Prevention of stone migration with the Accordion during endoscopic ureteral lithotripsy.

BACKGROUND AND PURPOSE: Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy. PATIENTS AND METHODS: We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various stages of each procedure. RESULTS: Patients who were treated with the Accordion device experienced significantly less retrograde migration during fragmentation (P=0.0064). When stone volume was taken into account (but not on a per stone basis), ablation and ureteral clearing were also expedited, and fewer lithotripter hits and basket sweeps were needed. CONCLUSION: The Accordion device is effective in preventing the migration of stone fragments during endoscopic ureteral lithotripsy. Our data suggest that this device may also increase efficiency of the fragmentation and clearance of ureteral calculi

Međudjelovanje četiri-razinskog atoma u impulsnom svojstvenom stanju s jednomodnim poljem

We study the interaction between a four-level atom (ladder type) in a momentum eigenstate with a single mode cavity field in the presence of non-linearities of both the field and the intensity-dependent coupling. The constants of motion and the wave function for the atomic system have been obtained. Special attention is given to discuss some statistical aspects of the considered atomic system such as momentum increment, momentum diffusion and high-order squeezing. The influence of the Kerr-like medium and the intensity dependent coupling on the momentum increment and the high-order squeezing are investigated numerically. It is found that addition of these parameters has an important effect on both the momentum increment and the squeezing phenomenon.Proučavamo međudjelovanje četiri-razinskog atoma (poput ljestvi) u impulsnom svojstvenom stanju s jednomodnim poljem u rezonatoru, uz nelinearnosti polja i vezanja ovisnog o intenzitetu. Izveli smo stalnice gibanja valne funkcije atomskog sustava. Posebnu smo pažnju posvetili raspravi o statističkim odlikama razmatranog atomskog sustava, kao što su povećanje i difuzija impulsa i zbijanje višeg reda. Numerički smo istražili utjecaj Kerrovog sredstva i vezanja ovisnog o intenzitetu na povećanje impulsa i zbijanje višeg reda. Našli smo da dodavanje tih parametara ima snažan učinak na povećanje impulsa i pojavu zbijanja

Međudjelovanje četiri-razinskog atoma u impulsnom svojstvenom stanju s jednomodnim poljem

We study the interaction between a four-level atom (ladder type) in a momentum eigenstate with a single mode cavity field in the presence of non-linearities of both the field and the intensity-dependent coupling. The constants of motion and the wave function for the atomic system have been obtained. Special attention is given to discuss some statistical aspects of the considered atomic system such as momentum increment, momentum diffusion and high-order squeezing. The influence of the Kerr-like medium and the intensity dependent coupling on the momentum increment and the high-order squeezing are investigated numerically. It is found that addition of these parameters has an important effect on both the momentum increment and the squeezing phenomenon.Proučavamo međudjelovanje četiri-razinskog atoma (poput ljestvi) u impulsnom svojstvenom stanju s jednomodnim poljem u rezonatoru, uz nelinearnosti polja i vezanja ovisnog o intenzitetu. Izveli smo stalnice gibanja valne funkcije atomskog sustava. Posebnu smo pažnju posvetili raspravi o statističkim odlikama razmatranog atomskog sustava, kao što su povećanje i difuzija impulsa i zbijanje višeg reda. Numerički smo istražili utjecaj Kerrovog sredstva i vezanja ovisnog o intenzitetu na povećanje impulsa i zbijanje višeg reda. Našli smo da dodavanje tih parametara ima snažan učinak na povećanje impulsa i pojavu zbijanja

The value of simultaneous co-registration of 99mTc- MDP and 131Iodine in metastatic differentiated thyroid carcinoma

BACKGROUND: The lack of anatomical details in standard 131Iodine whole body scanning (131I WBS) interferes with the proper localization of metastatic differentiated thyroid carcinoma (DTC) lesions. In addition, nearby or overlapping variable physiological distribution of 131I may affect the specificity of 131I uptake, giving indeterminate results. The aim of this study was to demonstrate the clinical usefulness of simultaneous co-registration of 99mTc MDP bone scanning as an anatomical landmark with 131I scanning in the evaluation of metastatic DTC. MATERIAL AND METHODS: Twenty-five patients (16 females and 9 males, mean age ± SD = 52 ± 13 years) with metastatic DTC (17 papillary, 8 follicular), were included. Whole body scanning using a 256 x 1024 matrix and an 8 cm/min scan rate were obtained 48 hours after oral administration of 185-370 MBq 131I and 2 hours after IV administration of 185-370 MBq 99mTc MDP using a dual head gamma camera equipped with high energy parallel hole collimators. Occasionally, additional simultaneous co-registration of localised detailed images was also performed using a 256 x 256 matrix size. The two planar images were fused with optional fusion of SPECT images. The data from standard 131I scanning and fused 131I/ 99mTc-MDP scanning were separately assessed by two nuclear medicine physicians. Fusion images were considered to improve image interpretation in comparison with standard 131I scanning when they provided better localization of lesions. RESULTS: All lesions in the present study were validated by radiological images and clinical follow up for at least 12 months. Forty-eight metastatic lesions were confirmed as follows: 2 in the skull, 10 in the neck, 20 in the thorax, 12 in the pelvic-abdominal region and 4 in the extremities. Standard 131I WBS showed 54 extra-thyroidal foci with 8 false positive lesions of which 2 were located in the scalp and 6 in the pelvic-abdominal region extra-skeleton (i.e. sensitivity 100%, specificity 86%). Out of the 48 validated lesions, 16 were indeterminately localized: 10 in the thorax (3 mediastinal nodal lesions, 5 vertebral lesions and 2 ribs) and 6 in the pelvic-abdominal region (2 upper sacral, 2 sacroiliac region and 2 ischial bone). Fusion images confirmed the precise localization of the pathological uptake in the validated 48 lesions (sensitivity 100%, specificity 100%). There were 2 (4%) indeterminate lesions in fused planar imaging that were clearly localized via fused SPECT images. CONCLUSIONS: Fusion images using simultaneous co-registration of 131I and 99mTc MDP scanning is a simple and feasible technique that improves the anatomically limited interpretation of scintigraphy using 131I alone in patients with metastatic differentiated thyroid carcinoma. The diagnostic advantage of this technique seems to be more apparent in the thoracic and pelvic- abdominal regions in contrast to the neck and extremities

Temperature dependence growth of CdO thin film prepared by spray pyrolysis

AbstractCdO thin films prepared by spray pyrolysis technique show temperature dependence growth when the spray time is constant. In contrast, the growth is film thickness dependent when the substrate temperature is constant. The films are polycrystalline in the covered spray time and substrate temperature ranges. The crystallite size and microstrain are calculated and analyzed. The Atomic Force Microscopy (AFM) micrographs prove that the grains are uniformly distributed within the scanning areas (5μm×5μm) and (50μm×50μm). The roughness shows a considerable decrease with substrate temperature. All samples show an abrupt change in transmission which indicates a direct transition and good crystallinity. The transmission of films is increased up to 80% with increasing substrate temperature in wavelength ranged from 450nm to 1000nm. Also, a broad absorption band is observed in the range 1500–2000nm. This band could be attributed to the increase in free carrier concentration which confirmed by a reasonable decrease in the film sheet resistance. The band gap Eg is determined and found to be in the range 2.45–2.55eV. The sheet resistance is reduced with increasing deposition temperature due to the increase in free carrier concentration and found to be 66Ω/□ at 450°C

Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest

BACKGROUND AND PURPOSE: Anecdotal reports suggest that a loss of distinction between gray (GM) and white matter (WM) as adjudged by CT scan predicts poor outcome in comatose patients after cardiac arrest. To address this, we quantitatively assessed GM and WM intensities at various brain levels in comatose patients after cardiac arrest. METHODS: Patients for whom consultation was requested within 24 hours of a cardiac arrest were identified with the use of a computerized database that tracks neurological consultations at our institution. Twenty-five comatose patients were identified for whom complete medical records and CT scans were available for review. Twenty-five consecutive patients for whom a CT scan was interpreted as normal served as controls. Hounsfield units (HUs) were measured in small defined areas obtained from axial images at the levels of the basal ganglia, centrum semiovale, and high convexity area. RESULTS: At each level tested, lower GM intensity and higher WM intensity were noted in comatose patients compared with normal controls. The GM/WM ratio was significantly lower among comatose patients compared with controls (P:\u3c0.0001, rank sum test). There was essentially no overlap in GM/WM ratios between control and study patients. The difference was greatest at the basal ganglia level. We also observed a marginally significant difference in the GM/WM ratio at the basal ganglia level between those patients who died and those who survived cardiac arrest (P:=0. 035, 1-tailed t test). Using receiver operating characteristic curve analysis, we determined that a difference in GM/WM ratio of \u3c1.18 at the basal ganglia level was 100% predictive of death. At the basal ganglia level, none of 12 patients below this threshold survived, whereas the survival rate was 46% among patients in whom the ratio was \u3e1.18. The empirical risk of death was 21.67 for comatose patients with a value below threshold. CONCLUSIONS: The ratio in HUs of GM to WM provides a reproducible measure of the distinction between gray and white matter. A lower GM/WM ratio is observed in comatose patients immediately after cardiac arrest. The basal ganglia level seems to be the most sensitive location on CT for measuring this relationship. Although a GM/WM ratio \u3c1.18 at this level predicted death in this retrospective study, the difference in this study is not robust enough to recommend that management decisions be dictated by CT results. The results, however, do warrant consideration of a prospective study to determine the reliability of CT scanning in predicting outcome for comatose patients after cardiac arrest

Impaired Cerebral Autoregulation Is Associated with Brain Atrophy and Worse Functional Status in Chronic Ischemic Stroke

Dynamic cerebral autoregulation (dCA) is impaired following stroke. However, the relationship between dCA, brain atrophy, and functional outcomes following stroke remains unclear. In this study, we aimed to determine whether impairment of dCA is associated with atrophy in specific regions or globally, thereby affecting daily functions in stroke patients. We performed a retrospective analysis of 33 subjects with chronic infarctions in the middle cerebral artery territory, and 109 age-matched non-stroke subjects. dCA was assessed via the phase relationship between arterial blood pressure and cerebral blood flow velocity. Brain tissue volumes were quantified from MRI. Functional status was assessed by gait speed, instrumental activities of daily living (IADL), modified Rankin Scale, and NIH Stroke Score. Compared to the non-stroke group, stroke subjects showed degraded dCA bilaterally, and showed gray matter atrophy in the frontal, parietal and temporal lobes ipsilateral to infarct. In stroke subjects, better dCA was associated with less temporal lobe gray matter atrophy on the infracted side ( = 0.029), faster gait speed ( = 0.018) and lower IADL score (0.002). Our results indicate that better dynamic cerebral perfusion regulation is associated with less atrophy and better long-term functional status in older adults with chronic ischemic infarctions

Prevalence and behavioral risk factors for STIs/HIV among attendees of the Ministry of Health hospitals in Saudi Arabia

Introduction: Sexually transmitted infections (STI) are a major public health, social, and economic problem leading to morbidity, mortality, and stigma. This study was conducted to determine the prevalence of STIs, investigate behavioral risk factors and the relationship between the STIs/HIV and demographic factors. Methodology: A cross-sectional survey was conducted between 2013 and 2014 among attendees of the Ministry of Health hospitals. Results: The total number of participants was 3,994 (2,441 males and 1,553 females), with a mean age of 31.95 ± 9.45 years (range 12 to 77 years). The prevalence of STIs and HIV was 6.2% and 0.05% respectively. The mean age for infected people with STIs was 29.42 ± 7.51, vs. 32.12 ± 9.55 for non infected (p < 0.05). There was no diffference between infected and non infected people regarding gender, occupation and marital status. The prevalence of STIs was more commonly reported among non-Saudi (10.9%). Drug use (OR = 4.74; 95%; CI: 3.47–6.48), intravenous drug use (OR = 4.51; 95% CI: 1.45–13.12), illegal sex (OR = 10.7; 95% CI: 7.62–13.32), sex for money (OR = 6.36; 95% CI: 4.52–8.93), sex for pleasure (OR=9.76; 95% CI: 7.29–13.07) were significantly associated with STIs. Conclusion: The prevalence of STIs including HIV in Saudi Arabia is low compared to other countries in the region and globally

Thermodynamics of viscous Matter and Radiation in the Early Universe

Assuming that the background geometry is filled with free gas consisting of matter and radiation and no phase transitions being occurred in the early Universe, we discuss the thermodynamics of this {\it closed} system using classical approaches. We find that essential cosmological quantities, such as Hubble parameter $H$, scale factor $a$ and curvature parameter $k$, can be derived from this simple model, which on one hand fulfills and entirely obeys the laws of thermodynamics. On the other hand, the results are compatible with the Friedmann-Lemaitre-Robertson-Walker model and the Einstein field equations. The inclusion of finite bulk viscosity coefficient derives to important changes in all these cosmological quantities. Accordingly, our picture about the evolution of the Universe and its astrophysical consequences seems to be a subject of a radical revision. We find that $k$ strongly depends on the thermodynamics of background matter. The time scale, at which negative curvature might take place, depends on the relation between the matter content and the total energy. Using quantum and statistical approaches, we assume that the size of the Universe is given by the volume occupied one particle and one photon. Different types of their interactions are taken into account. Expressions for $H$ and $a$ are introduced. Therefore, the expansion of the Universe turns to be accessible.Comment: 9 pages, 2 figures (3 eps graphs