Applying Nightingale charts to evaluate the heterogeneity of biomedical waste in a Hospital / Aplicação de gráficos nightingaleanos para avaliação da heterogeneidade de Resíduos de Serviço de Saúde de um hospital / Aplicación de gráficos Nightingale para la evaluación de la heterogeneidad de los residuos sanitarios en un Hospital

OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables. .

OBJETIVO: avaliar a heterogeneidade dos Resíduos de Serviço de Saúde por meio da aplicação de gráficos nightingaleanos. MÉTODO: estudo transversal, que consiste na coleta de dados sobre resíduos (observação direta dos locais de armazenamento, caracterização física e composição gravimétrica), desenvolvimento de um Sistema de Informação Gerencial e construção de gráficos estatísticos. RESULTADOS: os resíduos que apresentam maior grau de heterogeneidade são os recicláveis, infectantes e orgânicos, respectivamente; o resíduo químico atingiu maior eficiência na segregação; os gráficos nightingaleanos são úteis na visualização rápida e na sistematização das informações sobre a heterogeneidade. CONCLUSÃO: o desenvolvimento de um sistema de informação gerencial e a utilização dos gráficos nigthingaleanos permite identificar e corrigir erros na segregação dos resíduos que impactam tanto no aumento de riscos à saúde e de contaminação por resíduos infectantes e químicos como na redução da comercialização e receita com os recicláveis. .

OBJETIVO: evaluar la heterogeneidad de los residuos sanitarios (RS) usando gráficos Nightingale. MÉTODO: estudio transversal que consiste en la recopilación de datos sobre los residuos (observación directa de los recipientes, caracterización física y composición gravimétrica), desarrollo de un Sistema de Información para la Gestión y creación de gráficos estadísticos. RESULTADOS: los residuos con el mayor grado de heterogeneidad son los reciclables, infecciosos, y los residuos orgánicos, respectivamente; la segregación de los residuos químicos fue la más eficiente; los gráficos Nightingale son útiles para la visualización rápida y sistematización de la información sobre la heterogeneidad. CONCLUSIÓN: el desarrollo de un sistema de información para la gestión y el uso de gráficos Nightingale permiten la identificación y corrección de errores en la separación de los residuos; dichos errores aumentan los riesgos de salud y la contaminación por residuos infecciosos y químicos, y reducen la venta y beneficio obtenible de los materiales reciclables. .

Tetralogía de fallot con agenesia de sigmoides pulmonares: presentación de 3 pacientes / Tetralogy of fallot with agenesis of pulmonary sigmoid: report of three patients

Se presentan 3 pacientes con tetralogía de Fallot y agenesia de sigmonoides pulmonares correspondiente al grupo II (sin gran dilatación del tronco de la arteria pulmonar y con capacidad fucional entre I y III de la clasificación de la New York Heart Association) (NYHA) cuyas edades fueron 2, 12 y 27 años. Se les realizó cirugía electiva a la niña de 12 años(cierre de comunicación interventricular y liberación de la estenosis infundibuloanular con parche de dacrón); se decidió no hacer reconstrucción por el momento al otro niño por su corta edad y al paciente adulto no aceptó la intervención quirúrgica

1,25-dihydroxyvitamin D3 receptors in rat lung during the perinatal period: regulation and immunohistochemical localization.

We have previously reported that in contrast to what has been described in adult lung, 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] has specific binding sites in rat fetal lung at the end of gestation, and it stimulates in vitro the phospholipid biosynthesis and surfactant release from fetal rat type II pneumocytes. In the present study an immunohistochemical technique using a rat monoclonal antibody (9A7 gamma) and binding studies were carried out on fresh lung tissues from fetal and newborn rats during the perinatal period to identify the cell(s) directly responsive to 1,25-(OH)2D3 in fetal lung and to look for a down-regulation of the 1,25-(OH)2D3 receptors in the perinatal period. We also searched for a regulation of 1,25-(OH)2D3 binding to fetal lung by 1,25-(OH)2D3 itself and by factors known to affect lung maturation or be involved in parturition. Our results suggest that 1) fetal type II pneumocytes are target cells for 1,25-(OH)2D3; 2) a physiological down-regulation of the 1,25-(OH)2D3 receptors in rat lung occurs in the perinatal period, starting a few hours before birth and lasting at least up to the fifth day of life; and 3) the capacity of rat fetal lung to bind 1,25-(OH)2D3 can be modulated in vitro by different hormones; a small inhibitory effect is observed with oxytocin (100 microU/ml), while PRL (10(-8) M), T4 (10(-6)-10(-10) M), 1,25-(OH)2D3 (10(-9)-10(-10) M), and, to a lesser extent, dexamethasone (10(-7) M) induce a 2- to 4-fold increase in the number of 1,25-(OH)2D3 receptors without altering the binding affinity of receptor for 1,25-(OH)2D3.

Polycyclic aromatic hydrocarbon-DNA adducts in spontaneously aborted fetal tissue.

Fetal tissue and placentas from 15 human spontaneous abortions were evaluated for DNA adducts of polycyclic aromatic hydrocarbons (PAHs), using a competitive enzyme-linked immunosorbent assay (ELISA) with fluorescent end-point detection. PAH-derived adducts were found in 43% of placentas, 27% of fetal liver samples and 42% of fetal lung specimens, thus confirming that the human fetus is a target for DNA damage. As there was only 60% concordance between placenta and fetal lung or liver on the presence or absence of detectable PAH adducts, the placenta was not a good surrogate for adduct formation in other fetal organs. PAH-derived adducts in fetal liver and lung presumably form as a result of transplacental exposure to environmental stimuli. Since none of the positive fetal samples were from women who reported smoking during pregnancy, cigarette smoke is, in this case, an unlikely candidate and the adducts detected must be due to some other common source(s) of hydrocarbon exposure. The high frequency of positive samples in our small series casts some doubt on whether fetal PAH-DNA adducts identify a population at increased risk for transplacental carcinogenesis.

Molecular mapping of pulmonary endothelial membrane glycoproteins of the intact rabbit lung.

To study the biochemical characteristics of endothelium in vivo, we radioiodinated endothelial membrane proteins of the perfused rabbit lung using a water soluble analog of the Bolton-Hunter reagent, 125I-sulfosuccinimidyl (hydroxyphenyl) propionate (125I-s-SHPP). This technique led to a 10-fold increase in specific activity of radioiodinated lung membrane protein compared with our previously reported method using lactoperoxidase and glucose oxidase-catalyzed radioiodination. Tissue autoradiography confirmed that radioiodination was largely confined to the endothelium. Perfusion pressure, wet-to-dry weight ratios, and the morphological appearance of the lungs were within normal limits, indicating that the procedure does not cause apparent lung injury. Lectin binding to a crude membrane fraction of 125I-s-SHPP labeled lung led to isolation of several putative endothelial membrane proteins. Immunoprecipitation studies with appropriate antibodies enabled the identification of radioiodinated angiotensin-converting enzyme and beta 2-microglobulin associated major histocompatibility complex class I molecules in the membrane fraction. This technique will be useful for studying biochemical responses of the endothelium in vivo to a variety of pharmacological and physiology stimuli.

Functional role of the polysaccharide component of rabbit thrombomodulin proteoglycan. Effects on inactivation of thrombin by antithrombin, cleavage of fibrinogen by thrombin and thrombin-catalysed activation of factor V.

Thrombomodulin (TM), a major anticoagulant protein at the vessel wall, serves as a potent cofactor for the activation of Protein C by thrombin. Previous work has indicated that (rabbit) TM is a proteoglycan that contains a single polysaccharide chain, tentatively identified as a sulphated galactosaminoglycan, and furthermore suggested that this component may be functionally related to additional anticoagulant activities expressed by the TM molecule [Bourin, Ohlin, Lane, Stenflo & Lindahl (1988) J. Biol. Chem. 263, 8044-8052]. Results of the present study establish that (enzymic) removal of the polysaccharide chain abolishes the inhibitory effect of TM on thrombin-induced fibrinogen clotting as well as the promoting effect of TM on the inactivation of thrombin by antithrombin, but does not affect the ability of TM to serve as a cofactor in the activation of Protein C. Studies of yet another biological activity of rabbit TM, namely the ability to prevent the activation of Factor V by thrombin [Esmon, Esmon & Harris (1982) J. Biol. Chem. 257, 7944-7947], confirmed that TM markedly delays the conversion of the native 330 kDa Factor V precursor into polypeptide intermediates, and further into the 96 kDa heavy chain and 71-74 kDa light-chain components of activated Factor Va. In contrast, the activation kinetics of a similar sample of Factor V incubated with thrombin in the presence of chondroitinase ABC-digested TM did not differ from that observed in the absence of TM. It is concluded that the inhibitory effect of TM on Factor V activation also depends on the presence of the polysaccharide component on the TM molecule.

Polycyclic aromatic hydrocarbon-DNA adducts in lung tissue from lung cancer patients.

In an attempt to probe for polycyclic aromatic hydrocarbon (PAH)-DNA adducts in human subjects resulting from smoking (or other chronic environmental exposure), lung tissue and lung tumours were obtained from patients hospitalized for lung cancer. DNA was isolated from the tissue samples and examined both in an ELISA using a polyclonal antibody against (+/-)trans-7,8-dihydroxy-anti-9,10-epoxy-7,8,9,10- tetrahydrobenzo[a]pyrene (BPDE)-DNA as well as by the nuclease P1-mediated modification of the 32P-post-labelling technique. The ELISA results showed BPDE-DNA antigenicity in lung DNA from 6 out of 21 patients, and adduct levels ranged from 2 to 134 adducts per 10(8) nucleotides. For all 21 patients, the autoradiographs of chromatograms of 32P-postlabelled digests of DNA from non-tumorous lung tissue showed a strong diagonal radioactive zone (DRZ). This DRZ was generally absent in tumorous tissue. DNA samples that were positive in the ELISA contained a dominant spot within the DRZ that co-chromatographed with the major BPDE-DNA adduct (BPDE-dG). The quantities of the BPDE-dG spots ranged from 2.1 to 42 adducts in 10(9) nucleotides. These values were lower than the levels found in the ELISA but correlated well with the ELISA results (Kendall W = 0.97; P = 0.00). The levels of the DRZ adducts ranged from 1.9 to 34 adducts in 10(8) nucleotides. Correlations between smoking and DNA adduct levels were poor because of the small number of current smokers (n = 13). However, smokers of filter cigarettes had significantly lower DNA adduct levels compared with smokers of cigarettes without a filter (P = 0.02 by Fischer's exact test).

Lipid peroxidation and ultrastructural changes in rat lung isografts after single-passage organ flush and 48-hour cold storage with and without one-hour reperfusion in vivo.

Rat lung isografts were preserved for 48 hr at 0 degrees C using a simple organ flush technique. After storage alone, isotonic saline flush resulted in significantly raised indices of lipid peroxidation in vitro (Schiff bases and thiobarbituric-acid-reactive material [TBAR]). Lungs flushed with hypertonic citrate (HCA) had significantly less oxidative damage than saline-flushed lungs. The addition to the HCA flush of verapamil, a calcium channel blocker, or desferrioxamine, an iron chelator, significantly reduced TBA reactivity in stored lungs compared with HCA alone. After 1-hr reperfusion in vivo, lipid peroxidation was reduced in HCA-flushed lungs compared with saline flush (TBAR alone), but no additional protection from the use of desferrioxamine or verapamil was demonstrated. Electron microscopy after saline flush and storage alone showed gross endothelial swelling and fragmentation. Reperfusion with blood for 1 hr resolved cell swelling, but alveolar/capillary wall rupture occurred. HCA protected against cell swelling, but endothelial vesiculation and widening of the basement membrane were observed. After reperfusion, HCA-flushed lungs developed much endothelial loss that was considerably reduced by the use of desferrioxamine and verapamil. The lipid peroxidation results suggest that iron- and calcium-mediated free radical production may be important mechanisms in oxidative damage to stored rat lungs. Electron microscopy findings correlated with biochemical evidence of free-radical-mediated injury. Reduction of endothelial loss on reperfusion by the use of verapamil and desferrioxamine provides circumstantial evidence that ischemia and reperfusion damage of organs stored for transplantation is partly due to Fe++(+)- and Ca+(+)-dependent mechanisms that probably involve increased free radical production.

T2 of endotoxin lung injury with and without methylprednisolone treatment.

NMR relaxation times (T1 and T2) and the water content (WC) of in vitro rat lungs were measured during the course of endotoxin lung injury in rats. Measurements of normal lungs, untreated endotoxin-injured lungs, and endotoxin-injured lungs treated with methylprednisolone (MPSL) were compared. The untreated endotoxin lungs showed prolongation of the fast and slow T2 components (T2f and T2s), but no significant changes in T1 or water content. Also, there was no correlation between 1/WC and relaxation rates or between T1 and T2. MPSL treatment prevented T2f and T2s prolongation; however, the duration of MPSL effectiveness was limited. Animals which were treated with MPSL more than 7 h prior to measurements showed T2 prolongation. This study indicates that NMR relaxation times, particularly T2, can be useful in evaluating lung injuries and their treatments.

High-performance liquid chromatographic analysis of lung phospholipids and their precursors in the offspring of diabetic rats.

Pulmonary phospholipids and their precursors and metabolites were assayed in the offspring of streptozotocin-induced diabetic rats at 19 and 21 days gestation and at 2 days after birth by two unique methods that employ high performance liquid chromatography combined with automated phosphorus analysis. In general, lung phospholipids were not different between offspring of control versus diabetic mothers. Levels of phosphatidylglycerol, however, were decreased in the offspring of diabetics. Lysophosphatidylcholine appears to be increased in the lungs of offspring of diabetic mothers, suggesting that maternal diabetes is associated with alterations in the remodeling of phosphatidylcholine.

Histamine H1-receptor in heart: unique electrophoretic mobility and autoradiographic localization.

Histamine H1-receptors, visualized in the guinea pig heart by autoradiography using [125I]iodobolpyramine as a specific probe, are abundant in the nodal tissue and cardiac vessels but also occur heterogeneously in the myocardium. Following photoaffinity labeling with [125I]iodoazidophenpyramine and electrophoresis, the ligand binding domain of the heart H1-receptor was shown to be present on a major 68-kDa and a less abundant 54- to 58-kDa protein. The 68-kDa protein displayed a molecular size higher in heart than in all other tissues (56 kDa). This indicates the existence of at least two isoforms of the H1-receptor; the cardiac isoform, however, was pharmacologically indistinguishable from the common isoform studied in cerebellar membranes using available ligands. Its distinct electrophoretic properties suggest that the cardiac isoform may have a unique function.

Tissue sources of murine megakaryocyte potentiator: biochemical and immunological studies.

The immunological and biochemical characteristics of murine megakaryocyte potentiator from lung and bone marrow were examined and compared with thrombopoietic stimulatory factor. Biological activity was not neutralized by anti-erythropoietin, but megakaryocyte potentiator activity from all three sources was abolished or reduced when the preparations were treated with anti-thrombopoietic stimulatory factor or anti-interleukin-6. Megakaryocyte potentiator levels in lung conditioned medium were not found to be enhanced from mice treated with lipopolysaccharide, in contrast to granulocyte-macrophage colony-stimulating factor (GM-CSF) levels. The biochemical properties of murine megakaryocyte potentiator from lung and bone marrow were compared and found to be similar in the elution profiles from anion exchange, gel filtration and reversed phase liquid chromatography. It is concluded that the activities in lung and bone marrow are very similar if not identical, to interleukin-6.

Interstitial albumin-bound dye concentrations in mice with a protein-rich effusion.

Levels of intravenously injected Evans blue dye in eluates of the lung and kidney, an index of interstitial fluid albumin concentration, together with water content of these tissues and levels of serum albumin were measured in Ha-icr mice with a tumor cell-induced protein-rich peritoneal effusion. By the fourth day after the intraperitoneal injection of tumor cells, when mean serum albumin levels had fallen to 76% of control values, mean albumin bound dye concentrations in lung and kidney had decreased to 63 and 58%, respectively, of control values. By the tenth day when serum albumin levels had decreased further to 67% of control values, albumin-bound dye concentrations in the lung and kidney had decreased to 58 and 43%, respectively, of control values. During this 10-day period the water content of the lung remained unchanged whereas that of the kidney had decreased by 7%. These observations suggest that the reduction in serum albumin which results from an abnormal distribution of this protein into a nonvascular compartment is accompanied, as in other models of hypoalbuminemia, by a more than proportionate reduction in interstitial albumin concentration in the lung and kidney.

Decreased pulmonary vasoreactivity in an animal model of chronic Pseudomonas pneumonia.

Chronic pulmonary infection/colonization caused by Pseudomonas aeruginosa accounts for much of the morbidity and mortality in cystic fibrosis (CF). The effect of chronic pulmonary P. aeruginosa infection on the pulmonary circulation has not been studied. Therefore, we investigated the effect of chronic P. aeruginosa infection on pulmonary hemodynamics in a rat model. Two groups of rats were inoculated with either agar beads containing 1.0 x 10(4) colony-forming units of P. aeruginosa (infected) or an equal volume of sterile beads alone (control). In vivo, pulmonary vasoreactivity measured as the percent change in total pulmonary resistance during hypoxia was decreased at 1 wk (22 +/- 7% versus 57 +/- 3%), 2 wk (29 +/- 5% versus 73 +/- 17%), 3 wk (41 +/- 8% versus 77 +/- 14%), and 6 to 9 wk (23 +/- 10 versus 53 +/- 7; p less than 0.05 all time points; mean +/- SEM) postinoculation in infected animals when compared with that in time-matched control animals. At 6 to 9 wk postinoculation, pulmonary artery pressure was significantly elevated in infected rats (25.8 +/- 1.6 versus 21.0 +/- 1.0 mm Hg; p less than 0.05) when compared with that in control animals. Histopathologic findings were characterized by bronchiectasis as well as by chronic bronchial, parenchymal, and perivascular inflammation at all time points in infected animals.(ABSTRACT TRUNCATED AT 250 WORDS)

An assay for the assessment of lipocortin 1 levels in human lung lavage fluid.

The physiological function of the lipocortins, proteins which are thought to be glucocorticoid-regulated, is unclear. An improved assay for lipocortins might help to elucidate their role. A rapid and specific sandwich enzyme-linked immunosorbent assay (ELISA) for lipocortin 1 with a working range of 1-2000 ng/ml and an interrun coefficient of variation of less than 10% is described and used in this pilot study to quantify human lipocortin 1 for the first time in acellular bronchoalveolar lavage fluid (BALF), and in media conditioned by BAL cells, from control patients and those with pulmonary sarcoidosis. Using this assay a statistically significant relationship, not previously observed in man, has been demonstrated between concentrations of lipocortin 1/ml of BALF and serum cortisol levels (n = 10, rs = 0.6939, P less than 0.05). Although lipocortin 1 levels in acellular BALF were the same in control and sarcoid patients, significantly more lipocortin 1 was released from sarcoid BAL cells in culture (median 21.6, range 8.1-45.4 ng lipocortin/10(6) cells/h in culture) than from control cells (2.5, 1.5-7.6 ng lipocortin/10(6) cells/h in culture). The possible clinical significance of these data is discussed, but remains to be established.

Effect of age and IGF-I administration on elastin gene expression in rat aorta.

An age-related decrease in elasticity of arteries has been found in clinical and experimental studies done during the past two decades. We have investigated molecular and endocrine aspects of that decrease by examining the effects of age and insulin-like growth factor-I (IGF-I) on rat aorta elastogenesis. For comparison, pulmonary elastogenesis was examined in the same experimental animals. Different aged groups of male Fischer 344 rats (barrier protected) were implanted with minipumps for a two-week infusion of either 0.1 N acetic acid (vehicle solution) or IGF-I (1.2 mg/kg/day). The DNA content (micrograms DNA/g tissue) decreased with age in aorta but remained fairly constant in lung. Administration of IGF-I increased the aortic DNA content in all but the oldest rats. Conversely, the DNA content of pulmonary tissue was significantly increased in only the youngest animals. The steady-state levels of tropoelastin mRNA decreased dramatically in both aorta and lung with increased age. The decrease was greater in lung than aorta. Administration of IGF-I elevated aortic tropoelastin mRNA steady-state levels, whereas lung tropoelastin mRNA levels were unaffected by IGF-I administration. Aortic tissue synthesized decreased amounts of insoluble elastin with increased age. These results establish a direct relationship between aortic tropoelastin mRNA levels and the synthesis of insoluble elastin in aging. Administration of IGF-I increased aortic elastin synthesis throughout the life span of the rat, although the proportionate increase diminished with age.

Improved ultrasonic measurement techniques applied to assay of Pu and other transuranics in lung.

At the Lawrence Livermore National Laboratory, we are developing a system that will more accurately measure fat, muscle, and bone content from ultrasonic images of the chest wall. This paper describes a procedure that will allow chest-wall thickness to be determined to within +/- 1.5 mm (compared with the +/- 3-6 mm from current techniques) and may allow absolute errors in chest-wall composition to be reduced to +/- 4%.

Interaction between perdeuterated dimyristoylphosphatidylcholine and low molecular weight pulmonary surfactant protein SP-C.

A low molecular weight hydrophobic protein was isolated from porcine lung lavage fluid using silicic acid and Sephadex LH-20 chromatography. The protein migrated with an apparent molecular weight of 5000-6000 on SDS-PAGE under reducing and nonreducing conditions. Gels run under reducing conditions also showed a minor band migrating with a molecular weight of 12,000. Amino acid compositional analysis and sequencing data suggest that this protein preparation contains intact surfactant protein SP-C and about 30% of truncated SP-C (N-terminal leucine absent). The surfactant protein was combined with perdeuterated dimyristoylphosphatidylcholine (DMPC-d54) in multilamellar vesicles. The protein enhanced the rate of adsorption of the lipid at air-water interfaces. The ability of the protein to alter normal lipid organization was examined by using high-sensitivity differential scanning calorimetry (DSC) and 2H nuclear magnetic resonance spectroscopy (2H NMR). The calorimetric measurements indicated that the protein caused a decrease in the temperature maximum (Tm) and a broadening of the phase transition. At a protein concentration of 8% (w/w), the enthalpy change of transition was reduced to 4.4 kcal/mol compared to 6.3 kcal/mol determined for the pure lipid. NMR spectral moment studies indicated that protein had no effect on lipid chain order in the liquid-crystal phase but reduced orientational order in the gel phase. Two-phase coexistence in the presence of protein was observed over a small temperature range below the pure lipid transition temperature. Spin-lattice relaxation times (T1) were not substantially affected by the protein. Transverse relaxation time (T2e) studies suggest that the protein influences slow lipid motions.

Second generation monoclonal antibodies to the human integrin alpha 6 beta 4.

Second generation monoclonal antibodies to the alpha 6 beta 4 subunits of human integrins have been prepared. MAbs 450-9D, 10D, and 11A1 react at different sites on the beta 4 molecule and MAbs 450-30A1 and 33D react at the same site on the alpha 6 subunit. Double determinant (two-site) radioimmunoassays using combinations of these MAbs have been developed. Two assays for beta 4 distinguish between the whole beta 4 molecule and the beta 4 molecule truncated from the C-terminus (form c) while another assay measures the presence of alpha 6 subunits. Data from the two-site assays support the following conclusions: (1) Colon tumors and normal colon mucosa express large amounts of alpha 6 beta 4 although only form c of the beta 4 was detected; (2) There is no evidence for alpha 6 beta 1 expression in colon; however, some of this complex may be present in certain lung tumors. The extracellular domains of alpha 6 and beta 4 can associate with each other even if the cytoplasmic domain of the beta 4 subunit is not present. MAbs to specific domains of the beta 4 molecule may be useful in analyses of forms a and c in normal and malignant tissue. The fact that only the largest beta 4 molecule "a" retains the phosphorylation site may have functional significance.