The timing of exposure in clinic-based treatment for childhood anxiety disorders.

PubMed

Gryczkowski, Michelle R; Tiede, Michael S; Dammann, Julie E; Jacobsen, Amy Brown; Hale, Lisa R; Whiteside, Stephen P H

2013-03-01

The present study examines treatment length and timing of exposure from two child anxiety disorders clinics. Data regarding symptoms and treatment characteristics for 28 youth were prospectively obtained through self, parent, and therapist report at each session. Information regarding length of treatment, timing of exposure initiation, and drop-out rates were compared with those obtained through efficacy and effectiveness trials of manualized treatment for anxious youth. Findings from the authors' clinical data revealed significantly shorter treatment duration with exposures implemented sooner than in the previous studies. Dropout rates were significantly higher than in the efficacy trial but comparable with the effectiveness trial. Outcome data from a subset of eight patients revealed large effect sizes. These findings suggest that effective treatment can be shorter and more focused on exposure than is often outlined in manuals and have important implications for outcome research and dissemination.

Efficacy and safety of cryoballoon ablation versus radiofrequency catheter ablation in atrial fibrillation: an updated meta-analysis

PubMed Central

Ma, Honglan; Sun, Dongdong; Luan, Hui; Feng, Wei; Zhou, Yaqiong; Wu, Jine; He, Caiyun

2017-01-01

Introduction Cryoballoon ablation (CBA) and irrigated radiofrequency catheter ablation (RFCA) are the main treatments for drug-refractory symptomatic atrial fibrillation (AF). Aim To compare the efficacy and safety between CBA and RFCA for the treatment of AF. Material and methods We searched the Embase and Medline databases for clinical studies published up to December 2016. Studies that satisfied our predefined inclusion criteria were included. Results After searching through the literature in the two major databases, 20 studies with a total of 9,141 patients were included in our study. The CBA had a significantly shorter procedure time (weighted mean difference (WMD) –30.38 min; 95% CI: –46.43 to –14.33, p = 0.0002) and non-significantly shorter fluoroscopy time (WMD –3.18 min; 95% CI: –6.43 to 0.07, p = 0.06) compared with RFCA. There was no difference in freedom from AF between CBA and RFCA (CBA 78.55% vs. RFCA 83.13%, OR = 1.15, 95% CI: 0.95–1.39, p = 0.14). The CBA was associated with a high risk of procedure-related complications (CBA 9.02% vs. RFCA 6.56%, OR = 1.56, 95% CI: 1.05–2.31, p = 0.03), especially phrenic nerve paralysis (PNP, OR = 10.72, 95% CI: 5.59–20.55, p < 0.00001). The risk of pericardial effusions/cardiac tamponade was low in the CBA group (CBA 1.05% vs. RFCA 1.86%, OR = 0.62, 95% CI: 0.41–0.93, p = 0.02). Conclusions For AF, CBA was as effective as RFCA. However, CBA had a shorter procedure time and a non-significantly shorter fluoroscopy time, a significantly high risk of PNP and a low incidence of pericardial effusions/cardiac tamponade compared with RFCA. PMID:29056997

Multicenter Clinical Evaluation of BacT/Alert Virtuo Blood Culture System.

PubMed

Jacobs, Michael R; Mazzulli, Tony; Hazen, Kevin C; Good, Caryn E; Abdelhamed, Ayman M; Lo, Pauline; Shum, Bianche; Roman, Katharine P; Robinson, Danielle C

2017-08-01

BacT/Alert Virtuo is an advanced, automated blood culture system incorporating improved automation and an enhanced detection algorithm to shorten time to detection. A multicenter study of the investigational Virtuo system (bioMérieux, Inc., Durham, NC) compared to BacT/Alert 3D (BTA3D) for detection of bacteremia/fungemia in four bottle types, SA and FA Plus (aerobic) and SN and FN Plus (anaerobic), was performed in a clinical setting with patient samples in a matched system design clinical trial. Blood was added to paired aerobic or anaerobic bottles, with the volume in each bottle in each pair required to be ≤10 ml and with the volumes required to be within 30% of each other. Of 5,709 bottle sets (52.5% aerobic pairs and 47.5% anaerobic pairs), 430 (7.5%) were positive for bacterial or fungal growth, with 342 (6.0%) clinically significant and 83 (1.5%) contaminated. A total of 3,539 sets (62.0%) were volume compliant, with 203 sets (5.7%) clinically significant. The positivity rates for volume-compliant bottle pairs determined by the two systems were comparable, with 68.7% of clinically significant isolates detected by both instruments, 15.7% by Virtuo only, and 15.7% by BTA3D only. Virtuo detected microbial growth nearly 2 h sooner overall than BTA3D (mean, 15.9 h versus 17.7 h). Shorter time to detection by Virtuo was related to organism group, with the time to detection being significantly shorter for enteric Gram-negative bacilli and enterococci (means, 3.6 h and 2.3 h shorter, respectively). This large clinical study demonstrated that the Virtuo blood culture system produced results comparable to those seen with the long-established BTA3D system, with significantly shorter time to detection. Copyright © 2017 Jacobs et al.

Remote real-time monitoring of free flaps via smartphone photography and 3G wireless Internet: a prospective study evidencing diagnostic accuracy.

PubMed

Engel, Holger; Huang, Jung Ju; Tsao, Chung Kan; Lin, Chia-Yu; Chou, Pan-Yu; Brey, Eric M; Henry, Steven L; Cheng, Ming Huei

2011-11-01

This prospective study was designed to compare the accuracy rate between remote smartphone photographic assessments and in-person examinations for free flap monitoring. One hundred and three consecutive free flaps were monitored with in-person examinations and assessed remotely by three surgeons (Team A) via photographs transmitted over smartphone. Four other surgeons used the traditional in-person examinations as Team B. The response time to re-exploration was defined as the interval between when a flap was evaluated as compromised by the nurse/house officer and when the decision was made for re-exploration. The accuracy rate was 98.7% and 94.2% for in-person and smartphone photographic assessments, respectively. The response time of 8 ± 3 min in Team A was statistically shorter than the 180 ± 104 min in Team B (P = 0.01 by the Mann-Whitney test). The remote smartphone photography assessment has a comparable accuracy rate and shorter response time compared with in-person examination for free flap monitoring. Copyright © 2011 Wiley Periodicals, Inc.

Compartmentalized self-replication under fast PCR cycling conditions yields Taq DNA polymerase mutants with increased DNA-binding affinity and blood resistance.

PubMed

Arezi, Bahram; McKinney, Nancy; Hansen, Connie; Cayouette, Michelle; Fox, Jeffrey; Chen, Keith; Lapira, Jennifer; Hamilton, Sarah; Hogrefe, Holly

2014-01-01

Faster-cycling PCR formulations, protocols, and instruments have been developed to address the need for increased throughput and shorter turn-around times for PCR-based assays. Although run times can be cut by up to 50%, shorter cycle times have been correlated with lower detection sensitivity and increased variability. To address these concerns, we applied Compartmentalized Self Replication (CSR) to evolve faster-cycling mutants of Taq DNA polymerase. After five rounds of selection using progressively shorter PCR extension times, individual mutations identified in the fastest-cycling clones were randomly combined using ligation-based multi-site mutagenesis. The best-performing combinatorial mutants exhibit 35- to 90-fold higher affinity (lower Kd ) for primed template and a moderate (2-fold) increase in extension rate compared to wild-type Taq. Further characterization revealed that CSR-selected mutations provide increased resistance to inhibitors, and most notably, enable direct amplification from up to 65% whole blood. We discuss the contribution of individual mutations to fast-cycling and blood-resistant phenotypes.

Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems.

PubMed

Ozben, Volkan; Cengiz, Turgut B; Atasoy, Deniz; Bayraktar, Onur; Aghayeva, Afag; Erguner, Ilknur; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun

2016-10-01

We aimed to compare perioperative outcomes for procedures using the latest generation of da Vinci robot versus its previous version in rectal cancer surgery. Fifty-three patients undergoing robotic rectal cancer surgery between January 2010 and March 2015 were included. Patients were classified into 2 groups (Xi, n=28 vs. Si, n=25) and perioperative outcomes were analyzed. The groups had significant differences including operative procedure, hybrid technique and redocking (P>0.05). In univariate analysis, the Xi group had shorter console times (265.7 vs. 317.1 min, P=0.006) and total operative times (321.6 vs. 360.4 min, P=0.04) and higher number of lymph nodes harvested (27.5 vs. 17.0, P=0.008). In multivariate analysis, Xi robot was associated with a shorter console time (odds ratio: 0.09, P=0.004) with no significant differences regarding other outcomes. Both generations of da Vinci robot led to similar short-term outcomes in rectal cancer surgery, but the Xi robot allowed shorter console times.

The Role of Bolus Injection of Saline with Arm Elevation on Rocuronium onset Time: A Randomized Control Study

PubMed Central

Kulkarni, Malavika; Chuchendra, L. S.; Bhavya, P. J.

2018-01-01

Background: The onset time of neuromuscular blockade is a crucial time associated with the risk of hypoxia and pulmonary aspiration. Various strategies have been undertaken to shorten this onset time. Therefore, we investigated the effects of bolus of 20 ml saline followed by limb elevation after administration of rocuronium in a dose of 0.6 mg/kg to study the onset time. Methodology: Thirty patients were randomly allocated to the bolus saline group or control group. General anesthesia was induced and maintained with fentanyl and propofol. Rocuronium 0.6 mg/kg intravenous (IV) was administered followed by 20 ml saline bolus and limb elevation in the study group compared to administration of 0.6 mg/kg in a running drip only in the control. Onset of neuromuscular block was assessed by acceleromyography at the adductor pollicis muscle with train-of-four stimulation. Results: The lag time was shorter in bolus group (34 s median) than in control group (45 s median), P < 0.017. The onset time was shorter in bolus group (55 s median) than in control group (110 s median), P < 0.001. The T1 recovery to 25% was longer in bolus group (42 min median) than in control group (39 min median) which was statistically not significant. Conclusion: Rocuronium 0.6 mg/kg IV followed by bolus 20 ml saline and concomitant limb elevation resulted in shorter lag time, faster onset of neuromuscular blockade, good intubating conditions without prolonging clinical duration of action when compared to the control. PMID:29628555

Non-equilibrium electrokinetic micromixer with 3D nanochannel networks.

PubMed

Choi, Eunpyo; Kwon, Kilsung; Lee, Seung Jun; Kim, Daejoong; Park, Jungyul

2015-04-21

We report an active micromixer which utilizes vortex generation due to non-equilibrium electrokinetics near the interface between a microchannnel and a nanochannel networks membrane (NCNM), constructed from geometrically controlled in situ self-assembled nanoparticles. A large interfacing area where it is possible to generate vortices can be realized, because nano-interstices between the assembled nanoparticles are intrinsically collective three-dimensional nanochannel networks, which may be compared to typical silicon-based 2D nanochannels. The proposed mixer shows a 2-fold shorter mixing time (~0.78 ms) and a 34-fold shorter mixing length (~7.86 μm) compared to conventional 2D nanochannels.

Resin Flow Behavior Simulation of Grooved Foam Sandwich Composites with the Vacuum Assisted Resin Infusion (VARI) Molding Process

PubMed Central

Zhao, Chenhui; Zhang, Guangcheng; Wu, Yibo

2012-01-01

The resin flow behavior in the vacuum assisted resin infusion molding process (VARI) of foam sandwich composites was studied by both visualization flow experiments and computer simulation. Both experimental and simulation results show that: the distribution medium (DM) leads to a shorter molding filling time in grooved foam sandwich composites via the VARI process, and the mold filling time is linearly reduced with the increase of the ratio of DM/Preform. Patterns of the resin sources have a significant influence on the resin filling time. The filling time of center source is shorter than that of edge pattern. Point pattern results in longer filling time than of linear source. Short edge/center patterns need a longer time to fill the mould compared with Long edge/center sources.

A characterization of persistence at short times in the WFC3/IR detector

NASA Astrophysics Data System (ADS)

Gennaro, M.; Bajaj, V.; Long, K.

2018-05-01

Persistence in the WFC3/IR detector appears to decay as a power law as a function of time elapsed since the end of a stimulus. In this report we study departures from the power law at times shorter than a few hundreds seconds after the stimulus. In order to have better short-time cadence, we use the Multiaccum (.ima) files, which trace the accumulated charge in the pixels as function of time, rather than the final pipeline products (.flt files), which instead report the electron rate estimated via a linear fit to the accumulated charge vs. time relation. We note that at short times after the stimulus, the absolute change in persistence is the strongest, thus a linear fit to the accumulated signal (the .flt values) can be a poor representation of the strongly varying persistence signal. The already observed power-law decay of the persistence signal, still holds at shorter times, with typical values of the power law index, gamma in [-0.8,-1] for stimuli that saturate the WFC3 pixels. To a good degree of approximation, a single power law is a good fit to the persistence signal decay from 100 to 5000 seconds. We also detect a tapering-off in the power-law decay at increasingly shorter times. This change in behavior is of the order of Delta Gamma 0.02 - 0.05 when comparing power-law fits performed to the persistence signal from 0 up to 250 seconds and from 0 up to 4000 seconds after the stimulus, indicating that persistence decays slightly more rapidly as time progresses. Our results may suggest that for even shorter times, not probed by our study, the WFC3 persistence signal might deviate from a single power-law model.

Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access.

PubMed

Ligon, R Allen; Ooi, Yinn K; Kim, Dennis W; Vincent, Robert N; Petit, Christopher J

2017-09-11

The purpose of this study was to compare results between the femoral arterial (FA) and carotid arterial (CA) approaches in catheter-based interventions on Blalock-Taussig shunts (BTS). Transcatheter intervention on BTS is often performed in shunt-dependent, hypoxemic infants. The approach to BTS intervention likely has an impact on timeliness and overall success. The authors reviewed all cases of catheter intervention for BTS obstruction between 2012 and 2017 for their institution. They sought to compare procedural success rates and time, sheath time, time to arterial access, and time from access to stent implantation between FA and CA approaches. There were 42 BTS interventions between 34 patients. BTS intervention was more successful from the CA approach (p = 0.035). Among the FA cohort, BTS intervention was unsuccessful in 8 cases (25%), 5 of which were converted to CA with subsequent success. The CA cohort had lower procedure time (62 min vs. 104 min; p = 0.01) and anesthesia time (119 min vs. 151 min; p = 0.01). Additionally, CA access was associated with shorter time to arterial access (4.0 min vs. 9.3 min; p < 0.01), time to placement of the guidewire through the BTS (6.5 min vs. 13 min; p < 0.01), and time from the final sheath to BTS stent implantation (9 min vs. 20 min; p < 0.01). Operators should consider the route of access to the BTS deliberately. The authors' approach has been the carotid artery as an alternative access site-associated with greater procedural success, shorter procedural time, and shorter time to stent implantation. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2-3cm.

PubMed

Pieras, E; Tubau, V; Brugarolas, X; Ferrutxe, J; Pizá, P

2017-04-01

To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Effects of processing parameters on immersion vacuum cooling time and physico-chemical properties of pork hams.

PubMed

Feng, Chao-Hui; Drummond, Liana; Zhang, Zhi-Hang; Sun, Da-Wen

2013-10-01

The effects of agitation (1002 rpm), different pressure reduction rates (60 and 100 mbar/min), as well as employing cold water with different initial temperatures (IWT: 7 and 20°C) on immersion vacuum cooling (IVC) of cooked pork hams were experimentally investigated. Final pork ham core temperature, cooling time, cooling loss, texture properties, colour and chemical composition were evaluated. The application for the first time of agitation during IVC substantially reduced the cooling time (47.39%) to 4.6°C, compared to IVC without agitation. For the different pressure drop rates, there was a trend that shorter IVC cooling times were achieved with lower cooling rate, although results were not statistically significant (P>0.05). For both IWTs tested, the same trend was observed: shorter cooling time and lower cooling loss were obtained under lower linear pressure drop rate of 60 mbar/min (not statistically significant, P>0.05). Compared to the reference cooling method (air blast cooling), IVC achieved higher cooling rates and better meat quality. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sleep Patterns Are Associated with Common Illness in Adolescents

PubMed Central

Orzech, Kathryn M.; Acebo, Christine; Seifer, Ronald; Barker, David; Carskadon, Mary A.

2014-01-01

Summary This prospective, field-based study examined the association between actigraphically-measured total sleep time and incident illness including cold, flu, gastroenteritis, and other common infectious diseases (e.g., strep throat) in adolescents over the course of a school semester. Participants were 56 adolescents ages 14–19 years (mean = 16.6 (standard deviation = 1.2), 39% male) from 5 high schools in Rhode Island. Beginning in late January, adolescents wore actigraphs (mean 91 (19) days, range 16 – 112 days) and were assigned post-hoc to Longer or Shorter sleep groups based on median splits. Adolescents were interviewed weekly across as many as 16 weeks (modal number of interviews = 13) using a structured protocol that included 14 health event questions. Illness events and illness-related school absences were coded for 710 completed interviews, with 681 illness events and 90 school absences reported. Outcomes (illness bouts, illness duration, and absences) were compared among sex, sleep, and academic year groups using non-parametric regression. In a subset of 18 subjects, mean actigraphically estimated total sleep time 6 nights before matched illness/wellness events was compared using MANOVA. Longer sleepers and males reported fewer illness bouts; total sleep time effects were more apparent in males than females. A trend was found for shorter total sleep time before ill events. The present findings in this small naturalistic sample indicate that acute illnesses were more frequent in otherwise healthy adolescents with shorter sleep, and illness events were associated with less sleep during the prior week than comparable matched periods without illness. PMID:24134661

Gender differences among recidivist trauma patients.

PubMed

Kwan, Rita O; Cureton, Elizabeth L; Dozier, Kristopher C; Victorino, Gregory P

2011-01-01

Gender differences among trauma recidivist patients are not well-understood. We hypothesized that males are more likely to be repeatedly involved in the trauma system and have a shorter time to recurrence between repeat episodes of injury compared with females. A retrospective analysis of trauma patients treated at an urban university-based trauma center was performed. Variables including gender, race, insurance status, age, mechanism of injury, outcomes, and injury secondary to domestic violence were compared. Differences were compared using χ(2) tests and log-rank (Mantel-Cox) Kaplan-Meier cumulative event curves. We identified 689 trauma recidivist patients (4.0% of all trauma visits) over a 10-y period. Compared to single-visit patients, recidivist patients were more likely to be male (87% versus 73%), uninsured (78% versus 66%), and have injuries secondary to assaults (54% versus 37%) (P < 0.05). Time from the first to second trauma visit was shorter for females compared with males (23 ± 2.5 versus 30 ± 1.2 mo, P < 0.02). Additionally, female recidivists were more likely to be involved in blunt trauma than were male recidivists (69% versus 43%, P < 0.001). Furthermore, domestic violence was identified in a higher proportion of female recidivist patients than female single-visit patients (3.5% versus 1.6%, P < 0.0003). Contrary to our hypothesis, female recidivist trauma patients have a much shorter time to recurrence for a second traumatic injury than do males. Female recidivists have a high likelihood of assault-associated injuries and domestic violence. Trauma centers should screen for domestic violence among trauma patients to aid in preventing further repeat episodes of injury. Copyright © 2011 Elsevier Inc. All rights reserved.

Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: an outcomes comparison.

PubMed

Seruya, Mitchel; Fisher, Mark; Rodriguez, Eduardo D

2013-11-01

There has been rising interest in computer-aided design/computer-aided manufacturing for preoperative planning and execution of osseous free flap reconstruction. The purpose of this study was to compare outcomes between computer-assisted and conventional fibula free flap techniques for craniofacial reconstruction. A two-center, retrospective review was carried out on patients who underwent fibula free flap surgery for craniofacial reconstruction from 2003 to 2012. Patients were categorized by the type of reconstructive technique: conventional (between 2003 and 2009) or computer-aided design/computer-aided manufacturing (from 2010 to 2012). Demographics, surgical factors, and perioperative and long-term outcomes were compared. A total of 68 patients underwent microsurgical craniofacial reconstruction: 58 conventional and 10 computer-aided design and manufacturing fibula free flaps. By demographics, patients undergoing the computer-aided design/computer-aided manufacturing method were significantly older and had a higher rate of radiotherapy exposure compared with conventional patients. Intraoperatively, the median number of osteotomies was significantly higher (2.0 versus 1.0, p=0.002) and the median ischemia time was significantly shorter (120 minutes versus 170 minutes, p=0.004) for the computer-aided design/computer-aided manufacturing technique compared with conventional techniques; operative times were shorter for patients undergoing the computer-aided design/computer-aided manufacturing technique, although this did not reach statistical significance. Perioperative and long-term outcomes were equivalent for the two groups, notably, hospital length of stay, recipient-site infection, partial and total flap loss, and rate of soft-tissue and bony tissue revisions. Microsurgical craniofacial reconstruction using a computer-assisted fibula flap technique yielded significantly shorter ischemia times amidst a higher number of osteotomies compared with conventional techniques. Therapeutic, III.

Time-Resolved Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography in Patients with Chronic Expanding and Stable Aortic Dissections.

PubMed

Trojan, Michael; Rengier, Fabian; Kotelis, Drosos; Müller-Eschner, Matthias; Partovi, Sasan; Fink, Christian; Karmonik, Christof; Böckler, Dittmar; Kauczor, Hans-Ulrich; von Tengg-Kobligk, Hendrik

2017-01-01

To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA) is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections. 20 patients with chronic or residual aortic dissection in the descending aorta and patent false lumen underwent TR-MRA of the aorta at 1.5 T and repeated follow-up imaging (mean follow-up 5.4 years). 7 patients showed chronic aortic expansion and 13 patients had stable aortic diameters. Regions of interest were placed in the nondissected ascending aorta and the false lumen of the descending aorta at the level of the diaphragm (FL-diaphragm level) resulting in respective time-intensity curves. For the FL-diaphragm level, time-to-peak intensity and full width at half maximum were significantly shorter in the expansion group compared to the stable group ( p = 0.027 and p = 0.003), and upward and downward slopes of time-intensity curves were significantly steeper ( p = 0.015 and p = 0.005). The delay of peak intensity in the FL-diaphragm level compared to the nondissected ascending aorta was significantly shorter in the expansion group compared to the stable group ( p = 0.01). 3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections.

The risk of shorter fasting time for pediatric deep sedation.

PubMed

Clark, Mathew; Birisci, Esma; Anderson, Jordan E; Anliker, Christina M; Bryant, Micheal A; Downs, Craig; Dalabih, Abdallah

2016-01-01

Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications. This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4-6 h and >6 h). Complication rates were calculated and compared between the three groups. In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4-6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups. This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

Detection of placental alpha microglobulin-1 versus insulin-like growth factor-binding protein-1 in amniotic fluid at term: a comparative study.

PubMed

Pollet-Villard, Marie; Cartier, Régine; Gaucherand, Pascal; Doret, Muriel

2011-06-01

We compared two biochemical tests of premature rupture of membranes (PROM) in vitro: Actim PROM (Medix Biochemica, Kauniainen, Finland), which detects insulin-like growth factor binding protein-1, and AmniSure (AmniSure International LLC, Cambridge, MA), which detects placental alpha microglobulin-1. Samples of amniotic fluid were collected during caesarean section in 41 patients. A dilution series was prepared and both tests were performed twice at each dilution. Sensitivity, detection limit, response time, and reproducibility of both tests were compared. Both tests' sensitivity was 100% at dilution 1:10 and 1:20. AmniSure sensitivity was higher at dilution 1:40 and 1:80 ( P < 0.05). In 29 of 40 cases, AmniSure had a lower detection limit than Actim PROM. AmniSure response times were shorter and reproducibility was higher than Actim PROM ( P < 0.05). AmniSure had a lower detection limit of amniotic fluid than Actim PROM, with a shorter response time, a higher sensitivity, and a better reproducibility. © Thieme Medical Publishers.

Laparoendoscopic single-site surgery varicocelectomy versus conventional laparoscopic varicocele ligation: A meta-analysis

PubMed Central

Li, Mingchao; Wang, Zhengyun

2016-01-01

Objective To perform a meta-analysis of data from available published studies comparing laparoendoscopic single-site surgery varicocelectomy (LESSV) with conventional transperitoneal laparoscopic varicocele ligation. Methods A comprehensive data search was performed in PubMed and Embase to identify randomized controlled trials and comparative studies that compared the two surgical approaches for the treatment of varicoceles. Results Six studies were included in the meta-analysis. LESSV required a significantly longer operative time than conventional laparoscopic varicocelectomy but was associated with significantly less postoperative pain at 6 h and 24 h, a shorter recovery time and greater patient satisfaction with the cosmetic outcome. There was no difference between the two surgical approaches in terms of postoperative semen quality or the incidence of complications. Conclusion These data suggest that LESSV offers a well tolerated and efficient alternative to conventional laparoscopic varicocelectomy, with less pain, a shorter recovery time and better cosmetic satisfaction. Further well-designed studies are required to confirm these findings and update the results of this meta-analysis. PMID:27688686

2D projection-based software application for mobile C-arms optimises wire placement in the proximal femur - An experimental study.

PubMed

Swartman, B; Frere, D; Wei, W; Schnetzke, M; Beisemann, N; Keil, H; Franke, J; Grützner, P A; Vetter, S Y

2017-10-01

A new software application can be used without fixed reference markers or a registration process in wire placement. The aim was to compare placement of Kirschner wires (K-wires) into the proximal femur with the software application versus the conventional method without guiding. As study hypothesis, we assumed less placement attempts, shorter procedure time and shorter fluoroscopy time using the software. The same precision inside a proximal femur bone model using the software application was premised. The software detects a K-wire within the 2D fluoroscopic image. By evaluating its direction and tip location, it superimposes a trajectory on the image, visualizing the intended direction of the K-wire. The K-wire was positioned in 20 artificial bones with the use of software by one surgeon; 20 bones served as conventional controls. A brass thumb tack was placed into the femoral head and its tip targeted with the wire. Number of placement attempts, duration of the procedure, duration of fluoroscopy time and distance to the target in a postoperative 3D scan were recorded. Compared with the conventional method, use of the application showed fewer attempts for optimal wire placement (p=0.026), shorter duration of surgery (p=0.004), shorter fluoroscopy time (p=0.024) and higher precision (p=0.018). Final wire position was achieved in the first attempt in 17 out of 20 cases with the software and in 9 out of 20 cases with the conventional method. The study hypothesis was confirmed. The new application optimised the process of K-wire placement in the proximal femur in an artificial bone model while also improving precision. Benefits lie especially in the reduction of placement attempts and reduction of fluoroscopy time under the aspect of radiation protection. The software runs on a conventional image intensifier and can therefore be easily integrated into the daily surgical routine. Copyright © 2017 Elsevier Ltd. All rights reserved.

Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the 'Shorter Stays in ED' target.

PubMed

Jones, Peter G; Olsen, Sarah

2011-10-01

To document the extent of access block and ED overcrowding in New Zealand in 2010 and to determine whether these were linked to the hospital's ability to meet the Shorter Stays in ED target. Surveys of all New Zealand EDs were undertaken at two points in time in 2010 to determine ED occupancy. Data on target achievement during corresponding time periods were obtained from the Ministry of Health. In tertiary and secondary hospitals, respectively, access block was seen in 64% versus 23% (P= 0.05) and overcrowding was seen in 57.1% versus 39% (P= 0.45). No hospital with access block met the 'Shorter Stays' target, compared with 60% without access block (P= 0.001). Twenty-three per cent of hospitals with ED overcrowding met the target compared with 43% without ED overcrowding (P= 0.42). The number of patients experiencing ≥8 h delay to admission were 25 in May and 59 in August (P= 0.04). This represented 45.5% and 79.7% of patients waiting for admission, respectively (P= 0.08). Hospital access block was seen more often in larger hospitals and significantly associated with failure to meet the 'Shorter Stays in ED' health target, whereas ED overcrowding was seen in both small and large hospitals, but not associated with failure to meet the target. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer.

PubMed

Tan, Yuyong; Lv, Liang; Duan, Tianying; Zhou, Junfeng; Peng, Dongzi; Tang, Yao; Liu, Deliang

2016-07-01

Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35 mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma. We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35-55 mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS. A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P > 0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P < 0.05). No recurrence was noted in the STER and VATS groups during a mean follow-up of 10.9 and 30.8 months, respectively. The treatment efficacy was comparable between the STER and VATS for esophageal leiomyoma of 35-55 mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.

Anesthetic efficacy of ketamine-diazepam, ketamine-xylazine, and ketamine-acepromazine in Caspian Pond turtles (Mauremys caspica).

PubMed

Adel, Milad; Sadegh, Amin Bigham; Arizza, Vincenzo; Abbasi, Hossein; Inguglia, Luigi; Saravi, Hasan Nasrollahzadeh

2017-01-01

The objective of this study was to assess the efficacy of different anesthetic drug combinations on the Caspian Pond turtles ( Mauremys caspica ). Three groups of the Caspian Pond turtles ( n = 6) were anesthetized with three different drug combinations. Initially, a pilot study was conducted to determine the best drug doses for the anesthetization of the turtles, and according to these results, ketamine-diazepam (120 mg/kg ketamine hydrochloride [5%] and 2 mg/kg diazepam [5%]), ketamine-acepromazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg acepromazine [1%]), and ketamine-xylazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg xylazine [2%]) were injected intramuscularly. The onset times of anesthetization and the recovery time were measured. Statistical analysis of the data was performed using one-way analysis of variance followed by t -tests, and P < 0.05 was considered statistically significant. There were statistically significant differences in the mean of the onset times of anesthesia and recovery time among the three drug combinations depending on the treatment used. The onset of anesthesia of the animals treated with the ketamine-diazepam combination was 60% and 42% shorter, for male and female turtles, respectively, compared to that obtained with the ketamine-acepromazine combination and 64% (male turtles) and 50% (female turtles) shorter than that obtained with the ketamine-xylazine combination. Further, the recovery time, in male turtles, was 17% shorter in animals treated with the first drug combination than those treated with the ketamine-acepromazine combination and 37% shorter than those treated with the ketamine-xylazine combination. The recovery time, in female turtles, did not seem to be significantly different among treatments. The study showed that the ketamine-diazepam drug combination is the anesthetic combination with the fastest onset time and shortest recovery time.

The role of ultrasound guidance in pediatric caudal block

PubMed Central

Erbüyün, Koray; Açıkgöz, Barış; Ok, Gülay; Yılmaz, Ömer; Temeltaş, Gökhan; Tekin, İdil; Tok, Demet

2016-01-01

Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations. PMID:26837396

Acute procedural outcomes of orbital atherectomy for the treatment of common femoral artery disease: Sub-analysis of the CONFIRM Registries.

PubMed

Lee, Michael S; Heikali, Daniel; Mustapha, Jihad; Adams, George; Mahmud, Ehtisham

2017-08-01

This analysis compared the angiographic outcomes of patients treated with orbital atherectomy for calcified common femoral artery (CFA) and superficial femoral artery (SFA) disease. The ideal revascularization strategy for CFA disease is unknown. Endarterectomy has been considered the standard of care for CFA disease for over 50 years. Endovascular intervention is becoming more commonly used to revascularize the CFA given the advances in technology and the less invasive nature of the procedure. Patient demographics, lesion characteristics, and procedure data for all CONFIRM patients with at least one CFA lesion location ( n=147 patients; n=200 lesions) were compared to patients with at least one SFA lesion location ( n=1508 patients; n=2367 lesions). The primary endpoint was angiographic complication, defined as the composite of dissection, perforation, slow flow, closure, spasm, embolism, or thrombosis. The CFA group had more patients with Rutherford class 4 and shorter lesion length. The CFA group had a higher final residual stenosis, shorter total run time, and shorter total inflation time. The primary endpoint was lower in the CFA group compared with the SFA group (17% vs 24%, p=0.02), driven by a lower dissection rate (10% vs 15%, p=0.04). Plaque modification of the CFA with orbital atherectomy was safe and compared favorably with SFA disease. The need for bail-out stenting was low. A randomized trial is needed to determine the ideal treatment strategy for calcified CFA disease.

Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain.

PubMed

Hermans, Maaike P J; Velders, Matthijs A; Smeekes, Martin; Drexhage, Olivier S; Hautvast, Raymond W M; Ytsma, Timon; Schalij, Martin J; Umans, Victor A W M

2017-08-04

Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients. Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays. Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.

Pediatric procedural sedation with ketamine: time to discharge after intramuscular versus intravenous administration.

PubMed

Ramaswamy, Preeti; Babl, Franz E; Deasy, Conor; Sharwood, Lisa N

2009-02-01

Ketamine is an attractive agent for pediatric procedural sedation. There are limited data on time to discharge comparing intramuscular (IM) vs. intravenous (IV) ketamine. The authors set out to determine whether IM or IV ketamine leads to quicker discharge from the emergency department (ED) and how side effect profiles compare. All patients who had received ketamine IM or IV at a tertiary children's hospital ED during the 3-year study period (2004-2007) were identified. Prospective sedation registry data, retrospective medical records, and administrative data were reviewed for drug dosages, use of additional agents, time of drug administration to discharge, total ED time (triage to discharge), and adverse events. A subgroup analysis for patients requiring five or fewer sutures (short suture group) was performed. A total of 229 patients were enrolled (60% male) with median age of 2.8 years (IQR =1.8-4.3 years) and median weight of 15.7 kg (range = 8.7-74 kg). Ketamine was most frequently employed for laceration repair (80%) and foreign body removal (9%). Overall, 48% received ketamine IM and 52% received it IV. In the short-suture subgroup, 52% received ketamine IM, while 48% received it IV. Multivariate linear regression analysis determined time from drug administration to patient discharge as 21 minutes shorter for IV compared with IM administration, adjusted for age and number of additional doses (R(2) = -0.35; 95% CI = -0.5 to -0.19; p < 0.001). Total time in the ED (triage to discharge) comparing IV versus IM administration, adjusting for age and gender and number of additional doses, was not significantly different (p = 0.16). In the short-suture subgroup, time to discharge from administration was also shorter in the IV ketamine group (R(2) = -0.454; 95%CI = -0.66 to -0.25; p < 0.001) but similar for total time in ED (p = 0.16). Overall, adverse events occurred in 35% (95% CI = 27% to 45%) of the IM group and 20% (95% CI = 13% to 28%) of the IV group (p = 0.01). Only one patient required brief bag-mask ventilation. In this institution, time from drug injection to discharge was shorter in the IV compared to IM ketamine group, both overall and for the short-suture group. However, time from triage to discharge was similar.

A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure.

PubMed

Yang, Wendy; Ming, Yung-Ching; Kau, Yi-Chuan; Liao, Chia-Chih; Tsai, Shih-Chang; Wong, Kit-Man; Wong, Shu-Yam; Lai, Jin-Yao

2015-12-01

The purpose of this study was to compare the results of thoracic epidural analgesia (TEA) and parecoxib in controlling postoperative pain after the Nuss procedure. Between August 2005 and July 2014, 120 adolescents and adults underwent Nuss procedures and received either TEA or parecoxib for postoperative pain control. Demographic data, preoperative preparation times, visual analog scale (VAS) pain scores from postoperative day 1 to day 5, medical costs of pain control, days to Foley catheter removal, days to being able to sit up, days to being able to walk, days of hospital stay, nausea/vomiting scores, and complications related to pain control were compared. A total of 106 patients received TEA, and 14 received parecoxib. No between-group differences in demographics were observed. Patients in the parecoxib group had shorter preparation times (p<0.001), lower VAS pain scores from postoperative day 2 to day 5 (day 2, p=0.006; day 3, p=0.006; day 4, p<0.001; day 5, p<0.001), shorter hospital stays (p<0.001), lower pain control costs (p<0.001), and lower nausea/vomiting scores (p=0.046). For adolescents and adults undergoing the Nuss procedure, parecoxib affords better pain control efficacy, a shorter hospital stay, lower medical pain control costs, and fewer side effects compared with TEA. Copyright © 2015 Elsevier Inc. All rights reserved.

Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment.

PubMed

Zhou, Yanming; Zhao, Min; Wu, Lupeng; Ye, Feng; Si, Xiaoying

Enucleation of pancreatic tumors is rarely performed. The aim of this study was to evaluate the published evidence for its short- and long-term outcomes. PubMed (MEDLINE) and EMBASE databases were searched from 1990 to March 2016. Studies including at least ten patients who underwent enucleation of pancreatic lesions were included. Data on the outcomes were synthesized and meta-analyzed where appropriate. Twenty-seven studies involving 1316 patients were included in the systematic review. The postoperative mortality was 0.3%, and the postoperative morbidity was 50.3%, mainly represented by pancreatic fistula (38.1%). Endocrine insufficiency, exocrine insufficiency and tumor recurrence was observed in 2.4%, 1.1% and 2.3% of the patients respectively. Compared with typical resection, the operation time, blood loss, length of hospital stay, and the incidence of endocrine and exocrine insufficiency were all significantly reduced after enucleation. The occurrence of pancreatic fistula was significantly higher in enucleation group, but overall morbidity, the reoperation rate and mortality were comparable between the two groups. There was no significant difference in disease recurrence between the two groups. Compared with central pancreatectomy, enucleation had a shorter operation time, lower blood loss, less morbidity, and better pancreatic function. Compared with open enucleation, minimally invasive enucleation had a shorter operation time and a shorter length of hospital stay. Enucleation is an appropriate surgical procedure in selected patients with benign or low-malignant lesions of the pancreas. The benefits of minimally invasive approach need to be validated in further investigations with larger groups of patients. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy.

PubMed

Elbadawey, M R; Hegazy, H M; Eltahan, A E; Powell, J

2015-11-01

This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients. A total of 120 patients aged 10-15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong-Baker FACES(®) pain scale. The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml; p = 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml; p = 0.0001). Diode laser tonsillectomy had a shorter operative time (p = 0.0001) and less blood loss (p = 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p = 0.042) and coblation (p = 0.04) tonsillectomy groups. Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

The Time Course for Language Acquisition in Biologically Distinct Populations: Evidence from Deaf Individuals

ERIC Educational Resources Information Center

Ross, Danielle S.; Bever, Thomas G.

2004-01-01

The present study provides evidence that individuals who have different patterns of cerebral lateralization and who develop along different maturational time courses can attain comparable levels of language proficiency. Right-handed individuals with left-handed family members (left-handed familials, LHFs) showed a shorter sensitive period for…

Speech Timing and Working Memory in Profoundly Deaf Children after Cochlear Implantation.

ERIC Educational Resources Information Center

Burkholder, Rose A.; Pisoni, David B.

2003-01-01

Compared speaking rates, digit span, and speech timing in profoundly deaf 8- and 9-year-olds with cochlear implants and normal-hearing children. Found that deaf children displayed longer sentence durations and pauses during recall and shorter digit spans than normal-hearing children. Articulation rates strongly correlated with immediate memory…

Comparison of pressure ulcer treatments in long-term care facilities: clinical outcomes and impact on cost.

PubMed

Narayanan, Siva; Van Vleet, John; Strunk, Billy; Ross, Robert N; Gray, Mikel

2005-01-01

This study compared clinical outcomes and nursing labor costs associated with (a) balsam Peru, hydrogenated castor oil, and trypsin (BCT) ointment; (b) BCT + Other; and (c) Other treatments in 2014 wound episodes occurring in 861 patients (mean 2.34 wounds/patient). Treatment with BCT ointment or BCT + Other was associated with a higher healing rate (P < .05). No Stage 1 or 2 ulcer treated with BCT ointment progressed, compared with 13.8% treated with BCT + Other and 13.4% treated with Other. The reported mean duration of treatment and time to heal were shorter for ulcers treated with BCT ointment, but differences did not reach significance, possibly because of the variability in reported treatment times. Mean daily nursing labor costs were lower for treatment with BCT than Other ($50.8 vs $61.7, P < .05). These data suggest that treatment of Stage 1 or 2 ulcers with BCT may be associated with shorter treatment time and time to heal and a potential reduction in treatment-related nursing labor costs.

Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies.

PubMed

Brunetti, Natale Daniele; De Gennaro, Luisa; Correale, Michele; Santoro, Francesco; Caldarola, Pasquale; Gaglione, Antonio; Di Biase, Matteo

2017-04-01

A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine. Data were pooled and compared by relative time reduction and 95% C.I.s. A meta-regression analysis was performed in order to find possible predictors of shorter time to treatment. Eleven studies were selected and finally evaluated in the study. The overall relative reduction of time to treatment with pre-hospital triage and telemedicine was -38/-40% (p<0.001). Absolute time reduction was significantly correlated to time to treatment in the control groups (p<0.001), while relative time reduction was independent. A non-significant trend toward shorter relative time reductions was observed over years. Pre-hospital triage with telemedicine is associated with a near halved time to treatment in AMI. The benefit is larger in terms of absolute time to treatment reduction in populations with larger delays to treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Association between coagulation function and patients with primary angle closure glaucoma: a 5-year retrospective case-control study.

PubMed

Li, Shengjie; Gao, Yanting; Shao, Mingxi; Tang, Binghua; Cao, Wenjun; Sun, Xinghuai

2017-11-04

To evaluate the association between coagulation function and patients with primary angle closure glaucoma (PACG). A retrospective, hospital-based, case-control study. Shanghai, China. A total of 1778 subjects were recruited from the Eye & ENT Hospital of Fudan University from January 2010 to December 2015, including patients with PACG (male=296; female=569) and control subjects (male=290; female=623). Sociodemographic data and clinical data were collected. The one-way analysis of variance test was used to compare the levels of laboratory parameters among the mild, moderate and severe PACG groups. Multivariate logistic regression analyses were performed to identify the independent risk factors for PACG. The nomogram was constructed based on the logistic regression model using the R project for statistical computing (R V.3.3.2). The activated partial thromboplastin time (APTT) of the PACG group was approximately 4% shorter (p<0.001) than that of the control group. The prothrombin time (PT) was approximately 2.40% shorter (p<0.001) in patients with PACG compared with the control group. The thrombin time was also approximately 2.14% shorter (p<0.001) in patients with PACG compared with the control group. The level of D-dimer was significantly higher (p=0.042) in patients with PACG. Moreover, the mean platelet volume (MPV) of the PACG group was significantly higher (p=0.013) than that of the control group. A similar trend was observed when coagulation parameters were compared between the PACG and control groups with respect to gender and/or age. Multiple logistic regression analyses revealed that APTT (OR=1.032, 95% CI 1.000 to 1.026), PT (OR=1.249, 95% CI 1.071 to 1.457) and MPV (OR=1.185, 95% CI 1.081 to 1.299) were independently associated with PACG. Patients with PACG had a shorter coagulation time. Our results suggest that coagulation function is significantly associated with patients with PACG and may play an important role in the onset and development of PACG. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Electronic mail was not better than postal mail for surveying residents and faculty.

PubMed

Akl, Elie A; Maroun, Nancy; Klocke, Robert A; Montori, Victor; Schünemann, Holger J

2005-04-01

To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

Outcome after introduction of laparoscopic appendectomy in children: A cohort study.

PubMed

Svensson, Jan F; Patkova, Barbora; Almström, Markus; Eaton, Simon; Wester, Tomas

2016-03-01

Acute appendicitis in children is common and the optimal treatment modality is still debated, even if recent data suggest that laparoscopic surgery may result in shorter postoperative length of stay without an increased number of complications. The aim of the study was to compare the outcome of open and laparoscopic appendectomies during a transition period. This was a retrospective cohort study with prospectively collected data. All patients who underwent an operation for suspected appendicitis at the Astrid Lindgren Children's Hospital in Stockholm between 2006 and 2010 were included in the study. 1745 children were included in this study, of whom 1010 had a laparoscopic intervention. There were no significant differences in the rate of postoperative abscesses, wound infections, readmissions or reoperations between the two groups. The median operating time was longer for laparoscopic appendectomy than for open appendectomy, 51 vs. 37minutes (p<0.05). The postoperative length of stay was similar in the two groups. A simple comparison between the groups suggested that laparoscopic appendectomy had a shorter median postoperative length of stay, 43 vs. 57hours (p<0.05). However, there was a trend in time for a shorter postoperative length of stay, and a trend for more of the procedures to be performed laparoscopically over time so on regression analysis, the apparent decrease in length of stay with laparoscopy could be ascribed to the general trend toward decreased length of stay over time, with no specific additional effect of laparoscopy. Our data show no difference in outcome between open and laparoscopic surgery for acute appendicitis in children in regard of complications. The initial assumption that the patients treated with laparoscopic surgery had a shorter postoperative stay was not confirmed with linear regression, which showed that the assumed difference was due only to a trend toward shorter postoperative length of stay over time, regardless of the surgical intervention. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Time-Resolved Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography in Patients with Chronic Expanding and Stable Aortic Dissections

PubMed Central

Trojan, Michael; Kotelis, Drosos; Müller-Eschner, Matthias; Partovi, Sasan; Fink, Christian; Karmonik, Christof; Böckler, Dittmar; Kauczor, Hans-Ulrich; von Tengg-Kobligk, Hendrik

2017-01-01

Objective To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA) is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections. Materials and Methods 20 patients with chronic or residual aortic dissection in the descending aorta and patent false lumen underwent TR-MRA of the aorta at 1.5 T and repeated follow-up imaging (mean follow-up 5.4 years). 7 patients showed chronic aortic expansion and 13 patients had stable aortic diameters. Regions of interest were placed in the nondissected ascending aorta and the false lumen of the descending aorta at the level of the diaphragm (FL-diaphragm level) resulting in respective time-intensity curves. Results For the FL-diaphragm level, time-to-peak intensity and full width at half maximum were significantly shorter in the expansion group compared to the stable group (p = 0.027 and p = 0.003), and upward and downward slopes of time-intensity curves were significantly steeper (p = 0.015 and p = 0.005). The delay of peak intensity in the FL-diaphragm level compared to the nondissected ascending aorta was significantly shorter in the expansion group compared to the stable group (p = 0.01). Conclusions 3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections. PMID:29317855

Employment and work schedule are related to telomere length in women

PubMed Central

Parks, C G; DeRoo, L A; Miller, D B; McCanlies, E C; Cawthon, R M; Sandler, D P

2011-01-01

Objectives To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status. Methods This cross-sectional analysis of 608 women aged 35–74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones. Results Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of −329 bp (95% CI −110 to −548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of −472 bp, 95% CI −786 to −158 for 20+ vs 1–5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels. Conclusions Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL. PMID:21540175

Employment and work schedule are related to telomere length in women.

PubMed

Parks, C G; DeRoo, L A; Miller, D B; McCanlies, E C; Cawthon, R M; Sandler, D P

2011-08-01

To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status. This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones. Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels. Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL.

Propofol for procedural sedation and analgesia reduced dedicated emergency nursing time while maintaining safety in a community emergency department.

PubMed

Reynolds, Joshua C; Abraham, Michael K; Barrueto, Fermin F; Lemkin, Daniel L; Hirshon, Jon M

2013-09-01

Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P < 0.001) and higher rates of procedural success (propofol 98%; midazolam 92%; P = 0.02). There were no significant differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

[Total laryngectomy using a linear stapler for laryngeal cancer].

PubMed

Tomifuji, Masayuki; Araki, Koji; Kamide, Daisuke; Tanaka, Shingo; Tanaka, Yuya; Fukumori, Takayuki; Shiotani, Akihiro

2014-06-01

Total laryngectomy is a well established method for the treatment of laryngeal cancer. In some cases such as elderly patients or patients with severe complications, a shorter surgical time is preferred. Total laryngectomy using a linear stapler is reportedly advantageous for shortening of the surgical time and for lowering the rate of pharyngeal fistula formation. We applied this surgical technique in three laryngeal cancer cases. After skeletonization of the larynx, the linear stapler is inserted between the larynx and the pharyngeal mucosa. Excision of the larynx and suturing of the pharyngeal mucosa are performed simultaneously. Although the number of cases is small for statistical analysis, the surgical time was shortened by about 30 minutes compared to laryngectomy with manual suturing. Total laryngectomy by linear stapler cannot be applied in all cases of advanced laryngeal cancer. However, if the tumor is confined to the endolarynx, it is a useful tool for some cases that require a shorter surgical time.

Prospective Comparative Study of the Efficacy and Safety of New-Generation Versus First-Generation System for Super-Mini-Percutaneous Nephrolithotomy: A Revolutionary Approach to Improve Endoscopic Vision and Stone Removal.

PubMed

Zeng, Guohua; Zhu, Wei; Liu, Yang; Fan, Junhong; Lam, Wayne; Lan, Yu; Cai, Chao; Deng, Tuo; Li, Xiaohang; Zhao, Zhijian

2017-11-01

The study sought to compare the procedural and clinical results of super-mini-percutaneous nephrolithotomy (SMP) with the use of first- and new-generation devices. A prospective, comparative cohort study was carried out between February 2013 and January 2017. Patients who underwent either first- or new-generation SMP were eligible for the study. Inclusion criteria were adult patients with renal stone <4 cm, or in pediatric patients with renal stone <2.5 cm with a history of failed extracorporeal shockwave lithotripsy. The primary outcome of the present study was the operating time, which was calculated from the starting of percutaneous puncture to the wound closure. Secondary outcomes were the stone-free rate (SFR), blood loss (hemoglobin decrease), hospital stay, and postoperative complications. One hundred fifty-six consecutive patients who underwent SMP for treatment of renal stones were eligible for the study, with the first 85 patients undergoing SMP with the first-generation device, and the remaining 71 consecutive patients being treated with the new-generation SMP system. The two groups of patients had comparable demographic data, including age, BMI, stone size, Guy's score, stone location, comorbidities, grade of hydronephrosis, and history of urinary tract infection. The new-generation SMP had a shorter operation time (39.3 vs 50.5 min, p = 0.016) and shorter postoperative hospitalization time (2.1 vs 3.0 days, p < 0.001) than the first-generation SMP. No significant difference existed between the two groups for SFR, hemoglobin decrease, and tubeless rate. The overall operative complication rates using the Clavien-Dindo grading system were similar between the two cohorts of patients. The clinical outcomes of the new-generation SMP in patients with moderate-sized renal stone were comparable when compared with the first-generation SMP. New-generation SMP system using an irrigation/suction sheath improved intraoperative irrigation, a more efficient hydrodynamic mechanism for retrieval of fragments. This may account for the shorter operative time than the first-generation SMP system demonstrated in this study.

Formation of Minor Phases in a Nickel-Based Disk Superalloy

NASA Technical Reports Server (NTRS)

Gabb, T. P.; Garg, A.; Miller, D. R.; Sudbrack, C. K.; Hull, D. R.; Johnson, D.; Rogers, R. B.; Gayda, J.; Semiatin, S. L.

2012-01-01

The minor phases of powder metallurgy disk superalloy LSHR were studied. Samples were consistently heat treated at three different temperatures for long times to approximate equilibrium. Additional heat treatments were also performed for shorter times, to then assess non-equilibrium conditions. Minor phases including MC carbides, M23C6 carbides, M3B2 borides, and sigma were identified. Their transformation temperatures, lattice parameters, compositions, average sizes and total area fractions were determined, and compared to estimates of an existing phase prediction software package. Parameters measured at equilibrium sometimes agreed reasonably well with software model estimates, with potential for further improvements. Results for shorter times representing non-equilibrium indicated significant potential for further extension of the software to such conditions, which are more commonly observed during heat treatments and service at high temperatures for disk applications.

[Comparison of the application between circular stapler and linear stapler in Billroth II( anastomosis of distal gastrectomy].

PubMed

Zhang, Nan; Su, Xiangqian; Xu, Kai

2018-02-25

To compare the safety and effectiveness of circular stapler and linear stapler in Billroth II( anastomosis following distal gastrectomy for gastric cancer patients. Clinical data of gastric adenocarcinoma patients who received distal gastrectomy with Billroth II( anastomosis at Ward IIII( of Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2013 to April 2017 were collected retrospectively. (1) patients identified as stage IIII( gastric cancer by preoperative clinical and postoperative pathological staging. (2) patients undergoing emergency operation due to perforation, obstruction, or bleeding of digestive tract. (3) patients receiving chemotherapy before operation. (4) patients undergoing combined organ resection due to tumor involving other organs. (5) patients complicating with other malignancies. A total of 116 cases were enrolled and divided into circular stapler (CS, 61 cases) group and linear stapler (LS, 55 cases) group according to the application of mechanical stapler. Clinicopathological characteristics, operative conditions and postoperative recovery were compared between two groups. Differences in baseline data, such as tumor size, Lauren classification, differentiation grade, and pathologic stage, between two groups were not statistically significant (all P>0.05). The mean operative time (230 min vs. 234 min), median intra-operative blood loss (50.0 ml vs. 50.0 ml), median number of harvested lymph node (28.0 vs. 26.0) and median number of positive lymph node (1.0 vs. 2.0) between LS group and CS group were not significantly different (all P>0.05) As compared to CS group, LS group presented shorter median time to the first flatus (3.0 days vs. 4.0 days, P=0.038), shorter median time to the first liquid diet (7.0 days vs. 8.0 days, P=0.000), shorter median time to remove the first abdominal drainage tube (7.0 days vs. 9.0 days, P=0.000) and shorter median time of postoperative hospital stay (8.0 days vs. 10.0 days, P=0.000). The morbidity of postoperative complication was 11.5% and 1.8% in CS group and LS group respectively without significant difference (P=0.092). In CS group, 1 case (1.6%) developed anastomotic hemorrhage, 3 cases (4.9%) gastric emptying disorder and 3 cases (4.9%) abdominal infection after operation, who all were cured by conservative treatment without duodenal stump fistula and re-operation. In LS group, only 1 case (1.8%) developed duodenal stump fistula and was cured by re-operation. In distal gastrectomy with Billroth II( anastomosis for gastric cancer, the application of linear stapler results in faster recovery of gastrointestinal function and shorter hospital stay, indicating more advantages.

Food consumption and retention time in captive whooping cranes (Grus americana)

USGS Publications Warehouse

Nelson, J.T.; Gee, G.F.; Slack, R.D.

1997-01-01

Food consumption, digesta retention time, and food preference were measured for captive whooping cranes fed pelleted diets. The basal commercial diet was compared to four mixtures containing 70% basal and 30% of one of four important winter foods for the whooping crane: blue crab (Callinectes sapidus), wolfberry fruit (Lycium carolinianurn), live oak acorn (Quercus virginiana), or common Rangia clam (Rangia cuneata). Because captive birds would not eat whole foods, we were prevented from direct food preference tests. Food passed through the gut rapidly, with almost complete elimination within 7 hr. There was some indication that retention time was shorter for the low fiber and high ash and calcium clam diet. Cranes ate less wolfberry feed (g/day) than the other feeds, and all birds ate less wolfberry feed on the day it was first fed, compared to basal diet the previous day. Birds ate more low energy feed than high energy feed. Due to combined effects of low energy content, lower metabolizable energy coefficients, and reduced feed consumption, less energy was assimilated for study diets than basal diet. Apparent shorter retention times for some diets con-taming whooping crane foods may partly explain lower digestibilities and metabolizable energy of winter whooping crane foods compared to commercial crane diet.

Crystal residence times from trace element zoning in plagioclase reveal changes in magma transfer dynamics at Mt. Etna during the last 400 years

NASA Astrophysics Data System (ADS)

Viccaro, Marco; Barca, Donatella; Bohrson, Wendy A.; D'Oriano, Claudia; Giuffrida, Marisa; Nicotra, Eugenio; Pitcher, Bradley W.

2016-04-01

Trace element zoning in plagioclase of selected alkaline lavas from the historic (1607-1892 AD) and recent (1983-2013 AD) activity of Mt. Etna volcano has been used to explore the possible role that volcano-tectonics exert on magma transfer dynamics. The observed textural characteristics of crystals include near-equilibrium textures (i.e., oscillatory zoning) and textures with variable extent of disequilibrium (patchy zoning, coarse sieve textures and dissolved cores). Historic crystals exhibit lower K concentrations at lower anorthite contents, a feature in agreement with the general more potassic character of the recent lavas if compared to the historic products. Historic plagioclases have statistically higher Ba and lower Sr concentrations than the recent crystals, which result in different Sr/Ba ratios for the two suites of plagioclase. Variations in the anorthite content along core-to-rim profiles obtained on crystals with different types of textures for both the historic and recent eruptive periods were evaluated particularly versus Sr/Ba. At comparable average An contents, crystals characterized by oscillatory zoning, which are representative of near-equilibrium crystallization from the magma, display distinct Sr/Ba ratios. We suggest that these features are primarily related to recharge of a new, geochemically-distinct magma into the storage and transport system of the volcano. In addition to distinct trace element and textural characteristics of plagioclase, Sr diffusion modeling for plagioclase suggests that residence times are generally shorter for crystals found in recently erupted lavas (25-77 years, average 43 years) compared to those of the historic products (43-163 years, average 99 years). Shorter residences times correlate with gradual increases in eruption volume and eruption frequency rates through time. We attribute these features to an increasing influence, since the 17th century, of extensional tectonic structures within the upper 10 km of the Etnean crust, which have promoted shorter residence times and higher eruption frequency.

Sutureless versus Conventional Aortic Valve Replacement: Outcomes in 70 High-Risk Patients Undergoing Concomitant Cardiac Procedures.

PubMed

Hanedan, Muhammet Onur; Yuruk, Mehmet Ali; Parlar, Ali Ihsan; Ziyrek, Ugur; Arslan, Ali Kemal; Sayar, Ufuk; Mataraci, Ilker

2018-02-01

In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all P =0.001), postoperative drainage amounts were lower ( P =0.009), hospital stays were shorter ( P =0.004), and less red blood cell transfusion was needed ( P =0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; P =0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

PubMed

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

A comparison of sugammadex and neostigmine for reversal of rocuronium-induced neuromuscular blockade in children.

PubMed

Ammar, A S; Mahmoud, K M; Kasemy, Z A

2017-04-01

Sugammadex is designed to be a reversal agent for steroidal muscle relaxants. The current trial was aimed to compare between sugammadex and neostigmine concerning the recovery time from neuromuscular blockade. We hypothesised that sugammadex might have shorter recovery time than neostigmine. Sixty paediatric patients aged 2-10 years scheduled for lower abdominal surgeries were randomly assigned into two equal groups to receive 4 mg/kg sugammadex (Group S) or 0.35 mg/kg neostigmine and 0.02 mg/kg atropine (Group N) as a reversal agent for rocuronium at the end of surgery. Primary outcome was the recovery time [time from starting of sugammadex or neostigmine till reaching train of four (TOF) ratio> 0.9] whereas secondary outcomes included number of patients who needed another dose of sugammadex or neostigmine to reach TOF ratio> 0.9, extubation time (time from stoppage of anaesthetic inhalation until the patient fulfilled criteria for safe extubation, post-anaesthesia care unit (PACU) discharge time and post-operative adverse effects. The mean recovery and extubation times were significantly shorter (P = 0.002 and 0.005) in Group S compared with Group N (2.5 and 2.0 min vs. 12.6 min and 4.3 min respectively). In the Group N, eight patients needed another reversal dose compared with one patient in Group S (P = 0.035). PACU discharge time showed no significant difference between both groups. Incidence of nausea, vomiting, tachycardia, and dry mouth were significantly higher in Group N. Sugammadex administration in children resulted in faster recovery and extubation times and lower incidence of adverse events compared with neostigmine. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Anesthetic efficacy of ketamine–diazepam, ketamine–xylazine, and ketamine–acepromazine in Caspian Pond turtles (Mauremys caspica)

PubMed Central

Adel, Milad; Sadegh, Amin Bigham; Arizza, Vincenzo; Abbasi, Hossein; Inguglia, Luigi; Saravi, Hasan Nasrollahzadeh

2017-01-01

Objectives: The objective of this study was to assess the efficacy of different anesthetic drug combinations on the Caspian Pond turtles (Mauremys caspica). Subjects and Methods: Three groups of the Caspian Pond turtles (n = 6) were anesthetized with three different drug combinations. Initially, a pilot study was conducted to determine the best drug doses for the anesthetization of the turtles, and according to these results, ketamine–diazepam (120 mg/kg ketamine hydrochloride [5%] and 2 mg/kg diazepam [5%]), ketamine–acepromazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg acepromazine [1%]), and ketamine–xylazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg xylazine [2%]) were injected intramuscularly. The onset times of anesthetization and the recovery time were measured. Statistical analysis of the data was performed using one-way analysis of variance followed by t-tests, and P < 0.05 was considered statistically significant. Results: There were statistically significant differences in the mean of the onset times of anesthesia and recovery time among the three drug combinations depending on the treatment used. The onset of anesthesia of the animals treated with the ketamine–diazepam combination was 60% and 42% shorter, for male and female turtles, respectively, compared to that obtained with the ketamine–acepromazine combination and 64% (male turtles) and 50% (female turtles) shorter than that obtained with the ketamine–xylazine combination. Further, the recovery time, in male turtles, was 17% shorter in animals treated with the first drug combination than those treated with the ketamine–acepromazine combination and 37% shorter than those treated with the ketamine–xylazine combination. The recovery time, in female turtles, did not seem to be significantly different among treatments. Conclusions: The study showed that the ketamine–diazepam drug combination is the anesthetic combination with the fastest onset time and shortest recovery time. PMID:28458430

[Difference in time of bowel sounds and passing of gas in abdominal hysterectomy patients having San-Yin-Jia (SP-6) acupressure].

PubMed

Chang, Soon Bok; Kim, Young Ran; Yoon, Mi Hee; Shim, Joung Un; Ko, Eun Hui; Kim, Min Ok

2004-12-01

The purpose of this study was to compare differences in the time when bowel sounds were heard and gas was passed in women who had an abdominal hysterectomy and were treated for 5 minutes (experimental group A) or 10 minutes (experimental group B) with San-Yin-Jiao (SP-6) acupressure. The design of this study was a nonequivalent control group non-synchronized post test only design. The participants included 142 women, 39 in experimental group A, 30 in experimental group B, and 73 in the control group. Data was collected using a structured questionnaire which included items on general characteristics and a self report of time when gas was passed. Differences for the three groups as to time when bowel sounds were heard and gas was passed were analyzed using ANOVA. The time when bowel sounds were heard was statistically significantly shorter in both experimental groups compared to the control group(F=10.29, p=.000). The time when gas was passed was statistically significantly shorter in experimental group B(10 min) compared to the control group(F=4.68, p=.011). It could be concluded that SP-6 acupressure of 10 minutes was effective in shortening the time until bowel sounds were heard and gas was passed for women who had had an abdominal hysterectomy. Replication of the study with a larger number of participants is necessary in order to be able to generalize the results.

A point-of-care chemistry test for reduction of turnaround and clinical decision time.

PubMed

Lee, Eui Jung; Shin, Sang Do; Song, Kyoung Jun; Kim, Seong Chun; Cho, Jin Seong; Lee, Seung Chul; Park, Ju Ok; Cha, Won Chul

2011-06-01

Our study compared clinical decision time between patients managed with a point-of-care chemistry test (POCT) and patients managed with the traditional central laboratory test (CLT). This was a randomized controlled multicenter trial in the emergency departments (EDs) of 5 academic teaching hospitals. We randomly assigned patients to POCT or CLT stratified by the Emergency Severity Index. A POCT chemistry analyzer (Piccolo; Abaxis, Inc, Union City, Calif), which is able to test liver panel, renal panel, pancreas enzymes, lipid panel, electrolytes, and blood gases, was set up in each ED. Primary and secondary end point was turnaround time and door-to-clinical-decision time. The total 2323 patients were randomly assigned to the POCT group (n = 1167) or to the CLT group (n = 1156). All of the basic characteristics were similar in the 2 groups. The turnaround time (median, interquartile range [IQR]) of the POCT group was shorter than that of the CLT group (14, 12-19 versus 55, 45-69 minutes; P < .0001). The median (IQR) door-to-clinical-decision time was also shorter in the POCT compared with the CLT group (46, 33-61 versus 86, 68-107 minutes; P < .0001). The proportion of patients who had new decisions within 60 minutes was 72.8% for the POCT group and 12.5% for the CLT group (P < .0001). A POCT chemistry analyzer in the ED shortens the test turnaround and ED clinical decision times compared with CLT. Copyright © 2011 Elsevier Inc. All rights reserved.

Transoral robotic surgery vs transoral laser microsurgery for resection of supraglottic cancer: a pilot surgery.

PubMed

Ansarin, Mohssen; Zorzi, Stefano; Massaro, Maria Angela; Tagliabue, Marta; Proh, Michele; Giugliano, Gioacchino; Calabrese, Luca; Chiesa, Fausto

2014-03-01

Transoral laser microsurgery (TLM) is a mature approach to supraglottic cancer, while transoral robotic surgery (TORS) is emerging. The present study compared these approaches. The first 10 patients (2002-2005) given TLM were compared with the first 10 (2007-2011) given TORS for cT1-3 cN0-cN2c supraglottic cancer. A feeding tube was used in four TLM and seven TORS patients. Margins were more often positive, but operating times shorter, in TORS. All 10 TORS patients are without evidence of disease, but only six TLM patients remain disease-free after much longer follow-up. TORS was considerably less uncomfortable and fatiguing for the surgeon. TORS seems as safe and effective as TLM. Shorter TORS operating times are probably attributable to prior experience with TLM. For laryngeal exposure, length of tube placement and margin evaluability, TLM was superior; however, this may change as TORS develops and transoral robotic instruments are optimized. Copyright © 2013 John Wiley & Sons, Ltd.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist.

PubMed

Reebye, Uday; Young, S; Boukas, E; Davidian, E; Carnahan, J

2017-01-01

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.

A favorable course of palliative sedation: searching for indicators using caregivers' perspectives.

PubMed

Brinkkemper, Tijn; Rietjens, Judith A C; Deliens, Luc; Ribbe, Miel W; Swart, Siebe J; Loer, Stephan A; Zuurmond, Wouter W A; Perez, Roberto S G M

2015-03-01

Comparing characteristics of a favorable sedation course during palliative sedation to a less favorable course based on the reports Dutch physicians and nurses. Cases identified as having a favorable sedation course less often concerned a male patient (P = .019 nurses' cases), reached the intended sedation depth significantly quicker (P < .05 both nurses and physicians' cases), reached a deeper level of sedation (P = .015 physicians' cases), and had a shorter total duration of sedation compared (P < .001 physicians' cases) to patients with a less favorable sedation course. A favorable course during palliative sedation seems more probable when health care professionals report on a (relatively) shorter time to reach the required depth of sedation and when a deeper level of sedation can be obtained. © The Author(s) 2013.

An application of a relational database system for high-throughput prediction of elemental compositions from accurate mass values.

PubMed

Sakurai, Nozomu; Ara, Takeshi; Kanaya, Shigehiko; Nakamura, Yukiko; Iijima, Yoko; Enomoto, Mitsuo; Motegi, Takeshi; Aoki, Koh; Suzuki, Hideyuki; Shibata, Daisuke

2013-01-15

High-accuracy mass values detected by high-resolution mass spectrometry analysis enable prediction of elemental compositions, and thus are used for metabolite annotations in metabolomic studies. Here, we report an application of a relational database to significantly improve the rate of elemental composition predictions. By searching a database of pre-calculated elemental compositions with fixed kinds and numbers of atoms, the approach eliminates redundant evaluations of the same formula that occur in repeated calculations with other tools. When our approach is compared with HR2, which is one of the fastest tools available, our database search times were at least 109 times shorter than those of HR2. When a solid-state drive (SSD) was applied, the search time was 488 times shorter at 5 ppm mass tolerance and 1833 times at 0.1 ppm. Even if the search by HR2 was performed with 8 threads in a high-spec Windows 7 PC, the database search times were at least 26 and 115 times shorter without and with the SSD. These improvements were enhanced in a low spec Windows XP PC. We constructed a web service 'MFSearcher' to query the database in a RESTful manner. Available for free at http://webs2.kazusa.or.jp/mfsearcher. The web service is implemented in Java, MySQL, Apache and Tomcat, with all major browsers supported. sakurai@kazusa.or.jp Supplementary data are available at Bioinformatics online.

Patient navigation reduces time to care for patients with breast symptoms and abnormal screening mammograms.

PubMed

McKevitt, Elaine; Dingee, Carol; Warburton, Rebecca; Pao, Jin-Si; Brown, Carl J; Wilson, Christine; Kuusk, Urve

2018-05-01

Concern has been raised about delays for patients presenting with breast symptoms in Canada. Our objective was to determine if our Rapid Access Breast Clinic (RABC) improved care for patients presenting with breast symptoms compared to the traditional system (TS). A retrospective chart review tabulated demographic, surgical, pathology and radiologic information. Wait times to care were determined for patients presenting with symptomatic and screen detected breast problems. Time from presentation to surgeon evaluation was shorter in the RABC group for patients with breast symptoms (81 vs 35 days, p < .0001) and abnormal screens (72 vs 40 days, p = .092). Cancer patients with abnormal screens had shorter wait times than patients with breast symptoms in the TS (47 vs 70 days, p = .036). Coordination of imaging and clinical care reduces wait times in patients with both abnormal screening mammograms and symptomatic breast presentations and should be expanded in our province. Copyright © 2018 Elsevier Inc. All rights reserved.

Gas Chromatograph Method Optimization Trade Study for RESOLVE: 20-meter Column v. 8-meter Column

NASA Technical Reports Server (NTRS)

Huz, Kateryna

2014-01-01

RESOLVE is the payload on a Class D mission, Resource Prospector, which will prospect for water and other volatile resources at a lunar pole. The RESOLVE payload's primary scientific purpose includes determining the presence of water on the moon in the lunar regolith. In order to detect the water, a gas chromatograph (GC) will be used in conjunction with a mass spectrometer (MS). The goal of the experiment was to compare two GC column lengths and recommend which would be best for RESOLVE's purposes. Throughout the experiment, an Inficon Fusion GC and an Inficon Micro GC 3000 were used. The Fusion had a 20m long column with 0.25mm internal diameter (Id). The Micro GC 3000 had an 8m long column with a 0.32mm Id. By varying the column temperature and column pressure while holding all other parameters constant, the ideal conditions for testing with each column length in their individual instrument configurations were determined. The criteria used for determining the optimal method parameters included (in no particular order) (1) quickest run time, (2) peak sharpness, and (3) peak separation. After testing numerous combinations of temperature and pressure, the parameters for each column length that resulted in the most optimal data given my three criteria were selected. The ideal temperature and pressure for the 20m column were 95 C and 50psig. At this temperature and pressure, the peaks were separated and the retention times were shorter compared to other combinations. The Inficon Micro GC 3000 operated better at lower temperature mainly due to the shorter 8m column. The optimal column temperature and pressure were 70 C and 30psig. The Inficon Micro GC 3000 8m column had worse separation than the Inficon Fusion 20m column, but was able to separate water within a shorter run time. Therefore, the most significant tradeoff between the two column lengths was peak separation of the sample versus run time. After performing several tests, it was concluded that better detection via good peak separation with a longer run time is a better asset than moderate peak separation with a shorter run time. Even given that RESOLVE is highly interested in water and that mission timeline is of significant importance given the short seven-to-ten-day mission timeline, worse detection with an 8m column may lead to overlooking other substances existing on the moon that could advance planetary science. Thus, I recommend the 20m column. However, if mission timeline and water separation are deemed the highest priority, the 8m column should be selected due to its ability to separate water within a shorter run time than the 20m column.

Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade.

PubMed

Kriege, Marc; Alflen, Christian; Noppens, Ruediger R

2017-01-01

It is generally accepted that using a video laryngoscope is associated with an improved visualization of the glottis. However, correctly placing the endotracheal tube might be challenging. Channeled video laryngoscopic blades have an endotracheal tube already pre-loaded, allowing to advance the tube once the glottis is visualized. We hypothesized that use of a channel blade with pre-loaded endotracheal tube results in a faster intubation, compared to a curved Macintosh blade video laryngoscope. After ethical approval and informed consent, patients were randomized to receive endotracheal Intubation with either the King Vision® video laryngoscope with curved blade (control) or channeled blade (channeled). Success rate, evaluation of the glottis view (percentage of glottic opening (POGO), Cormack&Lehane (C&L)) and intubating time were evaluated. Over a two-month period, a total of 46 patients (control n = 23; channeled n = 23) were examined. The first attempt success rates were comparable between groups (control 100% (23/23) vs. channeled 96% (22/23); p = 0.31). Overall intubation time was significantly shorter with control (median 40 sec; IQR [24-58]), compared to channeled (59 sec [40-74]; p = 0.03). There were no differences in glottis visualization between groups. Compared with the King Vision channeled blade, time for tracheal intubation was shorter with the control group using a non-channeled blade. First attempt success and visualization of the glottis were comparable. These data do not support the hypothesis that a channeled blade is superior to a curved video laryngoscopic blade without tube guidance. ClinicalTrials.gov NCT02344030.

Treatment of gallbladder stone with common bile duct stones in the laparoscopic era.

PubMed

Zhang, Wei-jie; Xu, Gui-fang; Huang, Qin; Luo, Kun-lun; Dong, Zhi-tao; Li, Jie-ming; Wu, Guo-zhong; Guan, Wen-xian

2015-01-26

Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients. From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE. Intraoperative findings, postoperative complications, postoperative hospital stay and costs were analyzed. Because of LCBDE failure,16 cases (4.6%) required open surgery. Of 330 successful LCBDE-treated patients, 237 underwent LTSE and 93 required LC. No mortality occurred in either group. The bile duct stone clearance rate was similar in both groups. Patients in the LTSE group were significantly younger and had fewer complications with smaller, fewer stones, shorter operative time and postoperative hospital stays, and lower costs, compared to those in the LC group. Compared with patients with T-tube insertion, patients in the LC group with primary closure had shorter operative time, shorter postoperative hospital stay, and lower costs. In cases requiring LCBDE, LTSE should be the first choice, whereas LC may be restricted to large, multiple stones. LC with primary closure without external drainage of the CBDS is as effective and safe as the T-tube insertion approach.

Single-incision versus conventional three-port laparoscopic appendectomy: A meta-analysis of randomized controlled trials.

PubMed

Chen, Jiang-Ming; Geng, Wei; Xie, Sheng-Xue; Liu, Fu-Bao; Zhao, Yi-Jun; Yu, Li-Quan; Geng, Xiao-Ping

2015-01-01

The aim of this article was to compare the advantages and disadvantages of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA). A meta-analysis was performed by analyzing all randomized controlled trials (RCTs) published in English that compared SILA and CTLA for appendicitis in adults and children. These studies compared these two methods from different angles including outcomes of interest, patient characteristics, operative time, pain visual analogue scales scores (VAS scores), length of hospital stay, time to return to full activity, resumption of diet, postoperative complications and cosmetic results The risk ratios (RR) and mean difference (MD) with 95% confidence intervals (CIs) were employed to assess the outcome. Seven recent RCTs encompassing 1170 patients (586 SILA and 584 CTLA cases) were included in this meta-analysis. The pooled results demonstrated that conversion rate, drain inserted, reoperation, length of hospital stay, resumption of normal diet and postoperative complications were statistically comparable between the two groups. The postoperative abdominal pain within 24 h was -0.57 in favor of the SILA technique (p = 0.05). Compared with CTLA, SILA showed a better cosmetic satisfaction score (SMD, 0.58; 95% CI, 0.32-0.83; p < 0.0001) and shorter time to recover normal activity (WMD, -0.69; 95% CI, -1.11-0.26; p = 0.001). However, SILA has a longer operative time (WMD, 5.38; 95% CI, 2.94-7.83; p < 0.0001). In selected patients, SILA was confirmed to be as safe and effective as CTLA. Despite the longer operative time, SILA has higher cosmetic satisfaction and shorter recovery time to normal activity. Due to the limitations of the available data, further research is needed.

Life history traits in selfing versus outcrossing annuals: exploring the 'time-limitation' hypothesis for the fitness benefit of self-pollination

PubMed Central

Snell, Rebecca; Aarssen, Lonnie W

2005-01-01

Background Most self-pollinating plants are annuals. According to the 'time-limitation' hypothesis, this association between selfing and the annual life cycle has evolved as a consequence of strong r-selection, involving severe time-limitation for completing the life cycle. Under this model, selection from frequent density-independent mortality in ephemeral habitats minimizes time to flower maturation, with selfing as a trade-off, and / or selection minimizes the time between flower maturation and ovule fertilization, in which case selfing has a direct fitness benefit. Predictions arising from this hypothesis were evaluated using phylogenetically-independent contrasts of several life history traits in predominantly selfing versus outcrossing annuals from a data base of 118 species distributed across 14 families. Data for life history traits specifically related to maturation and pollination times were obtained by monitoring the start and completion of different stages of reproductive development in a greenhouse study of selfing and outcrossing annuals from an unbiased sample of 25 species involving five pair-wise family comparisons and four pair-wise genus comparisons. Results Selfing annuals in general had significantly shorter plant heights, smaller flowers, shorter bud development times, shorter flower longevity and smaller seed sizes compared with their outcrossing annual relatives. Age at first flower did not differ significantly between selfing and outcrossing annuals. Conclusions This is the first multi-species study to report these general life-history differences between selfers and outcrossers among annuals exclusively. The results are all explained more parsimoniously by selection associated with time-limitation than by selection associated with pollinator/mate limitation. The shorter bud development time reported here for selfing annuals is predicted explicitly by the time-limitation hypothesis for the fitness benefit of selfing (and not by the alternative 'reproductive assurance' hypothesis associated with pollinator/mate limitation). Support for the time-limitation hypothesis is also evident from published surveys: whereas selfers and outcrossers are about equally represented among annual species as a whole, selfers occur in much higher frequencies among the annual species found in two of the most severely time-limited habitats where flowering plants grow – deserts and cultivated habitats. PMID:15707481

Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography.

PubMed

Hirayama, Yasutaka; Kawamura, Yuichiro; Sato, Nobuyuki; Saito, Tatsuya; Tanaka, Hideichi; Saijo, Yasuaki; Kikuchi, Kenjiro; Ohori, Katsumi; Hasebe, Naoyuki

2017-02-01

Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P <0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P <0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P =0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P =0.002) compared with RVA and RVMS pacing. These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.

Clinical and molecular predictors of disease severity and survival in chronic lymphocytic leukemia.

PubMed

Weinberg, J Brice; Volkheimer, Alicia D; Chen, Youwei; Beasley, Bethany E; Jiang, Ning; Lanasa, Mark C; Friedman, Daphne; Vaccaro, Gina; Rehder, Catherine W; Decastro, Carlos M; Rizzieri, David A; Diehl, Louis F; Gockerman, Jon P; Moore, Joseph O; Goodman, Barbara K; Levesque, Marc C

2007-12-01

Several parameters may predict disease severity and overall survival in chronic lymphocytic leukemia (CLL). The purpose of our study of 190 CLL patients was to compare immunoglobulin heavy chain variable region (IgV(H)) mutation status, cytogenetic abnormalities, and leukemia cell CD38 and Zap-70 to older, traditional parameters. We also wanted to construct a simple, inexpensive prognosis score that would significantly predict TTT and survival in patients at the time of diagnosis and help practicing clinicians. In univariate analyses, patients with higher clinical stage, higher leukocyte count at diagnosis, shorter leukocyte doubling time, elevated serum lactate dehydrogenase (LDH), unmutated immunoglobulin heavy chain variable region (IgV(H)) genes, and higher CD38 had a shorter overall survival and time-to-treatment (TTT). CLL cell Zap-70 expression was higher in patients with unmutated IgV(H), and those with higher Zap-70 tended to have shorter survival. IgV(H)4-34 or IgV(H)1-69 was the most common IgV(H) genes used (16 and 12%, respectively). Of those with IgV(H)1-69, 86% had unmutated IgV(H) and had a significantly shorter TTT. A cytogenetic abnormality was noted in 71% of the patients tested. Patients with 11q22 del and 17p13 del or complex abnormalities were significantly more likely to have unmutated IgV(H). We found that a prognostic score constructed using modified Rai stage, cellular CD38, and serum LDH (parameters easily obtained clinically) significantly predicted TTT and survival in patients at the time of diagnosis and performed as well or better than models using the newer markers.

Assessment of the effectiveness of head only and back-of-the-head electrical stunning of chickens

PubMed Central

Gibson, T. J.; Taylor, A. H.; Gregory, N. G.

2016-01-01

Abstract The study assesses the effectiveness of reversible head-only and back-of-the-head electrical stunning of chickens using 130–950 mA per bird at 50 Hz AC.Three trials were conducted to compare both stunning systems: (a) behavioural assessment of return of consciousness, (b) insensibility to thermal pain, and (c) assessment of return of brain activity with visually evoked potentials (VEPs).Assessment of behaviour suggested that the period of unconsciousness following head-only electrical stunning was shorter in hens compared to broilers.Stunning across the back-of-the-head delayed the time to return of brainstem function compared to stunning with standard head-only electrodes. Additionally, back-of-the-head stunning produced a more prolonged period of electroanalgesia compared to head-only.Based on examination of return of brain function with VEPs in hens, back-of-the-head stunning produced a shorter-lasting stun than standard head-only. However, even for standard head-only, the stun was notably shorter than previously reported. In some birds, brain function had returned within 9 s after the end of stunning.The results suggest that some birds may recover consciousness prior to or during the neck cut. Based on these findings, back-of-the-head stunning and standard head-only stunning of hens should not be recommended without further development. PMID:27023411

Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes.

PubMed

Paydarfar, Joseph A; Patel, Urjeet A

2011-01-01

To compare intraoperative, postoperative, and functional results of submental island pedicled flap (SIPF) against radial forearm free flap (RFFF) reconstruction for tongue and floor-of-mouth reconstruction. Multi-institutional retrospective review. Academic tertiary referral center. Consecutive patients from February 2003 to December 2009 undergoing resection of oral tongue or floor of mouth followed by reconstruction with SIPF or RFFF. Two groups: SIPF vs RFFF. Duration of operation, hospital stay, surgical complications, and speech and swallowing function. The study included 60 patients, 27 with SIPF reconstruction and 33 with RFFF reconstruction. Sex, age, and TNM stage were similar for both groups. Mean flap size was smaller for SIPF (36 cm²) than for RFFF (50 cm²) (P < .001). Patients undergoing SIPF reconstruction had shorter operations (mean, 8 hours 44 minutes vs 13 hours 00 minutes; P < .001) and shorter hospitalization (mean, 10.6 days vs 14.0 days; P < .008) compared with patients who underwent RFFF. Donor site, flap-related, and other surgical complications were comparable between groups, as was speech and swallowing function. Reconstruction of oral cavity defects with the SIPF results in shorter operative time and hospitalization without compromising functional outcomes. The SIPF may be a preferable option in reconstruction of oral cavity defects less than 40 cm².

May radiofrequency be the best choice for III-IV degree hemorrhoids?

PubMed

Milito, Giovanni; Lisi, Giorgio; Aronadio, Elena; Campanelli, Michela; Venditti, Dario; Grande, Simona; Grande, Michele

2017-03-01

Hemorrhoidectomy is considered the most efficient method to treat hemorrhoids of III and IV grades. The aim of this study was to compare conventional diathermy hemorrhoidectomy and radiofrequency hemorrhoidectomy based on a large series of patients. Between June 2001 and June 2014, 1000 patients have been treated with radiofrequency hemorrhoidectomy (group A) and 500 patients have been treated with diathermy (group B) as a day-case procedure. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. The mean follow-up was seven years. The mean operating time for radiofrequency hemorrhoidectomy was shorter than diathermy but not significantly. Patients treated with radiofrequency had significantly less postoperative pain (measured on a Visual Analogue Scale; P=0.001), a shorter wound healing time, less time off work and postoperative complications (P=0.001) than patients who had diathermy. Neither wound healing nor mean hospital stay (day-case surgery) was significantly different. Radiofrequency hemorrhoidectomyis a valid alternative to the conventional diathermy technique, due to the reduction of operative time, postoperative pain, early and late complication rate.

Efficacy and indications of transradial and transfemoral approaches for peripheral artery stent implantation.

PubMed

Chen, Peng; Li, Huijie; Zeng, Chunyu; Fang, Yuqiang; Shi, Weibin; Zhang, Xiaoqun; Yang, Chengming

2017-06-01

The transradial approach (TRA) has become an attractive alternative to the transfemoral approach (TFA) in percutaneous coronary intervention. To date, however, these two approaches have not been systematically compared in various percutaneous peripheral artery interventions (PPAIs). In the present study 258 patients with peripheral artery disease that underwent PPAI via the TRA (n=75) or the TFA (n=183) were analyzed. Clinical factors and outcomes in these two groups were compared. The puncture time was significantly longer (P<0.05) and the prevalence of artery vasospasm significantly higher (P<0.05) in patients who underwent PPAI via the TRA rather than via the TFA. However, the complication rate was significantly lower (P<0.05) and the artery compression time (P<0.05) and time bedridden (P<0.05) were significantly shorter via the TRA than via the TFA. These results suggest that PPAI via the TRA was associated with a lower complication rate, and shorter artery compression time and bedridden time than PPAI via the TFA. The TRA may be preferable for bilateral vertebral artery stenosis, whereas the TFA may be preferable for interventional treatment of carotid and subclavian artery stenosis. Therefore, the catheter length, artery support and push force should be comprehensively considered before choosing the TRA or TFA in the interventional treatment of renal artery stenosis.

Effectiveness of Acupuncture for Early Recovery of Bowel Function in Cancer: A Systematic Review and Meta-Analysis.

PubMed

Liu, Yi-Hua; Dong, Guang-Tong; Ye, Yang; Zheng, Jia-Bin; Zhang, Ying; Lin, Hong-Sheng; Wang, Xue-Qian

2017-01-01

The aim of this study was to evaluate the effects of acupuncture therapy to reduce the duration of postoperative ileus (POI) and to enhance bowel function in cancer patients. A systematic search of electronic databases for studies published from inception until January 2017 was carried out from six databases. Randomized controlled trials (RCTs) involving the use of acupuncture and acupressure for POI and bowel function in cancer patients were identified. Outcomes were extracted from each study and pooled to determine the risk ratio and standardized mean difference. 10 RCTs involving 776 cancer patients were included. Compared with control groups (no acupuncture, sham acupuncture, and other active therapies), acupuncture was associated with shorter time to first flatus and time to first defecation. A subgroup analysis revealed that manual acupuncture was more effective on the time to first flatus and the time to first defecation; electroacupuncture was better in reducing the length of hospital stay. Compared with control groups (sham or no acupressure), acupressure was associated with shorter time to first flatus. However, GRADE approach indicated a low quality of evidence. Acupuncture and acupressure showed large effect size with significantly poor or inferior quality of included trials for enhancing bowel function in cancer patients after surgery. Further well-powered evidence is needed.

Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

PubMed

van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

2017-01-01

To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

Association between reported sleep need and sleepiness at the wheel: comparative study on French highways between 1996 and 2011

PubMed Central

Quera-Salva, M A; Sauvagnac-Quera, R; Sagaspe, P; Taillard, J; Contrand, B; Micoulaud, J A; Lagarde, E; Barbot, F; Philip, P

2016-01-01

Objective To investigate the evolution over 15 years of sleep schedules, sleepiness at the wheel and driving risk among highway drivers. Methods Comparative survey including questions on usual sleep schedules and before the trip, sleepiness at the wheel, the Epworth sleepiness scale, Basic Nordic Sleep Questionnaire (BNSQ) and a travel questionnaire. Results 80% of drivers stopped by the highway patrol agreed to participate in both studies with a total of 3545 drivers in 2011 and 2196 drivers in 1996 interviewed. After standardisation based on sex, age and mean annual driving distance, drivers in 2011 reported shorter sleep time on week days (p<0.0001), and week-ends (p<0.0001) and shorter optimal sleep time (p<0.0001) compared to 1996 drivers. There were more drivers sleepy at the wheel in 2011 than in 1996 (p<0.0001) and 2.5 times more drivers in 2011 than in 1996 had an Epworth sleepiness score >15 indicating severe sleepiness. Conclusions Even if drivers in 2011 reported good sleep hygiene prior to a highway journey, drivers have reduced their mean weekly sleep duration over 15 years and have a higher risk of sleepiness at the wheel. Sleep hygiene for automobile drivers remains an important concept to address. PMID:28003284

Midface distraction osteogenesis: internal vs. external devices.

PubMed

Meling, T R; Høgevold, H-E; Due-Tønnessen, B J; Skjelbred, P

2011-02-01

This study compares internal and external distraction devices in the treatment of midface retrusion. 20 patients were treated with midface distraction (12 Crouzon, 4 Apert, 4 others); 12 with internal distraction (MID device), 8 with external distraction (Red or Blue device). The two groups were compared regarding operation time, peroperative blood loss and complications. The groups were comparable regarding patient age, sex, weight and diagnosis. In the MID-group, 7 of 12 patients (58%) underwent Le Fort III, 5 underwent 12 monobloc (32%). In the Blue device group, three of eight patients underwent Le Fort II (38%), three of eight underwent Le Fort III (38%), and two of eight underwent monobloc (25%). Operation time was shorter in the Blue device (mean 298 min) than in the MID group (mean 354 min). Peroperative blood loss and complication rates were similar. The internal distraction device is the 'gold standard' for treating midface retrusion. The use of an external distraction device in midface distraction osteogenesis is associated with a shorter operation time; peroperative blood loss and complications were similar. An external device affords better 3-dimensional control during the distraction process, so external distraction is preferable in patients who will tolerate this treatment. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A comparison of heart rate variability, n-3 PUFA status and lipid mediator profile in age- and BMI-matched middle-aged vegans and omnivores.

PubMed

Pinto, Ana M; Sanders, Thomas A B; Kendall, Alexandra C; Nicolaou, Anna; Gray, Robert; Al-Khatib, Haya; Hall, Wendy L

2017-03-01

Low heart rate variability (HRV) predicts sudden cardiac death. Long-chain (LC) n-3 PUFA (C20-C22) status is positively associated with HRV. This cross-sectional study investigated whether vegans aged 40-70 years (n 23), whose diets are naturally free from EPA (20 : 5n-3) and DHA (22 : 6n-3), have lower HRV compared with omnivores (n 24). Proportions of LC n-3 PUFA in erythrocyte membranes, plasma fatty acids and concentrations of plasma LC n-3 PUFA-derived lipid mediators were significantly lower in vegans. Day-time interbeat intervals (IBI), adjusted for physical activity, age, BMI and sex, were significantly shorter in vegans compared with omnivores (mean difference -67 ms; 95 % CI -130, -3·4, P50 % and high-frequency power) were similarly lower in vegans, with no differences during sleep. In conclusion, vegans have higher 24 h SDNN, but lower day-time HRV and shorter day-time IBI relative to comparable omnivores. Vegans may have reduced availability of precursor markers for pro-resolving lipid mediators; it remains to be determined whether there is a direct link with impaired cardiac function in populations with low-n-3 status.

[Coronary bypass in treatment of high-risk patients].

PubMed

Avdagić, Harun; Mujanović, Emir; Mesanović, Nihad; Sijereić-Avdagić, Selma; Pirić, Melika

2009-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit, total length of hospitalisation and number of complication in two groups of patients operated with these methods. Patients with EuroScore > or =5 with CABG operated in Cardiovascular Clinic Tuzla, from May 2000 to May 2005 divided in two groups, were included in this study. There were 100 patients in the first group operated with CPB and 100 patients in the second group operated without CPB. The average time spent on respirators was shorter in patients operated without CPB (3.7 vs.9.74 hours, p = 0.023) and the time spent in Intensive care shorter too (19 vs. 23 days, p = 0.008). Volume of postoperative bleeding was less in patients operated without CPB (574.9 vs. 988.9 ml, p = 0.038), as volume after blood transfusion (168.8 vs. 350.3 mi, p = 0.001). Intraoperative inotrope support was less in patients operated without CPB (8.0 vs. 19.0%, p = 0.038) as postoperative inotrope support (6.0 vs. 17.0%, p = 0.027). The most usual postoperative complication was atrial fibrillation and there was no difference between patients operated with CPB and without CPB (24% vs. 17%, p = 0.293). Mortality was not different in patients operated with or without CPB (2.0% vs. 6.0%, p = 0.140). The average time of total hospitalisation was also shorter in patients operated without CPB (8.0 vs. 9.5 days, p = 0.039. In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care. The total hospitalisation time is also reduced.

Gelatin-thrombin hemostatic matrix in neurosurgical procedures: hemostasis effectiveness and economic value of clinical and surgical procedure-related benefits.

PubMed

Esposito, Felice; Cappabianca, Paolo; Angileri, Filippo F; Cavallo, Luigi M; Priola, Stefano M; Crimi, Salvatore; Solari, Domenico; Germanò, Antonino F; Tomasello, Francesco

2016-07-26

Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value. In a 6-month retrospective evaluation at 2 hospitals, intraoperative and postoperative information were collected from patients undergoing neurosurgical procedures where bleeding was controlled with gelatin-thrombin matrix or according to local bleeding control guidelines (control group). Study endpoints were: length of surgery, estimated blood loss, hospitalization duration, blood units utilized, intensive care unit days, postoperative complications, and time-to-recovery. Statistical methods compared endpoints between the gelatin-thrombin and control groups and resource utilization costs were estimated. Seventy-eight patients (38 gelatin-thrombin; 40 control) were included. Gelatin-thrombin was associated with a shorter surgery duration than control 166±40 versus 185±55, p=0.0839); a lower estimated blood loss (185±80 versus 250±95ml; p=0.0017); a shorter hospital stay (10±3 versus 13±3 days; p<0.001); fewer intensive care unit days (10 days/3 patients and 20 days/4 patients); and shorter time-to-recovery (3±2.2 versus 4±2.8 weeks; p=0861). Fewer gelatin-thrombin patients experienced postoperative complications (3 minor) than the control group (5 minor; 3 major). No gelatin-thrombin patient required blood transfusion; 5 units were administered in the control group. The cost of gelatin-thrombin (€268.40/unit) was offset by the shorter surgery duration (difference of 19 minutes at €858 per hour) and the economic value of improved the other endpoint outcomes (ie, shorter hospital stay, less blood loss/lack of need for transfusion, fewer intensive care unit days, and complications). Gelatin-thrombin hemostatic matrix use in patients undergoing neurosurgical procedures was associated with better intra- and post-operative parameters than conventional hemostasis methods, with these parameters having substantial economic benefits.

Threshold units: A correct metric for reaction time?

PubMed Central

Zele, Andrew J.; Cao, Dingcai; Pokorny, Joel

2007-01-01

Purpose To compare reaction time (RT) to rod incremental and decremental stimuli expressed in physical contrast units or psychophysical threshold units. Methods Rod contrast detection thresholds and suprathreshold RTs were measured for Rapid-On and Rapid-Off ramp stimuli. Results Threshold sensitivity to Rapid-Off stimuli was higher than to Rapid-On stimuli. Suprathreshold RTs specified in Weber contrast for Rapid-Off stimuli were shorter than for Rapid-On stimuli. Reaction time data expressed in multiples of threshold reversed the outcomes: Reaction times for Rapid-On stimuli were shorter than those for Rapid-Off stimuli. The use of alternative contrast metrics also failed to equate RTs. Conclusions A case is made that the interpretation of RT data may be confounded when expressed in threshold units. Stimulus energy or contrast is the only metric common to the response characteristics of the cells underlying speeded responses. The use of threshold metrics for RT can confuse the interpretation of an underlying physiological process. PMID:17240416

Correlation of fermentation characteristics with intake and digestibility of alfalfa silage in gestating ewes

USDA-ARS?s Scientific Manuscript database

Baled silage production provides benefits to farmers because it reduces leaf losses, and requires a shorter wilting time, thereby limiting risks of exposure to rain compared with making hay. Our objective was to investigate the correlation of alfalfa silage fermentation parameters with intake and di...

Prospective and retrospective time perception are related to mental time travel: evidence from Alzheimer's disease.

PubMed

El Haj, Mohamad; Moroni, Christine; Samson, Séverine; Fasotti, Luciano; Allain, Philippe

2013-10-01

Unlike prospective time perception paradigms, in which participants are aware that they have to estimate forthcoming time, little is known about retrospective time perception in normal aging and Alzheimer's disease (AD). Our paper addresses this shortcoming by comparing prospective and retrospective time estimation in younger adults, older adults, and AD patients. In four prospective tasks (lasting 30s, 60s, 90s, or 120s) participants were asked to read a series of numbers and to provide a verbal estimation of the reading time. In four other retrospective tasks, they were not informed about time judgment until they were asked to provide a verbal estimation of four elapsed time intervals (lasting 30s, 60s, 90s, or 120s). AD participants gave shorter verbal time estimations than older adults and younger participants did, suggesting that time is perceived to pass quickly in these patients. For all participants, the duration of the retrospective tasks was underestimated as compared to the prospective tasks and both estimations were shorter than the real time interval. Prospective time estimation was further correlated with mental time travel, as measured with the Remember/Know paradigm. Mental time travel was even higher correlated with retrospective time estimation. Our findings shed light on the relationship between time perception and the ability to mentally project oneself into time, two skills contributing to human memory functioning. Finally, time perception deficits, as observed in AD patients, can be interpreted in terms of dramatic changes occurring in frontal lobes and hippocampus. Copyright © 2013 Elsevier Inc. All rights reserved.

Thermal inactivation of Listeria innocua in salmon (Oncorhynchus keta) caviar using conventional glass and novel aluminum thermal-death-time tubes.

PubMed

Al-Holy, M; Quinde, Z; Guan, D; Tang, J; Rasco, B

2004-02-01

Differences in the come-up times and thermal inactivation parameters of Listeria innocua in salmon (Oncorhynchus keta) caviar containing 2.5% salt using conventional thermal-death-time (TDT) glass tubes and a novel aluminum tube were tested and compared. Generally, the come-up times and decimal reduction times (D-values) were shorter and the change in temperature required to change the D-value (z-value) was longer in the aluminum than in the glass tubes. The D-values at 60, 63, and 65 degrees C for the aluminum TDT tubes were 2.97, 0.77, and 0.40 min, respectively, and for the glass TDT tubes, these values were 3.55, 0.84, and 0.41 min. The z-values were 5.7 degrees C in the aluminum and 5.3 degrees C in the glass. Because of the shorter come-up time, the aluminum TDT tubes may provide a more precise measurement of microbial thermal inactivation than the glass TDT tubes, particularly for viscous materials, solid foods, and foods containing particulate matter.

Complete Versus Incomplete Angiography Prior to Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction.

PubMed

Stiver, Kevin; Gao, Xu; Shreenivas, Satya; Boudoulas, Konstantinos Dean; Mazzaferri, Ernie; Makki, Nader; Lilly, Scott M

2017-08-01

Shorter reperfusion times in ST-elevation myocardial infarction (STEMI) are associated with improved survival. Prehospital strategies have been developed to minimize door-to-balloon (DTB) time, but few strategies within the catheterization laboratory itself have been evaluated. Incomplete angiography (IA) prior to percutaneous coronary intervention (PCI) is undertaken in clinical practice as a means to further reduce DTB time. We sought to determine whether or not those with STEMI who underwent IA prior to PCI had different preprocedural characteristics or post-PCI outcomes. We retrospectively reviewed patients presenting to our institution between March 2013 and December 2015. Clinical, demographic, and angiographic data were reviewed. The frequency, predictors, and outcomes among those who received IA vs complete angiography (CA) prior to PCI were compared with analysis of variance. Two hundred fifty-six patients were identified; 68 patients (26.6%) underwent IA and 188 patients (73.4%) had CA prior to PCI. Patients who received IA were younger, but no other preprocedural factors were predictive of IA. The practice of IA did vary by operator (range, 0%-47%; P<.01). DTB times were shorter in the IA group (28.1 min vs 37.3 min; P<.01). Overall outcomes, including peak troponin values, length of stay, in-hospital mortality, and discharge ejection fraction did not differ between the groups. IA is associated with shorter DTB times, although in this population was not associated with improvements in short-term outcomes.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist

PubMed Central

Young, S.; Boukas, E.; Davidian, E.; Carnahan, J.

2017-01-01

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries. PMID:28128661

Randomized prospective study of olecranon fracture fixation: cable pin system versus tension band wiring.

PubMed

Liu, Q-H; Fu, Z-G; Zhou, J-L; Lu, T; Liu, T; Shan, L; Liu, Y; Bai, L

2012-01-01

This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. The mean ± SD fracture healing time was significantly shorter in the CPS group (n = 30; 9.73 ± 2.02 weeks) compared with the TBW group (n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.

Modified gastroduodenostomy in laparoscopy-assisted distal gastrectomy: a 'tornado' anastomosis.

PubMed

Kubota, Keisuke; Kuroda, Junko; Yoshida, Masashi; Okada, Akihiro; Nitori, Nobuhiro; Kitajima, Masaki

2013-01-01

This study was to examine the utility of a modified double-stapling end-to-end gastroduodenostomy method ('Tornado' anastomosis) compared to a method with an additional gastrotomy ('Anterior Incision' method) in laparoscopy-assisted distal gastrectomy. Forty-two patients with gastric cancer who underwent laparoscopy-assisted distal gastrectomy were analyzed retrospectively. Billroth-I using an additional gastrotomy was performed in 24 patients (AI group) and Billroth-I without an additional gastrotomy was performed in 18 (TOR group). Clinicopathological features, operative outcomes (lymph node dissection, operative time, operative blood loss) and postoperative outcomes (complications, postoperative hospital stay, and body weight loss at one year after surgery) were evaluated and compared between groups. Operative time was significantly shorter in the TOR group (251 min) than in the AI group (282 min) (p < 0.01). There were no statistically significant differences in operative blood loss, postoperative complications, and hospital stay between the 2 study groups. Body weight loss at one year after surgery was -5.8 kg in the TOR group and -6.5 kg in the AI group, without a statistically significant difference. Completion time for Billroth-I anastomosis was significantly shorter with Tornado anastomosis than with the Anterior Incision method, with safety equal between the two methods.

Assessment of the use of latissimus dorsi restoration during modified radical mastectomy in breast cancer patients.

PubMed

Yang, Chao; Wang, Xinle; Zhang, Geng; Yang, Liu; Guo, Xuan; Wang, Xue; Song, Zhenchuan

2017-12-01

The incision area of modified radical mastectomy in breast cancer patients is associated with subcutaneous effusion and skin flap necrosis as the most common complications. The aim of the present study was to assess the effect of latissimus dorsi restoration during modified radical mastectomy in breast cancer patients by evaluating 365 cases. Among these cases, 185 received modified radical mastectomy combined with intraoperative latissimus dorsi restoration, while 180 received modified radical mastectomy alone. The flap tension, drainage fluid amount and extubation time were compared between the two methods. The flap tension in patients who received modified radical mastectomy combined with intraoperative latissimus dorsi restoration was significantly lower and the blood supply was better. After surgery, the drainage fluid amount was also significantly lower in these patients compared with the control group. Furthermore, the mean time to drainage tube removal was significantly shorter in these patients and the postoperative cosmetic outcome was superior. Thus, it was concluded that modified radical mastectomy combined with intraoperative latissimus dorsi restoration in breast cancer patients was associated with reduced drainage fluid effusion, shorter hospitalization time and decreased flap tension. Overall, this method appears to be potentially suitable for extensive application in the clinical setting.

Travel time and concurrent-schedule choice: retrospective versus prospective control.

PubMed

Davison, M; Elliffe, D

2000-01-01

Six pigeons were trained on concurrent variable-interval schedules in which two different travel times between alternatives, 4.5 and 0.5 s, were randomly arranged. In Part 1, the next travel time was signaled while the subjects were responding on each alternative. Generalized matching analyses of performance in the presence of the two travel-time signals showed significantly higher response and time sensitivity when the longer travel time was signaled compared to when the shorter time was signaled. When the data were analyzed as a function of the previous travel time, there were no differences in sensitivity. Dwell times on the alternatives were consistently longer in the presence of the stimulus that signaled the longer travel time than they were in the presence of the stimulus that signaled the shorter travel time. These results are in accord with a recent quantitative account of the effects of travel time. In Part 2, no signals indicating the next travel time were given. When these data were analyzed as a function of the previous travel time, time-allocation sensitivity after the 4.5-s travel time was significantly greater than that after the 0.5-s travel time, but no such difference was found for response allocation. Dwell times were also longer when the previous travel time had been longer.

Post-surgical treatment of thyroid carcinoma in dogs with retinoic acid 9 cis improves patient outcome

PubMed Central

Castillo, V.; Pessina, P.; Hall, P.; Blatter, M.F. Cabrera; Miceli, D.; Arias, E. Soler; Vidal, P.

2016-01-01

The objective of the present study was to compare the effects of isotretinoin 9-cis (RA9-cis) as a post-surgery treatment of thyroid carcinoma to a traditional treatment (doxorubicin) and no treatment. Owners who did not want their dogs to receive treatment were placed into the control group A (GA; n=10). The remaining dogs were randomly placed into either group B (GB; n=12) and received doxorubicin at a dose of 30 mg/m2 every three weeks, for six complete cycles or group C (GC; n=15) and treated with RA9-cis at a dose of 2 mg/kg/day for 6 months. The time of the recurrence was significantly shorter in the GA and GB compared to GC (P=0.0007; P=0.0015 respectively), while we did not detect differences between GA and GB. The hazard ratio of recurrence between GA and GB compared to GC were 7.25 and 5.60 times shorter, respectively. We did not detect any differences between the other groups. The risk ratio of recurrence was 2.0 times higher in GA compared to GC and 2.1 times higher in GB compared to GC. The type of carcinoma had an effect on time of survival with follicular carcinomas having an increased mean survival time than follicular-compact carcinomas (P<0.0001) and follicular-compact carcinomas had a longer mean survival time than compact carcinomas. The interaction among treatment and type was significant, but survival time in follicular carcinomas did not differ between treatments. In follicular-compact carcinomas the survival time of GC was greater than GB (P<0.05), but we did not detect a difference between GA and GB. In conclusion, this study shows that the use of surgery in combination with RA9-cis treatment significantly increases survival rate and decreases the time to tumor recurrence when compared to doxorubicin treated or untreated dogs. The histological type of carcinoma interacted with treatment for time to recurrence and survival time, with more undifferentiated carcinomas having a worse prognosis than differentiated carcinomas. PMID:26862515

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents

PubMed Central

Gaidos, Jill KJ; Draganov, Peter V

2009-01-01

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases. PMID:19764086

Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management.

PubMed

Arnesen, Kjell E; Erikssen, Jan; Stavem, Knut

2002-12-01

In a system with implicit queue management, to examine gender and socioeconomic status as determinants of waiting time for inpatient surgery, after adjusting for other potential predictors. A cohort of 452 subjects was examined in outpatient clinics of a general hospital and referred to inpatient surgery. They were followed until scheduled hospital admission (n=396) or until the requested procedure no longer was relevant (n=56). We compared waiting time between groups from referral date until hospital admission, using Kaplan-Meier estimates of waiting times and log rank test. A Cox proportional hazards model was used for assessing the risk ratio (RR) of hospital admission for scheduled surgery. Gender and socioeconomic status could not explain variations in waiting time. However, patients with suspected/verified neoplastic disease or a risk of serious deterioration without treatment had markedly shorter waiting times than the reference groups, with adjusted RR (95% confidence intervals (95%CI)) of time to receiving in-patient surgery of 2.3 (1.7-3.0) and 2.0 (1.3-3.0), respectively. Being on sick leave was associated with shorter waiting time, adjusted RR of 1.7 (1.2-2.5). Referrals from within the hospital or other hospitals had also shorter waiting times than referrals from primary health care physicians, adjusted RR=1.4 (1.1-1.8). There was no evidence of bias against women or people in lower socioeconomic classes in this implicit queue management system. However, patients' access to inpatient surgery was associated with malignancy, prognosis, sick leave status, physician experience, referral pattern and the major diagnosis category.

SU-F-T-635: Lung SBRT: Dosimetric and Treatment Time Comparison of Volumetric-Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Clinically Treated Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, J; Xu, Z; Baker, J

Purpose: To compare three-dimensional conformal radiotherapy (3D CRT) and volumetric-modulated arc therapy (VMAT) in lung stereotactic body radiation therapy (SBRT) Methods: A retrospective study of clinically treated lung SBRT cases treated between 2010 and 2015 at our hospital was performed. All treatment modalities were included in this evaluation (VMAT, 3D CRT, static IMRT, and dynamic conformal arc therapy). However, the majority of treatment modalities were either VMAT or 3D CRT. Treatment times of patients and dosimetric plan quality metrics were compared. Treatment times were calculated based on the time the therapist opened and closed the patient’s treatment plan. This treatmentmore » time closely approximates the utilization time of the treatment room. The dosimetric plan quality metrics evaluated include ICRU conformity index, the volume of 105% prescribed dose outside PTV, the ratio of volume of 50% prescribed dose to the volume of PTV, the percentage of maximum dose at 2 cm away from PTV to the prescribed dose, and the V20 (percentage of lung volume receiving 20 Gy or more). Results: Treatment time comparisons show that on average VMAT has shorter treatment times than 3D CRT. Dose conformity, defined by the ICRU conformity index, and high dose spillage, defined by the volume of 105% dose outside the PTV, is reduced when using VMAT compared to 3D CRT. V20 and intermediate dose spillage/fall-off metrics of VMAT and 3D are not significantly different. Conclusion: Clinically treated lung SBRT cases indicate VMAT is superior to 3D with regard to shorter treatment times, plan dose conformity, and plan high dose spillage.« less

Effect of gender and calendar year on time to and duration of virologic suppression among antiretroviral-naïve HIV-infected individuals initiating combination antiretroviral therapy.

PubMed

Raboud, Janet; Blitz, Sandra; Walmsley, Sharon; Thompson, Courtney; Rourke, Sean B; Loutfy, Mona R

2010-01-01

To determine the effects of gender and calendar year on time to and duration of virologic suppression among HIV-infected antiretroviral-naïve individuals initiating combination antiretroviral therapy (cART). Ontario Cohort Study antiretroviral-naïve participants who initiated cART after December 31, 1998, and who had ≥2 follow-up viral loads were included. Multivariable Cox proportional hazard models were used to estimate the effects of gender and calendar year on times to virologic suppression and rebound. Of the 840 patients, 81% were male (median age 40 years; interquartile range [IQR], 34-46). Time to virologic suppression was shorter among women (hazard ratio [HR]=1.27, P=.01) and in more recent calendar time periods (2002-2004: HR, 1.04, P=.67; 2005-2006: HR, 1.22, P=.06; 2007-2008: HR, 1.36, P=.004) compared to 1999-2001 after adjusting for age and type of cART regimens. Women had shorter times to virologic rebound (HR, 1.57; P<.01) after adjusting for age, injection drug use, and type of cART regimen. However, 14/18 (78%) women suspected to be taking cART only for prevention of mother-to-child transmission of HIV experienced virologic rebound compared to 28% of women who required cART for their own health, suggesting that the increased rate of virologic rebound was due to women stopping ART at the termination of a pregnancy if they did not need it for their own health. Rates of rebound did not differ by calendar year period. Time to virologic suppression has steadily decreased over time while duration of suppression remained stable. Time to virologic suppression was shorter for women than for men, whereas durability of virologic suppression was slightly longer for men than women. However, gender differences in virologic rebound were likely due to women discontinuing cART at the end of the pregnancy if it was not needed for their own health.

The Effect of Life History on Retroviral Genome Invasions

PubMed Central

Kanda, Ravinder K.; Coulson, Tim

2015-01-01

Endogenous retroviruses (ERV), or the remnants of past retroviral infections that are no longer active, are found in the genomes of most vertebrates, typically constituting approximately 10% of the genome. In some vertebrates, particularly in shorter-lived species like rodents, it is not unusual to find active endogenous retroviruses. In longer-lived species, including humans where substantial effort has been invested in searching for active ERVs, it is unusual to find them; to date none have been found in humans. Presumably the chance of detecting an active ERV infection is a function of the length of an ERV epidemic. Intuitively, given that ERVs or signatures of past ERV infections are passed from parents to offspring, we might expect to detect more active ERVs in species with longer generation times, as it should take more years for an infection to run its course in longer than in shorter lived species. This means the observation of more active ERV infections in shorter compared to longer-lived species is paradoxical. We explore this paradox using a modeling approach to investigate factors that influence ERV epidemic length. Our simple epidemiological model may explain why we find evidence of active ERV infections in shorter rather than longer-lived species. PMID:25692467

The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

PubMed Central

2009-01-01

Background There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI). Problem Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005). Results In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI. Conclusion Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research. PMID:20025744

Operative treatment of acute acromioclavicular dislocations Rockwood III and V-Comparative study between K-wires combined with FiberTape(®) vs. TightRope System(®).

PubMed

Vrgoč, G; Japjec, M; Jurina, P; Gulan, G; Janković, S; Šebečić, B; Starešinić, M

2015-11-01

Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. A retrospective two-centre study was conducted in patients with acute AC joint dislocation Rockwood types III and V. The two methods conducted were an open procedure using K-wires combined with FiberTape(®) (Arthrex, Naples, USA) (Group 1) and an arthroscopic procedure using the TightRope System(®) (Arthrex, Naples, USA) (Group 2). Groups underwent procedures during a two-year period. Diagnosis was based on the clinical and radiographic examination of both AC joints. Surgical treatment and rehabilitation were performed. Sixteen patients were included in this study: Group 1 comprised 10 patients, all male, average age 41.6 years (range 17-64 years), Rockwood type III (eight patients) and Rockwood type V (two patients); Group 2 had six patients, one female and five male, average age 37.8 years (range 18-58 years), Rockwood type III (two patients) and Rockwood type V (four patients). Time from injury to surgery was shorter and patients needed less time to return to daily activities in Group 1. Duration of the surgical procedure was shorter in Group 2 compared with Group 1. Complications of each method were noted. According to the measured scores and operative outcome between dislocation Rockwood type III and V, no significant difference was found. Implant material used in Group 2 was 4.7 times more expensive than that used in Group 1. Both methods offer many advantages with satisfying evaluated scores. K-wires with FiberTape(®) offer a shorter period for complete recovery and a significantly more cost-effective outcome, whereas the TightRope System(®) offers shorter operative procedure, better cosmetic result and avoidance of intraoperative fluoroscopy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Techniques for caesarean section.

PubMed

Hofmeyr, G J; Mathai, M; Shah, A; Novikova, N

2008-01-23

Rates of caesarean section (CS) have been rising globally. It is important to use the most effective and safe technique. To compare the effects of complete methods of caesarean section; and to summarise the findings of reviews of individual aspects of caesarean section technique. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3) and reference lists of identified papers. Randomised controlled trials of intention to perform caesarean section using different techniques. Two review authors independently assessed studies and extracted data. 'Joel-Cohen based' compared with Pfannenstiel CS was associated with: less blood loss, (five trials, 481 women; weighted mean difference (WMD) -64.45 ml; 95% confidence interval (CI) -91.34 to -37.56 ml); shorter operating time (five trials, 581 women; WMD -18.65; 95% CI -24.84 to -12.45 minutes); postoperatively, reduced time to oral intake (five trials, 481 women; WMD -3.92; 95% CI -7.13 to -0.71 hours); less fever (eight trials, 1412 women; relative risk (RR) 0.47; 95% CI 0.28 to 0.81); shorter duration of postoperative pain (two comparisons from one trial, 172 women; WMD -14.18 hours; 95% CI -18.31 to -10.04 hours); fewer analgesic injections (two trials, 151 women; WMD -0.92; 95% CI -1.20 to -0.63); and shorter time from skin incision to birth of the baby (five trials, 575 women; WMD -3.84 minutes; 95% CI -5.41 to -2.27 minutes). Serious complications and blood transfusions were too few for analysis.Misgav-Ladach compared with the traditional method (lower midline abdominal incision) was associated with reduced: blood loss (339 women; WMD -93.00; 95% CI -132.72 to -53.28 ml); operating time (339 women; WMD-7.30; 95% CI -8.32 to -6.28 minutes); time to mobilisation (339 women; WMD -16.06; 95% CI -18.22 to -13.90 hours); and length of postoperative stay for the mother (339 women; WMD -0.82; 95% CI -1.08 to -0.56 days). Misgav-Ladach compared with modified Misgav-Ladach methods was associated with a longer time from skin incision to birth of the baby (116 women; WMD 2.10; 95% CI 1.10 to 3.10 minutes). 'Joel-Cohen based' methods have advantages compared to Pfannenstiel and to traditional (lower midline) CS techniques, which could translate to savings for the health system. However, these trials do not provide information on mortality and serious or long-term morbidity such as morbidly adherent placenta and scar rupture.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study

PubMed Central

Aniulis, Povilas; Skaudickas, Darijus

2015-01-01

Objectives The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). Methods A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients – using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Results Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact – at 94.5% and SLING-IUFT – at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. Conclusion the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness. PMID:28352711

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

PubMed

Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus

2015-01-01

The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and a meta-analysis update

PubMed Central

Chen, Hongbo; Chen, Zhiqiang; Xu, Hua; Ye, Zhangqun

2017-01-01

CONTEXT The safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted. OBJECTIVE To obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer. METHODS A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications. RESULTS 78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR:0.88; P = 0.04), fewer positive lymph nodes (OR:0.45;P < 0.001), fewer overall complications (OR:0.43; P < 0.001), higher 3- and 12-mo potent recovery rate (OR:3.19;P = 0.02; OR:2.37; P = 0.005, respectively), and lower readmission rate (OR:0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR:1.33, P = 0.04). All the other calculated results are similar between the two groups. CONCLUSIONS Our results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients. PMID:27852051

Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

PubMed

Karaman, Murat; Gün, Taylan; Temelkuran, Burak; Aynacı, Engin; Kaya, Cem; Tekin, Ahmet Mahmut

2017-05-01

To compare intra-operative and post-operative effectiveness of fiber delivered CO 2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO 2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO 2 laser. The use of CO 2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO 2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO 2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

Comparison of CD HORIZON SPIRE spinous process plate stabilization and pedicle screw fixation after anterior lumbar interbody fusion. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.

PubMed

Wang, Jeremy C; Haid, Regis W; Miller, Jay S; Robinson, James C

2006-02-01

The authors present the early clinical results obtained in patients who underwent SPIRE spinous process plate fixation following anterior lumbar interbody fusion (ALIF). Between May 2003 and January 2005, 32 patients underwent titanium cage and bone morphogenetic protein-augmented ALIF and subsequent SPIRE (21 cases) or bilateral pedicle screw (BPS; 11 cases) fixation. Pedicle screws were implanted using either the open approach (three cases) or using a tubular retractor (eight cases). Patients' charts were reviewed for operative time, estimated blood loss (EBL), hospital length of stay (LOS), and evidence of pseudarthrosis or hardware failure. In SPIRE plate-treated patients, the median EBL (75 ml) was lower than in BPS-treated patients (open BPS [150 ml]; tubular BPS [125 ml]). The median operative time in SPIRE plate-treated patients was also shorter (164 minutes compared with 239 and 250 minutes in the open and tubular BPS, respectively). The median LOS was 3 days for both the SPIRE and tubular BPS groups, but 4 days in the open BPS group. There were no instances of major surgery-induced complication, pseudarthrosis, or hardware failure during mean follow-up periods of 5.5, 7.2, and 4.9 months in the SPIRE, open PS, and tubular BPS groups, respectively. The SPIRE plate is easy to implant and is associated with minimal operative risk. Compared with BPS/rod constructs, SPIRE plate fixation leads to less EBL and shorter operative time, without an increase in the rate of pseudarthrosis. Hospital LOS was also shorter in SPIRE plate-treated patients, which is consistent with the goals of minimal access spinal technologies.

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis.

PubMed

Xie, Lei; Wu, Wen-Jian; Liang, Yu

2016-08-20

The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RR s) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32). MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly.

PubMed

Freundt, Miriam; Ried, Michael; Philipp, Alois; Diez, Claudius; Kolat, Philipp; Hirt, Stephan W; Schmid, Christof; Haneya, Assad

2016-03-01

Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p<0.001]. In conclusion, MECC improves outcome in elderly patients undergoing CABG surgery. © The Author(s) 2015.

Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS: Is It Worthwhile?

PubMed

Wu, Ching-Feng; Gonzalez-Rivas, Diego; Wen, Chih-Tsung; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai; Hsieh, Ming-Ju; Wu, Ching-Yang; Chen, Wei-Hsun

2015-11-01

Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome.We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received sternotomy or thoracotomy, 29 patients received single-port VATS, and 60 patients received conventional VATS (3 ports). The operative time, blood loss, postoperation day 1 pain score, discharge day pain score, and postoperative hospital stay were compared. In order to establish a well balanced cohort study, we also use propensity scores match (1:1) to compare the short-term clinical outcome in 2 groups.No operative deaths occurred in this study. Single-port VATS was associated with shorter operative time, lower postoperation day 1 pain score, and shorter postoperation hospital stay in our cohort study (P = 0.001, <0.001, and 0.039), and propensity scores matched cohort study (P = 0.003, <0.001, and <0.001).Single-port VATS for mediastinum tumor appears to be a safe and promising technique with short-term outcome not inferior to conventional VATS in our cohort study. The long-term oncology outcome may require time and more enrolled patients to be further evaluated.

Efficacy and indications of transradial and transfemoral approaches for peripheral artery stent implantation

PubMed Central

Chen, Peng; Li, Huijie; Zeng, Chunyu; Fang, Yuqiang; Shi, Weibin; Zhang, Xiaoqun; Yang, Chengming

2017-01-01

The transradial approach (TRA) has become an attractive alternative to the transfemoral approach (TFA) in percutaneous coronary intervention. To date, however, these two approaches have not been systematically compared in various percutaneous peripheral artery interventions (PPAIs). In the present study 258 patients with peripheral artery disease that underwent PPAI via the TRA (n=75) or the TFA (n=183) were analyzed. Clinical factors and outcomes in these two groups were compared. The puncture time was significantly longer (P<0.05) and the prevalence of artery vasospasm significantly higher (P<0.05) in patients who underwent PPAI via the TRA rather than via the TFA. However, the complication rate was significantly lower (P<0.05) and the artery compression time (P<0.05) and time bedridden (P<0.05) were significantly shorter via the TRA than via the TFA. These results suggest that PPAI via the TRA was associated with a lower complication rate, and shorter artery compression time and bedridden time than PPAI via the TFA. The TRA may be preferable for bilateral vertebral artery stenosis, whereas the TFA may be preferable for interventional treatment of carotid and subclavian artery stenosis. Therefore, the catheter length, artery support and push force should be comprehensively considered before choosing the TRA or TFA in the interventional treatment of renal artery stenosis. PMID:28587369

[Leipzig fast-track protocol for cardio-anesthesia. Effective, safe and economical].

PubMed

Häntschel, D; Fassl, J; Scholz, M; Sommer, M; Funkat, A K; Wittmann, M; Ender, J

2009-04-01

In November 2005 a complex, multimodal anesthesia fast-track protocol (FTP) was introduced for elective cardiac surgery patients in the Cardiac Center of the University of Leipzig which included changing from an opioid regime to remifentanil and postoperative treatment in a special post-anesthesia recovery and care unit. The goal was to speed up recovery times while maintaining safety and improving costs. A total of 421 patients who underwent the FTP and were treated in the special recovery room were analyzed retrospectively. These patients were compared with patients who had been treated by a standard protocol (SP) prior to instituting the FTP. Primary outcomes were time to extubation, length of stay in the intensive care unit (ICU) and treatment costs. The times to extubation were significantly shorter in the FTP group with 75 min (range 45-110 min) compared to 900 min (range 600-1140 min) in the SP group. Intensive care unit stay and hospital length of stay were also significantly shorter in the FTP group (p<0.01). The reduction of treatment costs of intensive care for FTP patients was 53.5% corresponding to savings of EUR 738 per patient in the FTP group compared with the SP group. The Leipzig fast-track protocol for cardio-anesthesia including the central elements of switching opiate therapy to remifentanil and switching patient recovery to a special post-anesthesia recovery and care unit, shortened therapy times, is safe and economically effective.

Asymmetry in gait pattern following bicondylar tibial plateau fractures-A prospective one-year cohort study.

PubMed

Elsoe, Rasmus; Larsen, Peter

2017-07-01

Despite the high number of studies evaluating outcomes following tibial plateau fractures, the literature lacks studies including the objective assessment of gait pattern. The purpose of the present study was to evaluate asymmetry in gait patterns at 12 months after frame removal following ring fixation of a tibial plateau fracture. The study design was a prospective cohort study. The primary outcome measurement was the gait patterns 12 months after frame removal measured with a pressure-sensitive mat. The mat registers footprints and present gait speed, cadence, as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. Twenty-three patients were included with a mean age of 54.4 years (32-78 years). Patients presented with a shorter step-length of the injured leg compared to the non-injured leg (asymmetry of 11.3%). Analysis of single-support showed shorter support time of the injured leg compared to the non-injured leg (asymmetry of 8.7%). Moreover, analysis of swing-time showed increased swing-time of the injured leg (asymmetry of 8.9%). Compared to a healthy reference population, increased asymmetry in all gait patterns was observed. The association between asymmetry and health-related quality of life (HRQOL) showed moderate associations (single-support: R=0.50, P=0.03; step-length: R=0.43, P=0.07; swing-time: R=0.46, P=0.05). Compared to a healthy reference population, gait asymmetry is common 12 months after frame removal in patients treated with external ring fixation following a tibial plateau fracture of the tibia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Human auditory event-related potentials predict duration judgments.

PubMed

Bendixen, Alexandra; Grimm, Sabine; Schröger, Erich

2005-08-05

Internal clock models postulate a pulse accumulation process underlying timing activities, with more accumulated pulses resulting in longer perceived durations. We investigated whether this accumulation is reflected in the amplitude of event-related brain potentials (ERPs) elicited by auditory stimuli with durations of 400-600 ms. In a duration discrimination paradigm, we found more negative amplitudes to physically identical stimuli when they were judged as longer than the memorized standard duration (500 ms) as compared to being classified as shorter. This sustained negativity was already developing during the first 100 ms after stimulus onset. It could not be explained as a bias to respond with a particular hand (lateralized readiness potential), but rather reflects a processing difference between the tones to be judged as shorter or longer. Our results are in line with models of time processing which assume that higher numbers of accumulated pulses of a temporal processor result in an increase in perceived duration.

Comparison of Both Sides for Retroperitoneal Laparoscopic Donor Nephrectomy: Experience From a Single Center in China.

PubMed

Qiu, Y; Wang, X; Song, T; Rao, Z; Liu, J; Huang, Z; Lin, T

Laparoscopic donor nephrectomy (LDN) has gradually become the main approach to obtain live donor kidneys. However, the shorter right renal vein limits its wider application. The aim of this study was to compare the outcomes of left- and right-side retroperitoneal LDN. We reviewed the perioperative data of 527 consecutive donors receiving retroperitoneal pure LDN with a new method at our center between April 2009 and April 2014. The patients were divided into group A (the first 100 patients) and group B (the remaining 427 patients). A total of 423 cases of left donor surgery and 104 cases of right donor surgery were compared. The comparison of the laterality of LDN was also performed between group A and group B. This is currently the largest case series of LDN in our country. Although right-side LDN patients had longer operation time and a slightly higher incidence of intraoperative complications compared with left-side LDN patients, the operation time was shorter in both the groups compared with previous reports. In group B, patients undergoing right-side LDN had longer operation time and more frequent complications. Once the learning curve of 100 cases was completed, the incidence of complications and operation time were greatly reduced in both sides for LDN. There was no significant difference in the serum creatinine levels in recipients at 6 months of follow-up. Despite a slightly higher incidence of complications and longer operation time, right-side LDN can achieve equally safe and effective transplantation outcomes. This expands the source of potential donor kidneys. Copyright © 2017. Published by Elsevier Inc.

Self-motion perception compresses time experienced in return travel.

PubMed

Seno, Takeharu; Ito, Hiroyuki; Shoji, Sunaga

2011-01-01

It is often anecdotally reported that time experienced in return travel (back to the start point) seems shorter than time spent in outward travel (travel to a new destination). Here, we report the first experimental results showing that return travel time is experienced as shorter than the actual time. This discrepancy is induced by the existence of self-motion perception.

Duration of blastulation may be associated with ongoing pregnancy rate in single euploid blastocyst transfer cycles.

PubMed

Mumusoglu, Sezcan; Ozbek, Irem Y; Sokmensuer, Lale K; Polat, Mehtap; Bozdag, Gurkan; Papanikolaou, Evangelos; Yarali, Hakan

2017-12-01

Not all euploid embryos implant, necessitating additional tools to select viable blastocysts in preimplantation genetic screening cycles. In this retrospective cohort study, 129 consecutive patients who underwent 129 single euploid blastocyst transfers in cryopreserved embryo transfer cycles were included. All embryos were individually cultured in a time-lapse incubator from intracytoplasmic sperm injection up to trophoectoderm biopsy. Twenty-three time-lapse morphokinetic variables were tested among patients with (n = 68) or without (n = 61) ongoing pregnancy. All 23 time-lapse morphokinetic variables, apart from duration of blastulation (tB-tSB), were comparable between patients with or without ongoing pregnancy. Duration of blastulation was significantly shorter in patients with ongoing pregnancy (8.1 ± 3.2 versus 9.5 ± 3.4 h; P = 0.014); shorter duration of blastulation remained an independent predictor for ongoing pregnancy, when tested by logistic regression analysis (OR 0.81; 95% CI 0.70 to 0.93). One important limitation of this study, and a reason for caution, is the use of multiple comparisons, which can lead to differences at the 0.05 level simply by chance or random variation. Nonetheless, the study suggests that when more than one euploid blastocyst is available, priority might be given to those with a shorter duration of blastulation. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Common Atrial Fibrillation Risk Alleles at 4q25 Predict Recurrence after Catheter-based Atrial Fibrillation Ablation

PubMed Central

Shoemaker, M. Benjamin; Muhammad, Raafia; Parvez, Babar; White, Brenda W.; Streur, Megan; Song, Yanna; Stubblefield, Tanya; Kucera, Gayle; Blair, Marcia; Rytlewski, Jason; Parvathaneni, Sunthosh; Nagarakanti, Rangadham; Saavedra, Pablo; Ellis, Christopher; Whalen, S. Patrick; Roden, Dan M; Darbar, Dawood

2012-01-01

Background Common single nucleotide polymorphisms (SNPs) at chromosome 4q25 (rs2200733, rs10033464) are associated with both lone and typical AF. Risk alleles at 4q25 have recently been shown to predict recurrence of AF after ablation in a population of predominately lone AF, but lone AF represents only 5–30% of AF cases. Objective To test the hypothesis that 4q25 AF risk alleles can predict response to AF ablation in the majority of AF cases. Methods Patients enrolled in the Vanderbilt AF Registry underwent 378 catheter-based AF ablations (median age 60 years, 71% male, 89% typical AF) between 2004 and 2011. The primary endpoint was time to recurrence of any non-sinus atrial tachyarrhythmia (atrial tachycardia, atrial flutter, or AF; [AT/AF]). Results Two-hundred AT/AF recurrences (53%) were observed. In multivariable analysis, the rs2200733 risk allele predicted a 24% shorter recurrence-free time (survival time ratio 0.76 95% confidence interval [CI] 0.6–0.95, P=0.016) compared with wild-type. The heterozygous haplotype demonstrated a 21% shorter recurrence-free time (survival time ratio = 0.79, 95% CI 0.62–0.99) and the homozygous risk allele carriers a 39% shorter recurrence-free time (survival time ratio = 0.61, 95% CI 0.37–1.0) (P=0.037). Conclusion Risk alleles at the 4q25 loci predict impaired clinical response to AF ablation in a population of predominately typical AF patients. Our findings suggest the rs2200733 polymorphism may hold promise as an as an objectively measured patient characteristic that can used as a clinical tool for selection of patients for AF ablation. PMID:23178686

Improving Crotalidae polyvalent immune Fab reconstitution times.

PubMed

Quan, Asia N; Quan, Dan; Curry, Steven C

2010-06-01

Crotalidae polyvalent immune Fab (CroFab) is used to treat rattlesnake envenomations in the United States. Time to infusion may be a critical factor in the treatment of these bites. Per manufacturer's instructions, 10 mL of sterile water for injection (SWI) and hand swirling are recommended for reconstitution. We wondered whether completely filling vials with 25 mL of SWI would result in shorter reconstitution times than using 10-mL volumes and how hand mixing compared to mechanical agitation of vials or leaving vials undisturbed. Six sets of 5 vials were filled with either 10 mL or 25 mL. Three mixing techniques were used as follows: undisturbed; agitation with a mechanical agitator; and continuous hand rolling and inverting of vials. Dissolution was determined by observation and time to complete dissolution for each vial. Nonparametric 2-tailed P values were calculated. Filling vials completely with 25 mL resulted in quicker dissolution than using 10-mL volumes, regardless of mixing method (2-tailed P = .024). Mixing by hand was shorter than other methods (P < .001). Reconstitution with 25 mL and hand mixing resulted in the shortest dissolution times (median, 1.1 minutes; range, 0.9-1.3 minutes). This appeared clinically important because dissolution times using 10 mL and mechanical rocking of vials (median, 26.4 minutes) or leaving vials undisturbed (median, 33.6 minutes) was several-fold longer. Hand mixing after filling vials completely with 25 mL results in shorter dissolution times than using 10 mL or other methods of mixing and is recommended, especially when preparing initial doses of CroFab. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia.

PubMed

Hoffman, Heather J; LaVerda, Nancy L; Young, Heather A; Levine, Paul H; Alexander, Lisa M; Brem, Rachel; Caicedo, Larisa; Eng-Wong, Jennifer; Frederick, Wayne; Funderburk, William; Huerta, Elmer; Swain, Sandra; Patierno, Steven R

2012-10-01

Patient Navigation (PN) originated in Harlem as an intervention to help poor women overcome access barriers to timely breast cancer treatment. Despite rapid, nationally widespread adoption of PN, empirical evidence on its effectiveness is lacking. In 2005, National Cancer Institute initiated a multicenter PN Research Program (PNRP) to measure PN effectiveness for several cancers. The George Washington Cancer Institute, a project participant, established District of Columbia (DC)-PNRP to determine PN's ability to reduce breast cancer diagnostic time (number of days from abnormal screening to definitive diagnosis). A total of 2,601 women (1,047 navigated; 1,554 concurrent records-based nonnavigated) were examined for breast cancer from 2006 to 2010 at 9 hospitals/clinics in DC. Analyses included only women who reached complete diagnostic resolution. Differences in diagnostic time between navigation groups were tested with ANOVA models including categorical demographic and treatment variables. Log transformations normalized diagnostic time. Geometric means were estimated and compared using Tukey-Kramer P value adjustments. Average-geometric mean [95% confidence interval (CI)]-diagnostic time (days) was significantly shorter for navigated, 25.1 (21.7, 29.0), than nonnavigated women, 42.1 (35.8, 49.6). Subanalyses revealed significantly shorter average diagnostic time for biopsied navigated women, 26.6 (21.8, 32.5) than biopsied nonnavigated women, 57.5 (46.3, 71.5). Among nonbiopsied women, diagnostic time was shorter for navigated, 27.2 (22.8, 32.4), than nonnavigated women, 34.9 (29.2, 41.7), but not statistically significant. Navigated women, especially those requiring biopsy, reached their diagnostic resolution significantly faster than nonnavigated women. Results support previous findings of PN's positive influence on health care. PN should be a reimbursable expense to assure continuation of PN programs. 2012 AACR

Predictors of shorter sleep in early childhood

PubMed Central

McDonald, Laura; Wardle, Jane; Llewellyn, Clare H.; van Jaarsveld, Cornelia H.M.; Fisher, Abigail

2014-01-01

Objective The aim of this study was to identify socio-demographic and home environmental predictors of shorter sleep in early childhood, and to examine whether effects were mediated by the timing of bedtime or wake time. Methods Participants were from Gemini, a British birth cohort of twins, and included 1702 children; one randomly selected from each twin pair. Parents reported night-time sleep duration at an average age of 15.8 months (range 14–27 months) using a modified version of the Brief Infant Sleep Questionnaire. Multiple logistic regression models were used to identify predictors of shorter sleep for this study. Results Using a cut-off of <11 h a night, shorter sleep was reported in 14.1% of children. Lower maternal education, non-white ethnic background, being male, low birth weight, living in a home with >1 older child and watching >1 h of TV in the evening were independently associated with shorter sleep. Mediation analyses showed that associations between education, ethnicity, evening TV viewing and sleep were driven predominantly by later bedtimes, while sex differences were driven predominantly by earlier wake times in boys. Conclusion In this sample, multiple environmental factors were associated with shorter sleep in young children, with several operating predominantly through later bedtime. An emphasis on the importance of an early and consistent bedtime could help promote healthy sleep and reduce inequalities in child health. PMID:24726571

Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies

PubMed Central

Boylu, Sukru; Ok, Engin; Canturk, Nuh Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah; Tireli, Mustafa; Ihtiyar, Enver; Demircan, Orhan; Baskan, Mazhar Semih; Koyuncu, Ayhan; Tasdelen, Ismet; Dumanli, Esra; Ozdener, Fatih; Zaborek, Piotr

2015-01-01

Background: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. Methods: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. Results: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. Conclusion: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres. PMID:25096257

Generalized activity equations for spiking neural network dynamics.

PubMed

Buice, Michael A; Chow, Carson C

2013-01-01

Much progress has been made in uncovering the computational capabilities of spiking neural networks. However, spiking neurons will always be more expensive to simulate compared to rate neurons because of the inherent disparity in time scales-the spike duration time is much shorter than the inter-spike time, which is much shorter than any learning time scale. In numerical analysis, this is a classic stiff problem. Spiking neurons are also much more difficult to study analytically. One possible approach to making spiking networks more tractable is to augment mean field activity models with some information about spiking correlations. For example, such a generalized activity model could carry information about spiking rates and correlations between spikes self-consistently. Here, we will show how this can be accomplished by constructing a complete formal probabilistic description of the network and then expanding around a small parameter such as the inverse of the number of neurons in the network. The mean field theory of the system gives a rate-like description. The first order terms in the perturbation expansion keep track of covariances.

Speed-difficulty trade-off in speech: Chinese versus English

PubMed Central

Sun, Yao; Latash, Elizaveta M.; Mikaelian, Irina L.

2011-01-01

This study continues the investigation of the previously described speed-difficulty trade-off in picture description tasks. In particular, we tested a hypothesis that the Mandarin Chinese and American English are similar in showing logarithmic dependences between speech time and index of difficulty (ID), while they differ significantly in the amount of time needed to describe simple pictures, this difference increases for more complex pictures, and it is associated with a proportional difference in the number of syllables used. Subjects (eight Chinese speakers and eight English speakers) were tested in pairs. One subject (the Speaker) described simple pictures, while the other subject (the Performer) tried to reproduce the pictures based on the verbal description as quickly as possible with a set of objects. The Chinese speakers initiated speech production significantly faster than the English speakers. Speech time scaled linearly with ln(ID) in all subjects, but the regression coefficient was significantly higher in the English speakers as compared with the Chinese speakers. The number of errors was somewhat lower in the Chinese participants (not significantly). The Chinese pairs also showed a shorter delay between the initiation of speech and initiation of action by the Performer, shorter movement time by the Performer, and shorter overall performance time. The number of syllables scaled with ID, and the Chinese speakers used significantly smaller numbers of syllables. Speech rate was comparable between the two groups, about 3 syllables/s; it dropped for more complex pictures (higher ID). When asked to reproduce the same pictures without speaking, movement time scaled linearly with ln(ID); the Chinese performers were slower than the English performers. We conclude that natural languages show a speed-difficulty trade-off similar to Fitts’ law; the trade-offs in movement and speech production are likely to originate at a cognitive level. The time advantage of the Chinese participants originates not from similarity of the simple pictures and Chinese written characters and not from more sloppy performance. It is linked to using fewer syllables to transmit the same information. We suggest that natural languages may differ by informational density defined as the amount of information transmitted by a given number of syllables. PMID:21479658

Comparing Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Tumor Enucleation and Laparoscopic Partial Nephrectomy for Clinical T1a Renal Tumor: A Randomized Clinical Trial.

PubMed

Huang, Jiwei; Zhang, Jin; Wang, Yanqing; Kong, Wen; Xue, Wei; Liu, Dongming; Chen, YongHui; Huang, Yiran

2016-06-01

We evaluated the functional outcome, safety and efficacy of zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation compared with conventional laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted from April 2013 to March 2015 in patients with cT1a renal tumor scheduled for laparoscopic nephron sparing surgery. All patients were followed for at least 12 months. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group underwent tumor enucleation after radio frequency ablation without hilar clamping. The primary outcome was the change in glomerular filtration rate of the affected kidney by renal scintigraphy at 12 months. Secondary outcomes included changes in estimated glomerular filtration rate, estimated blood loss, operative time, hospital stay, postoperative complications and oncologic outcomes. The Pearson chi-square or Fisher exact, Student t-test and Wilcoxon rank sum tests were used. The trial ultimately enrolled 89 patients, of whom 44 were randomized to the laparoscopic radio frequency ablation assisted tumor enucleation group and 45 to the laparoscopic partial nephrectomy group. In the laparoscopic partial nephrectomy group 1 case was converted to radical nephrectomy. Compared with the laparoscopic partial nephrectomy group, patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a smaller decrease in glomerular filtration rate of the affected kidney at 3 months (10.2% vs 20.5%, p=0.001) and 12 months (7.6% vs 16.2%, p=0.002). Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a shorter operative time (p=0.002), lower estimated blood loss (p <0.001) and a shorter hospital stay (p=0.029) but similar postoperative complications (p=1.000). There were no positive margins or local recurrence in this study. Zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation enables tumor excision with better renal function preservation compared to conventional laparoscopic partial nephrectomy. Less blood loss and a shorter operative time were achieved with similar postoperative complication rates. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Early declaration of death by neurologic criteria results in greater organ donor potential.

PubMed

Resnick, Shelby; Seamon, Mark J; Holena, Daniel; Pascual, Jose; Reilly, Patrick M; Martin, Niels D

2017-10-01

Aggressive management of patients prior to and after determination of death by neurologic criteria (DNC) is necessary to optimize organ recovery, transplantation, and increase the number of organs transplanted per donor (OTPD). The effects of time management are understudied but potentially pivotal component. The objective of this study was to analyze specific time points (time to DNC, time to procurement) and the time intervals between them to better characterize the optimal timeline of organ donation. Using data over a 5-year time period (2011-2015) from the largest US OPO, all patients with catastrophic brain injury and donated transplantable organs were retrospectively reviewed. Active smokers were excluded. Maximum donor potential was seven organs (heart, lungs [2], kidneys [2], liver, and pancreas). Time from admission to declaration of DNC and donation was calculated. Mean time points stratified by specific organ procurement rates and overall OTPD were compared using unpaired t-test. Of 1719 Declaration of Death by Neurologic Criteria organ donors, 381 were secondary to head trauma. Smokers and organs recovered but not transplanted were excluded leaving 297 patients. Males comprised 78.8%, the mean age was 36.0 (±16.8) years, and 87.6% were treated at a trauma center. Higher donor potential (>4 OTPD) was associated with shorter average times from admission to brain death; 66.6 versus 82.2 hours, P = 0.04. Lung donors were also associated with shorter average times from admission to brain death; 61.6 versus 83.6 hours, P = 0.004. The time interval from DNC to donation varied minimally among groups and did not affect donation rates. A shorter time interval between admission and declaration of DNC was associated with increased OTPD, especially lungs. Further research to identify what role timing plays in the management of the potential organ donor and how that relates to donor management goals is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Patients' estimates of their sleep times: reliability and impact on diagnosis of obstructive sleep apnoea.

PubMed

Khor, Y H; Tolson, J; Churchward, T; Rochford, P; Worsnop, C

2015-08-01

Home polysomnography (PSG) is an alternative method for diagnosis of obstructive sleep apnoea (OSA). Some types 3 and 4 PSG do not monitor sleep and so rely on patients' estimation of total sleep time (TST). To compare patients' subjective sleep duration estimation with objective measures in patients who underwent type 2 PSG for probable OSA. A prospective clinical audit of 536 consecutive patients of one of the authors between 2006 and 2013. A standard questionnaire was completed by the patients the morning after the home PSG to record the time of lights being turned off and estimated time of sleep onset and offset. PSG was scored based on the guidelines of the American Academy of Sleep Medicine. Median estimated sleep latency (SL) was 20 min compared with 10 min for measured SL (P < 0.0001). There was also a significant difference between the estimated and measured sleep offset time (median difference = -1 min, P = 0.01). Estimated TST was significantly shorter than the measured TST (median difference = -18.5 min, P = 0.002). No factors have been identified to affect patients' accuracy of sleep perception. Only 2% of patients had a change in their diagnosis of OSA based on calculated apnoea-hypopnoea index. Overall estimated TST in the patients with probable OSA was significantly shorter than measured with significant individual variability. Collectively, inaccurate sleep time estimation had not resulted in significant difference in the diagnosis of OSA. © 2015 Royal Australasian College of Physicians.

[The randomized controlled trial of influences of T shape approach on the function of knee joint in the treatment of proximal tibial fractures].

PubMed

Peng, Wei-xiong; Zhang, Zhi; Liang, Jie-hong

2008-04-01

To investigate the clinical value of T shape approach in the treatment of proximal tibial fractures. One handrend and thirteen patients of proximal tibial fractures were randomly divided into two groups. Group A: 62 cases underwent the traditional exposure approach. According to Schatzker classification,the cases of II to VI type was 25, 10, 16, 6, 5 respectively. Group B:51 cases underwent T shape approach ahead of knee joint, the cases of II to VI type was 21, 8, 13, 5, 4 respectively. All data were analyzed by SPSS 10.0 to compare operation time, blood loss, duration of hospitalization, healing time, the time of osseous union and complications after operation. Sixty patients in group A and 50 patients in group B were followed-up from 12 to 24 months. (1) Operation time:group B was longer than A (P < 0.01). (2) Mean blood loss and duration of hospitalization was the same. (3) Clinical healing time:group B was shorter. (4) Mean time of osseous union: 48 group B was shorter. Function of knee: group B was better than group A. (Complication: group B was less than group A. As compared with traditional exposure approach, T shape approach of knee joint had advantages of small scar, fewer complications, faster union of fracture and earlier recovery of joint function. The approach is valuable for the treatment of proximal tibial fractures.

Adaptive online self-gating (ADIOS) for free-breathing noncontrast renal MR angiography.

PubMed

Xie, Yibin; Fan, Zhaoyang; Saouaf, Rola; Natsuaki, Yutaka; Laub, Gerhard; Li, Debiao

2015-01-01

To develop a respiratory self-gating method, adaptive online self-gating (ADIOS), for noncontrast MR angiography (NC MRA) of renal arteries to overcome some limitations of current free-breathing methods. A NC MRA pulse sequence for online respiratory self-gating was developed based on three-dimensional balanced steady-state free precession (bSSFP) and slab-selective inversion-recovery. Motion information was derived directly from the slab being imaged for online gating. Scan efficiency was maintained by an automatic adaptive online algorithm. Qualitative and quantitative assessments of image quality were performed and results were compared with conventional diaphragm navigator (NAV). NC MRA imaging was successfully completed in all subjects (n = 15). Similarly good image quality was observed in the proximal-middle renal arteries with ADIOS compared with NAV. Superior image quality was observed in the middle-distal renal arteries in the right kidneys with no NAV-induced artifacts. Maximal visible artery length was significantly longer with ADIOS versus NAV in the right kidneys. NAV setup was completely eliminated and scan time was significantly shorter with ADIOS on average compared with NAV. The proposed ADIOS technique for noncontrast MRA provides high-quality visualization of renal arteries with no diaphragm navigator-induced artifacts, simplified setup, and shorter scan time. © 2014 Wiley Periodicals, Inc.

Comparative study of the ''Misgav Ladach'' and traditional Pfannenstiel surgical techniques for cesarean section.

PubMed

Belci, D; Kos, M; Zoricić, D; Kuharić, L; Slivar, A; Begić-Razem, E; Grdinić, I

2007-06-01

The aim of this study was to evaluate the advantages of the Misgav Ladach surgical technique compared to traditional cesarean section. A prospective randomized trial of 111 women undergoing cesarean section was carried out in the Pula General Hospital. Forty-nine operations were performed using the Pfannenstiel method of cesarean section, 55 by the Misgav Ladach method and 7 by lower midline laparotomy. It was proved that the cases where the Misgav Ladach method was implemented, compared to the Pfannenstiel method, showed a significantly shorter delivery/extraction and operative time (P=0.0009), the incision pain on the second postoperative day was significantly lower (0.021), we recorded a quicker stand up and walking time (P=0.013), significantly fewer analgesic injections and a shorter duration of analgesia were required (P=0.0009) and the bowel function was restored to normal sooner (P=0.001). The Misgav Ladach method of cesarean section has advantages over the Pfannenstiel method in so far as it is significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic function is faster. No differences were found in intraoperative bleeding, maternal morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique.

Comparison between the short-term results of onlay and sublay mesh placement in the management of uncomplicated para-umbilical hernia: a prospective randomized study.

PubMed

Bessa, S S; El-Gendi, A M; Ghazal, A H A; Al-Fayoumi, T A

2015-02-01

The aim of this study was to compare between the short-term results of onlay and sublay mesh placement in the prosthetic repair of uncomplicated para-umbilical hernia (PUH). Eighty patients with a defect size ranging from 4 to 10 cm were prospectively randomized to either the onlay group (40 patients) or the sublay group (40 patients). The operative time, postoperative complications and short-term recurrence were reported. There were no statistically significant differences between both study groups as regards the patients' demographics, associated co-morbidities and mean defect size. The median operative time was significantly shorter in the onlay group compared to that in the sublay group (52 vs. 91 min respectively, p < 0.001). No statistically significant difference was found in the daily median pain score throughout the first postoperative week. The time required to remove the suction drain was significantly shorter in the sublay group compared to that in the onlay group (3 vs. 7 days respectively, p < 0.001).Complications were encountered in 4 patients (10%) in the onlay group compared to 3 patients (7.5%) in the sublay group (p = 1.000). Superficial wound infection was encountered in 1 patient (2.5%) in the sublay group, Seroma was encountered in 2 patients (5%) in the onlay group, Deep vein thrombosis was encountered in 1 patient (2.5%) in the onlay group, Chest infection was encountered in 2 patients (5%) in the sublay group compared to 1 patient (2.5%) in the onlay group. Throughout the 22 months median follow-up duration (range 6-42 months), 2 recurrences (5%) were encountered in either study group. Both techniques are safe, efficient and are associated with comparable complication and recurrence rates.

Impact of robotics on the outcome of elderly patients with endometrial cancer.

PubMed

Lavoue, Vincent; Zeng, Xing; Lau, Susie; Press, Joshua Z; Abitbol, Jeremie; Gotlieb, Raphael; How, Jeffrey; Wang, Yifan; Gotlieb, Walter H

2014-06-01

To evaluate the impact of introducing a robotics program on clinical outcome of elderly patients with endometrial cancer. Evaluation and comparison of peri-operative morbidity and disease-free interval in 163 consecutive elderly patients (≥70years) with endometrial cancer undergoing staging procedure with traditional open surgery compared to robotic surgery. All consecutive patients ≥70years of age with endometrial cancer who underwent robotic surgery (n=113) were compared with all consecutive patients ≥70years of age (n=50) before the introduction of a robotic program in December 2007. Baseline patient characteristics were similar in both eras. Patients undergoing robotic surgery had longer mean operating times (244 compared with 217minutes, p=0.009) but fewer minor adverse events (17% compared with 60%, p<0.001). The robotics cohort had less estimated mean blood loss (75 vs 334mL, p<0.0001) and shorter mean hospital stay (3 vs 6days, p<0.0001). There was no difference in disease-free survival (p=0.61) during the mean follow-up time of 2years. Transitioning from open surgery to a robotics program for the treatment of endometrial cancer in the elderly has significant benefits, including lower minor complication rate, less operative blood loss and shorter hospitalization without compromising 2-year disease-free survival. Copyright © 2014 Elsevier Inc. All rights reserved.

Assessment of the use of latissimus dorsi restoration during modified radical mastectomy in breast cancer patients

PubMed Central

Yang, Chao; Wang, Xinle; Zhang, Geng; Yang, Liu; Guo, Xuan; Wang, Xue; Song, Zhenchuan

2017-01-01

The incision area of modified radical mastectomy in breast cancer patients is associated with subcutaneous effusion and skin flap necrosis as the most common complications. The aim of the present study was to assess the effect of latissimus dorsi restoration during modified radical mastectomy in breast cancer patients by evaluating 365 cases. Among these cases, 185 received modified radical mastectomy combined with intraoperative latissimus dorsi restoration, while 180 received modified radical mastectomy alone. The flap tension, drainage fluid amount and extubation time were compared between the two methods. The flap tension in patients who received modified radical mastectomy combined with intraoperative latissimus dorsi restoration was significantly lower and the blood supply was better. After surgery, the drainage fluid amount was also significantly lower in these patients compared with the control group. Furthermore, the mean time to drainage tube removal was significantly shorter in these patients and the postoperative cosmetic outcome was superior. Thus, it was concluded that modified radical mastectomy combined with intraoperative latissimus dorsi restoration in breast cancer patients was associated with reduced drainage fluid effusion, shorter hospitalization time and decreased flap tension. Overall, this method appears to be potentially suitable for extensive application in the clinical setting. PMID:29285380

SHORT ACCELERATION TIMES FROM SUPERDIFFUSIVE SHOCK ACCELERATION IN THE HELIOSPHERE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Perri, S.; Zimbardo, G., E-mail: silvia.perri@fis.unical.it

2015-12-10

The analysis of time profiles of particles accelerated at interplanetary shocks allows particle transport properties to be inferred. The frequently observed power-law decay upstream, indeed, implies a superdiffusive particle transport when the level of magnetic field variance does not change as the time interval from the shock front increases. In this context, a superdiffusive shock acceleration (SSA) theory has been developed, allowing us to make predictions of the acceleration times. In this work we estimate for a number of interplanetary shocks, including the solar wind termination shock, the acceleration times for energetic protons in the framework of SSA and wemore » compare the results with the acceleration times predicted by standard diffusive shock acceleration. The acceleration times due to SSA are found to be much shorter than in the classical model, and also shorter than the interplanetary shock lifetimes. This decrease of the acceleration times is due to the scale-free nature of the particle displacements in the framework of superdiffusion. Indeed, very long displacements are possible, increasing the probability for particles far from the front of the shock to return, and short displacements have a high probability of occurrence, increasing the chances for particles close to the front to cross the shock many times.« less

Comparison of Single-Port Percutaneous Extraperitoneal Repair and Three-Port Mini-Laparoscopic Repair for Pediatric Inguinal Hernia.

PubMed

Korkmaz, Mevlit; Güvenç, B Haluk

2018-03-01

Laparoscopy has been widely used in surgical practice in pediatric age, and many techniques for laparoscopic hernia repair have been described till now. In this study, we compared two laparoscopic techniques performed by two surgeons; each surgeon practicing only one of the two techniques. A retrospective analysis was performed on the surgical charts, enrolling 71 patients with uncomplicated inguinal hernia. Patients were divided into two groups according to the type of surgery: (Group A, 24 patients aged 2 months-8 years) laparoscopic percutaneous internal ring suturing technique and (Group B, 47 patients aged 35 days-12 years) three-port mini-laparoscopic technique. The hernia sac was ligated at the level of internal ring, using nonabsorbable 4/0-3/0 suture. Any unexpected contralateral opening was repaired in the same manner for both groups. Follow-up period was 4 months-2 years and 9 months-8 years, respectively. Operative time and complications were analyzed. Operation time (19.58 ± 7.06 minutes versus 35.87 ± 10.34 minutes, P < .001) was shorter in the percutaneous repair group. However, when subdivided by unilateral and bilateral presentation, only unilateral operative time was shorter compared to three-port group. There were no recurrences in Group A, while two recurrences occurred in Group B during the learning curve period. A contralateral opening accompanied the presenting unilateral hernia in 3 cases for Group A and 16 for Group B. One patient had to be converted open resulting from epigastric vessel injury, and postop hydrocele formation was seen in another in Group A. No intraoperative complications were seen in Group B. The overall experience shows that laparoscopic repair is a reliable approach regardless of the chosen technique. Percutaneous repair seems to be a less invasive method with shorter operative time, but it is not free of complications according to this series.

Impact of a rapid respiratory panel test on patient outcomes.

PubMed

Rogers, Beverly B; Shankar, Prabhu; Jerris, Robert C; Kotzbauer, David; Anderson, Evan J; Watson, J Renee; O'Brien, Lauren A; Uwindatwa, Francine; McNamara, Kelly; Bost, James E

2015-05-01

Evolution of polymerase chain reaction testing for infectious pathogens has occurred concurrent with a focus on value-based medicine. To determine if implementation of the FilmArray rapid respiratory panel (BioFire Diagnostics, Salt Lake City, Utah) (hereafter RRP), with a shorter time to the test result and expanded panel, results in different outcomes for children admitted to the hospital with an acute respiratory tract illness. Patient outcomes were compared before implementation of the RRP (November 1, 2011, to January 31, 2012) versus after implementation of the RRP (November 1, 2012, to January 31, 2013). The study included inpatients 3 months or older with an acute respiratory tract illness, most admitted through the emergency department. Testing before RRP implementation used batched polymerase chain reaction analysis for respiratory syncytial virus and influenza A and B, with additional testing for parainfluenza 1 through 3 in approximately 11% of patients and for human metapneumovirus in less than 1% of patients. The RRP tested for respiratory syncytial virus, influenza A and B, parainfluenza 1 through 4, human metapneumovirus, adenovirus, rhinovirus/enterovirus, and coronavirus NL62. The pre-RRP group had 365 patients, and the post-RRP group had 771 patients. After RRP implementation, the mean time to the test result was shorter (383 minutes versus 1119 minutes, P < .001), and the percentage of patients with a result in the emergency department was greater (51.6% versus 13.4%, P < .001). There was no difference in whether antibiotics were prescribed, but the duration of antibiotic use was shorter after RRP implementation (P = .003) and was dependent on receiving test results within 4 hours. If the test result was positive, the inpatient length of stay (P = .03) and the time in isolation (P = .03) were decreased after RRP implementation compared with before RRP implementation. The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.

Comparison of clinical outcomes of iris fixation and scleral fixation as treatment for intraocular lens dislocation.

PubMed

Kim, Kyeong Hwan; Kim, Wan Soo

2015-09-01

To compare the efficacy and safety of iris fixation with scleral fixation in surgical repositioning of dislocated intraocular lenses (IOLs). Retrospective, consecutive, comparative interventional case series. setting: Referral hospital. Seventy-eight consecutive patients who underwent surgical repositioning of dislocated intraocular lenses using suturing to the sclera or iris. Forty-four eyes of 44 patients underwent scleral fixation and 35 eyes of 34 patients underwent iris fixation of dislocated intraocular lenses. Visual acuity, refractive stability, operation time, and perioperative complications, including recurrence of IOL dislocation. Corrected distance visual acuity (CDVA) improved significantly 1 month postoperatively in both groups (P < .01 each), and remained stable for 12 months. One week postoperatively, however, CDVA improved significantly in the scleral fixation (P = .040) but not in the iris fixation (P = .058) group. The amount of refractive error significantly diminished 1 day after surgery (P = .028 in the scleral fixation and P = .046 in the iris fixation group). For the astigmatic components, Jackson crossed cylinders equivalent to conventional cylinders of positive power at axes of 0 degrees (J0) and 45 degrees (J45), J45 differed significantly in the scleral fixation and iris fixation groups (P = .009), whereas J0 was similar (P > .05). Operation time was significantly shorter (P = .0007), while immediate postoperative inflammation was significantly more severe (P = .001), in the iris fixation than in the scleral fixation group. Recurrence rates were similar (P > .05), but the mean time to recurrence was significantly shorter in the iris fixation than in the scleral fixation group (P = .031). Iris fixation and scleral fixation techniques had similar efficacy in the repositioning of dislocated intraocular lenses. Although operation time was shorter for iris fixation, it had several disadvantages, including induced astigmatism, immediate postoperative inflammation, earlier recurrence, and less stable refraction. Copyright © 2015 Elsevier Inc. All rights reserved.

Robotic assisted gastrectomy compared with open resection: a case-matched study.

PubMed

Caruso, Riccardo; Vicente, Emilio; Quijano, Yolanda; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Ferri, Valentina

2018-05-04

In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy and to compare outcomes between open and robotic gastric resections. This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analyzed. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 19). The patient characteristics of the two groups have been compared. Robotic resection resulted in less blood loss, shorter postoperative hospital stay, and a longer operating time. The two groups had similar complication rates. Pathological data were similar for both procedures. Robotic gastrectomy for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. Robotic gastrectomy resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy.

Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer.

PubMed

Ng, Simon S M; Leung, Wing Wa; Mak, Tony W C; Hon, Sophie S F; Li, Jimmy C M; Wong, Cherry Y N; Tsoi, Kelvin K F; Lee, Janet F Y

2013-02-01

We investigated the efficacy of electroacupuncture in reducing the duration of postoperative ileus and hospital stay after laparoscopic surgery for colorectal cancer. We performed a prospective study of 165 patients undergoing elective laparoscopic surgery for colonic and upper rectal cancer, enrolled from October 2008 to October 2010. Patients were assigned randomly to groups that received electroacupuncture (n = 55) or sham acupuncture (n = 55), once daily from postoperative days 1-4, or no acupuncture (n = 55). The acupoints Zusanli, Sanyinjiao, Hegu, and Zhigou were used. The primary outcome was time to defecation. Secondary outcomes included postoperative analgesic requirement, time to ambulation, and length of hospital stay. Patients who received electroacupuncture had a shorter time to defecation than patients who received no acupuncture (85.9 ± 36.1 vs 122.1 ± 53.5 h; P < .001) and length of hospital stay (6.5 ± 2.2 vs 8.5 ± 4.8 days; P = .007). Patients who received electroacupuncture also had a shorter time to defecation than patients who received sham acupuncture (85.9 ± 36.1 vs 107.5 ± 46.2 h; P = .007). Electroacupuncture was more effective than no or sham acupuncture in reducing postoperative analgesic requirement and time to ambulation. In multiple linear regression analysis, an absence of complications and electroacupuncture were associated with a shorter duration of postoperative ileus and hospital stay after the surgery. In a clinical trial, electroacupuncture reduced the duration of postoperative ileus, time to ambulation, and postoperative analgesic requirement, compared with no or sham acupuncture, after laparoscopic surgery for colorectal cancer. ClinicalTrials.gov number, NCT00464425. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Comparison between multi-shot gradient echo EPI and balanced SSFP in unenhanced 3T MRA of thoracic aorta in healthy volunteers.

PubMed

Iyama, Yuji; Nakaura, Takeshi; Nagayama, Yasunori; Oda, Seitaro; Utsunomiya, Daisuke; Kidoh, Masafumi; Yuki, Hideaki; Hirata, Kenichiro; Namimoto, Tomohiro; Kitajima, Mika; Morita, Kosuke; Funama, Yoshinori; Takemura, Atsushi; Tokuyasu, Shinichi; Okuaki, Tomoyuki; Yamashita, Yasuyuki

2017-11-01

The purpose of this study was to compare scan time and image quality between magnetic resonance angiography (MRA) of the thoracic aorta using a multi-shot gradient echo planar imaging (MSG-EPI) and MRA using balanced steady-state free precession (b-SSFP). Healthy volunteers (n=17) underwent unenhanced thoracic aorta MRA using balanced steady-state free precession (b-SSFP) and MSG-EPI sequences on a 3T MRI. The acquisition time, total scan time, signal-to-noise ratio (SNR) of the thoracic aorta, and the coefficient of variation (CV) of thoracic aorta were compared with paired t-tests. Two radiologists independently recorded the images' contrast, noise, sharpness, artifacts, and overall quality on a 4-point scale. The acquisition time was 36.2% shorter for MSG-EPI than b-SSFP (115.5±14.4 vs 181.0±14.9s, p<0.01). The total scan time was 40.4% shorter for MSG-EPI than b-SSFP (272±78 vs 456±144s, p<0.01). There was no significant difference in mean SNR between MSG-EPI and b-SSFP scans (17.3±3.6 vs 15.2±4.3, p=0.08). The CV was significantly lower for MSG-EPI than b-SSFP (0.2±0.1 vs. 0.5±0.2, p<0.01). All qualitative scores except for image noise were significantly higher in MSG-EPI than b-SSFP scans (p<0.05). The MSG-EPI sequence is a promising technique for shortening scan time and yielding more homogenous image quality in MRA of thoracic aorta on 3T scanners compared with the b-SSFP. Copyright © 2017 Elsevier B.V. All rights reserved.

A prospective comparison between auto-registration and manual registration of real-time ultrasound with MR images for percutaneous ablation or biopsy of hepatic lesions.

PubMed

Cha, Dong Ik; Lee, Min Woo; Song, Kyoung Doo; Oh, Young-Taek; Jeong, Ja-Yeon; Chang, Jung-Woo; Ryu, Jiwon; Lee, Kyong Joon; Kim, Jaeil; Bang, Won-Chul; Shin, Dong Kuk; Choi, Sung Jin; Koh, Dalkwon; Seo, Bong Koo; Kim, Kyunga

2017-06-01

To compare the accuracy and required time for image fusion of real-time ultrasound (US) with pre-procedural magnetic resonance (MR) images between positioning auto-registration and manual registration for percutaneous radiofrequency ablation or biopsy of hepatic lesions. This prospective study was approved by the institutional review board, and all patients gave written informed consent. Twenty-two patients (male/female, n = 18/n = 4; age, 61.0 ± 7.7 years) who were referred for planning US to assess the feasibility of radiofrequency ablation (n = 21) or biopsy (n = 1) for focal hepatic lesions were included. One experienced radiologist performed the two types of image fusion methods in each patient. The performance of auto-registration and manual registration was evaluated. The accuracy of the two methods, based on measuring registration error, and the time required for image fusion for both methods were recorded using in-house software and respectively compared using the Wilcoxon signed rank test. Image fusion was successful in all patients. The registration error was not significantly different between the two methods (auto-registration: median, 3.75 mm; range, 1.0-15.8 mm vs. manual registration: median, 2.95 mm; range, 1.2-12.5 mm, p = 0.242). The time required for image fusion was significantly shorter with auto-registration than with manual registration (median, 28.5 s; range, 18-47 s, vs. median, 36.5 s; range, 14-105 s, p = 0.026). Positioning auto-registration showed promising results compared with manual registration, with similar accuracy and even shorter registration time.

Comparison of water-based foam and carbon dioxide gas mass emergency depopulation of White Pekin ducks.

PubMed

Caputo, M P; Benson, E R; Pritchett, E M; Hougentogler, D P; Jain, P; Patil, C; Johnson, A L; Alphin, R L

2012-12-01

The mass depopulation of production birds remains an effective means of controlling fast-moving, highly infectious diseases such as avian influenza and virulent Newcastle disease. Two experiments were performed to compare the physiological responses of White Pekin commercial ducks during foam depopulation and CO(2) gas depopulation. Both experiment 1 (5 to 9 wk of age) and 2 (8 to 14 wk of age) used electroencephalogram, electrocardiogram, and accelerometer to monitor and evaluate the difference in time to unconsciousness, motion cessation, brain death, altered terminal cardiac activity, duration of bradycardia, and elapsed time from onset of bradycardia to onset of unconsciousness between foam and CO(2) gas. Experiment 2 also added a third treatment, foam + atropine injection, to evaluate the effect of suppressing bradycardia. Experiment 1 resulted in significantly shorter times for all 6 physiological points for CO(2) gas compared with foam, whereas experiment 2 found that there were no significant differences between foam and CO(2) gas for these physiological points except brain death, in which CO(2) was significantly faster than foam and duration of bradycardia, which was shorter for CO(2). Experiment 2 also determined there was a significant positive correlation between duration of bradycardia and time to unconsciousness, motion cessation, brain death, and altered terminal cardiac activity. The time to unconsciousness, motion cessation, brain death, and altered terminal cardiac activity was significantly faster for the treatment foam + atropine injection compared with foam. Both experiments showed that bradycardia can occur as a result of either submersion in foam or exposure to CO(2) gas. The duration of bradycardia has a significant impact on the time it takes White Pekin ducks to reach unconsciousness and death during depopulation.

Comparison of intra-operative specimen mammography to standard specimen mammography for excision of non-palpable breast lesions: a randomized trial.

PubMed

Miller, Cynthia L; Coopey, Suzanne B; Rafferty, Elizabeth; Gadd, Michele; Smith, Barbara L; Specht, Michelle C

2016-02-01

Standard specimen mammography (SSM) is performed in the radiology department after wire-localized excision of non-palpable breast lesions to confirm the presence of the target and evaluate margins. Alternatively, intra-operative specimen mammography (ISM) allows surgeons to view images in the operating room (OR). We conducted a randomized study comparing ISM and SSM. Women undergoing wire-localized excision for breast malignancy or imaging abnormality were randomized to SSM or ISM. For SSM, the specimen was transported to the radiology department for imaging and interpretation. For ISM, the specimen was imaged in the OR for interpretation by the surgeon and sent for SSM. Interpretation time was from specimen leaving OR until radiologist interpretation for SSM and from placement in ISM device until surgeon interpretation for ISM. Procedure and interpretation times were compared. Concordance between ISM and SSM for target and margins was evaluated. 72 patients were randomized, 36 ISM and 36 SSM. Median procedure times were similar, 48.5 (17-138) min for ISM, and 54 (17-40) min for SSM (p = 0.72), likely since specimens in both groups traveled to radiology for SSM. Median interpretation time was significantly shorter with ISM, 1 (0.5-2.0) and 9 (4-16) min for ISM and SSM, respectively (p < 0.0001). Among specimens with ISM and SSM, concordance was 100 % (35/35) for target and 93 % (14/15) for margins. In this randomized trial, use of ISM compared with SSM significantly reduced interpretation times, while accurately identifying the target. This could result in decreased operative costs from shorter OR times with use of ISM.

Carcinoma of the apocrine glands of the anal sac in dogs: 113 cases (1985-1995).

PubMed

Williams, Laurel E; Gliatto, John M; Dodge, Richard K; Johnson, Jeffrey L; Gamblin, Rance M; Thamm, Douglas H; Lana, Susan E; Szymkowski, Mary; Moore, Antony S

2003-09-15

To characterize the signalment, clinical signs, biological behavior, and response to treatment of carcinoma of the apocrine glands of the anal sac in dogs. Retrospective study. 113 dogs with histologically confirmed carcinoma of the apocrine glands of the anal sac. Data on signalment, clinical signs, and staging were reviewed and analyzed along with treatment modality for potential association with survival time. Sex distribution was approximately equal (54% female, 46% male). One hundred four dogs underwent treatment consisting of surgery, radiation therapy, chemotherapy, or multimodal treatment. Median survival for treated dogs was 544 days (range, 0 to 1,873 days). Dogs treated with chemotherapy alone had significantly shorter survival (median, 212 days) than those receiving other treatments (median, 584 days). Dogs not treated with surgery had significantly shorter survival (median, 402 days) than those that underwent surgery as part of their treatment (median, 548 days). Dogs with tumors > or = 10 cm2 had significantly shorter survival (median, 292 days) than dogs with tumors < 10 cm2 (median, 584 days). Hypercalcemia was identified in 27% (n = 29) of dogs, and those dogs had significantly shorter survival (median, 256 days), compared with those that were normocalcemic (median, 584 days). Dogs with pulmonary metastasis had significantly shorter survival (median, 219 days) than dogs without evidence of pulmonary metastasis (median, 548 days). Unlike most previous reports, this study revealed an approximately equal sex distribution, and results suggest a more favorable prognosis.

Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) program: A new standard of care for injured workers in Hong Kong.

PubMed

Law, S W; Szeto, G P Y; Chau, W W; Chan, Carol; Kwok, Anthony W L; Lai, H S; Lee, Ryan K L; Griffith, James F; Hung, L K; Cheng, J C Y

2016-08-10

The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process. A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n= 139) or control group (n= 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of injury, waiting time for MRI screening and time to medical assessment board (MAB). Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months, 12.8 months, p< 0.01), and more RTW cases (n= 64, 46.0%) compared to CONTROL group (n= 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p< 0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p= 0.001) compared to CONTROL group. The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers.

High School Students Residing in Educational Public Institutions: Health-Risk Behaviors

PubMed Central

Silveira, Nusa de Almeida; Noll, Matias; Barros, Patrícia de Sá

2016-01-01

Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14–19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of <8 months and those of >20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors. PMID:27560808

Duration of Antimicrobial Treatment for Bacteremia in Canadian Critically Ill Patients.

PubMed

Daneman, Nick; Rishu, Asgar H; Xiong, Wei; Bagshaw, Sean M; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, Francois; Lauzier, Francois; Marshall, John; Martin, Claudio M; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steve; Stelfox, Henry T; Cook, Deborah J; Fowler, Robert A

2016-02-01

The optimum duration of antimicrobial treatment for patients with bacteremia is unknown. Our objectives were to determine duration of antimicrobial treatment provided to patients who have bacteremia in ICUs, to assess pathogen/patient factors related to treatment duration, and to assess the relationship between treatment duration and survival. Retrospective cohort study. Fourteen ICUs across Canada. Patients with bacteremia and were present in the ICU at the time culture reported positive. Duration of antimicrobial treatment for patients who had bacteremia in ICU. Among 1,202 ICU patients with bacteremia, the median duration of treatment was 14 days, but with wide variability (interquartile range, 9-17.5). Most patient characteristics were not associated with treatment duration. Coagulase-negative staphylococci were the only pathogens associated with shorter treatment (odds ratio, 2.82; 95% CI, 1.51-5.26). The urinary tract was the only source of infection associated with a trend toward lower likelihood of shorter treatment (odds ratio, 0.67; 95% CI, 0.42-1.08); an unknown source of infection was associated with a greater likelihood of shorter treatment (odds ratio, 2.14; 95% CI, 1.17-3.91). The association of treatment duration and survival was unstable when analyzed based on timing of death. Critically ill patients who have bacteremia typically receive long courses of antimicrobials. Most patient/pathogen characteristics are not associated with treatment duration; survivor bias precludes a valid assessment of the association between treatment duration and survival. A definitive randomized controlled trial is needed to compare shorter versus longer antimicrobial treatment in patients who have bacteremia.

Times to pain relief and pain freedom with rizatriptan 10 mg and other oral triptans

PubMed Central

Ng-Mak, D S; Hu, X H; Chen, Y; Ma, L; Solomon, G

2007-01-01

Background: In the clinical trial setting, oral rizatriptan 10 mg has greater efficacy than other oral triptans in freedom from migraine headache pain 2 h after dosing. Objective: The study objective is to compare the effectiveness of rizatriptan 10 mg and other oral triptans for acute migraine attack in a naturalistic setting. Methods: A total of 673 patients took rizatriptan 10 mg or their usual-care oral triptans for two migraine attacks in a sequential, cross-over manner and recorded outcomes using a diary and a stopwatch. Mean and median times to pain relief (PR) and pain freedom (PF) for rizatriptan and other oral triptans were compared. The effect of rizatriptan on times to PR and PF, adjusting for potential confounding factors (treatment sequence, treatment order and use of rescue medication), was computed via a Cox proportional hazard model. Results: Significantly, more patients taking rizatriptan achieved both PR and PF within 2 h after dosing than other oral triptans. Times to PR and PF were shorter with rizatriptan than with other oral triptans (median time to PR: 45 vs. 52 min, p < 0.0001; median time to PF: 100 vs. 124 min, p < 0.0001). The adjusted proportional hazard ratios (rizatriptan vs. other oral triptans) for times to PR and PF were 1.32 (95% CI: 1.22–1.44) and 1.27 (95% CI: 1.16–1.39) respectively. Conclusion: The times to PR and PF in a ‘naturalistic’ setting were significantly shorter for patients treating a migraine attack with rizatriptan 10 mg than with other oral triptans. PMID:17537184

Seasonal change of residence time in spring water and groundwater at a mountainous headwater catchment

NASA Astrophysics Data System (ADS)

Nagano, Kosuke; Tsujimura, Maki; Onda, Yuichi; Iwagami, Sho; Sakakibara, Koichi; Sato, Yutaro

2017-04-01

Determination of water age in headwater is important to consider water pathway, source and storage in the catchment. Previous studies showed that groundwater residence time changes seasonally. These studies reported that mean residence time of water in dry season tends to be longer than that in rainy season, and it becomes shorter as precipitation and discharge amount increases. However, there are few studies to clarify factors causing seasonal change in mean residence time in spring water and groundwater based on observed data. Therefore, this study aims to reveal the relationship between mean residence time and groundwater flow system using SFconcentration in spring and 10 minutes interval hydrological data such as discharge volume, groundwater level and precipitation amount in a headwater catchment in Fukushima, Japan. The SF6 concentration data in spring water observed from April 2015 to November 2016 shows the mean residence time of springs ranged from zero to 14 years. We also observed a clear negative correlation between discharge rate and residence time in the spring. The residence time in shallow groundwater in rainy season was younger as compared with that in low rainfall period. Therefore, the shallow groundwater with young residence time seems to contribute to the spring in rainy season, causing shorter residence time. Additionally, the residence time of groundwater ranged from 3 to 5 years even in low rainfall period. The residence time in high groundwater table level in ridge was older as compared with that in low groundwater table level. These suggest that the contribution of groundwater with older age in the ridge becomes dominant in the low discharge.

A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants.

PubMed

Mazzella, M; Bellini, C; Calevo, M G; Campone, F; Massocco, D; Mezzano, P; Zullino, E; Scopesi, F; Arioni, C; Bonacci, W; Serra, G

2001-09-01

To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome. Randomised controlled study. Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated. Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O(2) requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72 %) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant. IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial.

Laparoscopic versus open abdominal surgery in children with sickle cell disease is associated with a shorter hospital stay.

PubMed

Goers, Trudie; Panepinto, Julie; Debaun, Michael; Blinder, Morey; Foglia, Robert; Oldham, Keith T; Field, Joshua J

2008-03-01

Limited information exists comparing the post-operative complication rate of laparoscopic or open abdominal surgeries in children with sickle cell disease (SCD). The primary objective of this study was to compare the outcomes in children with SCD who required laparoscopic or open abdominal surgery for a cholecystectomy or splenectomy. We conducted a retrospective analysis of laparoscopic and open abdominal surgeries performed in children with SCD (ages 0-20 years) at two medical centers from 1984 to 2004. The primary outcome measures were the rates of post-operative pain and acute chest syndrome (ACS) episodes following laparoscopic or open abdominal surgery. The secondary outcome was length of hospital stay following surgery. We also examined the potential contribution of pre-operative (transfusion) and intra-operative factors (operating time, estimated blood loss, and end-operative temperature) to post-operative SCD-related complications. A total of 140 cases were identified, 98 laparoscopic and 42 open. Episodes of post-operative pain and ACS episodes were comparable between laparoscopic and open procedures (pain: 4% vs. 3%, P = 0.619; ACS: 5% vs. 5%, P = 0.933). Additionally, laparoscopic surgeries were associated with a significantly shorter hospital stay (2.9 vs. 5.4 days, 95% CI -3.7 to -1.4, P < 0.001). There was no difference in the number of hospital readmissions within 1 month of the surgery. For children with SCD who need a cholecystectomy or splenectomy, laparoscopy is the preferred strategy because of a shorter hospital stay with a similar complication rate compared to open surgeries. (c) 2007 Wiley-Liss, Inc.

Comparative photoluminescence study of close-packed and colloidal InP/ZnS quantum dots

NASA Astrophysics Data System (ADS)

Thuy, Ung Thi Dieu; Thuy, Pham Thi; Liem, Nguyen Quang; Li, Liang; Reiss, Peter

2010-02-01

This letter reports on the comparative photoluminescence study of InP/ZnS quantum dots in the close-packed solid state and in colloidal solution. The steady-state photoluminescence spectrum of the close-packed InP/ZnS quantum dots peaks at a longer wavelength than that of the colloidal ones. Time-resolved photoluminescence shows that the close-packed quantum dots possess a shorter luminescence decay time and strongly increased spectral shift with the time delayed from the excitation moment in comparison with the colloidal ones. The observed behavior is discussed on the basis of energy transfer enabled by the short interparticle distance between the close-packed quantum dots.

Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials.

PubMed

Su, Naichuan; Liu, Yan; Yang, Xianrui; Shi, Zongdao; Huang, Yi

2014-04-01

The objective of the study was to assess the efficacy and safety of mepivacaine compared with lidocaine used in local anaesthesia in dentistry. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure and WHO International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomised controlled trials comparing mepivacaine with lidocaine in terms of efficacy and safety. Twenty-eight studies were included, of which 15 had low risk of bias and 13 had moderate risk of bias. In comparison with 2% lidocaine with 1:100,000 adrenaline, 3% mepivacaine showed a lower success rate (P = 0.05), a shorter onset time of pulpal anaesthesia (P = 0.0005), inferior pain control during injection phase and superior inhibition of heart rate increase (P < 0.0001). In contrast, 2% mepivacaine with 1:100,000 adrenaline gave a higher success rate (P < 0.00001), a similar onset time of pulpal anaesthesia (P = 0.34) and superior pain control during injection phase (P < 0.0001); 2% mepivacaine with 1:20,000 levonordefrin had the same success rate (P = 0.69) and similar onset time of pulpal anaesthesia (P = 0.90). In addition, 3% mepivacaine had shorter onset time (P = 0.004), same level of success rate (P = 0.28) and similar pain control during injection and postinjection compared with 2% lidocaine with 1:50,000 adrenaline. Given the efficacy and safety of the two solutions, 2% mepivacaine with vasoconstrictors is better than 2% lidocaine with vasoconstrictors in dental treatment. Meanwhile, 3% plain mepivacaine is better for patients with cardiac diseases. © 2014 FDI World Dental Federation.

Maternal and fetal effect of misgav ladach cesarean section in nigerian women: a randomized control study.

PubMed

Ezechi, Oc; Ezeobi, Pm; Gab-Okafor, Cv; Edet, A; Nwokoro, Ca; Akinlade, A

2013-10-01

The poor utilisation of the Misgav-Ladach (ML) caesarean section method in our environment despite its proven advantage has been attributed to several factors including its non-evaluation. A well designed and conducted trial is needed to provide evidence to convince clinician of its advantage over Pfannenstiel based methods. To evaluate the outcome of ML based caesarean section among Nigerian women. Randomised controlled open label study of 323 women undergoing primary caesarean section in Lagos Nigeria. The women were randomised to either ML method or Pfannenstiel based (PB) caesarean section technique using computer generated random numbers. The mean duration of surgery (P < 0.001), time to first bowel motion (P = 0.01) and ambulation (P < 0.001) were significantly shorter in the ML group compared to PB group. Postoperative anaemia (P < 0.01), analgesic needs (P = 0.02), extra suture use, estimated blood loss (P < 0.01) and post-operative complications (P = 0.001) were significantly lower in the ML group compared to PB group. Though the mean hospital stay was shorter (5.8 days) in the ML group as against 6.0 days, the difference was not significant statistically (P = 0.17). Of the fetal outcome measures compared, it was only in the fetal extraction time that there was significant difference between the two groups (P = 0.001). The mean fetal extraction time was 162 sec in ML group compared to 273 sec in the PB group. This study confirmed the already established benefit of ML techniques in Nigerian women, as it relates to the postoperative outcomes, duration of surgery, and fetal extraction time. The technique is recommended to clinicians as its superior maternal and fetal outcome and cost saving advantage makes it appropriate for use in poor resource setting.

Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study.

PubMed

Cai, Wansong; Chen, Zhiyuan; Wen, Liping; Jiang, Xiangxin; Liu, Xiuheng

2016-01-01

Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered "successful". Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique.

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators.

PubMed

He, Yi-Zhou; Zhong, Ming; Wu, Wei; Song, Jie-Qiong; Zhu, Du-Ming

2017-04-01

The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. We analyzed 236 patients who had undergone central venous cannulation of axillary vein in this retrospective study. Patients were divided into two groups, the longitudinal approach group (n=120) and transverse approach group (n=116). Recorded the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate. We perform chest radiography to confirm pneumothorax on all patients. We compared the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate between the two groups. The two groups were comparable with clinical characters of patients. The overall success rates of the longitudinal group and the transverse group were both 100%. The rate of one-attempt success in the longitudinal approach group is higher than the transverse approach group (91.7% vs. 82.8%, P=0.040). The transverse approach group had shorter operation time than the longitudinal group (184.7±8.1 vs. 287.5±19.6 seconds, P=0.000). The two groups had lower postoperative complications. Arterial puncture occurred in 1 of 120 longitudinal and 2 of 116 transverse attempts and this difference was no significant (P=0.541). No pneumothorax occurred in the two groups. The longitudinal approach during ultrasound-guided axillary vein cannulation is associated with greater one-attempt success rate compared with the transverse approach by experienced operators. The transverse approach has shorter operation time. The two groups have lower postoperative complications and are comparable with pneumothorax and arterial puncture.

Diving bradycardia of elderly Korean women divers, haenyeo, in cold seawater: a field report

PubMed Central

LEE, Joo-Young; LEE, Hyo-Hyun; KIM, Siyeon; JANG, Young-Joon; BAEK, Yoon-Jeong; KANG, Kwon-Yong

2015-01-01

The purpose of the present field study was to explore diving patterns and heart rate of elderly Korean women divers (haenyeo) while breath-hold diving in cold seawater. We hypothesized that the decreasing rate in heart rate of elderly haenyeos during breath-hold diving was greater and total diving time was shorter than those of young haenyeos from previous studies. Nine haenyeos participated in a field study [68 ± 10 yr in age, ranged from 56 to 83 yr] at a seawater temperature of 10 to 13 °C. Average total diving time including surface swimming time between dives was 253 ± 73 min (155–341 min). Total frequency of dives was 97 ± 28 times and they dived 23 ± 8 times per hour. All haenyeos showed diving bradycardia with a decreased rate of 20 ± 8% at the bottom time (101 ± 20 bpm) when compared to surface swimming time (125 ± 16 bpm) in the sea. Older haenyeos among the nine elderly haenyeos had shorter diving time, less diving frequencies, and lower heart rate at work (p<0.05). These reductions imply that haenyeos voluntarily adjust their workload along with advancing age and diminished cardiovascular functions. PMID:26632118

Diving bradycardia of elderly Korean women divers, haenyeo, in cold seawater: a field report.

PubMed

Lee, Joo-Young; Lee, Hyo-Hyun; Kim, Siyeon; Jang, Young-Joon; Baek, Yoon-Jeong; Kang, Kwon-Yong

2016-01-01

The purpose of the present field study was to explore diving patterns and heart rate of elderly Korean women divers (haenyeo) while breath-hold diving in cold seawater. We hypothesized that the decreasing rate in heart rate of elderly haenyeos during breath-hold diving was greater and total diving time was shorter than those of young haenyeos from previous studies. Nine haenyeos participated in a field study [68 ± 10 yr in age, ranged from 56 to 83 yr] at a seawater temperature of 10 to 13 °C. Average total diving time including surface swimming time between dives was 253 ± 73 min (155-341 min). Total frequency of dives was 97 ± 28 times and they dived 23 ± 8 times per hour. All haenyeos showed diving bradycardia with a decreased rate of 20 ± 8% at the bottom time (101 ± 20 bpm) when compared to surface swimming time (125 ± 16 bpm) in the sea. Older haenyeos among the nine elderly haenyeos had shorter diving time, less diving frequencies, and lower heart rate at work (p<0.05). These reductions imply that haenyeos voluntarily adjust their workload along with advancing age and diminished cardiovascular functions.

Ball Machine Usage in Tennis: Movement Initiation and Swing Timing While Returning Balls from a Ball Machine and from a Real Server

PubMed Central

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-01-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers’ movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key points Players have shorter initial move time when they are facing the ball machine. Using the ball machine results in different swing timing and movement coordination. The use of the ball machine should be limited. PMID:24790483

Ball machine usage in tennis: movement initiation and swing timing while returning balls from a ball machine and from a real server.

PubMed

Carboch, Jan; Süss, Vladimir; Kocib, Tomas

2014-05-01

Practicing with the use of a ball machine could handicap a player compared to playing against an actual opponent. Recent studies have shown some differences in swing timing and movement coordination, when a player faces a ball projection machine as opposed to a human opponent. We focused on the time of movement initiation and on stroke timing during returning tennis serves (simulated by a ball machine or by a real server). Receivers' movements were measured on a tennis court. In spite of using a serving ball speed from 90 kph to 135 kph, results showed significant differences in movement initiation and backswing duration between serves received from a ball machine and serves received from a real server. Players had shorter movement initiation when they faced a ball machine. Backswing duration was longer for the group using a ball machine. That demonstrates different movement timing of tennis returns when players face a ball machine. Use of ball machines in tennis practice should be limited as it may disrupt stroke timing. Key pointsPlayers have shorter initial move time when they are facing the ball machine.Using the ball machine results in different swing timing and movement coordination.The use of the ball machine should be limited.

[Comparative trial between traditional cesarean section and Misgav-Ladach technique].

PubMed

Gutiérrez, José Gabriel Tamayo; Coló, José Antonio Sereno; Arreola, María Sandra Huape

2008-02-01

The cesarean section was designed to extract to the neoborn, when the childbirth becomes difficult by the natural routes. The institutional obstetrical work demands long surgical time and high raw materials; therefore, simpler procedures must be implemented. To compare traditional cesarean section vs Misgav-Ladach technique to assess surgical time, and hospital stay and costs. Forty-eight pregnant patients at term with obstetrical indication for cesarean delivery were randomized in two groups: 24 were submitted to traditional cesarean and 24 to Misgav-Ladach technique. The outcomes included surgical time, bleeding, amount of sutures employed, pain intensity and some others adverse effects. The surgical time with Misgav-Ladach technique was shorter compared with traditional cesarean section, bleeding was consistently lesser and pain was also low. None adverse effects were registered in both groups. Although short follow-up showed significant operative time reduction and less bleeding, longer follow-up should be desirable in order to confirm no abdominal adhesions.

Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn infants.

PubMed

Aghamohammadi, Azar; Zafari, Mandana; Moslemi, Leila

2012-06-01

Comparing the effect of topical human milk application and dry cord care on cord separation time. This research was a randomized clinical trial study on 130 singleton and mature newborns. Newborns were placed randomly in groups of topical application of human milk and dry cord care. The umbilical separation time was compared in the two groups. Data was analyzed by SPSS software. Independent Samples t-Test, χ(2), Fisher were used in this study. Median time of cord separation in human milk application group (150.95±28.68 hours) was significantly shorter than dry cord care group (180.93±37.42 hours) (P<0.001). Topical application of human milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and non invasive way for cord care.

Improvements In solar dry kiln design

Treesearch

E. M. Wengert

1971-01-01

Interest in solar drying of lumber has increased in recent years because previous results had indicated that: Drying times are shorter and final moisture contents are lower in solar drying than in air drying; much less lumber degrade occurs in solar drying when compared to air drying; and the cost of energy is less in solar drying than in kiln drying. Work in the field...

Speech Perception Engages a General Timer: Evidence from a Divided Attention Word Identification Task

ERIC Educational Resources Information Center

Casini, Laurence; Burle, Boris; Nguyen, Noel

2009-01-01

Time is essential to speech. The duration of speech segments plays a critical role in the perceptual identification of these segments, and therefore in that of spoken words. Here, using a French word identification task, we show that vowels are perceived as shorter when attention is divided between two tasks, as compared to a single task control…

The effect of filler addition and oven temperature to the antioxidant quality in the drying of Physalis angulata fruit extract obtained by subcritical water extraction

NASA Astrophysics Data System (ADS)

Susanti, R. F.; Christianto, G.

2016-01-01

Physalis angulata or ceplukan is medicinal herb, which grows naturally in Indonesia. It has been used in traditional medicine to treat several diseases. It is also reported to have antimycobacterial, antileukemic, antipyretic. In this research, Pysalis angulata fruit was investigated for its antioxidant capacity. In order to avoid the toxic organic solvent commonly used in conventional extraction, subcritical water extraction method was used. During drying, filler which is inert was added to the extract. It can absorb water and change the oily and sticky form of extract to powder form. The effects of filler types, concentrations and drying temperatures were investigated to the antioxidant quality covering total phenol, flavonoid and antioxidant activity. The results showed that total phenol, flavonoid and antioxidant activity were improved by addition of filler because the drying time was shorter compared to extract without filler. Filler absorbs water and protects extract from exposure to heat during drying. The combination between high temperature and shorter drying time are beneficial to protect the antioxidant in extract. The type of fillers investigation showed that aerosil gave better performance compared to Microcrystalline Celullose (MCC).

Muscle fatigue in fibromyalgia is in the brain, not in the muscles: a case-control study of perceived versus objective muscle fatigue.

PubMed

Bandak, Elisabeth; Amris, Kirstine; Bliddal, Henning; Danneskiold-Samsøe, Bente; Henriksen, Marius

2013-06-01

To investigate relationships between perceived and objectively measured muscle fatigue during exhausting muscle contractions in women with fibromyalgia (FM) compared with healthy controls (HC). Women with FM and HC completed an isometric muscle exhaustion task at 90° shoulder abduction. Surface electromyographic (EMG) activity in the deltoid muscle was recorded together with self-reported level of muscle fatigue. 25 participants with FM and 23 HC were included. Average time to exhaustion was 254 s shorter in participants with FM than in HC. Participants with FM did not exhibit the same level of objective signs of muscle fatigue, seen as fewer changes in the EMG activity, as the HC during the exhaustion task. The task did not provoke pain in the HC, while participants with FM reported a doubling of pain. Women with FM had shorter exhaustion times and showed fewer objective signs of muscle fatigue during an exhausting isometric shoulder abduction compared with younger HC. This indicates that perceived muscle fatigue may be of central origin and supports the notion of central nervous dysfunction as basic pathological changes in FM.

Verbs in the lexicon: Why is hitting easier than breaking?

PubMed

McKoon, Gail; Love, Jessica

2011-11-01

Adult speakers use verbs in syntactically appropriate ways. For example, they know implicitly that the boy hit at the fence is acceptable but the boy broke at the fence is not. We suggest that this knowledge is lexically encoded in semantic decompositions. The decomposition for break verbs (e.g. crack, smash) is hypothesized to be more complex than that for hit verbs (e.g. kick, kiss). Specifically, the decomposition of a break verb denotes that "an entity changes state as the result of some external force" whereas the decomposition for a hit verb denotes only that "an entity potentially comes in contact with another entity." In this article, verbs of the two types were compared in a lexical decision experiment - Experiment 1 - and they were compared in sentence comprehension experiments with transitive sentences (e.g. the car hit the bicycle and the car broke the bicycle) - Experiments 2 and 3. In Experiment 1, processing times were shorter for the hit than the break verbs and in Experiments 2 and 3, processing times were shorter for the hit sentences than the break sentences, results that are in accord with the complexities of the postulated semantic decompositions.

The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center.

PubMed

Liu, Rong; Zhang, Tao; Zhao, Zhi-Ming; Tan, Xiang-Long; Zhao, Guo-Dong; Zhang, Xuan; Xu, Yong

2017-06-01

Pancreaticoduodenectomy (PD) is a difficult and complex operation. The introduction of robotics has opened up new angles in pancreatic surgery. This study aims to assess the surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy relative to its laparoscopic counterpart. A retrospective study was designed to compare the surgical outcomes of 27 robot-assisted laparoscopic pancreaticoduodenectomy (RPD) and 25 laparoscopic pancreaticoduodenectomy (LPD). Perioperative data, including operating time, complication, morbidity and mortality, estimated blood loss, and postoperative length of stay, were analyzed. The robotic group exhibited significantly shorter operative time (mean 387 vs. 442 min), shorter hospital stay (mean 17 vs. 24 days), and less blood loss (mean 219 vs. 334 ml) than those in the LPD group. No statistical difference was observed between the two groups in terms of complication rate, mortality rate, R0 resection rate, and number of harvested lymph node. RPD is more efficient and secure process than LPD among properly selected patients. RPD is therefore a feasible alternative to the laparoscopic procedure. Further studies are needed to evaluate the cost effectiveness of the robotic approach for PD.

Comparison of life history parameters of two Frankliniella occidentalis (Thysanoptera: Thripidae) strains in New Zealand.

PubMed

Nielsen, M-C; Teulon, D A J; Chapman, R B; Butler, R C; Drayton, G M; Philipsen, H

2010-04-01

Two strains of western flower thrips, Frankliniella occidentalis (Pergande), are reputedly found in New Zealand. One strain was recorded in 1934, and it is most common in flowers of Lupinus arboreus outdoors (lupin strain); the other strain was first recorded in New Zealand in 1992 and is found mostly indoors on greenhouse crops (greenhouse strain). Laboratory studies were conducted to compare the life history parameters of these two strains. Thrips from each strain were fed sucrose solution and capsicum or lupin pollen and reared at 25 degrees C, >60% RH, and 16 L:8 D photoperiod. Significant differences in life history parameters were found. Preoviposition time was significantly shorter, and oviposition rate and fecundity were markedly higher (four-fold) for the greenhouse than for the lupin strain. The lupin strain performed significantly better on the capsicum pollen, laying more than twice as many eggs than on the lupin pollen over a 14-d period. The greenhouse strain development time from larvae to adult was marginally faster (0.7-1.1 d less) than the lupin strain because of a shorter prepupal and a marginally shorter pupal development time. Females of the greenhouse strain lived on average 69% longer than females from the lupin strain. Large differences in the intrinsic growth rate (r(m)) were found, with r(m) being 1.4-1.8 times higher for the greenhouse strain than the lupin strain, depending on pollen source. The results are discussed in relation to different ecological requirements and pest status of the two strains.

Time-to-detection of bacteria and yeast with the BACTEC FX versus BacT/Alert Virtuo blood culture systems.

PubMed

Somily, Ali Mohammed; Habib, Hanan Ahmed; Torchyan, Armen Albert; Sayyed, Samina B; Absar, Muhammed; Al-Aqeel, Rima; Binkhamis, A Khalifa

2018-01-01

Bloodstream infections are associated with high rates of morbidity and mortality. Rapid detection of bloodstream infections is important in achieving better patient outcomes. Compare the time-to-detection (TTD) of the new BacT/Alert Virtuo and the BACTEC FX automated blood culture systems. Prospective simulated comparison of two instruments using seeded samples. Medical microbiology laboratory. Blood culture bottles were seeded in triplicate with each of the standard ATCC strains of aerobes, anaerobes and yeast. TTD was calculated as the length of time from the beginning of culture incubation to the detection of bacterial growth. TTD for the various tested organisms on the two microbial detection systems. The 99 bottles of seeded blood cultures incubated in each of the blood culture systems included 21 anaerobic, 39 aerobic and 39 pediatric bottles. The BacT/Alert Virtuo system exhibited significantly shorter TTD for 72.7 % of the tested organisms compared to BACTEC FX system with a median difference in mean TTD of 2.1 hours (interquartile range: 1.5-3.5 hours). The BACTEC FX system was faster in 15.2% (5/33) of microorganisms, with a median difference in mean TTD of 25.9 hours (IQR: 9.1-29.2 hours). TTD was significantly shorter for most of the microorganisms tested on the new BacT/Alert Virtuo system compared to the BACTEC FX system. Use of simulated cultures to assess TTD may not precisely represent clinical blood cultures. None.

Retrograde light-guided laryngoscopy for tracheal intubation: clinical practice and comparison with conventional direct laryngoscopy.

PubMed

Yang, Tao; Hou, Jiong; Li, Jinbao; Zhang, Xu; Zhu, Xiaoyan; Ni, Wen; Mao, Yanfei; Deng, Xiaoming

2013-05-01

Tracheal intubation with conventional laryngoscopy requires many trials until beginners are sufficiently skilled in intubating patients safely. To facilitate intubation, the authors used retrograde light-guided laryngoscopy (RLGL) and compared its feasibility with conventional direct laryngoscopy (DL). Twenty operators participated in a prospective, randomized, open-label, parallel-arm study. These operators intubated 205 patients randomly according to a computer-generated procedure by using either DL or RLGL (five intubations with each technique). The primary outcome was the success rate of tracheal intubation. The authors evaluated the success rate of tracheal intubation, the time to glottic exposure and tracheal intubation, and the Cormack and Lehane grades. Compared with DL, the success rate was greater in the RLGL group for all five intubations (72% vs. 47%; rate difference, 25%; 95% CI [11.84-38.16%], P < 0.001). This was associated with a shorter time to glottic exposure (median [25th and 75th percentile]; 27 [15; 42] vs. 45 [30; 73] s, P < 0.001), shorter intubation time (66 [44; 120] vs. 120 [69; 120] s, P < 0.001), and decreased throat soreness (mean ± SD; visual analog scale, 2.1 ± 0.9 vs. 3.7 ± 1.0 cm, P = 0.001) in the RLGL group compared to the DL group. RLGL is an alternative intubation technique. In our study, it enables beginners to intubate patients more successfully and quickly than conventional DL.

Association between reported sleep need and sleepiness at the wheel: comparative study on French highways between 1996 and 2011.

PubMed

Quera-Salva, M A; Hartley, S; Sauvagnac-Quera, R; Sagaspe, P; Taillard, J; Contrand, B; Micoulaud, J A; Lagarde, E; Barbot, F; Philip, P

2016-12-21

To investigate the evolution over 15 years of sleep schedules, sleepiness at the wheel and driving risk among highway drivers. Comparative survey including questions on usual sleep schedules and before the trip, sleepiness at the wheel, the Epworth sleepiness scale, Basic Nordic Sleep Questionnaire (BNSQ) and a travel questionnaire. 80% of drivers stopped by the highway patrol agreed to participate in both studies with a total of 3545 drivers in 2011 and 2196 drivers in 1996 interviewed. After standardisation based on sex, age and mean annual driving distance, drivers in 2011 reported shorter sleep time on week days (p<0.0001), and week-ends (p<0.0001) and shorter optimal sleep time (p<0.0001) compared to 1996 drivers. There were more drivers sleepy at the wheel in 2011 than in 1996 (p<0.0001) and 2.5 times more drivers in 2011 than in 1996 had an Epworth sleepiness score >15 indicating severe sleepiness. Even if drivers in 2011 reported good sleep hygiene prior to a highway journey, drivers have reduced their mean weekly sleep duration over 15 years and have a higher risk of sleepiness at the wheel. Sleep hygiene for automobile drivers remains an important concept to address. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr: YSGG laser

PubMed Central

Pié-Sánchez, Jordi; España-Tost, Antonio J.; Arnabat-Domínguez, Josep

2012-01-01

Objectives: To compare upper lip frenulum reinsertion, bleeding, surgical time and surgical wound healing in frenectomies performed with the CO2 laser versus the Er, Cr:YSGG laser. Study design: A prospective study was carried out on 50 randomized pediatric patients who underwent rhomboidal resection of the upper lip frenulum with either the CO2 laser or the Er,Cr:YSGG laser. Twenty-five patients were assigned to each laser system. All patients were examined at 7, 14, 21 days and 4 months after the operation in order to assess the surgical wound healing. Results: Insertion of the frenulum, which was preoperatively located between the upper central incisors, migrated to the mucogingival junction as a result of using both laser systems in all patients. Only two patients required a single dose of 650 mg of paracetamol, one of either study group. CO2 laser registered improved intraoperative bleeding control results and shorter surgical times. On the other hand, the Er,Cr:YSGG laser achieved faster healing. Conclusions: Upper lip laser frenectomy is a simple technique that results in minimum or no postoperative swelling or pain, and which involves upper lip frenulum reinsertion at the mucogingival junction. The CO2 laser offers a bloodless field and shorter surgical times compared with the Er,Cr:YSGG laser. On the other hand, the Er,Cr:YSGG laser achieved faster wound healing. Key words:Frenectomy, upper lip frenulum, CO2 laser, Er,Cr:YSGG laser, laser. PMID:22143683

Waiting times for hospital admissions: the impact of GP fundholding.

PubMed

Propper, Carol; Croxson, Bronwyn; Shearer, Arran

2002-03-01

Waiting times for hospital care are a significant issue in the UK National Health Service (NHS). The reforms of the health service in 1990 gave a subset of family doctors (GP fundholders) both the ability to choose the hospital where their patients were treated and the means to pay for some services. One of the key factors influencing family doctors' choice of hospital was patient waiting time. However, without cash inducements, hospitals would get no direct reward from giving shorter waiting times to a subset of patients. Using a unique dataset, we investigate whether GP fundholders were able to secure shorter waiting times for their patients, whether they were able to do so in cases where they had no financial rewards to offer hospitals, and whether the impact of fundholding spilled over into shorter waiting times for all patients.

Treatment of femur fractures in young children: a multicenter comparison of flexible intramedullary nails to spica casting in young children aged 2 to 6 years.

PubMed

Heffernan, Michael J; Gordon, J Eric; Sabatini, Coleen S; Keeler, Kathryn A; Lehmann, Charles L; O'Donnell, June C; Seehausen, Derek A; Luhmann, Scott J; Arkader, Alexandre

2015-03-01

Spica casting is the standard of care for femur fractures in children up to 6 years of age. The indications for surgery are controversial. We sought to compare immediate spica casting (Spica) and flexible intramedullary nailing [titanium elastic nailing (TEN)] in a group of children ages 2 to 6 years. We hypothesized that young children can be successfully treated with flexible nails, resulting in faster return to ambulation and an equivalent complication rate when compared with spica casting. This was a multicenter retrospective review of 215 patients, 141 treated with immediate spica casting, and 74 treated with elastic nails. Patient demographics, fracture characteristics, mechanism of injury, associated injuries, outcomes, and complications were recorded and compared between the 2 groups. Patients in the elastic nailing group were more likely to be injured as a pedestrian struck by an automobile (Spica 8% vs. TEN 26%, P=0.001), and had increased rates of associated injuries (P<0.001). Time to fracture union was similar between the 2 groups (P=0.652). The TEN group had shorter time to independent ambulation (Spica 51±14 vs. TEN 29±14 d, P<0.001) and return to full activities (Spica 87±19 vs. TEN 74±28 d, P=0.023). TEN is a reasonable option for treatment of femur fractures in young children when compared with spica casting with shorter time to independent ambulation and full activities. Fractures associated with a high-energy mechanism are especially appropriate for consideration of treatment with TEN. Level III, this was a retrospective comparative study.

Taking care of business in a flash: constraining the time-scale for low-mass satellite quenching with ELVIS

NASA Astrophysics Data System (ADS)

Fillingham, Sean P.; Cooper, Michael C.; Wheeler, Coral; Garrison-Kimmel, Shea; Boylan-Kolchin, Michael; Bullock, James S.

2015-12-01

The vast majority of dwarf satellites orbiting the Milky Way and M31 are quenched, while comparable galaxies in the field are gas rich and star forming. Assuming that this dichotomy is driven by environmental quenching, we use the Exploring the Local Volume in Simulations (ELVIS) suite of N-body simulations to constrain the characteristic time-scale upon which satellites must quench following infall into the virial volumes of their hosts. The high satellite quenched fraction observed in the Local Group demands an extremely short quenching time-scale (˜2 Gyr) for dwarf satellites in the mass range M⋆ ˜ 106-108 M⊙. This quenching time-scale is significantly shorter than that required to explain the quenched fraction of more massive satellites (˜8 Gyr), both in the Local Group and in more massive host haloes, suggesting a dramatic change in the dominant satellite quenching mechanism at M⋆ ≲ 108 M⊙. Combining our work with the results of complementary analyses in the literature, we conclude that the suppression of star formation in massive satellites (M⋆ ˜ 108-1011 M⊙) is broadly consistent with being driven by starvation, such that the satellite quenching time-scale corresponds to the cold gas depletion time. Below a critical stellar mass scale of ˜108 M⊙, however, the required quenching times are much shorter than the expected cold gas depletion times. Instead, quenching must act on a time-scale comparable to the dynamical time of the host halo. We posit that ram-pressure stripping can naturally explain this behaviour, with the critical mass (of M⋆ ˜ 108 M⊙) corresponding to haloes with gravitational restoring forces that are too weak to overcome the drag force encountered when moving through an extended, hot circumgalactic medium.

Motivational readiness for active commuting by university students: incentives and barriers.

PubMed

Cole, Rachel; Leslie, Eva; Donald, Maria; Cerin, Ester; Neller, Anne; Owen, Neville

2008-12-01

Walking for transport can contribute significantly to health-enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. Mail-back surveys were completed by 781 students in a regional university in south-east Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action-maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Evaluation of timings and outcomes in category-one caesarean sections: A retrospective cohort study

PubMed Central

Dunn, Clare Newton; Zhang, Qianpian; Sia, Josh Tjunrong; Assam, Pryseley Nkouibert; Tagore, Shephali; Sng, Ban Leong

2016-01-01

Background and Aims: A decision-to-delivery interval (DDI) of 30 min for category-one caesarean section (CS) deliveries is the standard of practice recommended by clinical guidelines. Our institution established a protocol for category-one (‘crash’) CS to expedite deliveries. The aim of this study is to evaluate DDI, factors that affect DDI and the mode of anaesthesia for category-one CS. Methods: This retrospective cohort study evaluated 390 women who underwent category-one CS in a tertiary obstetric centre. We analysed the factors associated with DDI, mode of anaesthesia and perinatal outcomes. Summary statistics were performed for the outcomes. The association factors were considered significant at P < 0.05. Results: The mean (standard deviation) DDI was 9.4 (3.2) min with all deliveries achieved within 30 min. The longest factor in the DDI was time taken to transfer patients. A shorter DDI was not significantly associated with improved perinatal outcomes. The majority (88.9%) of women had general anaesthesia (GA) for category-one CS. Of those who had an epidural catheter already in situ (34.4%), 25.6% had successful epidural extension. GA was associated with shorter DDI, but worse perinatal outcomes than regional anaesthesia (RA). Conclusions: Our ‘crash’ CS protocol achieved 100% of deliveries within 30 min. The majority (88.9%) of the patients had GA for category-one CS. GA was found to be associated with shorter anaesthesia and operation times, but poorer perinatal outcomes compared to RA. PMID:27601736

Dense plasma formation on the surface of a ferroelectric induced by a driving pulse with a fast fall time

NASA Astrophysics Data System (ADS)

Chirko, K.; Krasik, Ya. E.; Sayapin, A.; Felsteiner, J.; Bernshtam, V.

2003-08-01

Experimental results are presented of dense plasma formation on the surface of a BaTi-based ferroelectric sample during the fall time of a driving pulse. A negative or positive driving pulse (⩽14 kV), with a slow rise time (˜450 ns) and a fast fall time (40-200 ns), was applied to the rear electrode of the ferroelectric. It was found by different electrical, optical, and spectroscopic diagnostics that this method allows one to form a plasma with a larger density (˜3×1013 cm-3) as compared with that formed by a driving pulse with a fast rise time (⩽4×1012 cm-3). It was shown that the shorter the fall time of the driving pulse the more intense plasma formation occurs. The most uniform and dense plasma formation occurs with a positive driving pulse. In addition, it was found that the shorter the fall time of the positive driving pulse the larger are the current amplitude, the energy, and the divergence of the emitted electrons. The obtained results are discussed in terms of the surface plasma formation and the compensation process of the polarization surface charge of the ferroelectric sample.

Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort.

PubMed

Collin, Simon M; Norris, Tom; Gringras, Paul; Blair, Peter S; Tilling, Kate; Crawley, Esther

2018-06-01

Sleep abnormalities are characteristic of chronic fatigue syndrome (CFS, also known as 'ME'), however it is unknown whether sleep might be a causal risk factor for CFS/ME. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. We describe sleep patterns of children aged 6 months to 11 years, who were subsequently classified as having (or not having) 'chronic disabling fatigue' (CDF, a proxy for CFS/ME) between the ages 13 and 18 years, and we investigated the associations of sleep duration at age nine years with CDF at age 13 years, as well as sleep duration at age 11 years with CDF at age 16 years. Children who had CDF during adolescence had shorter night-time sleep duration from 6 months to 11 years of age, and there was strong evidence that difficulties in going to sleep were more common in children who subsequently developed CDF. The odds of CDF at age 13 years were 39% lower (odds ratio (OR) = 0.61, 95% CI = 0.43, 0.88) for each additional hour of night-time sleep at age nine years, and the odds of CDF at age 16 years were 51% lower (OR = 0.49, 95% CI = 0.34, 0.70) for each additional hour of night-time sleep at age 11 years. Mean night-time sleep duration at age nine years was 13.9 (95% CI = 3.75, 24.0) minutes shorter among children who developed CDF at age 13 years, and sleep duration at age 11 years was 18.7 (95% CI = 9.08, 28.4) minutes shorter among children who developed CDF at age 16 (compared with children who did not develop CDF at 13 and 16 years, respectively). Children who develop chronic disabling fatigue in adolescence have shorter night-time sleep duration throughout early childhood, suggesting that sleep abnormalities may have a causal role in CFS/ME or that sleep abnormalities and CFS/ME are associated with a common pathophysiological cause. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Randomized, double-blind, placebo-controlled clinical trial of loperamide plus simethicone versus loperamide alone and simethicone alone in the treatment of acute diarrhea with gas-related abdominal discomfort.

PubMed

Hanauer, Stephen B; DuPont, Herbert L; Cooper, Kimberly M; Laudadio, Charles

2007-05-01

To compare efficacy and tolerability of a loperamide/simethicone (LOP/SIM) combination product with that of loperamide (LOP) alone, simethicone (SIM) alone, and placebo (PBO) for acute nonspecific diarrhea with gas-related abdominal discomfort. In this multicenter, double-blind, 48-h study, patients were randomly assigned to receive two tablets, each containing either LOP/SIM 2 mg/125 mg (n = 121), LOP 2 mg (n = 120), SIM 125 mg (n = 123), or PBO (n = 121), followed by one tablet after each unformed stool, up to four tablets in any 24-h period. The primary outcome measures were time to last unformed stool and time to complete relief of gas-related abdominal discomfort. For time to last unformed stool, an unformed stool after a 24-h period of formed stools or no stools was considered a continuance of the original episode (stricter definition) or a new episode (alternate definition). A total of 483 patients were included in the intent-to-treat analysis. The median time to last unformed stool for LOP/SIM (7.6 h) was significantly shorter than that of LOP (11.5 h), SIM (26.0 h), and PBO (29.4 h) (p < or = 0.0232 in comparison with survival curves) using the alternate definition; it was numerically but not significantly shorter than that of LOP (p = 0.0709) and significantly shorter than that of SIM and PBO (p = 0.0001) using the stricter definition. LOP/SIM-treated patients had a shorter time to complete relief of gas-related abdominal discomfort than patients who received either ingredient alone or placebo (all p = 0.0001). Few patients reported adverse events in the four treatment groups, none of which were serious in nature. Potential study limitations include the ability to generalize study results to the population at large, variability in total dose consumed, and subjectivity of patient diary data. LOP/SIM was well-tolerated and more efficacious than LOP alone, SIM alone, or placebo for acute nonspecific diarrhea and gas-related abdominal discomfort.

7 CFR 58.101 - Meaning of words.

Code of Federal Regulations, 2012 CFR

2012-01-01

... solution for the destruction of most human pathogens and other vegetative microorganisms to a level... the milk product, or the health of consumers. Sanitizing solutions shall comply with 21 CFR 178.1010... (higher heat shorter time pasteurization) 1.0 second. 194 °F (higher heat shorter time pasteurization) 0.5...

7 CFR 58.101 - Meaning of words.

Code of Federal Regulations, 2013 CFR

2013-01-01

... solution for the destruction of most human pathogens and other vegetative microorganisms to a level... the milk product, or the health of consumers. Sanitizing solutions shall comply with 21 CFR 178.1010... (higher heat shorter time pasteurization) 1.0 second. 194 °F (higher heat shorter time pasteurization) 0.5...

7 CFR 58.101 - Meaning of words.

Code of Federal Regulations, 2014 CFR

2014-01-01

... solution for the destruction of most human pathogens and other vegetative microorganisms to a level... the milk product, or the health of consumers. Sanitizing solutions shall comply with 21 CFR 178.1010... (higher heat shorter time pasteurization) 1.0 second. 194 °F (higher heat shorter time pasteurization) 0.5...

mStroke: "Mobile Stroke"-Improving Acute Stroke Care with Smartphone Technology.

PubMed

Andrew, Benjamin Y; Stack, Colleen M; Yang, Julian P; Dodds, Jodi A

2017-07-01

This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation. Effects were adjusted for confounders (age, sex, National Institutes of Health Stroke Scale [NIHSS] score) using multiple linear and logistic regression. The final dataset included 2589 cases. Cases activated by EMS were more severe (median NIHSS score 8 versus 4, P < .0001) and more likely to receive recombinant tissue plasminogen activator (20% versus 12%, P < .0001) than those with ED activation. After adjustment, cases with EMS activation had shorter DTC (6.1 minutes shorter, 95% CI [-10.3, -2]) and DTN (12.8 minutes shorter, 95% CI [-21, -4.6]) and were more likely to meet goal DTN (OR 1.83, 95% CI [1.1, 3]). Cases between 1200 and 1800 had longer DTC (7.7 minutes longer, 95% CI [2.4, 13]) and DTN (21.1 minutes longer, 95% CI [9.3, 33]), and reduced rate of goal DTN (OR .3, 95% CI [.15, .61]) compared to those between 0000 and 0600. Incorporating real-time prehospital data obtained via smartphone technology provides unique insight into acute stroke codes. Activation of mobile electronic stroke coordination in the field appears to promote a more expedited and successful care process. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies.

PubMed

Ozmen, Vahit; Boylu, Sukru; Ok, Engin; Canturk, Nuh Zafer; Celik, Varol; Kapkac, Murat; Girgin, Sadullah; Tireli, Mustafa; Ihtiyar, Enver; Demircan, Orhan; Baskan, Mazhar Semih; Koyuncu, Ayhan; Tasdelen, Ismet; Dumanli, Esra; Ozdener, Fatih; Zaborek, Piotr

2015-02-01

One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

[Coronary artery bypass grafting without use of cardiopulmonary bypass].

PubMed

Mujanović, Emir; Bergsland, Jacob; Hadziselimović, Mehdin; Softić, Muniba; Azabagic, Azur; Stanimirović-Mujanović, Sanja; Kabil, Emir

2002-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5.77% vs. 21.15%). The mortality rate was reduced in patients operated without CPB (0.00% vs. 5.76%). There were reduced need for transfusion in patients operated without CPB (0.28 vs. 1.11 units of blood). The average time spent on respirators was shorter in patients operated without CPB (1.50 vs. 4.76 hours). The average time of total hospitalisation was also shorter in patients operated withouth CPB (6.53 vs. 8.13 days). In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care and the total hospitalisation time is also less.

First Results on a Transatlantic Time and Frequency Transfer by GPS Carrier Phase

DTIC Science & Technology

1998-12-01

Washington (USNO). Besides the longer baseline the choice of these two sites offers aho the possibility to compare frequently GeTT and TWSTFT . The paper...INTRODUCTION The GPS Common View (CV) and thc Two Way Satellite Time and Frequency Transfer ( TWSTFT ) are up to now the most used methods for precise tirnc... TWSTFT technique allows comparisons with a shorter trme but at the prize of heavy sending and receiving equipment on each site An interesting

Spectrum and variation of gamma-ray emission from the galactic center region

NASA Technical Reports Server (NTRS)

Riegler, G. R.; Ling, J. C.; Mahoney, W. A.; Wheaton, W. A.; Jacobson, A. S.

1982-01-01

Continuum emission at 60-300 keV from the galactic center region was observed to decrease in intensity by 45 percent and to show a spectrum steepening between fall 1979 and spring 1980. At the same time 511 keV positron annihilation radiation decreased by a comparable fraction. No variations over shorter time scales were detected. The observations are consistent with a model where positrons and hard X-rays are produced in an electromagnetic cascade near a massive black hole.

[A study of laparoscopic stoma creation for patients with malignant bowel obstruction].

PubMed

Nakata, Ken; Fukunaga, Mutsumi; Ebihara, Takeshi; Kato, Fumitaka; Amano, Kouji; Babaya, Akihito; Matsushita, Ako; Furukawa, Haruna; Matsushima, Yuko; Matsumoto, Hironori; Fujihara, Shinichi; Kawabata, Ryohei; Usui, Akihiro; Yamamoto, Tameyoshi; Oda, Kazuyuki; Kawase, Tomono; Kimura, Yutaka; Nakata, Yasuki; Ohzato, Hiroki

2013-11-01

We evaluated the efficacy of laparoscopic palliative stoma creation for patients with malignant bowel obstruction (MBO). Twenty-four patients with MBO who underwent laparoscopic stoma creation between January 2009 and December 2012 were studied and their clinical outcome was evaluated retrospectively. Compared to the open approach, the laparoscopic approach led to significantly shorter operation times and a significantly lower incidence of surgical site infection( SSI). The rate of removal of the intestinal tube and intravenous drip after surgery was 100% and 88%, respectively, and the rate of oral intake was 100% after palliative stoma creation. The prognosis was 58% in 3 months and 29% in 1 year, and the median survival time was approximately 4 months. The quality of surgery by the laparoscopic approach was better than that by the open approach, and the quality of life( QOL) after stoma creation was better than that before surgery. Given the shorter operation time, lower incidence of SSI, and better QOL, laparoscopic stoma creation is a beneficial choice for palliative treatment in patients with MBO.

Post-Transurethral Resection of the Prostate Inflation of Pressure-Controlled Endorectal Balloon-Impact on Postoperative Bleeding: A Preliminary Experimental Pilot Study.

PubMed

Mohyelden, Khaled; Ibrahim, Hamdy; Abdel-Kader, Osman; Sherief, Mahmoud H; El-Nashar, Ahmed; Shaker, Hosam; Elkoushy, Mohamed A

2016-02-01

To evaluate the impact of rectal balloon (RB) inflation on post-transurethral resection of the prostate (TURP) bleeding in patients with symptomatic benign prostatic hyperplasia. After institutional review board approval, patients who were eligible for TURP were randomized into two equal groups, depending on whether they received postoperative endorectal balloon (RB) (GII) or not (GI). The tip of three-way Foley catheter was fixed to a balloon by a blaster strip to prepare air-tight RB. Postoperatively, the RB was inflated for 15 minutes by a pressure-controlled sphygmomanometer. Perioperative data were compared between both groups, including hemoglobin (Hb) deficit 24-hour postoperatively and at time of discharge. Functional outcomes, anorectal complaints, and adverse events were assessed perioperatively and after 1 and 3 months. Fifty patients were enrolled, including 13 (26%) patients who presented with indwelling urethral catheters. Baseline data and mean resected tissue weight were comparable between both groups, including preoperative Hb (p = 0.17). Immediate postoperative Hb deficit was, comparable between GI and GII patients (0.58 ± 0.18 vs 0.60 ± 0.2, p = 0.56) before RB inflation, respectively. However, compared to GI patients, mean Hb deficit significantly decreased in GII patients 24-hour postoperatively (0.2 ± 0.2 vs 0.7 ± 0.3 g, p = 0.002) and at time of discharge (0.8 ± 0.2 vs 1.3 ± 0.4 g, p = 0.003). GII patients needed significantly less postoperative irrigation (2.1 ± 1.6 vs 8.3 ± 1.8 L, p < 0.001), shorter catheterization time (2.3 ± 0.8 vs 3.8 ± 1.3 days, p < 0.001), and shorter hospital stay (2.6 ± 0.5 vs 4.3 ± 1.0 days, p < 0.001). Both groups were comparable in all functional outcomes at the most recent follow-up. Blood transfusion was needed in only one patient (4%) in GI. No patient needed recystoscopy for hematuria or clot retention in either group, while there were no anorectal complaints reported by GII patients. Post-TURP endorectal balloon inflation seems to be simple, safe, and an efficient procedure to reduce postoperative bleeding and irrigation volume. It is significantly associated with shorter catheterization time and hospital stay.

SU-F-T-435: Helical Tomotherapy for Craniospinal Irradiation: What We Have Learned from a Multi-Institutional Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Du, D; Kaprealian, T; Low, D

Purpose: To report cranio-spinal irradiation (CSI) planning experience, compare dosimetric quality and delivery efficiency with Tomotherapy from different institutions, and to investigate effect of planning parameters on plan quality and treatment time. Methods: Clinical helical tomotherapy IMRT plans for thirty-nine CSI cases from three academic institutions were retrospectively evaluated. The planning parameters: field width (FW), pitch, modulation factor (MF), and achieved dosimetric endpoints were cross-compared. A fraction-dose-delivery-timing index (FDTI), defined as treatment time per fraction dose per PTV length, was utilized to evaluate plan delivery efficiency. A lower FDTI indicates higher delivery efficiency. We studied the correlation between planning quality,more » treatment time and planning parameters by grouping the plans under specific planning parameters. Additionally, we created new plans using 5cm jaw for a subset of plans that used 2.5cm jaw to exam if treatment efficiency can be improved without sacrificing plan quality. Results: There were significant dosimetric differences for organ at risks (OARs) among different institutions (A,B,C). Using the lowest average MF (1.9±0.4) and 5cm field width, C had the highest lung, heart, kidney, liver mean doses and maximum doses for lens. Using the same field width of 5cm, but higher MF (2.6±0.6), B had lower doses to the OARs in the thorax and abdomen area. Most of A’s plans were planned with 2.5cm jaw, the plans yielded better PTV coverage, higher OAR doses and slightly shorter FDTI compared to institution B. The replanned 5cm jaw plans achieved comparable PTV coverage and OARs sparing, while saving up to 44.7% treatment time. Conclusion: Plan quality and delivery efficiency could vary significantly in CSI planning on Tomotheapy due to choice of different planning parameters. CSI plans using a 5cm jaw, with proper selection of pitch and MF, can achieve comparable/ better plan quality with shorter delivery time compared to 2.5cm jaw plans.« less

Mode of entry to an early intervention service for psychotic disorders: determinants and impact on outcome.

PubMed

Pira, Shamira; Durr, Georges; Pawliuk, Nicole; Joober, Ridha; Malla, Ashok

2013-11-01

Specialized early intervention services for first-episode psychosis should treat a proportion of patients without using inpatient beds. This study compared such service users by their initial mode of treatment before entry-inpatient (N=157) or outpatient (N=102). On entry to a Montreal early intervention service, the groups were compared on baseline clinical and functional variables and on hospitalizations during two years of treatment. Initial presentation at an emergency service, shorter duration of untreated psychosis, lower functioning level, and aggressive and bizarre behavior were associated with the inpatient entry mode to early intervention services. During follow-up, individuals entering as inpatients spent more days hospitalized than those entering as outpatients, and their time to rehospitalization was shorter. Results suggest that entry into early intervention services via the hospital emergency department and presentation with behavioral and functional disturbances were more predictive than core psychotic symptoms of hospital inpatient status on referral to an early intervention service.

Residence time control on hot moments of net nitrate production and uptake in the hyporheic zone

USGS Publications Warehouse

Briggs, Martin A.; Lautz, Laura K.; Hare, Danielle K.

2014-01-01

moments of net production and uptake, enhancing NO3- production as residence times approach the anaerobic threshold, and changing zones of net NO3- production to uptake as residence times increase past the net sink threshold. The anaerobic and net sink thresholds for beaver-influenced streambed morphology occur at much shorter residence times (1.3 h and 2.3 h, respectively) compared to other documented hyporheic systems, and the net sink threshold compares favorably to the lower boundary of the anaerobic threshold determined for this system with the new oxygen Damkohler number. The consistency of the residence time threshold values of NO3- cycling in this study, despite environmental variability and disparate morphology, indicates that NO3- hot moment dynamics are primarily driven by changes in physical hydrology and associated residence times.

Spin-dependent delay time in ferromagnet/insulator/ferromagnet heterostructures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xie, ZhengWei; Zheng Shi, De; Lv, HouXiang

2014-07-07

We study theoretically spin-dependent group delay and dwell time in ferromagnet/insulator/ferromagnet (FM/I/FM) heterostructure. The results indicate that, when the electrons with different spin orientations tunnel through the FM/I/FM junction, the spin-up process and the spin-down process are separated on the time scales. As the self-interference delay has the spin-dependent features, the variations of spin-dependent dwell-time and spin-dependent group-delay time with the structure parameters appear different features, especially, in low incident energy range. These different features show up as that the group delay times for the spin-up electrons are always longer than those for spin-down electrons when the barrier height ormore » incident energy increase. In contrast, the dwell times for the spin-up electrons are longer (shorter) than those for spin-down electrons when the barrier heights (the incident energy) are under a certain value. When the barrier heights (the incident energy) exceed a certain value, the dwell times for the spin-up electrons turn out to be shorter (longer) than those for spin-down electrons. In addition, the group delay time and the dwell time for spin-up and down electrons also relies on the comparative direction of magnetization in two FM layers and tends to saturation with the thickness of the barrier.« less

Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department

PubMed Central

Masiello, Italo; Ponzer, Sari; Farrokhnia, Nasim

2018-01-01

Objective To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. Design Single-centre before-and-after study. Setting Adult ED of a Swedish urban hospital. Participants Patients arriving on weekdays 08:00 to 21:00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. Interventions Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08:00 to 21:00 November 2014 to November 2015. Main outcome measures Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. Results The crude median LOS was shortest for teamwork, 228 min (95% CI 226.4 to 230.5) compared with 232 min (95% CI 230.8 to 233.9) for nurse-led and 250 min (95% CI 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% CI 54.5 to 56.6) compared with 116 min (95% CI 114.4 to 117.5) for nurse-led triage and 74 min (95% CI 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values<0.01. Conclusions Interprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times. PMID:29674366

[Establishment and testing practice of an integrative medical pathway for clinical management of acute myocardial infarction].

PubMed

Wang, Lei; Zhang, Min-zhou; Zhang, Jun

2011-01-01

To establish an integrative medical approach (IMA) for clinical management of acute myocardial infarction (AMI), and to test its efficacy. IMA was preliminarily established according to the guidelines and based on the Chinese medical therapy of benefiting vital qi and promoting blood circulation. And adopting non-synchronous queue design, AMI patients were assigned to the IMA group (71 cases) and the non-IMA group (70 cases), they were managed following or didn't follow the established IMA respectively. The total hospitalization time (THT), the ICU indwelling time (ICUD) and the total medical expenditure (TME) of patients were compared between groups. Moreover, for patients received primary PCI, the time for door-to-balloon (DTB) was compared in addition. Comparisons between groups showed that THT in the IMA group was shorter than that in the non-IMA group (9.80 +/- 5.62 days vs. 12.01 +/- 7. 35 days , P < 0.05); but the difference of TME between groups was insignificant. For those received PCT, the DTB in the IMA group was shorter than that in the non-IMA group in terms of DTB time (82.56 +/- 17.36 min vs. 119.19 +/- 30.88 min, P < 0.01), THT (9.69 +/- 5.59 vs. 13.34 +/- 7.49 days, P < 0.01) and TME. Practicing IMA for AMI, which was established based on Chinese medical therapy of benefiting vital qi and promoting blood circulation, could shorten the hospitalization time of patients, reduce the DTB time and TME in patients receiving primary PCI; fully displays its significance in hospital administration and quality control on AMI.

Cognitive functioning of long-term heavy cannabis users seeking treatment.

PubMed

Solowij, Nadia; Stephens, Robert S; Roffman, Roger A; Babor, Thomas; Kadden, Ronald; Miller, Michael; Christiansen, Kenneth; McRee, Bonnie; Vendetti, Janice

2002-03-06

Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain. To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence. Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls. Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence. Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P =.001) or controls (P =.005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P =.007), retention (P =.003), and retrieval (P =.002) compared with controls. Both user groups performed poorly on a time estimation task (P<.001 vs controls). Performance measures often correlated significantly with the duration of cannabis use, being worse with increasing years of use, but were unrelated to withdrawal symptoms and persisted after controlling for recent cannabis use and other drug use. These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.

Comparison between the Trachway video intubating stylet and Macintosh laryngoscope in four simulated difficult tracheal intubations: A manikin study

PubMed Central

Ong, Jimmy; Lee, Chia-Ling; Huang, Shen-Jer; Shyr, Ming-Hwang

2016-01-01

Objectives: It remains to be determined whether the TVI-4000 Trachway video intubating (TVI) stylet (Markstein Sichtec Medical Corp, Taichung, Taiwan), an airway device for novices, improves airway management practice by experienced anesthesiologists. The aim of this study was to evaluate the feasibility of using the TVI stylet in difficult tracheal intubation situations compared with that of using the Macintosh laryngoscope on an airway manikin. Materials and Methods: Ten anesthesiologists (with 3–21 years’ experience), including three senior residents, participated. We compared tracheal intubation in four airway scenarios: normal airway, tongue edema, cervical spine immobilization, and tongue edema combined with cervical spine immobilization. The time of tracheal intubation (TTI), success rate, and perceived difficulty of intubation for each scenario were compared and analyzed. Results: The TTI was significantly shorter in both the tongue edema and combined scenarios with the TVI stylet compared with the Macintosh laryngoscope (21.60 ± 1.45 seconds vs. 24.07 ± 1.58 seconds and 23.73 ± 2.05 seconds vs. 26.6 ± 2.77 seconds, respectively). Success rates for both devices were 100%. Concomitantly, participants rated using the TVI stylet in these two scenarios as being less difficult. Conclusion: The learning time for tracheal intubation using the TVI stylet in difficult airway scenarios was short. Use of the TVI stylet was easier and required a shorter TTI for tracheal intubation in the tongue edema and combined scenarios. PMID:28757736

Kinesthetic information facilitates saccades towards proprioceptive-tactile targets.

PubMed

Voudouris, Dimitris; Goettker, Alexander; Mueller, Stefanie; Fiehler, Katja

2016-05-01

Saccades to somatosensory targets have longer latencies and are less accurate and precise than saccades to visual targets. Here we examined how different somatosensory information influences the planning and control of saccadic eye movements. Participants fixated a central cross and initiated a saccade as fast as possible in response to a tactile stimulus that was presented to either the index or the middle fingertip of their unseen left hand. In a static condition, the hand remained at a target location for the entire block of trials and the stimulus was presented at a fixed time after an auditory tone. Therefore, the target location was derived only from proprioceptive and tactile information. In a moving condition, the hand was first actively moved to the same target location and the stimulus was then presented immediately. Thus, in the moving condition additional kinesthetic information about the target location was available. We found shorter saccade latencies in the moving compared to the static condition, but no differences in accuracy or precision of saccadic endpoints. In a second experiment, we introduced variable delays after the auditory tone (static condition) or after the end of the hand movement (moving condition) in order to reduce the predictability of the moment of the stimulation and to allow more time to process the kinesthetic information. Again, we found shorter latencies in the moving compared to the static condition but no improvement in saccade accuracy or precision. In a third experiment, we showed that the shorter saccade latencies in the moving condition cannot be explained by the temporal proximity between the relevant event (auditory tone or end of hand movement) and the moment of the stimulation. Our findings suggest that kinesthetic information facilitates planning, but not control, of saccadic eye movements to proprioceptive-tactile targets. Copyright © 2016 Elsevier Ltd. All rights reserved.

Robotic surgery start-up with a fellow as the console surgeon.

PubMed

Reinhardt, Susanne; Ifaoui, Inge Boetker; Thorup, Jorgen

2017-08-01

Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume. The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5 year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site. The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182 min and was significantly shorter than in laparoscopic surgery (median 250 min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1 day) than after both laparoscopic (median 2 days) and open surgery (median 3.5 days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6 weeks. The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.

Eddy current-nulled convex optimized diffusion encoding (EN-CODE) for distortion-free diffusion tensor imaging with short echo times.

PubMed

Aliotta, Eric; Moulin, Kévin; Ennis, Daniel B

2018-02-01

To design and evaluate eddy current-nulled convex optimized diffusion encoding (EN-CODE) gradient waveforms for efficient diffusion tensor imaging (DTI) that is free of eddy current-induced image distortions. The EN-CODE framework was used to generate diffusion-encoding waveforms that are eddy current-compensated. The EN-CODE DTI waveform was compared with the existing eddy current-nulled twice refocused spin echo (TRSE) sequence as well as monopolar (MONO) and non-eddy current-compensated CODE in terms of echo time (TE) and image distortions. Comparisons were made in simulations, phantom experiments, and neuro imaging in 10 healthy volunteers. The EN-CODE sequence achieved eddy current compensation with a significantly shorter TE than TRSE (78 versus 96 ms) and a slightly shorter TE than MONO (78 versus 80 ms). Intravoxel signal variance was lower in phantoms with EN-CODE than with MONO (13.6 ± 11.6 versus 37.4 ± 25.8) and not different from TRSE (15.1 ± 11.6), indicating good robustness to eddy current-induced image distortions. Mean fractional anisotropy values in brain edges were also significantly lower with EN-CODE than with MONO (0.16 ± 0.01 versus 0.24 ± 0.02, P < 1 x 10 -5 ) and not different from TRSE (0.16 ± 0.01 versus 0.16 ± 0.01, P = nonsignificant). The EN-CODE sequence eliminated eddy current-induced image distortions in DTI with a TE comparable to MONO and substantially shorter than TRSE. Magn Reson Med 79:663-672, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

Localised hydrodynamics influence vulnerability of coral communities to environmental disturbances

NASA Astrophysics Data System (ADS)

Shedrawi, George; Falter, James L.; Friedman, Kim J.; Lowe, Ryan J.; Pratchett, Morgan S.; Simpson, Christopher J.; Speed, Conrad W.; Wilson, Shaun K.; Zhang, Zhenlin

2017-09-01

The movement of water can have a significant influence on the vulnerability of hermatypic corals to environmental disturbances such as cyclone damage, heat stress and anoxia. Here, we explore the relationship between small reef-scale water circulation patterns and measured differences in the abundance, composition and vulnerability of coral assemblages over decades. Changes in coral cover and community structure within Bill's Bay (Ningaloo Reef, Western Australia) over a 22-yr period, during which multiple disturbance events (including mass bleaching, anoxia, and tropical cyclones) have impacted the area, were compared with spatial variation in water residence times (WRT). We found that reef sites associated with longer water residence times (WRT >15 h) experienced higher rates of coral mortality during acute environmental disturbances compared to reef sites with shorter WRT. Shifts in coral community composition from acroporid to faviid-dominated assemblages were also more prominent at sites with long WRT compared to reef sites with shorter WRT, although shifts in community composition were also observed at sites close to shore. Interestingly, these same long-WRT sites also tended to have the fastest recovery rates so that coral cover was returned to original levels of approximately 20% over two decades. This study provides empirical evidence that spatial patterns in water circulation and flushing can influence the resilience of coral communities, thus identifying areas sensitive to emerging threats associated with global climate change.

The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics.

PubMed

Hudić, Igor; Bujold, Emmanuel; Fatušić, Zlatan; Skokić, Fahrija; Latifagić, Anela; Kapidžić, Mirela; Fatušić, Jasenko

2012-11-01

The objective of this study is to compare the intraoperative and short-term outcomes of two cesarean techniques: the modified Misgav-Ladach and the Pfannenstiel-Kerr. We performed a prospective observational cohort study of women undergoing a primary cesarean at the Clinic for Obstetric and Gynecology Tuzla, Bosnia and Herzegovina, between January 2003 and December 2011. The two cesarean techniques were compared for intraoperative and short terms outcomes. A total of 4,944 women were included in this study, 4,336 allocated to the modified Misgav-Ladach and 608 to the Pfannenstiel-Kerr techniques. The rate of modified Misgav-Ladach increased from 74 % in 2003 to 99 % in 2011. The modified Misgav-Ladach technique was associated with a shorter operative time (13.3 min ± 7.4 vs. 19.1 min ± 6.8, p < 0.05), as well as significantly less surgical material (3.5 ± 2.5 vs. 7.9 ± 2.1, p < 0.05). The modified Misgav-Ladach technique was also associated with lower analgesic requirements, lower rates of febrile morbidity and wound infection compared to the Pfannenstiel-Kerr technique (p < 0.05). No significant differences were observed in the incidence of endometritis, wound dehiscence, bowel restitution, postoperative antibiotic use, and hospital stay. The modified Misgav-Ladach technique is associated with a shorter operative time than Pfannenstiel-Kerr and might lead to better postoperative outcomes.

[Comparison of minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar].

PubMed

Xu, Fang; Zhang, Hui-Xia

2016-10-01

To compare minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar. One hundred and sixty patients with impacted mandibular third molar were equally divided into two groups. Patients in the experimental group were treated with minimally invasive extraction, using implant machine and luxator, while patients in the control group were treated with traditional methods including use of orthodox chisel. The operation time, intraoperative and postoperative complications including deformation of extraction sockets, dry socket, limitation of mouth opening, pain and swelling, and fear were observed and compared between the two groups. The data were analyzed with SPSS18.0 software package. The operation time was (17.32±1.01) min in the experimental group, significantly shorter than the control group which was (33.46±1.12）min (P<0.05); significant difference was found in the incidence of root fracture, medium or severe tooth sockets deformation and incidence of psychological fear during operation between the control group and experimental group(P<0.05); the degree of mouth opening after surgery, the incidence of moderate or severe pain after surgery was significantly lower in the experimental than in the control group(P<0.05). Minimally invasive extraction of mandibular impacted wisdom tooth is better than traditional method, with shorter operation time and less intraoperative and postoperative complications, which should be widely applied in clinic.

A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants

PubMed Central

Mazzella, M; Bellini, C; Calevo, M; Campone, F; Massocco, D; Mezzano, P; Zullino, E; Scopesi, F; Arioni, C; Bonacci, W; Serra, G

2001-01-01

OBJECTIVE—To compare the effectiveness of the Infant Flow Driver (IFD) with single prong nasal continuous positive airway pressure (nCPAP) in preterm neonates affected by respiratory distress syndrome.
DESIGN—Randomised controlled study.
PATIENTS—Between September 1997 and March 1999, 36 preterm infants who were eligible for CPAP treatment were randomly selected for either nCPAP or IFD and studied prospectively for changes in oxygen requirement and/or respiratory rate. The requirement for mechanical ventilation, complications of treatment, and effects on mid-term outcome were also evaluated.
RESULTS—Use of the IFD had a significantly beneficial effect on both oxygen requirement and respiratory rate (p < 0.0001) when compared with nCPAP. Moreover, O2 requirement and respiratory rate were significantly decreased by four hours (p < 0.001 and p < 0.03 respectively). The probability of remaining supplementary oxygen free over the first 48 hours of treatment was significantly higher in patients treated with the IFD than with nCPAP (p < 0.02). IFD treated patients had a higher success (weaning) rate (94% v 72%) and shorter duration of treatment (49.3 (31) v 56 (29.7) hours respectively; mean (SD)), although the difference was not significant.
CONCLUSIONS—IFD appears to be a feasible device for managing respiratory distress syndrome in preterm infants, and benefits may be had with regard to oxygen requirement and respiratory rate when compared with nCPAP. The trend towards reduced requirement for mechanical ventilation, shorter clinical recovery time, and shorter duration of treatment requires further evaluation in a multicentre randomised clinical trial.

 PMID:11517199

PATIENT REFUSAL OF THROMBOLYTIC THERAPY FOR SUSPECTED ACUTE ISCHEMIC STROKE

PubMed Central

FS, Vahidy; MH, Rahbar; AP, Lal; JC, Grotta; SI, Savitz

2012-01-01

Objective To determine factors associated with patients refusing IV t-PA for suspected acute ischemic stroke (AIS), and to compare the outcomes of patients who refused t-PA (RT) with those treated with t-PA. Methods Patients who were treated with and refused t-PA at our stroke center were identified retrospectively. Demographics, clinical presentation, and outcome measures were collected and compared. Clinical outcome was defined as excellent (mRS: 0–1), good (mRS: 0–2), and poor (mRS: 3–6). Results Over 7.5 years, thirty (4.2%) patients refused t-PA. There were no demographic differences between the treated and RT groups. The rate of RT decreased over time (OR 0.63, 95% CI 0.50 – 0.79). Factors associated with refusal included a later symptom onset to emergency department presentation time (OR 1.02, 95% CI 1.01 – 1.03), lower NIHSS (OR 1.11, 95% CI 1.03 – 1.18), a higher proportion of stroke mimics (OR 17.61, 95% CI 6.20 – 50.02) and shorter hospital stay (OR 1.32, 95% CI 1.09 – 1.61). Among patients who were subsequently diagnosed with ischemic stroke, only length of stay was significantly shorter for refusal patients (OR 1.37, 95% CI 1.06 – 1.78). After controlling for mild strokes and stroke mimics, clinical outcome was not different between the groups (OR 1.61, 95% CI 0.69 – 3.73). Conclusion The incidence of patients refusing t-PA has decreased over time, yet it may be a cause for t-PA under-utilization. Patients with milder symptoms were more likely to refuse t-PA. Refusal patients presented later to the hospital and had shorter hospital stays. One out six refusal patients (16.6%) had a stroke mimic. PMID:23227830

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis.

PubMed

Fröhlich, Georg M; Lansky, Alexandra J; Webb, John; Roffi, Marco; Toggweiler, Stefan; Reinthaler, Markus; Wang, Duolao; Hutchinson, Nevil; Wendler, Olaf; Hildick-Smith, David; Meier, Pascal

2014-03-10

The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830). These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.

Motor and Gaze Behaviors of Youth Basketball Players Taking Contested and Uncontested Jump Shots

PubMed Central

van Maarseveen, Mariëtte J. J.; Oudejans, Raôul R. D.

2018-01-01

In this study, we examined the effects of a defender contesting jump shots on performance and gaze behaviors of basketball players taking jump shots. Thirteen skilled youth basketball players performed 48 shots from about 5 m from the basket; 24 uncontested and 24 contested. The participants wore mobile eye tracking glasses to measure their gaze behavior. As expected, an approaching defender trying to contest the shot led to significant changes in movement execution and gaze behavior including shorter shot execution time, longer jump time, longer ball flight time, later final fixation onset, and longer fixation on the defender. Overall, no effects were found for shooting accuracy. However, the effects on shot accuracy were not similar for all participants: six participants showed worse performance and six participants showed better performance in the contested compared to the uncontested condition. These changes in performance were accompanied by differences in gaze behavior. The participants with worse performance showed shorter absolute and relative final fixation duration and a tendency for an earlier final fixation offset in the contested condition compared to the uncontested condition, whereas gaze behavior of the participants with better performance for contested shots was relatively unaffected. The results confirm that a defender contesting the shot is a relevant constraint for basketball shooting suggesting that representative training designs should also include contested shots, and more generally other constraints that are representative of the actual performance setting such as time or mental pressure. PMID:29867671

Accelerated recovery from sevoflurane anesthesia with isocapnic hyperpnoea.

PubMed

Katznelson, Rita; Minkovich, Leonid; Friedman, Zeev; Fedorko, Ludvik; Beattie, W Scott; Fisher, Joseph A

2008-02-01

Isocapnic hyperpnoea (IH) reduces recovery time from isoflurane anesthesia in animals and humans. We studied the effect of IH on the emergence profile of sevoflurane-anesthetized patients by comparing postoperative recovery variables in patients administered IH (IH group) to those recovered in the customary fashion (control group). We enrolled 30 ASA I-III patients undergoing elective gynecological surgery. Induction and maintenance of anesthesia were standardized with a protocol consisting of fentanyl, propofol, rocuronium, and sevoflurane in air/O2. Patients were randomly assigned to control (C) or IH groups at the end of the surgery. We recorded time intervals from discontinuing sevoflurane to recovery milestones. Time to tracheal extubation was much shorter in the IH group compared with group C (6.2 +/- 2.1 vs 12.3 +/- 3.8 min, respectively, P < 0.01). The IH group also had shorter times to initiation of spontaneous ventilation (4.2 +/- 1.7 vs 6.5 +/- 3.8 min, P = 0.047), eye opening (5.5 +/- 1.4 vs 13.3 +/- 4.4 min, P < 0.01), bispectral index value >75 (3.9 +/- 1.1 vs 8.8 +/- 3.7 min, P < 0.01), leaving operating room (7.7 +/- 2.0 vs 15.3 +/- 3.4 min, P < 0.01), and eligibility for postanesthetic care unit discharge (67.2 +/- 19.3 vs 90.6 +/- 20.0 min, P < 0.01). IH accelerates recovery from sevoflurane anesthesia and shortens operating room and postanesthetic care unit stay.

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

PubMed

Rogula, Tomasz; Koprivanac, Marijan; Janik, Michał Robert; Petrosky, Jacob A; Nowacki, Amy S; Dombrowska, Agnieszka; Kroh, Matthew; Brethauer, Stacy; Aminian, Ali; Schauer, Philip

2018-04-10

The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.

Dosimetric and efficiency comparison of high-dose radiotherapy for esophageal cancer: volumetric modulated arc therapy versus fixed-field intensity-modulated radiotherapy.

PubMed

Lin, C-Y; Huang, W-Y; Jen, Y-M; Chen, C-M; Su, Y-F; Chao, H-L; Lin, C-S

2014-08-01

The aim of this study was to compare high-dose volumetric modulated arc therapy (VMAT) and fixed-field intensity-modulated radiotherapy (ff-IMRT) plans for the treatment of patients with middle-thoracic esophageal cancer. Eight patients with cT2-3N0M0 middle-thoracic esophageal cancer were enrolled. The treatment planning system was the version 9 of the Pinnacle(3) with SmartArc (Philips Healthcare, Fitchburg, WI, USA). VMAT and ff-IMRT treatment plans were generated for each case, and both techniques were used to deliver 50 Gy to the planning target volume (PTV(50)) and then provided a 16-Gy boost (PTV(66)). The VMAT plans provided superior PTV(66) coverage compared with the ff-IMRT plans (P = 0.034), whereas the ff-IMRT plans provided more appropriate dose homogeneity to the PTV(50) (P = 0.017). In the lung, the V(5) and V(10) were lower for the ff-IMRT plans than for the VMAT plans, whereas the V(20) was lower for the VMAT plans. The delivery time was significantly shorter for the VMAT plans than for the ff-IMRT plans (P = 0.012). In addition, the VMAT plans delivered fewer monitor units. The VMAT technique required a shorter planning time than the ff-IMRT technique (3.8 ± 0.8 hours vs. 5.4 ± 0.6 hours, P = 0.011). The major advantages of VMAT plans are higher efficiency and an approximately 50% reduction in delivery time compared with the ff-IMRT plans, with comparable plan quality. Further clinical investigations to evaluate the use of high-dose VMAT for the treatment of esophageal cancer are warranted. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Robotic bariatric surgery: a systematic review.

PubMed

Fourman, Matthew M; Saber, Alan A

2012-01-01

Obesity is a nationwide epidemic, and the only evidence-based, durable treatment of this disease is bariatric surgery. This field has evolved drastically during the past decade. One of the latest advances has been the increased use of robotics within this field. The goal of our study was to perform a systematic review of the recent data to determine the safety and efficacy of robotic bariatric surgery. The setting was the University Hospitals Case Medical Center (Cleveland, OH). A PubMed search was performed for robotic bariatric surgery from 2005 to 2011. The inclusion criteria were English language, original research, human, and bariatric surgical procedures. Perioperative data were then collected from each study and recorded. A total of 18 studies were included in our review. The results of our systematic review showed that bariatric surgery, when performed with the use of robotics, had similar or lower complication rates compared with traditional laparoscopy. Two studies showed shorter operative times using the robot for Roux-en-Y gastric bypass, but 4 studies showed longer operative times in the robotic arm. In addition, the learning curve appears to be shorter when robotic gastric bypass is compared with the traditional laparoscopic approach. Most investigators agreed that robotic laparoscopic surgery provides superior imaging and freedom of movement compared with traditional laparoscopy. The application of robotics appears to be a safe option within the realm of bariatric surgery. Prospective randomized trials comparing robotic and laparoscopic outcomes are needed to further define the role of robotics within the field of bariatric surgery. Longer follow-up times would also help elucidate any long-term outcomes differences with the use of robotics versus traditional laparoscopy. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Fast Simulation of the Impact Parameter Calculation of Electrons through Pair Production

NASA Astrophysics Data System (ADS)

Bang, Hyesun; Kweon, MinJung; Huh, Kyoung Bum; Pachmayer, Yvonne

2018-05-01

A fast simulation method is introduced that reduces tremendously the time required for the impact parameter calculation, a key observable in physics analyses of high energy physics experiments and detector optimisation studies. The impact parameter of electrons produced through pair production was calculated considering key related processes using the Bethe-Heitler formula, the Tsai formula and a simple geometric model. The calculations were performed at various conditions and the results were compared with those from full GEANT4 simulations. The computation time using this fast simulation method is 104 times shorter than that of the full GEANT4 simulation.

[Amelanotic melanoma and nuclear magnetic resonance tomography--case report].

PubMed

Schilling, A; Seiler, T; Bende, T; Wollensak, J

1989-01-01

In MRI choroidal melanoma shows a very short relaxation time (T2), shorter than that of any other intraocular tumor. This short T2 time is referred to the high concentration of paramagnetic melanine in this tumor. Therefore, it is of interest to measure the relaxation time in an amelanotic melanoma and compare it with the histological analysis. The duration of T2 for the amelanotic melanoma examined ranged from 130 to 160 ms. The small concentration of melanine is not a sufficient explanation, but it is possible that there are some precursors of melanine with paramagnetic characteristics.

[Effect of actoprotectors on the work capacity of operators during modeling of various factors of space flight].

PubMed

Bobkov, Iu G; Epishkin, A K

1988-01-01

This paper presents experimental findings indicating that bemithyl, an actoprotective agent, has a beneficial effect on the health status and work capacity of operators during simulated space flight and 56-hour continuous work. The drug enhanced psychophysiological tolerance of the operators and improved the quality of their work: the quality of their compensatory tracking was on the average 10% higher, the number of errors of their porsuit tracking was 1.8 times lower, and the time of visual signal detection was 2.4 times shorter as compared to the placebo controls.

Assessment of Time to Clinical Response, a Proxy for Discharge Readiness, among Hospitalized Patients with Community-Acquired Pneumonia Who Received either Ceftaroline Fosamil or Ceftriaxone in Two Phase III FOCUS Trials

PubMed Central

Anzueto, Antonio R.; Weber, David J.; Shorr, Andrew F.; Yang, Min; Smith, Alexander; Zhao, Qi; Huang, Xingyue; File, Thomas M.

2014-01-01

The primary driver of health care costs for patients with community-acquired pneumonia (CAP) is the hospital length of stay (LOS). Unfortunately, hospital LOS comparisons are difficult to make from phase III CAP trials because of their structured designs and prespecified treatment durations. However, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. The intent of this study was to quantify the time to a clinical response, a proxy for the time to discharge readiness, among hospitalized CAP patients who received either ceftaroline or ceftriaxone in two phase III CAP FOCUS clinical trials. On the basis of the Infectious Diseases Society of America and American Thoracic Society CAP management guidelines and recent FDA guidance documents for community-acquired bacterial pneumonia, a post hoc adjudication algorithm was constructed a priori to compare the time to a clinical response, a proxy for the time to discharge readiness, between patients who received ceftaroline or ceftriaxone. Overall, 1,116 patients (ceftaroline, n = 562; ceftriaxone, n = 554) from the pooled FOCUS trials met the selection criteria for this analysis. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting the clinical response criteria (P = 0.03). Of the patients on ceftaroline, 61.0, 76.1, and 83.6% achieved a clinical response by days 3, 4, and 5, compared to 54.3, 69.8, and 79.3% of the ceftriaxone-treated patients. In the Cox regression, ceftaroline was associated with a shorter time to a clinical response (HR, 1.16, P = 0.02). The methodology employed here provides a framework to draw comparative effectiveness inferences from phase III CAP efficacy trials. (The FOCUS trials whose data were analyzed in this study have been registered at ClinicalTrials.gov under registration no. NCT00621504 and NCT00509106.) PMID:25487791

77 FR 7640 - Self-Regulatory Organizations; BATS Y-Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... 30 days after the date of the filing, or such shorter time as the Commission may designate, it has...-4(f)(6)(iii) \\8\\ permits the Commission to designate a shorter time if such action is consistent... without further delay. The Exchange notes that the introduction of the additional optional variation of...

77 FR 7642 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... 30 days after the date of the filing, or such shorter time as the Commission may designate, it has...-4(f)(6)(iii) \\8\\ permits the Commission to designate a shorter time if such action is consistent... trading costs without further delay. The Exchange notes that the introduction of the additional optional...

Risk Factors for Extended Duration and Timing of Peak Severity of Hot Flashes

PubMed Central

Gallicchio, Lisa; Miller, Susan R.; Zacur, Howard A.; Flaws, Jodi A.

2016-01-01

Objective To identify risk factors associated with the duration of hot flashes and the time of peak hot flash severity in mid-life women. Methods A cohort of 647 women reporting hot flashes were followed for 1–7 years, with survey data and hormone measurements. Survival analysis determined the association of risk factors with the duration of hot flashes. Linear regression determined the association of risk factors with the time of peak severity. Final models were determined through stepwise model selection. Results Average hot flash duration was 2.5 years (range: 1–33), with peak severity on average at 2.96 years (range: 1–20). Duration of hot flashes was associated with race, education, menopause status, smoking history, BMI, alcohol consumption, leisure activity levels, and levels of estradiol and progesterone. In the final model, only race, alcohol consumption, leisure activity, and menopause were retained. White women had significantly shorter hot flash durations than non-white women. Women consuming at least 12 alcoholic drinks in the previous year had a significantly shorter duration of hot flashes with a smaller effect of hot flash duration on increasing in time to peak severity compared to those who consumed less than 12 alcoholic drinks in that year. Higher serum progesterone levels were associated with later peak severity if the duration of the hot flashes was less than 2 years and an earlier peak severity otherwise. Conclusions These results suggest that some behaviors (such as moderate alcohol consumption) are associated with shorter durations of hot flashes, and that progesterone was associated with the dynamics of hot flash severity. PMID:27149066

Effects of preparation time and trial type probability on performance of anti- and pro-saccades.

PubMed

Pierce, Jordan E; McDowell, Jennifer E

2016-02-01

Cognitive control optimizes responses to relevant task conditions by balancing bottom-up stimulus processing with top-down goal pursuit. It can be investigated using the ocular motor system by contrasting basic prosaccades (look toward a stimulus) with complex antisaccades (look away from a stimulus). Furthermore, the amount of time allotted between trials, the need to switch task sets, and the time allowed to prepare for an upcoming saccade all impact performance. In this study the relative probabilities of anti- and pro-saccades were manipulated across five blocks of interleaved trials, while the inter-trial interval and trial type cue duration were varied across subjects. Results indicated that inter-trial interval had no significant effect on error rates or reaction times (RTs), while a shorter trial type cue led to more antisaccade errors and faster overall RTs. Responses following a shorter cue duration also showed a stronger effect of trial type probability, with more antisaccade errors in blocks with a low antisaccade probability and slower RTs for each saccade task when its trial type was unlikely. A longer cue duration yielded fewer errors and slower RTs, with a larger switch cost for errors compared to a short cue duration. Findings demonstrated that when the trial type cue duration was shorter, visual motor responsiveness was faster and subjects relied upon the implicit trial probability context to improve performance. When the cue duration was longer, increased fixation-related activity may have delayed saccade motor preparation and slowed responses, guiding subjects to respond in a controlled manner regardless of trial type probability. Copyright © 2016 Elsevier B.V. All rights reserved.

Hereditary Angioedema Attacks Resolve Faster and Are Shorter after Early Icatibant Treatment

PubMed Central

Maurer, Marcus; Kaplan, Allen; Investigators, on behalf of I. O. S.

2013-01-01

Background Attacks of hereditary angioedema (HAE) are unpredictable and, if affecting the upper airway, can be lethal. Icatibant is used for physician- or patient self-administered symptomatic treatment of HAE attacks in adults. Its mode of action includes disruption of the bradykinin pathway via blockade of the bradykinin B2 receptor. Early treatment is believed to shorten attack duration and prevent severe outcomes; however, evidence to support these benefits is lacking. Objective To examine the impact of timing of icatibant administration on the duration and resolution of HAE type I and II attacks. Methods The Icatibant Outcome Survey is an international, prospective, observational study for patients treated with icatibant. Data on timings and outcomes of icatibant treatment for HAE attacks were collected between July 2009–February 2012. A mixed-model of repeated measures was performed for 426 attacks in 136 HAE type I and II patients. Results Attack duration was significantly shorter in patients treated <1 hour of attack onset compared with those treated ≥1 hour (6.1 hours versus 16.8 hours [p<0.001]). Similar significant effects were observed for <2 hours versus ≥2 hours (7.2 hours versus 20.2 hours [p<0.001]) and <5 hours versus ≥5 hours (8.0 hours versus 23.5 hours [p<0.001]). Treatment within 1 hour of attack onset also significantly reduced time to attack resolution (5.8 hours versus 8.8 hours [p<0.05]). Self-administrators were more likely to treat early and experience shorter attacks than those treated by a healthcare professional. Conclusion Early blockade of the bradykinin B2 receptor with icatibant, particularly within the first hour of attack onset, significantly reduced attack duration and time to attack resolution. PMID:23390491

Ease of intubation: A randomized, double-blind study to compare two doses of rocuronium bromide for endotracheal intubation.

PubMed

Shukla, Aparna; Misra, Shilpi

2016-01-01

Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. A prospective, randomized, double-blind study. All the patients were divided in a randomized, double-blind fashion into two groups of twenty patients each. Group I patients received rocuronium bromide 0.6 mg/kg intravenously and intubated at 60 s, Group II patients received rocuronium bromide 0.9 mg/kg and intubated at 60 s. The neuromuscular block was assessed using single twitch stimulation of 0.1 Hz at adductor pollicis muscle of hand at every 10 s. The results were compiled and analyzed statistically using Chi-square test for qualitative data and Student's t -test for quantitative data. Time of onset was significantly shorter ( P < 0.01) and duration of action was prolonged ( P < 0.001) for Group II as compared to Group I. The intubating conditions were (excellent + good) in 100% patients of Group II and (excellent + good) in 80% of Group I. There was no significant change in pulse rate and mean arterial pressure from the baseline value after the administration of muscle relaxants in either of the two groups. Rocuronium bromide 0.9 mg/kg is a safer alternative to rocuronium bromide 0.6 mg/kg for endotracheal intubation with shorter time of onset and better intubating conditions.

Implementation of LED fluorescence microscopy for diagnosis of pulmonary and HIV-associated tuberculosis in a hospital setting in Indonesia.

PubMed

Chaidir, Lidya; Parwati, Ida; Annisa, Jessi; Muhsinin, Soni; Meilana, Intan; Alisjahbana, Bachti; van Crevel, Reinout

2013-01-01

Fluorescence microscopy (FM) has not been implemented widely in TB endemic settings and little evaluation has been done in HIV-infected patients. We evaluated diagnostic performance, time and costs of FM with light-emitting diodes technology (LED-FM), compared with conventional (Zieh-Neelsen) microscopy in a hospital in Indonesia which acts as referral centre for HIV-infected patients. We included pulmonary tuberculosis suspects from the outpatient and HIV clinic. Direct and concentrated sputum smears were examined using LED-FM and ZN microscopy by two technicians who were blinded for the HIV-status and the result of the comparative test. Mean reading time per slide was recorded and cost of each slide was calculated. Mycobacteria culture served as the reference standard. Among 404 tuberculosis suspects from the outpatient clinic and 256 from the HIV clinic, mycobacteria culture was positive in 12.6% and 27%, respectively. The optimal sensitivity of LED-FM was achieved by using a threshold of ≥2 AFB/length. LED-FM had a higher sensitivity (75.5% vs. 54.9%, P<0.01) but lower specificity (90.0% vs 96.6%, P<0.01) compared to ZN microscopy. HIV was associated with a lower sensitivity but similar specificity. The average reading time using LED-FM was significantly shorter (2.23±0.78 vs 5.82±1.60 minutes, P<0.01), while costs per slide were similar. High sensitivity of LED-FM combined with shorter reading time of sputum smear slides make this method a potential alternative to ZN microscopy. Additional data on specificity are needed for effective implementation of this technique in high burden TB laboratories.

Comparison of spring-loaded, loss of resistance and hanging drop techniques in lumbar epidural blocks.

PubMed

Gülen, Güven; Akkaya, Taylan; Ozkan, Derya; Kaydul, Mehmet; Gözaydin, Orhan; Gümüş, Haluk

2012-01-01

The spring-loaded syringe is a loss of resistance syringe that provide a more objective sign that the epidural space has been entered compared with the traditional techniques. The aim of this study was to compare the time required to locate the epidural space and the backache incidence with the spring-loaded (SL), loss of resistance (LOR) and the hanging drop (HD) techniques for epidural blocks in patients undergoing transurethral resection procedure. Sixty patients undergoing transurethral resections were enrolled in the study. The patients were randomly assigned to one of three groups. Epidural block was performed in the first group with a spring-loaded syringe (n=20), in the second group with loss-of-resistance syringe (n=20), and in the third group with the hanging drop technique (n=20). The required time to locate the epidural space, the number of attempts, the incidence of dural puncture and the backache incidence were assessed during the procedure and for four weeks after the procedure in all patients. The required time to locate the epidural space was 29.1 ± 9.16 seconds in Group 1; 45.25 ± 19.58 seconds in Group 2, and 47.35 ± 11.42 seconds in Group 3 (p<0.001). In Group 1 this was significantly shorter than the other two groups. There was no significant difference in the number of attempts, the incidence of dural puncture and backache incidence between the three groups (p>0.05). The use of SL syringe was found to have a shorter time period to locate the epidural space when compared with the LOR syringe and hanging drop technique.

Quality aspects of ex vivo root canal treatments done by undergraduate dental students using four different endodontic treatment systems.

PubMed

Jungnickel, Luise; Kruse, Casper; Vaeth, Michael; Kirkevang, Lise-Lotte

2018-04-01

To evaluate factors associated with treatment quality of ex vivo root canal treatments performed by undergraduate dental students using different endodontic treatment systems. Four students performed root canal treatment on 80 extracted human teeth using four endodontic treatment systems in designated treatment order following a Latin square design. Lateral seal and length of root canal fillings was radiographically assessed; for lateral seal, a graded visual scale was used. Treatment time was measured separately for access preparation, biomechanical root canal preparation, obturation and for the total procedure. Mishaps were registered. An ANOVA mirroring the Latin square design was performed. Use of machine-driven nickel-titanium systems resulted in overall better quality scores for lateral seal than use of the manual stainless-steel system. Among systems with machine-driven files, scores did not significantly differ. Use of machine-driven instruments resulted in shorter treatment time than manual instrumentation. Machine-driven systems with few files achieved shorter treatment times. With increasing number of treatments, root canal-filling quality increased, treatment time decreased; a learning curve was plotted. No root canal shaping file separated. The use of endodontic treatment systems with machine-driven files led to higher quality lateral seal compared to the manual system. The three contemporary machine-driven systems delivered comparable results regarding quality of root canal fillings; they were safe to use and provided a more efficient workflow than the manual technique. Increasing experience had a positive impact on the quality of root canal fillings while treatment time decreased.

Nonlinear stratospheric variability: multifractal de-trended fluctuation analysis and singularity spectra

PubMed Central

Domeisen, Daniela I. V.

2016-01-01

Characterizing the stratosphere as a turbulent system, temporal fluctuations often show different correlations for different time scales as well as intermittent behaviour that cannot be captured by a single scaling exponent. In this study, the different scaling laws in the long-term stratospheric variability are studied using multifractal de-trended fluctuation analysis (MF-DFA). The analysis is performed comparing four re-analysis products and different realizations of an idealized numerical model, isolating the role of topographic forcing and seasonal variability, as well as the absence of climate teleconnections and small-scale forcing. The Northern Hemisphere (NH) shows a transition of scaling exponents for time scales shorter than about 1 year, for which the variability is multifractal and scales in time with a power law corresponding to a red spectrum, to longer time scales, for which the variability is monofractal and scales in time with a power law corresponding to white noise. Southern Hemisphere (SH) variability also shows a transition at annual scales. The SH also shows a narrower dynamical range in multifractality than the NH, as seen in the generalized Hurst exponent and in the singularity spectra. The numerical integrations show that the models are able to reproduce the low-frequency variability but are not able to fully capture the shorter term variability of the stratosphere. PMID:27493560

Histopathological and Postoperative Behavioral Comparison of Rodent Oral Tongue Resection: Fiber-Enabled CO2 Laser versus Electrocautery

PubMed Central

Shires, Courtney Brooke; Saputra, Jennifer Marie; King, Lauren; Thompson, Jerome W.; Heck, Detlef H.; Sebelik, Merry Ellen; Boughter, John Dudley

2015-01-01

Objective To compare operative time and hemostasis of fiber-enabled CO2 laser (FECL) energy to that of the electrocautery (EC) technique for oral tongue resection, to compare return to oral intake and preoperative weight after FECL and EC resection, and to compare histologic changes in adjacent tissue after FECL and EC resection. Study Design Prospective animal study. Setting Research laboratory. Subjects and Methods The CO2 laser fiber and the Bovie cautery were each used to resect the anterior tongue in 15 adult rats. Fixative perfusion and killing were performed on postoperative day 0 (n = 10), 3 (n = 10), or 7 (n = 10). Body weight, food intake, and water intake were recorded daily for 3- and 7-day survival rats. After preparation for histologic analysis, the tongue tissue was graded with a mucosal wound-healing scale (MWHS). Results A higher incidence of intraoperative bleeding and shorter operative times were noted in the EC group. No statistically significant difference in postoperative food or water intake between the EC and FECL groups was noted. The FECL group returned to baseline weight by postoperative day 6. MWHS scores were lower in the EC group by postoperative day 3 and lower in the FECL group by postoperative day 7. Conclusions Both EC and FECL are effective for resection of the tongue in rats. EC has the advantage of shorter operative time and lower MWHS scores by postoperative day 3; FECL has the advantages of less intraoperative bleeding, faster return to baseline body weight, and lower MWHS score by postoperative day 7. PMID:22535916

Impacts of visuomotor sequence learning methods on speed and accuracy: Starting over from the beginning or from the point of error.

PubMed

Tanaka, Kanji; Watanabe, Katsumi

2016-02-01

The present study examined whether sequence learning led to more accurate and shorter performance time if people who are learning a sequence start over from the beginning when they make an error (i.e., practice the whole sequence) or only from the point of error (i.e., practice a part of the sequence). We used a visuomotor sequence learning paradigm with a trial-and-error procedure. In Experiment 1, we found fewer errors, and shorter performance time for those who restarted their performance from the beginning of the sequence as compared to those who restarted from the point at which an error occurred, indicating better learning of spatial and motor representations of the sequence. This might be because the learned elements were repeated when the next performance started over from the beginning. In subsequent experiments, we increased the occasions for the repetitions of learned elements by modulating the number of fresh start points in the sequence after errors. The results showed that fewer fresh start points were likely to lead to fewer errors and shorter performance time, indicating that the repetitions of learned elements enabled participants to develop stronger spatial and motor representations of the sequence. Thus, a single or two fresh start points in the sequence (i.e., starting over only from the beginning or from the beginning or midpoint of the sequence after errors) is likely to lead to more accurate and faster performance. Copyright © 2016 Elsevier B.V. All rights reserved.

High permeance sulfur tolerant Pd/Cu alloy membranes

DOEpatents

Ma, Yi Hua; Pomerantz, Natalie

2014-02-18

A method of making a membrane permeable to hydrogen gas (H.sub.2.uparw.) is disclosed. The membrane is made by forming a palladium layer, depositing a layer of copper on the palladium layer, and galvanically displacing a portion of the copper with palladium. The membrane has improved resistance to poisoning by H.sub.2S compared to a palladium membrane. The membrane also has increased permeance of hydrogen gas compared to palladium-copper alloys. The membrane can be annealed at a lower temperature for a shorter amount of time.

Fast Conversion of Ionic Liquids and Poly(Ionic Liquid)s into Porous Nitrogen-Doped Carbons in Air

PubMed Central

Men, Yongjun; Ambrogi, Martina; Han, Baohang; Yuan, Jiayin

2016-01-01

Ionic liquids and poly(ionic liquid)s have been successfully converted into nitrogen-doped porous carbons with tunable surface area up to 1200 m2/g at high temperatures in air. Compared to conventional carbonization process conducted under inert gas to produce nitrogen-doped carbons, the new production method was completed in a rather shorter time without noble gas protection. PMID:27070588

Fast Conversion of Ionic Liquids and Poly(Ionic Liquid)s into Porous Nitrogen-Doped Carbons in Air.

PubMed

Men, Yongjun; Ambrogi, Martina; Han, Baohang; Yuan, Jiayin

2016-04-08

Ionic liquids and poly(ionic liquid)s have been successfully converted into nitrogen-doped porous carbons with tunable surface area up to 1200 m²/g at high temperatures in air. Compared to conventional carbonization process conducted under inert gas to produce nitrogen-doped carbons, the new production method was completed in a rather shorter time without noble gas protection.

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial.

PubMed

Andersson, Bodil; Hallén, Magnus; Leveau, Per; Bergenfelz, Anders; Westerdahl, Johan

2003-05-01

This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group.

The effect of the severity of obstructive sleep apnea syndrome on telomere length.

PubMed

Tempaku, Priscila Farias; Mazzotti, Diego Robles; Hirotsu, Camila; Andersen, Monica Levy; Xavier, Gabriela; Maurya, Pawan Kumar; Rizzo, Lucas Bortolotto; Brietzke, Elisa; Belangero, Sintia Iole; Bittencourt, Lia; Tufik, Sergio

2016-10-25

Aging is associated with an increase in the prevalence of obstructive sleep apnea syndrome (OSAS) as well as the shortening of telomeres. It is known that OSAS-related factors are stimuli that can contribute to the acceleration of cellular senescence. Thus, the present study aimed to compare the leukocyte telomere length (LTL) between OSAS patients and controls, as well as to verify the correlation between LTL and sleep parameters. We used DNA extracted of 928 individuals from EPISONO to measure the LTL by the quantitative real-time polymerase chain reaction. All individuals were subjected to one full-night polysomnography. LTL was significantly shorter in OSAS patients compared to controls. The results showed negative correlations between LTL and the following variables: apnea-hypopnea index, respiratory disturbance index, desaturation index and wake after sleep onset. LTL was positively correlated with sleep efficiency, total sleep time, basal, minimum and maximum oxygen saturation. Lastly, it was observed that OSAS severity was associated with shorter LTL even after adjusting for sex, age, years of schooling, body mass index, diabetes, stroke and heart attack. In conclusion, our study indicates the presence of an association between LTL and OSAS and a significant impact of severity of OSAS in telomeres shortening.

Elastomeric impression materials: a comparison of accuracy of multiple pours.

PubMed

Kumar, Dheeraj; Madihalli, Anand U; Reddy, K Rajeev Kumar; Rastogi, Namrataa; Pradeep, N T

2011-07-01

The aim of the present study is to compare the various elastomeric impression materials in terms of accuracy and dimensional stability, with respect to obtaining multiple casts from a single elastomeric impression at various times of pours. Three master dies were prepared for the impression making, two of these were made of brass containing a central hole with undercuts. The third die simulated a conventionally prepared typodont maxillary central incisor. Three elastomeric impression materials were chosen for the study. Each impression was poured at various time periods. Casts thus obtained were evaluated under a traveling microscope to evaluate various dimensional changes. Addition silicones provided dies which were shorter in height and bigger in diameter. Polyethers provided dies which were shorter in both height and diameter. Condensation silicones showed insignificant changes from the master die at the immediate pour but deteriorated rapidly after that in subsequent pours. None of the impression material showed a consistent behavior up to the fourth pour. They occasionally showed deviation from the pattern, but all these values were statistically insignificant. Polyethers showed lesser ability than both the addition silicones as well as the condensation silicones to recover from induced deformation. Addition silicones as well as the condensation silicones have better ability to recover from induced deformation when compared to polyether.

A randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation.

PubMed

Sullivan, J T; Grobman, W A; Bauchat, J R; Scavone, B M; Grouper, S; McCarthy, R J; Wong, C A

2009-10-01

Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia. Parturients with singleton breech presentation (n=96) were randomized to receive CSE analgesia with bupivacaine 2.5mg and fentanyl 15 microg (CSE group) or intravenous fentanyl 50 microg (SYS group) before ECV attempt. The primary outcome was ECV success. The success rate of ECV was 47% with CSE and 31% in the SYS group (P=0.14). Subsequent vaginal delivery was 36% for CSE and 25% for SYS (P=0.27). Median [IQR] visual analog pain scores (0-100mm scale) were lower with CSE (3 [0-12]) compared to SYS analgesia (36 [16 to 54]) (P<0.005) and patient satisfaction (0-10 scale) was higher (CSE 10 [9 to 10] versus SYS 7 [4 to 9]) (P<0.005). There were no differences in fetal heart rate patterns, but median time to return to fetal heart rate reactivity after analgesia was shorter with CSE (13 [IQR 9-21] min) compared to the SYS group (39 [IQR 23-51] min) (P=0.02). There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.

Controlled feasibility trial comparing the use of 1470nm and 940nm diode laser for the treatment of hyperplastic inferior nasal turbinates

NASA Astrophysics Data System (ADS)

Sroka, Ronald; Havel, Miriam; Leunig, Andreas; Betz, Christian S.

2012-02-01

Introduction: So far various laser systems have been used for volume reduction of hyperplastic nasal turbinates. In case of endonasal application, fiber controlled diode lasers are preferred due to reasons of cost and practicability. The aim of this clinical study was to compare the coagulative tissue effects using either λ=1470nm vs. λ=940nm emitting lasers in treatment of hyperplastic inferior nasal turbinates in an intraindividual manner. Patients and methods: This prospective, randomized, double-blind, clinical feasibility trial included 20 patients suffering from hyperplastic inferior nasal turbinates. In each case, one nasal cavity was treated using 1470nm laser at 4- 5W, the other one with 940nm laser at 12W. Treatment was performed endoscopically controlled in non-contact mode. Clinical presentation and patients symptoms were documented preoperatively and on day 1, 3, 7, 14 and 21 postoperatively using rhinomanometry, standardized questionnaires including SNOT 20 GAV (German adapted version), and separate endoscopic examination respectively. Results: None of the patients showed infections, hemorrhages or other complications occurred intra- or postoperatively. The mean operation time was significantly shorter using the 1470nm diode laser as compared to the 940nm laser, thus lower energy was applied. There was a significant reduction of nasal obstruction on day 21 postoperatively compared to the preoperative condition on both sides regardless of the laser system used. Evaluation of the SNOT-Scores as assessed before and three weeks after surgery showed significant subjective improvements. Conclusion: Compared with standard application of 940nm diode laser, 1470nm diode laser application provides an equivalent tissue reduction in shorter operation time using less total energy and a comparable relief of nasal obstruction postoperatively.

Preemptive analgesia in rhegmatogenous retinal detachment surgery: is it effective?

PubMed

Mahfouz, Abdul Kader M; Nabawi, Khaled S

2002-10-01

To evaluate the efficacy of preemptive analgesia in surgical repair of retinal detachment (RD) using scleral buckle and cryopexy under general anesthesia. Thirty patients who were scheduled for rhegmatogenous RD surgical repair using scleral buckle and cryopexy and who were American Society of Anesthesiologists physical status I, II, or III were included in this study. The patients were randomly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in Group 2, sub-Tenon anesthesia was given as preemptive analgesia after induction anesthesia and before start of surgery. Both groups were statistically comparable as regards patient age and weight and duration of anesthesia and surgery. The incidences of intraoperative oculocardiac reflex and postoperative vomiting were significantly lower in Group 2 compared with Group 1 (P < 0.001 and 0.0113, respectively). The time of first postoperative analgesic dose was significantly shorter in Group 1 (46.67 +/- 18.84 minutes) compared with Group 2 (162.67 +/- 29.391 minutes) (P < 0.001). The total analgesic consumption per 24 hours was significantly higher in Group 1 compared with Group 2 (P < 0.001). The time of discharge from the hospital was significantly shorter in Group 2 (8.8 +/- 2.704 hours) compared with Group 1 (12.4 +/- 3.481 hours) (P = 0.0018). The use of sub-Tenon block as preemptive analgesia after induction of general anesthesia and before the start of rhegmatogenous RD surgical repair was effective in reducing postoperative pain and analgesic requirements compared with an unblocked group. The use of sub-Tenon block was also effective in reducing intraoperative incidence of oculocardiac reflex and postoperative incidence of vomiting.

Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques.

PubMed

Pishnamaz, Miguel; Wilkmann, Christoph; Na, Hong-Sik; Pfeffer, Jochen; Hänisch, Christoph; Janssen, Max; Bruners, Philipp; Kobbe, Philipp; Hildebrand, Frank; Schmitz-Rode, Thomas; Pape, Hans-Christoph

2016-01-01

Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures. Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05. 160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001). Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.

Comparison of Ultrasound with Peripheral Nerve Stimulator-guided Technique for Supraclavicular Block in Upper Limb Surgeries: A Randomized Controlled Trial.

PubMed

Alfred, Vinu Mervick; Srinivasan, Gnanasekaran; Zachariah, Mamie

2018-01-01

The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin. The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications. Prospective, randomized controlled study. Sixty patients aged above 18 years scheduled for elective upper limb surgery were randomly allocated into two groups. Group A patients received supraclavicular brachial plexus block under ultrasound guidance and in Group B patients, PNS was used. In both groups, local anesthetic mixture consisting of 15 ml of 0.5% bupivacaine and 10 ml of 2% lignocaine with 1:200,000 adrenaline were used. Independent t -test used to compare mean between groups; Chi-square test for categorical variables. The procedure time was shorter with USG (11.57 ± 2.75 min) compared to PNS (21.73 ± 4.84). The onset time of sensory block (12.83 ± 3.64 min vs. 16 ± 3.57 min) and onset of motor block (23 ± 4.27 min vs. 27 ± 3.85 min) were significantly shorter in Group A compared to Group B ( P < 0.05). The duration of sensory block was significantly prolonged in Group A (8.00 ± 0.891 h) compared to Group B (7.25 ± 1.418 h). None of the patients in either groups developed any complications. The ultrasound-guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique.

77 FR 67409 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

...), 7410A (Definitions), 7420A (Applicability), 7430A (Synchronization of Member Business Clocks), 7440A... days after the date of the filing, or such shorter time as the Commission may designate if consistent... the proposed rule change, or such shorter time as designated by the Commission. \\11\\ 15 U.S.C. 78s(b...

Hand-assisted laparoscopic versus robot-assisted laparoscopic partial nephrectomy: comparison of short-term outcomes and cost.

PubMed

Elsamra, Sammy E; Leone, Andrew R; Lasser, Michael S; Thavaseelan, Simone; Golijanin, Dragan; Haleblian, George E; Pareek, Gyan

2013-02-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion. A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient. Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot. While early in our experience, RALPN offered no significant advantage in short-term outcomes over HALPN and was associated with an increased cost of over $1150.

Efficacy of clonidine versus phenobarbital in reducing neonatal morphine sulfate therapy days for neonatal abstinence syndrome. A prospective randomized clinical trial.

PubMed

Surran, B; Visintainer, P; Chamberlain, S; Kopcza, K; Shah, B; Singh, R

2013-12-01

To compare the efficacy of clonidine versus phenobarbital in reducing morphine sulfate treatment days for neonatal abstinence syndrome (NAS). Prospective, non-blinded, block randomized trial at a single level III NICU (Neonatal Intensive Care Unit). Eligible infants were treated with a combination of medications as per protocol. Primary outcome was treatment days with morphine sulfate. Secondary outcomes were the mean total morphine sulfate dose, outpatient phenobarbital days, adverse events and treatment failures. A total of 82 infants were eligible, of which 68 were randomized with 34 infants in each study group. Adjusting for covariates phenobarbital as compared with clonidine had shorter morphine sulfate treatment days (-4.6, 95% confidence interval (CI): -0.3, -8.9; P=0.037) with no difference in average morphine sulfate total dose (1.1 mg kg(-1), 95% CI: -0.1, 2.4; P=0.069). Post-discharge phenobarbital was continued for an average of 3.8 months (range 1 to 8 months). No other significant differences were noted. Phenobarbital as adjunct had clinically nonsignificant shorter inpatient but significant overall longer therapy time as compared with clonidine.

A polymorphism in a transporter of testosterone is a determinant of androgen independence in prostate cancer.

PubMed

Sharifi, Nima; Hamada, Akinobu; Sissung, Tristan; Danesi, Romano; Venzon, David; Baum, Caitlin; Gulley, James L; Price, Douglas K; Dahut, William L; Figg, William D

2008-08-05

To determine if patients with advanced prostate cancer carrying a polymorphism that codes for a more active testosterone transporter have less durable responses to androgen-deprivation therapy (ADT) than patients not carrying this polymorphism. We previously determined that a polymorphism in SLCO1B3 affects testosterone transport and that those men who have at least one wild-type T allele at the 334 T > G polymorphism in this gene have a shorter survival. We hypothesized that the T allele which increases testosterone transport would be associated with a shorter interval from ADT to androgen independence. We examined the association between this SLCO1B3 polymorphism and time from ADT to androgen independence, ADT to prostate-specific antigen (PSA) nadir and PSA nadir to androgen independence in 68 Caucasian patients with advanced prostate cancer who were treated with ADT with metastatic disease (D2) or biochemical failure with no metastatic disease (D0). When examined separately, patients in the individual stages tended to have a shorter time to androgen independence with the T allele in the D0 (P = 0.11) and D2 (P = 0.18) groups. Combining these groups and stratifying by stage yielded a statistically significant shorter time to androgen independence with the T allele (P = 0.048). A polymorphism in a transporter that increases testosterone import is associated with a shorter time to androgen independence in patients with prostate cancer who are treated with ADT.

Short sleep as an environmental exposure: a preliminary study associating 5-HTTLPR genotype to self-reported sleep duration and depressed mood in first-year university students.

PubMed

Carskadon, Mary A; Sharkey, Katherine M; Knopik, Valerie S; McGeary, John E

2012-06-01

This study examined whether the 5-HTTLPR polymorphism in the SLC6A4 gene is associated with self-reported symptoms of depressed mood in first-year university students with a persistent pattern of short sleep. Students provided DNA samples and completed on-line sleep diaries and a mood scale during the first semester. A priori phenotypes for nocturnal sleep and mood scores were compared for the distribution of genotypes. Brown University, Providence, Rhode Island. A sample of 135 first-year students, 54 male, 71 Caucasian, mean age 18.1 (± 0.5) yr. None. Students completed on-line sleep diaries daily across the first term (21-64 days; mean = 51 days ± 11) and Center for Epidemiologic Studies-Depression (CES-D) mood scale after 8 wk. DNA was genotyped for the triallelic 5-HTTLPR polymorphism. Low-expressing S and L(G)polymorphisms were designated S', and high-expressing L(A) was designated L'. Phenotype groups were identified from a combination of CES-D (median split: high > 12; low < 13) and mean nocturnal total sleep time (TST) from diaries: (shorter ≤ 7 hr; longer ≥ 7.5 hr). Three genotypes were identified (S'S', S'L', L'L'); the S'S' genotype was present in a higher proportion of Asian than non-Asian students. FOUR PHENOTYPE GROUPS WERE COMPARED: 40 students with shorter TST/high CES-D; 34 with shorter TST/low CES-D; 29 with longer TST/high CES-D; 32 with longer TST/low CES-D. Female:male distribution did not vary across phenotype groups (chi-square = 1.39; df = 3; P = 0.71). S'S' participants (n = 23) were overrepresented in the shorter TST/high CES-D group (chi- square = 15.04; df = 6; P < 0.02). This association was sustained after removing participants with preexisting evidence of depressed mood (chi-square = 12.90; df = 6; P = 0.045). These data indicate that young adults who reported shorter nocturnal sleep and higher depressed mood are more likely than others to carry a variant of the SLC6A4 gene associated with low expression of the serotonin transporter.

Analysis of the release process of phenylpropanolamine hydrochloride from ethylcellulose matrix granules V. Release properties of ethylcellulose layered matrix granules.

PubMed

Fukui, Atsuko; Fujii, Ryuta; Yonezawa, Yorinobu; Sunada, Hisakazu

2008-04-01

In the pharmaceutical preparation of a controlled release drug, it is very important and necessary to understand the release properties. In previous papers, a combination of the square-root time law and cube-root law equations was confirmed to be a useful equation for qualitative treatment. It was also confirmed that the combination equation could analyze the release properties of layered granules as well as matrix granules. The drug release property from layered granules is different from that of matrix granules. A time lag occurs before release, and the entire release property of layered granules was analyzed using the combination of the square-root time law and cube-root law equations. It is considered that the analysis method is very useful and efficient for both matrix and layered granules. Comparing the granulation methods, it is easier to control the manufacturing process by tumbling granulation (method B) than by tumbling-fluidized bed granulation (method C). Ethylcellulose (EC) layered granulation by a fluidized bed granulator might be convenient for the preparation of controlled release dosage forms as compared with a tumbling granulator, because the layered granules prepared by the fluidized bed granulator can granulate and dry at the same time. The time required for drying by the fluidized bed granulator is shorter than that by the tumbling granulator, so the fluidized bed granulator is convenient for preparation of granules in handling and shorter processing time than the tumbling granulator. It was also suggested that the EC layered granules prepared by the fluidized bed granulator were suitable for a controlled release system as well as the EC matrix granules.

Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program

PubMed Central

Markossian, Talar W.; Darnell, Julie S.; Calhoun, Elizabeth A.

2012-01-01

Background We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Methods Women with an abnormal breast (n=352) or cervical (n=545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Results Compared to controls, the breast navigation group had shorter time to diagnostic resolution (aHR=1.65, CI=1.20–2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR= 2.31, CI=1.75–3.06), with no difference before 30 days (aHR= 1.42, CI=0.83–2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Conclusions Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Impact Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women. PMID:23045544

Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program.

PubMed

Markossian, Talar W; Darnell, Julie S; Calhoun, Elizabeth A

2012-10-01

We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Women with an abnormal breast (n = 352) or cervical (n = 545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Compared with controls, the breast navigation group had shorter time to diagnostic resolution (aHR = 1.65, CI = 1.20-2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR = 2.31, CI = 1.75-3.06), with no difference before 30 days (aHR = 1.42, CI = 0.83-2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women. 2012 AACR

Calculation of broadband time histories of ground motion, Part II: Kinematic and dynamic modeling using theoretical Green's functions and comparison with the 1994 northridge earthquake

USGS Publications Warehouse

Hartzell, S.; Guatteri, Mariagiovanna; Mai, P.M.; Liu, P.-C.; Fisk, M. R.

2005-01-01

In the evolution of methods for calculating synthetic time histories of ground motion for postulated earthquakes, kinematic source models have dominated to date because of their ease of application. Dynamic models, however, which incorporate a physical relationship between important faulting parameters of stress drop, slip, rupture velocity, and rise time, are becoming more accessible. This article compares a class of kinematic models based on the summation of a fractal distribution of subevent sizes with a dynamic model based on the slip-weakening friction law. Kinematic modeling is done for the frequency band 0.2 to 10.0. Hz, dynamic models are calculated from 0.2 to 2.0. Hz. The strong motion data set for the 1994 Northridge earthquake is used to evaluate and compare the synthetic time histories. Source models are propagated to the far field by convolution with 1D and 3D theoretical Green’s functions. In addition, the kinematic model is used to evaluate the importance of propagation path effects: velocity structure, scattering, and nonlinearity. At present, the kinematic model gives a better broadband fit to the Northridge ground motion than the simple slip-weakening dynamic model. In general, the dynamic model overpredicts rise times and produces insufficient shorter-period energy. Within the context of the slip-weakening model, the Northridge ground motion requires a short slip-weakening distance, on the order of 0.15 m or less. A more complex dynamic model including rate weakening or one that allows shorter rise times near the hypocenter may fit the data better.

Behavioral characteristics of Hanwoo (Bos taurus coreanae) steers at different growth stages and seasons.

PubMed

Kim, Na Yeon; Kim, Seong Jin; Jang, Se Young; Oh, Mi Rae; Tang, Yu Jiao; Seong, Hye Jin; Yun, Yeong Sik; Moon, Sang Ho

2017-10-01

This research analyzed behavioral characteristics of Hanwoo ( Bos taurus coreanae ) steers during each season and growth stage to enable measurement of the animals' welfare level for precision livestock farming. A hundred-eight beef steers were divided into three equal groups at a Hanwoo farm according to their growth stage: growing stage (GS), 8 months; early-fattening stage (EFS), 19 months; and late-fattening stage (LFS), 30 months. Twelve behavioral categories were continuously recorded for 13 day-time hours in each four seasons with three replications. Time spent standing was found to be significantly longer in summer at all growth stages (p<0.05). Hanwoos at the GS spent significantly longer standing time in spring and summer than those at the EFS and LFS (p<0.05). Lying time in summer was the shortest for all growth stages (p<0.05). Steers at the LFS spent significantly longer lying time than that at the GS (p<0.05) in summer. For GS and EFS, time spent eating in spring and autumn were longer than in summer and winter (p<0.05). Eating time was the longest for the GS in spring, autumn, and winter, excluding for the LFS in winter (p<0.05). Regarding ruminating, steers at the LFS spent significantly shorter time than those at other stages in all seasons (p<0.05). GS and EFS steers showed the longest walking time in summer compared with other seasons (p<0.05). At GS and LFS, drinking time in summer was the longest of all seasons (p<0.05). Sleeping time was significantly shorter in summer compared with the other seasons (p<0.05). Self-grooming time was the longest in winter for all growth stages (p<0.05). Steers were found to have more variable behavioral patterns during summer and the GS and less active behaviors during the LFS, thus extra care seems necessary during the GS, LFS, and summer period.

Patterns of inpatient care for immigrants in Switzerland: a case control study.

PubMed

Lay, Barbara; Lauber, Christoph; Nordt, Carlos; Rössler, Wulf

2006-03-01

Migration has become a major political and social concern in West European societies. A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period. Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients. Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.

Evaluation of the usefulness of color digital summation radiography in temporally sequential digital radiographs: a phantom study.

PubMed

Ogata, Yuji; Naito, Hiroaki; Tomiyama, Noriyuki; Hamada, Seiki; Kozuka, Takenori; Koyama, Mitsuhiro; Tsubamoto, Mitusko; Murai, Sachiko; Ueguchi, Takashi; Matsumoto, Mitsuhiro; Tamura, Shinichi; Nakamura, Hironobu; Johkoh, Takeshi

2006-04-01

The purpose of this study was to assess the usefulness of color digital summation radiography (CDSR) for detection of nodules on chest radiographs by observers with different levels of experience. A total of 30 radiographs of chest phantoms with abnormalities and 30 normal ones were arranged at random. Set A was conventional radiographs only. Set B consisted of both conventional radiographs and CDSR images, which were colored with magenta. Five chest radiologists and five residents evaluated both image sets on a TFT monitor. The observers were asked to rate each image set using a continuous rating scale. The reading time for each set was also recorded. In set A, the performance of chest radiologists was significantly superior to that of the residents (P < 0.05). However, in set B, there was no significant difference in the performance of the chest radiologists and the residents. In both observer groups, the mean reading time per case in set B was significantly shorter than that in set A (P < 0.01). By using CDSR, the detection capability of observers with little experience improves and is comparable to that of experienced observers. Moreover, the reading time becomes much shorter using CDSR.

Dyslexics’ faster decay of implicit memory for sounds and words is manifested in their shorter neural adaptation

PubMed Central

Jaffe-Dax, Sagi; Frenkel, Or; Ahissar, Merav

2017-01-01

Dyslexia is a prevalent reading disability whose underlying mechanisms are still disputed. We studied the neural mechanisms underlying dyslexia using a simple frequency-discrimination task. Though participants were asked to compare the two tones in each trial, implicit memory of previous trials affected their responses. We hypothesized that implicit memory decays faster among dyslexics. We tested this by increasing the temporal intervals between consecutive trials, and by measuring the behavioral impact and ERP responses from the auditory cortex. Dyslexics showed a faster decay of implicit memory effects on both measures, with similar time constants. Finally, faster decay of implicit memory also characterized the impact of sound regularities in benefitting dyslexics' oral reading rate. Their benefit decreased faster as a function of the time interval from the previous reading of the same non-word. We propose that dyslexics’ shorter neural adaptation paradoxically accounts for their longer reading times, since it reduces their temporal window of integration of past stimuli, resulting in noisier and less reliable predictions for both simple and complex stimuli. Less reliable predictions limit their acquisition of reading expertise. DOI: http://dx.doi.org/10.7554/eLife.20557.001 PMID:28115055

Reduced nasal growth after primary nasal repair combined with cleft lip surgery.

PubMed

Yoshimura, Y; Okumoto, T; Iijima, Y; Inoue, Y

2015-11-01

Nasal growth after cleft lip surgery with or without primary nasal repair was evaluated using lateral cephalograms. In 14 patients who underwent simultaneous nasal repair with primary cleft lip repair and 12 patients without simultaneous nasal repair, lateral cephalograms were obtained at 5 and 10 years of age. Lateral cephalograms of normal Japanese children were used as a control. At 5 years of age, there were significant differences in the nasal height and columellar angle among the three groups. Children without simultaneous nasal repair had shorter noses with more upward tilt of the columella compared with the controls, while children with simultaneous nasal repair had much shorter noses and more upward tilt than those without repair. At 10 years of age, the children without simultaneous nasal repair showed no differences from the control group, while those with simultaneous repair still had shorter noses and more upward tilt of the columella. These findings suggest that performing nasal repair at the same time as primary cleft lip surgery has an adverse influence on the subsequent growth of the nose. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Maternal and Fetal Effect of Misgav Ladach Cesarean Section in Nigerian Women: A Randomized Control Study

PubMed Central

Ezechi, OC; Ezeobi, PM; Gab-Okafor, CV; Edet, A; Nwokoro, CA; Akinlade, A

2013-01-01

Background: The poor utilisation of the Misgav-Ladach (ML) caesarean section method in our environment despite its proven advantage has been attributed to several factors including its non-evaluation. A well designed and conducted trial is needed to provide evidence to convince clinician of its advantage over Pfannenstiel based methods. Aim: To evaluate the outcome of ML based caesarean section among Nigerian women. Subjects and Methods: Randomised controlled open label study of 323 women undergoing primary caesarean section in Lagos Nigeria. The women were randomised to either ML method or Pfannenstiel based (PB) caesarean section technique using computer generated random numbers. Results: The mean duration of surgery (P < 0.001), time to first bowel motion (P = 0.01) and ambulation (P < 0.001) were significantly shorter in the ML group compared to PB group. Postoperative anaemia (P < 0.01), analgesic needs (P = 0.02), extra suture use, estimated blood loss (P < 0.01) and post-operative complications (P = 0.001) were significantly lower in the ML group compared to PB group. Though the mean hospital stay was shorter (5.8 days) in the ML group as against 6.0 days, the difference was not significant statistically (P = 0.17). Of the fetal outcome measures compared, it was only in the fetal extraction time that there was significant difference between the two groups (P = 0.001). The mean fetal extraction time was 162 sec in ML group compared to 273 sec in the PB group. Conclusions: This study confirmed the already established benefit of ML techniques in Nigerian women, as it relates to the postoperative outcomes, duration of surgery, and fetal extraction time. The technique is recommended to clinicians as its superior maternal and fetal outcome and cost saving advantage makes it appropriate for use in poor resource setting. PMID:24380012

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators

PubMed Central

He, Yi-Zhou; Zhong, Ming; Wu, Wei; Song, Jie-Qiong

2017-01-01

Background The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. Methods We analyzed 236 patients who had undergone central venous cannulation of axillary vein in this retrospective study. Patients were divided into two groups, the longitudinal approach group (n=120) and transverse approach group (n=116). Recorded the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate. We perform chest radiography to confirm pneumothorax on all patients. We compared the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate between the two groups. Results The two groups were comparable with clinical characters of patients. The overall success rates of the longitudinal group and the transverse group were both 100%. The rate of one-attempt success in the longitudinal approach group is higher than the transverse approach group (91.7% vs. 82.8%, P=0.040). The transverse approach group had shorter operation time than the longitudinal group (184.7±8.1 vs. 287.5±19.6 seconds, P=0.000). The two groups had lower postoperative complications. Arterial puncture occurred in 1 of 120 longitudinal and 2 of 116 transverse attempts and this difference was no significant (P=0.541). No pneumothorax occurred in the two groups. Conclusions The longitudinal approach during ultrasound-guided axillary vein cannulation is associated with greater one-attempt success rate compared with the transverse approach by experienced operators. The transverse approach has shorter operation time. The two groups have lower postoperative complications and are comparable with pneumothorax and arterial puncture. PMID:28523170

Tooth movement using palatal implant supported anchorage compared to conventional dental anchorage.

PubMed

Borsos, Gabriella; Vokó, Zoltan; Gredes, Tomasz; Kunert-Keil, Christiane; Vegh, Andras

2012-11-01

Tooth stability is one of the most changing parameters in age. The aim of the present study has been to clarify the therapeutic benefit of the osseointegrated palatal implant (PI) supported anchorage in adolescents compared with conventional dental anchorage (DA) in extraction cases requiring 'maximum anchorage' in growing patients following the post pubertal growth spurt. Thirty patients (14.22±1.37 years) selected with homogeneous facial skeletal characteristics were divided in two groups. In the PI group, Orthosystem(®) implants were placed into the palate for anchorage and the transpalatal arch (TPA) was fixed to the implant and to the molar bands. In the DA group maximal anchorage was provided by a TPA and a utility arch. Super-elastic spring was used for canine- and contraction arch for incisor retraction. An insignificant difference was observed between the groups as to the duration of the canine retraction. In the PI group, the duration of the front retraction and the total treatment time was shorter compared to the DA group (P<0.05). No significant difference in molar mesial movement was found during canine retraction, but during front retraction, there was significantly less mesial molar movement in the PI group compared to the DA group (P<0.05). The use of palatal implant-based anchorage does not offer a shorter canine retraction period, but resulted in a significant shortening of the front-retraction phase and a total treatment time shortened by 5 months on average. The tooth stability in adolescent patients is adequate for tooth movements using both methods. Copyright © 2012 Elsevier GmbH. All rights reserved.

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

PubMed

Postlewait, Lauren M; Ethun, Cecilia G; McInnis, Mia R; Merchant, Nipun; Parikh, Alexander; Idrees, Kamran; Isom, Chelsea A; Hawkins, William; Fields, Ryan C; Strand, Matthew; Weber, Sharon M; Cho, Clifford S; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles; Bentrem, David; Kim, Hong J; Carr, Jacquelyn; Ahmad, Syed; Abbott, Daniel; Wilson, Gregory C; Kooby, David A; Maithel, Shishir K

2018-01-01

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000-2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data.

PubMed

Kasai, Meidai; Cipriani, Federica; Gayet, Brice; Aldrighetti, Luca; Ratti, Francesca; Sarmiento, Juan M; Scatton, Olivier; Kim, Ki-Hun; Dagher, Ibrahim; Topal, Baki; Primrose, John; Nomi, Takeo; Fuks, David; Abu Hilal, Mohammad

2018-05-01

The role of laparoscopy for major hepatectomies remains a matter of development to be further assessed. The purpose of this study is to compare the short- and long-term outcomes between laparoscopic and open major hepatectomies meta-analyzing individual patient data from published comparative studies. All retrospective studies comparing between laparoscopic and open major hepatectomies published until March 2017 were identified independently by 2 reviewers by searching in PubMed and Cochrane Central Register of Controlled Trials. Individual patient data were sought from all selected studies. Postoperative outcomes, including intraoperative blood loss, operative time, hospital stay, postoperative complications, mortality rates, and long-term survival were analyzed. A total of 917 patients were divided into the laparoscopic (427) and open (490) groups from 8 selected studies. The hospital stay was significantly shorter, and the total morbidity was lower in the laparoscopic group. When classified by severity, the incidence of postoperative minor complications was lower; however, that of major complications was not significantly different. The operative time was longer in the laparoscopic group; however, intraoperative blood loss, perioperative mortality, and blood transfusions were comparable between the 2 groups. The overall survival in the patients with colorectal liver metastases and hepatocellular carcinoma was not significantly different between the 2 groups. Laparoscopic major hepatectomies offer some perioperative advantages, including fewer complications and shorter hospital stay, without increasing the blood loss volume and mortality. Whether these results can anticipate the outcomes in future randomized controlled trials has not been determined. Copyright © 2018 Elsevier Inc. All rights reserved.

Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis

PubMed Central

Sahin, Selcuk; Resorlu, Berkan; Eksi, Mithat; Aras, Bekir; Atar, Arda; Tugcu, Volkan

2016-01-01

Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities. PMID:27375691

Sutureless circumcision using 2-Octyl cyanoacrylate results in more rapid and less painful procedures with excellent cosmetic satisfaction.

PubMed

Van Haute, C; Tailly, T; Klockaerts, K; Ringoir, Y

2015-06-01

Circumcision is the most common surgical procedure in male children in the world and is performed because of cultural, religious or medical reasons. Traditionally, interrupted sutures are used to close the wound, but 2-Octyl cyanoacrylate (2-OCA) tissue glue can be used as an alternative method to close the circumcision wound. To compare the use of 2-OCA with absorbable sutures in circumcision wound closure in prepubescent patients in terms of operative time, complication rate, postoperative pain and cosmetic results. We retrospectively evaluated 662 circumcision procedures using sutures and 609 procedures using 2-OCA for wound closure in prepubescent boys. All circumcision procedures were performed by 2 surgeons in a single centre. Operative time was collected from the hospital surgical software system. 62% of the patients in the suture group and 59% of the patients in the 2-OCA group presented for a postoperative check-up 6 weeks after the circumcision. Data regarding postoperative pain, need for analgesia, cosmetic satisfaction and the ease of wound care were collected through questionnaires completed by 25% of the boy's parents in the suture group and 53% of the parents in the 2-OCA group. Mean operative time was significantly shorter in the 2-OCA group (13 min) than in the suture group (17 min). Complications were comparable and mostly minor. Reintervention was only required in 3 cases. According to the parents, the degree of postoperative pain and the postoperative need for analgesics was significantly lower in the 2-OCA group. Wounds closed with 2-OCA were easier to care for. The cosmetic results after 1 day, after 1 week and after 1 month in the 2-OCA group were significantly superior than in the suture group, according to the parents' evaluation. The use of 2-OCA in circumcision wound closure has been reported before. Previous studies with mainly limited patient numbers report less pain, shorter procedure times and a higher surgeon satisfaction in terms of cosmetic results. This study is the largest study comparing the use of 2-OCA and interrupted sutures in circumcision wound closure. The retrospective character of the study, the lack of a validated questionnaire tool for the cosmetic evaluation and the use of the parent's evaluation are the limitations of this study. The use of 2-OCA in circumcision wound closure results in a shorter operative time, in less postoperative pain, in easy postoperative wound care and in excellent cosmesis when compared to interrupted absorbable sutures. 2-OCA is our current technique of choice in circumcision wound closure. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Poverty and mortality among the elderly: measurement of performance in 33 countries 1960-92.

PubMed

Wang, J; Jamison, D T; Bos, E; Vu, M T

1997-10-01

This paper analyses the effect of income and education on life expectancy and mortality rates among the elderly in 33 countries for the period 1960-92 and assesses how that relationship has changed over time as a result of technical progress. Our outcome variables are life expectancy at age 60 and the probability of dying between age 60 and age 80 for both males and females. The data are from vital-registration based life tables published by national statistical offices for several years during this period. We estimate regressions with determinants that include GDP per capita (adjusted for purchasing power), education and time (as a proxy for technical progress). As the available measure of education failed to account for variation in life expectancy or mortality at age 60, our reported analyses focus on a simplified model with only income and time as predictors. The results indicate that, controlling for income, mortality rates among the elderly have declined considerably over the past three decades. We also find that poverty (as measured by low average income levels) explains some of the variation in both life expectancy at age 60 and mortality rates among the elderly across the countries in the sample. The explained amount of variation is more substantial for females than for males. While poverty does adversely affect mortality rates among the elderly (and the strength of this effect is estimated to be increasing over time), technical progress appears far more important in the period following 1960. Predicted female life expectancy (at age 60) in 1960 at the mean income level in 1960 was, for example 18.8 years; income growth to 1992 increased this by an estimated 0.7 years, whereas technical progress increased it by 2.0 years. We then use the estimated regression results to compare country performance on life expectancy of the elderly, controlling for levels of poverty (or income), and to assess how performance has varied over time. High performing countries, on female life expectancy at age 60, for the period around 1990, included Chile (1.0 years longer life expectancy), China (1.7 years longer), France (2.0 years longer), Japan (1.9 years longer), and Switzerland (1.3 years longer). Poorly performing countries included Denmark (1.1 years shorter life expectancy than predicted from income), Hungary (1.4 years shorter), Iceland (1.2 years shorter), Malaysia (1.6 years shorter), and Trinidad and Tobago (3.9 years shorter). Chile and Switzerland registered major improvements in relative performance over this period; Norway, Taiwan and the USA, in contrast showed major declines in performance between 1980 and the early 1990s.

The impact of transgenic wheat expressing GNA (snowdrop lectin) on the aphids Sitobion avenae, Schizaphis graminum, and Rhopalosiphum padi.

PubMed

Miao, Jin; Wu, Yuqing; Xu, Weigang; Hu, Lin; Yu, Zhenxing; Xu, Qiongfang

2011-06-01

This study investigated the impact of transgenic wheat expressing Galanthus nivalis agglutinin (GNA), commonly known as snowdrop lectin, on three wheat aphids: Sitobion avenae (F.), Schizaphis graminum (Rondani), and Rhopalosiphum padi (L.). We compared the feeding behavior and the life-table parameters of aphids reared on GNA transgenic wheat (test group) and those aphids reared on untransformed wheat (control group). The results showed that the feeding behaviors of S. avenae and S. graminum on GNA transgenic wheat were affected. Compared with the control group, they had shorter initial probing period, longer total nonprobing period, shorter initial and total phloem sap ingestion phase (waveform E2), shorter duration of sustained ingestion (E (pd) > 10 min), and lower percentage of phloem phase of the total observation time. Moreover, S. graminum made more probes and had a longer total duration of extracellular stylet pathway (waveform C). The fecundity and intrinsic rate of natural increase (r(m)) of S. avenae and S. graminum on the transgenic wheat were lowered in the first and second generations, however, the survival and lifespan were not affected. The effects of the GNA expressing wheat on S. graminum and S. avenae were not significant in the third generation, suggesting rapid adaptation by the two aphid species. Despite the impact we found on S. avenae and S. graminum, transgenic GNA expressing wheat did not have any effects on R. padi.

Microdosimetric study for nanosecond pulsed electric fields on a cell circuit model with nucleus.

PubMed

Denzi, Agnese; Merla, Caterina; Camilleri, Paola; Paffi, Alessandra; d'Inzeo, Guglielmo; Apollonio, Francesca; Liberti, Micaela

2013-10-01

Recently, scientific interest in electric pulses, always more intense and shorter and able to induce biological effects on both plasma and nuclear membranes, has greatly increased. Hence, microdosimetric models that include internal organelles like the nucleus have assumed increasing importance. In this work, a circuit model of the cell including the nucleus is proposed, which accounts for the dielectric dispersion of all cell compartments. The setup of the dielectric model of the nucleus is of fundamental importance in determining the transmembrane potential (TMP) induced on the nuclear membrane; here, this is demonstrated by comparing results for three different sets of nuclear dielectric properties present in the literature. The results have been compared, even including or disregarding the dielectric dispersion of the nucleus. The main differences have been found when using pulses shorter than 10 ns. This is due to the fact that the high spectral components of the shortest pulses are differently taken into account by the nuclear membrane transfer functions computed with and without nuclear dielectric dispersion. The shortest pulses are also the most effective in porating the intracellular structures, as confirmed by the time courses of the TMP calculated across the plasma and nuclear membranes. We show how dispersive nucleus models are unavoidable when dealing with pulses shorter than 10 ns because of the large spectral contents arriving above 100 MHz, i.e., over the typical relaxation frequencies of the dipolar mechanism of the molecules constituting the nuclear membrane and the subcellular cell compartments.

Altitude exposures during commercial flight: a reappraisal.

PubMed

Hampson, Neil B; Kregenow, David A; Mahoney, Anne M; Kirtland, Steven H; Horan, Kathleen L; Holm, James R; Gerbino, Anthony J

2013-01-01

Hypobaric hypoxia during commercial air travel has the potential to cause or worsen hypoxemia in individuals with pre-existing cardiopulmonary compromise. Knowledge of cabin altitude pressures aboard contemporary flights is essential to counseling patients accurately about flying safety. The objective of the study was to measure peak cabin altitudes during U.S. domestic commercial flights on a variety of aircraft. A handheld mountaineering altimeter was carried by the investigators in the plane cabin during commercial air travel and peak cabin altitude measured. The values were then compared between aircraft models, aircraft classes, and distances flown. The average peak cabin altitude on 207 flights aboard 17 different aircraft was 6341 +/- 1813 ft (1933 m +/- 553 m), significantly higher than when measured in a similar fashion in 1988. Peak cabin altitude was significantly higher for flights longer than 750 mi (7085 +/- 801 ft) compared to shorter flights (5160 +/- 2290 ft/1573 +/- 698 m). Cabin altitude increased linearly with flight distance for flights up to 750 mi in length, but was independent of flight distance for flights exceeding 750 mi. Peak cabin altitude was less than 5000 ft (1524 m) in 70% of flights shorter than 500 mi. Peak cabin altitudes greater than 8000 ft (2438 m) were measured on approximately 10% of the total flights. Peak cabin altitude on commercial aircraft flights has risen over time. Cabin altitude is lower with flights of shorter distance. Physicians should take these factors into account when determining an individual's need for supplemental oxygen during commercial air travel.

Is Alcohol Use Disorder Identification Test (AUDIT) or Its Shorter Versions More Useful to Identify Risky Drinkers in a Chinese Population? A Diagnostic Study

PubMed Central

Yip, Benjamin H. K.; Chung, Roger Y.; Chung, Vincent C. H.; Kim, Jean; Chan, Iris W. T.; Wong, Martin C. S.; Wong, Samuel Y. S.; Griffiths, Sian M.

2015-01-01

Objective To examine the diagnostic performance of shorter versions of Alcohol Use Disorder Identification Test (AUDIT), including Alcohol Consumption (AUDIT-C), in identifying risky drinkers in primary care settings using conventional performance measures, supplemented by decision curve analysis and reclassification table. Study design and Setting A cross-sectional study of adult males in general outpatient clinics in Hong Kong. The study included only patients who reported at least sometimes drinking alcoholic beverages. Timeline follow back alcohol consumption assessment method was used as the reference standard. A Chinese translated and validated 10-item AUDIT (Ch-AUDIT) was used as a screening tool of risky drinking. Results Of the participants, 21.7% were classified as risky drinkers. AUDIT-C has the best overall performance among the shorter versions of Ch-AUDIT. The AUC of AUDIT-C was comparable to Ch-AUDIT (0.898 vs 0.901, p-value = 0.959). Decision curve analysis revealed that when the threshold probability ranged from 15–30%, the AUDIT-C had a higher net-benefit than all other screens. AUDIT-C improved the reclassification of risky drinking when compared to Ch-AUDIT (net reclassification improvement = 0.167). The optimal cut-off of AUDIT-C was at ≥5. Conclusion Given the rising levels of alcohol consumption in the Chinese regions, this Chinese translated 3-item instrument provides convenient and time-efficient risky drinking screening and may become an increasingly useful tool. PMID:25756353

The role of a microfinance program on HIV risk behavior among Haitian women.

PubMed

Rosenberg, Molly S; Seavey, Brian K; Jules, Reginal; Kershaw, Trace S

2011-07-01

Microfinance loans targeted at vulnerable female populations have the potential to foster female economic independence, possibly leading to the negotiation of safer sexual practices and reduced HIV risk. This study assessed the relationship between experience with microfinance loans and HIV risk behavior among 192 female clients of the Haitian microfinance organization Fonkoze. Clients with longer microfinance experience were generally found to have lower indicators of HIV risk behavior and higher indicators of relationship power compared to those with shorter experience. In particular, those with longer memberships were 72% less likely to report partner infidelity, were 3.95 times more likely to use condoms with an unfaithful partner, and had higher average general power index scores compared to those with shorter experience. This study provides evidence that long-term exposure to microfinance is associated with reduced HIV risk behavior in Haitian women and that this reduction may be partly regulated by influencing relationship power. These results suggest the need to further explore the use of microfinance as a tool to prevent the spread of HIV.

Facial Nerve Repair: Fibrin Adhesive Coaptation versus Epineurial Suture Repair in a Rodent Model

PubMed Central

Knox, Christopher J.; Hohman, Marc H.; Kleiss, Ingrid J.; Weinberg, Julie S.; Heaton, James T.; Hadlock, Tessa A.

2013-01-01

Objectives/Hypothesis Repair of the transected facial nerve has traditionally been accomplished with microsurgical neurorrhaphy; however, fibrin adhesive coaptation (FAC) of peripheral nerves has become increasingly popular over the past decade. We compared functional recovery following suture neurorrhaphy to FAC in a rodent facial nerve model. Study Design Prospective, randomized animal study. Methods Sixteen rats underwent transection and repair of the facial nerve proximal to the pes anserinus. Eight animals underwent epineurial suture (ES) neurorrhaphy, and eight underwent repair with fibrin adhesive (FA). Surgical times were documented for all procedures. Whisking function was analyzed on a weekly basis for both groups across 15 weeks of recovery. Results Rats experienced whisking recovery consistent in time course and degree with prior studies of rodent facial nerve transection and repair. There were no significant differences in whisking amplitude, velocity, or acceleration between suture and FA groups. However, the neurorrhaphy time with FA was 70% shorter than for ES (P < 0.05). Conclusion Although we found no difference in whisking recovery between suture and FA repair of the main trunk of the rat facial nerve, the significantly shorter operative time for FA repair makes this technique an attractive option. The relative advantages of both techniques are discussed. PMID:23188676

Facial nerve repair: fibrin adhesive coaptation versus epineurial suture repair in a rodent model.

PubMed

Knox, Christopher J; Hohman, Marc H; Kleiss, Ingrid J; Weinberg, Julie S; Heaton, James T; Hadlock, Tessa A

2013-07-01

Repair of the transected facial nerve has traditionally been accomplished with microsurgical neurorrhaphy; however, fibrin adhesive coaptation (FAC) of peripheral nerves has become increasingly popular over the past decade. We compared functional recovery following suture neurorrhaphy to FAC in a rodent facial nerve model. Prospective, randomized animal study. Sixteen rats underwent transection and repair of the facial nerve proximal to the pes anserinus. Eight animals underwent epineurial suture (ES) neurorrhaphy, and eight underwent repair with fibrin adhesive (FA). Surgical times were documented for all procedures. Whisking function was analyzed on a weekly basis for both groups across 15 weeks of recovery. Rats experienced whisking recovery consistent in time course and degree with prior studies of rodent facial nerve transection and repair. There were no significant differences in whisking amplitude, velocity, or acceleration between suture and FA groups. However, the neurorrhaphy time with FA was 70% shorter than for ES (P < 0.05). Although we found no difference in whisking recovery between suture and FA repair of the main trunk of the rat facial nerve, the significantly shorter operative time for FA repair makes this technique an attractive option. The relative advantages of both techniques are discussed. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Successful tocolysis: does cervical change affect time to delivery?

PubMed

Lewis, D F; Gallaspy, J W; Fontenot, M T; Burlison, R D; Imseis, J M; Edwards, M S

1997-11-01

Generally, it is preferable to tocolyze patients with idiopathic preterm labor (PTL). Little information is available about ultimate outcomes after successful tocolysis. Our objective is to evaluate the relationship between cervical change after the initiation of tocolysis and the delay in time to delivery in patients with preterm labor. A historical analysis of all patients with successful tocolysis after PTL between January 1992 and December 1993 was undertaken. The patients were then placed in one of three categories (regression, unchanged, or progression) based on cervical change after the initiation of tocolysis. Various demographic pregnancy characteristics and pregnancy outcome data were analyzed. One hundred and twenty-six patients had successful tocolysis and met the admission criteria. Patients who had cervical progression had shorter delay to delivery, delivered at an earlier gestational age (31.7 weeks compared to 34.0 and 34.1 weeks, respectively, p < 0.05), and were more likely to deliver before 35 weeks (88% compared to 50.0 and 55.0%, respectively, p < 0.05). Also, neonates remained in the hospital longer and were more likely to have respiratory distress syndrome when compared to the other two groups. Patients who had cervical progression after the initiation of tocolysis are more likely to deliver prematurely, had a shorter delay to delivery, and delivered lower birth weight infants than did patients whose cervix regressed or remained unchanged. In our population, patients who had successful tocolysis had a preterm delivery rate of 59.5% before the 35th week of gestation.

What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?

PubMed

Gehrig, Paola A; Cantrell, Leigh A; Shafer, Aaron; Abaid, Lisa N; Mendivil, Alberto; Boggess, John F

2008-10-01

Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for staging the obese and morbidly obese woman with endometrial cancer. Consecutive robotic endometrial cancer staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (p<0.0001), increased lymph node retrieval (p=0.004) and shorter hospital stay (p=0.0119). Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of the obese and morbidly obese woman with endometrial cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.

Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma.

PubMed

Ren, Tong; Liu, Yan; Zhao, Xiaowen; Ni, Shaobin; Zhang, Cheng; Guo, Changgang; Ren, Minghua

2014-01-01

To compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma and provide evidence-based medicine support for clinical treatment. A systematic computer search of PUBMED, EMBASE, and the Cochrane Library was executed to identify retrospective observational and prospective randomized controlled trials studies that compared the outcomes of the two approaches in laparoscopic partial nephrectomy. Two reviewers independently screened, extracted, and evaluated the included studies and executed statistical analysis by using software STATA 12.0. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables. There were 8 studies assessed transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN) were included. RLPN had a shorter operating time (SMD = 1.001,95%confidence interval[CI] 0.609-1.393,P<0.001), a lower estimated blood loss (SMD = 0.403,95%CI 0.015-0.791,P = 0.042) and a shorter length of hospital stay (WMD = 0.936 DAYS,95%CI 0.609-1.263,P<0.001) than TLPN. There were no significant differences between the transperitoneal and retroperitoneal approaches in other outcomes of interest. This meta-analysis indicates that, in appropriately selected patients, especially patients with intraperitoneal procedures history or posteriorly located renal tumors, the RLPN can shorten the operation time, reduce the estimated blood loss and shorten the length of hospital stay. RLPN may be equally safe and be faster compared with the TLPN.

Discover cervical disc arthroplasty versus anterior cervical discectomy and fusion in symptomatic cervical disc diseases: A meta-analysis.

PubMed

Shangguan, Lei; Ning, Guang-Zhi; Tang, Yu; Wang, Zhe; Luo, Zhuo-Jing; Zhou, Yue

2017-01-01

Symptomatic cervical disc disease (SCDD) is a common degenerative disease, and Discover artificial cervical disc, a new-generation nonconstrained artificial disk, has been developed and performed gradually to treat it. We performed this meta-analysis to compare the efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) for SCDD. An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials that compared DCDA with ACDF for patients suffering SCDD. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval. Of 33 articles identified, six studies were included. Compared with ACDF, DCDA demonstrated shorter operation time (P < 0.0001), and better range of motion (ROM) at the operative level (P < 0.00001). But no significant differences were observed in blood loss, neck disability index (NDI) scores, neck and arm pain scores, Japanese orthopaedic association (JOA) scores, secondary surgery procedures and adverse events (P > 0.05). Subgroup analyses did not demonstrated significant differences. In conclusion, DCDA presented shorter operation time, and better ROM at the operative level. However, no significant differences were observed in blood loss, NDI scores, neck and arm pain scores, JOA scores, secondary surgery procedures and adverse events between the two groups. Additionally, more studies of high quality with mid- to long-term follow-up are required in future.

A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery.

PubMed

Addae, Jamin K; Gani, Faiz; Fang, Sandy Y; Wick, Elizabeth C; Althumairi, Azah A; Efron, Jonathan E; Canner, Joseph K; Euhus, David M; Schneider, Eric B

2017-02-01

Data-assessing trends and perioperative outcomes relative to surgical approach for colorectal cancer (CRC) surgery are lacking. We report national trends of CRC surgery and compare postoperative outcomes by surgical approach. A total of 261,886 patients undergoing surgery for CRC were identified using the Nationwide Inpatient Sample from 2009 to 2012. Trends in surgical approach were assessed using the Cochrane-Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length of stay (LOS), postoperative complications, and cost by surgical approach. At the time of surgery, 57.5% underwent an open procedure, whereas 42.4% underwent either a laparoscopic (39.9%) or robotic (2.5%) colorectal surgery. The use of minimally invasive surgery increased over time (2009 versus 2012: 37.3% versus 46.8%; P < 0.001). Postoperative morbidity was 15.9% and was higher after open surgery (open versus laparoscopic versus robotic: 18.4% versus 12.4% versus 13.3%; P < 0.001). Patients who underwent a minimally invasive surgery had shorter LOS (laparoscopic: OR, 0.55, 95% CI, 0.52-0.58; robotic: OR, 0.58; 95% CI, 0.49-0.69; both P < 0.001). Robotic surgery was consistently associated with the highest mean costs followed by laparoscopic and open surgery (P < 0.001). Patients undergoing minimally invasive colorectal surgery had a lower postoperative morbidity and shorter LOS compared with patients undergoing open colorectal surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

[Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction].

PubMed

Liu, Tianzhou; Ma, Zhiming; Sun, Pengda; Li, Jinlong; Fang, Xuedong; Tong, Ti; Zhu, Jiaming

2016-01-01

To investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy. Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared. Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups. As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.

OK432 versus doxycycline for treatment of macrocystic lymphatic malformations.

PubMed

Motz, Kevin M; Nickley, Katherine B; Bedwell, Joshua R; Yadav, Bhupender; Guzzetta, Philip C; Oh, Albert K; Bauman, Nancy M

2014-02-01

A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients. OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.

Quick foot placement adjustments during gait are less accurate in individuals with focal cerebellar lesions.

PubMed

Hoogkamer, Wouter; Potocanac, Zrinka; Van Calenbergh, Frank; Duysens, Jacques

2017-10-01

Online gait corrections are frequently used to restore gait stability and prevent falling. They require shorter response times than voluntary movements which suggests that subcortical pathways contribute to the execution of online gait corrections. To evaluate the potential role of the cerebellum in these pathways we tested the hypotheses that online gait corrections would be less accurate in individuals with focal cerebellar damage than in neurologically intact controls and that this difference would be more pronounced for shorter available response times and for short step gait corrections. We projected virtual stepping stones on an instrumented treadmill while some of the approaching stepping stones were shifted forward or backward, requiring participants to adjust their foot placement. Varying the timing of those shifts allowed us to address the effect of available response time on foot placement error. In agreement with our hypothesis, individuals with focal cerebellar lesions were less accurate in adjusting their foot placement in reaction to suddenly shifted stepping stones than neurologically intact controls. However, the cerebellar lesion group's foot placement error did not increase more with decreasing available response distance or for short step versus long step adjustments compared to the control group. Furthermore, foot placement error for the non-shifting stepping stones was also larger in the cerebellar lesion group as compared to the control group. Consequently, the reduced ability to accurately adjust foot placement during walking in individuals with focal cerebellar lesions appears to be a general movement control deficit, which could contribute to increased fall risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Endoscopic Endonasal Pituitary Surgery: Impact of Surgical Education on Operation Length and Patient Morbidity

PubMed Central

Dedhia, Raj C.; Lord, Christopher A.; Pinheiro-Neto, Carlos D.; Fernandez-Miranda, Juan C.; Wang, Eric W.; Gardner, Paul A.; Snyderman, Carl H.

2012-01-01

Objectives To determine the difference in operative times and associated complications for cases performed solely by attending-level surgeons versus cases assisted by surgeons-in-training for endoscopic endonasal pituitary surgeries. Design Retrospective chart review. Setting Tertiary-care academic medical center. Participants A total of 228 patients having undergone endoscopic endonasal pituitary surgery from 2005 to 2011. Main Outcome Measure Duration of surgery comparing attending only (AO) and trainee-assisted (TA) surgeries. Results Thirty-seven (19%) of 198 cases were identified as AO surgeries, the remaining 161 (81%) were TA. Operative times (minutes) for the AO group were significantly shorter than the TA group (149.1 ± 54.8 vs 219.5 ± 83.7, p < 0.001). The AO group had fewer intraoperative cerebrospinal fluid leaks (30% vs 39%, p = 0.318), decreased estimated blood loss (408 mL vs 523 mL, p = 0.176), fewer postoperative complications (27% vs 37%, p = 0.268), and shorter length of stay (3.5 vs 4.3 days, p = 0.294). Conclusions This is the first study in otolaryngology or neurosurgery to compare operative times and outcomes for AO versus TA cases at a single academic institution. Operative times were significantly decreased and a trend toward a decrease in patient morbidity was noted for cases performed solely by attendings. The valuation of teaching activities in the operating room is a necessary first step toward optimizing the allocation of resources and funding of surgical education. PMID:24294558

A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis.

PubMed

Dehong, Cao; Liangren, Liu; Huawei, Liu; Qiang, Wei

2013-11-01

The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.

Comparison of Tension-Band Wiring With the Cable Pin System in Patella Fractures: A Randomized Prospective Study.

PubMed

Tian, Qing-xian; Hai, Yong; Du, Xin-ru; Xu, Zi-yu; Lu, Tie; Shan, Lei; Liu, Yang; Zhou, Jun-lin

2015-12-01

To compare the outcome of tension-band wiring (TBW) with the cable pin system (CPS) for transverse fractures of the patella. Randomized prospective study. Academic Level I trauma center. From February 2008 to December 2011, 73 consecutive patients with transverse fractures of the patella were prospectively enrolled in this study. The patients were randomly divided into 2 groups: one group was treated using the CPS, and the other group was treated using the modified TBW. The clinical outcome assessment included analyses of the radiographic images, the modified Hospital for Special Surgery scoring system, and complications. The follow-up time ranged from 12 to 29 months. All fractures healed, with a union rate of 100%. The fracture healing time was significantly shorter in the CPS group (8.51 ± 2.59 weeks, n = 34) compared with the TBW group (11.79 ± 3.04 weeks, n = 39). Postoperative complications in the CPS and TBW groups were observed in 1 and 9 patients, respectively, a difference that was statistically significant. The mean Hospital for Special Surgery score for the CPS group (90.53 ± 5.19 points) was significantly higher than that for the TBW group (81.36 ± 12.71 points). The CPS is a viable option for transverse fractures of the patella and is associated with a shorter healing time, fewer complications, and better function than TBW. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

[Impact of onsite or dispatched automated external defibrillator use on early survival after sudden cardiac arrest occurring in international airports].

PubMed

Garcia, Elena Linda; Caffrey-Villari, Sherry; Ramirez, Diomeda; Caron, Jean-Luc; Mannhart, Patrice; Reuter, Paul-Georges; Lapostolle, Frederic; Adnet, Frederic

2017-03-01

Out-of-hospital cardiac arrest (OHCA) is a major public health challenge. Use of automated external defibrillators (AED) by laypersons improves survival of patient's victim of OHCA. The aim of our study was to compare onsite AED vs. dispatched AED management of cardiac arrest occurring in international airports. We conducted a retrospective, observational, comparative, study on data collected from three international airports: Paris-Charles-de-Gaulle (CDG), Chicago and Madrid-Barajas. We included patients with OHCA occurring inside the airport between 2009 and 2013. Group public access (PUB) included airports where AED were available to laypersons and group dispatched (SEC) was represented by Paris-CDG airport where AED was provided by paramedic teams. The primary endpoint was successful resuscitation defined as survival at time of hospital admission. We included 150 consecutive patients victim of OHCA in the three airports. The time between collapse and AED setting was significantly shorter in the PUB vs. SEC group (4±3minutes vs. 11±11, P=0.0006). The total duration of resuscitation was shorter in the PUB group (10±10minutes vs. 36±25minutes, P<0.0001). Survival at time of hospital admission was higher in the PUB group (62% vs. 38%, P=0.01). The availability of public access AEDs in international airports seems to allow a quicker defibrillation and an increased success rate of resuscitation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

A Comparison of Robotic Versus Laparoscopic Adrenalectomy in Patients With Primary Hyperaldosteronism.

PubMed

Colvin, Jennifer; Krishnamurthy, Vikram; Jin, Judy; Shin, Joyce; Siperstein, Allan; Berber, Eren

2017-10-01

Over the last decade, robotic approaches have been described for removing adrenal tumors. Although there are reports comparing robotic and laparoscopic techniques in general, there are limited data on outcomes in patients with primary hyperaldosteronism (PHA). The aim of this study is to compare the safety and efficacy of robotic adrenalectomy (RA) versus laparoscopic adrenalectomy (LA) for PHA. The records of 20 patients who underwent RA for PHA were compared with 16 patients who underwent LA between 2000 and 2014. Data were retrospectively reviewed from a prospectively maintained, IRB-approved adrenal database. Statistical analysis was performed using t test and the Fisher exact analysis. Continuous variables are reported as mean±SEM. Demographic and clinical parameters were similar between the groups. There were no conversions to open in either group. Estimated blood loss, length of stay, and complication rates were comparable. Operative time was shorter in the robotic versus laparoscopic group (130±8.94 vs. 159±11.1 min, P=0.0487). In follow-up, the improvement in patients' blood pressure after adrenalectomy, as assessed by the reduction in the number of antihypertensive medications, was similar between the 2 groups. However, 1 patient in the RA and 1 patient in the LA group were not cured, as determined by postoperative aldosterone:renin levels. The biochemical cure rate between the groups was similar (P=0.529). To our knowledge, this is the first study comparing robotic versus laparoscopic resection of PHA. Our results show that the robotic approach was similar to laparoscopic regarding safety and efficacy. Operative time was shorter with the robotic approach, which could be related to more efficient dissection with wristed instrumentation.

A single ultrasound determination of ≥25 follicles ≥3 mm in diameter in dairy heifers is predictive of a reduced productive herd life.

PubMed

Jimenez-Krassel, F; Scheetz, D M; Neuder, L M; Pursley, J R; Ireland, J J

2017-06-01

Fertility and productive herd life (time in herd after birth of first calf) are inferior in dairy cows with relatively low compared with intermediate but not high numbers of follicles growing during ovarian follicular waves. The present study, therefore, tested the hypothesis that fertility and productive herd life are lower in dairy heifers with high follicle numbers compared with age-matched herdmates with fewer follicles. To test this hypothesis, 11 to 15 mo old Holstein heifers were subjected to a single ultrasound measurement of the number of follicles ≥3 mm in diameter. Heifers were classified into a high- (≥25 follicles), mid- (16-24), or low-range (≤15) follicle number group (FNG). All heifers not removed from the herd before first calving (n = 408) had the opportunity to start their fifth or sixth lactation after birth of their first calf. During this time, performance and health parameters for each individual were recorded daily by herd managers. Results showed that heifers in the high-range FNG had a 180-d shorter productive herd life, reduced survival rate, and greater probability of being culled after birth of the first calf, as well as fewer lactations compared with heifers in the low-range FNG. Cows in the high-compared with the mid- or low-range FNG also had greater involuntary culling rates, days open, and services per conception, and lower pregnancy rates during the first, second, or third lactations. We concluded that dairy heifers with ≥25 follicles ≥3 mm in diameter have suboptimal fertility and a shorter productive herd life compared with herdmates with fewer follicles. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Asymmetry in gait pattern following tibial shaft fractures - a prospective one-year follow-up study of 49 patients.

PubMed

Larsen, Peter; Laessoe, Uffe; Rasmussen, Sten; Graven-Nielsen, Thomas; Berre Eriksen, Christian; Elsoe, Rasmus

2017-01-01

Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. 49 patients were included with a mean age of 43.1 years (18-79 years). Forty-three patients completed the 12-month follow-up (88%). Gait speed and cadence were significantly increased between the 6- and 12-month follow-up (P<0.001). At 6-month follow-up, patients showed considerable asymmetry in the injured leg compared with the non-injured leg: single-support time 12.8% shorter, swing-time 12.8% longer, step-length 11.9% shorter, and rotation of the foot increased by 32.3%. At the 12-month follow-up, gait asymmetry become almost normalized compared to a healthy reference group. In patients treated by intramedullary nailing following a tibial shaft fracture, gait asymmetry accompanied with slower speed and cadence are common during the first 6 months and become normalized compared with a healthy reference population between 6 and 12 months post-operatively. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography.

PubMed

Dietrich, Tobias J; Pfirrmann, Christian W A; Schwab, Alexander; Pankalla, Katja; Buck, Florian M

2013-07-01

To compare the radiation dose, workflow, patient comfort, and financial break-even of a standard digital radiography and a biplanar low-dose X-ray system. A standard digital radiography system (Ysio, Siemens Healthcare, Erlangen, Germany) was compared with a biplanar X-ray unit (EOS, EOS imaging, Paris, France) consisting of two X-ray tubes and slot-scanning detectors, arranged at an angle of 90° allowing simultaneous vertical biplanar linear scanning in the upright patient position. We compared data of standing full-length lower limb radiographs and whole spine radiographs of both X-ray systems. Dose-area product was significantly lower for radiographs of the biplanar X-ray system than for the standard digital radiography system (e.g. whole spine radiographs; standard digital radiography system: 392.2 ± 231.7 cGy*cm(2) versus biplanar X-ray system: 158.4 ± 103.8 cGy*cm(2)). The mean examination time was significantly shorter for biplanar radiographs compared with standard digital radiographs (e.g. whole spine radiographs: 449 s vs 248 s). Patients' comfort regarding noise was significantly higher for the standard digital radiography system. The financial break-even point was 2,602 radiographs/year for the standard digital radiography system compared with 4,077 radiographs/year for the biplanar X-ray unit. The biplanar X-ray unit reduces radiation exposure and increases subjective noise exposure to patients. The biplanar X-ray unit demands a higher number of examinations per year for the financial break-even point, despite the lower labour cost per examination due to the shorter examination time.

Transplantation of Ex Vivo Expanded Umbilical Cord Blood (NiCord) Decreases Early Infection and Hospitalization.

PubMed

Anand, Sarah; Thomas, Samantha; Hyslop, Terry; Adcock, Janet; Corbet, Kelly; Gasparetto, Cristina; Lopez, Richard; Long, Gwynn D; Morris, Ashley K; Rizzieri, David A; Sullivan, Keith M; Sung, Anthony D; Sarantopoulos, Stefanie; Chao, Nelson J; Horwitz, Mitchell E

2017-07-01

Delayed hematopoietic recovery contributes to increased infection risk following umbilical cord blood (UCB) transplantation. In a Phase 1 study, adult recipients of UCB stem cells cultured ex vivo for 3 weeks with nicotinamide (NiCord) had earlier median neutrophil recovery compared with historical controls. To evaluate the impact of faster neutrophil recovery on clinically relevant early outcomes, we reviewed infection episodes and hospitalization during the first 100 days in an enlarged cohort of 18 NiCord recipients compared with 86 standard UCB recipients at our institution. The median time to neutrophil engraftment was shorter in NiCord recipients compared with standard UCB recipients (12.5 days versus 26 days; P < .001). Compared with standard UCB recipients, NiCord recipients had a significantly reduced risk for total infection (RR, 0.69; P = .01), grade 2-3 (moderate to severe) infection (RR, 0.36; P < .001), bacterial infection (RR, 0.39; P = .003), and grade 2-3 bacterial infection (RR, 0.21; P = .003) by Poisson regression analysis; this effect persisted after adjustment for age, disease stage, and grade II-IV acute GVHD. NiCord recipients also had significantly more time out of the hospital in the first 100 days post-transplantation after adjustment for age and Karnofsky Performance Status (69.9 days versus 49.7 days; P = .005). Overall, transplantation of NiCord was associated with faster neutrophil engraftment, fewer total and bacterial infections, and shorter hospitalization in the first 100 days compared with standard UCB transplantation. In conclusion, rapid hematopoietic recovery from an ex vivo expanded UCB transplantation approach is associated with early clinical benefit. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Speech timing and working memory in profoundly deaf children after cochlear implantation

PubMed Central

Burkholder, Rose A.; Pisoni, David B.

2012-01-01

Thirty-seven profoundly deaf children between 8- and 9-years-old with cochlear implants and a comparison group of normal-hearing children were studied to measure speaking rates, digit spans, and speech timing during digit span recall. The deaf children displayed longer sentence durations and pauses during recall and shorter digit spans compared to the normal-hearing children. Articulation rates, measured from sentence durations, were strongly correlated with immediate memory span in both normal-hearing and deaf children, indicating that both slower subvocal rehearsal and scanning processes may be factors that contribute to the deaf children’s shorter digit spans. These findings demonstrate that subvocal verbal rehearsal speed and memory scanning processes are not only dependent on chronological age as suggested in earlier research by Cowan and colleagues (1998). Instead, in this clinical population the absence of early auditory experience and phonological processing activities before implantation appears to produce measurable effects on the working memory processes that rely on verbal rehearsal and serial scanning of phonological information in short-term memory. PMID:12742763

Arthroscopic ankle arthrodesis with intra-articular distraction.

PubMed

Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

2014-01-01

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Transitioning to a narrow path: the impact of fear of falling in older adults.

PubMed

Dunlap, Pamela; Perera, Subashan; VanSwearingen, Jessie M; Wert, David; Brach, Jennifer S

2012-01-01

Everyday ambulation requires navigation of variable terrain, transitions from wide to narrow pathways, and avoiding obstacles. While the effect of age on the transition to a narrow path has been examined briefly, little is known about the impact of fear of falling on gait during the transition to a narrow path. The purpose was to examine the effect of age and fear of falling on gait during transition to a narrow path. In 31 young, mean age=25.3 years, and 30 older adults, mean age=79.6 years, step length, step time, step width and gait speed were examined during usual and transition to narrow pathway using an instrumented walkway. During the transition to narrow walk condition, fearful older adults compared to young had a wider step width (0.06 m vs 0.04 m) prior to the narrow path and took shorter steps (0.53 m vs 0.72 m; p<0.001). Compared to non-fearful older adults, fearful older adults walked slower and took shorter steps during narrow path walking (gait speed: 1.1m/s vs 0.82 m/s; p=0.01; step length: 0.60 m vs 0.47 m; p=0.03). In young and non-fearful older adults narrow path gait was similar to usual gait. Whereas older adults who were fearful, walked slower (0.82 m/s vs 0.91 m/s; p=0.001) and took shorter steps (0.44 m vs 0.53 m; p=0.004) during narrow path walking compared to usual walking. Changes in gait characteristics with transitioning to a narrow pathway were greater for fear of falling than for age. Copyright © 2011 Elsevier B.V. All rights reserved.

Comparison of oxygen saturation values and measurement times by pulse oximetry in various parts of the body.

PubMed

Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Khorshid, Leyla

2011-11-01

The aim of this study, which included 40 patients, was to compare the values pulse oximetry and the measurement times in various regions of the body. Data were analyzed using intraclass correlation coefficient test and paired-sample test. The confidence power value was found to be .81 for the comparison of oxygen saturation values by arterial blood gas analysis and measurement by the forehead probe. It was found that the time for oxygen saturation measurement using the forehead probe was shorter than those using the finger and toe probes. Copyright © 2011 Elsevier Inc. All rights reserved.

Torus-margo pits help conifers compete with angiosperms.

PubMed

Pittermann, Jarmila; Sperry, John S; Hacke, Uwe G; Wheeler, James K; Sikkema, Elzard H

2005-12-23

The unicellular conifer tracheid should have greater flow resistance per length (resistivity) than the multicellular angiosperm vessel, because its high-resistance end-walls are closer together. However, tracheids and vessels had comparable resistivities for the same diameter, despite tracheids being over 10 times shorter. End-wall pits of tracheids averaged 59 times lower flow resistance on an area basis than vessel pits, owing to the unique torus-margo structure of the conifer pit membrane. The evolution of this membrane was as hydraulically important as that of vessels. Without their specialized pits, conifers would have 38 times the flow resistance, making conifer-dominated ecosystems improbable in an angiosperm world.

Impact of temporal resolution of inputs on hydrological model performance: An analysis based on 2400 flood events

NASA Astrophysics Data System (ADS)

Ficchì, Andrea; Perrin, Charles; Andréassian, Vazken

2016-07-01

Hydro-climatic data at short time steps are considered essential to model the rainfall-runoff relationship, especially for short-duration hydrological events, typically flash floods. Also, using fine time step information may be beneficial when using or analysing model outputs at larger aggregated time scales. However, the actual gain in prediction efficiency using short time-step data is not well understood or quantified. In this paper, we investigate the extent to which the performance of hydrological modelling is improved by short time-step data, using a large set of 240 French catchments, for which 2400 flood events were selected. Six-minute rain gauge data were available and the GR4 rainfall-runoff model was run with precipitation inputs at eight different time steps ranging from 6 min to 1 day. Then model outputs were aggregated at seven different reference time scales ranging from sub-hourly to daily for a comparative evaluation of simulations at different target time steps. Three classes of model performance behaviour were found for the 240 test catchments: (i) significant improvement of performance with shorter time steps; (ii) performance insensitivity to the modelling time step; (iii) performance degradation as the time step becomes shorter. The differences between these groups were analysed based on a number of catchment and event characteristics. A statistical test highlighted the most influential explanatory variables for model performance evolution at different time steps, including flow auto-correlation, flood and storm duration, flood hydrograph peakedness, rainfall-runoff lag time and precipitation temporal variability.

Interactive vs passive screen time and nighttime sleep duration among school-aged children.

PubMed

Yland, Jennifer; Guan, Stanford; Emanuele, Erin; Hale, Lauren

2015-09-01

Insufficient sleep among school-aged children is a growing concern, as numerous studies have shown that chronic short sleep duration increases the risk of poor academic performance and specific adverse health outcomes. We examined the association between weekday nighttime sleep duration and 3 types of screen exposure: television, computer use, and video gaming. We used age 9 data from an ethnically diverse national birth cohort study, the Fragile Families and Child Wellbeing Study, to assess the association between screen time and sleep duration among 9-year-olds, using screen time data reported by both the child (n = 3269) and by the child's primary caregiver (n= 2770). Within the child-reported models, children who watched more than 2 hours of television per day had shorter sleep duration by approximately 11 minutes per night compared to those who watched less than 2 hours of television (β = -0.18; P < .001). Using the caregiver-reported models, both television and computer use were associated with reduced sleep duration. For both child- and parent-reported screen time measures, we did not find statistically significant differences in effect size across various types of screen time. Screen time from televisions and computers is associated with reduced sleep duration among 9-year-olds, using 2 sources of estimates of screen time exposure (child and parent reports). No specific type or use of screen time resulted in significantly shorter sleep duration than another, suggesting that caution should be advised against excessive use of all screens.

Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer.

PubMed

Wang, Yong; Zhang, Chuan; Feng, Yi-Fei; Fu, Zan; Sun, Yue-Ming

2017-02-01

Colorectal cancer (CRC) is the third most common cancer worldwide. Although laparoscopic-assisted complete mesocolic excision (LCME) is a superior treatment, there are few studies available on it owe to the low incidence and technical difficulty of LCME in transverse colon cancer. The clinical data of 78 patients with transverse colon cancer who were treated by LCME and open complete mesocolic excision (OCME) were retrospectively analyzed. A total of 39 cases had been treated by LCME, compared with 39 cases treated by OCME. The patient characteristics and short-term outcomes including operation time, intra-operative blood loss, length of incision, time to first flatus, first postoperative ambulation, postoperative hospitalization time, number of harvested lymph nodes, length of resected specimen and incidence of complications were evaluated. There was no case converted to OCME in LCME group. LCME had significantly shorter length of incision, shorter operation time, less intra-operative blood loss, shorter postoperative hospitalization time (P<0.05). The length of resected specimen and the numbers of harvested lymph nodes were (26.5±5.4 cm) and (16.2±3.1) in LCME group, and (24.8±4.9 cm) and (15.1±3.5) in OCME group, with no differences between two groups. The incidence of wound infection was lower while the incidence of lymphatic leakage, anastomotic leakage, urinary tract infection and wound dehiscence had no significant differences between two groups. None of patients in these two groups developed urinary retention, anastomotic bleeding and postoperative intestinal obstruction. Our findings suggested that LCME is a safe, feasible and effective treatment method for the treatment of transverse colon cancer due to it can provide superior short-term outcomes including less intra-operative blood loss, faster recovery and lower incidence of wound infection.

Spatiotemporal properties of growing season indices during 1961-2010 and possible association with agroclimatological regionalization of dominant crops in Xinjiang, China

NASA Astrophysics Data System (ADS)

Ci, Hui; Zhang, Qiang; Singh, Vijay P.; Xiao, Mingzhong; Liu, Lin

2016-08-01

Variations of frost days and growing season length (GSL) have been drawing increasing attention due to their impact on agriculture. The Xinjiang region in China is climatically an arid region and plays an important role in agriculture development. In this study, the GSL and frost events are analyzed in both space and time, based on the daily minimum, mean and maximum air surface temperature data covering a period of 1961-2010. Results indicate that: (1) a significant lengthening of GSL is detected during 1961-2010 in Xinjiang, China. The increasing rate of GSL over Xinjiang is about 2.5 days per decade. Besides, the starting time of growing season is 0.7 days earlier per decade and the ending time is 1.6 days later per decade. Generally, GSL in southern Xinjiang has larger increasing magnitude when compared to other regions of Xinjiang; (2) longer GSL and larger changing magnitude of growing season start (GSS), growing season end (GSE) and GSL in southern Xinjiang implies higher sensitivity of the growing season response to climate warming. Besides, GSL is in close relation with latitude, and higher latitude usually corresponds to later start and earlier end of growing season, and hence shorter GSL. In general, a northward increase of 1° latitude triggers an 8-day delay of the starting time of growing season, 6-day advance of the ending time of growing season, and thus the GSL is 14 days shorter; (3) GSL under different rates can reflect light and heat resources over Xinjiang. The GSL related to 80 % guarantee rate is 5-14 days shorter than the long-term annual mean GSL; (4) Lengthening of GSL has the potential to increase agricultural production. However, negative influences by climate warming, such as enhanced evapotranspiration, increasing weeds, insects, and pathogen-mediated plant diseases, should also be considered in planning, management and development of agriculture in Xinjiang.

Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department.

PubMed

Liu, Jenny; Masiello, Italo; Ponzer, Sari; Farrokhnia, Nasim

2018-04-19

To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. Single-centre before-and-after study. Adult ED of a Swedish urban hospital. Patients arriving on weekdays 08:00 to 21:00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08:00 to 21:00 November 2014 to November 2015. Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. The crude median LOS was shortest for teamwork, 228 min (95% CI 226.4 to 230.5) compared with 232 min (95% CI 230.8 to 233.9) for nurse-led and 250 min (95% CI 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% CI 54.5 to 56.6) compared with 116 min (95% CI 114.4 to 117.5) for nurse-led triage and 74 min (95% CI 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values<0.01. Interprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation.

PubMed

Errahmouni, Abdelkarim; Latcu, Decebal Gabriel; Bun, Sok-Sithikun; Rijo, Nicolas; Dugourd, Céline; Saoudi, Nadir

2015-07-01

The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation. Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN-RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN-CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027). The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

PubMed Central

Errahmouni, Abdelkarim; Latcu, Decebal Gabriel; Bun, Sok-Sithikun; Rijo, Nicolas; Dugourd, Céline; Saoudi, Nadir

2015-01-01

Aims The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation. Methods and results Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN–RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN–CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027). Conclusion The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced. PMID:25662989

Utility of Intravascular US-Guided Portal Vein Access during Transjugular Intrahepatic Portosystemic Shunt Creation: Retrospective Comparison with Conventional Technique in 109 Patients.

PubMed

Pillai, Anil K; Andring, Brice; Faulconer, Nicholas; Reis, Stephen P; Xi, Yin; Iyamu, Ikponmwosa; Suthpin, Patrick D; Kalva, Sanjeeva P

2016-08-01

To compare safety and effectiveness of intravascular ultrasound (US)-guided portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) creation with conventional TIPS technique. In this retrospective study, TIPS creation using intravascular US guidance in 55 patients was compared with conventional TIPS creation in 54 patients by 10 operators over a 3-year period. Operators were classified as experienced if they had performed ≥ 20 TIPS procedures at the beginning of the study period. Time to portal vein access, total radiation dose, and needle pass-related capsular perforation were recorded. Baseline demographic characteristics of patients were similar (P > .05). Mean time to portal venous access was 46 minutes ± 37 for conventional TIPS and 31 minutes ± 19 for intravascular US-guided TIPS (P = .007). Intravascular US guidance allowed significantly shorter times (48 min ± 30 vs 28 min ± 16; P = .01) to portal vein access among operators (n = 5) with limited experience but failed to achieve any significant time savings (44 min ± 43 vs 34 min ± 22; P = .89) among experienced operators (n = 5). Needle pass-related capsular perforation occurred in 17/54 (34%) patients with conventional TIPS and 5/55 (9%) patients with intravascular US-guided TIPS (P = .004). Radiation dose was 2,376 mGy ± 1,816 for conventional TIPS and 1,592 mGy ± 1,263 for intravascular US-guided TIPS (P = .004). Intravascular US-guided portal vein access during TIPS creation is associated with shorter portal vein access times, decreased needle pass-related capsular perforations, and reduced radiation dose. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems.

PubMed

Kinoshita, Hidefumi; Nakagawa, Ken; Usui, Yukio; Iwamura, Masatsugu; Ito, Akihiro; Miyajima, Akira; Hoshi, Akio; Arai, Yoichi; Baba, Shiro; Matsuda, Tadashi

2015-08-01

Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits. We conducted a multicenter, open-label, randomized trial to compare the surgical outcome of 3D-high-definition (HD) resolution and 2D-HD imaging in laparoscopic radical prostatectomy (LRP), in order to determine whether an LRP under HD resolution 3D imaging is superior to that under HD resolution 2D imaging in perioperative outcome, feasibility, and fatigue. One-hundred twenty-two patients were randomly assigned to a 2D or 3D group. The primary outcome was time to perform vesicourethral anastomosis (VUA), which is technically demanding and may include a number of technical difficulties considered in laparoscopic surgeries. VUA time was not significantly shorter in the 3D group (26.7 min, mean) compared with the 2D group (30.1 min, mean) (p = 0.11, Student's t test). However, experienced surgeons and 3D-HD imaging were independent predictors for shorter VUA times (p = 0.000, p = 0.014, multivariate logistic regression analysis). Total pneumoperitoneum time was not different. No conversion case from 3D to 2D or LRP to open RP was observed. Fatigue was evaluated by a simulation sickness questionnaire and critical flicker frequency. Results were not different between the two groups. Subjective feasibility and satisfaction scores were significantly higher in the 3D group. Using a 3D imaging system in LRP may have only limited advantages in decreasing operation times over 2D imaging systems. However, the 3D system increased surgical feasibility and decreased surgeons' effort levels without inducing significant fatigue.

Administration of clomiphene citrate in patients with polycystic ovary syndrome, without inducing withdrawal bleeding, achieves comparable treatment characteristics and outcome.

PubMed

Farhi, Jacob; Orvieto, Raoul; Homburg, Roy

2010-04-01

In an attempt to evaluate the effect of random timing of the start of clomiphene citrate (CC) treatment in anovulatory patients with polycystic ovary syndrome on treatment characteristics and outcome, with no regard to time of menstruation, we studied 291 women in their first CC treatment cycle. Duration of treatment was shorter by 2 days and number of leading follicles was higher when treatment was started late (7-29 days from starting a bleed, as compared with day 5), but no effect of starting day was observed on response rate to CC, maximal E(2) level, endometrial thickness, and pregnancy rate. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Novel calcium infusion regimen after parathyroidectomy for renal hyperparathyroidism

PubMed Central

Tan, Jih Huei; Tan, Henry Chor Lip; Arulanantham, Sarojah A/P

2017-01-01

Abstract Aim Calcium infusion is used after parathyroid surgery for renal hyperparathyroidism to treat postoperative hypocalcaemia. We compared a new infusion regimen to one commonly used in Malaysia based on 2003 K/DOQI guidelines. Methods Retrospective data on serum calcium and infusion rates was collected from 2011–2015. The relationship between peak calcium efflux (PER) and time was determined using a scatterplot and linear regression. A comparison between regimens was made based on treatment efficacy (hypocalcaemia duration, total infusion amount and time) and calcium excursions (outside target range, peak and trough calcium) using bar charts and an unpaired t‐test. Results Fifty‐one and 34 patients on the original and new regimens respectively were included. Mean PER was lower (2.16 vs 2.56 mmol/h; P = 0.03) and occurred earlier (17.6 vs 23.2 h; P = 0.13) for the new regimen. Both scatterplot and regression showed a large correlation between PER and time (R‐square 0.64, SE 1.53, P < 0.001). The new regimen had shorter period of hypocalcaemia (28.9 vs 66.4 h, P = 0.04), and required less calcium infusion (67.7 vs 127.2 mmol, P = 0.02) for a shorter duration (57.3 vs 102.9 h, P = 0.001). Calcium excursions, peak and trough calcium were not significantly different between regimens. Early postoperative high excursions occurred when the infusion was started in spite of elevated peri‐operative calcium levels. Conclusion The new infusion regimen was superior to the original in that it required a shorter treatment period and resulted in less hypocalcaemia. We found that early aggressive calcium replacement is unnecessary and raises the risk of rebound hypercalcemia. PMID:26952689

White-Light Observations of Major Flares Compared to Total Solar Irradiance and Short-Wavelength Observations

NASA Astrophysics Data System (ADS)

Petrie, Gordon; Kopp, Greg; Harvey, J. W.

2014-06-01

The NSO’s GONG network produces “white light” (WL) continuum intensity images from one-minute integrations averaged across a 0. Å wide band pass centered at 676 Å at one minute cadence using six sites worldwide. Clear WL signatures of solar flares are present in GONG intensity data for only the largest flares because of low spatial resolution (2.5 arcsec pixel size). For six major flares (GOES class X6.5 - X28) observed by GONG, we compare integrated GONG full-disk WL intensity curves with SORCE/TIM total solar irradiance (TSI) measurements. Distinctive p-mode signatures are evident in both GONG and SORCE time series, though the correlation between GONG and SORCE data varies from flare to flare. In some cases a clear TSI peak and an interruption of the GONG p-mode pattern accompany the flare. The flare signature is generally weaker in the GONG data, suggesting that most of the TIM flare signal arises from wavelengths shorter than the GONG band pass. The flare kernels nevertheless are clear and last many minutes in the spatially resolved GONG image time series. We also compare the GONG active region intensity observations with shorter-wavelength data. In one case observed by TRACE, the GONG and TRACE WL curves are very similar and the TRACE 160 Å curve shows a significant precursor and a long tail. In most cases the GONG WL and RHESSI 25-100 keV counts appear well correlated in time. This work utilizes GONG data obtained by the NSO Integrated Synoptic Program (NISP), managed by the National Solar Observatory, which is operated by AURA, Inc. under a cooperative agreement with the National Science Foundation.

Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis.

PubMed

Richardson, John; Di Fabio, Francesco; Clarke, Hannah; Bajalan, Mohammed; Davids, Joe; Abu Hilal, Mohammed

2015-01-01

The adoption of laparoscopy for distal pancreatectomy has proven to substantially improve short-term outcomes. Stress response after major surgery can be further minimized within an enhanced recovery programme (ERP). However, data on the potential benefit of an ERP for laparoscopic distal pancreatectomy are still lacking. The aim was to assess the feasibility, safety and cost of ERP for patients undergoing laparoscopic distal pancreatectomy. This is a case-control study from a Tertiary University Hospital. Sixty-six consecutive patients who underwent laparoscopic distal pancreatectomy were analyzed. Twenty-two patients were enrolled for the ERP and compared with previous consecutive 44 patients managed traditionally (1:2 ratio). Operative details, post-operative outcome and cost analysis were compared in the two groups. Patients enrolled in the ERP had similar intraoperative blood loss (median 165 ml vs. 200 ml; p = 0.176), operation time (225 min vs. 210 min; p = 0.633), time to remove naso-gastric tube (1 vs. 1 day; p = 0.081) but significantly shorter time to mobilization (median 1 vs. 2 days; p = 0.0001), start solid diet (2 vs. 3 days; p = 0004), and pass stools (3 vs. 5 days; p = 0.002) compared to the control group. Median length of stay was significantly shorter in the ERP group (3 vs. 6 days; p < 0.0001). No significant difference in readmission or complication rate was observed. Cost analysis was significantly in favor of the ERP group (p = 0.0004). Implementation of ERP optimizes outcomes for laparoscopic distal pancreatectomy with significant earlier return to normal gut function, reduced length of stay and cost saving. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Evaluation of the BD Vacutainer(®) RST blood collection tube for routine chemistry analytes: clinical significance of differences and stability study.

PubMed

Kocijancic, Marija; Cargonja, Jelena; Delic-Knezevic, Alma

2014-01-01

Preanalytical variables account for most of laboratory errors. There is a wide range of factors that affect the reliability of laboratory report. Most convenient sample type for routine laboratory analysis is serum. BD Vacutainer(®) Rapid Serum Tube (RST) (Becton, Dickinson and Company, Franklin Lakes, NJ, USA) blood collection tube provides rapid clotting time allowing fast serum separation. Our aim was to evaluate the comparability of routine chemistry parameters in BD Vacutainer(®) RST blood collection tube in reference with the BD Vacutainer(®) Serum Separating Tubes II Advance Tube (SST) (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). Blood specimens were collected from 90 participants for evaluation on its results, clotting time and stability study of six routine biochemistry parameters: glucose (Glu), aspartate aminotransferase (AST), alanine aminotransferase (ALT), calcium (Ca), lactate dehidrogenase (LD) and potassium (K) measured with Olympus AU2700 analyzer (Beckman Coulter, Tokyo, Japan). The significance of the differences between samples was assessed by paired t-test or Wilcoxon Matched-Pairs Rank test after checking for normality. Clotting process was significantly shorter in the RSTs compared to SSTs (2.49 min vs. 19.47 min, respectively; P < 0.001). There was a statistically significant difference between the RST and SST II tubes for glucose, calcium and LD (P < 0.001). Differences for glucose and LD were also clinically significant. Analyte stability studies showed that all analytes were stable for 24 h at 4 °C. Most results (except LD and glucose) from RST are comparable with those from SST. In addition, RST tube provides shorter clotting time.

An Assessment of Incentive Versus Survey Length Trade-offs in a Web Survey of Radiologists

PubMed Central

Niederhauser, Blake D; Kallmes, David; Beebe, Timothy J

2013-01-01

Background It is generally understood that shorter Web surveys and use of incentives result in higher response rates in Web surveys directed to health care providers. Less is known about potential respondent preference for reduced burden as compared to increased reward. Objective To help elicit preference for minimized burden compared to reward for completion of a survey, we observed physician preferences for shorter Web surveys compared to incentives as well as incentive preference (small guaranteed incentive compared to larger lottery incentive) accompanying an electronic request to complete a survey. Methods This was an observational study that accompanied a large Web survey study of radiology staff, fellows, and residents at select academic medical centers in the United States. With the request to complete the survey, potential respondents were offered three options: (1) a 10-minute Web survey with the chance to win an iPad, (2) a 10-minute Web survey with a guaranteed nominal incentive ($5 amazon.com gift card), or (3) a shorter (5-7 minute) Web survey with no incentive. A total of 254 individuals responded to the Web survey request. Results Overwhelmingly, individuals chose a longer survey accompanied by an incentive compared to a shorter survey with no incentive (85% compared to 15%, P<.001). Of those opting for an incentive, a small, but not significant majority chose the chance to win an iPad over a guaranteed $5 gift card (56% compared to 44%). Conclusions When given the choice, radiologists preferred a reward (either guaranteed or based on a lottery) to a less burdensome survey, indicating that researchers should focus more attention at increasing perceived benefits of completing a Web survey compared to decreasing perceived burden. PMID:23514869

An assessment of incentive versus survey length trade-offs in a Web survey of radiologists.

PubMed

Ziegenfuss, Jeanette Y; Niederhauser, Blake D; Kallmes, David; Beebe, Timothy J

2013-03-20

It is generally understood that shorter Web surveys and use of incentives result in higher response rates in Web surveys directed to health care providers. Less is known about potential respondent preference for reduced burden as compared to increased reward. To help elicit preference for minimized burden compared to reward for completion of a survey, we observed physician preferences for shorter Web surveys compared to incentives as well as incentive preference (small guaranteed incentive compared to larger lottery incentive) accompanying an electronic request to complete a survey. This was an observational study that accompanied a large Web survey study of radiology staff, fellows, and residents at select academic medical centers in the United States. With the request to complete the survey, potential respondents were offered three options: (1) a 10-minute Web survey with the chance to win an iPad, (2) a 10-minute Web survey with a guaranteed nominal incentive ($5 amazon.com gift card), or (3) a shorter (5-7 minute) Web survey with no incentive. A total of 254 individuals responded to the Web survey request. Overwhelmingly, individuals chose a longer survey accompanied by an incentive compared to a shorter survey with no incentive (85% compared to 15%, P<.001). Of those opting for an incentive, a small, but not significant majority chose the chance to win an iPad over a guaranteed $5 gift card (56% compared to 44%). When given the choice, radiologists preferred a reward (either guaranteed or based on a lottery) to a less burdensome survey, indicating that researchers should focus more attention at increasing perceived benefits of completing a Web survey compared to decreasing perceived burden.

Comprehensive Numerical Analysis of Finite Difference Time Domain Methods for Improving Optical Waveguide Sensor Accuracy

PubMed Central

Samak, M. Mosleh E. Abu; Bakar, A. Ashrif A.; Kashif, Muhammad; Zan, Mohd Saiful Dzulkifly

2016-01-01

This paper discusses numerical analysis methods for different geometrical features that have limited interval values for typically used sensor wavelengths. Compared with existing Finite Difference Time Domain (FDTD) methods, the alternating direction implicit (ADI)-FDTD method reduces the number of sub-steps by a factor of two to three, which represents a 33% time savings in each single run. The local one-dimensional (LOD)-FDTD method has similar numerical equation properties, which should be calculated as in the previous method. Generally, a small number of arithmetic processes, which result in a shorter simulation time, are desired. The alternating direction implicit technique can be considered a significant step forward for improving the efficiency of unconditionally stable FDTD schemes. This comparative study shows that the local one-dimensional method had minimum relative error ranges of less than 40% for analytical frequencies above 42.85 GHz, and the same accuracy was generated by both methods.

Does Wait-List Size at Registration Influence Time to Surgery? Analysis of a Population-Based Cardiac Surgery Registry

PubMed Central

Sobolev, Boris; Levy, Adrian; Hayden, Robert; Kuramoto, Lisa

2006-01-01

Objective To determine whether the probability of undergoing coronary bypass surgery within a certain time was related to the number of patients on the wait list at registration for the operation in a publicly funded health system. Methods A prospective cohort study comparing waiting times among patients registered on wait lists at the hospitals delivering adult cardiac surgery. For each calendar week, the list size, the number of new registrations, and the number of direct admissions immediately after angiography characterized the demand for surgery. Results The length of delay in undergoing treatment was associated with list size at registration, with shorter times for shorter lists (log-rank test 1,198.3, p<.0001). When the list size at registration required clearance time over 1 week patients had 42 percent lower odds of undergoing surgery compared with lists with clearance time less than 1 week (odds ratio [OR] 0.58 percent, 95 percent, confidence interval [CI] 0.53–0.63), after adjustment for age, sex, comorbidity, period, and hospital. The weekly number of new registrations exceeding weekly service capacity had an independent effect toward longer service delays when the list size at registration required clearance time less than 1 week (OR 0.56 percent, 95 percent CI 0.45–0.71), but not for longer lists. Every time the operation was performed for a patient requiring surgery without registration on wait lists, the odds of surgery for listed patients were reduced by 6 percent (OR 0.94, CI 0.93–0.95). Conclusion For wait-listed patients, time to surgery depends on the list size at registration, the number of new registrations, as well as on the weekly number of patients who move immediately from angiography to coronary bypass surgery without being registered on a wait list. Hospital managers may use these findings to improve resource planning and to reduce uncertainty when providing advice on expected treatment delays. PMID:16430599

Developmental kinetics of pig embryos by parthenogenetic activation or by handmade cloning.

PubMed

Li, J; Li, R; Liu, Y; Villemoes, K; Purup, S; Callesen, H

2013-10-01

The developmental kinetics of pig embryos produced by parthenogenetic activation without (PAZF) or with (PAZI) zona pellucida or by handmade cloning (HMC) was compared by time-lapse videography. After cumulus cell removal, the matured oocytes were either left zona intact (PAZI) or were made zona free by pronase digestion (PAZF) before they were activated (PA). Other matured oocytes were used for HMC based on foetal fibroblast cells. On Day 0 (day of PA or reconstruction), the embryos were cultured for 7 days in vitro in our time-lapse system. Pictures were taken every 30 min, and afterwards, each cell cycle was identified for each embryo to be analysed. Results showed that the PA embryos (both PAZF and PAZI) had shorter first cell cycle compared with HMC (17.4. 17.8 vs 23.6 h), but had a longer time length from four cell to morula stages (57.9, 53.8 vs 44.9 h). However, at the second cell cycle, PAZF embryos needed shorter time, while PAZI embryos had similar time length as HMC embryos, and both were longer than PAZF (23.4, 24.8 vs 14.6 h). Both PAZF and PAZI embryos used similar time to reach the blastocyst stage, and this was later than HMC embryos. In addition, when all of these embryos were grouped into viable (developed to blastocysts) and non-viable (not developed to blastocysts), the only difference in the time length was observed on the first cell cycle (18.6 vs 24.5 h), but not on the later cell cycles. In conclusion, our results not only give detailed information regarding the time schedule of in vitro-handled pig embryos, but also indicate that the first cell cycle could be used as a selecting marker for embryo viability. However, to evaluate the effect of the produced techniques, the whole time schedule of the pre-implantation developmental kinetics should be observed. © 2013 Blackwell Verlag GmbH.

In-vitro comparison of instrumentation time and cleaning capacity between endodontic handpiece and manual preparation techniques in primary molar teeth.

PubMed

Seraj, B; Ramezani, G; Ghadimi, S; Mosharrafian, S H; Motahhary, P; Safari, M

2013-01-01

The aim of this study was to evaluate and compare the cleaning ability and instrumentation time of manual method and use of endodontic handpiece for preparation of primary molar teeth. Forty primary teeth canals were used in this experimental study. Access cavities were prepared and India ink was injected into the canals. The samples were divided into three groups according to the preparation technique. In the first group the root canals were manually instrumented by k_files. Endodontic handpiece (TEP-ER10, NSK, Japan) were used for canal preparation in the second group and the samples in the third group (control) were not instrumented. After preparing the canal, the teeth were cleared with methyl salicylate and the removal of India ink was measured in the cervical, middle and apical thirds. The instrumentation time was transcribed by chronometer. Statistical analysis was performed using Mann-Whitney and t-test. There was no significant difference in cleaning capacity between the two techniques, but results of the first and second group differ from those of the control group. In fact, time taken for preparation was significantly shorter with endodontic handpiece system. Seen the shorter working time of endodontic handpiece and the similar cleaning ability of the two techniques, the application of the endodontic handpiece is recommended for preparation of deciduous root canals during pulpectomy.

Nuclear resonant scattering experiment with fast time response: Photonuclear excitation of 201Hg

NASA Astrophysics Data System (ADS)

Yoshimi, A.; Hara, H.; Hiraki, T.; Kasamatsu, Y.; Kitao, S.; Kobayashi, Y.; Konashi, K.; Masuda, R.; Masuda, T.; Miyamoto, Y.; Okai, K.; Okubo, S.; Ozaki, R.; Sasao, N.; Sato, O.; Seto, M.; Schumm, T.; Shigekawa, Y.; Stellmer, S.; Suzuki, K.; Uetake, S.; Watanabe, M.; Yamaguchi, A.; Yasuda, Y.; Yoda, Y.; Yoshimura, K.; Yoshimura, M.

2018-02-01

Nuclear resonant excitation and detection of its decay signal for the 26.27-keV level of 201Hg is demonstrated with high-brilliance synchrotron radiation (SR) and a fast x-ray detector system. This SR-based photonuclear excitation scheme, known as nuclear resonant scattering (NRS) in the field of materials science, is also useful for investigating nuclear properties, such as the half-lives and radiative widths of excited nuclear levels. To date, because of the limited time response of the x-ray detector, the nuclear levels to which this method could be applied have been limited to the one whose half-lives are longer than ˜1 ns. The faster time response of the NRS measurement makes possible NRS experiments on nuclear levels with much shorter half-lives. We have fabricated an x-ray detector system that has a time resolution of 56 ps and a shorter tail function than that reported previously. With the implemented detector system, the NRS signal of the 26.27-keV state of 201Hg could be clearly discriminated from the electronic scattering signal at an elapsed time of 1 ns after the SR pulse. The half-life of the state was determined as 629 ± 18 ps, which has better precision by a factor of three compared with that reported to date obtained from nuclear decay spectroscopy.

[Results of the Misgav Ladach caesarean section].

PubMed

Heidenreich, W; Borgmann, U

2001-11-01

At the Department of Obstetrics and Gynecology, Allgemeines Krankenhaus Celle, 224 caesarean sections according to the Misgav Ladach technique were performed from 01. 05. 1998 to 30. 04. 1999. Anamnestic findings, intraoperative conditions, and postoperative course were compared to 125 conventionel caesarean deliveries. The Misgav Ladach technique resulted in notably shorter operative time, fewer complications of wound healing and reduced hospital stay. No further significant differences were observed in both groups. - The question of postoperative adhesions still remains to be answered. According to our experience the Misgav Ladach operation shows some advantages as compared to the usual method.

The limited role of recombination energy in common envelope removal

NASA Astrophysics Data System (ADS)

Grichener, Aldana; Sabach, Efrat; Soker, Noam

2018-05-01

We calculate the outward energy transport time by convection and photon diffusion in an inflated common envelope and find this time to be shorter than the envelope expansion time. We conclude therefore that most of the hydrogen recombination energy ends in radiation rather than in kinetic energy of the outflowing envelope. We use the stellar evolution code MESA and inject energy inside the envelope of an asymptotic giant branch star to mimic energy deposition by a spiraling-in stellar companion. During 1.7 years the envelope expands by a factor of more than 2. Along the entire evolution the convection can carry the energy very efficiently outwards, to the radius where radiative transfer becomes more efficient. The total energy transport time stays within several months, shorter than the dynamical time of the envelope. Had we included rapid mass loss, as is expected in the common envelope evolution, the energy transport time would have been even shorter. It seems that calculations that assume that most of the recombination energy ends in the outflowing gas might be inaccurate.

Ultrasound-promoted green approach for the synthesis of sulfonamides using natural, stable and reusable Natrolite nanozeolite catalyst at room temperature.

PubMed

Nasrollahzadeh, Mahmoud; Ehsani, Ali; Rostami-Vartouni, Akbar

2014-01-01

Natural Natrolite nanozeolite has been investigated as an efficient and reusable catalyst for the N-sulfonylation of amines under ultrasound irradiation at room temperature. Compared with traditional methods, the significant advantages for method are green solvent, milder and cleaner conditions, higher purity and yields, shorter reaction time, easier work-up procedure and the lower generation of waste or pollutions. The catalyst can be recovered and reused several times without significant loss of its catalytic activity. Copyright © 2013 Elsevier B.V. All rights reserved.

Amplified Self-replication of DNA Origami Nanostructures through Multi-cycle Fast-annealing Process

NASA Astrophysics Data System (ADS)

Zhou, Feng; Zhuo, Rebecca; He, Xiaojin; Sha, Ruojie; Seeman, Nadrian; Chaikin, Paul

We have developed a non-biological self-replication process using templated reversible association of components and irreversible linking with annealing and UV cycles. The current method requires a long annealing time, up to several days, to achieve the specific self-assembly of DNA nanostructures. In this work, we accomplished the self-replication with a shorter time and smaller replication rate per cycle. By decreasing the ramping time, we obtained the comparable replication yield within 90 min. Systematic studies show that the temperature and annealing time play essential roles in the self-replication process. In this manner, we can amplify the self-replication process to a factor of 20 by increasing the number of cycles within the same amount of time.

Telomere length differences between subcutaneous and visceral adipose tissue in humans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lakowa, Nicole; Trieu, Nhu; Flehmig, Gesine

Adipocyte hypertrophy and hyperplasia have been shown to be associated with shorter telomere length, which may reflect aging, altered cell proliferation and adipose tissue (AT) dysfunction. In individuals with obesity, differences in fat distribution and AT cellular composition may contribute to obesity related metabolic diseases. Here, we tested the hypotheses that telomere lengths (TL) are different between: (1) abdominal subcutaneous and omental fat depots, (2) superficial and deep abdominal subcutaneous AT (SAT), and (3) adipocytes and cells of the stromal vascular fraction (SVF). We further asked whether AT TL is related to age, anthropometric and metabolic traits. TL was analyzedmore » by quantitative PCR in total human genomic DNA isolated from paired subcutaneous and visceral AT of 47 lean and 50 obese individuals. In subgroups, we analyzed TL in isolated small and large adipocytes and SVF cells. We find significantly shorter TL in subcutaneous compared to visceral AT (P < 0.001) which is consistent in men and subgroups of lean and obese, and individuals with or without type 2 diabetes (T2D). Shorter TL in SAT is entirely due to shorter TL in the SVF compared to visceral AT (P < 0.01). SAT TL is most strongly correlated with age (r = −0.205, P < 0.05) and independently of age with HbA1c (r = −0.5, P < 0.05). We found significant TL differences between superficial SAT of lean and obese as well as between individuals with our without T2D, but not between the two layers of SAT. Our data indicate that fat depot differences in TL mainly reflect shorter TL of SVF cells. In addition, we found an age and BMI-independent relationship between shorter TL and HbA1c suggesting that chronic hyperglycemia may impair the regenerative capacity of AT more strongly than obesity alone. - Highlights: • Telomere lengths (TL) differ between fat depots mainly due to different lengths in SVF. • TL is not associated with gender, BMI and T2D. • The tendency for shorter TL in small versus large adipocytes suggests that small adipocytes represent a younger generation of adipocytes. • TLs of superficial subcutaneous adipose tissue are shorter in T2D patients compared to non-diabetic controls. • TL is not different between deep and superficial adipose tissue.« less

Sleep and sleepiness among working and non-working high school evening students.

PubMed

Teixeira, Liliane Reis; Lowden, Arne; Turte, Samantha Lemos; Nagai, Roberta; Moreno, Claudia Roberta de Castro; Latorre, Maria do Rosário Dias de Oliveira; Fischer, Frida Marina

2007-01-01

The aim of this study was to evaluate patterns of sleepiness, comparing working and non-working students. The study was conducted on high school students attending evening classes (19:00-22:30 h) at a public school in São Paulo, Brazil. The study group consisted of working (n=51) and non-working (n=41) students, aged 14-21 yrs. The students answered a questionnaire about working and living conditions and reported health symptoms and diseases. For seven consecutive days, actigraphy measurements were recorded, and the students also filled in a sleep diary. Sleepiness ratings were given six times per day, including upon waking and at bedtime, using the Karolinska Sleepiness Scale. Statistical analyses included three-way ANOVA and t-test. The mean sleep duration during weekdays was shorter among workers (7.2 h) than non-workers (8.8 h) (t=4.34; p<.01). The mean duration of night awakenings was longer among workers on Tuesdays and Wednesdays (28.2 min) and shorter on Mondays (24.2 min) (t=2.57; p=.03). Among workers, mean napping duration was longer on Mondays and Tuesdays (89.9 min) (t=2.27; p=.03) but shorter on Fridays and Sundays (31.4 min) (t=3.13; p=.03). Sleep efficiency was lower on Fridays among non-workers. Working students were moderately sleepier than non-workers during the week and also during class on specific days: Mondays (13:00-15:00 h), Wednesdays (19:00-22:00 h), and Fridays (22:00-00:59 h). The study found that daytime sleepiness of workers is moderately higher in the evening. This might be due to a work effect, reducing the available time for sleep and shortening the sleep duration. Sleepiness and shorter sleep duration can have a negative impact on the quality of life and school development of high school students.

First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment.

PubMed

Munier, Francis L; Mosimann, Pascal; Puccinelli, Francesco; Gaillard, Marie-Claire; Stathopoulos, Christina; Houghton, Susan; Bergin, Ciara; Beck-Popovic, Maja

2017-08-01

The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC. This is a retrospective mono-centric comparative review of consecutive patients. Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy. 48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality. Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2-218.6) and 41.7 months (range 19.6-89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group. The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Woody climbers show greater population genetic differentiation than trees: Insights into the link between ecological traits and diversification.

PubMed

Gianoli, Ernesto; Torres-Díaz, Cristian; Ruiz, Eduardo; Salgado-Luarte, Cristian; Molina-Montenegro, Marco A; Saldaña, Alfredo; Ríos, Rodrigo S

2016-12-01

The climbing habit is a key innovation in plants: climbing taxa have higher species richness than nonclimbing sister groups. We evaluated the hypothesis that climbing plant species show greater among-population genetic differentiation than nonclimber species. We compared the among-population genetic distance in woody climbers (eight species, 30 populations) and trees (seven species, 29 populations) coexisting in nine communities in a temperate rainforest. We also compared within-population genetic diversity in co-occurring woody climbers and trees in two communities. Mean genetic distance between populations of climbers was twice that of trees. Isolation by distance (increase in genetic distance with geographic distance) was greater for climbers. Climbers and trees showed similar within-population genetic diversity. Our longevity estimate suggested that climbers had shorter generation times, while other biological features often associated with diversification (dispersal and pollination syndromes, mating system, size, and metabolic rate) did not show significant differences between groups. We hypothesize that the greater population differentiation in climbers could result from greater evolutionary responses to local selection acting on initially higher within-population genetic diversity, which could be driven by neutral processes associated with shorter generation times. Increased population genetic differentiation could be incorporated as another line of evidence when testing for key innovations. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.

Telomere length in non-neoplastic gastric mucosa and its relationship to H. pylori infection, degree of gastritis, and NSAID use.

PubMed

Tahara, Tomomitsu; Shibata, Tomoyuki; Kawamura, Tomohiko; Ishizuka, Takamitsu; Okubo, Masaaki; Nagasaka, Mitsuo; Nakagawa, Yoshihito; Arisawa, Tomiyasu; Ohmiya, Naoki; Hirata, Ichiro

2016-02-01

Telomere shortening occurs with human aging in many organs and tissues and is accelerated by rapid cell turnover and oxidative injury. We measured average telomere length using quantitative real-time PCR in non-neoplastic gastric mucosa and assessed its relationship to H. pylori-related gastritis, DNA methylation, ulcer disease, and nonsteroidal anti-inflammatory drug (NSAID) usage. Gastric biopsies were obtained from 151 cancer-free subjects including 49 chronic NSAID users and 102 nonusers. Relative telomere length in genomic DNA was measured by real-time PCR. H. pylori infection status, histological severity of gastritis, and serum pepsinogens (PGs) were also investigated. E-cadherin (CDH1) methylation status was determined by methylation-specific PCR (MSP). Average relative telomere length of H. pylori-infected subjects was significantly shortened when compared to H. pylori-negative subjects (p = 0.002) and was closely associated with all histological parameter of gastritis (all p values <0.01) and CDH1 methylation (p = 0.0002). In H. pylori-negative subjects, NSAID users presented significantly shorter telomere length than nonusers (p = 0.028). Shorter telomere length was observed in duodenal and gastric ulcer patients compared with non-ulcer subjects among NSAID users. Telomere shortening is closely associated with severity of H. pylori-induced gastritis and CDH1 methylation status. Also, telomere shortening is accelerated by NSAID usage especially in H. pylori-negative subjects.

A systematic review and meta-analysis of randomized controlled trials comparing hysteroscopic morcellation with resectoscopy for patients with endometrial lesions.

PubMed

Li, Chunbo; Dai, Zhiyuan; Gong, Yuping; Xie, Bingying; Wang, Bei

2017-01-01

Results on the efficacy of hysteroscopic morcellation for patients with endometrial lesions remain conflicting. To compare hysteroscopic morcellation with conventional resectoscopy for removal of endometrial lesions. Electronic databases were searched for reports published up to February 1, 2016, using terms such as "morcellator," "morcellators," "morcellate," "morcellation," "morcellated," "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical." Randomized controlled trials were included if they assessed success rate, procedure speed, complications, tolerability, and/or learning curve. Data were extracted by two independent reviewers and a meta-analysis was performed. Four trials including 392 patients were analyzed. Successful removal of all endometrial lesions was more frequent with hysteroscopic morcellation than conventional resectoscopy (odds ratio 4.49, 95% confidence interval [CI] 1.94-10.41; P<0.001). Total operative time was also shorter with hysteroscopic morcellation (mean difference -4.94 minutes, 95% CI -7.20 to -2.68; P<0.001). No significant differences in complications were found. Meta-analyses were not possible for tolerability and learning curve. In one study, hysteroscopic morcellation was acceptable to more patients (P=0.009). Hysteroscopic morcellation is associated with a higher operative success rate and a shorter operative time among patients with endometrial lesions than is resectoscopy. More high-quality trials are required to validate these results. © 2016 International Federation of Gynecology and Obstetrics.

Observations of market pigs following transport to a packing plant.

PubMed

Kephart, K B; Harper, M T; Raines, C R

2010-06-01

A field study was conducted to record observations of 41,744 market-weight pigs upon arrival at a commercial abattoir to evaluate the relationships between various independent factors and open-mouth breathing, skin discoloration, lameness, unloading time, and mortality during transport. Observations were recorded from 242 trailer loads on 46 separate days over a period of 14 mo. Travel time (<2.5 h or >or=2.5 h), wait time before unloading (<20 min or >or=20 min), loading pressure (<260 kg of BW/m(2) trailer floor space or >or=260 kg of BW/m(2) trailer floor space), ambient temperature while unloading (<17 degrees C or >or=17 degrees C), and trailer type [potbelly (PB); straight-deck with conventional unloading doors (SDC); or straight-deck with wide unloading doors (SDW)] were recorded for each load. Open-mouth breathing was more prevalent in pigs when transported on PB trailers compared with that of SDC or SDW trailers (P < 0.01), and at warmer temperatures (>or=17 degrees C, P < 0.001). Skin discoloration was more prevalent (P < 0.001) among pigs unloaded at temperatures >or=17 degrees C. Lameness was more prevalent (P < 0.05) after shorter travel times at greater loading pressure compared with shorter travel times at decreased loading pressure. Unloading time for PB trailers was longer (P < 0.001) than for SDC and SDW. Mortality rates during transport were minimal (0.06%) in the deliveries that we observed, and there were no significant (P > 0.10) relationships between mortality and any independent variable tested. Wait time before unloading was not associated (P > 0.10) with any of the dependent variables included in the statistical model. In conclusion, warmer ambient temperatures (>or=17 degrees C) and the use of PB trailers are associated with an increased incidence of open-mouth breathing and skin discoloration, and longer unloading times after the transport of market pigs.

Air-Q® versus LMA Fastrach™ for fiberoptic-guided intubation: A randomized cross-over manikin trial.

PubMed

Portas, M; Canal, M I; Barrio, M; Alonso, M; Cabrerizo, P; López-Gil, M; Zaballos, M

2018-03-01

Airway management is still a major cause of anesthesia-associated morbidity and mortality. Supraglottic devices are recommended in difficult airway management guidelines. The aim of this study was to compare the performance of the Air-Q ® and the LMA Fastrach™ for fiberoptic guided tracheal intubation. Thirty-three anesthesia trainees participated in this randomized crossover study. Time to insert the dedicated airways (insertion of the airway into the manikin and delivery of two breaths), time to tracheal intubation (fiberoptic-guided tracheal intubation), time to remove the dedicated airway (removal of the Air-Q ® /LMA Fastrach™ over the tracheal tube) and the opinion of the ease of use of the anesthesia trainees were measured. There was 100% success rate for tracheal intubation with both devices on the first attempt. Time to insert the dedicated device and deliver two breaths was 10±3s for the Air-Q ® and 11±3s for the LMA Fastrach™, P=.07. Time taken to intubate the trachea was shorter with the air-Q ® , 38±15 s, than with the LMA Fastrach™, 47±19s, P=.017. Overall procedure time was significantly shorter with the Air-Q ® as compared with the LMA Fastrach™, with a mean time of 74±21s and 87±28s respectively, P=.002. Air-Q ® removal was considered easier than LMA Fastrach™ removal, P=.005. There were no tube dislodgements during the removal of the dedicated airways. Inexperienced anesthesia residents can perform fiberoptic-guided intubation through Air-Q ® and LMA Fastrach™ in a clinically acceptable time with high success. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Relationship Between Final Performance and Block Times with the Traditional and the New Starting Platforms with A Back Plate in International Swimming Championship 50-M and 100-M Freestyle Events

PubMed Central

Garcia-Hermoso, Antonio; Escalante, Yolanda; Arellano, Raul; Navarro, Fernando; Domínguez, Ana M.; Saavedra, Jose M.

2013-01-01

The purpose of this study was to investigate the association between block time and final performance for each sex in 50-m and 100-m individual freestyle, distinguishing between classification (1st to 3rd, 4th to 8th, 9th to 16th) and type of starting platform (old and new) in international competitions. Twenty-six international competitions covering a 13-year period (2000-2012) were analysed retrospectively. The data corresponded to a total of 1657 swimmers’ competition histories. A two-way ANOVA (sex x classification) was performed for each event and starting platform with the Bonferroni post-hoc test, and another two-way ANOVA for sex and starting platform (sex x starting platform). Pearson’s simple correlation coefficient was used to determine correlations between the block time and the final performance. Finally, a simple linear regression analysis was done between the final time and the block time for each sex and platform. The men had shorter starting block times than the women in both events and from both platforms. For 50-m event, medalists had shorter block times than semi- finalists with the old starting platforms. Block times were directly related to performance with the old starting platforms. With the new starting platforms, however, the relationship was inverse, notably in the women’s 50-m event. The block time was related for final performance in the men’s 50- m event with the old starting platform, but with the new platform it was critical only for the women’s 50-m event. Key Points The men had shorter block times than the women in both events and with both platforms. For both distances, the swimmers had shorter block times in their starts from the new starting platform with a back plate than with the old platform. For the 50-m event with the old starting platform, the medalists had shorter block times than the semi-finalists. The new starting platform block time was only determinant in the women’s 50-m event. In order to improve performance, specific training with the new platform with a back plate should be considered. PMID:24421729

Potential sulfur-free pulping methods

Treesearch

Edward L. Springer; Rajai H. Atalla; Richard S. Reiner

2002-01-01

Lodgepole pine chips were pulped to Kappa numbers of about 70 using soda–AQ, soda–ODiMAQ, and kraft methods. At a catalyst level of 0.20% (oven-dry wood basis), cooking times for the soda cooks were significantly shorter than that for the kraft cook. The ODiMAQ catalyzed cooking time was much shorter than that of the AQ cook. It might be possible to replace the kraft...

Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study.

PubMed

ElSheemy, Mohammed S; Elmarakbi, Akram A; Hytham, Mohammed; Ibrahim, Hamdy; Khadgi, Sanjay; Al-Kandari, Ahmed M

2018-03-16

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm 2 ; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm 2 ), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm 2 ), but not with single stones or stone burden ≤ 2 cm 2 .

How many hours do people sleep in Bangladesh? A country-representative survey.

PubMed

Yunus, Fakir M; Khan, Safayet; Akter, Tahera; Jhohura, Fatema T; Reja, Saifur; Islam, Akramul; Rahman, Mahfuzar

2016-06-01

This study investigated total sleep time in the Bangladeshi population and identified the proportion of the population at greater risk of developing chronic diseases due to inadequate sleep. Using a cross-sectional survey, total sleep time was captured and analysed in 3968 respondents aged between 6 and 106 years in 24 (of 64) districts in Bangladesh. Total sleep time was defined as the hours of total sleep in the previous 24 h. We used National Sleep Foundation (2015) guidelines to determine the recommended sleep hours in different age categories. Less or more than the recommended total sleep time (in hours) was considered 'shorter' and 'longer' sleep time, respectively. Linear and multinomial logistic regression models were used to determine the relationship between demographic variables and estimated risk of shorter and longer total sleep time. The mean (±standard deviation) total sleep time of children (6-13 years), teenagers (14-17 years), young adults and adults (18-64 years) and older adults (≥65 years) were 8.6 (±1.1), 8.1 (±1.0), 7.7 (±0.9) and 7.8 (±1.4) h, respectively, which were significantly different (P < 0.01). More than half of school-age children (55%) slept less than, and 28.2% of older adults slept longer than, recommended. Residents in all divisions (except Chittagong) in Bangladesh were less likely to sleep longer than in the Dhaka division. Rural populations had a 3.96× greater chance of sleeping for a shorter time than urban residents. The Bangladeshi population tends to sleep for longer and/or shorter times than their respective recommended sleep hours, which is detrimental to health. © 2016 European Sleep Research Society.

Effect of Ankle Joint Contact Angle and Ground Contact Time on Depth Jump Performance.

PubMed

Phillips, Joshua H; Flanagan, Sean P

2015-11-01

Athletes often need to both jump high and get off the ground quickly, but getting off the ground quickly can decrease the vertical ground reaction force (VGRF) impulse, impeding jump height. Energy stored in the muscle-tendon complex during the stretch-shortening cycle (SSC) may mitigate the effects of short ground contact times (GCTs). To take advantage of the SSC, several coaches recommend "attacking" the ground with the foot in a dorsiflexed (DF) position at contact. However, the efficacy of this technique has not been tested. This investigation tested the hypotheses that shorter GCTs would lead to smaller vertical depth jump heights (VDJH), and that this difference could be mitigated by instructing the athletes to land in a DF as opposed to a plantar flexed (PF) foot position. Eighteen healthy junior college athletes performed depth jumps from a 45-cm box onto force platforms under instruction to achieve one of the 2 objectives (maximum jump height [hmax] or minimal GCT [tmin]), with one of the 2 foot conditions (DF or PF). These variations created 4 distinct jump conditions: DF-hmax, DF-tmin, PF-hmax, and PF-tmin. For all variables examined, there were no significant interactions. For all 4 conditions, the ankle was PF during landing, but the DF condition was 28.87% less PF than the PF condition. The tmin conditions had a 23.48% shorter GCT than hmax. There were no significant main effects for jump height. The peak impact force for tmin was 22.14% greater than hmax and 19.11% greater for DF compared with PF conditions. A shorter GCT did not necessitate a smaller jump height, and a less PF foot did not lead to improvements in jump height or contact time during a depth jump from a 45-cm box. The same jump height was attained in less PF and shorter GCT conditions by larger impact forces. To decrease contact time while maintaining jump height, athletes should be instructed to "get off the ground as fast as possible." This cue seems to be more important than foot position. However, it should be acknowledged that this technique leads to larger impact forces, which should be considered when prescribing the number of foot contacts in a plyometrics program. The ability of athletes to truly land in a DF position during depth jumps is questioned and needs further investigation.

Outcomes of robotic, laparoscopic and open hysterectomy for benign conditions in obese patients.

PubMed

Borahay, Mostafa A; Tapısız, Ömer Lütfi; Alanbay, İbrahim; Kılıç, Gökhan Sami

2018-04-27

To compare outcomes of robotic assisted (RAH), total laparoscopic (LH) and total abdominal (TAH) hysterectomy for benign conditions in obese patients. Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. Patients' characteristics, operative data and post-operative outcomes were collected and statistically analyzed. A total of 208 patients who underwent RAH ( n= 51 ), LH ( n=24 ) or TAH ( n=133 ) were analyzed. There were no significant differences among groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with less estimated blood loss (EBL) ( P < .001) and shorter length of hospital stay (LOS) ( P < .001) compared to TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤ 6 weeks) complications compared with TAH ( P = .002). However, the procedure time was longer in RAH and LH ( P < .001). No significant differences were noted among groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits. Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications and shorter LOS.

Assessment of time to clinical response, a proxy for discharge readiness, among hospitalized patients with community-acquired pneumonia who received either ceftaroline fosamil or ceftriaxone in two phase III FOCUS trials.

PubMed

Lodise, Thomas P; Anzueto, Antonio R; Weber, David J; Shorr, Andrew F; Yang, Min; Smith, Alexander; Zhao, Qi; Huang, Xingyue; File, Thomas M

2015-02-01

The primary driver of health care costs for patients with community-acquired pneumonia (CAP) is the hospital length of stay (LOS). Unfortunately, hospital LOS comparisons are difficult to make from phase III CAP trials because of their structured designs and prespecified treatment durations. However, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. The intent of this study was to quantify the time to a clinical response, a proxy for the time to discharge readiness, among hospitalized CAP patients who received either ceftaroline or ceftriaxone in two phase III CAP FOCUS clinical trials. On the basis of the Infectious Diseases Society of America and American Thoracic Society CAP management guidelines and recent FDA guidance documents for community-acquired bacterial pneumonia, a post hoc adjudication algorithm was constructed a priori to compare the time to a clinical response, a proxy for the time to discharge readiness, between patients who received ceftaroline or ceftriaxone. Overall, 1,116 patients (ceftaroline, n=562; ceftriaxone, n=554) from the pooled FOCUS trials met the selection criteria for this analysis. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting the clinical response criteria (P=0.03). Of the patients on ceftaroline, 61.0, 76.1, and 83.6% achieved a clinical response by days 3, 4, and 5, compared to 54.3, 69.8, and 79.3% of the ceftriaxone-treated patients. In the Cox regression, ceftaroline was associated with a shorter time to a clinical response (HR, 1.16, P=0.02). The methodology employed here provides a framework to draw comparative effectiveness inferences from phase III CAP efficacy trials. (The FOCUS trials whose data were analyzed in this study have been registered at ClinicalTrials.gov under registration no. NCT00621504 and NCT00509106.). Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Modification of Propellant Binder Network for Improvement of Mechanical Properties

DTIC Science & Technology

1984-12-01

skeletal atoms) is more beneficial than 22 mole % of the shorter PEG 3350 (230 skeletal atoms) or 25 mole % of shorter PCP 0260 (180 skeletal atoms). One...of the reasons may be that a higher degree of strain-induced crystalliza- tion of PEG 8000 occurs compared with PEG 3350 or PCP 0260. 4.8 Effect of...prepolymer rubbers. Also, the stress capability of the cured rubbers is improved compared to the long chain prepolymer rubbers. Polyethylene glycol 8000 ( PEG

Determinants of psychogeriatric inpatient length of stay and direct medical costs: a 6-year longitudinal study using a national database in Taiwan.

PubMed

Liu, Chin-Ming; Li, Chu-Shiu; Liu, Chwen-Chi; Tu, Chu-Chin

2012-08-01

This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002. Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002-2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ(2) -test and zero truncated Tobit regression. Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC. Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

Chromosome Connections: Compelling Clues to Common Ancestry

ERIC Educational Resources Information Center

Flammer, Larry

2013-01-01

Students compare banding patterns on hominid chromosomes and see striking evidence of their common ancestry. To test this, human chromosome no. 2 is matched with two shorter chimpanzee chromosomes, leading to the hypothesis that human chromosome 2 resulted from the fusion of the two shorter chromosomes. Students test that hypothesis by looking for…

Hysteroscopic Endometrial Polypectomy: Clinical and Economic Data in Decision Making.

PubMed

Franchini, Mario; Lippi, Giuseppe; Calzolari, Stefano; Giarrè, Giovanna; Gubbini, Giampietro; Catena, Ursula; Di Spiezio Sardo, Attilio; Florio, Pasquale

To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral hospital and center for gynecologic care. Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016. Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system. The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p = .0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p = .0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p = .0002) CONCLUSION: The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy: A Multicenter Early Comparative Experience of Clinical Outcomes.

PubMed

Kedia, Prashant; Tarnasky, Paul R; Nieto, Jose; Steele, Stephen L; Siddiqui, Ali; Xu, Ming-Ming; Tyberg, Amy; Gaidhane, Monica; Kahaleh, Michel

2018-04-17

The standard of care for managing pancreaticobiliary disease in altered Roux-en-Y gastric bypass patients is laparoscopy-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP), but is limited by cost and adverse events. Recently a minimally invasive, completely endoscopic approach using endoscopic ultrasound (EUS) directed transgastric ERCP (EDGE) has been described. We aim to compare EDGE to LA-ERCP in this study. Patients from May 2005 to June 2017 with Roux-en-Y gastric bypass anatomy having undergone LA-ERCP or EDGE at 4 tertiary centers were captured in a registry. Patient demographics, procedural details, and clinical outcomes were measured for each group. Seventy-two patients (n=29 EDGE, n=43 LA-ERCP) were included in this study. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.5%) versus LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.5% vs. LA-ERCP 97.7%) and number of ERCP (EDGE 1.2 vs. LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. Adverse event rate for EDGE, 24% (7/29) and LA-ERCP, 19% (8/43) was similar. The total procedure time (73 vs. 184 min) and length of hospital stay (0.8 vs. 2.65 d) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was -6.6 lbs at an average 28-week follow-up. This study suggests that the EDGE procedure has similar technical success and adverse events compared with LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain.

Da Vinci Xi and Si platforms have equivalent perioperative outcomes during robot-assisted partial nephrectomy: preliminary experience.

PubMed

Abdel Raheem, Ali; Sheikh, Abulhasan; Kim, Dae Keun; Alatawi, Atalla; Alabdulaali, Ibrahim; Han, Woong Kyu; Choi, Young Deuk; Rha, Koon Ho

2017-03-01

The aims of this study were to compare the perioperative outcomes of da Vinci Xi to Si during robotic-assisted partial nephrectomy (RAPN) and to discuss the feasibility of our novel port placement scheme for the da Vinci Xi platform, to overcome the existing kinetic and technical difficulties we faced with the linear port placement in patients with a small body habitus. A retrospective data analysis of patients who underwent RPN using da Vinci Xi (n = 18) was carried out. The outcomes of the Xi group were compared with the Si group (n = 18) selected using a case-matched methodology. For da Vinci Xi, we applied the universal linear port placement in 12 patients and our modified port placement in the remaining 6 patients. The Xi group had a shorter mean docking time of 17.8 ± 2.6 min compared to the Si group of 20.5 ± 2.1 min (p = 0.002); otherwise, no significant difference was present with regard to the remaining perioperative variables (p > 0.05). The modified Xi port placement had a shorter mean console time of 70.8 ± 9.7 min compared to the universal linear port placement of 89.3 ± 17.2 min (p = 0.03). Moreover, it provided a broader field of vision with excellent robotic arms movement, minimizing collisions and allowing an easier and comfortable surgical assist. Da Vinci Xi appears to be feasible and safe during RPN with similar outcomes to Si. The novel Xi port placement makes surgery easier in patients with low BMI.

The Impact of a Junior Faculty Fellowship Award on Academic Advancement and Retention.

PubMed

Connelly, Maureen T; Sullivan, Amy M; Chinchilla, Manuel; Dale, Margaret L; Emans, S Jean; Nadelson, Carol Cooperman; Notman, Malkah Tolpin; Tarbell, Nancy J; Zigler, Corwin M; Shore, Eleanor G

2017-08-01

Academic faculty experience barriers to career development and promotion. In 1996, Harvard Medical School (HMS) initiated an intramural junior faculty fellowship to address these obstacles. The authors sought to understand whether receiving a fellowship was associated with more rapid academic promotion and retention. Junior faculty fellowship recipients and all other instructor and assistant professors at HMS between 1996 and 2011 were identified. Using propensity score modeling, the authors created a matched comparison group for the fellowship recipients based on educational background, training, academic rank, department, hospital affiliation, and demographics. Time to promotion and time to leaving were assessed by Kaplan-Meier curves. A total of 622 junior faculty received fellowships. Faculty who received fellowships while instructors (n = 480) had shorter times to promotion to assistant professor (P < .0001) and longer retention times (P < .0001) than matched controls. There were no significant differences in time to promotion for assistant professors who received fellowships (n = 142) compared with matched controls, but assistant professor fellowship recipients were significantly more likely to remain longer on the faculty (P = .0005). Women instructors advanced more quickly than matched controls, while male instructors' rates of promotions did not differ. Fellowships to support junior faculty were associated with shorter times to promotion for instructors and more sustained faculty retention for both instructors and assistant professors. This suggests that relatively small amounts of funding early in faculty careers can play a critical role in supporting academic advancement and retention.

Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review.

PubMed

Ding, Chao; Wang, Chunmao; Dong, Aiqiang; Kong, Minjian; Jiang, Daming; Tao, Kaiyu; Shen, Zhonghua

2012-05-04

Anterolateral Minithoracotomy (ALMT) for the radical correction of Congenital Heart Defects is an alternative to Median Sternotomy (MS) due to reduce operative trauma accelerating recovery and yield a better cosmetic outcome after surgery. Our purpose is to conduct whether ALMT would bring more short-term benefits to patients than conventional Median Sternotomy by using a meta-analysis of case-control study in the published English Journal. 6 case control studies published in English from 1997 to 2011 were identified and synthesized to compare the short-term postoperative outcomes between ALMT and MS. These outcomes were cardiopulmonary bypass time, aortic cross-clamp time, intubation time, intensive care unit stay time, and postoperative hospital stay time. ALMT had significantly longer cardiopulmonary bypass times (8.00 min more, 95% CI 0.36 to 15.64 min, p = 0.04). Some evidence proved that aortic cross-clamp time of ALMT was longer, yet not significantly (2.38 min more, 95% CI -0.15 to 4.91 min, p = 0.06). In addition, ALMT had significantly shorter intubation time (1.66 hrs less, 95% CI -3.05 to -0.27 hrs, p = 0.02). Postoperative hospital stay time was significantly shorter with ALMT (1.52 days less, 95% CI -2.71 to -0.33 days, p = 0.01). Some evidence suggested a reduction in ICU stay time in the ALMT group. However, this did not prove to be statistically significant (0.88 days less, 95% CI -0.81 to 0.04 days, p = 0.08). ALMT can bring more benefits to patients with Congenital Heart Defects by reducing intubation time and postoperative hospital stay time, though ALMT has longer CPB time and aortic cross-clamp time.

Capture and Emission of Charge Carriers by Quantum Well

NASA Astrophysics Data System (ADS)

Davydov, V. N.; Karankevich, O. A.

2018-06-01

The interaction of electrons from the conduction band of the barrier layer of a LED heterostructure with the quantum well size-quantization level described by the capture time and emission time of charge carriers is considered. Relaxation of an excess energy upon capture and emission of charge carriers occurs as a result of their collisions with phonons of the quantum well substance and the "barrier layer-quantum well" interface. Analytical expressions are obtained for the interaction times, taking into account the depth of the sizequantization level, involved in the interaction with electrons, and the width of the well. Numerical estimates show that in real conditions, the capture time is shorter than the emission time, and this difference increases with increasing depth of the level. At shallow depths, the capture and emission times are comparable.

Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?

PubMed

Huang, Hua-Wei; Zheng, Bo-Lu; Jiang, Li; Lin, Zong-Tong; Zhang, Guo-Bin; Shen, Ling; Xi, Xiu-Ming

2015-03-19

Sleep deprivation is common in critically ill patients in the intensive care unit (ICU). Noise and light in the ICU and the reduction in plasma melatonin play the essential roles. The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality, and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects. This study was conducted in two parts. In part one, 40 healthy subjects slept under baseline night and simulated ICU noise and light (NL) by a cross-over design. In part two, 40 subjects were randomly assigned to four groups: NL, NL plus placebo (NLP), NL plus use of earplugs and eye masks (NLEE) and NL plus melatonin (NLM). 1 mg of oral melatonin or placebo was administered at 21:00 on four consecutive days in NLM and NLP. Earplugs and eye masks were made available in NLEE. The objective sleep quality was measured by polysomnography. Serum was analyzed for melatonin levels. Subjects rated their perceived sleep quality and anxiety levels. Subjects had shorter total sleep time (TST) and rapid eye movement (REM) sleep, longer sleep onset latency, more light sleep and awakening, poorer subjective sleep quality, higher anxiety level and lower serum melatonin level in NL night (P <0.05). NLEE had less awakenings and shorter sleep onset latency (P <0.05). NLM had longer TST and REM and shorter sleep onset latency (P <0.05). Compared with NLEE, NLM had fewer awakenings (P = 0.004). Both NLM and NLEE improved perceived sleep quality and anxiety level (P = 0.000), and NLM showed better than NLEE in perceived sleep quality (P = 0.01). Compared to baseline night, the serum melatonin levels were lower in NL night at every time point, and the average maximal serum melatonin concentration in NLM group was significantly greater than other groups (P <0.001). Compared with earplugs and eye masks, melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light. Chinese Clinical Trial Registry ChiCTR-IPR-14005458 . Registered 10 November 2014.

Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS.

PubMed

Martin, Adam; Payne, Rupert; Wilson, Edward Cf

2018-06-01

The National Health Service (NHS) in England spends over £9 billion on prescription medicines dispensed in primary care, of which over two-thirds is accounted for by repeat prescriptions. Recently, GPs in England have been urged to limit the duration of repeat prescriptions, where clinically appropriate, to 28 days to reduce wastage and hence contain costs. However, shorter prescriptions will increase transaction costs and thus may not be cost saving. Furthermore, there is evidence to suggest that shorter prescriptions are associated with lower adherence, which would be expected to lead to lower clinical benefit. The objective of this study is to estimate the cost-effectiveness of 3-month versus 28-day repeat prescriptions from the perspective of the NHS. We adapted three previously developed UK policy-relevant models, incorporating transaction (dispensing fees, prescriber time) and drug wastage costs associated with 3-month and 28-day prescriptions in three case studies: antihypertensive medications for prevention of cardiovascular events; drugs to improve glycaemic control in patients with type 2 diabetes; and treatments for depression. In all cases, 3-month prescriptions were associated with lower costs and higher QALYs than 28-day prescriptions. This is driven by assumptions that higher adherence leads to improved disease control, lower costs and improved QALYs. Longer repeat prescriptions may be cost-effective compared with shorter ones. However, the quality of the evidence base on which this modelling is based is poor. Any policy rollout should be within the context of a trial such as a stepped-wedge cluster design.

Effect of Prior Injury on Changes to Biceps Femoris Architecture across an Australian Football League Season.

PubMed

Timmins, Ryan G; Bourne, Matthew N; Hickey, Jack T; Maniar, Nirav; Tofari, Paul J; Williams, Morgan D; Opar, David A

2017-10-01

To assess in-season alterations of biceps femoris long head (BFlh) fascicle length in elite Australian footballers with and without a history of unilateral hamstring strain injury (HSI) in the past 12 months. Thirty elite Australian football players were recruited. Twelve had a history of unilateral HSI. Eighteen had no HSI history. All had their BFlh architecture assessed at approximately monthly intervals, six times across a competitive season. The previously injured limb's BFlh fascicles increased from the start of the season and peaked at week 5. Fascicle length gradually decreased until the end of the season, where they were shortest. The contralateral uninjured limb's fascicles were the longest when assessed at week 5 and showed a reduction in-season where weeks 17 and 23 were shorter than week 1. Control group fascicles were longest at week 5 and reduced in-season. The previously injured limb's BFlh fascicles were shorter than the control group at all weeks and the contralateral uninjured limb at week 5. Compared with the control group, the contralateral uninjured limb had shorter fascicles from weeks 9 to 23. Athletes with a history of HSI end the season with shorter fascicles than they start. Limbs without a history of HSI display similar BFlh fascicle lengths at the end of the season as they begin with. All athletes increase fascicle length at the beginning of the season; however, the extent of the increase differed based on history of HSI. These findings show that a HSI history may influence structural adaptation of the BFlh in-season.

Legal Status, Time in the USA, and the Well-Being of Latinos in Los Angeles.

PubMed

Young, Maria-Elena De Trinidad; Pebley, Anne R

2017-12-01

In the USA, undocumented Latino immigrants may have poorer health because of barriers to health care, stressors, and detrimental effects of immigration enforcement. Previous immigrant health research, however, suggests that recently arrived Latino immigrants have better health than US-born Latinos and their health deteriorates over time. Given the current environments that undocumented immigrants face, legal status is a structural factor that likely influences the patterns of immigrant health. Therefore, the aim of this study was to examine the extent to which physical and mental health differed by legal status and duration in the USA for the Latino population in Los Angeles County, California. We conducted analysis of Latino respondents (n = 1396) to the Los Angeles Family and Neighborhood Survey (L.A.FANS) Wave II. We examined self-reported health, depression measured by the Composite International Diagnostic Interview-Short Form, and blood pressure collected by trained interviewers. Respondents reported their legal status, time in the USA, and other sociodemographic characteristics. Regression models were used to test associations between each outcome and 1) legal status and 2) legal status by duration (≤ 15 and > 15 years) in the USA. Without taking duration into account, we found no significant differences in outcomes between undocumented, documented, or US-born Latinos. Taking duration into account, shorter duration undocumented immigrants had worse self-reported health than the US born. Undocumented immigrants, regardless of duration, had higher blood pressure than documented immigrants who had been in the USA for less time and the same level of blood pressure as the US born. In contrast, shorter duration documented immigrants had lower blood pressure compared to longer duration documented immigrants and US-born counterparts, and marginally lower blood pressure than shorter duration undocumented immigrants. The findings suggest that the "health advantage" generally presumed to exist among immigrants may not affect undocumented immigrants.

[Effects of different drying methods on processing performance and quality in bulbus of Tulipa edulis].

PubMed

Yang, Xiao-hua; Guo, Qiao-sheng; Zhu, Zai-biao; Chen, Jun; Miao, Yuan-yuan; Yang, Ying; Sun, Yuan

2015-10-01

Effects of different drying methods including sun drying, steamed, boiled, constant temperature drying (at 40, 50, 60 °C) on appearance, hardness, rehydration ratio, dry rate, moisture, total ash, extractive and polysaccharides contents were studied to provide the basis of standard processing method for Tulipa edulis bulbus. The results showed that the treatments of sun drying and 40 °C drying showed higher rehydration ratios, but lower dry rate, higher hardness, worse color, longer time and obvious distortion and shrinkage in comparison with other drying methods. The treatments of 60 °C constant temperature drying resulted in shorter drying time, lower water and higher polysaccharides content. Drying time is shorter and appearance quality is better in the treatment of steaming and boiling compared with other treatments, but the content of extractive and polysaccharides decreased significantly. The treatments of 50 °C constant temperature drying led to similar appearance quality of bulb to commercial bulb, and it resulted in lowest hardness and highest dry rate as well as higher rehydration ratio, extractive and polysaccharides content, moderate moisture and total ash contents among these treatments. Based on the results obtained, 50 °C constant temperature drying is the better way for the processing of T. edulis bulbus.

Medicaid Enrollment Gap Length and Number of Medicaid Enrollment Periods Among US Children

PubMed Central

Schoendorf, Kenneth C.

2014-01-01

Objectives. We examined gap length, characteristics associated with gap length, and number of enrollment periods among Medicaid-enrolled children in the United States. Methods. We linked the 2004 National Health Interview Survey to Medicaid Analytic eXtract files for 1999 through 2008. We examined linkage-eligible children aged 5 to 13 years in the 2004 National Health Interview Survey who disenrolled from Medicaid. We generated Kaplan-Meier curves of time to reenrollment. We used Cox proportional hazards models to assess the effect of sociodemographic variables on time to reenrollment. We compared the percentage of children enrolled 4 or more times across sociodemographic groups. Results. Of children who disenrolled from Medicaid, 35.8%, 47.1%, 63.5%, 70.8%, and 79.1% of children had reenrolled in Medicaid by 6 months, 1, 3, 5, and 10 years, respectively. Children who were younger, poorer, or of minority race/ethnicity or had lower educated parents had shorter gaps in Medicaid and were more likely to have had 4 or more Medicaid enrollment periods. Conclusions. Nearly half of US children who disenrolled from Medicaid reenrolled within 1 year. Children with traditionally high-risk demographic characteristics had shorter gaps in Medicaid enrollment and were more likely to have more periods of Medicaid enrollment. PMID:25033135

Immunochromatographic strip assay for the rapid and sensitive detection of Salmonella Typhimurium in artificially contaminated tomato samples.

PubMed

Shukla, Shruti; Leem, Hyerim; Lee, Jong-Suk; Kim, Myunghee

2014-06-01

This study was designed to confirm the applicability of a liposome-based immunochromatographic assay for the rapid detection of Salmonella enterica subsp. enterica serovar Typhimurium (Salmonella Typhimurium) in artificially contaminated tomato samples. To determine the detection limit and pre-enrichment incubation time (10, 12, and 18 h pre-enrichment in 1% buffered peptone water), the tests were performed with different cell numbers of Salmonella Typhimurium (3 × 10(0), 3 × 10(1), 3 × 10(2), and 3 × 10(3) CFU·mL(-1)) inoculated into 25 g of crushed tomato samples. The assay was able to detect as few as 30 Salmonella Typhimurium cells per 25 g of tomato samples (1.2 cells·g(-1)) after 12 h pre-enrichment incubation. Moreover, when the developed assay was compared with traditional morphological and biochemical culture-based methods as well as colloidal gold nanoparticle-based commercial test strips, the developed assay yielded positive results for the detection of Salmonella Typhimurium within a shorter period time. These findings confirm that the developed assay may have practical application for the sensitive detection of Salmonella Typhimurium in various food samples, including raw vegetables, with a relatively low detection limit and shorter analysis time.

Eye movements as a function of response contingencies measured by blackout technique1

PubMed Central

Doran, Judith; Holland, James G.

1971-01-01

A program may have a low error rate but, at the same time, require little of the student and teach him little. A measure to supplement error rate in evaluating a program has recently been developed. This measure, called the blackout ratio, is the percentage of material that may be deleted without increasing the error rate. In high blackout-ratio programs, obtaining a correct answer is contingent upon only a small portion of the item. The present study determined if such low response-contingent material is read less thoroughly than programmed material that is heavily response-contingent. Eye movements were compared for two versions of the same program that differed only in the choice of the omitted words. The alteration of the required responses resulted in a version with a higher blackout ratio than the original version, which had a low blackout ratio. Eighteen undergraduates received half their material from the high and half their material from the low blackout-ratio version. The order was counterbalanced. Location and duration of all eye fixations in each item were recorded by a Mackworth Eye Marker Camera. On high blackout-ratio material, subjects used fewer fixations, shorter fixation time, and shorter scanning time. High blackout-ratio material failed to evoke the students' attention. PMID:16795275

Bioavailability of syrup and tablet formulations of cefetamet pivoxil.

PubMed

Ducharme, M P; Edwards, D J; McNamara, P J; Stoeckel, K

1993-12-01

Two studies examining the bioavailability of cefetamet pivoxil in healthy male subjects were conducted. In the first, the bioavailabilities of the 250-mg (M250) and M500 tablet formulations of cefetamet pivoxil to be marketed were compared with that of a tablet used in clinical trials. All products were given with food at a dose of 500 mg. In the second study, the bioavailability of the syrup formulation was evaluated under both fasting and nonfasting conditions and compared with that of the M500 tablet formulation given with food. The absolute bioavailabilities of the M500 and M250 tablets (55.0% +/- 8.0% and 55.7% +/- 7.0%, respectively) were not significantly different from that of the clinical-trial formulation (49.8% +/- 8.5%). The newer tablet formulations exhibited faster absorption as evidenced by higher peak concentrations (3.8 [M500] and 3.9 [M250] mg/liter compared with 3.2 mg/liter for the clinical-trial formulation), a shorter time to peak concentration, and a shorter mean absorption time. The syrup formulation was found to have significantly lower absolute bioavailability (37.9% +/- 6.0%) compared with that of the M500 tablet (58.4% +/- 9.0%) when both were given with food. Food had no significant effect on the bioavailability of the syrup, which averaged 34.0% +/- 8.6% under fasting conditions, although absorption was delayed by food (mean absorption time increased from 2.2 to 3.9 h). This contrasts with the results of previous studies documenting significant increases in tablet bioavailability with food. Despite the lower bioavailability of the syrup, unbound-cefetamet concentrations are expected to remain above the MICs for 90% of the strains tested for susceptible organisms for approximately 10 h of the usual 12-h dosing interval with both syrup and tablet formulations of cefetamet pivoxil given with food.

Bioavailability of syrup and tablet formulations of cefetamet pivoxil.

PubMed Central

Ducharme, M P; Edwards, D J; McNamara, P J; Stoeckel, K

1993-01-01

Two studies examining the bioavailability of cefetamet pivoxil in healthy male subjects were conducted. In the first, the bioavailabilities of the 250-mg (M250) and M500 tablet formulations of cefetamet pivoxil to be marketed were compared with that of a tablet used in clinical trials. All products were given with food at a dose of 500 mg. In the second study, the bioavailability of the syrup formulation was evaluated under both fasting and nonfasting conditions and compared with that of the M500 tablet formulation given with food. The absolute bioavailabilities of the M500 and M250 tablets (55.0% +/- 8.0% and 55.7% +/- 7.0%, respectively) were not significantly different from that of the clinical-trial formulation (49.8% +/- 8.5%). The newer tablet formulations exhibited faster absorption as evidenced by higher peak concentrations (3.8 [M500] and 3.9 [M250] mg/liter compared with 3.2 mg/liter for the clinical-trial formulation), a shorter time to peak concentration, and a shorter mean absorption time. The syrup formulation was found to have significantly lower absolute bioavailability (37.9% +/- 6.0%) compared with that of the M500 tablet (58.4% +/- 9.0%) when both were given with food. Food had no significant effect on the bioavailability of the syrup, which averaged 34.0% +/- 8.6% under fasting conditions, although absorption was delayed by food (mean absorption time increased from 2.2 to 3.9 h). This contrasts with the results of previous studies documenting significant increases in tablet bioavailability with food. Despite the lower bioavailability of the syrup, unbound-cefetamet concentrations are expected to remain above the MICs for 90% of the strains tested for susceptible organisms for approximately 10 h of the usual 12-h dosing interval with both syrup and tablet formulations of cefetamet pivoxil given with food. PMID:8109939

Short tip-big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon.

PubMed

Heeger, Christian-H; Wissner, Erik; Mathew, Shibu; Hayashi, Kentaro; Sohns, Christian; Reißmann, Bruno; Lemes, Christine; Maurer, Tilmann; Fink, Thomas; Saguner, Ardan M; Santoro, Francesco; Riedl, Johannes; Ouyang, Feifan; Kuck, Karl-Heinz; Metzner, Andreas

2016-06-01

The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome data. The novel third-generation cryoballoon (CB3) incorporates a 40 % shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). Thirty consecutive patients with paroxysmal or short-standing persistent atrial fibrillation underwent CB3-based PVI and were compared to 30 patients treated with the CB2. Individual freeze-cycle duration was set to TTE + 120 s for both groups. A total of 118 (CB3) and 119 (CB2) pulmonary veins (PV) were identified and all PVs successfully isolated utilizing the CB3 and CB2, respectively. The real-time PVI visualization rate was 74 % (CB3) and 40 % (CB2; p = 0.001) and the mean freeze-cycle duration 204 ± 88 s (CB3) and 215 ± 90 s (CB2; p = 0.15). Per individual PV, a shorter mean freeze-duration was found for the CB3 and the right superior PVs (188 ± 92 vs. 211 ± 124 s, p = 0.04) and right inferior PVs (192 ± 75 vs. 200 ± 37 s, p = 0.02). No differences were found for the left-sided PVs. A higher rate of real-time electrical PV recordings is seen using the novel CB3 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.

Trends of earlier palliative care consultation in advanced cancer patients receiving palliative radiation therapy.

PubMed

Chang, Sanders; Sigel, Keith; Goldstein, Nathan E; Wisnivesky, Juan; Dharmarajan, Kavita V

2018-06-06

The American Society of Clinical Oncology recommends that all patients with metastatic disease receive dedicated palliative care (PC) services early in their illness, ideally via interdisciplinary care teams. We investigated the time trends of specialty palliative care consultations from the date of metastatic cancer diagnosis among patients receiving palliative radiation therapy (PRT). A shorter time interval between metastatic diagnosis and first PC consultation suggests earlier involvement of palliative care in a patient's life with metastatic cancer. In this IRB-approved retrospective analysis, patients treated with PRT for solid tumors (bone and brain) at a single tertiary care hospital between 2010 and 2016 were included. Cohorts were arbitrarily established by metastatic diagnosis within approximately two-year intervals: (1) 1/1/2010-3/27/2012; (2) 3/28/2012-5/21/2014; and (3) 5/22/2014-12/31/2016. Cox-proportional hazards regression modelling was used to compare trends of PC consultation among cohorts. Of 284 patients identified, 184 patients received PC consultation, whereas 15 patients died before receiving a PC consult. Median follow-up time until an event or censor was 257 days (range: 1,900). Patients in the most recent cohort had a shorter median time to first PC consult (57 days) compared to those in the first (374 days) and second (186 days) cohorts. On multivariable analysis, patients in the third cohort were more likely to undergo a PC consultation earlier in their metastatic illness (HR: 1.8, 95% CI: 1.2,2.8). Over a six-year period, palliative care consultation occurred earlier for metastatic patients treated with PRT at our institution. Copyright © 2018. Published by Elsevier Inc.

Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm.

PubMed

Akbulut, Fatih; Kucuktopcu, Onur; Kandemir, Emre; Sonmezay, Erkan; Simsek, Abdulmuttalip; Ozgor, Faruk; Binbay, Murat; Muslumanoglu, Ahmet Yaser; Gurbuz, Gokhan

2016-01-01

To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2 cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40 min, 2.9 min, 22.4 h, and 91.9 min, 6.4 min, and 63.8 h, respectively. All three parameters were significantly shorter among the F-URS group (p < 0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to mini-PNL group (0.39 mg/dL vs. 1.15 mg/dL, p = 0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p = 0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings.

Transition-Tempered Metadynamics Is a Promising Tool for Studying the Permeation of Drug-like Molecules through Membranes.

PubMed

Sun, Rui; Dama, James F; Tan, Jeffrey S; Rose, John P; Voth, Gregory A

2016-10-11

Metadynamics is an important enhanced sampling technique in molecular dynamics simulation to efficiently explore potential energy surfaces. The recently developed transition-tempered metadynamics (TTMetaD) has been proven to converge asymptotically without sacrificing exploration of the collective variable space in the early stages of simulations, unlike other convergent metadynamics (MetaD) methods. We have applied TTMetaD to study the permeation of drug-like molecules through a lipid bilayer to further investigate the usefulness of this method as applied to problems of relevance to medicinal chemistry. First, ethanol permeation through a lipid bilayer was studied to compare TTMetaD with nontempered metadynamics and well-tempered metadynamics. The bias energies computed from various metadynamics simulations were compared to the potential of mean force calculated from umbrella sampling. Though all of the MetaD simulations agree with one another asymptotically, TTMetaD is able to predict the most accurate and reliable estimate of the potential of mean force for permeation in the early stages of the simulations and is robust to the choice of required additional parameters. We also show that using multiple randomly initialized replicas allows convergence analysis and also provides an efficient means to converge the simulations in shorter wall times and, more unexpectedly, in shorter CPU times; splitting the CPU time between multiple replicas appears to lead to less overall error. After validating the method, we studied the permeation of a more complicated drug-like molecule, trimethoprim. Three sets of TTMetaD simulations with different choices of collective variables were carried out, and all converged within feasible simulation time. The minimum free energy paths showed that TTMetaD was able to predict almost identical permeation mechanisms in each case despite significantly different definitions of collective variables.

Once-Daily Ceftriaxone Plus Metronidazole Versus Ertapenem and/or Cefoxitin for Pediatric Appendicitis.

PubMed

Hurst, Amanda L; Olson, Daniel; Somme, Stig; Child, Jason; Pyle, Laura; Ranade, Daksha; Stamatoiu, Alexandra; Crombleholme, Timothy; Parker, Sarah K

2017-03-01

Appendicitis is a common surgical emergency in pediatric patients, and broad-spectrum antibiotic therapy is warranted in their care. A simplified once-daily regimen of ceftriaxone and metronidazole (CTX plus MTZ) is cost effective in perforated patients. The goal of this evaluation is to compare a historic regimen of cefoxitin (CFX) in nonperforated cases and ertapenem (ERT) in perforated and abscessed cases with CTX plus MTZ for all cases in terms of efficacy and cost. A retrospective review compared outcomes of nonperforated, perforated, and abscessed cases who received the historic regimen or CTX plus MTZ. Length of stay, time to afebrile, time to full feeds, postoperative abscess, and wound infection rates, inpatient readmissions, and antibiotic costs were evaluated. There were a total of 841 cases reviewed (494 nonperforated, 247 perforated, and 100 abscessed). Overall, the CTX plus MTZ group had a shorter time to afebrile (P < .001). Treatment groups did not differ in length of stay. Postoperative abscess rates were similar between groups (4.1% vs 3.3%, not significant). Other postoperative complications were similar between groups. Total antibiotic cost savings were over $110 000 during the study period (from November 2010 to June 2013). Both CFX and/or ERT and CTX plus MTZ result in low abscess and complication rates, suggesting both are effective strategies. Treatment with CTX plus MTZ results in a shorter time to afebrile, while also providing significant antibiotic cost savings. Ceftriaxone plus MTZ is a streamlined, cost-effective regimen in the treatment of nonperforated, perforated, and abscessed appendicitis. © The Author 2015. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Facial palsy in children: emergency department management and outcome.

PubMed

Wang, Cheng-Hsien; Chang, Yu-Che; Shih, Hong-Mo; Chen, Chun-Yu; Chen, Jih-Chang

2010-02-01

To describe the characteristics of children who present to an emergency department (ED) with facial palsy and determine the association of outcome with etiology, degree of initial paralysis, and ED management. This was a retrospective cohort study of children who presented to an ED with facial nerve paralysis (FNP). There were 85 patients with a mean age of 8.0 (SD, 6.1) years; 60% (n = 51) of the patients were male, and 65.9% (n = 56) were admitted to the hospital. Bell palsy (50.6%) was the most common etiology followed by infectious (22.4%), traumatic (16.5%), congenital (7.1%), and neoplastic etiologies (3.5%). Patients with Bell palsy had shorter recovery times (P = 0.049), and traumatic cases required a longer time for recovery (P = 0.016). Acute otitis media (AOM)-related pediatric FNP had shorter recovery times than non-AOM-related cases (P = 0.005) in infectious group. Patients given steroid therapy did not have a shorter recovery time (P = 0.237) or a better recovery (P = 0.269). There was no difference in recovery rate of pediatric patients with Bell palsy between hospitalization or not (P = 0.952). Bell palsy, infection, and trauma were most common etiologies of pediatric FNP. Recovery times were shorter in pediatric patients with Bell palsy and AOM-related FNP, whereas recovery took longer in traumatic cases. Steroid therapy did not seem beneficial for pediatric FNP. Hospitalization is not indicated for pediatric patients with Bell palsy.

Bioconcentration of lipophilic compounds by some aquatic organisms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hawker, D.W.; Connell, D.W.

1986-04-01

With nondegradable, lipophilic compounds having log P values ranging from 2 to 6, direct linear relationships have been found between the logarithms of the equilibrium bioconcentration factors, and also reciprocal clearance rate constants, with log P for daphnids and molluscs. These relationships permit calculation of the times required for equilibrium and significant bioconcentration of lipophilic chemicals. Compared with fish, these time periods are successively shorter for molluscs, then daphnids. The equilibrium biotic concentration was found to decrease with increasing chemical hydrophobicity for both molluscs and daphnids. Also, new linear relationships between the logarithm of the bioconcentration factor and log Pmore » were found for compounds not attaining equilibrium within finite exposure times.« less

Comparison of perioperative outcomes between endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps.

PubMed

Huang, Jen-Wu; Huang, Chih-Sheng; Shih, Yu-Chung; Perng, Cherng-Kang; Lin, Yi-Ying; Wu, Szu-Hsien

2018-06-01

The endoscopic technique has been utilized to harvest muscle flaps and detect perforators of fasciocutaneous flaps. This study aimed to compare the perioperative outcomes between the endoscope-assisted technique and handheld acoustic Doppler for perforator identification in fasciocutaneous flaps.This retrospective case-control study included patients who underwent fasciocutaneous flap reconstruction for traumatic soft tissue defects. In the case group, perforator identification was assisted by the endoscope-assisted technique. In the control group, age- and sex-matched patients received handheld acoustic Doppler to detect perforators. Perioperative outcomes, flap characteristics, and postoperative complications were compared.There were 12 patients in the case group and 12 in the control group. Compared with the control group, the case group had a significantly shorter length of donor-site wounds (9 cm vs 12 cm, P = .023) and a significantly smaller proportion of patients receiving skin grafting at the donor sites (0% vs 41.7%, P = .037). The case group had a longer operative time, but the difference was not statistically significant (180 minutes vs 150 minutes, P = .367). The amount of blood loss, the time length of postoperative drainage, and complications did not significantly differ between the 2 groups.The endoscope-assisted technique for perforator identification of fasciocutaneous flaps provided less donor-site morbidity and a significantly shorter length of donor-site wounds than the conventional handheld acoustic Doppler, which suggests that this technique could be a valuable alternative when a precise design is indicated.

Hyperforin alleviates mood deficits of adult rats suffered from early separation.

PubMed

Zhu, Minghui; Liu, Chunhua; Qin, Xuan; Yang, Zhuo

2015-11-03

In this study, we aimed to explore the effect of hyperforin (Hyp) on adult rats suffered from early separation. Wistar infant rats were randomly divided into three groups: control group (CON), early separation from parents group (ESP), and early separation from parents+treatment with 3mg/kg/day Hyp group (ESP+Hyp). Postnatal rats of ESP group and ESP+Hyp group were separated from their mothers for 6h every day on the 14th day after birth, and this separation lasted for 3 weeks, while rats of CON group had no separation. Hyperforin was intragastric administrated on the 21th day after birth, and lasted for 2 weeks in ESP+Hyp group. After separation, adult rats were evaluated by using the open field test (OFT), novelty suppressed feeding test (NSF) and forced swimming test (FST). In OFT, time spent in central grids was much shorter in ESP group compared with that of CON group. After treatment with hyperforin, time spent in central area was much longer compared with that of ESP group. In NSF, the feeding latency of ESP group was much longer than that of CON group. After treatment with hyperforin, the feeding latency was shorter compared with that of ESP group. In FST, score of ESP group was markedly higher than that of CON group. Interestingly, the score was obviously lower in ESP+Hyp group than that of ESP group. In conclusion, these results suggest that hyperforin is able to alleviate anxiety and remit depression in ESP rats. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Crew Factors in Flight Operations 7: Psychophysiological Responses to Overnight Cargo Operations

NASA Technical Reports Server (NTRS)

Gander, Philippa H.; Gregory, Kevin B.; Connell, Linda J.; Miller, Donna L.; Graeber, R. Curtis; Rosekind, Mark R.

1996-01-01

To document the psychophysiological effects of flying overnight cargo operations, 41 B-727 crew members (average age 38 yr) were monitored before, during, and after one of two typical 8-day trip patterns. During daytime layovers, the average sleep episode was 3 hr (41%) shorter than nighttime sleeps and was rated as lighter, less restorative, and poorer overall. Sleep was frequently split into several episodes and totaled 1.2 hr less per 24 hr than on pretrip days. Each trip pattern included a night off, which was an effective countermeasure against the accumulating sleep debt. The organization of sleep during daytime layovers reflected the interaction of duty timing with circadian physiology. The circadian temperature rhythm did not adapt completely to the inverted wake-rest schedule on duty days, being delayed by about 3 hr. Highest subjective fatigue and lowest activation occurred around the time of the temperature minimum. On duty days, reports of headaches increased by 400%, of congested nose by 200%, and of burning eyes by 900%. Crew members also reported eating more snacks. Compared with daytime short-haul air-transport operations, the overnight cargo trips included fewer duty and flight hours, and had longer layovers. Overnight cargo crews also averaged 5.4 yr younger than their daytime short-haul counterparts. On trips, both groups lost a comparable amount of sleep per 24 hr, but the overnight cargo crews had shorter individual sleep episodes and more broken sleep. These data clearly demonstrate that overnight cargo operations, like other night work, involve physiological disruption not found in comparable daytime operations.

I can see what you are saying: Auditory labels reduce visual search times.

PubMed

Cho, Kit W

2016-10-01

The present study explored the self-directed-speech effect, the finding that relative to silent reading of a label (e.g., DOG), saying it aloud reduces visual search reaction times (RTs) for locating a target picture among distractors. Experiment 1 examined whether this effect is due to a confound in the differences in the number of cues in self-directed speech (two) vs. silent reading (one) and tested whether self-articulation is required for the effect. The results showed that self-articulation is not required and that merely hearing the auditory label reduces visual search RTs relative to silent reading. This finding also rules out the number of cues confound. Experiment 2 examined whether hearing an auditory label activates more prototypical features of the label's referent and whether the auditory-label benefit is moderated by the target's imagery concordance (the degree to which the target picture matches the mental picture that is activated by a written label for the target). When the target imagery concordance was high, RTs following the presentation of a high prototypicality picture or auditory cue were comparable and shorter than RTs following a visual label or low prototypicality picture cue. However, when the target imagery concordance was low, RTs following an auditory cue were shorter than the comparable RTs following the picture cues and visual-label cue. The results suggest that an auditory label activates both prototypical and atypical features of a concept and can facilitate visual search RTs even when compared to picture primes. Copyright © 2016 Elsevier B.V. All rights reserved.

Robotic Liver Resection: A Case-Matched Comparison.

PubMed

Kingham, T Peter; Leung, Universe; Kuk, Deborah; Gönen, Mithat; D'Angelica, Michael I; Allen, Peter J; DeMatteo, Ronald P; Laudone, Vincent P; Jarnagin, William R; Fong, Yuman

2016-06-01

In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic hepatectomy, however, is still in its infancy. Our goals were to examine the adoption of robotic hepatectomy and to compare outcomes between open and robotic liver resections. The robotic hepatectomy experience of 64 patients was compared to a modern case-matched series of 64 open hepatectomy patients at the same center. Matching was according to benign/malignant diagnosis and number of segments resected. Patient data were obtained retrospectively. The main outcomes and measures were operative time, estimated blood loss, conversion rate (robotic to open), Pringle maneuver use, single non-anatomic wedge resection rate, resection margin size, complication rates (infectious, hepatic, pulmonary, cardiac), hospital stay length, ICU stay length, readmission rate, and 90-day mortality rate. Sixty-four robotic hepatectomies were performed in 2010-2014. Forty-one percent were segmental and 34 % were wedge resections. There was a 6 % conversion rate, a 3 % 90-day mortality rate, and an 11 % morbidity rate. Compared to 64 matched patients who underwent open hepatectomy (2004-2012), there was a shorter median OR time (p = 0.02), lower median estimated blood loss (p < 0.001), and shorter median hospital stay (p < 0.001). Eleven of the robotic cases were isolated resections of tumors in segments 2, 7, and 8. Robotic hepatectomy is safe and effective. Increasing experience in more centers will allow definition of which hepatectomies can be performed robotically, and will enable optimization of outcomes and prospective examination of the economic cost of each approach.

The Direct Anterior Approach Does Not Increase Return to Function Following Hemiarthroplasty for Femoral Neck Fracture.

PubMed

Carlson, Victor R; Ong, Alvin C; Orozco, Fabio R; Lutz, Rex W; Duque, Andres F; Post, Zachary D

2017-11-01

The purpose of this study was to evaluate functional outcomes for hemiarthroplasty using a direct anterior approach or a direct lateral approach for femoral neck fracture. This retrospective review used data collected from a single institution between 2006 and 2016. Eighty-five and 75 consecutive patients who underwent hemiarthroplasty via a direct anterior approach and a direct lateral approach, respectively, met inclusion criteria. All patients with femoral neck fractures were treated by 1 of 2 fellowship-trained orthopedic surgeons using the direct anterior approach or the direct lateral approach to hemiarthroplasty. Disposition, ambulation, and other perioperative surgical outcomes were compared between the cohorts. Compared with the direct lateral cohort, the direct anterior cohort had a shorter mean operative time (2.4 minutes, P<.01), a shorter mean length of hospital stay (2.7 days, P<.01), and a smaller mean decrease in hemoglobin postoperatively (0.7 g/dL, P<.01). No significant difference was observed between the cohorts for postoperative disposition, the number of feet ambulated on the second postoperative day, or the prevalence of ambulatory decline at 4- to 6-week and 4- to 6-month follow-up visits. Compared with the direct lateral approach, the direct anterior approach may benefit patients by small, but statistically significant, improvements in blood loss, surgical time, and length of hospital stay after hemiarthroplasty. However, the direct anterior approach does not appear to decrease the likelihood of transfer to a skilled nursing facility postoperatively or accelerate return to preoperative function. [Orthopedics. 2017; 40(6):e1055-e1061.]. Copyright 2017, SLACK Incorporated.

Comparative analysis of human gait while wearing thong-style flip-flops versus sneakers.

PubMed

Shroyer, Justin F; Weimar, Wendi H

2010-01-01

Flip-flops are becoming a common footwear option. Casual observation has indicated that individuals wear flip-flops beyond their structural limit and have a different gait while wearing flip-flops versus shoes. This alteration in gait may cause the anecdotal foot and lower-limb discomfort associated with wearing flip-flops. To investigate the effect of sneakers versus thong-style flip-flops on gait kinematics and kinetics, 56 individuals (37 women and 19 men) were randomly assigned to a footwear order (flip-flops or sneakers first) and were asked to wear the assigned footwear on the day before and the day of testing. On each testing day, participants were videotaped as they walked at a self-selected pace across a force platform. A 2 (sex) x 2 (footwear) repeated-measures analysis of variance (P = .05) was used for statistical analysis. Significant interaction effects of footwear and sex were found for maximal anterior force, attack angle, and ankle angle during the swing phase. Footwear significantly affected stride length, ankle angle at the beginning of double support and during the swing phase, maximal braking impulse, and stance time. Flip-flops resulted in a shorter stride, a larger ankle angle at the beginning of double support and during the swing phase, a smaller braking impulse, and a shorter stance time compared with sneakers. The effects of footwear on gait kinetics and kinematics is extensive, but there is limited research on the effect of thong-style flip-flops on gait. These results suggest that flip-flops have an effect on several kinetic and kinematic variables compared with sneakers.

EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques.

PubMed

Chen, Yen-I; Kunda, Rastislav; Storm, Andrew C; Aridi, Hanaa Dakour; Thompson, Christopher C; Nieto, Jose; James, Theodore; Irani, Shayan; Bukhari, Majidah; Gutierrez, Olaya Brewer; Agarwal, Amol; Fayad, Lea; Moran, Robert; Alammar, Nuha; Sanaei, Omid; Canto, Marcia I; Singh, Vikesh K; Baron, Todd H; Khashab, Mouen A

2018-05-01

EUS-guided gastroenterostomy (EUS-GE) is a developing modality in the management of gastric outlet obstruction (GOO) with several technical approaches, including the direct and balloon-assisted techniques. The aim of this study was to compare the direct with the balloon-assisted modality while further defining the role of EUS-GE in GOO. This multicenter, retrospective study involved consecutive patients who underwent EUS-GE with the direct or balloon-assisted technique for GOO (January 2014 to October 2016). The primary outcome was technical success. Secondary outcomes were success (ability to tolerate at least a full fluid diet), procedure time, and rate/severity of adverse events (AEs). A total of 74 patients (44.6% women; mean age 63.0 ± 11.7 years) underwent EUS-GE for GOO (direct gastroenterostomy, n = 52; balloon-assisted gastroenterostomy, n = 22). GOO was of malignant and benign etiology in 66.2% and 33.8% of patients, respectively. Technical success was achieved in 94.2% of the direct and 90.9% of the balloon-assisted approach (P = .63). Mean procedure time was shorter with the direct technique (35.7 ± 32.1 minutes vs 89.9 ± 33.3 minutes, P < .001). The clinical success rate was 92.3% for the direct technique and 90.9% for the balloon-assisted modality (P = 1.00), with a mean time to oral intake of 1.32 ± 2.76 days. The AE rate was 6.8% with only 1 severe AE noted. Rate of AEs, postprocedure length of stay, need for reintervention, and survival were similar between the 2 groups. EUS-GE is effective and safe in the management of GOO. The direct technique may be the preferred method given its shorter procedure time when compared with the balloon-assisted approach. Prospective trials are needed to confirm these findings. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Comparison of dexmedetomidine and propofol for conscious sedation in awake craniotomy: a prospective, double-blind, randomized, and controlled clinical trial.

PubMed

Shen, She-liang; Zheng, Jia-yin; Zhang, Jun; Wang, Wen-yuan; Jin, Tao; Zhu, Jing; Zhang, Qi

2013-11-01

It has been reported that dexmedetomidine (DEX) can be used for conscious sedation in awake craniotomy, but few data exist to compare DEX versus propofol (PRO). To compare the efficacy and safety of DEX versus PRO for conscious sedation in awake craniotomy. Thirty patients of American Society of Anesthesiologists grade I-II scheduled for awake craniotomy, were randomized into 2 groups each containing 15 subjects. Group D received DEX and group P received PRO. Two minutes after tracheal intubation (T1), PRO (target plasma concentration) was titrated down to 1 to 4 µg/mL in group P. In group D, PRO was discontinued and DEX was administered 1.0 µg/kg followed by a maintenance dose of 0.2 to 0.7 µg/kg/h. The surgeon preset the anticipated awake point-in-time (T0) preoperatively. Ten minutes before T0 (T3), DEX was titrated down to 0.2 µg/kg/h in group D, PRO was discontinued and normal saline (placebo) 5 mL/h was infused in group P. Arousal time, quality of revival and adverse events during the awake period, degree of satisfaction from surgeons and patients were recorded. Arousal time was significantly shorter in group D than in group P (P < .001). The quality of revival during the awake period in group D was similar to that of group P (P = .68). The degree of satisfaction of surgeons was significantly higher in group D than in group P (P < .001), but no difference was found between the 2 groups with respect to patient satisfaction (P = .80). There was no difference between the 2 groups in the incidence of adverse events during the awake period (P > .05). Either DEX or PRO can be effectively and safely used for conscious sedation in awake craniotomy. Comparing the two, DEX produced a shorter arousal time and a higher degree of surgeon satisfaction.

Laparoscopic versus open repair for perforated peptic ulcer: A meta analysis of randomized controlled trials.

PubMed

Tan, Shanjun; Wu, Guohao; Zhuang, Qiulin; Xi, Qiulei; Meng, Qingyang; Jiang, Yi; Han, Yusong; Yu, Chao; Yu, Zhen; Li, Ning

2016-09-01

The role of laparoscopic surgery in the repair for peptic ulcer disease is unclear. The present study aimed to compare the safety and efficacy of laparoscopic versus open repair for peptic ulcer disease. Randomized controlled trials (RCTs) comparing laparoscopic versus open repair for peptic ulcer disease were identified from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and references of identified articles and relevant reviews. Primary outcomes were postoperative complications, mortality, and reoperation. Secondary outcomes were operative time, postoperative pain, postoperative hospital stay, nasogastric tube duration, and time to resume diet. Statistical analysis was carried out by Review Manage software. Five RCTs investigating a total of 549 patients, of whom, 279 received laparoscopic repair and 270 received open repair, were included in the final analysis. There were no significant differences between these two procedures in some primary outcomes including overal postoperative complication rate, mortality, and reoperation rate. Subcategory analysis of postoperative complications showed that laparoscopic repair had also similar rates of repair site leakage, intra-abdominal abscess, postoperative ileus, pneumonia, and urinary tract infection as open surgery, except of the lower surgical site infection rate (P < 0.05). In addition, there were also no significant differences between these two procedures in some second outcomes including operative time, postoperative hospital stay, and time to resume diet, but laparoscopic repair had shorter nasogastric tube duration (P < 0.05) and less postoperative pain (P < 0.05) than open surgery. Laparoscopic surgery is comparable with open surgery in the setting of repair for perforated peptic ulcer. The obvious advantages of laparoscopic surgery are the lower surgical site infection rate, shorter nasogastric tube duration and less postoperative pain. However, more higher quality studies should be undertaken to further assess the safety and efficacy of laparoscopic repair for peptic ulcer disease. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

PubMed

Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

1993-01-01

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

Non-random temporary emigration and the robust design: Conditions for bias at the end of a time series: Section VIII

USGS Publications Warehouse

Langtimm, Catherine A.

2008-01-01

Knowing the extent and magnitude of the potential bias can help in making decisions as to what time frame provides the best estimates or the most reliable opportunity to model and test hypotheses about factors affecting survival probability. To assess bias, truncating the capture histories to shorter time frames and reanalyzing the data to compare time-specific estimates may help identify spurious effects. Running simulations that mimic the parameter values and movement conditions in the real situation can provide estimates of standardized bias that can be used to identify those annual estimates that are biased to the point where the 95% confidence intervals are inadequate in describing the uncertainty of the estimates.

Depressive and Anxiety Disorders Showing Robust, but Non-Dynamic, 6-Year Longitudinal Association With Short Leukocyte Telomere Length.

PubMed

Verhoeven, Josine E; van Oppen, Patricia; Révész, Dóra; Wolkowitz, Owen M; Penninx, Brenda W J H

2016-06-01

Several cross-sectional studies have related depressive and anxiety disorders to shorter leukocyte telomere length (LTL) as an indicator of cellular aging. However, these studies have left many unresolved questions about underlying causality and ordering of associations. The objective of the present large, longitudinal study was to examine the relationship between depressive and anxiety disorders and LTL over a 6-year time period. Data are from the Netherlands Study of Depression and Anxiety, including 2,292 patients with remitted and current diagnoses of depressive or anxiety disorders and 644 healthy control subjects. LTL was assessed using quantitative PCR and measured at baseline and after 6 years; depressive and anxiety disorder diagnoses and characteristics (course, duration, and severity) were determined at baseline and after 2, 4, and 6 years. Results showed that persons with remitted (B=-52.6) and current (B=-60.8) depressive or anxiety disorder had consistently shorter LTL compared with healthy control subjects across baseline and at the 6-year follow-up, remaining significant when controlling for lifestyle and somatic health variables. Changes in the course of depressive or anxiety disorder characteristics over 6 years, however, were not associated with different LTL attrition rates. This study confirmed robust associations of depressive and anxiety disorders with shorter telomeres, but interestingly, it did not demonstrate that depressive and anxiety disorders and LTL change together over time, suggesting the absence of a direct within-person relationship. Short LTL is suggested to be either a long-term consequence or an underlying vulnerability factor for depressive or anxiety disorders.

High Numbers of Stromal Cancer-Associated Fibroblasts Are Associated With a Shorter Survival Time in Cats With Oral Squamous Cell Carcinoma.

PubMed

Klobukowska, H J; Munday, J S

2016-11-01

Cancer-associated fibroblasts (CAFs) are fibroblastic cells that express α-smooth muscle actin and have been identified in the stroma of numerous epithelial tumors. The presence of CAFs within the tumor stroma has been associated with a poorer prognosis in some human cancers, including oral squamous cell carcinomas (SCCs). Cats frequently develop oral SCCs, and although these are generally highly aggressive neoplasms, there is currently a lack of prognostic markers for these tumors. The authors investigated the prognostic value of the presence of CAFs within the stroma of oral SCC biopsy specimens from 47 cats. In addition, several epidemiologic, clinical, and histologic variables were also assessed for prognostic significance. A CAF-positive stroma was identified in 35 of 47 SCCs (74.5%), and the median survival time (ST) of cats with CAF-positive SCCs (35 days) was significantly shorter than that of cats with CAF-negative SCCs (48.5 days) (P = .031). ST was also associated with the location of the primary tumor (P = .0018): the median ST for oropharyngeal SCCs (179 days) was significantly longer than for maxillary (43.5 days; P = .047), mandibular (42 days; P = .022), and sublingual SCCs (22.5 days; P = .0005). The median ST of sublingual SCCs was also shorter compared with maxillary SCCs (P = .0017). Furthermore, a significant association was identified between site and the presence of stromal CAFs (P = .025). On the basis of this retrospective study, evaluating the tumor stroma for CAFs in feline oral SCC biopsy specimens may be of potential prognostic value. © The Author(s) 2016.

The Brief Death Implicit Association Test: Scoring recommendations, reliability, validity, and comparisons with the Death Implicit Association Test.

PubMed

Millner, Alexander J; Coppersmith, Daniel D L; Teachman, Bethany A; Nock, Matthew K

2018-05-21

Assessing suicidal thoughts and behaviors is difficult because at-risk individuals often fail to provide honest or accurate accounts of their suicidal thoughts or intentions. Research has shown that the Death Implicit Association Test (D-IAT), a behavioral test that measures implicit (i.e., outside of conscious control) associations between oneself and death concepts, can differentiate among people with different suicidal histories, such as those with different severity or recency of suicidal behaviors. We report here on the development and evaluation of a shorter and simpler version of the D-IAT called the Death Brief Implicit Association Test (D-BIAT). We recruited large (ns > 1,500) samples of participants to complete the original D-IAT and shorter D-BIAT via a public web-based platform and evaluated different scoring approaches, assessed the reliability and validity of the D-BIAT and compared it with the D-IAT. We found that the D-BIAT was reliable, provided significant group differences with effect sizes on par with the D-IAT, as well as similarly sized classification metrics (i.e., receiver operator characteristics). Although the D-IAT was nonsignificantly better on most outcomes, the D-BIAT is 1-1[1/2] minutes shorter and provided larger effect sizes for distinguishing between past year and lifetime attempters. Thus, there is a trade-off between administration time and improved outcomes associated with increased data. The D-BIAT should be considered for use where time or participant burden needs to be minimized, such as in clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sedation protocol with fasting and shorter sleep leads to magnetic resonance imaging success.

PubMed

Kimiya, Takahisa; Sekiguchi, Shinichiro; Yagihashi, Tatsuhiko; Arai, Mie; Takahashi, Hirotaka; Takahashi, Takao

2017-10-01

Young children undergoing magnetic resonance imaging (MRI) require sedation. In June 2013, Tokyo Metropolitan Ohtsuka Hospital (TMOH) introduced an oral sedation protocol for young children undergoing MRI; the protocol included instructions on fasting before sedation, and recommended a shorter duration of sleep the night before MRI. We compared the MRI success rate before and after the introduction of this protocol. The eligible subjects were children under 3 years old who underwent MRI by appointment at TMOH between October 2012 and March 2014, under sedation with triclofos sodium. All those who underwent MRI in or after June 2013 were enrolled prospectively as a post-protocol group. All patients who underwent MRI before June 2013 were enrolled retrospectively as a pre-protocol group, with data collected from chart review. Seventy-four patients were enrolled in the post-protocol group, and 42 in the pre-protocol group. The MRI success rate was significantly higher in the post-protocol group than in the pre-protocol group (98.7% vs 88.1%), as was the rate of on-time starting of MRI (86.5% vs 71.4%). The post-protocol group woke up earlier on the day of examination (6:18 a.m. vs 6:43 a.m.), resulting in a significantly longer time between awakening and the beginning of sedation (289.8 min vs 265.9 min), and a significantly shorter average duration of sleep on the previous night (504.8 min vs 532.3 min). Implementation of a hospital-wide sedation protocol for young children undergoing MRI significantly improved the MRI success rate. © 2017 Japan Pediatric Society.

Normal sleep on mechanical ventilation in adult patients with congenital central alveolar hypoventilation (Ondine's curse syndrome).

PubMed

Attali, Valérie; Straus, Christian; Pottier, Michel; Buzare, Marie-Annick; Morélot-Panzini, Capucine; Arnulf, Isabelle; Similowski, Thomas

2017-01-23

The purpose of this study was to describe the sleep structure (especially slow wave sleep) in adults with congenital central hypoventilation syndrome (CCHS), a rare genetic disease due to mutations in the PHOX2B gene. Fourteen patients aged 23 (19.0; 24.8) years old (median [1 rst -3rd quartiles]) with CCHS underwent a sleep interview and night-time attended polysomnography with their ventilatory support. Their sleep variables were compared to those collected in 15 healthy control subjects matched for age, sex and body mass index. The latency to N3 sleep was shorter in patients (26.3 min [24.0; 30.1]) than in controls (49.5 min [34.3; 66.9]; P = 0.005), and sleep onset latency tended to be shorter in patients (14.0 min [7.0; 20.5]) than in controls (33.0 min [18.0; 49.0]; P = 0.052). Total sleep time, sleep stage percentages, sleep fragmentation as well as respiratory and movement index were within normal ranges and not different between groups. Normal sleep in adult patients with CCHS and adequate ventilator support indicates that the PHOX2 gene mutations do not affect brain sleep networks. Consequently, any complaint of disrupted sleep should prompt clinicians to look for the usual causes of sleep disorders, primarily inadequate mechanical ventilation. Shorter N3 latency may indicate a higher need for slow wave sleep, to compensate for the abnormal respiratory-related cortical activity during awake quiet breathing observed in patients with CCH.

The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques.

PubMed

Lotan, Yair; Cadeddu, Jeffrey A; Gettman, Matthew T

2004-10-01

We evaluated the costs components of laparoscopic (LRP) and robot assisted prostatectomy (RAP), and compared their costs to those of open radical retropubic prostatectomy (RRP). A model was created using commercially available software to compare the costs of treatment with LRP, RAP or RRP. Hospital costs were obtained from a large county hospital. A literature search was performed to determine typical (average) robot costs, length of stay and operative time for RRP, LRP and RAP. We limited our analysis to mature series and included only the most recent efforts. The cost of the robot was estimated at 1,200,000 dollars with a 100,000 dollars yearly maintenance contract. It was assumed that the robot would be used across specialities for a total of 300 cases yearly in a 7-year period. We performed a series of 1 and 2-way sensitivity analyses to evaluate the costs of LRP, RAP and RRP, while varying robot costs, the number of robotic cases, hospital length of stay, operative time and cost of laparoscopic/robotic equipment. RRP was the most cost-effective approach with a cost advantage of 487 dollars and 1,726 dollars over LRP and RAP, respectively. If we excluded the initial cost of purchasing a robot, the cost difference between RRP and RAP was 1,155 dollars. This large difference in RRP and RAP costs resulted from a cost of 857 dollars per case to pay for robot purchase and maintenance, and the high cost of 1,705 dollars for equipment per case. An even shorter RAP operative time (140 vs 160 minutes) and length of stay (1.2 vs 2.5 days) did not compensate for the added expenditure. LRP cost more than RRP primarily due to equipment costs (533 dollars) since the shorter hospital stay (1.3 vs 2.5 days) was compensated for by longer operative time (200 vs 160 minutes). The costs of new technology are typically borne out in the first years of use and RAP is no exception with high robot costs for purchase, maintenance and operative equipment overshadowing savings gained by shorter length of stay. While RRP is currently the least costly approach, LRP has proved to be almost as cost competitive as RRP, whereas RAP will require a significant decrease in the cost of the device and maintenance fees.

Loop-Mediated Isothermal Amplification Test for Trypanosoma gambiense Group 1 with Stem Primers: A Molecular Xenomonitoring Test for Sleeping Sickness.

PubMed

Njiru, Zablon K; Mbae, Cecilia K; Mburugu, Gitonga N

2017-01-01

The World Health Organization has targeted Human African Trypanosomiasis (HAT) for elimination by 2020 with zero incidence by 2030. To achieve and sustain this goal, accurate and easy-to-deploy diagnostic tests for Gambian trypanosomiasis which accounts for over 98% of reported cases will play a crucial role. Most needed will be tools for surveillance of pathogen in vectors (xenomonitoring) since population screening tests are readily available. The development of new tests is expensive and takes a long time while incremental improvement of existing technologies that have potential for xenomonitoring may offer a shorter pathway to tools for HAT surveillance. We have investigated the effect of including a second set of reaction accelerating primers (stem primers) to the standard T. brucei gambiense LAMP test format. The new test format was analyzed with and without outer primers. Amplification was carried out using Rotorgene 6000 and the portable ESE Quant amplification unit capable of real-time data output. The stem LAMP formats indicated shorter time to results (~8 min), were 10-100-fold more sensitive, and indicated higher diagnostic sensitivity and accuracy compared to the standard LAMP test. It was possible to confirm the predicted product using ESE melt curves demonstrating the potential of combining LAMP and real-time technologies as possible tool for HAT molecular xenomonitoring.

Pulsed CO2 Laser Ablation of Superficial Basal Cell of Limbs and Trunk: A Comparative Randomized Clinical Trial With Cryotherapy and Surgical Ablation.

PubMed

Zane, Cristina; Facchinetti, Elena; Arisi, Mariachiara; Ortel, Bernhard; Calzavara-Pinton, Piergiacomo

2017-07-01

Pulsed CO2 laser is a treatment of superficial basal cell carcinoma (sBCC) although robust clinical evidence has not been reported so far. The authors investigated efficacy, safety, time to wound healing, cosmetic outcome, patient satisfaction, and cost-effectiveness ratio of pulsed CO2 laser in comparison to cryotherapy and surgery. BCCs of the trunk and extremities were randomized to one of the treatments. After 90 days, efficacy and cosmetic outcome were assessed. Patients recorded the time to complete healing of the wound and scored their overall satisfaction. Two hundred forty patients were randomized. After 3 months, complete remission (CR) rate with pulsed CO2 laser was 78.8%. This was significantly lower than surgery, whereas the CR rate with cryotherapy was not significantly different. Cosmetic result was better with surgery. High satisfaction was reported by 65.0% of patients treated with CO2 ablation. Time of wound healing was significantly shorter with CO2 laser. In comparison to cryotherapy, pulsed CO2 laser showed no statistically significant difference in efficacy, cosmetic outcome, and patient satisfaction. Time to healing was shorter; the cost and cost-effectiveness ratio were similar. Surgery had the greatest efficacy rate. The main limitation of this study was the short duration of follow-up (3 months).

The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI.

PubMed

Oh, Mi Mi; Kim, Jin Wook; Park, Min Gu; Kim, Je Jong; Yoo, Kee Hwan; Moon, Du Geon

2012-03-01

We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR). 230 children, 90 girls and 140 boys with first febrile UTI were included. Radiologic (USG, DMSA, and VCUG), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (CBC with differential count, ANC (absolute neutrophil count), BUN, Creatinine, urine analysis, gram stain, culture, CRP and ESR) variables were analysed. DMSA was performed within 5 days and after six months. VCUG was performed after acute phase of UTI. The differences in TDT according to the presence of ASL, USF and VUR were assessed. And the correlation between ASL or USF with the duration of TDT was assessed. Of 230 patients enrolled, 142 patients had refluxing UTI and 88 patients had non-refluxing UTI. TDT was the risk factor associated with ASL and USF along with presence of VUR. TDT was longer in ASL positive group compared with the ASL negative group. Also USF group showed longer TDT compared with those without USF in both refluxing UTI and non refluxing UTI. The TDT was significantly shorter in USF group with the presence of VUR. Positive linear association was noted between prevalence of ASL and USF and duration of TDT. In conclusion, the impact of UTI on formation of USF may be enhanced by the presence of VUR with shorter duration of TDT.

Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

PubMed Central

Eshghi, Alireza; Mohammadpour, Mehrnaz; Kaviani, Nasser; Tahririan, Dana; Akhlaghi, Najmeh

2016-01-01

Background: Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the efficacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age. Materials and Methods: In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test. Results: The BIS value was significantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was significantly shorter in remifentanil group (P = 0.008 and P = 0.003). Conclusion: It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures. PMID:26962308

Interactive vs passive screen time and nighttime sleep duration among school-aged children

PubMed Central

Yland, Jennifer; Guan, Stanford; Emanuele, Erin; Hale, Lauren

2016-01-01

Background Insufficient sleep among school-aged children is a growing concern, as numerous studies have shown that chronic short sleep duration increases the risk of poor academic performance and specific adverse health outcomes. We examined the association between weekday nighttime sleep duration and 3 types of screen exposure: television, computer use, and video gaming. Methods We used age 9 data from an ethnically diverse national birth cohort study, the Fragile Families and Child Wellbeing Study, to assess the association between screen time and sleep duration among 9-year-olds, using screen time data reported by both the child (n = 3269) and by the child's primary caregiver (n= 2770). Results Within the child-reported models, children who watched more than 2 hours of television per day had shorter sleep duration by approximately 11 minutes per night compared to those who watched less than 2 hours of television (β = −0.18; P < .001). Using the caregiver-reported models, both television and computer use were associated with reduced sleep duration. For both child- and parent-reported screen time measures, we did not find statistically significant differences in effect size across various types of screen time. Conclusions Screen time from televisions and computers is associated with reduced sleep duration among 9-year-olds, using 2 sources of estimates of screen time exposure (child and parent reports). No specific type or use of screen time resulted in significantly shorter sleep duration than another, suggesting that caution should be advised against excessive use of all screens. PMID:27540566

Comparison of Delta-Shape Anastomosis and Extracorporeal Billroth I Anastomosis after Laparoscopic Distal Gastrectomy for Gastric Cancer: A Systematic Review with Meta-Analysis of Short-Term Outcomes.

PubMed

Hu, Geng-Yuan; Tao, Feng; Ji, Ke-Wei; Wang, Wei

2016-01-01

The aim of this systematic review and meta-analysis is to evaluate the safety and relative benefits of delta-shape anastomosis (DA) by comparing to conventional laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy (LADG BI). Studies and relevant literature regarding DA versus LADG BI were searched in the electronic databases. Operation time, postoperative complications, estimated blood loss, number of retrieved lymph nodes, time to first flatus, time to oral intake, length of postoperative hospitalization in DA and LADG BI were pooled and compared using meta-analysis. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of DA. Eight studies of 1739 patients were included in the meta-analysis. Compared with LADG BI, DA had shorter postoperative hospitalization (WMD = -0.47, 95%CI: -0.69 to -0.25, P<0.01), less blood loss (WMD = - 25.90, 95%CI: -43.11 to -8.70, P<0.01), shorter time to oral intake (WMD = -0.25, 95%CI: -0.49 to -0.01, P = 0.04), and more retrieved lymph nodes (WMD = 1.36, 95%CI: 0.30 to 2.43, P = 0.01). Operation time (WMD = -0.07, 95%CI -15.58 to 15.43, P = 0.99), overall postoperative complication rate (OR = 1.05, 95%CI: 0.74 to 1.49, P = 0.63), surgical complication rate (OR = 1.02, 95%CI: 0.70 to 1.49, P = 0.90), nonsurgical complication rate (OR = 1.21, 95%CI: 0.54 to 2.72, P = 0.64), leakage rate (OR = 2.54, 95%CI: 0.92 to 7.01, P = 0.07), stricture rate (OR = 0.36, 95%CI: 0.09 to 1.44, P = 0.15), wound complication rate (OR = 0.71, 95%CI: 0.33 to 1.55, P = 0.39), time to first flatus (WMD = -0.10, 95%CI: -0.27 to 0.07, P = 0.26), and proximal surgical margin (WMD = -0.25, 95%CI: -1.14 to 0.65, P = 0.59) was not statistically different. Compared with LADG BI, DA is a safe and feasible procedure, with significantly reduced blood loss, time to oral intake, and postoperative hospitalization.

Closure of colostomy.

PubMed Central

Beck, P H; Conklin, H B

1975-01-01

We analyzed the records of 77 cases of loop colostomy closure in Vietnam War Casualties. All records were complete from the date of injury to discharge following colostomy closure. Simple of the loop colostomy was performed in 44 patients and resection of the stoma and reanastomosis of bowel segments was performed in 33 patients. Average operating time for simple closure of the loop was 70 minutes compared to 115 minutes for resection and anastomosis. Nasogastric suction was used less frequently and for a shorter time with simple loop closure. The total postoperative complication rate was 9% with simple loop closure as compared to 24% for resection and anastomosis. Simple closure of the loop described in this report is technically easier and as safe as resection of the stoma and reanastomosis. Images Fig. 1. PMID:1094967

Autocorrelated process control: Geometric Brownian Motion approach versus Box-Jenkins approach

NASA Astrophysics Data System (ADS)

Salleh, R. M.; Zawawi, N. I.; Gan, Z. F.; Nor, M. E.

2018-04-01

Existing of autocorrelation will bring a significant effect on the performance and accuracy of process control if the problem does not handle carefully. When dealing with autocorrelated process, Box-Jenkins method will be preferred because of the popularity. However, the computation of Box-Jenkins method is too complicated and challenging which cause of time-consuming. Therefore, an alternative method which known as Geometric Brownian Motion (GBM) is introduced to monitor the autocorrelated process. One real case of furnace temperature data is conducted to compare the performance of Box-Jenkins and GBM methods in monitoring autocorrelation process. Both methods give the same results in terms of model accuracy and monitoring process control. Yet, GBM is superior compared to Box-Jenkins method due to its simplicity and practically with shorter computational time.

Novel Analytic Methods Needed for Real-Time Continuous Core Body Temperature Data

PubMed Central

Hertzberg, Vicki; Mac, Valerie; Elon, Lisa; Mutic, Nathan; Mutic, Abby; Peterman, Katherine; Tovar-Aguilar, J. Antonio; Economos, Jeannie; Flocks, Joan; McCauley, Linda

2017-01-01

Affordable measurement of core body temperature, Tc, in a continuous, real-time fashion is now possible. With this advance comes a new data analysis paradigm for occupational epidemiology. We characterize issues arising after obtaining Tc data over 188 workdays for 83 participating farmworkers, a population vulnerable to effects of rising temperatures due to climate change. We describe a novel approach to these data using smoothing and functional data analysis. This approach highlights different data aspects compared to describing Tc at a single time point or summaries of the time course into an indicator function (e.g., did Tc ever exceed 38°C, the threshold limit value for occupational heat exposure). Participants working in ferneries had significantly higher Tc at some point during the workday compared to those working in nurseries, despite a shorter workday for fernery participants. Our results typify the challenges and opportunities in analyzing big data streams from real-time physiologic monitoring. PMID:27756853

Novel Analytic Methods Needed for Real-Time Continuous Core Body Temperature Data.

PubMed

Hertzberg, Vicki; Mac, Valerie; Elon, Lisa; Mutic, Nathan; Mutic, Abby; Peterman, Katherine; Tovar-Aguilar, J Antonio; Economos, Eugenia; Flocks, Joan; McCauley, Linda

2016-10-18

Affordable measurement of core body temperature (T c ) in a continuous, real-time fashion is now possible. With this advance comes a new data analysis paradigm for occupational epidemiology. We characterize issues arising after obtaining T c data over 188 workdays for 83 participating farmworkers, a population vulnerable to effects of rising temperatures due to climate change. We describe a novel approach to these data using smoothing and functional data analysis. This approach highlights different data aspects compared with describing T c at a single time point or summaries of the time course into an indicator function (e.g., did T c ever exceed 38 °C, the threshold limit value for occupational heat exposure). Participants working in ferneries had significantly higher T c at some point during the workday compared with those working in nurseries, despite a shorter workday for fernery participants. Our results typify the challenges and opportunities in analyzing big data streams from real-time physiologic monitoring. © The Author(s) 2016.

The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial.

PubMed

Delibegović, Samir; Mehmedovic, Zlatan

2018-05-01

During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method. The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome. No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044). All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.

Clinical characteristics and outcome of pauci-immune glomerulonephritis in African Americans.

PubMed

Geetha, Duvuru; Poulton, Caroline J; Hu, Yichun; Seo, Philip; McGregor, Julie Anne G; Falk, Ronald J; Hogan, Susan L

2014-06-01

Pauci-immune glomerulonephritis is rare in African Americans (AA) and the clinical presentation and treatment outcomes of vasculitis have not been well described. We identified patients who were 2-92 years of age between 1983 and 2011 with a diagnosis of biopsy-proven pauci-immune glomerulonephritis (GN) at any point during their disease course. Comparing AA to Caucasian patients, we examined demographics, clinical features at presentation, treatment and outcomes of relapse, end-stage renal disease (ESRD), and death. Of the 672 patients, 75 were AA with the remainder being Caucasian. Compared to Caucasians, disease onset in AA was at an earlier age (52 vs. 57 years, p = 0.05) and was more often myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) positive (71% vs. 54%, p = 0.01). AA patients had a shorter median time between onset of symptoms and biopsy compared to Caucasians [median (IQR): 0.23 (0.00, 1.22) months vs. 0.66 (0.00, 3.62) months, p = 0.003]. Median [Interquartile range (IQR)] follow-up in months was 28 (5, 52) in AA and 26 (10, 55) in Caucasian patients. Median estimated glomerular filtration rate was similar at presentation (21 vs. 22 ml/min/m(2)). Both groups had similar induction treatment regimens. There was less favorable treatment response among AA compared to Caucasians for initial treatment resistance (28% vs. 18%, p = 0.05) and complete remission (72% vs. 82%, p = 0.05). There were no differences in the number of renal relapses or number of deaths between the 2 groups. Overall, in multivariable analyses controlling for age, race, ANCA type, and entry serum creatinine, there were not differences by race in treatment response, renal relapse, ESRD, or death over the entire time of follow-up. AA patients with pauci-immune GN are younger and more often MPO-ANCA positive compared to Caucasians. Despite a shorter time to diagnosis for AA patients, there were no differences compared to Caucasians in treatment response, ESRD, renal relapse, or death rates by race over the entire duration of follow-up. © 2013 Published by Elsevier Inc.

[Clinical study of tissue-selecting therapy in the treatment of mixed hemorrhoids: a single-blind randomized controlled trail].

PubMed

He, Hongyan; He, Ping; Liu, Ning

2014-06-01

To evaluate the clinical efficacy and safety of tissue-selecting therapy (TST) in treatment of mixed hemorrhoids. A single-blind randomized study was carried out. A total of 120 patients with mixed hemorrhoids from January to December 2012 were prospectively enrolled in the study and equally divided into two groups, TST group and procedure for prolapse and hemorrhoids(PPH) group. Surgical data, efficacy and postoperative complications were compared between the two groups. As compared to PPH group, patients in TST group had shorter operation time [(15.9±5.18) min vs. (22.6±7.1) min, P<0.05], lower scores of rectal urgency (0.5±0.2 vs. 1.5±1.4, P<0.05), and shorter hospital stay [(11.2±3.7) d vs. (14.8±3.7) d, P<0.05]. No anastomotic stricture case was found in TST group, while 11 cases(18.3%) developed anastomotic stricture in PPH group. There were no significant differences in effective rate and pain score of first defecation between the two groups. TST is reliable and safe for mixed hemorrhoids with the advantage of simple, rapid recovery and less complications.

Biallelic ATM alterations detected at diagnosis identify a subset of treatment-naïve chronic lymphocytic leukemia patients with reduced overall survival similar to patients with p53 deletion.

PubMed

Lozano-Santos, Carol; García-Vela, José A; Pérez-Sanz, Nuria; Nova-Gurumeta, Sara; Fernandez-Cuevas, Belen; Gomez-Lozano, Natalia; Sánchez-Beato, Margarita; Sanchez-Godoy, Pedro; Bueno, José Luis; Garcia-Marco, José A

2017-04-01

The prognostic impact of biallelic ATM abnormalities (ATM mutation and concurrent 11q deletion) remains unknown. We studied ATM, BIRC3, SF3B1, and NOTCH1 genes in 118 treatment-naïve CLL patients at diagnosis. Patients with biallelic ATM alteration had a similar time to first treatment (TTFT) and shorter overall survival (OS) compared with patients with isolated 11q deletion and shorter TTFT and OS when compared to patients with wild-type ATM. Furthermore, biallelic ATM alteration (HR: 6.4; p ≤ 0.007) was significantly associated with an increased risk of death similar to p53 deletion (HR: 6.1; p ≤ 0.004), superior to 11q deletion alone (HR: 2.8; p ≤ 0.022) and independent of other significant parameters such as age, advanced clinical stage, and complex karyotype. Our results suggest the identification of ATM mutations in CLL patients with 11q deletion at diagnosis is clinically relevant and predicts disease progression, poor response to the treatment, and reduced OS independent of other molecular prognostic factors.

The Glycated Albumin (GA) to HbA1c Ratio Reflects Shorter-Term Glycemic Control than GA: Analysis of Patients with Fulminant Type 1 Diabetes.

PubMed

Koga, Masafumi; Inada, Shinya; Nakao, Taisei; Kawamori, Ryuzo; Kasayama, Soji

2017-01-01

Glycated albumin (GA) reflects shorter-term glycemic control than HbA1c. We have reported that HbA1c is paradoxically increased in diabetic patients whose glycemic control deteriorated before ameliorating. In this study, we analyzed paradoxical increases of glycemic control indicators after treatment in patients with fulminant type 1 diabetes (FT1D). We also investigated whether the GA/HbA1c ratio may reflect shorter-term glycemic control than GA. Five FT1D patients whose post-treatment HbA1c and GA levels were measured were enrolled. We also used a formula to estimate HbA1c and GA from the fictitious models of changes in plasma glucose in FT1D patients. In this model, the periods during which HbA1c, GA, and the GA/HbA1c ratio were higher than at the first visit were compared. In addition, the half-life for the GA/HbA1c ratio was calculated in accordance with the half-lives for HbA1c and GA (36 and 14 days, respectively). In all FT1D patients, HbA1c levels 2-4 weeks after treatment were increased, with three patients (60%) experiencing an increase of GA levels. In contrast, an increase of the GA/HbA1c ratio was observed in only one patient. In all of the different models of changes in plasma glucose in FT1D patients, the length of time during which the values were higher than at the first visit was in the order of HbA1c > GA > GA/HbA1c ratio. The half-life for the GA/HbA1c ratio was 9 days, shorter than GA. These findings suggest that the GA/HbA1c ratio reflects shorter-term glycemic control than GA. © 2016 Wiley Periodicals, Inc.

Endovascular aortic sealing with Nellix reduces intraoperative radiation dose when compared to endovascular aortic repair.

PubMed

Ockert, Stefan; Heinrich, Mirjam; Kaufmann, Thomas; Syburra, Thomas; Lopez, Ruben; Seelos, Robert

2018-04-01

To analyze radiation exposure during endovascular aortic sealing (EVAS) in comparison with standard endovascular aortic repair (EVAR) in clinical practice. From December 2013 to October 2016 (35 months), 60 patients were analyzed for intraoperative radiation exposure during EVAR: 30 consecutive patients (mean age, 73.10 years; 28 male) received EVAS (Nellix Endologix); within the same time frame, 30 patients were treated with standard EVAR (mean age, 71.87 years; 30 male). An indirect dose analysis was performed for both groups of patients, including effective dose and cumulative air kerma. Furthermore, fluoroscopy time (FT), dose area product, and time of procedure were included in the study. The effective dose was significantly reduced in the EVAS group (3.72 mSv) compared with the group treated with standard EVAR (6.8 mSv; P ≤ .001). The cumulative air kerma was also lowered in EVAS (67.65 mGy vs 139 mGy in EVAR; P ≤ .001). FT for the entire group was 13 minutes and was shorter (P < .001) for EVAS (9 minutes) in comparison with EVAR (19 minutes). The dose area product for the entire cohort was 16.95 Gy.cm 2 and was lower during EVAS (12.4 Gy.cm 2 ) than during EVAR (22.6 Gy.cm 2 ; P < .001). The median operating time for the entire group was 123.5 minutes and was significantly shorter (P < .01) for EVAS (119 minutes vs EVAR at 132 minutes). The FT shows a significant correlation with the patient's weight (P = .022), body mass index (P = .004), and time of procedure (P = .005). EVAS is associated with a relevant decrease in indirect measured radiation dose and time of procedure compared with standard EVAR. A relevant reduction in dose during EVAS is highly likely to result in lower exposure to radiation for physicians and staff. Such a result would be highly advantageous and calls for further analysis. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Subsphaerolaimus minor sp. n. and Micromicron cephalatum Cobb, 1920 (Nematoda) from the Yen River Estuary of Vietnam.

PubMed

Gagarin, Vladimir G; Nguyen, Vu Thanh

2015-08-03

Two nematode species found in Yen River Estuary of Vietnam are described and illustrated. Subsphaerolaimus minor sp. n. is similar to S. lamasus Gerlach, 1956, but differs from it in the shorter body, comparatively shorter pharynx and shorter cephalic setae. A pictorial key for determination of valid species in the genus Subsphaerolaimus Lorenzen, 1978 is given. Micromicron cephalatum Cobb, 1920 is redescribed and reillustrated based on numerous males and females. The genus Micromicron Cobb, 1920 is confirmed as a valid genus with type and only species, M. cephalatum Cobb, 1920.

Simultaneous image reproduction on CRT screen: Moves ultrasonic sectional view and electrocardiogram curves

NASA Technical Reports Server (NTRS)

1978-01-01

A method for simultaneous reproduction of images, requiring different amounts of time to reproduce, on a cathode ray tube (CRT) screen is disclosed. Ultrasonic sectional views and electrocardiogram curves are simultaneously reproduced on the CRT screen by producing the images on different areas of a screen with two phosphors having different persistence times and luminous colors, within the times required for the appearance of the images. In front of the area on which is produced the image requiring the shorter time is a color filter which is permeable to the color of the phosphor with the shorter persistence time by which absorbs the color of the other phosphor.

Low-temperature electron-spin relaxation in the crystalline and glassy states of solid ethanol

NASA Astrophysics Data System (ADS)

Kveder, Marina; Merunka, Dalibor; Jokić, Milan; Rakvin, Boris

2008-03-01

X -band electron paramagnetic resonance spectroscopy was used to study the spectral properties of a nitroxide spin probe in ethanol glass and crystalline ethanol, at 5-11.5K . The different anisotropy of molecular packing in the two host matrices was evidenced by different rigid limit values for maximal hyperfine splitting in the signal of the spin probe. The significantly shorter phase memory time Tm for the spin probe dissolved in crystalline ethanol, as compared to ethanol glass, was discussed in terms of contribution from spectral diffusion. The effect of low-frequency dynamics was manifested in the temperature dependence of Tm and in the difference between the data measured at different spectral positions. This phenomenon was addressed within the framework of the slow-motional isotropic diffusion model [S. Lee and S. Z. Tang, Phys. Rev. B 31, 1308 (1985)] predicting the spin probe dynamics within the millisecond range, at very low temperatures. The shorter spin-lattice relaxation time of the spin probe in ethanol glass was interpreted in terms of enhanced energy exchange between the spin system and the lattice in the glass matrix due to boson peak excitations.

A comparison of battery testing protocols: Those used by the U.S. advanced battery consortium and those used in China

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robertson, David C.; Christophersen, Jon P.; Bennett, Taylor

Two testing protocols, QC/T 743 and those used by the U.S. Advanced Battery Consortium (USABC), were compared using cells based on LiFePO4/graphite chemistry. Differences in the protocols directly affected the data and the performance decline mechanisms deduced from the data. A change in capacity fade mechanism from linear-with-time to t1/2 was observed when the power density measurement was included in the QC/T 743 testing. The rate of resistance increase was linear with time using both protocols. Overall, the testing protocols produced very similar data when the testing conditions and metrics used to define performance were similar. The choice of depthmore » of discharge and pulse width had a direct effect on estimated cell life. At greater percent depth of discharge (%DOD) and pulse width, the estimated life was shorter that at lower %DOD and shorter pulse width. This indicates that cells which were at the end of life based on the USABC protocol were not at end of life based on the QC/T 743 protocol by a large margin.« less

A Meta-Analysis Examining Differences in Short-Term Outcomes Between Sutureless and Conventional Aortic Valve Prostheses.

PubMed

Hurley, Eoghan T; O'Sullivan, Katie E; Segurado, Ricardo; Hurley, John P

2015-01-01

Sutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional surgical aortic valve replacement. A systematic review was conducted in accordance with the Prisma guidelines. All searches were performed on August 10, 2014. Studies between 2007 and 2014 were included in the search. A total of 832 patients were included in the sutureless group and 3,740 in the conventional group. Aortic cross-clamp (39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7 minutes; P = 0.002) times were shorter in the sutureless group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1% vs 2.4%; P = 0.025). Sutureless aortic valve prostheses are associated with significantly shorter cardiopulmonary bypass and aortic cross-clamp times and a higher incidence of PPM insertion than conventional. Further investigation of the prognostic significance is required.

Novel analogues of degarelix incorporating hydroxy-, methoxy-, and pegylated-urea moieties at positions 3, 5, 6 and the N-terminus. Part III.

PubMed

Samant, Manoj P; Hong, Doley J; Croston, Glenn; Rivier, Catherine; Rivier, Jean

2006-06-15

Novel degarelix (Fe200486) analogues were screened for antagonism of GnRH-induced response (IC(50)) in a reporter gene assay. Inhibition of luteinizing hormone release over time was measured in the castrated male rat. N(omega)-Hydroxy- and N(omega)-methoxy-carbamoylation of Dab and Dap at position 3 (3-6), and N(omega)-hydroxy-,N(omega)-methoxy-carbamoylation and pegylation of 4Aph at positions 5 and 6 (7-10, 15-17, 22-25) were carried out. Modulation of hydrophobicity was achieved using different acylating groups at the N-terminus (11-14, 18-21, 26-28). Analogues 8, 15-17, 22, and 23 were equipotent to acyline (IC(50) = 0.69 nM) and degarelix (IC(50) = 0.58 nM) in vitro. Analogues 7, 17, and 23 were shorter acting than acyline, when 9, 11, 13, 15, 16, and 22 were longer acting. Only 9 and 14 were inactive at releasing histamine. No analogue exhibited a duration of action comparable to that of degarelix. Analogues with shorter and longer retention times on HPLC (a measure of hydrophilicity) than degarelix were identified.

Noise characteristics analysis of short wave infrared InGaAs focal plane arrays

NASA Astrophysics Data System (ADS)

Yu, Chunlei; Li, Xue; Yang, Bo; Huang, Songlei; Shao, Xiumei; Zhang, Yaguang; Gong, Haimei

2017-09-01

The increasing application of InGaAs short wave infrared (SWIR) focal plane arrays (FPAs) in low light level imaging requires ultra-low noise FPAs. This paper presents the theoretical analysis of FPA noise, and point out that both dark current and detector capacitance strongly affect the FPA noise. The impact of dark current and detector capacitance on FPA noise is compared in different situations. In order to obtain low noise performance FPAs, the demand for reducing detector capacitance is higher especially when pixel pitch is smaller, integration time is shorter, and integration capacitance is larger. Several InGaAs FPAs were measured and analyzed, the experiments' results could be well fitted to the calculated results. The study found that the major contributor of FPA noise is coupled noise with shorter integration time. The influence of detector capacitance on FPA noise is more significant than that of dark current. To investigate the effect of detector performance on FPA noise, two kinds of photodiodes with different concentration of the absorption layer were fabricated. The detectors' performance and noise characteristics were measured and analyzed, the results are consistent with that of theoretical analysis.

Sub-clinical hepatic encephalopathy in cirrhotic patients is not aggravated by sedation with propofol compared to midazolam: a randomized controlled study.

PubMed

Khamaysi, Iyad; William, Nseir; Olga, Alexandrov; Alex, Isakson; Vladimir, Mysh; Kamal, Dabbah; Nimer, Assy

2011-01-01

The risk of exacerbating sub-clinical hepatic encephalopathy (HE) by propofol has not been established. The aim of this study is to determine whether the use of propofol, for upper endoscopy in patients with cirrhosis, precipitates sub-clinical HE. Sixty-one patients with compensated HCV and HBV cirrhosis (CP score 5-6) were randomly selected and divided into two groups (intent-to-treat population) matched for age, gender, and BMI. The first group received a single propofol sedation (N = 31, age 57 ± 12, dose range 70-100 mg/procedure) and the second group (N = 30, age 56 ± 12, dose 3-6 mg/procedure) received a single midazolam sedation, all done by an anesthesiologist. All patients completed number connection test (NCT), cognitive function score, time to recovery, time to discharge sheets, and hemodynamic parameters before sedation, and at discharge from the endoscopy unit, 1h post-procedure. Thirty control subjects without cirrhosis were matched to the cirrhotic patients who received sedation with regard to age, gender, BMI, and education level. A total of 58/61 cirrhotic patients (95%) had sub-clinical encephalopathy before the endoscopy (mean NCT 84.7 ± 77 s, normal < 30 s). No patient developed overt HE after sedation. There were no differences between groups in the incidence of adverse effects, cognitive function, MELD score, CP score, oxygen saturation, or respiratory and heart rates before and after sedation. Propofol did not exacerbate minimal HE when compared to midazolam (NCT changed from 87.5 ± 62 s prior to sedation to 74.2 ± 58 s after sedation in the propofol group versus 72.8 ± 62 s before to 85.6 ± 72 s after sedation in the midazolam group; p < 0.01). Time to recovery (4.1 ± 1.9 min vs. 11.5 ± 5.0 min, p < 0.001), and time to discharge (38.0 ± 9 min vs. 110 ± 42 min, p < 0.001) were significantly shorter with propofol than midazolam. Pre- and post-procedure NCT (from 25 ± 20 s to 24 ± 20 s), cognitive function score (from 25 to 26), time to recovery (3.5 ± 1.0 min), and time to discharge (35 ± 10 min) did not change in the healthy controls. Sedation with propofol has a shorter time recovery and a shorter time to discharge than midazolam and does not exacerbate sub-clinical hepatic encephalopathy in patients with compensated liver cirrhosis. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Rotary Mtwo system versus manual K-file instruments: efficacy in preparing primary and permanent molar root canals.

PubMed

Azar, Mohammad-Reza; Mokhtare, Maziar

2011-01-01

To compare the cleaning ability and preparation time of rotary instruments (Mtwo) and conventional manual instruments (K-file) in preparing primary and permanent molar root canals. Access cavities were prepared in 70 primary and 70 permanent teeth and India ink was injected into 120 canals of selected molars. The teeth were randomly divided into two main subgroups (n=20) and three control groups (n=10). In each of these main subgroups, either the manual instrument (K-file) or the rotary system (Mtwo) was used to prepare root canals. After cleaning the canals and clearing the teeth, dye removal was evaluated with the help of a stereomicroscope. In addition, the time needed for root canal preparation was recorded by a chronometer. Statistical analyses were done using the Kruskal-Wallis, Mann-Whitney and t tests. With regard to the cleaning ability of root canals, there were no significant differences between the K-file and Mtwo rotary system in primary and permanent teeth in the apical, middle or coronal third of the canals. Moreover, there were no significant differences between primary and permanent teeth prepared with K-files and rotary instruments. In all the groups, shorter times were recorded with the rotary technique. The working time was shorter in primary than in permanent teeth. The Mtwo rotary system showed acceptable cleaning ability in both primary and permanent teeth, and achieved results similar to those of K-files in less time.

Feeding kinematics of freshwater turtles: what advantage do invasive species possess?

PubMed

Nishizawa, Hideaki; Tabata, Runa; Hori, Tomoya; Mitamura, Hiromich; Arai, Nobuaki

2014-10-01

The red-eared slider (Trachemys scripta) is an invasive turtle species that is displacing the populations of native freshwater turtles in many countries. However, the mechanism that makes red-eared sliders superior competitors has been less well studied. In this study, we compare the feeding kinematics of the red-eared slider with those of Reeves' pond turtle (Mauremys reevesii), a turtle native to East Asia, and offer an explanation as to why red-eared sliders are superior in food competition. Reeves' pond turtles sympatric to red-eared sliders have been reported to have a mainly durophagous diet in contrast to the preference for a soft diet in areas of allopatry to red-eared sliders, indicating the dietary shift resulted from food competition. Maximum neck extension and retraction speed are considered to be indicators of striking ability, but were not found to be superior in red-eared sliders. In fact, maximum neck extension speed was significantly higher in Reeves' pond turtles, though this advantage may be counteracted by the longer neck of Reeves' pond turtles, resulting in similar neck extension times. On the other hand, red-eared sliders had a significantly shorter gape cycle time and neck retraction time, indicating that they can complete feeding in a short time. Therefore, red-eared sliders are suggested to be superior in food competition not due to their striking ability, but due to exploiting preferable food in a shorter time. Copyright © 2014 Elsevier GmbH. All rights reserved.

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy.

PubMed

Seo, Su Hyun; Kim, Ki Han; Kim, Min Chan; Choi, Hong Jo; Jung, Ghap Joong

2012-06-01

Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.

Investigation of dairy cattle ease of movement on new methyl methacrylate resin aggregate floorings.

PubMed

Franco-Gendron, N; Bergeron, R; Curilla, W; Conte, S; DeVries, T; Vasseur, E

2016-10-01

Freestall dairy farms commonly present issues with cattle slips and falls caused by smooth flooring and manure slurry. This study examined the effect of 4 new methyl methacrylate (MMA) resin aggregate flooring types (1-4) compared with rubber (positive) and concrete (negative control) on dairy cow (n=18) ease of movement when walking on straight and right-angled corridors. Our hypothesis was that cow ease of movement when walking on the MMA surfaces would be better than when walking on traction milled concrete, and at least as good as when walking on rubber. Cattle ease of movement was measured using kinematics, accelerometers, and visual observation of gait and associated behaviors. Stride length, swing time, stance time, and hoof height were obtained from kinematic evaluation. Acceleration and asymmetry of variance were measured with accelerometers. Locomotion score and behaviors associated with lameness, such as arch back, head bob, tracking up, step asymmetry, and reluctance to bear weight were visually observed. Stride length, swing time, stance time, and the number of steps taken were the only variables affected by flooring type. Differences between flooring types for these variables were tested using a generalized linear mixed model with cow as a random effect, week as a random block factor, and flooring type as a fixed effect. Multiple comparisons with a Scheffé adjustment were done to analyze differences among flooring types. Stride length was 0.14 m longer (better) on rubber when compared with concrete, and 0.11 and 0.17 m shorter on MMA 1 and 2 compared with rubber. On MMA 3 and 4, stride length did not differ from either rubber or concrete. Swing time was 0.04 s shorter (worse) on MMA 1 than on rubber, but did not differ from any other flooring. Stance time was 0.18 s longer (worse) on MMA 2 when compared with rubber, but it did not differ from any other treatment. The number of steps was higher on MMA 4 compared with rubber (4.57 vs. 3.95 steps), but did not differ from any other treatment. Of all the MMA floors tested, MMA 3 was the only one that was consistently as good as rubber (positive control). All 4 MMA floors never differed from concrete (negative control) in any of the ease of movement variables measured. These results suggest that MMA 3 may improve cow ease of movement, compared with the other MMA floors, but more research is required to confirm these findings. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Tracheal intubation with rocuronium using a "modified timing principle".

PubMed

Kwon, Min A; Song, Jaegyok; Kim, Ju-Ri

2013-03-01

Rapid sequence induction (RSI) is indicated in various situations. Succinylcholine has been the muscle relaxant of choice for RSI, and rocuronium has become an alternative medicine for patients who cannot be administered succinylcholine for various reasons. Although rocuronium has the most rapid onset time among non-depolarizing muscle relaxants, the standard dose of rocuronium (0.6 mg/kg) takes 60 seconds to achieve appropriate muscle relaxation. We evaluated intubating conditions using the "modified timing principle" with rocuronium and succinylcholine. In this prospective controlled blinded study, all patients received 1.5 µg/kg fentanyl intravenously with preoxygenation for 2 minutes and were randomized to receive 0.6 mg/kg rocuronium followed by 1.5 mg/kg propofol or 1.5 mg/kg propofol and 1.5 mg/kg succinylcholine. The rocuronium group was intubated just after confirming loss of consciousness, and the succinylcholine group was intubated 1 minute after injecting succinylcholine. Intubation condition, timing of events, and complications were recorded. All patients were successfully intubated in both groups. Apnea time of the rocuronium group (38.5 seconds) was significantly shorter than that in the succinylcholine group (100.7 seconds). No significant differences were observed in loss of consciousness time or intubation time. The succinylcholine group tended to show better intubation conditions, but no significant difference was observed. None of the patients complained awareness of the intubation procedure or had respiratory difficulty during a postoperative interview. The modified RSI with rocuronium showed shorter intubation sequence, acceptable intubation conditions, and a similar level of complications compared to those of conventional RSI with succinylcholine.

Using Discrete Event Simulation to Model the Economic Value of Shorter Procedure Times on EP Lab Efficiency in the VALUE PVI Study.

PubMed

Kowalski, Marcin; DeVille, J Brian; Svinarich, J Thomas; Dan, Dan; Wickliffe, Andrew; Kantipudi, Charan; Foell, Jason D; Filardo, Giovanni; Holbrook, Reece; Baker, James; Baydoun, Hassan; Jenkins, Mark; Chang-Sing, Peter

2016-05-01

The VALUE PVI study demonstrated that atrial fibrillation (AF) ablation procedures and electrophysiology laboratory (EP lab) occupancy times were reduced for the cryoballoon compared with focal radiofrequency (RF) ablation. However, the economic impact associated with the cryoballoon procedure for hospitals has not been determined. Assess the economic value associated with shorter AF ablation procedure times based on VALUE PVI data. A model was formulated from data from the VALUE PVI study. This model used a discrete event simulation to translate procedural efficiencies into metrics utilized by hospital administrators. A 1000-day period was simulated to determine the accrued impact of procedure time on an institution's EP lab when considering staff and hospital resources. The simulation demonstrated that procedures performed with the cryoballoon catheter resulted in several efficiencies, including: (1) a reduction of 36.2% in days with overtime (422 days RF vs 60 days cryoballoon); (2) 92.7% less cumulative overtime hours (370 hours RF vs 27 hours cryoballoon); and (3) an increase of 46.7% in days with time for an additional EP lab usage (186 days RF vs 653 days cryoballoon). Importantly, the added EP lab utilization could not support the time required for an additional AF ablation procedure. The discrete event simulation of the VALUE PVI data demonstrates the potential positive economic value of AF ablation procedures using the cryoballoon. These benefits include more days where overtime is avoided, fewer cumulative overtime hours, and more days with time left for additional usage of EP lab resources.

Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a prospective randomized study.

PubMed

Zhang, Liang; Liu, Zhongjun; Wang, Jingcheng; Feng, Xinmin; Yang, Jiandong; Tao, Yuping; Zhang, Shengfei

2015-06-14

Percutaneous vertebroplasty (PVP) typically involves conventional lower-viscosity cement injection via bipedicular approach. Limited evidence is available comparing the clinical outcomes and complications in treating osteoporotic vertebral compression fractures (OVCFs) with PVP using high-viscosity cement through unipedicular or bipedicular approach. Fifty patients with OVCFs were randomly allocated into two groups adopting unipedicular or bipedicular PVP. The efficacy of unipedicular and bipedicular PVP was assessed by comparing operation time, X-ray exposure time, incidence of complications, vertebral height restoration, and improvement of the visual analogue scale (VAS), Oswestry disability index (ODI) and Short Form-36 (SF-36) General Health Survey scores. The mean operative and exposure time to X-rays in the unipedicular PVP group was less than that of the bipedicular group (p < 0.05). No statistically significant differences were observed in the VAS score, ODI score, SF-36 score, cement leakage rate or vertebral height restoration between the two groups (p > 0.05). Unipedicular and bipedicular PVP are safe and effective treatments for OVCF. Compared with bipedicular PVP, unipedicular PVP entails a shorter surgical time and lower X-ray irradiation.

Runoff forecasting using a Takagi-Sugeno neuro-fuzzy model with online learning

NASA Astrophysics Data System (ADS)

Talei, Amin; Chua, Lloyd Hock Chye; Quek, Chai; Jansson, Per-Erik

2013-04-01

SummaryA study using local learning Neuro-Fuzzy System (NFS) was undertaken for a rainfall-runoff modeling application. The local learning model was first tested on three different catchments: an outdoor experimental catchment measuring 25 m2 (Catchment 1), a small urban catchment 5.6 km2 in size (Catchment 2), and a large rural watershed with area of 241.3 km2 (Catchment 3). The results obtained from the local learning model were comparable or better than results obtained from physically-based, i.e. Kinematic Wave Model (KWM), Storm Water Management Model (SWMM), and Hydrologiska Byråns Vattenbalansavdelning (HBV) model. The local learning algorithm also required a shorter training time compared to a global learning NFS model. The local learning model was next tested in real-time mode, where the model was continuously adapted when presented with current information in real time. The real-time implementation of the local learning model gave better results, without the need for retraining, when compared to a batch NFS model, where it was found that the batch model had to be retrained periodically in order to achieve similar results.

Comparison of Early and Delayed Open Reduction and Internal Fixation for Treating Closed Tibial Pilon Fractures.

PubMed

Tang, Xin; Liu, Lei; Tu, Chong-qi; Li, Jian; Li, Qi; Pei, Fu-xing

2014-07-01

The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial. The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures. Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided). In the delayed group, 9 patients were treated first by temporary external fixation. All the closed fractures were managed by ORIF with locking plates. At follow-up, the clinical and radiographic results were retrospectively analyzed. The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B. There was no significant difference (P > .05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score. The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 ± 3.7 weeks, P < .05), operating time (84.3 ± 12.1 months vs 100.6 ± 13.7 months, P < .01), and hospital stay (7.6 ± 2.6 days vs 15.2 ± 4.2 days, P < .01). If soft tissue conditions are acceptable, early ORIF for treating closed type C pilon fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay. These results favorably compare with delayed ORIF treatment. Level III, retrospective comparative study. © The Author(s) 2014.

Time frequency requirements for radio interferometric earth physics

NASA Technical Reports Server (NTRS)

Thomas, J. B.; Fliegel, H. F.

1973-01-01

Two systems of VLBI (Very Long Baseline Interferometry) are now applicable to earth physics: an intercontinental baseline system using antennas of the NASA Deep Space Network, now observing at one-month intervals to determine UTI for spacecraft navigation; and a shorter baseline system called ARIES (Astronomical Radio Interferometric Earth Surveying), to be used to measure crustal movement in California for earthquake hazards estimation. On the basis of experience with the existing DSN system, a careful study has been made to estimate the time and frequency requirements of both the improved intercontinental system and of ARIES. Requirements for the two systems are compared and contrasted.

Withholding response to self-face is faster than to other-face.

PubMed

Zhu, Min; Hu, Yinying; Tang, Xiaochen; Luo, Junlong; Gao, Xiangping

2015-01-01

Self-face advantage refers to adults' response to self-face is faster than that to other-face. A stop-signal task was used to explore how self-face advantage interacted with response inhibition. The results showed that reaction times of self-face were faster than that of other-face not in the go task but in the stop response trials. The novelty of the finding was that self-face has shorter stop-signal reaction time compared to other-face in the successful inhibition trials. These results indicated the processing mechanism of self-face may be characterized by a strong response tendency and a corresponding strong inhibition control.

Can pre-season fitness measures predict time to injury in varsity athletes?: a retrospective case control study

PubMed Central

2012-01-01

Background The ability to determine athletic performance in varsity athletes using preseason measures has been established. The ability of pre-season performance measures and athlete’s exposure to predict the incidence of injuries is unclear. Thus our purpose was to determine the ability of pre-season measures of athletic performance to predict time to injury in varsity athletes. Methods Male and female varsity athletes competing in basketball, volleyball and ice hockey participated in this study. The main outcome measures were injury prevalence, time to injury (based on calculated exposure) and pre-season fitness measures as predictors of time to injury. Fitness measures were Apley’s range of motion, push-up, curl-ups, vertical jump, modified Illinois agility, and sit-and-reach. Cox regression models were used to identify which baseline fitness measures were predictors of time to injury. Results Seventy-six percent of the athletes reported 1 or more injuries. Mean times to initial injury were significantly different for females and males (40.6% and 66.1% of the total season (p < 0.05), respectively). A significant univariate correlation was observed between push-up performance and time to injury (Pearson’s r = 0.332, p < 0.01). No preseason fitness measure impacted the hazard of injury. Regardless of sport, female athletes had significantly shorter time to injury than males (Hazard Ratio = 2.2, p < 0.01). Athletes playing volleyball had significantly shorter time to injury (Hazard Ratio = 4.2, p < 0.01) compared to those playing hockey or basketball. Conclusions When accounting for exposure, gender, sport and fitness measures, prediction of time to injury was influenced most heavily by gender and sport. PMID:22824555

Usefulness of video-laryngoscopy with the Airway Scope for intubation performance and learning: an experimental manikin controlled study.

PubMed

Declercq, Pierre-Louis; Bubenheim, Michael; Gelinotte, Stéphanie; Guernon, Kévin; Michot, Jean-Baptiste; Royon, Vincent; Carpentier, Dorothée; Béduneau, Gaëtan; Tamion, Fabienne; Girault, Christophe

2016-12-01

Different video-laryngoscopes (VDLs) for endotracheal intubation (ETI) have recently been developed. We compared the performance of the VDL Airway Scope (AWS) with the direct laryngoscopy by Macintosh (DLM) for ETI success, time and learning. We performed an experimental manikin controlled study. Twenty experienced (experts) and 40 inexperienced operators (novices) for DLM-ETI were enrolled. None of them had experience with the use of AWS-VDL. Novices were assigned to start learning with DLM or AWS, and two sub-groups of 20 novices were formed. Experts group constituted the control group. Each participant performed 10 ETI attempts with each device on the same standard manikin. The primary endpoint was the ETI success probability. Secondary endpoints were ETI time, technical validity and qualitative evaluation for each technique. We also assessed the learning order and the successive attempts effects for these parameters. Overall, 1200 ETI attempts were performed. ETI success probability was higher with the AWS than with the DLM for all operators (98 vs. 81 %; p < 0.0001) and for experts compared to novices using devices in the same order (97 vs. 83 %; p = 0.0002). Overall ETI time was shorter with the AWS than with the DLM (13 vs. 20 s; p < 0.0001) and for experts compared to novices using devices in the same order (11 vs. 21 s; p < 0.0001). Among novices, those starting learning with AWS had higher ETI success probability (89 vs. 83 %; p = 0.03) and shorter ETI time (18 vs. 21 s; p = 0.02). Technical validity was found better with the AWS than DLM for all operators. Novices expressed global satisfaction and device preference for the AWS, whereas experts were indifferent. AWS-VDL permits faster, easier and more reliable ETI compared to the DLM whatever the previous airway ETI experience and could be a useful device for DLM-ETI learning.

Anesthetic drugs and onset of malignant hyperthermia.

PubMed

Visoiu, Mihaela; Young, Michael C; Wieland, Keith; Brandom, Barbara W

2014-02-01

The time between the beginning of anesthetic administration and recognition of the first sign of malignant hyperthermia (MH) (MH onset time) could differ among anesthetic drugs. We examined the time of the first signs of suspected MH, anesthetic drugs administered, subject age, and year of event in Adverse Metabolic/Musculoskeletal Reaction to Anesthesia reports in the North American Malignant Hyperthermia Registry. Inclusion criteria were judgment by the reporting clinician that the event was possible or fulminant MH, documentation of the time when anesthetic administration began, and the time when the first MH sign was noted. Descriptive statistics, Kruskal-Wallis analysis, and nonparametric correlation were used to assess the difference in MH onset times under different conditions. Four hundred seventy-seven cases met inclusion criteria; 58.5% were possible MH and 41.5% fulminant MH. Inhaled anesthetic and succinylcholine were given in 53.9% of cases, inhaled anesthetic only in 41.7%, and succinylcholine without inhaled anesthetics in 2.9%. No causative anesthetic drugs were reported in 7 MH cases. In 394 patients exposed to only 1 of the 4 inhaled anesthetics, without regard for subject age, MH onset time was shorter in the presence of halothane than any of the other anesthetics and shorter after succinylcholine in all anesthetics. If succinylcholine was not given, MH onset was shorter during sevoflurane anesthesia than during desflurane or isoflurane. In 322 cases, 1 rather than multiple first signs of MH were reported with masseter spasm as the earliest MH sign. In 339 cases in which masseter spasm was not reported, there was no difference in MH onset time with or without succinylcholine. In 146 cases in which masseter spasm was not reported and succinylcholine was not given, MH onset was shorter during halothane anesthesia, than during exposure to desflurane, or isoflurane. MH onset time during sevoflurane was shorter than during desflurane or isoflurane. MH was reported later in the course of anesthesia after 1998, when halothane and succinylcholine were less often reported. MH occurred after succinylcholine administration in the absence of inhaled anesthetics. We could not separate an effect of age from that of other variables. The onset of MH has been observed later during desflurane and isoflurane anesthesia than during exposure to sevoflurane. Since 1998, MH signs have more often appeared later, in the second or third hour of anesthesia, than they did before 1998.

Retinoblastoma Vitreous Seed Clouds (Class 3): A Comparison of Treatment with Ophthalmic Artery Chemosurgery with or without Intravitreous and Periocular Chemotherapy.

PubMed

Francis, Jasmine H; Iyer, Saipriya; Gobin, Y Pierre; Brodie, Scott E; Abramson, David H

2017-10-01

To compare the efficacy and toxicity of treating class 3 retinoblastoma vitreous seeds with ophthalmic artery chemosurgery (OAC) alone versus OAC with intravitreous chemotherapy. Retrospective cohort study. Forty eyes containing clouds (class 3 vitreous seeds) of 40 retinoblastoma patients (19 treated with OAC alone and 21 treated with OAC plus intravitreous and periocular chemotherapy). Ocular survival, disease-free survival and time to regression of seeds were estimated with Kaplan-Meier estimates. Ocular toxicity was evaluated by clinical findings and electroretinography: 30-Hz flicker responses were compared at baseline and last follow-up visit. Continuous variables were compared with Student t test, and categorical variables were compared with the Fisher exact test. Ocular survival, disease-free survival, and time to regression of seeds. There were no disease- or treatment-related deaths and no patient demonstrated externalization of tumor or metastatic disease. There was no significant difference in the age, laterality, disease, or disease status (treatment naïve vs. previously treated) between the 2 groups. The time to regression of seeds was significantly shorter for eyes treated with OAC plus intravitreous chemotherapy (5.7 months) compared with eyes treated with OAC alone (14.6 months; P < 0.001). The 18-month Kaplan-Meier estimates of disease-free survival were significantly worse for the OAC alone group: 67.1% (95% confidence interval, 40.9%-83.6%) versus 94.1% (95% confidence interval, 65%-99.1%) for the OAC plus intravitreous chemotherapy group (P = 0.05). The 36-month Kaplan-Meier estimates of ocular survival were 83.3% (95% confidence interval, 56.7%-94.3%) for the OAC alone group and 100% for the OAC plus intravitreous chemotherapy group (P = 0.16). The mean change in electroretinography responses was not significantly different between groups, decreasing by 11 μV for the OAC alone group and 22 μV for the OAC plus intravitreous chemotherapy group (P = 0.4). Treating vitreous seed clouds with OAC and intravitreous and periocular chemotherapy, compared with OAC alone, resulted in a shorter time to regression and was associated with fewer recurrences requiring additional treatment and fewer enucleations. The toxicity to the retina does not seem to be significantly worse in the OAC plus intravitreous chemotherapy group. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Description of the life stages of quill mite Mironovia lagopus sp. nov. (Acari: Syringophilidae) parasitizing the rock ptarmigan Lagopus muta (Phasianidae) from Iceland.

PubMed

Bochkov, Andre V; Skirnisson, Karl

2011-03-01

A new species of syringophilid mites, Mironovia lagopus sp. nov. (Acari: Syringophilidae) is described from feather quills of the rock ptarigman Lagopus muta (Montin) (Phasianidae) from Iceland. Females of this new species differ from the closely related Mironovia rouloul Skoracki and Sikora by setae d2, which are subequal or 1.1-1.2 times shorter than setae e2 (vs. d2 1.4-1.5 times longer than e2 in Mironovia rouloul) and by setae ag1, which are 1.3-1.5 times shorter than ag2 (vs. ag1 1.7-1.8 times shorter than ag2). The postembryonic stages of this new species are figured and described in details. In ontogeny of Mironovia spp., the observed pattern of setal appearance is not different from the pattern in other galliform-associated genera such as Syringophilus and Colinophilus, with exception for tarsal setae p'I, II which are absent in protonymphs. The key to all four species of the genus Mironovia is also provided.

The practical use of simplicity in developing ground water models

USGS Publications Warehouse

Hill, M.C.

2006-01-01

The advantages of starting with simple models and building complexity slowly can be significant in the development of ground water models. In many circumstances, simpler models are characterized by fewer defined parameters and shorter execution times. In this work, the number of parameters is used as the primary measure of simplicity and complexity; the advantages of shorter execution times also are considered. The ideas are presented in the context of constructing ground water models but are applicable to many fields. Simplicity first is put in perspective as part of the entire modeling process using 14 guidelines for effective model calibration. It is noted that neither very simple nor very complex models generally produce the most accurate predictions and that determining the appropriate level of complexity is an ill-defined process. It is suggested that a thorough evaluation of observation errors is essential to model development. Finally, specific ways are discussed to design useful ground water models that have fewer parameters and shorter execution times.

The effects of in-vehicle tasks and time-gap selection while reclaiming control from adaptive cruise control (ACC) with bus simulator.

PubMed

Lin, Tsang-Wei; Hwang, Sheue-Ling; Su, Jau-Ming; Chen, Wan-Hui

2008-05-01

This research aimed to find out the effects of in-vehicle distractions and time-gap settings with a fix-based bus driving simulator in a following scenario. Professional bus drivers were recruited to perform in-vehicle tasks while driving with adaptive cruise control (ACC) of changeable time-gap settings in freeway traffic. Thirty subjects were divided equally into three groups for different in-vehicle task modes (between subjects), including no task distraction, hands-free, and manual modes. Further, time-gap settings for the experimental ACC were: shorter than 1.0 s, 1.0-1.5 s, 1.5-2.0 s, and longer than 2.0 s (within subjects). Longitudinal (mean headway, forward collision rate, and response time) and lateral control (mean lateral lane position and its standard deviation) performance was assessed. In the results, longitudinal control performance was worsened by both shorter time-gaps and heavier in-vehicle tasks. But the interaction indicated that the harm by heavier in-vehicle distraction could be improved by longer time-gaps. As for the lateral control, it would only be negatively affected by shorter time-gap settings. This research indicates the effects of time-gaps and in-vehicle distraction, as well as the interaction. Proper time-gap selection under different in-vehicle distractions can help avoid accidents and keep safe.

Effect of axial length on laser spot size during photodynamic therapy: an experimental study in monkeys.

PubMed

Kondo, Mineo; Ito, Yasuki; Miyata, Kentaro; Kondo, Nagako; Ishikawa, Kohei; Terasaki, Hiroko

2006-01-01

To investigate the effect of shorter axial length on the laser spot size and laser energy during photodynamic therapy (PDT) in monkeys. Experimental study with four rhesus monkeys. PDT was performed on the normal retina of monkeys whose ocular axial lengths are shorter (19.55 to 20.25 mm) than that of humans. After the PDT, the eyes were enucleated, and the diameter of the irradiated laser spot was measured with a microcaliper. The area of actual laser spot was only 0.56 to 0.61 times of the planned area, which indicated that the laser energy/area was 1.64 to 1.78 times more intense than planned initially. These results are the in vivo demonstration that the diameter of PDT laser spot is smaller for eyes with shorter axial lengths.

Method matters: Experimental evidence for shorter avian sperm in faecal compared to abdominal massage samples.

PubMed

Girndt, Antje; Cockburn, Glenn; Sánchez-Tójar, Alfredo; Løvlie, Hanne; Schroeder, Julia

2017-01-01

Birds are model organisms in sperm biology. Previous work in zebra finches, suggested that sperm sampled from males' faeces and ejaculates do not differ in size. Here, we tested this assumption in a captive population of house sparrows, Passer domesticus. We compared sperm length in samples from three collection techniques: female dummy, faecal and abdominal massage samples. We found that sperm were significantly shorter in faecal than abdominal massage samples, which was explained by shorter heads and midpieces, but not flagella. This result might indicate that faecal sampled sperm could be less mature than sperm collected by abdominal massage. The female dummy method resulted in an insufficient number of experimental ejaculates because most males ignored it. In light of these results, we recommend using abdominal massage as a preferred method for avian sperm sampling. Where avian sperm cannot be collected by abdominal massage alone, we advise controlling for sperm sampling protocol statistically.

Personality Disorder Symptom Severity Predicts Onset of Mood Episodes and Conversion to Bipolar I Disorder in Individuals with Bipolar Spectrum Disorder

PubMed Central

Ng, Tommy H.; Burke, Taylor A.; Stange, Jonathan P.; Walshaw, Patricia D.; Weiss, Rachel B.; Urosevic, Snezana; Abramson, Lyn Y.; Alloy, Lauren B.

2017-01-01

Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every four months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR]= 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR= 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. PMID:28368159

Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder.

PubMed

Ng, Tommy H; Burke, Taylor A; Stange, Jonathan P; Walshaw, Patricia D; Weiss, Rachel B; Urosevic, Snezana; Abramson, Lyn Y; Alloy, Lauren B

2017-04-01

Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Pessimistic orientation in relation to telomere length in older men: the VA Normative Aging Study

PubMed Central

Ikeda, Ai; Schwartz, Joel; Peters, Junenette L.; Baccarelli, Andrea A.; Hoxha, Mirjam; Dioni, Laura; Spiro, Avron; Sparrow, David; Vokonas, Pantel; Kubzansky, Laura D.

2014-01-01

Background Recent research suggests pessimistic orientation is associated with shorter leukocyte telomere length (LTL). However, this is the first study to look not only at effects of pessimistic orientation on average LTL at multiple time points, but also at effects on the rate of change in LTL over time. Methods Participants were older men from the VA Normative Aging Study (n=490). The Life Orientation Test (LOT) was used to measure optimistic and pessimistic orientations at study baseline, and relative LTL by telomere to single copy gene ratio (T:S ratio) was obtained repeatedly over the course of the study (1999-2008). A total of 1,010 observations were included in the analysis. Linear mixed effect models with a random subject intercept were used to estimate associations. Results Higher pessimistic orientation scores were associated with shorter average LTL (percent difference by 1-SD increase in pessimistic orientation (95% CI): -3.08 (-5.62, -0.46)), and the finding was maintained after adjusting for the higher likelihood that healthier individuals return for follow-up visits (-3.44 (-5.95,-0.86)). However, pessimistic orientation scores were not associated with rate of change in LTL over time. No associations were found between overall optimism and optimistic orientation subscale scores and LTL. Conclusion Higher pessimistic orientation scores were associated with shorter LTL in older men. While there was no evidence that pessimistic orientation was associated with rate of change in LTL over time, higher levels of pessimistic orientation were associated with shorter LTL at baseline and this association persisted over time. PMID:24636503

Association of telomere length with type 2 diabetes, oxidative stress and UCP2 gene variation.

PubMed

Salpea, Klelia D; Talmud, Philippa J; Cooper, Jackie A; Maubaret, Cecilia G; Stephens, Jeffrey W; Abelak, Kavin; Humphries, Steve E

2010-03-01

High oxidative stress potentially leads to accelerated telomere shortening and consequent premature cell senescence, implicated in type 2 diabetes (T2D) development. Therefore, we studied the association of leukocyte telomere length (LTL) with the presence of T2D, as well as the effect on the patients' LTL of plasma oxidative stress and of variation in UCP2, a gene involved in the mitochondrial production of reactive oxygen species. Mean LTL was determined in 569 Caucasian, 103 South Asian and 70 Afro-Caribbean T2D patients aged from 24 to 92 years, 81 healthy Caucasian male students aged from 18 to 28 years and 367 healthy Caucasian men aged from 40 to 61 years by real-time PCR. Plasma total antioxidant status (TAOS) was measured in the T2D patients by a photometric microassay. The patients were also genotyped for the UCP2 functional variants -866G>A and A55V. Afro-Carribeans had 510bp longer mean length compared to Caucasians (p<0.0001) and 500bp longer than South Asians (p=0.004). T2D subjects displayed shorter age-adjusted LTL compared to controls [6.94(6.8-7.03) vs. 7.72(7.53-7.9), p<0.001] with subjects in the middle and the lowest tertile of LTL having significantly higher odds ratios for T2D compared to those in the highest tertile [1.50(1.08-2.07) and 5.04(3.63-6.99), respectively, p<0.0001]. In the patients, LTL was correlated negatively with age (r=-0.18, p<0.0001) and positively with TAOS measures (r=0.12, p=0.01) after adjusting for age, while carriers of the UCP2 -866A allele had shorter age-adjusted LTL than common homozygotes [6.86(6.76-6.96)kb vs. 7.03(6.91-7.15)kb, p=0.04]. The present data suggest that shorter LTL is associated with the presence of T2D and this could be partially attributed to the high oxidative stress in these patients. The association of the UCP2 functional promoter variant with the LTL implies a link between mitochondrial production of reactive oxygen species and shorter telomere length in T2D.

Drawing from Memory: Hand-Eye Coordination at Multiple Scales

PubMed Central

Spivey, Michael J.

2013-01-01

Eyes move to gather visual information for the purpose of guiding behavior. This guidance takes the form of perceptual-motor interactions on short timescales for behaviors like locomotion and hand-eye coordination. More complex behaviors require perceptual-motor interactions on longer timescales mediated by memory, such as navigation, or designing and building artifacts. In the present study, the task of sketching images of natural scenes from memory was used to examine and compare perceptual-motor interactions on shorter and longer timescales. Eye and pen trajectories were found to be coordinated in time on shorter timescales during drawing, and also on longer timescales spanning study and drawing periods. The latter type of coordination was found by developing a purely spatial analysis that yielded measures of similarity between images, eye trajectories, and pen trajectories. These results challenge the notion that coordination only unfolds on short timescales. Rather, the task of drawing from memory evokes perceptual-motor encodings of visual images that preserve coarse-grained spatial information over relatively long timescales as well. PMID:23554894

A comparison of ultra-endurance cyclists in a qualifying ultra-cycling race for Paris-Brest-Paris and Race Across America-Swiss cycling marathon.

PubMed

Knechtle, Beat; Wirth, Andrea; Knechtle, Patrizia; Rüst, Christoph Alexander; Rosemann, Thomas

2012-02-01

Ultra-endurance events test the adaptation of human physiology to extreme physical and mental demands, high levels of training, motivation, and physical conditioning among participants. To understand basic differences among participants according to the severity of the race, participants in qualifying events for two ultra-endurance cycling races, differing in length and intensity, were compared on measures of anthropometry, training, and support. One race was four times longer, required supporting teams, and racers typically had little sleep, which should lead to the qualifiers being substantially more highly trained than those from the shorter race. The qualifiers in the longer race had greater intensity in training while the qualifiers in the shorter race relied more on training volume. Different strategies and types of training reflected the different demands of the races. Future studies should evaluate personality and motivational differences in ultra-endurance events and between these athletes and athletes in other sports.

Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study.

PubMed

Abu Hilal, Mohammed; Di Fabio, Francesco; Badran, Abdallah; Alsaati, Hani; Clarke, Hannah; Fecher, Imogen; Armstrong, Thomas H; Johnson, Colin D; Pearce, Neil W

2013-01-01

Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. The aim of this pilot study was to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. This was an observational single-surgeon case-control study (before-and-after pathway). A total of 20 consecutive patients were prospectively enrolled for the ERP-PD and compared with 24 consecutive patients previously treated during an equal time frame. Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 5 vs. 7 days, p = 0.0001), start liquid diet (median of 2 vs. 5 days, p < 0.0001), start solid food (median of 4 vs. 9 days, p < 0.0001), pass stools (median of 6 vs. 7 days, p = 0.002), and had shorter length of stay (median of 8.5 days vs. 13 days, p = 0.015) compared to the pre-pathway group. Postoperative complications were overall less frequent but not significantly different in the ERP-PD group (p = 0.077). No difference in mortality and readmission rates was found. Our findings support the feasibility and safety of ERP-PD. Improved patients' outcomes, significant bed day savings and increase National Health Service productivity are anticipated with implementation of ERP-PD on a larger scale. Copyright © 2012 IAP and EPC. Published by Elsevier B.V. All rights reserved.

The gait speed advantage of taller stature is lost with age.

PubMed

Elbaz, Alexis; Artaud, Fanny; Dugravot, Aline; Tzourio, Christophe; Singh-Manoux, Archana

2018-01-24

Taller individuals walk faster but it is unknown whether this advantage persists at older ages. We examined the cross-sectional/longitudinal associations of height with gait speed (GS) in participants from the Dijon-Three-City cohort study (France) over 11 years. In 4011 participants (65-85 y), we measured usual/fast GS (6 m) up to five times. We examined whether the baseline height-GS association varied with age using linear regression, and whether height influenced GS change using linear mixed models. Taller participants 65 y at baseline walked faster than shorter ones (fast GS difference between top/bottom height quartiles, 0.100 m/s, P < 0.001); this association weakened with age (P-interaction = 0.02), with a 0.012 m/s (P = 0.57) difference at 80 y. Ten-year fast GS decline was 51% greater (P < 0.001) in younger participants in the top height quartile (-0.183 m/s) compared to those in the bottom quartile (-0.121 m/s), leading the GS difference between the two groups to be attenuated by 50% over the follow-up. The height-related difference in fast GS decline was not explained by time-dependent comorbidities or height shrinkage. Analyses for usual GS yielded consistent findings. The height-GS relation is more complex than previously thought, as the height related advantage in GS disappears as persons grow older due to faster decline in taller compared to shorter persons.

Two new mini-slings compared with transobturator tension-free vaginal tape for treatment of stress urinary incontinence: A 1-year follow-up randomized controlled trial.

PubMed

Gaber, Mohamed E; Borg, Tamer; Samour, Hazem; Nawara, Mai; Reda, Ahmed

2016-12-01

The aim of this study was to compare the outcome of two single-incision mini-slings (the Contasure-Needleless [C-NDL] and the endopelvic free anchorage) with the standard midurethral transobturator tension-free vaginal tape (TVT-O) procedure. A double blind randomized controlled study was conducted at Ain Shams University Maternity Hospital from August 2014 until July 2015. A total of 209 patients were randomized into three groups. The first group underwent the TVT-O procedure, the second group underwent the endopelvic free anchorage procedure and the third group underwent the C-NDL procedure. Patients were followed up for 12 months in terms of subjective cure, objective cure, and complications rate. After 12 months of follow-up, there were no differences among the three groups in terms of objective cure rate, subjective cure rate, patient satisfaction, or incidence of complications (de novo urge, hemorrhage, infection, and mesh erosion). The C-NDL was associated with a shorter operative time (P < 0.001) and less blood loss (P = 0.021) than the standard TVT-O. The new single-incision mini-slings showed similar efficacy and patient acceptance to that of the standard TVT-O for up to 12 months postoperatively with no difference in the complications rate. The C-NDL is associated with shorter operative time and less blood loss. © 2016 Japan Society of Obstetrics and Gynecology.

Do presenting symptoms explain sex differences in emergency department delays among patients with acute stroke?

PubMed

Gargano, Julia Warner; Wehner, Susan; Reeves, Mathew J

2009-04-01

Previous studies report that women with stroke may experience longer delays in diagnostic workup than men after arriving at the emergency department. We hypothesized that presenting symptom differences could explain these delays. Data were collected on 1922 acute stroke cases who presented to 15 hospitals participating in a statewide stroke registry. We evaluated 2 in-hospital time intervals: emergency department arrival to physician examination ("door-to-doctor") and emergency department arrival to brain imaging ("door-to-image"). We used parametric survival models to estimate time ratios, which represent the ratio of average times comparing women to men, after adjusting for symptom presentation and other confounders. Women were significantly less likely than men to present with any stroke warning sign or suspected stroke (87.5% versus 91.4%) or to report trouble with walking, balance, or dizziness (9.5% versus 13.7%). Difficulty speaking and loss of consciousness were associated with shorter door-to-doctor times. Weakness, facial droop, difficulty speaking, and loss of consciousness were associated with shorter door-to-image times, whereas difficulty with walking/balance was associated with longer door-to-image times. In adjusted analyses, women had 11% longer door-to-doctor intervals (time ratio, 1.11; 95%, CI 1.02 to 1.22) and 15% longer door-to-image intervals (time ratio, 1.15; 95% CI, 1.08 to 1.25) after accounting for presenting symptoms, age, and other confounders. Furthermore, these sex differences remained evident after restricting to patients who arrived within 6 or within 2 hours of symptom onset. Women with acute stroke experienced greater emergency department delays than men, which were not attributable to differences in presenting symptoms, time of arrival, age, or other confounders.

Icon flickering, flicker rate, and color combinations of an icon's symbol/background in visual search performance.

PubMed

Huang, Kuo-Chen; Chiang, Shu-Ying; Chen, Chen-Fu

2008-02-01

The effects of color combinations of an icon's symbol/background and components of flicker and flicker rate on visual search performance on a liquid crystal display screen were investigated with 39 subjects who searched for a target icon in a circular stimulus array (diameter = 20 cm) including one target and 19 distractors. Analysis showed that the icon's symbol/background color significantly affected search time. The search times for icons with black/red and white/blue were significantly shorter than for white/yellow, black/yellow, and black/blue. Flickering of different components of the icon significantly affected the search time. Search time for an icon's border flickering was shorter than for an icon symbol flickering; search for flicker rates of 3 and 5 Hz was shorter than that for 1 Hz. For icon's symbol/background color combinations, search error rate for black/blue was greater than for black/red and white/blue combinations, and the error rate for an icon's border flickering was lower than for an icon's symbol flickering. Interactions affected search time and error rate. Results are applicable to design of graphic user interfaces.

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience.

PubMed

Gong, Chung Sik; Kim, Byung Sik; Kim, Hee Sung

2017-12-28

To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients. We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed. The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005). The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer.

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: A single-center experience

PubMed Central

Gong, Chung Sik; Kim, Byung Sik; Kim, Hee Sung

2017-01-01

AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy (TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy (LATG) using a circular stapler in gastric cancer patients. METHODS We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed. RESULTS The TLTG group had higher mean ages at the time of operation (57.78 ± 11.20 years and 55.69 ± 11.96 years, P = 0.020) and more histories of abdominal surgery (20.2% and 12.4%, P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions, combined operations, pain scores and administration of analgesics, and complications were similar between the two groups. However, compared with the LATG group, the TLTG group required a shorter operation time (149 min vs 170 min, P < 0.001), had lower postoperative hematocrit change (3.49% vs 4.04%, P = 0.002), less intraoperative events (3.1% vs 10.2%, P < 0.001), less intraoperative anastomosis events (2.4% vs 7.1%, P = 0.003), faster postoperative recovery such as median time to first flatus (3.30 d vs 3.60 d, P < 0.001), faster median commencement of soft diet (4.30 d vs 4.60 d, P < 0.001) and shorter length of postoperative hospital stay (6.75 d vs 7.02 d, P = 0.005). CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore, TLTG can be recommended as an appropriate procedure for gastric cancer. PMID:29358863

Do the EMA accelerated assessment procedure and the FDA priority review ensure a therapeutic added value? 2006-2015: a cohort study.

PubMed

Boucaud-Maitre, Denis; Altman, Jean-Jacques

2016-10-01

The Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have both implemented procedures in order to shorten review time for marketing authorizations with potential therapeutic added value, called priority review and accelerated assessment procedure, respectively. The aim of this study is to compare the new molecular entities (NME) assessed in shorter review time by both agencies and to investigate whether granting a shorter review time status subsequently predicts its therapeutic value attributed by a health technology assessment agency, the French Haute Autorité de Santé (HAS). All NME approved by the EMA and the FDA with a therapeutic added value between 2007 and June 30, 2015 were extracted. We assessed the sensibility, the positive predictive value, and the EMA review time. One hundred seventy-eight NME were approved by the FDA and the EMA and a therapeutic value was available for 160 NME. Eighty-eight (55.0 %) NME were on FDA priority review, 24 (15.0 %) on EMA accelerated procedure and 43 (26.9 %) were considered of high clinical added value. The sensibility was 86.0 % for the FDA and 30.2 % for the EMA. The positive predictive value was, respectively, 42.0 and 54.2 %. Twenty-five NME on FDA priority review and of high therapeutic added value were not on EMA accelerated assessment procedure, leading to a supplementary mean EMA review time of 146 days. The EMA was restrictive to grant a shorten review time status for products with therapeutic interest during the study period.

PTEN Loss as Determined by Clinical-grade Immunohistochemistry Assay Is Associated with Worse Recurrence-free Survival in Prostate Cancer.

PubMed

Lotan, Tamara L; Wei, Wei; Morais, Carlos L; Hawley, Sarah T; Fazli, Ladan; Hurtado-Coll, Antonio; Troyer, Dean; McKenney, Jesse K; Simko, Jeffrey; Carroll, Peter R; Gleave, Martin; Lance, Raymond; Lin, Daniel W; Nelson, Peter S; Thompson, Ian M; True, Lawrence D; Feng, Ziding; Brooks, James D

2016-06-01

PTEN is the most commonly deleted tumor suppressor gene in primary prostate cancer (PCa) and its loss is associated with poor clinical outcomes and ERG gene rearrangement. We tested whether PTEN loss is associated with shorter recurrence-free survival (RFS) in surgically treated PCa patients with known ERG status. A genetically validated, automated PTEN immunohistochemistry (IHC) protocol was used for 1275 primary prostate tumors from the Canary Foundation retrospective PCa tissue microarray cohort to assess homogeneous (in all tumor tissue sampled) or heterogeneous (in a subset of tumor tissue sampled) PTEN loss. ERG status as determined by a genetically validated IHC assay was available for a subset of 938 tumors. Associations between PTEN and ERG status were assessed using Fisher's exact test. Kaplan-Meier and multivariate weighted Cox proportional models for RFS were constructed. When compared to intact PTEN, homogeneous (hazard ratio [HR] 1.66, p = 0.001) but not heterogeneous (HR 1.24, p = 0.14) PTEN loss was significantly associated with shorter RFS in multivariate models. Among ERG-positive tumors, homogeneous (HR 3.07, p < 0.0001) but not heterogeneous (HR 1.46, p = 0.10) PTEN loss was significantly associated with shorter RFS. Among ERG-negative tumors, PTEN did not reach significance for inclusion in the final multivariate models. The interaction term for PTEN and ERG status with respect to RFS did not reach statistical significance ( p = 0.11) for the current sample size. These data suggest that PTEN is a useful prognostic biomarker and that there is no statistically significant interaction between PTEN and ERG status for RFS. We found that loss of the PTEN tumor suppressor gene in prostate tumors as assessed by tissue staining is correlated with shorter time to prostate cancer recurrence after radical prostatectomy.

Neural Mechanisms of Selective Attention in Children with Amblyopia.

PubMed

Zhou, Aibao; Jiang, Yanfei; Chen, Jianming; Wei, Jianlan; Dang, Baobao; Li, Shifeng; Xu, Qiongying

2015-01-01

Previous studies have indicated that amblyopia might affect children's attention. We recruited amblyopic children and normal children aged 9-11 years as study subjects and compared selective attention between the two groups of children. Chinese characters denoting colors were used in the Stroop task, and the event-related potential (ERP) was analyzed. The results show that the accuracy of both groups in the congruent condition was higher than the incongruent condition, and the reaction time (RT) of amblyopic children was longer. The latency of the occipital P1 in the incongruent condition was shorter than the neutral condition for both groups; the peak of the occipital P1 elicited by the incongruent stimuli in amblyopic children was higher. In both groups, the N1 peak was higher in the occipital region than frontal and central regions. The N1 latency of normal children was shorter in the congruent and neutral conditions and longer in the incongruent condition; the N1 peak of normal children was higher. The N270 latencies of normal children in the congruent and neutral conditions were shorter; the N270 peak was higher in parietal and occipital regions than frontal and central regions for both groups. The N450 latency of normal children was shorter; in both groups, the N450 average amplitude was significantly higher in the parietal region than central and frontal regions. The accuracy was the same for both groups, but the response of amblyopic children was significantly slower. The two groups showed differences in both stages of the Stroop task. Normal children showed advantages in processing speed on both stimulus and response conflict stages.Brain regions activated during the Stroop task were consistent between groups, in line with their age characteristics.

Time perception and reproduction in young adults with attention deficit hyperactivity disorder.

PubMed

Barkley, R A; Murphy, K R; Bush, T

2001-07-01

Adults with attention deficit hyperactivity disorder (ADHD; n = 104) were compared with a control group (n = 64) on time estimation and reproduction tasks. Results were unaffected by ADHD subtype or gender. The ADHD group provided larger time estimations than the control group, particularly at long intervals. This became nonsignificant after controlling for IQ. The ADHD group made shorter reproductions than did the control group (15- and 60-s intervals) and greater reproduction errors (12-, 45-, 60-s durations). These differences remained after controlling for IQ and comorbid oppositional defiant disorder, depression, and anxiety. Only the level of anxiety contributed to errors (at 12-s duration) beyond the level of ADHD. Results extended findings on time perception in ADHD children to adults and ruled out comorbidity as the basis of the errors.

Effect of Temperature, Time, and Material Thickness on the Dehydration Process of Tomato

PubMed Central

Correia, A. F. K.; Loro, A. C.; Zanatta, S.; Spoto, M. H. F.; Vieira, T. M. F. S.

2015-01-01

This study aimed to evaluate the effects of temperature, time, and thickness of tomatoes fruits during adiabatic drying process. Dehydration, a simple and inexpensive process compared to other conservation methods, is widely used in the food industry in order to ensure a long shelf life for the product due to the low water activity. This study aimed to obtain the best processing conditions to avoid losses and keep product quality. Factorial design and surface response methodology were applied to fit predictive mathematical models. In the dehydration of tomatoes through the adiabatic process, temperature, time, and sample thickness, which greatly contribute to the physicochemical and sensory characteristics of the final product, were evaluated. The optimum drying conditions were 60°C with the lowest thickness level and shorter time. PMID:26904666

Carrier transport dynamics in Mn-doped CdSe quantum dot sensitized solar cells

NASA Astrophysics Data System (ADS)

Poudyal, Uma; Maloney, Francis S.; Sapkota, Keshab; Wang, Wenyong

2017-10-01

In this work quantum dot sensitized solar cells (QDSSCs) were fabricated with CdSe and Mn-doped CdSe quantum dots (QDs) using the SILAR method. QDSSCs based on Mn-doped CdSe QDs exhibited improved incident photon-to-electron conversion efficiency. Carrier transport dynamics in the QDSSCs were studied using the intensity modulated photocurrent/photovoltage spectroscopy technique, from which transport and recombination time constants could be derived. Compared to CdSe QDSSCs, Mn-CdSe QDSSCs exhibited shorter transport time constant, longer recombination time constant, longer diffusion length, and higher charge collection efficiency. These observations suggested that Mn doping in CdSe QDs could benefit the performance of solar cells based on such nanostructures.

Study on the temperature-dependent coupling among viscosity, conductivity and structural relaxation of ionic liquids.

PubMed

Yamaguchi, Tsuyoshi; Yonezawa, Takuya; Koda, Shinobu

2015-07-15

The frequency-dependent viscosity and conductivity of three imidazolium-based ionic liquids were measured at several temperatures in the MHz region, and the results are compared with the intermediate scattering functions determined by neutron spin echo spectroscopy. The relaxations of both the conductivity and the viscosity agree with that of the intermediate scattering function at the ionic correlation when the relaxation time is short. As the relaxation time increases, the relaxations of the two transport properties deviate to lower frequencies than that of the ionic structure. The deviation begins at a shorter relaxation time for viscosity than for conductivity, which explains the fractional Walden rule between the zero-frequency values of the shear viscosity and the molar conductivity.

Comparison of the effectiveness and antibiotic cost among ceftriaxone, ertapenem, and levofloxacin in treatment of community-acquired complicated urinary tract infections.

PubMed

Lin, Hsin-An; Yang, Ya-Sung; Wang, Jing-Xun; Lin, Hsin-Chung; Lin, De-Yu; Chiu, Chun-Hsiang; Yeh, Kuo-Ming; Lin, Jung-Chung; Chang, Feng-Yee

2016-04-01

To study characteristics of patients with community-acquired complicated urinary tract infections (cUTIs) and to compare effectiveness and antibiotic cost of treatment with ceftriaxone (CRO), levofloxacin (LVX), and ertapenem (ETP). This retrospective study enrolled patients who had community-acquired cUTIs admitted to Division of Infectious Diseases in a single medical center from January 2011 to March 2013. Effectiveness, antibiotic cost, and clinical characteristics were compared among patients treated with CRO, LVX, and ETP. There were 358 eligible cases, including 139 who received CRO, 128 treated with ETP, and 91 with LVX. The most common pathogen was Escherichia coli. The susceptibilities of these three agents were higher and more superior than first-line antibiotics. Treatment with ETP was associated with a significantly shorter time to defervescence since admission (CRO: 39 hours, ETP: 30 hours, and LVX: 38 h; p = 0.031) and shorter hospitalization stay (CRO: 4 days, ETP: 3 days, and LVX: 4 days; p < 0.001). However, the average antibiotic costs in the CRO group were significantly lower than that in the other two groups [CRO: 62.4 United States dollars (USD), ETP: 185.33 USD, and LVX: 204.85 USD; p < 0.001]. The resistance of cUTIs isolates to first-line antibiotic is high. Using ETP, CRO, and LVX in the treatment of cUTIs for good clinical response should be suggested. Among the three agents, ETP had better susceptibility than CRO and LVX, reached defervescence sooner, and was associated with shorter hospital stays. However, using CRO in cUTIs was less expensive than the other two agents. Copyright © 2015. Published by Elsevier B.V.

The cost of digestion in the fish-eating myotis (Myotis vivesi).

PubMed

Welch, Kenneth C; Otálora-Ardila, Aída; Herrera M, L Gerardo; Flores-Martínez, José Juan

2015-04-15

Flying vertebrates, such as bats, face special challenges with regards to the throughput and digestion of food. On the one hand, as potentially energy-limited organisms, bats must ingest and assimilate energy efficiently in order to satisfy high resting and active metabolic demands. On the other hand, the assimilation of nutrients must be accomplished using a digestive tract that is, compared with that of similarly sized non-flying vertebrates, significantly shorter. Despite these competing demands, and the relative breadth of dietary diversity among bats, little work has been done describing the cost of digestion, termed 'specific dynamic action' (SDA). Here, we provide the first systematic assessment of the SDA response in a bat, the fish-eating myotis (Myotis vivesi). Given the shorter digestive tract and the relatively higher resting and active metabolic rates of bats in general, and based on anecdotal published evidence, we hypothesized that the SDA response in fish-eating myotis would be dependent on meal size and both significantly more brief and intense than in small, non-flying mammals. In agreement with our hypothesis, we found that the peak metabolic rate during digestion, relative to rest, was significantly higher in these bats compared with any other mammals or vertebrates, except for some infrequently eating reptiles and amphibians. Additionally, we found that the magnitude and duration of the SDA response were related to meal size. However, we found that the duration of the SDA response, while generally similar to reported gut transit times in other small bats, was not substantially shorter than in similarly sized non-flying mammals. © 2015. Published by The Company of Biologists Ltd.

Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

PubMed

Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

2017-10-01

Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P < .001) than TCV patients, fewer days in intensive care (0.3 vs 1.3, P < .001), and a shorter overall hospital stay (1.8 vs 4.2 d, P < .001), and they required fewer revisions (1% vs 6%, P = .05). The mean charge for the endoscopic procedure was $21 203, whereas the mean charge for the TCV reconstruction was $45 078 (P < .001). ES patients had more preoperative computed tomography scans (66% vs 44%, P = .003) than OSS patients, shorter operative times (68 vs 111 min, P < .001), and required fewer revision procedures (1% vs 8%, P < .001). The mean charge for the endoscopic procedure was $21 203 vs $20 535 for the OSS procedure (P = .62). The ES craniectomy for sagittal synostosis appeared to have less morbidity and a potential cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

The effects of publishing emergency department wait time on patient utilization patterns in a community with two emergency department sites: a retrospective, quasi-experiment design.

PubMed

Xie, Bin; Youash, Sabrina

2011-06-14

Providing emergency department (ED) wait time information to the public has been suggested as a mechanism to reduce lengthy ED wait times (by enabling patients to select the ED site with shorter wait time), but the effects of such a program have not been evaluated. We evaluated the effects of such a program in a community with two ED sites. Descriptive statistics for wait times of the two sites before and after the publication of wait time information were used to evaluate the effects of the publication of wait time information on wait times. Multivariate logistical regression was used to test whether or not individual patients used published wait time to decide which site to visit. We found that the rates of wait times exceeding 4 h, and the 95th percentile of wait times in the two sites decreased after the publication of wait time information, even though the average wait times experienced a slight increase. We also found that after controlling for other factors, the site with shorter wait time had a higher likelihood of being selected after the publication of wait time information, but there was no such relationship before the publication. These findings were consistent with the hypothesis that the publication of wait time information leads to patients selecting the site with shorter wait time. While publishing ED wait time information did not improve average wait time, it reduced the rates of lengthy wait times.

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital

PubMed Central

Haule, Caspar; Ongom, Peter A; Kimuli, Timothy

2013-01-01

Introduction The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. Methods An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital’s emergency and general surgical wards were included. Randomisation was to Gastrografin® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. Results All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance (P = 0.67). Average time to relief of obstruction was shorter in the Gastrografin® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference (P = 0.023). The average length of hospital stay was shorter in the Gastrografin® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference (P = 0.04). Conclusion The use of Gastrografin® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive. PMID:24729947

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital.

PubMed

Haule, Caspar; Ongom, Peter A; Kimuli, Timothy

2013-12-01

The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin ® ) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital's emergency and general surgical wards were included. Randomisation was to Gastrografin ® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin ® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance ( P = 0.67 ). Average time to relief of obstruction was shorter in the Gastrografin ® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference ( P = 0.023 ). The average length of hospital stay was shorter in the Gastrografin ® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference ( P = 0.04 ). The use of Gastrografin ® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive.

Gait and physical impairments in patients with acute ankle sprains who did not receive physical therapy.

PubMed

Punt, Ilona M; Ziltener, Jean-Luc; Laidet, Magali; Armand, Stéphane; Allet, Lara

2015-01-01

To assess ankle function 4 weeks after conservative management and to examine the correlation of function with gait. A prospective comparison study. Thirty patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. Participants underwent a clinical assessment and had to walk at a normal self-selected walking speed. Their results were compared with the data of 15 healthy subjects. Participants' joint swelling, muscle strength, passive mobility, and pain were assessed. In addition, patients' temporal-spatial, kinematic, and kinetic gait data were measured while walking. Muscle strength and passive mobility were significantly reduced on the injured side compared with the noninjured side (P < .001). During gait analysis, patients with ankle sprains showed slower walking speed, shorter step length, shorter single support time, reduced and delayed maximum plantar flexion, decreased maximum power, and decreased maximum moment (P < .050) compared with healthy persons. Decreased walking speed was mainly correlated with pain (R = -0.566, P = .001) and deficits in muscle strength of dorsiflexors (R = 0.506, P = .004). Four weeks after an ankle sprain, patients who did not receive physical therapy showed physical impairments of the ankle that were correlated with gait parameters. These findings might help fine-tune rehabilitation protocols. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Effects of interstimulus intervals on behavioral, heart rate, and event-related potential indices of infant engagement and sustained attention

PubMed Central

Xie, Wanze; Richards, John E.

2016-01-01

Maximizing infant attention to stimulus presentation during an EEG or ERP experiment is important for making valid inferences about the neural correlates of infant cognition. The present study examined the effects of stimulus presentation interstimulus interval (ISI) on behavioral and physiological indices of infant attention including infants’ fixation to visual presentation, the amount of heart rate (HR) change during sustained attention, and ERP components. This study compared an ISI that is typically used in infant EEG/ERP studies (e.g., 1,500–2,000 ms) with two shorter durations (400–600 ms and 600–1,000 ms). Thirty-six infants were tested cross-sectionally at 3, 4.5, and 6 months. It was found that using the short (400–600 ms) and medium (600–1,000 ms) ISIs resulted in more visually fixated trials and reduced frequency of fixation disengagement per experimental block. We also found larger HR changes during sustained attention to both of the shorter ISIs compared with the long ISI, and larger ERP responses when using the medium ISI compared to using the short and long ISIs. These data suggest that utilizing an optimal ISI (e.g., 600– 1,000 ms), which increases the presentation complexity and provides sufficient time for information processing, can promote infant engagement and sustained attention during stimulus presentation. PMID:27159263

Transumbilical laparoscopic-assisted appendectomy is a useful surgical option for pediatric uncomplicated appendicitis: a comparison with conventional 3-port laparoscopic appendectomy

PubMed Central

Go, Doo Yeon; Lee, Ji Sung; Jung, Cheol Woong

2016-01-01

Purpose Transumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that uses a combined intra- and extracorporeal method. The aim of this study was to compare surgical outcomes of TULA with conventional 3-port laparoscopic appendectomy (LA). Methods A retrospective review of medical records between 2010 and 2014 identified 303 pediatric patients who underwent LA with uncomplicated acute appendicitis. Of these, 85 patients underwent TULA and 218 patients underwent conventional LA. Demographic data, clinical characteristics, perioperative outcomes and postoperative complications were compared between the 2 groups. Results The mean operation time in the TULA group was 30.39 minutes, which was significantly shorter than that of the LA group (47.83 minutes) (P < 0.001). The first day of oral intake after surgery was earlier (1.05 days vs. 1.32 days; P < 0.001) and the length of hospital stay was also shorter (2.54 days vs. 3.22 days; P < 0.001) for the TULA group than the LA group. Furthermore, the postoperative complication rate was lower in the TULA group (1 of 85, 1.25%) compared to the LA group (19 of 218, 8.7%) (P = 0.018). Conclusion In conclusion, TULA procedure is recommended for uncomplicated appendicitis in children due to its simplicity and better postoperative outcomes. PMID:27478813

Chitinase activity of Pseudomonas stutzeri PT5 in different fermentation condition

NASA Astrophysics Data System (ADS)

Chalidah, N.; Khotimah, I. N.; Hakim, A. R.; Meata, B. A.; Puspita, I. D.; Nugraheni, P. S.; Ustadi; Pudjiraharti, S.

2018-03-01

This study aimed to determine the incubation condition of Pseudomonas stutzeri PT5 in producing chitin degrading enzyme in various pH and temperatures; to compare the production of chitin degrading enzyme in chitin medium supplemented with additional nitrogen, carbon and a mixture of nitrogen and carbon sources and to observe the production of chitin degrading enzyme in 250 mL-shake flasks and 2 L-fermentor. The parameters tested during production were chitinase activity (U·mL-1) of culture supernatant and N-acetylglucosamine concentration (μg·mL-1) in the medium. The results showed that Pseudomonas stutzeri PT5 was able to produce the highest chitinase activity at pH 6 and temperature of 37 °C (0.024 U·mL-1). The addition of 0.1 % of ammonium phosphate and 0.1 % of maltose, increased the chitinase activity of Pseudomonas stutzeri PT5 by 3.24 and 8.08 folds, respectively, compared to the control. The addition of 0.1 % ammonium phosphate and 0.1 % maltose mixture to chitin medium resulted in the shorter time of chitinase production compared to the addition of sole nutrition. The production of chitinase using 2 L-fermentor shows that the highest chitinase activity produced by Pseudomonas stutzeri PT5 was reached at 1-day incubation (0.0283 U·mL-1), which was shorter than in 250 mL-shake flasks.

Conventional and narrow bore short capillary columns with cyclodextrin derivatives as chiral selectors to speed-up enantioselective gas chromatography and enantioselective gas chromatography-mass spectrometry analyses.

PubMed

Bicchi, Carlo; Liberto, Erica; Cagliero, Cecilia; Cordero, Chiara; Sgorbini, Barbara; Rubiolo, Patrizia

2008-11-28

The analysis of complex real-world samples of vegetable origin requires rapid and accurate routine methods, enabling laboratories to increase sample throughput and productivity while reducing analysis costs. This study examines shortening enantioselective-GC (ES-GC) analysis time following the approaches used in fast GC. ES-GC separations are due to a weak enantiomer-CD host-guest interaction and the separation is thermodynamically driven and strongly influenced by temperature. As a consequence, fast temperature rates can interfere with enantiomeric discrimination; thus the use of short and/or narrow bore columns is a possible approach to speeding-up ES-GC analyses. The performance of ES-GC with a conventional inner diameter (I.D.) column (25 m length x 0.25 mm I.D., 0.15 microm and 0.25 microm d(f)) coated with 30% of 2,3-di-O-ethyl-6-O-tert-butyldimethylsilyl-beta-cyclodextrin in PS-086 is compared to those of conventional I.D. short column (5m length x 0.25 mm I.D., 0.15 microm d(f)) and of different length narrow bore columns (1, 2, 5 and 10 m long x 0.10 mm I.D., 0.10 microm d(f)) in analysing racemate standards of pesticides and in the flavour and fragrance field and real-world-samples. Short conventional I.D. columns gave shorter analysis time and comparable or lower resolutions with the racemate standards, depending mainly on analyte volatility. Narrow-bore columns were tested under different analysis conditions; they provided shorter analysis time and resolutions comparable to those of conventional I.D. ES columns. The narrow-bore columns offering the most effective compromise between separation efficiency and analysis time are the 5 and 2m columns; in combination with mass spectrometry as detector, applied to lavender and bergamot essential oil analyses, these reduced analysis time by a factor of at least three while separation of chiral markers remained unaltered.

Efficient constraint handling in electromagnetism-like algorithm for traveling salesman problem with time windows.

PubMed

Yurtkuran, Alkın; Emel, Erdal

2014-01-01

The traveling salesman problem with time windows (TSPTW) is a variant of the traveling salesman problem in which each customer should be visited within a given time window. In this paper, we propose an electromagnetism-like algorithm (EMA) that uses a new constraint handling technique to minimize the travel cost in TSPTW problems. The EMA utilizes the attraction-repulsion mechanism between charged particles in a multidimensional space for global optimization. This paper investigates the problem-specific constraint handling capability of the EMA framework using a new variable bounding strategy, in which real-coded particle's boundary constraints associated with the corresponding time windows of customers, is introduced and combined with the penalty approach to eliminate infeasibilities regarding time window violations. The performance of the proposed algorithm and the effectiveness of the constraint handling technique have been studied extensively, comparing it to that of state-of-the-art metaheuristics using several sets of benchmark problems reported in the literature. The results of the numerical experiments show that the EMA generates feasible and near-optimal results within shorter computational times compared to the test algorithms.

Efficient Constraint Handling in Electromagnetism-Like Algorithm for Traveling Salesman Problem with Time Windows

PubMed Central

Yurtkuran, Alkın

2014-01-01

The traveling salesman problem with time windows (TSPTW) is a variant of the traveling salesman problem in which each customer should be visited within a given time window. In this paper, we propose an electromagnetism-like algorithm (EMA) that uses a new constraint handling technique to minimize the travel cost in TSPTW problems. The EMA utilizes the attraction-repulsion mechanism between charged particles in a multidimensional space for global optimization. This paper investigates the problem-specific constraint handling capability of the EMA framework using a new variable bounding strategy, in which real-coded particle's boundary constraints associated with the corresponding time windows of customers, is introduced and combined with the penalty approach to eliminate infeasibilities regarding time window violations. The performance of the proposed algorithm and the effectiveness of the constraint handling technique have been studied extensively, comparing it to that of state-of-the-art metaheuristics using several sets of benchmark problems reported in the literature. The results of the numerical experiments show that the EMA generates feasible and near-optimal results within shorter computational times compared to the test algorithms. PMID:24723834

Optimizing the Protocol for Pulmonary Cryoablation: A Comparison of a Dual- and Triple-Freeze Protocol

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hinshaw, J. Louis, E-mail: jhinshaw@uwhealth.or; Littrup, Peter J.; Durick, Nathan

2010-12-15

The purpose of this study was to compare a double freeze-thaw protocol to a triple freeze-thaw protocol for pulmonary cryoablation utilizing an in vivo porcine lung model. A total of 18 cryoablations were performed in normal porcine lung utilizing percutaneous technique with 9 each in a double- (10-5-10) and triple-freeze (3-3-7-7-5) protocol. Serial noncontrast CT images were obtained during the ablation. CT imaging findings and pathology were reviewed. No imaging changes were identified during the initial freeze cycle with either protocol. However, during the first thaw cycle, a region of ground glass opacity developed around the probe with both protocols.more » Because the initial freeze was shorter with the triple freeze-thaw protocol, the imaging findings were apparent sooner with this protocol (6 vs. 13 min). Also, despite a shorter total freeze time (15 vs. 20 min), the ablation zone identified with the triple freeze-thaw protocol was not significantly different from the double freeze-thaw protocol (mean diameter: 1.67 {+-} 0.41 cm vs. 1.66 {+-} 0.21 cm, P = 0.77; area: 2.1 {+-} 0.48 cm{sup 2} vs. 1.99 {+-} 0.62 cm{sup 2}, P = 0.7; and circularity: 0.95 {+-} 0.04 vs. 0.96 {+-} 0.03, P = 0.62, respectively). This study suggests that there may be several advantages of a triple freeze-thaw protocol for pulmonary cryoablation, including earlier identification of the imaging findings associated with the ablation, the promise of a shorter procedure time or larger zones of ablation, and theoretically, more effective cytotoxicity related to the additional freeze-thaw cycle.« less

Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

PubMed

Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

2010-12-01

Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

Only minor changes in thrombin generation of children and adolescents with type 1 diabetes mellitus - A case-control study.

PubMed

Cimenti, Christina; Schlagenhauf, Axel; Leschnik, Bettina; Fröhlich-Reiterer, Elke; Jasser-Nitsche, Hildegard; Haidl, Harald; Suppan, Elisabeth; Weinhandl, Gudrun; Leberl, Maximilian; Borkenstein, Martin; Muntean, Wolfgang E

2016-12-01

Micro- and macrovascular diseases are frequent complications in patients with diabetes. Hypercoagulability may contribute to microvascular alterations. In this study, we investigated whether type 1 diabetes in children is associated with a hypercoagulable state by performing a global function test of coagulation - the thrombin generation assay. 75 patients with type 1 diabetes aged between 2 and 19years were compared to an age-matched healthy control group. Diabetes patients were divided into high-dose and low-dose insulin cohorts with a cut-off at 0.8Ukg -1 d -1 . Measurements were performed with platelet poor plasma using Calibrated Automated Thrombography and 1 pM or 5 pM tissue factor. Additionally, we quantified prothrombin fragments F1+2, thrombin-antithrombin complex, prothrombin, tissue factor pathway inhibitor, and antithrombin. Patients with type 1 diabetes exhibited a significantly shorter of lag time as well as decreased thrombin peak and endogenous thrombin potential compared to control subjects with 5 pM but not with 1 pM tissue factor. In high-dose insulin patients peak thrombin generation was higher and time to peak shorter than in low-dose patients. Thrombin-antithrombin complex was decreased in patients with type 1 diabetes, whereas prothrombin fragments F1+2 was comparable in both groups. Thrombin generation parameters did not correlate with parameters of metabolic control and the duration of diabetes. Taken together, we found only minor changes of thrombin generation in children and adolescents with type 1 diabetes which - in contrast to type 2 diabetes - do not argue for a hypercoagulable state. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of Climatic Region on Peritonitis Risk, Microbiology, Treatment, and Outcomes: a Multicenter Registry Study

PubMed Central

Cho, Yeoungjee; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Brown, Fiona G.; Boudville, Neil; Wiggins, Kathryn J.; Bannister, Kym M.; Clayton, Philip; Johnson, David W.

2013-01-01

♦ Background: The impact of climatic variations on peritoneal dialysis (PD)-related peritonitis has not been studied in detail. The aim of the current study was to determine whether various climatic zones influenced the probability of occurrence or the clinical outcomes of peritonitis. ♦ Methods: Using ANZDATA registry data, the study in cluded all Australian patients receiving PD between 1 October 2003 and 31 December 2008. Climatic regions were defined according to the Köppen classification. ♦ Results: The overall peritonitis rate was 0.59 episodes per patient-year. Most of the patients lived in Temperate regions (65%), with others residing in Subtropical (26%), Tropical (6%), and Other climatic regions (Desert, 0.6%; Grassland, 2.3%). Compared with patients in Temperate regions, those in Tropical regions demonstrated significantly higher overall peritonitis rates and a shorter time to a first peritonitis episode [adjusted hazard ratio: 1.15; 95% confidence interval (CI): 1.01 to 1.31]. Culture-negative peritonitis was significantly less likely in Tropical regions [adjusted odds ratio (OR): 0.42; 95% CI: 0.25 to 0.73]; its occurrence in Subtropical and Other regions was comparable to that in Temperate regions. Fungal peritonitis was independently associated with Tropical regions (OR: 2.18; 95% CI: 1.22 to 3.90) and Other regions (OR: 3.46; 95% CI: 1.73 to 6.91), where rates of antifungal prophylaxis were also lower. Outcomes after first peritonitis episodes were comparable in all groups. ♦ Conclusions: Tropical regions were associated with a higher overall peritonitis rate (including fungal peritonitis) and a shorter time to a first peritonitis episode. Augmented peritonitis prophylactic measures such as antifungal therapy and exit-site care should be considered in PD patients residing in Tropical climates. PMID:22942270

Efficacy of Reconstituted Oral Chloral Hydrate from Crystals for Echocardiography Sedation.

PubMed

Hill, Garick D; Walbergh, Deborah B; Frommelt, Peter C

2016-04-01

Chloral hydrate has been the drug of choice for uncooperative infants and children requiring sedation for echocardiography. Recently, the commercially available liquid formulation was discontinued by the manufacturer, and the only oral form of chloral hydrate available was made using reconstituted crystals. The aim of this study was to compare sedation efficacy before and after this change in chloral hydrate formulas. Consecutive patients presenting for echocardiography sedation during the transition from the manufacturer-derived old formulation to the locally reconstituted new formulation were retrospectively reviewed for time to onset of level 3 sedation, duration of level ≤3 sedation, requirement for additional sedative medications, sedation failure, ability to complete the echocardiographic examination, and adverse events related to the sedatives. The cohort included 124 patients (63 old, 61 new). Although the mean age at sedation was younger for the new group, the weight and average dose of chloral hydrate used were not significantly different. There were no adverse events in either group. Time to onset of sedation was the same between the two formulations, but the duration of sedation was significantly shorter for the new group (42.4 ± 24.5 vs 55.3 ± 26.2 min, P = .01). In addition, the need for secondary sedating agents because of inadequate sedation and sedation failure were significantly greater using the new compared with the old formulation. Chloral hydrate reformulation using reconstituted crystals results in a shorter duration of sedation, more frequent requirement for a secondary sedative agent, more frequent sedation failure, and occasional inability to complete the echocardiographic examination compared with the manufacturer's formulation. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

An integrated process analytical technology (PAT) approach to monitoring the effect of supercooling on lyophilization product and process parameters of model monoclonal antibody formulations.

PubMed

Awotwe Otoo, David; Agarabi, Cyrus; Khan, Mansoor A

2014-07-01

The aim of the present study was to apply an integrated process analytical technology (PAT) approach to control and monitor the effect of the degree of supercooling on critical process and product parameters of a lyophilization cycle. Two concentrations of a mAb formulation were used as models for lyophilization. ControLyo™ technology was applied to control the onset of ice nucleation, whereas tunable diode laser absorption spectroscopy (TDLAS) was utilized as a noninvasive tool for the inline monitoring of the water vapor concentration and vapor flow velocity in the spool during primary drying. The instantaneous measurements were then used to determine the effect of the degree of supercooling on critical process and product parameters. Controlled nucleation resulted in uniform nucleation at lower degrees of supercooling for both formulations, higher sublimation rates, lower mass transfer resistance, lower product temperatures at the sublimation interface, and shorter primary drying times compared with the conventional shelf-ramped freezing. Controlled nucleation also resulted in lyophilized cakes with more elegant and porous structure with no visible collapse or shrinkage, lower specific surface area, and shorter reconstitution times compared with the uncontrolled nucleation. Uncontrolled nucleation however resulted in lyophilized cakes with relatively lower residual moisture contents compared with controlled nucleation. TDLAS proved to be an efficient tool to determine the endpoint of primary drying. There was good agreement between data obtained from TDLAS-based measurements and SMART™ technology. ControLyo™ technology and TDLAS showed great potential as PAT tools to achieve enhanced process monitoring and control during lyophilization cycles. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Temperature and time variations during osteotomies performed with different piezosurgical devices: an in vitro study.

PubMed

Delgado-Ruiz, R A; Sacks, D; Palermo, A; Calvo-Guirado, J L; Perez-Albacete, C; Romanos, G E

2016-09-01

The aim of this experimental in vitro study was to evaluate the effects of the piezoelectric device in temperature and time variations in standardized osteotomies performed with similar tip inserts in bovine bone blocks. Two different piezosurgical devices were used the OE-F15(®) (Osada Inc., Los Angeles, California, USA) and the Surgybone(®) (Silfradent Inc., Sofia, Forli Cesena, Italy). Serrated inserts with similar geometry were coupled with each device (ST94 insert/test A and P0700 insert/test B). Osteotomies 10 mm long and 3 mm deep were performed in bone blocks resembling type II (dense) and type IV (soft) bone densities with and without irrigation. Thermal changes and time variations were recorded. The effects of bone density, irrigation, and device on temperature changes and time necessary to accomplish the osteotomies were analyzed. Thermal analysis showed significant higher temperatures during piezosurgery osteotomies in hard bone without irrigation (P < 0.05). The type of piezosurgical device did not influence thermal variations (P > 0.05). Time analysis showed that the mean time values necessary to perform osteotomies were shorter in soft bone than in dense bone (P < 0.05). Within the limitations of this in vitro study, it may be concluded that the temperature increases more in piezosurgery osteotomies in dense bone without irrigation; the time to perform the osteotomy with piezosurgery is shorter in soft bone compared to hard bone; and the piezosurgical device have a minimal influence in the temperature and time variations when a similar tip design is used during piezosurgery osteotomies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Effect of Optimally Timed Osteopathic Manipulative Treatment on Length of Hospital Stay in Moderate and Late Preterm Infants: Results from a RCT.

PubMed

Pizzolorusso, Gianfranco; Cerritelli, Francesco; Accorsi, Alessandro; Lucci, Chiara; Tubaldi, Lucia; Lancellotti, Jenny; Barlafante, Gina; Renzetti, Cinzia; D'Incecco, Carmine; Perri, Francesco Paolo

2014-01-01

Introduction. Little research has been conducted looking at the effects of osteopathic manipulative treatment (OMT) on preterm infants. Aim of the Study. This study hypothesized that osteopathic care is effective in reducing length of hospital stay and that early OMT produces the most pronounced benefit, compared to moderately early and late OMT. A secondary outcome was to estimate hospital cost savings by the use of OMT. Methods. 110 newborns ranging from 32- to 37-week gestation were randomized to receive either OMT or usual pediatric care. Early, moderately early, and late OMT were defined as <4, <9, and <14 days from birth, respectively. Result. Hospital stay was shorter in infants receiving late OMT (-2.03; 95% CI -3.15, -0.91; P < 0.01) than controls. Subgroup analysis of infants receiving early and moderately early OMT resulted in shorter LOS (early OMT: -4.16; -6.05, -2.27; P < 0.001; moderately early OMT: -3.12; -4.36, -1.89; P < 0.001). Costs analysis showed that OMT significantly produced a net saving of €740 (-1309.54, -170.33; P = 0.01) per newborn per LOS. Conclusions. This study shows evidence that the sooner OMT is provided, the shorter their hospital stay is. There is also a positive association of OMT with overall reduction in cost of care.

Comparison of maternal and neonatal outcomes for patients with placenta accreta spectrum between online-to-offline management model with standard care model.

PubMed

Sun, Wen; Yu, Lin; Liu, Shiliang; Chen, Yanhong; Chen, Juanjuan; Wen, Shi Wu; Chen, Dunjin

2018-03-01

Online-to-offline is a new model for emergent medical service with the ability to connect care providers with patients on instant basis. This study aims to evaluate maternal and neonatal outcomes in patients with placenta accreta spectrum managed by an online-to-offline care model. Starting from January 1, 2015, management of patients with placenta accreta spectrum was changed from standard care model into an online-to-offline care model through "Wechat" in Guangzhou Medical Centre for Critical Obstetrical Care. This study compared maternal and neonatal outcomes in patients affected by placenta accreta spectrum between 2015 (online-to-offline model) and 2014 (standard care model). A total of 209 cases of placenta accrete spectrum were treated in our center in 2015 and 218 such cases were treated in 2014. Patients treated in 2015 had lower rate of hysterectomy (14.83% versus 20.64%) and shorter hospital stay (7 days versus 8 days). The average interval from admission to emergency cesarean section for critically ill patients was 38.5 min in 2015 versus 50.7 min in 2014. Patients affected by placenta accreta spectrum managed by online-to-offline care model have reduced risk of hysterectomy, shorter hospital stay, and shorter response time from admission to emergency cesarean section. Copyright © 2018 Elsevier B.V. All rights reserved.

Kangaroo care and behavioral and physiologic pain responses in very-low-birth-weight twins: a case study.

PubMed

Cong, Xiaomei; Cusson, Regina M; Hussain, Naveed; Zhang, Di; Kelly, Sharon P

2012-09-01

The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants. Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Rituximab as an immunosuppressant in antineutrophil cytoplasmic antibody-associated vasculitis

PubMed Central

McGregor, JulieAnne G.; Hogan, Susan L.; Kotzen, Elizabeth S.; Poulton, Caroline J.; Hu, Yichun; Negrete-Lopez, Roberto; Kidd, Jason M.; Katsanos, Suzanne L.; Bunch, Donna O.; Nachman, Patrick H.; Falk, Ronald J.

2015-01-01

Background Rituximab has been used in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) since 2003. Our objective was to describe outcomes and adverse events following rituximab since that time in an inception cohort. Methods Patients with AAV (diagnosed 1991–2012) who received rituximab (n = 120) were evaluated and incidence per person-year (PPY) with 95% confidence interval was calculated for relapse and infections. Time to remission and relapse by number of rituximab infusions given per treatment course (≤2 versus >2) and by ever having been exposed to cyclophosphamide were compared using Kaplan–Meier curves. Rituximab-treated patients were characterized in comparison with AAV patients treated with cyclophosphamide but not exposed to rituximab (n = 351) using Fisher's exact or rank tests. Results Rituximab resulted in 86% achieving remission and 41% having a subsequent relapse in a median of 19 months (range 9–29). Time to remission and relapse were similar between rituximab infusion courses (≤2 versus >2; remission P = 0.86 and relapse P = 0.78, respectively). Incidence of relapse was 0.22 PPY (0.14, 0.31) and of severe infection was 0.12 PPY (0.08, 0.24). Time to relapse was shorter in those never exposed to cyclophosphamide (n = 20): 50% by 8 months versus 50% by 24 and 30 months for those with prior or concurrent exposure to cyclophosphamide (n = 100). Compared with those who never received rituximab, rituximab-treated patients were younger (P < 0.001), more likely to have granulomatosis with polyangiitis (P = 0.001) and had more upper airway (P = 0.01) and less kidney involvement (P = 0.007). Conclusions Rituximab is beneficial when prescribed outside of a trial setting. Response to treatment and relapse is similar regardless of infusion number. Rituximab without cyclophosphamide may result in a shorter time to relapse supporting combination of these therapies. PMID:25805743

Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study.

PubMed

Dinov, Borislav; Schönbauer, Robert; Wojdyla-Hordynska, Agnieska; Braunschweig, Frieder; Richter, Sergio; Altmann, David; Sommer, Philipp; Gaspar, Thomas; Bollmann, Andreas; Wetzel, Ulrike; Rolf, Sascha; Piorkowski, Christopher; Hindricks, Gerhard; Arya, Arash

2012-05-01

Remote magnetic navigation (RMN) aims to reduce some inherent limitations of manual radiofrequency (RF) ablation. However, data comparing the effectiveness of both methods are scarce. This study evaluated the acute and long-term success of RMN guided versus manual RF ablation in patients with ischemic sustained ventricular tachycardia (sVT). One hundred two consecutive patients (age 68 ± 10 years, LVEF 32 ± 12%, 88 men) with ischemic sVT were ablated with RMN (Stereotaxis; 49%) or manually (51%) using substrate and/or activation mapping (Carto) and open-irrigated-tip catheters. All received implantable defibrillators or loop recorders. Acute success was defined as noninducibility of any sVT at the end of the ablation procedure and long-term success as freedom from VT upon follow-up. There was no difference in the baseline characteristics between the groups. Three patients died in hospital. Acute success rate was similar for RMN and manual ablation (82% vs 71%, P = 0.246). RMN was associated with significantly shorter fluoroscopy time (13 ± 12 minutes vs 32 ± 17 minutes, P = 0.0001) and RF time (2337.59 ± 1248.22 seconds vs 1589.95 ± 1047.42 seconds, P = 0.049), although total procedure time was similar (157 ± 40 minutes vs 148 ± 50 minutes, P = 0.42). There was a nonsignificant trend toward better long-term success in RMN group: after a median of 13 (range 1-34) months, 63% in the RMN and 53% in the manual ablation group were free from VT recurrence (P = 0.206). RMN guided RF ablation of ischemic sustained VT is equally efficient compared with manual ablation in terms of acute and long-term success rate. These results are achieved with a significantly reduced fluoroscopy time and shorter RF time. © 2012 Wiley Periodicals, Inc.

In Vitro Comparison of Holmium Lasers: Evidence for Shorter Fragmentation Time and Decreased Retropulsion Using a Modern Variable-pulse Laser.

PubMed

Bell, John Roger; Penniston, Kristina L; Nakada, Stephen Y

2017-09-01

To compare the performance of variable- and fixed-pulse lasers on stone phantoms in vitro. Seven-millimeter stone phantoms were made to simulate calcium oxalate monohydrate stones using BegoStone plus. The in vitro setting was created with a clear polyvinyl chloride tube. For each trial, a stone phantom was placed at the open end of the tubing. The Cook Rhapsody H-30 variable-pulse laser was tested on both long- and short-pulse settings and was compared to the Dornier H-20 fixed-pulse laser; 5 trials were conducted for each trial arm. Fragmentation was accomplished with the use of a flexible ureteroscope and a 273-micron holmium laser fiber using settings of 1 J × 12 Hz. The treatment time (in minute) for complete fragmentation was recorded as was the total retropulsion distance (in centimeter) during treatment. Laser fibers were standardized for all repetitions. The treatment time was significantly shorter with the H-30 vs the H-20 laser (14.3 ± 2.5 vs 33.1 ± 8.9 minutes, P = .008). There was no difference between the treatment times using the long vs short pulse widths of the H-30 laser (14.4 ± 3.4 vs 14.3 ± 1.7 minutes, P = .93). Retropulsion differed by laser type and pulse width, H-30 long pulse (15.8 ± 5.7 cm), H-30 short pulse (54.8 ± 7.1 cm), and H-20 (33.2 ± 12.5 cm) (P <.05). The H-30 laser fragmented stone phantoms in half the time of the H-20 laser regardless of the pulse width. Retropulsion effects differed between the lasers, with the H-30 causing the least retropulsion. Longer pulse widths result in less stone retropulsion. Copyright © 2017 Elsevier Inc. All rights reserved.

Piezosurgery®-assisted periodontally accelerated osteogenic orthodontics.

PubMed

Pakhare, Vikas Vilas; Khandait, Chinmay Harishchandra; Shrivastav, Sunita Satish; Dhadse, Prasad Vijayrao; Baliga, Vidya Sudhindhra; Seegavadi, Vasudevan Dwarkanathan

2017-01-01

Periodontally accelerated osteogenic orthodontic procedure has become useful adjunct to reduce orthodontic treatment time as compared with conventional orthodontics. This case demonstrates the use of Piezosurgery ® to facilitate rapid tooth movement with relatively shorter treatment time. A 23-year-old male with Angles Class I malocclusion having spaced anterior teeth and protrusion requested orthodontic treatment with reduced time period. Before surgery, presurgical orthodontic treatment was done to do initial alignment of the teeth. This was followed by piezosurgical corticotomy and final space closure was achieved by active orthodontic tooth movement. The total treatment time required to complete the orthodontic treatment was 5 months. 1-year follow-up revealed no evidence of any adverse periodontal effects or relapse. Thus, Piezosurgery ® -assisted corticotomy may prove to be a noble and effective treatment approach to decrease the orthodontic treatment time.

Piezosurgery®-assisted periodontally accelerated osteogenic orthodontics

PubMed Central

Pakhare, Vikas Vilas; Khandait, Chinmay Harishchandra; Shrivastav, Sunita Satish; Dhadse, Prasad Vijayrao; Baliga, Vidya Sudhindhra; Seegavadi, Vasudevan Dwarkanathan

2017-01-01

Periodontally accelerated osteogenic orthodontic procedure has become useful adjunct to reduce orthodontic treatment time as compared with conventional orthodontics. This case demonstrates the use of Piezosurgery® to facilitate rapid tooth movement with relatively shorter treatment time. A 23-year-old male with Angles Class I malocclusion having spaced anterior teeth and protrusion requested orthodontic treatment with reduced time period. Before surgery, presurgical orthodontic treatment was done to do initial alignment of the teeth. This was followed by piezosurgical corticotomy and final space closure was achieved by active orthodontic tooth movement. The total treatment time required to complete the orthodontic treatment was 5 months. 1-year follow-up revealed no evidence of any adverse periodontal effects or relapse. Thus, Piezosurgery®-assisted corticotomy may prove to be a noble and effective treatment approach to decrease the orthodontic treatment time. PMID:29491592

Response of Volume Transport through the Taiwan and Tsushima Straits to the Wind Fields in the East China Sea

NASA Astrophysics Data System (ADS)

Matsuno, T.; Liu, C. T.; Fukudome, K.; Chen, H. W.; Ichikawa, K.; Doong, D. J.; Senjyu, T.

2016-02-01

Circulation in the shelf region of the East China Sea is strongly controlled by the volume transport (VT) through the Taiwan Strait (TwS). It is well known that the VT through TwS has a significant seasonal variation, large in summer and small in winter. Based on a time series of the current field obtained by ADCP installed on a ferry boat crossing the TwS, from Keelung to Matsu Island in Taiwan, it had been investigated that the seasonal variations have a good correlation with the local wind around the TwS. The VT through the TwS had been compared with that through Tsushima Strait (TsS), and the results using the data from 2009 to 2012 were presented in the last OSM. In this study the monitoring data were extended further to 2014 and the difference of VTs between TwS and TsS was compared with wind fields and Ekman transport for not only seasonal variation but also shorter time scale variations. Ekman transport across the shelf break with time scales shorter than one month has a good correlation with the difference of VTs between TwS and TsS, that is, net transport across the shelf break of the East China Sea. The correlation is much better with VT through TwS rather than through TsS. Onshoreward net transport due to the Ekman transport may decrease the VT through TwS, which means that the VT through TwS is not only related to the local wind but also wind field over the East China Sea.

Pulmonary Vein Isolation Alone Versus Additional Linear Ablation in Patients With Persistent Atrial Fibrillation Converted to Paroxysmal Type With Antiarrhythmic Drug Therapy: A Multicenter, Prospective, Randomized Study.

PubMed

Yu, Hee Tae; Shim, Jaemin; Park, Junbeom; Kim, In-Soo; Kim, Tae-Hoon; Uhm, Jae-Sun; Joung, Boyoung; Lee, Moon-Hyoung; Kim, Young-Hoon; Pak, Hui-Nam

2017-06-01

Atrial fibrillation (AF) type can vary depending on condition and timing, and some patients who initially present with persistent AF may be changed to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether circumferential pulmonary vein isolation (CPVI) alone is an effective rhythm control strategy in patients with persistent AF to paroxysmal AF. We enrolled 113 patients with persistent AF to paroxysmal AF (male 75%, 60.4±10.1 years old) who underwent catheter ablation for nonvalvular AF at 3 tertiary hospitals. The participants were randomly assigned to 2 groups: CPVI alone (n=59) or CPVI plus linear ablation (CPVI+Line; posterior box+anterior line, n=54). Compared with the CPVI+Line, CPVI alone required shorter procedure (187.2±58.0 versus 211.2±63.9 min; P =0.043) and ablation times (4922.1±1110.5 versus 6205.7±1425.2 s; P <0.001) without difference in procedure-related major complication (3% versus 2%; P =0.611). Antiarrhythmic drug utility rates after ablation were not different between the 2 groups (22% versus 30%; P =0.356). Overall, AF-free survival (log-rank; P =0.206) and AF and antiarrhythmic drug-free survival (log-rank; P =0.321) were not different between groups. CPVI alone is an effective rhythm control strategy with a shorter procedure time in persistent AF patients converted to paroxysmal AF compared with CPVI with linear ablation. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02176616. © 2017 American Heart Association, Inc.

How Effective Is Algorithm-Guided Treatment for Depressed Inpatients? Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial

PubMed Central

Wiethoff, Katja; Baghai, Thomas C; Fisher, Robert; Seemüller, Florian; Laakmann, Gregor; Brieger, Peter; Cordes, Joachim; Malevani, Jaroslav; Laux, Gerd; Hauth, Iris; Möller, Hans-Jürgen; Kronmüller, Klaus-Thomas; Smolka, Michael N; Schlattmann, Peter; Berger, Maximilian; Ricken, Roland; Stamm, Thomas J; Heinz, Andreas; Bauer, Michael

2017-01-01

Abstract Background Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Results Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance. PMID:28645191

Using methylene blue as a marker to find and remove tiny metallic foreign bodies embedded in the soft tissues of children: A randomised controlled trial.

PubMed

Su, Yuxi; Nan, Guoxin

2016-05-01

Embedment of metallic foreign bodies in the soft tissues is commonly encountered in the emergency room. Most foreign bodies are easily removed, but removal is difficult if the foreign body is very small or deeply embedded. To determine the usefulness of methylene blue staining in the surgical removal of tiny metallic foreign bodies embedded in the soft tissue. This prospective study involved 41 children treated between May 2007 and May 2012. The patients were randomly divided into a methylene blue group and a control group. In the control group, foreign bodies were located using a C-arm and removed via direct incision. In the methylene blue group, foreign bodies were located using a C-arm, marked with an injection of methylene blue and then removed surgically. The clinical outcomes, complications, operation time, surgical success rate, incision length, frequency of C-arm use, and length and depth of the foreign body were compared between the two groups. The surgical success rate was significantly higher in the methylene blue group. The average operation time was significantly shorter in the methylene blue group. The C-arm was used significantly less frequently in the methylene blue group than in the control group. The incision length was significantly shorter in the methylene blue group than in the control group. Methylene blue staining facilitated the location and removal of tiny metallic foreign bodies from the soft tissue, and significantly reduced operation time, incision length and radiation exposure compared to the conventional method. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Laparoscopic Donor Nephrectomy: Early Experience at a Single Center in Pakistan.

PubMed

Mohsin, Rehan; Shehzad, Asad; Bajracharya, Uspal; Ali, Bux; Aziz, Tahir; Mubarak, Muhammed; Hashmi, Altaf; Rizvi, Adibul Hasan

2018-04-01

Laparoscopic donor nephrectomy has become the criterion standard for kidney retrieval from living donors. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Pakistan. The objective of the study was to identify benefits and harms of using laparoscopic compared with open nephrectomy techniques for renal allograft retrieval. In this a retrospective study, patient files from May 2014 to September 2015 were analyzed. Patients were divided into 2 groups: those with open donor nephrectomy and those with laparoscopic donor nephrectomy. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time, perioperative and postoperative complications, surgery time, and length of hospital stay. Finally, serum creatinine patterns of both donors and recipients were analyzed. Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, USA). Of 388 total donors, 190 (49%) had open donor nephrectomy and 198 (51%) had laparoscopic donor nephrectomy. For both groups, most donors were older than 25 years with male preponderance. Left-to-right kidney donation ratio was markedly higher in the laparoscopic group than in the open donor nephrectomy group, with 6 cases of double renal artery also included in this study. There were no significant differences in surgery times between the 2 groups, whereas the laparoscopic donor nephrectomy group had shorter hospital stay. Analgesic requirements were markedly shorter in the laparoscopic donor nephrectomy group. The 1-year graft function was not significantly different between the 2 groups. The results for laparoscopic donor nephrectomy were comparable to those for open donor nephrectomy, and its acceptability was high. Laparoscopic donor nephrectomy should be the preferred approach for procuring the kidney graft.

Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient-reported outcome.

PubMed

Galal, Sherif; Safwat, Wael

2017-01-01

The 5th metacarpal fractures accounts for 38% of all hand fractures given that the neck is the weakest point in metacarpals, so neck fracture is the most common metacarpal fracture. Surgical fixation is also advocated for such fractures to prevent mal-rotation of the little finger which will lead to fingers overlap in a clenched fist. Various methods are available for fixation of such fractures, like intramedullary & transverse pinning. There are very few reports in the literature comparing both techniques. Authors wanted to compare outcomes and complications of transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures. A single-center, parallel group, prospective, randomized study was conducted at an academic Level 1 Trauma Center from October 2014 to December 2016. A total of 80 patients with 5th metacarpal's neck fractures were randomized to pinning using either transverse pinning (group A) or intramedullary pinning (group B). Patients were assessed clinically on range of motion, patient-reported outcome using the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire & radiographically. Two blinded observers assessed outcomes. At final follow up for each patient (12 months) the statistically significant differences were observed in operative time, the transverse pinning group showed shorter operative time, as well as complication rate as complications were observed only in intramedullary pinning group. No differences were found in range of motion or the Quick -DASH score. Both techniques are equally safe and effective treatment option for 5th metacarpal's neck fractures. The only difference was shorter operative time & less incidence of complications in transverse pinning group. Level II, Therapeutic study.

How Effective Is Algorithm-Guided Treatment for Depressed Inpatients? Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial.

PubMed

Adli, Mazda; Wiethoff, Katja; Baghai, Thomas C; Fisher, Robert; Seemüller, Florian; Laakmann, Gregor; Brieger, Peter; Cordes, Joachim; Malevani, Jaroslav; Laux, Gerd; Hauth, Iris; Möller, Hans-Jürgen; Kronmüller, Klaus-Thomas; Smolka, Michael N; Schlattmann, Peter; Berger, Maximilian; Ricken, Roland; Stamm, Thomas J; Heinz, Andreas; Bauer, Michael

2017-09-01

Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance. © The Author 2017. Published by Oxford University Press on behalf of CINP.

Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction.

PubMed

Chandrasegaram, Manju D; Eslick, Guy D; Mansfield, Clare O; Liem, Han; Richardson, Mark; Ahmed, Sulman; Cox, Michael R

2012-02-01

Malignant gastric outlet obstruction represents a terminal stage in pancreatic cancer. Between 5% and 25% of patients with pancreatic cancer ultimately experience malignant gastric outlet obstruction. The aim in palliating patients with malignant gastric outlet obstruction is to reestablish an oral intake by restoring gastrointestinal continuity. This ultimately improves their quality of life in the advanced stages of cancer. The main drawback to operative bypass is the high incidence of delayed gastric emptying, particularly in this group of patients with symptomatic obstruction. This study aimed to compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction, acknowledging the diversity and heterogeneity of patients with this presentation. This retrospective study investigated patients treated for malignant gastric outlet obstruction from December 1998 to November 2008 at Nepean Hospital, Sydney, Australia. Endoscopic duodenal stenting was performed under fluoroscopic guidance for placement of the stent. The operative patients underwent open surgical gastrojejunostomy. The outcomes assessed included time to diet, hospital length of stay (LOS), biliary drainage procedures, morbidity, and mortality. Of the 45 participants in this study, 26 underwent duodenal stenting and 19 had operative bypass. Comparing the stenting and operative patients, the median time to fluid intake was respectively 0 vs. 7 days (P < 0.001), and the time to intake of solids was 2 vs. 9 days (P = 0.004). The median total LOS was shorter in the stenting group (11 vs. 25 days; P < 0.001), as was the median postprocedure LOS (5 vs. 10 days; P = 0.07). Endoscopic stenting is preferable to operative gastrojejunostomy in terms of shorter LOS, faster return to fluids and solids, and reduced morbidity and in-hospital mortality for patients with a limited life span.

Training shortens search times in children with visual impairment accompanied by nystagmus.

PubMed

Huurneman, Bianca; Boonstra, F Nienke

2014-01-01

Perceptual learning (PL) can improve near visual acuity (NVA) in 4-9 year old children with visual impairment (VI). However, the mechanisms underlying improved NVA are unknown. The present study compares feature search and oculomotor measures in 4-9 year old children with VI accompanied by nystagmus (VI+nys [n = 33]) and children with normal vision (NV [n = 29]). Children in the VI+nys group were divided into three training groups: an experimental PL group, a control PL group, and a magnifier group. They were seen before (baseline) and after 6 weeks of training. Children with NV were only seen at baseline. The feature search task entailed finding a target E among distractor E's (pointing right) with element spacing varied in four steps: 0.04°, 0.5°, 1°, and 2°. At baseline, children with VI+nys showed longer search times, shorter fixation durations, and larger saccade amplitudes than children with NV. After training, all training groups showed shorter search times. Only the experimental PL group showed prolonged fixation duration after training at 0.5° and 2° spacing, p's respectively 0.033 and 0.021. Prolonged fixation duration was associated with reduced crowding and improved crowded NVA. One of the mechanisms underlying improved crowded NVA after PL in children with VI+nys seems to be prolonged fixation duration.

The efficiency of simultaneous binaural ocular vestibular evoked myogenic potentials: a comparative study with monaural acoustic stimulation in healthy subjects.

PubMed

Kim, Min-Beom; Ban, Jae Ho

2012-12-01

To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.

Hemi-transseptal Approach for Pituitary Surgery: A Follow-Up Study

PubMed Central

Fnais, Naif; Maio, Salvatore Di; Edionwe, Susan; Zeitouni, Anthony; Sirhan, Denis; Valdes, Constanza J.; Tewfik, Marc A.

2016-01-01

Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology. Main Outcome Measures Operative time, CSF rhinorrhea, and postoperative nasal morbidity. Results A total of 105 patients underwent the Hemi-T approach versus 40 controls. Operative time was shorter using the Hemi-T technique (180.51 ± 56.9 vs. 202.9 ± 62 minutes; p = 0.048). The rates of nasal morbidity (septal perforation [5/102 vs. 6/37; p = 0.029] and mucosal adhesion [11/102 vs. 10/39 p = 0.027]), fascia lata harvest (21/100 vs. 18/39; p = 0.0028), and postoperative CSF leak rates (7/100 vs. 9/38; p = 0.006) were lower in the Hemi-T group. Conclusion Advantages of the Hemi-T approach over traditional exposure techniques include preservation of the nasal vascular pedicle, shorter operative time, reduced fascia lata harvest rates, and decreased nasal morbidity. PMID:28321378

Height-income association in developing countries: Evidence from 14 countries.

PubMed

Patel, Pankaj C; Devaraj, Srikant

2017-12-28

The purpose of this study was to assess whether the height-income association is positive in developing countries, and whether income differences between shorter and taller individuals in developing countries are explained by differences in endowment (ie, taller individuals have a higher income than shorter individuals because of characteristics such as better social skills) or due to discrimination (ie, shorter individuals have a lower income despite having comparable characteristics). Instrumental variable regression, Oaxaca-Blinder decomposition, quantile regression, and quantile decomposition analyses were applied to a sample of 45 108 respondents from 14 developing countries represented in the Research on Early Life and Aging Trends and Effects (RELATE) study. For a one-centimeter increase in country- and sex-adjusted median height, real income adjusted for purchasing power parity increased by 1.37%. The income differential between shorter and taller individuals was explained by discrimination and not by differences in endowments; however, the effect of discrimination decreased at higher values of country- and sex-adjusted height. Taller individuals in developing countries may realize higher income despite having characteristics similar to those of shorter individuals. © 2017 Wiley Periodicals, Inc.

Hands-on Simulation versus Traditional Video-learning in Teaching Microsurgery Technique

PubMed Central

SAKAMOTO, Yusuke; OKAMOTO, Sho; SHIMIZU, Kenzo; ARAKI, Yoshio; HIRAKAWA, Akihiro; WAKABAYASHI, Toshihiko

2017-01-01

Bench model hands-on learning may be more effective than traditional didactic practice in some surgical fields. However, this has not been reported for microsurgery. Our study objective was to demonstrate the efficacy of bench model hands-on learning in acquiring microsuturing skills. The secondary objective was to evaluate the aptitude for microsurgery based on personality assessment. Eighty-six medical students comprising 62 men and 24 women were randomly assigned to either 20 min of hands-on learning with a bench model simulator or 20 min of video-learning using an instructional video. They then practiced microsuturing for 40 min. Each student then made three knots, and the time to complete the task was recorded. The final products were scored by two independent graders in a blind fashion. All participants then took a personality test, and their microsuture test scores and the time to complete the task were compared. The time to complete the task was significantly shorter in the simulator group than in the video-learning group. The final product scores tended to be higher with simulator-learning than with video-learning, but the difference was not significant. Students with high “extraversion” scores on the personality inventory took a shorter time to complete the suturing test. Simulator-learning was more effective for microsurgery training than video instruction, especially in understanding the procedure. There was a weak association between personality traits and microsurgery skill. PMID:28381653

Endotracheal Intubation With and Without Night Vision Goggles in a Helicopter and Emergency Room Setting: A Manikin Study.

PubMed

Gellerfors, Mikael; Svensén, Christer; Linde, Joacim; Lossius, Hans Morten; Gryth, Dan

2015-09-01

Securing the airway by endotracheal intubation (ETI) is a key issue in prehospital critical care. Night vision goggles (NVG) are used by personnel operating in low-light environments. We examined the feasibility of an anesthesiologist performed ETI using NVG in a helicopter setting. Twelve anesthesiologists performed ETI on a manikin in an emergency room (ER) setting and two helicopter settings, with randomization to either rotary wing daylight (RW-D) or rotary wing in total darkness using binocular NVG (RW-NVG). Primary endpoint was intubation time. Secondary endpoints included success rate, Cormack-Lehane (CL) score, and subjective difficulty according to the Visual Analoge Scale (VAS). The median intubation time was shorter for the RW-D compared to the RW-NVG setting (16.5 seconds vs. 30.0 seconds; p = 0,03). We found no difference in median intubation time for the ER and RW-D settings (16.8 seconds vs. 16.5 seconds; p = 0.91). For all scenarios, success rate was 100%. CL and VAS varied between the ER setting (CL 1.8, VAS 2.8), RW-D setting (CL 2.0, VAS 3.0), and RW-NVG setting (CL 3.0, VAS 6.5). This study suggests that anesthesiologists successfully and quickly can perform ETI in a helicopter setting both in daylight and in darkness using binocular NVG, but with shorter intubation times in daylight. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

77 FR 62191 - Approval and Promulgation of Air Quality Implementation Plans; New Mexico; Infrastructure and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... such shorter period as EPA may prescribe. Section 110(a)(2) lists the specific infrastructure elements... Act (Act) requires that each state adopt and submit to EPA, within 3 years (or such shorter time... Tailoring Rule because the State does not have the authority to apply the meaning of the term ``subject to...

Reactive nanolaminate pulsed-laser ignition mechanism: Modeling and experimental evidence of diffusion limited reactions

DOE PAGES

Yarrington, C. D.; Abere, M. J.; Adams, D. P.; ...

2017-04-03

We irradiated Al/Pt nanolaminates with a bilayer thickness (tb, width of an Al/Pt pair-layer) of 164 nm with single laser pulses with durations of 10 ms and 0.5 ms at 189 W/cm 2 and 1189 W/cm 2, respectively. The time to ignition was measured for each pulse, and shorter ignition times were observed for the higher power/shorter pulse width. While the shorter pulse shows uniform brightness, videographic images of the irradiated area shortly after ignition show a non-uniform radial brightness for the longer pulse. A diffusion-limited single step reaction mechanism was implemented in a finite element package to model themore » progress from reactants to products at both pulse widths. Finally, the model captures well both the observed ignition delay and qualitative observations regarding the non-uniform radial temperature.« less

Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor: A meta-analysis.

PubMed

Wu, Yu-Peng; Lin, Ting-Ting; Chen, Shao-Hao; Xu, Ning; Wei, Yong; Huang, Jin-Bei; Sun, Xiong-Lin; Zheng, Qing-Shui; Xue, Xue-Yi; Li, Xiao-Dong

2016-11-01

The aim of this meta-analysis was to compare the feasibility of en bloc transurethral resection of bladder tumor (ETURBT) versus conventional transurethral resection of bladder tumor (CTURBT). Relevant trials were identified in a literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting participant demographics, tumor characteristics, study characteristics, and outcome data were included. Seven trials with 886 participants were included, 438 underwent ETURBT and 448 underwent CTURBT. There was no significant difference in operation time between 2 groups (P = 0.38). The hospitalization time (HT) and catheterization time (CT) were shorter in ETURBT group (mean difference[MD] -1.22, 95% confidence interval [CI] -1.63 to -0.80, P < 0.01; MD -0.61, 95% CI -1.11 to -0.11, P < 0.01). There was significant difference in 24-month recurrence rate (24-month RR) (odds ratio [OR] 0.66, 95% CI 0.47-0.92, P = 0.02). The rate of complication with respect to bladder perforation (P = 0.004), bladder irritation (P < 0.01), and obturator nerve reflex (P < 0.01) was lower in ETURBT. The postoperative adjuvant intravesical chemotherapy was evaluated by subgroup analysis, and 24-month RR in CTURBT is higher than that in ETURBT in mitomycin intravesical irrigation group (P = 0.02). The first meta-analysis indicates that ETURBT might prove to be preferable alternative to CTURBT management of nonmuscle invasive bladder carcinoma. ETURBT is associated with shorter HT and CT, less complication rate, and lower recurrence-free rate. Moreover, it can provide high-qualified specimen for the pathologic diagnosis. Well designed randomized controlled trials are needed to make results comparable.

Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children†.

PubMed

Schmidt, A R; Buehler, P; Seglias, L; Stark, T; Brotschi, B; Renner, T; Sabandal, C; Klaghofer, R; Weiss, M; Schmitz, A

2015-03-01

Current guidelines suggest a fasting time of 2 h for clear fluids, which is often exceeded in clinical practice, leading to discomfort, dehydration and stressful anaesthesia induction to patients, especially in the paediatric population. Shorter fluid fasting might be a strategy to improve patient comfort but has not been investigated yet. This prospective clinical trial compares gastric pH and residual volume after 1 vs 2 h of preoperative clear fluid fasting. Children (1-16 yr, ASA I or II) undergoing elective procedures in general anaesthesia requiring tracheal intubation were randomized into group A with 60 min or B with 120 min preoperative clear fluid fasting. To determine gastric pH and residual volume, the gastric content was sampled in supine, left and right lateral patient position using an oro-gastric tube after intubation. Data are median (interquartile range) for group A or B (P<0.05). In total, 131 children aged 1.01-16.23 yr were included; gastric pH was determined in 120 cases. Patient characteristic data were similar between the two groups, except for gender (46/33 males in group A/B; P=0.02). Despite significantly shorter fasting times for clear fluids in group A compared with group B (76/136 min; P<0.001), no significant difference was observed regarding gastric pH [1.43 (1.30-1.56)/1.44 (1.29-1.68), P=0.66] or residual volume [0.43 (0.21-0.84)/0.46 (0.19-0.78) ml kg(-1), P=0.47]. One hour clear fluid fasting does not alter gastric pH or residual volume significantly compared with 2 h fasting. The study was approved by the local ethics committee (KEK-ZH-Nr. 2011-0034) and registered with ClinicalTrials.gov (NCT01516775). © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer: Results From the Medical Research Council ASTEC Trial.

PubMed

Kyrgiou, Maria; Swart, Anne-Marie; Qian, Wendi; Warwick, Jane

2015-10-01

Laparoscopic hysterectomy (LH) is increasingly used for the management of endometrial malignancy. Its benefits may be particularly pronounced as these women are more likely to be older or obese. The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy (OH). This was a prospective cohort study nested within the multicenter ASTEC (A Study in the Treatment of Endometrial Cancer) randomized controlled trial (1998-2005). Women with presumed early endometrial cancer were included. Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy. Overall survival, time to first recurrence, complication rates, and surgical outcomes were the main outcome measures. Of 1408 women, 1309 (93%) received OH, and 99 (7%) had LH. LH was associated with longer operating time (median, LH 105 minutes [interquartile range (IQR), 60-150] vs OH 80 minutes [IQR, 60-95]; P < 0.001) but 50% shorter hospital stay (median, LH 4 days [IQR, 3-5] vs OH 6 days [IQR, 5-7]). The number of harvested lymph nodes was similar (median, LH 13 [IQR, 10-16] vs OH 12 [IQR, 11-13]; P = 0.67). LH had fewer intraoperative and postoperative adverse events (9% difference, LH 21% vs OH 30%; borderline significance; P = 0.07). The rate of conversion to laparotomy for the LH group was high (27%). The median follow-up was 37 months. After adjusting for significant prognostic factors, the hazard ratio for overall survival in those who underwent LH compared with those who underwent OH was 0.67 (95% confidence interval, 0.31-1.43) (P = 0.30). Laparoscopic hysterectomy for early endometrial cancer is safe. Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile. Further studies are required to assess the long-term safety.