A call to action in thoracic transplant surgical training.

Thoracic organ recovery and implantation is increasing in complexity. Simultaneously the logistic burden and associated cost is rising. An electronic survey distributed to the surgical directors of thoracic transplant programs in the United States indicated dissatisfaction amongst 72% of respondents with current procurement training and 85% of respondents favored a process for certification in thoracic organ transplantation. These responses highlight concerns for the current paradigm of training in thoracic transplantation. We discuss the implications of advancements in organ retrieval and implant for surgical training and propose that the thoracic transplant community might address the need through formalized training in procurement and certification in thoracic transplantation.

CD154+ graft antigen-specific CD4+ T cells are sufficient for chronic rejection of minor antigen incompatible heart grafts.

We used a defined model system to address the role of minor histocompatibility antigen-specific CD4+ T cells in chronic rejection. The coronary arteries of vascularized heart grafts expressing the model antigen ovalbumin developed intimal hyperplasia in normal recipients and those lacking CD8+ T cells but not in those lacking CD4+ T cells. Furthermore, purified ovalbumin-specific CD4+ T cells from T-cell antigen receptor transgenic mice caused intimal hyperplasia in ovalbumin-expressing heart grafts in lymphocyte-deficient mice. The graft antigen-specific CD4+ T cells only caused intimal hyperplasia when expressing CD154 and were found in the intima of the affected coronary arteries along with CD40+ cells, CD11c+ dendritic cells and CD11b+, Gr-1+ monocytes. These results show that minor histocompatibility antigen-specific CD4+ T cells are required to cause the classical vascular changes of chronic rejection. They are capable of doing so without contributions from other lymphocytes, and may cause intimal hyperplasia by using CD154 to stimulate other non-lymphoid cells in the intima.

Adhesive retention dressings are more comfortable than alginate dressings on split skin graft donor sites--a randomised controlled trial.

A prospective randomised trial examining the effectiveness, comparative comfort and ease of care of two different split skin graft donor site dressings was performed. One of the dressings was an alginate (Kaltostat), and the other an adhesive retention tape (Mefix). Alginates are the standard plastic surgical dressing, whereas the use of adhesive retention tapes as a donor site dressing presents a novel use of a readily available product. A total of 30 consecutive patients requiring split skin grafts were randomised to receive either alginate or retention donor site dressings. Dressings were assessed by interview and questionnaire at 24 h and 48 h and at 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable. They also required less nursing care and attention. The retention dressings allowed the patients easier mobility and a greater range of daily activities, especially washing. There was no significant difference in wound healing nor in complications. Adhesive retention tape applied directly to the split skin graft donor site wound is an effective, cheap and comfortable dressing requiring little postoperative care.

Mood state changes of students enrolled in physical activity classes.

74 students enrolled in physical activity classes completed the happiness and sadness scales of the Emotional Assessment Scale each week for the 7-week course. A repeated measures analysis of variance indicated no significant change in mean mood state scores. Subjects' scores remained fairly happy throughout the length of the course, women having significantly happier scores than men.

Role of the cysteine-rich domain of the t-SNARE component, SYNDET, in membrane binding and subcellular localization.

Wild-type syndet is efficiently recruited at the plasma membrane in transfected AtT-20 cells. A deletion at the cysteine-rich domain abolishes palmitoylation, membrane binding, and plasma membrane distribution of syndet. Syndet, SNAP-25A, and SNAP-25B share four cysteine residues, of which three, Cys2, Cys4, and Cys5, are absolutely conserved in all three homologs. Mutations at any pair of cysteines within cysteines 2, 4, and 5 shift syndet from the cell surface into the cytoplasm. Thus, at least two cysteines within the conserved triplet are necessary for plasma membrane localization. Syndet C1S/C3S, with substitutions at the pair Cys1 and Cys3, distributes to the plasma membrane, a Golgi-like compartment, and the cytosol. We conclude that Cys1 and Cys3 are not absolutely necessary for membrane binding or plasma membrane localization. Our results show that the cysteine-rich domain of syndet plays a major role in its subcellular distribution.

Influence of fitness on susceptibility to noise-induced temporary threshold shift.

PURPOSE: Two earlier reports indicated that cardiovascular fitness attenuates susceptibility to noise-induced temporary threshold shift (TTS) in hearing sensitivity; however, other parameters of fitness also may be related to this phenomenon. This study investigated the association of three different physical fitness indicators on TTS. METHODS: Maximal aerobic power (VO2max), body composition. and recent activity history were determined in 33 normal-hearing females of various fitness levels. Audiometric thresholds were obtained at 2000, 3000, 4000, and 6000 Hz before and immediately after 10 min of exposure to 108-dB SPL narrow-band noise centered at 2000 Hz. RESULTS: All postnoise measurements were significantly less than prenoise measurements (P < 0.0001) with the greatest TTS occurring at 3000 Hz. Similarly, the strongest Pearson-product correlations for VO2max, % fat, and recent activity history with TTS occurred at 3000 Hz (r = -0.68, 0.60, -0.59, respectively; P < 0.05). Canonical correlation analysis indicated a moderate correlation between physical fitness and TTS (Rc = 0.71: P < 0.01). Individually, VO2max, % fat, and recent activity history had correlations of -0.70, 0.62, and -0.63, respectively, to the TTS canonical variable. CONCLUSIONS: From these results, we concluded that there is a moderate association of physical fitness and diminished temporary hearing loss experienced after noise exposure.

The identification and partial characterisation of a novel inducible extracellular thermostable esterase from the archaeon Sulfolobus shibatae.

Extracellular esterases have so far only been reported in eubacteria, here we report the first identification and partial characterisation of a novel inducible extracellular esterase from the thermoacidophilic archaeon Sulfolobus shibatae. This esterase exhibits remarkable stability to both acid and heat. Esterase activity is induced by growth on a range of polyoxyethylenesorbitan (Tween) compounds as sole carbon source. Activity occurs over a wide temperature (25-99 degrees C) and pH (pH4.0-9.0) range and is optimal at 90 degrees C and pH6.0. It exhibits high thermal stability, with a half-life of 20 min at 120 degrees C, and shows a transient thermal activation of 60% at 90 degrees C. The thermal inactivation of function occurs by first order kinetics, and after 120 min incubation at 120 degrees C 50% of activity still remains. It is able to hydrolyse mono- and diglycerides, but is unable to hydrolyse the triglycerides olive oil and triolein, which is indicative of an esterase and not a lipase.

Aesthetic indications for botulinum toxin injection.

A clinical trial was undertaken to evaluate the effects of commercially available botulinum toxin on 14 hyperactive corrugator muscles, 14 procerus muscles, one case of congenital aplasia of the depressor labii inferioris muscle, and one case of iatrogenic injury to the ramus mandibularis branch of the facial nerve with paralysis of the depressor labii and mentalis muscles. Of the 31 muscles injected, 28 were appropriately paralyzed with the initial injection. The desired results were obtained in the 3 remaining muscles following a second injection. The ability to frown was nullified in all subjects, resulting in the elimination of glabellar lines. Facial symmetry was achieved in both patients with muscle imbalance. The average duration of the paralysis was 8 weeks, with a range of 2 to 16 weeks. However, this period was prolonged in the latter part of the study with an adjustment of the toxin dose. Our results demonstrate that botulinum toxin injected into overactive facial muscles does produce a predictable and reversible paralysis and eliminates or ameliorates deep frown lines. We also illustrate its use in achieving facial symmetry in one patient with congenitally absent depressor labii inferioris and platysma muscles and in another with postrhytidectomy facial nerve paralysis.

Psychometric properties of the Driving Practices Questionnaire: assessment of risky driving.

A national public health goal is to reduce injuries and deaths from motor vehicle crashes (MVC). The development and psychometric evaluation of the 10-item Driving Practices Questionnaire (DPQ) to measure risky driving is described. Based on responses from 297 drivers divided into safe, unsafe, and injured groups, the DPQ was evaluated using item and factor analysis, and reliability and validity measures. Principal axis factor analysis isolated one factor with 42.3% of the variance explained. The alpha coefficient for the scale was .87 and test-retest correlation was .94. High DPQ scorers were three times more likely to have prior traffic violations. The identification of driver subtypes will assist the testing of injury prevention interventions.