Backreaction during inflation: a physical gauge invariant formulation.

Within a genuinely gauge invariant approach recently developed for the computation of the cosmological backreaction, we study, in a cosmological inflationary context and with respect to various observers, the impact of scalar fluctuations on the space-time dynamics in the long wavelength limit. We stress that such a quantum backreaction effect is evaluated in a truly gauge independent way using a set of effective equations which describe the dynamics of the averaged geometry. In particular we show under what conditions the free falling (geodetic) observers do not experience any scalar-induced backreaction in the effective Hubble rate and fluid equation of state.

Efficacy on menopausal neurovegetative symptoms and some plasma lipids blood levels of an herbal product containing isoflavones and other plant extracts.

OBJECTIVES: To assess the efficacy of a product containing isoflavones and other plant extracts (BIO) on whole menopausal symptomatology and plasma lipids profile. METHODS: Multicentre, randomized, double blind, placebo controlled clinical investigation on 125 menopausal women randomly assigned to two groups treated for 6 months with placebo or one tablet daily of an herbal product containing 72 mg/dose of isoflavones of different plants origin and other plant extracts (BIO). Primary end-point: Kupperman Menopause Index (KI) variations; secondary end-point: activity on plasma lipids profile and clinical global impression (CGI) on efficacy and tolerability by investigators and patients. The usual parametric test (paired Student t test) was performed to evaluate the significance. In case of non-applicability of parametric tests, the non-parametric Mann-Whitney U test was used. The differences where considered significant at p<0.05 level. RESULTS: At the end of treatment in both groups KI showed a significant decrease (p<0.001). However, in the BIO group the KI reduction was significantly higher (p=0.0265) than in the placebo group after 4 and 6 months of treatment. In the BIO treated patients the LDL cholesterol showed a borderline but not significant reduction compared to placebo (p=0.0608) and triglyceride (TG) a significant (p=0.0151) decrease compared to placebo. The investigator's and patient's CGI on BIO group where superior as compared to placebo. Clinical tolerability was good in booth groups. CONCLUSION: On the basis of positive effects on KI and lipids profile as well as of good clinical tolerability, BIO can be considered one of the possible alternative therapy for conventional HRT.

A survey: the prevalence of laparoscopic donor nephrectomy at large U.S. transplant centers.

BACKGROUND: There is controversy whether laparoscopic donor nephrectomy (LDN) is the procedure of choice for live kidney donors. The purpose of this survey therefore was to determine the current practices, attitudes, and plans regarding LDN in high-volume renal transplant centers. METHODS: Medical directors of the 31 highest volume kidney transplant centers were surveyed via telephone. Kidney transplant data for 1998 and 1999 were collected. RESULTS: The surveyed centers performed 5213 transplantations in 1998, representing 43% of all kidney transplantations done nationally. Twelve (39%) of the 31 centers performed LDN in 1998, increasing to 20 (65%) of 31 in 1999. Of 1174 live donor operations performed by the 20 centers in 1999, 365 (31%) were LDNs. Among the surveyed centers, four had no plans to begin an LDN program. The most commonly cited incentive for LDN was "shorter recovery time," whereas the most common disincentive was "concern about graft quality." A combination of observation and animate laboratory was the most commonly reported method of learning the LDN procedure. Six-month follow-up interviews found that 26 (84%) of 31 centers had performed LDN; only 1 of the 31 centers had no plans to perform LDNs. CONCLUSIONS: LDN may be the de facto procedure of choice for live donors within the next year. Efforts should now focus on improving techniques for performing and teaching this procedure.

Is laparoscopic donor nephrectomy the new criterion standard?

HYPOTHESIS: The posttransplantation renal function outcomes between consecutive open donor and laparoscopic donor nephrectomies (LDNs) are similar and affect living donation. DESIGN: Using the medical records of renal living donor-recipient pairs, 36 consecutive open donor nephrectomies were compared with the subsequent 100 LDNs. Data collected on donor characteristics included demographics (age, race, sex, weight, and height), renal vascular and ureteral anatomical features, surgical information (blood loss, number of blood transfusions, operating time, warm ischemia time, and renal injury), complications, and length of hospital stay. Recipients' data also included renal function information (serum creatinine level on postoperative days 7 and 30) and ureteral complications during the initial hospital stay. SETTING: A not-for-profit tertiary care teaching hospital in a metropolitan area. PATIENTS: Adults who had end-stage renal disease and received a living donation kidney. MAIN OUTCOME MEASURES: Operative time, warm ischemia time, blood loss, and posttransplantation serum creatinine level. RESULTS: Patient characteristics were not significantly different between the open donor nephrectomy and LDN groups. No right kidney LDNs were done because of the shortness of the right renal vein; and, after the initial experience, left kidneys with more than 2 arteries were excluded. Warm ischemia time was recorded only for LDN, and it was found that a warm ischemia time of 10 minutes or longer was associated with difficulty in extraction and was uniformly associated with elevated mean serum creatinine levels on postoperative day 7. CONCLUSIONS: The length of hospital stay was decreased and cosmetic result enhanced. The number of living donors has increased from 28 in 1997 to 53 in 1998 and to 63 in 1999 at our institution. The length of hospital stay, incidence of complications, and comparable kidney quality indicate that LDN should be the initiating procedure for most patients.

Is laparoscopic donor nephrectomy here to stay?

BACKGROUND: Open live donor nephrectomy is safe and provides kidneys of excellent quality. The complexity of the laparoscopic donor technique has raised considerable concerns. METHOD: Twenty-six laparoscopic live donor nephrectomies were done from October 1997 to October 1998. RESULTS: All kidneys had immediate function. All recipients except 1 had serum creatinines less than 2.0 mg at 2 months posttransplantation. Three complications (wound infection, neuroma, reoperation) occurred. There was no mortality. CONCLUSIONS: Proper surgical training and patient selection can result in a safe donor operation that provides kidneys of excellent quality.

[A double-blind study of neostigmine versus placebo in paralytic ileus as a result of surgical interventions]. / Studio in doppia cecità tra neostigmina en versus placebo nell'ileo paralitico conseguente ad interventi chirurgici.

A fully randomized double-blind study, stratified according to diagnosis, was carried out in order to assess the effect of endonasal neostigmine in the treatment of post-laparotic paralytic ileus. A total of 40 patients (16 M, 24 F), aged between 22 and 76 years old, were admitted to the study; of these 20 were cholecystectomized and 20 had undergone emergency surgery. According to a special randomization list, 10 patients from each pathological group were treated with 6% neostigmine en (1 puff = 5.4 mg) and the other ten were treated with placebo. Both treatments were administered at a dose of 2 puffs, one per nostril, at the end of surgery and then repeated every 4 hours up to a maximum of 6 puffs/day. Treatment was continued for 4 days or until canalization of feces and gas was achieved. The mean daily dose of endonasal neostigmine found to be efficacious was 4 puffs/day, equivalent to 24.7 mg in cholecystectomized patients and 23.5 mg in patients undergoing emergency surgery. In over-all terms the canalization of gas and feces was observed in 74% of patients treated with neostigmine and in 45% of those receiving placebo and the difference was statistically significant.

Atividades estrogênicas de dois agentes tópicos vaginais utilizados no tratamento da atrofia menopáusica / Estrogenic activities of two vaginal topical agents used in the treatment of the menopausal atrophy

Sabe-se, já há muito tempo, que as alteraçöes funcionais devidas à atrofia pós-menopáusica da mucosa feminina podem se beneficiar com a terapia a longo prazo de substitutos do estrogênio. A administraçåo por via intravaginal pode ser prescrita sempre que se desejar evitar a açåo sistêmica do hormônio, uma vez que pequenas doses da substância eståo associadas à mesma eficácia observada com as outras vias de administraçåo. Porém, todos os estrogênios comuns såo absorvidos pela vagina e a barreira vaginal se enfraquece nas mulheres pós-menopáusica devido à involuçåo trófica da mucosa. Estudos preliminares demonstraram que o promestriene, um dieteróxido de estradiol, quando administrado por via intravaginal, é eficaz na atrofia vaginal sem penetrar na circulaçåo geral. Isso foi confirmado em mulheres na pós-menopausa em uma comparaçåo entre as atividades local e sistêmica do promestriene com as do creme de estrogênio sulfoconjugado, ambos administrados localmente na dose de 20mg/dia e 1,25mg/dia, respectivamente. A análise estatística nåo demonstrou nenhuma diferença relacionada com a açåo antiatrófica entre as duas preparaçöes de uso tópico. Entretanto, somente a preparaçåo sulfoconjugada apresentou efeitos sistêmicos, incluindo alteraçöes nos níveis plasmáticos de estradiol e de gonadotrofina hipofisária. Foi observada uma diferença estatisticamente significativa entre as duas preparaçöes de estrogênio no que diz respeito a essa atividade bioquímica, uma vez que os níveis plasmáticos das substâncias mencionadas nåo foram alteradas com promestriene. Todos os estrogênios, quando associados a um excipiente adequado e administrado através da vagina ou da vulva, apresentam um efeito trófico específico na mucosa genital atrófica de mulheres na menopausa. Seu efeito tópico é melhor neste sentido, porém sua passagem sistêmica simultânea nåo pode ser evitada, podendo até mesmo ser aumentada pela atrofia. O promestriene*, um dieteróxido de estradiol, parece ser uma exceçåo a essa regra porque, quando administrado topicamente como creme ou em cápsulas, apresenta efeitos tróficos idênticos aos dos estrogênios, mas sem penetrar na circulaçåo geral, já que nåo pode ser detectado no sangue pelo radioimunoensaio e nåo provoca alteraçöes histológicas no endométrio. Essas características específicas, resultantes de vários estudos anteriores, servem para justificar o estudo que passamos a descrever, que comparou dois cremes vaginais contendo promestriene e estrogênios sulfoconjugados**, respectivamente, sob o ponto de vista dos efeitos antiatróficos e da penetraçåo sistêmica

Esophageal rupture complicated by a gastrocardiac fistula: review of the literature and report of a successfully treated case.

A 62-year-old man developed a fistula between the right ventricle and the stomach after Thal fundic patching of an emetogenic rupture of the esophagus. He underwent emergency surgical correction of the fistula and survived.

A case control study for major trauma in geriatric patients.

This study analyzed age as a univariate factor in survival in a national group of 46,613 major trauma patients and compared 180 elderly major trauma patients (greater than or equal to 65 years) to a similarly injured group of 3,918 younger patients (less than 65 years). In the national group, mortality rose sharply between age 45 (10%) and 55 (15%) and doubled at age 75 years (20%). This age-dependent survival decrement occurred at all Injury Severity Score values, for all mechanisms of injury, and for all body regions. In the comparison study, mortality in the elderly group was nearly double that of mortality in the younger group (27% vs. 14%). The older patients had a markedly higher complication death rate, especially for pulmonary (14/100 vs. 6.1/1100) and infectious complications (4.6/100 vs. 0.7/100). The median length of stay was twice as long for the older patients (14 days vs. 7 days). Cost data showed that the DRG prospective payment system grossly underestimated the cost of care for these patients (mean loss of $2,177.14 per patient). To minimize mortality and morbidity, triaging elderly trauma victims to trauma centers at a much lower threshold than similarly injured younger patients is recommended. The current DRG system should be altered to account for age-dependent morbidity. Further study is needed to determine whether more rigorous infection prophylaxis, immunomodulation, and pulmonary therapy will augment survival in elderly patients.

Emergency thoracotomy.

Eighty-nine consecutive trauma patients, who were treated at one institution and received emergency thoracotomy, were studied. Although 76 (85%) of the patients had no vital signs at hospital arrival, 15 (17%) patients survived the emergency thoracotomy to progress to other hospital treatments. Ten patients were ultimately discharged, nine of whom have normal functions. Maintaining a broad set of indications for emergency thoracotomy may increase survival amongst trauma patients for whom the procedure is indicated.

Emergency bay thoracotomy.

In recent years, there has been increased debate on the indications for and value of thoracotomies done in the Emergency Department for victims of trauma. The current literature, unfortunately, does not resolve many points of contention surrounding this procedure. Using strict terms to define Emergency Bay Thoracotomy (EBT), 89 consecutive patients seen over a 2-year period in a Trauma Unit were retrospectively reviewed and analyzed. Eighty-five per cent of the patients had no vital signs on arrival, yet the procedure proved to be valuable in sustaining life in 17% of patients, two thirds of whom were discharged, 90% with normal findings. A progressive increase in survival rate was observed with increased use of the procedure. A review of the prognostic factors found in this study and comparison with other published studies indicates that clear definition of the patient population and patient status is essential before aggregated data are used as a basis for therapeutic policies. Educational and research efforts must focus on determining which patients have zero prognosis after initiating resuscitation, rather than on denying care to any group, even when only a few will respond.

Host-Pathogen Interactions: IX. Quantitative Assays of Elicitor Activity and Characterization of the Elicitor Present in the Extracellular Medium of Cultures of Phytophthora megasperma var. sojae.

Resistance of soybean (Glycine max L.) seedlings to Phytophthora megasperma var. sojae (Pms) is in part due to the accumulation in infected tissue of a compound which is toxic to Pms. The accumulation of this compound, a phytoalexin called glyceollin, is triggered by infection, but it can also be triggered by molecules, "elicitors," present in cultures of Pms. The ability of the Pms elicitor to stimulate phytoalexin accumulation in soybean tissues has been used as the basis for biological assays of elicitor activity. Two bioassays were developed and characterized in this study of the Pms elicitor. These bioassays use the cotyledons and the hypocotyls of soybean seedlings. The cotyledon assay was used to characterize the extracellular Pms elicitor. This elicitor was isolated from Pms cultures and purified by ion exchange and molecular sieving chromatography. The extracellular Pms elicitor was determined to be a predominantly 3-linked glucan, which is similar in composition and structure to a polysaccharide component of Pms mycelial walls.