Preoperative staging of rectal cancer with MRI: correlation with pathologic staging

[INTRODUCTION] An accurate preoperative rectal cancer staging is crucial to the correct management of the disease. Despite great controversy around this issue, pelvic magnetic resonance (RM) is said to be the imagiologic standard modality. This work aimed to evaluate magnetic resonance accuracy in preoperative rectal cancer staging comparing with the anatomopathological results. METHODS We calculated sensibility, specificity, positive (VP positive) and negative (VP negative) predictive values for each T and N. We evaluated the concordance between both methods of staging using the Cohen weighted K (Kw), and through ROC curves, we evaluated magnetic resonance accuracy in rectal cancer staging. RESULTS 41 patients met the inclusion criteria. We achieved an efficacy of 43.9% for T and 61% for N staging. The respective sensibility, specificity, positive and negative predictive values are 33.3%, 94.7%, 33.3% and 94.7% for T1; 62.5%, 32%, 37.0% and 57.1% for T2; 31.8%, 79%, 63.6% and 50% for T3 and 27.8%, 87%, 62.5% and 60.6% for N. We obtained a poor concordance for T and N staging and the anatomopathological results. The ROC curves indicated that magnetic resonance is ineffective in rectal cancer staging. CONCLUSION Magnetic resonance has a moderate efficacy in rectal cancer staging and the major difficulty is in differentiating T2 and T3.

Brazilian multicenter study on efficacy and tolerability of trandolapril in mild-to-moderate essential arterial hypertension. EMBATHE substudy with ambulatory blood pressure monitoring

OBJECTIVE: A double-blind, placebo-controlled multicenter study involving 34 centers from different Brazilian regions was performed to evaluate the antihypertensive efficacy and tolerability of trandolapril, an angiotensin I converting enzyme inhibitor, in the treatment of mild-to-moderate systemic arterial hypertension. METHODS: Of 262 patients enrolled in this study, 127 were treated with trandolapril 2 mg/day for 8 consecutive weeks, and the remaining 135 patients received placebo for the same period of time. Reduction in blood pressure (BP) and the occurrence of adverse events during this period were evaluated in both groups. RESULTS: Significant reductions in both systolic and diastolic pressures were observed in patients treated with trandolapril when compared with those on placebo. Antihypertensive efficacy was achieved in 57.5% of the patients on trandolapril and in 42% of these normal values of BP were obtained. The efficacy of trandolapril was similar in all centers, regardless of the area of the country. In a subset of 30 patients who underwent ABPM, responders showed a significant hypotensive effect to trandolapril throughout the 24 hour day. The adverse event profile was similar in both trandolapril and placebo groups. CONCLUSION: Our results demonstrate, for the first time in a large group of hypertensive patients from different regions in Brazil, good efficacy and tolerability of trandolapril during treatment of mild-to-moderate essential systemic hypertension.

Is female sex an independent predictor of in-hospital mortality in acute myocardial infarction?

OBJECTIVE: To assess whether female sex is a factor independently related to in-hospital mortality in acute myocardial infarction. METHODS: Of 600 consecutive patients (435 males and 165 females) with acute myocardial infarction, we studied 13 demographic and clinical variables obtained at the time of hospital admission through uni- and multivariate analysis, and analyzed their relation to in-hospital death. RESULTS: Females were older (p<0.001) and had a higher incidence of hypertension (p<0.001). Males were more frequently smokers (p<0.001). The remaining risk factors had a similar incidence among both sexes. All variables underwent uni- and multivariate analysis. Through univariate analysis, the following variables were found to be associated with in-hospital death: female sex (p<0.001), age >70 years (p<0.001), the presence of previous coronary artery disease (p=0.0004), previous myocardial infarction (p<0.001), infarction in the anterior wall (p=0.007), presence of left ventricular dysfunction (p<0.001), and the absence of thrombolytic therapy (p=0.04). Through the multivariate analysis of logistic regression, the following variables were associated with in-hospital mortality: female sex (p=0.001), age (p=0.008), the presence of previous myocardial infarction (p=0.02), and left ventricular dysfunction (p<0.001). CONCLUSION: After adjusting for all risk variables, female sex proved to be a variable independently related to in-hospital mortality in acute myocardial infarction.

Myocardial Bridges and their Relationship to the Anterior Interventricular Branch of the Left Coronary Artery

OBJECTIVE: To analyze the relationship between myocardial bridges and the anterior interventricular branch (anterior descending) of the left coronary artery. METHODS: The study was carried out with postmortem material, and methods of dissection and observation were used. We assessed the perimeter of the anterior interventricular branch of the left coronary artery using a pachymeter, calculated its proximal and distal diameters in relation to the myocardial bridge, and also its diameter under the myocardial bridge in 30 hearts. We also observed the position of the myocardial bridge in relation to the origin of the anterior interventricular branch. RESULTS: The diameters of the anterior interventricular branch were as follows: the mean proximal diameter was 2.76±0.76 mm; the mean diameter under the myocardial bridge was 2.08±0.54 mm; and the mean distal diameter was 1.98±0.59 mm. In 33.33% (10/30) of the cases, the diameter of the anterior interventricular branch under the myocardial bridge was lower than the diameter of the anterior interventricular branch distal to the myocardial bridge. In 3.33% (1/30) of the cases, an atherosclerotic plaque was found in the segment under the myocardial bridge. The myocardial bridge was located in the middle third of the anterior interventricular branch in 86.66% (26/30) of the cases. CONCLUSION: Myocardial bridges are more frequently found in the middle third of the anterior interventricular branch of the left coronary artery. The diameter of the anterior interventricular branch of the left coronary artery under the myocardial bridge may be smaller than after the bridge. Myocardial bridges may not provide protection against the formation of atherosclerotic plaque inside the anterior interventricular branch of the left coronary artery.

Assessment of the techniques of blood pressure measurement by health professionals

OBJECTIVE: To assess blood pressure measurement by health professionals of a public hospital in São Paulo State. METHODS: Semi-structured interviews and direct observation were performed with a verification list according to the criteria reported by Perloff et al. One hundred and five health professionals took part in the study. After measuring blood pressure, the level of concordance between the way the procedure was performed and the recommended one was assessed. RESULTS: Nurses and nurse's aides abided by 40% of the recommended procedures for adequate blood pressure measurement. The other categories of health professionals (nursing and medicine teachers, physicians, residents, and nursing students) abided by approximately 70%. CONCLUSION: Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.

A change in the treatment of abdominal aortic aneurysms

OBJECTIVE: One of the most exciting potential applications of percutaneous therapy is the treatment of abdominal aneurysms. METHODS: Of 230 patients treated with a self-expanding polyester-lined stent-graft for different aortic pathologies at our institution, we selected 80 abdominal aneurysm cases undergoing treatment (from May 1997 to December 2002). The stent was introduced through the femoral artery, in the hemodynamic laboratory, with the patient under general anesthesia, with systemic heparinization, and induced hypotension. RESULTS: The procedure was successful in 70 (92.9%) cases; 10 patients with exclusion of abdominal aortic aneurysms were documented immediately within the hemodynamic room and 5 patients persisted with a residual leak. Two surgical conversions were necessary. Additional stent-grafts had to be inserted in 3 (3.7%) cases. In the follow-up, 91.4% of patients were alive at a mean follow-up of 15.8 months. CONCLUSION: We believe that stent-grafts are an important tool in improving the treatment of abdominal aneurysms, and this new policy may change the conventional medical management of these patients.

An assessment of biological and population parameters of the Common whelk, Buccinum undatum (L.) in the region of the North West Irish whelk fishery

The Common whelk, Buccinum undatum (L.) is a conspicuous benthic scavenger in Irish waters, and is a valuable fisheries resource in South East Ireland. B. undatum is fished in many parts of its range, and previous studies have shown that certain life history parameters, which vary with location, make this species vulnerable to overexploitation. This makes research into each exploited stock essential to ensure sustainable fisheries management of the species. In 2003, interest in B. undatum as a complementary species in the inshore fishery east of the Inishowen Peninsula, North West Ireland, initiated investigation into fisheries related biological and population aspects of the species in this region. The current study presents estimates of spatial variation and density of the stock, size at age and growth rates, size and age at onset of sexual maturity, and timing of reproductive events in the region of the North West Irish whelk fishery for the period of June 2003 to May 2004. Analysis of variance of the total shell length of whelk landings to the fishery was conducted over spatial scales of fishing pot, fishing string and landings to vessels. Landings varied significantly in shell length at the spatial scale at which whelks are attracted to baited pots, but did not vary significantly over larger spatial scales. Depletion estimates of stock density from fisheries derived Catch per Unit Effort data and a mark re-capture experiment estimate 0.134 - 0.227 whelks per m2. Two independent methods of age determination found similar growth logistics functions for B. undatum.Modal analysis of length frequency distribution of landings to the fishery estimated symptotic length, Leo = 151.64 mm and Brody growth coefficient, K = 0.04. Analysis of the striae in individual opercula, where each stria was found to represent annual growth, estimated Loo = 137.73 mm and K = 0.12. Common whelks in the region of the North West Irish whelk fishery grow slowly and are long-lived, with 19 opercula striae recorded in one individual. Onset of sexual maturity is late, and no sex-specific differences in size or age at maturity were determined in the present study. Males were found to achieve sexual maturity at 83.30 ± 10.77 mm, and 8.9 - 11.1 years of age, and females at 82.62 ± 10.68 mm and 8.8 to 11.1 years of age. Systematic observations of reproductive events, including histological changes to the female ovary and male testis, and changes in the size and mass of body components, suggest that breeding occurred between the autumn and winter months of October and December 2003. Biological aspects of B. undatum in the study region are compared with previous studies from other regions, and discussed in relation to sustainable management of the fishery.

Development of a data acquisition system to characterise sustainable energy technologies and to support Web-Based learning (DAQ-WBL)

Driven by concerns about rising energy costs, security of supply and climate change a new wave of Sustainable Energy Technologies (SET’s) have been embraced by the Irish consumer. Such systems as solar collectors, heat pumps and biomass boilers have become common due to government backed financial incentives and revisions of the building regulations. However, there is a deficit of knowledge and understanding of how these technologies operate and perform under Ireland’s maritime climate. This AQ-WBL project was designed to address both these needs by developing a Data Acquisition (DAQ) system to monitor the performance of such technologies and a web-based learning environment to disseminate performance characteristics and supplementary information about these systems. A DAQ system consisting of 108 sensors was developed as part of Galway-Mayo Institute of Technology’s (GMIT’s) Centre for the Integration of Sustainable EnergyTechnologies (CiSET) in an effort to benchmark the performance of solar thermal collectors and Ground Source Heat Pumps (GSHP’s) under Irish maritime climate, research new methods of integrating these systems within the built environment and raise awareness of SET’s. It has operated reliably for over 2 years and has acquired over 25 million data points. Raising awareness of these SET’s is carried out through the dissemination of the performance data through an online learning environment. A learning environment was created to provide different user groups with a basic understanding of a SET’s with the support of performance data, through a novel 5 step learning process and two examples were developed for the solar thermal collectors and the weather station which can be viewed at http://www.kdp 1 .aquaculture.ie/index.aspx. This online learning environment has been demonstrated to and well received by different groups of GMIT’s undergraduate students and plans have been made to develop it further to support education, awareness, research and regional development.

Spéciation of chromium in a chromium enriched yeast.

The sample under investigation in this project is an experimental chromium enriched yeast used as a possible additive in animal foodstuff, which was produced by growing yeast in the presence of chromium (III) chloride. Chromium on its own in not biologically active but chromium in the form of chromium enriched yeast is biologically active. The objective of this project was to show the complete absence of chromium(VI) from the sample. A literature survey describing previous work carried out on the speciation of Cr(VI) has been carried out. The principal methods of detection of Cr(VI) used in this project are Polarography, G.F.A.A. Spectroscopy, U.V. Spectroscopy and H.P.L.C. For each of the above methods a calibration curve was obtained and each method was applied to the yeast extract. The H.P.L.C. and U.V. spectroscopic method are specific for Cr(VI) but polarography and G.F.A.A. spectroscopy measure total chromium. Tris-NaOH buffer has been investigated for the extraction of chromium(VT). Problems associated with air oxidation of Cr(III) in alkaline solution have identified and procedures described for the suppression of air oxidation. Procedures are described for the application of the extraction procedure to the yeast extract and for the determination of Cr(VI) in the extract. Procedures are also described for the preconcentration of Cr(VI) on a HPLC column and for the application to the yeast extract. The rate of reduction of Cr(VI) by ascorbic acid is investigated and found to be first order with respect to ascorbic acid concentration. The reduction capacity of the yeast is also investigated and it was found that in acid solution the yeast will reduce Cr(VI) but in neutral or basic solution the reduction capacity is diminished. Conclusions regarding the objectives of the project are drawn and suggestions for further work are given.

Management and evaluation of a range of forest species for use as cut foliage

This project explored the possibility of harvesting marketable foliage stems in addition to producing timber from plantations of Larix leptolepis, Cupressus macrocarpa ‘Goldcrest’ and Tsuga heterophylla. Data recorded from trial sites included both growth parameters, in the form of height and diameter increments, and production parameters in the form of foliage stem yields. Results varied with species and site type. In many cases, results achieved appear to have been influenced more by the biology of the trees than by the treatments alone. Trials were also established to investigate methods of managing old or over grown Abies procera Christmas tree plantations for forest foliage production. Shelf life testing and market research into the domestic trade of forest foliage were also conducted over the course of the project. Recommendations for managing forest plantations for foliage production as well as a general discussion on the industry are presented in this report.

Statistical Characteristics of Flash Flood in Georgia

Results are presented from the analysis of observations data on flash flood in Georgia over a period of 45 years, from 1961 to 2005, provided of the of Hydro-meteorology Service of Georgia.

Diet of Astyanax paranae (Characidae) in streams with different riparian land covers in the Passa-Cinco River basin, southeastern Brazil

An analysis of the diet of Astyanax paranae Eigenmann, 1914 in nine streams located in the Passa-Cinco River basin (upper Paraná River system) was performed to investigate the feeding habits of this species, check for possible spatial variations in diet and to investigate the influence of riparian vegetation in the composition of the diet. Stomach contents of 243 specimens were analyzed by the methods of relative frequency of occurrence and volume, and the diet was characterized by the alimentary index (AIi). The species showed insectivorous feeding habits, with a predominance of terrestrial and aquatic insects in the diet, varying by location. In most streams, resources of allochthonous origin were the most consumed. The participation of aquatic insects and terrestrial plants were high in most streams, while terrestrial insects and invertebrates were highest in streams with a greater presence of riparian forest. The two streams located draining pasture fields were the only places were A. paranae consumed algae and macrophyte fragments. These results were corroborated by the analysis of similarity (ANOSIM): the descriptor "percentage of riparian forest" was the highest environmental influence on the diet of A. paranae. The study shows that riparian forest percentage on the stream reach determines the species diet composition, but A. paranae is also able to gather enough food resources in a variety of severely degraded environments.

A pilot study to control Lutzomyia umbratilis (Diptera: Psychodidae), the major vector of Leishmania brazileiensis guyanensis, in a peri-urban rainforest of Manaus, Amazonas State, Brazil

In the second half of 1980, 112 (or ca. 16%) of the inhabitants of the new settlement of São José, city of Manaus, contracted cutaneous leishmaniasis whilst clearing their properties of terra firme rainforest. With the aid of SUCAM, the authors carried out a pilot study to investigate the feasibility of reducing populations of Lutzomyia umbratilis, the local silvatic vector of Leishmania braziliensis guyanensis, by spraying insecticide on its favoured diurnal resting sites, the bases of the larger forest trees. Most manvector contact is at these resting sites and, therefore, it was encouraging to record a marked reduction of the tree-base populations of L. umbratilis for 21 days following just one application of D.D.T. emulsion in an area 200m square. Most of the treated trunks were not occupied by L. umbratilis for at least eleven months. Suggestions for extending the pilot study are made, and the need for collaboration with a clinical team is emphasized. Leishmania b. guyanensis is the aetiological agent of [quot ]pain bois[quot ], which is hyperendemic from French Guiana to central Amazônia. In the absence of proven vaccines or methods of vector control, some simple methods for limiting transmission of Le. b. guyanensis to man are listed.

Adherence: the journey of medication taking, are we there yet?

Patient adherence to medications has been an issue challenging healthcare professionals for decades. Adherence rates, causes of non-adherence, barriers and enablers to medication taking, interventions to promote adherence, and the impact of non-adherence on health outcomes, have been extensively studied. In light of this, the area of adherence research has progressed conceptually and practically. This special issue contains a range of articles which focus on different aspects of adherence, from standardising terminology and methods of measurement, to non-adherence in a broad range of patient populations, and to interventions to promote adherence.

A comparison of results from MRIO and interregional computable general equilibrium (CGE) analyses of the impacts of a positive demand shock on the ‘CO2 trade balance’ between Scotland and the rest of the UK

In previous work we have applied the environmental multi-region input-output (MRIO) method proposed by Turner et al (2007) to examine the ‘CO2 trade balance’ between Scotland and the Rest of the UK. In McGregor et al (2008) we construct an interregional economy-environment input-output (IO) and social accounting matrix (SAM) framework that allows us to investigate methods of attributing responsibility for pollution generation in the UK at the regional level. This facilitates analysis of the nature and significance of environmental spillovers and the existence of an environmental ‘trade balance’ between regions. While the existence of significant data problems mean that the quantitative results of this study should be regarded as provisional, we argue that the use of such a framework allows us to begin to consider questions such as the extent to which a devolved authority like the Scottish Parliament can and should be responsible for contributing to national targets for reductions in emissions levels (e.g. the UK commitment to the Kyoto Protocol) when it is limited in the way it can control emissions, particularly with respect to changes in demand elsewhere in the UK. However, while such analysis is useful in terms of accounting for pollution flows in the single time period that the accounts relate to, it is limited when the focus is on modelling the impacts of any marginal change in activity. This is because a conventional demand-driven IO model assumes an entirely passive supply-side in the economy (i.e. all supply is infinitely elastic) and is further restricted by the assumption of universal Leontief (fixed proportions) technology implied by the use of the A and multiplier matrices. In this paper we argue that where analysis of marginal changes in activity is required, a more flexible interregional computable general equilibrium approach that models behavioural relationships in a more realistic and theory-consistent manner, is more appropriate and informative. To illustrate our analysis, we compare the results of introducing a positive demand stimulus in the UK economy using both IO and CGE interregional models of Scotland and the rest of the UK. In the case of the latter, we demonstrate how more theory consistent modelling of both demand and supply side behaviour at the regional and national levels affect model results, including the impact on the interregional CO2 ‘trade balance’.