A web-based application for initial screening of living kidney donors: development, implementation and evaluation.

Most centers utilize phone or written surveys to screen candidates who self-refer to be living kidney donors. To increase efficiency and reduce resource utilization, we developed a web-based application to screen kidney donor candidates. The aim of this study was to evaluate the use of this web-based application. Method and time of referral were tabulated and descriptive statistics summarized demographic characteristics. Time series analyses evaluated use over time. Between January 1, 2011 and March 31, 2012, 1200 candidates self-referred to be living kidney donors at our center. Eight hundred one candidates (67%) completed the web-based survey and 399 (33%) completed a phone survey. Thirty-nine percent of donors accessed the application on nights and weekends. Postimplementation of the web-based application, there was a statistically significant increase (p < 0.001) in the number of self-referrals via the web-based application as opposed to telephone contact. Also, there was a significant increase (p = 0.025) in the total number of self-referrals post-implementation from 61 to 116 per month. An interactive web-based application is an effective strategy for the initial screening of donor candidates. The web-based application increased the ability to interface with donors, process them efficiently and ultimately increased donor self-referral at our center.

The human chromosome. Electron microscopic observations on chromatin fiber organization.

Human lymphocytes were grown in short-term tissue culture and were arrested in metaphase with Colcemid. Their chromosomes were prepared by the Langmuir trough-critical point drying technique and were examined under the electron microscope. In addition, some chromosomes were digested with trypsin, Pronase, or DNase. The chromosomes consist entirely of tightly packed, 240 +/- 50-A chromatin fibers. Trypsin and Pronase treatments induce relaxation of fiber packing and reveal certain underlying fiber arrangements. Furthermore, trypsin treatment demonstrates that the chromatin fiber has a 25-50 A trypsin-resistant core surrounded by a trypsin-sensitive sheath. DNase digestion suggests that this core contains DNA.

Reduction of permeability in granite at elevated temperatures.

The addition of hydrothermal fluids to heated, intact granite leads to permeability reductions in the temperature range of 300 degrees to 500 degrees C, with the rate of change generally increasing with increasing temperature. The addition of gouge enhances the rate of permeability reduction because of the greater reactivity of the fine material. Flow rate is initially high in a throughgoing fracture but eventually drops to the level of intact granite. These results support the fault-valve model for the development of mesothermal ore deposits, in which seals are formed at the base of the seismogenic zone of high-angle thrust faults. The lower temperature results yield varying estimates of mineral-sealing rates at shallower depths in fault zones, although they generally support the hypothesis that such seals develop in less time than the recurrence interval for moderate to large earthquakes on the San Andreas fault.

Number and size of human X chromosome fragments transferred to mouse cells by chromosome-mediated gene transfer.

Labeled probes of unique-sequence human X chromosomal deoxyribonucleic acid, prepared by two different procedures, were used to measure the amount of human X chromosomal deoxyribonucleic acid in 12 mouse cell lines expressing human hypoxanthine phosphoribosyltransferase after chromosome-mediated gene transfer. The amount of X chromosomal deoxyribonucleic acid detected by this procedure ranged from undetectable levels in the three stable transformants and some unstable transformants examined to about 20% of the human X chromosome in two unstable transformants. Reassociation kinetics of the X chromosomal probe with deoxyribonucleic acid from the two unstable transformants containing 15 to 20% of the human X chromosome indicate that a single copy of these sequences is present. In one of these lines, the X chromosomal sequences exist as multiple fragments which were not concordantly segregated when the cells were selected for loss of hprt.

A deletion in chromosome 1 in cells of a transplantable granulocytic leukemia (GL-13) in guinea pigs.

Chromosomes were examined in leukocytes from a unique transplantable granulocyte leukemia (GL-13) of strain 13 guinea pigs. The GL-13 leukemia has many similarities to human chronic myelogenous leukemia (CML). It has remained predominantly diploid after 90 transplant generations and is characterized cytogenetically by a terminal deletion of the long arm of one of the #1 pair of chromosomes. No other chromosomal abnormality was observed. These findings lend further support to the conclusion that the GL-13 leukemia may be a useful model for the study of human CML.

Population-based study of tamoxifen therapy and subsequent ovarian, endometrial, and breast cancers.

BACKGROUND: The success of tamoxifen in reducing the occurrence of contralateral breast cancer among breast cancer patients in clinical trials has prompted the study of its use in the primary prevention of breast cancer. Long-term risks associated with tamoxifen therapy, however, are still being evaluated, particularly with respect to subsequent cancer occurrence at sites other than the breast. PURPOSE: This population-based, nested case-control study investigated the risks of second primary cancers of the ovary, endometrium, and contralateral breast among women receiving tamoxifen for breast cancer in conventional medical practice. METHODS: A cohort of women diagnosed with breast cancer during 1978 through 1990 was identified from a population-based cancer registry. Case subjects included all women in the cohort who subsequently developed second primary ovarian (n = 39), endometrial (n = 42), or contralateral breast (n = 234) cancer prior to 1992. Control subjects were a random sample of the cohort who did not develop a second primary malignancy; they were matched to the case subjects on age, disease stage, and year of initial breast cancer diagnosis (approximately two control subjects per case subject). Information on tamoxifen use as well as on potential risk factors for the second primary cancers was obtained through medical record abstractions and physician questionnaires. RESULTS: The percentage of women who had received tamoxifen was 18% and 20%, respectively, among ovarian cancer case subjects and control subjects; 26% and 31%, respectively, among endometrial cancer case subjects and control subjects; and 10% and 18%, respectively, among contralateral breast cancer case subjects and control subjects. The mean duration of tamoxifen use was less than 2 years for all groups. The relative risks for ovarian and endometrial cancers in women who took tamoxifen were relatively low but were consistent with no association (for ovarian cancer, matched odds ratio [mOR] = 0.6 and 95% confidence interval [CI] = 0.2-1.8; for endometrial cancer, mOR = 0.6 and 95% CI = 0.2-1.9). Tamoxifen therapy was associated with a decreased risk of contralateral breast cancer (mOR = 0.5; 95% CI = 0.3-0.9), especially if the drug had been taken for more than 1 year (mOR = 0.4; 95% CI = 0.2-0.9) or if the women were postmenopausal at initial breast cancer diagnosis (mOR = 0.4; 95% CI = 0.2-0.8). CONCLUSIONS AND IMPLICATIONS: These data suggest that short durations of tamoxifen therapy are not associated with an increased risk of endometrial or ovarian cancer but are associated with a reduction in contralateral breast cancer risk. It would not be appropriate, however, to generalize these results to women who receive tamoxifen for longer periods.

Effect of L-10B-p-boronophenylalanine-fructose and the boron neutron capture reaction on mouse brain dopaminergic neurons.

Radiation damage to the dopamine tracts caused by enriched L-10B-p-boronophenylalanine (L-10BPA)-fructose and the boron neutron capture reaction was investigated using the mouse model. Following various treatments with L-10BPA and neutron irradiation of the head, the brain was perfusion fixed and removed; 50-microns frozen sections were cut. Dopaminergic neurons were visualized using immunohistochemistry for tyrosine hydroxylase. The administration of L-10BPA had no permanent effect on dopaminergic tracts. Neutron capture therapy with L-10BPA caused a reduction in tyrosine hydroxylase immunohistochemical activity within 4 h of irradiation, but by 48 h, this reduction reversed. No damage was observed at 120 h postirradiation.

Cost perspectives of laparoscopic and open appendectomy.

BACKGROUND: Despite multiple studies comparing laparoscopic and open appendectomies, the clinically and economically superior procedure still is in question. A cost analysis was performed using both institutional and societal perspectives. METHODS: A decision analytic model was developed to evaluate laparoscopic and open appendectomies. The institutional perspective addressed direct health care costs, whereas the societal perspective addressed direct and indirect health care costs. Baseline values and ranges were taken from randomized controlled trials, meta-analyses, and Medicare databases. RESULTS: From the institutional perspective, open appendectomy is the least expensive strategy, with an expected cost of $5,171, as compared with $6,118 for laparoscopic appendectomy. The laparoscopic approach is less expensive if open appendectomy wound infection rates exceed 23%. From the societal perspective, laparoscopic appendectomy is the least expensive strategy, with an expected cost of $10,400, as compared with $12,055 for open appendectomy. CONCLUSIONS: The decision analysis demonstrated an economic advantage to the hospital of open appendectomy. In contrast, laparoscopic appendectomy represents a better economic choice for the patient.

Sex hormone-binding globulin changes during the menstrual cycle.

Although sex hormone-binding globulin (SHBG) production is stimulated by estrogen, no change in SHBG has been demonstrated during the menstrual cycle. To further study possible cyclic changes in serum SHBG, 12 women with a normal menstrual and fertility history had daily SHBG measurements during a menstrual cycle. SHBG was measured by dextran-coated charcoal saturation analysis and RIA. Serum LH was measured by mouse Leydig cell bioassay and RIA, and FSH, estradiol (E2), and progesterone were determined by RIA. In 10 women, a significant increase in mean SHBG by both methods occurred during the luteal phase of the cycle, immediately after the preovulatory increase in serum E2 (P less than 0.001). Two women had no SHBG increase; although each had a significant rise in serum E2 before the LH surge, luteal phase E2 levels were similar to those in the early follicular phase. In one of these women, a rise in SHBG was demonstrated by RIA. This study demonstrates that SHBG changes during the menstrual cycle in association with E2 changes, and it appears to be a marker for the endogenous estrogen changes that occur in normal ovulating women.

The pharmacokinetics of p-Boronophenylalanine.fructose in human patients with glioma and metastatic melanoma.

PURPOSE: To study the biodistribution of p-Boronophenylalanine in patients undergoing surgery for intracranial tumors or metastatic melanoma. METHODS AND MATERIALS: D,L-p-Boronophenylalanine was administered as boronophenylalanine.fructose in an intravenous bolus 1-4 h before the operation. Blood samples were collected for 24 h from the time of administration of the compound, and the blood boron elimination parameters were determined. For the glioma patients tumor samples were obtained and skin, dura, periosteum, and surrounding brain samples were collected whenever possible. For the metastatic melanoma patients tumor, fat, skin, and muscle were collected. Determination of the boron content was performed using inductively coupled plasma-atomic emission spectrometry. Twelve melanoma patients and six glioma patients participated in the study. The melanoma patients included four cases of cutaneous metastatic melanoma, six cases of metastatic melanoma to the lymph nodes and two cases of cerebral metastasis. RESULTS: The results for the metastatic melanoma patients are encouraging with an average tumor:blood boron concentration ratio and standard deviation of about 4.4 +/- 3.2 and a maximum value of 10 for the cerebral metastasis. The glioma patients involved high grade glioma for which the tumor:blood ratio was 2.2 +/- 1.2. CONCLUSION: The tumor:blood ratios for melanoma fulfil requirements for epithermal boron neutron capture therapy for cerebral melanoma metastases, whereas those for high grade glioma do not.

Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis.

To define and quantitate histologic changes in the endometrium that best correlate with documented upper genital tract infection (UGTI) and laparoscopically diagnosed acute salpingitis, we studied endometrial biopsy specimens from 69 consecutive patients with clinically suspected acute pelvic inflammatory disease (PID) who underwent microbiological evaluation for UGTI and laparoscopic examination for acute salpingitis. Both UGTI and acute laparoscopically confirmed salpingitis were present in 37 patients (54%), UGTI without salpingitis in 1 (1%), salpingitis without UGTI in 11 (16%), and neither UGTI nor salpingitis in 20 (29%). Chlamydia trachomatis or Neisseria gonorrhoeae UGTI was found in 34 women, Escherichia coli in two patients, Peptococcus magnus in one woman, and with Streptococcus agalactiae in one woman. The following features were correlated both with UGTI and with salpingitis: presence of any neutrophils in the endometrial surface epithelium; neutrophils within gland lumens; dense subepithelial stromal lymphocytic infiltration; any stromal plasma cells; and germinal centers containing transformed lymphocytes. The simultaneous presence of five or more neutrophils per X 400 field in endometrial surface epithelium, together with one or more plasma cell per X 120 field in endometrial stroma, was the best predictor of UGTI plus salpingitis. This combination had a sensitivity of 92% and a specificity of 87% for predicting the diagnosis of both UGTI and laparoscopically confirmable acute salpingitis. Prospective studies are needed to assess the usefulness of these criteria.

Busulfan versus cyclophosphamide treatment in the early and late stages of granulocytic leukemia in guinea pigs.

A transplantable granulocytic leukemia (GL-13-BC) in strain 13 guinea pigs, which has many similarities to human CML, was used to test the antineoplastic effects of two alkylating agents, busulfan and cyclophosphamide, administered in the late and early stages of the disease. Busulfan had a pronounced cytoreductive effect on circulating leukemic cells in the late, pre-blast crisis stage of this disease but all treated animals, succumbed to the leukemia with only a marginal increase in survival time relative to that of untreated controls. In this respect the guinea pig model resembles human CML. Survival time was moderately increased with early busulfan treatment but, as in the late treatment group, all animals succumbed to the leukemia. A pronounced cytoreductive action on leukemic cells was also observed in guinea pigs treated with cyclophosphamide. Late treatment with this drug produced highly variable effects on the survival time of leukemic guinea pigs; of the nine animals treated, no effect was observe in five, three showed a significant increase in survival time and one animal was still in remission without treatment when the experiment was concluded. Early treatment with cyclophosphamide produced the most striking finding of this study. Two treatments with this drug produced a complete remission in all of the treated guinea pigs. This remission lasted without further treatment for the duration of the study (greater than 200 days) while all untreated controls died within 27-37 days after receiving leukemic cell transplants. The relevance of these findings to the treatment of human CML is discussed.

Comparison of nonionic and ionic contrast agents in the rabbit lung.

The objective of this study was to determine the short- and long-term radiographic, physiologic and histologic changes elicited in the lung of rabbits following the aspiration of commonly used radiographic contrast agents. All agents used, including nonionic agents, caused radiographically evident pulmonary edema which cleared by 24 hours. The contrast materials with higher osmolality, viscosity, and iodine content elicited the greatest physiologic and pathologic changes. No differences were found between an ionic and a nonionic agent with similar viscosities and iodine content, despite a lower osmolality in the nonionic agent. No contrast agent is innocuous when introduced into the lung.

Hydrostatic pulmonary edema in sheep. Effects of bronchial artery embolization on the plain chest radiograph.

RATIONALE AND OBJECTIVES: The bronchial circulation may influence pulmonary edema. This study evaluates possible effects of bronchoesophageal artery embolization on the plain film manifestations of hydrostatic pulmonary edema in sheep. METHODS: Anteroposterior and lateral chest radiographs were obtained during the induction of pulmonary edema both before and after embolization of the bronchoesophageal artery in six adult sheep. Interstitial lines and perivascular, segmental bronchial, proximal bronchial, carinal, tracheal, and parenchymal edema were evaluated. RESULTS: Only parenchymal edema was graded consistently. Though edema increased with left atrial pressure before embolization (P < .001), there was no similar change afterward. The embolized animals tended to be more edematous by the first film. CONCLUSION: Rather than any protective effect, bronchoesophageal artery embolization may increase edema. This model may be inappropriate for further investigation of the bronchial circulation in the development of human pulmonary edema.

Biological and lifestyle factors, and lipid and lipoprotein levels among Japanese Americans in Seattle and Japanese men in Japan.

BACKGROUND: It has been previously shown that Japanese Americans in Seattle have significantly higher cholesterol levels than native Japanese. The present study examines the association of biological and lifestyle factors with plasma lipid and lipoprotein levels among Japanese Americans (JA) and native Japanese (NJ) to determine if these associations are consistent between these high and low cholesterol populations. METHODS: Study samples consisted of 710 JA male and 728 JA female volunteers living in the Seattle area and a random sample of 3833 NJ male urban workers who participated in parallel cardiovascular disease screening and lifestyle surveys for 1989-1994. Multiple regression analysis was conducted to examine the association of lifestyle and biological factors with lipid and lipoprotein levels. RESULTS: Alcohol consumption was positively and linearly associated with high density lipoprotein cholesterol (HDL-C) levels and negatively associated with both low density lipoprotein cholesterol (LDL-C) levels and the ratio of total cholesterol (TC)/HDL-C (P < 0.05 to P < 0.001) among JA males and JA females and NJ males. Current smoking habit was observed to be negatively associated with HDL-C levels and positively with TC/HDL-C ratio and log TG levels (logarithmic transformation of triglyceride values) (P < 0.05 to P < 0.001) among all three groups. Body mass index (BMI) was negatively associated with HDL-C levels and positively associated with log TG and TC/HDL-C ratio among all three groups (P < 0.05 to P < 0.001). Moderate alcohol consumption was negatively associated with log TG levels among JA males and females (P < 0.05), whereas heavy alcohol consumption was positively associated with log TG levels in NJ males (P < 0.001). Smoking was positively associated with TC and LDL-C levels (P < 0.05) among JA males, whereas a negative association (P < 0.05) was observed in NJ males. CONCLUSION: Overall, the fitted models were consistent between JA males and females and NJ males with the exception of smoking on TC and LDL-C. The results suggest that moderate alcohol consumption favourably influences lipid profiles in both high and low cholesterol populations. The results also indicate that light alcohol consumption is associated with decreased triglyceride levels, whereas heavy alcohol consumption is associated with increased triglyceride levels.

An in vitro fertilization program using satellite physicians.

In order to provide an in vitro fertilization (IVF) service for a large geographic region, we developed the concept of Satellite IVF Centers. The goals of this program were as follows: 1) to facilitate patient participation by decreasing travel expenditures, time for screening appointments, and IVF cycle cancellations, and 2) to involve community physicians in a regionalized program. We established centers in nine cities within the Washington, Alaska, Montana, and Idaho region serviced by the University of Washington, and in Alberta, Canada. A 2-day training session was held to provide participating physicians with a basic knowledge of IVF. We considered the roles of the satellite IVF physician to include identification of couples for IVF, initiation of ovulation induction cycles, and determination of appropriate induction cycles for oocyte recovery. The staff of the University Department of Laboratory Medicine standardized the methodologies for estradiol measurements and maintained a quality control analysis for all participating community laboratories. Satellite activity was coordinated through the IVF office at the University, which monitored physicians' decisions based on hormone and ultrasound data from days 7 and 8 of the stimulation cycle. Patients meeting specific ovarian response criteria arrived at the University on day 9 of the stimulation cycle and completed IVF. During 18 months, 72 patients were screened and initiated cycles at the nine participating centers. Forty-four of these patients were sent to the University for oocyte recovery, which resulted in 39 embryo transfers and eight pregnancies. This service has reached a large geographic community, dramatically reduced the cost of IVF for this community, and met with both patient and physician acceptance.

A fever index evaluation of chloramphenicol or clindamycin in patients with serious pelvic infections.

The fever index measured the responses of 102 women with serious pelvic infections who had received either chloramphenicol or clindamycin, in combination with other antibiotics. There was no statistical difference in the number of degree hours in the two populations. Patients with salpingo-oophoritis had significantly more fever than those with a septic abortion. Bacteremia did not delineate a group of women with a markedly elevated febrile response. Within the populaton with salpingo-oophoritis, neither black women nor women with an intrauterine device in place had significantly more fever, but patients requiring operation had more fever while those with an endocervical culture positive for the gonococcus at the time of admission had the most favorable clinical response. The significance of these findings is discussed.

Tubal pregnancy and the risk of subsequent infertility.

One hundred forty-one women with tubal infertility, all of whom had been pregnant at least once before, were interviewed concerning their reproductive, contraceptive, medical, and sexual histories. Their responses were compared with those of a control group of 467 fertile women. A higher percentage of cases (13%) than controls (1%) had had a tubal pregnancy. From these percentages, we estimate that 92% of tubal infertility in women who have had a tubal pregnancy results from tubal pregnancy itself or factors that predisposed to its occurrence. We also estimate that approximately one-fifth of women who suffer a tubal pregnancy will subsequently be infertile because of a tubal abnormality. After controlling for the joint effects of several known risk factors for tubal pregnancy that independently predispose to infertility (eg, a history of pelvic inflammatory disease), the relative risk of tubal infertility associated with tubal pregnancy was 15.0 (95% confidence interval 5.2-43.6). However, because we had no sensitive indicator of antecedent tubal disease, we were extremely limited in our attempt to determine the extent to which this association was actually due to the consequences of the tubal pregnancy itself.

A comparison of the fallopian tube's response to overt and silent salpingitis.

We examined two groups of infertile women who underwent microsurgical repair of their fallopian tube(s) for distal tubal obstruction, one with a history of salpingitis (overt pelvic inflammatory disease) (N = 34) and one without (silent pelvic inflammatory disease) (N = 25). Nine women with normal tubes undergoing hysterectomy and salpingectomy served as controls. Tubal biopsy specimens were studied by light, scanning, and transmission electron microscopy to assess tubal damage. Morphologic damage was scored 0-9, with 0 representing normal tubal architecture and 9 assigned to severe tubal damage. The mean score (+/- SEM) in women with overt pelvic inflammatory disease was 4.2 +/- 0.4; in women with silent pelvic inflammatory disease, 4.3 +/- 0.4; and in the control group, 0.76 +/- 0.2 (P less than .001). Fallopian tube abnormalities seen in women with overt and silent pelvic inflammatory disease included flattened mucosal folds, extensive deciliation, and degeneration of secretory epithelial cells, morphologic changes that are similar to the cellular changes observed in our experimental Chlamydia trachomatis infections in monkeys. Laser light-scattering spectroscopy was used to measure the ciliary activity of the epithelial cells. Ciliary beat frequency was significantly reduced in women with overt pelvic inflammatory disease (N = 13; f = 6.4 +/- 1.2 Hz) and in women with silent pelvic inflammatory disease (N = 11; f = 7.2 +/- 1.2 Hz) as compared with the controls (N = 5; f = 23.4 +/- 1.5 Hz) (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Sperm penetration assay: useful test in evaluation of male fertility.

The recently developed sperm penetration assay (SPA) tests the functional capacity of sperm. It is based upon the ability of in vitro capacitated human spermatozoa to penetrate zona-free hamster eggs in vitro. The SPA was superior to seminal fluid analysis in predicting both fertility and infertility; in the prediction of infertility, the difference was highly significant. Data further indicated that fertility in the male may not remain constant with the passage of time. The SPA would appear to have wide application both clinically and experimentally.