Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT project. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments

BACKGROUND: Previous studies have shown wide variation in plasma dexamethasone (DEX) concentrations following a standard 1-mg dexamethasone suppression test (DST), and significantly lower DEX concentrations in DST nonsuppressors compared with suppressors, suggesting that DEX pharmacokinetics/bioavailability is an important variable associated with DST nonsuppression. METHODS: To determine the effect of plasma DEX levels on the DST in Chinese depressives, we measured plasma DEX and post-DEX cortisol levels at 4:00 PM in a group of 50 depressed outpatients, 28 anxiety outpatients, and 33 normal subjects during the course of 1-mg oral overnight DST. RESULTS: We found a significant difference in the plasma DEX levels between DST nonsuppressors and suppressors in the depression group and overall subject population, and a significant negative correlation between the plasma DEX and cortisol levels in the depression, anxiety, and total groups. Within a DEX "window", the DST performance was enhanced, whereas the relationships between plasma DEX and post-DEX cortisol levels remained equally strong. CONCLUSIONS: Our findings support a relationship between plasma DEX and post-DEX cortisol levels, a relationship that might be superimposed on the hypothalamic-pituitary-adrenal axis. Comparing our "window" range with those of previous studies, we suggest that Chinese depressives may have lower limits of plasma DEX window, and that ethnicity may be an intervening variable in both DST response and pharmacokinetics of DEX.     

Successful long-term kidney-pancreas transplants in diabetic patients with high C-peptide levels

Health Canada and the Canadian-Italian Physicians Association recently spent $20,000 to send 4 Canadian cancer specialists to Italy to check out the "miracle" anticancer cocktail prepared by an Italian physician. Most doctors remain decidedly sceptical about this latest "cure," but Charlotte Gray says their suspicions count for little when an issue like this captures the imagination of the public and their politicians.     

Congenital megalourethra associated with urethral duplication and imperforate anus

A newborn with a prenatal diagnosis of right hydroureteronephrosis and enlarged penis is presented. At birth, the baby had an imperforate anus (IA) with a megalourethra; radiologic and ultrasonographic studies showed a left polycystic kidney and right hydroureteronephrosis, right vesicoureteral reflux, and an incomplete urethral duplication with dilatation of the posterior urethra. The IA was corrected on the 1st day of life and a vesicostomy was performed at 1 month. At 1 year of age the valve obstructing the ventral posterior urethra was resected and the vesicostomy was closed. At 14 months the baby underwent a urethroplasty with a vertical preputial tubularized island flap and excision of the penile urethral duplication. Exact knowledge of the malformation was essential in planning the appropriate surgical treatment.     

Geometrically nonlinear analysis for some axially compressed laminated cylindrical panels

Mainly, this paper deals with cylindrical laminated panels, axially compressed under the constraint of four simply-supported edges.By imposing uniform increasing end-shortening to the two opposite circular edges, characteristic equilibrium paths have been obtained in correspondence to numerical evaluations with finite element models subject to geometric non linearity. A peculiar link among different branches of the total path, each of which is connected to a proper deformed configuration, is pointed out in the axial load/end-shortening space.Convergence problems and mesh sensibility are also examined.     

Reduced mechanical efficiency in chronic obstructive pulmonary disease but normal peak VO2 with small muscle mass exercise

We studied six patients with chronic obstructive pulmonary disease (COPD) (FEV1 = 1.1 +/- 0.2 L, 32% of predicted) and six age- and activity level-matched control subjects while performing both maximal bicycle exercise and single leg knee-extensor exercise. Arterial and femoral venous blood sampling, thermodilution blood flow measurements, and needle biopsies allowed the assessment of muscle oxygen supply, utilization, and structure. Maximal work rates and single leg VO2max (control subjects = 0.63 +/- 0.1; patients with COPD = 0.37 +/- 0.1 L/minute) were significantly greater in the control group during bicycle exercise. During knee-extensor exercise this difference in VO2max disappeared, whereas maximal work capacity was reduced (flywheel resistance: control subjects = 923 +/- 198; patients with COPD = 612 +/- 81 g) revealing a significantly reduced mechanical efficiency (work per unit oxygen consumed) with COPD. The patients had an elevated number of less efficient type II muscle fibers, whereas muscle fiber cross-sectional areas, capillarity, and mitochondrial volume density were not different between the groups. Therefore, although metabolic capacity per se is unchanged, fiber type differences associated with COPD may account for the reduced muscular mechanical efficiency that becomes clearly apparent during knee-extensor exercise, when muscle function is no longer overshadowed by the decrement in lung function.     

Novel optoelectronic sensing system for thin polymer films glass transition investigation

The glass transition zone of thin polystyrene films on silica substrates has been investigated by using a novel optoelectronic integrated sensor involving simultaneous refractive index and temperature measurements. The sensor design is based on the deposition of thin polymer film by chemical dipping on the distal end of a standard silica optical fiber. Direct reflectometric interrogation and fiber-Bragg grating sensor integration have been used to simultaneously retrieve information about the refractive index variation over the glass transition region revealed by a temperature ramping. Sensor modeling and sensitivity have been investigated. The glass transition has been identified by measuring the change of the thermooptic coefficient in cooling down experiments. The comparison between refractive index transition and standard calorimetric analysis has been carried out to test the optoelectronic integrated sensor reliability. The proposed sensing system has demonstrated that it is able to measure the glass transition temperature of thin polymer films; moreover, the system and procedure can be readily implemented to investigate the effect of polymeric sample finite size and specific energetic interactions on the glass transition zone.     

Temperature dependent optical properties of a synthesis blend of poly(methyl methacrylate) and vinyl rubber

The temperature dependent optical properties of a poly(methyl methacrylate) (PMMA) ethylene-co-vinylacetate (EVA) blend (PMMA-EVA) were investigated in order to study its thermo-optical behaviour in the temperature range 30–70C. The thermal coefficients of the refractive index dn/dt of PMMA-EVA, PMMA and EVA were measured as a function of the temperature. The observed trend of the, thermal coefficients is related to a first-order phase transition of the EVA component. A comparison with the results of calorimetric investigations by differential scanning calorimetry (DSC) is also reported. The possible use of this material in optics is described.     

Knowledge transfer in system modeling and its realization through an optimal allocation of information granularity

In this study, we introduce and discuss a concept of knowledge transfer in system modeling. In a nutshell, knowledge transfer is about forming ways on how a source of knowledge (namely, an existing model) can be used in presence of new, very limited experimental evidence. In virtue of the nature of the problem at hand (a situation encountered quite commonly, e.g. in project cost estimation), new data could be very limited and this scarcity of data makes it insufficient to construct a new model. At the same time, the new data originate from a similar (but not the same) phenomenon (process) for which the original model has been constructed so the existing model, even though it could applied, has to be treated with a certain level of reservation. Such situations can be encountered, e.g. in software engineering where in spite existing similarities, each project, process, or product exhibits its own unique characteristics. Taking this into consideration, the existing model is generalized (abstracted) by forming its granular counterpart – granular model where its parameters are regarded as information granules rather than numeric entities, viz. their non-numeric (granular) version is formed based on the values of the numeric parameters present in the original model. The results produced by the granular model are also granular and in this manner they become reflective of the differences existing between the current phenomenon and the process for which the previous model has been formed.In the study on knowledge transfer and reusability, information granularity is viewed as an important design asset and as such it is subject to optimization. We formulate an optimal information granularity allocation problem: assuming a certain level of granularity, distribute it optimally among the parameters of the model (making them granular) so that a certain data coverage criterion is maximized. While the underlying concept is general and applicable to a variety of models, in this study, we discuss its use to fuzzy neural networks with intent to clearly visualize the advantages of the approach and emphasize various ways of forming granular versions of the weights (parameters) of the connections of the network. Several granularity allocation protocols (ranging from a uniform distribution of granularity, symmetric and asymmetric schemes of allocation) are discussed and the effectiveness of each of them is quantified. The use of Particle Swarm Optimization (PSO) as the underlying optimization tool to realize optimal granularity allocation is discussed.