Establishment of a successful robotic pediatric general surgery practice

Robotic-assisted surgery (RAS) has a variety of theoretical advantages, including tremor filtration, optimal visualization, and improvement of surgeon ergonomics. Though it has achieved wide application in pediatric urology, the majority of pediatric general surgeons do not employ RAS. This study reports our institution's experience with RAS on a pediatric general surgery team. Following IRB approval, a retrospective review of all pediatric patients at our academic children's hospital who underwent RAS between 2017 and 2022 for pediatric general surgical conditions was performed. Patient demographics, operation performed, operating time, complications, and recovery were evaluated. A total of 159 children underwent RAS, increasing from 10 patients in 2017 to 59 patients in 2022. The median age and weight were 15.3 years and 76.4 kg, and 121 (76.1%) were female. The application of RAS was successful in all cases. There were no intraoperative complications and no conversions to an open approach. Eleven patients (6.9%) had unplanned presentations to the emergency department within 30 days. Five of these patients (3.1%) required admission to the hospital. This study demonstrates that the application of RAS in an academic pediatric general surgery practice is feasible and safe. The application of RAS to pediatric general surgery should continue to increase as operative teams increase their experience and comfort.Level of evidence Level IV.

Evaluation of potential biomarkers to determine adequate colostrum provision in male dairy-beef calves upon arrival at the rearing facility beyond 14 days of age

Colostrum consumption is crucial for passive immunization and development of the newborn calf. However, the incidence on failed transfer of passive immunity in male calves destined to dairy-beef production remains high to date. In addition, the lack of an automated procedure to validate the immunization status upon arrival at rearing facilities in calves beyond 14 d of age impedes the identification of failed transfer of passive immunity, and therefore, of those calves at high risk of suffering diseases. For this study, 82 newborn male Holstein calves (43.3 ± 0.86 kg of body weight; mean ± standard error) from a commercial dairy farm were used to investigate potential serum biomarkers of colostrum provision. The potential biomarkers selected were IgG, IgG1, cholesterol, alkaline phosphatase, gamma-glutamyl transferase (GGT), and total protein (TP). Treatments were as follows: high-colostrum (HC; n = 49), in which calves received 4 L of colostrum within the first 2 h after birth and 2 L of colostrum in the next 3 feedings within the first 24 h after birth, for a total of 10 L of colostrum; and low-colostrum (LC; n = 33), in which calves received only 2 L of colostrum within the first 2 h after birth. After colostrum consumption, calves were allocated to individual hutches and fed 2 L of milk replacer twice daily at a concentration of 125 g/L as fed. Starter feed and water were offered ad libitum. At approximately 14 d of age (14.2 ± 0.81 d of age; mean ± standard error) calves were transported 2.5 h to a research unit at IRTA (Torre Marimon, Spain) simulating the arrival to a rearing facility. Blood samples were collected before feeding at birth, 48 h after birth, and at arrival to the rearing facility. Results on the serum concentrations of the potential biomarkers at arrival to the rearing facility showed that IgG, IgG1, GGT, and TP were greater for the HC calves compared with the LC calves. Serum concentrations of cholesterol and alkaline phosphatase did not show differences between treatment groups. Additionally, body weight losses from birth until arrival to the rearing facility were greater for the LC treatment compared with the HC. Because of their low cost, quickness, and ease of measurement, GGT and TP were good indicators of colostrum intake in calves arriving at rearing facilities beyond 14 d of age.

Costs and Complications: Delayed Gastric Emptying after Pancreaticoduodenectomy

Postoperative delayed gastric emptying (DGE) is a very common complication after a pancreaticoduodenectomy (PD). This along with other complications can lead to increased health-care costs. This study investigates the costs and length of stay (LOS) associated with these. A retrospective study of 131 patients undergoing PD between 2000 and 2016 at Loma Linda University Health was performed. Chi-squared test was used to determine statistically significant differences between patients with and without DGE (according to the definition of the International Study Group of Pancreatic Surgery). Multiple logistic and linear regression analyses were performed to obtain adjusted odds ratios for variables of interest in association with DGE and relationship to LOS. Of 150 patients undergoing PD, 131 patients with tumors were analyzed. The overall incidence of DGE was 56 per cent. No pre- or postoperative factors were associated with increased risk of DGE. The median LOS for patients with DGE was 15 days versus 9 days for patients without DGE. Patients with DGE added $21,198 to the overall cost of hospitalization. Fourteen patients (10.7%) were readmitted, of whom 11 were because of DGE. Further studies assessing the utility of intraoperative G-tube placement in decreasing hospital costs and readmissions are needed.

SUN-174 Giant Bilateral Myelolipomas in a Patient with Congenital Adrenal Hyperplasia

INTRODUCTION Adrenal myelolipomas are rare, benign adrenal tumors composed of adipose and hematopoietic tissue. The first mass was identified by Gierke in 1905 and named by Oberling in 1929. Myelolipomas often coexist with CAH and other hormonal disorders although this relationship is still unclear. We present a rare case of giant bilateral myelolipomas in a patient with CAH. CASE REPORT A 28-year-old female with a history of CAH due to 21-hydroxylase deficiency diagnosed at birth presented to our endocrinology clinic after being lost to follow up for 4 years and a history of poor follow up for several years before that. She reported being on varying doses of hydrocortisone throughout her life with the most recent being 10mg TID with poor adherence. Over the past 4 years, the patient noticed increased hair growth on her face, abdomen, inner thighs and back, abdominal striae, and weight gain of 80-100lbs. She also reported a history of bilateral flank pain for the last several years, requiring several ER visits where she was told she had adrenal nodules based on scans that were done. A few months prior to her first visit to our clinic she developed increasing flank pain, which prompted a visit to a local ER. A CT of the abdomen revealed bilateral adrenal septated complex cystic masses measuring 19x12x20 cm on the left and 12x11x11 cm on the right. Initial biochemical workup was consistent with poorly managed CAH: ACTH 45.2 pg/mL (n 7.2 - 63.3), total testosterone 401 ng/dl (n 8-48), androstenedione 2085 ng/dl (n 41-262), 17-OH progesterone 18880 ng/dl, (n 15-290), DHEA-sulfate 423.5 ug/dl, (n 84.8-378), and estradiol 72.0 pg/dl, (n 12.5-498). Plasma renin activity was 13.904 ng/mL/hr (n 0.167-5.380 ng/mL/hr). Based on laboratory results hydrocortisone was decreased to 10mg BID and dexamethasone was added. Due to severe recurrent pain the patient underwent bilateral adrenalectomy. On pathology the bilateral masses were found to be myelolipomas with the left diameter measuring 22.3 cm and the right measuring 16.5 cm. Post-operatively her lab values showed significant improvement compared to her initial workup: ACTH 4.1 pg/mL, total testosterone 6.7 ng/dl, androstenedione 73 ng/dl, 17-OH progesterone 29 ng/dl, DHEA sulfate 7.2 ug/dl, and estradiol 228.3 pg/dl. Plasma renin was also within normal range at 1.776 ng/mL/hr. On follow up, the patient had recovered well and reported improvement in her flank pain. CONCLUSION This is a rare case of giant bilateral adrenal myelolipomas. Despite these tumors being benign and often asymptomatic, they are clinically relevant due to their role in the differential diagnosis of an adrenal mass. The presence of megakaryocytes in a biopsy specimen of a fatty adrenal mass is pathognomonic for myelolipoma. Treatment is guided by the tumor size and patient presentation; masses >7 cm, hormonally active, or causing abdominal pain should be surgically removed as demonstrated in this case

The extremely low energy cost of biosynthesis in holometabolous insect larvae

The metabolic cost of growth, which quantifies the amount of energy required to synthesize a unit of biomass, is an important component of an animal's ontogenetic energy budget. Here we investigated this quantity as well as other energy budget variables of the larvae of a holometabolous insect species, Vanessa cardui (painted lady). We found that the high growth rate of this caterpillar cannot be explained by its metabolic rate and the percentage of the metabolic energy allocated to growth; the key to understanding its fast growth is the extremely low cost of growth, 336 Joules/gram of dry mass. The metabolic cost of growth in caterpillars is 15-65 times lower than that of the endothermic and ectothermic species investigated in previous studies. Our results suggest that the low cost cannot be attributed to its body composition, diet composition, or body size. To explain the "cheap price" of growth in caterpillars, we assumed that a high metabolic cost for biosynthesis resulted in a high "quality" of cells, which have fewer errors during biosynthesis and higher resistance to stressors. Considering the life history of the caterpillars, i.e., tissue disintegration during metamorphosis and a short developmental period and lifespan, we hypothesized that an energy budget that allocates a large amount of energy to biosynthesizing high quality cells would be selected against in this species. As a preliminary test of this hypothesis, we estimated the metabolic cost of growth in larvae of Manduca sexta (tobacco hornworm) and nymphs of Blatta lateralis (Turkestan cockroach). The preliminary data supported our hypothesis.

Costs and Complications: Delayed Gastric Emptying after Pancreaticoduodenectomy

Postoperative delayed gastric emptying (DGE) is a very common complication after a pancreaticoduodenectomy (PD). This along with other complications can lead to increased health-care costs. This study investigates the costs and length of stay (LOS) associated with these. A retrospective study of 131 patients undergoing PD between 2000 and 2016 at Loma Linda University Health was performed. Chi-squared test was used to determine statistically significant differences between patients with and without DGE (according to the definition of the International Study Group of Pancreatic Surgery). Multiple logistic and linear regression analyses were performed to obtain adjusted odds ratios for variables of interest in association with DGE and relationship to LOS. Of 150 patients undergoing PD, 131 patients with tumors were analyzed. The overall incidence of DGE was 56 per cent. No pre- or postoperative factors were associated with increased risk of DGE. The median LOS for patients with DGE was 15 days versus 9 days for patients without DGE. Patients with DGE added $21,198 to the overall cost of hospitalization. Fourteen patients (10.7%) were readmitted, of whom 11 were because of DGE. Further studies assessing the utility of intraoperative G-tube placement in decreasing hospital costs and readmissions are needed.

Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship

OBJECTIVE

To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship.

DESIGN

A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online quiz, survey, and 2-part OSCE.

SETTING

The study was performed at Loma Linda University and affiliated hospitals where surgical clerkship students rotate.

PARTICIPANTS

A total of 148 year-3 medical students completed the study.

RESULTS

All testing modalities showed improvement. The mean average of the OSCE improved from 46% ± 27% to 81% ± 18%. The percentage of participants able to perform the examination in less than 6 minutes increased from 18% ± 27% to 84% ± 36%. Participants' comfort level in recognizing eFAST pathology increased from a mean of 2.40 ± 0.94 to 3.55 ± 0.87 out of 5. Comfort in performing the eFAST examination improved from 2.81 ± 0.79 to 3.77 ± 0.68. Comfort in interpreting the eFAST examination improved from 2.88 ± 0.87 to 3.65 ± 0.72.

CONCLUSIONS

This study demonstrates that incorporating 1 hour of eFAST training into the general surgery clerkship is feasible and may lead to improved competency in performing and interpreting the eFAST examination.

111 BIOCHEMICAL COMPOSITION OF FOLLICULAR FLUID IN RELATION TO THE STIMULUS TO INDUCE OVULATION IN ALPACAS (VICUGNA PACOS)

Alpacas, like other camelids, are induced ovulators. A study was designed to determine the effect of the ovulation-inducing stimulus on the biochemical composition of follicular fluid. Adult female alpacas (n = 18) were examined daily for 3 days by transrectal ultrasonography using a 5-MHz linear-array transducer (Aloka SSD-500, Tokyo, Japan). When the largest growing ovarian follicle was ≥7 mm, alpacas were given 1.0 mL of seminal plasma intramuscularly (SP, n = 9) or 40 µg of busereline acetate intramuscularly (GnRH, n = 9). A transvaginal transducer with an attached needle guide (Aloka UST-945BP-5) was used for collection of follicular fluid 22 h post-induction. Follicular contents were then centrifuged at 800 × g for 20 min to separate the fluid from the cells. The follicular fluid was collected and stored at –20°C until analysis with a semi-automatic biochemical analyzer (SINOWA, China). The results were glucose 49.17 and 47.95 (mg/dL; P > 0.05), total protein 1.85 and 1.15 (g/dL; P < 0.05), albumin 1.11 and 1.13 (g/dL; P > 0.05), triglycerides 3.94 and 3.16 (mg/dL; P > 0.05), cholesterol 39.01 and 42.5 (mg/dL; P > 0.05), phosphatase 32.68 and 21.36 (IU/L; P < 0.05), alanine aminotransferase 3.66 and 5.07 (IU/L; P > 0.05), and lactate dehydrogenase 42.17 and 27.27 (IU/L; P > 0.05) for SP or GnRH treatments, respectively. Results suggest the need to continue research to explain the effect of possible differences in total protein, cholesterol, and phosphatase on oocyte-expressed genes and follicular development. Research was supported by the project no. 405-PNICP-PIAP-2014-UNMSM.

Effect of heart failure on dipeptidyl peptidase IV activity in plasma of dogs

BACKGROUND

In congestive heart failure (HF), plasma B-type natriuretic peptide (BNP) seems devoid of biological effectiveness. BNP(1-32) could be truncated into BNP(3-32) by dipeptidyl peptidase IV (DPP4), and BNP(3-32) has reduced biological activities.

HYPOTHESIS

Increased DPP4 activity is associated with pathophysiology of HF.

ANIMALS

One hundred twenty-eight client-owned dogs and 9 experimental Beagles from the Clinical Veterinary Unit of the University of Liège.

METHODS

We prospectively measured plasma DPP4 activity in 5 groups of dogs: normal growing dogs (n = 21), normal adult dogs (n = 60), healthy Beagle (n = 9), dogs with myxomatous mitral valve disease (n = 35), and dogs with dilated cardiomyopathy (n = 12). The final diagnosis and the severity of HF were determined by Doppler echocardiography. Plasma DPP4 activity was measured kinetically by a fluorimetric method.

RESULTS

In growing dogs, DPP4 activity was higher than in adults (P < .001) and inversely correlated with age (r = -0.57, P < .01). In adults, DPP4 activity increased linearly with body weight (r = 0.39, P < .01), but there was no influence of age or sex. No effect of the circadian rhythm was noted. DPP4 activity was significantly higher in HF ISACHC I (16.3 ± 1.14 U/L) compared with healthy adults (12.4 ± 0.65 U/L, P < .05) and HF ISACHC III (11.0 ± 1.50 U/L, P < .05). Mean DPP4 activity in ISACHC II was 15.1 ± 1.4 U/L.

CONCLUSION AND CLINICAL IMPORTANCE

We did not find evidence that plasma DPP4 activity is responsible for the "BNP resistance" in overt congestive HF, but it may be implicated in early stages.

Survey of the levels of antimicrobial resistance in Argentina: WHONET program--1991 to 1994

The World Health Organization has implemented an international program of antibiotic resistance survey, called WHONET, with the participation of 121 laboratories from 41 countries around the world. Argentina joined WHONET program in 1989. Five hospitals from Buenos Aires are taking part, under the coordination of the National Institute of Microbiology 'Dr. C. Malbran'. From the results obtained between 1991 and 1994, the low level of susceptibility to aminopenicillins, cephalosporins and aminoglycosides is remarkable. On the other hand, vancomycin-resistant Enterococcus spp. and Staphylococcus spp. have not been detected and imipenem resistance in Pseudomonas aeruginosa, and Acinetobacter spp. isolates has not overcome 7% and 11%, respectively. Analytical programs utilizing these data aid in the understanding of the epidemiology of antibiotic resistance and in the development of rational antibiotic prescription practices and infection control procedures.

342 EFFECTS OF MELATONIN ON PREIMPLANTATION DEVELOPMENT OF PORCINE PARTHENOGENETIC EMBRYOS

In mammalian species, melatonin is a multi-functional pineal gland hormone that regulates several circadian and seasonal rhythms including reproduction. However, the melatonin study was not common as to the oocytes in the pig. Recently, we reported that exogenous melatonin has beneficial effects on nuclear and cytoplasmic maturation during porcine oocyte IVM and we also reported an existence of melatonin receptor on the cumulus cells and granulose cells (Kang JT et al. 2009 J. Pineal Res. 46(1), 22-28). In this study, as adding further experiments rather than our previous study, we investigated effect of exogeneous melatonin (10 ng mL-1) on the porcine oocytes and analyzed possible factors which can be responsible for that results. Oocytes were recovered by aspiration of slaughterhouse ovaries, and then matured in TCM-199 supplemented with EGF, insulin, pyruvate, cystine, and gonadotropin. Expression of apoptosis-related genes mRNA in oocytes cultured with melatonin were evaluated by real-time PCR (Exp 1), cumulus cell expansion on COC was assessed on the microscopes during in vitro maturation (Exp 2), and developmental effects between melatonin treatement group and non-treatment group on the in vitro culture of parthenogenetically activated oocytes was investigated (Exp 3). In results, oocytes matured with melatonin were assessed for the expression of apoptosis-related genes Bcl-xl (anti-apoptotic gene) and Bax (proapoptotic gene) by real-time quantitative PCR. Analysis of data showed that the expression of Bcl-xl was higher compared to the control while the expression of Bax was decreased relative to the control (P < 0.05). Cumulus cell expansion was evaluated under a stereomicroscope at 22 h, 44 h during IVM. Representative photomicrographs of porcine COC at the start of the IVM, after 22 h and 44 h treatment with melatonin, are shown in Figure. After 22 h of melatonin treatment, cumulus cells were visually expanded compared with non-treatment group. We analyzed significantly greater proportion of parthenogenetically activated oocytes developed to blastocyst when the IVM medium was supplemented with melatonin. Melatonin treatment in the IVM has consequently beneficial effect on the blastocyst formation rates on the development of porcine parthenogenetic embryos (15.4%) compared to non-treatment group (10.7%, P < 0.05). However, cleavage frequency was not affectedby the treatment. In conclusion, the present study demonstrated that melatonin had a beneficial effect on the development of parthenogenetically activated porcine embryos, probably through decreased apoptosis rate and increased cumulus cell expansion. This study was supported by Korean MKE, MEST (BK21 program), and Hanhwa L&C

Effect of weight loss induced by gastric bypass on proinflammatory interleukin-18, soluble tumour necrosis factor-alpha receptors, C-reactive protein and adiponectin in morbidly obese patients

OBJECTIVE

Interleukin-18 (IL-18) is a potent proinflammatory cytokine whose role in human obesity has recently been suggested. The aim of our study was to analyse in morbidly obese patients undergoing gastric bypass, the relationship of IL-18 with insulin resistance and with proinflammatory cytokines (tumour necrosis factor-alpha receptors, sTNFR), C-reactive protein (CRP) and with adiponectin.

DESIGN

Observational and prospective study.

PATIENTS

Sixty-five morbidly obese patients, aged 45 +/- 8.9 years, were studied before and 12 months after gastric bypass.

MEASUREMENTS

We analysed plasma concentrations of IL-18, sTNFR, CRP and adiponectin.

RESULTS

Plasma concentrations of sTNFR2, IL-18 and CRP were decreased and adiponectin significantly increased after bypass surgery. In the multiple regression analysis, preoperative values of IL-18 remained significantly associated with preoperative triglycerides (beta = 0.47, P = 0.005) and TNFR2 (beta = 0.47, P = 0.004). R(2) for the model = 0.38. Postoperative IL-18 concentrations in the multiple regression analysis were significantly associated with postoperative homeostasis model assessment of insulin resistance (HOMA-IR) (beta = 0.092, P = 0.019) and triglycerides (beta = 0.40, P = 0.036). R(2) for the model = 0.46. IL-18 did not correlate with body mass index, fat mass, fat-free mass or body fat. No relationship was either found between adiponectin and IL-18, TNFR1 and -2 and CRP.

CONCLUSIONS

Massive weight loss induced by gastric bypass reduces IL-18, TNFR2 and CRP. IL-18 might be a marker of the chronic inflammatory process underlying insulin resistance but its lack of association with anthropometric and body composition parameters does not support a major secretion by human adipocytes. IL-18 and sTNFR1 and -2 do not play a main role in the inhibition of the secretion of adiponectin.

Multiple cerebral aneurysms caused by cardiac myxoma. A case report and present state of knowledge

SUMMARY

A case of multiple cerebral aneurysms caused by left atrial myxoma is reported.We present the details of this case and discuss the hypothetical pathogenesis, radiological aspects and treatment of these neoplastic aneurysms.

Determinants of sex hormone-binding globulin concentrations in a cross-sectional study of healthy men randomly selected

Sex-hormone binding globulin (SHBG) is a glycoprotein synthesised in the liver and it is a transport protein which is primary modulator of the androgen signal. This cross-sectional study prompted us to investigate the relati-onship between SHBG and, age, anthropometric, body composition variables, the IGF-I system and leptin in a group of healthy adult men randomly selected. Included 134 men, aged 41.6 years, range 15-70 years. Body mass index (BMI) was calculated, and body composition was determined by a bioelectrical impedance analyser. Serum total IGF-I concentrations after acid-ethanol extraction, free IGF-I concentrations, IGFBP3, leptin, testosterone and SHBG were determined. Testosterone concentrations increased in the 2th decade and SHBG concentrations increased in the 4th decade. We observed an increase in leptin in the 4th decade with a decrease in IGF-I, free IGF-I and IGFBP3 throughout the decades. Total IGF-I correlated with waist/hip ratio; free IGF-I with BMI and waist/hip ratio and IGFBP3 did not correlated with any variable. As expected, there was a positive correlation between leptin and BMI, waist/hip ratio, fat free mass and fat mass. On the other hand, SHBG was negatively correlated with BMI, fat mass, total IGF-I, free IGF-I, IGFBP3 and leptin. Testosterone did not correlated with any anthropometric or body composition variable, IGF-I system components, leptin or SHBG. The multiple linear regression analysis produced a model that explained the 40.5% of SHBG variability; only fat mass and IGFBP3 brought an independent significant contribution to SHBG variability. In conclusion, in this population of healthy men randomly selected, we found that they had significant negative correlation between SHBG concentrations and anthropometric, body composition variables, the IGF-I system and leptin levels, and that fat mass and IGFBP3 may be the main determinants of SHBG changes.

PrP polymorphisms in Basque sheep breeds determined by PCR-restriction fragment length polymorphism and real-time PCR

Two new PCR-based methods were developed to decode prion protein (PrP) gene polymorphisms at codons 136, 154 and 171: a PCR-restriction fragment length polymorphism (RFLP) analysis consisting of two PCR reactions followed by three enzymatic digestions, and a real-time PCR consisting of four reactions with seven fluorogenic probes. Both methods were used to study the distribution of PrP gene polymorphisms in a representative sample (1297 animals) of the populations of the two native breeds of sheep of the Spanish Basque Country, Latxa and Carranzana. Fourteen genotypes were found in the Latxa breed, in which ARQ/ARQ was the genotype most frequently observed (49.3 per cent), followed by ARR/ARQ (32.6 per cent) and ARQ/ARH (5.8 per cent). The genotype associated with the highest resistance to scrapie (ARR/ARR) was present in 5 per cent of the animals analysed. Similar results were observed in the Carranzana sheep.

Patient and physician satisfaction in a clinical study of telemedicine in a hypertensive patient population

We studied patient and physician satisfaction with telemedicine for the care of a hypertensive population. Once recruited, participants were seen both in person and via telemedicine (in random order) on the same day. After each meeting, patient and physician satisfaction surveys were completed. In the 12-month study, there were 107 pairs of visits. The physicians reported a small but significant increase in workload, mental effort, technical skills and visit duration for telemedicine when compared with face-to-face consultations. They noted that the telemedicine system worked well in the majority of cases and could reduce the need for future treatment. Patients reported slightly but significantly higher satisfaction scores for the following for in-person than for telemedicine meetings: technical quality, interpersonal care and time spent. Patients reported high satisfaction scores for both telemedicine and in-person visits.

A method to report utilization for quality initiatives in medical facilities

OBJECTIVE

We undertook this project to outline a methodology for quantifying aggregate health care utilization of medical "technologies" that could be rank ordered by volume. The identification of specific high-volume technologies could guide future efforts for quality initiatives such as program planning, preventive services implementation, quality improvement activities, and innovative and cost-effective technology development.

DESIGN

This study utilized a retrospective cross-sectional study design.

METHODS

We generated combined ranks for the top 200 high-volume procedures from three data sources that incorporated in- and outpatient procedures. Data were collected using primarily ICD-9 and CPT-4 codes; all codes were translated into CPT-4 codes and collapsed into categories using truncated three-digit CPT-4 codes. Frequencies for each collapsed code were determined with each dataset; procedures were reranked based on the mean rank of the three sources.

MAIN OUTCOME MEASURES

We itemized the individual procedure codes making up each of the top 20 categories and reported the unique codes making up at least 80% of the procedure code category.

RESULTS

The top five procedure categories identified in this study were patient visits (inpatient and outpatient), chest x-rays, mammograms, ophthalmological services, and electrocardiograms.

CONCLUSION

The methodology described provides a new way to combine and concisely report on utilization of procedures that is relevant to data obtained from different sources. This methodology may be of potential benefit to health care administrators, technology developers, and other planners as they contemplate ways to identify quality and technology development initiatives that can have a broad impact on populations served by health care organizations.

MMPI-2 profiles of Colombian, Mexican, and Venezuelan university students

Performance of 82 Colombian, 87 Mexican, and 96 Venezuelan university students and adult community dwellers on Spanish translations of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were compared. Findings suggest more comprehensive research is required on applications of the MMPI-2 in Latin America and greater consideration of the roles of culture and nationality.

Helicopter emergency medical service in Canary Islands, Spain

This is a report on our first 2 years' experience of operating a helicopter emergency medical service in the Canary Islands, Spain. The two advanced life-support helicopters are staffed full time by a physician and a nurse. For the transport protocol, inter-hospital transport patients (secondary missions) were classified into three groups: group A, minor illnesses or injuries; group B, modified or middle critical condition; and group C, critical condition. On-scene patients (primary missions) were also divided into critical and non-critical condition. Cardiovascular and respiratory stabilization were necessary before transport. One thousand and fifty-four patients were transported, 19% of whom were primary missions and 81% of whom were secondary missions. Thirty per cent of the first group were in critical condition. The distribution of secondary missions was group A 16%, group B 44% and group C 40%. In group C, 60% of patients were mechanically ventilated, 70% needed cardiovascular drug support and 84% needed stabilization before transport. Thirty-two per cent were trauma patients and 12% neonates. The overall mortality rate was 0.8%. The cost per mission was US$2300. In the interests of safety and rationalization of the use of resources, transport of non-critical patients should be reduced. The presence of a trained physician and nursing crew and stabilization before transport could be responsible for the low mortality rate.

Both group IB and group IIA secreted phospholipases A2 are natural ligands of the mouse 180-kDa M-type receptor

Snake venom and mammalian secreted phospholipases A2 (sPLA2s) have been associated with toxic (neurotoxicity, myotoxicity, etc.), pathological (inflammation, cancer, etc.), and physiological (proliferation, contraction, secretion, etc.) processes. Specific membrane receptors (M and N types) for sPLA2s have been initially identified with snake venom sPLA2s as ligands, and the M-type 180-kDa receptor was cloned from different animal species. This paper addresses the problem of the endogenous ligands of the M-type receptor. Recombinant group IB and group IIA sPLA2s from human and mouse species have been prepared and analyzed for their binding properties to M-type receptors from different animal species. Both mouse group IB and group IIA sPLA2s are high affinity ligands (in the 1-10 nM range) for the mouse M-type receptor. These two sPLA2s are expressed in the mouse tissues where the M-type receptor is also expressed, making it likely that both types of sPLA2s are physiological ligands of the mouse M-type receptor. This conclusion does not hold for human group IB and IIA sPLA2s and the cloned human M-type receptor. The two mouse sPLA2s have relatively high affinities for the mouse M-type receptor, but they can have much lower affinities for receptors from other animal species, indicating that species specificity exists for sPLA2 binding to M-type receptors. Caution should thus be exerted in avoiding mixing sPLA2s, cells, or tissues from different animal species in studies of the biological roles of mammalian sPLA2s associated with an action through their membrane receptors.

The yeast halotolerance determinant Hal3p is an inhibitory subunit of the Ppz1p Ser/Thr protein phosphatase

Components of cellular stress responses can be identified by correlating changes in stress tolerance with gain or loss of function of defined genes. Previous work has shown that yeast cells deficient in Ppz1 protein phosphatase or overexpressing Hal3p, a novel regulatory protein of unknown function, exhibit increased resistance to sodium and lithium, whereas cells lacking Hal3p display increased sensitivity. These effects are largely a result of changes in expression of ENA1, encoding the major cation extrusion pump of yeast cells. Disruption or overexpression of HAL3 (also known as SIS2) has no effect on salt tolerance in the absence of PPZ1, suggesting that Hal3p might function upstream of Ppz1p in a novel signal transduction pathway. Hal3p is recovered from crude yeast homogenates by using immobilized, bacterially expressed Ppz1p fused to glutathione S-transferase, and it also copurifies with affinity-purified glutathione S-transferase-Ppz1p from yeast extracts. In both cases, the interaction is stronger when only the carboxyl-terminal catalytic phosphatase domain of Ppz1p is expressed. In vitro experiments reveal that the protein phosphatase activity of Ppz1p is inhibited by Hal3p. Overexpression of Hal3p suppresses the reduced growth rate because of the overexpression of Ppz1p and aggravates the lytic phenotype of a slt2/mpk1 mitogen-activated protein kinase mutant (thus mimicking the deletion of PPZ1). Therefore, Hal3p might modulate diverse physiological functions of the Ppz1 phosphatase, such as salt stress tolerance and cell cycle progression, by acting as a inhibitory subunit.