Snowboard traumatology: an epidemiological study

OBJECTIVE: To estimate the frequency of perioperative morbidities in patients who underwent anesthesia and a surgical procedure with no preoperative laboratory testing. MATERIAL AND METHODS: We conducted an electronic database search of medical records of 56,119 patients who underwent surgical or diagnostic procedures and anesthesia at Mayo Clinic Rochester in 1994 and found 5,120 who had no laboratory tests done within 90 days before the procedure. From this group, we randomly selected 1,044 patients (87 from each month) to document the absence of preoperative tests, the presence of preexisting disease (by organ system), the type of anesthetic agent, and the outcomes and tests intraoperatively and postoperatively. RESULTS: The 1,044 patients ranged in age from 0 to 95 years (median age, 21). No deaths or major perioperative morbidities occurred (0.0%; exact 95% confidence interval, 0.00 to 0.35%). Although 10 patients underwent blood typing and screening for antibodies immediately preoperatively, no blood transfusions were necessary. Intraoperatively, 17 laboratory tests and 1 electrocardiogram were obtained, and 3 results were abnormal. Postoperatively, 42 blood tests and 2 electrocardiographic procedures were performed. Five of the 42 blood tests showed abnormal results (hemoglobin levels in 3, serum sodium in 1, and arterial blood gases in 1). One electrocardiogram showed normal findings, and the other revealed normal results except for premature ventricular contractions. No laboratory test done intraoperatively or postoperatively was found to change surgical or medical management substantially. One patient who had unanticipated blood loss during an outpatient procedure was admitted to the hospital for observation. CONCLUSION: All 1,044 patients, 97% of whom were relatively healthy, with no recent laboratory testing safely underwent anesthesia and an operation. We conclude that patients who have been assessed by history and physical examination and determined to have no preoperative indication for laboratory tests can safely undergo anesthesia and operation with tests obtained only as indicated intraoperatively and post-operatively. Current anesthetic and medical practices rapidly identify perioperative indications for laboratory evaluation as they arise.     

Feedback tuning of bifurcations

The present paper studies a feedback regulation problem that arises in at least two different biological applications. The feedback regulation problem under consideration may be interpreted as an adaptive control problem for tuning bifurcation parameters, and it has not been studied in the control literature. The goal of the paper is to formulate this problem and to present some preliminary results.     

Picosecond photodiffraction in semiconductor multiquantum wells and microcavities

We study the transient gratings photogenerated in the picosecond regime in three families of structures, namely : - structures of thickness in the order of one micron, including quantum wells (GaAs/GaAlAs, CdTe/ CdZnTe). A transmission modulation due to the electric field has been observed. We show that, in accordance with our calculations, this modulation is screened faster than 10 ps at a fluence of a few µJ/cm2. - A structure including GalnAs/GalnAsP MQWS in a cavity. This structure shows a top diffraction efficiency of 2.5 × 10-² at 1.55 µm for an energy of excitation in the order of 100 µJ/cm2. The diffraction efficiency exhibits several oscillations due to Fabry-Pårot effects. By introducing cavity effects in our model, we show that the diffraction efficiency is amplified by more than a factor 2 with respect to the no-cavity case. Calculations show that the diffraction efficiency may reach 6 × 10-² around 1.625 µm, for a front mirror reflectivity of 90 %. - Structures including bulk GaAs microcavities. The risetime is lower or in the order of 1 ps while the diffraction efficiency attains 1 %, with an average power of 4 mW (i.e. an energy of 2 µJ/cm²/pulse), compatible with a commutation of packets at 80 MHz.     

Surveillance after colorectal cancer surgery

Early diagnosis of local and distant recurrences of colorectal cancer remains difficult and there is no agreement on the effectiveness of follow-up in these patients. The aim of this study is to assess the value of our method of follow-up. We consider 239 patients with colorectal cancer and at least 2 years follow-up following radical resection. A local recurrence appeared in 26 patients (10.9%), a distant metastasis in 41 (17.1%), while in seven (2.9%) local and distant recurrences appeared simultaneously. Local recurrence was detected because of an increase in carcinoembryonic antigen (CEA) level in 15 patients (57.7%), during a scheduled endoscopy in four (15.4%) and because of symptoms in seven (26.9%). In seven patients (26.9%) a radical resection was possible. Distant metastases were detected by CEA levels in 20 patients (48.8%), by ultrasonography (U.S.) in 12 (29.3%) and by chest X-ray in five (12.2%). In 13 of 26 patients with liver metastases a resection was performed. This study shows that few patients benefit from follow-up and only CEA levels and liver U.S. performed intensively between 15 and 36 months after surgery are useful in early detection of recurrences. A modification of the follow-up to the single patient, according to the stage, location and grading of cancer, could improve the results, so lowering the costs of this expensive practice.     

Editorial: Special Issue on “Texture Analysis and Synthesi”

International Journal of Computer Vision -     

Multihour engineering and traffic routing optimization in hierarchical telephone networks

Classical hierarchical routing in telephone networks is extended to a wider class called out-of-chain routing in such a way that some useful properties of hierarchical routing are retained. This new routing pattern offers more potential paths than the fixed hierarchical one and can be introduced as a dynamic routing where the fixed alternate sequences change at some predetermined instants during the day. The effect of this new routing pattern on the network performances is examined. The main topic of this paper is to present heuristic methods used to optimise such routings in large networks. We show on artificial networks that the throughput of a given network can be significantly improved by suitable routing choices. We demonstrate that the integration of routing changes within a multihour dimensioning process is possible but the lack of realistic data does not permit at this time to quantify the value of routing optimization on real networks.     

How disorder can diminish avalanche risks: effect of size distribution

We study the behavior of disk assemblies with a variable disorder distribution. The packing is first consolidated and then continuously tilted very slowly. The amount of displaced disks for each tilted angle is recorded. Large displacements of the disks can occur due to some local or global mechanical instabilities. The definition of neighboring disks is based on radical (extension of Voronoï) tessellation rules to decompose, in a unique and perfectly defined manner, the two-dimensional space for polydisperse disks. In this way, by comparing the characteristics of stability for one disk to the neighboring ones for local ordered cluster, we can predict the global amount of displaced disks. Some tilting cycles have been performed to check the correlation between the instability of the packing structure (collective displacements) with micro and macro order parameters.     

Impact of apolipoprotein E polymorphism on lipoproteins and risk of myocardial infarction. The ECTIM Study

Human apolipoprotein (apo) E, a polymorphic protein with three common alleles, epsilon 2, epsilon 3, and epsilon 4, plays an important role in lipoprotein metabolism. This article describes the association of this polymorphism with lipids, apolipoproteins, and lipoproteins with a particular regard to lipoprotein particles, as defined by their apolipoprotein content, as well as the risk of myocardial infarction in a multicenter population-based case-control study (ECTIM study). In the ECTIM study, 574 male patients aged 25 to 64 were examined 3 to 9 months after myocardial infarction in four regions participating in the World Health Organization MONICA project: Belfast (Northern Ireland) and Lille, Strasbourg, and Toulouse (France). Control subjects (n = 722) were randomly selected from the regional populations. The distribution of apoE phenotypes was significantly different across the four control samples (P = .04), with a higher frequency of the epsilon 4 allele in Belfast (14.3%) than in Toulouse (8.2%). The association of apoE polymorphism with biological measurements was studied in the control groups (n = 640) after men with coronary heart disease or those taking hypolipidemic drugs were omitted, with the apoE3/3 phenotype as a reference after adjustment for concomitant factors. Individuals carrying the epsilon 2 allele had lower levels of plasma cholesterol, low-density lipoprotein cholesterol (LDL-C), and apoB and higher levels of triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), apoC-III, apoE, lipoprotein (Lp) C-III:B, and Lp E:B. However, the effect of the epsilon 2 allele on triglyceride, VLDL-C, apoE, and Lp E:B parameters was heterogeneous across the populations.(ABSTRACT TRUNCATED AT 250 WORDS)