Primary Fibrinolysis in Acute Monocytic Leukemia

We present the case of a young man with acute monocytic leukemia (French-American-British classification:M5) and systemic hyperfibrinolysis with severe bleeding. Although fibrinolysis is usually mild and secorulary to disseminated intravascular coagulation, its role as a primary and dominant factor in rare cases of leukemia warrants that its presence be sought as a cause of abnormal bleeding. Decreased serum plasminogen and increased serum plasmin determined by synthetic substrate assay and a negative protamine paracoagulation test are crucial findings. Use of high-dose epsilon-aminocaproic acid was effective in treating this complication. A transient increase in fibrinolytic activity coincident with the early effect of antileukemic treatment suggested that plasminogen activator and/or fibrinolytic protease substances were released from leukemic cells. Fibrinolytic activity subsequently disappeared with reduction in the population of leukemic cells

Cross-National Logo Evaluation Analysis: An Individual Level Approach

The universality of design perception and response is tested using data collected from ten countries: Argentina, Australia, China, Germany, Great Britain, India, the Netherlands, Russia, Singapore, and the United States. A Bayesian, finite-mixture, structural-equation model is developed that identifies latent logo clusters while accounting for heterogeneity in evaluations. The concomitant variable approach allows cluster probabilities to be country specific. Rather than a priori defined clusters, our procedure provides a posteriori cross-national logo clusters based on consumer response similarity. To compare the a posteriori cross-national logo clusters, our approach is integrated with Steenkamp and Baumgartner’s (1998) measurement invariance methodology. Our model reduces the ten countries to three cross-national clusters that respond differently to logo design dimensions: the West, Asia, and Russia. The dimensions underlying design are found to be similar across countries, suggesting that elaborateness, naturalness, and harmony are universal design dimensions. Responses (affect, shared meaning, subjective familiarity, and true and false recognition) to logo design dimensions (elaborateness, naturalness, and harmony) and elements (repetition, proportion, and parallelism) are also relatively consistent, although we find minor differences across clusters. Our results suggest that managers can implement a global logo strategy, but they also can optimize logos for specific countries if desired.adaptation;standardization;Bayesian;international marketing;design;Gibbs sampling;concomitant variable;logos;mixture models;structural equation models

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a "spike"and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs

MALIGNANT SOMATOSTATINOMA PRESENTING WITH DIABETIC KETOACIDOSIS

High circulating levels of somatostatin (SRIF) were detected in a patient with a metastatic tumour after development of diabetic ketoacidosis (DKA). Fasting insulin and C-peptide levels were markedly suppressed, but plasma glucagon was not suppressed below normal. Progressive cachexia ensued; at autopsy a poorly differentiated non-small cell neuroendocrine carcinoma metastatic to liver was found. Small gallstones were noted. Electron microscopy of tumour tissue showed neurosecretory granules and tonofilament bundles. Immunohis-tochemical staining of tumour cells was diffusely positive for carcinoembryonic antigen, bombesin-like immunoreactivity, and calcitonin with focal immuno-reactivity for SRIF, serotonin, neuron-specific enolase, chromogranin, and epithelial membrane antigen. Column chromatography of plasma and tumour extract revealed five or more peaks of material with SRIF-like immunoreactivity (SRIF-LI): predominantly SRIF-28 and intermediates in tumour extract, and SRIF-14 and an intermediate between SRIF-28 and SRIF-14 in plasma. DKA in this case of somatostatinoma syndrome may reflect differential effects of tumour production of larger molecular weight SRIF forms on insulin and glucagon secretion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75579/1/j.1365-2265.1987.tb00817.x.pd

Ekstubacija nakon anestezije: randomizirana usporedba triju tehnika

The mode of ventilation used during awake extubation has not previously been studied. We conducted a randomised controlled trial comparing spontaneous respiration, intermittent positive pressure ventilation, and pressure support ventilation (each n=13) for incidence and severity of peri-extubation complications following routine elective surgery. We found the severity of peri-extubation cough was significantly affected by mode of ventilation used at extubation (p=0.049), with lowest severity grades for those in the pressure support ventilation group. The mean arterial pressure at extubation was lowest in the intermittent positive pressure ventilation group (p=0.007). Other peri-extubation complications and time to extubation following cessation of anaesthesia were not significantly different across the three groups. We suggest that the use of pressure support ventilation for awake extubation may offer an advantage over spontaneous and intermittent positive pressure ventilation extubation strategies.Dosad nije ispitivan način ventilacije tijekom budne ekstubacije. Proveli smo randomizirano kontrolirano ispitivanje uspoređujući spontanu respiraciju, povremenu ventilaciju pozitivnim tlakom i ventilaciju uz tlačnu potporu (n=13 svaka) u odnosu na incidenciju i težinu periekstubacijskih komplikacija nakon rutinske elektivne kirurške operacije. Nalazi su pokazali da na težinu periekstubacijskog kašlja značajno utiče način ventilacije primijenjen kod ekstubacije (p=0,049), pričem su najniži stupnjevi težine kašlja zabilježeni u skupini bolesnika kod kojih je primijenjena ventilacija uz tlačnu potporu. Srednji arterijski tlak kod ekstubacije bio je najniži u skupini kod koje je primijenjena povremena ventilacija pozitivnim tlakom (p=0,007). Ostale periekstubacijske komplikacije i vrijeme do ekstubacije nakon prestanka anestezije nisu se značajno razlikovale među trima skupinama. Smatramo da bi primjena ventilacije uz tlačnu potporu mogla imati prednost pred strategijama spontane respiracije i povremene ventilacije pozitivnim tlakom

Reference Distorted Prices

I show that when consumers (mis)perceive prices relative to reference prices, budgets turn out to be soft, prices tend to be lower and the average quality of goods sold decreases. These observations provide explanations for decentralized purchase decisions, for people being happy with a purchase even when they have paid their evaluation, and for why trade might affect high quality local firms 'unfairly'

Cross-National Logo Evaluation Analysis: An Individual Level Approach

The universality of design perception and response is tested using data collected from ten countries: Argentina, Australia, China, Germany, Great Britain, India, the Netherlands, Russia, Singapore, and the United States. A Bayesian, finite-mixture, structural-equation model is developed that identifies latent logo clusters while accounting for heterogeneity in evaluations. The concomitant v

Monitoring Tumorigenesis and Senescence In Vivo with a p16INK4a-Luciferase Model

Monitoring cancer and aging in vivo remains experimentally challenging. Here, we describe a luciferase knockin mouse (p16LUC), which faithfully reports expression of p16INK4a, a tumor suppressor and aging biomarker. Lifelong assessment of luminescence in p16+/LUC mice revealed an exponential increase with aging, which was highly variable in a cohort of contemporaneously housed, syngeneic mice. Expression of p16INK4a with aging did not predict cancer development, suggesting that the accumulation of senescent cells is not a principal determinant of cancer-related death. In 14 of 14 tested tumor models, expression of p16LUC was focally activated by early neoplastic events, enabling visualization of tumors with sensitivity exceeding other imaging modalities. Activation of p16INK4a was noted in the emerging neoplasm and surrounding stromal cells. This work suggests that p16INK4a activation is a characteristic of all emerging cancers, making the p16LUC allele a sensitive, unbiased reporter of neoplastic transformation