Comparing stimulation-induced pain during percutaneous (intramuscular) and transcutaneous neuromuscular electric stimulation for treating shoulder subluxation in hemiplegia

OBJECTIVE

To determine whether percutaneous (intramuscular) neuromuscular electric stimulation (perc-NMES) is less painful than transcutaneous neuromuscular electric stimulation (trans-NMES) for treating shoulder subluxation in hemiplegia.

DESIGN

Double-blind, crossover trial.

SETTING

University-affiliated tertiary care hospital.

PARTICIPANTS

A convenience sample of 10 hemiplegic subjects with at least 1 fingerbreadth of glenohumeral subluxation.

INTERVENTIONS

All subjects received 3 randomly ordered pairs of perc-NMES and trans-NMES to the supraspinatus and posterior deltoid muscles of the subluxated shoulder. Both types of stimulation were optimized to provide full joint reduction with minimal discomfort.

MAIN OUTCOME MEASURES

Pain was assessed after each stimulation with a 10-cm visual analog scale (VAS) and the McGill Pain Questionnaire, using the Pain Rating Index (PRI) scoring method. Subjects were asked which type of stimulation they would prefer for 6 weeks of treatment. Wilcoxon's signed-rank test was used to compare median differences in VAS and PRI between perc-NMES and trans-NMES.

RESULTS

Median VAS scores for perc-NMES and trans-NMES were 1 and 5.7, respectively (p = .007). Median PRI scores for perc-NMES and trans-NMES were 7 and 19.5, respectively (p = .018). Nine of the 10 subjects preferred perc-NMES to trans-NMES for treatment.

CONCLUSION

Data suggest that perc-NMES is less painful than trans-NMES in the treatment of shoulder subluxation in hemiplegia.

Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia: a pilot study

OBJECTIVE

To investigate the feasibility of percutaneous intramuscular neuromuscular electric stimulation (perc-NMES) for treating shoulder subluxation and pain in patients with chronic hemiplegia.

DESIGN

Before-after trial.

SETTING

University-affiliated tertiary care hospital.

PARTICIPANTS

A convenience sample of 8 neurologically stable subjects with chronic hemiplegia and shoulder subluxation.

INTERVENTION

Six weeks of perc-NMES to the subluxated shoulder.

MAIN OUTCOME MEASURES

Shoulder subluxation (radiograph), shoulder pain (Brief Pain Inventory), motor impairment (Fugl-Meyer score), shoulder pain-free external rotation (handheld goniometer), and disability (FIM instrument) were assessed before treatment (T1), after 6 weeks of neuromuscular stimulation (T2), and at 3-month follow-up (T3). A 1-way, repeated-measures analysis of variance using the generalized estimating equation approach was used to evaluate differences from T1 to T2 and from T1 to T3 for all outcome measures.

RESULTS

Subluxation (p =.0117), pain (p =.0115), shoulder pain-free external rotation (p <.0001), and disability (p =.0044) improved significantly from T1 to T2. Subluxation (p =.0066), pain (p =.0136), motor impairment (p <.0001), shoulder pain-free external rotation (p =.0234), and disability (p =.0152) improved significantly from T1 to T3.

CONCLUSIONS

Perc-NMES is feasible for treating shoulder dysfunction in hemiplegia and may reduce shoulder subluxation, reduce pain, improve range of motion, enhance motor recovery, and reduce disability in patients with chronic hemiplegia and shoulder subluxation. Further investigation is warranted.

Functional expression, purification, and characterization of recombinant human pyruvate carboxylase

The cDNA-encoding human pyruvate carboxylase (hPC) has been assembled and cloned into a very high efficiency mammalian expression vector and the construct transfected into 293T kidney cells. Stable clones expressing very high levels of hPC were produced and used as a source of the enzyme. Purification of the recombinant hPC was performed by selective precipitation with 40% ammonium sulfate followed by a single step avidin affinity chromatography, with an overall yield of 20%. Recombinant hPC purified by this method yielded a single band on SDS-PAGE with a specific activity of 20 U/mg. Kinetic analysis demonstrated that the recombinant human PC has the same properties as the native enzyme isolated from liver autopsy. This is the first report of production and purification of recombinant PC.

An assessment of two training interventions designed to increase the knowledge of obstetrical nurses and nurse-midwives about the maternal serum triple screen

The purpose of this study was to assess the effects of two brief training interventions designed to improve nurses' and nurse-midwives' knowledge about the maternal serum triple screen. The low intervention consisted of written information on the triple screen; the high intervention consisted of written information plus a one hour oral presentation. Knowledge was assessed at baseline, immediately following the oral presentation (high intervention only), and one month following the interventions. Forty-seven nurses, nurse-midwives and nursing assistants participated. Sixteen respondents (34 per cent) who routinely talk to patients about the triple screen obtained a score of less than 70 per cent on the knowledge questionnaire at baseline assessment. Respondents' knowledge about the maternal serum triple screen included areas that needed to be improved in order for them to be able to provide patients with accurate and complete information. Both interventions assessed in this study resulted in an increase in participants' knowledge about the maternal serum triple screen, however the high intervention was more effective. This study presents evidence that improvements in health care professionals' knowledge can be made with brief educational interventions.

Prenatal diagnosis of ring chromosome 6 in a fetus with hydrocephalus

A patient with ring chromosome 6/monosomy 6 mosaicism is presented. At 25 weeks' gestation, ultrasound examination demonstrated fetal hydrocephalus. Amniocentesis was performed. The fetal karyotype was 45,XY,-6/ 45,XY,-6,+f/46,XY,r(6)(p25q27). Delivery of this male infant was by Caesarean section at 37 weeks' gestation. The karyotype in peripheral blood lymphocytes was 46,XY,r(6)(p25q27) with no indications of mosaicism. The infant had hydrocephalus which required treatment with a ventriculoperitoneal shunt at 22 days of age. He had no other obvious serious congenital anomalies. By 17 months he had developed microcephaly, seizures, severe bilateral hearing loss, and global development delay. This patient provides information regarding phenotypic variability of ring chromosome 6 and also reinforces the importance of offering amniocentesis if fetal hydrocephalus is detected as an isolated anomaly.

Identification of novel alternatively spliced pyruvate carboxylase mRNAs with divergent 5'-untranslated regions which are expressed in a tissue-specific manner

We have identified and characterized multiple mRNA transcripts of rat and human pyruvate carboxylases [EC 6.4.1.1] using rapid amplification of cDNA 5' ends-polymerase chain reaction (RACE-PCR). Five alternative forms of rat pyruvate carboxylase cDNAs have been identified in liver, kidney, brain, and adipose tissue and these are expressed in a tissue-specific manner. Two alternative forms of human pyruvate carboxylase cDNA have also been identified in liver. These pyruvate carboxylase cDNAs have a common coding region but differ in their 5' untranslated regions (5'UTRs), suggesting that they are generated by alternative splicing of the primary transcript. Southern blot analysis of restriction enzyme digested rat genomic DNA revealed that pyruvate carboxylase is encoded by a single copy gene.

Polymorphism of the yeast pyruvate carboxylase 2 gene and protein: effects on protein biotinylation

In Saccharomyces cerevisiae there are two isoenzymes of pyruvate carboxylase (Pyc) encoded by separate genes designated PYC1 and PYC2. We report the isolation and sequencing of a PYC2 gene, and the localization of both genes on the physical map of S. cerevisiae. Comparison with the previously reported sequence [Stucka, Dequin, Salmon and Gancedo (1991) Mol. Gen. Genet. 229, 307-315] revealed significant differences within the open reading frame. The most notable difference was near the 3' end, where we found a single base deletion reducing the open reading frame by 15 bases. We have confirmed the C-terminus of Pyc2 encoded by the gene isolated here by expressing and purifying an 86-amino-acid biotin-domain peptide. In addition, we investigated the effects of the two changes in the Pyc2 biotin domain (K1155R substitution and Q1178P/five-amino-acid extension) on the extent of biotinylation in vivo by Escherichia coli biotin ligase, and compared the biotinylation of peptides containing these changes with that of two different-length Pyc1 biotin-domain peptides. The K1155R substitution had very little effect on biotinylation, but the five-amino-acid C-terminal extension to Pyc2 and the N-terminal extension to Pycl both improved biotinylation in vivo.

A new hospital library: a marketing opportunity

A new or remodeled library presents a unique marketing opportunity for the hospital librarian. Furthermore, a well-designed library markets itself through its convenience, attractiveness, and ease of use. A marketing approach to library planning takes into account needs of users and of library staff and considers the librarian's relations with the architect as well as with hospital employees. This paper describes ways to combine library planning with marketing techniques and specifies aspects of the library that contribute to its good image.

Assignment of the human pyruvate carboxylase gene (PC) to 11q13.4 by fluorescence in situ hybridisation

The gene for pyruvate carboxylase (PC) has been localised by fluorescence in situ hybridisation to normal and FRA11A human chromosomes. PC maps to 11q13 and distal to FRA11A, localising PC to 11q13.4-->q13.5.

Designing the smaller library: a hospital looks to the future

Like other libraries, hospital libraries are preparing for a future which will include a mix, as yet undetermined, of print and electronic information. This case study relates how the library at St. Jude Children's Research Hospital was designed to meet the needs of users and staff and to balance them with the need for more sophisticated methods of retrieving, storing, and delivering information. Details are provided on planning process and on design features such as lighting and color.

Health and Well-Being of Childbearing Women in Rural and Urban Contexts

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.

Regulation of pyruvate carboxylase isozyme (PYC1, PYC2) gene expression in Saccharomyces cerevisiae during fermentative and nonfermentative growth

In Saccharomyces cerevisiae there are two isoenzymes of pyruvate carboxylase (Pyc) encoded by separate genes, designated PYC1 and PYC2. In the wild type yeast, the expression of both genes is influenced by both the growth phase and the type of carbon source, indicating discrete regulatory mechanisms and metabolic roles for PYC1 and PYC2. On glucose minimal medium PYC1 and PYC2 are differentially regulated as shown by a constant level of PYC1 expression throughout the main growth phase compared to a high level of PYC2 expression only in the early growth phase. On ethanol minimal medium, the growth-related pattern of PYC1 and PYC2 expression was similar as shown by a 3.6-fold decline from early to mid log phase. PYC1 expression, however, was activated 10-fold above PYC2 mRNA levels during this period of growth. To further investigate the roles of the two PYC genes we determined the growth phenotypes and expression levels of PYC in pyc1 and pyc2 single null mutants. During fermentative growth, the lack of either PYC gene had little effect on the level and pattern of expression of the other PYC gene, indicating further their separate regulation. In comparison to the pyc2 null, the pyc1 null strain showed a 3- to 4-fold lower level of Pyc activity and Pyc protein concentration. Moreover, the pyc1 null showed a strong requirement for L-aspartate for efficient growth, indicating the importance of PYC1 expression for the synthesis of C4 intermediates. DV6.2 (PYC1, pyc2 delta) showed a 3.2-fold higher level of activity on ethanol minimal medium when compared to growth on glucose minimal medium, and supported growth in the absence of L-aspartate. The pyc1 null, MW21.3 (pyc1 delta, PYC2), on the other hand, did not support growth on ethanol in the absence of aspartate. This study represents the first report on the characterisation of expression of the PYC genes in yeast throughout growth. Their metabolic roles for both fermentative and gluconeogenic growth are considered.

Rhinometry and open-mouth posture in young children

A biracial sample of 348 elementary school children who were in the first grade were assessed for open-mouth posture (OMP) in the natural environment. In addition, rhinometry was performed on 296 of the children. Means were computed for percent OMP and cross-sectional nasal airway. Results indicated that, in general, these children exhibited relatively high rates of OMP. Boys displayed significantly greater OMP than girls, and black children showed significantly larger cross-sectional nasal areas than white children. A significant correlation between OMP and nasal area only was evident for children exhibiting OMP during more than 80% of the observation intervals. The implications of the findings were discussed.

Intratracheal aerosolization of endotoxin in the rat: a model of the adult respiratory distress syndrome (ARDS)

A technique is described for the intratracheal aerosolization of endotoxin into the rat. Using a miniaturized nozzle within the tracheal lumen to optimize uniform distribution 0.5 ml of an endotoxin solution (7 mg/kg) was aerosolized and dispersed throughout the lung. Time course studies of pulmonary function and histological changes revealed marked functional and morphological changes by 24 h. Histopathologic changes consisted of widespread pulmonary oedema and a diffuse neutrophilic alveolitis. At the same time, there were significant decreases in tidal volume, minute ventilation and lung compliance. Haematologic changes were also seen, including profound thrombocytopaenia and leukopaenia together with an increased haematocrit, indicating systemic effects in this model. Bronchoalveolar lavage (BAL) at 24 h revealed significant increases in BAL protein, erythrocytes and neutrophils. The functional, cytological and histological changes observed after endotoxin challenge mimic those seen in the Adult Respiratory Distress Syndrome in humans and can thus be used as a model to compare the efficacy of a variety of therapeutic interventions for this syndrome.

Yeast pyruvate carboxylase: identification of two genes encoding isoenzymes

In Saccharomyces cerevisiae, pyruvate carboxylase [EC 6.4.1.1] has an important anaplerotic role in the production of oxaloacetate from pyruvate. We report here the existence of two pyruvate carboxylase isozymes, which are encoded by separate genes within the yeast genome. Null mutants were constructed by one step gene disruption of the characterised PYC gene in the yeast genome. The mutants were found to have 10-20% residual pyruvate carboxylase activity, which was attributable to a protein of identical size and immunogenically related to pyruvate carboxylase. Immunocytochemical labelling studies on ultrathin sections of embedded whole cells from the null mutants showed the isozyme to be located exclusively in the cytoplasm. We have mapped the genes encoding both enzymes and shown the previously characterised gene, designated PYC1, to be on chromosome VII whilst PYC2 is on chromosome II.

Isolation of a yeast mutant deficient in pyruvate carboxylase activity

To improve our understanding of the catalytic mechanism and regulatory properties of pyruvate carboxylase (EC 6.4.1.1), an important biotin-dependent enzyme, we have sought to isolate mutants in Saccharomyces cerevisiae which are defective in pyruvate carboxylase activity. One mutant was isolated which was unable to grow on glucose minimal medium unless supplemented with aspartate. Although the enzyme had only 25% of the wild type pyruvate carboxylase activity, Western analysis and RNase protection analysis demonstrated that the mutant gene was expressed at approximately 70% of the wild type level. On the basis of genetic crosses and complementation tests, we have attributed the defect to mutations in the PYC gene encoding pyruvate carboxylase.

Effects of adrenergic antagonists on cocaine-induced changes in respiratory function

Cocaine-induced changes in respiratory rate (f), tidal volume (VT), total pulmonary ventilation (VE), dynamic lung compliance (Cdyn) and total pulmonary resistance (RL) were measured in anesthetized, spontaneously breathing Sprague-Dawley rats using a whole-body plethysmograph and an esophageal manometer. Carotid arterial pressure and heart rate were simultaneously monitored. An intravenous (i.v.) dose of 10 mg/kg of cocaine was lethal in all rats tested with death resulting from respiratory failure occurring between 0.25 and 1.5 min after dosing. At an i.v. dosage of 5 mg/kg, cocaine was nonlethal, although a reduction in VE was evident during the first minute after dosing. This reduction in VE was due to a decrease in f and the lack of a compensatory increase in VT. A slight decrease in RL also became evident approximately five minutes after dosing. Pretreatment with the nonselective alpha-adrenergic antagonist phentolamine (10 mg/kg) prevented the cocaine-induced depression in VE by reducing the decrease in f and blocking the inhibition of a compensatory increase in VT. In contrast, pretreatment with the nonselective beta-adrenergic antagonist propranolol (1 mg/kg) potentiated the cocaine-induced decrease in VE by enhancing the depression of f. Pretreatment with propranolol also caused a cocaine-dependent decrease in Cdyn. At a dosage of 0.3 mg/kg, labetalol, a compound possessing both nonselective alpha- and beta 1-antagonist activity (1:7) appeared to cause only a minimal potentiation of the cocaine-induced depressions in VE and f. Pretreatment with propranolol or labetalol also resulted in the death of 20% of the rats administered 5 mg/kg of cocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

Transport of the yeast ATP synthase beta-subunit into mitochondria. Effects of amino acid substitutions on targeting

We have isolated the yeast ATP2 gene encoding the beta-subunit of mitochondrial ATP synthase and determined its nucleotide sequence. A fusion between the N-terminal 15 amino acid residues of beta-subunit and the mouse cytosolic protein dihydrofolate reductase (DHFR) was transcribed and translated in vitro and found to be transported into isolated yeast mitochondria. A fusion with the first 35 amino acid residues of beta-subunit attached to DHFR was not only transported but also proteolytically processed by a mitochondrial protease. Amino acid substitutions were introduced into the N-terminal presequence of the beta-subunit by bisulphite mutagenesis of the corresponding DNA. The effects of these mutations on mitochondrial targeting were assessed by transport experiments in vitro using DHFR fusion proteins. All of the mutants, harbourin from one to six amino acid substitutions in the first 14 residues of the presequence, were transported into mitochondria, though at least one of them (I8) was transported and proteolytically processed at a much reduced rate. The I8 mutant beta-subunit also exhibited poor transport and processing in vivo, and expression of this mutant polypeptide failed to complement the glycerol- phenotype of a yeast ATP2 mutant. More remarkably, the expression of I8 beta-subunit induced a more general growth defect in yeast, possibly due to interference with the transport of other, essential, mitochondrial proteins.

An analysis of auditory alphabet confusions

The present study, using the nonhierarchical overlapping clustering algorithm MAPCLUS to fit the Shepard-Arabie (1979) ADCLUS model, attempted to derive a set of features that would accurately describe the auditory alphabet confusions present in the data matrices of Conrad (1964) and Hull (1973). Separate nine-cluster solutions accounted for 80% and 89% of the variance in the matrices, respectively. The clusters revealed that the most frequently confused letter names contained common vowels and phonetically similar consonants. Further analyses using INDCLUS, an individual differences extension of the MAPCLUS algorithm and ADCLUS model, indicated that while the patterns of errors in the two matrices were remarkably similar, some differences were also apparent. These differences reflected the differing amounts of background noise present in the two studies.

Serology for automated cytotoxicity testing. II. Routine reading of HLA-typing using the Contrast Fluorescence Test

We have previously reported on the "Contrast Fluorescence Test" (CFT), a method for the fluorimetric of living vs dead lymphocytes and have proposed its use in automated HLA typing. In this report, we present data obtained with the CFT in the evaluation of an automated system built around the Zonax instrument (Zeiss America, Inc.). 13,664 individual CFT results were read by the machine and compared with manual readings; assignment of HLA specificity was done independently but using the same logic by hand and by machine. Excellent correlation of the instrumented and manual serological readings and identical antigen assignments were observed.

When children die: death in current children's literature and its use in a library

Death and dying are dealt with realistically and sympathetically in current children's literature. Books can play an important role in helping children suffering from catastrophic illness by showing how other children have coped with similar situations; they can also form a basis for bibliotherapy with patients. This paper examines current trends in children's literature and describes how these books have been incorporated into a patient library at St. Jude Children's Research Hospital.

The HLA system in congenital rubella patients with and without diabetes

The HLA antigens of 173 patients with the congenital rubella syndrome (CR) are reported. Twenty-one of these patients are also clinically diabetic, and among them the frequencies of the HLA antigens DR2 and DR3 are significantly lower and higher, respectively, than in CR patients without diabetes or in controls. These data suggest that the genes that control susceptibility to type I or insulin-dependent diabetes mellitus are necessary for the development of glucose intolerance in CR patients.