bluuebunny/crossref_metadata_2025 huggingface dataset:
Solvent‐dehydrated cadaveric dermis: a new allograft for pubovaginal sling surgery
Authors: ONUR RAHMI , SINGLA AJAY
Published: September 2005

Abstract

Aim
The aim of this study was to evaluate the efficacy of solvent‐dehydrated cadaveric dermis in pubovaginal sling surgery for the first time in the literature.

Methods
Twenty‐five women with stress urinary incontinence underwent pubovaginal sling surgery using 2 × 12 cm allograft dermis. Preoperatively, all patients were evaluated by a detailed urogynecologic evaluation, voiding diary, pelvic examination and urodynamic investigation. Outcome was assessed by the Urogenital Distress Inventory short form and standardized follow‐up questionnaires.

Results
Twenty (80%) patients were cured of stress incontinence symptoms. Seventeen wore no pad and three reported occasional stress urinary incontinence and used no or one pad at a mean follow up of 12 months. Five (20%) patients in our series experienced the same amount of leakage as before the surgery. Seventy‐six percent of the patients indicated that urinary incontinence was no longer negatively affecting their daily life and were satisfied with the procedure.

Conclusions
Questionnaire‐based assessment of outcome suggests that solvent‐dehydrated cadaveric dermis is effective in the treatment of stress urinary incontinence. However, larger and comparative prospective studies with long‐term results and randomized comparison of tissue preparation techniques are warranted.
Oral clonidine advances spermatogenesis in oligozoospermic patients with spermatogenetic maturation arrest
Authors: TERADA HIROSHI , FUJITA KIMIO , OTSUKA ATSUSHI , SHINBO HITOSHI , MUGIYA SOICHI , OZONO SEIICHIRO
Published: September 2005

Abstract

Background:
Growth hormone (GH) plays an important role in the pubertal development of males and females, and inﬂuences the male reproductive function after puberty. The purpose of this study was to investigate the cause of GH deficiency in infertile men with spermatogenetic maturation arrest using the clonidine loading test (GH stimulation test). Based on the results of the loading test, we tried to conﬁrm whether clonidine might be usable as a male infertility remedy.

Methods:

We studied 75 infertile men (55 oligozoospermic and 20 azoospermic men) and 25 normal fertile volunteers. We used the oral clonidine (0.15 mg/m2) loading test to evaluate the GH secretory reserve. Histological diagnoses were performed using testicular biopsy and testicular sperm extraction specimens.

Results:
The most important finding was that the clonidine loading test caused a good response in 41 out of 55 (74.6%) patients with oligozoospermia. We treated these 41 good‐response patients with oral clonidine, and the sperm count improved in 34 (82.9%) cases, increasing to 12–79 million/mL. Spontaneous pregnancy was subsequently achieved by 10 (24.4%) couples.

Conclusions:
These findings also suggest that GH is necessary for spermatogenesis, at least for the process of spermatozoa maturation. Oral clonidine therapy improved the sperm count in patients who showed an excessive response to the clonidine loading test.
Clinical study of six cases showing late relapse of germ cell tumors
Authors: MURAMAKI MOTOTSUGU , HARA ISAO , MIYAKE HIDEAKI , YAMADA YUJI , KAWABATA GAKU , KAMIDONO SADAO
Published: September 2005

Abstract

Late relapse of germ cell tumors has been considered rare. We report six patients treated at our institution with relapses of germ cell tumors more than 2 years after first successful management. Median time to late relapse for pure seminomas and non‐seminomatous germ cell tumors was 30.0 and 75.5 months, respectively. The sites of the late relapses in two cases of pure seminoma were located out of the fields of irradiation. After systematic chemotherapy, both these patients remain disease free. Two patients with non‐seminomatous germ cell tumors received salvage chemotherapy at the time of late relapse, but tumor markers did not normalize in either case. A complete resection of relapsed masses was performed in three cases of non‐seminomatous germ cell tumors. All three patients are without evidence of disease. The incidence of late relapse in patients with pure seminomas and non‐seminomas was 2.4% and 3.3%, respectively, which suggests the necessity for long‐term follow up.
Ureteral obstruction caused by a duplicated anomaly of inferior vena cava
Authors: WANG LIANG‐TSAI , LO HUA‐CHENG , YU DAH‐SHYONG , SUN GUANG‐HUAN , WU CHING‐CHUN , FONG CHAU‐JYE
Published: September 2005

Abstract

Developmental anomalies of inferior vena cava are a rare cause of ureteral obstruction. We report a case that presented with right upper ureteral obstruction that radiologically simulated a retrocaval ureter. An aberrant vessel, which caused obstruction of the right ureter was identified at operation and surgical relief of ureteral obstruction was performed. Inferior venocavography was performed postoperatively and disclosed an unusual incomplete duplication of inferior vena cava. Our findings suggested that ureteral obstruction by incompletely duplicated anomaly of the inferior vena cava should be included in the differential diagnosis of extrinsic ureteral obstruction.
Fatigue of single‐ and double‐rivet self‐piercing riveted lap joints
Authors: IYER K. , HU S. J. , BRITTMAN F. L. , WANG P. C. , HAYDEN D. B. , MARIN S. P.
Published: September 2005

The fatigue behaviour of single‐ and double‐rivet aluminum alloy 5754‐O self‐piercing riveted (SPR) lap joints has been investigated experimentally and analytically. With the single rivet, the experimental program involves a set of 27 cyclic tension tests on joints with 1‐, 2‐ or 3‐mm‐thick sheet coupons. In most cases (85%), fatigue cracks are found to initiate in the gross section on the faying surface of the upper sheet. With two rivets (installed in two rows), the experimental program consists of nine cyclic tension tests, three for each of the three combinations of riveting orientation possible, on SPR joints consisting of 2‐mm‐thick sheet specimens. The fatigue life of double‐rivet joints is found to be strongly dependent on the orientation combination of the rivets. Monotonic tests with the double‐rivet joints also reveal an influence of orientation combination. In addition to experiments, values of local stress and rivet‐sheet microslip in the single‐rivet joints have been evaluated through three‐dimensional elastic finite‐element analysis. The analyses are used to interpret experimental observations of fatigue crack initiation location, life and fretting damage severity.
Determinants of accounting innovation implementation
Authors: Abernethy Margaret A. , Bouwens Jan
Published: September 2005

Accounting innovations are often not successfully implemented or diffused throughout the organization. This study seeks to explain this phenomenon. One of the major impediments to the successful implementation of accounting innovation is that management accounting systems are generally used to serve the decision control needs of top management while at the same time purportedly supporting the decision management needs of lower level managers. To the extent that the accounting system is used for decision control, innovation creates the potential for wealth effects to occur. This prompts managers, whose wealth will be negatively affected, to resist accounting innovation. We present conditions where it is likely for negative wealth effects to occur. Under these conditions the system will fail to achieve its intended objectives. Our theoretical model examines how decentralization choices influence resistance to accounting innovation. We argue that delegation of decision rights can limit the potential for resistance in two ways—(a) by creating the environment which allows managers to ensure that their subunits are able to adapt to the new signals provided by accounting innovations and (b) by enabling subunit managers to become involved in the design of these systems. Our model also enables us to assess the consequences on organizational outcomes when subunit managers resist accounting innovations. Based on data collected from production managers, our results demonstrate the importance of decentralization choices on the effective implementation of accounting innovations.
Accounting as a social and institutional practice: perspectives to enrich our understanding of accounting change
Authors: Potter Bradley N.
Published: September 2005

In the past two decades, a body of literature has developed which depicts accounting as a social and institutional practice. Researchers adopting this perspective typically demonstrate an appreciation for the pervasive and enabling characteristics of accounting and an awareness of the importance of local, time‐specific factors which shape accounting change within particular instances. This work examines this literature and classifies its content using the themes identified by Miller (1994). Drawing upon aspects of this literature, the final sections develop a broad, thematic framework to assist researchers in future studies directed at understanding the diverse and complex processes through which changes to the accounting domain can occur.
Investigating corporate management lobbying in the U.K. accounting standard‐setting process: a multi‐issue/multi‐period approach
Authors: Georgiou George
Published: September 2005

A large body of literature examines the motives of corporate managers to lobby accounting standard‐setters. In general, studies confine their examination to single episodes of the standard‐setting process (e.g., exposure draft). This article extends the literature by adopting a multi‐issue/multi‐period approach to investigate corporate lobbying of the U.K.'s ASB. The findings suggest that the extent of corporate lobbying, defined on the basis of the frequency with which companies made submissions to all of the publications issued by the ASB over a six‐year period, depends on the size of companies, the debt covenant costs they face and whether they are listed on a U.S. stock exchange. Separate analyses, however, involving (a) the frequency of lobbying on income‐related issues and (b) the frequency of lobbying on disclosure issues revealed that, while all these three variables explain lobbying on income‐related issues, only size is significant in explaining lobbying on disclosure issues. The results also suggest that the debt to equity ratio is an imperfect proxy for debt covenant costs.
Deliberative Democratic Evaluation: Successes and Limitations of an Evaluation of School Choice
Authors: Howe Kenneth R. , Ashcraft Catherine
Published: September 2005

This article briefly characterizes a deliberative democratic approach to program evaluation, recounts its application to the evaluation of school choice policy in the Boulder Valley School District, and describes the results and recommendations of the evaluation. It then assesses the evaluation in terms of its role in stimulating policy change and how it fits with the requirements of the deliberative democratic ideal. It concludes with an assessment of the deliberative democratic approach itself in light of the Boulder experience.
Toward an Evaluation Habit of Mind: Mapping the Journey
Authors: Katz Steven , Sutherland Stephanie , Earl Lorna
Published: September 2005

In this article we chronicle a particular professional development initiative designed to promote the acquisition of an evaluation habit of mind within an educational context. After describing the rationale behind this initiative in some detail, we proceed to map the experiences of four of the participants—a principal, a vice principal, a consultant, and a teacher—as they journeyed toward an understanding of evidence-informed decision making. A combination of document analyses and exit interviews allowed us to plot the developmental course by which this evaluation mindset unfolds. Ultimately, the process of using data as evidence for decision making is revealed as one of developing intrinsic motivation by way of personal “meaning making.” The three overarching cognitive themes of preconceptions, frameworks, and reflections given in the National Research Council's synthesized report on how people learn (Donovan, Bransford, & Pellegrino, 2000) are taken as the structural guideposts for the necessary construction of meaning.
Close up and Personal: The Effect of a Research Relationship on an Educational Program Evaluation
Authors: Mello Robin A.
Published: September 2005

This article addresses the construction of “critical friendships” within the practice of one particular program evaluation. It focuses on the evolution of relationships developed during one 2-year program evaluation study that examined a collaborative educational project. Findings show that a caring interest and mentoring rapport developed between program constituents and evaluator (the author of the study). Further, this study suggests that these relationships were essential to how formative and summative feedback was used. This article suggests that the interplay between evaluator and constituents is best practiced through what House and Howe call a methodological advocacy stance. Finally, it encourages further discourse and investigations into the ways that program evaluation is carried out in order to more thoroughly understand how relationships influence evaluation methodology and practice.
Applying the Joint Committee's 1994 Standards in International Contexts: A Case Study of Education Evaluations in Bangladesh
Authors: Chatterji Madhabi
Published: September 2005

This case study examines the applicability of 1994 standards, offered by the Joint Committee on Standards for Educational Evaluation, to evaluations conducted in international contexts. The work is undertaken in response to an open invitation from the Joint Committee in its 1994 publication. The article addresses two purposes. First, it asks whether the standards in the four broad areas—utility, feasibility, propriety, and accuracy—can be applied as written to guide and monitor evaluation practices in developing countries when the programmatic focus and evaluation models, including relationships among sponsors, program participants, stakeholders, and evaluators, vary significantly from the assumptions underlying the 1994 standards. Second, it develops and refines methods for conducting metaevaluations of international evaluations by analyzing documentary and interview-based data from one case, represented by series of connected studies on education and health literacy programs in Bangladesh. The findings set the stage for more informed discussions on the robustness of existing standards and on the need for continuing case studies toward generating a revised or new set of standards for international evaluations in diverse fields, programs, and policy areas. The 1994 standards are presently undergoing revision by a task force of the American Evaluation Association.
Confirmatory Program Evaluation: Applications to Early Childhood Interventions
Authors: Reynolds Arthur J.
Published: September 2005

Confirmatory program evaluation is discussed as a method for conducting theorydriven evaluations. It is an impact assessment that emphasizes the explication and testing of a priori program theories within a broad assessment of program effectiveness. Greater emphasis is given to identifying the causal mechanisms or active ingredients of intervention effects. Confirmatory evaluation approaches are applied to the field of early childhood intervention. Although significant progress in understanding the effects of early childhood interventions has occurred over the last four decades, questions remain about the causal mechanisms of change, who benefits most from which program components, and the reliability of effects for large-scale programs. Examples from the Chicago Longitudinal Study are highlighted to show how confirmatory evaluation can help validate the effects of social interventions. Studies of the Chicago Child-Parent Centers are described to emphasize how the causal criteria of coherence, specificity, and within- and between-study consistency can strengthen causal inference and generalizability.
INSTITUTIONALIZED CORRUPTION AND PRIVILEGE IN CHINA'S SOCIALIST MARKET ECONOMY: A GENERAL EQUILIBRIUM ANALYSIS
Authors: Li Ke , Smyth Russell , Yao Shuntian
Published: September 2005

Abstract.  This paper develops a general equilibrium model to consider the effects of corruption caused by institutionalized privilege on economic welfare, the network size of division of labour and productivity. First a Walrasian equilibrium in a market economy is computed; then we consider the effects on welfare when a privileged group is chosen to work as high‐level administrators. Finally, we allow for explicit collusion between administrators by introducing an administrator's agent who acts in the interests of all the administrators. The model shows that in equilibrium (fixed point) the degree of corruption, the degree of division of labour and productivity are interdependent.
Epidermoid carcinoma and perforating necrobiosis lipoidica: a rare association
Authors: Vanhooteghem O , André J , de la Brassinne M
Published: September 2005

We report the case of a 33‐year‐old patient who had had insulin‐dependent diabetes mellitus (IDDM) since he was 11 months old, and who presented with major perforating necrobiosis lipoidica (PNL) complicated by a well‐differentiated epidermoid carcinoma. PNL is a rare clinical form of NL, always associated with diabetes. Only seven cases have been reported to date in the literature, and to the best of our knowledge, an association of epidermoid carcinoma and PNL has never been described. The development of a tumoral transformation on a classical NL plaque has only been described 12 times. The presence of an epidermoid carcinoma on a weakened background with permanent ulceration suggests that early surgical excision of the tumour and of the NL followed by a skin graft might be the treatment of choice. Radiotherapy seems to be a poor therapeutic option.
The clinical benefit of moisturizers
Authors: Lodén M
Published: September 2005

Moisturizing creams marketed to consumers often contain trendy ingredients and are accompanied by exciting names and attractive claims. Moisturizers are also an important part of the dermatologist's armamentarium to treat dry skin conditions and maintain healthy skin.

The products can be regarded as cosmetics, but may also be regulated as medicinal products if they are marketed against dry skin diseases, such as atopic dermatitis and ichthyosis.

When moisturizers are used on the so‐called dry skin, many distinct disorders that manifest themselves with the generally recognized symptoms of dryness are treated. Dryness is not a single entity, but is characterized by differences in chemistry and morphology in the epidermis depending on the internal and external stressors of the skin. Patients and the society expect dermatologists and pharmacists to be able to recommend treatment for various dry skin conditions upon evidence‐based medicine.

Learning objective  Upon completing this paper, the reader should be aware of different types of moisturizers and their major constituents. Furthermore, s/he will know more about the relief of dryness symptoms and the functional changes of the skin induced by moisturizers.
Routine Transesophageal Echocardiography for the Evaluation of Cerebral Emboli in Elderly Patients
Authors: Vitebskiy Sergey , Fox Keith , Hoit Brian D.
Published: September 2005

Background: Approximately 20% of cerebral infarctions are cardioembolic in nature. Transesophageal echocardiography (TEE) is widely regarded as the initial study of choice for evaluating cardiac source of embolism. Although the majority of cerebrovascular accidents occur in elderly patients, the value of TEE in this population is poorly defined. Methods: We compared 491 patients older than 65 years with suspected embolic stroke or transient ischemic attack (TIA) who had undergone TEE evaluation between April 2000 and February 2004 to an age‐, sex‐, and time‐matched control group that consisted of 252 patients. Studies were reviewed for abnormalities associated with thromboembolic disease. Results: The overall incidence of stroke risk factors was significantly higher in the study than in the control group. However, the four patients with left atrial thrombi had a history of atrial fibrillation. Although ascending and aortic arch sessile atheromata were observed more frequently in the study than control group, there were no significant differences in the incidence of either complex or mobile aortic atheromata. The incidence of atrial septal aneurysm was higher in the stroke/TIA group, but not in association with patent foramen ovale. Finally, there were also no differences in the incidence of spontaneous echocontrast, and/or patent foramen ovale between study and control groups. Conclusions: We conclude: (1) There is a higher incidence of abnormalities implicated as sources of thromboembolic disease on TEE in elderly patients with cerebral infarctions, but (2) this incidence is driven by the presence of sessile aortic atheroma and atrial septal aneurysm. Until the benefits of specific therapies for these conditions are known, routine TEE in elderly patients with suspected embolic neurological events appears to be unwarranted.
Transthoracic and Transesophageal Echocardiographic Assessment of Mitral Regurgitation Severity: Usefulness of Qualitative and Semiquantitative Techniques
Authors: Khanna Deepak , Miller Andrew P. , Nanda Navin C. , Ahmed Sujood , Lloyd Steven G.
Published: September 2005

In this report, we review the advantages, limitations, and optimal utilization of various transthoracic and transesophageal echocardiographic (TTE and TEE) methods used for assessing mitral regurgitation (MR) as published in full‐length, peer‐reviewed articles since the color Doppler era began in 1984. In addition, comparison is made to other imaging modalities including catheter‐based, magnetic resonance and surgical assessment of MR. Although left ventricular (LV) angiography has been traditionally used for validation of various TTE methods and is time‐honored, its considerable limitations preclude it from being a real “gold standard.” Based on the reviewed literature, no clear “gold standard” for the assessment of MR can be identified at present, but newly emerging TTE and TEE techniques, such as three‐dimensional color Doppler, may have the potential to overcome some of the limitations of the two‐dimensional methods.
Assessment of Aortic Regurgitation by Live Three‐Dimensional Transthoracic Echocardiographic Measurements of Vena Contracta Area: Usefulness and Validation
Authors: Fang Ligang , Hsiung Ming Chon , Miller Andrew P. , Nanda Navin C. , Yin Wei Hsian , Young Mason S. , Velayudhan Dasan E.
Published: September 2005

In this report, we evaluate 56 consecutive adult patients who underwent standard two‐dimensional (2D) and live three‐dimensional transthoracic echocardiography (3D TTE), as well as left heart catheterization with aortography (45 patients) or cardiac surgery (11 patients), for evaluation of aortic insufficiency. Similar to the method we previously described for mitral insufficiency, aortic regurgitant vena contracta area (VCA) was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE data set. Assessments of aortic regurgitation (AR) by aortography and surgery are compared to measurements of VCA by 3D TTE and to 2D TTE measurements of vena contracta width (VCW). Aortographic or surgical grading correlated well with 2D TTE measurements of VCW (r = 0.92), but correlated better with 3D TTE measurements of VCA (r = 0.95), with improved dispersion between angiographic grades demonstrated by the 3D TTE technique. Live 3D TTE color Doppler measurements of VCA can be used for accurate assessment of AR and are comparable to assessment by aortography.
Comparison of Plasma Exchange With Different Membrane Pore Sizes in the Treatment of Severe Viral Hepatitis
Authors: Li Lan Juan , Liu Xiao Li , Xu Xiao Wei , Sheng Guo Ping , Chen Yu , Chen Yue Mei , Huang Jian Rong , Yang Qian
Published: September 2005

Abstract:  Plasma exchange has become an effective mode of blood purification in patients suffering from liver failure. To assist in patient recovery, we compared two plasma separators to identify a plasma separator with suitable pore sizes to remove toxic substances effectively, and retain important plasma components. The study focused on severe viral hepatitis patients. Of 206 rounds of plasma exchange, 137 were completed with the PS‐06 plasma separator (membrane pore size = 0.2 µm) and 69 with the EC‐4A plasma separator (membrane pore size = 0.03 µm). The efficacy of different plasma separators was compared using survival rate, changes in liver biochemistry, immunoglobulin, and complement parameters. The survival rate of patients treated with PS‐06 was 43.3% (13 of 30 patients). For patients treated with EC‐4A, two patients were bridged to liver transplantation successfully, and 57.9% (11 of 19 patients) survived. In both groups, the levels of total bilirubin, prothrombin time, and bile acid declined significantly. Compared to PS‐06, EC‐4A could retain significantly larger amounts of immunoglobulin and complements. Our study revealed that plasma exchange implementation with membrane pore size 0.03 µm could remove adequate bilirubin and bile acid, a class of toxins bound to plasma protein in severe viral hepatitis patients, and reduce the loss of essential plasma macromolecules.
Acute Effect of Rheopheresis on Peripheral Endothelial Dysfunction in Patients Suffering From Sudden Hearing Loss
Authors: Balletshofer Bernd M , Stock Jan , Rittig Kilian , Lehn‐Stefan Angela , Braun Norbert , Burkart Frank , Plontke Stefan , Klingel Reinhard , Häring Hans‐Ulrich
Published: September 2005

Abstract:  Single low density lipoprotein (LDL) fibrinogen apheresis has shown beneficial effects in the treatment of patients with sudden sensorineural hearing loss (SSHL). Pathophysiologically, a microcirculatory disorder of the inner ear, probably caused by disturbed endothelial function, is discussed as a final common pathway of a variety of SSHL etiologies. Thus, we carried out a prospective pilot study on the efficacy of Rheopheresis on vascular function in these patients, embedded into an ongoing randomized controlled multicenter trial investigating the efficacy of Rheopheresis for the treatment of SSHL. Potential modulation of systemic endothelial dysfunction by Rheopheresis was examined by measuring flow‐associated vasodilatation of the brachial artery (according to the criteria of the American College of Cardiology) in a small group of patients suffering from SSHL (N = 6, 5m/1f, mean age 56 ± 11 years) within the last 3 days. At baseline, five of the six patients with acute hearing loss showed endothelial dysfunction as evidenced by diminished flow‐mediated vasodilatation (FMD < 5%). After a single Rheopheresis treatment, flow‐mediated vasodilatation improved significantly (from 3.9 ± 3.6% to 7.2 ± 2.4%, P = 0.05, mean ± SD, two‐sided paired T‐test). This was paralleled by a reduction in fibrinogen (364 ± 216 mg/dL to 142 ± 96 mg/dL, P = 0.03), total cholesterol (228 ± 23 to 98 ± 10, P < 0.0001) and LDL cholesterol levels (153 ± 8 mg/dL to 83 ± 23 mg/dL, P < 0.01). Based on this case series we conclude that single Rheopheresis treatment might have an acute beneficial effect on endothelial dysfunction in patients suffering from SSHL.
A Case of Drug‐Induced Hypersensitivity Syndrome With Multiple Organ Involvement Treated With Plasma Exchange
Authors: Higuchi Makoto , Agatsuma Toshihiko , Iizima Miwako , Yamazaki Yoriko , Saita Toshiaki , Ichikawa Tohru , Kamijo Yuji , Arakura Hideo , Hora Kazuhiko , Kiyosawa Kendo
Published: September 2005

Abstract:  A 53‐year‐old male patient began treatment for systemic exanthema with diaphenylsulfone (DHS) on 21 November 2002. On 18 December 2002, the patient developed a fever and additional systemic erythematous exanthema. Systemic lymphadenopathy, hepatosplenomegaly, leukocytosis (in particular, an increase in the number of atypical lymphocytes) and liver dysfunction followed. After cessation of the DHS treatment on 25 December 2002, acute renal failure occurred and the patient was transferred to Shinshu University Hospital on 4 January 2003. The patient was diagnosed with drug‐induced hypersensitivity syndrome (DIHS). Steroid pulse therapy (methylprednisolone 1000 mg/day for 3 days) was given, followed by 60 mg/day of prednisolone. The patient's renal functions recovered and he was taken off hemodialysis therapy. However, the patient relapsed twice despite two sessions of steroid pulse therapy and an increase in the dose of prednisolone to 100 mg/day. Plasma exchange (PE) was carried out to reduce the activity of the disease. With a total of four plasma exchanges, we were able to reduce the dose of prednisolone from 100 mg/day to 60 mg/day without relapse. There were no adverse effects from the plasma exchanges. Plasma exchange should be considered in the treatment with corticosteroid‐resistant DIHS with multiple organ lesions.
Heat Stroke With Multiple Organ Failure Treated With Cold Hemodialysis and Cold Continuous Hemodiafiltration: A Case Report
Authors: Wakino Shu , Hori Shingo , Mimura Takuya , Fujishima Seitaroh , Hayashi Koichi , Inamoto Hajime , Saruta Takao , Aikawa Naoki
Published: September 2005

Abstract:  A 23‐year‐old comatose man was presented in the emergency room. He had been working inside a building under construction on a hot summer's day. His core body temperature was 42.1°C and he was diagnosed with heat stroke. Urgent cooling procedures, including applying cold vapor to the patient's skin, a gastric lavage with cold water and an intravenous cold saline infusion, were not completely successful and his body temperature remained above 40°C. Because his high temperature was refractory to conventional cooling procedures and we suspected that acute renal failure (ARF) by rhabdomyolysis would develop, we applied hemodialysis (HD) using cold dialysate (initially 30°C and later 35°C), followed by continuous hemodiafiltration (CHDF) with cold dialysate (35°C) at a high flow rate of 18 000 mL per hour. The patient's body temperature fell below 38.0°C within 3 h and was kept below 38.0°C. Continuous hemodiafiltration was continued for one week. During the first week, the patient suffered from multiple organ failure (MOF) involving renal failure, as well as the failure of heart, liver, lung, and central nervous systems. Disseminated intravascular coagulation also developed. However, by virtue of cold CHDF, he almost recovered 3 weeks after the onset, except for remaining mild liver and renal dysfunction. In severe heat stroke, cold HD and high flow, cold CHDF should be a therapeutic choice for cooling and treatment of MOF. Considering mild liver and renal dysfunction still remained, this case suggested these procedures should be initiated at the very beginning of the treatment of severe heat stroke.
Approach to Acute Renal Failure With Multiple Myeloma: Role of Plasmapheresis
Authors: El‐Achkar Tarek M , Sharfuddin Asif A , Dominguez Jesus
Published: September 2005

Abstract:  Multiple myeloma is commonly complicated by renal failure, which limits therapeutic options and aggravates the prognosis. In myeloma the most common cause of advanced renal failure is myeloma kidney, where light chains produced by tumor cells precipitate and impede kidney function. We suggest that plasma exchange is an appropriate intervention in advanced renal failure from multiple myeloma, and support this notion with two case reports. The two elderly individuals had advanced chronic and acute renal failure, and recovered after the removal of large quantities of light chains by existing membrane separation techniques. We also present an algorithm to approach renal failure and myeloma.
Cytokine and endotoxin removal in critically Ill patients
Authors: Yonekawa Motoki
Published: September 2005

Endotoxin and cytokine removal by blood purification is one of the most effective treatments for critical illness such as systemic inflammatory response syndrome (SIRS), sepsis and septic shock. SIRS and sepsis frequently associates with hepatic failure, renal failure, respiratory failure, cardiac failure, disseminated intravascular coagulation (DIC) and gastrointestinal bleeding. In these diseases endotoxin and several mediators such as inflammatory cytokines play important roles in clinical course and pathophysiology. The role of blood purification is to remove endotoxin and cytokines, to correct cytokine balance, and to modulate humoral conditions. We use 2 methods of blood purification. One is direct hemoperfusion using Toraymyxin developed by Kodama and Tani in Shiga University of Medical Science. Toraymyxin composed of a Polymyxin B immobilized, can remove endotoxin and can be applied to patients with endotoxemia or suspected bacteremia. The most impressive clinical effectiveness is the improvement of hemodynamic abnormalities. Blood pressure, cardiac index and oxygen consumption index improve after treatment by Toraymyxin. Furthermore inflammatory mediators such as TNF, IL‐6, IL‐10 and plasminogen activator inhibitor‐1 (PAI‐1) are significantly decreased either after 2 h or by the following day in survivors. An immediate mediator, endogenous cannabinoid which is generated by activated monocytes / macrophages and causes septic shock, is also reduced by Toraymyxin treatment. Another method of blood purification is continuous hemofiltration (CHF) and continuous hemodiafiltration (CHDF). CHF and CHDF have been applied only with renal indication, but recently it is widely applied with nonrenal indication for patients with critical illness. The main purpose of CHF and CHDF is to reduce humoral mediators level in blood. As in SIRS patients, inflammatory cytokines are continuously produced in inflammatory regions, the continuous therapy is recommended in ICU. Sometimes inflammatory cytokines are not so reduced in the blood level. The change in the blood level of cytokines depends on the balance between the generation rate and the removal rate of cytokines with continuous therapy. We have some successful results in patients with sepsis and SIRS, but further studies are required to make standardized strategy with blood purification and to have better survival rate.
Mercury exposure during immune apheresis
Authors: Bauer Edith , Schaffer Andreas , Kramer Ludwig , Derfler Kurt
Published: September 2005

Background: Immunoadsorption using protein A columns is increasingly used for selective extracorporeal removal of circulating antibodies and autoantibodies. Current apheresis systems employ reusable columns requiring long‐term storage (20–50 treatment sessions). To prevent microbial growth during storage, columns are primed with ethyl mercury thiosalicylic acid (thiomerosal, .01% solution) for storage and rinsed with phosphate buffer before use.

Aims: To test the hypothesis of a substantial mercury exposure in protein A immunoadsorption and to investigate the effect of adding N‐acetylcysteine to the rinsing solution.

Patients and Methods: Whole blood mercury levels were measured by atomic absorption spectroscopy (hydride method) before and after protein A immunoadsorption (11 patients, 26 treatments), anti‐IgG‐immunoadsorption (8 patients, 13 treatments) and LDL apheresis (DALI and Therasorb systems; 9 patients, 14 treatments).

Results: Protein A immune apheresis treatment significantly increased blood mercury levels from a median of 5.4 µg/L (range, 1.4–37.6, normal, <5 µg/L) to 23.7 µg/L, (range 7.2–107, P < 0.001). Baseline mercury levels were normal in treatment‐naive patients but gradually increased on regular treatment. In a single patient with excessive mercury levels (107 µg/L), neurologic toxicity (intention tremor) occurred during immune apheresis. In the other groups blood mercury levels were not different from healthy controls. Adding N‐acetlycysteine to the rinsing solution lead to a significant decrease in mercury exposure during protein A apheresis treatment.

Discussion: This preliminary report suggests that mercury toxicity may develop in patients on regular protein A immune apheresis treatment. Given impaired renal function in many patients, any effort should be undertaken to reduce systemic mercury exposure, either by adding chelators to the rinsing solution or ideally by replacement of thiomerosal. Adding N‐acetlycysteine significantly reduced mercury exposure, so that we now routinely rinse protein A columns with N‐acetylcysteine before use.
Design and Test of an Ultralow Solidity Flow-Controlled Compressor Stator
Authors: Kirtley K. R. , Graziosi P. , Wood P. , Beacher B. , Shin H.-W.
Published: September 2005

A full annulus fluidic flow-controlled compressor stator ring was designed and tested in the third stage of a four-stage low-speed research compressor. The solidity of the flow-controlled stator was near unity and significantly below design practice with a commensurately high diffusion factor. The design intent was to reduce the vane count by 30% and load the stator to the point of stall at the design point, then employ flow control to restore attached boundary layers and regain design-point stage matching. The flow control applied, which maintained attached flow, was 1% of the compressor mass flow and was introduced via discrete steady jets on the suction side of the stator. The design method used steady Computational Fluid Dynamics (CFD) with the flow control jets simulated to drive stator exit angles, velocities, and blockage to match the baseline machine. The experiment verified the pretest predictions and demonstrated degraded compressor performance without flow control and restoration of the pumping characteristics of the baseline high solidity compressor when flow control was applied. An assessment of the engine cycle impact of the flow-controlled compressor shows a 2.1 point stage efficiency reduction for the increased loading. Extrapolation of the data and analysis to a high-speed compressor shows a more modest 0.5 point stage efficiency trade.
Averaged and Time-Dependent Aerodynamics of a High Pressure Turbine Blade Tip Cavity and Stationary Shroud: Comparison of Computational and Experimental Results
Authors: Green Brian R. , Barter John W. , Haldeman Charles W. , Dunn Michael G.
Published: September 2005

The unsteady aero-dynamics of a single-stage high-pressure turbine blade operating at design corrected conditions has been the subject of a thorough study involving detailed measurements and computations. The experimental configuration consisted of a single-stage high-pressure turbine and the adjacent, downstream, low-pressure turbine nozzle row. All three blade-rows were instrumented at three spanwise locations with flush-mounted, high-frequency response pressure transducers. The rotor was also instrumented with the same transducers on the blade tip and platform and the stationary shroud was instrumented with pressure transducers at specific locations above the rotating blade. Predictions of the time-dependent flow field around the rotor were obtained using MSU-TURBO, a three-dimensional (3D), nonlinear, computational fluid dynamics (CFD) code. Using an isolated blade-row unsteady analysis method, the unsteady surface pressure for the high-pressure turbine rotor due to the upstream high-pressure turbine nozzle was calculated. The predicted unsteady pressure on the rotor surface was compared to the measurements at selected spanwise locations on the blade, in the recessed cavity, and on the shroud. The rig and computational models included a flat and recessed blade tip geometry and were used for the comparisons presented in the paper. Comparisons of the measured and predicted static pressure loading on the blade surface show excellent correlation from both a time-average and time-accurate standpoint. This paper concentrates on the tip and shroud comparisons between the experiments and the predictions and these results also show good correlation with the time-resolved data. These data comparisons provide confidence in the CFD modeling and its ability to capture unsteady flow physics on the blade surface, in the flat and recessed tip regions of the blade, and on the stationary shroud.
Development of an Experimental Capability to Produce Controlled Blade Tip∕Shroud Rubs at Engine Speed
Authors: Padova Corso , Barton Jeffrey , Dunn Michael G. , Manwaring Steve , Young Gamaliel , Adams Maurice , Adams Michael
Published: September 2005

An experimental capability using an in-ground spin-pit facility specifically designed to investigate aeromechanic phenomena for gas turbine engine hardware rotating at engine speed is demonstrated herein to obtain specific information related to prediction and modeling of blade-casing interactions. Experiments are designed to allow insertion of a segment of engine casing into the path of single-bladed or multiple-bladed disks. In the current facility configuration, a 90deg sector of a representative engine casing is forced to rub the tip of a single-bladed compressor disk for a selected number of rubs with predetermined blade incursion into the casing at rotational speeds in the vicinity of 20,000rpm.
Fluid Dynamics and Performance of Partially and Fully Shrouded Axial Turbines
Authors: Porreca L. , Behr T. , Schlienger J. , Kalfas A. I. , Abhari R. S. , Ehrhard J. , Janke E.
Published: September 2005

A unique comparative experimental and numerical investigation carried out on two test cases with shroud configurations, differing only in the labyrinth seal path, is presented in this paper. The blade geometry and tip clearance are identical in the two test cases. The geometries under investigation are representative of an axial turbine with a full and partial shroud, respectively. Global performance and flow field data were acquired and analyzed. Computational simulations were carried out to complement the investigation and to facilitate the analysis of the steady and unsteady flow measurements. A detailed comparison between the two test cases is presented in terms of flow field analysis and performance evaluation. The analysis focuses on the flow effects reflected on the overall performance in a multi-stage environment. Strong interaction between the cavity flow and the blade tip region of the rotor blades is observed up to the blade midspan. A marked effect of this interaction can be seen in the downstream second stator where different vortex structures are observed. Moreover, in the partial shroud test case, a strong tip leakage vortex is developed from the first rotor and transported through the downstream blade row. A measurable change in the second stage efficiency was observed between the two test cases. In low aspect ratio blades within a multi-stage environment, small changes in the cavity geometry can have a significant effect on the mainstream flow. The present analysis has shown that an integrated and matched blade-shroud aerodynamic design has to be adopted to reach optimal performances. The additional losses resulting from small variations of the sealing geometry could result in a gain of up to one point in the overall stage efficiency.
Pump Performance Improvement by Restraining Back Flow in Screw-Type Centrifugal Pump
Authors: Tatebayashi Yasushi , Tanaka Kazuhiro , Kobayashi Toshio
Published: September 2005

The authors have been investigating the various characteristics of screw-type centrifugal pumps, such as pressure fluctuations in impellers, flow patterns in volute casings, and pump performance in air-water two-phase flow conditions. During these investigations, numerical results of our investigations made it clear that three back flow regions existed in this type of pump. Among these, the back flow from the volute casing toward the impeller outlet was the most influential on the pump performance. Thus the most important factor to achieve higher pump performance was to reduce the influence of this back flow. One simple method was proposed to obtain the restraint of back flow and so as to improve the pump performance. This method was to set up a ringlike wall at the suction cover casing between the impeller outlet and the volute casing. Its effects on the flow pattern and the pump performance have been discussed and clarified to compare the calculated results with experimental results done under two conditions, namely, one with and one without this ring-type wall. The influence of wall’s height on the pump head was investigated by numerical simulations. In addition, the difference due to the wall’s effect was clarified to compare its effects on two kinds of volute casing. From the results obtained it can be said that restraining the back flow of such pumps was very important to achieve higher pump performance. Furthermore, another method was suggested to restrain back flow effectively. This method was to attach a wall at the trailing edge of impeller. This method was very useful for avoiding the congestion of solids because this wall was smaller than that used in the first method. The influence of these factors on the pump performance was also discussed by comparing simulated calculations with actual experiments.
The Impact of Blade-to-Blade Flow Variability on Turbine Blade Cooling Performance
Authors: Sidwell Vince , Darmofal David
Published: September 2005

The focus of this paper is the impact of manufacturing variability on turbine blade cooling flow and, subsequently, its impact on oxidation life. A simplified flow network model of the cooling air supply system and a row of blades is proposed. Using this simplified model, the controlling parameters which affect the distribution of cooling flow in a blade row are identified. Small changes in the blade flow tolerances (prior to assembly of the blades into a row) are shown to have a significant impact on the minimum flow observed in a row of blades resulting in substantial increases in the life of a blade row. A selective assembly method is described in which blades are classified into a low-flow and a high-flow group based on passage flow capability (effective areas) in life-limiting regions and assembled into rows from within the groups. Since assembling rows from only high-flow blades is equivalent to raising the low-flow tolerance limit, high-flow blade rows will have the same improvements in minimum flow and life that would result from more stringent tolerances. Furthermore, low-flow blade rows are shown to have minimum blade flows which are the same or somewhat better than a low-flow blade that is isolated in a row of otherwise higher-flowing blades. As a result, low-flow blade rows are shown to have lives that are no worse than random assembly from the full population. Using a higher fidelity model for the auxiliary air system of an existing jet engine, the impact of selective assembly on minimum blade flow and life of a row is estimated and shown to be in qualitative and quantitative agreement with the simplified model analysis.
Residue Phenomenon and Its Theoretical Implications
Authors: Schouten J. F.
Published: September 2005

A historical survey is given of the residue, both of its phenomenological properties and its implications with respect to the theory of subjective sound analysis and pitch perception. Recently published systematic investigations of the sound spectra exhibiting the residue phenomenon and of the various properties of the observed residue provide a powerful test of theoretical speculations. It must now be considered certain that the place theory in its original simple form has to be revised with respect to the attribution of pitch to stimulation of a particular area of the basilar membrane. A mechanism must exist at or beyond each area of the basilar membrane that attributes different pitches to different wave forms stimulating that area.