Severe Sepsis During Treatment for Childhood Leukemia and Sequelae Among Adult Survivors

Importance

Children undergoing treatment for leukemia are at increased risk of severe sepsis, a dysregulated immune response to infection leading to acute organ dysfunction. As cancer survivors, they face a high burden of long-term adverse effects. The association between sepsis during anticancer therapy and long-term organ dysfunction in adult survivors of childhood cancer has not been examined.

Objective

To determine whether severe sepsis during therapy for leukemia in childhood is associated with subsequent chronic health conditions in adult survivors.

Design, Setting, and Participants

This cohort study included 644 adult survivors of childhood leukemia who were diagnosed between January 1, 1985, and July 19, 2010, and participated in the St Jude Lifetime Cohort Study. Participants were excluded if they received hematopoietic cell transplant or had relapsed leukemia. Data collection ended June 30, 2017. Data were analyzed from July 1, 2020, to January 5, 2024.

Exposures

Severe sepsis episodes, defined according to consensus criteria as septic shock, acute respiratory distress syndrome, or multiorgan dysfunction associated with infection occurring during anticancer therapy, were abstracted by medical record review for all participants.

Main Outcomes and Measures

Common Terminology Criteria for Adverse Events-defined chronic health condition outcomes were independently abstracted. Associations between sepsis and cumulative incidence of chronic health conditions (eg, cardiovascular, pulmonary, kidney, neurological, and neurocognitive outcomes) were compared by adjusted hazard ratios from Cox proportional hazards logistic regression. Inverse propensity score weighting was used to adjust for potential confounders, including age, year of diagnosis, and leukemia type.

Results

The study sample consisted of 644 adult survivors of pediatric leukemia (329 women [51.1%] and 315 men [48.9%]; including 56 with a history of acute myeloid leukemia and 585 with a history of acute lymphoblastic leukemia) who were most recently evaluated at a median age of 24.7 (IQR, 21.2-28.3) years at a median time after leukemia diagnosis of 17.3 (IQR, 13.7-21.9) years. Severe sepsis during treatment of acute childhood leukemia occurred in 46 participants (7.1%). Participants who experienced severe sepsis during treatment were more likely to develop moderate to severe neurocognitive impairment (29 of 46 [63.0%] vs 310 of 598 [51.8%]; adjusted hazard ratio, 1.86 [95% CI, 1.61-2.16]; P < .001) significantly affecting attention, executive function, memory and visuospatial domains. Sepsis was not associated with long-term risk of cardiovascular, pulmonary, kidney, or neurological chronic health conditions.

Conclusions and Relevance

In this cohort study of long-term outcomes in survivors of pediatric leukemia, severe sepsis during anticancer therapy for leukemia was associated with a selectively increased risk for development of serious neurocognitive sequelae. Efforts to reduce the effects of anticancer therapy on long-term function and quality of life in survivors might include prevention of severe sepsis during therapy and early detection or amelioration of neurocognitive deficits in survivors of sepsis.

Sociability increases survival of adult female giraffes

Studies increasingly show that social connectedness plays a key role in determining survival, in addition to natural and anthropogenic environmental factors. Few studies, however, integrated social, non-social and demographic data to elucidate what components of an animal's socio-ecological environment are most important to their survival. Female giraffes (Giraffa camelopardalis) form structured societies with highly dynamic group membership but stable long-term associations. We examined the relative contributions of sociability (relationship strength, gregariousness and betweenness), together with those of the natural (food sources and vegetation types) and anthropogenic environment (distance from human settlements), to adult female giraffe survival. We tested predictions about the influence of sociability and natural and human factors at two social levels: the individual and the social community. Survival was primarily driven by individual- rather than community-level social factors. Gregariousness (the number of other females each individual was observed with on average) was most important in explaining variation in female adult survival, more than other social traits and any natural or anthropogenic environmental factors. For adult female giraffes, grouping with more other females, even as group membership frequently changes, is correlated with better survival, and this sociability appears to be more important than several attributes of their non-social environment.

Tunable Molybdenum Disulfide-Enabled Fiber Mats for High-Efficiency Removal of Mercury from Water

The application of molybdenum disulfide (MoS₂) for water decontamination is expanded toward a novel approach for mercury removal using nanofibrous mats coated with MoS₂. A bottom-up synthesis method for growing MoS₂ on carbon nanofibers was employed to maximize the nanocomposite decontamination potential while minimizing the release of the nanomaterial to treated water. First, a co-polymer of polyacrylonitrile and polystyrene was electrospun as nanofibrous mats and pretreated to form pristine carbon fibers. Next, three solvothermal methods of controlled in situ MoS₂ growth of different morphologies were achieved on the surface of the fibers using three different sets of precursors. Finally, these MoS₂-enabled fibers were extensively characterized and evaluated for their mercuric removal efficiency. Two mercury removal mechanisms, including reduction-oxidation reactions and physicochemical adsorption, were elucidated. The two nanocomposites with the fastest (0.436 min^-1 mg^-1) and highest mercury removal (6258.7 mg g^-1) were then further optimized through intercalation with poly(vinylpyrrolidone), which increased the MoS₂ interlayer distance from 0.68 nm to more than 0.90 nm. The final, optimal fabrication technique (evaluated according to mercuric capacity, kinetics, and nanocomposite stability) demonstrated five times higher adsorption than the second-best method and obtained 70% of the theoretical mercury adsorption capacity of MoS₂. Overall, results from this study indicate an alternative, advanced material to increase the efficiency of aqueous mercury removal while also providing the basis for other novel environmental applications such as selective sensing, disinfection, and photocatalysis.

Giraffe translocation population viability analysis

Most populations of giraffes have declined in recent decades, leading to the recent IUCN decision to upgrade the species to Vulnerable status, and some subspecies to Endangered. Translocations have been used as a conservation tool to re-introduce giraffes to previously occupied areas or establish new populations, but guidelines for founding populations are lacking. To provide general guidelines for translocation projects regarding feasibility, we simulated various scenarios of translocated giraffe populations to identify viable age and sex distributions of founding populations using population viability analysis (PVA) implemented in Vortex software. We explored the parameter space for demography and the genetic load, examining how variation in founding numbers and sex ratios affected 100 yr probability of population extinction and genetic diversity. We found that even very small numbers of founders (N ≤ 10 females) can appear to be successful in the first decades due to transient positive population growth, but with moderate population growth rate and moderate genetic load, long-term population viability (probability of extinction <0.01) was only achieved with ≥30 females and ≥3 males released. To maintain >95% genetic diversity of the source population in an isolated population, 50 females and 5 males are recommended to compose the founding population. Sensitivity analyses revealed first-year survival and reproductive rate were the simulation parameters with the greatest proportional influence on probability of extinction and genetic diversity. These simulations highlight important considerations for translocation success and data gaps including true genetic load in wild giraffe populations.

Anti-obesity effects of gochujang products prepared using rice koji and soybean meju in rats

The Korean traditional hot sauce gochujang has been reported to have biological activities. Different kinds of gochujang products were prepared based on combinations of a fungal rice koji with two kinds of bacterial soybean mejus. Diets that included gochujang products were fed to rats and anti-obesity effects were investigated. Gochujang products reduced body weight gains, epididymal fat weights, and triglyceride levels in the serum and the liver. Effects were exerted by the diet that included the non-fermented gochujang mixture, increased using a fungal rice koji, and further enhanced using a bacterial soybean meju. Dietary effects were apparently induced via inhibition of the lipogenic enzymes fatty acid synthase, malic enzyme, and lipoprotein lipase by gochujang products in epididymal adipose tissues, and inhibition of glucose-6-phosphate dehydrogenase in the liver. High levels of capsaicin and genistein in gochujang products are considered to contribute to anti-obesity effects.

Quantification of the placental epigenetic signature of the SERPINB5 gene in maternal plasma of pregnancies complicated by small for gestational age

INTRODUCTION

To investigate the association between pregnancies with small for gestational age (SGA) neonates and the concentration of cell-free fetal DNA or cell-free total DNA in maternal plasma during the first and second trimesters using tissue-specific epigenetic characteristics of the SERPINB5 gene.

METHODS

A nested case-control study was conducted with maternal plasma collected at 11 to 26 gestational weeks from 51 women with SGA neonates and 102 controls. We performed a real-time quantitative methylation-specific PCR to quantify concentrations of unmethylated-SERPINB5 (U-SERPINB5) as a cell-free fetal DNA marker and methylated-SERPINB5 (M-SERPINB5) as a cell-free total DNA marker.

RESULTS

A positive correlation was observed between U-SERPINB5 and M-SERPINB5 concentrations in both control (r = 0.363, p < 0.001) and SGA groups (r = 0.548, p < 0.001). Moreover, the concentration of U-SERPINB5 or M-SERPINB5 was significantly positive correlated with gestational age at sampling in both controls (U-SERPINB5: r = 0.397, p < 0.001; M-SERPINB5: r = 0.275, p = 0.005) and SGA (U-SERPINB5: r = 0.274, p = 0.052; M-SERPINB5: r = 0.439, p = 0.001). However, the concentration of U-SERPINB5 or M-SERPINB5 was not correlated with birthweight. At 11-14 weeks, U-SERPINB5 and M-SERPINB5 concentrations in SGA did not differ significantly from those of controls. There were also no statistically significant differences in the concentrations of U-SERPINB5 and M-SERPINB5 between SGA and controls at 15-26 weeks of gestation.

DISCUSSION

Our findings suggest that U-SERPINB5 and M-SERPINB5 concentrations in maternal plasma during early pregnancy are not associated with pregnancies who delivered SGA neonates.

Comparison of vasa vasorum after intravascular stent placement with sirolimis drug-eluting and bare metal stents

The cytostatic drug, sirolimis has shown prevention in neointimal hyperplasia after stent placement. Recent studies have shown persistent inflammation seen with drug-eluting stents (DES) may result in late stent thrombosis. The aim of this study is to compare effects of bare metal stents (BMS) and sirolimis DES on the neointima and vasa vasorum in stented rabbit aortas. Stents were implanted in eight New Zealand rabbits for 9 weeks. Group I rabbits received BMS. Group II rabbits received sirolimis DES. A balloon-mounted BMS or DES was placed in the infrarenal aorta. Following euthanasia, aortas were perfused with barium sulfate and sectioned for histology. After 9 weeks the qualitative intrastent luminal diameter was fairly uniform in both the DES and the BMS. The thickness of neointima was similar in both groups. The number of vasa vasorum in the sirolimis DES increased compared with the BMS (P < 0.05). An increased number of vasa vasorum produced by the DES when compared with the BMS shows a difference in response to local vessel injury in rabbits. This result suggests that vasa vasorum may play a role in the persistent inflammation generated by sirolimis-coated stents.

Systemic armed oncolytic and immunologic therapy for cancer with JX-594, a targeted poxvirus expressing GM-CSF

Targeted oncolytic viruses and immunostimulatory therapeutics are being developed as novel cancer treatment platforms. These approaches can be combined through the expression of immunostimulatory cytokines from targeted viruses, including adenoviruses and herpesviruses. Although intratumoral injection of such viruses has been associated with tumor growth inhibition, eradication of distant metastases was not reported. The major limitations for this approach to date have been (1) inefficient intravenous virus delivery to tumors and (2) the lack of predictive, immunocompetent preclinical models. To overcome these hurdles, we developed JX-594, a targeted, thymidine kinase(-) vaccinia virus expressing human GM-CSF (hGM-CSF), for intravenous (i.v.) delivery. We evaluated two immunocompetent liver tumor models: a rabbit model with reproducible, time-dependent metastases to the lungs and a carcinogen-induced rat liver cancer model. Intravenous JX-594 was well tolerated and had highly significant efficacy, including complete responses, against intrahepatic primary tumors in both models. In addition, whereas lung metastases developed in all control rabbits, none of the i.v. JX-594-treated rabbits developed detectable metastases. Tumor-specific virus replication and gene expression, systemically detectable levels of hGM-CSF, and tumor-infiltrating CTLs were also demonstrated. JX-594 holds promise as an i.v.-delivered, targeted virotherapeutic. These two tumor models hold promise for the optimization of this approach.

Matrix formalism of electromagnetic wave propagation through multiple layers in the near-field region: application to the flat panel display

We have developed an electromagnetic (EM) wave propagation theory through a single layer and multiple layers in the near-field and far-field regions, and have constructed a matrix formalism in terms of the boundary conditions of the EM waves. From the shielding efficiency (SE) against EM radiation in the near-field region calculated by using the matrix formalism, we propose that the effect of multiple layers yields enhanced shielding capability compared to a single layer with the same total thickness in conducting layers as the multiple layers. We compare the intensities of an EM wave propagating through glass coated with conducting indium tin oxide (ITO) on one side and on both sides, applying it to the electromagnetic interference (EMI) shielding filter in a flat panel display such as a plasma display panel (PDP). From the measured intensities of EMI noise generated by a PDP loaded with ITO coated glass samples, the two-side coated glass shows a lower intensity of EMI noise compared to the one-side coated glass. The result confirms the enhancement of the SE due to the effect of multiple layers, as expected in the matrix formalism of EM wave propagation in the near-field region. In the far-field region, the two-side coated glass with ITO in multiple layers has a higher SE than the one-side coated glass with ITO, when the total thickness of ITO in both cases is the same.

High-level expression and one-step purification of cyclic amidohydrolase family enzymes

The cyclic amidohydrolase family enzymes, including hydantoinase, dihydropyrimidinase, allantoinase and dihydroorotase, are metal-dependent hydrolases and play a crucial role in the metabolism of purine and pyrimidine in prokaryotic and eukaryotic cells. With the increasing demand for the elucidation of enzyme structures and functions, along with industrial applications, the research on the family enzymes has recently been proliferating, but the related enzymes had been purified conventionally by multistep purification procedures. Here, we reported the expression in Escherichia coli cells of maltose-binding protein-fused family enzymes and their one-step purification. The expression levels of the fusion proteins account for 20-35% of the total protein in E. coli, allowing approximately 2-3 mg of the purified proteins by affinity chromatography to be obtained per 0.3 L of bacterial culture. As more promising results, their nascent biochemical properties, after the cleavage of the fusion proteins with Factor Xa, in terms of oligomeric structure, optimal pH, specific activity, and kinetic property, were also conserved as those from the native enzymes. The availability of the family enzymes to fusion strategy shows potential as a convenient procedure to recombinant protein purification and accelerates the structure-function study of the related family enzymes.

Molecular cloning and cultivar specific expression of MAP kinases from Capsicum annuum

Two MAP kinases, MK1 and MK2, were cloned from Capsicum annuum (pepper) cv. Subicho using a parsley MAP kinase gene as a heterologous probe. MK1 and MK2 encode stress-inducible protein kinases that can contribute to the response to wounding, UV-C, and cold. MK1 has a 92% amino acid identity with WIPK of tobacco. It was transcriptionally induced in response to wounding. In contrast, no detectable MK1 transcript was found in unwounded leaves of pepper. MK2 has a high level of amino acid homology to MAP kinases, such as NTF4 and SIPK and was constitutively expressed in all tissues. Both MK transcripts were downregulated by UV-C treatment. Each MK protein activation was independently wound-inducible in a cultivar dependent manner. MK1 is phosphorylated in cv. Pungchon but not cv. Subicho; whereas, the MK2 protein activation by wounding is restricted to cv. Subicho. In addition, de novo synthesis of the MK1 protein and tyrosine phosphorylation was rapidly and transiently induced in cv. Pungchon by wounding. In contrast, it is highly unlikely that the MK1 protein is produced in cv. Subicho, even though there is an abundant expression of MK1 mRNA after wounding in this cultivar. In Escherichia coli, which overexpresses MK1, autophosphorylation is observed at conserved threonine and tyrosine phosphorylation sites.

Sclerotherapy with use of doxycycline after percutaneous drainage of postoperative lymphoceles

PURPOSE

To assess the use of doxycycline as a sclerosing agent after percutaneous drainage of postoperative lymphoceles.

MATERIALS AND METHODS

Symptomatic postoperative lymphoceles (n = 21) in 18 patients were treated by percutaneous tube drainage for an average of 10.8 days. Sclerosis was performed when the patient became asymptomatic, drainage had slowed to less than 30 mL/d and follow-up imaging (CT or US) showed either near complete or total resolution of the lymphocele. Doxycycline (500 mg) combined with 1% lidocaine (5 mL) was instilled into the cavity with use of a syringe after any remaining lymphocele fluid was removed through the tube. When possible, patients were instructed to perform a series of maneuvers for the next hour to distribute the sclerosing agent evenly throughout the cavity. After 1 hour, the sclerosing agent was aspirated from the cavity and the drainage tube was removed. Three patients with four lymphoceles underwent sclerotherapy immediately after percutaneous insertion of a drainage tube and aspiration of the lymphocele. No patients underwent previous sclerosis with any agent.

RESULTS

Successful treatment of postoperative lymphoceles was achieved in 17 of 18 patients. Primary success was achieved in 17 of 21 lymphoceles treated. There were four lymphocele recurrences in three patients. Three of the four recurrences were successfully treated by means of repeated drainage and sclerotherapy. One recurrent lymphocele persisted after re-treatment with 1 g of doxycycline. This patient underwent successful surgical repair. There were no complications related to doxycycline sclerosis. The mean duration of drainage for initial and recurrent lymphoceles was 10.8 days (range, 0-30 days).

CONCLUSION

Sclerotherapy with use of doxycycline after percutaneous drainage is an easy, safe, inexpensive, and effective means of treating postoperative lymphoceles.

Functional expression and characterization of the two cyclic amidohydrolase enzymes, allantoinase and a novel phenylhydantoinase, from Escherichia coli

A superfamily of cyclic amidohydrolases, including dihydropyrimidinase, allantoinase, hydantoinase, and dihydroorotase, all of which are involved in the metabolism of purine and pyrimidine rings, was recently proposed based on the rigidly conserved structural domains in identical positions of the related enzymes. With these conserved domains, two putative cyclic amidohydrolase genes from Escherichia coli, flanked by related genes, were identified and characterized. From the genome sequence of E. coli, the allB gene and a putative open reading frame, tentatively designated as a hyuA (for hydantoin-utilizing enzyme) gene, were predicted to express hydrolases. In contrast to allB, high-level expression of hyuA in E. coli of a single protein was unsuccessful even under various induction conditions. We expressed HyuA as a maltose binding protein fusion protein and AllB in its native form and then purified each of them by conventional procedures. allB was found to encode a tetrameric allantoinase (453 amino acids) which specifically hydrolyzes the purine metabolite allantoin to allantoic acid. Another open reading frame, hyuA, located near 64.4 min on the physical map and known as a UUG start, coded for D-stereospecific phenylhydantoinase (465 amino acids) which is a homotetramer. As a novel enzyme belonging to a cyclic amidohydrolase superfamily, E. coli phenylhydantoinase exhibited a distinct activity toward the hydantoin derivative with an aromatic side chain at the 5' position but did not readily hydrolyze the simple cyclic ureides. The deduced amino acid sequence of the novel phenylhydantoinase shared a significant homology (>45%) with those of allantoinase and dihydropyrimidinase, but its functional role still remains to be elucidated. Despite the unclear physiological function of HyuA, its presence, along with the allantoin-utilizing AllB, strongly suggested that the cyclic ureides might be utilized as nutrient sources in E. coli.

Construction and evaluation of a novel bifunctional N-carbamylase-D-hydantoinase fusion enzyme

A fully enzymatic process employing two sequential enzymes, D-hydantoinase and N-carbamylase, is a typical case requiring combined enzyme activity for the production of D-amino acids. To test the possibility of generating a bifunctional fusion enzyme, we constructed a fusion protein via end-to-end fusion of a whole gene that encodes an intact protein at the N terminus of the D-hydantoinase. Firstly, maltose-binding protein (MBP) gene of E. coli was fused with D-hydantoinase gene from Bacillus stearothermophilus SD1, and the properties of the resulting fusion protein (MBP-HYD) were compared with those of native D-hydantoinase. Gel filtration and kinetic analyses clearly demonstrated that the typical characteristics of D-hydantoinase are maintained even in a fusion state. Based on this result, we constructed an artificial fusion enzyme composed of the whole length of N-carbamylase (304 amino acids [aa]) from Agrobacterim radiobacter NRRL B11291 and D-hydantoinase (471 aa). The fusion enzyme (CAB-HYD) was functionally expressed with an expected molecular mass of 86 kDa and efficiently converted exogenous hydantoin derivatives to the D-amino acids. A related D-hydantoinase (HYD1) gene from Bacillus thermocatenulatus GH2 was also fused with the N-carbamylase gene at its N terminus. The resulting enzyme (CAB-HYD1) was bifunctional as expected and showed better performance than the CAB-HYD fusion enzyme. The conversion of hydantoin derivatives to corresponding amino acids by the fusion enzymes was much higher than that by the separately expressed enzymes, and comparable to that by the coexpressed enzymes. Thus, the fusion enzyme might be useful as a potential biocatalyst for the production of nonnatural amino acids.

Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts

PURPOSE

To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients.

MATERIALS AND METHODS

A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft.

RESULTS

Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts.

CONCLUSION

Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.

Comparison of behavioral responses to noxious cold and heat in mice

We investigated behavioral responses to noxious cold and heat stimuli in mice. Similar to the hot-plate test, mice showed licking or jumping responses on a cold-plate (0 degrees C). The sensitivity to noxious heat (55 degrees C) was not correlated to the sensitivity to noxious cold, indicating that nociceptive processing of cold and heat are different. Behavioral responses to noxious cold are inhibited by systemic morphine or intrathecal administration of morphine. Lesion of the medial frontal cortex, including the anterior cingulate cortex, or selective activation of two types of opioid receptors in the anterior cingulate cortex produces dose-dependent antinociceptive effects on behavioral responses to noxious cold stimuli. These results suggest that activation of opioid receptors in the anterior cingulate cortex can produce powerful antinociception.

Public information on private practice: the availability of physician inpatient data

Despite increased interest in information describing physicians and their hospitalized patients, little attention has been given to the availability of these data and the related policy issues. We surveyed the 20 states with a publicly mandated data system based on hospital discharge abstracts that included physician information. States vary considerably in their orientation toward the public availability of the information and in the ability to personally identify physicians from the data. Potential benefits and problems in using the information for health services research, in improving the quality of care, and in analyzing practice patterns are reviewed. The policy issues associated with the collection and use of publicly available data on physicians and their hospitalized patients are discussed.

Receptor activator of NF-kappaB recruits multiple TRAF family adaptors and activates c-Jun N-terminal kinase

Receptor activator of NF-kappaB (RANK) is a recently cloned member of the tumor necrosis factor receptor (TNFR) superfamily, and its function has been implicated in osteoclast differentiation and dendritic cell survival. Many of the TNFR family receptors recruit various members of the TNF receptor-associated factor (TRAF) family for transduction of their signals to NF-kappaB and c-Jun N-terminal kinase. In this study, the involvement of TRAF family members and the activation of the JNK pathway in signal transduction by RANK were investigated. TRAF1, 2, 3, 5, and 6 were found to bind RANK in vitro. Association of RANK with each of these TRAF proteins was also detected in vivo. Expression of RANK in cultured cells also induced the activation of JNK, which was blocked by a dominant-negative form of JNK. Furthermore, by employing various C-terminal deletion mutants of RANK, the regions responsible for TRAF interaction and JNK activation were identified. TRAF5 was determined to bind to the C-terminal 11 amino acids and the other TRAF members to a region N-terminal to the TRAF5 binding site. The domain responsible for JNK activation was localized to the same region where TRAF1, 2, 3, and 6 bound, which suggests that these TRAF molecules might mediate the RANK-induced JNK activation.

Use of intraoperative ultrasonography during hepatic transplantation

The aim of this study was to evaluate if intraoperative vascular ultrasonography is of clinical value in the perioperative management of hepatic transplant patients. Fifteen intraoperative ultrasonographic examinations were performed on 13 patients (five female, eight male) during transplantation. These patients had clinically suspected vascular compromise. Among the 13 patients studied intraoperatively, five were correctly diagnosed as having hemodynamically significant vascular compromise. Of the intraoperative vascular sonographic examinations, the results of 13 were in concordance with the surgical impression as to whether further intervention was necessary or if the procedure could be terminated. Intraoperative sonography demonstrates potential to be of aid to the surgeon in recognition of vascular compromise.

ICG-enhanced digital angiography and photocoagulation of choroidal neovascularization in age-related macular degeneration

Choroidal neovascular membranes are often poorly defined on fluorescein angiography because of fluorescein leakage or blockage of hyperfluorescence by overlying hemorrhage, lipid, turbid fluid, or pigment. Indocyanine green (ICG) is a highly protein-bound dye in the near infrared portion of the spectrum. Therefore, ICG remained in and around the neovascular membrane and enhanced the visualization of certain membranes poorly defined with fluorescein. ICG penetrated through the overlying turbid tissue, and improved the visualization of the underlying choroidal neovascular membrane. Using an infrared angiography system, the authors obtained 21 ICG-angiograms with suspected choroidal neovascularization, and compared them to fluorescein angiograms. In 5 of the 21 eyes, occult choroidal neovascularization was well delineated on the ICG angiograms. In 2 eyes, we were able to detect a well-defined choroidal neovascular membrane underlying a subretinal hemorrhage. In 12 of the 21 eyes with choroidal neovascular membrane, we performed argon-green laser photocoagulation applying the overlay technique of the ICG angiogram to red-free photo or the early fluorescein angiogram, and evaluated the effect of full coverage laser treatment.

Effects of hyperlipemia on radioimmunoassays for progesterone, testosterone, thyroxine, and cortisol in serum and plasma samples from dogs

Hyperlipemic serum and plasma samples often are received by clinical laboratories for endocrinologic analysis by radioimmunoassay. We designed a study to determine what effect, if any, hyperlipemia has on estimation of lipid-soluble hormone concentrations determined by solid-phase radioimmunoassays. Progesterone, testosterone, thyroxine, and cortisol concentrations were determined in canine plasma and serum with various degrees of lipemia. Samples of serum, heparinized plasma, and EDTA-treated plasma were obtained from blood collected from 4 female and 4 male Beagles by use of evacuated tubes. To induce hyperlipemia in vitro, IV fat emulsion was diluted in deionized water to produce 0 (water only), 33, 67, or 100% mixtures. Twenty microliters of each mixture then was added to the subsamples of serum and plasma from each dog. Hormone concentrations were determined, using validated radioimmunoassays. Triglyceride concentrations were determined by enzymatic assay. Addition of IV fat emulsion in vitro was an accurate and reproducible means of altering triglyceride concentrations in the samples. Triglyceride concentrations as high as 700 mg/dl had no effect on radioimmunoassays for progesterone, testosterone, and thyroxine in serum, heparinized plasma, or EDTA-treated plasma. Addition of 100% (but not 33 or 67%) fat emulsion reduced the mean cortisol concentration in heparinized plasma by 12% (P less than 0.05). This severe hyperlipemia did not affect quantification of cortisol in serum or EDTA-treated plasma.

Nonconstrained total elbow arthroplasty. Development and results in patients with functional class IV rheumatoid arthritis

Twenty-four nonconstrained total elbow arthroplasties (TEAs) in 20 patients with severe disabling functional class IV rheumatoid arthritis were reviewed retrospectively to determine the effects of their disease on the end result. The mean follow-up period was 6 years (range, 2-11 years). All planes of elbow motion improved after surgery (P less than .005), there was a highly significant reduction in pain and improvement in function (both P less than .005) and patient satisfaction was high. The severity of the disease does not appear to affect the end result when a nonconstrained TEA is used, and the results compare favorably with those of other series reported.

Research note: reference others and self-destruction

48 students were presented hypothetical situations having to do with smoking, drinking liquor, using other drugs, and over-eating. They were asked to indicate their reference others and the others' expectations for their behavior in these situations. Family members and friends were the most frequently named reference others, varying in importance with the situation. Perception of reference others' expectations tends to correspond with respondents' behavior, encouraging drinking and discouraging smoking and drugs. Inconsistencies between reference-others' expectations and respondents' behaviors and respondents' values elicited comments suggesting that the questions alone may lead respondents to feel dissatisfied with the behavior.

The self-deception of the self-destructive

317 college students as respondents were measured for suicide proneness and self-destructive behaviors and were also asked questions about self-attitudes, value for life, beliefs about suicide and self-destruction, religiosity and dogmatism. Those who score high on suicide proneness and self-destructiveness do not tend to be the same people, and they differ from one another. Correlations and factor analyses suggest the Suicide Prone are aware of their tendencies and are influenced by their value for life and beliefs about suicide and self-destruction. The Self-destructive are tied to negative self-evaluations, are less aware of their self-destructive tendencies, and score significantly higher than the Suicide Prone on dogmatism. Belief structure of the highly dogmatic person may allow those who are self-destructive to deny negative self-attitudes and to be unaware of self-destructive behaviors which are inconsistent with their beliefs.

'Catatonia' produced by alfentanil is reversed by methylnaloxonium microinjections into the brain

Alfentanil, a short-acting and powerful analgesic, when injected peripherally to rats (0.5 mg/kg) produced a catatonic state characterized by a rigid akinesia. The present study was designed to explore the neuroanatomical location of the opiate receptors mediating the alfentanil induced catatonia. The catatonic effect of alfentanil was measured using a bar test and depression of locomotor activity in rats tested in photocell cages during an active nocturnal phase of their cycle. Methylnaloxonium HCl (MN), a quaternary derivative of naloxone which does not readily cross the blood-brain barrier, injected into the lateral ventricle significantly reduced the catatonia at doses of 0.125-2.0 micrograms as measured in both the locomotor and bar test. MN perfusion of similar doses directly into the nucleus raphe pontis, but not in the caudate nucleus significantly antagonized the catatonia. These data complement results on alfentanil-induced muscular rigidity (Blasco et al., see companion paper) where EMG indices of rigidity in rats were reversed by microinjections of low doses of MN (0.125 and 0.5 microgram) in the nucleus raphe pontis, but not the caudate nucleus even at a high dose (4.0 micrograms). Together these results suggest that the region of the nucleus raphe pontis is an important neural substrate for opiate-induced muscular rigidity, and that the catatonic state produced by opiates depends on more diffuse opiate receptor activation of which one important component may be the nucleus raphe pontis.

Monosaccharide transport by Eimeria tenella sporozoites

Eimeria tenella sporozoites were incubated in the presence of 3 different [14C]-labeled sugars; D-glucose, 2-deoxy-D-glucose and 3-O-methyl-D-glucose. The initial velocity, Vi, of uptake of D-glucose and 2-deoxy-D-glucose was similar, 41 micrograms/10(10) sporozoites/min and 46 micrograms/10(10) sporozoites/min, respectively; whereas that for 3-O-methyl-D-glucose was significantly lower, 17 micrograms/10(10) sporozoites/min. Initial velocity studies also revealed that glucose uptake was a saturable event, with an apparent KT of 20 mM and an apparent Vmax of 312 micrograms/10(10) sporozoites/min. Uptake was unaffected by exogenous sodium levels or the presence of ouabain. However, 0.1 mM phloretin significantly inhibited glucose uptake. Thus, it would appear that E. tenella sporozoites possess a Na-independent, phloretin-sensitive, carrier-mediated monosaccharide-transport system.

Alternative self-destruction

Data from 63 respondents indicate significant relationships between both suicide proneness and self-destructive behavior and reverence for life but not with self-worth. Need for research includes construction of a different measure of self-worth and creation of typologies to compare correlates of suicide-proneness and of self-destruction.

Refractory distal ulcerative colitis responsive to 5-aminosalicylate enemas

Patients with distal ulcerative colitis may be refractory to standard drug therapy. 5-Aminosalicylate, the active moiety of sulfasalazine, is effective topically in new onset distal colitis. Six patients with distal colitis unresponsive to sulfasalazine and corticosteroids had a prompt and dramatic response to the administration of 5-aminosalicylate enemas with clinical, sigmoidoscopic, and histological improvement. Topical 5-aminosalicylate should be a useful addition to the current available therapies for some patients with refractory distal ulcerative colitis.

Nuclear deoxyribonuclease activities in human lymphoblastoid and mouse melanoma cells. A comparative study

Deoxyribonuclease activities were examined in isoelectric focusing fractions of non-histone, chromatin-associated and nucleoplasmic proteins of isolated normal human lymphoblastoid and mouse melanoma cell nuclei using parallel procedures. A very similar series of eight DNA endonucleases, each active on calf thymus DNA and containing no exonuclease activity, were found in the chromatin proteins of both cell lines. Several differences were observed: an activity in human cells at pI 6.6 was absent from murine cells, and there was an increased activity in mouse cells at pI 4.4 and a decreased activity at pI 7.3, as compared with corresponding human cell activities. Assay of these fractions against supercoiled, circular phage PM2 DNA showed greater activity among the fractions with acidic pI valves and slightly lower activities in the murine cells than in the human cells. Analysis of the nucleoplasmic fractions showed a series of DNA endonuclease and exonuclease activities which were again very similar between the two cell lines, although greater endonuclease activity at pI 4.4 occurred in mouse than in human nucleoplasm. These results demonstrate an entire series of deoxyribonuclease activities in both chromatin and nucleoplasm which are nearly identical in two very different mammalian cell lines, suggesting that many of these enzymes are ubiquitous in mammalian cell nuclei.

Intake of nickel and vanadium by humans. A survey of selected diets

The nickel and vanadium contents of nine institutional diets were determined by atomic absorption spectrometry with background correction. The following values were obtained for nickel: mean concentration, 0.27 +/- 0.02 microgram/g (dry weight); range, 0.19 and 0.41 microgram/g; mean intake, 165 +/- 11 microgram/day or 75 +/- 10 microgram/1000 cal. The respective values for vanadium were: 0.032 +/- 0.004 microgram/g (dry weight); 0.019 to 0.050 microgram/g; 20.4 +/- 2.3 microgram/day or 8.9 +/- 1.0 microgram/1000 cal. Thus, vanadium is present at approximately one order of magnitude less than nickel.

A method for qualitative identification of sugars and semiquantitative determination of lactose content suitable for a variety of foods

A semiquantitative chromatographic technique was developed and standardized using water/chloroform extracts of foods which are spotted onto heat-activated silica gel thin layer chromatographic (TLC) plates, run in butanol/acetic acid/ether/water, developed in acids anisaldehyde, and quantitated planimetrically using Purdy and Truter's formula. Clinically significant amounts of lactose were found in low-calorie sweeteners, breads, yogurt, margarine, penicillin, Gantrisin, and other commonly ingested nondairy substances.

Comfort studies of rail passengers

Nicol, J. F., Doré, C., Weiner, J. S., Lee, D. E., Prestidge, S. P., and Andrews, M. J. (1973).British Journal of Industrial Medicine,30, 325-334. Comfort studies of rail passengers. A short series of trials is described in which a specimen car of the new High Density Rolling Stock was laden with passengers at different densities and under different environmental constraints, designed to simulate `shut-down' conditions.

The results suggest that the limit for comfort, 21·8°C corrected effective temperature (CET), proposed by Bell and Watts (1971) is reasonable but that temperatures some 3 or 4°C higher can be tolerated without undue discomfort.

The physiological limit for safety recommended by Bell and Watts is a CET of 30·6°C. This will be reached in less than 20 minutes if there is a power failure in warm conditions in crowded trains.

An undesirable, possibly dangerous, level of discomfort will be experienced by passengers in ventilated but crowded trains after 30 minutes.

In any case it is recommended that the globe temperature in a carriage should not exceed 30°C.

Nutritional and environmental studies on an ocean-going oil tanker. 1. Thermal environment

Collins, K. J., Eddy, T. P., Lee, D. E., and Swann, P. G. (1971).Brit. J. industr. Med.,28, 237-245. Nutritional and environmental studies on an ocean-going oil tanker. I. Thermal environment. Investigations were made on board a modern, air-conditioned oil tanker (S.S. Esso Newcastle) en route to the Persian Gulf in July to August 1967 in order to study thermal conditions in the working environment, and the nutritional status of the crew, and to examine the interrelationship between climate and nutritional balance. In this introductory paper an account is given of the aims and design of the experiments together with details of the environmental survey.

The voyage round Africa lasted one month, with high ambient temperatures of 37·7°C dry bulb, 30·8°C wet bulb (100/87°F) occurring only on the last few days into and out of the Persian Gulf. Mean accommodation temperature was maintained in the zone of comfort throughout, and at 23·9°C (75°F) Corrected Effective Temperature (CET) in the Gulf. On a previous voyage in a tanker without air-conditioning CETs up to 31·6°C (89°F) had been recorded in the accommodation in the same ambient conditions. With exposure to high solar radiation in the Gulf, the deck officer's cabins and bridge house in the upper superstructure became uncomfortably warm (CET exceeding 26·6°C (80°F)) and in these temperatures skilled performance is likely to deteriorate.

The main thermal problems in the working environment were associated with the engine and boiler rooms which were consistently 11 to 17°C (20 to 30°F) higher than ambient temperature. For personnel on watch, the levels of heat stress were high but not intolerable if advantage was taken of the air blowers. Conditions under which emergency or repair tasks were carried out in very hot engine-room spaces were examined and often found to allow only a small margin of safety. Predicted average tolerance times were deduced from the Wet Bulb Globe Temperature (WBGT) scale of heat stress. Additional safeguards in these work situations could include the use of a WBGT meter and self-contained air-conditioned protective clothing, and the provision of air-conditioned cubicles.

The CET and WBGT heat stress indices were compared in a wide range of climates with Predicted 4-hr Sweat Rates (P4SR) from 0·1 to 4·9. The regressions of WBGT on P4SR and CET on P4SR were best fitted by quadratic relationships, but the WBGT regression approximated more closely to linearity under the conditions of the present survey.

Beliefs about self and others: a test of the dogmatism theory

The 7 propositions of Rokeach's theory of open- and closed-mind relating to beliefs about self and others were tested. It was hypothesized that closed-minded persons, in contrast to open-minded persons, would hold negative beliefs about self and about others, hold contradictory self-beliefs, engage in self-proselytization, seek status and power, report a sense of martyrdom, and display moral self-righteousness. In keeping with theoretical expectations, all hypotheses were confirmed although the magnitudes of correlations between dogmatism scale scores and the dependent variable measures were low.

Heat-protective ventilated jackets: a comparison of humid and dry ventilating air

A comparison has been made between humid and dry air for ventilating a heat-protective jacket. At sensible cooling capacities of 4·5 kcal./min. and above, humid and dry air provided equal protection. At sensible cooling capacities of 4 kcal./min. and above, the subject achieved thermal equilibrium within 65 min. with both humid and dry air, but below this value humid ventilating air is associated with elevated sweat rates and a failure to achieve thermal equilibrium within 65 minutes.