bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Low Dose Low Molecular Weight Heparin in the Treatment of Cutaneous Lichen Planus
Authors: Khan MSI , Uddin MN , Shah MOR , Khondker L , Hasan MS
Published: April 2014

Introduction: Lichen planus is a common pruritic, inflammatory disease of the skin, mucous membranes, nail and hair follicles. Low dose low molecular weight heparin is administered in the treatment of cutaneous lichen planus. Objective: The objective is to evaluate the efficacy of low dose low molecular weight heparin in the treatment of cutaneous lichen planus. Materials and Methods: An interventional study was carried out in the department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka. Total thirty seven patients of cutaneous lichen planus were selected by purposive type non-probability sampling technique. Data were collected by face to face interview and clinical examination. Results: It was observed that before treatment, the score of cutaneous lichen planus lesion was 6.83 ± 1.30 and after treatment was 3.83 ± 1.18 and t test was found statistically significant (P<0.05). Improvement was shown in 26 (70.27%) cases. Out of these, response was good in 23 (88.46%), fair in 2 (7.69%) and poor in 1 (3.85%) cases. Conclusion: The study revealed that low dose low molecular weight heparin has remarkable efficacy profile as treatment option for cutaneous lichen planus. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18717 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 2-7
Economic Burden of Type 2 Diabetes Mellitus among the Patients Attending Combined Military Hospital, Dhaka
Authors: Rahman MZ , Islam MZ , Alam MJ , Sajjad S , Ara R , Al-Azad MAS , Kabir MA
Published: April 2014

Introduction: Diabetes Mellitus (DM) is a major concern for the developed as well as developing countries. It poses with enormous disabilities and economic burden to the victims. The treatment cost of diabetes is increasing day by day. Aim: To ascertain how type 2 diabetes mellitus is incurring economic burden to the patients. Materials and Methods: This descriptive cross sectional study was conducted during the period from January to June 2010 on 110 type 2 diabetes mellitus patients attending Combined Military Hospital, Dhaka. The patients were selected conveniently and data were collected by face to face interview with the help of a semi-structured questionnaire. For estimation of economic burden, both direct and indirect treatment costs were calculated. Results: The study revealed that majority (36.4%) of the patients were in the age group of 46-55 years with the mean age of 53.65 (+10.44) years. Majority (60.0%) of them had lower monthly family income (Tk.5, 000-Tk.10, 000) and 36.4% of them lived in urban area. Most of the patients (90.9%) were under treatment with drug, diet control and physical exercise. Regarding sources of fund for treatment, 31.8% patients used their savings while 27.3% took loan, 20% got help from relatives and the remaining 20.9% got donation and sold wealth. Average treatment cost incurred by the patients was estimated to Tk. 5543.35 (+1273.29). Average direct treatment cost was estimated to Tk.2656.88 (+1367.23) of which average drug cost was Tk.653.36 (+476.36), investigation cost was Tk.596.73 (+375.56), travel cost Tk.530.31 (+795.46), attendant cost Tk.865.87 (+734.22) and consultation fee was Tk.244.48 (+167.22). Average indirect cost was calculated to Tk.3081.27 (+1275.91) which was only due to loss of income due to illness. Conclusion: The study findings will enable the health policy makers and health care providers at different levels to provide need based cost-effective health care services to reduce the economic burden of diabetes mellitus patients. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18718 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 8-13
A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL
Authors: Uddin MB , Ahmed MU , Haque MA , Hussain MD , Hossain SME
Published: April 2014

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19
Prevalence of Hearing Loss in Military Aviators: The Audiometry and Risk Factors Analysis
Authors: Alam MR , Wahab MA , Rahman MM , Asaduzzaman AKM , Al-Azad MAS , Karim MI , Sultana S
Published: April 2014

Introduction: Noise Induced Hearing Loss (NIHL) is an occupational health hazard linked with noise exposure of more than 85 dB. Aircraft noise and other occupational noise exposure cause military aviators more susceptible to NIHL than commercial jet pilots. Aim: To find out the prevalence of noise induced hearing loss among different military aircrew population with special emphasis on identifying the associated risk factors. Materials and Methods: This cross sectional study was conducted on Kuwait Air force pilots those who came for annual medical checkup from July 2010 to July 2012. Audiometry of all subjects was done by ENT specialist and necessary data were collected by structured questionnaires. All data were analyzed by SPSS (Statistical Package for the Social Sciences) version 17.0 Results: Out of 221 aircrew 32 (14.48%) developed NIHL. Hearing loss was mild to moderate and predominately at high frequencies. Most affected group was helicopter pilots. Pilots of more than 40 years of age and those who had more than 1000 flying hours had mean hearing threshold more than other groups. The right ear was affected in majority of cases than left ear. Conclusion: Noise exposure to aircrew is inevitable so hearing loss prevention strategies might play a pivotal role to save aircrew hearing. Active surveillance of hearing protection practices might have beneficiary effect. Steps can be taken for early detection of NIHL and hearing conservation program. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18721 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 19-24
Character and High Risk Behaviour of Drug Addicts for Spreading Hepatitis B and HIV Infection in a Selected Area of Dhaka City
Authors: Hakim M , Ahmad M , Naher S , Ali M , Ahmed MU
Published: April 2014

Introduction: The number of drug abusers is increasing in an alarming state in Bangladesh and they are identified as high risk group for developing Hepatitis B and HIV. Objectives: The aim of this study was to find out various information about drug addicts and their behavioural pattern which can guide the future developmental strategies and planning for reduction of spreading hepatitis B and HIV among the vulnerable population. Methods: This descriptive type of cross sectional study was performed during July 2006 to June 2007 in three different drug addiction treatment clinic in Uttara, Dhaka on high risk behaviour of drug addicts . A total 194 Drug addicts were interviewed individually by using a structured questionnaire. The questionnaire was filled up by the author during interview. All the data were checked and edited after collection on the spot. Compilation and subsequent tabulation were done manually. Simple technique of data analysis for percentage, average, standard deviations etc. were done with scientific calculator and using SPSS 11. Results: Out of 194 cases 180 (92.78%) were male and 114(58.76%) were unmarried. Most of them 118(60.82%) were within the age group of 20 to 29 years. They have an average family income of 12456.39 Taka per month. Most of the addicts 73(37.63%) were students.Average family size of drug addicts were 6.73 and majority of them 148(76.29%) resided with parents. Only 16(8.24%) drug addicts expressed quarrelsome relationship among their parents and 21(10.83%) stated a bad relationship with other family members. Of them 86(44.33%) started to have taking drug at an age range between 20 to 29 years and most of them 156(80.41%) used poly drug.Heroin 161(82.99%) ranked top as abused drug. Most of them 143(73.71%) were influenced by their friends for initiation of drug addiction. The average daily expense for drug was 191.13 Taka per day and most of them 142(73.19%) had frequency of drug abuse more than once daily. Only 20(10.31%) were found as Intravenous Drug Users (IDU); 16(80%) of the IDUs shared same syringe/needle.Among all the addicts 6(3.09%) were professional blood donor and among the IDU 4(20%) were professional blood donors. 139(71.65%) had history of sex without condom. 82(42.27%) were unaware about high risk behaviour due to lack of adequate knowledge. 185(95.36%) used to procure drug from black market. 5(25%) of IDU and 2(1.15%) of non IDU were found to be Hepatitis B positive though no HIV positive case was found. Conclusion: Wide spread motivation of the drug addicts and nationwide publicity regarding the ill effects of their high risk behaviour are needed to combat the spread of Hepatitis B/ HIV. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18723 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 35-42
Assessment of Reversal Pattern of Neuromuscular Blockade: A Comparative Study Between Clinical and Instrumental Methods
Authors: Azad AK , Ahsan MN , Tauhid-ul-Mulk M , Rahman MA
Published: April 2014

Introduction: Delayed reverse from the effect of neuromuscular blockade and from the effect of anaesthesia is a concern among anaesthesiologists. Objectives: Objectives of the study were to compare reversal pattern of neuromuscular blockade by clinical and instrumental methods and to elicit reliable clinical parameters. Methods: This prospective study was carried out in CMH, Dhaka among 50 adult patients and reversal pattern of neuromuscular blockade was evaluated by clinical and instrumental methods among pancuronium group(Group-I) and rocuronium group(Group-II). All data were collected in data collection sheet and were compiled and analyzed by Studentst test. Results: Clinical assessment was carried out by bedside test for muscular function & instrumental assessment was carried out by nerve stimulator and Train of Four (TOF). In pancuronium group (Gp-I) clinically patient was reversed on average (6.19 ± 2.04 min) (mean±SD, n=25) earlier than instrumental method of which tidal volume was found less reliable. But in rocuronium group (Gp-II) instrumentally patient was reversed average (12.56 ± 3.41 min) (mean±SD, n=25) earlier than clinical method of assessing reversal, here also tidal volume was found less reliable among clinical variables. Conclusion: The study revealed that tidal volume is the less reliable among the clinical variables. In Group-I clinical reversal criteria for neuromuscular blockade were fulfilled earlier than that of instrumental method but in Group-II instrumental criteria were fulfilled earlier than clinical method. We should combine 2 or 3 clinical criteria for adequate reversal from neuromuscular blockade. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18725 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 43-48
A Study on Histomorphological Spectrum of Childhood Malignant Tumour: Evaluation of 60 Cases at Different Center in Dhaka City
Authors: Karim MI , Ali SM , Akhter S , Islam SMJ , Karim MM , Alam MR
Published: April 2014

Introduction: About 2% of all malignant tumours occur in infancy and childhood. Malignancy is the second common cause of childhood death in developed world, accounting for 10 - 12.3% of all childhood deaths. Eighty eight percent of worlds children live in developing countries, where access to adequate care is limited. Incidence of childhood cancer is increasing in this region gradually. Objectives: The objective of this study was to find out the histomorphological pattern of childhood cancers in our country and assess the trends of malignancies in different age group. Methods: This prospective study was carried out from January 2008 to January 2012. During this period data was analyzed for the malignancies occurring in the age group 0-14 years. Data was categorized according to incidence of paediatric malignancies in different age groups, sex and types of tumours. All the children below 15 years with confirmed diagnosis of cancer by means of histopathological examinations were included in this study. Results: Total 3120 patients were diagnosed as having malignancies at Armed Forces Institute of Pathology (AFIP), Delta Hospital Ltd & Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, out of which 60 cases were paediatric malignant tumours. Overall incidence of paediatric tumour was 1.92%. Out of which 26 cases (43.33%) were female and 34 (56.66%) cases male. The male - female ratio was 1.3:1. Males were more affected than females. The peak incidence of paediatric tumors (37%) was found in children between the age group 10 to 14 yrs. The pattern of childhood tumours shows wide variation among the age groups. In this study, at 0-4 yrs age group small round cell tumours (Neuroblastoma, Retinoblastoma), 5-9 yrs germ cell tumour, 10-14 yrs bone tumour (Ewing sarcoma, Osteosarcoma) were the commonest tumour. Conclusion: We conclude that there are certain notable differences between tumours of our study and those reported from other parts of the world. In our study small round cell tumor is most frequent childhood tumour. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18727 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 57-62
Trends in Covering Different Aspects of Anatomy in Written Undergraduate MBBS Course
Authors: Ayub M , Habib MA , Huq AKMF , Manara A , Begum N , Hossain S
Published: April 2014

Introduction: Rapid advancement of biomedical knowledge along with consistent increase in technical facilities in medical science changes the teaching-learning processes of undergraduate medical course in many countries and Anatomy is no exception. Some of these changes have been incorporated into the undergraduate medical course in Bangladesh and some are yet to be incorporated. In this situation, a thorough understanding is required to know how different aspects of Anatomy are distributed in terms of weightage in the written assessment of Anatomy course, which indirectly influence the learning of the course. To have an insight regarding this, thorough analyses of recent question papers of two universities were done in this study. Objectives: Analyses of question papers give a clue about the variation in the distribution of weightage in different aspects of Anatomy in the undergraduate written exams (due to absence) in terms of allocation of proper weightage in the curriculum. Study design: A descriptive, observational study involving quantitative analysis. Place and period of study: Anatomy Department of AFMC from March 2012 to August 2012. Materials and Methods: The study includes analysis of 28 short answer question papers and 23 multiple choice question papers of two universities in Dhaka. This is a quantitative study and means of percentage value were calculated by using SPSS program for analyzing the question paper. Results: It is observed from the analyses that Topographic Anatomy got maximum coverage (40-89%) and aspects like Genetics, Radiographic Anatomy and Surface was covered less than 3% (absent in some question papers) of the question papers. The result of the present study will help in improvement of present written assessment system of the undergraduate Anatomy course. Conclusion: From result and analysis it is evident that the present assessment system needs to give proper weightage to different aspects of Anatomy to make the assessment more valid, objective and reliable. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18729Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 75-83
Zinc Supplementation Reduces Recurrent Acute Lower Respiratory Infection (ALRI)
Authors: Akhtar K , Chowdhury RB , Sultana M , Yasmeen S
Published: April 2014

Introduction: Pneumonia is a frequent and serious human illness. In Bangladesh, Acute Lower Respiratory Infection (ALRI) is a major cause of death among young children. Childhood mortality can be reduced by 50% with detection and early treatment of illness with antibiotics and immunization. Zinc plays an important role in the optimal function of the immune system by reducing the risk, severity and duration of infectious diseases. Zinc supplementation improves health and cell mediated immunity. Objectives: This study is aimed at documenting effect of zinc supplementation in preschool children on reducing ALRI. Methods: This was a double blind random control trial interventional study among180 child, conducted at Comilla CMH, from January 2010 to December 2011. The children aged 6-60 months were selected randomly for comparison of effect of Zinc and Vitamin B-Complex on ALRI. Results: In the study population, male to female ratio was 1.05:1. Baseline average age was 32 months and weight for height was 92% Of NCHS mean. It was found that 89% children completed immunization as per EPI schedule, the rest 11% were partially immunized. Twenty nine percent children had family history of Atopy. This study showed 15 episodes of ALRI in Zinc group in the control B-Complex group (1.09episodes/child/year) during the six months follow-up. There was no association of ALRI with sex. The male female ratio in this respect was 1.07:1. In this study there was statistically significant and clinically important (67%) reduction of episodes of ALRI in oral Zinc supplement group. Conclusion: This finding strongly suggests that oral supplement of Zinc reduces episodes of ALRI in children. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18736 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 84-89
Incidence and Outcome of Low Birth Weight Neonates in Combined Military Hospital Chittagong
Authors: Sultana M , Chowdhury RB , Hafiz SAMMA , Aktar K , Jannat F
Published: April 2014

Introduction: Incidence of low birth weight (LBW) neonates is high in the developing countries. In Bangladesh LBW accounts for one of the leading causes of less than 5 years children mortality. Long term follow up is required to reduce morbidity. Objectives: To evaluate the incidence and outcome of low birth weight neonates in a hospital set up. Methods: This prospective observational study was carried out on 67 low birth weight neonates admitted in the neonatal ICU of Combined Military Hospital (CMH) Chittagong over a period of one year. All the date was recorded in a questionnaire. Study group was regularly followed up to know outcome. Results: Out of 282 total neonatal admissions 67 (23.76%) was LBW. Thirty eight (57.71%) were preterm and 29 (43.28%) were term but small for date. Male 37 (55.22%) predominated female 30 (44.77%). Thirty one (81.57%) of preterm and 21 (72.41%) of small for gestational age (SGA) neonates had normal growth & psychomotor development. Out of 9 patients 3 (7.89%) of preterm & 6 (20.68%) of SGA neonates had developmental delay in various aspects of developmental milestones which was observed in the follow up period of this study. Four (5.97%) died in this study & one preterm neonates developed retinopathy of prematurity. Conclusion: Early follow up can find out cases with developmental delay. Early intervention can reduce morbidity. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18738 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 98-104
Role of Per Operative Use of Intravenous Magnesium in Reducing the Incidence of Per and Post Operative Arrhythmias in Conventional Coronary Artery Bypass Graft Surgery
Authors: Alam MMU , Ahsan MN , Rahman MMM , Khan M , Hossain MM , Tauhid-Ul-Mulk M , Sultana MS
Published: April 2014

Introduction: Arrhythmias are not uncommon after Coronary Artery Bypass Graft (CABG) surgery. There is increasing evidence that Magnesium, the important intracellular cation plays a crucial role in preventing and terminating cardiac arrhythmias. Objectives: The aim of this study was to establish the role of peroperative use of intravenous Magnesium in reducing the incidence of per and postoperative arrhythmias in CABG surgery. Materials and methods: A total sixty (Group-I 30 and Group-II 30) patients of both sexes and different ages undergoing conventional CABG surgery under general anesthesia in CMH Dhaka from January 2009 to December 2011 were selected randomly. After induction, Group-I received 2 gm of Magnesium in 100 ml normal saline intravenously over a period of 30 minutes and Group-II received no Magnesium. Parameters recorded per and postoperatively were- aortic cross clamp time, Cardio Pulmonary Bypass (CPB) time, total surgery time, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and blood sample were collected on arrival to Cardiac Intensive Care Unit (CICU) and after 6, 12, and 24 hours. Results were expressed as mean ± SD (Standard Deviation) or in frequencies (percentage) as applicable. The results were analyzed by Students t test. Results: Magnesium levels were significantly (p<0.05) low in Group-II patients than that of Group-I. In Group-II patients, the fluctuations of HR, SBP and DBP were significantly (p<0.05) more than that of Group-I. In Group-I patients incidence of arrhythmias were significantly (p<0.05) less than that of Group-II. Conclusion: Low serum Magnesium levels are a frequent finding after conventional CABG surgery. This acute loss of Magnesium has been suggested as an etiology of many per and postoperative arrhythmias. This study revealed that peroperative administration of Magnesium provided a significant reduction in arrhythmias per and postoperatively. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18739 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 105-114
Intracranial Haemorrhage due to Minor Trauma in a Patient with Idiopathic Thrombocytopenic Purpura- A Case Report
Authors: Chowdhury RU , Hamid S , Islam MT , Bhuiyan MN
Published: April 2014

Introduction: Intracranial haemorrhage (ICH) is a rare but the most dangerous complication of idiopathic thrombocytopenic purpura (ITP) which is usually fatal. ITP is caused by autoantibodies to platelet which can be demonstrated in plasma. Case-Report: A 32 years old male patient sustained minor trauma around his head, following which he developed features of raised intracranial pressure including headache, vomiting and loss of consciousness. On examination Glasgow Coma Scale was 7/15 (E2, M3, V2), left pupil was moderately dilated, there was bilateral papilloedema and haemorrhagic spots on the left sided retina. CT scan of the head showed significant intracranial haemorrhage. Laboratory investigation showed anaemia and thrombocytopenia with platelet count 40X109/L. All the relevant causes of thrombocytopenia were excluded and the diagnosis of ITP was established. Intracranial haemorrhage was managed conservatively without surgical intervention. ITP was managed with splenectomy on 12th day following a period of therapy with steroids, transfusion of packed cell and platelet concentrates. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18740 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 115-117
Anaesthetic Challenge in Undiagnosed Mitral Valvular Disease in Emergency Lower Segment Caesarean Section in a Secondary Level Hospital  A Case Report
Authors: Karim ME , Akhter S , Yasin MM
Published: April 2014

Although the incidence of Rheumatic Mitral Stenosis is grossly reduced in Indian subcontinent, it occupies a greater segment among heart diseases complicating pregnancy. A 25 years old lady, who was not known as a case of valvular heart disease, was admitted in a secondary level hospital for emergency lower segment caesarean section. The patient developed severe pulmonary oedema during operation which was managed successfully. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18741 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 118-121
Can peptide receptor radionuclide therapy be safely applied in florid bone metastases?
Authors: Sabet A. , Khalaf F. , Yong-Hing C. J. , Sabet A. , Haslerud T. , Ahmadzadehfar H. , Guhlke S. , Grünwald F. , Biersack H.-J. , Ezziddin S.
Published: April 2014

Aim: Highly advanced metastatic bone disease with extensive osseous infiltration of neuroendocrine tumours (NET) may preclude patients from treatment with peptide receptor radionuclide therapy (PRRT) in concern about haematotoxicity. This study aims to assess the safety and efficacy of PRRT with 177Lu-octreotate in a patient cohort with this condition. Patients, methods: 41 PRRT courses were performed in 11 patients with gastroenteropancreatic neuroendocrine tumours (GEP-NET) and florid bone metastases (severely advanced widespread metastatic bone disease). A mean activity of 6.95 GBq 177Lu-octreotate was administered per treatment cycle, aimed at four courses with standard intervals of 3 months. Haematological parameters were determined prior to each treatment course, in 2-4 weeks intervals between the courses, 8-12 weeks after the last course of PRRT and in 3 monthly intervals thereafter. Toxicity was recorded using Common Terminology Criteria for Adverse Events v3.0. Restaging was performed 3 months after termination of PRRT with CT/MRI and functional imaging (modified MDA criteria). Results: Significant (grade III-IV), reversible haematotoxicity occurred in 4 (35%) patients and after 10 (24%) administrations. It either resolved spontaneously (1 patient) or was controlled by supportive measures (3 patients), such as blood transfusions (3 patients) or deferral of the subsequent therapy cycle (1 patient). Patients returned to baseline blood values within up to 23 months after termination of PRRT. The observed treatment response of bone metastases consisted of a partial response in 2, a minor response in 1, stable disease in 7, and progressive disease in 1 patient. Of the 4 patients with metastatic bone pain, 1 experienced complete and 3 partial resolution of symptoms within 3-10 weeks after commencement of PRRT. Conclusion: These preliminary data indicate that PRRT with 177Lu-octreotate can be safely applied even in florid bone metastases with extensive, severely advanced osseous replacement. The higher myelosuppression rate was not associated with serious complications and should not preclude patients from being treated and potentially experiencing remarkable treatment efficacy despite the very advanced stage.
Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization
Authors: Sabet A. , Ahmadzadehfar H. , Bruhman J. , Sabet A. , Meyer C. , Wasmuth J.-C. , Pieper C.-C. , Biersack H.-J. , Ezziddin S.
Published: April 2014

Aim: This retrospective study aims to evaluate the predictive value of FDG PET/CT in patients with unresectable hepatocellular carcinoma (HCC) undergoing radioembolization with yttrium-90 labeled microspheres (RE). Patients, methods: The study cohort comprised 33 patients who were treated with RE at our institution and underwent FDG PET/CT at baseline and four weeks after radioembolization. According to the baseline FDG metabolic status of the HCC lesions, patients were divided into two groups: FDG-negative (n = 12) and FDG-positive (n = 21) HCC. FDG-positive patients were further divided into early metabolic responders and non-re- sponders according to the relative change in SUVmax of the treated lesions. Survival analyses were performed with the Kaplan-Meier method (log-rank test, p < 0.05). Multivariate analysis was performed to assess the influence of prognostic factors on overall survival (OS). Results: FDG-negative patients had a significantly longer OS (13 months, 95%CI 7-19) than FDG-positive patients (9 months, 95%CI 7-11; p = 0.010). Among FDG- positive patients, metabolic responders survived significantly longer than metabolic non- responders (10 months, 95%CI 8-12 vs. 5 months, 95%CI 4-6; p = 0.003). From the other baseline factors (including performance status, hepatic tumour burden, presence of extra-hepatic disease, administered activity) only the BCLC stage had a significant impact on OS (p = 0.028). Conclusion: Pre- and post- therapeutic FDG PET independently predicts overall survival in patients with HCC undergoing radioembolization. Interestingly, early metabolic response seems to be assessable as early as four weeks post-treatment.
Genetic structure within the Mesoamerican gene pool of wild Phaseolus lunatus (Fabaceae) from Mexico as revealed by microsatellite markers: Implications for conservation and the domestication of the species
Authors: Martínez‐Castillo Jaime , Camacho‐Pérez Luciana , Villanueva‐Viramontes Sara , Andueza‐Noh Rubén H. , Chacón‐Sánchez María I.
Published: April 2014

• Premise of the study: Understanding genetic structure in wild relatives of a crop is important for crop improvement and conservation. Recently, two gene pools (MI and MII) were reported in wild Lima bean (Phaseolus lunatus) from Mexico, a domestication center of Mesoamerican landraces. However, the evidence was based on limited genomic sampling. Here we sought to confirm the existence of these two gene pools by increased genome and population sampling.

• Methods: We characterized 67 wild populations of P. lunatus from Mexico with 10 microsatellite loci and studied the genetic structure by means of AMOVA, cluster analyses, assignment tests, and a georeferenced map.

• Key results: AMOVA indicated that most of the variation is found among populations (77%) rather than within populations (23%). Assignment tests were key to confirm not only the presence of the two gene pools (MI and MII) in Mexico, but also to propose the possible existence of two subgroups within MI (MIa and MIb). While MI and MII are mainly divergent geographically, MIa and MIb overlap in their distribution. Admixed individuals, which may represent cases of gene flow among gene pools, were detected.

• Conclusions: Our results show that the genetic structure of wild Lima bean in Mexico is more complex than previously thought and propose the presence of three gene pools (MIa, MIb, and MII), each one possessing relatively high levels of genetic diversity. We still need additional evidence, however, to confirm without doubt the split of the gene pool MI into subgroups MIa and MIb.
A convenient enantioselective decarboxylative aldol reaction to access chiral α-hydroxy esters using β-keto acids
Authors: Duan Zhiqiang , Han Jianlin , Qian Ping , Zhang Zirui , Wang Yi , Pan Yi
Published: April 2014

We show a convenient decarboxylative aldol process using a scandium catalyst and a PYBOX ligand to generate a series of highly functionalized chiral α-hydroxy esters. The protocol tolerates a broad range of β-keto acids with inactivated aromatic and aliphatic α-keto esters. The possible mechanism is rationalized.
AN APPROACH TO MULTIPLE ATTRIBUTE DECISION MAKING BASED ON THE INDUCED CHOQUET INTEGRAL WITH FUZZY NUMBER INTUITIONISTIC FUZZY INFORMATION
Authors: Wei Guiwu , Lin Rui , Zhao Xiaofei , Wang Hongjun
Published: April 2014

In this paper, we investigate the multiple attribute decision making problems with fuzzy number intuitionistic fuzzy information. Firstly, some operational laws of fuzzy number intuitionistic fuzzy values, score function and accuracy function of fuzzy number intuitionistic fuzzy values are introduced. Then, we have developed two fuzzy number intuitionistic fuzzy Choquet integral aggregation operators: induced fuzzy number intuitionistic fuzzy choquet ordered averaging (IFNIFCOA) operator and induced fuzzy number intuitionistic fuzzy choquet ordered geometric (IFNIFCOG) operator. The prominent characteristic of the operators is that they can not only consider the importance of the elements or their ordered positions, but also reflect the correlation among the elements or their ordered positions. We have studied some desirable properties of the IFNIFCOA and IFNIFCOG operators, such as commutativity, idempotency and monotonicity, and applied the IFNIFCOA and IFNIFCOGM operators to multiple attribute decision making with fuzzy number intuitionistic fuzzy information. Finally an illustrative example has been given to show the developed method.
INNOVATION STIMULANTS, INNOVATION CAPACITY, AND THE PERFORMANCE OF CAPITAL PROJECTS
Authors: Chen Hong Long
Published: April 2014

Abstract. Identifying the critical determinants of innovation performance is crucial. However, few studies explore and quantify systematically the relationships between innovation factors and the performance of capital projects. This study of 121 capital projects shows that the relationships among project innovation stimulants, innovation capacity, and project performance are indeed significant. Hierarchical robust regression analyses using a maximum R-square improvement procedure show that technology management has the highest effect on the variation in our project performance data. Validating out-of-sample data demonstrates that our optimal model explains 34.42% of the variation in the performance of capital projects. Ultimately, our findings suggest that project human factors are essential stimulants in innovation performance, which in turn affect the performance of capital projects. Our findings also reveal that the stimulant factors do not have a direct impact on capital project performance, but rather have an indirect impact via project innovation capacity.
PROCESSUAL ANTECEDENTS OF PERCEIVED CHANNEL CONFLICT IN FRANCHISING
Authors: Weaven Scott K. , Grace Debra A. , Frazer Lorelle , Giddings Jeffery
Published: April 2014

In this study, we develop and examine the network of relationships explaining perceived conflict in franchise relationships from a franchisee perspective. Our research contributes to the current knowledge of asymmetric exchange relationships through demonstrating the importance of a franchisee's expectations confirmation, relational trust and relationship satisfaction in franchisee assessments of network conflict. The goal of this paper is to empirically examine (1) the relationship between franchisee perceptions of information quality (information dissemination and information search) and the confirmation of franchisee performance expectations, (2) franchisee characterizations of their relationships with their franchisors in terms of relational sentiments such as trust and relational satisfaction, communication and conflict management, (3) the relationship between franchisee satisfaction and perceived conflict, and (4) the moderating effect of franchisee experience on the relationship between franchisee satisfaction and franchisee perceptions of conflict. Empirical results, utilizing a sample of 345 franchisees in Australia, present strong evidence for the support of nine of the ten hypotheses drawn from the conceptual model. Specifically, data reveal that in an effort to cultivate a network of cooperative and satisfied franchisees, franchisors should adopt strategies that promote the timely dissemination of relevant and meaningful pre- and post-entry information, open communication exchange, transparent conflict management systems and personalized support in accommodating individual franchisee needs.
USING QSPM AND WASPAS METHODS FOR DETERMINING OUTSOURCING STRATEGIES
Authors: Lashgari Shima , Antuchevičienė Jurgita
Published: April 2014

The aim of the current study is to select the best strategies for outsourcing development, applying decision-making tools that enable to make reasoned decision. To evaluate outsourcing strategies, a new model of Comprehensive Framework for Strategy Formulation and Selection is presented. Development of outsourcing of healthcare services in Tehran is analysed in the paper. Strengths, Weaknesses, Opportunities, and Threats analysis is used to evaluate the internal and external factors affecting the outsourcing of healthcare services in health deputy of the Tehran University of Medical Sciences in different aspects and to develop several possible outsourcing strategies. Quantitative Strategic Planning Matrix is applied for quantitative evaluation of strategies. It is proposed to validate the approach by applying Multiple Criteria Decision Making methods. Robust and accurate Weighted Aggregated Sum Product Assessment method is selected and applied for quantitative evaluation of strategies. Based on the consistency of the results of the both approaches, the five best strategies to develop healthcare services outsourcing are offered.
Sensibilité maternelle et sécurité de l'attachement de l'enfant au sein d'une population à haut risque psychosocial
Authors: Matos Inês , Tereno Susana , Wendland Jaqueline , Guédeney Nicole , Dugravier Romain , Greacen Tim , Saïas Thomas , Tubach Florence , Guédeney Antoine
Published: April 2014

La qualité des interactions précoces et la sensibilité du parent aux signaux de son enfant sont des facteurs fondamentaux pour la sécurité de l’attachement chez l’enfant. Cette recherche visait à étudier la sensibilité maternelle et l’attachement de l’enfant dans un échantillon à haut risque psychosocial, constitué de 46 dyades mère-bébé. Les dyades ont été évaluées lorsque les bébés avaient entre douze et dix-sept mois. L’attachement des enfants a été évalué à travers le paradigme de la Situation Etrange (Ainsworth, et al. , 1978), alors que la sensibilité maternelle a été examinée à travers l’analyse vidéo de trois situations d’interaction mère-enfant, en utilisant les échelles de Sensibilité Maternelle d’Ainsworth, et al. , (1974). Les résultats mettent en évidence l’impact de la sensibilité maternelle dans l’établissement d’un attachement sécure ou insécure chez l’enfant. Toutefois, en ce qui concerne la désorganisation de l’attachement, d’autres facteurs que la sensibilité maternelle semblent être en jeu car, dans la présente étude, ces deux facteurs n’apparaissent pas directement associés.
L'enfant, sa famille et la santé publique : une fable périlleuse ?
Authors: Delawarde Cécile , Briffault Xavier , Saïas Thomas
Published: April 2014

Ces dernières décennies, le développement de la prévention et de la promotion en santé mentale en France s’est accompagné de la volonté des pouvoirs publics d’investir dans des programmes de « promotion des compétences parentales » . Ce nouveau mode d’aide à la parentalité, issu de pays anglo-saxons, engendre d’intenses polémiques opposant un discours de santé publique à celui d’une partie significative d’acteurs de terrain. Ce travail de recherche vise à prendre en considération les différentes conceptions d’acteurs spécialisés dans l’aide à la parentalité afin de mieux appréhender ce qui les oppose. Des observations de terrain ont été effectuées dans des instances de santé publique et une dizaine d’acteurs ont été interrogés par le biais d’entretiens. Les résultats mettent en valeur trois conceptions anthropologique, sociopolitique et interventionnelle distinctes de l’aide à la parentalité.
Visites à domicile préventives périnatales dans les familles à problèmes multiples : efficacité et limites
Authors: Le Foll Julie , Guédeney Antoine
Published: April 2014

Les visites à domicile préventives périnatales représentent un outil puissant et efficace, notamment pour accéder aux familles les plus vulnérables. Ces familles, qui accumulent des difficultés psychosociales multiples, utilisent peu les lieux médico-sociaux mis à leur disposition et se retrouvent plus à risque de développer des troubles précoces de la relation parent-enfant ainsi qu’une psychopathologie ultérieure. Cet article repose sur une revue de la littérature du travail à domicile en périnatalité, en France et à l’étranger. Notre objectif est à la fois de mieux décrire cette pratique, encore peu formalisée au sein des institutions, mais aussi d’en étudier l’efficacité et les limites.
Introduction : Les nouveaux mondes des migrations et des territoires
Authors: Lacour Claude , Angeon Valérie
Published: April 2014

Cet article sert d’introduction générale au numéro spécial issu du colloque de l’ASRDLF tenu en Martinique en 2011. Il explique les raisons qui conduisent à penser que l’attention aux phénomènes migratoires revient d’actualité alors que les migrations internationales ou sur de longues distances constituent une réalité profonde et permanente. Les guerres, la pauvreté, les conflits ethniques, les changements climatiques ont largement conditionné les modes d’occupation de l’espace, ont structuré les modes de vie, la recherche d’emploi et de revenus etc. L’actualité tiendrait moins alors aux facteurs fondamentaux qu’à l’ampleur des mouvements, à la libéralisation des échanges, à la crise contemporaine et à l’affaiblissement de l’État-providence. Les territoires, tout particulièrement urbains, sont aussi de plus en plus concernés par les impératifs de l’efficacité, induisant des composantes nouvelles de brain drain et l’intensification de poches de pauvreté. Il est alors nécessaire de repenser les représentations des phénomènes migratoires et de les formaliser.
The Growth of U.S. Cities
Authors: Duranton Gilles
Published: April 2014

Cet article passe en revue les recherches récentes sur les déterminants de la croissance urbaine pour les villes américaines. Plusieurs moteurs importants ont été identifiés par la littérature: les routes, les aménités, le capital humain, les entrepreneurs et les effets d’agglomération, les contraintes sur le développement foncier et les chocs industriels. Les implications de ces résultats pour les politiques de développement local sont aussi discutées.
Savoir(s) et apprentissage : comment apprécier l'intelligence organisationnelle ?
Authors: Baujard Corinne
Published: April 2014

Dans un contexte où les entreprises sont soumises à des pertes de savoirs professionnels, la formation est confrontée à la transformation des environnements d’apprentissage. Ses dispositifs, plus ou moins formalisés, révèlent la difficulté de la transmission en raison de la nature tacite des enjeux. L’intelligence organisationnelle revêt aujourd’hui une dimension variable en raison de nombreux départs des salariés (retraites, démissions et licenciements). Comment la définir ? Comment repérer et opérationnaliser ce concept afin de mieux l’appréhender au sein des entreprises ? À partir d’une étude de cas exploratoire menée auprès d’un groupe international dans le secteur industriel, un cadre théorique en train de se réaliser est proposé pour transformer les décisions en problèmes scientifiques, expliciter les éléments et proposer des solutions. Si comprendre c’est inventer (Piaget, 1972), l’intelligence organisationnelle émerge selon une stabilisation de pratiques régulières entre des acteurs organisés. Dans ce contexte, la formation accueille de nouveaux espaces de savoirs professionnels avec une démarche propre qui mobilise l’action collective d’apprentissage.
Technological principles of the new German Concrete Standards
Authors: Bonzel J.
Published: April 2014

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How to avoid losses in drying and firing
Authors: Walley C. N.
Published: April 2014

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Influence of alkalis on the properties of cement and Portland cement clinker
Authors: Knöfel Dietbert
Published: April 2014

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Chemical control in the cement industry. Its importance
Authors: Jiménez Ortega Luis
Published: April 2014

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Standardization of cement. Notes and explanations on the revision of the German cement standard DIN 1164, June 1970
Authors: Wischers G.
Published: April 2014

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Importance of the Microscopy of the Clinker
Authors: Calleja J.
Published: April 2014

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Electron microscopy of clinker by the replica technique
Authors: KittI P. , Lyon P. , Führer X.
Published: April 2014

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On the setting and hardening of cements
Authors: Ludwig Udo
Published: April 2014

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Substituting complexometry for permanganimetry in lime evaluation in tests for puzolana
Authors: Pilar de Luxán M.
Published: April 2014

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Correct cement analysis by atomic absorbtion
Authors: Tenoutasse N. , De Donder A.
Published: April 2014

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Remarks on durability of carbonated and uncarbonated Portland cement under sulphate action. Infrared spectroscopy study
Authors: Vázquez Moreno T. , Fernández-Peña Secados O.
Published: April 2014

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Installation and working methods of a testing laboratory to establish a private control at the concrete plant (part 1)
Authors: Haarmann F. , Andernach -
Published: April 2014

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Concrete heat treatments
Authors: Barceló Rico-Avelló G.
Published: April 2014

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Measurement of concrete humidity
Authors: Hundt J. , Buschmann J.
Published: April 2014

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Fractographic clinker study by means of sweep electronic microscope (SEM). Preliminary results
Authors: KittI P. , Lyon P. , Marrapodi M. R.
Published: April 2014

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Winter concreting
Authors: Editorial Equipo
Published: April 2014

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Application of the Finite Piece Method to Simulate Viscoelastic Fluid Flows in L-Shaped Channel
Authors: Li Yong , Yang Zhou
Published: April 2014

The finite piece method is established to solve the flows of K-BKZ fluid in L-shaped channel. Numerical results are given to compare to the three-dimensional simulation using the finite element method (FEM). It is found that the results are highly consistent as a whole. The error of flow distribution is smaller than 2% at the outlet. There is a minor discrepancy of the pressure in the convergence region of channel but they are restricted to a small region. The present approach demonstrates its superiority over the conventional FEM for analyzing slit flow.
The Effect of Loading Path on Forming Results in Multi-Gripper Flexible Stretch Forming
Authors: Wang You , Li Ming Zhe , Liu Hong Wei
Published: April 2014

Multi-gripper flexible stretch forming (MGFSF) is a recent technological innovation of sheet metal flexible forming process. Straight jaws in traditional stretch forming machine are replaced by a pair of opposed clamping mechanisms which can move relative to each other. Taking the case of forming a sheet metal into spherical surface by stretching the sheet in two opposite directions, the finite element models of MGFSF under various loading paths were established and the effects on stretch amount, strain and thickness of the simulated parts were analyzed comparatively. It is founded that compared to the horizontal-tilting (HT) and horizontal-vertical (HV) loading paths, the horizontal-tilting-vertical (HTV) loading path would result in more uniform stretch amount, strain and thickness distributions also with lower strain and thickness reduction, which improves the forming quality significantly. Finite element simulations also revealed that the material flow state in the transition zone can be improved effectively and the local strain concentration can be greatly suppressed with reasonable loading path, which would decrease the possibility of material failure.