Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents

OBJECTIVES

To evaluate the impact of using different diagnostic criteria on prevalence rates of delirium and subsyndromal delirium (SSD) among demented long-term care (LTC) residents.

DESIGN

Descriptive study.

SETTING

LTC settings in Quebec City, Canada.

PARTICIPANTS

Participants were 155 individuals aged 65 and older, with dementia.

MEASUREMENTS

(1) Prevalence rates of delirium according to: (a) the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R, and DSM-IV) and (b) the Confusion Assessment Method (CAM) algorithms for definite and probable delirium; and (2) prevalence rates of SSD employing 2 definitions described in previous studies.

RESULTS

Prevalence rates of delirium according to each set of criteria were 26.5% for DSM-III; 29% for DSM-IV-TR; 41.3% for DSM-III-R; 45.8% for CAM algorithm for definite delirium; and 70.3% for CAM algorithm for probable delirium. A total of 109 subjects (70.3%) were identified as delirious consistent with at least one classification and 37 (23.9%) met all the sets of criteria considered. Prevalence rates for SSD were 75 (48.4%) and 78 (50.3%) depending on the definition employed.

CONCLUSION

Prevalence rates for delirium are much affected by the diagnostic formulations used. The use of DSM-IV-TR among this population could result in fewer cases being identified as delirious and thus compromise proper care for those individuals. Considering that SSD was prevalent among this population, a systematic implementation of protocols targeting risk factors of delirium might be beneficial among demented LTC residents.

cDNA sequencing and expression analysis of Dicentrarchus labrax heme oxygenase-1

The liver cDNA encoding heme oxygenase--1 (HO-1) was sequenced from European sea bass (Dicentrarchus labrax) (accession number no. EF139130). The HO-1 cDNA was 1250 bp in nucleotide length and the open reading frame encoded 277 amino acid residues. The deduced amino acid sequence of the European sea bass had 75% and 50% identity with the amino acid sequences of tetraodontiformes (Tetraodon nigroviridis and Takifugu rubripes) and human HO-1 proteins, respectively. A short hydrophobic transmembrane domain at the C--terminal region was found, and four histidine residues were highly conserved, including human his25 that is essential for HO catalytic activity. RT-PCR of mRNA from eight different European sea bass tissues revealed that, in a homeostatis state, the heme oxygenase--1 was abundant in the spleen and liver but not in the brain.

[Molecular effects of new calcium antagonists: is the principle of parcimony out of place?]

The calcium (Ca2+) channel antagonists (CCA) are used successfully in the treatment of hypertension and angina pectoris. Their mode of action is to decrease Ca2+ entry in the vascular smooth muscle cells. Their molecular targets are voltage activated Ca2+ channels (VACC), especially the L-type (VACC-L). This review examines the role of the VACC-L and of the T-type (VACC-T) in vascular physiology and hypertension. The molecular mechanisms at the base of the vascular selectivity of CCA are presented with, in filigree, the concern of trying to understand the effect of recently developed molecules. In particular, we will examine the ideas having recently emerged concerning the mode of action of last generation dihydropyridines (DHPs) stripped of some of the undesirable effects of prototypes AC considered as highly specific of the VACC-L. These properties could result, in particular, from their effects on the VACC-T, which could occur in addition to those classically observed on the VACC-L.

Detection of delirium by nurses among long-term care residents with dementia

Background

Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium.

Methods

In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses.

Results

Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]).

Conclusion

Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.

Intensity and duration of corticosterone response to stressful situations in Japanese quail divergently selected for tonic immobility

Two genotypes of Japanese quail have been divergently selected since the 1980s for long (LTI) or short (STI) duration of tonic immobility [Mills, A.D., Faure, J.M., 1991. Divergent selection for duration of tonic immobility and social reinstatement behavior in Japanese quail (Coturnix coturnix japonica) chicks. J. Comp. Psychol. 105(1), 25-38.], an unlearnt catatonic state characteristic of a behavioral fear response ([Jones, R.B., 1986. The tonic immobility reaction of the domestic fowl: a review. World's Poult. Sci. J. 42(1), 82-97.]; [Mills, A.D., Faure, J.M., 1991. Divergent selection for duration of tonic immobility and social reinstatement behavior in Japanese quail (Coturnix coturnix japonica) chicks. J. Comp. Psychol. 105(1), 25-38.]). The results of several behavioral tests conducted in LTI and STI quail have led to the conclusion that LTI quail are more fearful than STI quail [Faure, J.M., Mills, A.D., 1998. Improving the adaptability of animals by selection. In: Grandin, T. (Eds.), Genetics and the behavior of domestic animals. Academic Press, San Diego, pp. 235-264.]). However, few studies to date have focused on the Hypothalamic-Pituitary-Adrenal (HPA) axis response to stressful situations in LTI and STI quail, although the HPA axis is involved in fear responses [Siegel, H.S., 1971. Adrenals, Stress and the Environment. World's Poult. Sci. J. 27, 327-349.]. The corticosterone (CORT) response to various putatively stressful situations was therefore assessed in LTI and STI genotypes of quail in order to investigate their HPA axis reactivity to stress. Repeated induction of TI or 1 min manual restraint induced significant and comparable increases in CORT levels in both genotypes as a TI response. On the other hand, higher CORT responses were found in STI than in LTI quail when the manual restraint period lasted for 2 min or after restraint in a crush cage. Maximum CORT responses and genotype differences were maintained throughout the latter test even when it lasted for 120 min. Investigation of the CORT response to a single TI episode showed that CORT levels at the end of TI were negatively correlated with TI duration. Other experimental contexts consisting of isolation in a familiar or novel environment or the presentation of a novel object induced slight but significant and comparable increases in CORT response in both genotypes, whereas change of cagemates did not. In conclusion, the present findings indicate that differences in HPA axis response are observed between LTI and STI genotypes when quail are submitted to intense stressors, resulting in a high and prolonged CORT response. By contrast, plasma corticosterone concentrations do not differ between STI and LTI quail in response to stressful situations of lower intensity, which evoke responses limited in amplitude and duration. Genetic selection for divergent duration of TI has thus affected the HPA axis response to stress, and LTI and STI quail constitute an interesting model to investigate genetic variability of HPA axis activity in birds. More specifically, these genotypes of quail could be used to investigate the occurrence of functional differences at different levels of the HPA axis in order to explain the present findings.

Optimization of image acquisition techniques for dual-energy imaging of the chest

Experimental and theoretical studies were conducted to determine optimal acquisition techniques for a prototype dual-energy (DE) chest imaging system. Technique factors investigated included the selection of added x-ray filtration, kVp pair, and the allocation of dose between low- and high-energy projections, with total dose equal to or less than that of a conventional chest radiograph. Optima were computed to maximize lung nodule detectability as characterized by the signal-difference-to-noise ratio (SDNR) in DE chest images. Optimal beam filtration was determined by cascaded systems analysis of DE image SDNR for filter selections across the periodic table (Z(filter) = 1-92), demonstrating the importance of differential filtration between low- and high-kVp projections and suggesting optimal high-kVp filters in the range Z(filter) = 25-50. For example, added filtration of approximately 2.1 mm Cu, approximately 1.2 mm Zr, approximately 0.7 mm Mo, and approximately 0.6 mm Ag to the high-kVp beam provided optimal (and nearly equivalent) soft-tissue SDNR. Optimal kVp pair and dose allocation were investigated using a chest phantom presenting simulated lung nodules and ribs for thin, average, and thick body habitus. Low- and high-energy techniques ranged from 60-90 kVp and 120-150 kVp, respectively, with peak soft-tissue SDNR achieved at [60/120] kVp for all patient thicknesses and all levels of imaging dose. A strong dependence on the kVp of the low-energy projection was observed. Optimal allocation of dose between low- and high-energy projections was such that approximately 30% of the total dose was delivered by the low-kVp projection, exhibiting a fairly weak dependence on kVp pair and dose. The results have guided the implementation of a prototype DE imaging system for imaging trials in early-stage lung nodule detection and diagnosis.

Cerebral venous thrombosis caused by spontaneous intracranial hypotension: two cases

The association of spontaneous intracranial hypotension (SIH) with cerebral venous thrombosis (CVT) is rare. We are reporting two new cases. In one case, CVT is extensive concerning three sinuses and bilateral parietal cortical veins and, in the other case, only a cortical vein is involved. Both the patients presented had no thrombosis risk factors. There is certainly a link between these two pathologies. SIH should be considered as a risk factor of CVT. Modification of symptoms of SIH leading to CVT must be known to start early treatment.

Mercury speciation and exchanges at the air-water interface of a tropical artificial reservoir, French Guiana

The distribution and speciation of mercury (Hg) in air, rain, and surface waters from the artificial tropical lake of Petit-Saut in French Guiana were investigated during the 2003/04 period. In the air, total gaseous mercury (TGM) at the dam station averaged 12+/-2 pmol m(-3) of which >98% was gaseous elemental mercury (GEM). GEM distribution depicted a day-night cycling with high concentrations (up to 15 pmol m(-3)) at dawn and low concentrations (down to 5 pmol m(-3)) at nightfall. Reactive gaseous mercury (RGM) represented <1% of the GEM with a mean concentration of 4+/-3 fmol m(-3). Diel RGM variations were negatively related to GEM. In the rain, the sum of all Hg species in the unfiltered (HgT(UNF)) averaged 16+/-12 pmol L(-1). Temporal distribution of HgT(UNF) exhibited a pattern of high concentrations during the late dry seasons (up to 57.5 pmol L(-1)) and low concentrations (down to 2.7 pmol L(-1)) in the course of the wet seasons. Unfiltered reactive (HgR(UNF)), dissolved gaseous (DGM) and monomethyl (MMHg(UNF)) Hg constituted 20, 5 and 5% of HgT(UNF), respectively. All measured Hg species were positively related and displayed negative relationships with the pH of the rain. In the reservoir surface waters, dissolved total mercury (HgT(D)) averaged 3.4+/-1.2 pmol L(-1) of which 10% consisted of DGM. DGM showed a trend of high concentrations during the dry seasons (480+/-270 fmol L(-1)) and lower (230+/-130 fmol L(-1)) in the course of the wet seasons. Diel variations included diurnal photo-induced DGM production (of about 60 fmol L(-1) h(-1)) coupled to minute to hour oxidation/reduction cycles (of >100 fmol L(-1) amplitude). Finally, calculated atmospheric Hg inputs to the Petit-Saut reservoir represented 14 mol yr(-1) whereas DGM evasion reached 23 mol yr(-1). Apportionment among forms of Hg deposition indicated that up to 75% of the total Hg invasive flux follows the rainfall pathway.

Assessment of space radiation effects on solid-state Brillouin phase conjugate mirrors

Optical phase conjugation (OPC) provides a means of dynamical correction of thermally induced aberrations in high-power laser systems. This method is particularly interesting for space applications because it is passive, mechanically simple, and allows for improved beam quality with only a small loss in power. To exploit it one has to assess the effect of the space environment, and in particular of space radiation, on the properties of the materials that are suitable for phase-conjugating mirrors (PCMs). We have investigated both materials providing OPC via stimulated Brillouin scattering and actual PCMs with regard to their radiation hardness. Proton- and gamma-irradiated PCMs in the form of 30-cm long silica rods and 5-cm long TeO(2) crystals were tested in a single frequency flash-lamp pumped Nd:YAG system delivering up to 220 mJ pulses with a 20 ns duration at a 50 Hz repetition rate. The difference in the reflectivity between irradiated and nonirradiated components was found to be within the measurement errors. Gamma irradiation of TeO(2) resulted in a decrease of the laser-induced damage threshold, while for silica possible changes were below the detection limit. Our results show that synthetic fused silica, and Lithosil in particular, can be used for generating the OPC in laser systems operating in a space radiation environment.

Behavioural and endocrine fear responses in Japanese quail upon presentation of a novel object in the home cage

Most tests used to study fear in birds involve transferring them to a novel environment, which constitutes a bias in studies aiming at identifying the neural correlates of a specific fear-inducing situation. In order to investigate fear in birds with minimum interference by humans, behavioural and endocrine responses to the presentation of a novel object in the home cage were investigated in two lines of Japanese quail divergently selected for long or short duration of tonic immobility, a behavioural index of fear. Presentation of the novel object induced typical fear responses (avoidance of the object, increased pacing and increased plasma corticosterone levels) that were similar in the two lines of quail. Presentation of a novel object in the home cage thus appears to be a suitable stimulus to induce fear reactions in quail, with minimum interference from other motivational systems. The fact that quail of both lines reacted similarly in this test, while they are known to differ greatly in their behavioural responses to other fear-inducing tests, illustrates the multidimensional nature of fear.

Sam68 haploinsufficiency delays onset of mammary tumorigenesis and metastasis

The Src-associated substrate in mitosis Sam68 is a KH type RNA-binding protein known to be a substrate of numerous tyrosine kinases, and often referred to as a STAR (signal transduction activator of RNA) protein. Herein, we observed that Sam68-null mice display mammary gland and the uterine development defects. Moreover, we report that Sam68 haploinsufficiency impedes mammary tumor onset in vivo driven by the potent mammary-targeted polyoma middle T-antigen (MMTV-PyMT) oncogene. The effect was cell autonomous as the Sam68 knockdown in PyMT-transformed cell lines also delayed tumorigenesis and metastasis formation in nude mice. Interestingly, tumor extracts isolated from PyMT/Sam68(+/-) mice compared with PyMT/Sam68(+/+) mice contained activated Src and FAK kinases. These findings suggest that Sam68 may be a modulator of tyrosine kinase activity in vivo and a signaling requirement for mammary tumorigenesis and metastasis.

Optimization of dual-energy imaging systems using generalized NEQ and imaging task

Dual-energy (DE) imaging is a promising advanced application of flat-panel detectors (FPDs) with a potential host of applications ranging from thoracic and cardiac imaging to interventional procedures. The performance of FPD-based DE imaging systems is investigated in this work by incorporating the noise-power spectrum associated with overlying anatomical structures ("anatomical noise" modeled according to a 1/f characteristic) into descriptions of noise-equivalent quanta (NEQ) to yield the generalized NEQ (GNEQ). Signal and noise propagation in the DE imaging chain is modeled by cascaded systems analysis. A Fourier-based description of the imaging task is integrated with the GNEQ to yield a detectability index used as an objective function for optimizing DE image reconstruction, allocation of dose between low- and high-energy images, and selection of low- and high-kVp. Optimal reconstruction and acquisition parameters were found to depend on dose; for example, optimal kVp varied from [60/150] kVp at typical radiographic dose levels (approximately 0.5 mGy entrance surface dose, ESD) but increased to [90/150] kVp at high dose (ESD approximately 5.0 mGy). At very low dose (ESD approximately 0.05 mGy), detectability index indicates an optimal low-energy technique of 60 kVp but was largely insensitive to the choice of high-kVp in the range 120-150 kVp. Similarly, optimal dose allocation, defined as the ratio of low-energy ESD and the total ESD, varied from 0.2 to 0.4 over the range ESD=(0.05-5.0) mGy. Furthermore, two applications of the theoretical framework were explored: (i) the increase in detectability for DE imaging compared to conventional radiography; and (ii) the performance of single-shot vs double-shot DE imaging, wherein the latter is found to have a DQE approximately twice that of the former. Experimental and theoretical analysis of GNEQ and task-based detectability index provides a fundamental understanding of the factors governing DE imaging performance and offers a framework for system design and optimization.

Cure chirurgicale de l'incontinence urinaire d'effort par bandelette sous-urétrale transobturatrice

OBJECTIVE

Assessment of the suburethral transobturator tape in the treatment of female urinary stress incontinence.

PATIENTS AND METHODS

Retrospective evaluation of 39 slings. Three patients (7%) were lost to follow-up. Analysis was carried on 19 out/in procedures (mainly ObTape and Uratape slings) and 17 in/out procedures (TVT-O slings). Nine patients (25%) had a history of previous stress incontinence surgery. In 21 cases (58%) there was a concomitant surgical procedure, including genital prolapse repair (12) and total hysterectomy (6). Phone interviews were conducted with the validated questionnaires MHU and Ditrovie short form.

RESULTS

The mean operative time was 17 minutes (10-30). Three vaginal wounds (8%) were immediately repaired. Two urinary retentions (5%) were managed by suprapubic catheterization for more than 10 days. With a mean follow-up of 12 months (4-23) the subjective effectiveness on stress incontinence was 89% (cure: 58%; improvement: 31%). Urge incontinence symptoms were cured in 47% of mixed incontinences. Two patients reported an important dysuria. Two sling exposures occurred. Quality of life scores were significantly improved (mean 1,7 versus 3,2, p=0,002). The level of satisfaction reached 89% (very satisfied: 50%; satisfied: 39%).

DISCUSSION AND CONCLUSION

This technique is safe and effective. Our results are nevertheless inferior to those previously reported. Prospective randomised studies comparing the two surgical routes are required.

Mutations in BHD and TP53 genes, but not in HNF1beta gene, in a large series of sporadic chromophobe renal cell carcinoma

BHD, TP53, and HNF1β on chromosome 17 were studied in 92 cases of renal cell carcinoma (46 chromophobe, 19 clear cell, 18 oncocytoma, and nine papillary). Six, thirteen, and zero cases had, respectively BHD, TP53, and HNF1β mutations, (84% mutations involved chromophobe), suggesting a role for BHD and TP53 in chromophobe subtype.

A simple, direct method for x-ray scatter estimation and correction in digital radiography and cone-beam CT

X-ray scatter poses a significant limitation to image quality in cone-beam CT (CBCT), resulting in contrast reduction, image artifacts, and lack of CT number accuracy. We report the performance of a simple scatter correction method in which scatter fluence is estimated directly in each projection from pixel values near the edge of the detector behind the collimator leaves. The algorithm operates on the simple assumption that signal in the collimator shadow is attributable to x-ray scatter, and the 2D scatter fluence is estimated by interpolating between pixel values measured along the top and bottom edges of the detector behind the collimator leaves. The resulting scatter fluence estimate is subtracted from each projection to yield an estimate of the primary-only images for CBCT reconstruction. Performance was investigated in phantom experiments on an experimental CBCT bench-top, and the effect on image quality was demonstrated in patient images (head, abdomen, and pelvis sites) obtained on a preclinical system for CBCT-guided radiation therapy. The algorithm provides significant reduction in scatter artifacts without compromise in contrast-to-noise ratio (CNR). For example, in a head phantom, cupping artifact was essentially eliminated, CT number accuracy was restored to within 3%, and CNR (breast-to-water) was improved by up to 50%. Similarly in a body phantom, cupping artifact was reduced by at least a factor of 2 without loss in CNR. Patient images demonstrate significantly increased uniformity, accuracy, and contrast, with an overall improvement in image quality in all sites investigated. Qualitative evaluation illustrates that soft-tissue structures that are otherwise undetectable are clearly delineated in scatter-corrected reconstructions. Since scatter is estimated directly in each projection, the algorithm is robust with respect to system geometry, patient size and heterogeneity, patient motion, etc. Operating without prior information, analytical modeling, or Monte Carlo, the technique is easily incorporated as a preprocessing step in CBCT reconstruction to provide significant scatter reduction.

Spin-induced forbidden evanescent states in III-V semiconductors

Within the band gap of a semiconductor no electronic propagating states are allowed, but there exist evanescent states which govern charge transport such as tunneling. In this Letter, we address the issue of their spin dependence in III-V semiconductors. Taking into account the spin-orbit interaction, we treat the problem using a k . p 14 x 14 Hamiltonian that we numerically compute for GaAs. Our results show that the removed spin degeneracy in the band gap can lead to giant energy splittings and induces forbidden zones in space where evanescent states are suppressed.

Generalized DQE analysis of radiographic and dual-energy imaging using flat-panel detectors

Analysis of detective quantum efficiency (DQE) is an important component of the investigation of imaging performance for flat-panel detectors (FPDs). Conventional descriptions of DQE are limited, however, in that they take no account of anatomical noise (i.e., image fluctuations caused by overlying anatomy), even though such noise can be the most significant limitation to detectability, often outweighing quantum or electronic noise. We incorporate anatomical noise in experimental and theoretical descriptions of the "generalized DQE" by including a spatial-frequency-dependent noise-power term, S(B), corresponding to background anatomical fluctuations. Cascaded systems analysis (CSA) of the generalized DQE reveals tradeoffs between anatomical noise and the factors that govern quantum noise. We extend such analysis to dual-energy (DE) imaging, in which the overlying anatomical structure is selectively removed in image reconstructions by combining projections acquired at low and high kVp. The effectiveness of DE imaging in removing anatomical noise is quantified by measurement of S(B) in an anthropomorphic phantom. Combining the generalized DQE with an idealized task function to yield the detectability index, we show that anatomical noise dramatically influences task-based performance, system design, and optimization. For the case of radiography, the analysis resolves a fundamental and illustrative quandary: The effect of kVp on imaging performance, which is poorly described by conventional DQE analysis but is clarified by consideration of the generalized DQE. For the case of DE imaging, extension of a generalized CSA methodology reveals a potentially powerful guide to system optimization through the optimal selection of the tissue cancellation parameter. Generalized task-based analysis for DE imaging shows an improvement in the detectability index by more than a factor of 2 compared to conventional radiography for idealized detection tasks.

Maladie de von Hippel-Lindau : progrès génétiques et cliniques récents

Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome that predisposes to the development of a panel of highly vascularized tumors including CNS and retinal hemangioblastomas, endolymphatic sac tumors, clear-cell renal cell carcinomas (RCC), pheochromocytomas and pancreatic neuroendocrine tumors. CNS hemangioblastomas and RCC are the two main life-threatening manifestations. The disease is caused by germline mutations in the VHL tumor-suppressor gene that plays a major role in regulating the oxygen-sensing pathway by targeting the hypoxia-inducible factor HIF for degradation in proteasome. Somatic inactivation of the VHL gene occurs also in most sporadic RCC and sporadic CNS hemangioblastomas. The demonstration of the critical role of VHL in angiogenesis is paving the way for the development of new specific drugs that could represent an attractive potential treatment for VHL but also for sporadic RCC and other cancers.

Toward a detailed characterization of feline immunodeficiency virus-specific T cell immune responses and mediated immune disorders

Infection of domestic cats with feline immunodeficiency virus (FIV) is associated with the development of an acquired immunodeficiency syndrome (AIDS). The pathogenesis of FIV is not fully understood but it has been reported that the immune system is progressively impaired during disease progression. As a result, anti-FIV specific immune response will usually not clear the virus and the acute stage is followed by a chronic asymptomatic phase. The overall objective of this study was to characterized FIV-induced immune cellular responses and -mediated immune disorder following the first weeks post-infection. Using both cytokine ELISpot and intracellular staining assays, FIV-specific T cells were monitored at 6, 9 and 12 weeks post-infection. We demonstrated that both IFNgamma(+) and, CD4 and CD8 TNFalpha(+) T cells specifically respond to FIV antigens. These responses were found to reach a peak at 9 weeks post-infection. It was further shown that the TNFalpha(+)CD8(+) responding T cells were contained within a CD8beta(low)CD62L(-) T cell subpopulation, expanded in FIV-infected cats. This T cell subpopulation which present features of activated CD8 T cells was further shown to be susceptible to spontaneous apoptosis following a short-term in vitro culture. Moreover, it was observed that cell death by apoptosis of this T cell subset was increased following FIV antigen-recognition. Therefore, FIV might alter immune homeostasis in inducing chronic activation of TNFalpha(+)CD8(+) T cells which eventually will die following antigen contact while deleting CD4(+) T cells. Interestingly, this study confirmed the strong similarity between FIV and HIV pathogenesis.

Impact of plasmid supercoiling on the efficacy of a rabies DNA vaccine to protect cats

As of today, most DNA vaccination trials have been performed with plasmid preparations highly enriched in supercoiled molecules (sc) and the importance of supercoiled versus open circular (oc) plasmid isoforms for vaccine immunogenicity has only received limited attention. This study demonstrated that a single rabies DNA vaccination fully protected cats against a lethal rabies challenge as early as 3 weeks post vaccination provided that the proportion of supercoiled isoform in the vaccinal solution is at least 48%. In contrast, vaccination with a plasmid containing only 20% of supercoiled molecules induced significant but only partial protection. Further, a single rabies DNA vaccination with plasmids containing at least 70% of supercoiled molecules triggered statistically significant specific antibody titers and specific Th-1 oriented cell-based immunity as early as 2 and 3 weeks post vaccination, respectively. It is concluded that the oc isoforms are less efficient than supercoiled isoforms at inducing a complete profile of immune responses. Therefore, it is proposed that the target threshold of supercoiling that must be met by a rabies DNA vaccine to guarantee optimal immune responses and protection, be set at 70% of supercoiled molecules in the vaccine solution.

The influence of antiscatter grids on soft-tissue detectability in cone-beam computed tomography with flat-panel detectors

The influence of antiscatter x-ray grids on image quality in cone-beam computed tomography (CT) is evaluated through broad experimental investigation for various anatomical sites (head and body), scatter conditions (scatter-to-primary ratio (SPR) ranging from approximately 10% to 150%), patient dose, and spatial resolution in three-dimensional reconstructions. Studies involved linear grids in combination with a flat-panel imager on a system for kilovoltage cone-beam CT imaging and guidance of radiation therapy. Grids were found to be effective in reducing x-ray scatter "cupping" artifacts, with heavier grids providing increased image uniformity. The system was highly robust against ring artifacts that might arise in CT reconstructions as a result of gridline shadows in the projection data. The influence of grids on soft-tissue detectability was evaluated quantitatively in terms of absolute contrast, voxel noise, and contrast-to-noise ratio (CNR) in cone-beam CT reconstructions of 16 cm "head" and 32 cm "body" cylindrical phantoms. Imaging performance was investigated qualitatively in observer preference tests based on patient images (pelvis, abdomen, and head-and-neck sites) acquired with and without antiscatter grids. The results suggest that although grids reduce scatter artifacts and improve subject contrast, there is little strong motivation for the use of grids in cone-beam CT in terms of CNR and overall image quality under most circumstances. The results highlight the tradeoffs in contrast and noise imparted by grids, showing improved image quality with grids only under specific conditions of high x-ray scatter (SPR> 100%), high imaging dose (Dcenter> 2 cGy), and low spatial resolution (voxel size > or = 1 mm).

Spektr: A computational tool for x-ray spectral analysis and imaging system optimization

A set of computational tools are presented that allow convenient calculation of x-ray spectra, selection of elemental and compound filters, and calculation of beam quality characteristics, such as half-value layer, mR/mAs, and fluence per unit exposure. The TASMIP model of Boone and Seibert is adapted to a library of high-level language (Matlab) functions and shown to agree with experimental measurements across a wide range of kVp and beam filtration. Modeling of beam filtration is facilitated by a convenient, extensible database of mass and mass-energy attenuation coefficients compiled from the National Institute of Standards and Technology. The functions and database were integrated in a graphical user interface and made available online at http:// www.aip.org/epaps/epaps.html. The functionality of the toolset and potential for investigation of imaging system optimization was illustrated in theoretical calculations of imaging performance across a broad range of kVp, filter material type, and filter thickness for direct and indirect-detection flat-panel imagers. The calculations reveal a number of nontrivial effects in the energy response of such detectors that may not have been guessed from simple K-edge filter techniques, and point to a variety of compelling hypotheses regarding choice of beam filtration that warrant future investigation.

Disease-Management-Programme in der gesetzlichen Krankenversicherung

The structure of the German healthcare system impedes well-coordinated long-term care of the chronically ill. Based on centrally defined standards, German sickness funds have implemented nationwide disease management programs for patients with diabetes. Breast cancer programs are underway. The programs are evidence based. Performance standards are centrally defined and subject to accreditation by a federal office. The programs are designed to improve the coordination of care between the different sectors, but the associated administration costs are often criticized.

Somatic mutations of KIT in familial testicular germ cell tumours

Somatic mutations of the KIT gene have been reported in mast cell diseases and gastrointestinal stromal tumours. Recently, they have also been found in mediastinal and testicular germ cell tumours (TGCTs), particularly in cases with bilateral disease. We screened the KIT coding sequence (except exon 1) for germline mutations in 240 pedigrees with two or more cases of TGCT. No germline mutations were found. Exons 10, 11 and 17 of KIT were examined for somatic mutations in 123 TGCT from 93 multiple-case testicular cancer families. Five somatic mutations were identified; four were missense amino-acid substitutions in exon 17 and one was a 12 bp in-frame deletion in exon 11. Two of seven TGCT from cases with bilateral disease carried KIT mutations compared with three out of 116 unilateral cases (P=0.026). The results indicate that somatic KIT mutations are implicated in the development of a minority of familial as well as sporadic TGCT. They also lend support to the hypothesis that KIT mutations primarily take place during embryogenesis such that primordial germ cells with KIT mutations are distributed to both testes.

Critical temperature of a trapped, weakly interacting Bose gas

We report on measurements of the critical temperature of a harmonically trapped, weakly interacting Bose gas as a function of atom number. Our results exclude ideal-gas behavior by more than two standard deviations, and agree quantitatively with mean-field theory. At our level of sensitivity, we find no additional shift due to critical fluctuations. In the course of this measurement, the onset of hydrodynamic expansion in the thermal component has been observed. Our thermometry method takes this feature into account.

Aromatase activity modulation by lindane and bisphenol-A in human placental JEG-3 and transfected kidney E293 cells

Aromatase is the cytochrome P-450 involved in converting androgens to estrogens. The cytochrome P-450 family plays a central role in the oxidative metabolism of compounds including environmental pollutants. Since lindane and bisphenol-A (BPA) are two well-characterized endocrine disruptors that have been detected in animals and humans, it was important to learn whether they could affect aromatase activity and consequently estrogen biosynthesis. The present study investigates the effects of BPA and lindane on cytotoxicity, aromatase activity and mRNA levels in human placental JEG-3 cells and transfected human embryonal kidney 293 cells. Both cell lines were exposed to increasing concentrations of lindane (25, 50 and 75 microM) and bisphenol-A (25, 50 and 100 microM) over different time periods (10 min-18 h). As a result, none of these concentrations showed cytotoxicity. After short pre-incubation times (10 min-6 h), aromatase activity was enhanced by both compounds. Longer time incubation (18 h), however, produced dose-related inhibition. Lindane and BPA had no significant effects on CYP19 mRNA levels. Therefore, lindane and BPA modulate aromatase activity suggesting an interaction with the cytochrome P-450 aromatase. This study highlights the endocrine-modulating properties of lindane and bisphenol-A.