) and secondary effluent wastewater (SEWW). Although metals ions concentrations were the highest in the iron-based sludge amongst the sludge used in this study, it appeared to have the lowest P adsorption capacity and adsorption rate. A good correlation between aluminium to iron mass ratio and adsorption capacity for both types of waters were noted. However, a poor relation between aluminium to iron mass ratio and adsorption rates for the SEWW was observed. Further, the tested sludges were found to have a better P removal efficiency and adsorption capacity from the SEWW than from the SWW. Thus, this study demonstrates the ground water treatment plants sludges could be a low cost and effective adsorbent in removing P from wastewater.

  17. Comparative Review of Approved Melatonin Agonists for the Treatment of Circadian Rhythm Sleep-Wake Disorders.

    PubMed

    Williams, Wilbur P Trey; McLin, Dewey E; Dressman, Marlene A; Neubauer, David N

    2016-09-01

    Circadian rhythm sleep-wake disorders (CRSWDs) are characterized by persistent or recurrent patterns of sleep disturbance related primarily to alterations of the circadian rhythm system or the misalignment between the endogenous circadian rhythm and exogenous factors that affect the timing or duration of sleep. These disorders collectively represent a significant unmet medical need, with a total prevalence in the millions, a substantial negative impact on quality of life, and a lack of studied treatments for most of these disorders. Activation of the endogenous melatonin receptors appears to play an important role in setting the circadian clock in the suprachiasmatic nucleus of the hypothalamus. Therefore, melatonin agonists, which may be able to shift and/or stabilize the circadian phase, have been identified as potential therapeutic candidates for the treatment of CRSWDs. Currently, only one melatonin receptor agonist, tasimelteon, is approved for the treatment of a CRSWD: non-24-hour sleep-wake disorder (or non-24). However, three additional commercially available melatonin receptor agonists-agomelatine, prolonged-release melatonin, and ramelteon-have been investigated for potential use for treatment of CRSWDs. Data indicate that these melatonin receptor agonists have distinct pharmacologic profiles that may help clarify their clinical use in CRSWDs. We review the pharmacokinetic and pharmacodynamic properties of these melatonin agonists and summarize their efficacy profiles when used for the treatment of CRSWDs. Further studies are needed to determine the therapeutic potential of these melatonin agonists for most CRSWDs.

  18. Are the Clinical Characteristics of Anxious Youths Participating in Non-Treatment-Related Research Comparable to Those of Youths Receiving Treatment?

    ERIC Educational Resources Information Center

    De Los Reyes, Andres; Alfano, Candice A.; Clementi, Michelle A.; Viana, Andres

    2017-01-01

    Background: A key element of the evidence-based assessment and treatment movements is ensuring an adequate representation of clients across the different settings in which they receive mental health care (e.g., research and routine or usual care settings). Prior work has focused on comparing clients from research settings to those from usual care…

  19. Comparative estimation of the effectiveness of laser and other methods of stomatological disease treatment

    NASA Astrophysics Data System (ADS)

    Kunin, Anatoly A.; Erina, Stanislava V.; Pankova, Svetlana N.; Buerger, Friedhelm R.; Baumert, R.; Stepanov, Nicolay N.; Malinovskaya, L. A.; Sokolova, Irina A.; Podolskaya, Elana E.; Kazmina, Svetlana G.; Dergunova, Elvira I.; Mozhaev, N. N.

    1996-11-01

    A perspective trend in the perfection of laser methods of stomatological diseases treatment is the application of low intensity laser radiation having a wide range of the therapeutic effect. Thus, laser radiation has various, pathogenetic effect. Patients with carries, pulpits, periodontitis, diseases of parodontium and oral mucous membranes were treated. Traditional examination methods were used, i.e. biochemical, visual pulp examination, immunological and macrohistological ones. The obtained results prove high effectiveness of laser therapy in the treatment of a number of stomatological disease in comparison with traditional methods and can be recommended to be used in practice.

  20. Comparative effectiveness of membrane bioreactors, conventional secondary treatment, and disinfection to remove microorganisms from municipal wastewaters

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Log removals of bacterial indicators, coliphage, and enteric viruses were studied in three membrane bioreactor activated-sludge (MBR) and two conventional secondary activated-sludge municipal wastewater treatment plants during three disinfection seasons (May–Oct.). In total, 73 regular samples were ...

  1. Unpacking Phonological Awareness: Comparing Treatment Outcomes for Low-Skilled Kindergarten Children.

    ERIC Educational Resources Information Center

    O'Connor, Rollanda E.

    A study explored the construct of phonological awareness by examining the effects of different instructional treatments on the development of generalized phonological skills, reading, and spelling. The effect of phonological instruction with kindergarten children who might be expected to have more than average difficulty learning to read in first…

  2. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD

    DTIC Science & Technology

    2013-06-01

    subjects consented to study participation and 45 met all of the inclusion and none of the exclusion criteria and were randomized to treatment. During...participants consented to study participation and 35 met all the inclusion criteria and none of the exclusion criteria and were randomized.

  3. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD

    DTIC Science & Technology

    2012-06-01

    subjects consented to study participation and 45 met all of the inclusion and none of the exclusion criteria and were randomized to treatment. During...have been received, 72 participants consented to study participation and 43 met all the inclusion criteria and none of the exclusion criteria and were randomized.

  4. Comparative Psychotherapy: Rational-Emotive Therapy Versus Systematic Desensitization in the Treatment of Stuttering

    ERIC Educational Resources Information Center

    Moleski, Richard; Tosi, Donald J.

    1976-01-01

    The present study examined the efficacy of rational-emotive psychotherapy and systematic desensitization in the treatment of stuttering. Both therapies, making extensive use of in vivo behavioral assignments, were examined under the presence and absence of in vivo tasks. Results show that rational-emotive therapy was more effective in reducing…

  5. A Randomized Trial Comparing Bangerter Filters and Patching for the Treatment of Moderate Amblyopia in Children

    PubMed Central

    2009-01-01

    Objective To determine whether visual acuity improvement with Bangerter filters is similar to improvement with patching as initial therapy for children with moderate amblyopia. Design Randomized clinical trial. Participants 186 children, 3 to <10 years old, with moderate amblyopia (20/40 to 20/80). Methods Children were randomly assigned to receive either daily patching or to use a Bangerter filter on the spectacle lens in front of the fellow eye. Study visits were scheduled at 6, 12, 18 and 24 weeks. Main outcome measure Visual acuity in amblyopic eye at 24 weeks. Results At 24 weeks, amblyopic eye improvement averaged 1.9 lines in the Bangerter group and 2.3 lines in the patching group (difference in mean visual acuities between groups adjusted for baseline acuity = 0.38 line). The upper limit of a 1-sided 95% confidence interval was 0.76 line, which slightly exceeded a pre-specified non-inferiority limit of < 0.75 line. Similar percentages of subjects in each group improved ≥3 lines (Bangerter group 38% versus patching group 35%, P=0.61) or had 20/25 or better amblyopic eye acuity (36% versus 31%, respectively, P=0.86). There was a lower treatment burden in the Bangerter group as measured with the Amblyopia Treatment Index. With Bangerter filters, neither a fixation switch to the amblyopic eye nor induced blurring in the fellow eye to worse than that of the amblyopic eye was required for visual acuity improvement. Conclusion Because the average difference in visual acuity improvement between Bangerter filters and patching was less than half a line, and there was lower burden of treatment on the child and family, Bangerter filter treatment is a reasonable option to consider for initial treatment of moderate amblyopia. PMID:20163869

  6. Efficacy of terbinafine compared to lanoconazole and luliconazole in the topical treatment of dermatophytosis in a guinea pig model.

    PubMed

    Ghannoum, M A; Long, L; Kim, H G; Cirino, A J; Miller, A R; Mallefet, P

    2010-05-01

    The in vivo efficacy of terbinafine was compared to lanoconazole and luliconazole in the topical treatment of dermatophytosis caused by Trichophyton mentagrophytes using a guinea pig model. Topical antifungal treatment commenced three days post-infection, and each agent was applied once daily for seven consecutive days. Upon completion of the treatment period, evaluations of clinical and mycological efficacies were performed, as was scanning electron microscopy (SEM) analyses. Data showed that while all tested antifungals demonstrated significant mycological efficacy in terms of eradicating the fungi over untreated control, terbinafine and luliconazole showed superior clinical efficacy compared to lanoconazole (P-values < 0.001 & 0.003, respectively). Terbinafine demonstrated the highest clinical percent efficacy. SEM analysis revealed hairs from terbinafine and lanoconazole-treated animals had near complete clearance of fungi, while samples from luliconazole-treated animals were covered with debris and few conidia. This study demonstrates that, in general, terbinafine possessed similar efficacy to lanoconazole and luliconazole in the treatment of dermatophytosis. Terbinafine tended to have superior clinical efficacy compared to the azoles tested, although this difference was not statistically significant against luliconazole. This apparent superiority may be due to the fungicidal activity of terbinafine compared to the fungistatic effect of the other two drugs.

  7. Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis

    PubMed Central

    Tvete, Ingunn Fride; Natvig, Bent; Gåsemyr, Jørund; Meland, Nils; Røine, Marianne; Klemp, Marianne

    2015-01-01

    Rheumatoid arthritis patients have been treated with disease modifying anti-rheumatic drugs (DMARDs) and the newer biologic drugs. We sought to compare and rank the biologics with respect to efficacy. We performed a literature search identifying 54 publications encompassing 9 biologics. We conducted a multiple treatment comparison regression analysis letting the number experiencing a 50% improvement on the ACR score be dependent upon dose level and disease duration for assessing the comparable relative effect between biologics and placebo or DMARD. The analysis embraced all treatment and comparator arms over all publications. Hence, all measured effects of any biologic agent contributed to the comparison of all biologic agents relative to each other either given alone or combined with DMARD. We found the drug effect to be dependent on dose level, but not on disease duration, and the impact of a high versus low dose level was the same for all drugs (higher doses indicated a higher frequency of ACR50 scores). The ranking of the drugs when given without DMARD was certolizumab (ranked highest), etanercept, tocilizumab/ abatacept and adalimumab. The ranking of the drugs when given with DMARD was certolizumab (ranked highest), tocilizumab, anakinra, rituximab, golimumab/ infliximab/ abatacept, adalimumab/ etanercept. Still, all drugs were effective. All biologic agents were effective compared to placebo, with certolizumab the most effective and adalimumab (without DMARD treatment) and adalimumab/ etanercept (combined with DMARD treatment) the least effective. The drugs were in general more effective, except for etanercept, when given together with DMARDs. PMID:26356639

  8. The Effectiveness of an Experimental Treatment when Compared to Care as Usual Depends on the Type of Care as Usual

    ERIC Educational Resources Information Center

    van de Wiel, Nicolle M. H.; Matthys, Walter; Cohen-Kettenis, Peggy T.; Maassen, Gerard H.; Lochman, John E.; van Engeland, Herman

    2007-01-01

    In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A…

  9. Temperament and character dimensions in opiate addicts: comparing subjects who completed inpatient treatment in therapeutic communities vs. incompleters.

    PubMed

    Zoccali, R; Muscatello, M R A; Bruno, A; Bilardi, F; De Stefano, C; Felletti, E; Isgrò, S; Micalizzi, V; Micò, U; Romeo, A; Meduri, M

    2007-01-01

    The aim of this study was to compare temperamental profiles of patients who completed inpatient treatment of drug dependence with those who failed to complete the program. One hundred forty four opiate addicts, all resident in therapeutic communities and screened to exclude Axis I disorders, were assessed using the Temperament and Character Inventory (TCI). After one year, the TCI scores were compared between those who were still resident and those who had dropped out. Significant differences between groups were found in Reward Dependence, Persistence, Cooperativeness, Self-Transcendence. Temperament and character features may have an influence on motivation and on the adherence to treatment and community rules, as they modulate the maintenance of ongoing behaviors and the sensitivity to social rewards. The findings suggest that personality assessment with TCI in opiate addicts may be helpful in screening procedures to increase the efficiency of treatment and rehabilitative strategies.

  10. Cost-utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity.

    PubMed

    Chowdhury, Enayet K; Ademi, Zanfina; Moss, John R; Wing, Lindon M H; Reid, Christopher M

    2015-03-01

    The objective of this study was to examine the cost-effectiveness of angiotensin-converting enzyme inhibitor (ACEI)-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government's perspective.We used a cost-utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age ≥65 years) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into 2 groups. Group A was restricted to participants diabetes free at baseline (n = 5642); group B was restricted to participants with preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management costs were calculated from direct health care costs available from Australian government reimbursement data. Costs and QALYs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data.After a treatment period of 5 years, for group A, the ICER was Australian dollars (AUD) 27,698 (&OV0556; 18,004; AUD 1-&OV0556; 0.65) per QALY gained comparing ACEI-based treatment with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for group B; whereas for group A, the

  11. [Comparative experimental study of antioxidant efficiency in treatment of acute pancreatitis].

    PubMed

    Kliuĭko, D A; Korik, V E; Zhidkov, S A

    2011-01-01

    The aims of our experiments on animals were (i) to evaluate by direct oximery the efficiency of various antioxidant drugs in a complex treatment of acute pancreatitis and (ii) to determine the diagnostic value of the direct oximetry method for estimation of the efficiency of medical treatment. The article presents data obtained in a group 75 outbred Guinea with a model acute pancreatitis, which were treated with mexibel (group 1), emoxipin (group 2), end cytoflavin (group 3), with subsequent investigation of the pancreatic tissues by the direct oximetry method. The obtained results confirmed that the intraperitoneal injection of cytoflavin to animals stimulates tissue respiration, improves metabolism, promotes pancreas recovery, and also improves the prognosis and reduces the lethal outcome. The efficiency of cytoflavin within the complex therapy exceeds the effect of other antioxidants (mexibel and emoxipin) under otherwise equal conditions.

  12. Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C.

    PubMed

    Pfeil, Alena M; Reich, Oliver; Guerra, Ines M; Cure, Sandrine; Negro, Francesco; Müllhaupt, Beat; Lavanchy, Daniel; Schwenkglenks, Matthias

    2015-01-01

    In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.

  13. Biofeedback, autogenic training, and progressive relaxation in the treatment of Raynaud's disease: a comparative study.

    PubMed

    Keefe, F J; Surwit, R S; Pilon, R N

    1980-01-01

    Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26 degrees to 17 degrees C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.

  14. Obstructive sleep apnoea treatment and fasting lipids: a comparative effectiveness study.

    PubMed

    Keenan, Brendan T; Maislin, Greg; Sunwoo, Bernie Y; Arnardottir, Erna Sif; Jackson, Nicholas; Olafsson, Isleifur; Juliusson, Sigurdur; Schwab, Richard J; Gislason, Thorarinn; Benediktsdottir, Bryndis; Pack, Allan I

    2014-08-01

    Obstructive sleep apnoea (OSA) is associated with cardiovascular disease. Dyslipidaemia has been implicated as a mechanism linking OSA with atherosclerosis, but no consistent associations with lipids exist for OSA or positive airway pressure treatment. We assessed the relationships between fasting lipid levels and obesity and OSA severity, and explored the impact of positive airway pressure treatment on 2-year fasting lipid level changes. Analyses included moderate-to-severe OSA patients from the Icelandic Sleep Apnoea Cohort. Fasting morning lipids were analysed in 613 untreated participants not on lipid-lowering medications at baseline. Patients were then initiated on positive airway pressure and followed for 2 years. Sub-classification using propensity score quintiles, which aimed to replicate covariate balance associated with randomised trials and, therefore, minimise selection bias and allow causal inference, was used to design the treatment group comparisons. 199 positive airway pressure adherent patients and 118 non-users were identified. At baseline, obesity was positively correlated with triglycerides and negatively correlated with total cholesterol, and low-density and high-density lipoprotein cholesterol. A small correlation was observed between the apnoea/hypopnoea index and high-density lipoprotein cholesterol. No effect of positive airway pressure adherence on 2-year fasting lipid changes was observed. Results do not support the concept of changes in fasting lipids as a primary mechanism for the increased risk of atherosclerotic cardiovascular disease in OSA.

  15. Comparing oxalic acid and sucrocide treatments for Varroa destructor (Acari: Varroidae) control under desert conditions.

    PubMed

    Sammataro, D; Finley, J; Underwood, R

    2008-08-01

    The effectiveness of oxalic acid (OA) and Sucrocide (S) (AVA Chemical Ventures, L.L.C., Portsmouth, NH) in reducing populations of the varroa mite Varroa destructor Anderson & Trueman (Acari: Varroidae) in honey bee, Apis mellifera L. (Hymenoptera: Apidae) colonies was measured under the desert conditions of Arizona, USA. OA and S were applied three times 7 d apart. A 3.2% solution of OA was applied in sugar syrup via a large volume syringe, trickling 5 ml per space between frames in the colony. S was applied at a concentration of 0.625% (mixed with water), according to the label directions, using a compressed air Chapin sprayer at 20 psi to apply 59 ml per frame space. Varroa mites, collected on a sticky board before, during, and after the treatments, were counted to assess the effectiveness of the treatments. This study showed that a desert climate zone did not confer any positive or negative results on the acaricidal properties of OA. Even with brood present in colonies, significant varroa mite mortality occurred in the OA colonies. In contrast, we found that Sucrocide was not effective as a mite control technique. Despite its ability to increase mite mortality in the short-term, varroa mite populations measured posttreatment were not affected any more by Sucrocide than by no treatment at all.

  16. Efficacy and safety of barnidipine compared with felodipine in the treatment of hypertension in Chinese patients.

    PubMed

    Liau, C S; Chien, K L; Chao, C L; Lee, T M

    2002-01-01

    The efficacy and safety profiles of barnidipine in the treatment of hypertension were evaluated in an open parallel-group study. Fifty-nine Chinese patients with mild-to-moderate essential hypertension were randomized to receive either barnidipine or felodipine (5 mg once daily, titrated to 10 mg or 15 mg once daily, as indicated) for 12 weeks. Both drugs reduced blood pressures significantly with > or = 68% of cases obtaining marked or moderate blood pressure reduction. Mean reductions in systolic and diastolic blood pressure for barnidipine treatment were 23.7 +/- 13.5 mmHg and 12.7 +/- 7.9 mmHg, and for felodipine, 24.3 +/- 18.4 mmHg and 14.5 +/- 10.0 mmHg, respectively. There was no significant difference between these two drugs in anti-hypertensive effect, heart rate, laboratory measurements or incidence of adverse events. The only difference was that more patients taking felodipine experienced palpitations. We conclude that barnidipine has similar efficacy and a similar safety profile to felodipine in the treatment of mild-to-moderate essential hypertension in Chinese patients.

  17. Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study.

    PubMed

    Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S

    2016-02-01

    The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.

  18. Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study.

    PubMed

    Shin, Hyoseung; Kwon, Oh Sang; Won, Chong Hyun; Kim, Beom Joon; Lee, Yang Won; Choe, Yong Beom; Ahn, Kyu Joong; Eun, Hee Chul

    2009-03-01

    Previous studies have shown that topical steroid and shampoo containing zinc pyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. But the clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor on seborrheic dermatitis, is not well investigated yet. We wanted to compare the clinical efficacy of topical tacrolimus with that of conventional treatment (zinc pyrithione shampoo and topical betamethasone) for treatment of seborrheic dermatitis of the scalp. Patients with seborrheic dermatitis of the scalp were randomly allocated to receive topical betamethasone, topical tacrolimus or zinc pyrithione shampoo. Some patients were instructed to continue the treatments for 8 weeks and the others to discontinue the treatments at week 4. We evaluated the efficacy using a clinical severity score, dandruff score and sebum secretion at baseline, week 4 and week 8. All treatment groups showed significant improvements in clinical assessment after 4 weeks. While the patients treated by zinc pyrithione improved continuously even after cessation of the treatment, the patients treated by betamethasone lotion or tacrolimus ointment were aggravated clinically. Topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone. To treat seborrheic dermatitis of the scalp, we think that the combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione is recommended.

  19. A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders.

    PubMed

    Scott, Jan; Colom, Francesc; Vieta, Eduard

    2007-02-01

    This paper reviews published randomized controlled treatment trials of psychological therapies added to standard psychiatric treatment vs. standard psychiatric treatment alone to explore whether adjunctive psychotherapy reduces relapse rates in individuals with bipolar disorders. Core components and characteristics of effective psychological therapies were identified from descriptions in the literature. Relapse rates were calculated for selected treatment trials and then pooled odds ratios were calculated using meta-analytical techniques that explored differences in outcome according to therapy model, type of relapse experienced and whether the subject was euthymic at entry to the study. The different therapy models have a number of similar components. A meta-analysis of eight recent studies demonstrates a significant reduction in relapse rates (of about 40%) compared to standard treatment alone. Therapies were most effective in preventing relapses in subjects who were euthymic when recruited into the treatment trial, and may be less effective in those with a high number of previous episodes (previous relapses >12). Efficacy studies demonstrate that adjunctive psychological treatments for individuals with bipolar disorders reduce relapse risk, but there is a need to undertake pragmatic effectiveness studies to determine which individuals with bipolar disorders are most likely to benefit from such interventions.

  20. MiniJFil®: A New Safe and Effective Stent for Well-Tolerated Repeated Extracorporeal Shockwave Lithotripsy or Ureteroscopy for Medium-to-Large Kidney Stones?

    PubMed Central

    Vogt, Benoit; Desfemmes, Francois-Noel; Desgrippes, Arnaud; Ponsot, Yves

    2016-01-01

    Background Percutaneous nephrolithotomy (PCNL) is recommended for treating staghorn stones or stones measuring > 20 mm. Extracorporeal shockwave lithotripsy (ESWL) or flexible ureteroscopy (URS) may be used as a complement. However, PCNL can cause trauma to the kidney parenchyma, and patients may find a noninvasive procedure, such as ESWL, to be more attractive. Objectives The aim of this study was to evaluate the clinical efficiency of MiniJFil® stenting associated with ESWL or second-line URS for the treatment of medium-to-large kidney stones. The MiniJFil® is a stent reduced to a suture of 0.3F attached to a renal pigtail. The entire ureter is occupied only by the suture of the stent. Methods We retrospectively analyzed the data of 28 patients. Twenty-four patients had kidney stones measuring > 15 mm (group 1) and four patients had staghorn stones (group 2). All of the patients were fitted with MiniJFil® 2 - 3 weeks before any treatment. ESWL was always our first-line therapy. Stone-free (SF) status was defined as no evidence of stones. Results In group 1, the mean largest and cumulative stone diameters, respectively, were 18.7 ± 5.7 mm and 45.0 ± 12.0 mm. In group 2, the mean volume was 6,288.4 ± 2,733.0 mm3. The overall SF was 96.4% (100% for group 1 and 75% for group 2). The mean number of sessions of ESWL and URS, respectively, was 1.4 ± 0.7 and 0.8 ± 0.9 in group 1 and 4.0 ± 2.0 and 1.5 ± 1.3 in group 2. The mean times to achieve these rates were 3.2 ± 1.7 months and 5.6 ± 2.3 months for groups 1 and 2, respectively. One patient in group 2 was treated with only three sessions of ESWL. Renal colic was observed in only five patients (17.9%). Conclusions MiniJFil® stenting is safe and may be an alternative for the treatment of kidney stones during minimally invasive procedures. PMID:27878116

  1. Comparative study on methotrexate and hydroxychloroquine in the treatment of rheumatoid arthritis.

    PubMed

    Alam, M K; Sutradhar, S R; Pandit, H; Ahmed, S; Bhattacharjee, M; Miah, A H; Bari, M A; Islam, M Z; Khan, N A; Zannat, K F; Akhter, S

    2012-07-01

    This study was done to see the efficacy and tolerability of methotrexate and hydroxychloroquine in the Treatment of Rheumatoid Arthritis. It was an open label controlled clinical trial, done in Mymensingh Medical college hospital. Fifty six patients were selected by random sampling method, 28 were included in methotrexate group and another 28 for hydroxychloroquine group using inclusion & exclusion criteria. Primary efficacy variables (DAS28, daily naproxen), secondary efficacy variables, and safety measurement variables studied both clinically & laboratory investigations. The data were analyzed by computer with the help of SPSS. The student's t test was used as test of significant. The mean age of the patients at diagnosis was almost identically distributed between methotrexate and hydroxychloroquine group (41.7±12.2 vs. 42.9±9.2 years, p=0.659). Disease activity at baseline was found to be almost homogeneous to each group except CRP which was observed to be significantly higher in methotrexate group than hydroxychloroquine group (p<0.001). Disease activity at 1 month of treatment reduced in the methotrexate group than those in hydroxychloroquine group (p<0.05 in each case). After 3 and 6 months of treatment, disease activity decreased significantly in both groups (p<0.001 and p<0.05 respectively). The average daily dose of NSAID (Naproxen) decreased significantly (p<0.001). Safety variables at 6 month were within normal physiological ranges and did not differ in groups (p>0.05) indicating that both methotrexate and hydroxychloroquine were effective and safe to use in rheumatoid arthritis. The difference in the incidence of adverse effects, total or individual, was almost nil.

  2. Treatment methods and comparative risks of thorium removal from waste residues

    SciTech Connect

    Porter, R.D.; Hamby, D.M.; Martin, J.E.

    1997-07-01

    This study was done to examine the risks of remediation and the effectiveness of removal methods for thorium and its associated radioactive decay products from various soils and wastes associated with DOE`s Formerly Utilized Sites Remedial Action Program (FUSRAP). Removal of {sup 230}Th from uranium process residues would significantly reduce the buildup of {sup 226}Ra (half-life of 1600 years), and since {sup 230}Th concentrations at most of the important sites greatly exceed the {sup 226}Ra concentrations, such removal would reduce the accumulation of additional radiation risks associated with {sup 226}Ra and its products; and, if treatment also removed {sup 226}Ra, these risks could be mitigated even further. Removal of {sup 232}Th from thorium process residues would remove the source material for {sup 228}Ra, and since {sup 228}Ra has a half-life of 5.76 years, its control at FUSRAP sites could be done with land use controls for the 30--50 years required for {sup 228}Ra and the risks associated with its decay products to decay away. It must be recognized, however, that treatment methods invariably require workers to process residues and waste materials usually with bulk handling techniques. These processes expose workers to the radioactivity in the materials, therefore, workers would incur radiological risks in addition to industrial accident risks. An important question is whether the potential reduction of future radiological risks to members of the public justifies the risks that are incurred by remediation workers due to handling materials. This study examines, first, the effectiveness of treatment and then the risks that would be associated with remediation.

  3. Topical tacrolimus ointment for the treatment of lichen sclerosus, comparing genital and extragenital involvement.

    PubMed

    Kim, Gun-Wook; Park, Hyun-Je; Kim, Hoon-Soo; Kim, Su-Han; Ko, Hyun-Chang; Kim, Byung-Soo; Kim, Moon-Bum

    2012-02-01

    Lichen sclerosus is a chronic inflammatory dermatosis presenting with significant sclerosis, atrophy and pruritus. The treatment for this condition remains unsatisfactory, with potent corticosteroids being the most effective therapy. In this study, we investigated the efficacy and safety of tacrolimus ointment in patients with genital and extragenital lichen sclerosus. Sixteen patients with active lichen sclerosus (10 with anogenital and six with extragenital localization) were treated with topical tacrolimus ointment twice daily. The therapeutic effects were evaluated according to 3 grades: complete response (>75% improvement), partial response (25-75% improvement), or no response (<25% improvement). Applications were continued until complete disappearance or stabilization of the cutaneous lesions. In addition, we conducted telephone surveys to determine the long-term treatment outcome and relapse rate. Objective response to therapy occurred in nine of 10 patients (90%) with anogenital and one of six patients (16.7%) with extragenital lesions. Out of 10 patients with anogenital lichen sclerosus, five showed more than 75% improvement. Complete, partial and no response were achieved in five (50%), four (40%) and one (10%) patient, respectively. During the follow-up period of a mean of 29.3 months, six of nine patients had a relapse of symptoms. However, most patients with extragenital involvement did not respond to tacrolimus, except one patient showing partial response. No significant adverse effects were observed. Topical tacrolimus ointment was a safe and effective treatment for genital lichen sclerosus and should be used for long-term duration to prevent relapse. However, it was not useful for patients with extragenital lichen sclerosus.

  4. Comparing different treatment modalities for partial nephrectomies without ischemic period: laser, Hydro-Jet and RF

    NASA Astrophysics Data System (ADS)

    de Boorder, Tjeerd; Boeken Kruger, Arto; Klaessens, John; Grimbergen, Matthijs; Verdaasdonk, Rudolf

    2008-02-01

    The treatment of partial nefrectomies is usually performed under a warm ischemic period. Recently, various treatment modalities have become available to perform a partial nefrectomy without clamping off the blood circulation. We have studied three devices in laboratory setting, investigating the thermal and high speed imaging techniques in tissue models and consequently, applying the instruments in the clinic during open procedures especially looking at efficacy and blood loss. The continuous wave 2.0 micron laser of 70 W (Revolix, LISA laser) is used as a fiber delivered knife cutting through circulated tissue with controlled hemostasis for vessels up to 3 mm diameter. The 2 μm wavelength effectively vaporizes tissue water and coagulates the smaller vessels. The Hydro-Jet (ERBE, Germany) uses high pressure (20-80 bar) to ejects a water jet of 40 um diameter at high velocity (10-30 m/s). The parenchyma is resected while vessels are preserved. Consequently, the exposed vessels can be coagulated in a controlled way with minimal blood loss. The water jet showed to induce cavitation bubbles that resect the soft tissue from the matrix leaving the elastic microvessels intact. Various systems are based on bipolar RF technology. We are using the Habib device (Rita 1500X RF generator) to create a coagulation zone around the tumor. Subsequently, the tumor can be resected along the coagulation zone with minimal bleeding. The treatment modalities investigated, have their own advantages and, stand-alone or in combination, can facilitate laparoscopic partial nephrectomies without an ischemic period.

  5. A Comparative Study of Mass Removal Loads for a Range of Stormwater Treatment Strategies

    NASA Astrophysics Data System (ADS)

    Avellaneda, P. M.; Houle, J. J.; Roseen, R. M.; Ballestero, T. P.

    2005-05-01

    When evaluating performance efficiencies for stormwater BMPs, there are significant challenges with regards to normalizing the variations in design, and hydraulic and hydrological conditions. There can be significant variations that must be considered such as rainfall intensity and duration, influent quality, watershed characteristics, loading functions, antecedent dry period, and maintenance. This study assessed mass removal loads for different stormwater management measures, all located in the same facility. The research facility is unique because it enables monitoring of 12 different treatment devices in parallel. For this purpose, a 9-acre commuter parking lot at the University of New Hampshire was chosen to provide runoff. There are three classes of devices examined at the site, conventional structural Best Management Practices (BMP), Low Impact Development (LID) designs, and manufactured devices. These include a subsurface gravel wetland, a detention pond, a sand filter, a bioretention system, a vegetated swale, and 7 different manufactured devices. Flow was evenly distributed and piped to each stormwater treatment. An on-site rain gauge provided rainfall data and samples of stormwater influent and effluent (for each stormwater treatment) were collected during monitoring rainfall events between August (2004) and April (2005). Temperature, dissolved oxygen and conductivity were measured continuously. Runoff constituents such as TSS, TP, TN, Cu, metals, nutrients and bacteria were measured in temporal water samples for each monitoring rainfall event. Results are presented as both concentration and Event Mean Concentrations (EMCs) to evaluate mass load removal. The watershed rainfall-runoff pattern was investigated as well as a statistical analysis to determine whether or not the differences between inflow and effluent water quality parameters were statistically significant. Earlier results have shown significant differences in the effluent water quality

  6. Individual (N-of-1) trials can be combined to give population comparative treatment effect estimates: Methodologic considerations

    PubMed Central

    Zucker, Deborah R.; Ruthazer, Robin; Schmid, Christopher H.

    2010-01-01

    Abstract/Summary Objective To compare different statistical models for combining N-of-1 trials to estimate a population treatment effect. Study Design and Setting Data from a published series of N-of-1 trials comparing amitriptyline therapy and combination treatment (amitriptyline + fluoxetine ) were analyzed to compare summary and individual participant data meta-analysis, repeated measures models, Bayesian hierarchical models, single-period, single-pair and averaged outcome crossover models. Results The best fitting model included a random intercept (response on amitriptyline) and fixed treatment effect (added fluoxetine). Results supported a common, uncorrelated within-patient covariance structure that is equal between-treatments and across patients. Assuming unequal within-patient variances, a random effects model was favored. Bayesian hierarchical models improved precision and were highly sensitive to within-patient variance priors. Conclusion Optimal models for combining N-of-1 trials need to consider goals, data sources, and relative within and between patient variances. Without sufficient patients, between-patient variation will be hard to explain with covariates. N-of-1 data with few observations per patients may not support models with heterogeneous within-patient variation. With common variances, models appear robust. Bayesian models may improve parameter estimation but are sensitive to prior assumptions about variance components. With limited resources, improving within-patient precision must be balanced by increased participants to explain population variation. PMID:20863658

  7. A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.

    PubMed

    Kjellman, Görel; Oberg, Birgitta

    2002-07-01

    Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment; response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.

  8. Comparative study of the microbial quality of greywater treated by three on-site treatment systems.

    PubMed

    Friedler, E; Kovalio, R; Ben-Zvi, A

    2006-06-01

    This paper analyses the performance of a pilot scale treatment plant, treating light domestic greywater. The treatment included three parallel treatment units: stand-alone sand filtration (SFEB), RBC followed by sand filtration (SFRBC), and an MBR equipped with UF membranes (MBR). The performance of the SFEB unit was rather poor. The RBC and MBR units produced effluent of excellent quality, with COD of 42 and 40 mg l(-1), BOD of 1.8 and 1.1 mg l(-1), and turbidity of 0.6 and 0.2 NTU respectively. The SFEB failed to remove heterotrophic microorganisms (HPC), while the SFRBC and the MBR exhibited 2.1 and 3.6 logs removal, leading to effluent concentrations of 1.1 x 10(3) and 8.8 x 10(3) cfu ml(-1) respectively. Faecal coliforms (FC) counts were 3.4 x 10(5) 1.4 x 10(5) 1.1 x 10(3) and 3.5 x 10(2) cfu 100 ml(-1) in raw greywater, and in the SFEB, SFRBC and MBR effluents respectively. Further, in 60% of the samples no FC were detected in the MBR effluent. In order to simulate residence times in full scale systems, effluents were disinfected and stored for 0.5 h, 3 h, 6 h (normal operation), and one week (extreme event). The average chlorine demand was 8.1, 3.8 and 2.9 mg l(-1) for SFEB, SFRBC and MBR effluents respectively. Low residual chlorine (0.15-0.22 mg l(-1)) remained in all effluents even after a week-long storage. Disinfection reduced HPC by 5, 2 and 2 orders of magnitude in the SFEB, SFRBC and MBR effluents respectively, with no regrowth in short contact times (up to 6 hours). Some regrowth was observed after a week-long storage leading to 10(6), 10(4) and 10(3) cfu ml(-1) (SFEB SFRBC and MBR respectively). Disinfection reduced FC counts in all three types of effluent to 0 cfu 100 ml(-1), whilst no FC regrowth was observed after week-long storage. The results show that both RBC and MBR treatment units are viable options for on-site greywater reuse. The disinfection experiments strongly indicate that the health risk associated with the reuse of these effluents

  9. Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria12

    PubMed Central

    Opoka, Robert O; Ssemata, Andrew S; Georgieff, Michael K

    2016-01-01

    Background: The provision of iron with antimalarial treatment is the standard of care for concurrent iron deficiency and malaria. However, iron that is given during a malaria episode may not be well absorbed or used, particularly in children with severe malaria and profound inflammation. Objectives: We aimed to 1) determine baseline values of iron and inflammatory markers in children with severe malarial anemia (SMA), children with cerebral malaria (CM), and community children (CC) and 2) compare markers in iron-deficient children in each group who received 28 d of iron supplementation during antimalarial treatment with those in children who did not receive iron during treatment.. Design: Seventy-nine children with CM, 77 children with SMA, and 83 CC who presented to Mulago Hospital, Kampala, Uganda, were enrolled in a 28-d iron-therapy study. Children with malaria received antimalarial treatment. All children with CM or SMA, as well as 35 CC, had zinc protoporphyrin (ZPP) concentrations ≥80 μmol/mol heme and were randomly assigned to receive a 28-d course of iron or no iron. We compared iron markers at day 0 among study groups (CM, SMA, and CC groups) and at day 28 between children in each group who were randomly assigned to receive iron or to not receive iron. Results: At day 0, children with CM and SMA had greater values of C-reactive protein, ferritin, and hepcidin than those of CC. At day 28, interactions between study and treatment group were NS. Children in the no-iron compared with iron groups had similar mean values for hemoglobin (115 compared with 113 g/L, respectively; P = 0.73) and ZPP (124 compared with 124 μmol/mol heme, respectively; P = 0.96) but had lower median ferritin [101.0 μg/L (95% CI: 84.2, 121.0 μg/L) compared with 152.9 μg/L (128.8, 181.6 μg/L), respectively; P ≤ 0.001] and hepcidin [45.8 ng/mL (36.8, 56.9 ng/mL) compared with 83.1 ng/mL (67.6, 102.2 ng/mL), respectively; P < 0.011]. Conclusions: Severe inflammation is a

  10. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy.

    PubMed

    Zhang, Yang; Peng, Jian; Li, Xiaoli; Liao, Mingmei

    2016-10-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (P<0.01). Shortened exhaust time (P<0.05) and hospital stay (P<0.01) were present in patients who underwent ELC. Moreover, ELC showed decreased occurrence rate of dyspepsia and diarrhea in comparison with LC (P<0.01). The stone recurrence rate of ELC was 16.67%. ELC decreased the recurrence of stone in common bile duct in comparison with LC. The contractile function of gallbladder was close to normal (P<0.05), and the thickness of gallbladder wall significantly decreased (P<0.001). Patients who underwent ELC showed less digestive symptom, good recovery, and low stone recurrence compared with those who underwent LC.

  11. Infared beak treatment method compared with conventional hot blade amputation in laying hens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infrared lasers have been widely used for noninvasive surgical applications in human medicine and their results are reliable, predictable and reproducible. Infrared lasers have recently been designed with the expressed purpose of providing a less painful, more precise beak trimming method compared w...

  12. Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy

    PubMed Central

    Zhang, Yang; Peng, Jian; Li, Xiaoli

    2016-01-01

    The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (P<0.01). Shortened exhaust time (P<0.05) and hospital stay (P<0.01) were present in patients who underwent ELC. Moreover, ELC showed decreased occurrence rate of dyspepsia and diarrhea in comparison with LC (P<0.01). The stone recurrence rate of ELC was 16.67%. ELC decreased the recurrence of stone in common bile duct in comparison with LC. The contractile function of gallbladder was close to normal (P<0.05), and the thickness of gallbladder wall significantly decreased (P<0.001). Patients who underwent ELC showed less digestive symptom, good recovery, and low stone recurrence compared with those who underwent LC. PMID:27579981

  13. Comparing Treatment Effect Measurements in Narcolepsy: The Sustained Attention to Response Task, Epworth Sleepiness Scale and Maintenance of Wakefulness Test

    PubMed Central

    van der Heide, Astrid; van Schie, Mojca K.M.; Lammers, Gert Jan; Dauvilliers, Yves; Arnulf, Isabelle; Mayer, Geert; Bassetti, Claudio L.; Ding, Claire-Li; Lehert, Philippe; van Dijk, J. Gert

    2015-01-01

    Study Objectives: To validate the Sustained Attention to Response Task (SART) as a treatment effect measure in narcolepsy, and to compare the SART with the Maintenance of Wakefulness Test (MWT) and the Epworth Sleepiness Scale (ESS). Design: Validation of treatment effect measurements within a randomized controlled trial (RCT). Patients: Ninety-five patients with narcolepsy with or without cataplexy. Interventions: The RCT comprised a double-blind, parallel-group, multicenter trial comparing the effects of 8-w treatments with pitolisant (BF2.649), modafinil, or placebo (NCT01067222). MWT, ESS, and SART were administered at baseline and after an 8-w treatment period. The severity of excessive daytime sleepiness and cataplexy was also assessed using the Clinical Global Impression scale (CGI-C). Measurements and Results: The SART, MWT, and ESS all had good reliability, obtained for the SART and MWT using two to three sessions in 1 day. The ability to distinguish responders from nonresponders, classified using the CGI-C score, was high for all measures, with a high performance for the SART (r = 0.61) and the ESS (r = 0.54). Conclusions: The Sustained Attention to Response Task is a valid and easy-to-administer measure to assess treatment effects in narcolepsy, enhanced by combining it with the Epworth Sleepiness Scale. Citation: van der Heide A, van Schie MK, Lammers GJ, Dauvilliers Y, Arnulf I, Mayer G, Bassetti CL, Ding CL, Lehert P, van Dijk JG. Comparing treatment effect measurements in narcolepsy: the Sustained Attention to Response Task, Epworth Sleepiness Scale and Maintenance of Wakefulness Test. SLEEP 2015;38(7):1051–1058. PMID:25902810

  14. Electrocoagulation: Simply a Phase Separation Technology? The Case of Bronopol Compared to Its Treatment by EAOPs.

    PubMed

    Bocos, Elvira; Brillas, Enric; Sanromán, M Ángeles; Sirés, Ignasi

    2016-07-19

    Electrocoagulation (EC) has long been considered a phase separation process, well suited for industrial wastewater treatment since it causes a quick, drastic decay of organic matter content. This research demonstrates that EC also behaves, at least for some molecules like the industrial preservative bronopol, as an effective transformation technology able to yield several breakdown products. This finding has relevant environmental implications, pointing to EC as a greener process than described in literature. A thorough optimization of EC was performed with solutions of bronopol in a simulated water matrix, yielding the complete disappearance of the parent molecule within 20 min at 200 mA (∼20 mA/cm(2)), using Fe as the anode and cathode. A 25% of total organic carbon (TOC) abatement was attained as maximum, with bronopol being converted into bromonitromethane, bromochloromethane, formaldehyde and formic acid. N atoms were accumulated as NO3(-), whereas Br(-) was stable once released. This suggests that mediated oxidation by active chlorine, as well as by hydroxyl radicals resulting from its reaction with iron ions, is the main transformation mechanism. Aiming to enhance the mineralization, a sequential combination of EC with electro-Fenton (EF) as post-treatment process was proposed. EF with boron-doped diamond (BDD) anode ensured the gradual TOC removal under the action of (•)OH and BDD((•)OH), also transforming Br(-) into BrO3(-).

  15. Nanotechnology for sustainable wastewater treatment and use for agricultural production: A comparative long-term study.

    PubMed

    De La Cueva Bueno, Patricia; Gillerman, Leonid; Gehr, Ronald; Oron, Gideon

    2017-03-01

    Nanotechnology applications can be used for filtering low quality waters, allowing under given conditions, the removal of salts and other micropollutants from these waters. A long-term field experiment, implementing nanotechnology in the form of UltraFiltration (UF) and Reverse Osmosis (RO) for salt removal from treated wastewater, was conducted with secondary effluents, aiming to prove the sustainability of agricultural production using irrigation with treated wastewater. Six outdoor field treatments, each under four replications, were conducted for examining the salt accumulation effects on the soil and the crops. The field experiments proved that crop development is correlated with the water quality as achieved from the wastewater filtration capability of the hybrid nanotechnology system. The key goal was to maintain sustainable food production, despite the low quality of the waters. Of the six treatment methods tested, irrigation with RO-treated effluent produced the best results in terms of its effect on soil salinity and crop yield. Nevertheless, it must be kept in mind that this process is not only costly, but it also removes all organic matter content from the irrigation water, requiring the addition of fertilizers to the effluent.

  16. Comparative study between M. oleifera and aluminum sulfate for water treatment: case study Colombia.

    PubMed

    Salazar Gámez, Lorena L; Luna-delRisco, Mario; Cano, Roberto Efrain Salazar

    2015-10-01

    The world has a water deficit, mostly located in developing countries. For example, in Colombia, water deficit is a major concern and it increases in rural areas, where the rate of accessibility to drinking water is of 33.26% in 2005. Since the 1970s, the most used technology for water purification is the conventional physicochemical process. The most common coagulant used in this process is aluminum sulfate (alum). This study focuses on a comparison between Moringa oleifera seeds and alum for water treatment in different natural waters. Results showed that M. oleifera removed 90% turbidity and alum 96% from water samples from the tested natural brook. However, color removal for M. oleifera was 95 and 80.3% for alum. For water-polluted samples, both coagulants have shown high efficiency (100%) in color and turbidity removal. Usage of natural coagulants (i.e., M. oleifera) instead of chemical ones (i.e., alum) are more convenient in rural areas where the economic situation and accessibility of those products are key elements to maintain fresh water treatment standards. Additionally, results demonstrated that high dosages M. oleifera did not affect the optimal value in terms of color and turbidity removal. In rural and developing countries, this is important because it does not require a sophisticated dosing equipment.

  17. Nano/bio treatment of polychlorinated biphenyls with evaluation of comparative toxicity

    DOE PAGES

    Le, Thao Thanh; Francis, Arokiasamy J.; Nguyen, Hoang Khanh; ...

    2015-02-03

    The persistence of polychlorinated biphenyl (PCB) Aroclor 1248 in soils and sediments is a major concern because of its toxicity and presence at high concentrations. In this study, we developed an integrated remediation system for PCBs using chemical catalysis and biodegradation. The dechlorination of Aroclor 1248 was achieved by treatment with bimetallic nanoparticles Pd/nFe under anoxic conditions. Among the 32 PCB congeners of Aroclor 1248 examined, our process dechlorinated 99%, 92%, 84%, and 28% of tri-, tetra-, penta-, and hexachlorinated biphenyls, respectively. The resulting biphenyl was biodegraded rapidly by Burkholderia xenovorans LB400. Benzoic acid was detected as an intermediate duringmore » the biodegradation process. The toxicity of the residual PCBs after nano-bio treatment was evaluated in terms of toxic equivalent values which decreased from 33.8 × 10-5 μg g-1 to 9.5 × 10-5 μg g-1. The residual PCBs also had low cytotoxicity toward Escherichia coli as demonstrated by lower reactive oxygen species levels, lower glutathione peroxidase activity, and a reduced number of dead bacteria.« less

  18. Nano/bio treatment of polychlorinated biphenyls with evaluation of comparative toxicity

    SciTech Connect

    Le, Thao Thanh; Francis, Arokiasamy J.; Nguyen, Hoang Khanh; Jeon, Jong -Rok; Chang, Yoon -Seok

    2015-02-03

    The persistence of polychlorinated biphenyl (PCB) Aroclor 1248 in soils and sediments is a major concern because of its toxicity and presence at high concentrations. In this study, we developed an integrated remediation system for PCBs using chemical catalysis and biodegradation. The dechlorination of Aroclor 1248 was achieved by treatment with bimetallic nanoparticles Pd/nFe under anoxic conditions. Among the 32 PCB congeners of Aroclor 1248 examined, our process dechlorinated 99%, 92%, 84%, and 28% of tri-, tetra-, penta-, and hexachlorinated biphenyls, respectively. The resulting biphenyl was biodegraded rapidly by Burkholderia xenovorans LB400. Benzoic acid was detected as an intermediate during the biodegradation process. The toxicity of the residual PCBs after nano-bio treatment was evaluated in terms of toxic equivalent values which decreased from 33.8 × 10-5 μg g-1 to 9.5 × 10-5 μg g-1. The residual PCBs also had low cytotoxicity toward Escherichia coli as demonstrated by lower reactive oxygen species levels, lower glutathione peroxidase activity, and a reduced number of dead bacteria.

  19. Comparative studies on the differently operated trains of the North-Budapest Wastewater Treatment Plant.

    PubMed

    Jobbágy, A; Palkó, Gy; Weinpel, T; Makó, M

    2012-01-01

    In order to reduce the pollution load of the Danube, the North-Budapest Wastewater Treatment Plant has been upgraded to enhanced nitrogen removal by establishing a new activated sludge treatment line and modifying the existing unit for nitrification and denitrification. As both the influent flow rate and the influent chemical oxygen demand (COD), biological oxygen demand (BOD(5)) and total suspended solids (TSS) concentration levels remained far below the design values, setting one fourth of the reactor volume out of operation in the Old Line, and operating the nitrification reactor of the New Line with part-time aeration proved to be possible. Analytical data as well as simulation studies supported the advantage of the intermittent-aeration process in efficient N-removal. However, the lengths of the aerated periods have to be increased with decreasing temperature, and thereby effluent total nitrogen (TN) concentration can increase due to decreasing denitrification efficiency. Potential occurrence of low-dissolved oxygen (DO) bulking should be hindered through applying an efficient anoxic selector system.

  20. Serological Response to Treatment of Syphilis with Doxycycline Compared with Penicillin in HIV-infected Individuals.

    PubMed

    Salado-Rasmussen, Kirsten; Hoffmann, Steen; Cowan, Susan; Jensen, Jørgen Skov; Benfield, Thomas; Gerstoft, Jan; Katzenstein, Terese Lea

    2016-08-23

    Serological response to treatment of syphilis with orally administered doxycycline or intramuscularly administered penicillin was assessed in patients with concurrent HIV. All HIV-infected individuals diagnosed with syphilis attending 3 hospitals in Copenhagen, Denmark were included. Odds ratios (ORs) with 95% confidence intervals (CI) associated with serological outcome were modelled using propensity-score-adjusted logistic regression analysis. In total, 202 cases were treated with doxycycline or intramuscular penicillin. At 12 months, serological failure was observed in 12 cases (15%) treated with doxycycline and in 8 cases (17%) treated with penicillin (OR 0.78 (95% CI 0.16-3.88), p = 0.76). The serological cure rate at 12 months was highest in patients with primary syphilis (100%), followed by patients with secondary (89%), early latent (71%) and late latent (67%) syphilis (p = 0.006). In conclusion, this study provides evidence for the use of doxycycline as a treatment option when treating a HIV-infected population for syphilis.

  1. Small renal masses in the elderly: Contemporary treatment approaches and comparative oncological outcomes of nonsurgical and surgical strategies

    PubMed Central

    Vetterlein, Malte W.; Jindal, Tarun; Becker, Andreas; Regier, Marc; Kluth, Luis A.; Tilki, Derya

    2016-01-01

    Over the last decades, there has been a significant stage migration in renal cell carcinoma and especially older patients are getting diagnosed more frequently with low stage disease, such as small renal masses ≤4 cm of size. Considering the particular risk profile of an older population, often presenting with a nonnegligible comorbidity profile and progressive renal dysfunction, treatment approaches beyond aggressive radical surgical procedures have come to the fore. We sought to give a contemporary overview of the available different treatment strategies for incidental small renal masses in an elderly population with the focus on comparative oncological outcomes of nonsurgical and surgical modalities. PMID:27437532

  2. A prospective, open, comparative study of 5% potassium hydroxide solution versus cryotherapy in the treatment of genital warts in men*

    PubMed Central

    Camargo, Caio Lamunier de Abreu; Belda, Walter; Fagundes, Luiz Jorge; Romiti, Ricardo

    2014-01-01

    BACKGROUND Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. RESULT In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts. PMID:24770498

  3. O-(beta-hydroxyethyl)-rutosides systemic and local treatment in chronic venous disease and microangiopathy: an independent prospective comparative study.

    PubMed

    Belcaro, Gianni; Rosaria Cesarone, Maria; Ledda, Andrea; Cacchio, Marisa; Ruffini, Irma; Ricci, Andrea; Ippolito, Edmondo; Di Renzo, Andrea; Dugall, Mark; Corsi, Marcello; Marino Santarelli, Anna Rita; Grossi, Maria Giovanna

    2008-01-01

    O-(beta-hydroxyethyl)-rutosides (HR) is used to treat chronic venous disease and signs and symptoms of chronic venous insufficiency (CVI), varicose veins, and deep venous disease. This independent prospective controlled trial (a registry study) evaluates how the efficacy of HR at the local level (perimalleolar region) can be increased by the administration of a topical HR gel. The study is based on evaluation of microcirculatory variables in patients with severe CVI (ambulatory venous pressure, > 56 mm Hg) and venous microangiopathy. Patients are treated using 1 of the following 3 regimens: oral treatment with 1 g sachets of HR (2 g/d total) plus topical HR 2% gel applied 3 times daily at the internal perimalleolar region; oral treatment only (same dosage), or light elastic compression stockings. Laser Doppler skin flux at rest, skin flux at the perimalleolar region, and transcutaneous PO2 and PCO2 are measured at baseline and at the end of the treatment period. A comparable group of healthy individuals without treatment is observed for 8 weeks. In the treatment groups, flux is increased, PO2 is decreased, and PCO2 is increased compared with normal skin. At 4 and 8 weeks, the improvement in skin flux (which is decreased by all measurements), the increase in PO2, and the decrease in PCO2 (indicating microcirculatory improvement) are statistically significantly greater in the combined oral plus topical treatment group (P < .05). No adverse effects, tolerability problems, or compliance issues are noted. These results indicate an important role of HR in the treatment and control of CVI and venous microangiopathy.

  4. A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.

    PubMed

    Komolafe, J O; Kuti, O; Ijadunola, K T; Ogunniyi, S O

    2003-11-01

    A comparative study was conducted to demonstrate the difference, if any, in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate. Sixty pregnant women with iron deficiency anaemia were assigned randomly to either group and treated for 6 weeks. The age and parity distributions with mean packed cell volumes (PCVs) and gestational age at onset of treatment in the two groups were comparable. Comparing the mean PCVs at week 2, week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs (P<0.001). Thirty-six per cent of patients in the iron dextran group compared to 3.3% in the oral iron group (P=0.004) had their anaemia corrected by the sixth week. No significant side effects accompanied the use of intramuscular iron dextran. It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate. Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients.

  5. [Meta-analysis of clarithromycin compared with other antimicrobial drugs in the treatment of upper respiratory tract infections].

    PubMed

    Abad-Santos, F; Gálvez-Múgica, M A; Espinosa de los Monteros, M J; Gallego-Sandín, S; Novalbos, J

    2003-09-01

    The goal of this meta-analysis was to evaluate the effectiveness of clarithromycin versus most commonly used treatments for upper respiratory infections. We performed a systematic review of comparative clinical trials found in the literature. Regarding effectiveness, no significant differences were found in comparisons between clarithromycin and amoxicillin-clavulanic acid for upper respiratory infections, nor for cephalosporins, amoxicillin or amoxicillin-clavulanic acid for otitis media, nor oral penicillin for classic streptococcal tonsillitis. Clarithromycin was more effective than betalactam antibiotics for sinusitis (OR: 1.27, 95% CI: 1.01-1.61 in intent-to-treat analysis). The effectiveness of clarithromycin was better than that for azithromycin, but only reached statistical significance in the per-protocol analysis. The global analysis including all 33 clinical trials showed a small benefit for clarithromycin reaching statistical significance in the fixed-effects model (OR: 1.12, 95% CI: 1.01-1.25). Regarding safety, the incidence of adverse events was significantly lower for clarithromycin compared to amoxicillin and amoxicillin-clavulanic acid. No differences were found when comparing adverse events due to cephalosporins, azithromycin and betalactam antibiotics, but the incidence of adverse events for clarithromycin was higher compared to that of oral penicillin for streptococcal tonsillitis treatment. Overall, all the compared drugs were well tolerated; discontinuations due to adverse events were very low: 2.2% for clarithromycin treatment and 2.5% for the other antibiotics. It was concluded that clarithromycin is an effective and safe treatment for upper respiratory infection, and its new formulation in a single daily dose may improve therapeutic compliance.

  6. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment.

    PubMed

    Rollins, Angela L; Kukla, Marina; Salyers, Michelle P; McGrew, John H; Flanagan, Mindy E; Leslie, Doug L; Hunt, Marcia G; McGuire, Alan B

    2017-01-04

    Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

  7. Cost Effectiveness of Injectable Extended Release Naltrexone Compared to Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence

    PubMed Central

    Jackson, Heide; Mandell, Kara; Johnson, Kimberly; Chatterjee, Debanjana; Vanness, David J.

    2015-01-01

    Background The aim of this study was to estimate the cost-effectiveness of injectable extended release naltrexone (XR-NTX) compared to methadone maintenance and buprenorphine maintenance treatment (MMT and BMT respectively) for adult males enrolled in treatment for opioid dependence in the United States from the perspective of state-level addiction treatment payers. Methods We used a Markov model with daily time cycles to estimate the incremental cost per opioid-free day in a simulated cohort of adult males ages 18–65 over a six-month period from the state health program perspective. Results XR-NTX is predicted to be more effective and more costly than methadone or buprenorphine in our target population, with an incremental cost per opioid-free day gained relative to the next-most effective treatment (MMT) of $72. The cost-effectiveness of XR-NTX relative to MMT was driven by its effectiveness in deterring opioid use while receiving treatment. Conclusions XR-NTX is a cost-effective medication for treating opioid dependence if state addiction treatment payers are willing to pay at least $72 per opioid-free day. PMID:25775099

  8. Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents

    PubMed Central

    Bilgic, Fundagul; Gelgor, Ibrahim Erhan; Celebi, Ahmet Arif

    2015-01-01

    Abstract Objective: To determine the prevalence of malocclusion and orthodontic treatment need in a large sample of Central Anatolian adolescents and compare them with European-other nations' adolescents. Methods: The sample included 1125 boys and 1204 girls aged between 12 and 16 years with no previous orthodontic treatment history. Occlusal variables examined were molar relationship, overjet, overbite, crowding, midline diastema, posterior crossbite, and scissors bite. The dental health (DHC) and aesthetic components (AC) of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment for the total sample. Results: The results indicated a high prevalence of Class I (34.9%) and Class II, Division 1 malocclusions (40.0%). Moreover, increased (18%) and reduced bites (14.%), and increased (25.1%) and reversed overjet (10.%) were present in the sample. Conclusion: Using the DHC of the IOTN, the proportion of subjects estimated to have great and very great treatment need (grades 4 and 5) was 28.%. However, only 16.7% of individuals were in need (grades 8-10) of orthodontic treatment according to the AC. PMID:26691973

  9. Comparative Study of: Non-Invasive Conservative Treatments with Local Steroid Injection in the Management of Planter Fasciitis

    PubMed Central

    Iraqi, Aftab Ahmed; Narula, Kusum; Katyal, Rashmi; Saxena, Mridul Shanker

    2014-01-01

    Background: Planter Fasciitis is an annoying and painful condition that limits function. There is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking and is considered a self limiting condition. Symptoms resolve in 80% to 90% of cases within ten months. However, this long interval is frustrating for both patients and clinicians. Aim: This study was undertaken to compare the two different modalities of non operative treatment: Non- invasive conservative methods: NSAID’s, Soft Insoles, Stretching, Ultrasound therapy and Contrast baths versus local Steroid injection therapy. Materials and Methods: Patients by random sampling were divided in two groups. Group A as: Conservative group and Group B as Local Steroid Injections group, 100 patients in each. Patients were assessed as per Visual Analogue Scale (VAS) at the start of treatment and then after 4 wk and 8 wk duration on follow up. Statistical analysis used: SPSS for Windows (version 10.0) by the Chi-Square test. Results: The difference in the distribution of subjects belonging to either of the treatment modalities regarding the treatment outcome at four and eight week was found to be statistically insignificant. Conclusion: As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach because this can save the patients from the complications of steroid therapy. PMID:25386470

  10. Treatment of laboratory wastewater in a tropical constructed wetland comparing surface and subsurface flow.

    PubMed

    Meutia, A A

    2001-01-01

    Wastewater treatment by constructed wetland is an appropriate technology for tropical developing countries like Indonesia because it is inexpensive, easily maintained, and has environmentally friendly and sustainable characteristics. The aim of the research is to examine the capability of constructed wetlands for treating laboratory wastewater at our Center, to investigate the suitable flow for treatment, namely vertical subsurface or horizontal surface flow, and to study the effect of the seasons. The constructed wetland is composed of three chambered unplanted sedimentation tanks followed by the first and second beds, containing gravel and sand, planted with Typha sp.; the third bed planted with floating plant Lemna sp.; and a clarifier with two chambers. The results showed that the subsurface flow in the dry season removed 95% organic carbon (COD) and total phosphorus (T-P) respectively, and 82% total nitrogen (T-N). In the transition period from the dry season to the rainy season, COD removal efficiency decreased to 73%, T-N increased to 89%, and T-P was almost the same as that in the dry season. In the rainy season COD and T-N removal efficiencies increased again to 95% respectively, while T-P remained unchanged. In the dry season, COD and T-P concentrations in the surface flow showed that the removal efficiencies were a bit lower than those in the subsurface flow. Moreover, T-N removal efficiency was only half as much as that in the subsurface flow. However, in the transition period, COD removal efficiency decreased to 29%, while T-N increased to 74% and T-P was still constant, around 93%. In the rainy season, COD and T-N removal efficiencies increased again to almost 95%. On the other hand, T-P decreased to 76%. The results show that the constructed wetland is capable of treating the laboratory wastewater. The subsurface flow is more suitable for treatment than the surface flow, and the seasonal changes have effects on the removal efficiency.

  11. Treatment of co-infection with bancroftian filariasis and onchocerciasis: a safety and efficacy study of albendazole with ivermectin compared to treatment of single infection with bancroftian filariasis

    PubMed Central

    Makunde, William H; Kamugisha, Leo M; Massaga, Julius J; Makunde, Rachel W; Savael, Zakana X; Akida, Juma; Salum, Fred M; Taylor, Mark J

    2003-01-01

    Background In order to use a combination of ivermectin and albendazole for the elimination of lymphatic filariasis, it is important to assess the potential risk of increased adverse events in individuals infected with both lymphatic filariasis and onchocerciasis. We compared the safety and efficacy of albendazole (400 mg) in combination with ivermectin (150 micrograms/kg), for the treatment of co-infections of Wuchereria bancrofti and Onchocerca volvulus with single infection of W. bancrofti. Methods The safety study on co-infections was a crossover, double blind design, while for the single infection of bancroftian filariasis an open design comparing two treatments was used. For co-infection, one group was allocated a single dose of ivermectin (150 micrograms/kg) plus albendazole (400 mg) (Group A). The other group received placebo (Group B). Five days later the treatment regime was reversed, with the Group A receiving placebo and Group B receiving treatment. For the single bancroftian filariasis infection, one group received a single dose of albendazole (400 mg) plus ivermectin (150 μg/kg) (Group C) while the other group received a single dose of albendazole (400 mg) alone (Group D). Blood and skin specimens were collected on admission day, day 0, and on days 2, 3, and 7 to assess drug safety and efficacy. Thereafter, blood and skin specimens were collected during the 12 months follow up for the assessment of drug efficacy. Study individuals were clinically monitored every six hours during the first 48 hours following treatment, and routine clinical examinations were performed during the hospitalisation period and follow-up. Results In individuals co-infected with bancroftian filariasis and onchocerciasis, treatment with ivermectin and albendazole was safe and tolerable. Physiological indices showed no differences between groups with co-infection (W. bancrofti and O. volvulus) or single infection (W. bancrofti). The frequency of adverse events in co

  12. Comparative analysis of the effectiveness of the mandibular angle fracture treatment methods.

    PubMed

    Razukevicius, Dainius; Sabalys, Gintautas; Kubilius, Ricardas

    2005-01-01

    425 patients with mandibular angle fractures were treated at the Hospital of Kaunas University of Medicine (HKUM) Clinic of Maxillo-Facial Surgery. Treatment included the application of closed fracture fragments fixation methods (wire splint fixation, and Kirschner wire osteosynthesis), and methods of open fixation--osteosynthesis using the supra-periosteal miniplate, and osteosynthesis using supra-osseous Zes Pol plate (the latter method was modified by the authors). Relative computerized densitometry showed that closed fixation methods result in a faster healing of fractures. The findings of the pain threshold testing showed that open fixation methods more severely damage the function of the lower alveolar nerve. Using closed fixation methods, osteomyelitis occurred in 5.3% of cases, while using open fixation methods--in 15.3% of cases. Thus, the authors of the article maintain that when mandibular angle fractures, in the presence of suitable conditions, closed fracture fragments fixation methods should be given a priority.

  13. Comparative feasibility study on retrofitting ballast water treatment system for a bulk carrier.

    PubMed

    Jee, Jaehoon; Lee, Sangick

    2017-03-24

    Use of ballast water in ships causes harmful effects on marine environment accompanied by economic loss and negative impact on ecosystem and human health. To solve these problems, the international convention on ballast water management will take into force in September 2017. In this study, a comprehensive feasibility of retrofitting the ballast water treatment system for an ocean-going bulk carrier was conducted. The technologies involved, installation and operational aspects of direct flow and side stream electrolysis, UV, and ozone type BWTS are described in detail. The principal concept of each BWTS is explained and probable arrangements of retrofitting in engine room are suggested. The cost analysis is carried out for retrofitting 4 types of BWTS onboard the target ship by examining each processes of installation and operation.

  14. Comparative study of flotation techniques for the treatment of liquid effluents.

    PubMed

    Puget, F P; Melo, M V; Massarani, G

    2004-01-01

    This work aimed to study the performance of three different induced air flotation units (flotation column, flotation tank and centrifugal flotation in hydrocyclone) for the treatment of a synthetic dairy effluent. Under continuous operation, it was possible to achieve removal efficiencies of milky material in suspension up to 90%, both for the flotation column and the flotation tank units. Using the centrifugal flotation unit in hydrocyclone, it was possible to decrease up to 45% of all suspended material in the effluent, with a clarified flow rate approximately three times greater than those found for the previous flotation units. In the centrifugal flotation unit, better results were obtained for air flow rate-feed flow rate ratios (Q(air)/Q(L)) greater than 0.15, and for underflow-overflow ratios (Qu/Qo) lower than 1.0.

  15. Challenges in Conducting A Multi-Site Randomized Clinical Trial Comparing Treatments for Adolescent Anorexia Nervosa

    PubMed Central

    Brandt, Harry; Woodside, Blake; Agras, Stewart; Halmi, Katherine; Johnson, Craig; Kaye, Walter; Wilfley, Denise

    2011-01-01

    Objective To describe obstacles in the implementation of a controlled treatment trial of adolescent anorexia nervosa (AN). Method The original aim was to enter 240 participants with AN to one of 4 cells: Behavioral family therapy (BFT) plus fluoxetine; BFT plus placebo; systems family therapy (SFT) plus fluoxetine; SFT plus placebo. Results Recruitment was delayed pending a satisfactory resolution concerning participant safety. After 6 months of recruitment it became clear that the medication was associated with poor recruitment leading to a study redesign resulting in a comparison of two types of family therapy with a projected sample size of 160. One site was unable to recruit and was replaced. Discussion Problems with the delineation of safety procedures, recruitment, re-design of the study, and replacement of a site, were the main elements resulting in a 1-year delay. Suggestions are made for overcoming such problems in future AN trials. PMID:21495052

  16. Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans.

    PubMed

    Bailey, Michael; Lee, Franklin; Hsi, Ryan; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Sorensen, Mathew; Harper, Jonathan

    2014-09-03

    Animal studies have shown that shock wave lithotripsy (SWL) delivered with an initial course of low-energy shocks followed by a pause reduces renal injury. The pause correlates with increased arterial resistive index (RI) during SWL as measured by ultrasound. This suggests that renal vasoconstriction is associated with protecting the kidney from injury. This study explored whether a similar increase in RI is observed in humans. Patients were prospectively recruited from two hospitals. All received an initial dose of 250 lowest energy shocks followed by a two-minute pause. Shock power was then ramped up at the discretion of the physician; shock rate was maintained at 1 Hz. Spectral Doppler velocity measurements were taken from an interlobar artery at baseline after induction, during the pause at 250 shocks, after 750 shocks, after 1500 shocks, and at the end of the procedure. RI was calculated from the peak systolic and end diastolic velocities and a linear mixed-effects model was used to compare RIs. The statistical model accounted for age, gender, laterality, and body mass index (BMI). Measurements were taken from 15 patients. Average RI ± standard deviation pretreatment, after 250 shocks, after 750 shocks, after 1500 shocks, and post treatment was 0.68 ± 0.06, 0.71 ± 0.07, 0.73 ± 0.06, 0.75 ± 0.07 and 0.75 ± 0.06, respectively. RI was found to be significantly higher after 250 shocks compared to pretreatment (p = 0.04). RI did not correlate with age, gender, BMI, or treatment side. This is suggestive that allowing a pause for renal vascular vasoconstriction to develop may be beneficial, and can be monitored for during SWL, providing real-time feedback as to when the kidney is protected.

  17. Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans

    PubMed Central

    Bailey, Michael; Lee, Franklin; Hsi, Ryan; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Sorensen, Mathew; Harper, Jonathan

    2015-01-01

    Animal studies have shown that shock wave lithotripsy (SWL) delivered with an initial course of low-energy shocks followed by a pause reduces renal injury. The pause correlates with increased arterial resistive index (RI) during SWL as measured by ultrasound. This suggests that renal vasoconstriction is associated with protecting the kidney from injury. This study explored whether a similar increase in RI is observed in humans. Patients were prospectively recruited from two hospitals. All received an initial dose of 250 lowest energy shocks followed by a two-minute pause. Shock power was then ramped up at the discretion of the physician; shock rate was maintained at 1 Hz. Spectral Doppler velocity measurements were taken from an interlobar artery at baseline after induction, during the pause at 250 shocks, after 750 shocks, after 1500 shocks, and at the end of the procedure. RI was calculated from the peak systolic and end diastolic velocities and a linear mixed-effects model was used to compare RIs. The statistical model accounted for age, gender, laterality, and body mass index (BMI). Measurements were taken from 15 patients. Average RI ± standard deviation pretreatment, after 250 shocks, after 750 shocks, after 1500 shocks, and post treatment was 0.68 ± 0.06, 0.71 ± 0.07, 0.73 ± 0.06, 0.75 ± 0.07 and 0.75 ± 0.06, respectively. RI was found to be significantly higher after 250 shocks compared to pretreatment (p = 0.04). RI did not correlate with age, gender, BMI, or treatment side. This is suggestive that allowing a pause for renal vascular vasoconstriction to develop may be beneficial, and can be monitored for during SWL, providing real-time feedback as to when the kidney is protected. PMID:26203348

  18. A comparative analysis of methods to represent uncertainty in estimating the cost of constructing wastewater treatment plants.

    PubMed

    Chen, Ho-Wen; Chang, Ni-Bin

    2002-08-01

    Prediction of construction cost of wastewater treatment facilities could be influential for the economic feasibility of various levels of water pollution control programs. However, construction cost estimation is difficult to precisely evaluate in an uncertain environment and measured quantities are always burdened with different types of cost structures. Therefore, an understanding of the previous development of wastewater treatment plants and of the related construction cost structures of those facilities becomes essential for dealing with an effective regional water pollution control program. But deviations between the observed values and the estimated values are supposed to be due to measurement errors only in the conventional regression models. The inherent uncertainties of the underlying cost structure, where the human estimation is influential, are rarely explored. This paper is designed to recast a well-known problem of construction cost estimation for both domestic and industrial wastewater treatment plants via a comparative framework. Comparisons were made for three technologies of regression analyses, including the conventional least squares regression method, the fuzzy linear regression method, and the newly derived fuzzy goal regression method. The case study, incorporating a complete database with 48 domestic wastewater treatment plants and 29 industrial wastewater treatment plants being collected in Taiwan, implements such a cost estimation procedure in an uncertain environment. Given that the fuzzy structure in regression estimation may account for the inherent human complexity in cost estimation, the fuzzy goal regression method does exhibit more robust results in terms of some criteria. Moderate economy of scale exists in constructing both the domestic and industrial wastewater treatment plants. Findings indicate that the optimal size of a domestic wastewater treatment plant is approximately equivalent to 15,000 m3/day (CMD) and higher in Taiwan

  19. Comparing the efficacy of oral ivermectin vs malathion 0.5% lotion for the treatment of scabies.

    PubMed

    Goldust, Mohamad; Rezaee, Elham; Raghifar, Ramin; Hemayat, Sevil

    2014-01-01

    Scabies is found worldwide among people of all groups and ages. It is curable with scabicide medications. This study aimed to compare the efficacy and safety of oral ivermectin vs malathion 0.5% lotion for the treatment of scabies. In total, 148 patients with scabies were enrolled and randomized into two groups: the first group received a single dose of oral ivermectin 200 sg/kg body weight, and the second was treated with two applications of topical lindane lotion 1%, with a 1-week interval between applications. Treatment was evaluated at intervals of 2 and 4 weeks, and if there was treatment failure at the 2-week follow-up, treatment was repeated. A single dose of ivermectin provided a cure rate of 60.8% at the 2-week follow-up, which increased to 89.1% at the 4-week follow-up after repeating the treatment. Treatment with two applications oflindane lotion 1%, with a 1-week interval between them, was effective in 47.2% of patients at the 2-week follow-up, which increased to 72.9% at the 4-week follow-up after this treatment was repeated. A single dose of ivermectin was as effective as two applications of lindane lotion 1% at the 2-week follow-up. After repeat treatment, ivermectin was superior to lindane lotion 1% at the 4-week follow-up. The delay in clinical response with ivermectin suggests that it may not be effective against the parasite at all stages in the life cycle.

  20. A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole.

    PubMed

    Yin, Zhiqiang; Xu, Jiali; Luo, Dan

    2012-12-01

    As the most frequently used systemic antifungal agents for onychomycosis, terbinafine and itraconazole have both proved to have the conditions of recurrence in various degrees during follow-up period after end of therapy; very little is known about their comparative recurrences after long-term follow-up. We conducted a meta-analysis of available trials to compare the long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. Meta-analysis was performed by the Review Manager version 5.0.25. Risk ratio and 95% confidence intervals were calculated by the fixed effect model. Five trials and total 251 eligible patients were included in this meta-analysis. The combined risk ratio of the meta-analysis comparing terbinafine with itraconazole for mycological recurrence rate was 0.44 (95% CI 0.29-0.66), which suggests that itraconazole therapy is more likely to produce mycological recurrence compared with terbinafine therapy.

  1. Comparative assessment of different treatment modalities in miners with vibration- and noise-induced disease

    SciTech Connect

    Velskaya, M.L.; Nekhorosheva, M.A.; Konovalova, S.I.; Kukhtina, G.V.; Gonchar, I.G.; Terentyeva, D.P.; Grishchenko, L.A.; Soboleva, N.P.; Kharitonov, S.A.; Priklonskiy, I.V.

    1985-02-01

    A group of 71 miners with vibration sickness and noise-induced pathology were managed either by standard methods, or in combination with acupuncture and/or hyperbaric oxygenation for a comparative assessment of the effectiveness of the different therapeutic approaches. Analysis of subjective factors as well as standard physiological parameters (EKG, rheoencephalography, peripheral rheography, EEG, neuropsychological tests) demonstrate that both acupuncture and hyperbaric oxygenation are effective modalities in the majority of the subjects. Nevertheless, the lack of improvement in certain criteria, or even what could be regarded as adverse sequelae, suggest that the use of hyperbaric oxygenation in the management of such disorders be approached with considerable care.

  2. Influence of the laser beam wavelength on the gonoarthrosis treatment: a preliminary comparative study

    NASA Astrophysics Data System (ADS)

    Brojbeanu, Gabriela; Suteanu, S.; Udrea, Mircea V.; Vasiliu, Virgil V.

    1998-07-01

    A comparative study on four groups of patients which have been exposed to laser radiation was performed. Three wavelength were used (633, 670 and 830 nm). The fourth group received only laser placebo. Every group is composed by 20 people homogeneously selected from the point of view of age, sex and clinical and paraclinical parameters. The irradiation dose was kept almost the same, i.e. 15 J/cm2. The dependence of subjective and objective indicators on the laser wavelength were put into evidence.

  3. Selective laser trabeculoplasty compared with medical treatment for the initial management of open angle glaucoma or ocular hypertension.

    PubMed

    Pérez, Efraín; Rada, Gabriel; Maul, Eugenio

    2015-12-16

    Selective laser trabeculoplasty is a relatively new therapeutic alternative for the management of open angle glaucoma and ocular hypertension. On the other hand, medical treatment has robust data supporting its efficacy and has progressed in last decades with the introduction of prostaglandin analogues. To compare these two therapies, we searched Epistemonikos database, which is maintained by screening 30 databases, and identified four systematic reviews including four randomized and one non-randomized clinical trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that selective laser trabeculoplasty leads to a smaller absolute intraocular pressure reduction than medical treatment. However, it is not clear if there are differences in treatment success rate or need of additional antiglaucomatous interventions, because the quality of the evidence is low.

  4. Efficacy of dextranomer hyaluronic acid and polyacrylamide hydrogel in endoscopic treatment of vesicoureteral reflux: A comparative study

    PubMed Central

    Blais, Anne-Sophie; Morin, Fannie; Cloutier, Jonathan; Moore, Katherine; Bolduc, Stéphane

    2015-01-01

    Introduction: Various bulking agents are available for vesicoureteral reflux (VUR) endoscopic treatment, but their inconsistent success rates and costs are concerns for urologists. Recently, polyacrylamide hydrogel (PAHG) has been shown to have a good overall success rate, which seems comparable to dextranomer hyaluronic acid (Dx/HA), currently the most popular bulking agent. Our objective was to compare the short-term success rate of PAHG and Dx/HA for VUR endoscopic treatment in children. Methods: We performed a prospective non-randomized study using PAHG and Dx/HA to treat VUR grades I to IV in pediatric patients. All patients underwent endoscopic sub-ureteric injection of PAHG or Dx/HA, using the double-HIT technique, followed by a 3-month postoperative renal ultrasound and voiding cystourethrogram. Treatment success was defined as the absence of de novo or worsening hydronephrosis and absence of VUR. Results: A total of 90 pediatric patients underwent an endoscopic injection: 45 patients (78 ureters) with PAHG and 45 patients (71 ureters) with Dx/HA. The mean injected volume of PAHG and Dx/HA was 1.1 mL and 1.0 mL, respectively. The overall success rate 3 months after a single treatment was 73.1% for PAHG and 77.5% for Dx/HA. Postoperatively, 1 patient in each group presented with acute pyelonephritis and 2 patients in the Dx/HA group developed symptomatic ureteral obstruction. Conclusion: Success rates of PAGH and Dx/HA in endoscopic injections for VUR treatment were comparable. The rate of resolution obtained with Dx/HA was equivalent to those previously published. The lower cost of PAHG makes it an interesting option. PMID:26225173

  5. Comparative study of old and new versions of treatment planning system using dose volume histogram indices of clinical plans

    PubMed Central

    Krishna, Gangarapu Sri; Srinivas, Vuppu; Ayyangar, K. M.; Reddy, Palreddy Yadagiri

    2016-01-01

    Recently, Eclipse treatment planning system (TPS) version 8.8 was upgraded to the latest version 13.6. It is customary that the vendor gives training on how to upgrade the existing software to the new version. However, the customer is provided less inner details about changes in the new software version. According to manufacturer, accuracy of point dose calculations and irregular treatment planning is better in the new version (13.6) compared to the old version (8.8). Furthermore, the new version uses voxel-based calculations while the earlier version used point dose calculations. Major difference in intensity-modulated radiation therapy (IMRT) plans was observed between the two versions after re-optimization and re-calculations. However, minor difference was observed for IMRT cases after performing only re-calculations. It is recommended TPS quality assurance to be performed after any major upgrade of software. This can be done by performing dose calculation comparisons in TPS. To assess the difference between the versions, 25 clinical cases from the old version were compared keeping all the patient data intact including the monitor units and comparing the differences in dose calculations using dose volume histogram (DVH) analysis. Along with DVH analysis, uniformity index, conformity index, homogeneity index, and dose spillage index were also compared for both versions. The results of comparative study are presented in this paper. PMID:27651566

  6. Levodopa alone compared with levodopa-sparing therapy as initial treatment for Parkinson's disease: a meta-analysis.

    PubMed

    Xie, Cheng-long; Zhang, Yun-Yun; Wang, Xiao-Dan; Chen, Jie; Chen, Yi-He; Pa, Jia-Lin; Lin, Shi-Yi; Lin, Hua-Zhen; Wang, Wen-Wen

    2015-08-01

    To assess the long-term use of L-dopa alone vs L-dopa-sparing therapy, as initial treatment, provides the most efficient long-term control of symptoms and best quality of life for people with early Parkinson's disease (PD). PubMed; Google scholar; Cochrane Central Register of Controlled Trials and the Web of Science were searched for randomised, placebo-controlled trials (RCTs) on L-dopa alone and L-dopa sparing as initial treatment in early PD patients. We used a random effects model rather than a fixed effects model because of this takes into account heterogeneity between multi-studies. Eleven RCTs were included. The results showed that L-dopa alone could evidently improve the UPDRS part I (p = 0.005), part II (p < 0.0001), part III (p < 0.0001) and UPDRS total score (p = 0.004) compared with L-dopa-sparing therapy in PD patients. Meanwhile, a reduced risk of dyskinesia (p < 0.0001, RR = 1.88, 95 % CI 1. 37-2.59) and wearing-off phenomenon (p < 0.00001, RR = 1.36, 95 % CI 1. 20-1.55) in patients treated initially with L-dopa-sparing therapy compared to L-dopa has been consistently reported. What is more, we found more patients on aL-dopa-sparing therapy were more than triple as likely to discontinue treatment prematurely due to adverse events than L-dopa treatment patients (43.7 vs 15.8 %). L-Dopa alone is the most effective medication available for treating the motor symptoms of PD patients, despite the greater incidence of involuntary movements. Meanwhile, more patients on dopamine agonists or MAOBI were more likely to discontinue treatment prematurely than L-dopa alone treatment patients within the long follow-up period.

  7. Course of iron parameters in HFE-hemochromatosis patients during initial treatment with erythrocytapheresis compared to phlebotomy.

    PubMed

    Rombout-Sestrienkova, Eva; Koek, Ger H; Neslo, Rabin; van Kraaij, Marian; Menheere, Paul P; Masclee, Ad; Swinkels, Dorine W

    2016-12-01

    Current treatment for newly diagnosed patients with hereditary hemochromatosis (HH) and iron overload consist of weekly phlebotomy or less frequent and more personalized erythrocytapheresis. Previous observations during phlebotomy suggest an increase in intestinal iron uptake caused by lowering of hepcidin as a result of intensive bloodletting. It is not known whether such an effect is present or even more pronounced using erythrocytapheresis since a larger amount of iron is extracted per procedure. In this study we aimed to assess the effect of erythrocytapheresis on the course of iron parameters, with special focus on serum hepcidin. We performed a retrospective proof-of-principle observational study, comparing serum iron parameters in 12 males during the depletion phase using either phlebotomy (n = 6) or erythrocytapheresis (n = 6). Decreases in serum ferritin over time were similar for both treatments but more pronounced using erythrocytapheresis when expressed per treatment procedure. Hemoglobin did not change during erythrocytapheresis, whereas during phlebotomy decreased with 10%. Increase of erythropoietin and soluble transferrin receptor and decrease in transferrin saturation were similar for both treatments. Reduction in serum hepcidin was higher (50% versus 25% of initial value) and occurred more early using phlebotomy (10 versus 20 weeks after start). In aggregate, compared to phlebotomy, the less frequent and more personalized erythrocytapheresis leads to a more pronounced decrease in serum ferritin per treatment procedure, without a larger decrease in serum hepcidin. This may be clinically relevant and may prevent an increase in intestinal iron uptake and an ensuing vicious circle of more frequent treatment procedures. J. Clin. Apheresis 31:564-570, 2016. © 2015 Wiley Periodicals, Inc.

  8. Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study.

    PubMed

    El-Mohamady, Abd El-Shakor; Mearag, Ibrahim; El-Khalawany, Mohamed; Elshahed, Ahmed; Shokeir, Hisham; Mahmoud, Anas

    2014-05-01

    Plantar warts are common viral infection that are usually challenging in treatment. Conventional treatment methods are usually invasive, have low efficacy, and need long recovery periods. In this study, we compared pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) lasers in the treatment of recalcitrant plantar warts. The study included 46 patients with multiple plantar warts. In each patient, lesions were divided into two groups: one treated with Nd:YAG (spot size, 7 mm; energy, 100 J/cm(2); and pulse duration, 20 ms) and the other with PDL (spot size, 7 mm; energy, 8 J/cm(2); and pulse duration, 0.5 ms). Laser sessions were applied every 2 weeks with maximum of six sessions. The study included 63% males and 37% females with a mean age of 29.6 ± 7.34 years. The cure rate was 73.9% with PDL with no significant difference (p = 0.87) from Nd:YAG (78.3%). The number of sessions required was more in PDL (mean, 5.05 ± 0.2) compared with Nd:YAG (mean, 4.65 ± 0.5) but without significant difference. Complications were significantly higher with Nd:YAG (43.5%) compared with PDL (8.7%). Hematoma was the most common complication recorded by Nd:YAG (28.3 %), and it was significantly higher (p = 0.002) than PDL (2.2%). Relapse was recorded in 8.7% with Nd:YAG compared with 13% in PDL with no significant difference (p = 0.74). Our results suggested that PDL and Nd:YAG lasers are effective in the treatment of resistant plantar warts. PDL is safer and less painful but needs more sessions, while Nd:YAG is more painful and shows more complications.

  9. The Comparative Efficacy of the Masquelet versus Titanium Mesh Cage Reconstruction Techniques for the Treatment of Large Long Bone Deficiencies

    DTIC Science & Technology

    2014-10-01

    Efficacy of the Masquelet versus Titanium Mesh Cage Reconstruction Techniques for the Treatment of Large Long Bone Deficiencies 5a. CONTRACT NUMBER...and compare the functional outcome of patients with large segmental bone defects reconstructed with the Masquelet technique (MT) versus the titanium ...Masquelet technique; Titanium mesh cage technique 16. SECURITY CLASSIFICATION OF: U 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF

  10. [Comparative study of the efficacy of ultrasound and sonophoresis in the treatment of painful shouder syndrome].

    PubMed

    Vlak, T

    1999-01-01

    This research tries to determine the difference between two forms of physical therapy, as regards their efficiency, in treating painful shoulder syndrome. They are ultrasound and sonophoresis. The research comprised 64 patients, divided in two groups. One group was treated by 10 ultrasound procedures (16 women and 17 men, average age 49.3 years), the other by 10 sonophoresis (14 women and 17 men, average age 45.1 years), both having in addition individual physical training (corrective medical exercises) for each patient. The difference in efficiency regarding both procedures were observed on the basis of objective measurable parameters (abduction, anteflexion, retroflexion, outer and inner rotation, the distance between vertebrae prominens and styloid radius) as well as in view of anamnestic terms (pain both at rest and in motion) recorded before the treatment started and after the application of 10 therapeutic procedures. The statistics results of data processing showed significant difference in efficiency, regarding the objective parameters--sonophoresis is more efficient (retroflexion--p < 0.05). Nevertheless, sonophoresis (diclofenac gel) proved much more efficient in reducing pain at rest (p < 0.01) and in motion (p < 0.05).

  11. Comparing Two Antibacterial Treatments for Bioceramic Coatings at Short Culture Times

    NASA Astrophysics Data System (ADS)

    Melero, H.; Madrid, C.; Fernández, J.; Guilemany, J. M.

    2014-04-01

    Plasma-sprayed hydroxyapatite coatings were employed industrially for decades to improve osteointegration of articular implants, but many studies have warned about the problems inherent to this procedure (mechanical properties, harmful phases). Consequently, a combination of hydroxyapatite with TiO2 sprayed by high velocity oxy-fuel spray was considered in this study. As infection after joint replacement surgery is one of the most critical concerns when considering implant performance, it is necessary to study possible ways to reduce or eliminate it. Two coating treatments were chosen for this study: addition of a percentage of ZnO and immersion in gentamicin for 24 h. Furthermore, three bacteria were considered: Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. The evolution of bacteria viability in solution was measured at 0, 2, and 4 h; and plate assays were performed to study antibacterial effects by diffusion. The results show an important antibacterial effect of the as-sprayed coating, attributed to the presence of -OH radicals on the surface. The presence of ZnO did not have any additional influence on bacteria viability, but gentamicin-treated samples showed an improvement in antibacterial behavior for Gram-negative bacteria in solution, as well as a bactericidal effect in diffusion conditions.

  12. Treatment of drinking water residuals: comparing sedimentation and dissolved air flotation performance with optimal cation ratios.

    PubMed

    Bourgeois, J C; Walsh, M E; Gagnon, G A

    2004-03-01

    Spent filter backwash water (SFBW) and clarifier sludge generally comprise the majority of the waste residual volume generated and in relative terms, these can be collectively referred to as combined filter backwash water (CFBW). CFBW is essentially a low-solids wastewater with metal hydroxide flocs that are typically light and slow to settle. This study evaluates the impact of adding calcium and magnesium carbonates to CFBW in terms of assessing the impacts on the sedimentation and DAF separation processes. Representative CFBW samples were collected from two surface water treatment plants (WTP): Lake Major WTP (Dartmouth, Nova Scotia, Canada) and Victoria Park WTP (Truro, Nova Scotia, Canada). Bench-scale results indicated that improvements in the CFBW settled water quality could be achieved through the addition of the divalent cations, thereby adjusting the monovalent to divalent (M:D) ratios of the wastewater. In general, the DAF process required slightly higher M:D ratios than the sedimentation process. The optimum M:D ratios for DAF and sedimentation were determined to be 1:1 and 0.33:1, respectively. It was concluded that the optimisation of the cation balance between monovalent cations (e.g., Na(+), K(+)) and added divalent cations (i.e., Ca(2+), Mg(2+)) aided in the settling mechanism through charge neutralisation-precipitation. The increase in divalent cation concentrations within the waste residual stream promoted destabilisation of the negatively charged colour molecules within the CFBW, thereby causing the colloidal content to become more hydrophobic.

  13. Assessment of Decisional Conflict about the Treatment of carpal tunnel syndrome, Comparing Patients and Physicians

    PubMed Central

    Hageman, Michiel GJS.; Bossen, Jeroen K.; Neuhaus, Valentin; Mudgal, Chaitanya S.; Ring, David

    2016-01-01

    Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict. Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons. Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America. Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict. PMID:27200394

  14. Comparing the effects of treatment with sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunction in women: a randomized controlled clinical trial

    PubMed Central

    Omidi, Abdollah; Ahmadvand, Afshin; Najarzadegan, Mohammad Reza; Mehrzad, Fateme

    2016-01-01

    Background Sexual dysfunction in women is prevalent and common in women after menopause. Many attempts to treat patients with sexual dysfunction by cognitive-behavioral therapy (CBT) methods. But to the best of our knowledge, there has been no study that compared these two methods. Objective The aim of this study was to assess and compare the effects of sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunction in women. Methods In this randomized, controlled, clinical trial, 86 women with arousal and orgasm dysfunction were surveyed. The patients were divided into two groups, i.e., sildenafil and CBT groups. The patients in the sildenafil group were treated by 50 mg of oral sildenafil one hour before intercourse, and the other group had weekly sessions of CBT for eight weeks. Sexual dysfunctions were evaluated by the Female Sexual Function Index (FSFI), a sexual satisfaction questionnaire, and the Enrich marital satisfaction scale. Results The mean age of the participants was 33.14 ± 7.34 years. The mean scores for female sexual function index, sexual satisfaction, and the Enrich marital satisfaction scale were increased in both groups during treatment (p < 0.001). It was found that cognitive-behavioral therapy compared to treatment with sildenafil increased all subscales, except arousal, orgasm, and lubrication. Conclusion Cognitive-behavioral therapy is more effective than treatment with sildenafil for improving female sexual function. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2014070318338N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article. PMID:27382439

  15. Coated mesh photocatalytic reactor for air treatment applications: comparative study of support materials.

    PubMed

    Passalía, Claudio; Nocetti, Emanuel; Alfano, Orlando; Brandi, Rodolfo

    2016-06-14

    An experimental comparative study of different meshes as support materials for photocatalytic applications in gas phase is presented. The photocatalytic oxidation of dichloromethane in air was addressed employing different coated meshes in a laboratory-scale, continuous reactor. Two fiberglass meshes and a stainless steel mesh were studied regarding the catalyst load, adherence, and catalytic activity. Titanium dioxide photocatalyst was immobilized on the meshes by dip-coating cycles. Results indicate the feasibility of the dichloromethane elimination in the three cases. When the number of coating cycles was doubled, the achieved conversion levels were increased twofold for stainless steel and threefold for the fiberglass meshes. One of the fiberglass meshes (FG2) showed the highest reactivity per mass of catalyst and per catalytic surface area.

  16. A comparative study of four coronal obturation materials in endodontic treatment.

    PubMed

    Uranga, A; Blum, J Y; Esber, S; Parahy, E; Prado, C

    1999-03-01

    The aim of this study was to compare, in vitro, the ability of temporary versus permanent materials to seal the access cavity. Eighty human maxillary single-canal teeth were prepared biomechanically and obturated with gutta-percha and an endodontic cement AH Plus, using the warm vertical compaction technique. All access cavities were sealed with 1 of 4 materials (Cavit, Fermit, Tetric, or Dyract). Microleakage was assessed by methylene blue dye penetration. The teeth were submitted to 100 thermocycles, with temperature varying from 0 degree to 55 degrees C. The greatest degree of leakage was observed with the temporary materials (Cavit and Fermit). There was a significant difference (p < 0.05) in leakage between all materials except between Dyract and Tetric. This suggests that it may be more prudent to use a permanent restorative material for provisional restorations to prevent inadequate canal sealing and the resulting risk of fluid penetration.

  17. Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture

    SciTech Connect

    Wang Zhongmin; Huang Xunbo; Cao Jun; Huang Gang; Chen Kemin LIu Yu; Liu Fenju

    2012-04-15

    Objective: This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture. Methods: We studied two groups of patients with malignant esophageal stricture. Group A comprised 28 patients (19 men and 9 women) who underwent intraluminal radioactive stent loaded with iodine-125 seeds implantation and were followed prospectively. Group B comprised 30 patients (18 men and 12 women) who had previously received covered stent alone insertion; these patients were evaluated retrospectively. There was no crossover between the two groups during follow-up. Informed consent was obtained from each patient, and our institutional review board approved the study. The dysphagia score, overall survival rates, complication rates, and reintervention rates were compared in the two groups. Results: There were no significant differences between the two groups in terms of baseline characteristics. Stent placement was technically successful and well tolerated in all patients. The dysphagia score was improved in both groups after stent placement. The median survival was significantly longer in group A than in group B: 11 versus 4.9 months, respectively (P < 0.001). The complications of chest pain, esophageal reflux, and stent migration was more frequent in group B, but this difference did not reach statistical significance. There was no statistical difference in reintervention between two groups. Conclusions: Intraluminal radioactive stent loaded with iodine-125 seeds implantation was a feasible and practical management in treating malignant esophageal stricture and was superior to covered stent alone insertion, as measured by survival.

  18. Dentoalveolar comparative study between removable and fixed cribs, associated to chincup, in anterior open bite treatment

    PubMed Central

    TORRES, Fernando César; de ALMEIDA, Renato Rodrigues; de ALMEIDA-PEDRIN, Renata Rodrigues; PEDRIN, Fernando; PARANHOS, Luiz Renato

    2012-01-01

    Objective The aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite. Material and Methods Each group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test. Results Vertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting. Conclusions The Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet. PMID:23138739

  19. Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods.

    PubMed

    Morin, Mélanie; Dumoulin, Chantale; Bergeron, Sophie; Mayrand, Marie-Hélène; Khalifé, Samir; Waddell, Guy; Dubois, Marie-France

    2016-01-01

    Provoked vestibulodynia (PVD) is a highly prevalent and debilitating condition yet its management relies mainly on non-empirically validated interventions. Among the many causes of PVD, there is growing evidence that pelvic floor muscle (PFM) dysfunctions play an important role in its pathophysiology. Multimodal physiotherapy, which addresses these dysfunctions, is judged by experts to be highly effective and is recommended as a first-line treatment. However, the effectiveness of this promising intervention has been evaluated through only two small uncontrolled trials. The proposed bi-center, single-blind, parallel group, randomized controlled trial (RCT) aims to evaluate the efficacy of multimodal physiotherapy and compare it to a frequently used first-line treatment, topical overnight application of lidocaine, in women with PVD. A total of 212 women diagnosed with PVD according to a standardized protocol were eligible for the study and were randomly assigned to either multimodal physiotherapy or lidocaine treatment for 10weeks. The primary outcome measure is pain during intercourse (assessed with a numerical rating scale). Secondary measures include sexual function, pain quality, psychological factors (including pain catastrophizing, anxiety, depression and fear of pain), PFM morphology and function, and patients' global impression of change. Assessments are made at baseline, post-treatment and at the 6-month follow-up. This manuscript presents and discusses the rationale, design and methodology of the first RCT investigating physiotherapy in comparison to a commonly prescribed first-line treatment, overnight topical lidocaine, for women with PVD.

  20. Comparative Study of the Effectiveness of Oral Fluconazole and Intravaginal Clotrimazole in the Treatment of Vaginal Candidiasis

    PubMed Central

    Izumi, Koji; Ito, Kunihiko; Tamaya, Teruhiko

    1995-01-01

    Objective: A study was carried out to compare 3 treatment regimens for vaginal candidiasis. Methods: A total of 150 women with clinical and mycological evidence of vaginal candidiasis were randomized to receive 50 mg of oral fluconazole daily for 6 days (50 women), a single oral 150 mg dose of fluconazole (50 women), or 100 mg of intravaginal clotrimazole daily for 6 days (50 women). They were assessed at 5–15 days (short-term assessment) and again at 30–60 days (long-term assessment) after the completion of treatment. Results: Candida species were completely eradicated from the vagina in 88% or 80% in the 6-day oral fluconzaole group, 76% or 70% in the single oral fluconazole group, and 72% or 60% in the intravaginal clotrimazole group at short-term or long-term assessment, respectively. The rates of clinical effectiveness were 92% or 88% in the 6-day oral fluconzaole group, 80% or 76% in the single oral fluconazole group, and 72% or 58% in the intravaginal clotrimazole group at the short-term or long-term assessment, respectively. Treatment-related side effects were not found in any group. Conclusions: This study suggests that the treatment of vaginal candidiasis with oral fluconazole is effective and that a single oral fluconazole dose might be one choice in the treatment of vaginal candidiasis. PMID:18475414

  1. Comparative study for the removal and destruction of pentachlorophenol using activated magnesium treatment systems.

    PubMed

    Garbou, Amel M; Clausen, Christian A; Yestrebsky, Cherie L

    2017-01-01

    Chlorophenols are highly toxic, environmentally-persistent compounds which have been classified as probable human carcinogens by the United States Environmental Protection Agency. Due to the high toxicity of these compounds, it is necessary to treat water and soils with concentrations of chlorophenols above the detection limit set by regulatory agencies. The aim of this work is to demonstrate the capabilities of using ball-milled magnesium for the dechlorination of PCP. Comparison of dechlorination processes were performed in an attempt to determine the most effective system for degradation of PCP to phenol. Three systems with powerful capabilities of treatment were studied: ball-milled zero-valent magnesium (ZVMg), ball-milled zero-valent magnesium carbon (ZVMg/C), and ball-milled zero-valent magnesium with palladium (ZVMg/Pd). In addition to measuring PCP disappearance, all byproducts were identified and quantified for each degradation system. The results of these studies indicate that all three of the systems degrade PCP within 30 min. The most rapid and complete PCP dechlorination is achieved using ball-milled Mg/Pd and a matrix consisting of at least 0.02 g Mg0/mL ethanol, and 10 μL acetic acid/mL ethanol, in which case 20 ng/μL of PCP was dechlorinated to chlorophenols in approximately 15 min with complete dechlorination achieved in six days. Carbon mass balances of 90.16% for Mg, 94.76% (Mg/C) and 97.05% (Mg/Pd) verify dechlorination was responsible for declining concentrations of PCP. The reactions of PCP degradation and phenol formation were found to follow pseudo-first order kinetics for all systems. Further work will consist of optimization and development of field-scale applications.

  2. Characterization and comparative analysis of antibiotic resistance plasmids isolated from a wastewater treatment plant.

    PubMed

    Rahube, Teddie O; Viana, Laia S; Koraimann, Günther; Yost, Christopher K

    2014-01-01

    A wastewater treatment plant (WWTP) is an environment high in nutrient concentration with diverse bacterial populations and can provide an ideal environment for the proliferation of mobile elements such as plasmids. WWTPs have also been identified as reservoirs for antibiotic resistance genes that are associated with human pathogens. The objectives of this study were to isolate and characterize self-transmissible or mobilizable resistance plasmids associated with effluent from WWTP. An enrichment culture approach designed to capture plasmids conferring resistance to high concentrations of erythromycin was used to capture plasmids from an urban WWTP servicing a population of ca. 210,000. DNA sequencing of the plasmids revealed diversity of plasmids represented by incompatibility groups IncU, col-E, IncFII and IncP-1β. Genes coding resistance to clinically relevant antibiotics (macrolide, tetracycline, beta-lactam, trimethoprim, chloramphenicol, sulphonamide), quaternary ammonium compounds and heavy metals were co-located on these plasmids, often within transposable and integrative mobile elements. Several of the plasmids were self-transmissible or mobilizable and could be maintained in the absence of antibiotic selection. The IncFII plasmid pEFC36a showed the highest degree of sequence identity to plasmid R1 which has been isolated in England more than 50 years ago from a patient suffering from a Salmonella infection. Functional conservation of key regulatory features of this F-like conjugation module were demonstrated by the finding that the conjugation frequency of pEFC36a could be stimulated by the positive regulator of plasmid R1 DNA transfer genes, TraJ.

  3. Comparative decomposition kinetics of neutral monosaccharides by microwave and induction heating treatments.

    PubMed

    Tsubaki, Shuntaro; Oono, Kiriyo; Onda, Ayumu; Yanagisawa, Kazumichi; Azuma, Jun-ichi

    2013-06-28

    The stabilities of five neutral monosaccharides (glucose, galactose, mannose, arabinose, and xylose) were kinetically compared after the molecules were submitted to microwave heating (internal heating) and induction heating (external heating) under completely identical thermal histories by employing PID (proportional, integral, and derivative) temperature controlled ovens and homogeneous mixing. By heating in water at 200°C, the rate constants for the decomposition reactions varied from 2.13×10(-4) to 3.87×10(-4)s(-1) for microwave heating; however, the values increased by 1.1- to 1.5-fold for induction heating. Similarly, in a dilute (0.8%) sulfuric acid solution, the decomposition rate constants varied from 0.61×10(-3) to 2.00×10(-3)s(-1) for microwave heating; however, the values increased by 1.5- to 2.2-fold for induction heating. The results show that microwave heating imparts greater stability to neutral monosaccharides than does induction heating. The undesirable decomposition of monosaccharides at the surface boundary of reactor walls may have increased the probability of monosaccharide decomposition during induction heating.

  4. Comparative evaluation of Prostina and terazosin in the treatment of benign prostatic hyperplasia.

    PubMed

    Dogra, Prem N; Biswas, Nihar R; Ravi, Alok K; Mani, Kalaivani; Kumar, Vinod

    2005-02-01

    The objective of the present study was to evaluate the efficacy and safety of Prostina, a multi-ingredient herbal formulation in benign prostatic hyperplasia (BPH) in comparison with terazosin. A randomised, open, parallel, controlled clinical trial was carried out in ambulatory men aged between 40-80 years suffering from BPH, with American Urological Association (AUA) symptom index score of at least 8 or more at recruitment. One group received 2 Prostina capsules twice daily for 12 weeks; the other received terazosin 2 mg at bedtime for 12 weeks. Urodynamic parameters, AUA score, biochemical and clinical adverse effects were assessed. Twenty subjects completed the study in Prostina group and 20 in terazosin group. The groups were comparable at baseline in age and assessment criteria. Majority of urodynamic parameters showed improving trends in both the groups. AUA symptom score declined significantly from 19.50 +/- 1.40 (mean +/- standard error) to 1.04 +/- 0.68 in Prostina group and from 16.95 +/- 1.23 to 4.14 +/- 0.88 in terazosin group. The AUA symptom score in 12 weeks follow-up was significantly lower in Prostina group than terazosin group (p = 0.005). Other laboratory-parameters remained unaltered in both the groups. Prostina is as effective as terazosin in providing symptomatic relief in BPH.

  5. Comparative study of the efficacy of decellularization treatment of allogenic and xenogeneic nerves as nerve conduits.

    PubMed

    Wang, Wei; Itoh, Soichiro; Takakuda, Kazuo

    2016-02-01

    The objective of this study was to compare the results of allogenic and xenogeneic nerve grafts that were treated using decellularization. The sciatic nerves of Sprague-Dawley rats and the median nerves of Japanese white rabbits were decellularized with sodium dodecyl sulfate and Triton X-100 and examined with a scanning electron microscope and immunofluorescence staining. A bridge-graft into the sciatic nerve in Wistar rats was performed with the decellularized nerves (10 mm in length for short-term evaluation; 15 mm in length for long-term evaluation). As a control, an isograft was performed. The specimens were harvested at 4 weeks postoperatively and prepared for immunohistochemistry. Function, electrophysiological and histomorphological analyses were performed to evaluate nerve recovery at 24 weeks postoperatively. The 3-dimensional structure of the basal lamina column, on which the cell adhesion molecules were integrated, was preserved through the decellularization protocols. Limited ED1-positive macrophage invasion was observed, and abundant NF 160-positive axons, which were accompanied by S-100-positive Schwann cells, penetrated through the implanted nerves. The sciatic nerve function and electrophysiological and histomorphological analyses suggest that the xenogeneic nerve graft was statistically indistinguishable from the allogenic nerve graft but slightly inferior to the isograft in supporting the axonal regeneration and functional recovery.

  6. Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians

    PubMed Central

    Hageman, Michiel G.J.S.; Döring, Anne-Carolin; Spit, Silke A.; Guitton, Thierry G.; Ring, David

    2016-01-01

    Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. Methods: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. Conclusions: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited. PMID:27847849

  7. Subacromial triamcinolone mexacetonide and methylprednisolone injections in treatment of supra spinam tendinitis. A comparative trial.

    PubMed

    Valtonen, E J

    1976-01-01

    This statistical report describes a clinical trial on 60 patients with supraspinal tendinitis for the comparison of triamcinolone hexacetonide (in a 20 mg/cc suspension in 1 cc ampoules) with methylprednisolone acetate (in a 40 mg/cc suspension in 1 cc ampoules). The objective of the study was to determine the therapeutic activity, including onset and duration of relief, of triamcinolone hexacetonide as a subacromial injection, and to compare these results with those obtained with similar injections of methylprednisolone acetate. The following results were obtained. Triamcinolone hexacetonide reduced pain, local tenderness and functional impairment to a greater degree than did methylprednisolone acetate. A significantly smaller proportion of patients needed a second injection of triamcinolone hexacetonide (33%) than needed a second injection of methylprednisolone acetate (63%). Triamcinolone hexacetonide appears to have longer duration of activity than does methyl-prednisolone acetate, judging by the percentage of patients still getting relief from their first injection at the end of the study period. The drugs were similar as regards side effect incidence rates and time to onset of action.

  8. Comparative study on the treatment of raw and biologically treated textile effluents through submerged nanofiltration.

    PubMed

    Chen, Qing; Yang, Ying; Zhou, Mengsi; Liu, Meihong; Yu, Sanchuan; Gao, Congjie

    2015-03-02

    Raw and biologically treated textile effluents were submerged filtrated using lab-fabricated hollow fiber nanofiltration membrane with a molecular weight cut-off of about 650 g/mol. Permeate flux, chemical oxygen demand (COD) reduction, color removal, membrane fouling, and cleaning were investigated and compared by varying the trans-membrane pressure (TMP) and volume concentrating factor (VCF). It was found that both raw and biologically treated textile effluents could be efficiently treated through submerged nanofiltration. The increase of TMP resulted in a decline in water permeability, COD reduction, color removal, and flux recovery ratio, while the increase of VCF resulted in both increased COD reduction and color removal. Under the TMP of 0.4 bar and VCF of 5.0, fluxes of 1.96 and 2.59 l/m(2)h, COD reductions of 95.7 and 94.2%, color removals of 99.0, and 97.3% and flux recovery ratios of 91.1 and 92.9% could be obtained in filtration of raw and biologically treated effluents, respectively. After filtration, the COD and color contents of the raw effluent declined sharply from 1780 to 325 mg/l and 1.200 to 0.060 Abs/cm, respectively, while for the biologically treated effluent, they decreased from 780 to 180 mg/l and 0.370 to 0.045 Abs/cm, respectively.

  9. Bleeding Risk during Treatment of Acute Thrombotic Events with Subcutaneous LMWH Compared to Intravenous Unfractionated Heparin; A Systematic Review

    PubMed Central

    Costantino, Giorgio; Ceriani, Elisa; Rusconi, Anna Maria; Podda, Gian Marco; Montano, Nicola; Duca, Piergiorgio; Cattaneo, Marco; Casazza, Giovanni

    2012-01-01

    Background Low Molecular Weight Heparins (LMWH) are at least as effective antithrombotic drugs as Unfractionated Heparin (UFH). However, it is still unclear whether the safety profiles of LMWH and UFH differ. We performed a systematic review to compare the bleeding risk of fixed dose subcutaneous LMWH and adjusted dose UFH for treatment of venous thromboembolism (VTE) or acute coronary syndromes (ACS). Major bleeding was the primary end point. Methods Electronic databases (MEDLINE, EMBASE, and the Cochrane Library) were searched up to May 2010 with no language restrictions. Randomized controlled trials in which subcutaneous LMWH were compared to intravenous UFH for the treatment of acute thrombotic events were selected. Two reviewers independently screened studies and extracted data on study design, study quality, incidence of major bleeding, patients’ characteristics, type, dose and number of daily administrations of LMWH, co-treatments, study end points and efficacy outcome. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using the random effects model. Results Twenty-seven studies were included. A total of 14,002 patients received UFH and 14,635 patients LMWH. Overall, no difference in major bleeding was observed between LMWH patients and UFH (OR = 0.79, 95% CI 0.60–1.04). In patients with VTE LMWH appeared safer than UFH, (OR = 0.68, 95% CI 0.47–1.00). Conclusion The results of our systematic review suggest that the use of LMWH in the treatment of VTE might be associated with a reduction in major bleeding compared with UFH. The choice of which heparin to use to minimize bleeding risk must be based on the single patient, taking into account the bleeding profile of different heparins in different settings. PMID:22984525

  10. Mandibular Advancement Device as a Comparable Treatment to Nasal Continuous Positive Airway Pressure for Positional Obstructive Sleep Apnea

    PubMed Central

    Takaesu, Yoshikazu; Tsuiki, Satoru; Kobayashi, Mina; Komada, Yoko; Nakayama, Hideaki; Inoue, Yuichi

    2016-01-01

    Study Objectives: Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients. Methods: Among patients diagnosed with OSA at a single sleep center from January 2008 to May 2014, male subjects with moderate OSA were recruited and stringently categorized as having P-OSA when the ratio of their lateral apnea-hypopnea index (AHI) to supine AHI was ≤ 0.5, their lateral sleep time was > 60 minutes, and their lateral REM sleep time was longer than 10 minutes. Treatment efficacy was compared between P-OSA subjects with an MAD (n = 34) and those with nCPAP (n = 34) after matching for age, body-mass index, and baseline AHI. Results: There were no significant differences in baseline AHI (MAD: nCPAP = 20.6 ± 3.9/h: 21.3 ± 1.7/h, p = 0.35) or in follow-up AHI (MAD: nCPAP = 4.7 ± 3.5/h: 3.4 ± 3.7/h, p = 0.12) between the 2 treatment groups, and hence MADs lowered the AHI to the same extent as nCPAP. Conclusions: These findings suggest that an MAD is as efficacious as nCPAP for P-OSA patients. MAD treatment for this specific phenotype may be a promising patient-tailored and first-line approach to OSA. Commentary: A commentary on this article appears in this issue on page 1079. Citation: Takaesu Y, Tsuiki S, Kobayashi M, Komada Y, Nakayama H, Inoue Y. Mandibular advancement device as a comparable treatment to nasal continuous positive airway pressure for positional obstructive sleep apnea. J Clin Sleep Med 2016;12(8):1113–1119. PMID:27250814

  11. Challenges in the Design and Implementation of The Multicenter Uveitis Steroid Treatment (MUST) Trial – Lessons for Comparative Effectiveness Trials

    PubMed Central

    Holbrook, Janet T.; Kempen, John H.; Prusakowski, Nancy A.; Altaweel, Michael M.; Jabs, Douglas A

    2013-01-01

    Background Randomized clinical trials are an important component of comparative effectiveness (CE) research because they are the optimal design for head-to-head comparisons of different treatment options. Purpose To describe decisions made in the design of the Multicenter Uveitis Steroid Treatment (MUST) Trial to ensure that the results would be widely generalizable. Methods Review of design and implementation decisions and their rationale for the trial. Results The MUST Trial is a multicenter randomized controlled comparative effectiveness trial evaluating a novel local therapy (intraocular fluocinolone acetonide implant) versus the systemic therapy standard of care for noninfectious uveitis. Decisions made in protocol design in order to broaden enrollment included allowing patients with very poor vision and media opacity to enroll and including clinical sites outside the US. The treatment protocol was designed to follow standard care. The primary outcome, visual acuity, is important to patients and can be evaluated in all eyes with uveitis. Other outcomes include patient-reported visual function, quality of life, and disease and treatment related complications. Limitations The trial population is too small for subgroup analyses that are of interest and the trial is being conducted at tertiary medical centers. Conclusion CE trials require greater emphasis on generalizability than many RCTs but otherwise face similar challenges for design choices as any RCT. The increase in heterogeneity in patients and treatment required to ensure generalizability can be balanced with a rigorous approach to implementation, outcome assessment and statistical design. This approach requires significant resources that may limit implementation in many RCTs, especially in clinical practice settings. PMID:21994128

  12. [Mini-laparoscopy vs. laparoscopy for the gallblader stone treatment. Prospective and comparative study].

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