Journal articles: 'Early PCCI'

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Jeftić, Marko, Shui Yu, Xiaoye Han, Graham T. Reader, Meiping Wang, and Ming Zheng. "Effects of Postinjection Application with Late Partially Premixed Combustion on Power Production and Diesel Exhaust Gas Conditioning." Journal of Combustion 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/891096.

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The effects of postinjection with late partially premixed charge compression ignition (PCCI) were investigated with respect to diesel exhaust gas conditioning and potential power production. Initial tests comparing postinjection application with PCCI to that with conventional diesel high temperature combustion (HTC) indicated the existence of similar trends in terms of carbon monoxide (CO), total unburned hydrocarbon (THC), oxides of nitrogen (NOx), and smoke emissions. However, postinjection in PCCI cycles exhibited lower NOxand smoke but higher CO and THC emissions. With PCCI operation, the use of postinjection showed much weaker ability for raising the exhaust gas temperature compared to HTC. Additional PCCI investigations generally showed increasing CO and THC, relatively constant NOx, and decreasing smoke emissions, as the postinjection was shifted further from top dead center (TDC). Decreasing the overall air-to-fuel ratio resulted in increased hydrogen content levels but at the cost of increased smoke, THC and CO emissions. The power production capabilities of early postinjection, combined with PCCI, were investigated and the results showed potential for early postinjection power production.

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Liang, Xingyu, Zhiwei Zheng, Hongsheng Zhang, Yuesen Wang, and Hanzhengnan Yu. "A Review of Early Injection Strategy in Premixed Combustion Engines." Applied Sciences 9, no. 18 (September 7, 2019): 3737. http://dx.doi.org/10.3390/app9183737.

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Due to the increasing awareness of environmental protection, limitations on exhaust emissions of diesel engines have become increasingly stringent. This challenges diesel engine manufacturers to find a new balance between engine performance and emissions. Advanced combustion modes for diesel engines, such as homogeneous charge compression ignition (HCCI) and premixed charge compression ignition (PCCI), which can simultaneously reduce exhaust emissions and substantially improve thermal efficiency, have drawn increasing attention. In order to allow enough time to prepare the homogeneous mixture, the early injection strategy has been utilized widely in HCCI and PCCI diesel engines. This paper is aimed at providing a comprehensive review of the effects of early injection parameters on the performance and emissions of HCCI and PCCI engines fueled by both diesel and alternative fuels. Various early injection parameters, including injection pressure, injection timing, and injection angle, are discussed. In addition, the effect of the blending ratio of alternative fuels is also summarized. Every change in parameters has its own advantages and disadvantages, which are explained in detail in order to help researchers choose the best early injection parameters for HCCI and PCCI engines.

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Kong, S.-C., Y. Ra, and R. D. Reitz. "Performance of multi-dimensional models for simulating diesel premixed charge compression ignition engine combustion using low- and high-pressure injectors." International Journal of Engine Research 6, no. 5 (October 1, 2005): 475–86. http://dx.doi.org/10.1243/146808705x30567.

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An engine CFD model has been developed to simulate premixed charge compression ignition (PCCI) combustion using detailed chemistry. The numerical model is based on the KIVA code that is modified to use CHEMKIN as the chemistry solver. The model was applied to simulate ignition, combustion, and emissions processes in diesel engines operated to achieve PCCI conditions. Diesel PCCI experiments using both low- and high-pressure injectors were simulated. For the low-pressure injector with early injection (close to intake valve closure), the model shows that wall wetting can be minimized by using a pressure-swirl atomizer with a variable spray angle. In the case of using a high-pressure injector, it is found that late injection (SOI = 5 ° ATDC) benefits soot emissions as a result of low-temperature combustion at highly premixed conditions. The model was also used to validate the emission reduction potential of an HSDI diesel engine using a double injection strategy that favours PCCI conditions. It is concluded that the present model is useful to assess future engine combustion concepts, such as PCCI and low-temperature combustion (LTC).

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Sakai, A., H. Takeyama, H. Ogawa, and N. Miyamoto. "Improvements in premixed charge compression ignition combustion and emissions with lower distillation temperature fuels." International Journal of Engine Research 6, no. 5 (October 1, 2005): 433–42. http://dx.doi.org/10.1243/146808705x58288.

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The charge mixture in a premixed charge compression ignition (PCCI) engine with direct in-cylinder injection early in the compression stroke is still heterogeneous even at the compression end. Direct injection of a low-volatility fuel, such as diesel fuel, early in the compression stroke results in adhesion of unevaporated fuel on the cylinder liner wall. It may be possible to improve both mixture formation and homogeneity, and decrease wall wetting by using higher-volatility fuels with distillation temperatures lower than the in-cylinder gas temperature early in the compression stroke. This research addressed the potential for improvements in early direct injection type PCCI combustion with a higher-volatility fuel, experimentally and computationally. A normal heptane + isooctane blended fuel with ignitability similar to diesel fuel in PCCI operation was used as the higher-volatility fuel. The experimental results showed that the deterioration in thermal efficiency that occurs with advanced injection timings with ordinary diesel fuel could be eliminated with the higher-volatility fuel without significantly altering the total hydrocarbons (THC) and CO emissions. With early injection timings, the rate of heat release with diesel fuel is smaller than with higher-volatility fuels. This result suggests that with diesel fuel there is significant fuel adhesion to the cylinder liner wall and also absorption into the lubricating oil.

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Ji, Qian, Jie Li, Jingshan Wang, Ping Sun, and Pengcheng Wu. "Simulation analysis of the effects of methanol-polyoxymethylene dimethyl ethers blends on combustion and emissions of a PCCI engine." E3S Web of Conferences 252 (2021): 03022. http://dx.doi.org/10.1051/e3sconf/202125203022.

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The effects of methanol/polyoxymethylene dimethyl ethers (PODE) mixture with different blending ratios on premixed charge compression ignition (PCCI) combustion and emission performance have been researched through the anlysis of CFD software CONVERGE. Premixed combustion is achieved by a single early injection of fuel into the cylinder. The results show that the combustion start point delays and the peak pressure decreases with the increase of methanol blend ratio. The effects of injection timing on the combustion and emission characteristics of PCCI were studied by using a mixture of the same proportion of methanol. The results show that the advance of injection time leads to more homogeneous mixture and higher peak heat release. But too early injection reduces the temperature in the cylinder and makes the combustion worse, resulting in the increase of HC, soot and CO emissions. NOx emissions decrease with the advance of the injection time.

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Natarajan, S., S. Abhinav Shankar, and A. U. Meenakshi Sundareswaran. "Early Injected PCCI Engine Fuelled with Bio Ethanol and Diesel Blends – An Experimental Investigation." Energy Procedia 105 (May 2017): 358–66. http://dx.doi.org/10.1016/j.egypro.2017.03.326.

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Park, Sangki, Woong Il Kim, and Ki-Hyung Lee. "EFFECTS OF EARLY-INJECTION STRATEGY ON THE COMBUSTION AND EMISSION CHARACTERISTICS OF A PCCI DIESEL ENGINE." Atomization and Sprays 27, no. 1 (2017): 45–59. http://dx.doi.org/10.1615/atomizspr.2016016267.

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Sung, Yongha, Gilsung Jung, and Myung Taeck Lim. "Delay of ignition in early direct-injected PCCI engine combustion using fuel-evaporative cooling and cooled EGR." Journal of Mechanical Science and Technology 25, no. 6 (June 2011): 1409–14. http://dx.doi.org/10.1007/s12206-011-0401-4.

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HIRAYAMA, Kazuki, Takuji YOKOYAMA, Zhichao Bao, Naoto HORIBE, Hiroshi KAWANABE, and Takuji ISHIYAMA. "Study for Improvement of Diesel Engine Performance using a Combination of Early-injection PCCI and Conventional Diesel Combustion." Proceedings of Conference of Kansai Branch 2018.93 (2018): 1014. http://dx.doi.org/10.1299/jsmekansai.2018.93.1014.

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Kiplimo, Robert, Eiji Tomita, Nobuyuki Kawahara, and Sumito Yokobe. "HC2-1 Spectrum Analysis of Chemiluminescence of a Low Sooting PCCI Diesel Engine Operating with Moderately Early Injection Timing(HC: HCCI Combustion,General Session Papers)." Proceedings of the International symposium on diagnostics and modeling of combustion in internal combustion engines 2012.8 (2012): 410–15. http://dx.doi.org/10.1299/jmsesdm.2012.8.410.

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Kim, Hyung-min, Yung-jin Kim, and Ki-hyung Lee. "A Study of the Characteristics of Mixture Formation and Combustion in a PCCI Engine Using an Early Multiple Injection Strategy." Energy & Fuels 22, no. 3 (May 2008): 1542–48. http://dx.doi.org/10.1021/ef700568g.

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Kong, Song-Charng, Yong Sun, and Rolf D. Rietz. "Modeling Diesel Spray Flame Liftoff, Sooting Tendency, and NOx Emissions Using Detailed Chemistry With Phenomenological Soot Model." Journal of Engineering for Gas Turbines and Power 129, no. 1 (December 15, 2005): 245–51. http://dx.doi.org/10.1115/1.2181596.

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A detailed chemistry-based CFD model was developed to simulate the diesel spray combustion and emission process. A reaction mechanism of n-heptane is coupled with a reduced NOx mechanism to simulate diesel fuel oxidation and NOx formation. The soot emission process is simulated by a phenomenological soot model that uses a competing formation and oxidation rate formulation. The model is applied to predict the diesel spray lift-off length and its sooting tendency under high temperature and pressure conditions with good agreement with experiments of Sandia. Various nozzle diameters and chamber conditions were investigated. The model successfully predicts that the sooting tendency is reduced as the nozzle diameter is reduced and/or the initial chamber gas temperature is decreased, as observed by the experiments. The model is also applied to simulate diesel engine combustion under premixed charge compression ignition (PCCI) conditions. Trends of heat release rate, NOx, and soot emissions with respect to EGR levels and start-of-injection timings are also well predicted. Both experiments and models reveal that soot emissions peak when the start of injection (SOI) occurs close to TDC. The model indicates that low soot emission at early SOI is due to better oxidation while low soot emission at late SOI is due to less formation. Since NOx emissions decrease monotonically with injection retardation, a late injection scheme can be utilized for simultaneous soot and NOx reduction for the engine conditions investigated in this study.

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13

Moffatt, Craig. "Methodologies for Removing Heavy Oil as Used on the SS Jacob Luckenbach and Joint International Testing Programs." Marine Technology Society Journal 38, no. 3 (September 1, 2004): 64–71. http://dx.doi.org/10.4031/002533204787511318.

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At 0440 on July 14, 1953, the 468-foot long C3 Cargo/Oil Carrier SS Jacob Luckenbach was struck by the SS Hawaiian Pilot about 31 km (17 miles) west of the Golden Gate Bridge, San Francisco, CA. The Luckenbach sank with no loss of life, but sustained massive structural damage from the collision, which caused the sinking. At the time of her collision and sinking she was in route to Korea with a full cargo of jeeps, trucks, and railroad equipment for the Korean War effort. It is estimated that her bunkers were topped off for the trip with heavy bunker C oil.In early 2002, the Luckenbach was identified as the source of "mystery" oil spills along the California coast. In May 2002, Titan Maritime LLC, with engineers from PCCI Inc., was contracted by the U.S. Coast Guard, Pacific Area Command, San Francisco, to conduct a vessel assessment and remove available oil. Global Diving & Salvage, Seattle, provided saturation diving services and Crowley Maritime provided the primary work barge and tug services.Problems encountered included extended cold-water saturation diving at depths to 55 m, strong reversing currents, extremely adverse weather, and poor sub-sea visibility. The heavy residual oils in the deep tanks and double bottoms also proved to be a pumping challenge since some tanks contained oil that was far more viscous than normal number 6 fuel oil (Ingersoll-Dresser, 1998).This paper describes the approach to the oil recovery from this wreck, as well as expanding upon more recent and ongoing developments in the field of emergency ship and sunken vessel viscous oil off-loading methodologies.

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14

Huang, Ling-Hui, Lian-Shin Lin, Chun-Li Wang, Yu-Chen Chang, Lung-Chun Lee, Chung-Chieh Hu, Pi-Shan Hsu, and Wei-Min Chu. "Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan." International Journal of Environmental Research and Public Health 18, no. 18 (September 19, 2021): 9882. http://dx.doi.org/10.3390/ijerph18189882.

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Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.

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15

Ryabov, Vladimir M., Mikhail M. Baryshev, Mikhail A. Voskresenskiy, and Boris V. Popov. "Early Cell Cultures from Prostate Cancer Tissue Express Tissue Specific Epithelial and Cancer Markers." International Journal of Molecular Sciences 24, no. 3 (February 1, 2023): 2830. http://dx.doi.org/10.3390/ijms24032830.

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Prostate cancer (PCa) is a widespread oncological disease that proceeds in the indolent form in most patients. However, in some cases, the indolent form can transform into aggressive metastatic incurable cancer. The most important task of PCa diagnostics is to search for early markers that can be used for predicting the transition of indolent cancer into its aggressive form. Currently, there are two effective preclinical models to study PCa pathogenesis: patients derived xenografts (PDXs) and patients derived organoids (PDOs). Both models have limitations that restrict their use in research. In this work, we investigated the ability of the primary 2D prostate cell cultures (PCCs) from PCa patients to express epithelial and cancer markers. Early PCCs were formed by epithelial cells that were progressively replaced with the fibroblast-like cells. Early PCCs contained tissue-specific stem cells that could grow in a 3D culture and form PDOs similar to those produced from the prostate tissue. Early PCCs and PDOs derived from the tissues of PCa patients expressed prostate basal and luminal epithelial markers, as well as cancer markers AMACR, TMPRSS2-ERG, and EZH2, the latter being a promising candidate to mark the transition from the indolent to aggressive PCa. We also identified various TMPRSS2-ERG fusion transcripts in PCCs and PDOs, including new chimeric variants resulting from the intra- and interchromosomal translocations. The results suggest that early PCCs derived from cancerous and normal prostate tissues sustain the phenotype of prostate cells and can be used as a preclinical model to study the pathogenesis of PCa.

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16

Прилуцкая, В. А., А. В. Сукало, Т. А. Деркач, И. В. Наумчик, Л. В. Шалькевич, А. В. Зиновик, Б. Л. Елиневский, В. П. Стефаненкова, and И. П. Богданович. "Propionic Acidemia in Children: Literature Review and Clinical Observation." Педиатрия. Восточная Европа, no. 1 (May 11, 2020): 92–105. http://dx.doi.org/10.34883/pi.2020.8.1.008.

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Пропионовая ацидемия редкое наследственное заболевание обмена веществ с аутосомно-рецессивным типом наследования, которое связано с нарушением метаболизма органических кислот. Заболевание обусловлено недостаточностью фермента пропионил-КоА карбоксилазы, которая приводит к накоплению в органах и тканях пропионовой кислоты и ее метаболитов. Клинически выделяют 2 основные формы болезни: острую неонатальную и младенческую (или позднюю) формы. Диагностика заболевания является сложной задачей, так как клинические симптомы, обусловленные дефектами метаболизма, часто встречаются при внутриутробных инфекциях, гипоксически-ишемическом поражении центральной нервной системы, пороках развития головного мозга. Лабораторная диагностика основана на увеличении содержания пропионовой кислоты, метаболитов, изолейцина, валина, метионина и треонина в крови. Для точной верификации необходимо молекулярно-генетическое исследование с поиском мутаций в генах PCCA и PCCВ. Подтверждение диагноза важно не только для тактики ведения пациентов, но и при планировании последующих деторождений в таких семьях. В статье представлено наблюдение пропионовой ацидемии у ребенка в возрасте 3 месяцев жизни. Данный случай продемонстрирован с целью привлечения внимания педиатров к проблеме наследственных болезней обмена веществ. Несмотря на объективные сложности в диагностике пропионовой ацидемии, такие опорные симптомы, как раннее начало заболевания с наличием характерных кризов, обусловленных токсической энцефалопатией, лабораторные изменения, регистрирующие метаболический ацидоз, специфические изменения в крови и моче при генетическом исследовании, помогают не только заподозрить и диагностировать заболевание, но и своевременно назначить специфическое лечение и сохранить жизнь ребенку. Propionic acidemia is a rare hereditary metabolic disease with autosomal recessive type of inheritance, which is associated with a violation of the metabolism of organic acids. The disease is caused by the deficiency of the propionyl CoA carboxylase enzyme, which leads to the accumulation of propionic acid and its metabolites in organs and tissues. Two main forms of the disease are clinically distinguished: acute neonatal one and infant (or late) one. Diagnostics of the disease is a difficult task, because clinical symptoms caused by metabolic defects are often found in intrauterine infections, hypoxic-ischemic damage to the central nervous system, and brain malformations. Laboratory diagnostics is based on the increase of the content of propionic acid, metabolites, isoleucine, valine, methionine, and threonine in the blood. For accurate verification, a molecular genetic study with the search of mutations in the PCCA and PCCB genes is required. Confirmation of the diagnosis is important not only for the management of patients, but also when planning subsequent births in such families. The article presents the observation of propionic acidemia in a child at the age of 3 months. This case was demonstrated in order to attract the attention of pediatricians to the problem of hereditary metabolic diseases. Despite objective difficulties in the diagnostics of propionic acidemia, such supporting symptoms as early onset of the disease with the presence of specific crises caused by toxic encephalopathy, laboratory changes that record metabolic acidosis, specific changes in blood and urine during the genetic study help to not only suspect and diagnose the disease, but also timely prescribe specific treatment and save the life of the child.

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17

Steensma, David P., Morie A. Gertz, Philip R. Greipp, Robert A. Kyle, Martha Q. Lacy, John A. Lust, Janice R. Offord, Matthew F. Plevak, Terry M. Therneau, and Thomas E. Witzig. "A high bone marrow plasma cell labeling index in stable plateau–phase multiple myeloma is a marker for early disease progression and death." Blood 97, no. 8 (April 15, 2001): 2522–23. http://dx.doi.org/10.1182/blood.v97.8.2522.

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Abstract The plasma cell labeling index (PCLI) is a measure of plasma cell proliferative activity and is an important prognostic factor in newly diagnosed multiple myeloma (MM). Occasionally patients have been observed with stable, plateau phase MM with minimal numbers of residual light-chain–restricted monoclonal plasma cells, but a high PCLI. No data are available on the outcomes for such patients. Data from 57 patients with plateau phase MM and a marrow PCLI of more than 1.0% were compared with 105 matched control patients with MM with a marrow PCLI of less than 1.0%. All patients had less than 10% total plasma cells on marrow aspirate and biopsy. The median time to progression and overall survival were 8 months and 20 months, respectively, in the high PCLI group versus 39 months and 56 months, respectively, in the low PCLI group (P < .0001). These findings suggest that a high PCLI in patients with apparently stable, plateau phase MM is an adverse parameter that may predict a short time to disease progression and death.

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Lust, John A., Martha Q. Lacy, Angela Dispenzieri, Morie A. Gertz, Steven R. Zeldenrust, Philip R. Greipp, Thomas E. Witzig, et al. "Interleukin-1 Receptor Antagonist (IL-1Ra) Targets the Proliferative Component in Early Stage Myeloma." Blood 104, no. 11 (November 16, 2004): 2412. http://dx.doi.org/10.1182/blood.v104.11.2412.2412.

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Abstract Background: It has been hypothesized that multiple myeloma (MM) remains incurable due to a stemcell/proliferative component that responds only partially to standard treatment regimens. We have shown that abnormal production of IL-1beta in the myeloma microenvironment stimulates the generation of paracrine IL-6, the central myeloma growth factor, and that IL-1Ra will inhibit paracrine IL-6 production in vitro. Based on these preclinical studies, we have developed a Phase II trial using IL-1Ra. Purpose: To determine the biologic and clinical activity of IL-1Ra (Anakinra) in a subgroup of smoldering MM (SMM) patients that present with an elevated plasma cell labeling index (PCLI; a measure of myeloma cell proliferation). Methods: Patients that had ≥ 10% bone marrow plasma cells and/or an IgG or IgA M-spike ≥ 3 g/dL and did not require immediate chemotherapy were eligible. Patients received 100 mg of Anakinra (IL-1Ra) SQ qd for a total duration of 6 months. Results: Eleven of 29 patients enrolled on the protocol had an on-study PCLI > 0 and have completed six months of therapy with IL-1Ra. Seven of the 11 patients had a decrease in the PCLI of 75–100% (see Table), three had only modest changes (≤ 50%), and one had an increase. The decrease in the PCLI paralleled a decrease in the high sensitivity C-reactive protein (CRP) in all cases (43–90% decrease). The above results suggested that IL-1Ra inhibited IL-6 production in the myeloma microenvironment, as evidenced by a reduction in the CRP, resulting in suppression of myeloma cell growth. However, there was little effect on the M-protein. To investigate these clinical observations, we co-cultured IL-1beta transduced +/− myeloma cells with stromal cells +/− dexamethasone (DEX), IL-1Ra, or both for 48 hours and quantitated the percent apoptotic cells by flow cytometry and IL-6 production by ELISA. The results showed: 1) IL-1Ra was superior at inhibition of IL-6 but caused no increase in apoptosis; 2) the DEX apoptotic effect was eliminated by IL-6 3) DEX and IL-1Ra combined induced maximal IL-6 inhibition and apoptosis of myeloma cells. Based on these in vitro results, 5 of the 11 patients have been advanced to IL-1Ra + low dose DEX (20 mg/week) resulting in 4/5 minor responses (25–50% decrease M-spike) and 1/5 with stable disease. Conclusion: The use of IL-1Ra is a novel targeted therapeutic strategy that interferes with myeloma cell growth. By inhibiting IL-1beta induced IL-6 production, IL-1Ra specifically targets the proliferative myeloma fraction and also complements DEX induced apoptosis. Preliminary studies on the use of IL-1 inhibitors in SMM patients to delay/prevent progression to active MM and to minimize toxicity appear encouraging, however, more patients need to be studied. Patient # On Study 6 months % Change 1 PCLI 0.8% 0% −100% CRP (mg/L) 2.01 0.58 − 71% M-spike (g/dL) 2.5 2.4 − 4% 2 PCLI 0.2% 0% − 100% CRP 0.89 0.51 − 43% M-spike 2.8 2.7 − 3% 3 PCLI 0.2% 0% − 100% CRP 5.7 1.02 − 82% M-spike 2.9 2.9 0% 4 PCLI 4.1% 1% − 75% CRP 3.39 1.51 − 55% M-spike 3.8 3.6 − 5% 5 PCLI 0.4% 0% − 100% CRP 3.46 0.34 − 90% M-spike 2.7 3.1 15% 6 PCLI 0.3% 0% − 100% CRP 17 5.35 − 68% M-spike 4.4 3.9 − 11% 7 PCLI 1.2% 0% − 100% CRP 1.06 0.32 − 70% M-spike 3.1 2.9 − 6%

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Corssmit, Eleonora P., and Johannes A. Romijn. "MANAGEMENT OF ENDOCRINE DISEASE: Clinical management of paragangliomas." European Journal of Endocrinology 171, no. 6 (December 2014): R231—R243. http://dx.doi.org/10.1530/eje-14-0396.

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Paragangliomas (PGLs) are rare vascular, neuroendocrine tumors of paraganglia, which are associated with either sympathetic tissue in adrenal (pheochromocytomas (PCCs)) and extraadrenal (sympathetic paraganglioma (sPGLs)) locations or parasympathetic tissue of the head and neck paragangliomas (HNPGLs). As HNPGLs are usually benign and most tumors grow slowly, a wait-and-scan policy is often advised. However, their location in the close proximity to cranial nerves and vasculature may result in considerable morbidity due to compression or infiltration of the adjacent structures, necessitating balanced decisions between a wait-and-see policy and active treatment. The main treatment options for HNPGL are surgery and radiotherapy. In contrast to HNPGLs, the majority of sPGL/PCCs produces catecholamines, in advanced cases resulting in typical symptoms and signs such as palpitations, headache, diaphoresis, and hypertension. The state-of-the-art diagnosis and localization of sPGL/PCCs are based on measurement of plasma and/or 24-h urinary excretion of (fractionated) metanephrines and methoxytyramine (MT). sPGL/PCCs can subsequently be localized by anatomical (computed tomography and/or magnetic resonance imaging) and functional imaging studies (123I-metaiodobenzylguanidine-scintigraphy,111In-pentetreotide scintigraphy, or positron emission tomography with radiolabeled dopamine or dihydroxyphenylalanine). Although most PGL/PCCs are benign, factors such as genetic background, tumor size, tumor location, and high MT levels are associated with higher rates of metastatic disease. Surgery is the only curative treatment. Treatment options for patients with metastatic disease are limited. PGL/PCCs have a strong genetic background, with at least one-third of all cases linked with germline mutations in 11 susceptibility genes. As genetic testing becomes more widely available, the diagnosis of PGL/PCCs will be made earlier due to routine screening of at-risk patients. Early detection of a familial PGL allows early detection of potentially malignant PGLs and early surgical treatment, reducing the complication rates of this operation.

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Peng, Ding-Zhong, Jiong Lu, Bei Li, Hai-Jie Hu, Xi-Wen Ye, Xian-Ze Xiong, and Nan-Sheng Cheng. "A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma." Gastroenterology Report 7, no. 5 (April 21, 2019): 345–53. http://dx.doi.org/10.1093/gastro/goz012.

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Abstract Background Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma (pCCA) after resection. The objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant therapy. Methods In total, 244 patients who underwent radical resection for type IV pCCA were included. Data on clinicopathological characteristics, perioperative details and survival outcomes were analyzed. Survival curves were generated using the Kaplan–Meier method. Univariate and multivariate logistic-regression models were used to identify factors associated with early recurrence. Results Twenty-one months was defined as the cutoff point to distinguish between early and late recurrence. Univariate and multivariate analysis revealed that CA19-9 level >200 U/mL, R1 resection margin, higher N category and positive lymphovascular invasion were independent predictors of early recurrence. The scoring system was constructed accordingly. The early-recurrence rates of patients with scores of 0, 1, 2, 3, 4, and 5 were 23.9%, 38.7%, 60.0%, 78.6%, 83.4%, and 100%, respectively. Adjuvant therapy was significantly associated with higher overall survival rate for patients with early recurrence, but not for those with late recurrence. Patients in the early-recurrence group with scores ≥2 had better prognoses after adjuvant therapy. Conclusions A simple scoring system using CA19-9 level, N category, resection margin and lymphovascular invasion status could predict early recurrence, and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.

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Pimperton, Hannah, Hazel Blythe, Jana Kreppner, Merle Mahon, Janet L. Peacock, Jim Stevenson, Emmanouela Terlektsi, Sarah Worsfold, Ho Ming Yuen, and Colin R. Kennedy. "The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study." Archives of Disease in Childhood 101, no. 1 (November 25, 2014): 9–15. http://dx.doi.org/10.1136/archdischild-2014-307516.

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ObjectiveTo determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade.DesignProspective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS.SettingBirth cohort of 100 000 in southern England.Participants114 teenagers aged 13–19 years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6–10 years.InterventionsBirth in periods with and without UNHS; confirmation of PCHI before and after age 9 months.Main outcome measureReading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.ResultsConfirmation of PCHI by age 9 months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI −0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI −0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.ConclusionsThe benefit to reading comprehension of confirmation of PCHI by age 9 months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss.Trial registration numberISRCTN03307358.

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Kuner, Valerie, Nicole van Veelen, Stephanie Studer, Bryan Van de Wall, Jürgen Fornaro, Michael Stickel, Matthias Knobe, Reto Babst, Frank J. P. Beeres, and Björn-Christian Link. "Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?" Journal of Clinical Medicine 10, no. 6 (March 21, 2021): 1297. http://dx.doi.org/10.3390/jcm10061297.

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Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

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Adams, E. Kathleen, Janet M. Bronstein, and Curtis S. Florence. "The Impact of Medicaid Primary Care Case Management on Office-Based Physician Supply in Alabama and Georgia." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 40, no. 3 (August 2003): 269–82. http://dx.doi.org/10.5034/inquiryjrnl_40.3.269.

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The success of the “primary care case management (PCCM)” form of managed care implemented in many state Medicaid programs over the past several years depends in part on the expanded availability of primary care physician sites to substitute for hospital-based outpatient care and to provide a medical home for enrollees. However, the PCCM requirement for physicians to accept assignment of a caseload of patients and to provide all of their primary care likely conflicts with the approach of limited Medicaid participation favored by many Medicaid physician participants. This study examines the early impact of PCCM implementation, in the absence of physician reimbursement level increases, on the patterns of Medicaid participation by physicians in communities in Georgia and Alabama. We find that the implementation of PCCM under these conditions often was associated with reductions in the proportion of physicians participating in Medicaid, reductions in the number of very small Medicaid practices, and declines in Medicaid visit volumes across all participating physicians. We also find evidence of an overall reduction in the number of primary care visits per Medicaid enrollee, but an increase in the proportion of these visits that were for preventive care services associated with initial PCCM implementation.

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Hui, David, Nathan I. Cherny, Jimin Wu, Diane Liu, Nicola Jane Latino, and Florian Strasser. "Indicators of integration at ESMO Designated Centres of Integrated Oncology and Palliative Care." ESMO Open 3, no. 5 (July 2018): e000372. http://dx.doi.org/10.1136/esmoopen-2018-000372.

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BackgroundA recent international consensus panel identified 13 major indicators to assess the level of integration between oncology and palliative care. We examined these indicators among European Society for Medical Oncology (ESMO) Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) and determined the centre characteristics associated with greater integration.MethodsThis is a preplanned secondary analysis of a recent survey to characterise the structure, processes and outcomes of the palliative care programmes at ESMO-DCs. We assessed the level of integration using 13 major indicators. We calculated two Palliative Care and Oncology Integration Indexes consisting of all 13 indicators (PCOI-13, range 0–13) and 9 of the 13 indicators (PCOI-9, range 0–9), with a higher index indicating greater integration.ResultsThe survey response rate was 152/184 (83%). Among the 13 major indicators, interdisciplinary team was most likely to be achieved (95%), while early referral to palliative care (median time from referral to death >6 months before death) was only present in 24 (20%) of ESMO-DCs. The median PCOI-13 was 7.8 (IQR 6.4–9.6) and the median PCOI-9 was 6 (IQR 5–7). The presence of dually trained palliative oncologists was associated with higher PCOI-13 (median 8.4 vs 7.0; p=0.01) and PCOI-9 (median 6 vs 5; p=0.03). Non-tertiary hospitals generally had higher PCOI-13 (median 8.6 vs 7.2; p=0.01) and ESMO-DCs outside of Europe had higher PCOI-9 (median 7 vs 6; p=0.03).ConclusionsAssessment of the level of integration at ESMO-DCs with PCOIs highlighted strengths, areas for further development and how double-boarded palliative oncologists may promote integration.

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Gringeri, Enrico, Martina Gambato, Gonzalo Sapisochin, Tommy Ivanics, Erica Nicola Lynch, Claudia Mescoli, Patrizia Burra, Umberto Cillo, and Francesco Paolo Russo. "Cholangiocarcinoma as an Indication for Liver Transplantation in the Era of Transplant Oncology." Journal of Clinical Medicine 9, no. 5 (May 5, 2020): 1353. http://dx.doi.org/10.3390/jcm9051353.

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Cholangiocarcinoma (CCA) arises from the biliary tract epithelium and accounts for 10–15% of all hepatobiliary malignancies. Depending on anatomic location, CCA is classified as intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA). The best treatment option for pCCA is liver resection and when a radical oncological surgery is obtained, 5-year survival rate are around 20–40%. In unresectable patients, following a specific protocol, liver transplantation (LT) for pCCA showed excellent long-term disease-free survival rates. Fewer data are available for iCCA in LT setting. Nevertheless, patients with very early unresectable iCCA appear to achieve excellent outcomes after LT. This review aims to evaluate existing evidence to define the current role of LT in the management of patients with CCA.

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Segel, Sally, Jason Hashima, William Thomas Gregory, Alison Edelman, Hong Li, and Jeanne-Marie Guise. "A New Approach to Postpartum Rounds: Patient-Centered Collaborative Care Improves Efficiency." Journal of Graduate Medical Education 2, no. 1 (March 1, 2010): 67–72. http://dx.doi.org/10.4300/jgme-d-09-00060.1.

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Abstract Objective At our institution, traditional postpartum rounds were time consuming and inefficient with a low percentage (approximately 12%) of patients meeting the goal of being discharged by 11:00 am. A patient-centered collaborative care (PCCC) initiative was implemented to improve discharge efficiency, staff communication, and patient satisfaction. We investigated whether this paradigm shift to PCCC could improve clinical inefficiencies and timely discharge. Methods The PCCC rounding system was created by a representative group of physicians, residents, nurses, case managers, and social workers. An intervention study was conducted to examine the impact of PCCC during which physicians, residents, medical students, nurses, case managers, and social workers made rounds together. Efficiency data were collected for patients whose infants were delivered by the obstetric service for a 1-month period before and 6 months after implementing PCCC. Comparisons were made on the time of discharge and whether Foley catheter removal affected discharge time. χ2 test, Wilcoxon 2-sample test, and Pearson correlation coefficient were used where appropriate. Results Three hundred five patients were included in this analysis, of which 156 participated in traditional postpartum rounds and 149 in PCCC rounds. Discharge efficiency significantly improved with PCCC rounds, with 20.8% of patients being discharged by 11:00 am as compared to 11.5% for traditional postpartum rounds (P = .03). Early Foley catheter removal was significantly associated with time to discharge order (Pearson correlation coefficient, 0.22; P = .01) and discharge time (Pearson correlation coefficient, 0.28; P = .002). Conclusions Patient-centered collaborative care rounds improve the efficiency of postpartum care and discharge time.

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Brain, Timothy. "Police and crime commissioners: the first twelve months." Safer Communities 13, no. 1 (January 7, 2014): 40–50. http://dx.doi.org/10.1108/sc-09-2013-0020.

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Purpose – The purpose of this paper is to review the establishment of this new type of elected official and the conduct of those in office during the first twelve months of their official existence, and to consider whether a compelling case has yet been made for its retention as the principal method of police governance. Design/methodology/approach – The paper will review policy papers and data which preceded and followed the establishment of the office of police and crime commissioner (PCC) in November 2012; review the 2012 elections and their implications, review conduct since, particularly in respect of formal duties, principally setting budgets and police and crime plans; consider the potential for politicisation; and consider whether a case has been made for the retention of the office in future. Findings – The paper concludes that the government has succeeded with PCCs in implementing a major plank of the Conservative party's 2010 manifesto. It can reasonably be anticipated that the Conservatives will promote this record at the next election. However, it is simply too early to tell if PCCs are individually or collectively adding value to the sum of policing in England and Wales. A compelling case for their retention as a means of police governance is therefore yet to be made. On the other hand, Labour has still to determine whether it will offer the electorate an alternative in 2015. Research limitations/implications – With only ten months having elapsed since the first elections, it is early to draw firm conclusions about the effectiveness or, more pertinently, the added value that PCCs have brought to policing. Conversely, the first twelve months was an opportunity for PCCs to make a positive impression and this has not occurred. Practical implications – PCCs ought to be subject to a rigorous appraisal of effectiveness. This is unlikely, for political reasons, to occur. Originality/value – First rigorous review of PCCs based on a review of available data.

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Williams, Lashae N., Andrea Trubanova Wieckowski, Mary F. S. Dieckhaus, Yael G. Dai, Fengqing Zhang, Thyde Dumont-Mathieu, Marianne Barton, Deborah Fein, and Diana L. Robins. "Primary Care Clinician and Child Characteristics Impacting Autism Surveillance." Brain Sciences 13, no. 1 (December 22, 2022): 18. http://dx.doi.org/10.3390/brainsci13010018.

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Early detection of autism provides access to early intervention and subsequently fewer lifelong challenges. However, disparities in screening have been associated with socioeconomic status (SES) and race, and disparities in surveillance have been associated with clinician knowledge and beliefs about autism identification. The present study examines associations between demographic variables and clinician beliefs, and agreement between screening results and clinician surveillance. Surveillance included activities used by the primary care clinicians (PCCs) to assess risk for autism. PCCs reported their beliefs about autism screening and identification, their sex, race, years in practice, and racial distribution of their patient population. Children’s demographic information was also collected. PCCs identified children as having, or not having, an increased likelihood of autism, and parents of children completed an autism screener. Agreement between screening and surveillance results were examined across PCC, practice, and child demographics. Higher confidence in autism knowledge and screening resources, female PCC sex, and majority White practice patient demographics all predicted agreement between screening and surveillance. Female child sex and higher maternal education also predicted agreement between screening and surveillance. These findings highlight the importance of PCC screening beliefs and child and PCC demographics on the autism identification process.

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Crimì, Filippo, Elena Agostini, Alessandro Toniolo, Francesca Torresan, Maurizio Iacobone, Irene Tizianel, Carla Scaroni, Emilio Quaia, Cristina Campi, and Filippo Ceccato. "CT Texture Analysis of Adrenal Pheochromocytomas: A Pilot Study." Current Oncology 30, no. 2 (February 9, 2023): 2169–77. http://dx.doi.org/10.3390/curroncol30020167.

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Radiomics is a promising research field that combines big data analysis (from tissue texture analysis) with clinical questions. We studied the application of CT texture analysis in adrenal pheochromocytomas (PCCs) to define the correlation between the extracted features and the secretory pattern, the histopathological data, and the natural history of the disease. A total of 17 patients affected by surgically removed PCCs were retrospectively enrolled. Before surgery, all patients underwent contrast-enhanced CT and complete endocrine evaluation (catecholamine secretion and genetic evaluation). The pheochromocytoma adrenal gland scaled score (PASS) was determined upon histopathological examination. After a resampling of all CT images, the PCCs were delineated using LifeX software in all three phases (unenhanced, arterial, and venous), and 58 texture parameters were extracted for each volume of interest. Using the Mann–Whitney test, the correlations between the hormonal hypersecretion, the malignancy score of the lesion (PASS > 4), and texture parameters were studied. The parameters DISCRETIZED_HUpeak and GLZLM_GLNU in the unenhanced phase and GLZLM_SZE, CONVENTIONAL_HUmean, CONVENTIONAL_HUQ3, DISCRETIZED_HUmean, DISCRETIZED_AUC_CSH, GLRLM_HGRE, and GLZLM_SZHGE in the venous phase were able to differentiate secreting PCCs (p < 0.01), and the parameters GLZLM_GLNU in the unenhanced phase and GLRLM_GLNU and GLRLM_RLNU in the venous differentiated tumors with low and high PASS. CT texture analysis of adrenal PCCs can be a useful tool for the early identification of secreting or malignant tumors.

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Palfreyman, Harriet, and Roger L. Kneebone. "Blind alleys and dead ends: researching innovation in late 20th century surgery." Medical Humanities 44, no. 3 (January 5, 2018): 165–71. http://dx.doi.org/10.1136/medhum-2016-011176.

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This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.

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Abdeljawad, Ahmed, and Yasser Shaban Mubarak. "Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study." Heart Surgery Forum 25, no. 1 (February 24, 2022): E140—E146. http://dx.doi.org/10.1532/hsf.4431.

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Background: Extracorporeal membrane oxygenator (ECMO) has been implemented in refractory postcardiotomy cardiogenic shock (PCCS) patients to maintain excellent oxygenation and hemodynamic support. The aim of this study is to compare the results of early ECMO implantation to treat refractory PCCS in emergency versus elective patients who developed univentricular or biventricular pump failure. Patients and methods: Between January 2019 and June 2021, 35 patients received ECMO after refractory PCCS. Patients have been categorized into two groups: Group A contains 18 patients who were urgently operated on and Group B, which includes 17 patients who were electively operated on. ECMO was implanted through central cannulation (right atrium and ascending aorta), or through peripheral cannulation (femoral vessels or through axillary artery). Results: There was no statistically significant difference between the two ECMO groups in the preoperative patient’s characteristics, complication rate, duration of mechanical ventilation, post-ECMO weaning hospital stay, duration of ICU stay, in-hospital mortality, and number of patients discharged from the hospital or in 1-year survival on follow up. Conclusion: Early use of ECMO in high-risk emergency cardiac surgery should be taken into consideration when possible, without hesitance. Emergency and elective patients benefit equally from ECMO implantation and show comparable complication rates.

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Zou, Baiming, Hudson P. Santos, James G. Xenakis, Mike M. O’Shea, Rebecca C. Fry, and Fei Zou. "A mixed-effects two-part model for twin-data and an application on identifying important factors associated with extremely preterm children’s health disorders." PLOS ONE 17, no. 6 (June 13, 2022): e0269630. http://dx.doi.org/10.1371/journal.pone.0269630.

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Our recent studies identifying factors significantly associated with the positive child health index (PCHI) in a mixed cohort of preterm-born singletons, twins, and triplets posed some analytic and modeling challenges. The PCHI transforms the total number of health disorders experienced (of the eleven ascertained) to a scale from 0 to 100%. While some of the children had none of the eleven health disorders (i.e., PCHI = 1), others experienced a subset or all (i.e., 0 ≤PCHI< 1). This indicates the existence of two distinct data processes—one for the healthy children, and another for those with at least one health disorder, necessitating a two-part model to accommodate both. Further, the scores for twins and triplets are potentially correlated since these children share similar genetics and early environments. The existing approach for analyzing PCHI data dichotomizes the data (i.e., number of health disorders) and uses a mixed-effects logistic or multiple logistic regression to model the binary feature of the PCHI (1 vs. < 1). To provide an alternate analytic framework, in this study we jointly model the two data processes under a mixed-effects two-part model framework that accounts for the sample correlations between and within the two data processes. The proposed method increases power to detect factors associated with disorders. Extensive numerical studies demonstrate that the proposed joint-test procedure consistently outperforms the existing method when the type I error is controlled at the same level. Our numerical studies also show that the proposed method is robust to model misspecifications and it is applicable to a set of correlated semi-continuous data.

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Uyar, Emel, and M. Nilufer Yalindag-Ozturk. "Early Antibiotic Prescription and Early Discharge." Pediatric Critical Care Medicine 20, no. 8 (August 2019): 794–95. http://dx.doi.org/10.1097/pcc.0000000000001975.

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Ramzy, Danny, Mark Anderson, George Batsides, Masahiro Ono, Scott Silvestry, David A. D’Alessandro, Masaki Funamoto, Elias A. Zias, Anthony Lemaire, and Edward Soltese. "Early Outcomes of the First 200 US Patients Treated with Impella 5.5: A Novel Temporary Left Ventricular Assist Device." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 16, no. 4 (June 8, 2021): 365–72. http://dx.doi.org/10.1177/15569845211013329.

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Objective To report the initial clinical experience with the Impella 5.5® with SmartAssist®, a temporary left ventricular assist device that provides up to 6.2 L/min forward flow, with recent FDA approval for up to 14 days. Methods From October 2019 to March 2020, 200 patients at 42 US centers received the Impella 5.5 and entered into the IQ registry, a manufacturer-maintained quality database that captures limited baseline/procedural characteristics and outcomes through device explant. Post hoc subgroup analyses were conducted to assess the role of baseline and procedural characteristics on survival, defined as successful device weaning or bridge to durable therapy. Results Median patient age was 62 years (range, 13 to 83 years); 83.4% were male. The device was most commonly used for cardiomyopathy (45.0%), acute myocardial infarction complicated by cardiogenic shock (AMICS; 29.0%), and post cardiotomy cardiogenic shock (PCCS; 16.5%). Median duration of support was 10.0 days (range, 0.001 to 64.4 days). Through device explant, overall survival was 74.0%, with survival of 80.0%, 67.2%, 57.6%, and 94.7% in cardiomyopathy, AMICS, PCCS, and others (comprising high-risk revascularization, coronary artery bypass graft, electrophysiology/ablation, and myocarditis), respectively. Patients requiring extracorporeal membrane oxygenation and Impella support (35 patients, 17.5%) had significantly lower survival (51.4% vs 78.8%, P = 0.002). Conclusions In the first 200 US patients treated with the Impella 5.5, we observed overall survival to explant of 74%. Survival outcomes were improved compared to historic rates observed with cardiogenic shock, particularly PCCS. Prospective studies assessing comparative performance of this device to conventional strategies are warranted in future.

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Du, Zhongxiang, Xiajun Zhang, Weiya Gao, and Jie Yang. "Differentially expressed genes PCCA, ECHS1, and HADH are potential prognostic biomarkers for gastric cancer." Science Progress 104, no. 2 (April 2021): 003685042110113. http://dx.doi.org/10.1177/00368504211011344.

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Gastric cancer (GC) is one of the most common malignant tumors in the world. As far as we know, no biomarker has been widely accepted for early diagnosis and prognosis prediction of GC. The purpose of this study is to find potential biomarkers to predict the prognosis of GC. The differentially expressed gene (DEG) was analyzed from GSE93774. Enrichr was used to analyze the gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, the enrichment of transcription factors (TF), miRNA, and kinase. GO analysis showed DEGs was enriched in the process of amino acid metabolism. Pathway results showed DEGs was mainly enriched in cell cycle. Propionyl CoA carboxylase alpha (PCCA), Enoyl coenzyme A hydratase short chain 1 (ECHS1), and 3-hydroxyacyl-CoA dehydrogenase (HADH) have prognostic value in patients with GC. ECHS1 and HADH genes were significantly associated with disease-free survival. There was a significant correlation between PCCA and overall survival rate. The results of this study suggest that PCCA, ECHS1, and HADH may be new biomarkers for predicting the prognosis of GC.

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Mohamud, D., S. Nguyen, and J. Schawlm. "EARLY DISCHARGE OF PRIMARY PCI PATIENTS." Canadian Journal of Cardiology 37, no. 10 (October 2021): S18. http://dx.doi.org/10.1016/j.cjca.2021.07.047.

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Klugman, Darren. "Early Extubation." Pediatric Critical Care Medicine 17, no. 7 (July 2016): 699–700. http://dx.doi.org/10.1097/pcc.0000000000000808.

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Houtrow, Amy. "Early Rehabilitation." Pediatric Critical Care Medicine 18, no. 11 (November 2017): 1080–81. http://dx.doi.org/10.1097/pcc.0000000000001345.

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Dixon, Bill. "Who Needs Critical Friends? Independent Advisory Groups in the Age of the Police and Crime Commissioner." Policing: A Journal of Policy and Practice 14, no. 3 (September 7, 2018): 686–97. http://dx.doi.org/10.1093/police/pay068.

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Abstract In the early 2000s, many police forces in England and Wales set up independent advisory groups (IAGs) following an inquiry into the flawed investigation of the murder of a black teenager, Stephen Lawrence, by London's Metropolitan Police. Members of IAGs were to act as critical friends of the police providing independent advice on policies, procedures and practices, thus ensuring that no section of their local community was disadvantaged through a lack of understanding, ignorance or mistaken beliefs. Based on a case study of an IAG in an English police force, this article reviews the operation of IAGs following the radical changes made to police governance by the introduction of directly elected police and crime commissioners (PCCs). Its main argument is that more thought needs to be given to the role of IAGs in this new landscape and urgent steps taken to clarify their relationships with police forces and PCCs.

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Thomas, Shibu P., and Harpal Singh Nandhra. "Early Intervention in Psychosis." Primary Care Companion to The Journal of Clinical Psychiatry 11, no. 5 (October 15, 2009): 212–14. http://dx.doi.org/10.4088/pcc.08m00705.

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Turner, Liz. "PCCs, neo-liberal hegemony and democratic policing." Safer Communities 13, no. 1 (January 7, 2014): 13–21. http://dx.doi.org/10.1108/sc-07-2013-0016.

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Purpose – This paper aims to explore the recent introduction of directly elected police and crime commissioners (PCCs) in England and Wales, and to consider to what extent this new innovation should be considered as a positive contribution to the achievement of democratic policing. Design/methodology/approach – The paper draws on a range of key sources of academic literature on police accountability and the sociology of policing, as well as considering the content of government pronouncements and legislation. Findings – The central argument of the paper is that the introduction of PCCs needs to be examined within the context of the hegemony of neo-liberal logic in public services reform. It is argued that some enduring myths of policing, including the myth that the police impartially uphold an impartial law, lend themselves to the depoliticisation of policing which is necessary in order to facilitate neo-liberal colonisation of the service, which is inimical to democratic policing. Originality/value – The paper builds upon and contests some of the early critiques of the introduction of PCCs which have emerged and proposes a new direction for the development of critique in this area. It will be of interest to policing scholars as well as anyone concerned about the relationship between democracy and policing under current conditions of deep public service cuts and the colonisation of service provision by neo-liberal values.

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&NA;. "Statins: early mortality benefit at time of PCI." Inpharma Weekly &NA;, no. 1335 (April 2002): 14. http://dx.doi.org/10.2165/00128413-200213350-00028.

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Nierengarten, M. B., and A. W. J. van't Hof. "Early Ticagrelor Improves ST Segment Resolution after PCI." MD Conference Express 14, no. 42 (December 1, 2014): 10–11. http://dx.doi.org/10.1177/155989771442005.

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Spevak, A., and R. Mehran. "REGULATE-PCI Trial: Safety Concerns Cause Early Termination." MD Conference Express 15, no. 5 (April 1, 2015): 12–13. http://dx.doi.org/10.1177/1559897715583815.

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Ge, Heng, Jun Pu, Zheng Li, Robert Manka, Haiyan Ding, Jianrong Xu, and Ben He. "Comparison of Instant Thrombolysis Plus Early PCI And Primary PCI in STEMI Patients, View of CMR Early After Reperfusion Therapy." American Journal of Cardiology 111, no. 7 (April 2013): 8B. http://dx.doi.org/10.1016/j.amjcard.2013.01.025.

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Loveday, Benjamin, Jennifer J. Knox, Laura A. Dawson, Gary May, Ur Metser, Anthony M. Brade, Anne M. Horgan, et al. "Intention to treat analysis of neoadjuvant chemoradiation and liver transplantation for perihilar cholangiocarcinoma." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 394. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.394.

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394 Background: Neoadjuvant chemoradiation and liver transplantation is an option for selected unresectable patients with early stage perihilar cholangiocarcinoma (pCCA). This study aimed to determine the dropout rate, morbidity and survival of patients who entered a modified tri-modality protocol at Princess Margaret Cancer Centre. Methods: All patients enrolled into the protocol (Jan 2009 – Aug 2015) were included in the analysis. Enrollment criteria: ≤ 65 years old with brush biopsy-proven, unresectable pCCA proximal to the cystic duct, < 3.5 cm in diameter. Neoadjuvant protocol consisted of conformal radiation therapy (54-75 Gy, 1.5 Gy BID) concurrent with Capecitabine 800 mg/m2 BID until radiation completion. Following surgical staging patients received maintenance chemotherapy (Cisplatin 25 mg/m2 and Gemcitabine 1000 mg/m2, day 1 and 8 of 21 day cycle), until transplant or progression. Intention to treat analyses were performed on prospectively collected data to determine time to progression (TTP), dropout rate, overall survival (OS), and number of biliary procedures. Results: Seventeen patients were enrolled, with a median age of 53.9 (26.7-62.8) years, and tumour diameter of 2.7 (2.0-3.4) cm. Five patients had primary sclerosing cholangitis. Median follow up was 14 (6-41) months. The cohort required a median of 3 (0-8) biliary stents, and percutaneous transhepatic biliary drainage in 11/17. Median TTP was 6 (2-16) months. Protocol dropout occurred in 10/17 due to metastatic disease identified during chemoradiation (2), surgical staging (6), or maintenance chemotherapy (2). No dropouts were due to neoadjuvant toxicity. Four patients underwent transplantation (two living donor, two deceased donor), and three are on the transplant waiting list. Median survival from first consultation and start of chemoradiation was 18.2 and 17 months, respectively. Conclusions: Neoadjuvant chemoradiation and liver transplantation for unresectable early stage pCCA is feasible, although dropout during the protocol is high. Less than half of patients who began the treatment protocol remained eligible for transplantation due to cancer progression or upstaging after surgical staging.

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Radhakrishnan, Archana, Youngjee Choi, Zackary Berger, Craig Evan Pollack, Sydney Morss Dy, and Kimberly S. Peairs. "Implementation of a novel primary care-centered clinic for survivorship care." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 41. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.41.

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41 Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.

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Simmonds, Lesley. "The impact of local commissioning on victim services in England and Wales: An empirical study." International Review of Victimology 25, no. 2 (July 18, 2018): 181–99. http://dx.doi.org/10.1177/0269758018787938.

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This paper follows on from earlier work in which I discussed the potential impacts of the local commissioning of victim services by Police and Crime Commissioners (PCCs) in England and Wales. The introduction of this elected role and the devolution of responsibility to local PCCs was said to raise a range of issues for both victims and the voluntary sector, given that agencies within this sector are major providers of support for those affected by crime. Before 2014 the approach to the funding of victim services was not particularly of concern, save for questions being asked in the ‘audit culture’ of the early 2000s, around the extent to which the government-funded agency Victim Support could be said to be providing ‘value for money’. However, these concerns gained momentum with the incoming Coalition government of 2010, and by 2014 local commissioning by PCCs had been implemented. This meant the previous mixed economy of victim services provision via the largely centrally funded organisation ‘Victim Support’ as a ‘national victims’ service’, and an array of smaller and more financially independent victim agencies who had to bid for pots of funding much more competitively, has given way to the political appeal of a free market for all. In order then to explore the reality of this shift, a piece of empirical research was undertaken with voluntary-sector agencies in the far southwest of England. Essentially the research provides evidence that the issues raised in my earlier work have indeed come to fruition.

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Mehta, Nilesh M. "Early Enteral Nutrition in the PICU." Pediatric Critical Care Medicine 16, no. 8 (October 2015): 786–89. http://dx.doi.org/10.1097/pcc.0000000000000530.

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Choong, Karen. "Early Mobilization in Critically Ill Children." Pediatric Critical Care Medicine 17, no. 12 (December 2016): 1194–95. http://dx.doi.org/10.1097/pcc.0000000000000992.

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Journal articles on the topic 'Early PCCI'

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