A new technique for laparoscopic splenectomy with massively enlarged spleens

Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, splenomegaly, and recurrent sequestration. Over the last 6 months, we have developed a new technique for laparoscopic splenectomy (LS) for hypersplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the average weight was 18.7 kg (range, 13.2-30.1). On preoperative ultrasound, spleen size index ranged from 0.42 to 0.76. For the LS, four trochars were placed. One patient, who also underwent a laparoscopic cholecystectomy, had six trochars placed, two of which were used for both cholecystectomy and splenectomy. After laparoscopic mobilization of the spleen and hilar vascular stapling, a Steiner electromechanical morcellator was inserted through the 12-mm port to extract cores of splenic tissue until complete splenectomy was achieved. No patient required conversion to an open procedure or creation of a larger incision to remove the massively enlarged spleen. Operative time averaged 190 minutes; the combined LS and cholecystectomy took 245 minutes. Postoperative length of stay was <2 days for all patients. There were no complications, and no patient required postoperative transfusion. Based on these early findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleens in small children. It provides expedient recovery and minimal postoperative pain and scarring. This new technique should enable surgeons to perform LS even in patients with massive splenomegaly, eliminating the need for large and cumbersome intracorporeal bags or the creation of additional incisions to remove the spleen.     

Publication outcome of research funding by the Danish Heart Foundation 1988-1990

The aim of the survey was to analyse the investment by the Danish Heart Foundation in the cardiovascular research field in the period 1988-1990 and the ensuing research results. One hundred and thirty-nine researchers were allocated a total DDK 24.1 million. Eighty percent of the researchers have concluded their research work and published 362 scientific papers in 131 journals. The total journal impact factor obtained among 270 scientific papers with known journal impact factor was 642. The median journal impact factor was 1.580. Thirty-five percent of the papers were published in journals with journal impact factor greater than three. The productivity, defined as total journal impact factor obtained divided by an estimate of the total amount (DKK 200 million) of economic support received by the researcher from all sources, was estimated to 3.2 Journal Impact Factor/DKK million. A panel of international experts reviewed the outcome of funding by the Danish Heart Foundation, and concluded that the number of publications and their impact factor was adequate in relation to the economic input.     

Cleavage of rhesus rotavirus VP4 after arginine 247 is essential for rotavirus-like particle-induced fusion from without

We recently described our finding that recombinant baculovirus-produced virus-like particles (VLPs) can induce cell-cell fusion similar to that induced by intact rotavirus in our assay for viral entry into tissue culture cells (J. M. Gilbert and H. B. Greenberg, J. Virol. 71:4555-4563, 1997). The conditions required for syncytium formation are similar to those for viral penetration of the plasma membrane during the course of viral infection. This VLP-mediated fusion activity was dependent on the presence of the outer-layer proteins, viral protein 4 (VP4) and VP7, and on the trypsinization of VP4. Fusion activity occurred only with cells that are permissive for rotavirus infection. Here we begin to dissect the role of VP4 in rotavirus entry by examining the importance of the precise trypsin cleavage of VP4 and the activation of VP4 function related to viral entry. We present evidence that the elimination of the three trypsin-susceptible arginine residues of VP4 by specific site-directed mutagenesis prevents syncytium formation. Two of the three arginine residues in VP4 are dispensable for syncytium formation, and only the arginine residue at site 247 appears to be required for activation of VP4 functions and cell-cell fusion. Using the recombinant VLPs in our syncytium assay will aid in understanding the conformational changes that occur in VP4 involved in rotavirus penetration into host cells.     

Apolipoprotein E allele frequencies in argyrophilic grain disease

Glanzmann's thrombasthenia is a rare inherited hematological disorder defined by deficiency or abnormality of the glycoprotein (GP) IIb-IIIa complex. Presenting symptoms are hemorrhagic events, mainly epistaxis, purpura, or menorrhagia. We describe the clinical course and management of a 14-year-old girl with Glanzmann's thrombasthenia and severe menorrhagia. Following treatment with 20 U of packed red blood cells, 37 U of platelets, 7 U of fresh frozen plasma, cryoprecipitate, intravenous estrogens, and methylergotrine maleate with no improvement, the uterine cavity was packed for 48 hr. This unusual procedure halted the bleeding and avoided the necessity for a hysterectomy. When treating acute menorrhagia in patients with Glanzmann's thrombasthenia, the physician should be familiar with the characteristics and all treatment modalities for this disorder.     

Determination of the epitope of an inhibitory antibody to proliferating cell nuclear antigen

We identified an expansion of the CAG trinucleotide repeat in the coding region of the Machado-Joseph disease gene in 7 of 24 American families diagnosed with autosomal dominant ataxia. All affected individuals were heterozygous for an expanded allele that ranged from 67 to more than 200 CAG repeats, whereas the normal allele had 14 to 33 repeats. In contrast to the Azorean-Portuguese origins of Machado-Joseph disease, the two largest American families were of German and Dutch-African descent. Clinical, pathologic, and genetic evaluations suggest that American families with spinocerebellar ataxia type 3 differ from those with Machado-Joseph disease by their ethnic origins, predominant spinopontine atrophy, lack of dystonic features, and larger CAG repeat expansion.     

A home-page overhaul using other Web sites

The best prototype for designing a new user interface is your old user interface. The second best prototype is a competing product. Your competitors have invested significant resources in designing and implementing what they believe to be good user interfaces. You can glean much of what you need to create a new interface by examining products designed to solve similar problems. As with your own old user interface, you can analyze competing interfaces to see what works and what doesn't. You can also watch how users interact with competing products, and thus learn how they approach tasks. This, in essence, is competitive usability analysis. I recommend performing it very early in the usability engineering life-cycle-after you have visited the customer, gathered requirements, and defined the product vision, but before you design and prototype your new user interface     

EFFECTS OF SPECIFIED BLANK SIZE ON BODY WRINKLING DURING HYDRODYNAMIC DEEP DRAWING OF TAPERED RECTANGULAR BOX

1.~nonHydridapawhcdeepdrawing(HDD)belongstothefieldofsheetmetalfoeingandcanbeaPPliedinthefieldofautomotive,aerospace,drilitaryindustryetc.Ithasbeenrecognizedwidelyintheworld["'j.Fig.Ishowsitsprinciple:TheliqUidthatisfilledinthe~ngdiecavitywillbepressedwhenthepunchgoesdownsothattheeffectoffrictionkeepingandoverflowlubricatingcanbeformed,astherestilt,thefoeinglicitofsheetmetalwillbeimprovedareailvandthegualitVofthefinishedpartswillbeup~ed.BecauseofmanyadvantagesofHDDprocees,ithasbeenwidelys…     

Simulation of nitrogen dynamics and biomass production in winter wheat using the Danish simulation model DAISY

A dynamic simulation model for the soil plant system is described. The model includes a number of main modules, viz., a hydrological model including a submodel for soil water dynamics, a soil temperature model, a soil nitrogen model including a submodel for soil organic matter dynamics, and a crop model including a submodel for nitrogen uptake. The soil part of the model has a one-dimensional vertical structure. The soil profile is divided into layers on the basis of physical and chemical soil characteristics. The simulation model was used to simulate soil nitrogen dynamics and biomass production in winter wheat grown at two locations at various levels of nitrogen fertilization. The simulated results were compared to experimental data including concentration of inorganic nitrogen in soil, crop yield, and nitrogen accumulated in the aboveground part of the crop. Based on this validation it is concluded that the overall performance of the model is satisfactory although some minor adjustments of the model may prove to be necessary.     

In Situ EXAFS Study on the Chemical State of Arsenic Deposited on a NiMoP/Al2O3 Hydrotreating Catalyst

The chemical state of arsenic deposited on a NiMoP/Al₂O₃ hydrotreating catalyst exposed to ppb levels of arsenic over several years in a refinery reactor has been studied by in situ EXAFS. In the as-received As-NiMoP catalyst, arsenic is exclusively coordinated to oxygen atoms. Upon sulfiding the sample in 2%H₂S/2%H₂/96%He, the As atoms become surrounded by approximately two sulfur atoms. No evidence was found for Ni–As bond formation. A possible model for the As local environment is suggested on the basis of combined EXAFS results, STM data and FEFF8.0 simulations (program for ab initio calculations on multiple scattering XAFS and XANES). The FEFF8.0 simulations of the proposed model are in accord with the experimental data measured at the As K edge. In this model, an As atom is located at the edge of a hexagonally truncated Ni-MoS₂ slab and is blocking the active NiMoS site.