bluuebunny/crossref_metadata_2025 huggingface dataset:
Case of Corneal Perforation as a Complication after Uneventful CXL without Infection
Authors: Demirci Goktug , Ozdamar Akif
Published: February 2014

Purpose

To demonstrate that UVA/riboflavin crosslinking (CXL) can cause corneal melting in some unpredictable cases.

Materials and methods

We will present a case report of 25-year-old male patient referred for emergency keratoplasty which is due to corneal melting and perforation developed after uneventful CXL procedure for the treatment of keratoconus.

Results

We performed uncomplicated penetrating keratoplasty of the left eye in our hospital.

Conclusion

CXL is gradually becoming the standard treatment procedure for progressive keratoconus and the only major safety concerns associated with CXL are ocular surface damage and endothelial cell damage. This case has shown, however, that even if CXL seems to have been successful, there is still a risk of adverse outcomes. Our report suggests that further research is necessary regarding the safety of corneal collagen crosslinking in corneas with keratoconus.

How to cite this article

Demirci G, Ozdamar A. Case of Corneal Perforation as a Complication after Uneventful CXL without Infection. J Kerat Ect Cor Dis 2013;2(3):139-142.
Long-term Improvement after the Athens Protocol for Advanced Keratoconus with Significant Ectasia Progression in the Fellow Eye
Authors: Santos Rodrigo , Siqueira Jorge Augusto , Dias Luis Claudio , Siqueira Renata , Valbon Bruno , Dawson Daniel
Published: February 2014

To describe the long-term result of the Athens protocol (custom topography-guided advanced surface ablation followed by riboflavin-UVA collagen crosslinking in the same day) for progressive advanced keratoconus in the left eye, while the fellow right eye first presented with relatively mild keratoconus that was treated with a more conservative therapeutic approach of continuous contact lenses use with the goal for ectasia stabilization. Five years after the Athens protocol, a regression of over 10 D (diopters) was observed on the sagittal curvature with significant regularization of corneal shape and improvement of distance corrected visual acuity (DVCA) in the left eye. The right eye, which was treated more conservatively, had an over 12 D increase on sagittal curvature along with significant distortion of the corneal shape and reduction of DCVA.

How to cite this article

Siqueira JA, Dias LC, Siqueira R, Valbon B, Santos R, Dawson D, Ambrósio Jr R. Longterm Improvement after the Athens Protocol for Advanced Keratoconus with Significant Ectasia Progression in the Fellow Eye. J Kerat Ect Cor Dis 2013;2(3):143-146.
Comparative Study of Low Dose Conjugate Equine Estrogen 0.3 mg vs Standard Dose Conjugate Equine Estrogen 0.625 mg as Hormone Replacement Therapy
Authors: Gupta Meeta , Yadav Poonam , Kumar Sarvesh
Published: February 2014

Introduction

Since menopause was related to variety of genitourinary, vasomotor, psychological and musculoskeletal changes, conjugated equine estrogen (CEE) was introduced for all menopause-related symptoms in various doses.

Materials and methods

It is a comparative study in which 100 postmenopausal women were selected (natural or surgical menopause) with one or more menopausal symptoms. All patients were randomly divided in two groups. Group A received 0.3 mg CEE and group B received 0.625 mg CEE, and both groups were compared with each other in various aspects.

Results

Both the groups were comparable to each other with respect to mean age, residence, type of menopause, total duration of menopause. Both the groups show comparable improvement in vasomotor, genitourinary and psychological symptoms and p > 0.05 which is not significant. On evaluation of bone mineral density (BMD), the group B showed significant improvement than group A (p < 0.001). Effect on endometrium was not significant.

Conclusion

Because of the complications of estrogen ± progestin, it should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risk for individual women.

How to cite this article

Yadav P, Singh R, Kaur H, Gupta M, Kumar S. Comparative Study of Low Dose Conjugate Equine Estrogen 0.3 mg vs Standard Dose Conjugate Equine Estrogen 0.625 mg as Hormone Replacement Therapy. J South Asian Feder Menopause Soc 2013;1(2):45-49.
Relation of Ethnicity and Menopausal Symptoms in Nepal
Authors: Rajbhandari Swaraj , Amatya A , Giri Kanti
Published: February 2014

A cross-sectional study was conducted among women of different ethnic groups aged 40 to 60 years and health workers in different parts of Nepal using focus group discussions (FGDs), key informant interviews (KIIs) and clinical examinations to determine the symptoms and complains related to menopause.

The mean age at menarche was 15 years and the mean age of menopause was 47. The highest menarche and menopause (50 years) was found to be among the Gurung women. Mean age of menopause was found to be higher among currently older women (52 years among 60+ women vs 41 years among <45 years women) and unmarried women. Tharu perimenopausal women and Sarki, Gurung and Tharu postmenopausal women were found to have relatively more regular menstrual cycles. However, Tharu perimenopausal women were found to have excess bleedings during the menstrual cycle.

Most of the women had heard about menopause but did not have detailed knowledge on it. Loss of sexual interest (95.3%), decreased visual activity (58%), joint pain (31.3%) and body pain (31.3%) were the most commonly reported menopausal symptoms. Mean body mass index (BMI) was highest among the Gurung women (both perimenopausal and postmenopausal). Pap smear was normal in all 138 women but around 50% had some cervical and vaginal-related problems. One-third of Tharu postmenopausal women had atropic labia and onethird of Tamang women had leukoderma.

Since, very little knowledge is known about the postmenopausal symptoms and problems in Nepal, this study can serve as the basis for further researches in this area with an increased sample size.

How to cite this article

Rajbhandari S, Amatya A, Giri K. Relation of Ethnicity and Menopausal Symptoms in Nepal. J South Asian Feder Menopause Soc 2013;1(2):50-55.
A Study of Coronary Heart Disease in Postmenopausal Women and Identification of Major Modifiable Determinant Risks for its Prevention
Authors: Pradhan P , Upadhya AV
Published: February 2014

This is a retrospective study of postmenopausal women admitted with myocardial infarction (MI) in five hospitals (Nepal Medical College, Bir Hospital, Institute of Medicine, Norvic International Hospital, Medicare Hospital) having coronary care unit (CCU) in Kathmandu, Nepal, in 1 year period, from 1st Jan 2001 to 31st Dec 2001. Out of 210 cases admitted in CCU,147 (70%) were suffering from acute MI. Two of the three following criteria were used for the diagnosis of MI: characteristic substernal pain of recent origin more than 30 minutes, elevated cardiac enzymes (creatinine kinase, lactate dehydrogenase, aspirate transaminase), ECG: evidence of infarction (pathological Q waves, ST elevation more than 1 mm in standard lead 1/Avl and/or ST elevation more than 2 mm in precordial leads V1-6 followed by T wave inversion. The major identifiable modifiable risks identified are hypertension in 111 (53.8%), smoking 73 (35.0%), diabetes mellitus in 47 (23.03%), hyperlipidemia in 17 (8.1%), previous coronary heart disease (CHD) in 32 (15.2%) and family history of CHD was present in 2% of the cases. Twenty-two patients (10%) died during treatment and six patients (3%) were readmitted with repeat Ml within 6 months of the 1st Ml and all recovered well.

How to cite this article

Pradhan P, Upadhya AV. A Study of Coronary Heart Disease in Postmenopausal Women and Identification of Major Modifiable Determinant Risks for its Prevention. J South Asian Feder Menopause Soc 2013;1(2): 56-62.
Is There any Difference of Climacteric Symptoms between Natural and Surgical Menopause?
Authors: Nasreen Shaikh Zinnat Ara , Shahreen Shafinaz , Rahman Shahnaz
Published: February 2014

Objective

To compare the effects of the natural and the surgical menopause (SM) on climacteric condition.

Materials and methods

This prospective study was conducted from Jan 2008 to Jan 2013 in ZHSWMCH. Initially, 4,000 women were enrolled but finally 1,743 of natural menopause (NM) and 554 of SM were analyzed. All women were aged between 45 and 50 years, and they were of menopause for 1 to 5 years. Ethical and patient's permission was taken. Once enrolled, they were asked questions. The questions were related to menopausal symptoms (MS). Data was collected and analyzed by SPSS software.

Results

Hot flushes, (535 vs 290, p < 0.001), sweating (344 vs 122, p < 0.001), poor memory (99 vs 65 p < 0.001), feeling depressed (335 vs 126, p < 0.001), dry skin/mucosa (229 vs 91, p < 0.001), decreased libido (289 vs 117, p < 0.001), dry vagina (99 vs 65, p < 0.001) and urinary complains (59 vs 42, p < 0.001) were found in SM vs NM. Hypertension or cardiovascular disease was more (191 vs 92, p < 0.01), blood sugar were more (90 vs 32, p ≤ 0.001) and metabolic syndrome are also more (48 vs 26, p < 0.07) in SM than NM but this did not reach the significance.

Conclusion

Menopausal symptoms are common in both NM and SM. These MS were significantly higher in surgically menopause women and they were troubled more, so we need to be cautious about oophorectomy, and ovarian preservation should be the aim in all benign cases. Of course, we need to assess the risks and benefit where there is risk of ovarian cancer during the time of total abdominal hysterectomy. Both hormone replacement therapy (HRT) (following a risk/benefit analysis) and treatment of osteoporosis may be recommended after surgery to decrease the climacteric symptoms and osteoporosis in women with menopausal symptoms.

How to cite this article

Nasreen SZA, Shahreen S, Rahman S. Is There any Difference of Climacteric Symptoms between Natural and Surgical Menopause? J South Asian Feder Menopause Soc 2013;1(2):63-65.
Analysis of Genital Tract Malignancies in Postmenopausal Indian Women
Authors: Joshi Sulabha , Jain Sheela , Kawthalkar Anjali , Somalwar Savita A , Somalwar Ashutosh
Published: February 2014

Introduction

Genital malignancies in women varies widely from developed to developing countries. Postmenopausal women are at risk of developing various genital malignancies.

Objectives

(1) To determine frequency of genital tract malignancies in postmenopausal women, (2) to determine the type and stage of genital tract malignancies, (3) to create awareness of screening in women.

Materials and methods

This descriptive cross-sectional study was carried out over a period of 2 years from March 2010 to Feb. 2012. It included 200 postmenopausal women admitted with complaints like mass or fullness of abdomen, bleeding or discharge per vaginal and ulcer over vulva. They were evaluated clinically followed by relevant investigations. Malignancy was confirmed by histopathology report.

Results

Out of 200 postmenopausal women admitted during study period, malignancy was confirmed in 55 women (27.5%). The type of malignancy was cervical carcinoma (30, 54.54%), ovarian carcinoma (18, 32.72%), carcinoma endometrium (5, 9.09%), carcinoma vulva (1, 1.81%) and carcinoma vagina (1, 1.81%). Majority of carcinoma cervix and ovarian carcinoma were in advanced stage.

Conclusion

Carcinoma cervix was commonest genital malignancy found our study followed by carcinoma ovary. Importance of routine gynecological check-up in postmenopausal women was emphasised.

How to cite this article

Somalwar SA, Joshi S, Kawthalkar A, Bhalerao A, Jain S, Somalwar A. Analysis of Genital Tract Malignancies in Postmenopausal Indian Women. J South Asian Feder Menopause Soc 2013;1(2):66-69.
Menopause and Gynecological Malignancy
Authors: Ferdous Jannatul , Khatun Sabera
Published: February 2014

Menopause is a consequence of biological aging. Menopause does not cause cancer, but the risk of developing cancer increase as a woman ages. Treatment of cancer can also cause premature menopause. Among the gynecological cancer, cervical cancer tops the list of common cancer. Postmenopausal women are prone to have persistent human papillomavirus (HPV) infection. There is no role of primary prevention of cervical cancer by vaccination in postmenopausal women. Secondary prevention by Paps smear only may provide false negative result as the cervix is often flushed with the vagina. So, scraping by Ayres spatula and using endometrial brush is necessary in these women. Unfortunately, symptoms of cervical cancer in postmenopausal women are nonspecific and associated with comorbidities. So, any symptom of cervical cancer in postmenopausal women should be properly evaluated. Ovarian cancer is the number one cancer of death among all gynecologic malignancies. Majority of the ovarian cancer in postmenopausal women present with vague symptom and have the advance stage at prevention. Currently, no reliable screening test is available. Yearly routine pelvic examination, transvaginal ultrasonography and serum CA-125 can be performed in selective high-risk women only. Endometrial cancer is the most common gynecologic cancer in the USA. Most endometrial carcinomas are diagnosed at an early stage and have a good prognosis. Though vulvar and vaginal cancer are rare malignancies, yet these are prevalent in postmenopausal women. Any postmenopausal women with long-term intense itching, pervaginal discharge or any ulcer of vulva or vagina should be evaluated properly.

How to cite this article

Khatun S, Ferdous J. Menopause and Gynecological Malignancy. J South Asian Feder Menopause Soc 2013;1(2):75-79.
Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound
Authors: Sandhu Navparkash S , Capan Levon M
Published: February 2014

Transesophageal echocardiography (TEE) is useful in diagnosing cardiac and aortic injuries. A case of stab chest is described in which TEE ruled out cardiac injury, located the knife in the left lung and had potential to change the surgical plan.

How to cite this article

Sandhu NS, Capan LM. Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound. J Perioper Echocardiogr 2014;2(1):32-33.
TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy
Authors: Murray Andrew W
Published: February 2014

Thymectomies have traditionally been performed via a midline sternotomy but are now increasingly being conducted via a thoracoscopic approach. Insufflation of CO2 into the hemithorax during this procedure can create severe compression of the right atrium and ventricle with resultant hemodynamic instability as well as lead to hypercapnia with possible pulmonary vasoconstriction and right heart strain. Transesophageal echocardiography allows monitoring of both the effects of CO2 insufflation on the heart and the efficacy of interventions to restore hemodynamic stability.

How to cite this article

Murray AW, McHugh SM. TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy. J Perioper Echocardiogr 2014;2(1):34-37.
Assessment of Pulmonary Valve and Pulmonary Stenosis
Authors: Subramanian A , Malik V , Sreedhar R
Published: February 2014

The Fellow's Corner is a short treatise on material relevant for the learning of trainees in cardiac anesthesia. The first in this series is on the TEE assessment of the pulmonary valve.

How to cite this article

Subramanian A, Malik V, Sreedhar R. Assessment of Pulmonary Valve and Pulmonary Stenosis. J Perioper Echocardiogr 2014;2(1):40-41
Validation of the operational MSG-SEVIRI snow cover product over Austria
Authors: Surer S. , Parajka J. , Akyurek Z.
Published: February 2014

Abstract. The objective of this study is to evaluate the mapping accuracy of the MSG-SEVIRI operational snow cover product over Austria. The SEVIRI instrument is aboard the geostationary Meteosat Second Generation (MSG) satellite. The snow cover product provides 32 images per day, with a relatively low spatial resolution of 5 km over Austria. The mapping accuracy is examined at 178 stations with daily snow depth observations and compared with the daily MODIS-combined (Terra + Aqua) snow cover product for the period April 2008–June 2012. The results show that the 15 min temporal sampling allows a significant reduction of clouds in the snow cover product. The mean annual cloud coverage is less than 30% in Austria, as compared to 52% for the combined MODIS product. The mapping accuracy for cloud-free days is 89% as compared to 94% for MODIS. The largest mapping errors are found in regions with large topographical variability. The errors are noticeably larger at stations with elevations that differ greatly from those of the mean MSG-SEVIRI pixel elevations. The median of mapping accuracy for stations with absolute elevation difference less than 50 m and more than 500 m is 98.9 and 78.2%, respectively. A comparison between the MSG-SEVIRI and MODIS products indicates an 83% overall agreement. The largest disagreements are found in Alpine valleys and flatland areas in the spring and winter months, respectively.
On the entrainment coefficient in a forced plume: quantitative effects of source parameters
Authors: Matulka A. , López P. , Redondo J. M. , Tarquis A.
Published: February 2014

Abstract. The behavior of a forced plume is mainly controlled by the source buoyancy and momentum fluxes and the efficiency of turbulent mixing between the plume and the ambient fluid (stratified or not). The interaction between the plume and the ambient fluid controls the plume dynamics and is usually represented by the entrainment coefficient αE. Commonly used one-dimensional models incorporating a constant entrainment coefficient are fundamental and very useful for predictions in geophysical flows and industrial situations. Nevertheless, if the basic geometry of the flow changes, or the type of source or the environmental fluid conditions (e.g., level of turbulence, shear, ambient stratification, presence of internal waves), new models allowing for variable entrainment are necessary. The presented paper is an experimental study based on a set of turbulent plume experiments in a calm unstratified ambient fluid under different source conditions (represented by different buoyancy and momentum fluxes). The main result is that the entrainment coefficient is not a constant and clearly varies in time within the same plume independently of the buoyancy and the source position. This paper also analyzes the influence of the source conditions on the mentioned time evolution. The measured entrainment coefficient αE has considerable variability. It ranges between 0.26 and 0.9 for variable Atwood number experiments and between 0.16 and 0.55 for variable source position experiments. As is observed, values are greater than the traditional standard value of Morton et al. (1956) for plumes and jets, which is about 0.13.
A maturity model for governance, risk management and compliance in hospitals
Authors: Batenburg Ronald , Neppelenbroek Matthijs , Shahim Abbas
Published: February 2014

In this paper we propose a preliminary model (hereafter referred to as maturity model) to assess and monitor Governance, risk and compliance (GRC) and GRC maturity in Dutch hospitals. Relevant health care literature and a comprehensive comparison of existing maturity models served as input for the developed maturity model. The maturity model was tested and evaluated by interviewing senior hospital managers, representing 12.4% of the total Dutch hospital bed capacity. The need and relevance of knowledge about GRC was repeatedly emphasized by the interviewees. The model consists of 14 different dimensions based on the headlines of the practice in Dutch hospitals and five levels of maturity. The primary value of the model lies in the compact presentation and its practical approach which can guide hospitals to improve their GRC maturity.
Associação entre fadiga e fatores clínico-pessoais de pacientes com esclerose lateral amiotrófica
Authors: Silva Martins Lizianne Juline Do Nascimento e , Silva Nathalia Priscilla Oliveira , Ferreira Thaiana Barbosa , Cavalcanti Fabrícia Azevedo da Costa
Published: February 2014

Introdução: A fadiga progressiva e persistente na Esclerose Lateral Amiotrófica (ELA) é um sintoma cujos mecanismos causais ainda não são bem documentados pela literatura. Objetivo: Investigar a fadiga muscular de pacientes portadores de ELA e sua relação com os fatores clínico-pessoais. Métodos: Realizou-se uma pesquisa transversal com 25 portadores de ELA. Os instrumentos de avaliação foram a Medida de Independência Funcional (MIF) e a Escala de Severidade de Fadiga (FSS). Resultados: A fadiga estava presente em 56% da amostra cujo tempo de doença era de 4,5 ±4,34 anos. Entretanto, não foi encontrada relação significativa entre a fadiga e os fatores clínicos e pessoais dos pacientes. Conclusões: Os resultados apontaram a presença de fadiga sem relação com os parâmetros investigados, mostrando esta como um fator complexo e independente a ser explorado de forma diferenciada e específica para cada portador de ELA.
Teste da sacarina e de palato de rã: ferramentas para estudo do transporte mucociliar
Authors: Pereira Lilian Louise Coelho , Pinto Juliana Santi Sagin Torres , Chiavegato Luciana Dias
Published: February 2014

Introdução: Distúrbios no transporte mucociliar (TMC) podem afetar o clearance de secreções, e pode ser medido in vivo, utilizando sacarina, ou in vitro, usando palato de rã. Objetivo: Rever e analisar publicações e resultados sobre TMC com referência sobre teste de sacarina e palato de rã. Métodos: A revisão inclui artigos publicados em periódicos indexados nas bases Medline/Embase, CINAHL e SciELO realizada por três revisores. As palavras-chave utlizadas foram: (mucociliary or mucus) and [(transport or clearance) and (methods and saccharin test/ frog palate)]. Resultados: Foram encontrados 186 artigos, sendo excluídos: 90 pelo título, 41 por resumo, 4 pela língua, 11 não acessíveis, 20 por métodos do TMC incompatíveis com este estudo. Portanto, 20 estudos foram incluídos nesta revisão. Conclusão: Baseando-se nas evidências dos estudos encontrados, observou-se que, na prática clínica, o teste da sacarina mostrou-se mais factível, de baixo custo e boa reprodutibilidade, além promover fácil e rápida análise do TMC.
Efeito agudo dos exercícios resistidos sobre o desempenho da amplitude articular
Authors: Novaes Neto Lennart Da Silva , Bentes Claudio Melibeu , Miranda Humberto Lameira , Nunes Rodolfo De Alkmim Moreira , Gomes Thiago Matassoli , Novaes Jefferson Da Silva
Published: February 2014

Objetivo: Comparar o efeito de diferentes intensidades de exercícios resistidos sobre o desempenho da amplitude articular de jovens treinados. Métodos: Após a realização dos testes iniciais (força e flexibilidade), os voluntários foram divididos aleatoriamente nas seguintes condições experimentais: (a) protocolo de força com 100% 1RM + teste de flexibilidade (G100); (b) protocolo de força com 80% 1RM + teste de flexibilidade (G80); (c) protocolo de força com 60% 1RM + teste de flexibilidade (G60) e (d) protocolo de força com 40% 1RM + teste de flexibilidade (G40). Para determinar os efeitos das quatro condições experimentais sobre a variável dependente (amplitude articular), foi realizada a análise de variância de um fator (one-way ANOVA). Para determinar as diferenças específicas foi realizado o teste post hoc de Bonferoni. Resultados: Dentre todas as análises, a condição G80 foi a que promoveu maiores alterações significativas sobre o desempenho da amplitude articular. Conclusão: Diferentes intensidades de exercícios resistidos provocam aumentos significativos sobre a resposta da amplitude articular em indivíduos jovens treinados.
Lubomír Kopeček: Fenomén Václav Klaus. Politická biografie
Authors: Cabada Ladislav
Published: February 2014

Knižní recenze
Ellen Meiksins Wood: Původ kapitalismu
Authors: Profant Tomáš
Published: February 2014

Knižní recenze
A Tomb with a View
Authors: Silva Fabio
Published: February 2014

The orientations of European prehistoric structures have been studied independently by landscape archaeologists and archaeoastronomers. Despite their similar interests, the two fields have failed to converge primarily because of their differing epistemologies. This paper argues that archaeology has much to gain by integrating the two fields to provide a fuller and more balanced exploration and understanding of the location and orientation of the European megaliths. It is suggested that prehistoric archaeoastronomy needs to become more grounded on the archaeological record and context of the prehistoric structures it studies. If it is to generate knowledge of value to archaeology it needs to become a “skyscape archaeology.” This paper looks at current archaeoastronomical approaches through the lens of archaeological practice. It identifies some limitations and discusses how landscape archaeology can inform archaeoastronomy on overcoming them. A methodology that attempts this necessary cross-fertilization, by shedding unfounded assumptions and developing a more phenomenological approach to pattern-recognition, is proposed. This methodology is applied to a case study in central Portugal. The emergent narrative, linking a cluster of dolmens to a local mountain range and the star Aldebaran, not only fits the archaeological record, but is mirrored by local folklore, lending further support to the validity of this methodology.
Nonmasslike Lesions on Breast Sonography
Authors: Kim Suk Jung , Park Young Mi , Jung Hyun Kyung
Published: February 2014

Objectives

To compare the imaging and clinical features of benign and malignant nonmasslike lesions in the breast.

Methods

During a 2‐year period at a single institution, 186 nonmasslike lesions in 158 women were pathologically confirmed through surgery or sonographically guided biopsy. The sonographic patterns (mottled, geographic, and indistinct) and distributions (focal and regional) were compared between benign and malignant lesions. The presence of sonographically visible calcifications, amount of color Doppler signals, presence of positive findings on mammography, and presence of symptoms were also compared between the two groups.

Results

A total of 156 lesions (84%) were confirmed as benign and 30 (16%) as malignant. On sonography, malignant nonmasslike lesions more frequently had mottled and geographic patterns and regional distribution than benign lesions (P < .0001). Malignant lesions also more frequently had sonographically visible calcifications (40% versus 0%; P < 0.0001) and a greater amount of color Doppler signals than benign lesions (P< .0001). On mammography, malignant lesions more frequently had densities and calcifications than benign lesions (30.4% versus 7.1%; P= 0.0052; 73.9% versus 6.1%; P < .0001, respectively). Clinically, malignant lesions were more frequently palpable and accompanied by localized pain than benign lesions (50% versus 2.6%; P< .0001; 13.3% versus 0.6%; P = .0025).

Conclusions

The imaging and clinical features of malignant nonmasslike lesions differed significantly from those of benign nonmasslike lesions.
Differentiation of Branch Duct Intraductal Papillary Mucinous Neoplasms From Serous Cystadenomas of the Pancreas Using Contrast‐Enhanced Sonography
Authors: Chen Fen , Liang Jun-ying , Zhao Qi-yu , Wang Li-yin , Li Ju , Deng Zhuang , Jiang Tian-an
Published: February 2014

Objectives

The purpose of this study was to determine whether contrast‐enhanced sonography can improve the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas of the pancreas compared to conventional (unenhanced) sonography alone.

Methods

Between March 2008 and May 2012, there were 20 patients with branch duct intraductal mucinous neoplasms and 25 with serous cystadenomas in our institute, for whom preoperative conventional and contrast‐enhanced sonographic results were available. The final diagnosis was obtained by histopathology. Various conventional and contrast‐enhanced sonographic characteristics were retrospectively evaluated by 2 radiologists in consensus. A receiver operating characteristic curve analysis was used to evaluate the diagnostic value of conventional and contrast‐enhanced sonography for discriminating between the two entities.

Results

Three conventional sonographic characteristics (microcysts, cysts with internal echoes, and main pancreatic duct dilatation) and 2 contrast‐enhanced sonographic characteristics (communication between the lesion and main pancreatic duct and enhancement of mural nodules) significantly improved the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas. The area under the receiver operating characteristic curve increased from 0.691 with conventional sonography to 0.859 with combined contrast‐enhanced and conventional ultrasonography (P = .043).

Conclusions

In this series of patients, the addition of contrast‐enhanced sonography to conventional sonography improved the ability to differentiate branch duct intraductal mucinous neoplasms from serous cystadenomas.
Time to Revisit the Human Chorionic Gonadotropin Discriminatory Level in the Management of Pregnancy of Unknown Location
Authors: Ko Jennifer K. Y. , Cheung Vincent Y. T.
Published: February 2014

Objectives

The purpose of this study was to review the management and outcomes of all patients with pregnancy of unknown location who had serum human chorionic gonadotropin (hCG) levels greater than 1000 mIU/mL in our institution and to determine the likelihood of a subsequent normal intrauterine pregnancy at different hCG discriminatory levels.

Methods

A retrospective review was performed on all women admitted with the diagnosis of pregnancy of unknown location and an hCG level greater than 1000 mIU/mL over a 5‐year period (July 2007 to June 2012). Patients were identified from a computerized hCG result database. The medical records, including sonographic findings, hCG levels, and outcomes, were reviewed.

Results

A total of 113 patients were identified. There were 23 viable intrauterine pregnancies (20.4%) and 22 visualized ectopic pregnancies (19.5%). The highest hCG level associated with a subsequent normal intrauterine pregnancy was 9083 mIU/mL in a patient with triplet pregnancy. Possible factors associated with nonvisualization of a normal intrauterine pregnancy included uterine fibroids, adenomyosis, endometrial polyps, and obesity. The negative laparoscopy rate was 48.8%.

Conclusions

Viable intrauterine pregnancy is possible in patients with pregnancy of unknown location and hCG levels above the generally accepted discriminatory zone, strict adherence to which can potentially disrupt a normal pregnancy. We support the need for judicious use of the hCG discriminatory level in hemodynamically stable patients with pregnancy of unknown location, and the decision to intervene should not be based solely on a single hCG level.
Biometric Sonographic Findings of Abnormally Adherent Trophoblastic Implantations on Cesarean Delivery Scars
Authors: Moschos Elysia , Wells C. Edward , Twickler Diane M.
Published: February 2014

Objectives

The purpose of this study was to review first‐trimester transvaginal sonograms of patients with cervicoisthmic implantations and prior cesarean deliveries to determine whether sonographic biometric measurements can distinguish between abnormally adherent trophoblastic implantations and normally implanted pregnancies.

Methods

Our database was reviewed from October 2006 through December 2011 for patients with first‐trimester sonographic diagnoses of cervicoisthmic implantations and previous cesarean deliveries. Biometric measurements of the smallest distance from the anterior trophoblastic border to the uterine serosa were performed on transvaginal sagittal images of the uterus. Outcomes were classified into 5 categories: cesarean scar pregnancy, placental invasion (accreta/increta/percreta), previa without invasion, spontaneous abortion, and delivered intrauterine pregnancy. Statistical methods included analysis of variance with the Tukey range test and Student t test.

Results

Of 77 studies, outcome data were available for 56 patients. The mean gestational age was 8.8 weeks (minimum, 2.0 weeks; maximum, 14.9 weeks). The anterior trophoblastic border distances from the uterine serosa were significantly smaller in cesarean scar pregnancies (mean, 1.6 mm; SD, 0.6 mm) and placental invasion pregnancies (mean, 2.2 mm; SD, 1.0 mm) than the normally implanted groups (mean, 7.9 mm, SD, 3.3 mm; P < .0001).

Conclusions

Smaller trophoblastic border distances to the anterior uterine serosa are seen in abnormally adherent trophoblastic implantations, and these distances distinguish them from other pregnancy outcomes.
Relative Proportions of Stromal to Cellular Components of Pleomorphic Adenomas
Authors: Olgun Deniz Cebi , Kantarci Fatih , Taskin Umit , Kilic Fahrettin , Oktay Mehmet Faruk , Altinay Serdar , Kepil Nuray , Adaletli Ibrahim , Ada Mehmet , Mihmanli Ismail
Published: February 2014

Objectives

The purpose of this study was to evaluate whether the relative proportions of stromal to cellular components of pleomorphic adenomas have an effect on the shear elastic modulus determined by shear wave elastography (SWE).

Methods

This study was approved by the Ethics Committee of our institution and performed between September 2011 and December 2012. Thirty‐five patients who underwent surgery for a parotid mass were included in the study. The maximum shear elastic modulus of the mass was measured by SWE. Pleomorphic adenomas were histopathologically subdivided into stroma‐poor, intermediate‐stroma, and stroma‐rich tumors based on the relative proportion of stromal to cellular components.

Results

The maximum shear elastic modulus values of the pleomorphic adenomas ranged from 12.6 to 291.9 kPa (mean ± SD, 120.9 ± 92.8 kPa). The Friedman test revealed a statistically significant relationship between the stromal amount and maximum shear elastic modulus (P < .001). Stroma‐poor adenomas (mean, 32.3 ± 27.7 kPa; range, 12.6–81.1 kPa) were softer on SWE than stroma‐rich adenomas (mean, 174.1 ± 48.4 kPa; range, 92.7–217.2 kPa; P = .009). No such significant difference was detected between stroma‐poor and intermediate‐stroma tumors (mean, 146.3 ± 106.1 kPa; range, 19.1–291.9 kPa; P = .062) or between intermediate‐stroma and stroma‐rich tumors (P = .465).

Conclusions

Shear wave elastography depicts pleomorphic adenomas with a variable appearance, which is due to the relative proportions of stromal to cellular contents in the tumors.
Prenatal Sonographic Diagnosis of Intrahepatic Portosystemic Shunts
Authors: Jerabek-Klestil Susanne , Brantner Christine , Nehoda Regina , D'Costa Elisabeth , Campei Silvana , Scheier Matthias
Published: February 2014

The incidence of fetal portosystemic anastomoses is unknown, and it is presumed that many cases remain undetected, as visualization of the hepatic vasculature is not part of the routine 20‐week sonographic scan in pregnancy. However, portosystemic anastomoses are associated with fetal growth restriction due to a diminished oxygen supply to hepatocytes and, hence, downregulation of liver function. In these cases, uteroplacental perfusion might be normal.
Modeling U.S. water resources under climate change
Authors: Blanc Elodie , Strzepek Kenneth , Schlosser Adam , Jacoby Henry , Gueneau Arthur , Fant Charles , Rausch Sebastian , Reilly John
Published: February 2014

Water is at the center of a complex and dynamic system involving climatic, biological, hydrological, physical, and human interactions. We demonstrate a new modeling system that integrates climatic and hydrological determinants of water supply with economic and biological drivers of sectoral and regional water requirement while taking into account constraints of engineered water storage and transport systems. This modeling system is an extension of the Massachusetts Institute of Technology (MIT) Integrated Global System Model framework and is unique in its consistent treatment of factors affecting water resources and water requirements. Irrigation demand, for example, is driven by the same climatic conditions that drive evapotranspiration in natural systems and runoff, and future scenarios of water demand for power plant cooling are consistent with energy scenarios driving climate change. To illustrate the modeling system we select “wet” and “dry” patterns of precipitation for the United States from general circulation models used in the Climate Model Intercomparison Project (CMIP3). Results suggest that population and economic growth alone would increase water stress in the United States through mid‐century. Climate change generally increases water stress with the largest increases in the Southwest. By identifying areas of potential stress in the absence of specific adaptation responses, the modeling system can help direct attention to water planning that might then limit use or add storage in potentially stressed regions, while illustrating how avoiding climate change through mitigation could change likely outcomes.
Incoherent scatter radar‐FAST satellite common volume observations of upflow‐to‐outflow conversion
Authors: Sánchez Ennio R. , StrØmme Anja
Published: February 2014

Incoherent scatter radar measurements from the Sondrestrom Research Facility and the European Incoherent Scatter Svalbard radar have been combined with all‐sky images, polar convection measurements, and FAST particle and field measurements to quantify the contribution of different magnetosphere‐ionosphere coupling processes to the extraction efficiency of ions from the ionosphere. Upflowing ions are traced from their source vertically and horizontally to determine where and when they are likely to intersect the acceleration region observed by FAST. The duration and location of auroral emissions are used to estimate the size and duration of the acceleration region. The upflow‐to‐outflow efficiency is estimated for three periods of polar cap boundary intensifications and streamers during substorm recovery and steady magnetospheric convection. The extraction efficiency of conics ranges between 0.1%, for the lowest amplitude of broadband extremely low frequency waves, and 5%, for the highest‐amplitude waves sampled. Simultaneous measurements of all‐sky images and magnetic field‐aligned radar measurements show that the most intense ion upflux occurs adjacent to the boundary of intense electron precipitation characteristic of polar cap boundary intensifications and streamers, suggesting that the most efficient acceleration mechanisms couple ionospheric heating at F region altitude with dispersive Alfvén waves that grow from horizontal gradients in electric field and conductivity.
Interferometric meteor head echo observations using the Southern Argentina Agile Meteor Radar
Authors: Janches D. , Hocking W. , Pifko S. , Hormaechea J. L. , Fritts D. C. , Brunini C. , Michell R. , Samara M.
Published: February 2014

A radar meteor echo is the radar scattering signature from the free electrons generated by the entry of extraterrestrial particles into the atmosphere. Three categories of scattering mechanisms exist: specular, nonspecular trails, and head echoes. Generally, there are two types of radars utilized to detect meteors. Traditional VHF all‐sky meteor radars primarily detect the specular trails, while high‐power, large‐aperture (HPLA) radars efficiently detect meteor head echoes and, in some cases, nonspecular trails. The fact that head echo measurements can be performed only with HPLA radars limits these studies in several ways. HPLA radars are sensitive instruments constraining the studies to the lower masses, and these observations cannot be performed continuously because they take place at national observatories with limited allocated observing time. These drawbacks can be addressed by developing head echo observing techniques with modified all‐sky meteor radars. Such systems would also permit simultaneous detection of all different scattering mechanisms using the same instrument, rather than requiring assorted different classes of radars, which can help clarify observed differences between the different methodologies. In this study, we demonstrate that such concurrent observations are now possible, enabled by the enhanced design of the Southern Argentina Agile Meteor Radar (SAAMER). The results presented here are derived from observations performed over a period of 12 days in August 2011 and include meteoroid dynamical parameter distributions, radiants, and estimated masses. Overall, the SAAMER's head echo detections appear to be produced by larger particles than those which have been studied thus far using this technique.
Azimuthal extent and properties of midtail plasmoids from two‐point ARTEMIS observations at the Earth‐Moon Lagrange points
Authors: Li S.‐S. , Angelopoulos V. , Runov A. , Kiehas S. A.
Published: February 2014

Although distant‐tail plasmoids are perceived to extend across most of the magnetotail (~40 RE), recent studies in the near‐Earth region (X > −30 RE) have revealed that near‐Earth reconnection (where plasmoids originate) is likely localized and takes place preferentially on the duskside. This discrepancy in plasmoid azimuthal extent suggests that a plasmoid may grow as it moves from near‐Earth to the distant tail. Comprehensive multipoint, midtail plasmoid observations can be used to test this hypothesis. Between October 2010 and July 2011 the ARTEMIS spacecraft (P1 and P2) at the Earth‐Moon Lagrange points (midtail, X ~ −45 to −65 RE) provided simultaneous two‐point observations across the magnetotail for 4 days every lunar month, with a large range of spacecraft separations (0.1 to 25 RE). We find that plasmoids near lunar orbit, like other near‐Earth reconnection‐related phenomena, occur preferentially on the duskside of the magnetotail. Two‐point ARTEMIS observations reveal that the typical plasmoid azimuthal size in our data set is about 5 to 10 RE, much smaller than expected from previous distant‐tail observations. Plasmoids with an azimuthal size greater than 9 RE also exist but only at geomagnetic activity levels higher (AEpeak > 400 nT) than typically found in our data set (median AEpeak ~ 230 nT for our plasmoid data set and median AE ~ 100 nT during the entire period of ARTEMIS magnetotail observations). We conclude that plasmoids during small to moderate substorms (AEpeak < 400 nT) do not grow beyond ~10 RE until they have moved tailward of ~ −45 to −65 RE. Plasmoids during large substorms (AEpeak > 400 nT), however, either grow beyond ~10 RE before they reach lunar distance or initially extend across a large portion of the magnetotail.
Statistically measuring the amount of pitch angle scattering that energetic electrons undergo as they drift across the plasmaspheric drainage plume at geosynchronous orbit
Authors: Borovsky Joseph E. , Friedel Reiner H. W. , Denton Michael H.
Published: February 2014

Using five spacecraft in geosynchronous orbit, plasmaspheric drainage plumes are located in the dayside magnetosphere and the measured pitch angle anisotropies of radiation belt electrons are compared duskward and dawnward of the plumes. Two hundred twenty‐six plume crossings are analyzed. It is found that the radiation belt anisotropy is systematically greater dawnward of plumes (before the electrons cross the plumes) than it is duskward of plumes (after the electrons have crossed the plumes). This change in anisotropy is attributed to pitch angle scattering of the radiation belt electrons during their passage through the plumes. A test database in the absence of plumes finds no equivalent change in the radiation belt anisotropy. The amount of pitch angle scattering by the plume is quantified, scattering times are estimated, and effective pitch angle diffusion coefficients within the plume are estimated. The pitch angle diffusion coefficients obtained from the scattering measurements are of the same magnitude as expected values for electromagnetic ion cyclotron (EMIC) waves at high electron energies (1.5 MeV); however, expected EMIC diffusion coefficients do not extend to pitch angles of 90° and would have difficulties explaining the observed isotropization of electrons. The pitch angle diffusion coefficients obtained from the scattering measurements are of the same magnitude as expected values for whistler mode hiss at lower electron energies (150 keV). Outward radial transport of the radiation belt caused by the pitch angle scattering in the plume is discussed.
The quiet evening auroral arc and the structure of the growth phase near‐Earth plasma sheet
Authors: Coroniti F. V. , Pritchett P. L.
Published: February 2014

The plasma pressure and current configuration of the near‐Earth plasma sheet that creates and sustains the quiet evening auroral arc during the growth phase of magnetospheric substorms is investigated. We propose that the quiet evening arc (QEA) connects to the thin near‐Earth current sheet, which forms during the development of the growth phase enhancement of convection. The current sheet's large polarization electric fields are shielded from the ionosphere by an Inverted‐V parallel potential drop, thereby producing the electron precipitation responsible for the arc's luminosity. The QEA is located in the plasma sheet region of maximal radial pressure gradient and, in the east‐west direction, follows the vanishing of the approximately dawn‐dusk‐directed gradient or fold in the plasma pressure. In the evening sector, the boundary between the Region1 and Region 2 current systems occurs where the pressure maximizes (approximately radial gradient of the pressure vanishes) and where the approximately radial gradient of the magnetic flux tube volume also vanishes in an inflection region. The proposed intricate balance of plasma sheet pressure and currents may well be very sensitive to disruption by the arrival of equatorward traveling auroral streamers and their associated earthward traveling dipolarization fronts.
Assessing variability of evapotranspiration over the Ganga river basin using water balance computations
Authors: Syed Tajdarul H. , Webster Peter J. , Famiglietti James S.
Published: February 2014

A thorough assessment of evapotranspiration (ET) pervades several important issues of the 21st century including climate change, food‐security, land‐management, flood and drought prediction, and water resources assessment and management. Such a proper assessment is of particular importance in the Ganga river basin (GRB) with its backdrop of a rapidly increasing population pressure and unregulated use of water resources. Spatially averaged ET over the GRB is computed as the residual of atmospheric and terrestrial water budget computations using a combination of model simulations and satellite and ground‐based observations. The best estimate of monthly ET is obtained as the monthly mean of atmospheric and terrestrial water balance computations for the period 1980–2007. The mean monthly average of ET from these various estimates is 72.3 ± 18.8 mm month−1. Monthly variations of ET peak between July and August and reach a minimum in February. For the entire study period, the rate of change of ET across the GRB is −11 mm yr−2 (i.e., mm/yr/yr). Alongside a notable influence of the 1997–1998 El Niño, results allude to the existence of interim periods during which ET trends varied significantly. More specifically, during the period of 1998–2002, the rate of decline increased to −55.8 mm yr−2, which is almost 5 times the overall trend. Based on the correlation between ET and independent estimates of near‐surface temperature and soil moisture, we can infer that the ET over the GRB is primarily limited by moisture availability. The analysis has important potential for use in large‐scale water budget assessments and intercomparison studies. The analysis also emphasizes the importance of synergistic use of mutliplatform hydrologic information.