Cerebral microbleeds and cognitive decline in a hemodialysis patient: Case report and review of literature

Cerebral microbleeds (CMBs) are small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage and previously thought to be clinically silent. Recent population‐based cross‐sectional studies and prospective longitudinal cohort studies have revealed association between CMB and cognitive dysfunction. In the general population, CMBs are associated with age, hypertension, and cerebral amyloid angiopathy. In the chronic kidney disease (CKD) population, diminished estimated glomerular filtration rate has been found to be an independent risk factor for CMB, raising the possibility that a uremic milieu may predispose to microbleeds. In the end‐stage renal disease (ESRD) population on hemodialysis, the incidence of microbleeds is significantly higher compared with a control group without history of CKD or stroke. We present an ESRD patient on chronic hemodialysis with a history of gradual cognitive decline and progressive CMBs. Through this case and literature review, we illustrate the need to develop detection and prediction models to treat this frequent development in ESRD patients.     

Supply-side hurdles in Internet B2C e-commerce: an empirical investigation

Given Hong Kong's special circumstances of small physical size, advanced infrastructure, and low shopping cost, a survey is designed under which supply-side problems in Internet business-to-consumer (B2C) e-commerce are indirectly revealed by responses on the demand side. Difficulties arising from the reluctance to answer questionnaires on the part of e-firms wary about trade and innovation secrets and their small number at the outset are thereby overcome. Survey data on demand-side obstacle factors in the form of perceived low e-shopping comparability, e-shopping inconvenience, e-transaction insecurity, and poor Internet privacy, together with orientation toward social interaction and low awareness on the part of consumers, translate into information on notionally matching supply-side hurdles. Regression analysis and hypothesis testing indicate statistical significance for the above hurdle factors in terms of impact on individual unwillingness to shop online. These results add to the inductive basis for future research into a general demand-supply theory of Internet B2C e-commerce and offer an empirically-grounded position against which the effects of later supply-side changes can be evaluated. Useful information also follows for engineer-managers seeking to compare marginal improvements in supply-side problems, particularly in the form of estimated substitution ratios.     

A 1-V 10.7-MHz switched-opamp bandpass /spl Sigma//spl Delta/ modulator using double-sampling finite-gain-compensation technique

A 1 V switched-capacitor (SC) bandpass sigma-delta (/spl Sigma//spl Delta/) modulator is realized using a high-speed switched-opamp (SO) technique with a sampling frequency of up to 50 MHz, which is improved ten times more than prior 1 V SO designs and comparable to the performance of the state-of-the-art SC circuits that operate at much higher supply voltages. On the system level, a fast-settling double-sampling SC biquadratic filter architecture is proposed to achieve high-speed operation. A low-voltage double-sampling finite-gain-compensation technique is employed to realize a high-resolution /spl Sigma//spl Delta/ modulator using only low-DC-gain opamps to maximize the speed and to reduce power dissipation. On the circuit level, a fast-switching methodology is proposed for the design of the switchable opamps to achieve a switching frequency up to 50 MHz. Implemented in a 0.35-/spl mu/m CMOS process (V/sub TP/=0.82 V and V/sub TN/=0.65 V) and at 1 V supply, the modulator achieves a measured peak signal-to-noise-and-distortion ratio (SNDR) of 42.3 dB at 10.7 MHz with a signal bandwidth of 200 kHz, while dissipating 12 mW and occupying a chip area of 1.3 mm/sup 2/.     

Radiation therapy of giant aggressive keratoacanthomas

BACKGROUND AND DESIGN: Giant aggressive keratoacanthoma is a rare destructive subset of keratoacanthoma that frequently involves the facial region, grows rapidly to a large size, and often recurs after surgical management. The effectiveness of ionizing radiation therapy was examined in a retrospective study involving 16 patients; 14 of the tumors had recurred after surgical therapy. RESULTS: All tumors resolved with satisfactory cosmetic results and without recurrence following a fractionated course of superficial radiation therapy. CONCLUSIONS: Radiation therapy is an effective therapeutic modality for giant aggressive keratoacanthomas.     

Secobarbital in humans discriminating triazolam under two-response and novel-response procedures

The percentage of long-term survivors after intensive chemotherapy and the outcome of MDS patients who achieve partial remission (PR) with intensive chemotherapy (IC) are not known. Between 1981 and 1996 we treated 99 patients with de novo MDS who had high-risk MDS or progression to AML, with IC. 41 (41%) achieved CR, 16 (16%) achieved partial remission (PR), 26 (26%) had failure, and 16 (16%) died in aplasia. Eight of the patients who achieved CR were autografted, three were allografted and the remaining cases received moderate consolidation chemotherapy. After IC, the 16 PR patients fulfilled the criteria for RA in 15 cases and CMML in one case. Median PR duration was 17 months, and three PR were > 3 years (39, 50+, 82+ months). Median actuarial survival of patients who achieved PR and CR was 18 months and 20 months from the onset of IC, respectively (difference not significant). Of the 71 patients treated before 1993, with sufficient follow-up, 10 (14%) had survived > 4 years (long-term survivors). Four of them were alive in first CR after 49+ to 110+ months and probably cured, two were alive in PR after 50+ and 82+ months and four had died after 49-78 months. Long-term survivors were characterized by a significantly higher incidence of RAEB-T at diagnosis, and with normal or favourable cytogenetic findings. In patients with RAEB-T at diagnosis included before 1993, 8/23 (35%) cases who had no unfavourable karyotype had survived > 4 years. Our findings suggest that MDS patients who achieve PR with IC, and not only those who achieve CR, can benefit from this type of treatment. The percentage of long-term survivors remains low, however, and is almost restricted to patients with RAEB-T at diagnosis and no unfavourable karyotype.     

A high-linearity 100-element diode grid mixer

Grid-mixer arrays can achieve high linearity and dynamic range through quasi-optical power combining. We present a 100-element single-ended diode grid mixer operating at 2.45 GHz. Each element incorporates two diodes in series. We measure an input third-order intercept of 11 W (40.5 dBm), and output third-order intercept of 3.4 W (35.4 dBm), and an associated conversion loss of 5.1 dB. The power-handling capability of the array is 100 times larger than that of a microstrip mixer using a single element. The local oscillator (LO) drive requirement for the entire array is 1.4 W (31.6 dBm). The angular dependence of the array's IF power is also presented and is in agreement with theory     

Solution of Helmholtz equation by Trefftz method

The application of the Trefftz method for calculating wave forces on offshore structures is presented. Indirect and direct formulations using complete and non-singular systems of Trefftz functions for the Helmholtz equation are posed in this paper. An effective technique using different interpolation functions for the velocity potential and wave force are suggested to improve the computational accuracy of the wave force. The numerical examples show that the present method is highly efficient and accurate.     

Optimal transfer trees and distinguishing trees for testing observable nondeterministic finite-state machines

The fault-state detection approach for blackbox testing consists of two phases. The first is to bring the system under test (SUT) from its initial state to a targeted state t and the second is to check various specified properties of the SUT at t. This paper investigates the first phase for testing systems specified as observable nondeterministic finite-state machines with probabilistic and weighted transitions. This phase involves two steps. The first step transfers the SUT to some state t' and the second step identifies whether t' is indeed the targeted state t or not. State transfer is achieved by moving the SUT along one of the paths of a transfer tree (TT) and state identification is realized by using diagnosis trees (DT). A theoretical foundation for the existence and characterization of TT and DT with minimum weighted height or minimum average weight is presented. Algorithms for their computation are proposed.     

Processes of memory loss, recovery, and distortion

The author proposes that many forms of memory distortion, including the progressive changes in recollection of a learning experience often observed over successive tests, are due to the same processes that yield veridical recollection in some circumstances and memory loss and recovery in others. In a framework for interpreting all of these aspects of memory, the author assumes that the objects and events of a learning experience are encoded in parallel in traces of their perceptual attributes, which are basic to recognition, and in traces of reactions made to the events during or following learning, which are basic to recall. Random perturbation of remembered attribute values in both types of traces over retention intervals is a pervasive cause of both loss and distortions of memory.     

Effects of serotonin and the serotonin blocker metergoline on meal patterns and macronutrient selection

Serotonin [5-hydroxytryptamine(5-HT)] in the paraventricular nucleus (PVN) of rats has a suppressive effect on feeding behavior and causes a selective decrease in carbohydrate ingestion, specifically at the onset of the natural (dark) feeding period. Studies conducted here provide further evidence for this phenomena, showing a similar dose-related decrease in carbohydrate ingestion at dark onset after PVN injection of 5-HT or of the agonists, d-norfenfluramine or fluoxetine, which act through endogenous 5-HT. To further characterize the effects of this indoleamine on the macrostructure of feeding, a computer-automated data acquisition system was used to analyze macronutrient feeding patterns in freely feeding animals maintained on the pure diets of protein, carbohydrate, and fat. Results indicate that PVN administration of 5-HT at dark onset decreases intake of the carbohydrate nutrient by decreasing meal size, feeding time, and feeding rate for this nutrient and increasing the satiating effect of carbohydrate. These effects, which occur specifically during the first meal after injection, are opposite those seen after peripheral administration of the 5-HT receptor antagonist, metergoline. This drug stimulates feeding through a selective increase in carbohydrate intake, characterized by an increase in meal size, percent composition, and feeding time for this nutrient and a decrease in the satiety ratio for carbohydrate. These results implicate the serotonergic system in the termination of carbohydrate-rich meals that are prevalent during the early hours of the natural feeding cycle.