An exploratory data quality analysis of time series physiologic signals using a large-scale intensive care unit database

Physiological data, such as heart rate and blood pressure, are critical to clinical decision-making in the intensive care unit (ICU). Vital signs data, which are available from electronic health records, can be used to diagnose and predict important clinical outcomes; While there have been some reports on the data quality of nurse-verified vital sign data, little has been reported on the data quality of higher frequency time-series vital signs acquired in ICUs, that would enable such predictive modeling. In this study, we assessed the data quality issues, defined as the completeness, accuracy, and timeliness, of minute-by-minute time series vital signs data within the MIMIC-III data set, captured from 16009 patient-ICU stays and corresponding to 9410 unique adult patients. We measured data quality of four time-series vital signs data streams in the MIMIC-III data set: heart rate (HR), respiratory rate (RR), blood oxygen saturation (SpO2), and arterial blood pressure (ABP). Approximately, 30% of patient-ICU stays did not have at least 1 min of data during the time-frame of the ICU stay for HR, RR, and SpO2. The percentage of patient-ICU stays that did not have at least 1 min of ABP data was ∼56%. We observed ∼80% coverage of the total duration of the ICU stay for HR, RR, and SpO2. Finally, only 12.5%%, 9.9%, 7.5%, and 4.4% of ICU lengths of stay had ≥ 99% data available for HR, RR, SpO2, and ABP, respectively, that would meet the three data quality requirements we looked into in this study. Our findings on data completeness, accuracy, and timeliness have important implications for data scientists and informatics researchers who use time series vital signs data to develop predictive models of ICU outcomes.

A Patient Portal-Based Commitment Device to Improve Adherence with Screening for Colorectal Cancer: a Retrospective Observational Study

BACKGROUND

Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening.

OBJECTIVE

Compare the effectiveness of a commitment device (patient self-ordering fecal immunochemical test (FIT) kits) to standard CRC screening outreach.

DESIGN

A retrospective observational study.

PARTICIPANTS

Participants were > 49 years and < 75 years, had no history of CRC, and were eligible for CRC screening.

INTERVENTION

An electronic screening reminder with an embedded order button allowed participants to order FIT kits directly from a patient portal. Those who used the order button were promptly sent a kit; those who did not were later mailed kits.

MAIN MEASURES

Primary outcome was completion of FIT kits. Secondary outcomes included number of days to completion, completion of follow-up for positive results, and CRC diagnosis; we also examined prior use of FIT kit. We used inverse probability of treatment weights to control for pretreatment imbalances.

KEY RESULTS

The cohort comprised 176,231 participants: 53% female; median age was 59; 11% were Asian, 21% Hispanic/Latino, 7% black, 51% White, 3% other/mixed race. Approximately 10% (N = 16,918) used the button. Using inverse probability of treatment weights, we found that those who used the button had 3.8 times the odds of completing a kit compared to participants who did not (odds ratio, 3.77; 95% confidence interval, 3.57-3.98). Within the button group, 63% of those eligible completed a FIT kit in the year prior to the button compared to 87% in the year after the button became available (p < 0.0001).

CONCLUSION

The ability to self-order screening kits may act as a commitment device that increases CRC screening. Scalable tools leveraging existing patient portals such as this can complement existing CRC outreach strategies.

The Effect of Laboratory Test-Based Clinical Decision Support Tools on Medication Errors and Adverse Drug Events: A Laboratory Medicine Best Practices Systematic Review

BACKGROUND

Laboratory and medication data in electronic health records create opportunities for clinical decision support (CDS) tools to improve medication dosing, laboratory monitoring, and detection of side effects. This systematic review evaluates the effectiveness of such tools in preventing medication-related harm.

METHODS

We followed the Laboratory Medicine Best Practice (LMBP) initiative's A-6 methodology. Searches of 6 bibliographic databases retrieved 8508 abstracts. Fifteen articles examined the effect of CDS tools on (a) appropriate dose or medication (n = 5), (b) laboratory monitoring (n = 4), (c) compliance with guidelines (n = 2), and (d) adverse drug events (n = 5). We conducted meta-analyses by using random-effects modeling.

RESULTS

We found moderate and consistent evidence that CDS tools applied at medication ordering or dispensing can increase prescriptions of appropriate medications or dosages [6 results, pooled risk ratio (RR), 1.48; 95% CI, 1.27-1.74]. CDS tools also improve receipt of recommended laboratory monitoring and appropriate treatment in response to abnormal test results (6 results, pooled RR, 1.40; 95% CI, 1.05-1.87). The evidence that CDS tools reduced adverse drug events was inconsistent (5 results, pooled RR, 0.69; 95% CI, 0.46-1.03).

CONCLUSIONS

The findings support the practice of healthcare systems with the technological capability incorporating test-based CDS tools into their computerized physician ordering systems to (a) identify and flag prescription orders of inappropriate dose or medications at the time of ordering or dispensing and (b) alert providers to missing laboratory tests for medication monitoring or results that warrant a change in treatment. More research is needed to determine the ability of these tools to prevent adverse drug events.

Perspective on Publishing Quality Improvement Efforts

Quality improvement (QI) activities are critical to achieve the Triple Aim and to the Institute of Medicine's six "Aims for Quality Improvement": Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable. These QI activities are essential to create a learning health care system. Academic publishing is critical to foster continuous QI and sharing, and yet it tends to favor more traditional research articles. Publishing QI activities has great value, encourages greater rigor, and helps facilitate greater willingness to share improvement opportunities.

Neuroprotective effects of Nigella sativa on experimental spinal cord injury in rats

The aim of this study was to investigate the possible beneficial effects of Nigella sativa (NS) in comparison to methylprednisolone on experimental spinal cord injury (SCI) in rats. SCI was performed by placing an aneurysm clip extradurally at the level of T11-12. Rats were neurologically tested over 24 h after trauma and spinal cord tissue samples were harvested for both biochemical and histopathological evaluation. The neurological scores of rats were not found to be different in SCI groups. SCI significantly increased the spinal cord tissue malondialdehyde (MDA) and protein carbonyl (PC) levels, however SCI decreased superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) enzyme activities compared to the control. Methylprednisolone and NS treatment decreased tissue MDA and PC levels and prevented inhibition of SOD, GSH-Px and CAT enzymes in the tissues. The most significant results were obtained when NS was given. In SCI and placebo groups, the neurons of spinal cord tissue became extensively dark and degenerated with picnotic nuclei. The morphology of neurons in methylprednisolone and NS-treated groups were well protected, however, not as well as the neurons of the control group. The number of neurons in the spinal cord tissue of the SCI and placebo groups was significantly less than the control, laminectomy, methylprednisolone and NS-treated groups. In conclusion, NS treatment might be beneficial in spinal cord tissue damage, and therefore shows potential for clinical implications.

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

CONTEXT

For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties.

OBJECTIVE

To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system.

DESIGN

Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers.

MAIN OUTCOME MEASURES

Primary measure was satisfaction with one's day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income.

RESULTS

Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2-9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income.

CONCLUSION

It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction.

Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

CONTEXT

To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings.

OBJECTIVE

To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates.

DESIGN

Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters.

MAIN OUTCOME MEASURES

Providers' CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use.

RESULTS

Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001).

CONCLUSION

Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care.

Effects of Low Intensity Exercise Against Apoptosis and Oxidative Stress in Streptozotocin-induced Diabetic Rat Heart

Background The aim of this study was to investigate the effects of low intensity exercise on heart of streptozotocin (STZ)-induced diabetic rats. Materials and Methods The rats were randomly divided into 3 experimental groups: A (control), B (diabetic untreated), and C (diabetic treated with low intensity exercise); each group contains 8 animals. B and C groups received STZ. Diabetes was induced in 2 groups by a single intraperitoneal (i.p) injection of STZ (40 mg/kg, freshly dissolved in 0,1 M citrate buffer, pH 4.2). 2 days after STZ treatment, diabetes in 2 experimental groups was confirmed by measuring blood glucose levels. Rats with blood glucose levels of 250 mg/dl or higher were considered to be diabetic. Animals in the exercise group were made to run the treadmill once a day for 4 consecutive weeks. Exercise started 3 days prior to STZ administration. Results After induction of diabetes, histological abnormalities were observed, including myofibrillar loss, vacuolization of cytoplasm and irregularity of myofibrils. These alterations were attenuated by low intensity exercise. Our data indicates a significant reduction of oxidative stress and apoptosis in cardiomyocytes after exercise. Treatment of diabetic animals with low intensity exercise, decreased the elevated tissue malondialdehyde (MDA) levels and increased the reduced activities of the enzymatic antioxidants superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in cardiac tissue. Conclusion These findings suggest that low intensity exercise has a therapeutic protective effect in diabetes by decreasing oxidative stress and apoptosis, and by preservation of myocardial integrity.

The effects of quercetin on liver regeneration after liver resection in rats

The aim of the present study was to assess the influence of quercetine (QE) on liver regeneration after partial hepatectomy (PH) in rats. A total of 24 male Wistar albino rats were divided into three groups: sham-operated (SH), PH and PH+QE; each group contain 8 animals. The rats in QE-treated groups were given QE (15 mg/kg body weight) once a day i.p., for 7 days starting 3 days prior to hepatectomy operation. At 7 days after resection, liver samples were collected. The malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) levels were estimated in liver homogenates. Moreover, histopathological examination, mitotic index (MI), proliferating cell nuclear antigen labelling, proliferation index (PI), transferase-mediated dUTP nick end-labelling assay, apoptotic index (AI) were evaluated at 7 days after hepatectomy. As a result, QE significantly increased MI, PI, and significantly decreased AI in PH rats. Additionally, QE remarkably inhibited the elevation of MDA, restored impaired antioxidant SOD activity and GSH level, and also attenuated hepatic vacuolar degeneration and sinusoidal congestion. These results suggested that QE treatment had a beneficial effect on liver regenerative capacity of the remnant liver tissue after hepatectomy, probably due to its antioxidative, antiapoptotic and proliferative property.

Investigation of telomerase activity and apoptosis on invasive ductal carcinoma of the breast using immunohistochemical and Western blot methods

OBJECTIVE

Invasive ductal carcinoma (IDC) comprises the largest group of breast cancers. This study aimed to investigate telomerase activity and apoptosis using immunohistochemical and Western blot methods.

PATIENTS AND METHODS

In total, 75 cases that had been diagnosed as IDC and 20 cases that had undergone a freezing procedure were included. The histological sections were stained with Bax, Bcl-2, hTERT and BNIP3. The ages of the patients, as well as their hormonal status and tumour sizes and grades were evaluated, as well as the staining characteristics of the antibodies in question.

RESULTS

A decrease in Bcl-2 positivity and an increase in Bax positivity were found immunohistochemically with increasing tumour grades. The data obtained by western blot method showed that Bcl-2 was highest in grade 1 tumours although these results were not statistically significant. The relationship between estrogen and progesterone receptor positivity and Bcl-2 was statistically significant, suggesting there is hormonal control through apoptosis. BNIP3 was found to be decreased with increasing tumour grades. Similarly, BNIP3 was found to be having the lowest value in grade 3 tumours by western blot method. Furthermore, hTERT was found to be increased with increasing tumour grades. In the western blot method, hTERT increased nearly four-fold compared to the control. In addition, hTERT, which was seen in very high levels in tumours, may be a helpful cancer marker. Both hTERT and BNIP3 are important markers that can provide information about prognosis.

CONCLUSIONS

Big improvements can be achieved in tumour progression control with new treatment modalities that stop telomerase activity and hypoxic cell death.

Low-value care for acute sinusitis encounters: who's choosing wisely?

OBJECTIVES

To assess acute sinusitis (AS) encounters in primary care (PC), urgent care (UC), and emergency department (ED) settings for adherence to recommendations to avoid low-value care.

STUDY DESIGN

A retrospective, observational study of adult AS encounters (2010-2012) within a large integrated healthcare system.

METHODS

We compared ED and UC encounters with PC visits, adjusting for differences in patient characteristics.

PRIMARY OUTCOMES

adherence to recommendations to avoid antibiotics and a computed tomography (CT) scan of the face, head, or sinuses.

SECONDARY OUTCOMES

length of symptoms and adherence with AS recommendations.

RESULTS

Of 152,774 AS encounters, 89.2% resulted in antibiotics and 1.1% resulted in a CT scan. Compared with PC encounters, ED encounters were less likely to result in antibiotics (adjusted odds ratio [AOR], 0.57; 95% CI, 0.50-0.65) but more likely to result in a CT scan (AOR, 59.4; 95% CI, 51.3-68.7), while UC encounters were more likely to result in both antibiotics (AOR, 1.12; 95% CI, 1.08-1.17) and CT imaging (AOR, 2.4; 95% CI, 2.1-2.7). Chart review of encounters resulting in antibiotics found that 50% were inappropriately prescribed for symptoms of ≤7 days' duration (95% CI, 41%-58%), while 35% were appropriately prescribed for symptoms of ≥14 days' duration (95% CI, 27%-44%). Only 29% (95% CI, 22%-36%) of encounters were consistent with guideline-adherent care.

CONCLUSIONS

AS encounters in an integrated health system infrequently result in CT imaging, but antibiotic treatment is common. Differences exist across acute care settings, but improved antibiotic stewardship is needed in all settings.

Race/ethnicity, personal health record access, and quality of care

OBJECTIVES

To estimate the impact of race/ethnicity and written language preference on registration for a personal health record (PHR) that included emailing providers, viewing lab results, refilling prescriptions, and other functionalities, and the impact of PHR use on quality across racial/ethnic groups with comparable access.

STUDY DESIGN AND METHODS

Retrospective observational design among 3,173,774 adults. Factors affecting registration were assessed using logistic regression, and propensity score matching techniques assessed the impact of language preference on registration and PHR use on quality of care. Difference-in-differences methods assessed the significance of between-group changes in Healthcare Effectiveness Data and Information Set (HEDIS) scores, such as glycated hemoglobin and lipid screening and control.

RESULTS

Race/ethnicity most strongly predicted PHR registration. After adjusting for multiple factors, Asian American, Latino American, and African American members remained 23%, 55%, and 62% less likely to register, respectively, than non-Hispanic white members. Preference for Spanish as a written language predicted poor PHR adoption. The probability of registration was 0.451 (95% CI, 0.449-0.453) for English language-preferring Latinos and 0.174 (95% CI, 0.173-0.176) for Spanish language-preferring Latinos. For non- Hispanic whites, Latinos, and African Americans using the PHR, HEDIS scores increased after PHR use by 1.3 to 12.7 percentage points, compared with differences of -1.1 to 8.1 percentage points among nonusers. All but 2 difference-in-differences between PHR users and nonusers were statistically significant.

CONCLUSIONS

Nonwhite race/ethnicity and Spanish language preference independently predict poor PHR adoption. PHR use is associated with higher quality healthcare, and when PHR use is equivalent across racial/ethnic groups, so is quality of care.

The role of ionizing radiaton on ovulation rate and oocyte morphology in mouse

We investigated the effects of ionizing radiation on maturation ability and radiosensitivity of oocytes enclosed in preantral and antral follicles. Balb/c female mice received total body single dose gamma radiation (7.2 Gy) at the diestrous to proestrous transition period. In the first experiment, spontaneously ovulated oocytes were collected from irradiated animals. In the second experiment, irradiated animals were allowed to superovulate to assess the ovarian function. The spontaneous ovulation rate of the follicles exposed at antral stage was significantly lower than the sham-irradiated mice (p < 0.01), and most of the oocytes were found at the metaphase I stage. Oocyte morphology and the ovulation rate of the follicles exposed at preantral stage were similar to the sham-irradiated group. Minimal morphological abnormalities were observed in the oocytes and the polar body as well. The superovulation response of all the irradiated animals was lower than the respective control animals. The superovulation rate was significantly lower in the first ovulation after irradiation (p < 0.01). In conclusion, our findings indicate that total body gamma irradiation, on a basis of estrous cycle stages, leads to ovulation failure in the antral stage while causes abnormal oocyte morphology in the preantral stage follicles in mice.

Complex case conferences associated with reduced hospital admissions for high-risk patients with multiple comorbidities

OBJECTIVES

Reducing avoidable hospital readmissions presents an opportunity to improve health care quality and reduce avoidable costs. We studied the effect person-focused care may have on reducing avoidable admissions to the hospital.

METHODS

Among patients with heart failure discharged from the hospital, we evaluated the effect on 30-day readmissions of transitions-in-care interventions: home health visits, follow-up phone calls, and physician office visits. We also used a standardized diagnostic tool to interview readmitted patients to identify social reasons that may have contributed to the readmission. Finally, we used the learnings from both interventions to develop a new intervention: a single complex disease case conference that included the entire health care team. We measured hospital admissions for 21 patients during the 6 months before and after their complex case conferences.

RESULTS

Observed-over-expected hospital readmission rates were lowest for patients receiving a postdischarge visit with a home health nurse and a follow-up visit with their physician (0.54), compared with solely a physician visit (0.81), home health visit (1.2), or phone call (1.55). Various social issues may contribute to hospital readmissions, including caregiver knowledge, ability to care for oneself at home, and issues related to medications (adherence, ability to pay, and knowledge about potential side effects). Substantially fewer hospital admissions occurred after complex case conferences.

CONCLUSIONS

Complex case conferences with disease-focused and person-focused interventions may be associated with reduced hospital admissions for patients with heart failure and multiple comorbidities.

Protective effects of quercetin on testicular torsion/detorsion-induced ischaemia-reperfusion injury in rats

The aim of this study was to investigate the protective effect of quercetin (QE) on testicular torsion/detorsion-induced ischaemia-reperfusion (I/R) injury. A total of 24 male Wistar albino rats were divided into three groups: control, I/R and I/R treated with QE; each group contain eight animals. Testicular torsion was created by rotating the left testis 720° in a clockwise direction. The ischaemia period was 5 h and orchiectomy was performed after 5 h of detorsion. QE (15 mg kg(-1) , i.p.) was administered only once, 40 min prior to detorsion. Left orchiectomy was performed in all I/R groups. To date, no histopathological changes on testicular torsion/detorsion-induced I/R injury in rats by QE treatment have been reported. Spermatogenesis and mean seminiferous tubule diameter were significantly decreased in I/R groups were compared with the control group. Furthermore, QE treated animals showed an improved histological appearance in I/R group. Our data indicate a significant reduction in the activity of TUNEL, endothelial nitric oxide synthase and a rise in the expression of testosterone in testes tissue of I/R treated with QE therapy. We believe that further preclinical research into the utility of QE may indicate its usefulness as a potential treatment on testes injury after I/R in rats.

Proactive office encounter: a systematic approach to preventive and chronic care at every patient encounter

In 2007, Kaiser Permanente's (KP) Southern California Region designed and implemented a systematic in-reach program, the Proactive Office Encounter (POE), to address the growing needs of its three million patients for preventive care and management of chronic disease. The program sought staff from both primary and specialty care departments to proactively identify gaps in care and to assist physicians in closing those gaps. The POE engaged the entire health team in a proactive patient-care experience, creating standard work flows and using information technology to identify gaps in patient care. The goals were to improve consistency of preventive care and improve quality of care for chronic conditions and to improve reliability of staff support for physicians. The POE has been implemented in all outpatient settings in KP's Southern California Region's 13 medical centers and 148 medical office buildings. The program has contributed to significant improvements in key clinical quality metrics, including cancer screenings, blood pressure control, and tobacco cessation. It is now being extended into the inpatient setting and is being shared with other KP Regions.

Influence of a combination of formic and propionic acids added to wheat- and barley-based diets on the performance and gut histomorphology of broiler chickens

Day-old male chicks were used to test the effects of a combination of formic and propionic acids (CFP) added to wheat- and barley-based diets on the performance and gut histomorphology of broilers. The CFP, containing formic and propionic acids based on an inorganic phyllo-silicate carrier, was added to starter and grower broiler diets of standard (NRC, 1994) or lower nutrient density (LND) using different levels of wheat and barley. Body weight gain (BWG) and feed conversion ratio (FCR) of broiler chicks were significantly (P < 0.001) improved by CFP supplementation at 21 days of age regardless of nutrient density (ND). However, at 35 days of age CFP addition significantly (P < 0.001) increased BWG and FCR. Proventriculus weight was also significantly affected by the dietary treatments. Ileal viscosity was significantly (P < 0.05) affected by ND which was associated with wheat and barley contents, whereas feed viscosity was significantly (P < 0.05) affected by CFP supplementation. Villus height was significantly (P < 0.05) increased by the CFP supplementation. In the case of villus width, an interaction effect was observed: there was a significant (P < 0.05) decrease in the group fed the standard ND diet, but only a numerical decrease in the group fed the LND diet compared to control group. No significant effect of dietary treatment on the thickness of the lamina muscularis mucosae could be detected.

Vitamin E protects against acetone-induced oxidative stress in rat red blood cells

Acetone may induce oxidative stress leading to disturbance of the biochemical and physiological functions of red blood cells (RBCs) thereby affecting membrane integrity. Vitamin E (vit E) is believed to function as an antioxidant in vivo protecting membranes from lipid peroxidation. The aim of the present study was the evaluation of possible protective effects of vit E treatment against acetone-induced oxidative stress in rat RBCs. Thirty healthy male Wistar albino rats, weighing 200-230 g and averaging 12 weeks old were randomly allotted into one of three experimental groups: Control (A), acetone-treated (B) and acetone + vit E-treated groups (C), each containing ten animals. Group A received only drinking water. Acetone, 5% (v/v), was given with drinking water to B and C groups. In addition, C group received vit E dose of 200 mg/kg/day i.m. The experiment continued for 10 days. At the end of the 10th day, the blood samples were obtained for biochemical and morphological investigation. Acetone treatment resulted in RBC membrane destruction and hemolysis, increased thiobarbituric acid reactive substance (TBARS) levels in plasma and RBC, and decreased RBC vit E levels. Vit E treatment decreased elevated TBARS levels in plasma and RBC and also increased reduced RBC vit E levels, and prevented RBC membrane destruction and hemolysis. In conclusion, vit E treatment appears to be beneficial in preventing acetone-induced oxidative RBC damage, and therefore, it can improve RBC rheology.

Effect of thyroidectomy on the histology of rat sublingual gland

This study was carried out to investigate the effect of thyroidectomy on the histology of rat sublingual gland. Twenty-eight male Wistar albino rats, aged 4 weeks and weighing between 45-55 g, were used. The rats were divided into two experimental groups (control and thyroidectomy), each containing 14 animals. Total thyroidectomy of rats was performed under ether anesthesia in thyroidectomy group. The rats in the control group were sham operated without having the thyroidectomy. Seven rats randomly selected from both groups were fixed using the perfusion fixation technique 2 and 6 weeks after thyroidectomy, and their sublingual glands were harvested for histological investigation. No histological difference was observed between the two groups 2 weeks after thyroidectomy. However, 6 weeks after thyroidectomy considerable cytoplasmic vacuolization of the epithelial cells of the mucous tubules was seen in the thyroidectomy group compared to the controls. Enlargement of mucous tubules was also observed, and the lumina in most of the tubules was quite dilated. In the stroma surrounding the parenchymal tissues, increased lipid tissue mass was observed. In addition, increased connective tissue mass and mononuclear cell infiltrations were evident. Furthermore, the number of mast cells was significantly higher in the thyroidectomy group than in the controls 6 weeks after thyroidectomy. It was concluded that the thyroid gland and hormones might have an influence on the histology of the sublingual gland.

Effects of Nigella sativa L. and Urtica dioica L. on Lipid Peroxidation, Antioxidant Enzyme Systems and Some Liver Enzymes in CCl4-Treated Rats

This study was designed to investigate the effects Nigella sativa L. (NS) and Urtica dioica L. (UD) on lipid peroxidation, antioxidant enzyme systems and some liver enzymes in carbon tetrachloride (CCl4)-treated rats. A total of 60 healthy male Sprague-Dawley rats were utilized in this study. The rats were randomly allotted into one of four experimental groups: A (CCl4-only treated), B (CCl4 + UD treated), C (CCl4 + NS treated) and D (CCl4 + UD + NS treated), each containing 15 animals. All groups received CCl4 [0.8 ml/kg of body weight, subcutaneously, twice a week for 90 days starting day 1]. In addition, B, C and D groups also received daily intraperitoneal injections of 0.2 ml/kg NS or/and 2 ml/kg UD oils for 45 days starting day 46. Group A, on the other hand, received only 2 ml/kg normal saline solution for 45 days starting day 46. Blood samples for the biochemical analysis were taken by cardiac puncture from five randomly chosen rats in each treatment group at beginning, at 45th and at 90th day of the experiment. The CCl4 treatment for 45 days increased the lipid peroxidation and liver enzymes, and also decreased the antioxidant enzyme levels. NS or UD treatments (alone or combination) for 45 days starting day 46 decreased the elevated lipid peroxidation and liver enzyme levels and also increased the reduced antioxidant enzyme levels. Live weights of the rats decreased in group A, and increased in groups B, C and D. It is concluded that NS and UD decrease the lipid peroxidation and liver enzymes, and increase the antioxidant defence system activity in the CCl4-treated rats.

The effects of recombinant LHRH fusion proteins on testicular development and histology in ram lambs

Two recombinant luteinizing hormone releasing hormone (LHRH) fusion proteins were evaluated for their effectiveness in suppression of testicular development and histology by injecting together. Recombinant fusion proteins, ovalbumin-LHRH-7 and thioredoxin-LHRH-7, were generated using recombinant DNA technology and expressed in E. Coli. Eleven ram lambs ranked by age and body weight were randomly assigned to receive either ovalbumin and thioredoxin recombinant protein mixture (control group, n = 5) or ovalbumin-LHRH-7 and thioredoxin-LHRH-7 recombinant fusion protein mixture, anti-LHRH vaccine, (immunization group, n = 6). Animals in each group were weaned at 17 wk of age and were injected (primary immunization) with either mixture at 18 wk of age. Both groups received a booster immunization 8 wks later (26 wk of age). Scrotal circumference, scrotal length, testicular diameter and testicular length were measured in both groups every other week. All animals were slaughtered at 36 wk of age. Immediately after slaughter, a small testicular tissue was taken and processed for histological examination. In the ram lambs in immunization group scrotal circumference and testicular diameter increased steadily until second booster and then remained as a plateau until the end of the experiment. The differences in scrotal circumferences and testicular diameter were significant between the two groups during the last three weeks of the study (p < 0.05). There were no differences in testicular and scrotal length throughout the study (p > 0.05). Seminiferous tubules lost their regular shape and were decreased in diameter in immunization group. Although a few spermatozoa were seen in some tubules, in general, there were atrophy of the seminiferous tubules and loss of spermatogenesis, nevertheless, it seemed that animals in this group were potentially fertile.

Analysis of 16S rRNA and 51-kilodalton antigen gene and transmission in mice of Ehrlichia risticii in virgulate trematodes from Elimia livescens snails in Ohio

Operculate snails (the family Pleuroceridae: Elimia livescens) were collected between June and October 1998 from a river in central Ohio where repeated cases of Potomac horse fever (PHF) have occurred. Of collected snails, consistently 50 to 80% carried a combination of cercariae and sporocysts of digenetic virgulate trematodes. The trematodes obtained from each snail were pooled and tested for Ehrlichia risticii, the agent of PHF, by nested PCR using primers specific to the 16S rRNA gene. Out of a total of 209 trematode pools, 50 pools were found to be positive by PCR. The DNA sequence of the 16S rRNA gene identified in one trematode pool was identical to that of the type strain of E. risticii, and the sequence of the gene identified in another pool differed from that of the type strain by 1 nucleotide. Comparison of the deduced amino acid sequence of the partial 51-kDa antigen gene from various sources revealed that Maryland, Ohio (except Ohio 081), and Kentucky strains are in a cluster distinct from the sequences obtained from sources in California and Oregon. Ohio 081 was shown previously by antigenic composition analysis to be distinct from other groups. However, all sequences examined were not segregated according to their sources: horse blood or infected trematodes. E. risticii was found to be transmittable from trematodes to mice and was subsequently passaged from infected mice to additional mice, as determined by PCR analysis. Our findings suggest the evolution of E. risticii in the natural reservoir in separate geographic regions and persistent infection of trematode populations with E. risticii during summer and early fall. The study also suggests that the mouse can be used to isolate E. risticii from the infected trematode.

Antioxidant content of whole grain breakfast cereals, fruits and vegetables

BACKGROUND

Considerable scientific evidence suggests that whole grains, as commonly consumed in the United States and Europe, reduce risk for chronic disease including cancer and heart disease. Whole grains provide a wide range of nutrients and phytochemicals that may work synergistically to optimize human health. Fruits and vegetables provide protection against age related diseases. It is believed their high content of antioxidant compounds is key to such protection.

OBJECTIVE

This research compares the antioxidant activity of whole grain, ready-to-eat (RTE) breakfast cereals to that of fruits and vegetables.

METHOD

Antioxidant activity was determined by dispersing finely ground samples in a 50% aqueous methanol solution of the stable free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH). DPPH, which forms a deep purple solution, reacts with antioxidants and color loss at 515 nm correlates to antioxidant content, which is expressed as Trolox equivalents/100 grams (TE).

RESULTS

Whole grain breakfast cereals analyzed in this study contained from 2,200-3,500 TE. By comparison, fruits generally ranged from 600-1,700 TE, with a high of 2,200 TE for red plums. Berries averaged 3,700 TE and. vegetables averaged 450 TE with a high of 1,400 TE for red cabbage. A 41 gram average serving of RTE breakfast cereal provides 1,120 TE, while an average 85 gram serving of vegetables or fruits provides 380 and 1,020 TE, respectively.

CONCLUSION

Whole grain breakfast cereals, fruits and vegetables are all important dietary sources of antioxidants.

Free radicals, exercise and antioxidant supplementation

Although conflicting data exist, the preponderance of available information suggests that physical exercise promotes an increase in free-radical generation. However, few studies have actually measured exercise-induced free radicals directly, primarily because of a lack of sophisticated methodologies to measure this phenomenon. Instead, researchers have relied heavily on the measurement of lipid peroxidation as the principal indicator of exercise-induced free radicals. It should be noted that free radicals can also alter and inactivate enzyme complexes, damage DNA and RNA, and promote mutations and cancer, among other activities. However, there have been few reported studies dealing with exercise and oxidant stress which have measured these outcomes. It should also be noted that free-radical species are continuously produced in the human body, and that some have beneficial effects (Arouma, 1994), notably as a part of the body's natural immune system. It is not presently known if long-term ingestion of antioxidant compounds will affect these positive aspects of free-radical generation. The preponderance of available evidence suggests that antioxidant supplementation, particularly with the vitamins C and E, has favourable effects on markers of lipid peroxidation following exercise. Although the physiological implications of these effects remain to be elucidated, the prudent use of an antioxidant supplement can provide insurance against a suboptimal diet and/or the elevated demands of physical activity. Future research may uncover additional nutritional antioxidants that can benefit the physically-active individual. Numerous additional questions regarding the antioxidant needs for physical activity remain to be answered. Little is known about the needs of physically-active women, particularly those who habitually consume an energy-restricted diet, or the effects of monthly menstrual blood loss (coupled with exercise) on antioxidant requirements. The needs of the 'weekend warrior' (an individual who participates in strenuous activity sporadically) v. those of the habitual exerciser have not been addressed adequately. The needs of the ageing athlete are largely unknown; a study by Meydani et al. (1993) suggested that elderly, physically-active people can benefit from antioxidant supplementation more than their younger counterparts, but follow-up studies have not been reported to-date. Dietary issues also need to be addressed. How much supplementation is too much, and can chronically-elevated antioxidant intakes have an adverse impact on the positive effects of free radicals in living systems? Does a high-carbohydrate diet raise antioxidant needs, particularly of the fat-soluble vitamin E? Does a high polyunsaturated fat intake, or increased Fe intake affect needs? Obviously, there are a number of issues regarding the antioxidant needs of the physically-active individual that need to be elucidated. Future research utilizing newer, more sophisticated methodologies should provide answers to many of these questions.

Computerized hand diagnostic/rehabilitation system using a force feedback glove

This paper describes recent results of a unified computerized system for hand diagnosis and rehabilitation. Automatic diagnosis data collection and Virtual Reality rehabilitation exercises are the main characteristics of the system. The diagnosis subsystem includes a tactile sensing glove in addition to standard devices such as electronic dynamometer, pinchmeter and goniometer. Three standard rehabilitation exercises were simulated in a Virtual Reality environment, using the WorldToolKit graphics library. The first two exercises (ball squeezing and DigiKey) allow measurement of finger forces exerted during the rehabilitation routine. The third exercise (Peg board) involves the patient's visual-motor coordination. The rehabilitation subsystem uses a VPL DataGlove retrofitted with Rutgers Master (RM-I) and its interface. The exercises involve manipulation of objects with different stiffnesses and geometry. Grasping forces were modeled and fed back using the Rutgers Master worn on patient's hand. Data is gathered in real time from both diagnosis and rehabilitation subsystems. Finger specific forces recorded during rehabilitation exercises allow better diagnosis of the patient impairment. An ORACLE database is used to store and manipulate patients' records. Proof of concept trials were performed in a clinical environment. Some results of patient records analysis are presented in this paper. A new version of the system using an RM II haptic interface is presently under consideration.

Treatment of webbed neck in Turner's syndrome with tissue expansion

We describe a successful approach to the management of the webbed neck deformity in Turner's syndrome using skin expansion. This case report demonstrates the advantages of this method over previously described techniques.

The probability of finding suitable directed donors

A series of tables based on mathematical calculations is given as guidelines for the number of directed donors needed by members of various ethnic/racial groups to provide a desired number of units of blood with a selected probability of achieving this result. From these tables, certain conclusions can be drawn. Unrelated donors who do not know their blood type are an inefficient source of directed donors. Rh-negative patients are unlikely to obtain enough directed-donor units from either related or unrelated donors with confidence unless these donors known their blood type. In general, siblings, parents, and offspring are the most efficient directed donors from the standpoint of compatibility. Cousins, uncles, aunts, nieces, and nephews are not much more likely to be compatible than unrelated donors are. It is easier to obtain suitable directed-donor units among Hispanics than among whites, blacks, or Asians, due to their skewed blood group frequencies. In general, using O-negative directed donors for Rh-positive recipients does not significantly increase the likelihood of finding suitable donors.

Multiple malignant rectal carcinoid tumors with immunocytochemical demonstration of multiple hormonal substances

This case report deals with a patient who presented with 17 small carcinoid tumors of the rectum, the largest measuring less than 1 cm in diameter. After a review of the literature on this subject, this case is believed to be highly unusual in several respects: (1) despite their small size, these tumors resulted in multiple metastases to the regional lymph nodes; (2) both primary tumors and metastases were extensively and strongly argentaffin; and (3) most tumors and metastases contained, when investigated by immunocytochemistry, several biologically active substances such as serotonin, somatostatin, and glucagon-like immunoreactivity.

Spontaneous posterior fossa subdural hematoma as a complication of anticoagulation

We report a patient in whom a spontaneous subdural hematoma developed in the posterior fossa during anticoagulation therapy for mitral valve disease. This rare complication of anticoagulation has been reported in only three other patients.

Several mechanisms can account for defective E alpha gene expression in different mouse haplotypes

The murine Ia antigens, encoded by the I region of the major histocompatibility complex, are cell-surface glyco-proteins (consisting of alpha and beta polypeptides) thought to be involved in the control of immune responsiveness. Mice of haplotypes b, s, q, and f fail to express one of the Ia antigen complexes, the E complex, on the cell surface. We have attempted to determine at the molecular level how such a defect (or defects) might be generated. By using I-region E alpha and A alpha gene probes for analyses of RNA and DNA structure, it was possible to conclude that at least three mechanisms can operate. Mice of haplotypes b and s bear a deletion in the E alpha gene, f haplotype mice synthesize predominantly an E alpha mRNA of aberrant size, and mice of the q haplotype seem to have a defect in RNA processing or a problem with mRNA stability, or both.