Extended donor criteria: use of cardiac allografts after carbon monoxide poisoning

BACKGROUND: An increasing demand for cardiac allografts for the treatment of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high concentrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts after carbon monoxide poisoning. METHODS: Between March 13, 1989 and August 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carbon monoxide intoxication in all cases. At the time of organ explantation, donor hemodynamic parameters were feeble in all patients. RESULTS: The postoperative course was uneventful in three of the five recipients. The overall 3-year survival rate in this small group is 40%. Induction therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any specific signs of carbon monoxide poisoning. CONCLUSIONS: In our opinion, cardiac allografts from donors exposed to carbon monoxide can be transplanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central venous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminase. With extended donor criteria, the hearts of carbon monoxide-poisoned victims could increase the number of suitable organs and lower the death rate of patients on the United Network for Organ Sharing and Eurotransplant International Foundation waiting lists.     

On a large-gain theorem

The aim of this paper is to give a general quantitative requirement which the loop gain must satisfy in order to stabilize a given unstable (possibly nonlinear and time-varying) plant, namely that the gain must exceed one.     

Effect of shigella enterotoxin 1 (ShET1) on rabbit intestine in vitro and in vivo

The purpose of this study was to identify the optimal knot construction for interrupted dermal sutures. A synthetic braided absorbable suture, sizes 3-0 and 5-0, was selected for this evaluation. With reproducible mechanical performance tests, we determined that the construction of secure knots without ears required one additional throw as compared with secure knots with 3-mm ears. The direction of applied tension did not alter knot security, with the exception of granny knots, which required an extra throw when tension was applied parallel to the suture loop. Because interrupted dermal knot construction is accomplished without knot ears and with an applied tension parallel to the wound, one additional throw must be added to the knot to ensure knot security.     

Construction of recombination-deficient strains of Streptococcus gordonii by disruption of the recA gene

Degenerate oligonucleotide primers were used in a polymerase chain reaction (PCR) to amplify a region of the recA sequence of Streptococcus gordonii Challis. The resulting PCR fragment was cloned into the suicide vector pAM6199 and introduced into strain Challis, giving rise to recombination-deficient strains in which the recA gene was specifically inactivated.     

The muscular tissue of the vestibular folds of the larynx

The muscular tissue of the vestibular folds was investigated in plastinated serial sections of 32 normal adult larynges. Three muscular systems could be distinguished. A posterolateral muscle layer was found to be developed at the lateral margin of the posterior part of the vestibular fold. Its fibers extended in a sagittal direction, and their contraction probably resulted in an adduction of the entire tissue of the vestibular fold towards the midline. Within the anterior part of the vestibular fold, an anterolateral muscle sheet was seen to attach to the thyroid cartilage. An anteromedial muscular system consisted of scattered groups of muscle fibers situated medially and dorsally to the laryngeal ventricle and saccule. These fibers were presumed to exert a downward pressure on the vestibular folds, in addition to an adductor function. According to clinical experience, adductor movements of the vestibular folds can be trained, even in cases with a recurrent laryngeal nerve lesion, in order to produce a compensatory voice. Thus, the muscles of the vestibular folds are probably innervated by the superior laryngeal nerve.     

Effect of flexure induced transverse crack and self-healing on chloride diffusivity of reinforced mortar

Cracks in reinforced concrete are unavoidable. Durability is of increasing concern in the concrete industry, and it is significantly affected by the presence of cracks. The corrosion of reinforcing steel due to chloride ions in deicing salts or sea-water is a major cause of premature deterioration of reinforced concrete structures. Although, it is generally recognized that cracks accelerate the ingress of chlorides in concrete, a lack of consensus on this subject does not yet allow reliable quantification of their effects. The present work studies the relationship between crack widths and chloride diffusivity. Flexural load was introduced to generate cracks of width ranging between 29 and 390 μm. As crack width was increased, the effective diffusion coefficient was also increased, thus reducing the initiation period of corrosion process. For cracks with widths less than 135 μm, the effect of crack widths on the effective diffusion coefficient of mortar was found to be marginal, whereas for crack widths higher than 135 μm the effective diffusion coefficient increased rapidly. Therefore, the effect of crack width on chloride penetration was more pronounced when the crack width is higher than 135 μm. Results also indicate that the relation between the effective diffusion coefficient and crack width was found to be power function. In addition, a significant amount of self-healing was observed within the cracks with width below 50 μm subjected to NaCl solution exposure. The present research may provide insight into developing design criteria for a durable concrete and in predicting service life of a concrete structures.     

Conceptual damage-sensitive features for structural health monitoring: Laboratory and field demonstrations

The use of damage-sensitive features to evaluate structural condition or health is a very critical aspect of structural health monitoring. The purpose of this paper is to investigate the potential of two different damage-sensitive features for detecting damage. Different damage scenarios are simulated on a large-scale laboratory structure and a three-span highway bridge for demonstration. The features presented in this paper are the modal flexibility-based deflection and curvature both of which are obtained directly from dynamic properties. In the literature, flexibility associated with mode shapes and mode shapes curvatures have been mostly explored. In this study, multi-input–multi-output dynamic data are used to obtain modal flexibility, which is a close approximation to the actual flexibility. A main novelty is that the curvature is calculated from the deflected shapes using the modal flexibility as opposed to using modal vectors. In this paper, the theory of the methodology is explained and then experimental studies and results are presented. For the experimental studies, the laboratory specimen and the three-span bridge were gradually damaged. It is shown that both deflection and curvature are conceptual and physically meaningful features for damage detection and localization. The issues and the requirements for these features to perform successfully are also presented.