A case of toxicity to excess 'carbocaine' with probable reactivity of rheumatic disease

No Abstrac

Saccadic eye movements estimate prolonged time awake

Prolonged time awake increases the need to sleep. Sleep pressure increases sleepiness, impairs human alertness and performance and increases the probability of human errors and accidents. Human performance and alertness during waking hours are influenced by homeostatic sleep drive and the circadian rhythm. Cognitive functions, especially attentional ones, are vulnerable to circadian rhythm and increasing sleep drive. A reliable, objective and practical metrics for estimating sleepiness could therefore be valuable. Our aim is to study whether saccades measured with electro-oculography (EOG) outside the laboratory could be used to estimate the overall time awake without sleep of a person. The number of executed saccades was measured in 11 participants during an 8-min saccade task. The saccades were recorded outside the laboratory (Naval Academy, Bergen) using EOG every sixth hour until 54 hr of time awake. Measurements were carried out on two occasions separated by 10 weeks. Five participants participated in both measurement weeks. The number of saccades decreased during sustained wakefulness. The data correlated with the three-process model of alertness; performance differed between participants but was stable within individual participants. A mathematically monotonous relation between performance in the saccade task and time awake was seen after removing the circadian rhythm component from measured eye movement data. The results imply that saccades measured with EOG can be used as a time-awake metric outside the laboratory.Peer reviewe

Hysteroscopy in daily practice

In the recent past, the established method for investigating women with abnormal uterine bleeding was dilatation and curettage. When hysteroscopic examination of the uterus proved to be more accurate, diagnostic hysteroscopy with or without endometrial sampling was suggested as the method of choice. The small diameter scopes with working- channels combined with the vaginoscopic approach have caused a shift from the inpatient setting to an ambulatory one without anaesthesia. Likewise, the introduction of several new surgical techniques has improved handling of instruments, patient safety and therapeutic options. This thesis deals with the implementation of hysteroscopic surgery in The Netherlands, the diagnostic accuracy of hysteroscopy, the patient preference with regard to the method of examining the uterine cavity, and the effectiveness of several hysteroscopic applications in the treatment of abnormal uterine bleeding.Johnson & Johnson Medical bv JE Jurriaanse Stichting Medical Dynamics NVEC Olympus Nederland bv Serano Benelux bv Smith & Nephew bv Wyeth Pharmaceuticals bvUBL - phd migration 201

From undifferentiated arthritis to rheumatoid arthritis : epidemiology, immunology and early intervention

In this thesis clinical and immunological studies in patients with undifferentiated (UA) and rheumatoid arthritis (RA) are described. Depending on the study population 6-55% of the patients who presented with UA actually fulfilled the criteria for RA as defined by the ACR in 1987 over time. In the first four years, radiographic joint damage, disease activity and HAQ were comparable in patients with RA presenting with UA and patients presenting with RA. Treatment of UA patients with methotrexate resulted in postponing progression to RA and retarding radiographic joint damage. In UA patients who had low/intermediate pretreatment ACPA-levels and were treated with methotrexate, the incidence of RA was lower than in patients with high levels. The disease activity score that was used in RA patients was validated in patients with UA. To identify which patient with UA will progress to RA, a prediction rule was developed. In patients with RA, treatment with TNF-alpha resulted in recovery of regulatory T cells. The importance of these regulatory T cells was emphasized in the strength of the anti-inflammatory response to the human cartilage glycoprotein 39 in healthy individuals: it even suppressed other pro-inflammatory responses, whereas patients with RA reacted with a pro-inflammatory responseSubsidie tbv onderzoek: ZonMw, Reumafonds Financiele ondersteuning voor de druk van het proefschrift: Abbott bv, AstraZeneca, JE Jurriaanse Stichting, Het Reumafonds, Merck Sharp & Dohme bv, Roche, Schering-Plough, Sectra DXR-online, TEVA Pharma en UCB PharmaUBL - phd migration 201

Nontrivial Polydispersity Exponents in Aggregation Models

We consider the scaling solutions of Smoluchowski's equation of irreversible aggregation, for a non gelling collision kernel. The scaling mass distribution f(s) diverges as s^{-tau} when s->0. tau is non trivial and could, until now, only be computed by numerical simulations. We develop here new general methods to obtain exact bounds and good approximations of $\tau$. For the specific kernel KdD(x,y)=(x^{1/D}+y^{1/D})^d, describing a mean-field model of particles moving in d dimensions and aggregating with conservation of ``mass'' s=R^D (R is the particle radius), perturbative and nonperturbative expansions are derived. For a general kernel, we find exact inequalities for tau and develop a variational approximation which is used to carry out the first systematic study of tau(d,D) for KdD. The agreement is excellent both with the expansions we derived and with existing numerical values. Finally, we discuss a possible application to 2d decaying turbulence.Comment: 16 pages (multicol.sty), 6 eps figures (uses epsfig), Minor corrections. Notations improved, as published in Phys. Rev. E 55, 546

The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

To study whether the effects of prognostic factors associated with the occurrence of distant metastases (DM) at primary diagnosis change after the incidence of loco-regional recurrences (LRR) among women treated for invasive stage I or II breast cancer. The study population consisted of 3,601 women, enrolled in EORTC trials 10801, 10854, or 10902 treated for early-stage breast cancer. Data were analysed in a multivariate, multistate model by using multivariate Cox regression models, including a state-dependent covariate. The presence of a LRR in itself is a significant prognostic risk factor (HR: 3.64; 95%-CI: 2.02-6.5) for the occurrence of DM. Main prognostic risk factors for a DM are young age at diagnosis (</=40: HR: 1.79; 95%-CI: 1.28-2.51), larger tumour size (HR: 1.58; 95%-CI: 1.35-1.84) and node positivity (HR: 2.00; 95%-CI: 1.74-2.30). Adjuvant chemotherapy is protective for a DM (HR: 0.66; 95%-CI: 0.55-0.80). After the occurrence of a LRR the latter protective effect has disappeared (P = 0.009). The presence of LRR in itself is a significant risk factor for DM. For patients who are at risk of developing LRR, effective local control should be the main target of therapy

The Steady Boundary Layer due to a Fast Vortex

A point vortex located above and convected parallel to a wall is an important model of the process by which a boundary layer becomes unstable due to external disturbances. Often it has been assumed that the boundary layer due to the passage of the vortex is inherently unsteady. Here we show that for a vortex convected by a uniform shear flow, there is a steady solution when the speed of the vortex cv is sufficiently fast. The existence of the steady solution is demonstrated analytically in the limit of large vortex velocity (cv→∞) and numerically at more moderate speeds. This solution may provide a useful base state about which to investigate the stability of a boundary layer induced by external disturbances

Kinetic Anomalies in Addition-Aggregation Processes

We investigate irreversible aggregation in which monomer-monomer, monomer-cluster, and cluster-cluster reactions occur with constant but distinct rates K_{MM}, K_{MC}, and K_{CC}, respectively. The dynamics crucially depends on the ratio gamma=K_{CC}/K_{MC} and secondarily on epsilon=K_{MM}/K_{MC}. For epsilon=0 and gamma<2, there is conventional scaling in the long-time limit, with a single mass scale that grows linearly in time. For gamma >= 2, there is unusual behavior in which the concentration of clusters of mass k, c_k decays as a stretched exponential in time within a boundary layer k<k* propto t^{1-2/gamma} (k* propto ln t for gamma=2), while c_k propto t^{-2} in the bulk region k>k*. When epsilon>0, analogous behaviors emerge for gamma<2 and gamma >= 2.Comment: 6 pages, 2 column revtex4 format, for submission to J. Phys.