United States physician assistance in development of emergency medicine in Hangzhou, China

Emergency medicine is growing rapidly as a specialty and is beginning to be recognized as an essential component of medicine in China. Traditional Chinese medicine and modern technology exist together. A description of the US authors' experience as consultants at a new emergency department and in establishing an emergency medicine residency program in Hangzhou, China is provided. A total of 7 months were spent in the observation, identification, and development of a basic framework of emergency care at a new hospital. The practice of emergency medicine in China was researched by direct observation at several Chinese cities and by literature review. China is taking the parts of the Western system it can use and implementing its own methods in the overall practice of emergency medicine.

The effect of chemoprophylaxis on the timing of onset of falciparum malaria

The association between chemoprophylaxis and delayed onset of falciparum malaria was investigated in a retrospective study of 477 nonimmune cases reported to the UK Malaria Reference Laboratory (MRL) who had used either mefloquine (n = 56), chloroquine-proguanil (n = 90) or no chemoprophylaxis (n = 331). For holiday and short-term travellers using mefloquine the time between arrival in the UK and diagnosis was found to be significantly longer than for chloroquine and proguanil (C-P) users or for those who had not used prophylaxis at all (P < 0.004). This delay was primarily due to a later onset of symptoms. C-P use was not associated with delay in onset of symptoms or diagnosis when compared to not using prophylaxis. Possible reasons for the findings are discussed. Mefloquine may continue to exert a partially suppressive effect on resistant strains of Plasmodium falciparum (Pf). That chloroquine with proguanil was not found to have such an effect may be due to poor compliance to proguanil or differences in the mode of action and range of parasite resistance to the two regimens. Differences in drug compliance may be one reason why only mefloquine users on holiday or short-term journeys experienced delays to onset of disease. Drug compliance amongst cases of breakthrough malaria on chemoprophylaxis may be lower than is generally recognized. It is important for clinicians and travellers to be aware that the onset of falciparum malaria may be delayed by mefloquine prophylaxis.

Uniformity of the Soft-X-Ray Emissions from Gold Foils Irradiated by OMEGA Laser Beams Determined by a Two-Mirror Normal-Incidence Microscope with Multilayer Coatings

A two-mirror normal-incidence microscope with multilayer coatings was used to image the soft-x-ray emissions from planar foils irradiated by OMEGA laser beams. The bandpass of the multilayer coatings was centered at a wavelength of 48.3 ? (257-eV energy) and was 0.5 ? wide. Five overlapping OMEGA beams, without beam smoothing, were typically incident on the gold foils. The total energy was 1500 J, and the focused intensity was 6 x 10(13) W cm(-2). The 5.8x magnified images were recorded by a gated framing camera at various times during the 3-ns laser pulse. A pinhole camera imaged the x-ray emission in the energy range of >2 keV. On a spatial scale of 10 mum, it was found that the soft-x-ray images at 257 eV were quite uniform and featureless. In contrast, the hard-x-ray images in the energy range of >2 keV were highly nonuniform with numerous features of size 150 mum.

Isoflurane anesthesia in free ranging sea lion pups

California sea lion pups, Zalophus californianus, (n = 115), were captured and anesthetized for (mean +/- SD) 17.6 +/- 7.8 min on San Miguel Island, California (USA) in November of 1992. Mask isoflurane anesthesia allowed intubation in 7.1 +/- 2.74 min. Pups recovered and walked in 7.32 +/- 4.8 min. Mask anesthesia in pups resulted in relaxation in 45 +/- 14 sec. Safe, brief anesthesia was delivered in support of weighing, medical evaluation, and short surgical procedures. Recovery character of all pups was sufficient to permit release to the free ranging state immediately after surgery, saving labor, supervision personnel, and postoperative time.

The new dietary fats in health and disease

Lipids are an integral part of the routine diet of patients and the general public. In this article, the physiologic properties of various dietary lipids are reviewed, beginning with those most commonly consumed-the long-chain triglycerides (LCTs) and extending to those with special purposes: the short- and medium-chain triglycerides. The nutritional dietary management of patients typically includes physical mixtures of lipids. Recently, structured triglycerides (STs), which combine advantages from conventional fats with those of special purposes, have become available. STs are currently developed by interesterifying a mixture of conventional fats and oils, usually with medium-chain triglycerides, to achieve a specific fatty acid profile. This results in a triglyceride containing combinations of short-, medium-, and long-chain fatty acids on a single glycerol backbone. They have unique chemical, physical, or physiologic properties that are not observed by simply blending mixtures of the starting fats and oils. A number of STs are under intense laboratory and clinical investigation in models of cancer, burns, and immune dysfunction. Much interest in the fatty acids resides in the sn-2 position on the glycerol molecule. This is because the fatty acid in the sn-2 position of triglycerides is preferentially absorbed as the 2-monoglyceride and serves as the template for reesterification by intestinal cells to re-form triglycerides. The sn-2 fatty acids are also preferentially preserved as components of chylomicrons and very-low-density lipoprotein particles for ultimate incorporation in tissue membranes. Technology is evolving to create STs with a selected fatty acid in this sn-2 position. For instance, incorporating linoleic, arachidonic, or eicosapentaenoic acid at the sn-2 position is being evaluated for the specific objective of modulating serum cholesterol concentrations and essential fatty acid absorption (a review of this work is included).

Inflorescence commitment and architecture in Arabidopsis

Flowering plants exhibit one of two types of inflorescence architecture: indeterminate, in which the inflorescence grows indefinitely, or determinate, in which a terminal flower is produced. The indeterminate condition is thought to have evolved from the determinate many times, independently. In two mutants in distantly related species, terminal flower 1 in Arabidopsis and centroradialis in Antirrhinum, inflorescences that are normally indeterminate are converted to a determinate architecture. The Antirrhinum gene CENTRORADIALIS (CEN) and the Arabidopsis gene TERMINAL FLOWER 1 (TFL1) were shown to be homologous, which suggests that a common mechanism underlies indeterminacy in these plants. However, unlike CEN, TFL1 is also expressed during the vegetative phase, where it delays the commitment to inflorescence development and thus affects the timing of the formation of the inflorescence meristem as well as its identity.

Inflorescence commitment and architecture in Arabidopsis

Flowering plants exhibit one of two types of inflorescence architecture: indeterminate, in which the inflorescence grows indefinitely, or determinate, in which a terminal flower is produced. The indeterminate condition is thought to have evolved from the determinate many times, independently. In two mutants in distantly related species, terminal flower 1 in Arabidopsis and centroradialis in Antirrhinum, inflorescences that are normally indeterminate are converted to a determinate architecture. The Antirrhinum gene CENTRORADIALIS (CEN) and the Arabidopsis gene TERMINAL FLOWER 1 (TFL1) were shown to be homologous, which suggests that a common mechanism underlies indeterminacy in these plants. However, unlike CEN, TFL1 is also expressed during the vegetative phase, where it delays the commitment to inflorescence development and thus affects the timing of the formation of the inflorescence meristem as well as its identity.

Flame stretch rate as a determinant of turbulent burning velocity

A rational basis for correlating turbulent burning velocities is shown to involve the product of the Karlovitz stretch factor and the Lewis number. A generalized expression is derived to show how flame stretch is related to the velocity field. A new dimensionless correlation of experimental values of turbulent burning velocities is presented. Dimensionless groups also are used in correlations of laminar and turbulent flame extinction stretch rates. A distribution function of stretch rates in turbulent flames, based on an earlier one of Yeung et al ., is proposed and the experimental data are well predicted by a theory based on flamelet extinction by flame stretch with this distribution. Uncertainties arise concerning the role of negative stretch rate. Laminar flamelet modelling of complex combustion appears to have a broader validity than might be expected and some explanation for this is offered.

Detection and quantification of protein-losing enteropathy with indium-111 transferrin

Localisation and quantification of protein loss in protein-losing enteropathy (PLE) is useful in the clinical management of hypoalbuminaemia. Indium-111 transferrin offers the opportunity of combining localisation and quantification using a single agent. Twenty-five studies were performed in 23 patients with suspected PLE: 111In-transferrin was prepared by incubating autologous cell-free plasma with 111In chloride in vitro for 15 min. Protein loss was quantified by comparing whole-body counts recorded with an uncollimated gamma camera at 3 h and 5 or 6 days after injection of 111In-transferrin. Gamma camera imaging performed at 3 and 24 h after injection demonstrated a site of protein loss in 15 studies. Whole-body 111In excretion was abnormally elevated in 13 of these, ranging from 16% to 34% (normal <10%), was not assessed in one and was less than 10% in a patient with carcinoid syndrome. In the ten studies that were negative on imaging, whole-body 111In excretion was normal in nine and elevated at 22% in a further patient with carcinoid syndrome. Overall, the mean whole-body 111In excretion in studies with positive imaging was 21.4% (SD 6.1%) (n=14), significantly higher (P<0.01) than in studies with negative imaging, in which it was 7.5% (SD 6.7%) (n=10). This technique should be useful for the combined approach of localising and quantifying protein loss in PLE.

Pathways for inflorescence and floral induction in Antirrhinum

The presentation of flowers on a modified stem, the inflorescence, requires the integration of several aspects of meristem behaviour. In Antirrhinum, the inflorescence can be distinguished by its flowers, hairy stem, modified leaves, short internodes and spiral phyllotaxy. We show, by a combination of physiological, genetical and morphological analysis, that the various aspects of the inflorescence are controlled by three pathways. The first pathway, depends on expression of the floricaula gene, and is rapidly and discretely induced by exposure to long daylength. Activation of this pathway occurs in very young axillary meristems, resulting in a floral identity. In addition, the length of subtending leaves and hairiness of the stem are partially modified. The second pathway affects leaf size, internode length, and stem hairiness, but does not confer floral meristem identity. This pathway is induced by long daylength, but not as rapidly or discretely as the floricaula-dependent pathway. The third pathway controls the switch in phyllotaxy from decussate to spiral and is activated independently of daylength. The coordination of these three programmes ensures that apical and axillary meristem behaviour is integrated.

Control of inflorescence architecture in Antirrhinum

Flowering plants exhibit two types of inflorescence architecture: determinate and indeterminate. The centroradialis mutation causes the normally indeterminate inflorescence of Antirrhinum to terminate in a flower. We show that centroradialis is expressed in the inflorescence apex a few days after floral induction, and interacts with the floral-meristem-identity gene floricaula to regulate flower position and morphology. The protein CEN is similar to animal proteins that associate with lipids and GTP-binding proteins. We propose a model for how different inflorescence structures may arise through the action and evolution of centroradialis.

Blood ferritin concentrations in newborn infants and the sudden infant death syndrome

Liver iron concentrations have been shown to be higher in victims of SIDS than in postmortem controls suggesting that high levels of tissue iron may be implicated in SIDS. To determine whether infants who subsequently die from SIDS are born with greater iron stores than those who do not, the iron stores in newborn infants were assessed retrospectively by measuring blood ferritin concentration in spots from Guthrie cards (collected from almost all infants born in the UK in the first week of life). A method for extracting and measuring ferritin from stored blood spots is described. Eighteen cases of SIDS were identified in South Glamorgan along with four controls for each case. Ferritin concentrations did not differ in SIDS victims and controls suggesting that victims of SIDS are not born with abnormal concentrations of stored iron. If iron stores are found to be higher in SIDS victims than in healthy live infants of the same age then it is more likely that the iron will have been acquired after birth.

Immunosuppressive properties of tissues obtained from eyes with experimentally manipulated corneas

PURPOSE

To use explants of cornea and iris and ciliary body (I/CB) of experimentally manipulated eyes to determine whether loss of the capacity to suppress T-cell activation in vitro correlates with other consequences of manipulation, i.e., the migration of Langerhans cells into the central corneal epithelium, the leakiness of stromal neovessels, and the presence of axons in the cornea.

METHODS

Mouse eyes were subjected to cautery of central corneal surface, suture-induced neovascularization, circumferential or criss-crossed corneal surface wounds, and orthotopic corneal grafting. Corneas and I/CB were excised, explanted in vitro, and assayed for capacity to suppress mixed lymphocyte reaction. Integrity of suture-induced corneal neovessels was assessed with high molecular weight dextran, Langerhans cells were enumerated in corneal epithelium, nerve axons were evaluated in corneal stroma, and capacity of manipulated eyes to support anterior chamber-associated immune deviation (ACAID) induction after anterior chamber injection of bovine serum albumin were assessed.

RESULTS

Experimental manipulations that abolished ACAID included cautery, neovascularization, and keratoplasty, whereas criss-crossed corneal excision wounds did not. Loss of ACAID correlated variably with loss of ability of corneal explants to secrete immunosuppressive factors in vitro, presence of Langerhans cells within the central corneal epithelium, leakiness of corneal neovessels, loss of axons in corneal stroma, and loss of ability of I/CB after keratoplasty to secrete immunosuppressive factors.

CONCLUSIONS

The cornea plays an active role in ocular immune privilege and ACAID by creating a local immunosuppressive microenvironment, providing neural afferent stimuli that affect immunosuppressive properties of I/CB, and preventing neovascularization and infiltration with Langerhans cells.

Molecular cloning and disease association of hepatitis G virus: a transfusion-transmissible agent

An RNA virus, designated hepatitis G virus (HGV), was identified from the plasma of a patient with chronic hepatitis. Extension from an immunoreactive complementary DNA clone yielded the entire genome (9392 nucleotides) encoding a polyprotein of 2873 amino acids. The virus is closely related to GB virus C (GBV-C) and distantly related to hepatitis C virus, GBV-A, and GBV-B. HGV was associated with acute and chronic hepatitis. Persistent viremia was detected for up to 9 years in patients with hepatitis. The virus is transfusion-transmissible. It has a global distribution and is present within the volunteer blood donor population in the United States.