[The content and its teaching method of nursing for the elderly in baccalaureate program]

PURPOSE

The study is intended to examine the content of gerontological nursing for the baccalaureate program in nursing and to review its teaching methods.

METHODS

Articles and books were reviewed extensively, information was gathered from various gerontological health professionals and family caregivers were interviewed, and a survey was conducted by questionnaire on the students' views of the elderly people.

RESULTS

The contents of gerontological nursing education included features of the elderly, trends of social situations for the elderly and characteristics of the gerontological nursing approach. Features of the elderly mean a comprehensive understanding of the elderly including physical, psychological and social aspects. Characteristics of gerontological nursing included assistance for the elderly, assistance for families, and intervention for the organization which supports the elderly. In providing assistance to the elderly, it is necessary to be sensitive and to respect their life, independence, dignity, and relation with society. The teaching method of gerontological nursing education should be organized according to the principles of learning, that is, from familiar subjects to unknown subjects, and from simple to complicated ones. For future study, a detailed examination of the contents and methods of gerontological nursing education is needed.

[An experiment in a new method of nursing education--the problem-based learning for prenatal nursing]

At the opening of lectures in 1995 on the Science of maternity Nursing in the Special Subjects of Nursing, a problem-based learning was tried as a new educating method in the unit of "Prenatal Nursing." In the present paper, reviewing the introduction/implementation of the method, subjects in the future are described. This process contained two major flows, one was the training of tutors in problem-based learning, including participating the workshop held at McMaster University, and the other was the preparation for the class at the introduction of the new educational method, such as the overall subject composition and the development of teaching materials of prenatal nursing and resources, etc. according to the procedures of the problem-based learning. As the results of the actual implementation, various different reactions in comparison with the lecture method were observed both in tutors and students. As the subjects hereafter, the following three points have been clearly elucidated, that is, in order to proceed the problem-based learning under the present condition that it is not in the comprehensive curriculum, to prevent the overload and conflict in the student learning, considering and adjusting the relationship with contents and methods of concurrent subjects and units, to establish the system for tutorial assessment and evaluation, and to insure tutors and fulfill their training system.

Metalloproteinase inhibitor prevents hepatic injury in endotoxemic mice

This study was conducted to examine of [4-(N-hydroxyamino)-2R-isobutyl-3S-(phenylthiomethyl)-succinyl]-L- phenylalanine-N-methylamide (GI 129471), a matrix metalloproteinase inhibitor, for its effects on increase of serum pro-inflammatory cytokine levels as well as hepatic injury in D-galactosamine plus lipopolysaccharide-injected mice. In vitro experiments showed that GI 129471 was able to inhibit the elevation of tumor necrosis factor-alpha (TNF-alpha) in LPS-stimulated human and mouse whole blood with IC50 values of 370 nM and 260 nM, respectively. When administrated i.p. at 40 mg/kg, GI 129471 significantly reduced serum TNF-alpha level but not other pro-inflammatory cytokines in D-galactosamine plus lipopolysaccharide-injected mice. Treatment of mice with GI 129471 also reduced biochemical indices of hepatic injury to the normal level. Histopathological findings indicated that GI 129471 treatment can prevent severe centrilobular necrosis in liver. These results suggest that release of TNF-alpha from lipopolysaccharide-stimulated cells is the critical step leading to hepatic injury in endotoxemia and that a matrix metalloproteinase inhibitor with an inhibitory action on this step may be a promising drug for the clinical treatment of endotoxemia accompanied by hepatic injury.

Mean regional cerebral blood flow images of normal subjects using technetium-99m-HMPAO by automated image registration

The purpose of this study was twofold: to calculate relative uptake values for 99mTc-HMPAO in various regions of the normal brain after alignment and registration to a standard shape and size, and to validate the automated image registration (AIR) program for SPECT-to-SPECT transformation.

METHODS

Thirty subjects took part in this study. Technetium-99m-HMPAO brain SPECT and x-ray-CT scans were acquired. SPECT images were normalized to an average activity of 100 counts/pixel. Intersubject accuracy was evaluated on brain images of 17 normal subjects (mean age = 64.9 +/- 8.7 yr). These images were aligned and registered to a standard size and shape with the help of AIR. Realigned images were overlaid on reference images to determine the overlap areas. Intrasubject accuracy was evaluated by realigning 20 degree rotated brain images with an index calculated as: overlap area/(overlap area + nonoverlap area). Anatomical variability between realigned target and reference images was evaluated by measurements on corresponding x-ray-CT scans, realigned using transformations that were established by the SPECT images. Realigned brain SPECT images of 30 normal subjects (mean age = 50.7 +/- 18.7 yr), including those subjects examined in the accuracy validation study, were used to generate mean and s.d. images. Images based on the mean value of each voxel (n = 30) were compared with other mean images prepared by the human brain atlas (HBA) standardization technique on a voxel-by-voxel basis to generate T maps.

RESULTS

Accuracy indices were 0.98 +/- 0.006 and 0.99 +/- 0.002 for the intersubject and intrasubject evaluations, respectively. The maximum anatomical variability was 4.7 mm after realignment. Paired Student's t-test comparisons of mean HBA and AIR images revealed statistically significant differences for the deep white matter, pons and occipito-temporal regions. These differences could be explained by variation in the population being studied and the protocol for data handling by AIR and HBA.

CONCLUSION

AIR aligns and registers brain SPECT images with acceptable accuracy, without the necessity of MRI or x-ray-CT scans.

PET study of pointing with visual feedback of moving hands

This study was conducted to determine where in the human brain visual feedback of hand movements is processed to allow accurate pointing. Regional cerebral blood flow (rCBF) was measured with positron emission tomography (PET) and H2 15O in nine normal volunteers while performing one control and two reaching tasks. In all tasks, visual stimuli were presented on a head mounted display (HMD). A target board was placed in front of the subjects bearing six red light-emitting diodes (LEDs) aligned on a circle with a green LED at its center. The center green LED and one of the six red LEDs, randomly selected, were repeatedly switched on and off, alternatively. In the control task, subjects were instructed to gaze at the lit LED. In the two reaching tasks, the reaching with visual feedback (RwithF) task and the reaching without visual feedback (RwithoutF) task, they had to point to the lit red LED with their right index fingers. In the RwithF task, their right hands were visible on the HMD before touching the target, whereas in the RwithoutF task, they were not visible. For each subject, subtraction images of each reaching task minus the control and the RwithF task minus the RwithoutF task were calculated after transformation of PET images into the standard brain shape with an adjustable computerized brain atlas. These subtraction rCBF images were then averaged among the subjects, and significant changes of rCBF were identified. Significant increases in rCBF not only in the RwithF task minus control image but also in the RwithF task minus the RwithoutF task image were observed in the supramarginal cortex, the premotor cortex and the posterior cingulate cortex of the left hemisphere, the caudate nucleus and the thalamus of the right hemisphere, and the right cerebellum and vermis. These results indicate that the supramarginal cortex, the premotor cortex, and the posterior cingulate cortex of the left hemisphere and the cerebellum are involved in integrating visual feedback of hand movements and execution of accurate pointing.

Expression of prostaglandin EP2 receptor mRNA in the rat spinal cord

RT-PCR and an in situ hybridization analyses demonstrated expression of prostaglandin EP2 receptor mRNA in the subfield of the dorsal horn of the rat spinal cord. The intensive signals from the cells labeled with digoxigenin-11-dUTP were scattered through this region and they corresponded to neurons. EP2 receptor-mediated signal transduction is expected to play roles in modulating some neuronal functions such as transmission of nociceptive reaction or motor reflex.

A molecular basis for species differences in Thy-1 expression patterns

Thy-1 is a membrane glycoprotein that displays species-specific differences in its pattern of expression. Although it is expressed on thymocytes and splenocytes in mice, it is only expressed on thymocytes in rats. Based on previous studies suggesting that the third intron of the mouse Thy-1 gene is required for its expression in thymocytes, in vivo footprinting analysis was performed on the third introns of both the mouse and rat Thy-1 genes, and led to the identification of homologous 36 bp "footprinted" regions. The mouse 36 bp region was found to be capable of specifically binding an Ets-1-like nuclear factor present in both mouse thymocytes and splenocytes. In contrast, the homologous 36 bp region of the rat which differs from the mouse 36 bp region by three nucleotides resulting in the loss of the Ets-1 binding site, is unable to bind a similar Ets-1-like factor present in rat thymocytes. Instead, this region of the rat third intron binds another nuclear factor which is present in rat thymocytes but not splenocytes. These observations suggest that the differential expression of the mouse and rat Thy-1 genes in thymocytes and splenocytes is the result of differential expression of nuclear factors that bind to this 36 bp region.

CD79 alpha/CD79 beta heterodimers are expressed on pro-B cell surfaces without associated mu heavy chain

During B cell development, the surface expression of CD79 alpha/CD79 beta heterodimers had been thought to begin in the pre-B cell stage where the heterodimers constitute pre-B cell receptors together with mu heavy and surrogate light chains. Thereafter, in mature B cells, CD79 alpha/CD79 beta associates with surface Ig to form B cell antigen receptors. In this study, we revealed by using newly established mAb that CD79 beta was expressed on the surface of pro-B cells which had not undergone the productive Ig gene rearrangement. Biochemical analysis showed that CD79 beta on pro-B cells existed either as monomers or as disulfide-linked heterodimers with CD79 alpha, non-covalently associated with four unidentified membrane molecules. Our finding that CD79 beta is expressed on earlier B-lineage cells than previously expected coincides with the recent study in which CD79 beta-deficient mice exhibit a blockade of B cell differentiation at the pro-B cell stage. Thus, it is speculated that the CD79 beta-containing complexes on pro-B cell surfaces may function to induce early B cell differentiation.

[Efficacy and safety of sulbactam/cefoperazone for hepato-biliary infections]

We studied efficacy and safety of sulbactam/cefoperazone (SBT/CPT) in the treatment of biliary tract infections in hospitalized patients at 26 hospitals from February 1993 to March 1995. Secondary to dropout, 273 out of 338 patients entered in the study were evaluated, 127 patients with cholecystitis, 132 patients with cholangitis, and 14 patients with liver abscesses. Of these, 93 patients (34.1% had malignancy as an underlying disease. SBT/CPZ had an efficacy of 79.9% (218 patients; excellent: 52, good: 166), with the efficacy in patients with cholecystitis, cholangitis and liver abscess at 89.0% (113 patients), 77.3% (102 patients and 21.4% (3 patients), respectively. A significant difference (p < 0.05) was observed in the efficacy rates of patients with (59 patients [63.4%]) and without malignancy (159 patients [88.3%]). A total of 84 strains were isolated from bile specimens of 53 patients, and the major isolates were Escherichia coli, Pseudomonas aeruginosa and Enterococcus spp. Two or more bacterial strains were isolated simultaneously in 20 patients. Mild or moderate side effect (allergic reaction including rash etc.) were noted in 4 patients (1.18%), and laboratory abnormalities (increased GOT, etc.) were in 16 patients (4.71%) out of the total 338 patients. This study clearly demonstrated that SBT/CPZ retains its excellent clinical efficacy and safety profile, throughout its use over the past decade.

Preventative and therapeutic effects of AE0047 on renal injury in stroke-prone spontaneously hypertensive rats

1. The present study was designed to investigate the preventative and therapeutic effects of AE0047 on renal injury compared with those of nitrendipine in stroke-prone spontaneously hypertensive rats (SHRSP). 2. In the preventative study, drug administration was started before the appearance of renal injury, such as proteinuria. Treatment for 6 weeks with AE0047 (1 and 3 mg/kg, p.o.) led to a dose-related reduction in systolic blood pressure (SBP). Nitrendipine, at doses of 10 and 30 mg/kg, also lowered SBP to a similar degree to that seen with AE0047 at 1 and 3 mg/kg, respectively. 3. In the vehicle-administered SHRSP group, urinary excretion of protein (Uprotein V) increased progressively from 14 weeks of age for another 6 weeks. AE0047 at both doses maintained Uprotein V within normal levels throughout the experimental period. However, the elevation of Uprotein V was only inhibited in the 30 mg/kg nitrendipine-treated group. Urinary N-acetyl-beta-D-glucosaminide (NAG) activity in the vehicle-treated SHRSP group was elevated. Urinary NAG activity remained at a low level only in AE0047-treated groups. 4. Histopathological examination revealed severe lesions (i.e. fibrinoid necrosis, proliferative vasculitis and glomerular lesions) of the kidney in SHRSP. AE0047 treatment at each dose attenuated the development of renal lesions in SHRSP. In contrast, nitrendipine, at 10 mg/kg, was ineffective against the development of renal lesions. Although nitrendipine at 30 mg/kg suppressed the development of renal lesions, this effect was still weaker than that seen with AE0047 at 1 mg/kg. 5. In the therapeutic study, drugs were administered to 17-week-old SHRSP with moderate renal damage for 10 days. Treatment with AE0047 (1 and 3 mg/kg) produced dose-dependent decreases in Uprotein V. In the nitrendipine-treated group, Uprotein V tended to decrease but the changes were not significant. 6. Histopathological studies revealed that 3 mg/kg AE0047 improved renal lesions, such as fibrinoid necrosis, proliferative vasculitis and glomerular lesions, whereas 30 mg/kg nitrendipine did not. 7. Taken together, the results indicate that AE0047 is capable of preventing proteinuria as well as renal lesions, in part via a mechanism independent of its depressor action on SBP. Furthermore, AE0047 improves proteinuria and renal lesions in proteinuria-established SHRSP. Thus, AE0047 may have therapeutic potential in suppressing either the development or the progression of renal disease in hypertensive patients.

Parallel-up structure evidences the molecular directionality during biosynthesis of bacterial cellulose

The "parallel-up" packing in cellulose Ialpha and Ibeta unit cells was experimentally demonstrated by a combination of direct-staining the reducing ends of cellulose chains and microdiffraction-tilting electron crystallographic analysis. Microdiffraction investigation of nascent bacterial cellulose microfibrils showed that the reducing end of the growing cellulose chains points away from the bacterium, and this provides direct evidence that polymerization by the cellulose synthase takes place at the nonreducing end of the growing cellulose chains. This mechanism is likely to be valid also for a number of processive glycosyltransferases such as chitin synthases, hyaluronan synthases, and proteins involved in the synthesis of nodulation factor backbones.

Immunohistochemical assessment of proliferative activity in mammary adenomyoepithelioma

AIMS

Two cases of adenomyoepithelioma of the breast were examined by immunohistochemistry to evaluate proliferative activity of epithelial and myoepithelial components.

METHODS AND RESULTS

The tumours showed a bicellular pattern of gland-forming epithelial cells and proliferative myoepithelial cells with clear cytoplasm. They showed foci of monotonous growth of myoepithelial cells devoid of glands with low mitotic rate (1-2/10 high-power fields) and mild cytological atypia. Immunohistochemically, the glandular cells were positive for epithelial membrane antigen, cytokeratin (KL-1 and CAM5.2) and carcinoembryonic antigen, whereas tumour cells with clear cytoplasm were reactive with muscle-specific actin (MSA), alpha smooth muscle actin, vimentin, and S100 protein but negative for desmin. Proliferative activities assessed by MIB-1 (Ki-67)/MSA positive cell index were greater in myoepithelial cells in both cases (19.2% and 17.7%) as compared to those in epithelial cells (MIB-1/CAM5.2 index: 10.2% and 9.5%).

CONCLUSIONS

These results might account for the previous findings that myoepithelial components predominate over the epithelial ones in an advanced stage of this tumour as well as in recurrent or metastatic lesions.

Reversible intracranial changes in eclampsia demonstrated by MRI and MRA

CT and MRI allow visualization of eclampsia changes in the brain. Once case with reversible changes is reported.

Human decidual cell biosynthesis of leukemia inhibitory factor: regulation by decidual cytokines and steroid hormones

The production of leukemia inhibitory factor (LIF) is suggested to be critical for the successful implantation of blastocysts into decidua, because LIF expression is essential for the implantation of mouse blastocytes. We investigated the regulation of LIF production by decidual cytokines and steroid hormones. Stimulation of decidual cells by interleukin-1, tumor necrosis factor alpha, or transforming growth factor beta augmented LIF production in a dose-dependent manner. Moreover, estradiol, a steroid hormone that increases during ovulation and early pregnancy, also enhanced LIF production in a dose-dependent manner. These responses were blocked by protein kinase C (PKC) inhibitor but not by other kinase inhibitors, suggesting an important role of PKC in decidual LIF production mediated by cytokines and estradiol. We also showed that stimulating decidual cells with LIF failed to stimulate DNA synthesis and prolactin production in these cells. In summary, LIF was mainly localized in the decidual glands and stroma, and its production was increased by cytokines and estradiol in a dose-dependent fashion; but stimulation of decidual cells by LIF did not influence their proliferation or their prolactin production.

A method for the quantification of benzodiazepine receptors by using 123I-iomazenil and SPECT with one scan and one blood sampling

Iodine-123-iomazenil (Iomazenil) is a ligand of central type benzodiazepine receptors for single photon emission computed tomography (SPECT). Previously we reported a simple, table look-up method for quantification of its binding potential (BP) by using two SPECT scans and calibrated standard input function with one blood sampling. This method is based on a two-compartment model (K1: influx rate constant; k2: efflux rate constant; Vd (= K1/k2): the total distribution volume corresponding BP), and requires two SPECT scans for calculating both K1 and Vd values. If the K1 value in the two-compartment model can be assumed to be constant, the radioactivity of one SPECT scan at 180 min after injection can be considered to tabulate as a function of Vd for a given K1 value and a given input function, and a table look-up procedure provides the corresponding Vd value. The purpose of this study was to develop a simple, autoradiographic method for quantification of BP by using one SPECT scan and calibrated standard input function with one blood sampling. SPECT studies were performed on 14 patients. A dynamic SPECT scan was initiated following an intravenous bolus injection of Iomazenil. A static SPECT scan was performed at 180 min after the injection. Frequent blood sampling from the brachial artery was performed on all subjects to determine the arterial input function. Simulation studies revealed that errors in calculated Vd values were around +/-10-15% for varied K1 values. A good correlation was observed between total distribution volume values calculated by three-compartment model analysis and those calculated by the present method (r = 0.90), supporting the validity of this method. The present method is simple and applicable for clinical use, and will be able to provide images of BP.

Chymase is activated in the hamster heart following ventricular fibrosis during the chronic stage of hypertension

Chronic pressure overload induces cardiac tissue remodeling. Chymase is known to regulate matrix metabolism and angiotensin II formation. In the present study, we investigated the pathophysiological functions of chymase in the pressure-overloaded hamster heart induced by a two-kidney, one-clip (2K1C) hypertension procedure. Fibrosis and apoptosis were observed in the pressure-overloaded hearts of 2K1C hamsters 32 weeks after clipping, but these histological changes were not detected at 16 weeks. Heart chymase-like activity of 2K1C hamsters at 32 weeks increased 5.2-fold compared with that at 16 weeks, while angiotensin-converting enzyme was not activated. Chymase might be involved in cardiac tissue remodeling during the chronic stage of hypertension.

SPECT imaging of normal subjects with technetium-99m-HMPAO and technetium-99m-ECD

Technetium-99m-HMPAO and 99mTc-ECD have been used for regional cerebral blood flow (rCBF) studies using SPECT. However, details of the normal perfusion patterns of these agents still remain to be clarified. HMPAO-SPECT and ECD-SPECT images of normal individuals were investigated using an anatomical standardization technique.

METHODS

Twenty healthy subjects participated in this study. In 10 of these, regional cerebral perfusion was measured with HMPAO, and in the other 10, ECD was used. All SPECT images were globally normalized to 50 counts/voxel, and then, each SPECT image was transformed into a standard brain anatomy format with the aid of x-ray CT of each subject and a computerized human brain atlas system (HBA). Mean and s.d. images for each tracer were calculated on a voxel-by-voxel basis. For comparison of these SPECT images with blood flow, rCBF images were generated using PET in a separate group of 10 healthy male subjects during an eyes-closed resting state. The PET images were globally normalized to 50 ml/100 g/min and anatomically standardized using each subject's MRI and the HBA for the SPECT images.

RESULTS

In the HMPAO-SPECT images, relatively high radioactivities Were observed in the basal ganglia and cerebellum. In the ECD-SPECT images, high levels were observed in the medial aspect of the occipital lobe. These regions with high radioactivity were not apparent in the rCBF-PET images.

CONCLUSION

While both HMPAO and ECD have been used to investigate rCBF, their perfusion patterns differ from rCBF-PET images. This presumably reflects differences in the mechanism of accumulation of each agent in the brain. For clinical diagnoses, these patterns must be taken into consideration.

High-density lipoproteins from probucol-treated patients have increased capacity to promote cholesterol efflux from mouse peritoneal macrophages loaded with acetylated low-density lipoproteins

To elucidate the anti-atherogenic effect of probucol, high-density lipoprotein (HDL) was isolated from probucol-treated patients (n = 14) and compared with that from control subjects (n = 12). The HDL obtained from probucol-treated patients was low in cholesteryl ester (CE) in comparison with that from control subjects (21.3 +/- 3.9 mol per cent vs. 27.6 +/- 3.2 mol% of total lipids. P < 0.001), and the peak diameters of patients' HDL were significantly smaller than those of control subjects on 4-30% non-denaturing polyacrylamide gradient gel electrophoresis (10.6 +/- 0.6 nm vs. 12.1 +/- 0.4 nm, P < 0.001). These data may be explained by the increased cholesteryl ester transfer protein (CETP) activities of probucol-treated patients (129 +/- 12% of control subjects, P < 0.001). The in vitro ability of HDL to remove CE from lipid-laden macrophages induced by incubation with acetylated low-density lipoprotein (Ac-LDL) was studied. The small and CE-poor HDL obtained from probucol-treated patients had a greater capacity to promote CE efflux from macrophages than did control HDL (59.8 +/- 6.9% vs. 44.2 +/- 5.4%, P < 0.01). Furthermore, the ability of HDL to promote cholesterol efflux correlated negatively with the CE content and particle diameter of HDL (r = -0.561 and r = -0.583 respectively; P < 0.01). When the inhibitory effect of HDL on the incorporation of [14C]-oleate into cellular cholesteryl ester was compared, the HDL from patients and control subjects inhibited CE formation to a similar extent. The enhanced ability of probucol-treated patients' HDL may, therefore, be involved in the acceleration of hydrolysis of the CE pool in macrophages. Taken together, we conclude that CETP plays a crucial role in making HDL more active in its anti-atherogenic function by reducing CE and making HDL smaller, and that probucol may enhance reverse cholesterol transport by activating CE transfer in vivo. The current study demonstrated, for the first time, that HDL modified by enhanced CETP activity in vivo is potentially anti-atherogenic.

The influence of peri-operative blood transfusion during radical hysterectomy on the prognosis of uterine cervical cancer

To evaluate the clinical implications of peri-operative transfusion in the surgical treatment of uterine cervical cancer, a detailed analysis of the cumulative survival rate was performed using clinical data from 145 patients with FIGO stage Ib cervical cancer of the squamous cell type acquired between 1982 and 1989 at the Center for Adult Diseases. The cumulative survival rate was statistically analyzed using the Kaplan Meier method. Of the 145 patients with stage Ib cancer, 103 were considered to have undergone complete excision and received no further treatment post-operatively, and 42 were considered to have undergone incomplete excision because of the involvement of lymph nodes or the lymphovascular space. Of the 79 patients in the former group who received peri-operative transfusion, 69 received less than seven units (1400 mL) and 10 received more than eight units (1600 mL). The cumulative 5-year survival rate was 100% in the 24 patients who received no transfusions, 91.7% in those who received less than 1400 mL, and 90.0% in those who received more than 1600 mL. Similarly, of the 42 patients in the incomplete excision group, nine did not receive any peri-operative transfusion, 27 received less than 1400 mL, and six received more than 1600 mL. The 5-year survival rate in these groups was 88.9, 77.8 and 50.0%, respectively. The survival rate of our patients with stage Ib cervical cancer without peri-operative transfusion was significantly higher than that of those with transfusion, regardless of post-operative irradiation therapy status, indicating that peri-operative transfusion has an adverse influence on the prognosis in cervical cancer.

Biparental alleles of HLA-G are co-dominantly expressed in the placenta

HLA-G is the only major histocompatibility complex molecule expressed in the human placenta and thus has been considered to be necessary for maintenance of pregnancy. We investigated whether HLA-G expression is regulated in a parent-of-origin allele-specific manner. Of six first trimester and three third trimester placentas, three first trimester and two third trimester placentas showed heterozygosity at the PstI polymorphic site in the 3'-untraslated region. Reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed biallelic expression of HLA-G in all the informative cases, indicating that HLA-G is not imprinted during the gestational period, at least at the transcriptional level. As HLA-G has been postulated to be polymorphic not only at the DNA sequence level but also at the peptide level, co-dominant expression of the gene suggests that each parental allele is involved in the allogenic response during pregnancy.

Spool-like stent for the open sternum after cardiac operations

Severe edematous heart after a cardiac operation is impossible to treat if there is compression of the heart due to the sternum. In these patients delayed sternal closure may be a useful procedure until the heart decreases in size. We devised a spool-like stent for the open sternum to maintain the optimal cardiac space for the severely edematous heart and to fix the chest wall to allow for management while the sternum is open.