Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts

Background. We have recently shown that the transjugular intrahepatic portosystemic shunt (TIPS) is more effective than paracentesis in the treatment of cirrhotic patients with severe ascites and can prolong survival in selected patients. Although an improved quality of life (QOL) has been suggested in these patients after the TIPS procedure, so far there are no data available to substantiate this assumption. Therefore, the aim of this study was to determine the effect of TIPS on the QOL in cirrhotic patients with refractory or recidivant ascites. Methods: 21 cirrhotic patients who underwent TIPS for refractory or recidivant ascites were investigated. All patients were pretreated with repeated paracentesis for at least 1 year. Before the procedure and at 3 and 6 months during follow-up, the patients themselves rated QOL, fatigue and physical performance on a visual analogue scale (range 0-100). Furthermore, QOL was determined by the QOL index (range 0-10) according to Spitzer. Results: Patients' rating of the QOL on the visual analogue scale significantly increased from 35 +/- 25 (baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p = 0.02). Similarly, the QOL index significantly increased from 6.9 +/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6 months; p < 0.001). The increase of QOL was more pronounced in patients with complete response to TIPS. Conclusions: We demonstrate that TIPS for refractory or recidivant ascites improves the QOL in patients with cirrhosis. Our data indicates that this improvement is dependent on the response to therapy. Copyright (C) 2002 S. Karger AG, Basel

Cellular excitability and the regulation of functional neuronal identity: from gene expression to neuromodulation

The intrinsic properties of a neuron determine the translation of synaptic input to axonal output. It is this input– output relationship that is the heart of all nervous system activity. As such, the overall regulation of the intrinsic excitability of a neuron directly determines the output of that neuron at a given point in time, giving the cell a unique “functional identity.” To maintain this distinct functional output, neurons must adapt to changing patterns of synaptic excitation. These adaptations are essential to prevent neurons from either falling silent as synaptic excitation falls or becoming saturated as excitation increases. In the absence of stabilizing mechanisms, activity-dependent plasticity could drive neural activity to saturation or quiescence. Furthermore, as cells adapt to changing patterns of synaptic input, presumably the overall balance of intrinsic conductances of the cell must be maintained so that reliable output is achieved (Daoudal and Debanne, 2003; Turrigiano and Nelson, 2004; Frick and Johnston, 2005). Although these regulatory phenomena have been well documented, the molecular and physiological mechanisms involved are poorly understood

Quantum computers can search rapidly by using almost any transformation

A quantum computer has a clear advantage over a classical computer for exhaustive search. The quantum mechanical algorithm for exhaustive search was originally derived by using subtle properties of a particular quantum mechanical operation called the Walsh-Hadamard (W-H) transform. This paper shows that this algorithm can be implemented by replacing the W-H transform by almost any quantum mechanical operation. This leads to several new applications where it improves the number of steps by a square-root. It also broadens the scope for implementation since it demonstrates quantum mechanical algorithms that can readily adapt to available technology.Comment: This paper is an adapted version of quant-ph/9711043. It has been modified to make it more readable for physicists. 9 pages, postscrip

A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines.

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines. METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction. RESULTS: A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p \u3c 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p \u3c 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p \u3c 0.001). CONCLUSIONS: In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients\u27 opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids

A Cognitive-Perceptual Approach to Conceptualizing Speech Intelligibility Deficits and Remediation Practice in Hypokinetic Dysarthria

Hypokinetic dysarthria is a common manifestation of Parkinson's disease, which negatively influences quality of life. Behavioral techniques that aim to improve speech intelligibility constitute the bulk of intervention strategies for this population, as the dysarthria does not often respond vigorously to medical interventions. Although several case and group studies generally support the efficacy of behavioral treatment, much work remains to establish a rigorous evidence base. This absence of definitive research leaves both the speech-language pathologist and referring physician with the task of determining the feasibility and nature of therapy for intelligibility remediation in PD. The purpose of this paper is to introduce a novel framework for medical practitioners in which to conceptualize and justify potential targets for speech remediation. The most commonly targeted deficits (e.g., speaking rate and vocal loudness) can be supported by this approach, as well as underutilized and novel treatment targets that aim at the listener's perceptual skills

Particle aggregation, pH changes and metal behaviour during estuarine mixing: review and integration

Estuaries are dynamic mixing zones where river water interacts with seawater, resulting in large and complex geochemical changes. How two key factors, particle aggregation and pH, affect metal behaviour in estuaries is reviewed and integrated in this paper. Riverine particles are coated with organic matter and electrostatic repulsive forces restrict aggregation. In estuaries, increased concentrations of divalent cations reduce the repulsive forces between particles at low salinities, resulting in their rapid coagulation and removal of particulate-associated metals (e.g. Fe and Pb). However, truly dissolved metals may mix conservatively, and metals associated more with colloidal and dissolved organic material (e.g. Cu and Zn) can show variable behaviour. In many field studies and modelling of river inputs with different compositions, pH decreases slightly at low salinity. Geochemical model simulations of dissolved metal speciation indicated that Zn would be desorbed from iron oxide binding surfaces due to these pH and cation concentration changes, with Cu also showing less binding to dissolved organic matter (DOM). DOM, pH and particle surfaces can influence individual metal behaviour at various spatial and temporal scales. Further integrated field and laboratory research in estuaries where key geochemical processes affecting metal concentrations are measured and modelled is needed.Luke M. Mosley and Peter S. Lis

Brief on the future of non-MARC authority

The Indiana University PCC Non-MARC Authorities Issues Group was formed in response to the Program for Cooperative Cataloging’s (PCC) call for "… a well-articulated plan as to how [a non-MARC authorities] future could work based on [ideas from the PCC community]." Of particular interest were ideas that could serve as a bridge "between an ideal world and what [catalogers] can do now to create [that world]." In this brief paper, the group proposes many changes that may ease the transition from MARC to library linked open data with a particular focus on authority data. The group outlines policy changes that may promote robust, granular data encoding practices and encourage the addition of meaningful linkages to FRBR Group 1 and Group 2 entities. In addition to forward-thinking policies and standards, our community is in need of a strong advocate for metadata curation systems. Having proper tools will enable catalogers to focus on the intellectual activities associated with metadata creation, curation, and strategy

Effects of a Meditation and Contemplative Practice Course on College Students’ Mindfulness, Self-Compassion, and Mental Health

Objectives: Mindfulness-based practices have been shown to be effective in reducing depression and anxiety among college students. Less is known about whether coursework incorporating contemplative practices has similar beneficial effects. This study sought to investigate the benefits of a course focusing on contemplative practices that included mindfulness-based practice inside and outside the classroom. Method: In Study 1, 42 students enrolled in Meditation and Contemplative Practice, a course taught through the Department of Classics, Philosophy, and Religious Studies, completed measures of mindfulness, self-compassion, depression, and anxiety at the beginning and end of the semester. In Study 2, 43 students in this course, and 65 students in an Introduction to World Religions course completed the same measures at the beginning and end of the semester. In Study 3, 15 students enrolled in the contemplative practices course completed a pre-test, a post-test, and a follow-up assessment six weeks later. Results: Across all three studies mindfulness and self-compassion rose over the course of the semester. In Study 1, anxiety significantly decreased. In Study 2, those in the religious studies course did not experience increased mindfulness or self-compassion over the course of the semester. Furthermore, there were significant interactions indicating that the religion students increased in depression and anxiety over the course of the semester while those in the contemplative practices class decreased. Study 3 indicated that the gains made during the semester continued after the course was over. Conclusions: Results indicate that coursework on contemplative practices is beneficial to the mental health of college students

The Risk Factors Associated with Malaria Incidence in the Elelim Public Health Center in Yalimo District, Papua Province

Background: Malaria is still an endemic disease and one of Papua's health problems. Indonesia is the seventh largest in the world with 200,378 cases. In the province of Papua, the district of Yalimo is the third-highest with 18,821 cases. The Government is working to detect and prevent malaria in Papua Province by launching a program called "Malaria Elimination in Papua Province by 2030." Research Objectives: Identify the risk factors associated with malaria incidence at the Elelim Public Health Center in Yalimo District, Papua Province. Research method: The research method used in this study was an observational analysis with a case-control study approach. A sample of 90 patients consisted of 30 patients diagnosed with malaria as positive cases and 60 patients diagnosed with malaria as negative controls. This research was performed in July 2019. The statistical methods used in this analysis were univariate, bivariate and multivariate analyses. Data gathered through questionnaires and interviews. Results: The bivariate analysis showed a number of risk factors associated with the incidence of malaria in the Elelim Public Health Center in Yalimo District, Papua Province: the use of wire mesh (p = 0.013; RP = 3.237; 95% CI = 1.302-8.047), the type of house wall (p = 0.003; RP = 4.316; 95% CI = 1.696-10.981), the puddle near the house (p = 0.004; RP = 4.333; 95% CI = 1.686-11.138), the distance between house and breading place (p = 0.001; RP = 5.675; 95% CI = 2.097-15.362), the distance between house and large cattle pens (p = 0.042; RP = 2.615; 95% CI = 1.048-6.529), and the use of insecticide net (p = 0.008; RP = 6.000; 95% CI = 1.668-21.583); while age (p = 0.695; RP = 0.740; 95% CI = 0.289-1.897), sex (p = 0.412; RP = 0.474; 95% CI = 0.193-1.165), occupation (p = 0.157; RP = 0.474; 95% CI = 0.193-1.165), education (p = 0.701; RP = 0.750; 95% CI = 0.299-1.878), family income (p = 0.262; RP = 0.546; 95% CI = 0.255-1.325), the use of anti-mosquito repellent (p = 0.705; RP = 1.321; 95% CI = 0.536-3.253), and nighttime habits (p = 0.392; RP = 1.650; 95% CI = 0.668-4.075) were not associated with malaria incidence in the Elelim Public Health Center in Yalimo District, Papua Province

A53T-alpha-synuclein overexpression impairs dopamine signaling and striatal synaptic plasticity in old mice

BACKGROUND: Parkinson's disease (PD), the second most frequent neurodegenerative disorder at old age, can be caused by elevated expression or the A53T missense mutation of the presynaptic protein alpha-synuclein (SNCA). PD is characterized pathologically by the preferential vulnerability of the dopaminergic nigrostriatal projection neurons. METHODOLOGY/PRINCIPAL FINDINGS: Here, we used two mouse lines overexpressing human A53T-SNCA and studied striatal dysfunction in the absence of neurodegeneration to understand early disease mechanisms. To characterize the progression, we employed young adult as well as old mice. Analysis of striatal neurotransmitter content demonstrated that dopamine (DA) levels correlated directly with the level of expression of SNCA, an observation also made in SNCA-deficient (knockout, KO) mice. However, the elevated DA levels in the striatum of old A53T-SNCA overexpressing mice may not be transmitted appropriately, in view of three observations. First, a transcriptional downregulation of the extraneural DA degradation enzyme catechol-ortho-methytransferase (COMT) was found. Second, an upregulation of DA receptors was detected by immunoblots and autoradiography. Third, extensive transcriptome studies via microarrays and quantitative real-time RT-PCR (qPCR) of altered transcript levels of the DA-inducible genes Atf2, Cb1, Freq, Homer1 and Pde7b indicated a progressive and genotype-dependent reduction in the postsynaptic DA response. As a functional consequence, long term depression (LTD) was absent in corticostriatal slices from old transgenic mice. CONCLUSIONS/SIGNIFICANCE: Taken together, the dysfunctional neurotransmission and impaired synaptic plasticity seen in the A53T-SNCA overexpressing mice reflect early changes within the basal ganglia prior to frank neurodegeneration. As a model of preclinical stages of PD, such insights may help to develop neuroprotective therapeutic approaches