Ambulatory urodynamics: extramural testing of the lower and upper urinary tract by Holter monitoring of cystometrogram, uroflowmetry, and renal pelvic pressures

This article elucidates the clinical applicability and state of the art of ambulatory urodynamics. Ambulatory urodynamics have evolved into practical investigations like EAC, HFM, and EAC combined with renal pelvimetry. EAC has been shown to be the method of preference if detrusor overactivity is involved. Conventional filling cystometry has proved to be an unreliable way to exclude detrusor instability. De novo instability after suspension surgery often indicates that an existing detrusor overactivity was not identified preoperatively. EAC including flowmetry has shown considerable variance in obstructive and contractility parameters in males with LUTS indicative for BPH. This raises doubt whether the clinical flow analysis is the suitable "gold standard" as advocated by the ICS. For a real break through of EAC, less complex automatic analysis is necessary. HFM is a newer method within the range of ambulatory urodynamic tests. It has not yet been completely evaluated. But, because the technique is analogous to the office flowmetry, noninvasive and very well accepted by the patients, it is expected to be widely used. This expectation is strengthened by the fact that HFM seems to show individual therapeutic efficacy of drugs, such as alpha-blockers. As a research tool to evaluate efficacy, it is far more powerful than conventional methods because of the reduction of within-patient standard deviation to about 10%. Finally, EAC combined with pelvimetry offers a promising method for the clinical evaluation of a combined dysfunction of upper and lower urinary tract.     

Ethics of the distribution of health care

While the concept of a "right to health care" has been evolving in the United States, this should be distinguished from "the right to health," guaranteed in the constitutions of many socialist countries. In an effort to promote "quality of life" for their citizens, governments can, and do provide health care, but this does not always lead to health. In so doing, governments open access to care for those previously underserved--or unserved. For the United States at this time the goal becomes one of assuring equity, which will likely be achieved by locally based private and/or governmental entities, federated for greater efficiency and regulated by federal and state governments. Such programs will be staffed by a new breed of physician, the medical student of today.     

A neural-network packet switch controller: scalability, performance, and network optimization

We examine a novel combination of architecture and algorithm for a packet switch controller that incorporates an experimentally implemented optically interconnected neural network. The network performs scheduling decisions based on incoming packet requests and priorities. We show how and why, by means of simulation, the move from a continuous to a discrete algorithm has improved both network performance and scalability. The system's limitations are examined and conclusions drawn as to its maximum scalability and throughput based on today's technologies.     

Microstructure evolution and strain localization in Cu and Cu-8Al single crystals subjected to channel-die compression

Single crystals of pure Cu and Cu‐8%Al with two initial orientations, {112}〈111〉 and {112}〈110〉, were subjected to monotonic compression in channel‐die at room temperature (293 K). The dislocation microstructure and local crystallography were investigated by transmission electron microscopy after different amounts of deformation. Various factors, such as initial single crystal orientation, chemical composition and amount of plastic deformation, were analysed in order to determine their influence on the microstructure evolution, local orientation variations and strain localization phenomena.     

Determining dynamic output feedback of the least order for SIMO systems to locate poles in a specified region†

This paper presents a new theory for determining dynamic output feedback of the least order for a linear, time-invariant, controllable and observable SIMO system, such that poles of the closed-loop system lie in a given region Γ in the complex plane. When some poles have prespecified stationary locations in the complex plane, dynamic output feedback is obtained in the sense that the remaining poles lie in Γ This theory applies to continuous-time as well as discrete-time systems. Here a design algorithm for complete system realization and an illustrative example are given.     

Five-layer reverse tape casting of IT-SOFC

Tape casting is a well-established method for manufacturing thin ceramic layers with controllable thickness and porosity. This study investigates the potential of 10Sc1CeSZ material for the electrolyte and anode layers for intermediate-temperature solid oxide fuel cells (IT-SOFC) in an anode-supported cell (ASC) geometry. In order to use La_0.6Sr_0.4Co_0.2Fe_0.8 Oxide (LSCF) cathode material, a Gd_0.2Ce_0.8 Oxide (GDC) barrier layer is needed; however, thermal expansion coefficient mismatch results in delamination of the GDC from the electrolyte during high temperature sintering when fabricated by conventional tape casting procedures. For the first time, ASCs have been manufactured by a five-layer tape casting technique; barrier layer, novel composite layer, electrolyte, anode functional layer, and anode substrate. Ni-ScCeSZ composite cells were tested between 650 and 800°C in H₂:N₂ fuel (85% H₂) on the anode and air on the cathode to yield a maximum power density of .46 W/cm². These results demonstrate the feasibility of this new five-layer tape casting technique to produce IT-SOFC.     

Brain natriuretic peptide enhances the endothelium-independent cAMP and vasorelaxant responses of calcitonin gene-related peptide in rat aorta

The localization of cathepsin K protein in mouse osteoclasts was examined by immunolight and immunoelectron microscopy using the avidin-biotin-peroxidase complex method with anti-cathepsin K (mouse) antibody. With light microscopy, a strong immunoreaction for cathepsin K was found extracellularly along the bone and cartilage resorption lacunae and detected intracellularly in vesicles, granules, and vacuoles throughout the cytoplasm of multinuclear osteoclasts and chondroclasts attached to the surface of the bone or cartilage. Mononuclear cells, probably preosteoclasts, some distance from the bone also contained a few cathepsin K-positive vesicles and granules. Cathepsin K was sometimes found in the cisternal spaces of the rough endoplasmic reticulum and vesicles of the Golgi apparatus with electron microscopy of the basolateral region of the osteoclasts. Cathepsin K-positive vesicles and granules as lysosomal compartments were present in various stages of fusion with vacuoles as endosomal compartments that contained fragmented cathepsin K-negative fibril-like structures. Some of the vacuoles (endolysosomes), which seemed to be formed by this process of fusion, contained cathepsin K-positive vesicles and fibril-like structures that did not show the regular cross striation of type I collagen fibrils. In the apical region of the osteoclasts, cathepsin K-positive vesicles and pits had already fused with or were in the process of fusing with the ampullar extracellular spaces. There were large deposits of cathepsin K on fragmented fibril-like structures without regular cross striation in the extracellular spaces, as well as on and between the cytoplasmic processes of the ruffled border. There were also extensive deposits of cathepsin K on the type I collagen fibrils with cross striation in the bone resorption lacunae. Osteoblasts and osteocytes were negative for cathepsin K. In the immunocytochemical controls, no immunoreaction was found in the osteoclasts or preosteoclasts, or on the collagen fibrils in the resorption lacunae. The results indicate that cathepsin K is produced in mature osteoclasts attached to the bone and secreted into the bone resorption lacunae. The findings suggest that cathepsin K participates in the extracellular degradation of collagen fibrils in the resorption lacunae and in the subsequent degradation of the fragmented fibrils in the endolysosomes. It is also suggested that cathepsin K degrades the organic cartilage matrix.