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In the 10 cases with incorrect disease suggestion at the time of diagnosis, a number of characteristics were iden- Discussion tified, which are highlighted below. The rare disease suggestions were 25th 50th 75th Max based on the ranked fit of the symptom constellation for Among all included cases the respective disease models. Suggesting possi- physicians make better decisions in a real-world setting ble rare diseases can increase the level of early suspicion must be further investigated. Such false positive suggestions are not necessarily prob- Such an endeavor would require a structured and com- lematic in a reminder system. Moreover, availability of the tool, preferably via a nal medicine test cases revealed a low false positive rate. Number of cases per group: 0m: 5; 1-12m: 33; 1-5y: 30; >5y: 25 We do not know how either correct or false positive dis- inference of disease suggestions, or the possibility to man- ease suggestions will affect the diagnostic process, costs, ually exclude suggested conditions, should be considered patient safety, and health outcomes. These effects Information concerning therapy cannot be included in need to be evaluated in future studies. Examples include factors such as therapy the analysis disclosed several reasons for an inaccurate failure, symptom improvement with therapy, and consid- disease suggestion, which might indicate possible areas of eration of medication side effects. Multiple diagnoses led to of system interoperability should not be underestimated a lower accuracy and subsequently a lack of early correct and future optimization should prioritize compatibility. To increase diagnostic accuracy, the Knowledge base compatibility with existing rare disease possibility to recognize multimorbidity is an ideal target databases like Orphanet [22] should be emphasized and for improvement. The existing Orphanet nomenclature (Orpha numbers) Strict diagnostic criteria should be represented in the Ada knowledge base. Although the applica- French National Plan on Rare Diseases, and the German tion of strict criteria partly contradicts the concept of National Action League for People with Rare Diseases probabilistic reasoning, it is of great importance when [10, 11, 35]. Integration of strict diag- a more efficient and targeted knowledge base extension nostic criteria separately from or after the probabilistic because it could enable integration of further related Ronicke et al. Orphanet Journal of Rare Diseases (2019) 14:69 Page 10 of 12 databases, such as existing databases of genetic variants. It would facil- Study limitations itate the integration of known disease genotypes, gene- A retrospective analysis of confirmed rare disease cases phenotype relations, as well as the appropriate suggestion is generally suitable to assess the potential accuracy of and handling of genetic tests in Ada. A strength of the study is that a wide of over 7000 known rare diseases and rapidly increasing range of diagnoses from the group of systemic inflamma- medical knowledge, the process of disease model creation tory diseases were represented (n = 42), including cases should be supported by technological means. However, results are limited to this group for future disease model creation should aim for curated, of diseases. Generalization of the results to the entire automated modeling from structured disease databases. Sim- tric design, a generalization of the study results applying ilar technology could be applied to keep the knowledge to other institutions or medical domains is limited. Although such a process should still be curated case input was not blinded to diagnosis, it was based by medical editors and follow rigorous quality testing, it on written documented information from the medical could accelerate the process of knowledge base extension records to reduce hindsight bias and retrospective misin- and maintenance. Future studies that aim to validate ther tests that are needed to confirm the correct diagnosis.
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The concept is to heat the transition zone of the prostate while sparing the urethral mucosa; preserving the mucosa reduce pain and improve patient tolerance. The conclusion now is that the reduction in prostatic volume is less than initially anticipated. Concepts such as prostatic muscle dysfunction, alpha adrenergic nerve dysfunction and other concepts were proposed; however, no clear conclusion has been reached. No significant short-term complications, including need for transfusion, were reported in 155 either arm of these three reports, nor was bleeding reported a fourth randomized trial. The improvement for both arms was sustained at five years but there was a slight deterioration in both 153 154 arms. Short-term complications, including the need for transfusion, are uncommon or nonexistent. Four are larger 156-159 group studies; the others included fewer than 50 patients. These cohort studies are often retrospective and occasionally stated to include consecutive patients. These studies confirm that symptom scores, QoL and Qmax improve in a fashion very similar to that reported in the randomized trials and will not be detailed again here. Likewise these cohorts confirm that retrograde ejaculation is very rare to nonexistent. But these studies, which range in follow-up from two years to as long as 10 years, provide additional information on perioperative bleeding, patient selection, and need for 157, 160, 161 retreatment. The prostates in these studies were © Copyright 2010 American Urological Association Education and Research, Inc. Significant procedure-related bleeding, which was not encountered in the randomized trails, did occur in two of 30 162 patients and required catheter balloon traction to control bleeding. Another report encountered one 158 case of bleeding (in one of 70 patients) requiring bladder irrigation. In the cohort studies, rates of urinary retention and the need for catheterization varied greatly but were common. Rosario et al (2007) noted that only one of their first nine patients voided after the 158 procedure so they adopted routine postprocedure catheterization for all patients for seven days. Specific practice variations and attitudes such as this make it difficult to discern the rate of retention and duration of retention. Zlotta et al (2003) reported retreatment rates of 23% by five years with more than half of retreated patients opting for 159 invasive treatment. Attempts have been made to identify preoperative parameters that might predict success or failure. In a group of 41 patients, prostate volume and prostate transition zone volume decreased significantly at three months and the difference was not significant at 12 months; when patients were evaluated for differences in baseline prostate volume and transition zone, no differences were found 160 between responders and those patients who fared less well. They were more likely at baseline to be over the age of 70, have a higher 165 detrusor pressure, a greater residual volume and a worse QoL score.
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Similar series solutions can be constructed for cylinders and spheres that are convectively cooled at their outer surface, r = ro. The solutions for slab, cylinders, and spheres all have the form #∞ T − T∞ 2 Θ = = A exp −λˆ Fo f (5. Since the coordinates are semilogarithmic, this portion of the graph cor- responds to the lead term—the only term that retains any importance— in eqn. They were simply calculated from different solutions, and the numerical values on them are somewhat different. The quantity Φ has a close relationship to the mean temperature of a body at any time, T(t). Specifically, the energy lost as heat by time t determines the difference between the initial temperature and the mean temperature at time t t! They have approximately the same physical properties as water, and h is approximately 6 W/m2K as the result of natural convection. How much heat will the refrigerator have to carry away to get the centers to 10◦C? Nevertheless, hundreds of such charts have been formed for other situations, a number of which have been cataloged by Schneider [5. Analytical solutions are available for hundreds more problems, and any reader who is faced with a complex heat conduction calculation should consult the literature before trying to solve it. The laboratory workers who operate it are attempting to measure the boiling heat transfer coefficient, h, by sup- plying an alternating current and measuring the difference between the average temperature of the heater, Tav, and the liquid tempera- ture, T. They get h = 30, 000 W/m2K at a wire temperature of 100◦C ∞ and are delighted with such a high value. Then a colleague suggests that h is so high because the surface temperature is rapidly oscillating as a result of the alternating current. Heat is being generated in proportion to the product of 2 voltage and current, or as sin ωt, where ω is the frequency of the current in rad/s. If the boiling action removes heat rapidly enough in comparison with the heat capacity of the wire, the surface tempera- ture may well vary significantly. Because this problem is common and the solution is not widely avail- able, we include the curves for flat plates and cylinders in Fig. If high accuracy is not required, these one-term approximations may generally be used whenever Fo ≥ 0. The metal is heated, folded, beaten, and formed, over and over, to create a blade of remarkable toughness and flexibility. When the blade is formed to its final configu- ration, a tapered sheath of clay is baked on the outside of it, so the cross section is as shown in Fig. The red-hot blade with the clay sheath is then subjected to a rapid quenching, which cools the uninsulated cutting edge quickly and the back part of the blade very slowly. The result is a layer of case-hardening that is hardest at the edge and less hard at points farther from the edge. Prior to t = t4, the blade might as well be infinitely thick insofar as cooling is concerned.
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Saline infusion sonohysterography is more sensitive and specifc C 21, 22 Meta-analysis and a small for the detection of endometrial abnormalities than transvaginal prospective comparison trial ultrasonography. The levonorgestrel-releasing intrauterine system (Mirena) is an A 35, 44 Cochrane review and effective treatment for menorrhagia, with patient satisfaction randomized trial scores similar to endometrial ablation and hysterectomy. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease- oriented evidence, usual practice, expert opinion, or case series. Reprints are not available from If excessive uterine bleeding is unresponsive to medi- the authors. This intervention is considered permanent and not advised in women who desire continued fertility. Disadvantages include increased number of 549, 553-556, 560-561, 566, 569, 628-629, 808, 811. A process designed to lead to interna- health care costs compared with uterine-sparing pro- 42,43 tional agreement on terminologies and defnitions used to describe cedures. Hysterectomy also may be associated with abnormalities of menstrual bleeding [published correction appears in ovarian failure nearly four years earlier than expected. American Col- the opinions and assertions contained herein are the private views of the lege of Obstetricians and Gynecologists. Menorrhagia I: measured blood loss, clinical features, and the Authors outcome in women with heavy periods: a survey with follow-up data. J Reprod tute, and is on the faculty at the Carilion Clinic Family Medicine Residency Med. The effect of the levonorgestrel releas- of risk factors for endometrial hyperplasia in premenopausal women ing intrauterine system on endometrial hyperplasia: an Australian study with abnormal menstrual bleeding. Nonsteroidal anti-infam- ebrand disease in women with menorrhagia: a systematic review. Con- Willebrand disease: key points from the 2008 National Heart, Lung, and trol of menorrhagia by the cyclo-oxygenase inhibitors naproxen sodium Blood Institute guidelines. Antifbrinolytics for heavy menstrual for identifying women with menorrhagia for hemostatic evaluation. Obstet Gyne- Comparison of transvaginal sonography, saline infusion sonography, col. Endometrial carcinoma risk tional uterine bleeding: a randomized controlled trial. Concurrent endometrial carcinoma with the levonorgestrel-releasing intrauterine system or hysterectomy in women with a biopsy diagnosis of atypical endometrial hyperplasia: for treatment of menorrhagia: randomized trial 5-year follow-up. Accordingly, plans, goals, and other statements may not be realized as described, and actual financial results, success/failure or progress of development, and other projections may differ materially from those presented herein. Information concerning pharmaceuticals (including compounds under development) contained herein is not intended as advertising or as medical advice. Pipeline acquisition: possibility of acquiring over 25 innovative of innovative new drugs clinical programs. Improves R&D productivity by utilizing DrugOme to enhance the capability of pipeline acquisition and R&D Meet needs for preventive medical care.