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Objectives: Previous studies indicate that low-dose hormone replacement therapy (LD-HRT) can relieve vasomotor symptoms and prevent spine bone loss. Methods: In the present study, we evaluated the effects of a low dose of conjugated equine estrogens (CEE; 0.3 mg) associated with different progestins in continuous combined scheme [2.5 mg of medroxyprogesterone acetate (n=25), 5 mg dydrogesterone (n=27), 2.5 mg nomegestrol (n=11)] as single group, on femur bone mineral density (BMD) and bone metabolism in young postmenopausal women (≤56 years). All women were supplemented with 1 g of calcium per day, and compared with women treated with 1 g of calcium per day alone (control group, n=15). There were no significant differences in age, body mass index (BMI), hormone values, bone metabolism markers and femur BMD in the treatment and control groups before the study. Results: In calcium-treated women serum plasma osteocalcin (BGP) and hydroxyproline/creatinine urinary excretion (OHP/Cr) remained stable during all the observation period. In this group, femoral neck, Ward's triangle and trochanter BMD showed a progressive and significant (P

Objectives: To describe the effects of low dose hormonal replacement therapy (LD-HRT) on quality of life in early postmenopausal women, since the postmenopausal estrogen deprivation in mid age women often brings along a series of changes and symptoms, which may greatly affect quality of life. Methods: Fifty normal postmenopausal women were recruited and randomly treated with LD-HRT, 17β-estradiol (1 mg/day) and norethisterone acetate (0.5 mg/day) (LD-HRT) or calcium supplement (controls). No significant differences in age, age at menopause, the presence of chronic diseases and socio-economic status were present in the two groups. The Women's Health Questionnaire (WHQ), a validated quality-of-life instrument for perimenopausal and postmenopausal women, was administered at baseline and after 6 and 12 weeks of treatment in both groups. Results: At baseline no significant differences in WHQ scores were present in the two groups. In the control group the scores in all different areas showed no significant modification either after 6 and 12 weeks of observation. Conversely, the LD-HRT group showed a significant decrease in the scores of vasomotor symptoms, somatic symptoms, anxiety/fear, depressed mood and sleep problem items. No effects on memory/concentration and menstrual symptoms areas were evident. Conclusion: Although quality of life is also and may be mainly influenced by socio-economic and cultural factors, LD-HRT definitively can improve not only vasomotor symptoms, but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women.

Human milk, unlike formula feeds, contains long-chain polyunsatured fatty acids, such as docosahexaenoic acid and arachidonic acid which are essential in the development of the central nervous system. If human milk is the optimal food for brain development, and if schizophrenia is a neurodevelopment disorder, might people who become schizophrenic in adult life be less likely to have been breast-fed?To compare the incidence and length of breast-feeding in patients, siblings and normal controls and to examine the relationship between the duration of breast-feeding and age at onset of schizophrenia.113 schizophrenic patients were recruited, as were 140 siblings of the patients and 113 nonschizophrenic controls. The breast-feeding history of the patients, their siblings and controls was obtained through interviews with the mothers of the patients and controls.There were no significant differences between groups in the incidence of breast- feeding. The duration of breast-feeding was positively correlated with the age at onset of illness (r = +0.25, p0.02).Breast-feeding is no less common in those who develop schizophrenia in later life. However, breast milk might postpone the onset of the illness in schizophrenic patients.

TJ-II is a medium size stellarator under construction in Madrid, Spain, with an average major radius of R/sub 0/=1.5 m and a maximum minor radius a=0.2 m. The average toroidal field is 1 T. The pulse length varies from 0.2 s to 1 s and the duty cycle is 5 minutes. This device is capable to generate magnetic field configurations with rotational transform between 0.9 and 2.5, a shear between 1% and 10% and a magnetic well from 0 to 6%. Start of operation is expected in 1996. An RF heating power of 400 kW/53.2 GHz will be available in stage I of the experiment. Later in stage II, 2 MW NBI power will be applied. In stage III, 4 MW NBI power will be used. This paper reports on the engineering and design of the TJ-II in-vessel components as well as the pumping system. The vacuum vessel (VV) is an all-welded piece. Its groove is protected along the entire toroidal circumference against damage due to the bean-shaped plasma by 3 mm stainless steel sheets for the low and medium power operation (stage I and II) and graphite tiles for the high power operation (stage III). Furthermore, the VV is protected on the areas where the neutral beams deposit a residual shine-through heat flux. Four movable poloidal limiters will be used to limit the heat load on the groove area of the VV, especially during stage III. The limiters will be movable to adjust them to the plasma geometry. The VV will be pumped through four symmetrically spaced bottom ports to a base pressure of 10/sup -8/ mbar. Four identical and independent vacuum pumping subsystems will be used.

Application of artificial neural networks (ANN) in power factor preregulators (PFP) control is investigated. Both continuous conduction mode (CCM) and discontinuous conduction mode (DCM) converters are analyzed. At present the system gives good results for DCM in both static and dynamic conditions. For CCM good results are being obtained for static conditions. Simulation results indicate that the approach is viable and represents an alternative novel technique in PFP control. >

Tri-dimensional (3D) visualization of coronary arteries can considerably improve the diagnosis and therapeutic evaluation of the related coronary dysfunction. Reconstruction based on bi-dimensional (2D) images is a multiple solution problem. The correct solution identification is only possible using a priori information. This includes 3D and 2D aspects. In this work the authors study the influence that 2D properties can have on the reduction of the search space (possible solutions) for the right coronary case. The results obtained from real images show that selected properties (diameter correspondence, and relative position of some arteries) are very useful for the correct solution identification. Also, the modeling done is not very sensitive to the parameters involved and hence to the input data precision.

A methodology based on heart rate variability (HRV) analysis, is proposed to study ambulatory sudden death in Chagas patients who died while wearing a Holter monitor. The HRV evolution over time before death is carefully reviewed and a compressed spectral array graphic is obtained. The procedure is divided in three main parts whose technical aspects are considered here: ECG acquisition, heart rate signal generation and preprocessing, and HRV spectral analysis. >

Tridimensional (3D) visualization of coronary arteries offers an excellent way to improve the diagnostic and the therapeutical evaluation of certain pathological coronary affections. Reconstruction of 3D images based on two bidimensional projections (Image 2D) is unfortunately a multiple solution problem. Identification of the correct solution is only possible using a priori knowledge, which includes 2D and 3D aspects. In this work, using visual resources, the authors study the influence of 3D proprieties in reducing the search space (set of possible solutions). Particularly the ventricular surface generated using the coronary "arteries. Research carried out using real data (P. Windyga, Doctoral Thesis, 1994) shows that the 3D properties useful in identifying the correct solution are: arteries not crossing each other, arteries not crossing the ventricular cavity and all the arteries wrapping an elipsoidal space. The modelling used shows that with the application of these properties the authors can reduce the search space by at least 30%. Nevertheless it was realized that properties of the generated ventricular surface are sensible to the choice of the reference ventricular axis. The results obtained are highly promising and encourage further research.

The main reason for lumen reduction of the arteries is lipid accumulation in their walls. Diagnosis of this disease is possible by the application of image analysis techniques. A tridimensional representation of the coronaries (arteries that perfuse the heart muscle) is needed for their precise evaluation. The present research proposes a tool to evaluate 2D and 3D processing algorithms from angiographic images. ANIA (Angiographic Image Analyzer) is developed on a Silicon Graphics platform, in Object Oriented Programming, and represents an alternative tool for improving the study of the coronaries.

Stress electrocardiography is very important in myocardial ischaemia diagnosis and gives insight into therapeutic and preventive procedures. In this work the application of trend analysis is evaluated based on a digital processing of temporal series. Among other indicators, the ST vs. HR relation was studied in a database collected for this particular study. Preliminary results show the feasibility of using this information for a more precise interpretation of stress electrocardiograms.

Coupling of acoustical and optical modes is introduced to interpret zero-phonon lines in extended absorption spectra of ${\mathrm{Fe}}^{2+}$ in binary compounds of local symmetry ${T}_{d}.$ Both cubic II-VI (CdTe, ZnTe, ZnSe, ZnS) and cubic III-V (GaAs, InP, GaP) compounds are included in analysis and calculations. For the case of ${\mathrm{Z}\mathrm{n}\mathrm{S}:\mathrm{F}\mathrm{e}}^{2+},$ which plays an important role here, interesting experiments are reported. The interpretation of the low-temperature absorption spectra of the seven systems unfolds generalities so all observed lines, as well as the absence of some expected lines, can be identified in the same generic way. In fact, only one parameter is freely varied, which is the coupling constant to one optical mode (additional to the usual acoustical one) which is necessary to explain high-energy lines. The general and consistent explanation of several lines for seven different systems provides a complete picture which allows a deep understanding of vibronic coupling to ${\mathrm{Fe}}^{2+}$ in binary compounds. The values of coupling constants explaining the experiments are tabulated.

Perinatal asphyxia is the main cause of morbidity and mortality in the new-borns and in the infants. During delivery the risk of severe asphyxia is high not only in pre-term infants but also in those at term. A correct assistance during the first minutes of life is crucial for the outcome of the asphyxiated babies. The interventions to perform are few and quite simple but they must be performed carefully. There are some standardised steps in the correct assistance of the new-borns in the delivery room: A)--airways gentle cleaning. B)--breathing, maintain a good ventilation with manual assistance avoiding the use of oxygen. Oxygen is toxic not only for preterm infants but also for babies at term. C)--cardiac activity, check in order to maintain a good blood pressure. Permanent brain damages are related not only to the length and the severity of asphyxia but mainly to the cardiac activity and to the circulation., D)--drugs: only few drugs are seldom necessary for rescutation of the new-borns in the delivery room--beta-mimetics, Na-bicarbonate, surfactant--and they must be used carefully. The time is another critical point to prevent permanent damages, in the severe asphyxia only few minutes and for this reason it is mandatory the presence in delivery room of a person with very good experience in the newborn resuscitation.

We now have convincing data that surfactant administration in newborns with the respiratory distress syndrome (RDS) is effective in reducing the need for respiratory supports and improves the clinical outcomes. To evaluate the different strategies adopted in clinical practice for the surfactant use we performed an observational multicenter study. All newborns with gestational age (g.a.) between 24-32 wk. with RDS and that were in need of mechanical ventilation and treated with exogenous surfactant from 1994 to 1996 in twelve Neonatal Intensive Care Units have been evaluated. The patients have been divided into two groups: one includes babies that were given surfactant within the first 15 minutes of life (very early -VE- treated) and the other includes those that received the treatment at age 16- 180 minutes (early -E- treated). The analysis concerned 246 cases, 54 VE treated and 192 E treated. The two groups were comparable with regards to sex, Apgar score at one and five minutes, maternal treatment with steroids and multiple pregnancy. Mean birth weight and g.a. were significantly lower and the rate of caesarean sections was higher in the VE than in the E. Almost 80% of the VE newborns had a g.a. equal or less than 28 wks. One single dose of surfactant was administered in 77.8% of VE babies and 45.3% in the E group, while 18.5% VE and 36.8% E received two doses, 3.7% VE and 16.3% E were given three doses. The mean number of doses used per patient was 1.3 in VE and 1.7 in E. 62.5% of cases with g.a. equal to or less than 26 wks and 80.8% of those with g.a. 27-28 wk. received a single dose if VE, compared to 31.9% and 49.1% respectively if E treated. Prenatal prophylaxis of RDS with steroids, considering only the mothers that received a complete course between 48 hrs and 7 days before the delivery, did not modify the number of doses of surfactant required in both groups. The main outcomes did not differ in the two groups: mortality at 28 days of life, age at death, pneumothorax, intraventricular haemorrhage grade 3-4, retinopathy of prematurity grade 3-4, patent ductus arteriosus and oxygen dependency at 36 wks post-conceptional age.Very early surfactant administration in clinical practice reserved for newborns with the lowest g.a., improves the outcome and does not increase surfactant consumption.

Streptococcus agalactiae strains or group B streptococci (GBS) are the leading cause of bacterial pneumoniae, sepsis and meningitis in neonates. GBS is also a major cause of bacteriemia in pregnant women. Colonization of the human rectovaginal tract with GBS is a risk factor associated with chorioamnionitis and transmission of the infection to the infant. Neonatal exposure to high concentrations of GBS, mainly during vaginal delivery, leads to colonisation of the lung airways and subsequent onset of severe diseases like pneumonia, sepsis and menigitis. GBS is present in the genitourinary tract of 10% to 40% of pregnant women, about 50% of the newborns of these mothers will be colonised during delivery and of these neonates, 1% to 2% present a severe invasive disease. The early-onset disease, appear in the neonates within 7 days of life and more than 90% occur within the first day of life. Fatal infection is associated commonly with fulminat and overwhelming early-onset disease. Maternal-intrapartum chemoprophylaxis is able to prevent the transmission of GBS to the newborn and to reduce the frequency and the severity of early onset disease. In many countries, in particular in US, several recommendations have been proposed to prevent the perinatal GBS infection. In this paper some recommendations to prevent GBS disease of the newborn, performed in collaboration with Italian Society of Perinatal Medicine, are presented. The most important problem in the prevention programme is the identification of the cases to treat, since it is not possible to give antibiotics to all the women. We combine two strategies for the identification of the women to be treated, one risk based and the other screening based. Intra-partum administration of ampicillin or penicillin is recommended for the women with one or more risk-factors (labour37 weeks of gestation, duration of ruptured membranes= 18 hours, intrapartum temperature= 38 degrees C, previous infant with invasive GBS disease, diabetes) and for women with collect vaginal and rectal swab for GBS culture at 36-38 weeks' gestation, positive for GBS. No treatment is required for the babies of women intrapartum treated or with negative culture performed near term. Treatment with ampicillin is necessary, only in the new-borns of women with incomplete or unknown results or not done cultures and in those born from mothers with positive cultures, but not intrapartum treated. Collection of swabs for GBS is recommended before antibiotic administration. If the culture is negative, we suggest to stop the antibiotic therapy, otherwise the treatment must be continuated for 5-7 days. In conclusion, a written protocol for prevention of GBS infection in new-born must be adopted in every delivery centre and one possible protocol is proposed in this paper.

Infrared luminescence spectra of Fe2+ in II-VI zinc-blende structures show more than 4 unequally spaced lines. To explain such experimental features, we introduce a Jahn-Teller coupling to acoustical phonons of E symmetry. We apply and compare two independent methods: Born-Oppenheimer’s and Lanczos’. Additionally we investigate the role of higher-order corrections such as spin-spin and third-order spin-orbit contributions to accurate calculation of energy levels. Details of the emission spectra of ZnS : Fe 2+, ZnSe : Fe 2+, ZnTe : Fe 2+, and CdTe : Fe 2+ are explained as due to a weak Jahn-Teller coupling which is enhanced when the energy of the coupling phonon is close to the spacing between electronic levels of appropriate symmetry.

A detailed treatment of the ground vibronic states in the linear T⊗(e+t 2 ) Jahn-Teller problem is presented. It is found that there is a parameter range for which the ground vibronic state is nondegenerate. This result has general significance for all Jahn-Teller problems.

The world's largest pulsed superconducting coil was successfully tested by charging up to 13 T and 46 kA with a stored energy of 640 MJ. The ITER central solenoid (CS) model coil and CS insert coil were developed and fabricated through an international collaboration, and their cooldown and charging tests were successfully carried out by international test and operation teams. In pulsed charging tests, where the original goal was 0.4 T/s up to 13 T, the CS model coil and the CS insert coil achieved ramp rates to 13 T of 0.6 T/s and 1.2 T/s, respectively. In addition, the CS insert coil was charged and discharged 10 003 times in the 13 T background field of the CS model coil and no degradation of the operational temperature margin directly coming from this cyclic operation was observed. These test results fulfilled all the goals of CS model coil development by confirming the validity of the engineering design and demonstrating that the ITER coils can now be constructed with confidence.

The tensile and fracture toughness properties of heavy section plates (90mm thick), and forgings (100–250 mm thick, 1–66 ton), a 1 ton casting and welded Type 316LN steel commercial products have been determined at 7 and 4.2 K with respect to the application of these structural materials for the ITER Toroidal Field Model Coil (TFMC) and for the most critical parts of the full size ITER TF coil casing. The homogeneity of the material properties and the influence of defects were investigated by testing tensile (4 and 22 mm gauge diameter) and fracture toughness (standard CT and 6 mm diameter EDM notched bar) specimens machined in all three spatial orientations. For the weldments, several commercially available filler materials and weld procedures (GTAW-HW, SAW, GMAW, SMAW, LBW, and EBW) were evaluated with the aim of establishing the most economical and industrially feasible process combined with optimum material properties. In addition, data are presented on the fatigue crack growth rates at 7 K and R-values of 0.1 and 0.4 for Incoloy 908 candidate jacket material for the ITER central solenoid model coil. The structures of the steel products are not described in this paper.

Three different and independent methods are used to find eigenfunctions and eigenvalues for a linear Jahn-Teller Hamiltonian. They are the following: diagonalization on a Born-Oppenheimer basis developed in the adiabatic limit, diagonalization on a Glauber states basis developed in the strong-coupling limit, and construction of the eigenfunctions by means of the Lanczos method. We explore the space of interactions aiming at the intermediate-coupling limit, finding the regions of best convergence for each method. Comparison among the three methods in terms of their numerical results for energy and expected optical transitions leads to regions of total and partial agreement. Conditions for several zero-phonon lines are discussed. The dominant line is not always the threshold line and it is determined by a nontrivial balance involving all interactions. Conclusions are focused toward finding reliable methods for the different regions of the parameter space. Preparation is done for applications of this approach to explaining optical spectra of magnetic impurities in crystals under different coupling regimes.

Fifty-two sporadic primary non-small-cell lung carcinomas (NSCLC) were examined for microsatellite instability. Six different microsatellite markers localized on chromosomes 2, 5, 8, 10, 11 and 17 were used. Genomic instability was observed in 35% (18/52) of NSCLC at single or multiple loci. The tumors were also analyzed for p53-gene mutations by PCR-SSCP analysis. Polynucleotide stretch frameshift mutations of TGFbetaRII (transforming-growth-factor-beta receptor II), IGFIIR (insuline growth-factor II receptor) and BAX genes were also analyzed. RER+ (replication-error-positive) tumors appear not to be affected by a higher rate of point mutations in coding sequences: no correlation was found between microsatellite instability and point mutations in the p53 gene, and the RER+ tumors showed no alterations in stretches of nucleotide inside TGFbetaRII, BAX or IGFIIR.

Bronchioloalveolar carcinoma (BAC) is a particular type of adenocarcinoma of the lung which accounts for up to 9 per cent of pulmonary malignancies. The aetiology and pathogenesis of this unique neoplastic disease are still unclear. Three histological subtypes of BAC have been recognized: mucinous, non-mucinous, and sclerosing. Of these, mucinous and sclerosing BAC have a worse prognosis than non-mucinous tumours. The different morphological patterns and clinical outcomes of the subtypes of BAC suggest differences in their biological behaviour. Previous reports have shown that the mucinous form of BAC is characterized by constant mutations at codon 12 of the K-ras gene, whereas the other two histotypes show a frequency of K-ras mutations which is not different from that observed in conventional lung adenocarcinomas. The present study of a series of 51 BACs, previously investigated for K-ras gene mutations, has evaluated the status of two other genes, p53 and FHIT, known to be frequently altered in non-small cell lung cancer. Loss of heterozygosity at microsatellite-containing loci located within the FHIT gene was observed in 22 (43 per cent) BACs. The distribution of FHIT gene abnormalities was not statistically different in the three histological subtypes. p53 mutations were present in 13 (32 per cent) non-mucinous/sclerosing BACs, while no mutations were seen in mucinous tumours (P = 0.039). Correlations with clinicopathological parameters showed that p53 mutations in BACs are associated with more aggressive tumours. No correlations were observed between FHIT or K-ras gene abnormalities and clinicopathological data. In conclusion, these results indicate that FHIT alterations are frequently involved in BAC tumourigenesis and that genetic changes in the p53 and K-ras genes can distinguish between different histotypes of BAC.

Background: Diagnostic laparoscopy has been used in abdominal trauma patients, although its role is not well defined. The safety of laparoscopic evaluation in trauma patients with severe intraabdominal hemorrhage has not yet been analyzed. The purpose of this study is to evaluate the hemodynamic and metabolic effects of CO2 pneumoperitoneum (COI) in hemorrhaged animals through a retroperitoneal hematoma (RH). Methods: Twenty-two 15–20-kg mongrel dogs were monitored for systemic and pulmonary hemodynamics, inferior vena cava pressure, and arterial blood gases. After 1 h of baseline, all animals were submitted to a RH. After 45 min the dogs were randomized into two groups. Control (CTR): dogs were submitted only to a RH; pneumoperitoneum (PN): dogs were submitted to a RH and 45 min later they were insufflated to an intraabdominal pressure of 10 mmHg with medical-grade CO2 gas for 30 min. Echocardiography was performed, only in PN animals, at baseline, 45 and 60 min after RH. Results: RH induced a shock condition with low, sustained levels of arterial pressure, cardiac index, left ventricular stroke index, base excess, and oxygen delivery which were further depressed following COI. Three deaths occurred in the PN group, all of them toward the end of COI. During COI, hypercapnia was observed in one animal. COI did not impair systolic function or ejection fraction. Conclusions: COI with an IAP of 10 mmHg may be deleterious in animals with hemorrhagic shock due to an intraabdominal lesion. These findings could be clinically significant in abdominal trauma patients.

nm23 gene expression is strictly related to the state of cell growth. The level of its expression parallels the fraction of thymidine-incorporating cells (S-phase cells) in neoplastic mammary tissues and in the synchronously cycling fraction of MCF 1OA cells. nm23.h1 reaches a peak of expression in the S-phase, and is present at very low level during the GO/G1 phase. Two strategies are used to demonstrate the direct involvement of the nm23.h1 gene in the process of cell proliferation. The first consists of transient inhibition of nm23.h1 expression by using anti-sense oligonucleotide treatment; weak inhibitory effect on cell proliferation is observed. The second strategy involves the stable inhibition of nm23.h1 expression by transfection of MCF1OA cells with a plasmid vector expressing the human nm23.h1 anti-sense mRNA. The anti-sense-transfected cells show consistently slower proliferative activity than the control.

The authors retrospectively review 22 patients with irresectable esophageal cancer in whom an isoperistaltic substernal gastric esophagogastric bypass was performed.After the operation eighteen patients (82%) regained normal swallowing. Seven patients developed anastomotic stenosis that was successfully treated in six by surgery or endoscopic dilatation. Two patients evolved with cervical fistulae until their death. As a whole, there was a statistically significant improvement in swallowing capability (p = 0.0352). Seventeen patients (77%) had postoperative complications, the most common being cervical fistulae (in 13.59%), pneumonia (in 10.45%) and anastomotic stenosis (in 7.32%). Postoperative morbidity was significantly associated with preoperative diseases and ASA class III (p0.05). There were three postoperative deaths (14%). Postoperative mortality was significantly related to severe malnutrition and preoperative associated disease (p0.05).The conclusion is that the procedure has acceptable morbidity and mortality for the population under consideration, permitting palliation of dysphagia in the majority of cases.

Vascular endothelial growth factor (VEGF) plays a pivotal role in the development of neovascularization in both physiological and pathological processes, e.g., developmental and reproductive angiogenesis, proliferative retinopathies, and cancers. Several solid tumors produce ample amounts of VEGF, which stimulates proliferation and migration of endothelial cells, thereby inducing neovascularization by a paracrine mechanism. Recently, VEGF expression has been shown to significantly affect the prognosis of different kinds of human cancer. Because neoangiogenesis represents an important prognostic indicator of poor prognosis in non-small cell lung cancer (NSCLC), we investigated the influence of VEGF during progression of this type of cancer and its relationship to tumoral neovascularization. VEGF expression was significantly associated with new vessel formation (r = 0.44; P0.0001). Moreover, in univariate analysis, VEGF expression significantly affected overall and disease-free survival (P = 0.00003 and P = 0. 0004, respectively). Backward stepwise regression analysis indicated that VEGF expression was an independent prognostic factor in patients with NSCLC. These findings support the hypothesis that VEGF is an important angiogenic factor in primary NSCLC and may help in predicting the outcome of this group of cancers.

The status of the P16 gene was investigated by Southern blot, polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP), and DNA sequencing analyses in 30 primary resected non-small cell lung carcinomas (NSCLCs) with metastatic involvement of thoracic lymph nodes and 33 NSCLCs without node metastases. Direct sequencing of tumour DNA samples scored positive by PCR-SSCP showed five somatic mutations of the P16 gene: four nonsense and one frameshift. The Southern blot analysis revealed the presence of a homozygous deletion of the P16 locus in one tumour. All of the six NSCLCs with somatic aberrations of the P16 gene belonged to the series of tumours with metastatic diffusion to thoracic lymph nodes. In each of these six cases, the genetic aberration was seen in both the primary tumour and the node metastasis. No P16 alteration was found in tumours without metastatic lymph nodes. This difference was statistically significant (P = 0.02). No correlation was present between P16 alterations and other clinicopathological parameters including age of patients, tumour size, histological type, and grade. In three tumours with genetic aberration of P16, there was a concomitant alteration of the p53 gene. Our results indicate that the P16 gene is infrequently mutated (10 per cent of the cases examined) in primary resected NSCLC. However, since P16 mutations were found only in metastatic tumours, they may be important events in late phases of tumour progression and could represent useful markers of tumour aggressiveness in NSCLC.

In this study the results of two different initial doses (Group A: 200 mg/kg--82 patients; Group B: 100 mg/kg--83 patients) of a porcine surfactant were compared in the treatment of neonatal respiratory distress syndrome. Main entry criteria were: birth weight between 700 and 2,000 grams, need of mechanical ventilation, FiO2or = 0.60 to obtain a PaO2 between 50 and 80 mmHg (PaO2/FiO2or = 133.3 mmHg) and less than 15 hours of postnatal age. Two further 100 mg/kg doses could be given in both groups at 12 hours interval if FiO2 was0.40. Birth weight (Group A: 1,231 +/- 281 g. and Group B: 1,324 +/- 355 g.), gestational age (Group A: 29.9 +/- 2.7 wk. and Group B: 30.6 +/- 2.6 wk.) and Apgar scores were similar in the two groups. Group A had a significantly higher mean PaO2/FiO2 ratio (p0.05) after 12 hours--178 (40-506) vs 133 (17-243) mmHg, before receiving a 2nd dose, after 24 hours--180 (17-431) vs 152 (39-360), and in the 3rd day--177 (40-333) vs 124 (24-249) and needed a lower FiO2 (p0.05) after 36 hours (0.47 +/- 0.20 vs 0.53 +/- 0.23) and on the 3rd day (0.51 +/- 0.23 vs 0.61 +/- 0.24). The mean peak inspiratory pressure was lower in Group A at 36 hours (17.5 +/- 4.5 vs 20.6 +/- 6.8) after the initial dose (p0.05). The time of exposure to high oxygen concentrations (FiO2or = 0.40) was lower in Group A--85 (3-643) vs 131 (3-672) hours; p0.05). Total amount of phospholipids given per patient was meanly 224 mg in Group A and 144 mg in Group B. Mortality was lower in group A but without significant difference (Group A: 17/82; Group B: 26/83). The analysis of the subgroup of babies with less than 1,500 gr. at birth showed a statistically significant difference in mortality (Group A: 15/70; Group B: 24/56; p0.02).

In the framework of the activities for the CS Model Coil of ITER, the European Union (EU) is in charge of providing 6.5t of bronze Nb3Sn strand, cabling for 798m of MCI and 396m of MC2 cables and final conductor manufacture (jacketing and compaction) for all the conductor lengths of the CS Model Coil, for a total of 5787m. The related industrial activities are in progress. This paper describes in some details the manufacturing experience gained in EU and the present status.

Several studies have documented a relevant prognostic role of microvessel count (MC) in non-small-cell lung carcinomas (NSCLC). However, no evidence has been reported about the involvement of neo-angiogenesis in the development of bronchial cancers. The aim of this study was to analyze microvessel density both in normal and in pathological features of the bronchial tree detected concomitantly with carcinomas. In a group of 34 patients resected for NSCLC, 48 bronchial lesions (hyperplasia, squamous metaplasia, moderate dysplasia and in situ carcinoma) were identified. In addition, 20 samples of normal bronchial epithelium from the same patients were analyzed. A monoclonal antibody was used in order to identify microvessels in the most intense areas of neovascularization from the bronchial specimens. MC was also analyzed in invasive components. An increased number of microvessels was observed from normal to dysplastic epithelium, including in situ carcinoma. Mean MC was significantly lower in normal, hyperplastic and squamous metaplastic epithelium than in dysplastic epithelium and in situ carcinoma. In particular, no differences were observed between normal and hyperplastic/metaplastic components, whereas a statistically significant difference appeared between the latter and dysplastic lesions. Moderate dysplasia and in situ carcinoma showed a number of microvessels in the lamina propria of their mucosa which were not significantly different from the invasive component, whereas hyperplastic/metaplastic lesions presented a much lower number of microvessels than invasive cancer. From these data it appears that normal bronchial epithelium and lesions associated with cancers of the bronchial tree show neovascularization in their stromal component. Hyperplasia and squamous metaplasia, unlike dysplasia and in situ carcinoma, show a low microvessel count, and they cannot represent precursor or incipient changes in the bronchial epithelium before the fully developed in situ stage has also been reached.

The paper describes an approach to intelligent ischaemia event detection based on ECG ST-T segment analysis. ST-T trends are processed by means of a Bayesian forecasting approach using the multistate Kalman filter. A complete procedure, intended for use in CCU/ICU monitoring areas, is proposed, in order to give the clinician an intelligent monitoring tool. The approach serves to describe trends and their changes in a symbolic way. A novel aspect is its ability to observe certain features of ST-T elevation/depression not detected by other means, and to reject artefacts and erroneous events. A sensitivity of 89.58% and a predictivity of 84.31% are obtained on selected records of the European ST-T database. Using a restriction on event amplitude, the predictivity is raised to 95.55%. An ischaemia sensitivity index of 1.2 was determined. The method has been shown to be a robust and practical trend analysis tool, and seems to be appropriate for numeric/symbolic transformations in next-generation intelligent monitoring systems.

TJ-II 1 is a medium size stellarator under construction in Madrid, Spain. Its major plasma radius is 1.5 m and its minor plasma dimensions are 0.2m by 0.4m. The toroidal magnetic field on the axis is IT. The bean shaped helical plasma is contained in a stainless steel vacuum vessel 2 with a total of 96 ports, including 8 manholes to have access to its interior. The vacuum vessel will be baked at 150 °C. Its complicated geometry along with the high tolerance requirements make this component a difficult manufacturing challenge.

Risk factors for respiratory distress syndrome (RDS) in the newborn have been evaluated using data from a large survey conducted between 1980 and 1989 in selected periods in eleven perinatal units placed in five Italian regions. A total of 1624 liveborn infants consecutively delivered at the collaborating centers, at delivery 26-37 weeks gestational age and without clinically evident congenital anomalies were included in the survey. All the newborns were followed up to the 28th day of life. A total of 131 newborns (7.8%) developed RDS. Overall 1st-7th and 1st-28th day of life infant mortality rates were 54.8 and 61.6/1,000 livebirths; the corresponding rates in babies who developed RDS were 419.8 and 465.6/1,000 livebirths. The frequency of RDS was higher in males than in females and the corresponding relative risk, RR, was 0.7, with 95% confidence interval, CI, ranging from 0.5 to 0.9. The risk of RDS markedly increased with decreasing birth weight: compared to babies weighing more than 2500 g at birth the RR estimates were respectively 1.4, 4.5, 8.8 and 39.3 in those weighing2000-2500 g,1500-2000 g,1000-1500 g and 1000 g or less. Likewise, compared to babies born between the 35th and the 37th week of gestation, the RR of RDS was 3.3 and 21.5 in those born between the 31st-34th or before the 31st week of gestation. Multiple pregnancy, gestational or chronic diabetes, pregnancy-induced or chronic hypertension and premature rupture of the membranes were not related to the risk of RDS.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a case of malignant gastric leiomyoblastoma (epithelioid leiomyosarcoma) which was mistaken for a pseudocyst of the pancreas. The patient was operated several times in another hospital. At one of the operations a cystogastrostomy was performed. In november, 1989, when operated again by us, a large tumoral mass arising from the posterior gastric wall was found. The histopathological diagnosis was leiomyoblastoma of the stomach. It is concluded that the wall of a pancreatic cystic lesion should always be submitted to histologic examination in order to be excluded the possibility of a malignant neoplasm.

The various problems encountered during the design and the construction phases of the TCV vacuum vessel are described. The difficulties related to the large forces on the all-welded continuous vessel and the design of the gas heating system are shown. In addition, the development and testing of modified Conflat vacuum flanges withstanding high temperature thermal cycling is reported. Finally the specific problems encountered during the manufacturing of the vessel are underlined.

A randomized trial comparing outcome of babies treated with a natural surfactant (Curosurf) for moderately severe respiratory distress syndrome (RDS) with corresponding data from babies treated at a more advanced stage of the disease is reported. A total of 182 newborn babies (mean gestational age 29.8 weeks) requiring mechanical ventilation and a fraction of inspired oxygen (FiO2) in the range of 0.40-0.59 for RDS were randomized to immediate ("early") treatment (No = 86) with surfactant (200 mg/kg), or to a control group (No = 96). According to the protocol 49 controls (51%) qualified for a "late" surfactant treatment at an FiO2 requirement ofor = 0.60. In both groups of treated patients administration of surfactant led to a rapid improvement of oxygenation, but the peak value for PaO2 and the variability of the response tended to be lower in babies given immediate treatment. In comparison with the total control group, babies treated immediately had lower incidence of grade III-IV intraventricular hemorrhage (7% vs 18%; p0.05), lower mortality (9% vs 23%; p0.05), and lower incidence of unfavourable outcome--defined as death or bronchopulmonary dysplasia--(18% vs 34%; p0.05) at 28 days. Also significant reductions of time in oxygen21% and time on mechanical ventilation were observed. Our data suggest that treatment with surfactant when RDS is moderately severe prevents or reverses the natural progression of the disease in at least 50% of the cases and lowers the risk of serious complications.

The vacuum vessel (VV) is one of the most critical components of the TJ-II1. The VV is designed to provide the maximum reasonable volume inside the toroidal field (TF) coils. Furthermore the hard core (CC/HX) coil2, which is the other critical component of this machine, remains outside the VV in order to facilitate assembly, accessibility and maintenance.

The authors report on a study conducted to analyze the professional situation of physicians residing in the State of São Paulo, Brazil, five years after completion of a medical residency program. At least 50% of the professionals were interviewed in each specialty. A heavy work load was observed in physicians working both in the metropolitan area of the State capital and in other regions of the State. Male doctors had a higher income than female ones. The latter, however, had a higher proportion working in a single specialty, although 16.8% did not practice in the specialty in which they were trained. The most frequent working environment was a hospital, followed by an ambulatory facility and a private office. The metropolitan area physicians exceeded the remaining in teaching activities and public hospital appointments. They had also a higher tendency to work in a different specialty. This study offers significant information with respect to professional decisions as well as regarding the creation or expansion of residency programs.

A young female patient had a recurrence of severe spherocytic anemia there years after having been submitted to splenectomy. The presence of two accessory spleens with a size of 3.5 cm and 4.0 cm, was demonstrated by technetium scanning and ultrasound images. Surgical removal of these noduli resulted again in prompt recovery. The development of the spleen beings in the fifth week of intrauterine life at the dorsal mesogastrium. The lack of fusion of splenic lobuli is responsible for the occurrence of accessory spleens. A surgeon performing splenectomy for the treatment of hemolytic anemia should always search for possible existences of accessory spleens.

Between January 1988 and June 1990, seven previously untreated patients with histologically confirmed and clinically staged IIIa invasive thymoma (IT) were enrolled in a prospective, single treatment arm study of neoadjuvant chemotherapy (NC) followed by surgery and postoperative radiation therapy (4600 to 6000 cGy). The NC included three cycles of cisplatin (75 mg/m2 on day 1), epirubicin (100 mg/m2 on day 1), and etoposide (120 mg/m2 on days 1, 3, and 5), every 3 weeks. All patients showed a partial response (greater than 50%) and underwent complete (n = 4) or incomplete (gross [n = 1] or microscopic [n = 2] residual tumor) surgical resection. Histologic examination was negative for two completely resected patients. Projected 2-year survival was 80%; all patients but one currently are alive and disease-free. This approach appeared to be feasible and may be a new therapeutic choice in the management of IT, but its use on a regular basis should be reserved until a larger number of patients and longer follow-up are available.

One of the most critical components of the TJ-II heliac device is the vacuum vessel (VV). The considerable effort expended in optimizing its design resulted in a modular structure surrounding the central conductor coils (CC/HX). This solution allows a high grade of geometric accuracy and reliability and enables the best surface treatments for ultra high vacuum.

Since 1984 a European multicentre trial (EMCT) on the use of a natural surfactant extracted from minced porcine lungs (Curosurf) in the treatment of neonatal RDS has been in progress. In the first phase of the study, finished in 1987, the effectiveness of a single dose of Curosurf (200 mg kg−1) in improving clinical conditions and short-term outcome of newborn infants suffering from severe RDS (on intermittent positive pressure ventilation (IPPV) with FiO2≥0.6) was demonstrated [1]. The most obvious and immediate effect was observed on alveolar gas exchange, as documented by a rapid and marked increase in the value of PaO2/FiO2 ratio, which was significantly higher in treated versus control infants just 5 min after surfactant administration. This difference remained until 48 h after randomization. Besides mortality, frequency of pulmonary interstitial emphysema (PIE) and pneumothorax (PTX) was significantly lower in the treated infants than in the control babies. Duration of mechanical ventilation and frequency of bronchopulmonary dysplasia (BPD) was lower in the treated newborns, too, though the difference was not significant [1].

Study of pulmonary function is of fundamental importance in the newborn infant with respiratory failure.

The scope of this paper is to identify the critical issues related to the development of all the protective elements for the TJ-II vacuum vessel. The design studies include an analysis of the heat deposition patterns in different plasma configurations, transient thermal analyses during the heating and cooling phases and finite element structural analyses. Results show that the shield can properly withstand the predicted loads even without active cooling. Original engineering solutions are presented for the shields locking system and for the graphite tiles bonding technique.

The authors review the cases of traumatic rectal injuries admitted to the Emergency Service of the "Hospital das Clínicas", University of São Paulo Medical School, during the period of July 1981 to July 1988. Forty-five patients (62.5%) had their injuries due to gunshot, 14 (19.4%) due to foreign bodies on the rectum, 10 (13.8%) due to blunt trauma and 3 (4.1%) due to stab wounds. The intraperitoneal rectum was injured in 32 patients (44.4%) and extraperitoneal portion of the rectum in 40 patients (55.5%). On the intraperitoneal injuries the management adopted were simple suture (14 patients), associated with a colostomy (17 patients) and in one patient the Hartmann procedure was adopted. On the extraperitoneal wounds the management adopted were rectal repair (when feasible), colostomy, distal washout and drainage. The complications rate was 27.8%, and from them, the majority (70%) were related to infectious nature. Seven patients died (9.7%), four of them as a consequence of sepsis. The morbidity and mortality of the rectal injuries were closed related to infectious complications as a consequence of late diagnosis. For this reason, the authors consider that all efforts should be employed to establish the prompt diagnosis.