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The availability of an accurate three-dimensional (3-D) model of the tracheostoma and trachea of the laryngectomy patient would be of great help in prototyping of endotracheal prostheses. Stereolithography has been described for skull and jaw models but never for soft-tissue reconstructions of the trachea. CT was performed on tracheostomas of 8 patients. The CT data were used to make 3-D models by means of stereolithography. Inverted CT data were used to create air contour models of the same tracheostomas. Eight soft-tissue and 8 air contour models were reconstructed from CT data, showing accuracy and great detail. In this paper we present a previously unreported application of the stereolithography technique. Measurements and prosthesis prototyping, which are impossible to perform on tracheostomas in patients, can now be executed safely. We are using the 3-D tracheostoma models in our research project to develop an endotracheal fixation method for tracheostomal valves.

A multi-institutional, prospective clinical study was undertaken to investigate whether the use of a heat and moisture exchanger (HME) in the period following total laryngectomy could prevent the development or reduce the severity of respiratory symptoms. Fifty-nine patients from three hospitals were provided with HMEs, either immediately post-surgery or, in the case of post-surgical radiotherapy, upon completion of the radiotherapy. For the total sample (n = 59) statistically significant improvements over time (between 3 and 6 months) could be found in forced expectoration (P < 0.05), in the perceived voice quality (P < 0.001), social anxiety (P < 0.001), social interactions (P < 0.001) and in feelings of anxiety and depression (P < 0.05). Repeated measures analysis of variance indicated statistically significant group differences over time in forced expectoration and stoma cleaning (P < 0.05). No statistically significant differences over time were noted between the regular and non(regular) HME user groups in voice quality or in various aspects of daily living.

The amount of technological aids on the market to support people in their everyday functioning is increasing. For example mobile telephone, electronic diary, skyping and domotics. Many of these aids are too complicated to operate for people with cognitive impairments, like dementia. For technology to be practicable and useful for them, it will have to meet certain requirements. This paper addresses the needs and impairments of people with dementia, and the functional requirements for assistive technology for people with dementia. © 2012 Springer-Verlag.

The mechanisms underlying obesity-related hypertension are incompletely understood. Microvascular dysfunction might play a role by increasing peripheral vascular resistance (PVR). Metabolic and microvascular effects of insulin are impaired in obesity, but how these impairments contribute to disturbed blood pressure homeostasis is unclear. Specifically, it is unknown whether local microvascular vasoactive effects of insulin play a role in determining systemic vascular resistance. The aim of this study was to investigate the association between PVR and local microvascular effects of insulin.Thirty-seven healthy, overweight subjects (age 25-55 years, BMI 25-30 kg/m(2) ) were cross-sectionally studied. Local insulin-mediated vasodilation was measured using skin laser Doppler fluxmetry combined with transcutaneous iontophoresis of insulin. For comparison, local vasodilatory effects of acetylcholine and sodium nitroprusside were measured. PVR was calculated from mean arterial pressure and cardiac output, assessed by pulse-dye densitometry.PVR was inversely correlated with insulin-mediated vasodilation (r = -0.50; P0.01). This finding was maintained after adjustment for age, sex, blood pressure, and smoking. PVR was not associated with local microvascular effects of acetylcholine.Our study in overweight subjects suggests that insulin's role in the microvasculature may contribute to blood pressure control.

Catastrophizing is a defining factor in the pain experience and strongly contributes to the prediction of various aspects of health. Catastrophizing is not just present in pain patients, but may also be present in people with non-clinical pain. The aim of the present study is to investigate levels of catastrophizing in pain patients and people with pain from the general population. Also, the relationship between catastrophizing and pain intensity, specialist consultation and use of pain medication is studied.A cross-sectional survey design was used, including 150 pain patients and 376 respondents from the general population.The results show that pain is highly prevalent in the general population. The pain patients reported significantly higher levels of pain intensity and catastrophizing than the community pain sample. In both samples, significant positive correlations between catastrophizing and pain intensity were found. The data show a linear relationship between catastrophizing and pain intensity, which can be interpreted as evidence for a dose-response pattern in pain-related catastrophizing. Furthermore, catastrophizing predicted specialist consultation and medication use in the community pain sample.It can be concluded that pain-related catastrophizing is present in pain patients as well as people with pain from the general population in a dose-response pattern. Catastrophizing seems to be an important factor determining certain aspects of pain-related medical consumption, even in non-clinical pain, and should therefore be a target of the screening procedure and early intervention.

Blooms of the marine microalga Fibrocapsa japonica (Raphidophyceae) are suggested to lead to the diminution of fish stocks, but the exact mechanism(s) involved in ichthyotoxicity is still unclear. In the present study fish tests were performed, using larvae of the common flat fish sole (Solea solea), to further investigate properties and variability of F. japonica toxicity. Sole larvae were directly and indirectly exposed to a density range of a Dutch Wadden Sea F. japonica strain, as well as F. japonica cell extracts, for a maximum of 7 days, during which larval mortality was monitored. Most experiments were done at 16 degrees C, however some experiments were performed at 20 degrees C. Furthermore, larvae were exposed to concentration ranges of the alleged toxic compounds, e.g. the brevetoxins PbTx-2 and PbTx-3, and three poly-unsaturated fatty acids (PUFAs): M, EPA and OTA.The larvae showed highly variable responses to the F. japonica treatments. At the late exponential growth phase of F. japonica highest sole mortality was found: 100% mortality after 7 days of direct exposure. Indirect and cell extract exposures as well as direct exposure to other growth phases caused lower larval mortality (up to 40%) after the same incubation period. Temperature had a distinct effect on sole mortality, showing significantly enhanced toxicity at 20 degrees C, compared with 16 degrees C. Exposure to PbTx-2 showed an LC50 of 28.7 ng mL(-1) after 48 h, while exposure to PbTx-3 caused no 100% mortality up to 10 ng mL(-1). Exposure to pure PUFAs showed the fastest mortality observed in all experiments, with an LC50 ofOur research suggests pronounced ichthyotoxicity in late exponential F. japonica cells, related primarily with the combination of endo- and exotoxins, with most probably haemolytic PUFAs as the main endotoxins, and other haemolysins and/or ROS as the main exotoxins. Implications are given for present and future risks in the already warming Dutch coastal waters. (C) 2012 Elsevier B.V. All rights reserved.

Toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxin B (SEB) are two examples of variable genetic traits produced by Staphylococcus aureus. Regarding phenotypes, most investigations have reported that SEB and TSST-1 are not coproduced in S. aureus. However, it is unclear whether genotypically SEB (entB) and TSST-1 (tst) genes are found within the same isolate. Gene probes specific for entB and tst showed that both genes were present within 8 TSST-1+ isolates analyzed. However, SEB was not produced by any of these isolates. In contrast, none of 9 SEB-producing S. aureus isolates contained the TSST-1 genetic element DNA. Hybridization of restriction fragments with TSST-1 and SEB genetic element probes and tryptophan auxotyping suggested that tst and entB are located in close proximity on the chromosome. The entB locus may be a preferred site of insertion for the TSST-1 genetic element, and such insertion may interfere with the expression of SEB.

Experimentally the authors determine the energy levels of the 4f and 5f states in xenon as a function of laser intensity. In short-pulse (400 fs) photoelectron spectra they observe an enhancement of the seven-photon ionization yield due to resonances at the six-photon level. Two prominent peaks are attributed to the 4f and 5f states. Since the peaks are observed over a large range of wavelengths (555 nm to 650 nm), the authors follow the energy levels of these states from low to high intensity. The AC Stark shifts of these states are well described by a shift equal to the ponderomotive shift, up to the highest intensities studied (7*1013 W cm-2).

BACKGROUND Patients with unstable angina despite intensive medical therapy, ie, refractory angina, are at high risk for developing thrombotic complications: myocardial infarction or coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA). Chimeric 7E3 (c7E3) Fab is an antibody fragment that blocks the platelet glycoprotein (GP) IIb/IIIa receptor and potently inhibits platelet aggregation. METHODS AND RESULTS To evaluate whether potent platelet inhibition could reduce these complications, 60 patients with dynamic ST-T changes and recurrent pain despite intensive medical therapy were randomized to c7E3 Fab or placebo. After initial angiography had demonstrated a culprit lesion suitable for PTCA, placebo or c7E3 Fab was administered as 0.25 mg/kg bolus injection followed by 10 micrograms/min for 18 to 24 hours until 1 hour after completion of second angiography and PTCA. During study drug infusion, ischemia occurred in 9 c7E3 Fab and 16 placebo patients (P = .06). During hospital stay, 12 major events occurred in 7 placebo patients (23%), including 1 death, 4 infarcts, and 7 urgent interventions. In the c7E3 Fab group, only 1 event (an infarct) occurred (3%, P = .03). Angiography showed improved TIMI flow in 4 placebo and 6 c7E3 Fab patients and worsening of flow in 3 placebo patients but in none of the c7E3 Fab patients. Quantitative analysis showed significant improvement of the lesion in the patients treated with c7E3 Fab, which was not observed in the placebo group, although the difference between the two treatment groups was not significant. Measurement of platelet function and bleeding time demonstrated > 90% blockade of GPIIb/IIIa receptors, > 90% reduction of ex vivo platelet aggregation to ADP, and a significantly prolonged bleeding time during c7E3 Fab infusion, without excess bleeding. CONCLUSIONS Combined therapy with c7E3 Fab, heparin, and aspirin appears safe. These pilot study results support the concept that effective blockade of the platelet GPIIb/IIIa receptors can reduce myocardial infarction and facilitate PTCA in patients with refractory unstable angina.

Background: Both pregnant women and providers of obstetric care are aware of the rapid advances in noninvasive prenatal diagnosis (NIPD) of fetal trisomies, and appear to look forward to its clinical introduction. Objectives: To review and critically assess the published literature on diagnostic accuracy of NIPD using cell-free fetal DNA or RNA in maternal blood to detect fetal trisomy 21. Method: An electronic search was performed in MEDLINE, EMBASE and the Cochrane library (1997 to April 2011). Of a total of 201 citations, 9 studies were eligible for full-text analysis by 2 independent reviewers, using the QUADAS tool. Results: Two of the 9 analyzed studies complied with the criteria of the QUADAS tool. Combining the selected 2 studies, with a total of 681 pregnancies included, overall sensitivity was 125/125 (100%, 95% CI 97.5–100%) and specificity 552/556 (99.3%, 95% CI 98.7–99.3%). Conclusions: NIPD of fetal trisomy 21, using fetal nucleic acids in maternal plasma, appears to have a high diagnostic accuracy. Large-scale prospective studies are awaited before implementation in clinical practice.

In 511 patients with T3N0-3M0 laryngeal carcinoma, 24 possible prognostic factors were analysed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnoea, and dysphagia, previous tracheotomy, tumour extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumour and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension were also evaluated. Univariate analysis revealed prognostic significance on survival for tumour extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy). In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumour, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.

In this paper we use the first-order autoregressive scheme in order to introduce dynamics into the AIDS model. We also consider the theoretical restrictions of additivity, homogeneity and symmetry, and use two different specifications of the covariance matrix. We estimate the models using import allocation data for the UK 1952–1979 of five EEC countries and test different specifications against each other.

In this paper, we estimate a factor demand system based on Hanoch's homogeneous constant differences of elasticities of substitution production function under a newly proposed specification of the contemporaneous covariance matrix. This admits that the variances of the factor demands may be different but, nevertheless, does not ask for many observations.

Resonant and nonresonant multiphoton ionization of xenon is studied using short, circularly polarized light pulses (100 fs, 597 nm, 22 TW/${\mathrm{cm}}^{2}$). A pump-probe measurement shows that, although bound states are substantially populated, they do not enhance the ionization signal. The bound states do not ionize because their high angular momentum repels the wave functions from the nucleus. Ionization does occur through intermediate states in the continuum, in spite of a large energy mismatch, because these states have more energy and therefore suffer less from the centrifugal barrier.

This qualitative explorative survey aimed at investigating the personal experiences of elderly people with early-stage dementia with regard to their illness and the extent to which they experience their situation as 'suffering'. In the Netherlands insight in this suffering is relevant with regard to ongoing debate on euthanasia and physician assisted death in early dementia. Participants in the study were 24 elderly (mean age 76.3 years) diagnosed with early-stage Alzheimer's disease. The semi-structured interviews were transcribed verbatim, and qualitatively analyzed. The elderly were found to be very capable of sharing experiences about their disease. They indicated not to experience their situation 'as a whole' as one of dreadful suffering. The gradual progression, which is distinctive of Alzheimer's disease, also allows people to adapt and adjust to their changing situation. As a result, the actual experiences of the disease can, in a positive manner, deviate from their anticipatory beliefs. The experiences of the participants appeared less negative than the ideas 'healthy' elderly often have about a life with dementia. The results from this study emphasize the importance of listening to the voices of people with dementia. Communication with elderly with Alzheimer's disease, is in the early stages quite possible and essential for advance care planning to be adjusted to their actual wishes and needs.

Muscle mass and strength are well known to decline in response to actual and simulated microgravity exposure. However, despite the considerable knowledge gained on the physiological changes induced by spaceflight, the mechanisms of muscle atrophy and the effectiveness of in-flight countermeasures still need to be fully elucidated. The present review examines the effects and mechanisms of actual and simulated microgravity on single fibre and whole muscle structural and functional properties, protein metabolism, tendon mechanical properties, neural drive and reflex excitability. The effects of inflight countermeasures are also discussed in the light of recent advances in resistive loading techniques, in combined physical, pharmacological and nutritional interventions as well as in the development of artificial gravity systems. Emphasis has been given to the pioneering work of Pietro Enrico di Prampero in the development of artificial gravity systems and in the progress of knowledge on the limits of human muscular performance in space.

Pulmonary arterial hypertension (PAH) still cannot be cured, warranting the search for novel treatments. Fasudil (a Rho kinase inhibitor) was compared with bosentan (an endothelin receptor blocker) and sildenafil (a phosphodiesterase 5 inhibitor), with emphasis on right ventricular (RV) function, in a reversal rat model of monocrotaline (MCT)-induced PAH. In addition, the effects of combining bosentan or sildenafil with fasudil were studied. MCT (40 mg·kg body weight(-1)) induced clear PAH in male Wistar rats (n = 9). After 28 days, echocardiography, RV catheterisation and histochemistry showed that cardiac frequency, stroke volume and RV contractility had deteriorated, accompanied by RV dilatation and hypertrophy, and marked pulmonary arterial wall thickening. Mean pulmonary arterial pressure and pulmonary vascular resistance increased significantly compared to healthy rats (n = 9). After 14 days, MCT-treated rats received a 14-day oral treatment with bosentan, sildenafil, fasudil or a combination of fasudil with either bosentan or sildenafil (all n = 9). All treatments preserved cardiac frequency, stroke volume and RV contractility, and reduced pulmonary vascular resistance and RV dilatation. Fasudil lowered RV systolic pressure and mean pulmonary arterial pressure significantly, by reducing pulmonary arterial remodelling, which reduced RV hypertrophy. Combining bosentan or sildenafil with fasudil had no synergistic effect. Fasudil significantly improved PAH, to a greater degree than did bosentan and sildenafil.

In deze kwalitatief exploratieve veldstudie is onderzocht hoe ouderen in de beginstadia van dementie zelf hun situatie en ziekte beleven en in hoeverre zij onder de gevolgen daarvan lijden. In Nederland is inzicht in dit lijden van belang in het kader van het debat over euthanasie/ hulp bij levensbeeindiging bij dementie. Deelnemers aan het onderzoek waren 24 ouderen (gemiddelde leeftijd 76,3 jaar) met het beginstadium van de ziekte van Alzheimer. De semi-gestructureerde interviews werden verbatim uitgetypt en kwalitatief geanalyseerd. Praten met ouderen over hun ziekte bleek zeer goed mogelijk te zijn. Ze gaven aan dat zij hun situatie ‘als geheel’ niet te ervaren als een groot lijden. De geleidelijke achteruitgang, die kenmerkend is voor de ziekte van Alzheimer, biedt ook ruimte voor aanpassing, als gevolg waarvan de actuele beleving van de ziekte in gunstige zin kan afwijken van de opvattingen die zij daarover in het verleden hadden. De ervaringen van de deelnemers leken minder negatief dan het beeld dat ‘gezonde’ ouderen vaak hebben over een leven met dementie. Deze bevindingen benadrukken het belang om mensen met dementie zelf aan het woord te laten. Gesprekken met ouderen met de ziekte van Alzheimer zijn, in de beginstadia, heel goed mogelijk en essentieel bij het plannen van zorg en behandeling die zo goed mogelijk aansluit bij hun actuele wensen en behoeften.

Atoms subjected to an intense subpicosecond laser pulse (${10}^{13}$ W/${\mathrm{cm}}^{2}$, 100 fs) survive in excited states, as is shown by probing with a second laser. Electron spectroscopy with this 5-ns probe pulse enables identification of the resonant intermediate states as well as an unusually reliable energy calibration of the short-pulse electron spectrum. Only after incorporating population of intermediate levels is the mechanism for short-pulse multiphoton ionization consistent with the new data.

A two-dimensional position-sensitive dosimetry system based on a scintillating gas detector is being developed for pre-treatment verification of dose distributions in particle therapy. The dosimetry system consists of a chamber filled with an Ar/CF(4) scintillating gas mixture, inside which two gas electron multiplier (GEM) structures are mounted (Seravalli et al 2008b Med. Phys. Biol. 53 4651-65). Photons emitted by the excited Ar/CF(4) gas molecules during the gas multiplication in the GEM holes are detected by a mirror-lens-CCD camera system. The intensity distribution of the measured light spot is proportional to the 2D dose distribution. In this work, we report on the characterization of the scintillating GEM detector in terms of those properties that are of particular importance in relative dose measurements, e.g. response reproducibility, dose dependence, dose rate dependence, spatial and time response, field size dependence, response uniformity. The experiments were performed in a 150 MeV proton beam. We found that the detector response is very stable for measurements performed in succession (sigma = 0.6%) and its response reproducibility over 2 days is about 5%. The detector response was found to be linear with the dose in the range 0.05-19 Gy. No dose rate effects were observed between 1 and 16 Gy min(-1) at the shallow depth of a water phantom and 2 and 38 Gy min(-1) at the Bragg peak depth. No field size effects were observed in the range 120-3850 mm(2). A signal rise and fall time of 2 micros was recorded and a spatial response ofor=1 mm was measured.

Background. Although the beneficial effects of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have been demonstrated in a number of trials, most studies were conducted in Western countries. Experience, logistics and patient characteristics may differ in other parts of the world. Methods. Consecutive patients treated with primary PCI in Cinere Hospital, Jakarta, Indonesia, between January 2008 and October 2008 were compared with those treated in the Isala Clinics, Zwolle, the Netherlands. Results. During the study period, a total of 596 patients were treated by primary PCI, 568 in Zwolle and 28 in Jakarta. Patients in Indonesia were younger (54 vs 63 years), more often had diabetes (36 vs. 12%) and high lipids and were more often smokers (68 vs. 31%). Time delay between symptom onset and admission was longer in Indonesia. Patients from Indonesia more often had signs of heart failure at admission. The time between admission and balloon inflation was longer in Indonesia. At angiography, patients from Indonesia more often had multivessel disease. There was no difference in the percentage of restoration of TIMI 3 flow by primary PCI between the two hospitals. Conclusion. Patients with STEMI in Indonesia have a higher risk profile compared with those in the Netherlands, according to prevalence of coronary risk factors, signs of heart failure, multivessel disease and patient delay. Time delay between admission and balloon inflation was much longer in Indonesia, because of both logistic and financial reasons. (Neth Heart J 2009;17:418-21.)

We observe new effects in frequency doubling of colliding-pulse, mode-locked dye-amplified pulses (300 fsec, 620 nm, up to 1 mJ of energy) due to phase mismatch. If the second-harmonic generation in the nonlinear crystal (30-mm KDP crystal) is phase matched, the output is a square pulse. In contrast, when a phase mismatch is introduced, the generated pulse contains two peaks. We observe that the time profile is affected by depletion and chirp of the fundamental. The experimental results agree well with our numerical calculations.

When I started my cardiology training, back in 1976, cardiology in the Netherlands was highly dependent on internal medicine. Coronary care and intensive care units were led by internal medicine physicians in most hospitals in the Netherlands whereas in the US (where I had worked for a while) cardiology was a discipline in its own right, at least in university centres. In our country, this changed rapidly in the ensuing years and the Netherlands Society of Cardiology (NVVC) played a key role in this process.

Background: Most infants born through meconium-stained amniotic fluid (MSAF) are observed clinically for 24 h postnatally. Only 5% of infants born through MSAF develop the meconium aspiration syndrome (MAS), a serious condition requiring medical intervention. Objective: To evaluate the value of 24-h postnatal observation of infants born through MSAF. Methods: A cohort of 394 term neonates born through MSAF was studied. Data were collected on Apgar scores, the development of MAS and other perinatal factors. Results: Nineteen of the 394 (4.8%) infants born through MSAF developed MAS. 298 (76%) infants had a 5-minute Apgar score (5′AS) of ⩾9. In this group the number of infants developing MAS (1; 0.3%) was significantly lower compared with the 5′AS ⩽8 group (18; 19%). Conclusion: MAS develops rarely in infants born through MSAF with 5′AS above 8. These infants can be safely discharged from the hospital shortly after birth.

An experiment was conducted to assess the effects of different types of sentences and recording methods on naive judges' evaluations of the speech communication effectiveness of four patients who had undergone surgery for oral cancer. As expected, judges understood patients better if they read meaningful rather than meaningless sentences and if their speech was evaluated under video rather than audio conditions. However, these general findings were qualified because of the powerful influence of individual differences among patients. For example, whereas the intelligibility of three of the patients increased under the audio condition if the sentences being read were meaningful, one patient was poorly understood no matter what type of sentence he read under the same condition. The results suggested that the identification of the unique personality characteristics of patients that are related to their intelligibility merits serious consideration by both researchers and rehabilitation clinicians.

A two-dimensional position-sensitive dosimetry system based on a scintillating gas detector is being developed with the aim of using it for pre-treatment verification of dose distributions in charged particle therapy. The dosimetry system consists of a chamber filled with an Ar/CF(4) scintillating gas mixture, inside which two cascaded gas electron multipliers (GEMs) are mounted. A GEM is a thin kapton foil with copper cladding structured with a regular pattern of sub-mm holes. In such a system, light quanta are emitted by the scintillating gas mixture during the electron avalanches in the GEM holes when radiation traverses the detector. The light intensity distribution is proportional to the energy deposited in the detector's sensitive volume by the beam. In the present work, we investigated the optimization of the scintillating GEM detector light yield. The light quanta are detected by means of a CCD camera or a photomultiplier tube coupled to a monochromator. The GEM charge signal is measured simultaneously. We have found that with 60 microm diameter double conical GEM holes, a brighter light signal and a higher electric signal are obtained than with 80 microm diameter holes. With an Ar + 8% CF(4) volume concentration, the highest voltage across the GEMs and the largest light and electric signals were reached. Moreover, we have found that the emission spectrum of Ar/CF(4) is independent of (1) the voltages applied across the GEMs, (2) the x-ray beam intensity and (3) the GEM hole diameter. On the other hand, the ratio of Ar to CF(4) peaks in the spectrum changes when the concentration of the latter gas is varied.

Cervical cancer is the most common cancer among women in the Indonesian population, yet little is known about the prevalence of human papillomavirus (HPV). We investigated age-specific prevalence of HPV types and possible risk factors of HPV positivity in a population-based sample of 2686 women, aged 15-70 years, in Jakarta, Tasikmalaya, and Bali, Indonesia. The overall HPV prevalence was 11.4%, age-standardized to the world standard population 11.6%. The most prevalent types found were HPV 52, HPV 16, HPV 18, and HPV 39, respectively, 23.2, 18.0, 16.1, and 11.8% of the high-risk HPV types. In 20.7% of infections, multiple types were involved. Different age-specific prevalence patterns were seen: overall high in Jakarta, and in Tasikmalaya, and declining with age in Bali. The number of marriages was most associated with HPV positivity (OR 1.81 95% CI 1.31-2.51)). Remarkably, in Indonesia HPV 16 and HPV 18 are equally common in the general population, as they are in cervical cancer. HPV 52 was the most prevalent type in the general population, suggesting that this type should be included when prophylactic HPV vaccination is introduced in Indonesia.

AIM: The present study investigated the influence of muscle architectural changes on muscle torque during 3-week unilateral lower limb suspension (ULLS). METHODS: Plantarflexion maximal voluntary contraction (MVC), soleus (SOL), gastrocnemius medialis (GM) and lateralis (GL) muscle volume (VOL), GL fascicle length (L(f)) and pennation angle (theta), physiological cross-sectional area (PCSA), and electromyographic (EMG) activity were assessed in eight healthy men (aged 19 +/- 0 years) after days 14 and 23 of ULLS. RESULTS: After 14 day of ULLS, MVC and SOL EMG decreased (P < 0.05) by 10% and 29%, respectively, but did not further decline between days 14 and 23. SOL, GM and GL muscle VOL decreased by 5%, 6% and 5%, respectively (P < 0.05), on day 14, and by 7% (SOL), 10% (GM) and 6% (GL) on day 23. In GL, theta and L(f) were reduced by 3% (P < 0.05) and 2% (NS), respectively, on day 14, and by 5% (P < 0.05) and 4% (P < 0.05), respectively, on day 23. Consequently, GL PCSA declined by 3% (P < 0.05) on day 14, but did not further decrease on day 23. Similarly, the 7% (P < 0.05) loss in GL force/PCSA observed on day 14 persisted until the end of the unloading period. CONCLUSION: These findings suggest that rapid muscle architecture remodelling occurs with lower limb unloading in humans, with changes occurring within 14 days of weight bearing removal. These adaptations, mitigating the decline in muscle PCSA, might protect from a larger loss of muscle force.

In this paper we apply the maximum likelihood method in order to estimate the Rotterdam model of consumer demand. As we dispose of 23 observations and want to distinguish 15 budget categories, well-defined estimators and test statistics can only be obtained by constraining the model in some way. In applied research this is usually done by imposing constraints on the contemporaneous covariance matrix of the disturbances of the model. The purpose of the present paper is to present a new and more flexible restricted specification of this covariance matrix, to compare its performance with those that are usually applied and to investigate the estimation results which it generates.

In 1987, a thoroughly renewed TNM classification was published; the revision was a conjunct effort of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC). With respect to the former UICC classification, a major change was introduced regarding the regional lymph node subcategories in head and neck cancer; that is compared to the 1978 edition the subjective subcategory of fixation was eliminated and size of the lymph node has become of paramount importance. To see whether the 1987 UICC classification system is indeed more predictive and discriminatory than the 1978 edition, we have analysed patients with supraglottic cancer with clinically detectable lymph node metastasis (TI -4, N+). All patients treated between 1965 and 1980 by radiation therapy only were staged according to both editions of the UICC classification system. From these data we conclude that the prognosis of patients with lymph nodal involvement indeed worsens from N1 to N3 when classified according to the 1987 edition; in contrast, no difference is seen between the NI, N2 or N3 subcategories when staged according to the 1978 classification rules.

A 56-year-old man with a history of stent insertion in the circumflex artery two years before presented to the hospital with recurrent symptoms of angina. A 64-slice computed tomography scan was performed revealing mild in-stent and post-stent restenosis but no clear explanation for the symptoms. Coronary angiography demonstrated a severe localised stenosis of the left main coronary artery, not detected on multi-slice computed tomography, and subsequent angioplasty and placement of two stents obtained a good result. (Neth Heart J 2007;15:255-6.17923881)

Objective: To evaluate the prognostic role of postprocedural single-lead residual ST-segment deviation for electrocardiographic evaluation of myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty. Design: Prospective observational clinical cohort study. Setting: Tertiary referral centre. Patients: 1660 patients treated with primary angioplasty for STEMI. Main outcome measure: Mortality at 1-year follow-up. Results: Single-lead ST-segment deviation significantly correlated with infarct size, predischarge ejection fraction, distal embolisation and myocardial blush grade 3. At 1-year follow-up, 63 patients had died. The method correlated well with 1-year mortality. At multivariate analysis, after correction for baseline demographic, clinical and angiographic variables, postprocedural single-lead ST-segment deviation showed better accuracy than residual single-lead ST-segment elevation or resolution and residual 12-lead ST-segment deviation. Conclusions: This study showed that maximal residual ST-segment deviation in a single lead at 3 hours after the procedure is an easy and accurate predictor of 1-year mortality after primary angioplasty for STEMI.

Admission hyperglycaemia is associated with an increased risk of mortality after myocardial infarction. Whether long-term glucose dysregulation (assessed by HbA1c) is more important than acute hyperglycaemia is unknown. We evaluated the prognostic value of admission glucose and HbA1c levels in nondiabetic patients with ST-segment elevation acute myocardial infarction (STEMI).In 504 unselected, consecutive patients with STEMI, glucose and HbA1c levels were measured on admission. Glucose was categorised as11.1 mmol/l (n=422) andor= 11.1 mmol/l (n=82). HbA1c levels were categorised as6.0% (n=416) andor=6.0% (n=88). Mean follow-up was 1.6+/-0.6 years.Patients with hyperglycaemia on admission were comparable with those with normoglycaemia. However,patients with HbA1cor=6.0%, as compared with those with HbA1c6%, were older, were more often on beta-blockers and more frequently had multivessel disease. Thirty-day mortality in the subsequent glucose categories (11.1 mmol/l andor=11.1 mmol/l) was 4% and 19% (p0.001) and in the subsequent HbA1c categories (6% andor=6%) was 5% and 12% (p=0.03). After multivariable analyses, admission glucose (OR 4.91,95% CI 2.03 to 11.9, p0.001) but not HbA1c (OR 1.33, 95%CI 0.48 to 3.71, p=0.58) was significantly associated with 30-day mortality. Among 30-day survivors, neither admission glucose nor HbA1c were predictors of long-term mortality.Elevated admission glucose is an important predictor of 30-day outcome after STEMI, while prior long-term glucose dysregulation is a covariate of other high-risk clinical characteristics. Among 30-day survivors, neither admission blood glucose nor HbA1c were predictors of long-term outcome.

Purpose: We investigated the prognostic value of plasma soluble urokinase plasminogen activator receptor (suPAR) on day 1 in patients with the acute respiratory distress syndrome (ARDS) for intensive care unit (ICU) mortality and compared it with established disease severity scores on day 1. Methods: suPAR was determined batchwise in plasma obtained within 24 h after admission. Results: 632 ARDS patients were included. Significantly (P = 0.02) higher median levels of suPAR were found with increasing severity of ARDS: 5.9 ng/ml [IQR 3.1–12.8] in mild ARDS (n = 82), 8.4 ng/ml [IQR 4.1–15.0] in moderate ARDS (n = 333), and 9.0 ng/ml [IQR 4.5–16.0] in severe ARDS (n = 217). Non-survivors had higher median levels of suPAR [12.5 ng/ml (IQR 5.1–19.5) vs. 7.4 ng/ml (3.9–13.6), P

The introduction of molecular detection of infectious organisms has led to increased numbers of positive findings, as observed for pathogens causing gastroenteritis (GE). However, because little is known about the prevalence of these pathogens in the healthy asymptomatic population, the clinical value of these additional findings is unclear. A case–control study was carried out in a population of patients served by general practitioners in the Netherlands. A total of 2710 fecal samples from case and matched control subjects were subjected to multiplex real-time PCR for the 11 most common bacterial and four protozoal causes of GE. Of 1515 case samples, 818 (54%) were positive for one or more target organisms. A total of 49% of the controls were positive. Higher positivity rates in cases compared to controls were observed for Campylobacter spp., Salmonella spp., Clostridium difficile, enteroinvasive Escherichia coli/Shigella spp., enterotoxigenic E. coli, enteroaggregative E. coli, atypical enteropathogenic E. coli (EPEC), Cryptosporidium parvum/hominis, and Giardia lamblia. However, Dientamoeba fragilis and Shiga-like toxigenic E. coli were detected significantly less frequent in cases than in controls, while no difference in prevalence was found for typical EPEC and enterohemorrhagic E. coli. The association between the presence of microorganisms and GE was the weakest in children aged 0 to 5 years. Higher relative loads in cases further support causality. This was seen for Campylobacter spp., Salmonella spp., enterotoxigenic E. coli, and C. parvum/hominis, and for certain age categories of those infected with C. difficile, enteroaggregative E. coli, and atypical EPEC. For D. fragilis and Shiga-like toxigenic E. coli/enterohemorrhagic E. coli, pathogen loads were lower in cases. Application of molecular diagnostics in GE is rapid, sensitive and specific, but results should be interpreted with care, using clinical and additional background information.

Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.

A drug-eluting stent was implanted in four patients, a man aged 67 and a woman aged 42 with acute myocardial infarction, a woman aged 41 with unstable angina pectoris and a man aged 41 with stable angina pectoris. All suffered stent thrombosis after discontinuation (in three cases prematurely) of clopidogrel therapy. Reasons for discontinuation included allergic reaction, a dental procedure and refusal of reimbursement by the insurer. In order to restore stent patency they were treated by percutaneous coronary intervention and all patients suffered irreversible myocardial damage. Combination therapy using acetylsalicylic acid and clopidogrel during and after angioplasty for the prevention of long- and short-term complications is necessary. Stent thrombosis after drug-eluting stent implantation usually occurs within 1-4 weeks following discontinuation ofantiplatelet medication. These cases stress the importance of antiplatelet therapy after stent implantation. Physicians, dentists and patients must be aware of the risk of the early discontinuation ofantiplatelet therapy.

The onset of whole muscle hypertrophy in response to overloading is poorly documented. The purpose of this study was to assess the early changes in muscle size and architecture during a 35-day high-intensity resistance training (RT) program. Seven young healthy volunteers performed bilateral leg extension three times per week on a gravity-independent flywheel ergometer. Cross-sectional area (CSA) in the central (C) and distal (D) regions of the quadriceps femoris (QF), muscle architecture, maximal voluntary contraction (MVC), and electromyographic (EMG) activity were measured before and after 10, 20, and 35 days of RT. By the end of the training period, MVC and EMG activity increased by 38.9 ± 5.7 and 34.8% ± 4.7%, respectively. Significant increase in QF CSA (3.5 and 5.2% in the C and D regions, respectively) was observed after 20 days of training, along with a 2.4 ± 0.7% increase in fascicle length from the 10th day of training. By the end of the 35-day training period, the total increase in QF CSA for regions C and D was 6.5 ± 1.1 and 7.4 ± 0.8%, respectively, and fascicle length and pennation angle increased by 9.9 ± 1.2 and 7.7 ± 1.3%, respectively. The results show for the first time that changes in muscle size are detectable after only 3 wk of RT and that remodeling of muscle architecture precedes gains in muscle CSA. Muscle hypertrophy seems to contribute to strength gains earlier than previously reported; flywheel training seems particularly effective for inducing these early structural adaptations.

We present the design and validation of a micromachined gripper array that enables reliable transmission of forces of at least 14 mN. The gripper is constructed with polycrystalline silicon (polysilicon), a brittle material, and is compatible with polysilicon surface micromachining. Two ingressive snap-and-lock array designs are presented. After developing design guidelines, it is shown that the first gripper array is functional. However, a risk remains that the gripper array rather than the tensile bar that it grips in its intended application fails. Therefore, an improved geometry is designed and it is shown that it is robust with respect to failure. Scanning confocal Raman imaging directly confirms that the local peak tensile stresses in the robust gripper array are approximately 50% of the lower bound material strength, and also resolves a 25% stress variation across the array.

Two pregnant women, 19 and 26 years old, presented at the beginning of the third trimester with one growth-retarded foetus in a multiple pregnancy. Both cases were managed conservatively. In the first woman, one foetus died at 30 weeks of gestation, after the mother developed pre-eclampsia. After the death of the impaired foetus pre-eclampsia resolved and the second child was born healthy at 36 weeks of gestation. The second woman had triplets with one severely growth-retarded foetus. This foetus died at 3I weeks of gestation. At 33317 weeks, caesarean section was performed on both maternal and foetal indications. Two healthy premature neonates were born. In multiple pregnancy with discordant growth, the interests of the foetuses may be in opposition, which creates an ethical dilemma. This may be resolved by carefully addressing the interests of all those involved and keeping in mind the prognosis, duration of pregnancy and the best interests of the healthy foetus, which should not be harmed by intervention. Therefore, active intervention is not always the best option; the least harm it does is increasing the risk ofpreterm birth.

Fatigue resistance of knee extensor muscles is higher during voluntary isometric contractions at short compared with longer muscle lengths. In the present study we hypothesized that this would be due to lower energy consumption at short muscle lengths. Ten healthy male subjects performed isometric contractions with the knee extensor muscles at a 30, 60, and 90° knee angle (full extension = 0°). At each angle, muscle oxygen consumption (mV̇o2) of the rectus femoris, vastus lateralis, and vastus medialis muscle was obtained with near-infrared spectroscopy. mV̇o2 was measured during maximal isometric contractions and during contractions at 10, 30, and 50% of maximal torque capacity. During all contractions, blood flow to the muscle was occluded with a pressure cuff (450 mmHg). mV̇o2 significantly ( P < 0.05) increased with torque and at all torque levels, and for each of the three muscles mV̇o2 was significantly lower at 30° compared with 60° and 90° and mV̇o2 was similar ( P > 0.05) at 60° and 90°. Across all torque levels, average (± SD) mV̇o2 at the 30° angle for vastus medialis, rectus femoris, and vastus lateralis, respectively, was 70.0 ± 10.4, 72.2 ± 12.7, and 75.9 ± 8.0% of the average mV̇o2 obtained for each torque at 60 and 90°. In conclusion, oxygen consumption of the knee extensors was significantly lower during isometric contractions at the 30° than at the 60° and 90° knee angle, which probably contributes to the previously reported longer duration of sustained isometric contractions at relatively short muscle lengths.

This research considers the control of a Thermal Deformable Mirror (TDM), which is used to correct a static aberration in a light beam. The TDM is a cheap, but relatively slow, deformable mirror suited for the correction of static and thermal aberrations. Correction of quasi-static disturbances can, for example, be used to enhance microscope images, or to improve the quality of femto-second light wave packages. The control objective is to maximize the light power that drops through a pinhole after focusing of the beam in a minimal time span. Only the light power behind the pinhole is available for feedback. The slow dynamics of the mirror and the lack of measurement information complicate the control task. The optimization algorithm (OA) used to maximize the light power is based on consecutive line searches in the direction of several Zernike modes. The OA operates on the surface shape of the mirror, rather than the mirror input voltages. To speed up and to improve the performance of the algorithm, model predictive control (MPC) is used to adjust the mirror shape to the shape provided by the OA. The effectiveness of using MPC has been experimentally validated. The disturbance in the experiments consists of a focus and tilt misalignment, and the zero-input shape of the TDM. Without MPC, the light power reaches 40% of the maximum light power within 3000 iterations. When applying the MPC controller, 40% of the maximum intensity is obtained within 700 iterations, and 50% within 2200 iterations.

This article reviews literature on the psychosocial correlates of cancer relapse and survival from 1979 through 1995. The factors studied were structured according to a theoretical model of coping with cancer. Reviewed studies have shown that factors most frequently evaluated were depression, anxiety, hopelessness/helplessness, hostility, marital status and social involvement. Mainly inconsistent results were found. The strongest evidence for a relationship between psychosocial variables and prognosis was found for social involvement/social support; in 7 of 15 studies a positive relationship was demonstrated, while no negative associations were found. Coping styles e.g., fighting spirit and stoic acceptance, and severe/stressful life events were found to have no conclusive influence on the length of survival. Important determinants of the coping model, such as uncertainty and information given by the specialist were not studied as possible predictors of survival and/or relapse free period. Among the factors that showed no correlation at all was multidimensional health locus of control. For the inconsistent findings, a considerable number of methodologic shortcomings with respect to study design, sample size, measure and statistical analysis are enumerated.

We evaluated the toxicity and efficacy of the first palliative chemotherapy regimen after failure of high-dose chemotherapy in 148 patients with primary or metastatic breast cancer treated with high-dose chemotherapy (one full dose CTC, (cyclophosphamide 6000 mg/m2, thiotepa 480 mg/m2, carboplatin 1600 mg/m2) or multiple courses CTC or 'tiny' CTC (tCTC) (two-thirds of the agents of the full-dose regimen), all divided over 4 days). After a median follow-up time of 46.8 (range 1-120) months, 79 patients had a relapse or progressive disease and 41 patients were treated with palliative chemotherapy. The most commonly used regimens were classical CMF (n = 13), docetaxel (n = 16) and less frequently anthracycline (n = 4), paclitaxel (n = 5), capecitabine (n = 2) and vinorelbine (n = 2). In both the CMF and docetaxel group, 3 patients required a dose reduction because of hematological toxicity. Objective responses were seen with CMF (23%) and docetaxel (69%) with a median duration of 161 (range 28-481) and 196 (range 62-437) days, respectively. We found no relationship of toxicity and response with treatment-free interval after high-dose chemotherapy. This report shows that conventional-dose palliative chemotherapy regimens may be safe and effective after failure of high-dose chemotherapy.