The economic costs associated with body mass index in a workplace

This study was undertaken to determine if a progressive correlation exists between body mass index (BMI), health care costs, and absenteeism and to identify an economically optimal BMI. We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data. Analysis was completed for those employees with and without a risk for BMI. People at risk for BMI are more likely to have additional health risks, short-term disability and illness absence, and higher health care costs than those not at risk for BMI. A "J-shaped" curve between health care costs and BMI exists, with the low point occurring at about 25 to 27 kg/m2. We concluded that indirect and direct costs to an employer increase with increasing BMI. Employers may benefit from helping employees achieve a healthy weight. The initial target population should be those who are at highest risk of complications from obesity.     

Idiopathic perforation of a porcine aortic bioprosthesis in the aortic position

The report of a failure of glutaraldehyde-preserved porcine aortic xenograft bioprosthesis in the aortic position after 13 months is presented. Severe aortic regurgitation resulted from three "idiopathic" perforations in one of the cusps, and a linear tear in another cusp. Light and electron microscopy showed generalized degeneration of collagen thoughout the faulty valve. The absence of a platelet-fibrin coat on edges of the tear suggested a recent origin, compatible with cardiac catheter manipulation during unsuccessful attempts to cross the valve. The histopathologic data from this valve correlate with previously reported failures with formaldehyde preserved xenograft valves.     

Shock-induced and self-propagating high-temperature synthesis reactions in two powder mixtures: 5:3 Atomic ratio Ti/Si and 1:1 Atomic ratio Ni/Si

The conditions for initiation and propagation of the reaction forming the intermetallic compounds Ti₅Si₃ and NiSi from mixtures of elemental powders of varying porosity have been investigated using shock waves of different pressure and at atmospheric pressure using hot wire ignition in air and in an argon atmosphere. In each case, the reaction either went to completion or the powder remained essentially unreacted. The conditions for the initiation of the reaction in Ti/Si are sensitive to the presence of air. Two regimes of porosity and shock pressure are found for the Ti/Si mixture which cause complete reaction. A low-energy regime with a high initial porosity (producing a low shock pressure) with 0.1 torr of residual air triggers the reaction, while no reaction is observed with a 128 pct higher shock energy and a lower initial porosity (producing a higher shock pressure) when the residual air is replaced with argon. Hot wire ignition of porous Ti/Si powder at room temperature initiates a self-propagating high-temperature synthesis (SHS) reaction more easily in air than in an argon atmosphere, while the Ni/Si powder must be heated to allow the SHS reaction to propagate in high- or low-porosity mixtures in air. These observations are compared to published work on self-sustaining reactions in multilayer films. Reasons for the difference in behavior of the two powder mixtures are discussed. This paper is based on a presentation made in the symposium “Reaction Synthesis of Materials” presented during the TMS Annual Meeting, New Orleans, LA, February 17–21, 1991, under the auspices of the TMS Powder Metallurgy Committee.     

Ondansetron in the treatment of intractable nausea associated with theophylline toxicity

OBJECTIVE: To report the efficacy of ondansetron in the treatment of a patient poisoned with theophylline. PATIENT: A 36-year-old man who ingested 6 g of sustained-release theophylline. INTERVENTION: Ondansetron 8 mg intravenously after clinical failure of other antiemetics. RESULTS: Subjective relief of nausea within minutes, enabling the patient to tolerate multiple doses of activated charcoal and whole bowel irrigation. CONCLUSIONS: Ondansetron may offer an alternative to present antiemetic therapy in the poisoned patient.     

The crystal structure of a class II fructose-1,6-bisphosphate aldolase shows a novel binuclear metal-binding active site embedded in a familiar fold

BACKGROUND: [corrected] Aldolases catalyze a variety of condensation and cleavage reactions, with exquisite control on the stereochemistry. These enzymes, therefore, are attractive catalysts for synthetic chemistry. There are two classes of aldolase: class I aldolases utilize Schiff base formation with an active-site lysine whilst class II enzymes require a divalent metal ion, in particular zinc. Fructose-1,6-bisphosphate aldolase (FBP-aldolase) is used in gluconeogenesis and glycolysis; the enzyme controls the condensation of dihydroxyacetone phosphate with glyceraldehyde-3-phosphate to yield fructose-1,6-bisphosphate. Structures are available for class I FBP-aldolases but there is a paucity of detail on the class II enzymes. Characterization is sought to enable a dissection of structure/activity relationships which may assist the construction of designed aldolases for use as biocatalysts in synthetic chemistry. RESULTS: The structure of the dimeric class II FBP-aldolase from Escherichia coli has been determined using data to 2.5 A resolution. The asymmetric unit is one subunit which presents a familiar fold, the (alpha/beta)8 barrel. The active centre, at the C-terminal end of the barrel, contains a novel bimetallic-binding site with two metal ions 6.2 A apart. One ion, the identity of which is not certain, is buried and may play a structural or activating role. The other metal ion is zinc and is positioned at the surface of the barrel to participate in catalysis. CONCLUSIONS: Comparison of the structure with a class II fuculose aldolase suggests that these enzymes may share a common mechanism. Nevertheless, the class II enzymes should be subdivided into two categories on consideration of subunit size and fold, quaternary structure and metal-ion binding sites.     

Advances in the management of Crohn's disease: economic and clinical potential of infliximab

New therapies for Crohn's disease are being developed based on improvements in our understanding of the disease's immune and inflammatory properties. One of these new therapies is infliximab, a monoclonal antibody directed against the proinflammatory cytokine tumor necrosis factor-alpha. Recent studies indicate that treatment of moderately to severely ill Crohn's disease patients with infliximab produces a rapid and profound reduction in the signs, symptoms, and severity of this disease. Beyond its clinical impact, Crohn's disease also carries significant economic consequences. Earlier reports on the costs of managing this disease estimated the average annual medical costs per patient at $9197, with the total annual cost of illness estimated to exceed $1.7 billion. Hospitalizations and surgeries represented 80% of these costs. Additional analyses have been conducted for this review to reflect more current treatment patterns. Assuming that proven increases in response and remission rates lead to diminished disease severity, infliximab can be expected to reduce the number of hospitalizations and surgeries in moderately to severely ill patients, with substantial cost savings. Moreover, improvement in disease status and quality of life may allow Crohn's disease patients to lead more productive lives.     

Are maternal diabetes and preeclampsia independent simulators of fetal erythropoietin production?

To determine if diabetes and preeclampsia are independent stimulators of erythropoietin, distinct from hypoxia, we measured umbilical cord plasma erythropoietin in 239 deliveries from 24 to 40 weeks of gestation. Mean plasma erythropoietin levels were not different between normal, diabetic, and preeclamptic women when all deliveries were analyzed. When infants with suspected intrauterine hypoxia were excluded, the mean erythropoietin level was considerably lower within all three groups but there was no difference among the groups. In suspected hypoxia, the mean fetal erythropoietin was elevated, but there was no difference between control, diabetic, or preeclamptic pregnancies. These results provide further support that hypoxia remains the only known stimulator of erythropoietin production in the fetus.     

Inhibition of white blood cell adhesion at reperfusion decreases tissue damage in postischemic striated muscle

By correlating data obtained from environmental indicators and health indicators over a five-year period, a system for measuring the effects of air pollution on health has been established and tested. Rises in air pollution levels do appear to be accompanied by increases in the relevant health problems.     

Using bioinspired thermally triggered liposomes for high-efficiency mixing and reagent delivery in microfluidic devices

High-efficiency mixing is of fundamental importance for the successful development and application of lab-on-a-chip devices. In this report, we present the use of bioinspired thermally triggered liposomes for the controlled delivery and subsequent rapid mixing of reagents in a microfluidic device. In this technique, reagents are encapsulated inside the aqueous interior of liposomes that are dispersed evenly throughout a microfluidic system. Mixing of the encapsulated reagent and reaction do not occur until the reagent is released by a thermal trigger. This approach takes advantage of the dramatically increased lipid membrane permeability of liposomes near the gel-to-liquid phase transition temperature (T(m)) to deliver reagents at a precise location in the microfluidic device through the modulation of temperature. Implementation of this technique requires the encapsulation of the desired reagent in a liposome whose formulation has an appropriate T(m), as well as accurate spatial control of the temperature in the microfluidic device. As the liposomes are uniformly dispersed through the microfluidic channel, mixing occurs quite rapidly upon the release of the reagent. We demonstrate this technique by using several formulations of thermally triggered liposomes to release the hydrophilic fluorescent dyes at controlled locations in a polycarbonate microfluidic device. Additionally, we demonstrate a DNA labeling reaction using liposomes in a capillary-based microfluidic device. Under the conditions studied here, mixing and reaction are complete in approximately 200 microm of channel length. We believe this approach holds great promise for the performance of rapid high-throughput assays and in particular for biological analytes whose native environment is mimicked by the liposome.