Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume

Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.

Pain determinants of pain in autosomal dominant polycystic kidney disease

Pain is the most common symptom reported by ADPKD patients, afflicting approximately 60% of cases and may result from renal hemorrhage, calculi, urinary tract infections, cyst rupture, or due to stretching of the capsule or traction of the renal pedicle. We have recently investigated pain patterns in AD-PKD patients using a translated version of a pain questionnaire specific for AD-PKD population. The questionnaire revealed that 67% patients with ADPKD exhibited some type of pain. The findings of that study emphasized that pain appeared early in the course of ADPKD, when patients still exhibited preserved renal function. In the present study, a multivariate logistic regression analysis disclosed that renal volume (9-fold increased risk) and nephrolithiasis (4-fold increased risk) were the most important determinant factors for pain in ADPKD patients with preserved renal function, after adjustments for the presence of hypertension and duration of the disease.

Algorithmes heuristiques et exacts pour le problème de l’ensemble dominant connexe minimum.

Dans ce mémoire, nous abordons le problème de l’ensemble dominant connexe de cardinalité minimale. Nous nous penchons, en particulier, sur le développement de méthodes pour sa résolution basées sur la programmation par contraintes et la programmation en nombres entiers. Nous présentons, en l’occurrence, une heuristique et quelques méthodes exactes pouvant être utilisées comme heuristiques si on limite leur temps d’exécution. Nous décrivons notamment un algorithme basé sur l’approche de décomposition de Benders, un autre combinant cette dernière avec une stratégie d’investigation itérative, une variante de celle-ci utilisant la programmation par contraintes, et enfin une méthode utilisant uniquement la programmation par contraintes. Des résultats expérimentaux montrent que ces méthodes sont efficaces puisqu’elles améliorent les méthodes connues dans la littérature. En particulier, la méthode de décomposition de Benders avec une stratégie d’investigation itérative fournit les résultats les plus performants.

Dominant partial least square factors of consumer purchase behaviour of passenger cars

Globalization and liberalization, with the entry of many prominent foreign manufacturers, changed the automobile scenario in India, since early 1990’s. World Leaders in automobile manufacturing such as Ford, General Motors, Honda, Toyota, Suzuki, Hyundai, Renault, Mitsubishi, Benz, BMW, Volkswagen and Nissan set up their manufacturing units in India in joint venture with their Indian counterpart companies, by making use of the Foreign Direct Investment policy of the Government of India, These manufacturers started capturing the hearts of Indian car customers with their choice of technological and innovative product features, with quality and reliability. With the multiplicity of choices available to the Indian passenger car buyers, it drastically changed the way the car purchase scenario in India and particularly in the State of Kerala. This transformed the automobile scene from a sellers’ market to buyers’ market. Car customers started developing their own personal preferences and purchasing patterns, which were hitherto unknown in the Indian automobile segment. The main purpose of this paper is to develop a model with major variables, which influence the consumer purchase behaviour of passenger car owners in the State of Kerala. Though there are innumerable studies conducted in other countries, there are very few thesis and research work conducted to study the consumer behaviour of the passenger car industry in India and specifically in the State of Kerala. The results of the research contribute to the practical knowledge base of the automobile industry, specifically to the passenger car segment. It has also a great contributory value addition to the manufacturers and dealers for customizing their marketing plans in the State

Dominant Mean Percentage Score Factors Of The Consumer Purchase Behaviour Of Passenger Cars

Globalization and liberalization, with the entry of many prominent foreign manufacturers, changed the automobile scenario in India, since early 1990’s. World Leaders in automobile manufacturing such as Ford, General Motors, Honda, Toyota, Suzuki, Hyundai, Renault, Mitsubishi, Benz, BMW, Volkswagen and Nissan set up their manufacturing units in India in joint venture with their Indian counterpart companies, by making use of the Foreign Direct Investment policy of the Government of India, These manufacturers started capturing the hearts of Indian car customers with their choice of technological and innovative product features, with quality and reliability. With the multiplicity of choices available to the Indian passenger car buyers, it drastically changed the way the car purchase scenario in India and particularly in the State of Kerala. This transformed the automobile scene from a sellers’ market to buyers’ market. Car customers started developing their own personal preferences and purchasing patterns, which were hitherto unknown in the Indian automobile segment. The main purpose of this paper is to come up with the identification of possible parameters and a framework development, that influence the consumer purchase behaviour patterns of passenger car owners in the State of Kerala, so that further research could be done, based on the framework and the identified parameters.

Nonlinear Analysis of Shear Dominant Prestressed Concrete Beams using ANSYS

This study reports the details of the finite element analysis of eleven shear critical partially prestressed concrete T-beams having steel fibers over partial or full depth. Prestressed T-beams having a shear span to depth ratio of 2.65 and 1.59 that failed in shear have been analyzed using the ‘ANSYS’ program. The ‘ANSYS’ model accounts for the nonlinearity, such as, bond-slip of longitudinal reinforcement, postcracking tensile stiffness of the concrete, stress transfer across the cracked blocks of the concrete and load sustenance through the bridging action of steel fibers at crack interface. The concrete is modeled using ‘SOLID65’- eight-node brick element, which is capable of simulating the cracking and crushing behavior of brittle materials. The reinforcement such as deformed bars, prestressing wires and steel fibers have been modeled discretely using ‘LINK8’ – 3D spar element. The slip between the reinforcement (rebars, fibers) and the concrete has been modeled using a ‘COMBIN39’- nonlinear spring element connecting the nodes of the ‘LINK8’ element representing the reinforcement and nodes of the ‘SOLID65’ elements representing the concrete. The ‘ANSYS’ model correctly predicted the diagonal tension failure and shear compression failure of prestressed concrete beams observed in the experiment. The capability of the model to capture the critical crack regions, loads and deflections for various types of shear failures in prestressed concrete beam has been illustrated.

Hisendats, de classe dominant classe dirigent

Estudi dels hisendats a les comarques gironins durant el s. XIX. Es tractava de famílies que durant centúries havien anat acumulant propietats agrícoles, i així es van consolidar com una minoria de grans propietaris rurals que podien viure de les seves rendes

Business Strategy and Dominant Economic Theories under Critics

En este ensayo el autor analiza, o más exactamente critica, la esencia del pensamiento “estratégico” y los modelos de gobierno corporativo de tipo anglosajón, y el pensamiento neoliberal dominante que predomina en la escena académica y gerencial, dibujando simultáneamente los escritos que sobre este tema han predominado desde el punto de vista histórico, epistemológico y metodológico. El autor se refiere específicamente al “Porterismo”, presentando una profunda critica, tanto a las teorías de gerencia “estratégica” como a los autores más notables en este campo, principalmente, Michael Porter.

Autosomal dominant polycystic kidney disease in hemodialysis patients in southern Brazil

Introduction: Autosomal dominant polycystic kidney disease is the most common hereditary renal disease in humans. Objective: To examine the prevalence, clinical and laboratory characteristics of patients with polycystic kidneys and relate disease manifestations by gender. Methods: This was an observational and retrospective study. All the medical records of patients with polycystic kidneys who initiated hemodialysis between 1995 and 2012, in four centers that treat patients of the coverage area of the 15th regional health Paraná (Brazil), were analyzed. Results: The study included 48 patients with polycystic kidneys, the primary cause of stage 5 CKD. Disease prevalence was one in 10,912 people. The average age of dialysis initiation was 50.7 years and the follow-up time on dialysis until transplantation (36.5 months) was lower among men. Hypertension was the most frequent diagnosis in 73% of patients, predominantly in women (51.4%). The liver cyst was the most frequent extrarenal manifestations in men (60.0%). The death occurred in 10.4% of patients using hemodialysis, and 60% of men. The class of antihypertensive drug used was that acts on the renin-angiotensin system with higher frequency of use among women (53.3%). The post-dialysis urea was significantly higher in men. Conclusion: The prevalence of the disease is low among hemodialysis patients in southern Brazil. The differences observed between genders, with the exception of the post-dialysis urea, were not significant. The findings are different from those reported in North America and Europe.

Representing El Niño in coupled ocean–atmosphere GCMs: the dominant role of the atmospheric component

A systematic modular approach to investigate the respective roles of the ocean and atmosphere in setting El Niño characteristics in coupled general circulation models is presented. Several state-of-the-art coupled models sharing either the same atmosphere or the same ocean are compared. Major results include 1) the dominant role of the atmosphere model in setting El Niño characteristics (periodicity and base amplitude) and errors (regularity) and 2) the considerable improvement of simulated El Niño power spectra—toward lower frequency—when the atmosphere resolution is significantly increased. Likely reasons for such behavior are briefly discussed. It is argued that this new modular strategy represents a generic approach to identifying the source of both coupled mechanisms and model error and will provide a methodology for guiding model improvement.