A large area diamond-based beam tagging hodoscope for ion therapy monitoring

The MoniDiam project is part of the French national collaboration CLaRyS (Contrôle en Ligne de l’hAdronthérapie par RaYonnements Secondaires) for on-line monitoring of hadron therapy. It relies on the imaging of nuclear reaction products that is related to the ion range. The goal here is to provide large area beam detectors with a high detection efficiency for carbon or proton beams giving time and position measurement at 100 MHz count rates (beam tagging hodoscope). High radiation hardness and intrinsic electronic properties make diamonds reliable and very fast detectors with a good signal to noise ratio. Commercial Chemical Vapor Deposited (CVD) poly-crystalline, heteroepitaxial and monocrystalline diamonds were studied. Their applicability as a particle detector was investigated using α and β radioactive sources, 95 MeV/u carbon ion beams at GANIL and 8.5 keV X-ray photon bunches from ESRF. This facility offers the unique capability of providing a focused (~1 μm) beam in bunches of 100 ps duration, with an almost uniform energy deposition in the irradiated detector volume, therefore mimicking the interaction of single ions. A signal rise time resolution ranging from 20 to 90 ps rms and an energy resolution of 7 to 9% were measured using diamonds with aluminum disk shaped surface metallization. This enabled us to conclude that polycrystalline CVD diamond detectors are good candidates for our beam tagging hodoscope development. Recently, double-side stripped metallized diamonds were tested using the XBIC (X Rays Beam Induced Current) set-up of the ID21 beamline at ESRF which permits us to evaluate the capability of diamond to be used as position sensitive detector. The final detector will consist in a mosaic arrangement of double-side stripped diamond sensors read out by a dedicated fast-integrated electronics of several hundreds of channels.

Synchrotron Bragg diffraction imaging characterization of synthetic diamond crystals for optical and electronic power device applications

Bragg diffraction imaging techniques are described, and their capabilities for studying the quality of diamond substrates and overgrown layers, and the surface damage caused by mechanical polishing, are illustrated by examples.

Bragg diffraction imaging enables the quality of synthetic single-crystal diamond substrates and their overgrown, mostly doped, diamond layers to be characterized. This is very important for improving diamond-based devices produced for X-ray optics and power electronics applications. The usual first step for this characterization is white-beam X-ray diffraction topography, which is a simple and fast method to identify the extended defects (dislocations, growth sectors, boundaries, stacking faults, overall curvature etc.) within the crystal. This allows easy and quick comparison of the crystal quality of diamond plates available from various commercial suppliers. When needed, rocking curve imaging (RCI) is also employed, which is the quantitative counterpart of monochromatic Bragg diffraction imaging. RCI enables the local determination of both the effective misorientation, which results from lattice parameter variation and the local lattice tilt, and the local Bragg position. Maps derived from these parameters are used to measure the magnitude of the distortions associated with polishing damage and the depth of this damage within the volume of the crystal. For overgrown layers, these maps also reveal the distortion induced by the incorporation of impurities such as boron, or the lattice parameter variations associated with the presence of growth-incorporated nitrogen. These techniques are described, and their capabilities for studying the quality of diamond substrates and overgrown layers, and the surface damage caused by mechanical polishing, are illustrated by examples.

Integrating active tuberculosis case finding in antenatal services in Zambia

SETTING

Three out-patient antenatal care (ANC) clinics in Lusaka, Zambia.

OBJECTIVE

To estimate tuberculosis (TB) prevalence in human immunodeficiency virus (HIV) infected and symptomatic, non-HIV-infected pregnant women and explore the feasibility of routine TB screening in ANC settings.

DESIGN

Peer educators administered TB symptom questionnaires to pregnant women attending their first ANC clinic visit. Presumptive TB patients were defined as all HIV-infected women and symptomatic non-HIV-infected women. Sputum samples were tested using smear microscopy and culture to estimate TB prevalence.

RESULTS

All 5033 (100%) women invited to participate in the study agreed, and 17% reported one or more TB symptoms. Among 1152 presumed TB patients, 17 (1.5%) had previously undiagnosed culture-confirmed TB; 2 (12%) were smear-positive. Stratified by HIV status, TB prevalence was 10/664 (1.5%, 95%CI 0. 7-2.8) among HIV-infected women and 7/488 (1.4%, 95%CI 0.6-2.9) among symptomatic non-HIV-infected women. In HIV-infected women, the only symptom significantly associated with TB was productive cough; symptom screening was only 50% sensitive.

CONCLUSION

There is a sizable burden of TB in pregnant women in Zambia, which may lead to adverse maternal and infant outcomes. TB screening in ANC settings in Zambia is acceptable and feasible. More sensitive diagnostics are needed.

Using problem solving therapy to treat veterans with subsyndromal depression: a pilot study

OBJECTIVE

We conducted a pilot study comparing problem solving therapy for primary care (PST-PC) to a dietary education control condition in middle-aged and older veterans with symptoms of emotional distress and subsyndromal depression.

METHODS

This was a two-site study at the VA Pittsburgh Healthcare System and Philadelphia VA Medical Center. Participants included veterans >50 years of age referred from primary care clinics who were eligible if they obtained a pre-screen score >11 on the Centers for Epidemiologic Studies Depression (CES-D) scale. Exclusions were a DSM-IV Major Depressive Episode within the past year, active substance abuse/dependence within 1 month, current antidepressant therapy, and a Mini mental status exam score <24. Participants were randomized to receive one of two interventions--either PST-PC or an attention control condition consisting of dietary education (DIET)--each consisting of six to eight sessions within a 4-month period.

RESULTS

Of 45 individuals randomized, 23 (11 PST-PC and 12 DIET) completed treatment. Using regression models in completers that examined outcomes at end of treatment while controlling for baseline scores, there were significant differences between treatment groups in SF-36 mental health component scores but not in depressive symptoms (as assessed with either the 17-item Hamilton Rating Scale for Depression or the Beck Depression Inventory), social problem solving skills, or physical health status (SF-36 physical health component score).

CONCLUSIONS

These pilot study findings suggest that a six-to-eight session version of PST-PC may lead to improvements in mental health functioning in primary care veterans with subsyndromal depressive symptoms.

'Trochars no more': Teaching chest drain insertion to remote and rural practitioners using a mobile skills unit

BACKGROUND

There are a number of approaches to teaching high-risk clinical skills, such as a large bore chest drain insertion, although effectiveness is limited and realism is only achieved at great expense. Summary of work: In response to a training needs' analysis of practitioners in remote and rural areas in Scotland, training in chest drains was identified as an urgent priority need. Subsequently, the Clinical Skills Managed Educational Network (CSMEN) developed an evidence-based multi-professional clinical skills pack. This e-learning resource encompasses all aspects of chest drain management, both pre and in-hospital. The pack and an interactive workshop is used to deliver 'blended' chest drain training on a mobile clinical skills unit. Evaluation confirms that the chest drain training is a valuable resource and has been widely used to deliver skills training in remote and rural areas. Feedback from all professional groups is positive.

CONCLUSIONS

Developing shared national resources, with standardised workshops taught in local contexts via a mobile skills unit is one approach to the challenges associated with delivering high-risk clinical skills education.

Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa

OBJECTIVE

To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings.

DESIGN

Nationally representative survey of clinicians.

SETTING

HIV-prevalent settings in South Africa and Zimbabwe.

POPULATION

Clinicians in South Africa and Zimbabwe.

METHODS

Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs.

MAIN OUTCOME MEASURE

Multivariable logistic regression of contraceptive provision and clinician training needs.

RESULTS

Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians' perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training.

CONCLUSIONS

Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.

Post-traumatic stress disorder symptoms in emotionally distressed individuals referred for a depression prevention intervention: relationship to problem-solving skills

OBJECTIVES

This study examined the rates of syndromal and subthreshold post-traumatic stress disorder (PTSD) and PTSD symptom scores in participants with symptoms of emotional distress, subsyndromal depression, and a history of traumatic exposure. Participants had been referred to a study of an indicated depression prevention intervention using problem-solving therapy in primary care. We hypothesized that higher severity of PTSD symptom scores would predict poorer problem-solving skills. In addition, some reports have suggested that there are higher rates of PTSD in minority populations relative to Caucasians; thus we hypothesized that race would also predict problem-solving skills in these individuals.

METHODS

We examined the rates of traumatic exposure, syndromal, and subthreshold PTSD. In those exposed to trauma, we performed a multiple linear regression to examine the effects of PTSD symptoms, depression symptoms, race, age, and gender on social problem-solving skills.

RESULTS

Of the 244 participants, 64 (26.2%) reported a traumatic event; 6/234 (2.6%) had syndromal PTSD, and 14/234 (6.0%) had subthreshold PTSD. By way of regression analysis, higher PTSD symptom scores predicted poorer problem-solving skills. In addition, racial status (Caucasian vs. African American) predicted problem-solving skills; Caucasians exhibited lower levels of problem-solving skills.

CONCLUSIONS

Individuals presenting with subsyndromal depressive symptoms may also have a history of traumatic exposure, subthreshold and syndromal PTSD. Thus, screening these individuals for PTSD symptoms is important and may inform clinical management decisions because problem-solving skills are lower in those with more severe PTSD symptoms (even after adjusting for race, age, gender, and depressive symptoms).

Macrophage migration inhibitory factor and DJ-1 in gastric cancer: differences between high-incidence and low-incidence areas

BACKGROUND

There is a need for sensitive and specific blood-borne markers for the detection of gastric cancer. Raised serum macrophage inhibitory factor (MIF) levels have been proposed as a marker for gastric cancer diagnosis but, to date, studies have only encompassed patients from high-incidence areas.

METHODS

We have compared the serum concentration of MIF in a large cohort of UK and Japanese gastric cancer patients, together with appropriate control subjects (age and gender matched). Carcinoembryonic antigen and H. pylori IgG were also measured, as was DJ-1, a novel candidate protein biomarker identified by analysis of gastric cancer cell line secretomes.

RESULTS

Marked elevations of the serum concentration of MIF and DJ-1 were seen in Japanese patients with gastric cancer compared with Japanese controls, a trend not seen in the UK cohort. These results could not be accounted for by differences in age, disease stage or H. pylori status.

CONCLUSION

In regions of high, but not low incidence of gastric cancer, both MIF and DJ-1 have elevated serum concentrations in gastric cancer patients, compared with controls. This suggests that differing mechanisms of disease pathogenesis may be at play in high- and low-incidence regions.

First robotic tracheal intubations in humans using the Kepler intubation system

BACKGROUND

Intubation is one of the most important anaesthetic skills. We developed a robotic intubation system (Kepler intubation system, KIS) for oral tracheal intubation.

METHODS

In this pilot study, 12 patients were enrolled after approval of the local Ethics board and written informed consent. The KIS consists of four main components: a ThrustMaster T.Flight Hotas X joystick (Guillemot Inc., New York, NY, USA), a JACO robotic arm (Kinova Rehab, Montreal, QC, Canada), a Pentax AWS video laryngoscope (Ambu A/S, Ballerup, Denmark), and a software control system. The joystick allows simulation of the wrist or arm movements of a human operator. The success rate of intubation and intubation times were measured.

RESULTS

Eleven men and one woman aged 66 yr were included in this study. Intubation was successful in all but one patient using KIS at a total time of [median (inter-quartile range; range)] 93 (87, 109; 76, 153) s; in one patient, fogging of the video laryngoscope prevented intubation using KIS.

CONCLUSIONS

We present the first human testing of a robotic intubation system for oral tracheal intubation. The success rate was high at 91%. Future studies are needed to assess the performance and safety of such a system.

Traditional herbal remedies that influence cell adhesion molecule activity

Many traditional medicines have demonstrated immune activity, however, research has largely neglected their effects on cell adhesion molecules (CAMs). This review reports on extracts from 37 medicinal plant species, similar to or replicating traditional preparations, that up- or downregulate either gene or protein activity of CAMs. The majority of the investigations were in vitro, primarily of the immunoglobulin superfamily of CAMs, specifically intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and secondarily on the integrin (CD11b or MAC-1) and selectin (E-selectin and P-selectin) families of CAMs. The following plant species have demonstrated modulation of multiple CAMs: Artemisia asiatica, Boswellia serrata, Canscora decussata, Cinnamomum povectum, Dehaasia incrassate, Ganoderma lucidum, Ginkgo biloba, Hypericum perforatum, Juglans regia, Lycopus lucidus, Panax notoginseng, Rheum undulatum, Salvia miltiorrhiza. Many other species have documented activity on one CAM. Currently there are limited in vivo/ex vivo investigations, including a clinical trial on Mahonia aquifolium. Although further evidence is needed, the data suggest that the reviewed botanical medicines may have the potential to provide therapeutic potential in disease processes involving CAMs. Additionally, the reported success of many of these plant extracts by traditional cultures and modern phytotherapists may involve the modulation of CAMs.

Diamond X-ray beam-position monitoring using signal readout at the synchrotron radiofrequency

Single-crystal diamond is a material with great potential for the fabrication of X-ray photon beam-position monitors with submicrometre spatial resolution. Low X-ray absorption combined with radiation hardness and excellent thermal-mechanical properties make possible beam-transmissive diamond devices for monitoring synchrotron and free-electron laser X-ray beams. Tests were made using a white bending-magnet synchrotron X-ray beam at DESY to investigate the performance of a position-sensitive diamond device using radiofrequency readout electronics. The device uniformity and position response were measured in a 25 microm collimated X-ray beam with an I-Tech Libera ;Brilliance' system. This readout system was designed for position measurement and feedback control of the electron beam in the synchrotron storage ring, but, as shown here, it can also be used for accurate position readout of a quadrant-electrode single-crystal diamond sensor. The centre-of-gravity position of the F4 X-ray beam at the DORIS III synchrotron was measured with the diamond signal output digitally sampled at a rate of 130 Msample s(-1) by the Brilliance system. Narrow-band filtering and digital averaging of the position signals resulted in a measured position noise below 50 nm (r.m.s.) for a 10 Hz bandwidth.

Wavelength-dispersive spectrometer for X-ray microfluorescence analysis at the X-ray Microscopy beamline ID21 (ESRF)

The development of a wavelength-dispersive spectrometer for microfluorescence analysis at the X-ray Microscopy ID21 beamline of the European Synchrotron Radiation Facility (ESRF) is reported. The spectrometer is based on a polycapillary optic for X-ray fluorescence collection and is operated in a flat-crystal geometry. The design considerations as well as operation characteristics of the spectrometer are presented. The achieved performances, in particular the energy resolution, are compared with the results of Monte Carlo simulations. Further improvement in the energy resolution, down to approximately eV range, by employing a double-crystal geometry is examined. Finally, examples of applications requiring both spatial and spectral resolutions are presented.

Social domain dysfunction and disorganization in borderline personality disorder

BACKGROUND

Social dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD.

METHOD

Patients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of 'domain disorganization' (DD).

RESULTS

Pervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count.

CONCLUSIONS

A focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.

Neutron production from feedback controlled thermal cycling of a pyroelectric crystal

The LLNL Crystal Driven Neutron Source is operational and has produced record ion currents of approximately 10 nA and neutron output of 1.9(+/-0.3)x10(5) per thermal cycle using a crystal heating rate of 0.2 degrees C/s from 10 to 110 degrees C. A 3 cm diameter by 1 cm thick LiTaO(3) crystal with a socket secured field emitter tip is thermally cycled with feedback control for ionization and acceleration of deuterons onto a deuterated target to produce D-D fusion neutrons. The entire crystal and temperature system is mounted on a bellows which allows movement of the crystal along the beam axis and is completely contained on a single small vacuum flange. The modular crystal assembly permitted experimental flexibility. Operationally, flashover breakdowns along the side of the crystal and poor emitter tip characteristics can limit the neutron source. The experimental neutron results extend earlier published work by increasing the ion current and pulse length significantly to achieve a factor-of-two higher neutron output per thermal cycle. These findings are reviewed along with details of the instrument.

Active-edge planar radiation sensors

Many systems in medicine, biology, high-energy physics, and astrophysics require large area radiation sensors. In most of these applications, minimizing the amount of dead area or dead material is crucial. We have developed a new type of silicon radiation sensor in which the device is active to within a few microns of the mechanical edge. Their perimeter is made by a plasma etcher rather than a diamond saw. Their edges can be defined and also passivated by growing, in an intermediate step, a field oxide on the side surfaces. In this paper, the basic architecture and results from a synchrotron beam test are presented.

Active-edge planar radiation sensors

Many systems in medicine, biology, high-energy physics, and astrophysics require large area radiation sensors. In most of these applications, minimizing the amount of dead area or dead material is crucial. We have developed a new type of silicon radiation sensor in which the device is active to within a few microns of the mechanical edge. Their perimeter is made by a plasma etcher rather than a diamond saw. Their edges can be defined and also passivated by growing, in an intermediate step, a field oxide on the side surfaces. In this paper, the basic architecture and results from a synchrotron beam test are presented.

Active-edge planar radiation sensors

Many systems in medicine, biology, high-energy physics, and astrophysics require large area radiation sensors. In most of these applications, minimizing the amount of dead area or dead material is crucial. We have developed a new type of silicon radiation sensor in which the device is active to within a few microns of the mechanical edge. Their perimeter is made by a plasma etcher rather than a diamond saw. Their edges can be defined and also passivated by growing, in an intermediate step, a field oxide on the side surfaces. In this paper, the basic architecture and results from a synchrotron beam test are presented.

Electron-beam tomography coronary calcium scores are superior to Framingham risk variables for predicting the measured proximal stenosis burden

Previous studies of electron-beam tomography (EBT) have correlated coronary calcium scores with simplistic visual estimates of disease severity. In a clinical trial designed to evaluate 2 treatment strategies in coronary artery disease (CAD) patients with low levels of high-density lipoprotein cholesterol, we used quantitative coronary angiography to measure composite proximal stenosis burden from the baseline coronary angiogram and assessed the traditional Framingham risk variables in 146 patients. Stenosis burden is the sum, per patient, of percent stenosis for the worst lesion found in each of 9 standard proximal coronary segments. EBT estimates of coronary calcium (Agatston score, calcium volume score) were obtained for 115 of these patients. Stenosis burden was correlated with the calcium scores and risk variables. The best traditional correlates of stenosis burden were smoking status (r = 0.31, p = 0.001), prior myocardial infarction (r = 0.24, p = 0.005), body mass index (r = 0.23, p = 0.005), pack-years smoking (r = 0.20, p = 0.05), and age (r = 0.17, p = 0.04). With adjustment for age, all these correlations improved (eg, body mass index x age [r = 0.28, p = 0.001]). In addition, total cholesterol x age (r = 0.22, p = 0.008), fibrinogen x age (r = 0.19, p = 0.03), and systolic blood pressure x age (r = 0.18, p = 0.03) became significant correlates. Spearman correlations of the calcium scores with stenosis burden were considerably greater (Agatston: r = 0.62, p <0.0001; calcium volume: r = 0.63, p <0.0001). In multivariate regression analysis, calcium score, body mass index, and history of myocardial infarction were independent correlates of stenosis burden (R(2) = 0.45). At a given point in time, the EBT coronary calcium scores are greatly superior to the Framingham risk factors in predicting the measured proximal stenosis burden. Agatston and calcium volume scores are comparably predictive of stenosis burden.

Use of archival tissue in epidemiologic studies: collection procedures and assessment of potential sources of bias

Collection and analyses of archival tumor tissue as a means to increase our understanding of disease pathways is becoming an important avenue of epidemiologic research. In this paper, we present methods of collection and processing of archival tissue and assess the population characteristics of those for whom we were able to and unable to obtain tumor DNA. Cases of colon cancer diagnosed between September, 1991 and October, 1994 living in Utah, Northern California, or the Twin Cities Metropolitan area of Minnesota were targeted for this study. Of the 2477 people for whom we had permission to obtain tumor blocks, we were able to collect blocks and extract DNA for 2117 (85.5%). There were no differences in age, tumor site, or diet and lifestyle characteristics between those with and without DNA extracted. However, we were less likely to be able to extract DNA if the case was diagnosed at a more advanced disease stage or at the earliest disease. Potential bias from exclusion of those with the most advanced disease stage is discussed.

Doctors, nurses, and parents are equally poor at estimating pediatric weights

OBJECTIVE

To evaluate the relative accuracy of physicians, nurses, and parents in estimating the weight of children presenting to the emergency department.

METHODS

One hundred pediatric patients between the ages of 0 and 8 years presenting to an urban teaching emergency department (40,000 patients per year) were enrolled over a 1-month period (September 1996). The parents, triage nurse, and examining physician were asked to estimate the patient's weight, each blinded to the others' estimates and the child's actual weight.

RESULTS

Parents, nurses, and physicians all slightly underestimated patient weights (P < 0 .05), but these groups did not differ among themselves (P > 0 .05). The total range of estimates was broad in each group (parents +292% to -41%, nurses +30% to -36%, and physicians +43% to -56%). There was no significant relationship between estimates with regard to age, weight, or sex. Twenty-nine percent of physicians' estimates, 40% of nurses' estimates, and 16% of parents' estimates differed from the actual weight by more than 15%.

CONCLUSION

Emergency department pediatric weight estimates by parents, nurses, and physicians are significantly and similarly unreliable.

Antianginal response to once-daily diltiazem CD in patients receiving concomitant beta-blockers, long-acting nitrates, or both. Diltiazem CD Study Group

STUDY OBJECTIVE

To determine the safety and efficacy of diltiazem CD 180 mg administered once/day in patients with chronic stable angina inadequately controlled with P-blockers, long-acting nitrates, or both.

DESIGN

Multicenter, randomized, double-blind, placebo-controlled, parallel-group trial.

SETTING

Medical clinics in the private and academic sectors.

PATIENTS

Of 172 patients, 170 completed the 2-week double-blind treatment period.

INTERVENTION

. Patients received either diltiazem CD 180 mg or placebo once/day in combination with existing antianginal therapy.

MEASUREMENTS AND MAIN RESULTS

The time to termination of exercise tolerance testing, 24 hours after the dose increased significantly in the diltiazem CD group (37.2 sec) compared with the placebo group (21.3 sec, p=0.0438). Time to onset of angina during exercise testing also increased (57.6 vs 35.0 sec, respectively, p=0.0324), as did time to moderate angina (37.5 vs 20.6 sec, respectively, p=0.0354). The rates of total angina attacks and of angina attacks on exertion were significantly reduced in the diltiazem CD group versus placebo (p<0.05). Significant reductions in systolic and diastolic blood pressures and heart rate-blood pressure product measured at rest, submaximum exercise, and exercise termination were observed in diltiazem CD-treated patients compared with placebo (p<0.05). The frequency of treatment-related adverse events was identical in the two groups, 15.1%.

CONCLUSION

Diltiazem CD 180 mg once/day is an effective, safe, and beneficial initial dosage when added to existing antianginal therapy.

Wide dynamic range germanium detector for perturbation crystallography

An IR detector based on a cooled germanium photodetector has been tested for applications in X-ray diffraction. The detector can be used simultaneously in photon-counting mode and current mode giving a dynamic range from < 1 to 10(9) photons s(-1). Since germanium is used as the photodetector, its efficiency at energies above 25 keV is much better than the silicon equivalents. The detector proved to be highly linear both in the low-flux region (< 10(5) photons s(-1)) where photon counting is used and in the high-flux region (> 10(5) photons s(-1)) where the detector is run in current mode. The response time of the detector is of the order of 1 mus, making it suitable for studies in perturbation crystallography, especially when coupled to a lock-in amplifier. As an example, the shift of a reflection of LiNbO(3) induced by an external electric field was determined with the germanium detector and lock-in amplifier.

Injury-induced regulation of ciliary neurotrophic factor mRNA in the adult rat brain

Ciliary neurotrophic factor (CNTF) is a pleiotropic molecule that acts as a neurotrophic factor for a wide range of embryonic neurons as well as a differentiation factor for sympathetic neuroblasts and O2A progenitor cells in culture. CNTF messenger RNA (mRNA) is present at very low levels in the normal adult rat central nervous system (CNS), but is dramatically up-regulated after an aspiration lesion of dorsal hippocampus and overlying cortex, in the area coincident with glial scar. The increased level of CNTF mRNA in lesioned hippocampus is maximal by 3 days and is sustained for up to 20 days, the longest time point examined. In contrast, mRNA levels for brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) were slightly decreased during the same period. In situ hybridization experiments revealed that cells expressing CNTF mRNA were concentrated at the margin of the wound, and also present within the gelfoam which filled the lesion cavity. This distribution of CNTF-expressing cells corresponded very closely to that of cells expressing high levels of glial fibrillary acidic protein mRNA at the wound site. Paralleling the observed increase in CNTF mRNA, increased levels of CNTF-like neurotrophic activity were apparent in soluble extracts of the lesioned tissues. This neurotrophic activity for ciliary ganglion neurons was completely blocked by the addition of neutralizing antiserum against CNTF. Basic fibroblast growth factor, which has been shown by others to increase after a similar lesion paradigm (Frautschy et al., Brain Res., 553, 291-299, 1991), does not contribute appreciably to this trophic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

A cross-over comparison of acrivastine, pseudoephedrine and their combination in seasonal allergic rhinitis

In a four period, double-blind cross-over study, forty patients with moderate to severe symptoms of seasonal allergic rhinitis received in randomised order 8 mg acrivastine, 60 mg pseudoephedrine, 8 mg acrivastine plus 60 mg pseudoephedrine and placebo. Each treatment was given three times daily for six days with a one day washout period between treatments. Acrivastine alone significantly reduced all the symptom severity scores when compared to placebo or pseudoephedrine alone (p less than 0.01). These severity scores were assigned daily by patients for itchy nose/throat, sneezing, running nose, blocked nose, watery eyes, itchy eyes and overall symptoms. The combination of acrivastine and pseudoephedrine was significantly better than either placebo or pseudoephedrine alone in controlling all symptom scores (p less than 0.01) and it was also superior to acrivastine alone (p less than 0.05) in controlling all symptoms except itchy eyes. The results confirm the expected additive rather than synergistic effect of acrivastine and pseudoephedrine in combination. The control of symptoms assessed at the end of each treatment period was considered either excellent or good by 79% of patients and 84% of investigators for acrivastine plus pseudoephedrine and, for acrivastine alone, by 69% of patients and 67% of investigators. Both acrivastine alone and acrivastine and pseudoephedrine in combination were well tolerated. There was no significant difference in the number of adverse experiences reported in either of these two groups compared to the number of adverse experiences reported in the placebo group.

Paradoxical priorities in breastfeeding research: challenges for new directions

In recent years there has been a greater amount of research on infant feeding by medical and nutritional scientists than by behavioural and social scientists. The consequences of this imbalance of research focus is an extensive amount of information about breast milk with a lack of knowledge about breastfeeding. If we wish to increase the rate and duration of breastfeeding, greater attention needs to be paid to the art of nursing by resetting research priorities to take account of the mother's perspective.

Oxygen tension measurements using an oxygen polarographic electrode sealed in an implantable silastic tonometer: a new technique

Our new method is comparable to the standard, "open-end" tonometer system and incorporates all its abilities to monitor oxygen tension and perfusion. The new device has the advantage of being completely sealed, providing a true, continuous direct measurement over several days, with freedom of movement for the patient without operator attention and with improved stability of the electrode, which minimizes the drift artifacts previously encountered. These improvements will facilitate routine clinical monitoring of tissue oxygen tension.

Nifedipine therapy for diffuse esophageal spasm

Although nifedipine therapy resulted in substantial relief of dysphagia in six patients with diffuse esophageal spasm, significant side effects, particularly in young working subjects, precluded prolonged use.

Left ventricular fistula as a cause of intractable angina pectoris. Successful surgical repair

Two patients had intractable angina pectoris due to left-coronary-artery to left-ventricle fistulas. Surgical repair resulted in complete relief of symptoms. Postoperative cardiac catheterization showed obliteration of the fistulas, with preservation of ventricular function. Operative therapy is indicated in this disorder.