Avaliação por ressonância magnética funcional da necrose coagulativa por ablação de radiofrequência nas metástases hepáticas colorretais

A maioria dos pacientes que apresentam metástases hepáticas colorretais (MHCR) não são elegíveis para ressecção. Por isso, outras técnicas para se alcançar o controle locorregional da doença têm sido utilizadas. A Ablação por Radiofrequência (ARF) hepática tem sido empregada frequentemente para o tratamento desta condição devido às boas taxas de resposta, principalmente quando associada ao emprego de quimioterápicos modernos. Apesar da caracterização das MHCR no pré-operatório estar bem estabelecida, os parâmetros de ressonância magnética (RM) após ARF no período pós-cirúrgico requerem maior padronização objetiva. O coeficiente de difusão aparente de água (CDA) tem sido usado na RM como um parâmetro de isquemia e necrose. Entretanto, não está ainda bem definido seu papel e das imagens ponderadas de difusão (DWI) na avaliação da necrose coagulativa gerada pela ARF, especificamente em pacientes com MHCR. O objetivo deste estudo consiste em avaliar o espectro de mudança em RM funcional após a ARF de MHCR. Foi realizado estudo retrospectivo entre 2001 e 2006, avaliando 51 pacientes que foram submetidos à ARF por MHCR no Hospital Johns Hopkins (Baltimore, EUA) dos quais 16 preencheram os critérios de inclusão. Os critérios de inclusão foram: (1) apresentar MHCR tratada cirurgicamente com intenção curativa por ARF guiados por ultrassom per-operatório, e (2) ter uma RM anterior e imediatamente após a cirurgia (até 10 dias). As imagens de RMs antes e após a ablação hepática para MCHR foram identificadas e revistas. As imagens de RM de difusão e captação de contraste foram feitas numa unidade de 1.5 T. Imagens em T2 e T1 foram realizadas na presença e ausência de contraste venoso. Todos os exames tiveram a espessura de 4 a 6 mm e um intervalo de 2 mm, apresentando um angulo de rotação de 150. O índice de difusão foi determinado com um b-valor (intensidade do gradiente de difusão) de 500 seg/mm2. As análises de parâmetros para avaliar e comparar o pré e pós ARF através da RM funcional incluiram: (1) valores do mapa de CDA, (2) captação de contraste, (3) difusão e (4) mudança no tamanho da lesão. Em adição, a sobrevida mediana global e tempo para recorrência local foram calculados. As imagens foram avaliadas por um consenso de dois radiologistas/cirurgiões. Foram avaliados no total 65 lesões, com tamanho médio pré-ablação de 1,7 cm. Após ablação o tamanho médio da lesão aumentou para 3,5 cm (p<0,001). A captação de contraste nas fases arterial e venosa diminuíram significativamente após ARF (diminuição média 10% e 17,5%, respectivamente, p = 0,002 e <0,001). O valor médio do mapa de CDA da lesão foi de 2.79 x 10-3 mm2/seg pré-ARF, e após ARF diminui em média para 1.75 x 10-3 mm2/seg (p<0.001). A sobrevida mediana global foi de 34,7 meses. A ressonância magnética funcional através da captação de contraste e difusão pode prover uma estimativa subjetiva e objetiva da necrose coagulativa tissular e da desidratação celular na área ablada por radiofrequência. Quando combinada ao aumento no tamanho do tumor, podem atuar como um marcador adicional de resposta tumoral.

淹水对三峡库区几种植物的生理生态影响

自然界木本植物在某些情况下可能面对淹水带来的胁迫伤害，木本植物对淹水的生理生态响应及适应机制的研究，不仅可以从机理上解释河岸带和消落区树种分布的规律，对于大型水库消落区的治理也能起到理论依据的作用，因此，木本植物对淹水的生理生态响应及适应机制历来是植物生理生态研究领域的热点问题之一。 三峡水库蓄水造成库区部分陆地岛屿化，这将对岛屿优势植物带来深远影响。短柄枹栎(Quercus glandulifera)、栓皮栎(Quercus variabilis)、马尾松(Pinus massoniana)是这些岛屿上的三种优势树种。在岛屿形成初期，应用生理生态学手段，在7月和9月分别对其水势和叶绿素荧光进行了野外测定，从而为岛屿化对植物生理生态影响的研究和监测提供重要的本底数据。研究结果表明马尾松较其它两种植物更耐旱。水势和Fv/Fm在清晨高中午低，经过一个晚上可以基本恢复，因此就目前状况看岛上的三种优势植物均生长健康。但是库区蓄水后，在淹水胁迫下植物的生理生态过程将如何变化，还需要后期的连续观测。 枫杨（Pterocarya stenoptera）、池杉（Taxodium ascendens）和栓皮栎（Quercus variabilis）是三峡库区河岸带和库塘消落区常见的植物，对于河岸带和库塘消落区的水土保持和水源涵养具有十分重要的作用。通过设计模拟淹水实验，研究了这三种植物对淹水的生理生态响应及适应机制。淹水对枫杨和栓皮栎生理生态过程的早期影响是快速降低了二者的最大净光合速率、气孔导度、最大光化学量子效率（Fv/Fm）。但经过最初的下降后，枫杨的最大净光合速率、气孔导度和最大光化学量子效率逐渐恢复，而栓皮栎的则持续下降。在试验过程中，枫杨和池杉均产生了有利于吸收氧气的不定根和肥大的皮孔，而栓皮栎没有产生不定根。随淹水时间的增加枫杨的叶绿素含量与对照没有显著差异;而栓皮栎的叶绿素含量在第33天后大幅降低，Chla/Chlb的比值下降。淹水后第10天和70天测定的清晨水势，受淹栓皮栎比对照高，而受淹枫杨比对照低。淹水导致池杉和栓皮栎的根/茎/叶膜质过氧化状态均呈现动态变化。淹水处理的栓皮栎根的MDA含量低于对照而池杉的高于对照，比如：淹水24天后，栓皮栎根的丙二醛含量是对照的73％;而池杉是对照的111.5％。淹水处理第10天和第24天两个种的叶和茎MDA含量均高于对照但第50天则略低于对照。淹水导致池杉和栓皮栎两个种的根/茎/叶可溶性糖含量呈现动态变化。持续淹水导致栓皮栎叶片可溶性糖含量相比于对照先略下降后上升，茎可溶性糖含量显著上升而根可溶性含量先下降后上升。而池杉根/茎/叶可溶性糖含量对照和处理之间差异不显著。淹水导致栓皮栎的比叶重（Leaf dry mass per area）持续升高，池杉的与对照没有显著差异。淹水导致栓皮栎的根系活力持续下降，池杉则开始时下降后又升高，这可能与池杉在淹水过程中产生了有利于吸收氧气的不定根，而栓皮栎没有产生不定根有关。 以上生理生态的实验结果说明相对枫杨和池杉，栓皮栎应属于对淹水较敏感的树种。并得到以下一些结论：1）间接支持了“长期淹水导致不耐淹种（如栓皮栎）库量减小，进而导致光合速率下降的负反馈效应”假说;2）淹水对不耐淹种光合速率下降的影响至少包括气孔开度降低、光化学量子效率降低和库尺寸下降导致的光合速率下调的负反馈效应（长期）三个生理生态原因;3）淹水对水势的影响与树种相关;4）淹水并未导致不耐淹种（如栓皮栎）根膜质过氧化状态上升，而是导致其下降。导致其下降的主要原因是根系缺氧造成的;5）淹水胁迫初期耐淹种（如枫杨和池杉）和不耐淹种（栓皮栎）均出现部分生理生态过程的下调，持续时间大概在1－10天内。随后耐淹种生理过程逐渐恢复而不耐淹种在略为恢复1－2天后逐渐下降到较低水平。耐淹种恢复的关键原因可能是不定根和肥大的皮孔的出现。 令人意外的是70天的淹水过程并没有导致栓皮栎的死亡，这说明该树种对淹水具有一定的忍耐能力。因此，栓皮栎分布于河岸带和消落区较高海拔处并很少受到季节性淹水影响的生理生态原因可能还包括其他方面。淹水后可能要面对土壤透气性恢复带来的生理干旱胁迫可能对栓皮栎的生理过程造成影响。因此进一步研究淹水后恢复过程中三个种的生理生态过程对于深刻理解河岸带和消落区树种分布的生理生态原因无疑具有十分重要的理论意义。

Effect of feeding frequency on the growth of common carp (Cyprinus carpio L.) fry

A laboratory-feeding trail was conducted for 45 days with fry of common carp Cyprinus carpio L. (0.45±0.03g) in aquaria in a static indoor fish rearing system. The fry were fed on a pelleted diet containing 33% crude protein having fishmeal as major protein source. The fish fry in five treatments A, B, C, D, and E, each with two replicates were fed on 5% daily ration divided into different feeding frequencies of 2, 3, 4, 5 and 6 times a day respectively in order to observe the growth performance. Each replicate contained 15 fry having total initial weight of 6.87±0.31g. At the end of the feeding trial, significantly different and higher (p<0.05) growth response was observed in treatment C having a feeding frequencies of 4 times a day. Significantly the highest and the lowest percent growth of 334.30 and 218.91% were observed in fish fed on the diet (Treatment C) with 4 times and (Treatment A) 2 times feeding frequencies per day, respectively. Food conversion ratio (FCR) of 1.78 was significantly higher (p2 times feeding frequencies whereas, the least value of 1.22 was obtained in fish fed on the diet with 4 times daily feeding. Protein efficiency ratio (PER) ranged from 1.68 in fish in treatment A having a feeding frequencies of 2 times per day to 2.48 in fish in treatment C fed on the diet with 4 times feeding frequencies. Other growth parameters viz, specific growth rate (SGR), apparent protein digestibility (ADP) were also higher in treatment C than the other treatments. The results of the present study demonstrated that the growth performance of C. carpio was the best at 4 times feeding in a day using 33% dietary protein containing fish meal as major protein source.

A New Method to Investigate InGaAsP Single-Photon Avalanche Diodes Using a Digital Sampling Oscilloscope

A near-infrared single-photon detection system is established by using pigtailed InGaAs/InP avalanche photodiodes. With a 50GHz digital sampling oscilloscope, the function and process of gated-mode (Geiger-mode) single-photon detection are intuitionally demonstrated for the first time. The performance of the detector as a gated-mode single-photon counter at wavelengths of 1310 and 1550nm is investigated. At the operation temperature of 203K,a quantum efficiency of 52% with a dark count probability per gate of 2. 4 * 10~(-3), and a gate pulse repetition rate of 50kHz are obtained at 1550nm. The corresponding parameters are 43% , 8. 5 * 10~(-3), and 200kHz at 238K.

Stable carbon and nitrogen isotopic compositions of high molecular weight dissolved organic matter from four US estuaries

High molecular weight dissolved organic matter (HMW-DOM) represents an important component of dissolved organic carbon (DOC) in seawater and fresh-waters. In this paper, we report measurements of stable carbon (delta(13)C) isotopic compositions in total lipid, total hydrolyzable amino acid (THAA), total carbohydrate (TCHO) and acid-insoluble "uncharacterized" organic fractions separated from fourteen HMW-DOM samples collected from four U.S. estuaries. In addition, C/N ratio, delta(13) C and stable nitrogen (delta(15)N) isotopic compositions were also measured for the bulk HMW-DOM samples. Our results indicate that TCHO and THAA are the dominant organic compound classes, contributing 33-46% and 13-20% of the organic carbon in HMW-DOM while total lipid accounts for only <2% of the organic carbon in the samples. In all samples. a significant fraction (35-49%) of HMW-DOM was included in the acid-insoluble fraction. Distinct differences in isotopic compositions exist among bulk samples, the compound classes and the acid-insoluble fractions. Values of delta(13)C and delta(15)N measured for bulk HMW-DOM varied from -22.1 to -30.1parts per thousand and 2.8 to 8.9parts per thousand, respectively and varied among the four estuaries studied as well. Among the Compound classes, TCHO was more enriched in C-13 (delta(13)C = -18.5 to -22.8parts per thousand) compared with THAA (delta(13)C = -20.0 to -29.6parts per thousand) and total lipid (delta(13)C = -25.7 to -30.7parts per thousand). The acid-insoluble organic fractions, in general, had depleted C-13 values (delta(13)C = -23.0 to -34.4parts per thousand). Our results indicate that the observed differences in both delta(13)C and delta(15)N were mainly due to the differences in sources of organic matter and nitrogen inputs to these estuaries in addition to the microbial processes responsible for isotopic fractionation among the compound classes. Both terrestrial sources and local sewage inputs contribute significantly to the HMW-DOM pool in the estuaries studied and thus had a strong influence on its isotopic signatures. Copyright (C) 2004 Elsevier Ltd.

Analysis of diets of upland buzzards using stable carbon and nitrogen isotopes

We measured the stable carbon and nitrogen isotope ratios for muscles of the upland buzzards (Buteo hemilasius) and their potential food sources, plateau pikas (Ochotona curzoniae), Qinghai voles (Lasiopodomys fuscus), plateau zokors (Myospalax fontanierii), and several passerine bird species at the alpine meadow in Maduo county, Guoluo prefecture of Qinghai province, People's Republic of China, to provide diet information of upland buzzards, highlighting different diet composition of upland buzzards exposed to different locations. The results demonstrated that stable carbon isotope ratios of upland buzzards, passerine birds, plateau pikas, plateau zokors, and Qinghai voles were -24.42 +/- 0.25parts per thousand, -22.89 +/- 1.48parts per thousand, -25.30 +/- 1.47parts per thousand, -25.78 +/- 0.22parts per thousand, and -25.41 +/- 0.01parts per thousand, respectively, and stable nitrogen isotope ratios were 7.89 +/- 0.38parts per thousand, 8.37 +/- 2.05parts per thousand, 5.83 +/- 1.10parts per thousand, 5.23 +/- 0.34parts per thousand, and 8.86 +/- 0.06parts per thousand, respectively. Fractionation of stable carbon and nitrogen isotope ratios between upland buzzards and their food were 1.03parts per thousand and 2.11parts per thousand, respectively. Based on mass balance principle of stable isotopes and the Euclidean distance mixing model, upland buzzards depended mainly on plateau pikas as food (74.56%). Plateau zokors, Qinghai voles, and passerine birds only contributed a small proportion (25.44%) to diets of upland buzzards. The results were closely accordant with analyses of stomach contents and food pellets, which firmly supported the feasibility of using stable carbon and nitrogen isotope ratios to investigate diet information of upland buzzards. Another study based on stable carbon isotopes showed that upland buzzards living in the Haibei prefecture (another prefecture located in the southeast Qinghai province) mainly preyed on passerine birds (64.96% or more) as food supply. We were alarmed by the preliminary results that widespread poisoning activities of small mammals could reshape the food composition of upland buzzards, influencing the stability and sustainability of the alpine meadow. Bio-control on rodent pests should be carried out rather than the chemical measures.

长江水环境的地球化学初步研究

1）长江沿程水溶态#delta#~(34)SO~(2-)_4的变化范围为-3.474～+5.938 per thousand，算术平均值为2.254 per thousand；悬浮态#delta#~(34)S之间的变化范围为-4.031 approx +4.580 per thousand。长江中水溶态#delta#~(34)SO~(2-)_4与悬浮态#delta#~(34)S之间存在相关性；2）根据长江中水溶态#delta#~(34)SO~(2-)_4的平均和它的径流量，估算中国河流#delta#~(34)SO~(2-)_4的加权平均值为+2.7 per thousand。结合中国长江、黄河的硫同位素组成和亚洲其它主要河流水溶态SO~(2-)_4的含量，推测亚洲河流的#delta#~(34)SO~(2-)_4加权平均值可能为+5 per thousand；3）长江流域内的区域地质条件决定了河流悬浮物中稀土元素和微量元素的背景含量－－悬浮物中稀土元素和大多数微量元素的含量为东高西低；4）悬浮物中大多数元素的含量随时间的变化基本保护不变，其变化幅度在自然波动范围之内；而砷元素在悬浮物中的含量随时间有明显的增高趋势，这显示了长江流域内的As污染源的增加。

The Impact of AIDS on Government Service Delivery: The Case of the Zambia Wildlife Authority

Background: The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the capacity of a government agency, the Zambia Wildlife Authority (ZAWA), to patrol Zambia’s national parks. Methods: Data were collected from ZAWA on workforce characteristics, recent mortality, costs, and the number of days spent on patrol between 2003 and 2005 by a sample of 76 current patrol officers (reference subjects) and 11 patrol officers who died of AIDS or suspected AIDS (index subjects). An estimate was made of the impact of AIDS on service delivery capacity and labor costs and the potential net benefits of providing treatment. Results: Reference subjects spent an average of 197.4 days on patrol per year. After adjusting for age, years of service, and worksite, index subjects spent 62.8 days on patrol in their last year of service (68% decrease, p<0.0001), 96.8 days on patrol in their second to last year of service (51% decrease, p<0.0001), and 123.7 days on patrol in their third to last year of service (37% decrease, p<0.0001). For each employee who died, ZAWA lost an additional 111 person-days for management, funeral attendance, vacancy, and recruitment and training of a replacement, resulting in a total productivity loss per death of 2.0 person-years. Each AIDS-related death also imposed budgetary costs for care, benefits, recruitment, and training equivalent to 3.3 years’ annual compensation. In 2005, AIDS reduced service delivery capacity by 6.2% and increased labor costs by 9.7%. If antiretroviral therapy could be provided for $500/patient/year, net savings to ZAWA would approach $285,000/year. Conclusion: AIDS is constraining ZAWA’s ability to protect Zambia’s wildlife and parks. Impacts on this government agency are substantially larger than have been observed in the private sector. Provision of ART would result in net budgetary savings to ZAWA and greatly increase its service delivery capacity.

Differentiated Predictive Fair Service for TCP Flows

The majority of the traffic (bytes) flowing over the Internet today have been attributed to the Transmission Control Protocol (TCP). This strong presence of TCP has recently spurred further investigations into its congestion avoidance mechanism and its effect on the performance of short and long data transfers. At the same time, the rising interest in enhancing Internet services while keeping the implementation cost low has led to several service-differentiation proposals. In such service-differentiation architectures, much of the complexity is placed only in access routers, which classify and mark packets from different flows. Core routers can then allocate enough resources to each class of packets so as to satisfy delivery requirements, such as predictable (consistent) and fair service. In this paper, we investigate the interaction among short and long TCP flows, and how TCP service can be improved by employing a low-cost service-differentiation scheme. Through control-theoretic arguments and extensive simulations, we show the utility of isolating TCP flows into two classes based on their lifetime/size, namely one class of short flows and another of long flows. With such class-based isolation, short and long TCP flows have separate service queues at routers. This protects each class of flows from the other as they possess different characteristics, such as burstiness of arrivals/departures and congestion/sending window dynamics. We show the benefits of isolation, in terms of better predictability and fairness, over traditional shared queueing systems with both tail-drop and Random-Early-Drop (RED) packet dropping policies. The proposed class-based isolation of TCP flows has several advantages: (1) the implementation cost is low since it only requires core routers to maintain per-class (rather than per-flow) state; (2) it promises to be an effective traffic engineering tool for improved predictability and fairness for both short and long TCP flows; and (3) stringent delay requirements of short interactive transfers can be met by increasing the amount of resources allocated to the class of short flows.

Prevention of recurrences in frequently relapsing herpes labialis with thymopentin a randomized double-blind placebo-controlled multicenter study

The present randomized, placebo-controlled double-blind multicenter study included a population of 36 subjects with frequent recurrences (at least once a month) of herpes labialis. Most of the patients had failed to respond adequately to previous treatment with other therapeutic tools, including acyclovir. Either 50 mg of thymopentin or of placebo was administered 3 times a week, by the subcutaneous route, for 6 weeks. Subsequently, the patients were observed for nearly 6 months on the average. The results achieved with thymopentin for the individual parameters were significantly superior to those obtained with placebo; thus significant improvement was seen in patients on thymopentin in the duration of the longest symptomfree period (prolonged from 2.1 weeks to 20.9 weeks, p = 0.000), in the number of relapses (reduced from 1.6 to 0.4 episodes/month, p = 0.001), and in the total duration of herpes symptoms per month (shortened from 2.0 to 0.3 weeks, p = 0.000). Placebo treatment also resulted in considerable improvement (p < 0.05 or 0.01), but was significantly inferior to the improvement obtained with thymopentin. The longest symptomfree period in the placebo group was prolonged from 2.4 to 11.2 weeks. The number of relapses per month was reduced from 1.4 to 0.8, and the total duration of herpes symptoms per month from 2 to 0.9 weeks. The results of intergroup analyses, in which the observed parameters and the improvement achieved in either group were compared, significantly favored thymopentin treatment. The effect of thymopentin was in all but one parameters superior to that of placebo and highly significant (p < 0.01). © 1985 Humana Press Inc.

Systematic review of worldwide variations of the prevalence of wheezing symptoms in children

Background: Considerable variation in the prevalence of childhood asthma and its symptoms (wheezing) has been observed in previous studies and there is evidence that the prevalence has been increasing over time. Methods: We have systematically reviewed the reported prevalence and time trends of wheezing symptoms among children, worldwide and within the same country over time. All studies comprising more than 1000 persons and meeting certain other quality criteria published over a 16-year period, between January 1990 and December 2005, are reported and a comparison of ISAAC (International Study of Asthma and Allergies in Childhood) and non-ISAAC studies is made, in part as a way of expanding the power to examine time trends (the older studies tend to be non-ISAAC), but also to examine possible methodological differences between ISAAC and non-ISAAC questions. Results: A wide range of current prevalence of wheeze was observed between and within countries over time. The UK had the highest recorded prevalence of 32.2% in children aged 13–14 in 1994–5 and Ethiopia had the lowest prevalence, 1.7% in children aged 10–19 in 1996. All studies in Australia and the UK were compared using multiple logistic regression. ISAAC phase I and III studies reported significantly higher prevalence of current wheeze (OR = 1.638) compared with non-ISAAC studies, after adjusting for various other factors (country, survey year, age of child, parental vs child response to the survey). Australia showed a significantly higher prevalence of current wheezing (OR = 1.343) compared with the UK, there was a significant increase in the prevalence odds ratio per survey year (2.5% per year), a significant decrease per age of child (0.7% per year), and a significantly higher response in current wheezing if the response was self-completed by the child (OR = 1.290). These factors, when explored separately for ISAAC and non-ISAAC studies, showed very different results. In ISAAC studies, or non-ISAAC studies using ISAAC questions, there was a significant decrease in current wheezing prevalence over time (2.5% per year). In non-ISAAC studies, which tend to cover an earlier period, there was a significant increase (2.6% per year) in current wheezing prevalence over time. This is very likely to be a result of prevalence of wheezing increasing from the 1970s up to the early 1990s, but decreasing since then. Conclusion: The UK has the highest recorded prevalence of wheezing and Ethiopia the lowest. Prevalence of wheezing in Australia and the UK has increased from the 1970s up to the early 1990s, but decreased since then and ISAAC studies report significantly higher prevalences than non-ISAAC studies.

Risk of Malignant Progression in Barrett’s Esophagus Patients: Results from a Large Population-Based Study

Background: Barrett's esophagus (BE) is a premalignant lesion that predisposes to esophageal adenocarcinoma. However, the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett's esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005.

Subjects and Methods: We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General's Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests.

Results: After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P <. 001), in men compared with women (0.28% per year vs 0.13% per year; HR = 2.11, 95% CI = 1.41 to 3.16, P <. 001), and in patients with low-grade dysplasia compared with no dysplasia (1.40% per year vs 0.17% per year; HR = 5.67, 95% CI = 3.77 to 8.53, P <. 001).

Conclusion: We found the risk of malignant progression among patients with BE to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective. © The Author 2011. Published by Oxford University Press. All rights reserved.

Prescribing Practices and Polypharmacy in Kitovu Hospital, Uganda.

This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda. The average number of drugs prescribed per patient was 2.89 ± 0.11, of which 1.79±0.09 were generics and 0.69±0.06 antibiotics. No injections were prescribed. Patient essential drug knowledge was 100% while the adequacy of labelling was 0%. The number of drugs prescribed correlated positively with patient age, was greater for female patients, similar for doctors and clinical officers but greater in medical (3.30±0.15, n=50) than surgical (2.48±0.13, n=50) outpatient clinics. The mean consultation time was 6.56 min and 10.25 min per patient in medical and surgical outpatient clinics respectively. The patient essential knowledge indicators were greatly improved but only modest reduction in polypharmacy was evident compared to the Ugandan Pharmaceutical Sector national survey of 2002. Antibiotic prescription was high and generic prescribing was found to be low. Policy changes are required to enhance rational drug use in the health sector in Uganda.

PTEN mRNA detection by chromogenic, RNA in situ technologies: a reliable alternative to PTEN immunohistochemistry

Immunohistochemical staining for phosphatase and tensin homolog (PTEN) does not have either an acceptable standard protocol or concordance of scoring between pathologists. Evaluation of PTEN mRNA with a unique and verified sequence probe may offer a realistic alternative providing a robust and reproducible protocol. In this study, we have evaluated an in situ hybridization (ISH) protocol for PTEN mRNA using RNAScope technology and compared it with a standard protocol for PTEN immunohistochemistry (IHC). PTEN mRNA expression by ISH was consistently more sensitive than PTEN IHC, with 56% of samples on a mixed-tumor tissue microarray (TMA) showing high expression by ISH compared with 42% by IHC. On a prostate TMA, 49% of cases showed high expression by ISH compared with 43% by IHC. Variations in PTEN mRNA expression within malignant epithelium were quantifiable using image analysis on the prostate TMAs. Within tumors, clear overexpression of PTEN mRNA on malignant epithelium compared with benign epithelium was frequently observed and quantified. The use of SpotStudio software in the mixed-tumor TMA allowed for clear demonstration of varying levels of PTEN mRNA between tumor samples by the mRNA methodology. This was evident by the quantifiable differences between distinct oropharyngeal tumors (up to 3-fold increase in average number of spots per cell between 2 cases). mRNA detection of PTEN or other biomarkers, for which optimal or standardized immunohistochemical techniques are not available, represents a means by which heterogeneity of expression within focal regions of tumor can be explored with more confidence.

Expressividade e performance pianística

Esta tese consiste em uma pesquisa empírica sobre a expressividade musical. Os principais objetivos foram: identificar padrões e estratégias para o aprimoramento expressivo aplicados por profissionais de excelência; identificar como os performers conceitualizam a expressividade; identificar os principais componentes da expressividade; verificar relações entre a expressividade e o momento da performance; elaborar estratégias de estudo a partir das informações obtidas e aplicar estas estratégias na prática; verificar a sua pertinência e realizar uma avaliação qualitativa; e elaborar um modelo prático de estudo para a expressividade. Foram realizadas entrevistas com pianistas profissionais a fim de obter dados consistentes acerca da expressividade, e posteriormente foi conduzido um estudo de caso no qual estratégias de estudo sistematizadas a partir do relato dos pianistas foram aplicadas em um trabalho apoiado na autoetnografia, a fim de verificar a pertinência e realizar uma avaliação qualitativa sobre tais estratégias. Em termos gerais, os resultados indicaram que a expressividade consiste em um fenômeno de comunicação influenciado pela capacidade do intérprete em transmitir a mensagem e estrutura musical, cujos principais componentes compreendem elementos como o caráter, articulação e o fraseado. Além disso, os performers geralmente relacionam a expressividade a "modas" e tendências estético-interpretativas específicas e a elementos extramusicais. As principais estratégias pertinentes ao aprimoramento expressivo relacionam-se ao fraseado, realização de contrastes e sonoridade. A priorizar estes elementos, foi construído um modelo de estudo.