Endoscopic study of the small intestine with push enteroscopy. A prospective study

OBJECTIVE: To evaluate whether push enteroscopy of the small bowel (PES), undertaken after extensive previous investigations in suspected intestinal bleeding from an uncertain site, chronic diarrhoea or lymphoma of the small intestine, contributes to the diagnosis, and to ascertain the results of PES and its clinical significance. PATIENTS AND METHODS: 56 consecutive patients (29 men, 27 women; mean age 63 years) were investigated prospectively. The main indications for PES were the search for the source of intestinal bleeding in 79% of patients (group A), chronic diarrhoea or tropical sprue in 16% (group B) and search for tumour of lymphoma in 5% (group C). PES was always performed in fasting patients under sedation/analgesia using a video PES, which contrary to catheter enteroscopy provides a channel for intervention. RESULTS: In group A 27% of patients were found to have lesions, in particular angiodysplasias, or (in once case) leiomyoma. Half of these patients were successfully treated endoscopically without later surgical intervention being required (mean follow-up of six months). In the other half operation became necessary, either because the disease itself indicated it or the bleeding persisted, the source being in the more distant small intestine and thus not accessible to endoscopic intervention: only 50% of the length of the small intestine proved to be within reach of the instrument. No abnormalities were discovered in patients of groups B and C. CONCLUSION: In cases of gastrointestinal bleeding from an uncertain source PES should be performed first, because in many cases it may obviate surgical intervention. But PES seems to contribute little of diagnostic value in other indications.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Comparative hall measurements on wet- and dry-oxidized 4H-SiC MOSFETs

Hall measurements have been used to compare the properties of 4H-SiC inversion-mode MOSFETs with “wet” and “dry” gate oxides. While the field-effect mobilities were approximately 3–5 cm²/Vs, the Hall mobilities in 4H-SiC MOSFETs in the wet and dry oxide samples were approximately 70–80 cm²/Vs. The dry-oxidized metal oxide semiconductor field effect transistors (MOSFETs) had a higher transconductance, improved threshold voltage, improved subthreshold slope, and a higher inversion carrier concentration compared to the wet-oxidized MOSFETs. The difference in characteristics between the wet- and the dry-oxidized MOSFETs is attributed to the larger fixed oxide charge in the dry oxide sample and a higher interface trap density in the wet oxide sample.     

Metabolism of lysophosphatidylcholine by swine platelets

Incubation of intact platelets from Sinclair(S-1) miniature swine with³²P-labeled lysophosphatidylcholine (lyso PC) indicated the presence of an active lysophospholipase with a pH optimum of 8.0 for hydrolysis of the substrate. However, lyso PC was incorporated into the membrane phosphatidylcholines by the acyltransferase pathway upon addition of ATP, Mg⁺⁺ and CoA to the platelet suspension. These results suggest that intact platelets are able to resist the cytotoxic effects of lyso PC in plasma, and the phospholipids in platelet membranes are not readily affected by the lipid environment of the plasma. The acyltransfer reaction apparently is saturated with endogenous free fatty acids since arachidonic acid added exogenously did not further enhance the incorporation activity. Neither the acyltransferase nor the lysophospholipase activity was affected by Ca⁺⁺, but divalent metal ions such as Zn⁺⁺ inhibited the lysophospholipase activity. Cholesterol but not cholesteryl esters elicited a biphasic effect on both enzymes, stimulating at low concentration but inhibiting at a cholesterol to lyso PC ratio greater than 1. Serum albumin inhibited the lysophospholipase but gave a small biphasic effect to the acyltransferase.     

Explicit robust schemes for implementation of a class of principal value-based constitutive models: Symbolic and numeric implementation

The issue of developing effective and robust schemes to implement a class of the Ogden-type hyperelastic constitutive models is addressed. To this end, special purpose functions (running under MACSYMA) are developed for the symbolic derivation, evaluation, and automatic FORTRAN code generation of explicit expressions for the corresponding stress function and material tangent stiffness tensors. These explicit forms are valid over the entire deformation range, since the singularities resulting from repeated principal-stretch values have been theorectically removed. The required computational algorithms are outlined, and the resulting FORTRAN computer code is presented.     

"Comment on 'Articulation of values'": Response to Cochran (1988).

We respond to Cochran's critique of our 1986 study, which was in part a replication of Cochran's original grid methodology for the study of career values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

自动实时X射线检测技术在半导体制程控制中的应用

对X光检测的不同技术在半导体制程上的应用作了详细的介绍;着重讨论了全旋倾斜(off-axis)X射线技术的特点和优势。