The specific hospital significantly affects red cell and component transfusion practice in coronary artery bypass graft surgery: a study of five hospitals

BACKGROUND: Interhospital differences in blood transfusion practice during coronary artery bypass graft (CABG) surgery have been noted, but the underlying issues have not been identified. STUDY DESIGN AND METHODS: Records of 3217 consecutive CABG cases in five university teaching hospitals in 1992 and 1993 were stratified by hospital, type of revascularization conduit, patients' sex, and other factors. Statistical methods were used to compare patient characteristics, transfusion outcomes, and hospital outcomes. RESULTS: Forward two-step logistic regression using patient likelihood of red cell transfusion factors in the first step and the specific hospital in the second step revealed a significant effect of hospital on the delta odds ratios for red cell transfusion. This finding was confirmed by analyses of a highly stratified subset of cases, males in diagnosis-related group 107 (primary cases of coronary bypass without coronary catheterization) who underwent revascularization with venous and internal mammary artery grafts, revealing variations among hospitals from 109 to 457 units of red cells transfused per hundred cases. Corresponding variations in transfusions of all blood components were from 324 to 1019 units by hospital. Variation in red cell transfusion practice among surgeons in the same hospital was not responsible for these interhospital differences. CONCLUSION: The effect of the specific hospital on transfusion practice is attributed to institutional differences that, through reasons of training or hierarchy, become ingrained in hospitals.     

Study of factors affecting the determination of total plasma 7-fluorobenzo-2-oxa-1,3-diazole-4-sulfonate (SBD)-thiol derivatives by liquid chromatography

A flunixin metabolite, a hydroxylated product, has been identified in camel urine and plasma samples using gas chromatography-mass spectrometry (GC-MS) and GC-MS-MS in the electron impact and chemical ionization modes. Its major fragmentation pattern has been verified by GC-MS-MS in daughter ion and parent ion scan modes. The method could detect flunixin and its metabolite in camel urine after a single intravenous dose of 2.2 mg of flunixin/kg body weight for 96 and 48 h, respectively, which increases the reliability of antidoping control analysis.     

Tissue and developmental specificity of a polysialo-ganglioside species in the amphibian Xenopus

Xenopus embryos contain a considerable amount of a polysialo-ganglioside not yet fully characterized; in this paper, we will refer to it as ganglioside XI. Preliminary experiments indicate asialo-GMI as the core structure of the ganglioside XI and palmitic and oleic acid as the fatty acids of the ceramide moiety. Further analyses by comparative 2D-TLC with adult fish and chick embryo brains indicate the pentasialilated ganglioside GP1c as the possible structure of XI. In the adult Xenopus, XI characterizes the ganglioside pattern of the central nervous system while is absent in all the other tested tissues. At least two other more polar (presumably richer in sialic acid) bands are often visible under XI, both in embryos and in brain and spinal cord tissues of adult Xenopus. The persistence of polysialo-gangliosides in the brain and spinal cord of adult amphibians could serve to guarantee a proper functioning of the central nervous system at low body temperature.     

Wt-p53 action in human leukaemia cell lines corresponding to different stages of differentiation

Recent studies support the potential application of the wt-p53 gene in cancer therapy. Expression of exogenous wt-p53 suppresses a variety of leukaemia phenotypes by acting on cell survival, proliferation and/or differentiation. As for tumour gene therapy, the final fate of the neoplastic cells is one of the most relevant points. We examined the effects of exogenous wt-p53 gene expression in several leukaemia cell lines to identify p53-responsive leukaemia. The temperature-sensitive p53Val135 mutant or the human wt-p53 cDNA was transduced in leukaemia cell lines representative of different acute leukaemia FAB subtypes, including M1 (KG1), M2 (HL-60), M3 (NB4), M5 (U937) and M6 (HEL 92.1.7), as well as blast crisis of chronic myelogenous leukaemia (BC-CML: K562, BV173) showing diverse differentiation features. By morphological, molecular and biochemical analyses, we have shown that exogenous wt-p53 gene expression induces apoptosis only in cells corresponding to M1, M2 and M3 of the FAB classification and in BC-CML showing morphological and cytochemical features of undifferentiated blast cells. In contrast, it promotes differentiation in the others. Interestingly, cell responsiveness was independent of the vector used and the status of the endogenous p53 gene.     

A 1-Mbit MRAM based on 1T1MTJ bit cell integrated with copper interconnects

A low-power 1-Mb magnetoresistive random access memory (MRAM) based on a one-transistor and one-magnetic tunnel junction (1T1MTJ) bit cell is demonstrated. This is the largest MRAM memory demonstration to date. In this circuit, the magnetic tunnel junction (MTJ) elements are integrated with CMOS using copper interconnect technology. The copper interconnects are cladded with a high-permeability layer which is used to focus magnetic flux generated by current flowing through the lines toward the MTJ devices and reduce the power needed for programming. The 25-mm/sup 2/ 1-Mb MRAM circuit operates with address access times of less than 50 ns, consuming 24 mW at 3.0 V and 20 MHz. The 1-Mb MRAM circuit is fabricated in a 0.6-/spl mu/m CMOS process utilizing five layers of metal and two layers of poly.     

Novel high-temperature reliable heaters in plasma spray technology

Novel high-temperature (600°C) self-regulated heaters have been developed with air plasma spray technology on metal supports, according to the design and processes disclosed in the U.S. patent that was recently published. In the present article, the essential steps of this development are delineated together with the results achieved.     

Association of fasting plasma free fatty acid concentration and frequency of ventricular premature complexes in nonischemic non-insulin-dependent diabetic patients

We investigated the association between free fatty acid (FFA) concentration and ventricular premature complexes (VPCs) in nonischemic patients with non-insulin-dependent diabetes mellitus using 3 approaches: cross-sectional analysis (n = 142), intervention including induction of elevated FFA levels with Intralipid heparin (n = 15), and reduction in FFA levels with Acipimox (n = 34) and a longitudinal follow-up study (n = 59). Patients at the third tertile of fasting plasma FFA concentration had the strongest increase in VPCs. Independently of age, sex, body mass index (BMI), waist/hip ratio, left ventricular mass index, glycated hemoglobin, fasting plasma insulin and triglyceride concentration, and daily physical activity, FFA concentration and VPCs were significantly correlated (r = 0.21 p <0.01). At multiple logistic regression analysis independently of age, sex, BMI, waist/hip ratio, left ventricular mass index, mean arterial blood pressure, glycated hemoglobin, fasting plasma insulin, triglycerides and potassium concentration, fasting plasma low-density lipoprotein/high-density lipoprotein cholesterol ratio, and daily physical activity, plasma FFA concentration was a significant determinant of VPCs (odds ratio 1.2, 95% confidence interval 1.0 to 2.3). Intralipid infusion (10% in 24 hours) (n = 15) and acipimox administration (250 mg, 4 times/day) (n = 34) increased, and decreased fasting plasma FFA concentration, respectively. In those studies, change in VPCs paralleled the effects on plasma FFA. In the longitudinal study (n = 59), plasma FFA concentration predicted the development of VPCs (RR 1.4 95% confidence interval 1.0 to 1.9) independently of age, sex, BMI, waist/hip ratio, left ventricular mass index, mean arterial blood pressure, fasting plasma triglyceride concentration, fasting plasma low-density lipoprotein/high-density lipoprotein cholesterol ratio, and daily physical activity. In conclusion, in nonischemic patients with non-insulin-dependent diabetes mellitus, plasma FFA concentration is associated with the frequency of ventricular premature complexes.     

Determination of selected mycotoxins in mould cheeses with liquid chromatography coupled to tandem with mass spectrometry

A simple and feasible method is described for analysing nine mycotoxins in cheese matrix. The method involves liquid extraction followed by high performance liquid chromatographic separation and mass spectrometric detection of the analytes, and allows the determination of aflatoxins B1, B2, G1, G2 and M1, ochratoxin A, mycophenolic acid, penicillic acid and roquefortine C simultaneously. Average recoveries of the mycotoxins from spiked samples at concentration levels of 5-200 µg kg^-1 ranged from 96-143%. Within-day relative standard deviations at these concentration levels varied from 2.3-12.1%. The limit of quantification for aflatoxin M1 was 0.6 µg kg^-1 and for the other compounds 5 µg kg^-1. The method developed was applied for analysing these mycotoxins in blue and white mould cheeses purchased from Finnish supermarkets. Roquefortine C was detected in all of the blue mould cheese samples in concentrations of 0.8-12 mg kg^-1. One blue cheese contained also 0.3 mg kg^-1 mycophenolic acid. The other investigated mycotoxins were absent in the samples.     

Chronic motion perception deficits from midline cerebellar lesions in human

A selective motion perception deficit is seen in patients with acute midline cerebellar lesions. Patients with more lateralized acute cerebellar damage do not demonstrate such a deficit (Nawrot M, Rizzo M. Vis Res 1995;35:723-731). However, as these patients were tested only between 10 and 14 days post-ictus, the stability of this perceptual deficit into the chronic phase remained undetermined. The current study extends the previous findings by showing that the motion perception deficit caused by mid-line cerebellar lesions remains permanent at least 2 years into the chronic phase. The extent and longevity of this deficit resembles that of the well known motion-blind patient LM who has a large cerebellar lesion in addition to her extensive cortical damage. Again, we propose that the mid-line cerebellar damage may produce a severe motion perception deficit by disruption the visual-motor integration mechanisms involved in perceptual stabilization, even though cortical motion processing mechanisms are unaffected.