The Relationship Between Verified Organ Donor Designation and Patient Demographic and Medical Characteristics.

Previous studies on the correlates of organ donation consent have focused on self-reported willingness to donate and on self-reported medical suitability to donate. However, these may be subject to social desirability bias and inaccurate assessments of medical suitability. The authors sought to overcome these limitations by directly verifying donor designation on driver's licenses and by abstracting comorbid conditions from electronic health records. Using a cross-sectional study design, they reviewed the health records of 2070 randomly selected primary care patients at a large urban safety-net medical system to obtain demographic and medical characteristics. They also examined driver's licenses that were scanned into electronic health records as part of the patient registration process for donor designation. Overall, 943 (46%) patients were designated as a donor on their driver's license. On multivariate analysis, donor designation was positively associated with age 35-54 years, female sex, nonblack race, speaking English or Spanish, being employed, having private insurance, having an income >$45 000, and having fewer comorbid conditions. These demographic and medical characteristics resulted in patient subgroups with donor designation rates ranging from 21% to 75%. In conclusion, patient characteristics are strongly related to verified donor designation. Further work should tailor organ donation efforts to specific subgroups.

Implementation of a joint protocol for the management of thyroid nodules with a cytological diagnosis of follicular lesion of undetermined significance: experience in one hospital.

BACKGROUND: Follicular lesion of undetermined significance (FLUS) was introduced for fine needle aspiration (FNA) cytology in which there is insufficient evidence to classify the lesion as follicular neoplasm/suspicious of follicular neoplasm or suspicious for malignancy. The recommended management was repeat FNA and correlation with clinical and radiological data. In 2009 we started a joint clinicopathological protocol to improve management of FLUS, recommending follow-up with repeat FNA at 6months. The aim of this study was to report on the audit of results of this protocol. METHODS: We reviewed the medical records of the patients with FLUS at a single hospital. Between 2007 and 2010 we found 135 cases with this diagnosis (3.6%). We only had long enough follow-up information for the 95 patients that were included in the present study. RESULTS: FLUS was diagnosed in 74 FNAs before protocol implementation (3.2%) and 61 FNAs after (4.2%), with follow-up of 46 and 49 patients, respectively. Before 2009, 38/46 (82.6%) patients had surgical excisions, compared with 32/49 (65.3%): a significant reduction of 17% in the number requiring surgery (P=0.05). We have also shown a reduction in the median time to surgery (11.9 versus 2.9 months). Despite the joint protocol, the FNA was only repeated in two patients. The histological diagnoses were similar in the two periods of time: 31.6% and 31.3% follicular adenomas; 13.1% and 3.1% (P=0.2) papillary carcinoma (follicular variant). CONCLUSIONS: Implementation of a joint protocol reduced the number of surgical operations in patients with FLUS but in most cases FNA was not repeated as recommended. Excision was justified in one-third of operated patients. Less than 15% of lesions were malignant, which is in accordance with previous reports in the literature.

Elective surgery in patients with congenital coagulopathies and inhibitors: experience of the National Haemophilia Centre of Venezuela.

Elective surgery in patients with congenital haemophilia with inhibitors carries a high risk of bleeding. However, inhibitor patients also have a high risk of haemarthroses and other orthopaedic complications, and surgery could improve their quality of life. Successful elective surgery has been reported in inhibitor patients under haemostatic cover with plasma-derived activated prothrombin complex concentrate (pd-aPCC) or recombinant activated factor VII (rFVIIa). Recombinant FVIIa has recently become available in Venezuela and, unlike pd-aPCC, has not been associated with an anamnestic response. The aim of this study was to assess our experience using rFVIIa as a first-line and sustained treatment in elective invasive surgical procedures at the National Haemophilia Centre in Venezuela. Surgical procedures were classified as major or minor, under haemostatic cover with rFVIIa. A total of 13 patients (12 with haemophilia A with high-responding inhibitors and one with von Willebrand's disease type 3) underwent a total of 19 surgical procedures under rFVIIa cover. Thirteen procedures were classified as major surgeries. Intraoperative haemostasis was achieved in the majority of patients. Only two patients required an additional dose of rFVIIa, at 30 min and 75 min, respectively, with good results. Postoperative haemostasis was considered effective in 16 of 18 (89%) of the procedures in haemophilia A patients. Treatment was considered to be ineffective in two patients because of excessive postoperative bleeding. Data from the study provide no safety concerns, and demonstrate that rFVIIa provides effective haemostatic cover in elective surgery in patients with inhibitors; research is ongoing to determine the optimal dose for such procedures.

CIGB-258, a peptide derived from human heat-shock protein 60, decreases hyperinflammation in COVID-19 patients.

Hyperinflammation distinguishes COVID-19 patients who develop a slight disease or none, from those progressing to severe and critical conditions. CIGB-258 is a therapeutic option for the latter group of patients. This drug is an altered peptide ligand (APL) derived from the cellular stress protein 60 (HSP60). In preclinical models, this peptide developed anti-inflammatory effects and increased regulatory T cell (Treg) activity. Results from a phase I clinical trial with rheumatoid arthritis (RA) patients indicated that CIGB-258 was safe and reduced inflammation. The aim of this study was to examine specific biomarkers associated with hyperinflammation, some cytokines linked to the cytokine storm granzyme B and perforin in a cohort of COVID-19 patients treated with this peptide. All critically ill patients were under invasive mechanical ventilation and received the intravenous administration of 1 or 2 mg of CIGB-258 every 12 h. Seriously ill patients were treated with oxygen therapy receiving 1 mg of CIGB-258 every 12 h and all patients recovered from their severe condition. Biomarker levels associated with hyperinflammation, such as interleukin (IL)-6, IL-10, tumor necrosis factor (TNF-α), granzyme B, and perforin, significantly decreased during treatment. Furthermore, we studied the ability of CIGB-258 to induce Tregs in COVID-19 patients and found that Tregs were induced in all patients studied. Altogether, these results support the therapeutic potential of CIGB-258 for diseases associated with hyperinflammation. Clinical trial registry: RPCEC00000313.

Chemical synoviorthesis with oxytetracycline clorhydrate (Emicine) in recurrent haemarthrosis.

This is a non-controlled experimental prospective clinical study that evaluates the satisfactory results in the chemical synovectomy (synoviorthesis) with oxytetracycline clorhydrate (Emicine, Lab. Pfizer Ltda, Guarulhos, Sao Paulo, Brazil) in recurrence haemarthrosis in different joints, demonstrating that it is an effective method in the treatment of these recurrent haemarthrosis in haemophilia. 84 patients of whom 77 concluded the full course of treatment. 82 joints were injected. The dosage injected was 5 cm(3) of the drug (25 mg) in 5 cm(3) of anaesthesia for the knee, 2 cm(3) with 1 cm(3) of anaesthesia for the elbow and 1 cm(3) plus 1 cm(3) of anaesthesia for the ankle. These injections were administered once weekly with a reinforcement in 1 month. In case of failure the same can be administered repeatedly. Subjective parameters included pain, range of movement and use of the joint involved. Pain decreased from a mean of 6.5 to 0.9 (Likert scale). Range of movement increased from 5.9 to 9 and joint use increased from 5.9 to 9.2. Objective parameters included joint diameter and range of movement. Range of movement for flexion and extension improved from 72.2 and 149.2 to 73.7 and 167, respectively, for the knees. From 57.3 and 160 to 66.6 and 170, respectively, for the shoulder. And, from 22.7 and 10.8 to 34 and 18.6, respectively, for the ankle. This procedure has multiple advantages such as immediate therapeutic effect, short period of treatment, easy technique, much less AHF coverage (30% above coagulation level), less costly than radiocolloid treatment, which make it a perfect alternative treatment for developing countries.

Genomic organization of the gene and a related pseudogene for a human folate binding protein.

An unprocessed pseudogene which is 90% homologous with the cDNA encoding a folate binding protein in KB cells has been cloned from a human genomic library. This pseudogene contains TGA stop codons, base deletions and substitutions and lacks a 5' region. The size of the exons and the intron-exon sites are almost identical to the organization of the gene encoding this protein which has now been characterized from genomic DNA using the polymerase chain reaction with selected primers to the cDNA.

Clusters of drug involvement in Panama: results from Panama's 1996 National Youth Survey.

This report is based on the first epidemiological investigation of clustering of tobacco, alcohol, inhalant, and other drug involvement within individual schools using data from Panama's 1996 National Youth Survey on Alcohol and Drug Use. Clustering was estimated with the Alternating Logistic Regression method. Adjusted estimates of pair-wise cross-product ratios (PWCPR), a measure of clustering, show modest clustering (i.e. PWCPR>1.0) at the school level for tobacco smoking (PWCPR=1.41; 95% confidence interval, CI=1.22-1.64), alcohol consumption (PWCPR=1.33; 95% CI=1.22-1.45), use of inhalants, (PWCPR=1.35; 95% CI=1.07-1.69), and other drug use (PWCPR=1.38; 95% CI=1.14-1.68). These findings provide preliminary evidence that the odds of drug use among school-attending youths increase when another youth in the same school uses drugs, and suggest a new line of research on within-school diffusion that should include the identification of school-level factors that contribute to student drug use.

Variations of lignocellulosic activities in dual cultures of Pleurotus ostreatus and Trichoderma longibrachiatum on unsterilized wheat straw.

Trichoderma spp., soil filamentous fungi, are antagonists that can cause great losses in mushroom production. We have investigated the influence of T. longibrachiatum on the production of lignocellulolytic enzymes by Pleurotus ostreatus during its vegetative growth on a straw-based cultivation substrate that either had been sterilized, pasteurized or not heat treated. The variations in the lignocellulolytic activities and the electrophoretic patterns in single and dual cultures were used as a tool for perturbation assessment. The various heat treatments of the wheat straw before inoculation affected both the bacterial populations and the abilities of T. longibrachiatum and P. ostreatus to colonize the substrate and to produce extracellar lignocellulolytic enzymes. Interactions between T. longibrachiatum and the microflora of the substrate led to a great decrease of hydrolytic activities due to reduced colonization of the substrate. Pleurotus ostreatus also was affected but it was less sensitive than T. longibrachiatum. As a consequence, in dual cultures with P. ostreatus, the competitive ability of T. longibrachiatum was reduced by bacteria in the substrates. The presence of total microflora or thermotolerant microflora increased the production of phenoloxidase activities by P. ostreatus, despite reduced colonization of the substrate. This contributed to the improvement of the competitive ability of P. ostreatus in the pasteurized substrate. Furthermore, a direct effect of bacteria on T. longibrachiatum also was observed. In sterilized substrate, both laccase and Mn-peroxydase activities were increased dramatically in dual cultures due to a faster production of a laccase isoform, which was stimulated by T. longibrachiatum.

Multiple dose toxicity study of the humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 intravenously administered to Cercopithecus aethiops sabaeus monkeys.

The h-R3 is a humanized growth factor receptor monoclonal antibody (mAb) in development for the treatment of head and neck tumours in which malignant cells overexpress the Epidermal Growth Factor receptor. The present study was designed to evaluate the toxicity of repeated intravenous doses of the h-R3 mAb in a relevant species demonstrated by the avidin-biotin-peroxidase immunohistochemical (IHC) technique in skin biopsy samples from three Cercopithecus aethiops sabaeus monkeys (green monkeys). Additionally, 18 green monkeys were daily intravenously treated during 14 consecutive days. Monkeys were distributed into three experimental groups with three animals of each sex in each group. Group I received saline solution and served as control group; group II received 2.85 mg/kg of h-R3 mAb; and group III received 11.4 mg/kg of the h-R3 mAb. During the study there were no deaths, neither pathological clinical signs, or variations in the corporal weight curve. The electroneurophysiological and sanguine chemistry results did not evidence alterations related to the assay substance. Areas of haematomas, haemorrhages and inflammation, probably related with the administration procedure, were observed at the administration zones of all animals; this fact could also explain the increase in the neutrophil count of all animals at the end of the study. The electrocardiography study showed that in the 14 days of the study one female monkey, from the higher dose group, shifted its cardiac axis from +60 degrees to + 120 degrees; this finding could be interpreted as a right ventricular elongation due to the relative high daily administered volume. It is concluded that doses up to 11.4 mg/kg of h-R3, intravenously administered during 14 consecutive days to Cercopithecus aethiops sabaeus monkeys do not produce considerable toxic effects in the studied system.

Manifestaciones bucales de los pacientes sometidos a raioterapia en cabeza y cuello: pautas de atención odontológica / Oral manifestations of patients undergoing radiotherapy in head and neck: dental care guidelines

El cáncer de cabeza y cuello representa uno de los principales problemas oncológicos, tanto por su elevada mortalidad, como por las secuelas de su tratamiento. La radioterapia constituye una alternativa importante en el tratamiento de muchas de las lesiones que se presentan en esta región anatómica, ya sea que se utilice como único recurso o en combinación con otras modalidades terapéuticas; sin embargo, los efectos de la radiación no solo afectan a las células malignas, sino que ésta es también absorbida por los tejidos bucales y peribucales sanos, particularmente por aquellos con mayor capacidad de renovación celular. Presentándose lesiones bucales durante y después de la radiación, específicamente mucositis, xerostomía (suelen aparecer a los pocos días del inicio del tratamiento, con dosis superiores a 1500 cGy), disgeusia, ageusia, disfagia, infecciones, caries, gingivitis, periodontitis y osteoradionecrosis (dosis mayores a 5000 cGy). Estas lesiones disminuyen la calidad de vida de estos pacientes y en ocasiones pueden interferir en la continuidad de la radioterapia, poniendo en riesgo su vida. Por lo tanto es importante incluir a estos pacientes en protocolos de atención odontológica preventiva, donde se realice examen bucal individualizado que indique la necesidad de tratamiento y posteriores revisiones periódicas que refuercen las medidas preventivas adoptadas, siempre en conjunto con el oncólogo tratante. El objetivo de esta investigación es realizar una revisión de la literatura determinando las manifestaciones bucales más frecuentes que presentan este tipo de pacientes y de este modo establecer un protocolo de atención odontológica.

Head and neck cancer represents one of the major oncological problems, both for its high mortality, as for the sequelae of their treatment. Radiotherapy constitutes an important alternative in the treatment of many of the injuries that occur in this anatomic region, either is used as the only resource or in combination with other therapeutic modalities; However, the effects of the radiation not only affect malignant cells, but it is also absorbed by oral and perioral healthy tissues, particularly by those with greater capacity for cellular renewal. Presenting oral lesions during and after radiation, specifically mucositis, xerostomia (typically appear a few days after the start of treatment, with doses greater than 1500 cGy), dysgeusia, ageusia, dysphagia, infections, tooth decay, gingivitis, periodontitis and osteoradionecrosis (greater than 5000 cGy dose). These lesions decrease the quality of life of these patients and sometimes can interfere with the continuity of radiotherapy putting his life at risk. It is therefore important to include these patients in preventive dental care protocols, to make individualized oral exam that indicates the need for treatment and subsequent periodic reviews to strengthen preventive measures, always in conjunction with the treating oncologist. The objective of this research is to conduct a review of the literature by determining the most frequent oral manifestations that presents this kind of patient, and thereby establish a dental care protocol.

Manejo odontológico en pacientes con terapia antiagregante plaquetaria / Dental treatment in patients with anti-platelet (anti-aggregating) therapy

La terapia antiagregante plaquetaria se considera hoy en día esencial en aquellos pacientes que poseen riesgo de presentar accidentes cerebrovasculares, formación de trombos y en la colocación de prótesis valvular o stents coronarios, ésta permite la profilaxis ante cualquier evento tromboembólico que se pueda presentar; indiscutiblemente uno de sus efectos secundarios es la tendencia al sangrado, por lo tanto esto hace relevante conocer las consecuencias en la práctica odontológica habitual para evitar accidentes y prevenir hemorragias postoperatorias. El objetivo de este trabajo es presentar los fármacos más usados dentro de esta terapia, su mecanismo de acción y la elaboración de un protocolo definido para la atención adecuada de este tipo de pacientes.

Anti-platelet therapy is nowadays considered essential for those patients who are at risk to sustain strokes (cerebro-vascular events), thrombus formation, as well as in cases of coronary valvular prostheses (stents). This therapy allows prophylaxis before any possible thrombo-embolic event. Tendency to bleeding is doubtlessly one of its secondary effects. It therefore becomes relevant to be knowledgeable with consequences that might be encountered in common dental practice so as to avoid accidents and prevent post-operative bleeding (hemorrhage). The aim of the present study was to present drugs most used in this therapy, discuss their mechanism of action and to develop a defined protocol for the proper care of these patients.

Manejo odontológico del paciente con enfermedad pulmonar obstructiva crónica y asma bronquial / Dental management of chronic obstructive pulmonary disease and patients with bronchial asthma

La enfermedad pulmonar obstructiva crónica (EPOC) abarca todas aquellas enfermedades respiratorias que cursan con obstrucción no totalmente reversible del flujo aéreo. La limitación es progresiva y está asociada a una respuesta inflamatoria. La denominación de fenotipo se utiliza para referirse a formas clínicas de los pacientes con EPOC, describiéndose: 1. No agudizador, con enfisema o bronquitis crónica, 2. Mixto EPOC-asma, 3. Agudizador con enfisema y 4. Agudizador con bronquitis crónica. La superposición de los síntomas hace difícil el diagnóstico, y para la mayoría de los pacientes, el tabaquismo es el factor etiológico más importante. La obstrucción de las vías bronquiales en el asma es esencialmente reversible, pero muchos años de exacerbaciones recurrentes puede producir una obstrucción permanente debido al remodelado de las vías respiratorias. La inflamación crónica esta asociada a un aumento en la hiperreactividad de la vía aérea que conduce a episodios recurrentes de sibilancias, disnea, opresión torácica y tos, particularmente en la noche o temprano en la mañana. Estos episodios se asocian generalmente a la obstrucción generalizada pero variable en el flujo aéreo pulmonar que es frecuentemente reversible espontáneamente o con tratamiento. El cuidado rutinario de la salud bucal puede ser proporcionado en el consultorio del odontólogo, siempre y cuando éste tenga conocimientos sólidos sobre las enfermedades pulmonares y preste especial atención tanto a la evaluación de riesgos como a las precauciones que deben ser necesarias para prevenir exacerbaciones agudas dentro de la consulta. El objetivo de este trabajo es realizar una revisión bibliográfica de la EPOC y el asma bronquial, estableciendo su etiología, características clínicas, tratamiento médico y manejo odontológico del paciente que sufre estas enfermedades

Chronic obstructive pulmonary disease (COPD) includes all those respiratory diseases that curse with not fully reversible obstruction of the airflow. The limitation is progressive and its associated with a inflammatory response. The denomination of phenotype is used to refer to clinical forms of COPD patients, describing: 1. No peaking, emphysema or chronic bronchitis, 2. Mixed COPD-asthma, 3. Peaking with emphysema and 4. Peaking with chronic bronchitis. The superposition of the symptoms makes the diagnosis difficult, and for most patients, smoking is the most important etiologic factor. The bronchial airway obstruction in asthma is essentially reversible, but many years of recurrent exacerbations can produce a permanent obstruction due to airway remodelling. Chronic inflammation is associated with increased airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early in the morning. These episodes are usually associated with widespread but variable obstruction in lung airflow that is often reversible either spontaneously or with treatment. Routine care of oral health can be provided in the dentist's office, as long as it has a solid understanding of lung diseases and pay special attention to both risk assessment as to the precautions that must be necessary to prevent acute exacerbations in the consult. The objective of this paper is to make a literature review of COPD and bronchial asthma, establishing its etiology, clinical characteristics, medical treatment and dental management of the patient who is suffering these diseases

Manejo odontológico del paciente con enfermedad renal crónica terminal: revisión bibliográfica / Dental management of patients with chronic renal disease: a review

La enfermedad renal avanzada es la incapacidad de los riñones para excretar los productos de desecho del organismo, concentrar la orina y conservar los electrolitos, que trae como consecuencia manifestaciones sistémicas que provocan patologías bucales entre otras entidades. El objetivo de esta investigación es realizar una revisión bibliográfica destacando las manifestaciones bucales más importantes, el manejo y cuidados que debe tener el odontólogo al momento de atender a un paciente que presente este trastorno

Advanced renal disease is the inability of the kidneys to excrete waste products from the body, concentrate urine and conserve electrolytes, which results in systemic manifestations that cause oral pathologies among others. The objective of this research is to review literature highlighting the most important oral manifestations, management and care that should the dentist have when treating a patient with this disorder

Demographic, health services and socio-economic factors associated with pulmonary tuberculosis mortality in Los Altos Region of Chiapas, Mexico.

BACKGROUND: Chiapas is one of the Mexican states having the highest rates of Pulmonary Tuberculosis (PTB), due to the numerous factors impeding its management and control (poverty, poor housing and nutrition, shortage of health resources, among others). OBJECTIVES: To analyse the PTB mortality of a cohort of patients in Los Altos Region of Chiapas, who had been diagnosed with PTB from January 1, 1998 to December 31, 2002; and, to identify demographic, socioeconomic and health services utilization factors, associated with death from PTB. METHODS: Analysis of a cohort of patients aged over 14 years diagnosed with PTB in the above mentioned period (n = 431) in Los Altos region of Chiapas. The records of the Tuberculosis Programme were reviewed, and patients were located through a search attempting to locate them in their homes. Those found alive were interviewed and asked to provide sputum samples. In the case of deceased patients, a verbal autopsy was obtained from a member of their family. RESULTS: The records of the PTB Programme in the area were incomplete and erroneous in many cases. The results of the home follow-up visits were: 208 (48%) patients located alive, five of whom were still PTB positive (three with multi-drug resistance); 145 (34%) could not be located and 78 (18%) had already died. Apparently, in at least 40 cases, the deaths were associated with PTB. Of these forty, 33 (83%) died without having received any medical care. The factors associated with dying from PTB were: 45 and over years of age (OR = 1.3; 95% CI = 0.98-1.3), 0-3 schooling years (OR = 3.3; 95% CI = 1.1-9.6), engaged in agriculture (OR = 2.2; 95% CI = 1.1-4.4), not living in main villages of their municipality (OR = 1.2; 95% CI = 1.0-1.3), living in a rural community (OR = 2.7; 95% CI = 1.1-6.8), not having been treated in DOTS (OR = 1.2; 95% CI = 1.0-1.3) and having defaulted from treatment (OR = 11.5; 95% CI = 5.3-24.8). CONCLUSIONS: The high rate of mortality due to PTB observed constitutes a serious public health problem deserving attention. There is an urgent need to evaluate and restructure the Tuberculosis Programme in the studied area.

Tequila production.

Tequila is obtained from the distillation of fermented juice of agave plant, Agave tequilana, to which up to 49% (w/v) of an adjunct sugar, mainly from cane or corn, could be added. Agave plants require from 8 to 12 years to mature and during all this time cleaning, pest control, and slacken of land are required to produce an initial raw material with the appropriate chemical composition for tequila production. Production process comprises four steps: cooking to hydrolyze inulin into fructose, milling to extract the sugars, fermentation with a strain of Saccharomyces cerevisiae to convert the sugars into ethanol and organoleptic compounds, and, finally, a two-step distillation process. Maturation, if needed, is carried out in white oak barrels to obtain rested or aged tequila in 2 or 12 months, respectively.

[Theoretical contributions to an interpretation of urbanization in Latin America]. / Aportes teoricos para una interpretacion de la urbanizacion en America Latina.

PIP: This work analyzes two essays by Anibal Quijano and Paul Singer on urbanization, dependency, social change, and marginality in Latin America and suggests some elements for a theoretical interpretation of urbanization in Latin America. The work is divided into three major sections, each of which examines a specific question. The first section explores whether urban phenomena in Latin America are or are not attributable to a situation of dependency or whether they are derived from capitalism. The second section discusses whether changes in urban society and in the urban profile are also derived from dependency or from capitalism. The third section discusses factors leading to urban concentration and suggests some policies that have not yet been developed for urbanization and development, to be analyzed in later articles. Throughout this work, the theoretical approaches of Quijano and Singer are contrasted, and additional commentary on the author's own views is supplied. It is suggested that a policy to add subsidiary or complementary activities to zones that are currently exclusively agricultural would help to retain some part of rural population growth and would have other desirable effects.^ieng

[Current participation of the nurse in the activities covered in the "expanded role of nursing"]. / Participación actual de la enfermera en las actividades comprendidas en el "papel ampliado de enfermería".

The article reports on a survey conducted in Colombia to evaluate the part played by the nurse in the functions covered by what has come to be called "the expanded role of nursing." According to the survey, there are 2,213 practicing nurses, who are clustered in the principal cities of the country. Those who participated in the study are young nurses holding staff positions in such institutions as university and social security hospitals. Their training is mostly at the university level, and they have had five years or less of experience. The article notes that, to perform the duties of the expanded role, the nurse must participate in accordance with her training, interest and motivation. The participation may be conditioned by factors in the nurse herself (prior knowledge, former training, previous participation, and responsibility) and by factors in the working environment (the person who instructed her on her role, the post she holds, her length of service/length of her work day, permission received from the institution to exercise her function, and the medical and nursing agreement). Parodoxically, the nurse is being made a participant in new functions at hospitals where there are medical resources and not in regions and places where those resources are scarce or nonexistent. The expanded role of nursing opens to the nurse a range of activities that enable her to provide quality care to the patient and to his or her family and community, to extend the coverage of health services, and offer treatment effectively.

Characterization of the gene encoding a folate-binding protein expressed in human placenta. Identification of promoter activity in a G-rich SP1 site linked with the tandemly repeated GGAAG motif for the ets encoded GA-binding protein.

The gene encoding a folate-binding protein (FBP) expressed in human placenta has been cloned by screening a genomic library with the KB cell FBP complementary DNA. This gene, contained in a 10-kilobase EcoRI fragment of this genomic clone, has 5 exons, 4 introns, the AATAA polyadenylation signal in the 3'-untranslated region, and a 5'-flanking sequence which contains the promoter elements, all of which span approximately 5 kilobases. Transcription initiation was mapped by RNase protection to a site 73 base pairs downstream from a G-rich sequence linked to a tandemly repeated GGAAG sequence which is a motif that the ets oncogene encoded GA-binding protein (GABP) transcription factor binds. Gel-shift and supershift mobility assays indicate that the G-rich sequence and the ets motif bind specifically to SP1 and GABP, respectively. These cis regulatory elements in tandem drive expression of the chloramphenicol acetyltransferase reporter gene in transiently transfected mouse 3T3 cells. The location of these elements upstream of transcription initiation in this gene, which lacks an appropriately located TATA box promoter, indicates that this SP1-GA binding region most probably regulates expression of this placental FBP. The gene encoding this placental FBP has been assigned the FBP/PL-1 gene because it is a member of a multigene family that includes a gene encoding a FBP expressed in both KB cells and placenta and its unprocessed pseudogene.

The varied arrangement of the alpha globin genes in alpha thalassemia and Hb H disease in American blacks.

Both Eco RI and Eco RI x Bam HI restriction endonuclease digests of DNA from black Americans with alpha thalassemia yielded an alpha-specific fragment 4 kb shorter than in normals. In Hb H disease, only the shorter fragment was noted, while in "silent carriers" (alpha-thal 2 trait), both the normal and shorter fragments were detected. One subject with single gene deletions on both homologous chromosomes (alpha-thal 1 phe. A non-deletional form of alpha thalassemia also was discovered.

Rapid destruction of newly synthesized excess beta-globin chains in HbH disease.

A subject with HbG Philadelphia-HbH disease exhibited an unusually high alpha/beta synthesis ratio; when peripheral blood was tested in vitro on several occasions, ratios of 0.63 - 0.89 were obtained after incubations of 30-120 min. HbH amounted to 5%-8% of the circulating hemoglobin. Rapid destruction of excess newly synthesized beta-globin was demonstrated in kinetic and pulse-chase experiments. After 2 min of incubation, the alpha/beta synthesis ratio was 0.48; this figure rose to 0.89 by 30 min. The zero time alpha/beta ratio was estimated to be 0.35. The degradation of beta-chains was calculated to proceed at approximately one-half the rate of beta-globin synthesis; this result was confirmed by the loss of 50% of the specific activity in beta-chains during 9 min of a chase experiment following a 10-min radioactive pulse. The results suggest that efficient proteolysis may be responsible, in some blacks, for the low levels of excess beta-globin chains in HbH disease as well as for the mildness of the clinical disorder.