Physiological tremor: does handedness make a difference?

The purpose of this study was to quantify with precision the characteristics of normal physiological tremor in the dominant and nondominant hand of a group of right-handed females. Twenty-two right-handed females (aged 20 to 40) gave informed consent to participate. Manual dominance determined with a questionnaire had to be equal to, or above 90%, for subjects to be accepted in the study. While the subjects kept their eyes closed, tremor was recorded simultaneously in the two extended index fingers during 40 s. Preceding the recording of postural tremor there was a period during which the subjects were asked to relax (control condition); to exert a pressure with the two index fingers on two strain gauges (static condition); or to press on and off with both index fingers on two strain gauges (dynamic condition). Each condition was recorded twice with two helium neon velocity lasers. This procedure was repeated after permutation of the lasers, thus a total of twelve sweeps of data were recorded. Seven parameters were used to analyze the tremor signal including measures of harmonicity, median frequency, proportional power in the 7-12 Hz range, amplitude, waveform morphology, entropy, and nonlinearity. Significant differences between hands were found in three parameters (median frequency, power in 7-12 Hz and entropy) but not in tremor amplitude (RMS). In addition, significant differences were found in five out of seven characteristics between conditions. These results suggest that neuromotor activity preceding the recording of tremor has a significant influence on tremor characteristics and that some of these characteristics are significantly different between the right and left hand in right-handed females.

Synthetic zeolites as amendments for sewage sludge-based compost

The effects of incorporating a synthetic zeolite (Zeolite P) in a range of concentrations (0.1-1.0 w:w) into an experimental horticultural compost, derived from sewage sludge, have been investigated. The impact of zeolite treatment on time-related changes of the labile zinc, copper, iron and manganese pools within the compost was compared to lime incorporation (5% w:w) and to a proprietary unamended peat-based compost. Addition of 0.5% and 1.0% zeolite significantly reduced labile zinc over a 90 day period. The highest zeolite treatment was more effective than liming; 0.5% zeolite was as effective as lime. Plant growth trials measuring transfer of metals to ryegrass (Lolium perenne L. cv Elka) in successive harvests demonstrated that both 1.0% zeolite and 5% lime treatment caused significant reduction in total metal transfer from soil-plant over a 116 day growth period. It is concluded that the use of synthetic zeolite as an amendment for compost of this type significantly reduces potential for soil metal mobility and soil-plant transfer.

Measurement of glycated haemoglobin in whole blood by a novel fluorescence quenching assay

We describe a method for the specific measurement of glycated Hb (GHb) by fluorescence quenching. Whole blood is added to lysing solution, then the lysate is mixed with eosin-boronic acid solution and reacted for at least 5 min at room temperature. The quenching of the fluorescence of the eosin-boronic acid solution is proportional to the concentration of GHb present. Total Hb concentration was measured by absorbance and the GHb expressed as a percentage of the total Hb. Comparison with a commercial high-performance liquid chromatography (HPLC) system for HbA1c showed: %GHb=1.30 (SD 0.04) %HbA1c + 1.36 (SD 0.30), S(y/x) 0.803, n=95, r=0.965 (SD=standard deviation). Intra-assay coefficients of variation were <2.5% (for GHb concentrations in the range 6-20%) and inter-assay coefficients of variation were <4.1% (10 assays on six samples with GHb concentrations in the range 6-20%). Linearity of response was demonstrated by dilution. The effect of adding exogenous glucose, bilirubin and triglycerides was tested on samples with low, medium and high GHb concentrations. No significant interference was found. Variation of haematocrit over the range 0.4-0.6 also had no significant effect on percentage GHb. Preliminary results with samples containing variant Hb (HbAS and HbAC) indicated good agreement with HPLC for these samples also.

Single blind, randomised trial of efficacy and acceptability of oral picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening

OBJECTIVE

To compare the acceptability and efficacy of two methods of self administered bowel preparation for flexible sigmoidoscopy screening: a single phosphate enema and a single sachet of Picolax.

DESIGN

Single blind, randomised trial.

SETTING

Endoscopy units of two general hospitals.

PARTICIPANTS

1442 men and women aged 55-64 years who had agreed to be screened by flexible sigmoidoscopy. MAIN OUTCOME MESURESs: Attendance rates, compliance with allocated preparations, adverse effects, quality of bowel preparation, procedure time, and yield of neoplasia.

RESULTS

Compliance with the enema was higher than with the Picolax (608 (84%) v 566 (79%); difference 6%, 95% confidence interval 2% to 10%). Almost half of those who refused Picolax used an enema at home. Wind, incontinence, and sleep disturbance were more frequent in the Picolax group than the enema group; bottom soreness was more frequent in the enema group. Around 30% (187) found the diet restriction required by Picolax difficult; 78% (471) found the enema easy to administer. The quality of preparation was better with the enema; the proportion of procedures complete to the descending colon was greater and the mean duration of the procedure was shorter. There was no significant difference in polyp detection rates.

CONCLUSION

A single phosphate enema self administered around one hour before leaving home is a more acceptable and effective method of preparing the distal bowel for flexible sigmoidoscopy than Picolax.

Neuromotor profiles: what are they and what can we learn from them?

Eye movements, alternating movements, rapid pointing movements, and various tremors were measured on patients with Parkinson's disease (n = 21), on Cree subjects exposed to methylmercury (n = 36), and on healthy control subjects (n = 30). Neuromotor profiles were created according to thirty characteristics extracted from test results of four subgroups matched for age and composed of six subjects each. Z scores were calculated with respect to the mean and standard deviation of the control group for each of the 30 characteristics. The subgroup with the lower methylmercury blood level had larger z scores than the control subgroup and with a few positive values above one standard deviation. The subgroup with the higher methylmercury blood level had several z scores above two standard deviations. Interestingly, the abnormal values for the subgroup with Parkinson's disease were mostly limited to static tremor recorded with no visual feedback and reached up to 5 standard deviations. These results indicate that neuromotor profiles can be used to summarize information extracted from different neuromotor tests and to differentiate neurological conditions.

A phase I/II study of hypofractionated whole abdominal radiation therapy in patients with chemoresistant ovarian carcinoma: Karnofsky score determines treatment outcome

PURPOSE

Radiation therapy can provide useful palliation in chemorefractory ovarian cancer patients. The purpose of this study was to prospectively study the palliative effect of a hypofractionated radiation treatment regimen. Change in quality-of-life scores (Functional Assessment of Cancer Therapy [FACT], Karnofsky scale), pain score, and tolerance to therapy were also assessed.

METHODS AND MATERIALS

A single-institution Phase I/II trial was initiated in patients with chemoresistant recurrent or progressive ovarian cancer. All patients had symptomatic and measurable intra-abdominal disease. Patients were treated with a single radiation fraction (700 cGy) or two fractions (300 cGy twice a day) to the whole abdomen over 1 day. Quality-of-life scale (FACT G version 2) was assessed at baseline and 1 and 3 months following treatment. Karnofsky scale and pain score were also evaluated in the same time frame.

RESULTS

Sixteen patients were prospectively entered into this protocol between February 1996 and September 1998. Twelve patients received a single 700 cGy fraction and four 300 cGy twice a day. All were heavily pretreated and 9 (56%) had a poor performance status prior to treatment. Symptoms needing palliation included pain (14), ascites (10), and bleeding (2). Symptomatic improvement occurred in all patients with pain (5 complete response [CR] and 7 partial response [PR], all patients with bleeding (CR 2), and two (20%) with ascites. Five patients (31%) had a reduction in lesion size documented radiologically in three. The mean duration of response was 22 weeks in patients with a Karnofsky score >70. Thirteen patients developed transient nausea and vomiting which resolved in 48 hours in all. All patients developed a transient lymphopenia. Thirteen patients completed a follow-up quality-of-life scale. There was an improvement in the physical and functional components of the scale in patients with Karnofsky score of 90-100. There was no improvement in quality of life in patients with Karnofsky score <90 despite symptomatic response. Median survival was 3 months from the date of treatment.

CONCLUSION

Hypofractionated radiation therapy is an effective palliative treatment for end-stage ovarian cancer patients. Karnofsky score can help determine the duration of response and survival for this high-risk population.

A reliable non-separation fluorescence quenching assay for total glycated serum protein: a simple alternative to nitroblue tetrazolium reduction

A simple non-separation assay for the measurement of total glycated serum protein is described. It was found that the fluorescence intensity of a solution of a fluorescein-boronic acid derivative was quenched in proportion to the amount of serum added. This led to the development of an assay in which 10 microL of serum is added to 4 mL of a solution of the fluorescein-boronic acid derivative and the fluorescence intensity is measured after 15 min. The results, as measured by drop in fluorescence intensity, calibrated by a single standard, were compared with the results for nitroblue tetrazolium (NBT) reduction of fructosamine and showed good correlation (r=0.936, n=114). The intra-assay precision (seven samples each measured 10 times) was less than 2.1% (concentration range 190-660 micromol/L); inter-assay precision for seven samples in 10 assays was less than 2.5% (over the same concentration range). Dilution of serum that had a high concentration of total glycated protein showed the assay to be linear. Serum samples (with low, medium and high total glycated protein concentrations) showed less than 2.1% difference from base results with added glucose (up to 60 mmol/L), less than 9.7% difference with added bilirubin (up to 250 micromol/L) and less than 6.9% with added triglycerides (up to 50 mmol/L). Addition of haemoglobin (up to 0.9 g/dL) with high glycation (11.7% HbA1c) to plasma (298 micromol/L total glycated protein) showed less than 10% difference from the base result. Assays performed over a range of temperatures (12-34 degrees C) showed no significant differences in the results. The assay gives similar results to the currently used NTB method but with significantly less susceptibility to interferences. As such the method should be a useful aid in the management of diabetes.

Plant glutathione S-transferases: enzymes with multiple functions in sickness and in health

Glutathione S-transferases (GSTs) are abundant proteins encoded by a highly divergent, ancient gene family. Soluble GSTs form dimers, each subunit of which contains active sites that bind glutathione and hydrophobic ligands. Plant GSTs attach glutathione to electrophilic xenobiotics, which tags them for vacuolar sequestration. The role of GSTs in metabolism is unclear, although their complex regulation by environmental stimuli implies that they have important protective functions. Recent studies show that GSTs catalyse glutathione-depend-ent isomerizations and the reduction of toxic organic hydroperoxides. GSTs might also have non-catalytic roles as carriers for phytochemicals.

Sex-specific effects of pain-related anxiety on adjustment to chronic pain

OBJECTIVE

Considerable research indicates that both high levels of anxiety and female sex are associated with increased sensitivity to experimental pain and greater experience of clinical pain. In general, however, previous research has not investigated the joint effects of sex and anxiety on pain responses. A single previous laboratory-based study indicated that anxiety was inversely related to pain thresholds among men but not among women. The present study examined the relation between pain-related anxiety and adjustment to chronic pain in a sex-dependent manner.

DESIGN AND SETTING

A total of 215 (114 women, 101 men) chronic pain patients referred to a multidisciplinary treatment center completed questionnaires assessing anxiety and adjustment to chronic pain.

RESULTS

Results generally supported the previous laboratory-based finding indicating that an inverse relation between anxiety and adjustment to chronic pain was present only among male patients. Although male patients with high pain-related anxiety reported greater pain severity, greater interference of pain, and lower levels of daily activity than male patients with low anxiety, this effect was not present among female patients. Moreover, the effects of pain-related anxiety on adjustment to chronic pain were not attributable to either hypervigilance or use of passive coping strategies. Potential explanations and implications for the present findings are discussed.

Cloning and characterization of glyoxalase I from soybean

Glyoxalase I and glutathione transferase (GST) are two glutathione-dependent enzymes which are enhanced in plants during cell division and in response to diverse stress treatments. In soybean, a further connection between these two enzymes has been suggested by a clone (Accession No. X68819) resembling a GST being described as a glyoxalase I. To characterize glyoxalase I in soybean, GmGlyox I resembling the dimeric enzyme from animals has been cloned from a cDNA library prepared from soybean suspension cultures. When expressed in Escherichia coli, GmGlyox I was found to be a 38-kDa dimer composed of 21-kDa subunits and unlike the enzyme from mammals showed activity in the absence of metal ions. GmGlyox I was active toward the hemithioacetal adducts formed by reacting methylglyoxal, or phenylglyoxal, with glutathione, homoglutathione, or gamma-glutamylcysteine, showing no preference for homoglutathione adducts over glutathione adducts, even though homoglutathione is the dominant thiol in soybean. When the clone X68819 was expressed in E. coli, the respective recombinant enzyme was active as a GST rather than a glyoxalase and was termed GmGST 3. GmGST 3 was active as a homodimer (45 kDa) composed of 26-kDa subunits and showed a preference for glutathione over homoglutathione when conjugating 1-chloro-2,4-dinitrobenzene. Both enzymes are associated with cell division in soybean cultures, but GmGST 3 (0.4% total protein) was 40 times more abundant than GmGlyox I (0.01%).

Hypertension prevalence and care in an urban and rural area of Tanzania

OBJECTIVE

To describe the prevalence, detection, treatment and control of hypertension in an urban and rural area of Tanzania.

DESIGN

Two linked cross-sectional population-based surveys.

SETTING

A middle-income urban district of Dar es Salaam (Ilala) and a village in the relatively prosperous rural area of Kilimanjaro (Shari).

PARTICIPANTS

Seven hundred and seventy adults (> 15 years) in Ilala and 928 adults in Shari were studied.

RESULTS

Hypertension prevalence (blood pressure > or = 140 and/or 90 mmHg, or known hypertensives receiving anti-hypertensive treatment) was 30% (95% confidence interval, 25.1-34.9%) in men and 28.6% (24.3-32.9%) in women in Ilala, and 32.2% (27.7-36.7%) in men and 31.5% (27.8-35.2%) in women in Shari. Age-standardized hypertension (to the New World Population) prevalence was 37.3% (32.2-42.5%) among men and 39.1% (34.2-44.0%) in women in Ilala, and 26.3% (22.4-30.4%) in men and 27.4% (24A-30.4%) in women in Shari. In both areas, just under 20% of hypertensive subjects were aware of their diagnosis, approximately 10% reported receiving treatment and less than 1% were controlled (blood pressure < 140/90 mmHg). Hypertensive subjects were older, had greater body mass indices and waist: hip ratios, and had more risk factors for hypertension and its complications (smoking, heavy alcohol consumption, physical inactivity, obesity and diabetes) than non-hypertensives.

CONCLUSIONS

There is a high prevalence of hypertension in rural and urban areas of Tanzania, with low levels of detection, treatment and control. This demonstrates the need for cost-effective strategies for primary prevention, detection and treatment of hypertension and the growing public health challenge of non-communicable diseases in Sub-Saharan Africa.

A controlled trial of substrate-enhanced, warm reperfusion ("hot shot") versus simple reperfusion

BACKGROUND

Modified reperfusion after aortic cross-clamping is claimed to reduce myocardial injury, thus improving postoperative myocardial performance.

METHODS

We measured perioperative release of creatine kinase-MB and troponin-T in 40 patients undergoing valve replacement (combined with coronary grafts in 12 cases) to determine whether infusion of a modified reperfusate before cross-clamp removal reduced myocardial injury. Patients were randomly allocated to one of two groups with minimization for age, surgeon, operation, and ventricular function. The control group received unmodified reperfusion, while the study group received a normothermic reperfusate, enhanced with glutamate and aspartate, for 5 minutes before removal of the cross-clamp. Serial determinations of troponin-T, creatine kinase-MB isoforms, and total creatine kinase-MB activity were made up to 5 days postoperatively. Requirements for inotropic support and evidence of myocardial infarction were documented.

RESULTS

Creatine kinase-MB activity, creatine kinase-MB isoforms, and troponin-T were not significantly different between the two groups. There were no differences in the incidence of postoperative myocardial infarction or in inotrope requirement.

CONCLUSIONS

Our study did not demonstrate any advantage in using modified reperfusion in this group of patients.

Using time domain characteristics to discriminate physiologic and parkinsonian tremors

Tremor amplitude and frequency do not always clearly differentiate subjects with particular pathologies from control subjects or from subjects with other pathologies, especially in early stages of a disease. For patients with early stages of Parkinson's disease (PD) the discriminative power of amplitude was compared with that of other time domain characteristics of tremor recordings that are probably not evident clinically. Postural tremor with and without visual feedback and rest tremor were recorded in both hands of a group of patients with Parkinson's disease (n = 21) and a group of healthy control subjects (n = 30) using displacement lasers. Velocity and acceleration data were derived from displacement data. Twelve time domain characteristics were calculated on each recording and the discriminating power of each was evaluated using the worse hand in each case. Postural tremor with no visual feedback separates the two groups of subjects most efficiently, especially in velocity and acceleration. Tremor in Parkinson's disease (in comparison to normal physiologic tremor) has a specific morphology, has a distinctive histogram, is more periodic, and contains indications of nonlinearity in the underlying dynamics. There may also be greater difference in amplitude between the two hands and time asymmetry in tremor of patients with PD. A series of finger flexions seems to enhance normal tremor but not tremor in PD and may thus aid in discrimination. Discrimination of tremor attributable to PD from normal physiologic tremor can be enhanced by measuring time domain characteristics subtler than amplitude, particularly when amplitude itself is not large. Tremor measurement should not be limited to acceleration data because some information is more visible in other variables.

Nonmetallic fixation in elective maxillofacial surgery

Resorbable fixation technology offers several benefits, including easily cut and shaped plates, strong and predictable resorption qualities, and improved patient acceptance and expectations. Moreover, resorbable fixation implants can be completely reabsorbed into the body, eliminating the need for subsequent removal. This article describes the use of this innovative technology in orthognathic surgery, including preoperative and postoperative patient needs, intraoperative patient care, and potential complications.

Indicators that count! Measuring population health at the community level

We begin with a discussion of some vitally important conceptual and methodological issues. These issues concern our understanding of community, of health, of population health and its determinants, of the concept of 'measurement' and the values that underlie it, and our reasons for wishing to measure these constructs. We then present a framework for indicator categories, propose some criteria for indicator selection and suggest an initial set of core indicators. This indicator set reflects not simply health status--no matter how broadly defined--but also the environmental, social and economic determinants of health and the "healthfulness" of the community itself. Our most important conclusion is that if the information that is contained in the data of the indicator set is to be transformed into knowledge that can empower and emancipate the community, it has to be developed in consultation with the local community and local users of the information.

The measurement of tremor using a velocity transducer: comparison to simultaneous recordings using transducers of displacement, acceleration and muscle activity

Precise kinematic measurements of tremor have historically been obtained using accelerometers. However, current technology permits precise measurements in velocity and displacement. The primary advantage of velocity recording is that only one step of integration or differentiation is required for either displacement or acceleration. A method is presented of measuring finger tremor using a laser system that transduces velocity precisely. Measurements of postural finger tremor thus obtained were compared to those simultaneously obtained from a laser system that transduces displacement, from an accelerometer and from surface electromyography (EMG) of the extensor digitorum communis. A range of amplitude and frequency content was obtained by testing control subjects and subjects with Parkinson's disease. The velocity transducer showed excellent correspondence of amplitude and frequency measurement with the displacement transducer. Measures of absolute and relative amplitude correlated well (r > or = 0.96 in amplitude measures in displacement, velocity and acceleration), and high coherence was found throughout the frequency range of interest. Measurements by the accelerometer generally showed poorer correspondence with those of the other instruments. EMG measurements showed good correspondence in some trials but poorer correspondence in others, attributed to the low level of muscle activity required in the task. Precise kinematic measurements appear to be highly sensitive to neuromotor impairment.

Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome: a pilot study

This study investigated possible associations between perfectionistic personality traits, mood, and fatigue in chronic fatigue syndrome (CFS). Forty CFS sufferers referred to tertiary care and 31 control healthy subjects completed the Multidimensional Perfectionism Scale (MPS), Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression (HAD) scale. Total perfectionism scores did not correlate with fatigue, anxiety, or depression in either group. Other-oriented MPS scores were significantly lower among CFS sufferers (p = .0019), especially women, and correlated negatively with physical fatigue levels overall (R = -0.27, p = .02). Total and socially prescribed MPS scores correlated with age for the CFS group alone (p = .05). Possible reasons why this study did not confirm a positive association between perfectionism and CFS are discussed. The finding that CFS sufferers set lower standards and have lower expectations for significant others may have implications for rehabilitation and recovery from this disorder.

Using frequency domain characteristics to discriminate physiologic and parkinsonian tremors

The manner in which characteristics of time series in the frequency domain can enhance discrimination between physiologic and parkinsonian tremor when tremor amplitude is low was examined. Rest tremor and postural tremor with and without visual feedback were recorded twice in the two hands of a group of patients with Parkinson's disease (PD) (n = 21) and a group of healthy control subjects (n = 30) using displacement laser systems. Recordings were analyzed quantitatively using amplitude and seven frequency domain characteristics. Postural tremor with no visual feedback allowed the most efficient discrimination between the two groups of subjects especially in velocity and acceleration (derived from displacement) and allowed identification of more patients with PD as separate from the range observed in the control group. Moreover, the frequency domain characteristics that were investigated identified the majority of the patients even when amplitude did not. After eliminating redundant (correlated) characteristics, it was found that the frequency composition of tremor in PD can be described adequately with four characteristics, which are the most reliable, independent, and discriminative elements for detecting early or subtle modifications in tremor. Also, a series of finger flexions was found to enhance physiologic tremor but not tremor in PD. Discrimination of low-amplitude tremor in PD from normal physiologic tremor is enhanced by examining the median frequency of oscillations, the concentration of power in the power spectrum, and the distribution of power in particular ranges. Tremor measurement should not be limited to acceleration data as some information is more visible in velocity time series.

Individuals from North America, Australasia, and Africa are infected with four different genotypes of human herpesvirus 8

To study human herpesvirus 8 (HHV-8) transmission between individuals and in populations, we developed a system for genetic fingerprinting of HHV-8 strains based on variation in the HHV-8 K1, glycoprotein B (gB), and glycoprotein H (gH) genes. Using this system, we sequenced nearly the entire K1 gene (840 bp); two segments of the gB gene (open reading frame 8), totaling 813 bp; and a 702-bp segment of the gH gene (open reading frame 22) from blood and tissue samples obtained from 40 human immunodeficiency virus-infected and noninfected individuals, including those with Kaposi's sarcoma, primary effusion lymphoma, or Castleman's disease. The specimen collection was assembled from individuals living in diverse geographical locations, including the United States, Australia, New Zealand, Uganda, and Zambia. As reported by others, K1 was the most variable gene, with up to 16% variation at the nucleotide sequence level and up to 32% variation at the amino acid sequence level. Despite this extensive sequence variation, the K1 amino acid sequence contained 14 conserved cysteine sites, suggesting a conserved tertiary structure. gB and gH sequences were highly conserved, in most cases differing by <0.6% in pairwise comparisons. K1 was the most useful gene for strain discrimination, but the other genes enabled the discrimination of strains with identical K1 sequences. Individuals from diverse geographic locations were infected with four different HHV-8 genotypes; strains did not strictly segregate by continent of origin. The majority of HHV-8 strains from the United States and Europe were relatively closely related, whereas some strains identified from Uganda and Australia were phylogenetically distant. Genotype I strains were the most common and were found on three continents. Identical sequences were found in specimens obtained from different body sites and at different times from the same individual.