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Objective This study aimed to investigate changes in sleep parameters and self-perceived sleep quality in unilateral vestibular hypofunction participants after vestibular rehabilitation. Method Forty-six unilateral vestibular hypofunction participants (before and after vestibular rehabilitation) along with a control group of 60 healthy patients underwent otoneurological examination, a one-week actigraphy sleep analysis and a series of self-report and performance measures. Results After vestibular rehabilitation, unilateral vestibular hypofunction participants showed a significant score decrease in the Pittsburgh Sleep Quality Index, a self-rated reliable questionnaire depicting sleep quality during the last month, as well as a reduction in sleep onset latency and an increase in total sleep time, indicating an objective improvement in sleep quality as measured by actigraphy analysis. However, after vestibular rehabilitation, unilateral vestibular hypofunction participants still showed statistically significant differences with respect to the control group in both self-rated and objective measurements of sleep quality. Conclusion Vestibular rehabilitation may impact on sleep performance and chronotype behaviour, possibly by opposing long-term structural changes along neural pathways entangled in sleep activity because of the deafferentation of the vestibular nuclei.

Spontaneous coronary artery dissection (SCAD) is recently emerging as an increasingly frequent cause of myocardial infarction and among the main triggering factors we found hypertension, pregnancy, fibromuscular dysplasia and connective tissue diseases (e.g. Marfan syndrome). Recent studies also suggest that even bicuspid aortic valve may be a predisposing condition for the development of spontaneous coronary artery dissection. We report the case of a 45–year–old Caucasian man with no cardiovascular risk factors; his clinical history begins in August 2019, when he was hospitalized for acute coronary syndrome (NSTEMI). Echocardiography showed preserved left ventricular ejection fraction, bicuspid aortic valve (fusion of right and left cusps) with mild to moderate regurgitation without stenosis and mild dilatation of the aortic bulb (38 mm). The coronary angiography showed no significant stenoses and an anomalous origin of the right coronary artery from the common trunk. The patient was discharged two days later with a diagnosis of MINOCA and an indication to perform a coronary CT scan, which confirmed the anomalous origin of the right coronary artery with a retro–aortic course, and a cardiac MRI, which showed myocardial edema of the infero–lateral wall, mainly with sub–endocardial distribution and LGE in the same sites, compatible with ischemic damage. In September 2022 there was a new hospitalization for inferior–posterior–lateral STEMI with coronarographic finding of a large marginal branch collateral stenosis, with recovery of distal caliber. The angiographic pattern was consistent with type II SCAD (no intracoronary imaging has been performed because of vascular tortuosity and lesion distality). A retrospective comparative analysis of the 2019 angiography allowed to find a distal occlusion of the same branch, now healed, also compatible with SCAD. The patient was discharged on single antiplatelet therapy after one week of DAPT with acetylsalicylic acid and clopidogrel and indication to perform a genetic test for connective tissue diseases. The case described prompts the cardiologists to suspect an uncommon etiology (connective tissue disease, bicuspid aortic valve) in case of SCAD detection, especially if associated with anomalous origin of the coronary arteries.

Background Even if pilot studies have been conducted to validate Intravascular Lithotripsy, most challenging cases were excluded, including unprotected Left Main (LM) coronary stenosis. Methods We retrospectively enrolled patients treated with IVL in a real–world multicenter registry from 21 centers among Italy and Spain from January 2020 to November 2021. The primary safety endpoint was freedom from major adverse cardiovascular events (cardiac death, target vessel revascularization, stent thrombosis) at 30 days. The primary effectiveness endpoint was procedural success (defined as stent delivery with a residual stenosis Results From a total amount of 470 patients enrolled in our registry, 41 underwent IVL to LM stenosis. Most of them were males (78.0%). The clinical presentation was acute coronary syndrome (ACS) in 41.4% of cases. Mechanical circulatory support was necessary in 4 cases (9.7%). IVL before stent implantation was planned in 90% of cases. The primary safety endpoint occurred in 97.6%. of patients. The primary effectiveness endpoint was achieved in 97.6% of cases. Interestingly, at 6 months and 12 months, no MACE was recorded. Conclusions Intravascular lithotripsy for the treatment of severely calcified Left Main stenosis seems to be a safe and effective option with very high procedural success rate and low MACE rate at follow–up.

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Over the years, the interior noise levels have been improved, and nowadays a high acoustical comfort is of major importance for the commercial success of propeller aircraft. The use and development of high vibro-acoustic performance devices and their integration on the primary structure are, therefore, among the most critical topics in the greening of the next generation air transportation. The purpose of this research was properly focused on the analysis of a dynamic control system appointed to increase the noise attenuation transmitted in the propeller aircraft fuselage. Passive and active dynamic devices have been studied and characterized in this work. Simulations and tests performed on the first stage demonstrator structure highlighted how the passive tuned vibration absorber increases the comfort controlling the structural behaviour of the fuselage at the first blade pass frequency. Further improvements of fuselage comfort can be reached using active devices. A conceptual design of a hybrid active device able to act on the first three blade pass frequencies has been outlined. The characterization of the whole active noise control system has been described and its effect on noise reduction in fuselage of propeller aircraft has been evaluated.

Background: At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE. Methods: In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient. Results: A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383-750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386-580 V/cm) when the ablation zone volumes were used from the follow-up MRI. Conclusions: The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.

The necessity to requalify existing scholastic buildings is caused by the need of making them safe and of adjusting them to the current laws, so that they have the possibility to adopt the new didactic and organisational targets. To define the intervention strategies, it is necessary to assess the study protocols, to classify and model the spatial and architectural aspects and to support the activity of the stakeholders and the characters involved in the building process. The proposal shows the results of the research carried by the authors, also confirmed by the outcome obtained from didactic activity. The authors also developed protocols aimed to the definition/evaluation of the effects that the unsuitableness of the technological system could have on the energetic , functional and architectural yeld of the building. Therefore we propose a modelling of the interior subsystem that allows a more immediate identification of the interventions related to the concepts of wellness, usability and flexibility.

The improvement of interior comfort is becoming an increasingly required target in the transport engineering field, with particular attention to the aviation one. Generally, an aircraft is affected by several noise sources, from the engine power unit to the broadband components, related to the turbulent boundary layer (TBL). In this contest, the leading industries, in cooperation with research centers and universities, are actually employed in the development of innovative passive/active solutions for the internal noise as well as vibrations control: such technological implications must, on the one hand, satisfy these design requirements as well as meet the current airworthiness regulations. The paper deals with the vibro-acoustic testing activity on a typical turboprop fuselage subjected to different external load conditions: the damping ratio and the transmission loss characterization has been performed for several materials, including two innovative viscoelastic treatments too. The results highlighted a very good behaviour of the novel viscoelastic foams in terms of both acoustic and thermal performance when compared to standard blanket supported by extra viscoelastic treatments offering a very interesting self-embedded solution with a good weight to performance ratio.

Strawberry production is one of the most promising agricultural activities in Ushuaia (The End of the World, 54°48'S), Tierra del Fuego, Argentina; mainly focused on day-neutral cultivars. The main goal of this research was to assess yield as well as fruit quality of day-neutral strawberry cultivars grown "at the end of the world". Two trials were carried out on September 2004 at the experimental field of CADIC (Ushuaia). The first one, proved frigo plants of 'Aromas', 'Fern', 'Selva' and 'Seascape' from a Neuquen nursery (38°57'S). The second one, proved frigo plants of 'Aromas', 'Selva', 'Cegnidarem', 'Colima', 'Diamante', 'Seascape' and 'Whitney' from a Mendoza nursery (33°30'S). The trials were performed during two consecutive years. Planting was done on raised beds covered with plastic mulch film (PM), under polyethylene (LDT, 150 μ) low tunnels. After harvest, fruit quality (size, color, soluble solids content, firmness, titratable acidity and dry weight) was analyzed. 'Colima' was the most productive and had the best quality, showing the higher soluble solids:acidity ratio. 'Seascape' and 'Selva' also showed excellent performance. Among other attributes, 'Seascape' had the best color. Fruit size and other fruit quality attributes were superior to those observed in other regions of Argentina.

The purpose of this study was to obtain a better understanding of polychlorinated biphenyl (PCB) immunotoxicity in the developing mouse. Adult female mice were dosed with three subcutaneous injections per week of 50 mg/kg Aroclor 1242 (A1242), Aroclor 1254 (A1254), or corn oil for 2 weeks and then mated with nondosed males. First-litter pups were sacrificed at 7 or 28 days of age. At both ages, the tissue concentration of PCB was significantly higher in both the A1242 and A1254 pups than in oil-treated controls. Seven-day-old pups exposed to A1242 or A1254 had significantly decreased splenic IL-2 production. Alterations in the percentages of T cell subsets compared to controls were observed in A1242-exposed pups; an increased spleen somatic index was noted only in A1254-exposed pups. Twenty-eight-day-old pups exposed to A1254 demonstrated a significant decrease in thymus somatic index, an increase in liver somatic index, a 25% decrease in total circulating T(4), and decreased B cell percentages relative to their controls. Alteration in the percentages of CD3(int) T cells was observed in A1254-exposed 28-day-old pups. A significant increase in 7-ethoxyresorufin- O-deethylase (EROD) and 7-benzoxyresorufin-O-dearylase (BROD) activity was measured at both ages in A1254-exposed pups and in A1242-exposed 28-day-old pups. These data confirm that during gestation and lactation A1242 and A1254 are transferred from dams to pups and that such exposure results in immune-related effects in neonatal (7-day-old) and juvenile (28-day-old) mice. Furthermore, A1254 exposure produces more frequent and pronounced effects than exposure to A1242.

Several trials showed that early laparoscopic cholecystectomy is superior to delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis. However actual practice does not conform to current evidence. The aim of this study is to compare outcomes and total hospital costs between early and delayed laparoscopic cholecystectomy for acute cholecystitis.A retrospective analysis of patients with acute cholecystitis that underwent a laparoscopic cholecystectomy at our institutions was performed. Patients were divided into 2 groups on the basis of the treatment received and statistical analysis was performed.The study included 91 patients, 52 female and 39 male, with a mean age of 55. Early surgery was performed in 32 cases and delayed surgery in 59 cases. The two groups were comparable for demographics data and severity of disease on admission. There was a no significant difference (p = 0.174) in the mean operative time between early (54.8 min) and delayed group (47.8 min). Conversion rate was higher in the early group (34.3% vs. 20.3%), but difference was not statistically significant (p = 0.223). The overall complications rate was comparable (18.7% early vs. 16.9% delayed, p = 0.941). Length of postoperative stay (4.3 vs. 3.8 days) was similar (p = 0.437), but total hospital stay was significantly 4 days shorter in the early group (p0.0001). The mean total cost was higher for the delayed group (4171 vs. 6041), with a significant difference of 1870 Euro (p0.0001).Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.

Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstones. However, a conversion to open surgery is sometimes still required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in both elective and emergency cases.A retrospective review of all patients underwent laparoscopic cholecystectomy for symptomatic gallstones from January 2011 to October 2013 was performed. Data considered for analysis were: demographic data, comorbidities, preoperative laboratory values, preoperative ERCP, indication for surgery, and the timing of the intervention in acute cholecystitis. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.414 patients underwent laparoscopic cholecystectomy. 245 were female (59.1%) and 169 (40.8%) male, with a mean age of 51.7±16.4 years. The indication for surgery was acute cholecystitis in 91 cases (21.9%). Lithiasis of the bile duct was found in 40 patients (9.6%), and it was identified preoperatively in 37 patients, all treated with a preoperative ERCP. Conversion to open occurred in 33 cases (7.9%). Univariate analysis revealed as risk factor for conversion: increased age, acute cholecystitis, comorbidities, elevated white blood cell count, increased level of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase, C-reactive protein, and fibrinogen. Multivariate logistic regression analysis showed that acute cholecystitis (OR 5.63) and age65 years (OR 3.025) were independent predictive factors for conversion.These patients should be properly informed of their increased risk of conversion and should be operated by surgeons skilled in laparoscopic procedures to reduce this risk.

The Oil and Gas business is a technically challenging and risky industry where accidents can happen and have dramatic consequences. A major Accident Hazard and its aftermath can represent a catastrophe for an Oil company that will have to face production losses and asset damages, injuries to people or event worst loss of lives, environmental liabilities, fines and claims, and ultimately all the above most of the time is translated in a significant reputational damage. Reputation can be defined as the whole of expectations and perception of stakeholders towards an organization; reputational risk is the threat to compromise such complex system of expectations and perception with consequent financial and non financial implications. Reputational risk can be regarded as hidden danger that can threaten the survival of the biggest and best-run Companies therefore its effective management is crucial for companies’ long-term success. This paper proposes a qualitative methodology to evaluate reputational risk and implications of major Accident hazard in exploration and production operations. The methodology identifies primarily reputational drivers, stakeholders and risk factors that can create a deviation between expectations and perceptions. The extent of a deviation between perceptions and expectations, caused by an event and relevant consequences depends on context variables that can amplify or lower the impact of the event on the system of expectations and perceptions of the stakeholders (e.g. geographical location of the event). The above mentioned elements are used to build a Risk Reputational Model that foresees the Definition of a Country profile matrix (summarizing the most relevant reputational drivers for the specific country under evaluation), a Matrix of Risks vs. Reputational Drivers (summarizing risk factors influencing reputational drivers relevant for stakeholders) and ultimately a Technical Analysis to identify probability of occurrence of the events affecting the critical drivers. The final step is the qualitative evaluation of reputational risk through the comparison of stakeholders’ expectations and results of the technical analysis. In the paper the methodology is thoroughly explained through a real case application on a company Oil and Gas Asset.

Preremediation studies at Crab Orchard National Wildlife Refuge (CONWR) revealed statistically significant accumulations of polychlorinated biphenyls (PCBs) and effects in starling chicks (Sturnus vulgaris) from contaminated sites, including decreased nest attentiveness, decreased fledging success, and an increase in chick mortality. Although the expected route of exposure for starling chicks is thought to be via diet, this has not previously been documented at CONWR. The purpose of this study was to develop an equation to predict starling chick carcass PCB concentrations from PCB concentrations in ingested animal matter. During 1995 and 1996, stomach contents from 14 and 22 starling chicks collected from contaminated and reference sites, respectively, were evaluated. Animal, plant, and mineral matter in the stomach contents were separated and animal matter from stomachs of individuals from the same nest were combined, dried, and percent dry weight calculated. Composite samples of animal matter were then analyzed for the presence of PCBs (Aroclor 1254). Stomach contents were primarily composed of animal matter (76%), and the percent animal matter in the stomachs did not differ significantly among locations (range = 38.4% to 100%). The mean PCB concentration in composite samples of animal matter from stomachs of chicks collected from contaminated sites (1.82 +/- 1.17 mg/kg) was significantly greater than the concentrations in composite samples from two reference locations (

High Efficiency Video Coding (HEVC) is the latest video coding system jointly developed by ITU Video Coding Experts Group (VCEG) and ISO/IEC Moving Picture Experts Group (MPEG). According to the quality evaluation performed on the set of test sequences adopted for the development of the compression system, HEVC provides the same perceptual video quality of its predecessor ITU-T H.264 / MPEG-4 Part 10 Advanced Video Coding (AVC) almost halving the bitrate. This paper presents novel experimental results on HEVC compression efficiency with respect to AVC based on objective measurements carried out on new 2D and 3D video sequences. 2D test material includes both progressive (from UHD-1 to 720p resolutions, 8/10 bit-depth) and interlaced sequences (1080i) while 3D stereo sequences are full HD 1080p50 per eye.

Incisional hernia is one of the most common complications of laparotomy. Its repair with prosthesis has enabled a considerable improvement in the outcome, significantly reducing recurrences. This study analyses the results of open hernioplasty with mesh performed as a Day Surgery procedure in 42 patients between November 2008 and October 2010. The results were good, with low postoperative morbidity and recurrences (2.4%).

Methods of implementing the clinical nurse specialist (CNS) role can be approached in many ways. Providing the clinical specialist with concrete strategies to use during role implementation or expansion can aid in expediting the acceptance process for the CNS. Some authors have discussed phases the CNS encounters during role development. Time span of these phases vary greatly, dependent not only on the individual specialist, but also on the system for which they are employed. Kramer's four phases detailing the adjustment period of the newly practicing nurse may be used when discussing CNS role implementation. These four phases are: honeymoon, shock/rejection, recovery, and resolution. Practical suggestions to expedite role implementation can make progression through these phases easier and less overwhelming. Although obstacles will often be present, the CNS must then become a catalyst by using creative ideas and effective coping mechanisms to effect change and advance the role.

Polychlorinated biphenyls (PCBs) are environmental contaminants known to cause adverse health effects to biological systems. Limited data are available on their effects on the immune system of wildlife species. Previously, we found that 4 and 6-week-old white-footed mice (Peromyscus leucopus) born from dams injected with a single dose (300 mg/kg) of Aroclor 1254, had altered immunological, hematological, and biochemical responses. Here, we examined the effect of transplacental, lactational and postnatal exposure to Aroclor 1254, at a concentration similar to that found at contaminated sites, on various physiological parameters of 22-week-old white-footed mice. Liver weight and liver somatic index of PCB treated animals were significantly higher, the combined weights of the adrenal glands were significantly lower and EROD and BROD enzyme activity was significantly higher compared to control values. The number of thymocytes of the treated mice was significantly lower than that of the controls; however, thymocytes of treated mice had a higher proliferative response to the mitogen Con A. These alterations were correlated with the PCBs body burdens. Some toxic effects of chronic exposure to PCBs, at levels comparable to exposure found in contaminated sites in the USA, are still evident in adult P. leucopus.

The makers have examined 455 fingerprint cards of accidents at biologic risk needed in a sanitary structure from the month of november 1995 to the month of december 1998. After they have described the protocol of the sanitary supervision applied, the procedure of the accidents, the qualifications, and the departments mainly interested by the subject of study event, they have pointed out the need of a greater vaccinable covering against the virus B, parvying attention to the "non responders" subjects, thinking also it's necessary bigger resources for the personnel, training and information.

The aim of the present was to study the inhibitory and bactericide activity and risk of selection of mutants resistant or tolerant to vancomycin in strains of Staphylococcus aureus resistant to methicillin from out patient and hospitalary patients.The minimum inhibitory concentration was obtained by the macrodilution method in liquid medium and by the Etest system. The minimum bactericide concentration was obtained by the macrodilution method in liquid medium. The selection of resistant or tolerant mutants was performed inoculating more than 5 x 10(6) UFC/ml in brain-heart agar plates and in tripteinsoya brought with different concentrations of vancomycin.Vancomycin showed greater inhibitory and bactericide activity in strains sensitive to methicillin of out patient and hospitalary origin with respect to strains resistant to methicillin with a minimum inhibitory concentration1 mg/l in 23.3, 20.0 and 70.0%, respectively and a minimum bactericide concentration of 90%, 8.16 and 64 mg/l. The incidence of tolerance was greater in the strains resistant to methicillin in comparison with the out patient and hospitalary strains sensitive to methicillin, since a minimum bactericide/inhibitory concentration greater than 4 was obtained in 63.3 in comparison with 20.0%. Only mutants with diminished sensitivity (minimum inhibitory concentration of 3 and 6 mg/l) or tolerant in strains resistant to methicillin could be selected. The increases in the minimum inhibitory concentrations were not stable, while the tolerant mutants preserved this characteristic after 20 subcultures.The in vitro selection of mutants with decreased sensitivity or tolerant was only obtained in strains resistant to methicillin. The changes in the minimum inhibitory concentrations were not stable in contrast to the increase in the minimum bactericide concentrations which remained unchanged. The differences in the selection of mutants with diminished sensitivity or tolerant among strains resistant and sensitive to methicillin found in this study were correlated with the differences in minimum inhibitory and bactericide concentrations and the relation between both in the clinical isolates.

After reporting the pathophysiology of denervation the authors deal with the changes that affect nerves while going through reinnervation. A review of the drugs that may help healing and general care to be adopted in order to avoid sequential pathological phenomena related to paralysis are shown. Rehabilitative treatment is discussed, the Authors dwell upon rehabilitation of neurogenous bladder of patients with spina bifida and rehabilitation of patients with paralysis of brachial plexus. Facial paralysis has been discussed before dealing with benefits and complications of electrotherapy. The use of electromagnetotherapy and electromyography are shown with a rich photographic and bibliographic support.

Aim of the study was to identify the different hepatitis C virus (HCV) genotypes in chronic hepatitis patients living in the districts of Messina and Catania (Sicily, Italy), for epidemiological reasons but also to determine the effect of interferon therapy on therapeutic response of different viral genotypes. Genotyping was carried out by reverse-hybridization after amplification by polymerase chain reaction. The study was conducted on 271 patients with HCV-RNA positive chronic liver disease belonging to categories at risk or not for infection. HCV genotype sub-type 1b was the most common viral genotype identified.

The clinical nurse specialist (CNS) and nurse practitioner (NP) have been distinct and separate advanced nursing practice roles since the 1960s. The forces of economics and health care reform have fostered an interest in merging these two advanced practice roles. Economic and regulatory advantages have been noted in the literature for both roles. What is not so evident are the possible disadvantages. Several aspects of the merger issue are explored as is the recent background of the creation of the CNS and NP roles. Problems and questions are asked to stimulate future discussions in nursing's professional associations and in education and service settings.

To evaluate whether, in the forearm of hypertensive patients with different circulating renin profiles, local beta-adrenergic receptor-induced production of active renin, plasma renin activity, angiotensin I (Ang I), and angiotensin II (Ang II) was or was not related to the renin profile, we studied four groups of patients: 1) hypertensive patients with primary aldosteronism and suppressed circulating plasma renin activity values (0.15 +/- 0.1 ng Ang I/mL per hour; n = 7), 2) essential hypertensive patients with low (0.47 +/- 0.1 ng Ang I/mL per hour; n = 8) circulating plasma renin activity values, 3) essential hypertensive patients with normal (2.48 +/- 0.52 ng Ang I/mL per hour; n = 8) circulating plasma renin activity value, and 4) renovascular hypertensive patients with high circulating plasma renin activity values (4.16 +/- 2.1 ng Ang I/mL per hour; n = 10). Isoproterenol was infused into the brachial artery, and active renin, plasma renin activity, and Ang I and Ang II forearm balance (venous-arterial differences corrected for forearm blood flow by strain-gauge plethysmography) were measured. Despite a comparable vasodilation, beta-adrenergic stimulation failed to release active renin, plasma renin activity, and Ang I and Ang II in primary aldosteronism. It slightly increased them (except for Ang I) in low renin patients but determined a local production in normal renin and renovascular hypertensive patients. The individual increments in plasma renin activity and Ang II release induced by isoproterenol showed a correlation with the renin profile.(ABSTRACT TRUNCATED AT 250 WORDS)

e15561 Background: Many reports have correlated 1) hypoxia with attenuated responses to radiotherapy and 2) a good oxygenation as function of high HGB level in the peripheral blood. There is agreem...

Two cases of neuroleptic malignant syndrome presenting an unusual clinical course are reported. The first patient was untreated for the syndrome and recovered completely only after four months, while the other one was given dopaminergic and myorelaxing drugs only 10 days after the onset of the symptoms and died about six months later with an unmodified clinical picture. In both cases the treatment seemed to influence the clinical course, a delay or lack of drug intake worsening the prognosis.

The imposter phenomenon describes individuals who at times feel as if they are imposters in their chosen profession. Individuals experiencing the phenomenon have a deep feeling that they are fooling everyone. The title of clinical nurse specialist (CNS) in itself may foster misinterpretations and false beliefs in oneself or others. The term "specialist" implies expertise in the five subroles of the CNS (educator, consultant, research, clinician and manager). Feelings of imposture within the CNS role can precipitate or exacerbate low self-esteem and lead to ineffective role implementation. The phenomenon must be recognized in the CNS and management strategies instituted. Management strategies include peer support, CNS mentoring and self-provided positive reinforcement. Further research is essential to document the existence of the phenomenon within the CNS role and the creation of effective management strategies to prevent or alleviate it.

for atherosclerotic cardiovascular disease (ASCVD). No such WC cut-offs have been identified in adolescents, despite the consensus that risk factors for ASCVD are present in adolescents. The current study aims to identify WC cut-offs that will distinguish AfricanAmerican males ages 12 to 19 years with central adiposity who are at risk for ASCVD as defined by meeting metabolic syndrome (MetS) criteria. Methods: This study is a secondary data analysis using data from the CDC Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). A subpopulation of African-American males, ages 12 to 19 years with records containing data on WC and at least three of the following variables, were included in this study: fasting glucose, high density lipoprotein (HDL), serum triglyceride (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP). This resulted in 428 participants, with a weighted sample size of 1,688,814 African-American males. Participants were scored and grouped based on ASCVD risk factors as defined by the American Heart Association, National Cholesterol Education Program (NCEP) Adult Treatment Panel III as modified by Cook, et al. These include: fasting glucose 110 mg/ dL, HDL 40 mg/ dL, TG 110 mg/ dL, SBP and DBP 95% for age and gender. Individuals were categorized as low risk ( 3 risk factors) or high risk ( 3 risk factors) for ASCVD. Using WC as the independent variable, receiver-operating characteristics curve (ROC) analysis was used for each year of age to identify the optimal WC measurements that identify high-risk individuals. Results: Initial linear regression models confirm that WC predicts abnormal values in all dependent variables except fasting glucose. Results of ROC analysis are pending. Conclusions: It is expected that waist circumference values that identify three or more risk factors (thus defining MetS) will be considered the optimal cut-off point at which a clinical provider should begin screening for MetS. Sources of Support: None.

This fifth edition is a timely and welcome one because of recent management changes in the treatment of acute poisoning. The routine use of syrup of ipecac as the primary household emetic has been supplanted by immediately calling the Poison Control Center, which may then recommend ipecac or, more likely, other measures and actions. General management of poisoning and overdoses is more important than the use of specific antidotes. Nevertheless, important antidotes or antagonists are still useful and recommended for special situations. Each chapter ends with an in-depth discussion of the relevant antidotes for the particular type of poison. I particularly enjoyed the historical account of the "birth" of the Poison Control Center concept and movement, since I was a member of the first Accident Prevention Committee of the American Academy of Pediatrics when it made the survey of its 3000 members in 1952 seeking the most prevalent childhood accident.