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PubMed1997

The virtues of extended matching and uncued tests as alternatives to multiple choice questions.

The objectives of this study were to compare the reliability and validity of written test formats that are widely used in medical education (multiple choice, uncued, extended matching, and true/false) and evaluate the effects of uncued examinations on long-term retention of medical knowledge. Uncued tests were introduced into a traditional course in general and systemic pathology (six interim tests). In the following year, students were given eight tests written in the four formats, each being used twice. The academic achievement of students in these 2 years was compared with that of students in 2 previous years, in which multiple choice tests were used. Measures of academic achievement included performance on a final comprehensive examination and the United States Medical Licensing Examination (USMLE). Student performance on uncued tests was consistent over time (i.e., there was no learning curve). Mean scores ranged from 77% to 84%, and coefficient alpha reliability estimates on 100-item tests were excellent (0.79 to 0.90). Extended matching tests were also reliable, with a mean coefficient alpha of 0.90. There was no significant relationship between test format and student performance on subsequent comprehensive examinations. Our results indicate that extended matching and uncued tests have considerable advantages over multiple choice and true/false examinations. They are more reliable, better able to discriminate the well-prepared from the marginal student, and well suited for tested core knowledge. Contrary to our expectation, extended matching questions with 20 choices presented to the student were as statistically reliable and valid as uncued queries with several hundred choices.

Educational Measurement↗

PubMed2003

Concentrations of endogenous prostaglandin F2alpha in boar semen and effect of a 72-h incubation period on exogenous prostaglandin F2alpha concentration in extended boar semen.

PGF2alpha in semen has been shown to induce uterine contractions, thereby, facilitating sperm transport during fertilization. Previously, we demonstrated that extended boar semen used in artificial insemination does not increase myometrial contractility, but PGF2alpha supplementation did. In this study, we determined the concentrations of endogenous PGF2alpha in pre-sperm and sperm-rich fractions of the boar ejaculate and examined whether changes in the concentration of exogenous PGF2alpha occurred when added to extended boar semen after 72-h incubation at a 17 degrees C storage temperature. Concentrations of endogenous PGF2alpha (n = 10 boars) in pre-sperm and sperm-rich fractions were 69.6 +/- 7.6 and 58.9 +/- 4.4 pg/ml, respectively. No differences were observed in the concentrations of exogenous PGF2alpha in the extended boar semen at 0 h (59.3 +/- 3.3 microg/ml) and after a 72-h incubation period (52.0 +/- 2.1 microg/ml). These results suggest that the concentration of endogenous PGF2alpha in boar semen used for artificial insemination is < 100 pg/ml. The concentration of exogenous PGF2alpha in the extended boar semen did not differ after 72 h, which indicates that it is not metabolized during this period of time.

Animals↗

PubMed2001

Post-thaw survival of ram spermatozoa and fertility after insemination as affected by prefreezing sperm concentration and extender composition.

A study was conducted to investigate the effects of prefreezing sperm concentration using two extenders on post-thaw survival and acrosomal status of ram spermatozoa (Experiment 1) and fertility after intrauterine insemination with differing doses of semen (Experiment 2). In autumn (Northern hemisphere), semen was collected by artificial vagina from 8 adult Leccese rams and ejaculates of good quality semen were pooled. Two extender systems for cryopreservation were considered, one based on milk-lactose egg yolk (Milk-LY) and the other based on tris-fructose egg yolk (Tris-FY). Experiment 1 (2 x 6 factorial scheme) examined the in vitro characteristics of spermatozoa in relation to the Milk-LY and Tris-FY extenders and six prefreezing sperm concentrations (50, 100, 200, 400, 500 and 800 x 10(6) spermatozoa/mL). Experiment 2 (2 x 4 factorial) evaluated the influence of the Milk-LY vs Tris-FY extenders and four doses (20, 40, 80 and 160 x 10(6) spermatozoa/0.25 mL) corresponding to prefreezing spermatozoa concentrations of 100, 200, 400 and 800 x 10(6) spermatozoa/mL, on fertility of ewes inseminated in uterus by laparoscope. Prefreezing sperm concentration influenced (P < 0.01) freezability of spermatozoa and affected negatively all the in vitro parameters at 800 x 10(6) spermatozoa/mL. Overall, Milk-LY tended to ensure higher viability and acrosomal integrity of spermatozoa after thawing at the intermediate sperm densities (range 100 to 500 x 10(6) spermatozoa/mL). At 500 x 10(6) spermatozoa/mL concentration corresponded the best condition for survival of spermatozoa (71.2%), acrosome integrity (71.5%) and acrosomal loss (6.0%). At the lowest sperm concentration (50 x 10(6) spermatozoa/mL), Tris-FY resulted in a higher survival rate than Milk-LY (61.3%, P < 0.05) and lower acrosomal loss (9.7%, P < 0.05). Milk-LY supported spermatozoa motility better than Tris-FY after incubation at sperm concentration between 50 and 400 x 10(6) spermatozoa/mL (0.05 > P < 0.01). Semen doses of 20 to 40 x 10(6) spermatozoa/ewe provided satisfactory fertility rates (64 to 81%). The increase of inseminate doses to 160 x 10(6) spermatozoa/ewe failed to improve fertility, actually tending to decrease lambing rates.

Animals↗

PubMed2002

Reactive oxygen species-mediated loss of bovine sperm motility in egg yolk Tris extender: protection by pyruvate, metal chelators and bovine liver or oviductal fluid catalase.

Improvement of bovine semen cryopreservation requires a better understanding of the properties of the currently used extenders. At present, about half of the spermatozoa die or become immotile following cryopreservation. The implication of an oxidative stress during or following the process of cryopreservation has been suspected to alter sperm functions. However, insufficient information is available on the effect of oxidative stress on sperm functions in their surrounding environment, the extender, such as the one based on egg yolk, Tris and glycerol. In this study, we investigated the effects of hydrogen peroxide (H2O2) and superoxide anion (O2*-) on bovine sperm motility in a widely used egg yolk Tris glycerol (EYTG) extender in comparison to a reference medium, the Tyrode's albumen lactate pyruvate (TALP). Bovine sperm were incubated for 6 h with or without concentrations of H2O2 ranging from 12.5 microM to 1.25 mM and with the hypoxanthine/xanthine oxidase system (X/XOD) that generates O2*-. Sperm motility was established by computer assisted semen analysis (CASA) in four similar experiments using the same frozen pool of semen. We have found that sperm motility was reduced significantly by H2O2 concentrations 20-fold lower in EYTG than in TALP medium. The differential resistance of the two media was explained by pyruvate present in TALP that acts as an antioxidant and metals ions, chelated by ethylenediaminetetraacetic acid (EDTA) and diethylenetriaminepentaacetic acid (DETAPAC), found in egg yolk that might react with H2O2. Addition of only 5 U/ml of bovine liver catalase or oviductal fluid catalase (OFC) were sufficient to overcome the loss of sperm motility caused by 100 microM H2O2 in both EYTG and TALP. However, OFC was the most effective of the two catalases in EYTG. In addition to maintain sperm motility, catalase (5 U/ml) and pyruvate (5 mM) increased the intracellular sperm ATP level in comparison to sperm incubated alone for 6 h at 38.5 degrees C in EYTG. Moreover, EDTA, pyruvate and catalase prevented sperm ATP loss in presence of 100 mM of H2O2 in EYTG. These results indicated that EYTG has a very limited capacity to neutralize H2O2, and the addition of low amounts of catalase and millimolar concentrations of pyruvate greatly improved the antioxidant properties of a commonly used extender.

Animals↗

PubMed2002

Comparison of extenders, dilution ratios and theophylline addition on the function of cryopreserved walleye semen.

Walleye (Stizostedion vitreum) is a species of interest for the diversification of North American aquaculture production, and semen cryopreservation is of particular value to this effort. To test the hypothesis that adjusting semen extender composition and dilution ratio increases sperm quality after thawing, three extenders (Ext1, Ext2, Ext3; all with DMSO as a cryoprotectant) and three dilution ratios (semen/extender: 1:5, 1:9, 1:15) were screened. The best results were obtained when semen was diluted at a 1:15 ratio with Ext 1, Rathbun extender supplemented with 7% DMSO, 4 mg/ml BSA and 7.5 mg/ml ProFam, a soy-based protein (P = 0.05, n = 6). This method resulted in 46 +/- 3% motility of the thawed spermatozoa and a mortality rate of 39 +/- 4% whereas Ext2 and Ext3 resulted in motility rates of only 10 and 5%. respectively. To test an additional hypothesis that phosphodiesterase inhibition improves sperm function, we assessed the fertility of sperm frozen in optimal conditions and thawed in the presence or absence of 5 mM theophylline (n = 5). The best result was achieved in water without theophylline, with fertilization rates ranging from 28.51 +/- 6.84 to 59.02 +/- 1.06% eyed-up stage, and theophylline reduced fertility (P < 0.05). Our data show that Ext1 at a dilution ratio of one part semen to 15 parts extender should be used for walleye semen cryopreservation and that the fertilizing media does not benefit from theophylline supplementation.

Animals↗

PubMed2002

Capacitation and acrosomal exocytosis are enhanced by incubation of stallion spermatozoa in a commercial semen extender.

Preserved stallion semen often has decreased spermatozoal motility and fertility that can vary significantly between individual stallions. It is not known whether the medium used for extending equine sperm contributes to these decreases by inducing premature capacitation during storage. If spermatozoa undergo capacitation or acrosome reaction prior to insemination, this could result in a diminished capacity to penetrate the cumulus mass and fertilize the egg. We hypothesized that skim milk-based semen extenders, similar to those used in cooled storage, stabilize sperm membranes and prolong sperm motility and longevity. However, this could decrease the efficiency of sperm to undergo subsequent capacitation in vivo. This study was designed to evaluate the effects from two media on sperm function. Spermatozoal motility was analyzed, intracellular calcium was measured, and the ability of sperm to undergo acrosome reaction was compared after incubation in a skim milk extender (SME) and Tyrode's medium containing albumin, lactate, and pyruvate (TALP) at 37 degrees C. Results suggest that the SME facilitated capacitation as detected by an increase in both intracellular calcium and acrosome reactions, and a decrease in motility, as compared to TALP. Our data support a shortened functional lifespan for equine sperm in skim milk extender, which indicates that further refinements in cooled semen preservation are required to improve fertility of transported equine semen.

Acrosome↗

PubMed2003

The effect of semen extender, seminal plasma and raw semen on uterine and ovarian blood flow in mares.

Transrectal color Doppler sonography was used to evaluate the effect of intrauterine infusion of skim milk semen extender, seminal plasma and raw semen on the endometrium and blood flow in the uterine and ovarian arteries in mares. Six Trotter mares (mean age: 12 years) were examined during estrus in three cycles. Each mare received an intrauterine infusion of 20 ml of skim milk semen extender, seminal plasma or raw semen during estrus in one of three cycles. Blood flow measurements in both uterine and ovarian arteries and the determination of intrauterine fluid via sonography were performed before each infusion and 1, 3, 6, 12, and 24 h after infusion. Forty-eight hours later, the intrauterine infusion and measurements were repeated using the same time intervals. Changes in blood flow were detected using transrectal color Doppler sonography and were evaluated using the mean time-averaged maximum velocity (TAMV) of the blood flow. Cytological and bacteriological examination of uterine swabs performed 48 h after the second infusion revealed less inflammation and bacterial growth in mares infused with skim milk semen extender than in those infused with seminal plasma or raw semen. There was an increase in intrauterine fluid as early as 1 h after infusion of any of the substances. The infusion of skim milk semen extender had no effect on uterine blood flow. Within 1 h after infusion of seminal plasma or raw semen, there was an increase in the TAMV values of both uterine arteries (P<0.05). In contrast, ovarian blood flow increased only in the artery ipsilateral to the preovulatory follicle and only after the infusion of raw semen (P<0.05). In conclusion, the changes in uterine perfusion observed after intrauterine infusion may be associated with endometrial inflammation and vasodilatory components in the seminal plasma, whereas the changes seen in ovarian blood flow are possibly attributable to the interaction between sperm and oviduct.

Animals↗

PubMed1998

Caprine blastocyst development after in vitro fertilization with spermatozoa frozen in different extenders.

The feasibility of using frozen-thawed semen in caprine IVF outside the breeding season was investigated. Electroejaculated spermatozoa from a Nubian buck were washed twice and then frozen in skim milk- or in egg yolk-based extenders. Goat oocytes were matured and inseminated by frozen-thawed spermatozoa selected by swim-up. In vitro fertilization was performed in a modified defined medium (mDM), altered experimentally, for 24 h. Embryos were cultured in 50 microL of c-SOF + NEA for 9 d. The percentages of oocytes exposed to heparin-capacitated spermatozoa, (previously cryopreserved in skim milk-based extender) that cleaved, reached morula, blastocyst and expanded blastocyst stages were 82.8, 57.1, 35.7 and 30.0%, respectively. Without heparin treatment the rates for cleavage, morula, blastocyst and expanded blastocyst stages were 44.3, 31.4, 18.6 and 8.6%, respectively. Therefore, heparin treatment was included in sperm capacitation. Use of spermatozoa with BSA in the IVF medium yielded no cleavage. Although extenders containing 8 to 20% egg yolk enabled good sperm motility after cryopreservation, in vitro fertilizing ability was compromised under our conditions. By contrast, semen commercially processed in season in an egg yolk-based diluent remained effective for IVF. The highest proportion of blastocysts resulted from the use of spermatozoa diluted in a skim milk extender, heparin capacitation, and insemination in medium containing lamb serum.

Animals↗

PubMed1999

A technique for the evaluation of sperm penetrating ability and quality of bovine semen processed in an extender made with Brackett-Oliphant medium and egg yolk.

Egg yolk-sodium citrate (EYC) semen extender was compared with an extender made of Brackett-Oliphant medium and egg yolk (BOEY). Ejaculates were divided into equal portions, processed and frozen. Semen was thawed and evaluated for quality. Additional semen was thawed, stained with Hoechst 33342 and the spermatozoa capacitated, after which they were co-incubated with zona-free hamster oocytes to determine their penetrating ability. Sperm penetration of non-compressed, unfixed oocytes was evaluated using an optical sectioning technique on a standard research microscope. Sperm penetration was considered successful if a fluorescing sperm head was observed within the living oocyte in a hanging drop of fertilization medium. There were small differences in percentage of secondary abnormalities and percentage of progressive motility immediately after thawing between spermatozoa extended in EYC or BOEY diluent. There were no differences due to by extender composition in percentage of spermatozoa with intact acrosomes or percent of progressively motile after a 3 h incubation at 37 degrees C, nor the percentage of spermatozoa with head abnormalities. While there were significant correlations between all seminal quality characteristics, no quality measurements were correlated to percentage of oocyte penetration. The new penetration evaluation method allowed for examination of the fertilized oocytes using fluorescent microscopy initially and again after re-incubation for further development.

Acrosome Reaction↗

PubMed1998

Extended excretion of rotavirus after severe diarrhoea in young children.

BACKGROUND: Rotaviruses are the major cause of severe childhood diarrhoea. Knowledge of the natural history of infection, including duration of intestinal virus shedding, is important in the understanding of transmission, sources of infection, and immune responses. METHODS: We carried out a study of rotavirus excretion in 37 children admitted to hospital with severe rotavirus diarrhoea. Sequential faecal specimens were collected from each child during 100 days of surveillance, and screened for rotavirus by EIA and by amplification of genome double-stranded RNA by reverse-transcription PCR. IgA coproantibody was estimated by EIA. FINDINGS: Duration of rotavirus excretion ranged from 4 to 57 days after onset of diarrhoea. Excretion ceased within 10 days in 16 (43%) children, and within 20 days in 26 (70%) children. Extended excretion was detected for 25-57 days in the remaining 11 (30%) children owing mainly to continued excretion of the primary infecting strain. Extended excretion was significantly associated with antirotavirus IgA coproantibody boosts during 100 days of surveillance (p=0.001, log-rank test), and with recurrence of mild diarrhoea symptoms during convalescence (p=0.006, Fisher's exact test). INTERPRETATION: Severe rotavirus disease in young children may be followed by extended excretion of rotavirus. The risk of transmission to others may be greater than previously believed. Extended excretion could also explain some cases of the postgastroenteritis syndrome.

Antibodies, Viral↗

PubMed2001

Novel alleles at the lymphotoxin alpha (LTalpha) locus mark extended HLA haplotypes in native Africans.

Genetic variations at the closely related tumor necrosis factor alpha (TNFalpha or TNF) and lymphotoxin alpha (LTalpha, formerly TNFbeta) loci have been well documented in various human populations, and several haplotypes spanning the MHC class I and class II loci are known to carry specific TNF alleles. Genotyping of the TNFc microsatellite within the first intron of LTalpha in 285 Rwandans and 319 Zambians revealed two predominant alleles, c1 at frequencies of 0.598 and 0.683 and c2 at 0.384 and 0.307, respectively. Overall, the distribution of TNFc genotypes containing the major alleles conformed well to the Hardy-Weinberg equilibrium in both cohorts. Two previously unrecognized minor TNFc alleles were also detected: the first, designated c0, was found in 10 native Africans and was the only allele present in 10 chimpanzees; the second, designated c3, was seen in 6 other African patients. Further genotyping at loci for HLA class I, class II, and for transporters associated with antigen processing, subunit 1 (TAP1) in those 16 individuals suggested a tight, stable extended haplotype involving c0 and 26Asn (LTalpha)-TNF3 (TNF promoter -238A and -308G)-DRB1*1503-DQB1*0602-TAP1.2 (333Val)-TAP1.4 (637Gly). The c3 allele was observed on another extended haplotype with 26Thr (LTalpha)-TNF1 (TNF promoter -238G and -308G)-DQB1*0102-DQB1*0501-TAP1*0101 (333Ile and 637Asp). The c3-tagged haplotype further extended to Cw*15 at the HLA class I C locus, but no specific A or B alleles could be unambiguously assigned. Positive associations between c2 homozygosity and HIV-1 seronegative status in both Rwandans and Zambians (odds ratio = 2.03 and 2.00, p = 0.04 and 0.07, respectively) had little effect on the haplotype assignments. These findings suggest a preferential expansion of the human TNFc dinucleotide (CT/AG) repeat sequence and further imply the existence of two extended MHC lineages that have not been disrupted by recombinations.

Africa↗

PubMed2000

Orientation biased extended surround of the receptive field of cat retinal ganglion cells.

Here we report that the extended surround outside the classical receptive center (hereafter called the extended surround) of most retinal ganglion cells in the cat exhibit significant orientation bias to grating stimuli, and that the center and the extended surround show different orientation biases at different spatial frequencies. As a result, some retinal ganglion cells possess a complex receptive field structure, which allows them to detect sophisticated image segmentation (e.g. texture segmentation) in addition to simple luminance edges. This property was previously thought to exist primarily in the visual cortex. Moreover, in about one quarter of 128 cells studied the center did not exhibit an orientation bias. Thus, these surrounds alone may determine the cells' orientation bias.In conclusion, the extended surround may play an important role in processing more complex pattern in natural scenes since the classical receptive field is too small to describe all the properties of a retinal ganglion cell.

Animals↗

PubMed1997

Implant stability in revision total hip arthroplasty: allograft bone packing following extended proximal femoral osteotomy.

One method of revising the femoral component in revision total hip arthroplasty in the presence of compromised femoral bone stock is to pack the upper femur with particulate allograft and then to cement the femoral component into the allograft bed. This technique is being used clinically with encouraging results. Additionally, surgical exposure of the femoral canal during revision total hip arthroplasty can be greatly improved with an extended trochanteric osteotomy, which is subsequently repaired with wires or cables. To assess the feasibility of performing the allograft bone packing technique following an extended trochanteric osteotomy, the stability of this construct in a cadaver model was measured, using micromotion sensing instruments and loads applied on a materials testing machine. The stability of the cemented allograft impaction construct following extended trochanteric osteotomy was comparable to the stability of the control construct, which consisted of a similar impacted allograft construct without osteotomy. The stability of the osteotomized side was comparable to that of the control side. It is concluded that the initial in vitro stability of the allograft impaction technique following extended proximal femoral osteotomy is adequate to justify experimental in vivo use.

Arthroplasty, Replacement, Hip↗

PubMed2002

Divalproex extended-release versus the original divalproex tablet: results of a randomized, crossover study of well-controlled epileptic patients with primary generalized seizures.

PURPOSE: To compare the safety and efficacy of two formulations of divalproex, extended-release divalproex versus the original divalproex tablet, in adolescent and adult patients with epilepsy. METHODS: Eligible patients were between the ages of 12 and 65 years with primary generalized epilepsy, which was controlled over the month prior to study enrollment with divalproex or valproic acid 1000 mg to 2000 mg/day. The patients were well-controlled; 39 of 43 (91%) had no seizures in the previous year. Patients were randomized to receive 84 days of either divalproex two times a day (b.i.d.)/three times a day (t.i.d.) or extended-release divalproex qd and then (crossed over to) 84 days of the comparator formulation. During the two treatment periods, patients received the same daily dose equivalent of divalproex as was taken during the month prior to study entry. The clinical status of patients was evaluated at a screening visit and at four subsequent visits conducted every 42 days. RESULTS: There was no statistically significant difference between the formulation groups for seizure control rate (95% [41/43] for divalproex and 93% [40/43] for extended-release divalproex). Likewise, the formulation groups were similar based on the incidence of treatment-related adverse events. The most frequently reported (< or =11.4% for either formulation) treatment-related adverse events were asthenia, tremor, nausea, and dizziness. CONCLUSIONS: Extended-release divalproex was similar to divalproex for the treatment of well-controlled, primary generalized epilepsy in terms of overall safety and efficacy parameters.

Adolescent↗

PubMed2002

[Genotypic exploration of a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase].

BACKGROUND: The aim of the study was to explore nosocomial neonatal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase by macrorestriction genotyping. PATIENTS AND METHODS: Over a 25 days period, a hospital neonatal outbreak due to Klebsiella pneumoniae producing extended-spectrum-betalactamase affected 14 newborn infants admitted to a university hospital in Sousse (Tunisia). We collected 21 strains of Klebsiella pneumoniae producing extended-spectrum-betalactamase. Susceptibility testing to 17 antibiotics was determined. Macrorestriction genotyping of strains was determined by pulsed-field-electrophoresis. Neonatal intensive care unit survey was undertaken. RESULTS: A macrorestriction genotyping subdivided 21 strains into 3 clonally groups. Only cefoxitin, colistin, imipenem, amikacin and quinolons were active on the whole of strains. All infected babies died. The hygiene insufficiency and contamination of transfusion products at the time of their dividing in neonatal intensive care unit were incriminated. Handholding due to work overcharge was the main cause of bacterial diffusion. CONCLUSION: Multiclonal outbreak of Klebsiella pneumoniae producing extended-spectrum-betalactamase appeared following hygiene insufficiency related to work overcharge.

Cross Infection↗

PubMed1999

The crystal structure of the dimerization initiation site of genomic HIV-1 RNA reveals an extended duplex with two adenine bulges.

BACKGROUND: An important step in retroviral replication is dimerization of the genomic RNA prior to encapsidation. Dimerization is initiated by the formation of a transient 'kissing-loop complex' that is thought to be subsequently matured into an extended duplex by the nucleocapsid protein (NCp). Although chemical probing and nuclear magnetic resonance spectroscopy have provided insight into the structure of the kissing-loop structure, no structural information concerning the extended-duplex state is available so far. RESULTS: The structure of a minimal HIV-1 RNA dimerization initiation site has been solved at 2.3 A resolution in two different space groups. It reveals a 22 base pair extended duplex with two noncanonical Watson-Crick-like G-A mismatches, each adjacent to a bulged-out adenine. The structure shows significant asymmetry in deep groove width and G-A base-pair conformations. A network of eight magnesium cations was clearly identified, one being unusually chelated by the 3' phosphate of each bulge across an extremely narrowed deep major groove. CONCLUSIONS: These crystal structures represent the putative matured form of the initial kissing-loop complex. They show the ability of this self-complementary RNA hairpin loop to acquire a more stable extended duplex structure. Both bulged adenines form a striking 'base grip' that could be a recognition signal, either in cis for another viral RNA sequence, or in trans for a protein, possibly the NCp. Magnesium binding might be important to promote and stabilize the observed extrahelical conformation of these bulges.

Adenine↗

PubMed2002

Removal of cartilage rings prevents graft stenosis in extended tracheal allotransplantation with omentopexy and immunosuppression: an experimental study.

BACKGROUND: One of the serious problems in longer size tracheal transplantation is severe stenosis of the graft, probably caused by an inadequate blood supply. We have previously reported that removal of some cartilage rings of the graft and omentopexy helps to provide sufficient blood flow to the graft mucosal tissue and results in satisfactory survival and non-significant graft stenosis in extended tracheal autotransplantation. However, it is unclear whether this method can be applied to extended tracheal allotransplantation that requires immunosuppression. In this report, we describe midterm results of extended tracheal allotransplantation with the technique. METHODS: Twenty-four adult mongrel dogs were used. In 18 dogs, a nine-cartilage-ring length of the trachea was allotransplanted when five cartilage rings of the graft were removed, leaving two rings intact at both ends of the graft for simple fixing to the recipient. Two artificial tracheal rings outside the graft and a stent inside the graft were used for maintaining the lumen width. Omentopexy was done for sufficient blood supply to the graft. FK 506 (0.1 mg/kg) was given on each day after the operation in Group A (n = 10), but was not given at all in Group B (n = 8). In Group C (n = 6), a nine-cartilage-ring length of the trachea, without removal of any cartilage ring, was transplanted into the recipient dog and covered with an omental pedicle flap. The same dose of FK 506 as that used in Group A dogs was given to Group C dogs. RESULTS: In Group A, 2 dogs died of graft stenosis within 9 weeks after surgery and 1 died of emaciation without tracheal stenosis. Seven dogs (70%) survived until time of killing. Among the 8 dogs in Group B, 6 died of graft stenosis within 9 weeks after surgery, with 1 dying of pneumonia and only 1 (13%) surviving for >1 year until killing. In Group C, all 6 dogs died of graft stenosis within 6 weeks after surgery. Survival at 16 weeks after surgery was 70% in Group A, 13% in Group B and 0% in Group C (p < 0.01, A vs B and C). No significant graft stenosis was found in 6 dogs and mild stenosis was found in 2 dogs at the time of death or killing in Group A (80%), whereas mild stenosis was found in only 2 dogs in Group B (25%) (p < 0.05). Mucosal blood flow of the graft in Group A was higher than that in Group C and was the same as that in Group B within 4 weeks after surgery; however, it remained unchanged to ultimately be higher than in Group B at 6 and 8 weeks after surgery. CONCLUSIONS: Removal of some cartilage rings, omentopexy and immunosuppression improved blood supply to the graft and resulted in good survival and non-significant tracheal stenosis in extended tracheal allotransplantation.

Animals↗

PubMed1998

Selection and use of pressure ulcer risk-assessment tools and treatment protocols in extended-care facilities in the southwest.

PURPOSE: The purpose of this study was to investigate pressure ulcer treatment protocol selection and use by care providers in extended health care facilities. DESIGN: Descriptive survey. SETTING AND SUBJECTS: The target population was directors of extended health care facilities in the southwestern border region of Arizona, New Mexico, and west Texas. METHODS: Questionnaires were mailed to 427 directors of extended-care facilities, who were asked to self-report treatment selection methods. The results from 96 returned and usable questionnaires were analyzed. MAIN OUTCOME MEASURES: Descriptive statistics were used to analyze the returned data. RESULTS: Most (56.25%) of the respondents reported using a facility-developed assessment tool, 15.63% used no assessment tool at all, and less than 50% of the responding institutions reported using established protocols for pressure ulcer treatment. Although selection methods differed, most (61.46%) pressure ulcer treatments were reported to be determined by collaboration among nurses, physicians, and other health care providers. CONCLUSION: Selection and use of pressure ulcer risk-assessment tools and treatment protocols showed a wide range of variation by extended-care facilities. A high percentage of institutions did not report the use of established, research-based protocols for pressure ulcer treatment, although interdisciplinary collaboration for treatment selection was reported.

Guideline Adherence↗