Two endogenous gonadotropin-releasing hormones generate dissimilar Ca(2+) signals in identified goldfish gonadotropes

Ca(2+) signals are involved in the signal transduction of neuroendocrine regulators. In goldfish, two endogenous gonadotropin-releasing hormones, salmon (s)GnRH and chicken (c)GnRH-II, control maturational gonadotropin secretion. Although considerable evidence suggests that sGnRH and cGnRH-II exert their activity on goldfish gonadotropes through a single population of receptors, differences in signal transduction mechanisms between these peptides have been demonstrated. We used ratiometric Fura-2 Ca(2+) imaging of single morphologically identified gonadotropes to quantitatively compare the Ca(2+) signals evoked by sGnRH and cGnRH-II. The amplitude and the rate of rise of sGnRH- and cGnRH-II-evoked Ca(2+) signals increased with concentration. At maximal concentrations, Ca(2+) signals generated by cGnRH-II rose significantly faster than those elicited by sGnRH, while other parameters such as the maximum amplitude, average Ca(2+) increase, and latency did not differ between the two peptides. Ca(2+) signals evoked by sGnRH or cGnRH-II were often spatially restricted to one part of the cell over the duration of the response. We provide a comprehensive account of the spatial and temporal aspects, including calculated kinetics, of GnRH-evoked Ca(2+) signals in single identified gonadotropes. This is the first report of quantified differences in Ca(2+) signals generated by two endogenous GnRH neuropeptides, which may act through the same receptor population in this cell type.

Monitoring cocaine use in substance-abuse-treatment patients by sweat and urine testing

Sweat and urine specimens were collected from 44 methadone-maintenance patients to evaluate the use of sweat testing to monitor cocaine use. Paired sweat patches that were applied and removed weekly (on Tuesdays) were compared with 3-5 consecutive urine specimens collected Mondays, Wednesdays, and Fridays. All patches (N = 930) were extracted in 2.5 mL of solvent and analyzed by ELISA immunoassay (cutoff concentration 10 ng/mL); a subset of patches (N = 591) was also analyzed by gas chromatography-mass spectrometry (GC-MS) for cocaine, benzoylecgonine (BZE), and ecgonine methyl ester (EME) (cutoff concentration 5 ng/mL). Urine specimens were subjected to qualitative analysis by EMIT (cutoff 300 ng/mL) and subsets were analyzed by TDx (semiquantitative, LOD 30 ng/mL) and by GC-MS for cocaine (LOD 5 ng/mL). Results were evaluated to (1) determine the relative amounts of cocaine and its metabolites in sweat; (2) assess replicability in duplicate patches; (3) compare ELISA and GC-MS results for cocaine in sweat; and (4) compare the detection of cocaine use by sweat and urine testing. Cocaine was detected by GC-MS in 99% of ELISA-positive sweat patches; median concentrations of cocaine, BZE, and EME were 378, 78.7, and 74 ng/mL, respectively. Agreement in duplicate patches was approximately 90% by ELISA analysis. The sensitivity, specificity, and efficiency of sweat ELISA cocaine results as compared with sweat GC-MS results were 93.6%, 91.3%, and 93.2%, respectively. The sensitivity, specificity, and efficiency between ELISA sweat patch and EMIT urine results were 97.6%, 60.5%, and 77.7%, respectively. These results support the use of sweat patches for monitoring cocaine use, though further evaluation is needed.

Adults seeking treatment for marijuana dependence: a comparison with cocaine-dependent treatment seekers

Sixty-two individuals seeking treatment for marijuana dependence completed a comprehensive assessment. Sociodemographics, substance use, psychosocial functioning, psychiatric symptoms, and medical status were compared with similar data collected from 70 treatment-seeking, cocaine-dependent individuals. Substantial psychosocial and psychiatric problems were observed in both groups. In general, the marijuana group reported substance-use histories and a range of impairment comparable with the cocaine group; however, they showed less severe dependence. The marijuana group was more ambivalent and less confident about stopping their marijuana use than the cocaine group was about stopping their cocaine use. These findings indicate that treatment-seeking, marijuana-dependent individuals exhibit substantial problems and that further efforts to develop effective treatments for this population are warranted.

Broad beneficial effects of cocaine abstinence reinforcement among methadone patients

Escalating reinforcement for sustained abstinence has been effective in treating cocaine abuse. Under this schedule, patients receive vouchers for cocaine-free urine samples; vouchers have monetary values that increase with the number of consecutive cocaine-free urine samples. Cocaine-abusing methadone patients were randomly assigned to receive vouchers for 12 weeks under (a) an escalating schedule (n = 20), (b) an escalating schedule with start-up bonuses (n = 20), or (c) a noncontingent schedule (n = 19). Start-up bonuses were designed to provide added reinforcement for initiating abstinence; however, they did not improve outcomes. Both contingent interventions significantly increased cocaine abstinence. In addition, the contingent interventions increased abstinence from opiates and decreased reports of cocaine craving. These results replicate the efficacy of cocaine abstinence reinforcement and show that it can have broad beneficial effects.

Broad beneficial effects of cocaine abstinence reinforcement among methadone patients

Escalating reinforcement for sustained abstinence has been effective in treating cocaine abuse. Under this schedule, patients receive vouchers for cocaine-free urine samples; vouchers have monetary values that increase with the number of consecutive cocaine-free urine samples. Cocaine-abusing methadone patients were randomly assigned to receive vouchers for 12 weeks under (a) an escalating schedule (n = 20), (b) an escalating schedule with start-up bonuses (n = 20), or (c) a noncontingent schedule (n = 19). Start-up bonuses were designed to provide added reinforcement for initiating abstinence; however, they did not improve outcomes. Both contingent interventions significantly increased cocaine abstinence. In addition, the contingent interventions increased abstinence from opiates and decreased reports of cocaine craving. These results replicate the efficacy of cocaine abstinence reinforcement and show that it can have broad beneficial effects.

Lung function and general illness symptoms in a semiconductor manufacturing facility

Large quantities of potent gases, dopants, photoactive chemicals (photoresists, photoinitiators), solvents, and ionizing radiation are used in the semiconductor manufacturing process, but little is known about the occurrence of respiratory disease from exposures in this industry. The purpose of this study was to assess the pulmonary risk by conducting pulmonary function tests and symptoms survey in a semiconductor plant in Taiwan. This study is part of a clinical survey conducted on 926 workers in a semiconductor plant in Taiwan in July 1995. The study items included a standard self-administered questionnaire, chest x-rays, pulmonary function tests, and physical examinations in 249 workers. There was a borderline significance of higher prevalence (P = 0.06) of restrictive lung abnormality in male photolithographic workers (4 of 21; 19.1%) than in male control workers (0 of 17; 0%), and the smoking- and age-adjusted odds ratio was 4.1 (95% confidence interval [CI], 0.41-41.6). There was a significantly higher prevalence (P = 0.02) of restrictive lung abnormality in male ion-implantation workers (5 of 19; 26.3%) than in male control workers (0 of 17; 0%), and the smoking- and age-adjusted odds ratio was 3.7 (95% CI, 0.52-26.7). There were significantly higher prevalences of airway irritation, eye irritation, headache, stress, tiredness, and poor memory in female photolithographic or etch/diffusion workers than in control workers. This study suggests that restrictive lung abnormality is a potential health effect in male silicon-wafer fabrication workers in the semiconductor industry. The tasks of male process, maintenance, and equipment engineers put them at risk for intermittent short-term peak exposure. This may account for a higher prevalence of mild restrictive lung abnormality among male engineers of photolithographic and ionimplantation sections. The findings of this medical surveillance are tentative, but they suggest that further investigation of the etiologic factors and the subsequent health effects is necessary.

Photodynamic therapy for facial squamous cell carcinoma in cats using Photofrin

BACKGROUND

Photodynamic therapy (PDT) has been shown to be an effective treatment modality for surface-oriented neoplasms of the skin, respiratory, gastrointestinal, and urogenital systems. The purpose of our study was to assess the safety and efficacy of PDT using Photofrin in the treatment of squamous cell carcinomas of feline facial skin.

MATERIALS AND METHODS

Cats with naturally occurring squamous cell carcinomas of the skin were entered into the study. PDT was delivered to the tumors using an argon-pumped dye laser 48 hours after the administration of the photosensitizer porfimer sodium (Photofrin). Following treatment, the tumors were evaluated for complete response rates and local control durations.

RESULTS

Eight tumors were staged T1a, 9 staged T1b, and 14 staged T2b. Complete response rates as well as local control durations were significantly related to stage (p < 0.0001). Complete response was achieved in 100% of the T1a tumors and 53% of the T1b tumors; the overall 1-year local control rate for all treated tumors was 62%. Clinical, hematological, and biochemical evidence of toxicity was not seen in any cat following drug administration.

CONCLUSION

PDT with the photosensitizer Photofrin was safe and effective in treating early stage squamous cell carcinomas of the feline skin.

Connections of the basal forebrain of the weakly electric fish, Eigenmannia virescens

The organization of the ventral nucleus of the ventral telencephalon (Vv) was examined in the weakly electric fish, Eigenmannia virescens. This nucleus, which is considered the teleost homologue to the basal forebrain nuclei of other vertebrates, was subdivided into dorsal and ventral subdivisions, based upon cytoarchitectonic, immunohistochemical, and connectional criteria. Afferent projections were observed from the medial olfactory bulb as well as the terminal nerve ganglion. Telencephalic afferents to the Vv were very restricted, consisting of the supracommissural and the dorsal intermediate nuclei of the ventral telencephalon, the nucleus taenia, and the medial region of the posterior nucleus of the dorsal telencephalon. However, the major afferents to the Vv were diencephalic, particularly those originating from the rostral preoptic area and other hypothalamic nuclei. Additional afferents included the posterior tubercular nucleus, the locus coeruleus, the medial perilemniscal nucleus, and the periventricular nucleus of the posterior tuberculum. Relatively weak projections were observed from the ventral thalamus and the dorsal posterior thalamic nucleus. As described previously, the diencephalic complex of the central posterior thalamic nucleus/prepacemaker nucleus (CP/PPn), which also has cells that innervate the pacemaker circuitry controlling the production of an electric organ discharge, projects to the Vv. Terminal fields of the Vv were observed to be coextensive with afferent cell groups in the preoptic area, lateral and caudal hypothalamic nuclei, and thalamus. An additional efferent target of the Vv was the pretectal nucleus electrosensorius. That many cell groups that are connected with the Vv are also connected with the CP/PPn, particularly the preoptic and hypothalamic nuclei, suggests that the electrocommunicatory system is intimately linked with basal forebrain limbic pathways.

Afferent and efferent connections of the diencephalic prepacemaker nucleus in the weakly electric fish, Eigenmannia virescens: interactions between the electromotor system and the neuroendocrine axis

The afferent and efferent connections of the gymnotiform central posterior nucleus of the dorsal thalamus and prepacemaker nucleus (CP/PPn) were examined by retrograde and anterograde transport of the small molecular weight tracer, Neurobiotin. The CP/PPn was identified by physiological assay and received a local iontophoretic injection of Neurobiotin. Retrogradely labeled somata were observed in the ventral telencephalon, hypothalamus, and the pretectal nucleus electrosensorius. Anterogradely labeled fibers were traced from the CP/PPn to the ventral telencephalon, the hypothalamus, the neuropil immediately adjacent to the most rostral subdivision of the nucleus electrosensorius, the optic tectum, and the pacemaker nucleus. Retrograde transport of tracer following injections into the ventral telencephalon, preoptic area, lateral hypothalamus, tectum, and pacemaker nucleus confirmed these efferent targets. A rostromedial subarea of the CP/PPn can be identified that projects to basal forebrain regions and to a lateral region of the CP/PPn that contains afferents to the pacemaker. Many of the targets, which are connected with the CP/PPn, have been linked to reproductive behavior or neuroendocrine control in other fishes. A comparative analysis reveals that the efferent pathways of the CP/PPn appear similar and may be homologous to efferent pathways of some components of the auditory thalamus among tetrapods.

Feline ocular epithelial response to growth factors in vitro

OBJECTIVE

To examine the proliferative abilities of growth factors known to participate in wound healing on feline lens, iris pigment, ciliary, and retinal pigment epithelium cultured in vitro.

ANIMALS

8 clinically normal cats.

PROCEDURE

Iris pigment, lens, ciliary, and retinal pigment epithelia of normal eyes of cats were isolated and cultured. Morphologic characteristics of primary cell cultures were studied by light and electron microscopy. Subcultures of epithelial cells were exposed to media supplemented with 0.5% fetal bovine serum plus various combinations of insulin and/or growth factors, including transforming growth factor-alpha, epidermal growth factor, acidic fibroblast growth factor, and basic fibroblast growth factor. Growth promoting effects were evaluated by counting with an electronic cell counter.

RESULTS

Cells retained many of the morphologic characteristics of in vivo cells. Cell proliferation assays indicated that transforming growth factor-alpha stimulated lens and ciliary epithelial cell growth, and epidermal growth factor enhanced lens and iris pigment epithelial cell growth. Acidic fibroblast growth factor had proliferative effects on lens, iris pigment, and ciliary epithelium. Basic fibroblast growth factor was the most potent stimulator of all mitogens used, and caused substantial proliferation in all cell types. Insulin alone stimulated lens and ciliary epithelial proliferation but, combined with other growth factors, had a synergistic effect with those causing cell proliferation, except acidic fibroblast growth factor with iris pigment epithelium.

CONCLUSION

Morphologic studies support the argument that pigment-producing cells are involved in feline ocular sarcoma. Growth factor studies indicated that ciliary epithelium has the most profound proliferative effect of all growth factors used. These data may help guide future studies in determining the cell of origin for feline ocular sarcoma.

Motor control of the jamming avoidance response of Apteronotus leptorhynchus: evolutionary changes of a behavior and its neuronal substrates

The two closely related gymnotiform fishes, Apteronotus and Eigenmannia, share many similar communication and electrolocation behaviors that require modulation of the frequency of their electric organ discharges. The premotor linkages between their electrosensory system and their medullary pacemaker nucleus, which controls the repetition rate of their electric organ discharges, appear to function differently, however. In the context of the jamming avoidance response, Eigenmannia can raise or lower its electric organ discharge frequency from its resting level. A normally quiescent input from the diencephalic pre-pacemaker nucleus can be recruited to raise the electric organ discharge frequency above the resting level. Another normally active input, from the sublemniscal pre-pacemaker nucleus, can be inhibited to lower the electric organ discharge frequency below the resting level (Metzner 1993). In contrast, during a jamming avoidance response, Apteronotus cannot lower its electric organ discharge frequency below the resting level. The sublemniscal pre-pacemaker is normally completely inhibited and release of this inhibition allows the electric organ discharge frequency to rise during the jamming avoidance response. Further inhibition of this nucleus cannot lower the electric organ discharge frequency below the resting level. Lesions of the diencephalic pre-pacemaker do not affect performance of the jamming avoidance response. Thus, in Apteronotus, the sublemniscal pre-pacemaker alone controls the changes of the electric organ discharge frequency during the jamming avoidance response.

Does self-administration of a quality of life index for inflammatory bowel disease change the results?

We assessed the effect of self-administration of a disease-specific health-related quality of life instrument, the Inflammatory Bowel Disease Questionnaire (IBDQ), on score results. Patients were assessed at two visits in two tertiary centers. "Experienced" patients (N = 31) with Crohn's disease had previously completed the IBDQ several times while "novices" (N = 37) with Crohn's disease or ulcerative colitis had no prior exposure to the IBDQ. At each visit a self-administered IBDQ followed by a nurse-administered IBDQ (score range, 1-7; absolute score range, 32-224) and disease activity were assessed. At visit 1, the mean rates of discrepant responses between nurse and self-administered scores were 24 +/- 15% in experienced patients and 34 +/- 17% in novice patients (p = 0.018), which fell to 21 +/- 16 and 23 +/- 10%, respectively, by visit 2 (p = NS). However, discrepancy rates were not significantly different between novice and experienced patients when adjusted by center. Discrepancies occurred randomly in all 32 IBDQ items. Eighty percent of all discrepant responses differed by only one grade of a seven-point Likert scale. Baseline self-administered scores for all patients were 4.80 +/- 1.24 (absolute score, 153.0 +/- 39.9). Mean score differences at each visit (nurse minus self) were very small, ranging from 0.029 to 0.136, and would not be considered clinically important. Intraclass correlation coefficients between the nurse and self-administered IBDQ and the four dimensional scores were > or = 0.97 by visit 2, indicating excellent concordance and minimal observer error. Mean changes in score over time were of comparable magnitude for both self (0.320 +/- 0.819) and nurse (0.260 +/- 0.831) assessments. We conclude that the IBDQ may be reliably used as a self-administered instrument in clinical trials.

Increasing opiate abstinence through voucher-based reinforcement therapy

Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided: the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted. (P < or = 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P < or = 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P < or = 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.

Localization and developmental expression of surfactant proteins D and A in the respiratory tract of the mouse

Surfactant protein D (SP-D) is synthesized and secreted by pulmonary epithelial cells. Like surfactant protein A (SP-A), SP-D is a collagen-like glycoprotein belonging to the "collectin" class of C-type lectins that may play an important role in pulmonary host defense. To begin studies on SP-D gene regulation and function using the mouse as an animal model, we identified the cellular sites of SP-D gene expression in adult mouse lung and trachea and characterized the developmental expression of SP-D mRNA in murine fetal and newborn lungs. We compared these findings with similar studies for murine SP-A, which has an established role in surfactant function and metabolism and a probable role in pulmonary host defense. SP-D mRNA and protein were readily detected by in situ hybridization and immunocytochemistry in alveolar type II and nonciliated bronchiolar epithelial cells of the lung, as well as in cells of the tracheal epithelium and tracheal submucosal glands of the adult mouse. Although SP-A mRNA and protein were also localized to alveolar and nonciliated bronchiolar epithelial cells of the murine lung, there was no detectable labeling for either SP-A mRNA or protein in the murine trachea. Expression of murine SP-D mRNA was first detected by Northern blot analysis on d 16 of gestation in timed-pregnant mice, with an average gestational period of 17 d, and this increased dramatically before birth and during the immediate postnatal period. The developmental expression of murine SP-A mRNA paralleled that of SP-D except that there was a small decrease in mRNA content on postnatal d 5. These studies provide the first description of the cellular distribution and developmental expression of SP-D in mouse lung, which will be important for interpreting future studies of SP-D gene expression in transgenic animal models. In addition, these studies provide the first documentation that, unlike SP-A, SP-D is synthesized not only in the lung but also in submucosal glands of the trachea.

A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. I. Mortality and cardiovascular morbidity

The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome.

METHODS

This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations.

RESULTS

Cardiovascular morbidity and mortality were not affected by pH management, and the incidence of stroke (2.5%) did not differ between groups. Overall in-hospital mortality was 2.8%, eight of the nine deaths occurring in the nonpulsatile group (5.1% versus 0.6%; p = 0.018). The incidence of myocardial infarction was 5.7% in the nonpulsatile group and 0.6% in the pulsatile group (p = 0.010), and use of intraaortic balloon pulsation was significantly more common in the nonpulsatile group (7.0% versus 1.9%; p = 0.029). The overall percentage of patients having major complications was also significantly higher in the nonpulsatile group (15.2% versus 5.7%; p = 0.006). Duration of cardiopulmonary bypass, age, and use of nonpulsatile perfusion all correlated significantly with adverse outcome.

CONCLUSIONS

Use of pulsatile perfusion during cardiopulmonary bypass was associated with decreased incidences of myocardial infarction, death, and major complications.

A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes

This double-blind, randomized comparison of pulsatile or nonpulsatile perfusion and alpha-stat or pH-stat management during cardiopulmonary bypass was designed to assess postoperative central nervous system outcomes.

METHODS

Neurologic and cognitive testing was conducted before the operation and 7 days and 2 months after the operation in 316 patients having coronary artery bypass and in a reference cohort of 40 patients having major vascular and thoracic operations.

RESULTS

As detailed in part I of this study, mortality in patients having coronary bypass was 2.8%. The incidence of stroke was 2.5% and did not differ among bypass groups. Mortality was 2.5% for the major surgery cohort. The incidence of cognitive (p = 0.003) and either neurologic or cognitive dysfunction (p = 0.0002) was higher at 7 days for the coronary bypass group than for the major surgery cohort. The incidence of neurologic dysfunction remained higher (p = 0.050) at 2 months in the coronary bypass group. Cognitive dysfunction at 2 months was less prevalent after 90 minutes of cardiopulmonary bypass in patients managed with alpha-stat than with pH-stat strategy (27% versus 44%, p = 0.047).

CONCLUSIONS

Postoperative central nervous system dysfunction is more prevalent in patients having coronary bypass than in those having major operations. Pulsatility has no effect on central nervous system outcomes, but alpha-stat management is associated with a decreased incidence of cognitive dysfunction in patients undergoing prolonged cardiopulmonary bypass.

Serial cranial and spinal cord magnetic resonance imaging in multiple sclerosis

Twenty-nine mildly disabled patients with multiple sclerosis underwent serial clinical and magnetic resonance imaging (MRI) evaluations (pre- and postgadolinium cranial and spinal cord MRI) on at least 3 occasions at 13-week intervals and during periods of suspected relapse. Using clinical judgment of the presence of recent active disease as the gold standard, combined MRI studies confirmed the clinical impression of active disease in 93% of follow-up visits (sensitivity) and the absence of active MS in 63% of follow-up visits (specificity). None of the cranial and spinal MRI-detected abnormalities disappeared. Gadolinium administration particularly increased the yield of spinal MRI. Cranial MRI alone detected 80% of the MRI-active visits. Clinical and MRI concordance was significantly better for the presence of recent disease activity than for the anatomical localization of the presumed site of activity. MRI evidence of apparent ongoing disease activity was seen more frequently in patients believed to have active multiple sclerosis in the preceding year (13 of 21) than in patients who had been in clinical remission for at least the 2 preceding years (2 of 8). Although clinical evidence of new disease activity was much less common in patients with active, chronic-progressive disease (1 of 8) than in patients with active, relapsing disease (9 of 13), the proportion of patients with either infrequent relapses, frequent relapses, or slow chronic-progressive disease in the preceding year in whom MRI activity developed and the pattern of this new MRI activity was similar between these types of active patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular responses to naloxone challenge in opiate-dependent individuals

Vagally mediated tachycardia appears to be a common response to abused drugs and, therefore, has implications for abuse liability. To test the specificity of this common factor, we determined whether the tachycardia to naloxone in opiate-dependent individuals has a significant vagal component. Naloxone challenge (0.4 mg, IM) in 19 opiate-dependent men and women was associated with highly reliable tachycardia, but no significant change in vagal tone index, a noninvasive measure of parasympathetic inhibitory control of the heart. We conclude that tachycardia during naloxone-precipitated withdrawal is not vagally mediated. Thus, there is some degree of specificity to the common factor of vagally mediated tachycardia to abused drugs because it was ruled out in at least one drug (naloxone) with aversive subjective effects.

Location of motoneurons innervating the middle ear muscle of the chicken, (Gallus domesticus)

The motoneuron pool for the musculus columellae, the avian equivalent to the m. stapedius, was identified by retrograde labeling with WGA-HRP. It consists of a discrete group of approximately 65 neurons located along the dorsolateral border in the ventral subnucleus of the facial nuclear complex. Other facial motoneurons were only labeled when diffusion of the tracer into neighbor structures was not excluded. The dorsal subnucleus of the facial nerve innervates the m. depressor mandibulae.

Clinical correlates of white-matter changes on magnetic resonance imaging scans of the brain

We report our observations on the clinical and radiologic correlates of changes in cerebral white matter based on 94 subjects undergoing magnetic resonance imaging in a prospective study of dementia. Periventricular hyperintensity occurred twice as often in patients with Alzheimer's disease as in healthy control subjects. Within the control group, the presence of periventricular hyperintensity correlated significantly with one measure of cerebral atrophy and with the presence of changes in the adjoining deep white matter. The significance of white-matter changes distinct from the ventricles (leuko-araiosis) remains unsettled. Leuko-araiosis on the magnetic resonance imaging scan, unlike its correlate on the computed tomographic scan, was not shown to relate to cognitive decline or to the presence of focal abnormalities on neurologic examination. This is likely to reflect the heterogeneity of the changes detected with magnetic resonance imaging and their limited extent in our subjects.

Improved recognition of leukoaraiosis and cognitive impairment in Alzheimer's disease

We identified 85 patients in a longitudinal study of dementia who had uncomplicated Alzheimer's disease and in whom computed tomography of the head and psychometric testing were conducted within a 6-month period following their entry into the study. Thirty-four patients (40%) had leukoaraiosis, which was disproportionately common in female patients (62% vs 15% in male patients). Analysis of covariance demonstrated a relative reduction of scores on the Extended Scale for Dementia in those patients who had leukoaraiosis, after adjusting for the confounding effects of age, sex, educational level, and duration of illness. Leukoaraiosis was also much more common in women, even after adjusting for the possible confounding effects of age, duration of illness, Extended Scale for Dementia score, and hypertension. Multiple regression analysis showed that leukoaraiosis accounted for 11.6% of the variance of the Extended Scale for Dementia scores. Leukoaraiosis, together with duration of illness, accounted for 18.2% of the variance. Leukoaraiosis is associated with a greater degree of cognitive impairment in patients with Alzheimer's disease.

Routine intrauterine insemination and the effect of spermatozoal washing as assessed by computer-assisted semen analyzer

We present the results from 283 cycles of intrauterine insemination (IUI) performed on 237 patients. Their indications for treatment included cervical factor infertility, spermatozoal antibodies, idiopathy, poor postcoital test, and oligozoospermia. Pregnancies arose in all groups, with 28 pregnancies from natural cycles, and 17 from clomiphene citrate-supplemented cycles. A live birth rate per cycle of 12.7% (36/283) was achieved following nine miscarriages. A further 133 patients, with only cervical factor or idiopathic infertility, underwent 144 cycles of IUI in natural cycles; this more homogeneous group had their spermatozoal performance monitored by a computer-assisted semen analyzer (CASA) before and after spermatozoal washing for IUI. All factors in the spermatozoal profile changed significantly after washing. Twelve clinical pregnancies resulted from these 144 cycles of IUI, and a comparison was made between the spermatozoal profiles, as assessed by CASA, of conceptual and nonconceptual cycles. Post-wash spermatozoal concentration was slightly greater (P less than .1) in the conceptual cycles, whilst spermatozoal velocity was significantly less (P less than .005). The relevance of these findings to the definition of a "hyperactivational" state for human spermatozoa is discussed, and the general applicability of IUI as a "frontline" treatment for nontubal infertility is proposed.

Successful pregnancies resulting from the use of prolonged-incubation human spermatozoa in gamete intrafallopian transfer

Human spermatozoa that were incubated overnight at room temperature before intrafallopian transfer with freshly collected oocytes gave rise to successful pregnancies and normal live births. The resulting pregnancy rate per transfer of 50% (4 of 8) compared favorably with the average pregnancy rate of 41.8% (38 of 91), achieved by our standard spermatozoal preparation procedure that prepared the spermatozoa approximately 2 hours before the GIFT operation. This new approach for the preparation of human spermatozoa would be applicable to oligospermic patients and some GIFT patients whose partners may have difficulties in producing a semen specimen immediately before the GIFT operation.