Cortical cell death induced by IL-1 is mediated via actions in the hypothalamus of the rat

The cytokine IL-1 mediates diverse forms of neurodegeneration, but its mechanism of action is unknown. We have demonstrated previously that exogenous and endogenous IL-1 acts specifically in the rat striatum to dramatically enhance ischemic and excitotoxic brain damage and cause extensive cortical injury. Here we tested the hypothesis that this distant effect of IL-1 is mediated through polysynaptic striatal outputs to the cortex via the hypothalamus. We show that IL-1beta injected into the rat striatum with the excitotoxin alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (S-AMPA) caused increased expression of IL-1beta (mRNA and protein) mainly in the cortex where maximum injury occurs. Marked increases in IL-1beta mRNA and protein were also observed in the hypothalamus. S-AMPA, injected alone into the striatum, caused only localized damage, but administration of IL-1beta into either the striatum or the lateral hypothalamus immediately after striatal S-AMPA resulted in widespread cell loss throughout the ipsilateral cortex. Finally we showed that the cortical cell death produced by striatal coinjection of S-AMPA and IL-1beta was significantly reduced by administration of the IL-1 receptor antagonist into the lateral hypothalamus. These data suggest that IL-1beta can act in the hypothalamus to modify cell viability in the cortex. We conclude that IL-1-dependent pathways project from the striatum to the cortex via the hypothalamus and lead to cortical injury, and that these may contribute to a number of human neurological conditions including stroke and head trauma.

An analysis of the suitability of home health visits for telemedicine

To determine what percentage of traditional home health nursing visits could be done by telemedicine, we carried out a retrospective review of nursing charts (clinical records). Data of two types were recorded. The objective data, which were abstracted from the records, included demographic information, patient assessments, teaching activities and interventions. The subjective data were the opinions of four observers as to whether the visit could have been done using currently available telemedicine technology. Records were sampled randomly for patients who had received home nursing care from three home health agencies in rural and urban areas during the winter and summer of 1996. A 54-item coding instrument was applied to 906 different charted home nursing visits. For 412 (46%) of these, the on-site nursing could reasonably have been replaced by telenursing. Significant factors determining the possible use of telenursing included primary diagnosis, number of interventions and patient age. Among the 10 most common primary diagnoses, the most amenable to telenursing care were chronic airway obstruction and joint disorders; the least amenable were coagulation disorders and anaemia. Telenursing visits could substitute for a substantial fraction of on-site home nursing visits. This has important implications in terms of reducing the cost of home nursing care.

Epidemiologic issues of sexually transmitted diseases in sexual assault victims

The objective of this study was to investigate the epidemiologic aspects of sexually transmitted diseases (STDs) in victims of sexual assault and to discuss the methodological issues in determining risk of STD acquisition. We performed a comprehensive review of the medical literature to determine the prevalence of STDs in victims of sexual assault. A MEDLINE search and a search of bibliographies of published manuscripts was performed to discover relevant articles published in the English language. Studies were included in our review if they provided estimates of the prevalence of infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Trichomonas vaginalis, or human papillomavirus (HPV). The main outcome measure was prevalence rates of STDs in victims of sexual assault. It is difficult to determine the rate of newly acquired STDs from sexual assault. In the populations studied the prevalence of STDs can be summarized as follows: N. gonorrhoeae 0.0 to 26.3 percent; C. trachomatis 3.9 to 17 percent; T. pallidum 0.0 to 5.6 percent; T. vaginalis 0.0 to 19.0 percent; and HPV 0.6 to 2.3 percent. We conclude that prevalence estimates vary widely depending on the population studied and known risk factors for STDs. Given the limited follow-up rates in this population, preventive treatment for STDs in addition to emergency contraception should be offered in most instances.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to estimate the prevalence of STD transmission from an act of sexual assault, to describe the various types of STDs that a sexual assault victim is at risk for, and to explain the role of preventive therapy in this setting.

The effects of 4-nonylphenol in rats: a multigeneration reproduction study

The alkylphenol breakdown products of alkylphenol ethoxylates have been shown in in vitro studies to be weakly estrogenic, but few in vivo data address this issue in mammals. Because estrogens have been found to be most potent during developmental/perinatal exposures, this study maximized developmental exposure to nonylphenol (NP) by treating 3.5 generations of Sprague-Dawley rats to NP in diet at 200, 650, and 2000 ppm to determine the range and severity of any toxicity. Dose rate was higher for younger rats; calculated dose ranges were 9-35, 30-100, and 100-350 mg/kg/d for the low (200NP), middle (650NP), and high (2000NP) dose groups, respectively. There were adult (F0, F1, F2) and postnatal day (pnd) 21 (F1, F2, F3) necropsies; the oldest F3 rats were killed on pnd 55-58. Body weight gain was reduced by 8-10% in the 650NP and 2000NP groups. Vaginal opening was accelerated by approximately 2 days (650NP) and approximately 6 days (2000NP) in F1, F2, and F3 generations. Uterine weights at pnd 21 were increased in 650NP (14%) and 2000NP (50%) F1 females, but not in other generations. Testis descent, anogenital distance, and preputial separation were not consistently changed. No consistent changes were seen in pup number, weight or viability, litter indices, or other functional reproductive measures. Relative ovary weight in F2 adults was decreased at 650NP and 2000NP by 12%; relative ovary was unchanged in other generations. Follicle counts were unchanged in F2 adults. Sperm indices, including CASA measures, were unchanged in F0 and F1 males. In F2 rats, epididymal sperm density was reduced by 8% and 13% at 650NP and 2000NP, respectively. Testicular spermatid count was reduced by 13% in 2000NP F2 males; testis and epididymis weights were unchanged. Erosion of gastric and duodenal mucosa was monitored grossly and microscopically, and never found. Kidney weights were increased in 650NP and 2000NP males, and renal medullary tubular dilatation and cyst formation were noted in all generations of males, and often at the lowest dose tested. These data show that NP had limited effects on the reproductive system in the presence of measurable nephrotoxicity. The F2 sperm effects are either statistical/biological "noise," or imply heretofore unknown pharmacokinetics or toxicodynamics. These sperm data should be interpreted cautiously until the findings are repeated.

Nurse and patient reactions to a developmental home telecare system

Pilot studies have suggested that telemedicine is a satisfactory means of delivering nursing services into the home. A home telecare programme in Kansas provided nursing services to homes in four towns in Kansas. The present study examined patients' and nurses' perceptions of a variety of issues related to home telecare. Data-collection methods included in-depth interviews, observation and analyses of archival data from patient records. Patients suffered an average of 4.6 concurrent illnesses. On the whole, patients perceived the system as a valuable resource that offered great potential, although many saw no immediate health benefits for themselves. Nurses were enthusiastic about the prospect of practising in this way, although they did have strong opinions about what types of nurses, patients and illnesses were suited to telemedicine.

The duty of care of the occupational physician in assessing job applicants

Where an occupational physician carries out a medical assessment of a job applicant, he or she owes a duty to the employer but not to the applicant, unless actual physical harm is caused. If the applicant is unsuccessful as a result of an assessment which is alleged to be negligent, he or she cannot sue the physician. This is essentially because (i) the relationship between the physician and the applicant is insufficiently close, and (ii) the physician might be faced with a conflict of interest since differing duties might be owed to the employer and to the applicant.

Advances in pancreas transplantation: the University of Wisconsin experience

The data show that with careful surgical technique, modern immunosuppression with MMF and FK506, and pancreatic allograft biopsy, it should be possible to achieve: 1) a low rate of technical complications, 2) improved long-term graft survival, particularly in solitary pancreas recipients improving the risk/benefit ratio of this option for nonuremic diabetics, 3) a high safety profile with combined MMF and FK506 immunosuppression, 4) safe transplantation using enteric drainage without increased risk of rejection, infection or graft loss, and 5) successful pancreas transplantation without induction therapy.

Anti-glomerular basement membrane glomerulonephritis after extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a common noninvasive procedure for removal of upper urinary tract stones. We present a case of a man who developed anti-glomerular basement membrane (anti-GBM) disease after ESWL and review the two other cases described in the medical literature. In all cases, the affected individuals expressed the HLA DR2/HLA DR15 major histocompatibility antigen and developed a rapidly progressive anti-GBM-induced glomerulonephritis 3 to 7 months after ESWL. Anti-GBM disease may be a rare complication of ESWL in susceptible individuals and should be considered in patients who develop acute renal failure after lithotripsy.

Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients

Hepatitis C virus (HCV) infection has been associated with de novo or recurrent membranoproliferative glomerulonephritis and acute transplant glomerulopathy in transplanted kidneys. Recently, anticardiolipin antibodies (ACA) have been linked with chronic HCV infection. A few reports have suggested an association between ACA and renal allograft thrombosis. This study examines the clinical and pathologic features of HCV-positive renal allograft recipients at our institution. From 1990 to 1996, 379 kidney transplants were performed. We identified 18 recipients (4.8%) with HCV-positive serology pretransplant. Determination of IgG and IgM ACA was performed by enzyme-linked immunosorbent assay, using pretransplant sera. Among the 18 patients, five patients presented with biopsy-proven de novo renal thrombotic microangiopathy (RTMA), occurring 5 to 120 d (median, 14 d) after transplant. No differences in pretransplant characteristics were observed between patients with (n = 5) or without (n = 13) RTMA. All five patients had a positive ACA test (either IgG or IgM titer > 2 SD above normal), compared with only one of 13 patients without RTMA. The mean value for IgG ACA was significantly higher in the RTMA patients than in patients without RTMA (22.9 +/- 14.1 versus 6.9 +/- 4.9 IgG phospholipid units, P = 0.02); however, there were no significant differences in IgM ACA titers. Rheumatoid factor and complement C4 levels were normal in pretransplant sera of patients with RTMA. Patients with RTMA had their cyclosporine withdrawn (four of five) or the dose was decreased (one of five), and one of five underwent plasmapheresis. Four of five patients died within 5 yr after transplant, compared with no deaths in the other 13 patients. Finally, as a control group, seven HCV-negative renal allograft recipients who presented with RTMA/hemolytic uremic syndrome during the same time period were found to have normal ACA values (IgG or IgM). RTMA associated with ACA in HCV-positive renal allograft recipients may represent a new clinical entity. The occurrence of this syndrome may have deleterious consequences for patient and graft survival.

Liposome-anchored vascular endothelial growth factor aptamers

Nuclease-resistant aptamers identified from randomized nucleic acid libraries represent a novel class of drug candidates. Aptamers are synthesized chemically and therefore can be readily modified with functional groups that modulate their properties. We report here on the preparation, initial characterization, and functional properties of a nuclease-resistant vascular endothelial growth factor (VEGF) aptamer anchored in liposome bilayers through a lipid group on the aptamer. While the high-affinity binding to VEGF is maintained, the plasma residence time of the liposome-anchored aptamer is considerably improved compared with that of the free aptamer. The lipid group attachment and/or liposome anchoring leads to a dramatic improvement in inhibitory activity of the aptamer toward VEGF-induced endothelial cell proliferation in vitro and vascular permeability increase and angiogenesis in vivo.

Nurse reactions to a prototype home telemedicine system

We have studied nurse reactions to a prototype home health telemedicine system. The system used interactive video through the local cable television network. Six nurses were directly involved with telecare video-visits. There were 54 patients. The average age of the patients was 76 years (range 21-101). Thirty-six (67%) patients were female and 18 (33%) were male. The patients had an average of 4.6 different diagnoses (range 1-16). They were also on a very wide range of medications (mean 9.9, range 2-23). Nurses overwhelmingly felt the system was effective for what this particular project was trying to accomplish. They were enthusiastic about the prospects of practising nursing by telemedicine, even though they had reservations about aspects of the particular system being used. Their main complaints were about limitations of the software and limitations of the telecommunication system that linked them to the patients.

Perineural invasion in squamous cell carcinoma of the head and neck

OBJECTIVE

To determine if perineural invasion (PNI) of small nerves affects the outcome of patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract.

DESIGN

Retrospective clinicopathological study of patients with at least 2 years of follow-up and with negative margins and no prior, synchronous, or metachronous SCC.

SETTING

Academic otolaryngology department.

PATIENTS

One hundred forty-two patients who had SCC of the oral cavity, oropharynx and hypopharynx, or larynx resected between 1981 and 1991.

INTERVENTION

Surgery with or without adjuvant therapy.

MAIN OUTCOME MEASURES

Local recurrence was examined with respect to PNI, nerve diameter, and microvascular or microlymphatic invasion. Perineural invasion was correlated with lymph node metastasis, extracapsular spread, and survival.

RESULTS

Perineural invasion of nerves less than 1 mm in diameter was present in 74 patients, lymphatic invasion in 53, and vascular invasion in 9. Perineural invasion was significantly associated with local recurrence (23% for PNI vs 9% for no PNI; P=. 02), and disease-specific mortality (54% mortality for PNI vs 25% for no PNI; P<.001). With extralaryngeal tumors, PNI was associated with nodal metastasis (73% vs 46%; P=.03). Perineural invasion was not associated with extracapsular spread (P=.47). Microvascular invasion, lymphatic invasion, and nerve diameter were not significantly related to local recurrence.

CONCLUSIONS

Perineural invasion of small nerves is associated with an increased risk of local recurrence and cervical metastasis and is, independent of extracapsular spread, a predictor of survival for patients with SCC of the upper aerodigestive tract.

Secondary pleural involvement by an AIDS-related anaplastic large cell (CD30+) lymphoma simulating metastatic adenocarcinoma

We report a patient with acquired immunodeficiency syndrome with secondary pleural and pulmonary involvement by a CD30+ anaplastic large cell lymphoma (ALCL) that morphologically simulated metastatic adenocarcinoma. We describe the morphologic findings in order to heighten awareness that CD30+ ALCL may mimic metastatic adenocarcinoma in a body fluid or bronchial brushing and should be considered in the differential diagnosis. Primary body cavity based (PCBC) AIDS-related lymphoma is a relatively newly described disease entity with morphologic features bridging ALCL and large cell immunoblastic lymphoma with a CD30+ null immunophenotype. A morphology mimicking adenocarcinoma has not been previously described in this entity but should be considered in a patient with AIDS presenting exclusively with a serous effusion. Appropriate immunoperoxidase staining should aid in these differential diagnoses.

Thyroid nodules in the follow-up of irradiated individuals: comparison of thyroid ultrasound with scanning and palpation

In 1974 we began a prospective study of a cohort of 4296 individuals exposed to therapeutic head and neck irradiation during childhood for benign conditions. To define the role of thyroid ultrasonography in following irradiated individuals, we studied a subgroup of 54 individuals. They all had been screened between 1974-1976 and had normal thyroid scans and no palpable nodules at that time. Thyroid ultrasonography, thyroid scanning, physical examination, and serum thyroglobulin measurements were performed. One or more discrete ultrasound-detected nodules were present in 47 of 54 (87%) subjects. There were a total of 157 nodules, 40 of which were 1.0 cm or larger in largest dimension. These 40 nodules occurred in 28 (52%) of the subjects. Thirty (75%) of these 1.0-cm or larger nodules matched discrete areas of diminished uptake on corresponding thyroid scans. The 10 that did not match (false negative scans for > or = 1.0-cm nodules) were the only nodules of this size in 7 subjects. Of 11 nodules 1.5 cm or larger, only 5 were palpable. Serum thyroglobulin correlated to the number (P = 0.04; r2 = 0.10), but not the volume of the thyroid nodules (P = 0.07; r2 = 0.08). We conclude that thyroid nodules are continuing to occur and are exceedingly common in this irradiated cohort of individuals. The results confirm that thyroid ultrasonography is more sensitive than physical examination and scanning. However, thyroid ultrasound is so sensitive and nodules so prevalent that great caution is needed in interpreting the results.

Structure and activities of agencies providing HIV and AIDS education and prevention to Latina /Latino communities

Community agencies play an important role in HIV and AIDS education and prevention. On the other hand, important distinctions among these agencies many times go unrecognized by policy makers and program planners. The purpose of this study is to examine differences in the structure and activities of Latina/Latino and non-Latina/Latino agencies that both provide HIV and AIDS education and prevention services to Latina/Latino communities. A total of 280 agencies in counties in four regions of California (the Los Angeles area, the Bay area, the Central Valley, and counties that fell outside these three regions) were surveyed regarding agency characteristics and type and extent of HIV and AIDS education and prevention activities. One hundred eighty-one surveys were returned, a return rate of 65%. Non-Latina/Latino agencies were larger, in terms of staff size, offered a wider range of services, and utilized more volunteer staff than Latina/Latino agencies. Latina/Latino agencies were smaller in size and had more bilingual staff than non-Latina/Latino agencies. Latina/Latino agencies utilized local Spanish-language media more than non-Latina/Latino agencies, and Latina/Latino agencies were more likely to have had their education and prevention activities reported on by local Spanish-language media than non-Latina/Latino agencies. Latina/Latino agencies were more likely than non-Latina/Latino agencies to educate and to show educational videos to one or two persons at a time. Non-Latina/Latino agencies were more likely to do education and prevention activities with migrant farm-workers. There was also an effect of geographic region on types of education and prevention activities.

Review of universal health insurance: should we try it?

Health care delivery and finances are fragmented in the United States resulting in inaccessible services to many in need. Other countries with universal health insurance have developed systems that provide basic care for all individuals while maintaining costs in a reasonable range. It is time to make tough decisions to enhance the public's health status and gain control over the destiny of medical practice, while considering the bottom line.

Sudden cerebral vasoconstriction during induced polymorphic ventricular tachycardia and fibrillation: further observations of a paradoxic response

To determine the effect of induced polymorphic VT/VF on the cerebral circulation, transcranial Doppler (TCD) ultrasonography was used to prospectively assess changes in cerebral blood flow velocity during ICD implantation. Fourteen patients (13 men, 1 woman, mean age 58 +/- 20 years, range 34-74 years) who were survivors of an out of hospital cardiac arrest, were evaluated during routine ICD implantation. TCD ultrasonography was used to assess middle cerebral artery systolic velocity (Vs), diastolic velocity (Vd), pulsatility index (PI = Vs-Vd/Vmean) and resistance index (RI = Vs-Vd/Vs) before, during, and after DFT testing with alternating current induction of polymorphic VT/VF. In each of the 14 patients studied, concomitant with the abrupt onset of hypotension, TCD sonography demonstrated a 33% +/- 28% decrease in diastolic velocity, a 42% +/- 28% increase in systolic velocity, a 190% +/- 141% increase in PI, and a 44% +/- 19% increase in RI. These findings reflect an increase in cerebrovascular resistance secondary to arteriolar vasoconstriction distal to the point of insonation of the middle cerebral artery. This response is paradoxic, as the expected response of the cerebral circulation to hypotension is vasodilation, but it is consistent with observations made in other acute hypotensive settings, such as tilt induced neurocardiogenic syncope.

Home telenursing in Kansas: patients' perceptions of uses and benefits

Elderly individuals involved in a home telenursing project were studied. The project nurses provided home health services from 'telenursing cockpits' located in three separate sites in Kansas. A cable television-based interactive video system was used to transmit video pictures at 30 frames/s, with 288 horizontal lines of resolution. During phase 1 of the study, interview data were collected from 22 subjects (4 men, 18 women). During phase 2, the original participants were contacted but only 9 (1 man, 8 women) were still receiving home health services. Contrary to expectations, the technology was not an important issue for the participants. They did not express any particular worry or excitement about it. Nor did they describe difficulties in adapting to its use. Use of telemedicine technology did not appear to have any negative effects on communication. The results suggests that further thought needs to be given to defining clearly the purpose and goals of telemedicine projects.

Role of arachidonic acid metabolites in tumor growth inhibition by nonsteroidal antiinflammatory drugs

PURPOSE

A murine model of squamous cell carcinoma (SCC) was used to determine the role of arachidonic acid (AA) metabolites in the growth of SCC of the head and neck.

MATERIALS AND METHODS

C3H/HeJ mice bearing SCC (SCC VII) were treated with cyclooxygenase inhibitors (piroxicam and nabumetone) or a 5-lipoxygenase inhibitor (ketoconazole). Growth curves were established, and final tumor weights were measured. Following sacrifice, tumor tissue homogenates were assayed for prostaglandin E2 (PGE2) and 12-hydroxyeicosatetraenoic acid (12-HETE) by enzyme-linked immunosorbent assay (ELISA), and leukotriene B4 (LTB4) by radioimmunoassay (RIA). Inflammatory cell infiltrate was assessed histologically.

RESULTS

A significant inhibition of tumor growth (P = .001) and final tumor weight (P = .002) was noted in mice treated with piroxicam and nabumetone. Inhibition of tumor growth was associated with increased tumor tissue levels of PGE2 (P = .04) and lymphocytic infiltration (P = .07). Significant inhibition of tumor growth (P = .002) and final tumor weight (P = .05) was also noted in mice treated with ketoconazole.

CONCLUSION

These data suggest that both cyclooxygenase and lipoxygenase metabolites of AA affect tumor growth in this model and that inhibition of tumor growth by inhibitors of AA metabolism may be caused by an enhanced inflammatory cell response at the tumor site.

Adrenal ultrasonography correlated with histopathology in ferrets

The adrenal glands of twenty-six, 12- to 53-month-old, ferrets without clinical signs of adrenal disease were examined and measured by ultrasonography and the findings compared with those from gross examination and histopathology. Of 51 adrenal glands examined, 27 were normal, 23 had either nodular or diffuse cortical hyperplasia and 1 had an adenocarcinoma. There was no statistically significant difference between the sonographic nor gross size of normal adrenal glands and those with hyperplasia. Moderate correlation was found between gross and sonographic measurements of length for both right (r = 0.783; p < 0.0001) and left (r = 0.609; p < 0.001) and width (p < 0.02). In female ferrets, the length, width, and depth of the right adrenal gland sonographically measured (mean +/- sd) 7.5 +/- 1.2 mm, 3.7 +/- 0.6 mm, 2.8 +/- 0.4 mm, respectively, and the left measured 7.4 +/- 1.0 mm, 3.7 +/- 0.4 mm, 2.8 +/- 0.4 mm; in males, the right adrenal measured 8.9 +/- 1.6 mm, 3.8 +/- 0.6 mm, 3.0 +/- 0.8 mm and the left measured 8.6 +/- 1.2 mm, 4.2 +/- 0.6 mm, 3.0 +/- 0.6 mm. Accessory adrenal tissue was not identified during the sonographic examination but was grossly found in 10 of the ferrets. It was associated with either the right, left or both adrenal glands.

A specific RNA structural motif mediates high affinity binding by the HIV-1 nucleocapsid protein (NCp7)

Current research indicates that the nucleocapsid protein (NCp7) of human immunodeficiency virus type 1 (HIV-1) interacts with a variety of RNA substrates during the progression of the viral life cycle. The RNA features specifically recognized by the protein, however, have yet to be identified. SELEX was used to generate a set of RNAs whose affinities for nucleocapsid were on the order of 2 x 10(-9) M. Comparative analysis revealed that each RNA contains a highly conserved fourteen nucleotide sequence-block. Computer modeling and structure probing experiments indicate that the RNA ligands use the consensus sequence to fold into hairpins with an identical asymmetric bulge. The presence of the nucleocapsid protein protects the asymmetric bulge from ribonuclease attack, suggesting that it is the key element in protein recognition. A search for similar structural motifs within the HIV genome reveals several potential interaction sites for the nucleocapsid protein.

Same day surgery: results of a patient satisfaction survey

Same day surgery patients have unique needs, distinct from those of traditional long-stay inpatients and outpatients. Their postoperative needs at home are central to achieving complete recovery and ensuring there are no unplanned readmissions to hospital. In a quality improvement project at Royal Perth Hospital, a patient satisfaction questionnaire survey has attempted to measure the clinical outcome of same day surgery patients and whether this is influenced by factors such as the specific information expectations and needs of these patients, including their postoperative information needs and expectations. Survey results highlight that information delivery is crucial to same day surgery patients, not only in preparing for their procedure, but also in planning for, and coping with, their postoperative course. Information delivery is a principal factor influencing both clinical outcome and patient satisfaction with hospital service. Improving information delivery can contribute greatly to the quality and effectiveness of same day surgery services and ensure the continuum of care.

Three hospitals' survey experiences

The Joint Commission on Accreditation of Healthcare Organizations has made major alterations in its standards and survey process under the Agenda for Change, by emphasizing cross-functional healthcare. The Joint Commission published the changes in its 1994 Accreditation Manual for Hospitals, under which criteria these hospitals were surveyed. Surveyors concentrated on evaluating the following major issues: care of patients, particularly restraint policies and procedures; uniform performance of processes, particularly as related to conscious sedation; staff competency; and process improvement. The authors detail why a thorough, detailed preparation for the document review session is essential for a successful survey.

Aneuploidies and micronuclei in the germ cells of male mice of advanced age

The objective of this research was to determine whether the frequencies of chromosomally defective germ cells increased with age in male laboratory mice. Two types of chromosomal abnormalities were characterized: (1) testicular spermatid aneuploidy (TSA) as measured by a new method of multi-color fluorescence in situ hybridization (FISH) with DNA probes specific for mouse chromosomes X, Y and 8, and (2) spermatid micronucleus (SMN) analyses using anti-kinetochore antibodies. B6C3F1 mice (aged 22.5 to 30.5 months, heavier than controls but otherwise in good health) showed significant approximately 2.0 fold increases in the aneuploidy phenotypes X-X-8, Y-Y-8, 8-8-X and 8-8-Y with the greatest effects appearing in animals aged greater than 28 months. No age effect was observed, however, in X-Y-8 hyperhaploidy. Major age-related increases were seen in Y-Y-8 and X-X-8 hyperhaploidies suggesting that advanced paternal age is associated primarily with meiosis II rather than meiosis I disjunction errors. A approximately 5 fold increase was also found in the frequency of micronucleated spermatids in aged mice when compared with young controls. All micronuclei detected in the aged animals lacked kinetochore labeling, suggesting that they either did not contain intact chromosomes or the chromosomes lacked detectable kinetochores. The findings of the TSA and SMN assays are consistent with meiotic or premeiotic effects of advanced age on germ cell chromosomes, but there were differences in the age dependencies of aneuploidy and micronuclei. In summary, advanced paternal age may be a risk factor for chromosomal abnormalities (both aneuploidy and structural abnormalities) in male germ cells.

EPR persistence measurements of UV-induced melanin free radicals in whole skin

Electron paramagnetic resonance is used to detect the formation of free radicals caused by exposure to ultraviolet radiation in chemically untreated rabbit skin. A fast jump in EPR signal level, occurring over a few seconds, is observed immediately after a skin sample is exposed to UV. This is followed by a slower increase toward an elevated steady-state signal over a period of hours as the skin is continuously exposed to a UV light source. Upon cessation of UV light exposure, EPR signal levels undergo an abrupt drop followed by a slower decay toward natural levels. Elevated free radical concentrations following UV exposure are found to persist for several hours in whole skin. These results are consistent with time-resolved EPR measurements of photoinduced radicals in various natural melanins.

Changes in cerebral blood flow velocity associated with biofeedback-assisted relaxation treatment of migraine headaches are specific for the middle cerebral artery

Twenty-five patients with diagnosed migraine headaches were randomly assigned to a biofeedback-assisted relaxation therapy group or to a group who relaxed on their own. This study confirmed that the biofeedback trained group significantly decreased pain and medication more than the self-relax group. The best responders were those with the more elevated initial cerebral blood flow values and the changes in cerebral blood flow were specific for the middle cerebral artery.

Renal failure. Symptom relief in ESRF

This paper discusses the nursing care of a 65-year-old woman admitted to hospital with end-stage renal failure caused by the long-term effects of diabetes. Plans for the patient's discharge are also discussed.

An analysis of avian reproduction studies submitted for pesticide registration

Avian reproduction studies are currently part of the regulatory ecotoxicology requirements for pesticides in many countries. In the study, 134 avian reproduction studies were reviewed to determine their ability to identify pesticides that have the potential to affect reproduction in wild birds. A clustering procedure was first used to assign measured variables to parental, developmental, or eggshell effects. This assignation was found to be identical in the two bird species tested. Nineteen of 69 pesticides tested were found to cause developmental effects at levels lower than those giving rise to detectable parental toxicity. At least some of these should not have been registered without some assurance that developmental effects would not occur in the wild. The analysis also found very little similarity in the effects of pesticides on the two bird species commonly used in avian reproduction tests. This casts serious doubts on the ability to extend the results of avian reproduction studies to any potentially affected bird species. Modifications to the avian reproduction test, based on results of the analysis conducted, are suggested. It is recommended that the avian reproduction study be recognized as a rough screening tool only and that efforts not be made to make it more realistic, e.g., such as through a reduced exposure period.

Cells surrounding haemodialysis-associated amyloid deposits are mainly macrophages

Dialysis-related amyloidosis is a type of amyloidosis which had beta 2-microglobulin as the major protein constituent and occurs predominantly in haemodialysis patients. Its prevalence is very high with increasing time on dialysis treatment and its pathogenesis is not completely understood. While remarkable progress has been made in the identification of the components of the deposits, there are no reports characterizing the cells surrounding the amyloid fibrils. To characterize the cellular composition of the amyloid material, specimens from seven patients treated by maintenance haemodialysis were studied with immunoperoxidase labelling using monoclonal antibodies to leukocytes (CD3, CD14, CD68, CD4, CD8, CD45). The results were very reproducible for the seven deposits assessed: Of the 182 +/- 26 leukocytes/0.2 mm2 of amyloid tissue expressing the 71.5-CD45 marker (common leukocyte), 91 +/- 6% were CD68 (KP1) positive (monocyte macrophage). No CD3-positive cells (T-cell marker) were found in six of the seven patients, with only 1.6% in the remaining one. The present study shows that although amyloidosis has classically been considered as an acellular pathology, clearly there are cells surrounding amyloid fibrils. Strikingly, these cells are almost exclusively macrophages; there are no lymphocytes or granulocytes. The putative role of macrophages in the pathogenesis of beta 2-microglobulin amyloidosis remains to be established. However, the identification and quantitation of the cells surrounding the amyloid deposits may be important for subsequent studies to elucidate amyloid pathogenesis and particularly protein-cell interactions.

The usefulness of CT scanning in diagnosing dementia of the Alzheimer type

In order to determine the usefulness of Computerized Tomography (CT) scanning in making a diagnosis of dementia of the Alzheimer type, a group of patients diagnosed by NINCDS-ADRDA criteria (n = 22) were compared to a group of normal subjects (n = 49) using certain defined linear CT scan measurements. These measurements included specific measurements of the temporal lobes (temporal horns). Subjects were classified correctly 91.5% of the time with a high degree of probability. A diagnostic equation is presented which will allow testing of these methods in a prospective fashion.

Characterization of mutant strains of Candida albicans deficient in expression of a surface determinant

Monoclonal antibody (MAb) 17E4 reacts with a surface carbohydrate determinant and agglutinates cells of Candida albicans. Using this MAb, we have isolated N-methyl-N'-nitro-N-nitrosoguanidine-induced nonagglutinating mutants. Eleven of these were characterized for the presence and expression of the surface antigen recognized by MAb 17E4 by immunoblot analysis of whole cells and by fluorescence flow cytometry. Soluble cell wall extracts from five mutant strains were negative by immunoblot analysis. The reactivities of the strains with several other MAbs and commercial antisera (Candida Check; Iatron Laboratories, Tokyo, Japan) which also recognize carbohydrate determinants were examined by immunoblot analysis of whole cells. Mutant strains showed no or reduced expression of the MAb 17E4 antigen and could be placed into at least two distinct phenotypic classes. Recognition by the other MAbs tested showed a similar pattern, while recognition by the commercial antisera was unchanged in the mutant strains. 1H and 13C nuclear magnetic resonance spectral analysis of mannan prepared from the wild type and nonexpressing mutant-strain 4A showed that the spectra from the mutant strain were simpler than those of the wild type. Most of the beta-1,2 linkages and all of the C-1 phosphate linkages were absent in the 4A mannan spectra, which suggested that the mutant mannan lacked the phosphate-bound beta-1,2-linked mannooligosaccharides. The effect of the surface defect on the ability of mutant strain 4A to adhere and to invade host tissue was examined in two murine models. In ex vivo binding assays, strain 4A showed reduced binding to the marginal zone and increased binding to the white pulp of splenic tissue, decreased binding to kidney tissue, and no change in binding to liver tissue compared with the wild type. In vivo, no difference was observed in translocation of the wild type or strain 4A to liver following immuno-compromising treatment of infant mice which had been challenged with either strain by the oral-intragastric route.

Competition between native and immigrant Polygonum congeners

Coexistence of annual herbs Polygonum punctatum, a native, and Polygonum caespitosum, an immigrant, may result from (i) niche differentiation that reduces or avoids competition, (ii) competitive equivalence for shared resources, or (iii) interaction between a strong competitor and a species that tolerates competition. We investigated competitive interactions between the Polygonum congeners in a greenhouse experiment using plants grown from seed to seed set. Thinning profiles of monocultures were density dependent but did not differ between the species in monocultures. Biomass allocation to root, shoot, and racemes was not influenced by competition from conspecifics or congeners. Mature plant height and raceme production of both species were negatively affected by congener density; however, the species were not competitively equivalent. Polygonum caespitosum was suppressed into the shorter heights in mixture pots but produced more racemes at all but the greatest congener densities. Key words: competition, coexistence, annual herbs, immigrant.

Pleomorphic adenoma (benign mixed tumor) of the trachea

A 15-year-old "asthmatic" found to have a pleomorphic adenoma of the trachea was treated by staged CO2 laser excision. Primary tracheal tumors, the clinicopathologic features of mixed tumor in this rare location, and therapeutic options are briefly reviewed. Immunohistochemical stains for cytokeratin, S-100 protein, and glial fibrillary acidic protein are reliable methods of evaluating component cell types in pleomorphic adenoma, but immunohistochemical evidence has not resolved the issue of tumor histogenesis.