Search

BACKGROUND Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria. AIM To evaluate short- A nd long-term outcome in elderly patients (70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA. METHODS The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression. RESULTS After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Diseasefree survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate. CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (70 years) with HCC in Milan criteria. © 2021 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved.

Background Laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) represented potential treatments for patients with a single hepatocellular carcinoma (HCC) smaller than 3 cm. As the aging population soared, our study aimed to examine the advantage/drawback balance for these treatments, which should be reassessed in elderly patients. Methods A multicentric retrospective study compared 184 elderly patients (aged >70 years) (86 patients underwent LLR and 98 had RFA) with single ≤3 cm HCC, observed from January 2009 to January 2019. Results After propensity score matching (PSM), the estimated 1- and 3-year overall survival rates were 96.5 and 87.9% for the LLR group, and 94.6 and 68.1% for the RFA group (p = 0.001) respectively. The estimated 1- and 3-year disease-free survival rates were 92.5 and 67.4% for the LLR group, and 68.5 and 36.9% for the RFA group (p = 0.001). Patients with HCC of anterolateral segments were more often treated with laparoscopic resection (47 vs. 36, p = 0.04). The median operative time in the resection group was 205 min and 25 min in the RFA group (p = 0.01). Length of hospital stay was 5 days in the resection group and 3 days in the RFA group (p = 0.03). Conclusion Despite a longer length of hospital stay and operative time, LLR guarantees a comparable postoperative course and a better overall and disease-free survival in elderly patients with single HCC (≤3 cm), located in anterolateral segments.

Background: Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma. Methods: The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres. Patients were divided into laparoscopic and open liver resection groups. Perioperative and long-term outcomes were compared between these groups. Results: After a 1:1 propensity score matching, 219 patients were included in each group. Clavien-Dindo grades III/IV (6 vs. 20%, p = 0.04) were lower in the laparoscopic than in the open matched group. Hospital stay was shorter in the laparoscopic than in the open matched group (5 vs. 7 days, p < 0.001). There were no significant differences between laparoscopic and open groups regarding overall survival and disease-free survival at 1-, 3- and 5- year periods. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma is associated with good short-term outcomes in patients with ≥70 years of age compared to open liver resection. Laparoscopic liver resection is safe and feasible in elderly patients with hepatocellular carcinoma.

Background: Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM). Methods: We performed a multicentric retrospective study including 184 consecutive cases of HCC major liver resection in patients aged ≥ 70years in _8 European Hospital Centers. Patients were divided into LMH and OMH groups, and perioperative and long-term outcomes were compared between the 2 groups. Results: After propensity score matching, 122 patients were enrolled, 38 in the LMH group and 84 in the OMH group. Postoperative overall complications were lower in the LMH than in the OMH group (18 vs. 46%, p < 0.001). Hospital stay was shorter in the LMH group than in the OMH group (5 vs. 7days, p = 0.01). Mortality at 90days was comparable between the two groups. There were no significant differences between the two groups in terms of overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5years. Conclusion: LMH for HCC is associated with appropriate short-term outcomes in patients aged ≥ 70years as compared to OMH. LMH is safe and feasible in elderly patients with HCC.

We compared two "3 × 8" shift rotas with backward rotation and quick return (morning and night shift in the same day) in a 5- or 6-day shift cycle, and a "2 × 12" shift rota with forward rotation in a 5-d shift cycle. A total of 294 nurses (72.6% women, mean age 33.8) were examined in a survey on work-related stress, including the Standard Shiftwork Index. Ten nurses per each shift roster recorded their activity and rest periods by actigraphy, rated sleepiness and sleep quality, and collected salivary cortisol throughout the whole shift cycle. Nurses engaged in the "2 × 12" rota showed lower levels of sleep disturbances and, according to actigraphy, sleep duration was more balanced and less fragmented than in the "3 × 8" rosters. The counter-clockwise shift rotation and quick return of "3 × 8" schedules reduce possibility of sleep and recovery. The insertion of a morning shift before the day with quick return increases night sleep by about 1 h. Nurses who take a nap during the night shift require 40% less sleep in the morning after. The "2 × 12" clockwise roster, in spite of 50% increased length of shift, allows a better recovery and more satisfying leisure times, thanks to longer intervals between work periods. Sleepiness increased more during the night than day shifts in all rosters, but without significant difference between 8-h and 12-h rosters. However, the significantly higher level at the start of the night shift in the "3 × 8" rotas points out that the fast backward rotation with quick return puts the subjects in less efficient operational conditions. Some personal characteristics, such as morningness, lability to overcome drowsiness, flexibility of sleeping habits and age were significantly associated to sleep disturbances in nurses engaged in the "3 × 8" rotas, but not in the "2 × 12" schedule.

In this contribution, a novel low-profile folded monopole is presented, working in the UHF frequency band. The simple yet effective design is such to grant both physical strength and stable performances in terms of radiation pattern over the entire working frequency band.

Pacing threshold is not a stable value during the pacemaker's life. It is affected by many physiological, pharmacological and pathophysiological factors. A pacing system able to confirm capture and automatically adjust its output to the actual pacing threshold is highly desirable for a prolonged battery life and maximal patient safety. The Autocapture(TM) of St. Jude Medical and the Capture Management(TM) of Medtronic are currently available on the market. The key feature is the measurement of the evoked response (ER) signal by the pacemaker for capture confirmation. In case of loss of capture, the Autocapture(TM) System delivers a back up safety pulse of 4.5 Volt and 0.49 ms and starts a new threshold search. The pacemaker adapts its output to 0.3V/0.25V above the newly measured threshold. This system needs bipolar leads with low polarization for the first generation in Microny® and Regency® pacemakers; in the second generation with Affinity® and Integrity® pacemakers various bipolar leads are suitable. The Capture Management(TM) System of Medtronic, available in the Kappa® DR 700 series, performs a two point automatic threshold search once every day during rest. The output is determined by the programmed safety margin (nominal 1.5×voltage threshold). A backup pulse is only delivered during the threshold search. No special electrodes are necessary. These functions were shown to work safely and efficaciously in multicenter trials to decrease the current consumption with a prolongation of battery life up to 142%. The patients safety was increased by identifying changes of the capture threshold over time and adjusting the pacing stimulus. The conventional safety margins of 100% might not be safe for all patients. We also learned much about lead maturation and lead instability by the possibility of continuous follow-up of threshold changes in a larger group of leads in order to identify the risk group of about 10% of patients with late threshold increase and lead instability.

BACKGROUND: The constantly increasing life-expectancy has led to a high incidence of severe heart diseases in elderly people. The aim of this study was to compare the 30-day morbidity and mortality of octogenarians (group I) with a cohort younger than 60 years (group II). METHODS: Both groups (July 2008 and July 2011) were extracted from the Cardiac database. Demographic data, risk factors, surgical procedures and complications were double-checked. To compare the proportions of patients, Fisher's exact test was performed. RESULTS: In group I (n = 348 patients, 82.6±2.6 years) elective cases (35.3% valvular procedures) were performed in 77.6% and in 67.9% in group II (n = 656 patients, 50±2.4 years). The ICU-stay was 86±108 h (10–1040 h) (median: 51 h) in group I versus 94±256 h (3–4700 h) (median: 46 h). Postoperative renal failure occured in 2.9% in group I. After 17.9 h (1–760 h) (median 4.5 h) patients in group I could be weaned from ventiulation (group II: 26.4 h [1–1230 h] [median 4 h]). The need for blood transfusion was 1.7 units (0–10) in group I (1 unit (0–28) in group II). The 30-day mortality was 5.5% (n = 19) in group I versus 4.7 (n = 31) in group II and was in both groups lower than the expected EuroScore mortality of 16.1 and 6.25%. CONCLUSIONS: It must be argued that the surgical outcome of elderly patients is much better than the individual feeling in the daily routine. We proved that octogenarians should not be excluded from possible benefits of cardiac surgery. As a result of comparing postoperative data of the two different groups we cannot attribute higher costs for our elderly patients.

The Washington State University Honors College course, UH 290, “Science as a Way of Knowing,” engages freshmen in scientific inquiry and scholarly literature research. The UH 290 instructor, a learning design consultant, and two librarians collaborated to develop and deliver the course’s information literacy curriculum. The team used student surveys, research blogs, case studies, library instruction sessions, homework problem sets and exams. Students gained from scaffolded instruction including hands-on practice activities and feedback; embedded assessments informed adjustments to the course syllabus and activities. This case study details the progressively improved use of this approach and these tools over two semesters.

The perioperative risk for patients with pacemakers or implanted cardioverter/defibrillators (ICD) is mainly dependent on the underlying disease. However, severe to life-threatening complications of the implanted system can occur due to electromagnetic interference in the environment of the operation. These complications can be prevented or adequately treated by taking special precautions and measures. Even though the currently available data on the optimal perioperative management to pacemakers and ICDs is still unsatisfactory, the increasing clinical relevance of this topic was the reason for the formulation of recommendations by an interdisciplinary working group in Austria.

A prototype of the high-sampling lead-scintillating fiber KLOE calorimeter has been exposed to neutron beams of 21, 46 and 174 MeV, provided by the The Svedberg Laboratory, Uppsala, to test its neutron detection efficiency. The measurement of the neutron detection efficiency of an NE110 scintillator provided a reference calibration. The measured efficiency is larger than what expected considering the scintillator thickness of the KLOE prototype only. This result proves the existence of a contribution from the passive material to neutron detection efficiency, in a high-sampling calorimeter configuration. (c) 2008 Elsevier B.V. All rights reserved. RI Gauzzi, Paolo/D-2615-2009; Fiore, Salvatore/C-9722-2011; Di Domenico, Antonio/G-6301-2011; branchini, paolo/A-4857-2011; Battistoni, Giuseppe/B-5264-2012

American Entomologist • Winter 2009 Undergraduate curricula of many institutions of higher education include General Education Requirements (GERs). Most GER courses provide an overview of a given subject area to students who may have little experience and/or interest in the subject matter, which can present obstacles to achieving standards of proficiency. Generating and sustaining interest is critical, and teaching methods that emphasize interdisciplinary approaches may help students effectively weave course content into their current knowledge base. At Washington State University, Insects, Science, and World Cultures (Entom 150) is a lower-division, GER science course designed for non-science majors and elementary education majors. Students enrolled in the course represent diverse backgrounds, interests, and academic majors. The content and pedagogy of Entom 150 are intended to address the needs and challenges of a heterogeneous student population. Insects, Science, and World Cultures offers an interdisciplinary view of the global impact of insects on the arts, myths & legends, cuisine, medicine, scientific research, and agriculture. It emphasizes the role of insects and their products in various cultures around the world (historical and contemporary) and uses insects as a tool to examine topics of broad interest (e.g., nutrition and undernourishment in developing nations, biological control, pesticides, environmental issues, energy flow, insects as “recyclers,” forensics, water quality, and insects as key Insect Myths: An Interdisciplinary Approach Fostering Active Learning

The high-rate performance of a multiwire proportional chamber of the LHCb muon detector was tested. The chamber, equipped with the final front-end electronics, was tested using a � 100 GeV muon beam superimposed on a 662 keV g flux of variable intensity produced by the 137 Cs radioactive source of the CERN Gamma Irradiation Facility (GIF). No significant variation in the muon detection efficiency or in the time response of the chamber was observed at the highest gamma rate. & 2008 Elsevier B.V. All rights reserved.

The marine recreational fishing (MRF) represents one of the most popular activities along the coasts of numerous countries around the world, in particular in the Mediterranean Sea. Despite the evidences of potential effects on the marine biodiversity and commercially exploited stocks, a sound information base and adequate management plans are still lacking, both at the national and basin level. An analysis of the MRF on the West coasts of the Adriatic Sea was carried out, in 2014, by using a standardized questionnaires approach, aiming to describe the state of the art and to preliminarily assess catches, in comparison with the commercial ones, at the regional scale. Gilt-headed seabream, European seabass, cuttlefish, squid and Atlantic bluefin tuna resulted the anglers’ preferred species, even if the top five in term of caught biomass were bluefin tuna, seabream, cuttlefish, common dolphinfish and little tunny, in the order (accounting up to 60% of total catches). The exploitation level resulted to be significant, as confirmed by the comparison with commercial fisheries, being the MRF captures 30% or 45% of the artisanal fishery in the same area, with some species, such as bluefish, bonito, pandora and picarel, showing larger values. The preliminary assessment of ecological effects, highlighted that the exploitation use about 10%–16% of energy fixed by the primary production (Primary Production Required to sustain fishery), but the ecosystem effects are still sustainable (Lindex and probability to be sustainable fished). However, combining catches by MRF with those by small scale fishery completely changes the situation, showing an unsustainable condition, suggesting the need for taking into the account also MRF in the future management planning for the Adriatic coastal area.

A method is described which allows to deduce the dead-time of the front-end electronics of the LHCb muon detector from a series of measurements performed at different luminosities at a bunch-crossing rate of 20 MHz. The measured values of the dead-time range from 70 ns to 100 ns. These results allow to estimate the performance of the muon detector at the future bunch-crossing rate of 40 MHz and at higher luminosity. A method is described which allows to deduce the dead-time of the front-end electronics of the LHCb muon detector from a series of measurements performed at different luminosities at a bunch-crossing rate of 20 MHz. The measured values of the dead-time range from ~ 70 ns to ~ 100 ns. These results allow to estimate the performance of the muon detector at the future bunch-crossing rate of 40 MHz and at higher luminosity. A method is described which allows to deduce the dead-time of the front-end electronics of the LHCb muon detector from a series of measurements performed at different luminosities at a bunch-crossing rate of 20 MHz. The measured values of the dead-time range from 70 ns to 100 ns. These results allow to estimate the performance of the muon detector at the future bunch-crossing rate of 40 MHz and at higher luminosity.

When it can be pointed out that economic entomologists, whose proper concern is with insects that affect crops, medical entomologists, whose proper concern is with insects that affect man, and agricultural scientists, whose proper concern is with anything that affects agricultural production, have been making decisions about the treatment with poisonous chemicals of millions of acres of the land on which man depends, it may be properly asked, where were the ecologists, whose proper concern is with the environment in which we live? Ought they not to have a voice in these decisions? (Fosberg 1963)

Questa relazione è stata scritta da un gruppo di studenti che hanno partecipato ad uno stage organizzato presso il Liceo Ettore Majorana di Orvieto nel Dicembre 2014. Lo stage, inserito in una serie di iniziative organizzate da Giuseppe De Ninno e Adele Riccetti in occasione di 'Orvieto Scienza 2015', voleva avvicinare questo gruppo di studenti al mondo della fisica delle particelle elementari con una attività sperimentale e didattica. Contattati tramite Pasquale Di Nezza, coordinatore di 'Scienza Per Tutti', abbiamo proposto un percorso di scoperta degli sciami cosmici ispirato all'articolo di Pierre Auger 'Extensive Cosmic- Ray Showers' pubblicato sulla Review of Modern Physics Vol. 11 del 1939. In questo articolo di sole 4 pagine Auger, dotato di pochi contatori Geiger-Muller e di una incredibile intuizione, riesce a determinare le proprietà dei raggi cosmici primari e degli sciami da essi prodotti. Per svolgere l'attività sperimentale abbiamo allestito un piccolo apparato con alcuni rivelatori a scintillatore e un'opportuna elettronica per elaborare i segnali. Quindi, nell'arco di un pomeriggio, una notte di presa dati ed una mattina, abbiamo in parte ripercorso il ragionamento e le misure di Auger fino a stimare quanti raggi cosmici primari e con quale energia colpiscono l'atmosfera e quante particelle e quale estensione ha lo sciame prodotto. Pensiamo che la miglior testimonianza della riuscita di questa esperienza venga dalle parole di uno dei ragazzi che hanno passato molte ore a raccogliere dati, fare conti e ragionamenti: ≪A parte la suggestione che un esperimento come questo può esercitare su uno studente del Liceo, mi ha colpito in particolare come un argomento cosí complesso possa essere stato affrontato da noi in modo relativamente semplice≫. (M. Anelli, C. Gatti)

Background: Frequent and unnecessary right ventricular apical pacing increases the risk of atrial fibrillation or congestive heart failure. We evaluated a new pacing algorithm, managed ventricular pacing (MVP) which automatically changes modes between AAI/R and DDD/R in patients receiving pacemakers for symptomatic bradycardia. Methods: Patients were randomized to the MVP mode or DDD/R mode for 1 month and then crossed over to the alternate pacing modality for an additional month. On completion of the crossover phase, the pacing mode selected was individualized and patients were followed for an additional 4 months. Results: Of the 129 patients who successfully completed the crossover study, the cumulative percent ventricular pacing was significantly reduced in the MVP mode (median 1.4%) compared to the DDD/R mode (median 89.6%, 94.0% relative reduction; 95% CI 89.3–98.8%, P < 0.001). Patients with sinus node disease (SND, n = 51) when compared to patients with AV block (AVB) (n = 68) experienced a greater reduction in ventricular pacing with the MVP mode compared to the DDD/R mode (median relative reduction 99.1%; 95% CI 97.5–99.9% vs median relative reduction 60.1%; 95% CI 16.7–93.9% P < 0.001). The reduced percent ventricular pacing during MVP was sustained over longer term follow-up. Conclusions: The majority of patients with a bradycardia indication for cardiac pacing do not require ventricular pacing most of the time. The MVP mode significantly reduces unnecessary right ventricular pacing. This mode benefits even patients with intermittent AVB and is sustained over longer term follow-up.

American Entomologist • Volume 52, Number 1 Notwithstanding the current controversy in the United States surrounding the teaching of evolution, it is indeed diffi cult today to comprehend the upheaval that the Origin of Species wreaked among Darwin’s contemporaries. Darwin’s letter in 1844 to the botanist J. D. Hooker affords some appreciation, in that Darwin admitted that divulging his evolutionary views felt tantamount to “confessing a murder” (Darwin 1903). But why should it have been so? In this article, I explore that question, focusing on the reception of Darwinian theory in the 19th century. I also advance the argument that striking parallels exist between natural theology of the 19th century and “intelligent design” today, or, to put it more broadly, “What is past is prologue.” We stand to gain from a retrospective of the diffi culties faced by evolutionary theory in Darwin’s time. To provide a historical framework, I begin with an overview of Darwin’s experiences and the changes that his thinking underwent during the years preceding publication of the Origin. Next, I discuss religious beliefs prevalent among Darwin’s contemporaries, including those of prominent entomologists. Those views are contrasted with the writings of the 19th century entomologist B. D. Walsh, a vociferous defender of Darwinian theory. I also discuss current issues surrounding the teaching of evolution vs. intelligent design, provide some thoughts on scientifi c vs. religious endeavor, and close with suggested approaches toward public acceptance and understanding of Darwinian theory.

Little is known about the HRQL of pacemaker patients due to the limited availability of disease-specific instruments. The aim of the Pacemaker Patients Quality of Life (PAPQoL) study was to determine the psychometric properties for the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients before and after pacemaker implantation. Patients with a given indication for pacemaker therapy (N = 68) completed two self-administered HRQL instruments, the SF-36, a well-known and psychometrically sound health survey, and the MacNew, a reliable and valid heart-disease-specific HRQL instrument, before and one, three and six months after pacemaker implantation. We assessed disease severity with the New York Heart Association (NYHA) classification. Test-retest reliability, intra-class correlation, Cronbach's alpha, validity coefficients, sensitivity analyses (effect sizes) and confirmatory factor analysis were carried out. The MacNew demonstrated adequate reliability (Cronbach's alpha and ICCs0.80 on all scales), validity (correlations between similar SF-36 and MacNew subscales0.80), and responsiveness (all effect sizesor = 0.67) in pacemaker patients. The MacNew demonstrates adequate psychometric properties for evaluating HRQL in patients before and after pacemaker implantation.

Open Access.-- et al., The FIRST (Fragmentation of Ions Relevant for Space and Therapy) experiment at GSI has been designed to study carbon fragmentation, measuring 12C double differential cross sections (∂2σ/∂θ∂E) for different beam energies between 100 and 1000 MeV/u. The experimental setup integrates newly designed detectors in the, so called, Interaction Region around the graphite target. The Interaction Region upstream detectors are a 250 μm thick scintillator and a drift chamber optimized for a precise measurement of the ions interaction time and position on the target. In this article we review the design of the upstream detectors along with the preliminary results of the data taking performed on August 2011 with 400 MeV/u fully stripped carbon ion beam at GSI. Detectors performances will be reviewed and compared to those obtained during preliminary tests, performed with 500 MeV electrons (at the BTF facility in the INFN Frascati Laboratories) and 80 MeV/u protons and carbon ions (at the INFN LNS Laboratories in Catania)., This work has been supported by the European Community FP7 - Capacities, contract ENSAR nº 262010. This work was also supported by Junta de Andalucia and the Spanish Ministerio de Ciencia e Innovacion Contracts P07-FQM-02894, FIS2008-04189 and FPA2008-04972-C03.

Objectives: In this single-center study we reviewed our experience with a significant number of cardiac myxoma cases occurring over the past two decades. Patients and methods: Cardiac myxomas represented 86% of all surgically treated cardiac tumors at our center. Specifically, there were 49 consecutive patients, each with at least one myxoma. A detailed clinical, immunological, and echocardiographic long-term examination of 37 patients revealed one recurrent myxoma. Results: Most myxomas originated from the left atrium (87.7%), but also much less frequently from the mitral valve (6.1%), from the right atrium (4.1%), and from the left and right atria (2.0%). The myxomas produced a prolapse into the left ventricle in 40.8% of the patients, mitral stenosis in 10.2%, and threatened left ventricular outflow tract obstruction in 2.0%. Multiple myxomas were found in 20.4% of the patients. Cardiac signs appeared in 93.9% of the patients. Preoperative embolic events had occurred in 26.5%. Immunologic alterations were present in 87.5%. For resection, a bilateral atriotomy was used. An additional aortotomy was needed to expose one mitral valve myxoma. Postoperatively, 81.1% of the patients remained without cardiac symptoms. The early mortality rate was 2.0% and the late mortality rate was 6.1%. Long-term prognosis was excellent with an actuarial survival rate of 0.74. Specific immunologic alterations were found in 71.4% of the patients. The actuarial freedom from reoperation of the myxoma was 0.96. The rate of reoperations was low with 2.0% after 24 years. Conclusions: Myxomas were usually detected and operated on in symptomatic patients. A high index of suspicion seems important for early diagnosis. Immunologic findings may play an additional role in confirming the diagnosis and the recurrence of a myxoma. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Also, a familial genesis must be excluded in myxoma patients. q 2002 Elsevier Science B.V. All rights reserved.

Pacing threshold is not a stable value during the pacemaker's life. It is affected by many physiological, pharmacological and pathophysiological factors. A pacing system able to confirm capture and automatically adjust its output to the actual pacing threshold is highly desirable for a prolonged battery life and maximal patient safety. The Autocapture(TM) of St. Jude Medical and the Capture Management(TM) of Medtronic are currently available on the market. The key feature is the measurement of the evoked response (ER) signal by the pacemaker for capture confirmation. In case of loss of capture, the Autocapture(TM) System delivers a back up safety pulse of 4.5 Volt and 0.49 ms and starts a new threshold search. The pacemaker adapts its output to 0.3V/0.25V above the newly measured threshold. This system needs bipolar leads with low polarization for the first generation in Microny® and Regency® pacemakers; in the second generation with Affinity® and Integrity® pacemakers various bipolar leads are suitable. The Capture Management(TM) System of Medtronic, available in the Kappa® DR 700 series, performs a two point automatic threshold search once every day during rest. The output is determined by the programmed safety margin (nominal 1.5×voltage threshold). A backup pulse is only delivered during the threshold search. No special electrodes are necessary. These functions were shown to work safely and efficaciously in multicenter trials to decrease the current consumption with a prolongation of battery life up to 142%. The patients safety was increased by identifying changes of the capture threshold over time and adjusting the pacing stimulus. The conventional safety margins of 100% might not be safe for all patients. We also learned much about lead maturation and lead instability by the possibility of continuous follow-up of threshold changes in a larger group of leads in order to identify the risk group of about 10% of patients with late threshold increase and lead instability.

Objectives: Left ventricular hypertrophy in patients with critical aortic stenosis (AS) is an adaptive process that compensates for high intracavitary pressure and reduces systolic wall stress followed by an increase in myocardial masses. In the present prospective clinical trial, we investigated long-term compensatory changes in left ventricular geometry and function after aortic valve replacement using mechanical bileaflet prostheses with the main emphasis on the small-sized aortic annulus and valve prosthesis‐patient mismatch. Methods: A total of 58 patients with critical AS were assigned to the following groups according to the predictive value of prosthetic valve area index (VAI): group EXMIS: 29 patients (VAI # 0:99), expected mismatch; group NOMIS: 29 patients (VAI # 0:99), no mismatch. At controls T0 (before operation/operation (OP), T1 and T2 (4 and 20 months after OP) the left ventricular geometry was recorded by means of Imatron w electron beam tomography and the transprosthetic velocities were measured by echocardiography. Results: Statistical analysis showed a consistent reduction in the absolute (Pa 0:04) and indexed (Pa 0:04) left ventricular myocardial mass for both cohorts; furthermore, there was a significant difference between EXMIS and NOMIS patients concerning the factors, time and mass reduction (Pa 0:005), because of distinct baselines. A logistic regression report revealed preoperative cardiac output, absolute left ventricular myocardial mass, perfusion, body surface area and the native valve orifice area as predicting coefficients and factors for a minimum mass reduction of 25%. We explain a mathematical formula that turned out to be the most sensitive for correctly classified factors. Conclusions: The left ventricular geometry and transprosthetic velocities resulted in the same postoperative recovery for both EXMIS and NOMIS patients. The presented data showed that valve prosthesis‐ patient mismatch had no influence in several stepwise logistic regression models. We conclude that modern mechanical bileaflet prostheses allow both acceptable hemodynamics and recovery of left ventricular hypertrophy, even in small aortic annuli. q 2001 Elsevier Science B.V. All rights reserved.

Risk evaluation comparing the minimally invasive and standard aortic valve operations has not been studied.Four surgeons were randomly assigned to perform the minimally invasive (L-shaped sternotomy) (group 1) or the conventional (group 2) operation in 120 patients exclusively.In both groups (n = 60) a CarboMedics prothesis was implanted in 90% of patients. There was no significant difference in the cross-clamping period (group 1, 60 minutes; range, 35 to 116 minutes), in the duration of extracorporal circulation (group 1, 84 minutes; range, 51 to 179 minutes) or in the time from skin-to-skin (group 1, 195 minutes; range, 145 to 466 minutes). Patients in group 1 were extubated earlier (p0.001), the postoperative blood loss was less (p0.001), and the need for analgesics was reduced (p0.05). In 5 patients in group 1 a redo operation was required for bleeding (p0.05), 3 patients in group 1 required a redo operation because of paravalvular leakage or endocarditis (p0.05), the 30-day mortality rate was 1.6%. Overall the survival rate was 95% in group 1 and 97% in group 2 (mean follow-up, 294 days; range, 30 to 745 days).The advantages of minimally invasive aortic valve operation include reduced trauma from incision and duration of ventilation, decreased blood loss and postoperative pain, the avoidance of groin cannulation, and a cosmetically attractive result. Simple equipment is used with a high degree of effectiveness and with no sacrifice of safety. Our study demonstrated the practicability and reliability of this new method.

In the SAVE-trial we evaluated the safety, reliability and improvements of patient management using the BIOTRONIK Home Monitoring®-System (HM) in pacemaker (PM) and implanted cardioverter defibrillator (ICD) patients.115 PM (Module A) and 36 ICD-patients (Module B) were recruited 3 months after implantation.65 patients in Module A were randomised to HM-OFF and had one scheduled outpatient clinic follow-up(FU) per year, whereas patients randomised to HM-ON were equipped with the mobile transmitter and discharged without any further scheduled in-office FU. In Module B 18 patients were randomised to HM-OFF and followed by standard outpatient clinic controls every 6 months; 18 patients were randomised to HM-ON receiving remote monitoring plus one outpatient clinic visit per year; unscheduled follow-ups were performed when necessary.The average follow-up period was 17.1 ± 9.2 months in Module A and 26.3 ± 8.6 months in Module B. In both modules, the number of FUs per year was significantly reduced (Module A HM-ON 0.29 ± 0.6 FUs/year vs HM-OFF 0.53 ± 0.5 FUs/year; p b 0.001; Module B HM-ON 0.87 ± 0.25 vs HM-OFF 1.73 ± 0.53 FU/year,p b 0.001). Cost analysis was significantly lower in the HM-ON group compared to the HM-OFF group (18.0 ± 41.3 and 22.4 ± 26.9 € respectively; p b 0.003). 93% of the unscheduled visits in Module B were clinically indicated,whereas 55% of the routine FUs were classified as clinically unnecessary.Remote home monitoring of pacemaker and ICD devices was safe, reduced overall hospital visits, and detected events that mandated unscheduled visits.

A small-size calorimeter has been built in the Frascati National Laboratory of INFN for BESIII detector based on the BEPCII storage ring of the Institute of High Energy Physics in Beijing. It has been installed in one of the two small-theta angle regions of BEPCII to measure the energy of photons from Initial State Radiation events and is currently taking data together with BESIII. The detector is a sandwich of Pb and scintillating fibers, the same technique employed for the KLOE calorimeter at the DA Φ NE accelerator, but the readout is actuated by way of bundles of clear plastic fibers. We describe here the fabrication, present results from tests with cosmic rays and at the Frascati Beam Test Facility, the installation in BESIII, and preliminary luminosity measurements.

Background. Cancer of the male breast (MBC) is rare, accounting for less than 1% of cancer in males and representing less than 1% of all breast cancers. Reports of abnormalities in the expression of the tumor suppressor gene p53 in MBC have been few. Methods. To assess the expression and mutations of the p53 gene, 35 patients with 36 MBC (one patient with bilateral breast carcinoma) were examined using immunohistochemical methods, polymerase chain reaction (PCR)-single strand conformation polymorphism and DNA sequencing. Results. Thirty-one of the 36 carcinomas were studied by immunohistochemistry and by the PCR-based approach. Five patients were studied by immunohistochemistry only. Twelve patients (41.4%) of the 29 studied by molecular analysis presented an altered pattern in the single strand conformation polymorphism gel and point mutations were confirmed in all by direct DNA sequencing. Thirty-six tumors were studied by immunohistochemistry and 2 (5.5%) patients showed overexpression of the p53 protein. There were no statistically significant differences in p53 status with respect to : age, stage, estrogen receptors, progesterone receptors, tumor type. Patients with normal p53 showed a predisposition, although not statistically significant, for a longer disease free survival (5.6 years versus 4.2 years) and overall survival (5.9 years versus 4.8 years) than did patients with genetically altered p53. Conclusions. The incidence of male patients detected with p53 mutations (41.4%) in this series is concordant with the incidence of p53 mutations in female breast cancer, supporting the idea that cancer of the male breast is similar to the female counterpart. Cancer 1995 ;75 : 2233-8.

The effects of pretreatment with inducers of hepatic cytochrome P450 isoenzymes (phenobarbital, dexamethasone andβ-naphthoflavone) on the metabolism ofd-fenfluramine (d-F) and its acute and long-lasting indole-depleting effects were studied in rats, in an effort to obtain further information on the importance of hepatic drug metabolism in relation to its neurochemical actions. Twenty-four hours after the last dose of each inducer, rats were injected withd-F hydrochloride (5 mg/kg, IP) and killed at various times thereafter for parallel determination of indoles and drug concentrations in plasma and brain. Additional rats were treated as above and killed 1 week afterd-F hydrochloride (5 and 10 mg/kg) to study the recovery of indole in the cortex, a particularly sensitive brain area. Phenobarbital andβ-naphthoflavone and, to a lesser degree, dexamethasone, stimulated the metabolism ofd-F, as evidenced by a decrease in plasma and brain areas under the curve (AUC) compared to vehicle-treated rats. This indicated that multiple isoenzymes are capable of mediating the drug's metabolism, primarily byN-dealkylation tod-norfenfluramine (d-NF). None of the inducers raised plasma and brain AUC of the nor-derivative, and in fact phenobarbital and particularlyβ-naphthoflavone reduced it. These different effects were even apparent in rats givend-NF (2.5 mg/kg), indicating that both phenobarbital andβ-naphthoflavone also stimulate the sequential metabolism of the nor-metabolite (byN-deamintaion) which, however, is apparently enhanced most actively byβ-naphthoflavone-inducible forms of P-450. Total “active” brain concentrations (d-F+d-NF) after the different pretreatments were in the order ofβ-naphthoflavone < phenobarbital < dexamethasone ≤ vehicle. Interestingly,β-naphthoflavone rapidly reversed the depletion of brain indoles caused byd-F (andd-NF); phenobarbital provided partial protection and dexamethasone did not appreciably modify either the acute or long-term neurochemical effects of the drug. The fact that phenobarbital affectedd-NF kinetics less thanβ-naphthoflavone, and provided only partial protection against the acute and long-lasting neurochemical effects of high doses ofd-F, further stresses the critical role ofd-NF in the neurochemical outcome of its parent drug. These findings support the view that the degree and duration of the indole-depleting effects are related to critical brain concentrations of the parent compound and its nor-derivative, and provide indirect evidence that hepatic metabolites other thand-NF are unlikely to play any role in the neurochemical effects of high doses ofd-F in rats.

FIRST (FragmentationofIonsRelevantforSpaceandTherapy)isanexperimentdevotedtoaprecise measurementofion fragmentation for space radiation protection and hadron therapyapplications. Afirst run dedicated to the fragmentation of fully stripped 12 Cions on a thin graphite target has been already performed during August 2011 at GSI. The experiment is composed of already existing detectors complemented by a newly designed interaction region, including the so -called Upstream Detectors: a Start Counter and a Beam Monitor. The Start Counter is used to trigger the beam and to give a precise time reference for time of flight measurements, while the Beam Monitor is needed to track ions before their interaction in the target. In this paper we present their description and the results of the tests performed on different beams to validate their performances before the installation at GSI.

The Purdue Post-traumatic Stress Disorder Scale is a 15-item self-report instrument based on the DSM-III diagnostic criteria for post-traumatic stress disorder. This scale is a quick, easily administered, measure of psychological reactions to a traumatic event. The goal of the present report is to validate this instrument for use as a measure of long-lasting combat stress reactions of American Vietnam veterans. The PPS demonstrated a high degree of internal consistency with a Cronbach's coefficient alpha of 0.94. The PPS demonstrated construct validity through significant correlations with other self-report measures of combat experience and residual psychological distress, and through a factor analysis yielding three factors, labeled as arousal, avoidance, and the global perception of distress. Results support further use of the Purdue Post-traumatic Stress Scale as a research instrument for assessing the long-term impact of a traumatic event.

Nosema ceranae and pesticide exposure can contribute to honey bee health decline. Bees reared from brood comb containing high or low levels of pesticide residues were placed in two common colony environments. One colony was inoculated weekly with N. ceranae spores in sugar syrup and the other colony received sugar syrup only. Worker honey bees were sampled weekly from the treatment and control colonies and analyzed for Nosema spore levels. Regardless of the colony environment (spores+syrup added or syrup only added), a higher proportion of bees reared from the high pesticide residue brood comb became infected with N. ceranae, and at a younger age, compared to those reared in low residue brood combs. These data suggest that developmental exposure to pesticides in brood comb increases the susceptibility of bees to N. ceranae infection.

This note describes a prototype particle tracking detector constructed with 1 mm plastic scintillating fibres with a 64 channel Hamamatsu H8500 flat-panel multi-anode photomultiplier readout. Cosmic ray tracks from an array of 11 gas-filled drift tubes were matched to signals in the scintillating fibres in order to measure the resolution and efficiency of tracks reconstructed in the fibre-based tracker. A GEANT4 detector simulation was also developed to compare cosmic ray data with MC results and is discussed in the note. Using the parameters measured in this experimental setup, modified fibre tracker designs are suggested to improve resolution and efficiency in future prototypes to meet modern detector specifications., Comment: Laboratori Nazionali Di Frascati SIDS-Pubblicazioni LNF - 10 / 21(P) October 26, 2010

BACKGROUND: Numerous surveys reveal high levels of pesticide residue contamination in honey bee comb. We conducted studies to examine possible direct and indirect effects of pesticide exposure from contaminated brood comb on developing worker bees and adult worker lifespan. METHODOLOGY/PRINCIPAL FINDINGS: Worker bees were reared in brood comb containing high levels of known pesticide residues (treatment) or in relatively uncontaminated brood comb (control). Delayed development was observed in bees reared in treatment combs containing high levels of pesticides particularly in the early stages (day 4 and 8) of worker bee development. Adult longevity was reduced by 4 days in bees exposed to pesticide residues in contaminated brood comb during development. Pesticide residue migration from comb containing high pesticide residues caused contamination of control comb after multiple brood cycles and provided insight on how quickly residues move through wax. Higher brood mortality and delayed adult emergence occurred after multiple brood cycles in contaminated control combs. In contrast, survivability increased in bees reared in treatment comb after multiple brood cycles when pesticide residues had been reduced in treatment combs due to residue migration into uncontaminated control combs, supporting comb replacement efforts. Chemical analysis after the experiment confirmed the migration of pesticide residues from treatment combs into previously uncontaminated control comb. CONCLUSIONS/SIGNIFICANCE: This study is the first to demonstrate sub-lethal effects on worker honey bees from pesticide residue exposure from contaminated brood comb. Sub-lethal effects, including delayed larval development and adult emergence or shortened adult longevity, can have indirect effects on the colony such as premature shifts in hive roles and foraging activity. In addition, longer development time for bees may provide a reproductive advantage for parasitic Varroa destructor mites. The impact of delayed development in bees on Varroa mite fecundity should be examined further.

The importance of d-norfenfluramine in regard to the indole-depleting action of d-fenfluramine has not been well studied in sensitive animal species. The present study therefore examined the intensity and time course of the neurochemical effects of i.p. injected d-fenfluramine (2.5 and 5 mg/kg) and d-norfenfluramine (2.5 mg/kg) in vehicle- and SKF-525A-pretreated rats, relating the effects to the brain concentration-time profiles of the drug and its active metabolite. At the lower dose d-fenfluramine caused only a small, short-lasting decrease in brain serotonin (5-HT) without affecting the 5-hydroxyindoleacetic acid (5-HIAA). Higher doses affected both 5-HT and 5-HIAA (50-60 and 30-40% reductions, respectively), the effect being maximal for at least 8 h. d-Norfenfluramine reduced the brain content of 5-HT and 5-HIAA less (by about 30%) than 5 mg/kg d-fenfluramine did. Brain concentrations of d-norfenfluramine at the time of the maximal depletion of indoles were close to those of the metabolite after 5 mg/kg d-fenfluramine, indicating that the acute indole-depleting effects did not depend solely on the brain concentrations of its nor-metabolite. SKF-525A changed the metabolite-to-parent drug ratios in brain without appreciably influencing the action of d-fenfluramine. However, the maximum decrease in indole content caused by 2.5 mg/kg d-fenfluramine in SKF-525A-pretreated rats was only 12% of the control level, although the brain concentration of unchanged drug was comparable to that after 5 mg/kg d-fenfluramine in vehicle-pretreated rats.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to define a kinetic scheme and to calculate the kinetic parameters of the thermal cracking of petroleum residues, a vacuum residue of Belaym crude was thermally cracked at 410, 430, 450 and 470 °C for reaction times up to 120 min. The concentration of three pseudo-components, namely vacuum residue, distillate and coke, was detected during conversion and the data from these experiments were used for the definition of the kinetic model. Distillate production can be described as a simple first-order reaction while coke formation seems to be the consequence of consecutive reactions, in particular involving asphaltenes. A study of the structural changes of asphaltenes as a function of severity was also performed and the variations of the average molecular parameters with conversion were correlated. The results of this work have been used as reference data for a subsequent study of residue conversion in the presence of hydrogen-donor solvents.

Objective: Our study aimed to analyze the predictive value of intra-operative bypass graft flow measurements for long-term mortality. Methods: A total of 1593 consecutive coronary artery bypass graft (CABG) patients routinely underwent intra-operative bypass graft flow measurements with the transit-timeflow meter (TTFM:Cardiomed W ). The results of theflow measurements andthe demographics were analyzed retrospectively. Results: The mean follow-up was 3.8 years (0.5—8.8 years) with no losses to follow-up. Overall mortality was 10.1%. The preoperative left ventricular ejection fraction (LVEF) (echocardiograph) was the highest independent predictor of long-term survival (hazard ratio 0.97, p = 0.004) in all groups. The univariate analysis for the CABG I group showed that besides LVEF, female gender (hazard ratio 3.6, p = 0.02) was also significant. For the CABG II group, additive EuroSCORE (European System for Cardiac Operative Risk) (ES) (hazard ratio 1.4, p = 0.0001) and age (hazard ratio 1.1, p = 0.001) were significant. In the CABG III group, ES (hazard ratio 1.2, p < 0.0001), age (hazard ratio 1.04, p = 0.001), IMA (hazard ratio 0.5, p < 0.0001) and concomitant aortic valve replacement (AVR) (hazard ratio 2.1, p = 0.03) were significant, in addition to the LVEF. Conclusion: With quality-controlled surgeons checked by intra-operative TTFM, accurate quantification of preoperative LVEFsignificantlypredictslong-termoutcome.Effectivebypassgraftflowsfailedto predictoutcomeinCABGpatients,regardlessofthedegreeof coronary artery disease (CAD) and concomitant AVR. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.