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Regional wall motion abnormalities after prolonged exercise in the normal left ventricle.

To determine whether regional wall motion abnormalities exist or contribute to left ventricular dysfunction, we obtained two-dimensional echocardiograms in 12 athletes before (baseline), immediately after (race finish), and 1 day after (recovery) the Hawaii Ironman Triathlon (a 3.9-km swimming, 180.2-km bicycling, and 42.2-km running event). Left ventricular short-axis and apical four-chamber views were computer digitized and divided into six segments, and radial chord shortening and area ejection fraction were calculated. Global ejection fraction fell at race finish (51% versus 46%, p less than 0.05) but recovered by 1 day (54%, p less than 0.01 by repeated-measures analysis of variance). With the apical four-chamber view, midseptal and apical-septal motion were reduced at race finish but returned to baseline during recovery (midseptal radial chord shortening: 21%, 8%, 22%; apical-septal radial chord shortening: 27%, 12%, 25%; midseptal area ejection fraction: 39%, 30%, 40%; apical-septal area ejection fraction: 44% baseline, 33% race finish, 43% recovery; all p less than 0.01). In contrast, with the parasternal short-axis view, wall motion did not change at race finish but tended to be elevated during recovery and became significant for anteroseptal motion (radial chord shortening: 29%, 30%, 36%; area ejection fraction: 49% baseline, 51% race finish, 58% recovery; both p less than 0.05). Lateral wall motion was unchanged. In addition, an index of septal curvature was calculated using the ratio of the septal-lateral wall minor axis to the perpendicular anteroposterior minor axis. At all three data collections, this ratio remained close to 1.0 at end systole and end diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma.

PURPOSE: To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT). MATERIALS AND METHODS: Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method. RESULTS: Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points. CONCLUSION: Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.

Carcinoma, Squamous Cell↗

[A rapid detection of motor block in patients with Parkinson disease during volitional movements of the hand].

INTRODUCTION: An algorithm to study hand movements in patients with Parkinson's disease (PD) who experience temporary, involuntary inability to move a hand have been developed. In literature, this rather engimatic phenomenon has been described in gait, speech, handwriting and tapping, and noted as motor blocks (MB) or freezing episodes. Freezing refers to transient periods in which the voluntary motor activity being attempted by an individual is paused. It is a sudden, unplanned state of immobility that appears to arise from deficits in initiating or simultaneously and sequentially executing movements, in correcting inappropriate movements or in planning movements. The clinical evaluation of motor blocks is difficult because of a variability both within and between individuals and relationship of blocks to time of drug ingestion. In literature the terms freezing, motor block or motor freezing are used in parallel. AIM: In clinical settings classical manifestations of Parkinson's Disease (akinesia, bradykinesia, rigidity, tremor, axial motor performance and postural instability) are typically evaluated. Recently, in literature, new computerized methods are suggested for their objective assessment. We propose monitoring of motor blocks during hand movements to be integrated. For this purpose we have developed a simple method that comprises PC computer, digitizing board and custom made software. Movement analysis is "off line", and the result is the data that describe the number, duration and onset of motor blocks. METHOD: Hand trajectories are assessed during simple volitional self paced point-to-point planar hand movement by cordless magnetic mouse on a digitizing board (Drawing board III, 305 x 457 mm, GTCO Cal Comp Inc), Fig. 1. Testing included 8 Parkinsonian patients and 8 normal healthy controls, age matched, with unknown neurologic motor or sensory disorders, Table 1. Three kinematic indicators of motor blocks: 1) duration (MBT%); 2) onset (t%); and 3) number (N) of MB episodes, allow identification and quantification of motor blocks. Duration of motor blocks (MBT) is defined as the time sequence when (x,y) coordinates do not change their values and is expressed in percentage from the whole movement duration MBT% = MBT/T (%). If during some movements more than one motor block occurs (N > 1) then this movement is decomposed. The whole movement motor block (mbt) is the sum of all motor blocks MBT; during the same movement and expressed in percentage from the whole movement duration mbt% = mbt/T (%). The onset of motor block (t) is determined with the beginning of motor block and expressed in percentage from the whole movement duration: t% = t/T (%). After the determination of kinematic indicators of motor blocks (MBT, N, t) for healthy controls, their mean values are calculated. Statistical package ANOVA is applied to determine statistical significance of the difference between PD patients and mean values from age matched control healthy group. PD patients are then classified into two groups: one group consisting of PD patients with motor blocks and the other without motor blocks, similar to healthy controls. RESULTS: Acquired movements are processed and analyzed. Fig. 2 is an example of hand trajectories. Time course of (x, y) coordinates indicates motor block appearance, Fig. 3. Detailed presentation of kinematic indicators of motor block (MBT, N, t) is in Fig. 4. Intra-subject variability of these parameters is presented in Figs 5, 6 and 7 for patient #3. The results for N show that 45% of all patients #3 movements had none motor blocks (N = 0); 20% had N = 1; 15% had N = 2; 11.5% had N = 3; 5.7% had N = 4; 0.3% had N = 5; 0.7% had N = 6; 0.3% had N = 7 and 1% had N = 8 motor blocks. The results for t% show that 3% of all patients' #3 blocks started at first quarter, 17% started in the second, 36% in the third, and 44% in the last quarter of movement. The results for MBT% show that 14.5% of all movements had MBT% in the range 0-5%; 56% had MBT% 5-10%; 22% had MBT% 10-15%; 5.5% had MBT% 15-20% and 2% had MBT% 20-25%. No block lasted more than 25% from the whole movement duration. Table 2 is the summary of mean variability for kinematic indicators of motor block (N, mbt%, t%) and for the movement duration T during a 7 day-testing of patients #3. The analysis of calculated data for eight tested PD patients revealed a significant difference (p < 0.01) between healthy controls and three PD patients; data on five PD patients were not significantly different (ns). This method clustered 3 PD patients in the group that experience motor blocks, while the rest were in the group without their significant occurrence. DISCUSSION: This algorithm is an additional instrument in classical evaluation of PD patients during their clinical evaluation and treatment. It provides to clinician a rapid feedback on the changes of voluntary hand movements in everyday progress of illness. Furthermore, this method could be of assistance for developing strategies to overcome motor blocks in arm movements at their beginning, as well as for the feedback of the success of drug therapy.

Adult↗

A double-blind randomized trial of 0.1% tacrolimus vs 0.05% clobetasol for the treatment of childhood vitiligo.

OBJECTIVE: To assess the safety and efficacy of topical 0.1% tacrolimus vs 0.05% clobetasol propionate. DESIGN: Randomized double-blind trial. SETTING: Department of Dermatology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosí, México. PARTICIPANTS: From 20 children with vitiligo, 2 symmetrical lesions of about the same size and evolution time were selected. They were devoid of any topical or systemic therapy for 2 months prior to inclusion. Interventions Treatment with topical tacrolimus and clobetasol for a 2-month period. MAIN OUTCOMES MEASURES: The grade of repigmentation was evaluated by color slides at baseline and again at every 2-week visit. The slides were analyzed by 2 clinicians unrelated to the study and by a morphometric digitalized computer program. Characteristics of pigment, time of response, symptoms, telangiectasias, and atrophy were evaluated every 2 weeks. RESULTS: Eighteen (90%) of the 20 patients experienced some repigmentation. The mean percentage of repigmentation was 49.3% for clobetasol and 41.3% for tacrolimus. Lesions in 3 patients using clobetasol presented atrophy, and 2 lesions incurred telangiectasias; tacrolimus caused a burning sensation in 2 lesions. CONCLUSIONS: Tacrolimus proved almost as effective as clobetasol propionate to restore skin color in lesions of vitiligo in children. Because it does not produce atrophy or other adverse effects, tacrolimus may be very useful for younger patients and for sensitive areas of the skin such as eyelids, and it should be considered in other skin disorders currently treated with topical steroids for prolonged periods.

Administration, Topical↗

Cerebellar-pontine angle tumors. Results of quantitative vestibulo-ocular testing.

A new quantitative vestibulo-ocular test battery was evaluated in 12 patients with surgically confirmed cerebellar-pontine angle tumors. The battery consisted of precise vestibular and visual stimuli and digital computer analyses of responses. Eleven of 12 patients, including all patients with acoustic neurolemmomas, had significant vestibular deficits on the tumor side (P less than .01). Contrary to previous reports, rotatory tests (impulse and sinusoidal acceleration) reliably identified the side and magnitude of vestibular deficit. Eight of nine patients with surgically confirmed brain stem compression had significantly impaired smooth pursuit (P less than .05). Optokinetic nystagmus was impaired in five of nine patients with brain stem compression (P less than .05). By combining the results of the entire test battery with standard clinical evaluation, a good prediction of tumor size, location, and type was possible.

Adolescent↗

Dynamic shifts in corneal topography during the modified Ruiz procedure for astigmatism.

We utilized ten eye bank eyes to evaluate and quantitate the immediate corneal topographic shifts that occur after each stage of a modified Ruiz procedure for astigmatism. Computer digitization of photokeratoscope (Corneascope) photographs revealed that the initial two central paired tangential incisions induced an average of 5.10 diopters (D) of central astigmatism by flattening the meridian perpendicular to the incisions and by steepening the meridian 90 degrees away. Additional tangential incisions did not significantly alter the topography after placement of the first two central incisions. Addition of corridor incisions produced an additional 5.25 D of induced astigmatism by further extensive flattening of the incised meridian. The completed procedure produced an average of 11.03 D of astigmatic shift, but with a wide range of effect (7.15 to 12.96 D). With modification, the Ruiz procedure is a powerful keratorefractive surgical technique.

Astigmatism↗

Effect of electronic filters on electronystagmographic recordings.

With the advent of digital computer measurement techniques for nystagmus parameter determinations, the need has arisen for careful quality control of nystagmus recording methods. For this study, electronic filter distortion of nystagmus waveforms was quantified, and the results were used to formulate guidelines for selection of appropiate band-widths depending on the user's requirements. For minimum distortion, a lower time constant of at least three seconds and an upper frequency cutoff of at least 60 hertz are recommended.

Computers↗

The influence of intensive hyperbaric oxygen therapy on skin flap survival in a swine model.

Conflicting reports exist regarding the influence of hyperbaric oxygen therapy on random skin flap survival. The present investigation sought to demonstrate enhanced survival of experimental random skin flaps in swine using an intensive and tapering hyperbaric oxygen therapy regimen that would have direct application in human clinical trials. Random cutaneous flaps were surgically constructed on 12 domestic pigs. Flaps were designed to obtain a predictable length of necrosis. Six pigs did not undergo hyperbaric oxygen therapy and served as surgical controls. Six pigs were subjected to an intensive tapering hyperbaric regimen within 1.5 hours of completing the surgical procedure. Treatments were administered in a research hyperbaric vessel at a depth of 2.0 atm absolute (10 m of seawater) for 90 minutes of oxygen treatment in a tapering schedule over 6 days. This was structured to provide intensive therapy initially during the period of maximum tissue trauma and ischemia. Extent of flap necrosis was assessed by tracing clear plastic templates at necropsy, then converting to square centimeters using a computer digitizer tablet. The difference in flap necrosis between groups was significant, with random flaps subjected to hyperbaric oxygen therapy demonstrating a mean 35% less necrosis than surgical controls. Skin flaps treated with hyperbaric oxygen therapy demonstrated a mean survival of 77%, with a range of 56% to 100%. This reflected a 12% improvement in mean surviving area for hyperbaric oxygen therapy flaps over untreated surgical controls. We are unaware of similar studies reporting a comparable degree of enhancement in random skin flap survival using hyperbaric oxygen therapy alone. Adjunctive hyperbaric oxygen therapy in an intensive tapering schedule significantly improved flap survival in this model. Further investigations need to determine the optimum frequency of treatments and depth necessary to attain maximum tissue viability.

Animals↗

The heart is under the lower third of the sternum. Implications for external cardiac massage.

Current guidelines for cardiopulmonary resuscitation in children state that the heart lies under the midsternum in infancy and descends with age. To verify this statement, we studied 55 patients, aged 1 day to 19 years, including eight premature infants, during either routine chest x-ray films or right-sided heart angiography. Using a Cartesian coordinate system determined by radiopaque markers placed on the chest, and computer digitization, we located the center of each patient's cardiac silhouette and/or right ventricle. Using descriptive statistics, we found that the heart lay under the lower third of the sternum in all age groups. Analysis of variance indicated that there was no significant difference in this location between age groups. These results suggest that recommendations for external cardiac massage in infants and children may need to be revised.

Adolescent↗

Geographic information systems (GIS): new perspectives in understanding human health and environmental relationships.

Geographic information systems (GIS) and digital computer technology will advance the mission of the Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR) to protect public health. Geographic positioning, topology, and planar and surface measurements are basic GIS properties which enable highly precise locational referencing of spatial phenomena. The growing uses of remotely sensed imagery and satellite facilitated global positioning systems are contributing to unprecedented surveillance of the environment and greater understanding of known and suspected environmental disease associations with human and animal health. Earth science and public health monitoring GIS databases offer new analytic opportunities for disease assessment and prevention.

CD-ROM↗

Kinetics of product inhibition in alcohol fermentation. Reprinted from Biotechnology and Bioengineering, Vol. X, Issue 6, Pages 845-864 (1968).

The inhibitory effect of ethanol concentration p in a medium on the specific rates of growth mu and ethanol production nu of a specific strain of baker's yeast was studied in a chemostat, where except for ethanol as the product, only the concentration of glucose S was controlled to limit the metabolic activity of the yeast. This was designed to supplement the previous findings from the batch experiment, in which ethanol was added artificially and no substrate components were limiting the metabolism of the same yeast, that mu = mu(0)e(-k(1)p) and nu = nu(0)e(-k(1)p), where k(1) and k(2) are empirical constants and subscript the 0 denotes respective values at p = 0. The effects of p on the values of mu and nu were confirmed by the Line-weaver-Burk plot to belong to noncompetitive inhibition. The formulas here for mu and nu as affected by p, if extrapolated to the case of no limiting substrates, were in good agreement in respective forms with those derived previously from the batch experiment, though the values of corresponding coefficients in these formulas were different. The differential equations for mu and nu as functions of both p and S and, in addition for the rate of glucose consumption as correlated by the yield factors either with the cell growth rate or the rate of ethanol production, were solved properly with a digital computer. A kinetic pattern calculated so far was discussed with reference to the data obtained in the batch experiment and those relevant to actual "sake" brewing.

Culture Media↗

Evaluation of skin damage caused by percutaneous absorption enhancers using fractal analysis.

Fractal analysis of the cross-sectional morphology of rat skin was conducted to evaluate pathologic changes evoked by percutaneous absorption enhancers. Male hairless rats (WBN/Ht-ILA), 8 weeks old, weighing 160 to 180 g were used. Under anesthetization, glass cells (10-mm inner diameter) were attached to the rats' abdomens, and test solutions containing various mixtures of the percutaneous absorption enhancers, sodium lauryl sulfate, isopropanol, 2-methyl-1-butanol, and sodium myristate were applied. Six hours after application, the solutions were removed and the abdominal skin was excised. Skin cross sections were analyzed with a charge-coupled device (CCD) camera. Image data taken by the CCD camera were fed into a desktop digital computer; then the fractal dimension of each skin cross section was determined on the basis of the box-counting algorithm. A pathologic study was also performed on the skin treated with the test solution. All sections of skin were examined with an optical photo microscope. Pathologic findings were classified into five levels. The total irritation score (TIS) was defined as the summation of damage levels in all regions. Only with the administration of hydrogel containing 2-methyl-1-butanol or sodium lauryl sulfate were positive values of TIS observed. However, the TIS values were independent of the concentration of these components. The most severe skin damage was evoked by application of sodium lauryl sulfate. Noticeable skin damage was also seen with 2-methyl-1-butanol. No irritation to the skin resulted from treatment with isopropanol or sodium myristate. When test solution containing sodium lauryl sulfate was applied to the skin, a remarkable increment in fractal dimensions was noted. This may suggest that the structure of the skin was greatly compromised as a result of sodium lauryl sulfate application. Although no change in fractal dimension was observed as a result of application of the test solution containing only 25% isopropanol, the fractal dimension of skin cross section gradually increased with increasing concentrations of isopropanol, 2-methyl-1-butanol or sodium myristate in the test solutions. The increment of fractal dimension was around 0.4. Thus, the skin structure was also altered by the application of high concentrations of these compounds. Although the relevance to humans is not known, fractal analysis of skin structure is thought to be useful as a novel method for detecting skin damage that is brought about by the application of percutaneous absorption enhancers.

Animals↗

Natural selection, mental modules and intelligence.

The question of whether intelligence is one trait or many has exercised several generations of researchers, but no consensus is in sight. Evolutionary psychology, with its emphasis on domain-specific mental modules, seems to offer hope for advancing understanding of this question. We know that the mind has been shaped by natural selection to maximize reproductive success. This tells us what the mind must do--it must solve the adaptive problems that the organism confronts. However, whether this functional capacity is manifest in congruent anatomic, physiological, genetic, cognitive or psychometric structures is another matter. Examination of how natural selection shaped other mechanisms suggests that knowing functional demands provides only modest guidance as to the structure of mechanisms. None the less, it remains simultaneously clear that these mechanisms are not entirely general, but have been shaped to cope with specific challenges. Our metaphors for the mind, whether as a digital computer or a Swiss army knife, are misleading because computers and tools are products of intelligent design. In contrast, minds are products of natural selection whose intertwined components are products of incorporated genetic mutations whose effects are widespread and constrained by historical precedents. Our tendencies to describe the structure of the mind in terms of discrete components make it difficult for us to comprehend the mind as a mind. One antidote may be to minimize metaphorical descriptions of postulated structures of mind and focus instead on its function.

Animals↗

Anatomical informatics: Millennial perspectives on a newer frontier.

One of the most ancient of sciences, anatomy has evolved over many centuries. Its methods have progressively encompassed dissection instruments, manual illustration, stains, microscopes, cameras and photography, and digital imaging systems. Like many other more modern scientific disciplines in the late 20th century, anatomy has also benefited from the revolutionary development of digital computers and their automated information management and analytical capabilities. By using newer methods of computer and information sciences, anatomists have made outstanding contributions to science, medicine, and education. In that regard, there is a strong rationale for recognizing anatomical informatics as a proper subdiscipline of anatomy. A high-level survey of the field reveals important anatomical applications of computer sciences methods in imaging, image processing and visualization, virtual reality, modeling and simulation, structural database processing, networking, and artificial intelligence. Within this framework, computational anatomy is a developing field focusing on data-driven mathematical models of bodily structures. Mastering such computer sciences and informatics methods is crucial for new anatomists, who will shape the future in research, clinical knowledge, and teaching.

Anatomy↗

Drug and metabolite concentrations combined in predicting steady-state concentrations from test doses.

The first day test dose versus steady-state relationship for predicting drug doses was evaluated for the situation where metabolites are produced. An organ clearance model incorporated into a digital computer program simulated drug and metabolite disposition. When the terminal elimination rate for metabolite was similar to that of its precursor, the drug and metabolite concentrations could be summed for use in test dose predictions as the resulting accumulation ratios were similar. However, if an active metabolite is eliminated more slowly than its precursor, future studies should consider these concentrations separately for predictive purposes. The theoretical results agreed with concentration data obtained from a study of patients who took imipramine.

Desipramine↗

Pharmacokinetic-pharmacodynamic modelling and simulation using the electrical circuit simulation program SPICE2.

The use of the electrical circuit simulation program SPICE2 for performing digital computer simulations of linear and non-linear pharmacokinetic-pharmacodynamic models is described. SPICE2 utilizes the principles of network thermodynamics (thermodynamics of electrical circuits). These principles dictate analogy between the conservation laws of chemical reactions and mass transport and Kirchhoff's laws of current and voltage balance, and also prove that Fick's law of diffusion is isomorphous with the conductance form of Ohm's law. Detailed descriptions of program inputs, formats, and options for simulation of linear and non-linear pharmacokinetic-pharmacodynamic systems are provided, with appropriate examples. Single as well as multiple dose simulations (accumulation kinetics and dynamics) are discussed. The advantages of SPICE2 over other available simulation packages, including user-friendliness, ease of operation, versatility, power, and the economy of time and effort afforded, are emphasized. The educational value of SPICE2 as a highly versatile tool for teaching both fundamental and complex pharmacokinetic-pharmacodynamic concepts, as well as its routine usage in elucidating complex research problems, are also discussed.

Cimetidine↗

Comparison of digital boundary detection and semi-automated analysis of left ventricular cine angiograms.

A technique has been developed to analyze automatically 35 mm left ventricular cine angiograms with an image dissector and digital computer. The analysis procedure detected the ventricular boundary and aortic valve position, then calculated the projected left ventricular area and estimated volume, and performed a polar wall motion analysis as a function of time. The automated method was compared to a semi-automated method using a technician-operated electronic cursor linked to a mini-computer. The two methods were used to analyze a set of idealized ventricular models as well as normal and abnormal angiographic data. The volumetric and wall motion data for the idealized models calculated by the two methods were equivalent (r greater than 0.99). Volumetric analysis of the patients' ventriculograms produced correlation coefficients of 0.88-0.99. Corresponding wall motion data produced correlation coefficients of 0.72-0.94. The time necessary to analyze 30 frames of cine ventriculogram was approximately 30 minutes for each method.

Aged↗