Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.     

Total lymphoid irradiation preceding bone marrow transplantation for chronic myeloid leukaemia

Between August 1985 and October 1987 we treated 35 patients with chronic myeloid leukaemia (CML) by high dose chemotherapy, total body irradiation (TBI) (1000 or 1200 cGy, n = 31) and total lymphoid irradiation (TLI) (800 or 600 cGy, n = 35) preceding allogeneic bone marrow transplantation (BMT). Both TBI and TLI were given at 200 cGy/fraction. Twenty-three patients had HLA-identical sibling donors, nine patients had HLA-matched but unrelated donors, and three partially HLA-mismatched donors. Twenty-two patients received T-cell depleted marrow. The addition of TLI to the standard protocol did not add greatly to the toxicity. Four patients had recurrent leukaemia before engraftment was evaluable. The other 31 patients engrafted and no graft failed. Twenty-two patients survive at a median time from transplant of 305 days (range 81-586 days). Fourteen have no evidence of disease; eight have or had only cytogenetic evidence of leukaemia. We conclude that the addition of TLI to pretransplant immunosuppression increases the probability of reliable engraftment in patients receiving T-cell depleted marrow. This benefit is not associated with significantly increased toxicity.     

TUNEL-positive staining in white and grey matter after fatal head injury in man.

Paraffin sections from the hippocampus, the cingulate gyrus and the insula of 18 head-injured patients who survived between 5 hours and 10 days, and 18 age-matched controls, were stained by the terminal deoxynucleotidyl transferase mediated biotinylated deoxyuridine triphosphate nick end labelling (TUNEL) technique for evidence of in situ DNA fragmentation. Additional staining techniques (HE, combined LFB/CV and immunohistochemistry for GFAP and CD68) were used to characterize any lesions and their time course. Only the occasional TUNEL+ cell per area was seen in the control brains. TUNEL+ cells were identified in both grey and white matter of the head-injured material and their numbers peaked between 24 and 48 hours and were still present at 10 days. Within the hippocampus, fewer TUNEL+ cells were seen in grey (between 3-5 per area) than in the white matter, (up to 51+ per area) whereas in the cingulate gyrus and in the insula, the number of TUNEL+ cells was always greater in the cortex (between 11-20 per area) than in white matter (6-10 per area). In the grey matter, most TUNEL+ cells had the morphology of necrosis. However, the histological appearances of some of the neurons (2-3%), and of oligodendroglia and macrophages in white matter (about 5%) were those of apoptosis.     

Distributions of error correction tests for cointegration

This paper provides densities and finite sample critical values for the single‐equation error correction statistic for testing cointegration. Graphs and response surfaces summarize extensive Monte Carlo simulations and highlight simple dependencies of the statistic's quantiles on the number of variables in the error correction model, the choice of deterministic components, and the sample size. The response surfaces provide a convenient way for calculating finite sample critical values at standard levels; and a computer program, freely available over the Internet, can be used to calculate both critical values and p ‐values. Two empirical applications illustrate these tools.     

The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.     

Serum albumin and its acid hydrolysis peptides dominate preparations of mineral-bound enamel proteins

Serum albumin is a major noncollagenous protein component of bone, dentine, and, according to our results, enamel. Preparations of mineral-bound proteins from porcine developing enamel contain a single 67 kD protein at neutral pH or three proteins (67, 63, and 53 kD) at low pH that were assumed to be enamelins, a minor class of enamel proteins. A more complete analysis of these proteins in this study showed that they were derived from porcine serum albumin (PSA). This was demonstrated by amino acid analysis, by N-terminal sequence analysis, by immunoblot studies using an anti-PSA antibody, and by SDS-PAGE analysis of the acid hydrolysis, cyanogen bromide, and tryptic peptides. Examination of enamel at different developmental stages showed that PSA deposited in enamel from the enamel organ and from the dentine during development, not during the dissection process. These results indicate that true enamelins must represent a very small fraction of the total mineral-bound protein matrix in porcine developing teeth, and this has important implications on the role of mineral-bound proteins during mineralization of enamel.     

Non‐invasive assessment of kidney allograft fibrosis with shear wave elastography: A radiological‐pathological correlation analysis

Objectives

To evaluate the use of shear wave elastography in assessment of kidney allograft tubulointerstitial fibrosis.

Methods

Shear wave elastography assessment was carried out by two independent operators in kidney transplant recipients who underwent allograft biopsy for clinical indications (i.e. rising creatinine >15% or proteinuria >1 g/day). Allograft biopsies were interpreted by the same pathologist according to the 2013 Banff Classification.

Results

A total of 40 elastography scans were carried out (median creatinine 172.5 μmol/L [interquartile range 133.8–281.8 μmol/L]). Median tissue stiffness at the cortex (22.6 kPa [interquartile range 18.8–25.7 kPa] vs 22.3 kPa [interquartile range 19.0–26.5 kPa], P = 0.70) and medulla (15.0 kPa [interquartile range 13.7–18.0 kPa] vs 15.6 kPa [interquartile range 14.4–18.2 kPa]) showed no significant differences between the two observers. Interobserver agreement was satisfactory (intraclass correlation coefficient of the cortex 0.84, 95% CI 0.70–0.92 and intraclass correlation coefficient of the medulla 0.88, 95% CI 0.78–0.94). The areas under the receiver operating characteristic curves for detection of tubulointerstitial fibrosis were estimated to be 0.75 (95% CI 0.61–0.89), 0.85 (95% CI 0.75–0.95) and 0.65 (95% CI 0.53–0.78) for cortical, medullary tissue stiffness and serum creatinine, respectively.

Conclusions

Shear wave elastography can be used as a non‐invasive tool to evaluate kidney allograft fibrosis with reasonable interobserver agreement and superior test performance to serum creatinine in detecting early tubulointerstitial fibrosis.     

Trager Psychophysical Integration. A method to improve chest mobility of patients with chronic lung disease

The purpose of this study was to ascertain if Trager Psychophysical Integration would have an effect on patients with documented chronic lung diseases. The criterion measures were forced vital capacity (FVC), forced expiratory volume at one second and at three seconds (FEV1, FEV3), chest expansion, respiratory rate (RR), and subjective breathing difficulty. After a two-week regimen of Trager Psychophysical Integration administered by a physical therapist trained in the technique, our subjects exhibited significant changes at the p less than .05 level in FVC, RR, and chest expansion. We noted no significant changes in FEV1 and FEV3 or in subjective breathing difficulty. Because Trager Psychophysical Integration appears to have a positive effect on the restrictive component of chronic lung disease, physical therapists should learn this technique to treat more effectively their patients with chronic lung disease resulting from restriction.