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Illegal, unregulated, and unreported (IUU) fishing poses a major threat to effective management of marine resources, affecting biodiversity and communities dependent on these coastal resources. Spatiotemporal patterns of industrial fisheries in developing countries are often poorly understood, and global efforts to describe spatial patterns of fishing vessel activity are currently based on automatic identification system (AIS) data. However, AIS is often not a legal requirement on fishing vessels, likely resulting in underestimates of the scale and distribution of legal and illegal fishing activity, which could have significant ramifications for targeted enforcement efforts and the management of fisheries resources. To help address this knowledge gap, we analyzed 3 years of vessel monitoring system (VMS) data in partnership with the national fisheries department in the Republic of the Congo to describe the behavior of national and distant-water industrial fleets operating in these waters. We found that the spatial footprint of the industrial fisheries fleet encompassed over one-quarter of the Exclusive Economic Zone. On average, 73% of fishing activity took place on the continental shelf (waters shallower than 200 m). Our findings highlight that VMS is not acting as a deterrent or being effectively used as a proactive management tool. As much as 33% (13% on average) of fishing effort occurred in prohibited areas set aside to protect biodiversity, including artisanal fisheries resources, and the distant-water fleet responsible for as much as 84% of this illegal activity. Given the growth in industrial and distant-water fleets across the region, as well as low levels of management and enforcement, these findings highlight that there is an urgent need for the global community to help strengthen regional and national capacity to analyze national scale data sets if efforts to combat IUU fishing are to be effective.Amenazas de la Pesca Ilegal, No Regulada y No Reportada para la Biodiversidad y la Seguridad Alimentaria en la República del Congo Resumen La pesca ilegal, no regulada y no reportada (INN) representa una amenaza importante para el manejo efectivo de los recursos marinos, lo que afecta a la biodiversidad y a las comunidades que dependen de estos recursos costeros. Los patrones espaciotemporales de las pesquerías industriales en los países en desarrollo a menudo están poco comprendidas, y los esfuerzos globales para describir los patrones espaciales de la actividad de los navíos pesqueros actualmente están basados en los datos del sistema automático de identificación (SAI). Sin embargo, el SAI no es siempre un requerimiento legal en los navíos pesqueros, lo que probablemente resulta en valores subestimados de la escala y la distribución de la actividad pesquera legal e ilegal, lo que podría tener ramificaciones significativas para los esfuerzos enfocados de aplicación de la ley y para el manejo de los recursos de las pesquerías. Para ayudar a completar este vacío en el conocimiento, analizamos tres años de datos del sistema de monitoreo de navíos (SMN) en asociación con el departamento nacional de pesquerías de la República del Congo para describir el comportamiento de las flotas industriales nacionales y de altura que operan en estas aguas. Descubrimos que la huella espacial de la flota de pesquerías industriales abarcó más de un cuarto de la Zona Económica Exclusiva. En promedio, el 73% de la actividad pesquera se realizó en el talud continental (aguas con una profundidad menor a 200 m). Nuestros descubrimientos resaltan que el SMN no está actuando como un disuasivo o no se está usando efectivamente como una herramienta proactiva de manejo. Un máximo del 33% (13% en promedio) de los esfuerzos de pesca ocurrieron en áreas prohibidas apartadas para proteger a la biodiversidad, incluyendo los recursos para la pesca artesanal, con el 84% de la responsabilidad de esta actividad ilegal cayendo sobre las flotas de altura. Dado el crecimiento de flotas industriales y de altura en la región, así como los bajos niveles de manejo y aplicación de la ley, estos resultados resaltan la necesidad urgente que existe para que la comunidad global ayude a fortalecer la capacidad regional y nacional para analizar los conjuntos de datos de escala nacional si se espera que los esfuerzos para combatir la pesca INN sean efectivos.

Incidence of post-traumatic stress disorder (PTSD) ranges from 3 to 30% in individuals exposed to traumatic events, with the highest prevalence in groups exposed to combat, torture, or rape. To date, only a few FDA approved drugs are available to treat PTSD, which only offer symptomatic relief and variable efficacy. There is, therefore, an urgent need to explore new concepts regarding the biological responses causing PTSD. Animal models are an appropriate platform for conducting such studies. Herein, we examined the chronic behavioral and neurobiological effects of repeated unpredictable stress (RUS) in a mouse model. 12 weeks-old C57BL/6J male mice were exposed to a 21-day RUS paradigm consisting of exposures to a predator odor (TMT) whilst under restraint, unstable social housing, inescapable footshocks and social isolation. Validity of the model was assessed by comprehensive examination of behavioral outcomes at an acute timepoint, 3 and 6 months post-RUS; and molecular profiling was also conducted on brain and plasma samples at the acute and 6 months timepoints. Stressed mice demonstrated recall of traumatic memories, passive stress coping behavior, acute anxiety, and weight gain deficits when compared to control mice. Immunoblotting of amygdala lysates showed a dysregulation in the p75NTR/ProBDNF, and glutamatergic signaling in stressed mice at the acute timepoint. At 6 months after RUS, stressed mice had lower plasma corticosterone, reduced hippocampal CA1 volume and reduced brain-derived neurotrophic factor levels. In addition, glucocorticoid regulatory protein FKBP5 was downregulated in the hypothalamus of stressed mice at the same timepoint, together implicating an impaired hypothalamus-pituitary-adrenal-axis. Our model demonstrates chronic behavioral and neurobiological outcomes consistent with those reported in human PTSD cases and thus presents a platform through which to understand the neurobiology of stress and explore new therapeutic interventions.

Traumatic brain injury (TBI) is a serious public health concern which strikes someone every 15 s on average in the US. Even mild TBI, which comprise as many as 75% of all TBI cases, carries long term consequences. The effects of age and sex on long term outcome from TBI is not fully understood, but due to the increased risk for neurodegenerative diseases after TBI it is important to understand how these factors influence the outcome from TBI. This study examined the neurobehavioral and neuropathological effects of age and sex on the outcome 15 days following repetitive mild traumatic brain injury (r-mTBI) in mice transgenic for human tau (hTau). These mice express the six human isoforms of tau but do not express endogenous murine tau and they develop tau pathology and memory impairment in an age-dependent manner. After 5 mild impacts, aged female mice showed motor impairments that were absent in aged male mice, as well as younger animals. Conversely, aged female sham mice outperformed all other groups of aged mice in a Barnes maze spatial memory test. Pathologically, increases in IBA-1 and GFAP staining typically seen in this model of r-mTBI showed the expected increases with both injury and age, but phosphorylated tau stained with CP13 in the hippocampus (reduced in female sham mice compared to males) and PHF1 in the cortex (reduced in female TBI mice compared to male TBI mice) showed the only histological signs of sex-dependent differences in these mice.

Contains fulltext : 174756.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intrapartum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first-stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first-stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of labor. MATERIAL AND METHODS: Uterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrum. RESULTS: No significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean delivery. CONCLUSION: Uterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor.

We revisit the mechanism leading to the photoresponse of locally illuminated single-walled carbon nanotube (SWNT) films deposited on substrates. Our study examines the impact of multiple device parameters and provides many evidences that the position-dependent photocurrent is dominated by photothermoelectric effects. The photoresponse arises from the temperature variations at the metal-nanotube film interfaces, where mismatches of the Seebeck coefficients are measured. Our work also stresses the impact of the substrates, electrode materials and post-thermal treatments on the amplitude and dynamics of the photoresponse. The knowledge gained should guide the future development of photothermoelectric devices and detectors based on SWNTs.

Objectives. Validation of electrohysterography (EHG) as a method for uterine activity monitoring during labour by comparing with intra-uterine pressure catheter (IUPC) recordings.Design. Prospective observational study.Setting. Labour ward in a tertiary centre in the Netherlands.Population. Thirty-two women in labour.Methods. Simultaneous recording of uterine activity with EHG and IUPC for at least 30 min.Main outcome measures. Number of uterine contractions detected by both EHG and IUPC (sensitivity). Number of contractions detected by EHG only [positive predictive value (PPV)]. Correlation between contraction amplitude and duration measured by EHG and IUPC.Results. EHG detects uterine contractions accurately: sensitivity = 94.5% (95%CI: 87.5–100), PPV = 88.3% (95%CI: 76.2–100). The correlation of contractions' duration and amplitude between both methods is r = 0.31 (95%CI: 0.23–0.39) and r = 0.45 (95%CI: 0.38–0.52), respectively.Conclusions. EHG detects uterine contractions accurately during labour but ...

The electroluminescence (EL) properties from single-wall carbon nanotube network field-effect transistors (NNFETs) and small bundle carbon nanotube field effect transistors (CNFETs) are studied using spectroscopy and imaging in the near-infrared (NIR). At room temperature, NNFETs produce broad (approximately 180 meV) and structured NIR spectra, while they are narrower (approximately 80 meV) for CNFETs. EL emission from NNFETs is located in the vicinity of the minority carrier injecting contact (drain) and the spectrum of the emission is red shifted with respect to the corresponding absorption spectrum. A phenomenological model based on a Fermi-Dirac distribution of carriers in the nanotube network reproduces the spectral features observed. This work supports bipolar (electron-hole) current recombination as the main mechanism of emission and highlights the drastic influence of carrier distribution on the optoelectronic properties of carbon nanotube films.

Although evidence exists linking smoking to precancerous colorectal adenomatous polyps, few studies have examined the association between cigarette smoking and recurrence of colorectal polyps. This association was investigated prospectively with data from the Polyp Prevention Trial. Cigarette smoking data were collected through baseline interviews. The study was completed by 1872 men and women with presence of adenomas at baseline colonoscopy. Multiple logistic regression analysis was used to examine the association between cigarette smoking and polyp recurrence (adenomatous and hyperplastic) up to four years from baseline. Adenoma recurrence was not related to cigarette smoking. Current smokers had increased odds of hyperplastic polyps at follow-up compared to never smokers (OR 2.88, 95% CI 2.06–4.01). Current smoking was associated with subsequent distal (OR 3.44, 95% CI 2.38–4.95) and rectal (OR 3.53, 95% CI 2.15–5.78) hyperplastic polyps, but not subsequent proximal hyperplastic polyps. Cigarette smoking was associated with subsequent multiple and small size (4 mm) hyperplastic polyps. Significant linear trends were observed between development of subsequent hyperplastic polyps and all smoking variables. Although no association with recurrent adenomas was observed, cigarette smoking was significantly associated with hyperplastic polyp development, except for those in the proximal colon. This prospective study confirms that cigarette smoking has a significant effect on the development of hyperplastic colorectal polyps.

COLORECTAL CARCINOMA is the leading cause of cancer-related death in the nonsmoking United States population, with about 60,000 annual fatalities.1 Yet it is the most preventable cancer if the cancer precursor, polyps, can be detected and removed at an early stage. The current gold standard for colorectal cancer screening is optical colonoscopy because of its high accuracy compared to other screening methods such as fecal occult blood test, double-contrast barium enema, and sigmoidoscopy. Increased optical colonoscopy compliance for subjects over 50 would substantially decrease the cancer mortality; however, fewer than 40% of the average risk adults reported having received a optical colonoscopy in the past 5 years.1 Optical colonoscopy compliance is low due to its discomfort, perforation risk, high cost, and high negative statistic. Computed tomographic colonography (CTC), or virtual colonoscopy, has been considered a promising replacement for optical colonoscopy as a regular screening method since its introduction in 19942 and has been an active research field for both clinical researchers and technology developers. On the clinical side, many medical centers perform a CTC procedure, and some of them are doing large population clinical experiments on CTC. A multi-center clinical trial3 of CTC over a large asymptomatic population (1233 subjects) published encouraging results, which show the viability of virtual colonoscopy as a screening tool. Regarding radiologist interpretation, CTC acceptance has been hindered by two issues, detection accuracy, which is generally unacceptable for clinical practice, and interobserver variances. 4, 6, 7With observers at diverse levels of expertise and using different reading methods, multiple centers reported radiologists’ CTC results with sensitivities between 20% and 90% for 6-mm and larger polyps.5 Aside from interpretation variation, detection performance is affected by different raw image quality due to patient preparation, scanner parameters, and dose consideration. On the technology side, in addition to CT scanner improvement from single to multi-row detectors, researchers have made efforts to use computer techniques to solve the above clinical problems. Volume rendering and visualization that are available on commercial systems directly affect radiologists’ results.8 Computer-aided polyp detection (CAPD) or computerized polyp detection (CPD) may improve the platform to address the above issues in clinical research. Yoshida and Nappi reported a fully automatic CPD system tested on 43 patients with 12 polyps and yielded 1 to 2 false positive results (FPs)/case.9 Nappi and yoshida have extended the algorithm by introducing another geometric feature, modified gradient concentration, and applied the system to more patients but with no substantial improvement.10 Gokturk et al reported their statistical ROSS method used in false positive reduction,(11,12) which produced a 40-50% increment of specificity without sensitivity loss, an encouraging result but still far from radiologist accuracy, especially for the very low specificity. The main difficulties and challenges of CAPD in CTC are summarized by Summers.13 Given the CTC raw data, segmentation is the first step in our CPD scheme. There are two major segmentation approaches, surface methods and volume methods. In surface methods, a mesh surface that represents the colon lumen needs to be segmented from the volume data.14-16 In volume methods, the lumen surface voxels and/or their neighboring voxels are segmented using gradient operators(9, 10, 17) and volume subtraction.9 There is no convincing proof for the advantage of either method. For the subsequent polyp detection, there are also two sources for feature calculation. They are: Local volumetric information calculated from the intensity values of a small volumetric neighborhood. Local shape information calculated from the mesh surface structure. The local volumetric information approach uses the intensities of voxels in a neighborhood and the extracted features computed from them so that a CPD algorithm can classify the neighborhood. For example, Yoshida and Nappi.9 defined the local shape index (SI), curvedness (CV), and directional gradient concentration (DCG) as three geometric features in their classifier. Statistical values based on voxel intensities may provide useful features. When local shape information from the mesh surface is used, curvature-based shape features can be calculated from a group of connected vertices or from the polyp candidates. Also the size, roundness, etc., can be obtained easily from the surface data. Furthermore, the surface method intrinsically reduces the noise effect in curvature calculation. Making the decision to use one or both of the sources to calculate the geometric features is the beginning of feature selection and reduction. Selection is accomplished by observation, expert opinion, taking all possible measurements, and/or any other methods that transform knowledge of the system into metrics. Feature reduction is the subsequent and optional procedure to find the most useful and most independent set of features, from the originals, that also produces the optimum classification. In many practical situations, feature reduction is accomplished by observation or evaluating the system performance with a framing database. The goal of classifier selection is to find the best classifier for partitioning the feature space. Bayes classifiers18 are well-studied and widely used in many medical applications. A hyperplane, corresponding to a linear discriminant function (LDF), and a second-order surface, corresponding to a quadratic discriminant function (QDF), are the most frequently used Bayes classifiers because of their simplicity and effectiveness. Support vector machines (SVM) transform the given feature space to higher dimensions so that the sample vectors are linearly separable in the transformed space.11 In the above classifiers, we often assume(1) normal distributions for both the true positive and false positive, or non-polyp categories, and (2) sufficient training samples for parameter estimation. However, these assumptions are not quite practical in polyp detection. The first reason is that the false positive category is the dominant class, which may bias the calculation of the average covariance matrices. The second reason is that the normal distribution assumption for the false positive category is questionable because the category embraces anything other than polyps and the occurrences of the feature vectors of false positives in the feature space are generally unpredictable. Therefore, we propose an MLDF method, which corresponds to several empirical hyperplanes that frame a hypercubic region in a given feature space, and a MAP method, which requires parametric training only for the polyp category. We have developed a fully automatic CPD system, which begins with raw DICOM data and ends with a list of detected polyps by employing a typical CAPD/CPD scheme: segmentation, polyp candidate generation, and false positive reduction. In our system, both supine and prone scans are combined to increase the colon coverage in computerized segmentation14 and in turn to improve the detection sensitivity. Colon deformation between the two positions makes the surface registration practically unsolvable. Fortunately, the clinical significance of patient-based accuracy of CTC renders registration unnecessary; if a polyp showed in either or both scans, the patient would be forwarded to optical colonoscopy. In this specific situation, we redefine the accuracy terms for the CPD when using both scans. A true positive occurs when an optical colonoscopy polyp finding is CPD detected in either or both scans; a false positive occurs when a CPD finding in any scan cannot be matched to any of the optical colonoscopy polyp findings. Our results demonstrate that using both scans improves the detection sensitivity. The segmentation algorithm is presented in the accompanying article.14 In this article, we focus on the subsequent polyp detection. The details of our detection algorithm as well as a brief introduction of segmentation are presented below in Methodology, while the section titled Data describes the scanner parameters and the procedure for data acquisition. A description of the detection results follows; and we close with the Discussion and Conclusions.

Infected pancreatic necrosis is the leading cause of death in patients with severe acute pancreatitis. Early prophylactic antibiotic treatment is effective in preventing conversion of sterile necrosis to pancreatic infection, but its effect on mortality remains unproven. Fungal infections may predict a worse outcome, but no evidence supports the use of antifungal prophylaxis. Because infection of pancreatic necrosis by enteric bacteria can develop despite prophylaxis, a high index of suspicion should allow early detection followed by aggressive management.

Although ptosis of the tip of the chin is common and can be seen in persons of any age, it is frequently seen in older patients seeking facial rejuvenation. A variety of techniques have been described to correct ptosis of the chin. The authors describe a minimally invasive method that can be used correct chin ptosis. This technique uses a small intraoral incision to place a U-shaped Prolene suture that gathers the soft tissue of the chin and elevates it above the lower border of the mandibular symphysis. A retrospective review of 314 cases performed in conjunction with face lifts between January of 1994 and January of 2000 was performed to evaluate this technique. There were no significant complications, and long-term results have been very satisfactory and lasting.

Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities. Virtual colonoscopy, or computerized tomographic colography, is a minimally invasive technique that safely evaluates the entire colon and does not require sedation. Thorough cleansing as well as immobilization and air insufflation of the colon is crucial to a successful examination. Sensitivity and specificity rates are reasonable, compared with conventional colonoscopy, and it has been shown that the latter technique can be averted in over two-thirds of cases, with few false-negative examinations. Most patients find virtual colonoscopy more acceptable than the conventional technique, and would prefer it if a repeat procedure were warranted. An economic analysis that found that computerized tomographic colography was less cost effective than conventional colonoscopy did not consider the indirect costs of the latter, which is an important limitation. Virtual colonoscopy is a novel radiological technique that may revolutionize screening for colorectal cancer.

Endoscopy has provided a significant improvement in the surgical rejuvenation of the upper face. It offers a minimally invasive alternative that avoids many of the undesirable effects associated with the coronal approach. The standard minimal access forehead endoscopic procedure consists of a subperiosteal undermining through three small triangular prehairline incisions. To successfully elevate the eyebrows, it is essential to release the periosteum at the level of the supraorbital rims and ablate the brow depressor muscles of the glabella. Until the periosteum reattaches itself, elevation is maintained by a temporary suspension suture between staples at the incision sites and 5 cm posterior to the hairline. The transverse closure of the triangular skin incisions achieves some additional elevation. The biplanar approach adds a partial subcutaneous undermining of the forehead to the endoscopic technique and allows plication of the frontalis muscle and excision of excess forehead skin. It is offered to patients with very ptotic eyebrows, deep transverse wrinkles, or a high forehead. The prehairline incision is a disadvantage but is tolerated quite well in older patients. The medical records of 393 consecutive patients who underwent endoscopic forehead lift from 1994 to 2000 were reviewed. Because seven patients had the endoscopic forehead lift repeated, the number of forehead endoscopies totaled 400. The complication rate was quite acceptable and did not markedly increase when a forehead lift was performed in combination with other facial procedures. The endoscopic forehead lift consistently attenuated the transverse forehead wrinkles, reduced the glabellar frown lines, and raised the eyebrows. It provided an appearance that was less tired and angry in addition to opening the area around the eyes. Long-term follow-up has shown that the endoscopic forehead lift produces lasting and predictable results.

The midface is an area where definite and consistent improvement is still hard to achieve. Vertical suspension of the malar fat pad is an effective midface lift that complements facial rejuvenation to obtain an overall appearance of youth and beauty while maintaining the personal features of the patient. To substantiate its effectiveness, the authors evaluated the complications and long-term results of the malar fat pad elevation proper and in conjunction with other facial procedures. A retrospective review of the medical records of 458 consecutive patients who underwent malar fat pad elevation by the senior author (B.C.D.) from January of 1994 to January of 2000 was conducted. Because 14 patients had their malar fat pad re-elevated, the number of midface lifts totaled 472. Of these, 437 had a combined superficial musculoaponeurotic system excision and tightening, 19 had a combined limited superficial musculoaponeurotic system plication/imbrication, and 16 had elevation of the malar fat pad only. Elevating the malar fat pad appears to be a sound, straightforward, and effective means of rendering a youthful midface. It consistently reshapes the malar eminence, softens the nasolabial fold, and rejuvenates the lower eyelid. This technique provides lasting results, with an acceptable complication rate. Facial nerve injury, in particular, was infrequent and temporary. In addition, the prehairline scar happened to be quite inconspicuous, especially in patients older than 55 years. This experience confirms that malar fat pad elevation is a safe and effective method to rejuvenate the central third of the face.

This paper reviews the design of a large multicenter clinical trial currently being conducted to test the equivalence of two screening procedures for colorectal polyps. The primary outcome is the sensitivity and specificity of the new and standard procedures for detecting subjects with and without polyps of a size ⩾6 mm, respectively. An important secondary outcome is the accuracy of these procedures in detecting individual polyps. A total of 619 participants underwent virtual colonoscopy, the new procedure, followed by conventional colonoscopy, the standard procedure. Strategies for the design and implementation of the study are shared as well as the challenges encountered.

Pharmacy, Wake Forest University, School of Medicine, WinstonSalem, North Carolina. Presented at the 63rd annual meeting of the American College of Gastroenterology, October 1998, Boston, Massachusetts, as a Clinical Vignette (Am J Gastroenterol 1998;93:1720). Reprint requests: Benoit C. Pineau, MD, FRCP(c), Division of Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157. Copyright © 2001 by the American Society for Gastrointestinal Endoscopy 0016-5107/2001/$35.00 + 0 37/4/115318 doi:10.1067/mge.2001.115318 R Gupta, M Share, B Pineau Dissolution of an esophageal bezoar with pancreatic enzyme extract

Colorectal cancer, the second-leading cause of cancer-related mortality, is a preventable malignancy in many cases. Despite the availability of several screening modalities, compliance with screening recommendations remains unacceptably low. Virtual colonoscopy is a novel, minimally-invasive technique with the potential to increase colorectal cancer screening rates, but its effectiveness must first be validated. Published studies comparing virtual colonoscopy to conventional colonoscopy have reported varying results. These discrepancies may be attributed to differences in bowel preparation and scanning techniques, as well as errors in endoscopic lesion measurement, endoscopic colonic segmental localization, and the ability of conventional colonoscopy to actually detect lesions. These methodological issues can affect scientific results and ultimately affect the public's perception of this emerging technique.The goal of this report is to expose existing methodological shortcomings and propose solutions incorporated in this study design. This article describes the rationale, study design, and outcome definitions of a single-center, blinded, direct comparative trial aiming at assessing the ability of virtual colonoscopy to detect colorectal polyps and masses relative to the criterion standard, conventional colonoscopy. DESIGN FEATURES: Bowel preparation was standardized using oral sodium phosphate lavage, orally administered iodinated contrast, and controlled colonic insufflation. Segmental unblinding allowed a second-look when results were discrepant and polyp matching was performed using an algorithm based on segmental localization and lesion size determination.This methodology could be applied to other studies assessing the accuracy of virtual colonoscopy in order to have uniformity of results.

Since the introduction of acetylsalicylic acid in 1899 and the development of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in the 1960s, NSAIDs have become the most widely used medications in the world.1 It is estimated that 40 billion aspirin tablets are used every year around the world. More than 30 million people use NSAIDs each day worldwide.2,3 As with any medication, there are adverse as well as beneficial effects. NSAIDs are believed to injure the GI mucosa by inhibition of prostaglandin biosynthesis and through the uncoupling of mitochondrial oxidative phosphorylation. Although the stomach and duodenum have been the main focus in published reports of NSAID-induced GI damage, more recently there has been greater recognition of the adverse effects of NSAIDs on the colon.

Soft-tissue defects in the area of the periolecranon may be a source of concern to the reconstructive surgeon who aims for durable protection with a minimum of drawbacks. Lamberty and Cormack described the antecubital fasciocutaneous flap both as a local transposition and as a free flap. The island version of this flap enables a single-stage transfer of thin, pliable, sensitive skin into the region of the periolecranon without further scarring around the defect. In general, most of the donor site can be closed primarily together with a small, full-sheet, split-thickness skin graft on the remaining skin defect on the volar surface of the distal forearm. An additional advantage of this flap is the rather straightforward dissection with minimal repercussion on the forearm contour. An anatomic overview as well as 4 patients are described to illustrate the appealing features of this fasciocutaneous flap.

BACKGROUND: The curative rate of surgical resection of squamous cell carcinoma of the esophagus is low. Reports on the efficacy of preoperative and postoperative chemotherapy are conflicting or have included limited disease or radical surgery alone. OBJECTIVE: The authors' objective was to study the results of chemotherapy on the duration and quality of survival in patients who have undergone palliative surgical resection for esophageal squamous cell carcinoma. PATIENTS AND METHODS: Of 124 patients with histologically proven esophageal squamous cell carcinoma situated more than 5 cm from the upper end of the esophagus, 4 patients were withdrawn for failure to comply with the protocol. The remaining 120 patients, 116 males and 4 females (mean age, 57 +/- 9 years), were randomly assigned to either a control group who were to receive no chemotherapy (68 patients) or to a group who were to be treated with chemotherapy (52 patients). Patients were subdivided into two strata as follows: (1) stratum I, complete resection of the tumor with lymph node involvement (62 patients) and (2) stratum ii, incomplete resection leaving macroscopic tumor tissue in situ or with metastases. Noninclusion criteria were histologically proven tracheobronchial involvement, esotracheal fistula, major alteration of general health status (Karnofsky score 30% of parenchyma) hepatic metastasis, peritoneal carcinomatosis, associated or previously treated upper airway cancer, or, conversely, complete resection of tumor without lymph node involvement. Chemotherapy was given in 5-day courses, every 28 days, with a maximum of 8 courses. Cisplatin was administered either as a single dose of 100 mg/m2 at the beginning of the course or as 20 mg/m2/day for 5 days given over 3 hours. 5- Fluorouracil (5-FU) (100 mg/m2/day) was infused over 24 hours for 5 days. The duration of treatment ranged from 6 to 8 months. The main aim was to establish median survival and actuarial survival curves. The subsidiary aim was to evaluate quality of survival as judged by complications due to treatment and the duration of autonomous oral feeding, that is, without palliative endoscopic treatment. No difference in survival was noted between the two groups, overall (median, 14 months), or between the strata. Conversely, significantly more patients in the treated group had hematologic, neurologic, and renal complications compared with the control group. Four patients died of complications of chemotherapy. The duration of autonomous oral alimentation was exactly the same in both groups (median, 12 + months). CONCLUSION: The results of this study suggest that 5-FU and cisplatin are not useful for patients with squamous cell carcinoma of the esophagus who have not undergone curative resection.

We designed a thermopile based on a PN doping profile engineered in a suspended film of single-walled carbon nanotubes (SWNTs). Using estimates of the film local Seebeck coefficients, the SWNT thermopile was optimized in situ through depositions of potassium dopants. The overall performances of the thermopile were found to be comparable to state-of-the-art SWNT bolometers. The device is characterized at room temperature by a time response of 36 ms, typical of thermal detectors, and an optimum spectral detectivity of 2 × 10(6) cm Hz(1/2)/W in the visible and near-infrared. This paper presents the first thermopile made of a suspended SWNT film and paves the way to new applications such as broadband light (including THz) detection and thermoelectric power generation.

The photovoltage properties of suspended single-walled carbon nanotube (SWNT) films were measured in high vacuum. Experiments with localized illumination showed significant photovoltage amplitudes of up to 0.36 mV at 1.2 mW intensity. The photoresponse dependence upon the laser position was explained by a thermal mechanism that is independent of the nanotube-metal barrier. The response was also found to depend on doping heterogeneities of the film. A model was developed to deduce from the data the spatial variation of the local Seebeck coefficient for a given photovoltage profile.

Esophageal cancer is a common cause of dysphagia and upper endoscopy is the accepted standard for making the diagnosis; however, the accuracy of endoscopy is not known. The purpose of this study is to determine the sensitivity of upper endoscopy in making the diagnosis of esophageal cancer in clinical practice. All patients with a new diagnosis of esophageal cancer from 1997 to 2001 in the Tumor Registry of Wake Forest University Baptist Medical Center were identified. The medical records were reviewed to identify all patients who had undergone a previous endoscopy within two years that failed to diagnose esophageal cancer. The reason for failure was recorded. One hundred ten new cases of esophageal carcinoma were identified, and ten patients had had a previous false-negative endoscopy within two years for a sensitivity of 90.9% in clinical practice. The reasons for the failure of endoscopy were (1) lesion not seen in seven patients, (2) lesion seen and biopsied with benign histology in two patients, and (3) lesion seen but felt to be benign and not biopsied in one patient. Given the uncertain natural history of esophageal cancer, the data were also analyzed using a one-year window; this resulted in a sensitivity of 94.5%. The sensitivity of upper endoscopy in the diagnosis of esophageal cancer in general clinical practice is 90.9% using a two-year window and 94.5% using a one-year window. Understanding the reasons for the failure of endoscopy may allow us to improve the practice of endoscopy.

BACKGROUND AND STUDY AIMS Many lesions found during push enteroscopy to evaluate obscure gastrointestinal bleeding are within the reach of standard endoscopes. The aim of this study was to determine whether the rate of proximal lesions varies in relation to the type of obscure bleeding that is present. PATIENTS AND METHODS A retrospective review of consecutive push enteroscopies carried out for obscure gastrointestinal bleeding between July 1996 and July 2000 was conducted. The patients were categorized into three groups: those with recurrent obscure/overt gastrointestinal bleeding; those with persistent obscure/overt gastrointestinal bleeding; and those with obscure/occult gastrointestinal bleeding. RESULTS A total of 63 patients (24 men, 39 women; mean age 69.8) were included. Push enteroscopy examinations were conducted for recurrent obscure/overt bleeding in 32 patients; for persistent obscure/overt bleeding in 12 patients; and for obscure/occult bleeding in 19 patients. The overall diagnostic yield of push enteroscopy was 47 % (15 of 32) in the group with recurrent obscure/overt bleeding; 66 % (eight of 12) in the group with persistent obscure/overt bleeding; and 63 % (12 of 19) in the group with obscure/occult bleeding. However, when lesions within the reach of standard esophagogastroduodenoscopy (EGD) were excluded, the yield of push enteroscopy was slightly higher in the group with recurrent obscure/overt bleeding (41 %) than in the groups with persistent obscure/overt bleeding (33 %) and obscure/occult bleeding (26 %). There were fewer lesions within the reach of EGD in the group with recurrent obscure/overt bleeding than in the groups with persistent obscure/overt bleeding (6 % vs. 33 %; P < 0.05) or obscure/occult bleeding (6 % vs. 37 %; P < 0.05). CONCLUSIONS Patients undergoing push enteroscopy for recurrent obscure/overt bleeding were significantly less likely to have lesions within the reach of EGD than patients with persistent obscure/overt bleeding or obscure/occult bleeding. Patients in the latter two groups would be able to undergo a repeat EGD examination before more intense evaluation with push enteroscopy or capsule endoscopy.

Blunt neck trauma can cause isolated esophageal injuries that may be difficult to recognize. A high index of suspicion is necessary for optimal identification and management of this condition. We report a case of blunt esophageal trauma resulting from a motor vehicle accident that was initially unrecognized until the patient developed a tight stricture of the cervical esophagus. This was successfully dilated endoscopically. Aerodigestive trauma resulting from neck injuries is reviewed with emphasis on the pathophysiology of esophageal trauma.

Upper eyelid ptosis can present both functional and aesthetic problems. Because proper correction of ptosis can be difficult to achieve, numerous surgical procedures have been developed. Plication of levator aponeurosis can be combined with aesthetic blepharoplasty and facial rejuvenation procedures to successfully address ptosis. The authors assessed the effectiveness of levator aponeurosis plication for correction of acquired upper eyelid ptosis in patients presenting for concomitant cosmetic facial procedures. The medical records of 74 consecutive patients (68 women and six men) who had upper eyelid ptosis correction in conjunction with cosmetic facial procedures from January of 1994 to January of 2000 were reviewed. During this period, 400 endoscopic forehead lifts and 479 face lifts were performed. The correction was performed through an external upper blepharoplasty approach removing an ellipse of skin and orbicularis muscle. Once the orbital septum was opened, a plication of the levator aponeurosis was accomplished by one or more horizontal mattress sutures of 6-0 clear nylon (with the first bite placed at or just medial to the vertical level of the pupil). The average follow-up period was 14 months. Long-term correction of the ptosis was excellent. The complications were minor, with the most common occurrence being asymmetry. Revisions were performed on only four patients. Correction of ptosis can be performed safely and effectively in conjunction with periorbital and facial rejuvenation. The technique described is simple, reliable, and reproducible.

Background & Aims: Virtual colonoscopy using abdominal spiral computed tomography scanning allows total colonic evaluation with minimal invasiveness. Two-dimensional images and selective 3-dimensional images of the colon are used to detect colorectal lesions. This trial used conventional colonoscopy with segmental unblinding to determine the ability of virtual colonoscopy to identify patients with colorectal lesions who need conventional colonoscopy. Methods: We studied 205 patients with virtual colonoscopy using oral iodinated contrast preceding conventional colonoscopy. Colonic lavage was achieved with an oral sodium phosphosoda preparation and colonic distention with a carbon dioxide electronic insufflator. Results: The overall sensitivity and specificity of virtual colonoscopy in identifying patients with colorectal lesions was 61.8% and 70.7%, respectively. Virtual colonoscopy was more accurate in identifying patients with lesions ≥6 mm (sensitivity 84.4% and specificity 83.1%) and those with lesions ≥10 mm (sensitivity 90% and specificity 94.6%). The negative predictive value of virtual colonoscopy was 95% for a 6-mm cutoff size and 98.9% for a 10-mm cutoff. Using a 10-mm cutoff, virtual colonoscopy precludes the need for conventional colonoscopy in 86% of patients with a 1% false-negative rate (68% with a 3.4% false-negative rate when using a 6-mm cutoff). Conclusions: Virtual colonoscopy has a high sensitivity and specificity for detecting patients with significant colorectal lesions. Its high negative predictive value may help reduce the number of negative screening colonoscopies. Further studies are needed to determine what lesion cutoff size is clinically acceptable and the appropriate interval time for repeat virtual colonoscopy when it detects lesions below this cutoff size.

Primary suture suspension of the malar fat pad has been described as a safe and simple component of global facial rejuvenation. This review evaluates the efficacy and indications for re-elevation of the malar fat pad elevation. A retrospective review of the medical records of patients who underwent malar fat pad elevation was performed between 1994 and 2000. Of 472 procedures, 14 involved re-elevation of the malar fat pad. These cases were examined for complications, risks, and results. Secondary midface elevation was performed using a subcutaneous approach to the malar fat pad through a pre-hairline incision and vertical suspension of the malar fat pad to the temporoparietal fascia. The indications for re-elevation of the malar fat pad included nasolabial asymmetry, malar fat pad malposition, and malar fat pad asymmetry. Primary elevation of the malar fat was performed in 472 patients. Fourteen of these patients had suboptimal results that necessitated re-elevation of their malar fat pads. Their average age was 57.5 years. Of the 14 malar fat pad elevations, 12 included SMAS procedures, nine were combined with platysmal plication/ submental lipectomy, six with forehead lift, and three with eyelid procedures. The average interval between original malar fat pad elevation and the re-elevation was 40 months. Average follow-up was 15 months. Complications were seen in five patients, with the most significant being persistent eye irritation. Two patients had some minimal scar hypertrophy, which was self-limiting. Minor preauricular skin slough developed in one patient. Restoration of the youthful position of the deep structures in patients with a previous mid-facelift was successfully achieved by re-elevating the malar fat pad in a vertical direction. Re-elevation of the malar fat pad demonstrated effective and reliable long-term results. It is appropriate in the small number of patients who require revision or improvement of midface rejuvenation using the malar fat pad suspension technique.

Top of pageAbstract The purpose of this study was to determine the sensitivity and specificity of CT colonography (CTC) to detect colorectal polyps and cancer compared with conventional colonoscopy. In this investigation, 300 patients (97% male; mean age 62.6 yr) at a university-affiliated Veterans Affair hospital were recruited to undergo CTC 2–3 h before a clinically indicated conventional colonoscopy. Colonic lavage was achieved with 10 oz of magnesium citrate and 4 L of a polyethylene glycol electrolyte lavage solution; colonic distention was performed using hand-bulb insufflation of air. Volumetric data were acquired under 60 s using a single-slice spiral CT scan of the abdomen and pelvis in the supine position, and repeated in the prone position. Lesion size at CTC was determined by measuring the largest diameter with computed calipers; polyp size at conventional colonoscopy was estimated in reference to open biopsy forceps. The study population consisted of 204 subjects undergoing evaluation of gastrointestinal symptoms and 96 for colorectal neoplasia screening. Conventional colonoscopy found a total of 532 lesions, including eight cancers. The ability of CTC to identify individual lesions, as well as patients with lesions, was proportional to the lesion size. For individual lesion detection, the overall sensitivity of CTC was 69.7%; however, the sensitivity for lesions 5–9.9 mm and those 10 mm or greater were 80.1% and 90%, respectively (82% and 94% respectively for adenomas). All eight cancers were detected. For detecting lesions of any size, the sensitivity and specificity were 90.1 and 72% respectively. CT colonography was more accurate in identifying patients with lesions 5–9.9 mm and those with lesions 10 mm with sensitivities of 93 and 100% respectively. The results were comparable between asymptomatic and symptomatic patients. CT colonography demonstrated 185 false-positive lesions in 113 patients, 24 1 cm and 97 of 5–9.9 mm in size; it failed to detect eight polyps of size 10 mm or greater and 28 polyps measuring 5–9.9 mm. Inadequate bowel preparation appeared to be a greater factor than poor colonic distention. The authors conclude that CTC has excellent sensitivity for clinically important polyps of 10 mm or greater and can reliably detect colorectal cancers equally well in symptomatic and asymptomatic patients.

Cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS) is a noninvasive method reported to be highly accurate in the diagnosis of sphincter of Oddi dysfunction. Our primary aim was to assess the specificity of CCK-HBS by evaluating its ability to exclude disease in 20 asymptomatic postcholecystectomy individuals. Secondary aims were to assess the interobserver reliability in scoring the CCK-HBS examinations between three blinded observers and to assess reproducibility of CCK-HBS repeated in the same individuals.Twenty asymptomatic postcholecystectomy individuals with normal liver serum chemistries underwent CCK-HBS on two separate occasions. Three nuclear medicine specialists read each CCK-HBS study in a blinded fashion.There was good agreement between the three observers reading the same scans for both the first scan (kappa = 0.554) and the second scan (kappa = 0.507). There was poor agreement between the first and second scans on the same patient, read by the same nuclear medicine specialist (kappa = 0.062-0.385). The overall specificity of the CCK-HBS score was 77.5%; however, the specificity was only 60% when a true negative was defined as two negative CCK-HBS examinations.Quantitative CCK-HBS is of poor specificity in asymptomatic postcholecystectomy individuals. Hence, it is of questionable value in excluding sphincter of Oddi dysfunction in patients suspected to suffer from this disorder.

Esophageal sarcoma is an uncommon tumor, sporadically reported in the literature. Radiation therapy is frequently employed in the treatment of carcinoma of the esophagus, and the increased risk of development of sarcoma arising in irradiated fields is well known. However, to our knowledge, the occurrence of radiation-associated sarcoma of the esophagus after radiation therapy for carcinoma of the esophagus has not been reported. We therefore report the case of a 43-year-old female who developed a gastrointestinal stroma sarcoma 9 years following radiation therapy for esophageal squamous cell carcinoma. The patient underwent resection of her gastrointestinal stromal sarcoma by transhiatal esophagectomy with cervical anastomosis and is doing well 18 months later. The increasing use of radiation therapy for esophageal carcinoma suggests that radiation-associated sarcoma of the esophagus may be seen more frequently in the future.

ContextConventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers.ObjectiveTo assess the accuracy of CTC in a large number of participants across multiple centers.Design, Setting, and ParticipantsA nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results.Main Outcome MeasuresThe sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience.ResultsA total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique.ConclusionsComputed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.

Purpose: To determine the prevalence of extracolonic findings at virtual colonoscopy using CT scanning of the abdomen and pelvis for data acquisition.

Case: A 51 year old male with a history of coronary artery disease, hypertension, dyslipidemia and gallstones presented with fever, chills, and acute right upper quadrant pain radiating to the right chest and shoulder associated with elevated liver enzymes. His medications included losartan, atorvastatin, rabeprazole and multivitamins. His mother and two maternal uncles died from pancreatic cancer. Attempted ERCP at the referring institution showed an abnormal ampulla of Vater; cannulation was unsuccessful. Upon transfer, his temperature was 100.6° F and mild jaundice was evident. Physical examination was otherwise unremarkable. The hemoglobin was 12.4 g/dl, bilirubin 4.1 mg/dl, alkaline phosphatase 250 IU/L, AST 77 IU/L and ALT 246 IU/L. Repeat ERCP revealed tissue proliferation at the ampulla. Deep cannulation of the common bile duct (CBD) was successful following a needle-knife sphincterotomy revealing a dilated CBD to 8-mm; the pancreatic duct was normal. Numerous ampullary biopsies following sphincterotomy showed atypical lymphoid cells with a follicular pattern on microscopic examination. Molecular cytogenetics identified bcl-2 and immunohistochemistry was CD 20 positive. These findings supported a follicular center cell type, grade 1 lymphoma of the ampulla of Vater. A subsequent CT scan showed duodenal thickening at the ampulla but was otherwise normal. A bone marrow examination was normal. The patient is currently undergoing chemotherapy.

This paper presents the results of one year of Home Care treatment of 77 acutely ill psychiatric patients. Home Care treatment was successful in 83.1% of 77 patients during the first year. Since only four patients failed during the second six months of treatment, hospitalization was effectively prevented, and not delayed, during the first year of treatment. Finally, a history of previous psychiatric hospitalization is not an accurate predictor of success or failure in the patients receiving Home Care treatment in this study. It appears more likely that the psychosocial supports available to the patient, and the relationship between the patient, his family and the Home Care treatment team, are more important in determining the success or failure of treatment at home.

Objective We sought to study whether uterine electromyography (EMG) can identify inefficient contractions leading to first-stage labor arrest followed by cesarean delivery in term nulliparous women with spontaneous onset of labor. Study Design EMG was recorded during spontaneous labor in 119 nulliparous women with singleton term pregnancies in cephalic position. Electrical activity of the myometrium during contractions was characterized by its power density spectrum (PDS). Results Mean PDS peak frequency in women undergoing cesarean delivery for first-stage labor arrest was significantly higher (0.55 Hz), than in women delivering vaginally without (0.49 Hz) or with (0.51 Hz) augmentation of labor (P = .001 and P = .01, respectively). Augmentation of labor increased the mean PDS frequency when comparing contractions before and after start of augmentation. This increase was only significant in women eventually delivering vaginally. Conclusion Contraction characteristics measured by uterine EMG correlate with progression of labor and are influenced by labor augmentation.

Our objective was to develop a novel approach to generate individual maps of white matter (WM) innate immune cell activation using (18)F-DPA-714 translocator protein PET and to explore the relationship between these maps and individual trajectories of worsening disability in patients with multiple sclerosis (MS). Methods: Patients with MS (n = 37), whose trajectories of worsening disability over the 2 y preceding study entry were calculated, and healthy controls (n = 19) underwent MRI and (18)F-DPA-714 PET. A threshold for significant activation of (18)F-DPA-714 binding was calculated with a voxelwise randomized permutation-based comparison between patients and controls and used to classify each WM voxel in all subjects as characterized by a significant activation of innate immune cells (DPA+) or not. Individual maps of innate immune cell activation in the WM were used to calculate the extent of activation in WM regions of interests and to classify each WM lesion as DPA-active, DPA-inactive, or unclassified. Results: Compared with the WM of healthy controls, patients with MS had a significantly higher percentage of DPA+ voxels in the normal-appearing WM (NAWM) (NAWM in patients, 24.6% ± 1.4%; WM in controls, 14.6% ± 2.0%; P < 0.001). In patients with MS, the percentage of DPA+ voxels increased significantly from the NAWM to the perilesional areas, T2 hyperintense lesions, and T1 hypointense lesions (38.1% ± 2.6%, 45.0% ± 2.6%, 51.8% ± 2.6%, respectively; P < 0.001). Among the 1,379 T2 lesions identified, 512 were defined as DPA-active and 258 as DPA-inactive. A higher number of lesions classified as DPA-active (odds ratio, 1.13; P = 0.009), a higher percentage of DPA+ voxels in the NAWM (odds ratio, 1.16; P = 0.009), and a higher percentage of DPA+ voxels in T1 spin-echo lesions (odds ratio, 1.06; P = 0.036) were significantly associated with a retrospectively more severe clinical trajectory in patients with MS. Conclusion: A more severe trajectory of disability worsening in MS is associated with innate immune cell activation inside and around WM lesions. (18)F-DPA-714 PET may provide a promising biomarker to identify patients at risk of a severe clinical trajectory.

International audience; Background:To obtain reliable clinical data of human immunodeficiency virus type 1 group O (HIV-1/O) infection, and immunovirological responses to combination antiretroviral therapy (cART), in a large series of 101 patients.Methods:Piecewise linear models were used to estimate CD4 count before and after cART initiation. Kaplan-Meier survival curves were used to estimate time to reach clinical stage C before antiretroviral therapy (ART) and to analyze time to achieve a plasma viral load (pVL)