Analgesic effects of adenosine during exercise-provoked myocardial ischaemia

The analgesic potential of adenosine during myocardial ischaemia was studied in patients with coronary artery disease and exercise-limiting angina pectoris. Patients were given a low dose of adenosine or placebo in a double-blind cross-over fashion by continuous i.v. infusion before and during two exercise tests. Adenosine decreased chest pain by 45 +/- 13% (p < 0.02) while heart rate-blood pressure product and electrocardiographic signs of myocardial ischaemia did not change. Ten healthy volunteers received increasing doses of adenosine by continuous i.v. infusion. The heat pain threshold increased in skin covering the chest (p < 0.03) and also tended to increase at the left thenar eminence (p < 0.07). In conclusion, the neuromodulator adenosine can therefore act as an analgesic in myocardial ischaemia.

Inheritance of oilseed rape (Brassica napus) RAPD markers in a backcross progeny with Brassica campestris

Different cultivars/transgenic lines of oilseed rape (Brassica napus) were crossed (as females) with different cultivars/populations of Brassica campestris. All cross combinations produced seed, with an average seed set per pollination of 9.8. Backcrossing of selected interspecific hybrids (as females) to B. campestris resulted in a much lower seed set, average 0.7 seed per pollination. In the single backcross progeny where a large enough population (92 plants) was obtained for analysis, 33 B. napus specific RAPD markers were investigated to determine the extent of transfer of oilseed rape genetic material into this population. Markers were transferred to the backcross generation with frequencies ranging from 26% to 91%. Almost all of the markers (30/33) were transferred in a frequency not significantly different from 50%. Analysis of the pairwise segregation of markers revealed that 23 markers could be assigned to six linkage groups, most probably reflecting six B. napus C-chromosomes. The presence of backcross plants with recombinant genotypes suggests that complex genetic processes can take place during interspecific hybridisation and backcrossing in these Brassica species. The implications of our results for the possible choice of integration sites of transgenes in oilseed rape are discussed.

Vasoactivity and immunoreactivity of fish tachykinins in the vascular system of the spiny dogfish

Tachykinin control of gut blood flow (measured by pulsed Doppler technique), dorsal aortic pressure, and heart rate were studied in unrestrained spiny dogfish Squalus acanthias injected with the elasmobranch tachykinins scyliorhinin I and II (SCY I and SCY II), the trout tachykinins substance P (SP), and neurokinin A (NKA). Effects on somatic vasculature were measured by in vitro perfusion of the isolated tail. SCY I and trout SP produced hypotension due to a general vasodilation. This caused a transient increase in mesenteric blood flow and a prolonged increase in celiac blood flow. SCY II caused an initial hypertension induced by a general vasoconstriction, followed eventually by an elevated flow in both gut arteries due to dilation of the vascular beds. Trout NKA evoked a short-lasting increase in celiac blood flow due to a decrease in vascular resistance, a late decrease in mesenteric flow due to vasoconstriction, and no effect on the somatic vasculature. None of the peptides affected heart rate. The study demonstrates a significant vasoactive function of fish tachykinins in the vascular system of an elasmobranch species and, in addition, the occurrence of tachykinin receptor subtypes. Immunohistochemistry revealed a NKA/SCY II-like peptide in nerve fibers innervating many vessels, including the celiac and the mesenteric arteries, the gastrointestinal canal, and the heart.

Aging and bone metabolism in African American and Caucasian women

There is limited information concerning bone mineral density (BMD) and its determinants across a wide spectrum of ages in African American females (AAF). Therefore, we have performed a cross-sectional study of 54 AAF and 39 Caucasian females (CF), aged 20-90 yr, to quantify femoral and lumbar bone mineral density, total body calcium, as well as the potential determinants of bone density. BMD decreased with age in all sites after age 40 yr in both racial groups. Bone density was greater in AAF than in CF, although there was considerable overlap between the two groups. There was no significant difference in the rate of age-related bone loss between the two groups. At the femoral neck, BMD was below the fracture threshold in 28% of the postmenopausal AAF compared to 47% of postmenopausal CF. L1-L4 BMD was below the fracture threshold in 8% of postmenopausal AAF and 11% of postmenopausal CF. Serum-25 hydroxyvitamin D (25OHD) was inversely related to age in both othnic groups and lower (P < 0.05) in premenopausal AAF than CF. Twenty-four percent of the AAF and 22% of the CF had serum 25OHD levels of 8 ng/L or less. Serum PTH was directly related to age (r = 0.43; P = 0.003 in AAF and r = 0.55; P = 0.002 in CF), and 25OHD was inversely related to age (r = -0.43; P = 0.003 in AAF and r = -0.65; P < 0.001 in CF). PTH was higher (P < 0.05) in postmenopausal AAF than in CF. Serum testosterone was greater in AAF than in CF (P < 0.05). Serum estradiol was greater in premenopausal AAF than in CF. Serum dehydroepiandrosterone sulfate was inversely related to age (r = 0.42; P = 0.004 in AAF and r = 0.51; P = 0.005 in CF). Serum osteocalcin was related to age in AAF (r = 0.47; P = 0.001), but not in CF. There was also a trend for an increase in urinary dipyridinoline (expressed per 100 mg urinary creatinine) with age (r = 0.31; P = 0.055 in AAF and r = 0.37; P = 0.066 in CF). Both lean and fat mass were major determinants of femoral neck BMD in AAF. Femoral BMD was directly related to body weight and body mass index in both races. Serum 25OHD and dehydroepiandrosterone sulfate approached statistical significance as independent predictors of femoral BMD in AAF. We conclude that in AAF, 1) bone density is higher than in CF, but there is a significant risk of fracture in a substantial number of subjects on the basis of BMD; 2) there is no difference in rates of age-related bone loss compared to those in CF; 3) both lean and fat mass are significant determinants of bone density; 4) serum estradiol and testosterone were higher than those in CF; and 5) aging is associated with increased bone turnover, 25OHD deficiency, and secondary hyperparathyroidism in both races. The absence of a difference in rates of bone loss between AAF and CF despite higher serum levels of PTH is compatible with the concept of a relative skeletal resistance to PTH in AAF.

Redesigning the RN and NA roles

To ensure optimal utilization of RNs, the nursing care delivery system in a surgical nursing division assessed the tasks that could be delegated to ancillary personnel. Nursing assistants completed competency-based training and after six months, several positive outcomes were evident: dramatic decreases in overtime, improved patient care and increased patient and staff satisfaction.

Vascular applications of telepresence surgery: initial feasibility studies in swine

PURPOSE

Telepresence surgery is a novel technology that will allow procedures to be performed on a patient at locations that are physically remote from the operating surgeon. This new method provides the sensory illusion that the surgeon's hands are in direct contact with the patient. We studied the feasibility of the use of telepresence surgery to perform basic operations in vascular surgery, including tissue dissection, vessel manipulation, and suturing.

METHODS

A prototype telepresence surgery system with bimanual force-reflective manipulators, interchangeable surgical instruments, and stereoscopic video input was used. Arteriotomies created ex vivo in segments of bovine aortae or in vivo in femoral arteries of anesthetized swine were closed with telepresence surgery or by conventional techniques. Time required, technical quality (patency, integrity of suture line), and subjective difficulty were compared for the two methods.

RESULTS

All attempted procedures were successfully completed with telepresence surgery. Arteriotomy closures were completed in 192+/-24 sec with conventional techniques and 483+/-118 sec with telepresence surgery, but the precision attained with telepresence surgery was equal to that of conventional techniques. Telepresence surgery was described as intuitive and natural by the surgeons who used the system.

CONCLUSIONS

Blood-vessel manipulation and suturing with telepresence surgery are feasible. Further instrument development (to increase degrees of freedom) is required to achieve operating times comparable to conventional open surgery, but the system has great potential to extend the expertise of vascular surgeons to locations where specialty care is currently unavailable.

Effects of behavioral and pharmacological treatment on smokeless tobacco users

The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of group behavioral treatment versus minimal contact on cessation of smokeless tobacco use. Participants (N = 210) were randomly assigned 1 of the 4 treatment conditions. Withdrawal symptoms were assessed throughout the treatment. Follow-up assessments were made at 1, 6, and 12 months posttreatment. Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence. On the other hand, withdrawal symptoms were significantly reduced by nicotine gum, compared with placebo during the initial phases of cessation. The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco.

Survivorship analysis of cemented total condylar knee arthroplasty. A long-term follow-up report on 348 cases

Survivorship analysis was used in the evaluation of 348 consecutive primary total condylar knee arthroplasties (total knee arthroplasties) performed on 253 patients in a 27-month period, with a maximum follow-up period of 12 years. The diagnosis was osteoarthrosis in 184 cases and rheumatoid arthritis in 164 cases. Ten patients (10 total knee arthroplasties) were lost to follow-up evaluation. The endpoint was defined as prosthesis not in situ. The variables considered were age, sex, body mass index, and diagnosis. The overall cumulative survival rate was 92%. The survival rate of the osteoarthrosis group was significantly higher (97%) than that of the rheumatoid arthritis group (87%). None of the other variables affected survival rate significantly.

Chlorophenols in the terrestrial environment

Chlorophenols are presently widespread in the environment. Even in the most remote natural environments, the presence of chlorophenols in both aquatic and terrestrial food chains has been recorded. These pervasive compounds have been used for a wide range of domestic, agricultural, and industrial purposes for more than 50 years. In addition to industrial production and usage, chlorophenols are produced from naturally occurring phenols as a result of chlorine bleaching of wood pulp in the paper industry and through the chlorination of domestic water supplies and swimming pools. It must be emphasized that chlorophenols, although a local problem in some areas, generally cannot be considered a major environmental problem today because their use is prohibited or restricted in many countries. Future reduction in the use of the herbicidal phenoxy acids will further minimize their levels in the terrestrial environment. Because of the long persistence and high toxicity of pentachlorophenol in particular, however, it is important that the discharge of chlorophenols to the terrestrial environment by way of sewage sludge or pulp mill effluents be maintained at their current levels or even reduced to lower levels.

Vasoconstrictive effects of native tachykinins in the rainbow trout, Oncorhynchus mykiss

The role of trout substance P (tSP) and neurokinin A (tNKA) in cardiovascular regulation was investigated in the rainbow trout, Oncorhynchus mykiss, in vivo and in vitro. In vivo, the coeliac arterial and ventral aortic relative blood flows were measured with Doppler flow probes, and blood pressure was measured via a cannula inserted into the dorsal aorta. tSP (0.1 and 1 nmol kg-1) and tNKA (1 nmol kg-1) increased both systemic and coeliac vascular resistances, leading to hypertension and bradycardia. In addition, cardiac output was decreased. The mammalian NK1 tachykinin receptor antagonist CP-96,345 did not affect the responses to tSP or tNKA. In vitro perfusions of the dorsal aortic and coeliacomesenteric vascular beds were performed using peristaltic pumps. The dorsal aortic vascular resistance was dose-dependently increased following infusion of the two peptides (pD2 values 7.6 +/- 0.1 and 7.3 +/- 0.1 for tSP and tNKA, respectively). Tetrodotoxin did not affect the tSP-induced hypertension. Increases in coeliac vascular resistance caused by tSP was correlated with stomach contractions when measurement of intragastric pressure was made using an inserted balloon. In conclusion, native SP and NKA are potent vasoconstrictors of rainbow trout vasculature, a property quite unusual to tachykinins compared with the vasodilation normally seen in mammals.

Binding of ADP to sarcoplasmic reticulum Ca(2+)-ATPase in the absence of Mg2+ is specifically inhibited by thapsigargin: observations on the ligand stoichiometry

The conditions of nucleotide binding to native, though partly purified, Ca(2+)-ATPase from SR as well as the stoichiometry of nucleotide and strontium binding and the phosphorylation capacity was reevaluated. Binding of MgADP appeared to be aberrant whereas even high-affinity binding of [14C]-ADP took place in the absence of Mg2+. Also low-affinity ATP binding was possible in the absence of divalent cations. A heterogeneity in ADP binding compatible with a two-component model in the absence of thapsigargin was changed to an apparent homogeneity of low-affinity receptors following a mole:mole interaction of enzyme and thapsigargin. Since the affinity of both components was reduced by thapsigargin, high- as well as low-affinity ADP binding seem to be specific and probably to the substrate receptor proper. Analysis of ADP binding isotherms in the absence of Mg2+ according to a model of two independent populations of sites was compatible with a binding capacity of 8.49 +/- 0.43 nmoles/mg protein corresponding to a molecular mass of 118 +/- 6 kD per ADP site. The same total binding capacity was found for ATP. The phosphorylation capacity corresponded to more than one and less than two approximately P per two 110-kD peptides (formally one approximately P per 154 kD protein). Specific binding of Ca2+ and the congener Sr2+ to SR Ca(2+)-ATPase was compatible with their interaction with a single population of sites. The binding capacity was equal to one divalent cation per nucleotide binding peptide. The binding of one nucleotide and one divalent cation per approximately 110 kD peptide and the absence of cooperativity in divalent cation binding might imply that Ca(2+)-ATPase works as a monomer.

Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week-day were included in the study. Initially the SCL-25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8-item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.

Ischemia monitoring with on-line vectorcardiography compared with results from a predischarge exercise test in patients with acute ischemic heart disease

Information from 24-hour monitoring with on-line vectorcardiography, starting immediately after admission, was compared with results from a predischarge exercise test 3-13 days after admission. A total of 169 patients with acute myocardial infarction and 73 patients with unstable angina pectoris were investigated. Patients were followed for 487 +/- 135 days. During the follow-up period, 19 patients (8%) died from cardiac causes and 34 (14%) were hospitalized for a myocardial infarction. The QRS vector difference (QRS-VD), ST change vector magnitude (STC-VM), ST vector magnitude (ST-VM), and ST vector leads X, Y, Z were monitored. Patients with ST depression on the exercise test showed higher occurrence of transient, supposedly ischemic, episodes of QRS-VD, STC-VM, and ST-VM than patients without ST depression. The sensitivity and specificity of identifying patients with ST depression at the exercise test were respectively, 71 and 47% for QRS-VD episodes, 58 and 56% for ST-VM episodes, and 55 and 65% for STC-VM episodes. The maximum ST depression at the exercise test was related to the maximum ST depression in vector lead X (r = .44, P < .001) and the number of STC-VM (r = .40, P < .001), ST-VM (r = .37, P < .001), and QRS-VD (r = .33, P < .001) episodes on the VCG. In multivariate analysis, maximum ST depression in vector lead X and STC-VM episodes were the best determinants for ST depression at the exercise test. In a Cox regression model, the optimal combination of exercise test data in patients who died from cardiac causes exhibited a global chi-square value of 20.0. The combination of these data and the number of STC-VM episodes increased the global chi-square value to 30.6. This study indicates that in patients with acute ischemic heart disease, early continuous vectorcardiographic monitoring may predict the results from a predischarge exercise test and also contributes independent prognostic information beyond that of exercise test data.

Protein quality and digestibility of new high-lysine barley varieties in growing rats

Four new high-lysine barley mutants, the variety 'Lysimax', with the high-lysine gene lys3a and the mutants mother variety 'Sultan' were grown in a field trial in 1993 at Risø, Denmark. Mutants 609, 1242, 1385 and 1405 yielded in the range of 89 to 98 percent and cv 'Lysimax' yielded 102 percent of cv 'Sultan' (100 percent). One-thousand kernel weights for the mutants were in the range of 87 to 97 percent and cv 'Lysimax' 83 percent of cv 'Sultan' (100 percent). Protein contents of the mutants were slightly higher, in the range of 13.2 to 13.6 percent, than of cv 'Sultan' (13.1 percent) and 'Lysimax' which had a protein content of 12.6 percent. Fat content was higher in 'Lysimax' and in the mutants except for mutant 1385 than in cv 'Sultan' while dietary fibre contents of the barleys were similar. The levels of beta-glucans and starch were usually lower in 'Lysimax' and in the mutants. The highest lysine levels: 4.6, 4.0 and 3.7 g/16 g N occurred in cv 'Lysimax' and mutants 609 and 1405 compared to 3.3, 3.3 and 3.2 for cv 'Sultan' and mutants 1242 and 1385, respectively. Mutants 609 and 1405 and cv 'Lysimax' also had higher levels of threonine, histidine and valine. The increased lysine contents resulted in large, at most 20 percent, increases in biological value; 88.8, 81.7 and 78.3 percent for cv 'Lysimax' and mutants 609 and 1405 compared to 74.2 percent for cv 'Sultan'. True protein digestibilities and energy digestibilities were slightly lower in 'Lysimax' than in 'Sultan', 5.3 and 4.3 percentage units, respectively. It is concluded that the development of high-lysine barley varieties is very beneficial for meeting the requirements of indispensable amino acids for humans and monogastric animals. In addition, nitrogen excretion into the environment is drastically reduced due to the higher biological values of the mutants.

Volleyball injuries presenting in casualty: a prospective study

During 1986, all sports injuries (n = 5222) were prospectively recorded at the two casualty departments in Arhus, Denmark. Volleyball injuries (n = 278) accounted for 5.3% of all sports injuries. An evaluation of the rehabilitation period and the consequences of the injuries was undertaken by questionnaire three years after the injury. The injury incidence was 1.9 injuries/1000 inhabitants/year. Hand, finger, and ankle sprains were the most frequent injuries. Female players had significantly more hand/finger injuries than male players, who incurred more ankle/foot injuries. Knee (6%) and ankle injuries (31%) were responsible for the longest duration of absence from sports participation. There were relatively few chronic injuries. The study suggests the need to enhance prophylactic measures with regard to blocking and overhand pass techniques, in order to reduce the number and extent of ankle and hand/finger injuries.

Severe eosinophilia and hepatocellular carcinoma: an unusual association

Peripheral eosinophilia is an unusual but recognized paraneoplastic manifestation of malignant diseases. We report a case of eosinophilia associated with hepatocellular carcinoma which is the second case described in English literature.

Measuring dependence in smokeless tobacco users

Two scales based on the Fagerstrom Tolerance Questionnaire were developed to measure dependence in smokeless tobacco users. The total score for both scales correlated positively with saliva cotinine levels in subjects, and several individual items produced equally positive correlations. Regression analyses yielded two subsets of three items from each scale that predicted cotinine level. Reports of using smokeless tobacco within 30 min of waking served as a predictor in both models. For the purposes of measuring smokeless tobacco dependence, attention should be given to individual items correlated with saliva cotinine levels that could be used to determine the direction of cessation efforts. Future research should also develop additional items specific to the use of snuff or chewing tobacco and eliminate questions not contributing to the overall scale.

Effects of treatment on cardiovascular risk among smokeless tobacco users

BACKGROUND

Studies show sustained levels of nicotine among young males using smokeless tobacco, causing concern for subsequent cardiovascular risk. Also, there is little information on effects of nicotine replacement on cardiovascular risk in cessation programs. This study investigates the effects of nicotine gum replacement in smokeless tobacco cessation on cardiovascular risk factors.

METHODS

Smokeless tobacco users, ages 18-65, were randomly assigned in a double-blind fashion to 2-mg nicotine or placebo gum. At baseline, Week 4, and Week 8, dependent measurements, heart rate, blood pressure, and weight were recorded, and fasting lipoprotein profiles were drawn.

RESULTS

This paper focuses on the smokeless tobacco users who refrained from use during the study period (N = 56). The nicotine gum group weighed less (P = 0.033) than the placebo group throughout the study and weight increased at a significant rate between Weeks 4 and 8 for both groups as gum decreased. Triglycerides were higher for the nicotine gum group than the placebo group (P = 0.031), with triglycerides decreasing between Weeks 4 and 8, with a similar effect seen among nonabstinent smokeless tobacco users. There was no dose, time, or dose by time effect for the other dependent measures.

CONCLUSIONS

Among smokeless tobacco users who were abstinent, weight increased, with subjects on nicotine gum weighing less throughout the study. The lipoprotein profile, heart rate, and blood pressure did not improve over time, contrary to smokers in whom HDL increases and heart rate decreases with cessation. This could relate to different routes of administration, pharmacokinetics, or by-products of tobacco smoking being absent in smokeless tobacco. In addition, nicotine gum appeared to have neither an adverse nor a positive effect on heart rate, blood pressure, LDL, HDL, or total cholesterol.

Inheritance of rapeseed (Brassica napus)-specific RAPD markers and a transgene in the cross B. juncea x (B. juncea x B. napus)

We have examined the inheritance of 20 rapeseed (Brassica napus)-specific RAPD (randomly amplified polymorphic DNA) markers from transgenic, herbicide-tolerant rapeseed in 54 plants of the BC1 generation from the cross B. junceax(B. junceaxB. napus). Hybridization between B. juncea and B. napus, with B. juncea as the female parent, was successful both in controlled crosses and spontaneously in the field. The controlled backcrossing of selected hybrids to B. juncea, again with B. juncea as the female parent, also resulted in many seeds. The BC1 plants contained from 0 to 20 of the rapeseed RAPD markers, and the frequency of inheritance of individual RAPD markers ranged from 19% to 93%. The transgene was found in 52% of the plants analyzed. Five synteny groups of RAPD markers were identified. In the hybrids pollen fertility was 0-28%. The hybrids with the highest pollen fertility were selected as male parents for backcrossing, and pollen fertility in the BC1 plants was improved (24-90%) compared to that of the hybrids.

[Waiting lists--how valid are the official numbers? Evaluation of a waiting list at a department of orthopedic surgery]

With increasing waiting lists for admission to hospital, the aim of this study was to investigate the reliability of an orthopaedic waiting list. Questionnaires were sent to every patient listed as waiting for more than three months. The questionnaire addressed the current symptoms and the current need for surgical treatment. In case of no reply, a further evaluation was done before eventual removal from the waiting list. Of 809 questionnaires mailed, replies were received from 409. A total of 376 were removed from the list, including 111 due to registration errors in the central data base. This study has shown how the indication for operation changes during the waiting period but also that information from data bases can be most unreliable. We find the reasons so general, that we recommend a corresponding evaluation of other waiting lists. Altogether, today's waiting list is faulty and thus provides a wrong basis for management.