Depressed levels of Ca2+-cycling proteins may underlie sarcoplasmic reticulum dysfunction in the diabetic heart

In view of the depressed sarcoplasmic reticulum (SR) Ca2+-pump and Ca2+-release activities in the diabetic heart and the critical role of phosphorylation in regulating the SR function, we examined the status of Ca2+-calmodulin-dependent protein kinase (CaMK) and cAMP-dependent protein kinase (PKA)-mediated phosphorylations in the diabetic heart. Diabetes was induced in male Sprague-Dawley rats by an injection of streptozotocin (65 mg/kg i.v.), and the animals were killed 6 weeks later for assessment of the ventricular SR function. Depressed cardiac performance and SR Ca2+-uptake and -release activities in diabetic animals were accompanied by a significant decrease in the level of SR Ca2+-cycling proteins, such as ryanodine receptor, Ca2+-pump ATPase, and phospholamban. On the other hand, the CaMK- and PKA-mediated phosphorylations of these Ca2+-cycling proteins, the endogenous SR CaMK and PKA activities, and the endogenous SR and cytosolic phosphatase activities were increased in the diabetic heart. Treatment of 3-week diabetic animals with insulin partially or fully prevented the diabetes-induced changes in cardiac performance, SR Ca2+-uptake and -release activites, and SR protein content, whereas the diabetes-induced changes in SR CaMK- and PKA-mediated phosphorylations and activities, as well as phosphatase activities, were not significantly affected. These results suggest that the reduced content of the Ca2+-cycling proteins, unlike alterations in PKA and phosphatase activities, appear to be the major defect underlying SR dysfunction in the diabetic heart.

Congenital varicella syndrome: a rare case of central nervous system involvement without dermatological features

An unusual case of congenital varicella syndrome with significant central nervous system involvement, but without dermatological features at birth is described. The mother contracted chicken pox at 15 weeks' gestation. Congenital varicella syndrome involves multiple systems, but rarely without skin lesions identifiable at birth. Although varicella infection in pregnant women is an uncommon complication, the fetal embryopathy that may result can be devastating. Antenatal diagnosis of fetal embryopathy during the first 20 weeks of pregnancy should be established by amniocentesis or cordocentesis when a mother presents in the first trimester with chicken pox, and appropriate risk counselling provided.

Coordination of fibroblast growth factor receptor 1 (FGFR1) and fibroblast growth factor-2 (FGF-2) trafficking to nuclei of reactive astrocytes around cerebral lesions in adult rats

Traumatic injury to the adult central nervous system initiates a cascade of cellular and trophic events, culminating in the formation of a reactive gliotic scar through which transected axons fail to regenerate. Levels of fibroblast growth factor-2 (FGF-2), a potent gliogenic and neurotrophic factor, together with its full-length receptor, FGF receptor 1 (FGFR1) are coordinately and significantly increased postinjury in both nuclear and cytoplasmic fractions of extracted cerebral cortex biopsies after a penetrant injury. FGFR1 is colocalized with FGF-2 in the nuclei of reactive astrocytes, and here FGF-2 is associated with nuclear euchromatin. This study unequivocally demonstrates coordinate up-regulation and trafficking of FGF-2 and full-length FGFR1 to the nucleus of reactive astrocytes in an in vivo model of brain injury, thereby implicating a role in nuclear activity for these molecules. However, the precise contribution of nuclear FGF-2/FGFR1 to the pathophysiological response of astrocytes after injury is undetermined.

Effects of case-load size on the process of care of patients with severe psychotic illness. Report from the UK700 trial

BACKGROUND

Studies of intensive case management (ICM) for patients with psychotic illnesses have produced conflicting results in terms of outcome. Negative results have sometimes been attributed to a failure to deliver differing patterns of care.

AIMS

To test whether the actual care delivered in a randomised clinical trial of ICM v. standard case management (the UK700 trial) differed significantly.

METHOD

Data on 545 patients' care were collected over 2 years. All patient contacts and all other patient-centred interventions (e.g. telephone calls, carer contacts) of over 15 minutes were prospectively recorded. Rates and distributions of these interventions were compared.

RESULTS

Contact frequency was more than doubled in the ICM group. There were proportionately more failed contacts and carer contacts but there was no difference in the average length of individual contacts or the proportion of contacts in the patients' homes.

CONCLUSIONS

The failure to demonstrate outcome differences in the UK700 study is not due to a failure to vary the treatment process. UK standard care contains many of the characteristics of assertive outreach services and differences in outcome may require that greater attention be paid to delivering evidence-based interventions.

Phenotypic markers as risk factors in schizophrenia: neurocognitive functions

OBJECTIVE

To review the literature on neurocognitive measures as risk markers for schizophrenia and to present data from the Perth family study of schizophrenia. Of all the risk markers that have been identified, the most promising are deficits in sustained attention.

METHOD

Inclusion in the review was determined by whether the research addressed a number of key questions: methods of assessing sustained attention; evidence of sustained attention deficits in patients and first-degree relatives including children; the importance of attentional dysfunction in the schizophrenic process and functional outcome; and the biological basis of sustained attention deficits.

RESULTS

Sustained attention deficits are evident in both patients and a proportion of their first-degree relatives, a finding replicated in preliminary data from the Perth family study. The literature suggests that the attention deficit is a stable enduring trait that is independent of clinical state. The neural basis of the deficit may be a functional disconnection between prefrontal and parietal cortex. Attention impairment is an important predictor of functional outcome in patients and the development of social dysfunction in adulthood in the at-risk offspring of patients. However, sustained attention deficits that are measured in childhood results in an unacceptable high false-positive rate (21%) when predicting which at-risk offspring of parents with schizophrenia will develop a schizophrenia spectrum disorder, although the overall classification accuracy (78%) is impressive.

CONCLUSIONS

The main findings are that sustained attention deficits are important risk markers for schizophrenia but need to be supplemented by other neurocognitive risk markers to improve predictive accuracy.

Childhood emotional abuse and eating psychopathology

The potential role of childhood emotional abuse (CEA) in the etiology and maintenance of eating psychopathology is reviewed. While childhood sexual and physical abuse have been hypothesized as risk factors in multifactorial models of eating disorders, a role for CEA has only recently been considered. Initial findings demonstrate a phenomenological link between CEA and eating psychopathology, and suggest that this association might be different to the links for other forms of trauma (i.e., CEA may have a relationship with a broader range of eating symptoms than sexual and physical abuse). However, the psychological processes that might account for such a link are not yet well understood. Potential cognitive and affective mediators are considered, with a particular emphasis upon low self-esteem and anxiety. A model is proposed, to act as a framework for further research into this field. The clinical implications of the research to date and of the proposed model are discussed.

A study of mild fetal pyelectasia - outcome and proposed strategy of management

Mild fetal pyelectasia, defined as a renal pelvic anteroposterior (AP) diameter of 4-10 mm, has become a frequent finding on fetal ultrasonography. The natural history of such dilatation is unclear, resulting in confusion as to appropriate postnatal investigation and management. The aim of this study was to examine the urinary tract outcome of a series of infants with mild fetal pyelectasia demonstrated on routine morphology ultrasonogram between 16 and 21 weeks' gestation. Of the 37 cases identified, 13 (35%) went on to require medical or surgical intervention for significant urinary tract anomalies. These anomalies included pelvi-ureteric junction obstruction, dysplastic kidney, vesicoureteric reflux and posterior urethral valves. On initial scan all cases had an AP diameter of 4-8 mm and did not predict those infants who would go on to require intervention. An AP diameter of greater than 7 mm on repeat scans performed after 27 weeks' gestation had a positive predictive value of 0.92 and a negative predictive value of 0.76 for significant urinary tract anomaly requiring intervention. The specificity was 0. 94 and sensitivity 0.70. A protocol of one repeat antenatal ultrasound at 28-34 weeks' gestation would be able to identify those infants who would require postnatal investigation, using a measurement of >/=7 mm. The fetus with a normal repeat ultrasound would not require postnatal follow-up.

A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: the role of mediating variables

OBJECTIVE

Previous research on the role of trauma in eating psychopathology has generally focused on reported childhood sexual abuse. There has been relatively little research addressing the full range of abusive experiences, and none considering their long-term impact on eating. This study investigated the relationships between four forms of reported childhood abuse (physical abuse, sexual abuse, emotional abuse, neglect) and unhealthy eating attitudes in adult life. Within this relationship, depression, anxiety, and dissociation were considered potential mediators, and age of onset of abuse was considered a potential moderator.

METHOD

A nonclinical sample of 236 women completed self-report measures of abuse, eating psychopathology, and psychological function. Multiple regression analyses were used to test for associations as well as for mediating and moderating influences.

RESULTS

When the intercorrelations of the different forms of reported abuse were controlled for, emotional abuse was the only form of childhood trauma that predicted unhealthy adult eating attitudes. That relationship was perfectly mediated by the women's levels of anxiety and dissociation. Age at onset of emotional abuse did not moderate these relationships.

DISCUSSION

Although these results require extension to a clinical sample, the findings underscore the need to consider a history of emotional trauma as a potentially central factor in any abusive history. Treatment may depend on addressing the psychological consequences of such trauma.

Enhanced diffiraction limited output powerof tapered gain semiconductor lasers

The spatiotemporal dynamics of linearly and trumpet flared high brightness semiconductor lasers are compared and contrasted using a comprehensive model built up from the microscopic physics. While both devices display complex multi longitudinal mode dynamics, the trumpet flared device is less susceptible to transverse filamentation instabilities and, hence, displays superior time-averaged far-field imaging properties.

Concurrent and predictive validity of an early language screening program

The efficacy of screening 2-year-old children for language delay using a parent-report questionnaire was investigated in three studies. The Language Development Survey (Rescorla, 1989) was mailed to 650 families at the time of their child's second birthday. Fifty-three percent of the surveys received by parents were completed and returned. Screening outcomes were then compared, in double-blind fashion, with the results of comprehensive clinical evaluations at ages 2 (N = 64) and 3 (N = 36). Parents' report of the size of their children's expressive vocabularies was highly correlated with clinical language measures at age 2. Children who screened positive performed significantly poorer than children who screened negative on standardized language tests and on measures taken from spontaneous conversation. The screening program demonstrated excellent sensitivity and specificity for identifying language delay at age 2 but somewhat lower levels for predicting developmental status one year later.

The impact of childhood emotional abuse: an extension of the Child Abuse and Trauma Scale

OBJECTIVE

There are few well-validated measures of childhood emotional abuse. This study explored the potential of the Child Abuse and Trauma Scale (CATS; Sanders & Becker-Lausen, 1995) to yield such a measure. The CATS was originally devised to measure the extent of adverse sexual, physical and neglectful experiences, but contains items that also reflect the construct of emotional abuse.

METHOD

A sample of 236 nonclinical women completed the CATS and the Hospital Anxiety and Depression scale. A fourth subscale was drawn from the existing CATS items, reflecting reported emotional abuse during childhood.

RESULTS

The concurrent validity and internal consistency of this new subscale were tested, and were found to be at an acceptable level. Indeed, there was some indication that the new childhood emotional abuse subscale played a more central role in anxiety and depression than did the original three subscales.

CONCLUSIONS

It is recommended that this revised version of the CATS should be used in future research and clinical practice, in order that the multidimensional nature of abuse can be better understood.

Informing patients about tardive dyskinesia. Controlled trial of patient education

BACKGROUND

This paper evaluates the effects on knowledge and clinical stability of an educational intervention about tardive dyskinesia.

METHOD

Fifty-six patients receiving antipsychotic maintenance completed a questionnaire assessing their knowledge about tardive dyskinesia. After random allocation to either an educational intervention or a control group, their knowledge was reassessed at six months.

RESULTS

Ninety-five per cent of patients completed the study. The study patients gained significantly more knowledge than the controls, who made modest gains. There were no significant differences in clinical outcome between the groups.

CONCLUSION

Patients can learn about serious toxic effects of antipsychotic treatment with a low risk of non-compliance. Discussion about tardive dyskinesia is necessary in the process of obtaining informed consent to treatment.

Eating disorder in women admitted to hospital following deliberate self-poisoning

Measures of abnormal eating behaviour in 48 women referred for psychiatric assessment following an act of deliberate self-poisoning (subjects) were compared with those in 50 women attending an accident and emergency department following minor accidental injury (controls). Disordered eating behaviour was significantly more prevalent in the subject group, even when the effect of depression was removed. Four subjects fulfilled the diagnostic criteria for bulimia nervosa, but none of the subjects met the diagnostic criteria for anorexia nervosa. The prevalence of obesity was the same in both subject and control groups. The degree of abnormal eating was very strongly correlated with a measure of inwardly directed irritability in both subjects and controls, and was strongly associated with measures of impulsiveness, outwardly directed irritability and anxiety in subjects.

Ovarian morphology and insulin sensitivity in women with bulimia nervosa

OBJECTIVE

Hyperinsulinaemia has a role in the development of hyperandrogenism and polycystic ovary syndrome in women of normal weight. Polycystic ovaries are common in women with bulimia nervosa and this study aimed to determine whether women with bulimia nervosa are insulin resistant and to examine the relation between insulin sensitivity and ovarian morphology.

DESIGN

A short intravenous insulin tolerance test was used as a direct measure of insulin sensitivity in a group of women with bulimia nervosa and a control group.

PATIENTS

A series of 12 women with bulimia nervosa and normal weight was compared with a control group of 9 healthy women who had no clinical signs of eating disorder or hyperandrogenism and did not have polycystic ovaries.

MEASUREMENTS

Bulimic behaviour was assessed using the BITE (Bulimia Investigation Test, Edinburgh) questionnaire and clinical interviews. Ovarian morphology was assessed using transabdominal ultrasonography. Insulin sensitivity and serum insulin, fasting glucose, LH, FSH, prolactin, testosterone, androstenedione and sex hormone binding globulin (SHBG) were measured and compared between the two groups.

RESULTS

Ten of the 12 women with bulimia nervosa underwent ovarian ultrasound examination and they all had polycystic ovaries. There was no difference in serum LH, FSH, testosterone, androstenedione of SHBG concentrations between the women with bulimia nervosa and the non-bulimic control group. Fasting blood glucose concentrations were normal in all the women studied and did not differ between the women with bulimia nervosa and the control women. There was also no difference in fasting serum insulin or insulin sensitivity between the women with bulimia nervosa and the nonbulimic women.

CONCLUSIONS

Bulimia nervosa is not associated with insulin resistance and chronic hyperinsulinaemia.

Evidence for signalling by big endothelin-1 via conversion to endothelin-1 in pulmonary artery smooth muscle cells

In this study, signalling by big endothelin-1 (big ET-1) and a role for the phosphoramidon-sensitive endothelin converting enzyme in this signalling was investigated in smooth muscle cells cultured from bovine pulmonary artery. In whole cells, both ET-1 and big ET-1 stimulated inositol phosphate accumulation in a time- and concentration-dependent manner. The endothelin ET-A receptor antagonist (BQ 123, 1 microM) significantly inhibited stimulation by ET-1 (10 nM) or big ET-1 (100 nM). When cells were pretreated with 100 microM phosphoramidon, the stimulation by big ET-1, but not ET-1 was abolished. In separate experiments, when cells were incubated with exogenous big ET-1, a time-dependent phosphoramidon-sensitive conversion to ET-1 was detected by radioimmunoassay. These results are consistent with the presence of a phosphoramidon-sensitive endothelin converting enzyme on the surface of bovine pulmonary artery smooth muscle cells, which may play a role in regulating signalling by circulating big ET-1.

Assessing humanitarian needs--Afghanistan

During 5 weeks of 1993, 10,000 people were wounded and over 800 killed in Kabul, capital city of Afghanistan. 50,000 refugees have fled Kabul for the countryside, or the safety of Pakistan. In the Bosnian conflict 55,000 people have been injured over the past 2 years. At the present rate, Kabul will reach this total within 6 months. My brief in Kabul was to visit as many hospitals and polyclinics as possible, talk to the staff, and find out whether there is a need for MERLIN (Medical Emergency Relief International) to intervene in this area. This intervention would be in the form of a short mission of 3-4 months duration, deploying a trauma team, immunisation programme or supplies facility. It was essential to assess the trauma facilities and document what supplies and staff were needed.

Characterization of membrane proteins exported from Plasmodium falciparum into the host erythrocyte

Plasmodium falciparum is an intracellular parasite of the red blood cell. During development it exports proteins which are transported to specific locations within the host erythrocyte. We have begun to identify and characterize exported membrane proteins of P. falciparum in order to obtain specific marker molecules for the study of the mechanisms involved in the distribution of parasite-derived proteins within the host cell. In this report we describe the characterization of a 35 kDa protein which is recognized by a monoclonal antibody. The protein is tightly associated with membranes isolated from infected erythrocytes; it is resistant to extraction with alkali and soluble after treatment with detergents. It is located at the membrane of the parasitophorous vacuole and in membrane-bound compartments which appear in the cytoplasm of the infected erythrocyte. The protein co-localizes with the previously described exported protein-1 (exp-1). Considering its localization and physical similarities to exp-1, we name the 35 kDa protein the exported protein-2 (exp-2).

The Schwann cell precursor and its fate: a study of cell death and differentiation during gliogenesis in rat embryonic nerves

We have characterized a cell, the Schwann cell precursor, that represents a distinct intermediate differentiation stage in the process by which Schwann cells are generated from neural crest cells. The Schwann cell precursor shows radical differences from Schwann cells which include death regulation, antigenic phenotype, pattern of cell-cell interaction, migratory behavior, and morphology. In the nerves of the rat hind limb, Schwann cells are irreversibly generated from these during a brief period, essentially embryonic days 15-17. We also provide evidence that the survival of Schwann cell precursors is regulated by neurons and identify basic fibroblast growth factor as a potential key regulator of apoptosis in Schwann cell precursors and of precursor to Schwann cell conversion. These findings have implications for our understanding of gliogenesis in the peripheral nervous system.

Cellular morphology and extracellular space at rhombomere boundaries in the chick embryo hindbrain

The chick embryo hindbrain is a segmented region of the CNS characterised by repeated blocks of neuroepithelial cells, known as rhombomeres. Individual rhombomeres are polyclonal compartments, defined both by cell lineage restriction and by the restricted expression of development control genes, that later acquire specific patterns of neuronal differentiation and axon outgrowth. The interfaces between adjacent rhombomeres are defined by boundaries across which cells do not move; the boundaries contain specialised cells and are preferentially colonised at early stages of development by extending axons. In this study, routine electron microscopy and high-pressure cryopreservation, a technique that avoids artifacts of chemical fixation, have been used to examine the morphology of rhombomere boundaries through a staged series of chick embryos. We find that the boundary regions contain enlarged extracellular spaces and that these form conduits for axons subsequently extending in the circumferential plane of the hindbrain. Labeling the ventricular surface of the neuroepithelium with DiI crystals in aqueous suspension revealed the morphology of individual cells in the intact neural tube, and demonstrated unusual fan-shaped arrays of cells at the boundaries. These findings contribute further to the evidence that cells at rhombomere boundaries differ from those in rhombomere centres, and leads to hypotheses about both the mechanism of development of the boundaries, and the role they may play in hindbrain patterning.

Rehabilitation and staffing levels in a 'new look' hospital-hostel

The present study examined the utility of a new hospital-hostel with low staffing levels. Results showed that the hostel was able to maintain 9 of the 10 initially transferred patients and has been able to provide some improvements in their quality of life. However, unlike highly staffed hospital-hostels, it was not able to decrease patients' disabilities. Implications of this are discussed in relation to staffing levels and practices.