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ShSh Eliava IuM Filatov OB Sazonova AIu Lubnin IN Rudnev AS Khe?reddin 《Canadian Metallurgical Quarterly》1996,41(4):3-6
Internal carotid aneurysms in the ophthalmic area presents a challenge in cerebrovascular neurosurgery. The study was undertaken to provide evidence for the application of intravascular aspiration during direct surgical interventions and to outline their variants used at the N. N. Burdenko Institute of Neurosurgery. The study included 4 (3 females and 1 male) patients with large and giant internal carotid aneurysms of parasphenoidal site who were treated at the Institute. Clipping of the aneurysmal neck was made by employing intravascular blood aspiration from the aneurysm. The technique proved to be effective in proximal monitoring the carotid artery at surgery. It substantially reduced aneurysmal blood flow and wall tension, thus favouring aneurysmal dissection to make clipping. 相似文献
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Using total quality management principles within a shared governance framework, this case study discusses how to design and implement a plan to achieve independent nursing practice when an employee has unique needs. This experience demonstrates the importance of looking at root causes, separating ability and compliance issues, using all available resources creatively, and planning for success. 相似文献
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Ozlem Karahan Ozgun Bertan Basak Ceren Eropak Seda Abat Gamze Kirim Emine Girgin Asude Hanedar Elcin Gunes Ercan Citil Erdem Görgün Cigdem Yangin Gomec Fatos Germirli Babuna Suleyman Ovez Aysegul Tanik Izzet Ozturk Cumali Kinaci Yakup Karaaslan Sibel Mine Gucver Esra Siltu Aybala Koc Orhon 《Clean Technologies and Environmental Policy》2017,19(1):105-122
Monitoring and control of dangerous substances discharged into receiving waters have attracted more attention lately. Since it is not possible to analyze every single substance, a prioritization methodology is needed for the selection of those to be monitored. Existing well-developed models require significant amount of data for reliable outcomes. This paper presents a methodology to prioritize the dangerous substances having adverse effects on freshwaters in Turkey, where data are scarce. Such a methodology will also serve as a solid model for other countries with limited background data. The adopted methodology enabled the elimination of chemicals to generate a candidate list composed of 608 substances among more than 5000 substances. Further screening and prioritization were conducted using different assessment methods (i.e., Total Hazard Value, Total Impact Value, Combined Monitoring-based, and Modelling-based Priority Setting) to obtain a proposed Final Candidate Specific Pollutants List of 150 dangerous substances. The proposed Candidate National Pollutant List of Turkey was established by combining 45 priority pollutants of the European Union with a list of candidate specific pollutants. According to the outcomes of this study, monitoring and controlling of 195 dangerous substances in freshwaters are recommended. Further detailed studies should be conducted in order to observe the actual levels of these dangerous substances in freshwaters followed by a review of the monitoring list accordingly. Moreover, further revisions might be required in the proposed list due to some possible versatile conditions in terms of sampling points (i.e., change in the location of industries). 相似文献
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J Fernandez C Chen G Anolik OB Brdlik GW Laub WA Anderson LB McGrath 《Canadian Metallurgical Quarterly》1997,11(6):1133-1140
OBJECTIVE: Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients > or = 65 years (range 65-91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients. METHODS: Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges. RESULTS: Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P < 0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P < 0.01) and valve replacement (4% versus 9%, P = 0.01). Significant risk factors for hospital death in the elderly: diabetes (P < 0.01), hypertension (P < 0.01), myocardial infarction (P < 0.01) and congestive heart failure (P < 0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P < 0.01), congestive heart failure (P < 0.01), infection (P < 0.01), cerebrovascular accident (P < 0.01), and intra aortic balloon pump (P < 0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the < 65 group was 15.3 versus > 19.5 days for the > 65 group (P < 0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients > or = 65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age. CONCLUSIONS: Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs. 相似文献
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A major obstacle to stem cell gene therapy is the extremely low efficiency of stem cell transduction. In vivo selection is a strategy for enriching a minor population of genetically modified bone marrow cells through the introduction of a drug resistance gene, followed by subsequent administration of the corresponding cytotoxic drug in vivo. Achieving persistent effects from in vivo selection is expected to require selection at the level of stem cells or, minimally, selection at the level of progenitors. Major limitations to in vivo selection are the nonhematologic toxicities of the cytotoxic drugs used and the resistance of stem cells and progenitors to killing by most cytotoxic agents. Experiments were performed in mice to evaluate whether the drugs used for selection in combination with multiple drug resistance gene 1 (MDR1) could have an enhanced effect on clonogenic progenitors if preceded by administration of the cytokine, stem cell factor (SCF). Single doses of taxol, navelbine, or vinblastine produced 10-fold reductions in the total number of mononuclear cells per femur, indicating a significant depletion of nonclonogenic precursor cells. However, for each of these agents, clonogenic progenitors, assayed as colony-forming unit cells and day-12 spleen colony-forming units, were relatively spared. Administration of SCF before taxol, navelbine, or vinblastine completely abrogated the progenitor-sparing phenomenon, because clonogenic progenitors were depleted as effectively as nonclonogenic precursor cells. Furthermore, the administration of SCF before drug administration allowed the dosages of taxol and vinblastine to be reduced by more than half, while retaining reductions in progenitor numbers that were unachievable using very high doses of the cytotoxic drug alone. Doxorubicin administration resulted in a 30- to 40-fold depletion in progenitors that was not significantly altered by preceding SCF administration. These results suggest that previous observations of in vivo selection using MDR1 gene transfer followed by taxol administration may have resulted from selection at the level of relatively mature, nonclonogenic precursor cells. Furthermore, these data suggest that cytokine prestimulation may be a useful strategy for improving the selection of drug-resistant clonogenic progenitors and, possibly, stem cells in vivo. 相似文献
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The effect of chenodeoxycholic acid (CDCA) on the reservoir function of the gallbladder was studied in 46 patients with cholesterol cholelithiasis. There was a dependence between a clear increase of filling of the gallbladder in patients treated by this method with subsequent sharp reduction of its size and development of dyspepsia and diarrhea. In 14 patients increase of the gallbladder against the background of chemotherapy was not authentic but no dyspeptic phenomena occurred. Thus, decompensation of the reservoir function of the gallbladder in patients with cholelithiasis against the background of chemotherapy are manifested by a significant increase of the gallbladder size with subsequent emptying of bile into the duodenum and development of collagenous diarrhea. 相似文献
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