The Arabidopsis root hair cell wall formation mutant lrx1 is suppressed by mutations in the RHM1 gene encoding a UDP-L-rhamnose synthase

Cell and cell wall growth are mutually dependent processes that must be tightly coordinated and controlled. LRR-extensin1 (LRX1) of Arabidopsis thaliana is a potential regulator of cell wall development, consisting of an N-terminal leucine-rich repeat domain and a C-terminal extensin-like domain typical for structural cell wall proteins. LRX1 is expressed in root hairs, and lrx1 mutant plants develop distorted root hairs that often swell, branch, or collapse. The aberrant cell wall structures found in lrx1 mutants point toward a function of LRX1 during the establishment of the extracellular matrix. To identify genes that are involved in an LRX1-dependent developmental pathway, a suppressor screen was performed on the lrx1 mutant, and two independent rol1 (for repressor of lrx1) alleles were isolated. ROL1 is allelic to Rhamnose Biosynthesis1, which codes for a protein involved in the biosynthesis of rhamnose, a major monosaccharide component of pectin. The rol1 mutations modify the pectic polysaccharide rhamnogalacturonan I and, for one allele, rhamnogalacturonan II. Furthermore, the rol1 mutations cause a change in the expression of a number of cell wall-related genes. Thus, the lrx1 mutant phenotype is likely to be suppressed by changes in pectic polysaccharides or other cell wall components.

Initial therapeutic strategy in follicular lymphoma (FL): An analysis from the National LymphoCare Study (NLCS)

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Background: Initial treatment strategies in FL include observation (obs), rituximab (R), chemotherapy ± R, and XRT. A recent study suggests initial therapy may impact FL survival (JCO 23:8447). NLCS is the first prospective observational study in the US designed to assess FL presentation, prognosis, treatment, and clinical outcomes. We describe initial therapeutic strategy in NLCS FL pts. Methods: FL pts diagnosed within 6 months with no prior lymphomas were recruited in this ongoing study. Data collected includes histology, stage, therapy, response, relapse and death. There is no specified treatment regimen. Results: From 3/04 to 11/05 1493 pts enrolled at 237 sites in the United States. Demographics have been initially reported at ASH 2005 (Blood 106:293a) and are comparable to SEER. Initial therapeutic strategy was: obs, 19%; R-monotherapy, 13%; chemo+R, 51%; XRT, 5%; chemo only, 4%. Chemo+R regimens were: R-CHOP, 59%; R-CVP, 19%; R-fludarabine based,11%; other, 11%. Choice to initiate therapy was associated with FLIPI, stage, and grade (p < 0.0001). Significant regional differences (p < 0.0001) were noted: obs was used in 13% of pts in Southeast and 31% in Northeast (NE); fludarabine-based R-chemo was used in 18% of pts in Southwest and only 3% in NE. Academic sites were more likely than community sites to treat pts on clinical trials (12% vs 4%). In pts treated with R or chemo+R, a higher FLIPI was not associated with decision to utilize chemotherapy. 26% of initially observed pts have switched to active therapy after a median of 2.8 months on obs since diagnosis; this was associated with baseline grade (III>II>I), but not stage or FLIPI. Conclusions: Diverse regimens are used for initial management of FL in the United States. Few pts are treated on clinical trials. Significant differences among regions and between center types suggest physician preference may drive initial therapy. Studies such as NLCS are needed to better understand the impact of initial therapy on short- and long-term outcomes.

[Table: see text]

No increase in the prevalence of asthma, allergies, and atopic sensitisation among children in Germany: 1992-2001

BACKGROUND

From 1970 to 1990 increasing rates of asthma and allergic sensitisation were observed in several countries. The aim of this study was to investigate time trends in the prevalence of asthma and allergic sensitisation among school children in Germany between 1992 and 2001.

METHODS

Parental reports of asthma, hay fever, and wheezing and measurements of specific serum IgE antibodies were investigated in six serial cross sectional surveys of 9-11 year old school children in three study areas in south west Germany.

RESULTS

A total of 6762 school children of mean age 10 years (mean participation rate 77.9%) took part in the investigation in the three study areas. Over the 9 year study period no increase in the prevalence of current wheezing and asthma was observed. In addition, the prevalence of atopic sensitisation remained unchanged during the observation period.

CONCLUSIONS

These data, using parental reports and objective measures of allergy, suggest that there has been no further increase in the prevalence of asthma and atopy since 1992. The epidemic may thus have reached a plateau.

Humanbiomonitoring-Untersuchungen von Organohalogenverbindungen - PCB, DDE; HCB, β- und γ-HCH, PCDD/PCDF, koplanaren PCB sowie polybromierten Biphenylethern

Although PCB and PCB-containing materials are not processed for a long time, PCB is under discussion again and again caused by the pollution of indoor environments. To objectify the discussion, the dates of the PCB-biomonitoring, the organochlorine-compounds (DDE, HCB, beta-/gamma -HCH, PCDD/PCDF) and the polybrominated biphenyl ethers concerning the investigations within the project "Sentinel Health Departments" in Baden-Wurttemberg are represented. Additionally results from children from Kazakhstan (Aral-Sea area) and from teachers which are working in PCB polluted schools as well as from a long term investigated test person are reported. Blood concentrations of the following compounds decreased from 1996/97 to 2002/03: the sum of the concentration of PCB 138,153 and 180 decreased from 0.46 microg/L to 0.20 microg/L, DDE from 0.32 microg/L to 0.17 microg/, HCB from 0.20 microg/L to 0.08 microg/L, beta-HCH below the level of detection, I-TEQ NATO to 4.8 pg/g blood fat, TEQ WHO (without PCB) to 5.5 pg/g blood fat, PCB 126 to 18,8,pg/g blood fat and PCB 169 to 12.8 pg/g blood fat. The influence of breast feeding and the gender on the level of the pollution is conspicious. No local correlations were found in Baden-Wurttemberg, but they were found in comparison with the results of Kazakhstan (Aral-Sea area). The difficulty to produce time series while the analyzing pollutants are more and more decreasing, as well as the change of the calculation base of the summation of parameters like I-TEQ NATO to TEQ WHO are discussed.

[Determination of mold concentrations in homes and schools in Baden-Württemberg]

So far there have been rather few reliable and comparable data available on indoor pollution with mould. Following the publication of the Federal Environmental Agency and the Health Agency Baden-Württemberg which supports the assessment of mould pollution of indoor air, it seemed advisable to investigate as to how far these criteria can be used for the assessing the mould pollution in daily practice. The results of investigations of 130 homes and 117 classrooms in Baden-Württemberg. will be represented.

[Exposition and sensitisation to indoor allergens, house dust mite allergen and cat allergens]

The study examined the exposure to biological indoor air agents and their possible role for allergies and respiratory tract illnesses of children. It was conducted as a case control study (atopic vs non-atopic children) at the four surveillance public health departments in Baden-Württemberg in the winter season 1999/2000 and included 379 children of the fourth class. The concentrations of the house dust mite antigens Der F1, Der p1, and Der Gr2 as well as cat allergen Fel d1 were determined in the children's bedrooms on the ground and in the mattress. Specific IgE-antibodies against allergens from house dust, mites and cat were determined in the serum of the children. For mite allergens the following medians ( micro g/g) were estimated in floor dust: Der p1 = 0.6, Der f1 = 2.3, Gr2 = 0.1; in mattresses: Der p1 = 1.2, Der f1 = 3.4, Gr2 = 0.3. The median of Fel d1 in floor dust was 0.2 microg/g, in mattresses 0.1 microg/g. Sensitisation to dust mite allergen was found to be more prevalent than sensitisation to cat. The distribution of sensitisation among the cases and controls is different. Among the cases, more subjects were sensitised to dust mites (32.9 %) and cat (13.1 %). Among the controls, 17.1 % were sensitised to dust mites and 4.1 % to cat. The results showed no direct association between the prevalence of allergies or respiratory tract illnesses and the indoor concentrations of the allergens. Possible reasons for these findings are discussed.

[10 years of observation by public health offices in Baden-Württemberg--assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources]

Since 1992, in Baden-Württemberg, ten-year old children have been surveyed in the project "Sentinel Health Departments" to study their exposure to environmental pollutants and possible health effects. In the four study areas 1200 children have been investigated every year initially, since 1996 every second year. The data for mercury in body fluids are reported here. The decrease in the body burden of mercury as a result of the declining usage of dental amalgam fillings, was been verified. In 1992/93, of all the children who had been surveyed, the 95 percentile for the body burden of mercury was 3.1 microg/l and in 2000/01 1.35 microg/l. Also to be discussed is the reason why mercury-based cosmetic ointments seriously exceed the HBM-II-intervention-value. Because of using these ointments, concentrations of mercury in urine up to 1400 microg/l were found. A study within the project "Sentinel Health Departments" compared the concentrations of mercury in the urine of adults with those in blood and salvia. The results support the opinion that mercury in urine is appropriate for estimating the mercury uptake from dental amalgam fillings. It can be assumed that these results reflect the situation in the entire Federal Republic of Germany. The ten years' experience confirms that the concept of the "Sentinel Health Departments" is excellently suited to obtain data relevant for environmental health of children. Environmental health protection and the essential gathering of data for future health observation in Baden-Württemberg.

[Serum selenium levels in school children: results and health assessment]

BACKGROUND

In Germany, where geogenic selenium concentrations are low, only few data on selenium status in children are available. Aim of the study was to investigate serum selenium concentrations of children in a population-based sample and to additionally investigate spatial and temporal differences.

METHOD

In three consecutive cross sectional studies the selenium concentration in serum was determined in 1,918 children (mean age 10.3 years) from four study areas. Potential factors of influence were assessed by questionnaires filled in by parents and physicians, respectively. Selenium determination was done by hydride atomic absorption spectrometry after microwave digestion.

RESULTS

Mean selenium concentrations for the subcollectives ranged from 54.5 +/- 10.5 micro g/l to 71.9 +/- 15.1 micro g/l. The minimum observed was 14 micro g/l, the maximum 216 micro g/l. Turkish children had lower selenium concentrations than German children and children of other nationality, respectively. Controlling for sex and year of investigation German children from Stuttgart had significantly lower selenium concentrations than children from Aulendorf/Bad Waldsee. In the same regression model for the period from 1995/96 to 1998/99 a decreasing trend was found to be significant. However, the regression model only explains a very small part of variance.

CONCLUSIONS

The selenium concentrations determined in this study are in the range also found in other studies in children from Germany. They are far below the toxicologically relevant range, which starts at about 600 micro g/l. The 5 th percentile in nearly all subcollectives was below the threshold limit of the lower tolerable selenium concentration of 45 micro g/l. For children from south Germany deficiency of selenium is therefore more to be suspected than a burden relevant to health. Selenium supplementation should however be considered thoroughly. Balanced nutrition is also a main factor for an optimum selenial supply.

Molecular epidemiologic studies of polycyclic aromatic hydrocarbon-DNA adducts and breast cancer

We review our studies on the role of polycyclic aromatic hydrocarbon (PAH)-DNA adducts in breast cancer. Additionally we report on analyses of the reliability of the scoring procedures used with immunohistochemical assay for PAH-DNA adducts and of potential bias arising from the use of benign breast disease (BBD) controls. We conducted a case-control study utilizing two control groups: BBD controls who donated tissue and blood samples, and healthy controls who donated blood samples. In comparisons of tumor tissue from cases and benign tissue from BBD controls, increasing adduct levels were significantly associated with case-control status [odds ratio (OR) = 2.40, 95% confidence interval (CI) 1.18-4.92], whereas in comparisons of nontumor tissue from cases and benign tissue from BBD controls the association was nonsignificant (OR = 1.97, 95% CI 0.94-4.17). We also show among cases, but not among BBD controls, that the GSTM1 null genotype is associated with increased adduct levels in breast tissue. Our reliability study found the scoring procedures used with the immunohistochemical assay to have high reliability, 0.93 in nontumor, 0.82 in tumor, and 0.74 in benign tissues. However, we found that the technician significantly contributed to the total variability of a series of data. Finally, we did not find a consistent bias to the null associated with the use of BBD controls; however, BBD controls may overestimate the prevalence of family history of breast cancer compared to that of healthy controls (18% vs.14%). We hypothesize that the higher prevalence results from a referral bias and discuss how this may influence our results.

Influence of topical brimonidine on visual field in glaucoma

PURPOSE

We evaluated the efficacy of topical brimonidine in visual field preservation and/or improvement in eyes undergoing controlled glaucoma.

METHODS

Seventy eyes of patients were trained with two different visual field test strategies: The Octopus Tendency Oriented Perimetry (TOP) G1 and the Frequency Doubling Technology (FDT) 30 degrees. Following 2-4 months of brimonidine treatment, there were significant improvements in visual field, as assessed using the TOP G1 strategy (p = 0.003). The FDT 30 degrees test revealed no statistically significant differences.

CONCLUSIONS

These data support the results of other studies, which indicate that brimonidine may increase mean sensitivity in visual field tests. Since it is known that the control of intraocular pressure does not fully protect glaucomatous eyes from visual field loss, it is possible that the neuroprotective qualities of brimonidine may contribute to visual field preservation in glaucomatous eyes.

[Endobronchial juvenile hemangioma in infancy--removal by main bronchus cuff resection. Case report]

The rare case of a 3.5 month-old infant diagnosed with a endobronchial haemangioma is presented and discussed against a background of reference literary material. A main-bronchus sleeve resection with end-to-end anastomosis was performed without reduction of lung parenchyma. No complications were documented during the period of observation. The results of repeated bronchoscopy showed the post-operative period to be of a non-problematic nature.

CD20-directed antibody-mediated immunotherapy induces responses and facilitates hematologic recovery in patients with Waldenstrom's macroglobulinemia

Waldenstrom's macroglobulinemia (WM, lymphoplasmacytic lymphoma) is a B-cell lymphoproliferative disorder in which CD20 is expressed on tumor cells from most patients. Several small studies have suggested a benefit from the anti-CD20 monoclonal antibody rituximab (Rituxan, MabThera) in patients with WM. In this retrospective study, we examined the outcome of 30 previously unreported patients with WM who received treatment with single-agent rituximab (median age 60; range 32-83 years old). The median number of prior treatments for these patients was 1 (range 0-6), and 14 patients (47%) received a nucleoside analogue before rituximab therapy. Patients received a median of 4.0 (1-11.3) infusions of rituximab (375 mg/m2). Three patients received steroids with their infusions for prophylaxis of rituximab-related infusion syndrome. Overall, treatment was well tolerated. Median immunoglobulin M (IgM) levels for all patients declined from 2,403 mg/dL (range 720-7639 mg/dL) to 1,525 mg/dL (range 177-5,063 mg/dL) after rituximab therapy (p = 0.001), with 8 of 30 (27%) and 18 of 30 (60%) patients demonstrating >50% and >25% decline in IgM, respectively. Median bone marrow lymphoplasmacytic (BM LPC) cell involvement declined from 60% (range 5-90%) to 15% (range 0-80%) for 17 patients for whom pre- and post-BM biopsies were performed (p < 0.001). Moreover, 19 of 30 (63%) and 15 of 30 (50%) patients had an increase in their hematocrit (HCT) and platelet (PLT) counts, respectively. Before rituximab therapy, 7 of 30 (23.3%) patients were either transfusion or erythropoietin dependent, whereas only 1/30 (3.3%) patients required transfusions (no erythropoietin) after rituximab. Overall responses after treatment with rituximab were as follows: 8 (27%) and 10 (33%) of the patients achieved a partial (PR) and a minor (MR) response, respectively, and an additional 9 (30%) of patients demonstrated stable disease (SD). No patients attained a complete response. The median time to treatment failure for responding (PR and MR) patients was 8.0 months (mean 8.4: range 3-20+ months), and 5.0 months (mean 6.1; range 3-12+ months) for patients with SD. These studies therefore demonstrate that rituximab is an active agent in WM. Marked increases in HCT and PLT counts were noted for most patients, including patients with WM who had MR or SD. A prospective clinical trial to more completely define the benefit of single-agent rituximab in patients with WM has been initiated by many of our centers.

Endobronchial juvenile hemangioma--a case report of a neonate including immunohistochemical monitoring and nuclear, cellular, and vascular morphometry

A 3-month-old female child suffered from tachypnea and dyspnea with abnormal blood gas values. Chest X-rays revealed an increased transparency of the left lung and a mediastinal shift to the right side. High resolution computed tomography (CT) documented a narrowing of the left upper stem bronchus. Ensuing endoscopy detected an occlusive endobronchial tumor mass that did not infiltrate the bronchial cartilage as confirmed with endobronchial ultrasonic monitoring. Based on gross histological examination of the surgical specimen obtained using sleeve resection, the highly vascularized tumor exhibited an adenomatoid growth pattern with a rather homogeneous population of nuclei. The light microscopical presentation was consistent with a juvenile (infantile) hemangioma, which was confirmed using immunohistochemical examinations despite the display of neuroendocrine features. Although endobronchial juvenile hemangiomas are an extremely rare event in early childhood, this case underscores the necessity to not neglect its occurrence in differential diagnosis.

PCB-blood levels in teachers, working in PCB-contaminated schools

In order to get more information about potential health hazards due to indoor air PCBs the present study investigated the PCB indoor concentration in schools as well as the blood levels of 6 PCB-indicator congeners in teachers from these schools. 151 teachers (78 male and 73 female; mean age 48 years) from 3 contaminated and 2 control schools participated in the study. Maximal indoor air values for total PCBs (6 PCB-indicator congeners times 5) in schools ranged from 1587 to 10655 ng/m3. Blood analyses indicated an increase in mean PCB 28 level from 0.036 (control group) to 0.098 microg/l in teachers from a school with heavy contamination of low chlorinated PCB. But there was no significant increase of PCB 138, 153 and 180 in blood above the normal background concentrations in any of the contaminated schools (mean values of all groups: PCB 138 = 0.66, 153 = 0.95, 180 = 0.70 microg/l blood). The results of blood analyses and additional toxicokinetic calculations suggested that inhalative PCB-uptake in the most contaminated schools caused a minor increase above mean background-PCB concentrations in blood. In conclusion, despite high PCB indoor air levels in schools, there was only a moderate increase in blood concentrations of teachers, mainly due to congeners with low chlorination (PCB 28 to PCB 101).

Employment outcomes in family-aided assertive community treatment

Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.

Rituximab therapy in Waldenstrom's macroglobulinemia: preliminary evidence of clinical activity

To assess the preliminary efficacy of rituximab therapy in Waldenstrom's macroglobulinemia (WM), we examined the clinical and laboratory data for all patients with WM treated on IDEC Pharmaceuticals sponsored trials and one patient treated at Walter Reed Army Medical Center. Seven symptomatic patients with WM were treated with four (n = 6) or eight (n = 1) weekly infusions of rituximab (375 mg/m2). Patients had received a median of three prior therapies (range 1-4) which included alkylator therapy in all (five patients refractory) and fludarabine in four (all refractory). Therapy was tolerated well in all patients without decrement in cellular immune function or significant infectious morbidity. Partial responses were noted in three of these patients, including two with fludarabine-refractory disease. The median progression-free survival for these patients was 6.6 months (range 2.2-29+ months). These data suggest that rituximab has clinical activity in heavily pre-treated patients with Waldenstrom's macroglobulinemia. Based on these data, clinical studies of Rituximab in previously untreated and treated WM appear indicated.

Single-agent monoclonal antibody efficacy in bulky non-Hodgkin's lymphoma: results of a phase II trial of rituximab

PURPOSE

A phase II trial was performed to evaluate the safety and efficacy of rituximab, a chimeric anti-CD20 monoclonal antibody, in patients with bulky (> 10-cm lesion) relapsed or refractory low-grade or follicular non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

Thirty-one patients received intravenous infusions of rituximab 375 mg/m(2) weekly for four doses. All patients had at least one prior therapy (median, three; range, one to 13) and had progressive disease at study entry. Patients were a median of 4 years from diagnosis.

RESULTS

No patient had treatment discontinued because of an adverse event. No patient developed human antichimeric antibody. The overall response rate in 28 assessable patients was 43% with a median time to progression of 8.1 months (range, 4.5 to 18.6+ months) and median duration of response of 5.9 months (range, 2.8 to 12.1+ months). The average decrease in lesion size in patients who achieved a partial response was 76%, and patients with stable disease had a decrease in average lesion size of 26%. Median serum antibody concentration was higher in responders compared with nonresponders, and a negative correlation was shown between antibody concentration and tumor bulk at baseline.

CONCLUSION

Rituximab single-agent outpatient therapy is safe and shows significant clinical activity in patients with bulky relapsed or refractory low-grade or follicular B-cell NHL.

Social class, ethnicity, and mental illness: the importance of being more than earnest

This paper revisits a landmark study of the prevalence of mental illness in the state of Massachusetts conducted by Edward Jarvis in the 19th century. Jarvis drew an improper conclusion about the relationship between social class, ethnicity, and insanity, asserting that the Irish foreign-born had a higher prevalence of insanity in each social stratum. A reanalysis of Jarvis' data shows that in both the pauper and independent social classes in Massachusetts, the prevalence of insanity was significantly lower among foreign-born persons than among native-born persons. On the basis of his misperception, Jarvis constructed elaborate etiological theories. These theories made a strong impact on the mental health service policies of his day. The effects of incomplete examination of data on etiological theories and mental health policy in current times are highlighted in this article.

Neutrophil adhesion and activation during systemic thrombolysis in acute myocardial infarction

In a pilot study, alterations of polymorphonuclear neutrophil function during systemic thrombolysis in acute myocardial infarction have been investigated in humans. The following parameters of neutrophil function were measured before and at 15 and 45 minutes after initiation of systemic thrombolysis with a recombinant tissue-type plasminogen activator in 20 patients with acute myocardial infarction: (1) neutrophil adhesion and (2) neutrophil activation. During systemic thrombolysis a significant decrease was observed in neutrophil adhesion (5.5+/-6.4 to 3.2+/-3.3; p<0.05), in phagocyting neutrophil activation (39+/-18 to 25+/-14%; p<0.05), and in resting neutrophil activation (9+/-7 to 3+/-4%; p<0.05). Successful reperfusion coincided with a significantly higher reduction of phagocyting neutrophil activation (40+/-14 to 20+/-12% vs. 39+/-24 to 26+/-19% in unsuccessful reperfusion; p<0.05), and of neutrophil adhesion (6.2+/-5.7 to 2.7+/-3.0 vs. 4.1+/-3.8 to 3.5+/-4.0 in unsuccessful reperfusion; p<0.05) during thrombolysis. Systemic thrombolysis in acute myocardial infarction is accompanied by a reduction in neutrophil adhesion and activation dependent on thrombolytic success.

A comparison of two levels of family-aided assertive community treatment

OBJECTIVE

The study examined differences in outcomes for patients with schizophrenic disorders who were receiving assertive community treatment based on whether their families were involved in their treatment more intensively in psychoeducational multifamily groups or episodically in crisis family intervention.

METHODS

Sixty-eight individuals who met DSM-III-R criteria for schizophrenic disorders and who had at least one other major complicating factor were randomly assigned to the two treatment conditions, and clinical and functional outcomes over a 24-month follow-up period were compared.

RESULTS

Both groups had significant reductions in rehospitalization rates and symptom levels and increased participation in treatment. Patients in multifamily group treatment had higher employment rates during the study. Otherwise, few significant differences in the major outcome variables were found. In both treatment conditions family members reported significant improvements in their objective and subjective burden; in friction, dissatisfaction, and overinvolvement with the patient; and in the patient's functioning.

CONCLUSIONS

The results suggest that systematic family involvement enhances the rehabilitation and family-related outcomes of assertive community treatment. Patients in multifamily group treatment had better employment outcomes.

Multiple-family groups and psychoeducation in the treatment of schizophrenia

OBJECTIVE

To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment.

METHOD

A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New York. Psychotic relapse, symptom status, medication compliance, rehospitalization, and employment were assessed independently during 2 years of supervised treatment.

RESULTS

The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality (16% vs 27%) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge (13% vs 33%). The relapse hazard ratio between treatments was 1:3. The relapse rate for both modalities was less than half the expected rate (65% to 80% for 2 years) for patients receiving individual treatment and medication. Rehospitalization rates and psychotic symptoms decreased significantly, and medication compliance was high, to an equal degree in both modalities.

CONCLUSION

Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.

Lifetime and five-year prevalence of homelessness in the United States: new evidence on an old debate

A 1990 household-based telephone survey of 1,507 people was followed up by surveying a subsample of those interviewed for the initial report. Results showed very high prevalence figures for homelessness, quite close to those found in the earlier survey. Moreover, using explicit and stringent definitions of literal homelessness and doubling up, most periods of homelessness were found to last for more than one month and, particularly with regard to literal homelessness, to involve serious deprivations and violent victimization.

Psychoeducational multiple family groups: four-year relapse outcome in schizophrenia

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.

Home hazards and falls in the elderly: the role of health and functional status

OBJECTIVES

This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls.

METHODS

A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups.

RESULTS

Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons.

CONCLUSIONS

While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects.

Relationship between lifetime occupation and parietal flow: implications for a reserve against Alzheimer's disease pathology

We previously reported an inverse relation between parietal cerebral blood flow and years of education in Alzheimer's disease (AD) patients matched for clinical severity. This suggested that the clinical manifestation of advancing AD pathology is delayed in patients with higher educational attainment. Other aspects of life experience may also provide a reserve against the clinical expression of AD. To test this hypothesis, we classified the primary life-time occupations of 51 AD patients using the Dictionary of Occupational Titles, published by the US Department of Labor, and derived six factor scores describing intellectual, interpersonal, and physical job demands. Regional cerebral blood flow was measured using the xenon-133 inhalation method. After controlling for age, clinical dementia severity, and education, there was less relative perfusion in the parietal region in subjects whose occupations were associated with higher interpersonal skills and physical demands factor scores. We conclude that independent of education, aspects of occupational experience may provide a reserve that delays the clinical manifestation of AD.

Location of Golgi membranes with reference to dividing nuclei in syncytial Drosophila embryos

The role of cytoskeletal elements in the cellularization of syncytial Drosophila embryos is becoming evident; however, the distribution and role of organelles such as the Golgi complex, essential for membrane biogenesis, remain unknown. We have cloned a Golgi-membrane-associated polypeptide, beta-COP, from Drosophila. Immunocytochemical studies of syncytial Drosophila embryos with anti-Drosophila beta-COP antibody reveal that Golgi membranes are spatially segregated from the rapidly dividing nuclei. In early embryos, the Golgi membranes are located in the embryonic cortex and nuclei are confined to the core. This distribution of Golgi membranes may serve in preparation of the embryonic cortex for the accommodation of nuclei upon their eventual migration to the cortex and in biogenesis of the excessive plasma membrane needed for cellularization of syncytial embryos.

Diagnosis of dementia in a heterogeneous population. A comparison of paradigm-based diagnosis and physician's diagnosis

Each of 430 subjects received a diagnosis using two independent methods: a test-based quantitative paradigm and a semistructured neurological examination by a physician. The paradigm diagnosis was based on a battery of tests that assessed short- and long-term verbal memory and short-term nonverbal memory, orientation, construction, abstract reasoning, and language. The subjects came from a community in Manhattan County, in New York City, and were characterized by diversity with respect to both ethnicity (29.1% black, 33.4% Hispanic) and educational level (23.5% with 6 or fewer years of education, 25.6% college educated). Based on the paradigm, 10.5% of subjects received diagnoses of dementia, 29.1% of cognitive impairment, and 60.5% of normal. Based on the physician's diagnosis, 9.8% were demented, 21.6% cognitively impaired, and 68.6% normal. There was agreement between the two diagnostic methods for 71.8% of subjects. Diagnostic disagreement (n = 121) was in most cases between normal and cognitively impaired (71.0%) or between cognitively impaired and demented (21.5%). There were only nine cases (7.5%) in which a subject was judged demented by one method and normal by the other. The reliability of each method with respect to the other was moderate (intraclass correlation coefficient, .62), while the reliability of a composite diagnosis based on both methods was much higher (.77). The paradigm was more likely than the physician to give the diagnosis of dementia to patients with low educational levels. The physician's diagnosis was strongly influenced by measures of functioning and by the mental status test administered in the semistructured neurological examination. Race and diagnosis were not related when the effect of education was controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute health effects among firefighters exposed to a polyvinyl chloride (PVC) fire

Firefighters are frequently being called on to fight fires that are chemical in nature. In the aftermath of a chemical fire in Plainfield, New Jersey on March 20-21, 1985, the authors conducted a retrospective cohort study which surveyed 80 firefighters exposed to burning polyvinyl chloride (PVC) as well as 15 nonexposed firefighter subjects. By means of an 81-item symptom checklist, exposed firefighters reported more frequent and severe symptoms at 5-6 weeks post incident. This was true for a total symptomatology score as well as 19 individual items. Some of the items with an elevated risk were consistent with exposure to hydrogen chloride, the main pyrolysis product of polyvinyl chloride. Other items with an elevated risk appeared to be related to smoke inhalation while others seemed psychosocial in nature. Analyses conducted within the exposed firefighter group showed that fighting the fire the first day, being a truckman, and residence within 1 mile (1.6 km) of the firehouse were significant risk factors for high total symptom scores. These risk factors may have been associated with level or duration of exposure to the toxic substances produced during the fire.

A phase I-II trial of 4'-deoxydoxorubicin (esorubicin) in refractory or relapsed acute leukemia

In a phase I-II study, 21 patients with relapsed or refractory acute leukemia were treated with 4'-deoxydoxorubicin (esorubicin), the 4'-deoxy derivative of doxorubicin. Four of 14 evaluable patients with acute nonlymphocytic leukemia (ANLL) in relapse or refractory to other anthracyclines achieved partial response (28.5%). Pharmacokinetics were similar to those of the parent compound, doxorubicin. Esorubicin has activity in ANLL and has pharmacologic properties comparable to those of other anthracyclines. Dose-limiting toxicity occurs in the form of mucositis, which may limit its use in combination with other antileukemic drugs.

Age and recognition of depression: implications for a cohort effect in major depression

Studies relying on subjects' retrospective reports have recently been interpreted as indicating that individuals born since World War II are at increased risk for a diagnosis of lifetime major depression. Examining the validity of this 'cohort effect' is essential, given the potential importance of such a phenomenon for research and policy. Among a number of artefactual explanations for the cohort effect is the possibility that older individuals are less likely to recognize depression as a mental disorder, and hence are less likely to remember depressive episodes as such, or to report these episodes in interviews on mental health. To test whether age was related to the recognition of major depression as a mental problem, we analysed responses from 152 randomly selected community residents on whether a vignette describing DSM-III major depression represented a psychological or emotional problem. Older respondents were much less likely to characterize major depression this way, even controlling for other factors. Such an age effect may provide a partial explanation for the apparent cohort effect, although the issue is complex and further research is needed.

Psychological response of firefighters to a chemical fire

Samples of firefighter subjects (n = 80) and a comparison group (n = 15) were contrasted on a number of postincident psychological distress measures in the aftermath of a polyvinyl chloride (PVC) fire. Using a structured, self-administered questionnaire, firefighter subjects were found to be more psychologically distressed on demoralization, specific emotional distress, and perceived threat to physical health. After controlling for baseline characteristics on which subjects and the comparison group differed, these between-group effects remained significant. The three outcome scales, while correlated, measure different components of psychological distress.

Binding of trichloromethyl radicals to lipids of the hepatic endoplasmic reticulum during tetrachloromethane metabolism

Metabolism of tetrachloromethane (carbon tetrachloride) by liver microsomal fraction under anaerobic conditions and in vivo leads to covalent binding of trichloromethyl radicals to lipids. The resulting covalently modified lipids contain two different types of fatty acids: a group of monomeric trichloromethyl fatty acid residues, usually with one double bond less than the precursor fatty acids, and a group of fatty acids that are not sufficiently volatile for gas chromatography. The liquid-chromatographic properties of the latter indicate high molecular mass, presumably due to cross-linking. The chemical structures of the monomeric fatty acids were elucidated, and these support the view that the most significant reactive metabolite of tetrachloromethane is the trichloromethyl radical. The isomer patterns of the monomeric trichloromethyl fatty acids in vitro and in vivo are almost identical, which shows that anaerobic incubation of tetrachloromethane with microsomal fraction very well reflects the processes involved in hepatotoxicity of tetrachloromethane in vivo.

Anaerobic metabolism of carbon tetrachloride and formation of catabolically resistant phospholipids

Anaerobic incubation of microsomes with 14C-carbon tetrachloride leads to trichloromethyl radicals which, apart from other detrimental reactions, bind covalently to phospholipids. These labelled lipids are extracted, phosphatidylcholine is isolated and incubated with phospholipase A2 from Naja naja snake venom and from porcine pancreas. Half of the covalently modified phosphatidylcholine is resistant toward phospholipase A2. Distribution of such catabolically resistant phospholipids from the endoplasmic reticulum to other cell organelles may play an important role in the pathway leading from the primary lesion to hepatocyte necrosis.

Social functioning of psychiatric patients in contrast with community cases in the general population

Most cases in epidemiologic surveys of community populations have never been treated by mental health professionals. We studied how community cases and patients may be similar or different with respect to their social functioning in such areas as work, marriage, and parenting. There are grounds for two contrasting hypotheses: the universal hypothesis (disorder is accompanied by disability independently of treatment status) and the patient-specific hypothesis (disorder is accompanied by disability only for cases who become patients). We investigated these hypotheses using data from symptom scales and social functioning scales that are part of the Psychiatric Epidemiology Research interview. The sample consisted of 205 adults from the general population and 204 psychiatric patients from Jerusalem. The results provided some support for each hypothesis depending on the types of symptoms and functioning and disorder involved; however, the relationship between symptoms and social functioning in patients as well as cases from the community was weaker than had been supposed.

The primary medical care practitioner's attitudes toward psychiatry. An Israeli study

General practitioners are important to the delivery of mental health care because they perform three important functions, as an identifier, as a referral agent and as a caregiver. This study investigates the importance of the attitudes G.P.s hold on their performance of two of these functions, screening and referring. Relying on items developed in previous investigations, four measures of attitudinal dimensions are developed using factor analysis: Belief in Psychogenesis, Psychiatric Fatalism, Referral Reluctance and G.P. as Caregiver. These attitude dimensions are then related to the functions of screening and referral. Three major findings emerge from the results. First, the attitudinal dimensions uncovered are empirically distinct, suggesting that no single pro-to-anti psychiatry is present. Second, attitudes play a role in the screening of cases. A G.P. is more likely to identify cases if he believes in the psychogenesis of physical disorders, and is not concerned that identification and referral will lead to negative consequences for the patient. Third and finally, attitudes do not play a strong role in the referral of cases once they have been identified as such. The findings are presented and interpreted by referring to the sensitive position G.P.s occupy between the public and the psychiatrist.