1349 Epidural Cylindrical Electrodes for Monitoring of Intractable Epilepsy Richard W. Byrne, MD Andres Kanner, MD Michael Smith, MD Walter W. Whisler, MD, PhD Chicago, IL ; Key Words: epidural electrodes, epilepsy Introduction: This presentation describes our experience with a novel method for obtaining intracranial recordings of patients with med ically intractable epilepsy. Epidural cylindrical electrodes have been used at our epilepsy center for 15 years and have certain advantages over subdural, depth, and epidural peg Stereotactic and Functhional.
1 Hx: Persistent fever, rhinorrhea, progressive cough 2 PE: Inspiratory rales Lobar pneumoniarales ; , Rhonchi-sputum in Large bronchus, wheezing-small airway 3 Sputum: 4 M: chlamydia Ag. and RSV Ag ; 4 M 2Y: RSV Ag, ; Bacteria: culture and smear ; Virus: throat virus culture 4 CXR: PA Lat, Lat decubitus view ; Lobar: Bacteria , Mycoplasma Interstitial : Virus, Bacteria, Mycoplasma . CP-angle blunt: or pus, take Lateral decubitus view CXRpleural line, ; echo-guided ; 5 Chest C-T or Echo: pneumonia, R O abscess or tumor formation. 6 Blood test and others: CBC DC, B C , CRP, SGOT, BUN, Cre., DIC profile., 2 Y Mycoplasma IgG, IgM Ab bed-side rapid cold hemagglutinin test urine pneumococcus Ag $1200 ; 7 Tx 1. R consultation: Warm O2 flow, Chest percussion, and hood ; 2. Nebulizer Inhalation: Jusonine + Bricantl ; q6-8-h, stat, prn 3. Oral Medications: antihistamine, mucolytics, bronchodilator. 4. : ; : Age, Activity, CBC DC, CRP, CXR 3 M Ampicillin: 100~150mg kg Day + Gentamycin: 2-2.5mg kg dose q8h IVD R O meningitis ; Oral Erythromycin: 1cc kg Day 3 M ~ Pneumococcus, HI b, G - ; Bacteria- Pseudomonas. ; Ampicillin HIb 1 3 ; Zinacef , 100~150mg kg Day q6-8h ; Augmentin 100mg kg Day q6-8h ; 1 pseudomonas infection ; : Zinacef + Gentamycin Augmentin + gentamyin , or Data, DIC, sepsis Vancomycin , MRSA, 10mg kg doseIV Drip q6h red-man syndrome ; + Claforan or Recephine or Fortum Pseudomonas spp ; Atypical pneumonia or: Erythromycin or chlarithromycin Erythromyin G-I upset ; 2 Y ~ the same as 3 M Always Erythromycin or chlarithromycin Evythromycin G-I ; for Mycoplasma infection.
Disadvantages Difficult to use. Hard to coordinate actuation and inspiration. 10 second breath holding for peripheral deposition. Reduced lung deposition - up to 90% hits oropharynx, 10% reaches lungs. Unsuitable for young children. Unsuitable for Pt with arthritis. Often no dose counter, difficult to assess when empty. Check technique. Consider using with a spacer device if technique is poor. Spacers for use with MDI ; Types Vary in size. Not all spacers fit all MDIs. Volumatic- Good lung deposition. Easy to use. Nebuhaler For use with Bricamyl & Pulmicort only Aerochamber- Smaller. Good for portable use. Available with mask. Advantages Oral and GI deposition reduced. Lung deposition increased. Reduces local and systemic side effects. Easy to use Low inspiratory effort required Volumatic.
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Discontinued. Verizon states that the underlying reasons for rationing NXX codes are eliminated once pooling is implemented because unused numbers will need to be donated to the pool and shared by the pooling participants. Further, Verizon states that any continuation of rationing should be extended only to those carriers not participating in the pooling trial. Sprint argues that rationing of NXX codes is incompatible with FCC directives because it precludes carriers needing numbers from obtaining them. AT&T Wireless also argues the rationing should be ended with commencement of the pooling trial because the Commission's initial goals for extending the rationing plan will be moot upon implementation of the pooling trial. While we recognize the difficulty of rationing for carriers, we do not believe that ending rationing upon the commencement of pooling in the 412 NPA would serve our goal of preserving the life of both the 412 NPA and the 878 NPA. In response to Verizon's argument that rationing loses its rationale upon implementation of pooling, we do not agree because not all carriers participate in pooling. Therefore, while pooling may force a certain number of carriers to share numbering resources, it does not force all carriers needing numbering to do so. Consequently, implementation of the pooling trial alone does not guarantee that numbers in the 412 NPA will not be prematurely assigned to carriers. Regarding Sprint's argument that rationing violates FCC directives, we note that the continuation of the current industry consensus rationing plan until February 2002 was done through the express delegation of authority we received in the FCC's Delegation Order.21 Having determined that rationing should continue in the 412 NPA even upon implementation of the 1K pooling trial, we now consider AT&T Wireless' proposal regarding how to modify the rationing in consideration of pooling. AT&T Wireless submits that we should adopt an ``equal chance'' procedure which would allow all carriers to receive needed numbering resources in jeopardy situations. Under this procedure, carriers not participating in the pooling trial would participate in the rationing according to the already established rules. Carriers participating in the pooling trial would similarly participate in the rationing under the established rules once the pooling administrator certifies that these carriers' need for numbering resources cannot be met through the pool. Finally, the pooling administrator would participate in the lottery when there is less than 6 months inventory in a rate center until the NPA is 6 months from exhaust. We find merit in AT&T Wireless' approach to this situation in the sense that it attempts to ensure all carriers having a need for numbering resources be afforded the opportunity to receive them even in a rationing situation. However, we do have some concerns with this proposal such as the requirement that pooling carriers certify a need for numbers whereas non-pooling carriers do not need to do so. Further, there is no oversight regarding the pooling carriers' actual need for numbers. As we understand the proposal, the pooling administrator certifies that the carriers' need cannot be met by the numbering resources of the pool. However, the pooling administrator does not and should not be in the position of certifying that the need for the numbers exists. Because of these concerns, we have decided to establish different guidelines. To that end, we are going to direct the NANPA to set aside 15 NXX codes in the 412 NPA for the use of the pooling administrator. These 15 NXX codes.
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The membrane was incubated with the first antibody for 16 h at followed by incubation with the second antibody for 1 h. The proteins were visualized by enhanced chemiluminescence reagents Pierce, Rockford, IL, USA ; , and the images were recorded using the Light Capture chemiluminescence detection system Atto, Tokyo, Japan ; . The densities of bands were quantified using NIH image software version 162; National Institutes of Health, Bethesda, MD, USA ; . Immunohistochemistry Immunohistochemistry was performed mainly using the universal immuno-enzyme polymer UIP ; method Histofine, simple stain MAX-PO kit; Nichirei ; . According to the manufacturer's instruction, deparaffinization and rehydration were performed for paraffin-embedded, 3 m thick tissue sections mounted on silane-coated slides. The sections were then exposed to microwave radiation in 1 mM EDTA pH 80 ; for 9 min to retrieve antigens, and treated with 3% hydrogen peroxide for 10 min to quench endogenous peroxidase activity. Non-specific sites were blocked with bovine serum for 10 min. The sections were then incubated overnight at 4 C with the first antibody, followed by incubation for 30 min at room temperature and baclofen, because bricanyl ex.
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And urea moieties were incorporated with a view to improving solubility properties of the molecules. We were also interested in the in vitro antiparasitic activities of these compounds in view of previous aforementioned literature reports on related compounds.46 The synthesis of the target molecules was simple and straightforward and is depicted in Scheme 1. The amine scaffolds 5 were synthesised by reacting 6, 9-dichloro-2methoxyacridine 4 with a large excess of diamines in phenol. The resulting products were converted to the respective sulfonamide and urea products by standard reaction with the respective acid chloride and isocyanate. All new compounds gave 1H NMR, FABMS and, in relevant cases, microanalysis data consistent with their structures. The enzyme assays were performed essentially as described before.11 Recombinant T. cruzi TryR 128 mU ; was assayed using a Beckman DU640 spectrophotometer in 40 mM HEPES, pH 7.5, 1 mM EDTA and 200 mM NADPH at 25 C followed by the addition of 100 mM Try[SH]2. Human glutathione reductase, purified from human erythrocytes 42.3 mU ; , was analysed in a similar manner and under identical conditions followed by addition of glutathione disulfide 100 mM ; . Enzyme mixtures were preincubated with NADPH 10 min at 25 C ; before the addition of varying concentrations of inhibitor added in DMSO 1% v v final concentration ; . As can be seen from the data in Table 1, compounds 2 and 3 were generally superior to quinacrine in inhibiting TryR. Sulfonamides 2 were generally superior to ureas 3. This may be due to a more hydrophobic naphthalene moiety in 2 compared to the benzyl moiety in 3. However, despite the superior inhibitory activities of the derivatives, selectivity against the equivalent human enzyme, glutathione reductase, was lost. The loss of a positive charge from the terminal tertiary amino group ; in moving from quinacrine to the new derivatives could, for example, brucanyl ventolin.
Most modern scientists are pleased to have distanced themselves from earlier methods of confronting public scares - which often took the form of a condescending dismissal! However, the adoption of alternative, effective ways of confronting distortions has not been straightforward. Scientists' increased sensitivity to potential opposition seems also to have made them reticent when problems arise. More significantly, the scientific world has never before had to compete with so many health groups, environmental campaigns, campaigning journalists and new age therapy promoters, among others, each vying to comment on findings. At Sense About Science, we encourage scientists to take on the challenges of the broader implications of their work at two levels. The first is straightforward - to think about how claims are likely to be presented. Good advice is readily available. The Science Media Centre, established last year to respond when science hits the headlines, helps anticipate the media reaction to results. Professional and learned societies also provide a currently under-utilised ; resource. They should at least be informed about work entering the public domain. The scope for generating public confusion is greatest when unprepared contacts are asked for their reactions. The Society for Endocrinology, according to External Relations Officer Tom Parkhill, still learns late in the day about research news, `most often because the press ring up asking for a response.' The second level is to think more strategically about relationships with groups who have a role in how research results are received and understood, and to confront people directly over mistakes and disagreements. Active relationships can remove the scope for misunderstanding, and even for mischief. When we know people, we feel more compelled to confront them directly with disagreements rather than to project them publicly straightaway. Public scares about scientific matters are usually generated by active players, which include a wide range of institutions that shape public opinion, beyond the journalists on whom we tend to focus. Commentators on recent public scares have often been able to and betamethasone.
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Medical diagnostic devices tend to be costly and complicated and require highly educated and trained personnel. Simple, immunodiagnostic, paper strip, lateral flow tests have limited use in `point-of-care' testing because they provide only `yes or no' results. Physicians are reluctant to treat patients based on such limited data. There remains a definitive need for a rapid, simple and quantitative test platform for on-site detection of disease markers, antigens, micro-organisms and chemical species in a broad-based spectrum of applications. To meet these needs, scientists at umedik, Inc. have developed an Onsite-MicroDiagnosticTM lab-on-achip platform technology: the DIAPRO System. This system allows for on-site, portable, low-cost and rapid quantitative analysis of any human, animal, food or plant fluid. It will represent a significant paradigm shift in on-site diagnostics and bethanechol.
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Men; 12 g dL for women ; . A reverse J-shaped relationship with mortality was observed; age-, sex-, and race-adjusted hazard ratios 95% confidence interval [CI] ; in the first and fifth quintiles, compared with the fourth quintile, were 1.42 95% CI, 1.25-1.62 ; and 1.24 95% CI, 1.09-1.42 ; . After multivariate adjustment, these hazard ratios were 1.33 95% CI, 1.15-1.54 ; and 1.17 95% CI, 1.01-1.36 ; . The demographicand fully-adjusted hazard ratios of anemia for mortality were 1.57 95% CI, 1.38-1.78 ; and 1.38 95% CI, 1.19-1.54 ; . Adjustment for causes and consequences of anemia renal function, inflammation, or frailty ; did not reduce associations. The authors concluded that lower and higher hemoglobin con-centrations and anemia by World Health Organization criteria were independently associated with increased mortality. The WHO criteria did not identify risk as well as a lower hemoglobin value. Additional study is needed on the clinically valid definition for and causes of anemia in the elderly, and on the increased mortality at the extremes of hemoglobin concentrations and
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Charges for surcharges required by the New York Health Care Reform Act of 1996 or as later amended ; and other state imposed surcharges as applicable to the Plan ; , will be considered covered expenses by this Plan. Local, State and Federal taxes, associated with supplies or services covered under this Plan, will also be considered covered expenses by this Plan.
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Standardization of Criteria for AIS Brace Studies - SRS Committee on Bracing and Non-operative Management Robert Bernstein, MD, Charles d'Amato, MD, Ronney Ferguson, MD, George Thompson, MD, B. Stephens Richards, MD Texas Scottish Rite Hospital, Dallas, TX ; PURPOSE: To establish consistent parameters for future AIS bracing studies so that valid and reliable comparisons can be made. As prior literature lacks consistency for both inclusion criteria and brace effectiveness, clinicians are currently unable to draw valid conclusions from existing data. METHODS: A thorough review of published natural history studies was performed to determine the AIS patient population most at-risk for curve progression and the subsequent possible need for surgery ; . Then, 31 bracing articles including the current BrAIST proposal were analyzed to determine 1 ; inclusion criteria that will best identify those patients most at-risk for progression 2 ; the most appropriate definitions for bracing effectiveness, and 3 ; identification of additional variables which would provide valuable information. RESULT RESULTS: Early studies either lacked inclusion criteria or were quite varied in age at brace prescription 418.9 years ; , skeletal maturity Risser 0-4 ; , and curve magnitude 120-680 ; . In more recent studies, inclusion criteria narrowed considerably; specifically, Risser 0-2, age e" 10 years at brace prescription, and primary curves between 250-450 250-390 in the current BrAIST proposal ; . Curves 200-250 were included in some studies if progression had been documented. Brace effectiveness was usually defined as the prevention of curve progression d"50 at maturity. However, maturity was variably defined as the end of growth, Risser 4, or two years post-menarchal. Most commonly, bracing was described as ineffective when curve progression was e"60 or if surgical intervention was recommended. Less frequently, bracing was described as ineffective when progression was e"100, if the curve progressed to 450, or if there was change to another brace. In those studies with follow-up e"2 years beyond maturity, additional curve progression ultimately leading to surgical intervention ; was not unusual. Potentially useful additional variables included: curve patterns, curve grouping 250-350, 300-400, 350-450 ; , brace type, in-brace correction, and amount of daily time in brace. CONCLUSIONS: I. Inconsistent selection criteria in many older bracing studies prevent clinicians from drawing valid conclusions about the effectiveness of bracing in AIS. II. Optimal inclusion criteria for future AIS brace studies consist of age e"10 years old when brace is prescribed, Risser 0-2, primary curve angles between 250 and 390, and no prior treatment. III. Assessment of brace effectiveness should include: 1 ; the percentage of patients who have d"50 curve progression and the percentage who have e"60 progression at maturity 2 ; the percentage of patients who have had surgery recommended undertaken at maturity surgical indications must be documented ; , and 3 ; two-year follow-up beyond maturity to determine the percentage of patients who subsequently undergo surgery again, surgical indications must be documented ; . IV. All patients, regardless of subjective reports on compliance, should be included in results intent to treat ; . Whenever possible, compliance should be measured objectively. V. All studies should provide results stratified by curve type and size grouping.
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