[Quantitative classification of pivot-shift maneuver]. / Clasificación cuantitativa de la maniobra de pivot-shift.

INTRODUCTION: The diagnosis of ACL injury is established with the physical examination that includes the Lachman maneuver and the pivot-shift test since it has the highest positive predictive value. Imaging tests such as MRI are still used for confirmation of the same; so the quantification of clinical maneuvers is sought. MATERIAL AND METHODS: Prospective clinical study in which the maneuvers of pivot-shift and Lachman are quantified for later classification. RESULTS: Of 36 patients, 64% found a range between 0 and 3 mm when subtracting the value of the affected knee from the value of the healthy knee. It was found that 28% of the patients recorded values of KT-1000 ranging between 4 and 6 mm of displacement. In 8% of the total patients, values of KT-1000 were found that exceeded 7 mm of displacement. The data obtained are normalized and classified into 3 degrees of injury: grade 1 with partial injury; grade 2 with complete anteromedial and partial injury in posterolateral bundle; grade 3 with complete injury of both bundles. CONCLUSION: A classification is proposed for the degrees of ACL injury with future application to a more personalized reconstruction.

INTRODUCCIÓN: El diagnóstico de lesión del ligamento cruzado anterior se establece con la exploración física que incluya la maniobra de Lachman y la prueba de pivot-shift, ya que cuenta con el mayor valor predictivo positivo. Aún se recurre a pruebas de gabinete como la RMN para la confirmación del mismo; por lo que se busca la cuantificación de maniobras clínicas. MATERIAL Y MÉTODOS: Estudio clínico prospectivo en el que se cuantifican las maniobras de pivot-Shift y Lachman para su posterior clasificación. RESULTADOS: De 36 pacientes, 64% se encontró un rango entre 0 y 3 mm al restar al valor de la rodilla sana el valor de la rodilla afectada. Se encontró que 28% de los pacientes, registraron valores de KT-1000, que oscilan entre los 4 y 6 mm de desplazamiento. En 8% del total de los pacientes se encontraron valores de KT-1000 que superaron los 7 mm de desplazamiento. Se normalizan los datos obtenidos y se clasifican en 3 grados de lesión: grado 1 con lesión parcial; grado 2 con lesión completa de haz anteromedial y parcial en haz posterolateral; grado 3 con lesión completa de ambos haces. CONCLUSIONES: Se propone una clasificación para los grados de lesión del LCA con futura aplicación a una reconstrucción más personalizada.

Towards water sensitive cities in Asia: an interdisciplinary journey.

Rapid urbanisation, population growth and the effects of climate change drive the need for sustainable urban water management (SUWM) in Asian cities. The complexity of this challenge calls for the integration of knowledge from different disciplines and collaborative approaches. This paper identifies key issues and sets the stage for interdisciplinary research on SUWM in Asia. It reports on the initial stages of a SUWM research programme being undertaken at Monash University, Australia, and proposes a framework to guide the process of interdisciplinary research in urban water management. Three key themes are identified: (1) Technology and Innovation, (2) Urban Planning and Design, and (3) Governance and Society. Within these themes 12 research projects are being undertaken across Indonesia, China, India and Bangladesh. This outward-looking, interdisciplinary approach guides our research in an effort to transgress single-discipline solutions and contribute on-ground impact to SUWM practices in Asia.

The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage.

BACKGROUND: Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. METHODS: A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re-bled, represented with further bleeding, or who died. RESULTS: A total of 174 patients were seen with UGI bleeding. Eight of them self-discharged and were excluded. Of the remaining 166, 94 had a 'low risk' bleed, and 72 'high risk'. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver-operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95-1.00). When a cut-off value of > or = 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut-off value of < or = 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. CONCLUSIONS: The GBS accurately identifies low risk patients who could be managed safely as outpatients.

Experimental evidence of intermittent convection in the edge of magnetic confinement devices.

Probe measurements in the PISCES linear device indicate the presence of plasma radially far from where it is produced. We show that this is mainly caused by large-scale structures of plasma with high radial velocity. Data from the Tore Supra tokamak show striking similarities in the shape of these intermittent events as well as the fluctuation density probability distribution and frequency spectrum. The fact that intermittent, large-scale events are so similar in linear devices and tokamaks indicates the universality of convective transport in magnetically confined plasmas.

Signature authentication by forensic document examiners.

We report on the first controlled study comparing the abilities of forensic document examiners (FDEs) and laypersons in the area of signature examination. Laypersons and professional FDEs were given the same signature-authentication/simulation-detection task. They compared six known signatures generated by the same person with six unknown signatures. No a priori knowledge of the distribution of genuine and nongenuine signatures in the unknown signature set was available to test-takers. Three different monetary incentive schemes were implemented to motivate the laypersons. We provide two major findings: (i) the data provided by FDEs and by laypersons in our tests were significantly different (namely, the hypothesis that there is no difference between the assessments provided by FDEs and laypersons about genuineness and nongenuineness of signatures was rejected); and (ii) the error rates exhibited by the FDEs were much smaller than those of the laypersons. In addition, we found no statistically significant differences between the data sets obtained from laypersons who received different monetary incentives. The most pronounced differences in error rates appeared when nongenuine signatures were declared authentic (Type I error) and when authentic signatures were declared nongenuine (Type II error). Type I error was made by FDEs in 0.49% of the cases, but laypersons made it in 6.47% of the cases. Type II error was made by FDEs in 7.05% of the cases, but laypersons made it in 26.1% of the cases.

Dichotic listening in college students who report auditory hallucinations.

College students were placed in 2 groups, hallucinators and nonhallucinators, on the basis of their responses to a verbal hallucinations questionnaire. Both groups were given a consonant-vowel version of a Dichotic Listening Test under 3 conditions: nonforced, forced-right, and forced-left. When hallucinators were instructed to attend to the left ear stimuli (forced-left condition), they had fewer correct responses to right ear syllables than did nonhallucinators. This resulted in a left ear advantage for hallucinators. When nonhallucinators were instructed to attend to the left ear, they maintained a right ear advantage. Results suggest that auditory hallucinations in college students are associated with differences in hemispheric functioning.

Toxicity of lactide in dogs after 2 and 13 weeks of daily oral dosing.

Two-week and 13-week studies were conducted to determine the toxicity of lactide when the compound is administered orally in gelatin capsules to beagle dogs. In the 2-week study, daily doses of 0, 10, 100, 400, 1000 and 2500 mg/kg body weight/day were administered to dogs of both sexes for 14 consecutive days. All dogs survived to the end of the study. Clinical signs consistent with irritation of the alimentary tract occurred in dogs in the 1000 and 2500 mg/kg dose groups. Reductions in body weight gain and in absolute and relative thymus weights were observed in the same two dose groups, and reductions in absolute and relative spleen weights were seen in the 2500 mg/kg dose group. These changes were considered to be secondary to the stress resulting from irritation of the gastrointestinal tract. Gross and microscopic lesions were indicative of irritation, and included dark foci and haemorrhage of the stomach lining, and erosion and ulceration of the stomach and the oesophagus. Also noted in all high-dose dogs was renal tubular regeneration, which may represent repair of previous necrosis of the tubular epithelium. In the 13-week study, no deaths occurred when dogs were given daily oral doses of 0, 4, 20 or 100 mg/kg body weight/day. No clinical signs of toxicity were observed, and the compound had no effect on body weights, food consumption, or any of the clinical chemistry, haematology or urinalysis parameters assessed. Gross and microscopic findings considered to be potentially related to lactide administration were minimal, and included a stomach focus in one dog of each sex in the 100 mg/kg group. The stomach focus in the 100 mg/kg female dog was manifested microscopically as a stomach ulcer. Based on these results, the primary toxic effect of lactide was considered to be irritation of the gastrointestinal tract, and the no-observed-adverse-effect level (NOAEL) after subchronic oral dosing in dogs was considered to be 100 mg/kg/day.

Reduction of calcineurin activity in brain by antisense oligonucleotides leads to persistent phosphorylation of tau protein at Thr181 and Thr231.

Phosphorylation of tau protein promotes stability of the axonal cytoskeleton; aberrant tau phosphorylation is implicated in the biogenesis of paired helical filaments (PHF) seen in Alzheimer's disease. Protein kinases and phosphatases that modulate tau phosphorylation have been identified using in vitro techniques; however, the role of these enzymes in vivo has not been determined. We used intraventricular infusions of antisense oligodeoxynucleotides (ODNs) directed against the major brain isoforms of the Ca2+/calmodulin-dependent phosphatase calcineurin to determine how reduced activity of this enzyme would affect tau dephosphorylation. Five-day infusions of antisense ODNs (5 and 10 nmol/day) in rats decreased immunoreactive levels and activity of calcineurin throughout the brain; sense ODNs, scrambled ODNs, and infusion vehicle alone had no effect. When neocortical slices were prepared from antisense ODN-treated rats and incubated for 1 to 2 h in vitro, tau protein remained phosphorylated as determined by using the phosphorylation-sensitive monoclonal antibodies AT-180 (Thr231) and AT-270 (Thr181). In contrast, AT-180 and AT-270 sites were completely dephosphorylated during incubation of neocortical slices from vehicle-infused controls and sense ODN-treated rats. Neocortical slices from antisense-treated rats were incubated with the phosphatase inhibitors okadaic acid (100 nM; 10 microM) and FK-520 (5 microM); these preparations showed enhanced tau phosphorylation, consistent with a significant loss of calcineurin activity. Thus, we conclude that phosphorylation of at least two sites on tau protein, namely, Thr181 and Thr231, is regulated by calcineurin.

Quantification of G protein mRNA using reverse transcription and competitive PCR with a colorimetric microplate assay.

This paper reports an assay for the quantification of levels of specific mRNA for the alpha subunits of the inhibitory G proteins G alpha i-1, G alpha i-2, and G alpha i-3. The assay employs reverse transcription and competitive polymerase chain reaction (PCR) coupled to enzyme-linked oligonucleotide sorbent assay for differential detection and quantification of PCR products. The assay was conducted with conventional thermal block PCR cyclers as well as rapid air microcapillary cyclers. The detection stage consists of three steps using synthetic oligonucleotides, commercially available reagents and a conventional 96-well plate absorbance reader at settings of 450 and 630 nm. The assay is: (1) rapid, requiring about 3 h for quantification of PCR products; (2) safe, being non-radiometric; (3) relatively simple; (4) highly sensitive, being capable of detecting less than 10 initial copies of target cDNA; (5) precise, resolving two-fold differences in initial copy numbers of specific sequences as low as 10(-20) mol; (6) linear over a 3 log range, with two-fold differences in the quantity of cDNA producing consistent reductions in quantity of specific cDNA detected; and (7) reproducible, intra-assay and inter-assay coefficients of variation being 11.9 and 14.7%, respectively.

On the moving-obstacle path-planning algorithm of Shih, Lee, and Gruver.

We analyze a motion planning algorithm proposed by Shih, Lee, and Gruver (1990). In particular, we discuss the case of motion planning among moving obstacles, for which an algorithm is presented by Shih, Lee, and Gruver (1990). The algorithm is claimed to always yield a collision-free path when one exists. We provide a specific counter-example to this claim, examine the possibility of repairing the algorithm, and discuss the computational complexity of a corrected algorithm.

A counterexample to the Alexopoulos-Griffin path planning algorithm.

The planar stationary-obstacle path-planning problem for polygonal obstacles has been correctly and completely solved by T. Lozano-Perez and M. Wesley (1979), i.e., a global, optimal algorithm was provided which requires O(mu(2)logmu) computation time, where mu is the number of obstacle-faces in the scene. That algorithm is known as the VGRAPH algorithm. Two variants of VGRAPH have been developed to solve the same problem in O(mu(2)) computation time. Our paper discusses a recent algorithm proposed by C. Alexopoulos and P.M. Griffin (1992), called V*GRAPH, which also claims to provide an optimal solution. We demonstrate by counter-example that V*GRAPH is neither global nor optimal.

Changes in the American health care system: crisis in the clinical laboratory.

American medicine is undergoing unprecedented changes, and the resulting distortions are affecting the economics, organization and operations of all clinical laboratories. Professionals who work in these laboratories are facing administrative and economic pressures to reduce costs, to increase productivity, and to comply with proliferating new statutes and regulations. The medical 'cottage industry' in which the patient was the focus of the medical professionals' attention and endeavours is being replaced by the corporate management of many health care activities in which financial profits are being given first priority. Medical facilities, including clinical laboratories, are being bought and sold, being consolidated, or simply being closed. The clinical laboratories may be at the vortex of the maelstrom affecting American medicine. Cost pressures are encouraging further automation and retraining of laboratory staffs. If the leaders in laboratory medicine are unable to accomplish the necessary tasks to meet the new challenges, there inevitably is a non-medical, non-scientific financial manager at hand who is willing to define the changes and the desired outcome. Because of the rapidity of the changes taking place, it is not possible to predict with any confidence the modifications that will achieve a permanent status or the degree to which medical professionals will remain masters of their fates. The evolving health care system will become less costly, more technologically advanced, and a more challenging system in which to work.

Reduction of anxiety about death: need for beliefs about immortality.

It was hypothesized that individuals who are reminded of their own mortality will experience anxiety which is reduced by an increased need for belief in immortality. A questionnaire assessing the need for literal and two forms of symbolic immortality was developed. Analysis showed that awareness of mortality increased scores on the need for literal immortality but not on either form of symbolic immortality.

The new paradigm for coronary artery disease: altering risk factors, atherosclerotic plaques, and clinical prognosis.

The old paradigm states that the greater the stenosis, the greater the risk of cardiac events. Revascularization procedures are the only effective approach to improving prognosis associated with coronary artery disease. In contrast, on the basis of the new paradigm, the nature of the plaque determines the risk of acute cardiovascular events. Dangerous plaques have a lipid-rich core with surrounding inflammation and a thin friable overlying fibrous cap, but they usually appear innocuous on angiography. Effective risk factor modification stabilizes the dangerous plaques and is associated with prompt improvement in endothelial dysfunction and a substantial decrease in the risk of acute cardiovascular events and death.

Doxazosin for the treatment of benign prostatic hyperplasia in patients with mild to moderate essential hypertension: a double-blind, placebo-controlled, dose-response multicenter study.

A total of 248 hypertensive patients 45 years old or older with benign prostatic hyperplasia (BPH) was included in this 16-week, multicenter, double-blind, placebo-controlled, parallel-group dose-response study. Doxazosin, a selective alpha 1-adrenoceptor antagonist, produced a significant increase in maximum urinary flow rate (2.3 to 3.6 ml. per second) at doses of 4 mg., 8 mg. and 12 mg., and in average flow rate (8 mg. and 12 mg.) compared with placebo. The increase in maximum flow rate was significant with doxazosin versus placebo within 1 week of initiating double-blind therapy. Doxazosin compared to placebo significantly decreased patient-assessed total, obstructive and irritative BPH symptoms. Blood pressure was significantly lower with all doxazosin doses compared with placebo. Adverse events, primarily mild to moderate in severity, were reported in 48% of patients on doxazosin and 35% on placebo. Our results strongly support the use of doxazosin as a nonoperative therapeutic alternative in the management of uncomplicated BPH. Doxazosin would also be particularly useful in the management of patients who have BPH and hypertension.

Safety assessment of polylactide (PLA) for use as a food-contact polymer.

This report constitutes a safety assessment of polylactide (PLA), a polymer of lactic acid intended for use in fabricating various food-contact articles. Migration studies were conducted on samples of the polymer following guidelines issued by the Food and Drug Administration. Potential migrants from PLA include lactic acid, lactide (the monomer), and lactoyllactic acid (the linear dimer of lactic acid). The studies were designed to model reasonable 'worst' case extraction situations when the polymer is used (a) in houseware articles for short and intermediate time periods at various temperatures and (b) in food-packaging materials. The limited migration observed during the trials represents no significant risk since migrating species are expected to convert to lactic acid, a safe food substance. It is concluded that PLA is safe and 'Generally Recognized As Safe' for its intended uses as a polymer for fabricating articles that will hold and/or package food.

Spectroscopic diagnosis of bladder cancer with elastic light scattering.

BACKGROUND AND OBJECTIVES: Recently, significant progress has been made toward the development of optical, noninvasive medical diagnostics. The goal of this study was to evaluate elastic scatter measurements as a tool for diagnosing bladder cancer. STUDY DESIGN/MATERIALS AND METHODS: In vivo measurements on 10 patients with suspected bladder cancer were made with the optical biopsy system (OBS) developed at Los Alamos National Laboratory. Elastic-scatter spectra over the wavelength range 250-800 nm were obtained using a fiber-optic probe through one of the lumens of a urological cystoscope. Measurements were made on putatively normal areas and areas of uncertain abnormality, as well as those suspected to be cancerous. After measurements were made with the OBS, biopsy samples were taken at the measurement sites. Comparisons of the histopathology and the optical spectra were then made. RESULTS AND CONCLUSIONS: A diagnostic algorithm for distinguishing malignant from nonmalignant tissue based on the values of the slopes over the wavelength range 330-370 nm has a sensitivity of 100% and specificity of 97% for the limited number of patients in this study.