Receptors with opposing functions are in postsynaptic microdomains under one presynaptic terminal.

Fast excitatory synaptic transmission through vertebrate autonomic ganglia is mediated by postsynaptic nicotinic acetylcholine receptors (nAChRs). We demonstrate a unique postsynaptic receptor microheterogeneity on chick parasympathetic ciliary ganglion neurons-under one presynaptic terminal, nAChRs and glycine receptors formed separate but proximal clusters. Terminals were loaded with [3H]glycine via the glycine transporter-1 (GlyT-1), which localized to the cholinergic presynaptic terminal membrane; depolarization evoked [3H]glycine release that was calcium independent and blocked by the GlyT-1 inhibitor sarcosine. Ganglionic synaptic transmission mediated by nAChRs was attenuated by glycine. Coexistence of separate clusters of receptors with opposing functions under one terminal contradicts Dale's principle and provides a new mechanism for modulating synaptic activity in vivo.

Effect of prolactin versus growth hormone on islet function and the importance of using homologous mammosomatotropic hormones.

The purpose of this study was to determine the effects of homologous rat PRL (rPRL) and rat GH (rGH) on islet B-cell function in neonatal and adult rat islets in vitro. In neonatal rat islets, exposure to rPRL for more than 24 h was necessary for a stimulatory effect on insulin secretion. By day 4, insulin secretion was 3.8-fold greater in the islets cultured with rPRL. rGH had a modest effect on insulin secretion, and this effect was additive with that of rPRL. Both rPRL and rGH increased islet insulin content and [3H]thymidine incorporation. After removal of rPRL, more than 24 h were necessary to detect a reversal in the level of insulin secretion. In addition, even after 5 days without rPRL the previously treated islets still had elevated levels of insulin secretion. In a dose-response study of rPRL on insulin secretion, a detectable effect was observed at 62.5 ng/ml, with a half-maximal effect of approximately 100 ng/ml. Glucose oxidation by neonatal islets was enhanced by rPRL treatment, but not by rGH treatment. In adult rat islets, exposure to rPRL, but not to rGH, enhanced insulin secretion. In contrast, when using heterologous human GH, results similar to those obtained with rPRL, but not rGH, were observed. The results from these experiments indicate that rPRL and rGH have both individual and shared regulatory effects on rat islets. However, it is rPRL and not rGH that has the primary influence on insulin secretion. When interpreting studies examining the effect of GH and PRL on islet function, it is important to consider whether homologous hormones are used.

Changes in apoptosis of human polymorphonuclear granulocytes with aging.

Many alterations with aging occur at the cellular and organic levels in the immune system ultimately leading to a decrease in the immune response. Our aim in the present work was to study apoptosis of polymorphonuclear granulocytes (PMN) with aging under various stimulations since apoptosis might play an important role in several pathologies encountered with aging. The PMN of healthy young (20-25 years) and elderly (65-85 years) subjects were examined after 24 h of sterile culture with and without stimulation. The stimulating agents included: phorbol myristate acetate (PMA), hydrogen peroxide (H2O2), N-formyl-methionyl-leucyl phenylalanine (FMLP), granulocyte-macrophage colony stimulating factor (GM-CSF), reduced glutathione (GSH), lipopolysaccharide (LPS) and interleukin 2 (IL-2). Apoptosis was assessed by traditional staining of the plates, by flow cytometric staining and DNA gel electrophoresis. It was found that without stimulation the susceptibility of PMN to apoptosis was slightly increased with aging. Under various stimulations, such as PMA. H2O2, apoptosis was almost 100%, while the treatment by FMLP, oxLDL and GSH did not change its extent in PMN obtained either from young or elderly subjects. Marked age-related changes were observed in the extent of apoptosis under stimulation with GM-CSF, IL-2 and LPS. These agents were able to significantly prevent apoptosis in PMN of young subjects, while only the GM-CSF was able to slightly modulate it in neutrophils of elderly subjects. From these results, we suggest that changes in apoptosis of PMN with aging could play a role in the increased incidence of certain immune system related pathologies of aging, such as cancer, infections and autoimmune disorders.

Synaptic interactions regulate gephyrin expression in avian cholinergic neurons in vivo.

Our recent studies of chick parasympathetic ciliary ganglion (CG) neurons demonstrate a unique postsynaptic receptor microheterogeneity - under one presynaptic terminal, excitatory nicotinic acetylcholine receptor (nAChR) clusters and separate inhibitory glycine receptor (GlyR) clusters coexist in distinct membrane microregions. Gephyrin, a peripheral membrane protein that is required for GlyR clustering at synapses in the rodent central nervous system, is also expressed in chick CG neurons where it codistributes with GlyRs, but not nAChRs. We now extend these findings by characterizing the regulation of gephyrin expression in chick CG neurons in vivo. We show that developmental increases in gephyrin transcript levels occur during pre- and postganglionic synapse formation. The increases are induced by both innervation and target tissue interactions, with the target tissues having the greater regulatory influence. The time course of the developmental rise in gephyrin mRNA levels most closely resembles that reported for functional GlyR expression, but not that of functional nAChRs nor GABA(A) receptors. We also demonstrate that gephyrin is concentrated in the postsynaptic density of a subset of synapses on both the ciliary and choroid neurons in the CG and is stably expressed from embryonic to adult stages. Altogether, our results suggest that gephyrin is a synapse organizing molecule that functions to localize GlyRs, but not nAChRs, to discrete postsynaptic membrane microregions in chick CG neurons in vivo.

A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy.

In a prospective, randomized study, continuous infusion of epidural fentanyl citrate (group E) was compared with patient-controlled intravenously administered morphine sulfate (group P) for analgesia in 66 men after radical retropubic prostatectomy. Although both methods provided satisfactory analgesia, the mean comfort level scores were lower (that is, greater comfort) in group E than in group P at all observation times. The difference in mean resting comfort level scores between groups E and P was statistically significant (P < or = 0.05) at 9 of the 11 observation times. In addition, significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing, 5 of 11 during coughing, and 3 of 9 during ambulation. Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower (that is, less pain) in group E than in group P for all four categories of activity. The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing. No significant differences were noted in side effect profiles or duration of hospital stay. In summary, when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospectively, patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine, as evidenced by lower mean, maximal, and minimal comfort level scores and a greater proportion of patients with complete relief of pain.

Prototype Continuous Flow Ventricular Assist Device Supported on Magnetic Bearings.

This article describes a prototype continuous flow pump (CFVAD2) fully supported in magnetic bearings. The pump performance was measured in a simulated adult human circulation system. The pump delivered 6 L/min of flow at 100 mm Hg of differential pressure head operating at 2,400 rpm in water. The pump is totally supported in 4 magnetic bearings: 2 radial and 2 thrust. Magnetic bearings offer the advantages of no required lubrication and large operating clearances. The geometry and other properties of the bearings are described. Bearing parameters such as load capacity and current gains are discussed. Bearing coil currents were measured during operation in air and water. The rotor was operated in various orientations to determine the actuator current gains. These values were then used to estimate the radial and thrust forces acting on the rotor in both air and water. Much lower levels of force were found than were expected, allowing for a very significant reduction in the size of the next prototype. Hemolysis levels were measured in the prototype pump and found not to indicate damage to the blood cells.

Practical applications of skin biomechanics.

The biomechanical properties of skin have an important influence on plastic surgical decisions. They aid the surgeon in planning elective incisions, excisions, or scar revisions. They provide insight into the most appropriate method of coverage of skin defects as well as the design of an artificial skin substitute. Skin biomechanics can, in part, be characterized in vivo by either a skin extensiometer or by studying the deformation of skin defects. These methods indicate the magnitude and directional orientation of skin tensions which are dependent partly on the mechanical characteristics of the dermal fibers and partly on the pattern in which they are woven. The tensions to which the skin are subjected can be classified as either static or dynamic in origin. Static skin tensions are the natural tensions existing in skin. The magnitude of static tensions varies between individuals, at different sites in the same person, and in different directions in many sites. The dynamic tensions are caused by a combination of forces which are associated with joint movement, mimetic and other voluntary muscle activity, and gravity. Knowledge of these tensions allows the surgeon to align the operative site in the direction of maximal tension and to approximate the wound with the least amount of tension. As a consequence of this, the scar healing between the cut edges of the wound should be narrow and inconspicuous.

Particle image velocimetry measurements of blood velocity in a continuous flow ventricular assist device.

The third prototype of a continuous flow ventricular assist device (CFVAD3) is being developed and tested for implantation in humans. The blood in the pump flows through a fully shrouded four-bladed impeller (supported by magnetic bearings) and through small clearance regions on either side of the impeller. Measurements of velocities using particle image velocimetry of a fluid with the same viscosity as blood have been made in one of these clearance regions. Particle image velocimetry is a technique that measures the instantaneous velocity field within an illuminated plane of the fluid field by scattering light from particles added to the fluid. These measurements have been used to improve understanding of the fluid dynamics within these critical regions, which are possible locations of both high shear and stagnation, both of which are to be avoided in a blood pump. Computational models of the pump exist and these models are currently being used to aid in the design of future prototypes. Among other things, these models are used to predict the potential for hemolysis and thrombosis. Measurements of steady flow at two operating speeds and flow rates are presented. The measurements are compared with the computed solutions to validate and refine, where necessary, the existing computational models.

Implantable centrifugal pump with hybrid magnetic bearings.

Test methods and results of in vitro assessment of a centrifugal pump with a magnetically suspended impeller are provided. In vitro blood tests have been completed with a resulting normalized milligram index of hemolysis (NmIH) of 12.4 +/- 4.1, indicating that hemolysis is not a problem. Hydraulic characterization of the system with water has shown that a nominal pumping condition of 6 L/min at 100 mmHg was met at 2,200 rpm. Maximum clinically usable cardiac output is predicted be 10 L/min. The magnetic bearing supported impeller did not contact the housing and was shown to be stable under a variety of pumping conditions. The driving motor efficiency is 75% at the nominal condition. Finally, a description of the clinical version of the pump under development is provided.

Collected nondimensional performance of rotary dynamic blood pumps.

"Nonpulsatile" or "continuous flow" blood pumps are a relatively new application of the rotary dynamic blood pumping principle. They fall outside the normal envelop of pumps, considering their small size, viscosity of the fluid pumped, need for particularly good internal flow patterns, and desire for high efficiency. This article establishes the state of the art in the field of blood pump performance. Trends in efficiency, shut off pressure coefficient, and nondimensional power behavior as a function of nondimensional flow are identified. Blood pumps show agreement with the published effects of low Reynolds numbers in conventional pumps.

Numerical studies of blood shear and washing in a continuous flow ventricular assist device.

The third prototype of a continuous flow ventricular assist device (CF3) is being developed and tested for implantation in humans. The blood in the pump flows through a fully shrouded four bladed impeller (supported by magnetic bearings) and through small clearance regions on either side of the impeller. Computational fluid dynamics (CFD) solutions for this flow have been obtained by using TascFlow, a software package available from AEA Technology, UK. These flow solutions have been used to estimate the shear stresses on the blood in the pump and, hence, to minimize hemolysis. In addition, the solutions are informative for achieving a design that will provide good washing of the blood to minimize the possibility of stagnation points that can lead to thrombosis. This study presents numerical studies of these phenomena in the CF3. The calculated shear rate results are compared with values published in the open literature. The comparisons indicate that hemolysis will not be a problem with CF3, which is in agreement with preliminary experimental measurements. Flow studies are being conducted to determine the optimal size of the clearance regions.

In vitro characterization of a magnetically suspended continuous flow ventricular assist device.

A magnetically suspended continuous flow ventricular assist device using magnetic bearings was developed aiming at an implantable ventricular assist device. The main advantage of this device includes no mechanical wear and minimal chance of blood trauma such, as thrombosis and hemolysis, because there is no mechanical contact between the stationary and rotating parts. The total system consists of two subsystems: the centrifugal pump and the magnetic bearing. The centrifugal pump is comprised of a 4 vane logarithmic spiral radial flow impeller and a brushless DC motor with slotless stator, driven by the back emf commutation scheme. Two radial and one thrust magnetic bearing that dynamically controls the position of the rotor in a radial and axial direction, respectively, contains magnetic coils, the rotor's position sensors, and feedback electronic control system. The magnetic bearing system was able to successfully suspend a 365.5g rotating part in space and sustain it for up to 5000 rpm of rotation. Average force-current square factor of the magnetic bearing was measured as 0.48 and 0.44 (kg-f/Amp2) for radial and thrust bearing, respectively. The integrated system demonstrated adequate performance in mock circulation tests by providing a 6 L/min flow rate against 100 mmHg differential pressure at 2300 rpm. Based on these in vitro performance test results, long-term clinical application of the magnetically suspended continuous flow ventricular assist device is very promising after system optimization with a hybrid system using both active (electromagnet) and passive (permanent magnets) magnet bearings.

A magnetic bearing system for a continuous ventricular assist device.

This article describes a prototype continuous flow ventricular assist device (CFVAD3) supported in magnetic bearings. The VAD is a small centrifugal four bladed pump. The pump's geometry is explained. The CFVAD3 is the first compact VAD completely supported in magnetic bearings. The magnetic bearings are composed of an inlet side actuator divided into eight pole sets, and an outlet side actuator, also divided into eight pole sets. The pump operating performance was tested and found to be within the design flow rate of up to 9 L/min, and head up to 170 mm Hg for human circulatory support. Magnetic bearing operation out of center positions under various operating orientations were measured and found to be < 1/6 of the bearing clearance, well within specifications. The expected magnetic bearing power loss has been calculated at approximately 6.5 watts.

Magnetic suspension controls for a new continuous flow ventricular assist device.

A new continuous flow ventricular assist device (CFVAD III) using a full magnetic suspension has been constructed. The magnetic suspension centers the centrifugal impeller within the clearance passages in the pump, thus avoiding any contact. This noncontact operation gives very high expected mechanical reliability, large clearances, low hemolysis, low thrombosis, and relatively small size compared with current pulsatile devices. A unique configuration of a system of magnetic actuators on the inlet side and exit sides of the impeller gives full five axis control and suspension of the impeller. The bearing system is divided into segments that allow for three displacement axes and two angular control axes. For the first suspension tests, a decentralized set of proportional, derivative, and integral (PID) controllers acting along the modal coordinates are used to suspend the impeller. The controller design takes into account the blood forces acting on the magnetically suspended impeller, the unbalance forces on the impeller and gravitational loads during various body motions. In the final design, the bearing control axes will be coupled together through fluidic forces so the electronic feedback controller is a centralized multiple input, multiple output controller. The control system design must be robust against these types of externally imposed loads to keep the impeller centered and avoid blood damage. This article discusses the dynamic model, controller, and controller implementation for the magnetic suspension controller of CFVAD III.

Pulsatile operation of a centrifugal ventricular assist device with magnetic bearings.

A prototype bench top model of a continuous flow ventricular assist device using an impeller suspended by magnetic bearings has been developed. Generation of a pulsatile pressure was studied using both a computer model and in vitro loop tests of the prototype. The motivation for developing a computer model for a blood pump in the natural circulation is two-fold. First, it allows simulation of the pump under a large variety of operating conditions. Second, it provides insight into what parameters of the system design are important for achieving a specific result. For example, in one case, an aortic pressure of 118/87 mmHg was generated by varying the speed from 2,000 to 2,600 rpm. The computer model was verified by coupling the centrifugal pump prototype to a mock circulatory system. The results of the model were verified by generating an aortic pressure of 113/78 mmHg while varying the speed from 2,000 to 2,600 rpm. These experiments have shown that it is possible to generate pulsatile pressure similar to that of native physiology using a centrifugal left ventricular assist device. Further tests will be required to quantify the effects on hemolysis.

Development of a prototype magnetically suspended rotor ventricular assist device.

A continuous flow centrifugal blood pump with magnetically suspended impeller has been designed, constructed, and tested. The system can be functionally divided into three subsystem designs: 1) centrifugal pump and flow paths, 2) magnetic bearings, and 3) brushless DC motor. The centrifugal pump is a Francis vane type design with a designed operating point of 6 L/min flow and 100 mmHg pressure rise at 2,300 RPM. Peak hydraulic efficiency is over 50%. The magnetic bearing system is an all active design with five axes of control. Rotor position sensors were developed as part of the system to provide feedback to a proportional-integral-derivative controller. The motor is a sensorless brushless DC motor. Back electromotive force voltage generated by the motor is used to provide commutation for the motor. No slots are employed in the motor design in order to reduce the radial force that the bearings must generate. Tests pumping blood in vitro were very encouraging; an index of hemolysis of 0.0086 +/- 0.0012 was measured. Further design refinement is needed to reduce power dissipation and size of the device. The concept of using magnetic bearings in a blood pump shows promise in a long-term implantable blood pump.

Numerical solution for blood flow in a centrifugal ventricular assist device.

A very small centrifugal pump, fully supported by magnetic bearings, is being developed for use as a ventricular assist device to be implanted in humans. In this paper, we apply computational fluid dynamics to model the blood flow to aid in the design of the ventricular assist device. The flow of blood through the pump has been modeled using computational fluid dynamics (CFD) software that is commercially available from AEA Technology, UK. The flow regions modeled in version 3 of the Continuous Flow Ventricular Assist Device (CF3) are the fully shrouded four bladed impeller and the two clearance regions around the impeller that are bounded by the pump hub and shroud. This paper describes the geometry and computational grids developed for the flow regions, and the equations of motion for the blood flow are developed. The overall numerically-evaluated flow rates and head rise have similar trends to the flow parameters experimentally measured, indicating that future pump designs can be effectively modeled numerically before being constructed and tested. Numerical solutions are presented and compared with experimentally-obtained overall pump performance results. These solutions are used to predict shear stress levels to be experienced by the blood flowing through the pump, and it is predicted that hemolysis will be insignificant. The solutions also indicate no regions of flow stagnation that can be a source of thrombosis in pumps. The calculations provide a viable design method to achieve improved efficiency in future versions of this pump.

Design of a continuous flow centrifugal pediatric ventricular assist device.

Thousands of pediatric patients suffering from cardiomyopathy or single ventricular physiologies secondary to debilitating heart defects may benefit from long-term mechanical circulatory support due to the limited number of donor hearts available. This article presents the initial design of a fully implantable centrifugal pediatric ventricular assist device (PVAD) for 2 to 12 year olds. Conventional pump design equations, including a nondimensional scaling approach, enabled performance estimations of smaller scale versions (25 mm and 35 mm impeller diameters) of our adult support VAD. Based on this estimated performance, a computational model of the PVAD with a 35 mm impeller diameter was generated. Employing computational fluid dynamics (CFD) software, the flow paths through the PVAD and overall performance were analyzed for steady state flow conditions. The numerical simulations involved flow rates of 2 to 5 LPM for rotational speeds of 2750 to 3250 RPM and incorporated a k-epsilon fluid turbulence model with a logarithmic wall function to characterize near-wall flow conditions. The CFD results indicated best efficiency points ranging from 25% to 28%, which correlate well with typical values of blood pumps. The results further demonstrated that the pump could deliver 2 to 5 LPM at 70 to 95 mmHg for desired physiologic conditions in resting 2 to 12 year olds. Scalar stress levels remained below 300 Pa, thereby signifying potentially low levels of hemolysis. Several flow regions in the pump exhibited signs of vortices, retrograde flow, and stagnation points, which require optimization and further study. This CFD model represents a reasonable starting point for future model enhancements, leading to prototype manufacturing and experimental validation.

The CEO as organizational architect: an interview with Xerox's Paul Allaire. Interview by Robert Howard.

As chairman and CEO of the Xerox Corporation, Paul Allaire leads a company that is a microcosm of the changes transforming American business. With the introduction of the first plain-paper copier in 1959, Xerox invented a new industry and launched itself on a decade of spectacular growth. But easy growth led Xerox to neglect the fundamentals of its core business, leaving the company vulnerable to low-cost Japanese competition. Starting in the mid-1980s, Xerox embarked on a long-term effort to regain its dominant position in world copier markets and to create a new platform for future growth. Thanks to the company's Leadership through Quality program, Xerox became the first major U.S. company to win back market share from the Japanese. Allaire describes his efforts to take Xerox's corporate transformation to a new level. Since becoming CEO in 1990, he has repositioned Xerox as "the document company" at the intersection of the worlds of paper-based and electronic information. And he has guided the company through a fundamental redesign of what he calls the "organizational architecture" of Xerox's document processing business. Few CEOs have approached the process of organizational redesign as systematically and methodically as Allaire has. He has created a new corporate structure that balances independent business divisions with integrated R&D and customer operations organizations. He has redefined managerial roles and responsibilities, changed the way managers are selected and compensated, and renewed the company's senior management ranks. And he has articulated the new values and behaviors Xerox managers will need to thrive in a more competitive and fast-changing business environment.