Anti-D in a D-positive renal transplant patient

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.     

Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: a dosimetric analysis

OBJECTIVE: The structure of the collagen scar during healing of a myocardial infarction is a determinant of the function of the remodeled tissue. We hypothesize that the passive deformations of both scar and normal tissue are related to the underlying collagen uncoiling as the tissue stretches, and that the unloaded tortuosity of the collagen may be a determinant of tissue stiffness at low ventricular pressure. Hence collagen uncoiling and tissue strain were measured during passive loading in normal tissue, and in healing infarct tissue. METHODS: Left ventricles of rats were infarcted by ligation of the left anterior descending artery for 2 weeks. Surface strains were measured during passive inflation in the scar region in one set of excised hearts, and other arrested hearts were fixed at different ventricular pressures, after which collagen tortuosity was measured in the infarcted and normal tissue. RESULTS: Passive loading strains were smaller in the scar in both the fiber and cross-fiber directions. Tortuosity decreased with load in normal and infarcted tissue, with fibrils tending to straighten more in the scar tissue at higher pressures (1.056 +/- 0.009 vs. 1.024 +/- 0.009 at P = 20 mmHg) with similar tortuosities at zero pressure (1.110 +/- 0.012 vs. 1.098 +/- 0.019). The decrease in tortuosity with strain was greater for the infarcted tissue. CONCLUSIONS: The greater stiffness of infarcted tissue at low pressure is not due to 'straightened' collagen fibers, and there may be a different three-dimensional structure of infarct vs. normal coiled collagen fibers which can affect the material properties of these tissues.     

Disulfide bond assignment in human interleukin-7 by matrix-assisted laser desorption/ionization mass spectroscopy and site-directed cysteine to serine mutational analysis

Interleukin-7 (IL-7) is a proteinaceous biological response modifier that has a bioactive tertiary structure dependent on disulfide bond formation. Disulfide bond assignments in human (h)IL-7 are based upon the results of matrix-assisted laser desorption/ionization (MALDI) mass spectroscopy and Cys to Ser mutational analyses. A gene encoding the hIL-7 was synthesized incorporating Escherichia coli codon usage bias and was used to express biologically active protein as determined by stimulation of precursor B-cell proliferation. MALDI mass spectroscopic analysis of trypsin-digested hIL-7 was performed and compared with the anticipated results of a simulated tryptic digestion. Many of the anticipated hIL-7 tryptic fragments were detected including one with a molecular mass equivalent to the sum of two polypeptides linked through a disulfide bond formed from Cys residues (Cys3 and Cys142). Subsequently, Cys to Ser substitution mutational analyses were performed. A hIL-7 variant with all six Cys substituted with Ser was found to be biologically inactive (EC50 > 1 x 10(-7) M). In contrast, a family of single disulfide bond-forming variants of hIL-7 were constructed by reintroducing Cys pairs (Cys3-Cys142, Cys35-Cys130, and Cys48-Cys93), and each could stimulate cell proliferation with an EC50 of 4 x 10(-9), 2 x 10(-8), and 2 x 10(-9) M, respectively. In single disulfide bond-forming mutants of hIL-7, the ability to stimulate cell proliferation was abolished in the presence of 2 mM dithiothreitol. The results presented strongly suggest that only a single disulfide bond is required for hIL-7 to form a tertiary structure capable of stimulating precursor B-cell proliferation.     

Another false alarm? apnea monitor activation in a Neonatal Intensive Care Unit graduate

Neonatal emergencies have become more common as increasingly sophisticated Neonatal Intensive Care Units graduate lower birth-weight babies born at younger gestational ages. These patients present a number of challenges to emergency physicians. They are often discharged with apnea monitors, which generate a high number of false alarms. Neonatal Intensive Care Unit graduates, however, are predisposed to a number of conditions that can result in true episodes of apnea. We present such a case and will discuss the unusual underlying cause of apnea, the utility of apnea monitors, and the need for emergency physicians to be prepared to evaluate and treat these potentially complicated patients.     

Prenatal care in the inner-city: a cooperative effort

PAHCF and Women and Infants Hospital have been working together for many years to provide high quality, accessible prenatal and obstetrical care to low-income, inner-city residents in the Providence area. Many of these patients have multiple medical, social, and nutritional problems that place them at increased risk for poor pregnancy outcomes. The PAHCF sites offer convenient locations, evening hours, and culturally-sensitive, bilingual staffs; together the five sites provided prenatal care to nearly 1200 patients last year. Women and Infants Ambulatory Care Department provided prenatal care to an additional 1800 women in 1991, including all high risk patients referred for complications or diagnostic evaluations. All patients deliver at Women and Infants, then return to their original source of care for postpartum followup and family planning services. Patient records are readily transferred between the sites, eliminating the need for unnecessary duplication of information or laboratory tests. This close collaboration is mutually beneficial to both the health care providers and the patients whom they serve.     

Chronic interleukin-6 alters NMDA receptor-mediated membrane responses and enhances neurotoxicity in developing CNS neurons

Recent studies show that the cytokine interleukin-6 (IL-6) is expressed at elevated levels in the CNS in several disease states and contributes to the neuropathological process. The mechanisms through which IL-6 exerts its CNS effects are primarily unknown. We have investigated the pathophysiological effects of IL-6 on developing CNS neurons using a culture model system and a chronic treatment paradigm. Here, we show, using current- and voltage-clamp recordings, that chronic IL-6 treatment of developing cerebellar granule neurons increases the membrane and current response to NMDA and that these effects are the primary mechanism through which IL-6 produces an enhanced calcium signal to NMDA. We also show that calcium influx through voltage-sensitive calcium channels contributes to the enhanced calcium signal to NMDA in the IL-6-treated neurons in a developmentally regulated manner and that the membrane depolarization to NMDA is more sensitive to the NMDA receptor antagonist ifenprodil in the IL-6-treated neurons compared with control neurons at a late developmental stage, consistent with a larger proportion of NMDA receptors containing the NMDAR2B subunit in the IL-6-treated neurons. Additional studies show that IL-6 treatment reduces the number of granule neurons in culture and enhances neurotoxicity involving NMDA receptors. These results support a pathological role for IL-6 in the CNS and indicate that NMDA receptor-mediated functions are likely to play a critical role in neuropathological changes observed in CNS diseases associated with elevated CNS levels of IL-6.     

The moderating influence of attitude strength on the susceptibility to context effects in attitude surveys.

In 3 experiments, the authors assessed whether attitude strength moderates the susceptibility of attitudes to item context effects in surveys. In Experiment 1, respondents completed multiple measures of attitude strength. Three weeks later, respondents participated in a context experiment. Results revealed that respondents with weak attitudes exhibited significantly larger context effect for 1 of 2 issues. In Experiment 2, the results of Experiment 1 were conceptually replicated by use of measures of interattitudinal embeddedness to assess attitude strength. In Experiment 3, significant strength-moderated context effects were found when attitude strength was assessed in a multi-item, multidimensional manner but not when it was assessed with a single item. Discussion focuses on measurement and theoretical issues related to the moderation and mediation of context effects in attitude surveys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stress intensity for an edge crack in a semi-infinite orthotropic body

The problem of an edge crack in a semi-infinite plane of linear elastic orthotropic material is studied. The correction factor which relates the stress intensity factor for this problem to that for an isolated crack in an infinite body is evaluated for a range of orthotropic material properties. Calculations are restricted to mode I problems. The method requires the numerical solution of an integral equation, the integrands in which are derived from related complex variable solutions.

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Resumé On étudie le problème d'une fissure de bord dans un plan semi-infini en un matériau linéaire eastique et orthotrope. On évalue pour une gamme de propriétés orthotropes du matériau le facteur de correction qui permet de relier le facteur d'intensité de contraintes relatif à ce problème à celui relatif à une fissure isolée dans un corps infini. Ces calculs sont limités aux problèmes de rupture selon le mode. I. La méthode exige de trouver la solution numérique d'une intégrale dont les intégrants sont tirés de solutions associées à variables complexes.

     

Forces required to jettison a simulated S92 passenger exit: Optimal helicopter underwater egress training techniques

This paper outlines the first known examination of the forces required to jettison a simulated exit used during helicopter underwater egress training (HUET). To capture the forces placed on the simulated cabin exit, a purpose build force plate was designed to replace an existing simulator exit used during HUET. A 25-point map was created to identify specific jettison forces required across the entire exit surface. Ten participants completed a total of 120 underwater egress sequences in–air and in-water from a normal flight and fully compressed crash attenuating seat position. The results indicate that the force required to jettison the simulated exit is significantly different in relationship to location on the exit surface. From the results, it can be concluded that helicopter underwater egress training protocols should ensure that offshore candidates are informed of the different force requirements as well as have the opportunity to practice jettisoning a high physical fidelity exit from a fully compressed crash attenuating seat.