Value of the H-Q interval in patients with bundle branch block and the role of prophylactic permanent pacing

His bundle electrograms were obtained in 313 patients with chronic bundle branch block who were followed for a mean period of almost 3 years. The infranodal conduction time (H-Q interval) was less than 55 ms in 97 patients (Group I), 55 to 69 ms in 99 patients (Group II), and greater than or equal to 70 ms in 117 patients (Group III). There was a higher incidence of organic heart disease in patients in Group III, but the groups were otherwise comparable. On follow-up study, mortality and the incidence of sudden death were similar among the groups, but patients in Group III had a greater incidence of progression to high degree atrioventricular block (HDB) than did those in Groups I and II (14 of 117 [12%] versus 4 of 97 [4%] and 2 of 99 [2%], p less than 0.01, respectively). High degree block was found in 4 of 17 (24%) patients with an H-Q interval (H-Q) greater than or equal to 100 ms. Sixty-two patients underwent permanent prophylactic pacemaker insertion at the discretion of the referring physician and were compared with 231 patients who did not. Paced patients had a higher incidence of transient neurologic symptoms and prolonged H-Q, but the groups were otherwise comparable. On follow-up study, mortality and the incidence of sudden death were similar among the groups, but symptom relief was significantly more common among patients with pacemakers. In conclusion, in our population (1) H-Q greater than or equal to 70 ms was an independent risk factor for progression to HDB, (2) H-Q greater than or equal to 100 ms identified a subgroup at particularly high risk, and (3) prophylactic pacemakers relieved neurologic symptoms but did not prolong life.

Ninety-nine "tomboys" and "non-tomboys": behavioral contrasts and demographic similarities

Two samples of female children with diverse patterns of sex-typed behaviors are described. Fifty traditionally sex-typed and 49 nontraditionally sex-typed girls are contrasted. Their age range is 4-12 years. They are widely divergent on sex-typed preferred toys, gender of peer group, participation in sports, roles taken in playing house, and stated wish to be a boy. Their parents do not differ on age, marital status, religion, or number of children. These descriptions provide the baseline for a forthcoming series of papers describing the development of these divergent patterns of sex-typed behaviors and the association of these early patterns with later psychosexual and psychosocial attributes.

The relationship between alcohol consumption, liver enzymes and high-density lipoprotein cholesterol

High-density lipoprotein (HDL) cholesterol concentrations are inversely related to risk of heart attack. Alcohol consumption is a primary factor related to increased HDL concentrations. We investigated HDL cholesterol before and after cessation of high alcohol consumption in alcoholics. Men admitted to an alcohol detoxification hospital had a mean HDL cholesterol level of 85 mg/dl, which is almost twice that found in the general population. After 4 days of treatment, HDL cholesterol levels decreased an average of 12.5 mg/dl. The decrease was directly correlated with the initial HDL cholesterol levels and inversely correlated with the change in triglyceride levels. Alcoholics who abstained for at least 1 month had HDL cholesterol concentrations similar to those of the general population. The increased HDL cholesterol levels in the alcoholics were highly correlated with liver enzyme concentrations, especially SGOT. The results suggest that alcohol increases HDL cholesterol concentrations through hepatic microsomal enzyme induction.

Childhood sexual identity, childhood religiosity, and "homophobia" as influences in the development of transsexualism, homosexuality, and heterosexuality

We have studied the interaction between boyhood cross-gender behavior, "homophobia," and religiosity in men raised as Catholics who, during adulthood, considered themselves transsexual, homosexual, or heterosexual. The sample consisted of 43 transsexual, 78 homosexual, and 43 heterosexual subjects matched for age, race, educational level, and economic status. The transsexual men recalled the most "feminine" behavior during boyhood, followed by the homosexual men. The heterosexual group was most "homophobic," followed by the transsexuals. "Homophobia" positively correlated with religiosity among adult transsexuals and heterosexuals. Transsexuals, recalling childhood, perceived their parents as being more religious than did the homosexuals. At intermediate levels of "femininity," greater "homophobia" scores were associated with more transsexual characteristics. These data support the thesis that early developmental aspects of sexual identity, and later concerns over homosexuality that are partly of a religious derivative, may contribute to a transsexual outcome.

Modification, by tractive loading, of the energy cost of walking in sheep, cattle and man

1. A study was made in sheep and cattle walking on a treadmill, of the alteration to the energy expenditure that was caused by voluntarily exerted tension in the tether between animal and treadmill. 2. An additional experiment was carried out to investigate in human subjects walking on a treadmill, the alteration to the energy expenditure as a result of positive and negative tractive loads applied at waist level through a rope parallel to the plane of the treadmill. 3. Alterations to the net energy expenditure when walking were generally similar in the three species and varied with speed and gradient up to a maximum value of approximately 0.04 J per metre walked per gram of tension or negative load.

A technique developed for isolated canine papillary muscle function in various plasmas; and utility ascertained with plasma containing myocardial depressant factors

Isolated papillary muscles from young dogs were studied to determine the feasibility of utilizing plasma, without added foam depressants, as a test solution to support muscle function. Diluted canine plasma, undiluted canine plasma, plasma with adjusted protein content, monkey plasma, and plasma containing myocardial depressant factors (MDF) were evaluated. For each test, each papillary muscle served as its own control, with either Krebs-Henseleit solution or a control plasma to establish a basis for evaluation of the test plasma. A technique was implemented to oxygenate the muscle, in plasma, without foam production and to monitor pH continuously. These studies indicated that plasma (diluted, undiluted, or with protein adjustments to accommodate experimental procedural requirements) was a satisfactory test solution. Furthermore, plasma from species unrelated to the dog could be utilized. In utilizing plasma, it was essential to establish or adjust the pH and osmolarity for normal muscle function. These studies with plasma containing MDF indicated that MDF depressed canine papillary muscle function. The Vmax values and Po values were decreased and latency was increased. The effects of MDF in canine papillary muscle preparations were completely reversible in short-term studies (up 10 10 hours' duration).

Specific clonal regulation in the response to phosphocholine. I. Genetic analysis of the response of a distinct idiotype (M511 Id)

The genetic basis of the BALB/c anti-PC response pattern was studied in allotype and H-2 congenic mouse strains. In both a T-dependent (PC-KLH) and a T-independent (R36A) system, one of the major anti-PC idiotypes, the M511 IdI, is under specific clonal regulation. The expression of the two other major anti-PC idiotypes, T15 and M603X, is independent of such control. The expression of the M511 IdI is controlled by more than one gene, with at least one of the genes unlinked to either the Igh or the H-2 locus. Low responder mice, such as BALB/c, possesses the relevant genetic information coding for the H and L chains of the M511 Idi-positive antibodies, indicating that the expression of this idiotype is dependent on a specific regulatory mechanism.

Specific clonal regulation in the response to phosphocholine. I. Genetic analysis of the response of a distinct idiotype (M511 Id)

The genetic basis of the BALB/c anti-PC response pattern was studied in allotype and H-2 congenic mouse strains. In both a T-dependent (PC-KLH) and a T-independent (R36A) system, one of the major anti-PC idiotypes, the M511 IdI, is under specific clonal regulation. The expression of the two other major anti-PC idiotypes, T15 and M603X, is independent of such control. The expression of the M511 IdI is controlled by more than one gene, with at least one of the genes unlinked to either the Igh or the H-2 locus. Low responder mice, such as BALB/c, possesses the relevant genetic information coding for the H and L chains of the M511 Idi-positive antibodies, indicating that the expression of this idiotype is dependent on a specific regulatory mechanism.

Alpha 1-antitrypsin (pi) phenotypes in a village population from The Gambia, West Africa. Evidence of a new variant occurring at a polymorphic frequency

A total of 701 individuals from a village in The Gambia, West Africa were tested for serum alpha 1-antitrypsin phenotypes by isoelectric focusing in thinlayer polyacrylamide gels (pH 4--5). A new variant allele, PiGAM, was discovered at a polymorphic frequency (0.0642), and the inheritance of the variant phenotype was confirmed by family studies. The variant was not found to be associated with any decrease in serum alpha 1-antitrypsin concentration. The only other allele found within this population was the common allele PiM (0.9358).

A physiological model for hepatic metabolism of transferrin-bound iron

Hepatic iron and transferrin uptake following intravenous injection of purified native rat transferrin has been studied in the rat. Livers were removed at varying time intervals postinjection and were fractionated by isopycnic density gradient centrifugation. Neither 59Fe or 125I (labeling transferrin) appeared in the lysosomal or mitochrondrial fractions at any stage up to 14 days. 59Fe first appears in the supernatant zone of the sucrose gradient and with increasing time postinjection passes through regions of increasing density. By 16 h 59Fe became established at a density of 1.10 g/cm3 and it was identified as ferritin. Ferritin persisted labeled with 59Fe for up to 14 days. The study suggests hepatic iron uptake does not involve endocytosis. Iron is incorporated into ferritin of increasing density. This model can be used for the study of iron metabolism in human biopsy samples.

Epidemiological studies of rubella virus in a tropical African community

The single-radial-haemolysis test for antibody to rubella virus provides a simple rapid method for carrying out large serological surveys. The availability of a collection of sequential serum samples from inhabitants of two Gambian villages, Manduar and Keneba, made it possible to determine the pattern of rubella epidemics in these communities between 1966 and 1976. The serological findings indicated that an epidemic had occurred approximately two years before the commencement of the study. There was no further evidence of rubella infection until approximately 1973 when a large-scale epidemic occurred. Although the communities were monitored throughout the period of study there was no clinical evidence of infection and no cases of congenital rubella syndrome.

Virulence of Streptococcus mutans: revertants of mutant C4

Mutant C4, a poor plaque-forming mutant of Streptococcus mutans 6715-HSR, was employed to obtain isolates resembling the parent strain (a plaque former). Seventeen presumptive revertants, as identified by colonial morphology, were isolated from mutant C4 after enrichment cycles in a sucrose-glass beads medium. These isolates displayed properties which resembled the parent in ability to produce plaque, patterns of fermentation, and resistance to streptomycin. In a detailed study, five selected isolates were found to be similar to the parent type 6715-HSR with respect to content of the serotype antigen, sucrose- or dextran-induced cell aggregation, glucosyltransferase and adherence activities, and cariogenicity. Thus, in selection for revertants to parental colonial morphology, the pleiotropic changes in plaque formation, adherence, glycosyltransferase activity, and virulence demonstrated by C4 all concomitantly reverted to their parental phenotypes.

Structural characteristics of interferons from mouse Ehrlich ascites tumor cells

An improved procedure for the isolation of interferons produced by mouse Ehrlich ascites tumor cells infected with Newcastle disease virus provides interferons of three size classes (33,000, 26,000, and 20,000 daltons) with specific activities between 2 and 3 x 10(9) units/mg of protein and a yield of 11 to 20%. The tryptic peptide maps of the two larger species are very similar; that of the smallest species is different, at least in part. The amino acid compositions of the three species are very close. Their NH2-terminal amino acids are identical and so are the amino acids released by carboxypeptidase A treatment. These data are consistent with the possibility that the differences in size between the three species may be due, at least in part, to unequal glycosylation.

Serum protein polymorphisms in a village community from the Gambia, West Africa (Hp, Tf, and Gc)

Serum samples from 857 inhabitants of the village of Keneba, The Gambia, West Africa, were examined by means of polyacrylamide gel electrophoresis. In 203 cases no haptoglobin could be detected, whilst in the remaining 654 samples the three common haptoglobin phenotypes were found with gene frequencies of 0.651 (Hp1) and 0.349 (Hp2). The D1 transferrin variant gene was found with a frequency of 0.025. In the serum Gc system the fast variant Gc-Ab was detected, the gene frequencies being: Gc1, 0.943; Gc2, 0.044; and GcAb, 0.013.

Results from a new renal transplantation unit

158 kidneys, 9 from living related donors and 149 from cadavers, have been transplanted in the first 42 months of the establishment of a transplant unit at Oxford. Patients' ages ranged from 11 to 56 (mean 35) years. Azathioprine and prednisolone alone were used for immunosuppression, and a minimum-transfusion policy was in operation throughout. After cadaveric transplantation actuarial patient-survival is 70% and 68%, respectively, at the same intervals. 85% of patients who had a functioning graft are fully rehabilitated. Matching for HLA-DR, pregraft blood-transfusions, and the finding that a transplant could be performed in the presence of a positive B-cell crossmatch have proved to be the most significant of the many factors examined both prospectively and retrospectively. The function of the unit is based on dialysis and transplantation for all patients in end-stage renal failure, with transplantation being considered the first line of treatment for patients under the age of 56. The results of transplantation reported here, which have been achieved with conventional immunosuppressive therapy and minimum-transfusion policy, might be considered a standard against which modifications of the practice of renal transplantation can be compared.

Red cell glucose 6 phosphate dehydrogenase genotypes of the population of two West African villages

Blood samples from 1109 individuals, residents of two villages in The Gambia, West Africa, have been examined for red cell G6PD. Using both starch gel electrophoresis and a spectrophotometric assay, preliminary phenotypes were assigned to the 519 males and 590 females. The G6PD genotypes were established by reference to the family trees of the two village populations. In addition to the G6PD alleles B+, A+ and A-, a fourth allele, representing a new variant of human G6PD was discovered between the two villages, despite their being of the same tribal origin and only five miles apart.

Isoelectric focusing of human red cell phosphoglucomutase: the distribution of variant phenotypes in a village population from the Gambia, West Africa

A total of 637 individuals from the rural village of Keneba in The Gambia, West Africa, have been typed for red cell PGM using isoelectric focusing (pH 5--7) in polyacrylamide gels. Eight different phenotypes have been detected. The frequency of the four alleles at the PGM1 locus was found to be PGM1+(1) 0.795, PGM1-(1) 0.053, PGM2+(1) 0.133, AND PGM2-(1) 0.019. A study of the PGM phenotypes in 89 families confirmed the simple Mendelian codominant inheritance of the four alleles. Comparative population data suggest that red cell PGM typing by isoelectric focusing might prove to be a useful genetic marker in anthropological studies.

A new variant of human erythrocyte G6PD occurring at a high frequency amongst the population of two villages in The Gambia, West Africa

During the course of a large survey of red cell G6PD genotypes in The Gambia, a slow electrophoretic variant with reduced enzyme activity was found to occur at a high frequency. This variant, G6PD Gambia, was found in the following genotypic combinations: males; G6PDGam, females; G6PDA+/Gam, G6PDB+/Gam, and G6PDA-/Gam. From the electrophoretic mobility and kinetic characteristics it was concluded that G6PD Gambia was a hitherto unreported variant of G6PD. The frequency of the G6PDGam gene amongst the 1109 individuals examined was 0.024.

Clearance of myelin basic protein from blood of normal and EAE rabbits

The rate of clearance of porcine myelin basic protein (MBP) from plasma of rabbits was determined following intravenous injection of 20 mg MBP. The MBP level in the plasma was measured by a 2-site immunoradiometric assay with specific antibody to guinea pig MBP produced in rabbits. Plasma MBP-antibody levels were determined by competitive binding radioimmune assay (RIA). Unsensitized and those sensitized with complete Freund's adjuvant (CFA), with porcine MBP in CFA, and with whole porcine spinal cord in CFA were studied. Unsensitized and CFA sensitized rabbits exhibited maximum MBP levels in the plasma within two minutes after injection with rapid decrease to undetectable levels in one hour. Thirty-nine of the unsensitized (control) rabbits exhibited normal, rapid clearance and no subsequent physical signs of EAE while one of the control rabbits exhibited a slightly retarded clearance rate. Histologic examination of autopsy tissues from the control group revealed that five rabbits showed lesions which could be attributed to Encephalitozoan cuniculi or Toxoplasma and one rabbit autopsied 65 days after clearance had minimal EAE lesions. Rabbits sensitized with MBP exhibited a retarded rate of clearance at the acute stage of EAE and following recovery. Rabbits sensitized with whole spinal cord in CFA also exhibited a retarded rate of MBP clearance. Anti (MBP) antibodies were detected in the plasma of all rabbits which exhibited a retarded rate of MBP clearance. Significant rates of retardation were not detected until approximately three weeks after sensitization with CFA-MBP or CFA-spinal cord. While MBP antibody levels in most animals were not detected by the immunodiffusion technique, antibodies were demonstrated by RIA. The 20 mg MBP given intravenously is probably in great antigen excess and conducive to the formation of soluble MBP-anti (MBP) complexes in the blood.

Influenza infections during pregnancy in the mouse

The effect of a sublethal dose (0-5 LD50) of influenza A/WSN (H0N1) administered intranasally in the 1st and 3rd weeks of pregnancy was studied in C3H inbred mice. Maternal and neonatal mortality rates were significantly increased by infections in the 3rd week of pregnancy, but not in the 1st week. Infections during the last part of the 1st week significantly depressed the growth rate of neonates. No evidence of viraemia, transplacental transmission or congenital malformations were observed from infections during either week. The results are discussed in terms of a possible model for human influenza infections during pregnancy to determine the potential risks to the mother, fetus and neonate.

Renal transplantation and a positive serological cross-match

A renal transplant involving a recipient with a positive serological cross-match against donor lymphocytes generally results in hyperacute rejection of the graft. 13 cadaveric renal transplants were performed in recipients with a known positive serologic cross-match against donor B lymphocytes. 12 of these serological cross-matches were positive against donor blood, node, or spleen lymphocytes, but the reactivity was directed against donor B lymphocytes only. 3 transplants failed, 2 because of rejection and 1 because of renal-artery thrombosis. 10 transplants are functioning, 6 to 42 weeks after the operation. Of these 10 successful grafts, 3 had no acute rejection episodes, while 7 had an early acute rejection episode which responded to treatment. Histologically, the grafts showed a cellular rejection, similar to that in enhanced renal allografts in the rat. It is possible to transplant a kidney in a high-risk patient with a positive B lymphocyte cross-match with a low risk of failure. In addition active enhancement of the graft might sometimes occur.

Influenza A virus and its influence on the outcome of pregnancy in the mouse

The effect of sub-lethal doses of influenza A strains WSN (H0N1), MEL (H0N1) and MRC-7 (H3N2) administered intranasally during pregnancy was studied in C3H inbred and Prince Henry outbred mice. Maternal and neonatal mortality rates were significantly increased by infections in the last third of the gestational period. Infection with influenza strain WSN in the last part of the first third of the gestational period significantly depressed the growth rate of neonates. No evidence of viraemia, transplacental transmission or congenital malformations were observed. Invasion of alveolar spaces by mononuclear phagocytes and erythrocytes was more pronounced in pregnant mice infected in the last third of the gestational period than in non-pregnant mice, and paralleled an ablation of cell-mediated immune responsiveness.

The use of transportable single-radial-diffusion immunoplates in seroepidemiological studies of influenza in the Gambia. The occurrence and persistence of antibody to influenza A/Hong Kong/68 (H3N2) virus in selected inhabitants of two rural villages

Seroepidemiological studies of influenza in the Gambia were made using transportable single-radial-diffusion immunoplates containing A/Hong Kong/68 (H3N2) virus as antigen. The frequency and durability of antibody so detected in selected residents of two Gambian villages (Manduar and Kafuta) are described. Transportable immunoplates were found to be an effective method for the serological surveillance of influenza and to be applicable in studies in remote areas where laboratory facilities may not be available. Results indicated that infection with influenza was widespread in Manduar residents on several occasions between 1968 and 1974 and that reinfection with A/Hong Kong/68 virus or its antigenic variants occurred frequently. Serum levels of antibodies to the haemagglutinin and neuraminidase antigens of the A/Hong Kong/68 virus often persisted for only a short time (mean half-life about 28 days), particularly after first infections. Antibody persistence increased following repeated reinfection. No precise explanation can be offered at present for the relatively short persistence of antibodies in Gambians. Possible reasons include genetic and environmental factors, depressed immunological reactivity associated with concurrent infection (notably parasitic diseases), and unusually high rates of synthesis and catabolism of immunoglobulins. The value of transportable immunoplates for serological surveys and for accurate assessment of antibody persistence is discussed.

The Duffy blood group and malaria prevalence in Gambian West Africans

Erythrocytes from 1,168 donors, comprising almost the entire populations of two rural Gambian villages, have been tested for Duffy blood group antigens using antisera to both Fya and Fyb. All tests were negative. Blood film examination of the same samples showed complete absence of Plasmodium vivax parasitaemia, but infections with P. falciparum,P. malariae and P. ovale were observed. The findings are consistent with the view that the Duffy-negative phenotype, FyFy, constitutes the basis of innate resistance towards infection with P. vivax but not towards infection with the other plasmodial species.

Anti-inflammatory actions of dapsone and its related biochemistry

Dapsone has been examined by two established animal anti-inflammatory models and found to possess anti-inflammatory activity comparable with established non-steroidal anti-inflammatory drugs. Dapsone also possess some biochemical properties common to other anti-inflammatory drugs.

Precipitating antibody response to malarial S-antigens

The gel diffusion test has been used to detect antibodies to malarial S-antigens. Sera were obtained from entire Gambian village communities, from young children with acute P. falciparum malaria, from children convalescent from such infections and from immune adults. In community studies, small selections of S-antigens detected antibody frequently in sera from older persons but rarely in sera from young children. Larger panels of antigens detected antibodies in sera from half of 50 malarious children while homologous antibody responses were observed in 22% of 267 children followed at intervals during convalescence from malaria. In these latter cases, antibody tended to appear more swiftly when antigen was lost rapidly from the circulation, and observations made on individual responses indicated that antibody production was influenced by factors other than the intrinsic properties of the antigens. In adult sera antibodies usually occurred in association with IgG.

L-asparaginase reinduction and maintenance therapy in previously treated acute lymphocytic leukemia

Four patients with acute lymphocytic leukemia previously treated with conventional chemotherapy received intramuscular L-asparaginase in combination with other chemotherapy for reinduction and maintenance therapy. These patients received the L-asparaginase for 8, 14, 27, and 34+ months without demonstrating any significant adverse effects. Only 1 of the 4 was clearly resistant to the other chemo-therapy, and 3 of 4 had recurrence of their disease while receiving L-asparaginase. L-asparaginase can be added to reinduction and maintenance regimens of patients resistant to other chemotherapy and is well tolerated for long periods when given intramuscularly weekly with other immunosuppressant agents.

A convenient preparative method for tryptophan benzyl esters

The utilization of amino acid benzyl esters in synthetic peptide procedures offers advantages over the corresponding methyl or ethyl derivatives. Whereas the latter groups must by cleaved by alkaline saponification, the benzyl ester function can be removed by acidolysis or by catalytic hydrogenation under conditions which permit the simultaneous cleavage of N-acyl-protecting groups such as t-Boc or CBzl.*

Occurrence of S-antigens in serum in Plasmodium falciparum infections in man

Gambians with severe Plasmodium falciparum infections frequently have malarial S-antigens in their serum or plasma. Detection of these with the available antisera which are from immune adults is complicated because there are many different S-antigens and none of the antisera contains antibodies to them all. Despite this we found S-antigens in about 60% of a large series of malarious children and demonstrated that this was a considerable underestimate of the true incidence. We also showed that the prevalence of S-antigens was related to the malaria season and to the intensity of infection.

Red cell glutamate-pyruvate transaminase gene frequencies in Gambia, West Africa

The red cell GPT phenotypes have been determined in two village populations in Gambia, West Africa. A total of 887 people have been investigated. The results confirm the previous observations that the frequency of the GPT gene is far higher in African populations than Caucasian populations.