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Multiple
Kinds of Multiple Terms modified by Multiple Selected AbstractsThe Role of Natriuretic Peptides in Patients With Chronic Complex (Mixed or Multiple) Heart Valve DiseaseCONGESTIVE HEART FAILURE, Issue 2 2010FRACP, Naylin Bissessor MBChB N-terminal prohormone B-type natriuretic peptide (NT-proBNP) is an important biomarker of prognosis in heart failure and single valve disease. There are limited studies of complex valve disease. Patients with complex valve disease adopt a sedentary lifestyle, so symptoms may be difficult to detect. The authors aimed to determine whether NT-proBNP correlates with the severity of the valve lesion and underlying cardiac function and whether resting NT-proBNP predicts impaired peak VO2 in patients with complex valve disease. Forty-five patients with complex moderate to severe stenosis or regurgitation of the heart valves underwent a clinical assessment, echocardiography, resting NT-proBNP assessment, and formal cardiopulmonary exercise testing. In a multivariate analysis, the log NT-proBNP (,=,9.3, SE=1.9, P<.0001) and lean body weight (,=0.59, SE=0.22, P=.01) were dominant independent predictors of peak VO2. An NT-proBNP value of 84 pmol/L had 77% sensitivity and 70% specificity to predict impaired functional capacity, peak VO2 <60% (predicted), area under the curve=0.80. Resting NT-proBNP was the best predictor of peak VO2 in patients with complex valve disease, while symptoms and ejection fraction are a less reliable guide. Congest Heart Fail. 2010;16:50,54. © 2009 Wiley Periodicals, Inc. [source] Multiple fixed drug eruption due to drug combinationCONTACT DERMATITIS, Issue 6 2005A. Yokoyama We report the case of a multiple fixed drug eruption (FDE) after taking 1 g of PL® and 100 mg of levofloxacin (Cravit®) at the same time. Patch tests with PL® alone, levofloxacin alone and the combination of PL® and levofloxacin were all negative on the involved and uninvolved sites. Lymphocytic stimulation tests were also negative for PL® alone, levofloxacin alone and the combination of PL® and levofloxacin. Oral provocation tests with PL®alone or levofloxacin alone produced no reactivation. However, we could provoke multiple erythematous plaques on the involved areas by taking a 1/10th dose of the combination of PL® and levofloxacin at the same time. Drug eruption due to a drug combination appears to be very rare. This is the first case of multiple FDE caused by taking PL® -levofloxacin combination. [source] Etiology of strokes in children with sickle cell anemiaDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2006Michael R. DeBaun Abstract The most devastating complication of sickle cell anemia is cerebral infarction, affecting ,30% of all individuals with sickle cell anemia. Despite being one of the most common causes of stroke in infants and children, the mechanism of cerebral infarction in this population has not been extensively studied and is poorly understood. Multiple, synergistic factors are important in the pathogenesis of stroke including the hemodynamic effects of cerebral arterial occlusive disease, viscosity, chronic and acute anemia and acute medical events. This review focuses on the relationship between these factors in order to provide a foundation for further study of the etiology of strokes in this high-risk population. MRDD Research Reviews 2006;12:192,199. © 2006 Wiley-Liss, Inc. [source] How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?ADDICTION, Issue 4 2010Annie Britton ABSTRACT Objective To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up. Method Prospective cohort study of 5411 male civil servants aged 35,55 years at entry to the Whitehall II study in 1985,88. Alcohol consumption was reported five times over a 15-year period. Mortality, fatal CHD, clinically verified incident non-fatal myocardial infarction and definite angina were ascertained during follow-up. Results We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07,2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range. Conclusions Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time. [source] Microbial response to salinity change in Lake Chaka, a hypersaline lake on Tibetan plateauENVIRONMENTAL MICROBIOLOGY, Issue 10 2007Hongchen Jiang Summary Previous investigations of the salinity effects on the microbial community composition have largely been limited to dynamic estuaries and coastal solar salterns. In this study, the effects of salinity and mineralogy on microbial community composition was studied by using a 900-cm sediment core collected from a stable, inland hypersaline lake, Lake Chaka, on the Tibetan Plateau, north-western China. This core, spanning a time of 17 000 years, was unique in that it possessed an entire range of salinity from freshwater clays and silty sands at the bottom to gypsum and glauberite in the middle, to halite at the top. Bacterial and archaeal communities were studied along the length of this core using an integrated approach combining mineralogy and geochemistry, molecular microbiology (16S rRNA gene analysis and quantitative polymerase chain reaction), cultivation and lipid biomarker analyses. Systematic changes in microbial community composition were correlated with the salinity gradient, but not with mineralogy. Bacterial community was dominated by the Firmicutes -related environmental sequences and known species (including sulfate-reducing bacteria) in the freshwater sediments at the bottom, but by halophilic and halotolerant Betaproteobacteria and Bacteroidetes in the hypersaline sediments at the top. Succession of proteobacterial groups along the salinity gradient, typically observed in free-living bacterial communities, was not observed in the sediment-associated community. Among Archaea, the Crenarchaeota were predominant in the bottom freshwater sediments, but the halophilic Halobacteriales of the Euryarchaeota was the most important group in the hypersaline sediments. Multiple isolates were obtained along the whole length of the core, and their salinity tolerance was consistent with the geochemical conditions. Iron-reducing bacteria were isolated in the freshwater sediments, which were capable of reducing structural Fe(III) in the Fe(III)-rich clay minerals predominant in the source sediment. These data have important implications for understanding how microorganisms respond to increased salinity in stable, inland water bodies. [source] Multiple computer-automated structure evaluation study of aquatic toxicity.ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 3 2003Abstract An acute toxicity model was constructed on the basis of 901 chemicals tested for toxicity against the luminescent bacteria Vibrio fischeri (formerly Photobacterium phosphoreum, the Microtox® test). The model was created using the Multiple Computer-Automated Structure Evaluation (M-CASE) program. The model can correctly predict acute toxicity for 92% of the compounds with an error averaging 0.55 log units per median effect concentration (EC50). The main toxicophores, corresponding to polar and nonpolar narcosis, and other types of reactive chemicals were identified. [source] Adaptive measurement-based traffic engineering in small differentiated services domainsEUROPEAN TRANSACTIONS ON TELECOMMUNICATIONS, Issue 1 2007Sven Krasser In this paper, we propose a framework for measurement-based traffic engineering and connection admission control in small-differentiated services domains. The domain investigated is a wired radio access network based on the Internet protocol (IP). This framework is evaluated by simulation using the popular network simulator ns-2. The framework is adaptive to changes in the network load and supports multiple types of service. All traffic-engineering decisions are made by edge routers (ERs) at the rim of the network domain. Multiple disjoint paths are configured between those ERs. Network state information is gathered in two different fashions. We evaluate a scheme based on the states of the queues on each alternative path and a scheme based on end-to-end probe packet transmission characteristics on each alternative path. Both schemes are compared to a shortest path first (SPF) routing approach. Copyright © 2006 AEIT [source] European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV,HIV MEDICINE, Issue 2 2008JD Lundgren Background Metabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART). Summary of guidelines All HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intra-abdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in HIV and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases. Conclusion Multiple and relatively simple approaches exist to prevent metabolic diseases in HIV-infected persons; priority should be given to patients at high risk of contracting these diseases. [source] Species-specific evolution of MHC class I genes in the higher primatesIMMUNOLOGICAL REVIEWS, Issue 1 2001Erin J. Adams Summary: Humans express three highly polymorphic ,classical' (HLA-A,B and C) and three conserved ,non-classical' (HLA-E, F and G) MHC class I genes. Their comparison with the MHC class I genes of apes and monkeys reveals the differential extent to which MHC class I genes have been preserved during primate evolution. African apes have orthologues of all six human genes, and although allelic lineages of the A and C loci are shared, these species share none of the human alleles. In Asian apes, several MHC class I genes show significant differences from the human genes, a trend which continues with the Old World monkeys, and even more so in the New World monkeys, where E and F are the only human gene orthologues. The C locus is confined to humans and apes. Multiple A -related and B -related loci have been identified in apes and Old World monkeys showing that duplication of these loci has been a common event during primate evolution. Certain of the daughter loci exhibit low polymorphism, suggesting they have adopted a non-classical function. The differing rates at which MHC class I genes have evolved during primate evolution likely reflects their differing functions in the immune response. [source] Multiple semi-coarsened multigrid method with application to large eddy simulationINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 5 2006F. E. Ham Abstract The Multiple Semi-coarsened Grid (MSG) multigrid method of Mulder (J. Comput. Phys. 1989; 83:303,323) is developed as a solver for fully implicit discretizations of the time-dependent incompressible Navier,Stokes equations. The method is combined with the Symmetric Coupled Gauss,Seidel (SCGS) smoother of Vanka (Comput. Methods Appl. Mech. Eng. 1986; 55:321,338) and its robustness demonstrated by performing a number of large-eddy simulations, including bypass transition on a flat plate and the turbulent thermally-driven cavity flow. The method is consistently able to reduce the non-linear residual by 5 orders of magnitude in 40,80 work units for problems with significant and varying coefficient anisotropy. Some discussion of the parallel implementation of the method is also included. Copyright © 2005 John Wiley & Sons, Ltd. [source] DNA methylation patterns in adenomas from FAP, multiple adenoma and sporadic colorectal carcinoma patientsINTERNATIONAL JOURNAL OF CANCER, Issue 4 2006Coral V.A. Wynter Abstract Colorectal adenomas have traditionally been regarded as homogeneous. The aim of our study was to identify molecular features that may differentiate sporadic adenomas from familial adenomas such as Familial Adenomatous Polyposis (FAP) and Multiple Adenoma patients. DNA methylation was tested at Methylated IN Tumor (MINT) loci (1,2,12,31) and the CpG promoter region of genes MLH1, HPP1, MGMT, p14ARF and p16INK4a in FAP-associated adenomas (33) from 5 patients with a known APC mutation (Group 1, FAP), adenomas (29) from 4 Multiple Adenoma patients (Group 2 Multiple), adenomas (14) from 3 patients with sporadic colorectal cancers showing high microsatellite instability (Group 3, MSI-H) and adenomas (16) from 7 patients, with sporadic colorectal cancers showing microsatellite stable or low level instability (Group 4, MSS/MSI-L). Aberrant Crypt Foci (ACFs), Hyperplastic Polyps (HPs) and cancers were also examined for methylation status as well as K- ras mutation. Multiple Adenoma patients were examined for germline polymorphisms in the base excision repair gene, MYH. The familial syndrome, FAP -associated adenomas showed a significantly low frequency of MINT methylation (15.5%,) compared to sporadic MSS/MSI-L-associated adenomas (35.5%). Group 3 (MSI-H) adenomas were different in that many showed serration and a high level of methylation (57.1%). Group 2, Multiple Adenoma cases, resembled sporadic MSS/MSI-L-associated adenomas. However the promoter regions of key genes, MGMT, p14ARF and p16INK4a were methylated to a greater extent than MINTs in both sporadic and familial adenomas. Genetic profiling of adenomas supports the concept that adenomas belonging to familial syndromes pursue a different pathway to tumorigenesis than their sporadic counterpar/ts from their earliest formation. © 2005 Wiley-Liss, Inc. [source] Extranodal NK/T-cell lymphoma, nasal type, presenting after 5 years of remissionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2008Tomonobu Ito MD A 76-year-old woman with multiple edematous erythemas, erosions, and ulcers on the breast and abdomen was admitted to our hospital in June 2005. She had developed granulomatous bleeding lesions in the right nostril 6 years prior to her visit to our dermatology unit. She had been observed at the otorhinolaryngology department of our hospital, and a biopsy was taken from the nasal lesion. Computerized tomography and gallium scintigraphy (67Ga single-photon emission computed tomography) did not reveal any lesions corresponding to the diagnosis of malignant lymphoma. The histologic examination of the nasal specimen rendered a diagnosis of natural killer (NK)/T-cell lymphoma, nasal. Because imaging analysis indicated a small-sized tumor without metastases, oral prednisolone at 20 mg/day was administered for 1 month. The tumor decreased in size and disappeared after 19 months of low-dose steroid therapy. ,Five years after the initial treatment, the patient developed a fever of 38 °C with infiltrated erythemas and erosions on her breast. Erysipelas was initially suspected, but the antimicrobial agent did not show any effect and the multiple infiltrated erythemas and ulcers spread throughout her chest and abdomen (Fig. 1). The lymph nodes were not palpable. The right nasal cavity showed no granulomatous lesions or other signs of abnormality. The peripheral white blood cell count (3000/µL), red blood cell count (3.54 × 106/µL), and platelet count (112 × 103/µL) were reduced. Atypical lymphocytes were not observed. The serum lactic dehydrogenase (LDH; 1770 U/L; normal, 224,454 U/L), aspartate aminotransferase (AST; 140 U/L; normal, 10,30 U/L), and alanine aminotransferase (ALT; 57 U/L; normal, 3,29 U/L) levels were elevated. The soluble interleukin-2 (IL-2) receptor level was high (25,300 U/mL; normal, 167,497 U/mL). Epstein,Barr virus (EBV) serologic examination showed the immunoglobulin G (IgG) viral capsid antigen (VCA) at 1 : 320 and the EBV nuclear antigen (EBNA) at 1 : 40. IgM VCA and EBV early antigen-diffuse restricted antibody (EA) IgA and IgG were not detectable. Histologic findings from the left chest skin showed a distribution of atypical lymphocytes from the upper dermis to the subcutaneous tissue, and many foamy cells which had phagocytosed the hemocytes (Fig. 2a,b). Immunohistochemical analysis showed that the atypical lymphocytes were sCD3,, CD4,, CD8,, CD20,, CD56+, granzyme B+, and T-cell intracellular antigen (TIA-1) positive. Furthermore, EBV-encoded small RNAs (EBER), detected by in situ hybridization, exhibited a strong signal. The nasal lesions biopsied 6 years previously showed an identical staining pattern with the skin lesions immunohistochemically. Analysis of the T-cell receptor-, (TCR-,), TCR-,, and TCR-, gene did not reveal any clonal rearrangements, but the EBV gene was detected from the skin specimens by Southern blotting. Our patient's condition was diagnosed as a case of extranodal NK/T-cell lymphoma, nasal type, but the patient had concomitantly developed hemophagocytic syndrome (HPS). She was treated with a combination of steroid pulse therapy and chemotherapy (pirarubicin hydrochloride 30 mg/m2, cyclophosphamide 500 mg/m2, vincristine 1 mg/m2, prednisolone 30 mg/m2, etoposide 80 mg/m2). After the first session of chemotherapy, the lesions on the chest and abdomen diminished, but, 2 weeks later, the skin lesions recurred, and disseminated intravascular coagulation (DIC) induced by HPS supervened. The patient died as a result of multiple organ failure induced by HPS. Figure 1. Multiple infiltrated erythemas, erosions, and ulcers on the breast and abdomen Figure 2. Histologic findings of a skin biopsy specimen from the left chest (hematoxylin and eosin staining). (a) Dense infiltration of atypical lymphocytes from the upper dermis to the subcutaneous tissue (×40). (b) Many foamy cells had phagocytosed the hemocytes (×400) [source] Bullous variant of Sweet's syndromeINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2005Susanne Voelter-Mahlknecht MD A 69-year-old woman presented to our clinic as an emergency with erythematous, well-circumscribed plaques, which were partly vesicular, on her extremities and in her armpits, and additionally hemorrhagic blisters on both her palms and her fingers (Fig. 1a), which had developed 2 days after the first appearance of the skin lesions. The rapid onset of the lesions (within a few hours) and the pain associated with them were extremely troublesome to the patient. On admission she complained of fever, tiredness and being easily fatigued. Because of a urinary tract infection 1 month prior to admission, trospiumchloride was given. On clinical examination, body temperature was found to be above 38 °C and infraclavicular lymph nodes were enlarged but not tender. Figure 1. (a) Bullae on the patient's right hand. (b) Multiple partly confluent vesicles with neutrophilic granulocytes intraepidermally and a dense interstitial perivascular infiltration of neutrophilic granulocytes and lymphomononuclear cells (H&E, ×200) Normal or negative laboratory tests included blood counts, liver and kidney parameters, electrolytes and infection screen. Laboratory examination demonstrated minor leukocytosis and absolute neutrophilia (white blood cell count 10 440 cells/µL, neutrophils 8030 cells/µL). X-ray screening, abdominal ultrasound and laboratory investigations were all normal. There was no response to antibiotics when erythromycine was given. However, there was a good response to systemic corticosteroids. The patient was treated with a low dosage of prednisolone, beginning at 50 mg/day, which was then tapered off. Skin lesions resolved within 7 days. Histology from a lesion on the patient's left forearm showed a dense interstitial inflammatory infiltration consisting predominantly of neutrophilic granulocytes from the subepidermal layer to the middle of the reticular dermis. Inflammatory cells penetrated into both blood vessels and vessel walls; vasculitis was not prominent. In the lower dermis, perivascular infiltrations of lymphomononuclear cells were found. In addition, intraepidermally multiple partly confluent vesicles, with inclusions of neutrophilic granulocytes, were found, confirming the diagnosis of this rare variant of an acute febrile neutrophilic dermatosis (Fig. 1b). [source] Erythema dyschromicum perstans and hepatitis C virus infectionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2001George J. Kontochristopoulos MD A 48-year-old woman with a 10-month history of widespread, hyperpigmented, slightly pruritic macules, with a red border, involving the trunk and the proximal limbs (Fig. 1) was referred to our outpatient department. The oral mucosa, palms, soles, scalp, and nails were normal. Figure 1. Multiple hyperpigmented macules with an active border on the trunk Laboratory tests showed elevated liver enzymes [alanine aminotransferase (ALT), 68 IU/L (normal value, <,40 IU/L); aspartate aminotransferase (AST), 41 IU/L (normal value, <,40 IU/L)], the presence of antibodies to hepatitis C virus (anti-HCV) and HCV RNA (Amplicor Roche). In addition, cryoglobulinemia type III (IgM,,,, IgG,,,) was detected with a high cryocrit value, and there was detectable C-reactive protein, rheumatoid factor, and a low titer of antinuclear antibodies (1 : 80). A percutaneous liver biopsy showed changes compatible with mild chronic hepatitis (grade, 6; stage, 0). The possible source of infection was unknown, as the patient had no history of parenteral transmission (e.g. blood transfusions, intravenous illicit drug use). A skin biopsy specimen from the active border of a lesion showed hyperkeratosis, parakeratosis, and hydropic degeneration of the basal cell layer, with the formation of colloid bodies in the epidermis. A moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules was observed in the upper dermis (Fig. 2). Immunostaining of paraffin-embedded tissue sections with the TORDJT-22 IgG1 mouse monoclonal antibody to HCV (Biogenex, Son Ramon, USA), which is specific for the nonstructural region of HCV (NS3-NSH, C100 antigen) using the avidin,biotin,peroxidase complex (ABC) as well as the alkaline phosphatase antialkaline phosphatase (APAAP) methods, failed to detect HCV in the lesion of erythema dyschromicum perstans (EDP) (Nakopoulou L, Manolaki N, Lazaris A et al. Tissue immunodetection of C100 hepatitis C virus antigen in major thalassemic patients. Hepato-Gastroenterol 1999; 46: 2515,2520). Direct immunofluorescence showed IgG, IgM, IgA, and fibrinogen deposits on colloid bodies. EDP was diagnosed on the basis of these clinical and laboratory findings. Figure 2. Hydropic degeneration of the basal cell layer with colloid bodies in the epidermis. Moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules in the upper dermis (hematoxylin and eosin, ×,200) The patient was treated with interferon-,2b (Intron-A, Schering Plough Athens, Greece), 3 MU thrice weekly subcutaneously for 12 months, with additional topical steroid application. There was no response to this treatment with new lesions appearing in previously unaffected areas of the trunk and extremities. HCV RNA remained persistently positive. Thus, a modified regimen with interferon-,2b, 6 MU thrice weekly for 6 months, was tried. At the end of the treatment course, the eruption of EDP had greatly improved. Liver enzymes were normal (ALT, 22 IU/L; AST, 24 IU/L) and HCV RNA had become negative. Four months later, however, cutaneous lesions reappeared and hepatitis C relapsed. At this time point, combination therapy of interferon-,2b, 3 MU thrice weekly, with ribavirin, 1000 mg daily, was given. Six months later, liver enzymes were normal (ALT, 42 IU/L; AST, 39 IU/L), HCV RNA was negative, and the lesions of EDP had resolved. [source] Constrained total least-squares computations for high-resolution image reconstruction with multisensorsINTERNATIONAL JOURNAL OF IMAGING SYSTEMS AND TECHNOLOGY, Issue 1 2002Michael K. Ng Multiple undersampled images of a scene are often obtained by using a charge-coupled device (CCD) detector array of sensors that are shifted relative to each other by subpixel displacements. This geometry of sensors, where each sensor has a subarray of sensing elements of suitable size, has been popular in the task of attaining spatial resolution enhancement from the acquired low-resolution degraded images that comprise the set of observations. With the objective of improving the performance of the signal processing algorithms in the presence of the ubiquitous perturbation errors of displacements around the ideal subpixel locations (because of imperfections in fabrication), in addition to noisy observation, the errors-in-variables or the total least-squares method is used in this paper. A regularized constrained total least-squares (RCTLS) solution to the problem is given, which requires the minimization of a nonconvex and nonlinear cost functional. Simulations indicate that the choice of the regularization parameter influences significantly the quality of the solution. The L-curve method is used to select the theoretically optimum value of the regularization parameter instead of the unsound but expedient trial-and-error approach. The expected superiority of this RCTLS approach over the conventional least-squares theory-based algorithm is substantiated by example. © 2002 John Wiley & Sons, Inc. Int J Imaging Syst Technol 12, 35,42, 2002 [source] The irreversible cattle-driven transformation of a seasonally flooded Australian savannaJOURNAL OF BIOGEOGRAPHY, Issue 5 2003Ben R. Sharp Abstract Aim ,Anecdotal historical and photographic evidence suggests that woody vegetation is increasing dramatically in some northern Australian savanna habitats. Vegetation change in savannas has important implications for pastoral land-use, conservation management, and landscape-scale carbon storage, and informs theoretical debates about ecosystem function. This study seeks to determine the nature, extent and cause(s) of woody vegetation change in a seasonally flooded alluvial savanna habitat. Location ,The study area is located within the seasonally inundated alluvial zone of the tidal portion of the Victoria River, Northern Territory, Australia. The study area has been grazed by domestic stock since c. 1900, prior to which the area was inhabited and more likely regularly burnt by Aboriginal people for thousands of years. Methods ,Digital georeferenced aerial photographic coverages were used to examine and quantify woody vegetation change between 1948 and 1993. Transect surveys of woody and herbaceous vegetation were carried out to ground-truth air-photo results and determine the nature and causes of observed vegetation changes. Results ,There has been a dramatic increase in woody vegetation cover throughout the study area. Vegetation change patterns are roughly uniform across the full range of edaphic habitat variation and are unrelated to the depositional age of fluvial sediments. Two woody species, Eucalyptus microtheca and Excoecaria parvifolia, are predominantly responsible for observed increases. Demographic analyses reveal that woody invasions have been episodic and indicate that in most locations peak woody species establishment occurred in the mid-1970s. Grasses are almost absent in a majority of habitats within the study area. Instead, large areas are covered by scalded soil, dense invasive weed populations, and unpalatable forbs and sedges. What grasses do occur are predominantly of very low value for grazing. The condition of the herbaceous layer renders most of the study area almost completely non-flammable; what fires do burn are small and of low intensity. Main conclusions ,Multiple working hypotheses explaining observed patterns of woody vegetation increase were considered and rejected in turn. The only hypothesis consistent with the evidence is as follows: (1) observed changes are a direct consequence of extreme overgrazing by cattle, most likely when stocking rates peaked in the mid-1970s; (2) prolonged heavy grazing effected the complete transformation of much of the herbaceous vegetation to a new state that is not flammable; and (3) in the absence of regular fire mortality, woody vegetation increased rapidly. The relatively treeless system that existed in 1948 was apparently stable and resilient to moderate grazing levels, and perhaps also to episodic heavy grazing events. However, grazing intensity in excess of a sustainable threshold has forced a transition that is irreversible in the foreseeable future. Stable-state transitions such as this one inform debates at the heart of ecological theory, such as the nature of stability, resilience, equilibrium and carrying capacity in dynamic savanna ecosystems. [source] Radical prostatectomy: men's experiences and postoperative needsJOURNAL OF CLINICAL NURSING, Issue 7 2005Jean Burt MN Aims and objectives., This study sought to explore men's experiences after radical prostatectomy and whether they perceived their preoperative teaching adequately prepared them for postoperative recovery. Tape-recorded telephone and face-to-face interviews were conducted at days 2, 7 and 21, and 3 and 12 months postdischarge. Background., Although verbal and written instruction about postoperative expectations and care are provided routinely before radical prostatectomy, patients express concern about a lack of preparation in managing urinary incontinence and erectile dysfunction. Design., This qualitative descriptive study explored in-depth men's experiences during the year following their surgery. Methods., Multiple, tape-recorded, semistructured telephone interviews were conducted with 17 participants and a single, in-depth, face-to-face interview was conducted 12 months postoperatively with a subset of five men selected for their reflective and descriptive abilities. Results., Although participants received comprehensive written and verbal information preoperatively, it was not sufficient to foster their management of all postoperative sequelae. Telephone follow-up, used as a data collection strategy, was helpful in fostering adjustment after surgery and relieved anxiety caused by side effects of surgery and unanswered questions. Conclusions., Pre- and postoperative teaching needs to make allowances for the impact of stress on the recall and processing of information. Written information in itself is not adequate to answer necessary questions and provide reassurance. Follow-up telephone support is recommended as a way of fostering adjustment after surgery. Relevance to clinical practice., This study shows that: (i) Written information in itself is not adequate to answer necessary questions and provide reassurance, (ii) Nurses need to be prepared, both educationally and psychologically, to observe non-verbal cues and to address questions and concerns that are rarely voiced in ways that indicate their significance to the person and (iii) Men may not speak about sexuality issues in ways that accurately reflect the extent of their worry and/or distress about erectile dysfunction. [source] Nocardiosis in large yellow croaker, Larimichthys crocea (Richardson)JOURNAL OF FISH DISEASES, Issue 6 2005G-L Wang Abstract An epizootic in seawater-cage reared large yellow croaker, Larimichthys crocea, in China was caused by a Nocardia sp. from August to October 2003. The cumulative mortality rate was 15% and the diseased fish were 16 months old with individual length varying from 25 to 30 cm. Multiple, white nodules, 0.1,0.2 cm in diameter, were scattered on the heart, spleen and kidney. The morphology of isolated bacteria from Lowenstein,Jensen medium and tryptic soy agar was bead-like or long, slender, filamentous rods. Experimental infection indicated that the isolated bacterium was the pathogen responsible for the mortalities. A partial sequence of the 16S rRNA gene of the organism and the type strain of Nocardia seriolae JCM 3360T (Z36925) formed a monophyletic clade with a high sequence similarity of 99.9%. Based on the morphological, physiological, biological properties and the phylogenetic analysis, the pathogenic organism was identified as N. seriolae. This is the first report on N. seriolae -infected large yellow croaker in aquaculture. [source] Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old BoyJOURNAL OF FORENSIC SCIENCES, Issue 5 2009Charis Kepron M.D. Abstract:, Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury. [source] Hepatobiliary and Pancreatic: Multiple sexually transmitted infectionsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2010Y Nakanishi No abstract is available for this article. [source] Immediate and Long-Term Outcome of Recanalization of Chronic Total Coronary OcclusionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002FEDERICO PISCIONE M.D. Eighty-three consecutive patients with 85 coronary total occlusions undergoing coronary angioplasty were retrospectively studied. Patients were divided into two groups according to the occlusion age that was<30 days (subacute total occlusion [STO]: 25 patients; range 1,30 days) or>30 days (chronic total occlusion [CTO]: 58 patients; range 3,144 months). All procedures were carried out using a hydrophilic guidewire. Clinical success, consisting of crossing the lesion, balloon dilatation, stent deployment without complication, was 96% in STO and 81% in CTO. Multiple stepwise logistic regression analysis identified a family history of coronary artery disease (CAD), left anterior descending and right coronary artery occlusions as independent predictors of a successful procedure. No major events occurred during or immediately after the angioplasty. After a mean follow-up of 24 ± 2 months, no difference was found in survival or freedom from myocardial infarction or target vessel revascularization among the STO and CTO patients. Successful recanalization by using a hydrophilic guidewire was achieved in a high percentage of chronic total occlusions with a low incidence of complications and a satisfactory late clinical outcome. Family history of CAD and occlusion of left anterior descending or right coronary arteries are independent predictors of procedural success. [source] Oral manifestation of chronic mucocutaneous candidiasis: seven case reportsJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 9 2007Xiaosong Liu Background:, Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterized by persistent or recurrent candidal infections of the skin, nails and mucous membranes or by a variable combination of endocrine failure as well as immunodeficiency. Oral clinicopathological features of CMC have seldom been described in detail. Methods:, Seven patients with CMC were reported in the study. The clinical and histological findings, etiological Candida species, immunological evaluation, and therapeutic pattern of oral lesions, were analyzed. Results:, Long-standing whitish hyperplastic and nodule-like lesions with exaggerated deep fissure were the typical and characteristic oral manifestations presented by all patients. The tongue was the most common site affected. Histologically, no obvious distinction was found between CMC and other forms of candidal infection. Abnormal proportions of T-lymphocyte subsets and positive titers of autoantibody were observed in three subjects (42.9%) and one patient (14.3%) respectively. Meanwhile, four subjects (57.1%) showed decreased albumin and increased globulin, three cases (42.9%) had high levels of ESR. But no iron deficiency was found. Candida albicans was the microorganism isolated from these patients. Conclusions:, Multiple and widespread candidal infectious lesions can be observed on the oral cavity of CMC patients. Hyperplastic and nodule-like lesion with irremovable whitish patches and deep fissure are the most common oral manifestations of these patients. Dentists, otolaryngologists and pediatricians should be familiar with the clinical appearances of CMC to make an accurate diagnosis. Potential systemic disorders should be concerned to avoid the reoccurrence of oral candidiasis. [source] 120 Exploration of Morphological Variation Within the Genus Pediastrum Meyen 1829 (Chlorophyceae, Chlorophyta)JOURNAL OF PHYCOLOGY, Issue 2003H. A. McManus Monographic works on the green algal genus, Pediastrum Meyen 1829 (Chlorophyceae, Chlorophyta), have described species, varieties and forms based on such characteristics as the size and shape of the marginal cells, pattern of cell wall sculpturing and extent of cell wall sculpturing. Depending on the author, the number of taxa assigned to the genus Pediastrum varies. Due to the lack of quantitative value to these characteristics, it has been difficult for other researchers to assign appropriate taxonomy to wild isolates. A molecular phylogeny including multiple strains from both culture collections and wild samples confirms relationships found by previous molecular studies on fewer taxa, in which the family Hydrodictyaceae forms a monophyletic group within the Sphaeropleales, and that the genera Hydrodictyon and Sorastrum are derived from Pediastrum. Hydrodicyton forms a monophyletic clade and consists of three species, H. reticulatum, H. africanum, and H. patenaeforme. Multiple isolates of H. reticulatum reveal little genetic variation between different geographic localities. Inclusion of wild isolates permits a more thorough exploration of morphological variation within the genus Pediastrum, and what characters may be taxonomically informative, particularly in the species P. boryanum and P. duplex. Wild isolates sampled from different areas also offers information regarding geographic variation and potential morphological convergence. [source] Effect of a Comprehensive Lifestyle Modification Program on the Bone Density of Male Heavy DrinkersALCOHOLISM, Issue 5 2010Toshifumi Matsui Background:, Heavy alcohol drinking is implicated in osteoporosis. Although abstinence is rapidly followed by a restoration of osteoblastic activity, little is known about the contributions of alcohol-related factors or the effectiveness of a lifestyle modification program (LMP) on bone density. Methods:, We conducted a study of 138 male alcoholic patients to investigate whether drinking history and concurrent factors were associated with the bone density of the calcaneus. A 2.5-months LMP in an institutionalized setting was completed by 20 of them, and its effect on bone density, serum parathyroid hormone (PTH), and 1.25-(OH)2 vitamin D levels were assessed. Results:, The patients had a high prevalence of daytime drinking (93.5%), continuous drinking (84.1%), and current smoking (82.0%) with mean duration of alcohol abuse of 30.0 ± 12.8 years. The patients had lower bone density than a reference control group (Z-scores: ,0.45 ± 1.02). Multiple stepwise regression analysis identified age, poor activities of daily living (ADL), continuous drinking, absence of liver cirrhosis, depression, and dementia as determinants of low bone density. The bone density of the 20 participants in the LMP improved 2.3% (p = 0.0003) with a more ameliorating effect on bone density than a conventional abstinence therapy (p = 0.014 for interventional effect). The upper normal range of PTH levels at baseline were significantly decreased, and 1.25-(OH)2 vitamin D levels also had a trend toward decrease during the abstinence. Conclusions:, Alcoholic patients may have many complications such as poor ADL and dementia, which are independently associated with decreased bone density. The results of this study support the idea that comprehensive approach to lifestyle factors to minimize risk of osteoporosis is the best way to improve bone density. [source] Gene Expression in the Neuropeptide Y System During Ethanol Withdrawal Kindling in RatsALCOHOLISM, Issue 3 2010Janne D. Olling Background:, Multiple episodes of ethanol intoxication and withdrawal result in progressive, irreversible intensification of the withdrawal reaction, a process termed "ethanol withdrawal kindling." Previous studies show that a single episode of chronic ethanol intoxication and withdrawal causes prominent changes in neuropeptide Y (NPY) and its receptors that have been implicated in regulating withdrawal hyperexcitability. This study for the first time examined the NPY system during ethanol withdrawal kindling. Methods:, Ethanol withdrawal kindling was studied in rats receiving 16 episodes of 2 days of chronic ethanol intoxication by intragastric intubations followed by 5 days withdrawal. The study included 6 groups: 4 multiple withdrawal episode (MW) groups [peak withdrawal plus (MW+)/minus (MW,) seizures, 3-day (MW3d), and 1-month (MW1mth) withdrawal], a single withdrawal episode group (SW), and an isocalorically fed control group. Gene expression of NPY and its receptors Y1, Y2, and Y5 was studied in the hippocampal dentate gyrus (DG) and CA3/CA1, as well as piriform cortex (PirCx), and neocortex (NeoCx). Results:, MW+/, as well as SW groups showed decreased NPY gene expression in all hippocampal areas compared with controls, but, in the DG and CA3, decreases were significantly smaller in the MW, group compared with the SW group. In the MW+/, and SW groups, Y1, Y2, and Y5 mRNA levels were decreased in most brain areas compared with controls; however, decreases in Y1 and Y5 mRNA were augmented in the MW+/, groups compared with the SW group. The MW+ group differed from the MW, group in the PirCx, where Y2 gene expression was significantly higher. Conclusion:, Multiple withdrawal episodes reversibly decreased NPY and NPY receptor mRNA levels at peak withdrawal, with smaller decreases in NPY mRNA levels and augmented decreases in Y1/Y5 mRNA levels compared with a SW episode. Multiple withdrawal-induced seizures increased the Y2 mRNA levels in PirCx. These complex changes in NPY system gene expression could play a role in the ethanol withdrawal kindling process. [source] NEXAFS multiple scattering calculations of KO2JOURNAL OF SYNCHROTRON RADIATION, Issue 2 2001M. Pedio Since many years the oxidation of alkali metals has being attracted much interest due to the catalytic properties of metal promoters and the simple electronic structure of alkali atoms. The alkali-oxides phase diagram indicates that the interaction of oxygen with alkali metals can lead to the formation of different atomic O2- ions and molecular O2 - and O22- ions. Potassium superoxide has been prepared in situ and high resolution O k-edge absorption NEXAFS spectra have been measured at the VUV beam-line at ELETTRA facility. The experimental data have been analyzed by multiple scattering approach deriving many geometrical and electronic details. In particular, we have found that the growth material structure is of the KO2 type with an O-O distance of about 1.35Å and that the transition involving single , molecular empty state of the superoxide O2 - anion has a fine structure. Multiple Scattering self consistent calculation indicates that the bond between oxygen anion and K atom is totally ionic and that the fine structure is essentially due to solid state effects. [source] Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C , an updated Cochrane reviewALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010J. Brok Aliment Pharmacol Ther 2010; 32: 840,850 Summary Background, Multiple randomized trials have been published on antiviral treatment for chronic hepatitis C. Aim, To meta-analyse the effect of adding ribavirin to interferon for chronic hepatitis C. Methods, The results of randomized trials were combined in cumulative meta-analyses. Trial sequential analyses were used to adjust for spurious results because of random errors and multiplicity. The outcome measures were undetectable hepatitis C virus RNA in serum (sustained virological response) and liver-related morbidity plus all-cause mortality. Results, We included 82 randomized trials with 12 615 patients. Trial sequential analysis established clear beneficial effect of interferon plus ribavirin vs. interferon on the sustained virological response in 1998 after nine trials (RR: 0.74; 95% CI: 0.64,0.85, P < 0.0001, 1734 patients). Subsequently, additional 73 trials were published just narrowing the confidence interval and decreasing the P -value. By contrast, trial sequential analysis found that additional evidence is needed to convincingly detect a beneficial effect of interferon plus ribavirin vs. interferon monotherapy on clinical outcomes. Conclusions, The rationale behind several recent trials on adding ribavirin to interferon for chronic hepatitis C is debatable as the effect on virological response is established. More evidence is needed to assess if adding ribavirin to interferon improves clinical outcomes. [source] Review article: dual delayed release formulation of dexlansoprazole MR, a novel approach to overcome the limitations of conventional single release proton pump inhibitor therapyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009D. C. METZ Summary Background, Proton pump inhibitors (PPIs) provide the most effective pharmacotherapy for treating acid-related disorders. However, PPIs do not completely control acid over 24 h with once-daily dosing. Aims, To discuss limitations inherent in the pharmacokinetics (PK) and pharmacodynamics of conventional PPI formulations, which provide a single drug release. Also, to consider approaches to extending the duration of acid suppression focusing on dexlansoprazole MR, a PPI with a novel Dual Delayed Release (DDR) formulation. Method, We reviewed the available literature regarding marketed and investigational PPIs. Results, Non-standard dosing of currently marketed PPIs has produced incremental advances in acid control. Multiple approaches are being evaluated to enhance acid suppression with PPIs. Dexlansoprazole MR is a DDR formulation of dexlansoprazole, an enantiomer of lansoprazole, with two distinct drug release periods to prolong the plasma dexlansoprazole concentration,time profile and extend duration of acid suppression. Clinical studies show that dexlansoprazole MR produces a dual-peak PK profile that maintains therapeutic plasma drug concentrations longer than lansoprazole, with a single-peak PK profile, and increases the percentage of time that intragastric pH >4. Conclusions, Novel drug delivery platforms, including the dexlansoprazole MR DDR formulation, may improve acid suppression and offer benefits over conventional single release PPI formulations. [source] Stimulated Raman scattering and cascaded nonlinear laser (,(3) , ,(2)) effects in tetragonal non-centrosymmetric Li2B4O7 single crystalsLASER PHYSICS LETTERS, Issue 11 2006A. A. Kaminskii Abstract Multiple stimulated Raman scattering (SRS) and cascaded nonlinear ,(3) , ,(2) generation in tetragonal non-centrosymmetric Li2B4O7 crystal were observed under picosecond Nd3+:Y3Al5O12 laser excitation. All registered Stokes and anti-Stokes lasing components in the visible and near-IR were identified and attributed to the SRS-promoting vibration modes of the studied crystal. We classify the Li2B4O7 crystals as a promising media for up- and down-Raman laser-frequency converters. In the work a brief review of nonlinear-laser properties of SRSactive borate crystals is given. (© 2006 by Astro, Ltd. Published exclusively by WILEY-VCH Verlag GmbH & Co. KGaA) [source] Registered nurse-administered propofol sedation for endoscopyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2004S. C. Chen Summary Propofol has several attractive properties that render it a potential alternative sedative agent for endoscopy. Compared with meperidine and midazolam, it has an ultra-short onset of action, short plasma half-life, short time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. Shorter times to achieve sedation enhance efficiency in the endoscopy unit. Multiple studies have documented the safe administration of propofol by non-anaesthesiologists. Administration by registered nurses is more cost-effective than administration by anaesthesiologists. However, the administration of propofol by a registered nurse supervised only by the endoscopist is controversial because the drug has the potential to produce sudden and severe respiratory depression. More information is needed on how training nurses and endoscopists should proceed to give propofol, as well as the optimal level of monitoring to ensure the safety of nurse-administered propofol. [source] | |||||||||||||||||||||||||||||||