Post Observation Period Research Articles

Validation of Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with CRS-R

<h3>Research Objectives</h3> To examine the concurrent validity of the MATADOC with the criterion standard Coma Recovery Scale (CRS-R) for diagnostic outcomes of awareness To explore the function of comparable MATADOC items and CRS-R function scales across similar domains (e.g. auditory, visual). <h3>Design</h3> Prospective multisite cohort study collected concurrent MATADOC and CRS-R data using repeated measures with patients with disorders of consciousness (DOC). Raters were blinded. <h3>Setting</h3> Three specialist inpatient rehabilitation units for DOC (US, UK, Ireland). <h3>Participants</h3> 74 adults with prolonged DOC stemming from acquired brain injury recruited using convenience sampling. <h3>Interventions</h3> The MATADOC protocol elicits behavioral responsiveness using live music in five tasks during four clinical contacts of 15-30 minutes duration (60-120 mins total). Observed behavioral responses are rated across motor, communication, arousal, visual and auditory domains using a 14-item measure. Pre and post observation period records spontaneous behaviors. The CRS-R protocol delivers tasks in the motor, visual, auditory and communication domains in clinical contacts of 15-30 minutes duration (60 – 120 minutes in total for 4 contacts). Observed responses are rated in six function scales. <h3>Main Outcome Measures</h3> Two measures of awareness: MATADOC and CRS-R. <h3>Results</h3> Fair (Cohen's kappa or "k"=0.238, p=.006) ranging to moderate (k=0.419, p<.001) significant agreement found between CRS-R and MATADOC diagnostic outcomes for each contact, with significant correlations between scores (mean Pearson = 0.721, p<.001). Agreement increased over repeated contacts. Moderate agreement found for overall diagnostic outcomes ranging across VS, MCS and EMCS (k=0.397, p<.001). Moderate significant agreement found between measures for motor scores (k=.556, p<.001) and visual outcomes (mean k=0.326). No agreement was found for item outcomes assessing auditory responsiveness. <h3>Conclusions</h3> The MATADOC complements the CRS-R in treatment planning for DOC. MATADOC measures of auditory responsiveness suggest musical stimuli may elicit more complex behaviors than non-music protocols. The MATADOC rates complexity of auditory localization as MCS in line with recent recommendations which may explain diagnostic outcome differences with CRS-R outcomes. <h3>Author(s) Disclosures</h3> None.

Dietary effect of substituting Saccharina japonica with cabbage extract by‐product on the growth, body composition and air exposure of juvenile abalone (Haliotis discus hannai Ino 1952)

Dietary substitution effect of cabbage extract by‐product (CEB) for Saccharina japonica on the growth, body composition and air exposure stressor of juvenile abalone (Haliotis discus hannai) was determined. A total of 1260 abalone were randomly distributed into 18 net cages (seventy per cage). Five formulated diets were prepared. The control (CEB0) diet contained 20% S. japonica powder. Twenty-five, 50%, 75%, and 100% of S. japonica were substituted with the equal amount of CEB, referred to as the CEB25, CEB50, CEB75 and CEB100 diets, respectively. Ultimately, dry S. japonica was prepared to compare formulated diets on growth of abalone. Each diet was randomly assigned to triplicate groups of abalone and fed to abalone every other day for 16 weeks. After the 16-week feeding trial, abalone were subjected to air exposure for 24 h, and then survival was monitored for the next 6 days. All formulated diets achieved greater weight gain and specific growth rate (SGR) than those of abalone fed the S. japonica. Weight gain and SGR of abalone linearly improved with dietary increased substitution levels of S. japonica with CEB. Shell growth of abalone tended to agree with growth rate. The chemical composition of the soft body of abalone was not affected by the experimental diets. Survival of abalone fed all formulated diets was (P < 0.05) higher than that of abalone fed S. japonica at the end of the 6-day post observation period after the 24-h air exposure. In conclusion, S. japonica could be completely (100%) substituted with CEB in abalone feeds when 20% S. japonica was included. Substitution of S. japonica with CEB in feeds could improve growth of abalone, but lower feed cost.

Substitution effect of Saccharina japonica with beet leaf by-product in feed on the growth and chemical composition of the soft body of juvenile abalone (Haliotis discus hannai Ino 1952) subjected to air exposure

Dietary substitution effect of beet leaf by-product (BLB) for Saccharina japonica on the growth and soft body composition of abalone (Haliotis discus hannai) subjected to air exposure was determined. A total of 1260 juvenile abalone was randomly distributed into 18 containers. Five experimental diets were prepared. The control (Con) diet contained 20% S. japonica. Twenty five percent, 50%, 75% and 100% S. japonica were substituted with equal amount of BLB, referred to as the BLB25, BLB50, BLB75 and BLB100 diets, respectively. The dry S. japonica was also prepared to compare effect of formulated diets on growth of abalone. The experimental diets were fed to triplicate groups of abalone for 16 weeks, and then exposed to air for 24 h. Survival of abalone was monitored for the next 6-day post observation period after the 24-h air exposure. Weight gain and specific growth rate (SGR) of abalone fed with formulated diets were greater than those of abalone fed with the S. japonica. The greatest weight gain and SGR were obtained in abalone fed the BLB25 diet, followed by the BLB50, BLB75, BLB100 and Con diets, in that order. The maximum values of weight gain, SGR, shell length and shell width of abalone were estimated to be approximately 42.3%, 43.5%, 39.8% and 33.7% of substitution level of BLB for S. japonica in abalone feed. The chemical composition of abalone soft body was not affected by the experimental diets. Survival of abalone fed with formulated diets was higher than that of abalone fed with the S. japonica at the end of the 6-day post observation period. In conclusion, S. japonica could be completely replaced with BLB in abalone feed without retardation of growth and survival of abalone subjected to the 24-h air exposure. The greatest weight gain and SGR were obtained in abalone fed the BLB25 diet.

Pre-Merger and Post-Merger Operating Performance of SBI

In today’s business world the corporate and PSUs have practiced of major restructuring through merger and acquisition strategies. This is well acknowledged fact Mergers and Acquisitions are being considered as an admired strategy for augmentation. This research paper is based on how the merger of SBI associates into its parents company affects the financial performance on consolidation basis. In this article we analyzed the financial position before merger and after merger of SBI and find out an increase in the profitability by few parameters in short run while it gives the hike in performance as well as in efficiency for long term basis because of low operating cost. It has been observed that after the merger, bad loan pile up, suddenly the profit of the bank come down, during this period when the entire economy of India was facing the pressure of demonetization and GST regime in India while SBI was thinking to be indexed in top 50 banks of the world. This research article also reveals the fact and figures how mergers &amp; acquisitions have consequences and effects on financial position of the bank performance considering five years from the very beginning of pre and post observation period. In this study t-test is used to evaluate all financial parameters before and after merger of five SBI associates into SBI and it is found that for short period of time, after merger the SBI did not perform well but after two years it has not only increased its profitability but also increase the efficiency by minimizing the operating cost.

Effect of a Protected Mealtime Pilot on Energy and Protein Intake in a Canadian Hospital.

Purpose: In Canada, approximately 45% of hospitalized patients are moderately or severely malnourished upon admission. The protected mealtime policy was designed to address malnutrition in institutions. This pilot study aimed to provide preliminary results examining the effect of this policy on patient energy and protein intake. Methods: A 1-group, pre-post observation design was conducted in a Canadian hospital. Pre- and post-observations included the frequency and type of interruptions, type of interrupter, and patient energy and protein intake at each meal. Results: The average number and length of interruptions decreased, and the average length of mealtime assistance provided to patients (n = 12) increased in the post-observation period. Energy and protein consumption showed a slight increase during the post-observation period. Conclusion: A protected mealtime policy may be an effective policy to address malnutrition among hospitalized Canadian adults. Further studies are warranted in Canada to determine the effects and feasibility of this policy implementation.

The study of acute and chronic toxicity of the sodium-, calcium-, iron-polygalacturonate pharmacological substance in rabbits.

The purpose of this study is the assessment of the acute and chronic toxicity of pharmacological substance sodium, calcium, iron-polygalacturonate (PG Na,Ca,Fe) in rabbits as one of the stages of preclinical studies. We studied an acute and chronic oral toxicity of PG Na,Ca,Fe, which stimulates the process of hemopoiesis, in male and female rabbits of the "Chinchilla". According to the results of the study of acute toxicity of PG Na,Ca,Fe, treating with it the rabbits of both sexes in doses of 0.5-5 g/kg has no toxic effect (LD50 greater than 5 g/kg). The histostructure of studied organs of animals, treated with preparations in a dose of 5 g/kg, did not differ from that of the animals of the control group. This study allow to classify PG Na,Ca,Fe as a preparation of the 6th class with respect to harmless drugs. An estimate of the chronic toxicity of PG Na,Ca,Fe at administration of preparation in the form of boluses to rabbits in doses 0.025, 0.262 and 0.5 g/kg of the body weight demonstrated that the general condition and behavior of animals did not differ from the norm. The data of hematological and biochemical studies of blood serum and urine, electrocardiographic studies, the study of the mass coefficients of the internal organs of the experimental rabbits, treated with PG Na,Ca,Fe in the mentioned doses for 60 days, compared to those obtained in the 30-day post-observation period, did not show significant changes with respect to the control and intact group of rabbits.

Pharmacy Diabetes Management of a Veteran Population in a Long-Term Care Setting: A Program Evaluation.

The benefits of an outpatient pharmacy diabetes clinic has been established, with improved patient outcomes and reduced total costs of care. We describe the benefits of an inpatient clinical pharmacy diabetes service within a Department of Veterans Affairs long-term care facility. Patients were referred to the pharmacy diabetes monitoring program between February 2016 and August 2016. During this time, clinical pharmacy specialists managed all pharmacotherapy relating to diabetes care as well as all fingerstick monitoring frequencies and laboratory monitoring to achieve a prespecified, patient-specific A1C goal. The primary endpoints were optimization of blood glucose fingerstick monitoring frequency and cessation of sliding-scale insulin. Secondary end points were achievement of A1C goal, reduction of hypoglycemic/hyperglycemic events, and reduction of total insulin injections per day. At the time of discharge or end of the observation period, fingerstick frequency had been reduced by a mean of 7.7 fingersticks/patient/week (35.6% total reduction, median 17.5; interquartile range [IQR] 5.5-21; P = 0.002). All eight patients initially prescribed sliding-scale insulin upon referral had their sliding scale stopped by the end of observation. Total injections per day had been reduced from baseline with a mean reduction of 0.55 injections/patient/day (16.5% total reduction; P < 0.05). A1C also showed improvement from baseline, though this was not statistically significant (median 7.75%, IQR 6.8-8.3; P = 0.1). Total hyperglycemic events were reduced from 36 prior to enrollment to 23 post-observation period, while hypoglycemic events decreased from 8 before enrollment to 4 post-observation period. Type 2 diabetes mellitus patients managed by clinical pharmacy specialists at a Veterans Affairs long-term care facility significantly decreased weekly fingerstick blood monitoring frequency, number of insulin injections per day, and ceased sliding-scale insulin use. A1C and hypoglycemic and hyperglycemic events remained stable. Our results are limited because of a small sample size.

Limited Post-observation Period in Pediatric Outpatient Ultrasound-Guided Liver Biopsies.

We retrospectively studied whether a limited 2 h post-biopsy observation period after a percutaneous outpatient ultrasound-guided liver biopsy is a sufficient monitoring period for children. This study is an IRB-approved retrospective cohort review of consecutive outpatient percutaneous ultrasound-guided liver biopsies from June 01, 2014, to June 30, 2016. A total of 198 biopsies in 192 patients (85 females and 113 males) underwent an outpatient ultrasound-guided liver biopsy between June 01, 2014, and June 30, 2016 (age range 3weeks-18years, mean 11.6years). Outpatient biopsies were performed with a limited patient observation time [median (IQR) observation 2.25 (0.83) h]. Adequate histopathology was obtained in 99% (197/198) of cases. Only one case was determined by a pathologist as not sufficient to render a diagnosis. 84% (166/198) of the biopsies were performed with a 16G needle, and 16% (32/198) were performed with an 18G needle. Overall, seven complications were detected (3.5% of all biopsies, 7/198) in seven patients. All complications detected were minor, 1.5% (3/198) were categorized as SIR A and 2% (4/198) as SIR B. The most common complication included pain after biopsy (4/198), followed by rash at the biopsy site (3/198). No major complications were detected in our sample. In a consecutive cohort of children, the use of a limited 2 h observation period after an ultrasound-guided percutaneous biopsy was a sufficient monitoring period for complications. Additionally, we did not observe a high proportion of patients returning for follow-up medical care after discharge due to complications.

The effects of visual stimuli on EEG mu rhythms in healthy adults.

[Purpose] Several action observation/imagery training studies have been conducted in patients with limited physical activity showing improvements in motor function. However, most studies compared effects of action observation and imagery, so little is known about the changes caused by subsequent observation of target objects. Moreover, few studies analyzed brain wave changes in the EEG mu rhythm. [Subjects and Methods] Eighteen healthy female adults participated in this study, and were divided into two groups: ‘Visual Stimuli’ and ‘Non-Visual Stimuli’. EEG amplitude in the 8–13 Hz frequency band over the sensorimotor cortex was evaluated. [Results] Significant mu suppression was obtained in the action observation trials. Mu power showed a main effect of visual stimuli, with decreased power during action observation, and increased power post-observation in both conditions. Comparing the ‘Visual Stimuli’ and ‘Non-Visual Stimuli’ conditions during the post-observation period, mu power demonstrated a greater increase in the ‘Non-Visual Stimuli’ condition. Furthermore, mu power was lower post-observation than pre-observation. [Conclusion] These results show the effects of visual input between maintaining target objects and no visual input, and their relevance to modulations of the mirror neuron system. It also suggests that greater visual input may be more effective for cognitive rehabilitation.

Long-term analysis to objectify the tumour grading by means of automated microscopic image analysis of the nucleolar organizer regions (AgNORs) in the case of breast carcinoma

BackgroundApart from a number of cases of inaccurate prognosis in regard to individual patients, the inter- and intra-observer variability of the classical, histological prognosis parameters have been under repeated discussion. For this reason, a long-term analysis was carried out in regard to overall survival by means of automated microscopic image analysis of the nucleolar organizer regions (AgNORs) to objectify tumour grading in the case of breast carcinoma.This consists of a selective representation of argyrophilic proteins that are associated with the nucleolus organising regions.MethodsThe evaluation included 244 female patients with an average age of 59.3 years. The characterisation of the histological sections was carried out on the basis of the AMBA/R system. With this software the histometric characterisation level was evaluated in terms of the nucleolus organizer regions. The post-observation data were obtained from the clinical register and were complemented by mortality data from the cancer registers and by data supplied by the residents’ registration office of Berlin.ResultsThe average post-observation period was 106.6 months. With the Cox-Regression the influence of the co-variables (conventional prognosis parameters and AgNOR parameters) were examined. In the model, only the parameters pN, G and various AgNOR parameters remain present.ConclusionThere is a strong correlation between survival and selected AgNOR parameters. These could replace the conventional grading as the standard measure for the mitosis rate together with the pleomorphism level. Instead of the-time consuming AMBA/R system originally used, a new implementation of AgNOR quantification with modern VM systems could be applied.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1449591192859058.

1098 First Randomized Trial of Colonoscopy Screening for the Prevention of Colorectal Cancer

potentially improve outcomes after COL. We have recently described a significant overall improvement in ADR when endoscopists were simply made aware that their performance was being recorded. Aim: To determine whether a short term period of ADR monitoring can lead to a prolonged improvement in COL performance that outlives the known interval of observation. Methods: Procedure indication, patient demographics, fellow involvement, bowel prep description, colonoscope generation used, endoscopic findings, and pathology of removed polyps were recorded during a 9-month period at a VA medical center. Only screening colonoscopies performed without fellow involvement were analyzed. Baseline ADR was calculated for each of 6 endoscopists during a period of 2 non-consecutive months and was then compared to results after: [1] endoscopists were informed that ADR was being recorded and compared to their peers during a period of 3 months (observation period), and [2] during a subsequent 3 month period in which endoscopists were unaware that their performance was still being evaluated (post-observation period). Endoscopists were arbitrarily designated as high (1 or more adenomas removed during 45% of screening COL), moderate (1 or more adenomas removed during 30% 45% of screening COL), and low (1 or more adenomas removed during 30% of screening COL) detectors for each study interval. Results: We reviewed 2,350 colonoscopies. The ADR for the entire group during the observation period was significantly higher (46.3%) than the baseline period (p 0.05). Despite being unaware that their ADR was still being recorded, performance during the postobservation period also remained higher than the baseline period (43.8% vs. 36.1%). Every endoscopist surpassed the minimal ADR recommendations during both periods. Although baseline high-detectors (n 2) did not improve throughout the study, the remaining 4 endoscopists (non-high detectors) improved significantly at each interval when compared to baseline (Table 1), and all low detection performances were eliminated during the observation and postobservation periods. Conclusions: 1) Endoscopists substantially improve COL performance when aware of their own ADR and how it compares to their peers. 2) This improvement is sustainable, even after endoscopists are no longer under the assumption that their performance is being monitored. 3) A simple intervention of ADR monitoring for a short period of time can ensure that endoscopists remain above current minimal recommendations for adenoma detection during screening COL. 4) Low and moderate detectors benefit the most from ADR monitoring

Self-as-a-model training of left foot Australian Football punt kicking in two cases using reversed video footage of the player's right foot kicks

Introduction: In Australian Football, bilateral punt kicking skill is desirable, but players’ preferred side kick is often better. To investigate the effectiveness of video self-as-a-model for improving performance, two Australian Football players viewed video-clips of kicks by their non-preferred foot (left) in order to improve the performance ratio of non-preferred to preferred. To display an apparent left foot kick, video-clips of the athletes performing a right footed kick were reversed. Players were asked to observe the video-clip sequence three times a day during the 2-week training period. Methodology: The video footage was obtained from two Australian Football players performing 10 kicks each with the right and left foot, while aiming at a target placed 50 metres away. Adobe Premier Pro was used to produce a DVD for each player. The DVD displayed footage of their three best right foot kicks which was reversed, thus displaying apparent left kicks. The player watched their DVD three times a day for two weeks, after which a post-test was conducted, with a retention test at six weeks. Results: Both players showed a significant right foot advantage for kick distance after the pre-test, an advantage of 13 metres for player 1 (p< 0.01) and three metres (p= 0.02) for player 2. Thereafter, left foot distance was analysed as a proportion of the distance kicked on the right foot. Bilaterality of performance over the three sessions showed significant improvement. The L/R ratios were 0.73, 0.79, and 0.83 for player 1 (linear trend over sessions p= 0.01), and were 0.93, 0.96 and 0.99 for player 2 (p= 0.04). In terms of accuracy, although the deviation of the kicks from the goal centre lessened over sessions, improvements of 0.8 and 0.2 metres were not significant (p= 0.24 and 0.76, respectively). Player questioning afterwards indicated that both thought they had been observing good examples of their left foot kicks. Conclusion: The training time needed to influence bilateral skill differences is so great that few players or coaches attempt to do so, despite its advantage. As such, non-preferred side skills are typically worse. This study used a video editing application to present players with an improved version of their apparent left side skill performance. Repeated observation of this performance was associated with a significant improvement in the L:R ratio for kick distances in the post-observation period in both cases. Thus further research into innovative and efficient methods of training non-preferred-side skills, such as reversed self-as-a-model footage, are needed.

Nutrigenomic Studies of Effects of Chlorella on Subjects with High-Risk Factors for Lifestyle-Related Disease

In order to clarify the physiological effects of Chlorella intake on subjects with high-risk factors for lifestyle-related diseases, we conducted Chlorella ingestion tests on 17 subjects with high-risk factors for lifestyle-related diseases and 17 healthy subjects over a 16-week period, including a 4-week post-observation period. We conducted blood biochemical tests and analyzed gene expression profile in whole blood cells in the peripheral blood before and after Chlorella intake. We confirmed that in both groups, Chlorella intake resulted in noticeable reductions in body fat percentage, serum total cholesterol, and fasting blood glucose levels. Through gene expression analysis, we found that gene expression profiles varied with Chlorella intake and identified many genes that exhibited behavior such that after the completion of the intake period, expression levels returned to pre-intake expression ones. Among these were genes related to signal transduction molecules, metabolic enzymes, receptors, transporters, and cytokines. A difference in expression level was found between the two groups at the start of the tests, and we were able to identify genes with noticeable variance in expression level resulting from Chlorella intake in the high-risk factor group. These included genes involved in fat metabolism and insulin signaling pathways, which suggests that these pathways could be physiologically affected by Chlorella intake. There were clear variations in the expression profiles of genes directly related to uptake of glucose resulting from Chlorella intake, indicating that the activation of insulin signaling pathways could be the reason for the hypoglycemic effects of Chlorella.

Physical activity levels during phase IV cardiac rehabilitation in a group of male myocardial infarction patients

Objective: To determine physical activity levels during phase IV cardiac rehabilitation in 31 male myocardial infarction patients (median age 62, range 53–77 years). Methods: Patients recorded daily physical activity over...

Tea Catechins Reduce Serum Cholesterol Levels in Mild and Borderline Hypercholesterolemia Patients

Blood cholesterol-lowering effect and safety of tea catechins were examined in a placebo-controlled double-blind study in which a beverage containing tea catechins (a 250ml beverage containing 197.4mg of catechins) was given twice a day at breakfast and dinner for 12 weeks. The subjects used were adult males and females with mild and borderline hypercholesterolemia with the range of serum total cholesterol levels 180-259mg/dl (male/ female, 38/22; age, 48±9 years; total cholesterol, 222±20mg/dl), who were not taking drugs that may affect lipid metabolism. The study was initiated with a 2-week pre-observation period followed by a 12-week intake period and a 2-week post-observation period. The results revealed that the serum total cholesterol levels in the test beverage group (initial intake level) was significantly decreased at 8 weeks (228±23mg/dl to 220±21mg/dl, p<0.01) and the decrease was maintained until 12 weeks (222±20mg/dl, p<0.05). Such significant decreases in serum cholesterol levels were not observed in the placebo group at any time points. In terms of the safety, no abnormal findings were noted in blood tests, physical measurements and interviews by physicians. Thus these results demonstrated the benefits and safety of tea catechins in individuals with mild or borderline hypercholesterolemia.

REPEATED PULMONARY FUNCTION MEASUREMENTS IN RATS AFTER INTRATRACHEAL INSTILLATION OF A POLYAMINE TEXTILE PIGMENT COMPONENT

The pulmonary response of Wistar rats to a cumulative dose of 1 mg/kg body weight of a polymeric alpha,omega-diamine was examined using the intratracheal route of administration. Instillation of the test substance was on days 0 and 7 followed by a 3-month postobservation period. Static and dynamic pulmonary function tests, including arterial blood gas determinations, were performed during wk 5, 9, and 13. At all time points, significantly depressed flow-volume curves, reduced quasistatic compliance, and reduced vital capacity were observed. These were associated with increases of residual volume and functional residual capacity in the presence of unremarkable changes of total lung capacity (TLC). One of the most predominant dysfunctions of the lung was a severe maldistribution of ventilation, indicated by the single-breath nitrogen washout test. The carbon monoxide diffusing capacity (DL(CO)), in turn, was only mildly decreased, and differences between treatment and control groups did not reach statistical significance. Assessment of arterial blood gases demonstrated a statistically significantly increased venous admixture with subsequent slight hypoxemia. In summary, the predominant dysfunction appeared to be consistent with an obstructive rather than restrictive lung disease. The functional changes observed may account for the effect on arterial blood gases, suggesting a mismatch of the ventilation-perfusion relationship. Either measurement appear to demonstrate a relative stable dysfunction during the 3-mo postinstillation observation period. Collectively, this study supports the view held that polymeric alpha, omega-diamines appear to be potent pneumotoxicants.

Arterioplastia com enxerto de pericárdio bovino: estudo experimental em cães

Com o objetivo de avaliar a eficácia do pericárdio bovino (PB) para corrigir defeitos arteriais, provocado nas artérias femorais cão, foram realizados remendos de PB e veia cefálica autóloga (VA). Foram utilizados vinte cães, Canis familiaris (oito machos e doze fêmeas), divididos em dois grupos de dez animais (I e II), para serem reoperados no 7º e 30º dias de pós-operatório (PO), respectivamente. Para análise dos dados, aplicou-se o teste do qui-quadrado ou teste exato de Fisher (a£ 0,05). Nas avaliações clínicas não foram observadas alterações significantes, independentemente, do tipo de enxerto utilizado e tempo de observação PO. As avaliações histológicas, entre os enxertos de PB e VA, não diferiram significantemente quanto à presença de infiltrado inflamatório agudo e trombo mural, que predominaram no 7º PO, enquanto a presença de tecido de granulação, placa miofibroblástica e células endoteliais predominaram no 30º PO. A presença de necrose, no 7º PO, entre os enxertos de PB e VA, foi significantemente maior no PB. Os enxertos não sofreram calcificação. Ocorreu significante reação tipo corpo estranho ao fio de polipropileno, no 30º PO, em ambos os enxertos. O PB mostrou-se eficaz como substituto arterial em cães, comparável à VA, para o período de observação estabelecido.

Polyethylene glycol with metoclopramide is superior to polyethylene glycol alone or with cisapride for colon lavage prior to colonoscopy

THERAPEUTIC ERCP IN OUTPATIENTS: A CHANGE IN PRACTICE. T.CK. Tham, I. Vandervoort, R.CK. Wong, DR. Lichtonstein, J. Van Dam, F. Ruymann, F. Farraye, D.L. Carr-Loeke. Gastroenterology Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA Patients have been routinely admitted for observation following therapeutic ERCP for potential complications. Since most complications are apparent within a few hours, outpatient therapeutic ERCP would seem feasible when certain conditions are met. AIM: To determine the safety of discharge following therapeutic ERCP. METHODS: We prospectively followed 160 patients undergoing outpatient therapeutic ERCP from a cohort of 343 consecutive ERCP procedures from 1993 1995. Patients were selected for ontpatiem therapeutic ERCP based on relative good health (ASA I or II), accommodation for a minimum of 24 hours near the hospital. They were observed for a minimum of 2 hours before discharge and were told to contact our service if any symptoms developed. RESULTS: Plastic bilia D, stents were inserted in 61 patients (indications: stricture without confirmed etiology 25, malignancy 21, chronic pancreatitis 6, selerosing eholangitis 7, cystic duct leak 2); pancreatic stents in 25 (chronic pancreatitis 12, stricture 3, stones 4, malignancy 3, miscellaneous 3); biliary sphincterotomy in 40 (choledocholitihiasis and stone extraction 36, ampullary tumor 2, sphincter of Oddi dysfunction 2); Wallstent insertion in 17 with malignant biliary obstruction, biliary balloon or catheter dilation in 8 (stricture 6, choledocholithiasis 1, sphincter of Oddi dysfunction 1); pancreatic balloon or catheter dilation in 6 (stricture 3, chronic pancrcatitis 2, pseudocyst 1); and panerea.tie sphineterotumy in 2 (chronic pancreatitis 1, stone 1). Admission was necessary in 23 (14% of outpatients); 18 (11%) of these during the 2 hour post ERCP observation period and 5 (3%) from home after a median time of 24 hours following discharge (range 5 to 48 hours). Reasons for admission were: mild pancrcatitis in 14, post-sphincterotomy bleed in 7, cholangitis in 1, pain in 1. Of the patients who were admired from home, 3 had pancreatitis (following sphincterotomy in 1, pancreatic stenting in 1, pancreatic balloon dilation in 1) and 2 had bleeds post sphincterotomy. The overall median hospital stay was 3 days (range 1 17) and all patients recovered with conservative treatment. CONCLUSIONS: A policy of selected outpatient therapeutic ERCPs, with admission reserved for those with a complication, appears to be safe and costeffective.

Anti-idiotype antibodies to Marek's disease-associated tumour surface antigen in protection against Marek's disease

Marek's disease-associated tumour surface antigen (MATSA) removed by enzymatic (papain) digestion of Marek's disease tumour cells was fractionated by gel filtration chromatography. The first peak (F1) was used to raise antibody in rabbits. Monoclonal antibody (RPH-6) directed against MATSA and the anti-F1 IgG were used as idiotypic antibodies to raise polyclonal anti-idiotype serum in heterologous hosts; rabbit and goat, respectively. The anti-idiotypes (anti-Id) were purified by affinity chromatography and characterized by competitive binding assay using immunofluorescent (IF) tests. Day-old white Leghorn chicks were immunized with anti-Id to MATSA (Group 1) or anti-Id to F1 (Group 3) and challenged with virulent Marek's disease virus (MDV) on the tenth day post immunization. In positive control groups, the day-old chicks were inoculated with anti-BALB/c mouse globulin (Group 2) and anti-rabbit globulin (Group 4) and challenged with virulent MDV on the tenth day post inoculation. As compared with positive control groups, the vaccinated groups (1 and 3) had considerably lower level of MATSA positive cells during the post challenge observation period. The protection level against MD in the immunized groups was 66.6% (Group 1) and 86.6% (Group 3).