Progressive dural venous sinus thrombosis treated with local streptokinase infusion

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Impact of sexual and nonsexual assault on secondary victims

Much information has been collected on the effects of crime upon victims. Experts have spoken as well about the ripple effects of crime on those close to victims. To date, however, little empirical data are available to assess the impact of crime upon "secondary victims." Our research looks at the effects of crime on a sample of persons named by victims of sexual and nonsexual assault as their primary significant others (SOs). We found that distress experienced by SOs did not vary according to victim distress or according to whether the crime was a sexual or nonsexual assault. Female SOs, however, experienced greater fear of crime than male SOs. High levels of SO distress did not interfere with the ability of SOs to lend supportive actions, but were associated with higher levels of SO unsupportive behavior. Higher levels of unsupportive behavior were also more likely among SOs of sexual assault victims than among SOs of nonsexual assault victims. Clinical implications of the findings are discussed.

C1q binding properties of monomer and polymer forms of mouse IgM mu-chain variants. Pro544Gly and Pro434Ala

The effect of replacing proline with alanine at position 434 in the C mu 3 domain (P434A) and with glycine at position 544 in the C mu 4 domain (P544G) of the mu-chain of mouse IgM has been studied. The P434A substitution results in the loss of measurable complement-mediated cytolytic activity (CML) and a decrease in the association rate constant at low ionic strength (mu = 0.06), that results in a diminished Ka for C1q binding to P434A IgM bound to haptenated cells (0.4 x 10(9) M-1). Binding of C1(qr2s2) could not be detected. In contrast, replacement of proline at 544 had no measurable effect on the cytolytic or C1q/C1 binding properties of the polymeric molecule, supporting the view that the C mu 3 domain is important in C1q binding and CML. The secreted monomeric subunit of P544G was not able to mediate CML. Also, whereas hapten-bound P544G polymer bound C1q with a functional affinity of 1.5 x 10(9) M-1 at low ionic strength (mu = 0.06), similar to that observed with wild-type polymer (1.7 x 10(9) M-1) and wild-type IgG monomer (4.7 x 10(9) M-1), no C1q binding was detected with the P544G IgM monomer. This could not be attributed to differences in glycosylation. Inasmuch as the P544G mutation per se had no effect on the C1q binding properties of the polymer, we conclude that unlike IgG, aggregation does not sufficiently enhance the avidity of IgM monomer to enable it to activate complement. Augmentation of the site must occur during polymerization or when the IgM binds to Ag.

C1q binding properties of monomer and polymer forms of mouse IgM mu-chain variants. Pro544Gly and Pro434Ala

The effect of replacing proline with alanine at position 434 in the C mu 3 domain (P434A) and with glycine at position 544 in the C mu 4 domain (P544G) of the mu-chain of mouse IgM has been studied. The P434A substitution results in the loss of measurable complement-mediated cytolytic activity (CML) and a decrease in the association rate constant at low ionic strength (mu = 0.06), that results in a diminished Ka for C1q binding to P434A IgM bound to haptenated cells (0.4 x 10(9) M-1). Binding of C1(qr2s2) could not be detected. In contrast, replacement of proline at 544 had no measurable effect on the cytolytic or C1q/C1 binding properties of the polymeric molecule, supporting the view that the C mu 3 domain is important in C1q binding and CML. The secreted monomeric subunit of P544G was not able to mediate CML. Also, whereas hapten-bound P544G polymer bound C1q with a functional affinity of 1.5 x 10(9) M-1 at low ionic strength (mu = 0.06), similar to that observed with wild-type polymer (1.7 x 10(9) M-1) and wild-type IgG monomer (4.7 x 10(9) M-1), no C1q binding was detected with the P544G IgM monomer. This could not be attributed to differences in glycosylation. Inasmuch as the P544G mutation per se had no effect on the C1q binding properties of the polymer, we conclude that unlike IgG, aggregation does not sufficiently enhance the avidity of IgM monomer to enable it to activate complement. Augmentation of the site must occur during polymerization or when the IgM binds to Ag.

Haloperidol-induced morphological changes in striatum are associated with glutamate synapses

Sub-chronic treatment with the typical neuroleptic, haloperidol (0.5 mg/kg/d, s.c.), but not the atypical neuroleptic, clozapine (35 mg/kg/day, s.c.), causes an increase in synapses containing a perforated postsynaptic density (referred to as 'perforated' synapses) and in dopamine (DA) D2 receptors within the caudate nucleus [46]. To determine if these perforated synapses are glutamatergic, we systemically co-administered MK-801 (0.3 mg/kg/day for 2 weeks), a non-competitive antagonist at the N-methyl-D-aspartate (NMDA) receptor-associated ion channel, and haloperidol. MK-801 blocked the haloperidol-induced increase in striatal perforated synapses, but not the haloperidol-induced increase in DA D2 receptors. Injection of MK-801 into the striatum also attenuated the haloperidol-induced increase in perforated synapses. Post-embedding immuno-gold electron microscopy using antibodies to glutamate indicated that the gold particles were localized within striatal presynaptic nerve terminals that make contact with perforated postsynaptic densities. These findings support the hypothesis that the haloperidol-induced increase in perforated synapses is regulated by the NMDA subtype of excitatory glutamate receptor. The increase in perforated synapses following administration of haloperidol, which is associated with a high incidence of extrapyramidal side effects (EPS), and the lack of a synaptic change following administration of clozapine, known to have a low frequency of EPS, suggests that glutamate synapses play a role in the motoric side effects that are observed with typical neuroleptic drug treatment.

Validating the GDS depression screen in the nursing home

OBJECTIVE

The GDS (Geriatric Depression Scale) has demonstrated validity among ambulatory elderly but is less useful in nursing home (NH) populations, probably because of high rates of cognitive impairment. We, therefore, sought the lowest level of Mini-Mental Status Exam (MMSE) score for which the GDS would remain valid.

DESIGN

Validation Study.

SETTING

Nursing Homes in New York City.

PARTICIPANTS

A total of 66 of 168 newly admitted residents to the NH were able to complete psychiatric assessment, undergo an MMSE, and complete the GDS. The psychiatrists and testers (all non-MDs) were blinded to each others' results. Using a cutoff of 10 or greater on the GDS to indicate depression, the GDS's validity (when compared with the psychiatric diagnoses) was sought at ever decreasing levels of cognitive function as measured by the MMSE.

RESULTS

The results of all participants (n = 66) revealed a sensitivity of 63% and a specificity of 83%. When only those with an MMSE score > or = 15 (the best cutoff score) were included, 44 (64%) participants were selected, with a sensitivity and specificity of 84% and 91%, respectively.

CONCLUSIONS

The two-step procedure of first selecting those with MMSE scores > or = 15 and then giving the GDS significantly increases the utility of the GDS in detecting depression in NH residents and should improve the diagnostic process for this widely underdetected problem.

Reaction to injury following balloon angioplasty and intravascular stent placement in the canine femoral artery

Intravascular stents are used clinically as an adjunct to coronary and iliac angioplasty. This study was performed to evaluate the thrombogenicity and intimal hyperplasia incited by stents deployed in non-injured and in balloon-injured femoral arteries in the canine model. Medinvent stents (4 mm) were placed in the femoral arteries bilaterally in five mongrel dogs via cut down. This was preceded by balloon catheter angioplasty of the stent site on one side. Platelet deposition was measured at 30, 60, and 90 minutes and at 24 and 48 hours after stent placement, using gamma camera imaging of Indium111 platelets. The animals were killed after 2 months using a pressure perfusion technique, and the stents harvested. All vessels were patent at the time of harvest. Neointimal thickness was measured by computer image analysis. Platelet deposition was significantly increased on the angioplastied side compared to the non-angioplastied side at 60 minutes (5.67 x 10(9) +/- 1.4 versus 2.17 x 10(9) +/- 0.5 platelets/cm; P < 0.05), at 90 minutes (8.13 x 10(9) +/- 1.8 versus 2.33 x 10(9) +/- 0.6 platelets/cm; P < 0.05), and at 24 hours (stent-to-blood ratio = 15.86 +/- 6.3 versus 3.75 +/- 1.5; P < 0.05). Neointimal thickness was also significantly greater on the side of combined angioplasty and stent placement (0.45 +/- 0.21 mm versus 0.33 +/- 0.09 mm; P < 0.05). These results demonstrate that placement of intravascular stents in normal arteries is associated with a certain degree of thrombogenicity and formation of neointimal hyperplasia. Combining balloon angioplasty with stent placement significantly augments both thrombogenicity and production of intimal hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability and construct validity of a structured technical skills assessment form

Current methods of evaluating technical competence of surgical residents are subjective and potentially unreliable. This study assesses the reliability and construct validity of a new format for the assessment of technical ability, the two part Structured Technical Skills Assessment Form (STSAF). Part I, which is completed while an operation is proceeding consists of approximately 120 essential components of the procedure. Part II, completed at the end of the operation, is a 10-point global rating form. Forty-one operations were evaluated using the STSAF, with multiple observers present at 26. Inter-rater reliability of both Parts I and II were high (.78 and .73, respectively). Statistically significant differences were noted between senior-resident and junior-resident performances, suggesting construct validity. The incorporation of structured guidelines to the assessment of technical skill leads to high inter-rater reliability and construct validity, which ultimately may result in improved and reproducible evaluations of surgical trainees.

The carrot secreted glycoprotein gene EP1 is expressed in the epidermis and has sequence homology to Brassica S-locus glycoproteins

Non-embryogenic carrot suspension cells secrete the EP1 glycoprotein. A cDNA clone encoding EP1 was isolated and sequenced. The EP1 sequence revealed a region of homology with Brassica S-locus glycoprotein genes, an Arabidopsis S-like gene and putative S-like receptor protein kinases from maize and Arabidopsis. EP1 gene expression, analysed by in situ mRNA localization, was detected in cells located at the surface of the seedling: in the epidermis of the root, the hypocotyl and the cotyledons, in the root cap, and in a crescent of cells in the apical dome of the shoot. In developing seeds, expression was most pronounced in both the inner and outer integument epidermis.

Workstation robotics: a pilot study of a Desktop Vocational Assistant Robot

Rehabilitation robots are increasingly being viewed as an appropriate assistive technology interface for persons with disabilities. The Desktop Vocational Assistant Robot (DeVAR) system is a voice-controlled robotic workstation designed to enable persons with severe mobility impairments to function independently in a work environment. This study examined the overall efficacy of the DeVAR system, the level of expertise required for therapist and support personnel, routine maintenance requirements, and the readiness of the device for a multicenter evaluation. Two precommercial DeVAR workstations were installed at selected sites. The pilot study spanned 8 months in which staff members and four subjects with high-level quadriplegia evaluated the systems extensively. Responses were generally favorable regarding ease of use and overall training process. Subjects recommended modifications, including incorporation of a noise cancellation microphone, more effective use of workstation space, and addition of vocational tasks. All respondents thought that if the recommended changes were implemented, DeVAR would have potential as a vocational assistant. The small number of subjects was due to the limited subject pool available for the study. On the basis of pilot results, the Veterans Administration Rehabilitation Research and Development Service, Baltimore, Maryland, is conducting a national multicenter evaluation to determine the overall utility and commercial readiness of the DeVAR system.

Influence of homelessness on acute admissions to hospital

The aim of this study was to look at the influence of homelessness on acute medical admissions. A prospective case-controlled study was therefore performed on all homeless children admitted through the accident and emergency department over one year, comparing them with the next age matched admission from permanent housing. Assessments made were: whether homelessness or other social factors influenced the doctors' decision to admit; differences in severity of illness; length of stay; and use of primary care. The admitting doctors completed a semi-structured questionnaire during admission about social factors that influenced their decision to admit and graded the severity of the child's illness. The length of hospital stay was recorded. The family's social risk factors and accommodation were assessed at a home visit using a standardised questionnaire and by observation. Seventy homeless children were admitted. Social factors influenced the decision to admit in 77% of homeless children and 43% of controls. More of the homeless children were only mildly ill (33/70) than those from permanent housing (21/70), although three of the homeless children died of overwhelming infections compared with none of the controls. Among homeless families many were recent immigrants (44%). There was a marked increase in socioeconomic deprivation, in major life events in the previous year (median score 3 v 1), and in maternal depression (27% v 8%). Referral to the hospital was made by a general practitioner in only 5/50 (10%) of homeless compared with 18/50 (36%) of controls. Social factors were an important influence on the decision to admit in over three quarters of the homeless children and resulted in admission when less severely ill even when compared with admissions from an inner city population. Even though there was marked social deprivation among the homeless families, the decision to admit was based on vague criteria that need to be further refined.

Energy distribution in the spectrograms of the cries of normal and birth asphyxiated infants

This paper describes the distribution of energy and energy variance with frequency in the cries of normal and birth asphyxiated infants recorded within eight days of delivery. Single-variable statistical analysis suggested that asphyxiated infants have their cries shifted up in frequency compared to control infants, up to a frequency of 10 kHz.

Time-frequency analysis of infant cry: measures that identify individuals

As part of a larger study designed to test the predictive power of recordings of infant cry for neurological development at a year of age, we have developed a summary measure of a cry which shows a very high consistency within an individual. This measure may be useful in making assessments of anatomical structure in the infant vocal tract.

Factors affecting uptake of measles, mumps, and rubella immunisation

OBJECTIVE

To study factors affecting uptake of measles, mumps, and rubella immunisation.

DESIGN

Cohort study using data from computerised child health systems.

SETTING

10 health districts in North East Thames and North West Thames regions.

SUBJECTS

7841 children born in January to March 1990 and resident in the districts up till the end of October 1991.

MAIN OUTCOME MEASURES

Overall uptake of measles, mumps, and rubella immunisation, variation of uptake among groups of children, and odds ratio of being vaccinated against measles, mumps, and rubella.

RESULTS

The overall uptake rate of measles, mumps, and rubella immunisation for the study cohort in the 10 districts was 82%. Wide variation was identified among children with different demographic characteristics. Lower uptake was associated with absent or incomplete primary immunisation, including omission of pertussis vaccine. Other factors affecting uptake included the type of resident district, birth order, where registered for immunisation (general practitioner or clinic), and one parent family status.

CONCLUSIONS

Many districts have difficulties in meeting the 90% target for measles, mumps, and rubella immunisation, mainly because of the characteristics of their local population. To increase overall coverage, the health service should target families with adverse factors, especially those whose children have missed previous immunisations.

Chest tube stripping in pediatric oncology patients: an experimental study

BACKGROUND

Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue.

OBJECTIVE

To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping.

METHODS

Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment.

RESULTS

The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments.

DISCUSSION

Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain.

CONCLUSIONS

Stripping of chest tubes as a routine postoperative measure is questioned.

Chest tube stripping in pediatric oncology patients: an experimental study

BACKGROUND: Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue. OBJECTIVE: To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping. METHODS: Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment. RESULTS: The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments. DISCUSSION: Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain. CONCLUSIONS: Stripping of chest tubes as a routine postoperative measure is questioned.

Extended-cycle elutriation to adjust T-cell content in HLA-disparate bone marrow transplantation

We report the development of a double-cycle elutriation (DCE) technique separating 3 or greater logs of T cells from a stem-cell-enriched marrow fraction and the results of phase I T-cell depletion studies with HLA-disparate related bone marrow transplantation (BMT) donors in two patient groups. In group 1, 10 patients with refractory hematopoietic malignancies received combination chemotherapy, total body irradiation (TBI), and immunosuppression (pre- and post-BMT), and hematopoietic rescue with a marrow transplant, depleted of T cells by elutriation. Potentially to promote engraftment and a graft-versus-leukemia (GVL) effect, 0.5 to 0.75 x 10(5) T cells/kg were added back. All 10 patients engrafted. Five patients developed acute graft-versus-host disease (GVHD; four grade II, one grade III) and two subsequently developed chronic GVHD. Two patients have relapsed (median follow-up, 206 days; range, 46 to 1,035). Four patients died of BMT-related complications (three of infection, one of veno-occlusive disease [VOD]). Four patient are disease-free survivors (median follow-up, 960 days; range, 670 to 1,035). Group 2 included five infants, four with congenital lymphohematopoietic deficiencies and one with refractory acute lymphocytic leukemia (ALL). In these infants, busulfan and increased cyclophosphamide were substituted for TBI. Only the ALL patient received added T cells. Three patients engrafted: one has stable mixed chimerism, one relapsed with ALL, and one rejected the marrow. One patient had primary autologous recovery, while another failed to engraft. None developed GVHD. We conclude that, in this setting of HLA-disparate BMT with post-BMT antithymocyte globulin (ATG) and corticosteroids, DCE significantly depletes T cells from the marrow and that a defined number of T cells can be added without the occurrence of severe GVHD.