Single lung transplantation from a donor 8 months after double lung transplantation.

Scarcity of donors leads transplant surgeons to consider extended-criteria lungs and occasionally to accept the unlikely. Here we report a case of successful single lung transplantation from a donor 8 months after double lung transplantation.

Jersey calf performance in response to high-protein, high-fat liquid feeds with varied fatty acid profiles: blood metabolites and liver gene expression.

Most available Jersey calf milk replacers (CMR) use edible lard as the primary fat source, which lacks medium-chain fatty acids (MCFA). However, Jersey cow milk consists of over 10% MCFA. The objective of this trial was to determine whether altering the fatty acid profile of CMR by increasing the amount of MCFA would alter liver lipid infiltration, liver gene expression, and blood metabolites when fed to Jersey calves. Fifty Jersey calves were fed 1 of 4 diets: pasteurized saleable whole milk (pSWM) from Jersey cows [27.9% crude protein (CP), 33.5% fat, dry matter (DM) basis]; CMR containing 100% of fat as edible lard (100:00; 29.3% CP, 29.1% fat, DM basis); CMR containing 20% of fat as coconut oil (CO; 80:20; 28.2% CP, 28.0% fat); or CMR containing 40% of fat as CO (60:40; 28.2% CP, 28.3% fat). Liquid diet DM intake averaged 0.523, 0.500, 0.498, and 0.512 kg/d for pSWM, 100:00, 80:20, and 60:40, respectively. Calves were fed their assigned liquid diet daily at 0600 and 1800 h from 2 d of age until 7 wk of age, and once daily until 8 wk of age. Calves were taken off trial at 9 wk of age. Calves had access to water and grain (23.8% CP, 2.71% fat, DM basis). Grain DM intake averaged 0.386, 0.439, 0.472, and 0.454 kg/d for pSWM, 100:00, 80:20, and 60:40, respectively. Liver biopsy cores were obtained from 15 calves at 42 d of age (pSWM, n=4; 100:00, n=4; 80:20, n=3; 60:40, n=4) and from 4 baseline calves <2d of age. Liver biopsy cores were used for histological appraisal of lipid infiltration and gene expression analyses of short-, medium-, and long- chain acyl-coenzyme A dehydrogenases, sterol regulatory element binding transcription factor 1, acetyl coenzyme A carboxylase, and fatty acid synthase. Lipid infiltration and expression of selected genes were not different among diets. After an overnight fast, weekly blood samples were taken immediately before feeding at 0600 h via jugular venipuncture in all calves. Serum and plasma obtained from blood samples were used in the analyses of total protein, glucose, triglycerides, nonesterified fatty acids, and plasma urea nitrogen (PUN). Nonesterified fatty acids and PUN were the only blood metabolites affected solely by diet. Nonesterified fatty acids decreased in a linear manner with increased dietary CO inclusion. Calves fed pSWM had higher PUN than calves fed 80:20. In this trial, altering the fatty acid profile of CMR with the addition of medium-chain fatty acids from CO had minimal effects on liver lipid infiltration, liver gene expression, and blood metabolites when fed to Jersey calves.

Providing Access to Genomic Variant Knowledge in a Healthcare Setting: A Vision for the ClinGen Electronic Health Records Workgroup.

The Clinical Genome Resource (ClinGen) is a National Institutes of Health (NIH)-funded collaborative program that brings together a variety of projects designed to provide high-quality, curated information on clinically relevant genes and variants. ClinGen's EHR (Electronic Health Record) Workgroup aims to ensure that ClinGen is accessible to providers and patients through EHR and related systems. This article describes the current scope of these efforts and progress to date. The ClinGen public portal can be accessed at www.clinicalgenome.org.

Cell-surface glycoprotein of oligodendrocyte progenitors involved in migration.

Myelination by oligodendrocytes in the CNS involves the migration to and recognition and ensheathment of axons. These distinct developmental phases of myelination are assumed to involve the interplay of a precisely regulated set of cell adhesion molecules expressed by both neurons and glial cells. These molecules remain largely unelucidated. In this paper we have identified a large (330 kDa) glycoprotein expressed by murine oligodendrocyte progenitor cells in vitro and in vivo that is downregulated as oligodendrocytes mature. Antigen-positive oligodendrocyte progenitor cells purified by panning develop into myelin-associated glycoprotein-positive oligodendrocytes and also adhere to cultured neurons. Polyclonal antibodies directed against the protein reduce the migration of oligodendrocyte progenitor cells. The observations suggest that the AN2 antigen may play a role in early stages of myelination.

The AN2 protein is a novel marker for the Schwann cell lineage expressed by immature and nonmyelinating Schwann cells.

The expression of the 330 kDa AN2 glycoprotein was studied in the rodent peripheral nervous system. AN2 is expressed by immature Schwann cells in vitro and in vivo and downregulated as the cells upregulate myelin genes. A subpopulation of nonmyelinating Schwann cells in the adult sciatic nerve retains expression of AN2. In rat sciatic nerve crushes, where Schwann cell numbers increase after initial axonal loss and markers of immature Schwann cells show an upregulation, no increased expression of AN2 was observed. In contrast, AN2 expression was upregulated in nerves from peripheral myelin protein-22-transgenic rats, where immature Schwann cells expand without axonal loss. Furthermore, coculture with neurons upregulated AN2 expression on Schwann cells in vitro. Polyclonal antibodies against AN2 inhibited the migration of an immortalized Schwann cell clone in an in vitro migration assay, and the purified AN2 protein was shown to be neither inhibitory nor permissive for outgrowing dorsal root ganglion neurites. AN2 is thus a novel marker for the Schwann cell lineage. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis of purified AN2 from early postnatal mouse brain demonstrated that AN2 is the murine homolog of the rat NG2 proteoglycan.

Variation in prostate position quantitation and implications for three-dimensional conformal treatment planning.

PURPOSE: This study describes and quantitates the motion, i.e., variation in position, of the prostate within the pelvis and its effect on target and normal organ dose. METHODS AND MATERIALS: The motion of the planning target volume (PTV) borders and center of mass was studied in 13 patients with carcinoma of the prostate through the use of superimposed serial computerized tomography (CT) scans. Changes in bladder and rectal volumes were measured and their relationship to displacements of the PTV position were noted. The effects of this motion on target and normal organ doses were measured. RESULTS: A variability in the position of the PTV is seen over time, which is related to changes in bladder and rectal volumes. The one standard deviation displacements of the PTV center of mass with respect to the planning scan center of mass position were 0.12, 0.40, and 0.31 cm in the lateral, anterior-posterior, and superior-inferior directions, respectively. Movement was significantly larger in the superior part of the PTV above the base of the bladder than in the inferior part. Movement of the borders of the PTV outward from the patient axis; hence, toward the edges of the treatment field, was also examined. Outward displacements of the anterior target border below the base of the bladder were less than 0.3 cm in 90% of the cases, and 1.4 cm above the bladder base. For the posterior wall these displacements were less than 0.7 cm and 1.1 cm, respectively, whereas the lateral border displacements were less than 0.3 cm throughout (90% confidence limits). These displacements would cause a median of 6% of the PTV to receive less than 95% of the planned dose for any given treatment day in these patients; the effect on rectal and bladder wall doses was greater and true doses may not be measurable through the use of only one treatment planning CT scan. CONCLUSIONS: The prostate is not a static organ, but rather has some limited motion in the pelvis secondary to bladder and rectal volume changes. This motion has been quantified for a group of patients, and may provide a guide to further studies on the placement of field borders.

Oscillations due to two-electron exchange during He-Ne collisions

Ne (-)(1s(2)2s(2)2p(5)3s(2)) and He (-)(1s2s(2)) autodetachment peaks in electron spectra arising from He-Ne collisions at energies ranging from 350 eV to 6 keV have been measured. The areas of these two peaks are found to oscillate approximately in antiphase, with a constant wavelength, on a (velocity)(-1) scale. It is shown that this behavior can be explained by the "quasiresonance" situation for the separating particles in the channels Ne (-)-He (+) and He (-)-Ne (+). This explanation implies that the oscillations can be understood as being due to the simultaneous "hopping" of two electrons.

Photoassociation spectroscopy of cold He(2 3S) atoms

We observe vibrational states by photoassociation spectroscopy of cold He(2 3S) atoms. Photoassociation resonances are detected as peaks in the Penning ionization rate over a frequency range of 20 GHz below the atomic 2 3S1-2 3P2 transition frequency. We have observed three vibrational series, of which two can be identified. A possible mechanism to explain the observed increase of the Penning ionization rate is discussed.

Identification of a heparin activated amidolytic enzyme in carp (Cyprinus carpio) plasma.

A heparin activated amidolytic enzyme capable of cleaving synthetic thrombin sensitive chromogenic substrates was identified from the plasma of the carp (Cyprinus carpio). Activation was inhibited by KCl, protamine sulphate and human plasma. Heparin was not required for the continued action of the enzyme. Active enzyme was irreversibly inhibited by DFP. The pH and temperature optima was studied and the enzyme semi purified by Sephadex G100 superfine and Sephadex A50 chromatography. An approximate MW of 62,000 was found. Activity generated by as little as 0.002 units of heparin per ml carp plasma was detected. The trivial name carpamidase is proposed for the enzyme.

Is test security a concern when OSCE stations are repeated across clerkship rotations?

PURPOSE: To examine the issue of test security when the same stations on an objective structured clinical examination (OSCE) are repeated across clerkship rotations. Specifically, is there a significant difference in students' scores on stations repeated in three or four rotations within a single academic year? METHOD: The sample consisted of 15 stations in the OSCE given at the end of the third-year surgery clerkship at the Southern Illinois University School of Medicine from 1989-90 through 1993-94. Each station was administered three or four times a year. One-way analyses of variance with contrast coding to test for linear trends were used. Results were considered significant at or below the .05 level. RESULTS: Only three of the 15 stations showed significant linear trends. A two-part couplet orthopedic station showed a significant decreasing linear trend (p=.0001). Two stations showed significant increasing linear trends: a general surgery couplet station (p=.0004) and a plastic surgery station with an essay question (p=.0253). CONCLUSION: There was no consistent evidence that students scored increasingly higher on OSCE stations repeated throughout the year. Thus, it would appear that a clerkship can repeat OSCE stations within an academic year without risk of a trend toward increasing scores.

Assessment of a surgery clerkship's performance evaluation system.

BACKGROUND: This study was designed to examine the validity of a surgery clerkship's performance evaluation system. The study also assessed faculty members' confidence in how clerks are evaluated and promotion decisions made. METHODS: Student files from five classes (n = 339) were analyzed. A 25-item published survey designed to study faculty perceptions of a student evaluation system was distributed. Chi-square tests of independence and descriptive statistics were used. RESULTS: Faculty survey results showed faculty perceptions of strengths and weaknesses in the evaluation system. Significant relationships were found with prior performance indicators and clerkship performance yielding evidence of concurrent and predictive validity. CONCLUSIONS: Findings provide guidance for enhancing how clerks are evaluated as well as specific profiles of students who may need special attention or additional challenges during the surgery clerkship. This study provides a model for other clerkships to assess their student evaluations systems.

Patients' attitudes toward the involvement of medical students in their care.

BACKGROUND: Research has shown that medical students are generally accepted by patients, but specific details that elucidate patient perceptions of the advantages and disadvantages to student involvement have not been documented. This study was designed to determine variables that influence patient satisfaction with students. PATIENTS AND METHODS: Patients were interviewed by one of two faculty members using a questionnaire-style format that covered 12 variables regarding patient care. Patients were asked to rate the extent to which medical students helped or hindered their hospital stay, with regard to the 12 variables. RESULTS: Patients' attitudes were favorable regardless of the students' extent of clinical experience or clinical abilities or the patients' age or length of hospital stay. Patients reported that students spent time with them and answered their questions. Most patients stated that they would allow students to participate in their future hospital care. CONCLUSION: Positive patient-student interactions can have important effects on patients' expectations and their acceptance of future encounters with students. This fact is becoming increasingly important due to the changes in health care and the decreasing incidence of inpatient surgical encounters.

Evaluation of students' physical examination skills during their surgery clerkship.

BACKGROUND: Faculty often presume that students possess adequate physical examination skills upon graduation. Yet assessments of their performance with these skills often reveal deficiencies. This study was designed to determine if students' physical examination skills improved during their clerkship year. METHODS: Sixty-six students performed four specific physical examinations on patients during the first and last week of their surgery clerkship. Four consecutive clerkship rotations were examined. Encounters were videotaped and evaluated by faculty members. RESULTS: Posttest mean percent correct scores significantly improved for three examinations (P <0.01). Analysis of variance found no significant differences between clerkship mean percent correct scores. CONCLUSIONS: Students' physical examination skills improved slightly during their clerkship, however, no relationship was found between clerkship rotation and performance. These findings suggest unsupervised experiences during the third year do not positively influence student performance with physical examination skill proficiency.

Dysphagia: diagnosis and treatment in Kentucky.

Dysphagia, a disorder of swallowing, is commonly associated with neurological and neuromuscular disorders. Damage to the sensation or muscles of the swallowing mechanism leads to unsafe oral motor or pharyngeal movement patterns, placing a patient at risk for development of aspiration pneumonia. At present, multidisciplinary Dysphagia Teams are being used to improve the diagnosis and treatment of swallowing disorders. A survey including all 112 hospitals in the Commonwealth of Kentucky indicates 33 (29%) presently have such a team, while 42 (38%) offer outpatient dysphagia services. In addition, 56 (50%) of the hospitals indicate they perform modified barium swallows which is an essential test for diagnosing and treating dysphagia. An example of how a Dysphagia Team works in one Kentucky rehabilitation hospital is presented to illustrate how to provide early diagnosis and treatment of these problems.

Cardiac troponin I in calves with congenital heart disease.

BACKGROUND: The association between plasma cardiac troponin I (cTnI) and the magnitude of cardiac enlargement in calves with congenital heart disease (CHD) are not well defined. OBJECTIVE: To investigate the relationship between plasma cTnI concentrations and cardiac size in healthy calves and calves with CHD. ANIMALS: A total of 19 healthy calves (control) and 12 Holstein calves with CHD (patent ductus arteriosus, ventricular septal defect, tetralogy of Fallot or double outlet right ventricle). METHODS: Case control study. All animals underwent a comprehensive transthoracic echocardiographic study to document cardiac health or presence of CHD. The vertebral heart score (VHS) was determined in each animal using right lateral survey radiographic images. Blood samples were collected via jugular venipuncture and plasma cTnI concentration and creatine kinase (CK) activity were determined by a 3rd generation immunoassay and an automatic biochemical analyzer, respectively. Groups were compared using Mann-Whitney U-test and receiver-operating characteristics (ROC) curve analysis. RESULTS: Calves with CHD had significantly larger VHS values and higher plasma cTnI concentrations (P < .001) compared to control. Creatine kinase activity was not different between the control and CHD groups of calves. Diagnostic cutoffs of VHS and plasma cTnI for discrimination of groups were 8.9 vertebrae and 0.035 ng/mL, respectively. The cTnI concentration in plasma was significantly correlated with VHS (r (2) =0.512, P < .001). CONCLUSION AND CLINICAL RELEVANCE: Our results suggest that determination of plasma cTnI concentrations in calves with clinical signs compatible with CHD might prove useful as a guide to quantify cardiac remodeling associated with increased cardiac size.

Lectin-binding properties of oligodendrocyte lineage cells aid in defining functionally important surface proteins.

Oligodendrocytes are the myelin-forming cells of the central nervous system. They develop from migratory and proliferative precursor cells, which differentiate to mature myelinating cells. As a first step toward investigating the expression of cell surface glycoproteins by oligodendrocyte lineage cells, we tested 14 different lectins for their binding to oligodendrocyte lineage cells. Peanut agglutinin (PNA) was the only lectin used that showed a differentiation stage-dependent binding to oligodendrocytes. PNA-binding molecules are specifically expressed by oligodendrocyte precursor cells, downregulated with differentiation, and reexpressed by mature oligodendrocytes. It was additionally observed that PNA stimulates the proliferation of oligodendrocyte precursor cells. PNA may therefore be a useful tool for isolating and characterizing important cell surface glycoproteins expressed by oligodendrocyte lineage cells.