Patient-reported experience with Velosulin human insulin in continuous subcutaneous insulin infusion

A multicenter, retrospective survey of 339 patients with insulin-dependent diabetes mellitus was done to evaluate patient experience with Velosulin Human insulin, a regular insulin in a phosphate buffer, used in continuous subcutaneous insulin infusion. Patients had used this insulin exclusively for 3 months preceding the survey. Responses were elicited through interviews conducted by physicians or nurses. Patients were queried as to the occurrence of specific complications associated with pump therapy that occurred while using Velosulin Human insulin, including hypoglycemia, diabetic ketoacidosis, unexplained hyperglycemia, tubing obstruction, and infection or abscess at the infusion site. Most patients reported that they did not experience any of these complications during the preceding 3 months. The most frequently cited complication was hyperglycemia unexplained by dosage, exercise, or dietary changes, reported by 110 (32%) patients. The second most frequently reported complication was tubing obstruction, reported by 99 (29%) patients. The reported frequencies of the other complications were: severe hypoglycemia, 45 (13%) patients; diabetic ketoacidosis, 28 (8%) patients; and infection or abscess at the infusion site, 26 (8%) patients. The low morbidity reported by the patients in this survey probably was due in large part to careful patient selection, a high level of motivation on the part of the patients, and experience and education on the part of the health care team, as well as to the use of buffered regular human insulin.

Case report: concordant traumatic brainstem contusion delayed diagnosis in a young man with Wilson's disease

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism. The corresponding gene locus has been localized on the long arm of chromosome 13. Three different clinical variants of the disease can be distinguished: hepato-cerebral, abdominal/hepatic, and central nervous type. The heterogeneity of symptoms can cause problems in differential diagnosis, especially when another concordant disorder can also explain the pathogenesis of symptoms. The case report of a young man who suffered from brainstem contusion demonstrates the possibilities of misinterpretation because presenting symptoms could be attributed either to traumatic brain injury followed by adjustment disorder or Wilson's disease. Clinical signs included leftsided hemiparesis, bilateral gaze direction nystagmus, marked dysarthria with consecutive pervasive mutism, choreo-athetoid movements, spasmodic torticollis and diplopia dependent on gaze direction. Slit lamp examination showed Kayser-Fleischer's corneal ring. EEG- and computer assisted tomography investigations revealed non-specific findings. The patient was treated with D-Penicillamine. Alternative treatment with oral zinc preparations is discussed.

Acute exogenic psychosis following oral ingestion of 2 mg lormetazepam in an eleven-year-old boy

After oral ingestion of 2 mg lormetazepam given by his mother, an 11-year-old boy suffered from severe adverse effects. Main symptoms were disorientation, restlessness, amnesia, anxiety, hostility, and rage reactions. Paranoid ideations and impaired perception were concluded from strange reactions and remarks of the child. Symptoms are similar to the van der Kroef syndrome described after the use of rapidly eliminated high-potency benzodiazepines. This case demonstrates drug abuse on the part of parents wishing to induce sleep in their children.

Comparative localization of three classes of cell wall proteins

The localization of the cell wall proline-rich proteins (PRPs), and the gene expression of the cell wall glycine-rich proteins (GRPs) and the hydroxyproline-rich glycoproteins (HRGPs) were examined in several dicot species. The PRPs are accumulated in the corner walls of the cortex where several cells are joined together and in the protoxylem cell walls of 3-day-old soybean root. In 1-month-old soybean plants, the PRPs are specifically deposited in xylem vessel elements of the young stem, and they are accumulated in both phloem fibers and xylem vessel elements and fibers of the older stem. Likewise, the PRPs are localized in xylem vessel elements and fibers in tomato, petunia, potato and tobacco stems. They are also found in outer and inner phloem fiber cell walls of tomato stem and in outer phloem fiber cell walls of petunia stem. The gene expression of the HRGPs and the GRPs is developmentally regulated in tomato, petunia and tobacco stems. HRGP mRNAs are abundant in outer and inner phloem regions, while GRP mRNAs are present mostly in primary xylem and in the cambium region. Immunocytochemical localization showed that the GRPs have a localization pattern similar to that of the PRPs in tomato, petunia and tobacco stems.

[Development-dependent diagnosis in two children with a rare "combined disorder of school readiness" in accordance with ICD-10, F81.3]

The new category (ICD-10) of mixed disorder of scholastic skills (F81.3) includes the combination of specific reading and spelling disorders with specific disorder of arithmetical skills and the combination of specific spelling disorder with specific disorder of arithmetical skills. We could demonstrate such combinations of specific developmental disorders in two children. In addition to diagnostic approaches with standardized testing procedures we used a model that is based on the steps in the development of specific skills. This method can be helpful in determining what kinds of intervention would be most appropriate. Both children with mixed disorders of scholastic skills also had psychiatric disorders.

Peptidyl proline hydroxylation and the growth of a soybean cell culture

Peptidyl proline hydroxylase inhibitors block the growth of cultured soybean (Glycine max) cells and bring about the disappearance of the major salt-extractable hydroxyproline-rich protein, the 33 kilodalton repetitive proline-rich protein (RPRP2). Three polypeptides of 28, 20, and 14 kilodalton that cross-react with an antibody to RPRP2 accumulate in the culture during steady-state growth. In the presence of the proline hydroxylase inhibitors, all of these repetitive proline-rich proteins disappear. These results indicate that the hydroxyproline-rich proteins play a role in cell growth, and that hydroxylation may regulate the steady-state level of at least one of these proteins by influencing its turnover.

Intact stones or fragments? Potential pitfalls in the imaging of patients after biliary extracorporeal shock wave lithotripsy

Ultrasound is used after extracorporeal shock wave lithotripsy of gallbladder stones to assess fragmentation. In many patients with apparently successful fragmentation, the posttreatment studies show an intraluminal, echogenic focus within the gallbladder, with posterior acoustic shadowing characteristic of an intact stone. Cholesterol gallstones were fragmented in vitro by means of lithotripsy, and the sonographic appearance of the fragmented stones was followed up over time to study factors that might affect the process. After lithotripsy, fragments settled and produced an echogenic focus with posterior shadowing indistinguishable from the appearance of an intact stone. These experimental observations led to the development of a clinical maneuver to overcome the diagnostic pitfalls posed by the reaggregation of stone fragments in situ. This rollover maneuver helps distinguish between intact stones and fragments, and prevents both diagnostic errors in follow-up and unnecessary retreatment.

[Evaluation of a transitional group home for psychiatric patients during and after adolescence]

A report is given on a 6-year follow-up study of a project involving outpatient treatment of adolescents and young adults (16-21 years of age) coupled with group living following inpatient treatment for psychiatric disorders. During the period studied 45 of the 53 participants completed treatment. The mean duration of treatment was 46 weeks for both the group with and without psychotic symptoms.

Mortality and air pollution in London: a time series analysis

The relation between air pollution and mortality in London was examined for the winters of 1958-1972. The data exhibited a high degree of autocorrelation, requiring analyses using autoregressive models. There was a highly significant relation between mortality and either particulate matter or sulfur dioxide (after controlling for temperature and humidity), both overall and in each individual year. Graphic analysis revealed a nonlinear relation with no threshold, and a steeper exposure-response curve at lower air pollution levels. In models with both pollutants, particulate matter remained a significant predictor with about a 10% reduction in its estimated coefficients, while sulfur dioxide was insignificant, with a large drop in its estimated coefficient. The authors conclude that particulates are strongly associated with mortality rates in London, and the relation is likely causal.

Characterization of two soybean repetitive proline-rich proteins and a cognate cDNA from germinated axes

We have resolved and analyzed two proline-rich proteins isolated from the walls of soybean cells in culture. The proteins are similar in amino acid content, containing 20% proline, 20% hydroxyproline, 20% lysine, 16% valine, 10% tyrosine, and 10% glutamate. The proteins undergo a rearrangement or a limited cleavage in dilute NaOH, but are otherwise remarkably stable to a high concentration of alkali. We have cloned and sequenced a cDNA from soybean axes germinated for 31 hours (1A10-2) coding for a protein that closely corresponds in its amino acid content to that of the proline-rich proteins. The cDNA sequence predicts a decameric repeat of Pro-Pro-Val-Tyr-Lys-Pro-Pro-Val-Glu-Lys. Consequently, this class of proteins is referred to as repetitive proline-rich proteins, i.e., RPRP2 and RPRP3. We have also analyzed RNA gel blots with probes that discriminate between the new cDNA clone and a related cDNA previously reported [SbPRP1; Hong, Nagao, and Key (1987). J. Biol. Chem. 262, 8367-8376]. Messenger RNAs from young seedlings and from soybean suspension cultures correspond primarily to the new RPRP clone (1A10-2), whereas the predominant mRNA accumulating later in the roots corresponds to SbPRP1.

Ribosome binding to inosine-substituted mRNAs in the absence of ATP and mRNA factors

Incubating ribosomes and eukaryotic initiation factor eIF3 with an inosine-substituted mRNA (where the mRNA secondary structure is strongly reduced) in the absence of ATP and other protein synthesis factors produces a 40 S ribosome.mRNA complex. When Met-tRNAMeti and eIF2 are added, a 60 S ribosome subunit attaches forming an 80 S ribosome.mRNA complex. ATP and the three mRNA factors, eIF4B, cap-site factor, and eIF4A, strongly stimulate the attachment of the 60 S subunit. In the absence of Met-tRNAMeti, the 60-S subunit does not attach, and adding ATP and the mRNA factors inhibits the accumulation of 40 S ribosome.inosine mRNA complexes. These results indicate that a 40 S ribosome, probably in a complex with eIF3, has an intrinsic capacity to attach to mRNA. Further, they suggest that Met-tRNAMeti may interact in a subsequent step to stabilize the 40 S ribosome.mRNA complex and allow the attachment of a 60 S ribosome subunit. Although seen most clearly with the inosine-substituted mRNAs, the 40 S ribosome reaction is also obtained with "guanosine" mRNA. A 40 S ribosome attaches to guanosine mRNA without ATP and mRNA factors when an incubation mixture containing ribosomes, eIF3, and mRNA is fixed with glutaraldehyde. In addition, a 40 S ribosome.guanosine mRNA complex can be obtained without glutaraldehyde in incubations containing ATP and the three mRNA factors in the absence of Met-tRNAMeti. The latter reaction is limited because of the instability of the 40 S ribosome.mRNA complex in the absence of Met-tRNA. Nevertheless, its authenticity is indicated by its full dependence upon ATP and the three mRNA factors. The lack of factor requirement for the formation of 40 S ribosome complexes with inosine-substituted mRNAs indicates that ATP and the three mRNA factors function primarily to unwind the secondary structure of a guanosine mRNA. Data relevant to a role for ATP in facilitating ribosome migration on an mRNA are also discussed.

From soma to psyche: the crucial connection. Part 2. 'Cross-cultural medicine' decoded: learning about 'us' in the act of learning about 'them'

The scorpion's bite--a culturally inept response to a medical emergency. Margaret Clark's criteria--keys to cultural barriers in medical care. Clifford Geertz's injunction: to view the culturally "different" as mirrors of the unacknowledged self. The case of José--scandal of his "compartmentalized" treatment.

QUESTION

How much context may a physician be willing to absorb? Shawcross's The Quality of Mercy: western medical teams in Cambodian refugee camps--their good intentions versus their ethnocentric gaffes. The elderly as avatars of a "culture within a culture." Their beliefs, fears, dreams, and intimations--a "terra incognita" for service providers. Sardonic recoil against them (as in Shem's novel House of God) by residents--a professionally sanctioned response, deflecting what might otherwise be unendurable demands on their varied quotas of pity. Sisela Bok's moral claims: (1) for the integrity of decision making among the sick; (2) for the autonomy of the "dying response" among the aged. Steinberg's The Ethnic Myth: indictment of those using cultural difference to "explain" (or rationalize) health--and other--deficits rooted in historic, social, or economic inequity.

Workplace smoking policies: attitudes of union members in a high-risk industry

We surveyed members of a medium-size national union representing workers in high-risk industries to assess workers' support for union and company programs to help smokers break the habit and policies that restrict smoking. Two surveys were conducted that involved 690 respondents in 1984 and 593 respondents in 1985. Respondents overwhelmingly (82%) favored restrictions on smoking in the workplace but less than half agreed that companies or unions should be concerned about workers smoking off the job. For both smokers and nonsmokers, beliefs that cancer has specific causes and can be prevented strongly predict support for workplace smoking control policies. Exposure to company occupational health training also influenced smokers and nonsmokers to support selected smoking control policies. These and other findings led to the conclusion that: (1) educating workers about cancer may promote support for smoking control policies, and (2) smoking control policies are more acceptable in the context of a strong company health and safety program.

A hydroxyproline-rich protein in the soybean cell wall

A cDNA clone that hybridizes to an mRNA (1A10) that accumulates to a substantial level in the axis of the germinating soybean seed was sequenced. The amino acid sequence of the clone indicates an almost perfect repeat of Pro-Pro-Val-Tyr-Lys resulting in a protein containing 40% proline and lacking serine and histidine. On the likelihood that such a protein might be a hydroxyproline-rich cell-wall glycoprotein (HRGP), cell walls of a soybean cell culture were extracted by procedures used to obtain soluble basic cell-wall glycoproteins, and the proteins were fractionated and purified. A 33-kDa protein (and possibly a 28-kDa protein) was obtained that has an amino acid distribution similar to that of the cDNA clone. The protein lacks histidine and serine and contains 20% hydroxyproline and 20% proline. The HRGP is thus distinct both in its amino acid content and in its pentameric repeat of Pro-Pro-Val-Tyr-Lys, with half of the prolines being hydroxylated.

Gene expression in the soybean seed axis during germination and early seedling growth

Copy-DNA clones have been obtained that distinguish eight messenger mRNAs, moderately abundant in the axes of the germinating soybean (Glycine max (L.) Merr.) seedling. These clones have been used to characterize the size of the mRNAs and to anlyze the accumulation of the mRNAs at different time points and in different parts of the axis during germination and early seedling growth. Three of the mRNAs accumulate to a substantial level by 9 h, a time point before either the beginning of growth or the accumulation of polyribosomes. Four other mRNAs reach a substantial level only at 24 h, a period when rapid seedling growth is occurring. Those mRNAs whose accumulation begins at 24 h were found only in the top (hypocotyl) half of the 24-h seedlings, while the remaining mRNAs were present also in the bottom half of the seedlings in different amounts. By 44 h, the bottom 0.5 cm of the seedlings, i.e., the region of meristematic growth, had little or none of the mRNAs, with the exception of one mRNA. These temporal and spatial observations indicate that many of the mRNAs are not involved simply in the general maintenance of ongoing cell proliferation, but that they may be related to differentiation during early seedling formation. Further, the early accumulating mRNAs may be functioning in regulating the onset of seedling growth.

A wheat germ cap-site factor functional in protein chain initiation

Component C1 from wheat germ, a factor that functions in attaching ribosomes to mRNA, has been resolved into a fraction that does not bind to m7GDP-agarose (referred to as eIF4B) and one that binds and is eluted specifically by m7GDP. Both components are required for the attachment of ribosomes to [3H]methyl-labeled reovirus RNA and for the translation of a number of mRNAs, including the noncapped RNA of satellite tobacco necrosis virus. The component that binds to m7GDP-agarose, referred to as CSF (cap-site factor), contains primarily proteins of Mr 24,000, 26,000, and 75,000. Crosslinking studies with oxidized [3H]methyl-labeled reovirus RNA show that one of the lower molecular weight polypeptides of CSF interacts specifically with the 5'-cap of the mRNA in the absence of any other components. Incubation of component C1 and eIF4A in the presence of ATP results in the additional crosslinking of a 51- and a 65-kDa protein. In the absence of eIF4A, there is only the crosslinking of the lower molecular mass polypeptide (24 or 26 kDa). Attempts to reconstitute the C1 reaction with CSF and eIF4B result in a considerably diminished reaction. Crosslinking of eIF4A, however, is obtained in an incubation containing only CSF and eIF4A, suggesting that CSF may bring about an initial interaction of eIF4A with the 5' end of the mRNA.

Initiation factors eIF4A and C1 from wheat germ and the formation of mRNA X ribosome complexes

The binding of ribosomes to mRNA is analyzed in a fractionated system from wheat germ with [3H]uridine-labeled poly(A)+ RNA prepared from germinating wheat embryos. The reaction requires factors eIF3, eIF4C, and eIF5; Met-tRNA and the Met-tRNA binding system; either GTP or GMP-PNP; ATP; and factors C1 and eIF4A. These requirements are identical to those previously found to be necessary for formation of ribosome X Met-tRNAMeti complexes, with the exception of ATP, and factors C1 and eIF4A. The function of factors C1 and eIF4A is therefore specifically related to the mRNA attachment reaction. The presence of GTP in the mRNA binding reaction results in the formation of 80 S ribosome complexes, while with GMP-PNP only 40 S ribosome complexes are formed. Ribosome binding to native reovirus RNA in the fractionated wheat germ system is similar to the reaction with poly(A)+ RNA, strongly requiring ATP and factors C1 and eIF4A. Binding to inosine-substituted reovirus RNA, however, is only partially dependent upon ATP, and both the ATP-dependent and the ATP-independent binding reactions strongly require factor C1 and are substantially stimulated by factor eIF4A. The ATP-independent reaction is inhibited by pm7GDP, has a strong requirement for Met-tRNAMeti, and the 40 S ribosome complex is stable to RNase. These results indicate that the ATP-independent binding of ribosomes to inosine-substituted reovirus RNA proceeds through the normal initiation process. They further suggest that neither factor C1 nor eIF4A function exclusively to unwind mRNA secondary structure. Since eIF4A is required for the ATP-independent binding to inosine mRNA, and at the same time interacts with ATP in the reaction with ATP-requiring mRNAs, this factor may have two roles in protein chain initiation, one related to the mRNA X ribosome interaction, and one related to the function of ATP.

Omaha childhood blood lead and environmental lead: a linear total exposure model

The majority of experimental and population studies of blood lead (PbB) and environmental lead, including the Omaha study, have utilized the Goldsmith-Hexter log-log or power function model. Comparison was made of the log-log model and a linear model of total exposure to describe the Omaha Study of 1074 PbBs from children ages 1-18 years as related to air (PbA), soil (PbS), and housedust (PbHD) lead. The data fit of the linear model was statistically equivalent to the power model and the predicted curves were biologically more plausible. The linear model avoids the mathematical limitations of the power model which predicts PbB zero at PbA zero. From the Omaha data, this model, ln PbB = ln (beta 0 + B1 PbA + B2 PbS + beta 3 PbHD) predicts that PbB increases 1.92 micrograms/dl as PbA increases 1.0 microgram/m3. Since PbS and PbHD increase with PbA, however, the increases in total exposure predict a PbB increase of 4-5 micrograms/dl as PbA increases 1.0 microgram/m3.