Informatics and public health at CDC.

Since CDC acquired its first mainframe computer in 1964, the use of information technology in public health practice has grown steadily and, during the past 2 decades, dramatically. Public health informatics (PHI) arrived on the scene during the 1990s after medical informatics (intersecting information technology, medicine, and health care) and bioinformatics (intersecting mathematics, statistics, computer science, and molecular biology). Similarly, PHI merged the disciplines of information science and computer science to public health practice, research, and learning. Using strategies and standards, practitioners employ PHI tools and training to maximize health impacts at local, state, and national levels. They develop and deploy information technology solutions that provide accurate, timely, and secure information to guide public health action.

The DAZL1 gene is expressed in human male and female embryonic gonads before meiosis.

The human DAZL1 gene (known also as DAZH or DAZLA) is the autosomal homologue of the Y-chromosomal DAZ gene which has been found to be deleted in azoospermic males. Evidence suggests that the role of DAZL1 may not be restricted to spermatogenesis, but may include oogenesis as well. In order to study the function of human DAZL1 gene in the ovary, we observed its expression pattern during embryonic development. RNA in-situ hybridization showed that DAZL1 transcripts were localized to a subset of cells (somatic versus germ cells) in human embryonic ovary (23 weeks of gestation) and testis (21 weeks gestation). In the ovary, DAZL1 transcripts were found in oogonia and in oocytes and granulosa cells of primordial follicles. In the testis, DAZL1 transcripts were identified exclusively in the germ cells. Our results demonstrate high similarity between the human DAZL1 and the mouse Dazl1 gene expression patterns during embryonic development, suggesting that the human gene functions at the first phase of gametogenesis, just as in the mouse, where Dazl1 mutations cause male and female sterility.

The Dazh gene is expressed in male and female embryonic gonads before germ cell sex differentiation.

The autosomal homologs of the human Y-chromosomal DAZ gene (DAZH and Dazh in human and mouse, respectively) are strong candidate for Azoospermia factor and encode a testis specific RNA-binding proteins. We studied the expression pattern of the mouse Dazh during embryonic development by using Northern-blotting of developing gonads. In the mouse, we have detected 3.5 kb and 4.5 kb transcripts in male and female embryonic gonads at 12.5 dpc (days post coitum). During this period, the only germ cells present in the gonad are primordial germ cells. Dazh transcripts were not detected in embryonic gonads of mice that lack germ cells because of mutation in W gene, suggesting that expression is limited to germ-cells. In females, oogonia enter meiosis at 13.5-14.5 dpc: at this time Dazh transcription levels are similar to those of the male (when prospermatogonia are in the male gonad). Transcription levels decrease steadily after birth as the number of oocytes is depleted and is hardly detectable by puberty. A human DAZH transcript was also detected by Northern-blotting in the human ovary in levels which are of about 100 fold lower than those observed in the human testis. The expression of the Dazh in male and female gonad before germ cell sex differentiation suggests that these genes may act at the first phase of male and female gametogenesis.

Balloon tamponade: an alternative in the treatment of liver trauma.

Penetrating hepatic injury remains a therapeutic challenge for the surgeon. Surgical technique for the management of penetrating hepatic trauma includes balloon tamponade, which is most useful for central gunshot wounds that pass through both lobes. Our patient had two entrance wounds and no exit wounds. However, a bullet was palpable in the subcutaneous tissue just beneath the right shoulder in the supraclavicular region. A Penrose drain and red rubber catheter balloon device were placed in the abdominal cavity. The balloon device was inflated for 48 hours, after which the Penrose drain was allowed to slowly deflate and was removed. The abdomen was re-explored, found to be negative, and then closed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 14. The use of balloon tamponade is an option that should be kept in the surgeon's armamentarium for use in selected patients with hepatic trauma.

Effects of castration on thiol status in rat spermatozoa and epididymal fluid.

Mammalian spermatozoa gain their fertilizing ability as they mature in the epididymis, a process which is accompanied by oxidation of sperm protein thiols. Since sperm maturation is dependent upon normal androgenic support to the epididymis, the present work was designed to study the effects of castration on thiol status. Spermatozoa and epididymal fluid were isolated from the epididymides of male rats 5 days after castration or after 11 daily injections of the antiandrogen, cyproterone acetate. Spermatozoa and epididymal fluid were labeled with the fluorescent thiol labeling agent monobromobimane. Intact spermatozoa were evaluated by fluorescence microscopy, protein thiols were analyzed by electrophoresis, and fertilizing ability was examined after insemination of sperm suspension into the uterine horns of immature superovulated female rats. We found that both treatments resulted in an increase in cauda sperm thiols as shown by increased fluorescence in the intact spermatozoa. Protamines and nonbasic proteins were found to have increased levels of reactive thiols. The protein profiles of epididymal fluid from castrated rats were different from those of the controls, and the fluorescence patterns corresponded to the protein profiles. Our results indicate that testosterone withdrawal leads to inhibition of sperm thiol oxidation.

Common bile duct injury after laparoscopic cholecystectomy: report of two cases.

With a few exceptions, laparoscopic cholecystectomy has rapidly supplanted open cholecystectomy as the operation of choice for symptomatic cholelithiasis. The risk of bile duct injury using the laparoscopic technique is almost twice that of the open technique (0% to 1% vs 0% to 0.5%). There appears to be a direct correlation between the number of cases an individual surgeon performs and the frequency of bile duct injury. The nature of bile duct injuries following the laparoscopic technique tends to be more serious than those seen following the open procedure. In addition, more than 50% of bile duct injuries go undetected at the time of operation. A number of technical steps can be taken to help prevent bile duct injuries when using the laparoscopic technique. This article reports two such cases to alert the surgeon that a high index of suspicion must always be maintained concerning the possibility of bile duct injury following laparoscopic cholecystectomy.

Developing an economic model to reduce costs in a reengineered hospital environment.

In its recent reengineering efforts, the Mount Sinai Hospital developed economic tools to assure that this major restructuring project would reach its predetermined financial objectives. We discuss how these tools were designed and implemented and what impact they had.

Mouse autosomal homolog of DAZ, a candidate male sterility gene in humans, is expressed in male germ cells before and after puberty.

Deletion of the Azoospermia Factor (AZF) region of the human Y chromosome results in spermatogenic failure. While the identity of the critical missing gene has yet to be established, a strong candidate is the putative RNA-binding protein DAZ (Deleted in Azoospermia). Here we describe the mouse homolog of DAZ. Unlike human DAZ, which is Y-linked, in mouse the Dazh (DAZ homolog) gene maps to chromosome 17. Nonetheless, the predicted amino acid sequences of the gene products are quite similar, especially in their RNP/RRM (putative RNA-binding) domains, and both genes are transcribed predominantly in testes; the mouse gene is transcribed at a lower level in ovaries. Dazh transcripts were not detected in testes of mice that lack germ cells. In testes of wildtype mice, Dazh transcription is detectable 1 day after birth (when the only germ cells are prospermatogonia), increases steadily as spermatogonial stem cells appear, plateaus as the first wave of spermatogenic cells enters meiosis (10 days after birth), and is sustained at this level thereafter. This unique pattern of expression suggests that Dazh participates in differentiation, proliferation, or maintenance of germ cell founder populations before, during, and after the pubertal onset of spermatogenesis. Such functions could readily account for the diverse spermatogenic defects observed in human males with AZF deletions.

Thiol-disulfide status of human sperm proteins.

The thiol-disulfide status in proteins of human spermatozoa categorized as normozoospermic, teratozoospermic and asthenozoospermic was examined. Washed spermatozoa were incubated with or without dithiothreitol (DTT) to reduce disulfides (SS) to thiols (SH), and then labelled with the specific fluorescence thiol labelling agent monobromobimane (mBBr). The SH and SS in intact labelled spermatozoa were evaluated by fluorescence microscopy and by flow cytometry analysis; mBBr-labelled spermatozoa were solubilized and sperm proteins analysed by gel electrophoresis (SDS-PAGE for non-basic, whole sperm proteins and acid urea-PAGE for sperm nuclear basic proteins). Microscopy and flow cytometry showed that normozoospermic samples (having normal sperm count, morphology and motility) contained both SH and SS, with more SS than SH. Heterogeneity in the proportion of SH/(SH plus SS) was observed among spermatozoa within the ejaculates. The total SH plus SS was similar among the ejaculates, with some variability in SH/(SH plus SS) noted among them. SDS-PAGE of solubilized normozoospermic cells showed differences in the SH and SS content of the protein bands. Acid urea-PAGE of basic proteins isolated from normozoospermic samples showed protamines P1 and P2 and traces of non-protamine basic proteins. P1 and P2 contained SH and SS, with variability in SH/(SH plus SS) observed among the samples. Teratozoospermic samples (in which > 90% of the spermatozoa exhibited abnormal morphology) were similar in thiol-disulfide status to normozoospermic samples, but contained non-protamine basic proteins in addition to protamines.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of caput ligation on rat sperm and epididymis: protein thiols and fertilizing ability.

Mammalian spermatozoa mature while passing through the epididymis. Maturation is accompanied by thiol oxidation to disulfides. In rats, sperm become motile and fertile in the cauda. We have previously demonstrated that rat caput sperm contain mostly thiols and that upon passage from the corpus to the cauda epididymidis, sperm protein thiols are oxidized. The present work was undertaken to study the role of the regions of the epididymis in sperm maturation as reflected in the thiol status, fertility, and motility of the spermatozoa. The distal caput epididymidis of mature albino rats was ligated on one side. After 5 days, sperm were isolated from the ligated caput and from caput and cauda of the control side. Thiol groups in sperm, epididymal luminal fluid (EF), and epididymal tissue were labeled using the fluorescent thiol-labeling agent monobromobimane. After ligation, changes were observed in a) sperm proteins, sperm nuclear proteins, and epididymal fluid by electrophoresis; b) epididymal tissues by histochemistry; c) progressive motility by phase microscopy; and d) fertilizing ability after insemination into uteri of immature females. We found that after ligation, caput sperm thiols, especially protamine thiols, are oxidized, rendering them similar to mature sperm isolated from the cauda epididymidis. Spermatozoa from ligated caput epididymidis gain progressive motility and partial fertilizing ability. Morphology of epithelial cells of ligated caput is similar to that of cauda cells. However, other changes in caput EF and epithelium induced by ligation render the ligated caput epididymidis different from either control caput or cauda. Hence, sperm thiol oxidation, along with the development of fertilizing ability, can occur in sperm without necessity for sperm transit through the corpus and cauda epididymidis.

Protein thiols in spermatozoa and epididymal fluid of rats.

Thiol (SH) oxidation to disulphides (SS) is thought to be involved in sperm chromatin condensation and tail structure stabilization, which occur during maturation of spermatozoa. Previously developed procedures, using the fluorescent labelling agent monobromobimane (mBBr), enabled us to study the thiol-disulphide status of spermatozoa. Electrophoretic separation of labelled sperm proteins from the caput and cauda regions showed that during maturation thiol oxidation occurs in many protein fractions from the tail and that the magnitude of oxidation differs between proteins. Among the protein bands, one major band (MPB), probably a dense fibre constituent, is quantitatively prominent. N-Ethylmaleimide (NEM) or mBBr alkylation (of intact spermatozoa) changes the mobility of the caput MPB, but not that of the cauda MPB. The results indicated that the altered mobility of MPB is mainly due to a change in its shape, possibly resulting from the alkylation of a few critical SH groups. Epididymal fluid proteins contain both SH and SS. The thiol and disulphide content of the various epididymal proteins appears similar, although some diminution in fluorescence is seen in epididymal fluid proteins from the cauda region as compared with those from the caput region. The prominent changes in thiol status occur in the spermatozoa.

The histomorphologic and morphometric study of asymptomatic hip arthroplasty. A postmortem study.

The purpose of this study was to determine the histologic findings at the bone-cement interface in successful asymptomatic total hip replacements (THR) retrieved from patients at autopsy. The criteria for a successful hip arthroplasty were clinical, radiologic, and direct examination of the prosthesis at the time of harvesting. Twelve patients with a total of 14 cemented hip arthroplasties came to autopsy at a mean of 4.7 years after implantation. A detailed histomorphometric objective means of assessing the tissue response was applied to the membrane. The density of histiocytes correlated with the thickness of the membrane, the density of polyethylene particles, and the time after implantation. The fibrohistiocytic membrane in this group of patients was similar to that described in the literature in cases of loose THRs. These findings advance current understanding of transcellular particle transportation (directional exocytosis) in tissue reactions to endoprostheses of THR.

Sperm analysis by flow cytometry using the fluorescent thiol labeling agent monobromobimane.

The fluorescent labeling agent monobromobimane (mBBr) was used to label thiols and disulfides (after reduction of sperm disulfides by dithiothreitol) in intact spermatozoa. Bimane-labeled sperm of several mammalian species were analyzed by flow cytometry (FCM) and examined by fluorescent microscopy. FCM analysis showed sperm thiol oxidation to disulfides during epididymal maturation. FCM of labeled mature spermatozoa showed differences among species in the sperm thiol content. Heterogeneity in thiol content of sperm within individual samples was also observed. In addition, FCM patterns showed heterogeneity among and within samples in the content of disulfides and their resistance to reduction. FCM analysis reflected the microscopic appearance of the labeled spermatozoa. FCM analysis of bimane-labeled spermatozoa offers a convenient method for the study of sperm thiol-disulfide status and permits detection of sperm subpopulations within an individual sample. FCM analysis of mBBr-labeled spermatozoa may serve as a test to evaluate sperm quality.

Thiol status in human sperm.

The passage of spermatozoa along the epididymis is characterized by a gradual stabilization of intracellular organelles mainly through the oxidation of thiol groups. In this study, we examined the relationship between the thiol-disulfide status of human spermatozoa (using a specific fluorescent probe, monobromobimane) and routine semen analysis parameters. Fluorescence intensity was measured by spectrofluorimeter and its frequency distribution within samples, using a fluorescence-activated cell sorter. The mean proportion of reactive thiols SH/(SS + SH) in 29 semen samples was 29.8% +/- 2.5%. When comparing thiol labeling patterns, oligozoospermic samples differed from normozoospermic ones (P less than 0.05). However, within the normozoospermic group, no correlation was found between thiol-labeling patterns and routine sperm parameters or fertilizing capacity in vitro. No difference in thiol labeling patterns was found between "swim-up" and "whole semen" preparations.

Dynamics of the thiol status of rat spermatozoa during maturation: analysis with the fluorescent labeling agent monobromobimane.

Mammalian spermatozoa undergo maturation as they pass through the epididymis. Maturation is accompanied by the oxidation of thiols to disulfides. Disulfides are probably involved in sperm chromatin condensation and tail structure stabilization. In this work, we used the fluorescent thiol-labeling agent monobromobimane to determine the changes occurring in thiols and disulfides in rat sperm heads and tails during maturation. Spermatozoa were obtained from testis, epididymis (caput, corpus, cauda, and vas deferens), and ejaculate. Intact spermatozoa were labeled with monobromobimane, with or without pretreatment with dithiothreitol. Labeling was evaluated microscopically, and quantitative analysis was carried out spectrofluorimetrically with labeled globin used as a standard. Samples were also analyzed by gel electrophoresis. The total amount of thiols and disulfides remained the same during the entire period of sperm maturation (26 +/- 0.5 nmoles thiols + disulfides/10(6) spermatozoa). However, the reactive thiols decreased markedly between the corpus and the cauda (from greater than 90% of total in testis and 75% in corpus to about 25% in cauda), with little or no further change in vas deferens and ejaculated sperm. Trypsin treatment followed by sucrose gradient was used to separate the heads from the tails. Thiols comprised 84% of the total SH + SS in the heads and 74% in the tails of caput spermatozoa, decreasing to 14% and 45%, respectively, in cauda sperm. Thus, the decrease in reactive thiols involved both heads and tails-oxidation to disulfides being very marked in the head. Electrophoresis revealed that oxidation of thiols to disulfides occurred in many protein fractions during maturation in the epididymis.

Centrode characteristics of the lumbar spine as a function of segmental instability.

A cadaveric study provides a quantitative measurement of early degenerative disc disease before significant radiographic changes are present. Accurate assessment of spinal motion is hampered by the inaccessibility of the lumbar joints and because of the small range of motion at each motion segment. Using Moiré fringes and, more recently, computerized digitization of spinal motion, the authors have developed a technique of measuring centers of rotation for small ranges of motion. The centers of rotation when joined form a locus that has characteristics that allow one to identify spines with degenerative disc disease. These loci, or centrodes, are longest in the earliest stages of degeneration, but maintain their length through moderate degenerative disc disease. Furthermore, radiographic changes consistent with moderate disc disease are associated with inferior migration of the centrode.

Centrode patterns and segmental instability in degenerative disc disease.

Moiré fringes were used to determine centrode patterns in cadaveric spines with degenerative disc disease. The normal centrodes were compared with those with minor, mild, moderate, and severe degenerative disc disease. The most complex loci noted were those discs that showed minimal radiographic evidence of degeneration, that is, the minor and mild groups. The loci lengthened significantly (P less than 0.001) when compared with normal controls. The position of the centrode shifted downward into the body of L5 in the moderate group.

Moiré patterns: an accurate technique for determination of the locus of the centres of rotation.

This study describes an accurate technique for the determination of the centre of rotation of small angles. The moiré fringe method localizes the centre of rotation by defining two primary fringes, each of which is found by the intersection of three lines. The primary fringes intersect at the centre of rotation at 90 degrees to each other, the angle least likely to produce an error in measurement. By utilizing joints with known centres of rotation, we have found that the method is extremely accurate and reproducible to within 2 mm of the real centre for angular changes as small as 3 degrees. This technique is useful in evaluating whether a joint is a simple hinge, i.e. rotating about a single axis of rotation or whether the joint moves about a changing axis of rotation referred to as a locus or centrode.