RESUMEN
Accurate measurements of nitrogen dioxide (NO2), a key trace gas in the formation and destruction of tropospheric ozone, are important in studies of urban pollution. Nitrogen dioxide column abundances were measured during the Texas Air Quality Study 2000 using visible absorption spectroscopy from an aircraft. The method allows for quantification of the integrated total number of nitrogen dioxide molecules in the polluted atmosphere and is hence a useful tool for measuring plumes of this key trace gas. Further, we show how such remote-sensing observations can be used to obtain information on the fluxes of nitrogen dioxide into the atmosphere with unique flexibility in terms of aircraft altitude, and the height and extent of mixing of the boundary layer. Observations of nitrogen dioxide plumes downwind of power plants were used to estimate the flux of nitrogen oxide emitted from several power plants in the Houston and Dallas metropolitan areas and in North Carolina. Measurements taken over the city of Houston were also employed to infer the total flux from the city as a whole.
Asunto(s)
Contaminantes Atmosféricos/análisis , Aeronaves , Monitoreo del Ambiente/métodos , Dióxido de Nitrógeno/análisis , Oxidantes Fotoquímicos/análisis , Emisiones de Vehículos/análisis , Movimientos del Aire , Ciudades , Análisis Espectral/métodosRESUMEN
CD81 exerts a range of interesting effects on T cells including early thymocyte differentiation, LFA-1 activation, and provision of costimulation. To better understand the mechanisms by which CD81 influences T cell function we evaluated CD81 molecular complexes on T cells. The most prominent CD81-associated cell surface protein on thymocytes as well as a number of T cell and B cell lines has an apparent molecular mass of 75 kDa. The 75-kDa protein was purified and analyzed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry followed by postsource-decay profiling. p75 is a novel type I transmembrane protein of the Ig superfamily which is most similar to FPRP. We cloned and sequenced both human and mouse PG regulatory-like protein (PGRL) and characterized mouse PGRL expression in both lymphocytes and nonlymphoid tissues. The discovery of PGRL allows for the clustering of a small family of related proteins including PGRL, FPRP, V7/CD101, and IGSF3. Expression constructs containing various domains of PGRL with an epitope tag were coexpressed with CD81 and used to determine that the interaction of CD81 with PGRL requires the membrane distal Ig3-Ig4 domains of PGRL. Although it remains to be determined whether PGRL possesses PG regulatory functions, transwell chamber experiments show that PGs and CD81 coordinately regulate T cell motility.
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Antígenos CD/fisiología , Proteínas de la Membrana , Proteínas de Neoplasias , Proteínas/análisis , Linfocitos T/química , Secuencia de Aminoácidos , Animales , Células COS , Movimiento Celular , Dinoprostona/biosíntesis , Humanos , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Datos de Secuencia Molecular , Peso Molecular , Proteínas/fisiología , Linfocitos T/fisiología , Tetraspanina 28RESUMEN
OBJECTIVE: To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur. DESIGN: Prospective, pseudorandomised, controlled trial. SETTING: St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998. PARTICIPANTS: 111 patients (80 women and 31 men; mean age, 81 years) admitted via the emergency department with a primary diagnosis of fractured neck of femur. INTERVENTIONS: Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients). MAIN OUTCOME MEASURES: Timing of referrals and discharge planning; total length of stay; and complication and readmission rates within 28 days of discharge. RESULTS: Patients managed according to the clinical pathway had a shorter total stay (6.6 versus 8.0 days; P = 0.03), even if assessment for placement by the Aged Care Assessment Service was required (9.5 versus 13.6 days; P = 0.03). There were no significant differences in complication and readmission rates between pathway and control patients (complication rates, 24% versus 36%; P = 0.40; readmission rates, 4% versus 11%; P = 0.28). CONCLUSION: Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.
Asunto(s)
Vías Clínicas , Fracturas del Cuello Femoral/terapia , Tiempo de Internación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Cuello Femoral/complicaciones , Humanos , Modelos Lineales , Masculino , Estudios Prospectivos , Derivación y Consulta , Resultado del TratamientoRESUMEN
We examined immunohistochemically 370 tumour-free lymph nodes from 41 patients with a head and neck squamous cell carcinoma (HNSCC) to clarify whether the tumour-associated epitopes CD44v6 and E48 are suitable for adjuvant postoperative immunotherapy. All the positively immunostained cells found were single cells. CD44v6+ cells were found in 55% of the lymph nodes, with their numbers increasing in pN>0-patients (62%). Only pN>0-patients had abundant to massive CD44v6+ cells. A comparison with mononuclear cells in lymphatic tissue from control patients suggested a similarity with activated T-cells. In the 41 cancer patients there were significantly fewer lymph nodes with E48+ cells (11%), but the number of E48+ cells increased in pN> 1-patients (29%) with predominantly abundant E48+ cells. We conclude from the comparison with the epithelial marker EMA that the E48+ single cells are epithelial in origin. Only a specific E48 peptide sequence appears suitable for adjuvant immunotherapy in patients with head-neck tumours.
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Carcinoma de Células Escamosas/inmunología , Moléculas de Adhesión Celular/análisis , Glicoproteínas/análisis , Neoplasias de Cabeza y Cuello/inmunología , Receptores de Hialuranos/análisis , Anciano , Antígenos de Neoplasias/análisis , Carcinoma de Células Escamosas/patología , Células Epiteliales/inmunología , Epítopos/análisis , Femenino , Proteínas Ligadas a GPI , Neoplasias de Cabeza y Cuello/patología , Humanos , Inmunohistoquímica , Ganglios Linfáticos/inmunología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding. METHODS: This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes. RESULTS: Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709). CONCLUSIONS: Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.
Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Cuidados a Largo Plazo/métodos , Personal de Enfermería/educación , Personal de Enfermería/psicología , Instituciones de Cuidados Especializados de Enfermería , Control de Esfínteres , Incontinencia Urinaria/enfermería , Incontinencia Urinaria/prevención & control , Adulto , Anciano , Educación Continua en Enfermería , Femenino , Enfermería Geriátrica/educación , Enfermería Geriátrica/métodos , Humanos , Capacitación en Servicio , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Evaluación en Enfermería , Evaluación de Programas y Proyectos de SaludRESUMEN
The results are presented of afterloading high-dose-rate-radiation with iridium-192 in 34 patients with squamous cell carcinomas of the floor of the mouth and tongue. Some patients were also treated surgically or given percutaneous radio- or chemotherapy. At the time of diagnosis, 28.0% had a T2 tumour, 41.9% a T3 tumour and 30.1% a T4 tumour, 41.2% had positive lymph nodes and 2.9% distant metastases. The response rate was 64.7%, 26.5% of which were complete remissions and 38.2% partial remissions. In 61.8% of cases, the tumour was recurrent and responded with a rate as high as 57.2%, 23.9% of which were complete remissions and 33.3% partial remissions. Survival times were dependent upon therapy results. The mean survival of patients with complete remission was 40.3 months, with partial remission 16.1 months as opposed to 7.2 and 3.5 months respectively in patients showing no change or progressive disease. It can be concluded that afterloading therapy using high-dose-rate-radiation with iridium-192 achieves good palliative results and should be looked at as a supplementary treatment modality for squamous cell carcinomas of the floor of the mouth and tongue.
Asunto(s)
Braquiterapia/métodos , Carcinoma de Células Escamosas/radioterapia , Radioisótopos de Iridio/uso terapéutico , Suelo de la Boca , Neoplasias de la Boca/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Radioisótopos de Iridio/administración & dosificación , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Dosificación Radioterapéutica , Inducción de Remisión , Análisis de Supervivencia , Tasa de Supervivencia , Neoplasias de la Lengua/radioterapiaRESUMEN
We evaluated the homogeneity of drug concentrations in muscle in 14 cadavers, comprising 11 drug overdoses and three cases of chronic therapeutic drug use. Analyses were performed on samples from twelve named muscles and femoral venous blood. Standard analytical techniques and instrumentation were used throughout. There was marked within-case variability in drug concentrations with highest:lowest concentrations ranging up to 21.7. Overall highest concentrations were found in the diaphragm and mean diaphragm:blood ratios ranged from 1.1 (temazepam, two cases) and 1.2/1.3 (paracetamol, six cases) up to 6.5/13.5 (amitriptyline, three cases) and 5.3/21.3 (propoxyphene, four cases). Excluding the diaphragm, mean muscle:blood ratios ranged from 0.4 (prothiaden), 0.5 (temazepam), and 0.7 (paracetamol) up to 3.7 (temazepam), 4.3 (propoxyphene) and 5.7 (amitriptyline). We suggest that muscle is suitable for qualitative analysis but not for quantitative corroboration of a blood sample or as a quantitative alternative to blood.
Asunto(s)
Acetaminofén/análisis , Amitriptilina/análisis , Fármacos del Sistema Nervioso Central/análisis , Dotiepina/análisis , Músculo Esquelético/química , Temazepam/análisis , Acetaminofén/sangre , Acetaminofén/envenenamiento , Adulto , Anciano , Amitriptilina/sangre , Amitriptilina/envenenamiento , Analgésicos/análisis , Analgésicos/sangre , Analgésicos/envenenamiento , Analgésicos Opioides/análisis , Analgésicos Opioides/sangre , Analgésicos Opioides/envenenamiento , Ansiolíticos/análisis , Ansiolíticos/sangre , Ansiolíticos/envenenamiento , Antidepresivos Tricíclicos/análisis , Antidepresivos Tricíclicos/sangre , Antidepresivos Tricíclicos/envenenamiento , Cadáver , Fármacos del Sistema Nervioso Central/sangre , Fármacos del Sistema Nervioso Central/envenenamiento , Cromatografía Líquida de Alta Presión , Diafragma/química , Dotiepina/sangre , Dotiepina/envenenamiento , Sobredosis de Droga/etiología , Femenino , Medicina Legal/métodos , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Persona de Mediana Edad , Suicidio , Temazepam/sangre , Temazepam/envenenamiento , Factores de Tiempo , Distribución Tisular , Toxicología/métodosAsunto(s)
Linfangioma/congénito , Imagen por Resonancia Magnética , Neoplasias de la Boca/congénito , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de los Tejidos Blandos/congénito , Neoplasias de la Lengua/congénito , Diagnóstico Diferencial , Humanos , Lactante , Linfangioma/diagnóstico , Masculino , Suelo de la Boca/patología , Neoplasias de la Boca/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de la Lengua/diagnósticoRESUMEN
Forty toothless patients were examined over a period of 3 years for the purpose of improving the face profile after integration of implant-supported, removable full dentures. The data before the treatment were related to the corresponding normal values. The same parameters were measured 3 months after the prosthetic treatment was finished and were compared to the preoperative data. In all parameters we saw an significant increase in the normal value rate.
Asunto(s)
Cefalometría , Ajuste de Precisión de Prótesis , Boca Edéntula/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Dentadura , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The National Oceanic and Atmospheric Administration Aeronomy Laboratory's rapid tunable daylight differential absorption lidar system for monitoring ozone throughout the free troposphere is described. The system components are optimized to provide continuously and rapidly profiles of ozone, day or night, with a vertical resolution of 1 km and an absolute accuracy of +/-10% to the tropopause under clear sky conditions. Routine observations of ozone with frequent error assessments are made by scanning wavelengths between 286 and 292 nm.
RESUMEN
The surgical technique, indications, and results of the infrahyoid muscle flap are presented. This flap is fed by the superior thyroid vessels and innervated by the ansa cervicalis. The flap is indicated in case of medium-sized defects in the floor of the mouth, the tongue, the buccal mucosa, and the lateral pharyngeal wall. The advantages of the technique presented include the rapid flap elevation close to the original operating field, the ability to use the motor capability of the flap, and the ability to combine it with other local flaps--for example, the platysma flap. This technique appeared to render excellent function for swallowing and speech. Safe flap grafting is possible only if the internal jugular vein is preserved.
Asunto(s)
Mejilla/cirugía , Suelo de la Boca/cirugía , Mucosa Bucal/cirugía , Músculos del Cuello/trasplante , Faringe/cirugía , Colgajos Quirúrgicos/métodos , Lengua/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Plexo Cervical/fisiología , Deglución/fisiología , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Venas Yugulares/anatomía & histología , Masculino , Persona de Mediana Edad , Neuronas Motoras/fisiología , Neoplasias de la Boca/cirugía , Músculos del Cuello/irrigación sanguínea , Músculos del Cuello/inervación , Neoplasias Faríngeas/cirugía , Habla/fisiología , Colgajos Quirúrgicos/patología , Neoplasias de la Lengua/cirugíaRESUMEN
The possibility that postmortem biochemical changes in blood might parallel drug redistribution and thus serve as markers was explored in a detailed case study. Eighteen blood and 14 tissue and fluid samples were taken at autopsy 16 h after the death of a 34-year-old female from amitriptyline overdose. Ranges of drug concentrations in blood were amitriptyline 1.8 to 20.2 micrograms/mL, nortriptyline 0.6 to 7.3 micrograms/mL, levels were lowest in femoral vein and highest in pulmonary vein blood. Corresponding levels of 17 amino acids showed markedly different patterns of site-to-site variability. There was a strong positive correlation between individual amino acid and drug concentrations in pulmonary blood samples (n = 5), particularly for glycine, leucine, methionine, serine, and valine. In blood samples from the great veins and right heart (n = 10), the correlation was less strong (r = 0.6 to 0.7). Methionine showed a strong positive correlation in pulmonary samples (r = 0.93), and negative correlation in great veing samples (r = -0.68). Lactic acid showed a strong negative correlation in pulmonary samples (r = -0.93) but a positive correlation in great vein samples (r = 0.71). Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, gamma-glutamyl transferase, glucose, and bilirubin had a weak positive correlation with drug levels in great vein samples but not pulmonary samples. The results suggest that hepatic enzymes are relatively poor markers for postmortem hepatic drug shifts but that amino acids, particularly methionine, may be useful markers for pulmonary drug shifts.
Asunto(s)
Amitriptilina/farmacocinética , Antidepresivos/farmacocinética , Biomarcadores/análisis , Cambios Post Mortem , Adulto , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aminoácidos/sangre , Amitriptilina/análisis , Amitriptilina/orina , Antidepresivos/análisis , Antidepresivos/orina , Aspartato Aminotransferasas/sangre , Bilis/química , Bilirrubina/sangre , Biomarcadores/sangre , Biomarcadores/orina , Glucemia/análisis , Duodeno/química , Femenino , Medicina Legal , Humanos , Yeyuno/química , Hígado/química , Pulmón/química , Metionina/sangre , Músculo Esquelético/química , Nortriptilina/análisis , Nortriptilina/farmacocinética , Nortriptilina/orina , Distribución Tisular , Cuerpo Vítreo/química , gamma-Glutamiltransferasa/sangreRESUMEN
This study is the first presentation of three-dimensional computed tomography (3D-CT) for the in vitro evaluation of the prenatal human cranium. The study was based on CT examinations from 26 aborted normal fetuses between 10 and 25 weeks gestational age. Incremental coronal and transverse CT slices of 1 mm thickness and a threshold segmentation algorithm were used to generate 3D-CT reconstructions (surface-shaded display, SSD) of the cranial bones similar to their anatomical appearance. The threshold of the segmentation algorithm was selected after comparison of the 3D-CT images generated with varying thresholds and graphically reconstructed histological serial sections of particular sutures in five specimens. The variation of the segmentation threshold resulted in alterations of the bone sizes and suture widths. However, 3D-CT images allowed sensitive identification of the cranial ossification centers and accurate evaluation of the bone topography. Cutting and rotating procedures made it possible to evaluate all imaged bones in arbitrary views without disturbing superpositions, thus making isolated examinations of particular macroscopic sections of the specimens unnecessary. In conclusion, 3D-CT of the fetal cranium promises to be of considerable help in the evaluation of prenatal cranial development.
Asunto(s)
Huesos Faciales/embriología , Cráneo/embriología , Algoritmos , Anatomía Transversal , Desarrollo Embrionario y Fetal , Huesos Faciales/diagnóstico por imagen , Edad Gestacional , Humanos , Osteogénesis/fisiología , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
A technique for otoplasty is presented, which combines the advantages of different methods. The procedure includes a dorsal skin excision, a cartilage incision at the border between the concha and scapha, scoring of the crus superior on the anterior side, and if necessary a reduction of the conchal height and modification of the position of the cauda helicis by cartilage excision. The results of the treatment of 526 ears in 312 patients are retrospectively analysed by a patient questionnaire and a chart review.
Asunto(s)
Oído Externo/cirugía , Adolescente , Adulto , Vendajes , Niño , Preescolar , Cicatriz/etiología , Procedimientos Quirúrgicos Dermatologicos , Cartílago Auricular/cirugía , Enfermedades del Oído/patología , Enfermedades del Oído/cirugía , Oído Externo/anomalías , Oído Externo/patología , Estética , Femenino , Humanos , Queloide/etiología , Masculino , Satisfacción del Paciente , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Recurrencia , Estudios Retrospectivos , Trastornos de la Sensación/etiología , Encuestas y Cuestionarios , Técnicas de SuturaRESUMEN
We evaluated postmortem diffusion of gastric drug residue into tissues and blood in eight suicidal overdoses. Analyses were performed on liver (five sites), lung (four sites), spleen, psoas muscle and kidney (left and right), blood (peripheral and torso), vitreous, pericardial fluid, bile and, urine as well as residual gastric contents. Standard analytical techniques and instrumentation gas chromatograph/mass spectrometer and high performance liquid chromatography (GC-MS and HPLC) were used throughout. These case studies confirm previous studies of an animal and human cadaver model of gastric diffusion, in that in several instances there was drug accumulation in the left posterior margin of the liver and, to a lesser extent, the left basal lobe of the lung. Uncontrollable variables, such as postmortem interval, refrigeration before autopsy, and position of the body appear to influence significantly drug accumulation in a specific site. We suggest that autopsy sampling techniques should be standardized on blood taken from a ligated peripheral (preferably femoral or external iliac) vein, and liver from deep within the right lobe.
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Acetaminofén/envenenamiento , Amitriptilina/envenenamiento , Dextropropoxifeno/envenenamiento , Hígado/química , Pulmón/química , Temazepam/envenenamiento , Acetaminofén/farmacocinética , Adulto , Amitriptilina/farmacocinética , Dextropropoxifeno/farmacocinética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cambios Post Mortem , Reproducibilidad de los Resultados , Suicidio , Temazepam/farmacocinética , Distribución TisularRESUMEN
1. Sulphur mustard reacts directly with benzenethiols and cysteine esters in aqueous medium. 2. Benzenethiols diffuse into lung slices in short term culture. 3. Treatment of lung slices in short term culture with benzenethiols does not protect cellular glutathione from conjugation with sulphur mustard. 4. Following uptake of cysteine ester into lung slices cysteine is elevated but this does not protect cellular glutathione from sulphur mustard.
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Carcinógenos/toxicidad , Sustancias para la Guerra Química/toxicidad , Glutatión/metabolismo , Pulmón/efectos de los fármacos , Gas Mostaza/toxicidad , Compuestos de Sulfhidrilo , Animales , Cisteína/análogos & derivados , Cisteína/farmacología , Inactivación Metabólica , Pulmón/metabolismo , Masculino , Fenoles/farmacología , RatasAsunto(s)
Vías Clínicas , Discectomía/enfermería , Tiempo de Internación , Dolor Postoperatorio/prevención & control , Cuidados Posoperatorios/normas , Servicio de Cirugía en Hospital/normas , Discectomía/efectos adversos , Control de Formularios y Registros , Hospitales Universitarios/organización & administración , Humanos , Dolor Postoperatorio/tratamiento farmacológico , PennsylvaniaRESUMEN
The current and future health care environment demands that health care providers place increased emphasis on the achievement of acceptable patient outcomes within an effective timeline and with more efficient use of resources. Clinical pathways provide a tool that defines the processes and activities that must occur to meet these goals. The purpose of this study is to describe a process for analysis of clinical and fiscal outcomes of a clinical pathway initiated at an academic medical center for elective abdominal aortic aneurysm repair. Patients were monitored throughout their preoperative and postoperative course to identify and trend variances, assess opportunities for improved resource use, and determine patient/family satisfaction. Data were collected by use of multiple electronic databases available within the university information systems network and analyzed to determine impact on patient charges, treatment course, and length of stay. Outliers were profiled as a means to identify prognostic indicators or establish a high preoperative risk. Results of a sample of 42 patients revealed a reduction in gross charges by 33% per case in comparison to the baseline data obtained before pathway implementation. This study will describe the rationale and process for instituting changes in resource use, such as diagnostic testing and blood use. Clinical outcomes and related nursing implications will also be discussed, including preoperative management, a streamlined same-day admission process, and factors associated with prolonged stay in the intensive care unit. Finally, strategies designed to enlist the support and participation of nurses, physicians, and other health team members will be discussed.