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Aims Heart disease might be an independent risk factor for cancer (reverse cardio-oncology). The co-occurrence of these diseases worsens patients' prognoses and limits therapeutic options. However, the cellular and molecular mechanisms that link heart disease to cancer remain elusive. Therefore, we hypothesized that cardiac extracellular vesicles (cEVs) secreted by diseased hearts carry and disseminate factors that promote tumor growth. Methods and results We subjected female mice to myocardial infarction (MI) or sham-MI and 28 days of follow-up. Left ventricular remodeling and dysfunction were assessed by echocardiography. To determine the role of cEVs in tumor growth, we focused on cardiac mesenchymal stromal cells (cMSCs), which play a central role in cardiac repair, remodeling, and fibrosis. We isolated cMSCs from mice hearts 10 or 28 days after MI or sham MI and purified cMSC-EVs from the conditioned medium using size exclusion chromatography. cEVs were characterized by nanoparticle tracking analysis (NTA), the classical EV markers: CD81 and Tumor susceptibility gene 101, and electron microscopy. cMSCs after MI secreted more small EVs than cMSCs from sham-MI (Fig. 1A, p Conclusions Our results suggest, for the first time, that cMSCs from the infarcted and failing heart secret EVs that target tumor cells and accelerate tumor growth. We propose cEVs as potential mediators and therapeutic targets in patients with concomitant heart disease and cancer. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Seymour Fefer Grant

Background Coronavirus disease 2019 (COVID-19) is associated with microvascular dysfunction. Non-invasive thermal imaging can hypothetically detect changes in perfusion, inflammation and vascular injury. We sought to develop a new point-of-care, non-contact thermal imaging tool to detect COVID-19 by microvascular dysfunction, based on image processing algorithms and machine learning analysis. Materials and methods We captured thermal images of the back of 101 individuals, with (n=62) and without (n=39) COVID-19, using a portable thermal camera that connects directly to smartphones. We developed new image processing algorithms that automatically extract multiple texture and shape features of the thermal images (Figure 1A). We then evaluated the ability of our thermal features to detect COVID-19 and systemic changes of heat distribution associated with microvascular disease. We also assessed correlations between thermal imaging to conventional biomarkers and chest X-ray (CXR). Results Our novel image processing algorithms achieved up to 92% sensitivity in detecting COVID-19 with an area under the curve of 0.85 (95% CI: 0.78, 0.93; p Conclusions We show, for the first time, that a hand-held thermal imaging device can be used to detect COVID-19. Non-invasive thermal imaging could be used to screen for COVID-19 in out-of-hospital settings, especially in low-income regions with limited imaging resources. Moreover, thermal imaging might detect micro-angiopathies and endothelial dysfunction in patients with COVID-19 and could possibly improve risk stratification of infected individuals (Figure 1B). Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): 1. The Israel Innovation Authority2. The Nicholas and Elizabeth Slezak Super Center for Cardiac Research and Biomedical Engineering at Tel Aviv University Figure 1. A. Representative steps of our thermal image processing algorithms. B. A schematic illustration of the research design and potential impact.

Introduction Diabetes as a multifactorial disorder requires prevention measures based upon the modification of several risk factors simultaneously; otherwise, there is insufficient potential for prevention. Following the success of the American Diabetes Prevention Program (DPP), we implemented an intervention program in a large Israeli healthcare organization with an emphasize on Mediterranean Diet (MedDiet) and physical activity. The objective was to evaluate the effectiveness of two types of intervention, individual and group therapies, in reducing risk factors and in preventing or delaying the development of type 2 diabetes. Methods Out of 180 primary care physicians, 85 who agreed to participate, were randomly assigned, between the years 2005 and 2006, into two groups: those who would refer pre-diabetes adult patients for individual therapy and those who would refer for group therapy. The two groups of patients consisted of 111 and 112 in each group. The intervention lasted for 6 months and discussed: the benefits of MedDiet, planning nutritional behavior and mindful eating, and the importance of physical activity. All patients were invited to participate in walking groups. Follow up lasted for 24 months and logistic, mixed models, and Cox regressions were employed. Results No statistically significant differences were detected between the two intervention groups in age; gender and clinical measurements at recruitment. Thirty nine percent of both groups developed diabetes (entered the DR by 2012), including 38.7% from the individual therapy and 39.3% from the group therapy ( P =0.933). The mean time from 2005 until entry to the Diabetes Registry (DR) was 2.9 and 2.5 years for the individual and group therapy respectively ( P =0.542). Conclusion Both interventions were equally effective in achieving the desired outcomes and time until entry to the DR. For large health organizations with a high number of pre-diabetes patients and scarce resources, group therapy, where 12 people are reached out by one team member are preferable and more costly effective, than a one on one therapy.

Summary The objective was to evaluate the prevalence of osteoporosis among Ethiopian immigrant and Israeli-born women and to determine the risk factors. The study revealed extreme prevalence of osteoporosis among Ethiopian immigrants (38.7). A strong association between calcium intake during adolescence, BMI, lactation duration, physical activity, oral contraceptive and osteoporosis is suggested.

A method is presented, geared to separating signals from different sources which are convoluted and mixed by the mechanical systems before being measured. The method is based on an automatically operating blind deconvolution separation method, with Kurtosis of the separated signals as the measure to be maximised. The application described involves bearings diagnostics, whereas with many classical diagnostic methods, Kurtosis is traditionally one of the accepted criteria for fault detection. The method is tested on simulation and experimental cases. Results show that separation is possible even when measurements are distanced from the vibration exciting sources of the faulty bearing. Furthermore, the method eliminates the effect of structural resonances, which often causes severe problems in classical diagnostic methods.

OBJECTIVES To assess the ability of colour Doppler transrectal ultrasonography (CD-TRUS) to improve the accuracy of detecting perineural invasion (PNI, reported to be an independent predictor of extraprostatic extension) and in predicting the pathological stage of the cancer, comparing it with the results of grey-scale TRUS-guided biopsies. PATIENTS AND METHODS This prospective study included 47 men with clinically localized disease; all underwent 10-core TRUS-guided biopsy and two bilateral CD-TRUS-guided biopsies, targeted on the area adjacent to the neurovascular bundle. The rates and accuracy of PNI detection on 10-core and CD-TRUS-targeted biopsies were compared with the pathological outcome. Various patient, clinical and pathological factors were compared, and multivariate analysis used to assess the value of the technique in predicting PNI and pathological outcome. RESULTS CD-TRUS-guided biopsies predicted the presence of PNI in the radical prostatectomy specimens with a sensitivity of 89%, and specificity and positive predictive values of 100%. Seven of 24 (29%) patients with PNI on the needle biopsies had pT3 disease. Conversely, the absence of PNI on guided biopsy accurately predicted pathologically localized disease in 96% (negative predictive value) of patients. However, the results of multivariate analysis showed that serum prostate-specific antigen was the only strong predictor of pT3. CONCLUSION CD-TRUS is a useful tool for detecting PNI and predicting pathological localized cancer; it can be used in candidates for nerve-sparing radical prostatectomy.

The time of equilibration, t, in reversible aggregation of colloidal particles was investigated. Estimates were calculated from Smoluchowski-type kinetic equations, extended to include dissociation reactions. An extension of the analytic solution for the monomer-dimer system yields a closed form expression for t in the general case. Equilibration time can also be estimated from a single equation which expresses the rate of change of the number of composite particles, using averaged values for the rate constants. Sodium-induced aggregation of phosphatidylserine vesicles was studied by means of turbidity and energy transfer measurements. The reversibility of the aggregation process has been verified with both procedures, confirming also no exchange of the fluorescent probes used between vesicles in an aggregate. The calculations can predict the decrease in t values with an increase in vesicle concentration and give rough estimates for t values. The kinetics of turbidity increase is similar to that of fluorescence increase of acceptor molecules. With 200 μ M lipid + 650 m M NaCl at 23°C, the turbidity and fluorescence intensity reach equilibrium values in approximately 2 min. At lower temperatures both the extent of aggregation and t increase in accord with estimates. At 35°C the extent of aggregation decreases as expected, but t increases. We interpret this to be the result of an increase in the potential barrier to close approach of the vesicles.

Objective To evaluate the influence of maternal and fetal parameters on the quality of fetal nuchal translucency measurement. Design This was a prospective study in 227 consecutive pregnant women undergoing nuchal translucency screening by transabdominal sonography. The same well-qualified sonographer performed all the scans and in each case the best-quality image was selected and scored according to an image scoring system (total maximum score, 9). The quality of the image was examined in relation to maternal age, weight, abdominal wall thickness, amniotic sac diameter, posterior uterine wall depth (distance between abdominal wall surface and posterior uterine wall surface), placental location, fetal crown–rump length and nuchal translucency thickness. Correlation coefficients were calculated and stepwise linear regression was used to adjust for confounders and to define the predictors for image score. Results The only two parameters that provided a significant independent contribution to the prediction of the image score were posterior uterine wall depth and fetal crown–rump length. Intravariable analysis of these two parameters demonstrated that the cut-off associated with a significant change in the image quality was 80 mm for posterior uterine wall depth (score difference, 1.06; P < 0.001) and 70 mm for crown–rump length (score difference, 0.77; P = 0.001). In the group of women with two values above these cut-off points, an average score decrease of 1.90 (P < 0.001) was observed. Conclusions The quality of fetal nuchal translucency measurement is poorer when the fetal crown–rump length is > 70 mm and the posterior uterine wall depth is > 80 mm.Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

To study the validity of the FIGO staging classification of endometrial cancer Stage IB by correlating degree of myometrial invasion depth with outcome measures.Fifty patients with endometrial adenocarcinoma FIGO Stage IB who underwent hysterectomy between 1989 and 2001 were divided into two groups according to depth of myometrial invasion. The first group comprised of 31 patients with myometrial invasion of less than or equal to one-third. The second group included 19 patients with invasion greater than one-third but less than one-half. The two groups were compared with regard to prognostic factors and outcome measures.The overall 5-year recurrence-free survival, disease specific survival and overall survival rates were 87%, 94% and 77%, respectively. These outcome measures did not vary significantly between the two groups. There were no statistically significant differences between the two groups with regard to the following parameters: duration of follow-up, age, proportion of patients who underwent complete surgical staging and postoperative adjuvant radiotherapy. Histologic parameters of the two groups, such as histological type, grade and proportion of patients with capillary space-like involvement and lower uterine segment involvement were not significantly different.In patients with Stage IB endometrial cancer the amount of myometrial invasion defined as less than one third compared with invasion greater than one third does not appear to correlate with their outcome, thus validating the FIGO staging system.

To assess the ability of colour Doppler transrectal ultrasonography (CD-TRUS) to improve the accuracy of detecting perineural invasion (PNI, reported to be an independent predictor of extraprostatic extension) and in predicting the pathological stage of the cancer, comparing it with the results of grey-scale TRUS-guided biopsies.This prospective study included 47 men with clinically localized disease; all underwent 10-core TRUS-guided biopsy and two bilateral CD-TRUS-guided biopsies, targeted on the area adjacent to the neurovascular bundle. The rates and accuracy of PNI detection on 10-core and CD-TRUS-targeted biopsies were compared with the pathological outcome. Various patient, clinical and pathological factors were compared, and multivariate analysis used to assess the value of the technique in predicting PNI and pathological outcome.CD-TRUS-guided biopsies predicted the presence of PNI in the radical prostatectomy specimens with a sensitivity of 89%, and specificity and positive predictive values of 100%. Seven of 24 (29%) patients with PNI on the needle biopsies had pT3 disease. Conversely, the absence of PNI on guided biopsy accurately predicted pathologically localized disease in 96% (negative predictive value) of patients. However, the results of multivariate analysis showed that serum prostate-specific antigen was the only strong predictor of pT3.CD-TRUS is a useful tool for detecting PNI and predicting pathological localized cancer; it can be used in candidates for nerve-sparing radical prostatectomy.

To evaluate the influence of maternal and fetal parameters on the quality of fetal nuchal translucency measurement.This was a prospective study in 227 consecutive pregnant women undergoing nuchal translucency screening by transabdominal sonography. The same well-qualified sonographer performed all the scans and in each case the best-quality image was selected and scored according to an image scoring system (total maximum score, 9). The quality of the image was examined in relation to maternal age, weight, abdominal wall thickness, amniotic sac diameter, posterior uterine wall depth (distance between abdominal wall surface and posterior uterine wall surface), placental location, fetal crown-rump length and nuchal translucency thickness. Correlation coefficients were calculated and stepwise linear regression was used to adjust for confounders and to define the predictors for image score.The only two parameters that provided a significant independent contribution to the prediction of the image score were posterior uterine wall depth and fetal crown-rump length. Intravariable analysis of these two parameters demonstrated that the cut-off associated with a significant change in the image quality was 80 mm for posterior uterine wall depth (score difference, 1.06; P0.001) and 70 mm for crown-rump length (score difference, 0.77; P = 0.001). In the group of women with two values above these cut-off points, an average score decrease of 1.90 (P0.001) was observed.The quality of fetal nuchal translucency measurement is poorer when the fetal crown-rump length is70 mm and the posterior uterine wall depth is80 mm.

To evaluate the prescription patterns of oral nitrates in terms of appropriateness and cost in a community setting.A period prevalence, descriptive, applied study. Data including age, gender, type of medication, dosage and cost were extracted from the database of the largest health maintenance organisation (HMO) in Israel. The study population included enrollees over 35 years of age who received oral nitrates at least once during the 12-month study period.Oral nitrates were prescribed for 8007 patients (mean age 72.85+/-9.59 years, male:female ratio 1:1). A total of 52,694 prescriptions were issued for 56,553 medications, of these 88.1% for mononitrates, which constituted 95% of the annual cost for patients and the HMO. The mean prescribed daily dose for the various drugs ranged from 30% less than to 50% more than the recommended dose. Combination therapy with at least two nitrates, which is not the recommended treatment, was given to 5% of the patients. The recommended alternative treatment will alleviate the financial burden for providers and patients.Improved prescription habits can provide enhanced quality as well as cost savings for patients and providers.

There is an international epidemic of violence in the emergency department (ED) which threatens medical staff daily. The problem is underestimated in Israel and there are as yet no regulations of the Ministry of Health and the Bureau of Security and Safety that deal with the problem. At the beginning of 1997 we conducted a retrospective survey to estimate the extent of this problem and to define its causes and the various options for management. An anonymous questionnaire was given to all permanent workers of our ED: physicians, nurses and reception clerks, as well as physicians who worked in the ED during evening and night shifts at least twice a week. 74% of (questionnaire) responders experienced violent events, most of them 5 or more times during the previous 2 years. Violence was experienced by 90% of nurses, 70% of physicians and 64% of clerks. The main reason for violence was prolonged waiting in the ED. Other causes were dissatisfaction with treatment, refusal to leave the ED, and language that displeased the patient. Most violent patients were middle-aged men, of whom alcohol and drug users were only a small proportion. Most victims of physical violence called hospital security personnel, but only a third of the victims of verbal violence pressed charges. Half of the staff who were physically attacked called the police and most pressed charges. Only 2 attackers were convicted; charges were dropped against 3 because of "lack of public concern." We were unable to ascertain the results of the other charges. Most victims of violence didn't press charges because of fear resulting from threats of the patient and/or family. The violent patient was usually characterized by responders as a middle-aged man, sober, of low socioeconomic level, impatient, with a bad previous hospital experience, dissatisfied with treatment and who insisted on being admitted to hospital. Suggestions for violence management by questionnaire-responders included 24-hour police protection and a training program in violence management for hospital security and medical staff.

Road accidents, work accidents, or other trauma can cause impotence and are frequently followed by insurance claims. During 1990-97 we examined 230 males with such a complaint. All underwent full polysomnographic recordings in the sleep laboratory for 2 nights, during the course of which NPT (nocturnal penile tumescence) was examined with special equipment. It was assessed by an experienced technician following planned awakenings from REM sleep. In 75 of the 230 subjects (33%), satisfactory erections were observed. In 100 (43%), who experienced at least 3 periods of REM sleep, no erections occurred. These patients were categorized as suffering from organic impotence. In the remaining 55 (24%), the results were inconclusive, with only partial erections or not enough REM sleep periods. Since a man recognized as suffering from impotence may be awarded large monthly payments for life, these examinations, in our opinion, are an important tool to prevent unjustified claims, and can save the state unnecessary expenses.

Ischemic heart disease (IHD) is women is characterized by a higher morbidity and mortality in the peri-infarction and coronary bypass peri-operative periods. These epidemiological data strengthen our impression that the health system unintentionally "ignores" the high proportion of females with IHD. The process of investigating chest pain, diagnosing IHD, and the subsequent treatment and rehabilitation, seem to differ between the genders. Time elapsed from beginning of chest pain to diagnosis of IHD seems to be longer in women than in men. Personal, educational and social factors are contributory. Although time elapsed between diagnosis and rehabilitation is usually similar in the genders, peri-operative morbidity and mortality are higher in women. It may be that the higher rates in women are caused by delay in diagnosis and treatment, which allows worsening of the disease in women before treatment. This delay can occur during the time needed for evaluation of chest pain, from the door of the physician to diagnosis and treatment. In our retrospective study we determined the difference in referral of men and women with chest pain to the emergency department (ED) and the attitude of physicians in the ED and medical department to chest pain in men and in women, including final diagnosis on discharge. 615 patients over 18 years referred to the ED for chest pain during 3 randomly chosen, consecutive months were studied. We found that women constituted only 39.5% of the referred patients, but the proportion hospitalized was similar to that in men. Hospitalized women were older (57.7 +/- 18.4 versus 49.7 +/- 17.8 years in men), and had more risk factors (4 versus 2 in men). Proportions of specific diagnoses on discharge from hospital were equal in the genders. To bridge the differences and to implement education in prevention, investigation and treatment of IHD in women, we established the "Female Heart" clinic. The objective of this clinic is to reduce differences in the first step, in the process of evaluating chest pain in women, by educating and encouraging them to present early to their physicians, and by changing physicians' attitudes in the investigation of chest pain in women. We plan to determine in a prospective study if these goals are reached.

There are about 6500 births yearly in the Ashkelon District. 6% of the mothers are Ethiopians, most of whom immigrated to Israel since the early 90's. Our data are from 3 sources: birth certificates, infant death certificates, and the national population register. Birth rates in single mothers and rates of low-birth-weight births have declined over the years. Infant mortality and still-birth rates have also shown remarkable and consistent declines between 1990-1995. We conclude that improvement in life conditions of Ethiopian immigrants and better use of health services have had a great impact on birth outcomes and pregnancy patterns. The gap between Ethiopian immigrants and other Jewish communities in Israel is closing fast.

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israel's southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985-94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV-positive.

Several surgical procedures have been developed for the treatment of sleep apnea syndrome. These include nasal, uvulopalatopharyngeal, and head and neck surgery, weight reduction surgery, and tracheostomy. Despite over 15 years of experience with some of these operations, there is still a lack of consensus regarding the indications, success rate, complications, and long-term prognosis associated with these procedures. The current status of these surgical procedures is reviewed.

The mechanism of leakage induced by surface active peptides is not yet fully understood. To gain insight into the molecular events underlying this process, the leakage induced by the peptide pardaxin from phosphatidylcholine/ phosphatidylserine/cholesterol large unilamellar vesicles was studied by monitoring the rate and extent of dye release and by theoretical modeling. The leakage occurred by an all-or-none mechanism: vesicles either leaked or retained all of their contents. We further developed a mathematical model that includes the assumption that certain peptides become incorporated into the vesicle bilayer and aggregate to form a pore. The current experimental results can be explained by the model only if the surface aggregation of the peptide is reversible. Considering this reversibility, the model can explain the final extents of calcein leakage for lipid/peptide ratios of > 2000:1 to 25:1 by assuming that only a fraction of the bound peptide forms pores consisting of M = 6 +/- 3 peptides. Interestingly, less leakage occurred at 43 degrees C, than at 30 degrees C, although peptide partitioning into the bilayer was enhanced upon elevation of the temperature. We deduced that the increased leakage at 30 degrees C was due to an increase in the extent of reversible surface aggregation at the lower temperature. Experiments employing fluorescein-labeled pardaxin demonstrated reversible aggregation of the peptide in suspension and within the membrane, and exchange of the peptide between liposomes. In summary, our experimental and theoretical results support reversible surface aggregation as the mechanism of pore formation by pardaxin.

The efficacy of the anterior mandibular positioning (AMP) device in obstructive sleep apnea syndrome was assessed. This device advances the mandible anteriorly by approximately 5-7 mm. 29 patients were examined and questioned about temporomandibular (TM) and facial pain before and after treatment with the device. Polysomnographic sleep studies were performed on all before, and 2 weeks after continuous use of the AMP device. 10 of the patients also underwent polysomnographic follow-up after 1 year. The mean apnea index (AI) before treatment was 40.1, which decreased to 24.3 (p0.0001) after 14.3 days of treatment with the AMP device. O2 saturation also increased, from 84.2% before, to 89.2% after treatment (p0.002). In 10 patients the mean AI after 1 year was 24.9, not different from that after only 2 weeks of treatment, but significantly different from their mean AI before treatment (39.8). Use of the AMP device did not change blood saturation levels; neither did it affect dental status, action of the masticatory muscles, nor did it cause TM joint dysfunction. 21 patients (72.4%) have now been fitted with an AMP device, and the mean follow-up is 13.4 months (range 2-22); 3 have been using the AMP only intermittently for TM joint pain or discomfort. We conclude that the AMP device helps the majority of patients and is an alternative, nonsurgical method for treating obstructive sleep apnea syndrome.

38 patients with obstructive sleep apnea syndrome underwent automated ambulatory 24-hour blood pressure monitoring. Systolic, diastolic and mean pressure values were significantly correlated with the apnea index (AI) during sleep, as well as during wakefulness. A significant negative correlation was found between minimal arterial O2 saturation in sleep and diastolic blood pressure values during waking hours. The contribution of the AI to blood pressure during sleep and wakefulness was significant, while the contribution of body mass index (BMI) was negligible. These results support the causal relationship between the severity of sleep apnea syndrome and systemic hypertension, independent of BMI.

Forty-seven obese sleep-apnea patients were investigated in the sleep laboratory before and after a massive weight reduction achieved by bariatric surgery. The first postoperative sleep investigations were performed approximately 1 y after surgery and revealed a highly significant decrease in the number of apneic episodes per hour of sleep and a significant improvement in all sleep-quality-related measures. A second postoperative sleep study was performed approximately 7 y postoperatively and revealed that regaining of weight was associated with the reappearance of sleep apnea syndrome, although the great majority of the patients still felt, subjectively, that they were well and did not suffer from recurrence of the sleep apnea syndrome.

38 patients with sleep apnea syndrome treated with uvulopalato-pharyngoplasty were interviewed 23 +/- 10.8 months after the operation (mean age 48.0 +/- 8.6 years, range 28-65). 22 were also studied in the sleep laboratory 10 +/- 10.7 months after operation. 3 months after operation 94% reported improvement in snoring and 77% improvement in excessive daytime sleepiness. 1 and 2 years after the operation snoring had decreased to 74% and 65%, respectively, and excessive sleepiness to 65%, for both periods. There was a decrease of at least 50% in the number of apneic periods per hour of sleep in 68%. Side-effects consisted of nasal regurgitation and vocal changes. Only age was of predictive value: the younger the patient the better the response.

The present study investigated the effects of the benzodiazepine receptor antagonist RO 15-1788 on the ability to resist sleep after 1 night of sleep deprivation. Repeated administrations of RO 15-1788 to 6 subjects significantly decreased their ability to resist sleep in comparison with repeated administration of 100 mg of vitamin C, and with a nontreatment condition. Most of the hypnotic effect occurred 80-100 min after drug ingestion. RO 15-1788 also significantly enhanced sleep stage 2 spindles activity. These results demonstrate that at certain dosages RO 15-1788 has agonist-like effects.

Cervical myelopathy due to ossification of the posterior longitudinal ligament of the spine is reported in a 48-year-old Caucasian Jewish man. Clinical and roentgenologic changes are presented. The va

The evaluation of the etching rate in thin film resistor delineation processes is considered in this paper. The calculation of the absolute etching linewidth error from sample resistance measurements has been considered in a previous paper. The method is extended in this paper to allow a dynamic (time-dependent) characterization of the linewidth overetching.

Auditory brain stem evoked potentials (ABEPs) were recorded from 10 adults and 10 children who where neurologically and audiometrically normal. ABEPs were recorded in response to 75 dB HL clicks presented at rates of 10/sec and 50/sec. Normative values were calculated for amplitude and latency, as well as for inter-peak amplitude ratio and a variety of inter-peak latency differences and interaural differences at the two stimulus presentation rates. Normative values of the effect of increasing stimulus rate were calculated as well. Measures of changes in ABEPs between stimulus rates of 50/sec and 10/sec were the only derived measures that were significantly different between our adult and child normal populations. In addition, 50 patients with various conditions affecting the brain stem were examined. Increasing stimulus presentation rate had a significant effect on detection of abnormality in ABEPs from the patients examined. Measures of changes in ABEPs between stimulus rates of 50/sec and 10/sec seemed to be sensitive to a subset of abnormalities in our patient population. The case histories of the patients indicate that the subset may be impaired synaptic function. Measures of the effect of rate on ABEPs may complement the traditional measures that are primarily sensitive to white matter lesions.

Treatment with clonazepam was studied in a group of 20 patients suffering from periodic movements in sleep, in a double-blind parallel group design. Eleven complained of excessive daytime sleepiness, and nine complained of insomnia. Ten patients received clonazepam, and 10 received placebo, over a period of 1 month. Clonazepam (0.5-2 mg per night) proved to be an effective treatment of periodic movements in sleep. Polysomnographic recordings demonstrated a significant decrease in the number of leg movements and a significant improvement in sleep parameters in the clonazepam group as compared with placebo. Subjective responses to treatment corroborated the sleep laboratory findings.

Auditory middle-latency evoked potentials (AMEP) were recorded in 10 subjects with predominantly central sleep apnea. AMEP were recorded during: waking; non-rapid eye movement (non-REM) sleep between apneic episodes; first half of apneas; and second half of apneas. Latencies of vertex positive peaks Po and Pa were determined, and the effect of the apnea phase on these latencies was evaluated. The latencies measured did not reveal chronic or acute functional abnormality of central auditory structures, which may result from or cause apneic episodes during non-REM sleep. The normalcy and stability of AMEP during apneic sleep may indicate effective compensatory mechanisms in central auditory structures. Alternatively, the lack of changes may result from the variability of AMEP, which may obscure small functional changes.

Eight whole-night polysomnographic recordings were conducted in a 33-year-old man with a localized pontine lesion inflicted by a shrapnel fragment. Sleep recordings revealed no rapid eye movement (REM) sleep in 3 nights, and markedly reduced REM sleep in 5 nights; non-rapid eye movement (NREM) sleep was normal. In spite of marked reduction of REM sleep, the patient conducted a normal life and had none of the typical symptoms of REM-sleep deprivation.

Excessive daytime sleepiness and hypersomnia are common complaints. In most cases, daytime hypersomnia is the result of disrupted nighttime sleep. For example, in the sleep apnea syndrome, disturbed breathing disrupts sleep by many arousals and awakenings, causing severe sleep fragmentation (Fig. 1). The same is true for periodic leg movements in sleep (nocturnal myoclonus) where arousals follow the abnormal movements in the lower extremities.

Seventy-eight patients with essential hypertension participated in a controlled study of group therapy (GT). They were alternately assigned alphabetically to receive GT (48 patients) and to a control group (30 patients). The therapy was aimed at changing some of the patients' coping mechanisms. In both groups, patients continued to take the same dose of antihypertensive medications that they had been taking previously. At the end of 6 months, eight patients had dropped out of the GT group. In the GT group there was a fall in systolic blood pressure of 20.9 +/- 13.1 and in diastolic pressure of 12.8 +/- 6.3 mm Hg (mean +/- SD, P less than 0.01), while in the control group there was no significant change in blood pressure. In neither group was there a significant change in weight. Follow-up 3 months and 1 year after group therapy showed that the effect of the therapy persisted in most patients.

Visual evoked potentials (VEPs) are a useful tool in the diagnosis of multiple sclerosis. To improve their diagnostic power in the early stages of the disease, the VEP shape, as well as its latency, were considered. The Karhunen-Loeve expansion (KLE) was used because it affords an unique advantage in classifying the VEPs by their shape, and gives a well-defined criterion based on similarity to the normative prototype. Using this criterion, it was possible to quantitatively define normative limits of waveform. We were also able to detect early changes in VEPs recorded from suspected multiple sclerosis patients. KLE promises to enable classification of waveforms in early stages of the pathology, when peak-latency comparisons are the least effective.