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Surfaces of polypropylene (PP), polystyrene (PS) and polytetrafluoroethylene (PTFE) were activated with radio frequency plasmas Ar and NH3 to aminate the polymer surface and were subsequently reacted with hyaluronic acid (HA) in one of the three different attachment schemes. Results show that ammonia plasma treated polymers were more reactive toward HA attachment. The three chemistry schemes consisted of two distinct approaches: (1) direct attachment of the HA to the aminated surface, and (2) extending the reactive group away from the surface with succinic anhydride and then reacting the newly formed carboxylic acid group with an adipic dihydrazide modified HA (HA-ADH). The latter scheme proved to be more effective, suggesting that steric effects were involved with the reactivity of the HA with surface groups. These HA-coated polymers are a candidate for cell attachment and growth.

Biofilm infections are a common complication of prosthetic devices in humans. Previous in vitro research has determined that low-frequency ultrasound combined with aminoglycoside antibiotics is an effective method of killing biofilms. We report the development of an in vivo model to determine if ultrasound enhances antibiotic action. Two 24-h-old Escherichia coli (ATCC 10798) biofilms grown on polyethylene disks were implanted subcutaneously on the backs of New Zealand White female rabbits, one on each side of the spine. Low-frequency (28.48-kHz) and low-power-density (100- and 300-mW/cm2) continuous ultrasound treatment was applied for 24 h with and without systemic administration of gentamicin. The disks were then removed, and the number of viable bacteria on each disk was determined. At the low ultrasonic power used in this study, exposure to ultrasound only (no gentamicin) caused no significant difference in bacterial viability. In the presence of antibiotic, there was a significant reduction due to 300-mW/cm2 ultrasound (P = 0.0485) but no significant reduction due to 100-mW/cm2 ultrasound. Tissue damage to the skin was noted at the 300-mW/cm2 treatment level. Further development of this technique has promise in treatment of clinical implant infections.

The primary objective of this study is the investigation of bioreduction kinetics of hydrophilic spin probes, 2,2,6,6, -tetramethyl-4-oxo-piperidinyl-1-oxyl (Tempone), and spin-labeled antibiotic gentamicin by gram-negative bacteria maintained at various oxygen tensions, with emphasis on the effect of probe penetration rate. This information was used to evaluate the effect of ultrasound on the penetration of hydrophilic compounds, including antibiotics, into Pseudomonas aeruginosa and Escherichia coli cells. Penetration of spin-labeled compounds into the cells was assessed by the reduction rate of the nitroxyl moiety measured by EPR. In cell suspensions, both Tempone and spin-labeled gentamicin were localized predominantly in the aqueous phase surrounding the cells. However, a gradual reduction of the probes in contact with the cells indicated that the probes penetrated through the outer membrane and periplasmic space into the cytoplasmic membrane, where the electron transport chains and other metabolic activities of gram-negative bacteria are localized. The kinetics of probe reduction depended on oxygen tension and presence of electron transport chain blockers. It was found that probe penetration rate through the outer cell membrane affected the rate of probe reduction; damaging the permeability barrier by cell incubation with EDTA or by powerful insonation above the cavitation threshold increased the rate of probe reduction. In contrast, insonation below the cavitation threshold did not affect the rate of probe reduction. These findings imply that the recently observed synergistic effect between hydrophilic antibiotics and low frequency ultrasound in killing gram-negative bacteria did not result from the enhanced antibiotic penetration through bacterial cell walls., (Copyright 1999 Academic Press.)

Bacterial biofilms growing on implanted medical devices are difficult to eradicate, even with aggressive antibiotic therapy. However, application of ultrasound enhances the effectiveness of the antibiotic. The possible mechanisms of this phenomenon were explored in light of the observed influence of various ultrasonic parameters on the enhanced action of gentamicin against biofilms of Pseudomonas aeruginosa. It is postulated that ultrasound increases the transport of gentamicin through the cell membranes, which is the proposed rate determining step in killing by gentamicin. It is possible that the ultrasound perturbs the cell membrane and stimulates active uptake or permits passive uptake by temporarily disrupting the membrane or other structural cell components. The cell membrane disruption could be caused by high pressure, high shear stress, or cavitation. The dependence upon peak power density suggests that acoustic pressure plays a significant role. There is also a strong frequency component that causes the killing effect to decrease as frequency increases. A mathematical analysis of oscillatory shear stress on the cell shows that the magnitude of stress increases with frequency; thus, the hypothesis of oscillatory shear inducing antibiotic uptake is discounted. In addition, the shear displacement caused by shear forces is very small, so the shear disruption caused by oscillatory flow in an acoustic field has minimal impact. The experimental data also rule out the existence of transient cavitation in the bioacoustic effect. It is possible that stable cavitation and the accompanying microstreaming contribute to the bioacoustic effect., (Copyright 1999 John Wiley & Sons, Inc.)

New studies on the effect of frequency and duration of exposure upon the ultrasonic enhanced action of gentamicin against biofilms of Escherichia coli are presented in this paper. Ultrasound was applied at clinical levels which would not harm human tissue. The study on frequency indicated that lower frequencies produce higher levels of killing. The results of the timed experiment indicate that complete sterilization of a 14-h biofilm can be achieved after 6 h of exposure. These findings are significant because they show that biofilms can be reduced to zero reproductive ability as assessed by plate counting.

The objective of this research was to elucidate the factors effecting the permeability of cell membranes of gram-negative bacteria toward hydrophobic compounds. Ultrasound treatment, cell age, and the phase state of phospholipid membranes were considered. Spin-labeling EPR method was used to quantify the penetration and distribution of a lipophilic spin probe, 16-doxylstearic acid (16-DS), in Pseudomonas aeruginosa cell membranes. This bacterium was chosen because of its reported resistance to the action of hydrophobic antibiotics caused by the low permeability of the outer cell membrane for hydrophobic compounds. EPR spectra were collected from cell pellets and cell lysates. The overall spin probe uptake was measured in 10% SDS-cell lysates. Lysis with 0.6% SDS revealed the fraction of the probe located in membrane sites readily accessible to the surfactant. The results indicated a structural heterogeneity of P. aeruginosa membranes, with the presence of structurally "stronger" and "weaker" sites characterized by different susceptibility to the SDS treatment. The intracellular concentration of 16-DS was higher in insonated cells and increased linearly with the sonication power. EPR spectra indicated that ultrasound enhanced the penetration of the probe into the structurally stronger sites of the inner and outer cell membranes. The effect of ultrasound on the cell membranes was transient in that the initial membrane permeability was restored upon termination of the ultrasound treatment. These results suggest that the resistance of gram-negative bacteria to the action of hydrophobic antibiotics was caused by a low permeability of the outer cell membranes. This resistance may be reduced by the simultaneous application of antibiotic and ultrasound. This hypothesis was confirmed in our experiments with P. aeruginosa exposed to erythromycin.

Microbial infections on implanted medical devices are difficult to treat. Application of 70 kHz ultrasonic irradiation to gentamicin treatment greatly enhanced the action of the antibiotic in terms of reduced viable bacterial concentrations. Ultrasonic irradiation was carried out at various insonation intensities that were noninhibitory in the absence of antibiotic. Synergistic killing was observed to be a function of ultrasonic intensity. Greatest killing (approximately 5 log reduction in viable population) was realized at full intensity (4.5 W/cm2), and decreased with reductions in power density. At lowest intensity (10 mW/cm2), no significant acoustic enhanced killing was noted.

It is widely recognized that the bacteria sequestered in a biofilm on a medical implant are much more resistant to antibiotics than their planktonic counterparts. Recent studies have shown that application of antibiotic along with low power ultrasound significantly increases the killing of planktonic bacteria by the antibiotic. Herein is reported a similar application of antibiotic and ultrasound to sessile bacteria in biofilms of Pseudomonas aeruginosa on a polyethylene substrate. Biofilm viability was measured after exposure to 12 micrograms/ml gentamicin sulfate and 10 mW/cm2 ultrasound at frequencies of 70 kHz, 500 kHz, 2.25 MHz, and 10 MHz. The results indicate that a significantly greater fraction of the bacteria was killed by gentamicin when they were subjected to ultrasound. However, ultrasound by itself did not have any deleterious effect on the biofilm viability. In addition, lower-frequency insonation is significantly more effective than higher frequency in reducing bacterial viability within the biofilm. The possible mechanisms of synergistic action are discussed.

A video microscope system and a mathematical model were developed to observe and model the early stage of bacterial growth on polymer surfaces. Glass slides were coated with polyorthoester, poly(L-lactic acid), and polysulfone, and inserted into a laminar flow cell to expose them to bacterial cultures of Staphylococcus epidermidis, Pseudomonas aeruginosa, or Escherichia coli. The free energy of adhesion (delta Fadh) was determined from contact-angle measurements. The microscopic observations along with the mathematical model allowed measurement of the rates of adhesion, release, and growth. The growth rate of P. aeruginosa on the various surfaces correlated to the delta Fadh. The growth rates of all species on all of the surfaces were slower than the growth rates of the bacteria in suspension. The mathematical model is valid for early growth before the bacteria form a complete monolayer, and is useful in predicting and modeling early growth of bacteria on implanted biomaterials.

Ultrasonic irradiation at 500 kHz and 10 mW cm-2 of a 24 h old biofilm of P. aeruginosa enhanced the killing of bacteria by gentamicin. To determine whether this bioacoustic effect was caused by ultrasonic-induced changes in the biofilm morphology (biofilm breakup or disruption), the biofilms were examined by confocal scanning laser microscopy (CSLM). Such disruption would be undesirable in the possible ultrasonic treatment of implant infections. The CSLM results showed that the biofilm is a partial monolayer of cells with occasional aggregates of cells, non-cellular materials and extracellular spaces. The aggregates contained large amounts of exopolysaccharide. The structure of biofilm was not changed when the biofilm was exposed to continuous ultrasound at 500 kHz and 10 mW cm-2, the same irradiation parameters that increased cell killing by nearly two orders of magnitude. The observation that low-intensity ultrasound does not disrupt biofilm or disperse the bacteria has significance in the possible use of ultrasound to enhance the action of antibiotics against biofilms.

The degradable polymers poly(orthoester) (POE), poly(L-lactic acid) (PLA), and the nondegradable polymers polysulfone (PSF), polyethylene (PE), and poly(ether ether ketone) (PEEK) were exposed to cultures of Staphylococcus epidermidis, Pseudomonas aeruginosa, or Escherichia coli. Bacteria washed and resuspended in phosphate buffered saline (PBS) adhered to polymers in amounts nearly twice those of bacteria that were left in their growth medium, tryptic soy broth (TSB). In TSB, there was variation in adhesion from species to species, but no significant variation from polymer to polymer within one species. In PBS there were significant differences in the amounts of bacteria adhering to the various polymers with the exception, of S. epidermidis, which had similar adhesion to all polymers. As a whole, P. aeruginosa was the most adherent while S. epidermidis was the least adherent. The estimated values of the free energy of adhesion (delta Fadh) correlated with the amount of adherent P. aeruginosa. When POE, PLA, and PSF were exposed to hyaluronic acid (HA) before exposure to the bacteria, there was 50% more adhesion of E. coli and P. aeruginosa on POE and PLA. With respect to bacterial adhesion, the biodegradable polymers (POE and PLA) in general were not significantly different from the nondegradable polymers.

The production of blood microemboli (BME) was studied using an ex vivo exteriorized left ventricular assist device (LVAD) model in calves. Each of eight calves received a series of three LVADs, each operating for 24 hr. Blood microemboli were measured directly by a laser (624 nm and 828 nm) light scattering microemboli detection (LSMD) system through the LVAD outflow cannula and by constant pressure filtration (CPF) of blood samples from the LVAD outflow cannula. Hematologic parameters were also measured. After LVAD removal, perivalvular thrombi were evaluated using polar coordinate mapping. The average LSMD and CPF results correlated. For example, in one series of three calves, one ventricle exhibited significantly greater thrombogenesis than did the other ventricles, as indicated by both the LSMD and CPF results. In a series of five calves, one calf developed an abnormally high activated thromboplastin time (APTT), even in the absence of heparin. For two of the three ventricles tested in that calf, microemboli concentration (CPF), Factor XII activity, level of fibrin degradation products (FDP), and accumulated thrombus were significantly lower than for the other calves. The whole blood viscosity (WBV, at 230 s-1) in this calf also decreased to lower values than were seen with the other calves.

Objective: To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children., Design: Case-control study by questionnaire completed by the children and their carers., Setting: Two large children's hospitals in Brisbane, Australia., Subject: 445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group., Main Outcome Measures: Cause and type of injury, wearing of helmet., Results: Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%)., Conclusions: The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.

Extended wear soft contact lenses have been implicated in the increased occurrence of corneal bacterial infections. This research investigated the effects of polymer chemistry, water content, and pre-sorbed proteins upon the adherence of Pseudomonas aeruginosa to model hydrogels with chemistries similar to those of extended wear soft contact lenses. The hydrogels were exposed to washed suspensions of P. aeruginosa in a laminar flow cell. Albumin, fibrinogen, desialylated fibrinogen, or mucin were deposited on the hydrogels before exposure to the bacteria. Results showed that with or without protein pre-exposure, bacterial adhesion decreased as water content increased. In the presence of the sorbed protein, the number of adherent bacteria increased by about 45%, and all four proteins caused similar increases in adhesion. Bacterial adhesion was not significantly influenced by the presence of sialic acid residues in the pre-sorbed protein.

The effects of water content and comonomer chemistry upon the adhesion of Pseudomonas aeruginosa to poly(hydroxyethyl methacrylate)-based hydrogels were studied. Hydrogels which varied in swollen water content from 33-69 wt% were polymerized onto glass microscope slides pretreated with a vinyl silane. The hydrogel water content was varied by adding methacrylic acid (1-5 wt%) or N-vinyl pyrrolidone (NVP, 10-25 wt%) or combinations of the two comonomers. The resulting hydrogel surfaces, which were 0.1 mm thick, transparent, and adherent to the glass slide, formed the test surfaces of laminar flow cells (Re = 1.3, wall shear rate = 1.6/s). The bacteria were grown for 8 h in tryptic soy broth (TSB), washed by filtration, and collected on 0.45-microns filters, resuspended in phosphate buffered saline (PBS) at pH = 7.2, and recirculated through the flow cell and across the test surface at 0.85 mL/min for 2 h. Results show that P. aeruginosa adhered less to hydrogels with higher water contents. In the presence of TSB and possible poly(NVP) contamination, the concentration of adherent bacteria was reduced to low and uniform levels independent of the hydrogel chemistry.

The kinetics of fibronectin (FN) adsorption upon three polyurethaneureas (PUU) were measured by Fourier transform infrared spectroscopy. The three polymers had soft blocks composed of polydimethylsiloxane (PDMS), polytetramethyleneoxide (PTMO), and polyethyleneoxide (PEO). On each polymer, the amount of adsorbate increased proportional to the square root of time, but the rates were less than that predicted for purely diffusion controlled adsorption. Adsorption rate constants and sticking coefficients (the fraction of encounters with the surface which result in adsorption) were calculated from the data. The adsorption rate constants are 4.8 x 10(-4), 1.3 x 10(-4), and 2.5 x 10(-5) cm/s on PDMS-PUU, PTMO-PUU and PEO-PUU respectively. The rate constants and sticking coefficients fall within the range of previously reported values for other protein/polymer systems. The sticking coefficients correlate in general with the amount of FN adsorbed at 120 min, and with the extent of conformational change of the adsorbed protein.

A low fluorescence background polypropylene (PP) membrane has been developed for ultimate use as an electroblotting membrane in DNA sequencing based on fluorescence detection. The DNA binding capacity of this membrane is improved by a surface modification using radio frequency plasma discharge (RFPD) in ammonia gas. The RFPD operational parameters are evaluated both in terms of membrane nitrogen content and in terms of the product's capacity for binding radioisotope-labeled DNA fragments. The surface morphologies of the derivatized membranes are examined by scanning electron microscopy; their mechanical and electrical properties, which are important for the subsequent sequencing procedures, are likewise established. Due to the goal of developing a membrane suitable for multiplex processing, in which the electroblotted DNA must withstand dozens of hybridization/stripping cycles, special attention is given the covalent attachment of DNA to the membrane. The modified PP membrane is evaluated in a multiplex sequencing application using radioisotope-labeled DNA probes, and found to yield somewhat better binding of a given amount of electroblotted DNA than the commonly used GeneScreen membrane. A tenfold repetition of the probing indicates little loss of signal; the membrane-bound DNA is stable upon storage and shows no detectable loss in probing efficiency after one month.

The protein sticking coefficient, phi, the fraction of collisions that result in adsorption, is a function of the molecular interactions between the protein and the surface. A random walk and diffusion-to-capture model was used to describe the kinetics of protein adsorption. The assumption of a constant sticking coefficient leads to a first-order model of the kinetics. A solution of the problem of adsorption from a semi-infinite medium with first-order kinetics at the boundary was obtained by numerical simulation on the computer. The results of the computer simulations match the time dependence observed experimentally. A correlation was developed to estimate phi from experimental data. phi has been found to be in the range 10(-5)-10(-8) for several protein adsorption kinetic studies reported in the literature.

Previous analysis of the distribution of experimental solvent molecule positions around amino acid side chains showed that distinct clustering occurred close to polar or charged atoms in proteins. We have used those data to predict likely solvent positions around proteins not used in our initial analysis. We envisage that this algorithm, AQUARIUS, will be useful for finding solvent positions in electron density maps generated by protein crystallography and as useful starting positions for solvent molecules in computer simulation studies of macromolecules.

Objective: To describe the epidemiology of domestic swimming pool drowning and near-drowning in Brisbane and to examine the efficacy of a broad range of preventive options, including pool fences., Design: A prospective, hospital-based, injury surveillance system to describe the epidemiology of drowning and near-drowning and a community survey to describe pool fencing., Setting: The surveillance questionnaire was completed at presentation in the Emergency Department by the parent, nurse and doctor. Personal interviews in households that were randomly selected by means of a stratified sampling scheme provided the pool fencing description., Participants: All 139 children suffering from an immersion injury resulting in presentation at a hospital in the catchment area of The Mater Children's Hospital were included. There were 204 households with a swimming pool in the 1024 households interviewed in the community survey., Results: The 100 domestic pool drownings and near-drownings were equivalent to 15.5 incidents per year per 100,000 children aged 0-13 years and 64.9 per year per 100,000 for the critical 1-3 years age group. Of 72 children who gained unintended access to a domestic pool, 88.9% were less than 3 years of age and 52.8% were less than 2 years. All 10 of the children who drowned and five who were severely brain damaged (age range, 12-32 months) were in this group. The risk of a drowning or near-drowning involving unintended access to an unfenced pool is 3.76 times higher than the risk associated with a fenced pool (95% confidence limits for relative risk: 2.14, 6.62)., Conclusions: Pool fences are an effective method of preventing child drownings and near-drownings. This effectiveness can be further improved if compliance with gate closure can be enhanced. This should be emphasised in health promotion accompanying the introduction of universal pool fencing.

A hydrophobicity gradient was created by gradually exposing a polydimethylsiloxane film to a radio frequency glow discharge in an oxygen atmosphere. A change in contact angle from 100 to 0 degrees was measured along the gradient surface by means of the Wilhelmy balance technique. The gradient surface was characterized by studying the adsorption from single protein solutions of human albumin, IgG and fibrinogen using total internal reflectance fluorescence (TIRF). Generally, adsorption values similar to monolayer capacities were measured on the hydrophobic side. The adsorption decreased towards the hydrophilic end in correspondence with the change in contact angle. The displacement of proteins with a ethylene oxide-propylene oxide copolymer (EO70PO100EO70) was higher on the hydrophobic side than on the hydrophilic side. Albumin showed an adsorption peak in the wetting transition region, indicating a very strong affinity.

Isolated mitral valve prolapse (MVP) may represent one end of a spectrum of disease involving dysfunction of multiple cardiac valves. Eighty-nine consecutive patients with MVP diagnosed by two-dimensional echocardiography (2-D echo) were prospectively studied specifically to determine the incidence of tricuspid valve prolapse (TVP) and its clinical correlations. Criteria for prolapse of the atrioventricular (A-V) valves by 2-D echo included extension of the valve leaflets behind an imaginary line defining the valve annulus. Forty-one of 82 patients with MVP had associated TVP. No significant differences existed between patients with isolated MVP and combined A-V valve prolapse with regard to sex, clinical history, symptoms, or physical examination. The parasternal long axis view was more sensitive than the apical four chamber view in diagnosing prolapse of either mitral or tricuspid valves. Thus, TVP is a frequent concomitant of MVP and occurs with equal frequency in both young and old patients.

Anger has traditionally been described as the most intense and prevalent affect in the borderline patient. This study was designed to characterize anger in the borderline patient in an in-depth analysis by determining whether inpatients with DSM-III borderline personality disorder differed from controls with dysthymic disorder. Standardized rating instruments including subscales of the Profile of Mood States, Brief Psychiatric Rating Scale, and Minnosota Multiphasic Personality Inventory were utilized. Results generally indicated that borderline patients manifested more severe anger than dysthymic controls. The findings are discussed in light of previous psychodynamic, empirical, and research literature.

The linguistic abilities of two groups of children who had been involved in immersion incidents are reported--one group at 12 months after the immersion incident (n = 25), and the second group at five years after the immersion incident (n = 9). The performances of the two experimental groups on standardized language tests were compared with the performances of appropriate control groups that were matched for age, sex and socioeconomic status. The speech and language skills of the 12-months post-immersion group and the matched control group were assessed by means of the sequenced inventory of communication development. Subjects who were assessed 12 months after the immersion injury scored significantly lower results than did control subjects on receptive and expressive language ages that were calculated as percentages of the chronological age. No differences in language scores were evident between the subjects who were at five years after the immersion incident and their control subjects as assessed by the test of language development--primary. The language abilities of the victims of an immersion incident were correlated with their neurological status at presentation to hospital. The results suggest a need to monitor the linguistic development of all children who present initially in a coma after an immersion incident. The need for a longitudinal study of the linguistic abilities of these children is indicated.

Industrialized nations face a critical problem in replacing the sources of liquid fuels that traditionally have been supplied by petroleum. One solution that has gained increasing support in this country is the use of ethanol produced by fermentation of renewable biomass as an extender in, or supplement to, gasoline for transportation fuel. Distillation, the present method of separating ethanol from the fermentation broth, is an energy-intensive one and frequently uses more energy than is available from the ethanol recovered. There are many investigations under way to find alternative, less energy-intensive techniques for the ethanol-water separation. The separations method described in this article involves the use of solid materials to preferentially remove ethanol from fermentation broths. Subsequent stripping of the ethanol from the sorbent with a dry gas reduces dramatically the energy required for the separation. Three solid sorbents have been investigated experimentally. Their sorption/desorption characteristics are described, and their incorporation in an ethanol recovery process is evaluated. Three sorbents were investigated: two commercially available divinylbenzene crosslinked polystyrene resins in bead form (one with a nominal surface area of 300 m(2)/g, the other with 750 m(2)/g) and an experimental proprietary molecular sieve with hydrophobic properties. Equilibrium adsorption isotherms for two of the sorbents were obtained at ambient temperature (21 degrees C) for ethanol-water solutions containing up to 12 wt. % ethanol. In addition, 40 degrees C isotherms were obtained for the polystyrene sorbents. Although different, the equilibrium isotherms for the sorbents indicated that ethanol could be preferentially sorbed from a dilute solution. Column breakthrough curves indicated very favorable kinetics. Desorption of the ethanol was readily effected with warm (60-80 degrees C), dry nitrogen.

Fifty-four consecutive patients with acute anterior myocardial infarctions were studied to determine the incidence and natural history of mural thrombus formation. Two-dimensional echocardiography was performed in the immediate postinfarction period. Multiple views were utilized. Standard criteria for defining mural thrombus formation and minimizing false-positive readings were adhered to. Correlation with clinical data was obtained in all patients to define a subgroup at high risk for the development of a mural thrombus. Follow-up was obtained for all patients to assess the natural history of mural thrombus formation, treated and untreated, with regard to peripheral embolization. Seventeen patients (32 percent) had mural thrombus formation. Statistically significant (p less than 0.001) correlation for mural thrombus formation was found with markedly elevated creatine kinase and lactate dehydrogenase levels and with apical dyskinesis. Ten patients with mural thrombi received anticoagulation therapy. None has had clinically evident emboli at a mean of 10.8 months follow-up. Resolution of the mural thrombus was demonstrated with serial two-dimensional echocardiography in eight patients (80 percent). Six of seven patients who did not receive anticoagulation therapy (86 percent) had embolic events within three months (p less than 0.001). None of the 36 patients without a mural thrombus has had a spontaneous clinical embolus. Thus, the presence of a mural thrombus can be accurately identified in patients with acute myocardial infarction and predicted in a subgroup of those patients. Such patients should be considered for anticoagulation to prevent systemic embolization and should be followed with serial two-dimensional echocardiography.

The long-term prognostic importance of sets of variables from different times in the hospital course after acute myocardial infarction was examined in 818 patients discharged from the hospital. Cardiac mortality during the first year after discharge was 11.1%. For the end point death within 1 year after admission, discriminant function analysis identified 5 important factors from the history and the first 24 hours of hospitalization: maximal level of blood urea nitrogen, previous myocardial infarction, age, displaced left ventricular apex (abnormal apex) on physical examination, and sinus bradycardia (negative correlation). When data from the entire hospitalization were included, extension of infarction and maximal heart rate were also selected. When variables obtained at discharge were included, only the presence of S3 gallop and abnormal apex were selected. In subgroups of patients, neither the left ventricular ejection fraction nor the presence of complex ventricular arrhythmias during a 24-hour ambulatory monitoring were independent predictors. Correct prediction was similar for each analysis, with 55 to 60% of the deaths and 79 to 81% of survivors correctly identified. The high-risk group consisted of 25% of the patients with 28 to 30% predictive value for death in the first year. In conclusion, outcome up to 1 year after acute myocardial infarction can be predicted early after admission. Addition of more information later during the hospitalization and at discharge did not improve correct prediction and may be redundant for prognostic evaluation.

The bulk and surface properties and blood compatibility of a series of polyurethanes based on methylene bis(p-phenyl isocyanate), 1,4-butanediol, and poly(tetramethylene oxide) of molecular weight 1000 were studied. The hard-to-soft segment ratio of these multiphase polymers was varied, and the effect of substituting a poly(dimethylsiloxane)-containing polyol in place of 5% of the polyether soft segment was studied. Bulk properties such as tensile strength and modulus increased with hard segment content, as did surface wettability and ESCA nitrogen content. However, blood compatibility measured by a canine ex vivo blood-contacting experiment was not found to vary with hard/soft segment ratio. The addition of the silicone-containing polyol did not significantly lower the surface wettability, although ESCA-measured silicon content increased and physical properties were unfavourably affected by the incorporation of this co-soft segment. Incorporation of the siloxane-containing component resulted in increased platelet adhesion and fibrinogen deposition at most blood contact times in comparison with the other polyurethanes.

Although it is common practice to digitize radionuclide images onto the finest matrix available, their low count densities and poor spatial resolution suggest that quite large pixels should be adequate. Observers find these large pixels visually obtrusive, but minification of the image can reduce this effect. Experiments reported here have investigated how minification (achieved by increasing viewing distance) affects the perceived quality of images digitized onto different sized matrices. Observers' subjective preference for different pixel sizes was measured at various viewing distances using clinical bone images as test patterns. An objective measure of image quality was made by comparing the detectability of computer-generated focal areas of increased activity both in simple noisy backgrounds and in clinical bone images. The results show that a 128 X 128 matrix is adequate when the image is 8 cm2 and is viewed from 1 and 2 m. A finer matrix failed to produce better results.

The effect of wall shear rate upon albumin adsorption onto a polyurethaneurea, Biomer, was studied using FTIR-ATR spectroscopy. In these experiments, nondiffusion controlled adsorption was observed from 10 mg/ml solutions at known wall shear rates. Results show that increasing wall shear rate during adsorption does not significantly affect the adsorption kinetics, but does decrease the rate of protein desorption. These results suggest that albumin adsorbed at higher shear rates is more tightly bound to the surface. Comparison of the data to simple mathematical models suggests that more than one layer of protein adsorbs in 2 h.

A high-pressure anion-exchange chromatographic system has been modified to provide measurement of large numbers of molecular constituents in serum and for direct comparison to similar measurement in urine. Operating parameters have been adopted which greatly extend the range of elution for strongly retained anionic constituents and limit resolution of early-eluting basic and neutral compounds which were of less interest in this study. Dual monitoring by UV absorption and fluorescence produced by cerate oxidation provides both sensitive and wide-ranging detection capability. Comparative serum and urine chromatograms for a clinically normal subject, a subject after ingesting the drug 4-hydroxyacetanilide, and an infant suffering from extreme acidosis, illustrate the potential usefulness of this analysis in studying the origin, transport, in vivo reactions, and disposition of metabolites.

Seventy-nine children with symptoms of urinary tract infections were randomly allocated to treatment with a single dose or a 7-day course of trimethoprim-sulphamethoxazole. Of the 42 patients (39 girls, 3 boys) who fulfilled the criteria for the trial, 23 were given a single-dose regimen and 19 of them a 7-day regimen. Both groups of patients had sterile urine cultures 2 days after starting treatment. Eight patients had underlying structural renal abnormalities (n = 3, single-dose regimen; n = 5, 7-day regimen). One patient in the single dose group had a recurrence of infection on day 7. These results show that single dose trimethoprim-sulphamethoxazole is as effective as the conventional 7-day course in children with symptomatic urinary tract infection. Further investigation of the renal tract is necessary regardless of the fact that the infection has been eradicated by single-dose treatment.

A comparison is made between the sensitivity of detection of focal abnormalities in radionuclide bone images by visual examination and by using simple quantification. The quantitative method calculates the ratio of radiopharmaceutical uptake in a region of interest drawn around a lesion to that in an area of normal bone. Quantification is found to be far more sensitive than visual examination in detecting focal metastases. The use of "baseline" images improved the precision of quantitation of rib lesions, but appeared not to alter the sensitivity of visual detection. This method of quantification is therefore limited more by the inability of observers to notice suspicious areas to which it should be applied than by inaccuracies inherent in the method itself. Further work should concentrate more on image enhancement than on improving quantitative techniques.

Linear alkyl chains containing 2, 10 and 18 carbon atoms were grafted to 10% of the urethane nitrogens in a polyether-polyurethane. The polyurethane was synthesized from methylene bis(p-phenyl isocyanate), 1,4-butanediol, and polytetramethylene oxide of 1000 molecular weight in a molar ratio of 3/2/1. Fourier transform infrared spectroscopy and attenuated total reflectance optics were used to study the adsorption of 5.0 mg/ml human serum albumin (HSA) at 37 degrees C to the derivatized and non-derivatized polymers. Both delipidized HSA and HSA containing 6.5 mol stearic acid per mol of albumin were used to study the effect of chain length upon the initial adsorption rate, the total amount adsorbed in 1 h, and the desorption rate. The initial adsorption rates revealed that non-specific adsorption was similar upon all four polymers. An increase in initial adsorption rate upon the C-18 derivatized polymer was attributed to a specific binding interaction between the HSA and the grafted alkyl chains. The conformational stability of the HSA also affected the adsorption rate. The total amount adsorbed after 1 h decreased as the alkyl chain length increased from 2 to 18 methylene groups. The desorption rate decreased in magnitude as the alkyl chain length increased from C-2 to C-18. These results support a hypothesis that alkyl chain length influences the interaction between albumin and an alkylated polymer system.

Use of the Hancock, glutaraldehyde-preserved, stented heterograft for aortic valve replacement has gained wide acceptance in the past 7 years. Nevertheless, very little is known about the long-term mechanical and pathological characteristics following implantation. A rare case is presented in which mechanical valve failure occurred secondary to leaflet disruption in the absence of infection 23 months after implantation. The literature is reviewed and the implications of this unusual complication are discussed.