Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Alemtuzumab more effective than interferon β-1a at 5-year follow-up of CAMMS223 clinical trial

OBJECTIVE

To report the long-term safety and efficacy results from CAMMS223 comparing alemtuzumab with interferon β-1a in early, active relapsing-remitting multiple sclerosis (RRMS). What are the long-term effects of alemtuzumab treatment, received 36 to 48 months previously, on relapse and disability in early, active RRMS? This study provides evidence of the effectiveness of alemtuzumab in reducing the relapse rate and accumulation of disability compared with interferon β-1a (IFNβ-1a) through extended follow-up (up to 60 months from baseline).

METHODS

Of 334 patients originally randomized, 198 participated in the extension phase (151 [68%] alemtuzumab and 47 [42%] IFNβ-1a). Disability, relapses, and safety were assessed as in the original study period. Efficacy outcomes were analyzed from baseline of the original trial period to 60 months. Safety data extended beyond 60 months.

RESULTS

Over 5 years, alemtuzumab lowered the risk of sustained accumulation of disability by 72% and the rate of relapse by 69% compared with IFNβ-1a (both p < 0.0001). The annualized relapse rate from baseline to month 60 was 0.11 for alemtuzumab and 0.35 for IFNβ-1a. Complete safety follow-up reflected 988 and 376 person-years for alemtuzumab and IFNβ-1a patients, respectively. Serious infections were seen in 7% of alemtuzumab patients and 3% of IFNβ-1a patients, and thyroid disorders were seen in 30% of alemtuzumab patients vs 4% of IFNβ-1a patients. Immune thrombocytopenia occurred in 3% of alemtuzumab patients and 0.9% of IFNβ-1a patients during the initial study period; no additional events were reported during the extension phase. One alemtuzumab patient developed Goodpasture disease 39 months after the second annual cycle of alemtuzumab.

CONCLUSIONS

Through extended follow-up, alemtuzumab remained significantly more efficacious than IFNβ-1a, with a safety profile consistent with previous reports.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that alemtuzumab is more effective than interferon β-1a in reducing relapses and disability in patients with RRMS in a long-term follow-up of a rater-blinded, randomized clinical trial with 59.5% of patients participating in the extended follow-up period.

A comparison of simple sequence repeat and single nucleotide polymorphism marker technologies for the genotypic analysis of maize (Zea mays L.)

We report on the comparative utilities of simple sequence repeat (SSR) and single nucleotide polymorphism (SNP) markers for characterizing maize germplasm in terms of their informativeness, levels of missing data, repeatability and the ability to detect expected alleles in hybrids and DNA pools. Two different SNP chemistries were compared; single-base extension detected by Sequenom MassARRAY, and invasive cleavage detected by Invader chemistry with PCR. A total of 58 maize inbreds and four hybrids were genotyped with 80 SSR markers, 69 Invader SNP markers and 118 MassARRAY SNP markers, with 64 SNP loci being common to the two SNP marker chemistries. Average expected heterozygosity values were 0.62 for SSRs, 0.43 for SNPs (pre-selected for their high level of polymorphism) and 0.63 for the underlying sequence haplotypes. All individual SNP markers within the same set of sequences had an average expected heterozygosity value of 0.26. SNP marker data had more than a fourfold lower level of missing data (2.1-3.1%) compared with SSRs (13.8%). Data repeatability was higher for SNPs (98.1% for MassARRAY SNPs and 99.3% for Invader) than for SSRs (91.7%). Parental alleles were observed in hybrid genotypes in 97.0% of the cases for MassARRAY SNPs, 95.5% for Invader SNPs and 81.9% for SSRs. In pooled samples with mixtures of alleles, SSRs, MassARRAY SNPs and Invader SNPs were equally capable of detecting alleles at mid to high frequencies. However, at low frequencies, alleles were least likely to be detected using Invader SNP markers, and this technology had the highest level of missing data. Collectively, these results showed that SNP technologies can provide increased marker data quality and quantity compared with SSRs. The relative loss in polymorphism compared with SSRs can be compensated by increasing SNP numbers and by using SNP haplotypes. Determining the most appropriate SNP chemistry will be dependent upon matching the technical features of the method within the context of application, particularly in consideration of whether genotypic samples will be pooled or assayed individually.

Dose finding in a low-dose 21-day combined oral contraceptive containing gestodene

An open label, non-comparative study was carried out in 22 women over a total of five cycles. After an untreated cycle, oral administration of 20 microg ethinyl estradiol (EE) with 50 microg gestodene (GST) (tablets taken daily for 21 days with a break of 7 days) was commenced, and three treatment cycles were followed by an untreated follow-up control cycle. The ability of this formulation to inhibit ovulation and suppress ovarian activity was assessed by using hormonal parameters and ultrasound. One ovulation occurred during treatment. Luteinized unruptured follicles were observed in three cases in the second treatment cycle and in one case during the third treatment cycle. Follicle-like structures larger than 13 mm associated with a serum estradiol level of more than 30 pg/mL were noted in 19% of the women in the first treatment cycle. The rate of active follicle-like structures was 43% in the second treatment cycle and 28% in the third treatment cycle. The results were compared with previously reported findings of a preparation containing 20 microg EE and 75 microg GST. With regard to ovarian grading and endogenous hormone secretion, considerably more residual ovarian activity, with all parameters examined, was found in the 20 microg EE and 50 microg GST preparation compared to the 20 microg EE and 75 microg GST preparation. It was concluded that the 20 microg EE and 50 microg GST preparation administered for 21 days does not meet the requirements of a combined oral contraceptive with respect to ovulation inhibition.

Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity

OBJECTIVE

To compare ovulation inhibition and ovarian activity with 21-day and 24-day regimens of a low-dose combined oral contraceptive (COC) containing 60 microg of gestodene and 15 microg of ethinyl estradiol.

DESIGN

Interventional observational study.

SETTING

Reproductive medicine unit.

PATIENT(S)

Fifty-eight healthy volunteers aged 18-35 years.

INTERVENTION(S)

Ovarian activity was monitored every other day with the use of ultrasound to measure the diameters of follicle-like structures and blood samples to measure serum concentrations of 17beta-E2 and progesterone. Subjects were observed for five cycles: pretreatment and posttreatment control cycles and three cycles in which the COC was administered for either 21 or 24 days of each cycle.

MAIN OUTCOME MEASURE(S)

Occurrence of ovulation and evidence of ovarian activity.

RESULT(S)

The study was completed by 27 (90%) of the 30 subjects who received the 24-day regimen and by 24 (79%) of the 28 subjects who received the 21-day regimen. Ovulation was inhibited in all cycles in the 24-day group and in 74 of 75 cycles in the 21-day group. Luteinized unruptured follicles were seen in no cycles with the 24-day regimen and in 6 (8%) of 75 cycles with the 21-day regimen. Mean ovarian follicular development and serum 17beta-E2 and progesterone levels were lower in the 24-day group.

CONCLUSION(S)

The 24-day regimen is an innovative strategy for maintaining effective ovulation inhibition at ultra-low doses of contraceptive steroids.

Designing an automated services tracking system for a caregiver support program

This article describes the process of developing an automated services tracking system for California's 11 regional Caregiver Resource Centers. The system was designed over a 3-year period for use by social workers, administrative personnel, and managers and has implications for both internal services monitoring and state reporting functions. The system development included input from clinical staff to be user-friendly to nontechnical staff. The article recounts technical and conceptual obstacles overcome and the evaluation of a relatively modest idea into a sophisticated, custom-made computer program. Issues of start-up, implementation, expansion, and report design are discussed. Lessons learned and other insights have practice and policy implications for documenting and reporting service usage at case management and other social services agencies. Lastly, an overview of the system's features and highlights of automated reports are provided.

An in-house coordinator program to increase organ donation in public trauma hospitals

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increase 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

An in-house coordinator program to increase organ donation in public teaching hospitals

The organ donor referral rates at Ben Taub General Hospital, a level 1 county trauma facility in Houston, Tex, were in the high 90s from 1993 through 1996. However, organs were procured from only 25% of those potential donors who were medically suitable. LifeGift Organ Donation Center identified two issues concerning the hospital's organ donor referrals: early medical management problems and a low consent rate. The hospital and LifeGift developed an in-house coordinator program along with specific protocols that have markedly increased the quantity of organ donors. In fiscal year 1994, 15 organ donors were recovered; in fiscal year 1995, following the implementation of the program, 25 organ donors were recovered. In fiscal year 1996, 39 organ donors were recovered. The in-house coordinators' consent rate was 72% of medically suitable potential donors. Early referrals for evaluation contributed to these successes.

Shorter pill-free interval in combined oral contraceptives decreases follicular development

The objective of the study was to determine the suppressive effect on ovarian activity of 20 micrograms ethinylestradiol plus 75 micrograms gestodene administered for 21 or 23 days. The study was designed as a double-blind, randomized, multicenter trial in 60 women. A pre-treatment cycle, three treatment cycles and a post-treatment period were monitored by ovarian ultrasound and by LH, FSH, 17 beta-estradiol and progesterone measurements every other day. No ovulation and no luteinized, unruptured follicle were observed. Suppression of ovarian activity was more pronounced by the 23-day regimen. 17 beta-Estradiol serum levels during the last six days of a cycle and during the first six days of the next cycle were significantly less (p < 0.05) in the 23-day regimen. The superiority of the 23-day regimen in comparison to the 21-day regimen with regard to the suppression of ovarian activity was shown in this study. The observed differences in the 17 beta-estradiol levels and follicular development between a 21-day and 23-day preparation combine to suggest that shortening the pill-free interval in combined oral contraceptives may increase the contraceptive safety margin in women on low-dose formulations.

Natural history of allograft coronary arteriopathy: a retrospective study of 54 patients over a 8 1/2-year period

A total of 288 patients underwent heart transplantation at Loyola University Medical Center over a 8 1/2-year period starting in March, 1984. Of these patients, 54 were identified as having allograft coronary arteriopathy. Diagnosis was made on the basis of abnormal findings on coronary angiography in 44 patients; either an autopsy or explanted heart revealed the diagnosis in the remainder. A total of 279 abnormal lesions were identified by coronary angiography, and over 70% of these stenoses were discrete and located in large epicardial vessels. The left ventricular ed-diastolic pressure demonstrated a steady rise over time (2.5 mmHg/year), and also correlated with the degree of allograft coronary arteriopathy stenosis. The rate of stenosis progression was 33% per year from the time of initial allograft coronary arteriopathy development. Actuarial survival rate was lower than that of patients with arteriopathy. In conclusion, first, the majority of allograft coronary arteriopathy stenoses detected on coronary angiography are discrete, involve large epicardial vessels, and progress rapidly over time. Second, left ventricular end-diastolic pressure seems to reflect the degree of allograft coronary arteriopathy stenosis, and may prove to be a useful indicator of left ventricular dysfunction related to allograft coronary arteriopathy. Third, patients with allograft coronary arteriopathy show a decreased actuarial survival rate.

Optimal size matching in single lung transplantation

BACKGROUND

Single lung transplantation for patients with end-stage obstructive lung disease has been highly effective in providing symptomatic relief, and it has been performed at a much increased frequency since 1983. However, there still lacks a convincing study showing the effect of size match and other preoperative variables in predicting functional outcome of patients after transplantation.

METHODS

We evaluated 23 single lung transplantations performed for obstructive lung disease over a 34-month period. Multiple physiologic variables and size match criteria were evaluated for their contribution in determining the postoperative forced expiratory volume in 1 second at 3 months after transplantation.

RESULTS

The size match ratio that was based on inframammary chest wall circumference was the most useful criterion to adopt, and the optimal donor/recipient size match ratio was 0.89. Furthermore, forced expiratory volume in 1 second at 3 months after transplantation could be predicted with a simple mathematical model that was based on the size match ratio and the recipient's calculated vital capacity of the transplanted hemithorax.

CONCLUSIONS

This model could be applied in a clinical setting to maximize functional outcome of the recipients undergoing single lung transplantation.

Survival and functional outcome after single and bilateral lung transplantation. Loyola Lung Transplant Team

BACKGROUND

The experience at Loyola University Chicago was retrospectively reviewed to evaluate survival and functional outcome after single lung transplantation (SLT) and bilateral lung transplantation (BLT).

METHODS

Ninety patients underwent lung transplantation at Loyola University Chicago between April 1990 and December 1993. Mean age was 45 years (range, 13 to 66 years). Fifty percent were male. Pre-lung transplant pulmonary diseases were as follows: emphysema and/or chronic obstructive pulmonary disease in 43 patients, pulmonary fibrosis in 13, cystic fibrosis in 14, pulmonary hypertension in eight, repeated transplantation for obliterative bronchiolitis in four, bronchiectasis in two, bronchoalveolar cell carcinoma in two, sarcoidosis in one, primary obliterative bronchiolitis in one, histiocytosis X in one, and lymphangiomyomatosis in one. Fifty-seven patients underwent SLT, and 33 had BLT. Maintenance immunosuppression medications consisted of cyclosporine, azathioprine, and prednisone.

RESULTS

Perioperative complications were as follows: seven of 33 patients bled after BLT, and two of 57 bled after SLT. Bronchial complications were found in six of 66 (9%) BLT anastomoses and eight of 57 (14%) SLT anastomoses. Nine operative deaths occurred in SLT patients: six from allograft failure, one from infection, one from intrapulmonary hemorrhage, and one from bronchial dehiscence. Only two patients died in the perioperative period after BLT and that was of infection. Three late deaths occurred after BLT, all as a result of infection; 13 recipients died late after SLT: five of infection, four patients from lymphoma, two of pancreatitis, one of tension pneumothorax, and one of pulmonary embolism. For the entire patient population the actuarial 1- and 2-year survival rates were 72% and 68%, respectively. One-year survival rates were significantly better for patients undergoing lung transplantation for obstructive and nonrestrictive lung diseases than those of patients undergoing lung transplantation for vascular or restrictive pulmonary disease. Recipients of BLT had a trend toward better survival than recipients of SLT. Lung function 6 months after transplantation measured by forced expiratory volume in 1 second was significantly better in BLT than SLT, 71% of predicted versus 54%.

CONCLUSIONS

Patients who undergo BLT have significantly better postoperative pulmonary function than those who undergo SLT. On the basis of the study there was a trend toward better survival with BLT.

Myocardial metabolism and adaptation during extreme hemodilution in humans after coronary revascularization

OBJECTIVE

This study was designed to evaluate the oxygen transport adjustments and myocardial metabolic adaptation that occurs with different levels of hemodilution during normothermia after cardiopulmonary bypass.

DESIGN

Prospective, nonrandomized study.

SETTING

Operating room in a university hospital.

PATIENTS

Eight patients with ejection fractions (> 40%) undergoing elective coronary artery bypass grafting.

METHODS

Before the institution of cardiopulmonary bypass, blood was withdrawn from patients to a target hematocrit of 15%. After coronary artery bypass grafting, a catheter was inserted directly into the coronary sinus. After the patients were rewarmed to 37 degrees C, they were weaned from cardiopulmonary bypass. Hemodynamic indices were measured, as well as measurements of myocardial oxygen consumption (VO2) and myocardial metabolism (lactate extraction and coronary sinus hypoxanthine). Measurements were made at three different hematocrit values: 15%, 20%, and 25%. Hematocrit was increased by autologous blood transfusion.

MEASUREMENTS AND MAIN RESULTS

The three levels of hemodilution (hematocrit: 17.4 +/- 3.4%; 23.0 +/- 3.7%; 27.8 +/- 4.8%) were significantly different from baseline (hematocrit 37 +/- 2.6%; p < .05). Oxygen delivery, which increased with autologous transfusion, exceeded 350 mL/min/m2 at each level of dilution. The myocardial VO2 increased significantly after autologous transfusion compared with the most dilute condition (7.0 +/- 3.7 mL/min at hematocrit 17.4% vs. 11.2 +/- 4.8 mL/min at hematocrit 23.0% and 12.4 +/- 4.0 mL/min at hematocrit 27.8%). This transfusion-induced increase was also true of myocardial oxygen extraction. Lactate extraction and hypoxanthine release were normal and unchanged at each level of hemodilution. Systemic oxygen extraction ratio increased with hemodilution and decreased with autologous transfusion.

CONCLUSIONS

Hemodilution to a hematocrit of approximately 15% is tolerated in anesthetized humans after coronary artery bypass surgery. There was no evidence of myocardial ischemia, as demonstrated by absence of S-T depression on the electrocardiogram, lactate extraction, or hypoxanthine release. In selected patients, postoperative transfusion may be based on systemic physiologic end-points, such as oxygen extraction ratio, rather than set hematocrit values.

Successful use of the total artificial heart as a bridge to transplantation with no mediastinitis

High rates of infection, especially mediastinitis, have been reported with the use of the total artificial heart (TAH), thereby limiting its usefulness. We have used the TAH as a bridge to transplantation with only minor infectious complications and a zero incidence of mediastinitis. Between February 1988 and August 1990, the TAH was inserted at Loyola University Medical Center in 19 patients, ages 16 to 64 years (mean, 44 years). Seventeen patients (89%) underwent transplantation within 1 to 34 days (mean, 9.8 days). Of the patients who did not undergo transplantation, one was brain dead and the other died of bleeding diathesis. Early (30-day) deaths occurred in two patients (11.7%): acute rejection at 18 days and multiple cerebral infarcts at 14 days. Three late deaths (17.6%) occurred: one patient, cytomegalovirus and pneumocystis pneumonia at 4 months; one patient, bronchopneumonia and multisystem failure at 9 months; and one patient, chronic rejection at 14 months. Minor infectious complications during the TAH implantation included Enterobacter pneumonia treated with antibiotics and positive sputum cultures (Escherichia coli; Candida), with no clinical evidence of infection in two patients. No cases of mediastinitis occurred either while the TAH was implanted or after transplantation. All patients were on antibiotics while the device was in place.

CONCLUSION

Our experience with the TAH shows this to be an excellent device for successful bridging of patients for heart transplantation. We have had minimal infectious complications and none directly attributed to the use of this device. This device should continue to be used safely as a bridge to transplantation.

Comparison of results after heart transplantation: mechanically supported versus nonsupported patients

Between March 1984 and July 1990 our team transplanted 168 hearts. One hundred twelve patients did not require mechanical support (group I). Fifty-six patients required mechanical support (group II). Intraaortic balloon counterpulsation was used in 37 patients (66%). The total artificial heart (TAH) was used in 16 patients (29%), and the ventricular assist device (VAD) was used in three patients (5%). The time spent on the device ranged from 1 to 35 days. No statistical difference was noted on the survival between the two groups. The 30-day and 1-year survival rate was 95% (106 patients) and 71% (79 patients) in group I and 91% (51 patients) and 68% (38 patients) in group II. As of July 31, 1990, 70% in group I and 68% in group II are alive. No significant differences were found between the two groups for the following variables (after heart transplantation): length of stay, 30-day survival, 1-year survival, and complications. The only significant difference found between the two groups was the incidence of infections: group I, 23%; group II, 51.7% (p = 0.001). Mechanical support as a bridge to transplantation provides excellent support until a donor becomes available. No difference was found in the 30-day and 1-year survival between the two groups.

Maternal and environmental factors associated with infections and undernutrition in young Australian aboriginal children

Forty-eight Aboriginal infants in remote communities in north-west Australia were studied monthly from birth to 2 years. Birthweight and growth were positively associated with maternal health during pregnancy, regular antenatal supervision and lack of drinking alcohol or smoking tobacco as well as with personal and family hygiene. Impaired growth was associated with families which had more expensive consumer goods such as televisions, air conditioners, video cassette recorders and cassette tape players. Most children had impaired growth or frank failure to thrive which was associated with high rates of infections, particularly of the respiratory and gastro-intestinal tracts, and high rates of hospitalization.

The resazurin reduction test provides an assessment of sperm activity

OBJECTIVE

The objective of the study was to determine if reduction of the dye resazurin by semen could be correlated with the concentration of motile sperm.

DESIGN

After assessment of sperm count and motility, specimens were incubated for 1 hour with resazurin (25 micrograms/mL of semen) and visual color changes indicative of dye reduction noted.

SETTING

Specimens were obtained from men seeking care for infertility at one of four sites: (1) University of California, San Francisco (UCSF) In Vitro Fertilization Program; (2) UCSF Andrology Laboratory; (3) a gynecological practice in Maine; and (4) a private andrology laboratory in Southern California.

PATIENTS

Individuals were self-selected by their desire to have a semen analysis in conjunction with the diagnosis or treatment of infertility.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The reduction of the dye resazurin and its correlation with motile sperm density.

RESULTS

When the motile sperm concentration was greater than or equal to 20 X 10(6)/mL, 86% of specimens produced a positive color change. Conversely, 86% of specimens with a motile sperm concentration of less than 20 X 10(6)/mL either did not change color or changed only over a narrow range.

CONCLUSION

Reduction of resazurin offers an assessment of the active sperm in a specimen without the need to do a sperm count or evaluation of motility.

Orthotopic cardiac transplantation in two patients with previous malignancy

This report presents 2 patients with previous malignancy in whom congestive cardiomyopathy developed secondary to doxorubicin toxicity. Both patients underwent orthotopic cardiac transplantation 3 and 5 years ago and are now in functional class I with no evidence of malignant recurrence.

Use of the total artificial heart and ventricular assist device as a bridge to transplantation

The proliferation of transplant programs has not been paralleled by a similar increase in the availability of organ donors. This has significantly prolonged the waiting period and consequently has resulted in increased mortality of the patients with end-stage heart disease who are awaiting transplantation. Between 1984 and 1987, 104 orthotopic heart transplants were performed at Loyola University Medical Center. During the same period, 25 patients died while waiting for a suitable donor. To reduce the mortality of our patients waiting for transplantation, we began using the total artificial heart and a ventricular assist device as a bridge to transplantation in 1988. Of 29 patients who underwent transplant procedures in 1988, 18 required either a total artificial heart (15) or a ventricular assist device (3) as a bridge to transplantation. The underlying heart conditions were ischemic cardiomyopathy (11), dilated cardiomyopathy (5), giant cell myocarditis (1), and allograft failure (1). The average duration of mechanical support was 10 days (range, 1 to 35 days). Seventeen of the supported patients had successful transplants. One patient had brain death and did not receive a heart transplant. Of the 17 patients who survived surgery, two died within 30 days: one at 17 days because of acute rejection, the other at 14 days because of a cerebral vascular event. Fifteen patients (83%) were long-term survivors. Nine of the supported patients required reoperation because of bleeding after device implantation. There was no mediastinal or incisional infection. While the mechanical device was in place, the activated clotting time was maintained between 170 and 200 seconds with the administration of heparin (400 to 1000 units per hour).(ABSTRACT TRUNCATED AT 250 WORDS)

High-risk heart surgery in the heart transplant candidate

Because of the limited supply of donor hearts, transplant physicians are searching for alternative treatments for patients referred for orthotopic heart transplantation. A group of 20 patients (7% of patients accepted for heart transplantation at Loyola University Medical Center) were nonrandomly sent for conventional heart surgery. Of 20 patients, 17 survived their hospitalization, and 11 of the original 20 have avoided heart transplantation or having their names added to the transplant list. This group represents a high-risk subset of patients. Patients with poor ventricular function and ventricular arrhythmias or with poor ventricular function who underwent first-time revascularization were well served by more conventional heart surgery (all 10 patients survived surgery). Patients with poor ventricular function who required redo bypass operation had a poor result (three of six died), and such patients should be considered carefully for initial heart transplantation.

Growth of remote Australian aborigines from birth to two years

Lengths and weights have been measured every month from birth to two years of age in 48 Aboriginal children born into six remote communities in the Kimberley region in the far north of Western Australia. Birthweights, on average, were slightly less than international reference values but growth rates in the first 3 months of life exceeded those reference values. However, between 3 and 6 months of age rates of weight gain and linear growth fell below those expected at that age and after 9 months of age Aboriginal infants were lighter than reference values and remained so throughout the first two years of life. By 2 years of age the Kimberley children were more than 1 kg lighter and 4.5 cm (boys) and 3.6 cm (girls) shorter than the international reference values. Monthly means and standard deviations for weight and length velocities are given. Environmental factors, particularly infections and inadequate nutrition, are important contributors to impaired growth in Aboriginal infants and young children.

Kindling in spontaneous hypertensive rats

Vasopressin is a neurohormone and neuromodulator with many effects on behavior. Rats lacking vasopressin have been found to develop kindled seizures more slowly with amygdala stimulation. In the present study the spontaneous hypertensive (SH) rat and rats from the parent strain, the Wistar-Kyoto (WKY) rat received amygdala and pyriform kindling. The SH rat has been reported to have increased plasma vasopressin and increased brain vasopressin release. Plasma vasopressin, osmolality and hematocrit were also measured in blood samples obtained through chronic, indwelling catheters implanted in SH, WKY normal and Sprague-Dawley rats. SH rats were found to kindle with fewer afterdischarges than WKY normal rats with both amygdala and pyriform cortex stimulation. The total afterdischarge duration required to reach each kindling stage was significantly shorter in the SH rat. Plasma osmolality and vasopressin were significantly higher in the SH rats compared to WKY normal rats and Sprague-Dawley rats. These findings provide additional evidence that vasopressin may influence the establishment of enduring behaviors such as kindled seizures.

Transesophageal echocardiography: experience of a Canadian centre

Transesophageal echocardiography (TEE) is a new application of echocardiography in which an ultrasonic transducer is positioned in the esophagus and stomach to obtain images of the heart without interference from lung and bone. It is particularly useful in the assessment of left atrial masses, atrial septal defects, mitral valve disease, valvular prostheses and aortic dissection. In the operative setting, TEE is used to detect early myocardial ischemia in patients with coronary artery disease undergoing noncardiac surgery as well as in the assessment of the results of valvular surgery. This review examines the technique of TEE, its indications and the early experience with the first 100 patients examined at the Toronto Western Hospital with this technique.

Effect of magnesium on in vitro production of toxic shock syndrome toxin 1

Batch and chemostat culture of Staphylococcus aureus strain S411 was conducted in an investigation of the role of Mg++ in the control of production of toxic shock syndrome toxin 1 (TSST-1). Under both growth conditions, Mg++ influenced bacterial growth, and TSST-1 production was correlated with bacterial growth. The specific activity of TSST-1 (ng/mg yield, ng/mg total protein) increased with increasing concentrations of Mg++ and was maximal at physiologic levels of Mg++. No production of TSST-1 was observed under anaerobic conditions. In chemostat cultures in which valine nutrient limitation was used with various levels of tryptophan in the chemically defined medium, tryptophan concentration controlled the production of TSST-1 by strain S411, regardless of the concentration of Mg++.

Early management of acute myocardial infarction

Management of acute myocardial infarction (AMI) has changed dramatically since 1962, when the world's first operating coronary care unit opened in our hospital. Recently, thrombolytic agents, aspirin and beta-blockers have been shown to reduce the mortality of patients with AMI if given early. This article reviews management strategies and therapeutic options currently available during the first 24 hours of the hospital phase of AMI.

Doppler color-flow imaging assessment of shunt size in atrial septal defect

Two-dimensional echocardiography and pulsed-Doppler studies have not proved to be reliable methods of assessing left-to-right shunt size in atrial septal defect. Doppler color-flow imaging displays the transatrial jet, providing a new dimension with the potential capability of quantifying left-to-right shunt size. Twenty-three patients with atrial septal defect were studied by color-flow imaging and cardiac catheterization. The defect size measured by two-dimensional echocardiography, the maximal color-flow jet width in the atrial septum, and the maximal color-flow jet area in the right atrium were correlated with cardiac catheterization-derived left-to-right shunt size. Correlation coefficients were 0.57 (p less than 0.01), 0.67 (p less than 0.001), and 0.65 (p less than 0.01), respectively. Atrial septal color-flow jet width distinguished patients with less than a 2:1 left-to-right shunt size ratio (eight patients, jet width less than 15 mm in in all) from patients with greater than a 2:1 left-to-right shunt size ratio (15 patients, jet width greater than 15 mm in all). These results indicate that Doppler color-flow imaging can distinguish left-to-right shunt size in atrial septal defect accurately enough to influence decisions with regard to subsequent patient management.

Growth of aboriginal infants in the first year of life in remote communities in north-west Australia

Growth in the first year of life was studied prospectively, at monthly intervals, in 49 Aboriginal babies born into 6 remote communities in the tropical north-west of Australia. Birthweights, on average, were slightly lower than international (NCHS) reference values but growth velocity in the first 3 months of life exceeded international reference values. After that, growth rates in Aboriginal infants slowed and their attained weights and lengths fell behind expected values for age. By 12 months of age the Kimberley boys were 1.35 kg lighter and 4 cm shorter than the NCHS values while the Kimberley girls were 1.04 kg and 2.8 cm less than the international reference values. Environmental factors are considered dominant in determining these growth patterns in Australian Aboriginal infants.

Food costs and nutrition of aborigines in remote areas of northern Australia

A locally-relevant "market basket" has been devised to help to assess the cost of usual food purchases for Aborigines who live in the Kimberley region. The range of foods in the market basket is relatively restricted, especially for fresh vegetables. In some communities, basic food items cost over 40% more than they would in the Perth metropolitan area. Price differentials and other difficulties encourage unsatisfactory dietary patterns for Aborigines in the region. A food-voucher system is proposed as one possible way to help to overcome serious nutritional imbalances for pregnant women and their infants and young children who are especially vulnerable to nutritional deficiencies. This proposal is likely to be politically unpopular, so other ways should be sought to help to improve the health of Aboriginal mothers and their children.

Infection of a ventricular aneurysm and cardiac mural thrombus. Survival after surgical resection

Infections of cardiac mural thrombi are rare, and because antemortem diagnosis is difficult and antibiotic therapy alone ineffective, the associated mortality has been significant. A patient with gram-negative bacillary infection of a mural thrombus is described. Gallium 67 citrate isotope scanning and two-dimensional echocardiography were helpful adjuncts in establishing the diagnosis. Surgical resection of the infected myocardial tissue and prolonged antimicrobial therapy were necessary for cure.

Parathyroid cysts: a report of eleven cases including two associated with hyperparathyroid crisis

Eleven parathyroid cysts were found in 325 patients who underwent parathyroid operations. Ten cysts were located in the neck and one was located in the mediastinum. The cysts ranged in size from 1.6 to 10 cm with a mean of 3.9 cm. The patients who had cysts included six women and five men, and their ages ranged from 28 to 72 years with a mean of 51 years. In contrast to other reports that have suggested that most parathyroid cysts are nonfunctional, all but one of our patients had hyperparathyroidism, as evidenced by hypercalcemia, hypophosphatemia, and elevated parathyroid hormone level, which was corrected by cyst removal. The nonfunctional cyst first appeared to be an asymptomatic neck mass. Two patients had acute hyperparathyroid crises, which required emergency operations. It is postulated that the crises may have been the result of spontaneous necrosis of preexisting parathyroid adenomas. This is supported by the pathologic findings of degeneration and early organization as well as by the presence within the cyst of sanguineous fluid that contained a parathormone concentration greater than 100 times normal serum levels.

Separation of human X and Y spermatozoa by albumin gradients and Sephadex chromatography

Two methods of separating X and Y spermatozoa in human sperm were evaluated. In the first method, the semen was laid over bovine serum albumin in order to obtain high proportions of Y spermatozoa. The mean number of Y spermatozoa increased from 52% to 74%. For the second method, the semen was passed through columns of Sephadex G50 in order to increase the proportion of X spermatozoa. The X spermatozoa increased from a mean of 60% to 74%. The degree of separation in individual samples showed considerable variation in both methods. In some samples only a 6% change in the proportion of X and Y spermatozoa could be obtained, whereas in others the increase was 37%. The proportion of motile spermatozoa showed a marked increase with the Sephadex method.

Immunoglobulins in the semen of men with azoospermia, oligospermia, or self-agglutination of spermatozoa

One hundred samples of semen showing azoospermia, oligospermia, self-agglutination of spermatozoa, or normal physiologic spermatozoa were examined for evidence of autoimmune disorders. Immunoglobulin A, secretory immunoglobulin A, and complements C3 and C4 were present in a greater proportion of abnormal samples than in normal ones. The immunoglobulin A content of the abnormal samples was markedly increased, and the immunoglobulin G level slightly increased, as compared with normal samples. These findings support the hypothesis that agglutination of spermatozoa in semen is an autoimmune mechanism. They also suggest that, although spermatozoa may activate the mechanism, it is possible that abnormalities of the male genital tract can stimulate the formation of spermatozoal antibodies.

Improved survival after surgical therapy for chronic angina pectoris: one hospital's experience in a randomized trial

Between 1972 and 1974, 121 patients with chronic stable angina pectoris and operative coronary artery disease, excluding significant left main coronary obstruction, were randomized to either medical therapy (60 patients) or surgical therapy (61 patients) as part of a larger Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. At the time of randomization, medical and surgical groups were similar with regard to clinical and hemodynamic features as well as degree of left ventricular impairment and extent of coronary disease. Follow-up to June 1, 1978, reveals significantly improved survival in surgical patients from 3 through 6 years after randomization. Sixteen cross-over patients (13 medical to surgery, and 3 surgical without surgery) do not appear to influence results. Results of this randomized study from a single hospital differ from the preliminary results of the larger cooperative study, primarily because of a higher mortality in the medical group. The medical mortality in our group is in keeping with other reports of the natural history of patients with angina pectoris, and we propose that the population of patients we randomized closely simulates the usual type of patient with chronic angina being considered for surgical treatment. Our good surgical results thus contrast significantly with the survival of medically treated patients, and this separates our study from the body of the Veterans Administration Cooperative Study.

Spermatozoal antibodies in human seminal plasma as a cause of failed artificial donor insemination

Seven couples who were in a program of artificial donor insemination (AID) which had not resulted in a pregnancy were advised to abstain from sexual intercourse for 2 days prior to AID. Six of the wives became pregnant following this advice. Seminal plasmas from the seven husbands showed evidence of spermatozoal antibodies. They agglutinated or immobilized healthy spermatozoa and contained immunoglobulin A and complements C-3 and C-4. Immunoglubulin G levels in these seminal plasmas were slightly elevated. Blood sera from the same husbands also agglutinated normal spermatozoa or decreased their motility. A comparison of 33 women who were not advised concerning sexual intercourse prior to AID and 17 women who were advised revealed that 46% of the former group became pregnant, whereas in the advised group 88% achieved pregnancy. The conclusion is that abnormal semen may contain spermatozoal antibodies which adversely affect normal spermatozoa. In order to avoid the presence of spermatozoal antibodies on the wife's cervix, couples are advised to abstain from sexual intercourse, or to use a condom, for 2 days prior to AID.

Physiologic disposition of nabilone, a cannabinol derivative, in man

Nabilone is a cannabinoid that is being evaluated in man as a potentially useful psychoactive drug. We found that nabilone was readily absorbed from the human gastrointestinal tract when administered orally as a coprecipitate with polyvinyl-pyrrolidone. The absorbed drug disappeared from plasma rather rapidly (half-life, approximately 2 hr), evidently due to extensive tissue distribution and rapid metabolism. The metabolites of nabilone persist in plasma for extended periods (half-life of total radioactivity exceeds 20 hr). Circulating metabolites include isomeric carbinols formed by reduction of the ketone in the 9-position of nabilone. Nabilone is eliminated in feces (about 65% of dose) and urine (20%). The excretory products in urine have not been identified, but metabolites that are labile to hydrolysis by beta-glucuronidase or sulfatase do not appear to be formed in significant amounts. A metabolite of nabilone in feces has been identified as a diol formed by reduction of the 9-keto group plus oxidation at the penultimate carbon of the dimethylheptyl side chain. The long duration of action of nabilone in the face of rapid and extensive metabolic elimination suggests that the pharmacologic effects, at least in part, may be exerted by one or more active metabolites.

Reversal of advanced left ventricular dysfunction following aortic valve replacement for aortic stenosis

A series of 12 consecutive patients who underwent aortic valve replacement (AVR) for aortic stenosis complicated by severe left ventricular dysfunction was reviewed. Ventricular dysfunction was reflected by pulmonary congestion, edema, renal and hepatic dysfunction, and by severely depressed ejection fractions (mean, 13%; range equal to 0-20%). Aortic valve replacement was accompanied by mitral commissurotomy in 1 patient and aortocoronary bypass in 5. Three of 5 patients with greater than 50% coronary obstruction died without reversal of heart failure, and 1 of the 5 died after a stroke. The 1 survivor of this group has done well. All 7 patients with minimal or no coronary disease survived operation and are now in New York Heart Association Class I or II. Postoperative catheterization (2 to 12 months) in 6 patients showed improved cardiac index and filling pressures. Left ventricular diastolic volume fell from 159 to 82 ml/m2, and ejection fraction rose from 13 to 45%. We conclude that left ventricular dysfunction owing to aortic stenosis alone is reversible and that AVR results in great clinical improvement. When coronary disease is present, survival may be accompanied by great improvement but the operative mortality is much higher.

The immunologic effects of husband's semen on donor spermatozoa during mixed insemination

Artificial insemination was performed on four women with the husband's and donor's semen mixed. No pregnancies resulted after several inseminations. One woman also received artificial donor insemination without success. Seminal plasmas from the husbands were allowed to react with donor semen and were observed to produce immobilization and agglutination of the donor's spermatozoa. Two of the husbands' seminal plasmas had high levels of immunoglobulin A, and all contained complements C-3 and C-4, which suggests that the mechanism is immunologic. Artificial donor inseminations were performed, and in addition the couples were advised to refrain from sexual intercourse for 2 days prior to insemination, in order to eliminate the risk of husband's seminal plasma being on the wife's cervix. Within 1 month, three of the four women became pregnant. As a practical measure, it is proposed that the effect of husband's semen on donor spermatozoa be determined prior to performing mixed inseminations and that couples refrin from sexual intercourse for 2 days prior to donor inseminations.

Antispermatozoal effects of human seminal plasma--an immunologic phenomenon

Semen samples were obtained from seven men who had self-agglutination of spermatozoa, and a spermatozoal antibody in the immunoglobulin G (IgG) fraction of their blood. The seminal plasma of these men produced spermatozoal immobilization and agglutination when added to normal semen from healthy men. Analysis of the seminal plasma samples showed that they contained IgA and complements C-3 and C-4, whereas only 1 of 10 samples from normal men contained IgA, and none had complements C-3 and C-4. The IgG levels of the seminal plasma from the study group were higher than those of the controls. It is suggested that the mechanism of spermagglutination is one of autooimmunization in which the main antibody is IgA from the genital tract, augmented by a circulating antibody from the IgG fraction of the blood.