Compromise Function Research Articles

Anemia in Advanced Heart Failure Is Due to Iron Deficiency and Malnutrition and It Is Associated with Worse Prognosis

Objective: This study sought to investigate the incidence of anemia and its possible impact on mortality in a population with extremely advanced heart failure (HF). Methods: We studied 343 patients (pts) with advanced HF (NYHA class III/IV, mean age 51.8 years, male 72.3% male), hospitalized for compensation and followed after discharge. Pts were submitted to clinical, laboratory and echocardiographyc evaluation. Iron and transderin dosage were performed in a group of 91 pts. Pts were divided into two groups: anemic (hemoglobin = < 12 g%) and non-anemic. These groups were compared through Mann-Whitney U-test for the continuous variables and qui-square test for the categorical variables. Mortality was analyzed stratifying the population in intervals of 1 g of Hb. Results: During hospitalization this extremely ill population presented a mortality of 53.6% in the first year of follow-up. Anemia was detected in 72 (20.9%) pts. In the comparison of the 2 groups, anemic pts were more lean (57.9 vs 63.3 kg; p = 0.027), presented lower albumin levels (3.28 vs 3.61 mg/dl; p = 0.001), with no difference in the degree of cardiac compromise and renal function (1.5 vs 1.5 mg/dl). Anemic pts had lower iron plasmatic levels (30.9 vs 63.9 mg/dl; p < 0.001), with no difference in transferrin levels. During the follow-up pts with Hb between 12 and 13 g% presented the lower mortality. The presence of anemia or polyglobulia was associated with greater mortality. Hb levels of 10.5 g% stratify significantly the population in those with better and worse prognosis. Conclusions: The presence of anemia in HF pts was associated with worse prognosis. Anemic pts had more frequently malnutrition and iron deficiency. The degree of left ventricular dysfunction and renal insufficiency did not show any correlation with the presence of anemia.

Proton radiotherapy for orbital rhabdomyosarcoma: Clinical outcome and a dosimetric comparison with photons

Over 85% of pediatric orbital rhabdomyosarcoma (RMS) are cured with combined chemotherapy and radiation. However, the late effects of photon radiation compromise function and cosmetic outcome. Proton radiation can provide excellent tumor dose distributions while sparing normal tissues better than photon irradiation. Conformal 3D photon and proton radiotherapy plans were generated for children treated with proton irradiation for orbital RMS at Massachusetts General Hospital. Dose-volume histograms (90%, 50%, 10%) were generated and compared for important orbital and central nervous system structures. Average percentages of total dose prescribed were calculated based on the 3 dose-volume histogram levels for normal orbital structures for both the proton and photon plans. The percent of normal tissue spared by using protons was calculated. Seven children were treated for orbital rhabdomyosarcoma with proton irradiation and standard chemotherapy. The median follow-up is 6.3 years (range, 3.5-9.7 years). Local and distant controls compare favorably to those in other published accounts. There was an advantage in limiting the dose to the brain, pituitary, hypothalamus, temporal lobes, and ipsilateral and contralateral orbital structures. Tumor size and location affect the degree of sparing of normal structures. Fractionated proton radiotherapy is superior to 3D conformal photon radiation in the treatment of orbital RMS. Proton therapy maintains excellent tumor coverage while reducing the radiation dose to adjacent normal structures. Proton radiation therapy minimizes long-term side effects.

Advances in the Modulation of Cutaneous Wound Healing and Scarring

Cutaneous wounds inevitably heal with scars, which can be disfiguring and compromise function. In general, the greater the insult, the worse the scarring, although genetic make up, regional variations and age can influence the final result. Excessive scarring manifests as hypertrophic and keloid scars. At the other end of the spectrum are poorly healing chronic wounds, such as foot ulcers in diabetic patients and pressure sores. Current therapies to minimize scarring and accelerate wound healing rely on the optimization of systemic conditions, early wound coverage and closure of lacerations, and surgical incisions with minimal trauma to the surrounding skin. The possible benefits of topical therapies have also been assessed. Further major improvements in wound healing and scarring require an understanding of the molecular basis of this process. Promising strategies for modulating healing include the local administration of platelet derived growth factor (PDGF)-BB to accelerate the healing of chronic ulcers, and increasing the relative ratio of transforming growth factor (TGF)beta-3 to TGFbeta-1 and TGFbeta-2 in order to minimize scarring.

Enhanced activity of human IL-10 after nitration in reducing human IL-1 production by stimulated peripheral blood mononuclear cells.

Nitric oxide and superoxide form the unstable compound, peroxynitrite, which can nitrate proteins and compromise function of proinflammatory cytokines at sites of inflammation. Reduced function of proinflammatory proteins such as IL-8, macrophage inflammatory protein-1alpha, and eotaxin suggest an anti-inflammatory effect of nitration. The effects of nitration on anti-inflammatory cytokines such as IL-10 are unknown. We hypothesized that peroxynitrite would modify the function of anti-inflammatory cytokines like IL-10. To test this hypothesis, the capacity of recombinant human IL-10 to inhibit production of human IL-1beta (IL-1) from LPS-stimulated human PBMC was evaluated. Human IL-10 was nitrated by incubation with peroxynitrite or by incubation with 3-morpholinosydnonimine, a peroxynitrite generator, for 2 h and then incubated with LPS-stimulated PBMC for 6 h, and IL-1 was measured in the culture supernatant fluids. Human IL-1 production was significantly lower in the peroxynitrite- or 3-morpholinosydnonimine-nitrated IL-10 group than in the IL-10 controls (p < 0.05, all comparisons). This finding demonstrates that although peroxynitrite inhibits proinflammatory cytokines, it may augment anti-inflammatory cytokines and further point to an important role for peroxynitrite in the regulation of inflammation.

Invertase, maltase, lactase, and peroxidase activities in duodenum of BB rats.

The development of immune-mediated diabetes in BB rats may involve a defect of the gastrointestinal tract (GI), as suggested by increased gut permeability. This study aimed at measuring invertase, maltase, lactase, and peroxidase activities in the duodenum of diabetesprone BioBreeding (BBdp) rats and control BioBreeding rats (BBc) given free access to NIH-07 diet up to the time of killing at 60 66 d of age. After washing the entire small intestine, the duodenal mucosa was scraped off in the first 5-cm segment from the pylorus and frozen in distilled water. Invertase, maltase, and lactase activities were measured by monitoring the conversion of [U-(14)C]sucrose, [U-(14)C]maltose, and [D-[1-(14)C]glucose] lactose to radioactive hexoses, which were phosphorylated in the presence of adenosine triphosphatase and yeast hexokinase and then separated from their precursor by ion-exchange chromatography. Peroxidase activity was measured by a spectrophotometric procedure. In the BBdp rats, the activity of invertase, maltase, and lactase averaged, respectively, 70.2 +/- 4.4, 81.2 +/- 4.3, and 75.7 +/- 4.1% (n = 16 and p < 0.001 in all cases) of the control values found in BBc rats of the same sex. Inversely, after exclusion of two female BBc rats with abnormally high plasma D-glucose concentration, the activity of peroxidase in the BBdp rats averaged 157.4 +/- 20.0% (n = 16; p < 0.02) of the mean control value recorded in BBc rats of the same sex (100.0 +/- 9.3%; n = 14). These findings are compatible with the view that a proinflammatory state of the GI associated with compromise function may precede the occurrence of pancreatic insulitis in BBdp rats and, possibly, human subjects with type 1 diabetes.

Disability Evaluation of Extremity Fractures

Most fractures heal with restoration of bone and joint function. Disability is generally temporary in these instances, and there is no permanent impairment to be rated in the majority of cases. However, multiple complications can occur that can lead to loss of skeletal function, restricted range of motion, and associated soft tissue injuries, and neurovascular damage can dramatically and severely compromise function and performance. Clearly, not all fractures heal within the timeframes as outlined in Table 2, and determination of the point of maximum medical improvement, which must be achieved in order to declare an impairment as permanent, can be challenging in these cases. Some individuals with fractures that demonstrate bone union radiologically may develop long-term disability; nearly 30% of individuals with a unilateral lower extremity fracture will not return to work within 12 months of injury. In the absence of a complicating soft tissue injury, the explanation for this discrepancy between impairment and disability can be elusive. During the past 10 years, improved systems of trauma care have reduced mortality rates in the United States. As greater numbers of persons survive motor vehicle accidents and other major trauma, the possibility exists that increasing numbers of fractures leading to impairment or disability may be seen. Recognition of how and when fractures heal, possible complications that may arise, risk factors for long-term disability, and the correlation of vocational and avocational physical demands with the resultant outcome will enable the clinician to appropriately and accurately assess disability status, design a rehabilitation program, and assign an impairment rating.

Reply to “Comment on ‘A general property of endoreversible thermal engines’ ” [J. Appl. Phys. 89, 1518 (2001)

In this reply to a comment by Yan on our previous article [J. Appl. Phys. 81, 2973 (1997)], we show that the compromise function C(ε) between high power output and low entropy production for CAN engines, proposed in that article to find the best ecological function, is not tautological. Moreover, this procedure is useful to construct the best ecological function for any heat transfer law used in endoreversible thermal engine models.

A multiobjective evolutionary algorithm toolbox for computer-aided multiobjective optimization

This paper presents an interactive graphical user interface (GUI) based multiobjective evolutionary algorithm (MOEA) toolbox for effective computer-aided multiobjective (MO) optimization. Without the need of aggregating multiple criteria into a compromise function, it incorporates the concept of Pareto's optimality to evolve a family of nondominated solutions distributing along the tradeoffs uniformly. The toolbox is also designed with many useful features such as the goal and priority settings to provide better support for decision-making in MO optimization, dynamic population size that is computed adaptively according to the online discovered Pareto-front, soft/hard goal settings for constraint handlings, multiple goals specification for logical "AND"/"OR" operation, adaptive niching scheme for uniform population distribution, and a useful convergence representation for MO optimization. The MOEA toolbox is freely available for download at http://vlab.ee.nus.edu.sg/-kctan/moea.htm which is ready for immediate use with minimal knowledge needed in evolutionary computing. To use the toolbox, the user merely needs to provide a simple "model" file that specifies the objective function corresponding to his/her particular optimization problem. Other aspects like decision variable settings, optimization process monitoring and graphical results analysis can be performed easily through the embedded GUIs in the toolbox. The effectiveness and applications of the toolbox are illustrated via the design optimization problem of a practical ill-conditioned distillation system. Performance of the algorithm in MOEA toolbox is also compared with other well-known evolutionary MO optimization methods upon a benchmark problem.

Voting by veto and the role of the compromise function

This paper analyzes voting by veto procedures in the context of a pure sharing problem. It is shown that the direct intuition about these voting mechanisms fails: the veto power of the players does not by itself make players act in an equitable manner. If the compromise function yields a constant compromise alternative, then it plays the role of a threat point and the behavior of the players in making proposals tends to be selfish. However, if it depends on the individual proposals, and selects a real compromise among them, then egalitarian proposals can be achieved as the unique subgame perfect equilibria with symmetric proposals of the game.

Dynamic cardiomyoplasty in the treatment of dilated cardiomyopathy: current results and perspectives.

The purpose of this article is to provide an overview of the current indications, results, and perspectives of dynamic cardiomyoplasty in the treatment of patients with dilated cardiomyopathy. Particular emphasis is placed on the clinical experience with 36 patients operated at the São Paulo Heart Institute between 1988 and 1995. Based on several clinical reports, the mechanisms of action of dynamic cardiomyoplasty in these patients include the enhancement of left ventricular systolic function, by the direct action of synchronized skeletal muscle flap contraction and the reversion of chamber remodeling. Moreover, both mechanisms seem to be responsible for improved diastolic function properties and for the decrease of ventricular wall stress. Besides the acceptable hospital mortality observed for patients with dilated cardiomyopathy ranging from 0% to 8% with this surgical procedure, clinical improvement after dynamic cardiomyoplasty has been demonstrated as a prevailing and significant outcome. Nevertheless, the 1-year survival for these patients ranges from 82% to 86% and the 5-year survival on the order of 41% to 49%. In addition, the analysis of factors influencing the outcome showed that cardiomyoplasty long-term survival was significantly affected by the severity of preoperative clinical compromise and cardiac function impairment. On the other hand, patients with dilated cardiomyopathy who were operated in functional Class III or intermittent Class IV and with pulmonary vascular resistance below 4 Wood units, present survival rates on the order of 79% at 2 years and of 64% at 5 years of follow-up, which are similar to those reported after cardiac transplantation. Furthermore, technological advances incorporated in the new cardiomyostimulators may ameliorate skeletal muscle flap performance at long term. Other developments are also discussed in this field.

Theories of dream function.

Some contemporary and psychoanalytic theories of dream function are reviewed. Particular attention is given to Jung's model of personality and theory of dream function, a dynamic, open-system approach that stands in contrast to Freud's mechanistic, drive-reduction model. Contemporary theories tend to focus on the function of environmental mastery, viewed from one of three perspectives: (a) problem solving, (i) information processing, or (c) ego consolidation. Only a few have gone beyond environmental control to consider creative functions of the dream. Most contemporary theories are at least partially supported by data, and many are not mutually exclusive, dealing with different processes or proposing similar processes in different-sou nding languages. Some dream theories do differ from others in underlying model, in scope, or in the degree to which nonrational processes are admissable as data. Jung's approach has much to add to contemporary dream theory, particularly in making room for creative and nonrational processes, as well as in the specific proposition that dreams function to balance and complete waking consciousness. Many answers have been suggested to the question of what function dreams serve in man's psychology. In this century, the most influential theory has been Freud's and his views have given laboratory psychology a fruitful source of hypotheses and debate. The mainstream of American scientific thought in this area has grown directly from laboratory research but is richly sprinkled with Freudian theory together with a Darwinian emphasis on adaptation as environmental mastery. Jung's approach to dream function, very different from Freud's and perhaps more compatible with current research findings, has remained outside the mainstream and is virtually unknown to American psychology. This paper aims to correct the omission, while providing an overview of psychoanalyti c and contemporary thought about the function pf dreams. Freud (1953) believed that dreams serve a dual, compromise function. According to his theory, unconscious, instinctual drive energy pushes for discharge, moving toward the expression of a consciously unacceptable impulse. The reduction in conscious restraints characteristic of sleep permits a symbolic, disguised dream expression of the repressed wish. The 1 Requests for reprints should be sent to Janet O.

The hydroxyl stretching bands of phenols: some aspects of half-band widths

The true half-band widths of the ν OH bands have been determined for a group of phenols at 25° and 75°C. It was found that a smooth relationship exists between Δν 1 2 and ν OH for the phenols having hydrocarbon groups or hydrogen in the 4-position. The band shapes, as defined by a compromise function between Lorentzian and Gaussian extremes, are shown to be invariant with temperature.