Leader-Following Consensus and Formation Control of VTOL-UAVs with Event-Triggered Communications †.

This article presents the design and implementation of an event-triggered control approach, applied to the leader-following consensus and formation of a group of autonomous micro-aircraft with capabilities of vertical take-off and landing (VTOL-UAVs). The control strategy is based on an inner-outer loop control approach. The inner control law stabilizes the attitude and position of one agent, whereas the outer control follows a virtual leader to achieve position consensus cooperatively through an event-triggered policy. The communication topology uses undirected and connected graphs. With such an event-triggered control, the closed-loop trajectories converge to a compact sphere, centered in the origin of the error space. Furthermore, the minimal inter-sampling time is proven to be below bounded avoiding the Zeno behavior. The formation problem addresses the group of agents to fly in a given shape configuration. The simulation and experimental results highlight the performance of the proposed control strategy.

Recurrence of hepatocellular carcinoma: importance of mRECIST response to chemoembolization and tumor size.

Determining risk for recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) is an important clinical need. We assessed consecutive patients who underwent LT for HCC following sequential transarterial chemoembolization (TACE). Treatment response was assessed using modified response evaluation criteria in solid tumors (mRECIST) categories: complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Cox proportional hazard models were used to predict HCC recurrence. One hundred seventy-three patients underwent TACE and imaging to assess response prior to LT. TACE responses were: CR = 23.7%, PR = 24.3%, SD = 27.7% and PD = 24.3%. Five-year HCC recurrence rate was 5.3% in patients responding to TACE (CR/PR), versus 17.6%, among patients who did not respond (SD/PD, p = 0.014). In multivariate analysis, independent pre-LT predictors of recurrence were response to TACE and largest radiologic size of tumor (>3 cm vs. ≤3 cm). HCC recurrence rate for patients with tumor size >3 cm and no response to TACE was 35.8%, compared with 1.9% for patients with tumor size ≤3 cm and response to TACE (p = 0.0007). We conclude that mRECIST criteria and tumor size differentiate patients with high or low likelihood of HCC recurrence after LT. These findings raise the possibility of incorporating response to TACE and largest tumor size to identify patients at highest risk for HCC recurrence.

The nutrition transition in the Venezuelan Amazonia: increased overweight and obesity with transculturation.

OBJECTIVES: Amerindians have a particularly high propensity to overweight and obesity as they change lifestyle and experience a nutrition transition. The aim of this study was to evaluate the effects of transculturation on nutritional status in three Amazonian Amerindian villages. METHODS: Nutritional status was assessed in 232 volunteers: 65 Yanomami from an isolated village and 167 Guahibo subjects from villages with intermediate and high levels of transculturation. RESULTS: There was a significant pattern of decreasing stunting and increasing overweight and obesity across the gradient of transculturation. From the jungle Yanomami to the intermediate and transculturated Guahibo, stunting was respectively 72, 55, and 39%, and children /adult overweight was 0, 3/44, and 15/89%. These anthropometric-based patterns were confirmed by bioimpedance vector analysis. CONCLUSIONS: Transculturation in these Amerindian populations is associated with an increase in overweight and obesity coexisting with undernourished children.

Effects of feeding various dosages of Saccharomyces cerevisiae fermentation product in transition dairy cows.

Feeding 56 versus 0 g/d of Saccharomyces cerevisiae fermentation product (SCFP; Diamond V Original XP; Diamond V, Cedar Rapids, IA) can increase feed intake and milk production in transition dairy cows. To evaluate the effects of various dosages of SCFP, Holstein cows were given individually a supplement containing 0 (n=14), 56 (n=15), or 112 g (n=13) of SCFP daily during morning lockup as a topdressing to their total mixed ration. The supplement consisted of 0, 56, or 112 g of SCFP mixed with 84 g of molasses and 168, 112, or 56 g of corn meal, respectively. Supplement feeding began 28 d before predicted calving date (no less than 14 d) and ended 28 d postpartum, and supplement intake was evaluated daily. Blood samples were collected at d -21, -14, -7, -3, -1, 0, 1, 3, 7, 14, 21, and 28 to measure serum concentrations of macrominerals, metabolites, acute-phase proteins, immunoglobulin, and hormones. Milk weights were measured and milk samples were collected 2 times/wk on nonconsecutive days and analyzed for milk fat, protein, lactose, and somatic cell count (SCC). During the first day after calving, feeding SCFP versus no SCFP decreased serum cortisol concentrations and at least tended to increase supplement intake and serum concentrations of calcium, glucose, urea N, and serum amyloid A. During the first 4 wk postpartum, feeding SCFP versus no SCFP decreased milk SCC and increased milk production and serum phosphorus concentrations. Feeding 112 versus 56 g of SCFP/d did not show additional effects. Feeding SCFP may have a dosage-independent beneficial effect in supporting the physiologic adaptations after parturition, resulting in higher milk production and lower milk SCC.

Partial characterization of digestive proteases in tropical gar Atractosteus tropicus juveniles.

Tropical gar (Atractosteus tropicus) is an economically and socially important freshwater species from Southeastern Mexico, with a high aquaculture potential. With this in mind, the purpose of this study was to characterize the digestive proteases of tropical gar juveniles through biochemical and electrophoretic analyses. Twenty specimens with an average weight of 73.6 ± 12.7 g were used to obtain stomach and intestinal tissue from which multienzymatic extracts were prepared. The general activities of the acid and alkaline proteases were evaluated, as well as the specific activities of trypsin, chymotrypsin, leucine aminopeptidase and carboxypeptidase A. The effect of the pH and temperature on the proteases was also analyzed, together with the composition of the multienzymatic extracts using protease inhibitors and electrophoretic tests. Results showed that A. tropicus have a functional stomach in which protein hydrolysis starts with pepsin and which contains endo- and exopeptidases (trypsin, chymotrypsin, leucine aminopeptidase and carboxypeptidase A) and proteases that are resistant to high temperatures (45 and 55 °C for alkaline and acid proteases, respectively) and pH values. Using zymogram technique, we found two acid protease isoforms (0.35 and 0.71 rf) and five alkaline protease isoforms (83.7, 43.7, 27.5, 24.0 and 19.4 kDa), which decrease or disappear with the different inhibitors. Thus, this species is considered to be a carnivore capable of adapting to its environment by consuming different types of proteins from preys and also could adapt rapidly to consume a compound diet with different animal protein sources.

Dichloroacetate inhibits aerobic glycolysis in multiple myeloma cells and increases sensitivity to bortezomib.

BACKGROUND: Dichloroacetate (DCA), through the inhibition of aerobic glycolysis (the 'Warburg effect') and promotion of pyruvate oxidation, induces growth reduction in many tumours and is now undergoing several clinical trials. If aerobic glycolysis is active in multiple myeloma (MM) cells, it can be potentially targeted by DCA to induce myeloma growth inhibition. METHODS: Representative multiple myeloma cell lines and a myeloma-bearing mice were treated with DCA, alone and in combination with bortezomib. RESULTS: We found that aerobic glycolysis occurs in approximately half of MM cell lines examined, producing on average 1.86-fold more lactate than phorbol myristate acetate stimulated-peripheral blood mononuclear cells and is associated with low-oxidative capacity. Lower doses of DCA (5-10 mM) suppressed aerobic glycolysis and improved cellular respiration that was associated with activation of the pyruvate dehydrogenase complex. Higher doses of DCA (10-25 mM) induced superoxide production, apoptosis, suppressed proliferation with a G0/1 and G2M phase arrest in MM cell lines. In addition, DCA increased MM cell line sensitivity to bortezomib, and combinatorial treatment of both agents improved the survival of myeloma-bearing mice. CONCLUSION: Myeloma cells display aerobic glycolysis and DCA may complement clinically used MM therapies to inhibit disease progression.

Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease.

Obesity is increasingly common before and after liver transplantation (LT), yet optimal management remains unclear. Our aim was to analyze the effectiveness of a multidisciplinary protocol for obese patients requiring LT, including a noninvasive pretransplant weight loss program, and a combined LT plus sleeve gastrectomy (SG) for obese patients who failed to lose weight prior to LT. Since 2006, all patients referred LT with a BMI > 35 were enrolled. There were 37 patients who achieved weight loss and underwent LT alone, and 7 who underwent LT combined with SG. In those who received LT alone, weight gain to BMI > 35 was seen in 21/34, post-LT diabetes (DM) in 12/34, steatosis in 7/34, with 3 deaths plus 3 grafts losses. In patients undergoing the combined procedure, there were no deaths or graft losses. One patient developed a leak from the gastric staple line, and one had excess weight loss. No patients developed post-LT DM or steatosis, and all had substantial weight loss (mean BMI = 29). Noninvasive pretransplant weight loss was achieved by a majority, though weight gain post-LT was common. Combined LT plus SG resulted in effective weight loss and was associated with fewer post-LT metabolic complications. Long-term follow-up is needed.

Parental exposure to methyl methane sulfonate of three-spined stickleback: contribution of DNA damage in male and female germ cells to further development impairment in progeny.

Data regarding the link between DNA integrity of germ cells and the quality of progeny in fish exposed to genotoxicant are scarce although such information is of value to understand genotoxic effects of contaminants in aquatic fauna. This work aimed at studying the consequences of a parental exposure during the breeding season on offspring quality in three-spined stickleback. After in vivo exposure of adult fish to methyl methane sulfonate, a model alkylating compound, a clear increase in DNA damage was observed in erythrocytes of both genders, here used as a biomarker of exposure. MMS exposure significantly affected sperm DNA integrity but neither female fecundity nor fertilization success. In order to understand the contribution of each sex to potential deleterious effects in progeny due to parental exposure, mating of males and females exposed or not to MMS, was carried out. Exposure of both males and females or of males alone led to a significant increase in both mortality during embryo-larval stages and abnormality rate at hatching that appeared to be sensitive stages. Thus, in accordance with recent studies carried out in other freshwater fish species, such development defects in progeny were clearly driven by male genome, known to be devoid of DNA repair capacity in spermatozoa. The next step will be to investigate the link between DNA damage in stickleback sperm and reproductive impairment in natural populations exposed to complex mixture of genotoxicants.

A meta-analysis of the effects of feeding yeast culture produced by anaerobic fermentation of Saccharomyces cerevisiae on milk production of lactating dairy cows.

The purpose of this study was to use meta-analytic methods to estimate the effect of a commercially available yeast culture product on milk production and other production measures in lactating dairy cows using a meta-analysis of randomized controlled trials. Sixty-one research publications (published journal articles, published abstracts, and technical reports) were identified through a review of literature provided by the manufacturer and a search of published literature using 6 search engines. Thirty-six separate studies with 69 comparisons met the criteria for inclusion in the meta-analysis. The fixed-effect meta-analysis showed substantial heterogeneity for milk yield, energy-corrected milk, 3.5% fat-corrected milk, milk fat yield, and milk protein yield. Sub-group analysis of the data showed much less heterogeneity in peer-reviewed studies versus non-peer-reviewed abstracts and technical reports, and tended to show higher, but not significantly different, treatment effects. A random-effects meta-analysis showed estimated raw mean differences between treated and untreated cattle reported in peer-reviewed publications of 1.18 kg/d [95% confidence interval (CI): 0.55 to 1.81], 1.61 kg/d (95% CI: 0.92 to 2.29), and 1.65 kg/d (95% CI: 0.97 to 2.34) for milk yield, 3.5% fat-corrected milk, and energy-corrected milk, respectively. Milk fat yield and milk protein yield for peer-reviewed studies showed an increase in the raw mean difference of 0.06 kg/d (95% CI: 0.01 to 0.10) and 0.03 kg/d (95% CI: 0.00 to 0.05), respectively. Estimated raw mean dry matter intake of the peer-reviewed studies during early lactation (<70 d in milk) and not-early lactation were 0.62 kg/d (95% CI: 0.21 to 1.02) and a decrease of 0.78 kg/d (95% CI: -1.36 to -0.21), respectively. These findings provide strong evidence that this commercially available yeast culture product provides significant improvement in several important milk production outcomes as evaluated in production settings typical for commercial dairies in North America. Utilizing meta-analytic methods to study the complete breadth of information relating to a specific treatment by studying multiple overcomes of all eligible studies can reduce the uncertainty often seen in small individual studies designed without sufficient power to detect differences in treatments.

A multibiomarker approach in juvenile turbot, Scophthalmus maximus, exposed to contaminated sediments.

Juvenile turbot were exposed in laboratory conditions to a mixture of chemical contaminants associated with harbour and estuarine sediments for seven and 21 days. Several molecular biomarkers of exposure were then measured in fish liver: two biotransformation parameters [ethoxyresorufin-O-deethylase (EROD) and phase II glutathione S-transferase (GST) activities] and an antioxidant enzyme activity [catalase (CAT)]. Modifications at the histological level were analysed by the measurement of the number and size of melanomacrophage centres (MMCs) and disturbances to the immune function by the measurement of cytokine transforming growth factor-beta (TGF-ß) and development of the thymus. The responses of these molecular and immunological biomarkers were correlated with metal and PAH concentrations measured in sediments and with the physiological performance of turbot analysed in a previous study on the same fish (growth rates, condition factor K, RNA:DNA ratio and lipid index). While no difference was found in thymus analysis, some molecular and immunological responses were observed in fish exposed to contaminated sediments. Weak relationships between molecular biomarkers' responses and PAH concentrations were recorded, while their responses were significantly correlated with some metals. MMC and aggregates were weakly related to chemical contaminants whereas some significant correlations were found between TGF-b1 responses and some metal concentrations. However, molecular and immunological biomarkers were weakly related to fish physiological damages since low responses were observed in the condition which led to the lowest growth and condition indices. These data suggest the complexity of cause-effect relationships between exposure to pollutants, metabolisms and health damages. Precautions should be considered in the use of molecular and immunological biomarkers alone in biomonitoring programs. Their complementary use with physiological biomarkers, such as fish growth and condition indices, could improve their utilisation.

Digestive enzyme activities during early ontogeny in Common snook (Centropomus undecimalis).

Common snook (Centropomus undecimalis) is one of the most important marine species under commercial exploitation in the Gulf of Mexico; for this reason, interest in developing its culture is a priority. However, larviculture remains as the main bottleneck for massive production. In this sense, our objective was to determine the changes of digestive enzymes activities using biochemical and electrophoretic techniques during 36 days of Common snook larviculture fed with live preys (microalgae, rotifers, and Artemia). During larviculture, all digestive enzymatic activities were detected with low values since yolk absorption, 2 days after hatching (dah) onwards. However, the maximum values for alkaline protease (6,500 U mg protein(-1)), trypsin (0.053 mU × 10(-3) mg protein(-1)), and Leucine aminopeptidase (1.4 × 10(-3) mU mg protein(-1)) were detected at 12 dah; for chymotrypsin at 25 dah (3.8 × 10(-3) mU mg protein(-1)), for carboxypeptidase A (280 mU mg protein(-1)) and lipase at 36 dah (480 U mg protein(-1)), for α-amylase at 7 dah (1.5 U mg protein(-1)), for acid phosphatases at 34 dah (5.5 U mg protein(-1)), and finally for alkaline phosphatase at 25 dah (70 U mg protein(-1)). The alkaline protease zymogram showed two active bands, the first (26.3 kDa) at 25 dah onwards, and the second (51.6 kDa) at 36 dah. The acid protease zymogram showed two bands (RF = 0.32 and 0.51, respectively) at 34 dah. The digestive enzymatic ontogeny of C. undecimalis is very similar to other strictly marine carnivorous fish, and we suggest that weaning process should be started at 34 dah.

Changes in digestive enzyme activity during initial ontogeny of bay snook Petenia splendida.

Several samples of P. splendida larvae were obtained from eggs until day 60 after hatching (dah) to determine acid and alkaline proteases, trypsin, chymotrypsin, leucine aminopeptidase, α-amylase, lipase, and acid and alkaline phosphatase activities using biochemical techniques. Additionally, SDS-PAGE alkaline protease zymogram and PAGE acid protease zymogram were carried out to identify active isoforms during larviculture. Alkaline protease and chymotrypsin were present at the moment of hatching, increased gradually reaching the maximum values at 35 dah. Trypsin and leucine aminopeptidase activities were low from hatching, increasing gradually as larvae grew. Alkaline protease zymogram showed four zymogens, which appears at different days, remaining present until the end of the larviculture (95.2 kDa at 11 dah, 26.4 kDa at 9 dah, 21.4 kDa at 3 dah, and 23.3 kDa at hatching). Pepsin activity was present at day 7 after hatching and increased progressively until the end of the larviculture. Acid protease zymogram only showed one zymogen (0.65 rf), which appear at 6 dah. Lipase was high at the time of hatching and increased until 15 dah, after which decreased gradually. Amylase was high from the beginning and until 15 dah and then decreased rapidly to almost nothing onward. Alkaline and acid phosphatases presented a high activity at the egg stage, fell slightly during the first feeding and increased again from 20 to 30 dah. Results obtained in this study show that larvae can be fed artificial diets starting on day 10 after hatching.

Development of digestive enzymes in larvae of Mayan cichlid Cichlasoma urophthalmus.

The development of digestive enzymes during the early ontogeny of the Mayan cichlid (Cichlasoma urophthalmus) was studied using biochemical and electrophoretic techniques. From yolk absorption (6 days after hatching: dah), larvae were fed Artemia nauplii until 15 dah, afterward they were fed with commercial microparticulated trout food (45% protein and 16% lipids) from 16 to 60 dah. Several samples were collected including yolk-sac larvae (considered as day 1 after hatching) and specimens up to 60 dah. Most digestive enzymes were present from yolk absorption (5-6 dah), except for the specific acid proteases activity (pepsin-like), which increase rapidly from 8 dah up to 20 dah. Three alkaline proteases isoforms (24.0, 24.8, 84.5 kDa) were detected at 8 dah using SDS-PAGE zymogram, corresponding to trypsin, chymotrypsin and probably leucine aminopeptidase enzymes, and only one isoform was detected (relative electromobility, Rf = 0.54) for acid proteases (pepsin-like) from 3 dah onwards using PAGE zymogram. We concluded that C. urophthamus is a precocious fish with a great capacity to digest all kinds of food items, including artificial diets provided from 13 dah.

Three-year incidence of AIDS in five cohorts of HTLV-III-infected risk group members.

The incidence of the acquired immune deficiency syndrome (AIDS) among persons infected with human T-lymphotropic virus type III (HTLV-III) was evaluated prospectively among 725 persons who were at high risk of AIDS and had enrolled before October 1982 in cohort studies of homosexual men, parenteral drug users, and hemophiliacs. A total of 276 (38.1 percent) of the subjects were either HTLV-III seropositive at enrollment or developed HTLV-III antibodies subsequently. AIDS had developed in 28 (10.1 percent) of the seropositive subjects before August 1985. By actuarial survival calculations, the 3-year incidence of AIDS among all HTLV-III seropositive subjects was 34.2 percent in the cohort of homosexual men in Manhattan, New York, and 14.9 percent (range 8.0 to 17.2 percent) in the four other cohorts. Out of 117 subjects followed for a mean of 31 months after documented seroconversion, five (all hemophiliacs) developed AIDS 28 to 62 months after the estimated date of seroconversion, supporting the hypothesis that there is a long latency between acquisition of viral infection and the development of clinical AIDS. This long latency could account for the significantly higher AIDS incidence in the New York cohort compared with other cohorts if the virus entered the New York homosexual population before it entered the populations from which the other cohorts were drawn. However, risk of AIDS development in different populations may also depend on the presence of as yet unidentified cofactors.

Calcium salts of polyunsaturated fatty acids deliver more essential fatty acids to the lactating dairy cow.

Recent research has focused on the importance of supplying essential fatty acids to the lactating dairy cow. The addition of essential fatty acids, specifically linoleic and linolenic acid, to dairy cow diets has been investigated as a method to increase reproductive efficiency. Rumen bacteria, however, biohydrogenate polyunsaturated fatty acids (PUFA) to saturated fatty acids. This is an important issue because it can also lead to milk fat depression when unsaturated fatty acids are fed. The formation of Ca salts has previously been shown to partially protect unsaturated fatty acids from rumen biohydrogenation. The objective of this experiment was to evaluate feed intake, milk production, and milk composition of cows fed Ca salts of palm fatty acids (CS) compared with those fed Ca salts of palm fatty acids with an increased content of PUFA (CS+PUFA). Nineteen lactating Holstein cows were used in a switchback experiment to determine any differences between CS and CS+PUFA on milk production and composition. This experiment consisted of 3 consecutive periods of 14 d. Treatments were formulated to provide 450 g/d (dry matter basis) of the Ca salt supplement and were mixed with the same basal ration. Milk weights and feed intakes were recorded daily for each cow. Milk samples were collected the last 2 d of each period and analyzed for milk composition and fatty acids. Dry matter intake [28.0 vs. 27.0 kg/d; standard error of the mean (SEM) = 0.4] and milk production (44.4 vs. 44.0 kg/d; SEM = 0.7) were not different between treatments for CS and CS+PUFA, respectively. Milk fat percentage (3.34 vs. 3.22%; SEM = 0.07) and milk protein percentage (2.78 vs. 2.80%; SEM = 0.01) were not different for CS- and CS+PUFA-fed cows. Feeding CS+PUFA reduced the concentration of palmitic acid in milk fat (28.3 vs. 26.8 wt%; SEM = 0.3). Supplementation of CS+PUFA increased the linoleic acid concentration (3.96 vs. 4.61 wt%; SEM = 0.1) of milk fat, indicating that linoleic acid was partially protected from rumen biohydrogenation. Concentrations of conjugated linoleic acid were also increased (0.44 vs. 0.52 wt%; SEM = 0.02) when cows consumed CS+PUFA, indicating that some biohydrogenation did occur. Supplementing CS+PUFA did not alter milk production, milk fat percentage, or dry matter intake when compared with CS. The CS+PUFA supplement supplied more linoleic acid to the small intestine for milk fat synthesis.

Biochemical effects of nonylphenol polyethoxylate adjuvant, Diquat herbicide and their mixture on the three-spined stickleback (Gasterosteus aculeatus L.).

This study examined the response of 7-ethoxyresorufine-O-deethylase, glutathione-S-transferase, glutathione peroxidase, glutathione content, level of thiobarbituric acid reactive compounds and circulating vitellogenin, in three-spined sticklebacks after 21 days of exposure to Diquat herbicide, commercial nonylphenol polyethoxylate adjuvant and mixture between Diquat and adjuvant. The results showed that adjuvant exerted more important oxidative effects than Diquat and that mixture effects were unlike to single additivity. This study argues for ecotoxicological risk assessment of adjuvants and mixtures of adjuvants and pesticides.

Human skin penetration and local effects of topical nano zinc oxide after occlusion and barrier impairment.

Public health concerns continue to exist over the safety of zinc oxide nanoparticles that are commonly used in sunscreen formulations. In this work, we assessed the effects of two conditions which may be encountered in everyday sunscreen use, occlusion and a compromised skin barrier, on the penetration and local toxicity of two topically applied zinc oxide nanoparticle products. Caprylic/capric triglyceride (CCT) suspensions of commercially used zinc oxide nanoparticles, either uncoated or with a silane coating, were applied to intact and barrier impaired skin of volunteers, without and with occlusion for a period of six hours. The exposure time was chosen to simulate normal in-use conditions. Multiphoton tomography with fluorescence lifetime imaging was used to noninvasively assess zinc oxide penetration and cellular metabolic changes that could be indicative of toxicity. We found that zinc oxide nanoparticles did not penetrate into the viable epidermis of intact or barrier impaired skin of volunteers, without or with occlusion. We also observed no apparent toxicity in the viable epidermis below the application sites. These findings were validated by ex vivo human skin studies in which zinc penetration was assessed by multiphoton tomography with fluorescence lifetime imaging as well as Zinpyr-1 staining and toxicity was assessed by MTS assays in zinc oxide treated skin cryosections. In conclusion, applications of zinc oxide nanoparticles under occlusive in-use conditions to volunteers are not associated with any measurable zinc oxide penetration into, or local toxicity in the viable epidermis below the application site.

Contemporary wars and their contributions to vascular injury management.

INTRODUCTION: Man's inhumanity for man still knows no boundaries, as we continue as a species as a whole to engage in war. According to Kohn's Dictionary of Wars [1], of over 3,700 years of recorded history, there have been a total of 3,010 wars. One is hard pressed to actually find a period of time in which here has not been an active conflict in the globe. The world has experienced two world wars: WWI (1914-1918) and WWII (1939-1945). The total number of military casualties in WWI was over 37 million, while WWII so far, has been the deadliest military conflict in history with over 60 million people killed accounting for slightly over 2.5% of the world's population. MATERIAL AND METHODS: The purpose of this study is to review contemporary wars and their contributions to vascular injury management. It is precisely wartime contributions that have led to the more precise identification and management of these injuries resulting in countless lives and extremities saved. However, surgeons dealing with vascular injuries have faced a tough and arduous road. Their journey was initiated by surgical mavericks which undaunted, pressed on against all odds guided by William Stewart Halsted's classic statement in 1912: "One of the chief fascinations in surgery is the management of wounded vessels." CONCLUSION: Contemporary wars of the XX-XXI centuries gave birth, defined and advanced the field of vascular injury management.

Effect of knowledge of human immunodeficiency virus infection status on sexual activity among homosexual men.

One hundred thirty-four homosexual men from a prospective cohort study of AIDS risk from New York City and Washington D.C. and 139 homosexual men from a similar cohort in Copenhagen and Aarhus, Denmark were questioned regarding their sexual practices and knowledge of their human immunodeficiency virus (HIV) status over the previous 12 months. Seventy percent of Danish men and 63% of U.S. men participated in anal intercourse during the previous 12 months. Knowledge of one's own HIV status by itself did not have any significant effect on participation in anal intercourse, partner number, or condom use. Only 23% of U.S. men and 24% of Danish men always asked potential partners about their HIV status. However, men who did ask were very unlikely to choose a partner of opposite HIV status (p less than 0.006). Danish men were more likely to practice anal intercourse without a condom than were the U.S. men (p less than 0.0001); however, Danes were more likely to be in a concordant monogamous relationship than were the U.S. men (p less than 0.001). Fourteen percent of U.S. men and 21% of Danish men were not aware of their own HIV status and 52% of the U.S. cohort and 31% of the Danes had anal intercourse with a man whose status was unknown to them. Overall, only 32% of American and 53% of Danish homosexual men were practicing completely safe sex. We suggest that education to promote the need for awareness of one's own and one's partner's HIV status should be stressed.

Cigarette smoking: a modifier of human immunodeficiency virus type 1 infection?

Two hundred and two homosexual men enrolled in a prospective cohort study of AIDS risk were assessed for differences in the occurrence and progression of human immunodeficiency virus type 1 (HIV-1) infection with respect to cigarette smoking. Among subjects who were initially seronegative, smokers were more likely than nonsmokers to become HIV-1 seropositive (p = 0.03). After seroconversion, serum beta 2-microglobulin and CD4+ lymphocyte levels were elevated in cigarette smokers relative to nonsmokers (p = 0.02 for both comparisons), but both of these differences disappeared within 2 years. There was no detectable difference in the risk of AIDS or Pneumocystis carinii pneumonia with respect to smoking. Our data suggest that cigarette smoking may alter the immune response to HIV-1 infection, but it appears to have no marked effect on clinical outcome. They also suggest that cigarette smoking may be a surrogate marker for continued high-risk sexual behavior in homosexual men.