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Pulmonary Embolism as a Cause of Death in Psychiatric Inpatients: a Case Series. East Asian Arch Psychiatry 2019; 29:136-137. [PMID: 31871311 DOI: 10.12809/eaap1837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report four cases of fatal pulmonary embolism confirmed by autopsy among inpatients in a Hong Kong psychiatric hospital from 2010 to 2014. None of the four patients had a medical or premorbid condition associated with vascular thromboembolism or causing prolonged immobilisation. Only two patients were taking long-term antipsychotic medication, but all were physically restrained shortly before the event.
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Clinical trials in Ontario’s quality-based funding model. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
186 Background: Clinical trials (CTs) are a key component of a quality cancer care system. When funding for systemic therapy services in Ontario transitioned in 2014 from a one-time payment for new cases to bundled payments for specific care activities (consultation, therapy, well follow-up, supportive care), a policy was developed to address public funding for systemic therapy in CTs. Methods: Treatment facilities receive funding from the Systemic Treatment-Quality Based Program (ST-QBP) for treatment with evidence-informed regimens inclusive of inexpensive drug, preparation and delivery costs. Under the new CT policy, randomized CTs with a standard of care comparator arm receive funding for all arms of the trial from the ST-QBP for older inexpensive drugs and all treatment administration costs at the band level for the disease type and stage. Non-randomized CTs are funded at the level of best supportive care or other appropriate band level. CT costs over and above the standard of care must be negotiated with industry sponsors. New and expensive drugs in CTs may be funded through separate provincial drug reimbursement programs if used according to publicly approved funding indications. Weekly joint reviews of new CT submissions by staff of the ST-QBP and drug reimbursement programs ensures timely communication to investigators concerning policy alignment and public funding and addresses potential concerns with regard to downstream access to expensive drugs. Results: As of January 29, 2016, 121 CT applications have been assessed (Phase 0 = 1, Phase I = 26, Phase II = 31, Phase III = 39, Phase IV = 1 and Multi-Phase = 23). Almost all CTs are aligned with the new policy and were assessed in a timely fashion. Assessments are posted on Cancer Care Ontario’s website within 1 week of review to allow all Ontario investigators access to this information. Conclusions: A clear CT funding policy and timely reviews support patient and investigator access to new and innovative therapies within an evidence-informed public funding model in Ontario, Canada. [Table: see text]
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Abstract
13 Background: According to USP 797 and the National Association of Pharmacy Regulatory Authorities standards, the Beyond Use Date (BUD) based on sterility for single-dose vials is 6 hours, after which the contents must be discarded. In Ontario, centres have traditionally based BUD on stability data, not sterility data. This change presents concern about potential drug waste so an analysis was done to estimate the financial impact to the 76 systemic treatment facilities in Ontario. Methods: Using an administrative database that records the daily total dose of drugs administered by facility, annual drug waste cost was calculated using daily dose administered, cost per milligram, and available vial size(s) for 26 publicly funded drugs. Two different methods were used to determine the amount of drug waste. Method 1 used the largest vial size matched to the closest amount of drug required. Method 2 used the optimal vial size mix, when there are multiple vial sizes, to minimize wastage across all configurations of vial size. Some assumptions made include: 1) each facility had access to all available vial sizes, and 2) single-dose vial contents were true to the stated quantity as per the manufacturer. Results: The 10 facilities with the highest waste estimates are summarized in the table. The total waste estimates for all facilities are $25,927,861 (method 1) and $12,945,353 (method 2). Waste estimates were also calculated by drug, with rituximab, bevacizumab and pemetrexed having the highest waste costs. These drugs are only available in vials with a large range in size (100 and 500 mg), but could waste more than drugs with more size options or less variance between sizes. Conclusions: Assigning a BUD based on 6 hour sterility standards will have significant financial implications to facilities in Ontario. Development of mitigation strategies should be explored to provide guidance to Ontario and other jurisdictions on how to curtail the budget impact.[Table: see text]
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Assessment of Fever Advisory Cards (FACs) as an Initiative to Improve Febrile Neutropenia Management in a Regional Cancer Center Emergency Department. J Oncol Pract 2016; 12:e858-63. [DOI: 10.1200/jop.2015.009183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: We aimed to improve the time to antibiotics (TTA) for patients treated with chemotherapy who present to the emergency department (ED) with febrile neutropenia (FN) by using standardized fever advisory cards (FACs). Methods: Patients treated with chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada, with suspected FN were identified, before (April 2012 to March 2013) and after (October 2013 to March 2014) FAC implementation. The primary outcome of interest was TTA. Additional process measures included Canadian Triage and Acuity Scale score, time to physician assessment, and FAC compliance. Outcomes were analyzed with descriptive statistics and control charts to determine whether the change in primary measures were within statistical control over time. Results: Between the pre-FAC cohort (n = 239) and post-FAC cohort (n = 69), TTA did not change significantly post-FACs (195 v 244 min, P = .09), with monthly averages demonstrating normal variation by statistical process control methodology. The introduction of FACs increased the percentage of patients with correctly assigned Canadian Triage and Acuity Scale scores (87% v 100%) but did not affect time to physician assessment. Compliance with FACs among patients was not ideal, with only 62.5% using them as intended. Conclusion: The distribution of FACs was associated with an improved incidence of correct FN triaging but did not demonstrate a meaningful improvement in the quality of FN management. This may be explained by FAC use among patients not being ideal. Next steps in the continued effort toward high-quality FN care include redesign of FACs, reinforcement of provider and patient education, and ED outreach.
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Dynamics from noisy data with extreme timing uncertainty. Nature 2016; 532:471-5. [PMID: 27121840 DOI: 10.1038/nature17627] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/18/2016] [Indexed: 11/09/2022]
Abstract
Imperfect knowledge of the times at which 'snapshots' of a system are recorded degrades our ability to recover dynamical information, and can scramble the sequence of events. In X-ray free-electron lasers, for example, the uncertainty--the so-called timing jitter--between the arrival of an optical trigger ('pump') pulse and a probing X-ray pulse can exceed the length of the X-ray pulse by up to two orders of magnitude, marring the otherwise precise time-resolution capabilities of this class of instruments. The widespread notion that little dynamical information is available on timescales shorter than the timing uncertainty has led to various hardware schemes to reduce timing uncertainty. These schemes are expensive, tend to be specific to one experimental approach and cannot be used when the record was created under ill-defined or uncontrolled conditions such as during geological events. Here we present a data-analytical approach, based on singular-value decomposition and nonlinear Laplacian spectral analysis, that can recover the history and dynamics of a system from a dense collection of noisy snapshots spanning a sufficiently large multiple of the timing uncertainty. The power of the algorithm is demonstrated by extracting the underlying dynamics on the few-femtosecond timescale from noisy experimental X-ray free-electron laser data recorded with 300-femtosecond timing uncertainty. Using a noisy dataset from a pump-probe experiment on the Coulomb explosion of nitrogen molecules, our analysis reveals vibrational wave-packets consisting of components with periods as short as 15 femtoseconds, as well as more rapid changes, which have yet to be fully explored. Our approach can potentially be applied whenever dynamical or historical information is tainted by timing uncertainty.
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Abstract
220 Background: Chemotherapy induced nausea and vomiting (CINV) remains one of the most feared treatment-related toxicities in cancer patients. CINV has been shown to decrease quality of life and to increase dose modifications and unplanned hospital visits. Cancer Care Ontario (CCO) and the American Society of Clinical Oncology (ASCO) updated their CINV guidelines in 2013. These changes included a reclassification of many regimens from moderate (MEC) to highly emetogenic (HEC) and a decrease in the duration of serotonin inhibitors (5HT3i). Uptake of the new guidelines at Trillium Health Partners has been slow. We aimed to improve CINV by increasing the percentage of patients who received guideline concordant anti-emetics with their first cycle of HEC/MEC chemotherapy. Methods: The first 25 patients started on MEC/HEC chemotherapy during 3 time periods (pre-guidelines, 6 months post guidelines, 1.5 years post guidelines) were identified. The primary measure of interest was the percentage of patients receiving MEC/HEC who were treated in concordance with the updated CINV guidelines. Secondary measures included the percentage of MEC/HEC patients who experienced grade 2+ CINV. The collected data was used with quality improvement techniques to guide the development of interventions to improve guideline concordance. Results: The concordance of anti-emetics on the day of chemotherapy improved over time, but post-chemotherapy concordance remained at 0% (table). The primary driver for concordance was the use of NK1inhibitors on chemotherapy day, and the duration of 5HT3i post-chemotherapy. Using quality improvement methodology, the highest impact intervention was identified as changing the default settings in the computerized order entry system (CPOE) to reflect the updated guidelines. These changes are currently in progress and a test of this change will be presented. Conclusions: Concordance with CINV guidelines improved over time resulting in lower CINV and less need for reactive CINV interventions. Further work to target duration of 5HT3i is ongoing. [Table: see text]
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Standardization of oral chemotherapy delivery to improve patient safety: A pilot study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: Oral chemotherapy (OC) presents unique challenges to patient safety. In contrast with parenteral chemotherapy, patient education and comprehension are crucial to the safe administration of OC, appropriate toxicity interventions and patient adherence. At Trillium Health Partners we identified a lack of standardization to OC education and monitoring, that resulted in gaps in patient care. Using the American Society of Clinical Oncology/Oncology Nursing Society 2013 chemotherapy safety standards as guidance, we developed and piloted a multi-disciplinary oral chemotherapy care pathway (OCCP) to improve the approach to education and monitoring of patients newly started on OC. Methods: Patients newly started on OC between 03/15–06/15 were enrolled by 2 participating physicians representing a predominantly lung/GI practice. Baseline data was abstracted retrospectively in the 3 months prior to the pilot to reflect all study participants. The OCCP included in-person and telephone assessments by an oncology pharmacist and nurse over 2 cycles of OC. Pilot outcomes included pharmacy interventions, dose modification for toxicity, medication errors, the percent of prescriptions on computerized physician order entry (CPOE), adherence documentation and comprehension of treatment plan. Results: The pilot enrolled 20 patients and compared them against 21 baseline patients. During the pilot there were improvements in the percentage of patients who had pharmacy interventions, documentation of adherence and assessment of comprehension of the treatment plan as well as a reduction in dose modifications due to toxicity (Table 1). Conclusions: Use of a newly developed oral chemotherapy care pathway demonstrated both feasibility as well as improvements in a variety of key patient safety indicators. These results suggest that implementation of a standardized oral chemotherapy care pathway can feasibly improve patient safety outcomes. [Table: see text]
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Single-particle structure determination by X-ray free-electron lasers: Possibilities and challenges. STRUCTURAL DYNAMICS (MELVILLE, N.Y.) 2015; 2:041601. [PMID: 26798800 PMCID: PMC4711626 DOI: 10.1063/1.4919740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/21/2015] [Indexed: 05/22/2023]
Abstract
Single-particle structure recovery without crystals or radiation damage is a revolutionary possibility offered by X-ray free-electron lasers, but it involves formidable experimental and data-analytical challenges. Many of these difficulties were encountered during the development of cryogenic electron microscopy of biological systems. Electron microscopy of biological entities has now reached a spatial resolution of about 0.3 nm, with a rapidly emerging capability to map discrete and continuous conformational changes and the energy landscapes of biomolecular machines. Nonetheless, single-particle imaging by X-ray free-electron lasers remains important for a range of applications, including the study of large "electron-opaque" objects and time-resolved examination of key biological processes at physiological temperatures. After summarizing the state of the art in the study of structure and conformations by cryogenic electron microscopy, we identify the primary opportunities and challenges facing X-ray-based single-particle approaches, and possible means for circumventing them.
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Abstract
Intervention resulted in a meaningful and sustained improvement in the number of components of an oral chemotherapy care plan documented in the medical record.
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Abstract
The advent of the X-ray free-electron laser (XFEL) has made it possible to record diffraction snapshots of biological entities injected into the X-ray beam before the onset of radiation damage. Algorithmic means must then be used to determine the snapshot orientations and thence the three-dimensional structure of the object. Existing Bayesian approaches are limited in reconstruction resolution typically to 1/10 of the object diameter, with the computational expense increasing as the eighth power of the ratio of diameter to resolution. We present an approach capable of exploiting object symmetries to recover three-dimensional structure to high resolution, and thus reconstruct the structure of the satellite tobacco necrosis virus to atomic level. Our approach offers the highest reconstruction resolution for XFEL snapshots to date and provides a potentially powerful alternative route for analysis of data from crystalline and nano-crystalline objects.
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Conformations of macromolecules and their complexes from heterogeneous datasets. Philos Trans R Soc Lond B Biol Sci 2015; 369:20130567. [PMID: 24914167 PMCID: PMC4052876 DOI: 10.1098/rstb.2013.0567] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe a new generation of algorithms capable of mapping the structure and conformations of macromolecules and their complexes from large ensembles of heterogeneous snapshots, and demonstrate the feasibility of determining both discrete and continuous macromolecular conformational spectra. These algorithms naturally incorporate conformational heterogeneity without resort to sorting and classification, or prior knowledge of the type of heterogeneity present. They are applicable to single-particle diffraction and image datasets produced by X-ray lasers and cryo-electron microscopy, respectively, and particularly suitable for systems not easily amenable to purification or crystallization.
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LEFT MAIN INTERVENTIOIN IN A STANDALONE PCI CENTRE - A RECENT 5 YEAR EXPERIENCE. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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TU-B-201B-01: Radiation Dose Reduction in Medical X-Ray CT Using Equally-Sloped Tomography. Med Phys 2010. [DOI: 10.1118/1.3469197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Structure of isolated biomolecules obtained from ultrashort x-ray pulses: exploiting the symmetry of random orientations. JOURNAL OF PHYSICS. CONDENSED MATTER : AN INSTITUTE OF PHYSICS JOURNAL 2009; 21:134014. [PMID: 21817489 DOI: 10.1088/0953-8984/21/13/134014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Amongst the promised capabilities of fourth-generation x-ray sources currently under construction is the ability to record diffraction patterns from individual biological molecules. One version of such an experiment would involve directing a stream of molecules into the x-ray beam and sequentially recording the scattering from each molecule of a short, but intense, pulse of radiation. The pulses are sufficiently short that the diffraction pattern is that due to scattering from identical molecules 'frozen' in random orientations. Each diffraction pattern may be thought of as a section through the 3D reciprocal space of the molecule, of unknown, random, orientation. At least two algorithms have been proposed for finding the relative orientations from just the measured diffraction data. The 'common-line' method, also employed in 3D electron microscopy, appears not best suited to the very low mean photon count per diffraction pattern pixel expected in such experiments. A manifold embedding technique has been used to reconstruct the 3D diffraction volume and hence the electron density of a small protein at the signal level expected of the scattering of an x-ray free electron laser pulse from a 500 kD biomolecule. In this paper, we propose an alternative algorithm which raises the possibility of reconstructing the 3D diffraction volume of a molecule without determining the relative orientations of the individual diffraction patterns. We discuss why such an algorithm may provide a practical and computationally convenient method of extracting information from very weak diffraction patterns. We suggest also how such a method may be adapted to the problem of finding the variations of a structure with time in a time-resolved pump-probe experiment.
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Keeping a promise of the XFEL: crystallography without crystals. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308096542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Solution to the phase problem for surface X-ray diffraction. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308096505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Phase and amplitude recovery and diffraction image generation method: structure of Sb/Au(110)–√3 × √3R54.7° from surface X-ray diffraction. Acta Crystallogr A 2007; 63:239-50. [PMID: 17435288 DOI: 10.1107/s0108767307002930] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 01/18/2007] [Indexed: 11/10/2022] Open
Abstract
The discovery that the phase problem of diffraction from non-periodic objects may be solved by oversampling the diffraction intensities in reciprocal space with respect to a Nyquist criterion has opened up new vistas for structure determination by diffraction methods. A similar principle may be applied to the problem of surface X-ray diffraction (SXRD), where, owing to the breaking of a crystal periodicity normal to its surface, diffraction data consist of a set of superstructure rods (SRs) due to scattering from the parts of the surface whose structure is different from that of the truncated bulk and of crystal truncation rods (CTRs), formed by interfering contributions from the surface and the bulk. A phase and amplitude recovery and diffraction image generation method (PARADIGM) is described that provides a prescription for finding the unmeasured amplitudes and phases of the surface contributions to the CTRs in addition to the phases of the SRs, directly from the diffraction data. The resulting ;diffraction image' is the basis of a determination of the previously unknown multidomain structure of Sb/Au(110)-radical3xradical3R54.7 degrees.
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Multimerin processing by cells with and without pathways for regulated protein secretion. Blood 1999; 94:1337-47. [PMID: 10438722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Multimerin is a massive, soluble, homomultimeric, factor V-binding protein found in platelet alpha-granules and in vascular endothelium. Unlike platelets, endothelial cells contain multimerin within granules that lack the secretory granule membrane protein P-selectin, and in culture, they constitutively secrete most of their synthesized multimerin. To further evaluate multimerin's posttranslational processing and storage, we expressed human endothelial cell prepromultimerin in a variety of cell lines, with and without pathways for regulated secretion. The recombinant multimerin produced by these different cells showed variations in its glycosylation, proteolytic processing, and multimer profile, and human embryonic kidney 293 cells recapitulated multimerin's normal processing for constitutive secretion by human endothelial cells. When multimerin was expressed in a neuroendocrine cell line capable of regulated protein secretion, it was efficiently targeted for regulated secretion. However, the multimerin stored in these cells was proteolyzed more extensively than normally occurs in platelets, suggesting that endoproteases similar to those expressed by megakaryocytes are required to produce platelet-type multimerin. The impact of the tissue-specific differences in multimerin's posttranslational processing on its functions is not yet known. Multimerin's sorting and targeting for regulated secretion may be important for its functions and its association with factor V in secretion granules.
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Abstract
Natural resistance of humans to the cattle pathogen Trypanosoma brucei brucei has been attributed to the presence in human serum of nonimmune factors that lyse the parasite. Normal human serum contains two trypanosome lytic factors (TLFs). TLF1 is a 500-kDa lipoprotein, which is reported to contain apolipoprotein A-I (apoA-I), haptoglobin-related protein (Hpr), hemoglobin, paraoxonase, and apoA-II, whereas TLF2 is a larger, poorly characterized particle. We report here a new immunoaffinity-based purification procedure for TLF2 and TLF1, as well as further characterization of the components of each purified TLF. Immunoaffinity-purified TLF1 has a specific activity 10-fold higher than that of TLF1 purified by previously described methods. Moreover, we find that TLF1 is a lipoprotein particle that contains mainly apoA-I and Hpr, trace amounts of paraoxonase, apoA-II, and haptoglobin, but no detectable hemoglobin. Characterization of TLF2 reveals that it is a 1,000-kDa protein complex containing mainly immunoglobulin M, apoA-I, and Hpr but less than 1% detectable lipid.
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Studies of multimerin in human endothelial cells. Blood 1998; 91:1304-17. [PMID: 9454761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multimerin is a novel, massive, soluble protein that resembles von Willebrand factor in its repeating, homomultimeric structure. Both proteins are expressed by megakaryocytes and endothelial cells and are stored in the region of platelet alpha-granules resembling Weibel-Palade bodies. These findings led us to study the distribution of multimerin within human endothelial cells. Multimerin was identified in vascular endothelium in situ. In cultured endothelial cells, multimerin was identified within round to rod-shaped, dense-core granules, some of which contained intragranular, longitudinally arranged tubules and resembled Weibel-Palade bodies. However, multimerin was found primarily in different structures than the Weibel-Palade body proteins von Willebrand factor and P-selectin. After stimulation with secretagogues, multimerin was observed to redistribute from intracellular structures to the external cellular membrane, without detectable accompanied secretion of multimerin into the culture media. In early passage endothelial cell cultures, multimerin was associated with extensive, fibrillary, extracellular matrix structures, in a different distribution than fibronectin. Although multimerin and von Willebrand factor are stored together in platelets, they are mainly found within different structures in endothelial cells, indicating that there are tissue-specific differences in the sorting of these soluble, multimeric proteins.
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Symbolic probabilistic inference with both discrete and continuous variables. ACTA ACUST UNITED AC 1995. [DOI: 10.1109/21.384253] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Application of optical cross talk to switching between bistable soliton states. OPTICS LETTERS 1990; 15:162-164. [PMID: 19759744 DOI: 10.1364/ol.15.000162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The dynamics of bistable soliton propagation and switching in a fiber whose intensity-dependent refractive index is described by the linear plus smooth-step model is numerically investigated under conditions where the fiber is evanescently coupled to an identical, initially empty, parallel fiber. The initially empty fiber can perform a number of useful operations on solitons in the first fiber, which could be of interest in optical device design.
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Abstract
Cyanoacrylates were first synthesized by Ardis in 1949. However, it was not until Coover in 1959 discovered their adhesive properties that an interest arose in using these substances in surgical procedures. Over the past two decades the use of cyanoacrylates has been varied and widespread among the surgical specialties. methyl 2-cyanoacrylate (Eastman 910 Monomer), Isobutyl-cyanoacrylate (Bucrylate), and 2-cyano-butyl-acrylate (Histoacryl) were the most widely used. Because of its tissue toxicity methyl 2-cyanoacrylate was discarded. The consensus of various investigators was that the higher homologues, in particular Histoacryl could be safely used in human applications. The authors thought it would be important to ascertain how the academic departments of Otolaryngology perceived the role of cyanoacrylates within their specialty. A questionnaire was distributed to 115 academic centers: 47% of the departments responded and, of those, 34% indicated a current working knowledge of the cyanoacrylates. This response confirmed a very active interest in these tissue adhesives despite a lack of F.D.A. approval. The otologic applications of these adhesives has been well documented, but the literature is devoid of studies using cyanoacrylates in other aspects of Otolaryngology. The authors feel that these adhesives (in particular Histoacryl) have a role as an adjunctive technique in facial reconstructive and cosmetic surgery for autogenous cartilage grafting. A study using rabbits was designed to determine if Histoacryl could be used safely to overcome the technical difficulties (graft migration during healing and cartilage fracture during suturing) often encountered when performing autogenous onlay cartilage grafting. On the left ear of each rabbit, a cartilage graft was harvested and reimplanted at a second site on the same ear by suturing the perichondrium of the graft to the perichondrium of the donor site. On the right ear the graft was secured to the donor site with Histoacryl. The histological analysis of the rabbits' ears sacrificed at weekly intervals from 1 week to 1 month failed to demonstrate cartilage damage or tissue toxicity in the ears where Histoacryl was used. In conclusion, the authors contend that a role exists for the use of Histoacryl as an adjunctive technique in facial reconstructive and cosmetic surgery. The study will be continued to assess the long-term results of using Histoacryl for autogenous onlay cartilage grafting.
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ABO blood groups in Chilean and Peruvian mummies. II. Results of agglutination-inhibition technique. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1978; 49:139-42. [PMID: 677292 DOI: 10.1002/ajpa.1330490121] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABO blood groups of Peruvian and Chilean mummies were determined with the agglutination-inhibition method. In Peru all ABO blood groups were found in the period from 3000 B.C. to 1400 A.D.; from this period to 1650 only A and O were seen. In Chile no B or AB was noted either in pre-Columbian or Colonial mummies. This confirms the archeological concept that the Chilean Indian was culturally as well as genetically different from the Peruvian Indian. Further studies using other genetic markers are in order, as well as changing certain preconceived notions on blood groups of American Indians.
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