Comparative testing for weak expression of D antigen: manual tube testing vs. a semiautomated IgG gel system.

Donor RBCs nonreactive in initial tests for D must be tested further for evidence of weak expression of D antigen. Performing this test in test tubes is labor intensive and prone to inconsistencies in readings (relative strength of agglutination) and interpretation (positive versus negative). These inconsistencies can lead to repeat testing, additional documentation, and delay in releasing units. We evaluated use of the Tecan MEGAFlex-ID pipettor to perform this test in anti-IgG gel cards. Results with this semi-automated gel test were compared with results obtained with 37 D- and 99 weak D samples, as determined by previous testing with a manual IAT tube test. Hands-on time was determined for both methods and both methods were evaluated for inconsistency, or nonagreement, between the interpretation of the current weak D test and the results on record for any prior donations. There were no discordant results obtained, with the majority of weak D samples giving stronger reactions with the gel test. The semiautomated gel test required less hands-on time, with an average savings of more than 70 seconds per test. There were no inconsistencies with the gel method, whereas manual tube testing was found to have an inconsistency rate of 0.035 percent of total samples tested. Semiautomated IgG gel is now used for all weak D testing, with a labor savings of more than 10 hours per week. Thus far, more than 70,000 donors have been tested, with no inconsistencies reported.

Nuclear multifragmentation, percolation, and the fisher droplet model: common features of reducibility and thermal scaling

It is shown that the Fisher droplet model, percolation, and nuclear multifragmentation share the common features of reducibility (stochasticity in multiplicity distributions) and thermal scaling (one-fragment production probabilities are Boltzmann factors). Barriers obtained, for cluster production on percolation lattices, from the Boltzmann factors show a power-law dependence on cluster size with an exponent of 0.42+/-0.02. The EOS Collaboration Au multifragmentation data yield barriers with a power-law exponent of 0.68+/-0.03. Values of the surface energy coefficient of a low density nuclear system are also extracted.

Production of neutrons from interactions of GCR-like particles.

In order to help assess the risk to astronauts due to the long-term exposure to the natural radiation environment in space, an understanding of how the primary radiation field is changed when passing through shielding and tissue materials must be obtained. One important aspect of the change in the primary radiation field after passing through shielding materials is the production of secondary particles from the breakup of the primary. Neutrons are an important component of the secondary particle field due to their relatively high biological weighting factors, and due to their relative abundance, especially behind thick shielding scenarios. Because of the complexity of the problem, the estimation of the risk from exposure to the secondary neutron field must be handled using calculational techniques. However, those calculations will need an extensive set of neutron cross section and thicktarget neutron yield data in order to make an accurate assessment of the risk. In this paper we briefly survey the existing neutron-production data sets that are applicable to the space radiation transport problem, and we point out how neutron production from protons is different than neutron production from heavy ions. We also make comparisons of one the heavy-ion data sets with Boltzmann-Uehling-Uhlenbeck (BUU) calculations.

Neutron yields from 435 MeV/nucleon Nb stopping in Nb and 272 MeV/nucleon Nb stopping in Nb and Al.

Neutron fluences were measured from 435 MeV/nucleon Nb ions stopping in a Nb target and 272 MeV/nucleon Nb ions stopping in targets of Nb and Al for neutrons above 20 MeV and at laboratory angles between 3 degrees and 80 degrees. The resultant spectra were integrated over angles to produce neutron energy distributions and over energy to produce neutron angular distributions. The total neutron yields for each system were obtained by integrating over the angular distributions. The angular distributions from all three systems are peaked forward, and the energy distributions from all three systems show an appreciable yield of neutrons with velocities greater than the beam velocity. Comparison of the total neutron yields from the two Nb + Nb systems suggests that the average neutron multiplicity decreases with decreasing projectile energy. Comparison of the total yields from the two 272 MeV/nucleon systems suggests that the total yields show the same dependence on projectile and target mass number as do total inclusive neutron cross sections. The data are compared with Boltzmann-Uehling-Uhlenbeck model calculations.

Postoperative factors contributing to prolonged length of stay in cardiac surgery patients.

In order to provide high quality, cost effective care, nurses need to identify and address factors that prolong the length of stay in various patient populations. The authors identify the postoperative factors contributing to prolonged length of stay in a cardiac surgery patient population and recommend collaborative management strategies to address these factors.

The delivery room resuscitation of the hydropic neonate.

Hydrops fetalis is a relatively rare disorder that will be encountered occasionally in all obstetric centers. The prognosis for infants with hydrops fetalis is poor, with mortality reported in the range of 50% to 98%. The effectiveness of delivery room resuscitation and the ability to achieve early adequate gas exchange in affected infants may be related to survival. Successful resuscitation requires an understanding of transitional neonatal physiology and the potential impact of hydrops fetalis, an experienced and well-prepared resuscitation team, meticulous attention to technical aspects of resuscitation, and careful assessment and monitoring of the infant during resuscitation.

Inversion (X)(p11.4q22) associated with Norrie disease in a four generation family.

We report on a 4-generation family in which Norrie disease occurs together with a pericentric inversion of the X chromosome in all affected males and carrier females. The breakpoint in the short arm of the X chromosome appears to be at the purported location of the Norrie disease gene. This is the second report of an association between Norrie disease and a chromosome aberration involving Xp11, and the first report of a specific gene disruption, thus physical gene location, due to a pericentric chromosome inversion.

Ontogeny of surfactant proteins A and B in human amniotic fluid as indices of fetal lung maturity.

Surfactant proteins A and B (SP-A and SP-B) were measured in human amniotic fluid by ELISA and correlated with lecithin to sphingomyelin ratio (L/S), phosphatidylglycerol (PG), and perinatal outcome. Amniotic fluid SP-A, SP-B, and L/S increased with advancing gestation. SP-A was detected at 19 wk gestation and increased dramatically in the 3rd trimester of pregnancy. SP-B was first detectable at 31 wk gestation and increased significantly to term. SP-A was a more specific predictor of nonrespiratory distress syndrome (RDS) than L/S or SP-B; however, the sensitivity of SP-A in predicting RDS was less than L/S less than 2.0 (26.3 versus 82.3%, respectively). In 209 pregnancies assessed within 48 h of delivery, the sensitivity of SP-B in predicting RDS (nondetectable SP-B) was comparable to the L/S, however, SP-B = 0 was frequently observed in mature infants, limiting its specificity for prediction of RDS. The greatest sensitivity and specificity were achieved with the measurement of L/S less than 2.0 and negative PG, which correctly predicted 100% of the infants with RDS and 94% of those who did not develop the disorder. Measurement of SP-A or SP-B did not improve the prediction of RDS. SP-A, SP-B, and L/S were not affected by infant sex, Apgar score, rupture of membranes, size for gestational age, maternal diabetes, hypertension, or exposure to medications. SP-A, SP-B, and L/S were significantly elevated in amniotic fluid from black mothers. SP-A was significantly elevated in amniotic fluid from mothers who smoked during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

A portion of the human surfactant protein A (SP-A) gene locus consists of a pseudogene.

SP-A is the most abundant, surfactant-associated protein isolated from lung lavage. Genomic blot analysis of total human cellular DNA with SP-A cDNA demonstrated the presence of multiple hybridizing fragments that are not accounted for by available SP-A gene sequences. In this report, we have cloned and characterized human genomic DNA fragments that account for some of the other hybridizing fragments. These clones contain nucleotide sequences that are highly homologous to the fourth intron and fifth exon of the human SP-A gene. Sequences upstream from these SP-A-like sequences are not detectable by Northern blot hybridization of SP-A-expressing cells and the SP-A-like sequences contain premature stop codons, consistent with the interpretation that these clones represent an SP-A pseudogene. Restriction fragments consistent with this pseudogene and the functional SP-A gene are present in a human chromosome 10 genomic library made from a single chromosome, showing that the functional SP-A gene and the pseudogene are syntenic.

Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study.

To evaluate the consistency, strength, and independence of the relation of carotid atherosclerosis to coronary atherosclerosis, we quantified coronary artery disease risk factors and extent of carotid atherosclerosis (B-mode score) in 343 coronary artery disease patients and 167 disease-free control patients. In univariable analyses, there was a strong association between coronary status and extent of carotid artery disease in men and women older than and younger than 50 years (p less than 0.001 for men and women greater than 50 years, p less than 0.001 for women less than or equal to 50 years, p = 0.045 for men less than or equal to 50). The relation remained strong after control for age in men and women older than 50 years and in women younger than 50 (p less than 0.001 for men and women greater than 50 years, p = 0.003 for women less than or equal to 50) but did not persist after control for age in men younger than 50. Logistic models that included coronary disease risk factors, with or without B-mode score, as independent variables and presence or absence of coronary disease as the outcome variable indicated that the extent of carotid atherosclerosis was a strong, statistically significant independent variable in models for men and women older than 50 years of age. Next, we examined the usefulness of B-mode score as an aid in screening for coronary artery disease in men and women older than 50 years. Classification rules, both including and excluding B-mode score, were developed based on logistic regression and, for comparison, recursive partitioning (decision trees). The performance of these rules and the bias of their performance statistics were estimated. The improved classification of the study sample when B-mode score was incorporated in the rule was statistically significant only for men (p = 0.015). However, the addition of B-mode score was found to 1) increase the median discrimination score for both sex groups based on the logistic model, and 2) yield better sensitivities and specificities for rules based on recursive partitioning. Thus B-mode score is strongly, consistently, and independently associated with coronary artery disease in patients older than 50 and is at least as useful as well-known risk factors for identifying patients with coronary artery disease.

Restriction fragment polymorphism of the cynomolgus monkey major histocompatibility complex.

Among old world monkeys, the major histocompatibility complex (MHC) is defined only in the rhesus (Macaca mulatta), cynomolgus (Macaca fascicularis) and pigtailed (Macaca nemistrina) species. However, little is known about the organization of class I and class II MHC genes or the extent of polymorphism in macaques. In the present study, human and murine class I and class II gene probes were used to analyze the leukocyte antigen (CyLA) system of unrelated and related cynomolgus monkeys. Restriction fragment length polymorphism (RFLP) analysis with a HLA-B7 cDNA probe supports the serologic evidence indicating the existence of a family of class I loci of which several are highly polymorphic. As in the human MHC, the class II beta genes are more polymorphic than class II alpha genes. In a pedigree study, RFLP patterns correlated with CyLA haplotypes as deduced from CyLA-A,B,C and complement factor B(Bf) phenotypes. The RFLP data are consistent with three expressed class I gene loci as well as nonclassical MHC genes potentially related to Qa/T1a in mice. We conclude that the RFLP analysis with cross-hybridizing DNA probes augments the information obtained by serotyping and sets the stage for gene mapping and structural analysis of the CyLA region.

Hyaline membrane disease and surfactant protein, SAP-35, in diabetes in pregnancy.

Surfactant-associated protein of Mr 28,000 to 35,000 (SAP-35) is an abundant glycoprotein present in the alveolus of the lung, which imparts both structural organization to surfactant phospholipids and provides regulatory information controlling surfactant phospholipid secretion and metabolism. SAP-35 expression is enhanced by 3'-5'-cyclic adenosine monophosphate and epidermal growth factor during perinatal differentiation of type II epithelial cells. Its synthesis and RNA are also controlled by a variety of inhibitory factors, which include transforming growth factor and insulin. Glucocorticoids both enhance and inhibit SAP-35 expression in fetal lung explants. There is evidence that fetal hyperinsulinemia or hyperglycemia, or both, inhibit the morphologic differentiation of the type II epithelial cell in association with decreased phospholipid surfactant synthesis or secretion. Insulin is also a potent inhibitor of SAP-35 expression in fetal lung tissue, and decreased SAP-35 was previously noted in amniotic fluid of patients with diabetes during pregnancy. Recent progress in the management of diabetes in pregnancy, characterized by more rigorous metabolic control, has decreased the risk of hyaline membrane disease for the infant of the diabetic mother and is associated with normal levels of SAP-35 in amniotic fluid. Hyaline membrane disease remains a major cause of morbidity in infants of diabetic mothers but may also reflect a higher incidence of premature delivery, cesarean section, and asphyxia at delivery as well as inhibition of pulmonary surfactant phospholipid synthesis or expression of the surfactant protein SAP-35.

Risk factors for extracranial carotid artery atherosclerosis.

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B-mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women. Multivariate analysis identified 6 significant variables (age, hypertension, pack-years smoked, and inversely, plasma concentrations of high density lipoprotein cholesterol and uric acid, and Framingham Type A score) that together accounted for 35% of the variability in extent of carotid atherosclerosis. In a second multivariate analysis, addition of coronary status (presence or absence of coronary stenosis as evaluated by coronary angiography) to the roster of candidate independent variables produced a new equation that accounted for an additional 5% of the variability in carotid atherosclerosis extent. Although much of the variability in extent of carotid atherosclerosis remains unexplained, these data define an association between coronary and carotid atherosclerosis that depends partly on shared exposure of both arteries to the same risk factors. They are also consistent with the concept that as yet undiscovered risk factors and/or genetic (e.g., arterial wall) factors common to both arterial beds also contribute to the relation between coronary and carotid atherosclerosis in human beings.