Cardiac transplantation in perspective for the future. Survival, complications, rehabilitation, and cost

Two hundred twenty-seven cardiac transplant procedures have been performed in 206 patients from January, 1968, to April, 1981. Postoperative survival rates, calculated by the actuarial method for program years 1968 to 1973 (66 patients), are 44%, 33%, 27%, 21%, and 18% at 1, 2, 3, 4, and 5 years after transplantation, respectively. Postoperative survival rates for program years 1974 to 1981 (140 patients) are 63%, 55%, 51, 44%, and 39% at 1, 2, 3, 4, and 5 years after transplantation, respectively. This increase results primarily from improvement in survival achieved in the first 3 postoperative months (59% +/- 7%, 1968 to 1973, versus 80% +/- 40%, 1974 to 1980), reflecting improved patient management. Infection remains the primary cause of death following transplantation (76/131 patients, 58%), followed by acute rejection (24/181, 18.3%), graft arteriosclerosis (14/131, 10.7%), and malignancy (6/131, 4.6%). The development of graft arteriosclerosis has been examined in 85 one-year survivors studied by annual coronary arteriograms. Coronary lesions of varying severity have developed in 21 patients. HLA-A2 incompatibility was associated with a higher incidence of graft arteriosclerosis than was apparent for all other A locus incompatibilities (p less than 0.0003). Lymphoma has been shown to be associated with younger recipient age, a primary disease diagnosis of idiopathic cardiomyopathy, and retransplantation. One hundred six patients have survived at least 1 year after transplantation; 97% were in NYHA Class 1 at that time interval and 82% returned to employment or activity of choice. The longest survival time is new 11 years, 3 months. Cardiac transplantation can be considered "reasonable and therapeutic treatment to extend life" in selected individuals.     

Subjective time experience in an intergenerational sample

The roles chronological age and gender play in subjective time experience were explored in a sample of 294 adult men and women. Subjective time experience (STE: the difference between subjective age and chronological age) was found to vary widely among individuals, with some being "accurate" (SA = CA), and others either "retarded" (SA less than CA) or "advanced" (SA greater than CA). Males were more retarded in STE than females at every point in the lifespan, and patterns of age differences in adulthood differed for the two sexes as well. The results suggest that chronological age may play a key role in transitions in STE, and that chronological age is more significant in the STE of women than in the STE of men.     

Sol–Gel Synthesis of Doped Vitreous Materials with the Use of Modified Aerosils

A novel variant of the sol–gel synthesis of silica glasses and optical composites containing transition-metal ions and nanoparticles is developed. Xerogels and glasses containing 10- to 46-nm particles are prepared with the use of aerosils modified by chromium oxide. The structural and physicochemical properties of chromium oxide–modified silica samples are investigated by X-ray powder diffraction, differential thermal analysis, thermal gravimetric analysis, and IR spectroscopy. The optical properties of transparent samples are examined using the transmission spectra and the refractive index distribution over the cross section of the xerogel preform. Xerogels and glasses containing nanoparticles of metallic copper and Cu _x Se are formed in the tetraethoxysilane–aerosil–copper nitrate system. An analysis of the optical properties of the nanocomposites demonstrates that SiO₂ : Cu _x Se nanocomposites can be used as passive Q switches.     

FREQUENCY DOMAIN ANALYSIS OF FAST AND SLOW MOTIONS IN SLIDING MODES

A frequency domain approach to analysis of fast and slow motions in sliding modes is proposed in the paper. The proposed approach is based on the construction of a relay system that is equivalent to the original sliding mode control system and on the application of the locus of a perturbed relay system method. A precise model of the fast motions and a non‐reduced order model of the slow motions for the SISO linear time‐invariant case are obtained as a result of the proposed approach.     

Boric acid and borax as antiscoring additives to glycerin-based lubricant

Boric acid and borax, which are used as antiscoring additives to an environmentally friendly glycerin-based lubricant, have been studied. It is shown that the adsorption of borax obeys the Langmuir isotherm. The equilibrium constants of the adsorption of the additives and the energy of the adsorption are estimated. It has been found that borax is a more effective antiscoring additive than boric acid. For borax used as the additive, the dependence of the coefficient of friction on the load applied to a friction unit is studied and interpreted.     

The stretch zone of automotive steel sheets

The paper deals with an experimental determination of the stretch zone dimensions in the notch tip in thin steel sheets. The stretch zone dimensions depend on steel grade, on the rolling direction as well as on the loading rate. Stretch zones were observed and measured on three steel grades. Fracture area and stretch zones were analysed by SEM. Stable crack growth was monitored by videoextensometry techniques on CT (Compact Tension) specimens. Specimens were loaded under two loading rates by eccentric tension, whereby the deformation in the notch surrounding area was recorded using a non-contact measurement–videoextensometry technique. Linear relation between the stretch zone dimensions was determined.     

Local rules simulation of the kinetics of virus capsid self-assembly

Jurkat T cells undergo rapid apoptosis upon stimulation of the Fas/APO-1 (CD95) receptor. We examined the role of the mitogen-activated protein kinase (MAPK) cascade as a negative regulator of Fas-mediated apoptosis. To this end, we used both physiologic and artificial activators of MAPK, all of which activate MAPK by distinct routes. MAPK activity could be efficiently elevated by two T cell mitogens, the lectin PHA and an agonistic Ab to the T cell receptor complex as well as by the type 1 and 2A phosphatase inhibitor, calyculin A, and the protein kinase C-activating phorbol ester, tetradecanoyl phorbol acetate. All these treatments were effective in preventing the characteristic early and late features of Fas-mediated apoptosis, including activation of caspases. Our results indicate that the elevated MAPK activities intervene upstream of caspase activation. The degree of MAPK activation by the different stimuli used in our study corresponds well to their potency to inhibit apoptosis, indicating that MAPK activation serves as an efficient modulator of Fas-mediated apoptosis. The role of MAPK in modulation of Fas-mediated apoptosis was further corroborated by transient transfection with constitutively active MAPK kinase, resulting in complete inhibition of the Fas response, whereas transfection with a dominant negative form of MAPK kinase had no effect. Furthermore, the apoptosis inhibitory effect of the MAPK activators could be abolished by the specific MAPK kinase inhibitor PD 098059. Modulation of Fas responses by MAPK signaling may determine the persistence of an immune response and may explain the insensitivity of recently activated T cells to Fas receptor stimulation.     

Cytoplasmic Ca2+ oscillations in pancreatic beta-cells

In the last 15 years it has been a growing interest in the cyclic variations of circulating insulin [46]. After the suggestion that this phenomenon may be due to oscillations of the beta-cell membrane potential [8,39], it was demonstrated that [Ca2+]i oscillates in the glucose-stimulated beta-cell with a similar frequency to that of pulsatile insulin release. The present review describes four types of [Ca2+]i oscillations in the pancreatic beta-cell. The slow sinusoidal oscillations, referred to as type-a, are those which most closely correspond to pulsatile insulin release. Although not affecting the properties of the type-a oscillations in individual beta-cells, the concentration of glucose is a determinant for their generation and further transformation into a sustained increase. Accordingly, cytoplasmic Ca2+ is regulated by sudden transitions between oscillatory and steady-state levels at threshold concentrations of glucose, which are characteristic for the individual beta-cell. This behaviour explains the observation of a gradual recruitment of previously non-secreting cells with increase of the extracellular glucose concentration [44]. However, it still remains to be elucidated how the sudden transitions between these three states translate into the co-ordinated slow oscillations of [Ca2+]i in the intact islet. Cyclic variations of circulating insulin require a synchronization of the [Ca2+]i cycles also among the islets in the pancreas. It is still an open question by which means the millions of islets communicate mutually to establish a pattern of pulsatile insulin release from the whole pancreas. The discovery that the beta-cell is not only the functional unit for insulin synthesis but also generates the [Ca2+]i oscillations required for pulsatile insulin release has both physiological and clinical implications. The fact that minor damage to the beta-cells prevents the type-a oscillations with maintenance of a glucose response in terms of raised [Ca2+]i reinforces previous arguments [54] that loss of insulin oscillations is an early indicator of type-2 diabetes. Further analyses of the [Ca2+]i oscillations in the beta-cells should include not only the mechanisms for their generation and subsequent propagation within or among the islets but also how modulation of their frequency affects the insulin sensitivity of various target cells. The latter approach may be important in the attempts to maintain normoglycemia under conditions minimizing the vascular effects of insulin supposed to precipitate hypertonia and atherosclerosis [70,71,77].