Conclusion In the year 2003 there is no “one best bariatric operation” for every severely obese patient. The choice of operation must
be tailored to each individual patient’s needs and wishes. For the superobese patient, the patient diagnosed with intestinal
metaplasia of the stomach, and for those patients who do not wish to undergo the severe dietary restrictions imposed by the
RNY-GB, the BPD-DS is a valuable surgical option. 相似文献
In 1998, an epithermal neutron test beam was designed and constructed at the Tsing Hua Open-Pool Reactor (THOR) for the purpose of preliminary dosimetric experiments in boron neutron capture therapy (BNCT). A new epithermal neutron beam was designed at this facility, and is currently under construction, with clinical trials targeted in late 2004. Depth dose-rate distributions for the THOR BNCT test beam have been measured by means of activation foil and dual ion chamber techniques. Neutron and structure-induced gamma spectra measured at the test beam exit were configured into a source function for the Monte Carlo-based treatment planning code NCTPlan. Dose-rate scaling factors (DRSFs) were determined to normalize computationally derived dose-rate distributions with experimental measurements in corresponding mathematical and physical phantoms, and to thus enable accurate treatment planning using the NCTPlan code. A similar approach will be implemented in characterizing the new THOR epithermal beam in preparation for clinical studies. This paper reports the in-phantom calculated and experimental dosimetry comparisons and derived DRSFs obtained with the THOR test beam. 相似文献
Depressive symptoms in older adults are common, but the minority of elderly meet criteria for major depressive disorder. This
has led to confusion regarding the recognition of diagnosis, approach to treatment, and monitoring of outcomes in this needy
population. Few depressed older adults are willing to seek treatment from psychiatrists or mental health specialists. Treatment
approaches to the depressive spectrum of disorders in late life, which encompasses major and minor depressive disorder, dysthymic
disorder, and mood disorders related to medical conditions, must include evidence-based algorithms that can be delivered in
a variety of health care settings. Several recent multisite trials have advanced the use of collaborative care models and
the systematic stepwise approach to the treatment of depression and anxiety states in older adults. This offers the ability
to provide effective treatment of depression for older adults, consistent with current guidelines, in primary care and specialized
health care settings. 相似文献
Background: As in inhaled isoflurane anesthesia, when isoflurane lipid emulsion (ILE; 8%, vol/vol) is intravenously administered, the primary elimination route is through the lungs. This study was designed to determine the minimum alveolar concentration (MAC) and the time course of washout of isoflurane for intravenously infused ILE by monitoring end-tidal isoflurane concentration.
Methods: Twelve healthy adult mongrel dogs were assigned randomly to an intravenous anesthesia group with 8% ILE or to an inhalation anesthesia group with isoflurane vapor. An up-and-down method and stimulation of tail clamping were used to determine MAC of 8% ILE by intravenous injection in the intravenous anesthesia group and MAC by the inhaled approach in the inhalation anesthesia group, respectively. Isoflurane concentration and partial pressure in end-tidal gas, femoral arterial blood, and jugular venous blood were measured simultaneously just before each tail clamping and during washout.
Results: The induction time in the intravenous anesthesia group (105 +/- 24 s) was shorter than that in the inhalation anesthesia group (378 +/- 102 s; P < 0.01). MAC of 8% ILE by intravenous injection (1.12 +/- 0.18%) was significantly less than MAC by the inhaled approach (1.38 +/- 0.16%; P < 0.05). No significant difference was found between the two groups in the time course of washout of isoflurane. 相似文献