Relationship of seizure duration to antidepressant efficacy in electroconvulsive therapy

BACKGROUND: Aprotinin and epsilon-aminocaproic acid are routinely used to reduce bleeding during cardiac surgery. The marked difference in average wholesale cost between these two drug therapies (aprotinin, $1,080 vs. epsilon-aminocaproic acid, $11) has generated significant controversy regarding their relative efficacies and costs. METHODS: In a multicenter, randomized, prospective, blinded trial, patients having repeated cardiac surgery received either a high-dose regimen of aprotinin (total dose, 6 x 10(6) kallikrein inactivator units) or epsilon-aminocaproic acid (total dose, 270 mg/kg). RESULTS: Two hundred four patients were studied. Overall (data are median [25th-75th percentiles]), aprotinin-treated patients had less postoperative thoracic drainage (511 ml [383-805 ml] vs. 655 ml [464-1,045 ml]; P = 0.016) and received fewer platelet transfusions (0 [range, 0-1] vs. 1 [range, 0-2]; P = 0.036). The surgical field was more likely to be considered free of bleeding in aprotinin-treated patients (44% vs. 26%; P = 0.012). No differences, however, were seen in allogeneic erythrocyte transfusions or in the time required for chest closure. Overall, direct and indirect bleeding-related costs were greater in aprotinin- than in epsilon-aminocaproic acid-treated patients ($1,813 [$1,476-2,605] vs. $1,088 [range, $511-2,057]; P = 0.0001). This difference in cost per case varied in magnitude among sites but not in direction. CONCLUSIONS: Aprotinin was more effective than epsilon-aminocaproic acid at decreasing bleeding and platelet transfusions. Epsilon-aminocaproic acid, however, was the more cost-effective therapy over a broad range of estimates for bleeding-related costs in patients undergoing repeated cardiac surgery. A cost-benefit analysis using the lower cost of half-dose aprotinin ($540) still resulted in a significant cost advantage using epsilon-aminocaproic therapy (P = 0.022).     

Association between cigarette smoking and lipid peroxidation in a controlled feeding study

BACKGROUND: Cigarette smoke may promote atherogenesis by producing oxygen-derived free radicals that damage lipids. However, evidence in support of this hypothesis is inconsistent because most studies did not control for aspects of diet (antioxidants and lipid substrate) that may confound the association between smoking and measures of lipid peroxidation. METHODS AND RESULTS: The relationships between cigarette smoking and two measures of lipid peroxidation, breath ethane (an in vivo assay) and thiobarbituric acid-reactive substances (TBARS, an in vitro assay), were examined in 123 adults (11% of whom were smokers) participating in a controlled feeding study. After 3 weeks of controlled feeding on a common diet (36% total fat, 14% saturated fats, 6% polyunsaturated fats, and 12% monounsaturated fats), breath and fasting serum samples were collected for measurement of ethane and TBARS, respectively. Baseline characteristics of smokers and nonsmokers were similar, including several indices related to diet and nutritional status (albumin, cholesterol, body mass index, and oxygen radical-absorbing capacity). Cigarette smokers had significantly higher breath ethane (8.88 versus 1.71 pmol/L; P<.0001) and TBARS (24.0 versus 20.7 micromol/mL; P=.008) than nonsmokers. The interval between breath collection and the time the last cigarette was smoked was significantly and inversely correlated with breath ethane. Neither measure of lipid peroxidation was associated with measures of serum cholesterol or albumin, body mass index, or serum oxygen radical-absorbing capacity. CONCLUSIONS: Cigarette smokers have higher rates of in vivo and in vitro lipid peroxidation. These results support the hypothesis that the atherogenic effects of smoking are mediated in part by free radical damage to lipids.     

Effects of design parameters on geared two-link mechanisms

The design of a specialized agricultural harvesting machine required the use of a path generation mechanism that was compact, accurate, inexpensive to manufacture and difficult attempts involved the use of a cam and follower, but they were expensive to manufacture and difficult to operate. This paper discusses an alternative method of using a coupled, open loop, two-link mechanism to generate a polygon-like closed path (pseudo-polygon) with an integer number of curved sides and apexes. A complete development of the path and path curvaturei equations are presented. The influence of the design variables on the coupler shape (flatness of each side) is shown in equation and design chart form. An example of a successful application of this design method applied to a plant cutting mechanism is presented.     

Supplementation of coconut oil from different sources to the diet induces cellular damage and rapid changes in fatty acid composition of chick liver and hepatic mitochondria

PURPOSE OF THE STUDY: Impaction in pertrochanteric fracture sites is a well known phenomenon; the screw-plate system is designed to stabilise the fracture. Although easier to use, the risk with the nail-plate system is postoperative penetration of the nail into the joint. The present study was conducted to determine the exact conditions of the impaction, and to identify possible ways to improve the nail-plate system. MATERIAL-METHOD: The study included 129 cases of pertrochanteric fracture, excluding sub-trochanteric fractures. All fractures were fixed with a 130 degrees angulated nail-plate. In all cases, consolidation was uneventful after 8 to a 12 weeks. The anatomical type of fracture, i.e. stable or unstable, was determined according to the size of the intermediary fragment, including the trochanter minor. The displacement was measured as the difference between the length of the nail and the length of the femoral head and neck measured along the axis of the femoral neck. The parameters examined were: fracture stability degree, bony mineralisation (Singh Index), nail length, femoral neck, length nail position in the femoral head, and above all, fracture reduction. All these parameters were computerised and compared using Stat View statistics software. RESULTS: Impaction was observed in 43 per cent of cases. Among these, 25 per cent were rated as slight (1 to 5 mm), 18 per cent as moderate (over 5 mm) and 9 per cent as marked (10 to 25 mm). Impaction was associated with demineralisation of the bone tissue (p = 0.001). The anatomical classification of the fracture was not a determining factor (p = 0.19), as marked displacements were also recorded in stable fractures. A posterior and inferior position of the intramedullary nail in the femoral head is one of displacement determining factors (p = 0.004, two-sided 1 test). Valgus over-correction is the most important factor, especially when it is associated with bony demineralisation (p = 0.02) and an inadequately centred intramedullary pin (p = 0.02). Shorter the femoral neck, and shorter the nail, greater was the frequency of nail articular penetration. DISCUSSION: The risk of articular penetration therefore reaches 15 per cent in petrochanteric fractures repaired with a nail plate, set at an angle of 130 degrees. A short neck, a cervicodiaphyseal angle superior to 140 degrees, and demineralisation are the three determining parameters. Stable or unstable fracture has in fact little effect on displacement incidence, and therefore does not, on its own, warrant the use of a prosthesis in comminuted fractures. The authors compared their results to literature on progressive sliding system: the incidence of complications associated with this type of fracture treatment is identical, but the determining parameters are different. CONCLUSION: The study shows that the nail-plate is efficient and provides simple and solid fracture fixation. However, this osteosynthesis material needs to be modified in order to improve its fixation in the femoral head.     

Effects of selenium and vitamin E on incidence of retained placenta

In a series of experiments over 3 yr, relatively low doses of selenium and vitamin E were injected intramuscularly 3 wk prepartum to pregnant Israeli-Holstein dairy cows in a high-producing herd (9000 kg milk/yr) with a history of retained placenta in 17% of the primiparous and 28% of the multiparous animals, as recorded for the 12 mo preceding the study. Selenium ranged from .035 to .109 ppm in the prepartum diet and from .160 to .200 ppm in the postpartum diet. Doses of selenium ranging from 2.3 to 23.0 mg reduced the incidence of retained placenta in 186 primiparous and in 428 multiparous to 7 and 15%, which was half of that of controls. Low doses of selenium (2.3 to 4.6 mg) tended to be more effective than higher ones. Selenium alone was at least as effective as a combination of selenium and vitamin E. Dosage, timing, mechanism, and interactions of selenium with other factors in reducing the incidence of retained placenta need clarification.     

Self-disclosure and liking: A meta-analytic review.

Self-disclosure plays a central role in the development and maintenance of relationships. One way that researchers have explored these processes is by studying the links between self-disclosure and liking. Using meta-analytic procedures, the present work sought to clarify and review this literature by evaluating the evidence for 3 distinct disclosure-liking effects. Significant disclosure-liking relations were found for each effect: (1) People who engage in intimate disclosures tend to be liked more than people who disclose at lower levels, (2) people disclose more to those whom they initially like, and (3) people like others as a result of having disclosed to them. In addition, the relation between disclosure and liking was moderated by a number of variables, including study paradigm, type of disclosure, and gender of the discloser. Taken together, these results suggest that various disclosure-liking effects can be integrated and viewed as operating together within a dynamic interpersonal system. Implications for theory development are discussed, and avenues for future research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Networks in workers' compensation medical delivery

Medical networks offer discounted fees, control of the workers' compensation case, quality monitoring, and managed care services. As channeling of workers' compensation cases to networks increases, credentialed physicians will benefit.