Comportamiento clínico de la variante oncocítica del cáncer papilar de tiroides: comparación de su evolución frente al cáncer papilar, variantes clásica y de células altas / Clinical behaviour of papillary thyroid cancer oncocytic variant: Stage-matched comparison versus classical and tall cell variant papillary thyroid cancer

Objetivo El cáncer papilar de tiroides (CPT) tiene diferentes variantes y la mayoría de ellas presentan diferencias sutiles. La variante oncocítica (VO) es un subtipo poco frecuente de CPT, sobre el pronóstico de la cual existen resultados controvertidos en la literatura. Investigamos su agresividad y curso clínico comparándolos con la variante clásica (VC) y la variante de células altas (CA) de CPT en diferentes estadios. Material y métodos En este estudio de cohortes retrospectivo se incluyeron: 100 muestras simples de VO, 71 de CA y 1.219 de VC. Las muestras VO se compararon con las VC y las de CA sobre la base de parámetros de pronóstico independientes. La recurrencia de la VO también se comparó estadio por estadio con la VC y CA. Resultados La edad media fue de 46,8 años y la relación hombres/mujeres de 25/75 para la VO. Las tasas de recurrencia en nuestro estudio fueron del 16% en VO; del 13,5% en VC y del 56% en CA. Existe una diferencia estadísticamente significativa con respecto a la recurrencia entre el estadio 1 y el estadio 4 comparando la VO y la VC (p=0,023; p=0,03, respectivamente). También hay una diferencia estadísticamente significativa con respecto a la recurrencia entre el estadio 1 y el estadio 4 comparando la VO y la CA (p=0,001; p=0,024, respectivamente). Se puede suponer que la VO tiene un comportamiento entre la VC y la CA, pero muy cercana a la CA. Conclusión La VO parece ser un poco más agresiva que la VC. A pesar de un tamaño de muestra inadecuado para los estadios 2 y 3, nuestros hallazgos implican un mayor riesgo de recurrencia para la VO que para la VC en los estadios avanzados (estadios 3 y 4) y la VC tiene un pronóstico más desfavorable que VO en estadios precoces (estadios 1 y 2), según el modelo de estadio pareado (AU)

Objective Papillary thyroid cancer (PTC) has many variants and most of them are mild tumors. Oncocytic variant (OV) is a rare subtype of PTC. There are controversial results about its prognosis in the literature. We investigated its aggressivity and clinical course by comparing it with classical variant (CV) and tall cell variant (TV) of PTC over a stage-matched design. Material and methods Pure 100 OV, 71 TV and 1,219 CV were included in this retrospective cohort study. OV was compared with CV and TV according to independent prognostic parameters. OV was also compared stage by stage with CV and TV for recurrence. Results Mean age was 46,8 years and male/female ratio 25/75 for OV. The recurrence rates in our study were 16% in OV, 13,5% in CV and 56% in TV. There is a statistically significant difference according to recurrence between stage 1 and stage 4 OV and CV (P = 0.023, P = 0.03, respectively). There is also a statistically significant difference between stage 1 and stage 4 OV and TV according to recurrence (P = 0.001, P = 0.024, respectively). OV can be supposed to behave between CV and TV, but very closer to CV. Conclusions OV seems to be slightly more aggressive than CV. Despite an inadequate sample size for stage 2 and 3, our findings imply an increased recurrence risk for OV than CV at the advanced stages (stage 3 and 4) and CV has an unfavorable prognosis than OV at early stages (stage 1 and 2) according to stage-matched model (AU)

Comparison of Albumin and Fresh Frozen Plasma as Colloid Therapy in Patients With Major Burns.

BACKGROUND: Burn injuries are one of the main causes of morbidity and mortality throughout the world, and burn patients have higher chances of recovery if they are treated with effective fluid and colloid management. Fresh frozen plasma (FFP) and albumin suspension used as a colloid treatment agent are very useful for the treatment of severe burns. METHODS: This retrospective clinical trial was conducted at the Numune Education and Research Hospital Burn Center, Ankara, Turkey. Two hundred and nine patients who had severe burns that involved more than 30% of their total body surface area (TBSA) were studied. After the first 24 hours, 13 patients were deceased, leaving 196 patients remaining in the study, including 139 patients in the fresh frozen plasma group and 57 patients in the albumin group. Both the fresh frozen plasma and albumin groups received the standard therapy of the burn center, which was based on a standard protocol. Then, these patients were compared according to their clinical findings and mortality. RESULTS: There were no significant differences between the groups with respect to age, gender, and comorbidities. The laboratory findings, blood, urine, and wound culture results were also similar between groups. The mortality rate was higher in the group receiving albumin than in the group receiving fresh frozen plasma (78.9% and 33.8%, respectively; p=0.0007). CONCLUSIONS: According to this study, there was a significant relationship between the improvement in mortality and the mode of colloid treatment in patients with major burns.

Clinical behaviour of papillary thyroid cancer oncocytic variant: stage-matched comparison versus classical and tall cell variant papillary thyroid cancer.

OBJECTIVE: Papillary thyroid cancer (PTC) has many variants and most of them are mild tumors. Oncocytic variant (OV) is a rare subtype of PTC. There are controversial results about its prognosis in the literature. We investigated its aggressivity and clinical course by comparing it with classical variant (CV) and tall cell variant (TV) of PTC over a stage-matched design. MATERIAL AND METHODS: Pure 100 OV, 71TV and 1219 CV were included in this retrospective cohort study. OV was compared with CV and TV according to independent prognostic parameters. OV was also compared stage by stage with CV and TV for recurrence. RESULTS: Mean age was 46,8 years and male/female ratio 25/75 for OV. The recurrence rates in our study were 16% in OV, 13,5% in CV and 56% in TV. There is a statistically significant difference according to recurrence between stage I and stage IV OV and CV (p=0.023, p=0.03, respectively). There is also a statistically significant difference between stage I and stage IV OV and TV according to recurrence (p=0.001, p=0.024, respectively). OV can be supposed to behave between CV and TV, but very closer to CV. CONCLUSIONS: OV seems to be slightly more aggressive than CV. Despite an inadequate sample size for stage II and III, our findings imply an increased recurrence risk for OV than CV at the advanced stages (stage III and IV) and CV has an unfavorable prognosis than OV at early stages (stage I and II) according to stage-matched model.

Comparison of standard prophylactic and preemptive therapeutic low molecular weight heparin treatments in hospitalized patients with COVID-19.

NTRODUCTION: Anticoagulant treatment approach in patients with COVID-19 is not well studied and not standardized. We aimed to compare the effects of standard prophylactic and pre-emptive therapeutic Low-Molecular-weight Heparin (LMWH) treatment approaches on mortality in patients with COVID-19. PATIENTS AND METHODS: This retrospective and single-centre study includes patients aged ≥ 18 years, who were diagnosed with COVID-19 and treated with LMWH during the hospital stay. Therapeutic dose of LMWH was defined as 1 mg/kg subcutaneously twice daily and prophylactic dose of LMWH was defined as 40 mg subcutaneously once daily. RESULTS: Among the 336 patients diagnosed with COVID-19 pneumonia, 115 patients, who received LMWH were included in the study. The mean age was 58.6 ± 13.3 and 58 (50.4 %) of the patients were male. Sixty-nine (60 %) of the patients were treated with prophylactic and 46 (40 %) therapeutic LMWH.In-hospital mortality was not different between patients treated therapeutic LMWH and prophylactic LMWH by the multivariate regression analysis (OR=2.187, 95% CI 0.484-9.880, p=0.309) and the propensity score modelling (OR=1.586, 95% CI 0.400-6.289, p=0.512.)CONCLUSION: Clinicians should consider the potential risks and benefits of standard prophylactic and pre-emptive therapeutic LMWH. Therefore, anticoagulant therapy should be individualized in patients with COVID-19 (Tab. 3, Ref. 28).

Synchronous thyroid cancer on the edge: Incidentalomas of 18F-FDG PET/CT in clinical practice.

AIMS: The objective of this study was to discuss the outcomes of the oncology patients whose PET/CT scans show incidental focal thyroid 18F-FDG uptake. METHODS: This retrospective analysis examined 2575 18F-FDG PET/CT scans from 1803 patients with no known thyroid cancer history. The survival rates were analyzed for patients with and without cytopathological evaluation. RESULTS: Increased metabolic activity of the thyroid was detected in 96 patients. Of those, 72 were diagnosed with a focal uptake of 18F-FDG and 24 subjects had a diffuse uptake. All 72 patients with a focal uptake were referred for ultrasound (US) and fine-needle aspiration cytology (FNAC). Of those patients, 44 were admitted for US and 16 underwent FNAC. The mean SUVmax was 16.0 ± 7.97 for patients with malignant lesions and 3.24 ± 0.88 for patients with benign lesions (p = 0.023). The mortality rate was higher in the patients who were not evaluated with FNAC. CONCLUSION: Patients with incidental focally increased thyroid 18F-FDG accumulation on PET/CT are known to have a high risk of malignancy. These patients require additional diagnostic procedures to distinguish the underlying pathology. However, the clinical condition of these patients will be the primary concern when performing these procedures.

Different patterns of hepatocellular carcinoma-related malign thrombosis in 18F-FDG PET/CT. / Los principales patrones de la trombosis maligna relacionada con el carcinoma hepatocelular en la 18F-FDG PET/TC.

Tumor thrombus is an intravascular malign tumor extension that may occur in various types of cancer. Hepatocellular carcinomas (HCC) are common causes of malign thrombus. The presence of a malign thrombus due to HCC has a dismal prognosis, which affects treatment choices. We present three cases of tumor thrombi due to advanced HCC detected by 18F-FDG PET/CT.

PeP-SCOT a health coaching intervention for people in prisons: the development of the intervention protocol.

There is a need for an alternative approach for health promotion prisons since previous work has indicated that health education, while improving health knowledge, does not result in behaviour change. Evidence has suggested that a health coaching assists in this regard. However, the question remained whether this approach would be appropriate and possible in prisons? This paper presents the public health strategies used to work in partnership with prison management to address challenges and accept opportunities as a health coaching intervention protocol was developed for oral health and wellbeing in the prison setting.

The role of self-efficacy in health coaching and health education for patients with type 2 diabetes.

PURPOSE: To assess the role of toothbrushing self-efficacy (TBSE) in diabetes management by comparing health education (HE) and health coaching (HC) in type 2 diabetes. METHODS: The data [HbA1c , Clinical Attachment Loss (CAL), TBSE] were collected initially and after intervention. Participants were allocated randomly to HC (n = 77) and HE (n = 109) groups. RESULTS: The low TBSE subgroup showed greater improvement in TBSE in the HC group (∆mean:23.4 ± 9.2) than the HE group (∆mean:12.4 ± 10.3), (P < 0.01). The moderate TBSE group showed significant improvements only in the HC group (P < 0.001).There was a significant reduction in HbA1c and CAL in all the TBSE subgroups in HC (P < 0.05), which was significantly higher than in the HE groups (P < 0.05). Improvements in TBSE and CAL were explanatory variables for the reduction in HbA1c among the HC patients in all the TBSE subgroups (P < 0.05). Among HE patients, improvement in CAL was an explanatory variable for change at HbA1c in the low TBSE subgroup. CONCLUSIONS: The present findings show that HC is more effective in terms of reduced HbA1c and CAL compared with HE. The data suggest that HC unlocks positive self-intrinsic motivation, anchoring the self-efficacy/competency beliefs for adjustment of healthy lifestyles. Thus, TBSE may be a practical starting point for empowerment and more effective outcomes.

First Report of Armillaria Root Rot Caused by Armillaria mellea Infecting Carrizo Citrange and Sour Orange Rootstocks in Turkey.

Citrus rootstocks, Carrizo citrange (Citrus sinensis [L.] Osb. × Poncirus trifoliata [L.] Raf.) and sour orange (C. aurantium L.) grown in containers filled with 5 liters of potting mix of 40% peat and 60% volcanic tuff declined in a 0.2-ha commercial nursery in Adana, Turkey, between 2004 and 2007. Seedlings with symptoms of root rot were found with an average disease incidence of 20% among 1,000 Carrizo citrange seedlings and 10% among 15,000 sour orange seedlings. The potting mixture preparation unit was located next to an oak tree (Quercus sp.) showing symptoms of Armillaria root rot. Six- to 12-month-old seedlings of both rootstocks were stunted and the crowns were necrotic with the presence of white mycelium. Mycelial fans were observed beneath the bark of infected roots and they expanded into the crown. The root systems and nearby potting mix contained rhizomorphs. Thus, Armillaria spp. was suspected as a possible causal agent. Three diseased crowns and three rhizomorphs were surface-sterilized with 1% NaClO for 1 min and cultured on benomyl-dichloran-streptomycin containing selective medium (3) at 25°C in the dark for 1 week. Six isolates transferred to 1.5% malt extract agar at 33°C in the dark for 7 weeks consistently yielded abundant aerial hyphae and mean diameter growth range was 4 to 21 mm and the mycelium margin was regular (1). To confirm pathogen identity, total DNA was extracted using the PowerSoil DNA Isolation Kit (MO BIO Laboratories, Inc., CA) directly from 7-day-old cultures grown in potato dextrose broth (PDB). The ribosomal DNA internal transcribed spacer (ITS) region was amplified by PCR using the primer pair ITS1 and ITS4 (5) and sequenced. The sequences were 99% identical to that of Armillaria mellea isolates from Japan (AB510880) and China (KF032535). This confirmed the identity of the causal agent as A. mellea (Vahl.) P. Kumm. Ten 3-month-old seedlings of Carrizo citrange and sour orange were transplanted into steam-sterilized potting mix and inoculated with wood pieces of oak (Quercus sp.) colonized by the fungus (two pieces for each container) (2). The oak wood pieces were sterilized prior to the colonization by the pathogen. Plants were maintained in a greenhouse (23 to 25°C) until symptoms appeared. Ten non-inoculated seedlings from each rootstock served as controls and were maintained in the same environment. After 4 months, the crowns of the seedlings developed necrotic areas and root systems contained rhizomorphs on all inoculated seedlings and fungus was re-isolated from crowns and rhizomorphs. All control plants remained disease-free and no fungus was re-isolated. A. mellea was reported to infect citrus rootstocks in Spain in 1999 (4). To our knowledge, this is the first report of Armillaria root rot caused by A. mellea infecting Carrizo citrange and sour orange rootstocks in Turkey. This indicates that citrus rootstocks could be at risk for infection and sterilization of the potting mix and good sanitation practices in nurseries are very important. References: (1) J. N. Bruhn et al. Mycopathologia 142:89, 1998. (2) F. M. Grasso et al. Plant Dis. 91:1517, 2007. (3) T. C. Harrington et al. Page 81 in: Methods for Research on Soilborne Phytopathogenic Fungi. APS Press, St. Paul, MN, 1992. (4) J. J. Tuset et al. Bol. San. Veg. Plagas 25: 491, 1999. (5) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

The effects of long term fasting in Ramadan on glucose regulation in type 2 diabetes mellitus.

INTRODUCTION: For Ramadan fasting, observing Muslims do not eat or drink between sunrise and sunset during Ramadan, Islam's holy month of the year according to the lunar calendar. In 2011, fasting patients with diabetes fasted for an average of 16.5 hours per day, having 2 meals between sunset and sunrise for a month. We aimed to evaluate the impact of extended fasting on glucose regulation and observe possible complications of extended fasting in type 2 diabetes mellitus patients. PATIENTS AND METHODS: We conducted a randomized, retrospective, observational study. Patients who presented at the Diabetes Clinic during the 15 days before and after Ramadan in August 2011 Istanbul, whose hemoglobin A1c, fasting plasma glucose, postprandial plasma glucose, weight and height value examinations and follow-up were completed were included in the study. FINDINGS: Seventy-six diabetes patients who fasted during Ramadan (fasting group) and 71 patients with diabetes who did not fast (non-fasting group) were included in the study. These two groups with similar demographic characteristics were compared before and after Ramadan. HbA1c, fasting and postprandial plasma glucose, body mass index, weight and adverse events were evaluated. No statistically significant difference was observed among the fasting and the non-fasting groups. There was no difference between the pre and post-Ramadan values of the fasting group. CONCLUSIONS: We could not find any negative effects of extended fasting on glucose regulation of patients with diabetes who are using certain medications. No serious adverse event was observed. We failed to demonstrate benefits of increasing the number of meals in patients with diabetes.

PSECMAC intelligent insulin schedule for diabetic blood glucose management under nonmeal announcement.

Therapeutically, the closed-loop blood glucose-insulin regulation paradigm via a controllable insulin pump offers a potential solution to the management of diabetes. However, the development of such a closed-loop regulatory system to date has been hampered by two main issues: 1) the limited knowledge on the complex human physiological process of glucose-insulin metabolism that prevents a precise modeling of the biological blood glucose control loop; and 2) the vast metabolic biodiversity of the diabetic population due to varying exogneous and endogenous disturbances such as food intake, exercise, stress, and hormonal factors, etc. In addition, current attempts of closed-loop glucose regulatory techniques generally require some form of prior meal announcement and this constitutes a severe limitation to the applicability of such systems. In this paper, we present a novel intelligent insulin schedule based on the pseudo self-evolving cerebellar model articulation controller (PSECMAC) associative learning memory model that emulates the healthy human insulin response to food ingestion. The proposed PSECMAC intelligent insulin schedule requires no prior meal announcement and delivers the necessary insulin dosage based only on the observed blood glucose fluctuations. Using a simulated healthy subject, the proposed PSECMAC insulin schedule is demonstrated to be able to accurately capture the complex human glucose-insulin dynamics and robustly addresses the intraperson metabolic variability. Subsequently, the PSECMAC intelligent insulin schedule is employed on a group of type-1 diabetic patients to regulate their impaired blood glucose levels. Preliminary simulation results are highly encouraging. The work reported in this paper represents a major paradigm shift in the management of diabetes where patient compliance is poor and the need for prior meal announcement under current treatment regimes poses a significant challenge to an active lifestyle.

A holistic food labelling strategy for preventing obesity and dental caries.

Obesity and dental caries in childhood are among the major public health concerns described as a global pandemic because of their global distribution and severe consequences. A consensus has developed as to a recently emerging and alarming common risk factor that leads to the double burden of dental caries and obesity; energy-dense foods (sugar-coated cereals, high-sugar yogurt, soft drinks) are becoming very popular among children because of their dense marketing, cheaper price, increased supply and variety. Implementation of health-promoting and -supporting marketing strategies for healthy food can be one initial cornerstone for successful application of the common risk factor approach in prevention of obesity and dental caries, as also suggested by World Health Organization. Labelling healthy food with a 'health-friendly' logo, illustrating that the teeth and the heart are both parts of the whole body (standing side by side supporting each other as close friends), both happy and protected because of consumption of healthy food for the whole body, can promote the foods that are friendly to health of the whole body, implementing the common risk factor approach under a single theme. Labelling healthy food as 'health-friendly' based on an international consensus will provide a clear and uniform picture of what is healthy to eat and result in an international integrated programme for prevention of obesity and caries.

Defective jejunal and colonic salt absorption and alteredNa(+)/H (+) exchanger 3 (NHE3) activity in NHE regulatory factor 1 (NHERF1) adaptor protein-deficient mice.

We investigated the role of the Na(+)/H(+) exchanger regulatory factor 1 (NHERF1) on intestinal salt and water absorption, brush border membrane (BBM) morphology, and on the NHE3 mRNA expression, protein abundance, and transport activity in the murine intestine. NHERF1-deficient mice displayed reduced jejunal fluid absorption in vivo, as well as an attenuated in vitro Na(+) absorption in isolated jejunal and colonic, but not of ileal, mucosa. However, cAMP-mediated inhibition of both parameters remained intact. Acid-activated NHE3 transport rate was reduced in surface colonocytes, while its inhibition by cAMP and cGMP was normal. Immunodetection of NHE3 revealed normal NHE3 localization in the BBM of NHERF1 null mice, but NHE3 abundance, as measured by Western blot, was significantly reduced in isolated BBM from the small and large intestines. Furthermore, the microvilli in the proximal colon, but not in the small intestine, were significantly shorter in NHERF1 null mice. Additional knockout of PDZK1 (NHERF3), another member of the NHERF family of adaptor proteins, which binds to both NHE3 and NHERF1, further reduced basal NHE3 activity and caused complete loss of cAMP-mediated NHE3 inhibition. An activator of the exchange protein activated by cAMP (EPAC) had no effect on jejunal fluid absorption in vivo, but slightly inhibited NHE3 activity in surface colonocytes in vitro. In conclusion, NHERF1 has segment-specific effects on intestinal salt absorption, NHE3 transport rates, and NHE3 membrane abundance without affecting mRNA levels. However, unlike PDZK1, NHERF1 is not required for NHE3 regulation by cyclic nucleotides.

The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy.

This study investigated whether the addition of 25 microg intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 microg fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function.

Individual and maternal determinants of self-reported dental health among Turkish school children aged 10-12 years.

OBJECTIVE: To assess the influence of maternal and individual characteristics on self-reported dental health of Turkish school children aged 10-12 years with different socio-economic backgrounds. METHOD: A cross-sectional study of children aged 10 to 12 (n = 611) using paired matches of self-administered questionnaires for children and their mothers. Clinical examinations based on World Health Organization criteria were conduced. The participation rate was 97% (n = 591) for the children, 87% (n = 533) for the mothers, and 95% (n = 584) for the clinical examinations. Multiple linear regression, descriptive statistics, Spearman correlation coefficient and chi-square test were applied. RESULTS: Private school children's mothers were more likely to have had higher education (95% at least high school) than public school children's mothers (11%); they reported better dental health (above average) than did mothers of public school children (p = 0.001). Among all mothers, those with above average self-reported dental health reported more regular dental visits than did those with below average scores (p = 0.001). Frequency of regular dental visits and toothbrushing among children attending public schools (5%, 65%) were lower than those attending private school (43%, 79%), (p = 0.001). The mean DMFS was negatively correlated with self-reported dental health (r(s) = -0.187, p = 0.001). Toothbrushing frequency and school performance were the common factors positively associated with self-reported dental health, among all children. CONCLUSION: The results emphasize the important role of mothers and their socio-economic background in enhancement of children's dental health. Their active role in conjunction with the potential of self-assessment provides a good basis for establishing and improving self-care among children, in developing countries in particular.

Bilateral hemorrhagic adrenal cysts in an incomplete form of Beckwith-Wiedemann syndrome: MRI and prenatal US findings.

Benign hemorrhagic adrenal cysts are a cause of subdiaphragmatic mass in the fetus and neonate with Beckwith-Wiedemann syndrome. Characteristic imaging features on ultrasonography, color Doppler, and magnetic resonance imaging help differentiate adrenal hemorrhage from neonatal neuroblastoma and help avoid unnecessary surgery in these patients. Bilateral adrenal hemorrhage is self-limiting, and spontaneous resolution is the usual outcome. This report presents this rare condition with prenatal ultrasonographic and magnetic resonance imaging findings and reviews the differential diagnosis of neonatal adrenal masses.

Takayasu's arteritis and tuberculosis: a case report.

The aetiology of Takayasu's arteritis is unknown, but an association with tuberculosis has been reported. We report the case of a 12-year-old-boy with Takayasu's arteritis: his blood pressure was 150/90 mmHg and fundoscopic examination showed grade I hypertensive changes. A tuberculin test was positive and acid-fast bacteria were seen in the urine. Angiography revealed involvement of the descending aorta, thoracic aorta and upper abdominal aorta, with fusiform enlargement and no filling of the left renal artery. He was started on prednisolone therapy, with cyclophosphamide being added subsequently. Despite vigorous treatment, including three courses of nitroprusside infusion, the severe hypertension persisted and his blood pressure became regulated only after left nephrectomy. Acid-fast bacteria were seen in the nephrectomy material. The exact role of Mycobacterium tuberculosis in the pathogenesis of Takayasu's arteritis is still unknown. In this patient the tuberculin test was positive and acid-fast bacteria were seen in both the urine and nephrectomy material. This finding is suggestive of the association between tuberculosis and the disease process.

Effect of hematocrit on blood pressure via hyperviscosity.

Increase in blood viscosity, defined as resistance to flow, is one factor in hypertension and atherosclerosis that contributes to the morbidity and mortality associated with tissue ischemia. In this research we evaluated the effect of hematocrit on increasing viscosity, and possible related changes in blood pressure, flow rate, and the equivalent physiologic compensation ratios. Blood samples were taken from 32 healthy individuals and centrifuged for 5 min at 3000 rpm to obtain 2.5 mL of erythrocyte mass from each. Then, at each step 0.5 mL of plasma was consecutively added in a total of 17 steps. The resultant hematocrit and viscosity changes were measured. Viscosity measurement was performed by capillary viscometer. The results were evaluated by the Student t test. It was observed that in the range of 60.16% and 25.32%, a 10.99% increase of hematocrit produced an increase of 1 unit relative viscosity, which means approximately a 20% increase in blood viscosity for a healthy individual. According to Poiseuille's equation, with a constant vessel length, if viscosity is increased by 20%, the decrease in blood flow rate will be 16.67% (100/120 = 83.33%; 100 - 83.33 = 16.67%). For the physiologic compensation of 20% increased viscosity, blood pressure increase will be 20% or vasodilation will be 4.66% in radius. Atherosclerotic and some healthy vessels with little vasodilatory capacities might benefit from treatment modalities to decrease the viscosity by hemodilution.

Acquisition, storage, and review of safety data from a commercial system for high temperature, short time pasteurization.

A high temperature, short time (HTST) pasteurization system was equipped with electronic sensors to determine the temperature, pressure, flow rate, and position of the flow diversion valve. A computer for data acquisition was wired to the sensors to monitor and to record processing conditions related to public health. The processing conditions were stored in safety files on the hard drive of the computer, transferred weekly to a tape drive, and stored. The processing conditions of the HTST system were monitored for 270 d to determine the accuracy and reliability of the data acquisition system. The size of the HTST safety files ranged from 6.2 to 9.1 MB when the sensors were monitored every second. The file size was reduced to < 1.8 MB when the monitoring frequency was increased to every 5 s. To determine accuracy, the temperatures recorded by the data acquisition system were compared with the temperatures recorded by an electronic recorder controller. To determine reliability, changes in the position of the flow diversion valve were examined to identify process deviations and were compared with the event marker on circular charts. The review of the data file by the actual time method was an effective alternative to the electronic recorder controller for monitoring the completeness of data in the safety files. Off-line review to determine reliability required approximately 10 min/d of records.

Automated control and monitoring of thermal processing using high temperature, short time pasteurization.

High temperature, short time pasteurization was used to evaluate a computer-based system for controlling the pasteurization process, acquiring data, and monitoring records. Software was used for the control of hot water temperature, flow rate through the centrifugal timing pump, and diversion of under-processed product. Three types of control strategies were conducted: single loop, cascade, and multivariable. The single loop control strategy showed the most rapid responses to temperature changes, but the temperature response curve was slowest to return to its set point. The cascade control strategy showed slower recoveries to temperature changes, but the temperature response curve was smoother. The multivariable control strategy responded slightly faster than the cascade control strategy, and the temperature response curve was slightly smoother than the cascade control strategy. The multivariable control strategy was able to control the flow diversion valve by the use of a lethality controller. The data acquisition system, used to monitor the data obtained from the high temperature, short-time pasteurization system, was within +/- 0.1 degree C of the temperature recorded by the safety thermal limit recorder. Reliability was determined by examining the changes in the position of the flow diversion valve to identify process deviations and by comparing the changes to the event marker on circular charts. The data acquisition system was an effective alternative for monitoring the completeness of data.