Urinalysis in clinical diagnosis

STUDY OBJECTIVE: To determine if the addition of alfentanil to propofol is more effective than propofol alone to provide adequate conditions for placement of a retrobulbar block prior to cataract surgery. DESIGN: Randomized, double-blinded study. SETTING: Outpatients at a university hospital. PATIENTS: 40 adult ASA physical status I, II, and III outpatients scheduled for elective cataract surgery. INTERVENTIONS: Patients were randomly assigned to receive one of four drug combinations prior to the placement of a retrobulbar block: Group 1, propofol alone; Group 2, alfentanil 5 micrograms/kg plus propofol; Group 3, alfentanil 10 micrograms/kg plus propofol; Group 4, alfentanil 15 micrograms/kg plus propofol. All patients were preoxygenated by face mask for two minutes prior to drug administration. The quality of conditions for block placement were determined by: (1) assessing the amount of movement by the patients while the block needle was in place, (2) cooperativeness of the patients during the operation, (3) hemodynamic side effects, (4) incidence and severity of respiratory depression, (5) incidence of nausea and vomiting, (6) recall of placement of the block, and (7) time to discharge from the hospital. Measurements and Main Results: The addition of alfentanil to propofol for sedation prior to placement of the retrobulbar block resulted in a dose-dependent reduction in movement by the patients. However, the highest dose of alfentanil (15 micrograms/kg) resulted in the greatest frequency (40% of the patients in this group) of respiratory depression (SpO2 < 90%). All patients were cooperative during the operation and responsive to verbal command within 5 minutes of placement of the block. In addition, all of the patients denied being nauseated, having vomited, or recalling block placement in the recovery room or the next day. CONCLUSIONS: The combination of alfentanil and propofol may be used to sedate patients in order to limit movement and provide a cooperative, alert patient with stable hemodynamics and limited respiratory depression during placement of retrobulbar block prior to ophthalmic surgery. However, excessive dosage of these drugs may result in hazardous respiratory depression in this patient population.     

Preferred strategies for secondary infrainguinal bypass: lessons learned from 300 consecutive reoperations

PURPOSE: To determine the optimal surgical strategies in reoperative infrainguinal bypass, we reviewed our results in 300 consecutive secondary bypasses in 251 patients operated on between Jan. 1, 1975, and Nov. 1, 1993. METHODS: There were 168 men (67%) and 83 women (33%), with a mean age of 64.8 years and a typical distribution of risk factors including smoking (76.4%), diabetes (33.7%), and coronary artery disease (47.1%). The indications for surgery were limb-threatening ischemia in 83.5% and severe claudication in 16.5% of patients. The majority of conduits (n = 213) were autogenous vein and were composed of a single segment of greater saphenous vein in 121 bypasses (57%) and various alternative veins including composite, arm, and lesser saphenous vein in 92 bypasses (43%). Prosthetic conduits included 69 polytetrafluoroethylene, 16 umbilical vein, and two Dacron grafts. RESULTS: There was one perioperative death (0.3%) and a 25% total morbidity rate including a 1.7% myocardial infarction rate. There was a 28.6% early (< 30 days) graft failure and 10.7% early amputation rate for prosthetic bypass grafts compared with 13.6% early graft failure and 5.6% early amputation rates for vein grafts. Autogenous vein bypasses had higher 5-year secondary patency rates than had prosthetic grafts (51.5% +/- 4.6% vs 27.4% +/- 6.1%, p < 0.001). Results with autogenous vein bypass improved significantly from the 1975 to 1984 to the 1985 to 1993 interval with 5-year secondary patency rates increasing from 38.3% +/- 6.9% to 59.1% +/- 5.8% (p = 0.017) and 5-year limb-salvage rates increasing from 40.4% +/- 7.6% to 72.4% +/- 6.6% (p < 0.001). Vein grafts to the popliteal and tibial outflow levels had equivalent long-term results. Vein grafts completed for claudication demonstrated results superior to those for limb salvage, with a 5-year secondary patency rate of 75.8% +/- 8.1% versus 52.3% +/- 7.9% (p = 0.048). Secondary autogenous vein bypass grafting performed after early primary graft failure (< 3 months) did particularly poorly, with only a 27.2% +/- 7.7% 4-year secondary patency rate. Greater saphenous veins tended to perform better than alternative vein bypasses, with a 5-year secondary patency rate of 68.5% +/- 6.0% compared with 48.3% +/- 10.5% (p = 0.09) and a 5-year limb-salvage rate of 77.8% +/- 7.4% versus 54.2% +/- 11.8% (p = 0.046). CONCLUSIONS: When patients suffer a recurrence of limb-threatening ischemia at the time of infrainguinal graft failure, aggressive attempts at secondary revascularization with autogenous vein are warranted based on the low surgical morbidity and mortality rates and the improved patency and limb salvage rates that are currently attainable.     

Call control and traffic transport for connection-oriented highspeed wireless personal communications over metropolitan area networks

A distributed circuit-switched approach for supporting the deployment of high speed wireless personal communication services in urban areas through the interconnection of base stations via metropolitan area networks (MANs) is proposed. Broadband MANs minimize traffic congestion by dynamic sharing of link capacity and by serving as distributed switches for partitioning call control functions. While the DQDB protocol readily supports distributed packet-switching over the IEEE 802.6 MAN, isochronous traffic such as voice and video is best supported by circuit-switched connections. The authors present an enhanced bi-state pre-arbitrated (PA) transport mechanism, and associated call control and handoff management techniques, which enable distributed circuit-switching over the MAN. These capabilities are not currently addressed in the 802.6 standards. The bi-state PA transport mechanism facilitates statistical multiplexing of variable rate isochronous traffic sources. The network capacity is constrained by the call setup delay performance, and is analyzed by simulations. Alternative signaling architectures, involving different placements of call control network elements, are evaluated. The effects of erasure nodes, and close bus versus open bus architectures, are considered. The overlap inter-MAN call setup procedure is proposed to reduce delays. Different call handoff procedures are formulated according to the type of handoff and the resulting change in call connectivity. Most handoffs are intra-MAN, requiring simple procedures with short delays     

Role of Specimen Geometry in the Effect of Fiber Orientation on the Thermal Conductivity of a Uniaxial Carbon-Fiber-Reinforced Aluminoborosilicate Glass-Matrix Composite

A study concerning the effect of fiber orientation on the thermal conductivity of a uniaxial carbon-fiber-reinforced borosilicate glass was conducted. For thin specimens, and thick specimens with specimen sides cut parallel to the fiber direction, the dependence of thermal conductivity on fiber orientation showed excellent agreement with theoretical behavior predicted for a composite infinite in extent. In contrast, the thermal conductivity data for rectangular thick specimens fell well below the data for the thin and angled specimens. For fiber orientation of 45° and higher, at which the heat was directed toward the side of the specimen rather than across, the thermal conductivity values showed excellent agreement with theoretical behavior predicted for a finite composite strip with insulated sides.     

Lithium-induced follicular hyperkeratosis

Scanning with Tc-99m labeled RBC was performed in two patients with recurrent postoperative gastrointestinal bleeding after partial colonic resection. Imaging correctly identified the source of bleeding at the anastomotic site in the large bowel, effectively contributing in the patient's treatment planning. Radionuclide scintigraphy provides a simple, noninvasive modality to diagnose and manage difficult clinical situations such as postoperative bleeding.     

认知定位系统的自适应精度研究

为了能够实现定位精度的自适应,本文分析了认知无线电定位系统(cognitive positioning systems,CPS)的原理。该系统利用频谱及环境感知等模块中的传感器单元来获取所需的定位参数,并将其与到达时间(time of arrival,TOA)定位估计算法相结合,以克拉美罗下界(Cramer-Rao lower bound,CRLB)为准则分析最大似然(maximum likelihood,ML)定位精度自适应算法。本文还对单径和多径环境条件下定位精度自适应性能进行了比较。仿真结果表明,该算法能够实现定位精度的自适应,并能通过改善系统可用的频带带宽、分散频谱的数目、信号的调制方式等因素来提高定位精度。     

国产软硬件环境下图像组织浏览构件设计

针对在国产软硬件环境下,应用系统读取、浏览大量图像数据的速度慢问题,设计了图像组织浏览构件。通过改进图像组织方式,将基础影像和目标对象图像分开组织管理,并对目标对象图像的属性和分层、分类进行探讨,实现图像信息的快速展现。对图像组织浏览构件进行了插件化设计与实现,利用QT跨平台开发工具,实现了应用集成框架,并通过实现统一集成接口,进行各业务插件的集成。