scholarly journals The Daily Resistive Index measurement useful tool in the estimation of the optimal time interval between two Shock Wave Lithotripsy sessions.

2015 ◽  
Vol 17 (2) ◽  
pp. 175
Author(s):  
Esin Yencilek ◽  
Aysegul Sarsılmaz ◽  
Ozgur Kilickesmez ◽  
Hakan Koyuncu ◽  
Bilal Eryildirim ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Resistive Index ◽  
Optimal Time ◽  
Time Interval ◽  
Index Measurement ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Aims: To monitor the impact of Shock Wave Lithotripsy (SWL) on the renal resisive index (RI) and to investigate the potential of the RI measurement for the estimation of the optimal duration between 2 SWL sessions. Material and methods: Thirty patients with single pelvis renalis stone were included. Participitants were grouped according to their age as group 1 (<40 years, mean age 36.2±3.9 years) and group 2 (≥40 years, mean age 55.4±6.5 years). RI measurement was performed in of all patients prior to SWL. After SWL, RI was monitored daily until RI returned to their pre-SWL values. Results: The mean stone size was 2 8.97±3.62 in group 1 and 10.08±4.67 mm in group 2 (p=0.077). Following SWL, the  RI value of both goups increased and the higher RI value was measured at the 24th hour as compared with their pre-SWL values (p<0.001). In day 2 RI of the groups declined, but the differences were still statistically different from their pre-SWL RI values (p<0.001). However, on the third day, RI of group 1 was close to their pre-SWL level (p=0.143). But, in group 2, RI value returned to their pre-SWL limits on day 4 (p=0.229). Conclusions: RI measurement gives important data regarding SWL related acute renal trauma and should be used as an US marker for recovery after SWL. 

scholarly journals Effect of Repeated Injection of Iodixanol on Renal Function in Healthy Wistar Rats Using Functional MRI

2018 ◽  
Vol 2018 ◽  
pp. 1-15
Author(s):  
Yongfang Wang ◽  
Ke Ren ◽  
Lizhi Xie ◽  
Wenge Sun ◽  
Yi Liu ◽  
...  
Keyword(s):  
Renal Damage ◽  
Time Window ◽  
Optimal Time ◽  
Control Group ◽  
Time Interval ◽  
Repeated Injection ◽  
Bold Imaging ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Purpose. To determine the optimal time interval of repeated intravenous injections of iodixanol in rat model and to identify the injury location and causes of renal damage in vivo. Materials and Methods. Rats were randomly divided into Control group, Group 1 with one iodixanol injection, and Group 2 with two iodixanol injections. Group 2 was subdivided into 3 cohorts according to the interval between the first and second iodixanol injections as 1, 3, and 5 days, respectively. Blood oxygen level-dependent (BOLD) imaging and diffusion weighted imaging (DWI) were performed at 1 hour, 1 day, 3 days, 5 days, and 10 days after the application of solutions. Results. Compared with Group 1 (7.2%), Group 2 produced a remarkable R2⁎ increment at the inner stripe of the renal outer medulla by 15.37% (P=0.012), 14.83% (P=0.046), and 13.53% (P>0.05), respectively, at 1 hour after repeated injection of iodixanol. The severity of BOLD MRI to detect renal hypoxia was consistent with the expression of HIF-1α and R2⁎ was well correlated with HIF-1α expression (r=0.704). The acute tubular injury was associated with urinary NGAL and increased significantly at 1 day. Conclusions. Repetitive injection of iodixanol within a short time window can induce acute kidney injury, the impact of which on renal damage in rats disappears gradually 3–5 days after the injections.

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

2021 ◽  
pp. 001857872110375
Author(s):  
Frank A. Fanizza ◽  
Jennifer Loucks ◽  
Angelica Berni ◽  
Meera Shah ◽  
Dennis Grauer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Medication Adherence ◽  
Hcv Treatment ◽  
Clinical Pharmacists ◽  
The Mean ◽  
Group 2 ◽  
Cure Rates ◽  
The Impact ◽  
Mean Time ◽  
Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

Intra-carotid arterial transfusion of circulatory-derived autologous endothelial progenitor cells in rodent after ischemic stroke — evaluating the impact of therapeutic time points on prognostic outcomes

2020 ◽  
Author(s):  
Kun-Chen Lin ◽  
Han-Tan Chai ◽  
Kuan-Hung Chen ◽  
Pei‐Hsun Sung ◽  
John Y. Chiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Optimal Time ◽  
Control Group ◽  
Endothelial Progenitor ◽  
Group 2 ◽  
The Impact ◽  
Carotid Arterial ◽  
Group 1

Abstract Background: This study tested the optimal time point for left intra-carotid arterial (LICA) administration of circulatory-derived autologous endothelial progenitor cells (EPCs) for improving the outcome in rat after acute ischemic stroke (IS). Methods and Results: Adult-male SD rats (n=70) were equally categorized into group 1 (sham-operated control), group 2 (IS), group 3 (IS+EPCs/1.2x106 cells/by LICA administration 3h after IS), group 4 (IS+EPCs/LICA administration post-day-3 IS), group 5 (IS+EPCs/LICA administration post-day-7 IS), group 6 (IS+EPCs/LICA administration post-day-14 IS) and group 7 (IS+EPCs/LICA administration post-day-28 IS). The brain-infarct volume (BIV) (at day 60/MRI) was lowest in group 1, highest in group 2 and significantly progressively increased from groups 3 to 7, whereas among the IS animals, the neurological function was significantly preserved in groups 3 to 6 than in groups 2 and 7 post-day-60 IS (all p<0.0001). By day 60, the endothelial cell markers at protein and cellular levels, and number of small vessels exhibited an opposite pattern of BIV among the groups (all p<0.0001). The protein and cellular levels of inflammation, and protein levels of oxidative stress, autophagy and apoptosis, were highest in group 2, lowest in group 1 and progressively increased from groups 3 to 7 (all p<0.0001). The angiogenesis biomarkers at protein and cellular levels were significantly progressively increased from groups 1 to 3, then significantly progressively decreased from groups 4 to 7 (all p<0.0001). Conclusion: Early EPC administration provided better benefits on improving functional/image/molecular-cellular outcomes after acute IS in rat.

scholarly journals Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

2021 ◽  
Author(s):  
Can Öztürk ◽  
Kim Sprenger ◽  
Noriaki Tabata ◽  
Atsushi Sugiura ◽  
Marcel Weber ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Independent Predictor ◽  
Time Varying ◽  
Severe Mitral Regurgitation ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

Value-based neurosurgery: the example of microvascular decompression surgery

2014 ◽  
Vol 120 (2) ◽  
pp. 462-472 ◽  
Author(s):  
Nancy McLaughlin ◽  
Farzad Buxey ◽  
Karen Chaw ◽  
Neil A. Martin
Keyword(s):  
Trigeminal Neuralgia ◽  
Outcome Measures ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Care ◽  
Decompression Surgery ◽  
The Mean ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

scholarly journals Usefulness of adjunctive alpha1-adrenergic antagonists, after single extracorporeal shock wave lithotripsy session, in ureteral stone expulsion.

2014 ◽  
Vol 8 (1-2) ◽  
pp. 8 ◽  
Author(s):  
Abdellatif Janane ◽  
Abdelaziz Hamdoun ◽  
Fouad Hajji ◽  
Youssef Dakkak ◽  
Mohamed Ghadouane ◽  
...  
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Extracorporeal Shock Wave ◽  
Standard Medical Therapy ◽  
Ureteral Colic ◽  
Adrenergic Antagonists ◽  
Group 2 ◽  
Group 1

Introduction: We evaluate the efficiency of alpha-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.Methods: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL.Results: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%).Conclusion: Adjunctive therapy with alpha1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of alpha-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.

scholarly journals Evaluation of Metachronous Breast and Endometrial Cancers: Preroutine and Postroutine Adjuvant Tamoxifen Use

2016 ◽  
Vol 26 (8) ◽  
pp. 1440-1447 ◽  
Author(s):  
Kassondra S. Grzankowski ◽  
J. Brian Szender ◽  
Chandra L. Spring-Robinson ◽  
Shashikant B. Lele ◽  
Kunle O. Odunsi ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Adjuvant Tamoxifen ◽  
Time Interval ◽  
Primary Tumors ◽  
Previous Diagnosis ◽  
Clinicopathologic Factors ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

BackgroundThe time interval between diagnoses of breast cancer (BC) and endometrial cancer (EC) is not well established in women with metachronous primary tumors. We sought to examine this interval and identify associations with treatment-related and clinicopathologic factors.MethodsWe identified 141 patients who developed both cancers during 1966 to 2013. Patients were divided into 2 groups: group 1, BC first, and group 2, EC first. Subanalysis performed of group 1 (59 patients) stratified around adjuvant tamoxifen use: pre-1990 BC diagnosis and post.ResultsFifty-nine and 82 patients were in groups 1 and 2, respectively. The mean time interval was comparable (76 vs 74 months,P= 0.861). Subanalysis divided group 1 into pre- (n = 27) and post- (n = 32) 1990 and resulted in different mean time intervals between diagnosis of metachronous cancers (106 vs 50 months, respectively [P= 0.042]). Median progression-free survival (PFS) and overall survival (OS) for EC were longer in the pre group (PFS, 51 vs 26 months [P= 0.169]; OS, 59 vs 27 months [P= 0.190]). Median PFS and OS for BC were also longer in this group (PFS, 147 vs 109 months [P= 0.005]; OS, 166 vs 114 months [P< 0.001]).ConclusionsOur data indicate the mean time interval between the diagnosis of EC and BC was approximately 6 years. Disease-specific EC survival was worse for patients with a previous diagnosis of BC. Stratification around implementation of tamoxifen use shows comparable grade and stage but different time interval and survival, suggesting resulting effects from adjuvant therapy for BC. These results are useful in counseling women at risk.

scholarly journals Intra-carotid arterial transfusion of circulatory-derived autologous endothelial progenitor cells in rodent after ischemic stroke — evaluating the impact of therapeutic time points on prognostic outcomes

2020 ◽  
Author(s):  
Kun-Chen Lin ◽  
Han-Tan Chai ◽  
Kuan-Hung Chen ◽  
Pei‐Hsun Sung ◽  
John Y. Chiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Optimal Time ◽  
Control Group ◽  
Endothelial Progenitor ◽  
Group 2 ◽  
The Impact ◽  
Carotid Arterial ◽  
Group 1

Abstract Background: This study tested the optimal time point for left intra-carotid arterial (LICA) administration of circulatory-derived autologous endothelial progenitor cells (EPCs) for improving the outcome in rat after acute ischemic stroke (IS). Methods and Results: Adult-male SD rats (n=70) were equally categorized into group 1 (sham-operated control), group 2 (IS), group 3 (IS+EPCs/1.2x10 6 cells/by LICA administration 3h after IS), group 4 (IS+EPCs/LICA administration post-day-3 IS), group 5 (IS+EPCs/LICA administration post-day-7 IS), group 6 (IS+EPCs/LICA administration post-day-14 IS) and group 7 (IS+EPCs/LICA administration post-day-28 IS). The brain-infarct volume (BIV) (at day 60/MRI) was lowest in group 1, highest in group 2 and significantly progressively increased from groups 3 to 7, whereas among the IS animals, the neurological function was significantly preserved in groups 3 to 6 than in groups 2 and 7 post-day-60 IS (all p<0.0001). By day 60, the endothelial cell markers at protein and cellular levels, and number of small vessels exhibited an opposite pattern of BIV among the groups (all p<0.0001). The protein and cellular levels of inflammation, and protein levels of oxidative stress, autophagy and apoptosis, were highest in group 2, lowest in group 1 and progressively increased from groups 3 to 7 (all p<0.0001). The angiogenesis biomarkers at protein and cellular levels were significantly progressively increased from groups 1 to 3, then significantly progressively decreased from groups 4 to 7 (all p<0.0001). Conclusion: Early EPC administration provided better benefits on improving functional/image/molecular-cellular outcomes after acute IS in rat.

scholarly journals The impact of students’ generating and answering questions on their performance

2021 ◽  
Vol 8 (12) ◽  
pp. 56-62
Author(s):  
Anas Mohammed Alshalan ◽  
Keyword(s):  
Student Performance ◽  
Research Question ◽  
Control Group ◽  
Research Groups ◽  
The Mean ◽  
Research Experiment ◽  
Group 2 ◽  
The Impact ◽  
Experimental Group ◽  
Group 1

The aim of the research is to measure the effect of students' use of the strategy of writing questions and answering them on their achievement performance. The researcher used the achievement test to measure the differences between variables, and checked the research tool from validity-consistency-experimental application. But for the implementation of the research experiment, the students were divided into three groups, namely: The experimental group 1 (generating questions and answering them by the learners in groups), the experimental group 2 (forming and answering the questions of the learners individually), and the control group (forming questions by the teacher). In addition, the researcher used the mean and standard deviation to answer the research question and compare student performance in all three research groups. The results showed that there were significant differences between the averages of the research groups, as the experimental group 2 achieved a higher average (26,474) than the experimental group 1 (24,333) and the control group (24,857).

scholarly journals Effect of Tamsulosin on Stone Clearance after Extra-corporeal Shock Wave Lithotripsy

1970 ◽  
Vol 40 (1) ◽  
pp. 27-32
Author(s):  
MZ Hossain ◽  
NP Biswas ◽  
MS Islam ◽  
MZ Hossain ◽  
IA Shameem ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Selection Criterion ◽  
Renal Stones ◽  
Stone Size ◽  
Stone Clearance ◽  
Female Patients ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

This prospective study was performed to observe effect of Tamsulosin on stone clearance after Extra-corporeal Shock Wave Lithotripsy (ESWL) for renal stones having size 6-20 mm. According to selection criterion total 80 patients with renal stones were divided into two groups. In group l, 40 patients treated with traditional hydrotherapy after ESWL and in group 2 another 40 patients were treated with additional Tamsulosin. In-group 1, there were 25 male and 15 female patients and in group 2, male and female patients were 30 and 10 respectively. Without considering the stone size within 3 weeks after ESWL stone clearance in group 1 and 2 was 57.50 and 80.00 percent respectively (P<0.05). Considering the stone size, stone clearance in group 1 was 50% and 33.3% among smaller (6-10 mm) and larger (11-20 mm) stones and in group 2 was 50% and 66.7% among smaller and larger stone respectively (P>0.05). In cases of smaller stones, clearance was 100% and 77.8% among group 1 and 2 respectively without any significant difference (P>0.05). But in larger stones, stone clearance was 34.60% and 81.8% among group 1 and 2 respectively and there was a statistically significant difference in clearance between the groups (P<0.05). Morbidity was significantly lower when ESWL was combined with Tamsulosin. Requirement of additional interventional procedures were significantly higher in group 1 (P<0.05). Complications were less common in group 2 than group 1. Haematuria and lower urinary tract symptoms were equally common in both groups. DOI: http://dx.doi.org/10.3329/bmj.v40i1.9959 BMJ 2011; 40(1): 27-32

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