Geriatric Trauma Patients: Outcomes Before and After Addition of a Hospitalist Consultation.

BACKGROUND: Research has shown improvements in patient care and outcomes with addition of a rounding geriatrician. The purpose of this study was to determine if addition of a hospitalist consultation improved patient outcomes. METHODS: A retrospective review was conducted of all trauma patients, ≥65 years, before (n=481) and after (n=430) addition of a hospitalist consultant. Data included were demographics, comorbidities, injury severity, blood pressure, laboratory levels, pain control methods, ICU and ventilator requirements, complications, hospital length of stay, mortality, preexisting wishes, and 30-day readmission. RESULTS: Adding a hospitalist consultation did not improve blood glucose or blood pressure control. It decreased narcotics-only use (36.0% vs 73.8%) while increasing multimodal pain control use (51.8% vs 14.8%, P<.001) and testing of HbA1c (7% vs .6%, P<.001). There was also increased knowledge of patient resuscitation status preferences (29.1% vs 12.9%, P<.001). CONCLUSIONS: This article does not support use of routine hospitalist consultation in the geriatric trauma population. However, with study limitations, we continue to evaluate hospitalist utility and will adjust our daily rounds to more closely match prior studies.

[Construction of recombinant human nerve growth factor (rh-ß-NGF) eukaryotic vector and its expression in HEK293 cells].

Human nerve growth factor (NGF) is a nerve cell growth regulation factor, which can provide nutrition for the neurons and promote the neurites outgrowth. In order to produce large-scale recombinant human nerve growth factor (rh-beta-NGF), we constructed a plasmid vector, which can stably express the rh-beta-NGF in the HEK293 cell lines. First, the plasmid of pCMV-beta-NGF-IRES-dhfr was constructed and transformed into HEK293 cells. Then MTX pressurized filter and limiting dilution methods were used to obtain monoclonal HEK293 cell lines. After stepwise reducing serum in culture media, the cells eventually adapted to serum-free medium and secreted rh-beta-NGF. SDS-PAGE analysis revealed that the expression product owned a molecular weight of about 13 kDa and a purity of more than 50%. The peptide mapping sequencing analysis demonstrated the sequences of rh-beta-NGF matched with the theoretical ones. Later we purified this protein by ion exchange and molecular sieve chromatograph. Finally, our experimental results exhibited that the recombinant cell lines can stably express rh-beta-NGF with a high efficiency of more than 20 pg/cell x day. In addition, this protein could successfully induce differentiation of PC12 cells. In summary, our recombinant HEK293 cells can express bio-active rh-beta-NGF with great efficiency and stability, which supply a valid basis to large-scale production of rh-beta-NGF.

Real time monitoring of hazardous airborne chemicals: a styrene investigation.

The low level detection of air pollutants requires reliable sampling and calibration techniques, as well as using sophisticated analytical instrumentation. Incorporating these requirements into a mobile platform allows for accurate, curb side measurement of airborne ambient chemicals in real time. In this case study, air emissions from two manufacturing facilities in close proximity to each other were monitored with a mobile unit to chemically characterize and differentiate the emissions from each facility. Based upon the downwind fingerprinting and concentration levels, the mobile unit was able to isolate the source of the emissions to the responsible facility. A few chemicals which were detected by the TAGA had never been reported by the companies. Real time proximity monitoring was accomplished by using a triple quadrupole mass spectrometer (TAGA IIe). The TAGA IIe interfaces with a low pressure chemical ionization source that operates at 3 Torr and 100 microA. By monitoring the response of specific parent/daughter ion pairs, the TAGA IIe unit was able to determine the point-of-impingement concentrations of styrene and other ambient airborne chemicals. Positive identification and quantitation of styrene was accomplished by multiple measurements of the following ion pairs: 104/78, 104/77, 104/65 and 104/52. By optimizing various parameters of the TAGA IIe a method detection limit of 1.1 microg/m(3) was achieved for styrene. A daily multi-point calibration was performed using a liquid standard. The maximum half-hour average concentration of styrene measured downwind of the two facilities was 2300 microg/m(3) and the maximum instantaneous level was measured at 15,000 microg/m(3). The mobile capability of the unit was also utilized in determining the ambient airborne concentration of styrene at various distances from the companies with the maximum levels measured at close proximity to the emission sources.

Extraordinary cluster formation and intramolecular ligand-ligand interactions in cyanoacetylene [corrected] mediated by Mg+*: implications for the atmospheric chemistry of titan and for circumstellar chemistry.

Experimental results are reported that track the kinetics of gas-phase reactions initiated by Mg+*, (c-C5H5)Mg+ and (c-C5H5)2Mg+* in hydrogen cyanide and cyanoacetylene. The experiments were performed with a selected-ion flow tube (SIFT) tandem mass spectrometer at a helium buffer-gas pressure of 0.35 +/- 0.01 Torr and at 294 +/- 3 K. The observed chemistries of Mg+* and (c-C5H5)Mg+ are dominated by sequential ligation, while that of (c-C5H5)2Mg+* is by ligand switching. The rate-coefficient measurements for sequential addition of cyanoacetylene to Mg+* indicate an extraordinary pattern in alternating chemical reactivity while multiple-collision induced dissociation experiments revealed an extraordinary stability for the Mg(HC3N)4+* cluster ion. Molecular orbital calculations with density functional theory (DFT) at the B3LYP level, Hartree-Fock (HF) and second-order Mphiller-Plesset (MP2) levels, all performed with a 6-31+G(d) basis set, have been used to calculate structures and energies for the observed Mg(HC3N)1-4(+)* cations. These calculations indicate that the path of formation of Mg(HC3N)4+* involves ligand-ligand interactions leading to two cyclic (HC3N)2 ligands which then interact to form 2,4,6,8-tetracyanosemibullvalene-Mg+ or 1,2,5,6-tetracyano-1,3,5,7-cyclooctatetraene-Mg+ cations. A case is made for the formation of similar complex organomagnesium ions in the upper atmosphere of Titan where subsequent electron-ion recombination may produce cyano derivatives of large unsaturated hydrocarbons. In contrast, circumstellar environments with their much higher relative content of free electrons are less likely to give rise to such chemistry.

Air monitoring of a coal tar cleanup using a mobile TAGA LPCI-MS/MS.

Real-time detection of air toxics is becoming increasingly important in understanding the sources and constituents of air pollution. The detection of low levels of air contaminants requires reliable sampling and calibration techniques, as well as sophisticated analytical instrumentation. Recently, a new low pressure chemical ionization (LPCI) source was developed for ambient air monitoring of benzene, toluene, xylene (BTX) and gas-phase polycyclic aromatic hydrocarbons (PAH) in real-time. This ion source in conjunction with a triple quadrupole (Q1, Q2, Q3) mass spectrometer (trace atmospheric gas analyzer (TAGA IIe)) has been proven highly useful for measuring selected air pollutants. The ion chemistry under LPCI conditions involves charge transfer reactions yielding parent ions which are selected in the first quadrupole, Q1, dissociated in the second quadrupole, Q2, and the resultant daughter ions are then identified by the third quadrupole, Q3. Monitoring of specific parent/daughter (P/D) ion pairs is used to measure concentrations of BTX and selected PAH. The response of the TAGA IIe is characterized through multi-point calibration curves. Detection limits (DL) as low as 0.5 microg/m(3) for BTX and PAH were accomplished by optimizing various TAGA IIe operating parameters. This unique method was applied in November 1999 to monitor emissions released during the cleanup of a historical coal tar site in Kingston, Ontario. This information was used by local officials for enhancing abatement activities or in some cases temporarily halting the excavation when levels of air toxics were higher than allowable provincial guidelines.