Endobronchial ultrasound (EBUS) is now the preferred tool to sample malignant mediastinal lesions. Data on its role in tubercular mediastinal adenopathy are limited.
To evaluate the efficacy of EBUS ...in diagnosing tubercular mediastinal lymphadenopathy and correlate the cytological and microbiological results obtained on aspirate with standard methods (radiology and the tuberculin skin test) suggesting tuberculosis (TB).
A prospective study of 125 patients with suspected tubercular mediastinal lymphadenopathy who underwent EBUS-transbronchial needle aspiration. Only patients with a microbiologically confirmed diagnosis or unequivocal clinico-radiological response to anti-TB treatment during follow-up were included.
A total of 122 patients showed findings suggesting TB on cytopathology (sensitivity 97.6%), 105 (84%) of whom had microbiological evidence of TB (positive smear/culture or both). Performing staining for acid-fast bacilli on slides prepared during the procedure vs. only on samples submitted in saline significantly improved the yield. Only 92 patients (73.6%) were Mantoux-positive. Cytology was more sensitive than computed tomography in picking up necrosis. Granulomas, with or without necrosis, were equally likely to be microbiologically positive. However, presence of only necrosis in a TB-endemic region invariably points towards TB diagnosis.
EBUS was highly sensitive and specific for diagnosis of mediastinal TB and may be considered the investigation of choice for tubercular mediastinal adenopathy.
This paper evaluates the predictive accuracy of neural networks in forecasting exchange rate. The multi-layer perceptron (MLP) and radial basis function (RBF) networks with different architectures ...are used to forecast five exchange rate time series. The results of each prediction are evaluated and compared according to the networks and architectures used. It is found that neural networks can be effectively used in forecasting exchange rate and hence in designing trading strategies. RBF networks performed better than MLP networks in our simulation experiment. This experiment suggests that it is possible to extract information hidden in the exchange rate and predict it into future.
To evaluate a pilot specialist practice-based minor oral surgery service.
Service monitoring data were analysed to evaluate activity, waiting times and outcomes. Patient satisfaction was assessed by ...a modified version of the Dental Visit Satisfaction Scale.
Of 705 treatment appointments, 12.7% were not attended and treatment was not provided in another 11.6%. Mean waiting time from referral receipt to treatment was 6.8 weeks. Treatment provided included surgical removal of third molars, surgical removal of non-third molars and surgical endodontics (26.7%, 60.4% and 4.9% of cases, respectively). Antibiotics were prescribed in 15.0% of treatment cases and 2.3% of treatment cases required appointments for postoperative complications. The response rate for the satisfaction survey was 81%. All participants reported overall satisfaction and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 77.8% were seen on time and 22.2% within 15 minutes of their appointment. Overall 74.1% felt the standard of service was better than they would expect from a hospital and none felt it was worse.
The findings of the evaluation suggest that specialist minor oral surgery can be successfully provided in dental practice and is acceptable to patients.
Objectives
Minimally invasive oesophagectomy offers a number of advantages over open approaches, including reduced discomfort, shorter length of stay, and a faster recovery to baseline status. ...Alternatively, minimally invasive procedures are typically longer and consume greater disposable instrumentation, potentially resulting in a higher overall cost. The objective of this study was to compare costs associated with oesophagectomy approaches for oesophageal cancer.
Methods
An institutional Resource Information Management System was queried for hospital cost data of patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic, or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures were excluded.
Results
A total of 158 oesophagectomies were identified, including 60 minimally invasive (MIO), 34 open transthoracic (TT), and 64 transhiatal (TH).The median costs on the day of surgery were higher in the MIE group ($12 187) than the open groups TT ($7689) or TH ($5118). The median costs of the entire hospitalization also appeared to be higher in the MIO group ($25 879) compared to TT ($23 622) and TH ($15 248). The median length of stay was lowest in the MIO group (8.0 days) compared to TT (11.5 days) and TH (9.0 days).
Conclusions
The operating room costs associated with minimally invasive oesophagectomy are significantly higher than open transthoracic or transhiatal approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expenses, as the total hospital costs trend is higher in the MIO patients. In a strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the postoperative period as well as operating room expenses.
Disclosure
All authors have declared no conflicts of interest.
OBJECTIVES
The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to ...baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer.
METHODS
An institutional Resource Information Management System (RIMS) was queried for cost data relating to hospital expenditures (as opposed to billings or collections). The RIMS was searched for patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic (OTT) (including Ivor Lewis, modified McKeown or thoracoabdominal) or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures, were excluded.
RESULTS
A total of 160 oesophagectomies were identified, including 61 minimally invasive, 35 open transthoracic and 64 transhiatal. Costs on the day of surgery averaged higher in the MIO group ($12 476 ± 2190) compared with the open groups, OTT ($8202 ± 2512, P < 0.0001) or OTH ($5809 ± 2575, P < 0.0001). The median costs associated with the entire hospitalization also appear to be higher in the MIO group ($25 935) compared with OTT ($24 440) and OTH ($15 248). The average length of stay was lowest in the MIO group (11 ± 9 days) compared with OTT (19 ± 18 days, P = 0.006) and OTH (18 ± 28 days P = 0.07). The operative mortality was similar in the three groups (MIO = 3%, OTT = 9% and OTH = 3%).
CONCLUSIONS
The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In an increasingly strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the inpatient hospitalization as well as operating theatre expenses.
Here, we report a measurement of cumulants and correlation functions of event-by-event proton multiplicity distributions from fixed-target Au+Au collisions at $\sqrt{s_\text{NN}}$ = 3 GeV measured by ...the STAR experiment. Protons are identified within the rapidity (y) and transverse momentum ($p_T$) region –0:9 < $\textit{y}$ < 0 and 0:4 < pT < 2:0 GeV/c in the center-of-mass frame. A systematic analysis of the proton cumulants and correlation functions up to sixth-order as well as the corresponding ratios as a function of the collision centrality, $p_T$, and $\textit{y}$ are presented. The effect of pileup and initial volume fluctuations on these observables and the respective corrections are discussed in detail. The results are compared to calculations from the hadronic transport UrQMD model as well as a hydrodynamic model. In the most central 5% collisions, the value of proton cumulant ratio $C_4 = C_2$ is negative, drastically different from the values observed in Au+Au collisions at higher energies. Compared to model calculations including Lattice QCD, a hadronic transport model, and a hydrodynamic model, the strong suppression in the ratio of $C_4/C_2$ at 3 GeV Au+Au collisions indicates an energy regime dominated by hadronic interactions.
Valproate-Induced Worsening of Seizures Dhamija, Radhika; Gavrilova, Ralitza H.; Wirrell, Elaine C.
Journal of child neurology,
10/2011, Letnik:
26, Številka:
10
Journal Article
Recenzirano
The use of valproate sodium as an antiepileptic is not advised in children with an undiagnosed metabolic condition because of the increased risk of hepatotoxicity and encephalopathy. Here the authors ...describe a 2.5-year-old girl with a history of developmental delay, failure to thrive, and a seizure disorder whose seizures worsened after the introduction of valproate sodium. This led to a search for an underlying metabolic disorder, and after extensive investigations, a diagnosis of nonketotic hyperglycinemia was made. In this report, the authors discuss the metabolic conditions that can be worsened by valproate sodium. Valproate sodium interferes with the glycine cleavage enzyme synthesis in the mitochondria, hence increasing glycine levels. The increased glycine levels are responsible for worsening of the underlying metabolic condition and increased seizure frequency.
In relativistic heavy-ion collisions, a global spin polarization, PH, of Λ and Λ¯¯ hyperons along the direction of the system angular momentum was discovered and measured across a broad range of ...collision energies and demonstrated a trend of increasing PH with decreasing $\sqrt{s{NN}}$. A splitting between Λ and Λ¯¯ polarization may be possible due to their different magnetic moments in a late-stage magnetic field sustained by the quark-gluon plasma which is formed in the collision. The results presented in this study find no significant splitting at the collision energies of $\sqrt{s{NN}}$ = 19.6 and 27 GeV in the BNL Relativistic Heavy Ion Collisions Beam Energy Scan Phase II using the STAR detector, with an upper limit of PΛ¯¯ – PΛ < 0.24 % and PΛ¯¯ – PΛ < 0.35 %, respectively, at a 95% confidence level. We derive an upper limit on the naive extraction of the late-stage magnetic field of B < 9.4 × 1012 T and B < 1.4 × 1013 T at $\sqrt{s{NN}}$ = 19.6 and 27 GeV, respectively, although more thorough derivations are needed. Differential measurements of PH were performed with respect to collision centrality, transverse momentum, and rapidity. With our current acceptance of |y| < 1 and uncertainties, we observe no dependence on transverse momentum and rapidity in this analysis. These results challenge multiple existing model calculations following a variety of different assumptions which have each predicted a strong dependence on rapidity in this collision-energy range.
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