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.     

Estimating phonation threshold pressure

Phonation threshold pressure (PTP) is the minimum subglottal pressure required to initiate vocal fold oscillation. Although potentially useful clinically, PTP is difficult to estimate noninvasively because of limitations to vocal motor control near the threshold of soft phonation. Previous investigators observed, for example, that trained subjects were unable to produce flat, consistent oral pressure peaks during/pae/syllable strings when they attempted to phonate as softly as possible (Verdolini-Marston, Titze, & Druker, 1990). The present study aimed to determine if nasal airflow or vowel context affected phonation threshold pressure as estimated from oral pressure (Smitheran & Hixon, 1981) in 5 untrained female speakers with normal velopharyngeal and voice function. Nasal airflow during /p/occlusion was observed for 3 of 5 participants when they attempted to phonate near threshold pressure. When the nose was occluded, nasal airflow was reduced or eliminated during /p/;however, individuals then evidenced compensatory changes in glottal adduction and/or respiratory effort that may be expected to alter PTP estimates. Results demonstrate the importance of monitoring nasal flow (or the flow zero point in undivided masks) when obtaining PTP measurements noninvasively. Results also highlight the need to pursue improved methods for noninvasive estimation of PTP.     

A cost comparison of balloon angioplasty and stenting versus endarterectomy for the treatment of carotid artery stenosis

PURPOSE: Percutaneous transluminal angioplasty with stenting (PTAS) of the carotid artery has been advocated as an alternative treatment for high-grade stenosis. Rationale for this approach includes less morbidity, shorter recovery, and lower cost when compared with carotid endarterectomy (CEA). METHODS: The clinical results and hospital charges of patients who underwent elective treatment for carotid stenosis were reviewed. During a concurrent 14-month period, 218 patients were admitted 229 times for 234 procedures for the treatment of 239 carotid bifurcation stenoses, 109 by PTAS and 130 by CEA. Hospital charges were reviewed for each hospitalization and were categorized according to radiology, operating room, cardiac catheterization laboratory, and all other hospital charges. RESULTS: The combined incidence of postprocedure strokes and deaths were: PTAS, eight strokes (7.7%) and one death (0.9%); CEA, two strokes (1.5%) and two deaths (1.5%). Total hospital charges per admission for the two groups were $30,140 for PTAS and $21,670 for CEA. The average postprocedure length of stay for PTAS was 2.9 days (median, 2 days) and for CEA was 3.1 days (median, 3 days). Cardiac catheterization laboratory charges for the PTAS group were $12,968, whereas the operating room charges for the CEA group were $4263. When hospitalizations that were extended by complications were excluded, the average total charges for the PTAS group (n = 84) dropped to $24,848 (mean length of stay, 1.9 days) and for the CEA group (n = 111) to $19,247 (mean length of stay, 2.6 days). CONCLUSIONS: After evaluating hospital charges, PTAS for the treatment of carotid stenosis cannot currently be justified on the basis of reduced costs alone. With future cost-containing measures, total hospital charges can be reduced in both groups.     

Promatech公司推出多用剑杆织机

意大利织机制造商Ｐｒｏｍａｔｅｃｈ公司以Ｓｏｍｅｔ品牌推出了一种新型剑杆织机。这种以“Ａｌｐｈａ”命名的织机于２００１年９月底首次在一个演示间里亮相，随后又成为新加坡ＩＴＭＡ　Ａｓｉａ展会上的一个亮点。Ｓｏｍｅｔ公司剑杆织机产品经理Ｐｉｅｒｍａｒｃｏ　Ａｒｎｏｌｄｉ先生说，这种新型织机操作简便，可靠性高和多用性强，能以非常高的织造速度织许多种织物。一、Ａｌｐｈａ剑杆织机的性能１．操作简便Ａｌｐｈａ的设计使操作工很容易接近机器和修复断头。例如：打纬点与胸梁之间的距离大幅度缩短，使操作工更容易用手来…     

青铜峡灌区水土资源平衡分析的探讨

本文根据青铜峡灌区四水转化的特点和灌区规划的要求，提出灌区节水改造规划的水土资源平衡应进行水资源的3个平衡分析，即水资源供需平衡分析，引水、耗水与排水平衡分析，水资源耗水平衡分析.水资源的3个平衡分析的目标与内容不同，但科学基础与依据都是灌区的四水转化关系.     

Model-driven systems development and integration environment

Telecommunications operators are undergoing massive transformations in order to metamorphose themselves into the ICT world and compete with agile, lean IT organisations. The main challenges facing telecommunications operators, such as BT, are to reduce costs and increase agility in deploying software systems for provisioning ICT services. Despite using reusable capabilities and COTS packages, the major source of increased cost lies in the heavy integration tax we incur for integrating diverse systems implemented on diverse platforms and middleware, with heterogeneous data and process models. This paper looks at cost implications of lengthy and often manual migration to-and-from systems and platforms, and shows the clear business benefits of model-driven development (MDD) as defined by the Object Management Group (OMG). It is clearly demonstrated that model-driven development has matured into a practical, industrialised, scalable and evolvable technology, culminating from decades of R&D on specification and design languages, executable formalisms and domainspecific languages and language transformations.     

Prevention and Mitigation Strategies to Address Recent Brittle Fractures in Steel Bridges

Brittle fracture results in unplanned loss of service, very costly repairs, concern regarding the future safety of the structure, and potential loss of life. These types of failures are most critical when there is no evidence of fatigue cracking leading up to the fracture and the fracture origin is concealed from view. Hence, the failure occurs without warning and the details are, essentially, noninspectable. In these cases, it appears desirable to take a proactive approach and introduce preventative retrofits to reduce the potential for future crack development. These efforts will help ensure that the likelihood of unexpected fractures is minimized. This paper examines the behavior of two bridge structures in which brittle fractures have developed in recent times, discusses the causes of the failures, and offers suggested design strategies for prevention and retrofit mitigation techniques. In situations where considerable uncertainty exists in the prediction of accumulated damage or in the ability to reliably inspect critical details, preemptive retrofit strategies appear to be highly desirable.     

Hormonal regulation of the estrogen receptor in primary cultures of hepatocytes from female rats

Estrogen treatment affects the hepatic synthesis and/or secretion of several proteins involved in clinically important pathological processes such as atherosclerosis, hypertension, and thrombosis. The endocrine regulation of the estrogen receptor (ER) concentration in primary cultures of rat hepatocytes was studied. Human growth hormone (hGH) and dexamethasone (DEX) in combination increased ER concentration 6-fold and ER mRNA levels 2.5-fold. These effects were not significantly different from those observed after treatment with the purely somatogenic bovine growth hormone (GH) in combination with DEX. Treatment with the lactogen ovine prolactin in the presence or absence of DEX did not significantly affect ER or ER mRNA concentrations. Triiodothyronine treatment at the most effective concentration (50 nM) increased ER and ER mRNA levels twofold. Medium supplementation with estradiol (0.1 nM) throughout the experiment did not affect the response to treatment with hGH and DEX. Treatment with high concentrations of ethinylestradiol in combination with hGH and DEX, however, increased the ER level twice as much as hGH and DEX without addition of estradiol or ethinylestradiol, whereas the ER mRNA concentration was the same in both the GH+DEX group and GH+ DEX+ (estradiol or ethinylestradiol) groups. These data indicate the importance of GH in combination with glucocorticoids for the maintenance of ER concentrations in the rat liver. Thyroid hormones may be of some, although minor importance, whereas the data suggest that prolactin is not directly involved in hepatic ER regulation.     

Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience

OBJECTIVE: The most common indication for electroconvulsive therapy (ECT) is major depression. It is less recognized that ECT is effective also in the treatment of acute mania. This article aims to provide a comprehensive and critical review of the literature on the use of ECT for manic patients. METHOD: All published papers in the English language on the use of ECT in acute mania that could be found were reviewed with regard to efficacy, frequency and number of treatments, bilateral versus unilateral electrode placement, predictors of antimanic response, stability of therapeutic response, cognitive consequences, and other relevant issues. RESULTS: The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy. Manic patients do not require a high frequency or prolonged course of treatments to respond to ECT. The seizure threshold appears to be lower in manic patients than in depressed patients. The issues of relapse following response to ECT, cognitive consequences of ECT, and the relative merits of unilateral versus bilateral ECT in manic patients require further study. CONCLUSIONS: ECT is an effective and safe treatment for acute mania. Remission of mania following ECT reflects a primary therapeutic effect rather than a secondary consequence of an ECT-induced organic brain syndrome.