To investigate a cluster of postoperative bleeding following open heart surgery.
A cohort and case/control study.
Palo Alto Veterans Administration Medical Center, Palo Alto, California.
Six (21.4%) ...of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period). All case-patients had chest tube drainage of greater than or equal to 1000 ml within 4 hours of surgery but did not have identifiable bleeding vessel(s) on exploration.
Upon comparison of the pre-outbreak (January 1986 through June 1988) and the outbreak period, a significant increase was found in the incidence of postoperative nonsurgical bleeding (5/440 versus 6/28, p = .0006), but not of postoperative surgical bleeding (8/440 versus 0/28, p = 1.0). Of all patients undergoing open heart surgery during the outbreak period, case patients were found to be older (67.8 versus 60.6, p = .02) and to have received a larger volume of hetastarch (HES), a synthetic colloidal plasma-volume expander (mean = 19.4 ml/kg versus 14.1 ml/kg, p = .02).
We conclude that the use of large volumes of HES during surgery in the elderly open heart surgery patient may increase the risk for severe, nonsurgical postoperative bleeding, probably caused by alterations of the coagulation system. As the incidence of open heart surgery increases among the elderly, surgeons and anesthesiologists should be alert to possible adverse reactions from exposures not associated with adverse reactions in younger patients.
Twenty patients were studied prospectively with indium-labeled leukocyte imaging to evaluate its effectiveness in differentiating noninfected delayed or nonunion from osteomyelitis complicating these ...entities. All patients underwent an open surgical procedure within 24 h of the scan. Bone specimens from the nonunion site were obtained for microbiological and histological analysis to confirm the presence or absence of osteomyelitis. In these twenty patients, the sensitivity of the indium scintigraphy was 100%, the specificity 100%, and the overall accuracy 100%. Indium-labeled leukocyte scintigraphy is significantly more accurate than 99mtechnetium and 67gallium imaging had been, when studied earlier, in detecting subclinical osteomyelitis complicating nonunion. Indium-labeled leukocyte scintigraphy should supplant sequential technetium and gallium studies in this patient population when the surgeon must determine whether subclinical osteomyelitis is complicating fracture management of delayed and nonunions.
A novel measurement technique utilising a new test structure is applied to the existing subthreshold methodology to extract coupling coefficients of the Top-Floating-Gate (TFG) cell. The TFG cell is ...unique in structure and operation in comparison with current NVM devices. It is designed with the FG surrounding the CG which greatly enhances the gate coupling ratio (/spl alpha//sub cg/) allowing a small area cell and avoiding the use of expensive z-direction extensions unlike the industry standard stacked-gate approach. This work quantifies this benefit for the area efficient TFG cell design.
An accurate SPICE compatible model for a novel flash memory device, the Top Floating Gate (TFG) cell, is described. This device can be integrated into CMOS processes with minimal disruption to the ...standard process. The cell is programmed and erased by Fowler Nordheim tunnelling, which is a low power operation thereby complying with a major requirement of system-on-chip applications. The development of an accurate model for flash memory is complicated by the variable nature of the cell. In standard flash memory, the threshold voltage and, therefore, the drain current of the cell vary as the cell is programmed or erased. In the TFG case, both the threshold voltage and series resistance vary which further complicates the model development. Our model has been found to be accurate over the full range of floating gate charge.
A Division of Cancer Biology, NCI sponsored workshop, Metabolic Reprogramming of the Immune Response in the Tumor Microenvironment, was held October 2nd in Bethesda, MD. The purpose of the workshop ...was to bring together cancer cell biologists and immunologists to explore the mechanistic relationships between the metabolic pathways used by cancer cells and anti-tumor immune cells and how this information could be used to improve cancer immunotherapy. At the conclusion of the workshop a general discussion focused on defining the major challenges and opportunities concerning the impact of metabolism on anti-tumor immunity and cancer immunotherapy as well as what tools, technologies, resources or community efforts are required to accelerate research in this area. Overall, future studies need to consider how cancer cell metabolic pathways differ from activated lymphocytes in order to define a therapeutic window for cancer therapy. Further, studies aimed at reprogramming the metabolic qualities of T cells with the goal of improving immunotherapy were considered a promising avenue.
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