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Background and aims High frequency ventilation (HFV) is frequently used in both term and preterm newborns. Hybrid neonatal ventilators capable of both HFV and conventional ventilation are currently available with different mechanisms for generating the required high frequency oscillation. In HFV, carbon dioxide elimination is directly correlated with VThf. The aim of the current study was to describe the impact of changes in amplitude, frequency and inspiratory-expiratory ratio (I:E) on VThf using different hybrid neonatal ventilators. Methods Three different hybrid neonatal ventilators were tested: Drager Babylog® VN500, Acutronic Fabian and SLE 5000. Each ventilator was calibrated using a new disposable ventilator circuit with a Drager pneumatic test lung leaving the humidifier dry to standardise all measurements. The VThf measured by the device was recorded after the system stabilised for 3 min. Each experiment was done using 21% oxygen, 8 cm H 2 O of pressure and repeated 3 times with negligible differences between measurements. Results In this setting, there is an expected inverse relationship between frequency and achieved VThf in all devices when using maximum amplitude. All three ventilators were more efficient at lower frequencies achieving higher VThf. In the two ventilators that allow I:E modification, the 1:1 ratio achieves higher VThf than 1:2 ratio. This becomes more evident at lower frequencies and higher amplitudes. Conclusions In tested ventilators the highest impact on VThf was achieved with frequency reduction. When modifiable, an I:E ratio of 1:1 optimises VThf at higher amplitudes. Clinicians need to be aware of these characteristics for optimising ventilation strategy.

Aim To describe the case of a successful heart transplant in a highly sensitized individual by antibody reduction with bortezomib and plasmapheresis. Methods A 38 year old female patient with a pre-transplant cPRA of 81% (Class I & II) was desensitized with 5 sessions of plasmapheresis and two doses of bortezomib. The alloimmune status was determined by solid phase single antigen and phenotype bead based assays. Post transplant follow up included endocardial biopsies and DSA monitoring. Results The patient’s class I and class II PRAs decreased from 81% to 44% and 31% respectively by day 6 of desensitization. The overall strength of HLA antibodies was also reduced. A prospective crossmatch was performed with a local donor. The crossmatch was technically negative, but the Flow median Channel Shift (MCS) was closer to the positive cut off value. The patient underwent another PP and was tested and crossmatched again when the MCS was significantly below the positive cutoff value. The patient received the transplant and is doing well 18 months post transplant. Conclusions This case report demonstrates the potential efficacy of bortezomib therapy in addition to plasmapheresis to transplant highly sensitized patient awaiting heart transplant. Because of limitations with the prospective crossmatch for heart transplant candidates, desensitization of the potential recipient to increase the likelihood for an acceptable donor by depleting pre-existing antibodies against the unacceptable antigens is an attractive option. Plasmapheresis and IVIG in combination with rituximab has been utilized in kidney transplant recipients with a living donor; however, candidates awaiting a deceased donor represent a significant immunological and logistical challenge. Rituxan does not deplete circulating plasma cells that produce antibodies. Bortezomib has been shown to induce plasma cell apoptosis. However, its use prior to heart transplant has been limited. More studies are needed to evaluate the efficacy of bortezomib-based desensitization strategy in heart transplant set up. Patient is currently pursuing her degree as an echo technician.

We report herein the results of the cross-cultural adaptation and validation into the Chilean language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Chilean CHAQ-CHQ were derived from the European Spanish version with changing of the few words whose use is different in the 2 countries. A total of 126 subjects were enrolled: 72 patients with JIA (29% systemic onset, 39% polyarticular onset, 4% extended oligoarticular subtype, and 28% persistent oligoarticular subtype) and 54 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the JIA patients having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the JIA patients having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Chilean version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

The anthracycline-like polyketide drug elloramycin is produced by Streptomyces olivaceus Tü2353. Elloramycin has antibacterial activity against Gram-positive bacteria and also exhibits antitumor activity. From a cosmid clone (cos16F4) containing part of the elloramycin biosynthesis gene cluster, three genes (elmMI, elmMII, and elmMIII) have been cloned. Sequence analysis and data base comparison showed that their deduced products resembled S-adenosylmethionine-dependent O-methyltransferases. The genes were individually expressed in Streptomyces albus and also coexpressed with genes involved in the biosynthesis of l-rhamnose, the 6-deoxysugar attached to the elloramycin aglycon. The resulting recombinant strains were used to biotransform three different elloramycin-type compounds: l-rhamnosyl-tetracenomycin C, l-olivosyl-tetracenomycin C, and l-oleandrosyl-tetracenomycin, which differ in their 2'-, 3'-, and 4'-substituents of the sugar moieties. When only the three methyltransferase-encoding genes elmMI, elmMII, and elmMIII were individually expressed in S. albus, the methylating activity of the three methyltransferases was also assayed in vitro using various externally added glycosylated substrates. From the combined results of all of these experiments, it is proposed that methyltransferases ElmMI, ElmMII, and ElmMIII are involved in the biosynthesis of the permethylated l-rhamnose moiety of elloramycin. ElmMI, ElmMII, and ElmMIII are responsible for the consecutive methylation of the hydroxy groups at the 2'-, 3'-, and 4'-position, respectively, after the sugar moiety has been attached to the aglycon.

Introduction Burns are a problem in public health that occupies the third leading cause of injury in children worldwide. Objective Analyse the epidemiology of burns in children and adolescents in the Burns Unit of the Guadalajara Civil Hospital Dr Juan I Menchaca. Methodology This research is descriptive. Data were obtained through 118 patient clinical records and interviews with their family members from 1 November 2008 to 31 October 2009. The variables studied were: gender, age, injury mechanism, injury agent, degree of burn, place where it happened, place where first medical care was received and time to first medical care after injury. Results Male gender was three times as frequent as female gender in burns patients (70 vs 48), and also suffered the most severe injuries. The largest age group was the 0–2 years old (48.3% of cases). In the majority, the mechanism of injury was non-intentional. The most common agents were hot liquids (55.9%) and fire (28.0%). The most frequent locations were injury occurred was home, mainly in the kitchen. In 11.0% of patients receive their first medical care after 3:00. Conclusions The groups at highest risk were children under 3 years old and males; the most frequent burning agent were hot liquids; and the events occurred at home.

The triggering events by which mononuclear cells throughout the body are induced to produce large amounts of cytokines during acute pancreatitis are unclear. However, recent work in our laboratory demonstrated that three specific pancreatic enzymes (elastase, carboxypeptidase A, and lipase) induced dramatic tumor necrosis factor-alpha (TNF-alpha) protein production from macrophages, whereas all others could not. This series of experiments was designed to examine the second messenger system by which this occurs. The rat macrophage cell line NR8383 was incubated for 3 hours with elastase, carboxypeptidase A, lipase, trypsin, or lipopolysaccharide (positive control). Activation of nuclear factor kappa B (NF-kappa B) was demonstrated by electrophoretic mobility shift assay, presence of inhibitory kappa B alpha and beta (I kappa B-alpha and I kappa B-beta) by Western blot analysis, and TNF-alpha protein production by enzyme-linked immunosorbent assay. Elastase, carboxypeptidase A, and lipase induced degradation of I kappa B-beta (but not I kappa B-alpha), activation of NF-kappa B, and production of TNF-alpha protein, whereas inhibition of I kappa B with pyrrolidine dithiocarbamate attenuated this response. Trypsin was unable to elicit any of these responses. Macrophages can be induced by specific activated pancreatic enzymes-elastase, carboxypeptidase A, and lipase-to produce TNF-alpha. This process is dependent on I kappa B-beta degradation and NF- kappa B activation, suggesting that these enzymes trigger this second messenger system through specific membrane-bound receptors.

To measure patient satisfaction with pregnancy and newborn care.To develop our survey, we reviewed domains of care that had been identified by national groups working to develop measures of satisfaction with care. Within these domains of care, items pertinent to pregnancy and newborn care were written, reviewed, and pilot tested in focus groups of women who had recently delivered a baby. A 24-item survey instrument was the result of this process.We sent our survey to 2337 female members of the Southern California Kaiser Permanente Medical Care Program approximately 8 weeks after they had delivered a baby. The demographic and clinical characteristics of the respondents were compared with those of the nonrespondents.A total of 1017 women (44%) completed and returned the survey. Eighty-eight percent of the women who responded were very or somewhat satisfied with the care they received during their pregnancy and the newborn period. Women who responded differed from those who did not respond on infant birthweight, maternal age and education, and other variables. The results of our survey were forwarded to local quality managers and physicians.Satisfaction with care is an important measure of quality of care. Many changes in the delivery system were made in response to the information provided by survey respondents, including offering alternative appointment times and scheduling postpartum appointments before hospital discharge. Our survey instrument, which assesses satisfaction with pregnancy and newborn care, might be useful for other health maintenance organizations for identifying areas where improvement in care is needed.

Kaposi's sarcoma is a tumour of multicentric origin, composed of endothelium-lined vascular spaces and spindle-shaped cells. The incidence of Kaposi's sarcoma in transplant recipients is 400--500 times greater than that in the general population, and is rising within the transplant population, currently comprising more than 5% of all de novo neoplasms in this group. The exact pathogenesis is still unknown but DNA sequences from human herpesvirus 8 (HHV-8) are present in the different clinical variants of Kaposi's sarcoma. Risk factors associated with development of these tumours posttransplantation include the geographical origin of the patient, HSV-8 infection before and after transplantation, and the immunosuppressive regimen used, but the importance of each factor remains to be determined. Apart from conventional treatment with surgical excision, radiotherapy or chemotherapy, cessation, reduction or modification of immunosuppressive therapy has been shown to be effective in a significant number of patients. This article reviews recent advances in our understanding of Kaposi's sarcoma after transplantation.

Although rarely encountered in the United States, urinary tract schistosomiasis occurs commonly in many countries in the eastern hemisphere. Travel and immigration may contribute to imported cases of schistosomiasis. Excessive morbidity and increased mortality, including the development of urinary-tract squamous-cell carcinoma, are associated with untreated Schistosoma haematobium infection. Therefore, in the appropriate clinical context, all efforts should be made to rule out infectious and readily treatable causes of chronic hematuria. The presence of characteristic eggs in the urinary sediment is the usual means of diagnosing a S. haematobium infection. Additionally, the small and less commonly encountered miracidium stage of S. haematobium may also be present in the urine, which is another means of diagnosing urinary tract schistosomiasis. The present report describes a case in which a miracidium was detected in a fresh, unstained urine specimen. As detection of miracidia can be made in specimens also processed by routine cytologic methods, it behooves cytologists to be aware of this entity for the diagnosis of schistosomiasis.

Myoporum laetum was collected in the counties of Rio Grande and Capao do Leao in winter and in Santa Vitoria in summer, autumn, winter and spring, in the state of Rio Grande do Sul and in the Department of Rocha, Uruguay, in winter and spring. The fresh green leaves were fed to 16 calves. Two calves that ingested the plant from Capao do Leao at 40 and 44 g/kg bw did not develop clinical signs. The other 14 calves had depression, abdominal pain, ruminal atony, ocular and nasal serous discharge, and dry feces with blood and mucus. Four calves developed icterus. First signs appeared 24-72 h after ingestion, and clinical period varied from 2 to 7 d. One animal had mild photosensitization. Calves dosed with 20 g/kg of plant from Santa Vitoria and 40 g/kg of plant from Uruguay had less severe clinical signs. All cattle recovered except 1 dosed with 40 g/kg of plant collected in winter in Santa Vitoria; it died 70 h after ingestion. Histologic lesions in the liver of this animal and in biopsies obtained 48 h after dosing other calves had centrilobular necrosis, sometimes extending to the midzonal region. Clinical signs and hepatic lesions were also observed in a calf dosed with 5 daily doses at 8 g/kg. Serum AST, GGT and bilirubin were increased. M laetum from Santa Vitoria was the most toxic for cattle, and the plant from Uruguay was the least toxic, suggesting variations in toxicity among plants from different regions.

Kaposi’s sarcoma (KS) is the most common neoplasm in patients with AIDS. Epidemiologic evidence and the recent identification of herpesvirus-like DNA sequences in patients with KS have suggested a role for viral agents in the etiopathogenesis of this disease. It is unclear if these sequences are present in all types of KS and if the copy number of these sequences has a correlation with disease severity (staging). In order to clarify these issues, we retrospectively analyzed, by PCR and Southern blotting, formalin-fixed, paraffin-embedded biopsy specimens from 12 patients previously diagnosed with KS by histopathologic examination of these specimens between the years of 1977 and 1996. We also analyzed tissue samples from these patients taken from dermal sites without KS lesions and control tissues from healthy subjects. Of the 12 patients, 6 had classic KS, 5 had AIDS-associated KS, and 1 had the endemic type of KS. We tested the specimens for other herpesviruses, including cytomegalovirus, human herpesvirus 6 (HHV-6), HHV-7, HHV-8, and Epstein-Barr virus. Of 20 biopsy specimens from patients previously diagnosed with KS, 19 were positive for HHV-8 sequences (95%), while PCR for the DNAs of other herpesvirus agents was negative. Uninvolved tissue from these patients and control tissue from healthy subjects gave negative results for all viruses. Semiquantitative analysis of Southern blots showed higher levels of HHV-8 DNA in those patients with multicentric and visceral involvement than in those patients with localized involvement. In addition, in patients with localized skin disease, the nodular stage had higher levels of HHV-8 DNA than the patch or plaque stages. Our data confirmed that HHV-8 is involved in the etiopathogenesis of all types of KS and that there is a correlation between HHV-8 DNA load and the severity and staging of this disease.

Three outbreaks of Xanthium cavanillesii intoxication occurred in the spring in the State of Rio Grande do Sul, southern Brazil. All outbreaks were observed in paddocks with sandy soils in flood plains along water streams. The paddocks had been under water, and after water withdrawal cattle were introduced to those areas which had seedlings of X cavanillesii and shortage of other forage. Mortality varied between 3 and 58%. Most animals were found dead or died a few hours after observation of clinical signs. The main lesion was a swollen liver with acute diffuse centrilobular necrosis. The disease was produced experimentally by feeding cotyledons at 0.75 and 1% bw in calves, and at 1.5 and 2% bw in sheep. Clinical signs and gross and microscopic lesions were similar to those observed in field cases. X cavanillesii in the 4-leaf stage with the attached cotyledons was also toxic for cattle and sheep, but the same plant without cotyledons lost its liver toxicity. The lethal dose of cotyledons divided in 5 daily doses was not toxic for cattle and sheep, demonstrating the non-cumulative effect of the plant.

Myoporum laetum was collected in the municipalities of Rio Grande and Capao do Leao in winter and in Santa Vitoria in summer, autumn, winter and spring, in the state of Rio Grande do Sul, Brazil, and in the Department of Rocha, Uruguay, in winter and spring. The fresh green plant was fed to 17 sheep. All sheep developed clinical signs, except 1 that consumed only 4 g/kg bw daily during 10 d. Five of the 9 sheep dosed with 40 g/kg died. Four sheep dosed with plants from Uruguay at 40 g/kg, 6 sheep dosed with 20 g/kg, and 1 sheep dosed with 2 daily doses of 8 g/kg survived. Clinical signs were anorexia, restlessness, ruminal stasis, jaundice and dry feces with mucus or blood. All surviving sheep had photodermatitis in the face, ears, eyes and lips. Histologic lesions were characterized by periportal liver necrosis. Serum levels of AST, GGT and bilirubin were increased. M laetum from Uruguay was less toxic, suggesting a variation in toxicity among plants from different regions.

Dietary nutrients may have pharmacological value in modulating the immune system. We studied the effects of two enteral diets, which differed in their content of arginine, fat source, and select trace elements, on immune function in critically injured patients. Leukocytes were isolated from healthy volunteers and severely injured (ISS > 13) patients on the first, sixth, and tenth day of receiving either a standard diet or experimental diet. Monocytes were assayed for tumor necrosis factor, procoagulant activity, and prostaglandin E2 following endotoxin exposure. Neutrophil oxidant production and lymphocyte blastogenesis was assessed. Leukocyte function was uniformly depressed compared to normal patients on day 1. The response of leukocytes from patients receiving experimental diet improved or "normalized" by day 6, while remaining depressed in patients receiving standard diet. Dietary nutrient modification can effect cellular immune responses to inflammatory stimuli in severely injured patients.

Snakebite caused by Bothrops neuwiedi in sheep of southern Brazil is described. In a flock of 135 sheep, 22 were bitten and 11 died. Most cases occurred at the end of December and during January when the pastures were overgrazed due to severe drought. No more cases were observed after the end of January when abundant rainfall began. The main clinical signs were local edema followed by necrosis and sloughing of the skin.

The decision making process in caring for prematures is a good example of the pos sible interference between medical and legal responsibilities, since both sometimes do not follow the same orientation. It is unfortunate to realize that our medical decisions are more and more disturbed by the fear of being faced with a legal problem, even if the decision is the correct one. The intrusive legal factor often distorts our practice since we frequently decide defensively and not only on the basis of what we as physicians believe is the best solution for our patient’s problem.

For the development of minimally invasive brain-computer interfaces (BCIs), it is important to accurately localize the area of implantation. Using fMRI, we investigated which brain areas are involved in motor imagery. Twelve healthy subjects performed a motor execution and imagery task during separate fMRI and EEG measurements. fMRI results showed that during imagery, premotor and parietal areas were most robustly activated in individual subjects, but surprisingly, no activation was found in the primary motor cortex. EEG results showed that spectral power decreases in contralateral sensorimotor rhythms (8-24 Hz) during both movement and imagery. To further verify the involvement of the motor imagery areas found with fMRI, one epilepsy patient performed the same task during both fMRI and ECoG recordings. Significant ECoG low (8-24 Hz) and high (65-95 Hz) frequency power changes were observed selectively on premotor cortex and these co-localized with fMRI. During a subsequent BCI task, excellent performance (91%) was obtained based on ECoG power changes from the localized premotor area. These results indicate that other areas than the primary motor area may be more reliably activated during motor imagery. Specifically, the premotor cortex may be a better area to implant an invasive BCI.

Introduction Falls are event that would occur in everyone, although the most affect are the children and the elderly, and represent a high healthcare costs. Objective To describe falls mortality trends in Mexico from 1979 to 2007. Methodology Mortalities and trends were estimated for the study period from Mexicos official data based on the International Classification of Diseases. Injuries code includes were E880 to E889 (ICD-9) and W00 to W19 (ICD-10). Results were analysed by age group, sex and year registered, as well as by state and size of city or town of residence. Results From 1979 to 2008 we count 52 072 deaths from falls, of which 77.7% were men. The group of age with the highest mortality was the 80 years old and older. The place where falls occur in a third of deaths is residential institution/home. The states that show the higher rates of mortality from falls in the last period of time (2006–2008) are Aguascalientes, Jalisco and Queretaro. Conclusions Falls are deathly events that predominantly affect the men and the elderly. In general, the trend shows a consistent mortality decrease interrupted by a rise in 1998, a year that introduced the ICD-10 in Mexico. Since the population in Mexico is ageing, the absolute number of deaths by this cause will increase.

Abstract 3950 Poster Board III-886 INTRODUCTION Germinal centers (GC) are unique sites in peripheral lymphoid tissue where clonal selection of B cells takes place. GC have been known to be a major source of B-cell lymphomas, including follicular (FL) and diffuse large cell (DLCL). DNA methylation of tumor-suppressor genes is a mechanism of gene silencing involved in the pathogenesis of FL and DLCBLs. Much less is known about the role of methylation in GCH. We determined the methylation status of 5 tumor-suppressor genes in 50 patients with lymphoma of GC origin and 50 GCH in order to find any differences between the pathological and the physiological state as well as its prognostic significance. MATERIAL AND METHODS. Genomic DNA extracted from paraffin-embedded samples of 30 DLCL, 20 FL and 50 GCH were analyzed by methylation-specific polymerase chain-reaction to determine promoter hypermethylation of DAP-k, SHP1, Rarβ, p14 and MGMT. Methylation status of each gene was correlated with clinicopathological status. Overall survival (OS) rates were calculated by the Kaplan-Meier method and differences were compared with the log-rank test. RESULTS. Median age was 65 in patients with lymphoma and 19 for GCH. Sex distribution was similar in all entities (60% females). Both lymphoma groups were balanced with respect to the presence of B symptoms, bulky disease, bone marrow infiltration, advanced stage and high IPI/FLIPI. DAP-k promoter methylation was present in more patients with lymphoma (89 and 87%) than with BFH (37%) p Disclosures: No relevant conflicts of interest to declare.

e15053 Background: Analysis of efficacy and toxicity of biweekly XELOX as first line monotherapy in elderly patients (pts) with metastatic colorectal cancer (MCRC), based in results of W. Scheithauer (J Clin Oncol 2003; 21: 1307). Methods: From March/06 to November/08, 28 chemonaïve elderly pts (>75 years old) with MCRC, PS: 0–2, and adequate renal, hepatic and bone marrow functions, were included in a phase II study of: oxaliplatin 85 mg/ m2/ day 1 plus capecitabine 2000/ m2/ in 2 divided doses/ days 1–7 every 2 weeks. Treatment was continued until 12 cycles, tumour progression or innaceptable toxicity. Response evaluation every 6 cycles and toxicity every cycle was performed. At present 28 pts for toxicity and 24 pts for response are evaluable. Results: Median age: 78.2 years (range: 73.5–79.5). Male/Female: 14/14. Rectal/Colon: 9/19. Metastatic sites 1/2/>2: 15/6/6. Liver 78.6%, Lung 32.1%, Local tumour 7.1%, Retroperitoneum 14.2%, Peritoneum 10.7%. and Bones 7.1 %. Previous adjuvant with 5-FU regimens to 4 pts. Comorbidity grade by Charlson index 0–1/2/>2: 60.8%/ 28.6% / 10.7%, respectively. Median number of cycles for oxaliplatin and capecitabine were 8 (5.25–12) and 8 (5.25–11.75). Response rate: 2 pts complete response (8.3%), 8 pts partial response (33.3%),10 pts stable disease (41.7 %) and 4 pts progression (16.7%). The main CTC toxicity was Asthenia G2+3 in 6 (21.5%), Nausea and emesis G2 in 7 (25%), Diarrhea G2+3 in 7 (25%) and Hand-foot syndrome G1+2 in 5 pts (17.8%). No G4 toxicity or toxic deaths were observed. Median time to progression was 8.6 months.Median overall survival will be given updated at the congress. Conclusions: Preliminary results suggest that bi-weekly XELOX is an effective first line treatment for MCRC in elderly pts with an acceptable toxicity profile (especial surveillance of diarrhea is necessary) and protocol cumpliment. Combination with bevacizumab should be considered. No significant financial relationships to disclose.

e16573 Background: Ephitelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancies among women worldwide. Little is known about reproductive factors or lifestyle determinants and ovarian cancer prognosis. The purpose of this study was to analyze the pathologic, clinical and other characteristics. Methods: This study included all EOC seen at the Institute from 2000–2006. Epidemiological and clinical variables were collected from the patients’ medical records. Exposure data on prediagnostic factors were collected through questionnaires. The cases were followed-up until December 31, 2007. Cox proportional hazard regression model was used to estimate the prognostic effect of each factor in terms of hazard ratios (HR) and 95% confidence intervals (CI), following adjustment for age at diagnosis, FIGO tumor stage and WHO grade of tumor differentiation. Results: 571 cases of ovarian cancers. Median age was 51 years, (range 18–95). 20.30%, 4.4%, and 63.5% of patients had stage I, II and III, respectively. The histological types: 52.2% serous, 17.2% endometrioid, 12.8% of mucinous origin; 62.5% underwent radical surgery, 24% with optimal cytorreduction. The mean follow-up was 60 ± 22 months. The overall three-year survival was 97.4% and 98% for mucinous and serous tumors, respectively. The survival rate was 100%, 90%, and 71.8% in stages I, II and III, respectively. After adjustment for the tumor characteristics, no clear associations were detected between reproductive history, anthropometric characteristics, factors before diagnosis (alcohol consumption, smoking and physical activity over lifetime), nor family history of breast cancer or ovarian cancer and survival Conclusions: Our findings indicate that the tumor characteristics significantly influenced the risk of death from ovarian cancer and no clear associations were detected between others factors and the survival. In this cohort the median age for ovarian cancer were 51 years old, one decade before than other reports. No significant financial relationships to disclose.

We present a systematic analysis of the fractional-quantum-Hall-effect (FQHE) Hamiltonian in the symmetric gauge and of the Laughlin wave function (LWF). As in the Landau Gauge, it turns out that the ground state (g.s.) is dominated by a multiple-drop parent state composed of drops of constant actual size (the number of electrons in a given drop thus depends on the distance between adjacent Landau orbitals). These drops are further diffused by correlation effects in order to obtain the g.s. We check the accuracy of the LWF to describe this behavior for one-drop parent states (i.e., the situation for less than six particles) but we find that it overestimates correlation effects when more electrons are present. We correct some of the failures of the LWF but others are hard to eradicate without drastic changes, and so we propose a new approximant for the FQHE g.s. Our proposal allows an easy comprehension of the ground state of unpolarized FQHE systems, the ground-state crystallization effect, and the excitation characteristics.

Background: The routine use of endomyocardial biopsy (EMB) as a diagnostic test in the evaluation of heart failure patients (HFP) is controversial and generally unadvisable because of low diagnostic yield and potential for significant procedural morbidity and mortality. Purpose: Therefore we reviewed our experience with EMB in a large and mostly referral HFP at our tertiary care center. Methods: We retrospectively reviewed 3419 EMB records from 3/1/97 to 2/28/02 and identified 78 (2.3%) HFP, who were screened and referred for EMB by the heart failure specialists. Pre-EMB clinical diagnosis included 55% dilated cardiomyopathy, 14% prior condition (amyloid, sarcoid, lupus), 7% probable myocarditis, 11% ischemia, 6% drug toxicity, 3% hypertrophic cardiomyopathy, 3% constrictive pericarditis, 1% restrictive cardiomyopathy. EMB samples were routinely submitted for light and electron microscopy, immunofluoresence, Congo red and iron staining. Results: There were 44 (56%) men and 34 (44%) women with mean age of 50.5±18.5 (13–81) years. EMB results were non-diagnostic in 57 (73.1%) and diagnostic in 21(26.9%). Diagnostic finding consisted of 8 (10.2%) amyloid, 5 (6.4%) drug toxicity, 4 (5.1%) myocarditis, 2 (2.6%) iron overload and 2 (2.6%) immunologic/lupus. In HFP undergoing EMB there were 2 (2.6%) of right ventricular perforations as the major procedural complication. In comparison in 3341 EMB performed routinely in heart transplant recipients there were 4 (0.12%) bleedings/hematoma, 3 (0.09%) life threatening arrhythmia, 3 (0.09%) carotid puncture and 1 (0.03%) right ventricular perforation. Conclusions: In HFP without established etiology for heart failure, EMB is of diagnostic value in 26.9% of cases. Contrary to prior concerns regarding the safety of the EMB in HFP this diagnostic test can be completed with low procedural morbidity and no mortality.