Secondary structure of a pair of fibronectin type 1 modules by two-dimensional nuclear magnetic resonance

The fourth and fifth type 1 module pair, corresponding to residues 151-244 from the amino terminus of human fibronectin, has been produced as a recombinant protein using a yeast expression system and studied by two-dimensional homonuclear 1H nuclear magnetic resonance (NMR) spectroscopy. The sequence-specific resonance assignment of the 1H NMR spectrum has been completed using a combination of 2D 1H nuclear Overhauser effect (NOE) spectroscopy, homonuclear Hartmann-Hahn, and correlated spectroscopy spectra recorded under a variety of pH and temperature conditions. Slow exchanging amide protons have been identified and estimates of many backbone 3JNH-C alpha H coupling constants were obtained by line shape fitting. The secondary structures of each module conform closely to the "consensus" fibronectin type 1 module structure determined previously for two other single type 1 modules. In the module pair described here, the two modules are linked by a short five-residue linker which appears to form a turn. The intermodule interface is defined by NOEs observed between a hydrophobic three-residue sequence from the fourth type 1 module and residues in the first double-stranded beta-sheet of the fifth type 1 module. The interaction is dominated by a tryptophan residue (unconserved in other type 1 sequences) within the fourth module, which causes large upfield ring current shifts for several proton resonances from the beta-sheet of the fifth module. The NMR data indicate that there is little or no relative reorientation of the two modules about the linker region but rather that the two modules combine with a fixed and intimate hydrophobic contact.

A medical diagnostic index for rehabilitation

This paper records the developments of a computerized database suitable for recording the history, signs and symptoms of handicapping conditions, monitoring recovery, and measuring the impact of different forms of treatment. The original model described was designed for stroke and the paper describes its integration into the routine use of a stroke and rehabilitation unit in a district general hospital.

Attitudes of funeral directors and embalmers toward autopsy

Although physician and family attitudes toward autopsy have been suggested as factors leading to declining autopsy rates, attitudes of funeral directors and embalmers toward autopsy have not been studied. We surveyed members of the Illinois Funeral Directors Association concerning beliefs about the purposes of autopsy, problems they experienced with autopsied cases, and the advice they gave to family members about permitting autopsy. Three hundred eight (42.2%) of 730 funeral directors and embalmers responded to the questionnaire. Although 80.3% believed that autopsy served a purpose, 46.4% had counseled families not to permit autopsy, and 16.6% did so more than half the time. Perceived difficulty in embalming autopsied cases (odds ratio, 2.3), family concern about the risk of disfigurement (odds ratio, 1.9 to 2.2), having attempted to talk to a pathologist or hospital administrator about a poorly performed autopsy (odds ratio, 2.0), and belief in the purpose of autopsy (odds ratio, 0.38), were significant independent predictors of counseling against autopsy. Of funeral directors who counseled against autopsy, 28.3% reported that families never permitted autopsy, and 39.4% reported that families only occasionally permitted autopsy, in cases where they had counseled against it. Funeral directors from Illinois counties with 1989 medical certificate case autopsy rates of less than 5% counseled against autopsy more frequently than funeral directors from counties with higher autopsy rates. We conclude that although most funeral directors and embalmers believe in the purposes of the autopsy, difficulties in embalming autopsied cases, and family concern about the risk of disfigurement, may lead members of the funeral profession to counsel against autopsy, and that such advice may influence families not to permit an autopsy.

Emergency department workload--a transatlantic comparison

This paper compares the workload of the emergency department of a Level One trauma center in the United States and a large city hospital in the United Kingdom. The referral pattern and diagnostic classification of 5,000 patients presenting to both departments were compared, as were the transportation systems at the two sites. It was shown that similarities existed in many areas. Major trauma formed only a small proportion of the overall workload of both departments. The conclusion is that although the two emergency care systems have fundamental differences in terms of organization and finance, the workloads are remarkably similar. Interesting differences arose in areas such as use of helicopter transport, psychiatric and drug and alcohol related admissions, and in the number of patients brought to hospital under police escort.

An improved method of communication between computerized accident and emergency departments and general practitioners

This new system of communication sends the data on four sticky labels (Fig. 1), one of which can be permanently left in the patients folder without taking up too much space. Further details can be obtained by telephoning the A&E department and quoting the A&E number on the sticky label.

A review of medical airlifts by a search and rescue squadron on the east coast of England over 18 years

This paper reviews the medical workload of a Royal Air Force Search and Rescue squadron on the East Coast of England over a period of 18 years and their association with the principal receiving hospitals in that area. It illustrates the effects of improvements in road networks on the workload of the squadron and contrasts the use of military helicopters with established U.K. civilian helicopter schemes.

The need for ventilation holes in children's dummies

A 2-year-old child was brought into the Accident Department with a history that he had swallowed his dummy. There were no direct witnesses to the injury. The child had come up to its mother salivating and pointing to its mouth. The initial incident happened approximately 20 min prior to presentation at the Accident Department after a 999 call. Attempts at digital removal of the dummy by ambulancemen had failed. The child was pink and quiet but responding to commands and cooperative. He had a small abrasion to his forehead presumably due to his initial fall when his dummy was forced into his mouth. The teat of the dummy was clearly visible in the pharynx. The child was able to breathe by virtue of the two air holes in the flange piece of the dummy.

Mortality in diabetes mellitus: experience of a geographically defined population

A population-based cohort study identified 915 deaths in 4186 patients with diabetes mellitus over a 5-year period. Ischaemic heart disease, cerebrovascular disease and malignant neoplasms were the major causes of death and accounted for 40%, 16%, and 14% of deaths, respectively, compared with 27%, 14%, and 25% of deaths in the non-diabetic population. Diabetic patients had a standardized mortality ratio (SMR) of 1.15 (95% Cl 1.08-1.22) (p less than 0.001). This excess risk of death was largely due to the excess death from ischaemic heart disease (SMR 1.55 (1.40-1.71); p less than 0.001) and the impact was greatest in middle-aged female patients. Stroke mortality was not significantly increased (SMR 1.09 (0.92-1.29)) while cancer mortality was reduced (SMR 0.75 (0.63-0.89); p less than 0.01). Death rates in diabetic male patients (SMR 1.04 (0.96-1.13)) did not differ significantly from those in non-diabetic male patients because the increased risk of ischaemic heart disease deaths (SMR 1.41 (1.22-1.62); p less than 0.001) was offset by the reduced risk of deaths from malignant neoplasms (SMR 0.65 (0.51-0.82); p less than 0.001). The reduction in cancer mortality did not reach statistical significance in diabetic women (SMR 0.82 (0.64-1.05)). Diabetic nephropathy and metabolic disasters were uncommon as causes of death.

Blunt trauma leading to facial nerve paralysis

A case in a young child of blunt trauma to the facial nerve, distal to the stylomastoid foramen, is reported. Although the patient made an uneventful recovery, an understanding of the possible sites of injury of the facial nerve and further investigations available to aid diagnosis is important. This child was followed up in the Accident and Emergency Department, however, early referral of this rare condition to an otolaryngologist is advisable.

Patterns of treated non-melanoma skin cancer in Queensland--the region with the highest incidence rates in the world

The incidence of non-melanoma skin cancer, comprising basal cell carcinoma and squamous cell carcinoma, was studied in Queensland during 1984. The world-standardised annual incidence rates (per 100,000 population) for the number of persons with non-melanoma skin cancer were estimated to be 1372 for men and 702 for women, the highest recorded incidence rates in the world. Rates in men were nearly double the rates in women and age-specific incidence rates increased curvilinearly with age. There were, on average, 1.4 skin cancers per person with non-melanoma skin cancer and the ratio of basal cell carcinomas to squamous cell carcinomas was approximately three to one. The age-standardised annual incidence rate (per 100,000 population) of basal cell carcinoma for residents of the Gold Coast was 1.83 times the Brisbane rate for men and 1.57 times that for women, indicating significant differences between the two regions. For squamous cell carcinoma the regional differences were not statistically significant. The average potential number of non-melanoma skin cancers (per person) treated during the lifetime of a cohort of 100,000 was estimated to be 0.014 for men and 0.009 for women by age 40. By age 65, these numbers increased to 0.22 for men and 0.11 for women. At age 90, these average numbers were 1.09 and 0.42, respectively. Although the incidence of non-melanoma skin cancer is much higher in the older age groups, it should be kept in mind that it also affects the younger population; 1028 Queenslanders under 40 required treatment for 2300 non-melanoma skin cancers in 1984. This study which provides baseline information about the occurrence of non-melanoma skin cancer in Queensland emphasises the importance of developing safe sun-exposure habits, detecting non-melanoma skin cancer early and protecting and restoring the atmosphere.

Effects of winter nutrition and summer pasture or a feedlot diet on plasma insulin-like growth factor I (IGF-I) and the relationship between circulating concentrations of IGF-I and thyroid hormones in steers

Effects of two winter nutritional levels (LOW, MOD) and two summer pastures (bahiagrass, BG; perennial peanut, PP) on plasma IGF-I, and the relationship between IGF-I and average daily gain (ADG), thyroid hormones, plasma urea, packed cell volume (PCV) and steer type were determined in 101 steers (217 kg) varying in breed composition, frame size and initial condition. Relationships between body composition or composition of gain and IGF-I were determined in 11 contemporary steers assigned directly to the feedlot. Initial IGF-I (57.9 +/- 3.5 ng/ml) was positively correlated (P less than .05) to initial condition, estimated percentage of Brahman and plasma T3, but not related to subsequent ADG. During the 126-day wintering period, ADG was .21 kg for the LOW winter treatment and .47 kg for the MOD winter treatment. Concentration of IGF-I in the wintering period was affected (P less than .01) by nutritional level (LOW = 71.8 ng/ml, MOD = 150.6 ng/ml) and was positively related to winter ADG in MOD steers (P less than .01) but not in LOW steers. Concentration of IGF-I in winter was also positively related to condition at the end of the winter period (P less than .01), T3 (P less than .05) and T4 (P less than .05). There were no effects of winter treatment on IGF-I during the subsequent summer pasture period. During the 145-d summer period, ADG was .53 kg for BG and .68 kg for PP. Concentration of IGF-I during the summer period was affected (P less than .05) by pasture treatment (BG = 138.6 ng/ml, PP = 181.9 ng/ml), was positively related (P less than .01) to PCV and percentage of Brahman, and was negatively related (P less than .05) to estimated percentage of English breeding. In steers assigned directly to the feedlot, IGF-I was correlated with empty body (EB) weight (r = -.59, P less than .10), EB water (r = -.59, P less than .10) and EB protein (r = -.60, P less than .10) at slaughter, and with days on feed (r = -.65, P less than .05), but was not correlated with ADG or rate of component gain. These data indicate that IGF-I is related to nutritional status in steers as in other species, that there may be significant breed or cattle type differences in circulating concentrations of IGF-I, and that circulating concentration of IGF-I may be functionally related to plasma concentration of thyroid hormones.

Prevention of leucaena toxicosis of cattle in Florida by ruminal inoculation with 3-hydroxy-4-(1H)-pyridone-degrading bacteria

Ruminal microorganisms in cattle at a Florida agriculture research station did not have the ability to detoxify leucaena by degradation of 3-hydroxy-4(1H)-pyridone (3,4,-DHP), but a DHP isomer (2,3-DHP) was degraded in some cattle. Cattle with microorganisms that degraded 2,3-DHP were mostly Senepol cattle imported from St. Croix, US Virgin Islands, where leucaena is an indigenous species. Hereford cattle at the research station in Florida generally did not degrade 3,4-DHP or 2,3-DHP. An experiment was conducted in which a pure culture of 3,4-DHP-degrading bacteria was inoculated into Hereford cattle (with ruminal fistula) grazing leucaena. The bacteria successfully colonized the rumen of recipient cattle and persisted through the following winter when there was no leucaena in the diet.

Hypertrichosis cubiti (hairy elbows) and short stature: a recognisable association

We report four patients with hypertrichosis cubiti who were referred for investigation of short stature. Two males, whose height was on and just below the 3rd centile respectively, were sporadic cases and two females with disproportionate short stature were mother and daughter. Radiological changes present in the familial cases were non-specific and biochemical investigations were normal. Of the four other published cases, two were sporadic and of normal height. The other two were sibs with short stature and their parents were heterozygous for the Weill-Marchesani syndrome. We were unable to ascertain whether hypertrichosis cubiti cosegregates with the same type of skeletal dysplasia or elucidate the type of genetic transmission of hypertrichosis cubiti alone.

Differential migration of lymphoblasts and small lymphocytes induced by mitogens in culture: characteristics of lymphoid cells

Lymphoid cells from peripheral lymph nodes, spleen, and gut-associated lymphoid tissues (mesenteric lymph nodes and Peyer's patches) of the mouse were stimulated by concanavalin A and bacterial lipopolysaccharide in culture: their migration in the mouse was studied. Lymphoblasts and small-medium lymphocytes from the cultures, irrespective of their tissue origins, showed a differential migration when they were passively transferred into syngeneic, immunoglobulin-allotype congeneic or allogeneic recipients. Large lymphoblasts, at late S and G2 + M phases and without MEL-14 reactive determinants, migrated preferentially to the gut. In contrast, small and medium lymphocytes, at Go/Gl and early S phases and with MEL-14 reaction determinants, migrated preferentially to the spleen and liver. The differential migration was shown to be an inherent characteristic of the cultured lymphoid cells. These results suggest that selective migration and lodging of lymphoid cells in the body may be determined by the phases of cell cycle and stages of differentiation.

Trauma systems. Current status--future challenges

The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. Only two states were found to have all components and statewide coverage. Nineteen states and the District of Columbia lacked one or more components of a regional trauma system. The remaining 29 states had yet to initiate the process of trauma center designation. In response to these shortcomings, an attempt was made to define the barriers to trauma system implementation and a step-by-step process was outlined for the development, management, and analysis of a comprehensive system of trauma care.

A male infant with the Catel-Manzke syndrome and dislocatable knees

A male infant is described with severe micrognathia and bilateral duplication of the proximal phalanges of the index fingers, an association which is characteristic of the Catel-Manzke syndrome. In addition, he had dislocatable knees, which have not been described in this disorder before.

Leiomyosarcoma of the rectum. Report of a case and review of the literature

A case of leiomyosarcoma of the rectum is presented and followed by a review of 135 cases from the literature. The five- and ten-year survival figures were the same whether the patient was treated by radical or local excision; however, local excision was followed by 67.5 percent recurrence. Abdominoperineal resection is still the procedure of choice. Local excision might be considered for small tumors of low-grade malignancy in a poor-risk patient.