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Background: We hypothesized that, compared with propofol, desflurane prolongs the antegrade accessory pathway effective refractory period (APERP) in children undergoing radiofrequency catheter ablation for Wolff-Parkinson-White (WPW) syndrome.Methods: In this randomized crossover study, children aged 4.1-16.1 years undergoing radiofrequency catheter ablation for WPW syndrome were randomly divided into four groups according to the concentration of desflurane and anesthetics used in the first and the second electrophysiological studies (EPS). After induction of general anesthesia with propofol and tracheal intubation, they received one of the following regimens: 0.5 minimum alveolar concentration (MAC) desflurane (first EPS) and propofol (second EPS) (Des0.5-Prop group, n = 8); propofol (first EPS) and 0.5 MAC desflurane (second EPS) (Prop-Des0.5 group, n = 9); 1 MAC desflurane (first EPS) and propofol (second EPS) (Des1.0-Prop group, n = 10); propofol (first EPS) and 1 MAC desflurane (second EPS) (Prop-Des1.0 group, n = 9). Radiofrequency catheter ablation was performed upon completion of EPS. Sample size was determined to detect a difference in the APERP.Results: Desflurane at 1.0 MAC significantly prolonged the APERP compared with propofol, but did not affect the sinoatrial conduction time, atrio-His interval or atrioventricular node effective refractory period. Supraventricular tachycardia was induced in all children receiving propofol, but not induced in 1 and 4 children receiving 0.5 MAC and 1.0 MAC desflurane, respectively.Conclusion: Desflurane enhances the refractoriness and may block the electrical conduction of the atrioventricular accessory pathway, and is therefore not suitable for use in children undergoing radiofrequency catheter ablation for WPW syndrome. [ABSTRACT FROM AUTHOR]

To determine whether maximum bite force ( MBF), an objective measure of oral function, is associated with development of frailty in community-dwelling older adults. This prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Baseline MBF was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up examinations, including physical fitness and anthropometric evaluation and structured questionnaires, were administered annually over a 5-year period to determine the incidence of frailty, which was defined by the presence of 3 or more of the following 5 components derived from the Cardiovascular Health Study: low level of mobility, low physical activity level, weakness, shrinking and poor endurance and energy. Adjusted hazard ratios ( HRs) of incidence of frailty according to sex-stratified tertiles of baseline MBF were calculated using Cox proportional hazards regression models. During the follow-up, 49 participants (15.2%) developed frailty. Participants in the lower tertile of MBF exhibited a significantly greater risk of frailty than those in the upper tertile. After adjustment for sex, depression, diabetes and Eichner index, the adjusted HRs for frailty in the upper through lower tertiles of MBF were 1.00 (reference), 1.27 (95% confidence interval [ CI]: 0.50-3.20) and 2.78 (95% CI: 1.15-6.72), respectively ( P for trend = .01). Poor oral function, as indicated by low MBF, increases the risk of development of frailty among elderly men and women. [ABSTRACT FROM AUTHOR]

Of fundamental interest are multidisciplinary interactions encompassing: (1) first order systems such as those encountered in parabolic heat conduction, first order hyperbolic systems such as fluid flow, and so on, and (2) second order systems such as those encountered in hyperbolic heat conduction, hyperbolic second order systems such as elastodynamics and wave propagation, and so on. After space discretization using methods such as finite differences, finite volumes, finite elements, and the like, the consequent proper integration of the time continuous ordinary differential equations is extremely important. In particular, the physical quantities of interest may need to be mostly preserved and/or the equations should be optimally integrated so that there is minimal numerical dissipation, dispersion, algorithm overshoot, capture shocks without too much dissipation, solve stiff problems and enable the completion of the analysis, and so on. To-date, practical methods in most commercial and research software include the trapezoidal family (Euler forward/backward, Galerkin, and Crank Nicholson) for first order systems and the other counterpart trapezoidal family (Newmark family and variants with controllable numerical dissipation) for second order systems. For the respective first/second order systems, they are totally separate families of algorithms and are derived from altogether totally different numerical approximation techniques. Focusing on the class of the linear multistep (LMS) methods, algorithms by design was first utilized to develop GS4-2 framework for time integration of second order systems. We have also recently developed the GS4-1 framework for integrating first order systems. In contrast to all past efforts over the past 50 years or so, we present the formalism of a generalized unified framework, termed GS4 (generalized single step single solve), that unifies GS4-1 (first-order systems) and GS4-2 (second-order systems) frameworks for simultaneous use in both first and second order systems with optimal algorithms, numerical and order preserving attributes (in particular, second-order time accuracy) as well. The principal contribution emanating from such an integrated framework is the practicality and convenience of using the same computational framework and implementation when solving first and/or second order systems without having to resort to the individual framework. All that is needed is a single novel GS4-2 framework for either second- and/or first-order systems, and we show how to switch from one to the other for illustrative applications to thermo-mechanical problems influenced by first/second order systems, respectively. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to demonstrate the distribution of haemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids. Method One-hundred and three patients with haemorrhoids were studied. Using power Doppler imaging ( PDI) transanal ultrasound and three-dimensional power Doppler angiography (3 D- PDA), the course of the arteries supplying the haemorrhoids was identified. Measurement of the PDI area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line. Results The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1% of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from Grade 1 to Grade 4 ( P < 0.0001). The PDI areas in Grades 1, 2, 3 and 4 were 0.04 ± 0.03, 0.18 ± 0.07, 0.38 ± 0.18 and 0.96 ± 0.32 cm2 ( P < 0.05). Conclusion The distribution of haemorrhoidal arteries varies widely in both number and position. Using PDI transanal ultrasonography and 3 D- PDA it was possible to visualize the haemorrhoid plexus and the course of the haemorrhoidal artery in vivo. [ABSTRACT FROM AUTHOR]

Aim The study aimed to use power Doppler imaging (PDI) transanal ultrasonography to produce three-dimensional power Doppler angiography images of haemorrhoidal tissue and to monitor the effects of Doppler-guided aluminium potassium sulfate and tannic acid (DGALTA) sclerotherapy. Method Ninety-six haemorrhoids in 43 patients were examined using PDI transanal ultrasonography, and DGALTA sclerotherapy was performed from April 2011 to April 2012. DGALTA sclerotherapy was conducted using a four-step injection process with pulse wave Doppler ultrasound under perianal local anaesthesia. Results A three-dimensional power Doppler angiography image of the blood flow in haemorrhoidal tissue was produced using PDI transanal ultrasonography. The cross-sectional area of blood flow in the haemorrhoidal tissue (PDI area) significantly decreased after DGALTA sclerotherapy. The PDI areas in the preoperative state and 1 and 3 months after treatment were 0.35 ± 0.27, 0.03 ± 0.05 and 0.04 ± 0.05 cm2 ( P < 0.0001). Conclusion A three-dimensional power Doppler angiography image of the haemorrhoidal tissue was technically possible and showed blood flow in the haemorrhoidal tissue to be significantly decreased after DGALTA sclerotherapy. [ABSTRACT FROM AUTHOR]

How cooperation can arise and persist, given the threat of cheating phenotypes, is a central problem in evolutionary biology, but the actual significance of cheating in natural populations is still poorly understood. Theories of social evolution predict that cheater lineages are evolutionarily short-lived. However, an exception comes from obligate socially parasitic species, some of which thought to have arisen as cheaters within cooperator colonies and then diverged through sympatric speciation. This process requires the cheater lineage to persist by avoiding rapid extinction that would result from the fact that the cheaters inflict fitness cost on their host. We examined whether this prerequisite is fulfilled, by estimating the persistence time of cheaters in a field population of the parthenogenetic ant Pristomyrmex punctatus. Population genetic analysis found that the cheaters belong to one monophyletic lineage which we infer has persisted for 200-9200 generations. We show that the cheaters migrate and are thus horizontally transmitted between colonies, a trait allowing the lineage to avoid rapid extinction with its host colony. Although horizontal transmission of disruptive cheaters has the potential to induce extinction of the entire population, such collapse is likely averted when there is spatially restricted migration in a structured population, a scenario that matches the observed isolation by distance pattern that we found. We compare our result with other examples of disruptive and horizontally transmissible cheater lineages in nature. [ABSTRACT FROM AUTHOR]

In dental procedures performed under intravenous sedation in patients with intellectual disabilities, procedures are sometimes interrupted by the cough reflex, which may be triggered by intraoral use of water and/or increased secretion stimulating the pharyngeal/laryngeal mucosa, or by those irritating the tracheal mucosa directly through anesthetics-induced impairment of the laryngeal closure reflex. We investigated relationships between frequency of coughing episodes and intraoral use of water, water remaining in the oropharyngeal space, and mean infusion rate of propofol during dental treatments performed under intravenous sedation with midazolam and propofol. Twenty-one intellectually disabled patients were enrolled. After induction, a 14 Fr. suction catheter was inserted nasally, which was fixed where oropharyngeal suction could be done most effectively. Patients were divided into three groups according to the amount of intraoral use of water, amount of oropharyngeal suction and mean infusion rate of propofol. The amount of oropharyngeal suction significantly correlated with intraoral use of water. Frequency of coughing episodes significantly correlated with amount of oropharyngeal suction per minute. However, coughing episodes correlated neither with intraoral use of water nor with infusion rate of propofol. These findings suggested that accumulation of water in the oropharynx increased vulnerability to the cough reflex in dental treatments performed under intravenous sedation. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present paper was to detect the clinical factors most predictive of red blood cell (RBC) transfusion in extremely low-birthweight (ELBW) infants in the recombinant human erythropoietin era. Methods: Between 1995 and 2000, 66 ELBW infants were admitted to a level III neonatal intensive care unit. Fifty-four of 66 infants were eligible for enrollment in the present study. Infants were treated with erythropoietin 200 IU/kg per dose s.c. twice a week with 4-6 mg/kg per day iron supplement. Results: The mean gestational age and birthweight were 26.5 +/- 2.1 weeks and 776 +/- 134 g, respectively. Ten of 54 ELBW infants (18.5%) died during the first 21 days. Eight of 10 dead infants (80.0%) and 27 of 44 surviving infants (61.4%) received one or more RBC transfusions. The overall requirement for RBC transfusions in the surviving infants was 3.0 +/- 3.2 per infant/hospital course (range: 0-9). There were significant differences in gestational weeks, birthweight, initial hemoglobin value, 5 min Apgar score, phlebotomy loss, phlebotomy loss/birthweight, duration of mechanical ventilation, duration of oxygen supplement, and incidence of both intraventricular hemorrhage and chronic lung disease between the transfused and non-transfused group. The predictive variables, initial hemoglobin level (odds ratio [OR] 2.61; 1 g/dL), birthweight (OR 3.00; 100 g), and gestational week (OR 1.89; 1 week), were found to be most predictive for transfusion on logistic regression analysis. Conclusion: ELBW infants are still the population at greatest risk for repeated blood transfusions after introduction of erythropoietin treatment. If labor develops, it is often impossible to extend the pregnancy period, therefore efforts should be made to increase hemoglobin level at birth. [ABSTRACT FROM AUTHOR]

Patients with serious intellectual disability (ID) are occasionally unable to tolerate dental treatment when intravenous sedation or general anaesthesia (IVS/GA) is involved. In order to make a decision regarding the application of IVS/GA, the International Classification of Functioning, Disability and Health (ICF) is useful. Therefore, in this study, a set of codes involved in dental problems were chosen from the ICF, and patients with ID who could tolerate dental treatments were compared with those who could not.From preliminary interviews of six patients with ID, 16 codes were chosen, and an objective five-rank scale was then constructed for use with all chosen codes. Forty-nine ID patients who visited the Okayama University Hospital for dental treatment between January and April 2003 were evaluated. Facility workers were interviewed according to the code set chosen. The participants were then divided into two subgroups depending on their tolerability of dental treatment. The results of these groups for all 16 codes were then compared.Of the 49 patients interviewed, 23 were able to tolerate the dental treatment. In the‘Activities&Participation’ section of the ICF, the tolerable group showed lower disability levels with regard to d110 Watching, d540 Dressing and d550 Eating. In other sections, there were no significant differences between the groups. The code set chosen in this study and the five-rank scales in each code were useful as they enabled easy interviewing.The ICF was raised as a possibility for considering the application of IVS/GA for dental treatment on patients with ID. For clinical use of the ICF, it is recommended that significant codes should be selected and that the five-rank scale is used so that more objective results are obtained from interviews. [ABSTRACT FROM AUTHOR]

The poor quality of oral health care for people with intellectual disability (ID) has been recognized, and the strong fears about dental treatment suggested as a major reason for disturbances of visits to dentists by such patients. Intravenous sedation is a useful method for relieving the anxiety and fear of such patients about dental treatment, and is frequently essential for ID patients undergoing dental treatment. However, decision regarding the dose of sedative required to be administered for an adequate level of sedation is difficult because the effect of sedation cannot be adequately assessed in patients with severe ID. As an appropriate sedative dose for dental patients with ID has not been fully established, we investigated sedative doses required and the effect of sedation in patients with ID, compared with other dental patients.We reviewed the anaesthetic records of dental patients with ID (73 cases) and other dental patients (19 cases) aged between 20 and 29 years who had undergone intravenous sedation with midazolam and propofol in Okayama University Dental Hospital, from January 2000 to December 2000. Intravenous sedation was induced with a bolus intravenous administration of midazolam (2–3 mg) and maintained with a continuous infusion of propofol. The dose of propofol was titrated to achieve an adequate level of sedation: asleep but responding to painful stimulation. The efficacy of sedation, the required doses of propofol, and the wake-up times were investigated for all subjects. The efficacy of sedation was evaluated by judging whether the patient became cooperative and allowed the dental treatment to be carried out or not. The complications induced by intravenous sedation were also evaluated in each subject. Differences in variables between subjects with ID and other subjects were analysed using the Mann–WhitneyU-test.Intravenous sedation was effective for dental treatment in all subjects with or without ID. The required dose of propofol in subjects with ID was 4.74 mg/kg/h (2.63–10.33 mg/kg/h), significantly higher than that required for other subjects (3.31, 1.72–4.80 mg/kg/h). Wake-up times of subjects with ID were similar to those of the other subjects. Severe complications were not seen during or after intravenous sedation.The results of this study show that intravenous sedation is a useful method for dental patients with ID as well as for other dental patients, but indicate that dental patients with ID need higher doses of sedative to obtain an adequate level of sedation. [ABSTRACT FROM AUTHOR]

c-erbB-2 and c-Met expression relates to cholangiocarcinogenesis and progression of intrahepatic cholangiocarcinoma Aims: The c-erbB-2 and c-Met proto-oncogenes are important for tumour invasiveness and metastasis in many types of malignant tumours. Previous studies have indicated that these proteins are associated with carcinogenesis in intrahepatic cholangiocarcinoma. In this study, we examined c-erbB-2 and c-Met expression by immunohistochemistry in hepatolithiasis, intrahepatic cholangiocarcinoma and metastatic lymph node, in order to clarify whether these proteins play a role in carcinogenesis and tumour metastasis in intrahepatic cholangiocarcinoma. Methods and results: In hepatolithiasis, the staining for c-erbB-2 was positive in 14 of the 23 (61%) cases, while staining for c-Met was positive in eight of the 23 (35%) cases. In intrahepatic cholangiocarcinoma, staining for c-erbB-2 was positive in 45 of the 81 (55%) cases, while staining for c-Met was positive in 28 (35%) cases. The positivity of c-Met staining in intrahepatic cholangiocarcinoma was significantly higher in the differentiated type of cholangiocarcinoma than in the undifferentiated type. In addition, c-Met-positive staining had an inverted correlation with tumour size, the presence of perineural invasion and the presence of lymph node metastasis. c-Met staining had a significantly higher positivity in cases at an early stage of intrahepatic cholangiocarcinoma. In contrast, the positivity of c-erbB-2 staining in intrahepatic cholangiocarcinoma was significantly higher in cases with lymph node metastasis than in cases without. In metastatic lymph nodes, the staining for c-erbB-2 was positive in 20 of the 25 (80%) cases, while staining for c-Met was positive in six of the 25 (24%) cases. There was no difference in survival between c-erbB-2-positive and negative patients. However, the patients with c-Met-positive tumours had a significantly longer survival than those with c-Met-negative tumours... [ABSTRACT FROM AUTHOR]

Summary 1. Time-series data from a twice-replicated population experiment (consisting of a seed beetle (host), Callosobruchus chinensis, and two parasitoids, Anisopteromalus calandrae and Heterospilus prosopidis) were studied in order to identify and to estimate the density-dependent structure. 2. A non-parametric host–parasitoid model based on the Nicholson–Bailey model, was studied through non-parametric autoregressive modelling. An additive non-linear structure was found in the population growth/parasitism rates for all three species. 3. The analysis suggests that the abundance of A. calandrae only weakly affects its own parasitism rate as well as H. prosopidis parasitism rate. 4. The analysis also suggests that the net population growth rate of C. chinensis is highly non-linear, which may be due to disproportionately higher egg mortality at high adult densities. 5. Non-linearity was also demonstrated in the parasitism rate of H. prosopidis, which is consistent with assuming that the density-dependent mutual interference becomes disproportionately higher at high H. prosopidis adult densities. [ABSTRACT FROM AUTHOR]

Enhanced gastric mucosal chemokine activity has been demonstrated in patients with Helicobacter pylori infection. However, little is known about the mechanisms involved in this phenomenon. To examine whether in vivo chemokine activity is similar to in vitro response of gastric epithelial cells infected by H. pylori. In organ cultures of mucosal tissues, the levels of interleukin-8 and growth-related gene product α were elevated in patients with peptic ulcer disease compared with those with erosive gastritis or endoscopically normal mucosa. However, there were no significant differences in vitro cultures of MKN45 or KATO III cells that were infected with H. pylori isolated from these same patients. These in vivo and in vitro α-chemokine levels showed no significant association with the presence of cagA gene and CagA protein, ureB genotype, or binding capacity to MKN45 or KATO III cells in individual H. pylori isolates. In contrast, in vivo mucosal α-chemokine activity correlated with H. pylori colonization density. Mucosal chemokine profiles and inflammatory responses in H. pylori infection may be associated more closely with host factors, including those determining bacterial adhesiveness, than with differences in H. pylori strains. [ABSTRACT FROM AUTHOR]

We report here multiple cerebellar infarctions detected by MRI in a young boy. The results of our clinical and imaging studies indicated that his infarctions occurred with no cerebellar signs. Consideration of FLAIR images contributed to the estimate of the age of infarctions. However, extensive investigations failed to reveal a cause of the infarctions. There is no established prognosis or treatment for cerebellar infarction of unknown origin. We proceeded with a course of anti-coagulant therapy in order to reduce the possibility of further ischemic stroke. [ABSTRACT FROM AUTHOR]

We developed 12 polymorphic microsatellite markers from a salt-marsh sedge Carex rugulosa. The number of alleles per locus ranged from two to four, with an average of 2.75. The observed and expected heterozygosities ranged from 0.067 to 0.600 and from 0.128 to 0.620, respectively. These simple sequence repeat markers will allow the identification of genets and evaluation of the genetic diversity of C. rugulosa. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 67-year-old woman who reported spontaneous edema and severe liver dysfunction of unknown etiology. It mentions that vibration-controlled transient elastography and computed tomography was performed after which the patient was diagnosed with AL hepatic amyloidosis.

Presents a letter to the editor about serum cortisol level and depth of propofol-induced sedation.

Investigates metastases found in the human liver through ultrasound and computed tomography scans. Findings revealed by selective arteriography; Vascularity of the disease; Difference between diaphragmatic and liver metastases.

An abstract of the study "Increase of C-reactive Protein Is Poorly Prognostic Factor with Degenerative Aortic Valvular Stenosis," by M. Shimada and A. Baba, is presented.