Predicting the efficacy of convection warming in anaesthetized children.

BACKGROUND: We previously described a convection warming technique (Cassey J, Armstrong P, Smith GE, Farrell PT. Paediatr Anaesth 2006; 16: 654-62). This study further analyses the children in that original study with three aims: (i) to investigate factors purported to influence children's heating rates, (ii) to describe the most effective usage of this warming technique, and (iii) to understand better the physiology of convection warming. METHODS: Children having anaesthesia for elective surgery lasting longer than 90 min in ambient temperature 21 degrees C were warmed by a 'Bair Hugger' attached to a custom-built heat dissipation unit. Relationships between child and procedure characteristics and various thermal measures were analysed, and a thermodynamic model was evaluated. RESULTS: Thirty-nine children (aged 2 days to 12.5 yr) were studied. There were statistically significant correlations between a number of factors (e.g. height and weight) and heating efficacy. Our model demonstrated the impact of changing patient characteristics on temperature profiles. Neither the morphological characteristics nor our model could predict an individual's T(core) behaviour. CONCLUSIONS: (i) Although the effectiveness of this warming technique is influenced by patient/procedure characteristics, these do not predict normothermia (uncertainty +/-28 min). Effectiveness is independent of simple thermal measures. (ii) Previously described measures of vasoconstriction are not valid in children. (iii) Our model shows children's thermal properties change with their T(core). However, key factors are unknown for an individual and our model does not predict heating efficacy. (iv) To minimize the risk of hyperthermia, we recommend continuous measurement of T(core) during convection heating. The device air temperature should be turned to medium (38 degrees C) as T(core) approaches 37 degrees C.

Case presentation of a substance-abusing borderline patient. Illustrating use of the immediate transactional experience.

This paper presents a severely disturbed self-mutilating person with a chronic substance abuse history. It demonstrates how use of the immediate transactional experience is an analytic model, facilitated treatment. The authentic use of the therapist's self is endorsed as mutative in facilitating personality change in the patient. Fellow professionals are encouraged to respond to this paper in the service of fruitful analytic dialogue, in the service of promoting more effective treatment of this difficult population in equally difficult times.

BCL6 encodes a sequence-specific DNA-binding protein.

Chromosomal rearrangements of BCL6 are commonly associated with diffuse large-cell lymphomas. We set out to determine the DNA-binding site of a glutathione-S-transferase fusion protein containing the BCL6 zinc finger region by employing cyclic amplification and selection of targets (CASTing). From oligonucleotides containing 16 central random bases, sequences binding to the protein on glutathione-coated beads were repeatedly selected and amplified by polymerase chain reaction (PCR). The binding sites were cloned and sequenced. A consensus, TTTNNNGNNATNCTTT, was obtained. Protein binding studies of double-stranded oligomers containing point mutations within the 3' CTTT confirmed the binding specificity of this part of the consensus. In addition, evidence indicated that some of the base pairs held constant in the oligonucleotides used for CASTing also contributed to binding.