Laparoscopic cholecystectomy in pancreas transplant recipients

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Since its introduction in 1987, this procedure has been employed with increasing frequency as its safety has been documented in numerous studies. Absolute contraindications to laparoscopic cholecystectomy have become relative contraindications, and patients previously felt to be at excessive risk for laparoscopic cholecystectomy are viewed as patients who may benefit from laparoscopic cholecystectomy. The use of this procedure in patients with comorbid medical conditions has the potential to decrease patient morbidity. Patients who have previously undergone solid organ transplantation and require immunosuppressive therapy are a group of patients who may benefit from laparoscopic cholecystectomy. We report four patients who have previously undergone combined renal and pancreas transplantation who underwent successful laparoscopic cholecystectomy.     

Increase in leukocyte adhesiveness and aggregation with stress: a model of human congestive heart failure

Stress has a significant influence on the function of the human organism. A simple, rapid, inexpensive, and reliable marker for stress would therefore be of great value. We have recently noted that stress increases the state of leukocyte adhesiveness and aggregation in the peripheral blood. We evaluated 64 patients who had various degrees of congestive heart failure, a condition known to induce a state of physiologic stress, to verify whether a relation exists between the intensity of the stress response and the magnitude of leukocyte adhesiveness. Included in the 64 were 53 patients without congestive heart failure, 23 with compensated failure, 22 with significant congestive heart failure, and 19 with florid pulmonary edema. The percentage of aggregated leukocytes in these four group was 6% +/- 4%, 6% +/- 4%, 10.5% +/- 5%, and 15% +/- 14%. Values for the third and fourth group differed in a statistically significant way. Thus, with further investigation into additional stress-inducing conditions, the state of leukocyte adhesion and aggregation may prove to be a reliable marker for the detection of stress and an inexpensive tool for quantifying its severity.     

Optimal control of nonlinear systems to given orbits

Using optimal control techniques we derive and demonstrate the use of an explicit single-step control method for directing a nonlinear system to a target orbit and keeping it there. We require that control values remain near the uncontrolled settings. The full nonlinearity of the problem in state space variables is retained. The “one-step” of the control is typically a composition of known or learned maps over (a) the time required to learn the state, (b) the time to compute the control and (c) the time to apply the control. No special targeting is required, yet the time to control is quite rapid. Working with the dynamics of a well-studied nonlinear electrical circuit, we show how this method works efficiently and accurately in two situations: when the known circuit equations are used, and when control is performed only on a Poincaré section of the reconstructed phase space. In each case, because the control rule is known analytically, the control strategy is computationally efficient while retaining high accuracy. The target locations on the selected target trajectory at each control stage are determined dynamically by the initial conditions and the system dynamics, and the target trajectory is an approximation to an unstable periodic orbit of the uncontrolled system. A linear stability analysis shows that dissipation in the dynamical system is essential for reaching a controllable state.     

An economic evaluation of the use of rare earth screens to reduce the radiation dose from diagnostic X-ray procedures in Israel

In Israel the diffusion of rare earth screen technology has been limited. These screens could halve the radiation dose to the patient from diagnostic X-ray radiography, with little managerial effort and without being detrimental to the quality of the diagnostic image. We estimated the total effective dose from diagnostic film radiography capable of reduction by the use of rare earth screens, based on the number of hospital and ambulatory diagnostic X-ray procedures. This number was multiplied by the computed radiation dose per body site for a series of diagnostic procedures. The annual dose was approximately 0.53 mSv per head, approximately half of which could be averted by the introduction of rare earth screen technology. Based on a fatality risk of 3% Sv-1, it is estimated that the adoption of rare earth screen technology might reduce the annual incidence of cancer by some 93 cases, half of which would be fatal after an average latency period of 18.4 years. The cost of purchasing rare earth screens on a nationwide basis is approximately $3.0 million. This cost is outweighed by a saving of $9.6 million in X-ray tube replacement costs over the period 1997-2006. Government legislation enforcing the use of rare earth screens is essential, because of the lack of prestige associated with acquiring rare earth technology, as well as institutional reluctance to accept the external benefits of reduced morbidity and mortality and/or to extend budgetary time horizons.     

Advantages of high-field tokamaks for fusion reactor development

High-field designs could reduce the cost and complexity of tokamak reactors. Moreover, the certainty of achieving required plasma performance could be increased. Strong Ohmic heating could eliminate or significantly decrease auxiliary heating power requirements and high values of n_E could be obtained in modest-size plasmas. Other potential advantages are reactor operation at modest values of , capability of higher power density and wall loading, and possibility of operation with advanced fuel mixtures. Present experimental results and basic scaling relations imply that the parameterB ²a, where B is the magnetic field and a is the minor radius, may be of special importance. A superhigh-field compact ignition experiment with very high values ofB ²a (e.g.,B ²a=150 T² m) has the potential of Ohmically heating to ignition. This short-pulse device would use inertially cooled copper plate magnets. Compact engineering test reactor and/or experimental hybrid reactor designs would use steady-state, water-cooled copper magnets and provide long-pulse operation. Design concepts are also described for demonstration/commercial reactors. These devices could use high-field superconducting magnets with 7–10 T at the plasma axis.     

Outdoor attractancy of males ofMatsucoccus josephi (Homoptera: Matsucoccidae) andElatophilus hebraicus (Hemiptera: Anthocoridae) to synthetic female sex pheromone ofMatsucoccus josephi

The active component of the sex pheromone ofMatsucoccus josephi is (2E,6E,8E)-5,7-dimethyl-2,6,8-decatrien-4-one; the chemical is also a powerful kairomone of adult males and females of the bugElatophilus hebraicus the principal predator ofM. josephi. The presence of theZ isomer (2E,6Z,8E)-5,7-dimethyl-2,6,8-decatrien-4-one does not interfere with the attractancy of the activeE component forM. josephi males or the bug. Our results show a clear dose-response between trap catch ofM. josephi males andE. hebraicus. Conversely, increasing amounts of theZ isomer in the mixture did not affect the attraction of the scale insect males or the bug. The catch ofM. josephi males did not differ significantly among traps of different color, and was significantly higher with traps attached to the tree trunk than those suspended between trees. Comparison of the catch ofM. josephi among the three forests and between pine species suggests that the level of infestation ofPinus halepepsis andPinus brutia ssp.brutia is similar, despite the fact that the latter pine is resistant to the scale insect. Both sexes ofE. hebraicus were trapped in much lower numbers at the more infested sites. This may be related to interference with the activity ofE. hebraicus due to deterioration and drying of parts of the tree crowns and heavy colonization by generalist predators in injured trees.     

Deviant auditory stimuli activate human left and right auditory cortex differently

Infrequent "deviant' auditory stimuli embedded in a homogeneous sequence of "standard' sounds evoke a neuromagnetic mismatch field (MMF), which is assumed to reflect automatic change detection in the brain. We investigated whether MMFs would reveal hemispheric differences in cortical auditory processing. Seven healthy adults were studied with a whole-scalp neuromagnetometer. The sound sequence, delivered to one ear at time, contained three infrequent deviants (differing from standards in duration, frequency, or interstimulus interval) intermixed with standard tones. MMFs peaked 9-34 msec earlier in the right than in the left hemisphere, irrespective of the stimulated ear. Whereas deviants activated only one MMF source in the left hemisphere, two temporally overlapping but spatially separate sources, one in the temporal lobe and another in the inferior parietal cortex, were necessary to explain the right-hemisphere MMFs. We suggest that the bilateral MMF components originating in the supratemporal cortex are feature specific whereas the right-hemisphere parietal component reflects more global auditory change detection. The results imply hemispheric differences in sound processing and suggest stronger involvement of the right than the left hemisphere in change detection.     

Representation before computation

My main objective is to point out a fundamental weakness in the conventional conception of computation and suggest a promising way out. This weakness is directly related to a gross underestimation of the role of object representation in a computational model, hence confining such models to an unrealistic (input) environment, which, in turn, leads to “unnatural” computational models. This lack of appreciation of the role of structural object representation has been inherited from logic and partly from mathematics, where, in the latter, the centuries-old tradition is to represent objects as unstructured “points”. I also discuss why the appropriate fundamental reorientation in the conception of computational models will bring the resulting study of computation closer to the “natural” computational constrains. An example of the pertinent, class-oriented, representational formalism developed by our group over many years—Evolving Transformation System (ETS)—is briefly outlined here, and several related general lines of research are suggested.