Preoperative functional magnetic resonance imaging (fMRI) of the motor system in patients with tumours in the parietal lobe

Intracranial lesions may compromise structures critical for motor performance, and mapping of the cortex, especially of the motor hand area, is important to reduce postoperative morbidity. We investigated nine patients with parietal lobe tumours and used functional MRI sensitized to changes in blood oxygenation to define the different motor areas, especially the primary sensorimotor cortex, in relation to the localization of the tumour. Activation was determined by pixel-by-pixel correlation of the signal intensity time course with a reference waveform equivalent to the stimulus protocol. All subjects showed significant activation of the primary sensorimotor cortex while performing a finger opposition task with the affected and unaffected side. In five patients the finger opposition task additionally activated the ipsilateral sensorimotor cortex and the supplementary motor area (SMA). Extension and flexion of the foot, additionally performed in two patients, also activated the sensorimotor cortex, in one case within the perifocal oedema of the tumour. Tumour localization near the central sulcus induced displacement of the sensorimotor cortex as compared to the unaffected side in all patients with a relevant mass effect. The results of our study demonstrate that functional MRI at 1.5 T with a clinically used tomograph can reproducibly localize critical brain regions in patients with intracranial lesions.     

Treatment and prognosis of post-transplant lymphoproliferative disease

Post-transplant lymphoproliferative diseases (PTLDs) are a clinically and morphologically heterogeneous group of lymphoid proliferations. They represent a life-threatening complication of solid organ transplantation. The mechanisms of their pathogenesis are not yet fully understood. A combination of impaired immunity, oncogenic consequences of immunosuppressive therapy and EBV infection may play a role. Studies on incidence, treatment and prognosis are difficult because of the small number of cases occurring at each transplant center and the lack of reliable classification. Overall mortality remains high even though 25% of patients require no other measure than reduction in immunosuppression which must be the first step of treatment. Several treatments are currently used but more adequate classification as well as multicenter studies are urgently needed because many questions remain with regard to therapeutic strategy. Late-onset monoclonal tumors may be treated by conventional chemotherapy, while EBV-positive PTLDs may benefit from other approaches such as antiviral therapies or immunologic modulation of tumor functions.     

Acute lymphoblastic leukemia in children. Progress in life expectancy

Heuristic construction knowledge generated while contracting is seldom recorded and transferred to other workers. Experiences of past mistakes as well as efficient work practices are crucial means for saving money, time, and improving the safety and quality of construction. With the rising costs of construction and the increased demand of time constraints on contractor schedules, few members of the construction industry can afford to waste time and resources on errors or ineffective work practices. The Constructability Lessons Learned Database (CLLD) prototype described in this paper is a leading edge method of automatically gathering, systematically organizing and efficiently applying vital construction information to a contractor's daily activities. This paper presents a review of previous and current attempts at database constructability programs, uses of constructability feedback systems, challenges to develop and utilize such systems, and an overview of the design and development of the CLLD prototype. The overview describes knowledge elicitation techniques used to gather constructability knowledge, the design of the system (organizing and classifying construction information for efficient retrieval and expansion), and system's implementation, validation, and operation. The conclusion discusses future extensions of the CLLD concept in the construction industry.     

Increased levels of plasma cholesteryl ester hydroperoxides in patients with subarachnoid hemorrhage

The pathophysiology of subarachnoid hemorrhage (SAH) may involve free radical production and lipid peroxidation. We examined plasma levels of cholesteryl ester hydroperoxides (CEOOH) and antioxidants in 25 patients with SAH, and 10 neurologic controls with lacunar stroke. Patients with SAH had significantly increased plasma levels of CEOOH, which peaked on day 5 after the ictus. Concentrations of CEOOH were significantly increased, and ascorbic acid concentrations were significantly decreased in patients who developed vasospasm compared with patients without vasospasm. Increased levels of CEOOH were associated with increased mortality and correlated with clinical outcome scales. These results implicate oxidative stress in the pathogenesis of SAH and suggest that measurements of CEOOH in plasma may be useful both prognostically as well as in monitoring therapeutic interventions.     

Overview of the regional collaboratives

Responding to demands that nursing leaders conduct business in creative, proactive ways, the authors of this department share the work of The Robert Wood Johnson Foundation's national program. Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development. The purpose of this initiative is to enhance regional and state collaborative planning and implement actions and policies to address the rapid changes occurring in the United States nursing labor market. This department presents the ongoing work of the program, highlighting the work of the 20 individual collaboratives. Regional approaches to the expected program outcomes and specific challenges and opportunities that are unique to each region's environment are included. The Colleagues in Caring program is administered by the American Association of Colleges of Nursing. Current information on the initiative can be found at http:/(/)www.aacn.nche.edu under Special Projects. The staff at the National Program Office can be reached at 202/496-1095 (fax: 202/496-1093).