Centurion syndrome. Idiopathic anterior displacement of the medial canthus

Bone marrow transplantation (BMT) using HLA-partially matched family donors has produced disappointing results (25-30% of long-term survivors) in patients with severe aplastic anemia. We describe two children affected by severe aplastic anemia, not responsive to immunosuppressive therapy, who underwent allogeneic bone marrow transplantation using a HLA-partially matched family donor. Both cases presented 2 first class HLA-antigens (A and B) disparity between donor and recipient. The pretransplant conditioning regimen consisted of cyclophosphamide, thoracoabdominal irradiation, cytosine-arabinoside, and antilymphocyte globulin. As graft versus host disease (GVHD) prophylaxis, Cyclosporine-A was administered at usual dosages for 6 months. A full marrow engraftment was observed in both cases. Only grade I acute GVHD, promptly responsive to corticosteroid therapy, developed with no chronic GVHD. Five months after transplant, both children progressively developed hypertension, renal function impairment, thrombocytopenia, and severe normochromic anemia, with erythropoietin serum levels lower than expected for the haematocrit. After antihypertension treatment and supportive therapy, the clinical picture progressively improved, while treatment with recombinant human erythropoietin completely corrected the long-lasting anemia. The two children are alive and well 28 months after the transplant, with a Karnofsky score of 100% and a normal peripheral blood count. The authors suggest that, once immunosuppressive therapy has failed, BMT from donors other than HLA-identical sibling is a feasible approach in children affected by severe aplastic anemia, not having an HLA-identical donor.     

Performance of advanced resuscitation skills by pediatric housestaff

OBJECTIVE: To describe pediatric housestaff resuscitation experience and their ability to perform key resuscitation skills. DESIGN: Cohort study of 63 pediatric residents in a university-based training program. PARTICIPANTS AND METHODS: Investigators observed, scored, and timed resident performance on 4 key resuscitation skills. Cognitive ability was tested with 4 written scenarios. Housestaff provided self-reports of the number of months since their last American Heart Association Pediatric Advanced Life Support course, number of mock and actual codes attended, number of times skills were performed, and self-confidence with respect to resuscitation. RESULTS: A total of 45 pediatric residents (71%) participated. Median cognitive score was 5 (range, 1-5). Of all residents, 44 (97%) successfully bag mask-ventilated the mannequin; 24 (53%) and 36 (80%) used the correct bag and mask size, respectively. Thirty-nine residents (87%) placed a tube in the mannequin trachea, 12 (27%) checked that suction was working prior to intubation, and 30 (67%) chose the correct endotracheal tube size. Forty residents (89%) discharged the defibrillator, and 25 (56%) and 32 (71%) correctly chose asynchronous mode and infant paddles, respectively. Thirty-eight residents (84%) inserted an intraosseous line; 35 (78%) had correct placement. Median times for successful skill completion were 83 seconds for bag mask ventilation, 136 seconds for intubation, 149 seconds for defibrillation, and 68 seconds for intraosseous line placement. CONCLUSION: Pediatric housestaff previously trained in pediatric advanced life support were generally able to reach the end point of 4 key resuscitation skills but less frequently performed the specific subcomponents of each skill. This poor performance and the prolonged time to skill completion suggest the need for greater attention to detail during training.     

Autonomous mental development: soaring beyond tradition

This article provides a brief overview of the history of autonomous mental development as a discipline     

Protoporphyrin-IX as a Substitute for Nitrite in Cured-Meat Color Production

The iron-free heme derivative protoporphyrin-IX, was added to a cooked emulsified beef product to mimic the typical cured-color obtained with nitrite. Although the pigment was stable and could be recovered from the emulsion it imparted a purple hue as noted by visual observation and Hunterlab color values (L,a,b). The possible implications of this pigment as a meat colorant are discussed.     

Are all cognitive therapies alike? A comparison of cognitive and noncognitive therapy process and implications for the application of empirically supported treatments.

The definition of an empirically supported treatment (EST) arguably embodies 2 untested assumptions: (a) that different manualized renditions of the same therapy are functionally equivalent and (b) that therapies can be reliably applied independently of therapist, setting, and format. These assumptions were tested as applied to cognitive therapy (CT), using process data from a large multisite study (N=235) that included 3 cognitive and 6 alternative therapies. Although the non-CTs were more variable than the CTs on 2 of 4 dimensions studied (directiveness and emotional arousal), there was considerable variation among the 3 CTs, even when implemented in the current context of rigorous training, manualization, and adherence checks. Results are discussed as related to the assumptions underlying EST criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Layout-Specific Circuit Evaluation in 3-D Integrated Circuits

In this paper, we describe a comprehensive layout methodology for bonded three-dimensional integrated circuits (3D ICs). In bonded 3D integration technology, parts of a circuit are fabricated on different wafers, and then, the wafers are bonded with a glue layer of Cu or polymer based adhesive. Using our layout methodology, designers can layout such 3D circuits with necessary information on inter-wafer via/contact and orientation of each wafer embedded in the layout. We have implemented the layout methodology in 3DMagic. Availability of 3DMagic has led to interesting research with a wide range of layout-specific circuit evaluation, from performance comparison of 2D and 3D circuits to layout-specific reliability analyses in 3D circuits. Using 3DMagic, researchers have designed and simulated an 8-bit encryption processor mapped into 2D and 3D FPGA layouts. Moreover, the layout methodology is an essential element of our ongoing research for the framework of a novel Reliability Computer Aided Design tool, ERNI-3D.     

NUMERICAL ANALYSIS OF THE EFFECTS OF LOCAL HYDRODYNAMICS ON MASS TRANSFER IN HETEROGENEOUS POROUS MEDIA

Many engineering problems require the estimation of mass transfer coefficients in porous materials. In heterogeneous materials or in cases where mass transfer sites are not spatially uniform, empirical equations for mass transfer coefficients vary widely, and the origin of these differences is not well understood. In this article, we use a stochastic algorithm to model mass transfer from single particles in a two-dimensional heterogeneous packed bed. The computed mass transfer coefficients are used to generate a distribution of local Peclet numbers in the bed. Detailed hydrodynamics are then used to interpret variations in the local Peclet number. The results show clear relationships between pore structure, streamline patterns, and mass transfer rates.     

The static and dynamic characteristics of single and multiplephase-shifted DFB laser structures

The influence of longitudinal mode spatial hole burning (LMSHB) on the performance of distributed feedback (DFB) laser structures is examined in detail. A comprehensive model has been used to interpret the experimental results and to construct a theoretical framework that was utilized to develop more advanced device designs. An increasing side mode intensity with output power, movement of the lasing mode relative to the stopband, and curvature of the light-current characteristic at low power can all be manifestations of the influence of LMSHB on the static device performance. The dynamic behavior can also be affected, with extended wavelength chirp and amplitude patterning effects on the timescale of the effective carrier recombination time being particularly important     

Clinical and experimental studies of intraoperative autotransfusion using a new filtration device

The Haemocell S-350 device has recently been introduced for intraoperative autotransfusion. The system uses a novel membrane filter to process shed blood. In the first part of this study a 0.2-micron pore size filter was used in a randomized trial comparing the use of autotransfusion (n = 8) with bank blood controls (n = 9) during aortic reconstruction. This part of the trial was abandoned because of unexpected non-surgical bleeding. Bank blood requirements fell from a median of 3.0 (range 0.0-9.0) units to 1.5 (range 0.0-7.0) units when autotransfusion was used, but these patients had a greater perioperative blood loss (1791 (range 932-3104) versus 1140 (range 440-3840) ml). There was evidence of postoperative heparin excess with an activated partial thromboplastin time ratio of 1.3 (range 0.9-3.0) versus 1.0 (range 1.0-1.2) in controls and an activated clotting time of 206 (range 143-280) versus 137 (range 107-142) s. This was confirmed by raised plasma heparin levels and a prolonged thrombin time normalized by protamine. To improve performance a 0.6-micron pore size filter was studied in ten patients. Filtration efficiency doubled from 19 to 38 per cent. Electron micrographs demonstrated better filter clearance, but 44 per cent of the original concentration of heparin remained in the reinfusate. The S-350 device may be an attractive alternative to centrifugation for intraoperative autotransfusion but, until efficiency is improved, it should only be used for cardiovascular surgery when excess heparin can be reversed with protamine.     

Treatment of perianal fistulas with ND:YAG laser--results in twenty cases

Excision of perianal fistulas using a 1.064 micron wavelength neodymium:yttrium aluminum garnet (ND:YAG) contact tipped laser with primary wound closure was used to treat 20 dogs with perianal fistulas. Overall, 19 of 20 (95%) dogs had resolution of fistulas after one or more ND:YAG treatments. The period of resolution ranged from 10 to 42 months with a mean of 22.9 months. Sixteen of 20 (80%) dogs had resolved fistulas after one laser excision. Three of the four recurrences underwent additional laser treatments with successful results. The total number of laser procedures ranged from one to three with a mean of 1.2 procedures. Postoperatively, anal tone as judged by digital rectal examination was reduced in about 60% of the cases, but clinical evidence of fecal incontinence only occurred in four of 20 cases. This was managed effectively with diet modification. The tendency toward loss of anal tone or fecal incontinence depended on the severity of preexisting anal stenosis. On a client survey, 19 of 20 owners believed that their animals experienced less pain during defecation after surgery and rated the results as excellent or good. The overall success rate using ND:YAG laser excision compared very favorably with previously reported studies of other methods of treatment for perianal fistulas in dogs.