Influence of hypertonic saline solution infusion on defibrillation efficacy

BACKGROUND: Transplantation of lung allografts from the same donor into 2 recipients ("twinning") provides an opportunity to study recipient and donor factors that influence early allograft function. METHODS: Twenty-seven pairs of recipients were identified and evaluated using multivariate logistic regression analysis (p < 0.05). Four measures of early graft function were analyzed: alveolar-arterial gradient in the operating room, first alveolar-arterial gradient in the intensive care unit, alveolar-arterial gradient at 24 hours, and days of mechanical ventilation. RESULTS: Analysis of the pooled data without regard to pairing showed that alveolar-arterial gradient in the operating room was influenced by donor age, length of donor hospitalization, recipient mean pulmonary artery (PA) pressure at unclamping, and transplantation of a left lung. The alveolar-arterial gradient in the intensive care unit was correlated with donor age, donor cause of death, and mean PA pressure on arrival in that unit. Only mean PA pressure remained significant at 24 hours. Days of mechanical ventilation was determined by mean PA pressure on arrival in the intensive care unit, drop in mean PA pressure during operation, and diagnosis of the recipient. In the paired analysis, receiving a left lung, recipient diagnosis (pulmonary hypertension worse than others), and need of cardiopulmonary bypass were significantly associated with immediate graft dysfunction, although these influences did not persist beyond the immediate postoperative period. Donor arterial oxygen tension and time of ischemia were not significant predictors in any analysis. CONCLUSIONS: Immediate allograft function was associated with donor-related characteristics initially, but these lost importance over the ensuing 24 hours. Recipient PA pressure was an immediate and persisting influence. In the analysis of differences in function between the members of each pair, transplantation of the left lung, recipient diagnosis, and cardiopulmonary bypass were identified, but their influence did not persist beyond the first 6 hours.     

Comparison of disability behavior after different sites and types of injury in a workers' compensation population

In this study, an extensive data set from a regional workers' compensation system was analyzed to determine whether particular sites or types of injury were associated with prolonged disability. This data shows a similar pattern of vocational disability for almost all sites and types of injury. A workers' compensation carrier collects data for financial purposes related to insurance, and such data therefore has several serious potential deficiencies when used for clinical research. However, published data on disablement after nonoccupational trauma shows similar patterns of vocational and nonvocational disability, and also shows dependence on severity of injury. In both settings, head injury is associated with greater occupational disability. Because treatment, policy, and medicolegal decisions are based on the impression of "typical disability" for particular sites and types of injury, there is a need for better documentation of post-traumatic disablement in compensation settings and in noncompensation settings. This should include better classification of the cause, type, and severity of the injury, and of the functional outcome in terms of both the resumption of occupational and nonoccupational roles, and of persistence in these roles.     

Development of a scoring system to assess disability in an Italian elderly population. Evaluation of a disability questionnaire

Patients with idiopathic and symptomatic restless legs syndrome (RLS) suffer from "dyskinesia while awake" or "daytime myoclonus" when at rest preceded by sensory symptoms. In order to characterise the RLS either as reflex movement or as voluntary movement we measured movement-related cortical potentials in 5 idiopathic and 8 uraemic RLS patients. Movements from both legs were polygraphically recorded concomitantly with cortical activity 2000 msec before to 500 msec after onset of EMG activity. These data were compared with a voluntary simulation of each patient's movement pattern and with 5 age-matched controls performing dorsiflexion of the right, left and both feet. Cortical activity preceding daytime myoclonus was absent in RLS patients whereas self-initiated leg movements in patients elicited onset times (1180-1380 msec) and amplitudes of Bereitschaftspotential (readiness potential) not significantly different from readiness potentials in control subjects (P > 0.05). Lack of movement-related potentials in myoclonus and/or dyskinesias during daytime in RLS patients is compatible with an involuntary mechanism of induction and points towards a subcortical or spinal origin of RLS.     

Longitudinal critical current in type II superconductors. I. Helical vortex instability in the bulk

The vortex lattice in type II superconductors is unstable against the growth of helical perturbations if the current along the vortices exceeds a critical value. The longitudinal critical current, the pitch, and the spatially varying amplitude of the elliptically polarized helices are calculated from the London theory at the onset of instability in planar current distributions far from the surface. For weak pinning (_L² c ₆₆) the wavelength and width of the mode extend over the entire specimen, and the critical current is 2H(c ₆₆/c ₁₁)^1/4. For moderate pinning (c _{66 L}² c ₁₁) the wavelength and width are close to Campbell's pinning length (c ₁₁/_L)^1/2, and the critical current times its mean density is 2H ²(_L/c ₁₁)^1/2. For strong pinning (_L² c ₁₁) helical instability occurs at pin-free vortex sections, the helix wavelength is 2.2d, and the critical current density is 0.47Hd/² (H, d, c ₁₁ and c ₆₆), and _L are the magnetic field, spacing, elastic moduli, and pinning parameter of the vortex lattice, and is the magnetic penetration depth).     

The renal factor in the post-traumatic "fluid overload" syndrome

Hypervolemia with hypertension often occurs 36-72 hours following massive blood and fluid replacement for hypovolemic shock. This syndrome of "fluid overload" has been attributed to the rapid intravascular flux of previously sequestered fluid in patients with impaired diuresis. This hypothesis was tested in 35 injured patients who received a mean of 9.3 L of blood and 17.4 L of salt during resucitation. The renal parameters measured soon after resuscitation included: 1) renal clearance of inulin (GFR), para-amino hippurate (ERPF), milliosmoles, sodium, and free water; 2) inulin space, renal vascular resistance (RVR), O2 consumption, renin, renal blood flow (RBF), and response to furosemide. Eighteen patients developed hypertension, hypervolemia, and respiratory insufficiency. When compared to the 17 normovolemic, non-hypertensive patients, the 18 hypervolemic patients had significantly increased RVR, with a significant decrease in RBF despite an increase in plasma volume and cardiac output. Furosemide produced less diuresis and natriuresis in the hypertensive patients. The balance between hypovolemia and "fluid overload" seemed percarious in the hypertensive patients. Peripheral renin and catecholamine levels were normal in both groups. Patients with post-traumatic "fluid overload" appear to have a combination of hypervolemia, respiratory insufficiency, hypertension, increased cardiac output, decreased extracellular fluid space, and decreased renal perfusion. These findings suggest that decreased interstitial fluid space compliance rather than "fluid overload" is the underlying factor leading to respiratory insufficiency. The therapeutic aspects of these findings are discussed.     

Prediction of backside micromotion in total knee replacements by finite element simulation

The micromotion at the interface between the polyethylene tibial insert and metal tibial tray [corrected] in modular total knee replacements [corrected] has been shown to contribute to wear particle-induced osteolysis and may [corrected] cause implant failure. Therefore, studying the design parameters that are involved in the backside wear process is an important task that may lead to improvement in new total knee replacements. In the present study, a finite element model was developed to predict the backside micromotion along the entire modular interface. Both the linear elastic constitutive model and non-linear J2-plasticity constitutive model were considered in the finite element model for polyethylene and were corroborated against published results obtained from displacement controlled knee simulator wear tests. The finite element simulation with the non-linear J2-plasticity constitutive model was able to predict backside micromotion [corrected] more accurately than the simulation with the linear elastic constitutive model. [corrected] The developed finite element model (including the non-linear J2-plasticity constitutive model) was then applied to assess the effects of the tibial tray locking mechanism design (dovetails versus fullperipheral [corrected] design) and different levels of interference fit on insert micromotion. The developed finite element model, implementing the non-linear J2-plasticity constitutive model, was shown to successfully predict clinical amounts of backside micromotion and could be used for the design and development of total knee replacements for the reduction of backside micromotion and polyethylene [corrected] wear.     

Flux-line cutting in type II superconductors

Experimental evidence for flux-line cutting in superconductors (intersection and cross-joining of singly quantized vortices) is briefly reviewed. The interaction energy between two straight vortices tilted at an angle ( 0)is then shown to be finite in the London model, i.e., in the limit of vanishing core radius. Next, the activation energy and maximum interaction force are calculated for the vortices in an analytic approximation to the Ginzburg-Landau theory. Here two competing interactions determine the behavior. Electromagnetic repulsion (0 < < /2) varies as cos and decays over distances scaled by the penetration depth , while core attraction is independent of and varies over distances scaled by the coherence length . The force is always repulsive at large flux-line separation (0 < < /2) and its maximum decreases rapidly as decreases, so that flux-line cutting isexpected to be more probable in low- materials. The calculations provide a basis for explaining longitudinal flux-flow resistance as well as some intriguing magnetization behavior in the same configuration.This work was supported by the U.S. Department of Energy, Office of Basic Energy Sciences, Materials Sciences Division, and by the Deutsche Forschungsgemeinschaft.On leave from Max-Planck-Institut für Metallforschung, Institut für Physik, Stuttgart, West Germany.On leave from New University of Ulster, Coleraine, Northern Ireland.     

A new formulation of Gor'kov's theory of clean type II superconductors

From Gor'kov's theory a functional for the free energy of the flux line lattice is derived which depends explicitly on the potentials andA. It may be interpreted as an extension of the Ginzburg-Landau functional to arbitrary temperatures. For periodic || ² andH=rotA, the functional is a rapidly converging series, of which often the main term (corresponding to the Brandt-Pesch-Tewordt approximation) plus a correction term depending on the lattice structure suffices. From the cutoff series all previously known results for the special casesT T _c ,B H _c2 ,orB 0 are reproduced by minimization with respect to || ² andH.     

Axonal excitability and motor propagation velocity of peripheral nerves in patients with acute vascular lesions of the brain

From measurements of maximum and minimum motor nerve propagation velocity and neuronal excitability we conclude that there is a functional loss of motor units and distal nerve "dying back" in persons affected with unilateral acute cerebral vascular lesions. The study also suggests that transynaptic degeneration affects the lower motor neurone function on both sides.     

Intercomparison of Thermophysical Property Measurements on an Austenitic Stainless Steel

The results of an inter laboratory comparison of thermal conductivity, thermal diffusivity, specific heat capacity, and thermal expansion measurements on austenitic stainless steel in the temperature range between 20 and 1000°C are presented here. Mean values are presented for the physical properties studied. Reliable relative expanded uncertainties can be stated for the properties determined, which were achieved by applying good measurement practice, i.e., 3% for thermal expansion, 5% for specific heat capacity and thermal diffusivity, and 6% for thermal conductivity. The mean values derived from this intercomparison agree well with the results of a previous intercomparison in 1990. An erratum to this article is availabale at .