Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients

In patients with cervical instability as the primary injury, either ligamentous or bony, a posterior approach and stabilization is the most likely definitive treatment. The goals should be to obtain and maintain satisfactory alignment, promote fusion, and allow safe and early mobilization. Many techniques that differ in safety, ease of application, cost, biomechanical strength, and postoperative requirements of immobilization are available. This article reviews different methods of posterior surgical interventions in subaxial cervical spine injuries and discusses the advantages and disadvantages of each.     

Immunohistochemical and molecular characterization of the rat 11 beta-hydroxysteroid dehydrogenase type II enzyme

Mineralocorticoid action is facilitated by 11 beta-hydroxysteroid dehydrogenase type II (11 beta HSD2), which metabolizes glucocorticoids and allows aldosterone to bind to the nonselective mineralocorticoid receptor. We have recently demonstrated the presence of the 11 beta HSD2 protein in a wide range of human epithelia, suggesting that it is the sole isoform endowing specificity in man. In the present study we have used an immunopurified polyclonal antibody (RAH23) raised against a C-terminal peptide derived from the cloned rat 11 beta HSD2 protein to perform immunohistochemical and molecular analysis in rat tissues. In frozen sections of rat kidney, strong staining was seen with the RAH23 antibody in the distal tubule; weaker staining was observed in the thick ascending loop of Henle and the medullary and papillary collecting ducts. Punctate cortical staining was observed in the fetus at 20 days gestation and in 8-day-old rats, with a noticeable increase in the staining pattern at 16 days of age. The kidney did not attain the adult pattern of staining until 28 days of age. Epithelia of ileum and colon also stained with RAH23, as did excretory ducts of the submandibular gland. Intrahepatic and excretory bile ducts displayed strong immunoreactivity in the epithelial lining. Rat adrenal glands showed evidence of the 11 beta HSD2 antigen in the zona fasciculata and zona reticularis, but not in the zona glomerulosa or medulla. Western blot analysis with the RAH23 antibody revealed strong bands in the kidney, colon, adrenal gland, and submandibular gland at 40 kDa, colinear with the migration of the cloned 11 beta HSD2 enzyme. A band of medium intensity was also seen at this size in the pancreas, whereas a band of moderate intensity was seen in the bile duct, and weaker bands were noticed in the stomach, small intestine, and liver, with a diffuse band at 36-42 kDa in the prostate. Strong bands were seen in the pancreas and prostate at 78 kDa, with weaker signals in the colon, adrenal, stomach, and bile duct. A number of tissues also displayed multiple bands at about 30 kDa. Enzymatic assays on tissue homogenates showed extensive conversion of corticosterone to its 11-dehydro product in an NAD-dependent manner in the submandibular gland, adrenal gland, and kidney, but not in the pancreas or prostate. This study confirms the ubiquitous presence of 11 beta HSD2 in sodium-transporting epithelia, demonstrates the high level of 11 beta HSD2 protein and enzyme activity in the rat adrenal, and suggests a possible role for the enzyme in the biliary system. Further studies are required to determine the relevance of the various molecular species to the activity, latency, and processing of the enzyme.     

Vinyl acetate monomer—a pilot plant study

The kinetics of the reaction of acetic acid and acetylene over zinc acetate-activated carbon catalyst was investigated over a wide range of process variables in a pilot reactor. Although various catalytic reaction mechanisms were postulated, the rate of reaction was most satisfactorily correlated by a mechanism of surface reaction between charged adsorbed acetic acid and acetylene, which assumes that the rate controlling step was the irreversible charged adsorption of acetylene and acetic acid.     

Serum enzyme abnormalities in protein energy malnutrition

A semi-quantitative right coronary artery score (RCA score) was derived from the ratio of the number of the major left ventricular branches of the right coronary artery to the total of the right coronary and left circumflex arteries, to stratify the extent of perfusion in patients with right coronary artery dominance. Thirty-seven patients with one-vessel coronary disease involving a dominant right coronary artery proximal to the left ventricular branches were selected for study. Thallium scintigraphy was performed after right intracoronary injection in 11 patients, and 26 patients underwent conventional stress thallium scintigraphy (24 exercise thallium and two dipyridamole thallium scintigraphy). Thallium scores of perfusion region size after right intracoronary thallium injection and perfusion defect size in stress thallium studies were quantitated from planar thallium images. Both the RCA score and the regional thallium scores spanned over a wide range. The RCA score (range 0.23-0.85) correlated best with the posterior (70 degrees left anterior oblique view) plus lateral segment (40 degrees left anterior oblique view) thallium score (r = 0.88 and 0.53 for intracoronary and stress thallium studies respectively). It also correlated with the summed thallium scores in the posterior, lateral, apical and inferior segments (r = 0.73 and 0.54 respectively) but not with thallium scores in the apex or inferior segment alone. The proposed RCA score quantitates the variable posterolateral perfusion territory of the right coronary artery, and could stratify the area of myocardium at risk from coronary stenosis in the majority of patients with right coronary dominance.     

Managing signal integrity [PCB design]

As system clock rates race to 100 MHz and beyond, designers of printed-circuit boards and multichip modules must watch out for such high-speed effects as ground bounce, ringing, reflections, and crosstalk. The author describes how today's high-speed printed-circuit boards and multichip modules require integrated design systems that include signal integrity analysis tools     

Dependence of critical current density on microstructure and processing of high-Tc superconductors

Microstructural origins for reduced weak-link behavior in high-J_c melt-processed YBCO, spray pyrolyzed thick films of Tl-1223, metallic precursor Y-124 polycrystalline powder-in-tube (PIT) wires and PIT Bi-2212/2223 are discussed. Since the materials studied are the highest J_c, polycrystalline, high-T_c superconductors fabricated worldwide, the results provide important guidelines for further improvements in superconducting properties, thereby enabling practical applications of these materials. It is found that strongly linked current flow within domains of melt-processed 123 occurs effectively through a single crystal path. In c-axis oriented, polycrystalline Tl-1223 thick films, local in-plane texture has been found to play a crucial role in the reduced weak-link behavior. Formation of “colonies” of grains with a common c-axis and modest in-plane misorientation was observed. Furthermore, a colony boundary in general has a varying misorientation along the boundary. Large regions comprised primarily of low angle boundaries were observed. Percolative transport through a network of such small angle boundaries appears to provide the nonweak-linked current path. Although powder-in-tube BSCCO 2212 and 2223 also appear to have a “colony” microstructure, there are some important differences. Colonies in BSCCO consist of stacks of grains with similar c-axis orientation in contrast to colonies in Tl-1223 films where few grains are stacked on top of one another. Furthermore, most grains within a colony in BSCCO have the same lateral dimensions as that of the colony, resulting largely largely in “twist” boundaries. Further microstructural characterization of high-J_c PIT 2212 and 2223 is currently underway. In the case of Y-124 wires, weak macroscopic in-plane texture is found. Additional measurements are underway to determine if a sharper, local in-plane texture also exists. It is found that in three of the four types of superconductors studied, reduced weak-link behavior can be ascribed to some degree of biaxial alignment between grains, either on a “local” or a “global” scale.