Localisation of androgen receptors in dermal fibroblasts, grown in vitro, from normal subjects and from patients with androgen insensitivity syndrome

Human genital skin fibroblasts show the androgen receptor (AR) as bright red granules (0.5 micron in diameter) after treatment with one (of 3) primary polyclonal antibody and a secondary antibody linked to alkaline phosphatase. Almost all AR were cytoplasmic in 12 normal strains and in 8 strains from patients with partial (PAIS) and 6 with complete androgen insensitivity syndrome (CAIS). When 25.8 nM 5-alpha-dihydrotestosterone (DHT) or methyltrienolone was added to the medium, some AR were translocated into the nucleus in 13 experiments with 8 strains of normal fibroblasts; of 8 strains of patients with PAIS 3 failed to translocate to a detectable extent in the presence of androgen in the medium and none of the 6 strains from patients with CAIS translocated.

Therapy-related leukemia and myelodysplastic syndrome in chronic lymphocytic leukemia

A retrospective analysis was performed to determine the incidence and clinical features of acute myelogenous leukemia/myelodysplastic syndrome (AML/MDS) developing in chronic lymphocytic leukemia (CLL) patients. AML/MDS occurred in 3/1374 CLL patients seen at a single institution between 1972 and 1992. The median follow-up exceeded 7 years and 72% of these patients had received prior alkylating agent therapy. The expected number of AML/MDS developing in a general population of the same size was 1.2 as calculated from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program data (observed-to-expected ratio = 2.49; 95% confidence interval = 0.9-7.3; p = 0.12). Although, not included in the incidence calculation, four patients with CLL were referred at the time of development of AML/MDS. CLL and AML/MDS were diagnosed concurrently in two patients. Three of the patients had received no prior alkylating agents. The median survival was 17 months in patients who had received no prior treatment, and 5 months in those who had received prior chemotherapy. Our results suggest that patients with CLL in whom AML/MDS develops have similar prognoses to other patients with AML/MDS. Furthermore, this analysis does not provide evidence for a heightened risk of AML/MDS in CLL patients, despite treatment with known leukemogenic agents.

Age and the van Herick ratio in a Chinese population

We derived estimates of the van Herick ratio or grading in a retrospective study using a Chinese clinical population. We found that the van Herick ratio decreased with age and increased with higher degrees of myopia. A lower van Herick ratio was found to be associated with higher intraocular pressure. There are significantly more patients with lower van Herick ratios or grades in our population than in populations described by others.

The use of peer evaluation in promoting nursing faculty teaching effectiveness: a review of the literature

Many authors have recommended that peer evaluation should be a key component in evaluating nursing faculty teaching effectiveness. Despite the purported advantages of peer evaluation it remains a controversial method for faculty evaluation. In a review of the literature the success of a peer evaluation depends on faculty involvement, short but objective methods, trained observers, constructive feedback for faculty development as well as open communication and trust.

Synergy test for recognition of epitopes on soluble proteins; its application in the study of CD21 and CD23 antigens and their respective antibodies

Antigens such as CD21 and CD23, which express only one copy of an epitope require two monoclonal antibodies (mAbs) for their detection and estimation. This requirement is exploited in two ways in a technique based on the chromic chloride haemagglutination test. For simple titration of antigen two portions of red cells each coated with one of a pair of synergising mAbs are used in a 1:1 combination. For testing the antigenic specificity of a mAb and assessing its region of epitope binding, the mAb under test is serially diluted in fluid containing a standard amount of antigen and red cells are added to which have been attached a different mAb. If the red cell-bound mAb recognises a determinant topographically distinct from that of the soluble mAb, red cell agglutination to high titre occurs. In titrations of ascitic fluid containing approximately 1 mg/ml mAb, titres of log2(9) to log2(16) were recorded from a starting dilution of 1 in 200. Hence the test is very sensitive and only minute amounts of a mAb are required for testing. The same test system can be used for assessing the relative display of epitopes on antigen obtained from different sources, e.g., culture supernates and body fluids. The method is of general applicability to monomeric antigens and its use is illustrated by analysis of CD21 and CD23 antigens and antibodies.

Reduction in stereoacuity with age and reduced retinal illuminance

Stereoacuity has been reported to decrease significantly in the seventh decade of life. Could this decrease be due to a reduction of retinal illuminance in the ageing eye? In this study, we used a more rigorous psychophysical procedure than that used previously, on 35 subjects, aged 21-67 years, to determine if the reported effect of age on stereoacuity could be replicated. We also compared the stereoacuity of 15 healthy young adults under normal and reduced retinal illuminance. A forced-choice algorithm was used to improve the accuracy of measurements. Results suggest that the reduced retinal illuminance resulting from normal ageing is not the cause of the decreased stereoacuity found with ageing.

Altered energy balance may account for growth failure in Rett syndrome

To determine whether alterations in energy balance account for growth failure in Rett syndrome, we measured dietary energy intakes, fecal fat losses, activity patterns, and sleeping as well as quietly and actively awake metabolic rates in Rett syndrome girls and healthy controls. Dietary energy intakes and fecal fat losses did not differ between the groups. Metabolic rates while sleeping and quietly awake were 23% lower (P < .05) in Rett syndrome girls than in controls; metabolic rates while actively awake did not differ between the groups. However, because of the 2.4-fold greater time (P < .001) spent in involuntary motor movement, energy expenditure associated with activity was twofold greater (P < .05) in Rett syndrome girls than in controls. Although total daily energy expenditure of the two groups did not differ significantly, energy balance was less positive in the Rett syndrome girls than in the controls. This small difference in energy balance, if sustained over months to years, is sufficient to account for growth failure in Rett syndrome girls.

Protection of immunized and previously infected chimpanzees challenged with Mycoplasma pneumoniae

Following immunization, peak geometric mean serum metabolism inhibition antibody (MIT) titres were 1:13 and 1:16 for groups of three chimpanzees each that received either the formalin-inactivated OSU-1A or experimental acellular extract vaccine, respectively. Following challenge, the mean titres for chimpanzees given the acellular vaccine peaked at 1:256 in 4 weeks and was 1:48 at 10 weeks. Chimpanzees given the OSU-1A vaccine peaked at 1:80 in 4 weeks and remained at 1:80 at 10 weeks. There was no direct correlation between the serum MIT response and the severity of disease or colonization, and thus the MIT response was not a reliable measurement of protection. The two non-immunized chimpanzees showed significant signs of disease, including cough, pharyngitis, rhinitis, fever and abnormal X-ray findings, for about 5 weeks. The chimpanzees immunized with either vaccine were less colonized and showed far less disease than non-immunized controls. Protection afforded the chimpanzees was similar to that of vaccinees in the human clinical trial given the same OSU-1A vaccine (Wenzel et al., 1977). The two previously infected chimpanzees were most protected against colonization and disease on challenge.

The repeatability of the noninvasive blue field entoptic phenomenon method for measuring macular capillary blood flow

The speed of macular capillary blood flow can be estimated by using the blue field entoptic phenomenon. The technique uses a matching task in which the subject matches what is seen entoptically with a computer simulation of the phenomenon. In this study, we tested the repeatability of the leukocyte speed results obtained using this technique. Fourteen young subjects were tested on five different occasions. Group mean leukocyte speed did not vary significantly from one recording session to the next. However, readings for individuals varied substantially from one recording session to the next. This variability limits the usefulness of this technique for screening or monitoring macular blood flow in individuals.

Wellness education for individuals with chronic mental illness living in the community

The article reports a wellness education program developed to enhance and promote healthy life-style behaviors for individuals with chronic mental illness living in the community. Theoretical concepts from health promotion, wellness, and social learning were used in the development of this program. The program comprised three components: wellness education sessions, exercise/activity sessions, and a smoking reduction course.

Negative bone scintigraphy with diffuse osteoblastic breast carcinoma metastases

A patient with diffuse osteoblastic metastases from invasive lobular carcinoma of the breast is presented in whom radionuclide bone scan was negative for skeletal lesions. Skeletal metastases were documented by plain radiography, CT, MRI, and bone marrow biopsy. This case report points to the value of plain-film, CT, and MRI findings in situations of high clinical suspicion of metastatic disease despite a normal scintigraphy.

The natural history of familial cavernous malformations: results of an ongoing study

Cavernous malformations are congenital abnormalities of the cerebral vessels that affect 0.5% to 0.7% of the population. They occur in two forms: a sporadic form characterized by isolated lesions, and a familial form characterized by multiple lesions with an autosomal dominant mode of inheritance. The management of patients with cavernous malformations, particularly those with the familial form of the disease, remains a challenge because little is known regarding the natural history. The authors report the results of an ongoing study in which six families afflicted by familial cavernous malformations have been prospectively followed with serial interviews, physical examinations, and magnetic resonance (MR) imaging at 6- to 12-month intervals. A total of 59 members of these six families were screened for protocol enrollment; 31 (53%) had MR evidence of familial cavernous malformations. Nineteen (61%) of these 31 patients were symptomatic, with seizures in 12 (39%), recurrent headaches in 16 (52%), focal sensory/motor deficits in three (10%), and visual field deficits in two (6%). Twenty-one of these 31 patients underwent at least two serial clinical and MR imaging examinations. A total of 128 individual cavernous malformations (mean 6.5 +/- 3.8 lesions/patient) were identified and followed radiographically. During a mean follow-up period of 2.2 years (range 1 to 5.5 years), serial MR images demonstrated 17 new lesions in six (29%) of the 21 patients; 13 lesions (10%) showed changes in signal characteristics, and five lesions (3.9%) changed significantly in size. The incidence of symptomatic hemorrhage was 1.1% per lesion per year. The results of this study demonstrate that the familial form of cavernous malformations is a dynamic disease; serial MR images revealed changes in the number, size, and imaging characteristics of lesions consistent with acute or resolving hemorrhage. It is believed that the de novo development of new lesions in this disease has not been previously reported. These findings suggest that patients with familial cavernous malformations require careful follow-up monitoring, and that significant changes in neurological symptoms warrant repeat MR imaging. Surgery should be considered only for lesions that produce repetitive or progressive symptoms. Prophylactic resection of asymptomatic lesions does not appear to be indicated.

Risk assessment for aflatoxin: an evaluation based on the multistage model

Lifetime cancer potency of aflatoxin was assessed based on the Yeh et al. study from China in which both aflatoxin exposure and hepatitis B prevalence were measured. This study provides the best available information for estimating the carcinogenic risk posed by aflatoxin to the U.S. population. Cancer potency of aflatoxin was estimated using a biologically motivated risk assessment model. The best estimate of aflatoxin potency was 9 (mg/kg/day)-1 for individuals negative for hepatitis B and 230 (mg/kg/day)-1 for individuals positive for hepatitis B.

Investigation of parameters influencing intraocular pressure increases during sleep

In previous studies, we have observed that young normal subjects show an increase in intraocular pressure (IOP) after sleep. Here we describe three experiments which investigated: (i) the effects of sleep in five groups of subjects: glaucoma, suspect glaucoma, young high-normal IOP, old high-normal IOP groups and an elderly control group, (ii) the effect of exposure to bright light (2500 lux) during sleep on associated IOP changes, and (iii) the relationship between changes in IOP and plasma melatonin during sleep. For all experiments IOP was measured before and after sleep. We found that IOP increased significantly after sleep. There was also a significant difference between the five groups with the old high-normal group showing the greatest increase, and the young high-normal group showing the lowest increase in IOP. The increase in IOP after sleep was reduced when the same subjects slept in bright light compared to that recorded when subjects slept in the dark. Plasma melatonin levels, as well as IOP, increased after sleep in the dark although there was no correlation between these changes for individual subjects.

Experimentally induced Mycoplasma pneumoniae pneumonia in chimpanzees

Eight chimpanzees were examined. Two served as negative control and six inoculated with Mycoplasma pneumoniae became colonized. Colonization persisted for 28-68, 16-50 and 21 days with an average duration of 47, 32.5 and 21 days in the oropharyngeal, tracheal and lung tissues, respectively. Mycoplasma titers ranged from 10(8) to 10(1) color-changing units per specimen during the course of the infections. Seroconversion occurred within 12-15 days and peak antibody titers ranged from 1.256 to 1.1024 and developed between days 28 and 48 post-inoculation. Positive cold agglutinin titers were detected between 12 to 15 days and peak titers ranged from 1:80 to 1:640. Significant increases in sIgA and IgG immunoglobulin antibody levels were detected in lung lavage fluids. Unlike the many other experimentally infected animals examined, chimpanzees infected with M. pneumoniae had positive X-ray findings, developed cold agglutinins and showed overt signs of disease. These signs include persistent cough, low grade fever, rhinitis, oropharyngitis, diarrhea, and loss of appetite. Peak severity of disease corresponded with peak lung colonization, and the detection of cold agglutinins and positive X-ray findings. The microbiological, serological and clinical aspects of pneumonia induced in chimpanzees was similar to naturally occurring primary atypical pneumonia in humans.

Types of health problems and satisfaction with services in a rural nurse-managed clinic

The purpose of this study was to investigate the satisfaction of clients with care provided in a rural nurse-managed health center by family nurse practitioners and to describe common health problems for which family nurse practitioner services were sought. The results indicated that of the 2,106 visits from a case load of 1,350 clients, acute health problems were the most common (95.7%), and chronic health problems were the least common (3.9%). Respiratory and ear infections were the most frequent acute illness (55%), and hypertension (29%), respiratory (27%), and musculoskeletal complaints (27%) were the most frequent chronic conditions. Children up to 6 years of age constituted the largest client population (30%), followed by young adults (23%). Older adults were the smallest numbers of clients (3%). Client satisfaction with nurse practitioner-managed care was highly rated by 97% (n = 101) of the subjects in a random sample telephone survey. The results suggested that family nurse practitioners were providing effective and satisfactory healthcare for this rural community. Issues for further investigation are also discussed.

Distance visual acuity and monovision

We have investigated aspects of visual acuity with monovision correction. Binocular distance visual acuity with monovision was approximately equal to monocular visual acuity for addition powers (monocular defocus) of +1.00 to +2.50 D, using both high and low contrast logMAR visual acuity charts. Neither the eye chosen to be defocused (dominant or nondominant) or pupil size (3.5, 5 and 7 mm) affected the binocular visual acuity loss with monovision for high contrast charts. We also investigated the effect of induced residual astigmatism (+0.50, +1.00, and -1.00 D) on binocular distance visual acuity in monovision correction. Residual astigmatism caused a significantly greater reduction of binocular visual acuity in the monovision condition than it did in normal binocular conditions. This effect appears to be related to a process of meridional interocular suppression. It may therefore be of clinical importance to correct low amounts of residual astigmatism in monovision corrections to provide optimum binocular visual acuity.

Mechanical manipulation of the lids and tear break-up time measurements in Hong Kong Chinese

We measured tear break-up time (TBUT) after lid-rubbing in a single masked experiment, and found that TBUT was unaltered. A further single masked experiment in which non-invasive tear break-up time (NITBUT) was measured after the lids were raised as if to apply fluorescein also showed no effect of this interference with the lids. An experiment in which fluorescein was applied either with the lid raised or not raised during fluorescein application, again with the experimenter masked with respect to treatment, also produced no significant difference in TBUT. When we measured TBUT with the lid raised so that it was not in contact with the cornea, there was no difference in TBUT for the group between the 'lifted' and 'non-lifted' eye; some subjects showed substantially shorter TBUT values, while others showed substantially longer TBUT values. These findings are surprising in view of the concerns expressed in the literature regarding the sensitivity of the tear film to mechanical interference, and suggest that the tear film is more resistant to disruption than has previously been thought.

New Australopithecus boisei calvaria from East Lake Turkana, Kenya

The calvaria of an adult Australopithecus boisei from Area 104, Koobi Fora, Lake Turkana, is described. The specimen, KNM-ER 23000, comes from sediments dated to about 1.9 Ma. It consists of the frontal, both parietals, both temporals, most of the occipital as well as two small pieces of sphenoid, and a mandibular tooth root. The specimen is presumed to be an adult male, based on its size and the great development of features associated with the masticatory apparatus. KNM-ER 23000 is close in general size and shape to KNM-ER 406, KNM-ER 13750, and Olduvai Hominid 5 and it has a mixture of features seen in these three roughly contemporaneous crania. The frontal, especially the tori, resembles that of OH 5; the parietals are most like those of KNM-ER 13750; the occipital is like those of the two other Turkana specimens, and the temporals have a mixture of features from all of these, This specimen adds to our knowledge of variability in A. boisei.

Decrease in stereoacuity in the seventh decade of life

We measured stereoacuity in 41 subjects with normal Snellen acuity in each eye, and normal ocular health. Patients were measured in each of the age ranges 21-28, 41-49, 51-59 and 60-70 years. Stereoacuity was reduced from about 16 sec arc for the three younger groups to about 27 sec arc for the older subjects. Since stereopsis has a cortical neural substrate, these data suggest that there may be cortical changes affecting the interaction of information from the two eyes with advancing age, but whether these changes result from loss of contrast sensitivity, instability of ocular alignment or binocular stress, all of which have been reported in elderly subjects, is not known.

Long-term reduction in sperm count after chemotherapy with and without radiation therapy for non-Hodgkin's lymphomas

PURPOSE

Treatment of lymphomas with combination chemotherapy with or without radiation therapy (XRT) can result in long-term or permanent azoospermia.

PATIENTS AND METHODS

Semen analyses of lymphoma patients were performed before, during, and after treatment with cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo) chemotherapy. Some of the patients also received other drugs or radiation therapy.

RESULTS

Although no patients were azoospermic before treatment, all were rendered azoospermic during treatment. Following the completion of treatment, the fraction of patients whose sperm counts recovered increased gradually over 5 years and plateaued by 7 years, with two thirds of the men achieving normospermic levels. Scattered gonadal radiation dose and cumulative cyclophosphamide dose were found to be independently significant determinants of recovery: the fraction of patients whose sperm counts recovered to 10 x 10(6)/mL were 83%, 47%, and 20% for those who received less than 9.5 g/m2 of cyclophosphamide, greater than 9.5 g/m2 of cyclophosphamide, and pelvic XRT, respectively. The inclusion of additional drugs and interferon alfa did not significantly affect the long-term recovery of spermatogenesis.

CONCLUSION

Pelvic XRT and cumulative cyclophosphamide dosages greater than 9.5 g/m2 are associated with a high risk of permanent sterility in lymphoma patients treated with the CHOP-Bleo regimen.