Compartment syndrome secondary to prolonged intraosseous infusion

Intraosseous infusions are a valuable means of establishing intravascular access in pediatric emergencies. We report a case of compartment syndrome from prolonged intraosseous infusion (53 hours). We postulate that chemical irritation from medications, infections, the tenuous nature of intraosseous infusions, and the use of infusion pumps may all play a role in the development of compartment syndrome. We recommend that, when possible, intraosseous lines be used only temporarily until more permanent vascular access is established, that lines that do not flow with gravity be removed, and that drugs known to cause chemical burns be used with caution. In addition, the use of x-ray and hourly measurement of leg circumference may help to determine whether a line is still in place. Also, given the changing circumstances and technology under which intraosseous infusions are used, new prospective studies of their complications are needed.

Six State Survey of Container Nursery Nitrate Nitrogen Runoff

Container nursery bed runoff, reservoirs or ponds that contained runoff, wells, and surface water discharged from the property or at the property border were sampled at approximately 6-week intervals during April–October 1990 in Alabama, Florida, New Jersey, North Carolina, Ohio, and Virginia. Runoff from container beds averaged 8 and 20 ppm NO3-N, respectively, for nurseries using controlled-release fertilizers (CRF) and controlled-release fertilizers supplemented with solution fertilizers (CRFSS). Average NO3-N levels for runoff collection ponds, property borders, and wells were each less than 10 ppm, the drinking water limit, regardless of fertilizers used. However, ppm NO3-N for some samples exceeded the drinking water standard. In general, these data indicate reason for concern and nursery operators need to implement best management practices.

Evaluation of a turbidimetric procedure for apolipoproteins A1 and B on the Ciba Corning 550 EXPRESS

We evaluated a turbidimetric method for the estimation of apo A1 and apo B on the Ciba Corning 550 EXPRESS using Ciba Corning reagents. Interference due to bilirubin, hemoglobin, lipemia, triglycerides, and uremia was minimal, with apolipoproteins (apo) A1 and B results usually within +/- 4% of expected values. Within-run and day-to-day imprecision (coefficients of variation) ranged from 1.96 to 3.60% and 2.63 to 3.39% for apo A1 and 1.02 to 1.74% and 2.08 to 3.66% for apo B, respectively. Accuracy was determined by participation in the IFCC apolipoprotein standardization project in which results obtained on 50 patient samples were compared to those obtained by the reference laboratory. Apo A1 and apo B showed an average bias of +3.7% and +2.0% and correlation coefficients of 0.986 and 0.977, respectively. Results were also compared to those obtained on the Behring Turbitime system and showed a bias of +7.5% and -8.8% for apo A1 and apo B, respectively. The Ciba Corning automated method was rapid and gave good accuracy, precision, linearity, and parallelism and was relatively unaffected by raised triglyceride values.

A visual fuzzy cluster system for patient analysis

A visual fuzzy cluster (VFC) system is developed to assist physicians in interactively detecting and refining cluster partitions for patients with acute upper respiratory infections. The VFC system assists physicians in discovering relationships among patients by applying a fuzzy cluster algorithm to analyse a case base of patient findings. The algorithm discovers similarities among patients, while at the same time identifying atypical patients. The system visually presents the fuzzy cluster solutions on a three-dimensional animated display. Physicians then interactively manipulate icons representing patients to explore and refine the fuzzy cluster solution. Initial experiences with the VFC prototype are encouraging and support the claims that the system improves physician understanding and allows physicians to take advantage of visual recognition and manipulation skills to define and label patient groupings. The resulting labels and cluster centres or prototypes offer insight into the set of patient features that best discriminate between groups.

DiOC6 staining reveals organelle structure and dynamics in living yeast cells

When present at low concentrations, the fluorescent lipophilic dye, DiOC6, stains mitochondria in living yeast cells [Pringle et al.: Methods in Cell Biol. 31:357-435, 1989; Weisman et al.: Proc. Natl. Acad. Sci. U.S.A. 87:1076-1080, 1990]. However, we found that the nuclear envelope and endoplasmic reticulum were specifically stained if the dye concentration was increased or if certain respiratory-deficient yeast strains were examined. The quality of nuclear envelope staining with DiOC6 was sufficiently sensitive to reveal alterations in the nuclear envelope known as karmellae. These membranes were previously apparent only by electron microscopy. At the high dye concentrations required to stain the nuclear envelope, wild-type cells could no longer grow on non-fermentable carbon sources. In spite of this effect on mitochondrial function, the presence of high dye concentration did not adversely affect cell viability or general growth characteristics when strains were grown under standard conditions on glucose. Consequently, time-lapse confocal microscopy was used to examine organelle dynamics in living yeast cells stained with DiOC6. These in vivo observations correlated very well with previous electron microscopic studies, including analyses of mitochondria, karmellae, and mitosis. For example, cycles of mitochondrial fusion and division, as well as the changes in nuclear shape and position that occur during mitosis, were readily imaged in time-lapse studies of living DiOC6-stained cells. This technique also revealed new aspects of nuclear disposition and interactions with other organelles. For example, the nucleus and vacuole appeared to form a structurally coupled unit that could undergo coordinated movements. Furthermore, unlike the general view that nuclear movements occur only in association with division, the nucleus/vacuole underwent dramatic migrations around the cell periphery as cells exited from stationary phase. In addition to the large migrations or rotations of the nucleus/vacuole, DiOC6 staining also revealed more subtle dynamics, including the forces of the spindle on the nuclear envelope during mitosis. This technique should have broad application in analyses of yeast cell structure and function.

Modelling acidification at Beacon Hill-a low rainfall, high pollutant deposition site in Central England

The model MAGIC (Model of Acidification of Groundwater In Catchments) has been applied to the Beacon Hill site, near Loughborough in Central England. This site is heavily impacted by wet and dry deposition of oxides of sulphur and nitrogen. The high acid inputs have caused soil acidification and acid stream waters. Long term simulations suggest that there has been a major decline in alkalinity and pH over the past 50 years. Despite recent reductions in deposition levels, soils and streams are predicted to continue to acidify in the future. For this heavily impacted site, deposition must be reduced by 80-90% to reverse the acidification trend and allow recovery of soil and stream waters.

Effects of argon laser light, alternate source light, and cyanoacrylate fuming on DNA typing of human bloodstains

Restriction fragment length polymorphism (RFLP) profile results were obtained from deoxyribonucleic acid (DNA) isolated from human bloodstains that had been subjected to cyanoacrylate ester ("superglue") fuming, argon ion laser light and alternate light sources. All RFLP profile results obtained from treated samples were consistent with the DNA pattern from untreated bloodstains.

Mutation of a tyrosine localization signal in the cytosolic tail of yeast Kex2 protease disrupts Golgi retention and results in default transport to the vacuole

Kex2 protease processes pro-alpha-factor in a late Golgi compartment in Saccharomyces cerevisiae. The first approximately 30 residues of the 115 amino acid CO2H-terminal cytosolic tail (C-tail) of the Kex2 protein (Kex2p) contain a Golgi retention signal that resembles coated-pit localization signals in mammalian cell surface receptors. Mutation of one (Tyr713) of two tyrosine residues in the C-tail or deletion of sequences adjacent to Tyr713 results in loss of normal Golgi localization. Surprisingly, loss of the Golgi retention signal resulted in transport of C-tail mutant Kex2p to the vacuole (yeast lysosome), as judged by kinetics of degradation and by indirect immunofluorescence. Analysis of the loss of Kex2 function in vivo after shutting off expression of wild-type or mutant forms proved that mutations that cause rapid vacuolar turnover do so by increasing the rate of exit of the enzyme from the pro-alpha-factor processing compartment. The most likely explanation for these results is that mutation of the Golgi retention signal in the C-tail results in transport of Kex2p to the vacuole by default. Wild-type Kex2p also was transported to the vacuole at an increased rate when overproduced, although apparently not due to saturation of a Golgi-retention mechanism. Instead, the wild-type and C-tail mutant forms of Kex2p may follow distinct paths to the vacuole.

Bacteriology of hemodialysis fluids: are current methodologies meaningful?

Reports of increasing endotoxic reactions in dialysis centers using high-flux dialyzers and high contamination in liquid bicarbonate concentrates have resulted in concern for the microbial contamination of dialysate. The influence of salt-supplemented media on the recovery of bacterial contaminants from the fluids used in hemodialysis has been examined. This study found a negative influence of a 2% NaCl supplementation of growth media for both purified water and dialysate. Salt-supplemented pour plate cultures of bicarbonate concentrate samples were not statistically different from nonsupplemented cultures (p = 0.2). The influence of the bicarbonate salt on recovery in the pour plates was not addressed. The different media recommended for monitoring microbial contamination of dialysis fluids were compared. As previously reported, both water and dialysate collected from a relatively large geographic area showed higher recoveries on Reasoner's R2A agar than on media recommended by the Association for Advancement of Medical Instrumentation (AAMI) standards (p < 0.0001). Standard methods agar (SMA) and trypticase soy agar (TSA) produced the next highest recovery for water and dialysate, respectively. The higher recoveries generally observed on R2A or SMA suggest that to provide better patient safety these media should be selected for monitoring bacterial contamination of water, and R2A, SMA, or TSA for dialysate. The variability in the species identified across the three fluids and variability in counts observed in the different fluids suggest that significant dialysate contamination may occur from sources other than the water and bicarbonate concentrates.

Reversible inhibition of albumin production by rat hepatocytes maintained on a laminin-rich gel (Engelbreth-Holm-Swarm) in response to secretory products of Kupffer cells and cytokines

Decreased albumin synthesis by hepatocytes in liver injury is thought to occur in response to Kupffer cell-derived acute-phase cytokines. In this study we used hepatocytes maintained in a differentiated phenotype, by culture on a laminin-rich gel substratum (Engelbreth-Holm-Swarm matrix), to investigate the effects of Kupffer cell-conditioned medium and purified cytokines (interleukin-1, interleukin-6 and tumor necrosis factor-alpha) on albumin synthesis. Kupffer cell-conditioned medium caused a reversible decrease in albumin synthesis to 64.7% of control (p less than 0.01, Wilcoxon's rank sum test, n = 11) on day 2. Repeated doses caused further dose-dependent reversible responses. The same result was obtained when protease inhibitors (alpha 1-antitrypsin and alpha 2-macroglobulin) were added to Kupffer cell-conditioned medium (n = 3), thus eliminating the potential effect of matrix degradation. Pure interleukin-1, interleukin-6 and tumor necrosis factor-alpha also inhibited albumin synthesis (p less than 0.05, Wilcoxon's rank sum test, n = 5), interleukin-6 having the greatest effect. After exposure to interleukin-1 (30 U.ml-1) and tumor necrosis factor-alpha (300 U.ml-1), decreased albumin synthesis was followed by a rebound increase (n = 3). Our results support the hypothesis that reduced albumin synthesis in the acute-phase response is modulated by cytokines released from Kupffer cells. Moreover, our results suggest that hepatocytes may exhibit a compensatory increase in albumin synthesis after cytokine withdrawal. These findings may be of physiological importance in the recovery from injury and the acute-phase response in vivo.

Isolation and characterization of PEP3, a gene required for vacuolar biogenesis in Saccharomyces cerevisiae

The Saccharomyces cerevisiae PEP3 gene was cloned from a wild-type genomic library by complementation of the carboxypeptidase Y deficiency in a pep3-12 strain. Subclone complementation results localized the PEP3 gene to a 3.8-kb DNA fragment. The DNA sequence of the fragment was determined; a 2,754-bp open reading frame predicts that the PEP3 gene product is a hydrophilic, 107-kDa protein that has no significant similarity to any known protein. The PEP3 predicted protein has a zinc finger (CX2CX13CX2C) near its C terminus that has spacing and slight sequence similarity to the adenovirus E1a zinc finger. A radiolabeled PEP3 DNA probe hybridized to an RNA transcript of 3.1 kb in extracts of log-phase and diauxic lag-phase cells. Cells bearing pep3 deletion/disruption alleles were viable, had decreased levels of protease A, protease B, and carboxypeptidase Y antigens, had decreased repressible alkaline phosphatase activity, and contained very few normal vacuolelike organelles by fluorescence microscopy and electron microscopy but had an abundance of extremely small vesicles that stained with carboxyfluorescein diacetate, were severely inhibited for growth at 37 degrees C, and were incapable of sporulating (as homozygotes). Fractionation of cells expressing a bifunctional PEP3::SUC2 fusion protein indicated that the PEP3 gene product is present at low abundance in both log-phase and stationary cells and is a vacuolar peripheral membrane protein. Sequence identity established that PEP3 and VPS18 (J. S. Robinson, T. R. Graham, and S. D. Emr, Mol. Cell. Biol. 11:5813-5824, 1991) are the same gene.

Deoxyribonucleic acid amplification and hybridisation in Crohn's disease using a chlamydial plasmid probe

The possibility that Crohn's disease is caused by infection with Chlamydia trachomatis was examined by probing for chlamydial plasmid deoxyribonucleic acid (DNA) in DNA extracts from Crohn's disease tissue and by means of a serological study. Gut DNA extracts were obtained from 10 patients with Crohn's disease and four control subjects and were probed with a chlamydial plasmid probe after Southern blotting. The polymerase chain reaction was also used to amplify any chlamydial plasmid DNA present in tissue DNA extracts, before Southern blotting and probing. Chlamydial proctitis control specimens were not available: gut DNA extracts mixed with traces of chlamydia plasmid served as positive controls. Using these techniques, no chlamydial plasmid DNA sequences were found in Crohn's disease tissue. An enzyme linked immunosorbent assay for C trachomatis LI was performed on 48 patients with Crohn's disease and 48 control subjects. Seropositivity was present in 14.6% of patients and 29% of control subjects and was not statistically significant (p greater than 0.05). The failure to show chlamydial DNA and the lack of serological response to chlamydia make C trachomatis infection a very unlikely factor in the pathogenesis of Crohn's disease.

Prevention of sepsis following endoscopic retrograde cholangiopancreatography

Ora; ciprofloxacin was studied as a prophylactic antimicrobial agent in high- and low-risk patients undergoing endoscopic retrograde cholangiography. Ciprofloxacin appeared to be effective, good serum levels were attained, and the drug compared favourably on grounds of cost and convenience with a parenterally-administered cephalosporin.

Complementation between Sindbis viral RNAs produces infectious particles with a bipartite genome

Sindbis virus, the type member of the alpha-viruses, is an enveloped virus containing a nonsegmented positive-strand RNA genome. We show that the nonstructural and the structural genes can function to produce infectious virus particles when they are expressed on two different RNA segments. The nonstructural genes are translated from an RNA in which the structural genes have been replaced by the chloramphenicol acetyltransferase gene [Xiong, C., Levis, R., Shen, P., Schlesinger, S., Rice, C. M. & Huang, H. V. (1989) Science 243, 1188-1191]. The structural genes are encoded in a defective-interfering RNA but are translated from a subgenomic RNA. Both segments contain the cis-acting sequences required for replication and packaging and are copackaged. This type of genome provides a model for an ancestral intermediate between alphaviruses and the multipartite positive-strand RNA viruses of plants. These different viruses show sequence similarities in their replicative proteins and are thought to have evolved from a common ancestor.

Health, stress, psychological resources, and subjective well-being among older blacks

This study examines the structural relationships among sociodemographic characteristics, health status, stress, psychological resources, and subjective well-being (SWB) among the Black elderly. A structural equation model of SWB was evaluated with data from the 1979-1980 National Survey of Black Americans. The results revealed that poor subjective health status was predictive of lower levels of personal efficacy and SWB. Stressful life events tended to depress subjective assessments of health and had negative effects on self-esteem and SWB. Marital status and age had positive effects on SWB. Chronic health conditions and other demographic variables, however, had indirect effects on SWB.

Health, stress, psychological resources, and subjective well-being among older Blacks

This study examines the structural relationships among sociodemographic characteristics, health status, stress, psychological resources, and subjective well-being (SWB) among the Black elderly. A structural equation model of SWB was evaluated with data from the 1979-1980 National Survey of Black Americans. The results revealed that poor subjective health status was predictive of lower levels of personal efficacy and SWB. Stressful life events tended to depress subjective assessments of health and had negative effects on self-esteem and SWB. Marital status and age had positive effects on SWB. Chronic health conditions and other demographic variables, however, had indirect effects on SWB.

Evaluation of new cultivars of triticale as dual-purpose forage and grain crops

Two newly registered cultivars of triticale, Tiga and Empat, were compared with existing commercial cultivars of triticale, cereal rye and forage oats, for grain yield and dry matter production. Their performance was evaluated at Armidale, New South Wales, over 3 years with varying defoliation regimes (uncut to grain yield, cut in late autumn, cut in autumn and winter, and cut in winter only). Phenological observations confirmed that Tiga and Empat were midseason cultivars, intermediate between Coolabah and Blackbutt oats. Autumn and winter forage production and organic matter digestibility of Tiga and Empat were equal to those obtained from Cooba and Blackbutt oats. Grain yields (up to 4.0 t/ha) of the highest yielding triticale cultivar (Empat) were equal to, or greater than, the best oats cultivar (Blackbutt). Generally, the highest winter growth rates, dry matter yield at maturity and grain yield were recorded from uncut plots, except in the early oats cultivar Coolabah which, in 1 experiment, lodged in spring if left undefoliated through autumn and winter. Cutting only in autumn had small effects (negative) on grain yields, but cutting in both autumn and winter reduced total dry matter yields at maturity by 30% and grain yields by 50%. Cutting only in winter resulted in higher vegetative forage yields than a double cut (autumn and winter), but the single winter cut subsequently produced lowest dry matter yields at maturity. The high grain yields of triticale were linked to rapid spring growth. Harvest indices of triticale cultivars were generally lower than those of the oat cultivars. The results indicate the potential of triticale, especially cv. Empat, as a dual-purpose forage and grain crop.

Cell-type control of membrane biogenesis induced by HMG-CoA reductase

Quantitative increases in HMG-CoA reductase, the rate-limiting enzyme in sterol biosynthesis, induce membrane biogenesis in both yeast and mammalian cells. The subcellular organization of the resulting membrane differs in the two cell types: mammalian cells generate crystalloid endoplasmic reticulum whereas yeast cells assemble karmellae. We examined the consequences of heterologous expression of HMG-CoA reductase to distinguish features of this response that were cell-type specific from those that were isozyme-specific. This analysis demonstrated that membrane proliferation was induced in both mammalian and yeast cells by HMG-CoA reductase from either organism. However, the morphology of the induced membranes was determined by the cell type rather than the particular isozyme. Thus, both yeast and mammalian HMG-CoA reductase contained functional signals for membrane proliferation that were operational in either cell type, but the qualitative response to those signals was cell-type specific.

Bleeding oesophageal varices associated with anabolic steroid use in an athlete

A 30 year old bodybuilder who had been taking anabolic steroids for 18 months presented with bleeding oesophageal varices. Serious liver disease secondary to anabolic steroids including peliosis hepatis, nodular hyperplasia and malignant change is well recognized. We report what is, to our knowledge, the first case of bleeding oesophageal varices associated with the use of anabolic steroids.

Isolation and characterization of PEP5, a gene essential for vacuolar biogenesis in Saccharomyces cerevisiae

pep5 mutants of Saccharomyces cerevisiae accumulate inactive precursors to the vacuolar hydrolases. The PEP5 gene was isolated from a genomic DNA library by complementation of the pep5-8 mutation. Deletion analysis localized the complementing activity to a 3.3-kb DNA fragment. DNA sequence analysis of the PEP5 gene revealed an open reading frame of 1029 codons with a calculated molecular mass for the encoded protein of 117,403 D. Deletion/disruption of the PEP5 gene did not kill the cells. The resulting strains grow very slowly at 37 degrees. The disruption mutant showed greatly decreased activities of all vacuolar hydrolases examined, including PrA, PrB, CpY, and the repressible alkaline phosphatase. Apparently normal precursors forms of the proteases accumulated in pep5 mutants, as did novel forms of PrB antigen. Antibodies raised to a fusion protein that contained almost half of the PEP5 open reading frame allowed detection by immunoblot of a protein of relative molecular mass 107 kD in extracts prepared from wild-type cells. Cell fractionation showed the PEP5 gene product is enriched in the vacuolar fraction and appears to be a peripheral vacuolar membrane protein.