Coupled Flow-Structure-Biochemistry Simulations of Dynamic Systems of Blood Cells Using an Adaptive Surface Tracking Method.

A method for the computation of low Reynolds number dynamic blood cell systems is presented. The specific system of interest here is interaction between cancer cells and white blood cells in an experimental flow system. Fluid dynamics, structural mechanics, six-degree-of freedom motion control and surface biochemistry analysis components are coupled in the context of adaptive octree-based grid generation. Analytical and numerical verification of the quasi-steady assumption for the fluid mechanics is presented. The capabilities of the technique are demonstrated by presenting several three-dimensional cell system simulations, including the collision/interaction between a cancer cell and an endothelium adherent polymorphonuclear leukocyte (PMN) cell in a shear flow.

Transvenous echo Doppler in baboons: a new window to the cardiovascular system.

Ultrasound examinations of the heart and major peripheral arteries have been performed as separate procedures; both potentially limited by suboptimal views in certain subjects and the inability to obtain ideal pictures of particular intracardiac structures. Transvenous ultrasound may offer new advantages in certain areas, we therefore studied six adult baboons using a single-plane 5.5-10 MHz transducer mounted on a 10 French (10F) catheter, introduced via the right femoral vein and positioned under fluoroscopic control. Imaging and Doppler studies were performed to delineate cardiovascular anatomy as well as ventricular function response to positive (dobutamine) and negative inotropic (esmolol) agents. The procedure was safe and feasible in all cases. Clear and novel two-dimensional and flow information were obtained from the iliac arteries, descending aorta, both renal artery origins, ascending aorta, including the aortic arch, main pulmonary artery and its bifurcation, as well as head and neck vessels. Novel intracardiac views were obtained, including right ventricular long axis, left ventricular apex and 'flask' views of the left ventricle. Excellent dynamic information for left ventricular function was also available [e.g. myocardial Vmax of the anterior left ventricular wall was 6.8+/-2.5 cm/s at rest, 14.6+/-5.5 cm/s after dobutamine (P=0.009) and 4.5+/-1 cm/s after esmolol (P=0.03 compared with control)]. We conclude that, in adult primates, transvenous ultrasound safely and reliably provides novel information of cardiovascular structure and function.

The quality of medical evidence in hematology-oncology.

PURPOSE: The purpose of this study was to evaluate the quality of the medical evidence available to the clinician in the practice of hematology/oncology. METHODS: We selected 14 neoplastic hematologic disorders and identified 154 clinically important patient management decision/interventions, ranging from initial treatment decisions to those made for the treatment of recurrent or refractory disease. We also performed a search of the scientific literature for the years 1966 through 1996 to identify all randomized controlled trials in hematology/oncology. RESULTS: We identified 783 randomized controlled trials (level 1 evidence) pertaining to 37 (24%) of the decision/interventions. An additional 32 (21%) of the decision/interventions were supported by evidence from single arm prospective studies (level 2 evidence). However, only retrospective or anecdotal evidence (level 3 evidence) was available to support 55% of the identified decision/interventions. In a retrospective review of the decision/interventions made in the management of 255 consecutive patients, 78% of the initial decision/interventions in the management of newly diagnosed hematologic/oncologic disorders could have been based on level 1 evidence. However, more than half (52%) of all the decision/interventions made in the management of these 255 patients were supported only by level 2 or 3 evidence. CONCLUSIONS: We conclude that level 1 evidence to support the development of practice guidelines is available primarily for initial decision/interventions of newly diagnosed diseases. Level 1 evidence to develop guidelines for the management of relapsed or refractory malignant diseases is currently lacking.

Women's lived experience of conceptualizing the self: implications for health care practice.

In this article we describe a unique qualitative research design in which we used our own lived experiences as the basis for understanding theories of the self. Our purpose in this study was to (a) broaden current understandings of self theory, (b) juxtapose theories of the self with lived experiences of selfhood, and (c) use these new understandings to inform health care practice. The participants were four Canadian middle-aged female academic and health care practitioners. We conducted unstructured, open-ended interviews. Through a collaborative, interpretive process, four recurring themes emerged from the women's narratives: struggling for authenticity, inner knowing, changing over time, and the contextual self. We address the need for practitioners to understand theories of the self--their own and their clients--and how these theories impact their clinical practice.

Transforming our vision: emancipatory career planning for nurses.

Canadian nurses are experiencing profound and often disturbing changes in the health care sector. Not only have the number of jobs decreased but the nature and expectations of those jobs are changing dramatically. While these changes have raised nurses' anxiety, the changes simultaneously have presented nurses with an opportunity to transform their vision of nursing and their role in health care. This article describes a career planning pilot project for nurses which employed Freire's model of emancipatory learning. Based on the theoretical foundations of narrative psychology and critical social theory a series of four workshops were offered. Comments from the evaluation results indicate that the workshop was a transformative experience for the participants. Future implications for career planning for nurses are discussed.

Cloning and characterisation of the Schizosaccharomyces pombe rad8 gene, a member of the SNF2 helicase family.

The Schizosaccharomyces pombe rad8 mutant is sensitive to both UV and gamma irradiation. We have cloned the rad8 gene by complementation of the UV sensitivity of a rad8.190 mutant strain. The gene comprises an open reading frame of 3.4 kb which does not contain any introns and is capable of encoding a 1133 amino acid protein of 129 kDa. Deletion of the gene indicates that it is not essential for cell viability. Recognisable motifs are present for a nuclear localisation signal, a RING finger and helicase domains. The predicted protein is a member of the SNF2 subfamily of proteins and shows particular homology to the Saccharomyces cerevisiae RAD5 protein. Double mutant analysis demonstrated that the rad8 mutant is not epistatic to mutants in the excision repair pathway (rad13) or checkpoint pathway (rad9). Analysis of radiation sensitivity though the cell cycle indicates that, unlike most other rad mutants, rad8 is most sensitive to irradiation during the G1/S period.

Mitral valve repair using a flexible and adjustable annuloplasty ring.

Initial experience with a new flexible and adjustable mitral annuloplasty ring is described. Used in conjunction with standard techniques of mitral valve repair, this ring was implanted in 21 consecutive patients undergoing elective operation for mitral regurgitation. Satisfactory valve repair was feasible in 20 of these patients. Once the ring was sewn in place, adjustment of the ring to reduce or eliminate residual regurgitation was beneficial in 9 patients. Excellent results were achieved as determined by intraoperative transesophageal echocardiography. Comparable late results were found in all but 1 patient up to 1 year after repair. This patient required mitral valve replacement 6 months after repair due to failure of papillary muscle reconstruction. The BiFlex ring has the merits of a flexible prosthesis with the advantage of easy adjustment once secured in place.

Risk analysis of operative intervention for failed coronary angioplasty.

To assess the outcome of emergency coronary artery bypass grafting (CABG) after failed percutaneous transluminal coronary angioplasty (PTCA), 91 patients undergoing emergency CABG after failed PTCA over a 30-month period ending July 31, 1991, were studied. For reference, a cohort of patients (91) concurrently undergoing elective CABG equally matched for age, sex, number of grafts, ventricular function, and reoperative status was compared. Specific outcomes including death, hospital length of stay, use of blood products, and development of myocardial infarction were analyzed. More than half the patients undergoing emergency CABG for failed PTCA required three or more grafts. Operative mortality was 12.1% (11/99) for emergency CABG compared with 1% (1/91) for elective case-matched CABG patients (p = 0.007). Emergency CABG patients required frequent use of postoperative inotropes (p = 0.02) and intraaortic balloon counterpulsation (p = 0.001). Length of hospital stay (p = 0.005), administration of blood products (p = 0.009), postoperative myocardial infarction (p = 0.0005), and ventricular arrhythmias (p = 0.0004) were increased after emergency compared with elective CABG. The presence of multivessel disease or use of a reperfusion catheter had no influence on clinical outcome. Despite accumulated experience and improved operative management, patients requiring emergency CABG for failed PTCA remain at increased risk for postoperative complications and death.

'Sabre sheath' trachea with mediastinal lipomatosis mimicking a mediastinal tumour.

Two cases of 'sabre sheath' trachea in combination with mediastinal lipomatosis are reported. The initial chest radiographs in both cases were interpreted as showing a mediastinal tumour causing tracheal compression. The correct diagnosis was subsequently made using computed tomography (CT). It is important to be aware of these benign conditions when interpreting chest radiographs, particularly in cases of suspected mediastinal pathology.

Sampling time effects in the ACT device.

The signal-dependent sampling process in an acoustic charge transport (ACT) device is demonstrated. Theoretical calculations and experimental measurements show the direct effect of gate voltage, wave amplitude, and transport depth on the sampling interval. A decrease in gate voltage and transport depth, and an increase in wave amplitude, are shown to reduce the increase in sampling time delay for a fixed transport current. An analysis of the distortion generated by this nonuniform sampling is performed, and a channel-current-intercept value is computed for a typical ACT device.

The guide-eye ureteral access system.

Equipping ureteral instruments with the guide-eye feature has expanded the instrumentation options available to urologists. The guide-eye facilitates repetitive instrument access, allows coordinated instrument combinations, and enhances sequential placement of a series of instruments. We believe this concept increases the safety and efficacy of our present instruments and clearly encourages innovative designs for the future.

Direct amino acid analyses of mozzarella cheese.

The amino acid content of mozzarella (low moisture, part skim milk) and asadero cheeses was determined by the column chromatographic method. Data from the direct analyses of the mozzarella cheeses were compared with the calculated amino acid composition reported in tables in Agriculture Handbook No. 8-1. Phenylalanine and tyrosine contents were found to be higher in the direct analyses than in the calculated data in Handbook No. 8-1 (1.390 gm and 1.127 gm for phenylalanine, and 1.493 gm and 1.249 gm for tyrosine per 100 gm edible portion, respectively). That is of particular concern in the dietary management of phenylketonuria, in which accuracy in computing levels of phenylalanine and tyrosine is essential.

Metabolism of arachidonic acid by macaque platelets. Implications for studies on atherosclerosis.

The metabolism of [1-14C]arachidonic acid [( 1-14C]AA) by washed platelets from macaques and human subjects was investigated. The results were as follows: At substrate levels of 1 microM, similar amounts of prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), prostaglandin D2 (PGD2), and thromboxane A2 (TXA2), measured as thromboxane B2 (TXB2), were produced from [1-14C]AA by platelets from rhesus, Celebes black, and cynomolgus macaques and humans. An increase in the AA concentration from 1 microM to 20 microM decreased the TXB2: PGD2 ratio (aggregator: antiaggregator) from greater than 5 to less than 2 in all series. In the human series, the ratio decrease was due to an increase in PGD2 production; in the macaque series, PGD2 production increased and TXB2 production decreased. Under basal conditions and at 1 microM AA concentrations, the amounts of prostaglandins and thromboxanes produced by platelets from male and female rhesus macaques were the same. An increase in substrate concentration from 1 microM to 20 microM AA decreased TXB2 production and increased PGD2 production to the same extent in platelets from male and female rhesus macaques. Imidazole increased prostaglandin production and decreased TXB2 production by platelets from both male and female rhesus macaques. The TXB2: PGD2 ratios were reduced below 1.5; there was no difference between the ratios in the two series. In the presence of 1 mM imidazole, greater amounts of prostaglandins and thromboxanes were produced in the male than in the female series. These data indicate that macaque's platelets are a suitable model for the study of AA metabolism in human platelets.

A double-blind trial of patient-controlled nitrous-oxide/oxygen analgesia in myocardial infarction.

The analgesic effect of self-administered nitrous oxide 50%/oxygen 50% ('Entonox" analgesic apparatus) was compared with air given by the same method in a double-blind trial in 81 patients with myocardial infarction. Self-administered nitrous oxide/oxygen, which was associated with a low frequency of side-effects, proved significantly more effective than air in the early relief of severe cardiac pain, but not in the relief of moderate or slight pain or when administration was continued after ten minutes.