Increased flight surgeon role in military aeromedical evacuation

BACKGROUND: Physicians were involved in the development of aeromedical evacuation (medevac) and flight surgeons flew as crewmembers on the first U.S. military medevac flights. However, since World War II flight surgeons have not been routinely assigned to operational medevac units. The aeromedical literature addressing the role of physicians in medevac is controversial. Recent contingencies involving the U.S. Air Force (USAF) have required the augmentation of medevac units with flight surgeons. RECENT CHANGES IN THE EUROPEAN THEATER: Beginning in 1992, the United States Air Forces Europe (USAFE) assigned three flight surgeons to the medevac squadron. Between 2 February 1993 and 24 March 1994 USAFE moved 241 patients on 29 missions out of the former Yugoslavia--most of these missions had a flight surgeon on the crew. Because advance medical information on the status of these patients is often nonexistent, the presence of a physician on the crew proved life-saving in some instances. In peacetime operations, there has been a recent trend in the European theater for the USAF to move more unstable patients. OBSERVED BENEFITS OF PHYSICIANS IN MEDEVAC: Dedicated medevac flight surgeons have proven to have the specific experience and training to perform effectively in the role of in-flight medical attendant. In addition, they are effective in negotiating with referring physicians about the urgency of movement, required equipment, the need for medical attendants, etc. These flight surgeons also provide medical coverage of transiting patients in the Aeromedical Staging Flight (ASF), thus providing needed continuity in the medevac system. CONCLUSION: Dedicated medevac flight surgeons fill a unique and valuable role in medevac systems. Agencies with medevac units should consider assigning flight surgeons to these units.     

The functional anatomy of imagining and perceiving colour

OBJECTIVE: To determine whether the progression of urinary albumin excretion rate (AER) is higher during puberty than before or after this period. RESEARCH DESIGN AND METHODS: A prospective study was conducted in which normoalbuminuric prepubertal (n = 20), pubertal (n = 28), and postpubertal (n = 26) IDDM groups matched for diabetes duration and long-term metabolic control were followed for 3 years. At 6-month intervals, 24-h urine collection was used to determine AER. RESULTS: AER increased significantly over a period of 3 years in the pubertal (P = 0.001) and postpubertal (P = 0.003) subjects but not in prepubertal subjects. The annual progression of AER was significantly higher in the pubertal group than in the prepubertal (P = 0.001) or postpubertal (P = 0.001) groups. Six pubertal, two postpubertal, and none of the prepubertal subjects developed microalbuminuria (AER > or = 20 micrograms/min on two consecutive occasions) over a 3-year period (P = 0.047). Multiple logistic regression analysis showed that the risk of development of microalbuminuria was increased in pubertal subjects compared with the prepubertal and postpubertal subjects (adjusted relative risk [95% CI]: 4.3 [1.5-9.3], P = 0.012, and 2.1 [1.1-5.0], P = 0.023, respectively). CONCLUSIONS: Puberty represents an independent risk of the development of microalbuminuria in diabetes. This findings suggests that the endocrine changes of puberty lead to an accelerated process of early kidney damage in diabetes. In pediatric diabetes care, screening for microalbuminuria is needed soon after the onset of puberty.     

Can scintimammography reduce "unnecessary" biopsies?

99Tc-sestamibi prone scintimammography (SMM) is a new, noninvasive method of imaging breast tumors. A pilot study has suggested that SMM increases the specificity of mammography, and that SMM could be used as an adjunct to mammography to reduce the number of mammographically indicated biopsies. The goal of this study was to further evaluate the efficacy of SMM in diagnosing or excluding breast carcinoma. This was a prospective case series with each patient serving as her own control. All subjects who had an abnormal mammogram, a palpable breast mass, or both were eligible for inclusion. All patients underwent breast examination, conventional mammography, SMM, and breast biopsy. Of the 81 women originally enrolled, 79 women with 80 lesions completed the study. SMM produced the following results: a sensitivity of 81 per cent, a specificity of 81 per cent, a positive predictive value of 61 per cent, and a negative predictive value of 92 per cent. These values were significantly lower than the pilot study results at a power of 80 per cent and P = 0.05. Our results indicate that SMM does not increase the specificity of conventional mammography and has a low negative predictive value. We would not recommend it as a screening technique to avoid biopsy.     

Sustained local delivery of heparin to the rabbit arterial wall with an electroporation catheter

Since the rapid expansion of managed care coupled with dramatic reductions in lengths of inpatient stay, there is widespread concern that the emphasis on cost containment is eclipsing attention to patient care. The present study was undertaken to evaluate speculations that the majority of short-stay (less than 48 hours) admissions to a psychiatric inpatient service at a large teaching hospital in the midwestern United States consisted of public pay patients who were rapidly transferred to area state hospitals. Using two cases mix measures, severity of illness and changes in acuity and clinical outcomes of a sample of short-stay (n = 77) and longer stay (n = 145) admissions were compared. Short-stay admissions, although similar to longer stay patients in terms of demographics, Axis I diagnosis, payer status, and appropriateness of admission, are clinically distinct. The use of nonhospital alternatives in treating a subsample of suicidal patients and the implications for improved mental health services delivery are discussed.     

Recombinant proteins in newly developed foods: identification of allergenic activity

A number of agricultural crops are being modified for various purposes using recombinant DNA technology. Since transferred genes may code for proteins that are ordinarily not present, there is concern about the potential allergenicity of these new varieties. The safety evaluation of transgenic foods is relatively easy when the allergenicity of the gene source is known. Recombinant allergens in genetically engineered or altered foods can be identified using traditional immunological assays such as RAST or ELISA inhibition or immunoblotting procedures. Our recent studies of two corn proteins (10 kD and HSZ) used to alter grain amino acid composition and of transgenic soybeans with an altered fatty acid profile are examples of this approach. Both 10 kD and HSZ did not bind IgE antibodies from sera of corn-reactive subjects by immunoblotting. Studies of wild-type and transgenic soybeans with high oleic acidic content by RAST inhibition and immunoblotting with pooled sera of soy-allergic individuals demonstrated no difference in the allergen content of both extracts. In contrast to these studies, a recent investigation by Nordlee et al. (1996) of transgenic soybeans which expressed a methionine/cysteine-rich protein from Brazil nuts identified this protein as a major Brazil nut allergen. These studies indicate that, when the gene source is from a known allergen or if the recipient contains allergens, it is possible to determine whether the allergen content of the transgenic line is altered relative to the nontransgenic varieties.     

Higher-level snake phylogeny inferred from mitochondrial DNA sequences of 12S rRNA and 16S rRNA genes

N-Nitrosomethylbenzylamine (NMBA) is a potent esophagus-specific carcinogen that has been utilized extensively in the study of esophageal carcinogenesis in rats. While many studies have focused on the pathogenesis of NMBA-induced esophageal tumors, the tumorigenicity of NMBA itself has not been thoroughly investigated in any single, systematic dose-response study. Therefore, in this study we evaluated NMBA tumorigenicity in rats following various short-term s.c. treatment regimens with the aim of developing an abbreviated treatment protocol which could be used in future studies. To assess the possible correlation of basal cell proliferation with NMBA tumorigenicity, we evaluated the expression of proliferating cell nuclear antigen (PCNA) in both control and NMBA-treated rats. In rats which received a cumulative NMBA dosage of 7.5 mg/kg over the course of 5 weeks, tumor incidence and multiplicity were as follows: 40% with 0.4 +/- 0.3 tumors/rat at week 10; 100% with 2.2 +/- 1.0 tumors/rat at week 20; and 100% with 2.3 +/- 1.0 tumors/rat at week 30. These rats exhibited marked increases in basal cell labeling, with indices that were 1.5- to 1.8-fold higher than controls. NMBA treatment regimens of shorter duration with equivalent or higher cumulative dosages were generally ineffective in producing esophageal tumors, even though significantly elevated levels of basal cell proliferation occurred. Together, these findings indicate that the duration of NMBA treatment is of critical importance in the tumorigenic potential of the carcinogen.     

Stage-specific expression of activation antigens on NK cells at uterine implantation sites in mice

The differentiation of the cellular components of the uterine decidua, in particular the life history of NK cells, is poorly understood. With the use of two mAbs that recognize stage-specific activation Ags on NK cells, we investigated the development of NK cells known as granulated metrial gland (GMG) cells. Immunohistochemical analysis demonstrated that mAb 3C2, but not mAb 4H12, recognized numerous cells throughout the uterine decidua basalis during early gestation. Isolated (panned) 3C2+ decidual cells from day 7 of pregnancy co-expressed the NK1.1 Ag, displayed NK cytolytic activity, and proliferated in IL-2-containing media. A small percentage of those cells expressed the GMG-associated Ag 4H12. Immunohistochemical analysis of serial sections at midgestation demonstrated that most of the 3C2+ NK cells co-expressed 4H12 Ag. During the later part of pregnancy, however, 3C2 expression in the decidua was down-regulated, and the cells expressed high levels of 4H12 Ag. When 3C2+ NK cells were isolated from cell suspensions of decidua from 7-day pregnant mice, and cultured in IL-2-containing medium, the cells developed the large and granular morphology characteristics of GMG cells, and acquired 4H12 Ag. These results demonstrate that 4H12+ GMG cells differentiate from 3C2+, NK1.1+, cytolytic precursors that reside in the decidua during early gestation.