The influence of psychosocial factors on heart transplantation decisions and outcomes

In January 1990, a well-established heart transplant program added a psychosocial evaluation procedure to its medical evaluation of potential transplant recipients. To determine the predictive value of psychosocial evaluation for decisions to list patients for a transplant and for ultimate clinical outcomes, we reviewed records of 191 patients who underwent psychosocial evaluation in the subsequent 3 years. Informal prescreening for obvious psychopathology and other disqualifiers almost certainly restricted the ranges of psychosocial factors observed in the sample. Of 120 patients listed, 61 actually received transplants. Psychosocial factors were little used in deciding whether to list the patients and were not predictive of recipients' medical outcome or compliance, but were moderately predictive of complication rates and difficulty of managing patients after transplantation. Although psychosocial evaluation of prescreened potential transplant recipients has little value in predicting medical outcome, it may be useful for planning and scheduling care after transplantation.     

Sites of alcohol and volatile anaesthetic action on GABA(A) and glycine receptors

Volatile anaesthetics have historically been considered to act in a nonspecific manner on the central nervous system. More recent studies, however, have revealed that the receptors for inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA) and glycine are sensitive to clinically relevant concentrations of inhaled anaesthetics. The function of GABA(A) and glycine receptors is enhanced by a number of anaesthetics and alcohols, whereas activity of the related GABA rho1 receptor is reduced. We have used this difference in pharmacology to investigate the molecular basis for modulation of these receptors by anaesthetics and alcohols. By using chimaeric receptor constructs, we have identified a region of 45 amino-acid residues that is both necessary and sufficient for the enhancement of receptor function. Within this region, two specific amino-acid residues in transmembrane domains 2 and 3 are critical for allosteric modulation of both GABA(A) and glycine receptors by alcohols and two volatile anaesthetics. These observations support the idea that anaesthetics exert a specific effect on these ion-channel proteins, and allow for the future testing of specific hypotheses of the action of anaesthetics.     

The "epidemic" of breast cancer in the U.S.--determining the factors

Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I breast cancers have been increasing, while the incidence of later-stage cancers has been decreasing. Increased mammography screening may explain the documented jump in breast cancer incidence rates during the mid-1980s. Differences in the distribution of breast cancer risk factors may account, in part, for the temporal trends in breast cancer incidence. In particular, breast cancer risk factors may vary by birth cohort, including age at menarche, age at first birth, physical activity, obesity, diet, alcohol intake, estrogen therapy, and exposure to environmental organochlorines. After decades of epidemiologic research, a preventive approach to breast cancer that focuses on the physiologic effects of the sex steroid hormones, and their potential interactions with family history, is being carefully formulated.     

Characteristic Anthocyanin Pattern from Onions and other Allium spp

Three red onion (Allium cepa) cultivars, top onion (A. cepa var. vivi-parum), A. altaicum and chive (A. schoenoprasum) contained several or all of the following anthocyanins: 3-(6′-malonyl-3′-glucosylglucoside), 3-(3′,6′-dimalonylglucoside), 3-(6′-malonylglucoside), 3-(3′-malonyl-glucoside), 3-(3′-glucosylglucoside) and 3-glucoside of cyanidin. Trace amounts of two pelargonidin derivatives and the 3,5-diglucosides of cyanidin and peonidin were for the first time reported in red onion. Carbon NMR data showed that the sugars of the 3-(6′-malonyl-3′-glu-cosylglucoside), 3-(6′-malonylglucoside) and 3-glucoside of cyanidin were pyranoses. Substitution either by sugar or acid in the sugar 3-position of an anthocyanin has never been reported outside the genus Allium.     

Finite element stress analysis of a new design of synthetic leaflet heart valve

This paper presents a parametric finite element analysis of the stresses in the leaflets of a new design of polyurethane heart valve in the closed position. The alpharabola geometry of the valve has previously been reported by Leat and Fisher (1) and has been shown to demonstrate good opening characteristics. The effects of variations in leaflet offset parameter, g, length, h, and local thickening have been determined for a valve where the frame is assumed rigid. A spherical leaflet geometry has also been analysed for comparative purposes. Results have shown that the alpharabola leaflet geometry can reduce the maximum principal tensile stress to 60 per cent of that for a spherical valve of the same mesh density.     

The prevalence of clinically significant anaemia and haemoglobinopathy in children requiring dental treatment under general anaesthesia: a retrospective study of 1000 patients

There is little information on the possible value of screening children who are liable to haemoglobinopathies as part of pre-operative assessment for dental treatment under general anaesthesia. The present retrospective investigation examined, first, the number of patients having low haemoglobin levels among 1000 patients who had undergone haematological investigation prior to general anaesthesia in a dental outpatient unit, and, secondly, the subsequent clinical management of these patients. Haemoglobin levels of 10.0 g/dl or less were found in 31 children: 13 Asian, 7 Afro-Caribbean, 5 Mediterranean, 3 Arabic, 1 white Caucasian and 2 Oriental children. In addition, 17 patients had sickle-cell trait and 2 had beta-thalassaemia trait, but there was no relationship between the presence of haemoglobinopathy and low levels of haemoglobin. The planned general anaesthesia was undertaken for 22 of the 31 children who had low levels of haemoglobin and for the 19 children with haemoglobinopathy. Only 6 children ultimately did not undergo general anaesthesia, all failing to return. It is concluded that pre-anaesthetic haematological assessment of children needing minor dental surgery is rarely of any significant clinical value.