Natural killer cells are required for accelerated type 1 diabetes driven by interferon-beta

The destruction of beta cells by the islet infiltrating lymphocytes causes type 1 diabetes. Transgenic mice models expressing interferon (IFN)-beta in beta cells, in the non-obese diabetic (NOD) strain and in a diabetes-free, major histocompatibility complex-matched, homologous strain, the non-obese resistant (NOR) mice, developed accelerated type 1 diabetes after 3 weeks of age. Our aim was to determine if natural killer (NK) cells could affect the acceleration of the disease. We determined the amount of NK cells in the pancreas, spleen and lymph nodes from NOD rat insulin promoter (RIP)-IFN-beta mice. Pancreatic cytokines were assessed by quantitative real-time polymerase chain reaction and protein arrays. To confirm the relevance of NK cells in the acceleration of autoimmune diabetes this subset was depleted with anti-asialo GM1 antibodies. An increase of intrapancreatic NK cells characterized the accelerated onset of diabetes both in NOD and NOR RIP-IFN-beta transgenic models. Cytokines involved in NK function and migration were found to be hyperexpressed in the pancreas from accelerated diabetic mice. Interestingly, the depletion of NK cells in vivo abolished completely the acceleration of diabetes. NK cells connect innate to adaptive immunity and might play a role in autoimmunity. We report here that NK cells are required critically in the pancreas for accelerated diabetes. This model links inflammation to acceleration of beta cell-specific autoimmunity mediated by NK cells.

Reg (regenerating) gene overexpression in islets from non-obese diabetic mice with accelerated diabetes: role of IFNbeta

AIMS/HYPOTHESIS

The expression of IFNbeta in beta cells results in accelerated type 1 diabetes. The REG family of beta cell proliferation factors have been described as autoantigens in autoimmune diabetes. The aim of this study was to determine the effect of IFNbeta on Reg expression, and the implications of this in terms of autoimmunity.

METHODS

Reg gene expression was determined in islets from non-obese diabetic (NOD) RIP-HuIFNbeta mice by cDNA microarray, quantitative real-time PCR and immunohistochemistry. The effect of IFNbeta on Reg1 and Reg2 expression was assessed in the NOD insulinoma cell line NIT-1. IL-6, known to induce Reg expression, was measured in the insulitis microenvironment. Morphological studies were carried out to determine islet enlargement in this model.

RESULTS

Reg2 was upregulated in islets from the NOD RIP-HuIFNbeta mice at the onset of the autoimmune attack. IFNbeta upregulates Reg1 and Reg2 genes in NIT-1 cells. The expression of Il6 was increased in islets from transgenic mice and in NIT-1 cells exposed to HuIFNbeta. Moreover, islets from transgenic mice were enlarged compared with those from wild-type mice.

CONCLUSIONS/INTERPRETATION

Reg overexpression correlates well with the acceleration of diabetes in this model. The upregulation of Reg suggests that islets try to improve hyperglycaemia by regenerating the cells lost in the autoimmune attack. Reg expression is regulated by several factors such as inflammation. Therefore, the overexpression of an IFNbeta-induced autoantigen (REG) in the islets during inflammation might contribute to the premature onset of diabetes.

Syngeneic islet transplantation into seminal vesicles of diabetic rats

Pancreatic islet transplantation has been proposed as an attractive option for the treatment of type I diabetes. Transplantation into different sites has been investigated, among them those that are immuno-logically privileged (e.g., thymus, uterus, brain, anterior eye chamber, and testicle). Because of their characteristics, seminal vesicles could be considered as immunologically privileged organs, but there is no worldwide experience that can confirm it. The purpose of the present study is to assess the viability and functionality of islet transplantation into seminal vesicles of diabetic rats. One hundred ninety inbred adult male syngeneic Lewis rats were used as donors (n = 72), receptors (n = 36), and controls(n = 11). Diabetes was chemically induced through a single intraperitoneal injection of streptozotocin. Groups of 1200 purified islets were introduced in the right seminal vesicle of diabetic rats. Diabetic control rats were sham transplanted. Body weight and glycemia were monitored every 2 d. Of transplanted rats, 16.7% achieved a good function due to islet engraftment, while 30.6% achieved a partially good response, and 52.7% were considered as nonresponding. This is the first report about islet transplantation into seminal vesicles of diabetic animals. Our results indicate that islet transplantation into rat seminal vesicles is technically possible, and that islets can function normally after engraftment into the wall of the seminal vesicle.

Evidence of expression of endotoxin receptors CD14, toll-like receptors TLR4 and TLR2 and associated molecule MD-2 and of sensitivity to endotoxin (LPS) in islet beta cells

CD14, a GPI-linked membrane protein, is a component of the lipopolysaccharide (LPS) receptor complex, one of the pattern-recognizing receptors (PRR) expressed by myeloid lineage cells. Here we report that CD14, the functionally linked toll-like receptor molecules, TLR2 and TLR4, and the associated molecule MD-2 are expressed in endocrine cells of the human pancreatic islets. CD14 expression in human pancreatic islets was determined by immunofluorescence staining of tissue sections and primary cultures, and confirmed by flow cytometry of dispersed normal islets and SV40-transformed islet cells (HP62). The latter cells synthesized and secreted CD14 in response to lipopolysaccharide (LPS) in a time- and dose-dependent manner. Reverse transcription polymerase chain reaction (RT-PCR)-Southern was positive for CD14, TLR2, TLR4 and MD-2 in human pancreas, purified islets and HP62 cells. In vitro experiments using rat islets (also positive for CD14 by RT-PCR) and HP62 cells showed that LPS regulates glucose-dependent insulin secretion and induces inflammatory cytokines [interleukin (IL)-1alpha, IL-6 and tumour necrosis factor (TNF)-alpha]. The functional expression of CD14 and associated molecules in islet beta cells adds a new pathway that islet cells may follow to adjust their function to endotoxaemia situations and become vulnerable to the inflammatory events that occur during diabetogenic insulitis.

Expression of CD3 and CD11b antigens on blood and mammary gland leukocytes and bacterial survival in milk of cows with experimentally induced Staphylococcus aureus mastitis

OBJECTIVES

To differentiate early (1 to 8 days) from late (9 to 14 days) inflammatory phases and assess relationships between leukocyte phenotype and bacterial recovery in cows with Staphylococcus aureus-induced mastitis.

ANIMALS

10 first-lactation Holstein cows.

PROCEDURE

Blood and milk samples were collected from 4 or 6 cows before and after intramammary infusion of sterile broth or S. aureus, respectively. Flow cytometric expression of CD3 and CD11b antigens on blood and milk leukocytes, leukocyte differential counts, bacterial counts in milk, and somatic cell counts were determined longitudinally.

RESULTS

Density of CD3 molecules decreased on blood lymphocytes and increased on milk lymphocytes after infusion of bacteria. Density of CD11b molecules on lymphocytes and phagocytes and percentage of CD11b+ lymphocytes in milk increased significantly after infusion; maximum values were achieved during the early inflammatory phase. Density of CD3 and CD11b molecules on milk lymphocytes and macrophages, respectively, 1 day after inoculation were negatively correlated with bacterial recovery on day 1 and days 9 to 14, respectively. Density of CD11b molecules on milk macrophages and the ratios of phagocyte to lymphocyte percentages and polymorphonuclear cell to macrophage percentages in milk differentiated the early from the late inflammatory phase.

CONCLUSIONS AND CLINICAL RELEVANCE

Activation of bovine mammary gland macrophages and T cells in response to intramammary infusion of S. aureus was associated with an inability to culture this bacterium from milk. Identification of specific inflammatory phases of S. aureus-induced mastitis in cows may allow for the design of more efficacious treatment and control programs.

The dental prosthesis used for intraoral muscle therapy in the rehabilitation of the stroke patient. A preliminary research study

The dentist can maximize the oral rehabilitation of the stroke patient's weak or paralyzed oral musculature, resulting in dysfunctional speech, swallowing and deglutition, with the use of palatal lift and palatal augmentation prostheses. The study described here evaluates functional changes using these prostheses for three post-stroke patients with left hemiparesis. Clinical tests indicated decreased nasal emission and hypernasality, and improved speech articulation. Videofluoroscopy evaluation showed improvement in the oral phase of swallowing. Patient self-assessment indicated improved satisfaction with treatment.

Expression of LRP and MDR1 in locally advanced breast cancer predicts axillary node invasion at the time of rescue mastectomy after induction chemotherapy

BACKGROUND

Axillary node status after induction chemotherapy for locally advanced breast cancer has been shown on multivariate analysis to be an independent predictor of relapse. However, it has been postulated that responders to induction chemotherapy with a clinically negative axilla could be spared the burden of lymphadenectomy, because most of them will not show histological nodal invasion. P-glycoprotein expression in the rescue mastectomy specimen has finally been identified as a significant predictor of patient survival.

MATERIALS AND METHODS

We studied the expression of the genes encoding multidrug resistance associated protein (MDR1) and lung cancer associated resistance protein (LRP) in formalin-fixed, paraffin-embedded tumor samples from 52 patients treated for locally advanced breast cancer by means of induction chemotherapy followed by rescue mastectomy. P-glycoprotein expression was assessed by means of immunohistochemistry before treatment in 23 cases, and by means of reverse-transcriptase-mediated polymerase chain reaction (RT-PCR) after treatment in 46 (6 failed). LRP expression was detected by means of immunohistochemistry, with the LRP-56 monoclonal antibody, in 31 cases before treatment. Immunohistochemistry for detecting the expression of c-erb-B2, p53, Ki67, estrogen receptor and progesterone receptor are routinely performed in our laboratory in every case, and the results obtained were included in the study. All patients had received between two and six cycles of standard 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) chemotherapy, with two exceptions [one patient received four cycles of a docetaxel-adriamycin combination, and the other four cycles of standard cyclophosphamide-methotrexate-5-fluorouracil (CMF) polychemotherapy]. Response was assessed in accordance with the Response Evaluation Criteria In Solid Tumors (RECIST). By these, 2 patients achieved a complete clinical response, 37 a partial response, and the remaining 13 showed stable disease. This makes a total clinical response rate of 75.0%. None achieved a complete pathological response.

RESULTS

MDR1 mRNA expression detected by RT-PCR was associated with the presence of invaded axillary nodes at surgery in 18/22 cases (81.8%), compared with 13/24 (54.2%) in the group with undetectable MDR1 expression. This difference was statistically significant (P < 0.05). LRP expression in more than 20% of tumor cells before any treatment was associated with axillary nodal metastasis after chemotherapy and rescue mastectomy in 17/23 cases, compared with 3/8 in nonexpressors. Again, this difference was highly significant (P < 0.01). LRP expression before treatment and MDR1 mRNA expression after treatment were significantly interrelated (P < 0.001), which might reflect the presence of chemoresistant clones liable to metastasize to the regional nodes. Persistence of previously detected MDR1-positivity after treatment (7/9 compared with 0/2 cases) was significantly associated with axillary node metastasis (P < 0.05). Finally, in a logistic regression multivariate model, histology other than ductal, a Ki67 labeling index of at least 20% and the combination of LRP and MDR1 positivity emerged as independent predictors of axillary node invasion at the time of rescue mastectomy.

CONCLUSION

The expression of different genes involved in resistance to chemotherapy, both before and after treatment with neoadjuvant, is associated with the presence of axillary node invasion at rescue surgery in locally advanced breast cancer. This might reflect the presence of intrinsically resistant clones before any form of therapy, which persist after it, and could be helpful both for prognosis and for the choice of individual treatment.

[Epidemic rhabdomyolysis due to the eating of quail. A clinical, epidemiological and experimental study]

BACKGROUND

Few toxic outbreaks by quails ingestion have been described, none in Spain, and the toxic hasn't been identified. A toxic outbreak, by quails ingestion that ate Galeopsis ladanum seeds, is described and an animal model is developed.

PATIENTS AND METHODS

A rhabdomyolysis outbreak by quails ingestion is studied clinical and epidemiologically. Quails crops were analyzed and 20 patients were studied. A murine model was developed. Alcaloid content in Galeopsis ladanum seeds and quail meat was measured.

RESULTS

Twenty patients suffered from rhabdomyolysis (myalgia, increase of muscular enzymes and myoglobinuria) by ingestion of quails that ate Galeopsis ladanum seeds as it could be seen at their crops. Six patients needed hospital care but evolution was benign. Rats fed with quails that ate Galeopsis ladanum seeds had higher creatinkinase (CK) levels than controls rats (near significance, p = 0.0588). Several alcaloids, stachydrine included, was detected in seeds. Another alcaloid no identified was detected in quails meat.

CONCLUSIONS

Quails that eat Galeopsis ladanum seeds are toxic for human beings, causing rhabdomyolysis. A plant alcaloid could be the toxic involved in the outbreak.

Carbon monoxide trend, meteorology, and three-way catalysts in Mexico City

From the analysis of data of the Inspection/Maintenance (I/M) program, and of the long-term trend of ambient CO concentrations in Mexico City, it is inferred that three-way catalysts (TWCs) have a 45% efficiency, well below the expected 90% value. The most probable causes are sulfur poisoning, lead contamination, and ceramic breakage due to bumps and potholes on the streets. Also, we have found a ratio between the average daily peak value of atmospheric CO and gasoline consumption: (11 +/- 1) ppbCO/MLm (million liters of gasoline per month) in 1988 decaying to (10 +/- 1) in 1991 for Mexico City before the introduction of TWCs. In addition, we found a correlation between the monthly averages of CO daily peak and meteorological variables, explaining most of the seasonal changes using only the intensity of the inversion layer and surface wind speed.

[Prevalence of human immunodeficiency virus infection in drug addicts assisted from 1991 to 1996 at a detoxification center in Castilla y Leon]

BACKGROUND

The Word Health Organization (WHO) has recommended epidemiologic surveillance of infection by the human immunodeficiency virus (HIV) in high risk populations. An important decrease has recently been observed in the prevalence of HIV infection in drug addicts in different regions in Spain with notable differences being found. The evolution of the prevalence of HIV infection in intravenous drug addicts initiating detoxication in Castilla and Leon was analyzed.

METHODS

Six hundred forty-seven drug addicts (535 males and 112 females) were studied over 6 years (1991-1996) analyzing HIV seropositivity, demographic variables, drug use, age of initiation in drug consumption and route used.

RESULTS

Most of the drug addicts were males (83%) with a mean age of initiation in the use of drugs of 19.6 years. Heroine was most frequently consumed in 95% of the patients. The mean length of consumption on admission was 8.6 years with no significant differences being observed in sexes. A relationship was observed between HIV infection and the lower age of initiation in drug usage with the greater the age of admission to detoxication the longer the time having consumed drugs. The prevalence of HIV infection significantly decreased in males and females from 36.8% in 1991 to 17.4% in 1996 (p < 0.0005), with this decrease being related to the change from the intravenous to the smoked route of drug intake. On multivariate analysis by logistic regression the odds ratio at one year of admission was significant (OR = 0.80), years of drug addiction (OR = 1.15), intravenous route (OR = 3.04) and female sex (OR = 2.75).

CONCLUSIONS

A significant decrease has been observed in the prevalence of HIV infection in drug addicts in Castilla and León attending a therapeutic center for detoxication from 1991-1996.

Localization of TIMP-1, TIMP-2, TIMP-3, gelatinase A and gelatinase B in pathological human corneas

PURPOSE

Determine the tissue distribution patterns for tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2, TIMP-3), gelatinase A and gelatinase B in normal and pathologic corneas.

METHODS

Corneas were examined by immunohistochemistry, using antibodies to TIMP-1, TIMP-2, TIMP-3, gelatinase A or gelatinase B.

RESULTS

In normal corneas, TIMP-1 antibody stained the epithelium and endothelium. TIMP-2 and TIMP-3 stained the epithelium, keratocytes and endothelium. Gelatinase A staining was weak and restricted to the epithelial cells. Radial keratotomy scars showed increased staining for TIMP-1 and TIMP-2 around the epithelial cell plug and along the incision. Bullous keratopathy corneas showed TIMP staining patterns similar to normal corneas and increased gelatinase A staining in regions of subepithelial fibrosis. Stromal scars of keratoconus corneas also had increased staining with TIMP-1 and TIMP-2 antibodies. In many keratoconus corneas, the TIMP-3 staining pattern was similar to normal corneas. However, in some keratoconus corneas, when Bowman's layer was missing, the stroma beneath was completely devoid of TIMP-3 antibody staining. No gelatinase B was seen in either the normal or diseased corneas.

CONCLUSION

These data suggest that TIMP-1 and TIMP-2 are important for scar formation and corneal remodeling, since they were found in increased amounts at radial keratotomy incision sites and keratoconus scars. The significance of the focal stromal defects in TIMP-3 staining, associated with absence of Bowman's layer on keratoconus corneas, needs to be elucidated. At the stages of disease examined in this study, gelatinase B may not play a significant role in these pathological processes, since it was not seen in any of the corneas examined.

[The rapid specific characterization of clinical isolates of the genus Mycobacterium by the polymerase chain reaction and restriction enzyme analysis]

BACKGROUND

Typing at species level of Mycobacterium is usually performed by microbiological and biochemical methods that require a long time and/or sufficient amount of bacteria. Molecular biology can avoid these problems using different techniques.

METHODS

A colony growth of the following mycobacteria has been analyzed: M. tuberculosis, M. kansasii, M. avium, M. intracellulare, M. gordonae, M. phlei, M. aurum, M. fortuitum, M. flavescens, M. marinum, M. xenopi, M. nonchromogenicum, M. terrae and M. chelonei. Strains were grown in Löwenstein-Jensen medium. DNA was obtained by proteolytic digestion and fenol extraction. The 16S rRNA gen was amplified by polymerase chain reaction (PCR) and the amplification was digested by HaeIII, HpaII, RsaI and AluI restriction enzymes. Restriction fragment patterns were analyzed by agarose gel electrophoresis and UV transillumination.

RESULTS

The combination of the patterns obtained with HpaII and RsaI was sufficient to generate 13 different combined ones. The patterns of M. intracellulare and M. avium were the same.

CONCLUSIONS

PCR and restriction enzyme analysis is an useful method for typing at species level of clinical isolates of mycobacteria.

Chronic ventilator use in osteogenesis imperfecta congenita with basilar impression: a case report

Osteogenesis imperfecta, a rare connective tissue disorder, is known to be associated sometimes with the invagination of the basilar skull. This deformity may disturb respiratory function secondary to brain stem compression and hydrocephalus. In addition, the deformed thoracic cage and fragile ribs make pulmonary care more complicated. A case of 24-year-old man is presented with brain stem compression syndrome secondary to osteogenesis imperfecta congenita with basilar impression. He developed respiratory failure and became tracheostomy positive-pressure ventilator dependent at the age of 21 years. He also suffered multiple skeletal abnormalities and mental retardation, and following the brain stem compression, severe quadriparesis. The patient's condition is stable since he has been using the ventilator and he is currently living in the community.

[Changes in the spectrum of the diseases in patients hospitalized with HIV infection]

BACKGROUND

Infections in subjects with HIV-1 infection are a frequent cause of hospital admission. Knowledge of the entities which most often motivate hospitalization may aid in designing the most appropriate diagnostic and prophylactic strategies. The causes of hospital admission in individuals with risk practices for HIV-1 infection attended in a Department of Infectious Diseases in Madrid over a period of 4 years were analyzed.

METHODS

The records of the patients admitted from 1989 to 1992 were retrospectively reviewed. The principal and associated diagnoses which led to hospitalization were considered. The admissions of the two years were compared.

RESULTS

Bacterial pneumonias were the principal cause of hospitalization in the 2 years studied. Forty-five percent of the infections leading to hospital admission were not included among those defining AIDS. Tuberculosis was the most frequent opportunistic infection. Admissions due to pulmonary pneumocystosis, tuberculosis, toxoplasmosis, esophageal candidiasis and Kaposi's sarcoma decreased from 1989-1992. To the contrary, disseminated Mycobacterium avium complex infection and systemic infection by cytomegalovirus significantly increased over the same period. The incidence of other diseases such as endocarditis or leishmaniasis remained stable. More than half of the diseases were diagnosed in association with another entity during the same admission. Likewise, an increase in atypical forms of infections thus making diagnosis and treatment more difficult was observed. The first cases of multiresistant tuberculosis, all of rapidly fatal evolution, were identified in 1992. Mean hospital stay increased 30% and the rate of mortality was of 9% in 1989 and rose to 20% in 1992.

CONCLUSIONS

The spectrum of infections which led to hospital admission of patients with HIV-1 infection has significantly modified over the last 4 years being related with the generalization of prophylactic medication for some opportunistic infections, the improvement of certain diagnostic techniques and more frequent ambulatory treatment of some diseases. The mean length of stay and hospital mortality have increased in the HIV+ population.

Influence of exercise on a heart transplant patient

A treadmill training protocol was implemented to examine the effects of a 12-week exercise program on the physiologic status of a patient who had a heart transplant in 1980. The patient was tested for exercise tolerance before programming, midway through the study, and immediately upon completing endurance training. Maximal METS levels achieved were 3.2 METS, 5.6 METS, and 6.3 METS, respectively. The subject began an anaerobic program consisting of 48 exercise sessions over a three-month period. Exercise sessions were interval in nature, walking at 2.5 mph, 0% grade, three repetitions, five minutes each and increasing to 3.0 mph, 2.5% grade, two repetitions, 15 minutes each. The patient improved from Class III (METS = 3.0), where less than ordinary physical activity causes fatigue, to Class I (METS = 6.5), where ordinary physical activity can be sustained without undue fatigue. These findings suggest that selected heart transplant patients may achieve up to 85% maximum oxygen consumption and maximum heart rate which demonstrates the need for endurance training programs in this population. This form of cardiovascular conditioning has enabled the participant to engage in higher levels of activities of daily living within the community.

[Role of x-ray computed tomography in the preoperative evaluation of aneurysm of the abdominal aorta]

The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.

Pneumobelt for sleep in the ventilator user: clinical experience

A pneumobelt with a positive pressure respirator was used for sleep for three patients with chronic respiratory insufficiency secondary to syringomyelia, poliomyelitis, and Friedreich's ataxia respectively. This device was found to be effective in improving and maintaining their daily functioning in the community or institute.

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.

Intermittent positive pressure ventilation via nasal access in the management of respiratory insufficiency

These are preliminary observations of the introduction of a new technique of noninvasive positive pressure respiratory support for patients with subacute or chronic respiratory failure. Clinical situations where intubation or tracheostomy may have been performed were managed by intermittent positive pressure ventilation via nasal access (NIPPV) with a CPAP mask, or a custom constructed Vel-Foam nose piece. Four patients were managed at home with the use of portable volume ventilators. One patient employed the technique while hospitalized with subacute respiratory failure. Two patients, otherwise dependent on mouth intermittent positive pressure ventilation (MIPPV) 24 hours a day, received necessary dental care with NIPPV support. In a large population with a decade or more follow-up, MIPPV was shown to be an effective noninvasive technique to support respiration in patients with the most severe paralytic respiratory failure. Preliminary observations suggest that NIPPV may compare favorably with MIPPV and deserves more widespread study and application.

A matching-to-sample feedback technique for training self-control of tinnitus

Thirty individuals with subjective tinnitus aurium of a variety of types and severity were treated with a matching-to-sample feedback procedure. Following initial evaluation measures, the participants' experienced tinnitus sounds were reproduced audiometrically on all characteristics and were presented to them in the noninvolved ear or in both ears when the tinnitus was binaural. This experimental sound was then reduced in 5 decibel (dB) steps within sessions, and participants had the task of concentrating on reducing the loudness of their tinnitus until a match was achieved between it and the experimental sound at each new dB level. Results showed an overall highly significant difference in dB levels from baseline to final training session. Nearly all participants demonstrated a marked reduction in tinnitus loudness, with 84% reducing it by 10 dB to 62 dB and several eliminating it completely. Individual and pathological variables played no role in training or outcome. Our approach appears to have major advantages over other tinnitus treatment strategies in that it provides direct, significant relief and gives the patient the psychological benefit of gaining control over the problem.

The primary role of the Erb's point--axilla segment in median and ulnar motor nerve conduction determinations in alcoholic neuropathy

Motor nerve conduction velocity (MNCV) was explored in the Erb's point-axilla (N-A) nerve segment of median and ulnar nerves, bilaterally, in 10 patients with a history of prolonged heavy drinking but in whom no other predisposing factors to peripheral neuropathy were found. For comparison, MNCV was determined also in the axilla-elbow (A-E), elbow-wrist (E-W) nerve segments, as well as the motor terminal latency (MTL) of the same nerves. A total of 140 nerve segments were tested tested but only 133 results were obtained. Abnormal MNCV or MTL was found in 36 or 27% of all tested nerve segments. From the latter, 38.9% were in the N-A nerve segments. Of N-A nerve segments tested, reduction in MNCV was found in 46.7%. Our results are statistically significant.

Pd/SiO2–AlPO4 systems. Influence of the preparation variables on their catalytic activity

A study on the liquid phase hydrogenation of cyclohexene over a series of Pd catalysts supported on various SiO2–AlPO4 systems (using a concentration of 2.47 M, with methanol as solvent, the initial hydrogen pressure is 5 bar and reaction temperature 300 K) is reported in this paper. The reaction has been studied as a standard in order to determine the most suitable preparation conditions for these catalystsWe have also studied the influence of other factors such as the kind of support, the nature of the metal precursor, the previous calcination of the precursor, the addition of alkaline hydroxides, and the catalyst reduction with various agents, on the catalytic activity of different Pd-supported systems

Learned self-control of tinnitus through a matching-to-sample feedback technique: a clinical investigation

Two cases are reported in which subjective tinnitus aurium was treated with a matching-to-sample procedure. Following baseline evaluations, the subjects' experienced tinnitus was reproduced audiometrically in terms of loudness, frequency, and quality. This was presented to them in the noninvolved ear and was gradually reduced within sessions. The subjects were required to concentrate on reducing their tinnitus until an equal match had been achieved between it and the stimulus sound at each new decibel level. Both subjects gained control over their tinnitus and were able to reduce it markedly from baseline levels. This procedure is viewed as an advance over other techniques not only in that it significantly reduces the tinnitus but in the fact that it is done through the subject's own control, providing psychological benefit as well.

Respiratory rehabilitation in severe restrictive lung disease secondary to tuberculosis

There is a need for portable and less expensive devices for patients with chronic respiratory insufficiency. The case of a 44-year-old Hispanic woman is illustrative. The patient had severe restrictive lung disease secondary to right phrenic nerve crush/pneumoperitoneum and left pneumonectomy/decortication for bilateral lower lobe tuberculosis. In 1969, 12 years after her last operation, she developed dyspnea, coryza, and somnolence. She was hospitalized with a PaO2 of 30mmHg; PaCO2 of 77mmHg and a pH of 7.28. Pulmonary function tests showed alveolar hypoventilation and her resting ventilation was between 2.26 to 3.74L/min. Her vital capacity was 1130cc (37% of predicted value) and maximum breathing capacity was 36L/min (44% of predicted value). From 1969, she used a poncho (wraparound) ventilator for her long-term respiratory care and modified the poncho suit to meet her personal needs. In 1971, she discovered that a mouth intermittent positive pressure ventilation (MIPPV) method, often used by patients with neuromuscular disorders, was easier to apply. Since then, she has continued to use a Bantam Respirator with MIPPV and a lipguard/mouthpiece during the night, and the respirator with a mouthpiece for a few hours during the days. However, when she has an upper respiratory infection or feels tired, she finds that she needs the greater rest and comfort that the poncho provides. With the assistance of these two respiratory devices, she has been able to complete her education, marry, and lead a fulfilling life in the community. This patient is considered the first person with severe lung pathology to utilize MIPPV for sleep.

Reduction of benzylideneacetone derivatives with Pd/SiO2–AlPO4 as catalyst and cyclohexene as hydrogen donor

The hydrogen transfer reduction of benzylideneacetone derivatives p-X-C6H4—CH=CH—CO—R (X = —OCH3, H; R = C6H5, alkyl, OR, OH) using cyclohexene as hydrogen donor has been studied. The selective reduction of the C=C bond is observed and the effects of the nature of X and R, solvent, catalyst, and reaction temperature on the initial reaction rate are analyzed. In all cases, and for any substrate or catalyst, the reaction is first-order with respect to the hydrogen donor and acceptor.

Long-term rehabilitation in advanced stage of childhood onset, rapidly progressive muscular dystrophy

The most common cause of death in patients with rapidly progressive neuromuscular disease has been respiratory failure. The medical community and society as a whole have not yet recognized the possibilities for markedly extended life expectancy and prolonged productivity in severely disabled neuromuscular patients with proper medical management and rehabilitation. In a population of 120 patients with early childhood onset, rapidly progressive muscular dystrophy, 29 were in the most advanced stage requiring mechanical ventilation 24 hr/day and had vital capacities of less than 10% predicted for age and height. Of these patients with severely weakened bulbar innervated muscles, 10 have been receiving positive pressure ventilation via indwelling tracheostomy tubes for an average of 3 years. The average age of the 29 patients is 27 years with a range of 15 to 54 years. Of the 29 patients, 24 live in the community. Three are married and have a total of 5 children. Some patients are in professional careers, or active in political and community organizations. The management of and potential for improved quality of life and increased longevity in these patients are discussed.

Recognition of matching tasks and stimulus novelty as a function of unilateral brain damage

A 96-trial tachistoscope recognition task was given to 15 left-hemisphere-damaged, 12 right-hemisphere-damaged, and 30 non-brain-damaged subjects. Procedure called for a first stimulus presented for 250 msec, a 1-sec. pause, and a second stimulus for 250 msec. The stimuli were 12 animal drawings used in repeated series according to a random schedule. Six animals were familiar and six were novel. For half of the trials, the two pictures were of different animals. Size and position of the animal picture were controlled. Both reaction time and accuracy were independently scored. Judgments of same and different appear to function as if they are governed by different processes. For the control group, measures of same and different judgments do not correlate highly despite high internal consistency of subtests. Recognition of same becomes impaired with brain damage, but more so if the damage is rightsided. Recognition of different judgments shows considerably less sensitivity to the effects of unilateral brain damage.

Reflex conditioning in a spinal man

A man with a completely transected spinal cord and a spastic neurogenic bladder was conditioned to void upon the presentation of an external stimulus. A classical conditioning paradigm was employed in which strong abdominal shock (unconditioned stimulus) was paired with an initially neutral mild electrical stimulation of the thigh (conditioned stimulus; CS). After the pairing trials, a reliable conditioned response of urination was elicited by the CS alone. The conditioned response did not extinguish over time, and the procedure left the bladder with clinically safe residual amounts of urine. Practical implications of the conditioning technique for the treatment of spastic neurogenic bladder conditions in spinally injured patients are discussed, as is the theoretical significance of conditioning at the reflex level in the absence of cortical involvement.

The effect of unilateral brain damage on the appearance of question-induced CLEM reactions

Three groups of subjects--34 non brain damaged, 15 left hemisphere damaged patients, and 15 right hemisphere damaged patients--were administered 40 questions facing the questioner while eye-movement following each question was recorded. 20 of the questions required subjects to indicate how many letters were in a given word. 20 questions tested their visuospatial capacity. The control group revealed a marked tendency to look to the left visual field regardless of the content of the question. The tendency to left-look or right-look, however, was not found to be related to education, age, length of hospitalization, the score on the "letters in a word" test, or the score on the visuospatial test. The left hemisphere damaged group performed remarkably like the control in that they too looked more to the left visual field than to the right. The right hemisphere damaged group, however, did not show a significant difference between left looking and right looking in response to both questionnaires. The findings were discussed in relation to the previous work of Kinsbourne (1972), and Gur, Gur and Harris (1975).

Median and ulnar nerve conduction determinations in the Erb's point--axilla segment in normal subjects

Twenty-one median and 22 ulnar nerves were tested in 12 patients for motor nerve conduction velocity (MNCV) and motor nerve conduction time (MNCT) in the segments from Erb's point (N) to axilla (A) bilaterally. It was found that on this segment for both nerves, MNCV values equal to or smaller than 51 m/s or conduction times equal to or longer than 4 ms are to be considered abnormal. For comparative studies and for checking the normality of the tested nerves in their entire length, the more distally located segments in the same nerve were also tested. For diagnostic purposes, the differences between right and left MNCV or MNCT values determined in the same person on N-A segments of homologous nerves were analysed. Motor nerve conduction velocity or MNCT determinations on the N-A nerve segment are expected to replace MNCV determinations on the longer N-AE (AE=100 mm above elbow) nerve segment, which is now in use, for diagnosis of the thoracic outlet syndrome.

Pilot study of d-penicillamine, vitamins and minerals in multiple sclerosis

A pilot study of the effect of D-penicillamine in multiple sclerosis (MS) was undertaken because of D-penicillamine's activity against RNA neurotropic viruses, because it is effective against the auto-immune disease, rheumatoid arthritis, and because both viruses and autoimmunity have been implicated in multiple sclerosis. We have treated 16 patients with advanced MS, nine on full doses (2-2.25 grams/day) and seven whose treatment was permanently stopped for reasons other than adverse reactions. There has been some improvement in most of those whose treatment was not withdrawn, and no change or deterioration in those not continued on the therapeutic regimen. Despite use of a high dosage regimen, such as has evoked intolerable side effects in a high percentage of patients with rheumatoid arthritis, we have experienced few side effects in a total of 48 patients suffering from diseases with auto-immune components, a finding we speculate is due to replacement of nutrients inactivated or removed by D-penicillamine, and to supplementation with selected nutrients.

Conditioned responding of the neurogenic bladder

Classical conditioning techniques were employed to condition responding of the spastic neurogenic bladder in a man with quadriparesis and urinary incontinence secondary to spinal cord injury at the cervical level. A neutral stimulus of mild electrical stimulation to the thigh was paired temporally with an unconditioned stimulus (UCS) of stronger electrical stimulation of the lower abdomen, and then was presented alone as a conditioned stimulus (CS) to elicit the conditioned response (CR) of voiding. The previously neutral CS reliably elicited large amounts of urine and left little residual urine in the subject's bladder. Following the experimental sessions, the subject self-applied the CS on a predetermined schedule during his daily routine outside of the laboratory. The CS initially was successful, but after several days the CR exhibited extinction. Additional CS-UCS pairing sessions did not reinstate the responses satisfactorily. Aspects of the experimental procedure and the results are discussed as well as the feasibility of conditioning the human spinal cord in the absence of an intact central nervous system

Conditioning bladder responses in patients with spinal cord lesions

Two patients with spinal cord lesions and spastic neurogenic bladders were treated with classical conditioning techniques to reinstate independent bladder function utilizing electrical stimulation of the abdomen as the unconditioned stimulus and mild electrical stimulation of the thigh as the conditioned stimulus. Successful conditioning was achieved in both cases. Urination was brought under the control of a previously neutral stimulus with a high rate of responding.

A matching-to-sample feedback technique for training self-control of tinnitus

Thirty individuals with subjective tinnitus aurium of a variety of types and severity were treated with a matching-to-sample feedback procedure. Following initial evaluation measures, the participants' experienced tinnitus sounds were reproduced audiometrically on all characteristics and were presented to them in the noninvolved ear or in both ears when the tinnitus was binaural. This experimental sound was then reduced in 5 decibel (dB) steps within sessions, and participants had the task of concentrating on reducing the loudness of their tinnitus until a match was achieved between it and the experimental sound at each new dB level. Results showed an overall highly significant difference in dB levels from baseline to final training session. Nearly all participants demonstrated a marked reduction in tinnitus loudness, with 84% reducing it by 10 dB to 62 dB and several eliminating it completely. Individual and pathological variables played no role in training or outcome. Our approach appears to have major advantages over other tinnitus treatment strategies in that it provides direct, significant relief and gives the patient the psychological benefit of gaining control over the problem.