Melphalan dosing regimens for management of recurrent melanoma by isolated limb perfusion: Application of a physiological pharmacokinetic model based on melphalan distribution in the isolated perfused rat hindlimb

The optimal dosing schedule for melphalan therapy of recurrent malignant melanoma in isolated limb perfusions has been examined using a physiological pharmacokinetic model with data from isolated rat hindlimb perfusions (IRHP), The study included a comparison of melphalan distribution in IRHP under hyperthermia and normothermia conditions. Rat hindlimbs were perfused with Krebs-Henseleit buffer containing 4.7% bovine serum albumin at 37 or 41.5 degrees C at a flow rate of 4 ml/min. Concentrations of melphalan in perfusate and tissues were determined by high performance liquid chromatography with fluorescence detection, The concentration of melphalan in perfusate and tissues was linearly related to the input concentration. The rate and amount of melphalan uptake into the different tissues was higher at 41.5 degrees C than at 37 degrees C. A physiological pharmacokinetic model was validated from the tissue and perfusate time course of melphalan after melphalan perfusion. Application of the model involved the amount of melphalan exposure in the muscle, skin and fat in a recirculation system was related to the method of melphalan administration: single bolus > divided bolus > infusion, The peak concentration of melphalan in the perfusate was also related to the method of administration in the same order, Infusing the total dose of melphalan over 20 min during a 60 min perfusion optimized the exposure of tissues to melphalan whilst minimizing the peak perfusate concentration of melphalan. It is suggested that this method of melphalan administration may be preferable to other methods in terms of optimizing the efficacy of melphalan whilst minimizing the limb toxicity associated with its use in isolated limb perfusion.

Management of Uncommon Hernias in Cirrhotic Patients

Background. Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high. Objective. We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures. Method. Review of hospital charts of selected rare cases of herniae in cirrhotic patients. Conclusion. Elective surgical approaches can treat even uncommon hernias in cirrhotic patients with good results.

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient`s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options.

The effect of resource aggregation at different scales: Optimal foraging behavior of Cotesia rubecula

Resources can be aggregated both within and between patches. In this article, we examine how aggregation at these different scales influences the behavior and performance of foragers. We developed an optimal foraging model of the foraging behavior of the parasitoid wasp Cotesia rubecula parasitizing the larvae of the cabbage butterfly Pieris rapae. The optimal behavior was found using stochastic dynamic programming. The most interesting and novel result is that the effect of resource aggregation within and between patches depends on the degree of aggregation both within and between patches as well as on the local host density in the occupied patch, but lifetime reproductive success depends only on aggregation within patches. Our findings have profound implications for the way in which we measure heterogeneity at different scales and model the response of organisms to spatial heterogeneity.

Optimal patch-leaving behaviour: a case study using the parasitoid Cotesia rubecular

1. Parasitoids are predicted to spend longer in patches with more hosts, but previous work on Cotesia rubecula (Marshall) has not upheld this prediction, Tests of theoretical predictions may be affected by the definition of patch leaving behaviour, which is often ambiguous. 2. In this study whole plants were considered as patches and assumed that wasps move within patches by means of walking or flying. Within-patch and between-patch flights were distinguished based on flight distance. The quality of this classification was tested statistically by examination of log-survivor curves of flight times. 3. Wasps remained longer in patches with higher host densities, which is consistent with predictions of the marginal value theorem (Charnov 1976). tinder the assumption that each flight indicates a patch departure, there is no relationship between host density and leaving tendency. 4. Oviposition influences the patch leaving behaviour of wasps in a count down fashion (Driessen et al. 1995), as predicted by an optimal foraging model (Tenhumberg, Keller & Possingham 2001). 5. Wasps spend significantly longer in the first patch encountered following release, resulting in an increased rate of superparasitism.

The management of rice grown on raised beds with continuous furrow irrigation

A field experiment compared two rice (Oryza sativa L.) cropping systems: paddy or raised beds with continuous furrow irrigation; and trialled four cultivars: Starbonnet, Lemont, Amaroo and Ceysvoni, and one test line YRL39; that may vary in adaptation to growth on raised beds. The grain yield of rice ranged from 740 to 1250 g/m(2) and was slightly greater in paddy than on raised beds. Although there were early growth responses to fertilizer nitrogen on raised beds, the crop nitrogen content at maturity mostly exceeded 20 g/m(2) in both systems, so nitrogen was unlikely to have limited yield. Ceysvoni yielded best in both systems, a result of good post-anthesis growth and larger grain size, although its whole-grain mill-out percentage was poor relative to the other cultivars. Starbonnet and Lemont yielded poorly on raised beds, associated with too few tillers and too much leaf area. When grown on raised beds all cultivars experienced a delay in anthesis resulting in more tillers, leaf area and dry weight at anthesis, and probably a greater yield potential. The growth of rice after anthesis, however, was similar on raised beds and in paddy, so reductions in harvest index and grain size on raised beds were recorded. The data indicated that water supply was not a major limitation to rice growth on raised beds, but slower crop development was an issue that would affect the use of raised beds in a cropping system, especially in rice-growing areas where temperatures are too cool for optimal crop development. (C) 2001 Elsevier Science B.V. All rights reserved.

Accuracy of frozen section for the operative management of endometrial cancer

Objective To assess the accuracy of intra-operative frozen section reports at identifying the features of high risk uterine disease compared with final histopathology. Design Retrospective study. Methods The records, of 460 patients with uterine cancer registered with the Queensland Centre for Gynaecological Cancer between January 1, 1996 and December 31, 1998 were reviewed. Intra-operative frozen section was undertaken in 260 patients with endometrial adenocarcinoma. Frozen section pathology was compared with the final histopathology reports. Inter-observer reliability was assessed using percentage agreement and kappa statistics. Clinical notes were also reviewed to determine if errors resulted in sub-optimal patient care. Results Respectively, tumour grade and depth of myometrial invasion were accurately reported in 88.6% of cases (expected 61.5%, Kappa 0.70) and 94.7% (expected 53.8%, Kappa 0.89). Errors were predominantly attributable to difficulties with respect to the interpretation of tumour grade. The error resulted in the patient receiving sub-optimal surgical management in only I I cases (5.3%) Conclusion Frozen section is accurate at identifying the features of high risk uterine disease in the setting of endometrial cancer and can play an important role in directing primary operative management.

Warranty and optimal reliability improvement through product development

For products sold with warranty, the warranty servicing cost can be reduced by improving product reliability through a development process. However, this increases the unit manufacturing cost. Optimal development must achieve a trade-off between these two costs. The outcome of the development process is uncertain and needs to be taken into account in the determination of the optimal development effort. The paper develops a model where this uncertainty is taken into account. (C) 2003 Elsevier Ltd. All rights reserved.

A congestion management and transmission price simulator for competitive electricity markets

In a liberalized electricity market, the Transmission System Operator (TSO) plays a crucial role in power system operation. Among many other tasks, TSO detects congestion situations and allocates the payments of electricity transmission. This paper presents a software tool for congestion management and transmission price determination in electricity markets. The congestion management is based on a reformulated Optimal Power Flow (OPF), whose main goal is to obtain a feasible solution for the re-dispatch minimizing the changes in the dispatch proposed by the market operator. The transmission price computation considers the physical impact caused by the market agents in the transmission network. The final tariff includes existing system costs and also costs due to the initial congestion situation and losses costs. The paper includes a case study for the IEEE 30 bus power system.

Energy resource scheduling considering reactive power management

The reactive power management is an important task in future power systems. The control of reactive power allows the increase of distributed energy resources penetration as well as the optimal operation of distribution networks. Currently, the control of reactive power is only controlled in large power units and in high and very high voltage substations. In this paper a reactive power control in smart grids paradigm is proposed, considering the management of distributed energy resources and of the distribution network by an aggregator namely Virtual Power Player (VPP).

Intelligent management of end consumers loads including electric vehicles through a SCADA system

The large penetration of intermittent resources, such as solar and wind generation, involves the use of storage systems in order to improve power system operation. Electric Vehicles (EVs) with gridable capability (V2G) can operate as a means for storing energy. This paper proposes an algorithm to be included in a SCADA (Supervisory Control and Data Acquisition) system, which performs an intelligent management of three types of consumers: domestic, commercial and industrial, that includes the joint management of loads and the charge/discharge of EVs batteries. The proposed methodology has been implemented in a SCADA system developed by the authors of this paper – the SCADA House Intelligent Management (SHIM). Any event in the system, such as a Demand Response (DR) event, triggers the use of an optimization algorithm that performs the optimal energy resources scheduling (including loads and EVs), taking into account the priorities of each load defined by the installation users. A case study considering a specific consumer with several loads and EVs is presented in this paper.

Optimal location of gas supply units in natural gas system network

Natural gas industry has been confronted with big challenges: great growth in demand, investments on new GSUs – gas supply units, and efficient technical system management. The right number of GSUs, their best location on networks and the optimal allocation to loads is a decision problem that can be formulated as a combinatorial programming problem, with the objective of minimizing system expenses. Our emphasis is on the formulation, interpretation and development of a solution algorithm that will analyze the trade-off between infrastructure investment expenditure and operating system costs. The location model was applied to a 12 node natural gas network, and its effectiveness was tested in five different operating scenarios.

A short-term risk management tool applied to OMEL electricity market using particle swarm optimization

Short-term risk management is highly dependent on long-term contractual decisions previously established; risk aversion factor of the agent and short-term price forecast accuracy. Trying to give answers to that problem, this paper provides a different approach for short-term risk management on electricity markets. Based on long-term contractual decisions and making use of a price range forecast method developed by the authors, the short-term risk management tool presented here has as main concern to find the optimal spot market strategies that a producer should have for a specific day in function of his risk aversion factor, with the objective to maximize the profits and simultaneously to practice the hedge against price market volatility. Due to the complexity of the optimization problem, the authors make use of Particle Swarm Optimization (PSO) to find the optimal solution. Results from realistic data, namely from OMEL electricity market, are presented and discussed in detail.

An optimal scheduling problem in distribution networks considering V2G

This paper addresses the problem of energy resource scheduling. An aggregator will manage all distributed resources connected to its distribution network, including distributed generation based on renewable energy resources, demand response, storage systems, and electrical gridable vehicles. The use of gridable vehicles will have a significant impact on power systems management, especially in distribution networks. Therefore, the inclusion of vehicles in the optimal scheduling problem will be very important in future network management. The proposed particle swarm optimization approach is compared with a reference methodology based on mixed integer non-linear programming, implemented in GAMS, to evaluate the effectiveness of the proposed methodology. The paper includes a case study that consider a 32 bus distribution network with 66 distributed generators, 32 loads and 50 electric vehicles.

Transmission costs allocation based on optimal re-dispatch

Congestion management of transmission power systems has achieve high relevance in competitive environments, which require an adequate approach both in technical and economic terms. This paper proposes a new methodology for congestion management and transmission tariff determination in deregulated electricity markets. The congestion management methodology is based on a reformulated optimal power flow, whose main goal is to obtain a feasible solution for the re-dispatch minimizing the changes in the transactions resulting from market operation. The proposed transmission tariffs consider the physical impact caused by each market agents in the transmission network. The final tariff considers existing system costs and also costs due to the initial congestion situation and losses. This paper includes a case study for the 118 bus IEEE test case.