Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection

OBJECT

A unique method of anterior spinal reconstruction after decompressive surgery was used to prevent methylmethacrylate-dural contact in cancer patients who underwent corpectomy. The purpose of this study was to assess the efficacy and stability of polymethylmethacrylate (PMMA) anterior surgical constructs in conjunction with anterior cervical plate stabilization (ACPS) in these patients.

METHODS

Approximately 700 patients underwent spinal surgery at The University of Texas M. D. Anderson Cancer Center over a 4-year period. The authors conducted a retrospective outcome study for 29 of these patients who underwent anterior cervical or upper thoracic tumor resections while in the supine position. These patients were all treated using the coaxial, double-lumen, PMMA technique for anterior spinal reconstruction with subsequent ACPS. No postoperative external orthoses were used. Twenty-seven patients (93%) harbored metastatic spinal lesions and two (7%) harbored primary tumors. At 1 month postsurgery, significant improvement was seen in spinal axial pain (p<0.001), radiculopathy (p<0.001), gait (p = 0.008), and Frankel grade (p = 0.002). A total of nine patients (31%) underwent combined anterior-posterior 360 degrees stabilization. Twenty-one patients (72%) experienced no complications. Complications related to instrumentation failure occurred in only two patients (7%). There were no cases in which the patients' status worsened, and there were no neurological complications or infections. The median Kaplan-Meier survival estimate for patients with spinal metastases was 9.5 months. At the end of the study, 13 patients (45%) had died and 16 (55%) were alive. Postoperative magnetic resonance images consistently demonstrated that the dura and PMMA in all patients remained separated.

CONCLUSIONS

The anterior, coaxial, double-lumen, PMMA reconstruction technique provides a simple means of spinal cord protection in patients in the supine position while undergoing surgery and offers excellent results in cancer patients who have undergone cervical vertebrectomy.

Direct magneto-optical observation of a structural phase transition in thin films of manganites

The spontaneous formation of twins in La(2/3)Ca(1/3)MnO3 films below T(S) approximately 105 K is observed by a magneto-optical technique. The twins are revealed as stripes along the {110} directions where magnetization tilts out of the film plane due to the stresses in twins. Their appearance is associated with a martensitic phase transition in the film triggered by the cubic-to-tetragonal transition in the SrTiO3 substrate. It is found that magnetization of the films proceeds by inhomogeneous rotation of magnetic moments. This is due to the presence of microscopic structural inhomogeneities. Their dominating role in the low-temperature transport can explain small effects of the transition at T(S) on the resistivity.

1,25-dihydroxyvitamin D3 treatment decreases macrophage accumulation in the CNS of mice with experimental autoimmune encephalomyelitis

Sunlight, which is required for vitamin D biosynthesis, may be protective in multiple sclerosis (MS), due to the immunoregulatory functions of 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3), the hormonally active vitamin D metabolite. This hypothesis provided the impetus for the experiments reported here investigating mechanisms whereby 1,25-(OH)2D3 may inhibit murine experimental autoimmune encephalomyelitis (EAE). Severe EAE was induced, 1,25-(OH)2D3 or mock treatment was administered, and clinical disease, histopathological disease, and encephalitogenic cells in the central nervous system (CNS) were analyzed within 24-72 h of the treatment. The mock-treated mice remained paralyzed (stage 3 EAE) while most hormone-treated animals regained the partial use of both hind limbs (stage 2 EAE) within 72 h of treatment. A histopathological examination showed the hormone-treated mice had a 50% decrease in white matter and meningeal inflammation at 72 h post treatment. A flow cytometric analysis of cell surface markers on spinal cord cells recovered 24 h post treatment showed the mock-treated mice with EAE had about 7.0 +/- 2.3 million Mac-1+ cells/cord, whereas the hormone-treated mice had about 2.1 +/- 2.6 million Mac-1+ cells/cord, which was not significantly different from the unmanipulated control mice. Otherwise, the flow cytometric analysis detected no significant differences between the groups with respect to CD4+ or CD8+ T cells or B cells or macrophages in draining lymph nodes or spinal cords. These results are discussed with regard to possible fates for the 5 million Mac-1+ cells that were rapidly lost from the inflamed CNS in the 1,25-(OH)2D3-treated mice, and the possible beneficial effect of hormone treatment in resolving acute MS.

The coral Acropora: what it can contribute to our knowledge of metazoan evolution and the evolution of developmental processes

The diploblastic Cnidaria form one of the most ancient metazoan phyla and thus provide a useful outgroup for comparative studies of the molecular control of development in the more complex, and more often studied, triploblasts. Among cnidarians, the reef building coral Acropora is a particularly appropriate choice for study. Acropora belongs to the Anthozoa, which several lines of evidence now indicate is the basal class within the phylum Cnidaria, and has the practical advantages that its reproduction is predictable, external and accessible and that the base content of its genome is not strongly biased. The Acropora system has already provided insights into ancestral linkages of homeobox genes and the evolution of the Pax genes, and has the potential to provide further new perspectives on the age, role in development, and evolution of these and other gene families.

Static subcritical water extraction combined with anion exchange disk sorption for determining chlorinated acid herbicides in soil

Static subcritical water extraction (SbWE) was coupled with collection on a strong anion exchange (SAX) disk for the determination of chlorinated acid herbicides and their esters in soil. With 100-150 degrees C water, esters were hydrolyzed into their acid form, and the herbicide acids extracted by subcritical water were trapped onto/into a SAX disk as the extraction cell was cooled. The trapped solutes were then derivatized for gas chromatographic (GC) analysis by placing the disk into a GC autosampler vial containing 1 mL of N,O-bis(trimethylsilyl)trifluoroacetamide derivatizing reagent. With the static SbWE/SAX disk extraction, nearly quantitative recoveries (typically over 80%) were obtained at 100 degrees C for 30 min in the extraction of herbicide acids and esters spiked on several different soils covering a range of organic content from 0.3 to 12%. Good agreements were reached between this method and EPA method 8151 for aged spiked soils. Detection limits of the static SbWE/SAX disk extraction were from 0.05 to 0.5 ppm and from 0.01 to 0.5 ppm using GC/electron capture detector and GC/mass spectrometry, respectively. The method is fast and simple and uses a small amount of organic solvent.

Porcine sperm surface beta1,4galactosyltransferase binds to the zona pellucida but is not necessary or sufficient to mediate sperm-zona pellucida binding

The binding of sperm to the zona pellucida is an integral part of the mammalian fertilization process, investigated most extensively in the mouse. Several sperm receptors for the murine zona pellucida have been studied (Snell WJ, White JM. 1996. Cell 85:629-637; Wassarman PM. 1999. Cell 96:175-183), but the most compelling evidence exists for beta-1,4-galactosyltransferase (GalTase). Considering that GalTase is present on the surface of porcine sperm (Larson JL, Miller DJ. 1997. Biol Reprod 57:442-453), we investigated the role of GalTase in porcine sperm-zona binding. Sperm surface GalTase catalyzed the addition of uridine diphosphate-[(3)H]galactose to the 55 kDa group of the porcine zona pellucida proteins implicated in sperm binding, demonstrating that GalTase binds the porcine zona. The functional importance of GalTase-zona pellucida binding was tested. Addition of uridine diphosphate galactose, a substrate that completes the GalTase enzymatic reaction and disrupts GalTase mediated adhesion, had no effect on binding of sperm to porcine oocytes. Furthermore, removal of the GalTase zona ligand by incubation of oocytes with N-acetylglucosaminidase had no effect on binding of sperm to oocytes. These results suggest that GalTase is not necessary for sperm to bind to the zona pellucida. Digestion of isolated porcine zona proteins with N-acetylglucosaminidase did not affect the biological activity of soluble porcine zona proteins in competitive sperm-zona binding assays, suggesting that GalTase alone is not sufficient to mediate sperm-zona attachment. From these results, it appears that, although GalTase is able to bind porcine zona proteins, its function in porcine sperm-zona binding is not necessary or sufficient for sperm-zona binding. This supports the contention that porcine sperm-zona binding requires redundant gamete receptors.

Head injuries in four British neurosurgical centres

An issue in the design of trials in traumatic brain injury is whether variation amongst centres in 'conventional' management could mask the impact of a powerful new pharmacological agent. We report the results of an observational study of 988 patients admitted to one of four British neurosurgical units between 1986 and 1988 within 3 days of a severe head injury. The centres fell into two pairs on the basis of the 'intensity' of management. In Edinburgh and Southampton, more frequent use of intracranial pressure monitoring, ventilation and osmotic diuretics was made than in Glasgow and Liverpool. The odds ratio for an independent outcome at 6 months in Edinburgh or Southampton, relative to Glasgow or Liverpool, controlling for case mix, was 1.43 (95% CI, 1.03-1.98, p = 0.033). Thus, there is weak evidence of an association between the approach to management and clinical outcome at 6 months.

Parental use of alcohol and children's behavioural health: a household production analysis

This study uses the 1988 National Health Interview Survey (NHIS) data to examine the effects of both heavy and problem drinking as well as moderate or light parental alcohol use on children's behaviour problems. The analysis is formulated within Becker's household production function framework. The production of child behavioural health is estimated using items from the Behavior Problems Index, a battery of 32 questions about behaviour problems which is derived from the Child Behavior Checklist (CBCL), a widely-used parent report instrument. Measures of parents' alcohol consumption are constructed from the NHIS Alcohol Supplement that was administered to one randomly selected adult in each household in 1988. Ordinary least squares (OLS) and two-stage least squares (TSLS) results are presented. The results provide consistent evidence that parental alcohol use is an input with negative marginal product in the production of child behavioural health, regardless of which parent drinks. The magnitude of the effect is generally larger in the TSLS specification. There is also strong evidence of relationships between some family structure variables and child behavioural health and between parental physical health and child behavioural health.

Optimism and coping styles: A comparison of candidates for liver transplantation with candidates for lung transplantation

BACKGROUND

Dispositional optimism and adaptive coping styles have been shown to correlate with each other and with physical and psychological well-being in a number of studies with medical patients. Few studies in the transplant literature evaluate psychological characteristics of patients across medical diagnoses. A comparison of optimism and coping styles among candidates for liver and lung transplantation is presented.

METHOD

Subjects were 73 candidates for lung transplantation at the University of Pittsburgh Medical Center and 76 candidates for liver transplantation at the Pittsburgh VA Healthcare System. All candidates were classified according to medical diagnosis and history of substance abuse (alcohol/drugs or smoking). There were no significant between- or within-group differences on optimism.

RESULTS

There was a significant difference within both groups, according to history of substance abuse on the coping style 'acceptance'. There were also significant between-group differences on a number of coping styles.

CONCLUSIONS

This preliminary study is intended to suggest direction for future research; studying psychological variables known to impact on health apart from medical diagnosis may provide data pertinent to selection criteria and the design of interventions to more effectively maximize the benefit of transplantation for all concerned.

Barriers to hypertension care and control in young urban black men

Barriers to high blood pressure (HBP) care and control have been reported in the literature for > 30 years. Few reports on barriers, however, have focused on the young black man with HBP, the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness, treatment, and control. In a randomized clinical trial of comprehensive care for hypertensive young urban black men, factors potentially associated with care and control were assessed at baseline for the 309 enrolled men. A majority of the men encountered a variety of barriers including economic, social, and lifestyle obstacles to adequate BP care and control, including no current HBP care (49%), risk of alcoholism (62%), use of illicit drugs (45%), social isolation (47%), unemployment (40%), and lack of health insurance (51%). Having health insurance (odds ratio = 7.20, P = .00) and a negative urine drug screen (odds ratio = .56, P = .04) were significant predictors of being in HBP care. Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior. Men currently using illicit drugs were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs, and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication. Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment, if HBP care is to be salient and effective in this high risk group.

Psychological characteristics of candidates for liver transplantation: differences according to history of substance abuse and UNOS listing. United Network for Organ Sharing

Liver transplantation for patients with a history of substance abuse remains controversial. Resumption of heavy alcohol use postoperatively is a threat to long-term survival, but recidivism among transplanted alcoholics is reportedly low. An argument against psychological evaluation prior to transplantation revolves around the speculation that candidates will attempt to portray themselves as more desirable prior to listing with UNOS (United Network for Organ Sharing). This study measured psychological distress, coping styles, optimism, selected personality features, and perception of family environment among 73 U.S. military veterans who were candidates for liver transplantation. Candidates with positive histories of substance abuse revealed significantly more distress, less adaptive coping styles, and more character pathology than their counterparts. The only significant difference according to UNOS listing was on one measure of family environment. Results support preoperative psychological assessment and intervention on a more extensive level for substance abusers and raise questions for future research.

Activation of mitogen-activated protein kinase by fumonisin B(1) stimulates cPLA(2) phosphorylation, the arachidonic acid cascade and cAMP production

Activation of mitogen-activated protein kinase (MAPK) results in pleiotropic effects such as modulation of the transcription and activation of enzymes involved in signal transduction. One such enzyme is the cytoplasmic phospholipase A(2) (cPLA(2)), which releases arachidonic acid (AA). AA is the precursor of prostaglandins and leukotrienes, two inflammatory mediators, which regulate gene expression and protein kinase (PK) activity. Fumonisin B(1) (FB(1)) was shown to increase PKC translocation and stimulate MAPK. We have investigated the effect of FB(1) on the AA cascade in a human epithelial cell line and the signal transduction pathway regulating PLA(2) activation. We observed that FB(1) stimulated cPLA(2) activity and increased AA release by a mechanism independent of PKC activation and that the activation of cPLA(2) is a two-step process: the first is phosphorylation of cPLA(2) by MAPK; the second is a consequence of the increase in sphingosine inside and outside the cells after 2 h, which is known to induce a rise in intracellular free calcium. Overall, this suggests that the effect of FB(1) on cells is partially dependent on the action of FB(1) on the enzymes involved in the cell cycle, such as MAPK and PKA, and on bioactive fatty acids, such as the prostaglandins and leukotrienes, and also on disruption of sphingolipid metabolism. In addition, we have observed down-regulation of cPLA(2) activity and AA metabolism by a mechanism involving prostaglandin production, cAMP synthesis and PKA activation.

Vertex epidural hematoma: surgical versus conservative management: two case reports and review of the literature

OBJECTIVE AND IMPORTANCE

Vertex epidural hematomas may be underestimated or overlooked altogether when computed tomographic scans alone are used for diagnosis. Such hematomas can be resolved with active intervention and sometimes with conservative treatment.

CLINICAL PRESENTATION

Two cases of successfully treated vertex epidural hematomas, in a 33-year-old man who presented with seizures and an 11-year-old girl who presented with headache and vomiting, are described. Both hematomas were traumatic in origin and were associated with cranial fractures. In each, coronal images (computed tomographic or magnetic resonance imaging scans) showed the extent of the hematoma much more clearly than did axial images.

INTERVENTION

One case was treated surgically and the other conservatively.

CONCLUSION

Magnetic resonance imaging is not usually indicated for trauma patients, but it is an appropriate diagnostic modality for these rare lesions, to supplement standard axial computed tomographic scans. Because vertex epidural hematomas may resolve spontaneously with time, conservative treatment should be considered on a case-by-case basis.

Coronary artery bypass surgery in nonagenarians

As the number of nonagenarians increases yearly in the United States, surgeons will be asked more often to evaluate the possibility of intervention for coronary artery disease in this age group. The purpose of this study is to document experience with patients 90 years of age or older in order to determine whether coronary artery bypass grafting surgery is justified. Eleven patients aged 90 years or more underwent cardiac surgery for symptomatic coronary artery disease refractory to medical management between January 1, 1987, and December 31, 1996. All patients were in NYHA Class IV preoperatively. In-hospital death occurred in two patients (18%). In-hospital morbidity occurred in all patients (100%) including seven cardiac, four respiratory, two neurologic, and one infectious. All survivors left the hospital symptomatically improved. The mean length of stay was 28 days. Four patients died at a mean of 2 years and 2 months postoperatively. Five patients remain alive at a mean of 1 year and 7 months. Coronary artery bypass grafting in nonagenarians can be performed successfully in selected cases. However, increased mortality and morbidity rates and length of stay are associated with this age group. For survivors, the quality of life is improved and the projected life expectancy restored.

Effects of reactive oxygen species on myofilament function in a rabbit coronary artery ligation model of heart failure

This study aimed to determine structural alterations occurring in cardiac myofilaments after exogenous application of oxidants and the effects of oxidants on contractile protein function in a rabbit coronary artery ligation model of heart failure. Myocardial "stiffness" was higher in the ligated animals (Lig) than sham-operated controls (Sh, 4.9+/-1.5 versus 1.6+/-0.8 mN.mm-1). Superoxide anion (O2-) exposure decreased active stiffness in both groups, whereas hypochlorous acid (HOCl) had no effect in Lig but increased stiffness in Sh. Resting stiffness was higher in Lig than Sh (0.6+/-0.2 versus 0.2+/-0.1 mN.mm-1), remaining unchanged after O2- exposure but increasing after HOCl in both groups. The frequency at minimum stiffness was lower in Lig than Sh (0.9+/-0.2 versus 1. 7+/-0.6 Hz) and was reduced in both groups after oxidant exposure. Myofilament calcium sensitivity (pCa50) was not altered by O2- in Sh but increased in Lig (pCa50 increased from 5.41+/-0.05 to 5.56+/-0. 06). Protease contamination in the xanthine oxidase used to generate O2- did not affect myofilament ultrastructure at the concentrations used here. These data demonstrate that contractile proteins from "failed" myocardium have a similar response to exogenously applied oxidants as controls and that application of protease-contaminated xanthine oxidase system does not degrade the contractile protein structure.

Simple histochemical stain for acrosomes on sperm from several species

The acrosome reaction is an exocytotic process that enables a sperm to penetrate the zona pellucida and fertilize an egg. The process involves the fenestration and vesiculation of the sperm plasma membrane and outer acrosomal membrane releasing the acro somal contents. Many different methods have been devel oped to detect the acrosomal status of sperm. These techniques are sometimes complicated, costly, and can be used on only a few species. The aim of this study was to develop an efficient and inexpensive method to assess the acrosomal status of sperm from a variety of species. We prepared and fixed sperm from humans, cattle, swine, rabbits, guinea pigs, and mice and stained them with Coomassie G250. The acrosomes were stained intensely blue in color. Following capacitation, some sperm were incubated for 1 hr with 10 microM calcium ionophore A23187 to induce the acrosome reaction. They were also stained with Coomassie G-250. Ionophore-treated sperm lacked Coomassie staining over the acrosomal region. Differential interference contrast (DIC), bright field microscopy or Pisum sativum agglutinin staining confirmed that the acrosomes of sperm from these species were reacted in response to calcium ionophore treatment and the acrosome reaction frequencies matched results with Coomassie staining. These results demonstrate that the acrosomal status of mammalian sperm from several species can be determined easily and reliably using this simple Coomassie Blue G-250 staining method.

Atypically low rate of cytochrome b evolution in the scleractinian coral genus Acropora

Unexpectedly low levels of mitochondrial DNA (mtDNA) cytochrome b sequence divergence are found between species of the scleractinian coral genus Acropora. Comparison of 964 positions of the cytochrome b gene of two out of the three Caribbean Acropora species with seven of their Pacific congeners shows only 0.3-0.8% sequence difference. Species in these biogeographic regions have been evolving independently for at least three million years (since the rise of the Isthmus of Panama) and this geological date is used to estimate nucleotide divergence rates. The results indicate that the Acropora cytochrome b gene is evolving at least 10-20 times slower than the 'standard' vertebrate mtDNA clock and is one of the most slowly evolving animal mitochondrial genes described to date. The possibility is discussed that, unlike higher animals, cnidarians may have a functional mtDNA mismatch repair system.

Information resources assessment of a healthcare integrated delivery system

While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.

Improved image decoding over noisy channels using minimum mean-squared estimation and a Markov mesh

Joint source-channel (JSC) decoding based on residual source redundancy is a technique for providing channel robustness to quantized data. Previous work assumed a model equivalent to viewing the encoder/noisy channel tandem as a discrete hidden Markov model (HMM) with transmitted indices the hidden states. We generalize this HMM-based (1-D) approach for images, using the more powerful hidden Markov mesh random field (HMMRF) model. While previous state estimation methods for HMMRFs base estimates on only a causal subset of the observed data, our new method uses both causal and anticausal subsets. For JSC-based image decoding, the new method provides significant benefits over several competing techniques.

Solid-phase microextraction with pH adjustment for the determination of aromatic acids and bases in water

Adjusting the pH of water samples before performing solid-phase microextraction (SPME) analysis can be used to selectively extract organic acids (at pH 2) and bases (at pH 12). Sorption behavior of test organics is predictable based on the acid dissociation constant in water. In general, polyacrylate (PA) and Carbowax-divinylbenzene (CW-DVB) show substantially higher fiber/water sorption coefficients (Kd values) than a polydimethylsiloxane (PDMS) coated fiber. Gas chromatography-flame ionization detection (GC-FID) detection limits with the CW-DVB sorbent are approximately 0.5 to 10 ng/ml in a 2-ml water sample for a variety of aromatic amines, phenols, and chlorinated phenols, and are approximately 1 to 50 ng/ml for the same solutes using the PA sorbent. However, the PA fiber is more selective (depending on the water pH) for the acid or base components than the CW-DVB fiber. With proper pH adjustment, the recovery of spiked aromatic amines and phenols from a surface wetlands water ranged from 73 to 118% of the known values, with a precision (R.S.D.) of approximately 5 to 20%. SPME quantitation of phenols in a coal gasification wastewater using a PA fiber also gave excellent agreement with conventional methylene chloride extraction, although continued use of a single fiber with this wastewater led to poorer precision.

Production of bovine alpha-lactalbumin in the milk of transgenic pigs

High production of milk and its components are necessary to allow maximal growth of developing pigs. In this study, transgenic pigs were produced containing the alpha-lactalbumin gene, whose product is a potential limiting component in the production of milk. Two lines of transgenic pigs were produced to analyze the effects that overproduction of the milk protein alpha-lactalbumin may have on milk production and piglet growth. Transgenic pigs were produced through microinjection of the bovine alpha-lactalbumin gene. The gene construct contained 2.0 kb of 5' flanking region, the 2.0 kb coding region, and 329 bp of 3' flanking region. Sows hemizygous for the transgene produced as much as .9 g of bovine alpha-lactalbumin per liter of pig milk. The production of the bovine protein caused approximately a 50% increase in the total alpha-lactalbumin concentration of pig milk throughout a lactation. The concentration of bovine alpha-lactalbumin was highest on d 0 and 5 of lactation and decreased as lactation progressed. The ratio of bovine to porcine alpha-lactalbumin changed during the sow's lactation. This ratio was 4.3 to 1 on d 0 of lactation, but by d 20 of lactation the ratio was .43 to 1. This suggested that the bovine transgene and the endogenous porcine gene are under slightly different control mechanisms. The higher level of total alpha-lactalbumin present on d 0 of lactation was correlated with higher lactose percentage on d 0 in transgenic sows (3.8%), compared with controls (2.6%) (P < .01). Although there was also a trend for higher lactose percentage in transgenic sows on d 5 and 10 of lactation, no significant differences were observed. These data suggest that alpha-lactalbumin is limiting early in lactation of swine. Furthermore, higher concentrations of alpha-lactalbumin early in lactation may boost milk output.