RESUMEN
Experiments were performed on laser wakefield acceleration in the highly nonlinear regime. With laser powers P<250 TW and using an initial spot size larger than the matched spot size for guiding, we were able to accelerate electrons to energies E_{max}>2.5 GeV, in fields exceeding 500 GV m^{-1}, with more than 80 pC of charge at energies E>1 GeV. Three-dimensional particle-in-cell simulations show that using an oversized spot delays injection, avoiding beam loss as the wakefield undergoes length oscillation. This enables injected electrons to remain in the regions of highest accelerating fields and leads to a doubling of energy gain as compared to results from using half the focal length with the same laser.
RESUMEN
The Arabian Sea accounts for a small fraction of Tropical Cyclones-about 2% of the annual global mean. However, the damage they might inflict there and along its coastlines, which are thickly populated, is considerable. This study explores the influence of the changes in the vertical profiles of atmosphere and oceanic environment throughout the seasons of March-June (MAMJ) and October-December (OND) in clustering the cyclogenesis over the Eastern Arabian Sea (EAS) next to the Indian West coast in recent decades. Further investigation has been done into the precise contribution of atmospheric and oceanic factors to fluctuations in cyclone intensity throughout the MAMJ and OND seasons separately. Two seasons have been studied independently in order to better understand the distinct influences of the vertical fluctuation of atmospheric factors and the thermal structure of the oceanic subsurface on cyclogenesis. More severe cyclones are caused by high tropical cyclone heat potential, and ocean subsurface warming present in this sea region influences the genesis of storms mostly during MAMJ. On the other hand, mid tropospheric relative humidity and thermal instability influences more on increasing cyclogenesis and its clustering over EAS during OND season. The findings suggest that large-scale oceanic subsurface conditions have a crucial influence on cyclogenesis over EAS through oceanic sensitivity to atmospheric forcing. This cyclone tendency and its clustering over EAS needs attention in terms of forecasting, catastrophe risk reduction, and climate change adaptation due to the security of coastal urban and rural habitats, livelihoods, and essential infrastructure along the coasts.
RESUMEN
The enormous progress in weather and extended range predictions for the Indian monsoon over the last decade has not been translated to operationalized irrigation water management tools despite many agricultural advisories from operational agencies. The limited implementation is mainly due to the resolution mismatches of forecasts and decision-needs and a lack of soil moisture monitoring networks. Sustained soil moisture monitoring suffers from the high cost to farmers in installing distributed sensors. Here we develop an irrigation water management tool for the farmers at farm scale, which starts with utilizing and merging a few available soil moisture sensors and L-band satellite observations of surface soil moisture using machine learning. Such derived soil moisture field is used as the initial condition with the multi-ensemble future rainfall for the following few weeks given the weather/extended range forecasts in a farm-scale ecohydrological model. This ecohydrological model is integrated with Monte-Carlo simulations within a stochastic optimization framework to minimize water use while not allowing the soil moisture to drop below a threshold level with a certain probability. The optimization results in water arrangement decisions 2 weeks in advance and water application decisions 1-7 days in advance. We also estimate the water storage capacity needed at farm scale for effective water utilization. We find that 20-45 % and 17-35 % water savings were achievable for Kharif and Rabi seasons, respectively, without losing any yield when applied to grape farms of Nashik, Maharashtra, India. The proposed framework is co-developed with the farmers and can be used in any region for any crops, since it is generalized and easy to transfer. This is an extension of our earlier work to an end-to-end system using satellite data for soil moisture.
RESUMEN
BACKGROUND: The base of the skull, particularly the pterygomaxillary region, has a sophisticated topography, the morphometry of which interests pathologists, maxillofacial and plastic surgeons. The aim of the study was to conduct pterygomaxillary morphometrics and test relevant hypotheses on sexual and laterality-based dimorphism, and causality relationships. MATERIALS AND METHODS: We handled 60 dry skulls of adult Asian males (36.7%) and females (63.3%). We calculated the prime distance D [prime] for the imaginary line from the maxillary tuberosity to the midpoint of the pterygoid process between the upper and the lower part of the pterygomaxillary fissure, as well as the parasagittal D [x-y inclin.] and coronal inclination of D [x-z inclin.] of the same line. We also took other morphometrics concerning the reference point, the maxillary tuberosity. RESULTS: Significant sexual as well as laterality-based dimorphism and bivariate correlations existed. The univariate models could not detect any significant effect of the predictors. On the contrary, summative multivariate tests in congruence with neural networks, detected a significant effect of laterality on D [x-y inclin.] (p-value = 0.066, partial eta squared = 0.030), and the interaction of laterality and sex on D [x-z inclin.] (p-value = 0.050, partial eta squared = 0.034). K-means clustering generated three clusters highlighting the significant classifier effect of D [prime] and its three-dimensional inclination. CONCLUSIONS: Although the predictors in our analytics had weak-to-moderate effect size underlining the existence of unknown explanatory factors, it provided novel results on the spatial inclination of the pterygoid process, and reconciled machine learning with non-Bayesian models, the application of which belongs to the realm of oral-maxillofacial surgery.
Asunto(s)
Maxilar , Hueso Esfenoides , Femenino , Humanos , Aprendizaje Automático , MasculinoRESUMEN
Among the other diseases, malaria and diarrhoea have a large disease burden in India, especially among children. Changes in rainfall and temperature patterns likely play a major role in the increased incidence of these diseases across geographical locations. This study proposes a method for probabilistic forecasting of the disease incidences in extended range time scale (2-3 weeks in advance) over India based on an unsupervised pattern recognition technique that uses meteorological parameters as inputs and which can be applied to any geographical location over India. To verify the robustness of this newly developed early warning system, detailed analysis has been made in the incidence of malaria and diarrhoea over two districts of the State of Maharashtra. It is found that the increased probabilities of high (less) rainfall, high (low) minimum temperature and low (moderate) maximum temperature are more (less) conducive for both diseases over these locations, but have different thresholds. With the categorical probabilistic forecasts of disease incidences, this early health warning system is found to be a useful tool with reasonable skill to provide the climate-health outlook about possible disease incidence at least 2 weeks in advance for any location or grid over India.
RESUMEN
OBJECTIVES: Limited data exist on the risks of complications associated with a suprapubic catheter (SPC) insertion. Bowel injury (BI) is a well-recognized albeit uncommon complication. Guidelines on the insertion of SPC have been developed by the British Association of Urological Surgeons, but there remains little evidence regarding the incidence of this complication. This study uses contemporary UK data to assess the incidence of SPC insertion and the rate of BI and compares to a meta-analysis of available papers. METHODS: National Hospital Episodes Statistics data were searched on all SPC insertions over an 18-month period for operating procedure codes, Code M38.2 (cystostomy and insertion of a suprapubic tube into bladder). Patients age, 30-day readmission rates, 30-day mortality rate, and catheter specific complication rate were collected. To estimate the BI rate, we searched patients who had undergone any laparotomy or bowel operation within 30 days of SPC insertion. Trusts were contacted directly and directed to ascertain whether there was SPC-related BI. PubMed search to identify papers reporting on SPC related BI was performed for meta-analysis RESULTS: 11 473 SPC insertions took place in the UK in this time period. One hundred forty-one cases had laparotomy within 30 days. Responses from 114 of these cases reported one BI related to SPC insertion. Meta-analysis showed an overall BI rate of 11/1490 (0.7%). CONCLUSIONS: This is the largest dataset reported on SPC insertions showing a lower than previously reported rate of BI. We recommend clinicians use a risk of BI of less than 0.25% when counseling low-risk patients.
Asunto(s)
Cistostomía/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Intestinos/lesiones , Cateterismo Urinario/efectos adversos , Colectomía/estadística & datos numéricos , Colostomía/estadística & datos numéricos , Humanos , Intestinos/cirugía , Auditoría Médica , Mortalidad , Readmisión del Paciente/estadística & datos numéricos , Proctectomía/estadística & datos numéricos , Reino Unido , Vejiga UrinariaRESUMEN
Heat waves over India occur during the months of March-June. This study aims at the real-time monitoring and prediction of heat waves using a multi-model dynamical ensemble prediction system developed at Indian Institute of Tropical Meteorology, India. For this, a criterion has been proposed based on the observed daily gridded maximum temperature (Tmax) datasets, which can be used for real-time prediction as well. A heat wave day is identified when either (1) Tmax (a)≥ its climatological 95th percentile (calculated from daily values during March-June and for 1981-2010), (b) >36 °C, and (c) its departure from normal is >3.5 °C, Or, (2) when the Tmax >44 °C. Three heat wave prone regions, namely, northwest, southeast and northwest-southeast regions are recognized and heat wave spells of minimum consecutive six days are identified objectively for each region during 1981-2018. It is noticed that the prediction system has reasonable skill in predicting the heat waves over heat wave prone regions of India. Forecast verification of heat wave spells during 2003-2018 reveals that the prediction system has great potential in providing overall indication about the onset, duration and demise of the forthcoming heat wave spell with sufficient lead time albeit with some spatio-temporal error.
RESUMEN
OBJECTIVE: To evaluate the effect of duration of caffeine use on long-term neurodevelopmental (ND) outcomes at 3 years corrected age (CA) in preterm infants with birthweights (BW) ≤ 1250 g. DESIGN/METHODS: All surviving infants with BW ≤ 1250 g admitted to the Foothills Medical Center neonatal intensive care unit (NICU) from January 2002 to December 2009 who received the first dose of caffeine in the first week of life and were followed up at three years CA were included in the study. Demographics and follow-up outcomes were compared based on early cessation of caffeine ≤ 14 days (ECC), intermediate cessation of caffeine 15-30 days (ICC), and late cessation of caffeine >30 days (LCC). The primary outcome of ND impairment was present if a child had any one of the following: cerebral palsy, cognitive delay, visual impairment, or hearing impairment or deafness. Univariate and logistic regression analyses were performed. RESULTS: Of the 508 eligible infants, 448 (88%) were seen at 3 years CA at follow-up. ECC (n = 139), ICC (n = 122) and LCC (n = 187) groups had a median (range) BW of 979 (560-1250), 1010 (530-1250), and 980 (520-1250) g (p = 0.524) and median (range) gestational age (GA) of 27 (23-33), 28 (24-33), and 27 (24-32) weeks, respectively (p = 0.034). In logistic regression models adjusting for GA, maternal smoking, and each neonatal risk factor separately (IVH, NEC, sepsis, blood transfusions, BPD, postnatal dexamethasone, SNAP-II, and ventilator days), none of the models showed a statistically significant association between caffeine duration and ND impairment. CONCLUSION: The duration of caffeine use in premature infants in the NICU does not impact on long-term ND outcomes at 3 years CA.
Asunto(s)
Cafeína/uso terapéutico , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal , Trastornos del Neurodesarrollo/prevención & control , Preescolar , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Trastornos del Neurodesarrollo/tratamiento farmacológico , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
A novel reduced-order method is presented for modeling reacting flows characterized by strong non-equilibrium of the internal energy level distribution of chemical species in the gas. The approach seeks for a reduced-order representation of the distribution function by grouping individual energy states into macroscopic bins, and then reconstructing state population using the maximum entropy principle. This work introduces an adaptive grouping methodology to identify and lump together groups of states that are likely to equilibrate faster with respect to each other. To this aim, two algorithms have been considered: the modified island algorithm and the spectral clustering method. Both methods require a measure of dissimilarity between internal energy states. This is achieved by defining "metrics" based on the strength of the elementary rate coefficients included in the state-specific kinetic mechanism. Penalty terms are used to avoid grouping together states characterized by distinctively different energies. The two methods are used to investigate excitation and dissociation of N2 (Σg+1) molecules due to interaction with N(Su4) atoms in an ideal chemical reactor. The results are compared with a direct numerical simulation of the state-specific kinetics obtained by solving the master equations for the complete set of energy levels. It is found that adaptive grouping techniques outperform the more conventional uniform energy grouping algorithm by providing a more accurate description of the distribution function, mole fraction and energy profiles during non-equilibrium relaxation.
RESUMEN
AIM: To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS: PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS: Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION: Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
Asunto(s)
Manejo de la Enfermedad , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Neoplasias Pélvicas/complicaciones , Algoritmos , Humanos , Neoplasias Pélvicas/terapiaRESUMEN
Self-guiding of an ultraintense laser requires the refractive index to build up rapidly to a sufficient value before the main body of the pulse passes by. We show that placing a low-intensity precursor in front of the main pulse mitigates the diffraction of its leading edge and facilitates reaching a self-guided state that remains stable for more than 10 Rayleigh lengths. Furthermore, this precursor slows the phase slippage between the trapped electrons and the wakefield and leads to an accelerating structure that is more stable, contains more energy, and is sustained longer. Examples from three-dimensional particle-in-cell simulations show that the conversion efficiency from the laser to the self-trapped electrons increases by an order of magnitude when using the precursor.
RESUMEN
We show that the bifurcations between dynamical states originating in the nonlinear dynamics of an external-cavity semiconductor laser at constant current can be detected by its terminal voltage V. We experimentally vary the intensity fed back into the gain medium by the external cavity and show that the dc component V(dc) of V tracks the optical intensity-based bifurcation diagram. It is shown using computational results based upon the Lang-Kobayashi model that whereas optical intensity accesses the dynamical-state variable |E|, V is related to population-inversion carrier density N. The change in feedback strength affects N and thereby the quasi-Fermi energy level difference at the p-i-n junction band-gap of the gain medium. The change in the quasi-Fermi energy-level thereby changes the terminal voltage V. Thus V is shown to provide information on the change in the dynamical-state variable N, which complements the more conventionally probed optical intensity.
RESUMEN
Botulinum toxin-A (BTX-A) is well established in the management of various aspects of lower urinary tract dysfunction (LUTD). One formulation, OnabotulinumtoxinA has recently been licensed in many parts of the world for use in neurogenic detrusor overactivity (NDO), and in the US for idiopathic overactive bladder (OAB), in patient's refractory to antimuscarinics. This review article looks at recent clinical publications that examine the use of BTX-A for the treatment of LUTD with a focus on OAB, detrusor overactivity (DO), benign prostatic hyperplasia (BPH) and Painful bladder syndrome / interstitial cystitis (PBS / IC). A literature review was conducted using the PubMed database and studies that were published within the time frame of January 2011 to present were included. Large randomised placebo controlled trials and a pooled analysis of patients with multiple sclerosis / spinal cord injury and NDO has suggested that BTX-A improved urinary incontinence (UI) episodes, urodynamic parameters and QoL in these patients. 200 U of OnabotulinumtoxinA appeared equivalent to 300 U. In patients with OAB, lower doses of 100 U OnabotulinumtoxinA, appear efficacious and with an acceptable adverse event profile. In one large phase III trial, de novo clean intermittent catheterisation rates were 6.1 %. Repeated injections in DO appear efficacious. Results from BPH studies are mixed, and the largest randomised study in this setting has shown significant improvements in a number of parameters for a variety of OnabotulinumtoxinA doses, but none of the doses were statistically better than placebo. Few studies have been conducted in PBS / IC and larger scale randomised placebo controlled trials are required to validate its use in this setting.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Síntomas del Sistema Urinario Inferior/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Hiperplasia Prostática/tratamiento farmacológico , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico , Cistitis Intersticial/tratamiento farmacológico , Femenino , Humanos , Masculino , Calidad de Vida , Resultado del Tratamiento , Vejiga Urinaria Neurogénica/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/tratamiento farmacológicoRESUMEN
BACKGROUND: Botulinum toxin-A (BoNT/A) is now established second-line management for refractory overactive bladder (OAB) and recognised in many incontinence guidelines and pathways. For those with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis, the toxin is currently licensed in certain parts of the world, including the UK. It is an effective treatment in those in whom antimuscarinics and conservative measures have failed who have symptoms of OAB and or detrusor overactivity (DO). METHODS: Treatment can be given in an outpatient setting and can be administered under local anaesthesia. Its efficacy lasts for between six and 12 months. RESULTS: It has an acceptable safety profile with the biggest risk being urinary tract infection and difficulty emptying the bladder, necessitating clean intermittent self-catheterisation (CISC). Medium-term follow-up suggests repeated injections are also safe and efficacious. CONCLUSIONS: The mechanism of action of the toxin is more complicated than originally thought, and it seems likely that it affects motor and sensory nerves of the bladder. In the last 10 years much of the progress of this treatment from early experimental trials to mainstream clinical use, and a better understanding of how it works in the bladder, are as a result of research conducted in the UK. This review summarises the significant and substantial evidence for BoNT/A to treat refractory OAB from UK centres.
Asunto(s)
Bloqueo Nervioso Autónomo/efectos adversos , Plexo Celíaco , Dolor Crónico/cirugía , Infarto/etiología , Hígado/irrigación sanguínea , Pancreatitis Crónica/complicaciones , Bazo/irrigación sanguínea , Bloqueo Nervioso Autónomo/métodos , Bupivacaína , Dolor Crónico/etiología , Endosonografía , Etanol , Resultado Fatal , Femenino , Humanos , Infarto/diagnóstico , Persona de Mediana Edad , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: There is undoubtedly a link between lower urinary tract and psychological symptoms. The association is likely to be multifactorial, but whether psychological symptoms are causal or coincidental remains unknown. METHODS: This paper is a result of a think tank session conducted at the ICI-RS meeting 2011 in Bristol and a PubMed search on the subject of psychology and LUTS. RESULTS: Recent population studies have shown that LUTS are prevalent and that psychological morbidity is related to severity of LUTS. Evidence suggests that the psychological status of patients plays a significant role in their symptoms perception. Animal studies have shown the importance of programming and emotional stress on subsequent psychological problems. The link between early events in childhood and resulting LUTS in later life remains uncertain. The possibility that for some patients urinary symptoms could be part of a somatizing process requires further consideration. The possibility that patients' symptoms could be part of a somatization process needs further consideration. Neuroendocrine and neuroimaging studies suggest pathways that may link psychological and lower urinary tract functioning from early life, opening new avenues to better understand the treatment of both symptom groups. CONCLUSION: Whilst psychological morbidity will result from any distressing chronic medical condition the possibility of causation, and or maintenance of LUTS through psychological causes requires further research. It is important to recognize that amongst our younger and older patients suffering with LUTS a significant psychological component exists. Failure to address this may lead to incomplete assessment and consequently inadequate treatment.
Asunto(s)
Síntomas del Sistema Urinario Inferior/psicología , Vejiga Urinaria/fisiopatología , Factores de Edad , Animales , Cistitis Intersticial/fisiopatología , Cistitis Intersticial/psicología , Emociones , Medicina Basada en la Evidencia , Humanos , Síntomas del Sistema Urinario Inferior/epidemiología , Síntomas del Sistema Urinario Inferior/fisiopatología , Enuresis Nocturna/fisiopatología , Enuresis Nocturna/psicología , Medición de Riesgo , Factores de Riesgo , Trastornos Somatomorfos/fisiopatología , Trastornos Somatomorfos/psicología , Estrés Psicológico/epidemiología , Vejiga Urinaria/inervación , Micción , UrodinámicaRESUMEN
BACKGROUND: Experimental studies have found several calcium channel blockers with anticonvulsant property. Flunarizine is one of the most potent calcium channel blockers, which has shown anticonvulsant effect against pentylenetetrazole (PTZ) and maximal electroshock (MES)-induced seizures. However, further experimental and clinical trials have shown varied results. We conducted a PTZ model experimental study to re-evaluate the potential of flunarizine for add-on therapy in the management of refractory epilepsy. MATERIALS AND METHODS: Experiments were conducted in PTZ model involving Swiss strain mice. Doses producing seizures in 50% and 99% mice, i.e. CD(50) and CD(99) values of PTZ were obtained from the dose-response study. Animals received graded, single dose of sodium valproate (100-300 mg/kg), lamotrigine (3-12 mg/kg) and flunarizine (5-20 mg/kg), and then each group of mice was injected with CD(99) dose of PTZ (65mg/kg i.p.). Another group of mice received single ED(50) dose (dose producing seizure protection in 50% mice) of sodium valproate and flunarizine separately in left and right side of abdomen. Results were analysed by Kruskal-Wallis ANOVA on Ranks test. RESULTS: As compared to control, sodium valproate at 250 mg/kg and 300 mg/kg produced statistical significant seizure protection. At none of the pre-treatment dose levels of lamotrigine, the seizure score with PTZ differed significantly from that observed in the vehicle-treated group. Pre-treatment with flunarizine demonstrated dose-dependent decrease in the seizure score to PTZ administration. As compared to control group, flunarizine at 20 mg/kg produced statistical significant seizure protection. CONCLUSION: As combined use of sodium valproate and flunarizine has shown significant seizure protection in PTZ model, flunarizine has a potential for add-on therapy in refractory cases of partial seizures. It is therefore, we conclude that further experimental studies and multicenter clinical trials involving large sample size are needed to establish flunarizine as add-on therapy in refractory epilepsy.
RESUMEN
OBJECTIVE: To assess the safety and efficacy of botulinum toxin-A (botn-A) in the management of patients with bladder oversensitivity (BO). PATIENTS AND METHODS: Twenty-three consecutive patients with a diagnosis of BO refractory to anticholinergics were enrolled in this randomised, double blind, placebo-controlled trial. Patients were randomly allocated to receive intradetrusor injections of either botn-A (100 U Botox) or saline (placebo) via a flexible cystoscopic approach. The study was designed to have 90% power to detect a change in the maximum cystometric capacity (MCC) of 30%. It was calculated that a total cohort of 58 patients would be required. Urodynamic assessment (UDS), voiding diaries (VD) and quality of life (QoL) were assessed at baseline and at 4 and 12 weeks following intervention. RESULTS: An interim analysis was performed and the trial halted after recruitment of 23 patients as a result of poorly perceived patient benefit. Data were analysed for 21 patients (10 botn-A; 11 placebo). In the treatment arm, there was a significant increase in MCC (mean rise 105 ml; p = 0.009). However, storage symptoms remained statistically unchanged following botn-A. Three patients in the treatment arm were required to perform clean intermittent self-catheterisation with no clinical improvement. The limitations of this trial include the small sample size and the unplanned interim analysis. CONCLUSIONS: This is the first randomised, double blind, placebo-controlled trial examining the effects of botn-A exclusively in patients with BO. A significant increase in MCC was observed but this did not translate to clinical benefit with no change observed in the symptoms and quality of life for the majority of patients.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Fármacos Neuromusculares/uso terapéutico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Método Doble Ciego , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Calidad de Vida , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/fisiopatología , Urodinámica/efectos de los fármacos , Adulto JovenRESUMEN
BACKGROUND AND STUDY AIM: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) for cyst fluid analysis (CFA) is often requested for pancreatic cystic lesions, to determine whether to operate or to observe. If this decision is not influenced by the EUS findings, the procedure may be unjustifiable. We aimed to determine whether EUS-CFA results predict surgery or observation in patients with pancreatic cysts referred for EUS. PATIENTS AND METHODS: Consecutive patients referred to a quaternary pancreaticobiliary center for EUS evaluation of pancreatic cysts were eligible. Clinical data, computed tomography (CT) results, EUS findings, and CFA results were reviewed retrospectively. Statistical analysis was performed to determine variables associated with surgery versus observation. RESULTS: Over 33 months, data on 194 consecutive patients referred for EUS for evaluation of pancreatic cysts were analyzed. Of these, 136 (70 %) patients had EUS-FNA. After the initial workup (including EUS with/without CFA), 35 (18 %) underwent surgery. Predictors of surgery were: younger age (< 65 years) (P = 0.0027), malignant appearance at EUS (P = 0.02), and history of EUS-FNA (P = 0.012). Cyst fluid appearance, and carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA 199), and amylase levels were not significant determinants of surgery. In 14/50 (28 %) of cases where EUS-CFA clearly suggested benign serous lesions, surgery was still performed and in 9/11 (82 %) of cases with malignant EUS-CFA findings, surgery was not done. CONCLUSIONS: In patients with pancreatic cysts referred for EUS, age and EUS appearance independently predict surgery. The "perceived need for EUS-CFA" also predicts surgery, but not the EUS-CFA results. The clinical value of EUS-CFA requires further study.
Asunto(s)
Biopsia con Aguja Fina/métodos , Endosonografía/métodos , Quiste Pancreático/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Líquido Quístico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quiste Pancreático/diagnóstico por imagen , Quiste Pancreático/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Espera VigilanteRESUMEN
BACKGROUND: Nicotine is heavily used addictive drug that has unpleasant side- effects, e.g. dizziness, nausea, emphysema. PURPOSE: The current study was designed to find the possible relationship of nicotine mediated microcystic oedema in white matter of cerebellum to postural imbalance. METHODS: Nicotine was administered for 8 weeks orally via cannula, using dose rate (5 mg/day, 10 mg/day) to male drukrey rats. The results were compared to control adult rats, given vehicle in identical manner. After 8 weeks exposure, the cerebellum was removed and processed for histopathologic study. RESULTS: The cellular microcystic change with interstitial oedema was found in white core of cerebellum of rat received 10 mg/kg of nicotine. Cytoplasmic vacuolation was also observed in most areas of cerebellum. CONCLUSION: These findings suggest that the mature adult cerebellum is susceptible to the damaging effects of nicotine in depleting white core of cerebellum.