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41.
The results of numerical simulations of the aerodynamics and of solid aerosol deaggregation phenomena arising in the process of airflow through various model human oropharyngeal cavities are reported. Special attention is given to the relevance of these simulations to the inhalation of dry-powder therapeutic aerosols. Several two- and three-dimensional mouth and throat geometries (terminating just beyond the larynx) are considered. Cross-sectional area-averaged viscous stress values are numerically determined as a function of distance from the mouth opening. These values, ranging from approximately 10 to 500 dyn cm−2, are compared with estimates of Van der Waals attractive forces per unit area of particle-particle contact so as to evaluate the ability of the flowing airstream to deaggregate aerosol particles that enter the mouth in an aggregated state (held together principally by Van der Waals attractive forces). Estimates of airstream viscous stress differ markedly depending on whether the geometry is two- or three-dimensional. Quantitative differences between flow in a 90°-bend model and an oropharyngeal geometry numerically reconstructed from a cast of a human mouth and throat are especially significant in regards to the ability of the airstream to break apart particle agglomerates. For all geometries it is observed that increasingly smaller particle agglomerates may potentially be separated as the airflow rate increases from 30 to 2001 min−1. At the highest airflows, aggregated particles of diameter near to or even below 1 μm may potentially be separated by the airflow. If separation of particle agglomerates is to occur, it appears far more likely to take place in the throat than in the mouth. This is especially apparent for the more physiologically faithful oropharyngeal geometries considered.  相似文献   
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The expression of cytokeratins (CKs) in normal cervical epithelium, low grade squamous intraepithelial lesions (SIL), high grade SILs and squamous cell carcinoma (SCC) were analyzed using four different monoclonal antikeratin antibodies. In normal cervical epithelium, CK 18 showed strong immunoreactivity in basal and parabasal layers. CK 19 and 14 were expressed only in the basal layer while CK 13 was found selectively n the spinal cells. As the lesions progressed from low grade SIL to high grade SIL, immunoreactivity of CK 18, 19 and 14 in the basal cell compartment increased while the expression of CK 13 decreased. In SCC, as well-differentiated tumors showed decreased immunoreactivity for CK 18, 19 and 14 with CK 13 showing a strong and focal (localized) immunoreactivity. Undifferentiated carcinomas totally lacked CK 13 reactivity. Our findings therefore suggest that expression of CK 18, 19 and 14 may be directly related to tumor grade and CK 13 may be a marker of differentiation in cervical lesions.  相似文献   
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OBJECTIVE: To examine the relationship between pregnancy incidence and the level of serum E2 during danazol therapy. DESIGN: Danazol was given by 200 mg four times daily for 3 months. Serum E2 level was checked after completing the therapy, but before stopping medication. Patients then were advised to conceive at the appropriate time over a 6-month period. SETTING: Reproductive and Endocrine Laboratory of the Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan. PATIENTS: Infertile women with invasive endometriosis receiving conservative surgery and danazol treatment. INTERVENTIONS: Serum E2 is checked before medication and at the end of danazol therapy, but before stopping medication. MAIN OUTCOME MEASURES: Whether pregnancy is related to the change of serum E2 caused by danazol therapy. RESULTS: There were 24 pregnancies in 38 patients with invasive endometriosis after treatment. Pregnant patients had significantly lower serum E2 levels as compared with the nonpregnant patients. CONCLUSIONS: After conservative surgery for invasive endometriosis associated with infertility, the therapeutic period of danazol treatment could be shortened to 3 months. Because there is significant correlation of fecundability and serum E2 after danazol medication, serum E2 could be a guideline for predicting pregnancy or for prolonging or changing of treatment after danazol therapy.  相似文献   
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The widespread use of landmines in conflict situations around the world and their continuing legacy for the civilian population in injuries, amputations, disabilities and economic costs has been recognized as a major problem. However, the psychosocial consequences for landmine victims are still to be realized. Although there are some facilities for the medical, orthopaedic and long-term rehabilitative care of landmine victims, hardly any exist for their psychosocial needs. This study considers the mental costs in terms of post-traumatic stress disorder, depression and anxiety. Individual difficulty in relationships and daily functioning is considerable, and the landmine victim faces social stigmatization, rejection and unemployment. Suggestions are made for brief training in relatively simple mental health care for staff working in already functioning programmes.  相似文献   
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BACKGROUND: This retrospective study assesses the outcomes and patterns of failure in patients with squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site treated with combined surgery and postoperative radiotherapy. METHODS: One hundred thirty-six patients with squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary source were treated postoperatively with radiotherapy at the University of Texas M. D. Anderson Cancer Center between the years 1968 and 1992. Stage distribution was: N1, 31 patients; N2a, 49; N2b, 25; N2c, 3; N3, 18; and Nx, 10. Thirty-nine patients had excisional biopsies only, 64 patients underwent modified neck dissections, and 33 had radical neck dissections. Extracapsular extension was present in 87 cases. Fifty-nine patients had multiple nodes involved. The median duration of follow-up for surviving patients was 8.7 years. RESULTS: Twelve patients, all with extracapsular nodal disease, developed regional relapse. The 5-year actuarial rates of regional relapse in patients with and without extracapsular nodal disease were 16% and 0%, respectively (p = .004). Nine patients (22%) with extracapsular disease and multiple nodes relapsed compared with three patients (7%) with extracapsular disease and a solitary node (p = .02). None of the patients treated with excisional biopsy and radiotherapy relapsed regionally. No statistically significant relationship between dose, treatment duration, time interval between surgery, and the start of radiotherapy and relapse was detected. The 2-, 5-, and 10-year actuarial disease-specific survival rates were 82%, 74%, and 68%, respectively. Fourteen patients developed cancers in head and neck mucosal sites; six of these cancers were located in unirradiated tissues. CONCLUSIONS: Relapse occurred infrequently in patients treated with excisional biopsies and postoperative radiotherapy. Extracapsular extension and multiple nodes were associated with worse regional control and disease-specific survival. These results appear consistent with those expected for patients with advanced neck disease and a known primary site, and the absence of a primary site should not exclude patients from studies aiming to improve outcomes in patients with extensive neck disease from a head and neck squamous cell cancer. We continue to recommend radiation to the necks and pharyngeal axis for patients suspected of having residual microscopic disease following surgery for squamous cell carcinoma metastatic to the neck from an unknown primary site.  相似文献   
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Four experiments investigated the effect of trains of clicks (usually 5 sec long and at 5 or 25 Hz) on subjective duration in humans, as previous research had suggested that such a manipulation would speed up the pacemaker of an internal clock by increasing participants' arousal. The 4 experiments used temporal generalization, pair comparison of duration, verbal estimation, and production of short durations. In all cases, preceding the durations to be judged by clicks changed their subjective length in a manner broadly consistent with the idea that pacemaker speed was increased, by an average of about 10%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   
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The authors present the case of 4-month-old girl with a midline prepubic sinus extending from the skin overlying the pubis to the superior surface of the bladder, and continuing to the umbilicus via the median umbilical ligament. The distal portion of the exicised sinus was surrounded by concentric bundles of collagen and smooth muscle with minimal inflammatory infiltrates, which suggests a developmental origin. According to Stephens' classification, the sinus appears to be a variant of dorsal urethral duplication of Stephens type 3.  相似文献   
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