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Robot-mediated rehabilitation is a rapidly advancing discipline that seeks to develop improved treatment procedures using new technologies, e.g., robotics, coupled with modern theories in neuroscience and rehabilitation. A robotic device was designed and developed for rehabilitation of upper limbs of post stroke patients. A novel force feedback bimanual working mode provided real-time dynamic sensation of the paretic hand. Results of the preliminary clinical tests revealed a quantitative evaluation of the patient's level of paresis and disability.

Unlabelled: We aimed at determining the pattern of liver disease in the Iranian children referred to the Medical Center of Children affiliated with the Tehran University of Medical Sciences., Materials and Methods: In a cross-sectional study conducted over 2 years, 425 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H & E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patients was calculated and compared with other similar studies., Results: The male to female ratio was 1.42:1. The age range was between 1 month and 18 years old and 41.4% were less than 2 years old. The most common histological diagnosis was iron overload due to major thalassemia (17.5%) followed by biliary atresia (9.7%), no significant pathologic change (8.7%), neonatal hepatitis (8.7%), chronic hepatitis (8.5%), cirrhosis (6.5%), metabolic disease (5.5%) and progressive familial intrahepatic cholestasis (5%). RESULTS of the hemosiderosis grading in patients with thalassemia revealed no or minimal, mild, medium, or marked increase in 10%, 27.1%, 10%, 21.4% and 31.5% of the cases, respectively and the degree of iron deposition rose in parallel with age and also the stage of fibrosis (p< 0.05)., Conclusion: A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. Also, we found that in non thalassemic children, biliary atresia, chronic hepatitis and neonatal hepatitis, in the stated order, are the most prevalent histologic diagnoses in Iranian pediatrics.

The utility of a novel, high-precision, non-intrusive, wireless, accelerometer-based patient orientation monitoring system (APOMS) in determining orientation change in patients undergoing radiation treatment is reported here. Using this system a small wireless accelerometer sensor is placed on a patient's skin, broadcasting its orientation to the receiving station connected to a PC in the control area. A threshold-based algorithm is developed to identify the exact amount of the patient's head orientation change. Through real-time measurements, an audible alarm can alert the radiation therapist if the user-defined orientation threshold is violated. Our results indicate that, in spite of its low-cost and simplicity, the APOMS is highly sensitive and offers accurate measurements. Furthermore, the APOMS is patient friendly, vendor neutral, and requires minimal user training. The versatile architecture of the APOMS makes it potentially suitable for variety of applications, including study of correlation between external and internal markers during Image-Guided Radiation Therapy (IGRT), with no major changes in hardware setup or algorithm.

Aim: The management of functional abdominal pain (FAP) in children and adolescents is challenging for health care professionals, and there are only limited or inconclusive studies of pharmacologic or behavioral therapy in childhood FAP. The objective of this randomized placebo-controlled clinical trial was to determine the potential efficacy and safety of cyproheptadine in the treatment of pediatric FAP., Methods: Between January 2006 and March 2007, 29 clinically referred children and adolescents with FAP (aged 4.5 to 12 years) completed a 2-week, double-blinded randomized placebo-controlled trial of cyprohetadine. Primary outcome measure was the self-reported change of frequency and duration of abdominal pain by using a 6-point scale, and the parents' impression or assessment of the children's improvement., Results: By week 1 and 2 of the intervention, the intensity and frequency of abdominal pain among the patients treated with cyproheptadine, were rated as complete resolved and very much improved or improved for 3 (20%), 10 (66.6%), respectively. However, in the placebo-receiver children, these scales had no change in 7 (50%), rated as improved or very much improved in 5 (35.7%), and become worse in 2 (14.3%). The patients' self-reported and the parents' impression in the cyproheptadine group were significantly better than it in the placebo group (P=0.003)., Conclusion: Among children with functional abdominal pain, cyproheptadine is enough effective to improve the intensity and frequency of abdominal pain in a short-term period.

A new approach, based on Adaptive-Network-based Fuzzy Inference System (ANFIS), is presented for the classification of arthrometric data of normal/ACL-ruptured knees, considering the insufficiency of existing criteria. An ANFIS classifier was developed and tested on a total of 4800 arthrometric data points collected from 40 normal and 40 injured subjects. The system consisted of 5 layers and 8 rules, based on the results of subtractive data clustering, and trained using the hybrid algorithm method. The performance of the system was evaluated in four runs, in the framework of a 4-fold cross validation algorithm. The results indicated a definite correct diagnosis for typical injured and normal cases. Except for two, all cases with marginally distinct force-displacement curves were also diagnosed correctly. The overall sensitivity and specificity of the system in four runs were 95.5% and 100%, respectively. The superior performance of the ANFIS classifier over previously suggested criteria highlights its capability when dealing with marginal arthrometric data of knees with partially disrupted ACL or hypermobility syndrome.

Introduction: Extra-hepatic biliary atresia (EHBA) is an important cause of neonatal cholestasis. Several infectious agents have been proposed as etiologic factors such as Rotavirus and Reovirus. There is limited data on the role of Epstein Barr virus (EBV) infection in EHBA, so we decided to study the presence of EBV virus in a series of 16 proven EHBA cases by chromogenic in situ hybridization (CISH) technique., Methods: In the current study a total of 16 liver wedge biopsies of proven cases of EHBA were selected in a period of 4 years. CISH staining for EBV-encoded RNA (EBER) transcript was performed., Results: The review of H&E-stained slides of liver biopsies revealed fibrosis and marked ductular proliferation. In CISH-stained slides, EBV trace was observed in hepatocytes in two cases and in biliary epithelium in one case of EHBA., Discussion: Considering the association of hepatitis with the Epstein-Barr virus in later life, it is likely that EBV hepatitis and its complications occur in the neonatal/perinatal period. Since EHBA is a relatively rare disease, a similar study on wedge biopsies of this number of proven cases of EHBA has not been performed to date. Current observation proposes the need for a study of larger series and employing other methods for confirming the etiologic role of EBV in EHBA cases.

Object: Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection., Methods: A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods., Results: Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4-18%) in the EBF group, 16.5% (95% CI 7-35%) in the CFBF group, and 26.0% (95% CI 12-52%) in the EFF group. There was no statistically significant difference between these 3 groups (p=0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p=0.035), which persisted even after adjustment for potential confounding variables (hazard ratio=2.01, 95% CI 1.01-4)., Conclusions: This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose-response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

The effect of the variation in the femoral groove geometry on patellofemoral joint stability was studied using a two-dimensional transverse plane model with deformable articular surfaces. The femoral and patellar bony structures were modelled as rigid bodies with their profiles expressed by splines. The articular cartilage was discretized into compression springs, distributed along the femoral and patellar profiles, based on the rigid-body spring model. The medial and lateral retinacula were modelled as linear tensile springs, and the quadriceps muscles and patellar tendon as strings with known tension. The anatomical data were obtained from the transverse plane magnetic resonance images of a normal knee flexed at 20 degrees and from the literature. A dynamic analysis approach was employed to solve the governing equations of the model, i.e. three static equilibrium equations of the patella and a constraint equation for each cartilage spring, explicitly. The results of the model suggest that alteration of the sulcus angle from 139 degrees to 169 degrees causes a lateral shift and tilt of less than 3 mm and 4 degrees. This effect increased slightly with increasing total quadriceps force, however, to significantly more than 7 mm and 18 degrees respectively when the medial retinaculum was released. It was suggested that this might be the combined effect of the medial retinaculum deficiency and trochlear dysplasia that is responsible for patellar subluxation and, particularly, dislocation disorders.

A dynamic model of an above-knee prosthesis during the complete gait cycle was developed. The model was based on a two-dimensional multi-body mechanical system and included a hydraulic and an elastic controller for the knee and a kinematical driver controller for the prosthetic ankle. The equations of motion were driven using Lagrange method. Simulation of the foot contact was conducted using a two-point penetration contact model. The knee elastic and hydraulic controller units, the knee extension stop, and the kinematical driver controller of the ankle were represented by a spring and a dashpot, a nonlinear spring, and a torsional spring-damper within a standard prosthetic configuration. The hip trajectory and net joint moment were considered as the initial conditions of the coupled differential equations. Design optimization of the prosthesis, to achieve the closest knee flexion pattern to that of the normal gait, resulted in a good correlation; the average differences with normal data were 3.3 and 3.4 deg for prosthetic knee and ankle joints, respectively. A parametric study showed that both increase and decrease of the stiffness by 50% caused an earlier knee flexion in stance phase and a lower knee flexion in swing phase. The effect of hydraulic controller damping coefficient on the flexion pattern of the prosthetic knee and ankle was only significant in the swing phase of the gait cycle.

An extension to the classical mass-spring model for more realistic simulation of soft tissues for surgery simulation was proposed. The conventional equations of mass-spring model were generalized for non-linear springs, and model parameters were tuned using experimental data. Results show that the proposed model is fast and interactive, and also demonstrate the typical nonlinear and visco-elastic behaviors of soft tissues well.

We simulated the knee arthrometry test to obtain a deeper understanding of the joint's stability behavior and interpret the arthrometric results more effectively. A 2D sagittal plane finite element model of the lower limb in the standard configuration of knee arthrometry was developed using ANSYS APDL. A detailed model of the knee joint was considered including the femoral articulating contour represented by an ellipse, the tibial plateau represented by a circular arc, and four major knee ligaments and their individual bundles represented by linear and nonlinear tensile springs. A deformable layer of articular cartilage was also considered over the tibial plateau to simulate the bones engagement more precisely. The model was analyzed while the tibia was subjected to an anterior drawer force of up to 150 N with 10 N increments and the tibial anterior translation was obtained. Simulation of the arthrometry test for different curvatures of the tibial plateau revealed that the bones engagement has a considerable effect on the knee joint's laxity. However, a considerable change from the intact knee's data curve was only observed when the ACL total ruptured was simulated. This emphasizes the difficult task involved when trying to distinguish the partial injuries of the ACL using arthrometric data.

Background: The aim of this study was to investigate the relationship between mast cell density, histological severity of gastritis, and presence of Helicobacter pylori (H. pylori) in the antral mucosa of pediatric patients., Methods: The study included 352 (192 male and 160 female, < 14 years old) patients. All cases underwent endoscopy, and biopsies were obtained for histopathological examination and evaluation of Helicobacter pylori. All biopsies were evaluated according to the Sydney system and mast cell density in the antral mucosa was analyzed by Giemsa stain. Spearman's correlation test was used to determine the relationship between mast cell density and other histopathological parameters. The comparison of mast cell density between H. pylori positive and negative groups was analyzed by Mann Whitney U test., Results: Mast cell density was 12.6 +/- 0.87 in 0.25 mm2 (0-81). Means of severity of gastric inflammation in H. pylori-positive and negative patients were 1.7 +/- 0.6 and 0.6 +/- 0.7, respectively, which was statistically significant (p = 0.0001). Mast cell density was not correlated with presence and degree of inflammation, activity, presence and score of H. pylori in the antrum (p > 0.05). There was no significant correlation between mast cell density and allergy., Discussion: We concluded that there may be some other ways for contribution of mast cells in pathologic processes involving gastrointestinal tract in children.

Patellar lateral stability was studied using a 2D transverse plane model with deformable articular surfaces. Quadriceps muscles and patellar tendon were considered as strings with predefined forces and lateral and medial retinaculum as tensile springs. Deformation behavior of articular cartilage was modeled by a set of compression springs perpendicular to articular surfaces, based on rigid body spring model method (RBSM). Patellar lateral stability was investigated using restraining force method (the external force required to cause up to 10 mm lateral displacement on patella). The results were in good agreement with experimental reports for normal joint, vastus lateralis and vastus medialis relieved. Small changes in the femoral trochlear groove geometry provided significant variation in patellar stability. Simulation of different surgical treatments showed that the tibial tubercle medialization is the most effective procedure for patellar subluxation and dislocation disorders.

The aim of this study was to assess some permeability and swelling characteristics of free films prepared by combination of inulin as a bacterially degradable system and time- or pH-dependent polymers as a coating formulation for colonic drug delivery. Different free films were prepared by casting and solvent evaporation method. Formulations containing inulin with Eudragit RS, Eudragit RL, Eudragit RS-Eudragit RL, Eudragit FS and Eudragit RS-Eudragit S with different ratios of inulin were prepared. After preparation, free films were evaluated by water vapor transmission test, swelling experiment and permeability to indomethacin and theophylline in different media. Formulations containing Eudragit FS had high resistance to water vapor permeation; but were unable to protect premature swelling and drug release in simulated small intestine media. Also, combination of Eudragit RS and Eudragit S had no suitable characteristics for colon delivery. However, Eudragit RS and Eudragit RL in combination with inulin made free films which had more swelling and permeation of drug in the colonic medium rather than the other media. It was shown that formulations containing sustained release polymethacrylates in combination with inulin have more potential as a coating system for specific colon delivery compared with pH-dependent polymers.

Based on the force-deflection equation for a beam subjected to lateral point loads, a C2 continuous piecewise bicubic mathematical representation was proposed to model complicated geometrical surfaces, e.g. the articular surfaces of human joints. The method was then extended so that it could be used for mathematical modelling of incomplete nets of data points, as well as smoothing of noisy and/or filtering of erroneous data points. Mathematical techniques were also developed to calculate the required unknown parameters explicitly, with no need to solve the system of equations simultaneously. The performance of the proposed method was evaluated on a number of surface modelling problems, including two known analytical surfaces and the human femoral and patellar articular surfaces. The results indicate that the proposed method is precise, flexible, and easy to apply and has several advantages over the conventional smoothing methods, i.e. the B-spline approach.

Purpose: Identification of a novel rhodopsin mutation in a family with retinitis pigmentosa and comparison of the clinical phenotype to a known mutation at the same amino acid position., Methods: Screening for mutations in rhodopsin was performed in 78 patients with retinitis pigmentosa. All exons and flanking intronic regions were amplified by PCR, sequenced, and compared to the reference sequence derived from the National Center for Biotechnology Information (NCBI, Bethesda, MD) database. Patients were characterized clinically according to the results of best corrected visual acuity testing (BCVA), slit lamp examination (SLE), funduscopy, Goldmann perimetry (GP), dark adaptometry (DA), and electroretinography (ERG). Structural analyses of the rhodopsin protein were performed with the Swiss-Pdb Viewer program available on-line (http://www.expasy.org.spdvbv/ provided in the public domain by Swiss Institute of Bioinformatics, Geneva, Switzerland)., Results: A novel rhodopsin mutation (Gly90Val) was identified in a Swiss family of three generations. The pedigree indicated autosomal dominant inheritance. No additional mutation was found in this family in other autosomal dominant genes. The BCVA of affected family members ranged from 20/25 to 20/20. Fundus examination showed fine pigment mottling in patients of the third generation and well-defined bone spicules in patients of the second generation. GP showed concentric constriction. DA demonstrated monophasic cone adaptation only. ERG revealed severely reduced rod and cone signals. The clinical picture is compatible with retinitis pigmentosa. A previously reported amino acid substitution at the same position in rhodopsin leads to a phenotype resembling night blindness in mutation carriers, whereas patients reported in the current study showed the classic retinitis pigmentosa phenotype. The effect of different amino acid substitutions on the three-dimensional structure of rhodopsin was analyzed by homology modeling. Distinct distortions of position 90 (shifts in amino acids 112 and 113) and additional hydrogen bonds were found., Conclusions: Different amino acid substitutions at position 90 of rhodopsin can lead to night blindness or retinitis pigmentosa. The data suggest that the property of the substituted amino acid distinguishes between the phenotypes.

Heart beat is an unavoidable source of interference during lung sound recording. This disturbance is more significant at low and medium breathing flow rates. Removing heart sounds (HS) from lung sound recordings or vice versa is a challenging task but of great interest for respiratory specialists and cardiologists. In this study, to separate the two signals, a novel HS separation method based on Independent Component Analysis (ICA) is developed. This method applies an ICA algorithm to the spectrograms of two simultaneous lung sound recordings obtained at two different locations on the chest and yields the independent spectrograms of the separated signals. Then, by implementing the Inverse Short Time Fourier Transform (ISTFT), the separated signals are reconstructed in the time domain. The method was applied to data of two healthy subjects. Analysis of the results as well as subjective inspections indicate the efficiency of the proposed method in terms of HS separation from lung sounds.

This paper presents the design of an automatic and intelligent robot arm for object grasping for people on wheelchair with mild to severe disabilities. The system is equipped with stereovision detection in order to distinguish different objects from the background. The robot arm has been designed with 6 degrees of action to grasp the detected object from the floor and bring it in front of the user. Two precalibrated digital cameras, facing downward, simultaneously take pictures of the surface where the object is located. Then by applying a new and robust 3D object detection method, the height, location and orientation of the object with respect to the robot's base point are found. The resulting rotation periods are transferred through a designated electronic driver board to the joints' motors via the PC parallel port. Overall, the system detects the object, moves the robot arm to the location of the object, grasps it, moves it to a predefined position in front of the user, releases the object and finally returns to its home position. The system is automatic and is operated by only one command.

Based on the analogy between the B-spline curve modeling and the force-deflection behavior of a beam subjected to lateral point loads, an extension to the B-spline surface modeling method was introduced. The proposed method has strong extrapolating capability and can develop accurate surface models over an incomplete net of data points without affecting the original data. Extrapolation of the incomplete part of the data net is conducted simultaneously with interpolation of the existing part, with no need to recalculation. Approximation or data smoothing is a natural extension of the method, however, the smoothing intensity can be controlled continuously without reducing the number of spline intervals. The performance of the method was evaluated on some known analytical surfaces and produced more accurate results in comparison with the regular B-spline approach. The results indicate that the proposed method can also filter erroneous data points and reconstruct the original surface successfully.

Although right heart failure (RHF) contributes to 20% of all cardiovascular complications, most of the information available on RHF in general is based on the experiences with left heart failure. This study on RHF investigates changes in antioxidants and oxidative stress which are suggested to play a role in the transition from hypertrophy to failure. RHF subsequent to pulmonary hypertension was produced in rats by a single injection of monocrotaline (MCT, 60 mg/kg, i.p.). Based on hemodynamic, clinical and histopathologic observations, the animals were grouped in three functional stages at 1-, 2- and 6-week post-injection periods. In the 1-week group, RV pressure overload and hypertrophy, and a mild increase in antioxidant enzymes was seen. In the 2-week group, compensated HF, a significant increase in antioxidant enzymes, an increase in septal (IVS) wall thickness and leftward displacement of IVS without change in LV free wall were seen. In the 6-week group, lung and liver congestion, RVF and dilation, a decrease in antioxidant enzyme activities, increase in lipid peroxidation and severe bulging of the IVS into the left ventricle were seen. These changes in the hemodynamic, biochemical and histopathologic characteristics suggest that in early stages of MCT-induced pulmonary hypertension at 1 and 2 weeks, RV hypertrophy was accompanied by sustained hemodynamic function and an increase in antioxidant reserve. In the later stage at 6 weeks, clinical RHF was associated with abnormalities of the right heart systolic and diastolic function along with a decrease in antioxidant reserve. These biphasic changes in RV antioxidant enzymes, i.e. an increase during hypertrophy and a decrease in failure may suggest a role of oxidative stress in the pathogenesis of right ventricular dysfunction.

Patellofemoral joint stability is a result of the restraining effects of the quadriceps muscles, the retinacular structures, and engagement of the bones. The role and significance of these mechanisms in restraining patellar lateral displacement was investigated in this study by measuring the force needed to cause 5 mm lateral displacement (i.e. the mechanical stability, or 'stabilising force') of the patella. Six cadaver knees had 175 N quadriceps load distributed among three muscle groups. With a force ratio matching the muscles physiological cross sectional areas, no significant change occurred in the patellar stabilising force between 0 and 60 degrees knee flexion, but a significant increase occurred between 60 and 90 degrees, presumably reflecting the contribution of the femoral groove. Variation of the quadriceps force distribution changed the stability significantly. Relaxing the vastus lateralis increased the patellar lateral stabilising force 52+/-8%, while relaxing vastus medialis reduced the stabilising force 47+/-9%. The minimum stabilising force was at 30 degrees knee flexion. Transection of the medial retinaculum reduced the lateral stabilising force 34% in the extended knee. This effect disappeared by 45 degrees knee flexion. It was concluded that the quadriceps muscles had a significant and consistent effect across the whole range of knee flexion, but the contribution of the medial retinaculum was restricted to extended knee postures.

Increased oxidative stress and reduction in antioxidant enzymes have been suggested to be involved in the pathophysiology of congestive heart failure subsequent to myocardial infarction (MI). The objective of the present study was to characterize changes in the mRNA abundance and protein levels for the enzymatic antioxidants, superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase during the sequelae of congestive heart failure in rats. MI was produced by the ligation of the left coronary artery and hearts from controls and 1, 4 and 16 week PMI groups were analyzed. Losartan treatment (2 mg/ml in drinking water, daily) was started at 4 weeks and continued for 12 weeks. The mRNA levels for SOD were reduced by about 40% at 1-week PMI, were near to the control levels at 4-week PMI and at 16 weeks PMI, the levels were reduced by about 73% below the controls. GSHPx mRNA levels remained unchanged at all time points. The mRNA levels for catalase remained unchanged at 1 and 4 weeks PMI and were significantly reduced by about 44% at 16 weeks PMI as compared to the controls. The protein levels for MnSOD, CuZnSOD, GSHPx at 1 and 16 weeks remained unchanged in treated and untreated PMI groups. However, the protein levels for catalase was significantly increased in the control and PMI groups treated with Losartan. It is concluded that changes in the SOD and catalase activities during severe heart failure correlated with changes in mRNA for these enzymes. The precise mechanism/s for the improvement in antioxidant reserve and protein levels after Losartan treatment is/are unclear at this time.

Patellofemoral joint instability is a common clinical problem. However, little quantitative data are available describing the stability characteristics of this joint. We measured the stability of the patella against both lateral and medial displacements across a range of knee flexion angles while the quadriceps were loaded physiologically. For eight fresh-frozen knee specimens a materials testing machine was used to displace the patella 10 mm laterally and 10 mm medially while measuring the required force, with 175 N quadriceps tension. The patella was connected via a ball-bearing patellar mounting 10 mm deep to the anterior surface to allow natural tilt and other rotations. Patellar force-displacement behavior was tested at flexion angles of 0 degrees, 10 degrees, 20 degrees, 30 degrees, 45 degrees, 60 degrees, and 90 degrees. Significant differences were found between the lateral and medial restraining forces at 10 mm displacement. For lateral displacement, the restraining force was least at 20 degrees of knee flexion (74 N at 10 mm displacement), rising to 125 N at 0 degrees and 90 degrees of knee flexion. The restraining force increased progressively with knee flexion for medial patellar displacement, from 147 N at 0 degrees to 238 N at 90 degrees. With quadriceps tension, the patella was more resistant to medial than lateral displacement. Our finding that lateral patellar displacement occurred at the lowest restraining force when the knee was flexed 20 degrees agrees with clinical experience of patellar instability.

This article presents a new surgical technique for reconstruction of the nasal dorsum following excisional rhinoplasty in patients with prominent humps. Reinsertion of the excised hump is not a new concept. Rather, underlay grafting of the resected hump was developed by modification of the Skoog technique, addressing the problem by salvaging the upper cartilaginous vault.

The feeding effects of 5-hydroxytryptamine (5-HT)(1) and 5-HT(2) receptor agonists injected into the hypothalamic paraventricular nucleus (PVN) immediately prior to PVN administration of neuropeptide Y (NPY) were examined. The impact of these same compounds on NPY-induced alterations in energy metabolism was also assessed in an attempt to characterize further the potential interactive relationship of PVN NPY and 5-HT on feeding and whole body calorimetry. Specifically, several experiments examined the effect of various 5-HT receptor agonists on NPY-stimulated eating and alterations in energy substrate utilization [respiratory quotient (RQ)]. This included the 5-HT(1A) receptor agonist 8-OH-DPAT, the 5-HT(1B/1A) agonist RU 24969, the 5-HT(1D) agonist L-694,247, the 5-HT(2A/2C) agonist DOI, the 5-HT(2B) agonist BW 723C86 and the 5-HT(2C) agonist mCPP. In feeding tests conducted at the onset of the dark cycle, drugs were administered 5 min prior to PVN injection of NPY and food intake was measured 2 h postinjection. The metabolic effects of NPY following a similar pretreatment were monitored using an open-circuit calorimeter measuring the volume of oxygen consumed (VO(2)), carbon dioxide produced (VCO(2)) and RQ (VCO(2)/VO(2)). PVN injection of NPY (100 pmol) potentiated feeding and evoked reliable increases in RQ. Only DOI (2.5--5 nmol) pretreatment antagonized NPY-induced eating and blocked the peptide's effect on energy substrate utilization. Direct PVN pretreatment with spiperone (SPRN), a 5-HT(2A) receptor antagonist, and ketanserin (KTSN), a 5-HT(2A/2C) antagonist, but not SDZ SER 082, a 5-HT(2B/2C) antagonist, or the 5-HT(2C) antagonist RS 102221, blocked the effect of DOI in both feeding and metabolic tests providing additional evidence that activation of PVN 5-HT(2A) receptors inhibits NPY's action on feeding and substrate utilization.

When the equilibrium between free-radical production and cellular antioxidant defences is disturbed in favour of more free radicals, it causes oxidative stress which can promote cellular injury. Oxidative stress has been suggested to play a role in the pathogenesis of diabetic cardiomyopathy. In streptozotocin-induced diabetes, there is a decrease in antioxidant enzyme activities and an increase in myocardial lipid peroxidation. Probucol, an antioxidant, was found to improve cardiac function which may have been due to an increase in myocardial antioxidant enzyme activities and a decrease in lipid peroxidation in the diabetic animals. Some of the beneficial effects of probucol may also be due to an improvement in plasma insulin levels and a decrease in the plasma glucose. The diabetic state is also associated with endothelial dysfunction, retinopathy, neuropathy and renopathy. Some of these secondary complications may also be mediated by oxidative stress. It is suggested that diabetic cardiomyopathy is associated with an antioxidant deficit and that antioxidant therapy may be useful in improving cardiac function in diabetes.

Heart failure is considered to be a complex clinical syndrome, with alterations in the multiple neurohumoral systems and subcellular cardiac sites that correlate with abnormal cardiac function. Strong evidence for the role of oxidative stress in the pathogenesis of heart failure has been provided by studies on experimental animals as well as humans. This concept is gaining more acceptance due to the fact that during heart failure, changes in different neurohormones, cytokines, nitric oxide, and activated inflammatory cells are closely linked to oxidative stress at the cellular and molecular levels. The present article provides a simple description of oxygen free radicals as well as the antioxidant defense system. Evidence for the role of oxidative stress in the pathogenesis of heart failure is reviewed in a concise manner.

The suggested role of oxidative stress in the pathogenesis of heart failure is largely based on utilizing left heart failure models. The present study on rats evaluated changes in antioxidants as well as oxidative stress in relation to hemodynamic function subsequent to the right heart failure induced by monocrotaline (50 mg/kg, i.p.). During the post-injection period, monocrotaline (MCT)-treated rats demonstrated a persistent growth depression. Two to three weeks after the injection, MCT-treated rats showed signs of fatigue, peripheral cyanosis and dyspnea. In these rats, right heart hypertrophy was confirmed by a significant increase in right ventricular weight as well as right ventricle to body weight ratio. In MCT-treated rats, there was also a significant increase in right ventricular systolic as well as end diastolic pressures. No change in lung and liver wet/dry weight ratios between MCT-treated and control animals was observed. Based on the hemodynamic data as well as other clinical observations, the functional stage achieved was compensated heart failure. Myocardial antioxidant enzymes, catalase, glutathione peroxidase and superoxide dismutase, in the MCT-treated rats were not different compared to control rats. Vitamin E levels were significantly depressed in the RV and there was no change in retinol levels. There was a significant increase in lipid hydroperoxide concentrations in MCT-treated rats as compared to the control group. These data provide evidence that right heart failure is associated with an increase in oxidative stress.

Background: Although most previous studies have attempted to correlate plasma concentrations of vitamins with specific cardiovascular end points, metabolic considerations suggest that changes in myocardial tissue and storage organs may be better indicators of myocardial oxidative stress., Methods and Results: Rats fed commercial chow or a diet enriched with vitamin E for 2 weeks were subjected to either a surgical myocardial infarction (MI) or a sham procedure. Rats were hemodynamically assessed 16 weeks after surgery, and their heart, liver, kidney, and plasma were analyzed for antioxidant vitamins E (tocopherol) and A (retinol and total retinyl esters). At 16 weeks, MI rats on a control diet showed depressed peak systolic and elevated diastolic pressures in both right and left ventricles compared with their sham controls. Plasma concentrations of vitamins E and A in MI rats were not different from sham controls fed the same diet. However, concentrations of vitamin E in left ventricle and liver and of vitamin A in liver (retinol) and kidney (retinyl esters) were decreased in rats with MI compared with the sham controls. Vitamin E supplementation improved hemodynamic function in rats with MI and increased plasma, myocardial, liver, and kidney concentrations of vitamin E. The vitamin E diet also prevented the loss of total retinyl esters from the kidney but not of retinol from the liver in MI rats., Conclusions: Dietary supplements of vitamin E can sustain better cardiac function subsequent to MI. Antioxidant vitamin levels in the myocardium or in storage organs and not in plasma may be better indicators of myocardial oxidative stress.

This study measured the patellar lateral force-displacement behaviour at a range of knee flexion angles in normal human cadaver specimens. The knee extensor muscles were loaded in proportion to their physiological cross-sectional areas, the tensions being applied in physiological directions along the separate quadriceps muscles. Knee extension was blocked at a range of knee flexion angles from 0 to 90 degrees, and patellar lateral displacement versus force characteristics were measured. This experiment was repeated with three total muscle forces, 20, 175 and 350 N, which were held constant at all flexion angles. It was shown that similar stability variation was obtained with the different total muscle loads, and also the forces required to produce a range of patellar displacements (1.5, 9 mm) were examined. A 5 mm lateral patellar displacement required a constant displacing force (i.e. the patella had constant lateral stability) up to 60 degrees knee flexion, and then a significant increase at 90 degrees. The results were related to surgical and anatomical observations.

This was a quantitative study of the major anatomical structures associated with instability of the patellofemoral joint: the quadriceps muscles and the femoral trochlear groove. The attachments of the muscles to the patella, their lines of action, and their relative sizes (physiological cross-sectional areas) were found. On the basis of the physiological cross-sectional areas, it was estimated that the central muscles-the rectus femoris and vastus intermedius-contributed 35% of the quadriceps strength, with 40% from the vastus lateralis and 25% from the vastus medialis. The vastus lateralis had the most variable results, with the ratio of the lateralis to the medialis ranging from 0.90 to 2.18; this may be associated with patellar instability. Both the long and oblique parts of the vastus medialis were more oblique than the corresponding parts of the vastus lateralis. Photographic "skyline" views of the trochlear groove produced data on the sulcus angle and ratio of depth to width. The data showed that the trochlear groove did not deepen in the area contacted by the patella with progressive knee flexion (p > 0.53), contrary to popular belief. These data are useful for objective analysis of patellofemoral stability and related surgical interventions.