Modeling Global Carbon Costs of Plant Nitrogen and Phosphorus Acquisition

Most Earth system models (ESMs) do not explicitly represent the carbon (C) costs of plant nutrient acquisition, which leads to uncertainty in predictions of the current and future constraints to the land C sink. We integrate a plant productivity-optimizing nitrogen (N) and phosphorus (P) acquisition model (fixation & uptake of nutrients, FUN) into the energy exascale Earth system (E3SM) land model (ELM). Global plant N and P uptake are dynamically simulated by ELM-FUN based on the C costs of nutrient acquisition from mycorrhizae, direct root uptake, retranslocation from senescing leaves, and biological N fixation. We benchmarked ELM-FUN with three classes of products: ILAMB, a remotely sensed nutrient limitation product, and CMIP6 models; we found significant improvements in C cycle variables, although the lack of more observed nutrient data prevents a comprehensive level of benchmarking. Overall, we found N and P co-limitation for 80% of land area, with the remaining 20% being either predominantly N or P limited. Globally, the new model predicts that plants invested 4.1 Pg C yr-1 to acquire 841.8 Tg N yr-1 and 48.1 Tg P yr-1 (1994-2005), leading to significant downregulation of global net primary production (NPP). Global NPP is reduced by 20% with C costs of N and 50% with C costs of NP. Modeled and observed nutrient limitation agreement increases when N and P are considered together (r 2 from 0.73 to 0.83).

Multiscale Assessment of Agricultural Consumptive Water Use in California's Central Valley

Spatial estimates of crop evapotranspiration with high accuracy from the field to watershed scale have become increasingly important for water management, particularly over irrigated agriculture in semiarid regions. Here, we provide a comprehensive assessment on patterns of annual agricultural water use over California's Central Valley, using 30-m daily evapotranspiration estimates based on Landsat satellite data. A semiempirical Priestley-Taylor approach was locally optimized and cross-validated with available field measurements for major crops including alfalfa, almond, citrus, corn, pasture, and rice. The evapotranspiration estimates explained >70% variance in daily measurements from independent sites with an RMSE of 0.88 mm day-1. When aggregated over the Valley, we estimated an average evapotranspiration of 820 ± 290 mm yr-1 in 2014. Agricultural water use varied significantly across and within crop types, with a coefficient of variation ranging from 8% for Rice (1,110 ± 85 mm yr-1) to 59% for Pistachio (592 ± 352 mm yr-1). Total water uses in 2016 increased by 9.6%, as compared to 2014, mostly because of land-use conversion from fallow/idle land to cropland. Analysis across 134 Groundwater Sustainability Agencies (GSAs) further showed a large variation of agricultural evapotranspiration among and within GSAs, especially for tree crops, e.g., almond evapotranspiration ranging from 339 ± 80 mm yr-1 in Tracy to 1,240 ± 136 mm yr-1 in Tri-County Water Authority. Continuous monitoring and assessment of the dynamics and spatial heterogeneity of agricultural evapotranspiration provide data-driven guidance for more effective land use and water planning across scales.

GATA6 is essential for endoderm formation from human pluripotent stem cells

Protocols have been established that direct differentiation of human pluripotent stem cells into a variety of cell types, including the endoderm and its derivatives. This model of differentiation has been useful for investigating the molecular mechanisms that guide human developmental processes. Using a directed differentiation protocol combined with shRNA depletion we sought to understand the role of GATA6 in regulating the earliest switch from pluripotency to definitive endoderm. We reveal that GATA6 depletion during endoderm formation results in apoptosis of nascent endoderm cells, concomitant with a loss of endoderm gene expression. We show by chromatin immunoprecipitation followed by DNA sequencing that GATA6 directly binds to several genes encoding transcription factors that are necessary for endoderm differentiation. Our data support the view that GATA6 is a central regulator of the formation of human definitive endoderm from pluripotent stem cells by directly controlling endoderm gene expression.

Summary: Using the differentiation of huESCs as a model for endoderm formation, we reveal that the transcription factor GATA6 regulates the onset of endoderm gene expression and is required for its viability.

Uncertainty in the response of terrestrial carbon sink to environmental drivers undermines carbon-climate feedback predictions

Terrestrial ecosystems play a vital role in regulating the accumulation of carbon (C) in the atmosphere. Understanding the factors controlling land C uptake is critical for reducing uncertainties in projections of future climate. The relative importance of changing climate, rising atmospheric CO2, and other factors, however, remains unclear despite decades of research. Here, we use an ensemble of land models to show that models disagree on the primary driver of cumulative C uptake for 85% of vegetated land area. Disagreement is largest in model sensitivity to rising atmospheric CO2 which shows almost twice the variability in cumulative land uptake since 1901 (1 s.d. of 212.8 PgC vs. 138.5 PgC, respectively). We find that variability in CO2 and temperature sensitivity is attributable, in part, to their compensatory effects on C uptake, whereby comparable estimates of C uptake can arise by invoking different sensitivities to key environmental conditions. Conversely, divergent estimates of C uptake can occur despite being based on the same environmental sensitivities. Together, these findings imply an important limitation to the predictability of C cycling and climate under unprecedented environmental conditions. We suggest that the carbon modeling community prioritize a probabilistic multi-model approach to generate more robust C cycle projections.

Tree branch angle: maximizing effective leaf area

In a computer simulation of branching pattern and leaf cluster in Terminalia catappa, right and left branch angles were varied, and the effective leaf surface areas were calculated. Theoretical branch angles that result in maximum effective leaf area are close to the values observed in nature.

Ratio of tree branch lengths: The equitable distribution of leaf clusters on branches

The theoretical optimal ratios of branch lengths, which produce the most equitable distribution (minimum deviation) of leaf clusters in a computer-stimulated branch system, are similar to the observed ratios in real trees of Terminalia. In another study, observed values for branch angles in this species were shown to be similar to theoretical optimal values that produce the maximum effective leaf area. The relationship between these two fundamental parameters of bifurcation and tree geometry and their effect on effective leaf area and distribution of leaves are discussed.

Leaf photosynthetic traits scale with hydraulic conductivity and wood density in Panamanian forest canopy trees

We investigated how water transport capacity, wood density and wood anatomy were related to leaf photosynthetic traits in two lowland forests in Panama. Leaf-specific hydraulic conductivity ( k(L)) of upper branches was positively correlated with maximum rates of net CO(2) assimilation per unit leaf area ( A(area)) and stomatal conductance ( g(s)) across 20 species of canopy trees. Maximum k(L) showed stronger correlation with A(area) than initial k(L) suggesting that allocation to photosynthetic potential is proportional to maximum water transport capacity. Terminal branch k(L) was negatively correlated with A(area)/ g(s) and positively correlated with photosynthesis per unit N, indicating a trade-off of efficient use of water against efficient use of N in photosynthesis as water transport efficiency varied. Specific hydraulic conductivity calculated from xylem anatomical characteristics ( k(theoretical)) was positively related to A(area) and k(L), consistent with relationships among physiological measurements. Branch wood density was negatively correlated with wood water storage at saturation, k(L), A(area), net CO(2) assimilation per unit leaf mass ( A(mass)), and minimum leaf water potential measured on covered leaves, suggesting that wood density constrains physiological function to specific operating ranges. Kinetic and static indices of branch water transport capacity thus exhibit considerable co-ordination with allocation to potential carbon gain. Our results indicate that understanding tree hydraulic architecture provides added insights to comparisons of leaf level measurements among species, and links photosynthetic allocation patterns with branch hydraulic processes.

Comparative vessel anatomy of arctic deciduous and evergreen dicots

Arctic tundra plant species exhibit striking variation in leaf character and growth form. Both are likely related to differences in vessel anatomy, and all may affect responses to climate changes in the Arctic. To investigate the relationships among leaf character, growth form, vessel anatomy, and susceptibility to freeze-thaw-induced xylem cavitation, xylem vessel characteristics were compared among six deciduous and six evergreen arctic dicot species of erect and prostrate growth forms. We hypothesized that deciduous and erect species would have larger and longer vessels than evergreen and cushion/mat-forming species. Vessel lengths, diameters, and densities were measured for each species. Theoretical vessel flow rates were calculated using Poiseuille's law for ideal capillaries. Flow rates were used to determine the susceptibility of vessels to cavitation induced by freeze-thaw events that may become more frequent with global warming. Vessel diameters were larger in deciduous species compared to evergreens, and in shrubs/trees vs. cushion/mat-forming plants. Vessel length distributions, however, did not differ for growth form or leaf character. Vessel density was greater in cushion/mat-forming species than in shrub/tree species. Deciduous plants showed a greater contribution to total conductivity by relatively larger vessels than evergreens. One of the deciduous species, Vaccinium uliginosum, is predicted to be susceptible to freeze-thaw-induced cavitation. These results have important implications for future arctic species composition and plant community structure.

Stem vascular architecture in the rattan palm Calamus (Arecaceae-Calamoideae-Calaminae)

Climbing stems in the rattan genus Calamus can reach lengths of well over 100 m, are long-lived, and yet their vascular tissue is entirely primary. Such a combination suggests that stem vasculature is efficient and resistant to hydraulic disruption. By means of an optical shuttle and video recording of sequential images we analyzed the stem of a cultivated species. The stem has vascular features that are unusual compared with those in arborescent palms and seemingly inefficient in terms of long-distance water transport. Axial bundles are discontinuous basally because leaf traces, when followed downwards, always end blindly below. Furthermore, there is no regular distal branching of each leaf trace at its level of departure into a leaf, so that neither a continuing axial bundle nor bridges to adjacent axial bundles are produced as in the standard palm construction. Instead, the axial bundles in the stem periphery are connected to leaf traces and to each other by narrow and irregular transverse or oblique commissures that are not the developmental homologues of bridges. As in other palms, metaxylem within a leaf trace is not continuous into the leaf so that the only connection to a leaf is via protoxylem. Within the stem, protoxylem (tracheids) and metaxylem (vessels) are never contiguous, unlike in other palms, which suggests that water can only move from metaxylem to protoxylem, and hence into the leaf, across a hydraulic resistance. We suggest that this minimizes cavitation of vessels and/or may be associated with an unknown mechanism that refills embolized vessels. Also, the metaxylem can be significant in stem water storage in the absence of abundant ground parenchyma.

The internal jugular vein maintains its regional anatomy and patency after carotid endarterectomy: a prospective study

OBJECTIVE

To validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine whether these surface landmarks were altered after neck surgery.

SUMMARY BACKGROUND DATA

Carotid puncture and pneumothorax continue to be the most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The authors' modified technique of IJV venipuncture was associated with a 0.6% complication rate; notably, there were no instances of carotid artery puncture. Determining the accuracy of this method using duplex ultrasound would enhance the technique's applicability and safety. The authors also hypothesized that previous neck surgery would alter the regional anatomy in relation to these surface landmarks for IJV venipuncture.

METHODS

The authors prospectively evaluated 417 IJVs in 209 consecutive patients undergoing carotid duplex imaging before and after carotid endarterectomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of the neck served as a control for each patient. The position of the IJV in relation to the surface landmarks, the mobility of the IJV on neck rotation, and the size, patency, and relation of the IJV to the carotid artery were evaluated.

RESULTS

Overall accuracy of the surface landmarks for locating the IJV percutaneously was 99% for the control group and 95% for the CEA group. With neck rotation, the IJV was located in a more lateral position in relation to the landmarks that would significantly reduce its accessibility. After neck rotation, it was also noted that the carotid artery moved behind the jugular vein in 85% of the patients in both groups. The mean size of the vein and its patency were similar in both groups.

CONCLUSIONS

Duplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJV anatomy is not altered after CEA.

Thorn and hook ontogeny in Artabotrys hexapetalus (Annonaceae)

Artabotrys hexapetalus is widely planted in the tropics and is known as "climbing ylang-ylang," an ornamental liana or woody climber. New natural sprouts, or water shoots, and those induced by the damage of Hurricane Andrew (24 August 1992) were collected and fixed in formalin/acidic acid/alcohol. Seeds from these plants were planted and grown in a greenhouse where seedling morphology was observed and young material collected and fixed. The development of lateral plagiotropic and orthotropic shoots was studied using both epi-illumination light microscopy and scanning electron microscopy. A series of buds develops in the axils of leaves on the orthotropic shoot. At the lateral margins of the axillary shelf, plagiotropic shoots form that will develop into either vegetative shoots, or thorns, or sympodial shoots that bear hooks and flowers. In between the two marginal buds, a series of median vertical buds develop that either remain dormant or grow out as renewal orthotropic shoots. Previous work that suggested that the plagiotropic shoot buds were displaced out of the median vertical series of supernumerary buds is not supported. The sympodial development of plagiotropic branches as inflorescence hooks is documented.

Dorsalis pedis artery aneurysm: case report and literature review

The presentation, diagnostic evaluation, and treatment of a patient with a dorsalis pedis artery aneurysm is discussed, and the literature is reviewed on this rare entity.

Tandem duplication polymorphism upstream of the dopamine D4 receptor gene (DRD4)

The dopamine D4 receptor (DRD4) is a member of the D2-like dopamine receptor family. Polymorphisms at the DRD4 gene have been examined for association with a wide range of neuropsychiatric disorders and normal behavioral variation. The DRD4 gene is unusual in its high amount of expressed polymorphism in humans. Here we study the identification of a polymorphic tandem duplication of 120 bp located 1.2 kb upstream of the initiation codon. The duplicated region contains consensus sequences of binding sites for several known transcription factors, suggesting that different alleles may differ in their transcriptional activity. Because chimpanzees, gorillas, and orangutans lack the duplication, the duplicated allele is inferred to be derived. The frequency of this derived duplication allele ranges from 0.40-0.81 in the 11 populations from around the world typed for this polymorphism. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:705-709, 1999.

Branch geometry in Cornus kousa (Cornaceae): computer simulations

Computer simulations similar to actual trees were constructed using simple branching rules. Branch orientation with respect to the direction of gravity was a fundamental consideration. In Cornus kousa BUERG. ex HANCE, several types of branches develop from winter buds, varying from orthotropic shoots to plagiotropic ones. Based on actual observations and measurements of branching structures with a wide range of orientations, we made a flexible geometrical model consisting of five forking branches that varied in outgrowth depending on the direction of the shoot with respect to gravity. Repetition of the branching by computer generated a realistic tree pattern, which was close to the shape of a young C. kousa tree. Reproductive shoots seem to be under a branching rule that was a modification of vegetative branching, although the reproductive branch size was considerably smaller than the vegetative one, and reproductive branching was bifurcated instead of five-forked. We conclude that all branchings in orthotropic and plagiotropic shoots in the vegetative phase and shoots in the reproductive phase are formed under the same branching rule, but each has different parameter values.

A case study of the natural attenuation of gas condensate hydrocarbons in soil and groundwater

Condensate liquids have been found to contaminate soil and groundwater at two gas production sites in the Denver Basin operated by Amoco Production Co. These sites have been closely monitored since July 1993 to determine whether intrinsic aerobic or anaerobic bioremediation of hydrocarbons occurs at a sufficient rate and to an adequate end point to support a no-intervention decision. Groundwater monitoring and analysis of soil cores suggest that intrinsic bioremediation is occurring at these sites by multiple pathways, including aerobic oxidation, Fe(III) reduction, and sulfate reduction.

Spontaneous arterial thrombosis associated with nephrotic syndrome: case report and review of the literature

Hypercoagulability is a recognized complication of the nephrotic syndrome which commonly affects the venous system. Arterial thrombosis is very rare. Multiple factors contribute to the predisposition to thromboembolism in this condition. This report deals with a case of femoral artery thrombosis which responded well to thrombectomy and a short course of anticoagulant therapy. In spite of several exacerbations of his disease, our patients had no recurrence of thrombosis. Review of the literature reveals high rates of limb loss and recurrence of thrombosis. We, therefore, feel that it is important to emphasize this rare entity in view of the associated morbidity.

The effects of bedside pulmonary mechanics testing during infant mechanical ventilation: a retrospective analysis

We examined the effects of regular bedside testing of pulmonary mechanics (PM) on the outcome of 468 acutely ill, mechanically ventilated neonates. During the first of two 18-month study periods, 217 infants were mechanically ventilated without the assistance of PM measurements. During the second 18-month period, 251 infants were ventilated with the assistance of at least daily PM measurements. Using data obtained from the PM tests, we adjusted the infants' ventilators to maintain tidal volume, inspiratory time, and pressure-volume loops within predetermined limits. With the exception of the PM measurements, given the limitations of retrospective analyses, both groups of infants received identical medical and nursing care. The infants ventilated with the assistance of PM testing developed fewer pneumothoraces (4.0%; 10/251) vs. no PM testing, 10.1% (22/217); P < 0.05 by Chi-square analysis]. Infants weighing less than 1,500 g ventilated with the assistance of PM measurements had less intraventricular hemorrhage (IVH) overall, most notably, less grades I and II IVH (total IVH-PM testing, 39.1% vs. no PM testing, 65.7%; P < 0.01; Grades I-II IVH-PM testing, 30.4% vs. no PM testing, 54.9%; P < 0.01). IVH incidence was decreased independent of pneumothorax occurrence. Survival rates, incidences of bronchopulmonary dysplasia, and durations of mechanical ventilation and hospitalization were similar. This retrospective analysis suggests that PM testing during infant mechanical ventilation reduces common acute ventilator-associated complications.

The Ohio Cancer Information Service: technology transfer on clinical trials and other measures of cancer control

We examined trends in caller queries on tobacco, mammography, Pap tests, and clinical trials to the NCI-sponsored Cancer Information Service (CIS) of Ohio via its toll free telephone number (1-800-4-CANCER) during 1986-1991. Calls on NCI-approved clinical trials and treatment protocols tripled during the study period (from 6% in 1986 to 20% in 1991, p < 0.01) primarily due to counselor-initiated (proactive) recommendations and actions. Calls on breast cancer showed a significant increase whereas calls on respiratory system cancers showed a decline over the time period. There was also a dramatic increase in calls on mammography, reflecting the impact of national and local promotion of breast screening. Queries on tobacco use and Pap tests declined, perhaps due to a perceived saturation effect of public education on these two topics. Our results support the use of CIS as a technology transfer system.

Radial artery collateral aneurysm: a rare entity resulting from an unusual etiology

Atherosclerotic occlusive disease of the upper extremity can be a challenging and complex problem for the vascular surgeon. Due to the variety of pathologies that can affect the upper extremity, an accurate diagnosis may be difficult to obtain. We describe the case of a 52-year-old white man who presents with a pulsatile mass on the volar aspect of the right wrist. Arteriography of the aortic arch and right upper extremity revealed an 80% atherosclerotic stenosis at the origin of the right subclavian artery, as well as occlusion of the superficial radial artery. The occlusion resulted in the formation of an aneurysmal collateral, which communicated with the superficial palmar arch. A right carotid-subclavian bypass was necessary to prevent further embolic phenomena. The radial artery aneurysm was treated by resection and primary repair.

Aortic laceration: a rare complication of laparoscopy

Aortic laceration during laparoscopic procedures is a rare but well-known complication with a high mortality rate. Thus far, few cases which were recognized and treated successfully have been reported in the literature; the exact incidence is not known. Such a complication occurred after an elective laparoscopic sterilization in a 35-year-old woman. The situation was recognized early and successfully treated. The common complications of laparoscopy are usually of a minor nature but a few are life threatening. This case illustrates the need for emphasis on the prevention of complications and the appropriate course of action in the event of their occurrence.

Poor predictive value of hematocrit and hemodynamic parameters for erythrocyte deficits after extensive elective vascular operations

Fluid resuscitation and transfusion therapy are particularly critical in patients undergoing extensive vascular operations because of diffuse atherosclerosis and the risk of perioperative myocardial infarction. Sophisticated perioperative monitoring has reduced the mortality rate substantially, but indications for transfusion remain controversial. We determined erythrocyte volume, (EV), total blood volume (TBV) and plasma volume (PV) preoperatively and 18 to 24 hours postoperatively in 41 elderly patients (68.8 +/- 1.3 years) undergoing elective vascular operations (30 abdominal aortic aneurysmorrhaphy, ten aortofemoral bypass and one carotid endarterectomy). EV was measured using 51chromium-labeled autologous erythrocytes; TBV and PV were calculated from EV and total body hematocrit (peripheral venous hematocrit [HCT] x 0.89). Ideal blood volumes were calculated from nomograms based on body surface area and gender. Relationships between body volumes (percentage of ideal), simultaneously measured peripheral venous HCT and hemodynamic parameters heart rate, mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac index and systemic vascular resistance index were studied by stepwise regression. In 24 patients, blood volumes and hemodynamic parameters were also measured in the recovery room. HCT significantly correlated with EV at all three time periods (p less than 0.001), but the ability of HCT to predict EV in an individual patient was relatively poor (r = 0.50 preoperatively; r = 0.54 in recovery room and r = 0.66 24 hour postoperatively). By 24 hours postoperatively, EV had decreased to 78.3 +/- 2.4 percent of ideal EV (range of 47 to 112 percent). However, only two patients had HCT less than 30 despite the fact that 13 of 41 patients had an EV deficit of greater than 30 percent. No patient had a HCT of less than 25 percent. Hemodynamic parameters did not contribute to the prediction of EV, PV or TBV at any time. Two patients had myocardial infarctions postoperatively associated with 24 hour EV deficits of 18.5 and 29.6 percent. One patient died of a pulmonary embolus. Because of these findings, the concept of a "transfusion trigger" must be viewed with caution, since many patients undergoing vascular operations will have considerable EV deficits despite an "acceptable" HCT.

Effect of graft material on loss of erythrocytes after aortic operations

It has been suggested that loss of erythrocytes after abdominal aortic grafting is influenced by the type of synthetic graft used. A prospective randomized study was done to compare loss of erythrocytes in patients receiving Dacron (polyester fiber, Meadox woven double velour) and Gore-Tex (polytetrafluoroethylene [PTFE]) grafts during the perioperative period. A total of 25 patients (13 Dacron and 12 PTFE) was studied, including 21 with abdominal aortic aneurysms and four with aortoiliac occlusive disease. Erythrocyte volume (EV) was measured using 51Cr-labeled autologous erythrocytes on the day prior to the operation, one to two hours after the operation when the patients were hemodynamically stable and 24 hours postoperatively. In addition to measurements of 51Cr EV and the volume of intraoperatively salvaged washed erythrocytes, the length of storage of the units of homologous liquid preserved erythrocytes at 4 degrees C. prior to transfusion were recorded. The mean intraoperative erythrocyte loss (+/- S.D.) for the Dacron group was 892 +/- 543 milliliters and for the PTFE group, 842 +/- 403 milliliters (p = NS). Patients in the Dacron group received intraoperatively 2.2 +/- 1.6 (units +/- S.D.) milliliters with a range of zero to 4 units of homologous liquid preserved erythrocytes and patients in the PTFE group received 1.2 +/- 1.2 milliliters with a range of zero to 3 units of homologous liquid preserved erythrocytes (p = NS). The mean total loss of erythrocytes (+/- S.D.) was 1,055 +/- 649 milliliters for the Dacron group and 978 +/- 503 milliliters for the PTFE group (p = NS). Despite inherent differences in graft material, there were no significant differences in intraoperative or post-operative loss of erythrocytes or in the number of homologous units of liquid preserved erythrocytes transfused with a p value of less than 0.05 considered significant.

Evaluation of the perforating veins of the lower extremity using high resolution duplex imaging

The purpose of this study was to evaluate duplex imaging as a means of assessing perforating veins in patients with longstanding venous stasis ulceration. Thirty patients with nonhealing venous stasis ulcers and twenty normal volunteers serving as controls were evaluated with a standard 8-MHz imaging probe and integrated pulsed Doppler. The internal diameter of perforating veins was measured and perforators were grouped into one of four categories based on functional criteria: competent perforator with venous flow (C); incompetent perforator with venous flow (IC); competent perforator with arteriovenous flow (C-AVC); incompetent perforator with arteriovenous flow (IC-AVC). Sixteen of the patients with ulcers were subsequently studied by ascending venography and in 11 patients, intraoperative identification of perforating veins was made during the Rob procedure. In this subset of patients the vessel was categorized as competent or incompetent regardless of flow signal. There were significant differences in mean perforator diameter between ulcer patients and normal volunteers. Duplex imaging identified 93 perforators and venography a total of 70. In all 16 extremities, duplex imaging made the diagnosis of significant perforating vein incompetence, verified by venography. Intraoperative findings demonstrated an excellent correlation with duplex imaging. We believe duplex imaging to be a promising new modality for evaluation of the perforating veins of the lower extremity.

Effect of spontaneous and mechanical breathing on dynamic lung mechanics in hyaline membrane disease

We measured then compared the dynamic lung mechanics of spontaneous breaths and mechanical breaths in 9 mechanically ventilated neonates with hyaline membrane disease. All were receiving intermittent mandatory ventilation. All breathed spontaneously between ventilator breaths. Tidal volume, transpulmonary pressure, dynamic lung compliance, airways resistance, and peak inspiratory and peak expiratory gas flows were determined for both the mechanical and the spontaneous breaths. The mechanical breaths consistently had larger tidal volumes, higher transpulmonary pressures, higher airway resistance, and lower lung compliance values (P less than 0.05). Peak inspiratory and expiratory gas flows were also higher (P less than 0.01) during mechanical breathing. The spontaneous breaths generated by patients and the mechanical breaths generated by mechanical ventilators are different. The lung mechanics measurements of these two different types of breathing should be collected, analyzed, and reported separately.

Use of a beta-agonist in ventilated, very-low-birth-weight babies: a longitudinal evaluation

To determine if there is a specific postnatal (PNA) or postconceptional age (PCA) at which ventilated preterm infants respond to beta-agonists, we evaluated 15 infants with a mean gestational age of 26.5 +/- 1.5 weeks and mean birth weight of 0.89 +/- 0.23 kg who required mechanical ventilation at 10 days of age. Weekly pulmonary function testing (PFT) was performed before and 1 h after administration of albuterol. Taking the group as a whole, as well as individual babies, regression analysis showed no relationship between positive response and either PNA or PCA. Evaluation of individual infants, however, showed that some consistently responded to beta-agonists whereas others did not. We recommend individual PFT to identify those infants who will benefit from use of beta-agonists.

Water Transport in the Liana Bauhinia fassoglensis (Fabaceae)

To determine the efficiency of xylem conductance in the liana (woody vine) Bauhinia fassoglensis Kotschy ex Schweinf., we measured hydraulic conductance per unit stem length (measured K(h)), leaf-specific conductivity (LSC = K(h)/distal leaf area), transpiration rate (E), xylem water potential (epsilon), vessel number, and vessel diameter. The measured K(h) was 49% (se = 7%) of the predicted K(h) from Poiseuille's law. The mean LSC for unbranched stem segments was 1.10 x 10(-8) square meters per megapascal per second (se = 0.07). LSCs were much lower (about 0.2) at branch junctions. At midday, with E at 7 x 10(-8) meters per second, the measured drop in epsilon was about 0.08 megapascal per meter along the stems and branches and about 0.27 megapascal in going from stem to leaf. In addition, there was a drop of about 0.20 megapascal at branch junctions as predicted by E/LSC. In diurnal measurements leaf epsilon never dropped below about -1.2 megapascal. For long (e.g. 16 meters) stems, the predicted mid-day drop in epsilon through the xylem transport system might be great enough to have substantial physiological impact.

Congenital venous web causing subclavian vein obstruction: a case report

A 7 1/2-year-old black girl had exercise-induced swelling of the left arm and left anterior chest wall caused by a congenital venous web of the subclavian vein. Operative repair was accomplished by venotomy and excision of the web. A venous digital subtraction angiogram obtained on the sixth postoperative day showed unobstructed flow through the operative area. We believe that an isolated, nonthrombotic functional obstruction of the subclavian vein by a venous web has not been previously reported in the English-language literature.

Routine use of dexamethasone for the prevention of postextubation respiratory distress

We evaluated the routine use of dexamethasone for the prevention of postextubation respiratory distress by entering 60 ventilated infants into a prospective, randomized, blinded study. Thirty minutes before extubation, 30 infants were given a single dose of intravenous dexamethasone (0.25 mg/kg), and 30 infants received saline placebo. Infants were intubated orotracheally for at least 48 hours following a single intubation and were maintained on low ventilator settings (F10(2) less than 0.35, intermittent mandatory ventilation [IMV] less than 6, positive end-expiratory pressure [PEEP] less than 4) at least 12 hours before extubation. Following extubation, all infants weighing less than 1500 g were routinely placed on nasal continuous positive airway pressure (NCPAP). There was no difference between the two groups in postextubation Downes' score, serum pH, PCO2, or oxygen requirement at 30 minutes, 6 hours, and 24 hours. Respiratory acidosis occurred in one steroid-treated patient and in two placebo-treated infants. Stridor occurred in four infants in each group. No infant developed postextubation lobar atelectasis or required reintubation. We conclude that prophylactic administration of dexamethasone does not improve the immediate postextubation course of infants following a single intubation and that its routine use at the time of extubation is not indicated.

Identifying lung overdistention during mechanical ventilation by using volume-pressure loops

We measured the pulmonary mechanics of 23 mechanically ventilated neonates. Airway pressures, inspiratory and expiratory flows were simultaneously measured. Values for respiratory system mechanics were then derived from these data by using a personal computer and a special software program. Volume-pressure (V-P) loops and respiratory system compliance values were determined for representative mechanical breaths. Twelve infants had normal-appearing V-P loops. Eleven had V-P loops characteristic of lung overdistention, showing decreasing changes in volume with progressive increases in pressure. To quantify this visual observation, we determined the change in compliance during the last 20% of inspiration (C20). We then compared this value to the total compliance value for the entire breath (C) using the ratio C20/C. Mean values for C, C20, and C20/C were compared for the two patient groups. Total respiratory system compliance values were similar. C20 values were decreased in those patients with V-P loops showing overdistention. C20/C values were significantly decreased in those patients with V-P loop evidence of overdistention. Patients with V-P loop evidence of overdistention all had C20/C values less than 0.8. Those with normal-appearing V-P loops all had C20/C values greater than 1.0. The C20/C ratio appears to effectively quantitate visual V-P loop evidence of lung overdistention during mechanical ventilation.

Neonatal apnea associated with maternal clonazepam therapy: a case report

A 2750-g female infant was born at 36 weeks' gestation to a 40-year-old woman treated with clonazepam throughout her pregnancy. The infant developed apnea, cyanosis, and hypotonia within a few hours of birth. The mother's serum clonazepam level at delivery was 32 ng/mL; the cord blood level was 19 ng/mL. The infant had no congenital malformations, evidence of infection, or seizures. Clinical episodes ceased by ten days of age. The woman elected to breastfeed; breast milk clonazepam levels were between 11 and 13 ng/mL. She was discharged with a cardiorespiratory monitor. The authors suggest that infants of mothers receiving this agent during pregnancy or while nursing have serum levels measured. Additionally, these infants should be monitored for central nervous system depression or apnea.

Suction curettage to remove excess fat for body contouring

We have significantly expanded the use of a lipectomy procedure which heretofore had been restricted to the removal of strictly localized excess fat deposits by curettage through a small incision. By modifying the suction curette and utilizing it for extensive body contouring, we have been successful in correcting relatively major fat deformities without causing any postoperative surgical deformities. All our results to date have been satisfactory. This procedure may be helpful to those surgeons who have been seeking a simplified method for removing excessive fat without extensive scarring. The improvement in body contour is often beyond the preoperative expectations of both the surgeon and the patient.

Origin of the use of subcuticular sutures

The subcuticular suture has its origins not in the work of one individual but in that of generations of surgeons interested in obtaining the best wound healing possible. In their search for the perfect result they improvised and improved on the ideas of those preceding them. The result is an interesting lesson in medical history and a method of suturing that comes close to achieving the "invisible scar."

In vitro growth of embryos and callus of coconut palm

A medium for optimal growth of embryos of Jamaican Tall and Green Malayan Dwarf varieties of coconut palm was developed. The Liquid basal Murashige and Skoog medium was supplemented with coconut milk, IAA and 2IP. Activated charcoal improved embryo growth on agar medium. A single callus line was initiated from solid endosperm and subcultured on basal Schenk and Hildebrandt medium supplemented with 2 mg per 1 NAA. Attempts at inducing organogenesis in the callus were unsuccessful. No vascular tissue was present. The callus was aneuploid with the chromosome number = 8 (normal 2n = 32).

Control of bud inhibition in Cyperus

The axillary buds in the leaf crown of Cyperus alternifolius seedlings remain completely inhibited although the shoot is determinate and has no active apex. Buds can be released by detachment of the crown from the plant or by direct application of aqueous enzyladenine (BA), and grow out as inflorescences or vegetative shoots. These arise from activated growth centers of the primordial reproductive branch system which is enclosed within the prophyll of the inhibited bud. Buds are also released by the growth retardant, (2-chloroethyl) trimethylammonium chloride (CCC). Gibberellic acid maintains bud inhibition in detached crowns and inhibits bud release caused by CCC or BA. Naphthaleneacetic acid somewhat reduces BA-induced bud release and causes abnormal root proliferation in CCC-treated crowns. It is suggested that a high level of gibberellin within the crown, possibly in relation to a low level of cytokinin, maintains bud inhibition.