Optical side-band cooling of a low frequency optomechanical system.

For experimental investigations of macroscopic quantum superpositions and the possible role of gravitational effects on the reduction of the corresponding quantum wave function it is beneficial to consider large mass, low frequency optomechanical systems. We report optical side-band cooling from room temperature for a 1.5×10⁻¹° kg (mode mass), low frequency side-band resolved optomechanical system based on a 5 cm long Fabry-Perot cavity. By using high-quality Bragg mirrors for both the stationary and the micromechanical mirror we are able to construct an optomechanical cavity with an optical linewidth of 23 kHz. This, together with a resonator frequency of 315 kHz, makes the system operate firmly in the side-band resolved regime. With the presented optomechanical system parameters cooling close to the ground state is possible. This brings us one step closer to creating and verifying macroscopic quantum superpositions.

Amlodipine Besylate versus Candesartan Cilexetil in Hypertensive Patients - Office and Self-Measured Blood Pressure : A Randomised, Double-Blind, Comparative, Multicentre Trial.

OBJECTIVE: The aim of this study was to compare the antihypertensive efficacy and tolerability of the calcium channel antagonist amlodipine besylate versus the angiotensin II type 1 receptor antagonist candesartan cilexetil in hypertensive patients. PATIENTS AND METHODS: After a 2-week placebo washout period, 326 patients with essential hypertension were randomised to receive amlodipine 5mg once daily or candesartan cilexetil 8mg once daily in a double-blind, parallel-group design with a 12-week active treatment period followed by a 4-day placebo drug-free period. The initial daily dose could be doubled at week 6 if office diastolic blood pressure (DBP) was still >/=90mm Hg. BP changes were assessed daily through patient self-measurements, and fortnightly by office BP measurements. RESULTS: A total of 294 patients (151 amlodipine and 143 candesartan cilexetil) were included in the per-protocol analysis of the primary endpoint of BP change from baseline at 12 weeks. Reductions in sitting office systolic BP (SBP) [amlodipine 24.4mm Hg, candesartan cilexetil 22.3mm Hg] and DBP (amlodipine 14.9mm Hg, candesartan cilexetil 14.8mm Hg) were statistically equivalent within the chosen range of equivalence (5mm Hg for SBP and 3mm Hg for DBP). The proportion of controlled patients (office BP <140/90mm Hg) at the end of therapy was similar in both treatment groups (amlodipine 46.9%, candesartan cilexetil 44.4%). The reduction in self-measured DBP was significantly greater (p < 0.05) for amlodipine (7.2mm Hg) compared with candesartan cilexetil (4.8mm Hg). There was no significant difference between the two treatments in the incidence of adverse events reported. CONCLUSIONS: Amlodipine besylate and candesartan cilexetil were both very effective in lowering office BP after 12 weeks of treatment. There was a trend towards a better self-measured BP reduction with amlodipine compared with candesartan cilexetil. The overall incidence of adverse events was comparable between the two treatments.

The uninstitutionalized generation: a new breed to psychiatric patient.

Our first generation of young adult chronic psychiatric patients since deinstitutionalization has emerged in the community. Updated research results and case studies show different patterns of emergence but similar indications for clinician response.

Impact of humoral alloreactivity early after transplantation on the long-term survival of renal allografts.

BACKGROUND: The contribution of humoral alloreactivity to the rejection of renal allografts is not well defined because humoral antigraft reactions are not easily detectable in transplant biopsies, and serial measurements of circulating allo-antibodies in the post-transplantation period are not routinely performed. We have developed diagnostic techniques that improve the assessment of humoral alloreactivity in vivo and in vitro. METHODS: Humoral alloreactivity in transplant biopsies derived from 218 single kidney grafts was detected by assessing the deposition of complement fragment C4d in interstitial capillaries. Circulating alloantibodies were determined in corresponding serum samples by flow cytometry using lymphoblastoid cell lines of donor DR-type as target cells and by a conventional microcytotoxicity test. The impact of capillary C4d and other selected variables on renal graft survival was calculated by univariate and multivariate analysis. RESULTS: Capillary C4d, present in 46% of biopsies from first grafts and 72% of regrafts, is related to circulating alloantibodies. Grafts with capillary C4d have a markedly shorter survival than grafts without capillary C4d (50% graft survival, 4 vs. 8 years, P = 0.0001). Among several risk factors, capillary C4d is the strongest predictor of subsequent graft loss in a multivariate analysis (relative risk, 2.1, 95% CI, 1.4 to 3.1). Humoral alloreactivity detectable within six months after transplantation has a much stronger impact on graft survival than alloreactivity detected beyond this period. CONCLUSIONS: Humoral alloreactivity, manifested by the capillary deposition of complement C4d in about 50% of biopsied renal grafts, exerts a strong impact on graft survival when it operates within six months after transplantation.

Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports.

With the use of the newer antidepressants beyond the traditional tricyclics and monoamine oxidase inhibitors, newer options in headache prophylaxis are provided as well as the potential for undesirable and even potentially life-threatening interactions between medications. In this article, four patient reports of a specific interaction--the serotonin syndrome--are presented. These events resulted from transitioning headache patients from an older antidepressant (phenelzine) to a newer antidepressant (venlafaxine).

The time course of selected malarial infections in cytokine-deficient mice.

Murine malarial parasites have long been characterized by their requirement for either antibody-mediated immunity (AMI) or cell-mediated immunity (CMI) for suppression of acute parasitemia, with Plasmodium yoelii reportedly requiring AMI for suppression and P. chabaudi requiring CMI. To assess this characterization in terms of the current T(H1)/T(H2)-CMI/AMI hypothesis, we infected gene-targeted "knockout" mice lacking either a type-1 cytokine (IL-2 or IFN-gamma) or a type-2 cytokine (IL-4 or IL-10) with one or the other species of Plasmodium. We observed that type-1 cytokine-deficient mice developed exacerbated malaria with either P. yoelii or P. chabaudi, compared with that seen in heterozygote controls. Moreover, type-2 cytokine knockout mice showed a similar time course of infection with either parasite compared with that seen with their controls. We conclude that the mechanism of resolution of these well characterized malarial infections cannot be linked definitely to these T(H1)- and T(H2)-associated cytokines as predicted by the T(H1)/T(H2)-CMI/AMI hypothesis.

Expansion of the gammadelta T cell subset in vivo during bloodstage malaria in B cell-deficient mice.

Mice rendered B cell-deficient either by chronic anti-mu treatment initiated at birth or by gene knockout (JHD and mu-MT mice) suppressed acute Plasmodium chabaudi infections with a time course similar to intact control mice. Moreover, both kinds of B cell-deficient mice showed a 50- to 100-fold increase in splenic gammadelta T cell number after suppression of parasitemia compared with uninfected B cell-deficient controls; the magnitude of this increase resulted in significantly (P< 0.05) greater numbers of splenic gammadelta T cells in the B cell-deficient mice than in infected B cell-intact controls (about 10-fold). In contrast, the number of splenic CD4+ alphabeta T cells was only slightly elevated (< 2-fold) in both kinds of B cell-deficient mice compared with their intact controls. The number of splenic gammadelta T cells following suppression of P. vinckei parasitemia was approximately ninefold greater in JHD mice than in C57BL/6 controls, whereas similar numbers of splenic CD4+ alphabeta T cells were detected. Maximal numbers of gammadelta T cells were in cell-cycle in both JHD and C57BL/6 mice during descending P. chabaudi parasitemia, but the number of gammadelta T cells in cell-cycle was greater in B cell-deficient mice than in intact controls. Interleukin-10 (IL-10), a potent TH1 cell-suppressive molecule, does not appear to down-regulate the gammadelta T cell response during malaria in B cell-intact mice because the magnitude of the gammadelta T cell response was not significantly greater in IL-10 knockout mice compared with heterozygote controls. These findings collectively indicate that a markedly enhanced expansion of the gamma delta T cell population occurs in the absence of B cells, and this expansion occurs predominantly during acute malaria when parasite burdens are similar in B cell-deficient animals and intact controls.

Characteristics and treatment of homeless, mentally ill, chemical-abusing men.

Comparing two types of treatment modalities in treating homeless, mentally ill, chemical-abusing (HMICAs) men and studying their characteristics, 723 HMICAs were interviewed on their childhood and family background and their psychiatric and substance abuse disorders, and then randomly assigned into either therapeutic community (TC) or community residence (CR) programs. The TC and CRs were found to differ from one another in their intake and admission procedures, their preadmission and postadmission dropout rates, and the effects of treatment on psychological status. The TC admitted their clients into treatment faster, tended to take more impaired clients, and had a lower preadmission dropout rate than the CRs did. The CRs had a lower postadmission dropout rate and were able to retain clients longer than the TC did. Comparing clients who stayed in treatment one year or longer, the TC appears to be more effective than the CRs in reducing depressive, psychotic, and functional symptoms. HMICAs' childhood and family background reveal severe parental deprivations and high prevalence of alcohol and other drug abuse, mental illness, and criminal behavior among the clients' parents. HMICAs' characteristics suggest that these men are completely outside mainstream society. They are severely impaired psychiatrically, chronically addicted, and often involved with the criminal system, thus occupying multiple deviant roles.

Dual diagnosis of major mental illness and substance disorder: an overview.

Dual diagnosis of severe mental illness and substance disorder is a frequent and difficult challenge to the mental health and substance abuse systems. This chapter reviews the dual diagnosis problem and introduces the chapters that follow.

Heavy metal levels in the near vicinity to roads in a north London Borough.

The ingestion and inhalation of heavy metals through soil, surface dust, air and food contamination may have a detrimental effect on human health. Metal levels have been measured in a Local Authority in London, UK and are discussed where possible in relation to health risk and relevant guidelines.

Air quality in the vicinity of urban roads.

Motor vehicle emissions are a major source of CO, NOx and lead particulate concentrations to urban air quality. London urban Boroughs with high traffic densities are therefore a particular cause for concern. The air quality was monitored at an urban background site in the London Borough of Haringey for 2-years. The results of this study are assessed and their effect on human health is considered in the light of EC Directives and WHO guidelines. A desk top modelling technique based on Gaussian diffusion theory was used to predict the CO levels found at the background site. All predicted levels had a accuracy of better than 30%.

Neuropsychological characteristics of young adult chronic psychiatric patients: preliminary observations.

Psychological evaluation included tests of brain-behavior functioning and academic level for 110 young adults (16 to 39 yr. of age), each a moderate to heavy user of mental health services. The composite patient manifested borderline, diffuse brain dysfunction with deficiencies in language, visuospatial, motor, concentration, and higher-order problem-solving skills, together with below normal performance on tests of intelligence, reading comprehension, arithmetic calculation, and spelling. Standard mental health services appear inadequate for habilitation or rehabilitation of many such people. The findings suggest that one reason for these patients' lack of response to conventional mental health treatments is that clinicians fail to identify patients' fundamental deficiencies and to incorporate this knowledge in planning treatments and evaluating progress. Suggestions for further studies are offered.

By pass esofágico con estómago / Gastric bypass of the esophagus

Se presenta la experiencia en la técnica de by pass esofágico con estómago. Esta técnica fué indicada en 19 pacientes: 10 casos de cáncer esofágico no susceptibles de resección por ser infiltrativos o por limitación ventilatoria severa; fué empleado en 6 casos de estenosis esofágicas benignas, severas, extensas, con acortamiento esofágico y no dilatables; se utilizó también en 2 casos de várices esofágicas sangrantes, con múltiples sesiones de escleroterapia, como procedimiento de desvascularización. Se empleó el by pass como técnica de reconstrucción del tránsito en un enfermo con rotura esofágica espontánea. La principal morbilidad postoperatoria fué la fístula de la esófago-gastro-anastomosis que ocurrió en el 42%. La mortalidad operatoria de ésta serie fué de 2 pacientes (10,5%). Uno debido a neumopatía por aspiración y el otro, a un edema pulmonar