Emergency medicine in undergraduate education. SAEM Education Committee, Undergraduate Subcommittee, Society for Academic Emergency Medicine.

Society has a right to expect that all physicians possess basic knowledge of emergency care and the skills to manage acute problems. Competency in the care of acutely ill and injured patients is one of the fundamental exit goals of most medical schools as mandated by the Liaison Committee on Medical Education. Several groups have called for strengthening the general components of undergraduate medical education, and surveys during the early years of the development of the field of emergency medicine (EM) showed that only a small percentage of schools required significant education in EM. This paper defines the goals and objectives of undergraduate EM education in order to help guide the development of curricular offerings as the role of EM in undergraduate medical school education increases. This paper was developed by the SAEM Education Committee and presents this committee's beliefs on what all graduating medical students should know about assessment and treatment of acutely sick and injured patients. It also suggests methods by which acquisition of this information can occur in medical school education.

Undergraduate curriculum. SAEM Undergraduate Education Committee, Society for Academic Emergency Medicine.

The specialty of emergency medicine (EM) is becoming more and more involved in medical school education. The previous article discusses the integration of EM in medical school curricula. This outline was developed by the SAEM Undergraduate Education Committee to offer specific goals and objectives as well as suggestions for implementation of EM concepts into medical school curricula.

Matrix-free desorption of biomolecules using massive cluster impact.

Massive-cluster impact (MCI) ionization was found to be capable of producing high secondary-ion yields from biological samples without the use of a liquid matrix. Dry samples of molecules as large as cytochrome c were observed to be efficiently desorbed without significant fragmentation by the MCI beam of glycerol clusters. In addition, signals from protonated molecules retained a significant proportion of their initial intensity even after several minutes exposure to the primary beam. It was determined that these remarkable phenomena are not the result of the build-up of a layer of glycerol caused by the cluster bombardment.

Formation of multiply charged ions from large molecules using massive-cluster impact.

Massive-cluster impact is demonstrated to be an effective ionization technique for the mass analysis of proteins as large as 17 kDa. The design of the cluster source permits coupling to both magnetic-sector and quadrupole mass spectrometers. Mass spectra are characterized by the almost total absence of chemical background and a predominance of multiply charged ions formed from 100% glycerol matrix. The number of charge states produced by the technique is observed to range from +3 to +9 for chicken egg lysozyme (14,310 Da). The lower m/z values provided by higher charge states increase the effective mass range of analyses performed with conventional ionization by fast-atom bombardment or liquid secondary ion mass spectrometry.

Defective glycosylphosphatidylinositol anchor synthesis in paroxysmal nocturnal hemoglobinuria granulocytes.

To investigate the biosynthesis of the glycosylphosphatidylinositol (GPI) anchor in the granulocytes of paroxysmal nocturnal hemoglobinuria (PNH), the glycolipids of granulocytes from PNH patients and normal volunteers were biosynthetically labeled with [3H]mannose in the presence of tunicamycin. Extracted glycolipids were examined by thin-layer chromatography and compared with known biosynthetic intermediates. Normal granulocytes consistently showed [3H]mannose incorporation into the complete GPI core, several GPI biosynthetic intermediates, and dolichol phosphate mannose (DPM). The granulocytes of 10 patients with PNH that had no expression of CD55 and CD59 on greater than 95% of the cells were able to incorporate [3H]mannose into DPM, but were not able to incorporate detectable amounts into the complete GPI core. THus, PNH granulocytes do not synthesize detectable amounts of the complete GPI core and this defect likely accounts for the absence of GPI-linked membrane proteins on hematopoietic cells in this syndrome.

Shock wave model for sputtering biomolecules using massive cluster impacts.

A shock wave model is proposed to explain certain features of recently reported spectra obtained by massive duster impact (MCI) mass spectrometry. It is suggested that clusters that impact glycerol matrices with energies/nucleon in the range 0.01 eV/u < E/N < 1.0 eV/u provide an extremely soft method for sputtering intact biomolecules, Compared to the high energy/nucleon characteristic of atomic or molecular ion primary beams (typically < 50 eV/u), massive cluster primary beams possess much lower energies/nucleon, which are insufficient to cause appreciable ionization and radiation damage of matrix material. Moreover, fragmentation products of parent molecular ions are effectively lower. With these benefits, MCI spectra show lower chemical noise background and enhanced signalto-noise ratios. Rankine-Hugoniot analysis of the shock conditions is used to arrive at an estimate of the heat retained in the collision-affected matrix volume after bombardment by a characteristic cluster. For a cluster collision resulting in a 26.8 GPa shock pressure, by analogy with water data, rapid heating of the shocked volume to 1000 °C or more is plausible. In a beam consisting of clusters distributed in size and charge, an estimate is made for the range of cluster sizes over which hyrodynamic shock wave theory applies.

Massive cluster impact mass spectrometry: a new desorption method for the analysis of large biomolecules.

A new ion desorption method is described that utilizes a primary beam of massive, multiply charged cluster ions to generate secondary ions of peptides in a glycerol matrix. The massive cluster ion beam is generated via electrohydrodynamic emission using a 1.5 M solution of ammonium acetate in 30% aqueous glycerol. Negative ion spectra of peptides obtained using this technique show greatly decreased relative intensities for fragment ions and 'chemical noise' background when compared to spectra obtained using a xenon atom primary beam. The near absence of fragments derived from radiation damage to the sample solution is attributed to the impact of primary particles with energies less than 1 eV/nucleon.

Incidence of cancer in renal transplant recipients.

In summary, the susceptibility of transplant recipients to the development of cancer is dramatically revealed by the oncogenic effects of sunlight. Skin and other forms of carcinoma are aggressive and develop particularly in patients doing well from the immunological point of view post transplantation. Patients with cancer are less susceptible to rejection than those without. Patients with malignancy survive significantly better in the early post transplant years than do those without cancer, but fare much worse later on because of deaths caused by cancer and because of the need to withdraw immune suppressive therapy in those patients with proliferating cancer. Almost 40% of long survivors have cancer, an incidence which continues to increase. Cancer has become a major cause of mortality in long survivors. It seems that, with time, most carcinomas which occur in the general population will occur with increased frequency in renal transplant recipients.

Cancer following renal transplantation.

Ninety-nine (21%) of 471 patients who survived with functioning grafts for at least six months following renal transplantation developed cancer. Of these 76 (77%) had skin malignancy, 29 (29%) had malignancy affecting other organs, and six had cancer of both skin and other organs. In patients with skin cancer squamous cell carcinoma (SCC) was three times as frequent as basal cell carcinoma (BCC). SCC tended to be multiple, recurrent and aggressive. Seven (12%) patients with SCC developed metastases of whom five died. Cancers other than skin included reticulum cell sarcoma (9), acute leukaemia (2) and cancers involving the gastrointestinal (5), genitourinary (11) and respiratory (2) systems. Incidence of cancer in patients surviving beyond one, five and nine years after operation was 98/428 (23%), 70/179 (39%) and 20/45 (44%) respectively. In 31 patients who died more than five years after transplantation cancer was the major cause in eight (26%). For the types of cancers recorded estimates show allograft recipients to be at increased risk when compared with the age-matched Australian population by factors which varied from 300 times for reticulum cell sarcoma to 1.8 times for invasive carcinoma of the cervix. The full extent of the threat of cancer in immune suppressed transplant recipients remains to be determined.

Función de los antígenos de cardiolipina en la serología de la sífilis

Venereal Disease Infromation 30(8), 1949 (English)