Refractory

pletely dry after AC and oBTX, respectively. The overall and individual scores of the OAB-SAT-q were significantly higher among patients treated with AC than with oBTX. The incidence of the de novo need to use clean intermittent catheterisation after oBTX and AC was two of 16 and four of 15, respectively. Conclusions: Both procedures are effective in improving the symptoms of OAB and of quality of life, but patients were more satisfied with AC than oBTX therapy.

ObjectivesIV cyclosporin A (CSA) is an effective therapy in patients with severe ulcerative colitis (UC). It remains unclear if this treatment affects the course of the disease in the long run. We investigated the long-term efficacy and safety in 86 patients with ulcerative colitis treated with IV CSA at our center.IV cyclosporin A (CSA) is an effective therapy in patients with severe ulcerative colitis (UC). It remains unclear if this treatment affects the course of the disease in the long run. We investigated the long-term efficacy and safety in 86 patients with ulcerative colitis treated with IV CSA at our center.MethodsThe records of all patients treated with IV CSA between 11/1992 and 11/2000 were reviewed.The records of all patients treated with IV CSA between 11/1992 and 11/2000 were reviewed.ResultsSeventy-two of 86 patients (83.7%) responded to IV CSA therapy, administered for a mean of 9 ± 2 days. Following the initial treatment, 69 patients (96%) were discharged on oral CSA with mean blood CSA concentrations of 192 ± 55 ng/mL. Azathioprine was added in 64 (89%) patients. A second treatment with CSA was necessary in 11 patients; 1 patient received three courses of IV treatment.The duration of follow-up averaged 773 ± 369 days. Patients who were responders but were still having certain symptoms at discharge had a higher incidence of colectomy during follow-up. Of all initial responders, 18 (25%) underwent colectomy after a mean interval of 178 ± 141 days. The life-table predicts that of all treated patients, 55% will avoid a colectomy during a period of 3 years.Complications of CSA treatment were mostly reversible, but 3 patients (3.5%) died of opportunistic infections (1 of Pneumocystis carinii pneumonia and 2 of Aspergillus fumigatus pneumoniae). One patient with anaphylactic shock caused by the CSA solvent was successfully resuscitated.Seventy-two of 86 patients (83.7%) responded to IV CSA therapy, administered for a mean of 9 ± 2 days. Following the initial treatment, 69 patients (96%) were discharged on oral CSA with mean blood CSA concentrations of 192 ± 55 ng/mL. Azathioprine was added in 64 (89%) patients. A second treatment with CSA was necessary in 11 patients; 1 patient received three courses of IV treatment.The duration of follow-up averaged 773 ± 369 days. Patients who were responders but were still having certain symptoms at discharge had a higher incidence of colectomy during follow-up. Of all initial responders, 18 (25%) underwent colectomy after a mean interval of 178 ± 141 days. The life-table predicts that of all treated patients, 55% will avoid a colectomy during a period of 3 years.Complications of CSA treatment were mostly reversible, but 3 patients (3.5%) died of opportunistic infections (1 of Pneumocystis carinii pneumonia and 2 of Aspergillus fumigatus pneumoniae). One patient with anaphylactic shock caused by the CSA solvent was successfully resuscitated.ConclusionsCSA is an effective treatment of the majority of patients with severe attacks of UC, although the toxicity and even mortality associated with its use necessitates careful evaluation, selection, and follow-up.CSA is an effective treatment of the majority of patients with severe attacks of UC, although the toxicity and even mortality associated with its use necessitates careful evaluation, selection, and follow-up.

The corrosion of a sintered cordierite (2MgO • 2AI203 • 5SIO2) ceramic by sodium sulphate (Na2SO4) -a common combustion condensate -was investigated at 1000 ° C. Laboratory tests with thin films of Na2SO4/O 2 and Na2SO4/1% SO2-O 2 were performed. In the Na2SO4/ 02 case, the cordierite reacted to form NaAISiO4. After several hours of corrosion, the Na2SO 4 appeared to induced surface cracks in the cordierite. In the Na2SQ/1% SO2-O2 case, other dissolution reactions occurred. The material was also tested in a burner rig with No. 2 Diesel fuel and 2 p p m sodium. The corrosion process was similar to that observed in the Na2SO4/O 2 furnace tests, with more severe attack occurring.

The effect of carbon aggregates on the carbon refractory properties for a blast furnace was studied with X-ray diffraction (XRD), scanning electron microscopy (SEM), an energydispersive X-ray, mercury porosimetry, a resistivity instrument, and a laser thermal conductivity meter. The results showed that the microporous structure of a sample was determined by the amount of b-SiC whiskers. The thermal conductivity was controlled by the thermal conductivity of the corresponding carbon aggregate, and the alkali and molten-iron attack was decided mainly by the pore and the graphitization degree of aggregate, respectively. For samples using calcined anthracites as aggregates, the microporous structure became worse, the thermal conductivity increased, and the molten-iron as well as the alkali attack became more severe with an increase in the anthracite calcining temperature. For all samples, microcrystalline graphite possessed the best microporous structure and the least alkali and molten-iron attack, whereas the graphite electrode scraps had the highest thermal conductivity and the most severe alkali and molten-iron attack.

A study on castables refractories used in Blast Furnaces runners is presented. The objective is to increase the knowledge on the behavior of this type of materials. This study includes a characterization of the refractory material, both before and after use. The analysis of the sintering reaction, the study on silicon carbide dissociation and the thermodynamical interpretation on the SiC-CO system, jointly with the post mortem study results permitted to identify the carbon oxidation mechanisms of the several runner zones. Finally, the equilibrium phase diagram analysis and thermal profile diagram of the blast furnace runner let us to establish key factors on castable refractory wear in service.

Purpose: Myoclonic status in nonprogressive encephalopaties (MSNE) is characterized by recurrence of longlasting myoclonic status appearing in infants and young children with nonprogressive encephalopathy. Here, we describe the electroclinical features and evolution of MSNE.

In this study, optimization of some parameters of stirred mill on ultra-fine grinding of refractory Au/Ag ores was performed. A three-level Box-Behnken design combining a response surface methodology (RSM) with quadratic programming (QP) was employed for modelling and optimization of some operating parameters in ultra-fine grinding. Grinding tests were carried out in a laboratory scale pin-type vertical stirred mill. The relationship between the response, i.e. d 80 size, and four grinding parameters, i.e. ball diameter, grinding time, ball charge ratio and stirrer revolution was presented as empirical model equations. Analysis of variance showed a high coefficient of determination value (R 2 = 0.9698), thus ensuring a satisfactory of the second-order regression model with the experimental data. The model equations were then optimized using the quadratic programming method to minimize for d 80 size within the experimental range studied. The optimum conditions were found to be 1.61 mm for ball diameter, 11.50 min for grinding time, 80% for ball charge ratio and 745 rpm for stirrer revolution for this grinding process. In order to verify the improvement of grinding performance using the optimal level of control factors three verification experiments were conducted, and the results for d 80 was 3.37 μm, which were smaller than those obtained in the initial tests.

Mechanical properties of slip-cast alumina -mullite (AM) refractories were improved significantly by the addition of f 2-Am zircon (ZrSiO 4 ) particles. Fracture behaviour showed mainly transgranular, with some intergranular, fracture. R parameter showed that there was a marked incline in resistance to fracture initiation. Thermal shock tests confirmed that the retained strength and Young's modulus of alumina -mullite -zircon refractories were improved by increasing the quench temperature, indicating higher resistance to crack propagation. D

The architecture supporting our conceptual knowledge of abstract words has remained almost entirely unexplored. By contrast, a vast neuropsychological, neurolinguistic and neuroimaging literature has addressed questions relating to the structure of the semantic system underpinning our knowledge of concrete items (e.g. artefacts and animals). In the context of semantic refractory access dysphasia, a series of experiments exploring and comparing abstract and concrete word comprehesion are described. We demonstrate that semantically associated abstract words reliably interfere with one another significantly more than semantically synonymous abstract words, while concrete words show the reverse pattern. We report the first evidence that abstract and concrete word meanings are based in representational systems that have qualitatively different properties. More specifically, we show that abstract concepts, but not concrete concepts, are represented in an associative neural network. Furthermore, our patient was found to have significantly greater difficulty in identifying high frequency than low frequency abstract words. This observation constitutes the first evidence of an inverse word frequency effect. Our results challenge the generality of many existing models of human conceptual knowledge, which derive their structure from experimental findings in the concrete domain alone.

The aims of this research is to study and analysis on furnace walls with variation of hot face lining material types, variation of refractory material types, and variation of thickness of insulating materials to outer wall temperature at furnace with working temperature 1000 oC.
This research uses a variety of hot face lining material in the form of ceramic fiber blanket with CR1260, CR1400, and CR1430, variations of refractory material in the form of refractory brick with the type NJM-20, NJM-23, and NJM-26, and using ROCKWOOL as an insulating material with a thickness variation of 50 mm, 75 mm, 100 mm. This research was simulated using Steady State Thermal ANSYS Mechanical (ANSYS Multiphysic) software.

The result of the research shows the difference of the outer wall temperature value of the furnace. The highest wall temperature is in interaction with the wall without insulation, hot face lining material using CR1260, and NJM-26 as refractory material is 75.211 oC. While the lowest wall temperature is in the interaction of 100 mm thick insulation, hot face lining material using CR1430, NJM-20 as refractory material is  46.682 oC.

There is no standard salvage regimen for AML. We retrospectively compared two commonly used regimens at our institution: CLAG and MEC. The complete response rate (CR) was 37.9% for CLAG (n = 97) and 23.8% for MEC (n = 65) (P = 0.048), with median overall survival (OS) of 7.3 and 4.5 months, respectively (P = 0.05). In primary refractory disease, CR was 45.5% for CLAG and 22.2% for MEC (P = 0.09), with median OS of 11 and 4.5 months, respectively (P = 0.07). In first relapse, CR was 36.8% and 25.9% (P = 0.35) and median OS was 6.7 and 6.7 months, respectively (P = 0.87). Our data support use of CLAG for RR-AML.

To evaluate the pattern of prescription of antiepileptic drugs (AEDs) and other medications in a representative population of patients with refractory epilepsy attending tertiary referral centres in Italy.Descriptive analysis of data obtained at baseline from 933 adults and 191 children with refractory epilepsy enrolled consecutively in an observational study at 11 tertiary referral centres in Italy. Multivariate logistic regression analysis was used to assess predictors of utilization of the most commonly prescribed AEDs.Polytherapy was used in 79% of adults and 75% of children, with over one-third of adults and children being prescribed ≥3 AEDs. In adults, the most commonly used AEDs were levetiracetam (35%), carbamazepine (34%) and lamotrigine (30%). In children, valproic acid was by far the most commonly used AED (46%), followed by carbamazepine (27%), topiramate (21%), and phenobarbital (20%). The most common AED in partial epilepsy was carbamazepine (331 out of 893 patients, 37%), followed by levetiracetam (33%) and lamotrigine (26%). In generalized or undetermined epilepsies, the AEDs most commonly used were valproic acid (139 out of 223 patients, 62%), lamotrigine (33%) and levetiracetam (28%). Second generation AEDs were prescribed in 81% of adults and 54% of children. Comedications used for indications other than epilepsy were used by 32% of adults and 17% of children.Prescription patterns were consistent with current evidence about the spectrum of efficacy of individual AEDs in different epilepsy syndromes. The high prevalence of polytherapy, including combinations of three or more AEDs, is a cause for concern.

In this study, optimization of some parameters of stirred mill on ultra-fine grinding of refractory Au/Ag ores was performed. A three-level Box-Behnken design combining a response surface methodology (RSM) with quadratic programming (QP) was employed for modelling and optimization of some operating parameters in ultra-fine grinding. Grinding tests were carried out in a laboratory scale pin-type vertical stirred mill. The relationship between the response, i.e. d 80 size, and four grinding parameters, i.e. ball diameter, grinding time, ball charge ratio and stirrer revolution was presented as empirical model equations. Analysis of variance showed a high coefficient of determination value (R 2 = 0.9698), thus ensuring a satisfactory of the second-order regression model with the experimental data. The model equations were then optimized using the quadratic programming method to minimize for d 80 size within the experimental range studied. The optimum conditions were found to be 1.61 mm for ball diameter, 11.50 min for grinding time, 80% for ball charge ratio and 745 rpm for stirrer revolution for this grinding process. In order to verify the improvement of grinding performance using the optimal level of control factors three verification experiments were conducted, and the results for d 80 was 3.37 μm, which were smaller than those obtained in the initial tests.

Background: Paradoxically, some reports in the literature support the use of antipsychotics in the treatment of Obsessive Compulsive Disorder (OCD), while other reports suggest that antipsychotics can exacerbate OCD symptoms. To date, there is no published systematic review of the relationship between OCD symptoms and antipsychotic drugs. Methods: A Medline and PsychInfo search (1980 -2003) was conducted to collect published reports of the interactions between antipsychotics and OCD symptoms. Results: In the treatment of refractory OCD, case series, open label trials and placebo-controlled trials were found suggesting efficacy of antipsychotic augmentation to ongoing antidepressant treatment. In the placebo-controlled trials with haloperidol, risperidone, olanzapine, and quetiapine, a significantly higher response rate (46 -71%) was found for the antipsychotic groups, compared to no response for the placebo groups. Reports of exacerbation of OCD symptoms with the use of atypical antipsychotics were limited to individuals with a primary psychotic disorder. Limitations: Definition of response in most of these treatment studies was based on a modest reduction of OCD symptoms, and no studies were available on long-term efficacy. There were also no published reports that systematically evaluated the incidence of OCD symptoms associated with atypical antipsychotics. Conclusions: All antipsychotics mentioned above had short-term controlled evidence to support their use as augmenting agents in the treatment of refractory OCD. The suggested management of OCD induction/exacerbation due to atypical antipsychotics is to increase the dose of the atypical antipsychotic and/or add a selective serotonin reuptake inhibitor. D

Objective: To assess an uncontrolled, open-label trial of sleep-disordered breathing (SDB) treatment on two different samples of chronic insomnia patients. Method: In Study 1 (Retrospective), data from one diagnostic and one continuous positive airway pressure (CPAP) titration polysomnogram were compiled from 19 chronic insomnia patients with SDB. Objective polysomnogram indicators of sleep and arousal activity and self-reported sleep quality were measured. In Study 2 (Prospective), clinical outcomes were assessed after sequential cognitive-behavioral therapy (CBT) and SDB therapy (CPAP, oral appliances, or bilateral turbinectomy) were provided to 17 chronic insomnia patients with SDB. Repeat measures included the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Quality Index, and self-reported insomnia indices and CPAP use. Results: In Study 1, seven objective measures of sleep and arousal demonstrated or approached significant improvement during one night of CPAP titration. Sixteen of 19 patients reported improvement in sleep quality. In Study 2, Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, and Pittsburgh Sleep Quality Index improved markedly with CBT followed by SDB treatment and achieved an average outcome equivalent to curative status. Improvements were large for each treatment phase; however, of 17 patients, only 8 attained a nonclinical level of insomnia after CBT compared with 15 patients after SDB therapy was added. Self-reported insomnia indices also improved markedly, and self-reported SDB therapy compliance was high. Conclusions: In one small sample of chronic insomnia patients with SDB, objective measures of insomnia, arousal, and sleep improved during one night of CPAP titration. In a second small sample, validated measures of insomnia, sleep quality, and sleep impairment demonstrated clinical cures or near-cures after combined CBT and SDB therapies. These pilot results suggest a potential value in researching the pathophysiological relationships between SDB and chronic insomnia, which may be particularly relevant to patients with refractory insomnia.

Refractory celiac disease (RCD) is one of the most serious causes of persistent symptoms in patients with celiac disease (CD). Published reports suggest that approximately half of patients in Europe are RCD type II, which carries a poor prognosis with a 5-year survival rate of ~ 50 % compared with ~ 90 % for RCD type I. However, disease patterns may be different in North America. The aim of this study was to explore the clinical spectrum of RCD in a North American population.

A significant proportion of depressed patients eventually present with treatment-resistant/refractory major depression (TRD), a debilitating condition that imposes significant health, social, and economic burdens. Recently, a growing level of consensus has been reached on the general meaning of TRD, according to which, depression is considered resistant when at least two trials with antidepressants from different pharmacologic classes (adequate in terms of dose, duration, outcome, and compliance) failed to achieve clinical remission. Regarding the management of TRD, a two-step approach is suggested, involving first the evaluation of factors that may contribute to treatment nonresponse (such as comorbid medical and psychiatric conditions), and second, the use of the four classical strategies for enhancing antidepressant efficacy (namely optimization, augmentation, combination, and switching). Finally, future research on TRD should include studies addressing, among other issues, the validity of the proposed definitional criteria, the evaluation of reliable predictors of treatment outcome, and the development of novel therapeutic strategies.

The productivity of high speed milling operations is limited by the onset of self-excited vibrations known as chatter. Unless avoided, chatter vibrations may cause large dynamic loads damaging the machine spindle, cutting tool, or workpiece and leave behind a poor surface finish. The cutting force magnitude is proportional to the thickness of the chip removed from the workpiece. Many researchers focused on the development of analytical and numerical methods for the prediction of chatter. However, the applicability of these methods in industrial conditions is limited, since they require accurate modelling of machining system dynamics and of cutting forces. In this study, chatter prediction was investigated for orthogonal cutting in turning operations. Therefore, the linear analysis of the single degree of freedom (SDOF) model was performed by applying oriented transfer function (OTF) and \tau decomposition form to Nyquist criteria. Machine chatter frequency predictions obtained from both forms were compared with modal analysis and cutting tests.

A study to improve the integrity and reliability of alumina-based refractory bricks, installed as linings in furnaces and incinerators, is being conducted. Owing to the inherent porosity of such heat-insulating materials, problems associated with molten slag penetration and chemical degradation are often encountered. It is known that denser refractories degrade less rapidly since such penetration is hindered. One aim for the current research is to seal the surfaces of these refractory materials by laser surface processing. In this way the bulk properties of the brick are retained, while the surface properties are improved. This paper reports on the results of an investigation to determine the optimum laser processing parameters that produce a zone of densified material containing few defects at the refractory surface. The high thermal stresses usually associated with laser treatment are often relieved by fracture of the laser-treated zone. However, by using a novel flame-assisted laser surface treatment, a reduction in thermal stress has been achieved, resulting in a crack-free, dense laser-treated zone. This treated zone should reduce or even eliminate the ingress of molten slags and gases, thus providing a reduced area for attack by corrosive species.

Purpose To evaluate the efficacy of the Ahmed Glaucoma Valve implant in refractory glaucomas in Indian eyes. Materials and methods A retrospective review was conducted on the charts of 122 eyes of 122 patients with refractory glaucoma treated with Ahmed Glaucoma Valve implant placement at Guru Nanak Eye Centre, New Delhi between January 1996 and December 1999. The main outcome measure was success at the last follow-up. Success was defined as an intraocular pressure (IOP) of 22 mmHg or less and 5 mmHg or more and at least a 30% reduction in IOP without visually devastating complications or additional glaucoma surgery. Results The mean postoperative IOP (17.2973.79 mmHg) was significantly (Po0.001) lower than the mean preoperative IOP (31.4777.86 mmHg) at last follow up (mean 12.5178.37 months; range 3-24 months). The cumulative probability of success by Kaplan -Meier analysis was 85.95% at 12 months and 82.83% at 24 months. The mean number of postoperative antiglaucoma medications (0.7570.80) was also significantly lower (Po0.001) than the mean preoperative number of antiglaucoma medications (2.83 þ 0.72). The most common complication was corneal-tube contact, which occurred in five (4.10%) eyes. Retinal detachment occurred postoperatively in one eye with the clinical diagnosis of neovascular glaucoma secondary to Eale's disease. Two patients had tube extrusion requiring repositioning and reinforcement with scleral patch graft. Conclusions Ahmed Glaucoma Valve implantation is an effective and relatively safe therapy for the treatment of refractory glaucoma in Indians.

An expert panel convened to reach a consensus regarding the optimal use of lenalidomide in combination with dexamethasone (Len/Dex) in patients with relapsed or refractory multiple myeloma (RRMM). On the basis of the available evidence, the panel agreed that Len/Dex is a valid and effective treatment option for most patients with RRMM. As with other therapies, using Len/Dex at first relapse is more effective regarding response rate and durability than using it after multiple salvage therapies. Len/Dex may be beneficial regardless of patient age, disease stage and renal function, although the starting dose of lenalidomide should be adjusted for renal impairment and cytopenias. Long-term treatment until there is evidence of disease progression may be recommended at the best-tolerated doses of both lenalidomide and dexamethasone. Recommendations regarding the prevention and management of adverse events, particularly venous thromboembolism and myelosuppression, were provided on the basis of the available evidence and practical experience of panel members. Ongoing trials will provide more insight into the effects of continuous lenalidomide-based therapy in myeloma.

We report the efficacy of the ketogenic diet in refractory epilepsies focusing on outcomes with regard to epilepsy syndromes and etiology in children and adults with refractory epilepsy. Sixty-four consecutive children and four adults were prospectively enrolled from 2002 to 2009; seven were excluded from analysis. The classical ketogenic diet was initiated on an inpatient basis with dietary ratios ranging from 2:1 to 4:1 fat to carbohydrate and protein. Patients were classified according to syndrome and etiology using the 1989 and more recent 2010 International League Against Epilepsy (ILAE) classification systems. Responders were defined as >50% reduction in seizure frequency compared to baseline. Syndromes included symptomatic generalized (52), genetic (idiopathic) generalized , and focal epilepsies (2) and etiologies included structural (24), genetic (18), and unknown . Twenty-nine (48%) of 61 patients were responders at 3 months. Two children became seizure-free: one with focal epilepsy of unknown etiology and another with refractory childhood absence epilepsy. Responsive syndromes included migrating partial epilepsy of infancy, childhood absence epilepsy, focal epilepsy, epilepsy with myoclonic-atonic seizures, and Dravet syndrome. Children with lissencephaly and hypoxic ischemic encephalopathy had surprisingly good responses. The ketogenic diet is an effective treatment for children and adults with refractory epilepsy. The response is predicted by type of epilepsy syndrome. Accurate characterization of the electroclinical syndrome is an important factor in decisions about timing of initiation of the ketogenic diet.

A 36-year-old female with metastatic breast cancer involving bones, liver, lung, and pleura/chest wall with worsening back pain received weight-based intravenous (IV) ketamine and was transitioned to oral ketamine for cancer-related neuropathic pain. She had responded poorly to outpatient pain regimen of oxycodone sustained and immediate release, hydromorphone, gabapentin, and duloxetine (approximate 480 mg total oral morphine equivalents [OME]), reporting an initial pain score of 10/10. She was started on hydromorphone parenteral patient-controlled analgesia (PCA) bolus dose in addition to her outpatient regimen. Despite escalating doses of opioids and the addition of a lidocaine 5% patch, the patient's pain remained uncontrolled 6 days after admission. On hospital day 7, utilizing a hospital weight-based ketamine protocol, the patient was started on subanesthetic doses of ketamine at 0.2 mg/kg/h (288 mg/24 h) and titrated over 2 days to 0.4 mg/kg/h (576 mg/24 h). Then, a 3-day rotation from intravenous to oral ketamine was initiated, and the patient was discharged on ketamine oral solution, 75 mg every 8 hours. When the patient's dose was increased to 0.4 mg/kg/h, adequate pain relief was charted by the nurse within 120 minutes, "patient pain free and resting comfortably." Her pain continued to be well managed, with an average pain score of 5/10 with the ketamine continuous infusion and sustained with conversion to oral ketamine without any report of side effects. This was a 37% reduction in pain scores. With the patient's stabilized dose of ketamine, opioid requirements decreased by 61.4% (1017.5 mg reduction in total OME). The use of weight-based dosing of IV continuous infusion and transition to oral ketamine was effective and tolerable in the management of opioid-refractory, neuropathic cancer pain. It is hoped that this case report promotes a discussion regarding ketamine dosing in refractory neuropathic cancer pain.

BCG ϭ bacillus Calmette-Guérin CR ϭ complete response DLT ϭ dose limiting toxicity MDD ϭ maximum deliverable dose nab-paclitaxel ϭ nanoparticle albumin-bound paclitaxel NMIBC ϭ nonmuscle invasive bladder cancer NR ϭ no response NS ϭ normal saline TUR ϭ transurethral resection ). For another article on a related topic see page 702.

Objective. Botulinum toxin type A (BTX-A) has been used to treat migraine and occipital neuralgia. We report preliminary results of an ongoing study that assesses the efficacy of BTX-A on trigeminal neuralgia (TN) patients refractory to medical treatment. Study design. We treated 15 patients (8 men and 7 women) between 28 and 67 years of age who were suffering from drug-refractory TN from February 2008 to January 2010. Symptoms, including pain duration, provoking factors, affected nerve branch, frequency of TN attacks, and severity of pain just before injections, were evaluated 1 week, 1 month, and 6 months after injection. We injected 50 U reconstituted BTX-A solution at the trigger zones. The overall response to treatment was assessed via a 9-point patient global assessment scale and compared with values at baseline. Statistical analysis was performed by the analysis of variance (ANOVA) test for frequency of TN attacks, the Friedman test for severity of pain, and the Wilcoxon signed-rank test for PGA, and all with the use of SPSS software. Results. Eight men and 7 women aged 28-67 years (mean 48.9 y) suffering from TN from 6 months to 24 years all improved regarding frequency and severity of pain attacks; in 7 patients, pain was completely eradicated and there was no need for further medication. In 5 patients, nonsteroidal antiinflammatory drugs were enough to alleviate pain attacks, and 3 patients again responded to anticonvulsive drugs after injection. All patients developed higher pain thresholds after injections. The ANOVA test showed a significant difference in frequency of attacks before injection and at 1 week, 1 month, and 6 months after injection (P Ͻ .001). Friedman test and pair comparison of pain severity scores with Bonferroni correction adjustment showed a significant difference (P Ͻ .001) between severity of pain before and after injection. Wilcoxon signed-rank test showed significant improvement in all patients up to 6 months after injection (P Ͻ .001). Complications included transient paresis of the buccal branch of the facial nerve in 3 patients.

The properties of coal fly ash are strongly dependent on the geological origin and the combustion process of the coal. It is important to characterize regional fly ash in detail to ascertain its potential uses as raw material in the production of high value products. The physicochemical properties of fly ash coming from the "Jose Lopez Portillo" coal-fired power plant, Coahuila, Mexico (MFA), are presented in this work. A detailed study of trace elements, the chemical composition of the amorphous phase, thermal stability and the leaching of contaminant elements under different conditions are included. MFA is composed of mullite, quartz, calcite, magnetite and an amorphous phase. This material contains mainly silica (59.6%), alumina (22.8%) and magnetite (5.6%). Its amorphous phase (78.3%) has a high silica (49.4%) and alumina (14.4%) content. According to its mineralogical and chemical composition, MFA is potentially useful as a raw material for making cement, silica, and alumina, as well as low silica/alumina ratio zeolites. Deleterious elements could be removed during the zeolitization process or with an additional acid treatment. Because of its morphological properties and structural and thermal stability, MFA can be used in thermal isolation and refractory materials and as a support for heterogeneous catalysts.

Summary: Purpose: Angelman syndrome (AS) is a neurogenetic disorder characterized by developmental delay and a frequently refractory epileptic condition. Valproate, clonazepam and/or phenytoin are said to be the most effective antiepileptic drugs (AEDs) against the seizures in AS. Experience with the newer AEDs is very limited despite their better safety profile and tolerability. Considering its favorable side effect profile and its effectiveness against both partial and generalized seizures, we hypothesized that lamotrigine (LTG) might be more efficacious and better tolerated.Methods: Potential patients for this retrospective study were identified from the epilepsy clinics at Notre-Dame, Sainte-Justine, and Yale New Haven hospitals. Patients were included in the study if they had AS along with refractory seizures. The medical record of each patient was reviewed with interest on seizure types, previous AEDs and response to LTG.Results: Five patients (2M, 3F) were included in this study. Age at LTG ranged from 10 to 33 years old. All had ≥2 seizure types, mainly generalized tonic–clonic, myoclonic seizures, and atypical absences. Previously tried AEDs included valproic acid (5), benzodiazepines (5), phenytoin (4), carbamazepine (3), and topiramate (1). One patient had pancreatitis on phenytoin, one had worsened seizures on carbamazepine, and one developed hepatic encephalopathy on valproic acid. Three patients became seizure-free with LTG (9, 20, and 36 months FU), one was seizure-free for 1 year with subsequent loss of efficacy, and one showed >50% reduction in myoclonic seizures (20 months FU). No side effects were reported.Conclusion: LTG can be efficacious and well tolerated in patients with AS.

Silicon nitride-based materials are applied to many tribological components because of their superior thermal and mechanical properties and corrosion resistance. The purpose of this study is to investigate the wear performance of modified silicon nitride which contained 3 wt.% La 2 O 3 and 3 wt.% Y 2 O 3 . The relationships between microstructure and mechanical properties have been also addressed. Vickers microhardness and toughness were measured, the later being determined by means of the direct crack measurement method (DCM). Scanning electron microscopy technique (SEM) coupled with energy dispersive X-ray spectroscopy (EDS) was used for the morphological characterization of the samples as well as for the characterization of the wear scars. Wear properties were studied under a load of 10 N by using the ball-on-disk tribometer. AISI 52100 steel balls and balls of WC + 6% Co (6 mm diameter) were used as static counterparts, respectively. Steady state friction coefficients of 0.66 and 0.62 were measured for the tribological pairs WC + 6 % Co/Si 3 N 4 and AISI 52100/Si 3 N 4 , respectively. The wear mechanism was determined in each case, and comparison between the wear performance of the traditional and modified silicon nitride is also presented.

We studied long-term outcome (range, 28-89 months; mean, 56 months) after multiple subpial transections (MSTs) for medically refractory epilepsy. Forty-three (79.6%) of 54 patients had a consistent significant reduction in seizure frequency, and 27 (50%) of the 54 were either entirely seizure free or virtually so. However, 10 (18.6%) patients sustained an increase in seizure frequency several years after surgery, after showing initial postoperative improvement. This suggests that late seizure recurrence is a more important problem in cases in which MST has been performed than for pure resections.

The aim of the study was to assess the efficacy and safety of felbamate (FBM) as add-on therapy in pediatric patients with severe uncontrolled seizures during a 3-year follow-up. Thirty-six patients were enrolled between February 1994 and February 1997. Patients suffered from partial epilepsy (n= 13), Lennox-Gastaut syndrome (LGS) (n =9), infantile spasms (IS) n= 8 or other forms of generalized epilepsy (n= 6). FBM was titrated weekly from 15 up to 45 mg/kg. By February 1995, all patients had hematological and biochemical monitoring prior to FBM therapy and every 15 days during the study. The results achieved at different treatment durations were analyzed. Overall efficacy measured as ]50% reduction in seizure frequency varied during follow-up: 69% at 3 months, progressively decreasing to 66% at 6 months, to 47% at 1 year and 41% of the initial cohort at the end of the study. Most frequent side effects were anorexia, weight loss, urinary retention, somnolence, nervousness and insomnia. FBM controlled a broad spectrum of otherwise refractory seizures. Best results were obtained against simple partial seizures with or without secondary generalization, tonic and atonic seizures. A substantial improvement in seizure control was maintained in one-third of the patients for at least 3 years.

The activity–selectivity pattern of homogeneous (Cu2+, Fe3+, Mn2+) and ceria-supported (CuCeOx, MnCeOx) transition-metal catalysts in the wet air oxidation of phenol (CWAO) has been probed using a stirred batch reactor with continuous oxygen feeding (T, 150°C; PO2, 0.9Mpa). Both non-catalytic and catalytic homogeneous wet air oxidations proceed via an unselective autocatalytic free-radical path leading mostly to refractory C1–C2 acids, while a Langmuir–Hinshelwood (L–H) mechanism accounts for the superior CWAO performance of the MnCeOx system. A thorough kinetic analysis of the studied systems on the basis of homogeneous autocatalytic free-radical and heterogeneous surface L–H reaction paths has been addressed. The kinetic constants of the various reaction steps show that the MnCeOx system prompts a fast adsorption of phenol with the consequent abatement of TOC, though a slow oxidation rate determines the buildup of carbonaceous deposits on the catalyst surface. Lower oxidation stre...

Crystalline inclusions, commonly called stones, are very dangerous defects present in industrial glass products. Refractory materials of the furnace, raw materials and ceramic grains introduced with glass cullet, are the main sources of stones. To improve the quality of glass products, the understanding of the mechanisms responsible for the formation and the transformation of these defects is required. At the interface glass melt=stone surface several reactions occur leading to the formation of new glassy and crystalline micro-phases. These phases are usually studied by scanning electron microscopy and X-ray microanalysis on polished cross sections. Nevertheless SEM-EDX chemical analysis alone does not allow the complete identification of the different phases. In this work, the reactions occurring between refractory materials and the molten glass were studied with a micro-chemical and micro-textural approach completed by micro-structural investigation. Compositional and textural features were investigated by SEM-EDX and by-Raman spectroscopy. Raman spectra of pure crystalline well identified compounds were compared with those of the unknown phases. This technique allowed to identify the nature of the re-crystallized phases. The combined use of SEM-EDX and-Raman techniques revealed to be very promising in the study of the origin and in the characterization of stones in glass.