Continuous perfusion of donor hearts in the beating state extends preservation time and improves recovery of function.

OBJECTIVES: Improving methods of donor heart preservation may permit prolonged storage and remote procurement of cardiac allografts. We hypothesized that continuous, sanguineous perfusion of the donor heart in the beating, working state may prolong myocardial preservation. METHODS: We developed a portable perfusion apparatus for use in donor heart preservation. Contractile, metabolic, and vasomotor functions were monitored simultaneously in an isolated swine heart. The metabolic state was monitored by myocardial tissue pH. Vasomotor function was assessed in isolated coronary ring chambers. Hearts were randomized into 3 groups: group I (n = 5), cardioplegic arrest, 12-hour storage at 4 degrees C with modified Belzer solution, and 2-hour sanguineous reperfusion in the working state; group II (n = 6), 12-hour continuous perfusion in the beating working state, 30 minutes of arrest (to simulate re-implantation time), and 2 hours of reperfusion, as above; group III (n = 7), coronary ring control hearts. RESULTS: At 2 hours of reperfusion, left ventricular developed pressure in group II was higher than in group I (mean +/- standard deviation: 90 +/- 6 mm Hg, 53 +/- 15 mm Hg, P = .005). Significantly less myocardial edema was observed in group II than in group I (73% +/- 4%, 80% +/- 1% water content, P = .01). Significantly less myocardial acidosis was noted in group II than in group I during preservation (pH 7.3 +/- 0.01, 6.1 +/- 0.03, P < .001) and reperfusion (pH 7.3 +/- 0.008, 6.8 +/- 0.05, P < .001). Coronary endothelial vasomotor function was better preserved in group II than in group I as evidenced by dose-response relaxation of coronary rings to 10(-8) mol/L bradykinin (37%, 55% delta baseline, P = .01). CONCLUSION: This new method extends the current preservation limit and avoids time-dependent ischemic injury, thereby allowing for distant procurement of donor organs.

Cerebellar cortex: its simulation and the relevance of Marr's theory.

Marr's theory of the cerebellar cortex as an associative learning device is one of the best examples of a theory that directly relates the function of a neural system to its neural structure. However, although he assigned a precise function to each of the identified cell types of the cerebellar cortex, many of the crucial aspects of the implementation of his theory remained unspecified. We attempted to resolve these difficulties by constructing a computer simulation which contained a direct representation of the 13,000 mossy fibres and the 200,000 granule cells associated with a single Purkinje cell of the cerebellar cortex, together with the supporting Golgi, basket and stellate cells. In this paper we present a detailed explanation of Marr's theory based upon an analogy between Marr's cerebellar model and an abstract model called the associative net. Although some of Marr's assumptions contravene neuroanatomical findings, we found that in general terms his conclusion that each Purkinje cell can learn to respond to a large number of different patterns of activity in the mossy fibres is substantially correct. However, we found that this system has a lower capacity and acts more stochastically than he envisaged. The biologically realistic simulated structure that we designed can be used to assess the computational capabilities of other network theories of the cerebellum.

Combination medication cart and computer terminal in decentralized drug distribution.

A decentralized unit dose distribution system using mobile pharmacy carts and computer terminals for filling inpatient and discharge medication orders is described. The system uses computer terminals mounted on mobile medication carts. Medication orders are collected from each nursing station by the pharmacist. Using the mobile combination decentralized medication cart/computer terminal (cart/CRT), the pharmacist examines and updates the patient's drug profile, checking for drug allergies and interactions, and bills the patient for drugs dispensed. Unit dose drugs requiring no additional labeling are dispensed from the decentralized cart to the patient's drawer in the unit dose medication cart. When a label is necessary, the pharmacist commands the computer to print a label in the central pharmacy. Discharge orders are entered at the cart/CRT, filled and recorded in the central pharmacy, and distributed to the patients by the pharmacist on the nursing unit. Turnaround time for routine inpatient orders and discharge orders decreased substantially using this system, and the system was perceived as beneficial by nurses, physicians, and pharmacists.