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Background Autonomic failure (AF) complicates Parkinson’s disease (PD) in one-third of cases, resulting in complex blood pressure (BP) abnormalities. While autonomic testing represents the diagnostic gold standard for AF, accessibility to this examination remains limited to a few tertiary referral centers. Objective The present study sought to investigate the accuracy of a machine learning algorithm applied to 24-h ambulatory BP monitoring (ABPM) as a tool to facilitate the diagnosis of AF in patients with PD. Methods Consecutive PD patients naïve to vasoactive medications underwent 24 h-ABPM and autonomic testing. The diagnostic accuracy of a Linear Discriminant Analysis (LDA) model exploiting ABPM parameters was compared to autonomic testing (as per a modified version of the Composite Autonomic Symptom Score not including the sudomotor score) in the diagnosis of AF. Results The study population consisted of n = 80 PD patients (33% female) with a mean age of 64 ± 10 years old and disease duration of 6.2 ± 4 years. The prevalence of AF at the autonomic testing was 36%. The LDA model showed 91.3% accuracy (98.0% specificity, 79.3% sensitivity) in predicting AF, significantly higher than any of the ABPM variables considered individually (hypotensive episodes = 82%; reverse dipping = 79%; awakening hypotension = 74%). Conclusion LDA model based on 24-h ABPM parameters can effectively predict AF, allowing greater accessibility to an accurate and easy to administer test for AF. Potential applications range from systematic AF screening to monitoring and treating blood pressure dysregulation caused by PD and other neurodegenerative disorders.

The research aims to characterize the thermal behavior of a rock mass forming a little hill at the confluence of two glacial valleys in the Italian Alps, known since centuries for the particular warm microclimate and its botanical-archeological park. The characterization from a thermophysical point of view is done both with laboratory tests exploiting infrared thermography coupled with petro-physical characterization and in the field long-term thermographic survey.Methods based on infrared thermography allowed to measure thermal diffusivity, conductance and specific heat. The measurements animals to evaluate the use of thermographic methods for the early detection of falling rocks and to study the characteristics of temperate local microclimat

Spatiotemporal mode-locking is a promising lasing regime for developing coherent sources for multimode nonlinear photonics. In this paper we show that large-aspect-ratio vertical external-cavity surface-emitting lasers (VECSELs) can be operated in this regime. The emitted pulses exhibit a spatial profile resulting from the phase locking between an axial plane wave and a set of tilted waves having a hexagonal arrangement in the Fourier space. Moreover, we show that these pulsating patterns are temporally localized, i.e., they can be individually addressed by pulsing the optical pump. The theoretical analysis discloses that the emergence of these pulsating patterns is a signature of a Turing instability whose critical wave vector depends on the spherical aberrations of the optical elements. Our result reveals that large-aspect-ratio VECSELs offer unique opportunities for studying fully developed spatiotemporal dynamics and for applications to multidimensional control of light.

Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (ΔHR/ΔSBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ΔHR/ΔSBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ΔHR/ΔSBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (∆HR/∆SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.

In this work we present the hydrogeophysical imaging of a key sector of the Quaternary Po foreland basin (northern Italy), focussing on the reconstruction of clastic aquifers and aquitards in a complex tectono-sedimentary subsurface architecture. The study area includes the relic reliefs of Casalpusterlengo and Zorlesco, two smooth morphological features involving uplifted and gently folded Pleistocene marine to alluvial sediments, plausibly linked to the buried Northern Apennines thrust and fold belt. The geophysical data include 35 Direct Current Vertical Electrical Soundings collected over a 37 km2 wide area, acquired with Schlumberger array and maximum half-spacing of 500 m. 1-D resistivity-depth profiles were computed for each VES. An integrated hydrostratigraphic approach was applied, to constrain the interpretation of the geophysical data along several cross-sections, including the comparison of resistivity soundings to stratigraphic logs, borehole electric logs and the pore-water properties. The resistivity interfaces, traceable with the same laterally continuous vertical polarity, were used to develop an electrostratigraphic model in order to portray the stacking of electrostratigraphic units down to 200 m below ground surface. Their vertical associations show a general upward increase of electrical resistivity. This assemblage mimics the regional coarsening upwards depositional trend, from the conductive units of the Plio-Pleistocene marine-to-transitional depositional systems to the resistive units of the Middle–Late Pleistocene fluvial and alluvial plain depositional systems. Middle Pleistocene depositional systems host an alternation of North-dipping, high-to-intermediate permeability aquifer systems (70–180 Ωm, thickness of 5–70 m) separated by low permeability aquitards (20–50 Ωm, thickness up to 40 m). These units pinch out against the Casalpusterlengo and Zorlesco relic reliefs, where they cover the uplifted and folded regional aquitard (20–50 Ωm) formed by Pliocene-Lower Pleistocene clays to sandy silts with gravel lenses in agreement with borehole data. In the deepest part of the local stratigraphy, a broad low-resistivity anomaly (< 10 Ωm) was clearly mapped through the study area. By comparison with electrical borehole logs in deep oil-wells, it could be interpreted as the fresh–saltwater interface due to the presence of connate waters and brines hosted by the marine-to-transitional shales.

The integration of surface geological and geomorphological information with borehole point-data and geophysical (e.g., geoelectrical) images of the subsurface yields spatially consistent representations of alluvial aquifers heterogeneity at different scales, from depositional systems to basin fills. Such an approach requires a conceptual framework to match the stratigraphic units with their evidence from ground-based DC resistivity methods to effectively fill the gaps between sparse borehole data and to obtain valid representations of sedimentary heterogeneities. Such an approach is applied to characterize two sites of the Quaternary aquifers of the central Po Plain (Italy), which represent (1) the middle-upper Pleistocene braided to meandering river depositional systems sitting on Southalpine crust and (2) their down-current counterparts, where they are involved by the latest uplift and deformation due to the tectonic activity of the Apennine frontal thrusts. Electrical resistivity was considered as a proxy of the litho-textural properties of hydrofacies and their major hierarchical association at depth and was interpreted in accordance with the depth-decreasing resolution of ground-based resistivity methods. Thus, it was possible to identify the geophysical signature of hydrostratigraphic units through ''Electrostratigraphic Units'', i.e., sedimentary volumes identified by resistivity contrasts that spatially preserve the vertical polarity. Hydrostratigraphy and electrostratigraphy were then joined together through a site-specific relationship between electrical resistivity and hydraulic conductivity, which takes into account the prevailing process of current conduction, the litho-textural properties of hydrofacies and the groundwater electrical conductivity. At the scales of aquifer systems and complexes, this approach permitted to establish the conceptual framework to match hydrostratigraphy, electrostratigraphy, average hydrodynamic properties and distribution of heterogeneities.

The femoral neck fracture is actually the most important traumatic event in the elderly, because of its high rate and terrible complications. We reviwed clinical records of 314 patients treated in our institution with a bipolar implant for femoral neck fracture. At a mean follow-up of 5 years, 15 patients (4.8%) were lost to followup so data for 299 patients was studied to identity factors associated with mortality. Ten predictor variables were examined: age, sex, waiting time for surgery, pulmonary dysfunction, fracture etiology, and comorbidity with ischemic heart disease, and heart failure, hypertension, cerebrovascular disease, and chronic renal failure. Cumulative mortality rate during the first 6 months was 19% (55 of 299 patients) and in the first year it was 25% (76 of 299). At logistic regression analysis, mortality was associated with age, male gender, waiting period for surgery and presence of neoplastic disease or pathological fracture. Waiting for surgery was a significant factor for mortality at 6, 12 and 24 months: patients surgically treated in the first 24 hours had lower mortality than those who waited longer. The risk of mortality in the first 6 months doubled for an age increase of 12 years, while mortality within 2 years doubled for an age increase of 9 years. Although the motality rate after surgery for femoral neck fracture was high in the first year (25%), it dropped off in successive years to levels observed in a healthy population. Thus, we agree with the literature that femoral fracture is a risk factor for survival only in the first year after trauma, above all in the elderly.

Aims: To determine whether Ha-AP10, a member of the plant lipid transfer proteins (LTPs) family produces a direct cytotoxic effect on fungal cells mediated by membrane permeabilization. LTPs can inhibit fungal growth and are considered members of the ubiquitous class of antimicrobial peptides. However, the way they exert their effects on target cells is not yet understood. Methods and Results: Viability assays demonstrate that Ha-AP10 acts as a fungicidal compound but no harmful effect is observed on plant cells. Liposome leakage assays show that the protein induces a moderate release of fluorescent probes encapsulated in model membranes, indicating its ability to interact with phospholipids. Using a fluorescent indicator of damage at the membrane level, we demonstrate that Ha-AP10 is able to induce the permeabilization of intact fungal spores in a dose-dependent manner. Conclusion: The results presented here demonstrate the permeabilization of fungal spores caused by Ha-AP10. Significance and Impact of the Study: To our knowledge, this is the first demonstration of fungal membrane damage by an LTP, giving a clue to elucidate the basis of its antimicrobial properties.

A retrospective study was conducted to correlate the clinical result of joint replacement in dysplastic hips with the obtained modifications of the rotation centre.Sixty primary total hip arthroplasties were performed on 46 patients suffering from hip dysplasia at our institution. The radiographic evaluation of the hip rotation centre was performed using the method proposed by Pierchon. The clinical assessment was by Harris Hip Score. Our results revealed that it was possible to modify the position of the pathological rotational centre with a statistically significant difference (p

Using an experimental approach directed to the isolation of antimicrobial proteins, we have detected the presence of a trypsin inhibitor (TI) with associated antifungal activity in sunflower seeds. Purification of the isolated protein by affinity chromatography on a trypsin-agarose matrix confirmed that a trypsin inhibitor was responsible for the inhibition of spore germination of the fungal pathogen Sclerotinia sclerotiorum. The protein is a potent antifungal compound as it can completely inhibit the germination of S. sclerotiorum ascospores at a concentration of 14 μg/ml. The putative contribution of this TI to control fungal invasion is discussed.

Wavelet transform analysis of experimentally measured intensity fluctuations distinguishes the transition from low frequency fluctuations at moderate feedback to stable operation at strong feedback. Comparison of these results with those of a wavelet analysis of lowpass filtered solutions of the Lang-Kobayashi equations for deterministic evolution of a single mode semiconductor laser with optical feedback finds substantial agreement in the part of the wavelet spectrum corresponding to slow dynamics. Substantial disagreement is found in the fast dynamics, which lessens when noise is added to the equations.

The increasing use of geophysical surveys for the hydrological subsurface characterization does not ensure by itself the correct interpretation of an image showing the spatial distribution of a physical quantity. Geo-electrical methods, such as Vertical Electrical Soundings and Electrical Resistivity Ground Imaging, for example, are affected by uncertainties arising from model equivalence, related to non-uniqueness or low sensitivity of the inverse problem. Moreover, the laboratory experiments we performed on samples of alluvial sediments, ranging from fine gravel to silt and clay, saturated with pore water of varying electrical conductivity, show that a low resistivity value can be attributed to granular porous media saturated by fluids with high salinity or to fine-grained soils, even in a freshwater hydrogeological environment . This work aims at further investigating the electrical response of alluvial sediments at the REV (Representative Elementary Volume) scale, by systematically varying textural and fluid properties. The final purpose is to suggest a phenomenological model able to discriminate between the electrolytic conductivity component, connected to the free ions into the pore waters, and the "shale" component, due to unbalanced lattice charges on silty and clayey particles, and their physical-chemical interactions with adsorbed water molecules or other charged species. A georesistivimeter, commonly used for site surveys, was adapted for the laboratory tests with a specifically designed sample holder (a polycarbonate cylindrical cell, 12 cm height and 9 cm width, equipped with external copper plates as current electrodes and internal copper squared-grids as potential electrodes). The optimal acquisition conditions of DC measurements (time elapsed from the sample preparation, external applied electric field and temperature) were determined. Analysis were conducted on eight samples of Quaternary alluvial sediments of the Po plain (Northern Italy), texturally characterized by a coarse-to-fine grain ratio ?d (with threshold diameter d equal to 0.0625 mm) ranging from 0.29 to 61.5. This parameter has been useful to develop the above mentioned phenomenological model, which separates the contribution of the electrolytic, shale and pore solution/solid grains interaction components of electrical conduction. Such a model could be very effective if independent data on fluid conductivity, effective porosity and intrinsic conductivity of the fine sediment fraction are available. Since this last property is not easily measurable, the ongoing research is now focusing on analysis with alternate currents, to estimate both charge transport via classical ohmic conduction and polarization effects in the low frequency range (mHz-kHz), mostly due to charge accumulation against charged fine particles. The combination of electrical conductivity values and phase values is addressed to decrease model equivalence, even in the absence of external data.

We investigate the relationship between passive mode locking and the formation of time-localized structures in the output intensity of a laser. We show how the mode-locked pulses transform into lasing localized structures, allowing for individual addressing and arbitrary low repetition rates. Our analysis reveals that this occurs when (i) the cavity round-trip is much larger than the slowest medium time scale, namely the gain recovery time, and (ii) the mode-locked solution coexists with the zero intensity (off) solution. These conditions enable the coexistence of a large quantity of stable solutions, each of them being characterized by a different number of pulses per round-trip and with different arrangements. Then, each mode-locked pulse becomes localized, i.e., individually addressable. © 2014 American Physical Society., J. J. acknowledges financial support from Ramón y Cajal program and CNRS for supporting a visit at the INLN where part of his work was developed. J. J. and S. B. acknowledge financial support from project RANGER (TEC2012-38864- C03-01) and from Direcció General de Recerca de les Illes Balears cofunded by the European Union FEDER funds. INLN group acknowledges funding from Région PACA with the Projet Volet Général 2011 GEDEPULSE

We measure the time-resolved probability distribution of the light emitted by a semiconductor laser with optical feedback. We show and analyse, for the first time, high-frequency fluctuations of the laser intensity in the coherence collapse regime. Our results suggest that the noise induces the power drop-outs and the laser recovers in a deterministic fashion. We also give a new mechanism for a transition between erratic and synchronised behaviour in the laser dynamics.

Six cases of greater arc injury, defined as a perilunate dislocation of the carpus with a fracture of at least both the scaphoid and the capitate, were treated by open reposition and both internal and external fixation. Revascularisation of the capitate by implantation of the first dorsal intermetacarpal artery was attempted in three cases. At a mean follow-up of six years and four months, all patients complained of residual pain in the wrist. Carpal mobility and grip strength were reduced, and all patients showed mild or moderate arthritic changes. Progressive cartilage damage over the proximal pole of the capitate seems to be a determining factor in the outcome. Open reposition and both internal and external fixation are recommended in order to possibly diminish the incidence of arthritis and minimise secondary carpal instability.

We report on bistability in VCSEL involving two linear and orthogonal polarizations. The domain of coexistence is extended to the full current range of the device. We demonstrate control of the polarization state by perturbing optically the VCSEL. We show that the induced polarization state is recovered after having turned off and on the device.

Secretogranin II (chromogranin C) is an acidic tyrosine-sulfated secretory protein, known to be a marker of neuroendocrine secretory products and of specific neuroendocrine tumours. In order to obtain anti-secretogranin II monoclonal antibodies for cell biology studies and, in particular, for clinical applications, we immunized mice with a secretogranin II-enriched fraction prepared from homogenates of bovine anterior pituitaries. Hybridoma supernatants obtained from the splenocytes of a hyperimmune mouse, screened with an enzyme-linked immunosorbent assay, were analyzed by both immunocytochemistry and two-dimensional immunoblotting. By using this experimental approach, we were able to identify two monoclonal antibodies (8G1 and 5A7) which recognize bovine secretogranin II. Both immunocytochemistry and immunoblotting revealed that one of them, the 5A7 antibody, cross-reacts with the human antigen. The distribution patterns of the immunoreactivity, obtained by immunocytochemistry with the 5A7 antibody in animal and human tissues, partially overlap those, obtained by using a polyclonal antiserum elicited against bovine secretogranin II, previously described. Moreover, the 5A7, but not the polyclonal antibody, reacts with some duodeno-jejunal cells. In conclusion, both the 5A7 and 8G1 antibodies can be useful for cell biology studies. The 5A7 antibody can be used for the detection of secretogranin II in human tissues and should be of help in clinical and pathological practices.

The presence of small G proteins was investigated by [γ- 35 S]GTP-binding in 3 human neuroblastoma cell lines, IMR-32, SK-N-BE and SH-SY5Y, before and after treatment with differentiating agents (dibutyryl-cAMP, 5-bromodeoxyuridine or retinoic acid) which induce the appearance of secretory organelles. One major component of about 24 kDa and 3 minor components of smaller M r were found to bind specifically [γ- 35 S]GTP in all 3 cell lines already before differentiation. Differentiation did not affect the expression of small G proteins in IMR-32 cells and only modestly affected it in the other two cell lines. The possibility that the expression of small G proteins in neuroblastoma cells is not coupled with the assembly of secretory organelles is discussed.

Fifty cases of Hodgkin's disease in intravenous drug users (IVDU) have been collected by the Italian Cooperative Group on AIDS-Related Tumors (G.I.C.A.T.). Ninety-two per cent of the patients were males; the median age was 26 years. Persistent generalized lymphadenopathy (PGL) at onset was present in 54% of patients, AIDS in 9%, ARC in 9% while 28% were simply HIV-positive. The initial median absolute number of CD4 lymphocytes was 264/mmc. Opportunistic infections were diagnosed in 20% of patients. In most patients the histological pattern was that of mixed cellularity and lymphocytic depletion (76%). In almost half the initial symptom was a persistent lymph node enlargement due to PGL. In the majority of patients (58%) only a clinical staging and bone marrow biopsy could be performed due to the presence of opportunistic infections, rapid disease progression or refusal of pathologic staging procedures. One patient presented with a Waldeyer's ring involvement, but no other unusual presentations were observed. After MOPP alternated or followed by ABVD or MOPP alone, 15/29 CR (52%) and 14/29 PR (48%) were observed. The median duration of CR was 14 months, while the median survival of CR has not been reached; the median survival of patients treated with chemotherapy with CD4 values at presentation {geq}400/mmc was significantly superior to that in those with CD4 < 400/mmc. The overall median survival was 16 months. Twenty-eight per cent of patients receiving chemotherapy + radiotherapy developed opportunistic as well as non-opportunistic infections (21%). Lethal hepatic toxicity was observed in 2 patients. In conclusion, Hodgkin's disease in IVDU was not found to be associated with unusual presentations, as previously reported for homosexuals. Complete remissions could be achieved in over 50% of patients, but in IVDU non-opportunistic infections in addition to opportunistic infections may also limit treatment administration. The presence of parenchymal functional impairment due to drug abuse, or drug abuse-related infections, such as pneumonia, endocarditis and hepatitis, should lead to the choice of antitumour agents with no or only minor potential liver, lung and cardiac toxicity.

Cavity solitons represent a class of dissipative solitons which are generated inside an optical resonator. They have attracted considerable interest in the recent years due to their possible application to optical information processing. First of all, this review chapter illustrates the physics of cavity solitons in semiconductor devices. We discuss the experiments which demonstrated cavity solitons in vertical-cavity surface-emitting lasers, both below and above threshold, and all the theory which accompanied such experiments. Those features of the experimental results, which relate to prospective applications, are highlighted. The final part of the chapter deals with the theory of the cavity soliton laser.

Objectives To describe the cytogenetic and FISH characterization of a prenatally diagnosed de novo complex chromosome rearrangement (CCR), showing the involvement of four chromosomes and six breakpoints, and review the literature concerning prenatally detected CCRs in order to obtain insights into addressing karyotype-phenotype correlations in prenatal genetic counseling. Methods Conventional protocols were used to set up cultures and chromosome preparations. Commercial and homemade probes were used for the FISH analyses. Results An apparently balanced de novo t(4;10;20) was prenatally identified by means of cytogenetic analysis. FISH revealed a rearrangement mediated by six breakpoints and the insertion of chromosome 8 material within the 4q region. The pregnancy was interrupted. The fetus showed malformations and anomalous cortical neuron migration. The assembled list of 20 prenatally detected CCRs points to the preferential involvement of chromosomes 4, 6 and 14. The involvement of chromosome 20 is described here for the first time. Conclusions FISH analysis is essential for the accurate definition of a complex rearrangement. Phenotype description of fetuses carrying CCRs investigated by means of molecular cytogenetic techniques may contribute to improving and personalizing genetic counseling in prenatal diagnosis. Copyright © 2006 John Wiley & Sons, Ltd.

The Carpal tunnel syndrome is a common problem in various jobs, but not in the cleaning farms. A population of 99 women working in hospital cleaning activities was investigated to define if, although the risk assessment was negative for cumulative trauma diseases (CTD), the Occupational physician should search or not the CTS. We found that CTS prevalence in exposed group is higher than the common female population not exposed and the female workers are younger, so we can suppose the occupational risk exist although the negative risk assessment. The age and the working-age seem not to be determinant in the pathology of the disease, nether the different working-risks is, therefore the risk assessment doesn't consider other risk factor of the cleaning activities: strength, duration, frequency and recover time. This study confirms that the CTS seems to be a disease related with the cleaning workers and although the risk assessment is negative for CTD the Occupational physician should perform the health survaillance for CTD.

Alejandro M. Yacomotti ...et al.-- PACS number(s): 42.60.Mi, 05.45.2a, We analyze multi-longitudinal-mode semiconductor lasers experimentally. We show that the intensity of each mode displays large amplitude oscillations but obeys a highly organized antiphase dynamics leading to an almost constant total intensity output. For each mode, regular switching is observed in the megahertz range, while the optical frequency as a function of time follows a well defined sequence from blue to red. Using a multimode theoretical model, we identify that four-wave mixing is the dominant mechanism at the origin of the observed dynamics. The asymmetry of the susceptibility function of semiconductor materials allows us to explain the optical frequency sequence., The work in Bruxelles was supported by the Fonds National de la Recherche Scientifique and the Interuniversity Attraction Pole program of the Belgian government. A. Y. was supported by a grant from FOMEC (Argentina). S. B. acknowledges financial support from MECD (Spain) through sabbatical Grant No. PR2002-0329.

The investigations in the field of spatial pattern formation in nonlinear optical systems1 offer an approach to parallel optical information processing, by encoding information in the transverse structure of the field.

We report on experimental evidence of cavity solitons in driven diode lasers below threshold. We show for the first time in semiconductors that one-peaked structures, generated in arbitrary locations, are spatially uncorrelated, as required for solitons. A microscopic model shows excellent agreement with experimental results.

The Ablate and Pace Trial (APT) prospectively assessed the effects of catheter ablation of the AV conduction system and permanent pacemaker implantation on health-related quality of life, survival, exercise capacity, and ventricular function in 156 patients with symptomatic atrial fibrillation.All patients referred for catheter ablation and permanent pacemaker implantation because of medically-refractory atrial fibrillation at 16 centers were screened for enrollment in a prospective registry. Baseline assessment prior to ablation included measurement of quality of life, including the Health Status Questionnaire, the Quality of Life Index and the Symptom Checklist: Frequency and Severity. Exercise capacity was assessed with metabolic treadmill exercise testing and ventricular function was quantitated with echocardiography. The quality of life instruments, exercise capacity, and echocardiography were repeated at 3 and 12 months after catheter ablation.The APT population included 90 men and 66 women (66.1 +/- 11.5 years of age) with either chronic (n = 70), recurrent (n = 31), or paroxysmal atrial fibrillation (n = 55). Structural heart disease was present in 78.2% of patients. Successful ablation of AV conduction was achieved in 155 of 156 patients (99.4%). Survival at 1 year was 85.3%, with 5 of 23 deaths being sudden cardiac deaths. Survival over the first year of follow-up was significantly lower for patients with a baseline left ventricular ejection fraction (LVEF)0.45 (0.73) than for patients with a LVEFor = 0.45 (0.88, p = 0.03). The NYHA functional class improved from 2.1 at baseline to 1.8 at 3 months and 1.9 at 12 months of followup (p = 0.0001). Significant improvement in quality of life scores were noted for all 8 subscales of the Health Status Questionnaire, for the overall rating of the Quality of Life Index, the Health and Function subscales; Arrhythmia-related symptoms were markedly reduced as measured by the Symptom Checklist: Frequency and Severity scale. The mean LVEF improved from 0.50 +/- 0.20 at baseline to 0.54 +/- 0.20 at 3 months (p = 0.03). The LVEF 12 months after ablation was 0.52 +/- 0.20, not statistically different from baseline. Individuals with reduced systolic function at baseline had the greatest improvement, from LVEF 0.31 +/- 0.20 at baseline to 0.41 +/- 0.20 at 3 months and 0.41 +/- 0.30 at 12 months (p = 0.0001). There were no significant changes in treadmill exercise duration (10.0 +/- 4.3 min at baseline and 11.6 +/- 3.6 min at 12 months) or VO2max (1467 +/- 681 ml O2 min baseline and 1629 +/- 739 ml O2 min at 12 months).Catheter ablation of the AV conduction system and permanent pacemaker implantation were associated with improved quality of life and left ventricular function in this population of highly symptomatic patients with atrial fibrillation refractory to medical therapy.

A retrospective analysis of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The collected information included the date of specimen withdrawal (six labs only), receipt in the laboratory, and reporting. Time intervals between withdrawal and receipt. Two labs, received 3/4 of cases the same day, while the others had a very low prevalence of receipt. All labs but one, received 80-90% of cases within 48 hours. In one lab, 17% of cases arrived five days after from the withdrawal. Time intervals between receipt and reporting. The mean observed in the seven labs ranged from 3.1 to 6.1 days. Two labs were able to report within 24 hours, but this occurred only in 6% of their cases. The reporting prevalence within three days ranged between 5 and 64%, with a mean for the seven labs of 37%. The reporting prevalence within 6 days was about 95% (four labs), 60-70% (two labs) and 20% (one lab). All labs but one reported 95-100% of cases within ten days. Time intervals between withdrawal and reporting. Our labs were not able to report within 24 hours from the withdrawal (frozen sections excluded). The reporting prevalence within 2-3 days was about 35-40% (three labs), 16% (one lab), 2% (two labs), and within six days it was about 90% (three labs), and 61%, 38% and 14% (the remaining). These latter reported 95% of their cases within twenty days. The turnaround times we found are unsatisfactory. Probably, there are many sources of delay, and these are multifactorial. However, a major factor involved in these delays seems to be related to poor arrangements in the allocation and managing of human resources.

Following a major reorganization of the National Health Service, competition for resources will depend to a great extent on the quality of the service offered, and audit will be of increasing importance. The present investigation deals with the quantitative aspects of the histopathology workload. A retrospective analysis of the biopsy handling of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The data collected included information on specimen type, diagnosis, block/section/stain details for each specimen, as well as information about human resources, total workload and technical equipment. Among the seven labs, the histopathology workload ranged between 6,600 and 15,600 cases/year. The workload per person/year ranged between 1,400 and 2,600 (mean 1,900) for pathologists, between 800 and 3,000 (mean 1,500) for technicians, and between 2,200 and 8,300 (mean 4,400) for secretarial staff. The prevalence of biopsy fragments (endoscopic, endometrial curettage , etc.), "small" surgery (skin, appendix, gallbladder, etc.) and surgery was, respectively, between 42 and 50%, 34 and 47%, 9 and 21%. In all labs but one, 80% of cases were within 1-3 blocks; the seven labs had a mean of blocks/case ranging from 1.8 to 4.0 (total mean = 2.8). Differences in performing special stains were astonishing: one lab performed special stains in about 40%, and another in only 0.6% of cases (mean of the seven labs = 15%). Finally, the labs performed immunohistochemical stains within a range of 2.7-8% of cases (mean of the seven labs = 4.6%). The data we have collected provided baseline information on the laboratory running, and this is likely to be an integral part of laboratory administration in the near future.

During the past 10 years, 15 patients have had percutaneous catheter drainage (PCD) of pyogenic liver abscesses (PLA) at a major teaching hospital. Five PLA were related to biliary tract disease, two were secondary to colonic diverticulitis, two developed after abdominal surgery, and the remaining were associated with hepatic trauma, gastric ulcer, Crohn's ileitis, and colon cancer. Two abscesses were cryptogenic. Mean diameter of PLA was 8 cm and ranged from 2-14 cm. Three patients had multiple PLA. All patients were initially treated by PCD without major complications. However, one patient required a second PCD after developing a recurrent abscess. Fever and leukocytosis defervesced at a mean 3.6 days and 7 days, respectively, after PCD. Seven of the 15 patients subsequently had one-stage elective abdominal operations for treatment of diseases underlying PLA including two cholecystectomies, two colon resections, one gastrectomy, one ileostomy closure, and one laparotomy for unresectable gall bladder cancer. There were no postoperative complications. These results demonstrate that PLA are best treated by using PCD as primary treatment with surgical drainage reserved for patients who do not respond clinically to PCD. The need for operative treatment in diseases underlying PLA should not deter use of PCD as primary treatment.

Description of a clinical case diagnosed in the first hours of life in apparently well newborn. Diagnostic suspicion by palpation and transillumination. Absence of any subjective sign. Inspective symptom the light scrotal swelling. The neonate received an immediate surgical exploration with subsequent orchiectomy.