Total Restitution Research Articles

Determination of Recovery by Total Restitution or Compensation Using Multifrequency Vestibular Tests and Subjective Functional Scales in a Human Model of Vestibular Neuritis

Background: Vestibular Neuritis (VN) can induce unilateral acute vestibular syndrome (AVS). This study aimed to identify predictive factors of recovery from vestibular neuritis considering total restitution and/or compensation. Methods: In this longitudinal study, 40 patients were included. The initial assessment, performed within 36 to 72 h from the onset (T0), included medical history taking (general and specific), including screening for cardiovascular risk factors (CVRFs), and a battery of diagnostic vestibular tests, comprising the bithermal caloric test (BCT), video head impulse test (VHIT), and skull vibration-induced nystagmus (SVIN) test. All patients also completed a Dizziness Handicap Inventory (DHI). All assessments were repeated 90 ± 15 days later (T3). Subjective compensation criteria were based on the DHI total score, and objective compensation criteria were based on laboratory test results. Four groups of patients (A, B, C, D) were delineated by combining patients with normal vs. abnormal vestibular tests and patients with normal vs. abnormal DHI. Results: CVRFs (but not age or body mass index (BMI)) were associated with a poorer recovery of symptoms. The BCT (lateral semicircular canal paresis %), VHIT (lateral semicircular canal gain), and SVINT (nystagmus slow phase velocity) recovered to normal values in 20%, 20%, and 27% of patients, respectively, at T3. Conclusions: Vascular risk factors (hypercholesterolemia) are correlated with patients who do not recover their symptoms via either total restitution or compensation. There was no significant difference between high- and low-frequency vestibular tests in patients recovering from their symptoms. Some patients with objective recovery may continue to have persistent subjective symptoms.

Severe Conjunctival and Corneal Epithelial Dysplasia: A Case Series

Ocular surface squamous neoplasia (OSSN) are among the most frequent non-pigmented malignancies of the ocular surface. They have a wide range of histological characteristics - ranging from mild epithelial dysplasia to invasive carcinoma of the squamous cells of the cornea. They may be restricted to the conjunctiva or also involve the cornea. As there are no leading symptoms in the early stages, diagnosis may be very delayed in patients who do not receive regular ophthalmological treatment. The present case series describes clinical and histological data on OSSN and includes clinical and histological data on OSSN, including possible clinical presentations, important risk factors, special histological and cytological features and therapeutic options. Retrospective case series of patients with histologically confirmed severe epithelial dysplasia of the conjunctiva and cornea consistent with OSSN who presented to the Department of Ophthalmology in Basel University Hospital. The analysis covered demographic data, symptoms, diagnostic testing (photo documentation, brush biopsy), treatment and cytological and/or histological material and findings. We report on five patients aged between 41 and 92years at the time of diagnosis. The histological findings in all patients included severe epithelial dysplasia, but with a heterogenous clinical presentation. In all cases, the lesion started in the conjunctiva, but traversed the limbus and extended to the cornea. The primary treatment was always surgical removal. In one patient, this had to be repeated several times due to recurrent metaplasia and was complemented by subsequent mitomycin C therapy. The clinical outcome ranged between total restitution of the original state to inevitable enucleation. The clinical presentation of OSSN is highly heterogenous, so that the initial diagnosis is difficult. There are no official guidelines for treatment, so that the treatment of choice varied between clinics. Regular ophthalmological follow-ups are recommended, even after complete surgical excision. Possible relevant concomitant diseases and risk factors must be identified before therapy.

Experimental study on the fugitive characteristics of particles flow impacting inclined wall

The process of loading and unloading of bulk materials is common in industrial production, which is likely to cause dust pollution problems in the plant. In order to understand the dust generation mechanism of the material unloading process, this paper examines it through three processes. Firstly, we established an experimental model for the process of particle flow impacting on the wall. Secondly, the particle motion fugitive characteristics of the particles flow impacting the wall were tested using a high-speed camera. Finally, by processing the experimental data, the angle deviation ratio is pioneered to analyze the effect of wall angle on particle fugitive and the particle fugitive characteristics under different conditions. The results show that as the wall inclination angle increases, the angular deviation ratio is smaller, the total restitution coefficient of particles is larger, the fugitive contour tension angle is larger, and the outer particles fall further away; As the drop height increases, the farthest vertical distance of the fugitive contour from the impact surface is longer; As the outlet diameter increases, the particle impact velocity also increases. The research results can provide a theoretical basis for dust fugitive control during bulk material loading and unloading in industrial plants.

Rebound characteristics of burning aluminum droplets impacting surfaces

An experimental system is established to study the behavior of burning aluminum droplets impacting a wall in a solid-rocket-motor environment. First, the rebound process of droplets impinging on the wall is observed using shadow shooting; the size range of the burning aluminum droplets is 150–500 μm, and their range of impact speed is 1–5 m/s. Second, a formula is developed for predicting the droplet–wall contact time, and combined with energy conservation, a model for predicting the behavior of aluminum droplets impacting the wall is established. Furthermore, analyzing the droplet velocity reveals that the total restitution coefficient decreases gradually with increasing Weber number, whereupon a model for calculating the restitution coefficient is proposed. Compared with experimental results, the errors of the prediction model are within 15%. Finally, a new phenomenon involving the oscillatory motion of burning aluminum droplets is discovered; analyzing this oscillatory behavior gives an equation for the attenuation of the oscillation of droplets moving in a gas flow, and the results of this equation agree well with experimental data. The present experimental system and measurement method are suitable for fine measurements of the rebound process of burning aluminum droplets, and the present results lay a foundation for (i) studying the law governing the motion of aluminum droplets in a solid rocket motor and (ii) revealing the mechanism for interaction between them and the inner surface of the combustion chamber.

Study of the process of metal droplets with high surface tension impinging on wall

The behavior of aluminum droplets impacting a wall critically affects the operation of solid rocket motors. In the present study, the flow and rebound of aluminum droplets with a high surface tension are studied experimentally and numerically. In addition, the impact of aluminum droplets at different inclined angles is monitored experimentally. When the droplet is about to rebound away from the wall, it is stretched to its maximum length. An empirical correlation formula is proposed to predict the maximum length when a droplet is about to bounce off a flat plane. The velocity and pressure distributions of a droplet flowing over a flat plane and an inclined plane are compared by using the volume of fluid method. Furthermore, the restitution coefficient of the droplet is discussed in detail. When normal Weber number Wen ranges from 0 to 20, normal restitution coefficient en ranges from 0.3 to 0.6. When tangential Weber number Wet <10, tangential restitution coefficient et is subject to great uncertainty. When 10 < Wet < 80, et is maintained at 0.75. The formulas for the total restitution coefficient, normal restitution coefficient, and tangential restitution coefficient of the aluminum droplets are also presented. Based on the principle of conservation of energy, we calculate the remaining energy of the aluminum droplets impinging on a wall and provide the relationship between the restitution coefficient and the dissipated energy. The results elucidate the mechanisms at work when aluminum droplets collide with a wall.

Evolutionary aspects of psychotic disorders induced by cannabis

IntroductionCannabis is increasingly used by young people. Its several noxious effects on mental health have become a matter of preoccupation. Although cannabis use may be involved in the etiology of acute psychosis, there has been considerable debate about the association observed with chronic psychosis.Aims(1) To describe the profile of patients with cannabis use disorders (CUD); (2) to determine the evolutionary aspects.MethodsWe proceed with a retrospective and descriptive study conducted among 16 male patients with CUD and hospitalised for the first time in the psychiatric department at the University Hospital Hedi Chaker during the period from 1 January 2012 to 31 December 2014.ResultsAn overwhelming majority of the subjects were single and unemployed. One-third of the users had a stay abroad, the half was incarcerated at least once and one patient was implicated in illegal drugs trade. CUD were associated with specific personality disorders: borderline (18.8%) and antisocial (6.3%) personality. Into at least the 2 years of follow-up, different evolutionary aspects were distinguished. Many of the patients were lost to follow (18.8%). A total restitution of symptoms or a recurrence of the same disorders were observed in 25% of cases. About 56.3% of subjects had a change in diagnosis to either schizophrenia (43.3%) or affective disorder (12.5%).ConclusionThis study showed that cannabis use can be a cause of the emergence of chronic psychosis. This emphasizes the importance of early screening of the vulnerability to psychotic disorder and identify more effective strategies to improve intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Total re-establishment of superhydrophobicity of vertically-aligned carbon nanotubes by Co2 laser treatment

Total restitution of original superhydrophobicity of vertically-aligned multi-walled carbon nanotubes (VACNT) was achieved by CO2 laser treatment. Superhydrophobic VACNT films obtained by microwave plasma chemical vapour deposition (MWCVD) were pre-treated with oxygen plasma to convert them in superhydrophilic films. Treatments with CO2 laser at different powers were carried out on the superhydrophilic films for controlling of wettability. Changing in both surface energy and roughness of the VACNT films, was evaluated by contact angle measurement and atomic force microscopy images, respectively.

Decreased bone density and treatment in patients with autosomal recessive cutis laxa

Due to the occasional association pathological fractures and osteoporosis we evaluated four patients with cutis laxa syndrome for skeletal anomalies. We prospectively evaluated four patients, a male and a female child and a brother-sister sib pair, with dysmorphic features, growth delay, joint anomalies, psychomotor retardation and congenital cutis laxa. The clinical features and the family history were suggestive for autosomal recessive cutis laxa syndrome type II, partially overlapping with geroderma osteodysplastica. Skeletal survey, sequential bone density measurements, endocrine and metabolic investigations were performed including N- and O-linked glycosylation analysis. ATP6V0A2 and FBLN5 mutations were ruled out in all patients. All children were diagnosed with significantly decreased bone density, especially in the lumbar spine, including spontaneous vertebral and rib fractures in three children. Following 24 months of bisphosphonate treatment a total restitution of bone density was observed in three cases and no relapse was detected in the 2-year follow-up period. A spontaneous improvement was found in one female during puberty. Bone disease might occur early in the course in autosomal recessive cutis laxa syndrome. We report on a significant clinical improvement and stabilization in our patients following bisphosphonate therapy. We suggest early, systemic evaluation and follow up of bone density in all children presenting with inherited cutis laxa.

ERRATUM

Epidermal growth factor (EGF) is a cytoprotective peptide that has healing effects on the intestinal mucosa. We sought to determine whether systemic administration of EGF after the onset of sepsis improved intestinal integrity and decreased mortality. FVB/N mice were subjected to either sham laparotomy or 2 x 23 cecal ligation and puncture (CLP). Septic mice were further randomized to receive injection of either 150 microg kg(-1) d(-1) (i.p.) EGF or 0.9% saline (i.p.). Circulating EGF levels were decreased after CLP compared with sham animals but were unaffected by giving exogenous EGF treatment. In contrast, intestinal EGF levels increased after CLP and were further augmented by exogenous EGF treatment. Intestinal EGF receptor was increased after CLP, whether assayed by immunohistochemistry, real-time polymerase chain reaction, or Western blot, and exogenous EGF treatment decreased intestinal EGF receptor. Villus length decreased 2-fold between sham and septic animals, and EGF treatment resulted in near total restitution of villus length. Sepsis decreased intestinal proliferation and increased intestinal apoptosis. This was accompanied by increased expression of the proapoptotic proteins Bid and Fas-associated death domain, as well as the cyclin-dependent kinase inhibitor p21 cip1/waf Epidermal growth factor treatment after the onset of sepsis restored both proliferation and apoptosis to levels seen in sham animals and normalized expression of Bid, Fas-associated death domain, and p21 cip1/waf . To determine whether improvements in gut homeostasis were associated with a decrease in sepsis-induced mortality, septic mice with or without EGF treatment after CLP were followed 7 days for survival. Mortality decreased from 60% to 30% in mice treated with EGF after the onset of sepsis (P < 0.05). Thus, EGF may be a potential therapeutic agent for the treatment of sepsis in part due to its ability to protect intestinal integrity.

LeuCAM and Reactive Oxygen Species during Long-Term Exercise Combined with Sleep and Energy Deficiency

During the Norwegian military ranger-training course, cadets are exposed to prolonged physical exercise combined with sleep-, energy-, and food deficiency. The open-window postexercise hypothesis indicates that after hard physical activity, there is an increased risk of contracting infectious diseases. The purpose of the present study was to determine leukocyte reactive oxygen species (ROS) levels, total antioxidant status (TAS), leukocyte expression of the cell adhesion molecules CD62L and CD11b, and plasma levels of soluble adhesion molecule L-selectin before, during, and in the recovery phase of a military ranger-training course. Ten cadets from the Norwegian Military Academy were recruited to the study. Flow cytometry was used to study the intracellular levels of ROS in leukocytes (basally, as well as after in vitro stimulation with phorbol myristate acetate (PMA)), applying the probes dihydroethidium (DHE) and dihydrorhodamine 123 (DHR) and the leukocyte expression of adhesion molecules CD62L and CD11b. ELISA was used to assess the plasma levels of soluble L-selectin, and TAS in plasma was measured using the ABTS+ reduction assay kit. The basal levels of ROS as well as PMA-stimulated ROS in leukocytes declined gradually during the ranger-training course, being lowest on the last day (P < 0.05). The level of TAS increased (P < 0.01) during the course. A striking decrease (P < 0.001) was observed in leukocyte CD62L expression and was sustained even after 3 d of recovery. The leukocyte expression of CD11b remained unchanged. The ranger-training course leads to a partial exhaustion of the leukocyte ROS-generating machinery and to a nearly total extinguishing of leukocyte CD62L expression. These changes may support the open-window hypothesis indicating reduced ability to combat microbial invasions before total restitution.

Arthroscopic treatment of septic arthritis. Surgical technique and results

In a retrospective study we evaluated 22 patients suffering from septic arthritis, who were treated arthroscopically. We operated 15 male and 7 female patients with an average age of 38.1 years (4–70). There were 16 knee joints, 3 elbows, 2 shoulder and one hip. Arthroscopic therapy was indicated when the typical clinical signs and bloodchemical inflammation findings (increased ESR and CRP) were present and when bone involvement was excluded. Arthroscopic treatment was performed according to the local findings and the grade of infection. It consisted of lavage, debridement, synovectomy, and the application of an antibiotics-containing collagenous fleece. Additionally systemic antibiotics were applied peri- and postoperatively. None of our patients got a secondary osteomyelitis. 20 patients could be cured with a single operation, two patients had to be revised severeal times. Excluding one patient, in every patient the infect could be cured with a total restitution of the previous range of motion. CRP was the most sensitive parameter.

Arthroscopic therapy of septic arthritis. Surgical technique and results

In a retrospective study we evaluated 22 patients suffering from septic arthritis, who were treated arthroscopically. We operated 15 male and 7 female patients with an average age of 38.1 years (4-70). There were 16 knee joints, 3 elbows, 2 shoulder and one hip. Arthroscopic therapy was indicated when the typical clinical signs and blood-chemical inflammation findings (increased ESR and CRP) were present and when bone involvement was excluded. Arthroscopic treatment was performed according to the local findings and the grade of infection. It consisted of lavage, debridement, synovectomy, and the application of an antibiotics-containing collagenous fleece. Additionally systemic antibiotics were applied peri- and postoperatively. None of our patients got a secondary osteomyelitis. 20 patients could be cured with a single operation, two patients had to be revised several times. Excluding one patient, in every patient the infect could be cured with a total restitution of the previous range of motion. CRP was the most sensitive parameter. Considering the advantages of arthroscopic surgery and the good results in infection therapy, it should be recommended as a method as soon as joint infection is suspected.

Repair in arterial tissue 2 years after a severe single dilatation injury: The regenerative capacity of the rabbit aortic wall

The thoracic aortae from 11 rabbits that survived a single severe dilatation injury for 2 years were studied by vital staining with Evans blue, immunohistochemistry and transmission electron microscopy. Our results have shown almost total restitution of the thoracic aorta. Six of the 11 rabbits submitted to an injury had no blue-stained areas, indicating total reendothelialization. Five rabbits had a few blue areas often on the ventral side of the aorta. The reendothelialization from the first to the seventh pair of intercostal arteries ranged from 82% to 100%. There was intimal thickening inside the original internal elastic lamina in both white and blue areas. All blue areas had a surface composed of smooth muscle cells. Reendothelialized areas consisted of mature endothelium, reticular basal membrane, layered smooth muscle cells and an extracellular matrix consisting of pre-elastin, elastin, collagen and proteoglycans. An effective barrier had apparently been formed against penetration of macromolecules, judged from the absence of fibrinogen/fibrin and unmasked fibronectin. Intimal thickenings without endothelial cover were covered with smooth muscle cells without intercellular junctions. Our results indicate that an extracellular matrix of fibrin and fibronectin plays a role in forming an intimal thickening, and it is suggested that proteoglycans may modulate the biological role of the extracellular matrix in the healing process.

Maximizing Restitution for Erroneous Medical Payments When Auditing Samples from More Than One Provider

When auditing payments for medical services by a third party, estimates of payments erroneously made are frequently based on statistical samples. When such procedures are used by government agencies to audit Medicaid payments, hearing officers often base provider restitution on the lower end of an interval estimate, which is a function of sample size. Several methods are tested for maximizing the total restitution obtained from multiple audits subject to a constraint on the total cost of the auditing.

Mitochondrial Function in Cerebral Ischemia and Hypoxia: Comparison of Inhibitory and Adaptive Responses

In cerebral ischemia, brain oxygen supply is totally exhausted within seconds. This necessitates cessation of mitochondrial electron transfer and energy (ATP) production. After certain periods of ATP deficiency of from 5 to 90 min, irreversible damage of mitochondrial membranes occurs. This results in decreased mitochondrial function, characterized by inhibited State 3 respiratory rates, low respiratory control ratios, and inhibited Ca2+ transport activities. A 30-min recirculation period of the ischemic brain tissue induces total restitution of mitochondrial respiratory capacity after complete ischemia, but not after incomplete ischemia. Regional in situ measurements of brain pyridine nucleotide redox levels, tissue ATP, and lactate concentrations indicate variable metabolic responses of different brain regions to oligemia. Macroheterogeneity from region to region, as well as microheterogeneity within a region are demonstrated. Contrary to the effect of tissue ischemia involving reduced or zero cerebral blood flow and tissue oxygenation, sublethal hypoxia alone at normal or increased levels of blood flow induces adaptation of the mitochondrial enzyme system to a new level of respiratory capacity, without any indications of inhibited mitochondrial energy production. Acute hypoxia induces increased respiratory capacities within 30-60 min. Under chronic conditions, alterations of mitochondrial cytochrome concentrations accompany the increased respiratory capacities. Instead of the decreased efficiency of mitochondrial energy-producing mechanisms induced by ischemia, hypoxia induces increased efficiency of energy production.

Silicone rubber tubing as a guide in dilating chronic esophageal stricture in children

A LTHOUGH THE USE of systemic steroids has dramatically reduced the morbidity from alkaline esophageal injuries, occasional delayed strictures are still encountered. There have been few therapeutic advances beyond repeated dilatation of the desmoplastic lesion. Total restitution of function, however, usually can be expected even though the esophagus may be totally occluded at the initial dilatation. Periodic retrograde Tucker dilatation has proved to be the safest, most effective mode of therapy, especially if a guide string, used to pull the dilator through the cicatrix, is left in situ in the period between dilatations. This string, although preventing perforation and false channel formation, unfortunately is pulled taut by deglutition and peristaltic activity. Tension produced over a period of time irritates and erodes the nasal ala, an unpleasant and cosmetically disfiguring complication. To prevent this injury from occurring in the interval between dilatations, we substitute a no. 5 French silastic tubing for the silk string. The soft, pliable nonreactive characteristics of the silicone rubber cause no ala injury, even when taut, and in fact simultaneous healing of string-induced nasal injury has occurred. At dilatation the silk string is substituted for the silastic and is used to pull the Tucker dilators through the esophageal scar. After dilatation, the

Scleromyxedema

A 65-year-old woman developed typical scleromyxedema, with the associated M-type abnormal serum protein and marrow plasmacytosis. Treatment with systemic melphalan resulted in a dramatic response. The dermatosis improved noticeably after one month and a biopsy taken after five months of therapy showed almost total restitution to normal. The response of the circulating paraprotein was slower, between four and seven months being required for an observable decrease to take place. The possible relationship between scleromyxedema and plasma cell myeloma is discussed.

Scleromyxedema. A dramatic response to melphalan.

A 65-year-old woman developed typical scleromyxedema, with the associated M-type abnormal serum protein and marrow plasmacytosis. Treatment with systemic melphalan resulted in a dramatic response. The dermatosis improved noticeably after one month and a biopsy taken after five months of therapy showed almost total restitution to normal. The response of the circulating paraprotein was slower, between four and seven months being required for an observable decrease to take place. The possible relationship between scleromyxedema and plasma cell myeloma is discussed.