A cost comparison of balloon angioplasty and stenting versus endarterectomy for the treatment of carotid artery stenosis

PURPOSE: Percutaneous transluminal angioplasty with stenting (PTAS) of the carotid artery has been advocated as an alternative treatment for high-grade stenosis. Rationale for this approach includes less morbidity, shorter recovery, and lower cost when compared with carotid endarterectomy (CEA). METHODS: The clinical results and hospital charges of patients who underwent elective treatment for carotid stenosis were reviewed. During a concurrent 14-month period, 218 patients were admitted 229 times for 234 procedures for the treatment of 239 carotid bifurcation stenoses, 109 by PTAS and 130 by CEA. Hospital charges were reviewed for each hospitalization and were categorized according to radiology, operating room, cardiac catheterization laboratory, and all other hospital charges. RESULTS: The combined incidence of postprocedure strokes and deaths were: PTAS, eight strokes (7.7%) and one death (0.9%); CEA, two strokes (1.5%) and two deaths (1.5%). Total hospital charges per admission for the two groups were $30,140 for PTAS and $21,670 for CEA. The average postprocedure length of stay for PTAS was 2.9 days (median, 2 days) and for CEA was 3.1 days (median, 3 days). Cardiac catheterization laboratory charges for the PTAS group were $12,968, whereas the operating room charges for the CEA group were $4263. When hospitalizations that were extended by complications were excluded, the average total charges for the PTAS group (n = 84) dropped to $24,848 (mean length of stay, 1.9 days) and for the CEA group (n = 111) to $19,247 (mean length of stay, 2.6 days). CONCLUSIONS: After evaluating hospital charges, PTAS for the treatment of carotid stenosis cannot currently be justified on the basis of reduced costs alone. With future cost-containing measures, total hospital charges can be reduced in both groups.     

Technische Textilien zur Bewehrung von Betonbauteilen

Textile Reinforcement for Concrete For the best transmission of tensile and bending forces in the composite material, the textile reinforcement material has to be inserted as long fibres laid in straight orientation and depending on the load. Through the development of textile manufacturing technologies filament yarns can be manufactured into open grid structures which increase the potential of alternative reinforcements. It is currently possible to manufacture load‐adapted textile structures. It is essential that the high‐performance mechanical properties of the alkali‐resistant glass fibres or carbon fibres used are maintained throughout the manufacturing process until the finished component is complete. Therefore the quality of the yarn orientation and the yarn distribution has to be obtained secured throughout the manufacturing process until the finished textile fabric is complete.     

Profile- and deformation-measurements with high axial resolution using the acoustical holography

An improved acoustic-holographic reconstruction-algorithm is presented which allows a three-dimensional image-reconstruction, together with - for the first time - an axial resolution much below one wavelength. This high resolution makes it possible not only to evaluate exactly the contours of defects in the axial direction but also to measure its deformation under thermal or mechanical load. Experimental measurements correspond to the theoretical model, being limited primarily by the dynamic range of the experimental setup.     

A new method of real-time physical simulation of prime movers used in energy conversion chains

This paper focuses on exploring a new method of real-time replication of the dynamic behaviour of prime movers that drive rotating generators involved in energy conversion chains. Their behaviour depends on the mover’s mechanical characteristics and dynamical properties, such as inertia or friction coefficient, which are seldom known precisely. Being also dependent on the variations of the primary energy resource, not always controllable in its natural environment, this behaviour must be simulated by using a smaller and cheaper mover, whose model is sufficiently known such that to render it fully controllable. This paper explores the possibility that the desired real-time replication be achieved by means of a new method of tracking the mover’s rotational speed. To this end, various controllers, both linear and nonlinear can be employed. The design steps are provided for a PI controller, as well as for two nonlinear controllers, while focusing on the practical aspects of controller implementation. Their performance results are assessed comparatively on an experimental rig for two types of prime movers: one whose mechanical torque-speed characteristic is linear and a cross-flow water turbine, having a nonlinear torque-speed characteristic.     

Alterations of insulin response to different beta cell secretagogues and pancreatic vascular resistance induced by N omega-nitro-L-arginine methyl ester

1. We studied a possible interplay of pancreatic NO synthase activity on insulin secretion induced by different beta cell secretagogues and also on pancreatic vascular bed resistance. 2. This study was performed in the isolated perfused pancreas of the rat. Blockage of NO synthase was achieved with Nw-nitro-L-arginine methyl ester (L-NAME); The specificity of the antagonist was checked by using its D-enantiomer as well as by substitutive treatments with sodium nitroprusside (SNP) as a NO donor in studies of glucose-induced insulin secretion. 3. Arginine (5 mM) induced a monophasic response which was, in the presence of L-NAME at equimolar concentration, very strongly potentiated and converted into a 13 times higher biphasic one. D-NAME (5 mM) was only able to induce a 3 times higher response, but provoked a similar vasoconstrictor effect. 4. The small biphasic insulin secretion induced by L-leucine (5 mM) was also strongly enhanced, by 8 times, in the presence of L-NAME (5 mM) vs 2 times in the presence of D-NAME (5 mM). 5. beta cell responses to KCl (5 mM) and tolbutamide (0.185 mM) were only slight increased by L-NAME (5 mM) to values not far from the sum of the effects of L-NAME and of the two drugs alone. D-NAME (5 mM) was totally ineffective on the actions of both secretagogues. 6. L-NAME, infused 15 min before and during a rise in glucose concentration from 5 to 11 mM, was able in the low millimolar range (0.1-0.5 mM) to blunt the classical biphasic pattern of beta cell response to glucose and, at 5 mM, to convert it into a significantly greater monophasic one. In contrast, D-NAME (5 mM) was unable to induce similar effects. 7. SNP alone at 3 microM was ineffective but at 30 microM substantially reduced to second phase of insulin response to glucose; however, at both concentrations the NO donor partly reversed alterations in insulin secretion caused by L-NAME (5 mM) and restored a biphasic response.     

经编间隔织物制作的新型纤维增强纺织复合材料

描述了德国亚琛工业大学纺织技术研究所开发的新型纤维增强纺织复合材料.由于这种间隔织物具有非常好的反复压缩后的回弹性和较高的的减震性能,因此这种材料能满足创新的地板覆盖物的要求.由于它具有优异的缓冲特性,还能在汽车发动机罩上的减震/衬垫装置上发挥作用.     

Traumatic pseudoaneurysm of the superficial temporal artery

This paper describes, by case histories and a literature review, the cause, diagnosis and therapy of pseudoaneurysm of the superficial temporal artery. Two patients with a traumatic pseudoaneurysm of the superficial temporal artery were examined by physical examination and histology of the excised lesions. Blunt injury caused a histologically proved pseudoaneurysm in two reported cases. A total of 12 additional reports of pseudoaneurysm of the superficial temporal artery were found in the literature. Pseudoaneurysm of the superficial temporal artery is an uncommon complication of blunt head injury. Symptoms are limited and diagnosis can be made by noninvasive means. A high suspicion level for arterial injury and sufficient follow-up of patients is necessary for the detection of arterial injury.     

The relationship of partner support to outcomes for teenage mothers and their children: a review

OBJECTIVE: To examine the growth response over 3 years of growth hormone deficient (GHD) and non-GHD children who have received growth hormone (GH) in Australia. METHODOLOGY: A retrospective study of a group of patients (1362 children) who commenced GH prior to 1 September 1990. Data were collected at 12 growth centres located in major cities throughout Australia. The data were transferred after informed consent to the national OZGROW database located at the Royal Alexandra Hospital for Children, Sydney, NSW. Of the 1362 children, 898 had received 3 years or more GH therapy and were eligible for this analysis. This cohort was then categorized by diagnosis. Growth response was assessed using height standard deviation score, estimated mature height, growth velocity (GV), GH dose and bone age (years). RESULTS: For children who completed 3 years therapy, the baseline characteristics among diagnostic groups were similar with mean height standard deviation score (SDS) less than -3 SDS (except for the malignancy group) and mean GV ranging from 3.5 to 4.4cm/year. The GV during the first year improved in all groups (7.7-9.4cm/year)followed by an attenuated response during the second and third years of therapy. After 3 years GH therapy the GHD group with peak levels <10 mU/L demonstrated the greatest change in estimated mature height and height SDS. The GHD group with peak levels between > or = 10 but <2OmU/L had a growth response similar to the non-GHD children for all outcome parameters. Change in bone age ranged from 3.1 to 3.8 years with no differences being noted between the diagnostic groups, nor consistently with pubertal status. CONCLUSIONS: Australian GH guidelines have targeted very short children when compared to other series. This large cohort of non-GHD children has demonstrated short-term benefits of GH therapy; however, the long-term benefit remains unclear until these children reach final adult height.     

Dermal endothelial cells and keratinocytes produce IL-7 in vivo after human Schistosoma mansoni percutaneous infection

The parasite Schistosoma mansoni infects its definitive mammalian host through an obligatory cutaneous penetration. In this work, we studied early immune response following migration of larvae through human skin, the first immunocompetent organ encountered by the parasite. For this purpose we used an experimental model of severe combined immunodeficient mice engrafted with human skin and injected with autologous PBL. Six days after percutaneous infection, we observed an infiltration of lymphocytes within the human skin, predominantly composed of CD4+ T cells. Moreover, among the cytokines potentially present in the infected skin, immunohistochemistry analysis revealed an in vivo expression of IL-7 in the epidermal layers and strikingly at the level of vascular endothelium. Using an in vitro coculture system, we showed that the S. mansoni larvae directly trigger IL-7 production by human dermal microvascular endothelial cells but not by keratinocytes. Finally, measurements of IL-7 concentrations in plasma of 187 S. mansoni-infected individuals showed that the youngest, which are also the most infected, displayed the highest IL-7 levels. Together, these findings describe dermal endothelial cells as a novel source of IL-7, a cytokine particularly important in schistosomiasis.