Rigid fixation of mandibular condyle fractures

This article reviews the anatomy and surgical approaches for treating fractures of the mandibular condyle with plate and screw fixation. Advantages and disadvantages of the preauricular, submandibular, intraoral, retromandibular, and rhytidectomy approaches are presented.

Affect and age: cross-sectional comparisons of Structure and prevalence

The self-reports of 207 young-adult (ages 18-30), 231 middle-aged (ages 31-59), and 828 older-adult (age 60 and over) Ss were used to study the structure of affect. Affects were represented by terms included in various circumplex arrays of emotions as presented by previous investigators. A set of 46 affects was subjected to exploratory analysis, and a final set of 38 affects was subjected to confirmatory factor analysis. The goodness of fit of each group's factor loadings to the hypothesized factors of positive affect, depression, anxiety-guilt, contentment, hostility, and shyness was not up to the desired .90 level, and some significant differences in factor structure were observed for each age-group comparison. There were few age differences in levels of positive affect. Depression was most frequent among younger Ss and least frequent among older Ss. Younger Ss were most often anxious and shy. Older Ss were most often content and least often hostile.

Conservation of mammalian secondary sperm receptor genes enables the promoter of the human gene to function in mouse oocytes

The human zona pellucida is an extracellular sheath composed of three major proteins (ZP1, ZP2, and ZP3) which surround the ovulated egg and mediate the initial interactions with sperm. Although fertilization is relatively species-specific and human sperm will not bind to mouse zona, there is a high degree of conservation between the coding regions of human ZP3 and mouse Zp-3 (the primary sperm receptor) genes. We now report the characterization of the human ZP2 gene and demonstrate that the sequences of its coding regions are 70% identical with those of the mouse Zp-2 (the secondary sperm receptor) gene. In addition, the first 300 bp of the 5' flanking regions of human ZP2 and mouse Zp-2 are highly conserved. This region of 5' flanking DNA contains a previously described 12-bp DNA sequence (element IV) that forms an oocyte-specific DNA-protein complex important for mouse Zp-2 and Zp-3 promoter activity. Human element IV forms a DNA-protein complex in gel mobility shift assays when incubated with human or mouse ovarian extracts. The formation of this complex is inhibited with molar excess of either human or mouse element IV sequences and is not present in extracts of testes, uterus, spleen, lung, or kidney. The human promoter region (0.3 kbp), coupled to a luciferase reporter gene and microinjected into the nuclei of 50-microns-diameter mouse oocytes, results in reporter gene activity at a level comparable to that of the homologous mouse promoter. Clustered point mutations in element IV in either the mouse or the human sequence dramatically decrease reporter gene activity. These results indicate that the similarity between mouse Zp-2 and human ZP2 genes enables the human promoter to utilize the heterologous transcription machinery in mouse oocytes. The observed transcription may involve the recognition of promoter sequences in element IV by conserved transcription factor(s).

A new approach to prenatal cystic fibrosis carrier screening

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Comprehensive discharge planning: a hospital-home healthcare partnership

Shorter hospital stays place new demands on the discharge planning process. A research study that evaluated discharge planning outcomes reveals a critical need for comprehensive discharge planning involving both hospital and home healthcare agencies.

The factorial generality of brief positive and negative affect measures

Confirmatory factor analysis was used to test the structure of 5-item affect rating scales designed to measure positive affect and negative affect. A proposed circumplex affect structure was the source of scales constructed to represent a cluster of positive terms, including pleasantness and activation; the negative terms represented anxiety, depression, and hostility. The hypothesized simple-structured positive and negative trait affect factors, with a moderate correlation between them, were found in all cases. Equivalent structure was confirmed for younger adults, middle-aged, and older adults of good health and above-average education. Although the hypothesized simple-structured positive and negative factors emerged for all other groups, three other tests of factor equivalence failed to be confirmed: trait and state factors in the older adult group were not identical. Factors derived from healthy and frail elders were structurally different. Variability among frail elders and variability over 30 days within the same person, when factored, also showed nonequivalence. Although the scales are extremely useful in assessing affect, comparisons across some subject groups should be made with caution.

Dimensions of affective experience in three age groups

The dimensions by which adults of differing ages experience emotion were studied by self-administering questionnaires administered to older adults (n = 828) recruited from Elderhostel programs, middle-aged (ages 30-59) children of Elderhostel attenders (n = 231), and young adult (ages 18-29) subjects recruited from college classes or through Elderhostel participants (n = 207). Elders were higher in emotional control, mood stability, and emotional maturity through moderation and leveling of positive affect and lower in surgency, psychophysiological responsiveness, and sensation seeking. These findings are consistent with the hypothesized increase in self-regulatory capacity with age. These cross-sectional differences cannot, however, be distinguished from cohort-related explanations; they require considerable replication across different types of subjects and further characterization of the dimensions in terms of their functions for self-regulation.

Recombinant mouse ZP3 inhibits sperm binding and induces the acrosome reaction

Mammalian fertilization involves interactions of sperm surface receptors with ligands of the zona pellucida, an extracellular matrix surrounding the ovulated egg. In mouse, the zona is composed of three glycoproteins. One of them, ZP3, participates in primary sperm binding and in the subsequent triggering of the sperm's acrosome reaction. Considerable evidence suggests that carbohydrate determinants of ZP3 are responsible for binding to sperm and may be important for acrosomal exocytosis. A full-length cDNA encoding mouse ZP3 was assembled and cloned into expression vectors that contained either a cytomegalovirus (CMV) or a vaccinia (P11) promoter. Mouse L-929 cells were stably transformed with the pZP3-CMV constructs, and green monkey CV-1 cells were infected with a recombinant vaccinia virus containing ZP3. rZP3 was affinity purified from culture media and detected on Western blots as a single 60- to 70-kDa band, which differed in molecular weight from native ZP3 (mean, 83 kDa). Nevertheless, rZP3 is biologically active. rZP3 decreases sperm-zona binding with a potency equivalent to that of native zona pellucida and, like native ZP3, rZP3 triggers acrosomal exocytosis in capacitated mouse sperm. Thus, rZP3 isolated from both rodent and primate cells appears to contain those carbohydrate and protein structures necessary for ZP3's dual role in fertilization.

Kabuki make-up (Niikawa-Kuroki) syndrome: a study of 16 non-Japanese cases

Kabuki make-up (Niikawa-Kuroki) syndrome has been described mainly in Japanese patients. In this paper we report sixteen new cases from Europe and North America, suggesting that Kabuki make-up syndrome may be more common outside of Japan than supposed. Their features are compared with those of the Japanese patients and most of our findings are similar to those previously reported. The facial phenotype is specific and easily recognizable, regardless of ethnic origin. Postnatal growth retardation and mild mental retardation are confirmed to be cardinal manifestations of the syndrome. Skeletal anomalies were present in all cases but most of the radiological changes were non-specific. The specificity of metacarpophalangeal pattern profile is not confirmed. Conversely, dermatoglyphic analysis is helpful in the diagnosis of this condition. Two differences have emerged between the Japanese patients and those in this study. Firstly, two-thirds of the patients in this series had significant neurological dysfunction other than mental retardation. Secondly, joint hypermobility appears more common in non-Japanese patients. Confirmation of these findings requires further studies.

Biology of mammalian fertilization: role of the zona pellucida

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Alcohol and smokeless tobacco effects on the CD-1 mouse fetus

Tobacco products and alcohol are commonly used as nonmedicinal drugs by pregnant women, and both are known to cause various effects on the fetus and the newborn. The objective of this study was to examine the fetal effects of both drugs when administered individually and simultaneously to pregnant CD-1 mice at moderate dosages. Specifically, we wanted to determine whether or not the effect on the fetus of these two biologically active substances was additive, ameliorative, or synergistic. A total of 65 CD-1 dams were divided among four groups receiving either ST equivalent to 8 mg/kg nicotine, ethanol (ETOH) 1.8 g/kg, a combination of ST+ETOH in the same dosages, or D-glucose (controls and ST alone) to supply calories equivalent to the dose of ethanol. Mice were dosed three times per day on gestational days 6-15. On gestational day 17 all dams were killed, fetal and placental weights recorded, and the number of resorbed, dead, and malformed fetuses noted. The mean maternal plasma drug levels were: nicotine-321 ng/ml and ethanol-0.105 g%. No significant differences were observed in maternal weight gain, litter size, or in the incidence of resorptions, deaths and/or malformations. Fetal weights were reduced in all three treatment groups (P less than 0.05), with the greatest reduction (13% decrease) recorded in the ST group, followed by a 9% decrease in the ETOH group, and a 7% decrease in the ST+ETOH group. Placentas of the ST group weighed significantly less (P less than 0.05) than controls. Ossification of the fetal skeleton, observed in ten sites, was affected to the greatest extent in the ST group, followed by the ETOH and ST+ETOH groups. Craniofacial measurements were significantly affected (P less than 0.05) in all three treatment groups, compared to controls. We conclude that under these experimental conditions, in terms of fetal growth and ossification, ST had the greatest effect, followed by ETOH and ST+ETOH. The interaction of ST+ETOH was neither additive, synergistic, nor ameliorative.

Autoimmune disease of the ovary induced by a ZP3 peptide from the mouse zona pellucida

We describe a novel experimental system in mice for the study of ovarian autoimmune disease, a condition encountered in women with premature ovarian failure. The ovarian autoimmune disease is induced in B6AF1 mice by a 15-amino acid peptide (Cys-Ser-Asn-Ser-Ser-Ser-Ser-Gln-Phe-Gln-Ile-His-Gly-Pro-Arg) from mouse ZP3, the sperm-binding component of the zona pellucida that surrounds growing and mature oocytes. Whereas the peptide induces both T cell and antibody responses, adoptive transfer of CD4+ T cell lines derived from affected animals causes oophoritis without observable antibodies to the zona pellucida peptide. The primacy of the T cell response in the pathogenesis of disease is further substantiated by defining oophoritogenic peptides as small as eight amino acids (Asn-Ser-Ser-Ser-Ser-Gln-Phe-Gln) that do not elicit an antibody response to the full-length ZP3 peptide. The identification of a well characterized peptide as a causative agent of autoimmune oophoritis should facilitate understanding of the pathogenesis of this T cell-mediated autoimmune disease. Because the proteins of the zona pellucida are conserved among mammals (the mouse and human ZP3 proteins are 67% identical), this murine model may lead to better understanding of the pathogenesis of human autoimmune oophoritis.

Dimensions of affective experience in three age groups

The dimensions by which adults of differing ages experience emotion were studied by self-administering questionnaires administered to older adults (n = 828) recruited from Elderhostel programs, middle-aged (ages 30-59) children of Elderhostel attenders (n = 231), and young adult (ages 18-29) subjects recruited from college classes or through Elderhostel participants (n = 207). Elders were higher in emotional control, mood stability, and emotional maturity through moderation and leveling of positive affect and lower in surgency, psychophysiological responsiveness, and sensation seeking. These findings are consistent with the hypothesized increase in self-regulatory capacity with age. These cross-sectional differences cannot, however, be distinguished from cohort-related explanations; they require considerable replication across different types of subjects and further characterization of the dimensions in terms of their functions for self-regulation.

Oocyte-specific factors bind a conserved upstream sequence required for mouse zona pellucida promoter activity

The zona pellucida of mouse oocytes, composed of three major glycoproteins (ZP1, ZP2, and ZP3), performs crucial functions at fertilization and in early development. The transcripts encoding mouse ZP2 and ZP3 are coordinately expressed and accumulate in oocytes during a 2-week growth phase prior to ovulation. The 5'-flanking regions of mouse Zp-2 and Zp-3 genes and their human homologs contain five short DNA sequences (4 to 12 bp) that are 60 to 100% identical and are approximately equidistant upstream of the TATAA box in the four genes. Mutation of these five elements (I, IIA, IIB, III, and IV) in Zp-luciferase constructs demonstrates that the 12-bp element IV, positioned approximately 200 bp upstream from the TATAA box, is necessary for high-level expression from the mouse Zp-2 and Zp-3 promoters after microinjection into the nuclei of 50-microns-diameter oocytes. Injection of minimal Zp-3 promoter constructs containing element IV in either orientation also resulted in high levels of reporter gene activity, suggesting that the element is not only necessary but also sufficient for expression from zona pellucida promoters. Oligonucleotides containing the conserved element from either Zp-2 or Zp-3 form DNA-protein complexes of identical mobility in gel retardation assays using extracts of oocytes but not other tissues. These data are consistent with the hypothesis that common factors binding to conserved element IV are involved in coordinate expression of the oocyte-specific Zp-2 and Zp-3 zona pellucida genes.

Antidepressant drug treatment in relation to the use of ECT

The adequacy of antidepressant treatment by psychiatrists prior to ECT was examined in a group of 95 patients. ECT was considered inevitable in 16 cases. Of the remainder, 41 patients had not been given adequate antidepressant treatment prior to ECT. Alternative drug strategies were seldom pursued after one drug had failed. Most patients were continued on a variety of psychotropic drugs during ECT. Subsequent outcome was poor, which may reflect difficulty in identifying an appropriate drug for continuation treatment after ECT.

Interplay between adrenaline and interbeat interval on ventricular repolarisation in intact heart in vivo

STUDY OBJECTIVE

The aim was to examine the hypothesis that an interaction between adrenaline and change in heart rate may alter the normal time sequence of ventricular repolarisation (and hence refractoriness) in a manner that (1) may favour arrhythmia formation, (2) may partly explain conflicting reports of the effect of adrenaline, ie, there are two opposing effects on action potential duration, and (3) be relevant to T wave abnormalities that sometimes occur in normal people.

DESIGN

As a measure of the time course of repolarisation, monophasic action potentials were recorded simultaneously from three epicardial sites in the porcine heart (left ventricular apex, left ventricular base, and mid right ventricle). During steady state pacing, test pulse intervals were interposed at progressively shorter intervals in order to construct restitution curves.

MEASUREMENTS AND MAIN RESULTS

Adrenaline infusion (0.4-1.5 micrograms.kg-1.min-1) resulted in earlier repolarisation in the beats after shorter interbeat intervals, and delayed repolarisation after longer interbeat intervals, tending to turn the restitution curve anticlockwise (ie, there were two opposing effects on action potential duration). The effects were not homogeneous between regions. To show this inhomogeneity, pairs of monophasic action potentials from different regions were subtracted using a differential input amplifier to produce an ECG like waveform at the amplifier output. The resulting T wave was thereby a measure of the time difference in repolarisation between the monophasic action potentials from which it was derived. The inhomogeneity of repolarisation induced by adrenaline and rate change was reflected in the morphology of this derived T wave, particularly at early (premature) beats. These T wave changes correlated closely with the true T wave changes in bipolar electrograms recorded between the same recording sites (R = 0.89; p less than 0.0001).

CONCLUSIONS

These results show that adrenaline altered the normal relationship between interbeat interval and the timing of repolarisation. The effect was not homogeneous and when regional differences were observed they were reflected in changes in T wave morphology. These were marked at short intervals. It is possible that in addition to increased excitability observed with adrenaline, a combination of raised sympathetic activity and early beats predisposes to arrhythmias by exaggerating dispersion of repolarisation.

Human homolog of the mouse sperm receptor

The human zona pellucida, composed of three glycoproteins (ZP1, ZP2, and ZP3), forms an extracellular matrix that surrounds ovulated eggs and mediates species-specific fertilization. The genes that code for at least two of the zona proteins (ZP2 and ZP3) cross-hybridize with other mammalian DNA. The recently characterized mouse sperm receptor gene (Zp-3) was used to isolate its human homolog. The human homolog spans approximately 18.3 kilobase pairs (kbp) (compared to 8.6 kbp for the mouse gene) and contains eight exons, the sizes of which are strictly conserved between the two species. Four short (8-15 bp) sequences within the first 250 bp of the 5' flanking region in the human Zp-3 homolog are also present upstream of mouse Zp-3. These elements may modulate oocyte-specific gene expression. By using the polymerase chain reaction, a full-length cDNA of human ZP3 was isolated from human ovarian poly(A)+ RNA and used to deduce the structure of human ZP3 mRNA. Certain features of the human and mouse ZP3 transcripts are conserved. Both have unusually short 5' and 3' untranslated regions, both contain a single open reading frame that is 74% identical, and both code for 424 amino acid polypeptides that are 67% the same. The similarity between the two proteins may define domains that are important in maintaining the structural integrity of the zona pellucida, while the differences may play a role in mediating the species-specific events of mammalian fertilization.

Defensive spray of the bombardier beetle: a biological pulse jet

The defensive spray of the bombardier beetle Stenaptinus insignis is ejected in quick pulses (at about 500 pulses per second) rather than as a continuous stream. The pulsation may be a consequence of intermittency in the explosive chemical process that generates the spray. The ejection system of the beetle shows basic similarity to the pulse jet propulsion mechanism of the German V-1 "buzz" bomb of World War II.

Oocyte-specific expression of mouse Zp-2: developmental regulation of the zona pellucida genes

The zona pellucida surrounds all mammalian oocytes and plays a vital role at fertilization and in early development. The genes that code for two of the mouse zona proteins (ZP2 and ZP3) represent a developmentally regulated set of genes whose expression serves as markers of mouse oocyte growth and differentiation. We previously characterized the single-copy Zp-3 gene and showed that its expression is oocyte specific and restricted to a narrow window of oocyte development. We now define the Zp-2 gene transcript and show that it is coordinately expressed with Zp-3 only during the 2-week growth phase of oogenesis that occurs prior to ovulation. Like Zp-3, the expression of Zp-2 is restricted to oocytes, and, although not detectable in resting oocytes, both ZP2 and ZP3 transcripts accumulate to become very abundant messengers in 50-microns-diameter oocytes. Ovulated eggs contain ZP2 and ZP3 transcripts which are 200 nucleotides shorter than those found in growing oocytes and have an abundance of less than 5% of the peak levels. In an attempt to understand the molecular details associated with the developmentally regulated, tissue-specific gene expression of the zona genes, the Zp-2 genetic locus has been characterized and its 5' flanking sequences have been compared with those of Zp-3. Both genes contain three short (8- to 12-base-pair) DNA sequences of 80 to 88% identity located within 250 base pairs of their transcription start sites.

Primary care residents and the management of hypercholesterolemia

A survey of primary care residents' attitudes, beliefs, and knowledge and a medical record audit were used to assess barriers to appropriate detection, identification, and management of hypercholesterolemia. Previous studies have focused on either self-reports or audits alone. This study compares survey results to recorded clinical performance. Family practice and internal medicine residents were compared to determine if previous findings were specialty-specific. The results of the survey indicate that, even prior to the publication of the National Cholesterol Education Program, residents demonstrated positive attitudes and appropriate knowledge of risk levels, in contrast with previous reports on practicing physicians. The medical record audit, however, showed that residents were not providing care that approximated their own recommendations for hypercholesterolemia management. Results of the survey and audit demonstrated little or no difference between specialty groups. The results indicated that training in management skills and reducing practice barriers are important to improve resident physicians' management of patients with hypercholesterolemia. The use of a survey and audit provide a useful needs assessment for designing educational programs.