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Matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) is a sensitive mass spectrometric technique which utilises acidic materials as matrices for laser energy absorption, desorption and ionisation of analytes. These matrix materials produce background signals particularly in the low-mass range and make the detection and identification of small molecules difficult and nearly impossible. To overcome this problem this paper introduces matrix-free material-enhanced laser desorption/ionisation mass spectrometry (mf-MELDI-MS) for the screening and analysis of small molecules such as carbohydrates. For this purpose, 4,4'-azo-dianiline was immobilised on silica gel enabling the absorption of laser energy sufficient for successful desorption and ionisation of low molecular weight compounds. The particle and pore sizes, the solvent system for suspension and the sample preparation procedures have been optimised. The newly synthesised MELDI material delivered excellent spectra with regard to signal-to-noise ratio and detection sensitivity. Finally, wheat straw degradation products and Salix alba L. plant extracts were analysed proving the high performance and excellent behaviour of the introduced material.

(R)-Harmonine was synthesised in 15 % overall yield via a six-step sequence exploiting a Z-selective cross-metathesis reaction as its centrepiece. By this strategy, the cis-olefin present in the target could be installed exclusively. The use of an alcohol and an ester as the amine precursors was crucial for isolating the cross-metathesis product from the self-metathesis products. This method was also used to prepare two novel analogues of harmonine.

To compare executive functions (EF) in non-demented mild to moderate Parkinson's disease (PD) (Hoehn and Yahror =3) and pure degenerative cerebellar disease (CD) in order to evaluate the relative contribution and differential role of basal ganglia and cerebellum in those functions.14 patients with PD and 14 patients with CD matched by sex, education, disease's duration and MMSE were selected. A standardized neuropsychological battery and the Wisconsin Card Sorting Test (WCST) were administered. Z scores were compared for both groups through t-test for independent samples were used.The cerebellar group showed significant lower performance in measures of attention and EF, with a significant increase in both perseverative and non perseverative errors during the WCST. On the other hand the PD group showed a selective increase of non perseverative errors, without reaching significant between group difference.The CD group appears to have greater deficits in EF with a pattern of prefrontal dysfunction.

To investigate whether the cerebellum could participate in social cognition (SC).General neuropsychological tests, executive tests (EF), social cognition tests, which assess the ability to infer other peoples mental states, and the Beck Depression Inventory were given to 10 non-demented patients with isolated cerebellar degenerative disease, and to 10 healthy controls matched for sex, age, and years of education. ANOVA and correlation coefficients were employed for the statistical analysis.Patients within the cerebellar group were significantly impaired (por=0.05) in EF test [Wisconsin Card Sorting Test (WSCT)] and belief questions (BQ) from Theory of Mind (ToM) tests. Performance in control questions (CQ) from ToM tests was similar for both groups. Lower scores in BQ correlated with a lower conceptual ability, the severity of apathy (NPI) and static ataxia. CQ correlated with measures of attention and free recall.The cerebellum may contribute in the control of social behavior through the processing of multimodal data, motor, cognitive and emotional.

Objective Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for atrial arrhythmia. A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of steroids on the occurrence of atrial fibrillation after elective coronary artery bypass grafting. Methods Eighty-eight consecutive patients were prospectively entered in this study. No patient had documented or suspected arrhythmias before surgery. Forty-three patients received 1 g of methylprednisolone before surgery and 4 mg of dexamethasone every 6 hours for 1 day after surgery, and 43 patients received only placebo. The primary end point was the overall occurrence of postoperative atrial fibrillation. Results Postoperative atrial fibrillation occurred in 9 (21%) of the 43 patients in the steroid group, as compared with 22 (51%) of the 43 patients in the placebo group ( P = .003). Minor postoperative complications occurred in 15 steroid patients (35%) and in 6 patients (14%) receiving placebo ( P = .01). Major complications occurred in 4 patients who received steroids (9%) and in 2 patients (5%) who received placebo ( P = .68; for all complications, P = .05). Conclusions Prophylactic short-term steroid administration in patients undergoing coronary artery bypass grafting significantly reduced postoperative atrial fibrillation. In this study, there was no significant difference between the steroid group and the placebo group with regard to the length of hospital stay; however, the steroid group had more complications, which may contribute to prolonged hospitalization.

The cerebellum has been traditionally associated with motor control learning and performance. However, since 1970 a growing body of clinical and experimental evidences has suggested that the cerebellum may be involved in nonmotor cognitive functions as well.To explore the presence of eventual cognitive impairment in non-demented patients with isolated degenerative cerebellar diseases.Twelve patients with the diagnosis of selective degenerative cerebellar disorders, either inherited or sporadic, were selected (mean age: 40.42 +/- 13.49 years; mean education level: 9.92 +/- 3.99 years; duration of illness: 12.13 +/- 11.27 years, MMSE: 26.75 +/- 1.5) and evaluated through a standardized neuropsychological tests battery. Normalized Z scores were estimated and compared against 0, employing the t test for one sample.Significant cognitive deficits were found in the following domains: executive, visuo-spatial, memory and attention functions. Performance on the Wisconsin test showed a significative number of perseverative errors. Memory deficits included verbal learning and free recall difficulties, with good recognition of the material presented.The findings of this study are consistent with the role of the cerebellum as modulator of mental functions. The cognitive deficits resulting from cerebellar pathology may be related with the disruption of cerebello-cortical connexions involving a complex network which includes the prefrontal region, suggesting that the cerebellum may process cortical information coming from different areas linked with the control of cognition.

The findings of this single-center experience with the Medtronic Mosaic porcine bioprosthesis were evaluated to determine the clinical performance of the valve.Between 1994 and 2000, a total of 657 patients was implanted with the prosthesis. Aortic valve replacement (AVR) was performed in 415 patients (mean age 70.5+/-10.7 years; range: 26-89 years) and mitral valve replacement (MVR) in 242 patients (mean age 70.5+/-9.5 years; range: 19-86 years). Concomitant coronary artery bypass (CAB) was performed in 51.1% and 46.7% of AVR and MVR patients, respectively. The majority of patients were aged over 70 years (59.8% AVR, 58.7% MVR).Survival at six years was 73.0+/-2.4% after AVR, and 74.0+/-5% after MVR (p = NS). Actual freedom from valve-related mortality at six years was 98+/-1% for AVR and 96+/-1% for MVR; freedom from overall thromboembolism (TE) was 86+/-3% for AVR and 89+/-2% for MVR. After AVR, 42 thromboembolic events occurred in 39 patients (23 minor; 14 major; three reversible ischemic neurologic deficits (RIND); two thrombosis). After AVR, the late TE rate was 2.1% per pt-yr, and the major rate 0.6% per pt-yr (exclusive of thrombosis). The overall TE rate after AVR was 2.9% per pt-yr (major rate 1% per pt-yr). After MVR, 25 events occurred in 24 patients (10 minor; eight major; five RIND; two thrombosis). After MVR, the late TE rate was 2.6% per pt-yr, and the major rate 0.7% per pt-yr (exclusive of thrombosis). The overall TE rate after MVR was 3.5% per pt-yr (major rate 1.1% per pt-yr). There were four cases of structural valve deterioration (SVD) (two each after AVR and MVR). Reoperation was performed in three of four cases of thrombosis, and in two of four cases of SVD.The Medtronic Mosaic porcine bioprosthesis is safe and effective. The rate of SVD after six years was low, being zero in the aortic position of patients aged60 years, and zero also in the mitral position of patients aged60 years. The incidence of early and late thromboembolism was contributed to by the advanced age of the patient population.

With the recent realization of the extent to which adolescents are committing sexual offenses, researchers have attempted to identify valid and reliable assessment instruments for this population. Some such assessment instruments (i.e., plethysmography, self-report) have met with criticism relative to their utility with juvenile offenders. The present study aimed to assess the validity of the Abel Assessment for sexual interest™(AASI) with male adolescents who have molested children. Results indicated that the amount of time male adolescent child molesters viewed slides of children was significantly longer than nonmolesters. Additionally, viewing time of slides of children for male adolescent child molesters was significantly correlated with their number of victims and the number of times they carried out acts of child molestation. These results support the AASI as a valid measure of sexual interest in adolescent male child molesters.

Background— There are no randomized trials comparing outcomes after mitral valve (MV) repair and replacement. Propensity scoring is a powerful tool that has the potential to reduce selection bias in nonrandomized studies. Methods— From the BC Cardiac Registries, 2 060 patients presented for MV surgery, with or without CABG between 1991 and 2000. We then identified 322 MV repairs who were then matched by propensity score to an equal number of MV replacement patients. We compared survival and freedom from re-operation outcomes using Cox proportional hazards model analysis. Multivariable analysis was then used to compare outcomes in 358 MV repair patients with 352 MV replacement patients who had undergone chordal sparing surgery. Results— The comparison groups generated using propensity scores were well balanced with respect to all collected baseline risk factors. Median follow-up time was 3.4 years. Patients undergoing MV repair had significantly improved survival (RR 0.46; 95% CI, 0.28 to 0.75) but a trend toward more re-operations (RR 2.11; 95% CI, 1.00 to 4.47) compared with patients undergoing replacement. Mitral valve repair patients still had better survival (RR 0.52; 95% CI, 0.32 to 0.85) compared with MV replacement patients who had undergone chordal sparing surgery. Conclusion— We used propensity score methods to reduce selection bias in a population-based cohort of patients undergoing MV repair/replacement. Repair was associated with better survival, but a trend to increased re-operation.

Mission critical requirements of a low-cost recoverable unmanned-underwater vehicle (UUV) include range, stealth and maneuverability. In response to this shortlist of requirements, a thermal energy source can be used to power a UUV for medium length missions and with low acoustic emissions. A number of these systems have been under study at Honeywell. Showing promise is a system consisting of an electrically heated ceramic matrix block which powers an argon charged closed Brayton cycle (CBC) engine. BACKGROUND Torpedoes and other unmanned underwater vehicles have been powered by a number of means, the more popular choices being monopropellant fueled Otto cycle engines and battery powered electric motors. Crucial to the control and stealth of these vehicles are issues of range, speed, exhaust gases, operating noise, mass and buoyancy, center-of-gravity migration, depth sensitivity, logistics, handling safety, and reusability. In order to deal with these issues, a new technology is examined which offers superior stealth when compared to Otto engines (conventional torpedo), and has superior range when compared to a battery system. For a point design, the 21 inch diameter reusable LMRS vehicle was chosen along with its low mission speed of 8 knots. For the engine, a closed-cycle turbocompressor was chosen. Heat for the engine is provided by a heated thermal block. Heat is rejected through the skin of the UUV to the ambient seawater. The turbine drives an alternator, which in turn drives an electric motor driven propulsor. A schematic of the UUV is shown below. This system deals well with the above issues in that it offers constant mass and buoyancy, is depth insensitive, its only physical emission is heated seawater, it has no harmful chemicals, and it has limited moving parts (minimized vibration sources and reliability risks). • Senior Principal Engineer, Honeywell Aerospace, ESS, Tempe, AZ Heat Storage Engine Figure 1. UUV with Thermal Engine Before narrowing the cycle selection down to a specific form, general features of a closed-cycle turbine engine fitted into a UUV are described. The fluid, whether singleor two-phase, is sealed in. The only external connections for the engine are electrical. Power from the turbine is routed through an alternator, an electrical converter, a brushless dc motor, and finally to the propulsor. The alternator is cooled by the working fluid. The thermal mass is heated by “induction furnace” style heater coils prior to launch. The field from these coils remotely heats the conductive thermal mass (via eddy-currents). These coils are cooled by seawater passing through convection ports on the top and bottom of the UUV skin. The thermal mass is well insulated in order to provide extended standby time, but must be heated in advance of the UUV mission. The engine has minimal moving parts. These consist of the turbo-compressor rotating group, a mixing valve, a shutoff valve, and a check valve. Power is enabled and modulated via the shutoff valve, or a fluid inventory control. A passive mixing valve is required to temper the extremely hot fluid leaving the thermal mass, down to a moderate temperature – for use by the turbine, by mixing in unheated fluid. DISCUSSION In order to compare and contrast the value of the argon charged Brayton cycle, an H2O Rankine cycle is first examined. The Rankine cycle involves gaseous and liquid H2O and utilizes a positive displacement pump and a gas turbine. The cycle components also include the heater and a skin cooled condenser. Thermal Mass Heater Pressure Compensated Pump accumulator

The study aim was to characterize changes in mitral valve area and flow, and left ventricular (LV) size and function, following edge-to-edge (E-E) repair for severe functional mitral regurgitation (MR). The possibility that preoperative dobutamine stress echocardiography (DSE) might be used to predict post-repair recovery in LV function was also examined.Seventeen patients underwent preoperative transthoracic echocardiography (TTE) and DSE, intraoperative transesophageal echocardiography, and three-month postoperative TTE.After repair, mitral valve area was reduced from 8.5 +/- 1.9 cm2 to 3.8 +/- 0.9 cm2 by planimetry (p0.0001) and to 2.9 +/- 0.9 cm2 by pressure half-time. Valve area by pressure half-time correlated with the planimetered area (r = +0.55), but was consistently lower (p = 0.004). Sixxteen of 17 patients had mean transmitral gradients5 mmHg. Postoperative LV end-diastolic diameter improved from 72 +/- 11 to 64 +/- 10 mm (p0.01), and end-systolic diameter from 56 +/- 14 to 46 +/- 12 mm (p0.05). Mean ejection fraction improved from 25 +/- 12% before repair to 38 +/- 17% after repair (p0.02) in patients with evidence of LV function improvement on DSE, but was unchanged (15 +/- 5% versus 17 +/- 5%, p = NS) in patients without evidence of improvement. Postoperatively, 13 patients had no or mild MR, and two patients had moderate MR. There was one perioperative death.E-E repair, in combination with ring annuloplasty, reduces LV cavity dimensions and functional MR severity, without causing significant valve stenosis. Improvement on DSE may predict those patients in whom EF will improve following repair.

health related quality of life (HRQoL). METHODS: In this pilot study, 47 patients undergoing elective cardiac surgery underwent a detailed frailty assessment at both their pre-operative admissions clinic and their 3-month followup clinic visit. Frailty assessments were undertaken using the Modified Fried criteria examining dimensions of malnutrition, wasting, weakness, slowness, inactivity, mood and cognition. A score of greater than or equal to 3 on the Fried scale provided a dichotomous definition of frailty. Patients were then further assessed approximately 12 months following their index surgical procedure mark to determine their health related quality of life (HRQoL) using the EQ-5DVAS. RESULTS: Of the 47 cardiac surgery patients assessed, 28 (59.6%) were classified as frail at baseline (i.e. preoperative). Of these 28 patients who were frail at baseline, 16 (57.1%) were no longer frail at their three month follow-up appointment. For these 28 patients, a change in frailty status at three months was significantly associated with a higher health related quality of life at one year following surgery (p1⁄40.008). Preliminary trends indicate that preoperative diabetes, obesity and coronary artery disease (as opposed to isolated valvular disease) are associated with persistent postoperative frailty. CONCLUSION: In this pilot study, a number of cardiac surgery patients who were frail before their procedure were no longer frail at 3 months after their surgery. Improvement in frailty was associated with a “durable” improvement in HRQoL at 1 year. Patients who have persistent frailty at 3 months following their surgery appear to have lower long-term HRQoL. Further analysis into the domains of frailty that inform persistent frailty (i.e. low physical activity versus cognitive deficiencies) will be the subject of future studies.

s S159 n1⁄411). Injection of MSC at day 3 resulted in a modest and nonsignificant reduction in RVSP in MCT-treated SD rats (MCT/MSC: n1⁄415, p1⁄40.07). In contrast, transfected MSCs overexpressing HMOX1 significantly decreased RVSP (MCT/ HMOX1: n1⁄412, p1⁄40.005), whereas CoPP-treated MSCs had no beneficial effect (MCT/CoPP: n1⁄417, p1⁄40.51). Similar findings were observed in terms of RV hypertrophy (RV/LV+Septal mass ratio), as well as the echocardiographic parameters of PAAT and RVEDWT. CONCLUSION: Overexpression of HMOX1 potentiated the therapeutic effects of MSCs in the MCT model of PAH in rats. Pre-treatment of MSCs with CoPP, which resulted in substantial increases in endogenous HMOX1 expression, had no beneficial effects and even may have reduced the ability of MSCs to prevent PAH in this model. This may be due to the distinct temporal expression pattern of HMOX1 overexpression in CoPP-treated MSCs compared with transfection, or to off target effects of chemical induction on MSC activity. United Therapeutics, Northern Therapeutics Canadian Society of Cardiac Surgeons (CSCS) Oral

In this study, near-infrared (NIR) and attenuated-total-reflectance infrared (ATR-IR) spectroscopy techniques in hyphenation with partial least squares (PLS) regression were utilized to determine the antioxidant capacity of Primulae flos cum calycibus samples. Folin–Ciocalteu (FC), ferric ion reducing antioxidant power (FRAP), 2,2-diphenyl-picrylhydrazyl (DPPH), 2,2′-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) and cupric reducing antioxidant capacity (CUPRAC) assays were performed as reference methods. Different spectral pretreatments such as standard normal variate (SNV), 1st or 2nd derivative, were applied to remove scattering effects. For all assays, cross and test-set validations were performed. The ability of the two spectroscopic techniques to replace the five assays was evaluated and compared. The standard error of prediction (SEP) and the ratio performance deviation (RPD) were determined and corrected for the imprecision of the reference data to obtain the respective SEPcorr and RPDcorr values. In general, NIR demonstrated advantages over ATR-IR spectroscopy and resulted best for the ABTS assay (R2: 0.94, RPDcorr: 4.66; test-set validation). Also with ATR-IR spectroscopy, the best prediction power was obtained for the ABTS assay (R2: 0.94, RPDcorr: 4.10; test-set validation). The feasibility of vibrational spectroscopy as a fast and simple tool to replace wet chemistry assays for the measurement of the antioxidant capacity of Primulae flos cum calycibus samples was demonstrated.

The synthesis of heterocyclic-fused imidazoles was achieved by flash vacuum pyrolysis (FVP) of N-heterocyclic isoxazol-5(2H)-ones via an iminocarbene intermediate. Unlike iminocarbenes generated from triazoles, no structural rearrangements were observed during the current synthesis method. We also demonstrated that less volatile isoxazol-5(2H)-one derivatives yield the corresponding imidazoles by condensed phase pyrolysis.

Progesterone receptors (PR) contain three activation functions (AFs) that together define the extent to which they regulate transcription. AF1 and AF2 are common to the two isoforms of PR, PR-A and PR-B, whereas AF3 lies within the N-terminal 164 amino acids unique to PR-B, termed the "B-upstream segment" (BUS). To define the BUS regions that contribute to AF3 function, we generated a series of deletion and amino acid substitution mutants and tested them in three backgrounds as follows: BUS alone fused to the PR DNA binding domain (BUS-DBD), the entire PR-B N terminus linked to its DBD (NT-B), and full-length PR-B. Analyses of these mutants identified two regions in BUS whose loss reduces AF3 activity by more than 90%. These are associated with amino acids 54-90 (R1) and 120-154 (R2). R1 contains a consensus (55)LXXLL(59) motif (L1) identical to ones found in nuclear receptor co-activators. R2 is adjacent to a second nuclear receptor box (L2) at (115)LXXLL(119) and contains a conserved tryptophan (Trp-140). Their mutation completely disrupts AF3 activity in a promoter and cell type-independent manner. Critical mutations elicited similar effects on all three B-receptor backgrounds. This underscores the probability that these mutations alter a process linking BUS structure to the function of full-length PR-B in a fundamental way.

Objective: The aims of this study are to demonstrate 1) the criterion validity of the Abel Assessment for sexual interestTM (AASI) based on its ability to discriminate between non child molesters and admitting child molesters, and 2) its resistance to falsification based on its ability to discriminate between liar-denier child molesters and non child molesters. Method: A group of 747 participants matched by age, race, and income was used to develop three logistic regression equations. The models compare a group of non child molesting patients under evaluation for other paraphilias to three groups: 1) a group of admitting molesters of girls under 14 years of age, 2) a group of admitting molesters of boys under 14 years of age, and 3) a group believed to be concealing or denying having molested. Results: Both of the equations designed to discriminate between admitting child molesters and non child molesters were statistically significant. The equation contrasting child molesters attempting to conceal or deny their behavior and non child molesting patients was also statistically significant. Conclusions: The models classifying admitting child molesters versus non child molesters demonstrate criterion validity, while the third model provides evidence of the AASI’s resistance to falsification and its utility as a tool in the detection of child molesters who deny the behavior. Results of the equations are reported and suggestions for their use are discussed.

Limbic encephalitis is an unusual presentation of paraneoplastic syndrome, which includes among its symptoms seizures.We report a case with a rare presentation of limbic encephalitis as initial symptom of small cell lung carcinoma. A 69 year-old woman presented with partial non convulsive status epilepticus and neuropsychiatric disturbances. Chest radiography and computed tomography showed mediastinal lymphadenopathy and lung nodules. Subsequently, small cell lung carcinoma was diagnosed by lymph node biopsy. The cerebrospinal fluid study was normal. The electroencephalography and magnetic resonance imaging (MRI) findings had distinctive features compatible with temporo-limbic dysfunction. The anti-Hu antibodies were negative. The neuropsychiatric symptoms improved significantly after systemic chemotherapy and adjuvant radiotherapy. A serial follow-up MRI of the head showed no evidence of intracranial metastasis three months after the diagnosis of cancer. Limbic encephalitis may be an initial manifestation of lung cancer. Paraneoplastic limbic encephalitis is considered a remote effect of cancer commonly associated with anti-neuronal antibodies (anti-Hu) and small cell lung carcinoma.Status epilepticus could be an early sign of limbic encephalitis. The absence of anti-Hu antibodies does not rule out the presence of an underlying small cell lung carcinoma in patients with a clinical diagnosis of limbic encephalitis. Greater awareness for diagnosis and early treatment of the primary tumor offers the best chance for improvement in patients with lung cancer presenting with limbic encephalitis.

Elevated total plasma homocysteine (tHcy) levels have been associated with vascular disease and higher mortality in patients with coronary artery disease. Graft coronary disease is a major cause of mortality in long-term survivors of heart transplantation, and hyperhomocysteinemia may be one of its causes. The objectives of our study were to establish the effectiveness of a 3 stage homocysteine-lowering algorithm in a group of 84 heart transplant (HTx) patients and to evaluate the effect of renal function on the response to homocysteine-lowering therapy.Prospective treatment of 84 Htx patients (64 male; mean age, 48 +/- 13 years) with tHcy75th percentile consisted of a 3-stage treatment algorithm: Stage 1, folic acid (FA) 2 mg + vitamin (vit) B(12) 500 mcg daily; Stage 2, addition of vit B(6) 100 mg daily; Stage 3, increase FA to 15 mg daily. Serum creatinine (Cr) and tHcy levels were measured before treatment and 21 +/- 19 weeks after each stage of treatment.All 3 stages of treatment significantly lowered mean tHcy from 22.4 +/- 16.3 (mean +/- SD) micromol/liter to 16.3 +/- 6.7 micromol/liter (p0.00001), from 17.6 +/- 6.1 micromol/liter to 15.2 +/- 5.3 micromol/liter (p0.0001), and from 16.8 +/- 5.2 micromol/liter to 15.6 +/- 5.3 micromol/liter (p0.05), respectively. The average reduction from baseline was 38%. Creatinine levels did not change significantly during the study period. Total plasma homocysteine levels decreased below the 75th percentile in 55% of patients, with Cr levels significantly lower in this group of patients (126 +/- 36 micromol/liter vs 182 +/- 65 micromol/liter, p0.00001). However, we found no significant relationship between % change in tHcy and baseline Cr.In a group of 84 heart transplant patients with tHcy levels75th percentile, treatment with FA and vit B(6) and B(12) according to a 3-stage algorithm resulted in statistically significant declines in mean tHcy levels. Overall, tHcy levels decreased 38%, with target tHcy levels75th percentile achieved in 55% of the patients. The % change in tHcy was not related to Cr. Further studies are needed to correlate treatment of hyperhomocysteinemia with clinical endpoints, such as the time to development of transplant vasculopathy and long-term survival, and to define the most appropriate targets for therapy.

Transhiatal esophagectomy has recently been popularized for both benign and malignant esophageal disease. While we were performing a transhiatal esophagectomy for a squamous cell cancer of the upper third of the esophagus, a tear in the membranous trachea near the carina occurred. This was repaired through the cervical incision with a free pericardial patch. This solution to a potentially catastrophic complication of transhiatal esophagectomy gave a satisfactory result without early or late postoperative respiratory complications.

To examine services utilised by female sex workers in Christchurch for sexual and physical safety.Estimates were made of the sex worker population in Christchurch before conducting a cross-sectional survey.303 women responded. Almost all went for sexual health check-ups. Most (251) had a general practitioner, but only about half disclosed they were sex workers. Of the 135 women who used their own general practitioner for sexual health checks, 62% disclosed they were sex workers. In general, the women relied upon informal networks for information and advice, but the peer organisation of New Zealand Prostitutes Collective was also important.While general practitioners were used by the majority of sex workers, high levels of nondisclosure need to be understood and redressed. The preference of sex workers for informal, peer relationships should be considered in future health promotion efforts.

Our objective was to define the outcomes of patients with cardiogenic shock (CS) due to severe mitral regurgitation (MR) complicating acute myocardial infarction (AMI).Methods for early identification and optimal treatment of such patients have not been defined.The SHOCK Trial Registry enrolled 1,190 patients with CS complicating AMI. We compared 1) the cohort with severe mitral regurgitation (MR, n = 98) to the cohort with predominant left ventricular failure (LVF, n = 879), and 2) the MR patients who underwent valve surgery (n = 43) to those who did not (n = 51).Shock developed early after MI in both the MR (median 12.8 h) and LVF (median 6.2 h) cohorts. The MR patients were more often female (52% vs. 37%, p = 0.004) and less likely to have ST elevation at shock diagnosis (41% vs. 63%, p0.001). The MR index MI was more frequently inferior (55% vs. 44%, p = 0.039) or posterior (32% vs. 17%, p = 0.002) than that of LVF and much less frequently anterior (34% vs. 59%, p0.001). Despite having higher mean LVEF (0.37 vs. 0.30, p = 0.001) the MR cohort had similar in-hospital mortality (55% vs. 61%, p = 0.277). The majority of MR patients did not undergo mitral valve surgery. Those undergoing surgery exhibited higher mean LVEF than those not undergoing surgery; nevertheless, 39% died in hospital.The data highlight opportunities for early identification and intervention to potentially decrease the devastating mortality and morbidity of severe post-myocardial infarction MR.

Reliability, measured by Cronbach's coefficient alpha, and concurrent validity, measured by Pearson's r and polychoric correlation coefficients, were evaluated in this study. A sample of 371 sexual offenders referred to the Behavioral Medicine Institute of Atlanta for evaluation of sexual interests and behaviors by the courts were assessed using the Sexual Interest Cardsort Questionnaire (SI), a self-report measure of deviant and nondeviant sexual interest, as well as indicator variables obtained from classifications assigned by clinicians as a result of 2 hour-long, semistructured clinical interviews. Internal consistency of 75 items from the SI ranged from 0. 71 to 0.96, across 15 categories of sexual interest and behavior. Additionally, the SI was shortened utilizing Cronbach's alphas to maintain a high level of internal consistency. The resulting questionnaire, the shortened SI (SIS), had 45 items and 15 categories. Cronbach's alpha ranged from 0.78 to 0.97. Utilizing Pearson's r and polychoric correlation coefficients, significant correlations were found for the 11 sexually deviant categories of the SI and indicator variables, and the 10 sexually deviant categories of the SIS and indicator variables. The SI and SIS showed a high level of reliability and concurrent validity. Clinical and research issues pertaining to the clinical assessment of male sexual offend ers utilizing self-report and clinical interview data, both obtained as the result of comprehensive evaluations, are discussed.

To determine the prevalence of hyperhomocysteinemia in heart transplant recipients, and to assess the effect of renal function and immunosuppressive medication on total plasma homocysteine (tHcy) levels.Elevated plasma tHcy levels have been associated with increased risk of mortality in patients with established coronary artery disease. Graft coronary disease is the major cause of morbidity and mortality in long-term survivors of heart transplantation. The tHcy has been found to be elevated in heart and kidney transplant patients, however, the etiologic factors have not been clearly delineated.The study group consisted of 70 heart transplant recipients (56 males, 14 females, mean age 53+/-13 years [range 17 to 69 years]). The parameters evaluated were fasting tHcy level, cumulative cyclosporine (CyA) dose, cumulative prednisone dose, serum creatinine, and time from transplantation.The mean fasting tHcy level was 20.5+/-10.2 micromol/L (range 5.2 to 59.0 micromol/L). Sixty-one (87%) had fasting tHcy levels greater than the seventy-fifth percentile of the general population (12.2 micromol/L in males, and10.1 micromol/L in females). There was no difference in mean post-transplant tHcy level between patients with and without coronary artery disease before transplantation (21.0+/-11.4 vs. 19.3+/-6.7 micromol/L, p = NS). There were significant relationships between the tHcy level and the serum creatinine (r = 0.76, p0.001), and cumulative exposure to CyA (r = 0.31, p0.01). There were no significant relationships between tHcy levels and cumulative prednisone dose, or time from transplantation.Fasting tHcy levels are markedly elevated in the majority of patients following heart transplantation, and are correlated to serum creatinine. Further studies are needed to determine other etiologic factors of elevated tHcy following heart transplantation, and to examine the impact of elevated tHcy on clinical outcomes.

Background/Purpose: The longer-term sequelae of short bowel syndrome in infancy are reasonably well documented, but little is known about the long-term nutritional and metabolic effects of limited (less than 50 cm) ileal resection. This makes it difficult to formulate a rational follow-up policy in such children. Methods: All children who underwent limited ileal resection for either necrotizing enterocolitis (NEC) or intussusception at our institution between 1984 and 1992 were invited to attend a detailed clinical, anthropometric, hematologic, and biochemical assessment, together with a biliary and renal ultrasound scan and measurement of bone mineral density. Results: Twenty-four children (NEC, 17; intussusception, 7) of median age 7.4 years (range, 5.5 to 13.7 years) agreed to participate. Nine previously had undergone an isolated ileal resection, and 15 also had had variable lengths of colon removed. The length of resected ileum ranged from 3 to 44 cm, with a median of 10 cm. Seven control subjects in whom neonatal NEC developed but recovered without surgery were also evaluated. Median height, weight, and body mass index after ileal resection were between the 25th and 50th percentiles; no child was stunted or wasted. After ileal resection, one boy was found to have asymptomatic vitamin B 12 deficiency, and three children had low plasma concentrations of vitamin A. Hematologic and biochemical parameters were otherwise normal apart from a few marginally low trace element levels in both subjects and controls. No renal calculi were detected, and bone mineral density measurements were normal in all except one child. Four children had cholelithiasis, all of whom had previously undergone limited ileal resection for NEC (two isolated, two ileocolic). Thus, the prevalence of cholelithasis after limited ileal resection for NEC was 24% at a median age of 7.0 years. Conclusions: Growth and nutritional status are well preserved after limited ileal resection in infancy. Limited ileal resection for NEC is associated with a subsequent high prevalence of cholelithiasis and a risk of vitamin B 12 deficiency. These findings are important when planning strategies for long-term follow-up.

Background: Pulmonary hypertension in patients with congestive heart failure (CHF) is a risk factor for increased mortality after orthotopic cardiac transplantation. Reversibility of elevated pulmonary vascular resistance (PVR) by pharmacologic agents predicts improved outcomes. Milrinone, a phosphodiesterase inhibitor with vasodilating and positive inotropic properties, has been shown to lower PVR in one previous study. However, no study has documented outcomes after cardiac transplantation in patients in whom reversibility of pulmonary hypertension was demonstrated after administration of milrinone. Methods We retrospectively reviewed 19 patients with CHF and pulmonary hypertension defined as PVR ≥ 3 Wood units, PVRI (pulmonary vascular resistance index) ≥ 4 resistance units, or TPG (transpulmonary gradient=mean pulmonary artery pressure − mean capillary wedge pressure) ≥ 12 mmHg being assessed for cardiac transplantation. A sub-group of 14 patients with severe pulmonary hypertension defined as PVR ≥ 4, PVRI ≥ 6 and TPG ≥ 15 was also examined. Milrinone was administered as a bolus (50 ug/kg) and hemodynamic parameters were measured at 5, 10 and 15 minutes. Six patients received cardiac transplants. Results Administration of milrinone significantly lowered PVR, PVRI, mean pulmonary artery pressure (PAM) (all p = 0.002) and pulmonary capillary wedge pressure (PCWP) ( p = 0.006). Cardiac output (CO) increased significantly ( p = 0.001). TPG did not change ( p = 0.33). In patients with severe pulmonary hypertension, the magnitude of these changes was greater. In addition, TPG was significantly lowered ( p = 0.02). Conclusion Milrinone lowered PVR by decreasing PAM and increasing CO significantly. In addition, PCWP was significantly lowered. These finding confirm both vasodilatory and inotropic effects of milrinone. Patients with severe pulmonary hypertension had more pronounced effects. There were no deaths in the group of patients proceeding to cardiac transplantation. Our study demonstrates the efficacy of milrinone in lowering PVR as well as suggesting safety in use in patients undergoing cardiac transplantation.

The Medtronic (Minneapolis, MN) Mosaic porcine bioprosthesis is an investigational prosthesis which incorporates zero-pressure fixation, aortic root predilation, low profile stent, and alpha oleic acid antimineralization treatment.From September 1994 to August 1996, 289 patients (mean age 70 years, range, 28 to 88 years) had 227 (78.5%) aortic valve replacements and 62 (21.5%) mitral valve replacements. Concomitant procedures were performed in 61.2% (139) of aortic valve replacements and 54.8% (34) of mitral valve replacements. Of the aortic valve replacement group 70 (30.8%) were in the 61 to 70 age group and 134 (59.0%) were 71 years or older. Of the mitral valve replacements, 23 (37.1%) were 61 to 70 years and 30 (48.4%) 71 years or older.The early mortality, overall, was 4.2% (12 of 289); for aortic valve replacement it was 4.0% (9) and for mitral valve replacement it was 4.8% (3). The late mortality for aortic valve replacement was 2.6% per patient-year (3 events, 1.3% of total) and for mitral valve replacement it was 3.3% per patient-year (one event, 1.6% of total). The reoperative rate for aortic valve replacement was 3.0% per patient-year (4), while there were no mitral valve replacement reoperations. The freedom from major thromboembolism was 97.3%+/-1.6% for aortic valve replacement and 94.7%+/-3.0% for mitral valve replacement at 1 to 1.5 years. The freedom from reoperation was 96.7%+/-1.7% for aortic valve replacement; there was no reoperation for mitral valve replacement. There were no cases of structural valve deterioration. In the aortic position the mean systolic gradient was low, approximately 11 mm Hg, across all sizes (range 8 to 12 mm Hg at 3 months and 10 to 13 mm Hg at 12 months). In the mitral position the mean diastolic gradient was approximately 5 mm Hg (range, 2 to 6 mm Hg) for all sizes 25 to 31 mm at the early and 1 year follow-up echocardiographic assessment.The early clinical performance and in vivo hemodynamics are encouraging.

The controversial question of the extent of hepatocyte infection in chronic hepatitis C was re-examined in both chimpanzees and humans using a newly modified in situ hybridization (ISH) method for detecting hepatitis C virus (HCV) RNA. The specificity of the methodology for distinguishing positive- and negative-strand synthetic HCV RNA was at least six magnitudes greater than the reverse-transcription polymerase chain reaction (RT-PCR) assay for HCV. The sensitivity of the methodology as determined by cell culture assay was 14 +/- 2 genomic equivalents (gE) of HCV positive strand per cell, which was three magnitudes less sensitive than RT-PCR quantitation of HCV. In contrast to previous studies in both humans and chimpanzees with chronic hepatitis C, a high percentage of hepatocytes positive for both positive- and negative-strand HCV RNA was found in most specimens studied. In humans, the extent of hepatocyte infection varied with histological activity index (HAI). In the two chimpanzees studied, the liver biopsies showed minimal histological disease activity, but high percentages of hepatocytes were HCV-positive by ISH that correlated with hepatocyte ultrastructural changes associated with HCV infection. Hepatocyte infection was confirmed by RNA extraction and RT-PCR techniques for detecting HCV RNA that minimize the false detection of negative strands. In both human and chimpanzee liver biopsies showing minimal HAI, the hepatocyte concentration of HCV was estimated to be very low. These findings suggested the hypothesis that persistent infection in the liver may be caused in part by low-level HCV replication. The theoretical and clinical implications of these findings are discussed.