The impact of online medical control physician involvement on outcomes for calls related to emergency medical services patient refusals

This study investigates the impact of discussion between online medical control and patients who refuse transport to the hospital by emergency medical services. We find that a direct transport recommendation by a physician increases subsequent rates of patient transport

Advances in Corrosion Casting Methods

This paper briefly discusses the concept of corrosion cast preparation (primarily of blood vessels), the use of the scanning electron microscope (SEM) to study these casts and the observations which can be made, together with the merits and the limitations in various applications. A number of reviews and surveys are quoted in which the different injection media, injection methods, animal preparations and corrosion procedures are described. A new procedure of cleaning the corrosion casts with sodium hydroxide and Triton X-100 is described. The observations which can be made are listed and illustrated both on the cellular level as well as in organ systems as a whole. The discussion centers around some common misconceptions, the feasibility in various applications and the limitations of the method. The conclusion is that the method has proven to be useful especially in conjunction with other methods. Moreover, while the concept of the method may be very straight-forward the approach and the interpretation often need careful consideration and might not be as straight-forward as one tends to expect from the simple sounding principle

Vascular Changes in Popliteal Lymph Nodes due to Antigen Challenge in Normal and Lethally Irradiated Mice

The microvascular system of the murine popliteal lymph node was investigated using scanning electron microscopy of microcorrosion casts. Time-dependent changes in the microvasculature following regional antigen challenge in normal and lymphocyte-depleted mice were studied. Normal lymph node microvasculature exhibited a significant increase in both the vascular bed and post-capillary venules containing high-endothelium in response to antigen challenge. Lymph nodes of lymphocyte-depleted mice showed no microvascular size increase following antigen challenge and a reduction in the amount of high-endothelium was observed

Chemoattractant Receptor-Induced Phosphorylation of L-Selectin

The selectin adhesion molecules and chemoattractant receptors synergistically regulate leukocyte migration into lymphoid tissues and sites of inflammation, but little is known about how these families of receptors modulate each other\u27s function. In this study, L-selectin was found to be phosphorylated in lymphoblastoid cell lines, and phosphorylation was enhanced by phorbol ester (phorbol 12-myristate 13-acetate (PMA)) treatment. Interactions between L-selectin and chemoattractant receptors were therefore examined using transfected rat basophilic leukemia cell lines (RBL-2H3) that expressed human L-selectin along with human leukocyte chemoattractant receptors. L-selectin was rapidly phosphorylated in cells treated with chemoattractants, thrombin, IgE receptor agonists, or PMA. Pertussis toxin or the protein kinase C inhibitor, staurosporine, completely blocked chemoattractant receptor-induced phosphorylation of L-selectin. PMA-induced phosphorylation was on serine residues within the cytoplasmic tail of L- selectin that have been well conserved during recent evolution. Although L- selectin phosphorylation was not essential for basal levels of adhesion through L-selectin in transformed cell lines, the rapid increase in ligand binding activity of L-selectin that occurs following leukocyte activation was blocked by staurosporine. These results demonstrate that L-selectin can be phosphorylated following engagement of chemoattractant receptors and suggest that this may be a physiologically relevant mechanism for the synergistic regulation of these receptors during leukocyte migration

Fractalkine and CX3CR1 Mediate a Novel Mechanism of Leukocyte Capture, Firm Adhesion, and Activation under Physiologic Flow

Leukocyte migration into sites of inflammation involves multiple molecular interactions between leukocytes and vascular endothelial cells, mediating sequential leukocyte capture, rolling, and firm adhesion. In this study, we tested the role of molecular interactions between fractalkine (FKN), a transmembrane mucin-chemokine hybrid molecule expressed on activated endothelium, and its receptor (CX3CR1) in leukocyte capture, firm adhesion, and activation under physiologic flow conditions. Immobilized FKN fusion proteins captured resting peripheral blood mononuclear cells at physiologic wall shear stresses and induced firm adhesion of resting monocytes, resting and interleukin (IL)-2–activated CD8+ T lymphocytes and IL-2–activated NK cells. FKN also induced cell shape change in firmly adherent monocytes and IL-2–activated lymphocytes. CX3CR1-transfected K562 cells, but not control K562 cells, firmly adhered to FKN-expressing ECV-304 cells (ECV-FKN) and tumor necrosis factor α–activated human umbilical vein endothelial cells. This firm adhesion was not inhibited by pertussis toxin, EDTA/EGTA, or antiintegrin antibodies, indicating that the firm adhesion was integrin independent. In summary, FKN mediated the rapid capture, integrin-independent firm adhesion, and activation of circulating leukocytes under flow. Thus, FKN and CX3CR1 mediate a novel pathway for leukocyte trafficking

Regulation of L-Selectin–mediated Rolling through Receptor Dimerization

L-selectin binding activity for its ligand expressed by vascular endothelium is rapidly and transiently increased after leukocyte activation. To identify mechanisms for upregulation and assess how this influences leukocyte/endothelial cell interactions, cell-surface dimers of L-selectin were induced using the coumermycin–GyrB dimerization strategy for cross-linking L-selectin cytoplasmic domains in L-selectin cDNA-transfected lymphoblastoid cells. Coumermycin- induced L-selectin dimerization resulted in an approximately fourfold increase in binding of phosphomanan monoester core complex (PPME), a natural mimic of an L-selectin ligand, comparable to that observed after leukocyte activation. Moreover, L-selectin dimerization significantly increased (by ∼700%) the number of lymphocytes rolling on vascular endothelium under a broad range of physiological shear stresses, and significantly slowed their rolling velocities. Therefore, L-selectin dimerization may explain the rapid increase in ligand binding activity that occurs after leukocyte activation and may directly influence leukocyte migration to peripheral lymphoid tissues or to sites of inflammation. Inducible oligomerization may also be a common mechanism for rapidly upregulating the adhesive or ligand-binding function of other cell-surface receptors