978 resultados para Manipulation techniques
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Principles: Surgeon's experience is crucial for proper application of sentinel node biopsy (SNB) in patients with breast cancer. A 20-30 cases learning curve of sentinel node (SN) and axillary lymph node dissection (ALND) was widely practiced. In order to speed up this learning curve, surgeons may be trained intraoperative by an experienced surgeon. The purpose of this report is to evaluate the results of this procedure. Methods: Patients with one primary invasive breast cancer (cT1-T2[<3 cm]cN0) underwent SNB based on lymphoscintigraphy using technetium Tc 99m colloid, intraoperative gamma probe detection, with or without blue dye mapping. This was followed by completion ALND when SN was positive or not found. SNB was performed by one experienced surgeon (teacher) or by 10 junior surgeons trained by the experienced surgeon (trainees). Four groups were defined: (i) SNB with immediate ALND for the teacher's learning curve, (ii) SNB by the teacher, (iii) SNB by the trainees under the teacher's supervision, and (iv) SNB by the trainees alone. Results: Between May 1999 and December 2007, a total of 808 évaluable patients underwent SNB. The SN identification rate was 98% in the teacher's group, and 99% in the trainees' group (p = 0.196). SN were positive in respectively 28% and 29% of patients (p = 0.196). The distribution of isolated tumor cells, micrometastases and metastases was not statistically different between the teacher's and the trainees' groups (p = 0.163). Conclusion: These comparable results confirm the success with which the SNB was taught. This strategy avoided the 20-30 SNB followed by immediate ALND early required per surgeon.
Resumo:
This report describes the results of the research project investigating the use of advanced field data acquisition technologies for lowa transponation agencies. The objectives of the research project were to (1) research and evaluate current data acquisition technologies for field data collection, manipulation, and reporting; (2) identify the current field data collection approach and the interest level in applying current technologies within Iowa transportation agencies; and (3) summarize findings, prioritize technology needs, and provide recommendations regarding suitable applications for future development. A steering committee consisting oretate, city, and county transportation officials provided guidance during this project. Technologies considered in this study included (1) data storage (bar coding, radio frequency identification, touch buttons, magnetic stripes, and video logging); (2) data recognition (voice recognition and optical character recognition); (3) field referencing systems (global positioning systems [GPS] and geographic information systems [GIs]); (4) data transmission (radio frequency data communications and electronic data interchange); and (5) portable computers (pen-based computers). The literature review revealed that many of these technologies could have useful applications in the transponation industry. A survey was developed to explain current data collection methods and identify the interest in using advanced field data collection technologies. Surveys were sent out to county and city engineers and state representatives responsible for certain programs (e.g., maintenance management and construction management). Results showed that almost all field data are collected using manual approaches and are hand-carried to the office where they are either entered into a computer or manually stored. A lack of standardization was apparent for the type of software applications used by each agency--even the types of forms used to manually collect data differed by agency. Furthermore, interest in using advanced field data collection technologies depended upon the technology, program (e.g.. pavement or sign management), and agency type (e.g., state, city, or county). The state and larger cities and counties seemed to be interested in using several of the technologies, whereas smaller agencies appeared to have very little interest in using advanced techniques to capture data. A more thorough analysis of the survey results is provided in the report. Recommendations are made to enhance the use of advanced field data acquisition technologies in Iowa transportation agencies: (1) Appoint a statewide task group to coordinate the effort to automate field data collection and reporting within the Iowa transportation agencies. Subgroups representing the cities, counties, and state should be formed with oversight provided by the statewide task group. (2) Educate employees so that they become familiar with the various field data acquisition technologies.
Resumo:
Free-living energy expenditure (EE) was assessed in 37 young pregnant Gambian women at the 12th (n = 11, 53.5 +/- 1.7 kg), 24th (n = 14, 54.7 +/- 2.1 kg), and 36th (n = 12, 65.0 +/- 2.6 kg) wk of pregnancy and was compared with nonpregnant nonlactating (NPNL) control women (n = 12, 50.3 +/- 1.6 kg). The following two methods were used to assess EE: 1) the heart rate (HR) method using individual regression lines (HR vs EE) established at different activity levels in a respiration chamber and 2) the doubly labeled water (2H2(18)O) method in a subgroup of 25 pregnant and 7 control women. With the HR method the EE during the agricultural rainy season was found to be 2,408 +/- 87, 2,293 +/- 122, and 2,782 +/- 130 kcal/day at 12, 24, and 36 wk of gestation and were not significantly different from the control group (2,502 +/- 133 kcal/day). These findings were confirmed by the 2H2(18)O measurements, which failed to show any effect of pregnancy on EE. Expressed per unit body weight, the free-living EE was found to be lower (P less than 0.01 with 2H2(18)O method) at 36 wk of gestation than in the NPNL group. It is concluded that, in these Gambian women, energy-sparing mechanisms that contribute to meet the additional energy stress of gestation are operating during pregnancy (e.g., diminished spontaneous physical activity).
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Variable queen mating frequencies provide a unique opportunity to study the resolution of worker-queen conflict over sex ratio in social Hymenoptera, because the conflict is maximal in colonies headed by a singly mated queen and is weak or nonexistent in colonies headed by a multiply mated queen. In the wood ant Formica exsecta, workers in colonies with a singly mated queen, but not those in colonies with a multiply mated queen, altered the sex ratio of queen-laid eggs by eliminating males to preferentially raise queens. By this conditional response to queen mating frequency, workers enhance their inclusive fitness.
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Weathering steel is commonly used as a cost-effective alternative for bridge superstructures, as the costs and environmental impacts associated with the maintenance/replacement of paint coatings are theoretically eliminated. The performance of weathering steel depends on the proper formation of a surface patina, which consists of a dense layer of corrosion product used to protect the steel from further atmospheric corrosion. The development of the weathering steel patina may be hindered by environmental factors such as humid environments, wetting/drying cycles, sheltering, exposure to de-icing chlorides, and design details that permit water to pond on steel surfaces. Weathering steel bridges constructed over or adjacent to other roadways could be subjected to sufficient salt spray that would impede the development of an adequate patina. Addressing areas of corrosion on a weathering steel bridge superstructure where a protective patina has not formed is often costly and negates the anticipated cost savings for this type of steel superstructure. Early detection of weathering steel corrosion is important to extending the service life of the bridge structure; however, written inspection procedures are not available for inspectors to evaluate the performance or quality of the patina. This project focused on the evaluation of weathering steel bridge structures, including possible methods to assess the quality of the weathering steel patina and to properly maintain the quality of the patina. The objectives of this project are summarized as follows: Identify weathering steel bridge structures that would be most vulnerable to chloride contamination, based on location, exposure, environment, and other factors. Identify locations on an individual weathering steel bridge structure that would be most susceptible to chloride contamination, such as below joints, splash/spray zones, and areas of ponding water or debris. Identify possible testing methods and/or inspection techniques for inspectors to evaluate the quality of the weathering steel patina at locations discussed above. Identify possible methods to measure and evaluate the level of chloride contamination at the locations discussed above. Evaluate the effectiveness of water washing on removing chlorides from the weathering steel patina. Develop a general prioritization for the washing of bridge structures based on the structure’s location, environment, inspection observations, patina evaluation findings, and chloride test results.
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The use of laparoscopic surgery has increased rapidly. However, a technically feasible procedure is not automatically recommendable. Thus, if cholecystectomy and fundoplication are currently fully validated techniques, this does not hold true for gastroplasty and kidney harvesting for transplantation: these operations are feasible indeed but their efficacy remains to be proved. Laparoscopic oncology has been shown to be feasible too, but its efficacy has not been documented yet.
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Selostus: Kolme viljojen mekaanista rikkakasvintorjuntamentelmää
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Intraarterial procedures such as chemoembolization and radioembolization aim for the palliative treatment of advanced hepatocellular carcinoma (stage BCLC B and C with tumoral portal thrombosis). The combination of hepatic intraarterial chemotherapy and systemic chemotherapy can increase the probability of curing colorectal cancer with hepatic metastases not immediately accessible to surgical treatment or percutaneous ablation.