Greater Increase In Volume Research Articles

The Natural History of Observed SDHx-Related Head and Neck Paragangliomas Using Three-Dimensional Volumetric Tumor Analysis.

Characterize the natural history and clinical behavior of head and neck paragangliomas (HNPGLs) in subjects with succinate dehydrogenase (SDHx) pathogenic variants using volumetric tumor measurements. Cohort study. Tertiary academic referral center. Subjects with SDHx HNPGLs under observation for at least 6 months with 2 or more magnetic resonance imaging or computed tomography scans. Diagnostic interventions include next-generation sequencing, magnetic resonance imaging, and computed tomography. Therapeutic interventions include microsurgical resection or stereotactic radiosurgery. Radiographic progression was defined as a 20% or greater increase in volume. Cranial nerve (CN) functional outcomes were assessed using clinical documentation. A total of 19 subjects with 32 tumors met the inclusion criteria. Median radiographic follow-up was 2.2 years, and the median volumetric growth rate was 0.47 cm3/yr. Kaplan-Meier estimated rates of survival free of radiographic progression for all SDHx tumors at 1, 2, and 3 years were 69, 50, and 22%, respectively. No tumors developed new CN palsies during the period of observation. Over intermediate-term follow-up, observation of treatment-naive SDHx-related HNPGLs did not result in new cranial neuropathy. Although indefinite observation is only appropriate for select cases, these data support an interval of observation to characterize growth rate in asymptomatic to minimally symptomatic patients, who are at high risk of treatment-related morbidity. Given the early age at diagnosis and high risk of bilateral multifocal phenotypes in SDHx HNPGL mutation carriers, these data may aid in optimizing patient tumor control and CN functional preservation. Further studies are necessary to determine whether pretreatment growth rate is correlated with clinical outcomes.

Functional Perspective on Sourdough Bread

In recent years, with the awareness of people, the interest in natural and functional foods has increased. Sourdough is a dough piece in which industrial culture yeasts (Saccharomyces cerevisiae), endogenous yeasts, lactic and acetic bacteria from the air and the ingredients used (flour, water, etc.) are active. In sourdough fermentation, yeast and lactic acid bacteria work together to form the natural flora. It has been proven by studies that breads prepared from sourdough have many advantages such as greater volume increase, stronger aroma, better crumb structure and long shelf life. In addition, sourdough fermentation has very important positive effects on human health. Various additives (malt flours, emulsifiers, microbial enzymes, dairy products, soy flour and potato flour) are used to delay the staling of bread. In the production of sourdough bread, high quality and long shelf-life breads can be obtained without the need for these additives. Thus, both natural and additive-free and functional breads are produced. In this review, it is aimed to raise awareness by giving information about the advantages of using sourdough in bread production. In the study, the concept of sourdough was discussed and information was given about the content of bread prepared using sourdough and its benefits on health.

Effect of Aerobic Exercise as Adjunct Therapy on the Improvement of Negative Symptoms and Cognitive Impairment in Patients With Schizophrenia: A Randomized, Case-Control Clinical Trial.

The current study aimed to evaluate the effects of exercise on negative and cognitive symptoms and simultaneous evaluation of brain and hippocampus volume in patients with schizophrenia. Forty patients with schizophrenia were randomly divided into two groups. The intervention group, in addition to pharmacological treatment, underwent a multi-session exercise program for 8 weeks. At the beginning and end of the study, patients were assessed for cognitive status and negative symptoms using the Mini-Mental State Examination (MMSE) and Positive and Negative Syndrome Scale (PANSS), respectively. Total brain volume and hippocampus volume were also measured using magnetic resonance imaging. Overall, mean MMSE score significantly improved over time, but this improvement was greater in the intervention group (29%) compared to the control group (11%). The same was true for the PANSS negative score (21.5% vs. 53.5%). Absolute hippocampus volume during these 8 weeks, in exercise and control groups, increased from 6.24 to 7.11 and 6.44 to 6.59, respectively. The greater increase in volume obtained in the intervention group was statistically significant (p = 0.003). Exercise may be associated with improved cognitive function and negative symptoms in patients with schizophrenia; however, additional studies are warranted. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 37-43.].

Shaping ability of two root canal instrumentation systems in oval-shaped canals: A microcomputed tomography study.

The objective was to evaluate the shaping ability of XP-endo Shaper and Mtwo systems in oval-shaped canals preparation by microcomputed tomography (micro-CT) along the entire canal. The volume, surface area and percentage of unprepared area were evaluated by image processing in entire canal and apical third (5mm). Apical transportation and centring ability were evaluated at 3, 5 and 7mm from the apex. Forty single-canal oval canines were paired in two groups (n=20) according to the instrumentation system: XP-endo Shaper and Mtwo. The teeth were scanned by micro-CT before and after instrumentation, using a thermal vat at 37°C. The XP-endo Shaper system was more effective in the instrumentation of oval-shaped canals when compared to Mtwo system, resulting in greater volume increases and lower percentage of unprepared canals walls in apical region. Regarding apical transportation and centring ability, no statistical difference was observed.

Abstract 13738: Longitudinal Changes and Remodeling in the Right Atrium: The Multi-ethnic Study of Atherosclerosis

Introduction: The role of the right atrium (RA) in the pathogenesis and prediction of cardiovascular disease has been increasingly recognized, however the effects of aging on the RA remain unknown. In this longitudinal study we sought to describe the structural and functional changes in the RA over approximately ten years and explore their association with demographic and clinical risk factors. Methods: We included 1509 participants who had cardiovascular magnetic resonance at Exam 1 (2000-2002) and follow-up at Exam 5 (2009-2010) with adequate quality RA imaging at both timepoints. Quantification was performed using multimodality tissue tracking software, which has been extensively validated previously. Volumes were indexed to body-surface area. Adjusted multivariate linear regression used for analysis. Results: Participants were on average 58 years old at study onset, 54% female, 43% white, 14% Chinese American, 25% black, and 18% Hispanic. Over 10 years, RA indexed maximum and minimum volumes increased by 32% (8.8 mL/m2) and 37% (5.2 mL/m2) respectively. RA emptying fraction (EF) decreased by 1.3% and global strain trended towards a 0.7% decrease. Older age was associated with greater increases in volume but smaller decreases in function. Men had greater increase in volume and decrease in function, as did black and white races. Baseline obesity (BMI≥30), smoking, and diabetes status were all associated with greater decreases in function. Baseline use of ACE-inhibitors, lipid-lowering medications, and antihypertensives were not associated with larger or smaller changes in structure or function. Conclusions: In this large, diverse participant cohort, RA volumes substantially increased and function decreased over 10 years of follow-up. These differences were generally more prominent among men, older individuals, and white and black participants, and were further associated with baseline clinical risk factors.

An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients

BackgroundLymphedema is a common complication of breast cancer treatment that affects one in five breast cancer survivors, yet there is no reliable method to detect lymphedema in the subclinical range. The objective of this study was to determine the feasibility and reliability of using an infrared 3D scanning device (ISD) as a peri-operative limb volume measurement tool.MethodsFifteen patients were analyzed based on inclusion criteria. Peri-operative measurements were obtained using tape measure and an ISD. Volumes were calculated using a standard algorithm for tape measure and a custom algorithm for ISD measurements. Linear regression models were used to assess ISD and tape measurement volume and circumference correlation. One-way ANOVA was used to compare change in percent difference at set time points post-operatively (2–3 weeks, 4–6 weeks, and 7–12 weeks) for both ISD and tape measure. t tests for unequal variances with the Bonferroni correction were performed among these groups.ResultsThere is a positive linear correlation (R2 = 0.8518) between absolute volume measurements by the ISD and tape measure. Analyses over 2–10 weeks post-operatively showed that the ISD was able to detect volume changes in both the unaffected and the affected arm. Furthermore, the affected arm tended to have a greater increase in volume in the majority of patients, indicating these patients could be at risk for lymphedema.ConclusionsTechnology utilizing infrared 3D scanners can reliably measure limb volume pre- and post-treatment similarly to tape measure in a small sample of patients. Further research using 3D scanning technology with a longer follow up is warranted.

Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange.

Background: Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied. Objective: Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent. Methods: We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors. Results: Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent. Conclusions: Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors.

Serial Anatomical Prostate Ultrasound during Prostate Cancer Active Surveillance

The growth potential of low grade prostate cancer is unknown and yet it is potentially impactful for the practice of active surveillance. We evaluated the incidence, growth dynamics and clinical significance of changes in prostate lesions on serial transrectal ultrasound among a large cohort of men with prostate cancer managed by active surveillance. This retrospective study included men with prostate cancer treated with active surveillance at UCSF (University of California-SanFrancisco) from 2000 to 2014 who underwent a minimum of 2 transrectal ultrasound studies. Study inclusion criteria were prostate specific antigen 20ng/ml or less, clinical stage T2 or less and biopsy Gleason grade 3 + 4 or less. Progression end points included an increase in imaging stage, a 50% or greater increase in volume and an increase in the number of sites (sextants) with apparent lesions. The relationship between transrectal ultrasound progression and biopsy Gleason upgrade was assessed by univariate and multivariate logistic regression models. The 875 identified patients underwent a median of 5 transrectal ultrasound studies (IQR 3-8). Median followup was 49 months (IQR 27-81). Ofthe patients 345 (39%) progressed on serial transrectal ultrasound, including 51 by size, 265 by the number of lesion sites and 279 by stage. Median time to progression was 14 months. Transrectal ultrasound progression was independently associated with biopsy upgrade (OR 1.8, 95% CI 1.3-2.5, p <0.01). Local progression on transrectal ultrasound was associated with Gleason upgrade at biopsy. These results suggest that stable imaging findings on transrectal ultrasound may allow for increased intervals between biopsies among men on active surveillance. A prospective study is required to evaluate the usefulness of such a practice.

A micro-computed tomography evaluation of long-oval canal preparation using reciprocating or rotary systems.

To evaluate, using micro-computed tomography, the preparation of long-oval root canals using a single reciprocating system versus a multiple-file rotary system. Distal canals of thirty mandibular molars were selected and randomly assigned to one of two instrument groups (n = 15): Reciproc 40 (VDW, Munich, Germany) or BioRaCe system (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The teeth were scanned before and after preparation of the canal by a SkyScan 1172 micro-computed tomography scanner at 11-μm resolution. Morphometric variations were measured by volume increases and by the remaining untreated canal surface area in the entire canal and as well as in each third of the canal. Data were compared using the Mann-Whitney test. The Reciproc system left significantly more areas untouched (P < 0.001) in the cervical and middle thirds (18.14% and 21.82%) as compared to BioRaCe (8.14% and 11.35%). The Reciproc system had the greatest increase in volume of both the entire canal and the apical third (P < 0.5). Neither technique was able to completely prepare the outline of long-oval canals. The Reciproc system removed more tooth structure. The BioRaCe left fewer untouched dentine walls in the more coronal thirds of the canal, whilst Reciproc left fewer in the apical third.

Understanding the Thermo-Hydromechanical Pressurization in Two-Phase (Steam/Water) Flow and Its Application in Low-Permeability Caprock Formations in Steam-Assisted-Gravity-Drainage Projects

SummarySteam-assisted gravity drainage (SAGD) is one successful thermal-recovery technique applied in Alberta oil-sand reservoirs. When considering in-situ production from bitumen reservoirs, one must reduce viscosity for the bitumen to flow toward the production well. Steam injection is currently the most promising thermal-recovery method. Although steamflooding has proved to be a commercially viable way to extract bitumen from bitumen reservoirs, caprock integrity and the risk of losing steam containment can be challenging operational problems. Because permeability is low in Albertan thermal-project caprock formations, heating greatly increases the pressure on any water trapped in pores as a result of water thermal expansion. This water also sees a great increase in volume as it flashes to steam, causing a large effective-stress reduction. After this condition is established, pore-pressure increases can lead to caprock shear failure or tensile fracturing, and to subsequent caprock-integrity failure or potential casing failure. It is typically believed that low-permeability caprocks impede the transmission of pore pressure from reservoirs, making them more resistant to shear failure (Collins 2005, 2007). In considering the “thermo-hydromechanical pressurization” physics, low-permeability caprocks are not always more resistant. As the steam chamber rises into the caprock, the heated pore fluids may flash to steam. Consequently, there is a vapor region between the steam-chamber interface penetrated into the caprock and the water region within the caprock which is still at a subcritical state.This study develops equations for fluid-mass and thermal-energy conservation, evaluating the thermo-hydromechanical pressurization in low-permeability caprocks and the flow of steam and water after steam starts to be injected as part of the SAGD process. Calculations are made for both short-term and long-term responses, and evaluated thermal pressurization is compared for caprocks with different stiffness states and with different permeabilities. One can conclude that the stiffer and less permeable the caprock, the greater the thermo-hydromechanical pressurization; and that the application of SAGD can lead to high pore pressure and potentially to caprock shear, and to subsequent steam release to the surface or potential casing failure.

Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils

There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils. A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14). PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance. Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 ± 69 % and +23 ± 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 ± 43 ml and 162 ± 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups. NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.

Let’s Leave the Bias to the Mainstream Media: A Wikipedia Community Fighting for Information Neutrality

Let’s Leave the Bias to the Mainstream Media: A Wikipedia Community Fighting for Information Neutrality

Impact of Intraventricular Hemorrhage upon Intracerebral Hematoma Expansion

The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a "decompressive" effect that limits intracerebral hemorrhage (ICH) enlargement. Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH. Hemorrhage locations were classified as paraventricular (PV) or non-PV. Regression analyses were employed to identify predictors of IVH, hematoma expansion, and mortality. Of the 70 patients included 57% developed IVH, 85% of which occurred before initial CT. 71% of PV hemorrhages developed IVH, all before initial CT, and 48% of non-PV hemorrhages developed IVH, 29% of which occurred after initial CT. IVH was associated with PV location (P = 0.04), and among IVH patients PV location was associated with early IVH (P = 0.003). Predictors of mortality included age (P = 0.037), initial hematoma volume (P < 0.04), absolute volume change (P = 0.01), and final hematoma volume (P < 0.001). Variables predicting IVH included PV location (P < 0.0001), larger initial hematoma volume (P = 0.002), and greater absolute volume increase (P = 0.01). Hematoma expansion was greatest for non-PV with IVH (P = 0.08), and graphic inspection suggested that ICH volume tended to decrease with PV location and increase with IVH. Final hematoma volume was associated with initial volume (P < 0.0001), non-PV location (P = 0.02), and IVH (P = 0.04). IVH was not associated with less hematoma volume expansion, and for non-PV hemorrhages IVH was linked to greater volume increase.

Development of mucilage cells of Araucaria angustifolia (Araucariaceae)

The roles of mucilage cells were investigated through morphological and cytological analysis during leaf development in young Araucaria angustifolia plants. Differentiation began in leaf primordia in the shoot apex, when the young cells underwent a greater increase in volume in comparison with other mesophyll cells. The mucilage polysaccharides were synthesized by dictyosomes, from where they were taken by large vesicles and released into a cavity formed by detachment of the tonoplast, which was separated from the cytoplasm. At the end of differentiation, the cell was completely filled with mucilage, a gel consisting of a denser reticular structure surrounding less dense regions. The nucleus and cytoplasm were degenerated in mature cells. The A. angustifolia mucilage cells presented some cytological resemblances to the mucilage cells of members of some dicotyledonous families; however, differences in the dictyosomes and the secretion route were observed. Translocation and water storage of solutes was suggested by the use of the hydroxy pyrenetrisulfonic acid tri-sodium salt apoplastic tracer. The tonoplast detachment, dechromatinization, nuclear condensation, and general degeneration of the membrane systems observed during maturity indicated a programmed cell death process, one not yet described for angiosperm mucilage cells.

Early arm swelling after breast surgery: changes on both sides

Lymphedema is a common complication of treatment for breast cancer. However, little information is available describing changes in upper limb volumes in the early stages following surgery. Retrospective audit. Women who underwent unilateral mastectomy or axillary node removal for breast cancer at the Princess Alexandra Hospital, Brisbane, Australia. Circumferential measurements taken at 10 cm intervals from the ulnar styloid on each arm were converted to segmental volumes using the frustum approach. Pre-surgery baseline measures were taken by a physiotherapist at Preadmission Clinic at the Princess Alexandra Hospital. Follow-up measures were taken 6 weeks after surgery by Domiciliary Allied Health Acute Care and Rehabilitation Service physiotherapists in patients' homes. Limb segment volumes increased in the proximal upper limb segments at follow-up. The proportion of patients with a 10% or greater increase in volume in one or more segments of their upper limb were similar for ipsilateral (35%) and contralateral (32%) sides (to side of surgery), respectively. No significant interaction between time and arm (ipsilateral versus contralateral) was identified. These findings demonstrate that limb segment volume changes affect a greater proportion of patients during the first 6 weeks following surgery than previously recorded. They also indicate that flow of lymph from the side of surgery to the contralateral side may disperse lymph between sides during this early post-operative period. This has implications for how swelling is measured during this period and strategies to prevent onset of lymphedema.

Reserve growth in oil fields of the North Sea

The assessment of petroleum resources of the North Sea, as well as other areas of the world, requires a viable means to forecast the amount of growth of reserve estimates (reserve growth) for discovered fields and to predict the potential fully developed sizes of undiscovered fields. This study investigates the utility of North Sea oil field data to construct reserve-growth models. Oil fields of the North Sea provide an excellent dataset in which to examine the mechanisms, characteristics, rates and quantities of reserve growth because of the high level of capital investments, implementation of sophisticated technologies and careful data collection. Additionally, these field data are well reported and available publicly. Increases in successive annual estimates of recoverable crude oil volumes indicate that oil fields in the North Sea, collectively and in each country, experience reserve growth. Specific patterns of reserve growth are observed among countries and primary producing reservoir-rock types. Since 1985, Norwegian oil fields had the greatest volume increase; Danish oil fields increased by the greatest percentage relative to 1985 estimates; and British oil fields experienced an increase in recoverable oil estimates for the first ten years since 1985, followed by a slight reduction. Fields producing primarily from clastic reservoirs account for the majority of the estimated recoverable oil and, therefore, these fields had the largest volumetric increase. Fields producing primarily from chalk (limestone) reservoirs increased by a greater percentage relative to 1985 estimates than did fields producing primarily from clastic reservoirs. Additionally, the largest oil fields had the greatest volumetric increases. Although different reserve-growth patterns are observed among oil fields located in different countries, the small number of fields in Denmark precludes construction of reserve-growth models for that country. However, differences in reserve-growth patterns among oil fields that produce from primarily clastic and primarily chalk reservoirs, in addition to a greater number of fields in each of the two categories, allow separate reserve-growth models to be constructed based on reservoir-rock type. Reserve-growth models referenced to the date of discovery and to the date of first production may be constructed from North Sea field data. Years since discovery or years since first production are used as surrogates for, or measures of, field-development effort that is applied to promote reserve growth. Better estimates of recoverable oil are made as fields are developed. Because much of the field development occurs some time later than the field discovery date, reserve-growth models referenced to the date of first production may provide a more appropriate measure of development than does date of discovery.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 4. Morphometric, microscopic and biomechanical properties of the digital tendons of the forelimb

AIM: To determine the weight, volume, density and cross-sectional area (CSA) of the digital flexor tendons, common digital extensor tendon (CDET) and suspensory ligament (SL) of the forelimb of young Thoroughbred horses in early training, and to assess the response to a training programme of known parameters of superficial digital flexor tendon (SDFT) tissue at mid-metacarpal level. METHODS: The tendons of seven 2-year-old Thoroughbred horses in training were inspected, transected into segments of known length, and compared with those from seven untrained horses matched for age, sex and breed. The weight, volume, density and CSA of each segment, and the crimp angle, histological features, and biomechanical ultimate stress and stiffness of tendon samples from the mid-metacarpal region of the SDFT were determined. RESULTS: There was no macroscopic evidence of swelling or discolouration in any of the tendon segments or cut surfaces. The volumes of SDFT and CDET segments of horses in the trained group were significantly greater than those in the untrained group (p=0.036 and p=0.039, respectively). A greater increase in volume than weight resulted in a lower density in the SDFT but not CDET in trained compared with untrained horses (p=0.038). CSA of these two tendons was significantly greater in the trained group (p=0.002 and 0.036, respectively), the percentage increase being greater in the CDET than the SDFT. The number of tenocytes at four sites in the mid-metacarpal SDFT region was less in trained than untrained horses (p=0.025). There was no histological evidence of inflammation, and no difference in crimp angle between groups. There was no significant between-group difference in stiffness or ultimate stress of tendon strips. CONCLUSIONS: Volume and CSA of the SDFT and CDET were larger in trained than untrained horses. The SDFT was less dense in the trained group. Because no evidence of tendonitis was detected and training appeared to have no significant effect on crimp angle or biomechanical properties of tendon strips, the size and density changes were presumed to be adaptive and induced by the training. CLINICAL RELEVANCE: Although evident in this in vitro study, the detection of adaptive from initial pathological increase in size of the SDFT is likely to be difficult in vivo.

Patterns in costs and outcomes for patients with prolonged mechanical ventilation undergoing tracheostomy: an analysis of discharges under diagnosis-related group 483 in New York State from 1992 to 1996.

To analyze the costs and discharge status for patients with prolonged mechanical ventilation undergoing tracheostomy. Retrospective analysis of a statewide database. All patients (n = 37,573) >18 yrs of age who had prolonged mechanical ventilation (procedure code 96.72) and were discharged from the hospital between 1992 and 1996 with a final DRG code of 483. None. Rates of change in discharges and hospital reimbursements and the cost per survivor were examined by case payment groups and discharge year. A direct relation between volume and reimbursement rate was seen over time, although the patient age distributions remained relatively stable. The greatest increase in volume was from 1995 to 1996. For most years, there was a consistent inverse relation between age and survival, with older survivors being more likely to be discharged to residential healthcare facilities and younger patients more likely to be discharged home. There was a consistent direct relation between age and cost per survivor, mainly the result of improved survival rather than decreased reimbursements in later years. More controlled reimbursements and improved overall survival rates for DRG 483 have contributed to the improved cost per survivor among all age groups over the period. Given the greater proportion of elderly that do not survive or who are placed into residential healthcare facilities, more scrutiny is needed concerning the use of DRG 483 resources so that care is better coordinated for these patients in the inpatient and postacute care settings.

Study of the swelling capacity of a mild laxative formulation.

In this work, the swelling index is determined for various vegetable fibers (wheat bran. orange fibre and lemon fibre), and several granulated formulations to which different binding agents are added. The formulation that presents the highest swelling index (14.5 ml/g) was found to be composed of orange fibre, lemon fibre and pectin in a 1:1:1 proportion (OF + LF + PH). A study of the evolution of the swelling with time is also carried out, finding that the greatest volume increase is produced between 5 and 10 min from the start of the test. The application of the sigma-minus type calculation to the swelling rate curves produces correlation coefficients higher than 0.9. It is found that the swelling rate constant for lemon fibre is much lower than that of orange fibre. The addition of pectin lowers the swelling rate constant while the gum guar and polyvinylpyrrolidone increase the said constant. In addition, a general exponential equation is deduced which can be applied to all of the cases studied.

Persistent chemopreventive effect of S-adenosyl-L-methionine on the development of liver putative preneoplastic lesions induced by thiobenzamide in diethylnitrosamine-initiated rats.

S-Adenosyl-L-methionine (SAM) is a strong chemopreventive agent of rat liver carcinogenesis. Examination was made to determine whether inhibition by SAM of the development of preneoplastic liver lesions persists to SAM withdrawal in diethylnitrosamine-initiated F344 rats promoted with thiobenzamide (TB). The rats were subjected, 2 weeks after initiation, to 5 weeks feeding with a 0.1% TB diet followed by a TB-free diet for 6 weeks and then a second TB treatment for 3 weeks. SAM (384 micromol/kg/day) was injected i.m. during the first TB cycle (treatment A) or for 6 weeks after the first TB cycle (treatment B). Many gamma-glutamyltranspeptidase (GGT)-positive lesions developed in initiated rats after the first TB cycle. They decreased in number after TB withdrawal, while partial recovery of lesion number and a great increase in volume occurred after the second TB cycle. Liver ornithine decarboxylase (ODC) activity and c-myc and c-Ha-ras mRNAs increased during the TB cycles and returned to normal liver values after TB withdrawal. Number and size of GGT-positive lesions, DNA synthesis of GGT-positive cells, liver ODC activity and c-myc and c-Ha-ras mRNA levels decreased as a consequence of SAM treatment A. The recovery of these parameters, induced by a second TB cycle in rats not treated with SAM, was prevented by SAM treatment B. These results suggest that SAM causes a persistent decrease in growth capacity of preneoplastic liver lesions in rats subjected to a diethylnitrosamine/TB protocol.