A prospective pilot study evaluating the ‘cardiac decompensation score’ in the setting of intraaortic balloon counterpulsation

The study objective was to determine whether the ‘cardiac decompensation score’ could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p < 0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p = 0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p = 0.024). This pilot study indicates the ‘cardiac decompensation score’ to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.

The 66 k-Da protein identified as a light meromyosin is involved in the setting of surimi

The 66 kilo-Dalton (k-Da) protein split off from the cross linked myosin heavy chain (CMHC) formed due to the setting of Alaska pollack surimi, frozen-storage of Pacific cod flesh, and vinegar-curing of Pacific mackerel mince was identified as a light meromyosin (LMM). Puncture and stress-relaxation tests showed that the actomyosin subunits (AMS) of Alaska pollack surimi, upon setting at 30°C, transformed into gel, although the elasticity of this gel was very low when compared to the gels from surimi or actomyosin (AM). Electrophoretic studies showed that the band due to LMM in the gel from AMS gradually disappeared with the progress of setting but higher molecular weight polymer did not form. The intensity of the bands due to other myosin sub-fragments decreased a little. The findings suggest that at setting temperature, LMM of MHC molecule leads to an unfolding resulting in an intramolecular aggregation through non-covalent interactions, and thus plays a significant role in the crosslinking of MHC.

Rapid complete response of metastatic melanoma in a patient undergoing ipilimumab immunotherapy in the setting of active ulcerative colitis.

While blockade of the cytotoxic T-lymphocyte antigen-4 (CTLA-4) T cell regulatory receptor has become a commonly utilized strategy in the management of advanced melanoma, many questions remain regarding the use of this agent in patient populations with autoimmune disease. We present a case involving the treatment of a patient with stage IV melanoma and ulcerative colitis (UC) with anti-CTLA-4 antibody immunotherapy. Upon initial treatment, the patient developed grade III colitis requiring tumor necrosis factor-alpha (TNF-α) blocking antibody therapy, however re-treatment with anti-CTLA-4 antibody following a total colectomy resulted in a rapid complete response accompanied by the development of a tracheobronchitis, a previously described extra-intestinal manifestation of UC. This case contributes to the evolving literature on the use of checkpoint inhibitors in patients also suffering from autoimmune disease, supports future clinical trials investigating the use of these agents in patients with autoimmune diseases, and suggests that an understanding of the specific molecular pathways involved in a patient's autoimmune pathology may provide insight into the development of more effective novel combinatorial immunotherapeutic strategies.

A matter of fundamentals : sound and silence in the radio drama of Samuel Beckett

Samuel Beckett was arguably one of the most influential writers of the 20th century. Known for his stage plays, including the renowned En attendant Godot (1948), Beckett’s contribution to the field of radio drama is often overlooked. His corpus of radio dramas included some of the most innovativeradio works of the post-World War II period. For Beckett, radio drama was not exclusively verbocentric, for he always maintained that his work was “a matter of fundamental sounds (no joke intended) made as fully as possible” (Frost 362). His (radio) drama aesthetics defined a strict hierarchy of sound whereby the dramatist balances sound effects, music and the characters’ dialogue – and the use of silence. In this essay, I examine the juxtaposition of sound and silence in Samuel Beckett’s most influential radio dramas: All That Fall, Embers, Words and Music and Cascando. In the end, this essay will show that the sounds and silence employed in Beckett’s radio dramatic works were inextricably linked, which added to the overall meaning of his dramas.

The sight of silence : the conceptualisation of silence in the visual cultures of sign language communities

Deaf people are perceived by hearing people as living in a silent world. Yet, silence cannot exist without sound, so if sound is not heard, can there be silence? From a linguistic point of view silence is the absence of, or intermission in, communication. Silence can be communicative or noncommunicative. Thus, silence must exist in sign languages as well. Sign languages are based on visual perception and production through movement and sight. Silence must, therefore, be visually perceptible; and, if there is such a thing as visual silence, how does it look? The paper will analyse the topic of silence from a Deaf perspective. The main aspects to be explored are the perception and evaluation of acoustic noise and silence by Deaf people; the conceptualisation of silence in visual languages, such as sign languages; the qualities of visual silence; the meaning of silence as absence of communication (particularly between hearing and Deaf people); social rules for silence; and silencing strategies.

Women's silence : in the space of words and images

My thesis is made up of words and images. This study investigates the way in which silence operates productively within and between the two modes of communication. I suggest that in the process of changing words into images or scripto-visual art-practice, the silence in women's lives can be articulated. I argue that women draw on the generative qualities of silence to create forms of speech that override the cultural constructions of gender which have placed them within the space of ‘mute’ silence. To gain an historical perspective of this practice by women, I consider the lives of medieval nuns within religious enclosure and their work with words and images in the illuminated manuscript. I make a comparative study of original illuminated manuscripts, focussing mainly on visual language and locating aspects of the work closest to my own art-practice: the visual treatment of the space and inter-textual components of the page or folio. This project does not include an examination of miniatures or historiated initials. Rather, its aim is to identify and compare the use of other aesthetic devices available to the medieval scribe/artist through which they might have interacted with the text. I suggest links between verbal and visual performances of language and the repetition, or copying of texts by medieval nuns, as a means of female embodiment of words and their spaces. From the outcomes of my studio investigations and my consideration of other contemporary feminist art practices, I demonstrate how women artists may ‘re-write’ the text and ‘speak’ their silence through visual language and the acts of writing, drawing and painting the words of others. Through my engagement with feminist critical theory, the work of medieval scholars, original illuminated manuscripts and my studio research, I propose that scripto-visual practice remains particularly significant for women despite the differences between the medieval period and our own. As a generative practice, it negotiates some of the societal constraints on women's speech and visibility, because its language is ‘silent and disembodied’ from the image of woman constructed by male discourse. It is a form of speech that acknowledges as it defies the social and cultural conditions that shaped its necessity, articulating an alternative voice of women in the space of words and images.

Encounters with silence : toward a pedagogics of silence in the education of adults

Educational theory, if distanced from experience, positions silence as a problem rather than as a site of possibility. This thesis presents and analyses experiences of silence in the lives of a composer, a novelist, a meditation teacher, an Orthodox priest, a high school teacher, an Anglican priest, an actor, a grief counsellor, and a university lecturer. It draws upon discourses of philosophy, theology, language, the arts and the environment. By focussing on silence as experience, it suggests new ways of enriching pedagogical practice.

Acute delirium in the setting of primary hypothyroidism: the role of thyroid hormone replacement therapy.

Psychiatric illness, mostly mania and psychosis, are reported to occur after rapid normalization of thyroid function in patients with primary hypothyroidism. It is generally believed that the gradual restoration of thyroid function may reduce the risk of psychiatric complications. This case report describes the occurrence of acute delirium in a 67-year-old man with primary hypothyroidism shortly after the initiation of thyroid hormone replacement. The use of low-dose thyroxine initially and persistent severe biochemical hypothyroidism on presentation with psychiatric symptoms illustrate that psychiatric illness can still occur despite unaggressive thyroid hormone replacement. A temporal relationship with the initiation of thyroxine and rapid recovery of mental state over 1 to 2 weeks differentiate this condition from hypothyroidism-related psychopathology, which tends to have a more prolonged course.

Social determinants of health in the setting of hypertrophic cardiomyopathy.

Social determinants of health play an important role in explaining poor health outcomes across many chronic disease states. The impact of the social gradient in the setting of an inherited heart disease, hypertrophic cardiomyopathy (HCM), has not been investigated. This study sought to profile the socioeconomic status of patients attending a specialized multidisciplinary clinic and to determine the impact on clinical factors, psychosocial wellbeing and adherence to medical advice.

Retinol binding protein 4 and retinol in steatotic and nonsteatotic rat livers in the setting of partial hepatectomy under ischemia/reperfusion

Steatotic livers show increased hepatic damage and impaired regeneration after partial hepatectomy (PH) under ischemia/reperfusion (I/R), which is commonly applied in clinical practice to reduce bleeding. The known function of retinol-binding protein 4 (RBP4) is to transport retinol in the circulation. We examined whether modulating RBP4 and/or retinol could protect steatotic and nonsteatotic livers in the setting of PH under I/R. Steatotic and nonsteatotic livers from Zucker rats were subjected to PH (70%) with 60 minutes of ischemia. RBP4 and retinol levels were measured and altered pharmacologically, and their effects on hepatic damage and regeneration were studied after reperfusion. Decreased RBP4 levels were observed in both liver types, whereas retinol levels were reduced only in steatotic livers. RBP4 administration exacerbated the negative consequences of liver surgery with respect to damage and liver regeneration in both liver types. RBP4 affected the mobilization of retinol from steatotic livers, and this revealed actions of RBP4 independent of simple retinol transport. The injurious effects of RBP4 were not due to changes in retinol levels. Treatment with retinol was effective only for steatotic livers. Indeed, retinol increased hepatic injury and impaired liver regeneration in nonsteatotic livers. In steatotic livers, retinol reduced damage and improved regeneration after surgery. These benefits of retinol were associated with a reduced accumulation of hepatocellular fat. Thus, strategies based on modulating RBP4 could be ineffective and possibly even harmful in both liver types in the setting of PH under I/R. In terms of clinical applications, a retinol pretreatment might open new avenues for liver surgery that specifically benefit the steatotic liver. Liver Transpl 18:1198-1208, 2012. (c) 2012 AASLD.