Proteoglycans of rabbit cornea: Labelling in organ culture and in vivo

Rabbit corneas maintained with radioactively-labelled precursors in organ culture for up to 42 hr produced labelled proteoglycans of the same kind as those that exist normally or that are produced by labelling in vivo. Whole corneas, including a narrow strip of sclera, were kept in culture in the presence of [³H]-glucosamine and [³⁵S]-sulfate. The rate of incorporation of sulfate into extractable proteoglycans was linear over the time investigated, as was the rate of incorporation of glucosamine after a short lag. Three labelled proteoglycans were isolated and found to behave in ion-exchange chromatography and gel chromatography in the same way as they did in previous studies by chemical analysis. Their labelled glycosaminoglycans were primarily dermatan sulfate and keratan sulfate, with traces of hyaluronic acid and heparan sulfate. When labelled precursors were injected directly into the anterior chamber of rabbit eyes, the resulting labelled proteoglycans were similar to those obtained in organ culture. Both in vivo and during organ culture, the specific activity of hexosamine in the keratan sulfate proteoglycans was about one-half that in dermatan sulfate, probably because of different synthetic rates or different specific activities of immediate precursors.     

Dermal island-flap anoplasty for transsphincteric fistula-in-ano

PURPOSE: The aim of this study was to assess the treatment failures of island-flap anoplasty for fistula-in-ano, a procedure designed to treat fistula without sphincter division. METHODS: Data concerning all patients having dermal island-flap anoplasty for the treatment of transsphincteric fistula were reviewed. Variables assessed were age, gender, radial fistula location, cause, Crohn's disease, previous fistula operations, other complicating illnesses, internal sphincter closure, simultaneous use of fibrin adhesive injection, and use of combined dermal and rectal flap for large fistulas. Postoperative data collected included persistence of the distal tract, recurrence of the fistula, and treatment of the recurrence. Recurrence (or persistence) of the fistula was the dependant variable and each risk factor for recurrence was assessed using chi-squared analyses. RESULTS: Seventy-three flaps were performed in 65 individuals. Recurrence developed 17 times in 13 individuals. Recurrence was more likely to occur in males, patients who have had previous treatment of fistulas, patients with large fistulas requiring combined flaps, and patients who had simultaneous fibrin glue injection. Patients with Crohn's disease and individuals having internal sphincter closure had fewer recurrences. Factors reaching statistical significance included closure of the internal sphincter, the use of fibrin glue, and cause of the fistula. CONCLUSION: No specific anatomic or demographic characteristic is sufficiently associated with failure to exclude any patient from the operation. Closure of the internal sphincter should be done as part of the procedure and fibrin glue injection should not be done simultaneously.     

Technical manual for manufacturing autologous fibrin tissue adhesive

PURPOSE: The aim of this article is to provide a concise and simple technical manual for manufacturing autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing for surgery. METHODS: All materials and equipment needed to manufacture ethanol-based autologous fibrin tissue adhesive are listed. In addition, step-by-step instructions are provided to allow for easy and rapid fibrin adhesive production. RESULTS: Ethanol-based autologous fibrin tissue adhesive can be manufactured in under 60 minutes. Furthermore, at our institution the startup cost for manufacturing ethanol-based autologous fibrin tissue adhesive was under $2,500.00. CONCLUSION: Ethanol-based autologous fibrin tissue adhesive is a safe, reliable, and easily manufactured autologous fibrin tissue adhesive that can be made by a trained technician in any blood bank, pharmacy, or surgical laboratory.Supported by grants from The Research Foundation of The American Society of Colon and Rectal Surgeons and The American Hearing Research Foundation.     

Repair of fistulas-in-ano using autologous fibrin tissue adhesive

PURPOSE: Our goal was to determine if autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing, could be used to completely close both simple and complex fistulas-inano. METHODS: A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibrin tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted, and autologous fibrin tissue adhesive was injected into the secondary fistula tract opening until fibrin glue was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening, and the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later. RESULTS: Twenty-six patients received autologous fibrin tissue adhesive fistula injections, with a mean follow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an overall successful closure rate of 85 percent (22/26 patients). Of five patients who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure. CONCLUSION: Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.Supported by a grant from The Research Foundation of The American Society of Colon and Rectal Surgeons.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Policy education in a research-focused doctoral nursing program: Power as knowing participation in change

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings.     

A Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic Surgery

OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery.
DESIGN: Controlled prospective propensity score–matched clinical trial.
SETTING: New York City acute rehabilitation hospital.
PARTICIPANTS: Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty.
INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care.
MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge.
RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P =.004) and with PT (52% vs 38%, P =.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P =.02) and 7 (6.9 vs 9.2 seconds, P =.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P <.001), were more likely to receive standing orders for analgesia (98% vs 48%, P <.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P =.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P =.02) and that pain did not interfere with walking (7% vs 18%, P =.004) and were less likely to be taking analgesics (35% vs 51%, P =.03).
CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function.     

Androgen induces ornithine decarboxylase gene expression in colonic cell line HT-29

Carcinoma of the colon is the second most common cancer among men and women combined in the United States. PURPOSE: Ornithine decarboxylase (ODC) is the first and key regulatory enzyme in the polyamine biosynthesis pathway and is regulated by various factors. Polyamines are believed to participate in cellular proliferation and differentiation. High levels of polyamines and ODC activity are associated with rapid cell growth, particularly in tumor tissues. Regulation of this enzyme in vivo has important clinical implications. In the present study, we used Northern analysis and mobility shift assay to investigate whether ODC gene expression is regulated by androgens in the three human colonic cell lines, SW620, HT-29, and Caco-2. METHODS: Cell lines were maintained in Dulbecco's Modified Eagle's medium/F12 supplemented with 5 percent fetal bovine serum. At 60 percent confluency, medium was replaced with steroid-depleted medium, and incubation continued for 24 hours. Following this period, medium was replaced with fresh steroid-free medium containing 1 nM dihydrotestosterone. RESULTS: Dihydrotestosterone stimulated ODC messenger ribonucleic acid expression only in HT-29 colonic cell line. Studies using electrophoretic mobility shift assays of nuclear extracts also showed a binding pattern with SP1 and NF-B regulatory sequences only in testosterone-treated HT-29 cells. Conclusion: These results suggest that androgens may play an important role in the growth of HT-29 colonic cell lines.Supported by the Department of Veterans Affairs through the West Side Institute for Science and Education (W.I.S.E.) and The Turi Josephson Chair at The University of Illinois College of Medicine at Chicago.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.No reprints are available.