Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

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

Smeenk, Robert M., E-mail: r.m.smeenk@asz.nl; Kock, Mark C. J. M.; Elgersma, Otto E. H.

2011-02-15

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplastymore » (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.« less

Flat panel angiography images in the post-operative follow-up of surgically clipped intracranial aneurysms.

PubMed

Budai, Caterina; Cirillo, Luigi; Patruno, Francesco; Dall'olio, Massimo; Princiotta, Ciro; Leonardi, Marco

2014-04-01

Cerebral aneurysms must be monitored for varying periods after surgical and/or endovascular treatment and the duration of follow-up will depend on the type of therapy and the immediate post-operative outcome. Surgical clipping for intracranial aneurysms is a valid treatment but the metal clips generate artefacts so that follow-up monitoring still relies on catheter angiography. This study reports our preliminary experience with volumetric angiography using a Philips Allura Xper FD biplane system in the post-operative monitoring of aneurysm residues or major vascular changes following the surgical clipping of intracranial aneurysms. Volumetric angiography yields not only volume-rendered (VR) images, but a volume CT can also be reconstructed at high spatial and contrast resolution from a single acquisition, significantly enhancing the technique's diagnostic power. Between August 2012 and April 2013, we studied 19 patients with a total of 26 aneurysms treated by surgical clipping alone or in combination with endovascular treatment. All patients underwent standard post-operative angiographic follow-up including a rotational volumetric acquisition. Follow-up monitoring disclosed eight aneurysm residues whose assessment was optimal after surgical clipping both in patients with one metal clip and in those with two or more clips. In addition, small residues (1.3 mm) could be monitored together with any change in the calibre or course of vessels located adjacent to the clips. In conclusion, flat panel volume CT is much more reliable than the old 3D acquisitions that yielded only VR images. This is particularly true in patients with small aneurysm residues or lesions with multiple metal clips.

Cervical MRI scan

MedlinePlus

... you have: Brain aneurysm clips Certain types of artificial heart valves Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis (you may not be able to receive contrast) Recently placed artificial joints Certain types of vascular stents Worked with ...

Lumbar MRI scan

MedlinePlus

... you have: Brain aneurysm clips Certain types of artificial heart valves Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis (you may not be able to receive contrast) Recently placed artificial joints Certain types of vascular stents Worked with ...

Shoulder MRI scan

MedlinePlus

... you have: Brain aneurysm clips Certain types of artificial heart valves Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis (you may not be able to receive contrast) Recently placed artificial joints Certain types of vascular stents Worked with ...

Interhemispheric Information Transfer: A New Diagnostic Method for Mild Traumatic Brain Injury

DTIC Science & Technology

2011-10-01

brain tumors, meningitis, cerebral palsy, encephalitis, brain abscesses , vascular malformations, cerebrovascular disease, Alzheimer’s disease...disease including head trauma with loss of consciousness 2) Having a contraindication to MRI such as pregnancy, breast feeding, surgical clips

Adjunctive intracardiac echocardiography imaging from the left ventricle to guide percutaneous mitral valve repair with the MitraClip in patients with failed prior surgical rings.

PubMed

Saji, Mike; Rossi, Ann M; Ailawadi, Gorav; Dent, John; Ragosta, Michael; Lim, D Scott

2016-02-01

We evaluated intracardiac echocardiography (ICE) for adjunctively guiding the MitraClip procedure in patients with prior surgical rings. Transesophageal echocardiography (TEE) is the standard imaging modality used to guide the MitraClip procedure (Abbott Vascular, CA). However, in patients with post-surgical anatomy, clear imaging of the mitral valve leaflets may be complex because of shadowing from the surgical ring. In these patients, TEE may be suboptimal for guiding the procedure, even using three-dimensional imaging. This retrospective analysis included data from 121 consecutive patients with mitral regurgitation who underwent MitraClip procedures at the University of Virginia. ICE was used adjunctively when there was difficulty with TEE, particularly for assessing the insertion of the posterior leaflet into the MitraClip's arms. The ICE catheter was introduced transarterially into the left ventricle and flexed to obtain the short-axis view. Six patients had prior surgical rings, and in five, we used adjunctive ICE. The etiology of the mitral regurgitation was prolapse of the posterior leaflet in one patient and restriction of the posterior leaflet due to ischemic tethering in the remainder. All images were obtained from the left ventricle, and were adequate for assessing posterior leaflet insertion and the perpendicularity of the MitraClip arms. The procedural success rate was 80%. There was no adverse event related to the ICE procedure. Mitral valve repair with the MitraClip system assisted by ICE is feasible in patients with prior surgical rings, achieving an excellent risk profile and satisfactory procedural success. © 2015 Wiley Periodicals, Inc.

Preoperative simulation for the planning of microsurgical clipping of intracranial aneurysms.

PubMed

Marinho, Paulo; Vermandel, Maximilien; Bourgeois, Philippe; Lejeune, Jean-Paul; Mordon, Serge; Thines, Laurent

2014-12-01

The safety and success of intracranial aneurysm (IA) surgery could be improved through the dedicated application of simulation covering the procedure from the 3-dimensional (3D) description of the surgical scene to the visual representation of the clip application. We aimed in this study to validate the technical feasibility and clinical relevance of such a protocol. All patients preoperatively underwent 3D magnetic resonance imaging and 3D computed tomography angiography to build 3D reconstructions of the brain, cerebral arteries, and surrounding cranial bone. These 3D models were segmented and merged using Osirix, a DICOM image processing application. This provided the surgical scene that was subsequently imported into Blender, a modeling platform for 3D animation. Digitized clips and appliers could then be manipulated in the virtual operative environment, allowing the visual simulation of clipping. This simulation protocol was assessed in a series of 10 IAs by 2 neurosurgeons. The protocol was feasible in all patients. The visual similarity between the surgical scene and the operative view was excellent in 100% of the cases, and the identification of the vascular structures was accurate in 90% of the cases. The neurosurgeons found the simulation helpful for planning the surgical approach (ie, the bone flap, cisternal opening, and arterial tree exposure) in 100% of the cases. The correct number of final clip(s) needed was predicted from the simulation in 90% of the cases. The preoperatively expected characteristics of the optimal clip(s) (ie, their number, shape, size, and orientation) were validated during surgery in 80% of the cases. This study confirmed that visual simulation of IA clipping based on the processing of high-resolution 3D imaging can be effective. This is a new and important step toward the development of a more sophisticated integrated simulation platform dedicated to cerebrovascular surgery.

A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons

PubMed Central

King, J; Yonas, H; Horowitz, M; Kassam, A; Roberts, M

2005-01-01

Objective: To assess communication between vascular neurosurgeons and their patients with unruptured cerebral aneurysms about treatment options and expected outcomes. Methods: Vascular neurosurgeons and their patients with cerebral aneurysms were surveyed immediately following outpatient appointments in a neurosurgery clinic. Data collected included how well the patient understood their aneurysm treatment options, the risks of a poor outcome from various treatments, and the consensus "best" treatment. Patient and neurosurgeon responses were measured using Likert scales, multiple choice questions, and visual analogue scales. Agreement between patient and neurosurgeon was assessed with kappa scores. The Wilcoxon sign rank test was used to compare visual analogue scale responses. Results: Data for 44 patient–neurosurgeon pairs were collected. Only 61% of patient–neurosurgeon pairs agreed on the best treatment plan for the patient's aneurysm (κ = 0.51, moderate agreement). Among the neurosurgeons, agreement with their patients ranged from 82% (κ = 0.77, almost perfect agreement) to 52% (κ = 0.37, fair agreement). Patients estimated much higher risks of stroke or death from surgical clipping, endovascular embolisation, or no intervention compared with the estimates offered by their neurosurgeons (surgical clipping: patient 36% v neurosurgeon 13%, p<0.001; endovascular embolisation: patient 35% v neurosurgeon 19%, p = 0.040; and no intervention: patient 63% v neurosurgeon 25%, p<0.001). Conclusions: Following consultation with a vascular neurosurgeon, many patients with cerebral aneurysms have an inaccurate understanding of their aneurysm treatment plan and an exaggerated sense of the risks of aneurysmal disease and treatment. PMID:15774444

A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons.

PubMed

King, J T; Yonas, H; Horowitz, M B; Kassam, A B; Roberts, M S

2005-04-01

To assess communication between vascular neurosurgeons and their patients with unruptured cerebral aneurysms about treatment options and expected outcomes. Vascular neurosurgeons and their patients with cerebral aneurysms were surveyed immediately following outpatient appointments in a neurosurgery clinic. Data collected included how well the patient understood their aneurysm treatment options, the risks of a poor outcome from various treatments, and the consensus "best" treatment. Patient and neurosurgeon responses were measured using Likert scales, multiple choice questions, and visual analogue scales. Agreement between patient and neurosurgeon was assessed with kappa scores. The Wilcoxon sign rank test was used to compare visual analogue scale responses. Data for 44 patient-neurosurgeon pairs were collected. Only 61% of patient-neurosurgeon pairs agreed on the best treatment plan for the patient's aneurysm (kappa = 0.51, moderate agreement). Among the neurosurgeons, agreement with their patients ranged from 82% (kappa = 0.77, almost perfect agreement) to 52% (kappa = 0.37, fair agreement). Patients estimated much higher risks of stroke or death from surgical clipping, endovascular embolisation, or no intervention compared with the estimates offered by their neurosurgeons (surgical clipping: patient 36% v neurosurgeon 13%, p<0.001; endovascular embolisation: patient 35% v neurosurgeon 19%, p = 0.040; and no patient 63% v neurosurgeon 25%, p<0.001). Following consultation with a vascular neurosurgeon, many patients with cerebral aneurysms have an inaccurate understanding of their aneurysm treatment plan and an exaggerated sense of the risks of aneurysmal disease and treatment.

Surgical outcomes of Majewski osteodysplastic primordial dwarfism Type II with intracranial vascular anomalies.

PubMed

Teo, Mario; Johnson, Jeremiah N; Bell-Stephens, Teresa E; Marks, Michael P; Do, Huy M; Dodd, Robert L; Bober, Michael B; Steinberg, Gary K

2016-12-01

OBJECTIVE Majewski osteodysplastic primordial dwarfism Type II (MOPD II) is a rare genetic disorder. Features of it include extremely small stature, severe microcephaly, and normal or near-normal intelligence. Previous studies have found that more than 50% of patients with MOPD II have intracranial vascular anomalies, but few successful surgical revascularization or aneurysm-clipping cases have been reported because of the diminutive arteries and narrow surgical corridors in these patients. Here, the authors report on a large series of patients with MOPD II who underwent surgery for an intracranial vascular anomaly. METHODS In conjunction with an approved prospective registry of patients with MOPD II, a prospectively collected institutional surgical database of children with MOPD II and intracranial vascular anomalies who underwent surgery was analyzed retrospectively to establish long-term outcomes. RESULTS Ten patients with MOPD II underwent surgery between 2005 and 2012; 5 patients had moyamoya disease (MMD), 2 had intracranial aneurysms, and 3 had both MMD and aneurysms. Patients presented with transient ischemic attack (TIA) (n = 2), ischemic stroke (n = 2), intraparenchymal hemorrhage from MMD (n = 1), and aneurysmal subarachnoid hemorrhage (n = 1), and 4 were diagnosed on screening. The mean age of the 8 patients with MMD, all of whom underwent extracranial-intracranial revascularization (14 indirect, 1 direct) was 9 years (range 1-17 years). The mean age of the 5 patients with aneurysms was 15.5 years (range 9-18 years). Two patients experienced postoperative complications (1 transient weakness after clipping, 1 femoral thrombosis that required surgical repair). During a mean follow-up of 5.9 years (range 3-10 years), 3 patients died (1 of subarachnoid hemorrhage, 1 of myocardial infarct, and 1 of respiratory failure), and 1 patient had continued TIAs. All of the surviving patients recovered to their neurological baseline. CONCLUSIONS Patients with MMD presented at a younger age than those in whom aneurysms were more prevalent. Microneurosurgery with either intracranial bypass or aneurysm clipping is extremely challenging but feasible at expert centers in patients with MOPD II, and good long-term outcomes are possible.

Neuronavigated microvascular Doppler sonography for intraoperative monitoring of blood flow velocity changes during aneurysm surgery - a feasible monitoring technique.

PubMed

Malinova, Vesna; von Eckardstein, Kajetan; Rohde, Veit; Mielke, Dorothee

2015-10-01

The intraoperative microvascular Doppler sonography (iMDS) is a well-established tool in vascular surgery for blood flow velocity (BFV) monitoring, capable of detecting vessel occlusion. However, identification of subtotal vessel compromise is more difficult, since the measured BFV may substantially vary with changing insonation angles and insonated vessel segments. To keep these parameters constant we combined neuronavigation with iMDS (niMDS). The question was if niMDS allows the detection of subtotal vessel compromise in aneurysm surgery. During surgery, the 3-dimensional reconstruction of the CT-angiography, which was obtained routinely prior to surgery, was displayed by the neuronavigational system. Prior to clipping, neuronavigation was used to define target point and trajectory, which, by coupling the neuronavigational pointer with the Doppler probe, correspond to the insonated vessel segment and the insonation angle. After clipping, for each vessel segment, the same trajectory was used for all consecutive measurements. The mean BFVs pre- and post-clipping were documented. We performed 82 BFV-measurements in 39 aneurysm surgeries. Mean deviation between pre- and post-clipping BFV values was 2.12cm/s. There was a significant correlation between the mean BFV values before and after clipping (r=0.45 [95% CI 17-66%]; p=0.002). One patient experienced new neurological deficits due to occlusion of a perforating vessel that was not insonated. The study could not answer the question if niMDS can detect BFV changes after clipping indicating vessel compromise, as no subtotal vessel occlusion occurred in the 39 operations. However, we proofed that niMDS-measured BFVs only varied minimally in uncompromised vessels pre- and post-clipping, suggesting that vessel compromises might be easily detected during aneurysm surgery. Copyright © 2015 Elsevier B.V. All rights reserved.

Conventional Surgery for Early and Late Symptomatic Mitral Valve Stenosis After MitraClip® Intervention: An Institutional Experience With Four Consecutive Patients.

PubMed

Alozie, Anthony; Paranskaya, Liliya; Westphal, Bernd; Kaminski, Alexander; Steinhoff, Gustav; Sherif, Mohammad; Ince, Hüseyin; Öner, Alper

2017-12-01

Surgical mitral valve repair is the gold standard for treatment of mitral regurgitation. Recently, the transcatheter treatment of mitral regurgitation with the MitraClip ® device (Abbot Vascular Structural Heart, Menlo Park, CA) has demonstrated promising results in treating patients not amenable for surgical correction of mitral valve regurgitation. Most patients reported in the literature requiring surgical bailout after MitraClip treatment presented with residual or recurrent mitral valve regurgitation. Mitral valve stenosis after MitraClip treatment has been rarely reported. From February 2010 to December 2014, four patients out of 165 patients who underwent MitraClip therapy developed symptomatic mitral valve stenosis (2.4%) and needed surgical correction. Data of the four patients were reviewed retrospectively. Follow-up data were obtained from each patient's general practitioner/cardiologist by phone calls and facsimile and were complete in all patients. All four patients were treated with ≥ 2 MitraClip (MC) devices during their initial presentation. All four patients underwent MV replacement with a tissue valve. The postoperative course was uneventful and there was no 30-day mortality. At 6-month follow-up, all patients were alive and in NYHA class I-III. Placement of multiple clip devices may lead to slightly elevated transmitral gradients. This may not necessarily interpret into symptomatic mitral stenosis. However, in some cases this is possible. Caution should be exercised at this phase of the learning curve of the percutaneous MC treatment, especially in use of multiple MC devices. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair.

PubMed

Itabashi, Yuji; Utsunomiya, Hiroto; Kubo, Shunsuke; Mizutani, Yukiko; Mihara, Hirotsugu; Murata, Mitsushige; Siegel, Robert J; Kar, Saibal; Fukuda, Keiichi; Shiota, Takahiro

2018-04-01

Postprocedural mitral stenosis (MS) is a main limitation for MitraClip™ (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip™ implantation, which indicated postprocedural mitral stenosis (MS). We studied 79 patients who were implanted with MitraClip™ in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior-posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set. After the procedure, the mean TMPG was assessed using continuous-wave (CW) Doppler by periprocedural TEE. Preprocedural MVOA, and AP and ML diameter of left ventricular (LV) inflow orifices were larger in patients with mean TMPG ≤4mmHg than in patients with TMPG >4mmHg after 1-and 2-clip implantation. The large MVOA and ML diameter of LV inflow orifice strongly correlated with the low TMPG after 1- and 2-clip implantation. As a result of the receiver operating characteristic curve analysis, the preprocedural MVOA predicted the low postprocedural TMPG more accurately than the ML diameter of LV inflow orifice after 1-clip implantation either in the degenerative or functional mitral regurgitation (MR) patients. After 2-clip implantation, however, the preprocedural ML diameter of LV inflow orifice predicted it more accurately than the MVOA in the degenerative and functional MR patients. 3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope.

PubMed

Imizu, S; Kato, Y; Sangli, A; Oguri, D; Sano, H

2008-08-01

The objective of this article was to assess the clinical use and the completeness of clipping with total occlusion of the aneurysmal lumen, real-time assessment of vascular patency in the parent, branching and perforating vessels, intraoperative assessment of blood flow, image quality, spatial resolution and clinical value in difficult aneurysms using near infrared indocyanine green video angiography integrated on to an operative Pentero neurosurgical microscope (Carl Zeiss, Oberkochen Germany). Thirteen patients with aneurysms were operated upon. An infrared camera with near infrared technology was adapted on to the OPMI Pentero microscope with a special filter and infrared excitation light to illuminate the operating field which was designed to allow passage of the near infrared light required for excitation of indocyanine green (ICG) which was used as the intravascular marker. The intravascular fluorescence was imaged with a video camera attached to the microscope. ICG fluorescence (700-850 nm) from a modified microscope light source on to the surgical field and passage of ICG fluorescence (780-950 nm) from the surgical field, back into the optical path of the microscope was used to detect the completeness of aneurysmal clipping Incomplete clipping in three patients (1 female and 2 males) with unruptured complicated aneurysms was detected using indocyanine green video angiography. There were no adverse effects after injection of indocyanine green. The completeness of clipping was inadequately detected by Doppler ultrasound miniprobe and rigid endoscopy and was thus complemented by indocyanine green video angiography. The operative microscope-integrated ICG video angiography as a new intraoperative method for detecting vascular flow, was found to be quick, reliable, cost-effective and possibly a substitute or adjunct for Doppler ultrasonography or intraoperative DSA, which is presently the gold standard. The simplicity of the method, the speed with which the investigation can be performed, the quality of the images, and the outcome of surgical procedures have all reduced the need for angiography. This technique may be useful during routine aneurysm surgery as an independent form of angiography and/or as an adjunct to intraoperative or postoperative DSA.

Microsurgical training on an in vitro chicken wing infusion model.

PubMed

Olabe, Jon; Olabe, Javier

2009-12-01

Microneurovascular anastomosis and aneurysm clipping require extensive training before mastering the technique and are a surgical challenge. We developed the "infused chicken wing method" to provide a simple but realistic training method minimizing animal use and need for special facilities for animal care and anesthesia. Fresh chicken wings were used in this model. The main brachial artery was cannulated, and water was infused at 140 mm Hg followed by anatomical neurovascular dissection. Multiple microsurgical training exercises were performed under microscope vision including terminoterminal, lateroterminal, laterolateral vascular anastomosis, and nerve anastomosis. Different complexity aneurysms were created using venous patches, clipping, rupture, and vascular reconstruction techniques were performed. This novel training model is inexpensive, easily obtainable, and no live animals are required. The diameter and characteristics of arteries and veins used are similar to those of the human brain. Great microsurgical technique progress may be obtained. The infused chicken wing artery model presents a realistic microvascular training method. It is inexpensive and easy to set up. Such simplicity provides the adequate environment for developing microsurgical technique. Copyright 2009 Elsevier Inc. All rights reserved.

Hemodynamic response during aneurysm clipping surgery among experienced neurosurgeons.

PubMed

Bunevicius, Adomas; Bilskiene, Diana; Macas, Andrius; Tamasauskas, Arimantas

2016-02-01

Neurosurgery is a challenging field associated with high levels of mental stress. The goal of this study was to investigate the hemodynamic response of experienced neurosurgeons during aneurysm clipping surgery and to evaluate whether neurosurgeons' hemodynamic responses are associated with patients' clinical statuses. Four vascular neurosurgeons (all male; mean age 51 ± 10 years; post-residency experience ≥7 years) were studied during 42 aneurysm clipping procedures. Blood pressure (BP) and heart rate (HR) were assessed at rest and during seven phases of surgery: before the skin incision, after craniotomy, after dural opening, after aneurysm neck dissection, after aneurysm clipping, after dural closure and after skin closure. HR and BP were significantly greater during surgery relative to the rest situation (p ≤ 0.03). There was a statistically significant increase in neurosurgeons' HR (F [6, 41] = 10.88, p < 0.001), systolic BP (F [6, 41] = 2.97, p = 0.01), diastolic BP (F [6, 41] = 2.49, p = 0.02) and mean BP (F [6, 41] = 3.36, p = 0.003) during surgery. The greatest mean HR was after aneurysm clipping, and the greatest BP was after aneurysm neck dissection. Systolic, diastolic and mean BPs were significantly greater during surgical clipping for unruptured aneurysms compared to ruptured aneurysms across all stages of surgery (p ≤ 0.002); however, after adjusting for neurosurgeon experience, the difference in BP as a function of aneurysm rupture was not significant (p > 0.08). Aneurysm location, intraoperative aneurysm rupture, admission WFNS score, admission Glasgow Coma Scale scores and Fisher grade were not associated with neurosurgeons' intraoperative HR and BP (all p > 0.07). Aneurysm clipping surgery is associated with significant hemodynamic system activation among experienced neurosurgeons. The greatest HR and BP were after aneurysm neck dissection and clipping. Aneurysm location and patient clinical status were not associated with intraoperative changes of neurosurgeons' HR and BP.

Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model.

PubMed

Diana, Michele; Halvax, Peter; Pop, Raoul; Schlagowski, Isabel; Bour, Gaetan; Liu, Yu-Yin; Legner, Andras; Diemunsch, Pierre; Geny, Bernard; Dallemagne, Bernard; Beaujeux, Rémy; Demartines, Nicolas; Marescaux, Jacques

2015-02-01

Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized. To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ. A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks. Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs. 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs. 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008 mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences. Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation. © The Author(s) 2014.

Cerebral Aneurysm Clipping Surgery Simulation Using Patient-Specific 3D Printing and Silicone Casting.

PubMed

Ryan, Justin R; Almefty, Kaith K; Nakaji, Peter; Frakes, David H

2016-04-01

Neurosurgery simulator development is growing as practitioners recognize the need for improved instructional and rehearsal platforms to improve procedural skills and patient care. In addition, changes in practice patterns have decreased the volume of specific cases, such as aneurysm clippings, which reduces the opportunity for operating room experience. The authors developed a hands-on, dimensionally accurate model for aneurysm clipping using patient-derived anatomic data and three-dimensional (3D) printing. Design of the model focused on reproducibility as well as adaptability to new patient geometry. A modular, reproducible, and patient-derived medical simulacrum was developed for medical learners to practice aneurysmal clipping procedures. Various forms of 3D printing were used to develop a geometrically accurate cranium and vascular tree featuring 9 patient-derived aneurysms. 3D printing in conjunction with elastomeric casting was leveraged to achieve a patient-derived brain model with tactile properties not yet available from commercial 3D printing technology. An educational pilot study was performed to gauge simulation efficacy. Through the novel manufacturing process, a patient-derived simulacrum was developed for neurovascular surgical simulation. A follow-up qualitative study suggests potential to enhance current educational programs; assessments support the efficacy of the simulacrum. The proposed aneurysm clipping simulator has the potential to improve learning experiences in surgical environment. 3D printing and elastomeric casting can produce patient-derived models for a dynamic learning environment that add value to surgical training and preparation. Copyright © 2016 Elsevier Inc. All rights reserved.

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery.

PubMed

Eleraky, Mohammed A; Setzer, Matthias; Papanastassiou, Ioannis D; Baaj, Ali A; Tran, Nam D; Katsares, Kiesha M; Vrionis, Frank D

2010-05-01

The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord. This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases. All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases. Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months. Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome. Copyright 2010 Elsevier Inc. All rights reserved.

Significantly Elevated C-Reactive Protein Levels After Epicardial Clipping of the Left Atrial Appendage.

PubMed

Verberkmoes, Niels J; Akca, Ferdi; Vandevenne, Ann-Sofie; Jacobs, Luuk; Soliman Hamad, Mohamed A; van Straten, Albert H M

Besides mechanical and anatomical changes of the left atrium, epicardial closure of the left atrial appendage has also possible homeostatic effects. The aim of this study was to assess whether epicardial clipping of the left atrial appendage has different biochemical effects compared with complete removal of the left atrial appendage. Eighty-two patients were included and underwent a totally thoracoscopic AF ablation procedure. As part of the procedure, the left atrial appendage was excluded with an epicardial clip (n = 57) or the left atrial appendage was fully amputated with an endoscopic vascular stapler (n = 25). From all patients' preprocedural and postprocedural blood pressure, electrolytes and inflammatory parameters were collected. The mean age and left atrial volume index were comparable between the epicardial clip and stapler group (64 ± 8 years vs. 60 ± 9 years, P = non-significant; 44 ± 15 mL/m vs. 40 ± 13 mL/m, P = non-significant). Patients receiving left atrial appendage clipping had significantly elevated C-reactive protein levels compared with patients who had left atrial appendage stapling at the second, third, and fourth postoperative day (225 ± 84 mg/L vs. 149 ± 76 mg/L, P = 0.002, 244 ± 78 vs. 167 ± 76, P = 0.004, 190 ± 74 vs. 105 ± 48, P < 0.001, respectively). Patients had a significant decrease in sodium levels, systolic, and diastolic blood pressure at 24 and 72 hours after left atrial appendage closure. However, this was comparable for both the left atrial appendage clipping and stapling group. Increased activation of the inflammatory response was observed after left atrial appendage clipping compared with left atrial appendage stapling. Furthermore, a significant decrease in blood pressure was observed after surgical removal of the left atrial appendage. Whether the inflammatory response affects the outcome of arrhythmia surgery needs to be further evaluated.

Temporary clamping of external carotid artery in convexity, parasagittal and temporal base meningioma.

PubMed

Yadav, Yad Ram; Parihar, Vijay; Agarwal, Moneet; Bhatele, Pushp Raj

2012-01-01

The management of intraoperative bleeding during removal of a large hyper vascular meningioma is crucial for safe and efficient surgery. Preoperative embolization of meningioma is the best way to reduce vascularity of meningiomas but this technique is not readily available, costly and has its own limitations. The study is aimed to evaluate the use of temporary clamping of external carotid artery to reduce blood loss and operating time during excision of large convexity, parasagittal or temporal base meningiomas. A prospective study of 115 consecutively operated meningiomas of size 5 cms or more were operated from January 2002 to December2010. Temporary clamping of external carotid artery was done in 61 while 51 cases were managed without clamping. There was significant reduction of blood loss, operative time and blood transfusion given in the temporary clipping group compared to non clipping group. There was stitch abscess in two patients each in clamping, and non clamping group. There was no scalp necrosis or mortality in any of the group. Temporary clamping of external carotid artery is a safe, simple and cost-effective alternative to embolization for the surgery of large meningiomas. This can be practiced at all the centers.

Dual-Image Videoangiography During Intracranial Microvascular Surgery.

PubMed

Feletti, Alberto; Wang, Xiangdong; Tanaka, Riki; Yamada, Yasuhiro; Suyama, Daisuke; Kawase, Tsukasa; Sano, Hirotoshi; Kato, Yoko

2017-03-01

Indocyanine green videoangiography (ICG-VA) is a valuable tool to assess vessel and aneurysm patency during neurovascular surgical procedures. However, ICG-VA highlights vascular structures, which appear white over a black background. Anatomic relationships are sometimes difficult to understand at first glance. Dual-image videoangiography (DIVA) enables simultaneous visualization of light and near-infrared fluorescence images of ICG-VA. The DIVA system was mounted on an OPMI Pentero Flow 800 intraoperative microscope. DIVA was used during microsurgical procedures on 5 patients who were operated for aneurysm clipping and superficial temporal artery-middle cerebral artery bypass. DIVA provides real-time simultaneous visualization of aneurysm and vessels and surrounding structures including brain, nerves, and surgical clips. Although visual contrast between vessels and background is higher with standard black-and-white imaging, DIVA makes it easier to understand anatomic relationships between intracranial structures. DIVA also provides better vision of the depth of field. DIVA has the potential to become a widely used intraoperative tool to check patency of intracranial vessels. It should be considered as an adjunct to standard ICG-VA for better understanding of vascular anatomy in relation to surrounding structures and can have an impact on decision making during surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Hilar control during laparoscopic donor nephrectomy: Practice patterns in Canada.

PubMed

Mcgregor, Thomas B; Patel, Premal; Chan, Gabriel; Sener, Alp

2017-10-01

In recent years, the method of vascular control during laparoscopic donor nephrectomy (LDN) has come under scrutiny due to catastrophic consequences of a device failure. This study sought to examine the surgical preferences of Canadian donor surgeons with regards to vascular control and their perception on the safety of these modalities. We also surveyed the experience with device malfunction and their subsequent management during LDN. An online survey was sent out to donor surgeons registered with the Canadian Society of Transplantation. Surveys were anonymous and voluntary. Descriptive statistics were used to analyze the collected responses. Recollection of the sequelae and outcomes from device malfunction were also queried. Twenty-eight of 37 surgeons (76% response rate) responded to the survey. At least one surgeon from every institution in Canada performing LDN responded to the survey. Laparoscopic stapler is the most commonly used device for securing the renal artery (61%) and renal vein (67%). Overall, surgeons felt the stapler was the safest method of securing the renal artery. Stapler misfire and clip slippage were reported by eight (28.5%) and 12 (43%) surgeons, respectively. Most cases were salvageable: laparoscopically (30%), open conversion (30%), and by hand port (5%). Slippage of a plastic locking clip resulted in one emergent laparotomy on POD#1 and one stapler misfire was converted to open resulting in donor death. Although rare, hemorrhagic complications can occur from device malfunction resulting in poor outcomes for healthy volunteers undergoing LDN. Surgeons need to remain vigilant when selecting the appropriate modality for vascular control.

Vascular closure staples-a new technique for biliary reconstruction: prospective randomized comparison with manual suture in an animal model.

PubMed

Birth, Matthias; Markert, Uwe; Strik, Martin; Wohlschläger, Charlotte; Brugmans, Frederik; Gerberding, Jürgen; Bruch, Hans P

2002-01-15

In orthotopic liver transplantation the incidence of biliary complications is up to 49%. In view of the relative frequency of such complications despite seemingly good preconditions, method-related disadvantages of conventional suture must also be considered as a possible cause. These include perforating needle injury of the choledochal wall with at least temporary exposure of suture material in the lumen, suboptimal approximation of the mucosa, and an additional decrease in blood flow in the choledochal stumps as a result of suture-related tissue strangulation. Hence the search for alternative anastomosis techniques. To evaluate the surgical suitability of extramucosal titanium clips (Vascular Closure Staples; VCS) in comparison with conventional manual suture, a study was performed in 36 pigs, which were randomly assigned to 4 groups, each containing 9 animals. Choledochal excision was performed in 18 pigs and transection in the other 18 pigs; end-to-end anastomosis was then carried out, using a VCS stapler in half of the animals in each of these two groups and conventional manual suture in the other half. Pre- and postanastomotic blood flow was measured during the surgery with the aid of a laser Doppler flow meter. The long-term behavior of the closure techniques was ascertained by regular laboratory checks over the ensuing 6-month observation period, after which the pigs were killed so that the specimens could be harvested. Using medium-sized VCS clips, we were able to create a tension-free, everted biliary anastomosis with exact mucosal approximation and no narrowing of the lumen, and without any technical problems during the performance of the procedure. Measurements with the laser Doppler flow meter showed well-preserved anastomotic blood flow after clip reconstruction, with significantly higher perfusion values than after manual suture. The postoperative courses of the investigated laboratory parameters did not reveal any significant differences between the two methods. In contrast, histomorphometric evaluation showed wall thickness and thus fibrosis in the anastomosis region to be less in the clip group than in the suture group (median: 510 microm versus 660 microm, P<0.001). In the pigs in which clip anastomosis was used, there were no detectable anastomotic stenoses; in the pigs in which conventional suture was used, however, ultrasonography revealed five anastomoses with varying degrees of narrowing. Extramucosal VCS clip anastomosis not only offers potential advantages with respect to nonpenetrating and optimal mucosal contact, investigations in animals also show it to be superior to conventional manual suture as regards anastomotic blood flow and medium-term fibrosis formation. We believe that our data and the available literature warrant a clinical evaluation of this technique in appropriate studies.

Median Supraorbital Keyhole Approach for Clipping Ruptured Distal Anterior Cerebral Artery Aneurysm: Technical Report with Review of Literature.

PubMed

Dhandapani, Sivashanmugam; Sahoo, Sushant Kumar

2018-04-01

The minimally invasive approach to distal anterior cerebral artery (DACA) aneurysms has not gained much acceptance due to difficulties associated with the conventional frontal paramedian approach. The more proximal basal interhemispheric approach, however, necessitates extensive dissection of soft tissues. We describe a novel minimally invasive median supraorbital keyhole craniotomy with a basal interhemispheric approach for clipping a ruptured DACA aneurysm. A 62-year-old patient presented with subarachnoid hemorrhage. Computed tomography angiography revealed a DACA aneurysm. The surgical technique involved a keyhole craniotomy made via an eyebrow incision extending between the supraorbital notches, and flush with the anterior cranial fossa. The dura was opened at the anterior part, the falx was cut, an interhemispheric dissection was carried out, adequate proximal control was obtained, and the aneurysm neck was dissected and clipped. A relevant review of the literature was carried out. The patient recovered well, with no residual aneurysm or forehead numbness, with good cosmesis. Compared with the previously described "keyhole unilateral interhemispheric" approaches, our technique has less likelihood of encountering bridging veins; easier cisternal cerebrospinal fluid release, making it feasible even in swollen brain; better proximal vascular control; and trajectory toward the neck rather than dome. The median supraorbital keyhole approach is a minimally invasive technique sufficient for clipping most DACA aneurysms, with easier access, better proximal control, and good cosmesis. Copyright © 2018 Elsevier Inc. All rights reserved.

Intraoperative indocyanine green videoangiography for spinal vascular lesions: case report.

PubMed

Murakami, Tomohiro; Koyanagi, Izumi; Kaneko, Takahisa; Iihoshi, Satoshi; Houkin, Kiyohiro

2011-03-01

In surgery of spinal vascular lesions such as spinal arteriovenous fistula or vascular tumors, assessment of feeding arteries and draining veins is important. Intraoperative digital subtraction angiography is useful but is invasive and sometimes technically demanding. Near-infrared indocyanine green (ICG) videoangiography is less invasive and has been reported as an intraoperative diagnosis of arterial patency during clipping surgery of cerebral aneurysms or bypass surgeries. We present our experience with intraoperative ICG videoangiography in 3 cases of spinal vascular lesions. Two patients had spinal arteriovenous fistula (perimedullary, n = 1; dural, n = 1), and 1 patient had spinal cord hemangioblastoma at the thoracic or thoracolumbar level. The surgical microscope was an OPMI Pentero (Carl Zeiss, Oberkochen, Germany). After laminectomy and opening of the dura, ICG (5 mg) was injected intravenously. The ICG angiography clearly demonstrated feeding and draining vessels. The ICG findings greatly helped successful interruption of arteriovenous fistula and total removal of the tumor. Intraoperative ICG videoangiography for spinal vascular lesions was useful by providing information on vascular dynamics directly. However, the diagnostic area is limited to the field of the surgical microscope. Although intraoperative digital subtraction angiography is still needed in cases of complex spinal vascular lesions, ICG videoangiography will be an important diagnostic modality in the field of spinal vascular surgeries.

Circulating inhibitor of ouabain-insensitive cation transport in malignantrenal hypertension

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

Simon, G.

1986-03-01

The role of circulating humoral agents in the pathogenesis of vascular wall Na depletion in malignant hypertension (MHT) was investigated. Plasma was collected from 33 male F344 rats with malignant one-kidney, one clip HT and 22 normotensive control rats. MHT developed spontaneously and was characterized by inactivity, weight loss, edema, anemia or hemoconcentration, hyperkalemia, and renal insufficiency. For bioassay, monolayers of quiescent vascular smooth muscle cells from F344 rats were incubated in deproteinized or whole plasma for measurement of /sup 86/Rb uptake with or without 2 mM ouabain or 1 mM furosemide. Compared to controls, ouabain-insensitive /sup 86/Rb uptake wasmore » reduced from 8.2 +- 2.0 nmol/mg protein min/sup -1/ (mean +- SD) to 5.2 +- 1.4 in deproteinized plasma (p < 0.01, N = 12) and from 6.6 +- 1.9 to 4.0 +- 0.3 in whole plasma (p < 0.05, N=5) of rats with MHT, due in part to a reduction in furosemide-sensitive uptake (p < 0.01, N = 6). There were no differences in ouabain-sensitive /sup 86/Rb uptake of cells between groups. In rats with MHT the increased Na content of the aorta that characterizes benign one-kidney, one clip HT was reversed, and bladder wall Na content was reduced (p < 0.001, N = 9). In MHT, a furosemide-like, ouabain-insensitive cation transport inhibitor in blood and urine may be the cause of vascular wall Na loss and of natriuresis that triggers the syndrome.« less

Protocol design and current status of CLIVIT: a randomized controlled multicenter relevance trial comparing clips versus ligatures in thyroid surgery

PubMed Central

Seiler, CM; Fröhlich, BE; Veit, JA; Gazyakan, E; Wente, MN; Wollermann, C; Deckert, A; Witte, S; Victor, N; Buchler, MW; Knaebel, HP

2006-01-01

Background Annually, more than 90000 surgical procedures of the thyroid gland are performed in Germany. Strategies aimed at reducing the duration of the surgical procedure are relevant to patients and the health care system especially in the context of reducing costs. However, new techniques for quick and safe hemostasis have to be tested in clinically relevance randomized controlled trials before a general recommendation can be given. The current standard for occlusion of blood vessels in thyroid surgery is ligatures. Vascular clips may be a safe alternative but have not been investigated in a large RCT. Methods/design CLIVIT (Clips versus Ligatures in Thyroid Surgery) is an investigator initiated, multicenter, patient-blinded, two-group parallel relevance randomized controlled trial designed by the Study Center of the German Surgical Society. Patients scheduled for elective resection of at least two third of the gland for benign thyroid disease are eligible for participation. After surgical exploration patients are randomized intraoperatively into either the conventional ligature group, or into the clip group. The primary objective is to test for a relevant reduction in operating time (at least 15 min) when using the clip technique. Since April 2004, 121 of the totally required 420 patients were randomized in five centers. Discussion As in all trials the different forms of bias have to be considered, and as in this case, a surgical trial, the role of surgical expertise plays a key role, and will be documented and analyzed separately. This is the first randomized controlled multicenter relevance trial to compare different vessel occlusion techniques in thyroid surgery with adequate power and other detailed information about the design as well as framework. If significant, the results might be generalized and may change the current surgical practice. PMID:16948853

High-intensity focused ultrasound (HIFU)-assisted hepatic resection in an animal model.

PubMed

Gandini, Alessandro; Melodelima, David; Schenone, Francesco; N'Djin, Apoutou William; Chapelon, Jean Yves; Rivoire, Michel

2012-07-01

Bleeding is the main cause of postoperative complications of hepatic surgery. To minimize intraoperative bleeding during hepatectomy, resections are generally carried out under hepatic vascular control despite the risk of liver dysfunction in patients with chronic liver disease. This study evaluates the feasibility and safety of high-intensity focused ultrasound (HIFU)-assisted hepatic resection during an open procedure in an animal model. Three groups of 12-14-week-old Landrace pigs (n = 7/group) were used to evaluate HIFU-assisted liver resection (group A) vs liver resection with or without portal triad clamping (groups B and C). In each pig, liver resection was performed on the right and left paramedian lobes. The following were evaluated and compared in the 3 groups: total blood loss, blood loss/cm(2) of resection area, clip density, procedure duration, morbidity, and mortality. Median blood loss was significantly lower in group A than in group B (P = .02), and group C (P = .007). Median blood loss/cm(2) of resection area was 4.77 mL/cm² in group A, 11.35 mL/cm² in group B, 12.22 mL/cm² in Group C. Precoagulation resulted in sealing blood vessels <5 mm; therefore, median clip density during liver transection was 0.78 clip/cm² in group A, 1.61 clip/cm(2) in group B, and 1.57 clip/cm(2) in group C. Median duration of the surgical procedure was 12 min in group A, 21 min in group B, and 19 min in group C. HIFU-assisted hepatic resection during an open procedure in an animal model is safe, reduces bleeding, and allows real-time ultrasound guidance.

Atrial natriuretic factor in two kidney--two clip renovascular hypertension in the rat.

PubMed

Puyo, A M; Vega, G W; Pellegrino de Iraldi, A; Albornoz, L E; Rosón, M I; Scaglia, P; Celentano, M M; Corazza, J P; Palumbo, E L; Fernández, B E; de la Riva, I J

1998-01-01

Hig levels of circulating atrial natriuretic factor (ANF) have been reported in several physiopathologic conditions like hypertension, heart and renal failure, pregnancy and high sodium intake. Nevertheless, neither relationships with water-sodium space regulation nor the role of an ANF vascular relaxant effect have been yet defined. The aim of present experiments was to characterize the contribution of circulating ANF and its vascular relaxing effects in the two kidney-two clip (2K2C) experimental model of renovascular hypertension. Complementary, plasma metabolites nitrite/nitrate of nitric oxide (NO) was examined because of mediation for both (NO an ANF) through cGMP. Three results showed (two-four weeks after surgery): indirect systolic blood pressure (mmHg), 186 +/- 4 in HT and 122 +/- 1 in SH (p < 0.001); a significant increase of plasma ANF (fmol/ml) in HT (n = 7, 1221 +/- 253) vs. SH (n = 9, 476 +/- 82; p < 0.02). Nitrate/nitrite plasma concentrations (mumol/l) were mpt different between SH and. The relaxant effect of ANF (10(-9), 10(-8) and 10(-7) M) on phenylephrine (3,5 x 10(-6) M) contracted rings from HT rats was smaller than SH rats (10(-8) M, p < 0.05). Contractions to phorbol 12, 13-dibutyrate (seven weeks after surgery) were significantly higher in rings from HT rats (p < 0.001). We conclude: 1) in addition to decreased granularity in atrial myocardiocytes, high circulating values of ANF here described suggest an increased turnover of the peptide in 2K2C hypertensive rats; 2) lower significant vascular relaxant effects in HT rats would indicate down regulation of ANF receptors in this model; the latter would derive from high plasma ANF concentration and, tentatively, because of greater activity of protein kinase C in the vascular wall; 39 similar values of plasma nitrite/nitrate in SH and HT rats would indicate a comparable NO circulating availability in both groups.

Initial experience with the Cardiva Boomerang vascular closure device in diagnostic catheterization.

PubMed

Doyle, Brendan J; Godfrey, Michael J; Lennon, Ryan J; Ryan, James L; Bresnahan, John F; Rihal, Charanjit S; Ting, Henry H

2007-02-01

The authors studied the safety and efficacy of the Cardiva Boomerang vascular closure device in patients undergoing diagnostic cardiac catheterization. Conventional vascular closure devices (sutures, collagen plugs, or metal clips) have been associated with catastrophic complications including arterial occlusion and foreign body infections; furthermore, they cannot be utilized in patients with peripheral vascular disease or vascular access site in a vessel other than the common femoral artery. The Cardiva Boomerang device facilitates vascular hemostasis without leaving any foreign body behind at the access site, can be used in peripheral vascular disease, and can be used in vessels other than the common femoral artery A total of 96 patients undergoing transfemoral diagnostic cardiac catheterization were included in this study, including 25 (26%) patients with contraindications to conventional closure devices. Femoral angiography was performed prior to deployment of the Cardiva Boomerang closure device. Patients were ambulated at 1 hr after hemostasis was achieved. The device was successfully deployed and hemostasis achieved with the device alone in 95 (99%) patients. The device failed to deploy in 1 (1%) patient and required conversion to standard manual compression. Minor complications were observed in 5 (5%) patients. No patients experienced major complications including femoral hematoma > 4 cm, red blood cell transfusion, retroperitoneal bleed, arteriovenous fistula, pseudoaneurysm, infection, arterial occlusion, or vascular surgery. The Cardiva Boomerang device is safe and effective in patients undergoing diagnostic cardiac catheterization using the transfemoral approach, facilitating early ambulation with low rates of vascular complications. (c) 2006 Wiley-Liss, Inc.

Attenuation of hypertension and renal damage in renovascular hypertensive rats by iron restriction.

PubMed

Oboshi, Makiko; Naito, Yoshiro; Sawada, Hisashi; Iwasaku, Toshihiro; Okuhara, Yoshitaka; Eguchi, Akiyo; Hirotani, Shinichi; Mano, Toshiaki; Tsujino, Takeshi; Masuyama, Tohru

2016-12-01

Iron is a catalyst in the formation of reactive oxygen species. Oxidative stress is associated with the pathogenesis of both human and experimental animal models of renovascular hypertension. We hypothesized that iron is involved in the pathogenesis of renovascular hypertension and that iron restriction may affect the pathogenesis of renovascular hypertension via the inhibition of oxidative stress. Herein, we investigated the effect of iron restriction on hypertension and renal damage in a rat model of two-kidney one-clip (2K1C) renovascular hypertension. Renovascular hypertension was induced by 2K1C in male Sprague-Dawley rats. At the day of clipping, 2K1C rats were divided into untreated (2K1C) and dietary iron-restricted groups (2K1C+IR). The 2K1C rats showed hypertension after the day of clipping, whereas dietary iron restriction attenuated the development of hypertension. Vascular hypertrophy and the increased fibrotic area were suppressed in the 2K1C+IR group. The clipped kidney developed renal atrophy in both the 2K1C and 2K1C+IR groups after clipping. However, the unclipped kidney showed renal hypertrophy in the 2K1C and 2K1C+IR groups, and the extent was less in the 2K1C+IR group. The 2K1C rats exhibited glomerulosclerosis and tubulointerstitial fibrosis in the unclipped kidney, whereas these changes were attenuated by an iron-restricted diet. Importantly, proteinuria was decreased in the 2K1C+IR group, along with decreased urinary 8-hydroxy-2'-deoxyguanosine excretion and superoxide production of the unclipped kidney. Moreover, the expression of nuclear mineralocorticoid receptor in the unclipped kidney of the 2K1C rats was attenuated by iron restriction. These data indicate a novel effect of iron restriction on hypertension and renal damage in renovascular hypertension.

Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries.

PubMed

Harold, K L; Pollinger, H; Matthews, B D; Kercher, K W; Sing, R F; Heniford, B T

2003-08-01

Advanced laparoscopic procedures have necessitated the development of new technology for vascular control. Suture ligation can be time-consuming and cumbersome during laparoscopic dissection. Titanium clips have been used for hemostasis, and recently plastic clips and energy sources such as ultrasonic coagulating shears and bipolar thermal energy devices have become popular. The purpose of this study was to compare the bursting pressure of arteries sealed with ultrasonic coagulating shears (UCS), electrothermal bipolar vessel sealer (EBVS), titanium laparoscopic clips (LCs), and plastic laparoscopic clips (PCs). In addition, the spread of thermal injury from the UCS and the EBVS was compared. Arteries in three size groups (2-3, 4-5 and 6-7 mm) were harvested from freshly euthanized pigs. Each of the four devices was used to seal 16 specimens from each size group for burst testing. A 5-Fr catheter was placed into the open end of the specimen and secured with a purse-string suture. The catheter was connected to a pressure monitor and saline was infused until there was leakage from the sealed end. This defined the bursting pressure in mmHg. The ultrasonic shears and bipolar thermal device were used to seal an additional 8 vessels in each size group, which were sent for histologic examination. These were examined with hematoxylin and eosin stains, and the extent of thermal injury, defined by coagulation necrosis, was measured in millimeters. Analysis of variance was performed and, where appropriate, a Tukey's test was also performed. The EBVS's mean burst pressure was statistically higher than that of the UCS at 4 or 5 mm (601 vs 205 mmHg) and 6 or 7 mm (442 vs 175 mmHg). EBVS had higher burst pressures for the 4 or 5-mm group (601 mmHg) and 6 or 7-mm group (442 mmHg) compared with its pressure at 2 or 3 mm (128 mmHg) ( p = 0.0001). The burst pressures of the UCS and EBVS at 2 or 3 mm were not significantly different. Both clips were statistically stronger than the thermal devices except at 4 or 5 mm, in which case the EBVS was as strong as the LC (601 vs 593 mmHg). The PC and LC were similar except at 4 or 5 mm, where the PC was superior (854 vs 593 mmHg). The PC burst pressure for 4 or 5 mm (854 mmHg) was statistically higher than that for vessels 2 or 3 mm (737 mmHg) but not different from the 6 or 7 mm pressure (767 mmHg). Thermal spread was not statistically different when comparing EBVS and UCS at any size (EBVS mean = 2.57 mm vs UCS mean = 2.18 mm). Both the PC and LC secured all vessel sizes to well above physiologic levels. The EBVS can be used confidently in vessels up to 7 mm. There is no difference in the thermal spread of the LigaSure vessel sealer and the UCS.

Dynamic article: surgical anatomical planes for complete mesocolic excision and applied vascular anatomy of the right colon.

PubMed

Açar, Halil İbrahim; Cömert, Ayhan; Avşar, Abdullah; Çelik, Safa; Kuzu, Mehmet Ayhan

2014-10-01

Lower local recurrence rates and better overall survival are associated with complete mesocolic excision with central vascular ligation for treatment of colon cancer. To accomplish this, surgeons need to pay special attention to the surgical anatomical planes and vascular anatomy of the colon. However, surgical education in this area has been neglected. The aim of this study is to define the correct surgical anatomical planes for complete mesocolic excision with central vascular ligation and to demonstrate the correct dissection technique for protecting anatomical structures. Macroscopic and microscopic surgical dissections were performed on 12 cadavers in the anatomy laboratory and on autopsy specimens. The dissections were recorded as video clips. Dissections were performed in accordance with the complete mesocolic excision technique on 10 male and 2 female cadavers. Vascular structures, autonomic nerves, and related fascias were shown. Within each step of the surgical procedure, important anatomical structures were displayed on still images captured from videos by animations. Three crucial steps for complete mesocolic excision with central vascular ligation are demonstrated on the cadavers: 1) full mobilization of the superior mesenteric root following the embryological planes between the visceral and the parietal fascias; 2) mobilization of the mesocolon from the duodenum and the pancreas and identification of vascular structures, especially the veins around the pancreas; and 3) central vascular ligation of the colonic vessels at their origin, taking into account the vascular variations within the mesocolonic vessels and the autonomic nerves around the superior mesenteric artery. The limitation of this study was the number of the cadavers used. Successful complete mesocolic excision with central vascular ligation depends on an accurate knowledge of the surgical anatomical planes and the vascular anatomy of the colon.

PDGF-induced migration of synthetic vascular smooth muscle cells through c-Src-activated L-type Ca2+ channels with full-length CaV1.2 C-terminus.

PubMed

Guo, Xiaoguang; Kashihara, Toshihide; Nakada, Tsutomu; Aoyama, Toshifumi; Yamada, Mitsuhiko

2018-06-01

In atherosclerosis, vascular smooth muscle cells (VSMC) migrate from the media toward the intima of the arteries in response to cytokines, such as platelet-derived growth factor (PDGF). However, molecular mechanism underlying the PDGF-induced migration of VSMCs remains unclear. The migration of rat aorta-derived synthetic VSMCs, A7r5, in response to PDGF was potently inhibited by a Ca V 1.2 channel inhibitor, nifedipine, and a Src family tyrosine kinase (SFK)/Abl inhibitor, bosutinib, in a less-than-additive manner. PDGF significantly increased Ca V 1.2 channel currents without altering Ca V 1.2 protein expression levels in A7r5 cells. This reaction was inhibited by C-terminal Src kinase, a selective inhibitor of SFKs. In contractile VSMCs, the C-terminus of Ca V 1.2 is proteolytically cleaved into proximal and distal C-termini (PCT and DCT, respectively). Clipped DCT is noncovalently reassociated with PCT to autoinhibit the channel activity. Conversely, in synthetic A7r5 cells, full-length Ca V 1.2 (Ca V 1.2FL) is expressed much more abundantly than truncated Ca V 1.2. In a heterologous expression system, c-Src activated Ca V 1.2 channels composed of Ca V 1.2FL but not truncated Ca V 1.2 (Ca V 1.2Δ1763) or Ca V 1.2Δ1763 plus clipped DCT. Further, c-Src enhanced the coupling efficiency between the voltage-sensing domain and activation gate of Ca V 1.2FL channels by phosphorylating Tyr1709 and Tyr1758 in PCT. Compared with Ca V 1.2Δ1763, c-Src could more efficiently bind to and phosphorylate Ca V 1.2FL irrespective of the presence or absence of clipped DCT. Therefore, in atherosclerotic lesions, phenotypic switching of VSMCs may facilitate pro-migratory effects of PDGF on VSMCs by suppressing posttranslational Ca V 1.2 modifications.

Proper Motion Of Teh Magellanic Clouds Using SPM

DTIC Science & Technology

2013-01-01

determinado los movimientos propios absolutos para estrellas y galaxias hasta V = 17.5 sobre un área de 450 grados cuadrados que incluye a las Nubes...tos propios fueron combinadas en una solución de traslapo usando estrellas fotométricamente seleccionadas del disco galáctico como sistema de...referencia relativo, que luego fue transformado a uno absoluto usando galaxias externas y al ICRS usando estrellas Hipparcos. El catálogo resultante se usa

Internalization of Listeria monocytogenes in cantaloupes during dump tank washing and hydrocooling.

PubMed

Macarisin, Dumitru; Wooten, Anna; De Jesus, Antonio; Hur, Minji; Bae, Seonjae; Patel, Jitendra; Evans, Peter; Brown, Eric; Hammack, Thomas; Chen, Yi

2017-09-18

Recent listeriosis outbreaks and recalls associated with cantaloupes urge for studies to understand the mechanisms of cantaloupe contamination by Listeria monocytogenes. Postharvest practices such as washing and hydrocooling were suggested to facilitate the contamination of fresh fruits by human pathogens. This study assessed the potential of L. monocytogenes internalization into cantaloupes during dump tank washing and immersion-type hydrocooling in water contaminated with L. monocytogenes. The effect of cantaloupe cultivar, water temperature, and harvesting technique on L. monocytogenes internalization was also evaluated. Full slip (cantaloupe without any residual stem) Western and Eastern cultivar cantaloupes were pre-warmed to 42°C (to imitate peak-high field temperatures of freshly harvested cantaloupes) and then immersed in water at 6°C and 18°C containing 4 and 6logCFU/ml of L. monocytogenes. Clipped (cantaloupe with short stem residues obtained by clipping the stem at harvest) Western and Eastern cantaloupes were pre-warmed to 42°C and then immersed in water at 6°C containing 6logCFU/ml of L. monocytogenes. Additionally, full slip and clipped Western cantaloupes were equilibrated to 18°C and then immersed in water at 18°C containing 6logCFU/ml of L. monocytogenes (isothermal immersion without temperature differential). Water containing L. monocytogenes infiltrated both full slip and clipped cantaloupes through the stems/stem scars and was then distributed along the vascular system in hypodermal mesocarp reaching the calyx area of the fruit. The current study demonstrated that, under experimental conditions, L. monocytogenes can internalize into cantaloupes during immersion in water contaminated by L. monocytogenes, both in the presence and absence of temperature differential, and that temperature differential moderately enhanced the internalization of L. monocytogenes. The incidence and levels of L. monocytogenes internalized in the middle-mesocarp were significantly affected by harvesting technique but not by cantaloupe cultivar. Published by Elsevier B.V.

Sutureless Fixation of Amniotic Membrane for Therapy of Ocular Surface Disorders

PubMed Central

Kotomin, Ilya; Valtink, Monika; Hofmann, Kai; Frenzel, Annika; Morawietz, Henning; Werner, Carsten; Funk, Richard H. W.; Engelmann, Katrin

2015-01-01

Amniotic membrane is applied to the diseased ocular surface to stimulate wound healing and tissue repair, because it releases supportive growth factors and cytokines. These effects fade within about a week after application, necessitating repeated application. Generally, amniotic membrane is fixed with sutures to the ocular surface, but surgical intervention at the inflamed or diseased site can be detrimental. Therefore, we have developed a system for the mounting of amniotic membrane between two rings for application to a diseased ocular surface without surgical intervention (sutureless amniotic membrane transplantation). With this system, AmnioClip, amniotic membrane can be applied like a large contact lens. First prototypes were tested in an experiment on oneself for wearing comfort. The final system was tested on 7 patients in a pilot study. A possible influence of the ring system on the biological effects of amniotic membrane was analyzed by histochemistry and by analyzing the expression of vascular endothelial growth factor-A (VEGF-A), hepatocyte growth factor (HGF), fibroblast growth factor 2 (FGF 2) and pigment epithelium-derived factor (PEDF) from amniotic membranes before and after therapeutic application. The final product, AmnioClip, showed good tolerance and did not impair the biological effects of amniotic membrane. VEGF-A and PEDF mRNA was expressed in amniotic membrane after storage and mounting before transplantation, but was undetectable after a 7-day application period. Consequently, transplantation of amniotic membranes with AmnioClip provides a sutureless and hence improved therapeutic strategy for corneal surface disorders. Trial Registration ClinicalTrials.gov NCT02168790 PMID:25955359

Supraorbital Keyhole Craniotomy for Basilar Artery Aneurysms: Accounting for the "Cliff" Effect.

PubMed

Stamates, Melissa M; Wong, Andrew K; Bhansali, Anita; Wong, Ricky H

2017-04-01

Treatment of basilar artery aneurysms is challenging. While endovascular techniques have dominated, there still remain circumstances where open surgical clipping is required or preferred. Minimally invasive "keyhole" approaches are being used more frequently to provide the durability of surgical clipping with a lower morbidity profile; however, careful patient selection is required. The supraorbital "keyhole" approach has been described for the treatment of basilar artery aneurysms, but careful assessment of the basilar exposure is necessary to ensure proper visualization of the aneurysm and ability to obtain proximal vascular control. Various methods of estimating the basilar artery exposure in this approach have been described, including the anterior skull base line and the posterior clinoid line, but both are unreliable and inaccurate. To propose a new method, the orbital roof-dorsum line, to simply and accurately predict the basilar artery exposure. CT angiograms for 20 consecutive unique patients were analyzed to obtain the anterior skull base line, posterior clinoid line, and the orbital roof-dorsum line. CT angiograms were then loaded onto a Stealth neuronavigation system (Medtronic, Minneapolis, Minnesota) to obtain "true" visualization lengths. A case illustration is presented. Pairwise comparison tests demonstrated that both the anterior skull base and the posterior clinoid estimation lines differed significantly from the "true"  value ( P < .0001). Our orbital roof-dorsum estimation provided results that accurately predicted the "true" value ( P = .71). The orbital roof-dorsum line provides a simple and reliable method of estimating basilar artery exposure and should be used whenever considering patients for surgical clipping by this approach. Copyright © 2017 by the Congress of Neurological Surgeons

A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery.

PubMed

Lai, Leon T; Morgan, Michael K; Chin, David C W; Snidvongs, Kornkiat; Huang, June X Z; Malek, Joanne; Lam, Matthew; McLachlan, Rohan; Harvey, Richard J

2013-04-01

The anterior transclival route to basilar artery aneurysms is not widely performed. The objective of this study was to carry out a feasibility assessment of the transclival approach to basilar aneurysms with advanced endonasal techniques on 11 cadaver heads. Clival dura was exposed from the sella to the foramen magnum between the paraclival segments of the internal carotid arteries (ICA) laterally. An inverted dural "U" flap was reflected inferiorly to expose the basilar artery. The maximal dimensions from operative measurements were recorded. Surgical manoeuvrability of multiple instruments and the proficiency to place proximal and distal vascular clips were evaluated. The mean operative depth (± standard deviation), measured from the anterior choanae to the basilar artery, was 110±6mm. The lateral corridors were limited distally by the medial pterygoids (mean width 21±2mm) and paraclival ICA (mean width 20±2mm). The mean transclival craniectomy dimensions were 19±2mm (width) and 23±4mm (height). Exposure of the basilar-anterior inferior cerebellar artery junction, superior cerebellar artery, and the basilar caput were possible in 100%, 91%, and 64% of instances, respectively. Placements of proximal and distal aneurysm clips were achieved in all instances. Based on our findings, the transclival endoscopic endonasal surgery approach provides excellent visualisation of the basilar artery. Clip application and manoeuvrability of instruments was considered adequate for basilar aneurysm surgery. Surgical skills and instrumentation to control significant haemorrhage can potentially limit the clinical applicability of this technique. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Indocyanine Green Videoangiography Transoptic Visualization and Clipping Confirmation of an Optic Splitting Ophthalmic Artery Aneurysm.

PubMed

Rustemi, Oriela; Cester, Giacomo; Causin, Francesco; Scienza, Renato; Della Puppa, Alessandro

2016-06-01

Ophthalmic artery aneurysms with medial and superior projection in exceptionally rare cases can split the optic nerve. Treatment of these aneurysms is challenging, because the aneurysm dome is hidden from the optic nerve, rendering its visualization and clipping confirmation difficult. In addition, optic nerve function should be preserved during surgical maneuvers. Preoperative detection of this growing feature is usually missing. We illustrate the first case of indocyanine green videoangiography (ICG-VA) application in an optic penetrating ophthalmic artery aneurysm treatment. A 57-year-old woman presented with temporal hemianopsia, slight right visual acuity deficit, and new onset of headache. The cerebral angiography detected a right ophthalmic artery aneurysm medially and superiorly projecting. The A1 tract of the ipsilateral anterior cerebral artery was elevated and curved, being suspicious for an under optic aneurysm growth. Surgery was performed. Initially the aneurysm was not visible. ICG-VA permitted the transoptic aneurysm visualization. After optic canal opening, the aneurysm was clipped and transoptic ICG-VA confirmed the aneurysm occlusion. ICG-VA showed also the slight improvement of the optic nerve pial vascularization. Postoperatively, the visual acuity was 10/10 and the hemianopsia did not worsen. The elevation and curve of the A1 tract in medially and superiorly projecting ophthalmic aneurysms may be an indirect sign of under optic growth, or optic splitting aneurysms. ICG-VA transoptic aneurysm detection and occlusion confirmation reduces the surgical maneuvers on the optic nerve, contributing to function preservation. Copyright © 2016 Elsevier Inc. All rights reserved.

Which Clip? A Prospective Comparative Study of Retention Rates of Endoscopic Clips on Normal Mucosa and Ulcers in a Porcine Model

PubMed Central

Saxena, Payal; Ji-Shin, Eun; Haito-Chavez, Yamile; Valeshabad, Ali K.; Akshintala, Venkata; Aguila, Gerard; Kumbhari, Vivek; Ruben, Dawn S.; Lennon, Anne-Marie; Singh, Vikesh; Canto, Marcia; Kalloo, Anthony; Khashab, Mouen A.

2014-01-01

Background/Aim: There are currently no data on the relative retention rates of the Instinct clip, Resolution clip, and QuickClip2Long. Also, it is unknown whether retention rate differs when clips are applied to ulcerated rather than normal mucosa. The aim of this study is to compare the retention rates of three commonly used endoscopic clips. Materials and Methods: Six pigs underwent upper endoscopy with placement of one of each of the three types of clips on normal mucosa in the gastric body. Three mucosal resections were also performed to create “ulcers”. Each ulcer was closed with placement of one of the three different clips. Repeat endoscopy was performed weekly for up to 4 weeks. Results: Only the Instinct and Resolution clips remained attached for the duration of the study (4 weeks). At each time point, a greater proportion of Instinct clips were retained on normal mucosa, followed by Resolution clips. QuickClip2Long had the lowest retention rate on normal mucosa. Similar retention rates of Instinct clips and Resolution clips were seen on simulated ulcers, although both were superior to QuickClip2Long. However, the difference did not reach statistical significance. All QuickClip2Long clips were dislodged at 4 weeks in both the groups. Conclusions: The Resolution and Instinct clips have comparable retention rates and both appeared to be better than the QuickClip2Long on normal mucosa-simulated ulcers; however this did not reach statistical significance. Both the Resolution clip and the Instinct clip may be preferred in clinical situations when long-term clip attachment is required, including marking of tumors for radiotherapy and anchoring feeding tubes or stents. Either of the currently available clips may be suitable for closure of iatrogenic mucosal defects without features of chronicity. PMID:25434317

[Hepatic artery pseudoaneurysm: report of two cases].

PubMed

Tun-Abraham, Mauro Enrique; Martínez-Ordaz, José Luis; Romero-Hernández, Teodoro

2014-01-01

Hepatic pseudoaneurysm is rare and potentially fatal. It occurs as a consequence of injury to the vascular wall, erosion diathermy through clips, biliary leakage and secondary infection. The main symptom is intra-abdominal bleeding. To communicate the case of two patients with hepatic pseudoaneurysm. Case 1: We present a 43 year-old male with a history of grade IV liver injury due to blunt abdominal trauma and managed surgically. Case 2: A 67 year-old man with bile duct injury after laparoscopic cholecystectomy. Both patients presented with biliary leakage, abdominal sepsis and late intra-abdominal bleeding. Tomographic studies showed the lesion. Superselective embolization was performed proximal and distal to the lesion with good results. During follow-up, none of them showed signs of recurrent bleeding. Hepatic artery pseudoaneurysm is rare and usually secondary to bile duct injury associated with vascular injury after cholecystectomy or liver trauma. Arteriography with embolization is the best diagnostic and therapeutic procedure. Surgery is indicated for hemodynamically unstable patients, embolization failure or rebleeding. Early diagnosis reduces morbidity and mortality of this complication.

Intracranial aneurysm and arachnoid cyst: just a coincidence? A case report.

PubMed

Aguiar, Guilherme Brasileiro de; Santos, Rafael Gomes Dos; Paiva, Aline Lariessy Campos; Silva, João Miguel de Almeida; Silva, Rafael Carlos da; Veiga, José Carlos Esteves

2017-12-18

Presence of an arachnoid cyst and a non-ruptured intracystic brain aneurysm is extremely rare. The aim of this paper was to describe a case of a patient with an arachnoid cyst and a non-ruptured aneurysm inside it. Clinical, surgical and radiological data were analyzed and the literature was reviewed. A patient complained of chronic headache. She was diagnosed as having a temporal arachnoid cyst and a non-ruptured middle cerebral artery aneurysm inside it. Surgery was performed to clip the aneurysm and fenestrate the cyst. This report raises awareness about the importance of intracranial vascular investigation in patients with arachnoid cysts and brain hemorrhage.

In vivo measurement of hemodynamic information in stenosed rat blood vessels using X-ray PIV

NASA Astrophysics Data System (ADS)

Park, Hanwook; Park, Jun Hong; Lee, Sang Joon

2016-11-01

Measurements of the hemodynamic information of blood flows, especially wall shear stress (WSS), in animal models with circulatory vascular diseases (CVDs) are important to understand the pathological mechanism of CVDs. In this study, X-ray particle image velocimetry (PIV) with high spatial resolution was applied to obtain velocity field information in stenosed blood vessels with high WSS. 3D clips fabricated with a 3D printer were applied to the abdominal aorta of a rat cadaver to induce artificial stenosis in the real blood vessel of an animal model. The velocity and WSS information of blood flows in the stenosed vessel were obtained and compared at various stenosis severities. In vivo measurement was also conducted by fastening a stenotic clip on a live rat model through surgical intervention to reduce the flow rate to match the limited temporal resolution of the present X-ray PIV system. Further improvement of the temporal resolution of the system might be able to provide in vivo measurements of hemodynamic information from animal disease models under physiological conditions. The present results would be helpful for understanding the relation between hemodynamic characteristics and the pathological mechanism in animal CVD models.

Robotic digital subtraction angiography systems within the hybrid operating room.

PubMed

Murayama, Yuichi; Irie, Koreaki; Saguchi, Takayuki; Ishibashi, Toshihiro; Ebara, Masaki; Nagashima, Hiroyasu; Isoshima, Akira; Arakawa, Hideki; Takao, Hiroyuki; Ohashi, Hiroki; Joki, Tatsuhiro; Kato, Masataka; Tani, Satoshi; Ikeuchi, Satoshi; Abe, Toshiaki

2011-05-01

Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery. To describe initial clinical experience with a robotic DSA system in the hybrid OR. A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation. Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement. This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.

dCLIP: a computational approach for comparative CLIP-seq analyses

PubMed Central

2014-01-01

Although comparison of RNA-protein interaction profiles across different conditions has become increasingly important to understanding the function of RNA-binding proteins (RBPs), few computational approaches have been developed for quantitative comparison of CLIP-seq datasets. Here, we present an easy-to-use command line tool, dCLIP, for quantitative CLIP-seq comparative analysis. The two-stage method implemented in dCLIP, including a modified MA normalization method and a hidden Markov model, is shown to be able to effectively identify differential binding regions of RBPs in four CLIP-seq datasets, generated by HITS-CLIP, iCLIP and PAR-CLIP protocols. dCLIP is freely available at http://qbrc.swmed.edu/software/. PMID:24398258

DAI-CLIPS: Distributed, Asynchronous, Interacting CLIPS

NASA Technical Reports Server (NTRS)

Gagne, Denis; Garant, Alain

1994-01-01

DAI-CLIPS is a distributed computational environment within which each CLIPS is an active independent computational entity with the ability to communicate freely with other CLIPS. Furthermore, new CLIPS can be created, others can be deleted or modify their expertise, all dynamically in an asynchronous and independent fashion during execution. The participating CLIPS are distributed over a network of heterogeneous processors taking full advantage of the available processing power. We present the general framework encompassing DAI-CLIPS and discuss some of its advantages and potential applications.

Post-Vacuum-Assisted Stereotactic Core Biopsy Clip Displacement: A Comparison Between Commercially Available Clips and Surgical Clip.

PubMed

Yen, Peggy; Dumas, Sandra; Albert, Arianne; Gordon, Paula

2018-02-01

The placement of localization clips following percutaneous biopsy is a standard practice for a variety of situations. Subsequent clip displacement creates challenges for imaging surveillance and surgical planning, and may cause confusion amongst radiologists and between surgeons and radiologists. Many causes have been attributed for this phenomenon including the commonly accepted "accordion effect." Herein, we investigate the performance of a low cost surgical clip system against 4 commercially available clips. We retrospectively reviewed 2112 patients who underwent stereotactic vacuum-assisted core biopsy followed by clip placement between January 2013 and June 2016. The primary performance parameter compared was displacement >10 mm following vacuum-assisted stereotactic core biopsy. Within the group of clips that had displaced, the magnitude of displacement was compared. There was a significant difference in displacement among the clip types (P < .0001) with significant pairwise comparisons between pediatric surgical clips and SecureMark (38% vs 28%; P = .001) and SenoMark (38% vs 27%; P = .0001) in the proportion displaced. The surgical clips showed a significant magnitude of displacement of approximately 25% greater average distance displaced. As a whole, the commercial clips performed better than the surgical clip after stereotactic vacuum-assisted core biopsy suggesting the surrounding outer component acts to anchor the central clip and minimizes clip displacement. The same should apply to tomosynthesis-guided biopsy. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Three-dimensional intraoperative ultrasound of vascular malformations and supratentorial tumors.

PubMed

Woydt, Michael; Horowski, Anja; Krauss, Juergen; Krone, Andreas; Soerensen, Niels; Roosen, Klaus

2002-01-01

The benefits and limits of a magnetic sensor-based 3-dimensional (3D) intraoperative ultrasound technique during surgery of vascular malformations and supratentorial tumors were evaluated. Twenty patients with 11 vascular malformations and 9 supratentorial tumors undergoing microsurgical resection or clipping were investigated with an interactive magnetic sensor data acquisition system allowing freehand scanning. An ultrasound probe with a mounted sensor was used after craniotomies to localize lesions, outline tumors or malformation margins, and identify supplying vessels. A 3D data set was obtained allowing reformation of multiple slices in all 3 planes and comparison to 2-dimensional (2D) intraoperative ultrasound images. Off-line gray-scale segmentation analysis allowed differentiation between tissue with different echogenicities. Color-coded information about blood flow was extracted from the images with a reconstruction algorithm. This allowed photorealistic surface displays of perfused tissue, tumor, and surrounding vessels. Three-dimensional intraoperative ultrasound data acquisition was obtained within 5 minutes. Off-line analysis and reconstruction time depends on the type of imaging display and can take up to 30 minutes. The spatial relation between aneurysm sac and surrounding vessels or the skull base could be enhanced in 3 out of 6 aneurysms with 3D intraoperative ultrasound. Perforating arteries were visible in 3 cases only by using 3D imaging. 3D ultrasound provides a promising imaging technique, offering the neurosurgeon an intraoperative spatial orientation of the lesion and its vascular relationships. Thereby, it may improve safety of surgery and understanding of 2D ultrasound images.

Intraoperative loss of core biopsy clips: clinical implications.

PubMed

Calhoun, Kristine; Giuliano, Armando; Brenner, R James

2008-03-01

The purpose of this study was to report the occurrence of intraoperative loss of metallic marking clips placed during image-guided biopsy and to hypothesize the likely mechanism of this clinical problem. From January 2003 through December 2004, patients presenting for preoperative mammographic localization and operative excision of biopsy site marking clips were identified. Age, method of image-guided biopsy, number of excised specimens, and tissue diagnosis were determined. Specimen radiographs were used to identify cases of suspected intraoperative clip loss. Clips absent on specimen radiographs and postoperative mammograms were defined as lost intraoperatively. Biopsy site marking clips, surgical clips, and suction device apertures were measured. In 78 surgical procedures performed during the study period, three (3.8%) of the patients experienced clip loss. Specimen radiographs confirmed the absence of clips in all submitted tissues. A median of four (range, three to five) separate biopsy specimens were excised among these three cases. A healing biopsy site from the stereotactic biopsy preceding the clip placement procedure was confirmed in all cases. Absence of the metallic clip was confirmed on postoperative mammograms. The apertures of two types of suction device were four and two times those of the biopsy clips. Intraoperative loss of metallic clips placed at the conclusion of image-guided breast biopsy is unusual but can occur during subsequent surgical excision. Repeated inability to locate the clip on specimen radiographs after accurate preoperative localization should raise the suspicion that the target clip has been lost, not missed, during surgery, likely because of inadvertent removal of the clip with the suction device.

Three-Dimensional Printing of Surgical Clips: An In Vitro Pilot Study and Trial of Efficacy.

PubMed

Canvasser, Noah E; De, Shuvro; Koseoglu, Ersin; Lay, Aaron H; Sorokin, Igor; Fernandez, Raul; Cadeddu, Jeffrey A

2017-09-01

Three-dimensional (3D) printing applications have increased over the past decade. Our objective was to test rapid prototyping of a 3D printed surgical clip for intraoperative use. Our prototype was modeled after the 10 mm Weck ® Hem-o-lok ® polymer clip (Teleflex, Inc., Wayne, PA). A 3D computer-aided design model of the Hem-o-lok clip was reverse engineered using commercial microscopy and printing was done using an Objet Connex500 multijetting system (Stratasys, Eden Prairie, MN). The initial polymer was Objet VeroWhitePlus RGD835; the addition of Objet TangoBlackPlus FLX980 during the design process improved hinge flexibility. The 3D printed clips were then pressure tested on rubber Penrose tubing and compared in vitro versus commercial Hem-o-lok clips. Initial 3D printed clips were not functional as they split at the hinge upon closure of the clip jaws. Design changes were made to add Objet TangoBlackPlus FLX980 at the hinge to improve flexibility. Additional modifications were made to allow for clips to be compatible with the Hem-o-lok endoscopic clip applier. A total of 50 clips were tested. Fracture rate for the printed clips using a clip applier was 54% (n = 27), whereas none of the commercial Hem-o-lok clips broke upon closure. Of the 23 printed clips that closed, mean leak was at 20.7 κPa (range 4.8-42.7). In contrast, none of the commercial clips leaked, and fill continued until Penrose rupture at mean 46.2 κPa (44.8-47.6). This pilot study demonstrates feasibility of 3D printing functional surgical clips. However, the performance of our first generation clips is poor compared with commercial grade product. Refinement in printers and materials available may allow for customization of such printed surgical instruments that could be economically competitive to purchasing and stocking product.

Pontine infarction caused by medial branch injury of the basilar artery as a rare complication of cisternal drain placement.

PubMed

Horiuchi, Tetsuyoshi; Yamamoto, Yasunaga; Kuroiwa, Masafumi; Rahmah, Nunung Nur; Hongo, Kazuhiro

2012-04-01

We present a rare complication of cisternal drain placement during aneurysm surgery. A ruptured anterior communicating artery aneurysm was clipped through a right pterional approach. A cisternal drain was inserted from the retro-carotid to the prepontine cistern. Postoperatively, a left-sided paresis of the upper extremity had developed. A CT brain scan revealed that the drain was located between the pons and the basilar artery, resulting in a pontine infarction. Vascular neurosurgeons should keep this complication in mind when placing a cisternal drain tube. The drain tube should not be inserted too deep into the prepontine cistern. Copyright © 2011 Elsevier Ltd. All rights reserved.

Fabrication of cerebral aneurysm simulator with a desktop 3D printer

NASA Astrophysics Data System (ADS)

Liu, Yu; Gao, Qing; Du, Song; Chen, Zichen; Fu, Jianzhong; Chen, Bing; Liu, Zhenjie; He, Yong

2017-05-01

Now, more and more patients are suffering cerebral aneurysm. However, long training time limits the rapid growth of cerebrovascular neurosurgeons. Here we developed a novel cerebral aneurysm simulator which can be better represented the dynamic bulging process of cerebral aneurysm The proposed simulator features the integration of a hollow elastic vascular model, a skull model and a brain model, which can be affordably fabricated at the clinic (Fab@Clinic), under $25.00 each with the help of a low-cost desktop 3D printer. Moreover, the clinical blood flow and pulsation pressure similar to the human can be well simulated, which can be used to train the neurosurgical residents how to clip aneurysms more effectively.

Correction of clipped pixels in color images.

PubMed

Xu, Di; Doutre, Colin; Nasiopoulos, Panos

2011-03-01

Conventional images store a very limited dynamic range of brightness. The true luma in the bright area of such images is often lost due to clipping. When clipping changes the R, G, B color ratios of a pixel, color distortion also occurs. In this paper, we propose an algorithm to enhance both the luma and chroma of the clipped pixels. Our method is based on the strong chroma spatial correlation between clipped pixels and their surrounding unclipped area. After identifying the clipped areas in the image, we partition the clipped areas into regions with similar chroma, and estimate the chroma of each clipped region based on the chroma of its surrounding unclipped region. We correct the clipped R, G, or B color channels based on the estimated chroma and the unclipped color channel(s) of the current pixel. The last step involves smoothing of the boundaries between regions of different clipping scenarios. Both objective and subjective experimental results show that our algorithm is very effective in restoring the color of clipped pixels. © 2011 IEEE

Efficacy and safety of the remOVE System for OTSC® and FTRD® clip removal: data from a PMCF analysis.

PubMed

Caputo, Antonio; Schmidt, Arthur; Caca, Karel; Bauerfeind, Peter; Schostek, Sebastian; Ho, Chi-Nghia; Gottwald, Thomas; Schurr, Marc O

2018-06-01

The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system. A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip. Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%). Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.

Modified CLIP with objective liver reserve assessment retains prognosis prediction for patients with advanced hepatocellular carcinoma.

PubMed

Shao, Yu-Yun; Liu, Tsung-Hao; Lee, Ying-Hui; Hsu, Chih-Hung; Cheng, Ann-Lii

2016-07-01

The Cancer of the Liver Italian Program (CLIP) score is a commonly used staging system for hepatocellular carcinoma (HCC) helpful with predicting prognosis of advanced HCC. CLIP uses the Child-Turcotte-Pugh (CTP) score to evaluate liver reserve. A new scoring system, the albumin-bilirubin (ALBI) grade, has been proposed as they objectively evaluate liver reserve. We examined whether the modification of CLIP with ALBI retained its prognosis prediction for patients with advanced HCC. We included patients who received first-line antiangiogenic therapy for advanced HCC. Liver reserve was assessed using CTP and ALBI scores, which were then incorporated into CLIP and ALBI-CLIP, respectively. To assess their efficacies of prognostic prediction, the Cox's proportional hazard model and concordance indexes were used. A total of 142 patients were included; 137 of them were classified CTP A and 5 patients CTP B. Patients could be divided into four or five groups with different prognosis according to CLIP and ALBI-CLIP, respectively. Higher R(2) (0.249 vs 0.216) and lower Akaike information criterion (995.0 vs 1001.1) were observed for ALBI-CLIP than for CLIP in the Cox's model predicting overall survival. ALBI-CLIP remained an independent predictor for overall survival when CLIP and ALBI-CLIP were simultaneously incorporated in Cox's models allowing variable selection with adjustment for hepatitis etiology, treatment, and performance status. The concordance index was also higher for ALBI-CLIP than for CLIP (0.724 vs 0.703). Modification of CLIP scoring with ALBI, which objectively assesses liver reserve, retains and might have improved prognosis prediction for advanced HCC. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Rebleeding from clipped aneurysm after 35 years: Report of 2 cases

PubMed Central

Ishida, Atsushi; Matsuo, Seigo; Asakuno, Keizoh; Nemoto, Akio; Niimura, Kaku; Yoshimoto, Haruko; Shiramizu, Hideki; Yuzawa, Miki

2015-01-01

Background: A successfully applied clip for a ruptured aneurysm keeps the aneurysm's neck closed, preventing rerupture throughout the patient's life. Unfortunately, rebleeding from a clipped aneurysm does occur, but the likelihood declines with time. Since relatively old people suffer from subarachnoid hemorrhage, they die from diseases other than rebleeding, such as cancer. Therefore, rebleeding from a clipped aneurysm after two decades is quite rare. Case Description: Here, we report 2 cases of rerupture after an extremely long time since the initial clipping. In both cases, the old clip was removed, and the regrown gourd-shaped aneurysm was successfully obliterated. The clips in both cases were submitted to their manufacturers and inspected thoroughly. They were found to be second-generation, stainless steel clips, and were almost intact, even keeping their closing forces. In both cases, the clip existed on the surface of the newly made dome, and the previous dome completely disappeared. Conclusions: We experienced 2 cases of rebleeding from the clipped aneurysm after 35 years. In one of the cases, the clip was a Yasargil second generation stainless steel clip that retained its mechanical properties and surface elemental composition in vivo for a long time. These cases should be informative as they show extremely long-term course of a clip applied for a ruptured aneurysm. PMID:26322244

Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall.

PubMed

Linzey, Joseph R; Chen, Kevin S; Savastano, Luis; Thompson, B Gregory; Pandey, Aditya S

2018-06-01

Brain shifts following microsurgical clip ligation of anterior communicating artery (ACoA) aneurysms can lead to mechanical compression of the optic nerve by the clip. Recognition of this condition and early repositioning of clips can lead to reversal of vision loss. The authors identified 3 patients with an afferent pupillary defect following microsurgical clipping of ACoA aneurysms. Different treatment options were used for each patient. All patients underwent reexploration, and the aneurysm clips were repositioned to prevent clip-related compression of the optic nerve. Near-complete restoration of vision was achieved at the last clinic follow-up visit in all 3 patients. Clip ligation of ACoA aneurysms has the potential to cause clip-related compression of the optic nerve. Postoperative visual examination is of utmost importance, and if any changes are discovered, reexploration should be considered as repositioning of the clips may lead to resolution of visual deterioration.

Automated rule-base creation via CLIPS-Induce

NASA Technical Reports Server (NTRS)

Murphy, Patrick M.

1994-01-01

Many CLIPS rule-bases contain one or more rule groups that perform classification. In this paper we describe CLIPS-Induce, an automated system for the creation of a CLIPS classification rule-base from a set of test cases. CLIPS-Induce consists of two components, a decision tree induction component and a CLIPS production extraction component. ID3, a popular decision tree induction algorithm, is used to induce a decision tree from the test cases. CLIPS production extraction is accomplished through a top-down traversal of the decision tree. Nodes of the tree are used to construct query rules, and branches of the tree are used to construct classification rules. The learned CLIPS productions may easily be incorporated into a large CLIPS system that perform tasks such as accessing a database or displaying information.

The imperatorin derivative OW1, a new vasoactive compound, inhibits VSMC proliferation and extracellular matrix hyperplasia

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

Zhou, Nan; Zhang, Yu; Wang, Tao

Chronic hypertension induces vascular remodeling. The most important factor for hypertension treatment is reducing the risk of cardiovascular disease. OW1 is a novel imperatorin derivative that exhibits vasodilative activity and antihypertensive effects in two-kidney one-clip (2K1C) renovascular hypertensive rats. It also inhibited vascular remodeling of the thoracic aorta in a previous study. Here, the inhibitory effects and mechanisms of OW1 on arterial vascular remodeling were investigated in vitro and in 2K1C hypertensive rats in vivo. OW1 (20 μM, 10 μM, 5 μM) inhibited Ang II-induced vascular smooth muscle cells (VSMCs) proliferation and ROS generation in vitro. OW1 also reversed themore » Ang II-mediated inhibition of α-SMA levels and stimulation of OPN levels. Histology results showed that treatment of 2K1C hypertensive rats with OW1 (20, 40, and 80 mg/kg per day, respectively for 5 weeks) in vivo significantly decreased the number of VSMCs, the aortic cross-sectional area (CSA), the media to lumen (M/L) ratio, and the content of collagen I and III in the mesenteric artery. Western blot results also revealed that OW1 stimulated the expression of α-SMA and inhibited the expression of collagen I and III on the thoracic aorta of 2K1C hypertensive rats. In mechanistic studies, OW1 acted as an ACE inhibitor and affected calcium channels. The suppression of MMP expression and the MAPK pathway may account for the effects of OW1 on vascular remodeling. OW1 attenuated vascular remodeling in vitro and in vivo. It could be a novel candidate for hypertension intervention. - Highlights: • OW1, an imperatorin derivative, attenuates vascular remodeling caused by hypertension. • OW1 inhibits VSMC proliferation and media layer hypertrophy. • OW1 acts as an ACE inhibitor and affects calcium channels. • Suppression of MMPs expression and MAPK pathway may account for the effects of OW1 on vascular remodeling.« less

CLIPS++: Embedding CLIPS into C++

NASA Technical Reports Server (NTRS)

Obermeyer, Lance; Miranker, Daniel P.

1994-01-01

This paper describes a set of C++ extensions to the CLIPS language and their embodiment in CLIPS++. These extensions and the implementation approach of CLIPS++ provide a new level of embeddability with C and C++. These extensions are a C++ include statement and a defcontainer construct; (include (c++-header-file.h)) and (defcontainer (c++-type)). The include construct allows C++ functions to be embedded in both the LHS and RHS of CLIPS rules. The header file in an include construct is the same header file the programmer uses for his/her own C++ code, independent of CLIPS. The defcontainer construct allows the inference engine to treat C++ class instances as CLIPS deftemplate facts. Consequently existing C++ class libraries may be transparently imported into CLIPS. These C++ types may use advanced features like inheritance, virtual functions, and templates. The implementation has been tested with several class libraries, including Rogue Wave Software's Tools.h++, GNU's libg++, and USL's C++ Standard Components. The execution speed of CLIPS++ has been determined to be 5 to 700 times the execution speed of CLIPS 6.0 (10 to 20X typical).

Tracking flow of leukocytes in blood for drug analysis

NASA Astrophysics Data System (ADS)

Basharat, Arslan; Turner, Wesley; Stephens, Gillian; Badillo, Benjamin; Lumpkin, Rick; Andre, Patrick; Perera, Amitha

2011-03-01

Modern microscopy techniques allow imaging of circulating blood components under vascular flow conditions. The resulting video sequences provide unique insights into the behavior of blood cells within the vasculature and can be used as a method to monitor and quantitate the recruitment of inflammatory cells at sites of vascular injury/ inflammation and potentially serve as a pharmacodynamic biomarker, helping screen new therapies and individualize dose and combinations of drugs. However, manual analysis of these video sequences is intractable, requiring hours per 400 second video clip. In this paper, we present an automated technique to analyze the behavior and recruitment of human leukocytes in whole blood under physiological conditions of shear through a simple multi-channel fluorescence microscope in real-time. This technique detects and tracks the recruitment of leukocytes to a bioactive surface coated on a flow chamber. Rolling cells (cells which partially bind to the bioactive matrix) are detected counted, and have their velocity measured and graphed. The challenges here include: high cell density, appearance similarity, and low (1Hz) frame rate. Our approach performs frame differencing based motion segmentation, track initialization and online tracking of individual leukocytes.

CLIPS: An expert system building tool

NASA Technical Reports Server (NTRS)

Riley, Gary

1991-01-01

The C Language Integrated Production System (CLIPS) is an expert system building tool, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The commercial potential of CLIPS is vast. Currently, CLIPS is being used by over 3,300 individuals throughout the public and private sector. Because the CLIPS source code is readily available, numerous groups have used CLIPS as a basis for their own expert system tools. To date, three commercially available tools have been derived from CLIPS. In general, the development of CLIPS has helped to improve the ability to deliver expert system technology throughout the public and private sectors for a wide range of applications and diverse computing environments.

HyperCLIPS: A HyperCard interface to CLIPS

NASA Technical Reports Server (NTRS)

Pickering, Brad; Hill, Randall W., Jr.

1990-01-01

HyperCLIPS combines the intuitive, interactive user interface of the Apple Macintosh(TM) with the powerful symbolic computation of an expert system interpreter. HyperCard(TM) is an excellent environment for quickly developing the front end of an application with buttons, dialogs, and pictures, while the CLIPS interpreter provides a powerful inference engine for complex problem solving and analysis. By integrating HyperCard and CLIPS the advantages and uses of both packages are made available for a wide range of uses: rapid prototyping of knowledge-based expert systems, interactive simulations of physical systems, and intelligent control of hypertext processes, to name a few. Interfacing HyperCard and CLIPS is natural. HyperCard was designed to be extended through the use of external commands (XCMDs), and CLIPS was designed to be embedded through the use of the I/O router facilities and callable interface routines. With the exception of some technical difficulties which will be discussed later, HyperCLIPS implements this interface in a straight forward manner, using the facilities provided. An XCMD called 'ClipsX' was added to HyperCard to give access to the CLIPS routines: clear, load, reset, and run. And an I/O router was added to CLIPS to handle the communication of data between CLIPS and HyperCard.

Development of a new biodegradable operative clip made of a magnesium alloy: Evaluation of its safety and tolerability for canine cholecystectomy.

PubMed

Yoshida, Toshihiko; Fukumoto, Takumi; Urade, Takeshi; Kido, Masahiro; Toyama, Hirochika; Asari, Sadaki; Ajiki, Tetsuo; Ikeo, Naoko; Mukai, Toshiji; Ku, Yonson

2017-06-01

Operative clips used to ligate vessels in abdominal operation usually are made of titanium. They remain in the body permanently and form metallic artifacts in computed tomography images, which impair accurate diagnosis. Although biodegradable magnesium instruments have been developed in other fields, the physical properties necessary for operative clips differ from those of other instruments. We developed a biodegradable magnesium-zinc-calcium alloy clip with good biologic compatibility and enough clamping capability as an operative clip. In this study, we verified the safety and tolerability of this clip for use in canine cholecystectomy. Nine female beagles were used. We performed cholecystectomy and ligated the cystic duct by magnesium alloy or titanium clips. The chronologic change of clips and artifact formation were compared at 1, 4, 12, 18, and 24 weeks postoperative by computed tomography. The animals were killed at the end of the observation period, and the clips were removed to evaluate their biodegradability. We also evaluated their effect on the living body by blood biochemistry data. The magnesium alloy clip formed much fewer artifacts than the titanium clip, and it was almost absorbed at 6 months postoperative. There were no postoperative complications and no elevation of constituent elements such as magnesium, calcium, and zinc during the observation period in both groups. The novel magnesium alloy clip demonstrated sufficient sealing capability for the cystic duct and proper biodegradability in canine models. The magnesium alloy clip revealed much fewer metallic artifacts in CT than the conventional titanium clip. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of holding strength of suture anchors for hepatic and renal parenchyma.

PubMed

Ames, Caroline D; Perrone, Juan M; Frisella, Alison J; Morrissey, Kevin; Landman, Jaime

2005-12-01

Various laparoscopic devices have been described for suture anchoring during solidorgan parenchymal closure. Application of these devices expedites the closure of parenchymal defects and minimizes ischemia time. We compared different technologies as suture anchors for parenchymal closure. A tensometer was used to determine the amount of tension necessary to dislodge each of five different clips from Vicryl suture alone or against two different substrates (fresh pig kidney and liver) with and without an intervening pledget. The clips investigated were the Lapra-Ty (Ethicon), Endoclip II (US Surgical), small Horizon Ligating Clips (Weck), Hem-o-lok Medium Polymer Clips (Week), and a novel Suture-clip (Applied Medical). ANOVA and two-sided Fisher's exact test provided statistical analysis. The force required to dislodge the Lapra-Ty clip from bare suture for both 0 and 1 Vicryl (7.0 N) was approximately fourfold the force required to dislodge the Endoclips or the 5-mm or 10-mm Hem-o-lok clips (p<0.01). When clips were applied to suture running through renal or liver parenchyma, the novel Suture-clip required the greatest tension to dislodge (P<0.01), followed by the Horizon and Lapra-Ty clips. There were no statistically significant differences in the tension required to dislodge a given clip from the two parenchymal substrates or in the presence or absence of a pledget. In our experimental model, the Suture-clip, Lapra-Ty, and Horizon clips required significantly greater tension to dislodge than the Hem-o-lok and Endoclip clips. The addition of a pledget did not improve tension resistance.

Content-based video retrieval by example video clip

NASA Astrophysics Data System (ADS)

Dimitrova, Nevenka; Abdel-Mottaleb, Mohamed

1997-01-01

This paper presents a novel approach for video retrieval from a large archive of MPEG or Motion JPEG compressed video clips. We introduce a retrieval algorithm that takes a video clip as a query and searches the database for clips with similar contents. Video clips are characterized by a sequence of representative frame signatures, which are constructed from DC coefficients and motion information (`DC+M' signatures). The similarity between two video clips is determined by using their respective signatures. This method facilitates retrieval of clips for the purpose of video editing, broadcast news retrieval, or copyright violation detection.

Differential impact of diabetes mellitus type II and arterial hypertension on collateral artery growth and concomitant macrophage accumulation.

PubMed

Ito, Wulf D; Lund, Natalie; Sager, Hendrik; Becker, Wiebke; Wenzel, Ulrich

2015-01-01

Diabetes mellitus type II and arterial hypertension are major risk factors for peripheral arterial disease and have been considered to reduce collateral growth (arteriogenesis). Collateral growth proceeds through different stages. Vascular proliferation and macrophage accumulation are hallmarks of early collateral growth. We here compare the impact of arterial hypertension and diabetes mellitus type II on collateral proliferation (Brdu incorporation) and macrophage accumulation (ED 2 staining) as well as collateral vessel function (collateral conductance) in a rat model of peripheral vascular disease (femoral artery occlusion), diabetes mellitus type II (Zucker fatty diabetic rats and Zucker lean rat controls) and arterial hypertension (induced via clip placement around the right renal arteriy). We furthermore tested the impact of monocyte chemoattractant protein-1 (MCP‑1) on collateral proliferation and macrophage accumulation in these models Diabetic animals showed reduced vascular proliferation and macrophage accumulation, which however did not translate into a change of collateral conductance. Hypertensive animals on the contrary had reduced collateral conductances without altered macrophage accumulation and only a marginal reduction in collateral proliferation. Infusion of MCP‑1 only enhanced vascular proliferation in diabetic animals. These findings illustrate that impaired monocyte/macrophage recruitment is responsible for reduced collateral growth under diabetic conditions but not in arterial hypertension suggesting that diabetes mellitus in particular affects early stages of collateral growth whereas hypertension has its impact on later remodeling stages. Successful pro-arteriogenic treatment strategies in a patient population that presents with diabetes mellitus and arterial hypertension need to address different stages of collateral growth and thus different molecular and cellular targets simultaneously.

Radiologic advantages of potential use of polymer plastic clips in neurosurgery.

PubMed

Delibegović, Samir

2014-01-01

Plastic clips are made of diamagnetic material and may result in fewer computed tomography (CT) and magnetic resonance artifacts than titanium clips. Considering that polymer plastic clips are increasingly being used in endoscopic surgery, our study examined the CT and magnetic resonance imaging (MRI) characteristics of plastic clips after application in the neurocranium and compared them with titanium clips. Craniotomy was performed on the heads of domestic pigs (Sus scrofa domestica), and, at an angle of 90°, a permanent Yasargil FT 746 T clip was placed in a frontobasal, interhemispheric position. A plastic polymer medium-large Hem-o-lok clip was placed in the same position into another animal. After this procedure, CT of the brain was performed using Siemens 16 slice, followed by an MRI scan, on Philips MRI, 1.5 Tesla. The CT and magnetic resonance scans were analyzed. On axial CT sections through the site of placement of titanium clips, dotted hyperdensity with a high value of Hounsfield units (HUI) of about 2800-3000 could be clearly seen. At the site where the plastic polymer clips were placed, discrete hyperdensity was observed, measuring 130-140 HUI. MRI of the brain in which titanium clips were used revealed a hypointensive T1W signal in the interhemispheric fissure, with a hypointensive T2W signal. On the other hand, upon examination of the MRI of the brain in which plastic clips were used, the T1W signal described above did not occur, and there was also no T2W signal, and no artifacts observed. The plastic clips are made of a diamagnetic, nonconductive material that results in fewer CT and MRI artifacts than titanium clips. Copyright © 2014 Elsevier Inc. All rights reserved.

21 CFR 878.4320 - Removable skin clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Removable skin clip. 878.4320 Section 878.4320...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4320 Removable skin clip. (a) Identification. A removable skin clip is a clip-like device intended to connect skin tissues temporarily to aid...

Ratings for emotion film clips.

PubMed

Gabert-Quillen, Crystal A; Bartolini, Ellen E; Abravanel, Benjamin T; Sanislow, Charles A

2015-09-01

Film clips are widely utilized to elicit emotion in a variety of research studies. Normative ratings for scenes selected for these purposes support the idea that selected clips correspond to the intended target emotion, but studies reporting normative ratings are limited. Using an ethnically diverse sample of college undergraduates, selected clips were rated for intensity, discreteness, valence, and arousal. Variables hypothesized to affect the perception of stimuli (i.e., gender, race-ethnicity, and familiarity) were also examined. Our analyses generally indicated that males reacted strongly to positively valenced film clips, whereas females reacted more strongly to negatively valenced film clips. Caucasian participants tended to react more strongly to the film clips, and we found some variation by race-ethnicity across target emotions. Finally, familiarity with the films tended to produce higher ratings for positively valenced film clips, and lower ratings for negatively valenced film clips. These findings provide normative ratings for a useful set of film clips for the study of emotion, and they underscore factors to be considered in research that utilizes scenes from film for emotion elicitation.

Authoring Data-Driven Videos with DataClips.

PubMed

Amini, Fereshteh; Riche, Nathalie Henry; Lee, Bongshin; Monroy-Hernandez, Andres; Irani, Pourang

2017-01-01

Data videos, or short data-driven motion graphics, are an increasingly popular medium for storytelling. However, creating data videos is difficult as it involves pulling together a unique combination of skills. We introduce DataClips, an authoring tool aimed at lowering the barriers to crafting data videos. DataClips allows non-experts to assemble data-driven "clips" together to form longer sequences. We constructed the library of data clips by analyzing the composition of over 70 data videos produced by reputable sources such as The New York Times and The Guardian. We demonstrate that DataClips can reproduce over 90% of our data videos corpus. We also report on a qualitative study comparing the authoring process and outcome achieved by (1) non-experts using DataClips, and (2) experts using Adobe Illustrator and After Effects to create data-driven clips. Results indicated that non-experts are able to learn and use DataClips with a short training period. In the span of one hour, they were able to produce more videos than experts using a professional editing tool, and their clips were rated similarly by an independent audience.

Fully automated reconstruction of three-dimensional vascular tree structures from two orthogonal views using computational algorithms and productionrules

NASA Astrophysics Data System (ADS)

Liu, Iching; Sun, Ying

1992-10-01

A system for reconstructing 3-D vascular structure from two orthogonally projected images is presented. The formidable problem of matching segments between two views is solved using knowledge of the epipolar constraint and the similarity of segment geometry and connectivity. The knowledge is represented in a rule-based system, which also controls the operation of several computational algorithms for tracking segments in each image, representing 2-D segments with directed graphs, and reconstructing 3-D segments from matching 2-D segment pairs. Uncertain reasoning governs the interaction between segmentation and matching; it also provides a framework for resolving the matching ambiguities in an iterative way. The system was implemented in the C language and the C Language Integrated Production System (CLIPS) expert system shell. Using video images of a tree model, the standard deviation of reconstructed centerlines was estimated to be 0.8 mm (1.7 mm) when the view direction was parallel (perpendicular) to the epipolar plane. Feasibility of clinical use was shown using x-ray angiograms of a human chest phantom. The correspondence of vessel segments between two views was accurate. Computational time for the entire reconstruction process was under 30 s on a workstation. A fully automated system for two-view reconstruction that does not require the a priori knowledge of vascular anatomy is demonstrated.

Proposal for a CLIPS software library

NASA Technical Reports Server (NTRS)

Porter, Ken

1991-01-01

This paper is a proposal to create a software library for the C Language Integrated Production System (CLIPS) expert system shell developed by NASA. Many innovative ideas for extending CLIPS were presented at the First CLIPS Users Conference, including useful user and database interfaces. CLIPS developers would benefit from a software library of reusable code. The CLIPS Users Group should establish a software library-- a course of action to make that happen is proposed. Open discussion to revise this library concept is essential, since only a group effort is likely to succeed. A response form intended to solicit opinions and support from the CLIPS community is included.

Biocompatibility of Plastic Clip in Neurocranium - Experimental Study on Dogs.

PubMed

Delibegovic, Samir; Dizdarevic, Kemal; Cickusic, Elmir; Katica, Muhamed; Obhodjas, Muamer; Ocus, Muhamed

2016-01-01

A potential advantage of the use of the plastic clips in neurosurgery is their property of causing fewer artifacts than titanium clips as assessed by computed tomography and magnetic resonance scans. The biocompatibility of plastic clips was demonstrated in the peritoneal cavity, but their behavior in the neurocranium is not known. Twelve aggressive stray dogs designated for euthanasia were taken for this experimental study. The animals were divided into two groups. In all cases, after anesthesia, a craniotomy was performed, and after opening the dura, a proximal part titanium clip was placed on the isolated superficial Sylvian vein (a permanent Yasargil FT 746 T clip at a 90° angle, while a plastic Hem-o-lok clip ML was placed on another part of the vein). The first group of animals was sacrificed on the 7 < sup > th < /sup > postoperative day and the second group on the 60 < sup > th < /sup > postoperative day. Samples of tissue around the clips were taken for a histopathological evaluation. The plastic clip caused a more intensive tissue reaction than the titanium clip on the 7 < sup > th < /sup > postoperative day, but there was no statistical difference. Even on the 60 < sup > th < /sup > postoperative day there was no significant difference in tissue reaction between the titanium and plastic clips. These preliminary results confirm the possibility for the use of plastic clips in neurosurgery. Before their use in human neurosurgery, further studies are needed to investigate the long-term effects of the presence of plastic clips in the neurocranium, as well as studies of the aneurysmal model.

Fuzzy expert systems using CLIPS

NASA Technical Reports Server (NTRS)

Le, Thach C.

1994-01-01

This paper describes a CLIPS-based fuzzy expert system development environment called FCLIPS and illustrates its application to the simulated cart-pole balancing problem. FCLIPS is a straightforward extension of CLIPS without any alteration to the CLIPS internal structures. It makes use of the object-oriented and module features in CLIPS version 6.0 for the implementation of fuzzy logic concepts. Systems of varying degrees of mixed Boolean and fuzzy rules can be implemented in CLIPS. Design and implementation issues of FCLIPS will also be discussed.

Restoration of clipped seismic waveforms using projection onto convex sets method

PubMed Central

Zhang, Jinhai; Hao, Jinlai; Zhao, Xu; Wang, Shuqin; Zhao, Lianfeng; Wang, Weimin; Yao, Zhenxing

2016-01-01

The seismic waveforms would be clipped when the amplitude exceeds the upper-limit dynamic range of seismometer. Clipped waveforms are typically assumed not useful and seldom used in waveform-based research. Here, we assume the clipped components of the waveform share the same frequency content with the un-clipped components. We leverage this similarity to convert clipped waveforms to true waveforms by iteratively reconstructing the frequency spectrum using the projection onto convex sets method. Using artificially clipped data we find that statistically the restoration error is ~1% and ~5% when clipped at 70% and 40% peak amplitude, respectively. We verify our method using real data recorded at co-located seismometers that have different gain controls, one set to record large amplitudes on scale and the other set to record low amplitudes on scale. Using our restoration method we recover 87 out of 93 clipped broadband records from the 2013 Mw6.6 Lushan earthquake. Estimating that we recover 20 clipped waveforms for each M5.0+ earthquake, so for the ~1,500 M5.0+ events that occur each year we could restore ~30,000 clipped waveforms each year, which would greatly enhance useable waveform data archives. These restored waveform data would also improve the azimuthal station coverage and spatial footprint. PMID:27966618

Fabrication of cerebral aneurysm simulator with a desktop 3D printer

PubMed Central

Liu, Yu; Gao, Qing; Du, Song; Chen, ZiChen; Fu, JianZhong; Chen, Bing; Liu, ZhenJie; He, Yong

2017-01-01

Now, more and more patients are suffering cerebral aneurysm. However, long training time limits the rapid growth of cerebrovascular neurosurgeons. Here we developed a novel cerebral aneurysm simulator which can be better represented the dynamic bulging process of cerebral aneurysm The proposed simulator features the integration of a hollow elastic vascular model, a skull model and a brain model, which can be affordably fabricated at the clinic (Fab@Clinic), under $25.00 each with the help of a low-cost desktop 3D printer. Moreover, the clinical blood flow and pulsation pressure similar to the human can be well simulated, which can be used to train the neurosurgical residents how to clip aneurysms more effectively. PMID:28513626

A systematic review of discomfort due to toe or ear clipping in laboratory rodents

PubMed Central

Geessink, Florentine J.; Brouwer, Michelle A. E.; Tillema, Alice; Ritskes-Hoitinga, Merel

2017-01-01

Toe clipping and ear clipping (also ear notching or ear punching) are frequently used methods for individual identification of laboratory rodents. These procedures potentially cause severe discomfort, which can reduce animal welfare and distort experimental results. However, no systematic summary of the evidence on this topic currently exists. We conducted a systematic review of the evidence for discomfort due to toe or ear clipping in rodents. The review methodology was pre-specified in a registered review protocol. The population, intervention, control, outcome (PICO) question was: In rodents, what is the effect of toe clipping or ear clipping, compared with no clipping or sham clipping, on welfare-related outcomes? Through a systematic search in PubMed, Embase, Web of Science and grey literature, we identified seven studies on the effect of ear clipping on animal welfare, and five such studies on toe clipping. Studies were included in the review if they contained original data from an in vivo experiment in rodents, assessing the effect of toe clipping or ear clipping on a welfare-related outcome. Case studies and studies applying unsuitable co-interventions were excluded. Study quality was appraised using an extended version of SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE)’s risk of bias tool for animal studies. Study characteristics and outcome measures were highly heterogeneous, and there was an unclear or high risk of bias in all studies. We therefore present a narrative synthesis of the evidence identified. None of the studies reported a sample size calculation. Out of over 60 different outcomes, we found evidence of discomfort due to ear clipping in the form of increased respiratory volume, vocalization and blood pressure. For toe clipping, increased vocalization and decreased motor activity in pups were found, as well as long-term effects in the form of reduced grip strength and swimming ability in adults. In conclusion, there is too little evidence to reliably assess discomfort due to toe or ear clipping, and the quality of the available evidence is uncertain. Adequately powered, high-quality studies reporting reliable, relevant outcome measures are needed to accurately assess the impact of these identification techniques. Until more reliable evidence is available, any effect of toe clipping or ear clipping on animal welfare and study results cannot be confirmed or excluded. PMID:28429644

Taxonomic and Functional Responses of Soil Microbial Communities to Annual Removal of Aboveground Plant Biomass

PubMed Central

Guo, Xue; Zhou, Xishu; Hale, Lauren; Yuan, Mengting; Feng, Jiajie; Ning, Daliang; Shi, Zhou; Qin, Yujia; Liu, Feifei; Wu, Liyou; He, Zhili; Van Nostrand, Joy D.; Liu, Xueduan; Luo, Yiqi; Tiedje, James M.; Zhou, Jizhong

2018-01-01

Clipping, removal of aboveground plant biomass, is an important issue in grassland ecology. However, few studies have focused on the effect of clipping on belowground microbial communities. Using integrated metagenomic technologies, we examined the taxonomic and functional responses of soil microbial communities to annual clipping (2010–2014) in a grassland ecosystem of the Great Plains of North America. Our results indicated that clipping significantly (P < 0.05) increased root and microbial respiration rates. Annual temporal variation within the microbial communities was much greater than the significant changes introduced by clipping, but cumulative effects of clipping were still observed in the long-term scale. The abundances of some bacterial and fungal lineages including Actinobacteria and Bacteroidetes were significantly (P < 0.05) changed by clipping. Clipping significantly (P < 0.05) increased the abundances of labile carbon (C) degrading genes. More importantly, the abundances of recalcitrant C degrading genes were consistently and significantly (P < 0.05) increased by clipping in the last 2 years, which could accelerate recalcitrant C degradation and weaken long-term soil carbon stability. Furthermore, genes involved in nutrient-cycling processes including nitrogen cycling and phosphorus utilization were also significantly increased by clipping. The shifts of microbial communities were significantly correlated with soil respiration and plant productivity. Intriguingly, clipping effects on microbial function may be highly regulated by precipitation at the interannual scale. Altogether, our results illustrated the potential of soil microbial communities for increased soil organic matter decomposition under clipping land-use practices. PMID:29904372

It is time for a better clip applier - 3 mm, percutaneous, non-crushing and locking.

PubMed

Yuval, Jonathan B; Weiss, Daniel J; Paz, Adrian; Bachar, Yehuda; Brodie, Ronit; Shapira, Yinon; Mintz, Yoav

2017-10-06

Since the advent of laparoscopy there have been attempts to minimize abdominal wall incisions. For this purpose smaller instruments have been produced. Our aim was to develop the first 3 mm percutaneous clip applier and to make it better than the standard clips of today. The ClipTip clip is made of Nitinol and has a crocodile shaped jaws, which when apposed effectively seal vessels. The shaft operates as a retractable needle permitting percutaneous insertion. Closing, reopening and reclosing is possible. The physical properties of the device were compared to three commercially available clip appliers. Surgeries were performed on porcine animals by experienced surgeons. In comparison to available clips, the superiority of the ClipTip is a combination of wide effective length alongside the ability to withstand strong forces. In live animal studies the Cliptip was inserted into the peritoneal cavity without any injuries. Vessels were ligated successfully and no clip dislodgement or leakage occurred. We developed the next generation clip applier with better properties. Advantages include its length, the needleoscopic caliber, non-crushing effect, locking mechanism and wide aperture. The device has performed safely and effectively in pre-clinical tests. Further studies are planned in humans.

Persistence in and Release of 2,4-D and Azoxystrobin from Turfgrass Clippings.

PubMed

Jeffries, Matthew D; Yelverton, Fred H; Ahmed, Khalied A; Gannon, Travis W

2016-11-01

Research has shown that pesticide residue in clippings from previously treated turfgrass may become bioavailable as grass decomposes, adversely affecting off-target organisms. We conducted a field study to quantify 2,4-D (2,4-dichlorophenoxyacetic acid) and azoxystrobin (methyl(E)-2-{2[6-(2-cyanophenoxy)pyrmidin-4-yloxy]phenyl}-3-methoxyacrylate) residues in turfgrass clippings collected from hybrid bermudagrass [ (L.) Pers. × Burtt-Davy], tall fescue [ (Schreb.) S.J. Darbyshire], and zoysiagrass ( Steud.). A subsequent greenhouse experiment was conducted to measure pesticide release from clippings into water. 2,4-D (1.6 kg a.i. ha) and azoxystrobin (0.6 kg a.i. ha) were applied to field plots at 32, 16, 8, 4, 2, 1, or 0 d before collection of the clippings. Clippings were collected from each experimental unit to quantify pesticide release from clippings into water. Both 2,4-D and azoxystrobin were detected when turfgrass was treated over the 32-d experimental period, suggesting that clipping management should be implemented for an extended period of time after application. Pesticide residue was detected in all water samples collected, confirming 2,4-D and azoxystrobin release from turfgrass clippings; however, pesticide release varied between compounds. Two days after clippings were incorporated in water, 39 and 10% of 2,4-D and azoxystrobin were released from clippings, respectively. Our research supports the currently recommended practice of returning clippings to the turfgrass stand when mowing because removal of 2,4-D and azoxystrobin in clippings may reduce pest control and cause adverse off-target impacts. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

The efficiency of the new Yasargil titanium fenestrated mini-clips for ideal clipping of a cerebral aneurysm

PubMed Central

Ota, Nakao; Tanikawa, Rokuya; Noda, Kosumo; Tsuboi, Toshiyuki; Kamiyama, Hiroyasu; Tokuda, Sadahisa

2015-01-01

Background: The fenestrated clip is sometimes useful in limited approach angle and narrow working space. However, before the development of the new Yasargil titanium fenestrated mini-clip, the only variations of fenestrated clips were those of larger sizes. And those larger clips have a problem of the triangle-shaped gap at the proximal end of the blade. The authors describe the efficiency, limitations and surgical technique of using the Yasargil titanium fenestrated mini-clip. Methods: Fifty-nine cases of aneurysms were treated using these mini-clips. Aneurysm location, size and dome neck ratio, mean follow-up period, neck remnant, and recurrence rate were also analyzed. Among these cases, we present eight characteristic cases, including a case with aneurysm recurrence, and we review the problems associated with the triangle-shaped gap at the proximal end of the clip. Results: The average size of the aneurysms was 5.57 mm, and the dome neck ratio was >2.0 in 1.69%, >1.5 in 11.8%, >1.2 in 35.6%, and <1.2 in 50.8% of cases. The mean follow-up period for the 59 cases was 5.5 months (range, 0.5–16 months). Angiographic recurrence of the treated portion occurred in 1 case (1.7%), including an aneurysm in the basilar artery tip aneurysm. Conclusion: The availability of the Yasargil titanium fenestrated mini-clip increases the options for clipping to minimize the remnant of the clipped aneurysm. However, there is still concern over the triangular space at the base of the blade, especially when treating an aneurysm with a thin vessel wall. Therefore, modification of the clipping technique is sometimes needed. PMID:26664871

SU-E-J-201: Position Verification in Breast Cancer Radiotherapy Using Tantalum Clips in the Lumpectomy Cavity

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

Santvoort, J van; Van der Drift, M; Kuipers, J

2014-06-01

Purpose: To find out whether tantalum surgical clips can be used for online position verification in treatment of the lumpectomy cavity (LC) in breast cancer patients. Tantalum is a high density metal that could be visible on Electronic Portal Images (EPIs) and be an affordable alternative to gold markers. Clips are considered more representative for the LC position than nearby bony structures. Methods: In twelve patients the surgeon had placed 2 to 5 tantalum clips in the LC. The AP and lateral fields used for portal imaging, were adapted. In doing so, both bony structures and tantalum clips were visiblemore » on EPIs. The following analyses were performed:1. Image degradation, with respect to delineating the CTV, of the axial CT slices by artefacts because of the tantalum clips was evaluated by a radiation oncologist;2. The visibility of the tantalum clips on the EPIs was evaluated by four radiation therapists (RTTs);3. Bony anatomy and tantalum clip matches were performed on the same images independently by two observers. Results: 1. Delineation of the CTV by the radiation oncologist was not hampered by CT image artefacts because of the clips.2. The mean score for visibility of the clips on the EPIs, analysed by the four RTTs, was 5.6 on a scale of 10 (range 3.9 – 8.0).3. In total 12 patients with 16 fractions each were analysed. The differences between clip match and bone match are significant with a mean vector length of 5.2 mm (SD 1.9 mm) for the difference. Conclusion: Results of matches on tantalum clips as compared to matches on bony structures differ substantially. Therefore clip matches can result in smaller CTV to PTV margins than bone matches. Visibility of the clips on EPIs is sufficient, so they can be an alternative to gold markers.« less

Laparoscopic sterilization with the spring clip: instrumentation development and current clinical experience.

PubMed

Hulka, J F; Omran, K; Lieberman, B A; Gordon, A G

1979-12-15

Since the original spring clip sterilization studies were reported, a number of clinically important modifications to the spring clip and applicator have been developed. The spring-loaded clip, manufactured by Richard Wolf Medical Instruments Corporation of Chicago, Illinois, and Rocket of London, Inc., London, England, and New York, New York can be applied with either a one- or two-incision applicator and the clips and applicators currently available incorporate improvements to the original prototypes in design, manufacture, and quality control. The two-incision applicator is associated with significantly fewer misapplications and the high pregnancy rates reported with the original clip and applicator have not occurred with the current designs. Comparative studies between the clip and band have revealed less operative bleeding and pain associated with the clip. The method is appropriate to all women requesting sterilization but especially to those in the younger age group who may subsequently request reversal because of divorce and remarriage.

An object oriented extension to CLIPS

NASA Technical Reports Server (NTRS)

Sobkowicz, Clifford

1990-01-01

A presentation of software sub-system developed to augment C Language Production Systems (CLIPS) with facilities for object oriented Knowledge representation. Functions are provided to define classes, instantiate objects, access attributes, and assert object related facts. This extension is implemented via the CLIPS user function interface and does not require modification of any CLIPS code. It does rely on internal CLIPS functions for memory management and symbol representation.

Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage.

PubMed

Ito, Kiyoshi; Aoyama, Tatsuro; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

2015-12-01

The nonpenetrating titanium clip has been successfully used in peripheral arterial bypass surgery. The purpose of this study was to evaluate the leakage pressures and patterns of nonpenetrating titanium clips using a simple model that mimicked spinal surgery. In addition, the authors describe their surgical experience with these clips and the follow-up results in 31 consecutive patients. The authors compared nonpenetrating titanium clips and expanded polytetrafluoroethylene (ePTFE) sutures in relation to the water pressure that could be tolerated by sutured ePTFE sheets, and the leakage pressure patterns were determined. The changes in leakage pressures at 5 minutes, 30 minutes, and 12 hours were examined when the clips and sutures were used in combination with the mesh-and-glue technique in an in vitro study. Thirty-one patients underwent spinal intradural procedures using nonpenetrating titanium clips to suture the dura maters using the meshand-glue technique, involving fibrin glue and polyglycolic acid-fibrin sheets. A significant difference was apparent between the ePTFE suture group and the nonpenetrating titanium clip group, with the latter showing a leakage pressure that could be sustained and was 1508% higher than that of the former (p = 0.001). In relation to leakage patterns, the nonpenetrating titanium clips did not make any suture holes in the ePTFE sheet and fluid leakage occurred between the clips, whereas fluid leakage was associated with the pressure elevation that occurred at the suture holes made by the ePTFE sutures. Of the 31 patients who underwent spinal intradural procedures using nonpenetrating titanium clips, 1 (3.2%) experienced cerebrospinal fluid (CSF) leakage postoperatively. No other complications-for example, allergic reactions, adhesions, or infections--were encountered. The interrupted placement of nonpenetrating titanium clips enables dural closure without creating any holes. These clips facilitate improvements in the initial leakage pressure and reduce postoperative CSF leakage following spinal surgery. The authors conclude that it is very beneficial to suture the spinal dura mater using nonpenetrating titanium clips given the anatomical characteristics of the spinal dura mater and the fact that the clips do not create suture holes.

New concept of 3D printed bone clip (polylactic acid/hydroxyapatite/silk composite) for internal fixation of bone fractures.

PubMed

Yeon, Yeung Kyu; Park, Hae Sang; Lee, Jung Min; Lee, Ji Seung; Lee, Young Jin; Sultan, Md Tipu; Seo, Ye Bin; Lee, Ok Joo; Kim, Soon Hee; Park, Chan Hum

Open reduction with internal fixation is commonly used for the treatment of bone fractures. However, postoperative infection associated with internal fixation devices (intramedullary nails, plates, and screws) remains a significant complication, and it is technically difficult to fix multiple fragmented bony fractures using internal fixation devices. In addition, drilling in the bone to install devices can lead to secondary fracture, bone necrosis associated with postoperative infection. In this study, we developed bone clip type internal fixation device using three- dimensional (3D) printing technology. Standard 3D model of the bone clip was generated based on computed tomography (CT) scan of the femur in the rat. Polylacticacid (PLA), hydroxyapatite (HA), and silk were used for bone clip material. The purpose of this study was to characterize 3D printed PLA, PLA/HA, and PLA/HA/Silk composite bone clip and evaluate the feasibility of these bone clips as an internal fixation device. Based on the results, PLA/HA/Silk composite bone clip showed similar mechanical property, and superior biocompatibility compared to other types of the bone clip. PLA/HA/Silk composite bone clip demonstrated excellent alignment of the bony segments across the femur fracture site with well-positioned bone clip in an animal study. Our 3D printed bone clips have several advantages: (1) relatively noninvasive (drilling in the bone is not necessary), (2) patient-specific design (3) mechanically stable device, and (4) it provides high biocompatibility. Therefore, we suggest that our 3D printed PLA/HA/Silk composite bone clip is a possible internal fixation device.

Using CLIPS as the cornerstone of a graduate expert systems course

NASA Technical Reports Server (NTRS)

Yue, Kwok-Bun

1991-01-01

The effective use of the C Language Integrated Production System (CLIPS) as a cornerstone in a graduate expert systems course is described. The course include 8 or 9 hours of in-depth lecturing in CLIPS, as well as a broad coverage of major topics and techniques in expert systems. As part of the requirements of the course, students solved two small yet non-trival problems in CLIPS before going on to develop a toy expert system in CLIPS in an incremental manner as the term project. Furthermore, students were required to evaluate CLIPS programs written by their classmates. An anonymous questionnaire at the end of the semester revealed that the students responded very favorably to the course, especially their experience with CLIPS.

Third CLIPS Conference Proceedings, volume 2

NASA Technical Reports Server (NTRS)

Riley, Gary (Editor)

1994-01-01

Expert systems are computer programs which emulate human expertise in well defined problem domains. The C Language Integrated Production System (CLIPS) is an expert system building tool, developed at the Johnson Space Center, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The development of CLIPS has helped to improve the ability to deliver expert system technology throughout the public and private sectors for a wide range of applications and diverse computing environments. The Third Conference on CLIPS provided a forum for CLIPS users to present and discuss papers relating to CLIPS applications, uses, and extensions.

MIRO: A debugging tool for CLIPS incorporating historical Rete networks

NASA Technical Reports Server (NTRS)

Tuttle, Sharon M.; Eick, Christoph F.

1994-01-01

At the last CLIPS conference, we discussed our ideas for adding a temporal dimension to the Rete network used to implement CLIPS. The resulting historical Rete network could then be used to store 'historical' information about a run of a CLIPS program, to aid in debugging. MIRO, a debugging tool for CLIPS built on top of CLIPS, incorporates such a historical Rete network and uses it to support its prototype question-answering capability. By enabling CLIPS users to directly ask debugging-related questions about the history of a program run, we hope to reduce the amount of single-stepping and program tracing required to debug a CLIPS program. In this paper, we briefly describe MIRO's architecture and implementation, and the current question-types that MIRO supports. These question-types are further illustrated using an example, and the benefits of the debugging tool are discussed. We also present empirical results that measure the run-time and partial storage overhead of MIRO, and discuss how MIRO may also be used to study various efficiency aspects of CLIPS programs.

The disappearing clip: an unusual complication in MRI biopsy

PubMed Central

Bourke, Anita Geraldine; Peter, Prasant; Jose, Chaitra Lesli

2014-01-01

MRI-guided biopsies are being increasingly used for otherwise occult breast lesions. Clip migration has been reported however, to the best of our knowledge, there have been no documented cases of entire disappearance of a marker clip. Absence of the postbiopsy marker clip was noted when our patient returned for preoperative hook-wire localisation even though accurate clip placement had been confirmed on the post-MRI biopsy mammogram. PMID:25139917

Using film clips to enhance nursing education.

PubMed

Herrman, Judith W

2006-01-01

Film clips in nursing education provide a unique way to promote active learning. Several methods for using film clips and combining them with other teaching strategies are discussed. Suggestions for the use of popular clips, logistical aspects of showing clips in class, and legal issues associated with copyright are addressed. Faculty are encouraged to use this strategy to evoke emotional responses, generate discussion, enhance clinical decision making, and provide vicarious learning.

Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms

PubMed Central

Doss, Vinodh T.; Goyal, Nitin; Humphries, William; Hoit, Dan; Arthur, Adam; Elijovich, Lucas

2015-01-01

Background Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature. Objective We evaluated the correlation between ICG and DSA in clipped intracranial aneurysms. Methods A retrospective study of patients who underwent craniotomy and microsurgical clipping of intracranial aneurysms with ICG for 2 years. Patient characteristics, presentation details, operative reports, and pre- and postclipping angiographic images were reviewed to determine the adequacy of the clipping. Results Forty-seven patients underwent clipping with ICG and postoperative DSA: 57 aneurysms were clipped; 23 patients (48.9%) presented with subarachnoid hemorrhage. Nine aneurysms demonstrated a residual on DSA not identified on ICG (residual sizes ranged from 0.5 to 4.3 mm; average size: 1.8 mm). Postoperative DSA demonstrated no branch occlusions. Conclusion Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. This has important clinical implications with regard to follow-up imaging and surgical/endovascular management. PMID:26279659

Sex Differences in Emotional Evaluation of Film Clips: Interaction with Five High Arousal Emotional Categories.

PubMed

Maffei, Antonio; Vencato, Valentina; Angrilli, Alessandro

2015-01-01

The present study aimed to investigate gender differences in the emotional evaluation of 18 film clips divided into six categories: Erotic, Scenery, Neutral, Sadness, Compassion, and Fear. 41 female and 40 male students rated all clips for valence-pleasantness, arousal, level of elicited distress, anxiety, jittery feelings, excitation, and embarrassment. Analysis of positive films revealed higher levels of arousal, pleasantness, and excitation to the Scenery clips in both genders, but lower pleasantness and greater embarrassment in women compared to men to Erotic clips. Concerning unpleasant stimuli, unlike men, women reported more unpleasantness to the Compassion, Sadness, and Fear compared to the Neutral clips and rated them also as more arousing than did men. They further differentiated the films by perceiving greater arousal to Fear than to Compassion clips. Women rated the Sadness and Fear clips with greater Distress and Jittery feelings than men did. Correlation analysis between arousal and the other emotional scales revealed that, although men looked less aroused than women to all unpleasant clips, they also showed a larger variance in their emotional responses as indicated by the high number of correlations and their relatively greater extent, an outcome pointing to a masked larger sensitivity of part of male sample to emotional clips. We propose a new perspective in which gender difference in emotional responses can be better evidenced by means of film clips selected and clustered in more homogeneous categories, controlled for arousal levels, as well as evaluated through a number of emotion focused adjectives.

Recurrence of ICA-PCoA aneurysms after neck clipping.

PubMed

Sakaki, T; Takeshima, T; Tominaga, M; Hashimoto, H; Kawaguchi, S

1994-01-01

Between 1975 and 1992, 2211 patients underwent aneurysmal neck clipping at the Nara Medical University clinic and associated hospitals. The aneurysm in 931 of these patients was situated at the junction of the internal carotid artery (ICA) and posterior communicating artery (PCoA). Seven patients were readmitted 4 to 17 years after the first surgery because of regrowth and rupture of an ICA-PCoA aneurysmal sac that had arisen from the residual neck. On angiograms obtained following aneurysmal neck clipping, a large primitive type of PCoA was demonstrated in six patients and a small PCoA in one. A small residual aneurysm was confirmed in only two patients and angiographically complete neck clipping in five. Recurrent ICA-PCoA aneurysms were separated into two types based on the position of the old clip in relation to the new growth. Type 1 aneurysms regrow from the entire neck and balloon eccentrically. In this type, it is possible to apply the clip at the neck as in conventional clipping for a ruptured aneurysm. Type 2 includes aneurysms in which the proximal portion of a previous clip is situated at the corner of the ICA and aneurysmal neck and the distal portion on the enlarged dome of the aneurysm, because the sac is regrowing from a portion of the residual neck. In this type of aneurysm, a Sugita fenestrated clip can occlude the residual neck, overriding the old clip. Classifying these aneurysms into two groups is very useful from a surgical point of view because it is possible to apply a new clip without removing the old clip, which was found to be adherent to surrounding tissue.

Automated revision of CLIPS rule-bases

NASA Technical Reports Server (NTRS)

Murphy, Patrick M.; Pazzani, Michael J.

1994-01-01

This paper describes CLIPS-R, a theory revision system for the revision of CLIPS rule-bases. CLIPS-R may be used for a variety of knowledge-base revision tasks, such as refining a prototype system, adapting an existing system to slightly different operating conditions, or improving an operational system that makes occasional errors. We present a description of how CLIPS-R revises rule-bases, and an evaluation of the system on three rule-bases.

CLIPS: A proposal for improved usability

NASA Technical Reports Server (NTRS)

Patton, Charles R.

1990-01-01

This paper proposes the enhancement of the CLIPS user interface to improve the over-all usability of the CLIPS development environment. It suggests some directions for the long term growth of the user interface, and discusses some specific strengths and weaknesses of the current CLIPS PC user interface. Every user of CLIPS shares a common experience: his/her first interaction with the system itself. As with any new language, between the process of installing CLIPS on the appropriate computer and the completion of a large application, an intensive learning process takes place. For those with extensive programming knowledge and LISP backgrounds, this experience may have been mostly interesting and pleasant. Being familiar with products that are similar to CLIPS in many ways, these users enjoy a relatively short training period with the product. Already familiar with many of the functions they wish to employ, experienced users are free to focus on the capabilities of CLIPS that make it uniquely useful within their working environment.

Seismic signals hard clipping overcoming

NASA Astrophysics Data System (ADS)

Olszowa, Paula; Sokolowski, Jakub

2018-01-01

In signal processing the clipping is understand as the phenomenon of limiting the signal beyond certain threshold. It is often related to overloading of a sensor. Two particular types of clipping are being recognized: soft and hard. Beyond the limiting value soft clipping reduces the signal real gain while the hard clipping stiffly sets the signal values at the limit. In both cases certain amount of signal information is lost. Obviously if one possess the model which describes the considered signal and the threshold value (which might be slightly more difficult to obtain in the soft clipping case), the attempt of restoring the signal can be made. Commonly it is assumed that the seismic signals take form of an impulse response of some specific system. This may lead to belief that the sine wave may be the most appropriate to fit in the clipping period. However, this should be tested. In this paper the possibility of overcoming the hard clipping in seismic signals originating from a geoseismic station belonging to an underground mine is considered. A set of raw signals will be hard-clipped manually and then couple different functions will be fitted and compared in terms of least squares. The results will be then analysed.

CLIPS: The C language integrated production system

NASA Technical Reports Server (NTRS)

Riley, Gary

1994-01-01

Expert systems are computer programs which emulate human expertise in well defined problem domains. The potential payoff from expert systems is high: valuable expertise can be captured and preserved, repetitive and/or mundane tasks requiring human expertise can be automated, and uniformity can be applied in decision making processes. The C Language Integrated Production System (CLIPS) is an expert system building tool, developed at the Johnson Space Center, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The commercial potential of CLIPS is vast. Currently, CLIPS is being used by over 5,000 individuals throughout the public and private sector. Because the CLIPS source code is readily available, numerous groups have used CLIPS as the basis for their own expert system tools. To date, three commercially available tools have been derived from CLIPS. In general, the development of CLIPS has helped to improve the ability to deliver expert system technology throughout the public and private sectors for a wide range of applications and diverse computing environments.

The Labdane Ent-3-Acetoxy-Labda-8(17), 13-Dien-15-Oic Decreases Blood Pressure In Hypertensive Rats

PubMed Central

Simplicio, Janaina A.; Simão, Marilia R.; Ambrosio, Sergio R.; Tirapelli, Carlos R.

2016-01-01

Background Labdane-type diterpenes induce lower blood pressure via relaxation of vascular smooth muscle; however, there are no studies describing the effects of labdanes in hypertensive rats. Objective The present study was designed to investigate the cardiovascular actions of the labdane-type diterpene ent-3-acetoxy-labda-8(17), 13-dien-15-oic acid (labda-15-oic acid) in two-kidney 1 clip (2K-1C) renal hypertension. Methods Vascular reactivity experiments were performed in aortic rings isolated from 2K-1C and normotensive (2K) male Wistar rats. Nitrate/nitrite (NOx) measurement was performed in aortas by colorimetric assay. Blood pressure measurements were performed in conscious rats. Results Labda-15-oic acid (0.1-300 µmol/l) and forskolin (0.1 nmol/l - 1 µmol/l) relaxed endothelium-intact and endothelium-denuded aortas from both 2K-1C and 2K rats. Labda-15-oic acid was more effective at inducing relaxation in endothelium-intact aortas from 2K pre-contracted with phenylephrine when compared to the endothelium-denuded ones. Forskolin was more potent than labda-15-oic acid at inducing vascular relaxation in arteries from both 2K and 2K-1C rats. Labda-15-oic acid-induced increase in NOx levels was lower in arteries from 2K-1C rats when compared to 2K rats. Intravenous administration of labda-15-oic acid (0.3-3 mg/kg) or forskolin (0.1-1 mg/kg) induced hypotension in conscious 2K-1C and 2K rats. Conclusion The present findings show that labda-15-oic acid induces vascular relaxation and hypotension in hypertensive rats. PMID:27096521

76 FR 26242 - Paper Clips From the People's Republic of China: Final Results of Expedited Sunset Review of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... order are plastic and vinyl covered paper clips, butterfly clips, binder clips, or other paper fasteners... order is revoked. Parties can obtain a public copy of the I&D Memo from the Central Records Unit, room...

Annual Removal of Aboveground Plant Biomass Alters Soil Microbial Responses to Warming

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

Xue, Kai; Yuan, Mengting M.; Xie, Jianping

Clipping (i.e., harvesting aboveground plant biomass) is common in agriculture and for bioenergy production. However, microbial responses to clipping in the context of climate warming are poorly understood. We investigated the interactive effects of grassland warming and clipping on soil properties and plant and microbial communities, in particular, on microbial functional genes. Clipping alone did not change the plant biomass production, but warming and clipping combined increased the C4 peak biomass by 47% and belowground net primary production by 110%. Clipping alone and in combination with warming decreased the soil carbon input from litter by 81% and 75%, respectively. Withmore » less carbon input, the abundances of genes involved in degrading relatively recalcitrant carbon increased by 38% to 137% in response to either clipping or the combined treatment, which could weaken long-term soil carbon stability and trigger positive feedback with respect to warming. Clipping alone also increased the abundance of genes for nitrogen fixation, mineralization, and denitrification by 32% to 39%. Such potentially stimulated nitrogen fixation could help compensate for the 20% decline in soil ammonium levels caused by clipping alone and could contribute to unchanged plant biomass levels. Moreover, clipping tended to interact antagonistically with warming, especially with respect to effects on nitrogen cycling genes, demonstrating that single-factor studies cannot predict multifactorial changes. These results revealed that clipping alone or in combination with warming altered soil and plant properties as well as the abundance and structure of soil microbial functional genes. Aboveground biomass removal for biofuel production needs to be reconsidered, as the long-term soil carbon stability may be weakened. IMPORTANCE Global change involves simultaneous alterations, including those caused by climate warming and land management practices (e.g., clipping). Data on the interactive effects of warming and clipping on ecosystems remain elusive, particularly in microbial ecology. This study found that clipping alters microbial responses to warming and demonstrated the effects of antagonistic interactions between clipping and warming on microbial functional genes. Clipping alone or combined with warming enriched genes degrading relatively recalcitrant carbon, likely reflecting the decreased quantity of soil carbon input from litter, which could weaken long-term soil C stability and trigger positive warming feedback. These results have important implications in assessing and predicting the consequences of global climate change and indicate that the removal of aboveground biomass for biofuel production may need to be reconsidered.« less

Annual Removal of Aboveground Plant Biomass Alters Soil Microbial Responses to Warming

DOE PAGES

Xue, Kai; Yuan, Mengting M.; Xie, Jianping; ...

2016-09-27

Clipping (i.e., harvesting aboveground plant biomass) is common in agriculture and for bioenergy production. However, microbial responses to clipping in the context of climate warming are poorly understood. We investigated the interactive effects of grassland warming and clipping on soil properties and plant and microbial communities, in particular, on microbial functional genes. Clipping alone did not change the plant biomass production, but warming and clipping combined increased the C4 peak biomass by 47% and belowground net primary production by 110%. Clipping alone and in combination with warming decreased the soil carbon input from litter by 81% and 75%, respectively. Withmore » less carbon input, the abundances of genes involved in degrading relatively recalcitrant carbon increased by 38% to 137% in response to either clipping or the combined treatment, which could weaken long-term soil carbon stability and trigger positive feedback with respect to warming. Clipping alone also increased the abundance of genes for nitrogen fixation, mineralization, and denitrification by 32% to 39%. Such potentially stimulated nitrogen fixation could help compensate for the 20% decline in soil ammonium levels caused by clipping alone and could contribute to unchanged plant biomass levels. Moreover, clipping tended to interact antagonistically with warming, especially with respect to effects on nitrogen cycling genes, demonstrating that single-factor studies cannot predict multifactorial changes. These results revealed that clipping alone or in combination with warming altered soil and plant properties as well as the abundance and structure of soil microbial functional genes. Aboveground biomass removal for biofuel production needs to be reconsidered, as the long-term soil carbon stability may be weakened. IMPORTANCE Global change involves simultaneous alterations, including those caused by climate warming and land management practices (e.g., clipping). Data on the interactive effects of warming and clipping on ecosystems remain elusive, particularly in microbial ecology. This study found that clipping alters microbial responses to warming and demonstrated the effects of antagonistic interactions between clipping and warming on microbial functional genes. Clipping alone or combined with warming enriched genes degrading relatively recalcitrant carbon, likely reflecting the decreased quantity of soil carbon input from litter, which could weaken long-term soil C stability and trigger positive warming feedback. These results have important implications in assessing and predicting the consequences of global climate change and indicate that the removal of aboveground biomass for biofuel production may need to be reconsidered.« less

Dual-Channel Endoscopic Indocyanine Green Fluorescence Angiography for Clipping of Cerebral Aneurysms.

PubMed

Cho, Won-Sang; Kim, Jeong Eun; Kang, Hyun-Seung; Ha, Eun Jin; Jung, Minwoong; Lee, Choonghee; Shin, Il Hyung; Kang, Uk

2017-04-01

Neuroendoscopy is useful for assessing status of perforators, parent arteries, and aneurysms beyond the straight line of microscopic view during aneurysm clipping. We aimed to evaluate the clinical usefulness of our endoscopic indocyanine green angiography (ICGA) system, which can simultaneously display visible light and indocyanine green fluorescent images. Surgical clipping of 16 unruptured aneurysms in 10 patients was performed via the keyhole approach. Using our endoscopic ICGA and commercial microscopic ICGA systems, we prospectively compared 10 targeted cerebral aneurysms at the posterior communicating (n = 4) and anterior choroidal (n = 6) arteries. Microscopic ICGA and endoscopic ICGA were feasible during surgery. Microscopic ICGA displayed 50% of branch orifices, 100% of branch trunks, and 20% of exact clip positions, whereas endoscopic ICGA showed 100% of these. Based on endoscopic ICGA findings such as incomplete clipping and compromise of parent arteries or branches, clips were repositioned in 2 cases, and additional clips were applied in 2 cases. Complete occlusion and residual neck states were achieved in 6 and 4 aneurysms after surgery. There were no neurologic deficits within 3 months after surgery except for frontalis palsy and anosmia in each patient. The endoscopic ICGA system with dual imaging of visible light and indocyanine green fluorescence was very useful for assessing geometry of aneurysms and surrounding vessels before clipping and for evaluating completeness of clip position after clipping. Copyright © 2017 Elsevier Inc. All rights reserved.

Neural correlates of emotional regulation while viewing films.

PubMed

Shimamura, Arthur P; Marian, Diane E; Haskins, Andrew L

2013-03-01

Negative and arousal-inducing film clips were used to assess the neural correlates of emotional expression and suppression. Compared to viewing neutral clips, both negative (disgusting) and arousal (action) clips activated primarily posterior regions in the parietal and occipital cortex when participants were instructed to express their emotions. When instructed to suppress their emotions while viewing negative clips, a broad frontoparietal network was activated that included lateral, medial, and orbital regions in the prefrontal cortex as well as lateral and medial regions of the posterior parietal cortex. The suppression of arousal clips also activated prefrontal and parietal regions, though not to the same extent as the suppression of negative clips. The findings demonstrate the potency of using movies to engage emotional processes and highlight a broad frontoparietal network that is engaged during the suppression of negative film clips.

IDENTIFICATION BADGE WITH DETACHABLE CLIP

DOEpatents

Burns, M.T.

1962-09-18

The clip has a long slot with a round enlarged end, flat on one side. The badge has a headed member that is circular except for a flat side. The badge is connected to, or disconnected from, the clip by insertion of the headed member through the enlarged end of the slot in the clip. The badge is unlikely to be accidentally disconnected from the clip while being worn on a worker's clothing, because the weight of the badge keeps the headed member away from the enlarged end of the slot in the clip, and the headed member can pass through the enlarged end of the slot only at one relative angular position between badge and clip, namely, that angle at which the flat side of the headed member is coincident with the flat side of the enlarged end of the slot. (AEC)

Sex Differences in Emotional Evaluation of Film Clips: Interaction with Five High Arousal Emotional Categories

PubMed Central

Maffei, Antonio; Vencato, Valentina; Angrilli, Alessandro

2015-01-01

The present study aimed to investigate gender differences in the emotional evaluation of 18 film clips divided into six categories: Erotic, Scenery, Neutral, Sadness, Compassion, and Fear. 41 female and 40 male students rated all clips for valence-pleasantness, arousal, level of elicited distress, anxiety, jittery feelings, excitation, and embarrassment. Analysis of positive films revealed higher levels of arousal, pleasantness, and excitation to the Scenery clips in both genders, but lower pleasantness and greater embarrassment in women compared to men to Erotic clips. Concerning unpleasant stimuli, unlike men, women reported more unpleasantness to the Compassion, Sadness, and Fear compared to the Neutral clips and rated them also as more arousing than did men. They further differentiated the films by perceiving greater arousal to Fear than to Compassion clips. Women rated the Sadness and Fear clips with greater Distress and Jittery feelings than men did. Correlation analysis between arousal and the other emotional scales revealed that, although men looked less aroused than women to all unpleasant clips, they also showed a larger variance in their emotional responses as indicated by the high number of correlations and their relatively greater extent, an outcome pointing to a masked larger sensitivity of part of male sample to emotional clips. We propose a new perspective in which gender difference in emotional responses can be better evidenced by means of film clips selected and clustered in more homogeneous categories, controlled for arousal levels, as well as evaluated through a number of emotion focused adjectives. PMID:26717488

21 CFR 882.4215 - Clip rack.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Clip rack. 882.4215 Section 882.4215 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4215 Clip rack. (a) Identification. A clip rack is a...

21 CFR 882.4150 - Scalp clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Scalp clip. 882.4150 Section 882.4150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4150 Scalp clip. (a) Identification. A scalp clip is a...

21 CFR 882.4150 - Scalp clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Scalp clip. 882.4150 Section 882.4150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4150 Scalp clip. (a) Identification. A scalp clip is a...

21 CFR 886.1410 - Ophthalmic trial lens clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ophthalmic trial lens clip. 886.1410 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1410 Ophthalmic trial lens clip. (a) Identification. An ophthalmic trial lens clip is a device intended to hold prisms, spheres, cylinders, or...

21 CFR 882.4215 - Clip rack.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Clip rack. 882.4215 Section 882.4215 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4215 Clip rack. (a) Identification. A clip rack is a...

21 CFR 882.4175 - Aneurysm clip applier.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying intracranial...

21 CFR 882.5200 - Aneurysm clip.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood vessel...

21 CFR 882.4175 - Aneurysm clip applier.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying intracranial...

21 CFR 882.5200 - Aneurysm clip.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood vessel...

21 CFR 882.5200 - Aneurysm clip.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and... NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm clip is a device used to occlude an intracranial aneurysm (a balloonlike sac formed on a blood vessel...

21 CFR 882.4175 - Aneurysm clip applier.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a) Identification. An aneurysm clip applier is a device used by the surgeon for holding and applying intracranial...

Atorvastatin and sildenafil decrease vascular TGF-β levels and MMP-2 activity and ameliorate arterial remodeling in a model of renovascular hypertension

PubMed Central

Guimarães, Danielle A.; Rizzi, Elen; Ceron, Carla S.; Martins-Oliveira, Alisson; Gerlach, Raquel F.; Shiva, Sruti; Tanus-Santos, Jose E.

2015-01-01

Imbalanced matrix metalloproteinase (MMP)-2 activity and transforming growth factor expression (TGF-β) are involved in vascular remodeling of hypertension. Atorvastatin and sildenafil exert antioxidant and pleiotropic effects that may result in cardiovascular protection. We hypothesized that atorvastatin and sildenafil alone or in association exert antiproliferative effects by down-regulating MMP-2 and TGF-β, thus reducing the vascular hypertrophy induced by two kidney, one clip (2K1C) hypertension. Sham and 2K1C rats were treated with oral atorvastatin 50 mg/kg, sildenafil 45 mg/kg, or both, daily for 8 weeks. Blood pressure was monitored weekly. Morphologic changes in the aortas were studied. TGF-β levels were determined by immunofluorescence. MMP-2 activity and expression were determined by in situ zymography, gel zymography, Western blotting, and immunofluorescence. The effects of both drugs on proliferative responses of aortic smooth muscle cells to PDGF and on on MMP-2 activity in vitro were determined. Atorvastatin, sildenafil, or both drugs exerted antiproliferative effects in vitro. All treatments attenuated 2K1C-induced hypertension and prevented the increases in the aortic cross-sectional area and media/lumen ratio in 2K1C rats. Aortas from 2K1C rats showed higher collagen deposition, TGF-β levels and MMP-2 activity and expression when compared with Sham-operated animals. Treatment with atorvastatin and/or sildenafil was associated with attenuation of 2K1C hypertension-induced increases in these pro-fibrotic factors. However, these drugs had no in vitro effects on hr-MMP-2 activity. Atorvastatin and sildenafil was associated with decreased vascular TGF-β levels and MMP-2 activity in renovascular hypertensive rats, thus ameliorating the vascular remodeling. These novel pleiotropic effects of both drugs may translate into protective effects in patients. PMID:26343345

In search of the autologous clip: a case for experimental standardization.

PubMed

Krugman, Kimberly A; Martin, Kimberly E; Cosgriff, Ned; Slakey, Douglas P

2011-10-01

In an effort to enable faster and, at times, more challenging surgeries without compromising patient or physician safety, medical device manufacturers have created myriad solutions to vascular ligation through the development of novel tools. The speed of development, FDA approval, and dissemination of these devices into the hands of surgeons often outpaces the ability of investigators to critically evaluate comparative effectiveness of these devices. The Medline database was searched for energy-based vessel ligation devices. To remove any perception bias against non-Covidien instruments, critical review was applied only to the devices manufactured by our company. We report on the variability present in published results and offer vital metrics for future studies. Standardized testing and reporting for measures of safety and efficacy of these surgical instruments awaits definition from a consensus group.

Magnetic resonance imaging of the central nervous system

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

Not Available

1988-02-26

This report reviews the current applications of magnetic resonance imaging of the central nervous system. Since its introduction into the clinical environment in the early 1980's, this technology has had a major impact on the practice of neurology. It has proved to be superior to computed tomography for imaging many diseases of the brain and spine. In some instances it has clearly replaced computed tomography. It is likely that it will replace myelography for the assessment of cervicomedullary junction and spinal regions. The magnetic field strengths currently used appear to be entirely safe for clinical application in neurology except inmore » patients with cardiac pacemakers or vascular metallic clips. Some shortcomings of magnetic resonance imaging include its expense, the time required for scanning, and poor visualization of cortical bone.« less

Extravasal occlusion of large vessels with titanic clips: efficiency, indications, and contraindications.

PubMed

Vasilenko, Yu V; Kim, A I; Kotov, S A

2002-11-01

The mechanism of extravasal occlusion of blood vessels with titanic clips "Atrauclip" and "Ligaclip extra" was studied in order to reveal indications and contraindications to their use. Occlusion with the clips of both types was ineffective in vessels with a diameter of >7.0 mm. Arteritis or the presence of an intravascular occlusion facility in the vessel were also the contraindications for clip occlusion. In overcases the procedure of occlusion with titanic clips was efficient and atraumatic.

Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis.

PubMed

Targarona, Eduardo Ma; Balague, Carmen; Marin, Juan; Neto, Rene Berindoague; Martinez, Carmen; Garriga, Jordi; Trias, Manuel

2005-12-01

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Novel Resuscitation from Lethal Hemorrhage - Suspended Animation for Delayed Resuscitation

DTIC Science & Technology

2002-09-01

para la inducci6n rApida de hipotermia leve en perros , usando un equipo simple de bomba enfriadora. Se anetesiaron superficialmente dies perros de caza...21 - 28 kg) y se pusieron en ventilaci6n mecAnica. En cinco perros , se insertaron dos cat~teres en las venas femorales, uno perif~rico y el otro hacia...gasto cardiaco). En los otros 5 perros (grvpo control) se realiz6 un enfriamiento con m6todo dlinico externo, usando alcohol sobre ]a piel del tronco

Influences of emotion on context memory while viewing film clips.

PubMed

Anderson, Lisa; Shimamura, Arthur P

2005-01-01

Participants listened to words while viewing film clips (audio off). Film clips were classified as neutral, positively valenced, negatively valenced, and arousing. Memory was assessed in three ways: recall of film content, recall of words, and context recognition. In the context recognition test, participants were presented a word and determined which film clip was showing when the word was originally presented. In two experiments, context memory performance was disrupted when words were presented during negatively valenced film clips, whereas it was enhanced when words were presented during arousing film clips. Free recall of words presented during the negatively valenced films was also disrupted. These findings suggest multiple influences of emotion on memory performance.

Tricuspid Clip: Step-by-Step and Clinical Data.

PubMed

Tang, Gilbert H L

2018-01-01

Symptomatic severe tricuspid regurgitation (TR), if untreated, carries a dismal prognosis. These patients are at very high risk for surgical repair or replacement and transcatheter options to treat TR are emerging. More than 300 transcatheter tricuspid repairs with the MitraClip system have been performed worldwide with promising results. The TriClip system, with the MitraClip NT delivered via a dedicated tricuspid steerable guide catheter, is currently under investigation. This article describes the step-by-step technique on using the MitraClip system to perform transcatheter tricuspid repair using echocardiographic and fluoroscopic guidance. The latest data on worldwide experience with tricuspid clipping are also discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

21 CFR 884.2685 - Fetal scalp clip electrode and applicator.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Monitoring Devices § 884.2685 Fetal scalp clip electrode and applicator. (a) Identification. A fetal scalp clip electrode and applicator is a device designed to establish electrical contact between fetal skin... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fetal scalp clip electrode and applicator. 884...

21 CFR 884.2685 - Fetal scalp clip electrode and applicator.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Monitoring Devices § 884.2685 Fetal scalp clip electrode and applicator. (a) Identification. A fetal scalp clip electrode and applicator is a device designed to establish electrical contact between fetal skin... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fetal scalp clip electrode and applicator. 884...

21 CFR 884.2685 - Fetal scalp clip electrode and applicator.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Monitoring Devices § 884.2685 Fetal scalp clip electrode and applicator. (a) Identification. A fetal scalp clip electrode and applicator is a device designed to establish electrical contact between fetal skin... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fetal scalp clip electrode and applicator. 884...

21 CFR 884.2685 - Fetal scalp clip electrode and applicator.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Monitoring Devices § 884.2685 Fetal scalp clip electrode and applicator. (a) Identification. A fetal scalp clip electrode and applicator is a device designed to establish electrical contact between fetal skin... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Fetal scalp clip electrode and applicator. 884...

21 CFR 884.2685 - Fetal scalp clip electrode and applicator.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Monitoring Devices § 884.2685 Fetal scalp clip electrode and applicator. (a) Identification. A fetal scalp clip electrode and applicator is a device designed to establish electrical contact between fetal skin... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fetal scalp clip electrode and applicator. 884...

The Effects of Multimodality through Storytelling Using Various Movie Clips

ERIC Educational Resources Information Center

Kim, SoHee

2016-01-01

This study examines the salient multimodal approaches for communicative competence and learners' reactions through storytelling tasks with three different modes: a silent movie clip, a movie clip with only sound effects, and a movie clip with sound effects and dialogue. In order to measure different multimodal effects and to define better delivery…

Structural changes in the human vas deferens after tantalum clip occlusion and conventional vasectomy.

PubMed

Kothari, L K; Gupta, A S

1978-02-01

In 15 human subjects, the vasa deferentia were occluded by applying two tantalum clips on one side and by conventional vasectomy with silk ligatures on the other. After 2 weeks, the occluded segments were recovered for histopathologic examination of serial sections. Obstructing the seminal tract did not, as such, produce any significant change in the vas: the distal and proximal segments appeared to be essentially similar and normal. At the actual site of occlusion, however, tantalum clips produced marked flattening of the tube, complete loss of lining epithelium, distortion of the muscular lamellae, and areas of hemorrhage. The lumen was converted into a narrow slit. Under the ligatures, the damage was largely confined to denudation of the mucosal epithelium. The mucosa of the intersegment left unexcised between two clips showed hyalinization, invasion by macrophages, and degeneration of the epithelium. The changes under the clips suggest that, although clip occlusion may offer several advantages, sterility cannot be reversed merely by removing the clips. The mechanisms of these changes, different in the case of clips and ligatures, are discussed and some possible long-term consequences are considered.

Application of Micromirror in Microsurgical Clipping to the Intracranial Aneurysms.

PubMed

Zhao, Chao; Ma, Zhiguo; Zhang, Yuhai; Mou, Shanling; Yang, Yunxue; Yang, Yonglin; Sun, Guoqing; Yao, Weicheng

2018-05-01

The aim of the study was to explore the values and disadvantages of micromirror in the intracranial aneurysm clipping surgery. Micromirror was used to assist microsurgical clipping to 36 intracranial aneurysms in 31 patients, of which 3 were carotid-ophthalmic artery aneurysms, 3 were anterior choroidal artery aneurysms, 11 were posterior communicating artery aneurysms, 7 were middle cerebral artery aneurysms, 10 were anterior communicating artery or anterior cerebral artery aneurysms, and the rest were a posterior cerebral artery aneurysm and a posterior inferior cerebellar artery aneurysm. The micromirror was used before and after clipping to observe the anatomic features of necks hidden behind and medial to aneurysms, to visualize surrounding neurovascular structures, and to verify the optimal clipping position. Intraoperative indocyanine green fluorescein angiography, postoperative computerized tomography angiography, and digital subtraction angiography confirmed the success of sufficient clipping. Intraoperative indocyanine green angiography, postoperative computerized tomography angiography , or digital subtraction angiography were performed and showed no case of wrong or insufficient clipping of aneurysm. Micromirror-assisted microsurgical clipping to the intracranial aneurysm is safe, sufficient, convenient, and practical.

Urinary corticosterone responses to capture and toe-clipping in the cane toad (Rhinella marina) indicate that toe-clipping is a stressor for amphibians.

PubMed

Narayan, Edward J; Molinia, Frank C; Kindermann, Christina; Cockrem, John F; Hero, Jean-Marc

2011-11-01

Toe-clipping, the removal of one or more toes, is a common method used to individually mark free-living animals. Whilst this method is widely used in studies of amphibians, the appropriateness of the method, and its potential detrimental effects have been the subject of debate. Here, we provide for the first time, evidence that toe-clipping is a stressor in a wild amphibian. We measured urinary corticosterone responses of male cane toads (Rhinella marina) to capture and handling only, and to toe-clipping under field conditions. Urinary testosterone concentrations and white blood cell proportions were also measured. Urinary corticosterone metabolite concentrations increased 6h after capture and handling only and remained high for 24h; corticosterone returned to baseline levels after 48 h and remained low at 72 h post capture and handling. Corticosterone concentrations in toads subjected to toe-clipping increased at 6h to significantly higher concentrations than after capture and handling only, then decreased more slowly than after capture and handling, and were still elevated (approximately double basal level) 72 h after toe-clipping. Testosterone did not change significantly after capture and handling only, whereas after toe-clipping testosterone decreased at 6h and remained low at 72 h. There were weak short-term effects of toe-clipping compared with capture and handling only on white blood cell proportions. We have clearly shown that toe-clipping is a distinctly stronger stressor than capture and handling alone. This indicates that there is an ethical cost of toe-clipping, and this should be considered when planning studies of amphibians. Copyright © 2011 Elsevier Inc. All rights reserved.

Image quality and artefact generation post-cerebral aneurysm clipping using a 64-row multislice computer tomography angiography (MSCTA) technology: A retrospective study and review of the literature.

PubMed

Zachenhofer, Iris; Cejna, Manfred; Schuster, Antonius; Donat, Markus; Roessler, Karl

2010-06-01

Computed tomography angiography (CTA) is a time and cost saving investigation for postoperative evaluation of clipped cerebral aneurysm patients. A retrospective study was conducted to analyse image quality and artefact generation due to implanted aneurysm clips using a new technology. MSCTA was performed pre- and postoperatively using a Philips Brilliance 64-detector-row CT scanner. Altogether, 32 clipping sites were analysed in 27 patients (11 female and 16 male, mean ages 52a, from 24 to 72 years). Clip number per aneurysm was 2.3 mean (from 1 to 4), 54 clips were made of titanium alloy and 5 of cobalt alloy. Altogether, image quality was rated 1.8 mean, using a scale from 1 (very good) to 5 (unserviceable) and clip artefacts were rated 2.4 mean, using a 5 point rating scale (1 no artefacts, 5 unserviceable due to artefacts). A significant loss of image quality and rise of artefacts was found when using cobalt alloy clips (1.4 versus 4.2 and 2.1 versus 4.0). In 72% of all investigations, an excellent image quality was found. Excluding the cobalt clip group, 85% of scans showed excellent image quality. Artefacts were absent or minimal (grade 1 or 2) in 69% of all investigations and in 81% in the pure titanium clip group. In 64-row MSCTA of good image quality with low artefacts, it was possible to detect small aneurysm remnants of 2mm size in individual patients. By using titanium alloy clips, in our study up to 85% of postoperative CTA images were of excellent quality with absent or minimal artefacts in 81% and seem adequate to detect small aneurysm remnants. Copyright 2010 Elsevier B.V. All rights reserved.

Annual Removal of Aboveground Plant Biomass Alters Soil Microbial Responses to Warming

PubMed Central

Xue, Kai; Yuan, Mengting M.; Xie, Jianping; Li, Dejun; Qin, Yujia; Wu, Liyou; Deng, Ye; He, Zhili; Van Nostrand, Joy D.; Luo, Yiqi; Tiedje, James M.

2016-01-01

ABSTRACT Clipping (i.e., harvesting aboveground plant biomass) is common in agriculture and for bioenergy production. However, microbial responses to clipping in the context of climate warming are poorly understood. We investigated the interactive effects of grassland warming and clipping on soil properties and plant and microbial communities, in particular, on microbial functional genes. Clipping alone did not change the plant biomass production, but warming and clipping combined increased the C4 peak biomass by 47% and belowground net primary production by 110%. Clipping alone and in combination with warming decreased the soil carbon input from litter by 81% and 75%, respectively. With less carbon input, the abundances of genes involved in degrading relatively recalcitrant carbon increased by 38% to 137% in response to either clipping or the combined treatment, which could weaken long-term soil carbon stability and trigger positive feedback with respect to warming. Clipping alone also increased the abundance of genes for nitrogen fixation, mineralization, and denitrification by 32% to 39%. Such potentially stimulated nitrogen fixation could help compensate for the 20% decline in soil ammonium levels caused by clipping alone and could contribute to unchanged plant biomass levels. Moreover, clipping tended to interact antagonistically with warming, especially with respect to effects on nitrogen cycling genes, demonstrating that single-factor studies cannot predict multifactorial changes. These results revealed that clipping alone or in combination with warming altered soil and plant properties as well as the abundance and structure of soil microbial functional genes. Aboveground biomass removal for biofuel production needs to be reconsidered, as the long-term soil carbon stability may be weakened. PMID:27677789

Practical Use of the Extended No Action Level (eNAL) Correction Protocol for Breast Cancer Patients With Implanted Surgical Clips

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

Penninkhof, Joan, E-mail: j.penninkhof@erasmusmc.nl; Quint, Sandra; Baaijens, Margreet

Purpose: To describe the practical use of the extended No Action Level (eNAL) setup correction protocol for breast cancer patients with surgical clips and evaluate its impact on the setup accuracy of both tumor bed and whole breast during simultaneously integrated boost treatments. Methods and Materials: For 80 patients, two orthogonal planar kilovoltage images and one megavoltage image (for the mediolateral beam) were acquired per fraction throughout the radiotherapy course. For setup correction, the eNAL protocol was applied, based on registration of surgical clips in the lumpectomy cavity. Differences with respect to application of a No Action Level (NAL) protocolmore » or no protocol were quantified for tumor bed and whole breast. The correlation between clip migration during the fractionated treatment and either the method of surgery or the time elapsed from last surgery was investigated. Results: The distance of the clips to their center of mass (COM), averaged over all clips and patients, was reduced by 0.9 {+-} 1.2 mm (mean {+-} 1 SD). Clip migration was similar between the group of patients starting treatment within 100 days after surgery (median, 53 days) and the group starting afterward (median, 163 days) (p = 0.20). Clip migration after conventional breast surgery (closing the breast superficially) or after lumpectomy with partial breast reconstructive techniques (sutured cavity). was not significantly different either (p = 0.22). Application of eNAL on clips resulted in residual systematic errors for the clips' COM of less than 1 mm in each direction, whereas the setup of the breast was within about 2 mm of accuracy. Conclusions: Surgical clips can be safely used for high-accuracy position verification and correction. Given compensation for time trends in the clips' COM throughout the treatment course, eNAL resulted in better setup accuracies for both tumor bed and whole breast than NAL.« less

The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes.

PubMed

Woodford, Evangeline; Brown, Julie; Bilston, Lynne E

2018-05-19

Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age. Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury. Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips. Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.

Prophylactic clipping for the prevention of bleeding following wide-field endoscopic mucosal resection of laterally spreading colorectal lesions: an economic modeling study.

PubMed

Bahin, Farzan F; Rasouli, Khalid N; Williams, Stephen J; Lee, Eric Y T; Bourke, Michael J

2016-08-01

Clinically significant bleeding (CSPEB) is the most common adverse event following endoscopic mucosal resection (EMR) of large sessile and laterally spreading colorectal lesions (LSLs), and is associated with morbidity and resource utilization. CSPEB occurs more frequently with proximal LSLs. Prophylactic clipping of the post-EMR defect may be beneficial in CSPEB prevention. The aim of this study was to determine the cost-effectiveness of a prophylactic clipping strategy. We hypothesized that prophylactic clipping in the proximal colon was cost-effective. An economic model was applied to outcomes from the Australian Colonic Endoscopic Mucosal Resection (ACE) Study. Clip distances of 3, 5, 8, and 10 mm were analyzed. The cost of treating CSPEB was determined from an independent costing agency. The funds needed to spend (FNS) was the cost incurred in order to prevent one episode of CSPEB. A break-even analysis was performed to determine cost equivalence of the costs of clipping and CSPEB. Outcomes of 1717 LSLs (mean size 35.8 mm; 52.6 % proximal colon) that underwent EMR were analyzed. The overall rate of CSPEB was 6.4 % (proximal 8.9 %; distal 3.7 %). Endoscopic management was required in 45 % of CSPEB episodes. With a clip distance of 3 mm, the expected cost of prophylactic clipping was € 1106 per lesion compared with € 157 per lesion for the expected cost of CSPEB without clipping. At 100 % clipping efficacy, the FNS was € 14 826 (proximal and distal lesions € 9309 and € 29 540, respectively). A clip price of € 10.35 was required for the cost of clipping to offset the cost of CSPEB. A prophylactic clipping strategy is not cost-effective and at present cannot be justified for all lesions or selectively for lesions in the proximal colon. ClinicalTrials.gov (NCT01368289). © Georg Thieme Verlag KG Stuttgart · New York.

Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting.

PubMed

Kato, Masayuki; Jung, Yunho; Gromski, Mark A; Chuttani, Ram; Matthes, Kai

2012-01-01

Recently, endoscopic clip application devices have undergone redesign and improvements to optimize their clinical use and effectiveness. Initially designed for the treatment of bleeding nonvariceal lesions, these devices are also increasingly used for the closure of perforations, fistulas, and anastomotic leaks. Several clinical studies, both randomized and nonrandomized, have used endoscopic hemoclips for hemostasis. However, no comparative studies have yet been reported in the literature comparing the latest endoscopic clip devices for usability and effectiveness for hemostasis of acute upper GI hemorrhage. We aimed to compare the usability and efficacy of 3 different types of endoscopic clip application devices in an established experimental setting by using a porcine ex-vivo simulator of upper GI hemorrhage. Randomized, controlled, ex-vivo study. Academic medical center. Spurting vessels were created within ex-vivo porcine stomachs as published in prior studies. The vessels were attached to a pressure transducer to record the pressure of the circulating blood replacement. Before the initiation of bleeding, each vessel was randomized to 1 of 3 endoscopic clipping devices: 2 different commonly used hemoclips deployed through the working channel and 1 novel clip deployed via an over-the-scope applications device. Two investigators treated 45 bleeding sites (15 bleeding sites for each device at various randomized locations in the stomach: fundus, body, and antrum). Usability was measured via the endpoints of procedure time and quantity of clips required to achieve hemostasis. Efficacy was measured via the endpoint of pressure increase (Δp) from baseline to after treatment. All of the 45 hemostasis treatments were carried out successfully. The mean procedure times were significantly different among the hemoclips, with the clip deployed in an over-the-scope fashion requiring significantly less time to attain hemostasis compared with the other 2 clips. For number of clips needed to attain hemostasis, the clip deployed in an over-the-scope fashion was significantly superior to the others. There were also significant differences among the changes in pressure (Δp ± SD) among the different hemoclips tested. Ex-vivo study. In this prospective, randomized ex-vivo study, we observed significant differences in the usability (time to achieve hemostasis and number of clips required) and the efficacy (change in pressure achieved by the hemoclips) among the 3 clips. The clip applied in the over-the-scope fashion was superior to the other 2 tested clips with regard to time to achieve hemostasis and number of clips required. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

76 FR 31360 - Paper Clips From China; Scheduling of an Expedited Five-Year Review Concerning the Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... INTERNATIONAL TRADE COMMISSION [Investigation No. 731-TA-663 Third Review] Paper Clips From China; Scheduling of an Expedited Five-Year Review Concerning the Antidumping Duty Order on Paper Clips From China... paper clips from China would be likely to lead to continuation or recurrence of material injury within a...

76 FR 44575 - Paper Clips From the People's Republic of China: Continuation of the Antidumping Duty Order

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-826] Paper Clips From the People... the antidumping duty order on paper clips from the People's Republic of China (``PRC'') would likely... of the antidumping duty order on paper clips from the PRC pursuant to section 751(c) of the Tariff...

78 FR 78319 - Media Bureau Seeks Comment on Application of the IP Closed Captioning Rules to Video Clips

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Seeks Comment on Application of the IP Closed Captioning Rules to Video Clips AGENCY: Federal... captioning of video clips delivered by Internet protocol (``IP''), including the extent to which industry has voluntarily captioned IP- delivered video clips. The Commission directed the Media Bureau to issue this...

Integrating an object system into CLIPS: Language design and implementation issues

NASA Technical Reports Server (NTRS)

Auburn, Mark

1990-01-01

This paper describes the reasons why an object system with integrated pattern-matching and object-oriented programming facilities is desirable for CLIPS and how it is possible to integrate such a system into CLIPS while maintaining the run-time performance and the low memory usage for which CLIPS is known. The requirements for an object system in CLIPS that includes object-oriented programming and integrated pattern-matching are discussed and various techniques for optimizing the object system and its integration with the pattern-matcher are presented.

CLIPS: A tool for the development and delivery of expert systems

NASA Technical Reports Server (NTRS)

Riley, Gary

1991-01-01

The C Language Integrated Production System (CLIPS) is a forward chaining rule-based language developed by the Software Technology Branch at the Johnson Space Center. CLIPS provides a complete environment for the construction of rule-based expert systems. CLIPS was designed specifically to provide high probability, low cost, and easy integration with external systems. Other key features of CLIPS include a powerful rule syntax, an interactive development environment, high performance, extensibility, a verification/validation tool, extensive documentation, and source code availability. The current release of CLIPS, version 4.3, is being used by over 2,500 users throughout the public and private community including: all NASA sites and branches of the military, numerous Federal bureaus, government contractors, 140 universities, and many companies.

Segmental liver resection assisted by HIFU: tissue precauterization using a toroidal-shaped HIFU transducer

NASA Astrophysics Data System (ADS)

N'Djin, W. A.; Melodelima, D.; Schenone, F.; Rivoire, M.; Chapelon, J. Y.

2010-03-01

The development of new cauterization techniques for hepatic resection is critical for improving the safety of the procedure. Previous studies showed the feasibility of using HIFU or radiofrequency precoagulation to limit blood loss during dissection of the organ. Here we report a new therapeutic modality using high intensity focused ultrasound (HIFU) to perform a bloodless hepatic resection that could represent a promising alternative. A comparative study was performed to evaluate the interest of using this complementary tool to improve surgical resection in the liver. This study used a 3 MHz HIFU toroidal-shaped phased array transducer which allows the generation of a single conical lesion of 7 cm3 in 40 seconds. In order to minimize blood loss and dissection time, a barrier of coagulative necrosis was generated with the HIFU device before hepatectomy, by juxtaposing single conical lesions on the line of dissection. Resection assisted by HIFU (RA-HIFU) was compared with classical dissections with clamping (RC) and without clamping (Control). For each technique 14 partial liver resections were performed in seven pigs. The parameters examined were vascular control and times of treatment. Precoagulation allowed the vascular isolation of small vessels and surgical clips were mainly used for the control of vessels>5 mm in diameter. The number of clips used per unit of liver surface dissected in RA-HIFU (0.8±0.3 cm-2) was significantly lower than in the other groups (RC: 1.6±0.4 cm-2, Control: 1.8±0.8 cm-2, p<0.01). In addition, blood loss was lower in RA-HIFU (7.4±6.5 ml.cm-2) than in RC (11.2±4.5 ml.cm-2) and Control (14.0±6.7 ml.cm-2). The time of dissection in RA-HIFU (13±5 min) was shorter than in RC (23±8 minutes) and Control (18±5 minutes). The feasibility and the efficiency of RA-HIFU using a toroidal-shaped HIFU transducer without additional devices were demonstrated. This technique enhances the resection procedure and will be able to be tested in clinic.

Virtual Cerebral Aneurysm Clipping with Real-Time Haptic Force Feedback in Neurosurgical Education.

PubMed

Gmeiner, Matthias; Dirnberger, Johannes; Fenz, Wolfgang; Gollwitzer, Maria; Wurm, Gabriele; Trenkler, Johannes; Gruber, Andreas

2018-04-01

Realistic, safe, and efficient modalities for simulation-based training are highly warranted to enhance the quality of surgical education, and they should be incorporated in resident training. The aim of this study was to develop a patient-specific virtual cerebral aneurysm-clipping simulator with haptic force feedback and real-time deformation of the aneurysm and vessels. A prototype simulator was developed from 2012 to 2016. Evaluation of virtual clipping by blood flow simulation was integrated in this software, and the prototype was evaluated by 18 neurosurgeons. In 4 patients with different medial cerebral artery aneurysms, virtual clipping was performed after real-life surgery, and surgical results were compared regarding clip application, surgical trajectory, and blood flow. After head positioning and craniotomy, bimanual virtual aneurysm clipping with an original forceps was performed. Blood flow simulation demonstrated residual aneurysm filling or branch stenosis. The simulator improved anatomic understanding for 89% of neurosurgeons. Simulation of head positioning and craniotomy was considered realistic by 89% and 94% of users, respectively. Most participants agreed that this simulator should be integrated into neurosurgical education (94%). Our illustrative cases demonstrated that virtual aneurysm surgery was possible using the same trajectory as in real-life cases. Both virtual clipping and blood flow simulation were realistic in broad-based but not calcified aneurysms. Virtual clipping of a calcified aneurysm could be performed using the same surgical trajectory, but not the same clip type. We have successfully developed a virtual aneurysm-clipping simulator. Next, we will prospectively evaluate this device for surgical procedure planning and education. Copyright © 2018 Elsevier Inc. All rights reserved.

Energizing Staff Development Using Film Clips: Memorable Movie Moments that Promote Reflection, Conversation, and Action

ERIC Educational Resources Information Center

Olsen, Walter R.; Sommers, William A.

2005-01-01

Video and DVD clips give participants an opportunity to explore values and ideas, learn about one another, and, in the process, build a stronger learning community. "Energizing Staff Development Using Film Clips" is a collection of film and television clips that staff developers can use to encourage discussion and reflection on pertinent, common…

[Reliable fixation of cochlear implant electrode mountings in children and adults--initial experiences with a new titanium clip].

PubMed

Müller, J; Schön, F; Helms, J

1998-04-01

There is a reported 1% incidence of delayed migration of extrusions of the electrode arrays out of the cochlea. A titanium clip to fix the electrode array of the MED EL Combi 40 Cochlear Implant System is described. The clip is designed and shaped in a double U configuration. The clip material allows easy adaption to the individual anatomical situation. The clip is fixed to a bony bridge at the incus bar and fixes the electrode in a plane parallel to the chorda facial angle. It is closed around the electrode similarly to a stapes piston around the incus. Additional tests which examined the possible risk of damaging the electrode carrier and clinical findings are described. The clip was used in 23 cases with a follow-up period up to 1 year. No signs for dislocation of the electrode were found. In one revision case the clip was covered with a thin mucosal layer. The electrode array showed no signs of damage. Intraoperative findings confirmed the experimental tests on the electrode fixation. The titanium clip facilitates safe and quick fixation of the electrode array and prevents dislocation. its flexibility and shape minimizes the risk of damage.

Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips

PubMed Central

Schulz-Wendtland, R.; Dankerl, P.; Dilbat, G.; Bani, M.; Fasching, P. A.; Heusinger, K.; Lux, M. P.; Loehberg, C. R.; Jud, S. M.; Rauh, C.; Bayer, C. M.; Beckmann, M. W.; Wachter, D. L.; Uder, M.; Meier-Meitinger, M.; Brehm, B.

2015-01-01

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography. PMID:25684789

A defect in the CLIP1 gene (CLIP-170) can cause autosomal recessive intellectual disability.

PubMed

Larti, Farzaneh; Kahrizi, Kimia; Musante, Luciana; Hu, Hao; Papari, Elahe; Fattahi, Zohreh; Bazazzadegan, Niloofar; Liu, Zhe; Banan, Mehdi; Garshasbi, Masoud; Wienker, Thomas F; Ropers, H Hilger; Galjart, Niels; Najmabadi, Hossein

2015-03-01

In the context of a comprehensive research project, investigating novel autosomal recessive intellectual disability (ARID) genes, linkage analysis based on autozygosity mapping helped identify an intellectual disability locus on Chr.12q24, in an Iranian family (LOD score = 3.7). Next-generation sequencing (NGS) following exon enrichment in this novel interval, detected a nonsense mutation (p.Q1010*) in the CLIP1 gene. CLIP1 encodes a member of microtubule (MT) plus-end tracking proteins, which specifically associates with the ends of growing MTs. These proteins regulate MT dynamic behavior and are important for MT-mediated transport over the length of axons and dendrites. As such, CLIP1 may have a role in neuronal development. We studied lymphoblastoid and skin fibroblast cell lines established from healthy and affected patients. RT-PCR and western blot analyses showed the absence of CLIP1 transcript and protein in lymphoblastoid cells derived from affected patients. Furthermore, immunofluorescence analyses showed MT plus-end staining only in fibroblasts containing the wild-type (and not the mutant) CLIP1 protein. Collectively, our data suggest that defects in CLIP1 may lead to ARID.

A defect in the CLIP1 gene (CLIP-170) can cause autosomal recessive intellectual disability

PubMed Central

Larti, Farzaneh; Kahrizi, Kimia; Musante, Luciana; Hu, Hao; Papari, Elahe; Fattahi, Zohreh; Bazazzadegan, Niloofar; Liu, Zhe; Banan, Mehdi; Garshasbi, Masoud; Wienker, Thomas F; Ropers, H Hilger; Galjart, Niels; Najmabadi, Hossein

2015-01-01

In the context of a comprehensive research project, investigating novel autosomal recessive intellectual disability (ARID) genes, linkage analysis based on autozygosity mapping helped identify an intellectual disability locus on Chr.12q24, in an Iranian family (LOD score=3.7). Next-generation sequencing (NGS) following exon enrichment in this novel interval, detected a nonsense mutation (p.Q1010*) in the CLIP1 gene. CLIP1 encodes a member of microtubule (MT) plus-end tracking proteins, which specifically associates with the ends of growing MTs. These proteins regulate MT dynamic behavior and are important for MT-mediated transport over the length of axons and dendrites. As such, CLIP1 may have a role in neuronal development. We studied lymphoblastoid and skin fibroblast cell lines established from healthy and affected patients. RT-PCR and western blot analyses showed the absence of CLIP1 transcript and protein in lymphoblastoid cells derived from affected patients. Furthermore, immunofluorescence analyses showed MT plus-end staining only in fibroblasts containing the wild-type (and not the mutant) CLIP1 protein. Collectively, our data suggest that defects in CLIP1 may lead to ARID. PMID:24569606

Preoperative computed tomography-guided percutaneous hookwire localization of metallic marker clips in the breast with a radial approach: initial experience.

PubMed

Uematsu, T; Kasami, M; Uchida, Y; Sanuki, J; Kimura, K; Tanaka, K; Takahashi, K

2007-06-01

Hookwire localization is the current standard technique for radiological marking of nonpalpable breast lesions. Stereotactic directional vacuum-assisted breast biopsy (SVAB) is of sufficient sensitivity and specificity to replace surgical biopsy. Wire localization for metallic marker clips placed after SVAB is needed. To describe a method for performing computed tomography (CT)-guided hookwire localization using a radial approach for metallic marker clips placed percutaneously after SVAB. Nineteen women scheduled for SVAB with marker-clip placement, CT-guided wire localization of marker clips, and, eventually, surgical excision were prospectively entered into the study. CT-guided wire localization was performed with a radial approach, followed by placement of a localizing marker-clip surgical excision. Feasibility and reliability of the procedure and the incidence of complications were examined. CT-guided wire localization surgical excision was successfully performed in all 19 women without any complications. The mean total procedure time was 15 min. The median distance on CT image from marker clip to hookwire was 2 mm (range 0-3 mm). CT-guided preoperative hookwire localization with a radial approach for marker clips after SVAB is technically feasible.

The Emotional Movie Database (EMDB): a self-report and psychophysiological study.

PubMed

Carvalho, Sandra; Leite, Jorge; Galdo-Álvarez, Santiago; Gonçalves, Oscar F

2012-12-01

Film clips are an important tool for evoking emotional responses in the laboratory. When compared with other emotionally potent visual stimuli (e.g., pictures), film clips seem to be more effective in eliciting emotions for longer periods of time at both the subjective and physiological levels. The main objective of the present study was to develop a new database of affective film clips without auditory content, based on a dimensional approach to emotional stimuli (valence, arousal and dominance). The study had three different phases: (1) the pre-selection and editing of 52 film clips (2) the self-report rating of these film clips by a sample of 113 participants and (3) psychophysiological assessment [skin conductance level (SCL) and the heart rate (HR)] on 32 volunteers. Film clips from different categories were selected to elicit emotional states from different quadrants of affective space. The results also showed that sustained exposure to the affective film clips resulted in a pattern of a SCL increase and HR deceleration in high arousal conditions (i.e., horror and erotic conditions). The resulting emotional movie database can reliably be used in research requiring the presentation of non-auditory film clips with different ratings of valence, arousal and dominance.

The effect of positive and negative movie alcohol portrayals on transportation and attitude toward the movie.

PubMed

Koordeman, Renske; Anschutz, Doeschka J; Engels, Rutger C M E

2014-07-01

This study examined the effects of alcohol portrayals on transportation and attitude toward a movie. In addition, we examined whether positive and negative movie alcohol portrayals affect transportation into and attitude toward the movie. A within-subject design was used in which participants were exposed to 8 different movie clips containing alcohol (positive or negative context) or no alcohol portrayals in a controlled laboratory setting. A total of 159 college students (84 males and 75 females) ages 18 to 30 participated in the experiment. Transportation and attitude toward the movie were measured after each movie clip. Participants were more transported into and had a more positive attitude toward movie clips with alcohol portrayals compared to the same movie clips with no alcohol portrayal. In addition, participants were more transported into movie clips with negative alcohol (NA) portrayals compared to clips with positive alcohol (PA) portrayals. For attitude toward the movie, opposite results were found. Participants had a more positive attitudes toward clips with PA portrayals compared to clips with NA portrayals. The way alcohol is portrayed in movies may contribute to how people evaluate and get transported in movies. Copyright © 2014 by the Research Society on Alcoholism.

PCLIPS: Parallel CLIPS

NASA Technical Reports Server (NTRS)

Hall, Lawrence O.; Bennett, Bonnie H.; Tello, Ivan

1994-01-01

A parallel version of CLIPS 5.1 has been developed to run on Intel Hypercubes. The user interface is the same as that for CLIPS with some added commands to allow for parallel calls. A complete version of CLIPS runs on each node of the hypercube. The system has been instrumented to display the time spent in the match, recognize, and act cycles on each node. Only rule-level parallelism is supported. Parallel commands enable the assertion and retraction of facts to/from remote nodes working memory. Parallel CLIPS was used to implement a knowledge-based command, control, communications, and intelligence (C(sup 3)I) system to demonstrate the fusion of high-level, disparate sources. We discuss the nature of the information fusion problem, our approach, and implementation. Parallel CLIPS has also be used to run several benchmark parallel knowledge bases such as one to set up a cafeteria. Results show from running Parallel CLIPS with parallel knowledge base partitions indicate that significant speed increases, including superlinear in some cases, are possible.

Short term exposure to attractive and muscular singers in music video clips negatively affects men's body image and mood.

PubMed

Mulgrew, K E; Volcevski-Kostas, D

2012-09-01

Viewing idealized images has been shown to reduce men's body satisfaction; however no research has examined the impact of music video clips. This was the first study to examine the effects of exposure to muscular images in music clips on men's body image, mood and cognitions. Ninety men viewed 5 min of clips containing scenery, muscular or average-looking singers, and completed pre- and posttest measures of mood and body image. Appearance schema activation was also measured. Men exposed to the muscular clips showed poorer posttest levels of anger, body and muscle tone satisfaction compared to men exposed to the scenery or average clips. No evidence of schema activation was found, although potential problems with the measure are noted. These preliminary findings suggest that even short term exposure to music clips can produce negative effects on men's body image and mood. Copyright © 2012 Elsevier Ltd. All rights reserved.

Virus-Clip: a fast and memory-efficient viral integration site detection tool at single-base resolution with annotation capability.

PubMed

Ho, Daniel W H; Sze, Karen M F; Ng, Irene O L

2015-08-28

Viral integration into the human genome upon infection is an important risk factor for various human malignancies. We developed viral integration site detection tool called Virus-Clip, which makes use of information extracted from soft-clipped sequencing reads to identify exact positions of human and virus breakpoints of integration events. With initial read alignment to virus reference genome and streamlined procedures, Virus-Clip delivers a simple, fast and memory-efficient solution to viral integration site detection. Moreover, it can also automatically annotate the integration events with the corresponding affected human genes. Virus-Clip has been verified using whole-transcriptome sequencing data and its detection was validated to have satisfactory sensitivity and specificity. Marked advancement in performance was detected, compared to existing tools. It is applicable to versatile types of data including whole-genome sequencing, whole-transcriptome sequencing, and targeted sequencing. Virus-Clip is available at http://web.hku.hk/~dwhho/Virus-Clip.zip.

CLIPS - C LANGUAGE INTEGRATED PRODUCTION SYSTEM (IBM PC VERSION)

NASA Technical Reports Server (NTRS)

Riley, G.

1994-01-01

The C Language Integrated Production System, CLIPS, is a shell for developing expert systems. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. The primary design goals for CLIPS are portability, efficiency, and functionality. For these reasons, the program is written in C. CLIPS meets or outperforms most micro- and minicomputer based artificial intelligence tools. CLIPS is a forward chaining rule-based language. The program contains an inference engine and a language syntax that provide a framework for the construction of an expert system. It also includes tools for debugging an application. CLIPS is based on the Rete algorithm, which enables very efficient pattern matching. The collection of conditions and actions to be taken if the conditions are met is constructed into a rule network. As facts are asserted either prior to or during a session, CLIPS pattern-matches the number of fields. Wildcards and variables are supported for both single and multiple fields. CLIPS syntax allows the inclusion of externally defined functions (outside functions which are written in a language other than CLIPS). CLIPS itself can be embedded in a program such that the expert system is available as a simple subroutine call. Advanced features found in CLIPS version 4.3 include an integrated microEMACS editor, the ability to generate C source code from a CLIPS rule base to produce a dedicated executable, binary load and save capabilities for CLIPS rule bases, and the utility program CRSV (Cross-Reference, Style, and Verification) designed to facilitate the development and maintenance of large rule bases. Five machine versions are available. Each machine version includes the source and the executable for that machine. The UNIX version includes the source and binaries for IBM RS/6000, Sun3 series, and Sun4 series computers. The UNIX, DEC VAX, and DEC RISC Workstation versions are line oriented. The PC version and the Macintosh version each contain a windowing variant of CLIPS as well as the standard line oriented version. The mouse/window interface version for the PC works with a Microsoft compatible mouse or without a mouse. This window version uses the proprietary CURSES library for the PC, but a working executable of the window version is provided. The window oriented version for the Macintosh includes a version which uses a full Macintosh-style interface, including an integrated editor. This version allows the user to observe the changing fact base and rule activations in separate windows while a CLIPS program is executing. The IBM PC version is available bundled with CLIPSITS, The CLIPS Intelligent Tutoring System for a special combined price (COS-10025). The goal of CLIPSITS is to provide the student with a tool to practice the syntax and concepts covered in the CLIPS User's Guide. It attempts to provide expert diagnosis and advice during problem solving which is typically not available without an instructor. CLIPSITS is divided into 10 lessons which mirror the first 10 chapters of the CLIPS User's Guide. The program was developed for the IBM PC series with a hard disk. CLIPSITS is also available separately as MSC-21679. The CLIPS program is written in C for interactive execution and has been implemented on an IBM PC computer operating under DOS, a Macintosh and DEC VAX series computers operating under VMS or ULTRIX. The line oriented version should run on any computer system which supports a full (Kernighan and Ritchie) C compiler or the ANSI standard C language. CLIPS was developed in 1986 and Version 4.2 was released in July of 1988. Version 4.3 was released in June of 1989.

CLIPS - C LANGUAGE INTEGRATED PRODUCTION SYSTEM (MACINTOSH VERSION)

NASA Technical Reports Server (NTRS)

Culbert, C.

1994-01-01

The C Language Integrated Production System, CLIPS, is a shell for developing expert systems. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. The primary design goals for CLIPS are portability, efficiency, and functionality. For these reasons, the program is written in C. CLIPS meets or outperforms most micro- and minicomputer based artificial intelligence tools. CLIPS is a forward chaining rule-based language. The program contains an inference engine and a language syntax that provide a framework for the construction of an expert system. It also includes tools for debugging an application. CLIPS is based on the Rete algorithm, which enables very efficient pattern matching. The collection of conditions and actions to be taken if the conditions are met is constructed into a rule network. As facts are asserted either prior to or during a session, CLIPS pattern-matches the number of fields. Wildcards and variables are supported for both single and multiple fields. CLIPS syntax allows the inclusion of externally defined functions (outside functions which are written in a language other than CLIPS). CLIPS itself can be embedded in a program such that the expert system is available as a simple subroutine call. Advanced features found in CLIPS version 4.3 include an integrated microEMACS editor, the ability to generate C source code from a CLIPS rule base to produce a dedicated executable, binary load and save capabilities for CLIPS rule bases, and the utility program CRSV (Cross-Reference, Style, and Verification) designed to facilitate the development and maintenance of large rule bases. Five machine versions are available. Each machine version includes the source and the executable for that machine. The UNIX version includes the source and binaries for IBM RS/6000, Sun3 series, and Sun4 series computers. The UNIX, DEC VAX, and DEC RISC Workstation versions are line oriented. The PC version and the Macintosh version each contain a windowing variant of CLIPS as well as the standard line oriented version. The mouse/window interface version for the PC works with a Microsoft compatible mouse or without a mouse. This window version uses the proprietary CURSES library for the PC, but a working executable of the window version is provided. The window oriented version for the Macintosh includes a version which uses a full Macintosh-style interface, including an integrated editor. This version allows the user to observe the changing fact base and rule activations in separate windows while a CLIPS program is executing. The IBM PC version is available bundled with CLIPSITS, The CLIPS Intelligent Tutoring System for a special combined price (COS-10025). The goal of CLIPSITS is to provide the student with a tool to practice the syntax and concepts covered in the CLIPS User's Guide. It attempts to provide expert diagnosis and advice during problem solving which is typically not available without an instructor. CLIPSITS is divided into 10 lessons which mirror the first 10 chapters of the CLIPS User's Guide. The program was developed for the IBM PC series with a hard disk. CLIPSITS is also available separately as MSC-21679. The CLIPS program is written in C for interactive execution and has been implemented on an IBM PC computer operating under DOS, a Macintosh and DEC VAX series computers operating under VMS or ULTRIX. The line oriented version should run on any computer system which supports a full (Kernighan and Ritchie) C compiler or the ANSI standard C language. CLIPS was developed in 1986 and Version 4.2 was released in July of 1988. Version 4.3 was released in June of 1989.

CLIPS - C LANGUAGE INTEGRATED PRODUCTION SYSTEM (IBM PC VERSION WITH CLIPSITS)

NASA Technical Reports Server (NTRS)

Riley, , .

1994-01-01

The C Language Integrated Production System, CLIPS, is a shell for developing expert systems. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. The primary design goals for CLIPS are portability, efficiency, and functionality. For these reasons, the program is written in C. CLIPS meets or outperforms most micro- and minicomputer based artificial intelligence tools. CLIPS is a forward chaining rule-based language. The program contains an inference engine and a language syntax that provide a framework for the construction of an expert system. It also includes tools for debugging an application. CLIPS is based on the Rete algorithm, which enables very efficient pattern matching. The collection of conditions and actions to be taken if the conditions are met is constructed into a rule network. As facts are asserted either prior to or during a session, CLIPS pattern-matches the number of fields. Wildcards and variables are supported for both single and multiple fields. CLIPS syntax allows the inclusion of externally defined functions (outside functions which are written in a language other than CLIPS). CLIPS itself can be embedded in a program such that the expert system is available as a simple subroutine call. Advanced features found in CLIPS version 4.3 include an integrated microEMACS editor, the ability to generate C source code from a CLIPS rule base to produce a dedicated executable, binary load and save capabilities for CLIPS rule bases, and the utility program CRSV (Cross-Reference, Style, and Verification) designed to facilitate the development and maintenance of large rule bases. Five machine versions are available. Each machine version includes the source and the executable for that machine. The UNIX version includes the source and binaries for IBM RS/6000, Sun3 series, and Sun4 series computers. The UNIX, DEC VAX, and DEC RISC Workstation versions are line oriented. The PC version and the Macintosh version each contain a windowing variant of CLIPS as well as the standard line oriented version. The mouse/window interface version for the PC works with a Microsoft compatible mouse or without a mouse. This window version uses the proprietary CURSES library for the PC, but a working executable of the window version is provided. The window oriented version for the Macintosh includes a version which uses a full Macintosh-style interface, including an integrated editor. This version allows the user to observe the changing fact base and rule activations in separate windows while a CLIPS program is executing. The IBM PC version is available bundled with CLIPSITS, The CLIPS Intelligent Tutoring System for a special combined price (COS-10025). The goal of CLIPSITS is to provide the student with a tool to practice the syntax and concepts covered in the CLIPS User's Guide. It attempts to provide expert diagnosis and advice during problem solving which is typically not available without an instructor. CLIPSITS is divided into 10 lessons which mirror the first 10 chapters of the CLIPS User's Guide. The program was developed for the IBM PC series with a hard disk. CLIPSITS is also available separately as MSC-21679. The CLIPS program is written in C for interactive execution and has been implemented on an IBM PC computer operating under DOS, a Macintosh and DEC VAX series computers operating under VMS or ULTRIX. The line oriented version should run on any computer system which supports a full (Kernighan and Ritchie) C compiler or the ANSI standard C language. CLIPS was developed in 1986 and Version 4.2 was released in July of 1988. Version 4.3 was released in June of 1989.

Apparatus for the compact cooling of modules

DOEpatents

Iyengar, Madhusudan K.; Parida, Pritish R.

2015-07-07

An apparatus for the compact cooling of modules. The apparatus includes a clip, a first cover plate coupled to a first side of the clip, a second cover plate coupled to a second side of the clip opposite to the first side of the clip, a first frame thermally coupled to the first cover plate, and a second frame thermally coupled to the second cover plate. Each of the first frame and the second frame may include a plurality of channels for passing coolant through the first frame and the second frame, respectively. Additionally, the apparatus may further include a filler for directing coolant through the plurality of channels, and for blocking coolant from flowing along the first side of the clip and the second side of the clip.

Importance of nasal clipping in screening investigations of flow volume curve.

PubMed

Yanev, I

1992-01-01

Comparative analysis of some basic lung indices obtained from a screening investigation of the flow volume curve by using two techniques, with a nose clip and without a nose clip, was made on a cohort of 86 workers in a factory shop for the production of bearings. We found no statistically significant differences between the indices obtained by the two techniques. Our study showed that the FVC and FEV1 obtained in workers without using nose clips were equal to or better than those obtained using nose clips in 60% of the workers. The reproducibility of the two methods was similar. The analysis of the data has shown that the flow volume curve investigation gives better results when performed without a nose clip, especially in industrial conditions.

CLIPS/Ada: An Ada-based tool for building expert systems

NASA Technical Reports Server (NTRS)

White, W. A.

1990-01-01

Clips/Ada is a production system language and a development environment. It is functionally equivalent to the CLIPS tool. CLIPS/Ada was developed in order to provide a means of incorporating expert system technology into projects where the use of the Ada language had been mandated. A secondary purpose was to glean information about the Ada language and its compilers. Specifically, whether or not the language and compilers were mature enough to support AI applications. The CLIPS/Ada tool is coded entirely in Ada and is designed to be used by Ada systems that require expert reasoning.

A distributed Clips implementation: dClips

NASA Technical Reports Server (NTRS)

Li, Y. Philip

1993-01-01

A distributed version of the Clips language, dClips, was implemented on top of two existing generic distributed messaging systems to show that: (1) it is easy to create a coarse-grained parallel programming environment out of an existing language if a high level messaging system is used; and (2) the computing model of a parallel programming environment can be changed easily if we change the underlying messaging system. dClips processes were first connected with a simple master-slave model. A client-server model with intercommunicating agents was later implemented. The concept of service broker is being investigated.

Abundancias químicas de ψ Octantis

NASA Astrophysics Data System (ADS)

Medina, M. C.; Pintado, O. I.

Se determinan las abundancias químicas de ψ Oct usando espectros obtenidos con EBASIM en CASLEO. Los valores iniciales de temperatura efectiva y gravedad superficial se calculan con la fotometría uvbyβ. Esta estrella fue estudiada por Pintado y Adelman (1996) usando espectros REOSC y Adelman y otros (1993), este último basado en espectros echelle obtenidos con el Telescopio Anglo Australiano. Comparamos nuestros resultados con los de los trabajos anteriormente mencionados, pudiéndose realizar una evaluación de la calidad de los espectros EBASIM.

Successful removal of football helmet face-mask clips after 1 season of use.

PubMed

Scibek, Jason S; Gatti, Joseph M; McKenzie, Jennifer I

2012-01-01

Whereas many researchers have assessed the ability to remove loop straps in traditional face-mask attachment systems after at least 1 season of use, research in which the effectiveness of the Riddell Quick Release (QR) Face Guard Attachment System clip after 1 season has been assessed is limited. To examine the success rate of removing the QR clips after 1 season of use at the Football Championship Subdivision level. We hypothesized that 1 season of use would negatively affect the removal rate of the QR clip but repeated clip-removal trials would improve the removal rate. Retrospective, quasi-experimental design. Controlled laboratory study. Sixty-three football helmets from a National Collegiate Athletic Association Division I university located in western Pennsylvania used during the 2008 season were tested. Three certified athletic trainers (2 men, 1 woman; age = 31.3 ± 3.06 years, time certified = 9.42 ± 2.65 years) attempted to remove the QR clips from each helmet with the tool provided by the manufacturer. Helmets then were reassembled to allow each athletic trainer to attempt clip removal. The dependent variables were total left clips removed (TCR-L), total right clips removed (TCR-R), and total clips removed (TCR). Success rate of clip removal (SRCR) also was assessed. Percentages for TCR-L, TCR-R, and TCR were 100% (189 of 189), 96.30% (182 of 189), and 98.15% (371 of 378), respectively. A paired-samples t test revealed a difference between TCR-R and TCR-L (t(188) = 2.689, P = .008, μ(d) = 0.037, 95% confidence interval [CI] = 0.064, 0.010). The percentage for SRCR was 96.30% (n = 182), whereas SRCR percentages for trials 1, 2, and 3 were 95.24% (n = 60), 98.41% (n = 62), and 95.24% (n = 60), respectively, and did not represent a difference (F(2,186) = 0.588, P = .56, 95% (CI) = 0.94, 0.99). Our results indicated favorable and consistent success rates for QR clip removal after 1 season of use. Whereas the QR clip is an advancement in face-mask technology, continued examination of this system is required to ensure the highest level of function, allowing for effective management of the helmeted athlete.

Successful Removal of Football Helmet Face-Mask Clips After 1 Season of Use

PubMed Central

Scibek, Jason S.; Gatti, Joseph M.; McKenzie, Jennifer I.

2012-01-01

Context Whereas many researchers have assessed the ability to remove loop straps in traditional face-mask attachment systems after at least 1 season of use, research in which the effectiveness of the Riddell Quick Release (QR) Face Guard Attachment System clip after 1 season has been assessed is limited. Objective To examine the success rate of removing the QR clips after 1 season of use at the Football Championship Subdivision level. We hypothesized that 1 season of use would negatively affect the removal rate of the QR clip but repeated clip-removal trials would improve the removal rate. Design Retrospective, quasi-experimental design. Setting Controlled laboratory study. Patients or Other Participants Sixty-three football helmets from a National Collegiate Athletic Association Division I university located in western Pennsylvania used during the 2008 season were tested. Intervention(s) Three certified athletic trainers (2 men, 1 woman; age = 31.3 ± 3.06 years, time certified = 9.42 ± 2.65 years) attempted to remove the QR clips from each helmet with the tool provided by the manufacturer. Helmets then were reassembled to allow each athletic trainer to attempt clip removal. Main Outcome Measure(s) The dependent variables were total left clips removed (TCR-L), total right clips removed (TCR-R), and total clips removed (TCR). Success rate of clip removal (SRCR) also was assessed. Results Percentages for TCR-L, TCR-R, and TCR were 100% (189 of 189), 96.30% (182 of 189), and 98.15% (371 of 378), respectively. A paired-samples t test revealed a difference between TCR-R and TCR-L (t188 = −2.689, P = .008, μd = 0.037, 95% confidence interval [CI] = −0.064, −0.010). The percentage for SRCR was 96.30% (n = 182), whereas SRCR percentages for trials 1, 2, and 3 were 95.24% (n = 60), 98.41% (n = 62), and 95.24% (n = 60), respectively, and did not represent a difference (F2,186 = 0.588, P = .56, 95% CI = 0.94, 0.99). Conclusions Our results indicated favorable and consistent success rates for QR clip removal after 1 season of use. Whereas the QR clip is an advancement in face-mask technology, continued examination of this system is required to ensure the highest level of function, allowing for effective management of the helmeted athlete. PMID:22889659

Effect of apical meristem clipping on carbon allocation and morphological development of white oak seedlings

Treesearch

Paul P. Kormanik; Shi-Jean S. Sung; T.L. Kormanik; Stanley J. Zarnoch

1994-01-01

Seedlings from three open-pollinated half-sib white oak seedlots were clipped in mid-July and their development was compared to nonclipped controls after one growing season.In general when data were analyzed by family, clipped seedlings were significantly less desirable in three to six of the eight variables tested.Numerically, in all families seedlots, the clipped...

Clips as a knowledge based language

NASA Technical Reports Server (NTRS)

Harrington, James B.

1987-01-01

CLIPS is a language for writing expert systems applications on a personal or small computer. Here, the CLIPS programming language is described and compared to three other artificial intelligence (AI) languages (LISP, Prolog, and OPS5) with regard to the processing they provide for the implementation of a knowledge based system (KBS). A discussion is given on how CLIPS would be used in a control system.

Developmental and Behavioral Effects of Toe Clipping on Neonatal and Preweanling Mice with and without Vapocoolant Anesthesia

PubMed Central

Paluch, Lee-Ronn; Lieggi, Christine C; Dumont, Magali; Monette, Sebastien; Riedel, Elyn R; Lipman, Neil S

2014-01-01

Toe clipping is used to identify and genotype preweanling mice, but the procedure generates concerns relevant to pain and distress. The few pertinent studies available evaluated mice between postnatal days (PND) 3 and 7, advocate the use of toe clipping in mice PND 7 or younger, and identify handling as the most distressing aspect of the procedure. Because both toe and tail clipping may be necessary in older mice to obtain sufficient DNA for genotyping, we surmised that performing these procedures concurrently to minimize handling would be beneficial. We also examined reflex development until PND 21 and adult behavior at 8 to 10 wk of age in mice toe clipped at PND 7 or 17 and the benefits of using topical vapocoolant anesthesia. C57BL/6J pups at PND 7 and 17 were assigned to 1 of 4 groups: 1) clipping of digit 3 of contralateral fore- and hindpaws; 2) toe clipping after topical vapocoolant anesthesia; 3) unclipped, unsprayed controls; and, 4) unclipped and vapocoolant-sprayed. Compared with unanesthetized pups, those sprayed with vapocoolant vocalized and struggled more when handled and had more bleeding, erythema, and swelling, which persisted for as long as 12 h after toe clipping. Reflex development, anxiety, locomotion, and motor coordination were not different among groups or with regard to the age of toe clipping. No tissue reaction was noted microscopically in paws collected at 10 wk of age. We conclude that the use of vapocoolant cannot be recommended due to its harmful effects and that toe clipping at PND 7 or 17 does not significantly affect the long-term welfare of mice. PMID:24602538

Differences in displacement of the proximal and distal ends of mid-upper thoracic esophageal squamous cell carcinoma.

PubMed

Qiu, Guoqin; Wen, Dengshun; DU, Xianghui; Sheng, Liming; Zhou, Xia; Ji, Yongling; Bao, Wuan; Zhang, Danhong; Cheng, Lei

2016-07-01

In the present study, clips were used as markers to evaluate displacement differences between proximal and distal ends of esophageal tumors and to test whether their internal target volume (ITV) margins should be determined separately. A total of 23 patients with mid-upper thoracic esophageal squamous-cell carcinoma, a tumor length of ≤8 cm and an esophageal lumen suitable for endoscopic ultrasonography were recruited for the present study. Clips were implanted endoscopically at the proximal and distal ends of the esophageal tumor (upper and lower clips). In a further exploratory study on 16 of the patients, a third clip was placed at the distal esophagus 2 cm above the gastro-esophageal junction (GEJ) (cardiac clip). The clips were contoured for all 10 phases of the four-dimensional computed tomography and the maximum displacements of the clip centroids among different breathing phases in left-right (LR), superior-inferior (SI) and anterior-posterior (AP) directions were marked as x, y and z, respectively. The ITV margins that covered 95% of the LR, SI and AP motion were 2.89, 5.00 and 2.36 mm, respectively. Axial displacement (y) was greater than radial displacement (x, z; P<0.05). It was also revealed that LR(x), SI(y) and AP(z) displacement of cardiac clips was greater than that of upper or lower clips (P<0.05). Differences in the axial and radial displacement of the upper and lower clips indicated that axial and radial ITV margins should be determined separately. However, further study is required on patients in whom the distal tumor end is located in proximity to the GEJ.

CLIPS 6.0 - C LANGUAGE INTEGRATED PRODUCTION SYSTEM, VERSION 6.0 (UNIX VERSION)

NASA Technical Reports Server (NTRS)

Donnell, B.

1994-01-01

CLIPS, the C Language Integrated Production System, is a complete environment for developing expert systems -- programs which are specifically intended to model human expertise or knowledge. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. CLIPS 6.0 provides a cohesive tool for handling a wide variety of knowledge with support for three different programming paradigms: rule-based, object-oriented, and procedural. Rule-based programming allows knowledge to be represented as heuristics, or "rules-of-thumb" which specify a set of actions to be performed for a given situation. Object-oriented programming allows complex systems to be modeled as modular components (which can be easily reused to model other systems or create new components). The procedural programming capabilities provided by CLIPS 6.0 allow CLIPS to represent knowledge in ways similar to those allowed in languages such as C, Pascal, Ada, and LISP. Using CLIPS 6.0, one can develop expert system software using only rule-based programming, only object-oriented programming, only procedural programming, or combinations of the three. CLIPS provides extensive features to support the rule-based programming paradigm including seven conflict resolution strategies, dynamic rule priorities, and truth maintenance. CLIPS 6.0 supports more complex nesting of conditional elements in the if portion of a rule ("and", "or", and "not" conditional elements can be placed within a "not" conditional element). In addition, there is no longer a limitation on the number of multifield slots that a deftemplate can contain. The CLIPS Object-Oriented Language (COOL) provides object-oriented programming capabilities. Features supported by COOL include classes with multiple inheritance, abstraction, encapsulation, polymorphism, dynamic binding, and message passing with message-handlers. CLIPS 6.0 supports tight integration of the rule-based programming features of CLIPS with COOL (that is, a rule can pattern match on objects created using COOL). CLIPS 6.0 provides the capability to define functions, overloaded functions, and global variables interactively. In addition, CLIPS can be embedded within procedural code, called as a subroutine, and integrated with languages such as C, FORTRAN and Ada. CLIPS can be easily extended by a user through the use of several well-defined protocols. CLIPS provides several delivery options for programs including the ability to generate stand alone executables or to load programs from text or binary files. CLIPS 6.0 provides support for the modular development and execution of knowledge bases with the defmodule construct. CLIPS modules allow a set of constructs to be grouped together such that explicit control can be maintained over restricting the access of the constructs by other modules. This type of control is similar to global and local scoping used in languages such as C or Ada. By restricting access to deftemplate and defclass constructs, modules can function as blackboards, permitting only certain facts and instances to be seen by other modules. Modules are also used by rules to provide execution control. The CRSV (Cross-Reference, Style, and Verification) utility included with previous version of CLIPS is no longer supported. The capabilities provided by this tool are now available directly within CLIPS 6.0 to aid in the development, debugging, and verification of large rule bases. COSMIC offers four distribution versions of CLIPS 6.0: UNIX (MSC-22433), VMS (MSC-22434), MACINTOSH (MSC-22429), and IBM PC (MSC-22430). Executable files, source code, utilities, documentation, and examples are included on the program media. All distribution versions include identical source code for the command line version of CLIPS 6.0. This source code should compile on any platform with an ANSI C compiler. Each distribution version of CLIPS 6.0, except that for the Macintosh platform, includes an executable for the command line version. For the UNIX version of CLIPS 6.0, the command line interface has been successfully implemented on a Sun4 running SunOS, a DECstation running DEC RISC ULTRIX, an SGI Indigo Elan running IRIX, a DEC Alpha AXP running OSF/1, and an IBM RS/6000 running AIX. Command line interface executables are included for Sun4 computers running SunOS 4.1.1 or later and for the DEC RISC ULTRIX platform. The makefiles may have to be modified slightly to be used on other UNIX platforms. The UNIX, Macintosh, and IBM PC versions of CLIPS 6.0 each have a platform specific interface. Source code, a makefile, and an executable for the Windows 3.1 interface version of CLIPS 6.0 are provided only on the IBM PC distribution diskettes. Source code, a makefile, and an executable for the Macintosh interface version of CLIPS 6.0 are provided only on the Macintosh distribution diskettes. Likewise, for the UNIX version of CLIPS 6.0, only source code and a makefile for an X-Windows interface are provided. The X-Windows interface requires MIT's X Window System, Version 11, Release 4 (X11R4), the Athena Widget Set, and the Xmu library. The source code for the Athena Widget Set is provided on the distribution medium. The X-Windows interface has been successfully implemented on a Sun4 running SunOS 4.1.2 with the MIT distribution of X11R4 (not OpenWindows), an SGI Indigo Elan running IRIX 4.0.5, and a DEC Alpha AXP running OSF/1 1.2. The VAX version of CLIPS 6.0 comes only with the generic command line interface. ASCII makefiles for the command line version of CLIPS are provided on all the distribution media for UNIX, VMS, and DOS. Four executables are provided with the IBM PC version: a windowed interface executable for Windows 3.1 built using Borland C++ v3.1, an editor for use with the windowed interface, a command line version of CLIPS for Windows 3.1, and a 386 command line executable for DOS built using Zortech C++ v3.1. All four executables are capable of utilizing extended memory and require an 80386 CPU or better. Users needing an 8086/8088 or 80286 executable must recompile the CLIPS source code themselves. Users who wish to recompile the DOS executable using Borland C++ or MicroSoft C must use a DOS extender program to produce an executable capable of using extended memory. The version of CLIPS 6.0 for IBM PC compatibles requires DOS v3.3 or later and/or Windows 3.1 or later. It is distributed on a set of three 1.4Mb 3.5 inch diskettes. A hard disk is required. The Macintosh version is distributed in compressed form on two 3.5 inch 1.4Mb Macintosh format diskettes, and requires System 6.0.5, or higher, and 1Mb RAM. The version for DEC VAX/VMS is available in VAX BACKUP format on a 1600 BPI 9-track magnetic tape (standard distribution medium) or a TK50 tape cartridge. The UNIX version is distributed in UNIX tar format on a .25 inch streaming magnetic tape cartridge (Sun QIC-24). For the UNIX version, alternate distribution media and formats are available upon request. The CLIPS 6.0 documentation includes a User's Guide and a three volume Reference Manual consisting of Basic and Advanced Programming Guides and an Interfaces Guide. An electronic version of the documentation is provided on the distribution medium for each version: in MicroSoft Word format for the Macintosh and PC versions of CLIPS, and in both PostScript format and MicroSoft Word for Macintosh format for the UNIX and DEC VAX versions of CLIPS. CLIPS was developed in 1986 and Version 6.0 was released in 1993.

CLIPS 6.0 - C LANGUAGE INTEGRATED PRODUCTION SYSTEM, VERSION 6.0 (IBM PC VERSION)

NASA Technical Reports Server (NTRS)

Donnell, B.

1994-01-01

CLIPS, the C Language Integrated Production System, is a complete environment for developing expert systems -- programs which are specifically intended to model human expertise or knowledge. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. CLIPS 6.0 provides a cohesive tool for handling a wide variety of knowledge with support for three different programming paradigms: rule-based, object-oriented, and procedural. Rule-based programming allows knowledge to be represented as heuristics, or "rules-of-thumb" which specify a set of actions to be performed for a given situation. Object-oriented programming allows complex systems to be modeled as modular components (which can be easily reused to model other systems or create new components). The procedural programming capabilities provided by CLIPS 6.0 allow CLIPS to represent knowledge in ways similar to those allowed in languages such as C, Pascal, Ada, and LISP. Using CLIPS 6.0, one can develop expert system software using only rule-based programming, only object-oriented programming, only procedural programming, or combinations of the three. CLIPS provides extensive features to support the rule-based programming paradigm including seven conflict resolution strategies, dynamic rule priorities, and truth maintenance. CLIPS 6.0 supports more complex nesting of conditional elements in the if portion of a rule ("and", "or", and "not" conditional elements can be placed within a "not" conditional element). In addition, there is no longer a limitation on the number of multifield slots that a deftemplate can contain. The CLIPS Object-Oriented Language (COOL) provides object-oriented programming capabilities. Features supported by COOL include classes with multiple inheritance, abstraction, encapsulation, polymorphism, dynamic binding, and message passing with message-handlers. CLIPS 6.0 supports tight integration of the rule-based programming features of CLIPS with COOL (that is, a rule can pattern match on objects created using COOL). CLIPS 6.0 provides the capability to define functions, overloaded functions, and global variables interactively. In addition, CLIPS can be embedded within procedural code, called as a subroutine, and integrated with languages such as C, FORTRAN and Ada. CLIPS can be easily extended by a user through the use of several well-defined protocols. CLIPS provides several delivery options for programs including the ability to generate stand alone executables or to load programs from text or binary files. CLIPS 6.0 provides support for the modular development and execution of knowledge bases with the defmodule construct. CLIPS modules allow a set of constructs to be grouped together such that explicit control can be maintained over restricting the access of the constructs by other modules. This type of control is similar to global and local scoping used in languages such as C or Ada. By restricting access to deftemplate and defclass constructs, modules can function as blackboards, permitting only certain facts and instances to be seen by other modules. Modules are also used by rules to provide execution control. The CRSV (Cross-Reference, Style, and Verification) utility included with previous version of CLIPS is no longer supported. The capabilities provided by this tool are now available directly within CLIPS 6.0 to aid in the development, debugging, and verification of large rule bases. COSMIC offers four distribution versions of CLIPS 6.0: UNIX (MSC-22433), VMS (MSC-22434), MACINTOSH (MSC-22429), and IBM PC (MSC-22430). Executable files, source code, utilities, documentation, and examples are included on the program media. All distribution versions include identical source code for the command line version of CLIPS 6.0. This source code should compile on any platform with an ANSI C compiler. Each distribution version of CLIPS 6.0, except that for the Macintosh platform, includes an executable for the command line version. For the UNIX version of CLIPS 6.0, the command line interface has been successfully implemented on a Sun4 running SunOS, a DECstation running DEC RISC ULTRIX, an SGI Indigo Elan running IRIX, a DEC Alpha AXP running OSF/1, and an IBM RS/6000 running AIX. Command line interface executables are included for Sun4 computers running SunOS 4.1.1 or later and for the DEC RISC ULTRIX platform. The makefiles may have to be modified slightly to be used on other UNIX platforms. The UNIX, Macintosh, and IBM PC versions of CLIPS 6.0 each have a platform specific interface. Source code, a makefile, and an executable for the Windows 3.1 interface version of CLIPS 6.0 are provided only on the IBM PC distribution diskettes. Source code, a makefile, and an executable for the Macintosh interface version of CLIPS 6.0 are provided only on the Macintosh distribution diskettes. Likewise, for the UNIX version of CLIPS 6.0, only source code and a makefile for an X-Windows interface are provided. The X-Windows interface requires MIT's X Window System, Version 11, Release 4 (X11R4), the Athena Widget Set, and the Xmu library. The source code for the Athena Widget Set is provided on the distribution medium. The X-Windows interface has been successfully implemented on a Sun4 running SunOS 4.1.2 with the MIT distribution of X11R4 (not OpenWindows), an SGI Indigo Elan running IRIX 4.0.5, and a DEC Alpha AXP running OSF/1 1.2. The VAX version of CLIPS 6.0 comes only with the generic command line interface. ASCII makefiles for the command line version of CLIPS are provided on all the distribution media for UNIX, VMS, and DOS. Four executables are provided with the IBM PC version: a windowed interface executable for Windows 3.1 built using Borland C++ v3.1, an editor for use with the windowed interface, a command line version of CLIPS for Windows 3.1, and a 386 command line executable for DOS built using Zortech C++ v3.1. All four executables are capable of utilizing extended memory and require an 80386 CPU or better. Users needing an 8086/8088 or 80286 executable must recompile the CLIPS source code themselves. Users who wish to recompile the DOS executable using Borland C++ or MicroSoft C must use a DOS extender program to produce an executable capable of using extended memory. The version of CLIPS 6.0 for IBM PC compatibles requires DOS v3.3 or later and/or Windows 3.1 or later. It is distributed on a set of three 1.4Mb 3.5 inch diskettes. A hard disk is required. The Macintosh version is distributed in compressed form on two 3.5 inch 1.4Mb Macintosh format diskettes, and requires System 6.0.5, or higher, and 1Mb RAM. The version for DEC VAX/VMS is available in VAX BACKUP format on a 1600 BPI 9-track magnetic tape (standard distribution medium) or a TK50 tape cartridge. The UNIX version is distributed in UNIX tar format on a .25 inch streaming magnetic tape cartridge (Sun QIC-24). For the UNIX version, alternate distribution media and formats are available upon request. The CLIPS 6.0 documentation includes a User's Guide and a three volume Reference Manual consisting of Basic and Advanced Programming Guides and an Interfaces Guide. An electronic version of the documentation is provided on the distribution medium for each version: in MicroSoft Word format for the Macintosh and PC versions of CLIPS, and in both PostScript format and MicroSoft Word for Macintosh format for the UNIX and DEC VAX versions of CLIPS. CLIPS was developed in 1986 and Version 6.0 was released in 1993.

CLIPS 6.0 - C LANGUAGE INTEGRATED PRODUCTION SYSTEM, VERSION 6.0 (MACINTOSH VERSION)

NASA Technical Reports Server (NTRS)

Riley, G.

1994-01-01

CLIPS, the C Language Integrated Production System, is a complete environment for developing expert systems -- programs which are specifically intended to model human expertise or knowledge. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. CLIPS 6.0 provides a cohesive tool for handling a wide variety of knowledge with support for three different programming paradigms: rule-based, object-oriented, and procedural. Rule-based programming allows knowledge to be represented as heuristics, or "rules-of-thumb" which specify a set of actions to be performed for a given situation. Object-oriented programming allows complex systems to be modeled as modular components (which can be easily reused to model other systems or create new components). The procedural programming capabilities provided by CLIPS 6.0 allow CLIPS to represent knowledge in ways similar to those allowed in languages such as C, Pascal, Ada, and LISP. Using CLIPS 6.0, one can develop expert system software using only rule-based programming, only object-oriented programming, only procedural programming, or combinations of the three. CLIPS provides extensive features to support the rule-based programming paradigm including seven conflict resolution strategies, dynamic rule priorities, and truth maintenance. CLIPS 6.0 supports more complex nesting of conditional elements in the if portion of a rule ("and", "or", and "not" conditional elements can be placed within a "not" conditional element). In addition, there is no longer a limitation on the number of multifield slots that a deftemplate can contain. The CLIPS Object-Oriented Language (COOL) provides object-oriented programming capabilities. Features supported by COOL include classes with multiple inheritance, abstraction, encapsulation, polymorphism, dynamic binding, and message passing with message-handlers. CLIPS 6.0 supports tight integration of the rule-based programming features of CLIPS with COOL (that is, a rule can pattern match on objects created using COOL). CLIPS 6.0 provides the capability to define functions, overloaded functions, and global variables interactively. In addition, CLIPS can be embedded within procedural code, called as a subroutine, and integrated with languages such as C, FORTRAN and Ada. CLIPS can be easily extended by a user through the use of several well-defined protocols. CLIPS provides several delivery options for programs including the ability to generate stand alone executables or to load programs from text or binary files. CLIPS 6.0 provides support for the modular development and execution of knowledge bases with the defmodule construct. CLIPS modules allow a set of constructs to be grouped together such that explicit control can be maintained over restricting the access of the constructs by other modules. This type of control is similar to global and local scoping used in languages such as C or Ada. By restricting access to deftemplate and defclass constructs, modules can function as blackboards, permitting only certain facts and instances to be seen by other modules. Modules are also used by rules to provide execution control. The CRSV (Cross-Reference, Style, and Verification) utility included with previous version of CLIPS is no longer supported. The capabilities provided by this tool are now available directly within CLIPS 6.0 to aid in the development, debugging, and verification of large rule bases. COSMIC offers four distribution versions of CLIPS 6.0: UNIX (MSC-22433), VMS (MSC-22434), MACINTOSH (MSC-22429), and IBM PC (MSC-22430). Executable files, source code, utilities, documentation, and examples are included on the program media. All distribution versions include identical source code for the command line version of CLIPS 6.0. This source code should compile on any platform with an ANSI C compiler. Each distribution version of CLIPS 6.0, except that for the Macintosh platform, includes an executable for the command line version. For the UNIX version of CLIPS 6.0, the command line interface has been successfully implemented on a Sun4 running SunOS, a DECstation running DEC RISC ULTRIX, an SGI Indigo Elan running IRIX, a DEC Alpha AXP running OSF/1, and an IBM RS/6000 running AIX. Command line interface executables are included for Sun4 computers running SunOS 4.1.1 or later and for the DEC RISC ULTRIX platform. The makefiles may have to be modified slightly to be used on other UNIX platforms. The UNIX, Macintosh, and IBM PC versions of CLIPS 6.0 each have a platform specific interface. Source code, a makefile, and an executable for the Windows 3.1 interface version of CLIPS 6.0 are provided only on the IBM PC distribution diskettes. Source code, a makefile, and an executable for the Macintosh interface version of CLIPS 6.0 are provided only on the Macintosh distribution diskettes. Likewise, for the UNIX version of CLIPS 6.0, only source code and a makefile for an X-Windows interface are provided. The X-Windows interface requires MIT's X Window System, Version 11, Release 4 (X11R4), the Athena Widget Set, and the Xmu library. The source code for the Athena Widget Set is provided on the distribution medium. The X-Windows interface has been successfully implemented on a Sun4 running SunOS 4.1.2 with the MIT distribution of X11R4 (not OpenWindows), an SGI Indigo Elan running IRIX 4.0.5, and a DEC Alpha AXP running OSF/1 1.2. The VAX version of CLIPS 6.0 comes only with the generic command line interface. ASCII makefiles for the command line version of CLIPS are provided on all the distribution media for UNIX, VMS, and DOS. Four executables are provided with the IBM PC version: a windowed interface executable for Windows 3.1 built using Borland C++ v3.1, an editor for use with the windowed interface, a command line version of CLIPS for Windows 3.1, and a 386 command line executable for DOS built using Zortech C++ v3.1. All four executables are capable of utilizing extended memory and require an 80386 CPU or better. Users needing an 8086/8088 or 80286 executable must recompile the CLIPS source code themselves. Users who wish to recompile the DOS executable using Borland C++ or MicroSoft C must use a DOS extender program to produce an executable capable of using extended memory. The version of CLIPS 6.0 for IBM PC compatibles requires DOS v3.3 or later and/or Windows 3.1 or later. It is distributed on a set of three 1.4Mb 3.5 inch diskettes. A hard disk is required. The Macintosh version is distributed in compressed form on two 3.5 inch 1.4Mb Macintosh format diskettes, and requires System 6.0.5, or higher, and 1Mb RAM. The version for DEC VAX/VMS is available in VAX BACKUP format on a 1600 BPI 9-track magnetic tape (standard distribution medium) or a TK50 tape cartridge. The UNIX version is distributed in UNIX tar format on a .25 inch streaming magnetic tape cartridge (Sun QIC-24). For the UNIX version, alternate distribution media and formats are available upon request. The CLIPS 6.0 documentation includes a User's Guide and a three volume Reference Manual consisting of Basic and Advanced Programming Guides and an Interfaces Guide. An electronic version of the documentation is provided on the distribution medium for each version: in MicroSoft Word format for the Macintosh and PC versions of CLIPS, and in both PostScript format and MicroSoft Word for Macintosh format for the UNIX and DEC VAX versions of CLIPS. CLIPS was developed in 1986 and Version 6.0 was released in 1993.

CLIPS 6.0 - C LANGUAGE INTEGRATED PRODUCTION SYSTEM, VERSION 6.0 (DEC VAX VMS VERSION)

NASA Technical Reports Server (NTRS)

Donnell, B.

1994-01-01

CLIPS, the C Language Integrated Production System, is a complete environment for developing expert systems -- programs which are specifically intended to model human expertise or knowledge. It is designed to allow artificial intelligence research, development, and delivery on conventional computers. CLIPS 6.0 provides a cohesive tool for handling a wide variety of knowledge with support for three different programming paradigms: rule-based, object-oriented, and procedural. Rule-based programming allows knowledge to be represented as heuristics, or "rules-of-thumb" which specify a set of actions to be performed for a given situation. Object-oriented programming allows complex systems to be modeled as modular components (which can be easily reused to model other systems or create new components). The procedural programming capabilities provided by CLIPS 6.0 allow CLIPS to represent knowledge in ways similar to those allowed in languages such as C, Pascal, Ada, and LISP. Using CLIPS 6.0, one can develop expert system software using only rule-based programming, only object-oriented programming, only procedural programming, or combinations of the three. CLIPS provides extensive features to support the rule-based programming paradigm including seven conflict resolution strategies, dynamic rule priorities, and truth maintenance. CLIPS 6.0 supports more complex nesting of conditional elements in the if portion of a rule ("and", "or", and "not" conditional elements can be placed within a "not" conditional element). In addition, there is no longer a limitation on the number of multifield slots that a deftemplate can contain. The CLIPS Object-Oriented Language (COOL) provides object-oriented programming capabilities. Features supported by COOL include classes with multiple inheritance, abstraction, encapsulation, polymorphism, dynamic binding, and message passing with message-handlers. CLIPS 6.0 supports tight integration of the rule-based programming features of CLIPS with COOL (that is, a rule can pattern match on objects created using COOL). CLIPS 6.0 provides the capability to define functions, overloaded functions, and global variables interactively. In addition, CLIPS can be embedded within procedural code, called as a subroutine, and integrated with languages such as C, FORTRAN and Ada. CLIPS can be easily extended by a user through the use of several well-defined protocols. CLIPS provides several delivery options for programs including the ability to generate stand alone executables or to load programs from text or binary files. CLIPS 6.0 provides support for the modular development and execution of knowledge bases with the defmodule construct. CLIPS modules allow a set of constructs to be grouped together such that explicit control can be maintained over restricting the access of the constructs by other modules. This type of control is similar to global and local scoping used in languages such as C or Ada. By restricting access to deftemplate and defclass constructs, modules can function as blackboards, permitting only certain facts and instances to be seen by other modules. Modules are also used by rules to provide execution control. The CRSV (Cross-Reference, Style, and Verification) utility included with previous version of CLIPS is no longer supported. The capabilities provided by this tool are now available directly within CLIPS 6.0 to aid in the development, debugging, and verification of large rule bases. COSMIC offers four distribution versions of CLIPS 6.0: UNIX (MSC-22433), VMS (MSC-22434), MACINTOSH (MSC-22429), and IBM PC (MSC-22430). Executable files, source code, utilities, documentation, and examples are included on the program media. All distribution versions include identical source code for the command line version of CLIPS 6.0. This source code should compile on any platform with an ANSI C compiler. Each distribution version of CLIPS 6.0, except that for the Macintosh platform, includes an executable for the command line version. For the UNIX version of CLIPS 6.0, the command line interface has been successfully implemented on a Sun4 running SunOS, a DECstation running DEC RISC ULTRIX, an SGI Indigo Elan running IRIX, a DEC Alpha AXP running OSF/1, and an IBM RS/6000 running AIX. Command line interface executables are included for Sun4 computers running SunOS 4.1.1 or later and for the DEC RISC ULTRIX platform. The makefiles may have to be modified slightly to be used on other UNIX platforms. The UNIX, Macintosh, and IBM PC versions of CLIPS 6.0 each have a platform specific interface. Source code, a makefile, and an executable for the Windows 3.1 interface version of CLIPS 6.0 are provided only on the IBM PC distribution diskettes. Source code, a makefile, and an executable for the Macintosh interface version of CLIPS 6.0 are provided only on the Macintosh distribution diskettes. Likewise, for the UNIX version of CLIPS 6.0, only source code and a makefile for an X-Windows interface are provided. The X-Windows interface requires MIT's X Window System, Version 11, Release 4 (X11R4), the Athena Widget Set, and the Xmu library. The source code for the Athena Widget Set is provided on the distribution medium. The X-Windows interface has been successfully implemented on a Sun4 running SunOS 4.1.2 with the MIT distribution of X11R4 (not OpenWindows), an SGI Indigo Elan running IRIX 4.0.5, and a DEC Alpha AXP running OSF/1 1.2. The VAX version of CLIPS 6.0 comes only with the generic command line interface. ASCII makefiles for the command line version of CLIPS are provided on all the distribution media for UNIX, VMS, and DOS. Four executables are provided with the IBM PC version: a windowed interface executable for Windows 3.1 built using Borland C++ v3.1, an editor for use with the windowed interface, a command line version of CLIPS for Windows 3.1, and a 386 command line executable for DOS built using Zortech C++ v3.1. All four executables are capable of utilizing extended memory and require an 80386 CPU or better. Users needing an 8086/8088 or 80286 executable must recompile the CLIPS source code themselves. Users who wish to recompile the DOS executable using Borland C++ or MicroSoft C must use a DOS extender program to produce an executable capable of using extended memory. The version of CLIPS 6.0 for IBM PC compatibles requires DOS v3.3 or later and/or Windows 3.1 or later. It is distributed on a set of three 1.4Mb 3.5 inch diskettes. A hard disk is required. The Macintosh version is distributed in compressed form on two 3.5 inch 1.4Mb Macintosh format diskettes, and requires System 6.0.5, or higher, and 1Mb RAM. The version for DEC VAX/VMS is available in VAX BACKUP format on a 1600 BPI 9-track magnetic tape (standard distribution medium) or a TK50 tape cartridge. The UNIX version is distributed in UNIX tar format on a .25 inch streaming magnetic tape cartridge (Sun QIC-24). For the UNIX version, alternate distribution media and formats are available upon request. The CLIPS 6.0 documentation includes a User's Guide and a three volume Reference Manual consisting of Basic and Advanced Programming Guides and an Interfaces Guide. An electronic version of the documentation is provided on the distribution medium for each version: in MicroSoft Word format for the Macintosh and PC versions of CLIPS, and in both PostScript format and MicroSoft Word for Macintosh format for the UNIX and DEC VAX versions of CLIPS. CLIPS was developed in 1986 and Version 6.0 was released in 1993.

Plastic bag clip discovered in partial colectomy accompanying proposal for phylogenic plastic bag clip classification

PubMed Central

Lehmer, Larisa M; Ragsdale, Bruce D; Daniel, John; Hayashi, Edwin; Kvalstad, Robert

2011-01-01

A plastic bag clip was incidentally found anchored in the mucosa of a partial colectomy specimen 2.6 cm proximal to a ruptured diverticulum for which the patient, a mentally retarded, diabetic, 58-year-old man, underwent surgery. Over 20 cases of accidental ingestion of plastic bag clips have been published. Known complications include small bowel perforation, obstruction, dysphagia, gastrointestinal bleeding and colonic impaction. Preoperative diagnosis of plastic clips lodged in the gastrointestinal tract is frustrated due to radiographic translucency. This occult threat could likely be prevented by the design of gastrointestinally safe, plastic-bag-sealing devices. Presented here is a morphologically based classification of bag clips as a possible guide for determining the most hazardous varieties and to aid further discussions of their impact on health. PMID:22679182

CLIPS interface development tools and their application

NASA Technical Reports Server (NTRS)

Engel, Bernard A.; Rewerts, Chris C.; Srinivasan, Raghavan; Rogers, Joseph B.; Jones, Don D.

1990-01-01

A package of C-based PC user interface development functions has been developed and integrated into CLIPS. The primary function is ASK which provides a means to ask the user questions via multiple choice menus or the keyboard and then returns the user response to CLIPS. A parameter-like structure supplies information for the interface. Another function, SHOW, provides a means to paginate and display text. A third function, TITLE, formats and displays title screens. A similar set of C-based functions that are more general and thus will run on UNIX and machines have also been developed. Seven expert system applications were transformed from commercial development environments into CLIPS and utilize ASK, SHOW, and TITLE. Development of numerous new expert system applications using CLIPS and these interface functions has started. These functions greatly reduce the time required to build interfaces for CLIPS applications.

Effects of Japanese beetle (Coleoptera: Scarabaeidae) and silk clipping in field corn.

PubMed

Steckel, Sandy; Stewart, S D; Tindall, K V

2013-10-01

Japanese beetle (Popillia japonica Newman) is an emerging silk-feeding insect found in fields in the lower Corn Belt and Midsouthern United States. Studies were conducted in 2010 and 2011 to evaluate how silk clipping in corn affects pollination and yield parameters. Manually clipping silks once daily had modest effects on yield parameters. Sustained clipping by either manually clipping silks three times per day or by caging Japanese beetles onto ears affected total kernel weight if it occurred during early silking (R1 growth stage). Manually clipping silks three times per day for the first 5 d of silking affected the number of kernels per ear, total kernel weight, and the weight of individual kernels. Caged beetles fed on silks and, depending on the number of beetles caged per ear, reduced the number of kernels per ear. Caging eight beetles per ear significantly reduced total kernel weight compared with noninfested ears. Drought stress before anthesis appeared to magnify the impact of silk clipping by Japanese beetles. There was evidence of some compensation for reduced pollination by increasing the size of pollinated kernels within the ear. Our results showed that it requires sustained silk clipping during the first week of silking to have substantial impacts on pollination and yield parameters, at least under good growing conditions. Some states recommend treating for Japanese beetle when three Japanese beetles per ear are found, silks are clipped to < 13 mm, and pollination is < 50% complete, and that recommendation appears to be adequate.

Suture retraction technique to prevent parent vessel obstruction following aneurysm tandem clipping.

PubMed

Rayan, Tarek; Amin-Hanjani, Sepideh

2015-08-01

With large or giant aneurysms, the use of multiple tandem clips can be essential for complete obliteration of the aneurysm. One potential disadvantage, however, is the considerable cumulative weight of these clips, which may lead to kinking of the underlying parent vessels and obstruction of flow. The authors describe a simple technique to address this problem, guided by intraoperative blood flow measurements, in a patient with a ruptured near-giant 2.2 × 1.7-cm middle cerebral artery bifurcation aneurysm that was treated with the tandem clipping technique. A total of 11 clips were applied in a vertical stacked fashion. The cumulative weight of the clips caused kinking of the temporal M2 branch of the bifurcation with reduction of flow. A 4-0 Nurolon suture tie was applied to the hub of one of the clips and was tethered to the dura of the sphenoid ridge by a small mini-clip and reinforced by application of tissue sealant. The patient underwent intraoperative indocyanine green videoangiography as well as catheter angiography, which demonstrated complete aneurysmal obliteration and preservation of vessel branches. Postoperative angiography confirmed patency of the bifurcation vessels with mild vasospasm. The patient had a full recovery with no postoperative complications and was neurologically intact at her 6-month follow-up. The suture retraction technique allows a simple solution to parent vessel obstruction following aneurysm tandem clipping, in conjunction with the essential guidance provided by intraoperative flow measurements.

Expert system technologies for Space Shuttle decision support: Two case studies

NASA Technical Reports Server (NTRS)

Ortiz, Christopher J.; Hasan, David A.

1994-01-01

This paper addresses the issue of integrating the C Language Integrated Production System (CLIPS) into distributed data acquisition environments. In particular, it presents preliminary results of some ongoing software development projects aimed at exploiting CLIPS technology in the new mission control center (MCC) being built at NASA Johnson Space Center. One interesting aspect of the control center is its distributed architecture; it consists of networked workstations which acquire and share data through the NASA/JSC-developed information sharing protocol (ISP). This paper outlines some approaches taken to integrate CLIPS and ISP in order to permit the development of intelligent data analysis applications which can be used in the MCC. Three approaches to CLIPS/IPS integration are discussed. The initial approach involves clearly separating CLIPS from ISP using user-defined functions for gathering and sending data to and from a local storage buffer. Memory and performance drawbacks of this design are summarized. The second approach involves taking full advantage of CLIPS and the CLIPS Object-Oriented Language (COOL) by using objects to directly transmit data and state changes from ISP to COOL. Any changes within the object slots eliminate the need for both a data structure and external function call thus taking advantage of the object matching capabilities within CLIPS 6.0. The final approach is to treat CLIPS and ISP as peer toolkits. Neither is embedded in the other; rather the application interweaves calls to each directly in the application source code.

Surgical management of giant posterior communicating artery aneurysms.

PubMed

Velat, Gregory J; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

2012-09-01

Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.

Retractable pin dual in-line package test clip

DOEpatents

Bandzuch, Gregory S.; Kosslow, William J.

1996-01-01

This invention is a Dual In-Line Package (DIP) test clip for use when troubleshooting circuits containing DIP integrated circuits. This test clip is a significant improvement over existing DIP test clips in that it has retractable pins which will permit troubleshooting without risk of accidentally shorting adjacent pins together when moving probes to different pins on energized circuits or when the probe is accidentally bumped while taking measurements.

Subarachnoid haemorrhage with "Ecstasy" abuse in a young adult.

PubMed

Auer, J; Berent, R; Weber, T; Lassnig, E; Eber, B

2002-10-01

Abuse of the drugs like amphetamine, cocaine and "Ecstasy" may be complicated by intracerebral, subdural or subarachnoid haemorrhage. Contrary to historical opinion, drug-related intracranial haemorrhage (ICH) is frequently related to an underlying vascular malformation. We report the case of an 18-year-old man with a history of Ecstasy abuse preceding the onset of severe occipital headache. Cerebral computed tomography revealed right-sided subarachnoid haemorrhage and cerebral angiography showed right-sided middle cerebral artery aneurysm of 1 cm diameter. The patient was treated surgically with aneurysm clipping. Three weeks after onset of intracranial haemorrhage, neurological examination demonstrated normal findings. A history of severe headache immediately after using amphetamine, Ecstasy, or cocaine should alert doctors to the possibility of intracerebral haemorrhage. Arteriography should be part of the evaluation of most young patients with stroke or non-traumatic ICH.

Advanced CLIPS capabilities

NASA Technical Reports Server (NTRS)

Riley, Gary

1991-01-01

The C Language Integrated Production System (CLIPS) is a forward chaining rule based language developed by NASA. CLIPS was designed specifically to provide high portability, low cost, and easy integration with external systems. The current release of CLIPS, version 4.3, is being used by over 2500 users throughout the public and private community. The primary addition to the next release of CLIPS, version 5.0, will be the CLIPS Object Oriented Language (COOL). The major capabilities of COOL are: class definition with multiple inheritance and no restrictions on the number, types, or cardinality of slots; message passing which allows procedural code bundled with an object to be executed; and query functions which allow groups of instances to be examined and manipulated. In addition to COOL, numerous other enhancements were added to CLIPS including: generic functions (which allow different pieces of procedural code to be executed depending upon the types or classes of the arguments); integer and double precision data type support; multiple conflict resolution strategies; global variables; logical dependencies; type checking on facts; full ANSI compiler support; and incremental reset for rules.

Clipping in neurocontrol by adaptive dynamic programming.

PubMed

Fairbank, Michael; Prokhorov, Danil; Alonso, Eduardo

2014-10-01

In adaptive dynamic programming, neurocontrol, and reinforcement learning, the objective is for an agent to learn to choose actions so as to minimize a total cost function. In this paper, we show that when discretized time is used to model the motion of the agent, it can be very important to do clipping on the motion of the agent in the final time step of the trajectory. By clipping, we mean that the final time step of the trajectory is to be truncated such that the agent stops exactly at the first terminal state reached, and no distance further. We demonstrate that when clipping is omitted, learning performance can fail to reach the optimum, and when clipping is done properly, learning performance can improve significantly. The clipping problem we describe affects algorithms that use explicit derivatives of the model functions of the environment to calculate a learning gradient. These include backpropagation through time for control and methods based on dual heuristic programming. However, the clipping problem does not significantly affect methods based on heuristic dynamic programming, temporal differences learning, or policy-gradient learning algorithms.

Film clips and narrative text as subjective emotion elicitation techniques.

PubMed

Zupan, Barbra; Babbage, Duncan R

2017-01-01

Film clips and narrative text are useful techniques in eliciting emotion in a laboratory setting but have not been examined side-by-side using the same methodology. This study examined the self-identification of emotions elicited by film clip and narrative text stimuli to confirm that selected stimuli appropriately target the intended emotions. Seventy participants viewed 30 film clips, and 40 additional participants read 30 narrative texts. Participants identified the emotion experienced (happy, sad, angry, fearful, neutral-six stimuli each). Eighty-five percent of participants self-identified the target emotion for at least two stimuli for all emotion categories of film clips, except angry (only one) and for all categories of narrative text, except fearful (only one). The most effective angry text was correctly identified 74% of the time. Film clips were more effective in eliciting all target emotions in participants for eliciting the correct emotion (angry), intensity rating (happy, sad), or both (fearful).

Mounting clips for panel installation

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

Cavieres, Andres; Al-Haddad, Tristan; Goodman, Joseph

2017-02-14

An exemplary mounting clip for removably attaching panels to a supporting structure comprises a base, spring locking clips, a lateral flange, a lever flange, and a spring bonding pad. The spring locking clips extend upwardly from the base. The lateral flange extends upwardly from a first side of the base. The lateral flange comprises a slot having an opening configured to receive at least a portion of one of the one or more panels. The lever flange extends outwardly from the lateral flange. The spring bonding flange extends downwardly from the lever flange. At least a portion of the firstmore » spring bonding flange comprises a serrated edge for gouging at least a portion of the one or more panels when the one or more panels are attached to the mounting clip to electrically and mechanically couple the one or more panels to the mounting clip.« less

The use of video clips in teleconsultation for preschool children with movement disorders.

PubMed

Gorter, Hetty; Lucas, Cees; Groothuis-Oudshoorn, Karin; Maathuis, Carel; van Wijlen-Hempel, Rietje; Elvers, Hans

2013-01-01

To investigate the reliability and validity of video clips in assessing movement disorders in preschool children. The study group included 27 children with neuromotor concerns. The explorative validity group included children with motor problems (n = 21) or with typical development (n = 9). Hempel screening was used for live observation of the child, full recording, and short video clips. The explorative study tested the validity of the clinical classifications "typical" or "suspect." Agreement between live observation and the full recording was almost perfect; Agreement for the clinical classification "typical" or "suspect" was substantial. Agreement between the full recording and short video clips was substantial to moderate. The explorative validity study, based on short video clips and the presence of a neuromotor developmental disorder, showed substantial agreement. Hempel screening enables reliable and valid observation of video clips, but further research is necessary to demonstrate the predictive value.

Embedding CLIPS in a database-oriented diagnostic system

NASA Technical Reports Server (NTRS)

Conway, Tim

1990-01-01

This paper describes the integration of C Language Production Systems (CLIPS) into a powerful portable maintenance aid (PMA) system used for flightline diagnostics. The current diagnostic target of the system is the Garrett GTCP85-180L, a gas turbine engine used as an Auxiliary Power Unit (APU) on some C-130 military transport aircraft. This project is a database oriented approach to a generic diagnostic system. CLIPS is used for 'many-to-many' pattern matching within the diagnostics process. Patterns are stored in database format, and CLIPS code is generated by a 'compilation' process on the database. Multiple CLIPS rule sets and working memories (in sequence) are supported and communication between the rule sets is achieved via the export and import commands. Work is continuing on using CLIPS in other portions of the diagnostic system and in re-implementing the diagnostic system in the Ada language.

Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial.

PubMed

Chugh, A Jessey; Pace, Jonathan R; Singer, Justin; Tatsuoka, Curtis; Hoffer, Alan; Selman, Warren R; Bambakidis, Nicholas C

2017-03-01

OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite. This study is designed to determine whether use of a surgical rehearsal platform in aneurysm surgery is helpful in decreasing aneurysm dissection time and clip manipulation of the aneurysm. METHODS The authors conducted a blinded, prospective, randomized study comparing key effort and time variables in aneurysm clip ligation surgery with and without preoperative use of the SuRgical Planner (SRP) surgical rehearsal platform. Initially, 40 patients were randomly assigned to either of two groups: one in which surgery was performed after use of the SRP (SRP group) and one in which surgery was performed without use of the SRP (control group). All operations were videotaped. After exclusion of 6 patients from the SRP group and 9 from the control group, a total of 25 surgical cases were analyzed by a reviewer blinded to group assignment. The videos were analyzed for total microsurgical time, number of clips used, and number of clip placement attempts. Means and standard deviations (SDs) were calculated and compared between groups. RESULTS The mean (± SD) amount of operative time per clip used was 920 ± 770 seconds in the SRP group and 1294 ± 678 seconds in the control group (p = 0.05). In addition, the mean values for the number of clip attempts, total operative time, ratio of clip attempts to clips used, and time per clip attempt were all lower in the SRP group, although the between-group differences were not statistically significant. CONCLUSIONS Preoperative rehearsal with SRP increased efficiency and safety in aneurysm microsurgery as demonstrated by the statistically significant improvement in time per clip used. Although the rest of the outcomes did not demonstrate statistically significant between-group differences, the fact that the SRP group showed improvement in mean values for all measures studied suggests that preoperative rehearsal may increase the efficiency and safety of aneurysm microsurgery. Future studies aimed at improving patient outcome and safety during surgical clipping of aneurysms will be needed to keep pace with the quickly advancing endovascular field.

Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training.

PubMed

Vakharia, Vejay N; Vakharia, Nilesh N; Hill, Ciaran S

2016-04-01

Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessing arsenic and selenium in a single nail clipping using portable X-ray fluorescence.

PubMed

Fleming, David E B; Nader, Michel N; Foran, Kelly A; Groskopf, Craig; Reno, Michael C; Ware, Chris S; Tehrani, Mina; Guimarães, Diana; Parsons, Patrick J

2017-02-01

The feasibility of measuring arsenic and selenium contents in a single nail clipping was investigated using a small-focus portable X-ray fluorescence (XRF) instrument with monochromatic excitation beams. Nail clipping phantoms supplemented with arsenic and selenium to produce materials with 0, 5, 10, 15, and 20µg/g were used for calibration purposes. In total, 10 different clippings were analyzed at two different measurement positions. Energy spectra were fit with detection peaks for arsenic K α , selenium K α , arsenic K β , selenium K β , and bromine K α characteristic X-rays. Data analysis was performed under two distinct conditions of fitting constraint. Calibration lines were established from the amplitude of each of the arsenic and selenium peaks as a function of the elemental contents in the clippings. The slopes of the four calibration lines were consistent between the two conditions of analysis. The calculated minimum detection limit (MDL) of the method, when considering the K α peak only, ranged from 0.210±0.002µg/g selenium under one condition of analysis to 0.777±0.009µg/g selenium under another. Compared with previous portable XRF nail clipping studies, MDLs were substantially improved for both arsenic and selenium. The new measurement technique had the additional benefits of being short in duration (~3min) and requiring only a single nail clipping. The mass of the individual clipping used did not appear to play a major role in signal strength, but positioning of the clipping is important. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mitral stenosis due to dynamic clip-leaflet interaction during the MitraClip procedure: Case report and review of current knowledge.

PubMed

Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

2017-06-01

The goal of MitraClip therapy is to achieve mitral regurgitation reduction without iatrogenic creation of clinically significant MS. In some series, up to 35% of patients are left with mild MS. There are many contributors to the final transmitral gradient achieved in patients undergoing MitraClip therapy. Additionally, there are many modalities used for the intraprocedural assessment of MS with no one modality considered to be the benchmark. We herein describe a case which illustrates the dynamic nature of clip-leaflet interaction, and review intraprocedural techniques for invasively and noninvasively assessing MS. Copyright © 2016 Elsevier Inc. All rights reserved.

Preparation of digital movie clips for online journal publication.

PubMed

Yam, Chun-Shan

2006-07-01

This article presents general guidelines for preparing movie clips for online journal publication. As more and more radiology journals establish an online presence, radiologists wishing to submit journal articles with movie clips need to understand the electronic submission process. Viewing a movie clip via an online journal is different from viewing one with PowerPoint using a local desktop computer because the movie file must first be downloaded onto the client computer before it can be displayed. Users thus should be cautious in selecting movie format and compression when creating movie clips for online journals. This article provides step-by-step demonstrations and general guidelines for movie format and compression selections.

Indocyanine Green Videoangiography for Surgery of a Ruptured Dissecting Aneurysm in the Precommunicating Anterior Cerebral Artery: A Technical Case Report.

PubMed

Nagai, Yasunori; Goto, Masanori; Toda, Hiroki; Nishida, Namiko; Yoshimoto, Naoya; Iwasaki, Koichi

2017-08-01

Indocyanine green videoangiography (ICG-VA) is an important intraoperative adjunct for saccular aneurysm surgery, but its efficacy in surgery for dissecting aneurysms has rarely been reported. The authors describe the usefulness of preclipping ICG-VA in a rare case of a ruptured dissecting aneurysm located at the precommunicating (A1) segment of the anterior cerebral artery. A 52-year-old woman, with no history of connective tissue diseases or vascular disorders, presented with sudden headache and convulsion. The CT scan showed that the patient had subarachnoid hemorrhage. Angiography showed a dissecting aneurysm in the left A1 segment of the anterior cerebral artery. Thus, the patient underwent trapping of the dissecting aneurysm. ICG-VA was used as an intraoperative adjunct before and after clipping. The preclipping ICG-VA showed the heterogeneously bright dissecting aneurysm and branching arteries even in the presence of hematoma. Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms. Copyright © 2017 by the Congress of Neurological Surgeons

CLIPS: A tool for corn disease diagnostic system and an aid to neural network for automated knowledge acquisition

NASA Technical Reports Server (NTRS)

Wu, Cathy; Taylor, Pam; Whitson, George; Smith, Cathy

1990-01-01

This paper describes the building of a corn disease diagnostic expert system using CLIPS, and the development of a neural expert system using the fact representation method of CLIPS for automated knowledge acquisition. The CLIPS corn expert system diagnoses 21 diseases from 52 symptoms and signs with certainty factors. CLIPS has several unique features. It allows the facts in rules to be broken down to object-attribute-value (OAV) triples, allows rule-grouping, and fires rules based on pattern-matching. These features combined with the chained inference engine result to a natural user query system and speedy execution. In order to develop a method for automated knowledge acquisition, an Artificial Neural Expert System (ANES) is developed by a direct mapping from the CLIPS system. The ANES corn expert system uses the same OAV triples in the CLIPS system for its facts. The LHS and RHS facts of the CLIPS rules are mapped into the input and output layers of the ANES, respectively; and the inference engine of the rules is imbedded in the hidden layer. The fact representation by OAC triples gives a natural grouping of the rules. These features allow the ANES system to automate rule-generation, and make it efficient to execute and easy to expand for a large and complex domain.

What kind of erotic film clips should we use in female sex research? An exploratory study.

PubMed

Woodard, Terri L; Collins, Karen; Perez, Mindy; Balon, Richard; Tancer, Manuel E; Kruger, Michael; Moffat, Scott; Diamond, Michael P

2008-01-01

Erotic film clips are used in sex research, including studies of female sexual dysfunction and arousal. However, little is known about which clips optimize female sexual response. Furthermore, their use is not well standardized. To identify the types of film clips that are most mentally appealing and physically arousing to women for use in future sexual function and dysfunction studies; to explore the relationship between mental appeal and reported physical arousal; to characterize the content of the films that were found to be the most and least appealing and arousing. Twenty-one women viewed 90 segments of erotic film clips. They rated how (i) mentally appealing and (ii) how physically aroused they were by each clip. The data were analyzed by descriptive statistics. The means of the mental and self-reported physical responses were calculated to determine the most and least appealing/arousing film clips. Pearson correlations were calculated to assess the relationship between mental appeal and reported physical arousal. Self-reported mental and physical arousal. Of 90 film clips, 18 were identified as the most mentally appealing and physically arousing while nine were identified as the least mentally appealing and physically arousing. The level of mental appeal positively correlated with the level of perceived physical arousal in both categories (r = 0.61, P < 0.05 and r = 0.62, P < 0.05). The most appealing and physically arousing films tended to exhibit heterosexual behavior with vaginal intercourse. The least appealing and least physically arousing films tended to depict male homosexual behavior, fellatio, and anal intercourse. Erotic film clips reliably produced a state of self-reported arousal in women. The most appealing and arousing films tended to depict heterosexual vaginal intercourse. Film clips with these attributes should be used in future research of sexual function and response of women.

Machine-assisted editing of user-generated content

NASA Astrophysics Data System (ADS)

Cremer, Markus; Cook, Randall

2009-02-01

Over recent years user-generated content has become ubiquitously available and an attractive entertainment source for millions of end-users. Particularly for larger events, where many people use their devices to capture the action, a great number of short video clips are made available through appropriate web services. The objective of this presentation is to describe a way to combine these clips by analyzing them, and automatically reconstruct the time line in which the individual video clips were captured. This will enable people to easily create a compelling multimedia experience by leveraging multiple clips taken by different users from different angles, and across different time spans. The user will be able to shift into the role of a movie director mastering a multi-camera recording of the event. To achieve this goal, the audio portion of the video clips is analyzed, and waveform characteristics are computed with high temporal granularity in order to facilitate precise time alignment and overlap computation of the user-generated clips. Special care has to be given not only to the robustness of the selected audio features against ambient noise and various distortions, but also to the matching algorithm used to align the user-generated clips properly.

Duodenal Ulcer Induced by Hem-o-Lok clip after Reduced Port Laparoscopic Cholecystectomy.

PubMed

Soga, Koichi; Kassai, Kyoichi; Itani, Kenji

2016-03-01

The patient was a 66-year-old woman who had undergone laparoscopic cholecystectomy (Lap-C) secondary to chronic cholecystitis status post endoscopic choledocholithotomy 13 months previously. During surgery, Hem-o-Lok clips were used to control the cystic duct and the cystic artery. Due to the presence of extensive adhesions of the cystic duct and surrounding tissue, the surgeons had difficulty in debriding the area. Thirteen months after Lap-C, the patient underwent a screening esophagogastroduodenoscopy (EGD), which demonstrated clip appearance at the inferior wall of the first part of the duodenum. In the EGD, duodenal erosions and edema were observed around the clip. We appreciated that endoscopic clip removal would be difficult because of the presence of severe adhesions and inflammation of the duodenal bulb. On clinical examination of the patient, no major abnormalities or physical findings were noted. Therefore, we decided not to attempt to remove the clip. The patient was treated with an oral proton pump inhibitor to prevent extensive duodenal mucosal injury. Two months later, we repeated the EGD, which revealed that the clip was no longer present, and the duodenum was covered with normal mucosa surrounding the scar.

Age-Related Differences in Judgments of Inappropriate Behavior are Related to Humor Style Preferences

PubMed Central

Stanley, Jennifer Tehan; Lohani, Monika; Isaacowitz, Derek M.

2014-01-01

Identifying social gaffes is important for maintaining relationships. Older adults are less able than young to discriminate between socially appropriate and inappropriate behavior in video clips. One open question is how these social appropriateness ratings relate to potential age differences in the perception of what is actually funny or not. In the present study, young, middle-aged, and older adults were equally able to discriminate between appropriate and inappropriate social behavior in a diverse set of clips relevant to both age groups. However, young and middle-aged adults rated the gaffe clips as funnier than control clips and young adults smiled more during the inappropriate clips than the control clips. Older adults did not show this pattern, suggesting that they did not find the inappropriate clips funny. Additionally, young adults endorsed a more aggressive humor style than middle-aged and older adults and aggressive humor style endorsement mediated age differences in social appropriateness ratings. Results are discussed in terms of possible mechanisms such as cohort differences in humor and developmental prioritization of certain humor styles, as well as the importance of investigating age differences in both abilities and preferences. PMID:25244473

21 CFR 868.6225 - Nose clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ANESTHESIOLOGY DEVICES Miscellaneous § 868.6225 Nose clip. (a) Identification. A nose clip is a device intended to close a patient's external nares (nostrils) during diagnostic or therapeutic procedures. (b... from the current good manufacturing practice requirements of the quality system regulation in part 820...

A CLIPS expert system for clinical flow cytometry data analysis

NASA Technical Reports Server (NTRS)

Salzman, G. C.; Duque, R. E.; Braylan, R. C.; Stewart, C. C.

1990-01-01

An expert system is being developed using CLIPS to assist clinicians in the analysis of multivariate flow cytometry data from cancer patients. Cluster analysis is used to find subpopulations representing various cell types in multiple datasets each consisting of four to five measurements on each of 5000 cells. CLIPS facts are derived from results of the clustering. CLIPS rules are based on the expertise of Drs. Stewart, Duque, and Braylan. The rules incorporate certainty factors based on case histories.

Effects of fin clipping on survival and position-holding behavior of brown darters, Etheostoma edwini

USGS Publications Warehouse

Champagne, C.E.; Austin, J.D.; Jelks, H.L.; Jordan, F.

2008-01-01

Advent of the polymerase chain reaction (PCR) has allowed conservation biologists to use small portions of tissue to obtain genetic material for population genetic and taxonomic study. Fin clips are used extensively in large-sized fishes, but it is unclear how clipping enough fin tissue for genetic analysis will affect survival of smaller fishes such as minnows and darters, which are among the most threatened organisms in North America. We tested for effects of fin clipping on survival and swimming performance of non-threatened Brown Darters (Etheostoma edwini) in order to justify similar tissue collection in co-occurring endangered Okaloosa Darters (E. okaloosae). We collected 48 E. edwini from a small stream in northwest Florida, transported them to the laboratory, and randomly assigned them to one of three experimental groups: control, entire right pectoral fin removed, or rear half of caudal fin removed. Successful amplification of DNA indicated that our fin clips were large enough for genetic analysis using PCR. No mortality occurred during a two-month observation period. Fin regeneration was almost complete and we could not visually distinguish clipped fins from control fins after two months. We then randomly assigned fish into the same three experimental groups, clipped fins, and evaluated their ability to hold position at 20 cm/sec in an experimental flow chamber. Neither fish size nor treatment type affected position-holding behavior. Fin clipping does not adversely affect survival and swimming performance of E. edwini maintained in the laboratory. Additional research on the effects of fin clipping on small-sized fishes should be conducted in the field to evaluate survival under natural conditions. ?? 2008 by the American Society of Ichthyologists and Herpetologists.

Efficacy of electrocoagulation in sealing the cystic artery and cystic duct occluded with only one absorbable clip during laparoscopic cholecystectomy.

PubMed

Yang, Chang-Ping; Cao, Jin-Lin; Yang, Ren-Rong; Guo, Hong-Rong; Li, Zhao-Hui; Guo, Hai-Ying; Shao, Yin-Can; Liu, Gui-Bao

2014-02-01

Even though laparoscopic cholecystectomy (LC) emerged over 20 years ago, controversies persist with regard to the best method to ligate the cystic duct and artery. We proposed to assess the effectiveness and safety of electrocoagulation to seal the cystic artery and cystic duct after their occlusion with only one absorbable clip. We retrospectively compared the clinical data for 635 patients undergoing LC using electrocoagulation to seal the cystic artery and cystic duct that were occluded with only one absorbable clip (Group 1) and 728 patients undergoing LC using titanium clips (Group 2). In parallel, 30 rabbits randomized into six groups underwent cholecystectomy. After cystic duct ligation with absorbable or titanium clips, the animals were sacrificed 1, 3, or 6 months later, and intraabdominal adhesions were assessed after celiotomy. The mean operative time was significantly shorter (41.6 versus 58.9 minutes, P<.01) in Group 1 than in Group 2. No cystic duct leaks occurred in any patients from Group 1, compared with seven leaks among the 728 (0.96%) patients from Group 2 (P<.05). The morbidity was significantly higher in Group 2 than in Group 1 (3.43% versus 1.58%). Mean intraoperative blood loss and hospitalization length were not significantly different between the two groups, and no deaths occurred in either group. In animal experiments, adhesion was tighter for absorbable than for titanium clips, but fibrous tissue encapsulation was thinner at the site of titanium clips. Electrocoagulation of the cystic artery and cystic duct that were occluded with only one absorbable clip is safe and effective during LC. This approach is associated with shortened operative times and reduced leakage, compared with the standard method using metal clips.

Aneurysm clip motion during magnetic resonance imaging: in vivo experimental study with metallurgical factor analysis.

PubMed

Dujovny, M; Kossovsky, N; Kossowsky, R; Valdivia, R; Suk, J S; Diaz, F G; Berman, S K; Cleary, W

1985-10-01

Because of various mechanical, metallurgical, and commercial constraints, aneurysm clips are manufactured from different alloys, including several stainless steel and cobalt alloys. Some of the steels contain volume fractions of the crystal phase known as martensite. Martensitic alloys have body-centered cubic structure, are prone to stress corrosion failure, and are ferromagnetic. Martensitic steel can be displaced like a compass needle when exposed to a magnetic field such as that generated during magnetic resonance imaging (MRI). The force exerted by the magnetic field is proportional to the volume fraction of the magnetic phase. We investigated the martensitic content and magnetic field-induced displacement of 12 common aneurysm clips. Four clips of each of the following types were examined: Sugita, Sundt-Kees Multi-Angle, Heifetz (two types), Vari-Angle McFadden, Yasargil (two types), Scoville, Mayfield, Vari-Angle, Pivot, and Kapp. Phase homogeneity and crystal structure were analyzed by x-ray diffraction using a Phillips x-ray diffractometer. Clip deflection in an Oxford Research Systems MRI spectrometer was measured in our in vivo rat abdominal aortic aneurysm model. Results showed that the volume fraction of the martensitic phase in the various clips correlated with the magnitude of the deflection. Among the clips examined, the Yasargil, Sugita, Heifetz Elgiloy, and Vari-Angle McFadden had a nonmartensitic composition and did not deflect in the magnetic field. The Scoville contained 5% martensite and deflected only marginally. Martensite comprised 35% of the Mayfield clip, which deflected 45 degrees, and 90% of the Heifetz, Vari-Angle, Pivot, and Sundt-Kees Multi-Angle clips, which deflected approximately 70 degrees or slipped off the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

Intelligent tutoring using HyperCLIPS

NASA Technical Reports Server (NTRS)

Hill, Randall W., Jr.; Pickering, Brad

1990-01-01

HyperCard is a popular hypertext-like system used for building user interfaces to databases and other applications, and CLIPS is a highly portable government-owned expert system shell. We developed HyperCLIPS in order to fill a gap in the U.S. Army's computer-based instruction tool set; it was conceived as a development environment for building adaptive practical exercises for subject-matter problem-solving, though it is not limited to this approach to tutoring. Once HyperCLIPS was developed, we set out to implement a practical exercise prototype using HyperCLIPS in order to demonstrate the following concepts: learning can be facilitated by doing; student performance evaluation can be done in real-time; and the problems in a practical exercise can be adapted to the individual student's knowledge.

Stone formation from nonabsorbable clip migration into the collecting system after robot-assisted partial nephrectomy.

PubMed

Lee, Ziho; Reilly, Christopher E; Moore, Blake W; Mydlo, Jack H; Lee, David I; Eun, Daniel D

2014-01-01

We describe a case in which a Weck Hem-o-lok clip (Teleflex, Research Triangle Park, USA) migrated into the collecting system and acted as a nidus for stone formation in a patient after robot-assisted partial nephrectomy. The patient presented 2 years postoperatively with left-sided renal colic. Abdominal computed tomography scan showed a 10 millimeter renal calculus in the left middle pole. After using laser lithotripsy to fragment the overlying renal stone, a Weck Hem-o-lok clip was found to be embedded in the collecting system. A laser fiber through a flexible ureteroscope was used to successfully dislodge the clip from the renal parenchyma, and a stone basket was used to extract the clip.

Matrix Metalloproteinase-2 Activity is Associated with Divergent Regulation of Calponin-1 in Conductance and Resistance Arteries in Hypertension-induced Early Vascular Dysfunction and Remodelling.

PubMed

Parente, Juliana M; Pereira, Camila A; Oliveira-Paula, Gustavo H; Tanus-Santos, José E; Tostes, Rita C; Castro, Michele M

2017-10-01

Matrix metalloproteinase (MMP)-2 participates in hypertension-induced maladaptive vascular remodelling by degrading extra- and intracellular proteins. The consequent extracellular matrix rearrangement and phenotype switch of vascular smooth muscle cells (VSMCs) lead to increased cellular migration and proliferation. As calponin-1 degradation by MMP-2 may lead to VSMC proliferation during hypertension, the hypothesis of this study is that increased MMP-2 activity contributes to early hypertension-induced maladaptive remodelling in conductance and resistance arteries via regulation of calponin-1. The main objective was to analyse whether MMP-2 exerts similar effects on the structure and function of the resistance and conductance arteries during early hypertension. Two-kidney, one-clip (2K-1C) hypertensive male rats and corresponding controls were treated with doxycycline (30 mg/kg/day) or water until reaching one week of hypertension. Systolic blood pressure was increased in 2K-1C rats, and doxycycline did not reduce it. Aortas and mesenteric arteries were analysed. MMP-2 activity and expression were increased in both arteries, and doxycycline reduced it. Significant hypertrophic remodelling and VSMC proliferation were observed in aortas but not in mesenteric arteries of 2K-1C rats. The contractility of mesenteric arteries to phenylephrine was increased in 2K-1C rats, and doxycycline prevented this alteration. The potency of phenylephrine to contract aortas of 2K-1C rats was increased, and doxycycline decreased it. Whereas calponin-1 expression was increased in 2K-1C mesenteric arteries, calponin-1 was reduced in aortas. Doxycycline treatment reverted changes in calponin-1 expression. MMP-2 contributes to hypertrophic remodelling in aortas by decreasing calponin-1 levels, which may result in VSMC proliferation. On the other hand, MMP-2-dependent increased calponin-1 in mesenteric arteries may contribute to vascular hypercontractility in 2K-1C rats. Divergent regulation of calponin-1 by MMP-2 may be an important mechanism that leads to maladaptive vascular effects in hypertension. © 2017 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

40 CFR 60.3078 - What definitions must I know?

Code of Federal Regulations, 2010 CFR

2010-07-01

... shavings. Wood waste does not include: (1) Grass, grass clippings, bushes, shrubs, and clippings from bushes and shrubs from residential, commercial/retail, institutional, or industrial sources as part of..., flake board, and oriented strand board). Yard waste means grass, grass clippings, bushes, shrubs, and...

40 CFR 60.2977 - What definitions must I know?

Code of Federal Regulations, 2010 CFR

2010-07-01

... shavings. Wood waste does not include: (1) Grass, grass clippings, bushes, shrubs, and clippings from bushes and shrubs from residential, commercial/retail, institutional, or industrial sources as part of..., flake board, and oriented strand board). Yard waste means grass, grass clippings, bushes, shrubs, and...

21 CFR 886.3100 - Ophthalmic tantalum clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... blood vessels in the eye. (b) Classification. Class II (special controls). The device is exempt from the...) MEDICAL DEVICES OPHTHALMIC DEVICES Prosthetic Devices § 886.3100 Ophthalmic tantalum clip. (a) Identification. An ophthalmic tantalum clip is a malleable metallic device intended to be implanted permanently...

A graphical interface to CLIPS using SunView

NASA Technical Reports Server (NTRS)

Feagin, Terry

1990-01-01

The importance of the incorporation of various graphics-oriented features into CLIPS is discussed. These popular features, which have been implemented in a version of CLIPS developed for a popular workstation, are described and their usefulness in the development of expert systems is examined.

PubMed Central

Bédard, S; Desrochers, A; Fecteau, G; Higgins, R

2001-01-01

This study was designed to evaluate 4 preoperative skin preparations, that is, more specifically, to compare the efficacy of chlorhexidine gluconate (CG) and povidone-iodine (PI), as well as 2 hair removal techniques (clipper alone or clipper followed by razor) for preoperative skin preparation in cattle. The 4 protocols resulted in a significant decrease in the number of bacterial colony-forming units (cfu). Group 4 (clipping + shaving + CG) had a significantly lower number of preoperative cfu per gel plate compared with groups 1 (clipping + PI) and 3 (clipping + shaving + PI). Skin reaction frequency was significantly higher in groups 3 and 4 (47.8% for both protocols) than in groups 1 and 2 (clipping + PI or CG) (8.7% for both). Wound infection frequency was 4.3% (4/92) and no significant difference was observed between the 4 treatment groups. The 4 protocols tested were equivalent as to efficacy and satisfactorily decreased skin microflora. Clipping alone was shown to be preferable to clipping plus shaving as a method of hair removal in cattle, with fewer skin reactions and no more wound infections. PMID:11265188

Ruptured blebs and racing hearts: autonomic cardiac changes in neurosurgeons during microsurgical clipping of aneurysms.

PubMed

Ganne, Chaitanya; Talkad, Sathyaprabha N; Srinivas, Dwarakanath; Somanna, Sampath

2016-08-01

In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus the stress during microsurgical clipping of aneurysms. The aim of the current study is to evaluate the heart rate variability (HRV) of the neurosurgeons during microsurgical clipping of aneurysm by using continuous real time monitoring of the ECG intraoperatively. Lead II ECG was recorded using Bioharness(®) (Zephyr Technologies, Annapolis, MD) in 4 healthy neurosurgeons who performed 29 microsurgical clipping of aneurysms. ECG from 21 surgeries was analysed (LabChart(®) software, ADInstruments, Dunedin, New Zealand) across five stages: Baseline (BL), sylvian fissure dissection (SFD), perianeurysmal dissection (PAD), clipping of the aneurysm (CLIP) and haemostasis (HEMO). There was a reduction in TP and an increased LF/HF ratio in spite of suppression of both LF and HF powers. Contrary to the common understanding that the sympathetic limb of the autonomic system mostly mediates responses during stress and anxiety, we found that there was a significant contribution of the parasympathetic system too.

HYPERCLIPS

NASA Technical Reports Server (NTRS)

Hill, R. W.

1994-01-01

The integration of CLIPS into HyperCard combines the intuitive, interactive user interface of the Macintosh with the powerful symbolic computation of an expert system interpreter. HyperCard is an excellent environment for quickly developing the front end of an application with buttons, dialogs, and pictures, while the CLIPS interpreter provides a powerful inference engine for complex problem solving and analysis. In order to understand the benefit of integrating HyperCard and CLIPS, consider the following: HyperCard is an information storage and retrieval system which exploits the use of the graphics and user interface capabilities of the Apple Macintosh computer. The user can easily define buttons, dialog boxes, information templates, pictures, and graphic displays through the use of the HyperCard tools and scripting language. What is generally lacking in this environment is a powerful reasoning engine for complex problem solving, and this is where CLIPS plays a role. CLIPS 5.0 (C Language Integrated Production System, v5.0) was developed at the Johnson Space Center Software Technology Branch to allow artificial intelligence research, development, and delivery on conventional computers. CLIPS 5.0 supports forward chaining rule systems, object-oriented language, and procedural programming for the construction of expert systems. It features incremental reset, seven conflict resolution stategies, truth maintenance, and user-defined external functions. Since CLIPS is implemented in the C language it is highly portable; in addition, it is embeddable as a callable routine from a program written in another language such as Ada or Fortran. By integrating HyperCard and CLIPS the advantages and uses of both packages are made available for a wide range of applications: rapid prototyping of knowledge-based expert systems, interactive simulations of physical systems and intelligent control of hypertext processes, to name a few. HyperCLIPS 2.0 is written in C-Language (54%) and Pascal (46%) for Apple Macintosh computers running Macintosh System 6.0.2 or greater. HyperCLIPS requires HyperCard 1.2 or higher and at least 2Mb of RAM are recommended to run. An executable is provided. To compile the source code, the Macintosh Programmer's Workshop (MPW) version 3.0, CLIPS 5.0 (MSC-21927), and the MPW C-Language compiler are also required. NOTE: Installing this program under Macintosh System 7 requires HyperCard v2.1. This program is distributed on a 3.5 inch Macintosh format diskette. A copy of the program documentation is included on the diskette, but may be purchased separately. HyperCLIPS was developed in 1990 and version 2.0 was released in 1991. HyperCLIPS is a copyrighted work with all copyright vested in NASA. Apple, Macintosh, MPW, and HyperCard are registered trademarks of Apple Computer, Inc.

Modeling the effect of toe clipping on treefrog survival: Beyond the return rate

USGS Publications Warehouse

Waddle, J.H.; Rice, K.G.; Mazzotti, F.J.; Percival, H.F.

2008-01-01

Some studies have described a negative effect of toe clipping on return rates of marked anurans, but the return rate is limited in that it does not account for heterogeneity of capture probabilities. We used open population mark-recapture models to estimate both apparent survival (ϕ) and the recapture probability (p) of two treefrog species individually marked by clipping 2–4 toes. We used information-theoretic model selection to examine the effect of toe clipping on survival while accounting for variation in capture probability. The model selection results indicate strong support for an effect of toe clipping on survival of Green Treefrogs (Hyla cinerea) and only limited support for an effect of toe clipping on capture probability. We estimate there was a mean absolute decrease in survival of 5.02% and 11.16% for Green Treefrogs with three and four toes removed, respectively, compared to individuals with just two toes removed. Results for Squirrel Treefrogs (Hyla squirella) indicate little support for an effect of toe clipping on survival but may indicate some support for a negative effect on capture probability. We believe that the return rate alone should not be used to examine survival of marked animals because constant capture probability must be assumed, and our examples demonstrate how capture probability may vary over time and among groups. Mark-recapture models provide a method for estimating the effect of toe clipping on anuran survival in situations where unique marks are applied.

Measurement Of The Deformation Of Rail Track Fastening Clips By Holographic Interferometry

NASA Astrophysics Data System (ADS)

Ennos, A. E.

1985-01-01

One method of attaching railway rails to the sleepers (ties) is to use spring steel clips, mounted on either side of the rail, that exert a downward force on the foot of the rail. In service these will flex with the passing of a train. Holographic interferometry has been used to measure quantitatively the manner in which the spring clips deform when the rail is given a displacement in a prescribed direction. The information can be used both to provide data on the bending and torsion of the clip, and as a means of testing the validity of finite element analysis calculations. Measurements on three different designs of commercial clip were carried out on a section of sleeper holding a short length of rail. A controlled upward displacement of the rail was achieved pneumatically by means of plastic pipes interposed between rail and concrete sleeper. Double exposure holograms were recorded on large photographic plates, allowing views of the fringe patterns from widely spaced directions. The three components of displacement at points along the length of the clip were calculated from fringe information taken from nine directions, using least squares fit to obtain increased accuracy. Rotations of the surface were calculated from the fringe directions and spacings. In addition to deformation measurements of the clip under service conditions, information on local yielding of the clip under increasing stress was also obtained by means of real-time interferometry, using an instant hologram camera.

Accuracy assessment methods of tissue marker clip placement after 11-gauge vacuum-assisted stereotactic breast biopsy: comparison of measurements using direct and conventional methods.

PubMed

Yatake, Hidetoshi; Sawai, Yuka; Nishi, Toshio; Nakano, Yoshiaki; Nishimae, Ayaka; Katsuda, Toshizo; Yabunaka, Koichi; Takeda, Yoshihiro; Inaji, Hideo

2017-07-01

The objective of the study was to compare direct measurement with a conventional method for evaluation of clip placement in stereotactic vacuum-assisted breast biopsy (ST-VAB) and to evaluate the accuracy of clip placement using the direct method. Accuracy of clip placement was assessed by measuring the distance from a residual calcification of a targeted calcification clustered to a clip on a mammogram after ST-VAB. Distances in the craniocaudal (CC) and mediolateral oblique (MLO) views were measured in 28 subjects with mammograms recorded twice or more after ST-VAB. The difference in the distance between the first and second measurements was defined as the reproducibility and was compared with that from a conventional method using a mask system with overlap of transparent film on the mammogram. The 3D clip-to-calcification distance was measured using the direct method in 71 subjects. The reproducibility of the direct method was higher than that of the conventional method in CC and MLO views (P = 0.002, P < 0.001). The median 3D clip-to-calcification distance was 2.8 mm, with an interquartile range of 2.0-4.8 mm and a range of 1.1-36.3 mm. The direct method used in this study was more accurate than the conventional method, and gave a median 3D distance of 2.8 mm between the calcification and clip.

Spatially controlled coating of continuous liquid Interface production microneedles for transdermal protein delivery.

PubMed

Caudill, Cassie L; Perry, Jillian L; Tian, Shaomin; Luft, J Christopher; DeSimone, Joseph M

2018-06-09

Microneedle patches, arrays of micron-scale projections that penetrate skin in a minimally invasive manner, are a promising tool for transdermally delivering therapeutic proteins. However, current microneedle fabrication techniques are limited in their ability to fabricate microneedles rapidly and with a high degree of control over microneedle design parameters. We have previously demonstrated the ability to fabricate microneedle patches with a range of compositions and geometries using the novel additive manufacturing technique Continuous Liquid Interface Production (CLIP). Here, we establish a method for dip coating CLIP microneedles with protein cargo in a spatially controlled manner. Microneedle coating mask devices were fabricated with CLIP and utilized to coat polyethylene glycol-based CLIP microneedles with model proteins bovine serum albumin, ovalbumin, and lysozyme. The design of the coating mask device was used to control spatial deposition and loading of coated protein cargo on the microneedles. CLIP microneedles rapidly released coated protein cargo both in solution and upon insertion into porcine skin. The model enzyme lysozyme was shown to retain its activity throughout the CLIP microneedle coating process, and permeation of bovine serum albumin across full thickness porcine skin was observed after application with coated CLIP microneedles. Protein-coated CLIP microneedles were applied to live mice and showed sustained retention of protein cargo in the skin over 72 h. These results demonstrate the utility of a versatile coating platform for preparation of precisely coated microneedles for transdermal therapeutic delivery. Copyright © 2018. Published by Elsevier B.V.

Impulsivity Moderates the Effects of Movie Alcohol Portrayals on Adolescents’ Willingness to Drink

PubMed Central

Gibbons, Frederick X.; Kingsbury, John H.; Wills, Thomas A.; Finneran, Stephanie D.; Cin, Sonya Dal; Gerrard, Meg

2016-01-01

This study examined impulsivity as a moderator of adolescents’ reactions to positive vs. negative portrayals of drinking in American movie clips. Impulsivity, along with willingness and intentions to drink in the future, were assessed in a pretest session. In the experimental sessions, adolescents viewed a series of clips that showed drinking associated with either positive outcomes (e.g., social facilitation) or negative outcomes (fights, arguments). A third group viewed clips with similar positive or negative outcomes, but no alcohol consumption. All participants then responded to an implicit measure of attentional bias regarding alcohol (a dot probe), followed by explicit alcohol measures (self-reports of willingness and intentions to drink). Hypotheses, based on dual-processing theories, were: a) high-impulsive adolescents would respond more favorably than low-impulsive adolescents to the positive clips, but not the negative clips; and b) this difference in reactions to the positive clips would be larger on the willingness than the intention measures. Results supported the hypotheses: Adolescents high in impulsivity reported the highest willingness to drink in the positive-clip condition, but were slightly less willing than others in the negative-clip condition. In addition, results on the dot probe task indicated that reaction times to alcohol words were negatively correlated with changes in alcohol willingness, but not intention; i.e., the faster their response to the alcohol words, the more their willingness increased. The results highlight the utility of a dual-processing perspective on media influence. PMID:27099959

Digital video clips for improved pedagogy and illustration of scientific research — with illustrative video clips on atomic spectrometry

NASA Astrophysics Data System (ADS)

Michel, Robert G.; Cavallari, Jennifer M.; Znamenskaia, Elena; Yang, Karl X.; Sun, Tao; Bent, Gary

1999-12-01

This article is an electronic publication in Spectrochimica Acta Electronica (SAE), a section of Spectrochimica Acta Part B (SAB). The hardcopy text is accompanied by an electronic archive, stored on the CD-ROM accompanying this issue. The archive contains video clips. The main article discusses the scientific aspects of the subject and explains the purpose of the video files. Short, 15-30 s, digital video clips are easily controllable at the computer keyboard, which gives a speaker the ability to show fine details through the use of slow motion. Also, they are easily accessed from the computer hard drive for rapid extemporaneous presentation. In addition, they are easily transferred to the Internet for dissemination. From a pedagogical point of view, the act of making a video clip by a student allows for development of powers of observation, while the availability of the technology to make digital video clips gives a teacher the flexibility to demonstrate scientific concepts that would otherwise have to be done as 'live' demonstrations, with all the likely attendant misadventures. Our experience with digital video clips has been through their use in computer-based presentations by undergraduate and graduate students in analytical chemistry classes, and by high school and middle school teachers and their students in a variety of science and non-science classes. In physics teaching laboratories, we have used the hardware to capture digital video clips of dynamic processes, such as projectiles and pendulums, for later mathematical analysis.

Angiographic and epidemiological characteristics associated with aneurysm remnants after microsurgical clipping

PubMed Central

Dellaretti, Marcos; da Silva Martins, Warley Carvalho; Dourado, Jules Carlos; Faglioni, Wilson; Quadros, Ricardo Souza; de Souza Moraes, Vítor Vieira; de Souza Filho, Carlos Batista Alves

2017-01-01

Background: Despite new techniques for the treatment of cerebral aneurysms, the percentage of aneurysm remnants after surgical intervention seems to be relatively constant. The objective of this study was to assess angiographic and epidemiological features associated with aneurysm remnants after microsurgical clipping. Methods: This study was conducted from February 2009 to August 2012 on a series of 90 patients with 105 aneurysms referred to the Santa Casa of Belo Horizonte who were surgically treated and angiographically controlled. Results: Surgical clipping was considered incomplete in 13.3% of the aneurysms. The mean age of cases with an aneurysm remnant was 57.5 years, whereas the mean age without aneurysm remnant was 49.7 years (P = 0.02). Aneurysm remnants were detected more frequently on the internal carotid artery, nevertheless, no statistically significant differences were verified when comparing the locations. Aneurysm size in the preoperative angiography verified that the mean size of aneurysms operated was 6.56 mm, such that in cases showing a postoperative remnant, the mean size was 9.7 mm and in cases with complete clipping it was 6.08 mm (P = 0.02). Postoperative angiography showed that, in cases with residual aneurysm, the number of clips used was higher – a mean of 1.8 for complete clipping and 3.1 for incomplete clipping (P < 0.001). Conclusions: Aneurysm size and patient age showed significant correlations with residual intracranial aneurysm. The mean number of clips used was higher in cases with incomplete occlusion. PMID:28904825

Impact of Oncoming Headlight Glare With Cataracts: A Pilot Study

PubMed Central

Hwang, Alex D.; Tuccar-Burak, Merve; Goldstein, Robert; Peli, Eli

2018-01-01

Purpose: Oncoming headlight glare (HLG) reduces the visibility of objects on the road and may affect the safety of nighttime driving. With cataracts, the impact of oncoming HLG is expected to be more severe. We used our custom HLG simulator in a driving simulator to measure the impact of HLG on pedestrian detection by normal vision subjects with simulated mild cataracts and by patients with real cataracts. Methods: Five normal vision subjects drove nighttime scenarios under two HLG conditions (with and without HLG: HLGY and HLGN, respectively), and three vision conditions (with plano lens, simulated mild cataract, and optically blurred clip-on). Mild cataract was simulated by applying a 0.8 Bangerter diffusion foil to clip-on plano lenses. The visual acuity with the optically blurred lenses was individually chosen to match the visual acuity with the simulated cataract clip-ons under HLGN. Each nighttime driving scenario contains 24 pedestrian encounters, encompassing four pedestrian types; walking along the left side of the road, walking along the right side of the road, crossing the road from left to right, and crossing the road from right to left. Pedestrian detection performances of five patients with mild real cataracts were measured using the same setup. The cataract patients were tested only in HLGY and HLGN conditions. Participants’ visual acuity and contrast sensitivity were also measured in the simulator with and without stationary HLG. Results: For normal vision subjects, both the presence of oncoming HLG and wearing the simulated cataract clip-on reduced pedestrian detection performance. The subjects performed worst in events where the pedestrian crossed from the left, followed by events where the pedestrian crossed from the right. Significant interactions between HLG condition and other factors were also found: (1) the impact of oncoming HLG with the simulated cataract clip-on was larger than with the plano lens clip-on, (2) the impact of oncoming HLG was larger with the optically blurred clip-on than with the plano lens clip-on, but smaller than with the simulated cataract clip-on, and (3) the impact was larger for the pedestrians that crossed from the left than those that crossed from the right, and for the pedestrians walking along the left side of the road than walking along the right side of the road, suggesting that the pedestrian proximity to the glare source contributed to the performance reduction. Under HLGN, almost no pedestrians were missed with the plano lens or the simulated cataract clip-on (0 and 0.5%, respectively), but under HLGY, the rate of pedestrian misses increased to 0.5 and 6%, respectively. With the optically blurred clip-on, the percent of missed pedestrians under HLGN and HLGY did not change much (5% and 6%, respectively). Untimely response rate increased under HLGY with the plano lens and simulated cataract clip-ons, but the increase with the simulated cataract clip-on was significantly larger than with the plano lens clip-on. The contrast sensitivity with the simulated cataract clip-on was significantly degraded under HLGY. The visual acuity with the plano lens clip-on was significantly improved under HLGY, possibly due to pupil myosis. The impact of HLG measured for real cataract patients was similar to the impact on performance of normal vision subjects with simulated cataract clip-ons. Conclusion: Even with mild (simulated or real) cataracts, a substantial negative effect of oncoming HLG was measurable in the detection of crossing and walking-along pedestrians. The lowered pedestrian detection rates and longer response times with HLGY demonstrate a possible risk that oncoming HLG poses to patients driving with cataracts. PMID:29559933

21 CFR 882.4200 - Clip removal instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Clip removal instrument. 882.4200 Section 882.4200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4200 Clip removal instrument. (a...

21 CFR 882.4175 - Aneurysm clip applier.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a...

21 CFR 882.5225 - Implanted malleable clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted malleable clip. 882.5225 Section 882.5225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5225 Implanted malleable clip...

21 CFR 882.4190 - Clip forming/cutting instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Clip forming/cutting instrument. 882.4190 Section 882.4190 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4190 Clip forming...

21 CFR 882.5225 - Implanted malleable clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Implanted malleable clip. 882.5225 Section 882.5225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5225 Implanted malleable clip...

21 CFR 882.4175 - Aneurysm clip applier.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip applier. 882.4175 Section 882.4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4175 Aneurysm clip applier. (a...

21 CFR 882.5200 - Aneurysm clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm...

21 CFR 882.5200 - Aneurysm clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Aneurysm clip. 882.5200 Section 882.5200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5200 Aneurysm clip. (a) Identification. An aneurysm...

21 CFR 882.4200 - Clip removal instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Clip removal instrument. 882.4200 Section 882.4200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4200 Clip removal instrument. (a...

Implementing a frame representation in CLIPS/COOL

NASA Technical Reports Server (NTRS)

Myers, Leonard; Snyder, James

1991-01-01

An implementation is described and evaluated of frames in COOL. The test case is a frame based semantic network previously implemented in CLIPS (C Language Integrated Production System) Version 4.3 as part of the Intelligent Computer Aided Design System (ICADS) and reported at the first CLIPS conference.

21 CFR 878.4300 - Implantable clip.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Implantable clip. 878.4300 Section 878.4300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4300 Implantable clip. (a...

21 CFR 878.4300 - Implantable clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Implantable clip. 878.4300 Section 878.4300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4300 Implantable clip. (a...

21 CFR 878.4300 - Implantable clip.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Implantable clip. 878.4300 Section 878.4300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4300 Implantable clip. (a...

21 CFR 878.4300 - Implantable clip.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Implantable clip. 878.4300 Section 878.4300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4300 Implantable clip. (a...

21 CFR 878.4300 - Implantable clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implantable clip. 878.4300 Section 878.4300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4300 Implantable clip. (a...

Can We Use the Disposable Laparoscopic Clip Appliers as Suture Anchors? An In Vitro Feasibility Study.

PubMed

Buchholz, Vered; Sadot, Eran; Spivak, Hadar

2015-08-01

Intracorporeal suturing is time-consuming and could be difficult in certain operative circumstances. Instead of knot tying, specially designed clips have been introduced to anchor and secure the end of a single strand or suture. Although these clips provide a maximal required holding grip (HG), they considerably increase the cost of the procedure. The aim of this in vitro study was to identify the feasibility, and means of achieving the best HG, of commonly used disposable automatic clip appliers (LCAs) over regular strands. We placed 2-0 PDS (rigid) and 2-0 Vicryl (soft) sutures through fresh gastric wall specimens. Six different commercial-type LCAs, all having large or medium/large clips, were applied at the distal end of each suture. An IMDA manual digital force gauge was used to measure the HG of each clip at 2 positions: the middle clip position and the angle (at the crouch) position. A total of 192 measurements were taken. The results were classified into 3 HG levels measured by Newton units (N): the strongest grip (> 1 N), medium grip (> 0.5 and < 1 N), and weak grip (< 0.5 N). The strongest HG was obtained by applying 10 to 12 mm LCAs with large or medium/large clips over PDS at an angle position (HG = 1.1 ± 0.2 to 1.6 ± 0.3 N). The weakest grip was obtained by applying any type of LCA over Vicryl at the middle position (HG = 0.08 ± 0.04 to 0.2 ± 0.06 N, P < 0.001). The latter was associated with clips freely falling off the sutures even before applying any force. In general, more force was needed to dislodge any brand clip from the PDS compared with Vicryl suture (0.8 ± 0.6 vs. 0.4 ± 0.3 N, P < 0.001). The angle position was always stronger than the middle position (0.9 ± 0.6 vs. 0.3 ± 0.2 N, P < 0.001). There was a trend for the 10 to 12 mm LCA to have a better HG than the 5 mm ones (0.65 ± 0.5 vs. 0.51 ± 0.5 N, P = 0.08). We propose that 10 to 12 mm LCAs generate enough HG to secure a single strand when clips are placed at the angle position. This is especially true over PDS (hard) strands. The application of 5 mm LCA clips to secure the end of the Vicryl strand is not recommended. Further clinical studies are warranted.

Introduction of a simulation model for choledocho- and pancreaticojejunostomy.

PubMed

Narumi, Shunji; Toyoki, Yoshikazu; Ishido, Keinosuke; Kudo, Daisuke; Umehara, Minoru; Kimura, Norihisa; Miura, Takuya; Muroya, Takahiro; Hakamada, Kenichi

2012-10-01

Pancreaticoduodenectomy includes choledochojejunostomy and pancreaticojejunostomy, which require hand-sewn anastomoses. Educational simulation models for choledochojejunostomy and pancreaticojejunostomy have not been designed. We introduce a simulation model for choledochojejunostomy and pancreaticojejunostomy created with a skin closure pad and a vascular model. A wound closure pad and a vein model (4 mm diameter) were used as a stump model of the pancreas. Pancreaticojejunostomy was simulated with a stump model of the pancreas and a double layer bowel model; these models were stabilized in an end-to-side fashion on a magnetic board using magnetic clips. In addition, vein (6 or 8 mm diameter) and bowel models were used to simulate choledochojejunostomy. Pancreatic and hepatobiliary surgery are relatively rare, particularly in a community hospital although surgical residents wish to practice these procedures. Our simulator enables surgeons and surgical residents to practice choledocho- and pancreaticojejunostomy through open or laparoscopic approaches.

Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial Bypass Treatment.

PubMed

Cannizzaro, Delia; Peschillo, Simone; Mancarella, Cristina; La Pira, Biagia; Rastelli, Emanuela; Passacantilli, Emiliano; Santoro, Antonio

2017-06-01

Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Indocyanine green video-angiography as an aid to surgical treatment of spinal dural arteriovenous fistulae.

PubMed

Hettige, Samantha; Walsh, Daniel

2010-03-01

To illustrate the use of indocyanine green (ICG) video-angiography to confirm abolition of spinal dural arteriovenous fistula (SDAVF) and preserve the normal vascular anatomy intraoperatively. A 73-year-old woman presenting with progressive myelopathy was diagnosed with an SDAVF, where the origin of the fistula was in close proximity to the origin of the posterior spinal artery. ICG was injected intravenously. Using a filter on the microscope, dynamic filling of the abnormal vasculature was visualised. After applying a clip to the fistulous connection, we were able to see the successful interruption of the dural fistula, on-table in real time. ICG video angiography confirmed interruption of the fistula and preservation of the associated posterior spinal artery. We find the application of this relatively new technology has the potential to shorten operating times, gives additional reassurance of completeness of surgical treatment and preservation of normal spinal vasculature.

Chinese Language Video Clips. [CD-ROM].

ERIC Educational Resources Information Center

Fleming, Stephen; Hipley, David; Ning, Cynthia

This compact disc includes video clips covering six topics for the learner of Chinese: personal information, commercial transactions, travel and leisure, health and sports, food and school. Filmed on location in Beijing, these naturalistic video clips consist mainly of unrehearsed interviews of ordinary people. The learner is lead through a series…

21 CFR 870.3260 - Vena cava clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vena cava clip. 870.3260 Section 870.3260 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3260 Vena cava clip. (a) Identification. A vena...

A Simple Recipe for Whitening Old Newspaper Clippings.

ERIC Educational Resources Information Center

Carter, Henry A.

1995-01-01

Describes a method for experimenting with both whitening and deacidifying old newspaper clippings using sodium borohydride bleaching. Clippings are soaked in distilled water then immersed in sodium borohydride for 15-20 minutes. After rinsing with distilled water, the paper is washed with saturated Ca(OH)2 solution. Readers should not begin…

Understanding and Applying Psychology through Use of News Clippings.

ERIC Educational Resources Information Center

Rider, Elizabeth A.

1992-01-01

Discusses a student project for psychology courses in which students collect newspaper clippings that illustrate psychological concepts. Explains that the students record the source and write a brief description of the clipping, explaining how it relates to a psychological concept or theory. Includes results of student evaluations of the…

21 CFR 882.4190 - Clip forming/cutting instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Clip forming/cutting instrument. 882.4190 Section 882.4190 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.../cutting instrument. (a) Identification. A clip forming/cutting instrument is a device used by the...

21 CFR 870.3260 - Vena cava clip.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vena cava clip. 870.3260 Section 870.3260 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3260 Vena cava clip. (a) Identification. A vena...

Task acceptability and workload of driving city streets, rural roads, and expressways : ratings from video clips.

DOT National Transportation Integrated Search

2007-05-01

Subjects rated the workload of clips of forward road scenes (from the advanced collision avoidance system (ACAS) field operational test) in relation to 2 anchor clips of Level of Service (LOS) A and E (light and heavy traffic), and indicated if they ...

21 CFR 878.4320 - Removable skin clip.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Removable skin clip. 878.4320 Section 878.4320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4320 Removable skin clip. (a...

21 CFR 878.4320 - Removable skin clip.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Removable skin clip. 878.4320 Section 878.4320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4320 Removable skin clip. (a...

21 CFR 878.4320 - Removable skin clip.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Removable skin clip. 878.4320 Section 878.4320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4320 Removable skin clip. (a...

21 CFR 878.4320 - Removable skin clip.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Removable skin clip. 878.4320 Section 878.4320 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4320 Removable skin clip. (a...

Constructing complex graphics applications with CLIPS and the X window system

NASA Technical Reports Server (NTRS)

Faul, Ben M.

1990-01-01

This article will demonstrate how the artificial intelligence concepts in CLIPS used to solve problems encountered in the design and implementation of graphics applications within the UNIX-X Window System environment. The design of an extended version of CLIPS, called XCLIPS, is presented to show how the X Windows System graphics can be incorporated without losing DOS compatibility. Using XCLIPS, a sample scientific application is built that applies solving capabilities of both two and three dimensional graphics presentations in conjunction with the standard CLIPS features.

Attaching solar collectors to a structural framework utilizing a flexible clip

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

Kruse, John S

Methods and apparatuses described herein provide for the attachment of solar collectors to a structural framework in a solar array assembly. A flexible clip is attached to either end of each solar collector and utilized to attach the solar collector to the structural framework. The solar collectors are positioned to allow a member of the framework to engage a pair of flexible clips attached to adjacent solar collectors during assembly of the solar array. Each flexible clip may have multiple frame-engaging portions, each with a flange on one end to cause the flexible clip to deflect inward when engaged bymore » the framework member during assembly and to guide each of the frame-engaging portions into contact with a surface of the framework member for attachment.« less

The Use of Film Clips in a Viewing Time Task of Sexual Interests.

PubMed

Lalumière, Martin L; Babchishin, Kelly M; Ebsworth, Megan

2018-04-01

Viewing time tasks using still pictures to assess age and gender sexual interests have been well validated and are commonly used. The use of film clips in a viewing time task would open up interesting possibilities for the study of sexual interest toward sexual targets or activities that are not easily captured in still pictures. We examined the validity of a viewing time task using film clips to assess sexual interest toward male and female targets, in a sample of 52 young adults. Film clips produced longer viewing times than still pictures. For both men and women, the indices derived from the film viewing time task were able to distinguish individuals who identified as homosexual (14 men, 8 women) from those who identified as heterosexual (15 men, 15 women), and provided comparable group differentiation as indices derived from a viewing time task using still pictures. Men's viewing times were more gender-specific than those of women. Viewing times to film clips were correlated with participants' ratings of sexual appeal of the same clips, and with viewing times to pictures. The results support the feasibility of a viewing time measure of sexual interest that utilizes film clips and, thus, expand the types of sexual interests that could be investigated (e.g., sadism, biastophilia).

[Effects of clipping on nitrogen allocation strategy and compensatory growth of Leymus chinensis under saline-alkali conditions].

PubMed

Zheng, Cong Cong; Wang, Yong Jing; Sun, Hao; Wang, Xin Yu; Gao, Ying Zhi

2017-07-18

Soil salinization and overgrazing are two main factors limiting animal husbandry in the Songnen Grassland. Leymus chinensis is a dominant rhizome grass, resistant to grazing as well as to-lerant to salt stress. Foliar labeled with 15 N-urea was used to study the nitrogen allocation strategy and compensatory growth response to clipping under saline-alkali conditions. The results showed that the total absorbed 15 N allocated to the aboveground part was more than 60%. Compared with the control treatment (no saline-alkali, no clipping), saline-alkali increased the distribution of 15 N by 5.1% in root; the 15 N distribution into aboveground in the moderate clipping and saline-alkali treatment was 11.6% higher than that of the control, exhibiting over-compensatory growth of aboveground biomass and total biomass, however, 15 N allocated to stem base was significantly increased by 9.5% under severe clipping level and saline-alkali addition, showing under-compensatory growth of shoot, root and total biomass. These results suggested that L. chinensis adapted to mode-rate clipping by over-compensatory growth under salt-alkali stress condition. However, L. chinensis would take a relatively conservative growth strategy through the enhanced N allocation to stem base for storage under severe saline-alkali and clipping conditions.

Acquisition and processing pitfall with clipped traces in surface-wave analysis

NASA Astrophysics Data System (ADS)

Gao, Lingli; Pan, Yudi

2016-02-01

Multichannel analysis of surface waves (MASW) is widely used in estimating near-surface shear (S)-wave velocity. In the MASW method, generating a reliable dispersion image in the frequency-velocity (f-v) domain is an important processing step. A locus along peaks of dispersion energy at different frequencies allows the dispersion curves to be constructed for inversion. When the offsets are short, the output seismic data may exceed the dynamic ranges of geophones/seismograph, as a result of which, peaks and (or) troughs of traces will be squared off in recorded shot gathers. Dispersion images generated by the raw shot gathers with clipped traces would be contaminated by artifacts, which might be misidentified as Rayleigh-wave phase velocities or body-wave velocities and potentially lead to incorrect results. We performed some synthetic models containing clipped traces, and analyzed amplitude spectra of unclipped and clipped waves. The results indicate that artifacts in the dispersion image are dependent on the level of clipping. A real-world example also shows how clipped traces would affect the dispersion image. All the results suggest that clipped traces should be removed from the shot gathers before generating dispersion images, in order to pick accurate phase velocities and set reasonable initial inversion models.

Assessment of a simple, novel endoluminal method for gastrotomy closure in NOTES.

PubMed

Lee, Sang Soo; Oelschlager, Brant K; Wright, Andrew S; Soares, Renato V; Sinan, Huseyin; Montenovo, Martin I; Hwang, Joo Ha

2011-10-01

A reliable method for gastrotomy closure in NOTES will be essential for NOTES to become viable clinically. However, methods using existing and widely available endoscopic accessories have been ineffective. The objective of this study was to evaluate the feasibility and safety of a new simple method for gastric closure (retracted clip-assisted loop closure) that uses existing endoscopic accessories with minor modifications. The retracted clip-assisted loop closure technique involves deploying 3-4 Resolution(®) clips (modified by attaching a 90-cm length of suture to the end of each clip) along the margin of the gastrotomy with one jaw on the serosal surface and the other jaw on the mucosal surface. The suture strings are threaded through an endoloop. Traction is then applied to the strings causing the gastric wall to tent. The endoloop is secured below the tip of the clips, completing a full-thickness gastrotomy closure. The main outcome measures were feasibility, efficacy, and safety of the new retracted clip-assisted loop closure technique for NOTES gastrotomy closure. An air-tight seal was achieved in 100% (n = 9) of stomachs. The mean leak pressure was 116.3 (±19.4) mmHg. The retracted clip-assisted loop closure technique can be used to perform NOTES gastrotomy closure by using existing endoscopic accessories with minor modifications.

Smoking motives in movies are important for understanding adolescent smoking: A preliminary investigation

PubMed Central

Martino, Steven C.; Haviland, Amelia; Setodji, Claude; Primack, Brian A.

2010-01-01

Introduction: Exposure to smoking in movies is strongly associated with smoking uptake and maintenance among adolescents. However, little is known about what features of movies (e.g., the context for smoking or motives for a character smoking) moderate the association between exposure to movie smoking and adolescent smoking. This laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive is associated with the desire to smoke differently than smoking that is portrayed as having no clear motive. Methods: A sample of 77 middle school students (mean age of 12.8 years, 62% male, 60% Caucasian) viewed movie clips that portrayed smoking as helping to facilitate social interaction, to relax, to appear rebellious, or as having no clear motive. After exposure to each clip, participants rated their desire to smoke. Results: Exposure to clips where smoking was portrayed as helping characters to relax was associated with a significantly stronger desire to smoke compared with clips where the motive for smoking was unclear. Desire to smoke was similar for clips where no motive was clear, social smoking clips, and rebellious smoking clips. Discussion: These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking. PMID:20576800

Smoking motives in movies are important for understanding adolescent smoking: a preliminary investigation.

PubMed

Shadel, William G; Martino, Steven C; Haviland, Amelia; Setodji, Claude; Primack, Brian A

2010-08-01

Exposure to smoking in movies is strongly associated with smoking uptake and maintenance among adolescents. However, little is known about what features of movies (e.g., the context for smoking or motives for a character smoking) moderate the association between exposure to movie smoking and adolescent smoking. This laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive is associated with the desire to smoke differently than smoking that is portrayed as having no clear motive. A sample of 77 middle school students (mean age of 12.8 years, 62% male, 60% Caucasian) viewed movie clips that portrayed smoking as helping to facilitate social interaction, to relax, to appear rebellious, or as having no clear motive. After exposure to each clip, participants rated their desire to smoke. Exposure to clips where smoking was portrayed as helping characters to relax was associated with a significantly stronger desire to smoke compared with clips where the motive for smoking was unclear. Desire to smoke was similar for clips where no motive was clear, social smoking clips, and rebellious smoking clips. These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking.

Anticipation of high arousal aversive and positive movie clips engages common and distinct neural substrates

PubMed Central

Carlson, Joshua M.; Rubin, Denis; Cha, Jiook; Mujica-Parodi, Lilianne

2015-01-01

The neural correlates of anxious anticipation have been primarily studied with aversive and neutral stimuli. In this study, we examined the effect of valence on anticipation by using high arousal aversive and positive stimuli and a condition of uncertainty (i.e. either positive or aversive). The task consisted of predetermined cues warning participants of upcoming aversive, positive, ‘uncertain’ (either aversive or positive) and neutral movie clips. Anticipation of all affective clips engaged common regions including the anterior insula, dorsal anterior cingulate cortex, thalamus, caudate, inferior parietal and prefrontal cortex that are associated with emotional experience, sustained attention and appraisal. In contrast, the nucleus accumbens and medial prefrontal cortex, regions implicated in reward processing, were selectively engaged during anticipation of positive clips (depicting sexually explicit content) and the mid-insula, which has been linked to processing aversive stimuli, was selectively engaged during anticipation of aversive clips (depicting graphic medical procedures); these three areas were also activated during anticipation of ‘uncertain’ clips reflecting a broad preparatory response for both aversive and positive stimuli. These results suggest that a common circuitry is recruited in anticipation of affective clips regardless of valence, with additional areas preferentially engaged depending on whether expected stimuli are negative or positive. PMID:24984958

The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling.

PubMed

Mera Fernández, D; Santos Armentia, E; Bustos Fiore, A; Villanueva Campos, A M; Utrera Pérez, E; Souto Bayarri, M

2018-04-23

To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Coheńs κ statistic was used to determine interobserver agreement. The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Peptides-Derived from Thai Rice Bran Improves Endothelial Function in 2K-1C Renovascular Hypertensive Rats

PubMed Central

Boonla, Orachorn; Kukongviriyapan, Upa; Pakdeechote, Poungrat; Kukongviriyapan, Veerapol; Pannangpetch, Patchareewan; Thawornchinsombut, Supawan

2015-01-01

In recent years, a number of studies have investigated complementary medical approaches to the treatment of hypertension using dietary supplements. Rice bran protein hydrolysates extracted from rice is a rich source of bioactive peptides. The present study aimed to investigate the vasorelaxation and antihypertensive effects of peptides-derived from rice bran protein hydrolysates (RBP) in a rat model of two kidney-one clip (2K-1C) renovascular hypertension. 2K-1C hypertension was induced in male Sprague-Dawley rats by placing a silver clip around the left renal artery, whereas sham-operated rats were served as controls. 2K-1C and sham-operated rats were intragastrically administered with RBP (50 mg·kg−1 or 100 mg·kg−1) or distilled water continuously for six weeks. We observed that RBP augmented endothelium-dependent vasorelaxation in all animals. Administration of RBP to 2K-1C rats significantly reduced blood pressure and decreased peripheral vascular resistance compared to the sham operated controls (p < 0.05). Restoration of normal endothelial function and blood pressure was associated with reduced plasma angiotensin converting enzyme (ACE), decreased superoxide formation, reduced plasma malondialdehyde and increased plasma nitrate/nitrite (p < 0.05). Up-regulation of eNOS protein and down-regulation of p47phox protein were found in 2K-1C hypertensive rats-treated with RBP. Our results suggest that RBP possesses antihypertensive properties which are mainly due to the inhibition of ACE, and its vasodilatory and antioxidant activity. PMID:26184305

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip.

PubMed

Kaneko, Hidehiro; Neuss, Michael; Schau, Thomas; Weissenborn, Jens; Butter, Christian

2017-02-01

MitraClip (MC; Abbott Vascular, Menlo Park, CA, USA) is a treatment option for mitral regurgitation. Renal dysfunction is closely associated with cardiovascular disease. However, the influence of renal function in MC remains not fully understood. In this study, we aimed to clarify the association between renal function and MC. We examined 206 consecutive patients who underwent MC and divided patients into 3 groups according to estimated glomerular filtration rate (eGFR), normal eGFR (≥60mL/min/1.73m 2 ) (n=70), mild chronic kidney disease (CKD) (30-59mL/min/1.73m 2 ) (n=106), and severe CKD (<30mL/min/1.73m 2 ) (n=30). N-terminal pro-B type natriuretic peptide (NT-pro BNP) levels increased with decreasing eGFR. Kaplan-Meier curves revealed that the long-term survival rate significantly decreased with eGFR. After adjustment with the covariates, severe CKD was still associated with mortality. Improved renal function was observed in 30% and associated with baseline lower NT-pro BNP levels. Patients with improved renal function had higher chronic phase survival rate. Renal dysfunction is common in MC patients and the survival rate decreased with eGFR in association with increased NT-pro BNP levels. MC may improve renal function in approximately 30% of MC patients. Improved renal function is associated with lower NT-pro BNP levels and results in satisfactory prognosis. These results implies a close association between renal function and MC treatment. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Macrovascular Decompression of the Brainstem and Cranial Nerves: Evolution of an Anteromedial Vertebrobasilar Artery Transposition Technique.

PubMed

Choudhri, Omar; Connolly, Ian D; Lawton, Michael T

2017-08-01

Tortuous and dolichoectatic vertebrobasilar arteries can impinge on the brainstem and cranial nerves to cause compression syndromes. Transposition techniques are often required to decompress the brainstem with dolichoectatic pathology. We describe our evolution of an anteromedial transposition technique and its efficacy in decompressing the brainstem and relieving symptoms. To present the anteromedial vertebrobasilar artery transposition technique for macrovascular decompression of the brainstem and cranial nerves. All patients who underwent vertebrobasilar artery transposition were identified from the prospectively maintained database of the Vascular Neurosurgery service, and their medical records were reviewed retrospectively. The extent of arterial displacement was measured pre- and postoperatively on imaging. Vertebrobasilar arterial transposition and macrovascular decompression was performed in 12 patients. Evolution in technique was characterized by gradual preference for the far-lateral approach, use of a sling technique with muslin wrap, and an anteromedial direction of pull on the vertebrobasilar artery with clip-assisted tethering to the clival dura. With this technique, mean lateral displacement decreased from 6.6 mm in the first half of the series to 3.8 mm in the last half of the series, and mean anterior displacement increased from 0.8 to 2.5 mm, with corresponding increases in satisfaction and relief of symptoms. Compressive dolichoectatic pathology directed laterally into cranial nerves and posteriorly into the brainstem can be corrected with anteromedial transposition towards the clivus. Our technique accomplishes this anteromedial transposition from an inferolateral surgical approach through the vagoaccessory triangle, with sling fixation to clival dura using aneurysm clips. Copyright © 2017 by the Congress of Neurological Surgeons

Sympathetic block by metal clips may be a reversible operation.

PubMed

Thomsen, Lars L; Mikkelsen, Rasmus T; Derejko, Miroslawa; Schrøder, Henrik D; Licht, Peter B

2014-12-01

Thoracoscopic sympathectomy is now used routinely to treat patients with disabling primary hyperhidrosis or facial blushing. Published results are excellent, but side effects, such as compensatory sweating, are also very frequent. The surgical techniques used and the levels of targeting the sympathetic chain vary tremendously. Most surgeons transect or resect the sympathetic chain, but application of a metal clip that blocks transmission of nerve impulses in the sympathetic chain is used increasingly worldwide. This approach offers potential reversibility if patients regret surgery, but the question of reversibility remains controversial. Two recent experimental studies found severe histological signs of nerve damage 4-6 weeks after clip removal, but they only used conventional histopathological staining methods. Thoracoscopic clipping of the sympathetic trunk was performed in adult sheep, and the clip was removed thoracoscopically after 7 days. Following another 4 weeks (n = 6) or 12 weeks (n = 3), the sympathetic trunks were harvested and analysed by conventional and specific nerve tissue immunohistochemical stains (S100, neurofilament protein and synaptophysin). The contralateral sympathetic chains were used as controls. Conventional and immunohistochemical stains demonstrated severe signs of neural damage on the operated side 4 weeks after clip removal. After 12 weeks, these changes had decreased markedly and conventional histology had almost normalized. Conventional and immunohistochemical stains confirmed that application of metal clips to the sympathetic chain caused severe histological damage in the sympathetic trunk that remained visible 4 weeks after clip removal. However, after 12 weeks, these signs of damage had clearly decreased, which suggests in theory that application of metal clips to the sympathetic chain is a reversible procedure if only the observation period is prolonged. Further studies with longer periods between application and removal as well as investigations of nerve conduction should be encouraged, because we do not know whether histological reversibility at cellular level translates into physiological reversibility and possible correlation of nerve trauma with the duration of the applied clip. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

CLIPS, AppleEvents, and AppleScript: Integrating CLIPS with commercial software

NASA Technical Reports Server (NTRS)

Compton, Michael M.; Wolfe, Shawn R.

1994-01-01

Many of today's intelligent systems are comprised of several modules, perhaps written in different tools and languages, that together help solve the user's problem. These systems often employ a knowledge-based component that is not accessed directly by the user, but instead operates 'in the background' offering assistance to the user as necessary. In these types of modular systems, an efficient, flexible, and eady-to-use mechanism for sharing data between programs is crucial. To help permit transparent integration of CLIPS with other Macintosh applications, the AI Research Branch at NASA Ames Research Center has extended CLIPS to allow it to communicate transparently with other applications through two popular data-sharing mechanisms provided by the Macintosh operating system: Apple Events (a 'high-level' event mechanism for program-to-program communication), and AppleScript, a recently-released scripting language for the Macintosh. This capability permits other applications (running on either the same or a remote machine) to send a command to CLIPS, which then responds as if the command were typed into the CLIPS dialog window. Any result returned by the command is then automatically returned to the program that sent it. Likewise, CLIPS can send several types of Apple Events directly to other local or remote applications. This CLIPS system has been successfully integrated with a variety of commercial applications, including data collection programs, electronics forms packages, DBMS's, and email programs. These mechanisms can permit transparent user access to the knowledge base from within a commercial application, and allow a single copy of the knowledge base to service multiple users in a networked environment.

Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization

PubMed Central

TOYOTA, Shingo; TAKI, Takuyu; WAKAYAMA, Akatsuki; YOSHIMINE, Toshiki

2015-01-01

Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment. PMID:26437796

Retreatment of Recurrent Internal Carotid-Posterior Communicating Artery Aneurysm after Coil Embolization.

PubMed

Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

2015-01-01

Internal carotid-posterior communicating artery (IC-PC) aneurysms account for more than 20% of all intracranial aneurysms. As a result of the increase in coiling, there has also been an increase in recurrent IC-PC aneurysms after coiling. We present our experience of 10 recurrent IC-PC aneurysms after coiling that were retreated using surgical or endovascular techniques in order to discuss the choice of treatment and the points of clipping without removal of coils. From 2007 to 2014, 10 recurrent IC-PC aneurysms after coiling were retreated. When the previous frames covered the aneurysms all around or almost around except a part of the neck, coiling was chosen. In other cases, clipping was chosen. Clipping was attempted without removal of coils when it was technically feasible. Among the 10 IC-PC aneurysms retreated, 3 were retreated with coiling and 7 were retreated with clipping. In all three cases retreated with coiling, almost complete occlusion was accomplished. In the seven cases retreated with clipping, coil extrusion was observed during surgery in six cases. In most of them, it was necessary to dissect strong adhesions around the coiled aneurysms and to utilize temporary occlusion of the internal carotid artery. In all seven cases, neck clipping was accomplished without the removal of coils. There were no neurological complications in any cases. The management of recurrent lesions of embolized IC-PC aneurysms requires appropriate choice of treatment using both coiling and clipping. Clipping, especially without the removal of coils, plays an important role in safe treatment.

Zirconia-Polyurethane Aneurysm Clip.

PubMed

Cho, Won-Sang; Cho, Kyung-Il; Kim, Jeong Eun; Jang, Tae-Sik; Ha, Eun Jin; Kang, Hyun-Seung; Son, Young-Je; Choi, Seung Hong; Lee, Seunghyun; Kim, Chong-Chan; Sun, Jeong-Yun; Kim, Hyoun-Ee

2018-03-27

Susceptibility artifacts from metal clips in magnetic resonance (MR) imaging present an obstacle to evaluating the status of clipped aneurysms, parent arteries and adjacent brain parenchyma. We aimed to develop MR-compatible aneurysm clips. Considering the mechanical and biological properties, and MR compatibility of candidate materials, a prototype clip with a zirconia body and a polyurethane head spring (ZC, straight, 9-mm long) was developed. The closing forces, opening width of blades, and in vitro and in vivo artifact volumes in 3 tesla MR imaging were compared among the prototype and commercial metal clips such as a Yasargil ® clip (YC, curved type, 8.3-mm long) and a Sugita ® clip (SC, straight type, 10-mm long). An in vivo animal study was performed with a canine venous pouch aneurysm model. The closing forces (N) at 1 and 8 mm from the blade tip were 2.09 and 3.77 in YC, 1.85 and 3.04 in SC, and 2.05 and 4.60 in ZC. The maximum opening widths (mm) was 6.8, 9.0, and 3.0 in YC, SC, and ZC, respectively. The in vitro artifact volumes of YC, SC and ZC in time-of-flight MR imaging were 26.9, 29.7 and 1.9 times larger than the respective real volumes. The in vivo artifact volumes of YC, SC, and ZC were respectively 21.4, 29.4, and 2.6 times larger than real ones. ZC showed the smallest susceptibility artifacts and satisfactory closing forces. However, the narrow opening width of the blades was a weak point. Copyright © 2018. Published by Elsevier Inc.

Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

PubMed

Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

2014-02-20

Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

Impulsivity moderates the effects of movie alcohol portrayals on adolescents' willingness to drink.

PubMed

Gibbons, Frederick X; Kingsbury, John H; Wills, Thomas A; Finneran, Stephanie D; Dal Cin, Sonya; Gerrard, Meg

2016-05-01

This study examined impulsivity as a moderator of adolescents' reactions to positive versus negative portrayals of drinking in American movie clips. Impulsivity, along with willingness and intentions to drink in the future, were assessed in a pretest session. In the experimental sessions, adolescents viewed a series of clips that showed drinking associated with either positive outcomes (e.g., social facilitation) or negative outcomes (fights, arguments). A third group viewed clips with similar positive or negative outcomes, but no alcohol consumption. All participants then responded to an implicit measure of attentional bias regarding alcohol (a dot probe), followed by explicit alcohol measures (self-reports of willingness and intentions to drink). Hypotheses, based on dual-processing theories, were: (a) high-impulsive adolescents would respond more favorably than low-impulsive adolescents to the positive clips, but not the negative clips; and (b) this difference in reactions to the positive clips would be larger on the willingness than the intention measures. Results supported the hypotheses: Adolescents high in impulsivity reported the highest willingness to drink in the positive-clip condition, but were slightly less willing than others in the negative-clip condition. In addition, results on the dot probe task indicated that RTs to alcohol words were negatively correlated with changes in alcohol willingness, but not intention; that is, the faster their response to the alcohol words, the more their willingness increased. The results highlight the utility of a dual-processing perspective on media influence. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Fabrication and Characterization of ZnO Nano-Clips by the Polyol-Mediated Process

NASA Astrophysics Data System (ADS)

Wang, Mei; Li, Ai-Dong; Kong, Ji-Zhou; Gong, You-Pin; Zhao, Chao; Tang, Yue-Feng; Wu, Di

2018-02-01

ZnO nano-clips with better monodispersion were prepared successfully using zinc acetate hydrate (Zn(OAc)2·nH2O) as Zn source and ethylene glycol (EG) as solvent by a simple solution-based route-polyol process. The effect of solution concentration on the formation of ZnO nano-clips has been investigated deeply. We first prove that the 0.01 M Zn(OAc)2·nH2O can react with EG without added water or alkaline, producing ZnO nano-clips with polycrystalline wurtzite structure at 170 °C. As-synthesized ZnO nano-clips contain a lot of aggregated nanocrystals ( 5 to 15 nm) with high specific surface area of 88 m2/g. The shapes of ZnO nano-clips basically keep constant with improved crystallinity after annealing at 400-600 °C. The lower solution concentration and slight amount of H2O play a decisive role in ZnO nano-clip formation. When the solution concentration is ≤ 0.0125 M, the complexing and polymerization reactions between Zn(OAc)2·nH2O and EG predominate, mainly elaborating ZnO nano-clips. When the solution concentration is ≥ 0.015 M, the alcoholysis and polycondensation reactions of Zn(OAc)2·nH2O and EG become dominant, leading to ZnO particle formation with spherical and elliptical shapes. The possible growth mechanism based on a competition between complexing and alcoholysis of Zn(OAc)2·nH2O and EG has been proposed.

A clip domain serine protease involved in moulting in the silkworm, Bombyx mori: cloning, characterization, expression patterns and functional analysis.

PubMed

Liu, H-W; Wang, L-L; Meng, Z; Tang, X; Li, Y-S; Xia, Q-Y; Zhao, P

2017-10-01

Clip domain serine proteases (CLIPs), characterized by one or more conserved clip domains, are essential components of extracellular signalling cascades in various biological processes, especially in innate immunity and the embryonic development of insects. Additionally, CLIPs may have additional non-immune functions in insect development. In the present study, the clip domain serine protease gene Bombyx mori serine protease 95 (BmSP95), which encodes a 527-residue protein, was cloned from the integument of B. mori. Bioinformatics analysis indicated that BmSP95 is a typical CLIP of the subfamily D and possesses a clip domain at the N terminus, a trypsin-like serine protease (tryp_spc) domain at the C terminus and a conserved proline-rich motif between these two domains. At the transcriptional level, BmSP95 is expressed in the integument during moulting and metamorphosis, and the expression pattern is consistent with the fluctuating 20-hydroxyecdysone (20E) titre in B. mori. At the translational level, BmSP95 protein is synthesized in the epidermal cells, secreted as a zymogen and activated in the moulting fluid. Immunofluorescence revealed that BmSP95 is distributed into the old endocuticle in the moulting stage. The expression of BmSP95 was upregulated by 20E. Moreover, expression of BmSP95 was downregulated by pathogen infection. RNA interference-mediated silencing of BmSP95 led to delayed moulting from pupa to moth. These results suggest that BmSP95 is involved in integument remodelling during moulting and metamorphosis. © 2017 The Royal Entomological Society.

Using Humorous Sitcom Clips in Teaching Federal Income Taxes

ERIC Educational Resources Information Center

Cecil, H. Wayne

2014-01-01

This article shares the motivation, process, and outcomes of using humorous scenes from television comedies to teach the real world of tax practice. The article advances the literature by reviewing the use of video clips in a previously unexplored discipline, discussing the process of identifying and selecting appropriate clips, and introducing…

Assessment of Caudal Fin Clips as a Non-lethal Technique for Predicting Muscle Tissue Mercury Concentrations in Largeouth Bass

EPA Science Inventory

The statistical relationship between total mercury (Hg) concentration in clips from the caudal fin and muscle tissue of largemouth bass (Micropterus salmoides) from 26 freshwater sites in Rhode Island, USA was developed and evaluated to determine the utility of fin clip analysis ...

Capturing Students' Attention: Movie Clips Set the Stage for Learning in Abnormal Psychology.

ERIC Educational Resources Information Center

Badura, Amy S.

2002-01-01

Presents results of a study that evaluated using popular movie clips, shown in the first class meeting of an abnormal psychology course, in relation to student enthusiasm. Compares two classes of female juniors, one using clips and one class not using them. States that the films portrayed psychological disorders. (CMK)

First CLIPS Conference Proceedings, volume 2

NASA Technical Reports Server (NTRS)

1990-01-01

The topics of volume 2 of First CLIPS Conference are associated with following applications: quality control; intelligent data bases and networks; Space Station Freedom; Space Shuttle and satellite; user interface; artificial neural systems and fuzzy logic; parallel and distributed processing; enchancements to CLIPS; aerospace; simulation and defense; advisory systems and tutors; and intelligent control.

Mapping Argonaute and conventional RNA-binding protein interactions with RNA at single-nucleotide resolution using HITS-CLIP and CIMS analysis

PubMed Central

Moore, Michael; Zhang, Chaolin; Gantman, Emily Conn; Mele, Aldo; Darnell, Jennifer C.; Darnell, Robert B.

2014-01-01

Summary Identifying sites where RNA binding proteins (RNABPs) interact with target RNAs opens the door to understanding the vast complexity of RNA regulation. UV-crosslinking and immunoprecipitation (CLIP) is a transformative technology in which RNAs purified from in vivo cross-linked RNA-protein complexes are sequenced to reveal footprints of RNABP:RNA contacts. CLIP combined with high throughput sequencing (HITS-CLIP) is a generalizable strategy to produce transcriptome-wide RNA binding maps with higher accuracy and resolution than standard RNA immunoprecipitation (RIP) profiling or purely computational approaches. Applying CLIP to Argonaute proteins has expanded the utility of this approach to mapping binding sites for microRNAs and other small regulatory RNAs. Finally, recent advances in data analysis take advantage of crosslinked-induced mutation sites (CIMS) to refine RNA-binding maps to single-nucleotide resolution. Once IP conditions are established, HITS-CLIP takes approximately eight days to prepare RNA for sequencing. Established pipelines for data analysis, including for CIMS, take 3-4 days. PMID:24407355

Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series.

PubMed

Schmidt, Arthur; Riecken, Bettina; Damm, Michael; Cahyadi, Oscar; Bauder, Markus; Caca, Karel

2014-09-01

Over-the-scope clips (OTSCs; Ovesco Endoscopy, Tübingen, Germany) are extensively used for treatment of gastrointestinal perforations, leakages, fistulas, and bleeding. In this report, a new method of removing OTSCs using a prototype bipolar cutting device is described. A total of 11 patients underwent endoscopic removal of an OTSC. The OTSC was cut at two opposing sites by a prototype device (DC ClipCutter; Ovesco Endoscopy). The remaining clip fragments were extracted using a standard forceps. Mean procedure time was 47 minutes (range 35 - 75 minutes). Cutting of the OTSC at two opposing sites was successful in all cases (100 %). Complete retrieval of all clip fragments was possible in 10 patients (91 %). The overall success rate for cutting and complete removal of the clip was 91 %. No major complications were observed. Removal of OTSCs with the prototype device was feasible and effective. The device may be valuable for OTSC removal in emergency as well as elective indications. © Georg Thieme Verlag KG Stuttgart · New York.

Analysis of left atrial respiratory and cardiac motion for cardiac ablation therapy

NASA Astrophysics Data System (ADS)

Rettmann, M. E.; Holmes, D. R.; Johnson, S. B.; Lehmann, H. I.; Robb, R. A.; Packer, D. L.

2015-03-01

Cardiac ablation therapy is often guided by models built from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans. One of the challenges in guiding a procedure from a preoperative model is properly synching the preoperative models with cardiac and respiratory motion through computational motion models. In this paper, we describe a methodology for evaluating cardiac and respiratory motion in the left atrium and pulmonary veins of a beating canine heart. Cardiac catheters were used to place metal clips within and near the pulmonary veins and left atrial appendage under fluoroscopic and ultrasound guidance and a contrast-enhanced, 64-slice multidetector CT scan was collected with the clips in place. Each clip was segmented from the CT scan at each of the five phases of the cardiac cycle at both end-inspiration and end-expiration. The centroid of each segmented clip was computed and used to evaluate both cardiac and respiratory motion of the left atrium. A total of three canine studies were completed, with 4 clips analyzed in the first study, 5 clips in the second study, and 2 clips in the third study. Mean respiratory displacement was 0.2+/-1.8 mm in the medial/lateral direction, 4.7+/-4.4 mm in the anterior/posterior direction (moving anterior on inspiration), and 9.0+/-5.0 mm superior/inferior (moving inferior with inspiration). At end inspiration, the mean left atrial cardiac motion at the clip locations was 1.5+/-1.3 mm in the medial/lateral direction, and 2.1+/-2.0 mm in the anterior/posterior and 1.3+/-1.2 mm superior/inferior directions. At end expiration, the mean left atrial cardiac motion at the clip locations was 2.0+/-1.5mm in the medial/lateral direction, 3.0+/-1.8mm in the anterior/posterior direction, and 1.5+/-1.5 mm in the superior/inferior directions.

Public Awareness of Melioidosis in Thailand and Potential Use of Video Clips as Educational Tools

PubMed Central

Chansrichavala, Praveen; Wongsuwan, Nittayasee; Suddee, Suthee; Malasit, Mayura; Hongsuwan, Maliwan; Wannapinij, Prapass; Kitphati, Rungreung; Day, Nicholas P. J.; Michie, Susan; Peacock, Sharon J.; Limmathurotsakul, Direk

2015-01-01

Background Melioidosis causes more than 1,000 deaths in Thailand each year. Infection occurs via inoculation, ingestion or inhalation of the causative organism (Burkholderia pseuodmallei) present in soil and water. Here, we evaluated public awareness of melioidosis using a combination of population-based questionnaire, a public engagement campaign to obtain video clips made by the public, and viewpoints on these video clips as potential educational tools about the disease and its prevention. Methods A questionnaire was developed to evaluate public awareness of melioidosis, and knowledge about its prevention. From 1 March to 31 April 2012, the questionnaire was delivered to five randomly selected adults in each of 928 districts in Thailand. A video clip contest entitled “Melioidosis, an infectious disease that Thais must know” was run between May and October 2012. The best 12 video clips judged by a contest committee were shown to 71 people at risk from melioidosis (diabetics). Focus group interviews were used to evaluate their perceptions of the video clips. Results Of 4,203 Thais who completed our study questionnaire, 74% had never heard of melioidosis, and 19% had heard of the disease but had no further knowledge. Most participants in all focus group sessions felt that video clips were beneficial and could positively influence them to increase adherence to recommended preventive behaviours, including drinking boiled water and wearing protective gear if in contact with soil or environmental water. Participants suggested that video clips should be presented in the local dialect with simple words rather than medical terms, in a serious manner, with a doctor as the one presenting the facts, and having detailed pictures of each recommended prevention method. Conclusions In summary, public awareness of melioidosis in Thailand is very low, and video clips could serve as a useful medium to educate people and promote disease prevention. Presented in Part World Melioidosis Congress 2013, Bangkok, Thailand, 18–20 September 2013 (abstract OS VII-04). PMID:25803048

A Systematic Review and Meta-Analysis on Economic Comparison Between Endovascular Coiling Versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms.

PubMed

Zhang, Xiaoxi; Li, Li; Hong, Bo; Xu, Yi; Liu, Yuan; Huang, Qinghai; Liu, Jianmin

2018-05-01

Healthcare expenditures and cost reduction have been under critical surveillance in all countries and are critical for policymakers. This review aims at qualitatively and quantitatively analyzing the difference of hospital costs and length of stay between endovascular coiling versus neurosurgical clipping in ruptured intracranial aneurysms (RAs). MEDLINE, the Cochrane database, Embase, and the Web of Science database were searched and evaluated independently by 2 authors according to the Newcastle-Ottawa Scale for cohort studies describing economic hospital cost or length of stay in patients with RAs. A total of 8 studies were included, describing 24,219 RAs treated with neurosurgical clipping and 24,962 RAs with endovascular coiling. Meta-analysis revealed that the total hospital costs (THCs) were similar between coiling versus clipping in RAs (standard mean difference [SMD], -0.05; 95% confidence interval [CI], -0.12 to 0.22; I 2  = 99%; P = 0.50). Subgroup analysis showed that THCs of clipping and coiling were similar in ruptured aneurysms in the United States. However, in South Korea, the THCs of coiling were significantly higher than clipping. In the long run, 1-year medical costs of endovascular treatment were significantly lower than that of clipping in RAs (SMD, 0.15; 95% CI, 0.05-0.25; I 2  = 66%; P = 0.005). In addition, the length of stay of coiled patients was significantly shorter than clipped patients (SMD, 0.29; 95% CI, 0.13-0.45; I 2  = 96%; P < 0.001). Medical costs were region-specified. In the United States, total hospital costs and 1-year medical costs were similar in RA patients treated with endovascular coiling and neurosurgical clipping. However, in countries like South Korea and China, coiling was more expensive. The length of stay was much shorter in coiled patients in all countries. Copyright © 2018. Published by Elsevier Inc.

Maintainable substrate carrier for electroplating

DOEpatents

Chen, Chen-An [Milpitas, CA; Abas, Emmanuel Chua [Laguna, PH; Divino, Edmundo Anida [Cavite, PH; Ermita, Jake Randal G [Laguna, PH; Capulong, Jose Francisco S [Laguna, PH; Castillo, Arnold Villamor [Batangas, PH; Ma,; Xiaobing, Diana [Saratoga, CA

2012-07-17

One embodiment relates to a substrate carrier for use in electroplating a plurality of substrates. The carrier includes a non-conductive carrier body on which the substrates are placed and conductive lines embedded within the carrier body. A plurality of conductive clip attachment parts are attached in a permanent manner to the conductive lines embedded within the carrier body. A plurality of contact clips are attached in a removable manner to the clip attachment parts. The contact clips hold the substrates in place and conductively connecting the substrates with the conductive lines. Other embodiments, aspects and features are also disclosed.

Maintainable substrate carrier for electroplating

DOEpatents

Chen, Chen-An; Abas, Emmanuel Chua; Divino, Edmundo Anida; Ermita, Jake Randal G.; Capulong, Jose Francisco S.; Castillo, Arnold Villamor; Ma, Diana Xiaobing

2016-08-02

One embodiment relates to a substrate carrier for use in electroplating a plurality of substrates. The carrier includes a non-conductive carrier body on which the substrates are placed and conductive lines embedded within the carrier body. A plurality of conductive clip attachment parts are attached in a permanent manner to the conductive lines embedded within the carrier body. A plurality of contact clips are attached in a removable manner to the clip attachment parts. The contact clips hold the substrates in place and conductively connecting the substrates with the conductive lines. Other embodiments, aspects and features are also disclosed.

Shading decreases the abundance of the herbivorous California horn snail, Cerithidea californica

USGS Publications Warehouse

Lorda, Julio; Lafferty, Kevin D.

2012-01-01

Most of the intertidal zone in estuaries of California, USA and Baja California, Mexico is covered with vascular vegetation. Shading by these vascular plants influences abiotic and biotic processes that shape benthic community assemblages. We present data on the effects of shading on the California horn snail, Cerithidea californica. This species is important because it is the most common benthic macrofaunal species in these systems and acts as an obligate intermediate host of several species of rematode parasites that infect several other species. Using observational and experimental studies, we found a negative effect of shade on the distribution and abundance of the California horn snail. We hypothesized that shading reduces the abundance of the epipelic diatoms that the snails feeds on, causing snails to leave haded areas. We observed a negative relationship between vascular plant cover, sub-canopy light levels, and snail density in Mugu Lagoon. Then we experimentally manipulated light regimes, by clipping vegetation and adding shade structures, and found higher snail densities at higher light levels. In Goleta Slough, we isolated the effect of shade from vegetation by documenting a negative relationship between the shade created by two bridges and diatom and snail densities. We also found that snails moved the greatest distances over shaded channel banks compared to unshaded channel banks. Further, we documented the effect of water depth and channel bank orientation on shading in this system. An additional effect of shading is the reduction of temperature, providing an alternative explanation for some of our results. These results broaden our knowledge of how variation in the light environment influences the ecology of estuarine ecosystems.

Matrix metalloproteinase (MMP)-2 decreases calponin-1 levels and contributes to arterial remodeling in early hypertension.

PubMed

Belo, Vanessa de Almeida; Parente, Juliana Montenegro; Tanus-Santos, José Eduardo; Castro, Michele M

2016-10-15

Increased matrix metalloproteinase (MMP)-2 is implicated in the vascular remodeling of hypertension. Calponin-1 is a contractile protein, and its absence is associated with vascular smooth muscle cell (VSMC) phenotype switch, which leads to migration and remodeling. We evaluated whether increased MMP-2 activity precedes chronic vascular remodeling by decreasing calponin-1 and inducing VSMC proliferation. Sham or two kidney-one clip (2K1C) rats were treated with doxycycline at 30mg/kg/day. Systolic blood pressure was increased in the 2K1C rats after 1 and 2weeks post-surgery, and doxycycline was effective to reduce it only at 2weeks of hypertension (p<0.05). Increased activity of MMP-2 was observed in aortas from 2K1C at 1 and 2weeks of hypertension, followed by increased VSMC proliferation, and those effects were abolished by treating 2K1C rats with doxycycline (p<0.05). Increased aortic media to lumen ratio started to emerge in 2K1C rats at 1week of hypertension, and it was established by 2weeks. MMP-2 and calponin-1 co-localized in the cytosol of VSMC. Aortas from 2K1C rats showed a significant reduction in calponin-1 levels at 1week of hypertension, and doxycycline prevented its loss (p<0.05). However, at 2weeks of hypertension, calponin-1 was upregulated in 2K1C (p<0.05 vs. Sham groups). The mRNA levels of calponin-1 were not altered in the aortas of 2K1C at 1week of hypertension. MMP-2 may contribute to the post-translational decrease in calponin-1, thus culminating in hypertension-induced maladaptive arterial remodeling. Copyright © 2016 Elsevier Inc. All rights reserved.

Laser welding for vascular anastomosis using albumin solder: an approach for MID-CAB.

PubMed

Phillips, A B; Ginsburg, B Y; Shin, S J; Soslow, R; Ko, W; Poppas, D P

1999-01-01

To improve minimally invasive direct coronary artery bypass surgery (MID-CAB), new techniques of vascular anastomosis that are faster and more reliable need to be developed. Common carotids in a canine model were transected and an end-to-end anastomosis was performed by using one of four techniques (1) continuous 6-0 polypropylene closure (suture; n=6), (2) vascular clip (VCS; n=6), laser welding using 50% albumin solder with (3) a 1.32-micro laser (1.32las; n=6), and (4) a 1.9-micro diode laser (1.9las; n=4). Times for anastomosis (TA) were compared between groups by t-test. Pressures at which anastomosis failed (leak point pressure, LPP) were determined and compared by analysis of variance. TA was faster for 1.32las and 1.9las at 8.4+/-0.7 and 7.8+/-0.3 min, respectively, when compared with suture at 13.8+/-1.0 min (P=0.001, confidence interval [CI]-8.1, -2.6 for 1.32las and CI -8.9, -3.1 for 1.9las). There was no statistical difference between VCS (8.3+/-3.3 min) and any other group (P > 0.17). LPPs (mm Hg) were similar for all groups: 350+/-37 for 1.32las, 280+/-31 for 1.9las, 347+/-46 for suture, and 358+/-53 for VCS, P=0.68. In this study, laser welding using 50% human albumin solder resulted in faster anastomotic times. Anastomoses were equivalent to conventional sutured anastomoses in failing at similar pressures. Laser welding using human albumin solder may be advantageous in improving coronary anastomoses during MID-CAB, but long-term anastomotic strength and histologic evaluation need to be investigated.

Anticipation of high arousal aversive and positive movie clips engages common and distinct neural substrates.

PubMed

Greenberg, Tsafrir; Carlson, Joshua M; Rubin, Denis; Cha, Jiook; Mujica-Parodi, Lilianne

2015-04-01

The neural correlates of anxious anticipation have been primarily studied with aversive and neutral stimuli. In this study, we examined the effect of valence on anticipation by using high arousal aversive and positive stimuli and a condition of uncertainty (i.e. either positive or aversive). The task consisted of predetermined cues warning participants of upcoming aversive, positive, 'uncertain' (either aversive or positive) and neutral movie clips. Anticipation of all affective clips engaged common regions including the anterior insula, dorsal anterior cingulate cortex, thalamus, caudate, inferior parietal and prefrontal cortex that are associated with emotional experience, sustained attention and appraisal. In contrast, the nucleus accumbens and medial prefrontal cortex, regions implicated in reward processing, were selectively engaged during anticipation of positive clips (depicting sexually explicit content) and the mid-insula, which has been linked to processing aversive stimuli, was selectively engaged during anticipation of aversive clips (depicting graphic medical procedures); these three areas were also activated during anticipation of 'uncertain' clips reflecting a broad preparatory response for both aversive and positive stimuli. These results suggest that a common circuitry is recruited in anticipation of affective clips regardless of valence, with additional areas preferentially engaged depending on whether expected stimuli are negative or positive. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms.

PubMed

Nossek, Erez; Setton, Avi; Dehdashti, Amir R; Chalif, David J

2014-10-01

Proximally located posterior communicating artery (PCoA) aneurysms, projecting postero-laterally in proximity to the tentorium, may pose a technical challenge for microsurgical clipping due to obscuration of the proximal aneurysmal neck by the anterior petroclinoid fold. We describe an efficacious technique utilizing fenestration of the anterior petroclinoid fold to facilitate visualization and clipping of PCoA aneurysms abutting this aspect of the tentorium. Of 86 cases of PCoA aneurysms treated between 2003 and 2013, the technique was used in nine (10.5 %) patients to allow for adequate clipping. A 3 mm fenestration in the anterior petroclinoid ligament is created adjacent and lateral to the anterior clinoid process. This fenestration is then widened into a small wedge corridor by bipolar coagulation. In all cases, the proximal aneurysm neck was visualized after the wedge fenestration. Additionally, an adequate corridor for placement of the proximal clip blade was uniformly established. All cases were adequately clipped, with complete occlusion of the aneurysm neck and fundus with preservation of the PCoA. There were two intraoperative ruptures not related to creation of the wedge fenestration. One patient experienced post-operative partial third nerve palsy, which resolved during follow-up. We describe a technique of fenestration of the anterior petroclinoid fold to establish a critical and safe corridor for both visualization and clipping of PCoA aneurysms.

In-depth statistical analysis of the use of a website providing patients' narratives on lifestyle change when living with chronic back pain or coronary heart disease.

PubMed

Schweier, Rebecca; Grande, Gesine; Richter, Cynthia; Riedel-Heller, Steffi G; Romppel, Matthias

2018-07-01

To investigate the use of lebensstil-aendern.de ("lifestyle change"), a website providing peer narratives of experiences with successful lifestyle change, and to analyze whether peer model characteristics, clip content, and media type have an influence on the number of visitors, dwell time, and exit rates. An in-depth statistical analysis of website use with multilevel regression analyses. In two years, lebensstil-aendern.de attracted 12,844 visitors. The in-depth statistical analysis of usage rates demonstrated that audio clips were less popular than video or text-only clips, longer clips attracted more visitors, and clips by younger and female interviewees were preferred. User preferences for clip content categories differed between heart and back pain patients. Clips about stress management drew the smallest numbers of visitors in both indication modules. Patients are interested in the experiences of others. Because the quality of information for user-generated content is generally low, healthcare providers should include quality-assured patient narratives in their interventions. User preferences for content, medium, and peer characteristics need to be taken into account. If healthcare providers decide to include patient experiences in their websites, they should plan their intervention according to the different needs and preferences of users. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of endomycorrhizal infection, artificial herbivory, and parental cross on growth of Lotus corniculatus L.

PubMed

Borowicz, V A; Fitter, A H

1990-03-01

We examined how combinations of parentage, fungicide application, and artificial herbivory influence growth and shoot phosphorus content in pre-reproductive Lotus corniculatus, using young offspring arising from three parental crosses, two of which had one parent in common. Soil with vesicular-arbuscular mycorrhizal (VAM) fungi was treated with either water or benomyl, an anti-VAM fungicide, and added to trays containing groups of four full siblings. There were two experiments; in the first no plants were clipped while in the second two of the four plants were clipped to simulate herbivory. In both experiments plants of the two related crosses accumulated more biomass and total shoot P than did plants of the third cross. Plants inoculated with watertreated soil had greater shoot mass and P concentration than did fungicide-treated replicates but the extent of increase in P concentration varied among crosses. In Experiment 2, clipping reduced root mass and resulted in higher shoot P concentration. In this experiment there was a significant interaction of fungicide application and clipping: both unclipped and clipped plants grew better in soil not treated with fungicide, but the increase in shoot mass, total mass, and total P was greater in unclipped plants. Significant interaction of fungicide treatment and clipping is most likely due to reduced availability of carbon to the roots of clipped plants, resulting in poorer symbiotic functioning.

Heavy metal phytoextraction by Sedum alfredii is affected by continual clipping and phosphorus fertilization amendment.

PubMed

Huang, Huagang; Li, Tingqiang; Gupta, D K; He, Zhenli; Yang, Xiao-E; Ni, Bingnan; Li, Mao

2012-01-01

Improving the efficacy of phytoextraction is critical for its successful application in metal contaminated soils. Mineral nutrition affects plant growth and metal absorption and subsequently the accumulation of heavy metal through hyper-accumulator plants. This study assessed the effects of di-hydrogen phosphates (KH2PO4, Ca(H2PO4)2, NaH2PO4 and NH4H2PO4) application at three levels (22, 88 and 352 mg P/kg soil) on Sedum alfredii growth and metal uptake by three consecutive harvests on aged and Zn/Cd combined contaminated paddy soil. The addition of phosphates (P) significantly increased the amount of Zn taken up by S. alfredii due to increased shoot Zn concentration and dry matter yield (DMY) (P < 0.05). The highest phytoextraction of Zn and Cd was observed in KH2PO4 and NH4H2PO4 treatment at 352 mg P/kg soil. The amount of Zn removed by phytoextraction increased in the order of 1st clipping < 2nd clipping < 3rd clipping, and for Cd extraction the order was 2nd clipping < 1st clipping < 3rd clipping. These results indicate that the application of P fertilizers coupled with multiple cuttings can enhance the removal of Zn and Cd from contaminated soils by S. alfredii, thus shortening the time needed for accomplishing remediation goals.

Tracking Solar Energy Conersion Unit Adapted For Field Assembly

DOEpatents

Kaminar, Neil R.; Ross, III, James G.; Carrie, Peter J.

2000-02-01

A modular solar energy collector having elongated V-shaped side walls formed by a pair of coplanar panels for each side wall. The upper panels, occupying most of the wall area are diffusely reflective, but the lower panels are specularly reflective. A Fresnel lens, having a snap fit relation to the side walls focuses some light on the lower specularly reflective panels which direct light to the solar cells at the base of the V-shaped walls. A heat sink provides support for the two panels with two opposed, upwardly extending wings terminating in opposed linear clips located near the lengthwise seam of the coplanar panels, each clip holding two coplanar panels in parallel alignment. The clips not only provide support for the panels, but also transfer heat to the remainder of the heat sink. The clips are shaped so that edges of the panels engage each clip by a snap fit, outside of the clip in one embodiment and inside of the clip in another embodiment. End caps are also formed with structures which snap to the wall panels. Since all junctions of components snap together, the collector of the present invention is easily assembled without specialized tools. Using side walls which are only partly specularly reflective permits a large angle of acceptance, yet provides an economical wall design because the entire wall need not be specularly reflective.

Clipping affects flowering of California poppy at two growth stages

Treesearch

Raymond D. Ratliff; Richard L. Hubbard

1975-01-01

The effects of clipping California-poppy (Eschscholzia californica Cham.) at various growth stages on plant survival, flowering, herbage yield, and root production were studied at the San Joaquin Experimental Range, in central California. Plants were clipped once to a 2-cm stubble at one of six stages. Through the early reproductive stage, a single...

[Clip Sheets from BOCES. Opportunities. Health. Careers. = Oportunidades. Salud. Una Camera En...

ERIC Educational Resources Information Center

State Univ. of New York, Geneseo. Coll. at Geneseo. Migrant Center.

This collection of 83 clip sheets, or classroom handouts, was created to help U.S. migrants learn more about health, careers, and general "opportunities" including education programs. They are written in both English and Spanish and are presented in an easily understandable format. Health clip-sheet topics include the following: Abuse; AIDS;…

The "Isms" of Art. Introduction to the 2001-2002 Clip and Save Art Prints.

ERIC Educational Resources Information Center

Hubbard, Guy

2001-01-01

Provides an introduction to the 2001-2002 Clip and Save Art Prints that will focus on ten art movements from the past 150 years. Includes information on three art movements, or "isms": Classicism, Romanticism, and Realism. Discusses the Clip and Save Art Print format and provides information on three artists. (CMK)

Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis.

PubMed

Gaberel, Thomas; Borha, Alin; di Palma, Camille; Emery, Evelyne

2016-03-01

To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy. We conducted a systematic review of the literature and meta-analysis. The meta-analysis included 11 relevant studies involving 384 patients with third nerve palsy caused by PCoA aneurysms at baseline, of whom 257 (67.0%) were treated by clipping and 127 were treated by coiling (33.0%). Pooled odds ratios of the impact of clipping or coiling on complete ONP recovery, lack of ONP recovery, and procedure-related death were calculated. The overall complete ONP recovery rate was 42.5% in the coiling group compared with 83.6% in the clipping group. The increase in complete ONP recovery in the clipping group corresponds to an overall pooled Mantel-Haenszel odds ratio of 4.44 (95% confidence interval = 1.66-11.84). Subgroup analysis revealed a clear benefit of clipping over coiling in patients with ruptured aneurysms, but not in patients with unruptured aneurysms. No procedure-related deaths were reported by any of the 11 studies. Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

PubMed

Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

2012-11-01

Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

Early retreatment after surgical clipping of ruptured intracranial aneurysms.

PubMed

Ito, Yoshiro; Yamamoto, Tetsuya; Ikeda, Go; Tsuruta, Wataro; Uemura, Kazuya; Komatsu, Yoji; Matsumura, Akira

2017-09-01

Although a rerupture after surgical clipping of ruptured intracranial aneurysms is rare, it is associated with high morbidity and mortality. The causes for retreatment and rupture after surgical clipping are not clearly defined. From a prospectively maintained database of 244 patients who had undergone surgical clipping of ruptured intracranial aneurysms, we selected patients who experienced retreatment or rerupture within 30 days after surgical clipping. Aneurysm occlusions were examined by microvascular Doppler ultrasonography and indocyanine green video-angiography. Indications for retreatment included rerupture and partial occlusion. We analyzed the characteristics and causes of early retreatment. Six patients (2.5%, 95% CI 0.9 to 5.3%) were retreated within 30 days after surgical clipping, including two patients (0.8%, 95% CI 0.1 to 2.9%) who experienced a rerupture. The retreated aneurysms were found in the anterior communicating artery (AcomA) (n = 5) and basilar artery (n = 1). Retreatment of the AcomA (7.5%) was performed significantly more frequently than that of other arteries (0.56%) (p < 0.01). A laterally projected AcomA aneurysm (17.4%) was more frequently retreated than were other aneurysm types (2.3%). Cases of laterally projecting AcomA aneurysms tended to result from an incomplete clip placed using a pterional approach from the opposite side of the aneurysm projection. Despite developments, the rates of retreatment and rerupture after surgical clipping remain similar to those reported previously. Retreatment of the AcomA was significantly more frequent than was retreatment of other arteries. Patients underwent retreatment more frequently when they were originally treated for lateral type aneurysms using a pterional approach from the opposite side of the aneurysm projection. The treatment method and evaluation modalities should be considered carefully for AcomA aneurysms in particular.

Epicardial clip occlusion of the left atrial appendage during cardiac surgery provides optimal surgical results and long-term stability.

PubMed

Kurfirst, Vojtech; Mokrácek, Aleš; Canádyová, Júlia; Frána, Radim; Zeman, Petr

2017-07-01

Occlusion of the left atrial appendage (LAA) has become an integral and important part of the surgical treatment of atrial fibrillation. Different methods of surgical occlusion of the LAA have been associated with varying levels of short- and long-term success for closure. The purpose of this study was to evaluate long-term results of epicardial placement and endocardial occlusion in patients undergoing cardiac operative procedures. A total of 101 patients (average age 65.7 years) undergoing cardiac operative procedures with the epicardial AtriClip Exclusion System of the LAA were enrolled in the study. The AtriClip was placed via a sternotomy or a thoracotomy or from a thoracoscopic approach. Postoperative variables, such as thromboembolic events, clip stability and endocardial leakage around the device, were examined by transoesophageal echocardiography (TEE) and/or computed tomography. Perioperative clip implantation was achieved in 98% of patients. TEE and/or computed tomography conducted during the follow-up period, comprising 1873 patient-months with a mean duration of 18 ± 11 months, revealed no clip migration, no leakage around the device and no clot formation near the remnant cul-de-sac. During the follow-up period, 4 of the cardiac patients experienced transitory ischaemic attacks, whereas no patient experienced a cerebrovascular attack. The Epicardial AtriClip Exclusion System of the LAA appears to be a feasable and safe operative method with a high success rate. Long-term follow-up confirmed clip stability, complete occlussion of the LAA and absence of any atrial fibrilation-related thromboembolic events. These results need to be confirmed by a larger, multicentre study. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Impact of metal artifact reduction software on image quality of gemstone spectral imaging dual-energy cerebral CT angiography after intracranial aneurysm clipping.

PubMed

Dunet, Vincent; Bernasconi, Martine; Hajdu, Steven David; Meuli, Reto Antoine; Daniel, Roy Thomas; Zerlauth, Jean-Baptiste

2017-09-01

We aimed to assess the impact of metal artifact reduction software (MARs) on image quality of gemstone spectral imaging (GSI) dual-energy (DE) cerebral CT angiography (CTA) after intracranial aneurysm clipping. This retrospective study was approved by the institutional review board, which waived patient written consent. From January 2013 to September 2016, single source DE cerebral CTA were performed in 45 patients (mean age: 60 ± 9 years, male 9) after intracranial aneurysm clipping and reconstructed with and without MARs. Signal-to-noise (SNR), contrast-to-noise (CNR), and relative CNR (rCNR) ratios were calculated from attenuation values measured in the internal carotid artery (ICA) and middle cerebral artery (MCA). Volume of clip and artifacts and relative clip blurring reduction (rCBR) ratios were also measured at each energy level with/without MARs. Variables were compared between GSI and GSI-MARs using the paired Wilcoxon signed-rank test. MARs significantly reduced metal artifacts at all energy levels but 130 and 140 keV, regardless of clips' location and number. The optimal rCBR was obtained at 110 and 80 keV, respectively, on GSI and GSI-MARs images, with up to 96% rCNR increase on GSI-MARs images. The best compromise between metal artifact reduction and rCNR was obtained at 70-75 and 65-70 keV for GSI and GSI-MARs images, respectively, with up to 15% rCBR and rCNR increase on GSI-MARs images. MARs significantly reduces metal artifacts on DE cerebral CTA after intracranial aneurysm clipping regardless of clips' location and number. It may be used to reduce radiation dose while increasing CNR.

Fabrication and Characterization of ZnO Nano-Clips by the Polyol-Mediated Process.

PubMed

Wang, Mei; Li, Ai-Dong; Kong, Ji-Zhou; Gong, You-Pin; Zhao, Chao; Tang, Yue-Feng; Wu, Di

2018-02-09

ZnO nano-clips with better monodispersion were prepared successfully using zinc acetate hydrate (Zn(OAc) 2 ·nH 2 O) as Zn source and ethylene glycol (EG) as solvent by a simple solution-based route-polyol process. The effect of solution concentration on the formation of ZnO nano-clips has been investigated deeply. We first prove that the 0.01 M Zn(OAc) 2 ·nH 2 O can react with EG without added water or alkaline, producing ZnO nano-clips with polycrystalline wurtzite structure at 170 °C. As-synthesized ZnO nano-clips contain a lot of aggregated nanocrystals (~ 5 to 15 nm) with high specific surface area of 88 m 2 /g. The shapes of ZnO nano-clips basically keep constant with improved crystallinity after annealing at 400-600 °C. The lower solution concentration and slight amount of H 2 O play a decisive role in ZnO nano-clip formation. When the solution concentration is ≤ 0.0125 M, the complexing and polymerization reactions between Zn(OAc) 2 ·nH 2 O and EG predominate, mainly elaborating ZnO nano-clips. When the solution concentration is ≥ 0.015 M, the alcoholysis and polycondensation reactions of Zn(OAc) 2 ·nH 2 O and EG become dominant, leading to ZnO particle formation with spherical and elliptical shapes. The possible growth mechanism based on a competition between complexing and alcoholysis of Zn(OAc) 2 ·nH 2 O and EG has been proposed.

HITS-CLIP yields genome-wide insights into brain alternative RNA processing

NASA Astrophysics Data System (ADS)

Licatalosi, Donny D.; Mele, Aldo; Fak, John J.; Ule, Jernej; Kayikci, Melis; Chi, Sung Wook; Clark, Tyson A.; Schweitzer, Anthony C.; Blume, John E.; Wang, Xuning; Darnell, Jennifer C.; Darnell, Robert B.

2008-11-01

Protein-RNA interactions have critical roles in all aspects of gene expression. However, applying biochemical methods to understand such interactions in living tissues has been challenging. Here we develop a genome-wide means of mapping protein-RNA binding sites in vivo, by high-throughput sequencing of RNA isolated by crosslinking immunoprecipitation (HITS-CLIP). HITS-CLIP analysis of the neuron-specific splicing factor Nova revealed extremely reproducible RNA-binding maps in multiple mouse brains. These maps provide genome-wide in vivo biochemical footprints confirming the previous prediction that the position of Nova binding determines the outcome of alternative splicing; moreover, they are sufficiently powerful to predict Nova action de novo. HITS-CLIP revealed a large number of Nova-RNA interactions in 3' untranslated regions, leading to the discovery that Nova regulates alternative polyadenylation in the brain. HITS-CLIP, therefore, provides a robust, unbiased means to identify functional protein-RNA interactions in vivo.

Eliciting positive, negative and mixed emotional states: A film library for affective scientists.

PubMed

Samson, Andrea C; Kreibig, Sylvia D; Soderstrom, Blake; Wade, A Ayanna; Gross, James J

2016-08-01

We describe the creation of a film library designed for researchers interested in positive (amusing), negative (repulsive), mixed (amusing and repulsive) and neutral emotional states. Three hundred 20- to 33-second film clips videotaped by amateurs were selected from video-hosting websites and screened in laboratory studies by 75 female participants on self-reported amusement and repulsion (Experiments 1 and 2). On the basis of pre-defined cut-off values, 51 positive, 39 negative, 59 mixed and 50 neutral film clips were selected. These film clips were then presented to 411 male and female participants in a large online study to identify film clips that reliably induced the target emotions (Experiment 3). Depending on the goal of the study, researchers may choose positive, negative, mixed or neutral emotional film clips on the basis of Experiments 1 and 2 or Experiment 3 ratings.

Embedded CLIPS for SDI BM/C3 simulation and analysis

NASA Technical Reports Server (NTRS)

Gossage, Brett; Nanney, Van

1990-01-01

Nichols Research Corporation is developing the BM/C3 Requirements Analysis Tool (BRAT) for the U.S. Army Strategic Defense Command. BRAT uses embedded CLIPS/Ada to model the decision making processes used by the human commander of a defense system. Embedding CLlPS/Ada in BRAT allows the user to explore the role of the human in Command and Control (C2) and the use of expert systems for automated C2. BRAT models assert facts about the current state of the system, the simulated scenario, and threat information into CLIPS/Ada. A user-defined rule set describes the decision criteria for the commander. We have extended CLIPS/Ada with user-defined functions that allow the firing of a rule to invoke a system action such as weapons release or a change in strategy. The use of embedded CLIPS/Ada will provide a powerful modeling tool for our customer at minimal cost.

Using PVM to host CLIPS in distributed environments

NASA Technical Reports Server (NTRS)

Myers, Leonard; Pohl, Kym

1994-01-01

It is relatively easy to enhance CLIPS (C Language Integrated Production System) to support multiple expert systems running in a distributed environment with heterogeneous machines. The task is minimized by using the PVM (Parallel Virtual Machine) code from Oak Ridge Labs to provide the distributed utility. PVM is a library of C and FORTRAN subprograms that supports distributive computing on many different UNIX platforms. A PVM deamon is easily installed on each CPU that enters the virtual machine environment. Any user with rsh or rexec access to a machine can use the one PVM deamon to obtain a generous set of distributed facilities. The ready availability of both CLIPS and PVM makes the combination of software particularly attractive for budget conscious experimentation of heterogeneous distributive computing with multiple CLIPS executables. This paper presents a design that is sufficient to provide essential message passing functions in CLIPS and enable the full range of PVM facilities.

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

Friedman-Hill, Ernest

Java Expert Shell System - Jess - is a rule engine and scripting environment written entirely in Sun's Java language, Jess was orginially inspired by the CLIPS expert system shell, but has grown int a complete, distinct JAVA-influenced environment of its own. Using Jess, you can build Java applets and applications that have the capacity to "reason" using knowledge you supply in the form of declarative rules. Jess is surprisingly fast, and for some problems is faster than CLIPS, in that many Jess scripts are valid CLIPS scripts and vice-versa. Like CLIPS, Jess uses the Rete algorithm to process rules,more » a very efficient mechanism for solving the difficult many-to-many matching problem. Jess adds many features to CLIPS, including backwards chaining and the ability to manipulate and directly reason about Java objects. Jess is also a powerful Java scripting environment, from which you can create Java objects and call Java methods without compiling any Java Code.« less

Integrating CLIPS applications into heterogeneous distributed systems

NASA Technical Reports Server (NTRS)

Adler, Richard M.

1991-01-01

SOCIAL is an advanced, object-oriented development tool for integrating intelligent and conventional applications across heterogeneous hardware and software platforms. SOCIAL defines a family of 'wrapper' objects called agents, which incorporate predefined capabilities for distributed communication and control. Developers embed applications within agents and establish interactions between distributed agents via non-intrusive message-based interfaces. This paper describes a predefined SOCIAL agent that is specialized for integrating C Language Integrated Production System (CLIPS)-based applications. The agent's high-level Application Programming Interface supports bidirectional flow of data, knowledge, and commands to other agents, enabling CLIPS applications to initiate interactions autonomously, and respond to requests and results from heterogeneous remote systems. The design and operation of CLIPS agents are illustrated with two distributed applications that integrate CLIPS-based expert systems with other intelligent systems for isolating and mapping problems in the Space Shuttle Launch Processing System at the NASA Kennedy Space Center.

Emergency liver resection for combined biliary and vascular injury following laparoscopic cholecystectomy: case report and review of the literature.

PubMed

Felekouras, Evangelos; Megas, Thomas; Michail, Othon P; Papaconstantinou, Ioannis; Nikiteas, Nikolaos; Dimitroulis, Dimitrios; Griniatsos, John; Tsechpenakis, Anastasios; Kouraklis, Gregorios

2007-03-01

A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a conventional open approach. Copious hemostasis was achieved using sutures, clips and diathermy, and no bile duct or vascular injuries were recognized intraoperatively. Because of severe right upper quadrant abdominal pain and significant deterioration of the liver function tests (LFTs) on the first postoperative day, the patient underwent a Doppler ultrasound scan which showed absence of blood flow at the level of porta hepatis. Urgent relaparotomy revealed an ischemic liver on the right, a transected common bile duct at the level of its confluence, a divided and ligated right hepatic artery and thrombosed portal vein down to its confluence. Thrombectomy and reconstruction of the portal vein were performed to salvage the left hemiliver, and after restoration of blood flow to the left hemiliver, a right hemihepatectomy and a Roux-en-Y hepaticojejunostomy on the left were performed. Liver resection serves an important role in the case of parenchymal necrosis due to combined biliary, hepatic artery and portal vein injury following laparoscopic cholecystectomy and moreover, the operation can be safely performed in the acute setting.

Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

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

Muehlenbruch, Georg, E-mail: gmuehlenbruch@ukaachen.de; Nikoubashman, Omid; Steffen, Bjoern

2013-02-15

Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries usingmore » the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.« less

What's Eating Gilbert Grape?: A Case Study of Chronic Illness

ERIC Educational Resources Information Center

Alexander, Matthew; Waxman, Dael; White, Patricia

2006-01-01

Cinemeducation refers to the use of movies or movie clips to educate learners about the psychosocial aspects of health care. This paper describes the use of a clip from the movie, "What's Eating Gilbert Grape?" to teach medical students about chronic illness. The clip is used to set up a case study based on the lead character, Gilbert…

First CLIPS Conference Proceedings, volume 1

NASA Technical Reports Server (NTRS)

1990-01-01

The first Conference of C Language Production Systems (CLIPS) hosted by the NASA-Lyndon B. Johnson Space Center in August 1990 is presented. Articles included engineering applications, intelligent tutors and training, intelligent software engineering, automated knowledge acquisition, network applications, verification and validation, enhancements to CLIPS, space shuttle quality control/diagnosis applications, space shuttle and real-time applications, and medical, biological, and agricultural applications.

Using Film Clips to Teach Teen Pregnancy Prevention: "The Gloucester 18" at a Teen Summit

ERIC Educational Resources Information Center

Herrman, Judith W.; Moore, Christopher C.; Anthony, Becky

2012-01-01

Teaching pregnancy prevention to large groups offers many challenges. This article describes the use of film clips, with guided discussion, to teach pregnancy prevention. In order to analyze the costs associated with teen pregnancy, a film clip discussion session based with the film "The Gloucester 18" was the keynote of a youth summit. The lesson…

C Language Integrated Production System, Ada Version

NASA Technical Reports Server (NTRS)

Culbert, Chris; Riley, Gary; Savely, Robert T.; Melebeck, Clovis J.; White, Wesley A.; Mcgregor, Terry L.; Ferguson, Melisa; Razavipour, Reza

1992-01-01

CLIPS/Ada provides capabilities of CLIPS v4.3 but uses Ada as source language for CLIPS executable code. Implements forward-chaining rule-based language. Program contains inference engine and language syntax providing framework for construction of expert-system program. Also includes features for debugging application program. Based on Rete algorithm which provides efficient method for performing repeated matching of patterns. Written in Ada.

Blowout Monitor

NASA Technical Reports Server (NTRS)

1994-01-01

C Language Integrated Production System (CLIPS), a NASA-developed software shell for developing expert systems, has been embedded in a PC-based expert system for training oil rig personnel in monitoring oil drilling. Oil drilling rigs if not properly maintained for possible blowouts pose hazards to human life, property and the environment may be destroyed. CLIPS is designed to permit the delivery of artificial intelligence on computer. A collection of rules is set up and, as facts become known, these rules are applied. In the Well Site Advisor, CLIPS provides the capability to accurately process, predict and interpret well data in a real time mode. CLIPS was provided to INTEQ by COSMIC.

PCLIPS

NASA Technical Reports Server (NTRS)

Krolak, Patrick D.

1990-01-01

CLIPS is an expert system, created specifically to allow rapid implementation of an expert system. CLIPS is written in C, and thus needs a very small amount of memory to run. Parallel CLIPS (PCLIPS) is an extension to CLIPS which is intended to be used in situations where a group of expert systems are expected to run simultaneously and occasionally communicate with each other on an integrated network. PCLIPS is a coarse-grained data distribution system. Its main goal is to take information in one knowledge base and distribute it to other knowledge bases so that all the executing expert systems are able to use that knowledge to solve their disparate problems.

Microleakage of different temporary filling materials in primary teeth.

PubMed

Odabas, Mesut Enes; Tulunoglu, Ozlem; Ozalp, Serife Ozdemir; Bodur, Haluk

2009-01-01

The aim of this study was to compare the sealing properties of IRM, Coltosol, Cavit G, Adhesor and Clip, which used as temporary filling material in coronal access openings in extracted human primary teeth. Standardized access cavities of 2 x 2 mm were prepared in the eighty-four, caries-free human primary anterior teeth. The teeth were divided randomly into five groups of 16 teeth each. Temporary restorative materials Group A: IRM (Dentsply), Group B: Coltosol (Coltone), Group C: Cavit G (3M), Group D: Adhesor (Spofa Dental) and Group E: Clip (Voco) were applied according to the manufacturer's directions. The specimens were immersed silver nitrate and placed in film developer under fluorescent for 24 hours. The sectioned specimens were evaluated under a digital microscope at x 20 magnifications and blindly scored for microleakage. Clip presented the least microleakage value whereas; Adhesor and IRM presented the higher microleakage values. There were statistically significant differences between Clip and the others groups, while there were no statistically significant differences in microleakage between IRM, Adhesor, Coltosol and Cavit G. However the leakage scores of Clip and Cavit G were congruent (p = 0.454). Amongst the five materials, Clip exhibited a better sealing ability.

Rumen fluid fermentation for enhancement of hydrolysis and acidification of grass clipping.

PubMed

Wang, Siqi; Zhang, Guangming; Zhang, Panyue; Ma, Xiaowen; Li, Fan; Zhang, Haibo; Tao, Xue; Ye, Junpei; Nabi, Mohammad

2018-08-15

Rumen fluid, formed in rumen of ruminants, includes a complex microbial population of bacteria, protozoa, fungi and archaea, and has high ability to degrade lignocellulosic biomass. In this study, rumen fluid was used to ferment grass clipping for enhancing the hydrolysis and acidification of organic matters. Results showed that strict anaerobic condition, higher grass clipping content and smaller particle size of grass clipping were beneficial to the hydrolysis and acidification of organics. The increase of SCOD and total VFA concentration respectively reached 24.9 and 10.2 g/L with a suitable grass clipping content of 5%, a particle size <0.150 mm, and a fermentation time of 48 h. The VFA production was mainly attributed to the degradation of cellulose and hemicellulose with a total solid reduction of 55.7%. Firmicutes and Fibrobacteres were the major contributors to the degradation of cellulose and hemicellulose. The activity of carboxymethyl cellulose enzyme (CMCase), cellobiase and xylanase reached 0.027, 0.176 and 0.180 U/ml, respectively. The rumen fluid microorganisms successfully enhanced the hydrolysis and acidification of grass clipping. Copyright © 2018 Elsevier Ltd. All rights reserved.

Responses to water depth and clipping of twenty−three plant species in an Indian monsoonal wetland

USGS Publications Warehouse

Middleton, Beth A.; van der Valk, Arnold; Davis, Craig B.

2015-01-01

Responses of species to disturbances give insights into how species might respond to future wetland changes. In this study, species of monsoonal wetlands belonging to various functional types (graminoid and non−graminoid emergents, submersed aquatic, floating−leaved aquatic) varied in their growth responses to water depth and harvesting. We tested the effects of water depth (moist soil, flooded) and clipping (unclipped, and clipped) on the biomass and longevity of twenty−three dominant plant species of monsoonal wetlands in the Keoladeo National Park, India in a controlled experiment. With respect to total biomass and survival, six species responded positively to flooding and twelve species responded negatively to clipping. Responses to flooding and clipping, however, sometimes interacted. Individualistic responses of species to water levels and clipping regimes were apparent; species within a functional group did not always respond similarly. Therefore, detailed information on the individualistic responses of species may be needed to predict the vegetation composition of post−disturbance wetlands. In particular, as demands for fresh water increase around the world, studies of life history constraints and responses to hydrological changes will aid wetland managers in developing strategies to conserve biodiversity.

Effects of orally administered lavender essential oil on responses to anxiety-provoking film clips.

PubMed

Bradley, Belinda F; Brown, Stephen L; Chu, Simon; Lea, Robert W

2009-06-01

Lavender odour is commonly used to alleviate mild anxiety. Double blind studies are difficult to conduct with odours, and there are few reliable investigations of lavender's efficacy. Orally administered lavender capsules (placebo, 100, 200 microl) were tested in a randomised between-subjects (n = 97) double-blind study. Film clips were used to elicit anxiety. Measures included anxiety, State Trait Anxiety Inventory (STAI), mood, positive and negative affect scale (PANAS), heart rate (HR), galvanic skin response (GSR), and heart rate variation (HRV). Following baseline measurements capsules were administered. Participants viewed a neutral film clip, then an anxiety-provoking and light-hearted recovery film clip. For the 200 microl lavender dose during the neutral film clip there was a trend towards reduced state anxiety, GSR and HR and increased HRV. In the anxiety-eliciting film, lavender was mildly beneficial in females but only on HRV measures. In males sympathetic arousal increased during the anxiety film (GSR). HRV significantly increased at 200 microl during all three film clips in females, suggesting decreased anxiety. These findings suggest that lavender has anxiolytic effects in humans under conditions of low anxiety, but these effects may not extend to conditions of high anxiety.

Alleviating travel anxiety through virtual reality and narrated video technology.

PubMed

Ahn, J C; Lee, O

2013-01-01

This study presents an empirical evidence of benefit of narrative video clips in embedded virtual reality websites of hotels for relieving travel anxiety. Even though it was proven that virtual reality functions do provide some relief in travel anxiety, a stronger virtual reality website can be built when narrative video clips that show video clips with narration about important aspects of the hotel. We posit that these important aspects are 1. Escape route and 2. Surrounding neighborhood information, which are derived from the existing research on anxiety disorder as well as travel anxiety. Thus we created a video clip that showed and narrated about the escape route from the hotel room, another video clip that showed and narrated about surrounding neighborhood. We then conducted experiments with this enhanced virtual reality website of a hotel by having human subjects play with the website and fill out a questionnaire. The result confirms our hypothesis that there is a statistically significant relationship between the degree of travel anxiety and psychological relief caused by the use of embedded virtual reality functions with narrative video clips of a hotel website (Tab. 2, Fig. 3, Ref. 26).

Teaching professionalism to first year medical students using video clips.

PubMed

Shevell, Allison Haley; Thomas, Aliki; Fuks, Abraham

2015-01-01

Medical schools are confronted with the challenge of teaching professionalism during medical training. The aim of this study was to examine medical students' perceptions of using video clips as a beneficial teaching tool to learn professionalism and other aspects of physicianship. As part of the longitudinal Physician Apprenticeship course at McGill University, first year medical students viewed video clips from the television series ER. The study used qualitative description and thematic analysis to interpret responses to questionnaires, which explored the educational merits of this exercise. Completed questionnaires were submitted by 112 students from 21 small groups. A major theme concerned the students' perceptions of the utility of video clips as a teaching tool, and consisted of comments organized into 10 categories: "authenticity and believability", "thought provoking", "skills and approaches", "setting", "medium", "level of training", "mentorship", "experiential learning", "effectiveness" and "relevance to practice". Another major theme reflected the qualities of physicianship portrayed in video clips, and included seven categories: "patient-centeredness", "communication", "physician-patient relationship", "professionalism", "ethical behavior", "interprofessional practice" and "mentorship". This study demonstrated that students perceived the value of using video clips from a television series as a means of teaching professionalism and other aspects of physicianship.

Impact of Aneurysm Projection on Intraoperative Complications During Surgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

PubMed

Fukuda, Hitoshi; Hayashi, Kosuke; Yoshino, Kumiko; Koyama, Takashi; Lo, Benjamin; Kurosaki, Yoshitaka; Yamagata, Sen

2016-03-01

Surgical clipping of ruptured posterior communicating artery (PCoA) aneurysms is a well-established procedure to date. However, preoperative factors associated with procedure-related risk require further elucidation. To investigate the impact of the direction of aneurysm projection on the incidence of procedure-related complications during surgical clipping of ruptured PCoA aneurysms. A total of 65 patients with ruptured PCoA aneurysms who underwent surgical clipping were retrospectively analyzed from a single-center, prospective, observational cohort database in this study. The aneurysms were categorized into lateral and posterior projection groups, depending on direction of the dome. Characteristics and operative findings of each projection group were identified. We also evaluated any correlation of aneurysm projection with the incidence of procedure-related complications. Patients with ruptured PCoA aneurysms with posterior projection more likely presented with good-admission-grade subarachnoid hemorrhage (P = .01, χ test) and were less to also have intracerebral hematoma (P = .01). These aneurysms were found to be associated with higher incidence of intraoperative rupture (P = .02), complex clipping with fenestrated clips (P = .02), and dense adherence to PCoA or its perforators (P = .04) by univariate analysis. Aneurysms with posterior projection were also correlated with procedure-related complications, including postoperative cerebral infarction or hematoma formation (odds ratio, 5.87; 95% confidence interval, 1.11-31.1; P = .04) by multivariable analysis. Ruptured PCoA aneurysms with posterior projection carried a higher risk of procedure-related complications of surgical clipping than those with lateral projection.

Microsurgery Simulator of Cerebral Aneurysm Clipping with Interactive Cerebral Deformation Featuring a Virtual Arachnoid.

PubMed

Shono, Naoyuki; Kin, Taichi; Nomura, Seiji; Miyawaki, Satoru; Saito, Toki; Imai, Hideaki; Nakatomi, Hirofumi; Oyama, Hiroshi; Saito, Nobuhito

2018-05-01

A virtual reality simulator for aneurysmal clipping surgery is an attractive research target for neurosurgeons. Brain deformation is one of the most important functionalities necessary for an accurate clipping simulator and is vastly affected by the status of the supporting tissue, such as the arachnoid membrane. However, no virtual reality simulator implementing the supporting tissue of the brain has yet been developed. To develop a virtual reality clipping simulator possessing interactive brain deforming capability closely dependent on arachnoid dissection and apply it to clinical cases. Three-dimensional computer graphics models of cerebral tissue and surrounding structures were extracted from medical images. We developed a new method for modifiable cerebral tissue complex deformation by incorporating a nonmedical image-derived virtual arachnoid/trabecula in a process called multitissue integrated interactive deformation (MTIID). MTIID made it possible for cerebral tissue complexes to selectively deform at the site of dissection. Simulations for 8 cases of actual clipping surgery were performed before surgery and evaluated for their usefulness in surgical approach planning. Preoperatively, each operative field was precisely reproduced and visualized with the virtual brain retraction defined by users. The clear visualization of the optimal approach to treating the aneurysm via an appropriate arachnoid incision was possible with MTIID. A virtual clipping simulator mainly focusing on supporting tissues and less on physical properties seemed to be useful in the surgical simulation of cerebral aneurysm clipping. To our knowledge, this article is the first to report brain deformation based on supporting tissues.

The effect of music video clips on adolescent boys' body image, mood, and schema activation.

PubMed

Mulgrew, Kate E; Volcevski-Kostas, Diana; Rendell, Peter G

2014-01-01

There is limited research that has examined experimentally the effects of muscular images on adolescent boys' body image, with no research specifically examining the effects of music television. The aim of the current study was to examine the effects of viewing muscular and attractive singers in music video clips on early, mid, and late adolescent boys' body image, mood, and schema activation. Participants were 180 boys in grade 7 (mean age = 12.73 years), grade 9 (mean age = 14.40 years) or grade 11 (mean age = 16.15 years) who completed pre- and post-test measures of mood and body satisfaction after viewing music videos containing male singers of muscular or average appearance. They also completed measures of schema activation and social comparison after viewing the clips. The results showed that the boys who viewed the muscular clips reported poorer upper body satisfaction, lower appearance satisfaction, lower happiness, and more depressive feelings compared to boys who viewed the clips depicting singers of average appearance. There was no evidence of increased appearance schema activation but the boys who viewed the muscular clips did report higher levels of social comparison to the singers. The results suggest that music video clips are a powerful form of media in conveying information about the male ideal body shape and that negative effects are found in boys as young as 12 years.

A film set for the elicitation of emotion in research: A comprehensive catalog derived from four decades of investigation.

PubMed

Gilman, T Lee; Shaheen, Razan; Nylocks, K Maria; Halachoff, Danielle; Chapman, Jessica; Flynn, Jessica J; Matt, Lindsey M; Coifman, Karin G

2017-12-01

Emotions are highly influential to many psychological processes. Indeed, research employing emotional stimuli is rapidly escalating across the field of psychology. However, challenges remain regarding discrete evocation of frequently co-elicited emotions such as amusement and happiness, or anger and disgust. Further, as much contemporary work in emotion employs college students, we sought to additionally evaluate the efficacy of film clips to discretely elicit these more challenging emotions in a young adult population using an online medium. The internet is an important tool for investigating responses to emotional stimuli, but validations of emotionally evocative film clips across laboratory and web-based settings are limited in the literature. An additional obstacle is identifying stimuli amidst the numerous film clip validation studies. During our investigation, we recognized the lack of a categorical database to facilitate rapid identification of useful film clips for individual researchers' unique investigations. Consequently, here we also sought to produce the first compilation of such stimuli into an accessible and comprehensive catalog. We based our catalog upon prior work as well as our own, and identified 24 articles and 295 film clips from four decades of research. We present information on the validation of these clips in addition to our own research validating six clips using online administration settings. The results of our search in the literature and our own study are presented in tables designed to facilitate and improve a selection of highly valid film stimuli for future research.

Management of horses with focus on blanketing and clipping practices reported by members of the Swedish and Norwegian equestrian community.

PubMed

Hartmann, E; Bøe, K E; Jørgensen, G H M; Mejdell, C M; Dahlborn, K

2017-03-01

Limited information is available on the extent to which blankets are used on horses and the owners' reasoning behind clipping the horse's coat. Research on the effects of those practices on horse welfare is scarce but results indicate that blanketing and clipping may not be necessary from the horse's perspective and can interfere with the horse's thermoregulatory capacities. Therefore, this survey collected robust, quantitative data on the housing routines and management of horses with focus on blanketing and clipping practices as reported by members of the Swedish and Norwegian equestrian community. Horse owners were approached via an online survey, which was distributed to equestrian organizations and social media. Data from 4,122 Swedish and 2,075 Norwegian respondents were collected, of which 91 and 84% of respondents, respectively, reported using blankets on horses during turnout. Almost all respondents owning warmblood riding horses used blankets outdoors (97% in Sweden and 96% in Norway) whereas owners with Icelandic horses and coldblood riding horses used blankets significantly less ( < 0.05). Blankets were mainly used during rainy, cold, or windy weather conditions and in ambient temperatures of 10°C and below. The horse's coat was clipped by 67% of respondents in Sweden and 35% of Norwegian respondents whereby owners with warmblood horses and horses primarily used for dressage and competition reported clipping the coat most frequently. In contrast to scientific results indicating that recovery time after exercise increases with blankets and that clipped horses have a greater heat loss capacity, only around 50% of respondents agreed to these statements. This indicates that evidence-based information on all aspects of blanketing and clipping has not yet been widely distributed in practice. More research is encouraged, specifically looking at the effect of blankets on sweaty horses being turned out after intense physical exercise and the effect of blankets on social interactions such as mutual grooming. Future efforts should be tailored to disseminate knowledge more efficiently, which can ultimately stimulate thoughtful decision-making by horse owners concerning the use of blankets and clipping the horse's coat.

Four-year trends in the treatment of cerebral aneurysms in Poland in 2009-2012.

PubMed

Tykocki, Tomasz; Kostyra, Kacper; Czyż, Marcin; Kostkiewicz, Bogusław

2014-05-01

The dilemma concerning the appropriate treatment of the intracranial aneurysms (IAs) has not yet been resolved and still remains under fierce debate. This study refers to the recent trends in the use of and outcomes related to coiling compared with clipping for unruptured and ruptured IAs in Poland over a 4-year period. The analysis refers to treatment of IAs performed in Poland between 2009-2012. Patients' records were cross-matched by ICD-9 codes for ruptured SAH (430) or unruptured cerebral aneurysm (437.3) along with codes for clipping (39.51) and coiling (39.79, 39.72, or 39.52). Multivariable logistic regression was used to compare in-hospital deaths, hospital length of stay (LOS), therapy allocation and aneurysm locations in unruptured vs. ruptured and clipped vs. coiled groups. Differences in the number of procedures between 16 administrative regions were standardized per 100,000 people. In 2009-2012, 11,051 procedures were identified, including 5,968 ruptured and 5,083 unruptured aneurysms. Overall increase was 2.3 % in clipping and 13.1 % in coiling; a significant trend was found in endovascular procedures (p = 0.044). Ruptured aneurysms were clipped more frequently (OR = 1.66;); in unruptured IAs, endovascular procedure was preferred 3.5 times more than clipping. The annual in-hospital mortality was 7.6 % in clipping and 6.7 % in endovascular treatment. LOS was two times longer after clipping in unruptured aneurysms (OR = 2.013). After the procedures were standardized per 100,000 people, the average for Poland was established as 9.09 in 2009, 10.86 in 2010, 10.55 in 2011, and 11.49 in 2012. This index had the highest values in Mazovia (12.9, 2009; 15.4, 2010; 17.4, 2011; 18.6, 2012. Data analysis revealed an increase in overall number of IAs treated in Poland between 2009-2012. A significant upward trend of endovascular procedures was found, whereas the number of clipped aneurysms remained relatively steady over the study period.

PCLIPS: Parallel CLIPS

NASA Technical Reports Server (NTRS)

Gryphon, Coranth D.; Miller, Mark D.

1991-01-01

PCLIPS (Parallel CLIPS) is a set of extensions to the C Language Integrated Production System (CLIPS) expert system language. PCLIPS is intended to provide an environment for the development of more complex, extensive expert systems. Multiple CLIPS expert systems are now capable of running simultaneously on separate processors, or separate machines, thus dramatically increasing the scope of solvable tasks within the expert systems. As a tool for parallel processing, PCLIPS allows for an expert system to add to its fact-base information generated by other expert systems, thus allowing systems to assist each other in solving a complex problem. This allows individual expert systems to be more compact and efficient, and thus run faster or on smaller machines.

Ischemic mass effect from biliary surgical clips.

PubMed

Mateo, Rod; Tsai, Steven; Stapfer, Maria V; Sher, Linda S; Selby, Rick; Genyk, Yuri S

2008-02-01

Migrating surgical clips in the hepatic hilum are known causes of biliary stricture or obstruction, most often due to direct intraluminal obstruction or secondary stone formation. Two cases are reported on patients with previous cholecystectomies presenting with delayed symptoms of biliary tract stricture. Both patients were successfully treated with a resection of the strictured area and a Roux-en-Y hepatico-jejunostomy. Resected specimens grossly demonstrated surgical clips adjacent to the stricture, but not directly within the lumen, suggestive of an ischemic mass effect, which was supported by histology. In addition to the direct intraluminal obstruction and lithogenic effects of migratory surgical clips, "clipomas" due to an ischemic mass effect can also lead to biliary tract strictures.

Portable inference engine: An extended CLIPS for real-time production systems

NASA Technical Reports Server (NTRS)

Le, Thach; Homeier, Peter

1988-01-01

The present C-Language Integrated Production System (CLIPS) architecture has not been optimized to deal with the constraints of real-time production systems. Matching in CLIPS is based on the Rete Net algorithm, whose assumption of working memory stability might fail to be satisfied in a system subject to real-time dataflow. Further, the CLIPS forward-chaining control mechanism with a predefined conflict resultion strategy may not effectively focus the system's attention on situation-dependent current priorties, or appropriately address different kinds of knowledge which might appear in a given application. Portable Inference Engine (PIE) is a production system architecture based on CLIPS which attempts to create a more general tool while addressing the problems of real-time expert systems. Features of the PIE design include a modular knowledge base, a modified Rete Net algorithm, a bi-directional control strategy, and multiple user-defined conflict resolution strategies. Problems associated with real-time applications are analyzed and an explanation is given for how the PIE architecture addresses these problems.

CLIP-related methodologies and their application to retrovirology.

PubMed

Bieniasz, Paul D; Kutluay, Sebla B

2018-05-02

Virtually every step of HIV-1 replication and numerous cellular antiviral defense mechanisms are regulated by the binding of a viral or cellular RNA-binding protein (RBP) to distinct sequence or structural elements on HIV-1 RNAs. Until recently, these protein-RNA interactions were studied largely by in vitro binding assays complemented with genetics approaches. However, these methods are highly limited in the identification of the relevant targets of RBPs in physiologically relevant settings. Development of crosslinking-immunoprecipitation sequencing (CLIP) methodology has revolutionized the analysis of protein-nucleic acid complexes. CLIP combines immunoprecipitation of covalently crosslinked protein-RNA complexes with high-throughput sequencing, providing a global account of RNA sequences bound by a RBP of interest in cells (or virions) at near-nucleotide resolution. Numerous variants of the CLIP protocol have recently been developed, some with major improvements over the original. Herein, we briefly review these methodologies and give examples of how CLIP has been successfully applied to retrovirology research.

Using popular films to enhance classroom learning: the good, the bad, and the interesting.

PubMed

Butler, Andrew C; Zaromb, Franklin M; Lyle, Keith B; Roediger, Henry L

2009-09-01

Popular history films sometimes contain major historical inaccuracies. Two experiments investigated how watching such films influences people's ability to remember associated texts. Subjects watched film clips and studied texts about various historical topics. Whereas the texts contained only correct information, the film clips contained both correct information (consistent with the text) and misinformation (contradicted by the text). Before watching each clip, subjects received a specific warning, a general warning, or no warning about the misinformation. One week later, they returned for a cued-recall test about the texts. Watching a film clip increased correct recall of consistent information relative to recall of the same information when subjects did not see the clip. However, when the information in the film contradicted the text, subjects often (falsely) recalled misinformation from the film. The specific warning substantially reduced this misinformation effect. Teachers should use popular history films with caution and should warn students about major inaccuracies in the films.

Optimizing assessment of sexual arousal in postmenopausal women using erotic film clips.

PubMed

Ramos Alarcon, Lauren G; Dai, Jing; Collins, Karen; Perez, Mindy; Woodard, Terri; Diamond, Michael P

2017-10-01

This study sought to assess sexual arousal in a subgroup of women by identifying erotic film clips that would be most mentally appealing and physically arousing to postmenopausal women. By measuring levels of mental appeal and self-reported physical arousal using a bidirectional scale, we aimed to elucidate the clips that would best be utilized for sexual health research in the postmenopausal or over 50-year-old subpopulation. Our results showed that postmenopausal women did not rate clips with older versus younger actors differently (p>0.05). The mean mental and mean physical scores were significantly correlated for both premenopausal subject ratings (r=0.69, p<0.001) and postmenopausal subject ratings (r=0.94, p<0.001). Thus postmenopausal women do not show a preference for the age of actors used in erotic film clips; this knowledge is relevant for design of future sexual function research. Copyright © 2017 Elsevier B.V. All rights reserved.

iCLIP reveals the function of hnRNP particles in splicing at individual nucleotide resolution

PubMed Central

König, Julian; Zarnack, Kathi; Rot, Gregor; Curk, Tomaž; Kayikci, Melis; Zupan, Blaž; Turner, Daniel J.; Luscombe, Nicholas M.; Ule, Jernej

2010-01-01

In the nucleus of eukaryotic cells, nascent transcripts are associated with heterogeneous nuclear ribonucleoprotein (hnRNP) particles that are nucleated by hnRNP C. Despite their abundance however, it remained unclear whether these particles control pre-mRNA processing. Here, we developed individual-nucleotide resolution UV-cross-linking and immunoprecipitation (iCLIP) to study the role of hnRNP C in splicing regulation. iCLIP data demonstrate that hnRNP C recognizes uridine tracts with a defined long-range spacing consistent with hnRNP particle organization. hnRNP particles assemble on both introns and exons, but remain generally excluded from splice sites. Integration of transcriptome-wide iCLIP data and alternative splicing profiles into an ‘RNA map’ indicates how the positioning of hnRNP particles determines their effect on inclusion of alternative exons. The ability of high-resolution iCLIP data to provide insights into the mechanism of this regulation holds promise for studies of other higher-order ribonucleoprotein complexes. PMID:20601959

Nitinol Thermoreactive Clips for Secondary Sternal Closure in Cases of Noninfective Sternal Dehiscence

PubMed Central

Gucu, Arif; Toktas, Faruk; Eris, Cuneyt; Ata, Yusuf; Turk, Tamer

2012-01-01

Postoperative sternal dehiscence is a potentially catastrophic sequela to median sternotomy that can cause not only chest-wall discomfort and pulmonary dysfunction but infection, both superficial and mediastinal. Nitinol thermoreactive clips use a novel material in the treatment of sternal dehiscence. We sought to determine whether the use of these clips is an effective remedy for noninfective sternal dehiscence. From January 2008 through December 2011, we retrospectively studied the data on 10 patients whose sternums had been closed with nitinol thermoreactive clips after the development of noninfective sternal dehiscence. Diagnosis was made on the bases of clinical criteria, chest radiography, and microbiological investigation. There was no control group. No procedure-related sequelae occurred. There was no recurrent sternal instability and dehiscence, sternal-related hemorrhage, superficial wound infection, or mediastinal infection. We believe that the use of nitinol thermoreactive clips is a safe, easy, and efficient method of secondary sternal closure for noninfective sternal dehiscence. PMID:22949767

Judgments of Nonverbal Behaviour by Children with High-Functioning Autism Spectrum Disorder: Can They Detect Signs of Winning and Losing from Brief Video Clips?

ERIC Educational Resources Information Center

Ryan, Christian; Furley, Philip; Mulhall, Kathleen

2016-01-01

Typically developing children are able to judge who is winning or losing from very short clips of video footage of behaviour between active match play across a number of sports. Inferences from "thin slices" (short video clips) allow participants to make complex judgments about the meaning of posture, gesture and body language. This…

A Simple Recipe for Whitening Old Newspaper Clippings

NASA Astrophysics Data System (ADS)

Carter, Henry A.

1995-07-01

Newspaper clippings tend to brown quickly with aging as the result of chromophores that form during the degradation of one or more components of paper. Newsprint that consists of approximately 40% lignin is particularly susceptible to browning due to the relative ease of the oxidation of lignin. For readers who wish to experiment with both whitening and deacidifying old newspaper clippings, a simple recipe requiring few materials is presented.

CLIP-seq analysis of multi-mapped reads discovers novel functional RNA regulatory sites in the human transcriptome.

PubMed

Zhang, Zijun; Xing, Yi

2017-09-19

Crosslinking or RNA immunoprecipitation followed by sequencing (CLIP-seq or RIP-seq) allows transcriptome-wide discovery of RNA regulatory sites. As CLIP-seq/RIP-seq reads are short, existing computational tools focus on uniquely mapped reads, while reads mapped to multiple loci are discarded. We present CLAM (CLIP-seq Analysis of Multi-mapped reads). CLAM uses an expectation-maximization algorithm to assign multi-mapped reads and calls peaks combining uniquely and multi-mapped reads. To demonstrate the utility of CLAM, we applied it to a wide range of public CLIP-seq/RIP-seq datasets involving numerous splicing factors, microRNAs and m6A RNA methylation. CLAM recovered a large number of novel RNA regulatory sites inaccessible by uniquely mapped reads. The functional significance of these sites was demonstrated by consensus motif patterns and association with alternative splicing (splicing factors), transcript abundance (AGO2) and mRNA half-life (m6A). CLAM provides a useful tool to discover novel protein-RNA interactions and RNA modification sites from CLIP-seq and RIP-seq data, and reveals the significant contribution of repetitive elements to the RNA regulatory landscape of the human transcriptome. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Speed Biases With Real-Life Video Clips

PubMed Central

Rossi, Federica; Montanaro, Elisa; de’Sperati, Claudio

2018-01-01

We live almost literally immersed in an artificial visual world, especially motion pictures. In this exploratory study, we asked whether the best speed for reproducing a video is its original, shooting speed. By using adjustment and double staircase methods, we examined speed biases in viewing real-life video clips in three experiments, and assessed their robustness by manipulating visual and auditory factors. With the tested stimuli (short clips of human motion, mixed human-physical motion, physical motion and ego-motion), speed underestimation was the rule rather than the exception, although it depended largely on clip content, ranging on average from 2% (ego-motion) to 32% (physical motion). Manipulating display size or adding arbitrary soundtracks did not modify these speed biases. Estimated speed was not correlated with estimated duration of these same video clips. These results indicate that the sense of speed for real-life video clips can be systematically biased, independently of the impression of elapsed time. Measuring subjective visual tempo may integrate traditional methods that assess time perception: speed biases may be exploited to develop a simple, objective test of reality flow, to be used for example in clinical and developmental contexts. From the perspective of video media, measuring speed biases may help to optimize video reproduction speed and validate “natural” video compression techniques based on sub-threshold temporal squeezing. PMID:29615875

Speed Biases With Real-Life Video Clips.

PubMed

Rossi, Federica; Montanaro, Elisa; de'Sperati, Claudio

2018-01-01

We live almost literally immersed in an artificial visual world, especially motion pictures. In this exploratory study, we asked whether the best speed for reproducing a video is its original, shooting speed. By using adjustment and double staircase methods, we examined speed biases in viewing real-life video clips in three experiments, and assessed their robustness by manipulating visual and auditory factors. With the tested stimuli (short clips of human motion, mixed human-physical motion, physical motion and ego-motion), speed underestimation was the rule rather than the exception, although it depended largely on clip content, ranging on average from 2% (ego-motion) to 32% (physical motion). Manipulating display size or adding arbitrary soundtracks did not modify these speed biases. Estimated speed was not correlated with estimated duration of these same video clips. These results indicate that the sense of speed for real-life video clips can be systematically biased, independently of the impression of elapsed time. Measuring subjective visual tempo may integrate traditional methods that assess time perception: speed biases may be exploited to develop a simple, objective test of reality flow, to be used for example in clinical and developmental contexts. From the perspective of video media, measuring speed biases may help to optimize video reproduction speed and validate "natural" video compression techniques based on sub-threshold temporal squeezing.

[Correction of aphakia with the implantation of the retropupillary iris clip intraocular artificial lens].

PubMed

Szabó, Antal; Papp, András; Borbándy, Ágnes; D Géhl, Zsuzsanna; Nagy, Zoltán Zsolt; Resch, Miklós

2017-01-01

The correction of aphakia might be a challenge for the surgeon. The aim of this study is to describe the authors' experience with the implantation of the retropupillary iris clip intraocular lens. Patients between January 2014 and December 2015 were included in the retrospective study. Retropupillary implantation of iris clip intraocular lens VRSA 54 (AMO Advanced Medical Optics, USA) was performed in all cases. The minimum follow up period was three months. The stability of the intraocular lens and the intraoperative and postoperative complications and the visual acuity were evaluated. During this time period 11 cases (1 female, 10 males) were included in the study. The mean age at the time of the implantation was 57.7 years (between 25-74 years). In 4 cases the iris clip lens was implanted during the first intervention, in 7 cases during the secondary procedure. In all cases the lens was fixated onto the iris posteriorly. The best corrected visual acuity before the iris clip implantation was 0.43 (0.1-1.0) and postoperatively at the time of the follow up 0.49 (0.04-1.0). With the use of the retropupillary implanted iris clip intraocular lens all of the patients could have been rehabilitated without major complications. Orv. Hetil., 2017, 158(1), 20-24.

Integrating Commercial Off-The-Shelf (COTS) graphics and extended memory packages with CLIPS

NASA Technical Reports Server (NTRS)

Callegari, Andres C.

1990-01-01

This paper addresses the question of how to mix CLIPS with graphics and how to overcome PC's memory limitations by using the extended memory available in the computer. By adding graphics and extended memory capabilities, CLIPS can be converted into a complete and powerful system development tool, on the other most economical and popular computer platform. New models of PCs have amazing processing capabilities and graphic resolutions that cannot be ignored and should be used to the fullest of their resources. CLIPS is a powerful expert system development tool, but it cannot be complete without the support of a graphics package needed to create user interfaces and general purpose graphics, or without enough memory to handle large knowledge bases. Now, a well known limitation on the PC's is the usage of real memory which limits CLIPS to use only 640 Kb of real memory, but now that problem can be solved by developing a version of CLIPS that uses extended memory. The user has access of up to 16 MB of memory on 80286 based computers and, practically, all the available memory (4 GB) on computers that use the 80386 processor. So if we give CLIPS a self-configuring graphics package that will automatically detect the graphics hardware and pointing device present in the computer, and we add the availability of the extended memory that exists in the computer (with no special hardware needed), the user will be able to create more powerful systems at a fraction of the cost and on the most popular, portable, and economic platform available such as the PC platform.

Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage

PubMed Central

Yan, Shi; Wang, Xing; Lv, Chao; Phan, Kevin; Wang, Yuzhao; Wang, Jia; Yang, Yue

2016-01-01

Background Postoperative pleural drainage markedly influences the length of postoperative stay and financial costs of medical care. The aim of this study is to retrospectively investigate potentially predisposing factors related to pleural drainage after curative thoracic surgery and to explore the impact of mediastinal micro-vessels clipping on pleural drainage control after lymph node dissection. Methods From February 2012 to November 2013, 322 consecutive cases of operable non-small cell lung cancers (NSCLC) undergoing lobectomy and mediastinal lymph node dissection with or without application of clipping were collected. Total and daily postoperative pleural drainage were recorded. Propensity score matching (1:2) was applied to balance variables potentially impacting pleural drainage between group clip and group control. Analyses were performed to compare drainage volume, duration of chest tube and postoperative hospital stay between the two groups. Variables linked with pleural drainage in whole cohort were assessed using multivariable logistic regression analysis. Results Propensity score matching resulted in 197 patients (matched cohort). Baseline patient characteristics were matched between two groups. Group clip showed less cumulative drainage volume (P=0.020), shorter duration of chest tube (P=0.031) and postoperative hospital stay (P=0.022) compared with group control. Risk factors significantly associated with high-output drainage in multivariable logistic regression analysis were being male, age >60 years, bilobectomy/sleeve lobectomy, pleural adhesion, the application of clip applier, duration of operation ≥220 minutes and chylothorax (P<0.05). Conclusions This study suggests that mediastinal micro-vessels clipping during lymph node dissection may reduce postoperative pleural drainage and thus shorten hospital stay. PMID:27076936

The effects of media violence on anxiety in late adolescence.

PubMed

Madan, Anjana; Mrug, Sylvie; Wright, Rex A

2014-01-01

Exposure to media violence is related to anxiety in youth, but the causality of the effect has not been established. This experimental study examined the effects of media violence on anxiety, blood pressure, and heart rate in late adolescents. We also examined whether these responses varied by previous exposure to media and real-life violence. College students (N = 209; M age = 18.74; 75 % female; 50 % Caucasian, 34 % African American, 9 % Asian, 3 % Hispanic, and 3 % other racial minorities) were randomized to view either violent or nonviolent high-action movie clips. Participants reported on their anxiety before and after watching the clips, as well as their previous exposure to violence. Measures of blood pressure and heart rate were taken at baseline and during movie viewing. Participants watching violent movie clips showed a greater anxiety increase than those watching nonviolent clips. Both groups experienced increased blood pressure and reduced heart rate during movie watching compared to baseline. Prior exposure to media violence was associated with diminished heart rate response. Additionally, students previously exposed to high levels of real-life violence showed lower blood pressure increases when watching violent clips compared to nonviolent clips. Thus, relatively brief exposure to violent movie clips increased anxiety among late adolescents. Prior exposure to media and real-life violence were associated with lower physiological reactivity to high-action and violent movies, respectively, possibly indicating desensitization. Future studies should investigate long-term anxiety and physiological consequences of regular exposure to media violence in adolescence.

A P300 event related potential technique for assessment of sexually oriented interest.

PubMed

Vardi, Yoram; Volos, Michal; Sprecher, Elliot; Granovsky, Yelena; Gruenwald, Ilan; Yarnitsky, David

2006-12-01

Despite all of the modern, sophisticated tests that exist for diagnosing and assessing male and female sexual disorders, to our knowledge there is no objective psychophysiological test to evaluate sexual arousal and interest. We provide preliminary data showing a decrease in auditory P300 wave amplitude during exposure to sexually explicit video clips and a significant correlation between the auditory P300 amplitude decrease and self-reported scores of sexual arousal and interest in the clips. A total of 30 healthy subjects were exposed to several blocks of auditory stimuli administered using an oddball paradigm. Baseline auditory P300 amplitudes were obtained and auditory stimuli were then delivered while viewing visual clips with 3 types of content, including sport, scenery and sex. Auditory P300 amplitude significantly decreased during viewing clips of all contents. Viewing sexual content clips caused a maximal decrease in P300 amplitude (p <0.0001). In addition, a high correlation was found between the amplitude decrease and scores on the sexual arousal questionnaire regarding the viewed clips (r = 0.61, p <0.001). In addition, the P300 amplitude decrease was significantly related to the sexual interest score (r = 0.37, p = 0.042) but not to interest in clips of nonsexual content. The change in auditory P300 amplitude during exposure to visual stimuli with sexual context seems to be an objective measure of subject sexual interest. This method might be applied to assess therapeutic intervention and as a diagnostic tool for assessing disorders of impaired libido or psychogenic sexual dysfunction.

From tails to toes: developing nonlethal tissue indicators of mercury exposure in five amphibian species.

PubMed

Pfleeger, Adam Z; Eagles-Smith, Collin A; Kowalski, Brandon M; Herring, Garth; Willacker, James J; Jackson, Allyson K; Pierce, John R

2016-04-01

Exposure to environmental contaminants has been implicated as a factor in global amphibian decline. Mercury (Hg) is a particularly widespread contaminant that biomagnifies in amphibians and can cause a suite of deleterious effects. However, monitoring contaminant exposure in amphibian tissues may conflict with conservation goals if lethal take is required. Thus, there is a need to develop non-lethal tissue sampling techniques to quantify contaminant exposure in amphibians. Some minimally invasive sampling techniques, such as toe-clipping, are common in population-genetic research, but it is unclear if these methods can adequately characterize contaminant exposure. We examined the relationships between mercury (Hg) concentrations in non-lethally sampled tissues and paired whole-bodies in five amphibian species. Specifically, we examined the utility of three different tail-clip sections from four salamander species and toe-clips from one anuran species. Both tail and toe-clips accurately predicted whole-body THg concentrations, but the relationships differed among species and the specific tail-clip section or toe that was used. Tail-clips comprised of the distal 0-2 cm segment performed the best across all salamander species, explaining between 82 and 92% of the variation in paired whole-body THg concentrations. Toe-clips were less effective predictors of frog THg concentrations, but THg concentrations in outer rear toes accounted for up to 79% of the variability in frog whole-body THg concentrations. These findings suggest non-lethal sampling of tails and toes has potential applications for monitoring contaminant exposure and risk in amphibians, but care must be taken to ensure consistent collection and interpretation of samples.

Training in Cerebral Aneurysm Clipping Using Self-Made 3-Dimensional Models.

PubMed

Mashiko, Toshihiro; Kaneko, Naoki; Konno, Takehiko; Otani, Keisuke; Nagayama, Rie; Watanabe, Eiju

Recently, there have been increasingly fewer opportunities for junior surgeons to receive on-the-job training. Therefore, we created custom-built three-dimensional (3D) surgical simulators for training in connection with cerebral aneurysm clipping. Three patient-specific models were composed of a trimmed skull, retractable brain, and a hollow elastic aneurysm with its parent artery. The brain models were created using 3D printers via a casting technique. The artery models were made by 3D printing and a lost-wax technique. Four residents and 2 junior neurosurgeons attended the training courses. The trainees retracted the brain, observed the parent arteries and aneurysmal neck, selected the clip(s), and clipped the neck of an aneurysm. The duration of simulation was recorded. A senior neurosurgeon then assessed the trainee's technical skill and explained how to improve his/her performance for the procedure using a video of the actual surgery. Subsequently, the trainee attempted the clipping simulation again, using the same model. After the course, the senior neurosurgeon assessed each trainee's technical skill. The trainee critiqued the usefulness of the model and the effectiveness of the training course. Trainees succeeded in performing the simulation in line with an actual surgery. Their skills tended to improve upon completion of the training. These simulation models are easy to create, and we believe that they are very useful for training junior neurosurgeons in the surgical techniques needed for cerebral aneurysm clipping. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Contrast-Enhanced Sonography Depicts Spontaneous Ovarian Cancer at Early Stages in a Preclinical Animal Model

PubMed Central

Barua, Animesh; Bitterman, Pincas; Bahr, Janice M.; Basu, Sanjib; Sheiner, Eyal; Bradaric, Michael J.; Hales, Dale B.; Luborsky, Judith L.; Abramowicz, Jacques S.

2011-01-01

Objective Our goal was to examine the feasibility of using laying hens, a preclinical model of human spontaneous ovarian cancer, in determining the kinetics of an ultrasound contrast agent indicative of ovarian tumor-associated neoangiogenesis in early-stage ovarian cancer. Methods Three-year-old White Leghorn laying hens with decreased ovarian function were scanned before and after intravenous injection of a human serum albumin–perflutren contrast agent at a dose of 5 µL/kg body weight. Gray scale morphologic characteristics, Doppler indices, the arrival time, peak intensity, and wash-out of the contrast agent were recorded and archived on still images and video clips. Hens were euthanized thereafter; sonographic predictions were compared at gross examination; and ovarian tissues were collected. Archived clips were analyzed to determine contrast parameters and Doppler intensities of vessels. A time-intensity curve per hen was drawn, and the area under the curve was derived. Tumor types and the density of ovarian microvessels were determined by histologic examination and immunohistochemistry and compared to sonographic predictions. Results The contrast agent significantly (P < .05) enhanced the visualization of microvessels, which was confirmed by immunohistochemistry. Contrast parameters, including the time of wash-out and area under the curve, were significantly different (P < .05) between ovaries of normal hens and hens with ovarian cancer and correctly detected cancer at earlier stages than the time of peak intensity. Conclusions The laying hen may be a useful animal model for determining ovarian tumor-associated vascular kinetics diagnostic of early-stage ovarian cancer using a contrast agent. This model may also be useful for testing the efficacy of different contrast agents in a preclinical setting. PMID:21357555

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases.

PubMed

Park, Hyung-Ki; Jho, Hae-Dong

2012-12-01

Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy. Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications. Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications. Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.

Biological and histopathological investigations of moclobemide on injured ovarian tissue following induction of ischemia-reperfusion in rats.

PubMed

Ingec, Metin; Calik, Muhammet; Gundogdu, Cemal; Kurt, Ali; Yilmaz, Mehmet; Isaoglu, Unal; Salman, Suleyman; Akcay, Fatih; Suleyman, Halis

2012-04-01

The effects of moclobemide on damaged ovarian tissue induced by ischemia- reperfusion and damaged contralateral ovarian tissue were investigated in rats, biochemically and histologically. In this experimental study, 40 rats were equally divided into four groups: 10 mg/kg moclobemide, 20 mg/kg moclobemide, ischemia/reperfusion control, and intact control groups. A 2-2.5-cm-long vertical incision was made in the lower abdomen of each rat in order to reach the ovaries, after which a vascular clip was placed on the lower side of the right ovary of each animal in the two treatment groups and the ischemia-reperfusion control group, but not in the healthy (intact control) animal group. The purpose of this procedure was to create ischemia over the course of three hours, then the clips were unclamped to provide reperfusion for the next two hours. At the end of the two hours of reperfusion, all the animals were killed by high-dose anaesthesia and their ovaries were taken and subjected to histological and biochemical (malondialdehyde, nitric oxide, glutathione) studies. The obtained results showed that moclobemide suppressed nitric oxide and malondialdehyde production in the ischemia-reperfusion damage area, and prevented the decrease in endogenous antioxidant levels (glutathione) in the rat ovarian tissue. Moclobemide also prevented infiltration of leukocytes to the ovarian tissue. These results showed that moclobemide protected ovarian tissue against ischemiareperfusion injury. This study shows that moclobemide represses malondialdehyde and nitric oxide production in the rat ovarian tissue subjected to ischemia-reperfusion injury and keeps the endogenous antioxidant glutathione level from decreasing. Moclobemide also inhibits leukocytic migration into ovarian tissue following ischemia-reperfusion injury. From these results, it is suggested that moclobemide can be used in the treatment of ovarian ischemia-reperfusion injury.

Compensation and resistance to herbivory in seagrasses: induced responses to simulated consumption by fish.

PubMed

Vergés, Adriana; Pérez, Marta; Alcoverro, Teresa; Romero, Javier

2008-04-01

Herbivory can induce changes in plant traits that may involve both tolerance mechanisms that compensate for biomass loss and resistance traits that reduce herbivore preference. Seagrasses are marine vascular plants that possess many attributes that may favour tolerance and compensatory growth, and they are also defended with mechanisms of resistance such as toughness and secondary metabolites. We quantified phenotypic changes induced by herbivore damage on the temperate seagrass Posidonia oceanica in order to identify specific compensatory and resistance mechanisms in this plant, and to assess any potential trade-offs between these two strategies of defence. We simulated three natural levels of fish herbivory by repeatedly clipping seagrass leaves during the summer period of maximum herbivory. Compensatory responses were determined by measuring shoot-specific growth, photosynthetic rate, and the concentration of nitrogen and carbon resources in leaves and rhizomes. Induced resistance was determined by measuring the concentration of phenolic secondary metabolites and by assessing the long-term effects of continued clipping on herbivore feeding preferences using bioassays. Plants showed a significant ability to compensate for low and moderate losses of leaf biomass by increasing aboveground growth of damaged shoots, but this was not supported by an increase in photosynthetic capacity. Low levels of herbivory induced compensatory growth without any measurable effects on stored resources. In contrast, nitrogen reserves in the rhizomes played a crucial role in the plant's ability to compensate and survive herbivore damage under moderate and high levels of herbivory, respectively. We found no evidence of inducibility of long-term resistance traits in response to herbivory. The concentration of phenolics decreased with increasing compensatory growth despite all treatments having similar carbon leaf content, suggesting reallocation of these compounds towards primary functions such as cell-wall construction.

Non-contrast 3D time-of-flight magnetic resonance angiography for visualization of intracranial aneurysms in patients with absolute contraindications to CT or MRI contrast.

PubMed

Yanamadala, Vijay; Sheth, Sameer A; Walcott, Brian P; Buchbinder, Bradley R; Buckley, Deidre; Ogilvy, Christopher S

2013-08-01

The preoperative evaluation of patients with intracranial aneurysms typically includes a contrast-enhanced vascular study, such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography. However, there are numerous absolute and relative contraindications to the administration of imaging contrast agents, including pregnancy, severe contrast allergy, and renal insufficiency. Evaluation of patients with contrast contraindications thus presents a unique challenge. We identified three patients with absolute contrast contraindications who presented with intracranial aneurysms. One patient was pregnant, while the other two had previous severe anaphylactic reactions to iodinated contrast. Because of these contraindications to intravenous contrast, we performed non-contrast time-of-flight MRA with 3D reconstruction (TOF MRA with 3DR) with maximum intensity projections and volume renderings as part of the preoperative evaluation prior to successful open surgical clipping of the aneurysms. In the case of one paraclinoid aneurysm, a high-resolution non-contrast CT scan was also performed to assess the relationship of the aneurysm to the anterior clinoid process. TOF MRA with 3DR successfully identified the intracranial aneurysms and adequately depicted the surrounding microanatomy. Intraoperative findings were as predicted by the preoperative imaging studies. The aneurysms were successfully clip-obliterated, and the patients had uneventful post-operative courses. These cases demonstrate that non-contrast imaging is a viable modality to assess intracranial aneurysms as part of the surgical planning process in patients with contrast contraindications. TOF MRA with 3DR, in conjunction with high-resolution non-contrast CT when indicated, provides adequate visualization of the microanatomy of the aneurysm and surrounding structures. Copyright © 2013 Elsevier Ltd. All rights reserved.

Natriuretic peptides buffer renin-dependent hypertension.

PubMed

Demerath, Theo; Staffel, Janina; Schreiber, Andrea; Valletta, Daniela; Schweda, Frank

2014-06-15

The renin-angiotensin-aldosterone system and cardiac natriuretic peptides [atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP)] are opposing control mechanisms for arterial blood pressure. Accordingly, an inverse relationship between plasma renin concentration (PRC) and ANP exists in most circumstances. However, PRC and ANP levels are both elevated in renovascular hypertension. Because ANP can directly suppress renin release, we used ANP knockout (ANP(-/-)) mice to investigate whether high ANP levels attenuate the increase in PRC in response to renal hypoperfusion, thus buffering renovascular hypertension. ANP(-/-) mice were hypertensive and had reduced PRC compared with that in wild-type ANP(+/+) mice under control conditions. Unilateral renal artery stenosis (2-kidney, 1-clip) for 1 wk induced similar increases in blood pressure and PRC in both genotypes. Unexpectedly, plasma BNP concentrations in ANP(-/-) mice significantly increased in response to two-kidney, one-clip treatment, potentially compensating for the lack of ANP. In fact, in mice lacking guanylyl cyclase A (GC-A(-/-) mice), which is the common receptor for both ANP and BNP, renovascular hypertension was markedly augmented compared with that in wild-type GC-A(+/+) mice. However, the higher blood pressure in GC-A(-/-) mice was not caused by disinhibition of the renin system because PRC and renal renin synthesis were significantly lower in GC-A(-/-) mice than in GC-A(+/+) mice. Thus, natriuretic peptides buffer renal vascular hypertension via renin-independent effects, such as vasorelaxation. The latter possibility is supported by experiments in isolated perfused mouse kidneys, in which physiological concentrations of ANP and BNP elicited renal vasodilatation and attenuated renal vasoconstriction in response to angiotensin II. Copyright © 2014 the American Physiological Society.

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

Image Guidance in External Beam Accelerated Partial Breast Irradiation: Comparison of Surrogates for the Lumpectomy Cavity

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

Hasan, Yasmin; Kim, Leonard; Martinez, Alvaro

Purpose: To compare localization of the lumpectomy cavity by using breast surface matching vs. clips for image-guided external beam accelerated partial breast irradiation. Methods and Materials: Twenty-seven patients with breast cancer with two computed tomography (CT) scans each had three CT registrations performed: (1) to bony anatomy, (2) to the center of mass (COM) of surgical clips, and (3) to the breast surface. The cavity COM was defined in both the initial and second CT scans after each type of registration, and distances between COMs ({delta}COM{sub Bone}, {delta}COM{sub Clips}, and {delta}COM{sub Surface}) were determined. Smaller {delta}COMs were interpreted as bettermore » localizations. Correlation coefficients were calculated for {delta}COM vs. several variables. Results: The {delta}COM{sub Bone} (mean, 7 {+-} 2 [SD] mm) increased with breast volume (r = 0.4; p = 0.02) and distance from the chest wall (r = 0.5; p = 0.003). Relative to bony registration, clip registration provided better localization ({delta}COM{sub Clips} < {delta}COM{sub Bone}) in 25 of 27 cases. Breast surface matching improved cavity localization ({delta}COM{sub Surface} < {delta}COM{sub Bone}) in 19 of 27 cases. Mean improvements ({delta}COM{sub Bone} - {delta}COM{sub ClipsorSurface}) were 4 {+-} 3 and 2 {+-} 4 mm, respectively. In terms of percentage of improvement ([{delta}COM{sub Bone} - {delta}COM{sub ClipsorSurface}]/{delta}COM{sub Bone}), only surface matching showed a correlation with breast volume. Clip localization outperformed surface registration for cavities located superior to the breast COM. Conclusions: Use of either breast surface or surgical clips as surrogates for the cavity results in improved localization in most patients compared with bony registration and may allow smaller planning target volume margins for external beam accelerated partial breast irradiation. Compared with surface registration, clip registration may be less sensitive to anatomic characteristics and therefore more broadly applicable.« less

Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases

PubMed Central

Shi, Lei; Yu, Jing; Zhao, Ying; Xu, Kan; Yu, Jinlu

2018-01-01

It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I–III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms. PMID:29434749

Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases.

PubMed

Shi, Lei; Yu, Jing; Zhao, Ying; Xu, Kan; Yu, Jinlu

2018-02-01

It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I-III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms.

Psychophysiological Correlates of Sexually and Non-Sexually Motivated Attention to Film Clips in a Workload Task

PubMed Central

Carvalho, Sandra; Leite, Jorge; Galdo-Álvarez, Santiago; Gonçalves, Óscar F.

2011-01-01

Some authors have speculated that the cognitive component (P3) of the Event-Related Potential (ERP) can function as a psychophysiological measure of sexual interest. The aim of this study was to determine if the P3 ERP component in a workload task can be used as a specific and objective measure of sexual motivation by comparing the neurophysiologic response to stimuli of motivational relevance with different levels of valence and arousal. A total of 30 healthy volunteers watched different films clips with erotic, horror, social-positive and social-negative content, while answering an auditory oddball paradigm. Erotic film clips resulted in larger interference when compared to both the social-positive and auditory alone conditions. Horror film clips resulted in the highest levels of interference with smaller P3 amplitudes than erotic and also than social-positive, social-negative and auditory alone condition. No gender differences were found. Both horror and erotic film clips significantly decreased heart rate (HR) when compared to both social-positive and social-negative films. The erotic film clips significantly increased the skin conductance level (SCL) compared to the social-negative films. The horror film clips significantly increased the SCL compared to both social-positive and social-negative films. Both the highly arousing erotic and non-erotic (horror) movies produced the largest decrease in the P3 amplitude, a decrease in the HR and an increase in the SCL. These data support the notion that this workload task is very sensitive to the attentional resources allocated to the film clip, although they do not act as a specific index of sexual interest. Therefore, the use of this methodology seems to be of questionable utility as a specific measure of sexual interest or as an objective measure of the severity of Hypoactive Sexual Desire Disorder. PMID:22216305

Psychophysiological correlates of sexually and non-sexually motivated attention to film clips in a workload task.

PubMed

Carvalho, Sandra; Leite, Jorge; Galdo-Álvarez, Santiago; Gonçalves, Oscar F

2011-01-01

Some authors have speculated that the cognitive component (P3) of the Event-Related Potential (ERP) can function as a psychophysiological measure of sexual interest. The aim of this study was to determine if the P3 ERP component in a workload task can be used as a specific and objective measure of sexual motivation by comparing the neurophysiologic response to stimuli of motivational relevance with different levels of valence and arousal. A total of 30 healthy volunteers watched different films clips with erotic, horror, social-positive and social-negative content, while answering an auditory oddball paradigm. Erotic film clips resulted in larger interference when compared to both the social-positive and auditory alone conditions. Horror film clips resulted in the highest levels of interference with smaller P3 amplitudes than erotic and also than social-positive, social-negative and auditory alone condition. No gender differences were found. Both horror and erotic film clips significantly decreased heart rate (HR) when compared to both social-positive and social-negative films. The erotic film clips significantly increased the skin conductance level (SCL) compared to the social-negative films. The horror film clips significantly increased the SCL compared to both social-positive and social-negative films. Both the highly arousing erotic and non-erotic (horror) movies produced the largest decrease in the P3 amplitude, a decrease in the HR and an increase in the SCL. These data support the notion that this workload task is very sensitive to the attentional resources allocated to the film clip, although they do not act as a specific index of sexual interest. Therefore, the use of this methodology seems to be of questionable utility as a specific measure of sexual interest or as an objective measure of the severity of Hypoactive Sexual Desire Disorder. © 2011 Carvalho et al.

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

Piezoelectric resonator assembly with thin molybdenum mounting clips

DOEpatents

Peters, R. Donald

1981-01-01

A resonator mounting assembly wherein the resonator blank is mounted agai an essentially planar surface presented by a plurality of peripherally disposed mounting clips and bonded to this surface to provide substantially all the mechanical support for the blank in a direction normal to the major faces of the resonator blank, while being flexible in the directions parallel to said major faces so as to minimize radial stresses on the resonator blank, particularly during thermal cycling of the resonator assembly. The clips are fabricated of a low thermal expansion material, such as molybdenum, which also has considerable yield strength after exposure to processing temperatures; the bonding of the clips to the edges of the resonator blank can be achieved by a polyimide containing electrically conductive particles.

Expert networks in CLIPS

NASA Technical Reports Server (NTRS)

Hruska, S. I.; Dalke, A.; Ferguson, J. J.; Lacher, R. C.

1991-01-01

Rule-based expert systems may be structurally and functionally mapped onto a special class of neural networks called expert networks. This mapping lends itself to adaptation of connectionist learning strategies for the expert networks. A parsing algorithm to translate C Language Integrated Production System (CLIPS) rules into a network of interconnected assertion and operation nodes has been developed. The translation of CLIPS rules to an expert network and back again is illustrated. Measures of uncertainty similar to those rules in MYCIN-like systems are introduced into the CLIPS system and techniques for combining and hiring nodes in the network based on rule-firing with these certainty factors in the expert system are presented. Several learning algorithms are under study which automate the process of attaching certainty factors to rules.

Image recognition of clipped stigma traces in rice seeds

NASA Astrophysics Data System (ADS)

Cheng, F.; Ying, YB

2005-11-01

The objective of this research is to develop algorithm to recognize clipped stigma traces in rice seeds using image processing. At first, the micro-configuration of clipped stigma traces was observed with electronic scanning microscope. Then images of rice seeds were acquired with a color machine vision system. A digital image-processing algorithm based on morphological operations and Hough transform was developed to inspect the occurrence of clipped stigma traces. Five varieties of Jinyou402, Shanyou10, Zhongyou207, Jiayou and you3207 were evaluated. The algorithm was implemented with all image sets using a Matlab 6.5 procedure. The results showed that the algorithm achieved an average accuracy of 96%. The algorithm was proved to be insensitive to the different rice seed varieties.

Clip gage attachment for frictionless measurement of displacement during high-temperature mechanical testing

DOEpatents

Alexander, David J.

1994-01-01

An attachment for placement between a test specimen and a remote clip gage extensometer providing improved fracture toughness tests of materials at elevated temperature. Using a cylindrical tube and axial rod in new relationship, the device transfers the displacement signal of the fracture toughness test specimen directly to a clip gage extensometer located outside the high temperature furnace. Virtually frictionless operation is assured by having the test specimen center one end of the rod in one end of the tube, while the clip gage extensometer arms center the other end of the rod in the other end of the tube. By providing positive control over both ends of both rod and tube, the attachment may be operated in orientations other than vertical.

Retrograde Suction Decompression with an Inahara Carotid Shunt for Clipping a Large Distal Internal Carotid Artery Aneurysm.

PubMed

Park, Yong Sook; Nam, Taek Kyun

2017-03-01

We describe a technique to clip a large internal carotid artery (ICA) aneurysm via a retrograde suction decompression (RSD). A large aneurysm in the right distal ICA involving the bifurcation region measuring 1.2×1.1×0.7 cm with posterior projection was managed with assisted RSD technique. The anterior choroidal artery emerged from the side wall of the aneurysm. An Inahara shunt was inserted into the ICA with neck dissection, and RSD was applied after completely clipping the aneurysm. RSD with an Inahara carotid shunt is useful for complete visualization of the aneurysm, including its surrounding structures, and for proximal control of the parent vessels, subsequently achieving satisfactory clip placement.

The source parameters of 2013 Mw6.6 Lushan earthquake constrained with the restored local clipped seismic waveforms

NASA Astrophysics Data System (ADS)

Hao, J.; Zhang, J. H.; Yao, Z. X.

2017-12-01

We developed a method to restore the clipped seismic waveforms near epicenter using projection onto convex sets method (Zhang et al, 2016). This method was applied to rescue the local clipped waveforms of 2013 Mw 6.6 Lushan earthquake. We restored 88 out of 93 clipped waveforms of 38 broadband seismic stations of China Earthquake Networks (CEN). The epicenter distance of the nearest station to the epicenter that we can faithfully restore is only about 32 km. In order to investigate if the source parameters of earthquake could be determined exactly with the restored data, restored waveforms are utilized to get the mechanism of Lushan earthquake. We apply the generalized reflection-transmission coefficient matrix method to calculate the synthetic seismic records and simulated annealing method in inversion (Yao and Harkrider, 1983; Hao et al., 2012). We select 5 stations of CEN with the epicenter distance about 200km whose records aren't clipped and three-component velocity records are used. The result shows the strike, dip and rake angles of Lushan earthquake are 200o, 51o and 87o respectively, hereinafter "standard result". Then the clipped and restored seismic waveforms are applied respectively. The strike, dip and rake angles of clipped seismic waveforms are 184o, 53o and 72o respectively. The largest misfit of angle is 16o. In contrast, the strike, dip and rake angles of restored seismic waveforms are 198o, 51o and 87o respectively. It is very close to the "standard result". We also study the rupture history of Lushan earthquake constrained with the restored local broadband and teleseismic waves based on finite fault method (Hao et al., 2013). The result consists with that constrained with the strong motion and teleseismic waves (Hao et al., 2013), especially the location of the patch with larger slip. In real-time seismology, determining the source parameters as soon as possible is important. This method will help us to determine the mechanism of earthquake using the local clipped waveforms. Strong motion stations in China don't have good coverage at present. This method will help us to investigate the rupture history of large earthquake in China using the local clipped data of broadband stations.

CLIPSITS - CLIPS INTELLIGENT TUTORING SYSTEM

NASA Technical Reports Server (NTRS)

Riley, G.

1994-01-01

The CLIPS Intelligent Tutoring System (CLIPSITS) is designed to be used to learn CLIPS, the C-language Integrated Production System expert system shell developed by the Software Technology Branch at Johnson Space Center. The goal of CLIPSITS is to provide the student with a tool to practice the syntax and concepts covered in the CLIPS User's Guide. It attempts to provide expert diagnosis and advice during problem solving which is typically not available without an instructor. CLIPSITS is divided into 10 lessons which mirror the first 10 chapters of the CLIPS User's Guide. This version of CLIPSITS is compatible with the Version 4.2 and 4.3 CLIPS User's Guide. However, the program does not cover any new features of CLIPS v4.3 that were added since the release of v4.2. The chapter numbers in the CLIPS User's Guide correspond directly with the lesson numbers in CLIPSITS. Each lesson in the program contains anywhere from 1 to 10 problems. Most of these have multiple parts. The student is given a subset of these problems from each lesson to work. The actual number of problems presented depends on how well the student masters the previous problem(s). The progression through these lessons is maintained in a personalized file under the student's name. As with most computer languages, there is usually more than one way to solve a problem. CLIPSITS attempts to be as flexible as possible and to allow as many correct solutions as possible. CLIPSITS gives the student the option of setting his/her own colors for the screen interface and the option of redefining special keystroke combinations used within the program. CLIPSITS requires an IBM PC compatible with 640K RAM and optional 2 or 3 button mouse. A 286- or 386-based machine is preferable. Performance will be somewhat slower on an XT class machine. The program must be installed on a hard disk with 825 KB space available. The program was developed in 1989. The standard distribution media is three 5.25" IBM PC DOS format diskettes. The program is also sold bundled with CLIPS for a special combined price as COS-10025. NOTE: Only the executable code is distributed. Supporting documentation is included on the diskettes. IBM, IBM PC and XT are registered trademarks of International Business Machines Corporation.

Future of clip-on weapon sights: pros and cons from an applications perspective

NASA Astrophysics Data System (ADS)

Knight, C. Reed; Greenslade, Ken; Francisco, Glen

2015-05-01

US Domestic, International, allied Foreign National Warfighters and Para-Military First Responders (Police, SWAT, Special Operations, Law Enforcement, Government, Security and more) are put in harm's way all the time. To successfully complete their missions and return home safely are the primary goals of these professionals. Tactical product improvements that affect mission effectiveness and solider survivability are pivotal to understanding the past, present and future of Clip-On in-line weapon sights. Clip-On Weapon Sight (WS) technology was deemed an interim solution by the US Government for use until integrated and fused (day/night multi-sensor) Weapon Sights (WSs) were developed/fielded. Clip-On has now become the solution of choice by Users, Warriors, Soldiers and the US Government. SWaP-C (size, weight and power -cost) has been improved through progressive advances in Clip-On Image Intensified (I2), passive thermal, LL-CMOS and fused technology. Clip-On Weapon Sights are now no longer mounting position sensitive. Now they maintain aim point boresight, so they can be used for longer ranges with increased capabilities while utilizing the existing zeroed weapon and daysight optic. Active illuminated low-light level (both analog I2 and digital LL-CMOS) imaging is rightfully a real-world technology, proven to deliver daytime and low-light level identification confidence. Passive thermal imaging is also a real-world technology, proven to deliver daytime, nighttime and all-weather (including dirty battlefield) target detection confidence. Image processing detection algorithms with intelligent analytics provide documented promise to improve confidence by reducing Users, Warriors and Soldiers' work-loads and improving overall system engagement solution outcomes. In order to understand the future of Clip-On in-line weapon sights, addressing pros and cons, this paper starts with an overview of historical weapon sight applications, technologies and stakeholder decisions driving milestone events that helped shape the Clip-On weapon sight industry. Then, this paper systematically reviews current attributes of integrated multispectral wavelength electro-optical imaging systems that successfully (and sometimes unsuccessfully) shape today's Warrior, Soldier and User's net-capabilities. Finally, this paper explores the evolution, pros and cons, of future Clip-On weapon sights, from a manufacturing and real world applications perspective for tomorrow's military soldier and paramilitary first responder.

Mental Health

MedlinePlus

... usando el icono . Ver Mas Recursos Digital Tools Social Media Facebook Twitter Instagram YouTube Planning and Management Strategy & Planning Monitoring & Evaluation Social Media Policies Digital Government Strategy Virtual Office Hours Virtual ...

No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

PubMed

Hindman, Bradley J; Bayman, Emine O; Pfisterer, Wolfgang K; Torner, James C; Todd, Michael M

2010-01-01

Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration

PubMed Central

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-01-01

AIM: To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. METHODS: Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. RESULTS: Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. CONCLUSION: If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs. PMID:25954101

Clinical outcomes and economic impact of transcatheter mitral leaflet repair in heart failure patients.

PubMed

Asgar, Anita W; Khairy, Paul; Guertin, Marie-Claude; Cournoyer, Daniel; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsene; Tardif, Jean-Claude; Cohen, David J

2017-01-01

Mitral regurgitation (MR) is a common valvular heart disorder requiring intervention once it becomes severe. Transcatheter mitral repair with the MitraClip device is a safe and effective therapy for selected patients denied surgery. The authors sought to evaluate the clinical outcomes and economic impact of this therapy compared to medical management in heart-failure patients with symptomatic mitral regurgitation. The study was comprised of two phases; an observational study of patients with heart failure and mitral regurgitation treated with either medical therapy or the MitraClip, and an economic model. Results of the observational study were used to estimate parameters for the decision model, which estimated costs, and benefits in a hypothetical cohort of patients with heart failure and moderate-to-severe mitral regurgitation treated with either standard medical therapy or MitraClip. The cohort of patients treated with the MitraClip was propensity matched to a population of heart failure patients, and their outcomes compared. At a mean follow-up of 22 months, all-cause mortality was 21% in the MitraClip cohort and 42% in the medical management cohort (p = .007). The decision model demonstrated that MitraClip increased life expectancy from 1.87-3.60 years and quality-adjusted life years (QALY) from 1.13-2.76 years. The incremental cost was $52,500 Canadian dollars, corresponding to an incremental cost-effectiveness ratio (ICER) of $32,300.00 per QALY gained. Results were sensitive to the survival benefit. In heart failure patients with symptomatic moderate-severe mitral regurgitation, therapy with the MitraClip is associated with superior survival and is cost-effective compared to medical therapy.

Effects of precipitation and clipping intensity on net primary productivity and composition of a Leymus chinensis temperate grassland steppe.

PubMed

He, Feng; Wang, Kun; Hannaway, David B; Li, Xianglin

2017-01-01

Leymus chinensis (Trin.) is the dominant vegetation type in eastern Eurasian temperate grasslands but is decreasing due to the combined pressure of reduced precipitation and overgrazing. This study evaluated the separate and combined effects of precipitation and defoliation on net primary productivity (NPP) and composition of a L. chinensis steppe to promote the sustainable development of temperate grasslands through improved management practices. The effects of three precipitation gradients (precipitation unchanged, reduced by 50%, and increased by 50%) and two clipping intensities (clipping once or twice per year) were examined on NPP and composition of the L. chinensis community using a 7-year in situ controlled trial at the Guyuan State Key Monitoring and Research Station of Grassland Ecosystem in China. The results showed that: (1) a 50% reduction in natural precipitation significantly decreased NPP; a 50% increase in precipitation did not significantly increase NPP, but it decreased the importance value of L. chinensis because more water promoted the growth of competing species. (2) Clipping twice per year increased NPP, but the increase was from the dry matter of other species (DMO) component, and not from the dry matter of L. chinensis. (3) The standardized coefficients of a regression model (β) for DMO, NPP, and the importance value of L. chinensis were 0.685, 0.532, and -0.608 for precipitation, and 0.369, 0.419, and -0.276 for clipping mode, respectively. This study demonstrated that variation in precipitationis the key driver of NPP and composition of a L. chinensis steppe under the precipitation range and clipping intensities evaluated. This improved understanding of the effects of precipitation and clipping on NPP and composition will allow for improved, sustainable management of L. chinensis temperate grassland steppes.

Clips versus suture technique: is there a difference?

PubMed

Chughtai, T; Chen, L Q; Salasidis, G; Nguyen, D; Tchervenkov, C; Morin, J F

2000-11-01

Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.

Dosimetric impact of tumor bed delineation variability based on 4DCT scan for external-beam partial breast irradiation.

PubMed

Guo, Bing; Li, Jianbin; Wang, Wei; Li, Fengxiang; Guo, Yanluan; Li, Yankang; Liu, Tonghai

2015-01-01

This study sought to evaluate the dosimetric impact of tumor bed delineation variability (based on clips, seroma or both clips and seroma) during external-beam partial breast irradiation (EB-PBI) planned utilizing four-dimensional computed tomography (4DCT) scans. 4DCT scans of 20 patients with a seroma clarity score (SCS) 3~5 and ≥5 surgical clips were included in this study. The combined volume of the tumor bed formed using clips, seroma, or both clips and seroma on the 10 phases of 4DCT was defined as the internal gross target volume (termed IGTVC, IGTVS and IGTVC+S, respectively). A 1.5-cm margin was added by defining the planning target volume (termed PTVC, PTVS and PTVC+S, respectively). Three treatment plans were established using the 4DCT images (termed EB-PBIC, EB-PBIS, EB-PBIC+S, respectively). The results showed that the volume of IGTVC+S was significantly larger than that of IGTVCand IGTVS. Similarly, the volume of PTVC+S was markedly larger than that of PTVC and PTVS. However, the PTV coverage for EB-PBIC+S was similar to that of EB-PBIC and EB-PBIS, and there were no significant differences in the homogeneity index or conformity index between the three treatment plans (P=0.878, 0.086). The EB-PBIS plan resulted in the lowest ipsilateral normal breast and ipsilateral lung doses compared with the EB-PBIC and EB-PBIC+S plans. To conclude, the volume variability delineated based on clips, seroma or both clips and seroma resulted in dosimetric variability for organs at risk, but did not show a marked influence on the dosimetric distribution.

Dosimetric impact of tumor bed delineation variability based on 4DCT scan for external-beam partial breast irradiation

PubMed Central

Guo, Bing; Li, Jianbin; Wang, Wei; Li, Fengxiang; Guo, Yanluan; Li, Yankang; Liu, Tonghai

2015-01-01

This study sought to evaluate the dosimetric impact of tumor bed delineation variability (based on clips, seroma or both clips and seroma) during external-beam partial breast irradiation (EB-PBI) planned utilizing four-dimensional computed tomography (4DCT) scans. 4DCT scans of 20 patients with a seroma clarity score (SCS) 3~5 and ≥5 surgical clips were included in this study. The combined volume of the tumor bed formed using clips, seroma, or both clips and seroma on the 10 phases of 4DCT was defined as the internal gross target volume (termed IGTVC, IGTVS and IGTVC+S, respectively). A 1.5-cm margin was added by defining the planning target volume (termed PTVC, PTVS and PTVC+S, respectively). Three treatment plans were established using the 4DCT images (termed EB-PBIC, EB-PBIS, EB-PBIC+S, respectively). The results showed that the volume of IGTVC+S was significantly larger than that of IGTVCand IGTVS. Similarly, the volume of PTVC+S was markedly larger than that of PTVC and PTVS. However, the PTV coverage for EB-PBIC+S was similar to that of EB-PBIC and EB-PBIS, and there were no significant differences in the homogeneity index or conformity index between the three treatment plans (P=0.878, 0.086). The EB-PBIS plan resulted in the lowest ipsilateral normal breast and ipsilateral lung doses compared with the EB-PBIC and EB-PBIC+S plans. To conclude, the volume variability delineated based on clips, seroma or both clips and seroma resulted in dosimetric variability for organs at risk, but did not show a marked influence on the dosimetric distribution. PMID:26885108

Effects of precipitation and clipping intensity on net primary productivity and composition of a Leymus chinensis temperate grassland steppe

PubMed Central

Wang, Kun; Hannaway, David B.; Li, Xianglin

2017-01-01

Leymus chinensis (Trin.) is the dominant vegetation type in eastern Eurasian temperate grasslands but is decreasing due to the combined pressure of reduced precipitation and overgrazing. This study evaluated the separate and combined effects of precipitation and defoliation on net primary productivity (NPP) and composition of a L. chinensis steppe to promote the sustainable development of temperate grasslands through improved management practices. The effects of three precipitation gradients (precipitation unchanged, reduced by 50%, and increased by 50%) and two clipping intensities (clipping once or twice per year) were examined on NPP and composition of the L. chinensis community using a 7-year in situ controlled trial at the Guyuan State Key Monitoring and Research Station of Grassland Ecosystem in China. The results showed that: (1) a 50% reduction in natural precipitation significantly decreased NPP; a 50% increase in precipitation did not significantly increase NPP, but it decreased the importance value of L. chinensis because more water promoted the growth of competing species. (2) Clipping twice per year increased NPP, but the increase was from the dry matter of other species (DMO) component, and not from the dry matter of L. chinensis. (3) The standardized coefficients of a regression model (β) for DMO, NPP, and the importance value of L. chinensis were 0.685, 0.532, and −0.608 for precipitation, and 0.369, 0.419, and −0.276 for clipping mode, respectively. This study demonstrated that variation in precipitationis the key driver of NPP and composition of a L. chinensis steppe under the precipitation range and clipping intensities evaluated. This improved understanding of the effects of precipitation and clipping on NPP and composition will allow for improved, sustainable management of L. chinensis temperate grassland steppes. PMID:29287115

Desensitization to media violence: links with habitual media violence exposure, aggressive cognitions, and aggressive behavior.

PubMed

Krahé, Barbara; Möller, Ingrid; Huesmann, L Rowell; Kirwil, Lucyna; Felber, Juliane; Berger, Anja

2011-04-01

This study examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. Two weeks after completing measures of habitual media violence exposure, trait aggression, trait arousability, and normative beliefs about aggression, undergraduates (N = 303) saw a violent film clip and a sad or a funny comparison clip. Skin conductance level (SCL) was measured continuously, and ratings of anxious and pleasant arousal were obtained after each clip. Following the clips, participants completed a lexical decision task to measure accessibility of aggressive cognitions and a competitive reaction time task to measure aggressive behavior. Habitual media violence exposure correlated negatively with SCL during violent clips and positively with pleasant arousal, response times for aggressive words, and trait aggression, but it was unrelated to anxious arousal and aggressive responding during the reaction time task. In path analyses controlling for trait aggression, normative beliefs, and trait arousability, habitual media violence exposure predicted faster accessibility of aggressive cognitions, partly mediated by higher pleasant arousal. Unprovoked aggression during the reaction time task was predicted by lower anxious arousal. Neither habitual media violence usage nor anxious or pleasant arousal predicted provoked aggression during the laboratory task, and SCL was unrelated to aggressive cognitions and behavior. No relations were found between habitual media violence viewing and arousal in response to the sad and funny film clips, and arousal in response to the sad and funny clips did not predict aggressive cognitions or aggressive behavior on the laboratory task. This suggests that the observed desensitization effects are specific to violent content.

Desensitization to Media Violence: Links With Habitual Media Violence Exposure, Aggressive Cognitions, and Aggressive Behavior

PubMed Central

Krahé, Barbara; Möller, Ingrid; Huesmann, L. Rowell; Kirwil, Lucyna; Felber, Juliane; Berger, Anja

2015-01-01

This study examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. Two weeks after completing measures of habitual media violence exposure, trait aggression, trait arousability, and normative beliefs about aggression, undergraduates (N = 303) saw a violent film clip and a sad or a funny comparison clip. Skin conductance level (SCL) was measured continuously, and ratings of anxious and pleasant arousal were obtained after each clip. Following the clips, participants completed a lexical decision task to measure accessibility of aggressive cognitions and a competitive reaction time task to measure aggressive behavior. Habitual media violence exposure correlated negatively with SCL during violent clips and positively with pleasant arousal, response times for aggressive words, and trait aggression, but it was unrelated to anxious arousal and aggressive responding during the reaction time task. In path analyses controlling for trait aggression, normative beliefs, and trait arousability, habitual media violence exposure predicted faster accessibility of aggressive cognitions, partly mediated by higher pleasant arousal. Unprovoked aggression during the reaction time task was predicted by lower anxious arousal. Neither habitual media violence usage nor anxious or pleasant arousal predicted provoked aggression during the laboratory task, and SCL was unrelated to aggressive cognitions and behavior. No relations were found between habitual media violence viewing and arousal in response to the sad and funny film clips, and arousal in response to the sad and funny clips did not predict aggressive cognitions or aggressive behavior on the laboratory task. This suggests that the observed desensitization effects are specific to violent content. PMID:21186935

Effect of mental challenge induced by movie clips on action potential duration in normal human subjects independent of heart rate.

PubMed

Child, Nicholas; Hanson, Ben; Bishop, Martin; Rinaldi, Christopher A; Bostock, Julian; Western, David; Cooklin, Michael; O'Neil, Mark; Wright, Matthew; Razavi, Reza; Gill, Jaswinder; Taggart, Peter

2014-06-01

Mental stress and emotion have long been associated with ventricular arrhythmias and sudden death in animal models and humans. The effect of mental challenge on ventricular action potential duration (APD) in conscious healthy humans has not been reported. Activation recovery intervals measured from unipolar electrograms as a surrogate for APD (n=19) were recorded from right and left ventricular endocardium during steady-state pacing, whilst subjects watched an emotionally charged film clip. To assess the possible modulating role of altered respiration on APD, the subjects then repeated the same breathing pattern they had during the stress, but without the movie clip. Hemodynamic parameters (mean, systolic, and diastolic blood pressure, and rate of pressure increase) and respiration rate increased during the stressful part of the film clip (P=0.001). APD decreased during the stressful parts of the film clip, for example, for global right ventricular activation recovery interval at end of film clip 193.8 ms (SD, 14) versus 198.0 ms (SD, 13) during the matched breathing control (end film left ventricle 199.8 ms [SD, 16] versus control 201.6 ms [SD, 15]; P=0.004). Respiration rate increased during the stressful part of the film clip (by 2 breaths per minute) and was well matched in the respective control period without any hemodynamic or activation recovery interval changes. Our results document for the first time direct recordings of the effect of a mental challenge protocol on ventricular APD in conscious humans. The effect of mental challenge on APD was not secondary to emotionally induced altered respiration or heart rate. © 2014 American Heart Association, Inc.

Changes in salivary testosterone concentrations and subsequent voluntary squat performance following the presentation of short video clips.

PubMed

Cook, Christian J; Crewther, Blair T

2012-01-01

Previous studies have shown that visual images can produce rapid changes in testosterone concentrations. We explored the acute effects of video clips on salivary testosterone and cortisol concentrations and subsequent voluntary squat performance in highly trained male athletes (n=12). Saliva samples were collected on 6 occasions immediately before and 15 min after watching a brief video clip (approximately 4 min in duration) on a computer screen. The watching of a sad, erotic, aggressive, training motivational, humorous or a neutral control clip was randomised. Subjects then performed a squat workout aimed at producing a 3 repetition maximum (3RM) lift. Significant (P<0.001) relative (%) increases in testosterone concentrations were noted with watching the erotic, humorous, aggressive and training videos (versus control and sad), with testosterone decreasing significantly (versus control) after the sad clip. The aggressive video also produced an elevated cortisol response (% change) and more so than the control and humorous videos (P<0.001). A significant (P<0.003) improvement in 3RM performance was noted after the erotic, aggressive and training clips (versus control). A strong within-individual correlation (mean r=0.85) was also noted between the relative changes in testosterone and the 3RM squats across all video sessions (P<0.001). In conclusion, different video clips were associated with different changes in salivary free hormone concentrations and the relative changes in testosterone closely mapped 3RM squat performance in a group of highly trained males. Thus, speculatively, using short video presentations in the pre-workout environment offers an opportunity for understanding the outcomes of hormonal change, athlete behaviour and subsequent voluntary performance. Copyright © 2011 Elsevier Inc. All rights reserved.

From tails to toes: developing nonlethal tissue indicators of mercury exposure in five amphibian species

USGS Publications Warehouse

Pfleeger, Adam Z.; Eagles-Smith, Collin A.; Kowalski, Brandon M.; Herring, Garth; Willacker, James J.; Jackson, Allyson K.; Pierce, John

2016-01-01

Exposure to environmental contaminants has been implicated as a factor in global amphibian decline. Mercury (Hg) is a particularly widespread contaminant that biomagnifies in amphibians and can cause a suite of deleterious effects. However, monitoring contaminant exposure in amphibian tissues may conflict with conservation goals if lethal take is required. Thus, there is a need to develop non-lethal tissue sampling techniques to quantify contaminant exposure in amphibians. Some minimally invasive sampling techniques, such as toe-clipping, are common in population-genetic research, but it is unclear if these methods can adequately characterize contaminant exposure. We examined the relationships between mercury (Hg) concentrations in non-lethally sampled tissues and paired whole-bodies in five amphibian species. Specifically, we examined the utility of three different tail-clip sections from four salamander species and toe-clips from one anuran species. Both tail and toe-clips accurately predicted whole-body THg concentrations, but the relationships differed among species and the specific tail-clip section or toe that was used. Tail-clips comprised of the distal 0–2 cm segment performed the best across all salamander species, explaining between 82 and 92 % of the variation in paired whole-body THg concentrations. Toe-clips were less effective predictors of frog THg concentrations, but THg concentrations in outer rear toes accounted for up to 79 % of the variability in frog whole-body THg concentrations. These findings suggest non-lethal sampling of tails and toes has potential applications for monitoring contaminant exposure and risk in amphibians, but care must be taken to ensure consistent collection and interpretation of samples.

Cerebral Protection During MitraClip Implantation: Initial Experience at 2 Centers.

PubMed

Frerker, Christian; Schlüter, Michael; Sanchez, Oscar D; Reith, Sebastian; Romero, Maria E; Ladich, Elena; Schröder, Jörg; Schmidt, Tobias; Kreidel, Felix; Joner, Michael; Virmani, Renu; Kuck, Karl-Heinz

2016-01-25

This study sought to assess the feasibility and safety of using a filter-based cerebral protection system (CPS) during MitraClip implantation and to report on the histopathologic analysis of the captured debris. Stroke is one of the serious adverse events associated with MitraClip therapy. Between July 2014 and March 2015, 14 surgical high-risk patients (age 75 ± 7 years; 7 men; median logistic EuroSCORE 21%) underwent MitraClip implantation employing cerebral protection with a dual embolic filter system. All patients had severe mitral regurgitation of predominantly functional origin. All procedures were successfully completed for both CPS deployment/retrieval and MitraClip implantation. A total of 28 filters (2 from each patient) were analyzed. Microscopically, debris was identified in all 14 patients. The most common tissue types were acute thrombus and small fragments of foreign material, which were found in 12 patients (85.7%) each. Organizing thrombus was present in 4 patients (28.6%), valve tissue and/or superficial atrial wall tissue in 9 patients (64.3%), and fragments of myocardium in 2 patients (14.3%). No transient ischemic attacks, strokes, or deaths occurred peri-procedurally or during a median follow-up interval of 8.4 months. In this small study of patients undergoing MitraClip treatment with cerebral protection, embolic debris potentially conducive to cerebrovascular events was found in all patients. Debris was composed most often of acute thrombus, foreign material likely originating from the hydrophilic device coating, and valve/atrial wall tissue. Further studies are warranted to assess the impact of cerebral protection on the incidence of cerebrovascular events after MitraClip therapy. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effects of Substrate Addition on Soil Respiratory Carbon Release Under Long-Term Warming and Clipping in a Tallgrass Prairie

PubMed Central

Jia, Xiaohong; Zhou, Xuhui; Luo, Yiqi; Xue, Kai; Xue, Xian; Xu, Xia; Yang, Yuanhe; Wu, Liyou; Zhou, Jizhong

2014-01-01

Regulatory mechanisms of soil respiratory carbon (C) release induced by substrates (i.e., plant derived substrates) are critical for predicting ecosystem responses to climate change, but the mechanisms are not well understood. In this study, we sampled soils from a long-term field manipulative experiment and conducted a laboratory incubation to explore the role of substrate supply in regulating the differences in soil C release among the experimental treatments, including control, warming, clipping, and warming plus clipping. Three types of substrates (glucose, C3 and C4 plant materials) were added with an amount equal to 1% of soil dry weight under the four treatments. We found that the addition of all three substrates significantly stimulated soil respiratory C release in all four warming and clipping treatments. In soils without substrate addition, warming significantly stimulated soil C release but clipping decreased it. However, additions of glucose and C3 plant materials (C3 addition) offset the warming effects, whereas C4 addition still showed the warming-induced stimulation of soil C release. Our results suggest that long-term warming may inhibit microbial capacity for decomposition of C3 litter but may enhance it for decomposition of C4 litter. Such warming-induced adaptation of microbial communities may weaken the positive C-cycle feedback to warming due to increased proportion of C4 species in plant community and decreased litter quality. In contrast, clipping may weaken microbial capacity for warming-induced decomposition of C4 litter but may enhance it for C3 litter. Warming- and clipping-induced shifts in microbial metabolic capacity may be strongly associated with changes in plant species composition and could substantially influence soil C dynamics in response to global change. PMID:25490701

Effects of substrate addition on soil respiratory carbon release under long-term warming and clipping in a tallgrass prairie.

PubMed

Jia, Xiaohong; Zhou, Xuhui; Luo, Yiqi; Xue, Kai; Xue, Xian; Xu, Xia; Yang, Yuanhe; Wu, Liyou; Zhou, Jizhong

2014-01-01

Regulatory mechanisms of soil respiratory carbon (C) release induced by substrates (i.e., plant derived substrates) are critical for predicting ecosystem responses to climate change, but the mechanisms are not well understood. In this study, we sampled soils from a long-term field manipulative experiment and conducted a laboratory incubation to explore the role of substrate supply in regulating the differences in soil C release among the experimental treatments, including control, warming, clipping, and warming plus clipping. Three types of substrates (glucose, C3 and C4 plant materials) were added with an amount equal to 1% of soil dry weight under the four treatments. We found that the addition of all three substrates significantly stimulated soil respiratory C release in all four warming and clipping treatments. In soils without substrate addition, warming significantly stimulated soil C release but clipping decreased it. However, additions of glucose and C3 plant materials (C3 addition) offset the warming effects, whereas C4 addition still showed the warming-induced stimulation of soil C release. Our results suggest that long-term warming may inhibit microbial capacity for decomposition of C3 litter but may enhance it for decomposition of C4 litter. Such warming-induced adaptation of microbial communities may weaken the positive C-cycle feedback to warming due to increased proportion of C4 species in plant community and decreased litter quality. In contrast, clipping may weaken microbial capacity for warming-induced decomposition of C4 litter but may enhance it for C3 litter. Warming- and clipping-induced shifts in microbial metabolic capacity may be strongly associated with changes in plant species composition and could substantially influence soil C dynamics in response to global change.

Effect of mental challenge induced by movie clips on action potential duration in normal human subjects independent of heart rate

PubMed Central

Child, Nicholas; Hanson, Ben; Bishop, Martin; Rinaldi, Christopher A; Bostock, Julian; Western, David; Cooklin, Michael; O’Neil, Mark; Wright, Matthew; Razavi, Reza; Gill, Jaswinder; Taggart, Peter

2014-01-01

Background Mental stress and emotion have long been associated with ventricular arrhythmias and sudden death in animal models and humans. The effect of mental challenge on ventricular action potential duration (APD) in conscious healthy humans has not been reported. Methods and Results Activation recovery intervals (ARI) measured from unipolar electrograms as a surrogate for APD (n=19) were recorded from right and left ventricular endocardium during steady state pacing while subjects watched an emotionally charged film clip. To assess the possible modulating role of altered respiration on APD, the subjects then repeated the same breathing pattern they had during the stress, but without the movie clip. Haemodynamic parameters (mean, systolic, and diastolic blood pressure, and rate of pressure increase) and respiration rate increased during the stressful part of the film clip (p=0.001). APD decreased during the stressful parts of the film clip, eg for global RV ARI at end of film clip 193.8ms (SD 14) vs 198.0ms (SD13) during the matched breathing control (end film LV 199.8ms (SD16) vs control 201.6ms (SD15), p=0.004. Respiration rate increased during the stressful part of the film clip (by 2 breaths/minute), and was well matched in the respective control period without any haemodynamic or ARI changes. Conclusions Our results document for the first time direct recordings of the effect of a mental challenge protocol on ventricular action potential duration in conscious humans. The effect of mental challenge on APD was not secondary to emotionally-induced altered respiration or heart rate. PMID:24833641

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration.

PubMed

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-05-07

To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.

Laparoscopic uterine artery occlusion for symptomatic leiomyomas.

PubMed

Lichtinger, Moises; Hallson, Laurey; Calvo, Patricia; Adeboyejo, Ghea

2002-05-01

To describe a laparoscopic technique that safely occludes both uterine arteries, overcoming an altered surgical field resulting from scarring and/or uterine leiomyomatous growth. Prospective analysis (Canadian Task Force classification II-2). Nonprofit community hospital. Eight women with leiomyomas with abnormal uterine bleeding, pelvic pain or pressure, and/or anemia. Bilateral laparoscopic retroperitoneal uterine artery occlusion. Occlusion at the initial track of the uterine artery was performed by laparoscopic coated ligature in six patients. In two obese patients with deep retroperitoneal space, vascular clips were placed endoscopically using the same dissecting technique. All patients were discharged within 20 hours after the procedure. All five women with abnormal bleeding reported satisfactory decrease; none reported amenorrhea. Of eight with preoperative pain or pressure, seven reported complete disappearance and one significant relief. All three patients with anemia had normal red cell counts after 1 month. Laparoscopic uterine artery occlusion using a lateral retroperitoneal technique is safe and effective in women with pelvic scarring and altered pelvic anatomy.

False-negative contrast-enhanced spectral mammography: use of more than one imaging modality and application of the triple test avoids misdiagnosis.

PubMed

Taylor, Donna; O'Hanlon, Susan; Latham, Bruce

2017-03-31

A 50-year-old woman presented with chest tenderness. On examination, both breasts were lumpy. Bilateral mammography showed heterogeneously dense parenchyma, with possible stromal distortion laterally on the right at the 0900 position. On ultrasound (US), a corresponding 13×9×10 mm irregular hypoechoic mass with internal vascularity was noted and both breasts had a complex heterogeneous fibroglandular background pattern. US-guided core biopsy with marker clip insertion was performed with the diagnosis of a grade 2 invasive ductal carcinoma (IDC). In view of the parenchymal pattern on mammography and US, contrast-enhanced spectral mammography (CESM) was performed for local staging. Mild background enhancement was noted, but there was no enhancement at the lesion site. The patient elected to have bilateral mastectomies and sentinel node biopsies. Final histopathology showed a node negative 11 mm grade 2 oestrogen and progesterone receptor positive, IDC. 2017 BMJ Publishing Group Ltd.

Easy clip to treat anal fistula tracts: a word of caution.

PubMed

Gautier, M; Godeberge, P; Ganansia, R; Bozio, G; Godart, B; Bigard, M A; Barthet, M; Siproudhis, L

2015-05-01

Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion. Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.

Whole-brain haemodynamic after-effects of 1-Hz magnetic stimulation of the posterior superior temporal cortex during action observation.

PubMed

Arfeller, Carola; Schwarzbach, Jens; Ubaldi, Silvia; Ferrari, Paolo; Barchiesi, Guido; Cattaneo, Luigi

2013-04-01

The posterior superior temporal sulcus (pSTS) is active when observing biological motion. We investigated the functional connections of the pSTS node within the action observation network by measuring the after-effect of focal repetitive transcranial magnetic stimulation (rTMS) with whole-brain functional magnetic resonance imaging (fMRI). Participants received 1-Hz rTMS over the pSTS region for 10 min and underwent fMRI immediately after. While scanned, they were shown short video clips of a hand grasping an object (grasp clips) or moving next to it (control clips). rTMS-fMRI was repeated for four consecutive blocks. In two blocks we stimulated the left pSTS region and in the other two the right pSTS region. For each side TMS was applied with an effective intensity (95 % of motor threshold) or with ineffective intensity (50 % of motor threshold). Brain regions showing interactive effects of (clip type) × (TMS intensity) were identified in the lateral temporo-occipital cortex, in the anterior intraparietal region and in the ventral premotor cortex. Remote effects of rTMS were mostly limited to the stimulated hemisphere and consisted in an increase of blood oxygen level-dependent responses to grasp clips compared to control clips. We show that the pSTS occupies a pivotal relay position during observation of goal-directed actions.

Harmonic Scalpel versus electrocautery and surgical clips in head and neck free-flap harvesting.

PubMed

Dean, Nichole R; Rosenthal, Eben L; Morgan, Bruce A; Magnuson, J Scott; Carroll, William R

2014-06-01

We sought to determine the safety and utility of Harmonic Scalpel-assisted free-flap harvesting as an alternative to a combined electrocautery and surgical clip technique. The medical records of 103 patients undergoing radial forearm free-flap reconstruction (105 free flaps) for head and neck surgical defects between 2006 and 2008 were reviewed. The use of bipolar electrocautery and surgical clips for division of small perforating vessels (n = 53) was compared to ultrasonic energy (Harmonic Scalpel; Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) (n = 52) free-tissue harvesting techniques. Flap-harvesting time was reduced with the use of the Harmonic Scalpel when compared with electrocautery and surgical clip harvest (31.4 vs. 36.9 minutes, respectively; p = 0.06). Two patients who underwent flap harvest with electrocautery and surgical clips developed postoperative donor site hematomas, whereas no donor site complications were noted in the Harmonic Scalpel group. Recipient site complication rates for infection, fistula, and hematoma were similar for both harvesting techniques (p = 0.77). Two flap failures occurred in the clip-assisted radial forearm free-flap harvest group, and none in the Harmonic Scalpel group. Median length of hospitalization was significantly reduced for patients who underwent free-flap harvest with the Harmonic Scalpel when compared with the other technique (7 vs. 8 days; p = 0.01). The Harmonic Scalpel is safe, and its use is feasible for radial forearm free-flap harvest.

Pregnancy after tubal sterilization with silicone rubber band and spring clip application.

PubMed

Peterson, H B; Xia, Z; Wilcox, L S; Tylor, L R; Trussell, J

2001-02-01

To determine risk factors for pregnancy after tubal sterilization with silicone rubber bands or spring clips. A total of 3329 women sterilized using silicone rubber bands and 1595 women sterilized using spring clips were followed for up to 14 years as part of a prospective cohort study conducted in medical centers in nine US cities. We assessed the risk of pregnancy by cumulative life-table probabilities and proportional hazards analysis. The risk of pregnancy for women who had silicone rubber band application differed by location of band application and study site. The 10-year cumulative probabilities of pregnancy varied from a low of 0.0 per 1000 procedures at one study site to a high of 42.5 per 1000 procedures in the four combined sites in which fewer than 100 procedures per site were performed. The risk of pregnancy for women who had spring clip application varied by location of clip application, study site, race or ethnicity, tubal disease, and history of abdominal or pelvic surgery. The probabilities across study sites ranged from 7.1 per 1000 procedures at 10 years to 78.0 per 1000 procedures at 5 years (follow-up was limited to 5 years at that site). The 10-year cumulative probability of pregnancy after silicone rubber band and spring clip application is low but varies substantially by both clinical and demographic characteristics.

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the female genital organs. This generic type of device may include trocar and cannula, instruments... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the female genital organs. This generic type of device may include trocar and cannula, instruments... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula...

Minimally Invasive Repair of a Prostatorectal Fistula with an Over-the-Scope Rectal Clip

PubMed Central

Schmidt-Heikenfeld, Ekkehard; Degener, Stephan; Roosen, Alexander; Boy, Anselm

2017-01-01

Abstract Background: Fistulae between the prostatic urethra and the rectum are rare. They may result from prostatic or rectal surgery. Predisposing factors are previous radiation or immunosuppression. The repair of such fistulae usually involves major surgery. Recently, clips that can be deployed over an endoscope have been developed to close gastrointestinal fistulae or access points for natural orifice surgery. We report the first case of effective treatment of a prostatorectal fistula with a rectal “over-the-scope” clip. Case Presentation: A 64-year-old man under chronic immunosuppression presented with an iatrogenic fistula between the prostatic urethra and the rectum after transurethral resection of the prostate. A transverse colostomy was placed but the fistula failed to heal conservatively. The fistula was effectively closed with an endorectal clip. Six weeks after the procedure, spontaneous micturition was started. Two weeks further, the colostomy was reversed. At 32 months of follow-up, the remains closed, micturition is unimpaired. Conclusion: In select cases of prostatorectal fistula, an endorectal clip may be effectively used for closure. PMID:29098198

Using CLIPS in the domain of knowledge-based massively parallel programming

NASA Technical Reports Server (NTRS)

Dvorak, Jiri J.

1994-01-01

The Program Development Environment (PDE) is a tool for massively parallel programming of distributed-memory architectures. Adopting a knowledge-based approach, the PDE eliminates the complexity introduced by parallel hardware with distributed memory and offers complete transparency in respect of parallelism exploitation. The knowledge-based part of the PDE is realized in CLIPS. Its principal task is to find an efficient parallel realization of the application specified by the user in a comfortable, abstract, domain-oriented formalism. A large collection of fine-grain parallel algorithmic skeletons, represented as COOL objects in a tree hierarchy, contains the algorithmic knowledge. A hybrid knowledge base with rule modules and procedural parts, encoding expertise about application domain, parallel programming, software engineering, and parallel hardware, enables a high degree of automation in the software development process. In this paper, important aspects of the implementation of the PDE using CLIPS and COOL are shown, including the embedding of CLIPS with C++-based parts of the PDE. The appropriateness of the chosen approach and of the CLIPS language for knowledge-based software engineering are discussed.

Intraoperative Matas test using microscope-integrated intraoperative indocyanine green videoangiography with temporary unilateral occlusion of the A1 segment of the anterior cerebral artery.

PubMed

Murai, Yasuo; Adachi, Koji; Takagi, Ryo; Koketsu, Kenta; Matano, Fumihiro; Teramoto, Akira

2011-11-01

The aim of the present study was to assess a new technique of surgical microscope-based indocyanine green (ICG) videoangiography (VAG) to confirm the patency of the anterior communicating artery (AcomA) after clipping AcomA aneurysms. Aneurysmal clipping of five cases of unruptured, broad-neck AcomA aneurysm was performed using the Carl Zeiss Surgical Microscope OPMI Pentero INFRARED 800. In all five patients, after clipping AcomA aneurysms, the patency of AcomA was confirmed using ICGVAG findings and temporary unilateral occlusion of the A1 segment of the anterior cerebral artery using temporary clips. Images were excellent and enabled a real-time surgical assessment because the structures of interest, including vessels, perforating arteries, or residual aneurysm neck, were visible to the surgeon's eye under the microscope in all five patients. ICGVAG and temporary unilateral occlusion with clips provides a simple, reliable, real-time, and rapid intraoperative assessment of the patency of AcomA. This technique may help to improve the quality of neurosurgical procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device.

PubMed

Marotta, Thomas R; Riina, Howard A; McDougall, Ian; Ricci, Donald R; Killer-Oberpfalzer, Monika

2018-02-01

OBJECTIVE Intracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations. METHODS A preclinical model of wide-necked bifurcation aneurysms in rabbits was used to assess functional features and efficacy of aneurysm occlusion by the eCLIPs device. RESULTS The eCLIPs device, in bridging the aneurysm neck, allows coil retention, disrupts flow away from the aneurysm, leaves the main vessel and side branches unencumbered by intraluminal metal, and serves as a platform for endothelial growth across the neck, excluding the aneurysm from the circulation. CONCLUSIONS The eCLIPs device permits physiological remodeling of the bifurcation.

HIV Treatment Overview

MedlinePlus

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The computational structural mechanics testbed architecture. Volume 2: The interface

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1988-01-01

This is the third set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language CLAMP, the command language interpreter CLIP, and the data manager GAL. Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 3 describes the CLIP-Processor interface and related topics. It is intended only for processor developers.

Adaptive quantization-parameter clip scheme for smooth quality in H.264/AVC.

PubMed

Hu, Sudeng; Wang, Hanli; Kwong, Sam

2012-04-01

In this paper, we investigate the issues over the smooth quality and the smooth bit rate during rate control (RC) in H.264/AVC. An adaptive quantization-parameter (Q(p)) clip scheme is proposed to optimize the quality smoothness while keeping the bit-rate fluctuation at an acceptable level. First, the frame complexity variation is studied by defining a complexity ratio between two nearby frames. Second, the range of the generated bits is analyzed to prevent the encoder buffer from overflow and underflow. Third, based on the safe range of the generated bits, an optimal Q(p) clip range is developed to reduce the quality fluctuation. Experimental results demonstrate that the proposed Q(p) clip scheme can achieve excellent performance in quality smoothness and buffer regulation.

Clip gage attachment for frictionless measurement of displacement during high-temperature mechanical testing

DOEpatents

Alexander, D.J.

1994-01-04

An attachment for placement between a test specimen and a remote clip gage extensometer providing improved fracture toughness tests of materials at elevated temperature is described. Using a cylindrical tube and axial rod in new relationship, the device transfers the displacement signal of the fracture toughness test specimen directly to a clip gage extensometer located outside the high temperature furnace. Virtually frictionless operation is assured by having the test specimen center one end of the rod in one end of the tube, while the clip gage extensometer arms center the other end of the rod in the other end of the tube. By providing positive control over both ends of both rod and tube, the attachment may be operated in orientations other than vertical. 1 figure.

The computational structural mechanics testbed architecture. Volume 2: Directives

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1989-01-01

This is the second of a set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language (CLAMP), the command language interpreter (CLIP), and the data manager (GAL). Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 2 describes the CLIP directives in detail. It is intended for intermediate and advanced users.

Clipping and shading alter NH4+ uptake by plants in grazed and ungrazed Tibetan alpine grasslands

NASA Astrophysics Data System (ADS)

Sun, Yue; Schleuss, Per; Li, Qianru; Yang, Baijie; Xu, Xingliang; Kuzyakov, Yakov

2014-05-01

The Kobresia pastures are the most common and most important vegetation type on the Tibetan Plateau as it occupies more than 35% the plateau area. These pastures have been remained stable for about one million years, but have been strongly changed by increased grazing in the recent decades which led to serious grassland degradation. Previous studies on the N cycling in alpine grasslands showed that plant growth was limited by low N availability due to low N mineralization caused by low temperature. However, the effect of grazing on N turnover processes and plant N uptake remains unclear. To clarify the grazing effect for a better understanding N mineralization and plant N uptake in these alpine grasslands, we conducted a 15N experiment in grazed and ungraded plots in these alpine grasslands. Because ammonium was a dominant N form, we used 15N-labeled ammonium so that we can also measure gross N mineralization. To explore the effect of root exudates on 15NH4+ uptake by plants and gross N mineralization, three treatments such as clipping, shading and control were used. Initially, all treatments were labeled by 15NH4+, with blank treatments no 15N tracer addition. Plant and soil samples were collected 7, 14 and 28 days after the labelling. 15NH4+ uptake by alpine plants almost did not change after clipping in the grazed plots, but its uptake was lower under the clipping treatment than under the control treatment in the ungrazed plots. 15N recovery in plants under the shading treatment remained the lowest level in grazed and ungrazed plots. Although clipping removed a part of aboveground biomass, subsequent stimulation of plant growth increased N uptake by plants. Likely, moderate grazing removed a part of aboveground biomass, but 15N recovery in plants was still compared to that in the ungrazed plots, indicating moderate grazing stimulate N uptake by plants through compensatory growth. Gross N mineralization under the shading treatment was higher than under the clipping treatment (shading vs clipping: 0.42 vs 0.34 mg N kg-1 h-1) in the grazed plot. In contrast, gross N mineralization was lower for shading treatment than for clipping treatment (shading vs clipping 0.47 vs 0.63 mg N kg-1 h-1) in the ungrazed plot. Gross N mineralization in the ungrazed soil was higher than in the grazed soil, suggesting that grazing greatly reduced the potential to provide available nitrogen for plants and microorganisms. Therefore, we concluded that low photosynthesis caused by shading, clipping and grazing can affect N transformation and therefore affect the format of soil organic matter.

Ipratropium Nasal Spray

MedlinePlus

... follow these steps: Remove the clear plastic dust cap and the safety clip from the nasal spray ... the other nostril. Replace the clear plastic dust cap and safety clip. If the nasal tip becomes ...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... genital organs. This generic type of device may include: Trocar and cannula, instruments used through an... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... genital organs. This generic type of device may include: Trocar and cannula, instruments used through an... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...

What Is HIV/AIDS?

MedlinePlus

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Evaluation of Veriox as a Skin Decontamination Product after Dermal Exposure to the Nerve Agent VX

DTIC Science & Technology

2016-09-01

in hair -clipped, unanesthetized guinea pigs. Efficacy was established by generating VX dose-lethality curves for each DC product based on 24 survival...This study compared the effectiveness of Veriox® to RSDL when each was used as a DC product 2 min after dermal exposure to VX in hair -clipped...by the dermal LD90 of VX in untreated animals. A LD90 value of 188 μg/kg generated in hair -clipped, unanesthetized guinea pigs (Clarkson, personal

[Choledochal lithiasis and stenosis secondary to the migration of a surgical clip].

PubMed

Baldomà España, M; Pernas Canadell, J C; González Ceballos, S

2014-01-01

The migration of a clip to the common bile duct after cholecystectomy is an uncommon, usually late, complication that can lead to diverse complications like stone formation, stenosis, and obstruction in the bile duct. We present the case of a patient who presented with signs and symptoms of cholangitis due to clip migration one year after laparoscopic cholecystectomy; endoscopic retrograde cholangiopancreatography and biliary tract stent placement resolved the problem. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

Assessment of the Accuracy of Certain Reduced Order Models used in the Prediction of Occupant Injury during Under-Body Blast Events

DTIC Science & Technology

2014-04-15

the floor on which the platform is dropped upon. Alternatively, a base excitation can be provided to the sliding platform in the upward vertical...7ms clips of chest resultant acceleration, (7) 7ms clip of pelvic vertical acceleration, (8,9) Peak and 30ms clips of lumbar spine compression, and...10) Pelvic vertical Dynamic Response Index (DRI)[12]. The sample size for each of the three seating variants consisted of 230 MADYMO

Second CLIPS Conference Proceedings, volume 2

NASA Technical Reports Server (NTRS)

Giarratano, Joseph (Editor); Culbert, Christopher J. (Editor)

1991-01-01

Papers presented at the 2nd C Language Integrated Production System (CLIPS) Conference held at the Lyndon B. Johnson Space Center (JSC) on 23-25 September 1991 are documented in these proceedings. CLIPS is an expert system tool developed by the Software Technology Branch at NASA JSC and is used at over 4000 sites by government, industry, and business. During the three days of the conference, over 40 papers were presented by experts from NASA, Department of Defense, other government agencies, universities, and industry.

Next-Generation Image and Sound Processing Strategies: Exploiting the Biological Model

DTIC Science & Technology

2007-05-01

several video game clips which were recorded while observers interactively played the games. The feature vectors may be derived from either: the...phase, we use a different video game clip to test the model. Frames from the test clip are passed in parallel to a bottom-up saliency model, as well as... video games (Figure 6). We found that the TD model alone predicts where humans look about twice as well as does the BU model alone; in addition, a

40 CFR 60.1440 - What is yard waste?

Code of Federal Regulations, 2010 CFR

2010-07-01

....1440 What is yard waste? Yard waste is grass, grass clippings, bushes, shrubs, and clippings from bushes and shrubs. They come from residential, commercial/retail, institutional, or industrial sources as...

Serine protease-related proteins in the malaria mosquito, Anopheles gambiae.

PubMed

Cao, Xiaolong; Gulati, Mansi; Jiang, Haobo

2017-09-01

Insect serine proteases (SPs) and serine protease homologs (SPHs) participate in digestion, defense, development, and other physiological processes. In mosquitoes, some clip-domain SPs and SPHs (i.e. CLIPs) have been investigated for possible roles in antiparasitic responses. In a recent test aimed at improving quality of gene models in the Anopheles gambiae genome using RNA-seq data, we observed various discrepancies between gene models in AgamP4.5 and corresponding sequences selected from those modeled by Cufflinks, Trinity and Bridger. Here we report a comparative analysis of the 337 SP-related proteins in A. gambiae by examining their domain structures, sequence diversity, chromosomal locations, and expression patterns. One hundred and ten CLIPs contain 1 to 5 clip domains in addition to their protease domains (PDs) or non-catalytic, protease-like domains (PLDs). They are divided into five subgroups: CLIPAs (22) are clip 1-5 -PLD; CLIPBs (29), CLIPCs (12) and CLIPDs (14) are mainly clip-PD; most CLIPEs (33) have a domain structure of PD/PLD-PLD-clip-PLD 0-1 . While expression of the CLIP genes in group-1 is generally low and detected in various tissue- and stage-specific RNA-seq libraries, some putative GPs/GPHs (i.e. single domain gut SPs/SPHs) in group-2 are highly expressed in midgut, whole larva or whole adult libraries. In comparison, 46 SPs, 26 SPHs, and 37 multi-domain SPs/SPHs (i.e. PD/PLD-PLD ≥1 ) in group-3 do not seem to be specifically expressed in digestive tract. There are 16 SPs and 2 SPH containing other types of putative regulatory domains (e.g. LDLa, CUB, Gd). Of the 337 SP and SPH genes, 159 were sorted into 46 groups (2-8 members/group) based on similar phylogenetic tree position, chromosomal location, and expression profile. This information and analysis, including improved gene models and protein sequences, constitute a solid foundation for functional analysis of the SP-related proteins in A. gambiae. Copyright © 2017 Elsevier Ltd. All rights reserved.

Arsenic microdistribution and speciation in toenail clippings of children living in a historic gold mining area

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

Pearce, Dora C.; Dowling, Kim; Gerson, Andrea R.

2010-05-04

Arsenic is naturally associated with gold mineralization and elevated in some soils and mine waste around historical gold mining activity in Victoria, Australia. To explore uptake, arsenic concentrations in children's toenail clippings and household soils were measured, and the microdistribution and speciation of arsenic in situ in toenail clipping thin sections investigated using synchrotron-based X-ray microprobe techniques. The ability to differentiate exogenous arsenic was explored by investigating surface contamination on cleaned clippings using depth profiling, and direct diffusion of arsenic into incubated clippings. Total arsenic concentrations ranged from 0.15 to 2.1 {micro}g/g (n = 29) in clipping samples and frommore » 3.3 to 130 {micro}g/g (n = 22) in household soils, with significant correlation between transformed arsenic concentrations (Pearson's r = 0.42, P = 0.023) when household soil was treated as independent. In clipping thin sections (n = 2), X-ray fluorescence (XRF) mapping showed discrete layering of arsenic consistent with nail structure, and irregular arsenic incorporation along the nail growth axis. Arsenic concentrations were heterogeneous at 10 x 10 {micro}m microprobe spot locations investigated (< 0.1 to 13.3 {micro}g/g). X-ray absorption near-edge structure (XANES) spectra suggested the presence of two distinct arsenic species: a lower oxidation state species, possibly with mixed sulphur and methyl coordination (denoted As{sub (-S, -ch3)}{sup {approx}III}); and a higher oxidation state species (denoted As{sub (-O)}{sup {approx}V}). Depth profiling suggested that surface contamination was unlikely (n = 4), and XRF and XANES analyses of thin sections of clippings incubated in dry or wet mine waste, or untreated, suggested direct diffusion of arsenic occurred under moist conditions. These findings suggest that arsenic in soil contributes to some systemic absorption associated with periodic exposures among children resident in areas of historic gold mining activity in Victoria, Australia. Future studies are required to ascertain if adverse health effects are associated with current levels of arsenic uptake.« less

Sexually Transmitted Diseases (and HIV)

MedlinePlus

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Aortic perforation sustained at laparoscopy.

PubMed

Lynn, S C; Katz, A R; Ross, P J

1982-04-01

A major type of complication associated with laparoscopic sterilization has been overcome by changing from electrocautery to either the Hulka clip or silicone rubber band technique, but major puncture and laceration injuries continue at the rate of 0.5% to 2%. The only case of major vascular injury incurred in over 4000 laparoscopic sterilization procedures performed from 1974 through 1980 at the Hermann Hospital in Houston, Texas is reported. A 40-year-old white female, para 3-0-1-3, was admitted for a laparoscopic sterilization procedure. The physical examination was within normal limits. The procedure was carried out by insufflating the peritoneal cavity with 2 liters of CO2 through a 12-cm Verres needle placed subumbilically while testing the abdomen with towel clips. Insufflating pressure never rose above 15 mm of mercury, and an adequate pneumoperitoneum was obtained. With the patient in the Trendelenburg position the trocar was inserted and the laparoscope placed with no apparent difficulty. The Falope Ring applicator sleeve was inserted suprapublically under direct vision. After placing the rings bilaterally, the cul-de-sac was noted to contain approximately 300 cc of blood. This was aspirated, but blood slowly reaccumulated in the cul-de-sac. Laparoscopic examination provided inadequate visualization of the posterior surface of the mesosalpinges, and it was decided to perform laparotomy. Upon opening the abdomen, the pulse rose from 85 to 110 per minute and the blood pressure fell from 90/60 to 50/0 mm HG. Rapid infusion of isotonic crystalloid and 3 units of packed red blood cells restored the patient's vital signs to normal. Examination of the abdominal wall and pelvic organs was normal, but a retroperitoneal hematoma was discovered in the area of the sacral promontroy. The posterior peritoneum was opened, and a 13 x 15-cm hematoma was evacuated. A 3-mm puncture wound was noted in the anterior wall of the aorta 3 cm cephalad to the bifurcation. The square defect was isolated with vascular clamps and repaired with a single layer of simple interrupted Prolene sutures. Abdominal exploration revealed a 3-mm defect in the small bowel mesentery that was repaired with interrupted chromic sutures, and the abdomen was closed. This report illustrates the perpetual caution that must be exercised in the performance of a routine gynecologic procedure. The blind puncture of the abdominal wall with the Verres needle and the laparoscope trocar must be performed with great care.

National Anthem

NASA Technical Reports Server (NTRS)

1991-01-01

A montage of video clips over the years, footage shows the spacecrews, launch, and landing for different orbiters and missions. Clips include the Endeavour and Atlantis Orbiters and are shown to the music of the American National Anthem.

Photovoltaic module with removable wind deflector

DOEpatents

Botkin, Jonathan [El Cerrito, CA; Graves, Simon [Berkeley, CA; Danning, Matt [Oakland, CA; Culligan, Matthew [Berkeley, CA

2012-08-07

A photovoltaic (PV) module assembly including a PV module, a deflector, and a clip. The PV module includes a PV device and a frame. A PV laminate is assembled to the frame, and the frame includes a support arm forming a seat. The deflector defines a front face and a rear face, with the clip extending from either the trailing frame member or the rear face of the deflector. In a mounted state, the deflector is nested within the seat and is releasably mounted to the trailing frame member via the clip. In some embodiments, the support arm forms a second seat, with the PV module assembly providing a second mounted state in which the deflector is in a differing orientation/slope, nested within the second seat and releasably mounted to the trailing frame member via the clip.

Photovoltaic module with removable wind deflector

DOEpatents

Botkin, Jonathan; Graves, Simon; Danning, Matt; Culligan, Matthew

2014-02-18

A photovoltaic (PV) module assembly including a PV module, a deflector, and a clip. The PV module includes a PV device and a frame. A PV laminate is assembled to the frame, and the frame includes a support arm forming a seat. The deflector defines a front face and a rear face, with the clip extending from either the trailing frame member or the rear face of the deflector. In a mounted state, the deflector is nested within the seat and is releasably mounted to the trailing frame member via the clip. In some embodiments, the support arm forms a second seat, with the PV module assembly providing a second mounted state in which the deflector is in a differing orientation/slope, nested within the second seat and releasably mounted to the trailing frame member via the clip.

An Efficient Method for Hair Containment During Head and Neck Surgery.

PubMed

Zingaretti, Nicola; De Biasio, Fabrizio; Riccio, Michele; Marchesi, Andrea; Parodi, Pier Camillo

2017-11-01

The authors present a simple technique for operations around hair-bearing areas such as during a rhytidectomy. Hair surrounding the surgical field is twisted into bundles and clipped with duckbill clips. The authors repeat the procedure for each strand of hair. Between 5 and 7 duckbill clips may be required per surgery.The clippers are faster, easily applicable, and well performing. They can be used with different hair lengths, and they do not require any additional trimming or shaving; clips also keep the hair firmly in place, and they do not loosen up in the process.This technical note explains a very simple, economical, and less time-consuming method to control hair located around the surgical site. It may be applied to all procedures within the field of the hair-bearing scalp, including craniofacial and maxillofacial surgery.

Photovoltaic module with removable wind deflector

DOEpatents

Botkin, Jonathan; Graves, Simon; Danning, Matt; Culligan, Matthew

2013-05-28

A photovoltaic (PV) module assembly including a PV module, a deflector, and a clip. The PV module includes a PV device and a frame. A PV laminate is assembled to the frame, and the frame includes a support arm forming a seat. The deflector defines a front face and a rear face, with the clip extending from either the trailing frame member or the rear face of the deflector. In a mounted state, the deflector is nested within the seat and is releasably mounted to the trailing frame member via the clip. In some embodiments, the support arm forms a second seat, with the PV module assembly providing a second mounted state in which the deflector is in a differing orientation/slope, nested within the second seat and releasably mounted to the trailing frame member via the clip.

Third CLIPS Conference Proceedings, volume 1

NASA Technical Reports Server (NTRS)

Riley, Gary (Editor)

1994-01-01

Expert systems are computed programs which emulate human expertise in well defined problem domains. The potential payoff from expert systems is high: valuable expertise can be captured and preserved, repetitive and/or mundane tasks requiring human expertise can be automated, and uniformity can be applied in decision making processes. The C Language Integrated Production Systems (CLIPS) is an expert system building tool, developed at the Johnson Space Center, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The development of CLIPS has helped to improve the ability to deliver expert systems technology throughout the public and private sectors for a wide range of applications and diverse computing environments.

Flexible Ultrathin Endoscope Integrated with Irrigation Suction Apparatus for Assisting Microneurosurgery.

PubMed

Otani, Naoki; Morimoto, Yuji; Fujii, Kazuya; Toyooka, Terushige; Wada, Kojiro; Mori, Kentaro

2017-12-01

Endoscopy can observe the anatomical components in a deeply located and/or hidden area during neurosurgical procedures under the operating microscope. We have newly developed a flexible ultrathin endoscope integrated with irrigation suction apparatus (FUEISA) to visualize deeply located and/or hidden areas for assisting microneurosurgery. The present study investigated the usefulness of the FUEISA system for direct clipping surgery of cerebral aneurysms. Twenty-one patients underwent microneurosurgery assisted with the FUEISA system for direct clipping of cerebral aneurysms. The flexible ultrathin endoscope (outer diameter 0.75mm) consists of an image guide (6000 dpi) and a light guide, integrated with the irrigation suction apparatus. This endoscopic system was inserted before and after clipping to observe the anatomical conditions surrounding the lesions. In all cases, handling and operation of the FUEISA was technically successful during the surgical procedure. The ultrathin endoscope was adequately integrated with the irrigation suction apparatus in all cases. General anatomy visualization including the lenticulostriate arteries, medial striate arteries, and/or internal carotid artery perforators was possible, and the correct clip positioning and vessel conditions were easily checked. The endoscope revealed that the clip had been positioned incorrectly in one case. No complications associated with the endoscopic system occurred. The FUEISA system can be applied with safe manipulation, which was remarkably useful for confirmation of the presence of perforators and cranial nerves behind the lesions, particularly anatomical components located in deep and/or hidden areas during clipping of cerebral aneurysms. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

NASA Astrophysics Data System (ADS)

Fenz, Wolfgang; Dirnberger, Johannes

2015-03-01

Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilatation for achalasia treatment.

PubMed

Rieder, E; Asari, R; Paireder, M; Lenglinger, J; Schoppmann, S F

2017-04-01

The aim of this study is to compare endoscopic stent suture fixation with endoscopic clip attachment or the use of partially covered stents (PCS) regarding their capability to prevent stent migration during prolonged dilatation in achalasia. Large-diameter self-expanding metal stents (30 mm × 80 mm) were placed across the gastroesophageal junction in 11 patients with achalasia. Stent removal was scheduled after 4 to 7 days. To prevent stent dislocation, endoscopic clip attachment, endoscopic stent suture fixation, or PCS were used. The Eckardt score was evaluated before and 6 months after prolonged dilatation. After endoscopic stent suture fixation, no (0/4) sutured stent migrated. When endoscopic clips were used, 80% (4/5) clipped stents migrated (p = 0.02). Of two PCS (n = 2), one migrated and one became embedded leading to difficult stent removal. Technical adverse events were not seen in endoscopic stent suture fixation but were significantly correlated with the use of clips or PCS (r = 0.828, p = 0.02). Overall, 72% of patients were in remission regarding their achalasia symptoms 6 months after prolonged dilatation. Endoscopic suture fixation of esophageal stents but not clip attachment appears to be the best method of preventing early migration of esophageal stents placed at difficult locations such as at the naive gastroesophageal junction. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Emotion modulates eye movement patterns and subsequent memory for the gist and details of movie scenes.

PubMed

Subramanian, Ramanathan; Shankar, Divya; Sebe, Nicu; Melcher, David

2014-03-26

A basic question in vision research regards where people look in complex scenes and how this influences their performance in various tasks. Previous studies with static images have demonstrated a close link between where people look and what they remember. Here, we examined the pattern of eye movements when participants watched neutral and emotional clips from Hollywood-style movies. Participants answered multiple-choice memory questions concerning visual and auditory scene details immediately upon viewing 1-min-long neutral or emotional movie clips. Fixations were more narrowly focused for emotional clips, and immediate memory for object details was worse compared to matched neutral scenes, implying preferential attention to emotional events. Although we found the expected correlation between where people looked and what they remembered for neutral clips, this relationship broke down for emotional clips. When participants were subsequently presented with key frames (static images) extracted from the movie clips such that presentation duration of the target objects (TOs) corresponding to the multiple-choice questions was matched and the earlier questions were repeated, more fixations were observed on the TOs, and memory performance also improved significantly, confirming that emotion modulates the relationship between gaze position and memory performance. Finally, in a long-term memory test, old/new recognition performance was significantly better for emotional scenes as compared to neutral scenes. Overall, these results are consistent with the hypothesis that emotional content draws eye fixations and strengthens memory for the scene gist while weakening encoding of peripheral scene details.

Implant retained auricular prosthesis with a modified hader bar: a case report.

PubMed

Lovely, M; Dathan, Pradeep C; Gopal, Dinesh; George, Biji Thomas; Chandrasekharan Nair, K

2014-06-01

Auricular prostheses for defects of external ear are retained either by mechanical means or implants. All implant retained prostheses are retained by various means such as bar and clip, magnetic attachments or a combination of bar, clip and magnets. The commonest problem encountered with the bar and clip system is loosening of the clip after 3-4 months. When magnets are used as retaining component they tend to corrode over a period of time. So various alternative retention methods which possess good retentive qualities, ease of reparability and patient friendly were tried. In the present case a newly modified Hader bar design which can act as an additional retentive feature apart from the clip is employed to increase retention. The major advantages in the modified Hader bar system were that only two implants were employed, the additional loops in the Hader bar prevented micro movements and the retentive acrylic locks were easy to repair if broken. The modified Hader bar has anti-rotational slots which prevents the sliding or rotation of the prosthesis which gave new confidence to the patient who was otherwise worried of inadvertent displacement of the ear prosthesis while playing.

Trans-Pacific tele-ultrasound image transmission of fetal central nervous system structures.

PubMed

Ferreira, Adilson Cunha; Araujo Júnior, Edward; Martins, Wellington P; Jordão, João Francisco; Oliani, Antônio Hélio; Meagher, Simon E; Da Silva Costa, Fabricio

2015-01-01

To assess the quality of images and video clips of fetal central nervous (CNS) structures obtained by ultrasound and transmitted via tele-ultrasound from Brazil to Australia. In this cross-sectional study, 15 normal singleton pregnant women between 20 and 26 weeks were selected. Fetal CNS structures were obtained by images and video clips. The exams were transmitted in real-time using a broadband internet and an inexpensive video streaming device. Four blinded examiners evaluated the quality of the exams using the Likert scale. We calculated the mean, standard deviation, mean difference, and p values were obtained from paired t tests. The quality of the original video clips was slightly better than that observed by the transmitted video clips; mean difference considering all observers = 0.23 points. In 47/60 comparisons (78.3%; 95% CI = 66.4-86.9%) the quality of the video clips were judged to be the same. In 182/240 still images (75.8%; 95% CI = 70.0-80.8%) the scores of transmitted image were considered the same as the original. We demonstrated that long distance tele-ultrasound transmission of fetal CNS structures using an inexpensive video streaming device provided images of subjective good quality.

[A Case of Aphasia after Neck Clipping of a Ruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery].

PubMed

Miyoshi, Hiroyuki; Migita, Keisuke; Kumano, Kiyoshi; Hashimoto, Naomi; Toyota, Akihiro

2016-11-01

We report a case of aphasia after neck clipping of a ruptured aneurysm at the origin of the duplicated middle cerebral artery(DMCA). A 60-year-old woman had a sudden onset of headache and nausea. A computed tomography(CT)scan revealed diffuse subarachnoid hemorrhage. Head three-dimensional CT angiography(3D-CTA)showed a left DMCA with a saccular aneurysm at the origin. She became aphasic on the third day after aneurysmal neck clipping. A CT scan revealed a low-density area in the anterior portion of the left temporal lobe, which is perfused by the DMCA. The DMCA was patent on 3D-CTA, but the angle between the ICA and the DMCA changed steep. It is suspected that the clip changed the branching angle at the DMCA origin, which may have led to decreased blood flow in the DMCA. She received linguistic rehabilitation for dysnomia and was discharged with slight difficulty in naming objects. Six months later, she recovered from the aphasia. One year later, the DMCA was patent on 3D-CTA. We should pay attention to ischemic complications in clipping because DMCAs are easily deformed.

A tale of two sequences: microRNA-target chimeric reads.

PubMed

Broughton, James P; Pasquinelli, Amy E

2016-04-04

In animals, a functional interaction between a microRNA (miRNA) and its target RNA requires only partial base pairing. The limited number of base pair interactions required for miRNA targeting provides miRNAs with broad regulatory potential and also makes target prediction challenging. Computational approaches to target prediction have focused on identifying miRNA target sites based on known sequence features that are important for canonical targeting and may miss non-canonical targets. Current state-of-the-art experimental approaches, such as CLIP-seq (cross-linking immunoprecipitation with sequencing), PAR-CLIP (photoactivatable-ribonucleoside-enhanced CLIP), and iCLIP (individual-nucleotide resolution CLIP), require inference of which miRNA is bound at each site. Recently, the development of methods to ligate miRNAs to their target RNAs during the preparation of sequencing libraries has provided a new tool for the identification of miRNA target sites. The chimeric, or hybrid, miRNA-target reads that are produced by these methods unambiguously identify the miRNA bound at a specific target site. The information provided by these chimeric reads has revealed extensive non-canonical interactions between miRNAs and their target mRNAs, and identified many novel interactions between miRNAs and noncoding RNAs.

Ingested bread clip as an unexpected diagnostic tool.

PubMed

Jay, Sharon M; Russell, Michael J; Lau, Yee C; Dunn, Joel W; Roberts, Ross

2018-03-23

We describe a case where a bread clip has in fact became lodged adjacent to a portion of small bowel affected by a deposit of previously undiagnosed metastatic serous carcinoma of likely ovarian origin.

40 CFR 60.1940 - What definitions must I know?

Code of Federal Regulations, 2011 CFR

2011-07-01

... plastics or rubber recycling unit as specified under Applicability of State Plans (§ 60.1555(h) and (i...) of the combustion unit. Yard waste means grass, grass clippings, bushes, shrubs, and clippings from...

40 CFR 60.1940 - What definitions must I know?

Code of Federal Regulations, 2010 CFR

2010-07-01

... plastics or rubber recycling unit as specified under Applicability of State Plans (§ 60.1555(h) and (i...) of the combustion unit. Yard waste means grass, grass clippings, bushes, shrubs, and clippings from...

Oral nitrite circumvents antiseptic mouthwash-induced disruption of enterosalivary circuit of nitrate and promotes nitrosation and blood pressure lowering effect.

PubMed

Pinheiro, Lucas C; Ferreira, Graziele C; Amaral, Jefferson H; Portella, Rafael L; Tella, Sandra de O C; Passos, Madla A; Tanus-Santos, Jose E

2016-12-01

The nitric oxide (NO • ) metabolites nitrite and nitrate exert antihypertensive effects by mechanisms that involve gastric formation of S-nitrosothiols. However, while the use of antiseptic mouthwash (AM) is known to attenuate the responses to nitrate by disrupting its enterosalivary cycle, there is little information about whether AM attenuates the effects of orally administered nitrite. We hypothesized that the antihypertensive effects of orally administered nitrite would not be prevented by AM because, in contrast to oral nitrate, oral nitrite could promote S-nitrosothiols formation in the stomach without intereference by AM. Chronic effects of oral nitrite or nitrate were studied in two-kidney, one-clip (2K1C) hypertensive rats (and normotensive controls) treated with AM (or vehicle) once/day. We found that orally administered nitrite exerts antihypertensive effects that were not affected by AM. This finding contrasts with lack of antihypertensive responses to oral nitrate in 2K1C hypertensive rats treated with AM. Nitrite and nitrate treatments increased plasma nitrites, nitrates, and S-nitrosothiols concentrations. However, while treatment with AM attenuated the increases in plasma nitrite concentrations after both nitrite and nitrate treatments, AM attenuated the increases in S-nitrosothiols in nitrate-treated rats, but not in nitrite-treated rats. Moreover, AM attenuated vascular S-nitrosylation (detected by the SNO-RAC method) after nitrate, but not after nitrite treatment. Significant correlations were found between the hypotensive responses and S-nitrosothiols, and vascular S-nitrosylation levels. These results show for the first time that oral nitrite exerts antihypertensive effects notwithstanding the fact that antiseptic mouthwash disrupts the enterosalivary circulation of nitrate. Our results support a major role for S-nitrosothiols formation resulting in vascular S-nitrosylation as a key mechanism for the antihypertensive effects of both oral nitrite and nitrate. Copyright © 2016 Elsevier Inc. All rights reserved.

Hesperidin Suppresses Renin-Angiotensin System Mediated NOX2 Over-Expression and Sympathoexcitation in 2K-1C Hypertensive Rats.

PubMed

Wunpathe, Chutamas; Potue, Prapassorn; Maneesai, Putcharawipa; Bunbupha, Sarawoot; Prachaney, Parichat; Kukongviriyapan, Upa; Kukongviriyapan, Veerapol; Pakdeechote, Poungrat

2018-05-13

Hesperidin, a flavonoid derived from citrus fruits, possesses several beneficial effects including anti-oxidation and anti-inflammation. The aim of this study was to investigate the effects of hesperidin on the renin-angiotensin system (RAS) cascade that mediated oxidative stress and sympathoexcitation in two-kidney, one-clipped (2K-1C) hypertensive rats. 2K-1C hypertension was induced in male Sprague-Dawley rats. Hypertensive rats were treated with hesperidin at 20[Formula: see text]mg/kg or 40[Formula: see text]mg/kg or losartan at 10[Formula: see text]mg/kg beginning at three weeks after surgery and then continued for four weeks ([Formula: see text]/group). Hesperidin reduced blood pressure in a dose-dependent manner in hypertensive rats compared to untreated rats ([Formula: see text]). Increased plasma angiotensin converting enzyme (ACE) activity and angiotensin II levels, as well as, upregulated AT 1 receptor protein expression in aortic tissues were attenuated in hypertensive rats treated with hesperidin. Hesperidin suppressed oxidative stress markers and NADPH oxidase over-expression, and restored plasma nitric oxide metabolites in 2K-1C rats. This was associated with improvement of the vascular response to acetylcholine in isolated mesenteric vascular beds and aortic rings from 2K-1C rats treated with hesperidin ([Formula: see text]). Enhancement of nerve-mediated vasoconstriction related to high plasma noradrenaline in the 2K-1C group was alleviated by hesperidin treatment ([Formula: see text]). Furthermore, losartan exhibited antihypertensive effects by suppressing the RAS cascade and oxidative stress and improved vascular dysfunction observed in 2K-1C rats ([Formula: see text]). Based on these results, it can be presumed that hesperidin is an antihypertensive agent. Its antihypertensive action might be associated with reducing RAS cascade-induced NOX2 over-expression and sympathoexcitation in 2K-1C hypertensive rats.

Object/rule integration in CLIPS. [C Language Integrated Production System

NASA Technical Reports Server (NTRS)

Donnell, Brian L.

1993-01-01

This paper gives a brief overview of the C Language Integrated Production System (CLIPS) with a focus on the object-oriented features. The advantages of an object data representation over the traditional working memory element (WME), i.e., facts, are discussed, and the implementation of the Rete inference algorithm in CLIPS is presented in detail. A few methods for achieving pattern-matching on objects with the current inference engine are given, and finally, the paper examines the modifications necessary to the Rete algorithm to allow direct object pattern-matching.

Influence of a negative movie message on food perceptions.

PubMed

Oakes, Michael E; Slotterback, Carole S

2007-09-01

Many food scholars have suggested that popular media messages impact perceptions of foods. In the present study, experimental participants watched a disparaging video clip concerning McDonald's foods as well as a ruse video clip, then were asked to evaluate the healthfulness of 33 named foods as well as their nutrient descriptions. Control participants judged the named foods and their descriptions but saw no videos. The movie clip influenced only named foods that are identifiable with McDonalds and not other fast foods or other named foods that are considered unhealthy.

A CLIPS-based tool for aircraft pilot-vehicle interface design

NASA Technical Reports Server (NTRS)

Fowler, Thomas D.; Rogers, Steven P.

1991-01-01

The Pilot-Vehicle Interface of modern aircraft is the cognitive, sensory, and psychomotor link between the pilot, the avionics modules, and all other systems on board the aircraft. To assist pilot-vehicle interface designers, a C Language Integrated Production System (CLIPS) based tool was developed that allows design information to be stored in a table that can be modified by rules representing design knowledge. Developed for the Apple Macintosh, the tool allows users without any CLIPS programming experience to form simple rules using a point and click interface.

Flexibility in the parental effort of an Arctic-breeding seabird

USGS Publications Warehouse

Harding, A.M.A.; Kitaysky, A.S.; Hall, M.E.; Welcker, J.; Karnovsky, N.J.; Talbot, S.L.; Hamer, K.C.; Gremillet, D.

2009-01-01

Parental investment strategies are considered to represent a trade-off between the benefits of investment in current offspring and costs to future reproduction. Due to their high residual reproductive value, long-lived organisms are predicted to be more reluctant to increase parental effort. 2. We tested the hypothesis that breeding little auks (Alle alle) have a fixed level of reproductive investment, and thus reduce parental effort when costs associated with reproduction increase. 3. To test this hypothesis we experimentally increased the flight costs of breeding little auks via feather clipping. In 2005 we examined changes in the condition of manipulated parents, of the mates of manipulated parents, and of their chick as direct measures of change in parental resource allocation between self-maintenance and current reproduction. In 2007 we increased sample sizes to determine whether there was a physiological cost (elevated corticosterone, CORT) associated with the manipulation. 4. We found that: (i) clipped birds and their mates lost more body mass than controls, but there was no difference in mass loss between members of a pair; (ii) clipped birds had higher CORT levels than control birds; (iii) there were no inter-annual differences in body mass and CORT levels between clipped individuals and their mates at recapture, and (iv) chicks with a clipped parent had lower peak and fledging mass, and higher CORT levels than control chicks in both years. 5. Contrary to our hypothesis, the reduction in body mass of partners to clipped birds suggests that little auks can increase parental effort to some extent. Nonetheless, the lower fledging mass and higher CORT of chicks with a clipped parent indicates provisioning rates may not have been fully maintained. 6. As predicted by life-history theory, there may be a threshold to the additional reproductive costs breeders will accept, with parents prioritizing self-maintenance over increased provisioning effort when foraging costs become too high. ?? 2008 British Ecological Society.

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial.

PubMed

Mooney, Michael A; Simon, Elias D; Brigeman, Scott; Nakaji, Peter; Zabramski, Joseph M; Lawton, Michael T; Spetzler, Robert F

2018-04-27

OBJECTIVE A direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed. RESULTS Fifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0-2) in 70% (n = 19) of 27 Hunt and Hess grades I-III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up. CONCLUSIONS Microsurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

The MitraClip Asia-Pacific registry: Differences in outcomes between functional and degenerative mitral regurgitation.

PubMed

Tay, Edgar; Muda, Nasir; Yap, Jonathan; Muller, David W M; Santoso, Teguh; Walters, Darren L; Liu, Xianbao; Yamen, Eric; Jansz, Paul; Yip, James; Zambahari, Robaayah; Passage, Jurgen; Ding, Zee Pin; Wang, Jian'an; Scalia, Gregory; Soesanto, Amiliana M; Yeo, Khung Keong

2016-06-01

The objective of this study is to describe and compare the use of the MitraClip therapy in mitral regurgitation (MR) patients with degenerative MR (DMR) and functional MR (FMR). Percutaneous edge-to-edge repair of severe MR using the MitraClip device is approved for use in the USA for high risk DMR while European guidelines include its use in FMR patients as well. The MitraClip in the Asia-Pacific Registry (MARS) is a multicenter retrospective registry, involving eight sites in five Asia-Pacific countries. Clinical and echocardiographic characteristics, procedural outcomes and 1-month outcomes [death and major adverse events (MAE)] were compared between FMR and DMR patients treated with the MitraClip. A total of 163 patients were included from 2011 to 2014. The acute procedural success rates for FMR (95.5%, n = 84) and DMR (92%, n = 69) were similar (P = 0.515). 45% of FMR had ≥2 clips inserted compared to 60% of those with DMR (P = 0.064).The 30-day mortality rate for FMR and DMR was similar at 4.5% and 6.7% respectively (P = 0.555). The 30-day MAE rate was 9.2% for FMR and 14.7% for DMR (P = 0.281). Both FMR and DMR patients had significant improvements in the severity of MR and NYHA class after 30 days. There was a significantly greater reduction in left ventricular end-diastolic diameter (P = 0.002) and end systolic diameter (P = 0.017) in DMR than in FMR. The MitraClip therapy is a safe and efficacious treatment option for both FMR and DMR. Although, there is a significantly greater reduction in LV volumes in DMR, patients in both groups report clinical benefit with improvement in functional class. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

SU-E-J-64: Feasibility Study of Surgical Clips for Fiducial Tracking in CyberKnife System

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

Lee, H; Yoon, J; Lee, E

Purpose: To investigate the ability of CyberKnife to track surgical clips used as fiducial markers. Methods: The Octavius 1000SRS detector and solid water (RW3) slab phantom were used with motion platform to evaluate the study. The RW3 slab phantom was set up to measure the dose distribution from coronal plane. It consists of 9 plates and the thickness of each plate is 10mm. Among them, one plate was attached with 3 surgical clips, which are orthogonally positioned on outer region of array. The length of attached clip was represented as 1cm on planning CT. The clip plate was placed onmore » the 1000SRS detector and 3 slabs were stacked up on the plate to build the measuring depth. Below the detector, 5 slabs were set. The two-axis motion platform was programmed with 1D sinusoidal movement (20mm peak-to-peak, 3s period) toward superior/inferior and left/right directions to simulate target motion. During delivery, two clips were extracted by two X-ray imagers, which led to translational error correction only. Synchrony was also used for dynamic tracking. After the irradiation, the measured dose distribution of coronal plane was compared with the planar dose distribution calculated by the CyberKnife treatment planning system (Multiplan) for cross verification. The results were assessed by comparing the absolute Gamma (γ) index. Results: The dose distributions measured by the 1000SRS detector were in good agreements with those calculated by Multiplan. In the dosimetric comparison using γ-function criteria based on the distance-to-agreement of 3mm and the local dose difference of 3%, the passing rate with γ- parameter ≤1 was 91% in coronal plane. Conclusion: The surgical clips can be considered as new fiducials for robotic radiosurgery delivery by considering the target margin with less than 5mm.« less

The second-generation eCLIPs Endovascular Clip System: initial experience.

PubMed

Chiu, Albert H; De Vries, Joost; O'Kelly, Cian J; Riina, Howard; McDougall, Ian; Tippett, Jonathan; Wan, Martina; de Oliveira Manoel, Airton Leonardo; Marotta, Thomas R

2018-02-01

OBJECTIVE Treatment of wide-necked intracranial aneurysms is associated with higher recanalization and complication rates; however, the most commonly used methods are not specifically designed to work in bifurcation lesions. To address these issues, the authors describe the evolution in the design and use of the eCLIPs (Endovascular Clip System) device, a novel hybrid stent-like assist device with flow diverter properties that was first described in 2008. METHODS A registry was established covering 13 international centers at which patients were treated with the second-generation eCLIPs device. Aneurysm morphology and rupture status, device neck coverage, coil retention, and procedural and late morbidity and mortality were recorded. For those patients who had undergone successful implantation more than 6 months earlier, the final imaging and clinical follow-up results and need for re-treatment were recorded. RESULTS Thirty-three patients were treated between June 2013 and September 2015. Twenty-five (76%) patients had successful placement of an eCLIPs device; 23 (92%) of these 25 patients had complete data. Eight cases of nondeployment occurred during the 1st year of use, consistent with a learning curve; no failures of deployment occurred thereafter. Two periprocedural transient ischemic attacks and 2 asymptomatic thrombotic events occurred. Twenty-one (91%) of 23 patients underwent follow-up at an average of 8 months (range 3-18 months); 9 (42.9%) of these 21 patients demonstrated an improvement in Raymond grade at follow-up; no cases of worsening Raymond grade were recorded, and 17 (81.0%) patients sustained a modified Raymond-Roy Classification class of I or II angiographic result at follow-up. Two delayed ruptures were recorded, both in previously coiled, symptomatic giant aneurysms where the device was used as a part of a salvage strategy. CONCLUSIONS The second-generation eCLIPs device is a viable treatment option for bifurcation aneurysms. The aneurysm occlusion rates in this initial clinical series are comparable to the initial experience with other bifurcation support devices.

Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms

PubMed Central

Bekelis, Kimon; Gottlieb, Daniel J.; Su, Yin; O’Malley, A. James; Labropoulos, Nicos; Goodney, Philip; Lawton, Michael T.; MacKenzie, Todd A.

2016-01-01

OBJECTIVE The comparative effectiveness of the 2 treatment options—surgical clipping and endovascular coiling—for unruptured cerebral aneurysms remains an issue of debate and has not been studied in clinical trials. The authors investigated the association between treatment method for unruptured cerebral aneurysms and outcomes in elderly patients. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who had treatment for unruptured cerebral aneurysms between 2007 and 2012. To control for measured confounding, the authors used propensity score conditioning and inverse probability weighting with mixed effects to account for clustering at the level of the hospital referral region (HRR). An instrumental variable (regional rates of coiling) analysis was used to control for unmeasured confounding and to create pseudo-randomization on the treatment method. RESULTS During the study period, 8705 patients underwent treatment for unruptured cerebral aneurysms and met the study inclusion criteria. Of these patients, 2585 (29.7%) had surgical clipping and 6120 (70.3%) had endovascular coiling. Instrumental variable analysis demonstrated no difference between coiling and clipping in 1-year postoperative mortality (OR 1.25, 95% CI 0.68–2.31) or 90-day readmission rate (OR 1.04, 95% CI 0.66–1.62). However, clipping was associated with a greater likelihood of discharge to rehabilitation (OR 6.39, 95% CI 3.85–10.59) and 3.6 days longer length of stay (LOS; 95% CI 2.90–4.71). The same associations were present in propensity score–adjusted and inverse probability– weighted models. CONCLUSIONS In a cohort of Medicare patients, there was no difference in mortality and the readmission rate between clipping and coiling of unruptured cerebral aneurysms. Clipping was associated with a higher rate of discharge to a rehabilitation facility and a longer LOS. PMID:27203150

Development of new devices for detection of gastric cancer on laparoscopic surgery using near-infrared light

NASA Astrophysics Data System (ADS)

Inada, Shunko A.; Fuchi, Shingo; Mori, Kensaku; Hasegawa, Junichi; Misawa, Kazunari; Nakanishi, Hayao

2015-03-01

In recent year, for the treatment of gastric cancer the laparoscopic surgery is performed, which has good benefits, such as low-burden, low-invasive and the efficacy is equivalent to the open surgery. For identify location of the tumor intraperitoneally for extirpation of the gastric cancer, several points of charcoal ink is injected around the primary tumor. However, in the time of laparoscopic operation, it is difficult to estimate specific site of primary tumor, because the injected charcoal ink diffusely spread to the area distant from the tumor in the stomach. Therefore, a broad area should be resected which results in a great stress for the patients. To overcome this problem, we focused in the near-infrared wavelength of 1000nm band which have high biological transmission. In this study, we developed a fluorescent clip which was realized with glass phosphor (Yb3+, Nd3+ doped to Bi2O3-B2O3 based glasses. λp: 976 nm, FWHM: 100 nm, size: 2x1x3 mm) and the laparoscopic fluorescent detection system for clip-derived near-infrared light. To evaluate clinical performance of a fluorescent clip and the laparoscopic fluorescent detection system, we used resected stomach (thickness: 13 mm) from the patients. Fluorescent clip was fixed on the gastric mucosa, and an excitation light (λ: 808 nm) was irradiated from outside of stomach for detection of fluorescence through stomach wall. As a result, fluorescence emission from the clip was successfully detected. Furthermore, we confirmed that detection sensitivity of the emission of fluorescence from the clip depends on the output power of the excitation light. We conformed that the fluorescent clip in combination with laparoscopic fluorescent detection system is very useful method to identify the exact location of the primary gastric cancer.

33 CFR 183.532 - Clips, straps, and hose clamps.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) BOATING SAFETY BOATS AND ASSOCIATED EQUIPMENT Fuel Systems Equipment Standards § 183.532 Clips... under § 183.590, a hose clamp installed on a fuel line system requiring metallic fuel lines or “USCG...

Reading your own lips: common-coding theory and visual speech perception.

PubMed

Tye-Murray, Nancy; Spehar, Brent P; Myerson, Joel; Hale, Sandra; Sommers, Mitchell S

2013-02-01

Common-coding theory posits that (1) perceiving an action activates the same representations of motor plans that are activated by actually performing that action, and (2) because of individual differences in the ways that actions are performed, observing recordings of one's own previous behavior activates motor plans to an even greater degree than does observing someone else's behavior. We hypothesized that if observing oneself activates motor plans to a greater degree than does observing others, and if these activated plans contribute to perception, then people should be able to lipread silent video clips of their own previous utterances more accurately than they can lipread video clips of other talkers. As predicted, two groups of participants were able to lipread video clips of themselves, recorded more than two weeks earlier, significantly more accurately than video clips of others. These results suggest that visual input activates speech motor activity that links to word representations in the mental lexicon.

C-Language Integrated Production System, Version 6.0

NASA Technical Reports Server (NTRS)

Riley, Gary; Donnell, Brian; Ly, Huyen-Anh Bebe; Ortiz, Chris

1995-01-01

C Language Integrated Production System (CLIPS) computer programs are specifically intended to model human expertise or other knowledge. CLIPS is designed to enable research on, and development and delivery of, artificial intelligence on conventional computers. CLIPS 6.0 provides cohesive software tool for handling wide variety of knowledge with support for three different programming paradigms: rule-based, object-oriented, and procedural. Rule-based programming: representation of knowledge as heuristics - essentially, rules of thumb that specify set of actions performed in given situation. Object-oriented programming: modeling of complex systems comprised of modular components easily reused to model other systems or create new components. Procedural-programming: representation of knowledge in ways similar to those of such languages as C, Pascal, Ada, and LISP. Version of CLIPS 6.0 for IBM PC-compatible computers requires DOS v3.3 or later and/or Windows 3.1 or later.

Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats.

PubMed

Li, Peng; Huang, Pei-Pei; Yang, Yun; Liu, Chi; Lu, Yan; Wang, Fang; Sun, Wei; Kong, Xiang-Qing

2017-01-01

Li P, Huang P, Yang Y, Liu C, Lu Y, Wang F, Sun W, Kong X. Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats. J Appl Physiol 122: 121-129, 2017. First published October 14, 2016; doi:10.1152/japplphysiol.01019.2015-Sympathetic activity is enhanced in patients with essential or secondary hypertension, as well as in various hypertensive animal models. Therapeutic targeting of sympathetic activation is considered an effective antihypertensive strategy. We hypothesized that renal sympathetic denervation (RSD) attenuates hypertension and improves vascular remodeling and renal disease in the 2-kidney, 1-clip (2K1C) rat model. Rats underwent 2K1C modeling or sham surgery; then rats underwent RSD or sham surgery 4 wk later, thus resulting in four groups (normotensive-sham, normotensive-RSD, 2K1C-sham, and 2K1C-RSD). Norepinephrine was measured by ELISA. Echocardiography was used to assess heart function. Fibrosis and apoptosis were assessed by Masson and TUNEL staining. Changes in mean arterial blood pressure in response to hexamethonium and plasma norepinephrine levels were used to evaluate basal sympathetic nerve activity. The 2K1C modeling success rate was 86.8%. RSD reversed the elevated systolic blood pressure induced by 2K1C, but had no effect on body weight. Compared with rats in the 2K1C-sham group, rats in the 2K1C-RSD group showed lower left ventricular mass/body weight ratio, interventricular septal thickness in diastole, left ventricular end-systolic diameter, and left ventricular posterior wall thickness in systole, whereas fractional shortening and ejection fraction were higher. Right kidney apoptosis and left kidney hypertrophy were not changed by RSD. Arterial fibrosis was lower in animals in the 2K1C-RSD group compared with those in the 2K1C-sham group. RSD reduced plasma norepinephrine and basal sympathetic activity in rats in the 2K1C-RSD group compared with rats in the 2K1C-sham group. These results suggest a possible clinical efficacy of RSD for renovascular hypertension. The effects of renal sympathetic denervation (RSD) on hypertension, cardiac function, vascular fibrosis, and renal apoptosis were studied in the 2K1C rat model. Results showed that RSD attenuated hypertension, improved vascular remodeling, and reduced vascular fibrosis through decreased sympathetic activity in the 2K1C rat model, but it did not change the kidney size, renal apoptosis, or renal caspase-3 expression. These results could suggest possible clinical efficacy of RSD for renovascular hypertension. Copyright © 2017 the American Physiological Society.

From benchmarking HITS-CLIP peak detection programs to a new method for identification of miRNA-binding sites from Ago2-CLIP data.

PubMed

Bottini, Silvia; Hamouda-Tekaya, Nedra; Tanasa, Bogdan; Zaragosi, Laure-Emmanuelle; Grandjean, Valerie; Repetto, Emanuela; Trabucchi, Michele

2017-05-19

Experimental evidence indicates that about 60% of miRNA-binding activity does not follow the canonical rule about the seed matching between miRNA and target mRNAs, but rather a non-canonical miRNA targeting activity outside the seed or with a seed-like motifs. Here, we propose a new unbiased method to identify canonical and non-canonical miRNA-binding sites from peaks identified by Ago2 Cross-Linked ImmunoPrecipitation associated to high-throughput sequencing (CLIP-seq). Since the quality of peaks is of pivotal importance for the final output of the proposed method, we provide a comprehensive benchmarking of four peak detection programs, namely CIMS, PIPE-CLIP, Piranha and Pyicoclip, on four publicly available Ago2-HITS-CLIP datasets and one unpublished in-house Ago2-dataset in stem cells. We measured the sensitivity, the specificity and the position accuracy toward miRNA binding sites identification, and the agreement with TargetScan. Secondly, we developed a new pipeline, called miRBShunter, to identify canonical and non-canonical miRNA-binding sites based on de novo motif identification from Ago2 peaks and prediction of miRNA::RNA heteroduplexes. miRBShunter was tested and experimentally validated on the in-house Ago2-dataset and on an Ago2-PAR-CLIP dataset in human stem cells. Overall, we provide guidelines to choose a suitable peak detection program and a new method for miRNA-target identification. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

From benchmarking HITS-CLIP peak detection programs to a new method for identification of miRNA-binding sites from Ago2-CLIP data

PubMed Central

Bottini, Silvia; Hamouda-Tekaya, Nedra; Tanasa, Bogdan; Zaragosi, Laure-Emmanuelle; Grandjean, Valerie; Repetto, Emanuela

2017-01-01

Abstract Experimental evidence indicates that about 60% of miRNA-binding activity does not follow the canonical rule about the seed matching between miRNA and target mRNAs, but rather a non-canonical miRNA targeting activity outside the seed or with a seed-like motifs. Here, we propose a new unbiased method to identify canonical and non-canonical miRNA-binding sites from peaks identified by Ago2 Cross-Linked ImmunoPrecipitation associated to high-throughput sequencing (CLIP-seq). Since the quality of peaks is of pivotal importance for the final output of the proposed method, we provide a comprehensive benchmarking of four peak detection programs, namely CIMS, PIPE-CLIP, Piranha and Pyicoclip, on four publicly available Ago2-HITS-CLIP datasets and one unpublished in-house Ago2-dataset in stem cells. We measured the sensitivity, the specificity and the position accuracy toward miRNA binding sites identification, and the agreement with TargetScan. Secondly, we developed a new pipeline, called miRBShunter, to identify canonical and non-canonical miRNA-binding sites based on de novo motif identification from Ago2 peaks and prediction of miRNA::RNA heteroduplexes. miRBShunter was tested and experimentally validated on the in-house Ago2-dataset and on an Ago2-PAR-CLIP dataset in human stem cells. Overall, we provide guidelines to choose a suitable peak detection program and a new method for miRNA-target identification. PMID:28108660

Development of mitral stenosis after single MitraClip insertion for severe mitral regurgitation.

PubMed

Cockburn, James; Fragkou, Paraskevi; Hildick-Smith, David

2014-02-01

We report the first case of mitral stenosis following Mitra-Clip insertion in a patient with symptomatic NYHA IV heart failure, secondary to severe mitral regurgitation (MR). A 79-year-old female with a history of prior aortic valve replacement underwent percutaneous mitral valve (MV) repair. A single clip was advanced coaxially down onto the MV under TOE guidance, with the anterior and posterior leaflets clipped together between A2 and P2. TOE confirmed a significant reduction in MR (grade 4 to grade 1). Despite initial symptomatic relief, she represented 3 months later with similar symptoms. Repeat TOE confirmed a well positioned Mitra-Clip with mild residual MR. However, the possibility of significant mitral stenosis was raised due to the presence of significant turbulence through the bi-orifice valve, with a peak gradient of 25 mm Hg. In addition there was evidence of severe functional tricuspid valve (TV) regurgitation with elevated pulmonary artery pressures (PAP 90 mm Hg), confirmed on subsequent right heart catheterization. After repeated heart team discussions and a failure of optimal medical therapy, and despite a logistic EuroScore of 35.5, minimally invasive surgical replacement of the MV and simultaneous TV repair was undertaken via a right thoracotomy. Despite procedural success and initial good postoperative response, the patient died subsequently from a combination of hospital-acquired pneumonia and significant gastrointestinal bleeding (post operative day 35). Mitra-Clip is a promising novel approach to MV repair. The establishment of further clinical and echocardiographic based selection criteria will help identify the correct patients for this treatment. Copyright © 2013 Wiley Periodicals, Inc.

Genome-Wide Profiling of RNA–Protein Interactions Using CLIP-Seq

PubMed Central

Stork, Cheryl; Zheng, Sika

2017-01-01

UV crosslinking immunoprecipitation (CLIP) is an increasingly popular technique to study protein–RNA interactions in tissues and cells. Whole cells or tissues are ultraviolet irradiated to generate a covalent bond between RNA and proteins that are in close contact. After partial RNase digestion, antibodies specific to an RNA binding protein (RBP) or a protein–epitope tag is then used to immunoprecipitate the protein–RNA complexes. After stringent washing and gel separation the RBP–RNA complex is excised. The RBP is protease digested to allow purification of the bound RNA. Reverse transcription of the RNA followed by high-throughput sequencing of the cDNA library is now often used to identify protein bound RNA on a genome-wide scale. UV irradiation can result in cDNA truncations and/or mutations at the crosslink sites, which complicates the alignment of the sequencing library to the reference genome and the identification of the crosslinking sites. Meanwhile, one or more amino acids of a crosslinked RBP can remain attached to its bound RNA due to incomplete digestion of the protein. As a result, reverse transcriptase may not read through the crosslink sites, and produce cDNA ending at the crosslinked nucleotide. This is harnessed by one variant of CLIP methods to identify crosslinking sites at a nucleotide resolution. This method, individual nucleotide resolution CLIP (iCLIP) circularizes cDNA to capture the truncated cDNA and also increases the efficiency of ligating sequencing adapters to the library. Here, we describe the detailed procedure of iCLIP. PMID:26965263

The Effects of Mitral Valve Repair on Memory Performance, Executive Function, and Psychological Measures in Patients With Heart Failure.

PubMed

Nikendei, Christoph; Schäfer, Hannah; Weisbrod, Matthias; Huber, Julia; Geis, Nicolas; Katus, Hugo A; Bekeredjian, Raffi; Herzog, Wolfgang; Pleger, Sven T; Schultz, Jobst-Hendrik

2016-05-01

Heart failure (HF) is a prevalent disease that remains costly and associated with a high mortality rate. HF is also associated with poor neurocognitive functioning. For the treatment for HF patients with severe mitral regurgitation, the MitraClip device has emerged as a promising interventional tool that reduces the mitral valve leakage and thus increases cardiac output. Currently, there is only limited knowledge on changes in cognitive and psychosocial functioning before and after the MitraClip intervention. Cognitive function (memory and executive function) and psychosocial measures (depression, anxiety, and quality of life) were assessed before and after the MitraClip intervention in 24 HF patients and 23 healthy participants (comparison group). MitraClip intervention in HF patients was followed by improvements in figural long-term memory (p = .003) and executive function (planning ability, p < .001) relative to the comparison group. In addition, the intervention resulted in a significant improvement in depression (p = .002), anxiety (p = .003) and quality of life scores (physical p = .017, mental p = .013) as well as improved 6-minute walk test results over time (p = .002). The presented data provide evidence of a significant improvement in memory and executive function as well as in depression, anxiety, and quality of life scores in patients with chronic HF after MitraClip intervention. Further research is needed to shed light on the long-term development of cognitive function, psychosocial well-being, and clinical parameters after MitraClip intervention and how these factors depend on one another.

Is perception of quality more important than technical quality in patient video cases?

PubMed

Roland, Damian; Matheson, David; Taub, Nick; Coats, Tim; Lakhanpaul, Monica

2015-08-13

The use of video cases to demonstrate key signs and symptoms in patients (patient video cases or PVCs) is a rapidly expanding field. The aims of this study were to evaluate whether the technical quality, or judgement of quality, of a video clip influences a paediatrician's judgment on acuity of the case and assess the relationship between perception of quality and the technical quality of a selection of video clips. Participants (12 senior consultant paediatricians attending an examination workshop) individually categorised 28 PVCs into one of 3 possible acuities and then described the quality of the image seen. The PVCs had been converted into four different technical qualities (differing bit rates ranging from excellent to low quality). Participants' assessment of quality and the actual industry standard of the PVC were independent (333 distinct observations, spearmans rho = 0.0410, p = 0.4564). Agreement between actual acuity and participants' judgement was generally good at higher acuities but moderate at medium/low acuities of illness (overall correlation 0.664). Perception of the quality of the clip was related to correct assignment of acuity regardless of the technical quality of the clip (number of obs = 330, z = 2.07, p = 0.038). It is important to benchmark PVCs prior to use in learning resources as experts may not agree on the information within, or quality of, the clip. It appears, although PVCs may be beneficial in a pedagogical context, the perception of quality of clip may be an important determinant of an expert's decision making.

Microsurgical Clipping of an Unruptured Carotid Cave Aneurysm: 3-Dimensional Operative Video.

PubMed

Tabani, Halima; Yousef, Sonia; Burkhardt, Jan-Karl; Gandhi, Sirin; Benet, Arnau; Lawton, Michael T

2017-08-01

Most aneurysms originating from the clinoidal segment of the internal carotid artery (ICA) are nowadays managed conservatively, treated endovascularly with coiling (with or without stenting) or flow diverters. However, microsurgical clip occlusion remains an alternative. This video demonstrates clip occlusion of an unruptured right carotid cave aneurysm measuring 7 mm in a 39-year-old woman. The patient opted for surgery because of concerns about prolonged antiplatelet use associated with endovascular therapy. After patient consent, a standard pterional craniotomy was performed followed by extradural anterior clinoidectomy. After dural opening and sylvian fissure split, a clinoidal flap was opened to enter the extradural space around the clinoidal segment. The dural ring was dissected circumferentially, freeing the medial wall of the ICA down to the sellar region and mobilizing the ICA out of its canal of the clinoidal segment. With the aneurysm neck in view, the aneurysm was clipped with a 45° angled fenestrated clip over the ICA. Indocyanine green angiography confirmed no further filling of the aneurysm and patency of the ICA. Complete aneurysm occlusion was confirmed with postoperative angiography, and the patient had no neurologic deficits (Video 1). This case demonstrates the importance of anterior clinoidectomy and thorough distal dural ring dissection for effective clipping of carotid cave aneurysms. Control of venous bleeding from the cavernous sinus with fibrin glue injection simplifies the dissection, which should minimize manipulation of the optic nerve. Knowledge of this anatomy and proficiency with these techniques is important in an era of declining open aneurysm cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Delayed Visual Loss and Its Surgical Rescue Following Extracranial-Intracranial Arterial Bypass and Native Internal Carotid Artery Sacrifice.

PubMed

Li, Lai-Fung; Leung, Gilberto Ka-Kit; Lui, Wai-Man

2017-02-01

High-flow extracranial-intracranial (EC-IC) bypass followed by sacrifice of the native internal carotid artery (ICA) is a recognized treatment option for giant ICA aneurysm and skull base tumor involving the ICA. Distal clipping at the supraclinoid portion of the ICA is technically straightforward, but it can potentially compromise ophthalmic artery (OA) perfusion. Because of the extensive EC-IC anastomoses with the OA, visual symptoms are fortunately uncommon. We report a patient who developed complete blindness after distal trapping of the supraclinoid ICA; it was reversed after emergency clip removal. Our patient is a 47-year-old man with recurrent nasopharyngeal carcinoma in close proximity to the left petrosal ICA. The first stage of the procedure involved an EC-IC bypass using radial artery graft, followed by a second stage with combined craniofacial excision. Trapping of the native ICA was achieved using a permanent aneurysm clip placed at the supraclinoid ICA distal to the origin of the OA. He complained of a new onset of complete left eye visual loss approximately 6 hours after the distal aneurysm clip was applied. He was immediately sent to the operating theatre for the removal of the supraclinoid aneurysm clip. On the next day, his vision improved and left pupil became reactive again. OA flow following ICA trapping is complicated and precarious. Delayed onset of visual loss is possible. Prompt action by direct exploration and clip removal is needed and can be effective in reversing blindness. Copyright © 2016 Elsevier Inc. All rights reserved.

26. VIEW SHOWING SOUTH ELEVATION, LOOKING NORTHEAST From newspaper clipping, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

26. VIEW SHOWING SOUTH ELEVATION, LOOKING NORTHEAST From newspaper clipping, 'Notre Dame Bridge, Manchester, New Hampshire', Manchester Union Leader, c. 1938, photographer unknown. - Notre Dame Bridge, Spanning Merrimack River on Bridge Street, Manchester, Hillsborough County, NH

CDC Vital Signs: Prescription Painkiller Overdoses (Methadone)

MedlinePlus

... or www.samhsa.gov/treatment/ ). Top of Page Science Behind the Issue MMWR Science Clips Related Pages Vital Signs Issue details: Morbidity ... factsheet [PDF – 1.34 MB] Read the MMWR Science Clips File Formats Help: How do I view ...

Finishing Well

NASA Astrophysics Data System (ADS)

Riendeau, Diane

2011-05-01

As we finish this publishing cycle, I'd like to thank all the readers who sent in video clips. If you have a YouTube clip that you use in class, please send the link and a brief description to driendeau@dist113.org.

Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis.

PubMed

Egeto, Peter; Loch Macdonald, R; Ornstein, Tisha J; Schweizer, Tom A

2018-03-01

OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes. METHODS The MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures. RESULTS Thirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08-0.25) and language tests (g = 0.23, 95% CI 0.07-0.39), and all patients were impaired relative to healthy controls (g ranged from -0.93 to -0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.

Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial.

PubMed

Spetzler, Robert F; Zabramski, Joseph M; McDougall, Cameron G; Albuquerque, Felipe C; Hills, Nancy K; Wallace, Robert C; Nakaji, Peter

2018-01-01

OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) is a prospective, randomized trial in which treatment with clipping was compared to treatment with coil embolization. Patients were randomized to treatment on presentation with any nontraumatic subarachnoid hemorrhage (SAH). Because all other randomized trials comparing these 2 types of treatments have been limited to saccular aneurysms, the authors analyzed the current BRAT data for this subgroup of lesions. METHODS The primary BRAT analysis included all sources of SAH: nonaneurysmal lesions; saccular, blister, fusiform, and dissecting aneurysms; and SAHs from an aneurysm associated with either an arteriovenous malformation or a fistula. In this post hoc review, the outcomes for the subgroup of patients with saccular aneurysms were further analyzed by type of treatment. The extent of aneurysm obliteration was adjudicated by an independent neuroradiologist not involved in treatment. RESULTS Of the 471 patients enrolled in the BRAT, 362 (77%) had an SAH from a saccular aneurysm. Patients with saccular aneurysms were assigned equally to the clipping and the coiling cohorts (181 each). In each cohort, 3 patients died before treatment and 178 were treated. Of the 178 clip-assigned patients with saccular aneurysms, 1 (1%) was crossed over to coiling, and 64 (36%) of the 178 coil-assigned patients were crossed over to clipping. There was no statistically significant difference in poor outcome (modified Rankin Scale score > 2) between these 2 treatment arms at any recorded time point during 6 years of follow-up. After the initial hospitalization, 1 of 241 (0.4%) clipped saccular aneurysms and 21 of 115 (18%) coiled saccular aneurysms required retreatment (p < 0.001). At the 6-year follow-up, 95% (95/100) of the clipped aneurysms were completely obliterated, compared with 40% (16/40) of the coiled aneurysms (p < 0.001). There was no difference in morbidity between the 2 treatment groups (p = 0.10). CONCLUSIONS In the subgroup of patients with saccular aneurysms enrolled in the BRAT, there was no significant difference between modified Rankin Scale outcomes at any follow-up time in patients with saccular aneurysms assigned to clipping compared with those assigned to coiling (intent-to-treat analysis). At the 6-year follow-up evaluation, rates of retreatment and complete aneurysm obliteration significantly favored patients who underwent clipping compared with those who underwent coiling. Clinical trial registration no.: NCT01593267 (clinicaltrials.gov).

Movies and Literary Elements.

ERIC Educational Resources Information Center

Keller, Rodney D.

1987-01-01

Recommends using movie clips to stimulate students' interest in reading a novel as well as to teach elements of fiction such as plot, character, setting, symbol, irony, and theme. Describes each clip and provides study questions. Includes a listing of movies made from books. (NH)

Laparoscopic Filshie clip sterilization and selective use of the methylene blue dye test.

PubMed

Karoshi, Mahantesh; Yoong, Wai

2004-01-01

In laparoscopic Filshie clip sterilization, difficulties may arise in identifying the length of the fallopian tube, with the possibility of failure of sterilization. This article describes a novel intraoperative method of demonstrating adequate tubal closure.

Second CLIPS Conference Proceedings, volume 1

NASA Technical Reports Server (NTRS)

Giarratano, Joseph (Editor); Culbert, Christopher J. (Editor)

1991-01-01

Topics covered at the 2nd CLIPS Conference held at the Johnson Space Center, September 23-25, 1991 are given. Topics include rule groupings, fault detection using expert systems, decision making using expert systems, knowledge representation, computer aided design and debugging expert systems.