Central venous catheters revisited--infection rates and an assessment of the new Fibrin Analysing System brush

Sixty-one consecutive patients in the Intensive Care Unit requiring central venous lines (CVC) for five or more days were randomized to receive either a standard triple lumen CVC (STD/CVC) or a silver sulphadiazine and chlorhexidine impregnated CVC (SSD/CVC). Data from the 54 patients who completed the trial show a reduced infection rate (positive tip culture) in the SSD/CVC group (4 out of 28) compared to the STD/CVC group (10 out of 26) (P < 0.05). In addition, the new Fibrin Analysing System (FAS) brush was evaluated and used to determine the presence of infection in all the CVCs (STD/CVC and SSD/CVC combined, n = 54) at day 3 (i.e. early warning of CVC colonization/infection) and at the time of removal of the CVC. The FAS brush was able to detect an infected CVC on only one occasion on day 3 out of the 14 CVC tips which were later found to be colonized/infected at the time of removal. The sensitivity of the FAS brush in detecting colonized/infected CVCs at the time of CVC removal compared with CVC tip culture was 21% with a specificity of 100%. These findings would currently not support the routine use of the FAS brush in determining CVC infection/colonization.

Changes in enzyme histochemical profiles of identified spinal motoneurons of the European eel, Anguilla anguilla, following cordotomy

The enzyme histochemical profiles of glucose-6-phosphate dehydrogenase (a marker of synthetic performance), succinate dehydrogenase (an indicator of oxidative metabolism), and NADH tetrazolium reductase (a marker of overall neuronal activity) were determined for identified white muscle motoneurons in six control and six cordotomized cels. Images were digitized and mean integrated absorbances obtained using appropriate hardware and software. For motoneurons caudal to the transection site there was a significant decrease in the mean absorbance value for NADH tetrazolium reductases which declines from 0.28 a.u. (arbitrary units) in control animals to 0.23 a.u. in cordotomized animals. However, no significant changes were detected in the activities of glucose-6-phosphate and succinate dehydrogenases. The cross-sectional area of the motoneuronal cell body was not affected by cordotomy. The decrease by around 20% in overall neuronal activity, as expressed by NADH tetrazolium reductase activity, might be expected from the decline in body motility that follows cordotomy. Changes in SDH and G6PDH activities would also be expected to follow this surgery, but none were seen, perhaps because they are compensated for by changes in neuronal metabolism that result from deafferentation.

The effects of social support on the relationship of functional limitations and pain to depression

OBJECTIVE

This study assessed the effects of social support on the relationship of functional impairments and pain to depression.

METHODS

Fifty-nine persons with end-stage joint disease (27 men and 32 women with an average age of 65 years) were interviewed. The Arthritis Impact Measurement Scales (AIMS) was used to assess functional impairment and depression. The modified Inventory of Socially Supportive Behaviors was used to assess 4 types of social support (emotional, informational, tangible, and integrative).

RESULTS

Contrary to the moderator model of social support, only low tangible support attenuated the adverse effects of functional impairments on depression, while other levels of this type and 3 other types of support either had no effect or enhanced the deleterious effects of functional impairments. Social support did not attenuate the relationship between pain and depression.

DISCUSSION

The findings suggest that certain types and levels of social support may reduce the effects of functional limitation and pain on depression, while other types and levels may increase their adverse effects.

Cardiac response of elderly adults to normal activities and aerobic walking

To assess the cardiac response of elderly adults, three sedentary men and six women (M = 68 years) with no known cardiovascular disease had their cardiac responses to activities done in a laboratory setting (walking, climbing stairs, carrying bags, shuffleboard); normal daily activities and aerobic walking (pace at 60% of the age-adjusted heart rate) were assessed by a 24-hour holter monitor. Supraventricular and ventricular ectopies were common during the 24 hours of monitoring, but none occurred during any of the activities. Bradycardia occurred at night, along with some supraventricular and ventricular ectopy, none clinically significant. Heart rate increased as the intensity of the activity increased (e.g., 68/ minute for carrying 5 pounds of groceries to 90/ minute during aerobic walking). When prescribing exercise or activity limitations, the chronotropic effects of usual daily activities must be considered in counseling sedentary, apparently healthy older adults.

Affinity maturation of proteins displayed on surface of M13 bacteriophage as major coat protein fusions

This chapter described the preparation and fractionation of libraries of M13 phage displaying proteins as fusions to the major coat protein. High titer (10(13) pfu/ml) phage libraries can readily be generated using a single vector and the level of display surpasses that of gene III fusion phage. Since the synthetic VIII fusion gene can be customized, this system should provide the flexibility required to construct phage libraries displaying a variety of different peptides and proteins and to select variants possessing the highest affinity for target molecules of a diverse chemical nature.

An investigation of pain experience and management following gynecological day surgery: differences between open and closed surgery

This study aimed to investigate the pain and activity levels of patients for a 5-day period following gynecological day surgery. Patients recorded their degree of pain and activity on visual analogue scales in a diary; completed diaries were returned by 54.9% of the patients approached (106 of 193). The median age of the women was 28.5 years (range, 15-55 years). Each procedure was classified as either open or closed surgery, depending upon whether an incision was necessary. Most (63.2%) of the patients required analgesics on the first morning after their surgery. Open surgery patients experienced significantly more pain for at least 3 postoperative days and were less active until the fifth day (P < 0.05 by Mann-Whitney tests). Drowsiness (47.2%), nausea (30.2%), and headache (30.2%) were the most common adverse effects experienced in the first postoperative morning. The incidence of adverse effects declined over the five days, but a minority of patients still suffered with headache (14.2%), drowsiness (9.4%), sore throat (7.5%), and nausea (5.3%) on the fifth day following surgery. The percentage of patients who experienced constipation peaked at 19.8% on the second day, most likely reflecting the consumption of codeine-containing analgesics on the first and second postoperative days. While day surgery has an important role in many forms of gynecological surgery, the potential discomfort and recovery time following day surgery should not be underestimated.

A polyclonal antibody against mammalian FOS can be used as a cytoplasmic neuronal activity marker in a teleost fish

A polyclonal antibody raised against a conserved region of a mammalian FOS sequence was tested for its use as an activity marker in the rainbow trout. The FOS-like expression in the trout is entirely cytoplasmic and appears in a Nissl-like pattern. The reaction is specifically induced by both orthodromic and antidromic electrical stimuli and during motor responses evoked by natural stimulation, although some positive neurons are found at locations that are not obviously related to the presented stimuli. Following spinal nerve stimulation, antidromically activated motoneurons were found to be positive in the ipsilateral spinal cord. Orthodromic driving of spinal moto- and interneurons by stimulation of the medial longitudinal fasciculus (MLF) in the hindbrain evoked FOS-like immunoreactivity throughout the motor column in the spinal cord, but not in regions lying caudal to a lesion of the MLF-axons. Evoking about 25 startle responses by natural auditory stimulation gives FOS-like immunoreactivity in the Mauthner cell, which initiates the response, whereas positive Mauthner cells were never observed in control fish. The stimulation protocols that were used strongly activated the stimulated cells and so the observed FOS-like immunoreactivity might be related to an increase protein synthesis needed to restore their depleted transmitter levels.

Dopaminergic and GABAergic cerebrospinal fluid-contacting neurons along the central canal of the spinal cord of the eel and trout

In anamniote vertebrates the central region of the spinal cord has been implicated in its regeneration. This is a complex region and so as a first step in understanding its possible regenerative role we have examined the organization of the cells that contact the lumen of the spinal cord in two teleost fishes, eel and trout, using immunohistochemical procedures and light and electron microscopy. Cell bodies immunoreacting positively with antibodies for tyrosine hydroxylase and for dopamine were located at the ventral rim of the central canal, whereas cell bodies reacting for an antibody for gamma-aminobutyric acid were more laterally located. None of the canal-contacting cells were positively immunoreactive for choline acetyltransferase. All immunopositive cells have a similar morphology: the amphora-shaped perikaryon is bipolar and has a single process that extends to the lumen of the canal, and another that branches and forms extensive lateral and ventral plexuses. Electron microscopic investigations of the ventral dopaminergic cells showed that the apical processes bear one or more cilia, which protrude into the canal lumen and which originate from within a superficial rosette of nonciliated processes. The ventral process was occasionally seen to form synapses; the cell body was also the target of synapses.

Cadmium disposition in the earthworm Eisenia fetida

The disposition of cadmium was examined in the earthworm Eisenia fetida using two exposure media, filter paper, and artificial soil. Uptake and elimination rates were estimated to be 0.03039 and 0.00895 hr-1, respectively, for 1.25 micrograms Cd/cm2 filter paper exposure and 0.00512 and 0.00029 hr-1, respectively, for 10 micrograms Cd/g artificial soil exposure. The distribution of cadmium was examined using whole body autoradiography, tissue distribution, and subcellular localization. Cadmium tissue distribution was exposure-dependent, while cadmium subcellular localization apparently was not exposure-dependent. Acid-soluble thiol levels, examined as an index of cadmium exposure, were too variable in nonexposed earthworms to serve as an indicator of cadmium exposure.

Margin in life among hospitalized and non-hospitalized elderly persons

This study compared six dimensions of adult life among 39 hospitalized elders with a mean age of 72.1 years and 44 elders with a mean age of 75.7 years living in the community. The dimensions of life were physical function, work, spirituality, family, community and self concept. Multivariate analysis of variance revealed that the patterns of the subscales did not significantly differ between the groups. Except for the outside interest factor of the community subscale, univariate analysis of variance revealed no significant differences between hospitalized and community elders.

Coexistence of calcitonin gene-related peptide and choline acetyltransferase in eel efferent neurons

We applied choline acetyltransferase, (ChAT) and calcitonin gene-related peptide (CGRP) immunocytochemistry to the efferent neurons that innervate the lateral line and the ear of the eel. Strong immunoreactivity to the ChAT antiserum was observed in neurons located within the octavolateralis efferent nucleus that could be distinguished, on the basis of their form, location and dendritic organization, from the ChAT-immunopositive motoneurons of the adjacent facial motor nucleus. Both facial motoneurons and efferent neurons were found to be immunopositive for CGRP, although the reaction was always stronger in the motoneurons. Double labelling experiments established the presence of both ChAT and CGRP in many efferent neurons. The results are evidence that cholinergic efferent neurons supplying end organs of different modalities may also produce calcitonin gene-related peptide.

Physical, psychological, and social resources as moderators of the relationship of stress to mental health of the very old

The purpose of this pilot study was to assess the attenuating effects of physical, psychological, and social resources on the relationship between stress and mental health among the oldest old. Physical resources include perceived health and independence in functional and instrumental activities of daily living, while psychological resources include mastery, self-esteem, and coping. Social resources are measured by frequency of social interaction and size of the social network. Among the 124 women and 31 men (M = 89 years), greater independence in IADLs and greater perceived control of events significantly attenuated the adverse effects of strain on psychological well-being.

The size and number of neurons descending to the spinal cord in relation to body length in the European eel (Anguilla anguilla)

Cells of origin of descending spinal pathways in eels of different body lengths (15-59 cm) were identified by labelling them retrogradely with horseradish peroxidase from the rostral spinal cord. The aim was to determine whether changes in size, number and distribution of these neurons take place in line with changes in the size of the spinal targets that occur with increasing body length. The somal cross-sectional areas of the labelled cells were measured from horizontal frozen sections and counts were made of the axons within the ventral funiculus in 1 micron transverse sections of the pectoral spinal cord. The distributions and numbers of labelled cells in the brain, and the number of axons in the ventral funiculus in the pectoral spinal cord, were similar for all lengths of fish studied. The somata of most of the labelled cells in the brain increase in size in fish up to a length of 40 cm. Some reticulospinal neurons are individually identifiable and most of these show a distinct increase in size; however, the cells that have relatively large somata in small fish show no change in size as the fish lengthen.

Choline acetyltransferase immunoreactive neurons innervating labyrinthine and lateral line sense organs in amphibians

The goal of the present study was to investigate aspects of the central organization of the neurons belonging to the octavolateralis efferent system of amphibians. The perikarya of three genera, Pleurodeles, Xenopus, and Discoglossus, were located in the brainstem by applying retrograde tracers to the appropriate cranial nerves and choline acetyltransferase immunohistochemistry was used to identify cholinergic neurons. The efferent neurons supplying lateral line (Pleurodeles, Xenopus) and labyrinthine (Pleurodeles, Xenopus, and Discoglossus) end organs were found to intermingle in a single octavolateralis efferent nucleus. The neurons lie bilateral to the labelled nerves in Pleurodeles and ipsilateral in Xenopus and Discoglossus. Separate labelling of the anterior and posterior octavus rami provided no evidence for distinct groupings of efferent neurons that could be associated with auditory and vestibular end organs. In all three species many if not all octavolateral efferent neurons displayed immunoreactivity for choline acetyltransferase. They could be distinguished from the cholinergic facial motoneurons, with which they sometimes intermingle, on the basis of either their distinctive size and shape (Pleurodeles, Xenopus) or their location (Discoglossus). Double labelling in Xenopus confirmed the cholinergic nature of the efferent neurons.

Pilot study results. Falls among institutionalized elderly

Increased cognitive impairment relates to poorer balance, to greater dependence in activities in daily living (ADL), and to perceptions of greater balance. Also, greater depression relates to better balance, to less dependence in ADL, and to perceptions of poorer balance. Those who fell were significantly younger and more dependent in ADL than residents who did not fall. However, there were no significant differences between these two groups for sex, length of institutionalization, depression, cognitive impairment, balance, or perceptions of balance. The findings that actual balance and perceptions of balance may not be congruent among cognitively impaired and depressed elderly has important implications for assessment and intervention. Perceptions are central to the decision of a person to ambulate or transfer and engage in other activities, and discrepancies between actual and perceived abilities may lead them to perform activities that they are unable to do safely.

Protease inhibitor display M13 phage: selection of high-affinity neutrophil elastase inhibitors

We report display of the complete protease inhibitor (Kunitz) domain, BPTI, on the surface of bacteriophage M13 as a fusion to the gene III product. Phage that display BPTI bind specifically to anti-BPTI antibodies, trypsin and anhydrotrypsin. A point mutation of BPTI [Lys15-->Leu(K15L)] alters the binding specificity of fusion phage such that a human neutrophil elastase-binding phenotype is conferred while a trypsin-binding phenotype is eliminated. Phage were eluted from an immobilized protease with step gradients of decreasing pH. Phage that display Kunitz domains having higher affinity for the immobilized protease exhibit characteristic pH elution phenotypes, indicating that bound display phage can be selectively recovered from an affinity matrix. Utilization of this technology should enable the selection of remodeled protease inhibitors exhibiting novel binding specificities.

Differences in the dopaminergic innervation of the electroreceptive and mechanoreceptive medullary lateral line nuclei of the ray, Raja radiata

An immunohistochemical study was made of the octavolateral centres in the medulla of a cartilaginous fish, using an antibody specific for dopamine. No immunopositive cell bodies were observed but dopaminergic fibres were present in parts of the region. The overlying cerebellar crest was devoid of dopamine; the dorsal (electroreceptive) nucleus was poorly innervated, but the medial (mechanoreceptive) nucleus received a rich dopaminergic innervation comprising very fine, varicose fibres.

The influence of cerebellar lesions on the swimming performance of the trout

The influence of partial cerebellar ablation on the performance of rainbow trout, Oncorhynchus mykiss, swimming in a water tunnel was studied. Before surgery, all fish maintained a steady position in the water tunnel at all speeds tested. A linear relationship was found between the specific velocity (body length s-1) and the tail-beat frequency. After partial cerebellectomy, the fish swam well in the tunnel at low speeds, retaining the relationship between tail-beat frequency and specific velocity, but they were unable to maintain a steady position at water speeds requiring tail-beat frequencies above 3.5 s-1 and were swept backwards. Two sham-operated fish swam at all water speeds tested. Post mortem histological investigation showed that the lesions were restricted to the cerebellar corpus. We conclude that the cerebellum plays no role in the generation of motor programmes but may be essential for their selection and implementation.