Delirium phenomenology illuminates pathophysiology, management, and course

The phenomenology of delirium has received little standardized longitudinal study but offers the prospect of valuable insights regarding clinical subtypes, differentiation from other neuropsychiatric disorders, identification of underlying pathophysiologies, management, and course. This review examines current approaches to the investigation of delirium phenomenology and how the findings to date illuminate our understanding of delirium. It concludes with recommendations for future investigations.     

Does arterial revascularization decrease the risk of infarction after coronary artery bypass grafting?

BACKGROUND: This study sought to determine whether extensive arterial grafting reduces the prevalence and consequences of infarct after coronary artery bypass grafting. METHODS: Post-primary coronary artery bypass grafting infarcts and time-related events thereafter were identified by 99.9% complete follow-up of 9,600 patients (1971 to 1992). The contribution of arterial grafting to freedom from infarct was assessed by multivariable hazard function analysis to adjust for other risk factors. RESULTS: Unadjusted 1-month and 10-year freedom from infarction was 97% and 86%. By multivariable analysis, arterial grafting lowered the prevalence of periprocedural (p = 0.005), intermediate term (p = 0.007 and 0.006), and late infarction (arterial grafting to the left anterior descending coronary artery, p = 0.0006). Unadjusted survival after first infarct after coronary artery bypass grafting was 74% and 52% at 1 and 10 years; arterial grafting improved 10-year survival from 48% to 59% (p = 0.002). An additional benefit or cost of extending arterial grafting (n = 1,727) beyond a single one could not be identified (p > 0.1). CONCLUSIONS: Arterial conduits, particularly to the left anterior descending coronary artery, should be used for coronary artery bypass grafting to reduce early and late myocardial infarction and its consequences. However, use of more than a single arterial graft appears to confer no additional benefit.     

Anomalous right coronary artery from the pulmonary artery in Taussig-Bing anomaly

The presence of associated anomalies in patients with double-outlet right ventricle can significantly alter surgical intervention. Preoperative delineation of these anomalies can facilitate surgical planning and improve outcome. We describe a case in which the right coronary artery and anterior descending coronary artery arose from the pulmonary artery in a patient with double-outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly). Recognition of this important anomaly prevented significant intraoperative myocardial damage by altering techniques of cardioplegia administration for myocardial preservation.     

Continuous purification of porcine lipase by rotating annular size-exclusion chromatography

Non-accidental head injury, be it shaking, impact(s) or a combination of the two, is characterised by subdural and/or subarachnoid haemorrhages with retinal haemorrhages, but minimal or absent external cranio-facial trauma. The classical assault scenario depicts the infant being gripped around the head, face, chest and abdomen and shaken or being gripped by a limb and swung. This gripping might be expected to leave physical evidence in the form of bruising. A study was undertaken to establish the prevalence, distribution and pathological association of external bruising in 24 cases of fatal non-accidental head injury in children. At autopsy, 17 cases had new external bruises, 15 old external bruises and 13, a combination of both. However, seven (29%) cases showed no fresh external bruising and five (21%) showed no external bruising at all. Thus, external bruising may be absent in children with fatal intracranial injury. The face was shown to be the commonest site of bruising followed by the forehead and buttocks. Limb, chest and abdominal bruising were found to be uncommon. Retinal haemorrhages were confirmed in 23 (96%) cases. It is hypothesised that bruising, when present, may be a result of abuse in the form of punches and slaps rather than due to gripping during the assault. We discuss why gripping does not necessarily result in external bruising.     

beta-Amyloid precursor protein isoforms show correlations with neurones but not with glia of demented subjects

Post-mortem cerebral cortex from 15 demented patients was specially collected to minimise autolysis and two membrane fractions and one soluble fraction were quantitatively examined for the major species of beta-amyloid precursor protein (APP) of high apparent molecular mass (> or = 80 kDa) together with the major mRNA species encoding APP isoforms. The number of pyramidal neurones and astrocytes, putative biochemical indices of interneurones and pyramidal neurones, and choline acetyl transferase activity were also determined. Multiple regression analysis has been used to investigate intercorrelations of APP species with biochemical and morphometric measures, free of any effects of confounding demographic variables. Subjects with Alzheimer's disease showed a loss of cholinergic activity and D-aspartate uptake compared with patients with other causes of dementia. The major finding of the study is that measures of neurones rather than astrocytes most closely correlate with the concentration of APP. Pyramidal cell numbers were positively correlated with mRNA for APP695. APP in the soluble fraction showed a negative correlation with pyramidal cell numbers and cholinergic activity. These results indicate that neurones within the cerebral cortex are the major source of APP, and that secretion of APP is dependent upon cortical pyramidal neuronal activity and cholinergic activity.     

Liver failure associated with mitochondrial DNA depletion

BACKGROUND/AIMS: Liver failure in infancy can result from several disorders of the mitochondrial respiratory chain. In some patients, levels of mitochondrial DNA are markedly reduced, a phenomenon referred to as mitochondrial DNA depletion. To facilitate diagnosis of this condition, we have reviewed the clinical and pathological features in five patients with mitochondrial DNA depletion. METHODS: Cases were identified by preparing Southern blots of DNA from muscle and liver, hybridising with appropriate probes and quantifying mitochondrial DNA relative to nuclear DNA. RESULTS: All our patients with mitochondrial DNA depletion died of liver failure. Other problems included hypotonia, hypoglycaemia, neurological abnormalities (including Leigh syndrome) and cataracts. Liver histology showed geographic areas of fatty change, bile duct proliferation, collapse of liver architecture and fibrosis; some cells showed decreased cytochrome oxidase activity. Muscle from three patients showed mitochondrial proliferation, with loss of cytochrome oxidase activity in some fibres but not in others; in these cases, muscle mitochondrial DNA levels were less than 5% of the median control value. The remaining two patients (from a single pedigree) had normal muscle histology and histochemistry associated with less severe depletion of mitochondrial DNA in muscle. CONCLUSIONS: Liver failure is common in patients with mitochondrial DNA depletion. Associated clinical features often include neuromuscular disease. Liver and muscle histology can be helpful in making the diagnosis. Mitochondrial DNA levels should be measured whenever liver failure is thought to have resulted from respiratory chain disease.     

Semiconductor capacity planning: stochastic modelingand computational studies

This paper presents a multistage stochastic programming model for strategic capacity planning at a major US semiconductor manufacturer. Main sources of uncertainty in this multi-year planning problem include demand of different technologies and capacity estimations for each fabrication (fab) facility. We test the model using real-world scenarios requiring the determination of capacity planning for 29 technology categories among five fab facilities. The objective of the model is to minimize the gaps between product demands and the capacity allocated to the technology specified by each product. We consider two different scenario-analysis constructs: first, an independent scenario structure where we assume no prior information and the model systematically enumerates possible states in each period. The states from one period to another are independent from each other. Second, we consider an arbitrary scenario construct, which allows the planner to sample/evaluate arbitrary multi-period scenarios that captures the dependency between periods. In both cases, a scenario is defined as a multi-period path from the root to a leaf in the scenario tree. We conduct intensive computational experiments on these models using real data supplied by the semiconductor manufacturer. The purpose of our experiments is two-fold: first to examine different degree of scenario aggregation and its effects on the independent model to achieve high-quality solution. Using this as a benchmark, we then compare the results from the arbitrary model and illustrate the different uses of the two scenario constructs. We show that the independent model allows a varying degree of scenario aggregation without significant prior information, while the arbitrary model allows planners to play out specific scenarios given prior information.     

Theoretical and experimental analysis of wire segment holograms forstatistical interconnect metrology

Theoretical and experimental results using computer generated wire segment holograms for statistical interconnect metrology are presented. Test structures have been constructed using a process capable of imaging 1-μm features and consist of arrays of wire segments illuminated by a He-Ne Laser. Since the holograms are fabricated at the same time as actual wires on the wafer, the quality of the projected image correlates with the emergence of global feature patterning errors. Specifically, this paper presents data on the effect of varied exposure time on the intensity of the projected image. An initial statistical analysis indicates that the test structures are capable of detecting variations in wire geometry which are approximately 1.0% of the nominal wire width. It is anticipated that significant improvements to this level of sensitivity can be obtained by optimization of the holographic encoding process and test image selection     

Evidence of visual processing negativity with attention to orientation and color in central space

The aim of this study was to determine whether the visual frontal processing negativity reported in our earlier paper (Karayanidis, F. and Michie, P.T. Electroenceph. clin. Neurophysiol., 1996, 99: 38-56) is related to selection of spatial location, or occurs regardless of the stimulus features used to define the target. Subjects were instructed to respond to infrequent target stimuli of a particular combination of orientation, color and size. All stimuli were presented at central fixation. Posteriorly, orientation selection enhanced P125 amplitude over the right hemisphere but neither orientation nor color selection had an effect on N190. Posterior selection negativities emerged for orientation, color and their conjunction. At anterior sites, widespread effects of orientation and color processing were evident. The effect of location selection on the anterior N1 seen in our previous study was not evident with orientation selection. Instead, selection of orientation, color and their conjunction resulted in P145-250 frontally. Two later anterior negativities emerged. The early negativity (vPNe) was affected independently by orientation and color selection while the late negativity (vPNl) was affected only by selection of feature conjunction. Thus, the present results show that, like its auditory counterpart, the visual processing negativity occurs with a variety of stimulus classification features and is not exclusively related to spatial selection.