A test of brain electrical source analysis (BESA): a simulation study

The present report summarizes the results of a simulation study on the accuracy of Scherg's implementation of spatio-temporal analysis (BESA) for estimating the parameters (wave shape, location, orientation) of the intracranial sources of event-related brain potentials (ERPs) recorded from the scalp. In view of the subjective factors that might influence a solution, 10 subjects, ranging from those with much experience with ERPs and extensive background in the use of BESA to those with little experience with BESA and/or no knowledge of ERPs, independently analyzed a set of simulated somatosensory ERP data. The simulation contained wave forms from 32 electrode sites generated by a combination of 10 dipole sources. The primary question was how faithfully the different subjects would depict the source wave shapes, locations and orientations. Based on the 9 subjects who were familiar with ERPs, the grand-average cross-correlation coefficient between subjects' estimated and actual source wave shapes was 0.89 (standard deviation (S.D.) = 0.17). The grand-average location error, based upon a head diameter of 17 cm, was 1.4 cm (S.D. = 1.0 cm). The grand-average orientation error was 24.4 degrees (S.D. = 20 degrees).

Tissue disposition of 26aluminum in rats measured by accelerator mass spectrometry

A trace quantity of 26aluminum (26Al) was administered intravenously to 1 normal and 1 uremic rat. After a 3-week period, the animals were sacrificed and samples of bone, muscle, kidney, liver, heart, and brain were analyzed for their 26Al content. In the normal and uremic rats, most of the tissue 26Al was found in bone amounting to 0.9% and 2.0%, respectively, of administered dose/g dry weight of tissue. Much smaller amounts of isotope were found in the other tissues in both animals. In the normal rat, the descending order of 26Al content in other tissues was: kidney, 0.2% > liver, 0.06% > heart, 0.03%, > brain and muscle, 0.02%. In the uremic rat, the same order of tissue 26Al content was found with kidney, 0.37% > liver, 0.06% > heart, 0.02% > brain and muscle, 0.01% per g dry weight of tissue. When expressed per g wet weight of tissue in the 2 animals, a similar order of tissue 26Al content was found. In comparing the amount of 26Al in the bone of the 2 rats, the uremic animal was found to have more than twice that found in the bone of the normal rat when expressed either per g dry or wet weight of bone. However, 26Al content of other tissues was similar in the 2 animals. This suggests that uremic bone may have a greater affinity for aluminum than normal bone, but kidney, liver, brain, heart, and muscle appear to behave similarly in uremic and normal rats in regard to incorporation of a single trace dose of isotope in the 3-week time frame of the present study.

Grease gun injuries to the orbit and adnexa

The grease gun injury is an uncommon injury to the orbit. However, high-pressure injection of grease, oil, or paint is frequently reported in injuries of the hand and usually affects the fingers or palm, which require complicated surgical and medical care. Two cases of grease gun injury to the orbit are reported: one, a catastrophic injury, and the other resulting in satisfactory recovery after surgical debridement and adjuvant medical treatment. Presentation, investigation, and therapy are discussed.

Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer

OBJECTIVE

This study compares the human placental transport of glyburide, glipizide, chlorpropamide, and tolbutamide.

STUDY DESIGN

The recirculating single cotyledon human placenta model tested maternal-to-fetal transport in term placentas perfused immediately after delivery. Drug levels were measured by high-performance liquid chromatography and liquid scintillation spectrometry, and transport rates were calculated by comparing maternal and fetal concentrations.

RESULTS

The transport of these substances differed significantly over a tenfold range (analysis of variance, p < 0.0008). A significant association exists by multiple linear regression between drug transfer and molecular weight, dissociation constant, and the octanol-water partition coefficient (R2 = 0.91, p < 0.0001).

CONCLUSIONS

There is significant variability in human placental transfer rates of the oral hypoglycemics, which strongly correlates with molecular properties. These data suggest that less fetal exposure may occur with second-generation sulfonylureas and anticipate that regression models may be useful in selecting agents that minimize placental transport to the fetus.

Determinants of resting energy expenditure in young children

Resting energy expenditure (REE) in adults is influenced by fat-free mass (FFM) and fat mass (FM), and is significantly higher in men than in women. There are limited data, however, on the physiologic determinants of REE in children. We therefore measured REE in 113 prepubertal children (39 white girls, 41 white boys, 21 Mohawk girls, and 12 Mohawk boys), 3.9 to 7.8 years of age, representing a wide range of body weight (14.7 to 34.0 kg), height (0.97 to 1.30 m), FFM (10.3 to 25.0 kg), and FM (1.7 to 13.7 kg; 9.4% to 40.3%). The REE was measured in duplicate by indirect calorimetry (range, 830 to 1405 kcal/day) while the children were in a postprandial state and viewing a cartoon film. The FM and FFM values were determined by bioelectrical resistance by means of the Kushner equation. In stepwise regression analysis, the combination of FFM (p < 0.001; partial r = 0.77), sex (p = 0.001; partial r = 0.12), and FM (p = 0.01; partial r = 0.16) explained 63% of the variation in REE. The regression coefficients were 31.9 kcal/kg FFM, 53 kcal for boys, 0 for girls, and 13 kcal/kg FM. Mohawk background, age, fat distribution, heart rate, and physical activity were not independently associated with REE. After REE was adjusted for the aforementioned significant factors, there were no significant correlations with parental factors (body composition, physical activity, age, and REE) other than normalized maternal REE (r = 0.19; p = 0.05). We conclude that the effects of FFM, sex, and FM on REE in children are similar to those in adults. The higher REE in young boys suggests that the previously reported higher REE in adult men cannot be explained entirely by differences in sex hormones. Finally, our data do not support the hypothesis that REE in children is negatively influenced by obesity in children or in parents.

Relation between mouth and haematogenous infection in total joint replacements

OBJECTIVE

To investigate the source of infections associated with orthopaedic prostheses.

DESIGN

Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries.

SUBJECTS

Four adults (three men) aged 58-83.

RESULTS

For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries.

CONCLUSIONS

The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

The use of epidemiological concepts and techniques to discern factors associated with the nitrate concentration of well water on swine farms in the USA

This epidemiological study investigates the relationship between various factors associated with swine farms and the nitrate concentration of well water in the USA. Through a random sampling procedure, 605 swine farms located in 18 states were selected for inclusion in this study. A total of 631 well water samples were collected from these farms and tested for a variety of elements and compounds. The concentrations of nitrate, nitrite, sulfate, chloride, sodium, potassium, ammonia, fluoride, bromide and lithium were determined by an ion chromatograph while an inductively coupled argon plasma emission spectrophotometer was used to determine the concentrations of calcium, magnesium, barium, zinc, iron and phosphate. Data concerning various farm factors were gathered via a personally administered questionnaire. The data were examined using both multiple linear regression and logistic regression. Results indicate that 53.6% (338/631) of the wells contained detectable levels of nitrate, 11.7% (74/631) had nitrate levels exceeding 45 ppm and 4.3% (27/631) exceeded 100 ppm. Logistic models demonstrated an association between nitrate concentrations > 45 ppm, increasing water potassium levels and wells < 100 ft deep. Nitrate levels > 100 ppm were related to increasing water concentrations of potassium, magnesium, barium and zinc, wells 6-10 years old, increasing distance from the study farm to the nearest cattle farm and a greater distance to the nearest waterway located off the study farm. A negative association was seen between nitrate concentrations > 100 ppm, the water level of sulfate, and the use of the same well to supply both the household and livestock. Multiple linear regression models revealed a positive association between increasing nitrate concentration and the water levels of chloride, calcium, zinc and the greater number of miles from the study farm to the nearest farm with cattle or sheep. A negative association was noted between the concentration of well water nitrate and the water levels of sulfate and ammonia, the use of water treatment, the number of miles to the nearest farm with poultry, the employment of water treatment and the use of the same well to supply water to both livestock and the household.

Phosphorylation of the 61-kDa calmodulin-stimulated cyclic nucleotide phosphodiesterase at serine 120 reduces its affinity for calmodulin

Phosphorylation of the 61-kDa isoform of bovine calmodulin (CaM)-stimulated cyclic nucleotide phosphodiesterase (CaM-PDE) by the catalytic subunit of cyclic AMP-dependent protein kinase A (PKA) results in a decrease in the affinity of the enzyme for calmodulin [Sharma, R. K., & Wang, J. H. (1985) Proc. Natl. Acad. Sci. U.S.A. 82, 2603-2607]. In the present study, purified 61-kDa CaM-PDE was phosphorylated in the presence of [gamma-32P]ATP and cleaved with a Lys-C endoproteinase. The resultant phosphopeptides were resolved by reverse-phase HPLC and analyzed by electrospray mass spectrometry and Edman sequencing. Serine residues 120 and 138 were identified as the principal sites of phosphorylation. A cDNA encoding the 61-kDa CaM-PDE [Sonnenburg, W. K., Seger, D., & Beavo, J. A. (1993) J. Biol. Chem. 268, 645-652] was used to generate point mutants in which either or both of these serines were replaced with alanine. The mutants were expressed in COS-7 cells, purified, and phosphorylated. Phosphorylation of the mutant Ser 138-->Ala resulted in a decrease in affinity for CaM that was comparable to that seen with the wild-type enzyme. In contrast, phosphorylation of the mutant Ser 120-->Ala had virtually no effect on CaM affinity. We conclude that phosphorylation of serine 120 by PKA is responsible for the reduction in affinity of the 61-kDa CaM-PDE for CaM.

The application of a modified nucleotide in aptamer selection: novel thrombin aptamers containing 5-(1-pentynyl)-2'-deoxyuridine

Combinatorial libraries of nucleic acids are developing into novel sources for lead compounds in drug development. In order to diversify the pool of ss DNA sequences, we have used a modified nucleotide, 5-(1-pentynyl)-2'-deoxyuridine, in place of thymidine in a random nucleic acid library and screened this library against human thrombin. Previously, we described this screening method to identify a novel structural inhibitor (an aptamer) of the coagulation protease thrombin (Bock, L. et. al. (1992) Nature 355 564-566). Using the modified nucleic acid library, we have now isolated a second pool of thrombin inhibitors with strikingly different sequence composition compared to the selection using natural bases. This second class of aptamers is dependent on the presence of the modified nucleotide for protein binding and clotting inhibition. Our method represents a potential strategy to enhance the diversity of libraries for in vitro selection, and thereby increasing the utility of this technique in the identification of molecules with novel biochemical properties.

Where have all the pennies gone? The work of Manchester Medical Audit Advisory Group

Medical audit has its critics, who point to the large sums of NHS cash that seem to be disappearing down a medical plughole. These criticisms are recognised by medical audit advisory groups but there are many reasons why the work of these groups has not yet resulted in many publications in journals or bumped up health indicators. After discussing the criticism this article describes the work of the medical audit advisory group in Manchester. Real changes in cooperative working with general practice teams and between practices are taking place, and improved relationships between general practice and the hospitals are being helped by joint audit work. The Manchester group is also working to help in setting standards and to cooperate with purchasing. The work of the group is changing as it develops.

Targeted disruption of the c-fos gene demonstrates c-fos-dependent and -independent pathways for gene expression stimulated by growth factors or oncogenes

The c-fos proto-oncogene is believed to play a pivotal role in transducing growth factor-mediated signals from the extracellular milieu into the nucleus. c-fos protein dimerizes with c-jun and related proteins and mediates transcription via AP-1 sites. Using c-fos-deficient mice generated through gene knockout techniques, we derived 3T3-type cell lines from primary embryonic fibroblasts. The c-fos-deficient cells grow normally under optimal culture conditions and show only a slight reduction in growth rate in low serum culture compared with control cells. They also express mRNA for most of the Fos and Jun family members at normal levels. The overall levels of AP-1 DNA binding activity are normal and several genes (c-jun, MCP1, metallothionein) known to contain functional AP-1 sites are expressed normally in the c-fos-deficient and control cells. In contrast, mRNA for the metalloproteases stromelysin (MMP-3) and type I collagenase (MMP-1), which are often induced by oncogenes and growth factors and have been implicated in tumor invasiveness, cannot be induced by epidermal growth factor or platelet-derived growth factor in c-fos-deficient cells. Transformation of mutant cells with polyoma middle T oncogene essentially restores wild-type levels of stromelysin expression, while transformation with v-src leads to only a weak induction of the metalloprotease. These results clearly demonstrate that some AP-1-dependent genes require c-fos for full expression while others do not; oncogenes may activate expression of metalloproteases via either fos-dependent or fos-independent mechanisms. These results also imply that c-fos may play an important regulatory role in the invasive behavior of malignant tumors, independent of any role this proto-oncogene might play in cell growth per se.

Sensitive gas-liquid chromatographic method for the determination of loratadine and its major active metabolite, descarboethoxyloratadine, in human plasma using a nitrogen-phosphorus detector

A sensitive gas-liquid chromatographic (GLC) method was developed for the determination of loratadine, a long-acting tricyclic antihistamine, and its active metabolite, descarboethoxyloratadine, in human plasma. The method involved extraction with organic solvent at neutral and alkaline pH. The organic layer from the neutral pH extraction was evaporated to dryness, reconstituted and injected into the GLC system. On the other hand, to the organic layer from the alkaline pH extraction trifluoroacetic anhydride was added. Following addition of H2O, the mixture was centrifuged and the organic layer was evaporated to dryness, reconstituted and injected onto the GLC system that was equipped with a nitrogen specific detector and a fused-silica capillary column. The linearity for both loratadine and descarboxyloratadine were demonstrated with r > or = 0.998 at concentrations ranging from 0.1 to 30 ng/ml. The results showed that the GLC method was accurate (bias < or = 12%) and precise (coefficient of variation, C.V., < or = 12%) for loratadine and descarboethoxyloratadine. The limit of quantitation was 0.1 ng/ml for loratadine with a C.V. of 9.2% and for descarboethoxyloratadine with a C.V. of 5.3%. The GLC method described has been demonstrated to be useful for the determination of loratadine and descarboethoxyloratadine in plasma samples of pediatric volunteers following oral administration of a single dose of 10 mg of loratadine syrup.

Integrative transformation of the mycotoxin-producing fungus, Penicillium paxilli

A high frequency transformation system has been developed for Penicillium paxilli using pAN7-1. Up to 44% of the primary transformants were heterokaryons. Loss of hygromycin resistance was observed in primary transformants that were sub-cultured on non-selective media, but single spores of these primary transformants were mitotically stable on both selective and non-selective media. A molecular analysis of the transformants generated showed that 78% had single-site integrations, with half of these containing a single copy of pAN7-1. CHEF-gel electrophoresis showed that P. paxilli has at least six chromosomes with a total genome size of about 23.4 Mb.

A tribological study of a series of retrieved accord knee explants

A tribological study of a series of 27 retrieved Accord meniscal bearing knee joints has been carried out. The roughness of the articulating surfaces of the meniscal and the femoral components was investigated, and the penetration into the polyethylene meniscal component was determined. There was generally little damage to the highly polished metallic femoral components. A general polishing and smoothing of the ultra high molecular weight polyethylene meniscal components was observed, although there was some subsequent deterioration of the polyethylene surfaces in certain cases. The penetration rate of the femoral components into the menisci was low, and was found to be similar to that reported for other meniscal knee joints.

The West Point Study: 40 years of follow-up

Completion of cardiovascular evaluations of 387 members marked the end of 40 years of follow-up in the West Point Study. Coronary artery disease (CAD) caused 4 cases of sudden death, 14 cases of myocardial infarction (MI), 13 cases of angina, and 17 cases of silent CAD. Using risk factors (serum cholesterol, estimated HDL-cholesterol, systolic blood pressure, and smoking status) measured before age 28, we derived a multivariate regression formula for predicting which members of the study, had they been pilots, would have been grounded for CAD before age 55. This derivation used data from only those subjects with CAD or with no evidence of CAD. We then used the formula to compute a risk-related score for each member of the study. In the tertile group with the highest risk-related scores, 17% manifested CAD by age 55 and the first event occurred at age 39. In the tertile group of lowest scores, 2% experienced CAD by age 55 and the first event occurred at age 51. We conclude that it is possible to select pilot candidates with the lowest risk for CAD.

Genetics and molecular biology of mouse pigmentation

The formation of mouse coat color is a relatively complex developmental process that is affected by a large number of mutations, both naturally occurring and induced. The cloning of the genes in which these mutations occur and the elucidation of the mechanisms by which these mutations disrupt the normal pigmentation pattern is leading to an understanding of the way interactions between gene products lead to a final phenotype.

Event-related brain potential evidence for a verbal working memory deficit in multiple sclerosis

Memory deficits are frequently identified in patients with multiple sclerosis. Both working (short-term) and long-term memory appear affected, particularly on free-recall tasks. The focus of our study was to examine neurophysiological correlates of working memory processes and to identify the specific components responsible for the working memory deficits reported in multiple sclerosis. Event-related brain potentials (ERPs) were recorded from the scalp of mildly afflicted multiple sclerosis patients and their matched normal controls during the performance of phonological and visuo-spatial working memory tasks. Neuropsychological test, behavioural performance and ERP data all indicated that verbal working memory is especially susceptible to impairment by multiple sclerosis, while visuospatial working memory is less susceptible. The pattern of results further indicated that the verbal working memory dysfunction in multiple sclerosis is at least partially due to impairment in the phonological loop, a rehearsal mechanism for retaining verbal information in working memory.

Magnetic resonance imaging functional activation of left frontal cortex during covert word production

Six normal volunteers underwent 4-T functional magnetic resonance imaging while performing a covert letter fluency task. An echo planar imaging sequence was utilized to detect activation based on deoxyhemoglobin contrast. All 6 subjects showed consistent activation in the frontal operculum and premotor and primary motor cortices. Activation was also detected in the supramarginal gyrus and the posterior part of the superior temporal gyrus. These results show that magnetic resonance functional neuroimaging can be used to investigate cerebral activity noninvasively during performance of complex cognitive tasks.

The collateral ligament flexion-extension test (CLEFT) in total knee replacement

We present a simple preoperative clinical test, the collateral ligament extension-flexion test (CLEFT). In patients undergoing total knee arthroplasty, with a preoperative valgus or varus deformity, this test establishes which knees have balanced collateral ligaments. It predicts which knees will not require soft tissue adjustment during the course of their surgery despite, in some cases, large deformities. The mechanism of the test is based on the observation that, in certain patients, a deformity present in extension is seen to correct in flexion. The sensitivity of this observation was checked in 44 consecutive patients undergoing total knee arthroplasty, and who had either a valgus or varus deformity in extension greater than 10 degrees. In 34 patients the test was positive, and none of these required ipsilateral collateral ligament release. All of the 10 patients with a negative test required soft tissue adjustment. In patients undergoing unconstrained total knee arthroplasty this test is reliably predictive of those knees with preoperative deformity which can be corrected simply by correctly aligned bone cuts. It supports the principle of bony resection prior to soft tissue adjustment in this form of surgery.

Continuous assessment and improvement in quality of care. A model from the Department of Veterans Affairs Cardiac Surgery

OBJECTIVE

The authors organized the Department of Veterans Affairs (VA) Continuous Improvement in Cardiac Surgery Study (CICSS) to provide risk-adjusted outcome data for the continuous assessment and improvement of quality of care for all patients undergoing cardiac surgery in the VA.

BACKGROUND

The use of risk-adjusted outcomes to monitor quality of health care has the potential advantage over consensus-derived standards of being free of preconceived biases about how health care should be provided. Monitoring outcomes of all health care episodes, as opposed to review of selected cases (e.g., adverse outcomes), has the advantages of greater statistical power, the opportunity to compare processes of care between good and bad outcomes, and the positive psychology of treating all providers equally. These two concepts, together with a pre-existing peer committee (the VA Cardiac Surgery Consultants Committee) to review, interpret, and act on the risk-adjusted outcome data, form the primary design considerations for CICSS.

METHODS

Patient-level risk and outcome (operative mortality and morbidity) data are collected prospectively on each of the approximately 7000 patients undergoing cardiac surgery in the VA each year. These outcomes, adjusted for patient risk using logistic regression, are provided every 6 months to each cardiac surgery program and to a national peer review committee for internal and external quality assessment and improvement.

RESULTS

For the most recent 12-month period with complete data collection, observed-to-expected (O/E) ratios ranged from 0.2 to 2.2, with eight centers falling outside of the 90% confidence limits for an O/E ratio equaling 1.0. The O/E ratio for all centers has fallen by 14% over the 4.5-year period of this program (p = 0.06).

CONCLUSIONS

A large-scale, low-cost program of continuous quality improvement using risk-adjusted outcome is feasible. This program has been associated with a decrease in risk-adjusted operative mortality.