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Selected AbstractsSimultaneous bilateral external dacryocystorhinostomyACTA OPHTHALMOLOGICA, Issue 6 2007Bulent Yazici Abstract. Purpose:, To assess the outcome and complications of simultaneous bilateral external dacryocystorhinostomy (DCR) surgery. Methods:, The records of all patients who underwent bilateral external DCR in a single session between November 1999 and October 2005 were reviewed. Results:, The study cohort comprised 59 patients (50 females, nine males; age range: 6,72 years; mean age: 49 years). Nasolacrimal duct obstruction was acquired primarily in 54 patients, congenitally in three and secondary to sinonasal surgery in two. Thirteen eyes of eight patients had a history of unsuccessful lacrimal surgery. The operation was performed under local anaesthesia plus sedation in 54 patients (92%). Total intraoperative haemorrhage varied from 3 mL to 200 mL (median: 17 mL; mean: 37 mL). Excessive intraoperative haemorrhage (= 100 mL) occurred in five patients (9%). Total duration of surgery varied between 70 and 140 min, with an average of 89 min. Postoperatively, early bleeding requiring intranasal tamponade developed in one patient (2%) and bilateral wound infection in one patient (2%). Surgical success rate was 95%. Mean follow-up time was 8.8 months (range: 3,38 months). Conclusion:, This study supports that the simultaneous bilateral external DCR surgery may not adversely affect surgical success and complication rates. [source] Branching probabilities planning of stochastic network model using genetic algorithm supported by sensitivity analysisELECTRICAL ENGINEERING IN JAPAN, Issue 4 2008Kenzo Kurihara This paper proposes a new method of planning the project durations that are modeled as stochastic networks such as GERT networks. Since stochastic networks have a variable time and a branching probability for each arrow, the total duration of the network is also modeled as a variable. In order to complete the project by the desired date with a certain confidence, the variable times or branching probabilities of the network should be designed appropriately. We will propose a planning method for branching probabilities to realize the desired project duration using GA and Monte Carlo simulation. © 2007 Wiley Periodicals, Inc. Electr Eng Jpn, 162(4): 43,53, 2008; Published online in Wiley InterScience (www.interscience. wiley.com). DOI 10.1002/eej.20582 [source] Analysis by DC,EPG of the resistance to Bemisia tabaci on an Mi -tomato lineENTOMOLOGIA EXPERIMENTALIS ET APPLICATA, Issue 3 2001Y.X. Jiang Abstract The tomato Mi gene confers resistance to nematodes, Meloidogyne spp., and to the potato aphid, Macrosiphum euphorbiae (Thomas). Previous greenhouse choice assays with Bemisia tabaci (Gennadius) showed that tomato commercial varieties carrying this gene had significantly lower values of host suitability and whitefly reproduction than varieties lacking Mi. This indicated that Mi, or another gene in its region, could regulate partial resistance. In order to characterise this resistance, probing and feeding behaviour of Bemisia tabaci B-biotype was studied with DC Electrical Penetration Graph (EPG) technique on the near-isogenic tomato lines Moneymaker (without Mi) and Motelle (carrying Mi). Significant differences (P < 0.05) between tomato lines were found in EPG parameters related to epidermis and/or mesophyll tissues. On Motelle, a lower percentage of whiteflies achieved phloem phase and they made more probes before attaining first phloem phase, had a higher ratio (number of probes before first phloem phase)/(total number of probes), had a longer total duration of non-probing time, and a longer time before making the first intracellular puncture and before making the first phloem phase. In contrast, most of the parameters related to phloem phase were found not to differ significantly between these near-isogenic lines. The behavioural data strongly suggest that the partial resistance in the variety Motelle is due to factors in the epidermis and/or mesophyll that inhibit the whiteflies from reaching phloem sieve elements. However, once the stylets reach a sieve element, whitefly behaviour did not differ between the two varieties. Thus, phloem sap of the two varieties appears to be equally acceptable to the whiteflies. Further studies are necessary to provide a better understanding of these mechanisms of resistance to whiteflies in tomatoes. [source] Timing of exposure to a pulp and paper effluent influences the manifestation of reproductive effects in rainbow troutENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2002Michael R. Van den Heuvel Abstract Rainbow trout were exposed to a secondary treated, thermomechanical/bleached kraft pulp and paper effluent in 12,000-L, flow-through exposure tanks at an environmental research facility located at a pulp and paper mill in Kawerau, New Zealand. Trout (age, 2+ years) were obtained from a local hatchery and exposed either to upstream river water or a nominal concentration of 12% (v/v) effluent diluted in upstream river water. Three treatment groups were used: Effluent exposure that started approximately three months before gonadal growth (eight-month total exposure), effluent exposure that started approximately halfway through gonadal development (two-month total exposure), and trout exposed to reference water alone for the total duration of the experiment. Trout were sacrificed just before spawning; exposure, growth, and reproductive endpoints were assessed during and at the termination of the experiment. Reduction in growth was observed in both sexes in the eight-month treatment group relative to the river water reference treatment group. No differences were observed in condition factor or liver size in either treatment. Females in the eightmonth exposure group also had significantly lower ovary weight. The two-month exposure group showed no differences from the reference group in growth or somatic indices. Estradiol and testosterone were reduced in blood samples taken from the eight-month exposure group by four months into the experiment as compared to the reference treatment. Steroid and vitellogenin levels in individual female trout from this treatment were significantly correlated with gonadosomatic indices (GSI) measured at the termination of the experiment. The GSI was not correlated strongly or consistently with pregnenolone, nor were any treatment-related pregnenolone differences observed, indicating that the steroid hormone reductions likely were not related to cholesterol side-chain cleavage. Male trout showed significant induction of vitellogenin and lower 11-ketotestosterone during the experiment (only the eight-month group was examined), but this did not result in any significant differences in testes development. Thus, this study has shown an impact of pulp mill effluent exposure on the reproductive physiology of female trout that appeared to be hormonally mediated. Furthermore, the effect could only be manifest when the exposure was initiated before the start of gonad development. [source] Role of cortical dysplasia in epileptogenesis following prolonged febrile seizureEPILEPSIA, Issue 9 2010Kyung-Il Park Summary Purpose:, Hippocampal sclerosis, characterized by prominent neuronal loss and reactive gliosis, is the most common pathology in human temporal lobe epilepsy (TLE). Although prolonged febrile convulsion (FC) is a risk factor of TLE, it is not clear whether FC provokes hippocampal sclerosis and subsequent TLE. Given that underlying brain lesions, such as cortical dysplasia (CD), in the immature brain predispose patients to FC, CD may link FC and TLE. However, the role of CD in epileptogenesis after FC is also unclear. Here, we investigated whether inborn CD increases the risk of later epilepsy induced by prolonged FC using a rat model. Methods:, Experimental CD was induced by in utero exposure of methylazoxymethanol (MAM). Rat pups from MAM-treated or control rats were then subjected to prolonged FC. We examined morphologic changes in the hippocampi with respect to neuronal loss, reactive gliosis, and synaptogenesis, and evaluated spontaneous recurrent seizures (SRS) by long-term video-EEG (electroencephalography). Results:, The MAM+FC group had a significantly lower hippocampal neuronal density in the CA1 and dentate hilus than other control groups. A robust increase in glial cells and synaptic reorganization was also detected in the MAM+FC groups. Furthermore, later SRS occurred in all rats in the MAM+FC group and in 50% and 25% of the rats in the FC-only and MAM-only group, respectively. The frequency and total duration of SRS was highest in the MAM+FC group. Discussion:, Our results suggest that preexisting CD in the immature brain augments the proepileptogenic effects of prolonged FC, leading to TLE. [source] Fibre-type composition of rabbit jaw muscles is related to their daily activityEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2005T. van Wessel Abstract Skeletal muscles contain a mixture of fibres with different contractile properties, such as maximum force, contraction velocity and fatigability. Muscles adapt to altered functional demands, for example, by changing their fibre-type composition. This fibre-type composition can be changed by the frequency, duration and presumably the intensity of activation. The aim of this study was to analyse the relationship between the spontaneous daily muscle activation and fibre-type composition in rabbit jaw muscles. Using radio-telemetry combined with electromyography, the daily activity of five jaw muscles was characterized in terms of the total duration of muscle activity (duty time) and the number of activity bursts. Fibre-type composition of the muscles was classified by analysing the myosin heavy chain content of the fibres. The amount of slow-type fibres was positively correlated to the duty time and the number of bursts only for activations exceeding 20,30% of the maximum activity per day. Furthermore, cross-sectional areas of the slow-type fibres were positively correlated to the duty time for activations exceeding 30% of the maximum activity. The present data indicate that the amount of activation above a threshold (> 30% peak activity) is important for determining the fibre-type composition and cross-sectional area of slow-type fibres of a muscle. Activation above this threshold occurred only around 2% of the time in the jaw muscles, suggesting that contractile properties of muscle fibres are maintained by a relatively small number of powerful contractions per day. [source] Risk factors of fibrosis in alcohol-induced liver diseaseHEPATOLOGY, Issue 3 2002Bruno Raynard In patients with nonalcoholic steatohepatitis (NASH), age, obesity, and diabetes mellitus are independent predictors of the degree of fibrosis. The relative risk for fibrosis adjusted for sex was also associated with increasing grade of Perls stain. The aim of this study was to determine whether the risk factors for fibrosis described in NASH are also risk factors in alcohol-induced liver disease. A total of 268 alcoholic patients with negative hepatitis B virus and hepatitis C virus serology underwent liver biopsy. Fibrosis was assessed semiquantitatively by a score fluctuating between 0 to 8. Liver iron overload was assessed by Perls staining and graded in 4 classes. We have used multivariate regression with partial correlation analysis to assess the variability of fibrosis score according to the value of 7 variables: sex, age, body mass index (BMI) in the past year before the hospitalization when the patient was asymptomatic, daily alcohol intake over the past 5 years, total duration of alcohol abuse, Perls grade, and blood glucose level. In the multivariate regression, fibrosis score was positively correlated with age (P = .001), BMI (P = .002), female sex (P < .05), Perls grade (P < .05), and blood glucose level (P < .05). Twenty percent of the variability of fibrosis score was explained by the 7 variables. In conclusion, after adjustment for daily alcohol intake and total duration of alcohol abuse, BMI, Perls grade, and blood glucose are also independent risk factors for fibrosis in alcohol-induced liver disease, raising therapeutic implications for the management of these patients. [source] Two week induction of interferon-beta followed by pegylated interferon alpha-2b and ribavirin for chronic infection with hepatitis CHEPATOLOGY RESEARCH, Issue 8 2010Keiji Matsui Objectives:, To elucidate the efficacy of interferon (IFN)-beta induction therapy followed by pegylated IFN alpha and ribavirin for chronic infection with hepatitis C virus (HCV). Methods:, Patients chronically infected with HCV genotype 1, high titer were enrolled. Twice daily bolus injections of 3 million units IFN-beta were administered for 14 days. Thereafter, weekly injection of pegylated IFN alpha 2b and daily intake of ribavirin were followed. Therapy duration was adjusted according to the response to the therapy. When time to an undetectable HCV-RNA was 1, 2, 4, 8, and 12 weeks, total duration of therapy was 12, 24, 36, 48 and 60 weeks, respectively. Patients who failed to achieve an undetectable HCV-RNA within 12 weeks discontinued therapy on 12 week. Results:, Among the 101 patients treated, 56 (55.4%) achieved sustained virological response (SVR). SVR rate for each treatment duration was 10/10 for 12 weeks, 12/14 for 24 weeks, 18/19 for 36 weeks, 15/26 for 48 weeks, 1/4 for 60 weeks and 0/28 for patients who discontinued therapy at 12 weeks. Mean time to an undetectable HCV-RNA was 35.5 ± 2.7 days. Mean therapy duration was 27.3 ± 1.4 weeks. Using a cut off value of 21.5 fmol/L of HCV core-antigen in the first week, SVR could be predicted by sensitivity of 0.91 and specificity of 0.78. Conclusion:, IFN-beta induction therapy resulted in acceptable SVR rates despite short therapy duration. Steep reduction of HCV by IFN-beta enables us to predict SVR in the first week of therapy. [source] Matched case,control study to evaluate risk factors for hyperlactataemia in HIV patients on antiretroviral therapyHIV MEDICINE, Issue 4 2003D Datta Background Lactic acidosis is a life-threatening event during antiretroviral therapy (ART). Hyperlactataemia may be a prelude to acidosis. Our database study suggested that female gender, intercurrent illness and didanosine (ddI)-based regimens may increase risk of lactic acidosis. The aim of this matched case,control study was to identify risk factors for hyperlactataemia requiring screening. Methods Cases were defined as patients with two consecutive lactate samples ,3.5 mmol/L taken more than 1 week apart. Cases were matched to two controls on gender, use of ddI and total duration of therapy using a 6-month window on either side. Controls never had raised lactate >2.5 mmol/L. A conditional logistic regression analysis using the PHREG procedure in SAS (SAS Institute Inc, Cary, NC) was performed with a discreet logistic model stratified by matching variables. Results Twenty-one cases were matched to 42 controls. In the univariate model, current use of stavudine (d4T), total cholesterol >5.3 mmol/L and glucose levels ,5.2 mmol/L gave increased likelihood of persistent hyperlactataemia. The multivariate model showed current use of d4T to be a significant independent predictor of persistent hyperlactataemia. Conclusions The results of this case,control study indicate that, when controlling for ddI use, d4T use is an additional risk factor for hyperlactataemia. [source] Pediatric Crohn's disease activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years laterINFLAMMATORY BOWEL DISEASES, Issue 11 2009Tamara Mesker MD Abstract Background: No studies have been performed in which therapeutic regimens have been compared between mild and moderate-to-severe pediatric Crohn's disease (CD) at diagnosis. The aim was to analyze pediatric CD activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years later. Methods: In a retrospective multicenter study we divided pediatric CD patients at diagnosis into mild or moderate-severe disease. We compared initial therapies, duration of first remission, number of exacerbations, height-for-age and weight-for-height evolvement, and cumulative duration of systemic steroid use in a 5-year follow-up period. Results: Forty-three children were included (25 with mild and 18 with moderate-severe disease). Aminosalicylate monotherapy was more frequently prescribed in the mild group (40% versus 17%; P < 0.01). The median duration of systemic steroid use was 18.3 months in the mild group and 10.4 months in the moderate-severe group (P = 0.09). Duration of first remission was 15.0 months in the mild group and 23.4 months in the moderate-severe group (P = 0.16). The mean number of exacerbations was 2.2 in the mild group and 1.8 in the moderate-severe group (P = 0.28). Conclusions: CD patients with mild disease were treated with aminosalicylate monotherapy more frequently. These patients, however, tend to have more exacerbations, shorter duration of first remission, and longer total duration of systemic steroid use. Our data support the concept that severity of disease at diagnosis does not reliably predict subsequent clinical course. This study suggests that there is no indication that children with mild CD should be treated differently compared to children with moderate-severe disease. (Inflamm Bowel Dis 2009) [source] Computational energy analysis of an innovative isothermal chamber for testing of the special equipment used in the transport of perishable productsINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 10 2004S. K. Chatzidakis Abstract This paper describes an improved numerical simulation study of an isothermal chamber recently constructed at Zografou Campus of the National Technical University of Athens (NTUA) for the testing of special equipment used for transporting perishable foodstuffs in accordance with the United Nations ATP agreement. Using a transient finite difference model, a simulation is developed for a modern ATP test chamber and a typical specimen refrigerated vehicle to be tested. The simulation results are compared to experimental measurements taken under real conditions by a data acquisition system and a refrigerated semi-trailer as specimen. Proportional,integral control is employed for the regulation of the cooling and heating system. The impact of various parameters on the time required to reach the set-point temperature (tset) is investigated and the energy consumption is simulated for a period of 22 h. In particular, the impact of specimen insulation thickness and the thickness of the chamber insulation floor are considered in detail. The total energy consumption increases by approximately 16% when the concrete floor layer thickness is increased from 8 to 16 cm for typical initial conditions and desired chamber and specimen temperatures of 32.5 and 7.5°C, respectively. Using a floor insulation of 6 cm extruded heavy strain-resistant polystyrene reduces the energy consumption by at least 13%. Specimen insulation thickness increase from U -value of 0.35 W m,2 K to 0.75 W m,2 K result to an increase in energy consumption by a percentage of 28%. Thermal capacity, temperature of car body and specimen dimensions are also treated as variables that affect the total duration of an ATP test and its total energy consumption. Copyright © 2004 John Wiley & Sons, Ltd. [source] Randomized Comparison of Bipolar versus Unipolar Plus Bipolar Recordings During Segmental Ostial Ablation of Pulmonary VeinsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2002HIROSHI TADA M.D. Unipolar vs Bipolar Electrograms.Introduction: Segmental ostial ablation to isolate pulmonary veins is guided by pulmonary vein potentials. The aim of this prospective randomized study was to compare the utility of unipolar plus bipolar electrograms versus only bipolar electrograms as a guide for segmental ablation to isolate the pulmonary veins in patients with atrial fibrillation. Methods and Results: Isolation of the left superior, right superior, and left inferior pulmonary veins was attempted in 44 patients (35 men and 9 women; mean age 54 ± 10 years) with paroxysmal atrial fibrillation. A decapolar Lasso catheter was positioned in the pulmonary veins, near the ostium, and a conventional ablation catheter was used for segmental ablation aimed at elimination of all pulmonary vein potentials. One hundred fourteen pulmonary veins were randomly assigned for ostial ablation guided by either bipolar or unipolar plus bipolar recordings. Electrical isolation was achieved in 51 (96%) of 53 pulmonary veins randomized to the bipolar approach, and 57 (93%) of 61 pulmonary veins randomized to the unipolar plus bipolar approach (P = 0.7). In the unipolar plus bipolar group, the total duration of radiofrequency energy needed to achieve isolation, 5.5 ± 2.8 minutes/vein, was significant shorter than in the bipolar group, 7.6 ± 4.1 minutes/vein (P < 0.01). Mean procedure and fluoroscopy durations per vein were 19% to 28% shorter in the unipolar plus bipolar group. Conclusion: Segmental ostial ablation to isolate the pulmonary veins can be achieved more efficiently and with less radiofrequency energy when guided by both unipolar and bipolar recordings than by bipolar recordings alone. [source] Stringent cessation criterion results in better durability of lamivudine treatment: a prospective clinical study in hepatitis B e antigen-positive chronic hepatitis B patientsJOURNAL OF VIRAL HEPATITIS, Issue 4 2010L. Wang Summary., The cessation criteria for lamivudine treatment vary in published articles and their results are contradictory, especially factors predicting relapse. To clarify these contradictions, this long-term follow-up study of 125 Chinese hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients was designed with stringent cessation criterion. All patients received lamivudine and achieved HBeAg seroconversion (group A, n = 82) or loss (group B, n = 43) with undetectable hepatitis B virus (HBV) DNA by PCR assay during the treatment. Lamivudine was withdrawn ,6 months after HBeAg seroconversion/loss occurred. The median treatment durations were 24 (12,54) months and 36 (18,89) months in group A and group B, respectively. Patients were followed up for median 24 (2,84) months. The cumulative relapse (defined as serum HBV DNA ,104 copies/mL) rates in the two groups at months 12, 24, 36 and 48 were 23.4%vs 35.0%, 25.0%vs 37.7%, 25.0%vs 41.1% and 29.4%vs 41.1%, respectively (log-rank test, P = 0.119). For patients whose total treatment duration ,18 months in group A, the cumulative relapse rates at months 12, 24, 36 and 48 were 18.3%, 20.1%, 20.1% and 25.1%, which was significantly lower than those with a shorter duration (log-rank test, P = 0.002). The mean age and median total duration were statistically different between relapsers and nonrelapsers in group A (33.9 ± 13.6 vs 23.1 ± 11.0 years, P < 0.001 and 24 vs 26 months, P = 0.003). Cox regression revealed that age was the only predictive factor for relapse (RR, 1.069; 95% CI, 1.032,1.106, P < 0.001). Patients aged <30 years relapsed less frequently in 5 years (12.3%vs 53.5%, P = 0.001). In conclusion, for patients who maintained HBeAg seroconversion for ,6 months and total duration for ,18 months, lamivudine withdrawal is a reasonable option. Prolonged treatment may be required for patients aged greater than 30 years to reduce relapse. [source] Emergency hospital admissions in idiopathic Parkinson's diseaseMOVEMENT DISORDERS, Issue 9 2005Henry Woodford BSc Abstract Little is known about the hospital inpatient care of patients with idiopathic Parkinson's disease (PD). Here, we describe the features of the emergency hospital admissions of a geographically defined population of PD patients over a 4-year period. Patients with PD were identified from a database for a Parkinson's disease service in a district general hospital with a drainage population of approximately 180,000. All admissions of this patient subgroup to local hospitals were found from the computer administration system. Two clinicians experienced in both general medicine and PD then reviewed the notes to identify reasons for admission. Admission sources and discharge destinations were recorded. Data regarding non-PD patients was compared to PD patients on the same elderly care ward over the same time period. The total number of patients exposed to analysis was 367. There was a total exposure of 775.8 years and a mean duration of 2.11 years per patient. There were 246 emergency admissions to the hospital with a total duration of stay of 4,257 days (mean, 17.3 days). These days were accounted for by 129 patients (mean age, 78 years; 48% male). PD was first diagnosed during 12 (4.9%) of the admissions. The most common reasons for admission were as follows: falls (n = 44, 14%), pneumonia (n = 37, 11%), urinary tract infection (n = 28, 9%), reduced mobility (n = 27, 8%), psychiatric (n = 26, 8%), angina (n = 21, 6%), heart failure (n = 20, 6%), fracture (n = 14, 4%), orthostatic hypotension (n = 13, 4%), surgical (n = 13, 4%), upper gastrointestinal bleed (n = 10, 3%), stroke/transient ischemic attack (n = 8, 2%), and myocardial infarction (n = 7, 2%). The mean length of stay for the PD patients on the care of elderly ward specializing in PD care was 21.3 days compared to 17.8 days for non-PD patients. After hospital admission, there was a reduction in those who returned to their own home from 179 to 163 and there was an increase in those requiring nursing home care from 37 to 52. Infections, cardiovascular diseases, falls, reduced mobility, and psychiatric complications accounted for the majority of admissions. By better understanding the way people with PD use hospital services, we may improve quality of care and perhaps prevent some inpatient stays and care-home placements. © 2005 Movement Disorder Society [source] Ultrasound assessment of large joint amyloidosis in haemodialysisNEPHROLOGY, Issue 1-2 2000Marc Lanteri SUMMARY: Dialysis-related amyloidosis (DRA), associated with beta-2 microglobulin deposition, is a common cause of morbidity in patients with renal failure undergoing chronic dialysis. The non-invasive diagnosis of DRA in its early stages is difficult. High resolution ultrasound (US) was used to examine the shoulder, hip and knee joints of 25 chronic haemodialysis patients, and features distinctive of DRA were determined. Distinctive US features were associated with increased total duration of dialysis (15 ± 5 vs 4 ± 2 years), carpal tunnel syndrome (9/10 cases) and shoulder joint discomfort (19 vs three joints). These features include altered rotator cuff echogenicity (hyperechoic and hypoechoic areas; 20/48 joints), hypoechoic material in the biceps sheath (16/48), erosions of bone (15/48) and reduced biceps tendon fibril echogenicity (12/48). These changes are unique in the experience of the current authors, but histological proof that they are definitely the result of DRA has not yet been possible. Tears of the rotator cuff tendons (14/50) were not consistently associated with symptoms (7/14). Tendon thickness was also increased (as has been described previously). The hip capsule thickness was increased in patients with signs of DRA in the shoulder, but no specific changes in texture were seen. Asymptomatic knee joint effusions were present in 40/50 joints (80%). These features detectable on high resolution US allow the non-invasive early detection of DRA and are useful in the diagnosis and management of this condition. [source] Rapid Atrial Pacing: A Useful Technique During Slow Pathway AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007LEONARDO LIBERMAN M.D. Background: Catheter ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) with a success rate of 95,98%. The appearance of junctional rhythm during radiofrequency (RF) application to the slow pathway has been consistently reported as a marker for the successful ablation of AVNRT. Ventriculoatrial (VA) conduction during junctional rhythm has been used by many as a surrogate marker of antegrade atrioventricular nodal (AVN) function. However, VA conduction may not be an accurate or consistent marker for antegrade AVN function and reliance on this marker may leave some patients at risk for antegrade AVN injury. Objective: The purpose of this study is to describe a technique to ensure normal antegrade AVN function during junctional rhythm at the time of RF catheter ablation of the slow pathway. Methods: Retrospective review of all patients less than 21 years old who underwent RF ablation for AVNRT at our institution from January 2002 to July 2005. During RF applications, immediately after junctional rhythm was demonstrated, RAP was performed to ensure normal antegrade AVN function. Postablation testing was performed to assess AVN function and tachycardia inducibility. Results: Fifty-eight patients underwent RF ablation of AVNRT during the study period. The mean age ± SD was 14 ± 3 years (range: 5,20 years). The weight was 53 ± 15 Kg (range: 19,89 Kg). The preablation Wenckebach cycle length was 397 ± 99 msec (range: 260,700 msec). Fifty-four patients had inducible typical AVNRT, and four patients had atypical tachycardia. The mean tachycardia cycle length ± SD was 323 ± 62 msec (range: 200,500 msec). Patients underwent of 8 ± 7 total RF applications (median: 7; range 1 to 34), for a total duration of 123 ± 118 seconds (median: 78 sec, range: 20,473 sec). Junctional tachycardia was observed in 52 of 54 patients. RAP was initiated during junctional rhythm in all patients. No patient developed any degree of transient or permanent AVN block. Following ablation, the Wenckebach cycle length decreased to 364 ± 65 msec (P < 0.01). Acutely successful RF catheter ablation was obtained in 56 of 58 patients (96%). Conclusion: Rapid atrial pacing during radiofrequency catheter ablation of the slow pathway is a safe alternative approach to ensure normal AVN function. [source] Retreatment with bortezomib alone or in combination for patients with multiple myeloma following an initial response to bortezomib,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Raman Sood This clinical trial was conducted to determine the safety and efficacy of bortezomib retreatment in patients with multiple myeloma (MM) who had previously responded to bortezomib. Patients with progressive MM who had previously tolerated bortezomib as a single agent or in combination with other drugs, with a minimum of partial response (PR; ,50% M-protein reduction) for ,4 months, who had not received intervening MM therapy, were retreated with bortezomib (days 1, 4, 8, and 11 of a 21-day cycle) with a starting dose being the dose at which the patient ended the initial treatment. Patients were allowed to receive bortezomib on retreatment in combination with dexamethasone, thalidomide, or doxorubicin. Thirty-two patients received bortezomib retreatment (most with added dexamethasone). The median treatment-free interval (last dose of initial bortezomib treatment to first dose of retreatment) was 9.9 (range 2.5,34.0) months. The median duration of retreatment was 2.8 (<1,7.9) months; median total duration of bortezomib treatment was 6.7 (2.5,19.8) months. Based on the investigators' assessment of best response, the overall response rate (complete plus PR) was 50%. The median time from start of retreatment to progressive disease (PD) was 6.6 (95% confidence interval: 5.1,9.6) months. Thirteen patients (41%) experienced PN; bortezomib-related SAEs were reported in four patients. Retreatment with bortezomib alone or in combination is effective and well tolerated in patients with MM who have responded to their initial bortezomib treatment. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Association between serious ischemic cardiac outcomes and medications used to treat diabetes,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2008David J. Margolis MD Abstract Purpose Data on cardiovascular outcomes among treated diabetics have been inconsistent. Our goal was to compare cardiovascular outcomes associated with different treatments for diabetes. Methods This is a retrospective cohort study of diabetic patients at least 40 years of age treated in general practices participating in The Health Information Network (THIN) data system between 2002 and 2006. Our primary outcome was serious atherosclerotic vascular disease of the heart. Results Among all diabetics (N,=,63,579), the fully adjusted hazard ratios of association with our outcome were 1.2 (1.1, 1.3) for insulin, 1.03 (0.97, 1.09) for sulfonylureas, 0.8 (0.7, 0.8) for biguanide, 1.2 (0.99, 1.5) for meglitinide, 0.5 (0.5, 0.6) for thiazolidinediones, and individually 0.6 (0.5, 0.6) for rosiglitazone, and 0.5 (0.4, 0.7) for pioglitazone. Among those individuals newly diagnosed and treated for diabetes after 2002 (N,=,13,576), the adjusted hazard ratios of association with our outcome were 2.4 (2.0, 2.9) for insulin, 1.4 (1.2, 1.7) for sulfonylureas, 0.5 (0.4, 0.5) for biguanide, 0.9 (0.4, 2.1) for meglitinide, 0.8 (0.7, 1.0) for thiazolidinediones, and individually 0.8 (0.6, 1.0) for rosiglitazone, and 0.9 (0.6, 1.4) for pioglitazone. Risk increased as total duration of therapy increased for insulin, sulfonylureas, and biguanide, but decreased with duration for rosiglitazone and pioglitazone. Conclusions Overall, insulin was associated with an increased risk of myocardial infarction. Its risk increased with longer use, and risk emerged with longer use of sulfonylureas and biguanide. Conversely, a protective effect emerged with longer use of rosiglitazone or pioglitazone. Copyright © 2008 John Wiley & Sons, Ltd. [source] Constant rate allocation in nymphal development in species of HemipteraPHYSIOLOGICAL ENTOMOLOGY, Issue 4 2003Dionyssios CH. Abstract., This study investigated the existence of rate isomorphy (the constant allocation of relative times to different stages of development under different abiotic conditions) in Macrolophus pygmaeus (Hemiptera: Miridae; a phytophagous and predatory insect). Replicated data were used from a range of temperatures regarding (i) the developmental period of each nymphal stage in relation to the total duration of nymph development, when feeding on three host plants either with different prey species or without prey, and (ii) its egg, total nymphal and preoviposition period, on two host plants, with different prey species. The proportion of time required for the development of each nymphal stage of M. pygmaeus is not different among the temperatures or the kind of food available. These proportions ranged among the different host plants, temperatures and prey presence/absence from 17.3,21.8% in the first, 14.5,18.8% in the second, 14.2,18.3% in the third, 16.5,21.0% in the fourth and from 25.4,30.6% in the fifth nymphal stage. Thus, temperature does not significantly affect the proportion of time spent in each nymphal stage and rate isomorphy exists in nymphal development. This phenomenon was also investigated using data from the literature, and it also occurs in several other Hemiptera species. Therefore, there appears to be a constant time allocation in the nymphal development of the higher taxonomic groups of insects. However, for M. pygmaeus, rate isomorphy does not hold when considering egg-to-egg development and the relative duration of times to egg hatch, total nymphal development and preoviposition period. The ecophysiological implications of this rate isomorphy phenomenon are discussed in relation to endocrinological mechanisms. Apart from its theoretical interest, the existence of rate isomorphy simplifies studies on the rate of development and the estimation of thermal constants of an insect, which are essential for the prediction of insect population dynamics. It is also proposed that the term ,rate isomorphy' does not strictly describe the phenomenon, and it is suggested that ,constant rate allocation' would be a more suitable term. [source] Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009William E. Daniell MD Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. Methods This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n,=,8,224) filed during 1990,1994 (followed through 2000) and receiving lost-work compensation. Results Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P,<,0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. Conclusions There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 52:931,942, 2009. © 2009 Wiley-Liss, Inc. [source] Management of Descending Necrotizing MediastinitisTHE LARYNGOSCOPE, Issue 4 2004Marc Makeieff MD Abstract Objective/Hypothesis Descending necrotizing mediastinitis is caused by downward spread of neck infections and constitutes a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. In recent years, more aggressive management has been recommended. The aim of this study is to evaluate the results with the association of thoracotomy and cervicotomy, medical care in an intensive care unit, and daily washing of drained cervical and thoracic tissues. Study Design Retrospective study of 17 patients treated from 1984 to 1998. Method Descending necrotizing mediastinitis was consecutive to pharyngitis (6 cases), peritonsillar abscess (3 cases), dental abscess (6 cases), foreign body infection (1 case), and laryngitis (1 case). Corticotherapy was reported in seven cases. Twelve patients had no particular medical history. Mean age was 42 years. Mean duration of signs before diagnosis was 6 days. Thoracotomy was associated with the cervical approach in 14 cases, whereas 3 patients were treated by cervicotomy only. Results Fourteen patients of 17 (82.3%) were successfully treated. Three deaths occurred. The mean duration of hospitalization in the intensive care unit was 30 days, and the mean total duration of hospitalization was 45 days. Conclusion Descending necrotizing mediastinitis must be detected as soon as possible by computed tomography (CT) scanning in patients with persistent symptomatologia after treatment for oropharyngeal infections. Prompt surgical drainage with thoracotomy and cervicotomy in all cases of mediastinal involvement below the tracheal carena, use of CT scanning to monitor the disease evolution, and medical management in an intensive care unit significantly reduces the mortality rate to less than 20%. [source] Trichodysplasia spinulosa associated with chemotherapy for acute lymphocytic leukaemiaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2007Genevieve M Sadler SUMMARY We report two boys with trichodysplasia spinulosa associated with chemotherapy for acute lymphocytic leukaemia. Trichodysplasia spinulosa is a cutaneous viral infection of immunosuppressed patients that causes abnormal hair follicle maturation. Our patients presented with widespread papules, some extruding a central keratin spicule, which were most prominent on the face. Histopathology demonstrated hair follicles dilated by a proliferation of large eosinophilic cells containing numerous abnormal trichohyaline granules. Electron microscopy in case 1 revealed 30-nm viral particles in the stratum corneum consistent with a papovavirus. In case 1, the eruption persisted despite topical salicyclic acid 4%, ammonium lactate 17.5%, tretinoin 0.05% and oral acitretin. However, it resolved once the patient's immune function returned to normal (total duration of 2 years). In case 2, the eruption spontaneously resolved after 9 months. This case report discusses the characteristic clinicopathological features of trichodysplasia spinulosa and, for the first time, follows the condition's natural history. [source] Shortened intensified multi-agent chemotherapy and non-cross resistant maintenance therapy for advanced lymphoblastic lymphoma in children and adolescents: report from the Children's Oncology GroupBRITISH JOURNAL OF HAEMATOLOGY, Issue 2 2008Minnie Abromowitch Summary Pediatric lymphoblastic lymphoma (LL) has utilized treatment strategies similar to childhood acute lymphoblastic leukaemia (ALL) with prolonged maintenance chemotherapy. We report the results of a pilot study to estimate the feasibility, toxicity and efficacy of a 12-month aggressive multi-agent chemotherapy regimen in children and adolescents with advanced LL. Between July 1994 and June 1997, 85 eligible children and adolescents with advanced LL (Stage III/IV) were enrolled on this pilot study. Patients achieving a complete response following induction and consolidation received six cycles of maintenance chemotherapy for a total duration of 12 months. Grade III/IV toxicities included: hematological (80%), infections (20%), stomatitis and elevated transaminases, (29%). There were a total of 19 events, 13 relapses, two secondary acute myeloid leukaemia and four toxic deaths (5%). The 5-year event-free survival (EFS) and overall survival (OS) was 78 ± 4·5% and 85 ± 3·9%, respectively. Relapsed patients had a 5-year OS of only 33 ± 14%. Multivariate analysis failed to demonstrate age, gender, lactate dehydrogenase level, presence of marrow and/or central nervous system disease to have independent prognostic value. These results suggest that this experimental approach is safe and results in similar outcomes as more prolonged childhood ALL regimens. [source] Neurally released ATP mediates endothelium-dependent hyperpolarization in the circular smooth muscle cells of chicken anterior mesenteric arteryBRITISH JOURNAL OF PHARMACOLOGY, Issue 7 2005Marwan Draid The object of the present study was to clarify the neurotransmitter(s) controlling membrane responses to electrical field stimulation (EFS) in the circular smooth muscle cells of first-order branches of chicken anterior mesenteric artery. EFS (five pulses at 20 Hz, 1 ms) evoked a hyperpolarization of amplitude ,21.6±1.2 mV, total duration 21.8±1.2 s and latency 641.7±81.9 ms. The response was tetrodotoxin-sensitive and nonadrenergic noncholinergic (NANC) in nature. The NANC response was blocked by the nonspecific purinergic antagonist, suramin, indicating that the response is mediated by the neurotransmitter adenosine 5,-triphosphate (ATP). Either desensitization or blockade of P2Y receptor with its putative agonist 2-methylthioATP (1 ,M for 30 min) or with its antagonist cibacron blue F3GA (10 ,M), respectively, abolished the purinergic hyperpolarization. PPADS at concentrations up to 100 ,M had no effect on the EFS-induced response, indicating that this response is mediated through P2Y, but not P2X, receptor. In addition, the response was completely abolished by two specific P2Y1 receptor antagonists, namely, MRS 2179 (300 nM) and A3P5PS (10 ,M). Removal of the endothelium abolished the purinergic hyperpolarization, which was converted, in some preparations, to a small depolarization, indicating that the hyperpolarizing response is endothelium-dependent. The present study suggests that in first-order branches of chicken anterior mesenteric artery, ATP released from perivascular nerves may diffuse to the endothelium-activating P2Y1 receptor to induce release of an inhibitory substance that mediates hyperpolarization in the circular smooth muscle. British Journal of Pharmacology (2005) 146, 983,989. doi:10.1038/sj.bjp.0706413 [source] Anaplastic large cell lymphoma treated with a leukemia-like therapyCANCER, Issue 10 2005Oncology (AIEOP) LNH-92 protocol, Report of the Italian Association of Pediatric Hematology Abstract BACKGROUND Childhood anaplastic large cell lymphoma (ALCL) is a well defined entity with a rather poor prognosis. Different approaches have been adopted in the treatment of ALCL in various cooperative trials, including short high-dose intensive therapy and leukemia-like protocols. In the early 1990s, the Italian Association of Pediatric Hematology and Oncology (AIEOP) initiated a multicenter trial for the treatment of ALCL based on a modified LSA2-L2 protocol. METHODS Thirty-four consecutive eligible children with newly diagnosed ALCL were enrolled in the AIEOP LNH-92 protocol. Treatment was comprised of an induction of remission phase, followed by consolidation and maintenance for a total duration of 24 months, independently of disease stage. RESULTS Thirty of 34 patients (88%) achieved complete disease remission and 8 patients experienced disease recurrence. With a median follow-up of 8.4 years, the probabilities of survival and event-free survival were 85% (range, 79,91%) and 65% (range, 57,73%), respectively. Therapy was well tolerated and hematologic toxicity was the most frequent toxicity. CONCLUSIONS The leukemia-like protocol AIEOP LNH-92 was found to be an effective treatment for childhood ALCL. Its long duration may be beneficial to specific patient subgroups, but optimal treatment duration in ALCL remains to be elucidated. Cancer 2005. © 2005 American Cancer Society. [source] Reproductive factors and risk of breast carcinoma in a study of white and African-American women,,CANCER, Issue 2 2004Giske Ursin M.D., Ph.D. Abstract BACKGROUND Few studies have investigated the association between reproductive factors and the risk of breast carcinoma among African-American women. The authors assessed whether the number of full-term pregnancies, age at first full-term pregnancy, and total duration of breastfeeding were associated with similar relative risk estimates in white and African-American women in a large multicenter, population-based case,control study of breast carcinoma. METHODS Case patients were 4567 women (2950 white women and 1617 African-American women) ages 35,64 years with newly diagnosed invasive breast carcinoma between 1994 and 1998. Control patients were 4668 women (3012 white women and 1656 African-American women) who were identified by random-digit dialing and were frequency matched to case patients according to study center, race, and age. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. RESULTS For white women, the reduction in risk of breast carcinoma per full-term pregnancy was 13% among younger women (ages 35,49 years) and 10% among older women (ages 50,64 years). The corresponding risk reductions for African-American women were 10% and 6%, respectively. Risk decreased significantly with increasing number of full-term pregnancies for both races and both age categories. Duration of lactation was inversely associated with breast carcinoma risk among younger parous white (trend P = 0.0001) and African-American (trend P = 0.01) women. African-American women tended to have more children compared with white women, but parity rates were lower in younger women than in older women in both racial groups. However, breastfeeding was substantially more common in young white women than in young African-American women. CONCLUSIONS Overall, parity and lactation had similar effects on breast carcinoma risk in white and African-American women. If younger African-American women now are giving birth to fewer children than in the past, without a substantial increase in breastfeeding, breast carcinoma rates may continue to increase at a more rapid rate among these women compared with white women. Cancer 2004. Published 2004 by the American Cancer Society. [source] Effects of short-term dexamethasone treatment on collagen synthesis and degradation markers in preterm infants with developing lung diseaseACTA PAEDIATRICA, Issue 5 2003T Saarela Aim: To assess the effects of dexamethasone treatment on collagen turnover in preterm infants. Methods: The serum concentrations of the amino-terminal propeptide of type I and III procollagens (PINP and PIIINP), which reflect rates of type I and III collagen synthesis, respectively, and the carboxyterminal telopeptide of type I procollagen (ICTP), which reflects the rate of type I collagen degradation, were monitored in 13 preterm infants receiving dexamethasone and 13 matched control infants without glucocorticoid treatment for a total period of 12 mo. Dexamethasone was started at a median age of 12 d and continued at tapering doses for a median total duration of 10 d. Blood samples were taken immediately after birth, at 7, 14 and 28 d of age and at 2, 3, 6, 9 and 12 mo. The same markers were also measured just before the initiation of dexamethasone and on days 1, 3, and 7 of treatment. Results: A striking decrease in all of the markers was already observed in every case on day 1 of dexamethasone, the suppression being greatest on day 3 and still considerable on day 7. The percentages from the pretreatment levels recorded on days 1, 3 and 7 were: for PINP 51, 26 and 45%; for PIIINP 63, 44% and 52%; and for ICTP 64, 41 and 51%. A rebound rise in PINP levels was seen in dexamethasone-treated infants, the levels exceeding those of the controls at 3 and 6 mo of age. A similar phenomenon was noted concerning PIIINP at 3 mo. The levels settled down at 9 and 12 mo. Conclusion: Dexamethasone causes an immediate, inevitable, deep suppression of type I and III collagen synthesis and also type I collagen degradation. This should be taken into consideration, e.g. when assessing for the indications for steroid treatment in sick preterm infants and its dosing and duration. [source] Late-phase ischemic preconditioning in skeletal muscle: is the phenomenon protective?MICROSURGERY, Issue 2 2004Edwin E. Quan M.D. Reports in the literature on the effectiveness of late-phase Ischemic preconditioning (IPC) in skeletal muscle are controversial. The purpose of this study was to determine in the same muscle flap model the effectiveness of various IPC protocols in inducing late-phase protection. Rat latissimus dorsi muscle (LDM) flaps were preconditioned with either 30 or 60 min of total ischemia, divided as follows: single cycles of either 30 or 60 min, two cycles of 15 or 30 min, and three cycles of 10 or 20 min. Ischemia cycles were separated by 10 min of reperfusion. A day after IPC, flaps were elevated and challenged with 4 h of ischemia. Three days later, flaps were assessed for viability. We found that IPC protocols of different total durations and comprised of two or three cycles of ischemia elicited a protective effect against necrosis. We conclude that IPC induces late-phase protection against necrosis in skeletal muscle, and that the protection requires more than one ischemia/reperfusion cycle. © 2004 Wiley-Liss, Inc. [source] Influence of food properties and body posture on durations of swallowing-related muscle activitiesJOURNAL OF ORAL REHABILITATION, Issue 9 2008D. INAGAKI Abstract, The purpose of this study was to determine (i) whether or not textural properties of foods and body positions affect the durations of anterior tongue and suprahyoid muscle activities during swallowing, and (ii) if such changes occur, is the ,pre-peak' or the ,post-peak' duration of integrated muscle activity responsible. We used two test foods with different proprieties of hardness and adhesiveness. We recorded electromyograms (EMGs) from the anterior tongue and suprahyoid muscles as well as the laryngeal movement associated with swallowing in normal subjects (six men and three women; 21,30-years old). The subjects swallowed the test foods in four randomly set postures: upright, two inclined (60 ° and 30 ° to horizontal), and supine. None of the measured durations for the anterior tongue and suprahyoid EMGs were different among the four positions during swallowing of either food. The ,total' duration, from the start to the end of the integrated EMG, of anterior tongue activity was significantly (P < 0·001, anova) longer during the swallowing of the tougher and more adhesive food than during swallowing of the other food, but the ,total' duration of suprahyoid activity was unchanged. The ,post-peak' duration of anterior tongue activity, which stretched from the peak to the end of the integrated EMG, was also significantly longer (P < 0·001, anova) during swallowing of the tougher and more adhesive food. The results indicate that tougher and more adhesive foods prolong the duration, especially the ,post-peak' duration, of anterior tongue activity during swallowing in the upright, inclined and supine positions. [source] | ||||||||||||||||||||||||||||