Local shockwave-application prevents flap necrosis

Objective: Local shockwave-application (SW) has shown to improve healing of various tissues and decrease necrosis of flaps. Though, there is no data about the optimal time-point of SW-application with regard to induction of ischemia (i.e. flap elevation) and subsequent effect on flap survival. Therefore we compared 2 shock-wave protocols in a model of persistent ischemia and investigated underlying mechanisms. Methods: 18 C57BL/6-mice equipped with a skinfold chamber containing a musculocutaneous flap were assigned to 3 experimental groups: 1. One session of 500 SWimpulses at 0·15 mJ/mm2 applied 24 hrs before (preconditioning) or 2. Applied 30 min after flap elevation (treatment). 3. Untreated flaps (control). Tissue necrosis,microhemodynamics, inflammation, apoptosis and angiogenesis were assessed by intravital epi-fluorescence microscopy over 10 days. Results: SW significantly reduced flap necrosis independent from the application time-point (preconditioning: 29 ± 7%; treatment: 25 ± 7% vs. control: 47 ± 2%; d10, p<0·05). This was associated with an early increase of functional capillary density (preconditioning: 236 ± 39 cm/cm2; treatment: 211 ± 33 cm/cm2 vs. control: 141 ± 7 cm/cm2; day1, p<0·05). Arteriolar diameter, red blood cell velocity and blood flow were comparable between the 3 experimental groups. SW-application significantly decreased the ischemiainduced inflammatory response (apoptotic cell death and leukocyte-endothelial interaction: (p<0·05)). Sprouts indicating angiogenesis were observed from day 7 only after SW-application. Conclusions: SW protects ischemically challenged musculocutaneous tissue. Interestingly, postoperative SW-application is as efficient as preoperative SWapplication. The protective effect induced by mechanical stress might be based on an early recruitment of ''sleeping capillaries'' maintaining nutritive perfusion and an anti-inflammatory effect within the ischemically jeopardized tissue. SWapplication provides a non-invasive alternative to local thermic and systemic pre-treatment of endangered tissues.

A comparison of space weather analysis techniques used to predict the arrival of the Earth-directed CME and its shockwave launched on 8 April 2010

The Earth-directed coronal mass ejection (CME) of 8 April 2010 provided an opportunity for space weather predictions from both established and developmental techniques to be made from near–real time data received from the SOHO and STEREO spacecraft; the STEREO spacecraft provide a unique view of Earth-directed events from outside the Sun-Earth line. Although the near–real time data transmitted by the STEREO Space Weather Beacon are significantly poorer in quality than the subsequently downlinked science data, the use of these data has the advantage that near–real time analysis is possible, allowing actual forecasts to be made. The fact that such forecasts cannot be biased by any prior knowledge of the actual arrival time at Earth provides an opportunity for an unbiased comparison between several established and developmental forecasting techniques. We conclude that for forecasts based on the STEREO coronagraph data, it is important to take account of the subsequent acceleration/deceleration of each CME through interaction with the solar wind, while predictions based on measurements of CMEs made by the STEREO Heliospheric Imagers would benefit from higher temporal and spatial resolution. Space weather forecasting tools must work with near–real time data; such data, when provided by science missions, is usually highly compressed and/or reduced in temporal/spatial resolution and may also have significant gaps in coverage, making such forecasts more challenging.

Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis

A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.

Does Stepwise Voltage Ramping Protect the Kidney from Injury During Extracorporeal Shockwave Lithotripsy? Results of a Prospective Randomized Trial

BACKGROUND Renal damage is more frequent with new-generation lithotripters. However, animal studies suggest that voltage ramping minimizes the risk of complications following extracorporeal shock wave lithotripsy (SWL). In the clinical setting, the optimal voltage strategy remains unclear. OBJECTIVE To evaluate whether stepwise voltage ramping can protect the kidney from damage during SWL. DESIGN, SETTING, AND PARTICIPANTS A total of 418 patients with solitary or multiple unilateral kidney stones were randomized to receive SWL using a Modulith SLX-F2 lithotripter with either stepwise voltage ramping (n=213) or a fixed maximal voltage (n=205). INTERVENTION SWL. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was sonographic evidence of renal hematomas. Secondary outcomes included levels of urinary markers of renal damage, stone disintegration, stone-free rate, and rates of secondary interventions within 3 mo of SWL. Descriptive statistics were used to compare clinical outcomes between the two groups. A logistic regression model was generated to assess predictors of hematomas. RESULTS AND LIMITATIONS Significantly fewer hematomas occurred in the ramping group(12/213, 5.6%) than in the fixed group (27/205, 13%; p=0.008). There was some evidence that the fixed group had higher urinary β2-microglobulin levels after SWL compared to the ramping group (p=0.06). Urinary microalbumin levels, stone disintegration, stone-free rate, and rates of secondary interventions did not significantly differ between the groups. The logistic regression model showed a significantly higher risk of renal hematomas in older patients (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05; p=0.04). Stepwise voltage ramping was associated with a lower risk of hematomas (OR 0.39, 95% CI 0.19-0.80; p=0.01). The study was limited by the use of ultrasound to detect hematomas. CONCLUSIONS In this prospective randomized study, stepwise voltage ramping during SWL was associated with a lower risk of renal damage compared to a fixed maximal voltage without compromising treatment effectiveness. PATIENT SUMMARY Lithotripsy is a noninvasive technique for urinary stone disintegration using ultrasonic energy. In this study, two voltage strategies are compared. The results show that a progressive increase in voltage during lithotripsy decreases the risk of renal hematomas while maintaining excellent outcomes. TRIAL REGISTRATION ISRCTN95762080.

Virtuaalitilan suunnitteluja toteutus nuorisotyön tueksi

Tämän diplomityön tarkoituksena on suunnitella ja toteuttaa nuorisotyön tarpeisiin soveltuva virtuaalitila, jossanuoret voivat keskustella ongelmistaan oikean nuorisotyöntekijän kanssa. Ensin tutkitaan olemassa olevien virtuaalimaailmojen nykyistä tilaa, sekä luodaan katsaus virtuaalisuuteen ja mallintamiseen liittyviin perustekniikoihin. Olemassa olevien virtuaalimaailmojen ja niiden ominaisuuksien pohjalta suunnitellaan uusi, täysin nuorten auttamiseen tarkoitettu virtuaalitila. Tämän työn tarkoituksena ei ole tutkia nuorten auttamisen sosiaalista problematiikkaa, vaan tekniikoita, joilla auttaminen tehdään mahdolliseksi. Työn käytännöllisenä osuutena toteutettiin suunniteltu monen käyttäjän virtuaalitila, jossa käyttäjät voivat kommunikoida keskenään, keskustella nuorisotyöntekijän kanssa tai pelata ajanvietteeksi tarkoitettua junapeliä. Virtuaalitilan toteutuksessa käytettiin hyödyksi kolmiulotteista mallinnusta, Lingo-skriptikieltä, sekä Macromedian tarjoamaa monen käyttäjän palvelinta. Kaikki toteutetut osat koottiin yhdeksi sovellukseksi, joka julkaistiin Shockwave-elokuvana www-sivustolla.

Tratamento conservador de trauma renal grave após litotripsia extracorpórea por ondas de choque

Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

Dynamics of laser produced silver plasma under film deposition conditions studied using optical emission spectroscopy

Laser produced plasma from silver is generated using a Q-switched Nd:YAG laser. Optical emission spectroscopy is used to carry out time of flight (TOF) analysis of atomic particles. An anomalous double peak profile in the TOF distribution is observed at low pressure. A collection of slower species emerge at reduced pressure below 4 X lO-3 mbar and this species has a greater velocity spread. At high pressure the plasma expansion follows the shockwave model with cylindrical symmetry whereas at reduced pressure it shows unsteady adiabatic expansion (UAE). During UAE the species show a parabolic increases in the expansion time with radial distance whereas during shock wave expansion the exponent is less than one. The angular distribution of the ablated species in the plume is obtained from the measurement of optical density of thin films deposited on to glass substrates kept perpendicular to the plume. There is a sharp variation in the film thickness away from the film centre due to asymmetries in the plume.

Entering Data into SPSS

Video of how to set up and SPSS document and enter data

Getting Excel Data into SPSS

Video of how to get data in an Excel spreadsheet into SPSS. It starts with how to ensure the data is set and formatted correctly.

Entering Data into Excel

Video on how to enter data into Excel. This includes setting up column headings, changing sheet names, using lists for categorical items, using validation on columns of data, plus how to check validation is operating correctly.

Checking for invalid data in Excel

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How to enroll on Anatomy e-booklet site.

Step by step guide.

¿Qué factores inciden en la hospitalización de pacientes con cálculos ureterales menores a 10 mm en Fundación Santa Fe?

Debido a que el 12% de la población tendrá un cálculo en uréter hacia la mitad de su vida y a que las tasas de recurrencia en los que ya lo presentan son del 50% es necesario estudiar esta patología para aproximarse a un manejo adecuado en el servicio de urgencias. La literatura identifica un conjunto de factores que pueden contribuir a un cambio en el manejo médico. Objetivo: El objetivo de este estudio fue determinar los factores demográficos y clínicos asociados a manejo hospitalario en los pacientes con diagnóstico de cálculo ureteral menor de 10 mm. Métodos: Se diseñó un estudio de casos y controles no emparejados. Un caso fue definido como un paciente de 18 o más años con diagnóstico de urolitiasis con cálculo menor a 10 mm realizado por urotac que consultó (por primera vez para ese episodio) al servicio de urgencias de la Fundación Santa Fe de Bogotá entre el 1 de marzo de 2007 y 30 de abril de 2012. Se indagaron factores como edad, sexo, tamaño y localización del cálculo, respuesta a los analgésicos, evidencia de obstrucción e infección urinaria, además de otros antecedentes medicamentosos y clínicos. Se utilizó regresión logística no condicional bivariada y multivariada para evaluar la asociación entre tipo de manejo (hospitalario o ambulatorio) y las variables recolectadas, calculando odds ratio (OR) e intervalos de confianza al 95% (IC95%). Resultados: El riesgo de hospitalización se incrementó con: 1. La localización del cálculo en tercio superior o medio (OR=1.49; IC95%: 0.751-2.966) al comparar con el inferior, 2. El aumento del tamaño del cálculo (OR=1.49; IC95%: 0.751-2.966, por cada milímetro de incremento), y 3: Por la evidencia de obstrucción o infección urinaria y elevación de azoados. Por el contrario, hubo menos riesgo de hospitalización en aquellos pacientes con una respuesta analgésica apropiada en urgencias.

EBP process

EBP process