Добірка наукової літератури з теми "-192-868"

BackgroundDiagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical role of general practice over time in diagnostic pathways for patients with cancer.AimTo examine sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.Design and settingAnalysis of Routes to Diagnosis data, 2006–2015, for patients with cancer in England.MethodThe authors estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to accident and emergency (AE-EP), by patient sex, age, deprivation group, and year of diagnosis using multivariable regression.ResultsAmong 554 621 patients presenting as emergencies, 24% (n = 130 372) presented as GP-EP, 62% as AE-EP (n = 346 192), and 14% (n = 78 057) through Other-EP sub-routes. Patients presenting as emergencies were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%, n = 17 364, in 2006; 17%, n = 9155 in 2015), while that of AE-EP increased (55%, n = 31 049 to 68%, n = 36 868).ConclusionPatients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals.

Abstract Background: Intravenous immunoglobulin (IVIG) has been shown to reduce neutrophil adhesion to post capillary venular endothelium, reduce adherent neutrophil interactions with circulating red blood cells (RBCs), increase microcirculatory blood flow, and increase survival in murine models of sickle cell acute pain crisis in a dose dependent manner. We report results of a phase I, double blind, placebo controlled, randomized, dose escalation study of Gamunex brand of IVIG administered to pediatric and adult sickle cell disease (SCD) patients during acute pain events. Methods: Patients received a single, one-time dose of IVIG (Gamunex, Talecris Biotherapeutics/ Grifols) or equivalent volume normal saline placebo in addition to standard care. A dose-escalation strategy was used, with 4 patients (3 treatment, 1 control) randomized at each dose level of 100 mg/kg, 200 mg/kg, 400 mg/kg, 600mg/kg and 800 mg/kg. Primary endpoints were drug safety and time to end of vaso-occlusive crisis (VOC). The activation status of neutrophils was examined before and 24 hours after infusion. Results: There were no Grade 4-5 adverse events and no Grade 3 adverse events likely to be IVIG-related (Table 1). As expected in a Phase I study, numbers of patients were insufficient to assess clinical efficacy (Table 2). There were smaller increases in LDH and CRP in the IVIG group, suggesting a potential salutary effect on hemolysis and inflammation. Although significance was not reached, IVIG treatment was associated with down-regulated activated Mac-1 (Figure 1A) that was greater than down-regulation of the total amount of Mac-1 (Figure 1B), consistent with murine data on IVIG’s effect on RBC-neutrophil interactions mediated by Mac-1. E-selectin binding (Figure 1C), which mediates neutrophil recruitment/rolling, was not consistently decreased in the IVIG-treated group. These results are consistent with our previous observations in the murine model, where no down regulation of E-selectin binding, PSGL-1, or LFA-1 was observed after IVIG administration despite its effect on neutrophil adhesion and RBC interactions. IVIG inhibits Mac-1 activation through an independent antagonistic pathway involving Fc gammaRIII-mediated recruitment of Src-homology 2-containing tyrosine phosphatase-1. Conclusions: Our studies demonstrate that IVIG is well tolerated in SCD patients during acute VOC and provide proof of concept that the mechanism of action of IVIG in human sickle cell pain crisis indeed proceeds via the down-regulation of activated Mac-1 as observed in the murine model. We propose to conduct a phase II study to further evaluate these findings. Table 1.Safety OutcomesIVIG (n=15)Control (n=5)p-valuePre-specified serious adverse eventsAcute chest syndrome (%)701.0Thrombosis (%)701.0Other pre-specified adverse eventsPain crisis re-admission (%)40200.63Red cell transfusion (%)13400.2524 h serum creatinine0.5 (0.2-0.6)0.6 (0.4-0.8)0.28Possibly IVIG-related Grade 1-2 adverse eventsFever (%)20400.56Hypertension (%)20201.00Headache (%)2700.53 Table 2. Efficacy Outcomes IVIG (n=15) Control (n=5) p-value Clinical endpoint outcomes Time to crisis resolution* (h) 54 (1,215) 63 (31,164) 0.61 Cumulative opioid use* (ME/kg) 2.2 (0,8.8) 1.6 (1.1,15.6) 1.0 Time to hospital discharge (days) 4.4 (1,10) 4.8 (3,5) 0.67 Clinical laboratory indicators % Δ in hemoglobin (Hb)# -17 (-33,0) -17 (-25, -3) 0.76 % Δ in lactate dehydrogenase (LDH)# 4 (-48, 85) 14 (-11, 679) 0.46 % Δ in C-reactive protein (CRP)# 38 (-16, 868) 192 (1.5, 1427) 0.43 % Δ in white blood cell count (WBC) -15 (-48,13) -22 (-41, 37) 0.96 % Δ in absolute neutrophil count (ANC) -18 (-65, 45) -16 (-51,49) 0.81 Flow-cytometric analysis of surface expression of (A) activated Mac-1; (B) Mac-1; (C) E-selectin binding; (D) PSGL-1; (E) CD44; (F) L-selectin; (G) LFA-1 on CD16b-positive leukocytes. MFI, mean fluorescence intensity. Figure 1. Neutrophil surface marker expression Disclosures No relevant conflicts of interest to declare.

Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship. Levels of Evidence: III, Retrospective Study

Диссертация на соискание учёной степени кандидата технических наук по специальности 05.09.01 – электрические машины и аппараты. – Национальный технический университет Украины "Харьковский политехнический институт" Харьков, 2016. Диссертация посвящена вопросам разработки и исследованию особенностей электромагнитных и электромеханических процессов коаксиально-линейных двигателей с аксиальным и радиальным вектором намагничивания постоянных магнитов для привода рабочего органа погружателя. Рассмотрены конструкции коаксиально-линейных двигателей с постоянными магнитами для привода рабочего органа погружателя строительных элементов и разработана математическая модель, а также методы расчета магнитной индукции, электромеханических и частотных характеристик при статическом и динамическом режимах работы вибрационного оборудования на основе коаксиально-линейных двигателей с аксиальным и радиальным вектором намагничивания постоянных магнитов. Предложена модель коаксиально-линейного двигателя с постоянными магнитами с аксиальным и радиальным вектором намагничивания постоянных магнитов в виде электрической схемы замещения и проведён сравнительный анализ векторных диаграмм напряжений и токов, позволяющий характеризовать энергетические параметры и рабочие характеристики при различных частотах напряжения. Разработан и изготовлен экспериментальный стенд для исследования статических и динамических характеристик коаксиально-линейных двигателей с постоянными магнитами. Проведённый анализ электромеханических характеристик коаксиально-линейных двигателей с постоянными магнитами показал, что при одинаковых параметрах жёсткости тяговых и ход-амперных характеристик более эффективным является двигатель с радиальным вектором намагничивания постоянных магнитов. На основе проведенных исследований коаксиально-линейных двигателей с аксиальным и радиальным вектором намагничивания постоянных магнитов с одинаковыми конструктивными параметрами статора и равными по массе магнитами и сравнение их электромагнитных, электромеханических и частотных характеристик, полученных при статическом и динамическом режимах работы двигателей, установлена целесообразность использования коаксиально-линейных двигателей с радиальным вектором намагничивания постоянных магнитов для привода рабочего органа погружателя строительных элементов.
The thesis for competition of the academic degree of candidate of technical sciences on the speciality 05.09.01 - electrical machines and apparatus. - The National Technical University "Kharkiv Polytechnic Institute" (NTU "KhPI"), Kharkiv, 2016. The thesis is devoted to the issues of development and study of the characteristics of magnetic and electromechanical processes in the coaxial linear motors with axial and radial magnetization vector of permanent magnets for drive of the working body of immertor. The construction of coaxial linear motors with permanent magnets for drive of the working body of the immertor of building, models and methods of calculating the values of the parameters of electromagnetic induction, electromechanical and frequency characteristics under static and dynamic modes of vibration equipment with axial and radial magnetization vector of permanent magnets are researched. The experimental stand for removal of static and dynamic characteristics of coaxial linear motors with permanent magnets is developed and manufactured. The analysis of the effectiveness of using the coaxial linear motors with axial and radial magnetization vector of permanent magnets for drive of the working body of the immertor of building elements with the same design parameters of stator and magnets equal in weight during the process of creating drives of vibrators based on comparison, obtained by static and dynamic modes.

Дисертація на здобуття наукового ступеня кандидата технічних наук за спеціальністю 05.09.01 – електричні машини й апарати. – Національний технічний університет України "Харківський політехнічний інститут", Харків, 2016. Дисертаційна робота присвячена питанням розробки та дослідження особливостей електромагнітних та електромеханічних процесів коаксіально-лінійних двигунів з аксіальним та радіальним вектором намагнічування постійних магнітів для привода робочого органу занурювача. Запропоновані конструкції коаксіально-лінійних двигунів з постійними магнітами для привода робочого органу занурювача будівельних елементів, а також методи розрахунку магнітної індукції, електромеханічних та частотних характеристик при статичному та динамічному режимах роботи вібраційного обладнання на основі коаксіально-лінійних двигунів з постійними магнітами. Розроблені та виготовлені експериментальні стенди для дослідження статичних та динамічних характеристик коаксіально-лінійних двигунів з постійними магнітами. На основі проведеного дослідження коаксіально-лінійних двигунів з аксіальним та радіальним вектором намагнічування постійних магнітів з однаковими конструктивними параметрами статора та рівними за масою магнітами та порівняння їх характеристик, отриманих при статичному та динамічному режимах роботи двигунів, встановлено доцільність використання коаксіально-лінійних двигунів з радіальним вектором намагнічування постійних магнітів для привода робочого органу занурювача будівельних елементів.
The thesis for competition of the academic degree of candidate of technical sciences on the speciality 05.09.01 - electrical machines and apparatus. - The National Technical University "Kharkiv Polytechnic Institute" (NTU "KhPI"), Kharkiv, 2016. The thesis is devoted to the issues of development and study of the characteristics of magnetic and electromechanical processes in the coaxial linear motors with axial and radial magnetization vector of permanent magnets for drive of the working body of immertor. The construction of coaxial linear motors with permanent magnets for drive of the working body of the immertor of building, models and methods of calculating the values of the parameters of electromagnetic induction, electromechanical and frequency characteristics under static and dynamic modes of vibration equipment with axial and radial magnetization vector of permanent magnets are researched. The experimental stand for removal of static and dynamic characteristics of coaxial linear motors with permanent magnets is developed and manufactured. The analysis of the effectiveness of using the coaxial linear motors with axial and radial magnetization vector of permanent magnets for drive of the working body of the immertor of building elements with the same design parameters of stator and magnets equal in weight during the process of creating drives of vibrators based on comparison, obtained by static and dynamic modes.