Hemostasis at skin graft donor sites: evaluation of topical agents

Blood loss from split-thickness skin graft donor sites may be significant. Various topical agents have been used to decrease this blood loss, including thrombin and epinephrine solutions of varying concentrations. We describe a K-Y jelly/epinephrine mixture that serves both as a lubricant for the dermatome and as a hemostatic agent. This mixture, in comparison with other topical agents, produces rapid hemostasis and offers the advantages of easy use, ready availability, and low cost. The blood loss savings based on this hemostatic technique is quantifiable and significant.

Expression of beta 3-adrenoceptor mRNA in rat brain

The reverse transcription/polymerase chain reaction was used to demonstrate beta 3-adrenoceptor mRNA in rat brain regions. Levels were highest in hippocampus, cerebral cortex and striatum and lower in hypothalamus, brainstem and cerebellum.

Expression of the rat, S-100-related, calcium-binding protein gene, p9Ka, in transgenic mice demonstrates different patterns of expression between these two species

p9Ka (also known as mts1/18A2/calvasculin/CAPL) is a member of the S-100-related family of small, calcium-binding proteins. Previous studies suggest apparent discrepancies between the expression of the p9Ka gene in rat, mouse, and human tissues. Here we demonstrate that the natural p9Ka gene is expressed at lower levels in mouse than in rat, and that, in mouse but not in rat, p9Ka mRNA is more highly expressed in cells of lymphoid origin. Transgenic mouse strains express rat-p9Ka transgenes in a gene copy-number-dependent manner. The rat p9Ka transgene mRNA shows the same tissue distribution in several lines of transgenic mice, a distribution that is characteristic of the rat, from which the transgenes were derived. These results show that there is a difference in the pattern of expression of the same gene in two closely related species, and that the pattern of expression found in rat is specified by the DNA in the rat gene itself.

Bovine tuberculosis in badger (Meles meles) populations in southwest England: the use of a spatial stochastic simulation model to understand the dynamics of the disease

A spatial stochastic simulation model was developed to describe the dynamics of bovine tuberculosis in badger populations in southwest England, based on data from the literature and from unpublished sources. As there are no data on intra- and intergroup infection probabilities, estimates of these were obtained through repeated simulations based on field observations of the spread and prevalence of the disease. The model works on a grid-cell basis, with each grid cell potentially occupied by one badger social group; immigration to and emigration from the main grid are incorporated. Population regulation is assumed to occur at the group level through density-dependent fecundity and cub mortality, and the model can be run for various disease-free equilibrium group sizes (which are determined by the carrying capacity of the environment). The model works on a quarterly (three-monthly) basis and processes are stochastic at the individual level. Three classes of individual (adults, yearlings and cubs) and three classes of infection (susceptible, infected-but-not-infectious and infectious) are recognized. Bovine tuberculosis wa shown to persist in badger populations for long periods of time, even in populations with a disease-free equilibrium group size of only four adults and yearlings. However, with standard rates of intergroup infection and movement, the disease only became endemic in populations with a disease-free equilibrium group size greater than six adults and yearlings. In the endemic situation, the prevalence of the disease ranged between 11-22 degrees depending on the combination of inter- and intragroup infection probabilities used. Endemic infection within the homogeneous environment of the grid was characterized by a high degree of heterogeneity. Patches of infection were spatio-temporally unstable, but shifted in location relatively slowly. Spread of the disease from a point source of infection with standard rates of intergroup movement and infection only occurred to any marked extent in populations with disease-free equilibrium group sizes of eight or more adults and yearlings. Increasing the intergroup infection probability had a significant effect on increasing the probability and rate of spread, and considerably lowered the threshold group size for spread from a point source to around four adults and yearlings. However, increasing the rates of intergroup movement reduced the probability of spread of the disease except at the largest groups sizes. When both intergroup infection and movements were increased, the effects of increased infection in enhancing spread were offset to some degree by the increased movements. Perturbation to the badger population, as may be caused by control operations, could therefore increase the probability of persistence or spread of an infection.

Bovine tuberculosis in badger (Meles meles) populations in southwest England: an assessment of past, present and possible future control strategies using simulation modelling

A spatial stochastic simulation model was used to compare the efficacy of different badger control policies and to determine the theoretical requirements for the control of endemic bovine tuberculosis in badger populations in southwest England. Culling-based strategies for controlling endemic disease were compared with strategies employing a yet-to-be-developed oral vaccine which would provide uninfected badgers with immunity to the infection. A comparative assessment was made of the efficacy of previous and proposed culling-based strategies employed by the Ministry of Agriculture, Fisheries and Food for the control of localized disease, and the potential for an oral vaccine-based strategy for the control of localized disease was examined. For endemic bovine tuberculosis, to achieve a reasonable probability (p > 0.70) of successful control with a strategy involving a single culling operation, a very high proportion of the badger population (> 90%) must be culled. Single vaccination would not be successful in combating endemic disease. However, strategies involving repeated annual vaccination would have a very high probability of eradicating endemic disease, even with a relatively low (40-50%) annual vaccination efficiency. The most successful culling-based strategies for the control of localized disease were the gassing and clean ring strategies. Compared with no control at all, the interim strategy only offered benefits of a lower probability of disease spread and persistence in populations with low disease-free equilibrium group sizes or low initial prevalences of infection. In all other instances the benefits were negligible. The live test strategy will offer an improvement over the interim strategy, but will not be as effective as either the gassing or clean-ring strategies. In addition, it is likely to necessitate the culling of approximately four times as many badgers each year as the interim strategy, and the proportion of those killed that are infected will be approximately half that under the interim strategy. The efficacy of a strategy involving annually repeated oral vaccination of the badgers within a similar area to that covered by the live test depended on the efficiency of vaccination. A vaccination efficiency of 20-60% represented an overall improvement in efficacy over the interim strategy, being equivalent to the live test strategy. However, only vaccination efficiencies of 60-80% or greater achieved similar results to the gassing strategy, and none were so successful as the clean-ring strategy. Recommendations for future management are provided. Reactive strategies based on culling or vaccination will not solve the problem of bovine tuberculosis in badgers. Proactive strategies directed in those areas with a recent history of bovine tuberculosis in badgers should be considered as an alternative short-term control measure. The only strategy likely to eradicate bovine tuberculosis from badger populations in the long term is the use of repeated vaccination in proactive control operations in areas with a history of bovine tuberculosis in the badger population. Analyses should be conducted to evaluate whether the economic benefits of the live-test strategy are likely to outweigh its economic and ecological costs and whether continued research into the development of a vaccine for badgers is likely to offer any significant long-term economic benefits.

Azithromycin and terfenadine: lack of drug interaction

A double-blind placebo-controlled study was conducted in healthy men to determine the effect of coadministration of azithromycin on the pharmacodynamics and pharmacokinetics of terfenadine. Administration of 500 mg azithromycin for 1 day and 250 mg on 4 subsequent days did not affect the pharmacokinetics of the pharmacologically active terfenadine carboxylate metabolite when 60 mg terfenadine was given twice daily for 12 days, starting 7 days before azithromycin administration. Terfenadine alone resulted in a 0.010 msec increase in the rate-corrected QT interval (QTc), but the incremental effects of azithromycin and placebo on QTc in volunteers receiving terfenadine were not statistically different. It is concluded that the potentially life-threatening disorders that have been attributed to a pharmacokinetic interaction between macrolide antibiotics and terfenadine are unlikely to take place in patients treated simultaneously with azithromycin and terfenadine.

Epidemiological studies on intestinal helminth parasites of rural and urban red foxes (Vulpes vulpes) in the United Kingdom

An epidemiological study of intestinal helminths in 843 foxes (Vulpes vulpes) from southern England revealed the presence of 13 parasite species: five nematodes--Toxocara canis (prevalence 55.9%), Toxascaris leonina (1.5%), Uncinaria stenocephala (68.0%), Trichuris vulpis (0.5%) and Capillaria aerophila (0.2%); four cestodes--Taenia pisiformis (13.8%), Taenia hydatigena (2.5%), Echinococcus granulosus (0.1%) and Dipylidium caninum (3.8%); two trematodes--Brachylaima recurva (2.9%) and Cryptocotyle lingua (2.3%); two acanthocephalans--Prosthorhynchus transversus (0.7%) and Macracanthorhynchus catulinus (0.1%). Trichuris vulpis, Brachylaima recurva, Macracanthorhynchus catulinus and Prosthorhynchus transversus are new host records for the UK. Results are discussed with reference to variations in the diets of urban and rural foxes and to their potential as reservoir hosts for helminths of medical and veterinary importance.

Pressure ulcers and wound healing: educating the spinal cord injured individual on the effects of cigarette smoking

While it is well known that smoking causes an increased risk of lung cancer and cardiovascular problems, there is little information available about cigarette smoking and its adverse effects on pressure ulcers and wound healing in the individual with spinal cord injury (SCI). Due to SCI, circulation is already compromised. Smoking has a vasoconstrictive effect on the capillaries at the dermal level, which diminishes the amount of oxygenated blood reaching the tissues, further delaying the healing process of pressure ulcers and surgical wounds (Ting, 1991). A study was developed to focus on the knowledge of smoking among individuals with SCI. A video tape was prepared to provide comprehensive information about smoking. Twenty male patients with SCI were selected at random to view the videotape. A pre-test and post-test were given to evaluate the individual's knowledge of the effects of smoking on wound healing. The data collected demonstrated the effectiveness of the videotape as a teaching tool for increasing awareness of the adverse effects of cigarette smoking on pressure ulcer prevention and wound healing. Educating the individual with SCI on the effects of cigarette smoking is an important aspect of health education that needs to be addressed.

The effects of cytokines and growth factors on osteoblastic cells

In this short review, some regulatory mechanisms that are involved in the control of normal bone formation are proposed, based on several in vivo and in vitro models our group has utilized recently to study osteoblast differentiation and mineralized bone matrix formation. Of course, these proposals must be assessed in the light of the limitations of the models, which probably represent a simplification of the complex and different ways in which normal mammalian bone is formed at different sites. Nevertheless, it is likely that the same general types of control mechanisms are active in each of the different types of bone formation. In adult humans, bone formation predominantly occurs by remodeling, the process by which bone which has recently been resorbed by osteoclasts is replaced by teams of osteoblasts. Other types of bone formation such as endochondral bone formation and appositional bone formation are also important, particularly during growth and adolescence. The end results of each of these processes are the same, namely a complex mineralized proteinaceous bone matrix. These processes are modulated by systemic hormonal influences, which are particularly important with respect to pituitary hormones and sex steroids during growth and adolescence, and by local cellular microenvironmental differences. The former will not be discussed here. Rather, we will concentrate on the local events and factors which are likely involved in the bone formation process occurring during normal bone remodeling.

Postural control and vestibulospinal function in patients selected for cochlear implantation

Postural control, vestibular and eye motor function were evaluated in seven postlingually deaf patients before cochlear implantation and were compared with 21 control subjects. Vibration to the calf muscles or galvanic electrical stimulation of the vestibular nerves, perturbed stance and body sway velocity, statistical variance of antero-posterior body sway and identification of characteristic parameters of postural dynamics were all evaluated. Vibration-induced body sway was increased among the patients compared with the normal subjects and there were differences in characteristic parameters of postural dynamics, indicating decreased postural control. Galvanic stimulation induced a body sway not significantly different from the control group suggesting that the patients selected for cochlear implantation, and with an otherwise reduced postural control, are sensitive to electrical stimulation of the vestibular nerve. Thus, postlingually deaf subjects who perceive a sensation of sound at electrical promontorial stimulation also respond with increased body sway to electrical stimulation aimed at the vestibular nerves. This finding may contribute an additional hypothesis to the causes of dizziness among cochlear implant patients, complementary to the that of wrongly placed electrodes and peroperative vestibular lesions.

A yeast DnaJ homologue, Scj1p, can function in the endoplasmic reticulum with BiP/Kar2p via a conserved domain that specifies interactions with Hsp70s

Eukaryotic cells contain multiple Hsp70 proteins and DnaJ homologues. The partnership between a given Hsp70 and its interacting DnaJ could, in principle, be determined by their cellular colocalization or by specific protein-protein interactions. The yeast SCJ1 gene encodes one of several homologues of the bacterial chaperone DnaJ. We show that Scj1p is located in the lumen of the endoplasmic reticulum (ER), where it can function with Kar2p (the ER-lumenal BiP/Hsp70 of yeast). The region common to all DnaJ homologues (termed the J domain) from Scj1p can be swapped for a similar region in Sec63p, which is known to interact with Kar2p in the ER lumen, to form a functional transmembrane protein component of the secretory machinery. Thus, Kar2p can interact with two different DnaJ proteins. On the other hand, J domains from two other non-ER DnaJs, Sis1p and Mdj1p, do not function when swapped into Sec63p. However, only three amino acid changes in the Sis1p J domain render the Sec63 fusion protein fully functional in the ER lumen. These results indicate that the choice of an Hsp70 partner by a given DnaJ homologue is specified by the J domain.

Exercise versus overnight albumin excretion rates in subjects with type 1 diabetes

Diabetic nephropathy is the leading cause of new cases of renal failure in the US and Europe. An elevated albumin excretion rate (AER) on an overnight urine sample is considered an early predictor of end-stage renal failure. An elevated AER on a post-exercise urine sample has previously been considered to be an even earlier marker of renal damage. In a longitudinal prospective study, 373 subjects with insulin-dependent (type 1) diabetes mellitus had a total of 714 renal evaluations, each of which included one exercise and two overnight urine collections for AER determinations. All subjects were at least 13 years old and had diabetes for at least 4 years. There was a strong correlation between exercise and overnight AERs (r = 0.74, P < 0.001). For the 60 subjects with an initial borderline increase of either overnight or exercise AER, the overnight AER values (7.6-20 micrograms/min) progressed first for 52% of subjects whereas the exercise AERs (41-114 micrograms/min) progressed first for 43% of subjects (5% had simultaneous elevations of both). For the 22 subjects in which an abnormal overnight (> 20 micrograms/min) or exercise (> 114 micrograms/min) value was detected first, 17 (77%) had an elevated exercise AER first, whereas only 4 (18%) had an elevated overnight AER first. This study shows that an increase of either the exercise or the overnight AER can occur first, dependent upon the level of abnormality being considered. The two tests correlate closely with one another.(ABSTRACT TRUNCATED AT 250 WORDS)

Fracture of the accessory navicular

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Effect of positive heel inclination on posture

Millions of women wear high heels on a daily basis; however, few studies have analyzed the changes high heels (positive heel inclination) have on posture. The purpose of this study was to determine whether positive heel inclination changed the postural alignment of the head, spine, pelvis, and knees. Fifteen female college students ((mean age = 22.7, SD = 3.7 years) had sagittal plane angles measured for the cervical spine, thoracic spine, lumbar spine, sacral spine, and knee joints in addition to anterior/posterior displacements of the head and pelvis. All variables were assessed by a Metrecom Skeletal Analysis System, a three-dimensional electrogoniometer. Six randomized trials, three at zero heel inclination and three at 5 cm positive heel inclination, were measured. Analysis of variance results indicated positive heel inclination of subjects brought about significantly lower anterior pelvic tilt, lumbar lordosis, and sacral base angles when compared with zero heel inclination (p < .01). Clinically, patients with low back pain may be affected by high heel usage because of the reduction of the normal lumbar lordosis.

Effect of dichotic presentation on the recognition of telegraphy signs

The recognition of telegraphy signs (Morse code) masked by noise was studied at different interaural phase conditions at 250, 500, 1000 and 2000 Hz tone frequency in eight normal-hearing men. The possible effect of a left-right ear of dominance was considered. Best recognition was obtained at 500 Hz tone frequency with the telegraphy signs 180 degrees out of phase but with the noise in phase. When the telegraphy signs and noise were presented in one ear, recognition improved when the same masking noise without any phase difference was added to the other ear. The effect was most marked at 500 Hz. No significant difference was found between the left and right ear.

Rotational ablation of discrete lesions in the coronary arteries is safe. A nonrandomized comparison with percutaneous transluminal coronary angioplasty

Rotational ablation is receiving increasing attention as a new therapeutic intervention for coronary artery disease. In a nonrandomized study, we compared echocardiographic regional wall-motion scores of patients treated with rotational ablation with those of patients treated with percutaneous transluminal coronary angioplasty. We found that rotational ablation achieved angiographic results comparable to those of percutaneous transluminal coronary angioplasty, and was in fact associated with less myocardial ischemia. The reduction in ischemia observed in the ablation group might arise from shorter treatment times in those patients, from the use of nitroglycerin infusion in the ablation group, or from both factors.

Recognition of telegraphy in hearing-impaired telegraph operators

Recognition of Morse signs masked by noise was measured in five hearing-impaired telegraph operators with a high-frequency hearing loss. They all described problems typical for subjects with high-frequency hearing loss, i.e. problems with recognition of speech in noisy environments. Telegraphy speed, listening level, bandwidth of the masking-noise, frequency and interaural phase were systematically varied. At narrow-band masking with a bandwidth of 230 Hz (1/3 octave 891-1121 Hz) centred at 1000 Hz no statistical significant difference in recognition of telegraphy signs was found between the hearing-impaired subjects and the normal-hearing subjects investigated in our earlier studies at any telegraphy speed or at any S/N ratio. All hearing-impaired subjects improved in recognition when the telegraphy speed was lowered. When a broad-band noise (100-2500 Hz) was used as a masker all the hearing-impaired subjects improved in recognition when the frequency was lowered from 2000 to 500 Hz. At 40 signs/min telegraphy speed the hearing-impaired subjects showed a significantly lower recognition (p < 0.05) at low S/N ratios both at 2000 and 500 Hz frequency compared to the normal-hearing subjects investigated in our earlier studies. At monaural listening the normal-hearing subjects were significantly better (p < 0.01) in recognition. When the telegraphy signs were presented 180 degrees out of phase between the two ears, all subjects improved in recognition compared to when the telegraphy signs were presented in phase. This improvement was equal in hearing-impaired subjects and in the normal-hearing subjects investigated in our earlier studies.

Performance of electronic Morse decoders in decoding telegraphy masked by noise

The performance of five different electronic Morse decoders in decoding telegraphy signs (Morse code) consisting of 800 Hz pure tones masked by a narrow-band noise with a bandwidth of 185 Hz (1/3 octave 713-890 Hz) centred at 800 Hz and a broadband noise (100-2,500 Hz) was studied at 20, 40, 80, 150 and 200 signs/min telegraphy speed. In steps of 1 dB the S/N ratios were varied from high values where 100% was recognized to low values where nothing was recognized. At narrow-band masking noise with 80 and 150 signs/min telegraphy speed a S/N ratio varying from +8 to +12 dB and +8 to +11 dB respectively was required for 100% recognition. At broad-band masking noise the S/N ratios required for 100% recognition varied from -4 to +3 dB at 80 signs/min telegraphy speed and -3 to +3 dB at 150 signs/min telegraphy speed. When compared to earlier findings in our laboratory concerning human recognition of Morse signs it seems that man outperforms electronic Morse decoders at low S/N ratios and low to moderate telegraphy speeds (< 100 signs/min).