Residual Signs Research Articles

Film thickness effect on texture and residual stress sign transition in sputtered TiN thin films

Abstract Residual stress in thin films and coatings strongly affects their properties and behavior in service. Comprehensive understanding and precise measurements of residual stress are prerequisites for preparing high quality films and coatings. Residual stresses in TiN films with different thickness were measured by X-ray diffraction (XRD) employing the cos 2 α sin 2 ψ method with certain optimization. Grazing incidence parallel beam optics was combined with side-inclination geometry using in-house designed sample stage to ensure results accuracy. To validate this method, TiN films with thickness ranging from 1 to 3 µm were deposited on (100) Si single crystal substrates at 300 °C by RF magnetron sputtering. High compressive −2 GPa residual stress was present in the 0.9 µm thick film and decreased with film thickness. Tensile stress of less than 0.3 GPa was present in 2 µm TiN film. Compressive-to-tensile residual stress transition was observed with the film thickness increase. Microstructure change with growth, annihilation of grain boudaries, atomic peening and recovery mechanisms are responsible for the reported stress sign transition.

Combining the complex Langevin method and the generalized Lefschetz-thimble method

The complex Langevin method and the generalized Lefschetz-thimble method are two closely related approaches to the sign problem, which are both based on complexification of the original dynamical variables. The former can be viewed as a generalization of the stochastic quantization using the Langevin equation, whereas the latter is a deformation of the integration contour using the so-called holomorphic gradient flow. In order to clarify their relationship, we propose a formulation which combines the two methods by applying the former method to the real variables that parametrize the deformed integration contour in the latter method. Three versions, which differ in the treatment of the residual sign problem in the latter method, are considered. By applying them to a single-variable model, we find, in particular, that one of the versions interpolates the complex Langevin method and the original Lefschetz-thimble method.

Plasmapheresis, Intravenous Immunoglobulins, and Autologous Serum Eyedrops in the Acute Eye Complications of Toxic Epidermal Necrolysis.

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN. A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63.8 ± 24.7 years) with TEN. Bilateral, acute ocular surface complications were observed in 7 (78%) patients; 3 showed catarrhal conjunctivitis, whereas 4 had severe pseudomembranous conjunctivitis and corneal ulcers. All patients with TEN were immediately treated with plasmapheresis and human IVIg, which produced a marked improvement in the patients' general condition. In the 3 with catarrhal conjunctivitis, preservative-free artificial tears and topical antibiotics were beneficial. In the 4 with severe pseudomembranous conjunctivitis and corneal ulcers, treatment with AS eyedrops resulted in corneal and conjunctival epithelium healing over 3-6 weeks. After a minimum follow-up of at least 12 months, there were minimal/mild residual signs and symptoms of dry eye. Plasmapheresis and IVIg may be life-saving and contribute to reduce ocular surface inflammation in TEN. Autologous serum eyedrops, prepared after plasmapheresis completion and IVIg infusion, may be helpful in the management of the severe acute ocular complications of TEN.

Ophthalmic outcomes of fractured zygomas

In patients with fractures of the zygomatic complex, computed tomography (CT) often identifies extensive defects in the orbital floor. Some surgeons recommend routine exploration and repair of these defects during repair of the zygoma, while others advocate a more selective approach, but there is a paucity of evidence either way. We report a retrospective case series of 50 patients who had open reduction and internal fixation of zygomatic fractures by a single surgeon in the maxillofacial department at the John Radcliffe Hospital, Oxford, between 2011and 2014. The orbit was repaired only in those with severe diplopia, or restriction or malpositioning of the globe. Patients were evaluated by age, sex, aetiology, preoperative findings including diplopia and ocular malpositioning, fracture pattern, and morbidity. A total of 14 had preoperative ophthalmic signs. In five these were minimal so treatment was conservative. Nine (eight with diplopia and one with a malpositioned globe) had exploration and seven of them had the orbit repaired at the same time as the zygoma. This was not possible in the remaining two because of the complexity of the defect. There were no postoperative ophthalmic signs in the 41 who did not have orbit explored, or in the seven who had it repaired, and residual signs resolved after planned secondary reconstruction in the remaining two. We recommend that the orbit is explored only in patients with severe diplopia, or restriction or malpositioning of the globe.

Long-term follow-up of Norwegian horses affected with acquired equine polyneuropathy.

Acquired equine polyneuropathy (AEP), a neurological disease clinically characterised by knuckling of metatarsophalangeal joints, has been described in numerous Nordic horses during the last 20years. Although clinical recovery has been reported, large-scale data on long-term follow-up of survivors have been lacking. To describe long-term survival of AEP affected horses registered in Norway, with a focus on athletic performance and possible residual clinical signs connected to the disease. A retrospective cohort study. The study includes 143 horses recorded with AEP in Norway from 2000 to 2012, with the follow-up period continuing until 2015. Participating owners of survivors completed a standardised questionnaire, providing information on disease and convalescence, management, performance-level and possible residual clinical signs. To investigate the follow-up of survivors, we performed 2 multivariable linear regression models. The follow-up time of survivors was 1.0-14.5years (median 5.3, interquartile range 2.5-7.2). Fifty-seven horses survived and all but 3 horses returned to previous or higher level of performance. However, possible disease-related residual clinical signs were reported in 14/57 horses. Forty-nine of the survivors were in athletic use at time of contact. The majority of survivors were categorised with low severity-grades at time of diagnosis and the initial grade was significantly associated with time to resumed training. Only 3 horses had experienced relapse/new attack during the follow-up period. Athletic performance was judged by owners, which renders a possible source of bias. Although AEP is a potential fatal disease, most survivors will recover and return to minimum previous level of athletic performance. Some horses display residual clinical signs, but often without negative effect on performance and relapse of disease is rare.

Evolutionary trends in the geochemistry of steppe soils under long-term agricultural use

The aim of this research was to identify long-term changes in the material composition of arable and fallow lands in the agricultural district of an ancient center in the Northern Black Sea region. Geochemical features of changes in the upper mineral soil horizon of different-aged arable and fallow lands near the ancient city of Kerkinitis were studied. The multitemporal boundary between arable lands of different ages was identified, and indicators to diagnose residual signs of former agricultural loads were revealed in the material composition of agrozems using geostatistical methods. The use of such unique objects of study as soils of ancient agricultural areas is related to the potential evaluation of risks of fertility loss because of slow but practically irreversible processes of pedogenesis and the opportunity to prevent or reduce their negative manifestations in arable land.

Early improvement of symptoms using LCZ696 in a patient with systolic heart failure and a reduced ejection fraction: a case report

Heart failure is a progressive disease with high mortality and morbidity. LCZ696 is a drug that has recently shown its improved efficacy and safety in patients with systolic heart failure and a reduced ejection fraction. Reports on its impact on the improvement of clinical symptoms are, however, scarce. These are important because they improve a patient's compliance with treatment and their quality of life. We report on the case of a 71-year-old patient who had deteriorating symptoms and signs of heart failure (ejection fraction [EF] 34%) in whom we initiated LCZ696 treatment. After two months of LCZ696 treatment (including titration), the New York Heart Association (NYHA) classification had improved (III→II/I) with no residual signs of acrocyanosis and orthopnea. While creatinine values remained stable, potassium increased to 5.0 mmol/l and brain natriuretic peptide (BNP) dropped from 1260 ng/l to 680 ng/ml. The final EF was 47%. The patient reported substantial improvement of his quality of life. We show, based on a case report, that symptoms associated with heart failure deterioration are improved early after the initiation of LCZ696. This should foster specific research into symptoms and quality of life improvements with LCZ696.

Towards a method to differentiate chronic disorder of consciousness patients' awareness: The Low-Resolution Brain Electromagnetic Tomography Analysis

Assessing residual signs of awareness in patients suffering from chronic disorders of consciousness (DOC) is a challenging issue. DOC patient behavioral assessment is often doubtful since some individuals may retain covert traces of awareness; thus, some Unresponsive Wakefulness Syndrome (UWS) patients may be misdiagnosed. The aim of our study was to explore possible differences between the source powers within poly-modal cortices to differentiate Minimally Conscious State (MCS) from UWS. To this end, we recorded an electroencephalogram (EEG) during awake resting state and performed a Low-Resolution Brain Electromagnetic Tomography (LORETA), which is a 3D source localization method allowing the visualization of the most probable neuroanatomical generators of EEG differences. MCS and UWS patients showed significant variations concerning the frontal source power of delta-band, frontal and parietal of theta, parietal and occipital of alpha, central of beta, and parietal of gamma, in correlation with the Coma Recovery Scale-Revised (CRS-R) score. The alpha-band was the most significant LORETA data correlating with the consciousness level. In addition, we observed a significant correlation between central beta-peaks and the motor abilities and a dissociation between theta and gamma bands within parietal regions. Our findings suggest that LORETA analysis may be useful in DOC differential diagnosis since distinct neurophysiological correlates in some UWS patients could be used to assess deeper the residual cerebral activity of brain areas responsible for covert awareness.

Sugammadex in patients with chronic renal failure: two case reports

Rocuronium is a non-depolarizing aminosteroidal neuromuscular blocking agent that is widely used in general anesthesia. Its effects may be prolonged in patients with renal disease, especially renal failure, due to reduced clearance of the drug. Sugammadex, a modified γ-cyclodextrin, is known to be a highly effective reversal agent for rocuronium-induced muscle relaxation. However, the administration of sugammadex for reversal of rocuronium-induced neuromuscular block in patients with renal disease is controversial. Recently, we administered rocuronium for neuromuscular blockade during the surgery of two patients with chronic renal failure, instead of cisatracurium, a benzylisoquinoline compound. Therefore, we had to administer sugammadex to ensure maximum alleviation of residual neuromuscular blockade risk after surgery. Although the effect of rocuronium was prolonged during surgery, sugammadex quickly and completely restored the response of train-of-four stimulation postoperatively. There were no residual neuromuscular block signs or symptoms observed in these patients throughout the postoperative period. In this report, we share our experience with these cases, and discuss the effectiveness and safety of sugammadex in the context of chronic renal failure. Keywords: Neuromuscular blockade; Neuromuscular monitoring; Renal failure; Residual neuromuscular blockade; Rocuronium; Sugammadex

Health status evaluation in extremely premature infants

The health status was analyzed in extremely preterm infants at a postconceptual age of 38–40 weeks and in the first year of life. All the infants in the analyzed group were shown to have respiratory disorders, severe perinatal CNS lesions, and the high incidence of bronchopulmonary dysplasia and infectious and inflammatory diseases. In the first year of life, these children belonged to a group of the frequently ill. Dysfunction of the digestive system and intestinal microflora and residual signs of rickets were detected in the majority of the patients; the manifestations of bronchopulmonary dysplasia persisted in 50%. 40% of the infants had disabling complications.

Ostéome ostéoide de la glène : traitement arthroscopique

Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the visual analog scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.

Abstract 19103: Tolvaptan Increases Urine Output Without Hemodynamic Impairment in Heart Failure Patients With Renal Dysfunction

Introduction: There has been scant clinical evidence on whether the aquaretic effect of tolvaptan (TLV) contributes to decongestion without further renal impairment compared with furosemide (FUR). Methods: The Kanagawa Aquaresis Investigators Trial of TLV on Heart Failure Patients with Renal Impairment (K-STAR) is a multicenter, open-labeled, randomized, controlled prospective clinical study of 81 patients with heart failure (HF) in Japan. Patients with residual signs of congestion despite treatment with oral FUR at a dose of ≥40 mg/day with baseline estimated glomerular filtration rates of <45 mL/min were randomly assigned to two groups for 7-day treatments with either ≤15 mg/day of additive TLV or ≤40 mg/day of FUR. Results: During the treatment period, a more significant increase from baseline in urine volume (%ΔUV) was seen in the TLV group than in the FUR group (+42 ± 43% in the TLV group vs. +15 ± 39% in the FUR group, p < 0.01). Renal function was better preserved in the TLV group than in the FUR group [increase in serum creatinine (%ΔCr): +3 ± 13% in the TLV group vs. +10 ± 14% in the FUR group, p = 0.015]. Increases in the ratio of blood urea nitrogen to %ΔCr and %ΔUV were positively correlated in the FUR group (r = 0.33, p = 0.03) but were not significantly correlated in the TLV group (r = -0.15, p = 0.34). Moreover, an increase in pulse rate (%ΔPR: r = 0.31, p = 0.04) and decrease in stroke volume (%ΔSV: r = –0.35, p = 0.04) were positively correlated to the %ΔUV in the FUR group but not in the TLV group (%ΔPR: r = 0.10, p = 0.51; %ΔSV: r = –0.08, p = 0.65; respectively). Conclusions: TLV increases UV with less hemodynamic and renal impairment by maintaining adequate intravascular volume compared with FUR in HF patients with renal dysfunction.

Osteoid osteoma of the glenoid: Arthroscopic treatment

Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the Visual Analog Scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) Scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.

Hemodialysis-Associated Spondylodiscitis of the Cervical Spine: A Case Report.

A fifty-seven-year-old, hemodialysis-dependent man presented with a one-month history of progressive neck pain and paresthesias of the upper extremities. Radiographic examination demonstrated collapse of the C5 and C6 vertebrae with resultant kyphosis and spinal cord compression. The patient underwent a staged anterior debridement with C5 and C6 corpectomies, cage placement, and plate fixation of C4 to C7, followed by a posterior arthrodesis from C4 to C7. He completed a six-week course of intravenous antibiotics for the treatment of Staphylococcus epidermidis spondylodiscitis, followed by suppressive oral antibiotics. At one year of follow-up, he had no residual neck pain or neurological signs or symptoms.

Prospective study of recovery from copperhead snake envenomation: an observational study.

BackgroundAlthough much is known about signs, symptoms, and management in the acute phase of crotaline snake envenomation, little is known about signs, symptoms, function, and quality of life during the recovery phase. The purpose of this observational pilot investigation is to evaluate the utility of several clinical outcome instruments in the setting of copperhead snakebite, and to characterize the clinical course of recovery.MethodsThis is a multi-center prospective, open-label, observational study of patients envenomated by copperhead snakes. We administered the Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), Patient-Specific Functional Scale (PSFS), Work Productivity and Ability Impairment: Special Health Problem (WPAI: SHP), Patients’ Global Impression of Change (PGIC), Patient’s Global Assessment of Recovery (PGAR), and SF-36 instruments, obtained numeric pain rating scales, and measured grip strength, walking speed, and swelling prior to hospital discharge and 3, 7, 14, 21, and 28 days after envenomation.Results20 subjects were enrolled; none were lost to follow-up. Most (80%) had moderate severity swelling, and most (75%) received antivenom. Across the broad range of measures, abnormalities of pain, swelling, impairments of physical and role function, and quality of life persisted for 7–14 days in most subjects. Validated self-reported outcome measures, such as the DASH, LEFS, PSFS, PGIC, SF-36, and the daily activities impairment portion of the WPAI: SHP were more responsive than measurements of swelling or walking speed. Data quality issues limited the utility of the work impairment portion of the WPAI: SHP. Residual signs, symptoms, and impairment in some subjects lasted through the 28-day study period. The study design precluded any assessment of the effectiveness of antivenom.ConclusionsSigns, symptoms, impaired function, and decreased quality of life typically last 7 – 14 days after copperhead envenomation. Several tools appear responsive and useful in studying recovery from pit viper envenomation.Trial registrationClinicalTrials.gov NCT01651299

OP17 – 2537: Epilepsy, clinical presentation and MRI features in patients with COL4A1 mutations

Objective COL4A1 mutations disrupt the integrity of basement membranes and therefore predispose to a broad spectrum of disorders affecting multiple organ systems, but most notably causing cerebral small vessel disease. There is little data on epilepsy in these patients. The aim of our study was to describe characteristics of epilepsy in patients with COL4A1-mutations including therapeutical aspects, to establish diagnostic criteria on the basis of typical MRI findings and to evaluate co-morbidities. Patients and methods Data was collected retrospectively by attending physicians via standardized questionnaires. MRI images were reviewed by one experienced pediatric radiologist in our centre (PW). Results All 6 patients had history of pre- or perinatal stroke or cerebral hemorrhage and later showed impairment of cognitive functions and motor development. Epilepsy in all patients manifested within the first year of life (3–10 months, mean: 6 months). Multiple antiepileptic drugs were administered (4–11; mean: 6.3); among those, valproic acid (4/6) and vigabatrin (4/6) proved effective whereas oxcarbazepine had aggravating effects in 2/6 patients. All patients showed co-morbidities such as ophthalmological disorders (6/6), microcephaly (6/6), and elevation of plasma creatine kinase levels (4/6). We identified generalized leukomalacia in one or both cerebral hemispheres, focal cystlike white matter defects and focal or multifocal (susceptibility-related) residual signs of hemorrhage/hemosiderin deposition not related to arterial infarction as concordant MRI findings in all 6 patients. Conclusion COL4A1 mutations should be considered as differential diagnosis in children with history of pre-/perinatal stroke or cerebral hemorrhage, impairment of cognitive and motor development and epilepsy. Despite the heterogeneity of the clinical phenotype, typical MRI findings and co-morbidities can lead to the correct diagnosis. Epilepsy in our patients with COL4A1-mutations manifested in the first year of life; in the small collective of our ongoing study, valproic acid and vigabatrin were the most effective antiepileptic drugs.

Neuromuscular Signs Associated with Acute Hypophosphatemia in a Dog

The purpose of this report was to describe the successful recognition and management of neuromuscular dysfunction secondary to severe, acute hypophosphatemia in an adult dog with a 2 day history of vomiting, anorexia, and abdominal pain. Radiographs were suggestive of a foreign body obstruction, and surgery was recommended. Resection and anastomosis of the distal duodenum and proximal jejunum was performed. The dog recovered uneventfully, but approximately 36 hr postoperatively, he was found to have significant weakness and muscle tremors that were accompanied by hyperthermia. The only significant abnormality on a serum biochemical profile was a phosphorous level of 0.26 mmol/L. Within 6 hr of initiating phosphorous supplementation, the patient fully recovered and had no residual signs of neuromuscular dysfunction. Signs of neurologic dysfunction secondary to hypophosphatemia are commonly recognized in human patients. Reports of patients with severe muscle weakness, some of which necessitate ventilation due to weakening of muscles of respiration, are common throughout the literature. Less commonly, tremors are noted. This is the first known report of neuromuscular signs recognized and rapidly corrected in a dog. Although it is likely to be uncommon, hypophosphatemia should be recognized as a differential diagnosis in patients with tremors and/or muscle weakness.

A traceable physical calibration of the vertical advection‐diffusion equation for modeling ocean heat uptake

AbstractThe classic vertical advection‐diffusion (VAD) balance is a central concept in studying the ocean heat budget, in particular in simple climate models (SCMs). Here we present a new framework to calibrate the parameters of the VAD equation to the vertical ocean heat balance of two fully‐coupled climate models that is traceable to the models' circulation as well as to vertical mixing and diffusion processes. Based on temperature diagnostics, we derive an effective vertical velocity w∗ and turbulent diffusivity for each individual physical process. In steady state, we find that the residual vertical velocity and diffusivity change sign in middepth, highlighting the different regional contributions of isopycnal and diapycnal diffusion in balancing the models' residual advection and vertical mixing. We quantify the impacts of the time evolution of the effective quantities under a transient 1% CO2 simulation and make the link to the parameters of currently employed SCMs.

Lathyrus hirsutus (Caley Pea) intoxication in a herd of horses.

BackgroundCaley Pea (Lathyrus hirsutus) is potentially toxic to horses, but large case series are not reported.ObjectivesTo describe the clinical signs of horses intoxicated with Lathyrus hirsutus and speculate on the neuroanatomical lesion localization and pathogenesis based upon the observed clinical signs.AnimalsTwenty‐two of 25 horses ranging in age from 6 to 34 months were affected. Five affected horses were presented to the OSUCHVS for evaluation and treatment after having been attended at the ranch by a local veterinarian (ALA). An additional horse that had been euthanized was also presented for necropsy.MethodsA case series is presented. Diagnostic evaluation included: physical examination, complete blood count, serum biochemistry, CSF analysis, EMG, ERG, upper airway endoscopy, muscle biopsy, and serum vitamin E analysis. The grain ration consumed by the affected horses was analyzed for ionophores and cultured for fungi: the hay was examined for toxic plants.ResultsBermuda grass hay consumed by the horses contained large quantities of mature Lathyrus hirsutus. Acute clinical signs conform to earlier descriptions of Lathyrus hirsutus intoxication in cattle. Residual neurologic signs were characterized by incoordination in the rhythmicity of multiple gaits. Evidence of mild neurogenic muscle atrophy was recognized in 1 of 5 horses biopsied.Conclusions and Clinical ImportanceCaley Pea intoxication may occur within days of seed pod consumption. The neurologic signs are unique and suggest involvement of the upper motor neuron system and regions of the spinal cord influencing voluntary motor movement. Drought conditions during plant growth may increase the risk of toxicosis.

Central toxic keratopathy after laser in situ keratomileusis

To review cases of central toxic keratopathy (CTK) occurring over a period of 46 days. Moorfields Eye Hospital, London, United Kingdom. Retrospective consecutive case series. This was a review of patients with CTK after uneventful laser in situ keratomileusis (LASIK) performed by 1 of 5 surgeons at a single institute. The following parameters were analyzed: corrected distance visual acuity (CDVA), manifest refraction, and central corneal thickness from Scheimpflug pachymetry readings (Pentacam). The cohort consisted of 15 eyes of 9 patients. Thirteen eyes were diagnosed within 7 days after LASIK, while the remaining 2 eyes developed CTK 12 days postoperatively. In 10 eyes, the time to resolution was 1 to 8 months. Five eyes still had residual signs at the last outpatient visit. At the final follow-up, 3 eyes (20%) had a CDVA worse than 0.0 logMAR. Although a rare entity, CTK can occur in clusters. Although a cause was not fully isolated, ultimately each eye achieved excellent CDVA (all better than 0.2 logMAR) at the last follow-up.