A systematic review and meta-analysis of Macroplastique for treating female stress urinary incontinence.

Introduction and hypothesisMacroplastique® (polydimethylsiloxane injection) is a minimally invasive urethral bulking agent with global clinical literature describing its use over 20 years. This study critically assessed the safety and effectiveness outcomes for adult women treated with Macroplastique for stress urinary incontinence (SUI) through a systematic review and meta-analysis.MethodsA systematic review of the scientific literature from 1990 to 2010 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to quantitatively summarize the safety and effectiveness of Macroplastique for female SUI. A total of 958 patients from 23 cohorts were eligible for inclusion and were analyzed. Random-effects models were used to estimate the improvement and cure rates following treatment at three time periods: short-term (<6 months), mid-term (6-18 months), and long-term (>18 months). Expanded models assessed the effect of reinjection rate on successful treatment outcomes. Adverse event rates were aggregated and reported.ResultsImprovement rates were 75 % [95 % confidence interval (CI), 69-81] in the short-term, 73 % (95 % CI, 62-83) in the mid-term, and 64 % (95 % CI, 57-71) long-term. Cure/dry rates were 43 % (95 % CI, 33-54), 37 % (95 % CI, 28-46), and 36 % (95 % CI, 27-46) over the same respective follow-up periods. Higher study reinjection rates were associated with improved long-term SUI outcomes. No serious adverse events were reported.ConclusionsThis quantitative review supports Macroplastique as an effective, durable, and safe treatment option for female SUI. Meta-analytic evidence suggests that long-term therapeutic benefit is frequently maintained, with some patients requiring reinjection

Vortex-scalar element calculations of a diffusion flame stabilized on a plane mixing layer

The vortex-scalar element method, a scheme which utilizes vortex elements to discretize the region of high vorticity and scalar elements to represent species or temperature fields, is utilized in the numerical simulations of a two-dimensional reacting mixing layer. Computations are performed for a diffusion flame at high Reynolds and Peclet numbers without resorting to turbulence models. In the nonreacting flow, the mean and fluctuation profiles of a conserved scalar show good agreement with experimental measurements. Results for the reacting flow indicate that for temperature independent kinetics, the chemical reaction begins immediately downstream of the splitter plate where mixing starts. Results for the reacting flow with Arrhenius kinetics show an ignition delay, which depends on reactant temperature, before significant chemical reaction occurs. Harmonic forcing changes the structure of the layer, and concomitantly the rates of mixing and reaction, in accordance with experimental results. Strong stretch within the braids in the nonequilibrium kinetics case causes local flame quenching due to the temperature drop associated with the large convective fluxes

Chemical kinetics mechanism for oxy-fuel combustion of mixtures of hydrogen sulfide and methane

Oxy-fuel combustion of sour gas, a mixture of natural gas (essentially methane (CH[subscript 4])), carbon dioxide (CO[subscript 2]), and hydrogen sulfide (H[subscript 2]S), could enable the utilization of large natural gas resources, especially when combined with enhanced oil recovery. In this work, a detailed chemical reaction mechanism for oxy-fuel combustion of sour gas is presented. To construct the mechanism, a CH[subscript 4] sub-mechanism was chosen based on a comparative validation study for oxy-fuel combustion. This mechanism was combined with a mechanism for H[subscript 2]S oxidation, and the sulfur sub-mechanism was then optimized to give better agreement with relevant experiments. The optimization targets included predictions for the laminar burning velocity, ignition delay time, and pyrolysis of H[subscript 2]S, and H[subscript 2]S oxidation in a flow reactor. The rate parameters of 15 sulfur reactions were varied in the optimization within their respective uncertainties. The optimized combined mechanism was validated against a larger set of experimental data over a wide range of conditions for oxidation of H[subscript 2]S and interactions between carbon and sulfur species. Improved overall agreement was achieved through the optimization and all important trends were captured in the modeling results. The optimized mechanism can be used to make qualitative and some quantitative predictions on the combustion behavior of sour gas. The remaining discrepancies highlight the current uncertainties in sulfur chemistry and underline the need for more accurate direct determination of several important rate constants as well as more validation data.Siemens Corporatio

Emergence of Thermodynamics from Darwinian Dynamics

Darwinian dynamics is manifestly stochastic and nonconservative, but has a profound connection to conservative dynamics in physics. In the present paper the main ideas and logical steps leading to thermodynamics from Darwinian dynamics are discussed in a quantitative manner. A synthesis between nonequilibrum dynamics and conservative dynamics is outlined.Comment: latex, 8 page

Workup and conservative management of ileal conduit-vaginal fistulas: review of literature.

Ileal conduit-vaginal fistulas are a rare but challenging complication of urinary diversion. Here we identify risk factors and summarize the workup and conservative management strategies for this complication. We present two cases of elderly women with remote history of cancer who presented with persistent urinary leakage from the vagina several years after ileal conduit creation. Fistulas may be identified using dye or imaging with a loopogram and looposcopy. Correction of obstruction such as stomal stenosis or urinary diversion should be pursued to relieve pressure off the conduit. Minimally invasive management such as fulguration can result temporary relief; however, the recurrence rate is high

The Second Law and Cosmology

I use cosmology examples to illustrate that the second law of thermodynamics is not old and tired, but alive and kicking, continuing to stimulate interesting research on really big puzzles. The question "Why is the entropy so low?" (despite the second law) suggests that our observable universe is merely a small and rather uniform patch in a vastly larger space stretched out by cosmological inflation. The question "Why is the entropy so high" (compared to the complexity required to describe many candidate "theories of everything") independently suggests that physical reality is much larger than the part we can observe.Comment: Transcript of talk at the MIT Keenan Symposium; video available at http://mitworld.mit.edu/video/513, including slides and animation