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Steady state hemodynamic and energetic characterization of the Penn State/3M Health Care Total Artificial Heart.

Total Artificial Heart (TAH) development at Penn State University and 3M Health Care has progressed from design improvements and manufacturing documentation to in vitro and in vivo testing to characterize the system's hemodynamic response and energetic performance. The TAH system is completely implantable and intended for use as an alternative to transplantation. It includes a dual pusher plate pump and rollerscrew actuator, welded electronics and battery assembly, transcutaneous energy transmission system, telemetry, and a compliance chamber. In vitro testing was conducted on a Penn State mock circulatory loop with glycerol/water solution at body temperature. Tests were performed to characterize the preload and afterload response, left atrial pressure control, and power consumption. A sensitive preload response was demonstrated with left atrial pressure safely maintained at less than 15 mm Hg for flow rates up to 7.5 L/min. Variations in aortic pressure and pulmonary vascular resistance were found to have minimal effects on the preload sensitivity and left atrial pressure control. In vivo testing of the completely implanted system in its final configuration was carried out in two acute studies using implanted temperature sensors mounted on the electronics, motor, and energy transmission coil in contact with adjacent tissue. The mean temperature at the device-tissue interface was less than 4 degrees C above core temperature.

Animals↗

Dietary supplement use by women at risk for breast cancer recurrence. The Women's Healthy Eating and Living Study Group.

OBJECTIVE: To develop a method of collecting, organizing, and analyzing information on nutrient and nonnutrient dietary supplement use by women at risk for breast cancer recurrence as a component of nutrition assessment and monitoring, and to describe the characteristics associated with dietary supplement use in this population at enrollment in a clinical trial to prevent breast cancer recurrence. DESIGN: Cross-sectional descriptive study design. SUBJECTS: Women diagnosed with breast cancer within the previous 4 years (n=435). ANALYSIS: Dietary supplements reported in four 24-hour dietary recalls were categorized according to primary nutrient and nonnutrient contents. Prevalence of dietary supplement use is described. Associations between supplement use and demographic and participant characteristics were examined using chi(2) analysis and logistic regression. RESULTS: Dietary supplement use was reported by 80.9% of the women. Increased likelihood of supplement use was associated with demographic (eg, older age, higher level of education, white race vs other ethnic groups) and personal (eg, lower body mass index, moderate alcohol consumption) characteristics. Use of vitamin C and related compounds, other nutrients (eg, n-3 fatty acids, evening primrose oil), and herbal products was inversely associated with months since diagnosis; use of miscellaneous supplements (eg, shark cartilage) was directly associated with more advanced stage at diagnosis. APPLICATIONS: Monitoring dietary supplement use is an important aspect of nutrition assessment, especially in populations with chronic health conditions or medical diagnoses. Demographic and personal characteristics, time passed since diagnosis, and stage of cancer at diagnosis are predictive of dietary supplement use by women at risk for breast cancer recurrence. Associations in this population may be present in other groups that are the object of nutrition intervention efforts.

Adult↗

Xylem structure and connectivity in grapevine (Vitis vinifera) shoots provides a passive mechanism for the spread of bacteria in grape plants.

BACKGROUND AND AIMS: Bacterial leaf scorch occurring in a number of economically important plants is caused by the xylem-limited bacterium Xylella fastidiosa (Xf). In grapevine, Xf systemic infection causes Pierce's disease and is lethal. Traditional dogma is that Xf movement between vessels requires the digestion of inter-vessel pit membranes. However, Yersinia enterocolitica (Ye) (a bacterium found in animals) and fluorescent beads moved rapidly within grapevine xylem from stem into leaf lamina, suggesting open conduits consisting of long, branched xylem vessels for passive movement. This study builds on and expands previous observations on the nature of these conduits and how they affect Xf movement. METHODS: Air, latex paint and green fluorescence protein (GFP)-Xf were loaded into leaves and followed to confirm and identify these conduits. Leaf xylem anatomy was studied to determine the basis for the free and sometimes restricted movement of Ye, beads, air, paint and GFP-Xf into the lamina. KEY RESULTS: Reverse loading experiments demonstrated that long, branched xylem vessels occurred exclusively in primary xylem. They were observed in the stem for three internodes before diverging into mature leaves. However, this stem-leaf connection was an age-dependent character and was absent for the first 10-12 leaves basal to the apical meristem. Free movement in leaf blade xylem was cell-type specific with vessels facilitating movement in the body of the blade and tracheids near the leaf margin. Air, latex paint and GFP-Xf all moved about 50-60% of the leaf length. GFP-Xf was never observed close to the leaf margin. CONCLUSIONS: The open vessels of the primary xylem offered unimpeded long distance pathways bridging stem to leaves, possibly facilitating the spread of bacterial pathogens in planta. GFP-Xf never reached the leaf margins where scorching appeared, suggesting a signal targeting specific cells or a toxic build-up at hydathodes.

Air↗

Intravenous dipyridamole combined with isometric handgrip for near maximal acute increase in coronary flow in patients with coronary artery disease.

Twenty-four patients with coronary artery disease were studied during cardiac catheterization to determine the effects of sustained isometric handgrip exercise and intravenous dipyridamole and their combination on coronary and systemic hemodynamics and measured coronary luminal caliber. During 4 to 5 minutes of 25 percent maximal handgrip, blood pressure and heart rate increased 24 and 19 percent, respectively, coronary sinus flow increased to 1.7 x baseline value, and epicardial coronary arteries constricted to increase predicted flow resistance by 40 percent in 36 diseased arterial segments. After a 4 minute intravenous infusion of dipyridamole (0.56 mg/kg body weight), systemic pressure decreased 8 percent, heart rate increased 23 percent, coronary sinus flow increased to 2.4 x baseline value and coronary luminal caliber was unchanged. During isometric handgrip initiated 6 minutes after the infusion of dipyridamole, systemic pressure and heart rate increased to 14 and 31 percent, respectively, above control values, coronary sinus flow increased to 3.3 x baseline value (3.8 x baseline value in patients with normal anterior perfusion) and stenotic flow resistance increased by 36 percent. The response of coronary flow to the combined stresses was 68 percent greater than the response to dipyridamole alone (p less than 0.02); these flow levels exceed values previously reported for the human coronary circulation. Aminophylline plus nitroglycerin appears to assure patient safety.

Acute Disease↗

[Furunculoid myiasis caused by Dermatobia hominis].

The authors report a case of forunculoid miasis by "Dermatobia hominis" ("Ura" fly). a process that being not very common in the Argentine Republic is sometimes misjudged as a furunculosis. The patient reported, a white woman, 51, travelled to a zone where this parasitose is endemid. After some time of her stay there, she noted three small nodes in her vulvar region. They grew on until reaching nearly the size of a walnut. At her first consultation with a gynecologist it was taken as a case of furuncolosis and treated with antibiotics. As the treatment didn't prove succesful, she asked for dermatological advice. It was then possible to verify the presence of three nodes. In the central hole of one of them, there could be seen a whitish body that soon disappeared inwards. This lead to the diagnosis of forunculoid miasis. An accurate and easy-to-perform treatment was carried out: a 1% solution of formaldehyde in distilled water was infused through the central hole of each node. This determined the larva's caudal extremity to appear in search of air. It was taken advantage of this situation to remove the larvae with a pair of nippers. "Dermatobia hominis" is widely spread in the warm-climated Argentine northern provinces of Chaco, Formosa and Misiones, as well as in Brazil, Paraguay and some regions of Uruguay. It is also known under the name of "Ura". It is a large fly, yellow faced, with dark-blue thorax; an almost rombic metallic-blue abdomen, orange antennae and legs, and dark-brown wings. It lives on the nutrients spared during its larval stage and both fecundation and oviposition, take place along its week-long life. The fecundated female catches different haematophagus insects on the wing, sticking sets of eggs to their abdomens. An embryo developes in each egg, being ready to emerge in a week but does this only when the bearer insect settles on a homeothermal being piercing and penetrating the skin of the new guest in about 10 minutes.

Diptera↗

Vaccination of goats against the trematode Schistosoma bovis with a recombinant homologous schistosome-derived glutathione S-transferase.

We assayed the vaccine potentialities of a recombinant S. bovis-derived glutathione S-transferase (rSb28GST), member of a molecular family already shown to have protective capacities in the S. mansoni and S. japonicum models. Injection of the rSb28GST in Freund's Complete Adjuvant resulted in good specific IgG responses allowing all the animals to display high antibody titres on the day of experimental challenge with S. bovis cercariae. No statistically significant differences were observed in the faecal egg output. Although tissue egg counts in vaccinated animals were lower than in controls, the difference was not statistically significant, apart from the number of eggs trapped in the liver (P < 0.05). Likewise, PCV values remained parallel between the two groups. However, immunized goats gained 1.4 kg of body weight throughout the experiment whereas controls lost 1.2 kg (P < 0.05). In addition, the mean worm burden, assessed by perfusion 20 weeks after infection, was significantly reduced by 48% in the vaccinated group, the sex ratio being unaffected. It appears that a recombinant homologous protein can affect, in a natural host, the course of an experimental infection with a local strain of S. bovis, by affecting worm viability but not fecundity. These results also point to the striking differences in the effect of vaccination according to animal species. Because it has the capacity to prevent growth impairment due to schistosome pathogenicity, the molecule can be proposed as a valuable tool in the development of vaccine-based control programs in endemic areas.

Animals↗

[A penetrating cranio-facial injury due to a nail-gun accident].

We report a case of a penetrating cranio-facial injury due to a nail-gun accident. An 18-year-old worker was admitted to our hospital as an emergency patient. He was working using a nail-gun when a nail ricocheted off a wall and pierced the right side of his face. Skull X-rays and a CT scan showed that a 9 cm nail had pierced his right frontal lobe through the right maxillary bone via the orbital space. The patient was alert without any neurologically abnormal findings. A small stab wound was recognized on his face. The nail was removed six hours after the injury through a sublabial approach and a fronto-temporal craniotomy. The nail was very tightly fixed in the maxillary bone and skull base bones, and a screw driver normally used in orthopedic surgery proved to be very useful for removing the nail. The patient returned home 14 days later without any neurological deficits. The technical problems associated with such a nail-gun injury in the face and skull are also discussed.

Adolescent↗

Unrelated donor bone marrow transplantation to treat severe aplastic anaemia in children and young adults.

Alternative donor bone marrow transplantation (BMT) to treat severe aplastic anaemia (SAA) in children and young adults has been complicated by high rates of graft rejection and severe graft-versus-host disease (GVHD). We hypothesized that increased immunosuppression combined with T-cell depletion of the marrow graft would enable successful use of unrelated donor BMT in this disease. Preconditioning consisted of cytosine arabinoside, cyclophosphamide, and total body irradiation (TBI). T-cell depletion was with the anti-CD3 antibody T10B9. GVHD prophylaxis consisted of cyclosporine A. 28 previously transfused patients were transplanted. Nine donor/recipient pairs were HLA matched. As of 1 January 1996, 15/28 (54%) patients are alive, transfusion independent and well with a range of follow-up of 13 months to 8 years (median 2.75 years). Fatalities include all three patients with nonengraftment and all three patients with grade III/IV GVHD. Other fatalities were due to infections or therapy-related toxicity. The incidence >or= grade II acute GVHD was 28%. These data show that in children with SAA who have failed immunosuppression, unrelated donor BMT offers a reasonable hope of long-term survival.

Adolescent↗

Mycoplasma penetrans sp. nov., from the urogenital tract of patients with AIDS.

An unusual mycoplasma, which was isolated from the urine of a human immunodeficiency virus-positive male homosexual patient, has an elongated flask shape and two unique sharply divided internal compartments. The tiplike compartment is densely packed with fine granules, and the body compartment is loosely filled with coarse granules consistent with ribosomal structures. The organism has properties of adherence, hemadsorption, and cytadsorption and invades many different types of mammalian cells. Adhesion and penetration apparently involve the terminally located tiplike structure. Cholesterol is required for growth, and the mycoplasma ferments glucose and hydrolyzes arginine, but does not hydrolyze urea. The results of DNA homology studies revealed that this organism is not genetically related to previously described mycoplasma species that have the same biochemical properties. The results of serologic studies demonstrated that this organism is antigenically distinct from all previously described mycoplasmas. We propose that this new mollicute species should be named Mycoplasma penetrans sp. nov. The type strain is strain GTU-54-6A1 (= ATCC 55252).

Acquired Immunodeficiency Syndrome↗

Inhibition of the localization of urethane in mouse tissues by ethanol.

[ethyl-1-14C]Urethane in water or in 12% ethanol was administered orally to male A/JAX mice and 1 hr later the mice were frozen and processed for whole-body autoradiography to identify sites of localization of radioactivity. When the [14C]urethane was administered in water, radioactivity was localized in the liver and bile, the salivary, seromucous and Harderian glands, the bone marrow and pancreas and the stomach and intestinal epithelia. When the labelled urethane was administered in 12% ethanol, localization of radioactivity in each of these sites was almost completely inhibited; radioactivity was still seen within the lumen of the stomach and intestine. Using a defined chemical system, no transesterification was observed between urethane and 12% aqueous [2H6]ethanol at pH 1.5 in 80 min. The inhibition of the localization of radioactivity in the tissues appears to be due most probably to blocking of the metabolism of urethane in tissues. This suggests that ethanol may inhibit the carcinogenicity of urethane in mice.

Animals↗

Surgical extraction of traumatic orbital mercury.

Initial clinical observation of a 2-year-old boy whose right eyelid had been pierced by a glass thermometer 3 days earlier showed a scab-covered cicatrix and slight swelling in the eyelid. X-ray examination showed the broken thermometer tip, fine glass fragments, and mercury droplets beneath the eyelid and extending along the superior orbital margin. On surgical incision, glass fragments and the thermometer tip were found and extracted from the eyelid and orbital fatty tissue with forceps, and 70.3 mg of mercury droplets were readily removed from the same regions by suction via an elastic needle connected to an injection syringe. Blood mercury gradually rose from the normal range to a peak of 28.4 microg/dl 3 months after surgery, then declined during the following 7 months to a level of 15.1 microg/dl. No abnormality has been found in liver or renal function to present.

Child, Preschool↗

ORT and vomiting. Reply to Tambawal letter.

Oral rehydration therapy (ORT) can be considered as both curative and preventive with regard to dehydration due to diarrhea. When given to a dehydrated patient, usually in the form of oral rehydration salts, its purpose is to correct (cure) the dehydration by restoring normal amounts of water and salts to the body. However, when given soon after the onset of diarrhea, before dehydration develops, usually as a homemade solution, its purpose is to prevent the reoccurrence of dehydration. Vomiting happens frequently during diarrhea, especially when the illness is caused by rotavirus or cholera. Vomiting can occur, or continue, during the 1st hour or 2 of ORT, after which it will usually diminish or stop. When vomiting occurs during ORT, fluid administration should be continued after waiting 10 minutes but given more slowly in sips at short intervals. Although it may appear that a large amount of rehydration fluid has been vomited, most of what is given is actually retained, benefiting the patient. Antiemetics, such as chlorpromazine should not be given because (i) they have undesirable side effects, such as drowsiness, which can interfere with the continuation of ORT, and (ii) the vomiting will usually subside as ORT is continued.

Biology↗

Properties, use and health effects of depleted uranium (DU): a general overview.

Depleted uranium (DU), a waste product of uranium enrichment, has several civilian and military applications. It was used as armor-piercing ammunition in international military conflicts and was claimed to contribute to health problems, known as the Gulf War Syndrome and recently as the Balkan Syndrome. This led to renewed efforts to assess the environmental consequences and the health impact of the use of DU. The radiological and chemical properties of DU can be compared to those of natural uranium, which is ubiquitously present in soil at a typical concentration of 3 mg/kg. Natural uranium has the same chemotoxicity, but its radiotoxicity is 60% higher. Due to the low specific radioactivity and the dominance of alpha-radiation no acute risk is attributed to external exposure to DU. The major risk is DU dust, generated when DU ammunition hits hard targets. Depending on aerosol speciation, inhalation may lead to a protracted exposure of the lung and other organs. After deposition on the ground, resuspension can take place if the DU containing particle size is sufficiently small. However, transfer to drinking water or locally produced food has little potential to lead to significant exposures to DU. Since poor solubility of uranium compounds and lack of information on speciation precludes the use of radioecological models for exposure assessment, biomonitoring has to be used for assessing exposed persons. Urine, feces, hair and nails record recent exposures to DU. With the exception of crews of military vehicles having been hit by DU penetrators, no body burdens above the range of values for natural uranium have been found. Therefore, observable health effects are not expected and residual cancer risk estimates have to be based on theoretical considerations. They appear to be very minor for all post-conflict situations, i.e. a fraction of those expected from natural radiation.

Aerosols↗

Effects of estradiol on hematopoietic and marrow adherent cells of dogs.

Hematopoietic and marrow adherent cells were examined in 5 ovariohysterectomized dogs treated once with 1.5 mg of 17 beta-estradiol cyclopentylpropionate/kg of body weight. All dogs initially developed thrombocytopenia and neutrophilic leukocytosis, with megakaryocytopenia and an increased myeloid/erythroid ratio of the marrow. Later, 2 dogs became thrombocytopenic and neutropenic, with megakaryocytopenia, decreased myeloid/erythroid ratio, and increased concentration of plasma cells and mast cells in the marrow. The concentration of marrow granulocyte-macrophage colony-forming units (CFU-GM) was decreased at 2 and 3 weeks in all dogs after estradiol treatment. The concentration of marrow fibroblast CFU-F was decreased in all estradiol-treated dogs at 1 and 2 weeks. The ability of marrow adherent cells to support CFU-GM colony formation was unchanged in estradiol-treated dogs. Estradiol sulfate at final concentrations of 10(-8) to 10(-4)M did not affect the in vitro growth of CFU-GM and CFU-F, or the hematopoietic ability of marrow adherent cells from nontreated dogs.

Animals↗

Cholecystectomy and the incidence of cancer of the large bowel.

As part of an epidemiologic study of cancer of the large bowel in women, female residents of King and Pierce counties (Washington) who were diagnosed during 1976--77 were interviewed regarding previous gallbladder surgery. Their responses were compared with those of a random sample of women from the same population. A history of cholecystectomy was somewhat more frequent among patients with colon cancer than among controls--we estimate the colon cancer risk in women without a gallbladder to be 1.4 times that of other women--but the 05% confidence limits of the relative risk included 1.0 (0.8--2.5). There was no association between cholecystectomy and rectal cancer and, among the subsites of colon cancer, the magnitude of the excess risk failed to show any consistent right--left gradient. Nonepidemiologic data suggest that cholecystectomy could increase the risk of colon cancer. However, if such an association truly exists it is not a strong one, and studies larger than those conducted to date are needed to detect this association reliably.

Aged↗

Cotinine validation of self-reported smoking in commercially run community surveys.

A validation study was carried out on self-reported smoking for 1177 people in Sydney and Melbourne in 1983. Because of its long half life and the fact that smoking is its only source in body fluids, saliva cotinine was chosen as the validation measure. Cotinine levels above 250 nmol/l were used to classify people as smokers. The sensitivity of self-reported smoking was 92.6% and the specificity was 93.4%. There was some evidence that people in the process of changing their smoking status might be slow in updating their self-classification. The smoking prevalence estimate based on cotinine levels was found to be 1.7% lower than that for self-reported smoking status. The small proportion of false negatives and false positives suggests that commercially collected data banks can be valid sources of prevalence data. Correlation between cotinine level and reported cigarette consumption was not affected by sample volume, and was similar to that achieved for carbon monoxide and thiocyanate at a low 0.34. Regression analysis using self-reported cigarette consumption filter/non-filter cigarettes, and time since last cigarette as predictors, explained 13.6% of the variance in cotinine level.

Adolescent↗

Keratinocyte growth factor is an important endogenous mediator of hair follicle growth, development, and differentiation. Normalization of the nu/nu follicular differentiation defect and amelioration of chemotherapy-induced alopecia.

The growth and development of hair follicles is influenced by a number of different growth factors and cytokines, particularly members of the fibroblast growth factor (FGF) family. Keratinocyte growth factor (KGF or FGF-7) is a recently identified 28-kd member of the FGF family that induces proliferation of a wide variety of epithelial cells, including keratinocytes within the epidermis and dermal adnexa. Because KGF induces marked proliferation of keratinocytes, and both KGF and KGF receptor (KGFR) mRNA are expressed at high levels in skin, we sought to localize KGF and KGFR in skin by in situ hybridization. KGFR mRNA was relatively strongly expressed by keratinocytes in the basilar epidermis as well as throughout developing hair follicles of rat embryos and neonates. KGF mRNA was expressed at lower levels than was KGFR but could be localized to follicular dermal papillae in rat embryos and neonates. These results prompted us to investigate the effects of KGF on hair follicles in two distinct murine models of alopecia. In the first model, recombinant KGF (rKGF) induced dose-dependent hair growth over most of the body in nu/nu athymic nude mice when administered intraperitoneally or subcutaneously over 17 to 18 days. When administered subcutaneously, rKGF induced the most extensive hair growth at the sites of injection. Histologically, rKGF induced marked follicular and sebaceous gland hypertrophy, a normalization of the nu/nu follicular keratinization defect, and an increase in follicular keratinocyte proliferation as assessed by bromodeoxyuridine labeling. In the second model, a neonatal rat model of cytosine arabinoside chemotherapy-induced alopecia in which interleukin-1, epidermal growth factor, and acidic FGF have all demonstrated some degree of alopecia cytoprotection, rKGF induced a dose-dependent cytoprotective effect, abrogating as much as 50% of the alopecia in this model when administered beginning 1 day before the onset of chemotherapy. Taken together, these data suggest that KGF is an important endogenous mediator of normal hair follicle growth, development, and differentiation.

Alopecia↗

[Perforation of the ear drum. On the history of paracentesis and grommet insertion].

As early as 1649, Jean Riolan the Younger pierced an ear drum, after which the patient's hearing improved. This occurred as a result of an accidental ear drum injury while cleaning an ear canal with an ear-spoon. In 17th and 18th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experiments in an effort to ascertain the function of the ear drum in hearing. At the end of the 18th century, ear drum perforation, like perforation of a cataract, was indiscriminately performed by itinerent quacks and "physicians" in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. Astlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in the presence of obturation of the Eustachian tube. Because of the negative results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was only Herrmann Schwartze who reintroduced paracentesis into the daily practice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trailblazing treatise on the indications, value, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to closure of an artificial perforation, many physicians tried different techniques to obtain a permanent opening. Gruber resected half of the ear drum--unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his textbook of 1845, Martell Frank first described a grommet made of gold foil. Politzer experimented with a hard rubber ring but later abandoned his attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the handle of the malleur. Armstrong described a "new" therapy for chronic secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the first to reintroduce grommets in the middle of the 20th century. Theromoparacentesis was performed as early as 1867 by Voltolini, who performed this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis into the therapy of tube ventilation disorders. Paracentesis, grommet insertion, and thermoparacentesis are among the most successful treatments currently available to the ENT specialist when used properly. They are treatments with a long history.

Europe↗