Cognitive behavior therapy (CBT) has been shown to be effective in recent randomized controlled trials for chronic fatigue syndrome (CFS). We examined the effectiveness of CBT in a general hospital setting in a retrospective questionnaire follow-up study of 94 patients offered CBT by liaison psychiatry services. The questionnaire response rate was 61%. Eighteen percent had returned to normal functioning at follow-up. For the group as a whole, there was a significant improvement in the functional and social impairment and the number of frequently experienced symptoms. Those in work or study at follow-up was 53% (29% pretreatment), and 65% of patients mentioned occupational stress as a contributory factor in their illness. There was a significant reduction in the frequency of attendance at primary care in the year after the end of CBT. We conclude that cognitive behavioral therapy is an acceptable treatment for most patients and can be used in a general hospital outpatient setting by a variety of trained therapists. However, a proportion of patients do not benefit and remain significantly disabled by the condition.

Adult↗

PubMedDate not supplied

Mercury concentration in organs of contemporary Japanese.

Concentrations of inorganic mercury (IHg), methylmercury (MeHg), and total mercury (THg) were determined for autopsy samples from 46 Japanese subjects. Two laboratories (Labs A and B) participated in Hg analyses: Lab A for THg and IHg and Lab B for THg and MeHg. Total mercury concentration values were in good agreement between the two laboratories: the averages were several hundreds of ng/g in kidney cortex, kidney medulla, and liver, and were several tens of ng/g in cerebrum, cerebellum, heart, and spleen. Inorganic mercury accumulated more in kidney and liver: its percentage THg was 81-84% in the kidney, 67% in the liver, 25% in the heart, 22% in the spleen, 20% in the cerebrum, and 14% in the cerebellum. Methylmercury levels in tissues were uniform through all organs except the liver. Approximately 80% was in the form of MeHg in the cerebrum, cerebellum, heart, and spleen, whereas the values were 33%, 15%, and 11% in the liver, kidney medulla, and kidney cortex, respectively. Age was a significant factor in increased IHg concentrations in the cerebrum and heart, decreased values of %MeHg in the cerebrum, cerebellum, and heart, and increased values of %IHg in the cerebrum and heart.

Adolescent↗

PubMedDate not supplied

The hair-organ relationship in mercury concentration in contemporary Japanese.

The hair-organ relationship of mercury concentration was investigated in 46 autopsy samples in Tokyo, Japan. Hair mercury levels were highly significantly correlated with organ Hg levels in the cerebrum, cerebellum, heart, spleen, liver, kidney cortex, and kidney medulla, when the total mercury or methyl mercury value in the organ was compared with the hair total mercury or organic mercury, respectively. When the inorganic mercury value was tested, significant correlations remained, with weaker coefficients in all the organs but the spleen. Stepwise multiple regression analysis evidenced that the hair organic mercury value was the major explanatory variable for the organ total mercury or organ methyl mercury value in all the organs. To explain the organ inorganic mercury value, the hair organic mercury value was the major variable for the cerebrum and kidney (both cortex and medulla), the hair inorganic mercury value was the major variable for the cerebellum and heart, and the hair phosphorous and hair organic mercury were the major variables for the liver; no explanatory variable existed for the spleen. Auxiliary explanatory variables accounted for the organ total mercury and inorganic mercury levels, among which the hair selenium value was conspicuous with negative regression coefficients.

Adolescent↗

PubMedDate not supplied

High hair and urinary mercury levels of fish eaters in the nonpolluted environment of Papua New Guinea.

Hair and mercury concentrations of 134 fish-eating subjects in the Lake Murray area and 13 non-fish-eating subjects in the upper-Strickland area, Papua New Guinea, were studied. Hair mercury levels among the subjects in the Lake Murray area (mean = 21.9 micrograms/g, range = 3.7-71.9 micrograms/g) and urinary mercury levels (mean = 7.6 micrograms/g creatinine, range = 1.4-25.6 micrograms/g creatinine) were markedly higher than levels found in subjects from the upper-Strickland area (mean hair mercury = 0.75 micrograms/g, mean urinary mercury = 0.48 micrograms/g creatinine). Mercury intake of the fish eaters, estimated from mercury concentrations found in fish and from the observed amounts of fish consumed, was approximately 73 micrograms/d. Hair and urinary mercury concentrations were correlated significantly (r = .59), indicating that urinary mercury excretion was elevated because fish consumption was very high.

Adolescent↗

PubMedDate not supplied

A bioartificial ventricle used as a totally implantable circulatory assist device.

The authors designed a totally implantable circulatory assist device consisting of a bioartificial ventricle composed of a skeletal muscle ventricle lined with a bioartificial endocardium. The bioartificial endocardium consists of a structural matrix made of a polyurethane porous membrane, fragmented blood vessels, and collagen gel. The authors prepared the polyurethane porous membrane by solvent cocasting with salt powder. They used collagen gel with fragmented goat carotid vein to perform in vitro construction of the bioartificial endocardium. For in vivo construction of the bioartificial endocardium, the authors used a modified version of the tissue fragment method for vascular prostheses. The authors prepared suspensions of tissue fragments using collagen gel with fragmented goat carotid artery. They used a highly porous fabric vascular prosthesis as a structural matrix; tissue fragments were entrapped on the outer surface of the prosthesis, and the prosthesis then was implanted into the carotid artery of four adult goats. In specimens 1 and 3 months postimplantation, cells from the fragmented tissue regenerated an endothelium-like monolayer sheet on the inner surface of the prostheses. Output of a prototype bioartificial ventricle reached 660 ml/min at an afterload of 60 mmHg and a preload of 20 mmHg. Based on these data, the authors conclude that the bioartificial ventricle is promising as an implantable device with excellent antithrombogenicity.

Animals↗

PubMedDate not supplied

A motor integrated regenerative pump as the actuator of an electrohydraulic totally implantable artificial heart.

The authors have developed a new actuator to drive an electrohydraulic totally implantable artificial heart. The basic concept of this artificial heart is that the blood pumps are implanted in the thorax and an actuator is placed separately in the abdominal region. The actuator is a regenerative pump that pumps fluids against high pressures and is thin enough for easy implantation. The rotor-magnet of the brushless DC motor is mounted on the impeller of the pump to miniaturize the actuator and reduce the number of moving parts. The height, diameter, and weight of the actuator are 32.5 mm, 73 mm, and 360 g, respectively. A pair of oil ports is connected to the left and right blood pumps with mesh reinforced tubes filled with silicone oil. The blood pumps are alternately driven by bidirectional rotation of the motor. Performance of the system was evaluated in in vitro and in vivo experiments. Maximum output of the right heart was 6.7 L/min in both experiments. Systemic circulation was well maintained in acute animal experiments using 49 and 50 kg goats. The feasibility of the actuator was confirmed.

Animals↗

PubMedDate not supplied

Pulmonary function in a non-pulsatile pulmonary circulation.

The authors suggested that a mammal immediately accommodates well to nonpulsatile flow in the systemic circulation. In the current study, nonpulsatile pulmonary blood flow using a centrifugal pump was established in chronic models to analyze its influence on the pulmonary circulation. A pulsatile right ventricular assist device (RVAD) was implanted to draw blood from both the right atrium and ventricle and send blood to the pulmonary artery in six goats. After 2 weeks, the pulsatile pump was quickly replaced with a centrifugal pump without anesthesia, and a 100% non-pulsatile pulmonary blood flow was obtained. Cardiac output was kept at 80-120 ml/kg/min during the experiments. No changes were observed in hemodynamic parameters, including pulmonary arterial pressure, pulmonary vascular resistance index, and blood gas data, after the immediate depulsation of the pulmonary blood flow. There was also no significant change in the ventral to dorsal tissue blood flow ratio of the lower lobe of the right lung, which was calculated by a colored microsphere method, between pulsatile and non-pulsatile pulmonary blood perfusion. These results suggest that pulmonary function, including blood flow distribution, is not affected by non-pulsatile pulmonary circulation for periods up to 14 days.

Animals↗

PubMedDate not supplied

Permeation of silicone oil through a diaphragm in an electrohydraulic ventricular assist system.

This study was designed to investigate the permeation of silicone oil through a pump diaphragm made of Pellethane in the authors' electrohydraulic ventricular assist system (EHVAS) and to evaluate influences on organ function. The permeability of the diaphragm to silicone oil was investigated by in vitro experiments. Influences on organ function were evaluated in five goats with an EHVAS by monitoring serum silicon levels (SSi), blood chemical parameters, and histologic findings. Elevation of silicone oil levels in Pellethane sheets immersed in silicone oil demonstrated that the Pellethane diaphragm was, in fact, permeable to silicone oil. The permeation rate of silicone oil was calculated to be 1.75 ml/year in the authors' EHVAS from the data of a diffusion apparatus test. Serum silicon levels did not increase during the EHVAS pumping, and renal and hepatic function were not affected. No abnormality or deposit suggestive of silicone oil was observed. However, the problem of permeation of silicone oil through the pump diaphragm must be solved to allow for a circulatory assist device for long-term use.

Animals↗

PubMedDate not supplied

Influence of an impeller centrifugal pump on blood components in chronic animal experiments.

A chronic animal experiment was designed to examine the changes in blood components induced by the use of a centrifugal pump (CP). In the pump, an impeller spins in a blood chamber by magnetic coupling with a rotating magnet outside the blood chamber. A pulsatile ventricular assist device was implanted between the left atrium and the descending aorta in four goats weighing from 63 to 75 kg; the CP was installed to replace the assist device, without surgery and anesthesia, more than 2 weeks later when the influences of implantation surgery were diminished. Antithrombotic therapy was performed with oral administration of an antiplatelet agent, cilostazol, a cyclic adenosine monophosphate phosphodiesterase at a dose of 30 mg/kg/day. No significant differences were observed in any of the following parameters: 1) hematocrit, 2) plasma free hemoglobin, 3) lactic acid dehydrogenase, 4) adenosine diphosphate, 5) platelet count, 6) fibrinogen, and 7) antithrombin III, between the data before and after the use of the CP, nor were deformation or pseudopods of platelets seen. The CP developed in the authors' institute and evaluated in this study did not damage blood components, and it proved to be a promising device for long-term use.

Adenosine Diphosphate↗

PubMedDate not supplied

An abdominally placed, implantable left ventricular assist system for long-term use.

An implantable left ventricular assist system was developed for long-term use. The system includes an implantable blood pump, a portable control drive unit (CDU), and a monitoring system. The blood pump was designed to be positioned in the left abdominal wall and was made of segmented polyether polyurethane. A percutaneous drive line connected it to the external CDU. The CDU included a continuous pump performance monitoring system that measured electrical impedance between the two metal connectors of a blood pump. In animal experiments using six adult goats, the pump was installed between the left ventricular apex and the descending aorta, and it was placed in the abdominal wall. No antithrombogenic agents were administered during the course of the experiment. This LVAS was easy to use and provided stable hemodynamic conditions for > 8 weeks. Pump output (Op), estimated by impedance, was linearly related to Op measured with an electromagnetic flowmeter. Pump performance was effectively estimated, and the fill-empty drive was well controlled by impedance. There were no significant abnormal hematologic or blood chemistry values, no signs of infection around the pump pocket (except in one animal), and no obvious thromboembolic symptoms. Maximum flow was 6.7 L/min with use of a prototype portable CDU (dimensions, 500 x 168 x 435 mm; weight, 16 kg). In conclusion, this LVAS is promising for long-term clinical use.

Abdomen↗

PubMedDate not supplied

Development and evaluation of components for a totally implantable artificial heart system.

The authors have been developing an electrohydraulic (EH) artificial heart system for total implantation. This system consists of intrathoracic ventricles, an abdominally placed EH actuator, flexible silicone oil conduits, externally coupled transcutaneous energy transfer (TET) system, transcutaneous optical telemetry (TOT) system, internal battery, and internal control drive unit. Fitting was evaluated in chronic animal experiments as a pneumatic system in 11 goats weighing 55.2 +/- 4.2 kg and 3 calves of 52.3 +/- 1.2 kg. The longest survival time in calves was 111 days, and that in goats was 51 days. The assembled EH pump was implanted in two goats of 49 and 50 kg as an acute experiment, and 4.2-6.7 L/min of cardiac output was maintained. For the TET system, an internal coil 3 cm in diameter was implanted to make an arch covered by skin. Electric energy was transmitted from the external to the internal coil, and energy of about 20 W was carried through wires to an external load. The DC-to-DC efficiency of the system was 76-83% for 40 days. The TOT system with internal light emitting diodes and external photodiodes also was evaluated in a goat. Disalignment of up to 12 mm was tolerated. Although more improvement is necessary, most of the components showed characteristics desirable for a totally implantable system.

Animals↗