A tailored approach for the treatment of indirect inguinal hernia in adults--an old problem revisited.

A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment. A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of < 30 mm. Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34 years (range: 17-85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48 min, P <.0001). In a median follow-up period of 56 months (27-128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066). PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptoms.

Maintenance of remission in Crohn's disease.

When remission of Crohn's disease is achieved, the next goal is to maintain long-term remission. Aminosalicylates may be recommended for maintenance remission, even though the results are less consistent than those observed in ulcerative colitis. The benefit is mainly observed in the post-surgical setting and in patients with ileitis, and with a prolonged disease duration. Corticosteroids are not effective in maintaining remission and should not be used for this indication. Azathioprine and 6-mercaptopurine are effective in maintaining remission. Maintenance benefits remain significant for patients who continued with the therapy for up to 5 years. Methotrexate has also been found to be effective in maintaining remission in Crohn's disease in patients who have responded acutely to methotrexate. Cyclosporine has not been found to be an effective maintenance agent. Mycophenolate mofetil could be considered a therapy in patients who are either allergic to azathioprine or in whom azathioprine failed to induce remission. The use of infliximab may change the future approach to maintenance therapy for Crohn's disease. Patients who responded clinically to infliximab have maintained their clinical response when receiving repeat infusions at 8-week intervals. In patients refractory to other therapies, infliximab may be effective in maintaining remission.

Seizure semiology: an overview of the 'inverse problem'.

In clinical practice, a classification of seizures based on clinical signs and symptoms leads to an improved understanding of epilepsy-related issues and therefore strongly contributes to a better patient care. The inverse problem involves inferring the anatomical brain localization of a seizure from the scalp surface EEG, a concept we apply here to correlate seizure origin with seizure semiology. The spheres of sensorium, motor features, consciousness changes and autonomic alterations during ictal and postictal manifestations are reviewed, including several subdivisions used to better categorize particular features. Particular attention is given to behavioral features, as well as to features occurring in idiopathic generalized epileptic syndromes and psychogenic nonepileptic spells.

Mutations in CTC1, encoding conserved telomere maintenance component 1, cause Coats plus.

Coats plus is a highly pleiotropic disorder particularly affecting the eye, brain, bone and gastrointestinal tract. Here, we show that Coats plus results from mutations in CTC1, encoding conserved telomere maintenance component 1, a member of the mammalian homolog of the yeast heterotrimeric CST telomeric capping complex. Consistent with the observation of shortened telomeres in an Arabidopsis CTC1 mutant and the phenotypic overlap of Coats plus with the telomeric maintenance disorders comprising dyskeratosis congenita, we observed shortened telomeres in three individuals with Coats plus and an increase in spontaneous γH2AX-positive cells in cell lines derived from two affected individuals. CTC1 is also a subunit of the α-accessory factor (AAF) complex, stimulating the activity of DNA polymerase-α primase, the only enzyme known to initiate DNA replication in eukaryotic cells. Thus, CTC1 may have a function in DNA metabolism that is necessary for but not specific to telomeric integrity.

Linking Real Time and Location in Scheduling Demand-Responsive Transit, September 1996

The role of rural demand-responsive transit is changing, and with that change is coming an increasing need for technology. As long as rural transit was limited to a type of social service transportation for a specific set of clients who primarily traveled in groups to common meal sites, work centers for the disabled, or clinics in larger communities, a preset calendar augmented by notes on a yellow legal pad was sufficient to develop schedules. Any individual trips were arranged at least 24 to 48 hours ahead of time and were carefully scheduled the night before in half-hour or twenty-minute windows by a dispatcher who knew every lane in the service area. Since it took hours to build the schedule, any last-minute changes could wreak havoc with the plans and raise the stress level in the dispatch office. Nevertheless, given these parameters, a manual scheduling system worked for a small demand-responsive operation.

Use of Railroad Flat Cars for Low-Volume Road Bridges, August 1999

In an attempt to solve the bridge problem faced by many county engineers, this investigation focused on a low cost bridge alternative that consists of using railroad flatcars (RRFC) as the bridge superstructure. The intent of this study was to determine whether these types of bridges are structurally adequate and potentially feasible for use on low volume roads. A questionnaire was sent to the Bridge Committee members of the American Association of State Highway and Transportation Officials (AASHTO) to determine their use of RRFC bridges and to assess the pros and cons of these bridges based on others’ experiences. It was found that these types of bridges are widely used in many states with large rural populations and they are reported to be a viable bridge alternative due to their low cost, quick and easy installation, and low maintenance. A main focus of this investigation was to study an existing RRFC bridge that is located in Tama County, IA. This bridge was analyzed using computer modeling and field load testing. The dimensions of the major structural members of the flatcars in this bridge were measured and their properties calculated and used in an analytical grillage model. The analytical results were compared with those obtained in the field tests, which involved instrumenting the bridge and loading it with a fully loaded rear tandem-axle truck. Both sets of data (experimental and theoretical) show that the Tama County Bridge (TCB) experienced very low strains and deflections when loaded and the RRFCs appeared to be structurally adequate to serve as a bridge superstructure. A calculated load rating of the TCB agrees with this conclusion. Because many different types of flatcars exist, other flatcars were modeled and analyzed. It was very difficult to obtain the structural plans of RRFCs; thus, only two additional flatcars were analyzed. The results of these analyses also yielded very low strains and displacements. Taking into account the experiences of other states, the inspection of several RRFC bridges in Oklahoma, the field test and computer analysis of the TCB, and the computer analysis of two additional flatcars, RRFC bridges appear to provide a safe and feasible bridge alternative for low volume roads.

External dichotomous noise: The problem of the mean-first-passage time

A retarded backward equation for a non-Markovian process induced by dichotomous noise (the random telegraphic signal) is deduced. The mean-first-passage time of this process is exactly obtained. The Gaussian white noise and the white shot noise limits are studied. Explicit physical results in first approximation are evaluated.

Zenith angle distributions at Super-Kamiokande and SNO and the solution of the solar neutrino problem

We have performed a detailed study of the zenith angle dependence of the regeneration factor and distributions of events at SNO and SK for different solutions of the solar neutrino problem. In particular, we discuss the oscillatory behavior and the synchronization effect in the distribution for the LMA solution, the parametric peak for the LOW solution, etc. A physical interpretation of the effects is given. We suggest a new binning of events which emphasizes the distinctive features of the zenith angle distributions for the different solutions. We also find the correlations between the integrated day-night asymmetry and the rates of events in different zenith angle bins. The study of these correlations strengthens the identification power of the analysis.

Komik, Ernst und Mise en page. Zum Problem der Farblinien in Heinrich Wittenwilers "Der Ring"

Der Aufsatz nähert sich dem Interpretationsproblem des ,Ring', eines seit Forschungsbeginn ausserordentlich konträr diskutierten Textes, aus wissenschaftsanalytischer Perspektive. Er führt die Zersplitterung und die Extremisierung der Deutungsansätze, die die breite Forschung zu Wittenwilers Werk kennzeichnet, auf einen vergleichsweise simplen Befund zurück: die ungeklärte Frage nach dem Verhältnis von Komik und Didaktik und der Ernsthaftigkeit des lehrhaften Angebots im ,Ring'. Die so auf grundlegendster Ebene offen gebliebene Erfassung des Textes führt in einen interpretatorischen Leerraum, in dem die widersprüchlichsten, oft wissenschaftsideologisch begründeten Positionen Platz finden. Ihre Analyse zeigt, dass sie sich in wiederkehrende Gruppierungen ordnen. Als Schlüsselglied sowohl der Befunddaten als auch der konträren Vernetzungen von Befund und Deutung wird die wechselnd rote und grüne Initialenlinie der Münchner Handschrift identifiziert. Als im Prolog eingeführte Markierung von Ernst auf der einen und Komik auf der anderen Seite ist sie nicht nur visueller Ausdruck des Deutungsproblems des ,Ring', sondern sie hat es wegen der scheinbaren Unstimmigkeit ihrer Zuweisungen auch wesentlich bedingt. Der Aufsatz zeigt ihren bisher übersehenen Aufschluss für das Verständnis des Werks. Nimmt man die Linie als graphisches Verfahren ernst, stellt sie sich als strukturelle Markierung zum Auffinden von Text im diskontinuierlichen Zugriff dar - nicht aber, wie man sie bisher ausnahmslos verstand, als semantische Kommentierung eines laufenden, kontinuierlich zu lesenden Textes. Die strukturierende Funktion des Farbwechsels ist auf zwei Ebenen nachzuweisen: Auf Makroebene trennen seine Zuweisungen vorwiegend narrative und vorwiegend wissensvermittelnde Grosspartien des ,Ring' durch eine jeweilige Grundfarbe. Auf Mikroebene wird diese Grundfarbe durch die jeweils andere Farbe durchbrochen, um formale Einschnitte wie etwa Sprecherwechsel, Ortswechsel, Handlungsneueinsätze, Beginn und Ende eines eingeschalteten Binnentextes oder einer Sentenz anzuzeigen. Dem Benutzer der autornahen Handschrift sollte so in einem ersten Schritt (makrostrukturell) ermöglicht werden, gezielt auf gewünschte Stellen des Textes zuzugreifen und ihn in einem zweiten Schritt (mikrostrukturell) schneller zu erfassen. Nicht in seiner Umsetzung, sehr wohl aber in seiner Funktion steht dieses ungewöhnliche Layout zeitgenössischen Techniken der Buchgliederung durchaus nahe. Auch im Profil der Zusammenstellung seiner Binnentexte rückt der ,Ring' damit in die Nähe der im Spätmittelalter beliebten Sammelhandschriften mit Ziel einer Wissenssumme, die hier narrativ verbundenen wird. Es scheint, als möchte der ,Ring' in einem ungewöhnlichen Experiment beides sein: Kompilation und Werkganzes, Wissenssammlung und Erzählwerk - Texte und Text. Als Ergebnis einer Neuuntersuchung des Münchner codex unicus des ,Ring' weist der Beitrag schliesslich darauf hin, dass auch zahlreiche Markierungszeichen am Spaltenrand formale und strukturelle Texteinschnitte anzeigen und somit die gleiche Funktion haben wie der Farbwechsel auf Mikroebene. Ein kausaler, produktionstechnischer Zusammenhang zwischen diesen Zeichen und der Verteilung des Farbwechsels ist nicht auszuschliessen, zumal beide Verfahren etwa im letzten Fünftel des Textes zunehmend zusammenfallen. Möglicherweise war nur die makrostrukturelle Funktion des Farbwechsel ursprünglich indendiert und mit der Erläuterung im Prolog bezeichnet, während seine mikrostrukturelle Funktion erst Resultat des Abschreibprozesses ist.

Sexual selection in genetic colour-polymorphic species: a review of experimental studies and perspectives

Sexual selection theory has primarily focussed on the role of mating preferences for the best individuals in the evolution of condition-dependent ornaments, traits that signal absolute quality. Because the most suitable mate for one individual is not always the best for others, however, we argue that non-directional mate choice can promote the evolution of alternative morphs that are not condition-dependent in their expression (i.e. genetic polymorphism). We list the different mate-choice rules (i.e. all individuals have the same preference; preference depends on the chooser's morph; individuals mate preferentially with conspecifics displaying an uncommon or the most frequent morph) and review experimental studies that investigated mate choice in natural populations of colour-polymorphic animals. Our review emphasises that although the experimental data support the idea that sexual selection plays an important role in the evolution of genetic colour polymorphism in many different ways, little is known about the adaptive value of each mate-choice strategy and about their implication in the evolutionary stability of colour polymorphism. One way of solving this problem is to determine the adaptive function of colour morphs, a worthwhile objective, because better understanding of mate-choice rules in polymorphic species should provide important insights into sexual-selection processes and, in turn, into the maintenance of genetic variation.