LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report.

BackgroundGastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure.Case presentationOur patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting.ConclusionsLINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with gastroesophageal reflux disease and poorly controlled concomitant refractory asthma

On the Importance of Cross-Sectional Distortions and their Inclusion in an Efficient GBT-Formulation

This proceeding proposes an efficient generalized beam theory formulation, which accounts for cross-sectional deformations in slender prismatic structures. It was shown by the authors in a recent publication [1] that in-plane distortional deformations and accompanied out of plane warping deformations of the cross-section influence the accuracy of results in beam dynamics especially if thin-walled cross-sections are applied. The GBT formulation proposed in [1] overcomes the inaccuracies of classical beam mechanics, however, requires a two-dimensional plane discretization of the cross-section. The computational complexity can be reduced vastly, if the thin-walled cross-sections can be discretized with one-dimensional elements. Consequently, this proceeding discusses a corresponding derivation, where the line mesh which discretizes the cross-section has six degrees of freedom at each node. The membrane part consists of mass-less micro-polar rotations (drilling rotations) and can be derived independently from the bending part, where a shear elastic formulation is selected

Atrial fibrillation management strategies in routine clinical practice: insights from the International RealiseAF Survey

Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients' clinical characteristics, AF control, and symptom burden.RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit.Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p = II.In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved

Forced vibration of the aluminum beam using a piezoelectric actuator - experiment and finite element analysis.

This paper deals with the forced vibration of the aluminum beam using a piezoelectric actuator. Cantilever beam was excited by thin piezoelectric film placed near the fix support. The oscillation of the free end of the beam was measured using a laser displacement sensor. The beam's eigenfrequency and damping ratio for the first bending vibration mode was determined experimentally. The beam's deflection when the beam was excited by a piezoelectric actuator was also determined experimentally. The actuator was controlled by a signal generator and high-performance power supply and linear amplifier module for driving piezoelectric actuators. Data from experimental measurements were used to validate the finite element model of the beam with piezoelectric actuator. Results from experimental measurements and numerical simulations were compared

First mock-up of the CBM STS module based on a new assembly concept

A molecular dynamics model has been developed to investigate the effect of the crystallographic orientation on the material deformation behaviors in nano- indentation/scratching of BCC iron. Two cases with different substrate orientations have been simulated. The orientations along x, y and z direction are [001], [100] and [010] for Case I and [111], [-1-12] and [1-10] for Case II, respectively. Case I and Case II exhibit different deformation patterns in the substrate. During indentation, the pile-up can be observed in Case I, but not in Case II. During scratching the pile-up ahead of the movement of the indenter has been enlarged in Case I, while a chip with the disordered atoms is generated in Case II. It has been found that Case I has both higher hardness and larger coefficient of friction. The ratios of the hardness and the coefficient of friction between cases I and II are nearly 2. The reason is attributed to the different crystallographic orientations used in both cases

Multi-Jet Event Rates in Deep Inelastic Scattering and Determination of the Strong Coupling Constant

Jet event rates in deep inelastic ep scattering at HERA are investigated applying the modified JADE jet algorithm. The analysis uses data taken with the H1 detector in 1994 and 1995. The data are corrected for detector and hadronization effects and then compared with perturbative QCD predictions using next-to-leading order calculations. The strong coupling constant alpha_S(M_Z^2) is determined evaluating the jet event rates. Values of alpha_S(Q^2) are extracted in four different bins of the negative squared momentum transfer~\qq in the range from 40 GeV2 to 4000 GeV2. A combined fit of the renormalization group equation to these several alpha_S(Q^2) values results in alpha_S(M_Z^2) = 0.117+-0.003(stat)+0.009-0.013(syst)+0.006(jet algorithm).Comment: 17 pages, 4 figures, 3 tables, this version to appear in Eur. Phys. J.; it replaces first posted hep-ex/9807019 which had incorrect figure 4

Differential (2+1) Jet Event Rates and Determination of alpha_s in Deep Inelastic Scattering at HERA

Events with a (2+1) jet topology in deep-inelastic scattering at HERA are studied in the kinematic range 200 < Q^2< 10,000 GeV^2. The rate of (2+1) jet events has been determined with the modified JADE jet algorithm as a function of the jet resolution parameter and is compared with the predictions of Monte Carlo models. In addition, the event rate is corrected for both hadronization and detector effects and is compared with next-to-leading order QCD calculations. A value of the strong coupling constant of alpha_s(M_Z^2)= 0.118+- 0.002 (stat.)^(+0.007)_(-0.008) (syst.)^(+0.007)_(-0.006) (theory) is extracted. The systematic error includes uncertainties in the calorimeter energy calibration, in the description of the data by current Monte Carlo models, and in the knowledge of the parton densities. The theoretical error is dominated by the renormalization scale ambiguity.Comment: 25 pages, 6 figures, 3 tables, submitted to Eur. Phys.