Selective release of nitric oxide from retinal amacrine and bipolar cells

PURPOSE

To investigate the cellular origin of nitric oxide released from the rabbit retina in response to physiological stimulation with light.

METHODS

The release of nitric oxide from the retina was measured in rabbits anesthetized with urethane. An eye-cup was prepared and was filled with Krebs-Ringer bicarbonate. After washing for 45 minutes, 0.5 ml medium was placed in the eyecup. The medium was replaced every 10 minutes, and nitric oxide in the resultant samples was measured using nitrate reductase and a nitric oxide meter.

RESULTS

In the unstimulated dark-adapted retina there was a spontaneous resting release of nitric oxide (1.20 nmol/min). When the retina was stimulated for 10 minutes with flickering light there was an increase in nitric oxide release to almost double the resting release. Stimulation of the retina for 10 minutes with continuous light produced a similar increase in nitric oxide release. The exposure of the retina to L-amino-4-phosphonobutyrate (APB), which specifically blocks transmission between the photoreceptors and the depolarizing bipolar cells, abolished the evoked release of nitric oxide caused by flickering light and continuous light. In contrast, the nonselective excitatory amino acid antagonist cis-2,3-piperidinedicarboxylic acid (PDA) had no effect on the flicker-evoked release of nitric oxide, but it more than halved the release caused by continuous light. A similar differential effect on release was found with glycine, which abolished the nitric oxide release evoked with continuous light but did not affect the flicker-evoked release. The inhibitory effect of glycine was blocked by strychnine.

CONCLUSIONS

Nitric oxide was released in the retina by flickering light and by continuous light, but the two types of stimulation cause nitric oxide release from different cells. Because in the rabbit retina nitric oxide synthase occurs mainly in a subpopulation of amacrine cells and a few bipolar cells, our pharmacologic results suggest that continuous light causes nitric oxide release from amacrine cells, whereas flickering light evokes nitric oxide release from bipolar cells.

Effects of scopolamine on delayed-matching-to-sample and paired associates tests of visual memory and learning in human subjects: comparison with diazepam and implications for dementia

Two experiments examined dose-related effects of 200, 400 and 600 micrograms scopolamine (n = 24, s.c.) and 5 and 10 mg diazepam (n = 6, PO) on parallel tests of visual memory and learning taken from the CANTAB battery. Scopolamine significantly impaired accuracy of performance on a delayed matching to sample test of visual recognition memory in a dose- and delay-dependent manner, but had only marginal decremental effects on a test of visuospatial paired associates learning. Scopolamine significantly lengthened decision times in a visual search matching to sample task at the 400 and 600 micrograms doses, without significantly affecting accuracy. The drug also impaired performance on tests of spatial (on accuracy and response time measures) and pattern (on response time only) memory. Most of the deleterious effects on scopolamine were removed by covariance analyses with indices of subjective sedation, but the effects of delayed matching accuracy and latency remained. By contrast, diazepam significantly impaired paired associates learning but affected delayed matching to sample in a delay-independent manner. These results suggest that scopolamine can produce selective deficits in tests of short-term visual recognition memory which do not depend on overall impairments in arousal and which contrast with deficits in visual associative learning produced by diazepam. They have implications for the pharmacological modelling of dementia and memory disorders in man and for the neurochemical substrates of the short-term recognition memory and associative learning for visual stimuli.

Extracorporeal shock wave lithotripsy for obstructing pancreatic duct calculi

PURPOSE

A review was done to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of impacted pancreatic duct calculi.

MATERIALS AND METHODS

A total of 19 patients, who were potential candidates for radical pancreatic surgery after unsuccessful endoscopic retrograde cholangiopancreatography, sphincterotomy and attempted stone extraction from the pancreatic ducts, underwent ESWL of the calculi. Followup ranged from 6 months to 6 years.

RESULTS

Of the 19 patients 14 avoided a major operation and 6 have remained pain-free for the long term. Two patients died of causes not related to ESWL or endoscopic retrograde cholangiopancreatography. Five patients eventually underwent a Whipple or Puestow procedure for relief of symptoms or persistent obstruction. Complications were minimal.

CONCLUSIONS

ESWL is a valuable adjunct in patients with impacted pancreatic duct calculi unretrievable by primary endoscopic retrograde cholangiopancreatography.

Nitric oxide enhancement of cholinergic amacrine activity by inhibition of glycine release

PURPOSE

To investigate a possible interaction between cholinergic and nitrergic amacrine cells in the rabbit retina.

METHODS

The activity of cholinergic amacrine cells was estimated by measuring the light-evoked release of [3H]-acetylcholine (ACh) from the retina of rabbits anesthetized with urethane. An eyecup was prepared and filled with Krebs-Ringer bicarbonate solution, containing [3H]-choline. After washing with fresh medium containing physostigmine, 0.5 ml of medium was placed in the eyecup. The medium was replaced every 5 minutes, and the radioactivity in the resultant samples was measured. In some experiments the release of [3H]-ACh and glycine was measured using isolated retinas.

RESULTS

Local application of the nitric oxide (NO) donors, S-nitroso-N-acetyl-DL-penicillamine and sodium nitroprusside strikingly enhanced the light-evoked release of [3H]-ACh. In contrast, inhibition of nitric oxide synthase with L-nitromonomethylarginine (LNMMA) or N-nitro-L-arginine (LNA) greatly reduced the light-evoked release of [3H]-ACh. In that the response of cholinergic amacrine cells is damped by an inhibitory feedback circuit involving glycinergic amacrine cells, the effect of strychnine on the inhibitory action of LNMMA was examined, Strychnine abolished the inhibitory effect of LNMMA on the light-evoked release of [3H]-ACh, suggesting that endogenous NO normally has an inhibitory effect on glycinergic amacrine cells. This idea was supported by experiments using isolated retinas, in which sodium nitroprusside and S-nitroso-N-acetyl-DL-penicillamine inhibited the potassium-evoked release of glycine but enhanced the release of [3H]-ACh.

CONCLUSIONS

Endogenous NO is released in the retina and acts indirectly to facilitate the light-evoked response of cholinergic amacrine cells.

Effects of methylphenidate on spatial working memory and planning in healthy young adults

Previous studies of the effects of the psychomotor stimulant, methylphenidate, have concentrated on vigilance and reaction time tasks. In this study, the effects of methylphenidate on more complex aspects of cognition were studied using tasks from the CANTAB battery and related tests which have been shown to be sensitive to frontal lobe dysfunction. Twenty-eight young healthy men participated in a counterbalanced, double-blind, placebo-controlled study of the effects of methylphenidate. Cognitive assessment included tests of spatial working memory, planning, verbal fluency, attentional set-shifting and sustained attention. Methylphenidate had significant effects on performance of the tests of spatial working memory and planning but not on the attentional and fluency tests. When the drug was taken on the first test session, performance on the spatial tests was enhanced by the drug compared to placebo. However, when the drug was taken second, performance accuracy was impaired whereas response latencies were decreased. These results are consistent with a hypothesis that methylphenidate influences performance in two conflicting ways; enhancing executive aspects of spatial function on novel tasks but impairing previously established performance. This pattern of effects is discussed within the framework of dual, interacting arousal mechanisms.

Osteitis pubis after periurethral collagen injection

Periurethral collagen injection is a relatively new procedure to treat stress incontinence. Until now, complications and side effects have been minor and transient. We will present the first reported case of osteitis pubis after periurethral collagen injection.

FlyBase: a Drosophila database. The FlyBase consortium

FlyBase is a database of genetic and molecular data concerning Drosophila. FlyBase is maintained as a relational database (in Sybase) and is made available as html documents and flat files. The scope of FlyBase includes: genes, alleles (and phenotypes), aberrations, transposons, pointers to sequence data, clones, stock lists, Drosophila workers and bibliographic references. The Encyclopedia of Drosophila is a joint effort between FlyBase and the Berkeley Drosophila Genome Project which integrates FlyBase data with those from the BDGP.

Chronic mild stress and sucrose consumption: validity as a model of depression

Sucrose consumption and preference were examined in rats subjected to a 6-week regimen of unpredictable mild stressors, after Willner et al. (11). These subjects were compared with groups exposed to: 1. only the food deprivation element of the stress protocol; or 2. the stress protocol without the food deprivation element. A control group was not exposed to stressors. Body weight and sucrose consumption were significantly reduced in stressed and food-deprived animals compared to the other 2 groups. These variables therefore appeared dependent on food deprivation and independent of other elements of the stress protocol. Neither sucrose consumption per gram body weight nor sucrose preference differed significantly among the 4 groups. These results indicate that food deprivation is not only necessary, but sufficient, to produce sucrose consumption deficits in rats. It is, therefore, likely that reduced sucrose consumption in stressed rats results solely from diminished body weight rather than exposure to the series of stressors. We conclude that sucrose consumption is not a valid index of reward responsiveness. Other measures (such as place-preference conditioning or intracranial self-stimulation threshold) should be evaluated also with respect to body weight change when considering the validity of stressor-based models of depressive disorder.

Retarded acquisition and reduced expression of conditioned locomotor activity in adult rats following repeated early maternal separation: effects of prefeeding, d-amphetamine, dopamine antagonists and clonidine

Adult hooded rats exposed to a repeated maternal separation procedure during the neonatal period showed a blunted expression of locomotor hyperactivity conditioned to the presentation of the daily food ration. We have demonstrated that the expression of food-conditioned anticipatory hyperactivity is sensitive to the response-enhancing effects of systemic d-amphetamine (0.5; 1.0 mg/kg) and to the response-attenuating effects of the selective dopamine D2 antagonist sulpiride (8; 20 mg/kg), the selective dopamine D1 antagonist SCH 23390 (0.01; 0.022 mg/kg) and the mixed alpha 1/alpha 2 adrenoceptor agonist clonidine (5; 15 micrograms/kg) in a dose dependent manner. Animals from the early separation groups showed a reduced enhancement of activity in response to 0.5 mg/kg d-amphetamine and a greater attenuation of activity in response to 8 mg/kg sulpiride and 5 micrograms/kg clonidine. Female separated rats also exhibited an attenuated locomotor response to the unconditioned stimulant effects of 0.5 mg/kg systemic d-amphetamine. The experiments confirm that early maternal separation attenuates the response to conditioned appetitive cues in adult rats and implicate altered dopaminergic and noradrenergic function in the changes. It is possible that early maternal separation in the rat may offer a useful preparation for investigation of the neural substrates mediating affective development and affective psychopathology.

Rewarding electrical brain stimulation: similar thresholds for Flinders Sensitive Line Hypercholinergic and Flinders Resistant Line Hypocholinergic rats

Flinders Sensitive Line hypercholinergic rats, which exhibit augmented hypothermic responses to the cholinesterase inhibitor physostigmine and to the muscarinic agonist oxotremorine, have been proposed to represent a useful animal model for some aspects of human depression. With disturbance of reward processes considered to be a core feature of depression, the present studies were designed to investigate the neuropharmacology of brain stimulation-reward (BSR) in Flinders Sensitive Line (FSL) rats, Flinders Resistant Line (FRL) rats, and outbred control Sprague-Dawley rats. All animals were tested in a rate-free, current-threshold brain stimulation-reward paradigm, following acute challenges with the monoamine reuptake inhibitor cocaine, the dopamine D1 receptor antagonist SCH-23390, the cholinergic muscarinic antagonist scopolamine, and the serotonin reuptake inhibitor fluoxetine. Baseline BSR thresholds did not differ across the three groups. For all groups, cocaine lowered thresholds, SCH-23390 and scopolamine-elevated thresholds, while fluoxetine had no significant effect. Thresholds for the three groups were not differentially affected by pharmacological locomotor activity relative to outbred Sprague-Dawley controls. These results suggest that both Flinders lines exhibit behavioral differences from outbred control rats, but not with regard to reward processes as assessed by rewarding electrical stimulation of the lateral hypothalamus.

Repeated maternal separation of preweanling rats attenuates behavioral responses to primary and conditioned incentives in adulthood

Early social experience has profound effects on a wide spectrum of behaviors and neurochemical correlates in the rat. Repeated separation of rat pups from their dam during the early neonatal period causes acute perturbation of neuroendocrine and physiological status. The chronic sequelae of repeated separations have not been studied as extensively as the acute responses. Altered social experience at a later developmental stage, postweaning isolation rearing, is known to induce enduring changes in the behavioral responses to reward and reward-related stimuli in maturity. We have evaluated the influence of repeated early maternal separation on the responses to both primary and conditioned incentives in mature rats. Separated animals showed enhanced weight gain, a blunted locomotor response to a novel environment and a blunting of the response to both negative and positive contrast effects. Female separated animals, but not males, exhibited a profound attenuation of the acquisition of a conditioned anticipatory locomotor response to the presentation of food. These data are discussed with respect to the putative involvement of ventral striatal dopamine systems in reward mechanisms and the potential utility of early maternal separation as an animal model of depression.

Development of risk factors for cardiovascular disease among women from adolescence to older ages

The development of risk factors for young adults to older ages for women has been evaluated in several studies. The increase in risk factor levels is related to age, weight gain, and diet. The levels of risk factors are related to extent of atherosclerosis, even at relatively young ages. The prevention of increase in risk factors is of primary importance for the future reduction of morbidity and mortality due to cardiovascular disease.

Infrared spectrum of the cool brown dwarf Gl 229B

Spectroscopic measurements of a cool brown dwarf, Gl 229B, reveal absorption features attributable to methane in the near infrared much like those of Jupiter. These features are not seen in any star. The presence of methane indicates that the surface temperature of Gl 229B is below 1000 kelvin. Features attributed to water vapor also indicate that Gl 229B is much cooler than any known star.

Glycerol-3-phosphate dehydrogenase activity in human lymphocytes: effects of insulin, obesity and weight loss

Insulin exposure stimulates an increase in glycerol-3-phosphate dehydrogenase (G3PDH) activity in isolated human lymphocytes that correlates to an increase in G3PDH mRNA and requires new protein synthesis. Synthetic diacylglycerol or phorbol ester can mimic the effect of insulin on G3PDH activity, suggesting that protein kinase C may be involved in regulation of G3PDH levels. In addition, lithium chloride, an inositol phosphate phosphatase inhibitor, and calcium uptake inhibitors can abolish insulin stimulation of G3PDH activity. For obese subjects in whom insulin resistance in vitro can be demonstrated, the extent of insulin stimulation of G3PDH activity is decreased compared to normal weight individuals, and treatment by a very low calorie diet restores insulin stimulation of G3PDH activity. Thus, insulin stimulation of G3PDH activity is dependent upon the metabolic state of the subject from whom the cells are obtained.

Sucrose consumption as an hedonic measure following chronic unpredictable mild stress

The consumption of, and preference for, a rewarding 0.9% sucrose solution was examined in rats subjected chronically (8 wk) to a regimen of unpredictable mild stressors. Intake of sucrose was reduced in stressed animals compared to controls after 3 wk. However, correction for body weight changes revealed no significant difference in sucrose consumption between the groups. A comparison of the mean sucrose intakes of matched low-weight rats, with low weight a function of either immaturity or stress, failed to differentiate between the groups. Total sucrose consumption and total fluid intake correlated significantly with body weight of stressed animals and controls. Percentage preference for sucrose solution did not differ between controls and stressed animals. It is concluded that the validity and reliability of sucrose consumption as an hedonic measure within the context of exposure to chronic unpredictable mild stress must be questioned.

One year experience of elderly hypertensive patients with isradipine therapy

This is the first report of long-term use (one year) of isradipine, a new dihydropyridine calcium channel blocker, in the treatment of elderly patients with essential hypertension. Patients completing a three month, double-blind, multicentre study comparing isradipine to hydrochlorothiazide (HCTZ) were eligible to enroll in this open-label, continuation study. At initial baseline, patients were at least 60 years of age and had DBP from 95 mmHg to 120 mmHg. Patients were titrated when necessary every two weeks with isradipine, 5 mg to 15 mg once daily or 2.5 mg to 10 mg twice daily, to maintain sitting DBP < or = 90 mmHg. HCTZ, 12.5 mg to 50 mg once daily, could be added for better BP control. A total of 136 patients completed the one year, open-label phase. One hundred and fourteen patients (84%) received isradipine as monotherapy (mean dose, 9.7 mg/day); 22 received concomitant HCTZ therapy at one year. Reduction in DBP was significant and similar among all age groups and races (mean change of -19 mmHg). Reduction in SBP was similar among all age groups. Ninety-four per cent of those receiving isradipine monotherapy achieved BP control during the last four months of treatment. Twenty-six patients (16%) withdrew from the study: 11 (7%) had adverse reactions (one with headache, two with pedal oedema, eight with other problems); 11 (7%) had nondrug-related problems; and in four (2%), the drugs were ineffective. Based on these observations, isradipine is a well-tolerated, safe and effective agent for long-term BP control in elderly patients with essential hypertension.

Psychiatric resident moonlighting : a review and modest proposal

Moonlighting by psychiatric residents remains controversial, with debate surrounding the ethical, legal, financial, and educational risks involved in the practice. The authors present a literature review of resident moonlighting, which encompasses the policy positions of various organizations responsible for graduate medical education; surveys of various groups and specialties regarding the prevalence, form, and justification for moonlighting; and models of moonlighting programs in several institutions. The authors conclude with specific proposals for research regarding psychiatric resident moonlighting and, more importantly, emphasize the need for research on the effects of moonlighting on resident performance and education.

Flinders resistant hypocholinergic rats exhibit startle sensitization and reduced startle thresholds

Based on the hypothesis that depression involves a cholinergic-adrenergic neurotransmitter imbalance, a putative genetic animal model of depression has been developed by selectively breeding rats to exhibit hypocholinergia (Flinders Resistant Line--FRL), or hypercholinergia (Flinders Sensitive Line--FSL). The present experiments were designed to test the behavioral reactivity of these rats to external stimuli by measuring acoustic startle responses. The FRL rats exhibited lower startle thresholds compared to both FSL and control rats, while the FSL rats' startle thresholds were between those of controls and FRL rats. Despite the differences in thresholds, the three groups demonstrated similar levels of maximal startle reactivity to a high-intensity acoustic stimulus. With repeated stimulus presentations, FRL rats developed startle sensitization, a rarely observed phenomenon, while FSL and control rats exhibited habituation. There were no differences between the three groups in prepulse inhibition of startle. These results indicated that FRL rats exhibited interesting startle phenomena that are characteristic of certain psychiatric disorders, such as schizophrenia, post-traumatic stress disorder, and, potentially, depression.

Suicide in Scotland 1988-1989. Psychiatric and physical morbidity according to primary care case notes

BACKGROUND

The aim was to identify the amount of psychiatric and physical morbidity identified in suicide victims prior to death.

METHOD

A survey was made of primary care records of Scottish suicide victims in the years 1988 and 1989.

RESULTS

Less morbidity was encountered than in previous studies. Single persons and persons from lower socio-economic groups were less likely to have a diagnosis of depression. No association was found between physical and psychiatric morbidity. Depressed single persons and depressed persons from lower socio-economic groups were less likely to receive antidepressants. GPs prescribed lower dosages of antidepressants than psychiatrists. Patients receiving antidepressants were more likely to die by drug overdose.

CONCLUSIONS

There are groups in whom depression may be being overlooked and others in whom depression could be treated more vigorously. There are risks in prescribing antidepressants which are potentially fatal in overdose.

Role of doctors in the prevention of suicide: the final consultation

BACKGROUND

It is generally assumed that people committing suicide see their doctor shortly before their death, and consequently that enhancing doctors' psychiatric knowledge and interview skills might help prevent some suicides.

AIM

A study was undertaken to determine the nature and timing of final contacts with medical practitioners by people committing suicide.

METHOD

Adults dying by suicide in Scotland during 1988-89 were identified by the General Register Office for Scotland and their primary care case notes studied.

RESULTS

Within this national sample, medical contact near to the time of the suicidal act was rare, except for those individuals who had a previous psychiatric history.

CONCLUSION

These data suggest that medical practitioners, particularly those working in primary care, are not failing to detect and intervene in significant numbers of preventable suicides. Consequently, the likelihood of implementing successful suicide prevention strategies based within primary care is open to question. Greater awareness of the risk of eventual suicide in those with a previous history of psychiatric disorder may contribute to any future reduction in suicide rates.

Electrostatic forces contribute to interactions between trp repressor dimers

The trp repressor of Escherichia coli (TR), although generally considered to be dimeric, has been shown by fluorescence anisotropy of extrinsically labeled protein to undergo oligomerization in solution at protein concentrations in the micromolar range (Fernando, T., and C. A. Royer 1992. Biochemistry. 31:3429-3441). Providing evidence that oligomerization is an intrinsic property of TR, the present studies using chemical cross-linking, analytical ultracentrifugation, and molecular sieve chromatography demonstrate that unmodified TR dimers form higher order aggregates. Tetramers and higher order species were observed in chemical cross-linking experiments at concentrations between 1 and 40 microM. Results from analytical ultracentrifugation and gel filtration chromatography were consistent with average molecular weight values between tetramer and dimer, although no plateaus in the association were evident over the concentration ranges studied, indicating that higher order species are populated. Analytical ultracentrifugation data in presence of corepressor imply that corepressor binding destabilizes the higher order aggregates, an observation that is consistent with the earlier fluorescence work. Through the investigation of the salt and pH dependence of oligomerization, the present studies have revealed an electrostatic component to the interactions between TR dimers.

Climate change impact on distribution and abundance of wildlife species: an analytical approach using GIS

An analytical approach to modelling the likely impact of climate change on the distribution and abundance of wildlife species is described using examples from Scotland. Data for present day distribution of wildlife and habitat are analysed using map data describing geographic variation in climatic factors. Climate data for the present day and under specified scenarios of change are themselves modelled within a GIS; climate modelling uses meteorological station data, climate change scenarios developed from GCMs and a variety of spatial interpolation techniques. The analytical procedure generates hypotheses defining ecological relationships between species distribution and climatic factors (monthly, seasonal and annual data). These relationships are then used to model the distribution of the species directly from climate and predict impacts of climate change. The analysis takes account of both direct impacts of climate on wildlife and indirect effects manifested through habitat response to climate change. The analytical procedure is implemented as a generic tool for inductive spatial analysis in GIS.

The use of antidepressant drugs in general practice. A questionnaire survey

The aim of this study was to examine the anti-depressant drug prescribing preferences and habits of a population of general practitioners. The method used was that of a questionnaire survey, including case vignettes. The response rate exceeded 70% Data are presented out-lining the attitudes of the respondents to the use of antidepressant drugs in the management of common psychiatric presentations in the primary care setting. The majority of general practitioners (G.P.'s) had received little or no post-graduate education in psychiatry. The antidepressants most frequently prescribed were amitriptyline, clomipramine, trazodone and lofepramine. Despite recognition of the alarming frequency of serious self-poisoning incidents with some of these compounds, 26% of respondents confessed to an inability to make an informed choice of antidepressant drug, with 14% using the same drug with every patient with no attempt to select according to individual patient requirements. The management of depressive neurosis generates considerable clinical confusion with a variety of interventions favoured. The use of a sedating antidepressant is popular. There is greater accord for the management of endogenomorphic depression. The use of the benzodiazepine drugs in the management of anxiety disorders is infrequent, with appropriate recognition of the merits of behavioural approaches. However, the role for antidepressant drugs in the management of anxiety disorders is under-recognized. We conclude that general practitioners are required to undertake a significant body of work for which they may be inadequately trained.

Effects of exercise training on cardiovascular function and plasma lipid, lipoprotein, and apolipoprotein concentrations in premenopausal and postmenopausal women

This study examined the effects of aerobic exercise on lipid levels in premenopausal and postmenopausal women. Fifty healthy middle-aged women (mean age, 50 years) were randomly assigned to 12 weeks of either aerobic exercise (walking and jogging) or nonaerobic strength exercise (circuit Nautilus training). Concentrations of total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and very low density lipoprotein cholesterol were assessed, along with apolipoprotein (apo) A-I, apo A-II, apo B, and triglycerides. To document changes in aerobic capacity, maximum treadmill testing was performed with expired-gas analysis before and after the exercise program. Aerobic exercise was associated with an 18% improvement in peak VO2. Women in the aerobic group had an increased VO2, from 26.7 to 31.4 ml/kg/min (p less than 0.0001), while the VO2 of the women in the strength training group did not change (25.8 ml/kg/min before and after). There were no differential changes in lipid levels because all subjects experienced slight reductions in high density lipoprotein cholesterol and total cholesterol and increases in apo A-I and the apo A-I to apo B ratio. There was a tendency for the aerobic group to exhibit lower levels of apo A-II and a greater apo A-I to apo A-II ratio, however. We conclude that premenopausal and postmenopausal women experience similar changes in aerobic capacity and lipid levels with exercise and that the short-term effects of aerobic and nonaerobic exercise on lipid profiles are generally comparable.

Which antidepressant?

The prescription of psychotropic drugs, and particularly the use of antidepressants, has received considerable attention in the medical literature, the media and from legislative bodies in recent years. Medical practitioners are faced with a bewildering array of apparently efficacious drugs from which they must choose when prescribing for a depressed patient. This paper discusses the main parameters which guide this choice, namely clinical efficacy, adverse effects profile, safety in overdose and monetary cost. It concludes by making some recommendations for the prescription of antidepressant drugs.

The other side of the phone. Sales representatives in the OR

21. There are certain expectations that salespersons need to be aware of to have continued business, quality time, and an invitation to return to the surgery department. 2. It is important to know that even competitive institutions have their channels of communication open about products, equipment, and dependability of the sales representatives. 3. Not all companies offer appropriate training to prepare their sales representatives for the operating room. 4. Sales representatives need to remember that admission to the operating room is a privilege, not a right, and privileges can be revoked.

Endoscopic cholecystectomy: a new approach

Many general surgeons who want to do this procedure must learn the laparoscopic technique, which has long been the procedure of gynecology surgeons. The benefits associated with the laparoscopic cholecystectomy make it a procedure of choice for patients, third party payers, and employers.

A reliability assessment of the Psychotherapy Supervisory Inventory

The authors investigated the reliability of the Psychotherapy Supervisory Inventory scales, which rate behaviors of supervisors on the basis of observation of supervision sessions. The scales assess focus on the therapist and the patient, intellectual and experimental orientation, number of clarifying and interpretive comments, intensity of confrontation, depth of exploration, verbal activity level of the supervisor, dominance of the supervisor and the therapist, comfort and tension levels, and empathy of the supervisor. Intraclass correlation coefficients were significant for all scales, indicating that trained observers can agree in distinguishing supervisory behaviors. These scales can be used in further research and for feedback to supervisors.

Reproductive history of women dying of sudden cardiac death: a case-control study

Reproductive history events may be risk factors for sudden coronary death (SCD) among women. A retrospective case-control study of SCD among women aged 25-64 was conducted in Allegheny County, Pennsylvania. The present analysis focused on a description and analysis involving the childbearing and reproductive history of 67 ever-married female SCD cases and 73 ever-married neighbourhood controls with a mean age of 54.6 and 53.4 years respectively. Information included: age and number of years married, number of children, age at first birth, cardiovascular risk factors, obstetric and gynaecological history. Age and the risk factors, history of hypertension or diabetes, cigarette intake, death of significant other and psychiatric disease, were controlled for in the analysis. More cases than controls experienced their first birth before age 20 (14 of the SCD and 7 controls). However, after adjustment for cigarette smoking status, a strong predictor of sudden cardiac death, the effect of early childbearing did not remain significant for this population. In women less than or equal to 50 years of age, childlessness was not a risk factor for SCD (1 of 16 cases and 2 of 26 controls were childless). However in women greater than 50 years of age, childlessness was a significant predictor of SCD (OR = 6.7 (1.3-32] 12 of 51 cases were childless compared to 2 of 46 controls. After adjustment for aged and other coronary heart disease (CHD) risk factors, the relationship of nulliparity with sudden cardiac death remained in this age group. There was no difference in hysterectomy or miscarriage history or in the total years married between cases and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Obesity, obesity-related behaviors and coronary heart disease risk factors in black and white premenopausal women

Obesity is more common in black women than in white women in the USA, but there are few studies comparing black and white females on behaviors related to obesity or on the relationship between obesity and cardiovascular risk factors. We studied 490 white and 48 black premenopausal, nondiabetic, nonhypertensive women, aged 42-50 years, who were participating in the Pittsburgh Healthy Women Study. Black women had a higher BMI than white women and had a higher suprailiac:triceps ratio, suggesting a more central distribution of body fat. Weight gain since age 20 was greater in black women than in white women. Blacks and whites did not differ in caloric intake, smoking or alcohol consumption. However, there were marked differences in physical activity, with blacks reporting significantly less activity than whites. Differences in body fat distribution, weight gain since age 20 and activity remained after adjusting for education. Blacks also had higher blood pressure and poorer glucose tolerance than whites. The low activity level of black women should be considered when designing weight loss interventions.

Tryptophan repressor of Escherichia coli shows unusual thermal stability

Differential scanning calorimetry demonstrates that the tryptophan repressor of Escherichia coli is unusually resistant to thermal denaturation. The dimeric protein undergoes reversible dissociative unfolding at pH 7.5 centered at about 90 degrees C. The thermal stability may be due in part to the unusual structure of the protein, which is composed of two identical intertwined polypeptide chains.

The NGF-inducible SCG10 mRNA encodes a novel membrane-bound protein present in growth cones and abundant in developing neurons

We have characterized and sequenced cDNA clones corresponding to the neural-specific SCG10 mRNA. The predicted amino acid sequence is novel and not strongly homologous to that of any known polypeptide. The protein is encoded by two mRNAs that differ in their choice of polyadenylation site. Immunocytochemical localization experiments using an affinity-purified antibody (against an SCG10-TrpE fusion protein) reveal accumulations of punctate staining in the perinuclear cytoplasm, axons, and growth cones of cultured neurons. SCG10 levels are maximal in the embryonic CNS but are dramatically reduced in the adult. Preliminary cell fractionation experiments suggest that the protein is tightly associated with membranes but is not itself an integral membrane protein. The apparent localization and timing of expression of the SCG10 protein are reminiscent of GAP-43, but the sequences of the two polypeptides are unrelated. Cross-hybridizing mRNAs and antigenically related proteins are found in several nonneuronal cell lines that do not express SCG10.

Pelviscopy. An endoscopic alternative to laparotomy

Pelviscopy has positive aspects for the patient. The procedure reduces the amount of time the patient spends in surgery, the recovery period, and the amount of time the patient must be away from work. Much like other endoscopic procedures, pelviscopy incurs little or no bleeding, and reduces inflammatory tissue response.

Desmopressin and bleeding time in patients with cirrhosis

Desmopressin acetate 0.3 microgram/kg was given intravenously to nine patients with chronic liver disease and to a further six such patients in a double blind controlled study versus placebo. Desmopressin acetate significantly shortened the bleeding time compared with basal values in both groups and compared with placebo. There was also a significant decrease in partial thromboplastin time (but not prothrombin time) and significant increases in factor VIII and its components, von Willebrand factor and ristocetin cofactor activity, but not in factors VII, IX, X, XI, or XII. Increased fibrinolysis could be blocked by concomitant administration of tranexamic acid. No important side effects were seen. The multimer pattern of von Willebrand factor was studied for the first time in chronic liver disease. It was normal, but after administration of desmopressin acetate the percentage of multimers of higher molecular weight increased significantly. This may be an important mechanism in the shortening of the bleeding time in cirrhosis, as has been shown in uraemia and other conditions after administration of desmopressin acetate. Desmopressin acetate may be useful in correcting defects in primary haemostasis in chronic liver disease.