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Purpose: We conducted a trial in patients with prostate specific antigen (PSA) levels from 2 to 10 ng/ml to validate a newly developed nomogram that defines the optimal number of biopsy cores required for prostate cancer (PCa) detection... more

Purpose: We conducted a trial in patients with prostate specific antigen (PSA) levels from 2 to 10 ng/ml to validate a newly developed nomogram that defines the optimal number of biopsy cores required for prostate cancer (PCa) detection based on patient age and total prostate volume (Vienna nomogram).

This paper analyses the reality of total renewable electricity scenario (TRES) from renewable energy sources (RES) as a totally green strategy of electric energy production. The paper is based on the EREC's Agency forecast until the year... more

This paper analyses the reality of total renewable electricity scenario (TRES) from renewable energy sources (RES) as a totally green strategy of electric energy production. The paper is based on the EREC's Agency forecast until the year 2040, which foresees the share of 82% of RES, extended to 100% of RES. The key element that creates conditions for achieving this ambitious scenario is an innovative combination of RES and pump storage hydroelectric (PSH) power plants, the so-called Concept-H, which can simultaneously use the energy of local RES (sun and wind) and local precipitation (natural waterflows) and in this way can provide continuous supply of electric power and energy to consumers. The methodology is based on the model of equivalent RES and equivalent reservoir that allows a comprehensive view of available RES and hydro system. The total required land use of RES system would be 29,517 km 2 of RES (which would amount to about 0.5% of the total technical potential of using RES), total reservoir volumes would be 880 km 3 (which is only 8% of all artificial reservoirs built in the world to the date) and the orientation estimate of investment in TRES would then be approximately 1% of world GDP in 2009, which clearly shows that the TRES is realistically feasible. It has been shown that implementation of the green strategy of energy balance fulfilling can be realized with present day technology. Precisely this fact shows that further increase of efficiency of RES and their combining into RES-PSH power plants, along with increase in the cost of classic power fuels and the growing needs for environment protection, the proposed solution of TRES realization could be widely important and thus become a serious alternative to the existing energy strategies and a guideline to decision makers throughout the world.

The primary purpose of this study was to examine whether grip strength is related to total muscle strength in children, adolescents, and young adults. The second purpose was to provide reference charts for grip strength, which could be... more

The primary purpose of this study was to examine whether grip strength is related to total muscle strength in children, adolescents, and young adults. The second purpose was to provide reference charts for grip strength, which could be used in the clinical and research setting. This cross-sectional study was performed at primary and secondary schools and the University of Applied Sciences. Three hundred and eighty-four healthy Dutch children, adolescents, and young adults at the age of 8 to 20 years participated. Isometric muscle strength was measured with a handheld dynamometer of four muscle groups (shoulder abductors, grip strength, hip flexors, and ankle dorsiflexors). Total muscle strength was a summing up of shoulder abductors, hip flexors, and ankle dorsiflexors. All physical therapists participated in a reliability study. The study was started when intratester and intertester reliability was high (Pearson correlation coefficient >0.8). Grip strength was strongly correlated with total muscle strength, with correlation coefficients between 0.736 and 0.890 (p<0.01). However, the correlation was weaker when controlled for weight (0.485-0.564, p<0.01). Grip strength is related to total muscle strength. This indicates, in the clinical setting, that grip strength can be used as a tool to have a rapid indication of someone's general muscle strength. The developed reference charts are suitable for evaluating muscle strength in children, adolescents, and young adults in clinical and research settings.

To review the effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. METHODS: A systematic review and meta-analysis of randomized controlled trials was undertaken. Databases such as MEDLINE,... more

To review the effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. METHODS: A systematic review and meta-analysis of randomized controlled trials was undertaken. Databases such as MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2003. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise training alone or in combination with psychological or educational interventions. RESULTS: We included 48 trials with a total of 8940 patients. Compared with usual care, cardiac rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] ϭ 0.80; 95% confidence interval [CI]: 0.68 to 0.93) and cardiac mortality (OR ϭ 0.74; 95% CI: 0.61 to 0.96); greater reductions in total cholesterol level (weighted mean difference, -0.37 mmol/L [-14.3 mg/dL]; 95% CI: -0.63 to -0.11 mmol/L [-24.3 to -4.2 mg/dL]), triglyceride level (weighted mean difference, -0.23 mmol/L [-20.4 mg/dL]; 95% CI: -0.39 to -0.07 mmol/L [-34.5

1 -Crie um algoritmo que o usuário entre com vários números inteiros e positivos e imprima o produto dos números ímpares e a soma dos números pares.

Purpose: Total urogenital mobilization has achieved widespread use because it avoids surgical complications of vaginal reconstruction. We used urodynamic studies to assess bladder function and urological outcomes after definitive repair... more

Purpose: Total urogenital mobilization has achieved widespread use because it avoids surgical complications of vaginal reconstruction. We used urodynamic studies to assess bladder function and urological outcomes after definitive repair by total urogenital mobilization. Materials and Methods: We identified 27 girls diagnosed with persistent cloaca between 1991 and 2008. We retrospectively reviewed the records of 11 patients (median age 14 months) who underwent reconstruction of the cloaca by total urogenital mobilization. Urinary continence was assessed in 7 patients older than 4 years. Urodynamic studies were performed postoperatively in 7 patients. Median followup was 72 months. Results: Rate of surgical complications was 9%. Urinary continence was achieved in 6 patients (86%), while 1 patient (14%) remained incontinent. Of the continent patients 3 (43%) voided spontaneously and 3 (43%) required clean intermittent catheterization. Urodynamic studies showed detrusor underactivity or acontractile detrusor in all patients during the voiding phase. Bladder compliance was normal in 6 patients (86%) and poor in 1 (14%). Detrusor overactivity was seen in 5 patients (71%) but resolved on followup in 2 (40%). Rate of continence was higher in the absence of detrusor overactivity (1 of 1 patient vs 2 of 3 with detrusor overactivity). Conclusions: Most patients with persistent cloaca can achieve urinary continence after total urogenital mobilization. Two-thirds of patients display bladder dysfunction after the procedure. Detrusor overactivity can resolve with development of the bladder but persistent detrusor overactivity might delay the achievement of mechanisms of urinary continence.

This paper analyzes the Illinois State Variety Test results for total and extractable starch content in 708 samples of 401 commercial varieties of corn. It is shown that the normally distributed extractable starch content has the mean of... more

This paper analyzes the Illinois State Variety Test results for total and extractable starch content in 708 samples of 401 commercial varieties of corn. It is shown that the normally distributed extractable starch content has the mean of 66.2% and the standard deviation of 1.13%. The corresponding maximum theoretical yield of ethanol is 0.364 kg EtOH/kg dry corn, and the standard deviation is 0.007. In the ethanol industry units, this yield translates to 2.64 gal EtOH/nominal wet bushel, and the standard deviation is 0.05 gal/bu. The U.S. ethanol industry consistently has inflated its ethanol yields by counting 5 volume percent of # 14 gasoline denaturant (8% of energy content) as ethanol. Also, imports from Brazil and higher alcohols seem to have been counted as U.S. ethanol. The usually accepted USDA estimate of mean ethanol yield in the U.S., 2.682 gal EtOH/bu, is one standard deviation above the rigorous statistical estimate in this paper.

Cross-linked polyethylenes are being marketed by orthopaedic manufacturers to address the problem of osteolysis caused by polyethylene particulate wear debris. Wear testing of these cross-linked polyethylenes in hip simulators has shown... more

Cross-linked polyethylenes are being marketed by orthopaedic manufacturers to address the problem of osteolysis caused by polyethylene particulate wear debris. Wear testing of these cross-linked polyethylenes in hip simulators has shown dramatic reduction in wear rate compared with standard ultrahigh molecular weight polyethylene, either gamma irradiated in air or nitrogen -or ethylene oxide-sterilized. However, this reduction in wear rate is not without cost. The cross-linking processes can result in materials with lower mechanical properties than standard ultrahigh molecular weight polyethylene. To evaluate the effect of the various cross-linking processes on physical and mechanical properties of ultrahigh molecular weight polyethylene, commercially available cross-linked polyethylenes from six orthopaedic manufacturers were tested. This study was the culmination of collaboration with these manufacturers, who provided cross-linked polyethylene for this study, wear characteristics of the material they provided, and review of the physical and mechanical properties measure for their polyethylene. Cross-linked materials were evaluated as received and after an accelerated aging protocol. Free radical identity and concentration, oxidation, crystallinity, melt temperature, ultimate tensile strength, elongation at break, tensile stress at yield, and toughness are reported for each material. By comparing these physical and mechanical properties, surgeons can evaluate the trade-off that results from developing materials with substantially lower wear rates.

Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy,... more

Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy, and portal vein ligation, and the effect of such a condition on liver function have never been reported in humans. Herein a 32-year-old woman with familial adenomatous polyposis and multiple desmoid tumors involving the mesentery and the retroperitoneum underwent total enterectomy and pancreatectomy followed by en bloc transplantation of the stomach, small bowel, and pancreas. Due to early graft failure, the patient underwent graftectomy, ligation of the portal vein, and external drainage of the common bile duct. Liver function tests were checked daily and a liver biopsy performed 15 days after graftectomy. The patient died of a ruptured mycotic aneurysm of the abdominal aorta at 27 days after the graftectomy. Liver function tests remained normal throughout the postoperative period; liver biopsy showed normal hepatic architecture with mild portal inflammation and cholestasis and spotty necrosis. Total enterectomy with pancreatectomy and ligation of the portal vein are compatible with survival in humans (at least in the short term), allowing normal hepatic function with minimal histological alterations to the liver.

The purpose of this study is to systematically review the TQM milieu to identify the key dynamics of TQM infusion into management consulting professional training in Ghana. Systematic review of current literature significantly hinged on... more

The purpose of this study is to systematically review the TQM milieu to identify the key dynamics of TQM infusion into management consulting professional training in Ghana. Systematic review of current literature significantly hinged on synthesis, inference and finally typified by innovative frameworks for implementation. The study unfolds the key dynamics of TQM implementation focusing on "hard" and "soft" enablers, benefits of TQM implementation and innovative frameworks for TQM infusion into management consulting professional training couple with future research agenda for advancement of management consulting professional training. The infusion of TQM into the professional training of management consultants in Ghana sets the ambiance for churning out well-cut-out consultants to solve corporate problems and to guarantee value for donor inflows from advanced countries by managing projects efficiently. Developing a world class management consulting training institutions comparable to Boston Consulting Group among others in Ghana. This paper pioneers the application the infusion of TQM into management consulting training.

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still technically challenging. The use of tapered-tip guidewires in these lesions may improve the success rate of PCI. In order to avoid the needless radiation... more

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still technically challenging. The use of tapered-tip guidewires in these lesions may improve the success rate of PCI. In order to avoid the needless radiation exposure or contrast consumption, we have to determine a guideline for the termination of procedures in these lesions. We retrospectively analyzed the data of 182 patients between April 1997 and December 1999 (phase 1) and 80 patients between January and August 2001 (phase 2) who underwent angioplasty for CTO lesions ≥ 3 months. There were no significant differences in clinical or lesion characteristics except the use of tapered-tip guidewires. Tapered-tip guidewires were used in 60% of patients in phase 2 period but no patients in phase 1 period. The overall success rate of PCI was improved from 67% in phase 1 to 81% in phase 2 (P ‫؍‬ 0.019). In the phase 2 period, the success rate was higher in tapered-type occlusion (P ‫؍‬ 0.002) and shorter length of occlusion (P ‫؍‬ 0.004). Total procedure time was 46 ؎ 17 min and total volume of contrast dye was 180 ؎ 63 ml. The success rate was higher in patients treated by transradial coronary intervention (TRI) than transfemoral coronary intervention (89% vs. 64%; P ‫؍‬ 0.008). The use of tapered-tip guidewires can improve the success rate of PCI in CTO lesions. The following guideline for the termination of the procedures is reasonable: time from arterial access to successful penetration of a guidewire through occlusion ≤ 30 min; total procedure time ≤ 90 min; and total dye volume ≤ 300 ml. TRI can achieve a high success rate even in CTO lesions provided that the case selection is adequate. Cathet Cardiovasc Intervent 2003; 59:305-311.

x Total mercury concentrations Hg were measured in samples of water and sediments collected from the southern T Baltic Sea from the period 1993᎐1995. Picomolar concentrations of HgT were found in offshore surface water. Higher levels were... more

x Total mercury concentrations Hg were measured in samples of water and sediments collected from the southern T Baltic Sea from the period 1993᎐1995. Picomolar concentrations of HgT were found in offshore surface water. Higher levels were measured in samples from the plum of the Vistula. An exceptionally high concentration of Ž . mercury 25 pM Hg , 5 pM methylmercury was measured in the nearbottom, quasi-anoxic water of the Gdansk T Deep and explained by the release of mercury from fine grained sediments covering the bottom. In the sediments, the largest contents of Hg were found in fine grained, organic rich deposits of the Baltic deeps. The increase in T mercury contents in the upper layers of sediments deposited within the last 100᎐150 years was attributed to the anthropogenic load of mercury and its increased scavenging to sediments with organic matter. ᮊ 1998 Elsevier Science B.V.

The challenges of measuring in vivo total disc replacement (TDR) kinematics are well recognised, meaning that it is difficult to establish appropriate input conditions for wear simulation. Therefore, it is desirable to ascertain the... more

The challenges of measuring in vivo total disc replacement (TDR) kinematics are well recognised, meaning that it is difficult to establish appropriate input conditions for wear simulation. Therefore, it is desirable to ascertain the sensitivity of implant wear in vitro to perturbations of the kinematics and other testing parameters. It has previously been demonstrated in other metal-on-polyethylene joint replacements that the cross-shear strongly influences the wear rate. This study investigates this phenomenon by altering the phasing of the inputs by making the lag in the flexion-extension and lateral bend displacements zero.

Percutaneous coronary intervention with bare metal stent (BMS) in chronic total coronary occlusions (CTOs) is associated with a higher rate of angiographic restenosis and reocclusion than that observed in subtotal stenoses. Preliminary... more

Percutaneous coronary intervention with bare metal stent (BMS) in chronic total coronary occlusions (CTOs) is associated with a higher rate of angiographic restenosis and reocclusion than that observed in subtotal stenoses. Preliminary reports have suggested a better performance of drug-eluting stents in CTO. In this multicentre, randomized trial, we compared the mid-term angiographic and clinical outcome of sirolimus-eluting stent (SES) or BMS implantation after successful recanalization of CTO.

Background-The inability to measure IgE-based sensitivity to all allergens has limited our understanding of what portion of asthma is related to IgE. Total IgE can potentially overcome this limitation.

Y. Ishii et al.: Gait analysis after TKA ... Gait analysis after total knee arthroplasty. Comparison of ... Yoshinori Ishii1, Kazuhiro Terajima2, Yoshio Koga1, Hideaki E. Takahashi1, Joan E. Bechtold3, and Ramon B. Gustilo3 ...... more

Y. Ishii et al.: Gait analysis after TKA ... Gait analysis after total knee arthroplasty. Comparison of ... Yoshinori Ishii1, Kazuhiro Terajima2, Yoshio Koga1, Hideaki E. Takahashi1, Joan E. Bechtold3, and Ramon B. Gustilo3 ... Departments of 1 Orthopaedic Surgery and 2 ...

To describe a simple, rapid, quantitative ultramicrotest (UMTEST) based on the fluorometric method introduced by Fujimura et al. adapted to an Ultra Micro Analytic System (SUMA) for the detection of total galactose (GAL) in dried blood... more

To describe a simple, rapid, quantitative ultramicrotest (UMTEST) based on the fluorometric method introduced by Fujimura et al. adapted to an Ultra Micro Analytic System (SUMA) for the detection of total galactose (GAL) in dried blood specimens. Methods: The assay uses 3 mm discs of dried blood on Whatman 903 filter paper and small volumes of each reagent. A methanol/acetone/water solution is used for deproteination, and a specially designed 96-well polystyrene opaque ultramicroplates, with a maximum capacity of 30 mL per well, are used for the reading.

It is well known that checkerboard partitioning can exploit more concurrency than striped partitioning because the matrix computation can be divided among more processors than in the case of striping. In this work we analyze the... more

It is well known that checkerboard partitioning can exploit more concurrency than striped partitioning because the matrix computation can be divided among more processors than in the case of striping. In this work we analyze the performance of Neville method when a checkerboard partitioning is used, focusing on the special case of block-cyclic-checkerboard partitioning. This method is an alternative to Gaussian elimination and it has been proved to be very useful for some classes of matrices, such as totally positive matrices. The performance of this parallel system is measured in terms of the efficiency (the fraction of time for which a processor is usefully employed) which in our model is close to one, when the optimum block size is used. Also, we have executed our algorithms on a Parallel PC cluster, observing that both efficiencies (theoretical and empirical) are quite similar.

formed to rule out structural disease, and brain imaging was done when indicated. Blood samples for determination of serum IMg 2+ , total magnesium (TMg), and ICa 2+ concentrations and pH were drawn, after informed consent was obtained.... more

formed to rule out structural disease, and brain imaging was done when indicated. Blood samples for determination of serum IMg 2+ , total magnesium (TMg), and ICa 2+ concentrations and pH were drawn, after informed consent was obtained. The samples were tested immediately; when this could not be done, samples were centrifuged, separated, and stored at 0°C to 4°C for later analysis. 11 IMg 2+ /TMg and ICa 2+ /IMg 2+ ratios were calculated. The normal ranges (95% CIs) for these serum biochemical analytes in our laboratory are as follows: TMg, 0.72-0.98 mmol/L; IMg 2+ , 0.54-0.65 mmol/L; I C a 2 + , 1 . 1 4 -1 . 3 0 m m o l / L ; a n d ICa 2+ /IMg 2+ ratio, 1.90-2.28. 11 When appropriate, mean values were calculated and compared statistically with those of 35 age-matched control children from another study, who were found to be clinically healthy (unpublished data), by using the Student t test. A P value of <.05 was set as the significance level.

Objectives. To evaluate the relationship between age and complexed prostate-specific antigen (cPSA) in healthy white men with no evidence of prostatic disease and total PSA (tPSA) levels of 0 to 20 ng/mL. Methods. A total of 10,530 tests... more

Objectives. To evaluate the relationship between age and complexed prostate-specific antigen (cPSA) in healthy white men with no evidence of prostatic disease and total PSA (tPSA) levels of 0 to 20 ng/mL. Methods. A total of 10,530 tests for cPSA and tPSA in men between 40 and 79 years old were performed at Innsbruck University, Austria, between 2001 and 2002. After excluding 263 patients because of follow-up biopsy findings indicating prostatic disease, 10,267 PSA tests were available for study. All serum samples were analyzed using the Bayer Immuno 1 cPSA and tPSA assays. cPSA and tPSA values were determined in subjects with tPSA levels between 0 and 20 ng/mL. The concentrations were calculated for the 50th, 90th, and 95th percentiles of four age groups (40 to 49, 50 to 59, 60 to 69, and 70 to 79 years). For statistical analysis, the Kruskal-Wallis test was used. The 95th percentile was defined as the upper limit of normal. Results. A total of 10,267 PSA tests were available for study. cPSA and tPSA levels correlated linearly and positively with age (P Ͻ0.001). Percent free PSA showed a significant increase with age (P Ͻ0.001), which may be attributed to the increase in prostate volume with advancing age. Conclusions. Both cPSA and tPSA levels were found to increase with age. The low tPSA and cPSA levels observed at the 95th percentile in men aged 40 to 59 years suggest that lower cutoff values should be used in place of the currently accepted tPSA level of 4 ng/mL. Lower cutoff values may help improve the detection of prostate cancer among otherwise healthy men.

Background. We compared the effects of using hypothermic circulatory arrest (HCA) alone, HCA combined with selective cerebral perfusion (SCP), and use of SCP with a trifurcated graft (T) on outcome after aortic arch repair.

We report the case of a wheelchair-bound rheumatoid Jehovah's Witness who underwent rapid sequence, staged, simultaneous ipsilateral hip and knee replacements. Using perioperative erythropoietin and postoperative blood salvage, all four... more

We report the case of a wheelchair-bound rheumatoid Jehovah's Witness who underwent rapid sequence, staged, simultaneous ipsilateral hip and knee replacements. Using perioperative erythropoietin and postoperative blood salvage, all four joints were reconstructed without homologous blood transfusion. One year following surgery, the patient has achieved an independent functional status, and all four replaced joints remain painless.

C o lon and rec tum can cer is the third most common ma lig nancy, and also the third lead ing cause of can cer death in Tai wan. The treat ment largely de pends on ad e quate sur gi cal re sec tion of the ma lig nant le sion, if fea si... more

C o lon and rec tum can cer is the third most common ma lig nancy, and also the third lead ing cause of can cer death in Tai wan. The treat ment largely de pends on ad e quate sur gi cal re sec tion of the ma lig nant le sion, if fea si ble. 13,14 Stan dard rad i cal hemicolectomy and proctectomy ap ply to tu mors with lim ited in va sion. How ever, rec tal can cer with the inva sion of ad ja cent struc tures has long been a chal lenge to colorectal sur geons. A num ber of pa tients re ceived sur gi cal ex plo ra tion in a cu ra tive at tempt and tu mors were found to ex tend be yond the in tes ti nal wall and ad here to ad ja cent tis sues or or gans. A sig nif i cant percent age of these pa tients had no dis tant metastases. They are said to have lo cally ad vanced dis eases. Unlike other ma lig nan cies, colorectal can cer is not in curable in this cir cum stance. For op ti mal sur gi cal treatment, to tal pel vic exenteration is some times nec es sary to re move the tu mor with a clear re sec tion mar gin. J Soc Co lon Rec tal Sur geon (Taiwan) De cem ber 2002 Ad vanced rec tal can cer; Pel vic exenteration.

Our patient was diagnosed with complete atrioventricular canal and Tetralogy of Fallot with pulmonary atresia at the age of 1 month. Then he underwent right and left Blalock-Taussig shunts at the ages of 2 months and 5 years,... more

Our patient was diagnosed with complete atrioventricular canal and Tetralogy of Fallot with pulmonary atresia at the age of 1 month. Then he underwent right and left Blalock-Taussig shunts at the ages of 2 months and 5 years, respectively. His cyanosis had increased at 20 years of age. Cardiac catheterization showed occlusion of the left Blalock-Taussig shunt and absence of the left pulmonary artery. Lung perfusion scintigram showed late phase perfusion in the left lung. Chest computed tomographic scan demonstrated the left pulmonary artery. We describe the operative technique of total correction.

The surgical approach to differentiated thyroid carcinoma is still controversial, as many authors consider it necessary to remove the whole gland. Therefore, when definitive histological diagnosis is made following limited resection,... more

The surgical approach to differentiated thyroid carcinoma is still controversial, as many authors consider it necessary to remove the whole gland. Therefore, when definitive histological diagnosis is made following limited resection, reoperation and completion thyroidectomy (CT) is sometimes recommended. The main indications are for follicular cancer or for patients with a carcinoma of >/! cm previously treated with Iobectomy or limited resection (early CT), or for local recurrence after previous treatment (late CT). Several authors, however, draw attention to the high rate of complications following completion thyroidectomy and advocate its use in more limited circumstances. The aim of the study was to evaluate the results of our experience with CT in the National Cancer Institute in Naples. Of 131 patients treated for thyroid cancer 35 (26.7%) underwent a CT. Re-operation was performed within 6 months in 26 cases (74.3%) and later in the remaining nine cases (25.7%) : carcinoma in the residual gland was found in six cases (23%) of early CT, and in four cases (45%) in the late CT group with an overall incidence of 28.5%. Post-operative complications were: transient hypoparathyroidism, two cases (5.6%), permanent in one (2.8%). Transient recurrent laryngeal nerve palsy occurred in three patients (8.5%) and became permanent in one case (2.8%). Completion thyroidectomy can therefore be considered a safe procedure.

Electrocardiographic (ECG) Q-and ST-T-wave abnormalities predict coronary heart disease (CHD) and total mortality. No comparison has been made of the classification of these abnormalities by the 2 most widely used ECG coding systems for... more

Electrocardiographic (ECG) Q-and ST-T-wave abnormalities predict coronary heart disease (CHD) and total mortality. No comparison has been made of the classification of these abnormalities by the 2 most widely used ECG coding systems for epidemiologic studies-the Minnesota Code (MC) and Novacode (NC). We evaluated 12-lead electrocardiograms from 64,597 participants (49 to 79 years old, 82% non-Hispanic white) in the Women's Health Initiative clinical trial in 1993 to 1998, with a maximum of 11 years of follow-up. We used MC and NC criteria to identify Q-wave, ST-segment, and T-wave abnormalities for comparison. In total, 3,322 participants (5.1%) died during an average 8-year follow-up, and 1,314 had incident CHD in the baseline cardiovascular disease-free group. Independently, ECG myocardial infarction criteria by the MC or NC were generally equivalent and were strong predictors for CHD death and total mortality (hazard ratio 1.62, 95% confidence interval 1.05 to 2.51 for CHD death; hazard ratio 1.36, 95% confidence interval 1.09 to 1.71 for total mortality) in a multivariable analytic model. Electrocardiograms with major ST-T abnormalities by the MC or NC coding system were stronger in predicting CHD deaths and total mortality than was the presence of Q waves alone. In conclusion, the ECG classification systems for myocardial infarction/ischemia abnormalities from the MC and NC are valuable and useful in clinical trials and epidemiologic studies. ST-T abnormalities are stronger predictors for CHD events and total mortality than isolated Q-wave abnormalities.

The purpose of this study is to systematically review the TQM milieu to identify the key dynamics of TQM infusion into management consulting professional training in Ghana. Systematic review of current literature significantly hinged on... more

The purpose of this study is to systematically review the TQM milieu to identify the key dynamics of TQM infusion into management consulting professional training in Ghana. Systematic review of current literature significantly hinged on synthesis, inference and finally typified by innovative frameworks for implementation. The study unfolds the key dynamics of TQM implementation focusing on "hard" and "soft" enablers, benefits of TQM implementation and innovative frameworks for TQM infusion into management consulting professional training couple with future research agenda for advancement of management consulting professional training. The infusion of TQM into the professional training of management consultants in Ghana sets the ambiance for churning out well-cut-out consultants to solve corporate problems and to guarantee value for donor inflows from advanced countries by managing projects efficiently. Developing a world class management consulting training institutions comparable to Boston Consulting Group among others in Ghana. This paper pioneers the application the infusion of TQM into management consulting training.

Phenolic compounds have a fundamental importance in the nutritional and sensorial characteristics of olive. In this study phenolic compounds extracted from olive fruit stones of three Moroccan registered cultivars were analyzed. The... more

Phenolic compounds have a fundamental importance in the nutritional and sensorial characteristics of olive. In this study phenolic compounds extracted from olive fruit stones of three Moroccan registered cultivars were analyzed. The obtained results showed that the total amount of phenolic compounds varied according to the olive variety. The stones of the Moroccan Picholine variety were the richest in total phenolic compounds (11.32 mg of gallic acid equivalent (GAE)/g of dry weight (DW)) followed by Haouzia (4.55 mg GAE/g DW) and Menara (3.56 mg GAE/g DW). The qualitative analysis showed that the analyzed extracts were predominated by nuzhenide and its derivatives. Thus nuzhenide was observed among the major compound in the three studied cultivars. Its mono, di and tri 11-methyl oleoside adducts were also detected. Various compounds with the same molecular weight values and corresponding to nuzhenide or its derivatives were detected indicating the presence of various isomers.

In this paper, a technique has been developed to determine the optimum mix of logistic service providers of a make-to-order (MTO) supply chain. A serial MTO supply chain with different stages/ processes has been considered. For each stage... more

In this paper, a technique has been developed to determine the optimum mix of logistic service providers of a make-to-order (MTO) supply chain. A serial MTO supply chain with different stages/ processes has been considered. For each stage different logistic service providers with different mean processing lead times, but same lead time variances are available. A realistic assumption that for each stage, the logistic service provider who charges more for his service consumes less processing lead time and vice-versa has been made in our study. Thus for each stage, for each service provider, a combination of cost and mean processing lead time is available. Using these combinations, for each stage, a polynomial curve, expressing cost of that stage as a function of mean processing lead time is fit. Cumulating all such expressions of cost for the different stages along with incorporation of suitable constraints arising out of timely delivery, results in the formulation of a constrained nonlinear cost optimization problem. On solving the problem using mathematica, optimum processing lead time for each stage is obtained. Using these optimum processing lead times and by employing a simple technique the optimum logistic service provider mix of the supply chain along with the corresponding total cost of processing is determined. Finally to examine the effect of changes in different parameters on the optimum total processing cost of the supply chain, sensitivity analysis has been carried out graphically.

Background. Hypoparathyroidism with permanent hypocalcemia is a well-recognized complication after thyroid surgery. Aim. This study was conducted to assess the role of immediate parathyroid autotransplantation in the preservation of... more

Background. Hypoparathyroidism with permanent hypocalcemia is a well-recognized complication after thyroid surgery. Aim. This study was conducted to assess the role of immediate parathyroid autotransplantation in the preservation of parathyroid function after total thyroidectomy. Patients and Methods. Twenty-eight patients had autotransplantation of parathyroid glands resected or devascularized during total thyroidectomy. Data were collected prospectively regarding demographics, indication for surgery, operative procedure, pathologic diagnosis, number of glands transplanted, and subsequent course. Thyroid nodules were evaluated by ultrasonography, radionuclide scanning, and/or fine-needle aspiration cytology. All patients had serum ionized calcium, phosphorus, and intact parathyroid hormone (PTH) levels measured preoperatively and monitored regularly postoperatively for a period of 14 weeks and again at 6 months after operation. Patients were categorized into three groups according to the number of glands transplanted: one (group 1, n = 6), two (group 2, n = 14), or three glands (group 3, n = 8). In three other volunteers, one parathyroid gland was transplanted in the brachioradialis and subjected to electron microscopy 1, 2, and 4 weeks after transplantation. Results. Total thyroidectomy was performed for malignant disease in 16 patients (57.1%) and for benign disease in 12 (42.9%) patients. All patients reverted to asymptomatic normocalcemia without the need for any medications within 4 to 14 weeks. Normal levels of serum markers were regained slower when one gland was transplanted compared with two or three glands (P < .01). Electron microscopic examination showed evidence of ischemic degeneration in the transplanted tissues 1 week postoperatively. Regeneration started by the second week and coincided with normalization of PTH levels. Optimum resting and nearly normal status of parathyroid tissue was achieved by the fourth week. Conclusions. This study showed that active PTH production coincides with regeneration of parathyroid cells and that autotransplantation of at least two resected or devascularized glands during total thyroidectomy nearly eliminates permanent postoperative hypoparathyroidism, thus improving the safety of total thyroidectomy performed for malignant or benign disease.

This paper deals with valuating the experimental performance of 46MWh solar photovoltaic system which was designed, developed, sized and installed at multicomplex building of health centre, Obodo Ahiara, in Ahiazu Mbaise local government... more

This paper deals with valuating the experimental performance of 46MWh solar photovoltaic system which was designed, developed, sized and installed at multicomplex building of health centre, Obodo Ahiara, in Ahiazu Mbaise local government area, Imo State, Nigeria for converting abundant sunlight natural energy resource directly to electricity. The performance characteristics of the modules are valuated experimentally in terms of their response variables open circuit voltage (Voc), maximum voltage Vmax, short circuit current Isc, maximum current Imax, maximum power Pmax, and efficiency 𝜀 as a function of difference irradiance values of 400W/m2 , 450W/m2 , 500W/m2 and 600W/m2 for a period of 30 days in the month of January, 2018. These response variables are generally observed hourly to be directly proportional to irradiance with significant decrease in efficiency, Vmax, and Voc and Fill factor FF. Maximum efficiencies of 11.23% and 8.27% are achieved at irradiance of 500W/m2 for the module 1 and module 2 respectively. The maximum power outputs obtained at irradiance of 500W/m2 are 15.39 W and 22.65 W representing 30.78% and 45.3% of the manufacturer’s power specifications for the PV module 1 and module 2 tested respectively. The hourly daily measured total and average temperatures vary from high values of 345.400C (43.180C), 310.100C(38.760C) and 306.000C(38.250C) on the 1st, 3rd and 4th days to low values of 272.400C(34.050C) and 290.500C(36.310C) on the 5th and 2 nd days.

The differences in the water adsorptivity index, variable surface charge, surface dissociation constants, and the content of hydrophobic and hydrophilic bound amino acids were studied in 14 peat muck soils at various phases of the mucking... more

The differences in the water adsorptivity index, variable surface charge, surface dissociation constants, and the content of hydrophobic and hydrophilic bound amino acids were studied in 14 peat muck soils at various phases of the mucking process. In general, the total concentration of bound amino acids was the highest in secondary transformed mucks. The lowest content of amino acids was found in peat muck characterized by the lowest values of the water adsorption index. Among all amino acids present in soil samples, the content of neutral amino acids was the highest, whereas sulphur-containing amino acids were present at the lowest concentrations. The concentrations of h-alanine and lysine were higher in strongly and very strongly secondary transformed soils, which indicated a higher microbial biomass content in these soils. Linear correlations were found between the total amount of amino acid as well as the amount of hydrophobic amino acids and the water adsorption index. Significant relationships were also revealed among some physical and chemical properties of investigated soils. In particular, the process of secondary transformation of peat muck soils was strongly connected with water holding capacity, surface charge, and differentiation of bounded amino acids.

Background. Hyperhomocysteinemia is prevalent in more than 85% of patients with end-stage renal disease (ESRD) and is thought to contribute to the excess cardiovascular mortality and morbidity. Creatine is synthesized by methylation of... more

Background. Hyperhomocysteinemia is prevalent in more than 85% of patients with end-stage renal disease (ESRD) and is thought to contribute to the excess cardiovascular mortality and morbidity. Creatine is synthesized by methylation of guanidinoacetate with formation of S-adenosylhomocysteine and subsequently, homocysteine (Hcy). Creatine supplementation down-regulates its endogenous synthesis and, thus, may reduce Hcy production. The present study investigates the effect of creatine supplementation on Hcy concentrations in an animal model of uremia.

Although anthropogenic influences such as global warming, overfishing, and eutrophication may contribute to jellyfish blooms, little is known about the effects of ocean acidification on jellyfish. Most medusae form statoliths of calcium... more

Although anthropogenic influences such as global warming, overfishing, and eutrophication may contribute to jellyfish blooms, little is known about the effects of ocean acidification on jellyfish. Most medusae form statoliths of calcium sulfate hemihydrate that are components of their balance organs (statocysts). This study was designed to test the effects of pH (7.9, within the average current range, 7.5, expected by 2100, and 7.2, expected by 2300) combined with two temperatures (9 and 15°C) on asexual reproduction and statolith formation of the moon jellyfish, Aurelia labiata. Polyp survival was 100% after 122 d in seawater in all six temperature and pH combinations. Because few polyps at 9°C strobilated, and temperature effects on budding were consistent with published results, we did not analyze data from those three treatments further. At 15°C, there were no significant effects of pH on the numbers of ephyrae or buds produced per polyp or on the numbers of statoliths per statocyst; however, statolith size was significantly smaller in ephyrae released from polyps reared at low pH. Our results indicate that A. labiata polyps are quite tolerant of low pH, surviving and reproducing asexually even at the lowest tested pH; however, the effects of small statoliths on ephyra fitness are unknown. Future research on the behavior of ephyrae with small statoliths would further our understanding of how ocean acidification may affect jellyfish survival in nature.

Background: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively... more

Background: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture. Methods: Thirty total hip arthroplasties were performed with use of a cementless hemispheric, fiber-metal-meshcoated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture. The median interval between the fracture and the arthroplasty was thirty-seven months (range, eight to 444 months). The average age at the time of the arthroplasty was fifty-one years (range, twenty-six to eighty-six years), and the average duration of follow-up was sixty-three months (range, twenty-four to 140 months). Fifteen patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and fifteen patients had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis. Results: Operative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis. Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods. Eight of the fifteen patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the fifteen patients who had been treated by closed means (p = 0.005). Two of the fifteen patients with a previous open reduction and internal fixation required bone-grafting of acetabular defects compared with seven of the fifteen patients treated by closed means (p = 0.04). The thirty patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 points at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39). Twenty-seven patients (90%) had a good or excellent result. There were no dislocations or deep infections. The Kaplan-Meier ten-year survival rate, with revision or radiographic loosening as the end point, was 97%. These results were similar to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis. Conclusions: The intermediate-term clinical results of total hip arthroplasty with cementless acetabular reconstruction for posttraumatic osteoarthritis after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especially in patients with previous open reduction and internal fixation. Previous open reduction and internal fixation predisposed the hip to more intraoperative instability but less bone deficiency.

@The effect of amino acids on total parenteral nutrition (TPN)-associated cholestasis was examined using a newborn rabbit TPN model. Twenty-nine newborn Japanese white rabbits were divided into four groups. Group I received a TPN solution... more

@The effect of amino acids on total parenteral nutrition (TPN)-associated cholestasis was examined using a newborn rabbit TPN model. Twenty-nine newborn Japanese white rabbits were divided into four groups. Group I received a TPN solution with composition and total energy similar to that of rabbit breast milk. Group II received more dextrose than group I. Group Ill received a larger amount of amino acids than group II. Group IV was nourished by lactating mothers. After 7 days of TPN, blood samples and liver specimens were obtained.

A nationwide Finnish cohort from 1980 to 1996 involving 9,444 patients Pekka Paavolainen', Eero Pukkala2, Pekka Pulkkinen3 and Tuomo Visuri4 A nationwide, computer-based survey of all total joint arthroplasties performed in Finland has... more

A nationwide Finnish cohort from 1980 to 1996 involving 9,444 patients Pekka Paavolainen', Eero Pukkala2, Pekka Pulkkinen3 and Tuomo Visuri4 A nationwide, computer-based survey of all total joint arthroplasties performed in Finland has been carried out since January 1980. From these records, a cohort of 9,444 patients, with 51,756 person-years, after primary operation with a total polyethylene-on-metal knee arthroplasty (TKA) was followed up for cancer through the Finnish Cancer Register up to December 31,1996. During the follow-up, 706 cancers were observed. The expected number, based on national rates, was 7 1 9 therefore, the standardized incidence ratio (SIR) for all cancers was 0.98.

Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy,... more

Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy, and portal vein ligation, and the effect of such a condition on liver function have never been reported in humans. Herein a 32-year-old woman with familial adenomatous polyposis and multiple desmoid tumors involving the mesentery and the retroperitoneum underwent total enterectomy and pancreatectomy followed by en bloc transplantation of the stomach, small bowel, and pancreas. Due to early graft failure, the patient underwent graftectomy, ligation of the portal vein, and external drainage of the common bile duct. Liver function tests were checked daily and a liver biopsy performed 15 days after graftectomy. The patient died of a ruptured mycotic aneurysm of the abdominal aorta at 27 days after the graftectomy. Liver function tests remained normal throughout the postoperative period; liver biopsy showed normal hepatic architecture with mild portal inflammation and cholestasis and spotty necrosis. Total enterectomy with pancreatectomy and ligation of the portal vein are compatible with survival in humans (at least in the short term), allowing normal hepatic function with minimal histological alterations to the liver.

Increased circulating levels of endogenous ouabain (EO) have been observed in some heart failure patients, but their long term clinical significance is unknown. This study investigated the prognostic value of EO for worsening heart... more

Increased circulating levels of endogenous ouabain (EO) have been observed in some heart failure patients, but their long term clinical significance is unknown. This study investigated the prognostic value of EO for worsening heart failure among 140 optimally treated patients (age 50 T14 years; 104 male; NYHA class 1.9 T0.7) with idiopathic dilated cardiomyopathy. Plasma EO was determined by RIA

Pulmonary alveolar proteinosis (PAP) is a rare, heterogeneous diffuse lung disease in childhood. We report a case of an asymptomatic 13-year old girl with PAP. She had radiolographic findings suggesting the diagnosis, which was confirmed... more

Pulmonary alveolar proteinosis (PAP) is a rare, heterogeneous diffuse lung disease in childhood. We report a case of an asymptomatic 13-year old girl with PAP. She had radiolographic findings suggesting the diagnosis, which was confirmed by the ''milky'' bronchoalveolar lavage fluid and the histology of transbronchial biopsy. Total lung lavage was performed by flexible fiberoptic bronchoscope under local anesthesia with success. This is the first reported case of a PAP in a child that was treated by being awake during bronchoscopy. After one-year of follow-up, the patient remains free of symptoms.

Background. Gastroesophageal reflux (GER) appears to be related to laryngeal carcinoma. Little is known about GER and gastropharyngeal reflux (GPR) in the laryngectomized patient. Therefore, GER and GPR were studied in laryngectomized... more

Background. Gastroesophageal reflux (GER) appears to be related to laryngeal carcinoma. Little is known about GER and gastropharyngeal reflux (GPR) in the laryngectomized patient. Therefore, GER and GPR were studied in laryngectomized patients.