Balancing quality and quaternary care imperative using a high-risk case review committee in adults.

Objectives: Quaternary care centres have an imperative to serve as hospitals of last resort and must also meet professional quality targets. We developed a high-risk committee (HRC) to evaluate cases meeting pre-defined predicted risk cut-offs as a part of an overall quality improvement drive.

Methods: We describe the structure, outcomes and effects of the Penn HRC.

Proposal for a trial of early left ventricular venting during venoarterial extracorporeal membrane oxygenation for cardiogenic shock.

Objective: Patients with profound cardiogenic shock may require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for circulatory support most commonly via the femoral vessels. The rate of cardiac recovery in this population remains low, possibly because peripheral VA-ECMO increases ventricular afterload. Whether direct ventricular unloading in peripheral VA-ECMO enhances cardiac recovery is unknown, but is being more frequently utilized.

CD11b⁺, Ly6G⁺ cells produce type I interferon and exhibit tissue protective properties following peripheral virus infection.

The goal of the innate immune system is containment of a pathogen at the site of infection prior to the initiation of an effective adaptive immune response. However, effector mechanisms must be kept in check to combat the pathogen while simultaneously limiting undesirable destruction of tissue resulting from these actions. Here we demonstrate that innate immune effector cells contain a peripheral poxvirus infection, preventing systemic spread of the virus.

Use of a mucoadhesive disk for relief of dry mouth: a randomized, double-masked, controlled crossover study.

Background: Dry mouth is a frequent complaint of adults worldwide. In those who experience dry mouth, therapeutic options include the use of salivary substitutes and sialogogues.

Methods: The authors compared the efficacy and safety of mucoadhesive disks (OraMoist, Axiomedic, Zurich; distributed by Quantum Health, Eugene, Ore.

Diversity of escape variant mutations in Simian virus 40 large tumor antigen (SV40 Tag) epitopes selected by cytotoxic T lymphocyte (CTL) clones.

To better understand the relationship between epitope variation and tumor escape from immune surveillance, SV40 T antigen-transformed B6/K-0 cells were subjected to selection with individual CTL clones specific for the SV40 T antigen H-2D(b)-restricted epitopes I or V. CTL-resistant populations were isolated from a majority of the selection cultures and substituted epitope sequences were identified within most of the resistant populations. Tag sequences deleted of all or portions of the selection-targeted epitope were identified, but in lower numbers compared to epitope sequences bearing single residue substitutions.

Kinematics of healthy and meniscal repaired knees.

Differences have been reported between in vitro and in vivo meniscal kinematics, and no clinical study to date has investigated the effect of meniscal repair on meniscal kinematics. Eleven subjects with healthy knees and eight subjects who had undergone meniscal repair for an isolated tear were scanned using magnetic resonance imaging. Sagittal plane scanning was performed at 0, 30, 60, 90, and 120 degrees of knee flexion.

Differential diagnosis of intractable lateral knee pain with progressive symptoms: a case problem.

This case study of an active 22 year old female who sustained a traumatic incident to the right knee focuses on the differential diagnostic process. Although early subjective complaints, clinical presentation, and diagnostic testing results were commensurate with internal derangement of the knee, appropriate medical and surgical management failed to halt the progression of pain and subsequent onset of neurological symptoms. Electrodiagnostic testing conducted 10 months post initial injury produced a definitive diagnosis of an irritative lesion of the right peroneal nerve in the region of the fibular neck.

Arginine transport in catabolic disease states.

Arginine appears to be a semiessential amino acid in humans during critical illness. Catabolic disease states such as sepsis, injury, and cancer cause an increase in arginine utilization, which exceeds body production, leading to arginine depletion. This is aggravated by the reduced nutrient intake that is associated with critical illness.

Insulin-like growth factor-2 activation of intestinal glutamine transport is mediated by mitogen-activated protein kinases.

Insulin-like growth factor-2 (IGF-2) plays a pivotal role in regulating intestinal epithelial metabolism, growth, and proliferation, but its regulatory effects on mucosal cell amino acid transport have not been well studied. The purpose of this in vitro study was to investigate the regulatory mechanisms and intracellular signaling pathways involved in the regulation of IGF-2 on glutamine transport in cultured intestinal cells. Continuous incubation with IGF-2 stimulated glutamine transport activity in cultured IEC-6 cells in a dose- and time-dependent fashion.

Metabolic acidosis stimulates intestinal glutamine absorption.

Glutamine is an essential nutrient for cell integrity during acidotic states such as shock, but the effect of extracellular pH on intestinal mucosal cell glutamine uptake is poorly understood. The purpose of this in vitro study was to investigate the intracellular signaling pathways involved in controlling intestinal glutamine transport during acidosis. Lowering the pH in the cell culture medium resulted in an increase in glutamine transport activity in a time- and pH-dependent fashion.

Quantitation of CD8(+) T-lymphocyte responses to multiple epitopes from simian virus 40 (SV40) large T antigen in C57BL/6 mice immunized with SV40, SV40 T-antigen-transformed cells, or vaccinia virus recombinants expressing full-length T antigen or epitope minigenes.

The cytotoxic T-lymphocyte response to wild-type simian virus 40 large tumor antigen (Tag) in C57BL/6 (H2(b)) mice is directed against three H2-D(b)-restricted epitopes, I, II/III, and V, and one H2-K(b)-restricted epitope, IV. Epitopes I, II/III, and IV are immunodominant, while epitope V is immunorecessive. We investigated whether this hierarchical response was established in vivo or was due to differential expansion in vitro by using direct enumeration of CD8(+) T lymphocytes with Tag epitope/major histocompatibility complex class I tetramers and intracellular gamma interferon staining.

Cytotoxic T lymphocyte recognition sequences as markers for distinguishing among tumour antigens encoded by SV40, BKV and JCV.

Simian virus 40 (SV40) has been shown to be associated with a number of human tumours. Two other human papova viruses, BKV and JCV, infect humans at a relatively high frequency and are activated upon immune suppression. The T antigens of both of these viruses share considerable homologies with the transforming protein T antigen of SV40.

A rapid method for comparative quantitative polymerase chain reaction of HIV-1 proviral DNA extracted from cryopreserved brain tissues.

The quantitative polymerase chain reaction (PCR) method devised by Fujimura and Bockstahler (1995) was modified for rapid determination of distribution of HIV-1 proviral DNA load in AIDS brains. It was used for analysis of an association with HIV-1 associated dementia and HIV-1 encephalitis (Fujimura et al., 1997).

Induction and persistence of a cytotoxic T lymphocyte (CTL) response against a herpes simplex virus-specific CTL epitope expressed in a cellular protein.

CD8+ cytotoxic T-lymphocytes recognize small epitope peptides in association with MHC class I molecules expressed on the cell surface. In this study, we have determined whether an 8 amino acid viral CTL epitope, when expressed in a cellular protein, can be appropriately processed, presented, and recognized by the corresponding epitope-specific CTL and whether it is capable of inducing a CTL response in vivo. An H-2Kb-restricted CTL epitope from herpes simplex virus type 1 (HSV-1) glycoprotein B (gB epitope, residues 498-505) was cloned into the mouse dihydrofolate reductase protein (DHFR) at amino acid position 87.

Simian virus 40 large T antigen contains two independent activities that cooperate with a ras oncogene to transform rat embryo fibroblasts.

The simian virus 40 large T antigen immortalizes growing primary cells in culture. In addition, this viral oncoprotein cooperates with an activated ras protein to produce dense foci on monolayers of rat embryo fibroblasts (REF). The relationship between independent immortalization and cooperative transformation with ras has not been defined.

Antibody response to human papovavirus JC (JCV) and simian virus 40 (SV40) T antigens in SV40 T antigen-transgenic mice.

Human papovavirus JC (JCV) and simian virus 40 (SV40) genomes share approximately 69% homology; and there is antigenic cross-reactivity between JCV and SV40 tumor or T antigens. In order to determine whether a selective immune response to JCV T antigen could be demonstrated, transgenic mice (SV11+) that express SV40 T antigen in the choroid plexus and are partially tolerant to antigenic determinants on SV40 T antigen were immunized with SV40 or JCV T antigens and their antibody responses were analyzed. The results show that SV11+ mice responded as well as their nontransgenic litter mates to JCV T antigen.

[Continuous noninvasive recording of circulatory parameters while performing the Valsalva test under elevated ambient pressure].

The results are presented which confirm applicability of the Valsalva test as a functional exercise for the cardiovascular system while studying changes of the circulation regulation under high ambient pressure. Methods of transthoracic tetrapolar impedance plethysmography, electro- and intervalocardiography and mean arterial pressure measurement by means of the oscillometric servosystem are shown as adequate and highly informative under these conditions.

Effect of standard and Aircast tennis elbow bands on integrated electromyography of forearm extensor musculature proximal to the bands.

Classic tennis elbow, or lateral epicondylitis, has been described as an overuse or misuse injury resulting in a tendinitis. The extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) have been implicated as primary culprits in this pathology. Tennis elbow has been treated using a constrictive band placed several centimeters distal to the origin of these two muscles.

Effect of the AirStirrup in Controlling Ankle Inversion Stress.

Subtalar ankle inversion with and without AirStirrup application was evaluated using high speed cinematographic techniques and a specially designed platform that inverts the ankle 35 O. Eighteen subjects aged 19 to 35 and with no history of ankle injury participated in the study. Two trials were filmed for each subject.

Objective evaluation of peroneal response to sudden inversion stress.

The purposes of this paper are to describe an objective technique developed to assess the dynamic response of the peroneal muscles to a sudden inversion motion and to report the results obtained from testing injured and noninjured ankles. A platform was constructed to drop the ankle into a controlled degree of inversion while measuring the time to peroneal response and the angular rotation. Thirty volunteers were tested, 15 of whom had experienced a unilateral ankle sprain 3- 10 months prior to testing.

In vivo release of neurotransmitters in the medial basal hypothalamus of the monkey.

In vivo release rates of norepinephrine (NE), epinephrine (E), dopamine (DA), gamma-aminobutyric acid (GABA), glutamate (GLU) and beta-endorphin (beta E) in the medial basal hypothalamus (MBH) of unanaesthetized female macaca fascicularis monkey, and the effects thereon of estrogen (E2) treatment, have been estimated using push-pull perfusion methodology. DA, NE, E, GABA, GLU and beta E were all detectable in 30 min perfusate fractions. No direct correlation between their release rates and those of LH and PRL could be observed.