PspA, a protection-eliciting pneumococcal protein: immunogenicity of isolated native PspA in mice

PspA is a surface exposed virulence factor of S. pneumoniae that can elicit protective immunity to pneumococcal sepsis in mice. It can be released from pneumococci by washing them with a solution containing 2% choline chloride, by growing pneumococci in media containing 1.2% choline chloride, or by growing pneumococci in media in which the choline has been replaced by ethanolamine. Our results indicate that PspA is the major protection-eliciting antigen in each of these preparations. Two injections of < or = 1 microgram of native PspA purified by use of a choline-Sepharose column are highly immunogenic in BALB/c and CBA/N mice, and even in the absence of adjuvant can elicit protection against otherwise fatal sepsis with 100 times the LD50 of S. pneumoniae. Fragments comprising the N-terminal 115 and 245 amino acids of PspA were able to elicit protection but only in the presence of complete Freund's adjuvant (CFA). In the absence of CFA the 245 amino acid fragment was less than 1/100 as immunogenic as native PspA.

Controlled study of the putative interaction between famotidine and theophylline in patients with chronic obstructive pulmonary disease

The effects of famotidine (80 mg per day), cimetidine (1600 mg per day), and placebo on theophylline pharmacokinetic parameters in chronic obstructive pulmonary disease (COPD) patients were compared. This was an open-label, randomized, three-period cross-over study, in which each subject first underwent a seven-day theophylline washout period, and thereafter received three single intravenous doses of theophylline (5 mg/kg infused over 30 minutes) during the study. Each of the experimental treatments was administered orally every 12 hours for a total of 9.5 days (19 doses). Theophylline was infused after the 17th dose of each treatment. Fourteen serial blood samples were collected before the start of each infusion, and for 30 hours after the end of each infusion. Plasma samples were assayed for theophylline, pharmacokinetic parameters were estimated, and treatment effects on each parameter were compared. Fourteen COPD patients completed all three periods of the investigation. Famotidine treatment had virtually no effect on any of theophylline's pharmacokinetic parameters. In contrast, cimetidine treatment significantly altered every pharmacokinetic parameter of theophylline as follows: Cimetidine decreased theophylline geometric mean CL from 2.74 L/h to 2.07 L/h (P < .001), and prolonged theophylline harmonic mean half-life from 6.6 to 9.6 hours (P < .001) and mean residence time from 10.8 to 15.0 hours (P < .001). Cimetidine treatment slightly increased theophylline volume of distribution by approximately 10%, and that change also was statistically significant (P = .032). The authors conclude that the treatment effects of cimetidine on theophylline pharmacokinetic parameters were in accord with those reported by others, and that famotidine treatment had no effect on any of theophylline's pharmacokinetic parameters in COPD patients.

Nutrition management in women with gestational diabetes mellitus: a review by ADA's Diabetes Care and Education Dietetic Practice Group

Gestational diabetes mellitus (GDM) is the most common medical disorder complicating pregnancy that requires the services of a registered dietitian. Despite three international workshops on GDM, many questions remain regarding its epidemiology, pathophysiology, screening, diagnosis, and management. Registered dietitians encounter these controversial issues when working with women referred for GDM education and counseling. Nutrition intervention remains the cornerstone of therapy. The purpose of this article is not to provide practice guidelines but to review the literature and current practices in research centers across the United States. Registered dietitians are in a position to individualize nutrition care to each woman's needs and to participate in the decision-making process of nutrition management.

TGF-alpha protein and receptor localization in laryngotracheal tissue

Both normal cell turnover and healing of laryngeal and tracheal injuries involve cell migration and mitosis. The proteins that regulate normal cell turnover and wound healing in the larynx and trachea have not been established. It is possible that peptide growth factors, such as transforming growth factor-alpha (TGF alpha) acting through its receptor (EGF/TGF alpha-R), participate in the regulation of these processes. To investigate this hypothesis, we analyzed laryngotracheal cells for TGF alpha protein and receptor in normal and postwounding conditions. TGF alpha protein was detected by immunohistochemical analysis in normal ferret laryngeal and tracheal mucosa. Specific binding to the EGF/TGF alpha receptor in membrane homogenates of ferret larynx and trachea reached saturation after 60 minutes at 37 degrees C, and was effectively displaced by unlabeled epidermal growth factor (EGF) or TGF alpha, but not by unlabeled insulin, angiotensin II, or basic fibroblast growth factor. Scatchard analysis of the specific binding indicated the presence of high-affinity (Kd = 117 pmol) and low-affinity (Kd = 40 nmol) binding sites. The maximum number of available binding sites was 73 fmol/mg protein. Localization of the EGF/TGF alpha receptor by autoradiographic analysis of 125I-EGF binding to sections of normal ferret larynx and trachea revealed EGF/TGF alpha receptors throughout the epithelium, with the highest grain density in the basal layers. Quantitative analysis of autoradiographic grain density between normal, intubated, and extubated animals revealed no significant differences. The presence of TGF alpha protein and its receptor in normal and wounded larynx and trachea supports the hypothesis that these proteins are involved in regulating physiologic responses of laryngotracheal cells.

Review of slipped capital femoral epiphysis associated with endocrine disease

Review of type and bilaterality of 131 cases (40 bilateral) of slipped capital femoral epiphysis (SCFE) in patients with known endocrinopathies (hypothyroidism, panhypopituitarism, hypogonadism) from 1960 to 1990 showed an increased frequency of patients with endocrine disorders, primarily hypothyroidism (nine of 131 patients, 6.9%); three had bilateral slips; six developed bilateral slips in an average of 11.17 months. Delayed growth plate closure is common in SCFE. Because hypothyroidism can be easily overlooked, all patients with SCFE should be screened for hypothyroidism by measuring serum T4 and TSH (such screening is inexpensive (r = $60). Pituitary deficiency should be considered in children short for their age who have hypogonadism. Any child with a unilateral slip and one of these endocrine deficiencies has a high risk of subsequent bilateral involvement. Prophylactic pinning of the uninvolved hip is recommended because 100% of our patients eventually had bilateral slips.

Metabolism of a new HIV-1 reverse transcriptase inhibitor, 3-[2-(benzoxazol-2-yl)ethyl]-5-ethyl-6-methylpyridin-2(1H)-one (L-696,229), in rat and liver slices

L-696,229 is a potent and specific inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase and is currently undergoing clinical evaluation. In vivo metabolism in rats was investigated using an intravenous bolus dose of 5 mg/kg [3H]L-696,229. The amount of radioactivity eliminated in bile and urine over a period of 6 hr was 60 and 22%, respectively. Radiochromatographic analysis of the bile and urine showed that L-696,229 was metabolized rapidly and completely to several common metabolites. Sequential oxidation at the alpha-position of the 5-ethyl group to an acetyl moiety, aromatic hydroxylation of the benzoxazole group (position C4', C6', or C7'), and subsequent sulfate conjugation were the major metabolic pathways as determined by the application of enzymatic hydrolysis, FAB-MS, and 1H- and 13C-NMR spectroscopies. The in vitro metabolism of this 2-pyridinone derivative with rat liver slices resulted primarily in hydroxylation at the 6-methyl and 5-ethyl groups. The 6-hydroxymethyl- and 5-alpha-hydroxyethyl analogs were also inhibitors of HIV-1 reverse transcriptase.

Routine use of magnetic resonance imaging in idiopathic scoliosis patients less than eleven years of age

The purpose of this study was to determine the incidence of intraspinal pathology presenting as idiopathic scoliosis in children less than 11 years of age and otherwise neurologically normal. Twenty-six consecutive patients (5 boys, 21 girls) with idiopathic scoliosis measuring at least 15 degrees were studied with magnetic resonance imaging. Five children (19.2%) were diagnosed by magnetic resonance imaging to have Chiari-I malformations with hydromyelia (two patients), syringomelia (one patient), intramedullary tumor (one patient) and terminal lipoma (one patient). Only two of the five patients had left thoracic curves. Intramedullary spinal cord pathology can present as scoliosis without neurologic signs. Scoliosis can be the initial neurologic sign suggesting intraspinal pathology, and magnetic resonance imaging is indicated in routine evaluation of children less than 11 years of age.

An assessment of the radiological module of NEONATE as an aid in interpreting chest X-ray findings by nonradiologists

NEONATE is a prototype of an expert system for the Newborn Intensive Care Unit developed at the Primary Children's Medical Center in Salt Lake City, Utah. A pilot study was undertaken to see if the addition of radiological frames to the NEONATE software could aid attending Neonatologists to interpret chest X-ray films. A set of radiological frames was created from rules generated by a radiologist. The performance of these radiological frames was compared to the performance of other radiologists using the Kappa statistic to measure agreement. There is a good agreement between the computer's decisions and the radiologists' decisions. The radiological frames were also tested to see if they help physicians who are not trained in radiology. A system that compares the residents' interpretation and the computer's interpretation to a gold standard interpretation was developed. It shows that the computer helps the first and second year residents, but not the third year residents. This article suggests that NEONATE's interpretation of chest X-ray findings are close to the radiologists' interpretations. While NEONATE's radiological frames help novice physicians in reaching better chest X-ray interpretation, the current study suggests that they are not likely to help a Neonatologist.

Results of lumbar hemivertebral excision for congenital scoliosis

The purposes of this study were to determine the long-term correction achieved by excision of lumbar hemivertebrae and the risk attendant. Seven patients had a follow-up of 41.14 months for lumbar hemivertebral excisions. Six had two-stage anterior vertebral body excision and, 7-8 days later, posterior lamina and pedicle excision with fusion. One patient had a single-stage correction. After surgery, the patients were in pantaloon casts or braces for a minimum of 6 months (supine, first 6-12 weeks). Hemivertebrae were at L2 (N = 1), L3 (N = 1), L4-L5 (N = 1), and L5-S1 (N = 4). Preoperative curves or hemivertebral angles averaged 36.6 degrees (range, 30-52 degrees). Average age was 7.5 years (range, 22 months to 12.5 years). Mean follow-up was 41.14 months. Surgical correction of the seven cases averaged 28.0 degrees. Two-stage procedures yielded 29.7 degrees correction with no complications; single-stage yielded 18 degrees correction, and the only complication was an L5 nerve root paresis.

"NEONATE"--an expert application for the "HELP" system: comparison of the computer's and the physician's problem list

NEONATE is a prototype of an expert application for the HELP Hospital Information System. Its goal is to improve documentation in the Newborn Intensive Care Unit. The decision module of NEONATE is designed to produce an admission problem list. In this paper, the admission problem list that NEONATE generates was compared to the admission problem list of the current CETUS system for 30 patients. These were compared to a retrospectively constructed gold standard problem list. Of 101 problems in the gold standard list, 56 were on the current admission reports; 82 were found by NEONATE. NEONATE found 31 problems missed on the current admission reports; the current admission reports contained 5 problems missed by NEONATE. The current admission reports contained 9 false positives; whereas NEONATE's reports contained 27. Of the 27, 16 were caused by a single rule in NEONATE. We conclude that an expert system has great potential for improving the documentation of the patient problem list.

Congenital pseudarthrosis of the clavicle: a review of the literature and surgical results of six cases

This article is a retrospective review of six symptomatic patients who, when treated surgically, all healed with excision of pseudarthrosis, bone grafting, and plating. We discuss congenital pseudarthrosis of the clavicle with emphasis on etiologies, clinical presentation, differential diagnosis, and method of treatment. Our patients' chief complaints were cosmesis, pain, or shoulder deformity.

Results of 21 Wagner limb lengthenings in 20 patients

Roentgenograms and charts were reviewed on 20 patients (average age: 13.2 years) who had 21 Wagner limb lengthenings since 1975. Lengthenings included 15 femora (six acquired, eight congenital, and one fibrous dysplasia), four tibiae, and two humeri (one acquired and one congenital). Average femoral lengthening was 6.6 cm; tibial, 5.9 cm; and humeral, 9.7 cm. Lengthening of femora with congenital shortening (6.5 cm) was nearly the same as femora with acquired shortening (6.8 cm), and 85% of all lengthenings were greater than 5 cm. Humeri were lengthened more than 50%. Seventy-two percent of patients were in the 50th percentile or less of stature; 61% were in the 15th percentile or less of stature. Seventy-five percent had complications, with 65% having more than one major complication: pin tract and superficial infections in 40%; deep infections in 20%. All infections were in femoral lengthenings. Nonunion occurred in two patients (10%), and fracture after plate removal in two patients (10%). Five patients (25%) had nerve palsies, and four of these resolved without treatment. Malunion rate was 20%. Five patients developed joint contractures. Complications did not correlate with amount of lengthening but congenital deformities had a higher incidence of complication. Eleven patients required 19 additional procedures necessitated by the lengthening procedure. Wagner leg lengthening is generally recommended when amputation is only other surgical alternative and a full, complete informed consent is given to the parents and patient.

Bone imaging and skeletal radiology in dysbaric osteonecrosis

Twenty-nine United Kingdom deep sea divers were examined radiographically for skeletal abnormalities and also bone images were obtained using technetium-99m methylene diphosphonate. The results of the two forms of examination were compared and the use of radionuclide bone scanning was shown to be more sensitive than radiographic examination in monitoring those occupationally at risk of acquiring dysbaric osteonecrosis.

Angular Distributions for 6Li(p,g)7Be

Angular distributions of y rays leading directly to the ground and first excited states in the reaction 6Li(p, y) 7Be have been measured at bombarding energies of 500, 800 and 1000 keV. The results are compared with those of previous measurements and substantial agreement is found. The results are also compared with theoretical predictions of a simple direct capture model.

Petroleum Associated with Polymetallic Sulfide in Sediment from Gorda Ridge

A sediment sample, impregnated with asphaltic petroleum and polymetallic sulfide, was dredged from the southern end of Gorda Ridge (the Escanaba Trough) off northern California, within the offshore Exclusive Economic Zone of the United States. The molecular distributions of hydrocarbons in this petroleum show that it was probably derived from terrestrial organic matter in turbidite sediment filling the Escanaba Trough. Hydrothermal activity at the Gorda Ridge spreading center provided the heat for petroleum formation and was the source of fluids for sulfide mineralization.