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Background The aim of this study was to design and develop a set of, short message service (SMS) to promote specialized mental health care seeking within the framework of the Allillanchu Project. Methods The design phase consisted of 39 interviews with potential recipients of the SMS, about use of cellphones, and perceptions and motivations towards seeking mental health care. After the data collection, the research team developed a set of seven SMS for validation. The content validation phase consisted of 24 interviews. The participants answered questions regarding their understanding of the SMS contents and rated its appeal. Results The seven SMS subjected to content validation were tailored to the recipient using their name. The reminder message included the working hours of the psychology service at the patient's health center. The motivational messages addressed perceived barriers and benefits when seeking mental health services. The average appeal score of the seven SMS was 9.0 (SD±0.4) of 10 points. Participants did not make significant suggestions to change the wording of the messages. Conclusions Five SMS were chosen to be used. This approach is likely to be applicable to other similar low-resource settings, and the methodology used can be adapted to develop SMS for other chronic conditions. [ABSTRACT FROM AUTHOR]

Depression associated with stroke affects roughly one-third of stroke survivors. Post-stroke depression ( PSD) is thought to adversely influence functional outcome by limiting participation in rehabilitation, decreasing physical, social, and cognitive function, and affecting neuroplasticity thereby placing stroke survivors at high risk for future vascular events. PSD has also been associated with higher mortality rates after stroke. In Peru, a country where there is no national stroke program and mental health disorders are largely underdiagnosed and untreated, people with PSD are likely to be further challenged by dependency and impoverished conditions that will limit their use of ambulatory services, leading to inadequate clinical follow-up. In this scenario, mobile health ( mHealth) technology offers a promising approach to extend access to high-quality and culturally tailored evidence-based psychological care to address PSD given that cell phone use, Internet connectivity, and digital health technology have met a rapid growth in the last years and thus contribute to the attainment of broader Sustainable Development Goals ( SDGs). The limited evidence of the effectiveness of mHealth for PSD calls for researchers to fill a knowledge gap where Peru poses as an ideal setting because rapid expansion of digital technology and current mental healthcare reform could be leveraged to enhance post-stroke outcomes. This article proposes the rationale for a suitable evidence-driven, mHealth-based, PSD self-management intervention called iMOODS-Investigating the role of mHealth in overcoming occurrence of depression after stroke-that could be tested among recent stroke patients with PSD in resource constrained settings. [ABSTRACT FROM AUTHOR]

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The mechanism by which alcohol causes pancreatic damage is still largely unknown. One important contributory factor may be the endothelins, potent vasoconstricting endothelial-derived peptides. The aim of this study was to examine in vivo endothelin release from the pancreatic vascular endothelium after alcohol ingestion. In anesthetized cats immunoreactive endothelin was measured in serum after instillation of alcohol into the stomach (20 ml, 40%). After intragastric alcohol, a rise in endothelin was seen in pancreatic venous effluent (to a mean of 24.5 +/- 7.7 pg/ml at 60 min). Control serum from the femoral artery exhibited no rise in endothelin (2.11 +/- 1.2 pg/ml). Pancreatic blood flow was significantly decreased in a further group to 93% basal after intravenous infusion of 0.1 nmol/kg ET-1 and to 61% after infusion of 1 nmol/kg ET-1. Portal serum levels of endothelin were 105 pg/ml and 15 pg/ml, respectively, immediately following bolus infusion and decreased to normal levels within 120 sec. We conclude that the serum endothelin rise after intragastric ethanol may be a major factor behind the drop in pancreatic blood flow. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nitric oxide is a key signalling molecule in the pathogenesis of inflammation, but its role in acute pancreatitis and related abdominal pain induced by secretory phospholipase A2 (sPLA2 ) from Crotalus durissus terrificus (Cdt) venom has not been investigated. METHODS: Male Wistar rats were i.v. injected with L-NAME (20 mg/kg), aminoguanidine (AG, 50 mg/kg), 7-nitroindazole (7-NI, 10 mg/kg) or vehicle 10 min before or 60 min after the injection of sPLA2 (300 [mu]g/kg) into the common bile duct. After 4 h of sPLA2 injection, abdominal hyperalgesia and inflammation were assessed in addition to serum amylase, nitrite/nitrate (NOx), pancreas lipoperoxidation and 3-nitrotyrosine (3-NT) contents. RESULTS: sPLA2 -induced acute pancreatitis, related abdominal hyperalgesia, hyperamylasemia and increased concentration of NOx were not correlated with lipoperoxidation or increased 3-NT in the pancreas. Pretreatment with all the nitric oxide synthase (NOS) inhibitors significantly reduced abdominal mechanical hyperalgesia, but only iNOS blockade by AG suppressed pancreas oedema and serum NOx increase. The therapeutic approach with all the NOS inhibitors produced a similar reduction pattern of the abdominal hyperalgesia, but AG treatment also inhibited serum hyperamylasemia and NOx concentrations and pancreatic myeloperoxidase. The nNOS blockade by 7-NI treatment also inhibited myeloperoxidase activity in both pancreas and lung. CONCLUSIONS: Therapeutic blockade of iNOS or nNOS provides benefits in terms of inhibition of the acute pancreatitis-related abdominal hyperalgesia, while iNOS inhibition also ameliorates the inflammatory cell influx to the pancreas and reduces the resultant hyperamylasemia and NOx levels, thus representing alternative pharmacological strategies for treatment of clinical pancreatitis associated with increased PLA2 . [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome ( ARDS) is accompanied by severe lung inflammation induced by various diseases. Despite the severity of the symptoms, therapeutic strategies have been ineffective. High mobility group box 1 ( HMGB1), which was identified originally as a DNA binding protein, has been proposed as a mediator of acute lung injury. In addition to its anti-coagulant activity, recombinant thrombomodulin ( rTM) possesses an ability to suppress the inflammatory response through neutralizing HMGB1. T regulatory ( Treg) cells in the lungs are reported to modify innate immune responses during resolution of acute lung injury. In the present study, we investigated the therapeutic effect of rTM, and the contribution of Treg cells to this effect, in a mouse model of severe ARDS. C57 BL/6 mice received sequential intratracheal administration of α-galactosylceramide (α- Gal Cer) and lipopolysaccharide ( LPS), which resulted in the development of severe ARDS. HMGB1 levels in the lungs increased to a higher level in ARDS mice compared to those in mice treated with LPS alone. HMGB1 was expressed in the infiltrating neutrophils and macrophages in lungs. Treg cells were reduced significantly in the lungs of ARDS mice compared to those in mice treated with LPS alone. rTM administration prolonged the survival time and ameliorated the development of ARDS, which was associated with increased Treg cells and synthesis of interleukin ( IL)-10 and transforming growth factor ( TGF)-β in the lungs. These results suggest that HMGB1 is involved in the development of severe ARDS and rTM shows therapeutic effects through promoting the accumulation of Treg cells at the inflammatory sites. [ABSTRACT FROM AUTHOR]

Low molecular weight fragments of sulfated galactans (Boc-5 and Boc-10) from the red algae Botryocladia occidentalis significantly inhibited Crotalus durissus cascavella sPLA2 enzymatic activity. Equimolar ratios of sPLA2 to Boc-5 or Boc-10 resulted in allosteric inhibition of sPLA2. Under the conditions tested, we observed that both Boc-5 and Boc-10 strongly decreased edema, myonecrosis, and neurotoxicity induced by native sPLA2. [ABSTRACT FROM AUTHOR]

This paper explores the determinants of demand for prescription drug coverage among the elderly population in the United States, using data from the Medical Expenditure Panel Survey (MEPS) and seeks to analyse the impact that the Medicare prescription drug coverage bill (Medicare-Part D) has on Medicare beneficiaries. The results indicate that individuals who are Hispanic, black, or of another race or ethnicity, over the age of 74, not married, in poor health, fall into the low- to middle-income brackets, and have less than a high school degree are more likely to be covered through a public program, more likely to be uninsured for prescription medicine outlays, and less likely to have private prescription drug coverage. The paper concludes that there is cause for considerable concern for low income citizens who have significant prescription drug outlays, and, therefore, the greatest need because their prescription drug costs may not be covered beyond a certain limit unless they reach catastrophic proportions. This continues to raise equity in access concerns among elderly patients. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the role of phospholipase A2 (PLA2) inhibitors and tyrosine kinase in the Clostridium difficile toxin A-induced disruption of epithelial integrity, histologic inflammatory damage and intestinal secretion. The materials, methods, and results of the study are discussed. The obtained data suggests the involvement of PLA2 in the major pathway of toxin A-induced histologic inflammatory damage and hemorrhagic fluid secretion. It should also be investigated in clinical trials associated for the treatment of C. difficile colitis.

Unusually for a deep-sea fish, the retina of the myctophid (lanternfish) Myctophum nitidulum was found to contain two visual pigments, shown by extract spectrophotometry to be maximally sensitive at 468 and 522 nm, respectively, giving this species one of the broadest spectral ranges of all deep-sea fishes. High performance liquid chromatography (HPLC) indicated that the retina contained both A1- and A2-based chromophores. Surprisingly, the maximum absorbance (λmax) values of the two visual pigments were too far apart to form a rhodopsin–porphyropsin ‘pigment pair’, suggesting they were based on distinct opsins each linked to a different chromophore. This might be an adaptation to the detection of both long-wave bioluminescence and residual shorter-wave surface illumination, and could be related to this animal’s tendency to migrate towards surface waters at night. [ABSTRACT FROM AUTHOR]

Crotoxin, a potent neurotoxin from the venom of the South American rattlesnake Crotalus durissus terrificus, exists as a heterodimer formed between a phospholipase A2 and a catalytically inactive acidic phospholipase A2 analogue (crotapotin). Large single crystals of the crotoxin complex and of the isolated subunits have been obtained. The crotoxin complex crystal belongs to the orthorhombic space group P21212, with unit-cell parameters a = 38.2, b = 68.7, c = 84.2 Å, and diffracted to 1.75 Å resolution. The crystal of the phospholipase A2 domain belongs to the hexagonal space group P6122 (or its enantiomorph P6522), with unit-cell parameters a = b = 38.7, c = 286.7 Å, and diffracted to 2.6 Å resolution. The crotapotin crystal diffracted to 2.3 Å resolution; however, the highly diffuse diffraction pattern did not permit unambiguous assignment of the unit-cell parameters. [ABSTRACT FROM AUTHOR]

The paper examines the role played by various factors in the development of new products in the Thai food industry. Data collected from a sample survey covering 62 firms in the four main subsectors of the Thai food industry are examined using both multiple regression and ‘pair comparison’ analyses. From the regression analysis based on six selected independent variables (firm-size, age, ownership, market orientation, promotional status and product type), only firm-size was found to be a statistically significant determinant of technological capability for the development of new products. However, the ‘pair-comparison’ analysis shows that various other factors can also be influential. These include senior management values, policy and strategy, management and administration, the system of rewards and promotion, information flows and links, and R&D activities. [ABSTRACT FROM AUTHOR]

A novel method to measure oxidative stress resulting from exhaustive exercise in rats is presented. In this new procedure we evaluated the erythrocyte antioxidant enzymes, catalase (CAT) and glutathione reductase (GR), the plasma oxidative attack markers, reactive carbonyl derivatives (RCD) and thiobarbituric reactive substances (TBARS). Muscular tissue damage was evaluated by monitoring plasma creatine kinase (CK) and plasma taurine (Tau) concentrations. Also, we monitored total sulphydryl groups (TSG) and uric acid (UA), and the level of the 70 kDa heat shock protein (HSP70) in leukocytes as a marker of oxidative stress. In the study we found a correspondence between erythrocyte CAT and GR activities and leukocyte HSP70 levels, principally 3 h after the acute exercise, and this suggested an integrated mechanism of antioxidant defense. The increase in levels of plasma Tau was coincident with the increasing plasma levels of CK and TBARS, principally after two hours of exercise. Thus tissue damage occurred before the expression of any anti-oxidant system markers and the monitoring of Tau, CK or TBARS may be important for the estimation of oxidative stress during exhaustive exercise. Furthermore, the integrated analyses could be of value in a clinical setting to quantify the extent of oxidative stress risk and reduce the need to perform muscle biopsies as a tool of clinical evaluation. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the influence of hand dominance on skill acquisition during a basic laparoscopic skills curriculum.Methods: A total of 27 surgical residents (5 postgraduate year 3 [PGY-3] and 22 PGY-2 residents) participated in a 4-week laparoscopic skills curriculum. The residents were pre- and posttested on six laparoscopic tasks during weeks 1 and 4. During weeks 2 and 3, the residents attended a proctored practice session. The results were compared using analysis of variance (ANOVA), (with significance determined by a p value less than 0.05.Results: The posttest scores were significantly higher than the pretest scores. On the pretest, lefthand-dominant (LHD) surgeons (n = 4) performed significantly better than righthand-dominant (RHD) surgeons (n = 23). In the analysis of individual task pretest scores, LHD surgeons performed significantly better on pattern cutting and vessel loop application. Posttest analysis of overall performance did not show significant differences between the RHD and LHD surgeons.Conclusions: Participation in a laparoscopic skills curriculum improved overall performance. The LHD surgeons demonstrated better initial performance, but posttest comparison showed no difference between the two groups. [ABSTRACT FROM AUTHOR]

Adenoid cystic carcinoma (ACC) is known for its slow-growing but severely infiltrative nature with little tissue reaction. Although the masticatory muscles are often involved, their imaging features have not been well elucidated. We hereby report three patients with widespread ACC, which initially appeared with trismus and/or temporomandibular symptoms and involved the masticator space. Possible features of masticator space involvement are presented on magnetic resonance (MR) images. Masticatory muscle changes on MR images consisted of two aspects, namely, denervation changes and direct tumour invasion. [ABSTRACT FROM AUTHOR]

A lectin with a high affinity for glucose/mannose was isolated from Annona muricata seeds (Annonaceae) by gel filtration chromatography on Sephacryl S-200, ion exchange chromatography on a DEAE SP-5 PW column, and molecular exclusion on a Protein Pak Glass 300 SW column. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (PAGE) yielded two protein bands of approximately 14 kDa and 22 kDa. However, only one band was seen in native PAGE. The Mr of the lectin estimated by fast-performance liquid chromatography-gel filtration on Superdex 75 was 22 kDa. The lectin was a glycoprotein with 8% carbohydrate (neutral sugar) and required divalent metal cations (Ca2+, Mg2+, and Mn2+) for full activity. Amino acid analysis revealed a large content of Glx, Gly, Phe, and Lys. The lectin agglutinated dog, chicken, horse, goose, and human erythrocytes and inhibited the growth of the fungi Fusarium oxysporum, Fusarium solani, and Colletotrichum musae. [ABSTRACT FROM AUTHOR]

Focuses on computed tomographic (CT) features of odontogenic myxoma. Analysis of CT appearances of of several patients with histologically verified odontogenic myxoma; Evaluation of the cortical status of those patients using CT; Contribution of CT to establishing a consensus regarding the interpretation of conventional radiographic appearances in the disease.

Objective: To determine the incidence, etiology, prognosis, and treatment of vocal cord paralysis (VCP) after surgery for thoracic aortic aneurysm (TAA).Study Design: Retrospective study performed between 1989 and 1995.Setting: Academic, tertiary care, referral medical center.Patients: Seventy-one TAA patients underwent surgery at the Kameda Medical Center between 1989 and 1995.Results: Sixty-two of 71 patients were examined postoperatively for voice quality. Twenty patients (32%) had hoarseness develop caused by VCP, as confirmed by laryngoscopy. The left recurrent laryngeal nerve had been sacrificed in 1 patient during surgery, but it was preserved in the remaining 19 patients. Unilateral left VCP was noted in 19 patients, and bilateral VCP occurred in 1 patient. The incidence of VCP was higher in those patients who underwent surgery for type I aneurysms (9 of 14 patients, 64%). In 16 of the 19 patients (84%) who received follow-up for > 6 months, vocal cord movement did not return to normal. Surgery to improve voice quality, arytenoid adduction in five patients and intracordal injection in two patients, was performed with success.Conclusions: Our results indicate that surgery for TAA is associated with a relatively high incidence of VCP. VCP occurred despite preservation of the recurrent laryngeal nerve, and the paralysis did not show a spontaneous recovery even 6 months after surgery. [ABSTRACT FROM AUTHOR]

A lectin from Delonix regia (DRL) seeds was purified by gel filtration on Sephadex G-100 followed by ion-exchange chromatography on diethylaminoethyl-Sepharose and reverse-phase high-performance liquid chromatography on a C18 column. Hemagglutinating activity was monitored using rat erythrocytes. DRL showed no specificity for human erythrocytes of ABO blood groups. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) revealed a single protein in the presence of 0.1 M of dithiothreitol (DTT) and in nonreducing conditions. Native-PAGE showed that DRL is a monomer with a molecular mass of about 12 kDa, as determined by denaturing gel electrophoresis and gel filtration chromatography. An amino acid composition revealed the absence of cysteine residues, the presence of 1 mol methionine/mol protein and a high proportion of acidic amino acids and glycine. The N-terminal sequence of DRL was determined by Edman degradation, and up to 16 amino acid residues showed more than 90% homology with other lectins from the Leguminosae family. The optimal pH range for lectin activity was between pH 8.0 and 9.0, and the lectin was active up to 60°C. The lectin required Mn2+ for hemagglutinating activity and remained active after reduction with 0.1 M of DTT, but lost activity in the presence of 8 M of urea. Sodium metaperiodate had no effect on the activity of DRL. [ABSTRACT FROM AUTHOR]

The venom of Crotalus durissus terrificus was fractionated by reverse-phase HPLC to obtain crotapotins (F5 and F7) and PLA2 (F15, F16, and F17) of high purity. The phospholipases A2 (PLA2s) and crotapotins showed antimicrobial activity against Xanthomonas axonopodis pv. passiflorae, although the unseparated crotoxin did not. The F17 of the PLA2 also revealed significant anticoagulant activity, althrough for this to occur the presence of Glu 53 and Trp 61 is important. The F17 of the PLA2 showed allosteric behavior in the presence of a synthetic substrate. The amino acid sequence of this PLA2 isoform, determined by automatic sequencing, was HLLQFNKMLKFETRKNAVPFYAFGCYCGWGGQRRPKDATDRCCFVHDCCYEKVTKCNTKWDFYRYSLKSGYITCGKGTWCKEQICECDRVAAECLRRSLSTYKNEYMFYPDSRCREPSETC. Analysis showed that the sequence of this PLA2 isoform differed slightly from the amino acid sequence of the basic crotoxin subunit reported in the literature. The homology with other crotalid PLA2 cited in the literature varied from 60% to 90%. The pL was estimated to be 8.15, and the calculated molecular weight was 14664.14 as determined by Tricine SDS-PAGE, two-dimensional electrophoresis, and MALDI-TOFF. These results also suggested that the enzymatic activity plays an important role in the bactericidal effect of the F17 PLA2 as well as that of anticoagulation, although other regions of the molecule may also be involved in this biological activity. [ABSTRACT FROM AUTHOR]

A crotoxin homolog was purified from the Crotalus durissus collilineatus venom using molecular exclusion and reverse-phase HPLC. This crotoxin contained one PLA2 (Cdcolli III F6) and four crotapotin isoforms, whereas crotoxin from Crotalus durissus terrificus venom had three PLA2 isoforms and two crotapotin isoforms. SDS-PAGE showed that the C. d. collilineatus PLA2 and crotapotin had relative molecular mass of 15 and 9 kDa, respectively. Neither the PLA2 (Cdcolli III F6) nor the crotapotins (Cdcolli III F3 and F4) had any neurotoxicity in mouse phrenic nerve-diaphragm preparations when tested alone. However, when PLA2 and crotapotin were coincubated before testing, the neurotoxicity was restored to a level similar to test in the venom in native crotoxin. The two crotapotins (Cdcolli III F3 and F4) differed in their ability to inhibit PLA2 activity, perhaps because of variations in their affinities for this enzyme. Cdcolli III F6 showed allosteric enzymatic behavior, with maximal activity at pH 8.3 and 36°C. Full PLA2 activity required the presence of a low Ca2+ concentration and was inhibited by Cu2+ and Zn2+ and by Cu2+ and Mg2+ in the presence and absence of Ca2+, respectively. These results indicate that crotoxin from C. d. collineatus venom is very similar enzymatically to crotoxin from C. d. terrificus. [ABSTRACT FROM AUTHOR]

A novel basic phospholipase A2 (PLA2) isoform was isolated from Bothrops jararacussu snake venom and partially characterized. The venom was fractionated by HPLC ion-exchange chromatography in ammonium bicarbonate buffer, followed by reverse-phase HPLC to yield the protein Bj IV. Tricine SDS-PAGE in the presence or absence of dithiothreitol showed that Bj IV had a molecular mass of 15 and 30 kDa, respectively. This enzyme was able to form multimeric complexes (30, 45, and 60 kDa). Amino acid analysis showed a high content of hydrophobic and basic amino acids as well as 14 half-cysteine residues. The N-terminal sequence (DLWSWGQMIQETGLLPSYTTY . . .) showed a high degree of homology with basic D49 PLA2 myotoxins from other Bothrops venoms. Bj IV had high PLA2 activity and produced moderate myonecrosis in skeletal muscle, but showed no neuromuscular activity in mouse phrenic nerve-diaphragm preparations. Bj IV showed allosteric enzymatic behavior, with maximal activity at pH 8.2 and 35-45°C. Full PLA2 activity required Ca2+ but was inhibited by Cu2+ and Zn2+, and by Cu2+ and Mg2+ in the presence and absence of Ca2+, respectively. Crotapotins from Crotalus durissus terrificus rattlesnake venom significantly inhibited the enzymatic activity of Bj IV. The latter observation suggested that the binding site for crotapotin in this PLA2 was similar to that in the basic PLA2 of the crotoxin complex from C. d. terrificus venom. The presence of crotapotin-like proteins capable of inhibiting the catalytic activity of D49 PLA2 could partly explain the low PLA2 activity of Bothrops venoms. [ABSTRACT FROM AUTHOR]

The PLA2 and crotapotin subunits of crotoxin from Crotalus durissus cascavella venom were purified by a combination of high-performance liquid chromatography (HPLC) molecular exclusion (Protein Pack 300SW column) and reverse-phase HPLC (RP-HPLC). Tricine SDS-PAGE showed that the PLA2 and crotapotins migrated as single bands with estimated molecular masses of 15 and 9 kDa, respectively. The amino acid composition of the PLA2 showed the presence of 14 half-cysteines and a high content of basic residues (Lys, Arg, His), whereas the crotapotins were rich in hydrophobic, negatively charged residues and half-cysteines. The PLA2 showed allosteric behavior, with maximal activity at pH 8.3 and 35–40°C. C. d. cascavella PLA2 required Ca2+ for activity but was inhibited by Cu2+ and Zn2+ and by Cu2+ and Mg2+ in the presence and absence of Ca2+, respectively. Crotapotin (F3) and heparin inhibited the catalytic activity of the PLA2 by acting as allosteric inhibitors. [ABSTRACT FROM AUTHOR]

The PLA2 and crotapotin subunits of crotoxin from Crotalus durissus cascavella venom were purified by a combination of HPLC molecular exclusion (Protein Pack 300SW column) and reverse-phase HPLC (RP-HPLC). Tricine SDS—PAGE showed that the PLA2 and crotapotins migrated as single bands with estimated molecular masses of 15 and 9 kDa, respectively. The amino acid composition of the PLA2 showed the presence of 14 half-cysteines and a high content of basic residues (Lys, Arg, His), whereas the crotapotins were rich in hydrophobic, negatively charged residues and half-cysteines. The PLA2 showed allosteric behavior, with maximal activity at pH 8.3 and 35–40°C. The C. d. cascavella PLA2 required Ca2+ for activity, but was inhibited by Cu2+ and Zn2+ and by Cu2+ and Mg2+ in the presence and absence of Ca2+, respectively. Crotapotin (F3) and heparin inhibited the catalytic activity of the PLA2 by acting as allosteric inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To examine the possible correlation between the stage of internal derangement and the antero-posterior length of the disk in relation to the length of the articular eminence. Study design: Twenty asymptomatic volunteers with normal joints and 120 patients with TMJ dysfunction underwent MR imaging. The A-P length of the disk in relation to the length of the articular eminence (D/E ratio) was measured. Results: The D/E ratio was 0.95 in the asymptomatic volunteers, 0.83 in patients with disk displacement with reduction, 0.74 in those with disk displacement without reduction and 0.57 in the patients with disk displacement and osteoarthritis. The relationship between the D/E ratio and the stage of internal derangement was statistically significant (P < 0.01). Conclusion: The D/E ratio decreases with advancing internal derangement. We suggest that it is a reliable numerical method for staging the degree of the internal derangement. [ABSTRACT FROM AUTHOR]

Background: The mechanism by which duct decompression (DD) relieves pain in patients with chronic pancreatitis (CP) is unknown. CP is associated with increased tissue pressure (IP), low pancreatic microvascular blood flow (PMBF), and interstitial pH (pHI). The aims of this study were to examine the effects of acute DD on PMBF, increased IP, and pHI in cats with CP. Methods: The main pancreatic duct was partially obstructed. At 6 weeks PMBF (ml/min/100g H2 gas clearance), IP (mmHg needle electrode), and pHI (microelectrode) were measured before and after secretin stimulation. The duct was then opened, and the studies were repeated. Results: PMBF normally increased with secretin stimulation (118 ± 20 versus 271 ± 52, P < 0.05), IP was unaltered, and pHI decreased as hydrogen ions produced during bicarbonate secretion were dissipated (7.41 ± 0.01 versus 7.38 ± 0.01, P < 0.05). In CP, basal PMBF was lower than normal (51 ± 6 versus 118 ± 20, P < 0.05) and decreased with stimulation (51 ± 3.5 versus 31 ± 3.5, P < 0.05). Basal pancreatic IP was increased (3.47 ± 0.7 versus 0.05 ± 0.3, P < 0.05) and increased further with secretory stimulation (3.47 ± 0.7 versus 4.41 ± 0.7, P < 0.05) (a compartment syndrome). The low basal pancreatic pHI (7.23 ± 0.02) did not change with secretin stimulation, since bicarbonate secretion was minimal. DD decreased IP (3.66 ± 0.5 versus 2.81 ± 0.5, P < 0.05) and increased PMBF (50 ± 6 versus 79 ± 6, P < 0.05) and pHI (7.24 ± 0.02 versus 7.34 ± 0.02, P < 0.05). The normal increase in PMBF after stimulation was restored (79 ± 6 versus 218 ± 54, P < 0.05). pHI now increased with stimulation (7.34 ± 0.002 versus 7.37 ± 0.002, P < 0.05), perhaps due to the marked hyperaemic response. Conclusions: DD acutely restored basal and stimulated PMBF and IP towards normal. Basal pancreatic pHI also improved and reflects the underlying ischaemia. [ABSTRACT FROM AUTHOR]

In some patients with disc displacement without reduction, the symptoms of pain and decreased range of motion have been observed to resolve spontaneously over time without treatment. The natural history of this condition, however, is not well-understood. Thus, to study the natural course of disc displacement without reduction, we followed 40 patients without treatment for a period of 2.5 years. The diagnosis was established by history and physical examination and confirmed with magnetic resonance (MR) imaging. After 2.5 years, 43% of the patients were asymptomatic, 33% had decreased symptoms, and 25% of the patients showed no improvement or had required treatment. MR evidence of osteoarthritis and advanced stages of internal derangement at the initial evaluation was associated with a poor prognosis. The result of this prospective cohort study indicated that approximately 40% of patients with symptomatic disc displacement without reduction will be free of symptoms within 2.5 years, one-third will improve, whereas one-quarter will continue to be symptomatic. This knowledge should be valuable for the treatment planning and evaluation of prognosis of patients with non-reducing symptomatic disc displacement. [ABSTRACT FROM AUTHOR]

Acute aortic dissection occurred in three of four siblings without Marfan syndrome. All of them were successfully treated by operation and remain well 6-42 months after operation. Their mother died suddenly in another hospital of acute aortic dissection. All her siblings were dead and cardiovascular disease was suspected in all of them. [ABSTRACT FROM PUBLISHER]