Computational modelling of emboli travel trajectories in cerebral arteries: Influence of microembolic particle size and density

This article has been made available through the Brunel Open Access Publishing Fund.Ischaemic stroke is responsible for up to 80 % of stroke cases. Prevention of the reoccurrence of ischaemic attack or stroke for patients who survived the first symptoms is the major treatment target. Accurate diagnosis of the emboli source for a specific infarction lesion is very important for a better treatment for the patient. However, due to the complex blood flow patterns in the cerebral arterial network, little is known so far of the embolic particle flow trajectory and its behaviour in such a complex flow field. The present study aims to study the trajectories of embolic particles released from carotid arteries and basilar artery in a cerebral arterial network and the influence of particle size, mass and release location to the particle distributions, by computational modelling. The cerebral arterial network model, which includes major arteries in the circle of Willis and several generations of branches from them, was generated from MRI images. Particles with diameters of 200, 500 and 800 μ m and densities of 800, 1,030 and 1,300 kg/m 3 were released in the vessel's central and near-wall regions. A fully coupled scheme of particle and blood flow in a computational fluid dynamics software ANASYS CFX 13 was used in the simulations. The results show that heavy particles (density large than blood or a diameter larger than 500 μ m) normally have small travel speeds in arteries; larger or lighter embolic particles are more likely to travel to large branches in cerebral arteries. In certain cases, all large particles go to the middle cerebral arteries; large particles with higher travel speeds in large arteries are likely to travel at more complex and tortuous trajectories; emboli raised from the basilar artery will only exit the model from branches of basilar artery and posterior cerebral arteries. A modified Circle of Willis configuration can have significant influence on particle distributions. The local branch patterns of internal carotid artery to middle cerebral artery and anterior communicating artery can have large impact on such distributions. © 2014 The Author(s)

Idarucizumab for Dabigatran Reversal - Full Cohort Analysis.

BACKGROUND: Idarucizumab, a monoclonal antibody fragment, was developed to reverse the anticoagulant effect of dabigatran. METHODS: We performed a multicenter, prospective, open-label study to determine whether 5 g of intravenous idarucizumab would be able to reverse the anticoagulant effect of dabigatran in patients who had uncontrolled bleeding (group A) or were about to undergo an urgent procedure (group B). The primary end point was the maximum percentage reversal of the anticoagulant effect of dabigatran within 4 hours after the administration of idarucizumab, on the basis of the diluted thrombin time or ecarin clotting time. Secondary end points included the restoration of hemostasis and safety measures. RESULTS: A total of 503 patients were enrolled: 301 in group A, and 202 in group B. The median maximum percentage reversal of dabigatran was 100% (95% confidence interval, 100 to 100), on the basis of either the diluted thrombin time or the ecarin clotting time. In group A, 137 patients (45.5%) presented with gastrointestinal bleeding and 98 (32.6%) presented with intracranial hemorrhage; among the patients who could be assessed, the median time to the cessation of bleeding was 2.5 hours. In group B, the median time to the initiation of the intended procedure was 1.6 hours; periprocedural hemostasis was assessed as normal in 93.4% of the patients, mildly abnormal in 5.1%, and moderately abnormal in 1.5%. At 90 days, thrombotic events had occurred in 6.3% of the patients in group A and in 7.4% in group B, and the mortality rate was 18.8% and 18.9%, respectively. There were no serious adverse safety signals. CONCLUSIONS: In emergency situations, idarucizumab rapidly, durably, and safely reversed the anticoagulant effect of dabigatran. (Funded by Boehringer Ingelheim; RE-VERSE AD ClinicalTrials.gov number, NCT02104947 .)

Continued use of afatinib with the addition of cetuximab after progression on afatinib in patients with EGFR mutation-positive non-small-cell lung cancer and acquired resistance to gefitinib or erlotinib

Objectives: In a phase Ib trial, afatinib plus cetuximab demonstrated promising clinical activity (objective response rate [ORR]: 29%; median progression-free survival [PFS]: 4.7 months) in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) with acquired resistance to erlotinib or gefitinib. Here, a separate cohort exploring afatinib plus cetuximab after progression on afatinib is reported. Materials and methods: Patients with EGFR mutation-positive NSCLC who progressed on erlotinib or gefitinib received afatinib 40 mg daily until progression, followed by afatinib daily plus cetuximab 500 mg/m(2) every 2 weeks until progression or intolerable adverse events (AEs). Endpoints included safety, ORR, and PFS. Results: Thirty-seven patients received afatinib monotherapy. Two (5%) patients responded; median PFS was 2.7 months. Thirty-six patients transitioned to afatinib plus cetuximab. Four (11%) patients responded; median PFS was 2.9 months. Median PFS with afatinib plus cetuximab for patients who received afatinib monotherapy for >= 12 versus <12 weeks was 4.9 versus 1.8 months (p = 0.0354), and for patients with T790M-positive versus T790M-negative tumors was 4.8 versus 1.8 months (p = 0.1306). Fifty percent of patients receiving afatinib plus cetuximab experienced drug-related grade 3/4 AEs. The most frequent drug-related AEs (any grade) were diarrhea (70%), rash (49%), and fatigue (35%) with afatinib monotherapy and rash (69%), paronychia (39%), and dry skin (36%) with afatinib plus cetuximab. Conclusion: Sequential EGFR blockade with afatinib followed by afatinib plus cetuximab had a predictable safety profile and demonstrated modest activity in patients with EGFR mutation-positive NSCLC with resistance to erlotinib or gefitinib

The eastern margin of the Tanzanian Craton in the Dodoma-Mpwapwa area : preliminary findings

A number of traverses have been undertaken across a ca. 45 km section of the north-south oriented eastern margin of the Tanzanian Craton between Dodoma and Mpwapwa, Central Tanzania. The boundary is a SE-dipping zone of high strain between about 1 and 2 km wide. The rocks of the eastern craton are uniformly composed of coarse-grained, grey, migmatised granodiorite gneisses which are heterogeneous at outcrop scale but are regionally homogeneous. The orthogneisses have no regionally consistent fabric and foliations are variably oriented at outcrop scale. However, there is a gradual increase in strain eastwards towards the edge of the craton, manifest as an increasingly strong, regionally consistent, E to SE-dipping foliation. This strain increase eventually leads to mylonitic and porphyroclastic planar fabrics and strong, uniformly SE-plunging, linear fabrics. In most structural domains planar fabrics are predominant, but these alternate with minor domains dominated by linear fabrics, with fold mullions locally developed. The kinematics of the high-strain mylonites show a consistent, top-to-the-NW (oblique) sense of movement. The frontal thrust zone grades laterally into steep sinistral and dextral oblique strike-slip shear zones to the north and south respectively. The contact is a single wide deformation zone in the northern and southern segments of the study area, with a more complex imbricate belt in the central part

Geology of part of the eastern margin of the Tanzanian Craton in the Mpwapwa area and its relationships with an off-craton, high-grade supracrustal gneiss sequence (Mpwapwa Group) of possible Palaeoproterozoic age

A number of traverses have been undertaken across a ca. 45 km section of the north-south oriented eastern margin of the Tanzanian Craton between Dodoma and Mpwapwa, Central Tanzania. The boundary is a SE-dipping zone of high strain between about 1 and 2 km wide. The rocks of the eastern craton are uniformly composed of coarse-grained grey granodioritic, migmatised orthogneisses which are heterogeneous at outcrop scale, but are regionally homogeneous. The orthogneisses have no regionally consistent fabric and foliations are variably oriented at outcrop scale. However, there is a gradual increase in strain eastwards towards the edge of the craton, manifest as an increasingly strong, regionally consistent, SE-dipping foliation. This strain increase eventually leads to mylonitic and porphyroclastic planar fabrics and strong, uniformly SE-plunging, linear fabrics. The kinematics of the high-strain mylonites show a consistent top-to-the-NW sense of movement. The frontal thrust zone grades laterally into steep sinistral and dextral oblique strike-slip shear zones to the north and south respectively. The contact is a single wide thrust zone in the north and south section of the studied area, with an imbricate belt in the central part. To the east, the cratonic rocks are in contact with a high-grade supracrustal succession, termed here the Mpwapwa Group in the light of uncertain regional correlations (= “Isimani Suite”?). It consists of a thick sequence of leucocratic quartzo-feldspathic gneisses and migmatites, semi-pelitic two mica-kyanite-garnet schists/gneisses, quartzites, marbles and calc-silicate rocks and abundant metabasic layers. There appears to be an east-west zonation of Mpwapwa Group lithological units, with most of the quartzites, calcareous rocks and pelitic schists/gneisses tending to occur close to the craton margin, with semi-pelitic gneiss/migmatite to the east, along with interlayered repetitions of bimodal acid, quartzo-feldspathic leucogneisses and mafic gneisses (amphibolite, mafic garnet amphibolite). Mineral assemblages, as evidenced by garnet-kyanite in pelitic rocks, garnet-clinopyroxene in some metabasites suggest metamorphism under moderate to high pressure amphibolite facies, as might be expected at the base of a thrust stack and resulting crustal thickening. Possibly, therefore, the Mpwapwa Group was deposited in a rifted passive-margin setting at the edge of the Tanzanian Craton, with shallow marine environments at the immediate continental margin and bimodal volcanic rocks more distally. During collision orogeny, thrusting took place at this rifted margin, inverted the Mpwapwa Group basin and transported the supracrustal rocks over the craton margin, an event which telescoped, but did not obliterate the original depositional zonation. The group may thus be viewed as a parauthochthonous succession. The rocks were intruded by plutons of largely unfoliated biotite granite, two-pyroxene charnockite and tonalite, the ages of which are unknown. With the above hypothesis and uncertainties in mind, a suite of samples are undergoing U-Pb zircon dating in order to constrain the timing of these events

Geochronological constraints on the eastern margin of the Tanzanian Craton in the Dodoma-Mpwapwa area.

The position and nature of the eastern margin of the Tanzanian Craton in central Tanzania is poorly understood, especially with regard to its relationships with the Palaeoproterozoic Usagaran Belt and the Neoproterozoic Western Granulites of the East African Orogen (e.g. Reddy et al., 2003; Cutten et al., 2006; Fritz et al., 2009). Transects have been undertaken across a ca. 45 km N-S crustal section east of Dodoma, Central Tanzania, in order to ascertain the position, nature and geochronology of the eastern margin of the Tanzanian Craton and its relationship with a sequence of high-grade supracrustal gneisses to the east, known as the Mpwapwa Group

Meat Quality in Kosovo and Liaison with Consumers

The purpose of this paper is to provide a professional analysis and reflection of the quality of meat and its products and its impact on consumer selection, we should also mention that meat and its products as one of the main elements in the consumer table has a special importance in economic analysis both in terms of quality and customer satisfaction as well as in terms of price and economic well-being.We should also mention that it is not in vain to say that regular and quality food is the safest guarantee for a consolidated health, but not to forget that it can not always be taken into account and added care that what we consume in different places like in social organizations or different parties.But food safety should be a vital issue and a priority over priority because the food quality refers to some specific characteristics such as nutrient content as well as organoleptic properties mainly related to the taste and processing of food, packaging and others.Also, do not forget to mention that the food must be suitable for consumption and not to result in any way in the consequences and to harm the health of the consumer.So it is primary to pay special attention to the risks we may encounter in food products in advance to be attentive and prepared for the risks and consequences or diseases born of food, a regular nutrition and quality food reflects half of the health of the human body

The rate of success of the conservative management of liver trauma in a developing country

Abstract Background The conservative treatment of liver trauma has made important progress over the last 10 years at the Trauma University Hospital in Tirana, Albania. The percentage of success was 58.7%. The aims of this study were to analyze the conservative treatment of liver trauma and to compare the results with those in the literature. Methods This study was conducted prospectively from January 2009 to December 2012. We analyzed 173 patients admitted to our hospital with liver trauma. Liver injuries were evaluated according to the American Association for the Surgery of Trauma and the World Society of Emergency Surgery classification, while the anatomic gravity of the associated injuries was defined using the Injury Severity Score system. The potential mortality was estimated with the Revised Trauma Score. Results Out of the 173 patients with liver trauma, 83.2% were male. The main cause of liver trauma was motor vehicle crashes (50.9%). Blunt trauma was the cause of liver injury in 129 cases (74.6%), and penetrating trauma occurred in 44 cases (25.4%). Initially, the decision was to manage 88 cases (50.9%) via the conservative approach. Of these, 73 cases (42.2%) were successfully treated with conservative treatment, while in 15 cases (17.2%), this approach failed. The success rate of conservative treatment by grade of injuries was as follows: grade I (38.4%), grade II (30.1%), grade III (28.8%), and grade IV (2.7%). The likelihood of the success of conservative treatment had a significant correlation with the grade of the liver injury (p < 0.00001), associated intra-abdominal injuries (p = 0.00051), and complications (z = 2.3169, p = 0.02051). The overall mortality rate of liver trauma was 13.2%. Conclusions The likelihood of success in using conservative treatment had a significant correlation with the grade of liver injury and associated intra-abdominal injuries. The limited hospital resources and low level of consensus on conservative treatment had a negative impact on the level of success

Praeventive oekologische Bewertung von Produkten und Prozessen mit Fuzzy-Set-Modellierungen von unsicheren Eingangsinformationen am Beispiel des Wellenloetens elektronischer Baugruppen Abschlussbericht

Available from TIB Hannover: F01B421 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDeutsche Bundesstiftung Umwelt, Osnabrueck (Germany)DEGerman