Isolation of an abnormal protein C molecule from the plasma of a patient with thrombotic diathesis

Protein C has been purified from the plasma of a patient with thrombotic diathesis. Both before and after isolation, the protein showed reduced capacity to hydrolyze synthetic substrates and to anticoagulate plasma. Proteolysis with the soluble thrombin- thrombomodulin complex proceeded normally and to completion as judged by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting. Approximately one-third of the protein is functional, indicating a heterozygous defect. Indirect studies suggest that the abnormal component can bind to protein S and phospholipids. Both forms of activated protein C can also incorporate radiolabeled diisopropylfluorophosphate.     

Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography

Methods of preoperative radiologic localization of insulinoma were compared in 52 patients, 44 of whom had solitary tumors. Examinations performed in these 44 patients were preoperative ultrasonography (US) in 28, angiography in 26, and computed tomography in 23. Prospective sensitivities were 61%, 54%, and 30%, respectively. Imaging sensitivities were lower for the eight patients with multiple insulinomas. In 28 of the 44 patients, intraoperative US was performed without the examiner being aware of the surgical findings. The sensitivity was 84%. Four insulinomas were not palpable but were visualized sonographically. The combined sensitivity of intraoperative US and surgical palpation for detecting solitary insulinomas was 100%. High-frequency intraoperative US is valuable for detecting occult solitary insulinomas and considerably useful for determining the proximity of insulinomas to the pancreatic and bile ducts.     

贴壁培养细胞胶体金免疫电镜标本制备技术的改进

介绍一种贴壁培养细胞胶体金免疫电镜标本制备方法,本法适用于观察各种因素对细胞表面抗原性质影响的免疫电镜研究。     

Pay for performance for antibiotic timing in pneumonia: caveat emptor

BACKGROUND: Health care practitioners and hospital administrators have focused on a performance measure regarding antibiotic timing for patients with community-acquired pneumonia in anticipation of a pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) and private payers. ANTIBIOTIC TIMING AS A PERFORMANCE MEASURE: Early antibiotic administration is associated with improved outcomes, even after adjusting for severity. Yet although some patients may benefit through the early administration of antibiotics, there is a risk to other patients who are treated concurrently. Some patients' care may be delayed because they may not receive the same priority as patients with suspected pneumonia. Other patients may receive inappropriate antibiotics for suspected pneumonia to shorten the time to administration. POTENTIAL IMPACT OF PAY FOR PERFORMANCE: Attempts to address the performance measure are probably dependent on how well the emergency department functions and the level of crowding. Patients with a suspected pneumonia may be empirically covered with antibiotics before radiographic diagnosis, which should increase the rate of antibiotic administration for antibiotic-nonresponsive conditions and contribute to antibiotic resistance. The answer is to find measures of system throughput and/or work flow that are associated with improved patient care outcomes.