Activation of human neutrophils by mycobacterial phenolic glycolipids

The interaction between mycobacterial phenolic glycolipids (PGLs) and phagocytes was studied. Human neutrophils were allowed to interact with each of four purified mycobacterial PGLs and the neutrophil production of reactive oxygen metabolites was followed kinetically by luminol-/isoluminol-amplified chemiluminescence. The PGLs from Mycobacterium tuberculosis and Mycobacterium kansasii, respectively, were shown to stimulate the production of oxygen metabolites, while PGLs from Mycobacterium marinum and Mycobacterium bovis BCG, respectively, were unable to induce an oxidative response. Periodate treatment of the M. tuberculosis PGL decreased the production of oxygen radicals, showing the importance of the PGL carbohydrate moiety for the interaction. The activation, however, could not be inhibited by rhamnose or fucose, indicating a complex interaction which probably involves more than one saccharide unit. This is in line with the fact that the activating PGLs from M. tuberculosis and M. kansasii contain tri- and tetrasaccharides, respectively, while the nonactivating PGLs from M. marinum and M. bovis BCG each contain a monosaccharide. The complement receptor 3 (CR3) has earlier been shown to be of importance for the phagocyte binding of mycobacteria, but did not appear to be involved in the activation of neutrophils by PGLs. The subcellular localization of the reactive oxygen metabolites formed was related to the way in which the glycolipids were presented to the cells.

In vitro measurement of the tracking pattern of the human patella

This study sought to determine whether a general pattern describing the three-dimensional tracking characteristics of the human patella could be established, and if not, then to determine the extent and nature of interspecimen variations in the characteristics in a normal population. Using 32 fresh-frozen knees subjected to extensor moment magnitudes similar to those in "static-lifting" and "leg-raising against resistance" maneuvers, patellar displacements were measured in the knee extension range 120 to 0 deg. For static-lifting, a constant foot-floor reaction of 334 N was applied. For leg-raising, a constant net quadriceps tension of 668 N was used throughout the extension range. Measurements were taken with a calibrated six-degree-of-freedom electromechanical goniometer and a displacement coordinate system referenced to the geometry of individual specimens. The three patellar displacements in the plane of knee extension/flexion (extension rotation, and anterior and proximal translations) consistently demonstrated the same pattern in the entire knee extension range with an average coefficient of variation of 13 percent. For knee angles greater than 45 deg, the three other displacements (medial-lateral translation, and rotations about the anterior--posterior and proximal--distal axes) followed a general pattern. However, for knee angles less than 45 deg, these displacements differed considerably between specimens for each loading condition, both in terms of magnitude (average coefficient of variation: 70 percent), and direction.

Assessment of liver function by the MEGX test in patients with schistosomiasis and cirrhosis

OBJECTIVES

The aim of this study was to determine the effect of schistosomiasis infection on hepatic function in Egyptian patients with posthepatitic cirrhosis.

DESIGN AND METHODS

Hepatic function, was assessed in 66 Egyptian patients, with (n = 30) and without (n = 36) schistosomal liver fibrosis due to Schistosoma mansoni and in 20 healthy controls, using the monoethylglycinexylidide (MEGX) test. Serum MEGX concentrations were measured before and 5, 15, 30, 60, 120, and 180 min after a lidocaine bolus. The sero-prevalence of antibodies to hepatitis C was also determined in the patients.

RESULTS

MEGX test results were significantly lower in patients than in controls at all time points. MEGX test results declined with advancing Child Class. Receiver operating characteristic (ROC) curve analysis revealed the following areas under the ROC curves for discrimination of Child Class C from Child Classes A/B: 30 min, 0.762; 60 min, 0.743; 120 min, 0.731; 15 min, 0.728; 180 min, 0.728; 5 min, 0.602. Schistosomiasis infection had no influence on MEGX test results when cirrhotic patients with (Schisto+) and without (Schisto-) schistosomiasis were compared. While the prevalence of the hepatitis B surface antigen was only 16.7% (Schisto-) and 26.7% (Schisto+), there was an extremely high sero-prevalence of antibodies to hepatitis C (HCV) in both groups: 88.9% (Schisto-) and 73.3% (Schisto+).

CONCLUSIONS

The association of schistosomal liver fibrosis with cirrhosis does not additionally influence MEGX formation. In addition, HCV rather than schistosomiasis infection must be considered as a major cause for the progressive liver disease in these patients.

Calculated stress-shielding in the distal femur after total knee replacement corresponds to the reported location of bone loss

This study sought to determine the similarities between features of calculated stress-shielding and observed bone loss in the distal femur after total knee replacement. Stress-shielding was determined by comparing the magnitudes and distributions of strain energy density, calculated using three-dimensional finite element models of the intact bone, the bone after total knee replacement with bonding assumed at all prosthesis-bone interfaces, and the bone after total knee replacement with bonding assumed only at the distal interface. The loading condition simulated static lifting with the knee flexed at 45 degrees, producing tibiofemoral and patellofemoral joint reactions of 900 and 450 N, respectively. The maximum magnitudes of strain energy density calculated using the total knee replacement models were less than 15% of the corresponding magnitudes from the intact bone model. The greatest difference was found to occur at the anterior distal corner of the femur, suggesting this location as the one most vulnerable to stress-shielding. Clinically observed bone loss after total knee replacement frequently occurs at this location. At the anterior distal corner, the calculated magnitudes for the two total knee replacement models were similar, suggesting that stress-shielding at this location was not reduced by limiting fixation only to the distal interface. Although the study corresponded to one loading condition and one geometry of the total knee replacement femoral component with the inherent limitations of model calculations, the results suggest a possible scenario for stress-shielding.

Patients' perception of public, voluntary and private dispensaries in rural areas of Tanzania

Eighty percent of rural dispensaries are run by the government and 19% by voluntary organisations that charge for some services. After the re-legalisation of the private health sector in 1991, private dispensaries are also emerging in villages. Privatisation is among the health reform policies of the country. Moreover, cost-sharing will be introduced at public dispensaries soon. Perception of 320 patients in the Coast Region of Tanzania on services delivered by the three health sectors has been investigated. Results show that patients are generally satisfied with the services and they would go back to the same dispensaries for treatment. Polydrug prescription was common in all sectors, while lack of prescribed drugs was a main complaint among public dispensaries patients. Voluntary dispensaries patients were less satisfied with long waiting time and with staff that did not give them enough information about the treatment. Currently, health service in public dispensaries is free but cost-sharing will be introduced soon. Most of voluntary and private dispensaries patients stated that the fees for service were moderate. The paper discusses the need for monitoring the implementation of cost sharing in public dispensaries to ensure equity in access to services by rural patients.

Longterm outcome of endoscopic sclerotherapy of variceal bleeding: comparative study between schistosomiasis and others

BACKGROUND/AIMS

This comparative study was conducted on 111 patients to evaluate the long term outcome of endoscopic variceal therapy in patients with portal hypertension, and particularly with schistosomiasis.

PATIENTS AND METHODS

There were 45 patients with chronic liver disease due to schistosomiasis, 31 with chronic hepatitis B and 21 with chronic NNb hepatitis. The remaining 14 had chronic liver disease of other etiologies. The mean follow up period was 40 months.

RESULTS

Esophageal varices were completely sclerosed in 32 out of 111 patients in 5 sessions (average) over a mean duration of 8 months. A comparison of patients with schistosomal and non-schistosomal liver diseases revealed that 68% of the schistosomal group patients were in child's A classification, compared to 30% of the patients in the non-schistosomal group. There was no significant difference with respect to early rebleeding and recurrence of oesophageal varices. The outcome of sclerotherapy in schistosomal group was better with respect to survival span over a 5 year period of 78% while for the nonschistosomal group it was less than 59%.

CONCLUSIONS

This study has shown that injection sclerotherapy for bleeding oesophageal varices gives best results when liver function is usually well preserved and for chronic schistosomal liver disease.

Does health information alone help in equitable distribution of essential drug kits between health units at district level?

In Tanzania, the essential drugs programme (EDP) faces acute shortage of drugs brought about by a deteriorating economy and an expanding primary health care system. Many health units complain of shortages of drugs but no increase in the district allocation of EDP kits is foreseen. In the light of the aforementioned problem, a study was carried out in the Kisarawe district of Tanzania to discover, on behalf of the District Health Management Team (DHMT), the extent of the maldistribution with a view to reallocate the EDP kits among the health units on the basis of workload and catchment population. The relative workload of each health unit was estimated from the number of outpatient attendants and the catchment population estimates are based on a 1988 national census. An equitable distribution of EDP kits for each indicator was then developed by ranking the health units in order of workload and catchment population and dividing up the available number of EDP kits proportionately. Health units were categorised as either 'over-allocated', 'appropriately-allocated' or 'under-allocated' with EDP kits by comparing their actual drug supply with the equitable supply. The findings were presented to a meeting of the DHMT attended by the Regional Medical Officer and Ministry of Health officials. Despite being presented evidence of astounding inequity in drug distribution, there was a marked reluctance on the part of the DHMT to decide upon actions to redress some of the imbalance. In this study, we demonstrated that although data from the routine information system on essential drugs at peripheral health units provided sufficient information for managerial purposes, decision-making was delayed and limited. Several possible reasons for this are discussed.

Tensile stress-strain characteristics of the human meniscal material

The nonlinear stress-strain characteristics of the human menisci were determined by uniaxial elongation tests performed on circumferential and radial specimens prepared from different regions, layers, and locations. The properties of the collagen fibers and the matrix were calculated using the test results along with the values of the volume fractions of the meniscal components. Regression analysis showed that only three parameters, the elastic modulus, the maximum strain, and the strain intersect, are sufficient to define the nonlinear stress-strain relation up to failure. For radial specimens, the layer had a significant effect (p < 0.01) on the elastic modulus and the maximum strain, but had no effect on the strain intersect and the maximum stress. For the same specimens, the region had a significant effect (p < 0.01) only on the strain intersect and the maximum stress. For circumferential specimens, analysis indicated no significant effect of either the region, the layer, or the location of the specimens on the material parameters defining the stress-strain relation.

Protean manifestation of gastrointestinal tuberculosis: report on 130 patients

Over the past 8 years, 820 patients with tuberculosis were seen at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. A total of 292 of these patients (35.6%) had pulmonary tuberculosis, and 130 patients (15.8%) had alimentary tract tuberculosis, making this the second commonest site of involvement. In these 130 patients, the disease was located in the upper gastrointestinal tract in 11 patients (8.5%), small bowel 44 patients (33.8%), large bowel 29 patients (22.3%), peritoneum 40 patients (30.7%), and liver 19 patients (14.6%). The diagnosis in most patients was made by specimens from endoscopy or laparoscopy, or liver or surgical specimens. Gastrointestinal tuberculosis is not uncommon in developing countries, and its incidence is increasing in developed countries due to immigration and in patients with AIDS or those receiving immunosuppressive therapy. It can mimic any diseases affecting the gastrointestinal tract and may present with very different symptoms, so a high index of suspicion is required.

Alpha interferon in treatment of chronic hepatitis C viral infection (CHCV): Pilot study of 18 patients

Eighteen patients with chronic hepatitis C virus infection (CHCV) were treated with three million units of interferon (IFN) three times a week for a minimum of six months. Four (22.2%) had completely responded, two (11.1%) had partial response and the rest (eight or 44.4%) did not show any evidence of response. After stopping treatment, patients who had a complete or partial response developed a relapse during the follow-up period. Few reversible adverse effects of treatment were reported in more than half of the patients. So, we conclude that three million units of IFN three times weekly is not recommended for treating patients with CHCV. Perhaps a larger dose of five to six million units should be tried and for a longer duration.

The management of health services in Tanzania: a plea for health sector reform

There are essentially four main approaches used in attempts to strengthen the management of health services in developing countries. These are: information system development; management training; use of planning and evaluation methodologies; and, health sector reform. As part of a collaborative research project based in Kisarawe District, Tanzania, we tested the hypothesis that a combination of the first three of these approaches would be sufficient to ensure that decisions and actions were taken to bring about major improvements in the management of health services. It was assumed that the decentralization, which took place as part of the 1982 reorganization of local government responsibilities, had provided managers with sufficient decision-making autonomy to allow them to bring about improvement in health service performance, provided that the other conditions were met. In fact, it was found that despite being presented with clear evidence of serious inefficiencies and inequities in the allocation of health resources, managers were often highly reluctant to decide upon actions which would alleviate the problems in situations where there were potential losers as well as winners, even if the benefits greatly outweighed the costs. This article argues that interventions based solely on training, information systems, or planning and evaluation protocols will make only marginal improvements to health service management, and that changes to the system as a whole are needed in order to provide managers and health professionals with incentives to rectify performance failings. Some ideas for health sector reform, to give managers power and incentives for improving efficiency and quality of care, are put forward. Since it is likely that the systemic problems of the health sector in Tanzania are shared by many other developing countries, the lessons drawn from this study probably have more general applicability.

Helicobacter pylori: Prevalence in 352 consecutive patients with dyspepsia

At the Riyadh Armed Forces Hospital (RAFH), 352 patients had gastroscopy and from each, antral gastric biopsies were taken for identification of Helicobacter pylori, by urease test and histopathology. In 217 (61.64%) of these 352 patients, the histology specimens showed Helicobacter pylori in 73.68% of patients with duodenal ulcer, 70% of patients with gastric ulcers and gastric erosions, 61% of patients with duodenitis and 52% of patients with gastritis. The urease test was positive at six hours in 164 (49.59%) of these 352 patients. The urease test was positive in 60% of each group of patients with endoscopic findings of gastric erosions, gastric ulcers and duodenal erosions.

Helicobacter pylori: incidence and comparison of three diagnostic methods in 196 Saudi patients with dyspepsia

One hundred and ninety-six symptomatic Saudi patients with dyspepsia underwent gastroscopy, and multiple biopsies were taken from the antrum of the stomach for identification of Helicobacter pylori. Three methods were studied for diagnosis of Helicobacter pylori, including urease test, culture and histopathology. The commonest gastroscopic findings were gastritis in 82 patients (41.84%) and duodenal ulcer in 40 patients (20.41%). Among the 196 patients, Helicobacter pylori was identified by histopathology in 145 patients (73.98%), the urease test was positive in 126 patients (64.29%), and a positive culture was obtained in 102 patients (52.04%). These results show that there is a high incidence of Helicobacter infection among Saudi patients with peptic ulcer disease or non-ulcer dyspepsia. Helicobacter pylori identification was more successful by histopathology than by the urease test or culture.

Frequency of gastroesophageal reflux in patients with liver cirrhosis

Twenty-five adult patients with liver cirrhosis, and another 30 patients with no liver disease but referred with symptoms suggestive of gastroesophageal reflux disease were selected at random. Twenty-four hour ambulatory intra-esophageal pH measurement and upper gastrointestinal endoscopy were carried out on all patients recruited. Applying the former test, 16 (64%) of the patients with liver cirrhosis have gastroesophageal reflux disease. This figure is comparable with the 70% (21/30) rate recorded in the group of dyspeptic patients clinically thought to have the disorder. A positive endoscopic diagnosis was much lower at 12% and 23%, respectively. No significant differences were observed among liver disease patients when they were subdivided in accordance with the etiology of liver cirrhosis and the grade of esophageal varices. We conclude that gastroesophageal reflux disease occurs at a high frequency (64%) in patients with liver cirrhosis and portal hypertension, irrespective of the etiology of cirrhosis and the grade of esophageal varices. It is therefore considered to be the main cause of esophagitis in these patients, and that it might play a role in initiating a variceal bleeding episode. The latter hypothesis needs further evaluation.

The return of life-threatening puerperal sepsis caused by group A streptococci

A dramatic decline in the prevalence of serious puerperal infection caused by group A beta-hemolytic streptococci has been observed throughout most of the twentieth century, and it is currently a very uncommon cause of maternal morbidity and mortality. We report on two term pregnancies complicated by profound multisystem organ failure caused by group A streptococcal puerperal sepsis. This report serves to highlight the apparent return of serious group A streptococcal puerperal sepsis and to emphasize the clinical implications and sequelae attributable to an old yet virulent enemy.

Design and development of an unconstrained dynamic knee simulator

A dynamic knee simulator has been developed to allow in-vitro investigation of the mechanical response of the joint corresponding to dynamic functional activities, e.g., walking. In the simulator, the controlled inputs are the time-histories of three parameters of a given dynamic activity: the flexion angle, and the flexion/extension moment and tibial axial force components of the foot-to-floor reaction. A combination of stepping motors and electro-hydraulic actuators is used to apply to a knee specimen, simultaneously and independently, the specified load and/or displacement inputs while allowing unconstrained relative motion between the joint members. Satisfactory performance of the simulator has been established for walking gait conditions based on measurements on three fresh-frozen specimens.

Socio-economic determinants of labour mobility in Pakistan

"With the availability of Population, Labour Force, and Migration (PLM) Survey data, this paper attempts to develop a model of internal [labor] migration in Pakistan.... Keeping in line with the literature, three types of variables have been identified as the possible determinants of migration. These variables relate to the possession of human capital, commitment to job and place of residence, and cost-related factors. After controlling for other variables, it was observed that, in general, migrants were selective especially in terms of age, education, and choice of occupation. These findings are consistent with the evidence from other developing countries."

Ligament tension pattern in the flexed knee in combined passive anterior translation and axial rotation

Twenty-two fresh-frozen specimens were used to measure tensions generated in selected bands of the major ligaments of the flexed knee (40-90 degrees) when an axially prerotated tibia is subjected to passive anterior shear and when an anteriorly pretranslated tibia is subjected to passive axial torque. The tensions were measured using the buckle transducer attached to the anteromedial band of the anterior cruciate ligament [ACL (am)], the posterior fibers of the posterior cruciate ligament [PCL (pf)], the long fibers of the medial collateral ligament [MCL (lf)], and in the total lateral collateral ligament [LCL]. The knee specimens were subjected to the combined motions in a 6-df passive loading apparatus. The results indicated that the joint resistance to anterior translation increased markedly with internal prerotation and only marginally with external prerotation. This increase in joint resistance, however, was associated with a decrease in ACL function. It has been inferred that the posterior structures, capsular and meniscal, contribute significantly to joint resistance when the tibia is prerotated in either sense. For internal prerotation, the interference between the medial femoral condyle and the central tibial eminence was found to be an additional mechanism of resistance to anterior translation. Also, it has been found that although the ACL (am) tension increased with internal rotation in the normal case, it decreased with internal rotation in the presence of an anterior pretranslation. It is concluded that ACL response to combined joint motion cannot be ascertained by a simple summation of its responses to individual motions.

Endoscopic choledochoduodenostomy (ECDT): A practical approach to management of impacted papillary gallstones and ampullary tumors

We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy (ECDT) at Riyadh Armed Forces Hospital (RAFH). The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy (ECDT). This approach provides an access to the common bile duct thus following appropriate therapeutic procedurs on the biliary system to be performed.

The association between hepatitis C virus antibody and hepatocellular carcinoma in relation to hepatitis B viral infection (RAFH experinece)

Forty-two patients with hepatocellular carcinoma (HCC) were seen during two years at Riyadh Armed Forces Hospital (RAFH), Saudi Arabia. As viral hepatitis is common in this country, serological markers for hepatitis B virus (HBV) and the newly identified hepatitis C virus (HCV) were also studied in these patients. Fourteen (33.3%) patients were HBsAg positive, 11 (26.2%) were anti-HCV positive, two (4.8%) were positive for both HBsAg and anti-HCV and five (11.9%) were anti-HBc and anti-HBs positive. The remaining ten patients all were negative for markers. Serological markers were also studied in 1472 blood donors (control group) during the same period. Twenty-two (1.5%) were positive for anti-HCV, 59 (4%) for HBsAg and two (0.1%) for both markers. Our results are in accordance with previous studies carried out elsewhere, and it is suggested that hepatitis C virus like hepatitis B, may play an important etiological role in hepatocellular carcinoma in Saudi Arabia.

Hepatitis C virus infection in chronic liver disease and hepatocellular carcinoma in Saudi Arabia

The prevalence of antibody to hepatitis C virus (HCV) was determined in 139 patients with chronic liver disease (CLD) and 42 patients with hepatocellular carcinoma (HCC) during one year at the Riyadh Military Hospital, Saudi Arabia. The anti-HCV was detected in 36 of 96 (37.5%) HBsAg-negative patients with chronic liver disease and six of 43 (13.9%) HBsAg-positive patients with chronic liver disease. In addition, 11 (42.3%) HBsAg-negative hepatocellular carcinoma patients and two of 16 (12.5%) HBsAg-positive hepatocellular patients had antibody to HCV. The anti-HCV prevalence was 1.5% in 4818 healthy blood donors and 1% in 385 antenatal patients. The overall HCV seropositivity of 30.4% in 181 liver disease patients (CLD and HCC) in Saudi Arabia is lower than that reported from European countries.

Thermal modeling of polymerizing polymethylmethacrylate, considering temperature-dependent heat generation

A methodology for the modeling of unsteady heat conduction in polymethylmethacrylate (PMMA) during its exothermic polymerization is presented. The emphasis is on the formulation of a model for the volumetric rate of heat generation, including its temperature-dependent characteristics. Three parameters appear in the proposed model. The empirical determination of these parameters using Differential Scanning Calorimetry is demonstrated. The incorporation of the proposed model into finite volume methods is also demonstrated, in the context of unsteady, one-dimensional, radial heat conduction in cylindrical coordinates. In addition, the application of the proposed model to two test problems is presented and discussed. The results are encouraging, and the proposed methodology appears to be applicable to the thermal modeling of exothermic polymerization processes in general.

The role of axial rotation in the etiology of unilateral disc prolapse. An experimental and finite-element analysis

This study was done to establish the relevance of axial rotation as a cause of disc degeneration in the lumbar spine and the role of facet asymmetry in the injury mechanism. It previously was shown that facet asymmetry does not affect the axial torque-rotation response of lumbar motion segments. This study, in both an experimental and a finite-element analysis, examined three important points previously not considered for lumbar motion segments subjected to axial torque: 1) the effect of facet asymmetry on the coupled motions; 2) the effect of combined geometric parameters on the segment response; and 3) the effect of facet asymmetry on the annular strains. Three different lumbar-coupling patterns were observed; however, they did not appear to be influenced by facet joint asymmetry. An oblique and flat compression facet may allow an increased motion-segment response, but in general, combined geometric parameters were found to have no effect on segment response. It was concluded that, without facet damage, the right or left side of the disc is not biased by a particular facet geometry to experience unusual levels of stress and strain, either as a result of increased axial rotation or any of the associated coupled motions.

Effect of pulsed electromagnetic field on healing of experimental nonunion in rat tibiae

To see the effect of Pulsed Electromagnetic Field (PEMF) on nonunited fracture healing, nonunion was induced in rat tibiae and PEMF was applied on it. Out of five different techniques utilised for inducing nonunion soft tissue interposition was found to be the most suitable and effective method of experimental induction of nonunion. Twenty eight experimental and 15 control rats were finally evaluated for the effect of PEMF applied for up to 8 weeks. After sacrifice of 8 experimental and 4 controls, 6 experimental and 3 controls, again 6 experimental and 3 controls and finally 8 experimental and 5 controls at 2, 4, 6 and 8 weeks respectively of PEMF application no significant difference as to the quality of healing was observed between the experimental and control animals. It was thus concluded that PEMF appeared to have no beneficial effect on the healing of nonunited fractures in experimental set-up.

Prediction of stature from hand measurements

A sample of 166 normal adult males and females was taken from different colleges of Assiut representing those living in upper Egypt. Each subject has been studied for measurements of stature (S), hand length (HL) and hand breadth (HB). The data were statistically analysed in order to assess the relationship between stature and hand measurements. The correlation matrix of the study indicates close similarity of the relationship between stature and hand measurements in both sexes and in both sides. A generalized multiple regression equation has been designed to estimate stature from values of hand length and hand breadth regardless of sex or side in the form: S = 34.5 + 5.77 HL + 2.7 HB +/- 5.1. This equation may be helpful to obtain approximate stature when there is difficulty in obtaining a direct measurement or where there is a chance print of a criminal or an amputated hand or arm.

The effect of facet geometry on the axial torque-rotation response of lumbar motion segments

The objective of this study is to examine the effect of the facet geometry on the axial torque-rotation response of lumbar motion segments. The three-dimensional facet geometry of 35 L2-3 and 35 L4-5 specimens has been quantified in terms of seven parameters from computed tomographic transverse sections taken at 2-mm intervals. The motion segments have then been subjected to axial torque, for a variety of preload conditions, to establish the axial torque-rotation response. There exists significant variation of facet geometry between the segment levels; however, the degree of facet asymmetry is identical for each level. No significant correlation exists between the lumbar facet geometry and the axial torque-rotation response. The facet joints do, however, act as a "positive stop" to axial rotation, regardless of their orientation. Therefore, axial rotation sufficient to cause disc injury may only be possible after facet failure.

Investigation of the laminate structure of lumbar disc anulus fibrosus

The structure of the lumbar disc anulus fibrosus was investigated using a layer-by-layer peeling technique and microscopic examination of various cut surfaces. Anulus specimens from spines of two different age groups and from two levels, L2-3 and L4-5, were examined. The vertebra-disc-vertebra units were subjected to intentional controlled dehydration to enhance the visual contrast between the white opaque fiber bundles and the translucent ground substance. The variations of the anulus structure with circumferential and radial locations were studied. The following principal structural features were quantified: 1) the anulus, excluding the transition zone, consists of 15 to 25 distinct layers, depending on the circumferential location, the spine level, and the specimen age; 2) in any 20 degrees circumferential sector, nearly half of the layers terminate or originate, thereby causing local laminate irregularities; 3) there are two identifiable mechanisms of layer interruption at these irregularities; 4) the thickness of individual layers varies both circumferentially and radially and increases markedly with age; and 5) the number of fiber bundles over the total height of the disc varies from 20 to 62, with an average interbundle spacing of 0.22 mm.

Dynamic stress response of the implant/cement interface: an axisymmetric analysis of a knee tibial component

To determine the adverse effects on the implant/cement interface stresses caused by a dynamic load on the implant, an axisymmetric dynamic finite element analysis was performed for an idealized knee tibial component assuming perfect bonding at the interface. The component, consisting of a metal plate with a central stem, was subjected to a compressive load that varied with time as a terminated ramp function. At first, the reliability of the interface stress predictions was assessed by computing the effects of a number of method-related parameters, viz., the finite element mesh density, the assumed bone properties. Analysis was then performed considering the stem length, cement mantle thickness, and the type of implant metal as design variables. The analysis predicts high-frequency (600 Hz) stress oscillations of significant amplitude at those locations of the interface that are also subjected to high static stresses: near the stem-plate junction and the stem tip for normal stress, and at the stem tip for shear stress. However, the predicted stress amplitude has been found to be particularly sensitive to the assumed rise time of the input load function. With a rise time of 2.0 ms, an input condition considered to be severe enough to represent the most vigorous dynamic activity, the maximum stress augmentation, because of stress oscillations, is predicted to be less than 25%. In general, the design variables have been found to affect the static stresses much more than the dynamic ones. It has been concluded that for the cases studied, dynamic effects are relatively small and a static analysis is sufficient to characterize the interface stress condition.

A parametric axisymmetric model study on the interface motions in porous-surfaced tibial implants

The effects of a number of variables on the interface relative motions in porous-surfaced tibial implants are investigated using a simplified axisymmetric finite element model. The parameters considered are contact or link spacing, height of the central metal stem, presence of a circumferential metal flange, presence of a UHMWP articular plate resting freely on or fixed to the metal base, resting of the prosthesis edge on the cortical shell, and type of the metal alloy. In order to represent the immediate post-surgical situation with no bone ingrowth, the interface between the bone and porous-surfaced metal is modelled by frictionless rigid links oriented normal to the interface. Cases are also studied in which the horizontal interface is assumed to be fixed while the vertical interface remains frictionless. The magnitudes of the interface motion are negligibly affected by the variation in the link spacing from 0.3 mm to about 3.0 mm. The interface relative motion is predicted to decrease in cases with a shorter central metal stem, with the addition of a circumferential metal flange, with the use of more rigid prosthesis, and with the addition of a UHMWP articular plate.

Khat consumption: a pharmacological review

The present review deals with the considerable body of evidence gathered in the last ten years on the clinical and experimental pharmacology of Khat. Khat effects are generally agreed to be of amphetamine-like type. In particular, Khat ingestion, like amphetamine ingestion, produces sympathetic activation, anorexia, euphoria, increased intellectual efficiency and alertness. These effects are mainly mediated by phenylalkylamines, such as cathinone and cathine, because the pharmacological actions of these agents and those produced by amphetamine almost overlap. In infra-human species cathinone is an effective positive reinforcer (i.e., it maintains self-administration). However, it would be inappropriate to infer from cathinone and cathine effects assessed in animals a high potential of abuse for Khat in humans; apart from other reasons the bulk volume of Khat leaves, limits the ingestion of high quantities of the active principles. Accordingly, in habitual consumers Khat dependence is probably mild, because craving and tolerance to the sympathomimetic and neuroendocrine effects of Khat are present, but there is no definite abstinence syndrome. Therefore, in our opinion, policies restricting the use of Khat should be adopted with caution, lest they simply change the pattern of drug abuse and increase the spread of more dangerous drugs.

A stress compatible finite element for implant/cement interface analyses

A new finite element has been developed to enforce normal and shear stress continuity at bimaterial interface points in order to alleviate the problem of high stress discontinuity predictions by the conventional displacement finite element method. The proposed element is based on a five node isoparametric quadrilateral element where the fifth node is located at the interface boundary of the element. A series of validation tests have been carried out to assess the correctness of the stress distribution obtained by the new element at interfaces of highly dissimilar materials. The results of the tests are compared to analytical solutions and to results from convergence studies performed by the conventional finite element method (SAP-IV). Overall, the proposed element has been demonstrated to have a very satisfactory degree of reliability, especially in view of the observed inability of the conventional method to yield interpretable interface stress values for most cases analyzed. Finally, the new interface element has been applied to the analysis of an axisymmetric model of the knee tibial implant. The superiority of the proposed element over the conventional one has been demonstrated in this case by a convergence study.

Arachidonic acid metabolism and casein secretion in lactating rabbit mammary epithelial cells: effects of inhibitors of prostaglandins and leukotrienes synthesis

The metabolism of arachidonic acid (AA) in fragments of lactating rabbit mammary glands in vitro was studied by considering the distribution of 13-[14C]AA in the cells, and the effects of inhibitors of cyclooxygenase and lipoxygenase pathway on the basal and prolactin (PRL)-stimulated casein secretion. 13-[14C]AA was incorporated in all classes of lipids and PRL increased transiently the percentage of free fatty acid after 1 and 5 min. Ten microM ETYA (5,8,11,14-Eicosatetraynoic acid), a tetrayne analogue of AA inhibited prostaglandins F2 alpha (PGF2 alpha) production but not leukotrienes B4 and C4 (LTB4 and LTC4) production and increased basal casein secretion. 10(-4) M DCHA (Docosahexaenoic acid) a competitive inhibitor of prostaglandin-synthetase inhibited PGF2 alpha production but did not affect basal nor PRL-stimulated casein secretion. Fourteen microM indomethacin inhibited PGF2 alpha and LTC4 production and PRL-stimulated casein secretion. Ten microM NdgA (nordihydroguaiaretic acid) an inhibitor of lipoxygenase pathway, inhibited LTB4 and LTC4 production, increased basal level of casein secretion and inhibited PRL-stimulated casein secretion. Hundred microM caffeic acid, an inhibitor of glutathione-S-transferase (GST), a class of enzymes implied in the transformation of LTA4 into LTC4, had the same effect that NDGA on basal and PRL-stimulated casein secretion. These findings show that inhibitors of AA metabolites alter casein secretion.

Brief footshock analgesia: long-lasting enhancement induced by cathinone, an amphetamine-like agent

In view of the analgesic effects produced by cathinone (CATH), an amphetamine-like agent, and of the interaction of amphetamines with stressful environmental stimuli, the present study evaluated in rats the influence of CATH on the nonopioid analgesia induced by a brief electric footshock (FSA; 3 min of continuous 2.5 mA current). The influence of this combination on body temperature was also evaluated. CATH (5 mg/kg, i.p.) alone induced a brief and slight increase in latency during the hot plate test (HPT), but enhanced and prolonged the analgesic effect induced by FS. In addition, the presentation of the environment (shock box with unelectrified grid) where other rats received FS, caused CATH to induce a slow-rising analgesic effect for 180 min. A hyperthermic response paralleling the analgesic effect was observed in shocked and nonshocked rats receiving CATH. After 24 h, rats that had received both CATH and FS on the previous day showed prolonged latencies on the HPT before and after a 1-min presentation of unelectrified grid. These animals also showed an increased analgesic response to the subsequent application of a 15-second FS. At the same time no differences in body temperature were observed between treatment groups. These results suggest that CATH can interact with environmental stimuli to induce an analgesic effect, the time-course of which depends upon the intensity of the stimulus applied.

A simple unconstrained dynamic knee simulator

The design of a simple dynamic knee simulator is described. In the simulator the joint dynamics are reproduced in-vitro in a knee specimen by controlling the time-histories of the tensions in two flexible cables acting as lumped muscle group equivalents, without constraining the natural conjunct and passive motions of the specimen. The two cable tensions acting individually are used to control the active flexion/extension motion, while their simultaneous action is used to control joint compressive force. The characteristics of the electrohydraulic servo system acting under real-time microprocessor control are described. The system performance during simulation of an idealized level-walking function is evaluated.

In-vitro ligament tension pattern in the flexed knee in passive loading

Tensions generated in selected bands of the four major ligaments of the flexed knee (40-90 degrees) have been measured in vitro when the tibia is subjected to passive anterior translation and axial rotation with and without a compressive preload. The measurements were made in 30 fresh-frozen specimens using the buckle transducer attached to the anteromedial band of the anterior cruciate ligament [ACL (am)], the posterior fibres of the posterior cruciate ligament [PCL (pf)], the superficial fibres of the medial collateral ligament [MCL (sf)], and in the total lateral collateral ligament (LCL). Particular attention was placed on the evaluation of the performance of the transducer specific to such measurements in order to minimize the errors associated with the use of this transducer. The results indicate that, among the measured ligaments, substantial tension (greater than 20 N) is generated only in the ACL (am) in tibial anterior translation up to 5 mm. The tension pattern generated in response to tibial axial rotation, however, is complex and exhibits considerable variation between specimens. In general, both the MCL (sf) and LCL are tensed at all tested flexion angles, with the tension in external rotation being significantly greater than in internal rotation. At 40 degrees of flexion, the ACL (am) bears tension mainly in internal rotation, while at 90 degrees of flexion the PCL (pf) is tensed in both senses of rotation. The response of the LCL shows marked variation among specimens; very small tension (less than 15 N) is generated in internal rotation in 48% of the specimens, and in either sense of rotation in 20% of the specimens. The tension in the ACL (am) in internal rotation is invariably greater in those specimens in which LCL tension is negligible. This correlation between increased ACL (am) function and inadequate LCL restraint appears significant in terms of ACL injury and repair.

Force analysis of the patellar mechanism

The aim of this study is an experimental evaluation of a force analysis of the patellar mechanism based on the assumption that patellofemoral contact is frictionless. At first, the geometric characteristics of contact surfaces, a prior knowledge of which is necessary for quantitative analysis, were measured from radiographs of 42 fresh-frozen knee specimens in the flexion range 0-120 degrees. The results were then used in the analysis to predict the relations between the forces acting on the patella. For the evaluation of the analysis, the ratio of the tension in the ligamentum patellae and the rectus femoris was measured in ten specimens during simulation of two knee functions: (1) "leg raising" against a resistance; and (2) "static lifting". The effect of flexion angle on the ratio is found to be rather complex. With increasing flexion, the ratio increases initially up to 30 degrees, then decreases up to 90 degrees, and finally increases again beyond 90 degrees. The ratio is above unity up to around 45 degrees and below that in the remaining flexion range. The analysis has been found to predict not only the characteristic variation of the ratio but also its magnitude with reasonable accuracy. It has been concluded that for an accurate prediction of the patellofemoral joint reaction, the force analysis needs to be based on the geometry of the contact surfaces. This implies that the mechanical consequences of surgical procedures involving tibial tubercle relocation cannot be inferred simply on the basis of their effect on the patellar mechanism angle, but that they also require consideration of their effect on the contact geometry.

Mechanical response of a lumbar motion segment in axial torque alone and combined with compression

In the current study, a nonlinear three-dimensional finite element program has been used to analyze the response of a lumbar L2-3 motion segment subjected to axial torque alone and combined with compression. The analysis accounts both for material and geometric nonlinearities and treats the facet articulation as a general moving-contact problem. The disc nucleus has been considered as an incompressible inviscid fluid and the annulus as a composite of collagenous fibers embedded in a matrix of ground substance. The spinal ligaments have been modeled as a collection of nonlinear axial elements. Effects of loss of intradiscal pressure and removal of the facets on the joint response have been analyzed as well. Torsion is primarily resisted by the articular facets that are in contact and the disc annulus. The ligaments play an insignificant role in this respect. For the intact segment, with an increase in torque, the axis of rotation shifts posteriorly in the disc so that under maximum torque it is located posterior to the disc itself. Loss of disc pressure increases this posterior shift whereas removal of the facets decreases it. Torque, by itself, cannot cause the failure of disc fibers, but can enhance the vulnerability of those fibers located at the posterolateral and posterior locations when the torque acts in combination with other types of loading, such as flexion. The most vulnerable element of the segment in torque is the posterior bony structure.

Subjective effects of khat chewing in humans

The subjective effects of Khat (Catha edulis) chewing were studied in 14 male somali, habitual khat users, by means of the Addiction Research Center Inventory (ARCI) questionnaire and of visual analogue scales concerning mood and appetite. Results show that euphoria, improved intellectual efficiency and alertness were associated with khat consumption in 10 subjects. In contrast, the remaining 4 subjects experienced only dysphoria and mild sedation. These latter effects were present in all the subjects in the post-chewing period. In spite of these subjective differences, blood pressure and pulse rate increased in all the volunteers studied. As a whole, these results are consistent with the presumed amphetamine-like action of khat, but suggest also a major role of environmental factors in the expression of these actions.

Design and performance of a modified buckle transducer for the measurement of ligament tension

The basic features of a modified buckle transducer for the direct in-situ measurement of tension in ligamentous or tendonous tissues are described. The slender shape of the modified design allows measurement in ligaments located in confined spaces with reduced risk of physical interference between the transducer and adjacent bony structures. In addition, simultaneous measurements in different fiber groups of the same ligament are made convenient. The design procedure of the proposed transducer and its performance characteristics are described.

A finite element study of a lumbar motion segment subjected to pure sagittal plane moments

A nonlinear finite element program has been developed and applied to the analysis of a three-dimensional model of the lumbar L2-3 motion segment subjected to sagittal plane moments. The analysis accounts for both material and geometric nonlinearities and is based on the Updated Lagrangian approach. The disc nucleus has been considered as an incompressible inviscid fluid and the annulus as a composite of collagenous fibres embedded in a matrix of ground substance. Articulation at the facet joints has been treated as a general moving contact problem and the spinal ligaments have been modelled as a collection of nonlinear axial elements. Effects of the loss of intradiscal pressure in flexion and of facetectomy in extension have been analyzed. Comparison of the predicted gross response characteristics with available measurements indicates satisfactory agreement. In flexion relatively large intradiscal pressures are generated, while in extension negative pressures (i.e. suction) of low magnitude are predicted. The stress distribution results indicate that the load transfer path through the posterior elements of the joint in flexion is different from that in extension. In flexion the ligaments are the means of load transfer, while in extension the load is transmitted through the pedicles, laminae and articular processes. In flexion, the inner annulus fibres at the posterolateral location are subject to maximum tensile strain. It is suggested that large flexion moment in combination with other loads is a likely cause of disc prolapse commonly found at this location of the annulus.

The Thermodynamics of Partitioning of Phenothiazines between Phosphate Buffer and the Lipid Phases of Cyclohexane, n-Octanol and DMPC Liposomes

The partitioning of six phenothiazines was determined between phosphate buffer (pH 6.0) and the lipid phases of cyclohexane, n-octanol and dimyristoyl phosphatidylcholine (DMPC). For DMPC liposomes studies were carried out both below and above the phase transition temperature (Tc) of the liposomes. The partitioning of chlorpromazine hydrochloride between n-octanol and phosphate buffer was both pH and concentration-dependent. A linear relationship between the absolute temperature (T(-1)) and the logarithm of the equilibrium partition coefficient (ln K) was derived. The temperature dependence of the partition coefficient (K) over the temperature range 20-40° C in cyclohexane and n-octanol, and 5-40° C in DMPC liposomes, permitted the calculation of free-energy (G), enthalpy (H) and the entropy (S) of partitioning. Both the entropy and the enthalpy of partitioning of phenothiazines were positive in the three systems studied. In general, the partitioning of phenothiazines in cyclohexane, n-octanol and DMPC liposomes (both above and below the phase transition temperature (Tc)) is entropically controlled. Correlation was not however found between the free-energy of oil-water partitioning and liposome-water partitioning which may be attributed to the formation of surface associated phenothiazine in high concentrations at the liposome water interface. The concentration dependent partitioning of chlorpromazine in DMPC liposomes may be attributed to the adsorbed fraction of drug.

Stress analysis of the lumbar disc-body unit in compression. A three-dimensional nonlinear finite element study

It has been argued that a clarification of the mechanical causes of low-back pain requires a knowledge of the states of stress and strain throughout the lumbo-sacral spine. Since a purely experimental approach cannot provide this information, analytical model studies, to supplement measurements, are called for. In the present study, a general three-dimensional finite element program has been developed and applied for the analysis of the lumbar L2-3 disc-body unit. The analysis accounts for both the material and the geometric nonlinearities and is based on a representation of the annulus as a composite of collagenous fibers embedded in a matrix of ground substance. The geometry of the model analyzed is based on in vitro measurements. The validity of the model and the analysis procedure has been established by a comparison of those predictions that are also amenable to direct measurements, eg, the response of the disc-body unit to compressive load in terms of axial displacement, disc bulge, end-plate bulge, and intradiscal pressure. The states of stress and strain have then been computed in the cancellous bone, cortical shell, and the subchondral endplate of the intervertebral body and in the annulus fibers and ground substance of the disc when the unit is subjected to a compressive load. The results indicate that for a normal disc with an incompressible nucleus, the most vulnerable elements under compressive load are the cancellous bone and the end-plate adjacent to the nucleus space. On the other hand, for a degenerated disc, simulated in an extreme fashion by assuming it to be void of the nucleus, the analysis predicts the annulus bulk material to be also susceptible to failure. The annulus fibers do not appear to be vulnerable to rupture when the disc-body unit is subjected to pure compressive force.