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Abstract: Background: Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. Methods: Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 ± 6.4 years (range, 27–66 years) and a mean BMI of 30.1 ± 2.7 (range, 23.6–34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 ± 4.6 years (range, 3–22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). Results: The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3–19 months). The mean BMI was 23.8 ± 4.1 kg/m2, and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. Conclusions: Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.

We contend that there are not separate systems working in parallel that construct consciousness, as that would be singularly inefficient and perhaps even dangerous. We require sentience as the scanning mechanism to sit as the basis of interaction with our environment. It is not a separate component of consciousness but rather an integral part of it. Disorders of consciousness reflect a functional disconnection syndrome. It is the effective global functional interconnectivities that are the best markers of clinical states of consciousness rather than the activity associated with a piece of the larger system.

Following a review of the available assessment scales and current practices of evaluation of instrumental activities of daily living (IADL) in French memory centres by GREFON (Groupe de réflexion sur l’évaluation fonctionnelle; Working Group on Functional Assessment), the main aim of this position paper was to provide good clinical practice (GCP) guidelines for the assessment of IADL. Another aim was to highlight the need for innovative tools adapted to the present and future evolution of such activities in real life, including the use of new technologies, the need for earlier detection of IADL impairment during the diagnostic process of mild neurocognitive disorders, and greater sensitivity to IADL changes during follow-up to allow adaptation of clinical management and evaluation of the impact of therapeutic interventions.

In the present work we have focus our care on the controversial intermediate salt : Ni(NO3)2. 5.5H2O To prepare this phase, we have carried out, in the range 60-80°C, a controlled evaporation of a solution of nickel nitrate, hexahydrate resulting from the melting of a 100g Ni(NO3)2. 6H2O batch sample in an isothermal pilot reactor. The proof of its existence is given, for the first time, by powder x-ray diffraction data.

Random regression models (RRM) and multitrait models (MTM) were used to estimate genetic parameters for growth traits in Brazilian Brahman cattle and to compare the estimated breeding values obtained by these 2 methodologies. For RRM, 78,641 weight records taken between 60 and 550 d of age from 16,204 cattle were analyzed, and for MTM, the analysis consisted of 17,385 weight records taken at the same ages from 12,925 cattle. All models included the fixed effects of contemporary group and the additive genetic, maternal genetic, and animal permanent environmental effects and the quadratic effect of age at calving (AAC) as covariate. For RRM, the AAC was nested in the animal's age class. The best RRM considered cubic polynomials and the residual variance heterogeneity (5 levels). For MTM, the weights were adjusted for standard ages. For RRM, additive heritability estimates ranged from 0.42 to 0.75, and for MTM, the estimates ranged from 0.44 to 0.72 for both models at 60, 120, 205, 365, and 550 d of age. The maximum maternal heritability estimate (0.08) was at 140 d for RRM, but for MTM, it was highest at weaning (0.09). The magnitude of the genetic correlations was generally from moderate to high. The RRM adequately modeled changes in variance or covariance with age, and provided there was sufficient number of samples, increased accuracy in the estimation of the genetic parameters can be expected. Correlation of bull classifications were different in both methods and at all the ages evaluated, especially at high selection intensities, which could affect the response to selection.

La demencia de inicio precoz (DIP) se define como demencia con una edad de inicio antes de los 65 años. La DIP está siendo cada vez más reconocida como un importante problema clínico y social, con consecuencias devastadoras para los pacientes y para las personas que cuidan de ellos.

Rasmussen syndrome is characterized by continuous partial seizures with progressive neurological/cognitive impairment. Currently the only effective treatment is surgery (hemispherectomy). The objective of our study is to detect the exact epileptogenic focus through the analysis of multimodal noninvasive and innocuous functional neuroimaging.The subject is a 5-year-old female patient with Rasmussen encephalopathy. Continuous and simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) was record ed. The sources of background and paroxysmal activity of EEG were computed by low resolution electromagnetic tomography (LORETA). Image analysis (SPM: statistic parametric mapping) was obtained for the areas where statistically significant differences in the fMRI BOLD response were computed, and the results from both techniques were compared.The main source of paroxysmal activity by EEG analysis was found in the anterolateral left hemisphere, with a significant increase in absolute and relative energies of slow frequency bands (theta-delta): Z = 3. The fMRI BOLD signal (basal vs. paroxysmal activity) was significantly different in the same region (t-test = 2.39). The generators of propagated paroxysmal activity were found in similar areas for both techniques.In conclusion, simultaneous EEG-fMRI recording allows the analysis of two harmless functional neuroimaging techniques separately and together in the same time period. In our case, it allowed the accurate delineation of epileptogenic foci and areas of spread with high spatiotemporal resolution, which is crucial for epilepsy surgery.

Conventional EEG and quantitative EEG visual stimuli (close-open eyes) reactivity analysis have shown their usefulness in clinical practice; however studies at the level of EEG generators are limited. The focus of the study was visual reactivity of cortical resources in healthy subjects and in a stroke patient.The 64 channel EEG and T1 magnetic resonance imaging (MRI) studies were obtained from 32 healthy subjects and a middle cerebral artery stroke patient. Low Resolution Electromagnetic Tomography (LORETA) was used to estimate EEG sources for both close eyes (CE) vs. open eyes (OE) conditions using individual MRI. The t-test was performed between source spectra of the two conditions. Thresholds for statistically significant t values were estimated by the local false discovery rate (lfdr) method. The Z transform was used to quantify the differences in cortical reactivity between the patient and healthy subjects.Closed-open eyes alpha reactivity sources were found mainly in posterior regions (occipito-parietal zones), extended in some cases to anterior and thalamic regions. Significant cortical reactivity sources were found in frequencies different from alpha (lower t-values). Significant changes at EEG reactivity sources were evident in the damaged brain hemisphere. Reactivity changes were also found in the “healthy” hemisphere when compared with the normal population.In conclusion, our study of brain sources of EEG alpha reactivity provides information that is not evident in the usual topographic analysis.

Abstract: Background: Metabolic syndrome refers to risk factors for cardiovascular disease. Hyperglycemia is a critical component contributing to the predictive power of the syndrome. This study aimed to evaluate the results from the laparoscopic interposition of an ileum segment into the proximal jejunum for the treatment of metabolic syndrome in patients with type 2 diabetes mellitus and a body mass index (BMI) lower than 35. Methods: Laparoscopic procedures were performed for 60 patients (24 women and 36 men) with a mean age of 51.7 ± 6.4 years (range, 27–66 years) and a mean BMI of 30.1 ± 2.7 (range, 23.6–34.4). All the patients had a diagnosis of type 2 diabetes mellitus (T2DM) given at least 3 years previously and evidence of stable treatment using oral hypoglycemic agents, insulin, or both for at least 12 months. The mean duration of type 2 diabetes mellitus was 9.6 ± 4.6 years (range, 3–22 years). Metabolic syndrome was diagnosed for all 60 patients. Arterial hypertension was diagnosed for 70% of the patients (mean number of drugs, 1.6) and hypertriglyceridemia for 70%. High-density lipoprotein was altered in 51.7% of the patients and the abdominal circumference in 68.3%. Two techniques were performed: ileal interposition (II) into the proximal jejunum and sleeve gastrectomy (II-SG) or ileal interposition associated with a diverted sleeve gastrectomy (II-DSG). Results: The II-SG procedure was performed for 32 patients and the II-DSG procedure for 28 patients. The mean postoperative follow-up period was 7.4 months (range, 3–19 months). The mean BMI was 23.8 ± 4.1 kg/m2, and 52 patients (86.7%) achieved adequate glycemic control. Hypertriglyceridemia was normalized for 81.7% of the patients. An high-density lipoprotein level higher than 40 for the men and higher than 50 for the women was achieved by 90.3% of the patients. The abdominal circumference reached was less than 102 cm for the men and 88 cm for the women. Arterial hypertension was controlled in 90.5% of the patients. For the control of metabolic syndrome, II-DSG was the more effective procedure. Conclusions: Laparoscopic II-SG and II-DSG seem to be promising procedures for the control of the metabolic syndrome and type 2 diabetes mellitus. A longer follow-up period is needed.

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m2. Methods: For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36–66 years). The mean BMI was 30.1 kg/m2 (range, 23.4–34.9 kg/m2). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3–22 years). Results: The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4–16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m2 (range, 18.9–31.7 kg/m2). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. Conclusions: The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.

The objective of our study is to determine the predictive value of QEEG in patients suffering from an acute ischemic cerebral stroke. Twenty-eight patients were studied within the first 72 hours of clinical evolution of middle cerebral artery territory ischemic stroke. Thirty-seven QEEG recordings were obtained: 13 in the first 24 hours after cerebral stroke onset, 9 between 24–48 hours and 15 between 48–72 hours. Absolute Energies (AE) were the QEEG selected variables for statistical analysis: first, AE Z values were calculated using the Cuban QEEG norms, then the maximum and minimum AE Z values were selected within each frequency band and total power. The medians of the five neighboring Z values were also chosen. Regression models were estimated using the RANKIN scores as dependent variables and the selected QEEG variables as independent, then outcome predictions at hospital discharge and 3 months later were calculated. Percentages of concordance and errors between the estimated and real outcome scores were obtained.Alpha and theta AE were the best predictor for short-term outcome and delta AE for long-term outcome. We conclude that QEEG performed within the first 72 hours of ischemic stroke might be a powerful tool predicting short-and long-term outcome.

Abstract Until recently, accurate microbiological diagnosis of invasive aspergillosis (IA) was seldom established in HSCT recipients. Blood samples are rarely positive for Aspergillus species, the reliability of the cultures depends of the specimen (if taken from a normally sterile site or not) and biopsy samples require invasive procedures, rarely recommended in patients with severe thrombocytopenia. Implementing the international consensus defining the microbiological criteria for the diagnosis of Aspergillus infection, we retrospectively evaluated the role of serum galactomannan (GM) detection by EIA to diagnose IA among HSCT patients with proven invasive fungal infection (IFI) and the impact of serum storage in GM concentrations. The EIA assay allowed categorizing as “probable” 5 of the 10 cases of “possible” aspergillosis (50%). Considering a lower cut-off level for the reaction (1.0), 80% of the cases could be categorized as “probable” aspergillosis. Positive or undetermined results were detected one to 4 months before the diagnosis of IA in eight of the 11 patients (72.7%) with proven IFI. Retesting the stored samples after a second storage for four years, we could observe lower reactivity in 20% of the samples. The detection of galactomannan by the EIA test represents a major advance in the diagnosis of IA in HSCT recipients at high risk of IA. A better understanding of the kinetics of the GM in different clinical situations is necessary to maximize the benefit of the test in Aspergillus surveillance.

To estimate seasonal variation in herbage quality from a Friesian bull beef production system, 50 hand-plucked herbage samples were taken approximately every 2 weeks from paddocks about to be grazed at the Tuapaka bull beef unit, Massey University, between December 1998 and February 2002. The pastures were perennial ryegrass and white clover. Herbage mass (kg DM ha-1) was estimated using a calibrated rising plate meter. Herbage samples were assessed for crude protein (protein), lipid, ash, acid detergent fibre (ADF), neutral detergent fibre (NDF), non-structural carbohydrates (NSC), organic matter digestibility (OMD) and metabolisable energy content (ME) by near infra-red spectroscopy. A correlation analysis between variables was performed and an analysis of variance was carried out by month and season using year as a block. Additionally, a Bayesian smoothing analysis was applied to the complete data set of ME and protein. Fibre variables (NDF and ADF) had the strongest relationship between themselves and with other variables, and were negatively related to NSC, ME, and protein. The content of non-structural carbohydrates was positively associated with herbage ME and protein. Values of herbage quality were high throughout the measurement period (80.6% OMD, 11.3 MJ ME kg-1 and 25.8% protein). Protein levels for autumn, winter, spring, and summer were 26.4, 26.7, 26.9, and 23.3%, and ME levels were 10.9, 11.6, 11.8, and 10.9 MJ ME kg-1, respectively. Non-structural carbohydrates had the highest variability (31% coefficient of variation), followed by the fibre variables (15 and 16% for ADF and NDF respectively). In the smoothing analysis, both ME and protein showed a seasonal behaviour with a tendency for herbage protein to peak before ME in spring. Seasonal variation of specific nutrients and implications for animal performance are discussed, with particular reference to the influence of high herbage protein levels on protein and energy utilisation.

Objective:To determine and compare the predictive value of quantitative EEG (QEEG) and the Canadian Neurological Scale (CaNS), in patients with an acute cerebral stroke.Methodology:Twenty-eight patients were studied with the diagnosis of acute ischemic middle cerebral artery stroke, within the first 72 hours of clinical evolution. Thirty-seven EEGs and clinical evaluations were collected: 13 during the first 24 hours after stroke onset, 9 between 24–48 hours and 15 between 48–72 hours. The QEEG studied variables were: the Z values (maximum, minimum and the Z medians from the 5 nearest points to each one) of absolute energies (AE) from the 4 classic frequencies bands. The clinical scale showed a smaller percent of correct prognosis than QEEG variables.Conclusions:QEEG was demonstrated to be a powerful tool to predict the degree of residual functional disabilities after an acute ischemic stroke and showed a higher prognostic value than CaNS when they are performed within the first 72 hours of brain infarct.

Purpose: To evaluate the dosing and safety of intravenous magnesium sulfate administered via continuous infusion for refractory wheezing. Materials and Methods: All patients admitted to the pediatric intensive care unit (PICU) between January 1998 and March 2001 who were prescribed magnesium sulfate via continuous infusion were identified via retrospective chart review. The patient's medical history, demographic data, vital signs, magnesium dosing history, and concurrent medications were recorded. Results: Forty PICU patients represent our study population. The mean age was 82.6+/-64.6 mo; 18 patients were boys. The mean magnesium loading dose (mg/kg) was 29.6+/-13.2 with a mean infusion dose (mg/kg/h) of 18.4+/-6.5 with a significant difference in dosing noted between patients weighing less than 30 kg and those with a higher weight. The mean magnesium loading dose (mg/kg) in the less than 30 kg group was 35.3+/-12.7 compared with 21.9+/-9.9 in the higher weight group (P<.05). Mean infusion doses (mg/kg/h) were 21.6+/-6 and 14.6+/-4.2, respectively (P<.05). There was no significant difference between the mean concentrations (mg/dL) reported between the 2 groups (less than 30 kg group =3.9+/-0.6; higher weight group=3.6+/-0.5). All patients received nebulized albuterol, ipratropium, and intravenous methylpred-nisolone before magnesium therapy. Aminophylline and ketamine were prescribed to 28 and 4 patients, respectively. No cardiovascular adverse effects were noted during magnesium therapy. Conclusions: For the treatment of refractory wheezing, intravenous magnesium sulfate administered via continuous infusion respresents a safe mode of drug delivery.

A systematic study was carried out to investigate the role of antibody functional affinity in the capacity of immune complexes (IC) to activate the complement system and to trigger subsequently the molecular events involved in the handling of IC by providing a clearance mechanism. For this purpose, two populations of polyclonal anti-BSA IgG antibodies of different affinities were prepared, with values of 1.89 × 108 M-1 and 4.94 × 108 M-1. First we studied the capacity of IC formed at equivalence with both antibodies to activate the classical and the alternative pathways of human complement and the ability of the complexes to bind to erythrocyte C3b-C4b receptors (CR1; CD35). The data showed that the highest affinity antibodies were more efficient in activating complement by both pathways. However, their binding to erythrocyte CR1 was significantly lower compared to the binding of the lowest affinity IgG. Second we compared these IC in terms of their ability to stimulate the respiratory burst of neutrophils (PMN) and to induce the release of PMN lysosomal enzymes. In general, both of these PMN functions were better stimulated by the IC prepared with the IgG antibodies having a highest affinity, although the effects were variable for different IC concentrations. The suggestion to be drawn from the data is that the antibody affinity has an influence on the formation of the immune complex lattice, modulating its three-dimensional structure and the arrangement of the antibody Fc fragments, interfering with complement activation and access to the neutrophil IgG receptors. The significance of these observations for the understanding of how affinity influences the precise biological mechanism that participates in the fate of IC is discussed.

This paper presents the requirements definition for an environment to support design and analysis of business process (EDABP). This environment is compliant with the CIMOSA system life cycle and its main advantage is the integration between descriptive and analytical methods for the modeling and engineering of manufacturing systems. The manufacturing enterprise is considered as a system composed of a concurrent processes and agents execute these processes. A gearbox assembly line scenario shows the applicability of the EDABP.

An indirect reverse phase HPLC method to monitor low level impurities in an acyl halide, 3-phenylpropionyl chloride, is described. The method involves derivatization with aniline to form a stable N-anilide derivative followed by HPLC analysis. The selection of the derivatizing agent aniline was based on achieving similar detector responses for impurities relative to the 3-phenylpropionyl chloride. The method described is rugged, selective, and sensitive and provides an excellent way to assess the quality of acyl halides.

Summary.The opossum spermatic cord is characterized by a thick skeletal muscle coat, provided by the great development of the cremasteric muscle. Acetylcholine induced a powerful contraction of the spermatic cord placed in an organ bath containing Heller's solution. This contraction was blocked by curare but not completely by atropine as is usual for skeletal muscle. However, the ductus deferens did not respond to acetylcholine or catecholamines under the same conditions.Specific histochemical methods for both catecholamines and acetylcholinesterases revealed that the ductus deferens musculature, composed mainly of circular fibres, is richly innervated by adrenergic and presumed cholinergic nerve fibres. The lack of responsiveness to the neurotransmitters could be explained by the absence of longitudinally arranged muscle. It is suggested that in the opossum the cremaster could participate in the mechanism of sperm transport.

Summary The acute phase of the experimental Chagas' disease in rats induces extensive lesion of the heart sympathetic nerve terminals. Because of evidence indicating the involvement of immune reactions in neuron destruction provoked by Chagas' disease, we tested the effects of depleting the complement system by cobra venom factor upon the sympathetic denervation. The serum hemolytic activity against sensitized sheep erythrocytes ensured the efficacy of the anticomplementary treatment. Glyoxylic acid-induced histofluorescence and electron-microscopic methods allowed the study of the heart noradrenergic nerves.T. cruzi infection caused marked rarefaction of fluorescent nerve terminals at day 10 of infection and the ultrastructural study guaranteed that this rarefaction involved lesion of noradrenergic terminals. The complement depletion failed to prevent this early heart noradrenergic denervation, excluding the participation of complement-mediated lysis as a main mechanism.

AnArabidopsis thaliana cDNA was isolated by complementation of theEscherichia coli mutant strain BW535 (xth, nfo, nth), which is defective in DNA base excision repair pathways. This cDNA partially complements the methyl methane sulfonate (MMS) sensitive phenotype of BW535. It also partially corrects the UV-sensitive phenothpe ofE. coli AB1886 (uvrA) and restores its ability to reactivate UV-irradiated ? phage. It has an insert of ca. 1.3 kb with an open reading frame of 1047 bp (predicting a protein with a molecular mass of 36 kDa). This cDNA presents a high homology to a stress related gene from two species ofFusarium (sti35) and to genes whose products participate in the thiamine biosynthesis pathway,THI4, fromSaccharomyces cerevisiae andnmt2 fromSchizosaccharomyces pombe. TheArabidopsis predicted polypeptide has homology to several protein motifs: amino-terminal chloroplast transit peptide, dinucleotide binding site, DNA binding and bacterial DNA polymerases. The auxotrophy for thiamine in the yeastthi4::URA3 disruption strain is complemented by theArabidopsis gene. Thus, the cloned gene, namedthi1, is likely to function in the biosynthesis of thiamine in plants. The data presented in this work indicate thatthi1 may also be involved in DNA damage tolerance in plant cells.

The cholinergic and adrenergic innervation of human minor sublingual buccal and labial salivary glands has been studied with histochemical techniques for localizing acetylcholinesterase and catecholamines. A rich cholinergic innervation was observed around the acini, blood vessels and some ducts of the three glands. The adrenrgic innervation, however, was virtually absent from the parenchyma although present around the blood vessels, in marked contrast to the dense parenchymal adrenergic innervation observed in the human parotid and submandibular glands. These results suggest that the autonomic nervous mechanism which regulates salivary secretion is more elaborate in the major than in the minor salivary glands.

Subarachnoid hemorrhage is widely accepted as a potential cause of torsade de pointes (TdP), yet this putative etiologic relationship has never been systematically evaluated. We therefore undertook a MEDLINE search from 1966 through 1993, with relevant back referencing, and identified 20 cases of TdP in the setting of subarachnoid hemorrhage. It was impossible in any of these cases (usually because of insufficient data) to completely exclude one or more alternative explanations for TdP, including congenital long QT syndrome, hypokalemia, hypomagnesemia, or drug-induced QT prolongation. Furthermore, of a total of 1,139 patients in 16 prospective series of subarachnoid hemorrhage with electrographic analyses, there were only five reported cases of TdP, all in patients with hypokalemia. Thus, extremely limited scientific data exist to support the notion that subarachnoid hemorrhage can be a distinct cause of TdP. Until more definitive evidence is available, the development of TdP in patients with subarachnoid hemorrhage is probably better characterized as a multifactorial phenomenon occurring in an acute, typically intensive care, setting.