Investigation of infection with Campylobacter jejuni in a man with hypogammaglobulinaemia using PCR-single-stranded conformational polymorphism (PCR-SSCP) typing

This study investigated several episodes of infection of Campylobacter jejuni in an immunocompromised male with hypogammaglobulinaemia, presenting with diarrhoea and bacteraemia over a 16-month period, by employing three phenotyping and four genotyping schemes, including the single-stranded conformational polymorphism (SSCP) technique to establish if infection was reinfection or persistent infection. Four isolates from blood culture and two faecal isolates of Campylobacter jejuni were obtained from the patient by direct selective plating on Skirrow Selective agar. Isolates were characterised at the sub-species level by Penner serology, Preston biotyping, Preston phage-typing, as well as E3CJC2 restriction fragment length polymorphism (RFLP), 16S ribotyping, flagellin (flaA) RFLP and single-stranded conformational polymorphism (SSCP) analyses. Phenotyping and genotyping sub-species analyses demonstrated that the patient was infected with at least two different strains of Campylobacter jejuni, i. e. one strain that persisted throughout the 16-month period and another strain that was transient suggesting reinfection from a different source. SSCP analysis was the most discriminatory of all the typing schemes examined and demonstrated an altered genotype of the persistent strain, whereby there were subtle modifications to the hypervariable regions of the flaA gene. Overall, as SSCP examines the hypervariable region of the flaA gene and as this technique can detect point mutations, differences between SSCP banding patterns may represent markers and thus examine mutations that occur under immune selection, thereby permitting the C. jejuni to evade the host immune response. In conclusion, this study describes the novel use of SSCP genotyping of C. jejuni and demonstrated that this method is a highly discriminatory technique which may be beneficial in outbreak characterisation, but which is not suitable to examine the clonal patterns of C. jejuni over a long period of time.

Reconceptualising the outcomes of Continuing Professional Development

This paper considers the potential outcomes, both positive and negative, of continuing professional development from the perspectives of practitioners and managers. Following a consideration of the literature it draws upon data collected during a 3-year evaluation of the English National Board Framework and Higher Award to highlight divergent views and tensions within Continuing Professional Development (CPD). Considerable discrepancies between practitioners and managers emerge which raise a number of searching questions about the value each group accords to continuing professional development. Based on the data a new framework for conceptualizing the outcomes of CPD is presented which fundamentally undermines a quasi-market approach.

Parent-progeny recognition as a function of MHC odortype identity

The several linked polymorphic genes of the MHC, which has been proposed as a prime determinant of sensed genetic individuality within species, is known to operate in mice by olfactory recognition in aspects of reproductive behavior that concern mate selection, thereby favoring outbreeding and heterozygosity, and also concern the maintenance of pregnancy. A single base-change can alter an individual MHC odortype, and the potential range of combinatorial MHC-determined odortypes is clearly vast. Following our findings that newborn mice already express their MHC odortype (which is detectable at 9 days of gestational age), we sought to determine whether MHC is involved in behavioral aspects of early development, such as rearing. In the studies presented herein, we report the ability and proclivity of mothers to recognize and preferentially retrieve syngeneic (genetically identical) pups from other pups differing only for MHC. Reciprocally, we report the ability of pups to recognize their familial environment, regardless of whether they had been nursed by their biological mothers or by foster mothers. Early learning experiences of the MHC environment are apparently a key element in survival, assuring maternal protection and promoting outbreeding.

MHC-mediated fetal odourtypes expressed by pregnant females influence male associative behaviour

Mice can recognize one another by individually characteristic phenotypic body odours (odourtypes) that reflect their genetic constitution at the highly polymorphic major histocompatibility complex (MHC) of genes on chromosome 17. We have shown previously that MHC-determined odours are produced by fetuses: house mice, Mus domesticus, can be trained to discriminate between genetically identical pregnant females carrying 9-18-day-old fetuses of differing MHC type. Theoretically, it should be possible for a mouse to determine the MHC type of the sire based on the odourtype of the pregnant female. In the current study we investigated whether untrained male mice show spontaneous discrimination between such pregnant mice. In experiment 1, sexually inexperienced male mice spent more time near pregnant females that carried fetuses most genetically different from the males themselves. Experiment 2, designed to evaluate possible experiential effects on this preference, tested males that were cohabiting and had impregnated a female that was either genetically identical to the test male (excepting X and Y chromosomes) or differed from him only at the MHC. Males in the former case performed virtually identically to those tested in experiment 1. In contrast males in the latter group did not display this preference. These studies reveal that among untrained male mice, fetal MHC type influences choice behaviour presumably via fetal odourtypes expressed in maternal secretions/excretions and that previous housing and/or mating experience modulates male choice. Copyright 2000 The Association for the Study of Animal Behaviour.

Effect of B2m gene disruption on MHC-determined odortypes

Major histocompatibility complex (MHC) genes confer individual olfactory identity that can be detected with exquisite accuracy by mice. The fact that MHC genes themselves generate the characteristic odortype, rather than dedicated odor-determining genes, was supported in studies of point mutations in H2K and HLA transgenic mice, which evinced distinct odor profiles in olfactory assays. In this article we provide further evidence for a central role of MHC genes themselves in odortype specification by demonstrating that mice that are unable to express their genomic class I MHC genes because they lack beta2-microglobulin are distinguishable by scent from otherwise identical mice which possess an intact B2m gene. This odortype disparity appears at 9-12 days of gestational age, the period in which the MHC is first detectable in fetal cells of normal mice.

Sibling vesicoureteral reflux in multiple gestation births

BACKGROUND

Vesicoureteral reflux (VUR) is the most commonly inherited disease of the genitourinary tract. Although the majority of evidence supports a genetic cause, the tendency for this condition to spontaneously improve over time has made it difficult to determine the actual mode of transmission. We report the incidence of VUR in siblings of multiple gestation births and for the first time compare the relative incidence of reflux between identical and fraternal twins.

METHODS

A database consisting of all radionuclide cystograms and voiding cystourethrograms performed between the years 1986 and 1996 was searched for multiple gestation births. The medical records of each patient were evaluated for age at presentation, zygosity, reflux grade, and time to resolution. Children with secondary causes of VUR (eg, posterior urethral valves) were excluded. Triplets were treated as 2 pairs of twins for statistical analysis.

RESULTS

Forty-six pairs met the inclusion criteria (31 dizygotic and 15 monozygotic). Overall, 23 (50%) of 46 siblings of index cases had demonstrable VUR. Comparison of VUR prevalence between identical and nonidentical twins was revealing with 80% (12/15) of identical twins and 35% (11/31) of fraternal twins having VUR. When only the youngest individuals in each group were considered, 100% (7/7) of the monozygotics and 50% (5/10) of the dizygotics demonstrated this trait.

CONCLUSIONS

High concordance for VUR in identical twin siblings supports a genetic basis for the transmission of this disease. Results obtained from fraternal twin siblings provides convincing evidence that this trait is transmitted in an autosomal dominant fashion.

Assessing dehydroepiandrosterone in saliva: a simple radioimmunoassay for use in studies of children, adolescents and adults

While salivary assays for some hormones are widely used, the availability of assays for salivary DHEA is limited. By adapting a commercially available radioimmunoassay serum kit, we developed a reliable, efficient and sensitive measure of DHEA in saliva that does not require separation or extraction. The minimum detection limit was 4.0 pg/ml. Intra-assay coefficients of variation (CV%) were on average 4.05, and inter-assay CVs averaged 9.70. Method accuracy, determined by spike recovery, and linearity, determined by serial dilution, averaged 99.55 and 92.03%. Levels in matched serum and saliva samples showed strong linear relationships for adult males and females. Specific guidelines are developed for sample collection, storage, and preparation procedures. Reference ranges for salivary DHEA levels are provided for 64 children ages 8-11, 96 adolescents ages 12-17 and 48 adults ages 30-45. Salivary DHEA levels are shown to reflect developmental, gender and diurnal differences.

The prevalence of chronic knee injury in triathletes

OBJECTIVES

To add to the area of triathlon research by providing much needed prevalence data on knee injury in triathletes.

METHOD

An incidental "in field" sampling technique was used to interview 58 triathletes aged between 15 and 55 years about knee injury during a triathlon event. The sample comprised 46 men and 12 women.

RESULTS

Most knee injuries occurred during the running event (72%) and affected the lateral side of the knee (38%). In all, 78% of the sample sought treatment from a healthcare professional.

CONCLUSION

The study has provided much needed prevalence data on chronic knee injury in triathletes.

Maternal 1-deamino-8-D-arginine-vasopressin-induced sequential decreases in plasma sodium concentration: ovine fetal renal responses

OBJECTIVE

Acute maternal plasma hypotonicity induces a reduced placental osmotic gradient that contributes to augmented maternal-to-fetal water flow. Subsequently, maternal plasma hyponatremia results in fetal plasma hyponatremia, increased fetal urinary flow, and ultimately increased amniotic fluid volume. We hypothesized that both the degree of reduction in the placental osmotic gradient and the degree of fetal plasma hyponatremia influence fetal urinary diuretic responses. To differentiate the roles of these factors, we determined fetal urinary responses to graded levels of plasma hyponatremia during a constant placental osmotic gradient. Furthermore, we sought to establish the minimum level of plasma hyponatremia necessary to facilitate an increase in fetal urine production.

STUDY DESIGN

Seven pregnant ewes (130 +/- 2 days) were prepared with maternal and fetal vascular catheters and a fetal bladder catheter. After 6 days of recovery, fetal urinary flow and urine and plasma compositions were measured during a 2-hour control period. At 2 hours, tap water (2 L, 38 degreesC) with a 20-g bolus of 1-deamino-8-d-arginine-vasopressin was administered to the ewe. Maternal plasma sodium concentration was decreased from control by 5 to 7, 10 to 12, and 15 to 17 mEq/L, and held at each level (levels 1, 2, and 3) for 60 minutes.

RESULTS

1-Deamino-8-d-arginine-vasopressin administration induced sequential decreases in maternal and fetal plasma sodium concentrations (control 146.9 +/- 0.5 mEq/L and 141.0 +/- 0.5 mEq/L, respectively) at level 1 (140.1 +/- 0.6 mEq/L and 136.7 +/- 0.7 mEq/L, respectively), level 2 (132.5 +/- 0.7 mEq/L and 130.6 +/- 1.1 mEq/L, respectively), and level 3 (125.4 +/- 1.2 mEq/L and 123.0 +/- 1.5 mEq/L, respectively). The maternal-fetal placental osmolality and sodium gradients were constant at each hypotonicity level. Fetal urinary flow significantly increased in association with the degree of hyponatremia (from 0.17 +/- 0.03 mL/kg/min to 0. 26 +/- 0.04 mL/kg/min, 0.33 +/- 0.05 mL/kg/min, and 0.38 +/- 00.5 mL/kg/min at levels 1, 2, and 3, respectively).

CONCLUSIONS

These results indicate the following: (1) Sequential decreases in maternal plasma tonicity result in parallel decreases in fetal plasma tonicity. (2) The fetal urinary diuretic response is highly correlated with the degree of fetal plasma hypotonicity, despite a constant placental osmotic gradient. A fetal therapeutic response (53% increase in fetal urine production) may be induced by a maternal plasma sodium concentration decrease of only 5 to 7 mEq/L.

Evidence-based care: can we overcome the barriers?

Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.

National influenza surveillance 1997

In 1997 information from several sources was combined to detect trends in influenza activity in Australia. Data was included from laboratories, general practitioners and a national employer. Laboratory surveillance documented two consecutive outbreaks, influenza B in July followed by influenza A (H3N2) in August. Some of the influenza A (H3N2) viruses isolated, represented by the A/Sydney/5/97 strain, showed significant antigenic drift from the A/Wuhan/359/95 vaccine strain. Influenza activity was also reflected in the consultation rates recorded by sentinel general practitioner reporting schemes. The peak consultation rate recorded by the Australian Sentinel Practice Research Network was higher and later than in recent years, occurring in early August. Tropical Influenza Surveillance in the Northern Territory demonstrated an early outbreak in March followed by a second rise later in the year. There was no rise in absenteeism rates recorded by a national employer.

Nonphosphorylated peptide ligands for the Grb2 Src homology 2 domain

Critical intracellular signals in normal and malignant cells are transmitted by the adaptor protein Grb2 by means of its Src homology 2 (SH2) domain, which binds to phosphotyrosyl (pTyr) residues generated by the activation of tyrosine kinases. To understand this important control point and to design inhibitors, previous investigations have focused on the molecular mechanisms by which the Grb2 SH2 domain selectively binds pTyr containing peptides. In the current study, we demonstrate that the Grb2 SH2 domain can also bind in a pTyr independent manner. Using phage display, an 11-amino acid cyclic peptide, G1, has been identified that binds to the Grb2 SH2 domain but not the src SH2 domain. Synthetic G1 peptide blocks Grb2 SH2 domain association (IC50 10-25 microM) with a 9-amino acid pTyr-containing peptide derived from the SHC protein (pTyr317). These data and amino acid substitution analysis indicate that G1 interacts in the phosphopeptide binding site. G1 peptide requires a YXN sequence similar to that found in natural pTyr-containing ligands, and phosphorylation of the tyrosine increases G1 inhibitory activity. G1 also requires an internal disulfide bond to maintain the active binding conformation. Since the G1 peptide does not contain pTyr, it defines a new type of SH2 domain binding motif that may advance the design of Grb2 antagonists.

Australia's notifiable diseases status, 1996. Annual report of the National Notifiable Diseases Surveillance System

In 1996 there were 65,024 notifications to the National Notifiable Diseases Surveillance System. The record high number of Ross River virus infection notifications was of particular note. The highest rates were recorded in Western Australia, where an outbreak was documented in the South West, and in Queensland. Most cases occurred in the late summer and early autumn months. The number of measles cases has continued to fall markedly following the outbreak in 1993 and 1994. Rubella notifications also fell in 1996. The number of cases of pertussis remained at a similar level to that recorded in recent years, the highest notification rate being recorded for children under the age of one year. A peak in late 1996 marked a resurgence in the pertussis epidemic which has continued into 1997. Notifications of Haemophilus influenzae type b continued to decline reaching a record low rate of 0.3 notifications per 100,000 population. For the enteric diseases, the number of cases of campylobacteriosis rose, with an annual adjusted notification rate of 100.4 per 100,000 population; more notifications were received for this disease than for any other in 1996. The number of hepatitis A cases also rose relative to 1995. This is a reversal of the trend observed in recent years when the notification rate fell. The number of cases of salmonellosis and shigellosis remained stable. Notifications for chlamydial infection and gonococcal infection rose relative to 1995, whilst those for syphilis fell.

National Influenza Surveillance 1996

In 1996 data from laboratories, general practitioners and a national employer were combined to detect trends in influenza activity in Australia. An epidemic of influenza A (H3N2) was recorded. Little influenza B activity was noted throughout the winter months, however the number of laboratory reports of influenza B rose in the last quarter of the year. Influenza activity was reflected in the consultation rates recorder by sentinel general practitioner reporting schemes. Of particular note was the Tropical Influenza Surveillance in the Northern Territory which demonstrated a bimodal epidemic pattern. There was no apparent trend in national absenteeism rates recorded by a national employer.

HLA-DR antigens associated with major genetic risk for late-onset Alzheimer's disease

Hla-dr antigen types were determined from DNA isolated from post-mortem brain tissue of age-matched groups of 78 patients with pathologically confirmed late-onset Alzheimer's disease (AD) and 50 controls. The results suggest that for individuals with no apolipoprotein E epsilon 4 alleles the presence of either DR1, 2 or 3 antigens is associated with a significantly increased risk for development of late-onset AD. Conversely the DR4 or 6 antigens are associated with a decreased risk of similar magnitude. This DR effect, rather than prolonged use of non-steroidal anti-inflammatory drugs, could be responsible for the reported lower prevalence of AD in rheumatoid arthritis (a condition associated with an increased frequency of DR-4).

Pregnancy complicated by vesical calculus and vesicocutaneous fistula

Bladder stones are a rare complication of pregnancy, with only 10 cases reported this century. This patient required a cesarean section for obstructed labor resulting from a 7 cm stone. Cystotomy with removal of the stone was performed with subsequent development of a vesicocutaneous fistula.

Healthcare reform: a survey of college health services

As federal legislators moved closer to enacting significant healthcare reform during fall 1994, it was apparent to the college health community that campus health programs could be significantly affected. Uncertainty over the impending legislation led college health directors to consider two important questions: What is the federal government going to do? and What could college health directors do to position their organizations more effectively to respond to pending reform? The former question was debated on a daily basis throughout the United States with no resolution in sight. The latter question was the ultimate focus of this survey research involving 56 of 79 schools (71% response rate from institutions in 38 states). Half of the schools had enrollments between 15,001-25,000 students; 86% used prepaid fees as their primary financing mechanism. Survey results identified college health directors' preferences for 27 different organizational strategies in response to possible healthcare reform initiatives.

Entry to care: positive choice or fait accompli? developing a more proactive nursing response to the needs of older people and their carers

A range of issues surrounding admission to either residential or nursing home care are considered from the perspectives of older people and their family carers. Drawing on the literature and a number of studies conducted by the authors, the processes and perceptions that shape and influence admission to care are identified. On the basis of the interaction of these factors a four-stage typology of admission is suggested: the positive choice, the rationalized alternative, the discredited option, and the fait accompli. The characteristics of each admission type are discussed and the implications for professionals, particularly nurses, working with older people and their carers are addressed.

Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in low stage nonseminomatous testis cancer

PURPOSE

We determined whether teratomatous elements in the orchiectomy specimen predict for teratoma in the retroperitoneum in patients who have not received chemotherapy.

MATERIALS AND METHODS

We retrospectively reviewed the records of patients with clinical stages A, B and B2 nonseminoma who underwent retroperitoneal lymph node dissection.

RESULTS

Teratomatous elements in the orchiectomy specimen predict for retroperitoneal teratoma.

CONCLUSIONS

When deciding on treatment for low stage nonseminoma, the presence or absence of teratoma in the orchiectomy specimen should be considered to minimize double therapy.

Pharmacodynamics of doxacurium during cardiac surgery with hypothermic cardiopulmonary bypass

PURPOSE

To determine the characteristics of neuromuscular block produced by two and three times the 95% effective dose (ED95) of doxacurium in patients undergoing coronary artery surgery with hypothermic cardiopulmonary bypass.

METHODS

In a prospective non randomized study, ten patients received doxacurium 0.05 mg.kg-1 (Group 1) and ten others received 0.075 mg.kg-1 (Group 2) with midazolam and sufentanil. The mechanomyographic response of the adductor pollicis muscle after supramaximal train-of-four (TOF) stimulation of the ulnar nerve was recorded intraoperatively and postoperatively. Additional doxacurium (10% of the initial dose) was administered until sternal closure whenever the first twitch (T1) had recovered to 25% of control.

RESULTS

The onset time (time to maximal T1 depression) of doxacurium was 390 +/- 148 sec in Group 1 and 370 +/- 74 sec in Group 2 (P = 0.71). The clinical duration of neuromuscular block (time to 25% T1 recovery) was 165 +/- 90 min in Group 1 and 258 +/- 86 in Group 2 (P = 0.03). On arrival to recovery room the mean T1 was 57 +/- 23% in Group 1 and 24 +/- 21% in Group 2 (P = 0.003); the mean T4/T1 ratio was 0.25 +/- 0.15 for five patients of Group 1 with four responses to TOF stimulation and 0.10 for the only patient of Group 2 with four twitches.

CONCLUSION

In contrast with findings in patients without cardiac disease, this study shows comparable onset times of doxacurium with doses of two and three times ED95. The clinical duration of doxacurium is 60 to 100% longer than previously reported in noncardiac surgery.

Edrophonium requirements for reversal of deep neuromuscular block following infusion of mivacurium

Mivacurium is a new non-depolarizing muscle relaxant consisting of three stereoisomers. The two active isomers (cis-trans and trans-trans) undergo rapid metabolism by plasma cholinesterase (t1/2 beta < 2 min). Due to its rapid elimination, the need for reversal of mivacurium-induced neuromuscular block is controversial, and to date there have been no studies evaluating reversal of deep blocks. The object of the current investigation was to establish the lowest effective dose of edrophonium required to reverse deep mivacurium-induced neuromuscular block. One hundred ASA Class I and II patients undergoing outpatient surgery in two teaching institutions were studied in this randomized, placebo-controlled double-blind trial. Under balanced propofol/nitrous oxide/alfentanil anaesthesia, a continuous infusion of mivacurium was adjusted to maintain between 5-10% of control T1 amplitude. Upon completion of surgery, neuromuscular block was reversed by injecting normal saline (Group PLAC), edrophonium 0.125 mg.kg-1 (Group EDR-1), 0.25 mg.kg-1 (Group EDR-2), or 0.50 mg.kg-1 (Group EDR-3), in addition to a corresponding dose of atropine. Spontaneous recovery, from a T1 response of < 10% to a TOF ratio > or = 0.7, required 13.5 +/- 2.6 min (PLAC Group). In comparison, patients in the EDR-1 group required 9.2 +/- 2.6 min (P < 0.01). Higher doses of edrophonium conferred no advantage. Four patients (4%) had not achieved a TOF ratio of > or = 70%, 20 min after reversal, and required additional edrophonium. Two patients (PLAC group), had dibucaine numbers and cholinesterase levels consistent with an EUEA genotype, whereas the two patients with delayed recovery in the EDR-1 group had characteristics of a normal genotype. We conclude that a very low dose of edrophonium (0.125 mg.kg-1) hastens reversal of deep mivacurium-induced neuromuscular block by approximately four minutes, and that edrophonium doses exceeding 0.125 mg.kg-1 provide no additional benefit. Heterozygous patients with atypical plasma cholinesterase levels, as well as certain individuals with normal dibucaine numbers and plasma cholinesterase activity, are at risk for prolonged neuromuscular block, but the block is easily reversed with edrophonium.

Restricted movement of lipid and aqueous dyes through pores formed by influenza hemagglutinin during cell fusion

The fusion of cells by influenza hemagglutinin (HA) is the best characterized example of protein-mediated membrane fusion. In simultaneous measurements of pairs of assays for fusion, we determined the order of detectable events during fusion. Fusion pore formation in HA-triggered cell-cell fusion was first detected by changes in cell membrane capacitance, next by a flux of fluorescent lipid, and finally by flux of aqueous fluorescent dye. Fusion pore conductance increased by small steps. A retardation of lipid and aqueous dyes occurred during fusion pore fluctuations. The flux of aqueous dye depended on the size of the molecule. The lack of movement of aqueous dyes while total fusion pore conductance increased suggests that initial HA-triggered fusion events are characterized by the opening of multiple small pores: the formation of a "sieve".

Fetal H-2 odortypes are evident in the urine of pregnant female mice

The major histocompatibility complex (MHC) imparts to each mouse an individual urinary odor, called "odortype", which reflects its MHC genotype. Perception of odortypes affects mate selection and embryonic implantation. Recent findings that odortypes are expressed as early as one day of age suggested that they might already be expressed in utero. We now report that at 9-12 days of gestation, odortypes specified by paternal (non-maternal) MHC haplotypes become apparent in maternal urine. Thus, odortypes are expressed in utero, can be sensed even before birth, and may serve in familial identification and communication.

Locus heterogeneity of autosomal dominant long QT syndrome

Autosomal dominant long QT syndrome (LQT) is an inherited disorder that causes syncope and sudden death from cardiac arrhythmias. In genetic linkage studies of seven unrelated families we mapped a gene for LQT to the short arm of chromosome 11 (11p15.5), near the Harvey ras-1 gene (H ras-1). To determine if the same locus was responsible for LQT in additional families, we performed linkage studies with DNA markers from this region (H ras-1 and MUC2). Pairwise linkage analyses resulted in logarithm of odds scores of -2.64 and -5.54 for kindreds 1977 and 1756, respectively. To exclude the possibility that rare recombination events might account for these results, we performed multipoint linkage analyses using additional markers from chromosome 11p15.5 (tyrosine hydroxylase and D11S860). Multipoint analyses excluded approximately 25.5 centiMorgans of chromosome 11p15.5 in K1756 and approximately 13 centiMorgans in K1977. These data demonstrate that the LQT gene in these kindreds is not linked to H ras-1 and suggest that mutations in at least two genes can cause LQT. While the identification of locus heterogeneity of LQT will complicate genetic diagnosis, characterization of additional LQT loci will enhance our understanding of this disorder.

Effects of osmotic stress on mast cell vesicles of the beige mouse

The large size of the vesicles of beige mouse peritoneal mast cells (4 microns in diameter) facilitated the direct observation of the individual osmotic behavior of vesicles. The vesicle diameter increased as much as 73% when intact cells were perfused with a 10 mM pH buffer solution; the swelling of the vesicle membranes exceeded that of the insoluble vesicle gel matrix, which resulted in the formation of a clear space between the optically dense gel matrix and the vesicle membrane. Hypertonic solutions shrank intact vesicles of lysed cells in a nonideal manner, suggesting a limit to the compressibility of the gel matrix. The nonideality at high osmotic strengths can be adequately explained as the consequence of an excluded volume and/or a three-dimensional gel-matrix spring. The observed osmotic activity of the vesicles implies that the great majority of the histamine known to be present is reversibly bound to the gel matrix. This binding allows vesicles to store a large quantity of transmitter without doing osmotic work. The large size of the vesicles also facilitated the measurement of the kinetics of release as a collection of individual fusion events. Capacitance measurements in beige mast cells revealed little difference in the kinetics of release in hypotonic, isotonic, and hypertonic solutions, thus eliminating certain classes of models based on the osmotic theory of exocytosis for mast cells.

Posttransplantation diabetes mellitus in heart transplant recipients

This study was undertaken to investigate the impact of diabetes, which develops after heart transplantation, on infection and patient survival. Nondiabetic patients (366) underwent heart transplantation at our institution between June 1, 1980 and January 12, 1988. Of these patients, 29 (8%) developed posttransplantation diabetes (PTD), defined as a continued need for hypoglycemic agents. The PTD group did not differ significantly from the nondiabetic recipients in age, sex, or human leukocyte antigen type. The average age in the PTD group was 49 years. Average length of follow-up was 21 months (range 4 to 46 months). Eighteen patients are maintained on insulin. Eight patients are on oral hypoglycemic agents. Three patients died while on insulin. The average prednisone dosage in this group is 0.23 mg/kg/day. There have been 18 minor infections and four potentially serious nonlethal infections in the 27 PTD recipients. One lethal infection occurred 33 months after heart transplantation. The only other fatality was related to metastatic bladder cancer. This lethal infection rate of 3% compares with a rate of 11% in all nondiabetic recipients who have follow-up for 21 months. The 3-year actuarial survival of the PTD group is 75%, which compares favorably with the survival of nondiabetic patients. PTD cannot be predicted by sex, age, or human leukocyte type before transplantation, and it does not significantly increase the incidence of mortality or serious infection.

Blast injuries from glass bottles containing dry ice

We present three cases (two incidents) of severe blast injury from the explosion of covered glass bottles containing dry ice. The first patient sustained lacerations of the face, left eye, right wrist and forearm, and abdomen with protrusion of the small bowel. The second sustained a deep laceration to her anterior neck. The third sustained multiple lacerations to her lower extremities and one to the labia majora. All three patients were taken to the operating room for surgical exploration and repair and were discharged without complications.

Evaluation of seven immunoassays for detection of rotavirus in pediatric stool samples

The performance of seven commercially manufactured rotavirus assays was evaluated with 144 pediatric stool specimens and compared with electron microscopy (EM) findings. The four enzyme-linked immunosorbent assays used were Rotazyme II, Pathfinder, IDL rotavirus immunoassay, and Enzygnost (Behring) rotavirus assay. The three latex tests were Meritec rotavirus detection test, Virogen Rotatest, and Bartels rotavirus latex test. Test outcomes were compared with EM on the basis of sensitivity, specificity, positive-negative predictive value, and the kappa statistic. Relative to EM, Meritec had the highest specificity (97%), followed by Virogen (95%), IDL (91%), Pathfinder (85%), Behring (81%), Bartels (72%), and Rotazyme (71%). The sensitivities were as follows: Rotazyme (92%), Pathfinder (89%), Bartels (86%), Virogen (86%), Behring (82%), Meritec (71%), and IDL (75%). Patient age and sex did not influence test results. Owing to the absence of a true standard, the tests were also compared with each other on the basis of the kappa statistic, the frequency of positive test results, and the frequency of samples in which a test differed from all other tests. Using these measures, the assays could be classified into three groups with progressively decreasing utility: group 1 (Virogen, Meritec, IDL, and EM), group 2 (Pathfinder and Behring), and group 3 (Rotazyme and Bartels). Laboratory criteria were also compared. Latex tests were faster and required less equipment than enzyme-linked immunosorbent assays. The Virogen latex assay showed the best overall performance, which made it our choice for rapid and accurate rotavirus diagnosis. However, in children who have gastrointestinal symptoms with negative rotavirus test results, EM will be useful until such time as immunological tests for other enteric viruses are available.

Thoracic aortic occlusion: somatosensory evoked potential monitoring and neurologic outcome in a canine model

Somatosensory evoked potentials (SEPs) were monitored in 17 canines during spinal cord ischemia induced by balloon occlusion of the thoracic aorta. Graded distal aortic hypotension to 40 mmHg in seven animals had no significant effect upon the evoked potential. A significant alteration in the SEP did result in 21 +/- 9.8 minutes when distal aortic pressures were reduced in a graded fashion below 30 mmHg. Acute occlusion of the thoracic aorta (10 animals, distal pressure 15-25 mmHg) was associated with a change in the SEP in 8.4 +/- 4.3 minutes. Continuation of aortic occlusion for 30 minutes beyond an evoked potential change resulted in a moderate to severe motor deficit in all cases. Somatosensory evoked potentials obtained 72-96 hours after the ischemic injury were closely correlated with sensory deficits, but were not predictive of motor examination. Histologic examination of the spinal cords demonstrated central gray necrosis of the lumbar region in all animals with a severe deficit, and a variable degree of neuronal loss in the intermediate and dorsal gray matter zones in animals with moderate deficits. This balloon occlusion method is relevant as a model of spinal cord injury during aortic occlusion, such as may occur during aortic surgery.

Simultaneous electrical and optical measurements show that membrane fusion precedes secretory granule swelling during exocytosis of beige mouse mast cells

Mast cells show dramatic morphological changes when undergoing exocytosis. We have investigated whether the first of those morphological changes, swelling of the secretory granule, precedes--and therefore possibly initiates--secretion or whether it occurs after fusion of the granule and plasma membranes. We used cell membrane capacitance to detect the moment when granule and plasma membrane become continuous. We measured large capacitance increases, often preceded by transients in capacitance. The rise-times of the capacitance increases were half-maximal at 2-59 msec. We observed cells with high-resolution video microscopy while these measurements were done. The capacitance increase always preceded the granular swelling that leads to exocytosis. To rule out the possibility that fusion was induced by a mechanical stress imparted by the internal pressure of a taut granule, we performed control experiments using cells in which vesicles were shrunken with hyperosmotic solutions. With these flaccid granules, again, the capacitance rise always preceded the swelling of the granules. We conclude that swelling cannot be the driving force for membrane fusion in this system.

Mechanisms of ethanol tolerance at a cholinergic nerve terminal

In vitro rat phrenic nerve-diaphragm preparations illustrated a concentration-dependent increase in the spontaneous release (miniature end-plate potentials, MEPPs) of acetylcholine following acute administration of ethanol. In phrenic nerve terminals from rats subjected to long-term ethanol treatmet, ethanol in vitro was significantly less effective in increasing the frequency of MEPPs. The capacity of ethanol administration to change membrane viscosity and alter sequestration of intracellular Ca2+ is discussed as a possible explanation for the observed effects.

A survey of attitudes of patients in a department of genitourinary medicine

A questionnaire concerning clinic organisation was completed by 415 patients attending a department of genitourinary medicine. Most (62.9%) patients preferred to be identified by number rather than by name, and about half (52.7%) did not like mixed waiting rooms. An appointment system as well as having an open clinic was liked by twice as many (44.9%) as those patients (23.6%) against such a system. More information about sexually transmitted diseases in the form of leaflets, etc. at the clinic was requested by most (79.1%) patients and a similar number (82.0%) felt the department itself should be more widely advertised.

Problems in the control of hypertension in the community

A hypertension survey was conducted in Montreal to determine the extent, nature and distribution of the control of hypertension. Of the 12 055 persons screened in shopping centres, workplaces and a random sample of homes in four census tracts the hypertension was not controlled in 69.0% to 80.3% of those with the condition in each setting. Nearly two thirds of those with hypertension were aware of their condition, 13% were aware but had never been treated, 13% were receiving treatment inadequate to control their hypertension, and 11% had discontinued treatment, most reporting that they had done so on the advice of their physician. Among those screened in their home, discontinuance of therapy was most often reported by those with a low income, but lack of awareness of their condition was no more prevalent in this group than in the other income groups. Efforts to control hypertension should be directed to the variety of causes of lack of control, which may occur with various frequencies in different communities, and for which screening alone may be inadequate.

Alcohol tolerance in a cholinergic nerve terminal: relation to the membrane expansion-fluidization theory of ethanol action

Phrenic nerve terminals from rats subjected to long-term ethanol treatment were more resistant to ethanol (in vitro) than terminals from sucrose-fed rats, as measured by the effect of ethanol on the frequency of miniature end plate potentials. Long-term ethanol exposure may thus induce the synthesis of more rigid membrane lipids, reducing membrane "fluidizability". This may provide a neurocellular basis for ethanol tolerance and cross-tolerance with anesthetics and barbiturates.