Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GM-CSF signatures during symptomatic exacerbations

BACKGROUND

The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease.

OBJECTIVE

To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls.

METHODS

This was a non-interventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The sinonasal outcome test-22 (SNOT-22) scores and immunological parameters in the specimens were analysed using a novel, unsupervised learning method and by conventional univariate analysis.

RESULTS

Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis.

CONCLUSIONS

CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation.

The great American cookie experiment: engaging staff nurses in research

PURPOSE

The purpose of this study was to engage staff nurses in research in an informative and fun way by determining nurses' preference for sugar-free chocolate chip cookies versus regular chocolate chip cookies.

DESIGN AND METHODS

A descriptive, crossover, double-blinded study was performed using a convenience sample of 300 staff nurses.

RESULTS

Nurses preferred the texture, flavor, and overall preference of the regular chocolate chip cookie as compared with the sugar-free chocolate chip cookie (p<0.001).

IMPLICATIONS

The Great American Cookie Experiment remains a creative teaching strategy to enhance knowledge and engage nurses in the research process.

Prevalence and variations of the median maxillary labial frenum in children, adolescents, and adults in a diverse population

The median maxillary labial frenum (MMLF) is a normal anatomic structure with inherent morphologic variations. This study sought to evaluate the prevalence of those variations in a diverse ethnic population and to educate practitioners about the prevalence of MMLF variations to prevent unnecessary biopsies. This study included adult, adolescent, and child patients at the Louisiana State University Health Science Center School of Dentistry. Among the 284 subjects examined, frenum normale was the most common frenum classification, followed by frenum with nodule and frenum with appendix. Most nodules were found in the intermediate third of the MMLF, while appendices were mainly found in the labial third. The prevalence of an appendix was significantly higher (P < 0.001) in Caucasians compared to African-Americans. The prevalence of nodules was marginally higher (P = 0.096) in Caucasians than in African-Americans. No other statistically significant differences were found with regard to ethnicity. Additionally, nodules and appendices on the MMLF were identified in all age groups, and may become more common with increasing age. The authors determined that variations of the MMLF are inherent and do not represent a pathologic condition, nor do they require biopsy for diagnostic purposes.

Evaluation of correlation between dose and clinical outcomes in subcutaneous immunoglobulin replacement therapy

The importance of serum immunoglobulin (Ig)G concentration in IgG replacement therapy for primary immunodeficiency diseases is established in certain settings. Generally, IgG is infused via the intravenous (IVIG) or subcutaneous (SCIG) route. For IVIG infusion, published data demonstrate that higher IgG doses and trough levels provide patients with improved protection from infection. The same conclusions are not yet accepted for SCIG; data from two recent Phase III studies and a recent post-hoc analysis, however, suggest the same correlation between higher SCIG dose and serum IgG concentration and decreased incidence of infection seen with IVIG. Other measures of clinical efficacy have not been considered similarly. Thus, combined analyses of these and other published SCIG studies were performed; a full comparison of the 13 studies was, however, limited by non-standardized definitions and reporting. Despite these limitations, our analyses indicate that certain clinical outcomes improve at higher SCIG doses and associated higher serum IgG concentrations, and suggest that there might be opportunity to improve patient outcomes via SCIG dose adjustment.

Applicability of the pittsburgh staging system for advanced cutaneous malignancy of the temporal bone

The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan-Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.

Amelogenin-assisted ex vivo remineralization of human enamel: Effects of supersaturation degree and fluoride concentration

The formation of organized nanocrystals that resemble enamel is crucial for successful enamel remineralization. Calcium, phosphate and fluoride ions, and amelogenin are important ingredients for the formation of organized hydroxyapatite (HAP) crystals in vitro. However, the effects of these remineralization agents on the enamel crystal morphology have not been thoroughly studied. The objective of this study was to investigate the effects of fluoride ions, supersaturation degree and amelogenin on the crystal morphology and organization of ex vivo remineralized human enamel. Extracted third molars were sliced thin and acid-etched to provide the enamel surface for immersion in different remineralization solutions. The crystal morphology and mineral phase of the remineralized enamel surface were analyzed by field emission-scanning electron microscopy, attenuated total reflection-Fourier transformed infrared and X-ray diffraction. The concentration of fluoride and the supersaturation degree of hydroxyapatite had significant effects on the crystal morphology and crystal organization, which varied from plate-like loose crystals to rod-like densely packed nanocrystal arrays. Densely packed arrays of fluoridated hydroxyapatite nanorods were observed under the following conditions: σ(HAP)=10.2±2.0 with 1.5±0.5 mg l(-1) fluoride and 40±10 μg ml(-1) amelogenin, pH 6.8±0.4. A phase diagram summarizes the conditions that form dense or loose hydroxyapatite nanocrystal structures. This study provides the basis for the development of novel dental materials for caries management.

Dental trauma in children and adolescents with mental and physical disabilities

AIM

to determine the occurrence of dental trauma in children and adolescents with a mental and/or physical disability compared to otherwise healthy children, and to assess factors associated with and mechanism of such trauma.

METHODS

Eighty-six subjects consisting of 43 special needs and 43 otherwise healthy children between the ages of 8 and 15 years were chosen from the patient pool at Special Children's Dental Clinic within Children's Hospital, New Orleans. The study utilized a parent interview questionnaire and a clinical exam of the patient.

RESULTS

Although healthy children had a higher number of injuries than children with special needs on average, the difference was not statistically significant. Neither healthy children nor children with special needs exhibited a significant correlation between the number of injuries and the size of the overjet (mm) (p=0.722, 0.712). There was not a significant difference in the number of injuries for children with different oral profiles (p=0.949), or adequate versus inadequate lip coverage (p=0.940).

CONCLUSION

In this study population, the children with special needs living at home may have had the same amount of trauma as the otherwise healthy children and studies with larger sample sizes may be needed to further explore this possibility. Excessive overjet, type of facial profile, and adequacy of lip coverage did not seem to increase the amount of trauma noted in our study population.

Common agents used to unblock blood clots within tympanostomy tubes: an ex vivo study and review of literature

OBJECTIVES

To determine the efficacy of common solutions used to dissolve blood clots blocking tympanostomy tubes (TTs) of differing lengths and diameters.

STUDY DESIGN

An ex vivo experimental study.

METHODS

Ear models were built by the study investigator. Tympanostomy tubes were inserted into the models and blocked with blood clots. Test solutions were applied to the blood clots, and time for clearance was recorded via microscopic visual confirmation.

RESULTS

Richards T-tube had higher odds of unclogging than collar button tubes (odds ratio: 2.37, 95% confidence intervals 1.02-5.54, p=0.042). Vinegar and 3% hydrogen peroxide were most effective for Richards T-tubes and collar button tubes, respectively.

CONCLUSION

Common solutions (vinegar and hydrogen peroxide) were more effective than antibiotic drops in clearing blood clot blocking TTs.

Preschool healthcare utilisation related to home oxygen status

OBJECTIVE

To determine, in prematurely born children who had bronchopulmonary dysplasia (BPD), if respiratory morbidity, healthcare utilisation, and cost of care during the preschool years were influenced by use of supplementary oxygen at home after discharge from the neonatal intensive care unit.

DESIGN

Observational study.

SETTING

Four tertiary neonatal intensive care units.

PATIENTS

190 children, median gestational age 27 weeks (range 22-31), 70 of whom received supplementary oxygen when discharged home.

INTERVENTIONS

Review of hospital and general practitioner records together with a parent completed respiratory questionnaire.

MAIN OUTCOME MEASURES

Healthcare utilisation, cost of care, cough, wheeze, and use of an inhaler.

RESULTS

Seventy children had supplementary oxygen at home (home oxygen group), but only one had a continuous requirement for home oxygen beyond 2 years of age. There were no significant differences in the gestational age or birth weight of the home oxygen group compared with the rest of the cohort. However, between 2 and 4 years of age inclusive, the home oxygen group had more outpatient attendances (p = 0.0021) and specialist attendances (p = 0.0023), and, for respiratory problems, required more prescriptions (p<0.0001). Their total cost of care was higher (p<0.0001). In addition, more of the home oxygen group wheezed more than once a week (p = 0.0486) and were more likely to use an inhaler (p<0.0001).

CONCLUSIONS

Children with BPD who have supplementary oxygen at home after discharge have increased respiratory morbidity and healthcare utilisation in the preschool years.

Outcome analysis of patients with squamous cell carcinoma of the head and neck and hepatitis C virus

OBJECTIVE/HYPOTHESIS

Infection with the hepatitis C virus (HCV) is a global problem with over 170 million people infected. Recently, we have noticed that a large number of patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) have also been diagnosed with HCV. A review of the literature reveals little information concerning this patient population. The objective of this study was to compare the outcome of SCCHN patients who have been exposed to HCV with naïve SCCHN patients.

STUDY DESIGN

Retrospective chart review.

METHODS

A retrospective chart review from June 1991 through December 2002 was performed to identify patients diagnosed with SCCHN who were screened for HCV. Patients were stratified into two groups (HCV positive and HCV negative). Data were recorded on patients for status of disease at last clinic visit, pretreatment serum albumin and hematocrit levels, and RNA quantities of HCV. Statistical analysis was performed using paired t test to compare serum albumin and hematocrit levels. Kaplan-Meier survival curves were used to compare outcomes. The log-rank test was used to determine significance. Cox regression was used to examine the association of prognostic predictor variables with overall survival and disease-free survival.

RESULTS

There was no difference noted in 5 year survival between hepatitis C positive and hepatitis C negative groups in overall outcomes (66.7% vs. 67.9%, P = 1.000) or 5 year disease-free survival (90.5% vs. 80.8%, P = .514). The two groups, HCV positive versus HCV negative, also had similar serum albumin levels (3.62 g/dL vs. 3.72 g/dL, P = .37) as well as serum hematocrit levels (42.9% vs. 41.0%, P = .12). Serum levels of hepatitis C RNA were obtained in seven patients, with only one being undetectable. The only prognostic predictor variable that was significantly associated with overall survival was age. None of the predictor variables were significantly associated with disease-free survival.

CONCLUSION

Co-infection with HCV, although prevalent in the Veterans Administration Hospital population, did not affect patient outcome as defined by disease-free survival. Patients who were seropositive for HCV had comparable serum albumin levels as well as serum hematocrit when compared with HCV negative patients.

Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection

BACKGROUND

In prematurely born infants with chronic lung disease (CLD), RSV hospitalisation is associated with increased health service utilisation and costs in the first two years after birth.

AIMS

To determine whether RSV hospitalisation in the first two years was associated with chronic respiratory morbidity during the preschool years in prematurely born children who had had CLD.

METHODS

Retrospective review of readmissions, outpatient attendances, and community care in years 2-4 and, at age 5 years, assessment of the children's respiratory status and their health related quality of life. Comparison was made of the results of children who had had at least one hospitalisation in the first two years after birth for RSV infection (RSV group) to those of the rest of the cohort. Participants were 190 of an original cohort of 235 infants with CLD and a median gestational age 27 (range 22-33) weeks.

RESULTS

The 33 children in the RSV group, compared to the rest of the cohort, had a greater duration of hospital stay and more outpatient appointments. The RSV group had required more prescriptions for all treatments and respiratory medications, and more had used an inhaler. The cost of care of the RSV group was higher (median 2630 pounds sterling [4000 Euros, US4800 dollars], range 124-18,091 pounds sterling versus 1360 pounds sterling [2500 Euros, US3000 dollars], range 5-18 929 pounds sterling ) and their health related quality of life was lower.

CONCLUSION

In prematurely born children who had developed CLD, RSV hospitalisation in the first two years was associated with chronic respiratory morbidity and increased cost of care.

Death at the border

"Debates about United States border control policies have generally ignored the human costs of undocumented migration. We focus attention on these costs by estimating the number, causes and location of migrant deaths at the southwest border of the United States between 1993 and 1997.... Deaths from hyperthermia, hypothermia and dehydration increased sharply from 1993 to 1997 as intensified border enforcement redirected undocumented migration flows from urban crossing points to more remote crossing areas where the migrants are exposed to a greater risk of death."

A systematic, genome-wide, phenotype-driven mutagenesis programme for gene function studies in the mouse

As the human genome project approaches completion, the challenge for mammalian geneticists is to develop approaches for the systematic determination of mammalian gene function. Mouse mutagenesis will be a key element of studies of gene function. Phenotype-driven approaches using the chemical mutagen ethylnitrosourea (ENU) represent a potentially efficient route for the generation of large numbers of mutant mice that can be screened for novel phenotypes. The advantage of this approach is that, in assessing gene function, no a priori assumptions are made about the genes involved in any pathway. Phenotype-driven mutagenesis is thus an effective method for the identification of novel genes and pathways. We have undertaken a genome-wide, phenotype-driven screen for dominant mutations in the mouse. We generated and screened over 26,000 mice, and recovered some 500 new mouse mutants. Our work, along with the programme reported in the accompanying paper, has led to a substantial increase in the mouse mutant resource and represents a first step towards systematic studies of gene function in mammalian genetics.

Implementation of a large-scale ENU mutagenesis program: towards increasing the mouse mutant resource

Systematic approaches to mouse mutagenesis will be vital for future studies of gene function. We have begun a major ENU mutagenesis program incorporating a large genome-wide screen for dominant mutations. Progeny of ENU-mutagenized mice are screened for visible defects at birth and weaning, and at 5 weeks of age by using a systematic and semi-quantitative screening protocol-SHIRPA. Following this, mice are screened for abnormal locomotor activity and for deficits in prepulse inhibition of the acoustic startle response. Moreover, in the primary screen, blood is collected from mice and subjected to a comprehensive clinical biochemical analysis. Subsequently, secondary and tertiary screens of increasing complexity can be used on animals demonstrating deficits in the primary screen. Frozen sperm is archived from all the male mice passing through the screen. In addition, tail tips are stored for DNA. Overall, the program will provide an extensive new resource of mutant and phenotype data to the mouse and human genetics communities at large. The challenge now is to employ the expanding mouse mutant resource to improve the mutant map of the mouse. An improved mutant map of the mouse will be an important asset in exploiting the growing gene map of the mouse and assisting with the identification of genes underlying novel mutations-with consequent benefits for the analysis of gene function and the identification of novel pathways.

Children and electronic games: a comparison of parents' and children's perceptions of children's habits and preferences in a United States sample

Despite the popularity of violent electronic games, anecdotal evidence suggests that many parents lack even basic information about children's game-playing habits. The goal of the present study was to examine parental knowledge of children's electronic game-playing habits by assessing the congruence between children's and parents' perceptions of child's playing time, parental supervision, game preference, and reaction to actual game-playing. 35 children in Grades 3 to 5 and one parent of each child completed a background questionnaire and played either a violent or nonviolent electronic game. In paired comparisons, parents reported significantly higher estimates of supervision time than children. Most parents either named an incorrect game or were not able to guess their child's favorite game. In 70% of these incorrect matches, children described their favorite game as violent. Parents may underestimate their child's exposure to violence in electronic games. After playing the same electronic game as part of the study, parents reported significantly higher frustration than children. Higher frustration with game-playing could contribute to deficits in parental knowledge of children's playing habits.

5-HT4 receptor antagonism does not affect motor and reward mechanisms in the rat

5-HT4 receptors are concentrated in areas of the brain which are rich in dopamine neuronal markers, which may suggest that they influence motor and reward processes. We tested this hypothesis by examining the effects of a 5-HT4 receptor antagonist, 8-amino-7-chloro-(N-butyl-4-piperidyl)methylbenzo-1,4-dioxan-5-car boxylate hydrochloride (SB-204070-A) on amphetamine- and nicotine-induced locomotor stimulation in intact rats. In rats with unilateral 6-hydroxydopamine-induced lesions of the ascending nigrostriatal dopaminergic projection, SB-204070-A was tested for its effects on amphetamine-induced rotation. SB-204070-A was also tested for its effects on rewarded behaviour maintained by intracranial self-stimulation. SB-204070-A did not alter behaviour under any of these conditions, suggesting a lack of involvement of the 5-HT4 receptor in motor and reward processes.

Functional characterisation of the human cloned 5-HT7 receptor (long form); antagonist profile of SB-258719

1. The functional profile of the long form of the human cloned 5-HT7 receptor (designated h5-HT7(a)) was investigated using a number of 5-HT receptor agonists and antagonists and compared with its binding profile. Receptor function was measured using adenylyl cyclase activity in washed membranes from HEK293 cells stably expressing the recombinant h5-HT7(a) receptor. 2. The receptor binding profile, determined by competition with [3H]-5-CT, was consistent with that previously reported for the h5-HT7(a) receptor. The selective 5-HT7 receptor antagonist SB-258719 ((R)-3,N-Dimethyl-N-[1-methyl-3-(4-methylpiperidin-1-yl)propyl]ben zene sulfonamide) displayed high affinity (pKi 7.5) for the receptor. 3. In the adenylyl cyclase functional assay, 5-CT and 8-OH-DPAT were both full agonists compared to 5-HT and the rank order of potency for agonists (5-CT > 5-HT > 8-OH-DPAT) was the same in functional and binding studies. 4. Risperidone, methiothepin, mesulergine, clozapine, olanzapine, ketanserin and SB-258719 antagonised surmountably 5-CT-stimulated adenylyl cyclase activity. Schild analysis of the antagonism by SB-258719 gave a pA2 of 7.2+/-0.2 and slope not significantly different from 1, consistent with competitive antagonism. 5. The same antagonists also inhibited basal adenylyl cyclase activity with a rank order of potency in agreement with those for antagonist potency and binding affinity. Both SB-258719 and mesulergine displayed apparent partial inverse agonist profiles compared to the other antagonists tested. These inhibitory effects of antagonists appear to be 5-HT7 receptor-mediated and to reflect inverse agonism. 6. It is concluded that in this expression system, the h5-HT7(a) receptor shows the expected binding and functional profile and displays constitutive activity, revealing inverse agonist activity for a range of antagonists.

Domain organization of calbindin D28k as determined from the association of six synthetic EF-hand fragments

Calbindin D28k is an intracellular Ca(2+)-binding protein containing six subdomains of EF-hand type. The number and identity of the globular domains within this protein have been elucidated using six synthetic peptide fragments, each corresponding to one EF-hand subdomain. All six peptides were mixed in equimolar amounts in the presence of 10 mM Ca2+ to allow for the reconstitution of domains. The mixture was compared to native calbindin D28k and to the sum of the properties of the individual peptides using circular dichroism (CD), fluorescence, and 1H NMR spectroscopy, as well as gel filtration and ion-exchange chromatography. It was anticipated that if the peptides associate to form native-like domains, the properties would be similar to those of the intact protein, whereas if they did not interact, they would be the same as the properties of the isolated peptides. The results show that the peptides in the mixture interact with one another. For example, the CD and fluorescence spectra for the mixture are very similar to those of the intact calbindin D28k, suggesting that the mixed EF-hand fragments associate to form a native-like structure. To determine the number of domains and the subdomain composition of each domain in calbindin D28k, a variety of peptide combinations containing two to five EF-hand fragments were studied. The spectral and chromatographic properties of all the mixtures containing less than six peptides were closer to the sum of the properties of the relevant individual peptides than to the mixture of the six peptides. The results strongly suggest that all six EF-hands are packed into one globular domain. The association of the peptide fragments is observed to drive the folding of the individual subdomains. For example, one of the fragments, EF2, which is largely unstructured in isolation even in the presence of high concentrations of Ca2+, is considerably more structured in the presence of the other peptides, as judged by CD difference spectroscopy. The CD data also suggest that the packing between the individual subdomains is specific.

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge

Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people.

Adhesiveness of human ligament fibroblasts to laminin

The adhesiveness of fibroblasts from the human anterior cruciate and medial collateral ligaments to the laminin molecule was studied, with particular emphasis on the intrinsic differences between fibroblasts from the two ligaments. Cellular adhesion strength, adhesion area, laminin concentration, and seeding time were examined. Cell adhesion to laminin anchored with poly-D-lysine to a cleaned cover glass was measured with a micropipette micromanipulation system after seeding. The adhesion strength of fibroblasts from the anterior cruciate ligament to laminin was greater than and significantly different from that of fibroblasts from the medial collateral ligament, depending on the laminin concentration. Fibroblasts from the anterior cruciate ligament also exhibited an increase in adhesion strength, dependent on laminin concentration of as much as 30 micrograms/ml, at which the laminin receptors were thought to be saturated. Fibroblasts from the medial collateral ligament did not show such an increase except at laminin concentrations of 5-10 micrograms/ml. There was no significant difference in adhesion area between fibroblasts from the two ligaments except after 45 minutes at a laminin concentration of 40 micrograms/ml. For both, the adhesion to laminin showed little correlation to seeding time during periods of as long as 60 minutes. Measurements of adhesion area also failed to show a significant correlation to seeding time for fibroblasts from either ligament at laminin concentrations of 20 and 40 micrograms/ml. Adhesion strength normalized by adhesion area had no correlation to seeding time.(ABSTRACT TRUNCATED AT 250 WORDS)

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Airway obstruction following transhiatal esophagogastrectomy

A 79 year old man suffered acute respiratory distress secondary to delayed gastric emptying several months following esophagogastrostomy. No drainage procedure was performed at the time of the procedure. The need for a drainage procedure is controversial. Symptoms of gastric stasis have reportedly improved with a drainage procedure and the risk of concomitant pyloromyotomy or pyloroplasty has been shown to be minimal and may prevent a potentially catastrophic complication as described in this report.

Behavioral screening for cognition enhancers: from indiscriminate to valid testing: Part I

Preclinical efforts to detect and characterize potential cognition enhancers appear to have been dominated by a strategy of demonstrating a wide variety of apparently beneficial behavioral effects with little attention given to the specific psychological mechanisms underlying behavioral enhancement. In particular, the question of whether or not behavioral facilitation is based on relevant mnemonic mechanisms and is independent of the stimulus properties and/or the motivational and attentional components of a task is not often considered. As a result, an overwhelming number of compounds have failed to produce the clinical effects predicted for them on the basis of preclinical research. The available data suggest that a more successful approach requires deductive research strategies rather than the indiscriminate accumulation of apparently beneficial effects in a variety of behavioral tasks and animal models. The first step towards such an approach is a systematic and rigorous evaluation of the different aspects of validity for the models most frequently used in preclinical research. It is concluded that a combination of good construct validity and good face validity represents a necessary condition for screening tests with predictive validity, and that the most popular paradigms fail to fulfil these criteria. Future screening programs for cognition enhancers will probably be characterized by a depreciation of "fast and dirty tests" in favor of approaches focussing on the validity of the effects of potential cognition enhancers.

Lipids: impact on dietary prescription in diabetes

The rate of death from coronary artery disease is two to three times higher among individuals with diabetes than among their age- and sex-matched peers. In diabetes, many factors may affect blood lipid levels and complicate formulating an effective dietary prescription. Both Type I and Type II diabetes may have an independent effect on lipids. This article discusses metabolic derivations in carbohydrate and lipid metabolism that contribute to lipid abnormalities. The National Cholesterol Education Program Guidelines, which include dietary recommendations for lowering blood lipid levels by modifying fat intake, are discussed in regard to their effect on blood lipids in diabetes and their effect on other variables, such as blood glucose control. Other treatment approaches common in diabetes and lipid management include low-calorie diets and weight reduction, a change in the fatty acid composition of the diet, and high-carbohydrate diets. An evaluation of the etiologies of lipid abnormalities and interventions directed toward lipid levels and other indexes of diabetes management may lead to improved lipid levels, improved blood glucose control, and avoidance of unnecessary, ineffective, or deleterious dietary prescriptions for individuals with diabetes.

Oxytocin precipitation of prostaglandin-induced farrowing in swine: determination of the optimal dose of oxytocin and optimal interval between prostaglandin F2 alpha and oxytocin

The influence of dose of oxytocin and the interval between prostaglandin (PG) F2 alpha and oxytocin administration on the synchrony of farrowing, the prevalence of intrapartum complications, and the number of pigs dying perinatally was investigated. In study 1, sows were given 10 mg of PGF2 alpha IM on day 112, 113, or 114 of gestation or were not treated. Twenty hours after PGF2 alpha administration, sows were given 0, 5, 10, 20, or 30 USP U of oxytocin IM. Sows treated with PGF2 alpha or PGF2 alpha plus oxytocin had a shorter interval to farrowing than sows not treated or treated with oxytocin alone. Treatment with PGF2 alpha plus 30 U of oxytocin induced the most rapid onset and the greatest synchrony of farrowing, with the mean onset occurring 2.1 +/- 0.4 hours after oxytocin vs greater than 8 hours for all other treatments. Sows treated with 5 or 10 U of oxytocin had a delayed onset and a less synchronous farrowing, compared with sows treated with 0 or 20 U. Day of PGF2 alpha treatment influenced (P less than 0.05) the interval from oxytocin to onset of farrowing. As day during gestation decreased, there was a corresponding decrease in the interval between oxytocin administration and farrowing. Number of interventions to remove retained pigs was not influenced (P greater than 0.05) by day of PGF2 alpha administration. All sows treated with PGF2 alpha followed by oxytocin had a higher rate of manual interventions, compared with that in sows given PGF2 alpha but not oxytocin.(ABSTRACT TRUNCATED AT 250 WORDS)

Ctenidial autotomy in Corbicula fluminea in response to massive granulomas

Large granulomas (greater than 2 millimeters in diameter), stimulated by the presence of and formed around necrotic larval tissue in the inner demibranchs of Corbicula fluminea, are eliminated by autotomy. Granulocytes invade and destroy ctenidial epithelium adjacent to the granuloma, causing it and the granuloma to slough away into the mantle cavity, where they are removed as pseudofeces.