Hieu Tran

Fragile X syndrome is caused by an expansion of a CGG repeat in the FMR1 gene. The CGG repeat number of the FMR1 mutation and the percentage of cells with methylation of the gene were studied in 218 male patients. Physical and cognitive measurements were also performed. Patients were divided into three groups; those with full mutation and complete methylation (n = 160), those with full mutation and partial methylation (n = 12), and those with a mosaic pattern (n = 46). Statistical comparisons were made between males with the fully methylated full mutation and those with a mosaic pattern. Males having full mutation with complete methylation had the lowest IQ scores and greatest physical involvement. These significant differences were seen only in ages after puberty. CGG repeat length did not correlate with IQ or the physical index score in any group. These findings suggest that a partial production of FMR1 protein may predict milder clinical involvement in some males with fragile X syndrome.

This prospective, randomized, observer-blinded study compared single- and double-injection, ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery. Ninety-two patients were randomly allocated to receive a single-injection (n = 46) or double-injection (n = 46), ultrasound-guided supraclavicular block. Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The total anesthesia-related time was defined as the sum of the performance and onset times. The main outcome variable was the onset time. The onset time was shorter with the 2-injection technique (17.5 mins [SD, 8.4 mins] vs 21.7 mins [SD, 7.2 mins]; P = 0.021); however, performance time was also longer (7.2 mins [SD, 2.7 mins] vs 6.0 mins [SD, 2.4 mins]; P = 0.037). Thus, no differences were observed in terms of total anesthesia-related time (23.4-24.3 mins). Success rates (95.7%), block-related pain scores, and complication rates were also similar between the 2 groups. As expected, the 2-injection technique required a greater number of needle passes (3.5 [SD, 1.2] vs 1.9 [SD, 1.1]; P < 0.001). In return, it provided a faster onset for sensory and motor block of the musculocutaneous nerve and a faster sensory block of the radial nerve. However, at 30 mins, no differences were observed. The double-injection, ultrasound-guided supraclavicular block provides no significant advantages compared with its single-injection counterpart.

Background: Tacrolimus (FK 506), a metabolite of the fungus Streptomyces tsukubaensis, is an anti-T-cell drug. It acts by inhibiting the production of IL-2, IL-3, IL-4, TNFa, and GM-CSF. More potent and with slightly less secondary effects than cyclosporine, it has been the object of considerable interest, especially in conditions that could benefit from the latter. Objective: In psoriasis, a placebo-controlled double-blind study has shown oral tacrolimus at 0.1 mg/kg/day to be effective in controlling recalcitrant lesions. In human, small studies have reported tacrolimus ointment to be effective in controlling acute contact dermatitis. Short-term trials of topical tacrolimus in the treatment of atopic dermatitis have recently shown excellent results in both adults and children. In animal studies of hair growth disorders, topical tacrolimus induces anagen and protects from chemotherapy-induced alopecia. Animal studies with the ointment for the prevention of skin graft rejection, lupus dermatoses, and skin papilloma formation have also shown to be promising. Conclusions: There are case reports of pyoderma gangrenosum, Sezary's syndrome, and Behcet's disease successfully treated with oral tacrolimus but, because of their small number, they remain anecdotal at this point.

Proliferation of group-based real-time applications, such as online games and video conferencing has motivated research into QoS multicast routing. These types of applications require consideration of both source-to-destination delay (i.e., packet delay from the source to all destinations) and inter-destination delay variation (i.e., the difference in packet delay from the source to different destinations) constraints. In this paper, we formulate a new combined problem for delay partitioning and multicast routing with source-to-destination delay and inter-destination delay variation constraints in a QoS framework, where a delay dependent cost function is associated with each network link. After identifying the problem asnp-complete, we introduce a Genetic Algorithm (ga) based algorithm that computes a source-based multicast tree which satisfies both constraints with near-optimal cost. We compare differentga schemes using different selection operators and find that the combination of Steady Statega and Remainder Stochastic Sampling selection operator works best for our problem. Simulation results also show that ourga heuristic consistently perfornis better than several other simple heuristics. L’augmentation du nombre d’applications faisant dialoguer en temps réel des groupes d’utilisateurs, comme les jeux en ligne ou les visioconférences, est une des principales motivations de la recherche sur la qualité de service du routage multidestinataire (multicast routing). Il faut en effet maîtriser tout aussi bien le délai de transmission source-destination (c’est à dire de la source vers toutes les destinations) que la variation des délais de transmission selon les diverses destinations. Dans cet article, on formule un nouveau problème de partionnement du délai et de routage multidestinataire prenant en compte le délai source-destination et la variation de délai selon les destinataires, où une fonction de coût dépendante du délai est associée à chaque lien du réseau. Après avoir montré que le problème étaitnp-complet, on introduit un algorithme fondé sur l’algorithme génétique pour calculer l’arbre multidestinataire qui satisfait les deux contraintes à un coût presqu’optimal. On compare ensuite plusieurs modèles d’algorithmes génétiques en utilisant différents opérateurs de sélection pour trouver le plus adapté à notre problème. C’est une combinaison de l’algorithme génétique stationnaire et de l’opérateur de sélection à échantillonnage stochastique du reste. Les résultats de simulation indiquent que notre heuristique se comporte mieux que plusieurs autres heuristiques simples.

Purpose The purpose of this brief narrative review is to summarize the evidence derived from randomized controlled trials pertaining to the nonsurgical treatment of lumbar spinal stenosis (LSS). Source The MEDLINE (January 1950 to the fourth week of January 2010) and EMBASE (January 1980 to 2009, week 53) databases, the MESH term “spinal stenosis”, and the key words, “vertebral canal stenosis” and “neurogenic claudication”, were searched. Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, and published in peer-reviewed journals. Only RCTs pertaining to nonsurgical treatment were considered. Studies comparing conservative and surgical management or different surgical techniques were not included in the review. Principal findings The search criteria yielded 13 RCTs. The average enrolment was 54 subjects per study. Blinded assessment and sample size justification were provided in 85% and 39% of RCTs, respectively. The available evidence suggests that parenteral calcitonin, but not intranasal calcitonin, can transiently decrease pain in patients with LSS. In the setting of epidural blocks, local anesthetics can improve pain and function, but the benefits seem short-lived. The available evidence does not support the addition of steroids to local anesthetic agents. Based on the limited evidence, passive physical therapy seems to provide minimal benefits in LSS. The optimal regimen for active physiotherapy remains unknown. Although benefits have been reported with gabapentin, limaprost, methylcobalamin, and epidural adhesiolysis, further trials are required to validate these findings. Conclusions Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from “weaker” trials. Further well-designed RCTs are warranted. Objectif L’objectif de cette courte synthèse narrative consiste à résumer les données probantes provenant des essais comparatifs randomisés se rapportant au traitement non chirurgical de la sténose du canal lombaire (SCL). Source Les bases de données MEDLINE (de janvier 1950 à la quatrième semaine de janvier 2010) et EMBASE (de janvier 1980 à 2009, semaine 53), le terme MESH « spinal stenosis » et les mots clés « vertebral canal stenosis » et « neurogenic claudication » ont été utilisés. Les résultats ont été limités à des essais comparatifs randomisés (ECR) menés chez des sujets humains, rédigés en anglais et publiés dans des publications évaluées par les pairs. Seuls les ECR se rapportant au traitement non chirurgical ont été considérés. Les études comparant les approches conservatrice et chirurgicale ou les études comparant différentes techniques chirurgicales ont été exclues de cette synthèse. Résultats principaux Les critères de recherche ont permis d’identifier 13 ECR. Le taux de participation moyen était de 54 sujets par étude. L’évaluation en aveugle et la justification de la taille des échantillons étaient fournies dans 85 % et 39 % des ECR, respectivement. Les données probantes disponibles suggèrent que la calcitonine administrée par voie parentérale, et non par voie intranasale, peut réduire de manière transitoire la douleur chez les patients atteints de SCL. Dans le cadre d’une anesthésie épidurale, les anesthésiques locaux peuvent réduire la douleur et améliorer la capacité fonctionnelle, mais leurs bienfaits semblent être de courte durée. Les données probantes disponibles n’appuient pas l’ajout de stéroïdes aux anesthésiques locaux. Il existe des données limitées en faveur d’avantages minimes de la physiothérapie passive en cas de SCL. Le programme optimal de physiothérapie active demeure inconnu. Bien que certains avantages aient été notés lors de l’utilisation de la gabapentine, du limaprost, de la méthylcobalamine et de la lyse d’adhérences épidurales, d’autres essais sont nécessaires afin de valider les résultats. Conclusions En raison de leur qualité variable, les ECR publiées ne peuvent offrir qu’une quantité limitée de données probantes en vue de formuler des recommandations se rapportant au traitement non chirurgical d’une SCL. Dans le cadre de cette synthèse narrative, aucune étude n’a été exclue en raison de facteurs tels que la justification de la taille des échantillons, la puissance statistique, l’insu, la définition de l’attribution d’intervention ou les résultats cliniques. Cet aspect peut constituer une limite puisqu’il peut être utilisé pour amplifier l’importance des données provenant d’essais « plus faibles » . D’autres ECR bien conçus sont nécessaires.

In this paper an algorithm for integration of knowledge in multi-agent environments using logic disjunction and conjunction structures, is presented and analysed. The authors propose a distance function between the logic formulae and define a set of postulates (criteria) for integration. The worked out algorithm is analysed regarding the computation complexity and the proposed postulates.

To investigate in computed tomographic (CT) angiography whether an exponentially decelerated contrast medium injection, as compared with a standard constant-rate injection, can facilitate uniform vascular contrast enhancement with a reduced contrast material volume. CT angiography of the abdominal aorta was performed in 46 subjects by using an exponentially decelerated injection method: 134 mL of contrast medium was injected for 40 seconds, starting at 4.0 mL/sec and decreasing exponentially to 2.7 mL/sec by the end of the injection. Twenty-one of these subjects also underwent CT angiography with a constant-rate injection: 160 mL of contrast medium was injected for 40 seconds at a constant rate of 4 mL/sec. Time-enhancement curves and the magnitude of peak vascular enhancement were measured. Enhancement uniformity was evaluated by using three indexes: (a) duration of contrast enhancement achieved within 80% of the peak (80% DCE), (b) SD of the normalized contrast enhancement (SDNCE) measured from the beginning of spiral CT scanning to the time when the enhancement decreased to a level lower than the beginning level, and (c) slope of the enhancement curve calculated by using linear regression analysis. Exponentially decelerated injection resulted in more uniform enhancement. Mean values generated by using exponentially decelerated versus constant-rate injection in 21 paired comparisons were, respectively, 30.8 seconds +/- 5.0 versus 22.6 seconds +/- 7.6 for 80% DCE, 0.052 +/- 0.017 versus 0.086 +/- 0.031 for SDNCE, and 0.47 HU/sec +/- 0.70 versus 2.27 HU/sec +/- 0.87 for slope (P <.001 for all indexes). Compared with the peak enhancement resulting from the constant-rate injection, that resulting from the exponentially decelerated injection was reduced by a mean of 17.2% +/- 10.0. Uniform vascular contrast enhancement and reduced contrast medium volume, which are desirable in CT angiography, can be achieved with exponentially decelerated injection.

Fragile X syndrome is caused by an expansion of a CGG repeat in the FMR1 gene. The CGG repeat number of the FMR1 mutation and the percentage of cells with methylation of the gene were studied in 218 male patients. Physical and cognitive measurements were also performed. Patients were divided into three groups; those with full mutation and complete methylation (n = 160), those with full mutation and partial methylation (n = 12), and those with a mosaic pattern (n = 46). Statistical comparisons were made between males with the fully methylated full mutation and those with a mosaic pattern. Males having full mutation with complete methylation had the lowest IQ scores and greatest physical involvement. These significant differences were seen only in ages after puberty. CGG repeat length did not correlate with IQ or the physical index score in any group. These findings suggest that a partial production of FMR1 protein may predict milder clinical involvement in some males with fragile X syndrome.

This integrated circuit stores 256 analog voltage levels in high density, non-volatile memory with /spl sim/7.5m V resolution per level. By contrast, the multilevel storage capacity of a typical digital non-volatile memory is 4-level per cell. The integrated circuit operates over a voltage range of 2.5 V to 5.5 V. Previous analog storage implementation use a 5.0 V supply for /spl sim/12 mV equivalent resolution per level in a 128 k EEPROM.

Objectives: To determine if gender, age, and gender per age category, have an impact on QT and QTc dispersion in healthy volunteers.Methods: This study was undertaken in 150 patients (50 per age group, 75 males, 75 females). The age groups included young (20–40 years), middle-aged (41–69 years) and elderly (> 70 years) subjects. The QT intervals on a 12 lead ECG were determined and Bazett's formula was used to derive the QTc intervals. The QT and QTc dispersion were determined by subtracting the shortest QTc interval from the longest on each 12-lead recording.Results: Males had higher QT dispersion than females (50 ± 22 vs 42 ± 18 ms, P = 0.017) but QTc dispersion was not significantly changed. No significant differences were seen among the different age categories for QT or QTc dispersion. In elderly subjects, males had higher QT and QTc dispersion than females (54 ± 23 vs 42 ±15 ms, P = 0.039 and 63 ± 23.7 vs 48 ± 21 ms, P = 0.032, respectively).Conclusions: When evaluating the effect of gender in different age categories, elderly males have significantly greater QT and QTc dispersion than elderly female subjects. No other gender differences were noted for QT or QTc dispersion in the other two age categories. When evaluating a population of healthy volunteers, regardless of age, gender has an impact on QT dispersion but no significant interaction with QTc dispersion. Evaluating age without dividing the data by gender yields no significant differences in QT or QTc dispersion. A.N.E. 2001;6(2):129–133