Prevalence of Csh-like fibrillar surface proteins among mitis group oral streptococci

The prevalence of Csh-like fibrillar surface proteins among oral streptococci was investigated by ELISA and by immunoelectron microscopy using antiserum raised to recombinant fragments of CshA of Streptococcus gordonii DL1. The majority of S. gordonii, Streptococcus sanguis and Streptococcus oralis strains tested elaborated short (ca. 50-80 nm long) surface fibrils and reacted with antiserum to the amino acid repeat region of CshA, demonstrating the widespread nature of Csh-like proteins among these species. In contrast, reactivity with antiserum raised to the adhesion-mediating non-repetitive region of CshA was more restricted. On the basis of the ELISA results, several isolates were selected for immunogold analysis using CshA antisera. Immunogold-negative staining showed a surface distribution of 10 nm gold particles consistent with antibody binding to short fibrils. Long fibrils (>150 nm long), where present, were not significantly labelled with gold. The results suggest that some of the short peritrichous fibrils on many mitis group streptococci comprise Csh-like fibrillar protein. Further, the data are consistent with our hypothesis that the antigenically conserved amino acid repeat region of Csh-like proteins forms a scaffold for cell-distal presentation of the amino-terminal non-repetitive region that, at least in S. gordonii DL1, functions as an adhesin.

Passive avoidance training enhances cell proliferation in 1-day-old chicks

One-day-old domestic chicks were injected i.p. with bromodeoxyuridine (BrdU) before training on a one-trial passive avoidance task where the aversive experience was a bead coated with a bitter tasting substance, methyl anthranilate (MeA). Animals were tested 24 h later; those avoiding (if MeA-trained) or pecking if water (W)-trained (which they peck appetitively), along with a group of untrained naïve chicks, were used to determine cell proliferation either 24 h or 9 days post BrdU injection. In all three groups, BrdU positive cells were identified sparsely throughout the forebrain but labelling was pronounced around ventricular zone (VZ) surfaces at both 24 h and 9 days post-BrdU-injection. Double immunolabelling with neuronal specific antibodies, to either NeuN, or beta-tubulin III, confirmed that most BrdU labelled cells appeared to be neurons. Unbiased stereological analysis of labelled cells in selected forebrain areas 24 h post BrdU injection showed a significant MeA-training induced increase in labelled cells in both the dorsal VZ surface bordering the intermediate and medial hyperstriatum ventrale (IMHV) and the tuberculum olfactorium (TO). By 9 days post-BrdU-injection, there was a significantly greater number of BrdU labelled cells in MeA-trained birds within the IMHV, lobus parolfactorius (LPO) and TO. These results demonstrate that avoidance training in 1-day-old chicks has a marked effect on cell proliferation, in the LPO and IMHV, regions of the chick previously identified as a key loci of memory formation, and in a second region (TO), which has olfactory functions, but has not been previously investigated in relation to avoidance learning.

Advancing nursing scholarship through the interpretation of imaginative literature: ancestral connectedness and the survival of the sufferer

Imaginative literature has played an important role in nursing practice and education since the time of Florence Nightingale. Used primarily as an exemplar, however, its potential has not been realized fully by nurses. This article addresses the use of imaginative literature in scholarly inquiry. Often considered the aegis of literary critics and philosophers, the formal discipline of literary criticism enables the nurse to identify concepts and to generate theoretic explanations about human phenomena. The relationship between the ancestor and the survival of the sufferer is illustrated using Morrison's literary and cultural paradigm applied to selected novels. Implications for practice are identified.

Difficult cases in heart failure: Left ventricular dysfunction related to septic shock masquerading as postpartum cardiomyopathy

Peripartum cardiomyopathy, an uncommon cause of chronic heart failure, may present during the third trimester of pregnancy, but most often develops within 2 months postpartum. The etiologies of heart failure during pregnancy and postpartum are numerous, however. The authors describe the case of a 25-year-old woman who developed severe, symptomatic heart failure following delivery and discuss their initial consideration of peripartum cardiomyopathy and the differential diagnostic features of this case. (c)2001 CHF, Inc.

Comparison of oral capecitabine versus intravenous fluorouracil plus leucovorin as first-line treatment in 605 patients with metastatic colorectal cancer: results of a randomized phase III study

PURPOSE

To compare the response rate, efficacy parameters, and toxicity profile of oral capecitabine with bolus intravenous (IV) fluorouracil plus leucovorin (5-FU/LV) as first-line treatment in patients with metastatic colorectal cancer.

PATIENTS AND METHODS

We prospectively randomized 605 patients to treatment with oral capecitabine for 14 days every 3 weeks or 5-FU/LV by rapid IV injection daily for 5 days in 4-week cycles.

RESULTS

The overall objective tumor response rate among all randomized patients was significantly higher in the capecitabine group (24.8%) than in the 5-FU/LV group (15.5%; P =.005). In the capecitabine and 5-FU/LV groups, median times to disease progression were 4.3 and 4.7 months (log-rank P =.72), median times to treatment failure were 4.1 and 3.1 months (P =.19), and median overall survival times were 12.5 and 13.3 months (P =.974), respectively. Capecitabine, compared with bolus 5-FU/LV treatment, produced a significantly lower incidence (P <.0002) of diarrhea, stomatitis, nausea, and alopecia. Patients treated with capecitabine also displayed lower incidences of grade 3/4 stomatitis and grade 3/4 neutropenia (P <.0001) leading to significantly less neutropenic fever/sepsis. Grade 3 hand-foot syndrome (P <.00001) and grade 3/4 hyperbilirubinemia were the only toxicities more frequently associated with capecitabine than with 5-FU/LV treatment.

CONCLUSION

Oral capecitabine was more active than 5-FU/LV in the induction of objective tumor responses. Time to disease progression and survival were at least equivalent for capecitabine compared with the 5-FU/LV arm. Capecitabine also demonstrated clinically meaningful benefits over bolus 5-FU/LV in terms of tolerability.

Down-regulation of a ripening-related beta-galactosidase gene (TBG1) in transgenic tomato fruits

Exo-galactanase/beta-galactosidase (EC 3.2.1.23) activity is thought to be responsible for the loss of galactosyl residues from the cell walls of ripening tomatoes. Transgenic tomato plants (Lycopersicon esculentum Mill cv. Ailsa Craig) with reduced exo-galactanase/beta-galactosidase mRNA were generated to test this hypothesis and to investigate the role of the enzyme in fruit softening. A previously identified tomato beta-galactosidase cDNA clone, TBG1, was used in the experiments. Heterologous expression of the clone in yeast demonstrated that TBG1 could release galactosyl residues from tomato cell wall galactans. Transgenic plants showed a reduction in TBG1 mRNA to 10% of normal levels in the ripening fruits. However, despite the reduction in message, total beta-galactosidase and exo-galactanase activities were unaffected. Furthermore, there was no apparent effect on levels of cell wall galactosyl residues when compared with the control. It was concluded that during the ripening of tomato fruits a family of beta-galactosidases capable of degrading cell wall galactans are active and down-regulation of TBG1 message to 10% was insufficient to alter the degree of galactan degradation.

Neo-adjuvant therapy improves resectability rates for colorectal liver metastases

PURPOSE

Liver resection improves survival in selected patients with colorectal liver metastases. However, the majority of patients with colorectal liver metastases have inoperable disease at presentation. Neo-adjuvant therapy (systemic or regional chemotherapy and interstitial laser therapy) used singly or in combination may convert a selected group of patients with irresectable liver metastases into an operable state.

PATIENTS AND METHODS

We report a series of patients with initially inoperable multiple colorectal liver metastases who became operable after neo-adjuvant therapy. Operability was defined as unilateral disease limited to the liver. Twelve patients (7 female, 5 male, median age 57 years, range 38-69 years) with multiple inoperable colorectal liver metastases (8 synchronous, 4 metachronous) were initially treated with systemic chemotherapy (n = 7), hepatic arterial chemotherapy (n = 2) and chemotherapy plus interstitial laser therapy (n = 3).

RESULTS

In all cases, a significant response was achieved which enabled subsequent liver resection to be undertaken. There was only one postoperative complication (8%) and no peri-operative deaths. 3 patients were operated on within the last 12 months and are still alive. Of the remainder, 1 died within 1 year with recurrent disease. The remaining patients have a median survival of 2.5 years, range 1.39-4 years.

CONCLUSIONS

These results are similar to those reported for patients undergoing resection for operable metastases without neo-adjuvant therapy. Aggressive multimodality treatment of colorectal liver metastases in specialised centres may improve the resectability rates and survival in a selected group of patients.

Re-structuring of synapses 24 hours after induction of long-term potentiation in the dentate gyrus of the rat hippocampus in vivo

In male rats, long-term potentiation was induced unilaterally in the dentate gyrus, either by high frequency (200Hz) or theta rhythm stimulation. Structural synaptic changes were examined 24h after induction using quantitative electron microscopy. A disector technique was employed in order to estimate the density of synapses (using 70-80-nm sections) and of granule cell nuclei (using 2-microm sections) in the middle, and inner molecular layer in both hemispheres. Synaptic height and total lateral areas of synaptic active zones per unit tissue volume were assessed via assumption-free stereological techniques coupled with image analysis. The results obtained indicated that both synaptic density and number (corrected per neuron) of axo-spinous, but not axo-dendritic, synapses were approximately 40% higher in the middle, but not inner molecular layer of the potentiated hemisphere compared to the contralateral (control hemisphere). No significant inter-hemispheric difference was found in the volume densities of lateral areas of active zones. These data suggest that 24h after long-term potentiation induction, active zones of existing axo-spinous synapses either split forming separate contacts, or decrease in size while new synapses are formed.

Treating stuttering in young children: predicting treatment time in the Lidcombe Program

It is known that children may recover from stuttering without formal treatment during the first years after onset. Consequently, the timing of professional, early stuttering intervention is a pressing issue in speech-language pathology. This report presents data pertinent to this issue for 261 preschool-age children who received the Lidcombe Program of early stuttering intervention. Of these children, 250 completed the program and were considered by their clinicians to have been treated successfully. For the children who were treated successfully, logistical regression analyses were used to determine whether age, gender, period from onset to treatment, and stuttering severity related systematically to the time required for treatment. The present data confirmed previous reports that a median of 11 clinic visits was required to achieve zero or near-zero stuttering with the Lidcombe Program. Results were also consistent with a preliminary report of 14 children (C. W. Starkweather & S. R. Gottwald, 1993) showing a significant relation between stuttering severity and the time needed for treatment, with children with more severe stuttering requiring longer treatment times than children with less severe stuttering. However, results did not associate either increasing age or increased onset-to-treatment intervals with longer treatment times. This finding is not consistent with the Starkweather and Gottwald report, which linked advancing age with longer treatment time. In fact, the present data suggest that, for a short period after stuttering onset in the preschool years, a short delay in treatment does not appear to increase treatment time. An important caveat to these data is that they cannot be generalized to late childhood or early adolescence. The present findings are discussed in relation to natural recovery from stuttering.

Intolerable human suffering and the role of the ancestor: literary criticism as a means of analysis

Intolerable human suffering and the role of the ancestor: literary criticism as a means of analysis This essay explores the experience of intolerable human suffering in Toni Cade Bambara's novel, The Salt Eaters. The method of analysis is literary criticism, a technique that shares many of the same goals as other types of inquiry. It employs close reading to illuminate the novel's meaning(s), thereby revealing information about the nature of intolerable human suffering. Morrison's characteristics of black art is the literary and cultural framework that guides the analysis of Bambara's novel. The paradigm has broad application for nursing. The purpose of this analysis was to describe the role of the ancestral system as a predictor of the trajectory of suffering. The results extend Morrison's paradigm and her notion of ancestor to include traditions and other non-corporeal factors that are essential for well-being and survival. The protagonist in Bambara's novel, Velma Henry, is the patient and exemplar who does not succumb to intolerable suffering because of its cumulative weight, but because she has lost touch with the traditions of her people, an essential component of her ancestral system. The ancestral system is a rich and complex network of individuals, groups, customs and beliefs that are instructive, protective and benevolent. Ancestors are also timeless and provide wisdom, but when the ancestral system is weak or absent, the trajectory of suffering is not favourable. Nurses must learn to recognize intolerable human suffering, to identify the patient's ancestral system, and to work within that system to keep suffering patients from harm.

Intratracheal recombinant human deoxyribonuclease in acute life-threatening asthma refractory to conventional treatment

Recombinant human deoxyribonuclease (rhDNase) is a mucolytic agent used to relieve peripheral airway obstruction in patients with cystic fibrosis. We report dramatic sustained improvement following the intratracheal administration of rhDNase to a 3-yr-old boy with acute life-threatening asthma in whom 48 h of aggressive therapy had failed.

A quantitative autoradiographic comparison of binding to glutamate receptor sub-types in hippocampus and forebrain regions of a food-storing and a non-food-storing bird

In two species of birds, food-storing marsh tits, P. palustris, and non-storing blue tits, P. caeruleus, quantitative receptor autoradiography was used to localize NMDA (N-methyl-D-aspartate)-sensitive [3H]glutamate, [3H]MK801, and [3H]AMPA binding sites, in six regions of the forebrain: hippocampus and parahippocampus, hyperstriatum accessorium (vision) and ventrale (sensory integration), neostriatum (auditory), and lobus parolfactorius (basal ganglia). In both species high levels of labelling to both NMDA and AMPA receptors were observed throughout the forebrain. However, a marked difference in receptor labelling was apparent between the two species, with levels of binding to NMDA ion channel sites being significantly lower (20%) in both the hippocampus and parahippocampus, in food storers compared to non-food storers. The levels of binding to other forebrain regions were remarkably similar in the two species. No differences were seen in the binding to AMPA receptors in forebrain regions of either species.

Homeotic regulation of segment-specific differences in neuroblast numbers and proliferation in the Drosophila central nervous system

The number and pattern of neuroblasts that initially segregate from the neuroectoderm in the early Drosophila embryo is identical in thoracic and abdominal segments. However, during late embryogenesis differences in the numbers of neuroblasts and in the extent of neuroblast proliferation arise between these regions. We show that the homeotic genes Ultrabithorax and abdominal-A regulate these late differences, and that misexpression of either gene in thoracic neuroblasts after segregation is sufficient to induce abdominal behaviour. However, in wild type embryos we only detect abdominal-A and Ultrabithorax proteins in early neuroblasts. Furthermore, transplantation experiments reveal that segment-specific behaviour is determined prior to neuroblast segregation. Thus, the segment-specific differences in neuroblast behaviour seem to be determined in the early embryo, mediated through the expression of homeotic genes in early neuroblasts, and executed in later programmes controlling neuroblast numbers and proliferation.

Synapses in hippocampus occupy only 1-2% of cell membranes and are spaced less than half-micron apart: a quantitative ultrastructural analysis with discussion of physiological implications

Relatively little information exists regarding the spatial structure of synaptic neuropil in the brain. The present electron microscopic study employs unbiased stereological techniques and Monte Carlo simulations to characterise quantitatively the spatial organisation of synaptic circuitry in the dentate gyrus of the hippocampus, an area of particular importance in mechanisms of learning and the subject of a number of experimental neurobiological models of synaptic plasticity such as long-term potentiation. Firstly, tissue shrinkage/expansion resulting from embedding was assessed by imaging 300-microm thick hippocampal slices in the course of the entire embedding protocol, giving a value of 94.3 +/- 1.1% for distance measures and 84.3 +/- 2.8% for volumetric measures. Secondly, numeric synaptic density, Nv, was estimated using the disector. Thirdly, accumulated area of post-synaptic densities (PSDs) per tissue volume, Sv, and the overall cell membrane area per tissue volume, Sv*, were assessed using unbiased stereological rules coupled with image analysis of single sections. Finally, the mean area of individual PSDs was derived as a ratio Sv/Nv giving: 0.0394 microm2 for axo-spinous PSDs (thus representing approximately 1.3% of total cell membranes) and 0.0769 microm2 for dendritic shaft PSDs (approximately 0.25% of total cell membranes). From these data, the mean nearest neighbour distance between synapses was estimated using Monte Carlo simulations of a random 3D arrangement of synapses constrained by PSD sizes (a truncated Poisson process), giving a value of 0.48-0.51 microm. The physiological importance of the morphometric data obtained is discussed in terms of assessing (i) the role of synaptic environment in modifying synaptic efficacy and (ii) the plausibility of cross talk between synapses in relation to extrasynaptic neurotransmitter diffusion and transient depletion of extracellular Ca2+.

The effect of soybean protein on bone loss in a rat model of postmenopausal osteoporosis

This study was designed to investigate the modulatory effect of dietary soybean protein on the skeleton of an ovariectomized rat model with postmenopausal osteoporosis. Thirty-two female Sprague-Dawley rats were weight matched and divided into the following four experimental groups: Soy group, ovariectomized and fed soy protein diet; Estrogen group, ovariectomized, fed casein diet and injected with estrogen; Casein group, ovariectomized and fed casein diet; and Sham group, sham-operated and fed casein diet. The diets and estrogen were started two weeks after surgery, and continued for four weeks. Rats in the Sham, Soy and Estrogen groups had significantly higher (p < 0.05) femur and tibia ash content than those in the Casein group. Accordingly, the calcium content of the tibia and femur were also significantly higher (p < 0.05) in the Soy, Estrogen and Sham groups as compared to the Casein group. Serum total and bone-type alkaline phosphatase levels were both significantly lower (p < 0.05) in the Estrogen and Sham groups in relation to the Soy and Casein groups. This study demonstrated that a 22% soybean protein diet could be just as effective as daily estrogen administration in suppressing bone loss due to ovariectomy. However, unlike estrogen, soy protein diet did not have any uterotrophic effect and did not decrease the markers of bone turnover measured, suggesting a possible difference in the mechanism of action.

Ultrastructural synaptic correlates of spatial learning in rat hippocampus

Memory formation is believed to alter neural circuitry at the synaptic level. Although the hippocampus is known to play an important role in spatial learning, no experimental data exist on the synaptic correlates of this process at the ultrastructural level. Here, we have employed quantitative electron microscopy in order to compare the density, size and spatial arrangement of synapses in the dentate gyrus, and in area CA1, of spatially trained (water maze, invisible platform) versus control (visible platform) rats. No training-associated changes of hippocampal volume were found using a stereological estimaion (disector) of the volume density of dentate granule, or CA1 pyramidal cells. Nor were changes found in either density, or sizes of synapses (spinous or dendritic), in CA1 or dentate gyrus. However, analysis of synaptic spatial distribution showed a training-associated increase in the frequency of shorter distances (i.e. clustering) between synaptic active zones in CA1, but not dentate, thus indicating alterations in local neural circuitry. This finding indicates subtle changes in synaptic organization in area CA1 of the hippocampus following a learning experience, suggesting that spatial memory formation in mammalian hippocampus may involve topographical changes in local circuitry without synapse formation de novo.

The Lidcombe Programme of early stuttering intervention: methods and issues

The Lidcombe Programme is an operant intervention for early stuttering that parents administer to children in their everyday speaking environments. The treatment was developed at the Suttering Unit, Bankstown Health Service, Sydney, and The University of Sydney. Recently, staff from the Australian Stuttering Research Centre. The University of Sydney, toured universities and clinics in the UK to present lectures about this treatment. We were encouraged to write this paper because an independent survey showed that most speech and language therapists who attended the presentations were open to this treatment. Prior to and following that lecture tour, publications in the press and professional journals in the UK alluded to many positive features of the Lidcombe Programme, but also raised several issues about it. The purpose of this paper is to summarise the Lidcombe Programme and address the following criticisms of the treatment that were raised in the UK: (1) Stuttering is complex but the Lidcombe Programme is simple; (2) the Lidcombe Programme is not an operant treatment, but invokes positive changes in children's environments; (3) the Lidcombe Programme is harmful to children; and (4) the scientific evidence in support of the Lidcombe Programme is flawed. Each of these issues is addressed from logical, theoretical and empirical viewpoints.

mu-Opioid receptor binding in chicken brain in relation to degree of food restriction: a quantitative autoradiographic study

Quantitative receptor autoradiography was used to measure differences in [3H]DAGO binding to mu-opioid receptors in selected fore- and midbrain regions of chickens subject to varying degrees of chronic food restriction: either R (a recommended restricted ration), 2R (twice recommended restricted ration) or AL (ad libitum). A significant increase in binding of 75% was observed in the paleostriatum primitivum (a homologue of the mammalian globus pallidus) with the R treatment compared to the 2R and AL treatments. This finding concurs with results of earlier pharmacological manipulations with opioid antagonists, which indicated that activation of mu-opioid receptors plays a contributory role in reinforcement of post-feeding oral stereotypies in chickens subject to the same R treatment.

Speech outcomes of a prolonged-speech treatment for stuttering

It has been shown that people who stutter can speak with greatly reduced stuttering after treatments that use variations of Goldiamond's (1965) prolonged-speech (PS). However, outcome research to date has not taken account of several important issues. In particular, speech outcome measures in that research have been insufficient to show that lasting relief from stuttering has been achieved by clients outside the clinic for meaningful periods. The present study used extensive speech outcome measures across a variety of situations in evaluating the outcome of an intensive PS treatment (Ingham, 1987). The speech of 12 clients in this treatment was assessed on three occasions prior to treatment and frequently-on eight occasions-after discharge from the residential setting. For 7 clients, a further assessment occurred at 3 years posttreatment. Concurrent dependent measures were percent syllables stuttered, syllables per minute, and speech naturalness. The dependent measures were collected in many speaking situations within and beyond the clinic. Dependent measures were based on speech samples of substantive duration, and covert assessments were included in the study. Detailed data were presented for individual subjects. Results showed that 12 subjects who remained with the entire 2-3-year program achieved zero or near-zero stuttering. The majority of subjects did not show a regression trend in %SS or speech naturalness scores during the posttreatment period, either within or beyond the clinic. Some subjects showed higher posttreatment %SS scores during covert assessment than during overt assessment. Results also showed that stuttering was eliminated without using unusually slow and unnatural speech patterns. This treatment program does not specify a target speech rate range, and many clients maintained stutter-free speech using speech rates that were higher than the range typically specified in intensive PS programs. A significant correlation was found between speech rate and perceived posttreatment speech naturalness.

Development of a clinical tool and patient questionnaire for evaluation of patellofemoral pain syndrome patients

OBJECTIVE

To develop an evaluation tool for patellofemoral pain syndrome (PFPS) patients.

DESIGN

Exploratory, descriptive content validation study.

PARTICIPANTS

Convenience sample, three groups of clinicians: 15 sports physical therapists, 9 sports medicine physicians, and 10 physical therapists and physicians with limited experience with PFPS. Selection based on specialization qualifications and experience with PFPS patients. DESCRIPTION OF TESTS: Content validation questionnaire to determine importance of clinical outcomes in determining change in PFPS patients. Using 10-cm visual analogue scales, reviewers rated the importance of five domains and rated the importance of twenty-one clinical tests; using a categorical scale, determined appropriateness and clarity of potential patient questionnaire items.

MAIN RESULTS

Correlation values indicated significant correlation (p < 0.01) between pain and functional limitations (r = 0.068) and activity and functional limitations (r = 0.67), indicating that functional limitation may not be a unique component, but is integrated with pain and activity. A set of five pain questions, twelve function questions and six activity questions was developed. No statistical differences (p < 0.05) between the three groups of clinicians for the majority of clinical tests. Statistical differences (p < 0.05) between the three groups for rating of importance of flexibility of hip flexor and flexibility of gastrocnemius-soleus muscle groups, knee swelling, and radiographs. Good internal consistency among the 21 clinical tests (Cronbach's alpha = 0.84). The five top rated tests considering mean score values and standard deviations: lower extremity alignment, patellar orientation, patellar mobility, and flexibility of rectus femoris and tensor fasciae latae muscle groups.

CONCLUSIONS

The results provide evidence of content validity for the components of PFPS evaluation investigated. The findings provide a basis of design of an evaluation tool for PFPS patients consisting of patient self-report questionnaire items and clinical tests.

Research in the training of general surgeons: results of a survey

By means of a postal questionnaire to all members of the Association of Surgeons of Great Britain and Ireland, attitudes to the importance, timing, and assessment of research activity in surgical training were obtained. There was a 71% response rate. Most believe that a period of research is desirable, highly desirable or essential, irrespective of whether a University/Teaching or DGH consultant. The implications of incorporation of research into training programmes are discussed.