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Table of contents Marianne Kinnula, Netta Iivari, Sumita Sharma, Jussi Okkonen, Sirkku Kotilainen: Introduction to the Special Issue Nandhini Giri: Future Oriented Child-Centric Character Design and Interaction in Culturally Diverse Games Samira Miccolis: Towards a Child-Led Approach for Children’s Activation Iiris Tuvi & Jussi Okkonen: Children Centered Living Lab Approach Development in Education Angel Walia & Grace Eden: Empowering Children as Co-Designers of Technology Behnaz Norouzi: Intergenerational Aspect of Digital Fabrication and Making with Children Stephania Druga & Rebecca Michelson: Research Toolkit for Family Speculative Play with Future Toys

With the forced reboot of our lives due to the COVID-19 pandemic, our interpersonal relationships are nowhere yet everywhere. However, opportunities for initiating or maintaining friendships and romance in the physical world have dwindled. Within the context of India where multiple realities exist, the question arises — what is the future of these relationships? In this paper, we present the outcomes of a workshop looking at the future of relationships using design fiction. Participants worked in small teams to create scenarios that critically consider the future of love, friendships, and romance within the Indian context. Through the lenses of criticality, empowerment, and value creation, we examine the design scenarios and the design process including criticality of the designs, empowering experiences of the participants, and the perceived value gained from participating in such a workshop. Our findings indicate the potential of design fiction to allow participants to step out of their comfort zone into a critical stance in discussing love and intimacy. Based upon our findings, we discuss implications for design research, practice, and education.

As Artificial Intelligence (AI) is integrated into all things technical, there is a valid concern over its lack of diversity, inclusiveness, and accessibility. Further, questions such as what it means for AI to be accessible and inclusive, why is inclusive AI required, and how can it be achieved, is an emerging area of research. In this two-part workshop, we will explore the nuanced challenges towards Accessible and Inclusive AI together with participants with diverse backgrounds. First, we will collaboratively define Accessible and Inclusive AI (AIAI), building on the diverse experiences of the participants and moderators. The goal is to contribute to the formulation of a shared vision for Accessibility and AI as well as identify the challenges and opportunities towards realizing this vision. Working in small teams, participants will collaboratively conceptually design a future scenario for AIAI or critically analyse an example solution. The aim is for teams to tackle tough questions related to what it means for AI to be accessible and inclusive, while addressing algorithmic biases and limitations of AI, in addition to opportunities for overcoming them in the future. Finally, teams will present their conceptual designs and scenarios in the larger group. Overall, the workshop will ignite innovative, and even provocative, ideas and future scenarios, building towards an inclusive and accessible AI.

Bullying is a problem concerning us all, especially our children. Human Computer Interaction (HCI) has invited children to tackle this problem through design and technology. However, yet there is limited research including critical engagement with the topic, even if the critical agenda is arousing increasing interest in HCI. Design fiction has shown potential in addressing critical concerns. However, albeit design fiction has entered HCI method repertoire already some time ago, it is an ambiguous concept with multiple meanings and usages. We map and articulate some of this variety: fascinating, future-oriented, and provocative studies are identified, while also a lack of critical design fiction, aiming at empowerment of the power-weak. We contribute by exploring such kind of design fiction in collaboration with children to tackle the problem of bullying. We scrutinize our participatory and empowering design fiction process and outcomes and discuss their implications for HCI research and design fiction practice.

The Futures Cone, a prominent model in design futuring, is useful for promoting discussions about possible, plausible, probable, and preferable futures. Yet this model has limitations, such as representing diverse human experiences as a singular point of “the present” and implicitly embedding notions of linear progress. Responding to this, we argue that a plurality of perspectives is needed to engage imaginations that depict a diverse unfolding of potential futures. Through reflecting on our own cultural and professional backgrounds, we offer five perspectives for design futuring as a contribution to this plurality: Parallel Presents, “I Am Time”, Epithelial Metaphors, the Uncertainties Cone, and Meet (with) “Speculation”. These perspectives open alternative approaches to design futuring, move outside prevalent notions of technological progress, and foreground interdependent, relational agencies.

The past two decades have seen an increase in the amount of research in the CHI community from South Asia with a focus on designing for the unique and diverse socio-cultural, political, infrastructural, and geographical background of the region. However, the studies presented to the CHI community primarily focus on working with and unpacking the regional contextual constraints (of the users and the infrastructures), thus taking a developmental stance. In this online workshop, we aim to broaden the perspective of the CHI research and community towards the contributions from the region including and beyond development, by bringing together researchers, designers, and practitioners working or are interested in working within these regions on diverse topics such as universal education, global healthcare, accessibility, sustainability, and more. Through the workshop discussion, group design activity, and brainstorming, we aim to provide a space for symbiotic knowledge sharing, and defining shared visions and missions for HCI activities in South Asia for including and moving beyond the development agenda.

Bullying is a challenge concerning us all, and particularly our children. This has already been acknowledged by CHI, among others. Despite the interest, there is a lack of comprehensive understanding of the state of the art — a critical review is needed, addressing bullying in the lives of children, in the context of and/or by the means of design and technology, covering CHI as well as related computing fields, being inspired by the strong body of knowledge within human sciences. We report on a comprehensive literature review on the topic, with the aim to understand what and how has been done so far to handle this troublesome and widespread phenomenon as well as to indicate how to move the field forward. We report how the topic has been examined and with what kind of means tackled, revealing interesting underlying assumptions about design, technology and human agency.

Within Child Computer Interaction (CCI), there is an emphasis on empowering children through co-design and co-creation of technology that shapes their learning, inside and outside the classroom, their wellbeing and lifestyles, and everyday experiences. However, the focus has primarily been on now or the near future, with limited work on designing children’s future technological life worlds. This workshop takes a strategic approach towards “designing for the future,” this year’s conference theme, by reflecting on the past, discussing current trends, and exploring the future. We will further build on critical and/or future-oriented methods such as critical design, speculative design, design fictions, and others. Together with researchers in CCI, in this workshop we will compile a methodological toolbox for the future of IDC; one that enables us to inquire, design, and critically examine children’s technological futures together with them.

Space division multiplexing (SDM) super-channels are the only way to guarantee a sustainable scaling of the optical line interface rate. High-capacity terabit interfaces can be deployed by logically associating several optical sub-channels transmitted in parallel in different spatial cores or modes in order to create a (logical) optical channel with the desired interface rate. This paper is focused on the use of spatial modes for SDM super-channels. First, we present an SDN-controlled disaggregated SDM network architecture that deploys the proposed sliceable-mode transceivers with MIMO equalization. Then, we present the adaptive SDN workflow and heurisitcs for the provisioning, scaling up/down, and soft-failure restoration of SDM super-channels using spatial modes. Two proof-of-concepts are deployed in the joint testbed between KDDI Research and CTTC.

There is an increasing emphasis on empowering children through co-design and co-creation of technology that shapes their learning, wellbeing and lifestyle, and everyday lived experiences. However, several questions emerge: what does it really mean to empower children, what have we achieved thus far, and where are we headed now, as we fight the ongoing pandemic, and in the future when the pandemic is behind us? This workshop aims to answer such questions by investigating, through a strategy approach, different forms of empowerment of children and related ethical, practical, political, and technological implications, in line with this year’s conference theme of “shaping experiences, shaping society.” The outcome of the workshop includes a methodological toolbox for researchers working towards empowerment of children and other vulnerable users, with an aim to enable inquiry, design, and critical examination of children’s socio-technological futures.

Digital technologies are increasingly used with individuals with special needs for skill-building, social inclusion, and empowerment. However, different stakeholders involved in raising an individual with special needs have different and sometimes conflicting understanding of empowerment and motivations towards it. Using an empowerment framework, we collaboratively analyzed and critically reflected on the design and outcomes of three user studies conducted at a special needs school in New Delhi, India. The studies focused on learning how to make compost out of everyday kitchen waste, to assemble a solar lantern, and to buy groceries from a local store. Findings from the analysis provide insights into the complex socio-cultural conditions that enable, and in some cases limit, empowerment of individuals in an underserved and special needs context. We contribute to discussions on empowerment of children through design and use of digital technologies.

The field experiment was conducted at Horticultural Research Station, Kahikuchi of Assam Agricultural University for four consecutive years (2012–13 to 2015–16) to study the performance of flower crops as intercrop in adult coconut (Cocos nucifera) garden spaced at 7.5 m × 7.5 m taking five commercial flower crops, viz. Tuberose (Polianthes tuberosa) var. Single, Gerbera (Gerbera jamesonii) var. Red Monarch, Bird of Paradise (Strelitzia reginae) var. Glauca, Gladiolus (Gladiolus grandiflorus) var. Oscar, Marigold (Tagetes erecta) var. Siracole along with a control (coconut monocrop). Results showed that number of leaves on the crown, annual leaf production, number of inflorescences per palm and nut yield of coconut was not significantly influenced by the flower crops grown in coconut garden. Significantly the highest total coconut equivalent yield of 48920 nuts/ha/year was obtained in coconut + gerbera followed by coconut + tuberose (42717 nuts/ha/year), coconut + gladiolus (42334 nuts/ha/year) and the lowest in coconut as monocrop (10430 nuts/ha/year). Intercropping system of growing gerbera in coconut garden registered the highest net income (` 380075/ha) and B:C ratio (3.5) followed by tuberose (` 323420/ha and 3.1), gladiolus (` 315090/ha and 2.9), marigold (` 233050/ha and 2.8) and the lowest net income of ` 64050/ha and B:C ratio (1.6) obtained in monocropping of coconut.

Enterocytozoon bieneusi is an emerging opportunistic pathogen infecting humans, and both domestic and wild pigs are known to harbour zoonotic genotypes. There remains a paucity of information on the prevalence and epidemiology of this enteropathogen in Southeast Asia. The present study was undertaken to determine the molecular prevalence and risk factors associated with E. bieneusi infection among commercially farmed pigs in Malaysia. Faecal samples were collected from 450 pigs from 15 different farms and subjected to nested PCR amplification of the ribosomal internal transcribed spacer (ITS) gene of E. bieneusi. Phylogenetic analysis involved 28 nucleotide sequences of the ITS region of E. bieneusi. An interviewer-administered questionnaire provided information on the animal hosts, farm management systems and environmental factors and was statistically analysed to determine the risk factors for infection. The prevalence of E. bieneusi infection was relatively high (40.7%). The highest prevalence (51.3%) was recorded among the piglets, while the adults showed the lowest level of infection (31.3%). Multivariate analysis indicated that age of the pigs, distance of the farm from human settlement and farm management system were significant risk factors of infection. Three genotypes (EbpA, EbpC and Henan-III) detected among the pigs are potentially zoonotic. The high prevalence of E. bieneusi among locally reared pigs, the presence of zoonotic genotypes and the spatial distribution of pig farms and human settlements warrant further investigation on the possibility of zoonotic transmission.

The effect of enclosure design on diurnal activity and stereotypic behaviour was assessed in 17 adult Malayan Sun bears (Helarctos malayanus), kept either in barren indoor enclosures or relatively enriched outdoor enclosures. Locomotion was the most frequent activity observed in the indoor bears, followed by resting. In contrast, conspecifics housed outdoors spent most of the time resting. Eleven forms of stereotypic behaviours were recorded in the bears, with pacing being the most common. The frequency and repertoire of stereotypies were significantly higher in the indoor bears irrespective of enclosure size. Novel forms of locomotor (forward-reverse pacing) and oral (allo-sucking) stereotypies were recorded. Oral stereotypies were predominant in the bears housed indoors, while patrolling was confined to the outdoor bears. Enclosure complexity significantly influences activity budget and occurrence of stereotypic behaviours, highlighting the importance of appropriate enclosure design and enrichment for the welfare of captive bears.

We evaluated the usefulness of the total myocardial uptake ratio (TMUR) of 15-(p-[ 123 I]iodophenyl)-3(R,S)-methyl-pentadecanoic acid ( 123 I-BMIPP) for predicting cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy. Six patients with mitochondrial encephalomyopathy, four with myotonic dystrophy, and 10 control subjects were studied. Quantitative assessment of 123 I-BMIPP dynamic myocardial imaging was performed, and the TMUR of 123 I-BMIPP was calculated according to the Ishii-MacIntyre method. Then, the TMUR was compared in the 10 patients and 10 healthy controls, and all patients were followed for 56.1±22.1 months to evaluate cardiac complications. TMUR in patients (2.69±0.64) was significantly (P=0.01) lower than that in controls (3.28±0.25). Three patients in whom the TMUR value was above 3.00 had no cardiac complications. On the other hand, all patients in whom TMUR was below 3.00 had some kind of cardiac complication during the follow-up period. Two patients showed progressive conduction abnormality and underwent pacemaker implantation, one patient had sick sinus syndrome and underwent pacemaker implantation, another patient showed non-sustained ventricular tachycardia and paroxysmal atrial fibrillation, and four of seven patients, including one with a pacemaker, showed an increased cardiothoracic ratio value over 50%. In conclusion, measurement of the TMUR by the Ishii-MacIntyre method is useful for evaluating the development of cardiac complications in patients with mitochondrial encephalomyopathy or myotonic dystrophy.

We redescribe the camallanid nematode Serpinema octorugatum (Baylis, 1933) from the box turtle Cuora amboinensis (Daudin) collected in Malaysia. In this redescription, we amend the original description by noting that there are only four cephalic papillae and that there are five pairs of post-anal papillae, and propose that the name of this species be corrected from S. octorugatus to S. octorugatum. Additionally, we removed the tissues overlying the buccal capsule and have used SEM studies to show that the peribuccal shields extend laterally from the buccal capsule, forming a surface possibly used in muscle attachment. Furthermore, we show that the supposedly non-cuticularised cylinder connecting the buccal capsule to the oesophagus in the Camallanidae is part of the buccal capsule and is, therefore, likely to be cuticularised. We also examine morphological measurements of taxonomic interest for correlations with total body length and find that many characters traditionally used for inter- and intra-specific comparisons are correlated with total body length in adult female worms. This suggests that comparisons between samples of adult female worms that do not account for the potential effect of total body length may be misleading. However, we show that some features of taxonomic interest are not correlated with total body length.

It has been reported that cardiac function can be improved by implanting a DDD pacemaker (PM) and setting a short atrioventricular (AV) delay in patients with impaired cardiac function. A previous report found that the critical AV delay that induces diastolic mitral regurgitation (MR) may represent the upper limit of the optimal AV delay. The optimal AV delay can be predicted by a simple method: slightly prolonged AV delay minus the interval between the end of the atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting. The patient was a 84-year-old man with an old myocardial infarction. He had repeated admissions to hospital for congestive heart failure. ECG showed prolongation of the PQ interval (0.28 s) and complete left bundle branch block. Cardiac function was improved by AV sequential pacing when the AV delay was set at 120 ms. After DDD-PM implantation, the cardiothoracic ratio decreased from 57 to 45% and cardiac function was improved from New York Heart Association class III to I. The AV delay was optimized during follow-up. Four years after PM implantation, the patient was in good condition without further hospital admission. (Jpn Circ J 2001; 65: 46 - 49)

QT interval may change when cardiac function is improved by optimizing the atrioventricular the (AV) delay. The relationship between AV delay, QT interval and cardiac function in patients with implanted DDD pacemakers was studied in 12 patients (aged 71&12 SD years) with complete or high degree AV block. Cardiac output (CO) was measured using a Swan‐Ganz catheter or by continuous Doppler echocardiography. The pacing rate was fixed at 70‐80/min to eliminate the influence of heart rate. The AV delay was prolonged stepwise by 30 ms starting from 90 ms. All measurements were performed after 5 min of pacing. When the AV delay was prolonged, the CO and QT interval gradually increased and reached a peak, and then decreased. When the CO was increased from the minimum to the maximum value by optimizing the AV delay, the QT interval was significantly prolonged from 440&40 to 456&39 ms (P

Gross anatomical features of the male genital organs and accessory genital glands of the lesser mouse deer ( Tragulus javanicus ) are described. The long fibroelastic penis lacks a prominent glans and is coiled at its free end to form two and one-half turns. Near the tight coils of the penis, on the right ventrolateral aspect, lies a U-shaped ventral process. The scrotum is prominent, unpigmented, and devoid of hair and is attached close to the body, high in the perineal region. The ovoid, obliquely oriented testes carry a large cauda and caput epididymis. Accessory genital glands consist of paired, lobulated, club-shaped vesicular glands, and a pair of ovoid bulbourethral glands. A well-defined prostate gland was not observed on the surface of the pelvic urethra. Many features of the male genital organs of T. javanicus are pleisomorphic, being retained from suiod ancestors of the Artiodactyla.

To clarify whether plasma somatostatin affects thyrotropin secretion in critical illness, plasma somatostatin and thyrotropin responses to thyrotropin-releasing hormone were studied in forty-three critically ill patients. High somatostatin levels were associated with blunted thyrotropin secretion in critically ill patients. There was an inverse correlation between plasma somatostatin levels and the maximum increment of thyrotropin after stimulation by thyrotropin-releasing hormone. Decreased somatostatin and increased thyrotropin secretion before discharge from the intensive care unit were demonstrated in survivors. On the other hand, non-survivors maintained high somatostatin levels and had blunted thyrotropin secretion during their intensive care admission. These results suggest that high plasma somatostatin levels may play a role in the blunted thyrotropin secretion observed in critical illness.

We established a T cell line, MV1, specific for rat vascular smooth muscle antigen from the regional lymph nodes of immunized MRL/Mp-+/+ mice. Adoptive transfer of MV1 T cells induced vasculitis lesions in the lungs of the syngeneic recipient mice pre-treated with cyclophosphamide. Flow cytometric analysis showed that MV1 was a CD4+ T cell line. The T cells proliferated in the presence of the vascular smooth muscle antigen and mitomycin C-treated syngeneic spleen cells. The cross experiments using an ovalbumin-specific T cell line demonstrated that MV1 was specific for vascular smooth muscle antigen. The antigen-specific proliferation of MV1 was CD4-dependent, which was consistent with the flow cytometric analysis. In addition, MV1 T cells, upon activation with anti-CD3 antibody or antigen-specific activation, killed A20.2J mouse B lymphoma cells. MV1 T cells also killed a CD95 (Fas)-transfected T lymphoma line, but not its parental Fas-negative cell line. These findings indicate that MV1 T cells killed target cells via a Fas ligand (FasL)/Fas pathway. The cytotoxicity of MV1 T cells may play an important role in the development of vasculitis in this model. Although the antigenic epitopes of MV1 and the lung specificity of vasculitis remain to be clarified, MV1-induced vasculitis should serve as an experimental model of human pulmonary vasculitis.

To study whether the suppression of the thyrotropin (thyroid-stimulating hormone, TSH) response to thyrotropin-releasing hormone (TRH) correlates with severity of illness and death in patients with nonthyroidal critical illness.Prospective study.Intensive care unit (ICU) of a university hospital.Forty-one critically ill patients without thyroid disease with multiple organ failure who were admitted to the ICU.The TSH response to TRH was tested within 24 hrs of ICU admission. Blood samples were obtained just before, and at 15, 30, 60, 90, and 120 mins after 500-micrograms injection of synthetic TRH. Triiodothyronine, free-triiodothyronine, thyroxine, free-thyroxine and TSH concentrations were measured in the samples obtained just before TRH injection. Acute Physiology and Chronic Health Evaluation (APACHE II) scores and Sepsis scores were calculated based on the data obtained within 24 hrs of ICU admission. Individual variables were compared between survivors and nonsurvivors. The APACHE II scores and Sepsis scores of nonsurvivors were significantly higher than those scores of survivors. The overall occurrence of suppressed TSH response to TRH was 88%. Peak TSH concentration of the TSH response was significantly lower in nonsurvivors than in survivors. Serial measurement of the TSH response showed that nonsurvivors experienced a decrease in peak TSH concentration from 1.55 +/- 0.78 to 0.55 +/- 0.30 microIU/mL; in survivors, it increased from 2.10 +/- 0.26 to 7.38 +/- 1.83 microIU/mL. Conversely, the basal TSH concentration did not change in either survivors or nonsurvivors. The "severity" of illness of nonsurvivors remained high; their mean APACHE II score varied from 20.0 +/- 1.9 to 22.1 +/- 1.3 and the mean Sepsis score varied from 20.0 +/- 4.3 to 25.4 +/- 4.0, while the same scores for survivors decreased significantly (p.05): their APACHE II score decreased from 16.2 +/- 0.7 to 7.6 +/- 2.0 and the Sepsis score went from 14.0 +/- 1.9 to 6.0 +/- 1.6.In critically ill patients with multiple organ failure, suppression of the TSH response to TRH frequently occurs and correlates with severity of illness and outcome. Our data indicate that measurement of the TSH response is helpful in evaluating the severity of illness and prognosis for critically ill patients.

Several triterpenoid α- and β-diglycosides of oleanoic acid (1), 11-deoxoglycyrrhetic acid (4) and 11-deoxoglycyrrhetol (5) were synthesized. The synthetic diglycosides incluced one or both d -glucopyrnanosuronic acids as sugar components. Cytoprotective activities of the diglycosides against carbon tetrachloride-induced hepatotoxicity were investigated using mice. The activities of the synthetic diglycosides were estimated by assay of aspartate transaminase and alanine transaminase, which were released from the injured hepatocytes and compared with that of glycyrrhizin (9). The β-diglycosides of 1 and 4 showed potent activities in contrast to those of 5; none of the α-glycosides showed remarkable activity. Reduction of the carbonyl group (CO) at C-11 on the C-ring of the aglycons slightly enhanced the activity over that of 9, and replacement of the carboxyl group (COOH) on the aglycons by a hydroxylmethyl group (CH2OH) drastically decreased the activity.

Focuses on how to determine a set of parameters describing cell arrival stream characteristics and how to evaluate the accuracy of these measurements. Since a cell arrival stream is both correlated and bursty, the autocorrelation characteristics between the number of arriving cells in two adjacent intervals are analyzed, and then the time interval is determined for which the autocorrelation may be neglected. It is also shown that this set of parameters can represent the first and approximately second moment statistics during any interval. A method of estimating cell loss probability through the use of a queuing model that has an input process is presented. The input process is determined from the set of parameters that describe the characteristics of the source. In order to verify the accuracy, a brief simulation study is carried out. >

症例は48歳男性.高血圧,糖尿病を指摘され,平成4年12月,血液生化学的検査,画像診断にて左副腎褐色細胞腫と診断された.悪性褐色細胞腫を疑い化学療法を施行したが無効であった.腹部血管造影時,右腎血管性高血圧と診断された.本症例は左褐色細胞腫と右腎血管性高血圧を合併したまれな症例であり,かつ経過中膵仮性〓胞によると思われる癒着で褐色細胞腫の治療に難渋した. PTRA施行により,血圧,血漿レニン活性は低下傾向を示した.

A major problem is how to determine buffer capacity, and how to synthesize a service quality control scheme for both delay and loss probability so as to satisfy multiple grades of service requirements. This is because in multimedia communications systems, each medium may have its own grade of service requirements, and these requirements may differ greatly from medium to medium. A synthesis method is proposed based on a conservation law for an M/D/1 queue with finite capacity. The necessity of a buffer management scheme in a multimedia environment is discussed. The achievability of mean delay performance is examined on the basis of a conservation law for an M/D/1 queue with finite capacity. A synthesis of the buffer management scheme that satisfies both delay and loss probability requirements is examined. >

The purpose of this study was to evaluate whether or not cardiac sympathetic nerve activity, using (123)I-meta-iodobenzylguanidine ((123)I-MIBG) imaging, and cardiac natriuretic peptides (atrial and brain, ANP and BNP) were independent predictors of cardiac events, and, if so, which was the stronger predictor. Planar (123)I-MIBG images were obtained from 62 patients with heart disease. Plasma ANP and BNP levels, left ventricular ejection fraction (LVEF) by echocardiography, serum total cholesterol and triglyceride were measured. (123)I-MIBG was assessed as the heart-to-mediastinum (H/M) ratio of the delayed image and the washout rate (WoR) from the early to the delayed image. Patients were followed up for an average of 16.2 months, and 12 of 62 patients had cardiac events. Patients with events had significantly lower LVEF and H/M ratio compared with those without events. They had significantly higher WoR, ANP and BNP. By multivariate Cox proportional hazard analysis, (123)I-MIBG (H/M or WoR), ANP and BNP were independent predictors for cardiac events. Event-free survival using a Kaplan-Meier model, with a threshold value of 2.0 for H/M and 45% for WoR, showed that patients with H/M2.0 and/or WoR45% had a significantly poorer prognosis. These results suggest that (123)I-MIBG imaging and cardiac natriuretic peptides are useful tools for the evaluation of patients with heart disease, and that cardiac sympathetic nerve activity is a stronger predictor of cardiac events.

We evaluated the effects of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Forty-one ASA I-II patients scheduled for shoulder arthroscopic surgery, were allocated into following four groups. The patients, after intra-articular arthroscopic surgery, either received intra-articular lidocaine (Group I, n = 10) or did not (Group III, n = 10). The patients after extra-articular arthroscopic surgery either received intra-bursal lidocaine (Group II, n = 11) or did not (Group IV, n = 10). Group I and Group II received 8 ml of 1% lidocaine intra-articularly and intra-bursally, respectively, at the end of surgery, followed by continuous infusion of 1% lidocaine at the rate of 2 ml.hr-1 for 24 hours. The intensities of postoperative pain were evaluated by Visual Analogue Scale (VAS), 2, 5, 8, 12, 18 and 24 hours after surgery, and by the number of patients' request for supplemental analgesic for 24 hours. The VAS scores and the number of analgesic requests were significantly lower (P0.05) in Group I than Group III, and in Group II than Group IV throughout the postoperative observation period. No adverse effects were observed during this study. We conclude that continuous intra-articular and intra-bursal infusion of lidocaine provides effective postoperative pain relief for shoulder arthroscopic surgery.

Cardiac function is improved by optimizing the atrioventricular (AV) delay. An automatic optimizing function of AV delay may be necessary to achieve the most favourable haemodynamic state in paced patients. The QT interval may change when cardiac function is improved by optimizing the AV delay. The QT or stimulus-T interval is used as a sensor for rate-responsive pacemakers. Evoked (e) QT interval is measured as the time duration from the ventricular pace pulse (stimulus) and the T-sense point that is the steepest point of the intracardiac T wave (stimulus-T interval). The relationship between AV delay, eQT interval and cardiac function was studied in 10 patients (73 +/- 10 (SD) years old) with an implanted stimulus-T-driven DDDR pacemaker. Cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) were measured by Swan-Ganz catheter. The AV delay was prolonged stepwise by 30 ms. Electrocardiogram event markers which indicated ventricular spike and sensed T wave were recorded, and the interval between two event markers was measured as eQT interval. When AV delay was changed from 240 ms to the AV delay at which CO was maximal (172 +/- 33 ms), eQT interval prolonged from 346 +/- 60 to 353 +/- 62 ms (P < 0.01). There was a significant positive correlation between the optimal AV delay at which CO was maximal (172 +/- 33 ms) and the optimal AV delay which was predicted from the maximum eQT interval (179 +/- 37 ms, r = 0.92, P < 0.001). When AV delay was changed from 240 ms to the predicted optimal AV delay, CO increased from 4.2 +/- 0.7 to 4.5 +/- 0.81.min-1 (P < 0.001) and PCWP was decreased from 7.1 +/- 4.0 to 5.7 +/- 3.1 mmHg (P < 0.05). In conclusion, the optimal AV delay can be predicted from the eQT interval which is sensed by an implanted pacemaker. Automatic setting of the optimal AV delay may be achieved by the QT sensor of an implanted pacemaker.

Although sinus node recovery time (SNRT) assessment by the overdrive suppression test (ODST) is important in detecting sick sinus syndrome (SSS), its sensitivity is still inadequate. We have evaluated the effect of intravenous injection (i.v.) of disopyramide phosphate (DP) in ODST. The subjects were 30 SSS patients (64.9 +/- 10.0SDyears old). If SNRT was2,000 ms or the corrected SNRT (CSNRT) was1,000 ms, ODST was repeated after DP i.v. (2 mg. kg(-1),or = 100 mg in total). Eleven normal subjects (59.3 +/- 9.0 years old) were also studied. Although SNRT was2,000 ms or the CSNRT was1,000 ms in 13 of the 30 SSS patients (43%), SNRT was prolonged from 1,510 +/- 300ms to 3,400 +/- 1,160 ms (P0.01), and CSNRT from 510 +/- 190 to 2,470 +/- 1,470 ms (P0.01) after DP i.v. in these patients. Thus, SNRT wasor = 2,000 ms and the CSNRT wasor = 1,000 ms in 27 of 30 SSS patients (90%) after DP i.v. Using a combination of overdrive suppression and intravenous injection of disopyramide phosphate, the corrected sinus node recovery time was diagnostic (525 ms) in 29 of the 30 patients (97%). In contrast, SNRT and CSNRT were shortened in the normal subjects during ODST after DP i.v. (P0.01). The plasma concentration of DP estimated in nine patients was 4.1 +/- 1.0 microg.ml(-1). No serious side effect occurred. ODST employing DP i.v. is safe and seems to be highly effective in diagnosing SSS.