NK(3) receptors in the feline nucleus tractus solitarius are not involved with the muscle pressor response

Isometric muscle contractions cause an increase in mean arterial pressure and heart rate. Previously, we showed that substance P (SP) is released from sites in the feline medial nucleus tractus solitarius (mNTS) in response to isometric muscle contractions, and that it most likely interacted with NK(1) tachykinin receptors at these sites. This study was undertaken to determine whether other tachykinin receptors in this area of the brainstem are involved with the muscle pressor response. Receptor autoradiography, using [(125)I]Bolton-Hunter SP and [(125)I] [MePhe(7)] neurokinin B to label NK(1) and NK(3) receptors, respectively, indicated that NK(3) tachykinin receptors are as abundant as NK(1) and NK(3) receptors, respectively, indicated that NK(3) tachykinin receptors are as abundant as NK(1) receptors in this region of the feline brainstem Injections of the specific NK(3) receptor antagonist, SR 142801 (0.1 to 10 microM) into the mNTS did not modify the pressor response or the heart rate response to isometric muscle contractions. Injection of SR142801 into the NTS prior to the injection of the NK(1) antagonist, GR82334 did not affect the action of GR82334 to attenuate the muscle pressor reflex. We conclude that NK(3) receptors in the NTS are not involved with the regulation of cardiovascular function during activation of the muscle pressor response.

Oxygen uptake kinetics during treadmill running in boys and men

The purpose of this study was to compare the kinetics of the oxygen uptake (VO(2)) response of boys to men during treadmill running using a three-phase exponential modeling procedure. Eight boys (11-12 yr) and eight men (21-36 yr) completed an incremental treadmill test to determine lactate threshold (LT) and maximum VO(2). Subsequently, the subjects exercised for 6 min at two different running speeds corresponding to 80% of VO(2) at LT (moderate exercise) and 50% of the difference between VO(2) at LT and maximum VO(2) (heavy exercise). For moderate exercise, the time constant for the primary response was not significantly different between boys [10.2 +/- 1.0 (SE) s] and men (14.7 +/- 2.8 s). The gain of the primary response was significantly greater in boys than men (239.1 +/- 7.5 vs. 167.7 +/- 5.4 ml. kg(-1). km(-1); P < 0.05). For heavy exercise, the VO(2) on-kinetics were significantly faster in boys than men (primary response time constant = 14.9 +/- 1.1 vs. 19.0 +/- 1.6 s; P < 0.05), and the primary gain was significantly greater in boys than men (209.8 +/- 4.3 vs. 167.2 +/- 4.6 ml. kg(-1). km(-1); P < 0.05). The amplitude of the VO(2) slow component was significantly smaller in boys than men (19 +/- 19 vs. 289 +/- 40 ml/min; P < 0.05). The VO(2) responses at the onset of moderate and heavy treadmill exercise are different between boys and men, with a tendency for boys to have faster on-kinetics and a greater initial increase in VO(2) for a given increase in running speed.

A distinctive flavonoid chemistry for the anomalous genus Biebersteinia

Leaf surface extracts of Biebersteinia orphanidis have yielded a complex mixture of five flavones with the unusual 5,7-dihydroxy-6,8-dimethoxy A ring substitution pattern. They are acerosin, hymenoxin, nevadensin, sudachitin and 5,7,4'-trihydroxy-6,8-dimethoxyflavone. Also present at the leaf surface are gardenin B, luteolin, apigenin, acacetin and the coumarin umbelliferone. The internal leaf flavonoids include the 7-glucosides of apigenin, luteolin and tricetin, together with the 7-rutinosides of apigenin and luteolin. This profile differs from those of B. heterostemon and B. odora. It appears that B. orphanidis is as highly distinctive in its flavonoid pattern as it is phytogeographically. The data also confirm the conclusion of other studies, including rbcL and atpB gene sequence analysis, that Biebersteinia is completely unrelated to the Geraniaceae, where it was once placed.

Mental health consultation in a nursing home

As the world's population ages, increasing numbers of people can anticipate spending their latter years in long-term care settings. Many of these nursing home residents will also present psychiatric illnesses as primary or secondary diagnoses. The resulting behavioral problems may present challenges to nursing staff that they are ill-prepared to meet. This article illustrates the application of the Blake and Mouton consultation model to a Veterans Administration (VA) nursing home situation by a team of psychiatric mental health nurse specialists. The consultation is described and interpreted in terms of the Blake and Mouton model. The focal conflicts addressed in the consultation included issues of morale/cohesion, power/authority, and norms/standards. Interventions used were acceptant, prescriptive, confrontation, and theories/principles. The model provided a useful structure for conceptualizing and organizing assessment and intervention in the consultation situation.

Advances in flavonoid research since 1992

Some of the recent advances in flavonoid research are reviewed. The role of anthocyanins and flavones in providing stable blue flower colours in the angiosperms is outlined. The contribution of leaf flavonoids to UV-B protection in plants is critically discussed. Advances in understanding the part played by flavonoids in warding off microbial infection and protecting plants from herbivory are described. The biological properties of flavonoids are considered in an evaluation of the medicinal and nutritional values of these compounds.

Oxygen uptake kinetics in treadmill running and cycle ergometry: a comparison

The purpose of the present study was to comprehensively examine oxygen consumption (VO(2)) kinetics during running and cycling through mathematical modeling of the breath-by-breath gas exchange responses to moderate and heavy exercise. After determination of the lactate threshold (LT) and maximal oxygen consumption (VO(2 max)) in both cycling and running exercise, seven subjects (age 26.6 +/- 5.1 yr) completed a series of "square-wave" rest-to-exercise transitions at running speeds and cycling power outputs that corresponded to 80% LT and 25, 50, and 75%Delta (Delta being the difference between LT and VO(2 max)). VO(2) responses were fit with either a two- (<LT) or three-phase ( >LT) exponential model. The parameters of the VO(2) kinetic response were similar between exercise modes, except for the VO(2) slow component, which was significantly (P < 0.05) greater for cycling than for running at 50 and 75%Delta (334 +/- 183 and 430 +/- 159 ml/min vs. 205 +/- 84 and 302 +/- 154 ml/min, respectively). We speculate that the differences between the modes are related to the higher intramuscular tension development in heavy cycle exercise and the higher eccentric exercise component in running. This may cause a relatively greater recruitment of the less efficient type II muscle fibers in cycling.

Stress, pre-term labour and birth outcomes

Stress, pre-term labour and birth outcomes Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre-term labour; however, a systematic comparison of the stress of women with and without pre-term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre-term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996-1997 for the treatment of PTL (24-35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension-anxiety and depression-dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub-scale of the POMS and the work and future security sub-scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub-scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre-term birth after an episode of PTL.

NF1 mutation analysis using a combined heteroduplex/SSCP approach

Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder characterized predominantly by neurofibromas, café-au-lait spots, and Lisch nodules. The disease is caused by disruptive mutations of the large NF1 gene, with half of cases caused by new mutation. Less than 100 constitutional mutations have thus far been published, ranging from very large deletions to point mutations. We have pursued NF1 mutation analysis by heteroduplex analysis (HDA) and single-strand conformational polymorphism analysis (SSCP) of individual exons. We streamlined these techniques to eliminate the use of radioactivity, to apply both methods to the same PCR product, and to multiplex samples in gels. Applied simultaneously to a set of 67 unrelated NF1 patients, HDA and SSCP have thus far identified 26 mutations and/or variants in 45 of the 59 exons tested. Disease-causing mutations were found in 19% (13/67) of cases studied. Both techniques detected a variety of mutations including splice mutations, insertions, deletions, and point changes, with some overlap in the ability of each method to detect variants.

Analysis of CpG C-to-T mutations in neurofibromatosis type 1. Mutations in brief no. 129. Online

Neurofibromatosis type 1 (NF1) is a dominant disorder caused by mutations in the NF1 gene; approximately 100 NF1 gene mutations have been published. The CpG C-to-T transition is a frequent mutation mechanism in genetic disorders. To estimate its frequency in NF1, we employed a PCR-restriction digestion method to examine 17 CpGs in 65 patients, and also screened for a CpG nonsense transition (R1947X) that occurs in 1-2% of patients. The analysis revealed disease-related CpG C-to-T transitions (including a nonsense mutation that may be as frequent as R1947X) as well as a benign variant and another mutation at a CpG. Four patients showed CpG mutations in analysis of 18 sites (17 surveyed by restriction digest, plus the R1947X assay), including three C-to-T transitions and one C-to-G transversion. These 18 sites represent one-fifth of the 91 CpGs at which a C-to-T transition would result in a nonsense or nonconservative missense mutation. Thus, it is feasible that the CpG mutation rate at NF1 might be similar to that seen in other disorders with a high mutation rate, and that recurrent NF1 mutations may frequently reside at CpG sites.

Longitudinal changes in young people's short-term power output

PURPOSE

The influences of age, body size, skin-fold thickness, gender, and maturation on the short-term power output of young people were examined using multilevel modelling.

METHODS

Subjects were 97 boys and 100 girls, aged 12.2 +/- 0.4 yr at the onset of the study. Sexual maturity was classified according to Tanner's indices of pubic hair. Peak power (PP) and mean power (MP) were determined on two occasions 1 yr apart using the Wingate Anaerobic Test (WAnT). The data were analyzed using multilevel regression modelling.

RESULTS

Initial models identified body mass and stature as significant explanatory variables with an additional positive effect of age, which was smaller for girls' MP. A significant gender difference was apparent for both power indices with girls achieving lower values than boys. A significant incremental effect of later maturity (stages 4 and 5 for pubic hair development) was identified for MP only. Subsequent incorporation of sum of two skin-fold thicknesses into the model yielded significant negative parameter estimates for PP and MP and negated both the stature effects and the maturation influence upon MP.

CONCLUSION

There are gender differences in the longitudinal growth of performance on the WanT. Regardless of gender differences, body mass and skin-fold thicknesses appear to be the best anthropometric predictors of WAnT determined PP and MP in young people.

Aerobic responses of prepubertal boys to two modes of training

OBJECTIVE

To investigate the effects of two contrasting eight week training programmes on the aerobic performance of 39 prepubescent boys (mean age 10.1 years).

METHODS

All boys were volunteer subjects from three city schools and the schools were matched by a health related behaviour questionnaire. All of the boys were assessed as Tanner stage one for genitalia and pubic hair development. Criterion laboratory tests included peak VO2 as assessed by an incremental discontinuous treadmill test to voluntary exhaustion. Submaximal measurements of heart rate, minute ventilation (VE) and VO2 were also recorded during the treadmill test. One of the schools provided the control group (n = 14), and boys from the other schools followed two contrasting training programmes. The first was a sprint interval running programme (n = 12) comprising 10 second and 30 second sprints, and the second a continuous cycle ergometer programme (n = 13) maintaining a heart rate in the range 80-85% of maximum for 20 minutes on a Monark cycle ergometer. After eight weeks training three times a week, the three groups were retested.

RESULTS

There were no significant differences in peak VO2 (p>0.05) with training in either of the groups. Neither were there significant changes in any of the submaximal variables VO2, VE, or heart rate (p>0.05).

CONCLUSION

The findings of this study indicate that neither eight week sprint interval running nor continuous cycle ergometer training programmes significantly improve maximal or submaximal indicators of the aerobic performance of prepubertal boys.

Endomorphins: localization, release and action on rat dorsal horn neurons

Endomorphin (Endo) 1 and 2, two tetrapeptides isolated from the bovine and human brain, have been proposed to be the endogenous ligand for the mu-opiate receptor. A multi-disciplinary study was undertaken to address the issues of localization, release and biological action of Endo with respect to the rat dorsal horn. First, immunohistochemical studies showed that Endo-1- or Endo-2-like immunoreactivity (Endo-1- or Endo-2-LI) is selectively expressed in fiber-like elements occupying the superficial layers of the rat dorsal horn, which also exhibit a high level of mu-opiate receptor immunoreactivity. Second, release of immunoreactive Endo-2-like substances (irEndo) from the in vitro rat spinal cords upon electrical stimulation of dorsal root afferent fibers was detected by the immobilized antibody microprobe technique. The site of release corresponded to laminae I and II where the highest density of Endo-2-LI fibers was localized. Lastly, whole-cell patch clamp recordings from substantia gelatinosa (SG) neurons of rat lumbar spinal cord slices revealed two distinct actions of exogenous Endo-1 and Endo-2: (1) depression of excitatory and/or inhibitory postsynaptic potentials evoked by stimulation of dorsal root entry zone, and (2) hyperpolarization of SG neurons. These two effects were prevented by the selective mu-opiate receptor antagonist beta-funaltrexamine. The localization of endomorphin-positive fibers in superficial layers of the dorsal horn and the release of irEndo upon stimulation of dorsal root afferents together with the observation that Endo inhibits the activity of SG neurons by interacting with mu-opiate receptors provide additional support of a role of Endo as the endogenous ligand for the mu-opiate receptor in the rat dorsal horn.

Effect of acute and sub-chronic administration of the imidazoline compound S 22068 on in vivo glucose and insulin responses in normal lean CBA/Ca mice

Acute S 22068 (24 mg/kg po) improved glucose tolerance and increased insulin sensitivity, assessed as the acute blood glucose response to exogenous insulin. The same acute dose did not stimulate insulin secretion or induce hypoglycemia in fed animals. Comparison of acute S 22068 to equipotent doses (with respect to effect on glucose tolerance) of gliclazide (2 mg/kg) and metformin (60 mg/kg) found S 22068 to be similar to metformin with respect to its effects on basal glucose levels (BGL) and insulin sensitivity. This also suggests that S 22068 acts by a mechanism which does not involve insulin release. Acute or sub-chronic S 22068 (14 days at 25 mg/day) had no effect on brown adipose tissue (BAT) or white adipose tissue (WAT) lipogenesis, an insulin-sensitive metabolic pathway. Sub-chronic treatment with S 22068 did not alter body weight (BW) or food intake, and resulted in tolerance to its effects on glucose metabolism and insulin sensitivity. These findings suggest that S 22068 is similar in effect to metformin, and is not insulinogenic, in contrast to the sulfonylureas or putative I(3) imidazoline site ligands.

Elastin region deletions in Williams syndrome

Williams syndrome (WS) is considered a contiguous gene syndrome, with most patients having a 1.5-Mb deletion of chromosome 7q11.23 containing the elastin gene and flanking genes. Studies of the frequency, extent, and origin of these deletions are ongoing in many labs to discover ultimately the molecular and pathogenetic basis for WS. An analysis of 9 sporadic WS families with typical phenotypes was performed by genotyping polymorphisms in the region. This study revealed deletions in all 9 patients, with one showing a novel deletion extending much further centromeric than any other WS deletions yet reported.

Expression of c-fos-like immunoreactivity in the feline brainstem in response to isometric muscle contraction and baroreceptor reflex changes in arterial pressure

This study compared whether activation of muscle ergoreceptor afferents caused by isometric muscle contraction, activation of baroreceptor afferents induced by i.v. infusion of phenylephrine, or baroreceptor afferent inactivation, caused by carotid artery occlusion, elicit similar patterns of c-Fos induction in brainstem areas. Adult cats were anesthetized with alpha-chloralose, and in each case, the experimental intervention caused an increase in the arterial blood pressure. There were two sets of control experiments: in both, animals underwent the same surgical procedures but then either remained at rest for the entire study, or the tibial nerve was stimulated, as in the contraction group, following muscle paralysis with tubocurarine. Following the procedures, animals rested for 90 min to allow neuronal expression of c-Fos. Control cats showed very little c-Fos immunoreactivity (c-Fos-ir) in the brainstem. Muscle contraction induced c-Fos-ir expression mainly in the nucleus tractus solitarius, lateral reticular nucleus, lateral tegmental field, vestibular nucleus, subretrofacial nucleus, spinal trigeminal tract and in a lateral region of the periaqueductal grey (P 0.5-1.0). The majority of the c-Fos-ir was found in brainstem areas contralateral to the contracted muscle. In addition, muscle contraction induced c-Fos-ir in the dorsal horns of spinal segments L6-S1 on the ipsilateral side of the spinal cord. Phenylephrine infusion caused c-Fos-ir expression in the nucleus tractus solitarius, spinal trigeminal tract, solitary tract, and dorsal motor nucleus of the vagus. No c-Fos-ir was apparent in the periaqueductal grey. Carotid occlusions induced c-Fos-ir expression in the area postrema, nucleus tractus solitarius, solitary tract, and spinal trigeminal tract. Expression was bilateral. Areas that exhibited c-Fos-ir correspond to sites previously reported to release various neuropeptides in response to muscle contraction or carotid occlusions. These results indicate that the exercise pressor reflex and baroreflex activate similar, but not completely identical, sites in the brainstem.

A simple acute in vivo comparative test for sensitivity to insulin in the mouse

A method is described for measuring the acute blood glucose response to an insulin challenge which requires only 6 samples of 20 microl of blood collected over a 4 hour period. This evaluation of sensitivity to insulin was validated by comparing the effects of gliclazide, metformin and a novel antidiabetic imidazoline compound (S22068) on the blood glucose response. The test distinguished between the insulin-secreting and hypoglycaemic action of gliclazide and the insulin-sensitizing actions of metformin and S22068. The test has the advantage that it can be repeated in the same animal after a period of recovery and thus enables the overall sensitivity to insulin to be compared before and after acute or chronic dose regimes.

Release of endomorphin-2 like substances from the rat spinal cord

Release of endomorphin (ENDO)-2 like substances from the dorsal horn of the isolated rat spinal cord was measured by the immobilized-antibody microprobe technique. Spinal cords were removed from anesthetized 4-6 week old rats and superfused with oxygenated Krebs solution at room temperature. Glass microprobes coated with ENDO-2 antibodies were inserted into the dorsal horn of the lumbar spinal cord 1.5 mm lateral to the midline to a depth 2.5 mm below the dorsal surface of the cord. Each probe remained in situ for 10 min periods before, during and after electrical stimulation applied to the dorsal root entry zone of the same spinal segment. There was no detectable basal release of immunoreactive endomorphin-2 like substance (irENDO) from the dorsal horns during the pre-stimulation, nor following the stimulation period. A significant release of irENDO was measured during the electrical stimulation. These results provide the first evidence of a irEndo release that is correlated spatially with the dorsal horn laminae I and II where ENDO-2-immunoreactive fibers are concentrated in the dorsal horn in response to electrical activation of primary afferent fibers.

The flavonoids of Tanacetum parthenium and T. vulgare and their anti-inflammatory properties

The lipophilic flavonoids in leaf and flower of Tanacetum parthenium and T. vulgaris have been compared. While those of T. parthenium are methyl ethers of the flavonols 6-hydroxykaempferol and quercetagetin, the surface flavonoids of T. vulgare are methyl ethers of the flavones scutellarein and 6-hydroxyluteolin. Apigenin and two flavone glucuronides are surprisingly present in glandular trichomes on the lower epidermis of the ray florets of T. parthenium. The opportunity has been taken to revise the structures of the four 6-hydroxyflavonol methyl ethers of T. parthenium based on NMR measurements. These are now shown to be uniformly 6- rather than 7-O-methylated. Tanetin, previously thought to be a new structure, is now formulated as the known 6-hydroxykaempferol 3,6,4'-trimethyl ether. The vacuolar flavonoids of both plants are dominated by the presence of apigenin and luteolin 7-glucuronides; nine other glycosides were present, including the uncommon 6-hydroxyluteolin 7-glucoside in T. vulgare. When the major flavonol and flavone methyl ethers of the two plants were tested pharmacologically, they variously inhibited the major pathways of arachidonate metabolism in leukocytes. There were significant differences in potency, with the tansy 6-hydroxyflavones less active than the feverfew 6-hydroxyflavonols as inhibitors of cyclo-oxygenase and 5-lipoxygenase.

Entry into community-based nursing practice: perceptions of prospective employers

To better prepare new graduates for entry-level positions in community settings, faculty of one college of nursing gathered information using focus groups of prospective employers. The groups were to identify the skills and qualities nurses need to practice in the community and ways to redesign nursing curricula to better prepare undergraduates for community-based practice. Data for this qualitative study were collected in five separate focus groups conducted with prospective employers (N = 18) from four major areas of Kentucky. By collaborating with prospective employers in the community, a partnership was established between nurse educators and community health leaders to improve the marketability of baccalaureate graduates. Assessment was the most frequently named skill essential to nursing practice in the community. Independence, critical thinking, collaboration, and confidence consistently emerged as important skills and qualities. Prospective employers were positive about developing partnerships to improve under-graduate nursing curricula. Recommendations for curricula to better prepare undergraduates for community-based practice are suggested.

Characterization of turkey spermiophages with regard to traits common to macrophages

Turkey peritoneal exudate cells (PEC) and spermiophages (SMO) were assayed for characteristics of macrophages. The PEC elicited by i.p. injection of 3% Sephadex and SMO isolated from semen using Percoll were cultured in Dulbecco's Modified Eagle Medium supplemented with 20% bovine calf serum (DMEM-20) for 24 h at 41 C in 5% CO2 to provide adherent cells for assays. Most PEC and SMO showed esterase activity (99.3 +/- 0.6 and 98.8 +/- 0.9%, respectively), and exhibited nonspecific phagocytosis of carbon (89.5 +/- 3.6 and 95.3 +/- 0.6%, respectively), zymosan (26.5 +/- 7.6 and 24.3 +/- 2.5%, respectively), bacteria (11.3 +/- 0.8 and 9.3 +/- 0.3%, respectively), and opsonized and nonopsonized SRBC. Maximum uptake of SRBC was seen by 2 h for PEC but not until 4 h for SMO. At time of maximum uptake, SRBC were noted in 35 to 40% of PEC but only in 15 to 20% of SMO. Turkey IgG-FITC bound to both PEC and SMO, but goat anti-turkey IgG-FITC bound only to SMO. Increased nitrite was found in turkey semen after 24 h storage, with highest levels in samples in which SMO were added. Nitrite production was demonstrated using adhered PEC, but SMO could not be tested due to low cell numbers. This research clearly identifies SMO as having macrophage-like activities. Accordingly, these cells may possess the ability to process and present antigen via histocompatibility receptors. Such activity could lead to immune directed responses, including antibody production or activation of cytotoxic T-lymphocytes.

Methylenetetrahydrofolate reductase deficiency in a patient with phenotypic findings of Angelman syndrome

Deficiency of methylenetetrahydrofolate reductase (MTHFR) is associated with a variable phenotype that includes mental retardation, gait abnormalities, and seizures. Many of the same clinical findings are also seen in patients with Angelman syndrome. We report on a patient with MTHFR deficiency who was initially diagnosed as having Angelman syndrome. This case illustrates that MTHFR deficiency can mimic the phenotype of Angelman syndrome and that MTHFR deficiency should be excluded in patients with manifestations of Angelman syndrome whose molecular studies of chromosome 15 are normal.

Genetic counseling in Angelman syndrome: the challenges of multiple causes

The causal heterogeneity of Angelman syndrome (AS) makes providing information regarding recurrence risk both important and challenging, and may have a dramatic impact on reproductive decision-making for the nuclear and extended family. Most cases of AS result from typical large de novo deletions of 15q11-q13, and are expected to have a low (<1%) risk of recurrence. AS due to paternal uniparental disomy (UPD), which occurs in the absence of a parental translocation, is likewise expected to have a <1% risk of recurrence. Parental transmission of a structurally or functionally unbalanced chromosome complement can lead to 15q11-q13 deletions or to UPD and will result in case-specific recurrence risks. In instances where there is no identifiable large deletion or UPD, the risk for recurrence may be as high as 50% as the result of either a maternally inherited imprinting center (IC) mutation or a ubiquitin-protein ligase (UBE3A) gene mutation. Individuals with AS who have none of the above abnormalities comprise a significant proportion of cases, and some may be at a 50% recurrence risk. Misdiagnoses, as well, can be represented in this group. In light of the many conditions which are clinically similar to AS, it is essential to address the possibility of diagnostic uncertainty and potential misdiagnosis prior to the provision of genetic counseling. Summaries of the different causal classes of AS as an algorithm for determination of recurrence risks are presented.

Prevalence of 22q11 region deletions in patients with velopharyngeal insufficiency

Velo-cardio-facial syndrome, DiGeorge syndrome, conotruncal anomaly face syndrome, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect are all associated with hemizygosity of 22q11. While the prevalence of the deletions in these phenotypes has been studied, the frequency of deletions in patients presenting with velopharyngeal insufficiency (VPI) is unknown. We performed fluorescence in situ hybridization for locus D22S75 within the 22q11 region on 23 patients with VPI (age range 5-42 years) followed in the Craniofacial Clinic at the University of Florida. The VPI occurred either as a condition of unknown cause (n=16) or as a condition remaining following primary cleft palate surgery (n=7). Six of sixteen patients with VPI of unknown cause and one of seven with VPI following surgery had a deletion in the region. This study documents a high frequency of 22q11 deletions in those presenting with VPI unrelated to overt cleft palate surgery and suggests that deletion testing should be considered in patients with VPI.

Release of nociceptin-like substances from the rat spinal cord dorsal horn

Release of nociceptin-like substances from the dorsal horn of rat spinal cords in situ was measured by the immobilized-antibody microprobe technique. Spinal cords removed from anesthetized 4-6 week-old rats were superfused with oxygenated Krebs solution at room temperature (21+/-1 degrees C). Glass microelectrodes, coated with antibodies to nociceptin, were inserted into the dorsal horn of the lumbar spinal cord (1.9 mm lateral to the midline to a depth 2.5 mm below the surface of the cord) for 15 min periods before, during and after electrical stimulation applied to the dorsal root entry zone of the same segment. There was a basal release of immunoreactive nociceptin-like substance (irNC) from the dorsal horns during the pre-stimulation period. A significant increase in irNC release was detected during the period of electrical stimulation and this increase was maintained for at least 15 min following the cessation of electrical stimulation. These results provide the first evidence on the release of irNC, albeit non-quantitative, from the in situ rat spinal cord dorsal horn and an enhanced release upon electrical stimulation.

Bias and limits of agreement between hydrodensitometry, bioelectrical impedance and skinfold calipers measures of percentage body fat

Previous research has often used correlations as a statistical method to show agreement; however, this is not a valid use of the statistic. The purpose of this study was to investigate the bias and limits of agreement for three methods of estimating percentage body fat for 117 male and 114 female university athletes: hydrodensitometry (HYD), bioelectrical impedance (BIA) and skinfold calipers (SKF). The mean (SD) percentage body fat for males as assessed by HYD, BIA and SKF methods, respectively, were 13.2 (3.3)%, 14.1, (3.3)% and 13.0 (3.2)%. Female body fat measurements were 22.5 (3.9)%, 23.7 (4.3)% and 23.8 (4.2)%, respectively. Pearson product moment correlations for male and female body fat percentages between the three methods were high, ranging from 0.81 to 0.86 (P < 0.05). However, compared to the criterion measure of body fat percentage (HYD), the magnitude of agreement BIA and SKF revealed a different pattern. The mean absolute difference between HYD and BIA measurements of body fat for males was -0.8 (2.0)% fat, and between HYD and SKF was it was 0.2 (1.7)% fat. The mean absolute difference for females between HYD and BIA was -1.2 (2.5)%; for HYD and SKF it was -1.4 (2.2)%. Compared to the HYD measures for males and females, the BIA and SKF measures were as much as a 3.8% underestimation and a 6.2% overestimation of body fat. This study provides evidence that the strength of a correlation does not indicate agreement between two methods. In future, reliability and validity studies should examine the absolute differences between two variables and calculate limits of agreement around which a practitioner can appreciate the precision of the methodologies.

Substance P released in the rostral brainstem of cats interacts with NK-1 receptors during muscle pressor response

The release of immunoreactive substance P-like substances (irSP) was measured from sites in the rostral brainstem (at a level 1.3 mm anterior to the obex) of anesthetized cats in response to fatiguing isometric contractions using SP antibody-coated glass microprobes. The contractions caused a pressor and tachycardic response. irSP were released from sites in the medial subnucleus of the nucleus tractus solitarius (mNTS), the solitary tract and lateral tegmental field at this level of the brainstem. Injections of the specific NK-1 receptor antagonist, GR 82334, bilaterally into the mNTS significantly reduced the muscle pressor response, while bilateral injections of the SP NK-1 agonist, GR 73632, into the mNTS significantly increased the pressor and tachycardic responses during the contractions. Neither the antagonist nor the agonist, at the doses tested, affected the resting arterial pressure or heart rate. These data indicate that irSP are released from sites in the mNTS during the reflex pathways activated by isometric contractions and that they interact with NK-1 receptors in the area of the mNTS to affect the cardiovascular responses during the muscle pressor reflex.

Chrysin and other leaf exudate flavonoids in the genus Pelargonium

In a chemotaxonomic survey of 57 Pelargonium species, leaf exudate flavonoids were detected in 35% of the sample, mostly in trace amounts. However, chrysin and a related C-methylflavanone were identified as major leaf surface constituents of P. crispum, and a mixture of quercetin and kaempferol mono-, and di- and trimethyl ethers of P. quercifolium. In two other species, P. fulgidum and P. exstipulatum, methylated flavones were the only lipophilic flavonoids present. This is the first report of leaf surface flavonoids from the genus Pelargonium.

Purtscher-like retinopathy after uncomplicated administration of retrobulbar anesthesia

PURPOSE

To report a case of Purtscher-like retinopathy after administration of retrobulbar anesthesia for an otherwise uncomplicated cataract extraction.

METHOD

Case report.

RESULTS

After cataract surgery with retrobulbar anesthesia, the patient followed a typical course of Purtscher-like retinopathy with an initial severe loss of vision followed by a gradual and nearly complete improvement in visual function.

CONCLUSIONS

Purtscher-like retinopathy is uncommon after administration of retrobulbar anesthesia but had the same clinical course as other causes of this disorder.

Children's and adolescents' anaerobic performance during cycle ergometry

Cycle ergometry studies originated in the early 1900s but it was not until the early 1970s that the first studies of children and anaerobic performance were established. Since that time, research into the anaerobic performance of children and adolescents has proliferated, mainly due to attempts by investigators to overcome methodological problems. Besides the increase in studies using the most popular anaerobic test, the friction-braked Wingate, other tests such as the force-velocity and isokinetic cycle ergometers are becoming more common. No matter how the data are standardised, there is unequivocal agreement that children's and adolescents' anaerobic power scores are lower than those of adults. Qualitative muscular differences are often cited for this disparity rather than differences in the quantity of muscle, but conclusive research is lacking in this area. Despite the ethical considerations involved in studies with children, cycle ergometry has aided researchers to assess external short term power output, mean power and fatigue.

A new point mutation in a hypoxanthine phosphoribosyltransferase-deficient patient

A 12-year-old boy was referred because of abdominal pain, gross hematuria, and passage of stones. Further evaluation showed growth delay, low average range of intellectual functioning, and a speech articulation disorder. No signs of self-mutilation or self-injurious behavior were present. He had hyperuricemia, hyperuricosuria, uric acid crystalluria, uric acid calculi, macrocytosis, megaloblastic bone marrow changes, and mild anemia. Hypoxanthine phosphoribosyltransferase (HPRT) enzyme activity was reduced to approximately 26% of normal. Polymerase chain reaction-single strand conformational polymorphism analysis of the HPRT gene in DNA isolated from the patient's blood lymphocytes revealed a single nucleotide substitution at codon 200 in exon 8. The base change was a guanine to cytosine transversion, resulting in the conservative amino acid substitution of threonine in place of arginine. To our knowledge, this mutation has not previously been reported.

Unexpected familial recurrence in Angelman syndrome

We report on two instances of familial recurrence of Angelman syndrome which, from pedigree analysis, appear incompatible with currently known mechanisms of inheritance of this disorder. In these two families, deletion-positive Angelman syndrome has recurred in cousins. Several established mechanisms for deletion-positive familial recurrence have been ruled out. In each family, molecular cytogenetic studies show typical chromosome 15 deletions, and DNA methylation analysis verifies the maternal origin of the deleted chromosomes in all four individuals. Since the mothers of the affected individuals in each family are not known to be related, these recurrences appear to be secondary to coincidental, de novo events. This conclusion is consistent with direct and indirect estimates of the population frequency of Angelman syndrome.

Paternal exposures and the question of birth defects

Compared to maternal exposures, little attention has been paid to the possibility of paternally induced adverse effects on fetal development. There is increasing concern, however, about the potential for male-mediated developmental toxicity brought about by exposure to teratogenic agents. This is evidenced by the number of calls regarding paternal exposures that are received by teratogen information services. In this paper, we report the experience of the state of Florida's Teratogen Information Services regarding questions asked about paternal exposures, and briefly review what is known about the risk of paternal exposure to the 10 agents which are most frequently queried.

Effect of training on the aerobic power and anaerobic performance of prepubertal girls

The purpose of this study was to investigate the effects of two, three times a week, 8-week training programmes on the aerobic power and anaerobic performance of 30 prepubescent girls, with a mean age of 9.6 y. Peak oxygen uptake assessed by an incremental discontinuous treadmill test, and peak power in 5 s and mean power over 30 s estimated from a Wingate anaerobic test were used as the criterion measures. Twelve girls trained using a continuous cycle ergometer programme, 11 girls followed a sprint running programme and the control group consisted of 7 girls. Both training groups significantly (p < 0.05) increased their peak oxygen uptake and peak power in 5 s. However, the increase reported here are lower than those generally observed in adolescents following training. The control group demonstrated no significant (p > 0.05) change in either variable. No significant (p > 0.05) changes in mean power over 30 s were observed in any group.

Response to therapy in rheumatoid arthritis is influenced by immediately prior therapy

OBJECTIVE

Clinicians do not often employ washout periods before prescribing a change in therapy for rheumatoid arthritis (RA). As a result, the observed effectiveness or lack of effectiveness of a new drug actually represents the effectiveness of that drug had the patient been taking placebo minus the residual effectiveness of the old drug.

METHODS

We studied new starts of selected disease modifying antirheumatic drugs (DMARD) and prednisone in 2,898 patients with RA from 8 ARAMIS data bank centers, broken into subgroups on the basis of immediately prior therapy. Therefore, we examined the hypothesis that the chances of a treatment being observed effective depend upon the immediately preceding treatment. Using intent-to-treat analysis, we analyzed the effects upon Health Assessment Questionnaire (HAQ) disability and pain scores an average of 9 months after the new drug start.

RESULTS

Methotrexate reduced disability significantly except after intramuscular gold or hydroxychloroquine and it reduced pain significantly after all prior therapies. Hydroxychloroquine reduced disability significantly after nonsteroidal antiinflammatory drugs (NSAID) only, but disability increased after intramuscular gold; pain was decreased only after NSAID only. Prednisone had no consistent effect upon disability but was consistently associated with decreased pain. Greatest effectiveness was always seen with a new drug start after NSAID only treatment versus after DMARD treatment.

CONCLUSION

The effectiveness of a newly started RA treatment after 9 months may be substantially influenced by immediately prior treatment. This finding provides an additional reason for concern about direct extrapolation of clinical trial data into clinical practice.

Clinical spectrum and molecular diagnosis of Angelman and Prader-Willi syndrome patients with an imprinting mutation

Recent studies have identified a new class of Prader-Willi syndrome (PWS) and Angelman syndrome (AS) patients who have biparental inheritance, but neither the typical deletion nor uniparental disomy (UPD) or translocation. However, these patients have uniparental DNA methylation throughout 15q11-q13, and thus appear to have a mutation in the imprinting process for this region. Here we describe detailed clinical findings of five AS imprinting mutation patients (three families) and two PWS imprinting mutation patients (one new family). All these patients have essentially the classical clinical phenotype for the respective syndrome, except that the incidence of microcephaly is lower in imprinting mutation AS patients than in deletion AS patients. Furthermore, imprinting mutation AS and PWS patients do not typically have hypopigmentation, which is commonly found in patients with the usual large deletion. Molecular diagnosis of these cases is initially achieved by DNA methylation analyses of the DN34/ZNF127, PW71 (D15S63), and SNRPN loci. The latter two probes have clear advantages in the simple molecular diagnostic analysis of PWS and AS patients with an imprinting mutation, as has been found for typical deletion or UPD PWS and AS cases. With the recent finding of inherited microdeletions in PWS and AS imprinting mutation families, our studies define a new class of these two syndromes. The clinical and molecular identification of these PWS and AS patients has important genetic counseling consequences.

Juvenile rheumatoid arthritis in velo-cardio-facial syndrome: coincidence or unusual complication?

We report on two patients with velo-cardio-facial syndrome (VCFS) and juvenile rheumatoid arthritis (JRA). The first, a 9-year-old girl, presented with microcephaly, characteristic face, congenital heart disease, and velopharyngeal insufficiency. Fluorescence in situ hybridization (FISH) study showed deletion of D22S75 (N25), confirming the diagnosis of VCFS. At age 7, she developed joint pain, and polyarticular JRA was diagnosed. Awareness of this case led to the subsequent diagnosis of VCFS (also confirmed by FISH) in another, unrelated 12-year-old girl with characteristic face, hypernasal speech, and obesity. JRA was first diagnosed in this case at age 5 years, and she subsequently developed severe polyarticular disease. Neither patient had clinical or laboratory evidence of immunodeficiency. This observation represents the first report of the association of JRA with VCFS and raises the question of whether this is a coincidental association or a rare complication of this condition.

Neuropeptide Y-like substances are released from the rostral brainstem of cats during the muscle pressor response

1. In this study, the release of immunoreactive neuropeptide Y (NPY)-like substances (irNPYs) was measured from the rostral brainstem in response to fatiguing isometric contractions of the hindlimb muscle of cats anaesthetized with alpha-chloralose. 2. The irNPYs were measured using a solid phase autoradiographic immunoassay. NPY antibody-coated glass microelectrodes were inserted stereotaxically into the rostral brainstem during rest and contractions. Control procedures such as passive leg flexing, stimulation of the central end of the cut tibial nerve, brief repeated carotid occlusions and carotid sinus nerve stimulations were performed to determine whether patterns of release of irNPYs were specific to the pathways activated during the muscle pressor response. 3. During isometric contractions, the mean arterial blood pressure (MABP) and heart rate (HR) increased by 60-70 mmHg and 15-20 beats min-1, respectively. Only the brief carotid occlusions caused a similar increase in MABP and HR. 4. During isometric contractions, less irNPYs were released from sites in the lateral reticular nucleus, lateral tegmental field and vestibular nuclei at a level in the brainstem 4.0-4.4 mm rostral to the obex. In contrast, irNPYs were released from sites near the lateral tegmental field and nucleus ambiguus at a more caudal level tested (1.3 mm anterior to the obex) in response to contractions. Brief carotid occlusions caused a release of irNPYs from the lateral reticular nucleus on the contralateral side of the brainstem (at 3.5 mm anterior to the obex). None of the other procedures resulted in a release of irNPYs from these sites in the brainstem. 5. These data indicate there are differences in the patterns of release of irNPYs in response to activation of reflex pathways which increase arterial pressure. Given the sites in the rostral brainstem where irNPYs were released, irNPYs may be involved with the central regulation of arterial pressure during the muscle pressor response.

Flavonoids, cinnamic acids and coumarins from the different tissues and medicinal preparations of Taraxacum officinale

Three flavonoid glycosides: luteolin 7-glucoside and two luteolin 7-diglucosides were isolated from dandelion flowers and leaves together with free luteolin and chrysoeriol in the flower tissue. The hydroxycinnamic acids, chicoric acid, monocaffeyltartaric acid and chlorogenic acid were found throughout the plant and the coumarins, cichoriin and aesculin were identified in the leaf extracts. This represents the first report of free chrysoeriol (luteolin 3'-methyl ether) in Taraxacum officinale agg. An earlier provisional identification of chicoric acid, chlorogenic acid, cichoriin and aesculin in a phenolic survey of the tribe Cichorieae is confirmed. Chicoric acid and the related monocaffeyltartaric acid were found to be the major phenolic constituents in flowers, roots, leaves and involucral bracts and also in the medicinal preparations tested.

Lymphoma and luekemia in rheumatoid arthritis: are they associated with azathioprine, cyclophosphamide, or methotrexate?

Incident cases of lymphoma and leukemia in a cohort of 3824 rheumatoid arthritis (RA) patients from the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) database were identified, and the use of azathioprine, cyclophosphamide, and methotrexate was compared in a matched case-control study. Controls were matched on age, sex, year of study entry, disease duration, center, and years of follow-up. Twenty-four cases of lymphoma and 10 cases of leukemia were identified: 21% of patients with cancer versus 9% of controls had taken azathioprine [McNemar statistic 1.50 (p = 0.22), odds ratio 5.0 (95% confidence interval 0.6,236.5)]. Equal numbers of cases and controls (6% each) had taken cyclophosphamide and 18% of cases and 12% of controls had taken methotrexate [McNemar statistic 0.13 (p = 0.72), odds ratio 1.7 (0.3, 10.7)]. Results suggest but do not prove that RA patients taking azathioprine and methotrexate may have an increased risk of developing lymphoma. However, even if this increased risk can be confirmed, it accounts for only a small proportion of the greatly increased incidence of these malignancies in RA.

Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies

OBJECTIVE

Therapeutic strategies for rheumatoid arthritis (RA) have been evolving from the traditional "pyramid" approach toward one based upon early and sustained use of disease-modifying antirheumatic drugs (DMARDs), in the hope of improving long-term health outcomes. However, few data to have been presented to document the effects of this approach. We sought to directly assess associations between consistent DMARD use and long-term functional outcomes.

METHODS

We studied 2,888 RA patients who were followed up prospectively for up to 20 years (average 9 years) at 8 databank centers. The independent variable was the proportion of patient encounters that resulted in treatment with > or = 1 DMARD (hydroxychloroquine, sulfasalazine, auranofin, intramuscular gold, D-penicillamine, methotrexate, and/or azathioprine). The dependent variable was each patient's last recorded Disability Index value from the Health Assessment Questionnaire (HAQ).

RESULTS

Increased DMARD use was strongly associated with better long-term Disability Index values (P < 0.0001). The association was strengthened when restricted to more seriously affected (rheumatoid factor (RF)-positive) patients. The magnitude of the effect, unadjusted, was a difference of 0.53 HAQ Disability units (scale 0-3) between 100% DMARD use and 0%. Correlation coefficients ranged up to 0.26. Effects were similar for all disease duration periods (0-4, 5-9, 10-14, 15-19, and 20+ years). "Control" correlations, with variables computed to represent the proportion of time in which patients were taking either nonsteroidal anti-inflammatory drugs or prednisone, failed to show positive associations. A multiple linear regression model, which controlled for age, disease duration, sex, RF positivity, proportion of visits under a prednisone regimen, and initial disability level, included the proportion of time in which patients were taking DMARDs (P < 0.0001), with a model R2 of 0.54. These results were obtained despite an adverse selection bias in which more severely affected individuals were given DMARDS more frequently, and despite absence of data on drug use early in the disease course of many patients. Thus, these results, which suggest up to a 30 percent reduction in long term disability with consistent DMARD use, are most likely conservative.

CONCLUSION

An association between consistent DMARD use and improvement in long-term functional outcomes in RA is supported by these data.

Renal dysplasia with secondary hyperparathyroidism and loose teeth in a young dog

In a dog with renal dysplasia and secondary hyperparathyroidism, loose teeth resulted from excessive resorption of alveolar bone. Sharpey's fibers, still anchored in the cementum, were lost in the replacing fibrous tissue and few fibers found their way to distant bone fragments. The alveolar bone is the site of predilection for the excessive, generalized resorption of bone in hyperparathyroidism. Clinical radiographic examination of the jaws is a valuable tool in the detection of the disease.

Concurrent validity of the Health Assessment Questionnaire Disability Index in Scleroderma

OBJECTIVE

To establish the concurrent validity of the Health Assessment Questionnaire (HAQ) Disability Index in systemic sclerosis (SSc; scleroderma).

METHODS

Eighty subjects with SSc completed the HAQ Disability Index questionnaire. An occupational therapist, who was blind to the subjects' responses, observed each subject's performance on 10 of the items.

RESULTS

Paired t-tests showed significant differences between the observer and subjects' responses for tying shoes, buttoning, gripping, and walking. Intra-class correlations between observer and subjects ranged from 0.38 to 0.76.

CONCLUSION

The results support the validity of the HAQ Disability Index in patients with systemic sclerosis.

Benign neurofibromas in type 1 neurofibromatosis (NF1) show somatic deletions of the NF1 gene

Neurofibromatosis type 1 (NF1) is one of the most common human autosomal dominant diseases. NF1 is characterized by café-au-lait spots (CLS), axillary freckles and Lisch nodules of the iris. Another hallmark of NF1 is the development of neurofibromas, benign tumours that arise from peripheral nerve sheaths. NF1 patients also have an increased incidence of certain malignant tumours. Malignancies in NF1 are believed to follow the 'two-hit' hypothesis, in which one allele is constitutionally inactivated while the other allele is subsequently inactivated ('second hit') at the somatic level. This hypothesis has not, however, been fully tested in the aetiology of benign neurofibromas. This is a crucial issue since it addresses not only the basic mechanism behind the genesis of neurofibromas, but may also indicate a mechanism common to many or all NF1 features. Using both NF1 intragenic polymorphisms as well as markers from flanking and more distal regions of chromosome 17, we have investigated loss of heterozygosity (LOH) in 22 neurofibromas from five unrelated NF1 patients. Eight of these tumours revealed somatic deletions involving NF1, indicating that inactivation of NF1 is associated with at least some neurofibromas.

Using the EPC approach to develop health-based soil and water screening concentrations for environmental chemicals

Reference doses (RfDs) and reference concentrations (RfCs) developed by the United States Environmental Protection Agency (USEPA) are typically used to assess the risk of potential adverse human health effects from exposure to environmental chemicals. For a large number of chemicals, however, USEPA RfDs or RfCs have not yet been determined. Thus, for risk assessments that involve a large number of chemicals, there may not be USEPA- or state-derived toxicity constants for all chemicals present at a particular site. A potential solution to this problem is to use estimated permissible concentrations (EPCs) to develop acceptable daily dosages from occupational exposure limits. The EPC is defined as the concentration of a chemical which, under continuous exposure conditions, is expected to be devoid of all acute and chronic toxicities. EPC values are based on allowable occupational exposure limits such as threshold limit values (TLVs), which are workplace exposure guidelines suggested by the American Conference of Governmental Industrial Hygienists. In the present analysis, the EPC method was used to develop interim toxicity constants for more than 30 chemicals which possess TLVs and which appear in the Appendix VIII Hazardous Constituents list, but for which the USEPA has not yet assigned a current RfD or RfC. Appendix VIII chemicals are commonly found at hazardous waste and other sites. Consequently, the development of toxicity constants for the more than 30 chemicals on this list would prove to be most useful for risk assessment purposes. These toxicity constants were then used, together with standard exposure assumptions, to develop acceptable human health-based soil and water concentrations for these chemicals. The use of these values as interim guidance would therefore allow individuals responsible for assessing human health effects posed by environmental contamination to address all site chemicals without performing extensive, chemical-specific toxicological analyses.