Numerical Simulations of Realistic Lead Trajectories and an Experimental Verification Support the Efficacy of Parallel Radiofrequency Transmission to Reduce Heating of Deep Brain Stimulation Implants during MRI.

Patients with deep brain stimulation (DBS) implants may be subject to heating during MRI due to interaction with excitatory radiofrequency (RF) fields. Parallel RF transmit (pTx) has been proposed to minimize such RF-induced heating in preliminary proof-of-concept studies. The present work evaluates the efficacy of pTx technique on realistic lead trajectories obtained from nine DBS patients. Electromagnetic simulations were performed using 4- and 8-element pTx coils compared with a standard birdcage coil excitation using patient models and lead trajectories obtained by segmentation of computed tomography data. Numerical optimization was performed to minimize local specific absorption rate (SAR) surrounding the implant tip while maintaining spatial homogeneity of the transmitted RF magnetic field (B1+), by varying the input amplitude and phase for each coil element. Local SAR was significantly reduced at the lead tip with both 4-element and 8-element pTx (median decrease of 94% and 97%, respectively), whereas the median coefficient of spatial variation of B1+ inhomogeneity was moderately increased (30% for 4-element pTx and 20% for 8-element pTx) compared to that of the birdcage coil (17%). Furthermore, the efficacy of optimized 4-element pTx was verified experimentally by imaging a head phantom that included a wire implanted to approximate the worst-case lead trajectory for localized heating, based on the simulations. Negligible temperature elevation was observed at the lead tip, with reasonable image uniformity in the surrounding region. From this experiment and the simulations based on nine DBS patient models, optimized pTx provides a robust approach to minimizing local SAR with respect to lead trajectory.

Protein pattern transfer for biosensor applications.

This paper presents a very simple, industrially scalable method for transferring a high-resolution, biologically active protein pattern from one substrate to another. We demonstrate the transfer of a protein pattern formed initially by microcontact printing from a silicon surface (to which this form of printing is applicable) onto a glass or polymer substrate, almost independently of the surface/bulk properties of the second substrate. A very thin, spin-coated layer of a sugar is used to preserve the structure and organization of proteins during the subsequent plasma deposition of a siloxane polymer, after which the protein pattern could simply be peeled off the silicon substrate and glued onto any other desired substrate.

A limited autoimmunity to p185neu elicited by DNA and allogeneic cell vaccine hampers the progression of preneoplastic lesions in HER-2/NEU transgenic mice.

Prevention of the progression of precancerous lesions by vaccines is virtually uncharted territory. Their potential, however, is being assessed in transgenic mice which develop autochthonous tumors with defined stages of progression. In this paper we show that the DNA micro-array technology significantly helps assessment of the preventive efficacy of a combined DNA and cell vaccine. All female rat Her-2/neu transgenic BALB/c (BALB-neuT) mice develop an invasive carcinoma in each of their mammary glands within 25 weeks of age. This is elicited by the activated transforming rat Her-2/neu oncogene embedded in their genome. We have previously shown that vaccination of mice bearing multiple in situ carcinomas with DNA plasmids which code for the extracellular and transmembrane domain of rat p185neu, the product of the rat Her-2/neu oncogene, followed by a boost with rat p185neu+ allogeneic cells engineered to secrete interferon-gamma, keeps 48% of mice tumor free until week 32. We have now extended our follow-up until mice reach one year of age and show that protection vanishes as time progresses. This observation suggests that the accuracy of the results studying immunotherapy against life-threatening tumors is a function of the length of the follow-up. The application of microarrays, and the concordance of morphologic and gene expression data led us to identify antibody as the main mechanism induced by vaccination. Protection is associated with a break of tolerance and a limited autoimmunity against the endogenous mouse p185neu.

How will we manage?

Management of perianesthesia nursing units is complex. Comfortable practice that upholds the status quo but does not embrace opportunities may stagnate staff and management. The challenge is to focus on what is done well, and what practice should be questioned. Creating a unit atmosphere that supports change and explores growth requires effective nurse managers. Critical qualities set the tone for professionalism and positive growth of the staff in the unit, and the unit itself.

Informed consent.

Patients have a right to informed consent and a right to forego treatments, procedures, or surgery if they feel uninformed or have changed their minds.

Managing conflict/employee counseling.

Managers and nurse leaders can enhance skills and techniques to manage conflict and subsequent counseling of employees in the workplace. Stress, conflict, issues of miscommunication, and a poor job performance can be handled in a focused, orderly manner. Corrective action plans and documentation of counseling sessions are suggested. A framework for managers to perform self-assessment in counseling performance is provided. Developing specific competency checklists for managers and completing them on an annual basis validates important aspects of the role of nurse managers.

Tell me a story: a walk down ASPAN's memory lane.

Happy Birthday ASPAN! Our Society celebrates its 20th birthday this year. This anniversary issue of the Journal of PeriAnesthesia Nursing, and the 20th National Conference in Boston, 2001, will culminate a year of celebration for ASPAN. In the Breathline (November/December 1999), an article was printed requesting narratives or stories from perianesthesia nurses who are ASPAN members. The invitation was extended to share in the celebration of our success. Over 70 stories were sent in, some quite lengthy and detailed, and others with bulleted information of selected memorabilia. All share the heart and soul of ASPAN and of perianesthesia nursing. The heart of ASPAN is its membership-the memories we share about thefounding of our Society and its meaning in our lives are poignant. The excerpts included in this article are taken from perianesthesia nurses' stories. The member voices are heard, the passion is stirred, and the pride is evident. The stories were displayed at the ASPAN National Conference in Kansas City, MO, in April 2000, during ASPAN's kickoff birthday celebration, Walk Down Memory Lane, sponsored by the ASPAN Foundation through a grant from Stryker, Inc. The Conference was a perfect opportunity to stir the passion of perianesthesia nurses, to remember how we got started, and celebrate what we have become. Milestones, such as this anniversary, are significant events as we consider the past, the roots worth nourishing, and the years ahead. The stories are placed in 1 of 4 themes: Historical Perspective, Regional Pride, Personal Meaning and Passion, and National Conference. Expect to see several other themes emerge as well. Professionalism, mentoring, nursing friendships, focus on patient advocacy, and certification are frequently repeated. As individuals, ASPAN members share their own accomplishments with humility, surprise, and delight. The power and dignity of volunteer efforts and of our specialty Society are palpable. ASPAN thanks each author who took the time and effort to relate theirpersonal memories. Individual credentials for each writer are listed at the end of the article.

[Cefoxitin in the preventive treatment of infectious complications in high-risk gastro-jejuno-colic and biliary surgery]. / La cefoxitina nel trattamento preventivo delle complicanze infettive nella chirurgia gastro-digiuno-colica e biliare a rischio.

Cefoxitin is a bactericidal beta lactam antibiotic of the cephamycins group, with wide antimicrobial efficacy and active against both aerobes and anaerobes. In this study, 58 patients were divided in four groups according to the site of the disease (stomach, gallbladder and biliary tract, jejunum ileum and colon-rectum). The efficacy of cefoxitin in the prophylaxis of surgical infections was assessed for each group and for all patients. When compared with the combination of antibiotics used previously, cefoxitin led to a reduction of the mean duration of fever (7.2 and 5 days respectively with ampicillin/cloxacillin and lincomycin/gentamycin, 3.2 days with cefoxitin). Cefoxitin also led to a reduction in the incidence of surgical infections (50% with ampicillin/cloxacillin, 9.19% with lincomycin/gentamycin, 8.6% with cefoxitin) and in the incidence of localized surgical infections (29.6%, 20.3%, 8.6% respectively). In this study, cefoxitin has been found to be very useful and well tolerated in the prophylaxis of surgical infections.

Surgical treatment of an asymmetric double monstrosity with esophageal atresia, omphalocele, and interventricular defect.

In June 1981, at the Department of Pediatric Surgery, Children's Hospital, Palermo, we successfully operated on a male infant born with a set of accessory lower limbs attached to the sternum, a type IV esophageal atresia, omphalocele, and an interventricular defect (VSD).

[Dupuytren's disease in clinical practice]. / La malattia di Dupuytren nella pratica clinica.

The Authors have investigated the incidence of Dupuytren's disease in the field of internal medicine, they have observed a rather high rate in the old people, especially between 60 and 80 years, and point out the significance of metabolic and genetic factors in the pathogenesis and the development of the disease.

[Dupuytren's disease. Current etiopathogenetic perspectives]. / Malattia di Dupuytren. Prospettive etiopatogenetiche attuali.

The Authors after discussing some of the aetiopathogenetic factors of Dupuytren's disease, have studied the behavior of sera glycemic shape after oral load in 368 patients with Dupuytren's disease, finding a impairment tollerance of glucose in the 93.20% of these patients. This suggest that the impairment of the glycemic metabolism still outside of alcoholic pathology is one important factor in the Dupuytren's disease and perhaps in the development of cirrhosis and hepatica fibrosis.