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Resume L’admission en reanimation de malades atteints d’endocardite est generalement liee a une ou plusieurs complications, en particulier hemodynamique ou neurologique. L’echocardiographie transœsophagienne avec doppler est indispensable pour confirmer le diagnostic et faire une evaluation precise des lesions. L’epidemiologie microbienne des endocardites admises en reanimation se caracterise par une predominance de S. aureus et differe ainsi sensiblement de celle rapportee dans la population generale (role preponderant de streptocoques). Cette prevalence elevee s’explique par la virulence de cette espece, avec pour consequence des lesions valvulaires et perivalvulaires destructrices et une frequence elevee de complications neurologiques. En outre, un nombre croissant d’endocardites nosocomiales, souvent liees a des staphylocoques, est observe. La place de S. aureus explique, au moins en partie, le taux de mortalite eleve de l’endocardite necessitant l’admission en reanimation (36 % dans une serie de 127 episodes entre 1993 et 2000 dans le service de reanimation des maladies infectieuses, a l’hopital Bichat–Claude-Bernard). Des recommandations concernant l’antibiotherapie ont ete recemment publiees. Les indications et le delai de recours a la chirurgie doivent souvent etre discutes au cas par cas.

We discuss conditions such that strong stability and strong asymptotic compactness of a (discrete or continuous) semiflow defined on a subset in the positive cone of an ordered Banach space is preserved under asymptotic domination. This is used to show that on a Banach lattice with order continuous norm strong stability and almost periodicity of a (discrete or strongly continuous) semigroup of positive operators is preserved under asymptotic domination.

Die Vermeidung homologer Transfusionen ist zu einem wichtigen Zielkriterium in der operativen Medizin, aber auch in der medizinischen Onkologie oder Neonatologie geworden. Die Stimulation der Erythropoese durch rekombinantes humanes Erythropoetin (rHuEPO) kann hier bei ausgewahlten Patienten ohne wesentliche Nebenwirkungen das Spektrum fremdblutsparender Masnahmen erweitern. Unter dem Aspekt der Kosten-Nutzen-Relation eignen sich fur die Unterstutzung der Eigenblutspende, der am besten untersuchten Indikation, besonders Patienten mit praoperativer Anamie und zu erwartendem hohen Blutverlust in der Orthopadie, Kardiochirurgie und Urologie. Bei Eisenmangelanamie kann eine intravenose Eisensubstitution fur die optimale Effektivitat der rHuEPO-Therapie erforderlich werden. Derzeit ubliche Dosierungsschemata sind z. B. 2-mal wochentlich 300 U/kg KG s.c. uber 3 Wochen oder taglich 300 U/kg KG uber 10–14 Tage praoperativ. Weitere Einsatzmoglichkeiten und kostengunstigere Dosierungsformen werden derzeit zur Vermeidung von Transfusionen besonders in der onkologischen Chirurgie und Intensivmedizin untersucht. In einzelnen Fallen kann auch die Gabe von rHuEPO bei Patienten, die Bluttransfusionen generell ablehnen (Zeugen Jehovahs), sinnvoll sein.

The human automatic pre-attentive change detection system indexed by the mismatch negativity (MMN) component of the auditory event-related brain potential is known to be highly adaptive. The present study showed that even infrequent repetitions of tones can elicit MMN, independently of attention, when tones of varying frequency are rapidly presented in an isochronous rhythm. This demonstrates that frequency variation can be extracted as an invariant feature of the acoustic environment revealing the capacity for adaptation of the auditory pre-attentive change detection system. It is argued that this capacity is related to the temporal-window of integration.

Purpose: The relationships between the aerobic and anaerobic abilities for local and general exercises has been studied in twenty three subjects.Methods: Maximal aerobic power (PMA), the lactate level corresponding to 4 mmol l−1 (Pla4) and maximal anaerobic power on a Monark cycle ergometer (general exercises) have been correlated with aerobic and anaerobic performances for knee extension exercises (local exercises). Maximal anaerobic power (Pmax) has been determined by means of a force–velocity test on the same Monark ergometer. Two indices of local aerobic ability were estimated: 1) the peak power (Ppic) measured at the end of an incremental knee extension exercise, 2) the knee extension critical power (PC) calculated as equal to the slope of the relationship between exhaustion time and total work performed during three exhaustives exercises at constant load. Maximal anaerobic power of the knee extensors was determined by measuring the maximal power at an angular velocitie of 240° s−1 (Pbiodex) with an isokinetic ergometer.Results: The correlations between all the indices of local and general aerobic abilities were highly significant (0.82, Objectif: Afin de préciser les relations entre les aptitudes physiques locales et générales, nous avons procédé chez 23 sujets à l'étude des corrélations entre des indices généraux aérobies, des indices locaux aérobies et les puissances maximales anaérobies générale et locale.Méthodes: Les indices généraux aérobies, représentés par la puissance maximale aérobie (PMA) et la puissance correspondant à une lactatémie de 4 mmol l−1 (Pla4), ont été déterminés à l'occasion d'un exercice progressif sur bicyclette ergométrique. Les indices locaux aérobies ont été déterminés au moyen d'exercices réalisés sur un ergomètre conçu pour effectuer des extensions de jambe. Il s'agit de la puissance maximale mesurée au terme d'un exercice progressif (Ppic) et de la puissance critique (PC), calculées à partir de la relation qui unit le temps et le travail, établie à l'issue de trois exercices à charge constante menés à épuisement. Les puissances maximales anaérobies générale et locale ont été évaluées, respectivement, au moyen d'un test de charge-vitesse sur ergocycle (Pmax) et d'un test sur ergomètre isocinétique (Pbiodex).Résultats: Les corrélations entre toutes les variables aérobies sont hautement significatives (0,82

We develop a framework for optimal control policy synthesis for non-deterministic transition systems subject to temporal logic specifications. We use a fragment of temporal logic to specify tasks such as safe navigation, response to the environment, persistence, and surveillance. By restricting specifications to this fragment, we avoid a potentially doubly-exponential automaton construction. We compute feasible control policies for non-deterministic transition systems in time polynomial in the size of the system and specification. We also compute optimal control policies for average, minimax (bottleneck), and average cost-per-task-cycle cost functions. We highlight several interesting cases when optimal policies can be computed in time polynomial in the size of the system and specification. Additionally, we make connections between computing optimal control policies for an average cost-per-task-cycle cost function and the generalized traveling salesman problem. We give simulation results for motion planning problems.

Die reverse Transkriptase-Polymerase-Kettenreaktion fur das prostataspezifische Antigen und die Immunozytochemie fur Zytokeratin 18 (CK-18) kann zur Detektion eines mikrodisseminierten Prostatakarzinoms eingesetzt werden. In der Untersuchung von Knochenmarkaspiraten und peripher venosem Blut bei 50 Patienten mit einem klinisch lokal begrenzten Prostatakarzinom wurde die Rate positiver Resultate mit beiden Methoden bestimmt und zu pT-Stadium, Serum-PSA und vorheriger antiandrogener Behandlung in Beziehung gesetzt. Es lag kein Zusammenhang zwischen dem Nachweis von PSA-mRNA-Expression bzw. CK-18-positiven Zellen und diesen Parametern vor. Die Polymerasekettenreaktion und die Immunozytochemie sollten derzeit nur in prospektiven Untersuchungen eingesetzt werden, die eine standardisierte Methode verwendet und einen Serum-PSA Langzeitverlauf garantiert.

In the Xenopus laevis embryo, the overexpression of the Xl-FLI protein, a transcription factor of the ETS family, provokes severe developmental anomalies, which affect anteroposterior and dorsoventral polarities, optic cup formation, head cartilage morphogenesis, and erythrocyte differentiation. It has been proposed that these effects could be correlated to modifications of cell adhesion properties and/or to an increased engagement of cells in the apoptotic pathway during early development (Remy et al., Int. J. Dev. Biol. 40, 577–589, 1996). To address these questions, we have first analyzed the behavior of cells overexpressing the protein in both aggregation and adhesion assays. We observe perturbations of cell–cell interactions as well as perturbations of cell adhesion and spreading on fibronectin and extracellular matrix (ECM). Second, we have analyzed apoptosis of cells overexpressing the Xl-FLI protein, by testing DNA fragmentation, caspase-3 activity and by performing TUNEL assay. We show that Xl- Fli overexpression results in the appearance of hallmarks of apoptosis, including exclusion of cells from the interior of the embryo, internucleosomal fragmentation of DNA and dose-dependent induction of caspase-3, resulting in the hydrolysis of poly(ADP-ribose) polymerase. In addition, a dominant-negative mutation of BMPs receptors decreases the effects of Xl- Fli overexpression, suggesting that a modification of the BMP signalling could be responsible for increased apoptosis. The latter appears to affect predominantly ventral and ventrolateral regions of the embryo.

125 konsekutive Patienten mit Adenokarzinom der Prostata wurden einer erweiterten radikalen perinealen Prostatektomie entsprechend der Technik von Weldon unterzogen. Diese Technik wurde durch die primare komplette Mobilisation der Prostatahinterflache und der Samenblasen, der Inzision der Faszia endopelvina, der queren Inzision der Denonvillier-Faszia am Apex und der partiellen Durchtrennung des dorsalen Venenkomplexes nach vorangegangener Durchstechungsligatur modifiziert. Die perioperative Morbiditat war gering. Eine operative Wundrevision war bei 4 (3,2%) der Patienten wegen subkutaner arterieller Blutung aus dem Drainagekanal (n=1), Wundinfekt (n=2) und rektokutaner Fistel (n=1) erforderlich. Der Dauerkatheter wurde bei 104 (83%) Patienten am 4.–8. Tag entfernt. Positive Schnittrander fanden sich nur bei 22 (17,6%) Patienten. Es handelte sich dabei um 17 pT3- und 5 pT4-Tumoren mit Gleason-Score ≥7 (n=17), ausgedehntem, multifokalem Kapseldurchbruch (n=18), Infiltration der Samenblasen (n=11) und Lymphknotenmetastasen (n=4). Die unifokal positiven Schnittrander fanden sich am Apex (n=3), dorsolateral (n=6) und am Blasenhals (n=4); 9-mal lag ein multifokal positiver Schnittrand vor. Die Wahrscheinlichkeit des positiven Schnittrandes ist abhangig vom Serum-PSA, Gleason-Score und Tumorvolumen. Wird auf eine Potenzerhaltung verzichtet, so wird zur Vermeidung von positiven Schnittrandern die erweiterte radikale perineale Prostatektomie mit den angegebenen Modifikationen empfohlen.

Healthcare delivery involves complex systems Preventable injuries occur more frequently than in other complex industries. Clinical risk management aims to reduce the probability of adverse patient events occurring. Adverse events can be detected by medical record review, clinical incident reporting and other methods. Events are analysed to determine latent and active errors and ranked in order of risk severity. Action is then planned and implemented to prevent the event from recurring. Effective actions include simplifying systems, standardising procedures, introducing constraints, using reminders and checklists, providing timely information, and small-group interactive education. Organisational factors that may increase the probability of successfully reducing medical errors in hospitals include the availability of adequate resources and education, the presence of clinical, executive and board of management quality champions, and quality improvement and risk management as key objectives in a hospital's strategic plan. Governments can aid the implementation of risk management programs by financially rewarding high quality care.

Developing transdermal therapeutic systems for estradiol and norethindrone acetate raised questions about the steroids penetration pathway across and retention in the skin. This paper describes the distribution of 3H-estradiol and 3H-norethindrone acetate in human stratum corneum after topical application to dermatomed skin in vitro. The study involved (a) permeation experiments to determine the steroid flux, (b) autoradiographical visualization of the steroid distribution in the same skin samples, and (c) a correlation between flux and skin distribution in time. On correlating the steroid flux with intraepidermal steroid distribution, it was concluded that both permeants were bound in the skin tissue. The steroids were preferentially located in or close to the intercellular lipids of the stratum corneum, indicating that both transport and binding occurred via this domain of the stratum corneum. This study demonstrated the importance of correlating drug flux with intraepidermal drug distribution as a function of time.

This paper is devoted to an experimental investigation of concentration variance diffusion in a grid generated turbulent flow. Combined laser-induced fluorescence applied to concentration measurement and two-dimensional laser-Doppler velocimetry are implemented in order to measure simultaneously and instantaneously the molecular concentration of the passive tracer and two components of the carrier flow velocity. The different terms of the scalar variance transport equation can be measured directly in order to deduce the scalar fluctuations dissipation rate. It is shown that the approximation scalar variance advection ≃ dissipation is valid, similarly to the decay of turbulent kinetic energy in the wake of a grid. The simultaneous determination of both scalar variance and kinetic energy dissipation rates permit an experimental determination of the scalar to velocity time scale ratio. Finally, an analysis of the self similarity of the fluctuating concentration field is also provided.

We present an investigation of the formation, ionization and fragmentation processes of a new class of clusters consisting of an ionically bound cluster core, coated by a shell of Van der Waals bound atoms. Element specific soft X-ray photoionization spectroscopy was used to investigate the alkali halide cluster core and the Ar coating separately. The thickness of the coating controls the mechanism of ionization and fragmentation of these inhomogeneous clusters. Unusual metastable structures of alkali halide clusters were observed when the thickness of the coating exceeded two monolayers.

The purpose of this study was to test the hypothesis that renal cell carcinoma (RCC) exhibits an increased intratumoral interstitial fluid pressure (IT-IFP). Therefore, resected tumors from human primary (n = 23) or metastatic RCC (n = 3) were xenografted in SCID mice. The IFP of single tumor nodules (n = 65) and normal mouse tissue (n = 195) was measured by means of the "wick-in-needle" technique. Data demonstrate that the mean IT-IFP at neoplasia was 35 times greater than in normal tissue, and decreased precipitously at the tumor boundary. IT-IFP values tended to increase with the grade of malignancy of the tumor cells and tumor size. The mean IT-IFP of xenografts derived from primary RCC was twice as high as that from metastatic RCC tissue. These findings indicate a biophysical barrier to drug delivery in RCC; this may, in concert with cellular-based drug resistance mechanisms, be an additional explanation for resistance of the tumor to certain blood-borne anticancer therapies.

Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES) is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE). We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.

Medium size Ar clusters 〈N〉 ~ 500 were used to pick-up and aggregate CsI molecules. The primary Ar cluster beam can he converted into a beam of bare or Ar-covered alkali halide clusters by varying the number of pick-up events. Soft X-ray photoionisation was used to monitor the depletion of the Ar shell around the guest cluster. It was found that. the Ar coverage controls the mechanism and degree of guest cluster ionization. For embedded CsI clusters charge transfer from the Ar shell is the dominant soft X-ray ionization process. Small alkali halide cluster fragments are ejected from the Ar host cluster. The detection of weakly bound stoichiometric (CsI) n + , clusters indicates that the Ar-shell prevents the desorption of neutral halogen atoms.

Medium size Kr and Ar clusters ∼200-400 were used to pick up and aggregate CsI molecules. By varying the number of pick-up events it was possible to change the size of the guest cluster and the thickness of the rare gas coverage around the alkali halide cluster. “Soft” single (multiple) ionisation of the alkali halide core was achieved via charge transfer from the primary ionised rare gas shell. It turns out that the rare gas shell controls the vibrational relaxation of CsI cluster ions. Due to cooling by the rare gas shell shallow metastable states of multiply charged CsI clusters can be populated and detected. Clusters as small as Cs5I32+, Cs6I52+, Cs13I133+ and Cs17I143+ could be observed for the first time. The abundance of these multiply charged clusters steeply decreases if the thickness of rare gas shell shrinks.

X-ray absorption near edge spectroscopy (XANES) was used to investigate the size dependent development of XANES structures from free molecules and clusters up to the solid NaCl. For measurements on clusters a new type of cluster source was designed in order to provide an intense and continuous cluster beam for inner shell absorption experiments on tightly bound clusters. Partial ion yield absorption spectra at the Cl 2p-edge were recorded for different NanCln−1 ions using a time-of-flight mass spectrometer at the high flux and high resolution undulator beamline BW3 at HASYLAB. The absorption spectra revealed a gradual evolution from the NaCl molecule and cluster to the solid. A comparison with recently performed multiscattering calculations indicates that the bond length even for rather small clusters (n=4) is increased by approximately 50% of the bond length change from the molecule to the solid.

Pelvic lymphadenectomy in patients with organ confined prostate cancer (PCa) is of no therapeutic value and is questionable in many patients because of the low incidence of metastases. 49 patients with ≤ cT2 b, G1 + 2, PSA ≤ 10 ng/ml underwent laparocopic pelvine lymphadenectomy and radical perineal prostatectomy. Only 1 patient (2 %) had microscopic metastases which were missed on frozen section. Because of these own results and those reported in the literature we then performed in patients with this constellation the radical perineal prostatectomy without lymphadenectomy (n = 32). The differences present in both groups concerning complication rate and morbidity are due to laparoscopic lymphadenectomy and the learning curve in perineal prostatectomy.

Traditional approaches to dispute resolution in Micronesia offer elements of reconciliation that are practical and essential for maintaining peaceful relationships on a small island. These elements include family involvement, ritualistic processes, symbolism, mediation, and restitution. Using information gathered through interviews and an observation of a simulation, and by reviewing literature related to cultural differences in general, this paper introduces these elements, describes their application in real life and ceremonial events, and discusses theoretical connections with the cultural dimension of individualism and collectivism. In conclusion, the authors encourage a heightened awareness, further research, and continued practice of traditional Micronesian approaches to dispute resolution.

Objective: To examine whether prostate-specific antigen (PSA) is present in amniotic fluid, whether the amniotic fluid PSA concentration changes with gestational age, and whether there is an association between amniotic fluid PSA and fetal sex. Methods: The PSA concentration was measured in the amniotic fluid of 48 pregnant women. Thirty-four samples were obtained during routine amniotic fluid analyses performed during gestational weeks 16–18, whereas 14 samples were obtained during cesarean section performed after gestational week 36. Results: PSA was detected in all amniotic fluid samples. The median amniotic fluid PSA was 0.193 ng/ml during gestational weeks 16–18 and 0.39 ng/ml after gestational week 36 (p = 0.1). Furthermore, no significant association was seen between amniotic fluid PSA and fetal sex. The median amniotic fluid PSA level was 0.233 ng/ml for the 21 boys and 0.222 ng/ml for the 27 girls investigated (p = 0.72). Conclusions: These results confirm recent literature reports that PSA may serve as a growth regulator during normal fetal development. However, further studies are necessary to elucidate the exact role of PSA during fetal development.

A mathematical model is developed to analyze the unsteady flow through an harmonically oscillating cascade of airfoils, including separated flow. The model incorporates an inverse integral boundary layer solution with the time-marching Euler analysis NPHASE. An embedded composite grid formulation is incorporated, specifically a deforming C-grid embedded in a Cartesian H-grid, thereby simplifying grid generation. To reduce computational requirements, Fourier series unsteady periodic boundary conditions are implemented. The integral turbulent boundary layer model is closed with steady correlations adopted in a quasi-steady manner. To couple the inviscid and viscous solutions, the viscous effect is modeled in the unsteady Euler solution in a quasi-steady manner by a transpiration boundary condition. An isolated airfoil is used to compare the steady interaction model with experimental data. Then a flat plate cascade is used to verify the unsteady flow solver with linear theory predictions. An experimental unsteady aerodynamics data set of a loaded cascade with separated meanflow executing torsional oscillations compared favorably with the analysis. The code is then utilized to study the effect of flow separation on the unsteady aerodynamics.

Mutations in LRRK2 were first reported as causing Parkinson's disease (PD) in late 2004. Since then, approximately a dozen LRRK2 substitutions have been identified that are believed to be pathogenic mutations. The substitution of adenine for guanine at nucleotide 4541 (4541G>A) in LRRK2 was recently reported. This substitution resulted in the replacement of an arginine at position 1514 with a glutamine (R1514Q). Although this substitution was not found in a large cohort of controls, its pathogenicity could not be verified. We have now genotyped the R1514Q substitution in a sample of 954 PD patients from 429 multiplex PD families. This substitution was identified in 1.8% of the PD patients; however, the majority of the PD sibships segregating this substitution were discordant for this putative mutation. In addition, the R1514Q substitution was detected in 1.4% of neurologically evaluated, control individuals. These data suggest that the R1514Q variant is not a pathogenic LRRK2 mutation. We believe it is imperative that the causative nature of any newly identified genetic variant be determined before it is included in any panel for diagnostic testing.

We show the ability of a gelatin and a BSA-trehalose film to convert normally fragile dry immobilized acetylcholinesterase enzyme (AchE) into a stable reagent on nitrocellulose membrane. The remarkable property of the dry immobilized AchE enzyme preparation is its stability when exposed to temperatures as high as 50°C. The proposed method offers a rapid, simple, and inexpensive means in a non-laboratory setup for qualitative analytical colorimetric screening of AchE inhibitor residues such as pesticides and drugs in water and biological fluids.

We investigated event-related potential indications for the orienting towards task-irrelevant, distracting aspects of stimulation and for the subsequent reorienting towards task-related aspects of stimulation. An identical experimental protocol was run in three conditions manipulating the task relevance of the sounds. As to be expected, distractors elicited the MMN (reflecting the brain's pre-attentive change detection) in each condition (even when the sounds were ignored) and subsequent N2b and P3 (reflecting orienting towards the distractor) when the sounds were attended. A late negativity was confined to a condition in which subjects discriminating long from short sounds were distracted by task-irrelevant frequency deviations. The 'reorienting negativity' (RON) probably reflects processes in the context of reorienting towards task-relevant aspects of stimulation following distraction.

This paper is devoted to the analysis of the mass transfer properties in a grid generated turbulent flow. The closure of the transport equation of the turbulent mass flux has been experimentally investigated. Two combined optical non-intrusive methods, the laser-induced fluorescence and the laser Doppler velocimetry have been used in order to measure simultaneously and instantaneously the concentration of a passive contaminant and the velocity of the flow. It has been demonstrated that the approximation production = pressure scrambling is valid over the major part of the flowfield. A model for the pressure scrambling term has been analysed in order to define a turbulent diffusivity concept.

The purpose of this study was to validate a one-mile walk (1-MW) test for high school age individuals. Twenty-one students completed the 1-MW on two separate occasions. Forty-four students completed one 1-MW and a modified Balke walking treadmill test to volitional fatigue; the mean (M) of maximal oxygen comsumption (VO2max) = 45.39, standard deviation (SD) = 8.26 mL · kg-1 · min-1. VO2max values were predicted from the 1-MW results using the Kline, Porcari, Hintermeister, et al. (1987) Rockport Fitness Walking Test (RFWT) equation (M = 46.91, SD = 6.38 mL · kg-1 · min-1) and the Dolgener, Hensley, Marsh, and Fjelstul equation (1994; M = 39.88, SD = 5.87 mL · kg-1 · min-1). Intraclass stability reliability coefficients were .91 for the Kline, Porcari, Hintermeister, et al. equation and .97 for the Dolgener et al. equation. The validity coefficient was r =.84, standard errors of the estimate (SEE) = 4.50, Error = 7.16, and 38.6% of the measured VO2max values fell within ±4.5 mL · kg-1 · min-1 of the estima...

Purpose: To study the efficacy of prostate-specific antigen (PSA) and skeletal alkaline phosphatase (SAP) as staging markers in discriminating patients with cancer of the prostate (CaP) with (M+) and without bone metastases (M0). Material and Methods: 73 patients with untreated CaP entered the study. After staging the patients were divided into 3 groups: group I, patients with CaP and bone metastases (n = 21); group II, patients with locally advanced CaP without bone metastases (n = 26), and group III, patients with clinically localized CaP without bone metastases (n = 26). Results: None of the M0 patients but 71% of the M+ patients exhibited an increased SAP. A corresponding cutoff point of 100 ng/ml for PSA showed that 19% of M0 patients and 71% of the M+ patients exhibited a value of >100 ng/ml. This resulted in a sensitivity and specificity of 71 and 100% of SAP and 71 and 81% for PSA, respectively. Conclusion: SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it provides additional information concerning the skeletal status of these patients.

In an international, multicenter, open-label, randomized comparative study, adult patients in intensive care units were enrolled to receive cefpirome intravenously at 2 g twice daily or ceftazidime intravenously at 2 g three times daily for the empiric treatment of pneumonia. Randomization was performed after a double stratification according to the investigator’s initial choice of monotherapy or combination therapy and then on the basis of the severity of disease. The primary endpoint was the clinical response at the end of treatment in the intent-to-treat population. Data for all patients were reviewed by a blinded observer. Of the 400 enrolled patients, 201 received cefpirome (monotherapy, 56%) and 199 received ceftazidime (monotherapy, 51%). Pneumonia was hospital acquired for 75% of the patients. Clinical failures rates were 34 versus 36% (odds ratio = 0.922; upper bound of 90% confidence interval = 1.301) in the intent-to-treat analysis for cefpirome and ceftazidime, respectively. For the cefpirome and ceftazidime groups, there were 35 versus 30% clinical failures among monotherapy-stratified patients, respectively, and 34 versus 42% clinical failures among combination therapy-stratified patients, respectively. The rates of clinical failures in the per-protocol analysis were 38 and 42%, respectively. In the population of patients evaluable for bacteriologic efficacy, eradication or presumed eradication was obtained for 71% (172 of 241) and 70% (162 of 230) of the pathogens isolated from the patients receiving cefpirome and ceftazidime, respectively. The mortality rates within 2 weeks after the end of treatment were similar (cefpirome group, 31%; ceftazidime group, 26%), as were the percentages of patients with at least one treatment-related adverse event (17 and 19%, respectively). An empiric treatment strategy with cefpirome at 2 g twice daily is equivalent in terms of efficacy and tolerance to ceftazidime at 2 g three times daily for the treatment of pneumonia in patients in intensive care units.

Resume La necessite d'associer les glycopeptides a un ou deux autres antibiotiques lors du traitement d'infections graves a S. aureus resistant a la meticilline (SARM) reste controversee. Les resultats des tests in vitro sont variables et parfois contradictoires. Dans les modeles animaux, en particulier celui de l'endocardite, les associations ont dans l'ensemble un effet benefique. Les etudes cliniques sont cependant peu nombreuses et ne permettent pas de trancher. Les deux arguments habituellement mis en exergue en faveur de l'association sont l'utilisation d'antibiotiques a bonne diffusion tissulaire et l'obtention d'une bactericidie plus rapide. La question ne restera cependant pertinente que si l'evolution des pourcentages de resistance ne rend pas caduque l'emploi des partenaires aux glycopeptides.

Der vorliegende Obersichtsartikel stellt die Rationale der intermittierenden Androgenblockade (IAD) zur endokrinen Therapie des Prostatakarzinoms vor. Es wird ein Oberblick uber die aktuelle Datenlage der verschiedenen Pilotstudien zur IAD gegeben. In Deutschland hat sich die Arbeitsgemeinschaft Urologische Onkologie (AUO) des Themas angenommen und verschiedene prospektive, randomisierte Studien initiiert bzw. geplant. Bis langzeitresultate aus klinischen Studien vorliegen bleibt die IAD ein experimentelles Vorgehen. Eine Behandlung sollte nur unter Studienbedingungen erfolgen, wobei zu einer breiten Beteiligung aller onkologisch interessierten Urologen an den AUO-Studien aufgefordert wird.

The aim of this paper is to provide some significant experimental results for the mass diffusion process from a point source in a quasi-isotropic homogeneous turbulent field generated by means of a grid. Experimental data for the mean, the fluctuating concentration fields, and the turbulent mass flux, which is the cross-correlation between concentration and velocity, are provided. Two combined optical non-intrusive methods, laser-induced fluorescence and laser Doppler velocimetry, have been used to measure simultaneously and instantaneously the concentration of the passive contaminant and the velocity of the flow. The experimental results are compared with a theoretical development, including the concept of turbulent diffusivity. An experimental determination of the turbulent diffusivity is also performed.

Spatial separation of sound sources provides a primary cue for selecting relevant from irrelevant acoustic input. This competence for selective listening is important in every-day life, when several concurrent sound sources are simultaneously active. The present study demonstrated a temporal advantage in the preattentive processing of location information relative to frequency information. This was indicated by shorter latency of the mismatch negativity (MMN), generated by the brain's automatic detection of a sound change, to a location change than to a frequency change. Results suggest that the superior role of spatial location for selective listening may be due to faster automatic encoding of spatial than spectral information into the neural representations underlying attentional selection.

Max Brodel (1870–1941), from Leipzig, Germany, is often referred to in the USA as the father of modern medical illustration and mentioned in the same breath as Leonardo da Vinci or Andreas Vesal. After a classical formal art education in Leipzig he worked in Carl Ludwig's laboratory of physiology and anatomy, where he came in contact with American physicians. In 1894, the anatomist F. P. Mall convinced him to work for the recently inaugurated Johns Hopkins School of Medicine in Baltimore, where he collaborated with world-famous surgeons such as H. A. Kelly, W. S. Halsted, and H. Cushing. His illustrations were characterized by meticulous observation, both realistic and explanatory intention, technical superiority, and artistic merit. In 1911 he established the first “Department of Art as applied to Medicine”. Here, he proved to be an innovative artist, a creative scientist, and an inspiring and skillful instructor. By the time of Brodel's retirement in 1939, 160 students had graduated as medical illustrators. His pupils spread his principles and style throughout the USA and Canada, and several similar academic programs for medical illustration have been founded in these countries.

Bis(arene)ruthenium(II) complexes of the type [(η6-cymene)Ru(η6-aa)](CF3SO3)n (2-9) containing L-tyrosine and L-tryptophan derivatives may be prepared by treatment of [(η6-cymene)Ru({CH3)2CO}3](CF3SO3)2 with the appropriate bioligand in CH2Cl2, for fully protected compounds and CF3COOH for α-amino acids (aa) with unprotected amine or carboxylic acid groups. Whereas the tyrosine and tryptophan methyl ester complexes [(η6-cymene)Ru(η6-H2tyrOMe)](CF3SO3)3 (4) and [(η6-cymene)Ru(η6-H2trpOMe)](CF3-SO3)3 (8) contain trications with protonated amino functions, the remaining compounds all exhibit dications. The crystal structure analysis of [(η6-cymene)Ru(η6-HtyrOH)](CF3SO3)2 (5) confirms a marked distortion towards an η5-oxohexadienyl coordination with deprotonation of the aromatic side chain. Although facial isomers are formed in an effectively 1:1 ratio for all tryptophan derivatives fractional crystallization allowed an X-ray structural characterization of the β-isomer of [(η6-cymene)Ru(η6-ActrpOMe)](CF3SO3)2 (6). Chemospecific labeling of the tryptophan side chain was established for the mixed dipeptide phenylalanyltryptophan.

We investigated whether the free-to-total prostate-specific antigen (PSA) ratio (f-PSA/t-PSA ratio; i. e. percentage of free PSA) represents a better discriminator for the detection of cancer of the prostate (CaP). In a retrospective analysis, the persentage of free PSA was determined in the sera of 35 patients with histologically proven benign prostatic hyperplasia (BPH) and 35 patients with clinically localized CaP. Patients with urolithiasis (n = 33) served as a control group. Serum levels of free PSA and total PSA were determined employing a chemiluminescent enzyme immunoassay. Patients with CaP demonstrated a lower percentage of free PSA (median: 8.7) than patients with BPH (median: 20.0; P < 0.001) and those with urolithiasis (median: 18.8; P < 0.001). Determination of the percentage of free PSA enhances the differentiation between BPH and CaP and may reduce the number of unnecessary biopsies in patients with an elevated PSA. Confirmation of our preliminary results is required.

Objective To compare perinatal outcome in older oocyte recipients with that in women of advanced maternal age who conceived without assisted reproductive technologies. Methods We performed a retrospective cohort study of 46 oocyte recipients and 49 women who conceived without assisted reproductive technologies. The obstetric courses in singleton and multiple gestations in the two groups of women were compared. Results Among singleton pregnancies, a comparable obstetric course was noted between the groups. Fifty percent of the oocyte recipients experienced multiple gestations, resulting in an increased risk for placenta previa, premature rupture of membranes, preterm labor and delivery, glucose intolerance of pregnancy, pregnancy-induced hypertension, and cesarean delivery. However, only the risks for pregnancy-induced hypertension and cesarean delivery were significantly increased in the pregnancies of oocyte recipients with multiple gestations. Conclusions Perinatal complications in women receiving oocyte donation may be related to their higher incidence of multiple gestation.

Of the many intermetallic compounds identified to date, only a relatively small number are candidates suitable for further development as high-temperature structural intermetallics. Were it not for the relative scarcity of ruthenium, the B2 compound RuAl might have received considerably more development impetus from its unusual inherent combination of ductility, strength, and thermodynamic stability. Nevertheless, variations of this compound have received a great deal of attention. RuAl possesses an almost unique line-up of physical, chemical, and mechanical properties, and, provided that misconceptions that it is exotic and expensive can be addressed, it is bound to attract more attention in the future.

Chronic fatigue syndrome is a condition that affects women in disproportionate numbers, and that is often exacerbated in the premenstrual period and following physical exertion. The signs and symptoms, which include fatigue, myalgia, and low-grade fever, are similar to those experienced by patients infused with cytokines such as interleukin-1. The present study was carried out to test the hypotheses that (1) cellular secretion of interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1Ra), and soluble interleukin-1 receptor type II (IL-1sRII) is abnormal in female CFS patients compared to age- and activity-matched controls; (2) that these abnormalities may be evident only at certain times in the menstrual cycle; and (3) that physical exertion (stepping up and down on a platform for 15 min) may accentuate differences between these groups. Isolated peripheral blood mononuclear cells from healthy women, but not CFS patients, exhibited significant menstrual cycle-related differences in IL-1β secretion that were related to estradiol and progesterone levels (R 2 = 0.65, P < 0.01). IL-1Ra secretion for CFS patients was twofold higher than controls during the follicular phase (P = 0.023), but luteal-phase levels were similar between groups. In both phases of the menstrual cycle, IL-1sRII release was significantly higher for CFS patients compared to controls (P = 0.0002). The only changes that might be attributable to exertion occurred in the control subjects during the follicular phase, who exhibited an increase in IL-1β secretion 48 hr after the stress (P = 0.020). These results suggest that an abnormality exists in IL-1β secretion in CFS patients that may be related to altered sensitivity to estradiol and progesterone. Furthermore, the increased release of IL-1Ra and sIL-1RII by cells from CFS patients is consistent with the hypothesis that CFS is associated with chronic, low-level activation of the immune system.

Development of new optical sensor technologies has a major impact on the progression of diagnostic methods. Of the permanently increasing number of non-invasive 1 3 C-breath tests, the Urea Breath Test for detection of Helicobacter pylori is the most prominent. However, many recent developments go beyond gastroenterological applications. We present a new detection scheme for breath analysis that employs an especially compact and simple set-up based on Photoacoustic Spectroscopy. Using a wavelength-modulated DFB-diode laser and taking advantage of acoustical resonances of the sample cell, we performed very sensitive isotope-selective measurements on CO 2 . Detection limits for 1 3 CO 2 of a few ppm and for the variation of the 1 3 CO 2 concentration of approximately 1% were achieved.

Presented here are two cases of multidrug-resistant Nocardia farcinica infection that occurred in immunocompromised patients. One of the patients developed the infection despite being on trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis jiroveci. These cases demonstrate the propensity of Nocardia spp. to cause disseminated disease and to develop resistance to multiple antimicrobial agents used in the initial treatment of serious Nocardia infection. These factors lead to the conclusion that empiric monotherapy with trimethoprim/sulfamethoxazole may not be sufficient. Treatment with a combination regimen of imipenem and amikacin may be a more promising initial therapy.

The recognition of potential long-term effects of substances, has led to the development of regulations and legislation which emphasis the need for assessing the risks posed by both new and existing substances for man and the environment. The evaluation of fate and exposure models is put into perspective in relation to the developments over the last five years in the framework of the EU regulations and national legislation within the European Community. The validation of environmental exposure models (multi-media models) is described in the context of quality assurance of models available to a user group, which is different from the quality assurance aspects for a developers group.

We develop a method for the control of discrete-time nonlinear systems subject to temporal logic specifications. Our approach uses a coarse abstraction of the system and an automaton representing the temporal logic specification to guide the search for a feasible trajectory. This decomposes the search for a feasible trajectory into a series of constrained reachability problems. Thus, one can create controllers for any system for which techniques exist to compute (approximate) solutions to constrained reachability problems. Representative techniques include sampling-based methods for motion planning, reachable set computations for linear systems, and graph search for finite discrete systems. Our approach avoids the expensive computation of a discrete abstraction, and its implementation is amenable to parallel computing. We demonstrate our approach with numerical experiments on temporal logic motion planning problems with high-dimensional (10+ states) continuous systems.

This paper presents the results of a clinical study assessing the in vivo effects on plaque metabolism of a new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride compared to a commercially available dentifrice containing 1450 ppm fluoride alone.A four-week, parallel, randomized, double-blind clinical study using 54 subjects was conducted at the New York University College of Dentistry Bluestone Center for Clinical Research. Two study groups used the following products for two weeks: 1) a dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride as sodium monofluorophosphate (MFP; test); and 2) a commercial silica dentifrice with 1450 ppm fluoride as sodium fluoride (NaF; control). In the following two-week period, all subjects used the control product. The effects of product use on plaque metabolism in vivo were assessed by conducting ex vivo analyses at baseline, after two weeks of assigned product use, and after two weeks of control product use. These plaque analyses comprised pH measurements before and after an in vivo sucrose rinse, and measurements of ammonia production and lactate production.The study showed that subjects using the test dentifrice, containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, had significantly higher plaque pH values before the sucrose challenge than those using the commercially available control dentifrice (por = 0.01). Plaque samples from subjects using the arginine-containing dentifrice also produced significantly higher levels of ammonia (por = 0.01). Subjects using the arginine-containing dentifrice also had a directionally higher plaque pH after the sucrose challenge, and their plaque samples produced a directionally lower level of lactate during the two-week treatment period compared to subjects using the control dentifrice. Following two weeks of subsequent use of the control product, there were no significant differences in plaque metabolism measures between groups.A new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride has been shown in this study to modulate plaque metabolism, increasing ammonia production and decreasing lactate production, thereby increasing plaque pH to help restore a pH-neutral environment.

Androgen deprivation therapy is an integral part of the treatment of advanced and progressive prostate cancer. Various prospective randomised trials have investigated whether or not temporary suspension of androgen deprivation might delay the emergence of castration resistant prostate cancer and concomitantly improve quality of life. Until now, no phase III trial has been able to prove that intermittent androgen deprivation might delay the development of castration resistant tumours. Data from previous trials, except for one study, did at least not show adverse effects on survival. Data on quality of life are inconsistent, showing a trend towards improved quality of life with IAD. German as well as European guidelines reflect IAD as an established constituent of day-to-day medical practice. This review is intended to provide a code of practice for an individualised treatment as based on recently published studies.