Changes in coagulation parameters with exercise in patients with classic hemophilia

Vigorous exercise is known to increase VIII:C and VIIIR:Ag levels transiently in normal individuals. Although exercise programs are frequently advocated in the management of hemophilia, the effects of exercise on coagulation parameters in these patients have not been well studied. Eleven hemophiliacs were exercised on a bicycle ergometer to maximum voluntary effort as evidenced by an increase in pulse, blood pressure, and plasma catecholamine (norepinephrine and epinephrine) levels. The effects of this exercise on coagulation parameters, including functional and antigenic components of the factor VIII molecule, were determined. The entire group demonstrated a decrease in mean prothrombin time (11.7 to 11.2 sec). Four mild hemophiliacs demonstrated an increase in mean VIII:C (14.5% to 17.3%), and VIII:CAg (12% to 17.8%). Changes in VIII:C and VIII:CAg were not noted in the seven severe hemophiliacs. Both severe and mild patients demonstrated significant changes in fibrinogen, factor II, and factor VII after exercise. This study indicates that submaximal exercise modifies coagulation parameters in patients with hemophilia.

Coincident presence of thyro-gastric autoimmunity at onset of type 1 (insulin-dependent) diabetes

We have determined thyroid microsomal and gastric parietal cell autoantibodies in 972 patients with onset of Type 1 (insulin-dependent) diabetes before age 20 years. In a cross sectional study, the frequencies of these autoantibodies did not change significantly over the ensuing 20 years following diagnosis of diabetes. In a longitudinal study of 424 patients with Type 1 diabetes followed up to 5.3 years, few new patients with thyro-gastric autoantibodies were identified. Whereas the frequencies of these autoantibodies among the diabetic patients were more than fivefold greater than for age, sex and race matched controls, they resembled those seen in the non-diabetic general population (n = 1524) for the over 60 year age group. We conclude that in patients with thyro-gastric autoantibodies and Type 1 diabetes, the onset of autoimmune processes affecting the thyroid, gastric mucosa and pancreatic islets tend to be simultaneous, although the resultant diseases have different natural histories.

Effects of a fear appeal on arousal, self-reported anxiety, and attitude towards smoking

This paper describes the effects of an anti-smoking film on level of arousal and anxiety in a group of smokers and nonsmoking control. The aims of the study were threefold: to determine whether a fear appeal of this kind would increase arousal; to examine the relationship between self-reported, behavioral, and somatic responses to this type of fear appeal; and to assess the extent to which responses were influenced by consistent individual differences in the reporting of emotional states. The results indicated that a close correspondence existed between the self-reported and somatic measures of anxiety and that smokers showed a greater increase in anxiety than nonsmokers. Individual differences in reporting of emotional state were not related to somatic responses. Over-all, fear appeals of the type used here may be useful in manipulating level of anxiety and attitudes towards smoking.

Vitamin E supplementation and the retinopathy of prematurity

The effect of high-dosage E treatment (Rx) initiated at the stage of 3-plus active disease (target serum E levels, 5-6 mg/dl) was evaluated by a standardized scoring system of visual morbidity at the one to two year eye exam among infants cared for in the University of Pennsylvania Neonatal Complex (1976-1978). The incidence of legal blindness in both eyes or worse was decreased from 71 to 40% in E Rx (n = 10) as compared to non-E Rx (n = 14) infants, and the number of infants with minimal visual morbidity was increased. Pilot studies (1972-76; target serum E level, 1.5 and 3.0 mg/dl) of the prophylactic effect of E Rx from birth on showed a decrease in mean severity of acute stage disease and a decrease in sequelae at one to two years. A strikingly difference in visual morbidity following resolved low-grade ROP was seen when prestudy infants (1968-72) who were fed early iron supplements and given formulas with low E:PUFA ratios were compared to non-E Rx as well as to E Rx 1972-76 infants. Vitamin E seems to exert a beneficial effect at all stages of ROP, perhaps because of its broadly based regulatory role.

Correlation between estradiol and progesterone in cycles with luteal phase deficiency

Many studies have been published on luteal phase deficiency, and the emphasis in most of them is on progesterone deficiency. In this study 144 patients (455 cycles) with infertility were studied. The patients were divided into four groups. Group 1 consisted of patients with high estradiol and high progesterone levels in the midluteal phase. Group 2 consisted of patients with high estradiol and low progesterone levels. Group 3 consisted of patients with low estradiol and low progesterone levels. Group 4 consisted of patients with low estradiol and high progesterone levels. As expected, patients in groups 2 and 3 showed a low conception rate with outphased endometrial biopsy. However, group 4, in spite of the normal progesterone levels, had a low conception rate with an outphased endometrium. We conclude that estradiol deficiency during the luteal phase is a major factor in infertility, and replacement therapy with progesterone alone in these patients may not improve fertility.

The relationship between psychological factors and blood glucose regulation in insulin-dependent diabetic adolescents

Fifty-two insulin-dependent diabetic, white, rural, middle-class adolescent subjects who had diabetes 5 or more years participated in a project comparing psychological and personality variables to the degree of altered blood glucose regulation as measured by hemoglobin A1c (HbA1c) levels. An HbA1c level of 9.5% was arbitrarily chosen as a cutoff score to divide subjects into two groups: those having "adequate" (N = 25) and those having "inadequate" (N = 27) blood glucose regulation. There were no significant differences between high and low HbA1c groups for all psychological variables tested, i.e., anxiety, locus of control, self-concept, and various personality traits measured by the High School Personality Questionnaire (HSPQ). Female subjects scored significantly higher on the anxiety scale and had significantly higher HbA1c values and weight percentiles compared with male subjects. Six self-report diabetes questionnaires dealing with various aspects of diabetes care and adjustment were completed by mothers and five similar questionnaires were completed by the adolescents. There were no significant differences in the mean scores of the 11 diabetes questionnaires between the high and low HbA1c groups. Girls scored significantly higher than boys in "self-care" and on individual items pertaining to dysphoric feelings about diabetes. Our findings may have resulted from the homogeneity of the sample, but underlying metabolic and genetic factors need to be considered in differentiating subjects according to the level of blood glucose regulation.

CO2 elimination by high frequency ventilation (4 to 10 Hz) in normal subjects

We measured the rate of CO2 elimination (VCO2) by oscillatory high frequency ventilation (HFV) in 8 normal subjects and studied the effects of varying frequency, stroke volume, lung volume, and bronchodilation on VCO2. Subjects breath-held while a loudspeaker at the mouth sinusoidally forced low volumes (15 to 150 ml) of air at a high frequency (4 to 10 Hz) into the respiratory system. The CO2 eliminated from the lungs was washed out by a bias flow at the mouth. In each of 6 subjects studied, VCO2 was greater at 8 Hz than at 4 Hz (130 versus 74 ml/min; p less than 0.05) with oscillation volumes (VT) of 100 ml. At a fixed frequency of 10 Hz there was a positive linear correlation (p less than 0.01) between oscillation volume and VCO2. At a lung volume 500 ml below total lung capacity VCO2 ranged from 130 to 215 ml/min at a mean VT of 130 ml and 5 to 60 ml/min at a VT of only 10% of the estimated anatomic dead space. In 3 subjects, after inhalation of isoproterenol, there was a greater VCO2 over the entire vital capacity (p less than 0.01). We concluded that HFV can achieve values of CO2 elimination close to the estimated metabolic CO2 production in normal unintubated subjects over short periods of time.

Frequency of the first heart sound in the assessment of stiffening of mitral bioprosthetic valves

The frequency spectrum of the first heart sound (S1) was measured noninvasively in 54 patients with porcine bioprosthetic valves inserted in the mitral position. Phonocardiograms were recorded on magnetic tape on line with a signal processor with which the frequency spectrum and peak frequency of S1 were determined. In 19 patients with normal natural mitral valves, the apparent peak frequency within the range of measured frequencies of S1 was 46 +/- 2 Hz (mean +/- SEM). In 11 patients with porcine bioprosthetic valves implanted in the mitral position for less than or equal to 11/2 years, the apparent peak frequency of S1 was 43 +/- 3 Hz, which was not significantly different from S1 in patients with normal mitral valves. However, in 33 patients with porcine bioprosthetic valves in place 5-7 years, the apparent peak frequency of S1 was higher, 67 +/- 2 Hz (p < 0.001). In patients in whom the porcine bioprosthetic valve was implanted 5 years or longer, the frequency spectrum of S1 showed a greater proportion of sound energy at frequencies between 50-200 Hz compared with patients in whom the prosthetic valve was implanted 11/2 years or less. changes of the frequency of S1 in these patients may be a manifestation of stiffening of the valve as a result of early degenerative changes.

Compulsive water drinking in pregnancy

A case report of a pregnant woman with primary polydipsia is presented. The workup, including an investigation of the disturbance and the implications for fetal outcome, is described. The terms primary and secondary polydipsia are defined, and the differential diagnosis is discussed. Compulsive water drinking was finally diagnosed following psychiatric evaluation. A brief review of the literature concerning compulsive water drinking is presented.

Use of magnetometers to volume-reference flow-volume curves

Chest wall diameters measured by magnetometers were used to indicate a lung volume reference for repeated interrupted partial flow-volume curves (IPFVC's) and IPFVC's, and total respiratory conductances were measured before and after bronchodilation in normals. With posture rigidly controlled, subjects matched the magnetometer display on an X-Y oscilloscope to a previously marked point on the screen. Seven subjects performed six inspiratory capacities (IC's) from the reference point, completely reposturing before each maneuver. For a mean IC of 2.25 liters the standard deviation was 5.5%. IPFVC's were performed through a valve system triggering open at 60 cmH2O and shutting after 1 liter of expiration. Ten subjects each performed five sets of IPFVC's volume-referenced by magnetometers and the pooled flow variability was 5% or 0.15 l/s. Respiratory conductances by forced oscillations and IPFVC's were measured in five normal subjects before and after inhaled isoproterenol. In each subject the flow increase was always greater than the conductance increase (about 2.5:1.0) for P less than 0.05. We conclude that magnetometers may be used in normals to volume-reference IPFVC's with excellent reproducibility.

Endometrial carcinoma after Hodgkin disease in childhood

A 34-year-old patient developed metastic endometrial carcinoma after Hodgkin disease in childhood. She had ovarian failure after abdominal irradiation and chemotherapy for Hodgkin disease, and received exogenous estrogens, a treatment implicated in the development of endometrial cancer in menopausal women. Young women on replacement estrogens for ovarian failure after cancer therapy may also have increased risk of endometrial carcinoma and should be examined periodically.

Inhibition of lytic induction in lysogenic cyanophyces

When the lysogenic strain SPIcts1 of the blue-green alga Plectonema boryanum carrying a temperature-sensitive mutation in the LPP2 prophage was heated at a nonpermissive temperature in the light, a lytic cycle occurred, with production of infectious viral particles. Inhibitors of transcription, translation, and photosynthetic functions interfered with this process and produced different effects when administered at different phases of the viral cycle. The presence of the inhibitors during the temperature shift did not allow a successful induction to take place; lysogens submitted to such a process produced a normal virus yield, however, when the drugs were removed and the temperature was shifted again. Incubation with the inhibitors during the early postinduction period reduced the virus yield; at later times, however, the inhibitory action rapidly declined. When cells were induced in the presence of chloramphenicol, incubated with actinomycin, and then grown in the dark, at either permissive or nonpermissive temperatures, virus multiplication was equally inhibited. These data indicate that: (i) provirus induction in lysogenic cyanophyces relies on the synthesis of early viral proteins; (ii) induction of mRNA is unstable and becomes rapidly inactivated when its translation is prevented; and (iii) inhibition of photosynthesis prevents the induction message from being expressed. It is suggested that the SPIcts1 prophage codes for a mutated repressor, which is reversibly inactivated at a nonpermissive temperature, and that the repressor must be inactivated at the same time that the message coded for by very early genes is translated, for a successful induction of the lytic cycle.

Model for branch initiation in Aspergillus nidulans based on measurements of growth parameters

The rate of hyphal elongation and the number of branches per hypha were measured on short sporelings of Aspergillus nidulans growing at different rates. The rate of elongation was proportional to total length in unbranched and branched hyphae. At each growth rate, the number of branches per hypha increased with increasing length and gave approximately straight-line graphs when plotted against length. The average number of branches per unit of hyphal length was quite different for the various growth rates and increased in direct proportion to the growth rate. The results are interpreted to mean that (i) growing tips have a maximum rate at which they can elongate and which is reached at hyphal lengths characteristic of the particular growth rate and (ii) a new branch is formed when the capacity of the hypha to elongate exceeds that of the existing tips.

A study on the transcription of the polyoma viral genome

The transcription of polyoma (Py) viral RNA was studied in primary mouse kidney cell cultures (a) during normal, asynchronous infection, (b) under conditions where Py-induced DNA synthesis was inhibited with 5-fluorodeoxyuridine, and (c) after the synchronized onset of Py-induced DNA synthesis. The results obtained suggest that the bulk of Py RNA transcribed after the (asynchronous or synchronized) onset of Py-induced DNA synthesis, designated as "late" Py RNA, corresponds to the polycistronic transcript of most or all of the genetic information contained in a strand of circular Py DNA. The rate at which late Py RNA is transcribed is related to the amount of free Py DNA present in the cultures. Py-infected cultures contain a second, minor component of Py RNA (of one or possibly more species), designated as "early" Py RNA. At least some of this RNA continues to be transcribed if Py-induced DNA synthesis is inhibited with 5-fluorodeoxyuridine and, possibly, also late during normal infection.

A computer analysis of serial interactions in spaced responding

Serial dependencies in interresponse times were studied by means of a digital computer. In monkeys exposed to a DRL 20-sec schedule of reinforcement, serial interactions appeared at all stages of training. Early in training the serial effects consisted of trains of relatively long interresponse times interspersed among trains of relatively short ones. Later on, the serial effects appeared to be characterized by a tendency to drift up and down in long wavelength periods around the minimum interval required for reinforcement. After training to a point at which most interresponse times produced reinforcement, serial effects of a still more subtle nature appeared. These effects were made apparent by autocorrelation and power spectrum methods and consisted of both long-term and extremely short-term fluctuations in interresponse times.