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Hirai T, Bao L, Barabash V, Carrat R, Chappuis P, Eaton R, Edwards P, Escourbiac F, Gicquel S, Komarov V, Merola M, Raffray R, Chen J, Wang K, Gervash A, Makhankov A, Arkhipov N, Safronov V. Hypervapotron heat sinks in ITER plasma-facing components—Process qualifications and production control toward series production. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hirai T, Bao L, Barabash V, Chappuis P, Eaton R, Escourbiac F, Merola M, Mitteau R, Raffray R, Linke J, Loewenhoff T, Dorow-Gerspach D, Pintsuk G, Wirtz M, Boomstra D, Klaassen C, Magielsen A, Chen J, Wang P. High heat flux performance assessment of ITER enhanced heat flux first wall technology after neutron irradiation. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2022.113338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gilbert FJ, Harris S, Miles KA, Weir-McCall JR, Qureshi NR, Rintoul RC, Dizdarevic S, Pike L, Sinclair D, Shah A, Eaton R, Clegg A, Benedetto V, Hill JE, Cook A, Tzelis D, Vale L, Brindle L, Madden J, Cozens K, Little LA, Eichhorst K, Moate P, McClement C, Peebles C, Banerjee A, Han S, Poon FW, Groves AM, Kurban L, Frew AJ, Callister ME, Crosbie P, Gleeson FV, Karunasaagarar K, Kankam O, George S. Dynamic contrast-enhanced CT compared with positron emission tomography CT to characterise solitary pulmonary nodules: the SPUtNIk diagnostic accuracy study and economic modelling. Health Technol Assess 2022; 26:1-180. [PMID: 35289267 DOI: 10.3310/wcei8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current pathways recommend positron emission tomography-computerised tomography for the characterisation of solitary pulmonary nodules. Dynamic contrast-enhanced computerised tomography may be a more cost-effective approach. OBJECTIVES To determine the diagnostic performances of dynamic contrast-enhanced computerised tomography and positron emission tomography-computerised tomography in the NHS for solitary pulmonary nodules. Systematic reviews and a health economic evaluation contributed to the decision-analytic modelling to assess the likely costs and health outcomes resulting from incorporation of dynamic contrast-enhanced computerised tomography into management strategies. DESIGN Multicentre comparative accuracy trial. SETTING Secondary or tertiary outpatient settings at 16 hospitals in the UK. PARTICIPANTS Participants with solitary pulmonary nodules of ≥ 8 mm and of ≤ 30 mm in size with no malignancy in the previous 2 years were included. INTERVENTIONS Baseline positron emission tomography-computerised tomography and dynamic contrast-enhanced computer tomography with 2 years' follow-up. MAIN OUTCOME MEASURES Primary outcome measures were sensitivity, specificity and diagnostic accuracy for positron emission tomography-computerised tomography and dynamic contrast-enhanced computerised tomography. Incremental cost-effectiveness ratios compared management strategies that used dynamic contrast-enhanced computerised tomography with management strategies that did not use dynamic contrast-enhanced computerised tomography. RESULTS A total of 380 patients were recruited (median age 69 years). Of 312 patients with matched dynamic contrast-enhanced computer tomography and positron emission tomography-computerised tomography examinations, 191 (61%) were cancer patients. The sensitivity, specificity and diagnostic accuracy for positron emission tomography-computerised tomography and dynamic contrast-enhanced computer tomography were 72.8% (95% confidence interval 66.1% to 78.6%), 81.8% (95% confidence interval 74.0% to 87.7%), 76.3% (95% confidence interval 71.3% to 80.7%) and 95.3% (95% confidence interval 91.3% to 97.5%), 29.8% (95% confidence interval 22.3% to 38.4%) and 69.9% (95% confidence interval 64.6% to 74.7%), respectively. Exploratory modelling showed that maximum standardised uptake values had the best diagnostic accuracy, with an area under the curve of 0.87, which increased to 0.90 if combined with dynamic contrast-enhanced computerised tomography peak enhancement. The economic analysis showed that, over 24 months, dynamic contrast-enhanced computerised tomography was less costly (£3305, 95% confidence interval £2952 to £3746) than positron emission tomography-computerised tomography (£4013, 95% confidence interval £3673 to £4498) or a strategy combining the two tests (£4058, 95% confidence interval £3702 to £4547). Positron emission tomography-computerised tomography led to more patients with malignant nodules being correctly managed, 0.44 on average (95% confidence interval 0.39 to 0.49), compared with 0.40 (95% confidence interval 0.35 to 0.45); using both tests further increased this (0.47, 95% confidence interval 0.42 to 0.51). LIMITATIONS The high prevalence of malignancy in nodules observed in this trial, compared with that observed in nodules identified within screening programmes, limits the generalisation of the current results to nodules identified by screening. CONCLUSIONS Findings from this research indicate that positron emission tomography-computerised tomography is more accurate than dynamic contrast-enhanced computerised tomography for the characterisation of solitary pulmonary nodules. A combination of maximum standardised uptake value and peak enhancement had the highest accuracy with a small increase in costs. Findings from this research also indicate that a combined positron emission tomography-dynamic contrast-enhanced computerised tomography approach with a slightly higher willingness to pay to avoid missing small cancers or to avoid a 'watch and wait' policy may be an approach to consider. FUTURE WORK Integration of the dynamic contrast-enhanced component into the positron emission tomography-computerised tomography examination and the feasibility of dynamic contrast-enhanced computerised tomography at lung screening for the characterisation of solitary pulmonary nodules should be explored, together with a lower radiation dose protocol. STUDY REGISTRATION This study is registered as PROSPERO CRD42018112215 and CRD42019124299, and the trial is registered as ISRCTN30784948 and ClinicalTrials.gov NCT02013063. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Scott Harris
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK
| | - Kenneth A Miles
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Jonathan R Weir-McCall
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Nagmi R Qureshi
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Robert C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sabina Dizdarevic
- Departments of Imaging and Nuclear Medicine and Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Lucy Pike
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Donald Sinclair
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrew Shah
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Rosemary Eaton
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Andrew Clegg
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - James E Hill
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Andrew Cook
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Brindle
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jackie Madden
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kelly Cozens
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Louisa A Little
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kathrin Eichhorst
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Patricia Moate
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Chris McClement
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Charles Peebles
- Department of Radiology and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anindo Banerjee
- Department of Radiology and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sai Han
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, UK
| | - Fat Wui Poon
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | - Lutfi Kurban
- Department of Radiology, Aberdeen Royal Hospitals NHS Trust, Aberdeen, UK
| | - Anthony J Frew
- Departments of Imaging and Nuclear Medicine and Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew E Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Crosbie
- North West Lung Centre, University Hospital of South Manchester, Manchester, UK
| | - Fergus V Gleeson
- Department of Radiology, Churchill Hospital, Oxford, UK
- University of Oxford, Oxford, UK
| | | | - Osei Kankam
- Department of Thoracic Medicine, East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
| | - Steve George
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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Gilbert FJ, Harris S, Miles KA, Weir-McCall JR, Qureshi NR, Rintoul RC, Dizdarevic S, Pike L, Sinclair D, Shah A, Eaton R, Jones J, Clegg A, Benedetto V, Hill J, Cook A, Tzelis D, Vale L, Brindle L, Madden J, Cozens K, Little L, Eichhorst K, Moate P, McClement C, Peebles C, Banerjee A, Han S, Poon FW, Groves AM, Kurban L, Frew A, Callister MEJ, Crosbie PA, Gleeson FV, Karunasaagarar K, Kankam O, George S. Comparative accuracy and cost-effectiveness of dynamic contrast-enhanced CT and positron emission tomography in the characterisation of solitary pulmonary nodules. Thorax 2021; 77:988-996. [PMID: 34887348 DOI: 10.1136/thoraxjnl-2021-216948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 10/24/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these. METHODS In this prospective multicentre trial, 380 participants with an SPN (8-30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model. RESULTS 312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred. CONCLUSIONS PET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective. TRIAL REGISTRATION NUMBER NCT02013063.
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Affiliation(s)
- Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Scott Harris
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, Southampton, UK
| | - Kenneth A Miles
- Institute of Nuclear Medicine, University College London, London, UK
| | - Jonathan R Weir-McCall
- Department of Radiology, University of Cambridge, Cambridge, UK.,Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nagmi R Qureshi
- Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert Campbell Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sabina Dizdarevic
- Imaging and Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Lucy Pike
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Donald Sinclair
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Andrew Shah
- Radiation Protection, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Rosemary Eaton
- Radiation Protection, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Jeremy Jones
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Andrew Cook
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Dimitrios Tzelis
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Brindle
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jackie Madden
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kelly Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Louisa Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kathrin Eichhorst
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Patricia Moate
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Chris McClement
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Charles Peebles
- Department of Radiology and Respiratory Medicine, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Anindo Banerjee
- Department of Radiology and Respiratory Medicine, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Sai Han
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - Fat-Wui Poon
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | - Lutfi Kurban
- Department of Radiology, Aberdeen Royal Hospitals NHS Trust, Aberdeen, UK
| | - Anthony Frew
- Imaging and Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Phil A Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Fergus Vincent Gleeson
- Department of Radiology, Churchill Hospital, Oxford, UK.,Department of Radiology, University of Oxford, Oxford, UK
| | | | - Osei Kankam
- Department of Thoracic Medicine, East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
| | - Steve George
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, Southampton, UK
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Kropelnicki A, Eaton R, Adamczyk A, Waterman J, Mohaghegh P. Establishing local diagnostic reference levels for common orthopaedic procedures using the mini C-arm fluoroscope. Br J Radiol 2021; 94:20190878. [PMID: 33090887 DOI: 10.1259/bjr.20190878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Mini C-arm fluoroscopes are widely used by orthopaedic surgeons for intraoperative image guidance without the need for radiographers. This puts the responsibility for radiation exposure firmly with the operating surgeon. In order to maintain safe and best practice under U.K. Ionising Radiation (Medical Exposure) Regulations, one must limit radiation exposure and audit performance using national diagnostic reference levels (DRLs). In the case of the mini C-arm, there are no national DRLs. IR(ME)R, therefore, require the establishment of local DRLs by each hospital to act as an alternative guideline for safe radiation use. The aim of our audit was to establish local DRLs based on our experience operating with the use of the mini C-arm over the last 7 years. METHODS This retrospective audit evaluates the end dose-area product (DAP) recorded for common trauma and orthopaedic procedures using the mini C-arm in a busy district general hospital.We present the quartile data and have set the cut-off point as the third quartile for formulating the local DRLs, consistent with the methodology for the conventional fluoroscope. RESULTS For our data set (n = 1664), the third quartile DAP values were lowest for surgeries to the forearm (5.38 cGycm2), hand (7.62 cGycm2), and foot/ankle (8.56 cGycm2), and highest for wrist (10.64 cGycm2) and elbow (14.61 cGycm2) procedures. ADVANCES IN KNOWLEDGE To our knowledge, this is the largest data set used to establish local DRLs. Other centres may find our guidelines useful whilst they establish their own local DRLs.
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Affiliation(s)
- Anna Kropelnicki
- Specialist Trainee 8, Trauma and Orthopaedic Surgery, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Rosemary Eaton
- Medical Physics Expert and Radiation Protection Advisor, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Alexandra Adamczyk
- Trust SHO Trauma and Orthopaedic Surgery, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Jacqueline Waterman
- Consultant Surgeon Department of Trauma and Orthopaedics, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Pegah Mohaghegh
- Consultant Radiologist Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
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Sviridenko M, Leshukov A, Tomilov S, Poddubnyi I, Parshutin E, Strebkov Y, Safronov V, Raffray R, Eaton R, Gicquel S. Experimental validation of enhanced heat flux first wall panel mechanical attachment system. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gervash A, Giniyatulin R, Guryeva T, Glazunov D, Kuznetsov V, Mazul I, Ogursky, Piskarev P, Safronov V, Eaton R, Raffray R, Sevryukov O. The development of technology of Be/CuCrZr joining using induction brazing. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.03.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sviridenko M, Leshukov A, Razmerov A, Poddubnyi I, Skladnov K, Bushkov A, Elkin V, Kolganov V, Kirillov S, Strebkov Y, Safronov V, Putrick A, Raffray R, Eaton R, Egorov K, Calcagno B. Design, analysis and manufacturing of electrical strap for enhanced first wall panel. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.04.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tomilov S, Sviridenko M, Leshukov A, Strebkov Y, Gervash A, Mazul I, Okuneva E, Khokhlov M, Safronov V, Calcagno B, Eaton R, Raffray R. Analysis results of the enhanced heat flux first wall panel elements. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mitteau R, Eaton R, Gervash A, Kuznetcov V, Davydov V, Rulev R. Allowable heat load on the edge of the ITER first wall panel beryllium flat tiles. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roedig M, Barabash V, Eaton R, Hirai T, Kupriyanov I, Linke J, Liu X, Schmidt A, Wang Z. Experimental Simulation of Vertical Displacement Events and Thermal Shock Scenarios on Different Beryllium Grades. Fusion Science and Technology 2017. [DOI: 10.13182/fst12-a14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Roedig
- Forschungszentrum Jülich GmbH, EURATOM Association, 52425 Jülich, Germany
| | - V. Barabash
- ITER Organization, Route de Vinon sur Verdon, 13115 St Paul Lez Durance, France
| | - R. Eaton
- ITER Organization, Route de Vinon sur Verdon, 13115 St Paul Lez Durance, France
| | - T. Hirai
- ITER Organization, Route de Vinon sur Verdon, 13115 St Paul Lez Durance, France
| | - I. Kupriyanov
- Bochvar Institute, 5a, Rogova St., 123060 Moscow, Russia
| | - J. Linke
- Forschungszentrum Jülich GmbH, EURATOM Association, 52425 Jülich, Germany
| | - X. Liu
- Southwestern Institute of Physics, P.O. Box 432, Chengdu 610041, Sichuan, China
| | - A. Schmidt
- Forschungszentrum Jülich GmbH, EURATOM Association, 52425 Jülich, Germany
| | - Zh. Wang
- CNMC Orient Group Co. Ltd., Yejin Road 119, Shizuishan City 753000, Ninxia, China
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Qureshi NR, Rintoul RC, Miles KA, George S, Harris S, Madden J, Cozens K, Little LA, Eichhorst K, Jones J, Moate P, McClement C, Pike L, Sinclair D, Wong WL, Shekhdar J, Eaton R, Shah A, Brindle L, Peebles C, Banerjee A, Dizdarevic S, Han S, Poon FW, Groves AM, Kurban L, Frew AJ, Callister ME, Crosbie P, Gleeson FV, Karunasaagarar K, Kankam O, Gilbert FJ. Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules-the SPUtNIk study. BMJ Open Respir Res 2016; 3:e000156. [PMID: 27843550 PMCID: PMC5073572 DOI: 10.1136/bmjresp-2016-000156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Solitary pulmonary nodules (SPNs) are common on CT. The most cost-effective investigation algorithm is still to be determined. Dynamic contrast-enhanced CT (DCE-CT) is an established diagnostic test not widely available in the UK currently. METHODS AND ANALYSIS The SPUtNIk study will assess the diagnostic accuracy, clinical utility and cost-effectiveness of DCE-CT, alongside the current CT and 18-flurodeoxyglucose-positron emission tomography) (18FDG-PET)-CT nodule characterisation strategies in the National Health Service (NHS). Image acquisition and data analysis for 18FDG-PET-CT and DCE-CT will follow a standardised protocol with central review of 10% to ensure quality assurance. Decision analytic modelling will assess the likely costs and health outcomes resulting from incorporation of DCE-CT into management strategies for patients with SPNs. ETHICS AND DISSEMINATION Approval has been granted by the South West Research Ethics Committee. Ethics reference number 12/SW/0206. The results of the trial will be presented at national and international meetings and published in an Health Technology Assessment (HTA) Monograph and in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN30784948; Pre-results.
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Affiliation(s)
- N R Qureshi
- Department of Radiology , Papworth Hospital , Cambridge , UK
| | - R C Rintoul
- Department of Thoracic Oncology , Papworth Hospital , Cambridge , UK
| | - K A Miles
- Institute of Nuclear Medicine, University College London , London , UK
| | - S George
- Public Health Sciences and Medical Statistics, University of Southampton , Southampton , UK
| | - S Harris
- Public Health Sciences and Medical Statistics, University of Southampton , Southampton , UK
| | - J Madden
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - K Cozens
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - L A Little
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - K Eichhorst
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - J Jones
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
| | - P Moate
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - C McClement
- Southampton Clinical Trials Unit , University of Southampton , Southampton , UK
| | - L Pike
- Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK
| | - D Sinclair
- Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK
| | - W L Wong
- Department of Medical Physics , Paul Strickland Scanner Centre, Mount Vernon Hospital, East and North Herts NHS Trust , Stevenage , UK
| | - J Shekhdar
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - R Eaton
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - A Shah
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - L Brindle
- Faculty of Health Sciences , University of Southampton , Southampton , UK
| | - C Peebles
- Department of Radiology and Respiratory Medicine , Southampton University Hospitals NHS Foundation Trust , Southampton , UK
| | - A Banerjee
- Department of Radiology and Respiratory Medicine , Southampton University Hospitals NHS Foundation Trust , Southampton , UK
| | - S Dizdarevic
- Departments of Respiratory and Nuclear Medicine , Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - S Han
- West of Scotland PET Centre, Gartnavel Hospital , Glasgow , UK
| | - F W Poon
- West of Scotland PET Centre, Gartnavel Hospital , Glasgow , UK
| | - A M Groves
- Institute of Nuclear Medicine, University College London , London , UK
| | - L Kurban
- Department of Radiology , Aberdeen Royal Hospitals NHS Trust , Aberdeen , UK
| | - A J Frew
- Departments of Respiratory and Nuclear Medicine , Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - M E Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Crosbie
- North West Lung Centre, University Hospital of South Manchester, Manchester, UK
| | - F V Gleeson
- Department of Radiology , Churchill Hospital and University of Oxford , Oxford , UK
| | - K Karunasaagarar
- Department of Radiology , Worcestershire Royal Hospital , Worcester , UK
| | - O Kankam
- Department of Thoracic Medicine , East Sussex Hospitals NHS Trust , Saint Leonards-on-Sea , UK
| | - F J Gilbert
- Department of Radiology , University of Cambridge School of Clinical Medicine, Biomedical research centre, University of Cambridge , Cambridge , UK
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Mitteau R, Eaton R, Perez G, Zacchia F, Banetta S, Bellin B, Gervash A, Glazunov D, Chen J. Status of the beryllium tile bonding qualification activities for the manufacturing of the ITER first wall. Fusion Engineering and Design 2015. [DOI: 10.1016/j.fusengdes.2015.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Banetta S, Zacchia F, Lorenzetto P, Bobin-Vastra I, Boireau B, Cottin A, Mitteau R, Eaton R, Raffray R. Manufacturing of small-scale mock-ups and of a semi-prototype of the ITER Normal Heat Flux First Wall. Fusion Engineering and Design 2014. [DOI: 10.1016/j.fusengdes.2014.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitteau R, Calcagno B, Chappuis P, Eaton R, Gicquel S, Chen J, Labusov A, Martin A, Merola M, Raffray R, Ulrickson M, Zacchia F. The design of the ITER first wall panels. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mazul I, Alekseev A, Belyakov V, Bondarchuk D, Eaton R, Escourbiac F, Gervash A, Glazunov D, Kuznetsov V, Merola M, Labusov A, Ovchinnikov I, Raffray R, Rulev R. Russian development of enhanced heat flux technologies for ITER first wall. Fusion Engineering and Design 2012. [DOI: 10.1016/j.fusengdes.2011.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Howells P, Eaton R, Patel A, Taylor P, Modarai B. Risk of Radiation Exposure during Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2012; 43:393-7. [DOI: 10.1016/j.ejvs.2011.12.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/28/2011] [Indexed: 11/25/2022]
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Lou J, Eaton R, Dimitrova D, Blaine K, Davis M, Nutt J. P06.5 The effects of rTMS of different frequency and intensity on cortical excitability and finger tapping in PD. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Silbert LC, Nelson C, Holman S, Eaton R, Oken BS, Lou JS, Kaye JA. Cortical excitability and age-related volumetric MRI changes. Clin Neurophysiol 2006; 117:1029-36. [PMID: 16564739 DOI: 10.1016/j.clinph.2006.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 01/27/2006] [Accepted: 02/04/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Normative data on transcranial magnetic stimulation (TMS)-derived measures of cortical excitability in the elderly is sparse. Nevertheless, elderly subjects are included as controls in studies utilizing TMS to investigate disease states. Age-associated increased ventricular cerebrospinal fluid CSF (vCSF) and white matter hyperintensity (WMH) MRI volumes have uncertain significance in non-demented elderly. Information regarding cortical excitability in neurologically intact elderly would augment our understanding of the pathophysiology of aging and assist in the interpretation of TMS studies involving elderly subjects. METHODS Twenty-four healthy elderly subjects underwent TMS testing to determine outcomes of resting motor threshold (RMT) cortical silent period (cSP) and central motor conduction time for examination in relation to WMH, vCSF, and CNS volumes. RESULTS Increased vCSF and WMH volumes were associated with decreased right and left hemisphere RMT. Smaller CNS volumes were associated with decreased right hemisphere RMT and shorted cSP. CONCLUSIONS Commonly observed age-associated MRI changes are associated with findings consistent with increased cortical excitability. SIGNIFICANCE Age-related MRI findings likely reflect changes at a cellular level, and may influence cognitive and motor integrity in the elderly. Future TMS studies investigating cortical excitability may wish to consider neuroimaging markers of neurodegeneration prior to enrolling elderly subjects as controls.
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Affiliation(s)
- L C Silbert
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR 97201, USA.
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Malerich MM, Clifford J, Eaton B, Eaton R, Littler JW. Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion. J Hand Surg Am 1999; 24:1196-205. [PMID: 10584941 DOI: 10.1053/jhsu.1999.1196] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nineteen patients with chronic scaphoid nonunion and associated degenerative arthritis between the distal fragment and the radial styloid were treated by resection of the distal fragment. All patients had a dorsal intercalated segment instability wrist collapse pattern with an average radiolunate angle of -32 degrees and a 10% reduction in the carpal height, both of which changed minimally during the follow-up period. The duration of the nonunion averaged 12 years and the follow-up period averaged 49 months. Range of motion improved 85% and grip improved 134%. Thirteen of the patients experienced complete pain relief. One patient required additional surgery and elected wrist arthrodesis. Resection of the distal fragment is not recommended for patients with capitolunate arthritis. Two of the 4 patients with capitolunate arthritis had persistent symptoms; 3 had progressive degenerative changes.
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Affiliation(s)
- M M Malerich
- Department of Orthopedic Surgery, University of California, Irvine, Orange, USA
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Byrnes S, Eaton R, Kogut M. In vitro interleukin-1 and tumor necrosis factor-alpha production by macrophages from chickens infected with either Eimeria maxima or Eimeria tenella. Int J Parasitol 1993; 23:639-45. [PMID: 8225766 DOI: 10.1016/0020-7519(93)90170-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We measured the in vitro production of interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF- ) by macrophages from chickens during and immediately following an infection with one of two different species of Eimeria, E. maxima and E. tenella. Quantitatively, the amounts of IL-1 produced during each infection were nearly identical regardless of the oocyst dose of each parasite. TNF production followed a biphasic pattern of increased production with the first peak associated with the pathogenesis of disease and the second peak associated with the development of protective immunity. These experiments together with others we have reported imply cells taken from chickens infected with coccidia have a greater capacity to produce cytokines upon stimulation in vitro than cells from non-infected birds. The production of significantly greater amounts of TNF during the days 3-6 after inoculation correlates with the appearance of the most characteristic local and systemic pathophysiological changes in the host induced by the coccidia. The excessive release of TNF in response to a heavy coccidial infection may account for many of the pathological features observed with avian coccidiosis probably through the release of other mediators.
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Affiliation(s)
- S Byrnes
- Department of Biological Sciences, University of Arkansas, Fayetteville 72701
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23
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Wood JJ, O'Mahony JB, Rodrick ML, Eaton R, Demling RH, Mannick JA. Abnormalities of antibody production after thermal injury. An association with reduced interleukin 2 production. Arch Surg 1986; 121:108-15. [PMID: 3079998 DOI: 10.1001/archsurg.1986.01400010122017] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Antibody (Ab) production was studied in 25 burned patients who were immunized with 0.5 mg of tetanus toxoid adsorbed. Anti-tetanus toxoid (TT) Ab was measured by hemagglutination, radial immunodiffusion, and an enzyme-linked immunosorbent assay, and the results for the patients were compared with those for five similarly immunized healthy controls. As measured by hemagglutination, 12 (63%) of 19 patients had lower Ab responses than all five controls (P less than .05 by chi 2), and the median Ab response during the period of maximum response was significantly less than that in controls (8 vs 15.5 log2 maximum dilution; P = .014). After the initial response, serum Ab levels were not maintained in patients, in contrast to controls. This pattern was demonstrated by all three assays; enzyme-linked immunosorbent assay demonstrated that IgG anti-TT Ab was the major class of Ab produced. In nine patients interleukin 2 production by T lymphocytes was measured simultaneously; it was significantly depressed throughout the study except during the period from 36 to 45 days. The Ab response was also impaired in this patient group. Since maintained antibody production in response to TT is known to be T-cell dependent, these results suggest that inadequate interleukin 2 production leading to reduced T-cell help may be responsible for the lack of a persistent Ab response in these burned patients.
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Abstract
ABSTRACT; Acetabular reconstructions were performed on 12 hips possessing deficient acetabuli. Eleven required total hip arthroplasties for relief of pain; seven of which were surface replacements. The one remaining h ip had erosion of the posterior wall, secondary to spastic paraparesis, and the posterior wall was reconstructed. The etiologies of the deficient acetabuli included five secondary to fracture/dislocation, four with acetabular dysplasias, and three related to failed acetabular components from conventional total hip arthroplasties. There were six posterior Hp deficiencies, five superior rim deficiencies, and one central deficiency. The iliac crest provided the graft material utilized in 11 of 12 cases; in one case the femoral head was used for reconstruction. All peripheral defects, however, were handled similarly regardless of the source of graft material, in that all grafts were secured with at least two cortical cancellous screws lagged for compression. Central defects utilized single cortex grafts keyed into the defect upon a bed of cancellous graft and rimmed with methyl methacrylate. All patients were followed at routine intervals; the shortest followup was 14 months, and the longest 32 months. All grafts showed radiographic evidence of union by one year. Three-phase bone scans were routinely done in patients undergoing surface replacement by one year. The scan appearance of the femoral head was identical to other uncomplicated surface replacements. The grafted area showed increased uptake.The purpose of this report is twofold: to present iliac crest as a graft material from which deficient acetabuli can be reconstructed when autogenous femoral head is not available, and to offer a fixation technique potentially less demanding and yet no less secure than those previously suggested. The results of this study indicate that, in selected situations, iliac crest graft acetabuloplasty can be successfully employed so that the total hip arthroplasties may be performed reducing fear of premature acetabular loosening related to insufficient bony coverage of the acetabular component.
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Caplan M, Eaton R, Poland J, Mong F, Hess M. Immune mediated inflammatory myocarditis: Histopathology, hemodynamics and mechanics. J Mol Cell Cardiol 1983. [DOI: 10.1016/0022-2828(83)90934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Capello WN, Trancik TM, Misamore G, Eaton R. Analysis of revision surgery of resurfacing hip arthroplasty. Clin Orthop Relat Res 1982:50-5. [PMID: 7127964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Results of revision of 24 resurfacing hip prostheses followed up for a minimum of one year are encouraging. The average Iowa Hip Rating after salvage was higher than the average highest rating prior to failure of the original resurfacing procedure. There were no intraoperative complications in revising any of the failed resurfacing procedures. Results of revision of the failed component of a resurfacing procedure are comparable with those of conversion to a conventional hip arthroplasty. Thorough, prompt evaluation of hip pain in recipients of a hip resurfacing procedure is necessary for preservation of remaining bone stock. In comparison to revision of conventional hip arthroplasty, revision of failed resurfacing hip arthroplasty is technically easier and has a better prognosis in providing the patient with a pain-free, functional hip.
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Abstract
Steinmann pins have long been used as a means of internally fixing acromioclavicular separations. A few reported cases have described the complications of pin migration.1-5 The purpose of this case report is to support computerized tomography for localizing foreign bodies in selected cases.
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Hess ML, Krause SM, Komwatana P, Eaton R, Okabe E. Augmented venous return: a model of left ventricular afterload reduction during the course of endotoxin shock. Circ Shock 1981; 8:435-450. [PMID: 7023737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Utilizing a canine model of endotoxin shock (E coli, 4 mg/kg, B6:026) the major determinants of cardiac output (preload, afterload, contractility, and heart rate) were simultaneously followed for 5 hr in four study groups: Group I: time-matched controls, Group II: endotoxin shock, Group III: endotoxin shock and femoral-femoral A-V shunt, and Group IV: A-V shunt control. Groups II and III demonstrated an initial, abrupt increase in total peripheral resistance (TPR), coronary vascular resistance (CVR), and pulmonary vascular resistance (PVR), and a decrease in cardiac output (CO), coronary flow (CF) and heart rate (HR) and stroke work (P less than 0.05). Group II then demonstrated a decrease in TPR, CVR, PVR with an increase in CO and CF but systemic arterial pressure did not return to control values. At approximately 3 hr, Group II developed a progressive increase in TPR, CVR, and PVR, and a decrease in CO, CF, and SW. Heart rate did not change. In contrast, at 3 hr Group III demonstrated no significant increase in TPR, CVR, or PVR, a progressive increase of CO and CF, and preservation of SW. It is hypothesized that endotoxin shock is characterized by an initial phase characterized by an increase in resistance and decrease in flow that is not affected by an augmented venous return. However, in the intermediate and latter stages of shock, there is a progressive increase in resistance and decrease in flow, increasing impedance to left ventricular ejection that results in an imbalance between myocardial oxygen supply and demand, contributing to the observed myocardial failure. An augmented venous return, by decreasing resistance (afterload) and increasing venous return (preload) preserves cardiac output and myocardial function and thus serves as a model of left ventricular afterload reduction during the course of endotoxin shock.
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