Minimally Invasive Parathyroidectomy in Patients with Previous Endocrine Surgery

Minimally invasive parathyroidectomy with a lateral approach was found to be an acceptable option in select patients with sporadic primary hyperparathyroidism and previous endocrine neck surgery

Evaluation of WRF performance for the analysis of surface wind speeds over various Greek regions

In this study we analyze the surface wind variability over selected areas of the Greek territory by comparing a 3-Km spatial resolution simulation performed with the Weather Research and Forecasting (WRF) model for the summer months of 2013 with actual surface measurements. Daily 36hrs runs at 12 UTC were driven by FLN (1 deg x 1 deg) data for the period of 11 July 2013 to 17 July 2013. Various verification statistics such as BIAS, RMSE and DACC for wind speed and direction were used to gauge the mesoscale model performance

Health-Care Use and Cost in Dementia Caregivers: Longitudinal Results from the Predictors Caregiver Study

OBJECTIVE: To examine the effects of caregiver and patient characteristics on caregivers' medical care use and cost. METHODS: One hundred forty-seven caregiver/patient dyads were followed annually for 6 years in three academic Alzheimer's disease centers in the United States. Logistic, negative binomial, and generalized linear mixed models were used to examine overall effects of caregiver/patient characteristics on caregivers' hospitalizations, doctor visits, outpatient tests and procedures, and prescription and over-the-counter medications. RESULTS: Patients' comorbid conditions and dependence were associated with increased health-care use and costs of caregivers. Increases in caregiver depressive symptoms are associated with increases in multiple domains of caregivers' health-care use and costs. DISCUSSION: Findings suggest expanding our focus on dementia patients to include family caregivers to obtain a fuller picture of effects of caregiving. Primary care providers should integrate caregivers' needs in health-care planning and delivery. Clinical interventions that treat patients and caregivers as a whole will likely achieve the greatest beneficial effects

In Vitro Evaluation of Focused Ultrasound-Enhanced TNK-Tissue Plasminogen Activator-Mediated Thrombolysis

The low and incomplete recanalization performance of thrombolytic therapy in patients with acute ischemic stroke has created the need to use focused ultrasound (FUS) energy as a way to enhance thrombolysis efficiency (sonothrombolysis). Using an in vitro flow model, the role of various parameters involved in FUS-enhanced tenecteplase (TNK-tPA [tissue plasminogen activator])-mediated thrombolysis was evaluated. Materials and methods Fully retracted porcine blood clots were used for the proposed parametric studies. A spherically FUS transducer (4 cm diameter), focusing at 10 cm and operating at 1 MHz, was used. Pulsed ultrasound protocols were applied that maintained temperature elevation at the focus that never exceeded 1°C. Thrombolysis efficiency was measured as the relative reduction in the mass of the clot. Results The role of various properties on thrombolysis efficacy was examined. These various properties are the acoustic power, the TNK-tPA concentration, the flow rate, the exposure time, the pulse length, the pulse repetition frequency, the duty factor, the formation of standing waves, the acoustic medium, and the administration of microbubbles. Study results have demonstrated that the parameters examined influenced thrombolysis efficacy and the degree of thrombolysis achieved by each parameter was measured. Conclusions Study findings helped us to optimize the treatment protocol for 1 MHz pulsed FUS that maximizes the thrombolytic efficacy of TNK-tPA, which potentially could be applied for therapeutic purposes. The outcome of the study showed poor thrombolysis efficacy, as with 30 minutes of FUS treatment only 370 mg of clot was removed

Laparoscopically Assisted Vaginal Radical Hysterectomy: Systematic Review of the Literature

Laparoscopically assisted vaginal radical vaginal hysterectomy (LAVRH), a minimally invasive technique that seems to be an attractive alternative to traditional surgery, remains unexplored in the treatment of cervical cancer. We searched Medline (1966-2013) and Scopus (2004-2013) search engines, as well as reference lists from all included studies. Ten studies were retrieved; including 6 retrospective cohort studies, 2 prospective cohort studies, 1 retrospective randomized trial, and a phase II randomized control trial. LAVRH provided equal recurrence-free rates when performed in patients with tumors not exceeding 2 cm in greatest diameter. Its main advantages seem to be less intraoperative blood loss and more radical pelvic lymphadenectomy. The primary disadvantages, of the technique are a higher rate of disease-positive surgical margins, resulting in the need for adjuvant therapy, and the slow learning curve required for a surgeon to gain expertise. With use in minimally invasive surgery of newer techniques such as total laparoscopic radical hysterectomy and robotic-assisted radical hysterectomy, and possible future adoption of more conservative techniques such as cervical conization with pelvic lymphadenectomy, the question remains as to whether LAVRH will be adopted by the surgical community or lost to oblivion. (C) 2013 AAGL. All rights reserved

Evaluation of a small flat rectangular therapeutic ultrasonic transducer intended for intravascular use

.Background The aim of the proposed study was to evaluate the performance of a flat rectangular (2 × 10 mm2) transducer operating at 4 MHz. The intended application of this transducer is intravascular treatment of thrombosis and atherosclerosis. Methods The transducer's thermal capabilities were tested in two different gel phantoms. MR thermometry was used to demonstrate the thermal capabilities of this type of transducer. Results Temperature measurements demonstrated that this simple and small transducer adequately produced high temperatures, which can be utilized for therapeutic purposes. These high temperatures were confirmed using thermocouple and MR measurements. Pulsed ultrasound in combination with thrombolytic drugs and microbubbles was utilized to eliminate porcine thrombi. Conclusions The proposed transducer has the potentials to treat atherosclerotic lesions using the thermal properties of ultrasound, since high temperatures can be achieved in less than 5 s. The results revealed that the destruction of thrombi using pulsed ultrasound requires long exposure time and high microbubble dosage

MR relaxation times of agar-based tissue-mimicking phantoms

Agar gels were previously proven capable of accurately replicating the acoustical and thermal properties of real tissue and widely used for the construction of tissue-mimicking phantoms (TMPs) for focused ultrasound (FUS) applications. Given the current popularity of magnetic resonance-guided FUS (MRgFUS), we have investigated the MR relaxation times T1 and T2 of different mixtures of agar-based phantoms. Nine TMPs were constructed containing agar as the gelling agent and various concentrations of silicon dioxide and evaporated milk. An agar-based phantom doped with wood powder was also evaluated. A series of MR images were acquired in a 1.5 T scanner for T1 and T2 mapping. T2 was predominantly affected by varying agar concentrations. A trend toward decreasing T1 with an increasing concentration of evaporated milk was observed. The addition of silicon dioxide decreased both relaxation times of pure agar gels. The proposed phantoms have great potential for use with the continuously emerging MRgFUS technology. The MR relaxation times of several body tissues can be mimicked by adjusting the concentration of ingredients, thus enabling more accurate and realistic MRgFUS studies

Energy upgrading of buildings. A holistic approach for the Natural History Museum of Crete, Greece

This article presents the fundamental points of the accomplished work regarding the energy upgrading of the building of the Natural History Museum of Crete, Greece, based on a cluster of passive and active measures. The main target was the building's energy efficiency upgrading from D to A+ rank. Among the passive measures, insulation of the building's envelope, installation of new windows and doors, construction of a green roof and planting of an outdoor space at the south side of the building to improve the ambient climate locally are included. Furthermore, small wind turbines and a photovoltaic station on the roof, geothermal heat pumps with an open loop system operating with seawater, new lighting equipment controlled by a central management system and reactive power coefficient compensation constitute the proposed active systems. Energy saving percentages from 40% to 93% are achieved with all the proposed technologies. In total, the primary energy specific consumption is reduced from 273.65 kWh/m(2) at 18.36 kWh/m(2), giving a total energy saving percentage of 93.29%. The building's energy efficiency is upgraded from the rank D to the rank A+, according to the European Union's standards. The total cost of the proposed measures is estimated approximately at 900,000