The maximum surgical blood order schedule and surgical blood use in the United States

The outdating of units of blood can be reduced by decreasing the amount of time they spend in an assigned or crossmatched status. This reduction can be achieved in a hospital by establishing a maximum surgical blood order schedule (MSBOS) which reduces the excessive number of units of blood crossmatched preoperatively for patients undergoing elective surgery. The various steps which occurred in the development of a MSBOS in a large general hospital are detailed and the projected reduction in the number of crossmatched units which can be achieved with the MSBOS is illustrated. illustrated. The projected number of units of blood transfused to patients during their hospitalization for 50 common primary surgical procedures in the United States during 1974 is presented as a basis for defining maximum blood orders for each procedure.     

Photoaffinity labeling of the human erythrocyte nucleoside transporter by N6-(p-Azidobenzyl)adenosine and nitrobenzylthioinosine. Evidence that the transporter is a band 4.5 polypeptide

N6-(p-Azidobenzyl)adenosine (ABA) and nitrobenzylthioinosine (NBMPR) were employed as covalent probes of the nucleoside transport mechanism in human erythrocytes. NBMPR, a potent inhibitor of nucleoside transport, binds tightly (KD 0.3-1 nM) to specific sites on nucleoside transporter elements. ABA, a less potent inhibitor of uridine influx, competitively inhibited NBMPR binding (Ki 15 nM). [3H]ABA was bound tightly (KD 13.4 nM) but reversibly to sites on erythrocytes which appeared to be those which bind NBMPR. ABA binding was inhibited by uridine and adenosine. Irradiation with UV light caused site-bound [3H]ABA on erythrocyte membranes to become covalently bound and, similarly, photoactivation resulted in covalent attachment of membrane-bound [3H]NBMPR. In the presence of dithiothreitol, a free radical scavenger, photoactivation of the site-bound 3H-ligand on membranes depleted of extrinsic membrane proteins resulted in selective incorporation of 3H into band 4.5 of the membrane polypeptides which were resolved on sodium dodecyl sulfate-polyacrylamide gel electropherograms. This result, when considered with previous findings, indicates that the NBMPR-binding component of the nucleoside transport mechanism (or the entire mechanism, if the NBMPR site is an integral part) is a band 4.5 polypeptide.     

The United States--The Netherlands Round Table Conference on immunization. Summary report

A group of public health scientists from the United States and The Netherlands met at a Bicentennial Round Table Conference December 1-2, 1982, to discuss the latest developments in immunization against infectious diseases, focusing on pertussis, poliomyelitis, measles, and rubella. The major differences in immunization practices in the two countries are: (a) In The Netherlands, inactivated polio vaccine is used exclusively; in the United States, the oral polio vaccine is used. Polio-myelitis has virtually disappeared from both countries. (b) In The Netherlands, the pertussis component of DTP (diphtheria, tetanus, pertussis) is not given to children over the age of 1 year, whereas in the United States, it is given to children up to their seventh birthday. (c) Rubella vaccine is given only to girls at ages 11-12 years in The Netherlands, but to all children at ages 12-15 months in the United States. (d) Mumps vaccine is not administered to children in The Netherlands, but in the United States it is given routinely to children at 12-15 months (in combination with measles and rubella vaccine). The participants concluded that both the United States and The Netherlands have effective immunization programs that have significantly reduced the impact of these diseases.     

Distance-Optimal Navigation in an Unknown Environment Without Sensing Distances

This paper considers what can be accomplished using a mobile robot that has limited sensing. For navigation and mapping, the robot has only one sensor, which tracks the directions of depth discontinuities. There are no coordinates, and the robot is given a motion primitive that allows it to move toward discontinuities. The robot is incapable of performing localization or measuring any distances or angles. Nevertheless, when dropped into an unknown planar environment, the robot builds a data structure, called the gap navigation tree, which enables it to navigate optimally in terms of Euclidean distance traveled. In a sense, the robot is able to learn the critical information contained in the classical shortest-path roadmap, although surprisingly it is unable to extract metric information. We prove these results for the case of a point robot placed into a simply connected, piecewise-analytic planar environment. The case of multiply connected environments is also addressed, in which it is shown that further sensing assumptions are needed. Due to the limited sensor given to the robot, globally optimal navigation is impossible; however, our approach achieves locally optimal (within a homotopy class) navigation, which is the best that is theoretically possible under this robot model.     

Insulin-like growth factor-I-mediated neurite outgrowth in vitro requires mitogen-activated protein kinase activation

Insulin-like growth factor-I (IGF-I) induces neuronal differentiation in vitro. In the present study, we examined the signaling pathway underlying IGF-I-mediated neurite outgrowth. In SH-SY5Y human neuroblastoma cells, treatment with IGF-I induced concentration- and time-dependent tyrosine phosphorylation of the type I IGF receptor (IGF-IR) and extracellular signal-regulated protein kinases (ERK) 1 and 2. These effects of IGF-I were blocked by a neutralizing antibody against IGF-IR. Whereas IGF-IR phosphorylation was observed within 1 min, maximal phosphorylation of ERKs was not reached for 30 min. Both IGF-IR and ERK phosphorylation were maintained for at least 24 h. Also, the concentration dependence of IGF-I-stimulated IGF-IR and ERK tyrosine phosphorylation paralleled that of IGF-I-mediated neurite outgrowth. We further examined the role of mitogen-activated protein kinase activation in IGF-I-stimulated neuronal differentiation using the mitogen-activated protein kinase/ERK kinase inhibitor PD98059. Whereas PD98059 had no effect on IGF-IR phosphorylation, PD98059 reduced IGF-I-mediated ERK tyrosine phosphorylation and ERK phosphorylation of the substrate Elk-1. PD98059 also produced a parallel reduction of IGF-I-stimulated neurite outgrowth. Finally, consistent with its ability to block neuronal differentiation, PD98059 inhibited IGF-I-dependent changes of GAP-43 and c-myc gene expression. Together these results suggest that activation of ERKs is essential for IGF-I-stimulated neuronal differentiation.     

The value of immediate cytologic evaluation for needle aspiration lung biopsy

RATIONALE AND OBJECTIVES: The authors evaluate the role of immediate cytologic evaluation (ICE) with fine-needle aspiration biopsy (FNAB) for lung lesions at highest risk for pneumothorax. METHODS: A prospective randomized study was conducted of 80 patients with lung lesions surrounded by aerated parenchyma undergoing FNAB with and without ICE (47 and 33 patients, respectively). An analysis of needle passes, procedure time, complications, specimen adequacy, diagnostic yield, and accuracy of procedure was made. RESULTS: There was an increased number of needle passes with ICE (> or = three passes: 23% [11 biopsies] versus 3% [1 biopsy]; P = 0.01). Fluoroscopic procedures took longer with ICE (median time: 15 versus 9 minutes; P = 0.002) with no difference in complication rates. Specimen adequacy was similar (74% and 64%) and the procedure was diagnostic in 79% (37 biopsies) with ICE and in 70% (33 biopsies) without ICE. There were no significant differences in the sensitivity, specificity, or accuracy of the biopsy. CONCLUSIONS: Immediate cytologic evaluation improved results marginally with increased procedure time and needle passes. Immediate cytologic evaluation may be most useful for lesions at lowest risk of complications to assure that a second procedure is not required.     

Dioctyl sodium sulphosuccinate increases net ultrafiltration in peritoneal dialysis

BACKGROUND: The surface-active substance dioctyl sodium sulphosuccinate (DSS) has been reported to increase the peritoneal clearances of urea and creatinine. This study investigated the effects of DSS on the fluid and solute transport characteristics of the peritoneum. DESIGN: A 4-h single-dwell experiment session of peritoneal dialysis using 25 ml of 3.86% glucose dialysis solution with an intraperitoneal volume maker was performed in 16 male Sprague-Dawley rats. In eight rats, 0.005% (50 p.p.m.) DSS was added to the dialysis fluid. No DSS was given to the other eight rats (control group). The transport of fluid, glucose, potassium, sodium, urea, phosphate and urate were analysed. RESULTS: There was a significant increase in the intraperitoneal volume in the DSS group. At 240 min, the drain volume in DSS group (33.0 +/- 2.9 ml) was significantly higher compared to the control group (28.8 +/- 2.1 ml, P < 0.01). This increase in the drain volume was mainly due to a decrease in peritoneal fluid absorption rate in the DSS group (0.040 +/- 0.013 ml/min) as compared to the control group (0.054 +/- 0.010 ml/min, P < 0.05). There was no significant difference in the diffusive permeability and sieving coefficient for the small solutes between these two groups. However, the clearances for urea and sodium were higher in the DSS group, mainly due to the increase in the dialysate volume. CONCLUSION: Our results suggest that DSS significantly increases the net ultrafiltration of peritoneal dialysis. This effect, which was mainly due to a decrease in the fluid absorption rate, contributed to the increased clearances for urea and sodium. DSS did not alter the diffusive permeability and sieving coefficient for the small solutes.     

Cyclosporine-insensitive partial signaling and multiple roles of Ca2+ in Fas ligand-induced lysis

The induction of Fas ligand (FasL) mRNA expression and FasL-mediated cytotoxicity in CD8+ CTL is a rapid and transient response to activation via the TCR. This response can also be initiated by pharmacologic activation of two major TCR signaling pathways using phorbol ester (PMA) and calcium ionophore (ionomycin). In these experiments using CD8+ alloreactive cell lines, we demonstrate that induction of FasL mRNA can occur in response to either PMA or ionomycin independently. However, only the ionomycin pathway is sensitive to inhibition by cyclosporine A. Both pathways are blocked by genistein, a general protein tyrosine kinase inhibitor. The magnitude of induction of FasL mRNA is not proportional to the manifested FasL-dependent cytotoxicity. We also found a calcium requirement for cytotoxicity that is unrelated to FasL mRNA induction. In addition to the positive effects of constitutive and induced calcium levels on FasL-mediated cytotoxicity, calcium may play a role in the rapid down-regulation of the response. We also present data suggesting that CD2 and LFA-1 contribute to FasL-mediated cytotoxicity. Together these results suggest pathways by which partial TCR activation could, among the many activation-induced functions of a T cell, selectively lead to the induction of FasL-mediated cytotoxicity that can be regulated by lineage/ activation-dependent accessory molecules on the target.