Allegheny Valley Hospital

Treatment results on 109 patients with craniopharyngioma treated surgically or by combined surgery and radiation therapy are reported. The five- and ten-year survival rates were 62.9% and 48%, respectively, for 74 patients treated primarily with surgery. For 32 patients treated with combined surgery and radiation therapy, the survival rates were 82.2% and 71%. The 74 patients treated with surgery but no radiotherapy had five- and ten-year relapse-free survival rates of 31.5% and 17.4%, respectively, and for the 32 patients treated with combined surgery and radiation therapy, these relapse-free survival rates were 76.3% and 43.8%, respectively. The survival and relapse-free survival rates were better for children. Morbidity and mortality were higher in patients who were reoperated on for recurrent tumors. Our data indicate that radiation therapy should play a major role in the initial combined management of cranio-pharyngiomas especially when the lesion cannot be totally resected and when postoperative CT scan shows residual tumors. Cancer 47:847–852, 1981.

Little research is available on the muscle activity patterns of the lower extremity muscles during dynamic closed chain squatting activities. The purpose of this study was to examine the effect of lower extremity position during an Olympic squat on the muscle activity patterns of the vastus medialis, vastus lateralis, semimembranosus/semitendinosus, and biceps femoris. Twenty-five healthy, untrained subjects, 18-35 years old, were randomly assigned initial squatting positions of either self-selected neutral or 30 degrees of lower extremity turn-out from the self-selected neutral position. Surface electromyography and motion analysis data were collected simultaneously in 10 degrees intervals and analyzed from 10-60 degrees of knee flexion in both the ascending and descending phases of the squat. A four-way analysis of variance indicated that the main effect of lower extremity position and the interaction of extremity position and knee joint angles were not found to cause significant changes in muscle activity patterns. Significant changes in muscle activity did occur with changes in knee flexion angles in the vastus medialis and vastus lateralis but not in the semimembranosus/semitendinosus or biceps femoris.

OBJECTIVE: To study and compare the incidence and main background characteristics of do-not-resuscitate (DNR) decision making in six European countries. DESIGN: Retrospective. SETTING: We studied DNR decisions simultaneously in Belgium (Flanders), Denmark, Italy (four regions), the Netherlands, Sweden, and Switzerland (German-speaking part). In each country, random samples of death certificates were drawn from death registries to which all deaths are reported. The deaths occurred between June 2001 and February 2002. PARTICIPANTS: Reporting physicians received a mailed questionnaire about the medical decision making that had preceded death. The response percentage was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. The total number of deaths studied was 20,480. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measurements were frequency of DNR decisions, both individual and institutional, and patient involvement. Before death, an individual DNR decision was made in about 50-60% of all nonsudden deaths (Switzerland 73%, Italy 16%). The frequency of institutional decisions was highest in Sweden (22%) and Italy (17%) and lowest in Belgium (5%). DNR decisions are discussed with competent patients in 10-84% of cases. In the Netherlands patient involvement rose from 53% in 1990 to 84% in 2001. In case of incompetent patients, physicians bypassed relatives in 5-37% of cases. CONCLUSIONS: Except in Italy, DNR decisions are a common phenomenon in these six countries. Most of these decisions are individual, but institutional decisions occur frequently as well. In most countries, the involvement of patients in DNR decision making can be improved.

Summary The Violet-throated Metaltail Metallura baroni is a high altitude hummingbird endemic to south-central Ecuador currently considered globally ‘Endangered’. Here we present the first detailed assessment of its distribution, ecology and conservation. We first used a maximum entropy model (Maxent model) to create a predicted distribution for this species based on very limited species occurrence data. We used this model to guide field surveys for the species between April and October 2006. We found a positive relationship between model values and species presence, indicating that the model was a useful tool to predict species occurrence and guide exploration. In the sites where the metaltail was found we gathered data on its habitat requirements, food resources and behaviour. Our results indicate that Violet-throated Metaltail is restricted to the Western Cordillera of the Andes Mountains in Azuay and Cañar provinces of Ecuador, with an area of extent of less than 2,000 km 2 . Deep river canyons to the north and south, lack of suitable habitat, and potential interspecific competition in the east may limit the bird's distribution. The species occurred in three distinct habitats, including Polylepis woodland, the upper edge of the montane forest, and in shrubby paramo, but we found no difference in relative abundance among these habitats. The metaltail seems to tolerate moderate human intervention in its habitats as long as some native brushy cover is maintained. We found that Brachyotum sp., Berberis sp., and Barnadesia sp. were important nectar resources. The ‘Endangered’ status of this species is supported due to its restricted distribution in fragmented habitats which are under increasing human pressures.

Embolic events, particularly involving the central nervous system, represent one of the important hazards associated with the implantation of mechanical valves. The use of the transcranial Doppler to insonate the middle cerebral artery has allowed us to detect microembolic events in some of these patients. Patients with long term implantation and frequent microemboli appear to be more prone to transient ischemic attacks or stroke. Evaluation of 26 patients with mechanical valves revealed 14 with detectable microemboli, four of whom experienced central nervous system symptoms. Modifications in the medical or anticoagulant regimes have not been successful in decreasing or eliminating these microemboli. As the transcranial Doppler is a non-invasive means of quantifying these microemboli, it may become a useful tool in identifying those patients in need of a new type of antithrombotic regimen, or even a valve replacement. Transcranial Doppler could thus provide advance warning before a catastrophic cerebral embolism occurs.

Recent climate change has been linked to shifts in the timing of life-cycle events in many organisms, but there is debate over the degree to which phenological changes are caused by evolved genetic responses of populations or by phenotypic plasticity of individuals. We estimated plasticity of spring arrival date in 27 species of bird that breed in the vicinity of an observatory in eastern North America. For 2441 individuals detected in multiple years, arrival occurred earlier during warm years, especially in species that migrate short distances. Phenotypic plasticity averaged -0.93 days °C(-1) ± 0.70 (95% CI). However, plasticity accounted for only 13-25% of the climate-induced trend in phenology observed over 46 years. Although our approach probably underestimates the full scope of plasticity, the data suggest that part of the response to environmental change has been caused by microevolution. The estimated evolutionary rates are plausible (0.016 haldanes).

Eighty-four cases of condyloma acuminatum were presented, with conventional treatment, e.g., surgical excision and fulguration with or without Podophyllin application. Recurrence rate was 28 per cent to 65 per cent, depending on the number and duration of treatments. Immunotherapy was used on 17 patients with recurrent and giant condyloma acuminatum. Condylomata were successfully eradicated in 94.1 per cent of patients, which indicates that immunotherapy is a very effective alternative in the treatment of recurrent and giant condyloma acuminatum.

The hepatic cytochrome P450 enzyme system is involved in the metabolism of numerous drugs. Specific enzymes are associated with the metabolism of specific drugs. The potential for drug interactions arises when one drug inhibits or induces the enzyme(s) responsible for metabolism of another drug given concurrently. Most psychotropics are metabolized by these enzymes. Clinically significant drug interactions are reported between the selective serotonin reuptake inhibitors and other psychotropics. Specifically, interactions between fluoxetine and phenytoin are reported with substantial elevations of phenytoin concentrations. Phenytoin is metabolized by the CYP2C subfamily, and fluoxetine is known to inhibit this subfamily. Similarly, sertraline also inhibits the CYP2C subfamily, but no case reports to date have been identified. To minimize and prevent these interactions, one must be aware of the P450 enzymes involved in drug metabolism. The significance of these interactions seems to rely both on the concentration of the drug at the enzyme and its potency for inhibiting the enzyme. Frequent monitoring of serum concentrations of drugs with a narrow therapeutic range would be appropriate when a potential inhibitor is added. This article describes an apparently similar interaction between sertraline and phenytoin in two elderly patients, which resulted in elevated phenytoin concentrations without symptoms of toxicity.

The fact that bronchogenic carcinoma can seldom, if ever, be cured by irradiation has rarely been disputed. There are many factors which account for the failure of radiation to cure carcinoma of the lung. The most important of these are as follows: 1. Bronchogenic carcinoma is usually invasive by nature, and, because it is growing in an organ which is extremely vascular, it invades the blood and lymphatic channels early, often producing metastases before detection of the primary tumor. 2. Bronchogenic carcinomas are generally radioresistant. Undifferentiated carcinomas often have been classified erroneously as radiosensitive tumors. They are more correctly classified as radio-responsive, since they respond promptly but usually have invaded the blood and lymphatic channels before they are controlled locally, and thus are never cured. 3. Patients with bronchogenic cancer have often so deteriorated before the diagnosis is made that they are unable to tolerate cancerocidal tumor doses. 4. The lung tolerates radiation poorly, and a tumor dose which is cancerocidal for a pulmonary neoplasm is often sufficiently high to produce irreparable damage to the normal tissues overlying and surrounding it. Since the nature of the disease and the bed in which the tumor is growing cannot be altered by any means at present at our disposal, the only hope of improving the results of treatment in bronchogenic carcinoma lies in an attempt to deliver a cancerocidal dose to the neoplasm without producing critical damage to the surrounding tissues and to the host himself. Cobalt teletherapy and supervoltage x-ray therapy have a better chance of accomplishing this than radiation of lower energy. Percentagewise, the improvement in statistics thus attained would be small, since treatment failures are seldom due to insufficient dose alone. Any improvement, however, is significant, considering the hopelessness of inoperable carcinoma of the lung at the present time. In 1956, the writer of this paper compiled statistics on all patients receiving 400-kv x-ray therapy for bronchogenic carcinoma between March 1, 1952, and March 1, 1955, in the Radiation Therapy Department of Allegheny General Hospital. These statistics have been reported elsewhere (8). In summary, 50 histologically proved cases were reported. Twenty patients had lesions which were undifferentiated, 18 had well differentiated squamous-cell lesions, 9 histologically proved malignant tumors of unknown cell type, and 3 adenocarcinomas. Analysis of the undifferentiated group showed an average survival time of only 4.7 months, and no patient lived as long as a year following the initiation of x-ray therapy. The squamous-cell group, comprising 18 patients, had an average survival time of 11.4 months at the time of the report, and 53 per cent of the patients had lived over one year.

The probability of long-term persistence of a population is strongly determined by adult survival rates, but estimates of survival are currently lacking for most species of birds in the tropical Andes, a global biodiversity hotspot. We calculated apparent survival rates of birds in the Ecuadorian tropical Andes using a moderately long-term (11 yr) capture–recapture dataset from three habitats that varied in how much they had been modified by human activities (native forest, introduced forest, and shrubs). We fit mark–recapture models for 28 species with habitat as a covariable. For all species, recapture rates between sampling sessions were low and varied from 0.04 for Rainbow Starfrontlets (Coeligena iris) to 0.41 for Stripe-headed Brushfinches (Arremon assimilis) when averaged across all occupied habitats. Annual survival rates varied from 0.07 for Black-crested Warblers (Margarornis squamiger) to 0.75 for Violet-throated Metaltails (Metallura baroni). We found no significant differences in survival rates either among habitats or species grouped by habitat specialization. Because we found similar survival rates in native forest and human-modified habitats, our results support those of recent studies concerning the potential value of secondary habitats for the conservation of some species of birds in the tropics. However, our conclusions are tempered by the uncertainty around the estimates of survival rates. Despite the relatively long-term nature of our study, obtaining survival estimates for bird species in this region was challenging, and either more years of study or modification of field protocols may be needed to obtain more precise survival estimates. Estimaciones de supervivencia de especies de aves a través de habitas alterados en los Andes tropicales La probabilidad de la persistencia a largo plazo de una población esta fuertemente determinada por las tasas de supervivencia de los adultos, sin embargo hacen falta las estimaciones de supervivencia para la mayoría de las especie de aves en los Andes tropicales, un hotspot de biodiversidad global. Calculamos las tasas de supervivencia aparente de aves en los Andes tropicales Ecuatorianos usando una base de datos de marca y recaptura de moderado largo plazo (11 años) en tres hábitats que variaron en el nivel de transformación por actividades humanas (bosque nativo, bosque introducido y matorral). Ajustamos modelos de marca recaptura para 28 especies con el hábitat como una co-variable. Para todas las especies, las tasas de recaptura entre sesiones de muestreo fue baja y vario entre 0.04 en Coeligena iris y 0.41 en Arremon assimilis luego de promediar a través de los hábitats. Las tasas de supervivencia anual variaron entre 0.07 en Margarornis squamiger y 0.75 en Metallura baroni. No encontramos diferencias significativas en las tasas de supervivencia ni entre hábitats o entre especies agrupadas por especialización del hábitat. Debido a que encontramos tasas de supervivencia similares en bosque nativo y hábitats modificados por el hombre, nuestros resultados apoyan estudios recientes relacionados con el valor potencial de hábitats secundarios para la conservación de algunas especies de aves en los trópicos. Sin embargo, nuestras conclusiones son limitadas por la incertidumbre alrededor de las estimaciones de las tasas de supervivencia. A pesar de la naturaleza de largo plazo de nuestro estudio, obtener estimaciones de supervivencia para especies de aves en esta región es un reto y se requiere un mayor numero de años de estudio o una modificación en los protocolos de campo para obtener estimados de supervivencia mas precisos. Table S1. Recapture histories of 28 birds captured in Cajas National Park and Mazan private reserve, south Ecuador, from 2006 to 2016. Table S2. Apparent survival estimates for 28 species of birds with apparent survival (ϕ) and recapture probability (P) estimated separately for each habitat. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

While an increasing number of studies are adopting molecular and chemical methods for dietary characterization, these studies often employ only one of these laboratory-based techniques; this approach may yield an incomplete, or even biased, understanding of diet due to each method's inherent limitations. To explore the utility of coupling molecular and chemical techniques for dietary characterizations, we applied DNA metabarcoding alongside stable isotope analysis to characterize the dietary niche of breeding Louisiana waterthrush (Parkesia motacilla), a migratory songbird hypothesized to preferentially provision its offspring with pollution-intolerant, aquatic arthropod prey. While DNA metabarcoding was unable to determine if waterthrush provision aquatic and terrestrial prey in different abundances, we found that specific aquatic taxa were more likely to be detected in successive seasons than their terrestrial counterparts, thus supporting the aquatic specialization hypothesis. Our isotopic analysis added greater context to this hypothesis by concluding that breeding waterthrush provisioned Ephemeroptera and Plecoptera, two pollution-intolerant, aquatic orders, in higher quantities than other prey groups, and expanded their functional trophic niche when such prey were not abundantly provisioned. Finally, we found that the dietary characterizations from each approach were often uncorrelated, indicating that the results gleaned from a diet study can be particularly sensitive to the applied methodologies. Our findings contribute to a growing body of work indicating the importance of high-quality, aquatic habitats for both consumers and their pollution-intolerant prey, while also demonstrating how the application of multiple, laboratory-based techniques can provide insights not offered by either technique alone.

Physicians can personally search MEDLINE to answer clinical questions or to update their knowledge base. The components required, each of which is discussed in the text, are a personal computer, a communications software program, a modem, the literature database, and an information vendor. Physicians can assemble and use these components with a minimum of expense and computer knowledge. For the novice searcher who does not want to make a large initial investment, obtaining a low-cost personal computer and using an information vendor such as GRATEFUL MED or PaperChase may be the most suitable alternative. For searchers without access to a medical library or for more experienced searchers, an information vendor such as BRS, MEDIS, or DIALOG may be more appropriate.

This chapter examines a suite of contemporary technologies used to deliver instruction – initially in a traditional classroom environment, and, most recently, in a virtual home-bound setting. Most readers were likely introduced to these tools well before the advent of the 2020-2022 COVID-19 pandemic. However, for these particular technologies, the demand for remote distance learning, student-centered instruction, and online delivery most certainly impacted the manner in which they were temporarily adopted or permanently infused into the curriculum. And, for most of these technologies, their continued use in both traditional and untraditional ways continues even now that the pandemic is behind us. The top twelve technologies explored in this chapter most certainly had their beginnings prior to the pandemic years. Yet, they were suddenly and without warning reinforced during the challenges of teaching from 2020-2022. Still, each technology has found its broadest application once students were welcomed back into the post-pandemic classroom. The examinations that follow begin with a description of each technology, its primary features, advantages and disadvantages, and additional resources that promoted its use before the pandemic reached critical mass forcing students and teachers alike to abandon the traditional classroom. This familiarization is followed by how each technology was integrated by sometimes hesitant faculty into the routine delivery of instruction when students were forced to remain at home for the better part of two years. Finally, with the pandemic now behind us, the chapter discusses ways in which faculty might continue to use these technologies to better deliver individualized instruction even in a predominantly traditional, face-to-face classroom.

As the pace of environmental change increases, there is an urgent need for quantitative data revealing the temporal dynamics of local communities in tropical areas. Here, we quantify the stability of avian assemblages in the highly threatened, but poorly studied, Andean biodiversity hot spot. We evaluated the temporal variation in species richness and community composition of local bird assemblages in three habitat types (native forest, introduced forest, native shrub) using a unique, relatively long-term data series from Cajas National Park and Mazán Reserve in the southern Andes of Ecuador. We sampled birds with mist nets using a standardized protocol over 11 years, from 2006 to 2016. Species richness remained stable over time across habitats, but community composition changed in the native forest. In particular, we observed taxonomic reordering in the native forest, in which the evenness in the distribution of abundances of taxa decreased over time. This finding is consistent with other studies where species richness remained constant over time while community composition changed. Our study highlights the value of long-term studies in the tropical Andes as we show that species composition of birds in a montane forest is changing, consistent with global trends in biodiversity change.

A NEW INSTRUMENT: CONTROLLABLE GUIDE FOR ANGIOGRAPHYMARK H. WHOLEY, M.D. and VICTOR JACKMANAudio Available | Share

Renal cell carcinoma (RCC) is known to be more prevalent in autosomal dominant polycystic kidney disease (ADPKD) patients than in the general population. However, little is known about genetic alterations or changes in signaling pathways in RCC in patients with ADPKD.In the current report, whole-exome and transcriptome sequencing was performed for paired samples of tumor tissue, cyst tissue, and peripheral blood (triple set) from a patient diagnosed with ADPKD and RCC.A 68-year-old man with ADPKD underwent left partial nephrectomy and was diagnosed with RCC. DNA and RNA were extracted from the triple set of the patient. A nonsense mutation in PKD2 (p.Arg742X), which is well known as a pathogenic variant in ADPKD, was identified in the paired triple set. In the tumor sample, a somatic missense mutation of VHL (p.S65L) was found, which is known as a pathogenic mutation in Von Hippel-Lindau syndrome and RCC. Furthermore, loss of chromosome 3p, where VHL is located, was detected. Upregulated VEGFA was found in the analysis of RCC mRNA, which might be caused by the loss of VHL and accelerate angiogenesis in RCC.Proliferation was also expected to be activated by the MAPK signaling pathway, including NRAS and MAPK1 expression.

El ecosistema de páramo alberga una alta concentración de especies de aves de rango restringido y amenazadas. Sin embargo, las modificaciones humanas al paisaje altoandino han generado pérdida y fragmentación de hábitat en todo este ecosistema. Por lo tanto, las áreas protegidas en esta región son prioritarias para la conservación de la biodiversidad. Las zonas de amortiguamiento en los alrededores de las áreas protegidas tienen por objeto reducir las perturbaciones en éstas; sin embargo, no están exentas de fuentes de estrés. La abundancia y la diversidad de aves, registradas en transectas, se usó para comparar la composición de la comunidad entre áreas protegidas y zonas de amortiguamiento en un hotspot de diversidad y endemismo: la Reserva de la Biósfera del Macizo del Cajas, en los altos Andes del sur del Ecuador. La comunidad de aves no varió en su composición entre las áreas protegidas y las zonas de amortiguamiento. No obstante, las características del hábitat sí explicaron diferencias en la presencia y abundancia de grupos tróficos. En particular, el incremento en la heterogeneidad del páramo, con mayor cobertura de plantas leñosas y menos intervención, explicó una mayor presencia y abundancia de gremios tróficos especializados, tales como nectarívoros en arbustos e insectívoros aéreos en árboles y arbustos. En conclusión, hay hábitats heterogéneos de páramo, en zonas de amortiguamiento, que deben considerarse en una planificación de conservación más formal para mantener la diversidad de aves especialistas y, por lo tanto, la funcionalidad del ecosistema de páramo herbáceo.

BACKGROUND: Depression is one of the most commonly diagnosed and persistent psychiatric disorders among women. Women survivors of the suicide of their significant other and women survivors of abuse appear to be two groups who might likely experience depression. However, little research has been done to identify the psychological implications of both situations. OBJECTIVE: The study sought to compare psychological implications, specifically depression and behavioral manifestations of depression, among female survivors of the suicide of their significant other and female survivors of abuse. STUDY DESIGN: A descriptive cohort design was used. The Beck Depression Inventory (BDI) was used to measure the presence and behavioral manifestations of depression. RESULTS: The two groups of women did not differ in their overall level of depression. Both groups were moderately to severely depressed. Differences on three BDI items were found: sadness, irritability, and social withdrawal. CONCLUSIONS: Researchers have only just begun to explore and report information with respect to women’s health in relation to abuse and bereavement. The presence of depression and behavioral manifestations of depression in these two groups of women (survivors of the suicide of their significant other and survivors of abuse) needs to be examined further. Subsequently, psychiatric mental-health interventions may be developed that will impact the outcomes for both groups.

Although recent mainstream waveform-domain end-to-end (E2E) neural audio codecs achieve impressive coded audio quality with a very low bitrate, the quality gap between the coded and natural audio is still significant. A generative adversarial network (GAN) training is usually required for these E2E neural codecs because of the difficulty of direct phase modeling. However, such adversarial learning hinders these codecs from preserving the original phase information. To achieve human-level naturalness with a reasonable bitrate, preserve the original phase, and get rid of the tricky and opaque GAN training, we develop a score-based diffusion post-filter (SPF) in the complex spectral domain and combine our previous AudioDec with the SPF to propose ScoreDec, which can be trained using only spectral and score-matching losses. Both the objective and subjective experimental results show that ScoreDec with a 24 kbps bitrate encodes and decodes full-band 48 kHz speech with human-level naturalness and well-preserved phase information.

At the present time most injectors are calibrated in pounds per square inch or kilograms per square centimetre and the flow rate is determined accoringly. Nomographs for flow rate conversion are availabe but in actual practice are not used routinely. Unfortunately, in the absence of controlled flow, variations will occur according to several factors including catheter material, length, internal diameter, number and size of side holes, open or closed ends, size of adaptors and contrast media temperature and viscosity.