Prion-like properties of disease-relevant proteins in amyotrophic lateral sclerosis.

The hallmark of age-related neurodegenerative diseases is the appearance of cellular protein deposits and spreading of this pathology throughout the central nervous system. Growing evidence has shown the involvement and critical role of proteins with prion-like properties in the formation of these characteristic cellular aggregates. Prion-like domains of such proteins with their proposed function in the organization of membraneless organelles are prone for misfolding and promoting further aggregation. Spreading of these toxic aggregates between cells and across tissues can explain the progression of clinical phenotypes and pathology in a stereotypical manner, characteristic for almost every neurodegenerative disease. Here, we want to review the current evidence for the role of prion-like mechanisms in classical neurodegenerative diseases and ALS in particular. We will also discuss an intriguingly central role of the protein TDP-43 in the majority of cases of this devastating disease.

Southern Appalachian peatlands support high archaeal diversity.

Mid-latitude peatlands with a temperate climate are sparsely studied and as such represent a gap in the current knowledge base regarding archaeal populations present and their roles in these environments. Phylogenetic analysis of the archaeal populations among three peatlands in the Southern Appalachians reveal not only methanogenic species but also significant populations of thaumarchaeal and crenarchaeal-related organisms of the uncultured miscellaneous crenarchaeotal group (MCG) and the terrestrial group 1.1c, as well as deep-branching Euryarchaeota primarily within the Lake Dagow sediment and rice cluster V lineages. The Thaum/Crenarchaea and deep-branching Euryarchaea represented approximately 24-83% and 2-18%, respectively, of the total SSU rRNA clones retrieved in each library, and methanogens represented approximately 14-72% of the clones retrieved. Several taxa that are either rare or novel to acidic peatlands were detected including the euryarchaeal SM1K20 cluster and thaumarchaeal/crenarchaeal-related clusters 1.1a, C3, SAGMCG-1, pSL12, and AK59. All three major groups (methanogens, Thaumarchaea/Crenarchaea, and deep-branching Euryarchaea) were detected in the RNA library, suggesting at least a minimum level of maintenance activity. Compared to their northern counterparts, Southern Appalachian peatlands appear to harbor a relatively high diversity of Archaea and exhibit a high level of intra-site heterogeneity.

Microbial sequencing analyses suggest the presence of a fecal veneer on indoor climbing wall holds.

Artificial climbing walls represent a unique indoor environment in which humans interact closely with a variety of surface types. Climbing wall holds may mediate transmission of organisms between individuals, and yet there are no studies that identify microorganisms present on these surfaces. In the current study, the microorganisms found on climbing wall holds were characterized by analysis of amplified SSU rRNA gene sequences. In contrast to many other studies of built environments, the majority of microorganisms on holds were most closely related to microbes annotated as being recovered from environmental sources, such as soil, with human skin also representing an important source. Regional patterns were evident as rRNA gene sequences from the marine cyanobacterium Prochlorococcus were abundant in gyms found within 16 km of the ocean. Enterobacteriaceae were present on 100 % of holds surveyed, and the members detected are commonly associated with fecal matter.

Stroke management: updated recommendations for treatment along the care continuum.

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management.

Culturable Rhodobacter and Shewanella species are abundant in estuarine turbidity maxima of the Columbia River.

Measurements of dissolved, ascorbate-reducible and total Mn by ICP-OES revealed significantly higher concentrations during estuarine turbidity maxima (ETM) events, compared with non-events in the Columbia River. Most probable number (MPN) counts of Mn-oxidizing or Mn-reducing heterotrophs were not statistically different from that of other heterotrophs (10³ -104 cells ml⁻¹) when grown in defined media, but counts of Mn oxidizers were significantly lower in nutrient-rich medium (13 cells ml⁻¹). MPN counts of Mn oxidizers were also significantly lower on Mn(III)-pyrophosphate and glycerol (21 cells ml⁻¹). Large numbers of Rhodobacter spp. were cultured from dilutions of 10⁻² to 10⁻5, and many of these were capable of Mn(III) oxidation. Up to c. 30% of the colonies tested LBB positive, and all 77 of the successfully sequenced LBB positive colonies (of varying morphology) yielded sequences related to Rhodobacter spp. qPCR indicated that a cluster of Rhodobacter isolates and closely related strains (95-99% identity) represented approximately 1-3% of the total Bacteria, consistent with clone library results. Copy numbers of SSU rRNA genes for either Rhodobacter spp. or Bacteria were four to eightfold greater during ETM events compared with non-events. Strains of a Shewanella sp. were retrieved from the highest dilutions (10⁻5) of Mn reducers, and were also capable of Mn oxidation. The SSU rRNA gene sequences from these strains shared a high identity score (98%) with sequences obtained in clone libraries. Our results support previous findings that ETMs are zones with high microbial activity. Results indicated that Shewanella and Rhodobacter species were present in environmentally relevant concentrations, and further demonstrated that a large proportion of culturable bacteria, including Shewanella and Rhodobacter spp., were capable of Mn cycling in vitro.

Age rationing and prudential lifespan account in Norman Daniels' Just health.

Could age be a valid criterion for rationing? In Just health, Norman Daniels argues that under certain circumstances age rationing is prudent, and therefore a morally permissible strategy to tackle the problem of resource scarcity. Crucial to his argument is the distinction between two problem-settings of intergenerational equity: equity among age groups and equity among birth cohorts. While fairness between age groups can involve unequal benefit treatment in different life stages, fairness between birth cohorts implies enjoying approximate equality in benefit ratios. Although both questions of fairness are distinct, the resolution of the one depends on resolution of the other. In this paper, I investigate whether Daniels' account of age rationing could be defended as a fair way of setting limits to healthcare entitlements. I will focus on two main points. First, I will consider whether the age group problem could be resolved without appealing to a conception of the good. Second, I will demonstrate that the connection between the age group problem and the birth cohort problem runs deeper than Daniels initially thought-and that it ultimately suggests a method for prioritisation in problem solving strategies.

Impacts of dance on cognition, psychological symptoms and quality of life in Parkinson's disease.

BACKGROUND: While dance may improve motor features in Parkinson's disease (PD), it is not yet clear if the benefits extend to non-motor features. OBJECTIVE: To determine whether dance classes based on Dance for PD®, improve cognition, psychological symptoms and Quality of Life (QoL) in PD. METHODS: Participants were allocated to a Dance Group (DG; n = 17) or Control Group (CG: n = 16). Participants had early-stage PD (Hoehn & Yahr: DG = 1.6±0.7, CG = 1.5±0.8) with no cognitive impairment (Addenbrooke's score: DG = 93.2±3.6, CG = 92.6±4.3). The DG undertook a one-hour class, twice weekly for 12 weeks, while the CG had treatment as usual. Both groups were assessed for disease severity (MDS-UPDRS), cognition (NIH Toolbox® cognition battery, Trail Making Test), psychological symptoms (Hospital Anxiety and Depression Scale, MDS-UPDRS-I) and QoL (PDQ-39, MDS-UPDRS-II). RESULTS: Group comparison of pre-post change scores showed that selected cognitive skills (executive function and episodic memory), psychological symptoms (anxiety and depression) as well as QoL (PDQ-39 summary index) were significantly improved by the intervention (DG > CG, p's < 0.05, Cohen's d > 0.8). DISCUSSIONS AND CONCLUSION: Dance classes had a clear benefit on psychological symptoms, QoL and a limited cognitive benefit. Follow-up assessment is required to confirm the durability of these effects.

The impact of staffing model in a 6-day rehabilitation physiotherapy service.

BACKGROUND AND PURPOSE: The impact of staffing model providing weekend physiotherapy rehabilitation has not been evaluated. This study aims to determine the impact of staffing a weekend rehabilitation service with physiotherapists currently working in rehabilitation compared to acute hospital physiotherapists, on length of stay (LOS), functional independence and gait and balance, and to determine the impact on neurological, orthopaedic, and reconditioning diagnostic groups. METHODS: A prospective cohort study with historical control was completed in a private, metropolitan Australian rehabilitation unit. All participants admitted to the rehabilitation unit over two, 20-week periods in 2011 and 2012 were included. Weekend physiotherapy was provided by physiotherapists working in rehabilitation in 2012 (intervention) and physiotherapists working in the acute wards in 2011 (control). Outcomes included LOS, Functional Independence Measure (FIM), and gait and balance measures. RESULTS: Overall, there were 504 participants; 234 in 2012 and 270 in 2011. No difference was found in LOS between staffing models (mean difference-1.5 days, 95%CI -4.4 to 1.3). Greater FIM change (mean difference 3.5, 95%CI 0.3 to 6.7) and efficiency (FIM change/LOS: mean difference 0.3, 95%CI 0.1 to 0.5) were found with rehabilitation compared to acute staffing. There was no between-group difference in gait or balance performance. When diagnostic groups were compared, no difference in LOS was found between staffing models. Participants with an orthopaedic diagnosis had a significantly greater FIM change (mean difference 3.8, 95%CI 0.4 to 7.1), whereas FIM efficiency was improved in neurological (mean difference 0.4, 95%CI 0.1 to 0.7) and orthopaedic populations (mean difference 0.3, 95%CI 0.03 to 0.5) with rehabilitation staffing. DISCUSSION: Staffing a weekend rehabilitation service with physiotherapists currently working in rehabilitation influences functional independence. Different diagnostic groups appear to respond differently.

Melanesian origin of Polynesian Y chromosomes.

BACKGROUND: Two competing hypotheses for the origins of Polynesians are the 'express-train' model, which supposes a recent and rapid expansion of Polynesian ancestors from Asia/Taiwan via coastal and island Melanesia, and the 'entangled-bank' model, which supposes a long history of cultural and genetic interactions among Southeast Asians, Melanesians and Polynesians. Most genetic data, especially analyses of mitochondrial DNA (mtDNA) variation, support the express-train model, as does linguistic and archaeological evidence. Here, we used Y-chromosome polymorphisms to investigate the origins of Polynesians. RESULTS: We analysed eight single nucleotide polymorphisms (SNPs) and seven short tandem repeat (STR) loci on the Y chromosome in 28 Cook Islanders from Polynesia and 583 males from 17 Melanesian, Asian and Australian populations. We found that all Polynesians belong to just three Y-chromosome haplotypes, as defined by unique event polymorphisms. The major Y haplotype in Polynesians (82% frequency) was restricted to Melanesia and eastern Indonesia and most probably arose in Melanesia. Coalescence analysis of associated Y-STR haplotypes showed evidence of a population expansion in Polynesians, beginning about 2,200 years ago. The other two Polynesian Y haplotypes were widespread in Asia but were also found in Melanesia. CONCLUSIONS: All Polynesian Y chromosomes can be traced back to Melanesia, although some of these Y-chromosome types originated in Asia. Together with other genetic and cultural evidence, we propose a new model of Polynesian origins that we call the 'slow-boat' model: Polynesian ancestors did originate from Asia/Taiwan but did not move rapidly through Melanesia; rather, they interacted with and mixed extensively with Melanesians, leaving behind their genes and incorporating many Melanesian genes before colonising the Pacific.

Elimination of mycoplasma from infected leukemia cell lines.

The infection of cell lines with mycoplasma can cause severe problems as the contaminants affect virtually every cell parameter. We attempted to eliminate mycoplasma from contaminated cell lines using the fluoroquinolone antibiotic ciprofloxacin. Mycoplasma-infected cell lines were cultured with 10 micrograms/ml ciprofloxacin for 14 days. The elimination or persistence of mycoplasmal infection was monitored by diamidino-2-phenylindole (DAP) DNA staining, RNA hybridization test and broth-agar microbiological culturing. Seventeen out of 21 positive cell lines (81%) have been successfully treated using ciprofloxacin. Mycoplasma infections are unacceptable in experimental in vitro systems and require an elimination procedure of certain efficiency. The use of adequate detection methods in the routine control of cell lines and the avoidance of emerging resistant strains are of the utmost importance.

Sensitivity and specificity of five different mycoplasma detection assays.

The sensitivity and specificity of five different mycoplasma detection tests were evaluated in comparison with the classical microbiological culture assay on agar plates as the reference method: direct fluorochrome DNA staining (direct DAPI), DNA staining of an indicator cell line (indirect DAPI), RNA hybridization with a cDNA specific for ribosomal mycoplasmal RNA, an enzyme-linked immunosorbent assay (ELISA) with mycoplasma-specific antibodies, and a biochemical cytotoxicity assay (6-MPDR). A large panel of continuous cell lines (20 adherent and 233 suspension cell lines, most of the latter were human leukemia-lymphoma cell lines) were analyzed for infection with mycoplasma. The results of the comparative analysis for sensitivity and specificity of the various tests were as follows: 100% and 100% for the indirect DAPI, 100% and 98% for the RNA hybridization assay, 87% and 94% for the direct DAPI, 72% and 100% for the ELISA, 75% and 90% for the biochemical 6-MPDR assay. Each of these approaches has both advantages and disadvantages with regard to cost, time, reliability, specificity, and sensitivity. The best compromise for routine mycoplasma testing is a combination of several techniques (e.g. direct culture on agar, RNA hybridization, and direct or indirect DAPI).

Upper limb recovery after stroke: the stroke survivors' perspective.

PURPOSE: This study investigated stroke survivors' perspective of upper limb recovery after stroke. The aim was to determine factors other than medical diagnosis and co-morbidities that contribute to recovery. The objectives were to explore how stroke survivors define recovery, identify factors they believe influence recovery and determine strategies used to maximize upper limb recovery. METHOD: A qualitative study consisting of three focus groups and two in-depth interviews was conducted with stroke survivors (n = 19) and spouses (n = 9) in metropolitan, regional and rural Queensland, Australia. Data were analysed using principles of grounded theory. RESULTS: Stroke survivors maximize upper limb recovery by 'keeping the door open' a process of continuing to hope for and work towards improvement amidst adjusting to life with stroke. They achieve this by 'hanging in there', 'drawing on support from others', 'getting going and keeping going with exercise', and 'finding out how to keep moving ahead'. CONCLUSIONS: This study provides valuable insight into the personal experience of upper limb recovery after stroke. It highlights the need to develop training strategies that match the needs and aspirations of stroke survivors and that place no time limits on recovery. It reinforces the benefits of stroke support groups and advocates their incorporation into stroke recovery services. These findings can be used to guide both the development and evaluation of stroke survivor centred upper limb training programmes.

Focal humero-ulnar impingement following subtotal coronoid ostectomy in six dogs with fragmented medial coronoid process.

OBJECTIVE: To report acute eburnation of joint cartilage at the humeral trochlea following subtotal coronoid ostectomy (SCO) in a clinical case series of six elbows. MATERIAL AND METHODS: Six dogs (median BW 27.1 kg; median age 7.5 months) with fragmented medial coronoid process (FCP) and varying degree of radio-ulnar incongruence (RUI) (mean 2 mm) were treated with SCO using an arthroscopic burr. Second look arthroscopy 4-12 weeks later was performed either because of recurrent or persistent lameness in three dogs. In the others, second-look arthroscopy was scheduled prospectively because of RUI, which was thought to be a risk factor for the observed humero-ulnar impingement. RESULTS: All six elbows had a 1-2 mm wide line of focal full-thickness cartilage loss along the edge of the SCO, while the opposing trochlea had diffuse cartilage damage of Outerbridge grade III-IV, indicating focal humero-ulnar impingement. None of the elbows showed repeated FCP. CONCLUSION: In some cases SCO might lead to focal humero-ulnar impingement along the osteotomy line. CLINICAL SIGNIFICANCE: Whether this relays to variations in respect the amount of resected bone (too much vs. too less) or concomitant joint pathologies like RUI or joint instability remains unknown and warrants further studies.

Differential regulation of apoptosis in the normal human adrenal gland.

Analysis of apoptosis in the human adrenal appears to be of eminent importance in the understanding of adrenal structure, zonation, and function. In this study we investigated the programmed cell death of normal adrenal tissues on the basis of apoptotic index by the nonradioactive in situ end labeling of DNA fragments, proliferating cell nuclear antigen, (PCNA), CD95 (cluster of differentiation), major histocompatibility complex class II immunohistochemistry, and ultrastructural analysis. The highest apoptotic index was detected in the outermost zones of the adrenal cortex, mainly in the zona glomerulosa. A labeling index of 50.46 +/- 5.22% (mean +/- SEM) for zona glomerulosa, 9.36 +/- 1.68% for zona fasciculata, 3.90 +/- 0.78% for zona reticularis, and 7.37 +/- 1.62% for the zona medullaris was found. Immunohistochemistry was used to distinguish between apoptotic and S phase cells. Positive anti-PCNA staining occurred in the inner cortical zones, whereas anti-CD95 signals appeared throughout the whole cortex, albeit at a much weaker level. MHC class II expression, which is known to be associated with programmed cell death, was demonstrated in the inner cortical zone. The data showed that mechanisms of cell death other than necrosis occur in the adrenal. In conclusion, we found a differential regulation of cell death for each zone of the adrenal cortex; the old theories of adrenal zonation (migrational vs. zonal or transformation theory) may, in fact, correlate with each other.

Synaptophysin immunoreactivity in primary pigmented nodular adrenocortical disease: neuroendocrine properties of tumors associated with Carney complex.

Carney complex (CNC) is characterized by lentiginosis and myxomatosis together with a variety of endocrine, neural crest-derived, and other tumors, including primary pigmented nodular adrenocortical disease (PPNAD). PPNAD is characterized by lipofuscin-containing, autonomously functioning, cortisol-producing nodules surrounded by mostly atrophic adrenocortical and normal adrenomedullary tissue. The nature and origin of the tumors, including the myxomas and PPNAD, are unclear. In this study, seven paraffin-embedded PPNAD tumors, one skin myxoma, and two cell lines (one myxoma and one PPNAD) established from patients with CNC were stained with antisera for synaptophysin (SYN), neuron-specific enolase, chromogranin A, tyrosine hydroxylase, and the neural cell adhesion molecule (NCAM). In addition, one PPNAD specimen and one myxoma were analyzed by electron microscopy. The results showed that chromogranin A and tyrosine hydroxylase stained adrenomedullary tissue, but not the PPNAD nodules or the extranodular adrenal cortex. SYN, neuron-specific enolase, and NCAM also stained the medulla. PPNAD nodules and the PPNAD cell line, but not the extranodular adrenal cortex, stained intensely for SYN. The myxoma cell line, but not normal fibroblasts, stained for SYN and NCAM. Ultrastructural analysis of a PPNAD tumor and a skin myxoma revealed a well developed rough endoplasmic reticulum, prominent mitochondria, and vesicle-like structures dispersed throughout the cytoplasm. We conclude that immunostaining for SYN, a marker protein for neuroendocrine cells, clearly distinguishes PPNAD nodules from surrounding adrenocortical tissue and can be helpful in the detection of small nodules in apparently unaffected cortex. The cells of a cutaneous myxoma were also stained positive by two of the three neuroendocrine markers. Finally, both PPNAD and myxoma cells demonstrated ultrastructural features suggestive of neuroendocrine properties. These results support the previously suggested hypothesis that the genetic mechanism leading to CNC involves genes with a neuroendocrine role.

A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers.

BACKGROUND: The identification of specific risk factors for falls in community-dwelling elderly persons is required to detect early changes and permit a preventative approach to management. This study determines the ability of various laboratory measures and clinical tests of postural stability to prospectively predict fallers in community-dwelling elderly women. METHODS: One hundred elderly women (65-86 years, mean age 73 +/- 5 years) performed a reaction-time step task, a limits of stability, and a quiet stance balance task. Postural muscle timing and movement speed were recorded during the step task. Center of pressure (COP) motion was recorded in quiet stance and at the limits of stability. Four common clinical balance tests were performed, and balance confidence, medical and activity history questionnaires were completed. Subjects were followed up regularly for a 6-month period following testing to determine the frequency and characteristics of any falls that occurred. Predictive capabilities of the balance measures to determine fallers were determined through logistic regression models. RESULTS: The clinical balance tests investigated were not able to predict fallers in this community-dwelling elderly population. A combination of variables from the laboratory tasks provided the best overall prediction rate (77%) of fallers (sensitivity 51%) and nonfallers (specificity 91%) from laboratory measures. Of these, step movement time and gluteus medius onset times were the factors best able to predict fallers. Alone, measures of COP motion in quiet stance and at the limits of stability had a poor ability to predict fallers, although they could correctly identify most nonfallers. Prediction was not significantly improved when clinical balance test results were added to the most predictive laboratory measures. CONCLUSIONS: Not all older adults with a reduction in balance ability reported a fall over a 6-month period. Of those who did, a combination of measures reflective of different aspects of mediolateral postural stability during a rapid step task, quiet stance, and movement to the limits of stability were best able to predict faller status, with nonfallers better predicted than fallers. These results emphasize the importance of the multifactorial nature of falls in the community-dwelling elderly population in that the clinical and laboratory measures did not predict a high proportion of fallers.

The interacting effects of cognitive demand and recovery of postural stability in balance-impaired elderly persons.

BACKGROUND: Although postural recovery is attentionally demanding in healthy elderly persons, an inability to recover balance due to competition for attentional resources between the postural system and a second task could contribute to falls in older adults with poor balance. This study examined the attentional demands of balance recovery from a mild postural disturbance in balance-impaired elderly persons. A second purpose of this research was to determine the effect of performing a cognitive task on the recovery of balance in balance-impaired elderly persons. METHODS: Fifteen healthy older adults and 13 older adults with clinical balance impairment were exposed to balance disturbances by means of sudden movement of a platform on which they stood. A dual-task paradigm where postural recovery served as the primary task and verbal reaction time to auditory tones served as the secondary task was used to assess attentional demand. To determine the effect of the cognitive task on postural recovery, kinetic, kinematic, and neuromuscular measures of a feet-in-place response were investigated. RESULTS: Balance recovery using a feet-in-place response was attentionally demanding in both groups of older adults and was more demanding in balance-impaired than in healthy elderly persons. With the concurrent performance of a cognitive task, balance-impaired elderly persons took longer to stabilize their center of pressure and regain balance than in a single task, while healthy elderly persons showed no change between conditions. In addition, only balance-impaired elderly individuals had a greater center-of-pressure resultant velocity during recovery in a dual-task compared with a single-task situation. CONCLUSIONS: The ability to recover balance using a feet-in-place response was more attentionally demanding in balance-impaired than in healthy elderly persons. The recovery of balance was also slower and less efficient in balance-impaired elderly persons when simultaneously performing a cognitive task, whereas the ability of healthy elderly individuals to recover was not influenced by concurrent task demands. This suggests that dual-task performance may contribute to postural instability and falls in balance-impaired elderly individuals.

Ultra fast track in elective congenital cardiac surgery.

BACKGROUND: Changes in healthcare delivery have affected the practice of congenital cardiac surgery. We recently developed a strategy of limited sternotomy, early extubation, and very early discharge, and reviewed the perioperative course of 198 pediatric patients undergoing elective cardiovascular surgical procedures, to assess the efficacy and safety of this approach. METHODS: One hundred ninety-eight patients aged 0 to 18 years (median 3.2 years) underwent 201 elective cardiovascular surgical procedures over a 1-year period. All patients were admitted on the day of surgery. Patients were divided into six diagnostic groups: group 1, complex left-to-right shunts (n = 14, 7.0%); group 2, simple left-to-right shunts (n = 83, 41.3%); group 3, right-to-left shunts with pulmonary obstruction (n = 33, 16.4%); group 4, isolated, nonvalvular obstructive lesions (n = 30, 14.9%); group 5, isolated valvular anomalies (n = 20, 10.0%); and group 6, miscellaneous (n = 21, 10.4%). RESULTS: After 201 procedures, 175 patients (87.1%) were extubated in the operating room and 188 (93.6%) within 4 hours from operation. Four patients (2.0%) were extubated more than 24 hours from completion of the procedure, and 2 (1.0%) died while on respiratory support (never weaned). Five patients (2.6%) failed early extubation (<4 hours). Early discharge was achieved for the vast majority of patients. Overall median length of stay (LOS, including day of surgery as day 1) was 2.0 days, with a median LOS of 3.0 days for those patients requiring circulatory arrest duration exceeding 20 minutes. Of 195 patients, 43 (24.6%), 121 (74.0%), and 159 (81.5%) were discharged, respectively, at <24, <48, <72 hours from admission. Longest and shortest mean postoperative LOS were in group 6 (9.9+/-14.5 days) and group 2 (1.6 = 0.7 days), respectively. Six patients (2.9%) died, and 11 (5.5%) suffered in-hospital complications. Thirty patients (15.4%) were either treated as outpatients (n = 11, 5.7%) or readmitted (n = 19, 9.7%) within 30 days from the time of surgery. Only 8 of 195 patients (4.1%) were readmitted with true surgical complications requiring invasive therapeutic procedures. CONCLUSIONS: Selected patients with a broad spectrum of congenital heart disease may enjoy same-day admission, limited sternotomy, immediate extubation, and very early discharge with excellent outcomes and acceptable morbidity.

Acid Phosphatase Isoenzyme Profiles in Acute and Chronic Leukemias.

We analyzed the acid phosphatase (AcP) isoenzyme profiles of normal and malignant hematopoietic cells using isoelectric focusing followed by diazo staining. Reproducibly defined bands and band complexes could be identified and were correlated with the cellular material analyzed. Different isoenzyme profiles were indeed associated with the various cell types and cell lineages. Lymphoid cells were characterized by the expression of one or two bands at pH 6.0, thus termed L1 or L2 pattern. Myeloid cells showed different isoenzyme profiles (consisting of 3-11 bands) designated M1 and M2. One particular isoenzyme near the cathodal end of the gel could not be inhibited by tarirate, the so-called tartrate-resistant AcP (TRAP). Expression of the TRAP isoenzyme was found in nearly all cases of hairy cell leukemia, but also in a significant number of other B-cell or monocyte derived malignancies. TRAP appears to be an enzymatic parameter for activated B-cells and monocytes. The monocytic cell lineage was clearly documented by the detection of a unique triplet of strongly stained isoenzymes. The AcP isoenzyme profiles represent biochemical cell markers indicating states of activation and lineage of differentiation.

A rapid upward step challenges medio-lateral postural stability.

A rapid step up was compared with a rapid step forward to assess the challenge they posed to postural stability in the medio-lateral (ML) direction. The center of pressure (COP) motion, and hip abductor muscle activity were compared between the two tasks in nine young healthy subjects. Analysis revealed that in the step up task there was a greater range and velocity of medio-lateral COP motion, an earlier gluteus medius onset time and a larger magnitude of gluteus medius activity than in the step forward task. The step up task appears to provide a greater challenge to ML postural stability than a step forward and thus may be an appropriate paradigm for the investigation of medio-lateral postural instability.