Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion

BACKGROUND/PURPOSE: Fetuses with congenital diaphragmatic hernia (CDH) who have a "poor prognosis" with postnatal treatment now can be identified on the basis of liver herniation, early diagnosis (before 25 weeks' gestation) and a low lung-to-head ratio (LHR). Because complete in utero repair proved unsuccessful for this group, the strategy of temporary tracheal occlusion was developed to gradually enlarge the hypoplastic fetal lung. The purpose of this study is to compare the outcome of patients in the poor-prognosis group treated by one of three methods: (1) standard postnatal care, (2) fetal tracheal occlusion via open hysterotomy, and (3) the recently developed video-fetoscopic (Fetendo) technique of tracheal occlusion without hysterotomy. METHODS: In the past 3 years, 34 of 86 fetuses with an isolated left CDH met criteria for the poor-prognosis group. Thirteen families chose postnatal treatment at an extracorporeal membrane oxygenation (ECMO) center, 13 underwent open fetal tracheal occlusion, and eight underwent fetoscopic tracheal occlusion. RESULTS: The survival rate was 38% in the group treated by standard postnatal therapy, 15% in the open tracheal occlusion group, and 75% in the Fetendo group. There were less postoperative pulmonary complications noted in mothers who underwent the Fetendo procedure versus the open tracheal occlusion. All but one Fetendo clip patient had a striking physiological response demonstrated by sonographic enlargement of the small left lung that was documented postnatally by plain radiographs and its subjective appearance during repair of the CDH. In contrast, only 5 of the 13 open tracheal occlusion patients demonstrated lung growth. CONCLUSION: Fetuses with a left CDH who have liver herniation and a low LHR are at high risk of neonatal demise and appear to benefit from temporary tracheal occlusion when performed fetoscopically, but not when performed by open fetal surgery.     

A systems model for low vision rehabilitation. II. Measurement of vision disabilities

BACKGROUND: This study presents and tests a method of measuring vision disabilities. Based on the model presented in the first paper of this series, cognitive and motor activities ("tasks") are organized in a hierarchy that identifies the tasks' behavioral goals (purposes) and the social objectives the goals serve. Two latent variables important to the definition of vision disability are identified: "value of living independently" and "visual ability for independent living." The basic principles of the Rasch measurement model are reviewed, and Rasch models are used to measure the two variables that define vision disability. The need for rehabilitation to meet each goal is represented by "rehabilitative demand," a mathematical function of the measurements made of the value and difficulty of achieving each goal independently. METHODS: Over 400 patients with low vision rated both the importance and difficulty of independently achieving each of 24 goals. Rasch analysis was used to derive interval measures of the social value of each goal, the value that individual patients placed on each goal relative to the derived social definition of independence, the visual ability required to achieve each goal without help, and the visual ability of individual patients to live independently. A rehabilitative demand function was ascertained from the judgments of 17 AAO Diplomates in Low Vision through triadic comparisons and multidimensional scaling. RESULTS: Self-care had the greatest "social value" for independence; performing music had the least. Recreational reading required the greatest "visual ability" to accomplish independently; self-care required the least. Rehabilitative demand was linear with value and nonmonotonic with difficulty. CONCLUSIONS: Rehabilitative demand, an algorithm for defining vision disability, incorporates interval measures of visual ability and the value of independent living estimated from patient-based assessments, a social scale of the value of activities relative to independent living, and a consensus opinion of low vision experts on the prioritization of the need for rehabilitation.     

Comparison of CT and MR imaging in staging of neck metastases

OBJECTIVE: To determine whether adaptive cytoprotection exists in human intestinal cells under in vitro conditions and what role, if any, endogenous prostaglandins or calcium may play in mediating this protective response. SUMMARY BACKGROUND DATA: Adaptive cytoprotection can be defined as that process whereby the administration of a low concentration of a damaging agent, termed a "mild irritant," which by itself is not injurious, can attenuate gastrointestinal mucosal injury subsequently induced by the application of higher concentrations of the same or other necrotizing agents. Despite substantial investigation, the mediator or mediators of adaptive cytoprotection remain poorly understood. METHODS: Postconfluent Caco-2 cells were used in all experiments. Cellular death was quantitated using a dual-component fluorescent assay. Changes in intracellular calcium concentration were quantitated by measuring fluorescent signal changes of the single wavelength calcium indicator (Fluo-3). Finally, prostaglandin E2 release into the media was quantitated by radioimmunoassay. RESULTS: Pretreatment of Caco-2 cells with low concentrations of ethanol (mild irritant) significantly attenuated injury induced by higher damaging concentrations of ethanol. The protection conferred by the mild irritant was directly dependent on both the concentration of the irritant used and the duration of exposure and was abrogated when cells were pretreated with an endogenous prostaglandin inhibitor (indomethacin) or if the mild irritant was administered in calcium-free media. Cells exposed to ethanol had a significant and concentration-dependent increase in intracellular calcium concentration, an effect that was highly related to cellular injury. Pretreatment with a mild irritant significantly decreased intracellular calcium increases induced by not only ethanol but also by a calcium ionophore (A23187). Cells treated with low concentrations of ethanol demonstrated no significant elevation in prostaglandin E2 release. CONCLUSIONS: Adaptive cytoprotection induced by ethanol exists in human colonocytes under in vitro conditions independent of mucosal blood flow, neural innervation, or circulating humoral factors. The authors' data suggest that this response does not require endogenous prostaglandin synthesis but may involve processes whereby intracellular calcium accumulation is prevented.     

Plasma-derived proteins in airway defence, disease and repair of epithelial injury

One significant characteristic of the airway mucosa in vivo, that cannot easily be mimicked in vitro, is its microcirculation, which generates a highly dynamic, biologically active milieu of plasma-derived molecules that may pass to the airway lumen in vivo. New data on the mechanisms of airway mucosal exudation indicate that the protein systems of circulating plasma may contribute significantly to the biology and immunology of the lamina propria, its surface epithelium and the luminal surface, not only in injured airways, but also in airways that are activated but display no sign of oedema, epithelial disruption, or increased absorption capacity. We suggest that present knowledge of the mechanisms of plasma exudation, together with rapidly emerging information (not detailed herein) on receptors, target cells and cellular responses to the plasma-derived molecules, must be considered in any realistic model that investigates "immuno-inflammatory" mechanisms of the airway mucosa.     

Extension of a typology of alcohol dependence based on relative genetic and environmental loading

Mild, severe, and dyssocial subtypes of alcohol dependence, previously identified among Caucasian men from the Epidemiologic Catchment Area study, were also identified among Caucasian men and women with DSM-IV alcohol dependence from the National Longitudinal Alcohol Epidemiologic Survey (n = 2,703; 1,746 respectively). These subtypes were not identified among African American and Hispanic American men or women with DSM-IV alcohol dependence. Among Caucasians with alcohol dependence, the subtypes were characterized by differential loading on three dimensions: genetic, general environmental, and dyssocial environmental symptom scales developed in a prior twin study. The mild subtype (60% of men and 66% of women) was distinguished by low mean scores on all three scales; the dyssocial subtype (24% of men and 20% of women) by low mean genetic and general environmental scores but high mean dyssocial environmental scores; and the severe subtype (16% of men and 14% of women) by high scores on the genetic and general environmental scales. These subtypes also showed the expected distinctions in clinical characteristics. The severe subtype showed greater comorbid drug dependence and major depression, more treatment seeking, and a higher prevalence of parental alcoholism. The severe subtype also showed significantly greater genetic influence adjusted for overall severity of alcohol dependence (genetic ratio). Only the severe subtype showed a pattern of scale scores and clinical characteristics suggestive of substantial genetic influence. The present study indicates a robustness of the typology originally developed among DSM-III alcohol-dependent Caucasian men by empirical extension of the subtypes to a different sample of Caucasian men and, separately, Caucasian women. The use of this typology may aid in distinguishing between Caucasian alcohol-dependent individuals on the basis of relative genetic influence, enabling genetic, behavioral, and epidemiological investigations to reduce genetic or environmental "noise" and better focus on specific aspects of alcohol dependence.     

Effect of fenfluramine on food intake, mood, and performance of humans living in a residential laboratory

Five male and four female normal weight research volunteers, participating in 13-day residential studies, received oral fenfluramine (20, 40 mg) or placebo at 09:30 and 17:00. Food intake, performance, and subjective ratings were measured throughout the day. Carbohydrate intake was manipulated by providing lunch meals high (males: 120 g; females: 80 g) or low (males: 25 g; females: 16 g) in carbohydrate on 8 days; on the remaining days subjects self-selected lunch. Total caloric intake (approximately 2800 Kcal) did not differ among the low- and high-carbohydrate, and self-selected lunch conditions when subjects received placebo, indicating caloric compensation. Total carbohydrate intake was significantly less, however, when subjects consumed the low-carbohydrate lunch compared to the other lunch conditions. Fenfluramine significantly decreased total caloric intake (approximately 500 kcal) by decreasing meal size, not number, only when subjects consumed the low-carbohydrate lunch. Fenfluramine was only an effective anorectic drug when subjects consumed a lunch with fewer calories and a lower carbohydrate:protein ratio than self-selected baseline. Also, fenfluramine improved performance on a range of computer tasks and increased ratings of "Alert," "Friendly," and "Talkative," while decreasing ratings of "Tired" and "Irritable."     

Automatic 3D model reconstruction of cutting tools from a single camera

Collision detection by machining simulation requires the 3D models of rotating cutters. However, the 3D models of a cutter and holder are not always available. In this paper, a new method is proposed to design an automatic vision-based 3D modeling system, which is able to quickly reconstruct the 3D model of a cutter and holder when they are installed onto the spindle. Only a single camera is mounted on the machine tool to capture the image of the rotating cutter and holder. By viewing the rotating cutter and holder as an object of surface of revolution, the contour of the imaged cutter and holder can be used to reconstruct the 3D model as a stack of circular cross-sections. Then the complete generating function of the cutter and holder can be recovered from the cross-sections. Finally, the 3D model of the cutter is built by rotating the generating function around the spindle axis. The effectiveness and accuracy of the proposed method are verified by experiments on-machine using 12 kinds of cutters and holders, which can satisfy the requirement of collision detection.     

eSeeTrack--visualizing sequential fixation patterns

We introduce eSeeTrack, an eye-tracking visualization prototype that facilitates exploration and comparison of sequential gaze orderings in a static or a dynamic scene. It extends current eye-tracking data visualizations by extracting patterns of sequential gaze orderings, displaying these patterns in a way that does not depend on the number of fixations on a scene, and enabling users to compare patterns from two or more sets of eye-gaze data. Extracting such patterns was very difficult with previous visualization techniques. eSeeTrack combines a timeline and a tree-structured visual representation to embody three aspects of eye-tracking data that users are interested in: duration, frequency and orderings of fixations. We demonstrate the usefulness of eSeeTrack via two case studies on surgical simulation and retail store chain data. We found that eSeeTrack allows ordering of fixations to be rapidly queried, explored and compared. Furthermore, our tool provides an effective and efficient mechanism to determine pattern outliers. This approach can be effective for behavior analysis in a variety of domains that are described at the end of this paper.