Good Alternative In Cases Research Articles

Effect of Remifentanil on Active Phase Duration of Labor in Nulliparous Pregnant Women: A Cross-sectional Study

Objectives: Due to the increase in elective cesarean section and its high complications, epidural analgesia is the gold standard for reducing the pain of vaginal delivery. In contraindication cases, other effective and safe analgesic methods such as remifentanil are suggested. The present study aimed to compare the duration of active phase of labor at stages I and II, as well as neonatal Apgar score following the use of remifentanil analgesia. Materials and Methods: In this study, 120 healthy primiparous women who were candidates for vaginal delivery were selected. After matching for age and body mass index (BMI), the participants were assigned into two equal groups (n=60 each) of intervention (receiving remifentanil) and control. We compared the duration of active phase of labor at stages I and II, neonatal Apgar scores, and the cesarean section rate between the groups. Statistical analysis was performed using SPSS software (version 23). Results: There was no statistically significant difference between the two groups in terms of the duration of active phase in the first and second stages of labor (P=0.84 and P=0.78, respectively), 1-minute Apgar score (P=0.95), 5-min Apgar score (P=0.92), and the rate of cesarean section (P=0.067). Moreover, we observed no maternal complications with remifentanil. Conclusions: According to our results, remifentanil did not increase the duration of labor, rate of cesarean section, and maternal complications. Hence, it can be a good alternative in cases where epidural analgesia is contraindicated.

The applicability of Fourier transform infrared microspectroscopy for correction against matrix effects in X-ray fluorescence microimaging of tissues

X-ray fluorescence (XRF) and Fourier transform infrared (FTIR) microscopy techniques are now considered popular for rapid and label-free complementary spectrochemical analysis of chemical elements and molecular systems in biological specimens. The morphological heterogeneity but also the inhomogeneities associated with the thickness/density of biological samples demonstrate challenges for the quantitative XRF microimaging. Therefore, in the present work, we proposed for the first time the application of the total absorbance under the FTIR spectra as a mass surface correction procedure for two-dimensional (2D) XRF microimaging of tissues. We also evaluated the equivalence of the developed correction method based on total absorbance of FTIR spectra with the proposed approaches based on incoherent scattering of primary X-rays as well as on the membrane Si–Kα transmission signal, on the example of selected rat organ tissues. Thin cryo-sections taken from various organs of Wistar rats were deposited on silicon nitride membranes (Si3N4). The FTIR microscopy studies were performed to collect infrared absorption spectra, used then for the determination of total absorbance values in the selected areas of tissue samples. In turn, hard X-ray imaging based on synchrotron radiation allowed the determination of characteristic radiation intensities of the elements detectable from the tissue, as well as the characteristic radiation of the membrane Si and incoherently scattered X-ray photons (Compton scattering). The latter served as correction factors for the surface mass of the sample alongside the FTIR total absorbance. The qualitative and quantitative analyses showed a high agreement between the results of elemental surface mass correction using total absorbance under FTIR spectra of tissues with those obtained using surface mass correction factors determined directly from XRF spectra. Therefore, the proposed procedure is a good alternative in cases where the surface mass effect of the sample cannot be eliminated based on the information provided directly by the XRF spectrum, as in the case of using polymer films as sample support. We have also proposed a procedure for synchronizing SRXRF and FTIR images, not limited to visual inspection of imaging/mapping data, but also enabling quantitative analysis. We found that the total absorbance determined from FTIR spectra can be successfully used as a correction factor for eliminating the surface mass effect in XRF microimaging of thin freeze-fried tissues and therefore to obtain the surface mass-independent elemental quantities. The proposed approach for 2D-FTIR-XRF analysis can also be a powerful and versatile tool for fostering a correlation and co-localization analysis to search for common distribution patterns between molecular arrangements and chemical elements.

Stereotactic body radiotherapy boost in patients with cervical cancer

Our aim was to evaluate the oncological outcomes of stereotactic body radiotherapy (SBRT) boost in patients with cervical cancer. The data of 21 patients who received SBRT boost after definitive radiotherapy (RT) or chemoradiotherapy (CRT) between March 2012 and April 2019 were retrospectively evaluated. External beam radiotherapy (EBRT) was applied to patients with a total dose of 50.4 Gy in 28 fractions. Kaplan–Meier method was used for survival analysis (IBM SPSS 23 software) and p < .05 value was considered significant. After definitive RT or CRT, there was a complete response in 9 (43%) patients, partial response in 11 (52%) patients and stable disease in 1 (5%) patient. The median follow-up period was 28 months (range, 7.5–88 months). Two-years cancer-specific survival rate was 80%. While 2-year LC rate was 75% in patients with residual tumour size <4 cm, it was 50% when there was ≥4 cm residual tumour after definitive CRT (p = .1). The treatment was well-tolerated and no acute or late toxicity was observed. Although brachytherapy (BRT) is an essential part of the treatment in locally advanced cervical cancer, SBRT may be used in patients with small residual disease who are not candidate for BRT. IMPACT STATEMENT Cervical cancer is one of the most common cancers in the world, and external beam radiotherapy (EBRT) and brachytherapy (BRT) are the main treatment options. However, in rare cases where BRT is not feasible, it has been questioned whether stereotactic body radiotherapy (SBRT) as an alternative to BRT. What is already known on this subject? Nowadays, BRT still appears to be the gold standard treatment. However, studies with a small number of patients and short follow-up periods in the literature show that SBRT can be a good alternative in cases where BRT cannot be performed. What do the results of this study add? Our study is one of the series with the largest number of patients in the literature and with the longest follow-up period. In this area where there is no prospective study, we think that retrospective data with high patient numbers are enlightening. What are the implications of these findings for clinical practice and/or further research? Our study shows that SBRT is an alternative option in cases with small residual disease where BRT cannot be applied, and it provides a basis for a prospective randomised study.

Tunneled catheters in hemodialysis: Indications and complications.

Tunneled central venous catheters (TCVC) are a good alternative in case that an arteriovenous fistula (AVF) cannot be made, awaiting maturation or during unscheduled hemodialysis. We report the experience in placing these catheters by nephrologists and establish the various indications and complications in hemodialysis patients. We also relate the lifespan of tunneled catheters in our series. Our study is a retrospective, descriptive and analytical, study carried out in nephrology department, including all the patients who benefited from a TCVC between June 2018 to June 2020. We included a total of 138 patients, Glomerular nephropathy was the main cause of end stage renal disease (ESRD) (34.6%). In total, 116 patients previously had an AVF. The average duration of use of TCVC was 140.62 days±106.104 [10-548 days]. The most frequent indication for placement of the tunneled catheter was pending for AVF to be made. We identified 64 (46%) cases who presented with complications per procedure (mechanical and hemorrhagic), the delayed complications were present in 12.3% of patients with 56.5% who presented with infectious complications in our series, and 43.5% of them experienced thrombotic complications. Two deaths in our series were related to a septic shock and a hemothorax. Mechanical and thrombotic complications occurred more frequently in women (P=0.032, P=0.018, respectively). For bleeding complications, the significant risk factor during our study was thrombocytopenia (P=0.027). Infectious complications, were linked to seniority in hemodialysis (P=0.014). Thrombotic complications were related to history of heart disease and anemia<8g/dL (P=0.01; P=0.043, respectively). The first indication of a CVC was a pending for AVF. Even if the per procedure complications were more frequent, they were benign in most cases. The delayed complications were mostly infectious and thrombotic. The lifespan of TCVC in our series was short since the main indication of the removal was the maturation of an AVF.

C2/3 Transfacetal fixation: An underutilized technique of C2 fixation in the management of atlantoaxial dislocation - A technical note with review of literature.

Background:Atlantoaxial Dislocation (AAD) is a complex disorder of craniovertebral junction (CVJ). Many techniques are available to treat AAD but there are some specific conditions where some techniques have advantage over the other.Technical Advantage:C2-3 transfacetal screw with standard C1 lateral mass fixation provides a stronger construct because of four cortices incorporation and divergent course of screws and is biomechanically comparable to other forms of C2 fixation techniques. It is a technically less demanding and time-consuming. It is also a good alternative in cases having significant osteopenia.Conclusion:C2-3 transfacetal screw with standard C1 lateral mass fixation is an effective alternative to routine C1 lateral mass and C2 pedicle/pars screw fixation in cases of atlantoaxial dislocation complicated with high riding or posteriorly placed vertebral artery and thin pedicle of C2 vertebra.

Comparison of the colon with T1 breath-hold vs T1 free-breathing—A retrospective fetal MRI study

ObjectivesFetal magnetic resonance imaging (MRI) plays an increasingly important role in the prenatal diagnosis of gastrointestinal abnormalities. During gestation, the bowel develops T1-weighted hyperintensity due to meconium formation. Currently used T1-weighted sequences are performed in maternal breath-hold (BH) technique, which may take up to 20 s. The free-breathing (FB) T1-weighted 3D radial VIBE (volumetric interpolated breath-hold examination) sequence requires no breath-hold, improving patient comfort. This study aimed to address how well the FB acquisition technique can visualize large bowel structures compared to the routinely performed breath-hold sequence. MethodsForty-seven fetal MRI studies between 21 and 36 weeks of gestation without abdominal pathologies on prenatal MRI and ultrasound were included. All fetal scans were performed using a Philips Ingenia 1.5 T MRI. Coronal T1-weighted BH and FB sequences without fat suppression were compared. The following acquisition parameters were used (T1, FB): resolution 1.137 mm, 1.004 mm; matrix size 288 × 288, 448 × 448; FOV 328 mm, 450 mm; TR 81−132 ms, 3.47 ms; TE 4.6 ms, 1.47 ms. Due to the necessity of the breath-hold the duration of the sequence could not exceed 20 s (mean duration of the T1-weighted BH sequence 15.17 s, and mean duration of the FB sequence 26.42 s). In all examined fetuses the following structures were evaluated with respect to their visibility (0-not visible, 1-partially visible, 2-clearly visible): rectum, sigmoid, descending, transverse and ascending colon, cecum. Furthermore, motion artifacts were assessed (0-none, 1-intermediate, 2-severe motion artifacts), and the signal intensity (SI) ratio between maternal fat and fetal rectum SI was calculated. ResultsNo significant differences in the visibility of sigmoid and colon between BH and FB were detected, only the cecum could be seen slightly better (in 29.8 % of cases) using BH technique. Motion artifacts were similar between BH and FB. There was a non-significant SI difference (p = 0.68) in the rectum, with a higher SI in the BH sequence. ConclusionsThe FB acquisition technique compared to T1 using BH is equal regarding visibility of bowel structures and artifacts. Due to non-inferiority to the BH technique, the FB sequence is a good alternative in cases where BH cannot be performed. As the FB sequence further allows for thinner slices with a good signal, even small bowel loops may be visualized.

Het (on)voorspelbare brein

Abstract The (un)predictable brain In this paper I give an assessment of the (potential) predictive power of brainreading technology by comparing it to our capacity to predict others’ behavior by means of mental state attribution (mindreading). I identify two constraints that are typically ignored in the literature on brainreading and discuss their implications for the predictive power of brainreading. I conclude that there is little reason to expect that brainreading technology will generate better predictions than everyday mindreading, but that it might offer a good alternative in cases where mindreading underperforms or completely fails.

An alternative methodology to determine 210Pb activity soil profiles

Unsupported 210Pb (Pbexc) is generated in air and is subsequently deposited on soil surface. The Pbexc can be used for sediment dating, soil erosion/sedimentation and air mass studies.In many cases, 210Pb activity determination (gamma ray 46.5 keV) cannot be performed due to the lack of efficiency calibration curve, especially when radioactive patron source is not available.This work presents an alternative methodology to obtain the 210Pb activity values, based on the activity definition and the attenuation coefficient determinations and assuming that soil samples coming from depth higher than 25 cm only contain 210Pb generated in the soil (Pbexc free, i.e., for those soil layers the 210Pb activity is equal to the 226Ra activity, at secular equilibrium).The proposed methodology was evaluated using soils from La Plata region, Argentina. The same soil samples were also analyzed in a second laboratory by the conventional methodology. The obtained results indicated that the proposed procedure can be used as a good alternative in cases where a calibration sample is not available.

Comparison of contrast-enhanced and diffusion-weighted MRI in assessment of the terminal ileum in Crohn\u2019s disease patients

PurposeThe purpose of the study was to compare the performance of contrast-enhanced (CE)-MRI and diffusion-weighted imaging (DW)-MRI in grading Crohn’s disease activity of the terminal ileum.MethodsThree readers evaluated CE-MRI, DW-MRI, and their combinations (CE/DW-MRI and DW/CE-MRI, depending on which protocol was used at the start of evaluation). Disease severity grading scores were correlated to the Crohn’s Disease Endoscopic Index of Severity (CDEIS). Diagnostic accuracy, severity grading, and levels of confidence were compared between imaging protocols and interobserver agreement was calculated.ResultsSixty-one patients were included (30 female, median age 36). Diagnostic accuracy for active disease for CE-MRI, DW-MRI, CE/DW-MRI, and DW/CE-MRI ranged between 0.82 and 0.85, 0.75 and 0.83, 0.79 and 0.84, and 0.74 and 0.82, respectively. Severity grading correlation to CDEIS ranged between 0.70 and 0.74, 0.66 and 0.70, 0.69 and 0.75, and 0.67 and 0.74, respectively. For each reader, CE-MRI values were consistently higher than DW-MRI, albeit not significantly. Confidence levels for all readers were significantly higher for CE-MRI compared to DW-MRI (P < 0.001). Further increased confidence was seen when using combined imaging protocols.ConclusionsThere was no significant difference of CE-MRI and DW-MRI in determining disease activity, but the higher confidence levels may favor CE-MRI. DW-MRI is a good alternative in cases with relative contraindications for the use of intravenous contrast medium.

The effects of lipoic acid and methylprednisolone on nerve healing in rats with facial paralysis

Objective: To investigate the effects of lipoic acid and methylprednisolone on nerve healing in rats with traumatic facial paralysis.Materials and methods: The rats were randomly divided into four groups, with six rats in the control group and eight each in the remaining three groups. The buccal branch of the facial nerve in all groups except the control group was traumatized by a vascular clamp for 40 minutes. Group 1 was given lipoic acid (LA), Group 2 was given methylprednisolone (MP), and Group 3 was given lipoic acid and methylprednisolone (LA + MP) for one week. Nerve stimulus thresholds were measured before trauma, after trauma and at the end of the one week treatment period.Results: When the groups were compared with each other, post-treatment threshold levels of LA + MP were significantly lower than LA. Although post-treatment threshold levels of LA and MP were still higher than the control group, there was no significant difference between LA + MP and control values (p > .05).Conclusion: Lipoic acid has a positive effect on nerve healing and can enhance the effect of methylprednisolone treatment. It is a good alternative in cases where methylprednisolone cannot be used.

Nutrition of the preterm infant

Nutrition is of great importance for the preterm infant. It is not only essential for survival, but also makes provision for rapid development of many organs outside the uterus which process normally takes place in the third trimester of pregnancy. It is for future life essential that all factors that might influence the development are as optimal as possible, including nutrition. However, there might also be an upper limit to the intake of some ingredients in the neonatal period. The rate of growth of the preterm infant is five times higher compared to term infants and the breast of the mother delivering preterm might yet be ready to produce the optimal composition of milk. Preterm infants receiving mothers milk only are known to show a lower gain in weight and length than the so called reference fetus. It is therefore at least questionable if preterm human milk can be used to define the nutritional needs of the preterm infant. To define the optimal composition and amounts of nutrients for the preterm infant a factorial approach can be used. The estimated requirements are calculated from the calculated requirements for maintenance and growth. Though some studies have shown that the protein content of milk from mothers who delivered preterm can be higher in the first few weeks after birth compared to milk of term delivering mothers, soon after there is a rapid decline in protein content after which period the content is not different from the term delivered mother. Providing exclusively mothers own milk leads to suboptimal growth and insufficient accretion of minerals. The needs of the preterm infant in energy, protein, lipids, carbohydrates, minerals, pro- and prebiotics to provide optimal nutrition in the first days after birth are discussed in the paper. It is concluded that nowadays early, aggressive nutrition directly after premature birth with the immediate introduction of amino acids and rapid introduction of lipids is advised. Enteral feeding should be started very soon after birth, preferably on the first day of life and increased in the days thereafter. The first choise for enteral feeding is mothers own milk, supplemented from the second week with a fortifier. Special preterm formula might serve as a good alternative in case when breast milk is not available.

Comparison and ranking of different modelling techniques for prediction of site index in Mediterranean mountain forests

Forestry science has a long tradition of studying the relationship between stand productivity and abiotic and biotic site characteristics, such as climate, topography, soil and vegetation. Many of the early site quality modelling studies related site index to environmental variables using basic statistical methods such as linear regression. Because most ecological variables show a typical non-linear course and a non-constant variance distribution, a large fraction of the variation remained unexplained by these linear models. More recently, the development of more advanced non-parametric and machine learning methods provided opportunities to overcome these limitations. Nevertheless, these methods also have drawbacks. Due to their increasing complexity they are not only more difficult to implement and interpret, but also more vulnerable to overfitting. Especially in a context of regionalisation, this may prove to be problematic. Although many non-parametric and machine learning methods are increasingly used in applications related to forest site quality assessment, their predictive performance has only been assessed for a limited number of methods and ecosystems. In this study, five different modelling techniques are compared and evaluated, i.e. multiple linear regression (MLR), classification and regression trees (CART), boosted regression trees (BRT), generalized additive models (GAM), and artificial neural networks (ANN). Each method is used to model site index of homogeneous stands of three important tree species of the Taurus Mountains (Turkey): Pinus brutia, Pinus nigra and Cedrus libani. Site index is related to soil, vegetation and topographical variables, which are available for 167 sample plots covering all important environmental gradients in the research area. The five techniques are compared in a multi-criteria decision analysis in which different model performance measures, ecological interpretability and user-friendliness are considered as criteria. When combining these criteria, in most cases GAM is found to outperform all other techniques for modelling site index for the three species. BRT is a good alternative in case the ecological interpretability of the technique is of higher importance. When user-friendliness is more important MLR and CART are the preferred alternatives. Despite its good predictive performance, ANN is penalized for its complex, non-transparent models and big training effort.

2D shape similarity as a complement for Voronoi–Delone methods in shape reconstruction

In surface reconstruction from planar cross sections it is necessary to build surfaces between 2D contours in consecutive cross sections. This problem has been traditionally attacked by (i) direct reconstruction based on local geometric proximity between the contours, and (ii) classification of topological events between the cross sections. These approaches have been separately applied with limited success. In case (i), the resulting surfaces may have overstretched or unnatural branches. These arise from local contour proximity which does not reflect global similarity between the contours. In case (ii), the topological events are identified but are not translated into the actual construction of a surface. This article presents an integration of the approaches (i) and (ii). Similarity between the composite 2D regions bounded by the contours in consecutive cross sections is used to: (a) decide whether a surface should actually relate two composite 2D regions, (b) identify the type and location of topological transitions between cross sections and (c) drive the surface construction for the regions found to be related in step (a). The implemented method avoids overstretched or unnatural branches, rendering a surface which is both geometrically intuitive and topologically faithful to the cross sections of the original object. The presented method is a good alternative in cases in which correct reproduction of the topology of the surface (e.g. simulation of flow in conduits) is more important than its geometry (e.g. assessment of tumor mass in radiation planning).

Comparison of equilibrium radionuclide ventriculography with cardiovascular magnetic resonance for assessing the systemic right ventricle after Mustard or Senning procedures for complete transposition of the great arteries

We assessed the utility of equilibrium radionuclide ventriculography for assessing function of the systemic right ventricle by comparing it with cardiovascular magnetic resonance (CMR) in subjects who had undergone the Mustard or Senning operations for complete transposition of the great arteries. The 95% limits of agreement for right ventricular ejection fraction by the 2 techniques were 15.8% to −16.0%, demonstrating that equilibrium radionuclide ventriculography has good agreement with CMR and provides a good alternative in cases in which CMR is not available or appropriate.

Experience with alternative material for nasal augmentation.

In the last six years, 101 Proplast II implants were used for correcting various nasal deformities. The time of observation ranged from one to six years. During this period, four implants were removed: two because of late postoperative infection and two others because of trauma. Our experience indicates that Proplast II is a good alternative in cases that require alloplastic implants to correct an existing nasal deformity.