Spatial control of actin filament assembly: lessons from Listeria

STUDY OBJECTIVE: To determine the effect of the CHAMPUS Reform Initiative (CRI) on emergency department use and charges, and to ascertain whether any reductions were concentrated among repeat users of the ED, those with less serious ED diagnoses, or those with selected chronic medical conditions. METHODS: Participants were approximately 1.2 million beneficiaries of the Civilian Health and Medical Program of Uniformed Services (CHAMPUS) residing within either 11 military hospital catchment areas in California and Hawaii ("demonstration areas") or 11 matched control areas in other parts of the United States. Under CRI, participants were offered a choice of the standard CHAMPUS indemnity plan, a Preferred Provider Organization-type plan, or a network-model Health Maintenance Organization plan. Beneficiaries were encouraged to use alternatives to the ED for nonemergency conditions. Visits to civilian EDs during two 12-month periods, before and after institution of CRI, were compared. RESULTS: Under CRI, the number of CHAMPUS ED visits decreased by approximately 40% relative to the control, and allowed charges fell by almost 50%. Relative reductions in ED use under CRI were seen among both frequent and infrequent users of the ED. ED case-mix severity increased modestly relative to control (+3.5% versus +.9%). ED use among patients with diabetes, hypertension, and asthma fell sharply in the demonstration areas (by 14% to 41%) but rose in control areas (by 4% to 9%). CONCLUSION: In one of the largest managed care demonstrations ever conducted, a nonintrusive use management program and improved access to outpatient care appeared to reduce ED use, allowed charges, and costs to the government. Reductions in ED use were concentrated to some extent among repeat users and patients with less severe illnesses and were effected without capitation of provider groups or strict gatekeeping requirements.     

Laparoscopic appendectomy in acute appendicitis

Laparoscopic technology was applied as diagnostic method in 608 patients, 50 patients have undergone laparoscopic appendectomy. There were no diagnostic errors in laparoscopy application. Laparoscopic technology allowed to perform appendectomy quite safely and without any complications. This method permitted considerably reduce terms of treatment of the acute appendicitis patients and quickly restore their ability to work.     

Design and Management of Subsurface Horizontal Drainage to Reduce Salt Loads

Many irrigated areas have shallow water tables creating waterlogging and salinization problems. This has often been controlled by installation of subsurface horizontal pipe drainage; however, these systems export large amounts of salt off farm in the drainage effluent. Improved design and management of subsurface drainage systems to reduce drainage salt loads were tested in a replicated field experiment. Deep, widely spaced drains allowed to flow without control were compared to drains with management to reduce drain flow. These were also compared with shallow, closely spaced drains that protected the root zone only and an undrained control. The deep drains flowed continuously during the two irrigation seasons with an electrical conductivity of around 11 dS∕m resulting in a drainage salt load of 5,867 kg∕ha. The management measures reduced drainage volume and salinity resulting in a 50% reduction in salt load. The shallow drains only flowed directly after an irrigation or rainfall event with low salinity, around 2 dS∕m, resulting in a 95% reduction in salt load. This showed that by management there is great potential for reducing salt mobilization in existing drainage systems, and for new systems shallower drains will minimize salt loads.     

Behavior of carbon and nitrogen during the continuous casting of IF-type steels with the use of different slag-forming compositions

In attempting to restrain the increase in the carbon content of IF steels during their casting, two of the key factors to be considered are lowering the carbon content of the charge materials and selecting the correct processes for forming the slag in the tundish and the mold. Optimizing slag formation in turn better protects the steel from secondary oxidation and results in a smaller increase in the steel’s nitrogen content. Optimization of the use of slag-forming mixtures has allowed steelmakers to reduce the increase in the carbon and nitrogen contents of the steel by 20%. The results of the study reported here have made it possible to improve the IF steel production method used in the continuous-casting section of the oxygen converter shop at the Severstal’ Metallurgical Combine.     

Localization of heparin binding activity in recombinant laminin G domain

BACKGROUND: Smoking regulations at the workplace have been found to be acceptable and effective in many studies conducted in the United States. There is limited knowledge, however, on acceptance and effects of smoking regulations in European countries, particularly among blue collar employees. METHODS: We conducted a survey on smoking behaviour and attitude toward smoking regulations and passive smoking in a South German metal company. A self-administered questionnaire was mailed to 1,500 predominantly blue collar employees of whom 974 participated in the study (response rate 64.9%). RESULTS: About 30% of the employees were not allowed to smoke at their immediate work area. Among them, about 95% of both smokers and nonsmokers agreed with this smoking policy. More than 60% of nonsmoking blue collar workers were bothered by passive smoking at work whether or not smoking was allowed at their immediate work area. In contrast, the proportion of nonsmoking white collar employees who were bothered by passive smoking varied from 52% if smoking was allowed at their immediate work area to 18% if smoking was not allowed. Prevalence of active smoking and average amount of smoking among active smokers were considerably lower among employees who were not allowed to smoke at work than among other employees. These differences were partly due to confounding by occupation, however, which was strongly related to both smoking habits and smoking policy. CONCLUSIONS: Our results, which confirm and extend previous findings, give further support to the acceptability and potential effectiveness of smoking regulations at the workplace. Particular efforts should be devoted to limit both active and passive smoking among blue collar employees.     

Evaluating the blast pressure of iron-aluminum thermites

When thermites or thermite-type exothermic mixtures are being prepared, the aluminum content of these materials should not be allowed to exceed the stoichiometric concentrations. Adhering to this guideline will significantly reduce the blast pressure that is generated in accidental explosions of these materials and thus prevent or mitigate the associated damage. __________ Translated from Metallurg, No. 7, pp. 37–38, July, 2007.     

Upper gastrointestinal bleeding in an open-access dedicated unit

The open-access high dependency bleeding unit in Aberdeen admits all patients with suspected gastrointestinal bleeding from a stable adult population of 468,000. The aim is to reduce mortality, morbidity and hospital stay, and create a prospective whole community database. An agreed management protocol is based on prompt resuscitation and early diagnosis. From October 1991 to September 1993 there were 1,602 consecutive admissions with suspected upper or lower gastrointestinal haemorrhage. Bleeding was confirmed in 1,098 of 1,324 patients with presumed upper gastrointestinal haemorrhage, (117 bleeding episodes per 100,000 per year). The overall 30-day mortality was 3.9%, with all deaths attributable to significant concurrent illness. Mortality from peptic ulcer bleeding was 5.3%, with an operation rate of 17% and surgical mortality of 8%. Rapid diagnosis allowed 48% of 523 patients with trivial bleeds to be discharged after a median stay of 24 hours. Centralised expertise and equipment is the essence of the unit's success. The interests of patient care are better served, nursing skills are better developed and teaching opportunities better structured. The major improvement in clinical care, welcomed by hospital colleagues, management and general practitioners, makes the unit an indispensable part of acute medical provision.     

Modulation of alloreactivity in transplant recipients by phenotypic manipulation of donor endothelium

Phenotypic manipulation of allograft endothelium to reduce immunogenicity would have a significant impact on transplantation. In this study we have demonstrated that random seeding of a heart allograft with endothelium, of host origin, not only promotes long-term survival, but reduces the requirement for pharmacologic immunosuppression. We propose that this simple technology could easily be extrapolated to the clinical arena where hypothermia and preservation solutions have allowed allografts to remain ex vivo for extended periods.     

The effects of coculture with autologous cryopreserved endometrial cells on human in vitro fertilization and early embryo morphology: a randomized study

PURPOSE: The aim of this study was to examine the influence of endometrial cells on the fertilization rate and early embryonic morphology following routine in vitro fertilization (IVF). Cryopreservation with subsequent thawing allowed the use of autologous somatic cells, thus minimizing the risk of transmission of infective agents. Interpatient variability was eliminated by randomizing oocytes from each cycle into the control or coculture group. RESULTS: Two hundred ninety-four oocytes from 24 IVF cycles (21 patients) were included in the study (145 coculture and 149 control). The normal fertilization rate of control oocytes (56.4%) was not significantly different from that of oocytes cocultured with endometrial cells (61.4%). The mean number of blastomeres in cocultured embryos (3.65) was not significantly different from the number in control embryos (3.46) 2 days after insemination, but the proportion of embryos with minimal or no fragmentation was significantly higher in the coculture group [34/84 (40.5%) vs. 17/80 (21.3%); P < 0.01]. CONCLUSIONS: The inclusion of cryopreserved autologous endometrial cells in routine clinical IVF procedures does not influence fertilization or the early cleavage rate but may reduce the extent of embryo fragmentation during the early cleavage divisions.     

Chewing gum affects smoking topography.

In a previous study, Wrigley's chewing gum was shown to reduce cravings to smoke and nicotine withdrawal when smokers were not allowed access to cigarettes. The present study expanded these findings by examining smoking behavior of 20 dependent cigarette smokers who were allowed free access to cigarettes throughout the study session but were encouraged and rewarded not to smoke. Each experimental session consisted of the participant watching a movie, then waiting an additional 30 min. Half of the participants were assigned to a gum condition in which they were asked to chew at least one piece of gum and had free access to chewing gum throughout the experimental session; half were assigned to a no-gum control. Results from this study indicate that when gum was present, participants took significantly fewer puffs and abstained for a longer period of time until their first cigarette. These results suggest that chewing gum may facilitate quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Operative treatment of hip fractures in patients with renal failure

The conditions of a hip fracture and renal failure cause particularly high mortality. Eight patients (average age, 63 years) who had operative treatment for nine hip fractures were studied retrospectively. Three had intertrochanteric fractures fixed with sliding compression screws, and five had femoral neck fractures (bilateral in one patient): two nondisplaced femoral neck fractures were fixed with percutaneous screws, and four displaced femoral neck fractures were treated with arthroplasties in three and percutaneous screws in one. Operative treatment was done when the patient was in medically stable condition (average, 8 days). Full weightbearing was allowed on the injured limb after surgery. Early morbidity analysis showed no wound infections, thromboembolic events, or hemorrhagic complications. The first year mortality was three (38%). Late morbidity included one nonunion and one sliding screw penetration. Total mortality at 6 years was seven (88%) patients, with an average postoperative survival time of 28 months. Preoperative ambulation was preserved in five of seven (71%) patients. One the basis of this study, it appears that a team approach to operative management including nephrologist and surgeon helps to reduce short term complications and mortality and allows such patients to be mobilized and regain ambulation.     

Silicon and aluminum removal from ilmenite concentrates by alkaline leaching

In this paper, a hydrometallurgical process for the treatment of ilmenite concentrates is developed, in order to reduce the silicon content to the maximum allowed value for the production of “grade B” ferrotitanium. The process was based on pressure leaching with sodium hydroxide and the effect of the main leaching parameters, namely the temperature, sodium hydroxide concentration and retention time, on the efficiency of silicon removal was studied. Caustic leaching of the ilmenite concentrates resulted in the removal of silicon, as well as of aluminum, without affecting the contents of titanium and iron. Leaching temperature and the retention time were proved as crucial parameters for the effective dissolution of silicon. Besides, these parameters affected directly the secondary precipitation of silicon and aluminum as a zeolitic phase, which polluted the treated ilmenite concentrate. Leaching kinetics determined the feasibility of the process, leading to the development of two optimized alternatives. The first alternative achieved the reduction of silicon and aluminum content to 0.32% and 0.61%, respectively, after 72 h leaching at 120 °C. This alternative necessitated a leached solids washing stage in order to separate the formed precipitate from the treated ilmenite concentrate. The second alternative achieved to reduce silicon and aluminum to 0.29% and 0.59%, respectively, after 1 h leaching at 200 °C, while avoided the formation of the secondary precipitate. Both alternatives achieved the selective leaching of silicon and aluminum without affecting titanium and iron content of the ilmenite concentrate. The applicability of each alternative is a matter of detailed technical and economic studies.     

Mineralocorticoid receptor antagonism prevents hedonic deficits induced by a chronic sodium appetite.

Our laboratory has reported that manipulations that provoke a robust sodium appetite (e.g., sodium depletion, deoxycorticosterone acetate) decrease lateral hypothalamic self-stimulation (LHSS) reward if rats are denied access to hypertonic saline solutions. The following studies investigated the interaction between chronic sodium appetite and the renin-angiotensin-aldosterone system on LHSS reward. In Experiment 1, animals treated with the diuretic furosemide (20 mg/kg) when denied access to saline exhibited an increase in the current required to produce 50% of the maximum LHSS response rate (ECu50) 48 hr after extracellular volume depletion. Furosemide-depleted rats that were allowed to drink 0.3 M saline after depletion, or that were treated with the selective mineralocorticoid receptor (MR) antagonist spironolactone, which significantly reduced sodium appetite, did not show ECu50 changes. In Experiment 2 chronic intracerebroventricular administration of the selective MR antagonist RU 28318 (10 μg/μl/hr) prevented decreases in the ECu50 induced by deoxycorticosterone acetate-no salt treatment. We conclude that an unresolved sodium appetite will reduce responding for rewards and that experimental manipulations that reduce sodium appetite (e.g., access to saline or blockade of MR) decrease hedonic deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unco-parahippocampectomy for direct surgical treatment of downward transtentorial herniation

Downward transtentorial herniation is a major cause of death and disability caused by acute supratentorial mass lesions. Thirteen patients, 7 men and 6 women aged from 23 to 75 years old, with progressive transtentorial herniation caused by cerebral contusion with acute subdural haematoma, acute brain swelling after aneurysmal subarachnoid haemorrhage, or massive cerebral infarction were treated by direct surgery using selective removal of the uncus and parahippocampal gyrus (unco-parahippocampectomy). All patients showed progressive deterioration of transtentorial herniation (late third nerve stage or midbrain stage) with unilateral pupillary dilation and absent light reflex. Preoperative Glasgow Coma Scale scores ranged from 4 to 8. Unco-parahippocampectomy was performed via the middle temporal gyrus under the operating microscope. The oculomotor nerve, posterior cerebral artery, and midbrain were directly decompressed. Incision of the arachnoid membrane in the tentorial incisura allowed free communication of the cerebrospinal fluid between the supra- and finfra-cranial fossae to reduce the pressure gradient. Two of the 13 patients died (15%). Two of the 11 survivors (18%) were functionally independent and 1 (9%) required minimal assistance but was independent at home. This series suggests the lifesaving nature of unco-parahippocampectomy in patients with deteriorating clinical condition because of transtentorial herniation.     

Frostbite as a problem for dermatoplastic surgery

An analysis of the 35-years experiences with treatment of 621 patients with the IV-degree frostbite of hands and feet is presented. The surgical strategy of treatment of frostbite has undergone considerable evolution for these years. In addition to classical surgical treatment, the surgeons began to widely use methods of dermo-plastic surgery which allowed not only to save the maximum possible length of the extremity segment stump, but also to reduce the frequency of purulent complications and reamputations and thus to shorten the duration of hospital treatment.     

Grain boundary composition and associated hydrogen cracking of modified 4130 steels

Earlier work on AISI 4130 steels showed that phosphorus segregation to prior austenite grain boundaries was the primary cause for intergranular fracture of these steels when exposed to hydrogen. Reduction of P segregation to grain boundaries by removing the strong segregation couples of Mn-P and Si-P was expected to increase the hydrogen stress cracking resistance of 4130 type steels. Elimination of Mn and/or Si did reduce the concentration of P at prior austenite grain boundaries, but allowed segregation of S and N which acted in the same manner as P, promoting intergranular hydrogen stress cracking.     

The immediate reconstruction of the breast after a mastectomy for carcinoma. Our experience

The authors surgically treated 281 consecutive women with breast cancer by breast conservation techniques (45.2%) or by mastectomy (38.8%), during a four-year period. Forty-five of these 281 patients (16%) were treated in the same period of time by mastectomy and immediate reconstruction (IR) of the breast. IR of the breast was performed by inserting a submuscular tissue expander at the same time of mastectomy (first stage of reconstruction). A second operation allowed the replacement of the expander with a prosthesis (second stage of reconstruction) and the simultaneous symmetrization of the contralateral breast (not always performed, however). In some cases nipple-areola complex was eventually reconstructed with a delayed surgical procedure (third stage of reconstruction). In the present paper the authors analyze the results and outline the advantages of IR. This easy and safe technique slightly increased the average operative time of a mastectomy, did not interfere with routine oncological follow-up, did definitely reduce patient's psychological trauma following mastectomy. The authors conclude that IR of the breast undoubtedly plays a major role in the so called "onco-plastic" surgical management of breast cancer.     

Superhydrophobic and anti-icing properties of sol–gel prepared alumina coatings

Sol–gel is a convenient method to fabricate micro-nano structures on various surfaces. In the present study, rough alumina surfaces were prepared from aluminum isopropoxide and ethyl acetoacetate and modified with low-concentration lauric acid (LA) dissolved in ethanol. The sample hydrophobicity and antiicing property were optimized by changing the rotation speed, rotation time, and coating thickness during spin-coating, and the type and concentration of surface modifier used during surface hydrophobization. Superhydrophobic surfaces were achieved with contact angle values as high as 157.6°, when 0.4-mm-thick coatings were modified with 0.4% LA dissolved in ethanol. The surface morphology of the superhydrophobic samples was shown to be rough at micro/nano-scale, which allowed them to demonstrate excellent anti-icing properties. Specifically, the optimized sample could delay the icing time and reduce the freezing temperature from 15 min and–4.1°C (for uncoated aluminum) to 65 min and–8.3°C, respectively, while also reducing the ice adhesion strength twice.     

Must the patient fast before intravascular injection of a non-ionic contrast medium? Results of a controlled study

PURPOSE: Prospective evaluation of food and fluid restriction before the intravascular injection of a non-ionic contrast medium. MATERIAL AND METHODS: 1000 patients (657 men, 343 women; average age 59 +/- 1/4 5 years) undergoing intravascular contrast injections (CT, phlebography, angiography, urography) were randomly allocated to two groups. Group A had no fluid or solids for at least four hours before the injection (499 cases); group B were allowed unlimited food and fluid (501 cases). Both groups were comparable in all other respects and all were given the non-ionic contrast medium iopamidol (300 mg l/ml). RESULTS: The incidence of acute complications was 3.5%. There was, however, no statistically significant difference between the two groups (p = 0.29). Late adverse reactions were seen in 3.9% patients. There was again no difference between the two groups (p = 0.33). No serious or life threatening complications occurred. CONCLUSION: Restriction of food and fluid before intravascular injection of contrast medium does not reduce the number of adverse side effects. For reasons of patient comfort and compliance, and to achieve adequate hydration, the patient should not fast before injection of contrast.