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Endosonography-guided treatment of esophageal carcinoma.

Endosonography is helpful in managing patients with esophageal cancer due to its capacity to stage the tumor for the depth of tumoral invasion and the presence of metastatic lymph nodes. Thus, ES will help the surgeon to determine if surgery is advisable. If the patient does not undergo surgery, it will provide a very accurate prognosis and allow the adaptation of non-surgical multimodal therapy to determine tumor extension. Finally, following the initial phase of treatment. ES will be useful in the follow-up, especially to detect and stage recurrences.

Actuarial Analysis↗

The temporal properties of rod vision.

1. Profiles which represent rod thresholds for flickering fields seen against backgrounds of various intensity have shapes which depend on flicker frequency. Low frequency profiles rise smoothly as background intensity is increased. High frequency profiles are only affected by bright backgrounds, which cause them to rise steeply. Intermediate frequency profiles contain two distinct branches which resemble separate increment threshold functions. 2. The high intensity branches of two-branched threshold profiles cannot be attributed to cone intrusion. Instead, both branches of such profiles are mediated by visual mechanisms which have the spectral properties, the dark adaptation properties and the directional insensitivity of rod vision. Thus, the stimuli are detected by rods. 3. Plots of critical flicker frequency (c.f.f.) as a function of intensity contain two rising branches which are separated by a plateau (when modulation depth is large), or they form two enclosed lobes so that only intermediate frequencies, but neither high nor low ones, are seen (when modulation depth is small). C.f.f. is profoundly depressed by very bright light (above 100 scotopic trolands) which saturates rod vision. 4. In dim light rod modulation sensitivity functions resemble those of low-pass filters, but in bright light they resemble those of band-pass filters. 5. Several forms of rod mediated interference occur at moderate intensities, where rod vision's temporal properties ordinarily improve abruptly. With certain stimuli, rod signals conveying temporal information disrupt one another so completely that suprathreshold flicker cannot be seen within a ten-fold intensity range. 6. Many of these observations can be explained by the hypothesis that rod vision comprises two temporal channels which have different properties.

Flicker Fusion↗

Inhomogeneous cartilage properties enhance superficial interstitial fluid support and frictional properties, but do not provide a homogeneous state of stress.

It has been well established that articular cartilage is compositionally and mechanically inhomogenous through its depth. To what extent this structural inhomogeneity is a prerequisite for appropriate cartilage function and integrity is not well understood. The first hypothesis to be tested in this study was that the depth-dependent inhomogeneity of the cartilage acts to maximize the interstitial fluid load support at the articular surface, to provide efficient frictional and wear properties. The second hypothesis was that the inhomogeneity produces a more homogeneous state of elastic stress in the matrix than would be achieved with uniform properties. We have, for the first time, simultaneously determined depth-dependent tensile and compressive properties of human patellofemoral cartilage from unconfined compression stress relaxation tests. The results show that the tensile modulus increases significantly from 4.1 +/- 1.9 MPa in the deep zone to 8.3 +/- 3.7 MPa at the superficial zone, while the compressive modulus decreases from 0.73 +/- 0.26 MPa to 0.28 +/- 0.16 MPa. The experimental measurements were then implemented with the finite-element method to compute the response of an inhomogeneous and homogeneous cartilage layer to loading. The finite-element models demonstrate that structural inhomogeneity acts to increase the interstitial fluid load support at the articular surface. However, the state of stress, strain, or strain energy density in the solid matrix remained inhomogeneous through the depth of the articular layer, whether or not inhomogeneous material properties were employed. We suggest that increased fluid load support at the articular surface enhances the frictional and wear properties of articular cartilage, but that the tissue is not functionally adapted to produce homogeneous stress, strain, or strain energy density distributions. Interstitial fluid pressurization, but not a homogeneous elastic stress distribution, appears thus to be a prerequisite for the functional and morphological integrity of the cartilage.

Anisotropy↗

Oxygen distribution and consumption in the developing rat retina.

PURPOSE: To determine the intraretinal oxygen distribution and oxygen consumption in the rat before eye opening and maturation of the retina. METHODS: Oxygen-sensitive microelectrodes were used to measure the oxygen tension as a function of depth through the retina in anesthetized Sprague-Dawley rats at postnatal day (P)15. Measurements were made under air-breathing conditions and at increasing levels of systemic oxygenation (20%, 40%, 60%, 80%, and 100% oxygen) under light-adapted conditions. Oxygen consumption in the outer retina and in the predominantly avascular region of the inner retina was assessed by fitting the oxygen profiles to a mathematical model of oxygen consumption. The retinas were processed for histology and compared with retinas from mature animals. RESULTS: Under normal conditions, the intraretinal oxygen distribution at P15 was significantly different in some respects from that in mature animals. Oxygen consumption analysis indicated an average outer retinal oxygen consumption rate of 103 +/- 15 nL/min per cm2 and an inner retinal oxygen consumption rate of 42.4 +/- 11.7 nL/min per cm2. Inner retinal oxygen consumption was significantly (P < 0.001) lower than that previously measured in mature rats, but outer retinal oxygen consumption was similar. Systemic hyperoxia increased the oxygen level throughout the retina, but choroidal PO2 in particular remained significantly lower than in adult rats (P < 0.001). At P15 there were marked differences in the relative thickness of some retinal layers when compared with adult rats. In particular the inner and outer nuclear layers were much thicker at P15, the outer segments of the photoreceptors and the inner and outer plexiform layers were not fully developed. CONCLUSIONS: At P15, before eye opening, the oxygen consumption of the inner retina is lower than in mature retinas, presumably reflecting the immaturity of the retina in such young animals so soon after their first exposure to light stimuli.

Animals↗

Stroke patients' carers' views of formal community support.

Stroke is a common, disabling condition. Those who look after stroke patients in the community are placed under a lot of strain. In this study a purposive sample of eight carers, chosen to obtain as wide a spread of opinion as possible, were interviewed in depth on their views about the formal support services they receive in the community. A detailed content analysis of the transcripts of the interviews revealed four areas important to carers: information and education; provision of practical help; convenience, coordination and adaptability of service; and consultation with and consideration of the carer. In all areas there was considerable room for improvement. Carers particularly valued community care professionals who listened to them, seemed to understand them and were prepared to put in some effort for them. The importance of ongoing information provision was stressed.

Caregivers↗

Design and pilot testing of the DVA/Seattle Footwear System for diabetic patients with foot insensitivity.

Clinical epidemiology studies suggest the majority of lower limb amputations were preceded by a minor traumatic event, often footwear-related, and lower limb ulcers. To reduce foot trauma and ulcers, the diabetic patient with foot insensitivity has unique footwear needs. To address these needs for patients not requiring custom shoes, the DVA/Seattle Footwear System was developed. The six components of this system include: 1) a specially designed shoe last based on the geometry of the diabetic foot and research findings on foot regions at highest risk of ulceration, 2) a depth-inlay shoe, "Custom Stride by PRS," designed to be paired with either a custom-fabricated cork insole or a preformed polyurethane insole, 3) a laser digitizing system that captures 3-D plantar foot contours, 4) DVA/Seattle ShapeMaker software adaptation for modifying plantar surface contours and applying free-form and template modifications to increase or relieve loading, 5) software that translates files into code used by a milling machine to define the cutting path and carve cork blockers into custom insoles, and 6) a preformed polyurethane insole thicker than a typical insole to accommodate the extra volume and the interior dimensions of the shoe. A 6-month pilot cross-over trial of 24 diabetic male veterans without prior foot ulcers was conducted to determine the feasibility of producing, and the safety of wearing, these depthinlay shoes and both types of insoles. During the first 4 weeks, patients were assigned to the study shoes and one type of insole. During the next 4 weeks, they wore the other type of insole, and during the final 4 months, they chose which pair of insoles to wear with the study shoes. Over 150 person-months of footwear observation revealed no breaks in the cutaneous barrier with use of either cork or polyurethane insoles and the study shoes. Patient compliance with the footwear was 88%. Patients were highly satisfied with the appearance, stability, and comfort of the shoes and the comfort of both types of insole. However, 75% of the patients noted that the study shoes felt heavier than their customary shoes. Further research is needed to determine the long-term effectiveness of footwear in prevention of foot ulcers in the population at highest risk for diabetic reulceration and amputation.

Aged↗

Pattern of mucosal adaptation in acute and chronic pouchitis.

PURPOSE: Variant pathological changes have been observed in ileoanal pouches, including inflammation, villous atrophy, and crypt hyperplasia. Therefore, we investigated the type and degree of mucosal adaptation in patients with ulcerative colitis and familial adenomatous polyposis. METHODS: Forty-two patients with ulcerative colitis and 14 patients with familial adenomatous polyposis with ileoanal pouches were assessed. Samples were taken from three months to eight years after creation of an ileoanal pouch. Mucosal architecture was examined by morphometry after microdissection. RESULTS: Structural changes of the mucosa can be categorized into three groups. Compared with preoperative values, patients without pouchitis (73 percent) has only minor decrease of villous length (402 microm vs. 540 microm) and increase in crypt depth (274.5 microm vs. 177 microm). In patients with acute pouchitis (20 percent), a slight increase in villous length (477 microm vs. 402 microm) and pronounced crypt hyperplasia (376 microm vs. 274.5 microm) was observed compared with noninflamed ileoanal pouches. In contrast, in patients with chronic pouchitis (7 percent), severe villous atrophy (62.5 microm) and crypt hyperplasia (543 microm) was found. CONCLUSIONS: Minor structural changes of ileoanal pouch mucosa develop early as an adaptive response to a new environment. Only in a small group of patients with chronic pouchitis does severe villous atrophy and crypt hyperplasia of the ileoanal pouch mucosa develop, most likely as a consequence of mucosal inflammation.

Adenomatous Polyposis Coli↗

Adaptive clutter filtering via blind source separation for two-dimensional ultrasonic blood velocity measurement.

A method for adaptive clutter rejection via blind source separation (BSS) using principal and independent component analyses is presented in application to blood velocity measurement in the carotid artery. In particular, the filtering method's efficacy for eliminating clutter and preserving lateral blood flow signal components is presented. The performance of IIR filters is compromised by shorth data ensembles (10 to 20 temporal samples) as implemented for color-flow and high frame-rate imaging due to initialization requirements. Further, the ultrasonic imaging system's transfer function maps axial wall and lateral blood motion to overlapping spectra. As such, frequency domain-based approaches to wall filtering are ineffective for distinguishing wall from blood motion signals. Rather than operating in the frequency domain. BSS performs clutter rejection by decomposing the input data ensemble into N constitutive source signals in time, where N is the ensemble length. Source signal energy coupled with respective signal depth and time course profiles reveal which source signals correspond to blood, noise and clutter components. Clutter components may then be removed without disruption of lateral blood flow information needed for two-dimensional blood velocity measurement. A simplistic data simulation is employed to offer an intuitive understanding of BSS methods for signal separation. The adaptive BSS filter is further demonstrated using a Field II simulation of blood flow through the carotid artery including tissue motion. BSS clutter filter performance is compared to the performance of FIR, IIR and polynomial regression clutter filters. Finally, the filter is employed for clinical application using a Siemens Elegra scanner, carotid artery data with lateral blood flow collected from healthy volunteers, and Speckle Tracking; velocity magnitude and angle profiles are shown. Once again, the BSS clutter filter is contrasted to FIR, IIR and polynomial regression clutter filters using clinical examples. Velocities computed with Speckle Tracking after BSS wall filtering are highest in the center of the artery and diminish to low velocities near the vessel walls, with velocity magnitudes consistent with physiological expectations. These results demonstrate that the BSS adaptive filter sufficiently suppresses wall motion signal for clinical lateral blood velocity measurement using data ensembles suitable for color-flow and high frame-rate imaging.

Blood Flow Velocity↗

Epidermal growth factor and bombesin act synergistically to support intestinal adaptation in rats with massive small bowel resection.

Intestinal adaptation is the most important event in short bowel syndrome following a massive small bowel resection. Effects of various growth factors and their synergism have been well documented in intestinal adaptation. This study aimed to compare the effect of two different trophic agents, epidermal growth factor (EGF) and bombesin (BBS), on intestinal adaptation following massive intestinal resection. Sprague-Dawley male rats were assigned to one of four groups after a 75% small bowel resection. Either EGF (90 microg/kg), BBS (10 microg/kg), EGF+BBS, or bovine serum albumin (BSA) were injected subcutaneously three times a day. The animals were killed 10 days after the operation. Weight loss and morphologic parameters such as mucosal thickness, villus height, crypt depth, villus-to-crypt ratio, and muscularis propria height were measured. In the EGF+BBS group, mucosal thickness was found to be significantly increased compared with the other study groups (p<0.05). Similarly, villus height was significantly increased only in the EGF+BBS group (p<0.05). In the BBS group, both villus height and mucosal thickness showed a slight increase, but the values were not statistically significant compared with the vehicle-treated group. There were no significant differences in any of the remaining parameters between the groups. The results of this study indicate that the gut hormones EGF and BBS act synergistically in facilitating the adaptive response of the remnant ileum to massive intestinal resection.

Adaptation, Physiological↗

Seed size and germination response: a relationship for fire-following plant species exposed to thermal shock.

Thermal shock is well known to be an important stimulus for the germination of soil-stored seeds in fire-prone plant communities. Nevertheless, while the overall germination response of different species is known to vary, the interaction between seed size and germination to a range of thermal-shock temperatures is poorly understood. This interaction may be important in regulating post-fire plant community establishment, since larger seeds are able to emerge from deeper within the soil profile than smaller seeds, and are therefore likely to be insulated against high above-ground temperatures by a deeper soil covering. In this experiment we examined how germination of eight co-occurring Western Australian fire-followers was influenced by thermal shock, and whether germination was significantly correlated with seed size. We found that small-seeded species not only showed enhanced germination at higher temperatures, but that their ability to germinate at higher temperatures was also greater than that displayed by larger-seeded species. These findings suggest that while seed size may be a useful general predictor of post-fire recruitment success, under different fire regimes the interaction between seed size, maximum seedling emergence depth, and the ability to withstand different thermal-shock temperatures is complex and may confound recent predictive models.

Adaptation, Physiological↗

Specialization of retinal function in the compound eyes of mantis shrimps.

Visual function and its specialization at the level of the retina were studied in 13 species of stomatopod crustaceans, representing three superfamilies: Gonodactyloidea, Lysiosquilloidea, and Squilloidea. We measured attenuation and irradiance spectra in the environment of each species, at the actual depths and times of activity where we observed individuals. We also characterized the intrahabdomal filters of all study species and determined the absolute spectral sensitivity functions and approximate photon capture rates of all photoreceptor classes below the level of the 8th retinular cell in seven of these species. Shallow-water gonodactyloid species have four distinct classes of intrarhabdomal filters, producing photoreceptors that are relatively insensitive but which have the broadest spectral coverage of all. Deep-water gonodactyloids and all lysiosquilloids have filters that are spectrally less diverse. These species often discard the proximal filter classes of one or more receptor types. As a result, their retinas are more sensitive but have reduced spectral range or diversity. The single squilloid species has the most sensitive photoreceptors of any we observed, due to the lack both of intrarhabdomal filters and tiered photoreceptors. Photon absorption rates, at the times of animal activity, were similar in most photoreceptor classes of all species, whether the receptors were tiered or untiered, or filtered or unfiltered. Thus, the retinas of stomatopods are specialized to operate at similar levels of stimulation at the times and depths of actual use, while evidently maintaining the greatest possible potential for spectral coverage and discrimination.

Adaptation, Physiological↗

Maternal role of clerical workers: a feminist analysis.

This paper presents the qualitative findings about women's maternal role from an interview study of role integration and health in a U.S. sample of 87 women clerical workers. The data draws from clerical women's perceptions of the satisfactions and stresses they experience in their roles as mothers, the coping strategies they use, and the resources available to them. The analysis provided is based on participants' descriptions of their subjective experiences as mothers within the larger context of managing domestic responsibilities and fulltime jobs outside their homes. Results suggest that women in clerical jobs find many aspects of their maternal role satisfying, like participating in their children's growth, nurturing them, receiving unconditional love, and finding companionship. However, they identify multiple and pervasive stresses including boundless worries, strained relationships, overload, child care problems, and financial burdens. Many of their coping strategies are solitary in nature, although they also engage in active problem-solving, especially when they have to juggle child care and occupational responsibilities. Many do not view their spouses as sources of emotional and tangible support in childrearing. In addition to an in-depth discussion of qualitative findings, the authors examine implications for social policy, intervention, and future research about multiple roles and health.

Adaptation, Psychological↗

Influence of temperature on the development and decay of thermotolerance and heat shock proteins.

The development of thermotolerance and its decay in plateau-phase Chinese hamster cells are shown to be temperature-dependent phenomena. Development of tolerance, after an initial dose of 10 min at 45 degrees C, is appreciably slower between 20 and 28 degrees C than it is at 37 degrees C. Decay of tolerance is also slower in that temperature range; at 4-23 degrees C, it does not decay at all during the 96-h interval of the experiment. At 41 degrees C, thermotolerance decay, "step-down" cell killing, and thermotolerance induction apparently all occur and affect cell survival. The decay of HSP 70 mirrors that of thermotolerance, except at 41 degrees C. At that temperature very likely de novo synthesis of that protein becomes important in determining protein concentration. Our data show that care must be taken when extrapolating from kinetic data obtained with surface tissues in vivo to those in depth. The former are usually at a temperature between 25 and 32 degrees C; the latter are at 37 degrees C.

Adaptation, Physiological↗

Effect of IGF-rich colostrum on bowel adaptation in neonatal piglets with short bowel syndrome.

BACKGROUND: Insulin-like growth factor 1 (IGF-1), a polypeptide growth factor with mitogenic effects on intestinal epithelial crypt cells occurs naturally in high concentrations in colostrum. The hypothesis for this study was that colostrum rich in IGF-1 could promote small bowel adaptation in neonatal piglets with short bowel syndrome. METHODS: Twenty-four piglets, aged 7 days, underwent 75% small bowel resection and were fed 525 kJ x kg(-1) x d(-1) (125 kcal) of colostrum-based formula (Rs(+)) or placebo formula (Rs(-)). Immunoglobulin G (IgG) accounted for 35% of the protein and was compensated with casein and whey protein in the control feed. The piglets were weighed daily and killed 28 days after surgery. Bowel samples were taken at surgery and at death. RESULTS: Relative body-weight increase did not differ between the Rs(+) and Rs(-) group (84% +/- 9% vs. 90% +/- 12%, P = 0.83). There was a significant relative increase in crypt depth in the Rs - compared with the Rs + group (201% +/- 15% vs. 147% +/- 17%, P = 0.02) and total protein (mg/cm bowel) (482 +/- 51 vs. 278 +/- 46, P = 0.008). Increase in villus length, DNA/RNA content, and mitotic index did not differ between groups. CONCLUSION: Colostrum supplement rich in IGF-1 has no benefits over protein-enriched feed with respect to growth and bowel adaptation in neonatal piglets with short bowel syndrome.

Adaptation, Physiological↗

Morphological and functional adaptation of the small intestine after colectomy and ileal pouch-anal anastomosis in rats.

BACKGROUND AND AIMS: This study investigated morphological and functional changes in the small bowel after colectomy and ileal pouch-anal anastomosis (IPAA). METHODS AND MATERIALS: In 15 rats electrolyte, glucose, and water absorption was determined by in vivo single-pass perfusion of the proximal and distal small intestine 15 weeks after IPAA. Afterwards the small intestine was resected for morphometric evaluation. Controls were 15 identically treated rats without operation. RESULTS: IPAA led to a significant increase in the small intestinal diameter and a significant increase in villus length and density, which was more apparent in ileum than in jejunum. Therefore the mucosal surface per unit serosa increased significantly by 59% in the jejunum and by 76% in the ileum. In the pouch there was a significant increase in goblet cell density, crypt depth, and diameter of the muscularis which was not detectable in the segments proximal from the pouch. Due to the increase in mucosal surface there was a significant increase in total glucose and electrolyte and sorption in the ileum while absorption rates per unit mucosa were unchanged, with the exception of an increase in mucosal sodium absorption. Jejunal absorption and ileal absorption of water remained unchanged. CONCLUSION: Adaptation of the small intestine after IPAA leads to colonic metaplasia in the pouch and intestinal hyperplasia proximal from the pouch. The loss of colonic absorption is compensated by the increase in ileal mucosal surface with subsequently elevated electrolyte and glucose absorption. Changes in intestinal permeability may be responsible for additional water depletion, which is compensated by the upregulation of enteric water and sodium absorption.

Adaptation, Physiological↗

Plasticity and acclimation to light reflected in temporal and spatial changes of small-scale macroalgal distribution in a stream.

The small-scale distribution pattern of macroalgae in the river Ilm, in Germany was monitored. These patterns were then related to abiotic factors and tested to discover whether the distribution of the common macroalgae, Cladophora glomerata (L.) Kütz. and Vaucheria sp., was linked to differences in their photosynthetic plasticity. Cladophora glomerata revealed higher maximum photosynthetic electron transport rates after acclimation to high light (HL) compared with low light (LL) acclimated samples. By contrast, Vaucheria sp. did not acclimate to different growth light conditions. The photosynthetic performance of both algae also varied according to diurnal conditions. High light caused a reversible decrease of the dark-adapted quantum yield (F(v)/F(m)) in C. glomerata and a concomitant reversible decrease of the light-adapted quantum yield (DeltaF/F'(m)). In Vaucheria sp., F(v)/F(m) remained mostly unchanged over the day, whereas DeltaF/F'(m) decreased during the morning at low light. Photosynthetic pigments confirmed acclimational differences between the species. HL C. glomerata showed increased chlorophyll a:chlorophyll b ratios, and higher amounts of xanthophyll-cycle pigments compared with LL samples, whereas Vaucheria sp. did not reveal differences between the light treatments. While preferences for substrate size, water velocity, and depth are similar for C. glomerata and Vaucheria sp., the physiological responses to light conditions are different. It is concluded that light conditions significantly affect the small-scale spatial distribution of macroalgae and that fitness is enhanced in species with a higher plasticity in photosynthetic acclimation in unstable environments.

Adaptation, Physiological↗

Stage-dependent therapy of rectal carcinoid tumors.

Although malignant behavior of rectal carcinoid tumors is rare, the risk of metastases and death does exist. Adaptation of therapy according to the estimated malignancy seems necessary. To develop a stage-dependent therapy, 31 patients with rectal carcinoid tumors measuring 5 to 50 mm in diameter were analyzed retrospectively. Malignancy was estimated according to tumor size, infiltration depth, and histopathology. There were 18 tumors within the mucosa and submucosa (T1), 7 tumors with muscularis propria invasion (T2), and carcinoid tumor penetrating the full rectal wall (T3) or spreading to surrounding tissue (T4) in 6 patients. Altogether 20 patients (65%) were treated with a minimally invasive intervention: endoscopic polypectomy (EP) in 12 and transanal excision (TE) in 8 patients. In 11 patients (35%) aggressive surgical procedures--anterior resection (AR) in 4 and abdominoperineal resection (APR) in 7--were performed. After a mean +/- SD follow-up of 86.0 +/- 61.3 months, tumor recurrence was not seen in any of the 20 patients with minimally invasive treatment, and all were still alive. No severe complications associated with surgical procedures were detected. In contrast, 5 of the 10 patients with advanced tumor stage died from their disease despite aggressive surgery (AR, APR). In conclusion, depending on tumor stage, treatment of rectal carcinoids includes EP, TE, or extended resection. Minimally invasive techniques are safe treatments for small to medium-size T1/T2 rectal carcinoids. Extended surgery cannot improve the overall survival of those with advanced tumors (T3/T4, N1, M1) but can be beneficial for preventing local complications.

Adult↗

Molecular analyses of the sediment of the 11,000-m deep Mariana Trench.

We have obtained sediment samples from the world's deepest sea-bottom, the Mariana Trench challenger point at a depth of 10,898 m, using the new unmanned submersible Kaiko. DNA was extracted from the sediment, and DNA fragments encoding several prokaryotic ribosomal RNA small-subunit sequences and pressure-regulated gene clusters, typically identified in deep-sea adapted bacteria, were amplified by the polymerase chain reaction. From the sequencing results, at least two kinds of bacterial 16S rRNAs closely related to those of the genus Pseudomonas and deep-sea adapted marine bacteria, and archaeal 16S rRNAs related to that of a planktonic marine archaeon were identified. The sequences of the amplified pressure-regulated clusters were more similar to those of deep-sea barophilic bacteria than those of barotolerant bacteria. These results suggest that deep-sea adapted barophilic bacteria, planktonic marine archaea, and some of the world's most widespread bacteria (the genus Pseudomonas) coexist on the world's deepest sea-bottom.

Base Sequence↗