Time trends, frequency, characteristics and prognosis of short-duration transient global amnesia.

BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia lasting up to 24 h. One major differential for TGA is transient epileptic amnesia, which typically lasts < 1 h. However, TGA can also be short in duration and little is known about the time trends, characteristics and prognosis of TGA cases lasting < 1 h. METHODS: We compared the clinical features of TGA ascertained in two independent cohort studies in Oxfordshire, UK [Oxford cohort 1977-1987 versus Oxford Vascular Study (OXVASC) 2002-2018] to determine the time trends of clinical features of TGA. Results were validated in another independent contemporary TGA cohort in Italy [Northern Umbria TGA registry (NU) 2002-2018]. We compared the risk factors, clinical features and long-term prognosis (major cardiovascular events, recurrent TGA and seizure/epilepsy) of patients presenting with episodes lasting < 1 h versus those lasting ≥ 1 h. RESULTS: Overall, 639 patients with TGA were included (114 Oxford cohort, 100 OXVASC, 425 NU). Compared with the original Oxford cohort, there were more cases with TGA lasting < 1 h in OXVASC [32 (32.0%) vs. 9 (8.8%)] and NU (11.8% vs. 8.8% in Oxford cohort). In both OXVASC and NU, patient age, vascular risk factors and clinical features were largely similar between those with TGA lasting < 1 h versus those lasting ≥ 1 h. Moreover, there was no difference in the long-term risk of seizure/epilepsy or major cardiovascular events between TGA lasting < 1 h versus TGA lasting ≥ 1 h. CONCLUSIONS: Short-duration TGA episodes (<1 h) were not uncommon and were more frequent than in earlier studies. The clinical features and long-term prognosis of short-duration TGA did not differ from more typical episodes lasting ≥ 1 h.

Nature of spatiotemporal light bullets in bulk Kerr media.

We present a detailed experimental investigation which uncovers the nature of light bullets generated from self-focusing in a bulk dielectric medium with Kerr nonlinearity in the anomalous group velocity dispersion regime. By high dynamic range measurements of three-dimensional intensity profiles, we demonstrate that the light bullets consist of a sharply localized high-intensity core, which carries the self-compressed pulse and contains approximately 25% of the total energy, and a ring-shaped spatiotemporal periphery. Subdiffractive propagation along with dispersive broadening of the light bullets in free space after they exit the nonlinear medium indicate a strong space-time coupling within the bullet. This finding is confirmed by measurements of a spatiotemporal energy density flux that exhibits the same features as a stationary, polychromatic Bessel beam, thus highlighting the nature of the light bullets.

Soliton-induced relativistic-scattering and amplification.

Solitons are of fundamental importance in photonics due to applications in optical data transmission and also as a tool for investigating novel phenomena ranging from light generation at new frequencies and wave-trapping to rogue waves. Solitons are also moving scatterers: they generate refractive index perturbations moving at the speed of light. Here we found that such perturbations scatter light in an unusual way: they amplify light by the mixing of positive and negative frequencies, as we describe using a first Born approximation and numerical simulations. The simplest scenario in which these effects may be observed is within the initial stages of optical soliton propagation: a steep shock front develops that may efficiently scatter a second, weaker probe pulse into relatively intense positive and negative frequency modes with amplification at the expense of the soliton. Our results show a novel all-optical amplification scheme that relies on soliton induced scattering.

Space-time focusing of Bessel-like pulses.

We report on a space-time compression technique allowing for complete and independent control of the longitudinal dynamics and of the transverse pulse localization by means of spatial beam shaping. We experimentally observe both strong temporal compression and high transverse localization, of the order of a few wavelengths, along free-space propagation.

High throughput analysis of drugs of abuse in hair by combining purposely designed sample extraction compatible with immunometric methods used for drug testing in urine.

Drug testing in hair usually requires a rather complex sample treatment before drugs are amenable to analysis by either immunological and/or chromatographic coupled to mass spectrometry methods. Immunological methods applied are usually dedicated to hair analysis as analytes present in this matrix are not always the same present in urine. Comedical s.a.s. laboratories recently commercialized reagents (VMA-T) purposely designed for hair sample treatment which are compatible with current immunometric methods used for urine drug testing. This is possible as some analytes (6-MAM and cocaine) present in hair after sample treatment are converted to those detected in urine (morphine and benzoylecgonine). A correlation study for several drug classes performed in two laboratories with 32 clinical and 12 spiked drug free (controls) hair samples shows that implementation of the method on clinical chemistry analyzers is easy and that results obtained by different operators and instruments are comparable and reproducible. The main advantage of VMA-T method is the possibility to simultaneously extract from hair main drug classes, in a period of time lower than 2h and its compatibility with immunological methods applied in urine drug testing.

Tratamiento físico rehabilitador en el hombro doloroso / Physical treatment reoutfitter in the painful shoulder

Objetivo:Valorar la eficacia del tratamiento combinado de corriente interferencial y crioterapia comparándolo cuando además se realizan ejercicios de movilidad en el hombro doloroso.Pacientes y métodosEn el estudio prospectivo han participado 40 pacientes con edad media de 48 años, incidencia por sexos de 12 mujeres y 28 hombres, que en su mayoría efectuaban trabajo de oficina con computadora y referidos al Centro de Investigaciones Clínicas para tratamiento fisiátrico primario entre julio de 2006 a enero de 2007, Hombro más afectado: derecho (22 pacientes) y 6 con afectación bilateral. La tenosinovitis de la porción larga del bíceps y la tendinitis del supraespinoso fueron los diagnósticos ecográficos de mayor frecuencia en el estudio.Pacientes y métodosLa muestra fue dividida randomialmente en 2 grupos donde el grupo i o estudio correspondería con los números pares y el grupo ii o control con los números impares.Pacientes y métodosSe valoró antes de iniciar el tratamiento el grado de dolor, aplicando la escala visual analógica (EVA) y la escala de valoración funcional del hombro modificada por la Sociedad Cubana de Reumatología de Hombro, y luego de realizar 15 sesiones (cinco sesiones a la semana durante 3 semanas) de tratamiento se hizo una nueva valoración del dolor y la movilidad del hombro.Pacientes y métodosEl tratamiento consistió en corriente interferencial analgésica por 10min, seguido de crioterapia por 10min con una bolsa fría en ambos grupos y en el grupo estudio seguidamente se realizaron movilizaciones de hombro para todos los movimientos.ResultadosTras 15 sesiones se logró el 85% de eficacia con el tratamiento en el grupo i y el 80% en el grupo ii según los parámetros del estudio. Trece pacientes terminaron el tratamiento sin dolor según la EVA en el grupo i y 10 pacientes en el grupo ii, y sólo 3 pacientes del grupo i y 4 pacientes del grupo ii (AU)

Objective: To asses the efficacy of the combined treatment of cryotherapy and interferential current when additional mobility exercises are practiced for the painful shoulder.Patients and methodsA prospective study was conducted in which 40 patients with average age of 48 years of both sexes (12 females and 28 males) participated. Most of them worked at office with desktop computers and were referred to the Center of Clinical Research for primary physiatric treatment from July 206 to January 2007; the right shoulder was the most affected (22 patients) and six patients suffered pain in both shoulders. Tenosynovitis in PLB and tendinitis of the supraspinous muscle were the most frequent echographic diagnoses in this study.Patients and methodsThe sample was randomly divided into 2 groups where group I (the study group) included the even numbers and group II (control group) the odd numbers. Before the treatment, the degree of pain was determined according to the Visual Analogical Scale and the Functional Assessment Scale of the shoulder modified by the Cuban Society of Shoulder Rheumatology. After 15 sessions of treatment (five rehabilitation sessions per week for 3 weeks), pain and mobility of the shoulder was again assessed. The treatment consisted of applying analgesic interferential current for 10min, followed by cryotherapy with cold bag for 10min to the affected shoulders in both groups; in this case, the study group was subjected to mobilization technique in the shoulder for all kind of movements.ResultsAfter 15 sessions, 85% efficacy was reached in group I and 80% in group II according to the study parameters. Thirteen patients from group I finished their treatment without any pain whatsoever; 10 patients succeeded in group II and only 3 patients and 4 patients from group I and II respectively (AU)

Complete retrieval of the field of ultrashort optical pulses using the angle-frequency spectrum.

We propose an experimental technique that allows for a complete characterization of the amplitude and phase of optical pulses in space and time. By the combination of a spatially resolved spectral measurement in the near and far fields and a frequency-resolved optical gating measurement, the electric field of the pulse is obtained through a fast, error-reduction algorithm.

Finite-energy, accelerating Bessel pulses.

We numerically investigate the possibility to generate freely accelerating or decelerating pulses. In particular it is shown that acceleration along the propagation direction z may be obtained by a purely spatial modulation of an input Gaussian pulse in the form of finite-energy Bessel pulses with a cone angle that varies along the radial coordinate.We discuss simple practical implementations of such accelerating Bessel beams.

Spontaneous emergence of pulses with constant carrier-envelope phase in femtosecond filamentation.

We study the possibility to obtain high-intensity pulses that maintain a constant Carrier Envelope Phase (CEP) during propagation in dispersive media, i.e. pulses such that the carrier-wave offset with respect to the main intensity peak remains fixed. Our numerical experiments strongly suggest that pulse splitting and X-wave formation within femtosecond laser pulse filamentation leads to the formation of "constant-CEP" within well-defined regions inside the filament. We study the creation of "constant- CEP" pulses in both gasseous and condensed media showing that this is a generic feature of filaments.

Talalgia. Revisión bibliográfica / Talalgia. Bibliographic review

Objetivo. Analizar los conceptos generales del dolorlocalizado en el talón que pudiera estar en relación conla irritación de la fascia plantar o del hueso del talón,donde se precisará la epidemiología del dolor, laetiopatogenia, el cuadro clínico referido por el pacienteasí como los estudios de imagenología que ayudarían asu diagnóstico.Método. El tratamiento se debe comenzar con medidassimples y con baja probabilidad de efectos secundarioshaciendo recomendaciones a los pacientes;posteriormente indicando medicamentos analgésicosy/o antinflamatorios no esteroideos y medidas físicasrehabilitadoras como termoterapia, ultrasonidos,magnetoterapia, hidroterapia, láser, iontoforesis,corrientes analgésicas de baja y media frecuencia, ondasde choque extracorpóreas, ortesis, taloneras, calzadoadecuado, yesos, masajes y ejercicios de estiramiento dela fascia plantar y en algunos casos bloqueo, anestésicodel nervio tibial posterior, infiltraciones con esteroides y en caso de ser necesario o estuviera indicado, la conducta quirúrgica.Conclusiones. Su diagnóstico precoz, el tratamientodel dolor, la descarga de la tensión de la fascia plantary la corrección de las anomalías del antepié y retropiéson factores que contribuyen atenuar las molestiasen el paciente y a disminuir la discapacidad queocasiona esta enfermedad de quienes la padecen

Objective. To analyze the general concepts of heel located pain that might be related to the irritation of the plantar fascia or bone of the heel, which require pain epidemiology, pathogenesis, clinical manifestationsreported by the patient and imaging studies that wouldhelp its diagnosis.Methods. Treatment should begin with simple measuresand with low probability of side effects recommendingpatients; subsequently indicating pain medication and /or non-steroidal antiinflammatory and physicalrehabilitative measures as thermotherapy, ultrasound,magnetotherapy, hydrotherapy, laser, iontophoresis, lowand medium frequency analgesic currents, extracorporealshock waves, bracing, plantar insoles, appropriatefootwear, plasters, massage and stretching exercises of the plantar fascia, and in some cases anesthetic blockade of the posterior tibial nerve, steroid infiltration and if necessary or indicated, surgical treatment.Conclusions. The early diagnosis and treatment,pain, discharge from the tension of the plantar fascia,the correction of forefoot and rearfoot anomalies arecontributing factors to ease discomfort in the patientand to reduce the disability that causes this diseaseto whom suffer

Reference values of urinary 3,5,6-trichloro-2-pyridinol in the Italian population--validation of analytical method and preliminary results (multicentric study).

The interlaboratory validation of analytical procedures for the assay of urinary 3,5,6-trichloro-2-pyridinol (TCP) in the general Italian population is reported. The determinations were performed by high-resolution gas chromatography (HRGS) with electron capture detection and HRGS with mass spectrometry (MS) in 2 laboratories. The urine samples were from 42 participants from 3 regions of Italy. The results were evaluated by interlaboratory quality control. Urinary TCP concentrations were above the detection limit (1.2 micrograms/L) in 88% of the population, with a mean detectable concentration [GM (GSD)] of 2.8 (1.9) micrograms/g creatinine (creat). (GM, geometric mean; GSD, geometric standard deviation.) The Mann-Whitney U test showed that wine consumption was a statistically significant variable (p < 0.05) for urinary concentrations of TCP. Analysis of variance of the logarithm of urinary TCP versus wine consumption and diet showed a statistically significant fit. The model used explained 30% of the total variance: wine consumption and diet accounted for 37 and 17% respectively of the explained variance.

Less-invasive heart surgery: the preservation of median approach.

OBJECTIVE: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. METHODS: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. RESULTS: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84+/-9 and 61+/-11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290+/-180 ml/m2. CONCLUSIONS: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.

Less invasive cardiac operations through a median sternotomy: 100 consecutive cases.

BACKGROUND: In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete (manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is instituted, and no modifications to the surgical techniques are necessary. METHODS: In 100 consecutive patients (mean age, 62.04 years; range, 9 to 92 years), 70 aortic, 13 mitral, and 17 other cardiac procedures were performed. Surgical technique required many self-made instruments; anesthetic "fast-tracking" management was performed. RESULTS: Four patients died. One conversion to a standard sternotomy and five reoperations for bleeding were necessary. Cross-clamp time ranged from 33 to 140 minutes (mean +/- standard deviation, 69.23 +/- 20.99 minutes) and total drainage loss ranged from 120 to 1,800 mL x m(-2) x 24 h(-1) (mean, 288 mL x m(-2) x 24 h(-1)). The postoperative course was shorter than usual, and one complication in the healing wound was observed. The scar was shorter than 9 cm in all patients. CONCLUSIONS: Our work shows that a less invasive approach to many cardiac operations is possible through a modified median sternotomy. This technique provides many potential and practical advantages: there is less trauma and pain reported by patients, and the small wound reduces the risk of infection and blood loss. Patients are extubated and discharged from the hospital earlier.

Urinary excretion of ethylenethiourea in five volunteers on a controlled diet (multicentric study).

Urinary excretion of ethylenethiourea (ETU) was monitored for 8 days in a group of five male non-smoker volunteers on a diet, the items of which were assayed for ETU and carbon sulphide. Urinary excretion of ETU reflected the consumption of wine, fruit and vegetables. Urinary ETU concentrations ranged from 0.6 to 6.7 micrograms/g creatinine. ETU concentrations in the food eaten by the volunteers were generally below the detection limit whereas in wine 8.8 micrograms/l ETU was detected. Evolution of carbon sulphide by food samples ranged from 0.03 to 0.17 mg/kg. Mean (+/- S.D.) daily intake of ETU in wine was 3.5 +/- 0.2% of the acceptable daily intake (ADI): 0.070 +/- 0.004 micrograms/kg body wt. During the 8 days of the study, an average of 48.3% of the ETU ingested in wine was excreted unmodified by the kidneys. Twenty-four hour urinary excretion of ETU was significantly correlated with daily intake of ETU (r = 0.768) and CS2 evolved by the daily food items (r = 0.414).

Reference values of urinary ethylenethiourea in four regions of Italy (multicentric study).

The results of a study in which urinary ethylenethiourea (ETU) was assayed in the general population (167 subjects) of four Regions of Italy (Veneto, Lombardy, Piedmont and Trentino Alto Adige) are reported. The results are compared with those in a population of 97 subjects from Rovescala, a hillside wine-producing town a few kilometers from Pavia, where ethylenebisdithiocarbamates are sprayed by helicopter. It was found that an average of 24% of the populations of the four regions, taken together, had urinary ETU levels above detection limits (1.0 microgram 1(-1)) as compared to 37% of the population of Rovescala. The ranges of concentration were 0.8-8.3 micrograms 1(-1) for the four regions and 0.9-61.4 micrograms 1(-1) for Rovescala. Statistically significant variables for urinary ETU levels were smoking and wine drinking.

Gene expression in regenerating liver in relation to cell proliferation and stress.

When hepatocyte proliferation is stimulated in the liver by partial hepatectomy, messenger RNAs coding for fibrinogen, actin, c-myc and topoisomerase I are rapidly accumulated. We distinguish an early phase of accumulation (0-3 h after partial hepatectomy) which is also observed after a sham operation for the four genes, and during inflammation produced by Freund's adjuvant in the case of fibrinogen and c-myc genes. The hepatic response to inflammation appears therefore to mimic events characteristic of the G0/G1 transition, such as the accumulation of the c-myc mRNA. The late phase of mRNA accumulation (beyond 3 h after partial hepatectomy) is typical of liver regeneration. The level of c-myc mRNA is transiently increased (20-fold over normal) 20 h after partial hepatectomy, that is, at the time of DNA synthesis. Topoisomerase-I mRNA level increases between 3 and 24 h after partial hepatectomy (5-10-fold over normal). These results suggest that accumulation of c-myc and topoisomerase-I mRNAs is associated with DNA replication in regenerating liver.

[A case of primary cardiac tumor in childhood. Echographic and anatomo-pathologic study]. / Un caso di tumore primitivo cardiaco in età pediatrica. Studio ecografico ed anatomo-patologico.

Primary cardiac tumors are rare in children. The benign forms constitute 90% of cases, with often fatal clinical course due to the origin site. Here is reported a case of fibroelastic hamartoma in a four month baby, with multiple malformations, in which the initial signs have been alterations of ECG and of the cardiac profile at Rx chest. Bidimensional echocardiography suggested the correct diagnosis, revealing the mass in the interventricular septum. Cardiac catheterization excluded connections with coronary arteries. The baby died before cardiosurgical operation, probably because of a hyperkinetic ventricular arrhythmia. Anatomo-pathologic examination discusses the diagnosis of this tumor versus other kinds, defining our case as a fibroelastic hamartoma.

Molecular cloning of mRNA sequences transiently induced during rat liver regeneration.

In order to isolate genes which are induced during liver regeneration, we have constructed a cDNA library from 16-h-regenerating liver poly(A)+ RNA. By computer analysis of autoradiograms produced by differential plaque hybridization with cDNA from normal or 16-h-regenerating liver, we have isolated several recombinant clones representing sequences transiently increased during liver regeneration. Three of these were further characterized: the level of the corresponding mRNAs increase rapidly after partial hepatectomy, before the onset of DNA synthesis. Two clones were identified as fibrinogen clones. It is speculated that alpha-fibrinogen may be involved in the growth process, or in its regulation.

4-Aminobutyrate:2-oxoglutarate aminotransferase from Candida. Purification and properties.

An enzyme which catalyzes the transamination of 4-aminobutyrate with 2-oxoglutarate was purified 588-fold to homogeneity from Candida guilliermondii var. membranaefaciens, grown with 4-aminobutyrate as sole source of nitrogen. An apparent relative molecular mass of 107,000 was estimated by gel filtration. The enzyme was found to be a dimer made up of two subunits identical in molecular mass (Mr 55,000). The enzyme has a maximum activity in the pH range 7.8-8.0 and a temperature optimum of 45 degrees C. 2-Oxoglutarate protects the enzyme from heat inactivation better than pyridoxal 5'-phosphate. The absorption spectrum of the enzyme exhibits two maxima at 412 nm and 330 nm. The purified enzyme catalyzes the transamination of omega-amino acids; 4-aminobutyrate is the best amino donor and low activity is observed with beta-alanine. The Michaelis constants are 1.5 mM for 2-oxoglutarate and 2.3 mM for 4-aminobutyrate. Several amino acids, such as alpha,beta-alanine and 2-aminobutyrate, are inhibitors (Ki = 38.7 mM, Ki = 35.5 mM and Ki = 33.2 mM respectively). Propionic and butyric acids are also inhibitors (Ki = 3 mM and Ki = 2 mM).