Expression of hepatocyte low-density lipoprotein receptor-related protein is post-transcriptionally regulated by extracellular matrix

A clinical trial was conducted to assess the feasibility, safety, and efficacy of the atrial septal defect (ASD) occlusion system for transcatheter closure of secundum ASD and patent foramen ovale (PFO) after episodes of cerebral embolism. Occlusion was attempted in 200 patients aged 1 to 74 years (mean 32). The procedure failed in 26 patients (13%); the device was retrieved through a catheter in 20 and through surgery in 6 patients. Procedure-related complications necessitating surgical removal of the device included device embolization in 2, device entrapment within the Chiari network in 1, frame fracture in 1, and perforation of atrial wall in 2. All 6 patients experienced an uneventful postoperative course. An additional 11 patients (6%) underwent surgical removal of the device during follow-up. There were 163 patients (81%) with an implanted ASD occlusion system at follow-up of from 6 to 36 months (mean 17). Thrombus formation around the device was detected by transesophageal echocardiography in 9 patients 1 to 4 weeks after implantation. One of these patients (who had a coagulation factor XII deficiency) suffered a cerebral thromboembolism. Late atrial wall perforation (5, 6, and 8 months after implantation) occurred in 3 adult patients. Infectious endocarditis developed in 2 adult patients (1%). No late device embolization and no atrioventricular valve injury occurred. An asymptomatic device frame fracture was found in 14% and frame deformity in 4% of all patients during the follow-up period of >230 patient-years. Immediately after closure, a moderate/large residual shunt remained in 8% and a small shunt in 29% of patients. After 1 year, a moderate/large shunt was present in 2% and a small one in 26% of patients. During a total follow-up of 49 patient-years, only 1 of 46 patients with PFO had a transient neurologic event after the closure. The study indicates that patients with centrally situated secundum ASD and those with PFO after cerebral embolism can be treated with this system with a high success rate and an acceptable morbidity.     

Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review

BACKGROUND: Single-dose antimicrobial prophylaxis for major surgery is a widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single-dose prophylaxis has not been universally accepted and multiple-dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple-dose antimicrobial prophylaxis for major surgery and across surgical disciplines. METHODS: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 x 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, a high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple-dose regimens and a low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed. RESULTS: Combined OR by both fixed (1.06, 95% CI, 0.89-1.25) and random effects (1.04, 95% CI, 0.86-1.25) models indicated no clear advantage of either single or multiple-dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta-lactam vs other), blinded wound assessment, length of the multiple-dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other). CONCLUSIONS: Continued use of single-dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.     

Process issues in treatment: Application to sexual offender programs.

How critical is the therapeutic alliance in the treatment of sexual offenders? To date such process issues have been neglected in the field of sex offender treatment. This article reviews the literature on the influence on behavior change of therapist features, clients' perceptions, and the therapeutic alliance. Among the many therapist features identified as helpful are empathy, warmth, and being directive and rewarding. Therapists who are aggressively confrontational appear not to foster beneficial changes in their clients. These issues are directly related to treatment issues faced by therapists who work with sexual offenders, such as dealing with cognitive distortions, lack of empathy, and lack of motivation to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cytokine messenger RNA expression by donor-specific cytotoxic T-cell clones after allogeneic heart transplantation

BACKGROUND: Aspergillosis is an uncommon yet serious opportunistic infection in patients with AIDS. It has been extensively reported in HIV-infected adult patients. To our knowledge there are no studies that describe the epidemiology, clinical manifestations and outcome of aspergillosis in a large HIV-infected pediatric population. METHODS: We reviewed the records of all 473 HIV-infected children followed in the Pediatric Branch of the National Cancer Institute for 9 years from 1987 through 1995 for the presence of Aspergillus infection. RESULTS: Seven (1.5%) patients developed invasive aspergillosis during the study period. All patients had low CD4 counts reflecting severe immunosuppression. Sustained neutropenia (> 7 days) or corticosteroid therapy as a predisposing factor for invasive aspergillosis was encountered in only two patients (28%). Invasive pulmonary aspergillosis developed in five patients and cutaneous aspergillosis in two. The most common presenting features in patients with pulmonary aspergillosis were fever, cough and dyspnea. Patients with cutaneous aspergillosis were diagnosed during life and successfully treated with amphotericin B and surgery, whereas diagnosis of pulmonary aspergillosis was made clinically in only one patient. CONCLUSIONS: Aspergillosis is an uncommon but highly lethal opportunistic infection in HIV-infected children. Invasive pulmonary aspergillosis should be considered in the differential diagnosis in febrile, HIV-infected children with persistent pulmonary infiltrates.     

Ultrasound evaluation of piglet diaphragm function before and after fatigue

Clinically, a noninvasive measure of diaphragm function is needed. The purpose of this study is to determine whether ultrasonography can be used to 1) quantify diaphragm function and 2) identify fatigue in a piglet model. Five piglets were anesthetized with pentobarbital sodium and halothane and studied during the following conditions: 1) baseline (spontaneous breathing); 2) baseline + CO2 [inhaled CO2 to increase arterial PCO2 to 50-60 Torr (6.6-8 kPa)]; 3) fatigue + CO2 (fatigue induced with 30 min of phrenic nerve pacing); and 4) recovery + CO2 (recovery after 1 h of mechanical ventilation). Ultrasound measurements of the posterior diaphragm were made (inspiratory mean velocity) in the transverse plane. Images were obtained from the midline, just inferior to the xiphoid process, and perpendicular to the abdomen. M-mode measures were made of the right posterior hemidiaphragm in the plane just lateral to the inferior vena cava. Abdominal and esophageal pressures were measured and transdiaphragmatic pressure (Pdi) was calculated during spontaneous (Sp) and paced (Pace) breaths. Arterial blood gases were also measured. Pdi(Sp) and Pdi(Pace) during baseline + CO2 were 8 +/- 0.7 and 49 +/- 11 cmH2O, respectively, and decreased to 6 +/- 1.0 and 27 +/- 7 cmH2O, respectively, during fatigue + CO2. Mean inspiratory velocity also decreased from 13 +/- 2 to 8 +/- 1 cm/s during these conditions. All variables returned to baseline during recovery + CO2. Ultrasonography can be used to quantify diaphragm function and identify piglet diaphragm fatigue.     

Menadione-induced oxidative stress accelerates onset of Emory mouse cataract in vivo

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it.     

Development of the large neutron imaging system for inertial confinement fusion experiments

Inertial confinement fusion (ICF) requires a high resolution (~10 μm) neutron imaging system to observe deuterium and tritium (DT) core implosion asymmetries. A new large (150 mm entrance diameter: scaled for Laser Me?gaJoule [P. A. Holstein, F. Chaland, C. Charpin, J. M. Dufour, H. Dumont, J. Giorla, L. Hallo, S. Laffite, G. Malinie, Y. Saillard, G. Schurtz, M. Vandenboomgaerde, and F. Wagon, Laser and Particle Beams 17, 403 (1999)]) neutron imaging detector has been developed for such ICF experiments. The detector has been fully characterized using a linear accelerator and a (60)Co γ-ray source. A penumbral aperture was used to observe DT-gas-filled target implosions performed on the OMEGA laser facility. [T. R. Boehly, D. L. Brown, R. S. Craxton, R. L. Keck, J. P. Knauer, J. H. Kelly, T. J. Kessler, S. A. Kumpan, S. J. Loucks, S. A. Letzring, F. J. Marshall, R. L. McCrory, S. F. B. Morse, W. Seka, J. M. Soures, and C. P. Verdon, Opt. Commun. 133, 495 (1997)] Neutron core images of 14 MeV with a resolution of 15 μm were obtained and are compared to x-ray images of comparable resolution.     

Nitrogen budget for fescue pastures fertilized with broiler litter in Major Land Resource Areas of the southeastern US

The southeast US produces a tremendous number of broiler chickens (Gallus gallus), which in turn produce massive quantities of litter (manure and bedding materials). In the Southeast, litter is most often disposed of via land application to pastures, however, the ultimate fate of much of the applied nitrogen (N) is not known. We have constructed N budgets for three sites across the southeastern U.S. in an effort to determine how much of the applied N is useful for plant production and how much is left to be absorbed by the environment. Study sites were located in the Coastal Plain (Alabama), Piedmont (Georgia), and Cumberland Plateau (Tennessee) Major Land Resource Areas (MLRA) of the southeastern US. Litter was applied in the Spring of two consecutive years at a rate to supply 70 kg of available N ha^–1. The total amount of N applied ranged from 103 to 252 kg N ha^–1 depending on site and year. Nitrogen fluxes monitored in this study were broiler litter N, ammonia (NH₃) volatilization, denitrification, plant uptake, and leaching. Plant uptake represented the largest flux of applied N, averaging 43% of applied N. Losses due to NH₃ volatilization and denitrification combined were only 6% of applied N on average. Loss of N due to NO₃-N leaching appeared to be significant only at the Coastal Plain site where NO₃-N concentrations in the groundwater peaked at 38 mg N l^–1. We believe the majority of excess N shown in these budgets is likely accounted for by leaching losses and soil accumulation. Regardless of these assumptions and low gaseous losses, it is apparent that on average, 57% of applied N is destined for a fate other than plant uptake. The results of this study indicate that land-application of broiler litter at currently recommended rates has the potential for negative impacts on the environment of the southeastern U.S. in the long-term.     

Enhanced Fracture Toughness in Layered Microcomposites of Ce-ZrO2 and Al2O3

Laminar composites, containing layers of Ce-ZrO₂ and either Al₂O₃ or a mixture of Al₂O₃ and Ce-ZrO₂, have been fabricated using a colloidal method that allowed formation of layers with thicknesses as small as 10 μm. Strong interactions between these layers and the martensitic transformation zones surrounding cracks and indentations have been observed. In both cases, the transformation zones spread along the region adjacent to the layer, resulting in an increased fracture toughness. The enhanced fracture toughness was observed for cracks growing parallel to the layers as well as for those that were oriented normal to the layers.