On the origin of the high capacitance of nitrogen-containing carbon nanotubes in acidic and alkaline electrolytes.

The synthesis of nitrogenated carbon nanotubes (N-CNTs) with up to 6.1 wt% N, via the use of pyridine as the nitrogen containing carbon precursor, can provide a facile route to significantly enhance the low intrinsic specific capacitance of carbon nanotubes. The nitrogen functionalities determine this, at least, five-fold increase of the specific capacitance.

Growth of aligned carbon nanofibres over large areas using colloidal catalysts at low temperatures.

Highly purified cobalt colloids have been employed as a catalyst to grow aligned carbon nanofibres at temperatures as low as 300 degree C by dc plasma enhanced chemical vapour deposition over large areas.

The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial.

OBJECTIVE: ischaemic lower-extremity ulcers in the diabetic population are a source of major concern because of the associated high risk of limb-threatening complications. The aim of this study was to evaluate the role of hyperbaric oxygen in the management of these ulcers. METHOD: eighteen diabetic patients with ischaemic, non-healing lower-extremity ulcers were recruited in a double-blind study. Patients were randomly assigned either to receive 100% oxygen (treatment group) or air (control group), at 2.4 atmospheres of absolute pressure for 90 min daily (total of 30 treatments). RESULTS: healing with complete epithelialisation was achieved in five out of eight ulcers in the treatment group compared to one out of eight ulcers in the control group. The median decrease of the wound areas in the treatment group was 100% and in the control group was 52% (p=0.027). Cost-effectiveness analysis has shown that despite the extra cost involved in using hyperbaric oxygen, there was a potential saving in the total cost of treatment for each patient during the study. CONCLUSION: hyperbaric oxygen enhanced the healing of ischaemic, non-healing diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible.

POSSUM and P-POSSUM overpredict mortality for carotid endarterectomy.

OBJECTIVES: the aim was to test the predictive accuracy of POSSUM and P-POSSUM on patients undergoing CEA. DESIGN: retrospective and prospective study. MATERIALS: 499 CEAs performed by four vascular surgeons from a single unit from 1992-99. The median age was 68 (range 38-86) and 60% were men. METHODS: physiological parameters, operative parameters and the 30-day mortality were collected. Predicted mortality for each patient was calculated using POSSUM and P-POSSUM equations. Patients were stratified into risk groups and observed and predicted deaths were compared. Accuracy of the prediction was assessed using chi-squared analysis. RESULTS: the observed 30-day mortality was 1.8% (9/499). The predicted deaths using POSSUM and P-POSSUM analysis were 49 and 25 respectively compared to nine observed deaths. There was significant evidence of lack of fit of both models in predicting mortality (chi-squared analysis, p<0.05). CONCLUSIONS: POSSUM and P-POSSUM overpredict mortality and are unsuitable for comparative audit of CEA. Models developed specific for CEA might accurately predict mortality.

Risk modelling study for carotid endarterectomy.

BACKGROUND: The aims of this study were to identify factors that influence the risk of stroke or death following carotid endarterectomy (CEA) and to develop a model to aid in comparative audit of vascular surgeons and units. METHODS: A series of 839 CEAs performed by four vascular surgeons between 1992 and 1999 was analysed. Multiple logistic regression analysis was used to model the effect of 15 possible risk factors on the 30-day risk of stroke or death. Outcome was compared for four surgeons and two units after adjustment for the significant risk factors. RESULTS: The overall 30-day stroke or death rate was 3.9 per cent (29 of 741). Heart disease, diabetes and stroke were significant risk factors. The 30-day predicted stroke or death rates increased with increasing risk scores. The observed 30-day stroke or death rate was 3.9 per cent for both vascular units and varied from 3.0 to 4.2 per cent for the four vascular surgeons. Differences in the outcomes between the surgeons and vascular units did not reach statistical significance after risk adjustment. CONCLUSION: Diabetes, heart disease and stroke are significant risk factors for stroke or death following CEA. The risk score model identified patients at higher risk and aided in comparative audit.

Transient kinetic and dynamic interactions between verapamil and dofetilide, a class III antiarrhythmic.

Potential kinetic and dynamic interactions between the new class III antiarrhythmic dofetilide (D) and the calcium channel blocker verapamil (V) were determined in 12 young healthy male volunteers. A fixed sequence of V80 mg tid, placebo, D 0.5 mg bid, and D + V was given as matching active and placebo capsules. In steady-state conditions during combination treatment, a modest increase in mean (+/- SD) peak plasma concentration of dofetilide from 2.40 +/- 0.42 to 3.43 +/- 0.71 ng x ml(-1) (43% increase, p < 0.1) was noted. During the combination period, for the first 4 hours, mean AUC values for D increased from 7.4 +/- 1.0 (D alone) to 9.2 +/- 1.4 ng x h x ml(-1) (26% increase, p <0.1). No other significant pharmacokinetic interaction was seen. These transient changes were concurrent with trends for a dynamic interaction. The maximal mean increase in QT, over steady-state baseline values was 20 msec for D alone versus 26 msec during combination therapy. This relatively small interactive effect occurred only while peak plasma drug concentrations were developing at 1 to 3 hours after dosing and is probably caused by the known effect of verapamil to increase hepatic and portal bloodflow. In view of this interaction and the relationship between dofetilide plasma concentration and torsade, verapamil is contraindicated in patients receiving dofetilide.

NMR studies of Ru(3)(CO)(10)(PMe(2)Ph)(2) and Ru(3)(CO)(10)(PPh(3))(2) and their H(2) addition products: detection of new isomers with complex dynamic behavior.

The clusters Ru(3)(CO)(10)L(2), where L = PMe(2)Ph or PPh(3), are shown by NMR spectroscopy to exist in solution in at least three isomeric forms, one with both phosphines in the equatorial plane on the same ruthenium center and the others with phosphines in the equatorial plane on different ruthenium centers. Isomer interconversion for Ru(3)(CO)(10)(PMe(2)Ph)(2) is highly solvent dependent, with DeltaH decreasing and DeltaS becoming more negative as the polarity of the solvent increases. The stabilities of the isomers and their rates of interconversion depend on the phosphine ligand. A mechanism that accounts for isomer interchange involving Ru-Ru bond heterolysis is suggested. The products of the reaction of Ru(3)(CO)(10)L(2) with hydrogen have been monitored by NMR spectroscopy via normal and para hydrogen-enhanced methods. Two hydrogen addition products are observed with each containing one bridging and one terminal hydride ligand. EXSY spectroscopy reveals that both intra- and interisomer hydride exchange occurs on the NMR time scale. On the basis of the evidence available, mechanisms for hydride interchange involving Ru-Ru bond heterolysis and CO loss are proposed.

Solvent-free routes to clean technology.

A major aim for the chemical technology of the future is the avoidance of noxious and environmentally unacceptable organic solvents. In this concept article we discuss more environmentally friendly and highly selective alternatives which we have evolved for carrying out a number of important chemical conversions. These entail the use of porous heterogeneous catalysts in which the active sites have been atomically engineered and fully characterized. Such solid catalysts operate under solvent-free conditions and usually entail one-step processes.

A design for testing interventions to improve adherence within a hypertension clinical trial.

The Potassium Adherence Clinical Trial (PACT) incorporates one randomized clinical trial within another. A randomized trial of interventions to increase adherence to medication is nested within a second randomized clinical trial testing hypotensive effect of supplemental oral potassium. The trial aims principally to compare the effects of three intervention strategies: two sessions of individual patient counseling, two telephone contacts, or standard care. The trial aims secondarily to evaluate the effect of 60 mEq supplemental oral potassium daily on sitting systolic and diastolic blood pressure in hypertensive patients on established drug therapy. Therefore, it organizes the patients given potassium into three study groups for adherence interventions, and the patients assigned to placebo into a further three. We evaluate adherence primarily by means of the Medication Event Monitoring System (MEMS), an electronic system that records the date and time that the container of study medication is opened. Additional measurements, such as assessments of change in levels of urinary potassium, pill counts, appointment records, self-reporting by patients, and estimates by physician of adherence, are used and correlated with MEMS data. At a single center, the trial enrolled 107 participants between the ages of 26 and 80. This paper describes the background to this trial within a trial, details its design, documents the baseline characteristics of participants enrolled, and describes issues experienced during implementation of the trial.

Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion.

OBJECTIVE: To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival. DESIGN: Randomized prospective study. SETTING: Tertiary referral renal unit. PATIENTS: Fifty patients commencing peritoneal dialysis. INTERVENTION: Catheters were implanted laparoscopically or by a conventional surgical technique. MAIN OUTCOME MEASURES: The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared. RESULTS: The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed. CONCLUSIONS: The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.

A biomechanical evaluation of visually impaired persons' gait and long-cane mechanics.

This study was designed to compare selected kinematic components of gait and long cane mechanics between groups of visually impaired travelers. Twenty subjects were placed in Traditional or Modified technique groups according to their long cane traveling technique. Subjects were measured during the following conditions; 1) normal walking (NW), 2) walking while anticipating a simulated drop-off (AD), 3) walking while responding to an audible task (ST) and, 4) walking while anticipating a simulated drop-off and responding to an audible task (STAD). Data were analyzed using a repeated measures analysis of variance (ANOVA) and Pearson's r correlation coefficient. Analyses revealed no differences between groups of travelers. However, significant differences were noted between trials for components of gait velocity, stride length, and hip flexion velocity. These findings may indicate a potentially dangerous alteration in the normal gait cycle of visually impaired travelers when faced with additional attention-demanding tasks while walking.

Assessment of anteroposterior instability of the knee during gait.

A noninvasive kinematic recording technique involving geometric modeling of the knee joint was employed to determine anteroposterior displacements of the knee during walking. The model estimated how much the femoral condyles slid and rolled on the tibial plateau. Movement not due to sliding or rolling was attributed to horizontal translation of the tibia with respect to the femur. Thirty normal adults participated in this study. A three-dimensional analysis system with noninvasive skin markers was employed to collect kinematic data of the femur and tibia during walking. Within-session and between-session reliabilities were high in the tested subjects. Normal subjects had an average of 5.5 mm of maximum anterior displacement of the tibia during stance phase of walking. These results differed neither between left and right knees, nor between men and women. Dynamic instability of the knee during walking can be reasonably measured by the proposed method in normal subjects.

Ruptured fission yeast walls. Structural discontinuities related to the cell cycle.

Distributions of rupture sites of fission yeast cells ruptured by glass beads have been related to a new morphometric analysis. As shown previously (Johnson et al., Cell Biophysics, 1995), ruptures were not randomly distributed nor was their distribution dictated by geometry, rather, ruptures at the extensile end were related to cell length just as the rate of extension is related to cell length. The extension patterns of early log, mid-log, late log, and stationary phase cells from suspension cultures were found to approximate the linear growth patterns of Kubitschek and Clay (1986). The median length of cells was found to decline through the log phase in an unbalanced manner.

Gait and long cane kinematics: a comparison of sighted and visually impaired subjects.

Although visually impaired individuals have used the long cane to increase mobility for many years, few empirical studies have examined the effectiveness of this tool. The purposes of this research were to determine if these cane procedures provide adequate protection for visually impaired individuals and to compare sighted and visually impaired gait mechanics. Seven sighted (four females, three males) and five visually impaired subjects (two females, three males) were videotaped at 60 Hz by two cameras situated at opposite 45 degrees angles to the subjects' frontal plane so that three-dimensional coordinates could be calculated via direct linear transformation. One-way analyses of variance were calculated on 17 variables to determine if there was a significant biomechanical difference between sighted and visually impaired gait at an adjusted alpha = .003. The results showed that for both groups the cane tip touched outside where the foot landed and that the only variable significantly different between the two groups was resultant cane velocity. The major conclusion of this research was that present cane techniques may not provide adequate protection for visually impaired individuals since the purpose of mobility training is to have the person touch the ground with the cane tip at the foot contact positions.

Sexual co-flocculation by heterothallic cells of the fission yeast Schizosaccharomyces pombe modulated by medium constituents.

Novel simple synthetic media for inducing sexual co-flocculation in a short time after mixing heterothallic fission-yeast (Schizosaccharomyces pombe) cells of h- and h+ were devised; The most effective of these, mannose synthetic medium (MSM), contains 0.4% mannose as a carbon source in addition to galactose, KH2PO4 (pH4.0) and 4 vitamins. The addition of galactose to the medium suppressed the asexual self-flocculation but rather promoted the sexual co-flocculation. By transferring and mixing h- and h+ cells grown in malt-extract broth plus galactose into MSM, these heterothallic strains were revealed to be sexually ready through a long period of the log to stationary phases. Furthermore, a variety of C sources and NH4Cl at various concentrations in various media were examined for their effects upon sexual co-flocculation, conjugation and sporulation; it was found that the sugar concentration strictly affected the progress of the sequence of sexual reproduction at 26 degrees C but not 30 degrees C and that sexual co-flocculation of the heterothallic strains was induced only under lower concentrations of C and N source than that for the homothallic one.

A prospective study of the effect of limb-threatening ischaemia and its surgical treatment on the quality of life.

OBJECTIVE: To assess the quality of life after treatment for limb-threatening ischaemia. DESIGN: An open, prospective, observational study in a Vascular Unit of a University Hospital. MATERIALS: One hundred and fifty consecutive patients presenting with actual or threatened tissue loss of the leg. METHODS: A single, experienced observer assessed the patients for pain, mobility, anxiety, depression, self-care and lifestyle at presentation, 6 and 12 months later. RESULTS: Six different treatment outcomes were recognised: successful angioplasty, successful thrombolysis/thrombectomy, successful surgical bypass, amputation after failed revascularisation, primary unilateral amputation and primary bilateral amputation. Pain was significantly improved in all groups (p < 0.05) except for patients after failed revascularization (p = 0.08). Mobility improved in patients who underwent angioplasty (p = 0.05) or a successful surgical bypass (p = 0.001). Anxiety and depression both improved significantly only after surgical reconstruction (p < 0.02). Self-care ability improved significantly after angioplasty (p < 0.05), surgical reconstruction (p < 0.005) and unilateral primary amputation (p < 0.05), but was unaltered in the other groups. Lifestyle significantly deteriorated following thrombolysis/thrombectomy and failed surgical reconstruction (p < 0.05), but was maintained in all other groups. CONCLUSIONS: The treatment of limb-threatening ischaemia should aim to maintain pre-morbid lifestyle, an aim which is best achieved by limb-salvage. The patient's own expectations and needs have a major bearing on the choice of therapy.

The site of residual abnormalities in the leg veins in long-term follow-up after deep vein thrombosis and their relationship to the development of the post-thrombotic syndrome.

Two major sequelae of deep vein thrombosis (DVT), obstruction to outflow due to the presence of residual thrombus and reflux due to valvular damage, may contribute to the development of the post-thrombotic syndrome (PTS). We studied the nature and site of residual abnormality, non-invasively with duplex ultrasound, in the veins of 69 limbs in 66 patients, 1 to 6 years after primary acute DVT. There were clinical features of the PTS in 27 limbs and 42 legs were asymptomatic. The pattern of duplex abnormalities was complex and varied for both the PTS and asymptomatic groups. The proportion of abnormal common and external iliac veins and abnormal common, deep and superficial femoral veins was similar for limbs with the PTS and asymptomatic limbs. Twenty-six per cent of legs with the PTS had reflux at the saphenofemoral junction compared with 19% asymptomatic legs (difference not significant). The PTS was associated with proportionally more abnormal popliteal veins (81% vs 55%) and posterior tibial veins (PTV), PTV#1 (41% vs 21%) and PTV#2 (41% vs 14%) when compared with asymptomatic limbs. The odds ratio for a popliteal vein abnormality being associated with the PTS was 3.63 (95% CI 1.16 to 11.43). The odds ratios for PTV#1 and PTV#2 abnormalities in association with the PTS compared to asymptomatic limbs were 2.52 (95% CI 0.87 to 7.31) and 4.13 (95% CI 1.30 to 13.11). In conclusion, residual venous abnormalities after DVT are common and when present in the popliteal and tibial veins are associated with an increased likelihood of PTS expression.