Genetic relatedness among human rotaviruses as determined by RNA hybridization

Viral RNAs from human rotaviruses were compared by gel electrophoresis and by hybridization to probes prepared by in vitro transcription of two well-characterized laboratory strains (Wa and DS-1). Also, the viral RNAs were compared by hybridization to probes prepared from three of the test viruses. Thirteen specimens (diarrheal stools) were obtained from infants and children 5 to 21 months old on a single day at the emergency ward of the Caracas Children's Hospital, and an additional specimen was obtained from the same hospital 6 months before. When the electrophoresed viral RNAs were stained with ethidium bromide and examined by UV light, five different migration patterns (electropherotypes) were distinguished on the basis of differences in mobility of the RNA segments. The hybridization technique that was employed permitted only qualitative comparisons of corresponding genes of different human rotaviruses. Ten of the specimens contained enough virus to yield sufficient RNA for hybridization studies. Eight of the viruses studied by hybridization contained 4 to 11 genes that reacted specifically with the Wa probe to yield double-stranded RNA segments with a mobility similar to that of Wa viral RNA or test virus RNA. The other two viruses contained 11 genes that reacted specifically with the DS-1 hybridization probe to yield double-stranded RNA segments with a mobility similar to DS-1 viral RNA or test virus RNA. A more complex picture emerged when hybridization probes were prepared from three of the test viruses and used to compare the different electropherotypes. Corresponding genes that exhibited similar migration did not necessarily exhibit homology when studied by hybridization. Also, some corresponding genes that exhibited homology did not have the same mobility by gel electrophoresis.

A syndrome of thrombosis and hemorrhage complicating L-asparaginase therapy for childhood acute lymphoblastic leukemia

L-Asparaginase therapy for childhood acute lymphoblastic leukemia causes deficiencies of plasma hemostatic proteins, especially antithrombin, plasminogen, and fibrinogen. Severe thromboses and hemorrhages occurred in 18 children receiving vincristine, prednisone, and asparaginase therapy for ALL. Thirteen children had intracranial thrombosis or hemorrhage, four had extremity thrombosis, and one had both an intracranial hemorrhage and an extremity thrombosis. These events occur characteristically in the third and fourth weeks of therapy during or just after a three-week course of L-asparaginase. Symptoms of headache, obtundation, hemiparesis, and seizure were common for the intracranial events: local pain, swelling, and discoloration were common for the extremity thromboses. These complications have been recognized in 1 to 2% of children undergoing induction therapy which includes asparaginase.

Effect of prolonged administration of interferon-alpha on pharmacokinetics, fever, lymphocyte proliferative response, and NK cell activity

Over a 60-week period, a patient with multiple warts received a total of 281 x 10(6) units of human leukocyte interferon (IFN-alpha) by intramuscular (IM) or intralesional (IL) injections. Circulating IFN was significantly higher following IM administration than after IL administration. These pharmacokinetics did not change. The patient's body temperature was always significantly elevated after administration of IFN. However, hyporeactivity to the febrile response developed when the interval between repeated injections of IFN was less than six days. The lymphocyte count was significantly decreased within 5-7 h after administration of IFN and had returned to normal by 24 hours, whereas total WBC, platelet, and monocyte counts were not altered. There was a depression of specific lymphocyte proliferative response to herpes simplex virus after multiple daily injections, but not after prolonged therapy. Circulating natural killer (NK) levels were not elevated during the first two months of IFN therapy. After the patient had received about 100 x 10(6) units of IFN, however, the NK cell level became elevated and remained elevated upon cessation of treatment. NK activity was stimulated by in vitro incubation of peripheral mononuclear cells with 1000 units of IFN during the initial phase of treatment. A decline of in vitro stimulation of NK activity by interferon developed during two subsequent periods of treatment with mean daily doses of 2.46 and 1.07 x 10(6) units of IFN. Long-term therapy in our patient with an average of 4.7 x 10(6) units of IFN/week was well tolerated, did not irreversibly affect platelet or white cell counts or nonspecific or virus-specific cell mediated immune responses, and enhanced circulating NK levels.

Increased food intake following the manipulation of intracerebral dopamine levels with gamma-hydroxybutyrate

The administration of gamma-hydroxybutyric acid (GHB) initially causes a temporary "sleep-like" state during which there is an increase in forebrain dopamine levels. The present series of experiments examined whether in the period following the GHB-induced behavioural depression, when accumulated dopamine is dispersed, there is any behavioural evidence of increased dopaminergic activity. The first experiment, in which GHB was injected directly into the cerebral ventricles, demonstrated that in the immediate post-recovery period rats exhibited various forms of stereotyped oral behaviour and stereotyped sniffing. Unexpectedly, it was also observed that if food were present animals preferred to eat. The nature of this feeding response was examined in two further experiments. Firstly, it was shown that in the period following the behavioural depression animals would perform, in a dose-dependent fashion, an operant response which was rewarded by food. Secondly, the GHB-induced increase in feeding was abolished by the pre-treatment of animals with either the dopamine synthesis inhibitor alpha-methyl-p-tyrosine, or the dopamine receptor blocker haloperidol. These data indicate that (i) in the period when it is known that the GHB-induced accumulation of dopamine is dispersing, there is behavioural evidence of increased dopaminergic activity; (ii) the feeding response is not a simple oral reflex; and (iii) in addition to being essential for food intake dopaminergic transmission may play a direct role in the production of feeding.

Hydroxyethyl starch for resuscitation of patients with hypovolemia and shock

The authors evaluated the effectiveness of 6% hydroxyethyl starch (hetastarch) solution for treatment of hypovolemia in 46 critically ill patients. Thirty-two of the patients were studied retrospectively and in 14 patients, cardiopulmonary variables were prospectively measured. A total of 29 patients were in shock secondary to hypovolemia (13), sepsis (13), or myocardial infarction (3). Average hetastarch infusion volume was 829 and 842 ml, respectively, in prospectively and retrospectively studied patients, with maximum of 2000-2500 ml infused over 48 h. Approximately 30% of 24 h fluid needs were supplied with colloids. Infusion of 500 ml of hetastarch in 14 prospective study patients was associated with increases in pulmonary artery wedge pressure (WP) from 9 +/- 1.5 to 12 +/- 2.1 mm Hg, cardiac index (CI) from 2.9 +/- 0.2 to 3.5 +/- 0.3 (p less than 0.05) along with an increase in mean arterial pressure (MAP) from 87-99 mm Hg and reduction in arteriovenous O2 difference [C(a-v)O2] from 4.9 to 4.2 ml/dl. Intrapulmonary shunt (Qsp/Qt) was similar (20 vs. 21% as were alveolar-arterial O2 gradient [P(A-a)O2] (164 vs. 158 torr), whereas O2 consumption (VO2) increased from 224 to 247 ml/min. Immediate survival was 90% in shock patients and 100% in nonshock patients, whereas hospital survival was 65.5% and 88%, respectively. The authors conclude that hetastarch is an effective fluid for resuscitation of hypovolemic patients. This synthetic colloid does not appear to adversely affect pulmonary function.

Virus detection by nucleic acid hybridization: examination of normal and ALS tissues for the presence of poliovirus

A nucleic acid hybridization assay was developed as a sensitive assay for the presence of poliovirus RNA in human tissue. The assay could detect the presence of an average of one poliovirus per 200 cells. A method for determining the extent of degradation of the tissue RNA was developed and used to show that a significant fraction of human central nervous system (CNS) autopsy material contains highly degraded RNA which is unsuitable for hybridization studies. A total of 15 different control and amyotrophic lateral sclerosis tissues were assayed for the presence of poliovirus-like RNA. Virus RNA was detected in one of the control tissues and in none of the ALS tissues.

Precautions in medical care of, and in handling materials from, patients with transmissible virus dementia (Creutzfeldt-Jakob disease)

We have formulated a series of precautions to be observed in caring for patients with Creutzfeldt-Jakob disease and in handling their tissues. The virus resists inactivation by simple boiling in water. Also ineffective are 10 per cent formalin, 70 per cent alcohol and ionizing and ultraviolet radiation. Autoclaving for one hour at 121 degrees C and 20 psi inactivates the agent completely. Five per cent hypochlorite, 0.03 per cent permanganate, phenolics and iodine solutions are adequate disinfectants inactivating large infective doses of the virus. Special isolation wards for afflicted patients seem unwarranted. Workers exposed to infected saliva, nasopharyngeal secretions, urine or feces need to and should wash thoroughly with ordinary soap. Needles and needle electrodes should be autoclaved or incinerated and discarded. Demented persons should not be used for donations of blood or other tissues. Although precautions are necessary, the epidemiologic evidence does not suggest an unusual risk of Creutzfeldt-Jakob disease for medical workers.

Prediction of short-term outcome in newly admitted psychogeriatric patients

Thirty-six consecutive admissions to a geriatric service recently reorganized to function within a community psychiatric framework were evaluated by means of a series of behavioral and psychologic measures. Assessments upon admission and at three, five and eight weeks and five months afterward, revealed that the greatest therapeutic responses and the most discharges occurred within the first few weeks after admission. Patients remaining for longer periods tended to stabilize at a lower level of functioning or to deteriorate. A combination of two simple measures used in evaluation upon admission and relating to physical and mental functioning was found to predict the patient's status at five months (still in the hospital, dead, or discharged) with 75 percent accuracy. Use of the lambda statistic for judging the predictive power of measures is suggested.

RNA-instructed DNA polymerase activity in a cytoplasmic particulate fraction in brains from Guamanian patients

Nervous system tissues from a number of patients with idiopathic neurological disorders were examined for biochemical evidence of RNA tumor virus infection. RNase-sensitive DNA polymerase activity was found in a cytoplasmic particulate fraction from two patients with Guamanian amyotrophic lateral sclerosis (ALS) but not in brains from two normal U.S. individuals. The buoyant density of the enzyme-containing fraction was 1.16-1.18 g/ml and could be converted to a denser region of the gradient (1.24 g/ml) by treatment with the nonionic surfactant, Sterox. The cation and detergent requirements for the endogenous RNase-sensitive DNA polymerase reaction were determined. The early (5 min) endogenous reverse transcriptase product was analyzed by cesium sulfate gradient centrifugation. RNase- and heat-sensitive RNA-DNA hybrids were detected in the product analysis of two ALS, one Parkinsonism-dementia (PD) brain, and two brains from asymptomatic Chamorros but not in brains from normal U.S. individuals and a number of patients with neuro-psychiatric disorders. The DNA product was a 4.5S heteropolymer that hybridized more extensively to RNA extracted from the enzyme-containing pellet from PD brain as compared to a similar fraction from normal U.S. brain. The DNA product appeared to be unrelated to Rausvher or visna virus 70S RNA as determined by RNA-[-3H]DNA hybridization.

Rapid diagnosis of sickle cell disease at birth by microcolumn chromatography

Accurate specific diagnosis of sickle cell disease can now be made at birth on routinely obtained cord blood samples by microcolumn chromatography. The method uses a small column of a cation ion exchange resin, CM-Sephadex, and a single developer that allows definitive rapid distinction of hemoglobin SS, AS, AC, SC, and CC, within two hours. Seventy-five samples or more per day have been analyzed by one technician in a laboratory without special precautions or equipment. In a program which has been initiated on a large, totally unpredictable obstetrical service in Los Angeles, 10,401 consecutively born infants have been studied for hemoglobin type without regard to racial origin. Three SS infants, 1 SC, 143 AS infants, and 37 AC infants as well as several with other abnormal hemoglobins have been identified without interfering with the routine operation of the delivery rooms of the obstetrical service. The diagnosis of sickle cell disease has been confirmed on subsequent examinations of the infants. The feasibility of using microcolumn chromatography as a rapid, accurate, inexpensive, and easy method for the rapid diagnosis of sickle cell disease in newborns has now been established.

Evaluation of isobaric oxygenation for the aged with cognitive impairment: pilot study

The effect of isobaric oxygenation on psychogeriatric subjects, with mild cognitive impairment was assessed in a single-blind controlled pilot study. Three of the 7 subjects were treated with a mixture of 97% oxygen plus 3% carbon dioxide, and 4 treated with compressed air. The oxygen or air was administered during two 1.5 hr sessions daily for fifteen consecutive days. Use of a miner's type mask ensured a closed system which permits the maximal partial pressure of oxygen. Psychologic and clinical observations did not indicate any advantage for the oxygenation therapy. Minimal side effects, which arose only in the oxygen group, may have involved some interactions between CO2 sensitivity and anxiety. Careful differential diagnosis and the control of motivational factors are of major importance in any study of the effects of oxygenation upon symptoms in psychogeriatric patients.

A new approach to measuring short-term memory in geriatric SS: a pilor study

The short-term memory of 20 geriatric Ss in a state hospital was evaluated with a new method. Ss were asked to place figures of a doll family into various rooms of a doll house, and then asked to recall their placement. Since S is asked to recall his own placement, initial level of learning is assured. Pilot data suggest the measure is reliable even with Ss suffering from both psychiatric and physical illness.