Medical training in psychiatry residency. A proposed curriculum

During the coming decades, psychiatrists will be asked to participate to a greater extent in the physical evaluation and treatment of patients with behavioral or emotional problems. Despite the high frequency with which psychiatric symptoms are caused or exacerbated by organic disease, psychiatrists have been reluctant, and in some ways, even discouraged to include physical assessments. Psychoanalysis and concerns about boundary issues have influenced psychiatrists to cede physical assessment and physical illness to other physicians. To help overcome these barriers to improved care of psychiatric patients, a curriculum is proposed for psychiatry residents. It will allow them to better use their medical backgrounds while increasing their contributions as mental health specialists.

Growth inhibition of Prevotella ruminicola by protamine

Growth of Prevotella ruminicola strains B(1)4 (subsp. brevis) and D31d (subsp. ruminicola), was inhibited by protamine, a polycationic, low molecular mass protein. Results showed that protamine has a bacteriocidal effect when present in concentrations exceeding 30 micrograms ml-1. Protamine exerted its toxic effects by disrupting the outer membrane, which was demonstrated by: (i) an increased sensitivity to hydrophobic antibiotics (novobiocin and monensin) and (ii) release of the periplasmic enzyme alkaline phosphatase following short-term exposure to protamine. Although the concentrations of protamine inhibitory to P. ruminicola are relatively low, the effects of such a compound are probably too broad to permit its successful use in terms of manipulating ruminal proteolysis.

Pattern recognition in muscle misuse voice disorders: how I do it

The diagnosis of the patient with a muscle misuse voice disorder can be a complex process. The dysphonia is usually caused by problems stemming from a number of interacting factors that may include habitual vocal technique and postural use, vocal behavior, emotion, manifestations of gastroesophageal reflux, neuromuscular abnormalities, and associated organic mucosal disease. Sorting out the relative importance of the various factors is the first step towards planning an effective treatment program. This article addresses the difficulties caused by trying to classify dysphonia too rigidly, and presents a strategy for collecting the necessary information in a manner that facilitates the development of effective tools for clinical decision making. For each dysphonic patient, a pattern of causation will emerge in a way that helps the clinician to disentangle the interrelated factors.

Biochemical and mutational analysis of a gingipain-like peptidase activity from Prevotella ruminicola B(1)4 and its role in ammonia production by ruminal bacteria

A chemical mutagenesis protocol was used with the ruminal bacterium Prevotella ruminicola strain B(1)4 to generate mutant strains defective in peptidase activity. Compared with the wild-type parent strain, the isolated mutants possessed 1/10 of the enzyme activity responsible for cleavage of glycine-arginine-4-methoxy-beta-naphthylamide (Gly-Arg-MNA). A concomitant loss in activity against arginine-arginine-4-methoxy-beta-naphthylamide (Arg-Arg-MNA) was also observed. Both activities were similarly affected by various proteinase inhibitors, suggesting that the same enzyme is responsible for the Arg-Arg-MNA peptidase and Gly-Arg-MNA peptidase activities. Growth rates of wild-type and mutant strains grown in batch culture with various nitrogen sources did not differ. However, a role for the Gly-Arg-MNA peptidase activity was demonstrated in coculture experiments with gram-positive, ammonia-producing ruminal bacteria. The rate and extent of ammonia production were reduced by approximately 25% in cocultures containing the mutants when compared with that of wild-type-containing cultures. These reductions could not be accounted for simply by the decrease in ammonia production by the mutant strain alone. To our knowledge, this paper reports the first successful use of chemical mutagenesis with ruminal microorganisms.

The NAD(P)H-utilizing glutamate dehydrogenase of Bacteroides thetaiotaomicron belongs to enzyme family I, and its activity is affected by trans-acting gene(s) positioned downstream of gdhA

Previous studies have suggested that regulation of the enzymes of ammonia assimilation in human colonic Bacteroides species is coordinated differently than in other eubacteria. The gene encoding an NAD(P)H-dependent glutamate dehydrogenase (gdhA) in Bacteroides thetaiotaomicron was cloned and expressed in Escherichia coli by mutant complementation from the recombinant plasmid pANS100. Examination of the predicted GdhA amino acid sequence revealed that this enzyme possesses motifs typical of the family I-type hexameric GDH proteins. Northern blot analysis with a gdhA-specific probe indicated that a single transcript with an electrophoretic mobility of approximately 1.6 kb was produced in both B. thetaiotaomicron and E. coli gdhA+ transformants. Although gdhA transcription was unaffected, no GdhA enzyme activity could be detected in E. coli transformants when smaller DNA fragments from pANS100, which contained the entire gdhA gene, were analyzed. Enzyme activity was restored if these E. coli strains were cotransformed with a second plasmid, which contained a 3-kb segment of DNA located downstream of the gdhA coding region. Frameshift mutagenesis within the DNA downstream of gdhA in pANS100 also resulted in the loss of GdhA enzyme activity. Collectively, these results are interpreted as evidence for the role of an additional gene product(s) in modulating the activity of GDH enzyme activity. Insertional mutagenesis experiments which led to disruption of the gdhA gene on the B. thetaiotaomicron chromosome indicated that gdhA mutants were not glutamate auxotrophs, but attempts to isolate similar mutants with insertion mutations in the region downstream of the gdhA gene were unsuccessful.

The NAD(P)H-dependent glutamate dehydrogenase activities of Prevotella ruminicola B(1)4 can be attributed to one enzyme (GdhA), and gdhA expression is regulated in response to the nitrogen source available for growth

Prevotella ruminicola B(1)4 possesses both NADPH- and NADH-linked glutamate dehydrogenase (GDH) activities, with the greatest specific activity being measured from ammonia-limited cultures. Relative to cells grown in the presence of 1 mM ammonium chloride, the NADPH-dependent activity was decreased approximately 10-fold when peptides were provided as a nitrogen source. Nondenaturing polyacrylamide gel electrophoresis (PAGE) was used to visualize the GDH protein(s) in cell extracts of P. ruminicola. For all growth conditions tested, only one GDH protein was detectable, and its relative abundance, as well as its reactivity with either NAD(P)+ or NAD(P)H, correlated well with the specific activities measured from whole-cell assays. Consistent with the findings from enzyme assays and PAGE activity gels, Northern (RNA) blot analysis revealed that expression of a gene encoding NAD(P)H-GDH activity was greatest in ammonia-grown cultures and that GDH activity is regulated in response to nitrogen source (ammonia versus peptides), probably at the level of transcription. A gene encoding the NAD(P)H-utilizing GDH activity (gdhA) was cloned, and its nucleotide sequence was determined and shown to contain an open reading frame of 1,332 bp which would encode a polypeptide of 48.8 kDa. The deduced amino acid sequence possesses three highly conserved motifs typical of family I GDHs, but several unique amino acid substitutions within these motifs were evident. These results are discussed within the context of ruminal nitrogen metabolism and the growth efficiency of succinate- and propionate-producing anaerobic bacteria.

Do ruminal bacteria exchange genetic material?

This paper discusses the reasons and current evidence for gene transfer between ruminal bacteria and other bacteria in the environment, possible routes for genetic exchange, and candidate genes. Gene transfer between ruminal bacteria has been demonstrated in vitro; however, success has been only minimal in obtaining plasmids and other self-transmissible genetic material from ruminal bacteria. The application of molecular biology techniques with ruminal microorganisms should permit the opportunity for an in vivo assessment of gene transfer. Studies that could provide pertinent information for ruminal microbiologists and dairy nutritionists are outlined.

The role of stroboscopy in the management of a patient with a unilateral vocal fold paralysis

Stroboscopy is well established as an essential diagnostic tool in the assessment of the vocal folds during phonation. This paper analyses the stroboscopic findings in 100 patients with a unilateral vocal fold paralysis. Reliable stroboscopic signals were only obtained in patients with the paralysed fold close to the midline. These patients seldom require surgery however, usually responding to speech therapy with laryngeal compensation giving a good voice. Most patients that require surgery have a large glottal deficiency, but in this series these patients did not give an adequate signal for analysis. Although useful in the assessment of the muscle tone of the paralysed fold, the influence of stroboscopy on the surgical treatment in this series was limited.

Nitrogen metabolism by ruminal microorganisms: current understanding and future perspectives

This review presents an outline of our current understanding of ruminal nitrogen metabolism from three perspectives: proteolytic microorganisms and their enzymes, intraruminal recycling of microbial protein, and enzymes of ammonia assimilation. Some of the pending advances and future research opportunities in these areas are also discussed. The 'smugglin' concept appears to offer the potential to inhibit peptide-utilizing bacteria selectively in the rumen, as demonstrated by initial studies with Prevotella ruminicola. The relative contributions of protozoa-, bacteriophage-, and self-mediated lysis of bacteria to intraruminal recycling of microbial protein are not yet quantified, and further efforts to understand the biology and dynamics of ruminal bacteriophage and protozoa populations are warranted. In Ruminococcus flavefaciens and Prevotella ruminicola, glutamate dehydrogenase (GDH) appears to be the predominant route of ammonia assimilation irrespective of ammonia concentration, and peptides modulate GDH activity in P. ruminicola. The physiological basis behind the difference between optimal ammonia concentrations for ruminal fibre digestion and microbial protein synthesis remains unclear. Molecular biology techniques extend beyond their application in pursuit of the 'superbug' concept, by offering new and exciting opportunities to understand better microbial physiology, diversity, and ecology. Fundamental research in these areas must be continued if further advances in feed utilization and nutrient retention are to be realized.

Short-term results of laryngeal framework surgery--thyroplasty type 1: A pilot study

This article prospectively analyses 10 patients with a unilateral vocal cord paralysis who were nonrandomly selected for laryngeal framework surgery. Pre- and postoperative videolaryngoscopic, acoustic, and laryngeal airflow recordings of each patient's voice were taken and compared with the patient's own subjective analysis of his/her voice. Results indicate that laryngeal framework surgery using the surgical technique described in this paper gives a statistically and clinically improved voice in the short term.

Managing sacral pressure ulcers with hydrocolloid dressings: results of a controlled, clinical study

One-hundred and three patients with Stage II and III sacral pressure ulcers were enrolled in a prospective, controlled, multi-center clinical study to evaluate and compare dressing performance, safety and efficacy. Fifty-two patients were randomized to treatment with a triangle-shaped hydrocolloid border dressing and 51 patients were randomized to a different, oval shape, hydrocolloid dressing. The majority of patients (70 percent) utilized a pressure reducing mattress or bed. Most ulcers were Stage II, had existed for < 1 month and exhibited no change utilizing previous treatments. Patients and wounds were similarly distributed among treatment groups. Patients in the oval dressing group were more likely to exhibit a product related adverse reaction resulting in discontinuation of treatment as compared to patients treated with the triangle border dressing (p = 0.057, Fisher's Exact Test). Wear time was longest for wounds dressed with the triangle dressing applied point down. Incontinence reduced the interval between dressing changes in both groups. Healing was more likely to occur in wounds dressed with the triangle border dressing. These ulcers showed a greater reduction in ulcer width as compared to wounds dressed with the oval dressing (p < 0.03, Fisher's Exact Test).

Filgrastim fails to improve haemopoietic reconstitution following myeloablative chemotherapy and peripheral blood stem cell rescue

The morbidity of high-dose chemotherapy has been considerably reduced by the use of autologous peripheral blood progenitor cell reinfusion. Most studies have used myeloid colony-stimulating factors after stem cell reinfusion, making it difficult to determine the relative contribution of each of these variables to the early recovery of blood cells. The financial implications of colony-stimulating factor use are an area of concern as dose intensification in chemosensitive malignancies is increasingly employed. We have studied 19 consecutive patients receiving high-dose chemotherapy with and without filgrastim (Amgen, granulocyte colony-stimulating factor, G-CSF) after stem cell infusion to examine its effect on the kinetics of blood cell recovery, the complications of myelosuppression and the associated costs. Analysis of the two treatment groups reveals that administration of filgrastim 10 micrograms kg-1 day-1 following stem cell reinfusion does not further accelerate haemopoietic recovery, fails to reduce the incidence of neutropenic fever or antibiotic usage and significantly increases the cost of the procedure. The results of this study do not support the routine use of filgrastim after high-dose chemotherapy and peripheral blood stem cell reinfusion.

The restriction endonuclease RflFII, isolated from Ruminococcus flavefaciens FD-1, recognizes the sequence 5'-AGTACT-3', and is inhibited by site-specific adenine methylation

Molecular studies of the rumen bacterium Ruminococcus flavefaciens are constrained by the lack of stable gene transfer systems. We report here on the characterization of RflFII, a restriction endonuclease isolated from R. flavefaciens FD-1. The enzyme is an isoschizomer of ScaI, and cleavage of the DNA is blunt-ended, between the internal TA dinucleotide sequence of 5'-AGTACT-3'. Chromosomal DNA preparations were used to demonstrate that adenine methylation of DNA within the sequence 5'-GTAC-3' inhibits both RflFII and the restriction endonucleases RsaI and ScaI. Chromosomal DNA from R. flavefaciens FD-1 is also host modified to protect against cleavage by ScaI.

Asthma ski day: cold air sports safe with peak flow monitoring

The Colorado Asthma Ski Day, an annual cross-country and alpine skiing event, encourages children with asthma to participate fully in outdoor winter sports. Since cold air and exercise can trigger bronchospasm, we examined the peak expiratory flow rates of 80 children who attended Asthma Ski Day 1992 or Asthma Ski Day 1993 to establish a safety profile for this event. Peak expiratory flow rates were measured prior to skiing, at lunchtime, and at the end of the day's activities. We asked the children to pretreat with their regular medications, as prescribed by their physicians, to use their bronchodilator inhalers p.r.n., and to report to our medical station if an episode of acute asthma occurred. The average age of the participants was 9.5 years, and the average baseline daytime peak flow rate was 100.03% of predicted. The average percent change in peak flow rates during the day was an increase of 5.00%. Our results demonstrate that with medical supervision, peak expiratory flow rate monitoring, and properly administered medications, peak flow rates can be stabilized and even improve during cold-weather exercise to an extent that safety concerns need not restrict children with asthma from engaging in exercise or cold-weather sports. The Colorado Asthma Ski Day can serve as a model event for other organizations that want to promote outdoor activities for children with asthma.

Multidimensional locus of control and attitudes toward mental illness

University students (55 women and 37 men) participated in a study of the relationship between multidimensional locus of control and attitudes toward mental illness as measured by the five factors of the Opinions About Mental Illness scale. Semipartial correlations suggested that scores on multidimensional locus of control were related to scores on three of the five factors but that the pattern of relationships is subject to gender differences.

Record of Volcanism Since 7000 B.C. from the GISP2 Greenland Ice Core and Implications for the Volcano-Climate System

Sulfate concentrations from continuous biyearly sampling of the GISP2 Greenland ice core provide a record of potential climate-forcing volcanism since 7000 B.C. Although 85 percent of the events recorded over the last 2000 years were matched to documented volcanic eruptions, only about 30 percent of the events from 1 to 7000 B.C. were matched to such events. Several historic eruptions may have been greater sulfur producers than previously thought. There are three times as many events from 5000 to 7000 B.C. as over the last two millennia with sulfate deposition equal to or up to five times that of the largest known historical eruptions. This increased volcanism in the early Holocene may have contributed to climatic cooling.

State association-sponsored program for SBB candidates

Concern about the closure of the only Specialist in Blood Banking (SBB) School in the State of Michigan prompted the Michigan Association of Blood Banks (MABB) to develop and administer a comprehensive series of lectures to meet the needs of technologists seeking SBB certification via the experiential route. The program consisted of more than 60 1(1/2)-hour lectures covering all aspects of blood banking (genetics, coagulation, immunology, blood group serology, blood collection and administration, and transfusion medicine) except infectious disease testing and management issues. The latter were presented during two free-standing one-day seminars (for which a fee was charged for those not registered for the lecture series). Educational techniques were covered in a self-study module. Two lectures were presented one morning each week from March through December, with no presentations during July. Lecturers were local volunteer experts, and detailed learning objectives were established for each topic. Each registrant was charged a nominal fee ($100 for MABB members; $150 for nonmembers). There were 32 registrants for the lecture series, with additional registrants for the seminars. Total revenue was $5,100, and expenses amounted to approximately $2,400, mostly for faculty honoraria and catering for the two seminars. The popularity of our program reflects the need for alternatives to formal SBB schools.

Synaptosomal amino acid release: effect of inhibiting protein phosphatases with okadaic acid

The protein phosphatase inhibitor okadaic acid was used to investigate the role of protein phosphatases in regulating the release of amino acids from synaptosomes. Okadaic acid increased the basal release of the amino acids glutamate, aspartate and GABA. The effect was specific in that taurine was not released by either KCl or okadaic acid and there was no synaptosomal lysis or change in ATP/ADP ratios in the presence of okadaic acid. The okadaic acid-stimulated release of amino acids was, however, only a small proportion of that produced by KCl depolarisation. Since okadaic acid raised synaptosomal protein phosphorylation levels to those equivalent to that produced by KCl depolarisation, it is unlikely therefore that there is a direct causal relationship between protein phosphorylation and the release of amino acids. Nevertheless, that release of amino acids from synaptosomes can be elevated under basal conditions by okadaic acid treatment does suggest that okadaic acid-sensitive protein phosphatases have a modulatory role in this process.

Molecular cloning of the human kidney differentiation antigen gp160: human aminopeptidase A

gp160 is a cell surface differentiation-related glycoprotein of 160 kDa expressed by epithelial cells of the glomerulus and proximal tubule cells of the human nephron but only by a subset of renal cell carcinomas (RCCs). We have reported that gp160 expression correlates with the resistance of cultured RCCs to the antiproliferative effects of alpha interferon, while lack of expression correlates with sensitivity to alpha interferon. In this study, we have purified gp160 protein, obtained partial sequences of random peptides, and isolated a full-length cDNA. The gp160 cDNA possesses 78% homology to the murine BP-1/6C3 antigen, a B-lymphocyte differentiation protein that exhibits aminopeptidase A (APA; EC 3.4.11.7) activity. Enzymatic assays on human RCC cell lines indicated a 100% concordance between APA activity and gp160 expression. APA activity of gp160-expressing RCC cells was increased or decreased by a panel of APA activators or inhibitors, respectively. Furthermore, anti-gp160 monoclonal antibodies immunoprecipitate APA activity from RCC cell lysates and selectively deplete APA activity from RCC cell extracts. These data indicate that the gp160 human kidney/RCC glycoprotein is human APA.

CORRELATES OF SOCIALLY RESTRICTIVE AND AUTHORITARIAN ATTITUDES TOWARD MENTAL PATIENTS IN UNIVERSITY STUDENTS

Ninety-two university students (55 women; 37 men) participated in a study of the relationship between authoritarian and socially restrictive attitudes toward mental patients and the variables of trait -anxiety, self-esteem, locus of control, age, and gender. Results of multivariate analyses showed that individuals who score high in authoritarianism tend to be young, male, and believers in chance and fate (external locus of control). A similar pattern was found for social restrictiveness.

Identification and characterization of three genes that affect expression of ADH2 in Saccharomyces cerevisiae

Using a new selection protocol we have identified and preliminarily characterized three new loci (ADR7, ADR8 and ADR9) which affect ADH2 (alcohol dehydrogenase isozyme II) expression. Mutants were selected which activate ADH2 expression in the presence of an over-expressed, normally inactive ADR1 allele. The mutants had very similar phenotypes with the exception that one was temperature sensitive for growth. In the absence of any ADR1 allele, the mutants allowed ADH2 to partially escape glucose repression. However, unlike wildtype strains deleted for ADR1, the mutants were able to efficiently derepress ADH2. The mutations allowed a small escape from glucose repression for secreted invertase, but had no effect on the glucose repression of isocitrate lyase or malate dehydrogenase. The mutations were shown to be nonallelic to a wide variety of previously characterized mutations, including mutations that affect other glucose-repressed enzymes.

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home

Few researchers have assessed family interaction patterns associated with childhood depression, especially using observations in natural settings. We directly sampled the interaction patterns of families with depressed, conduct-disordered, mixed depressed-conduct-disordered, and comparison children ages 7-14 years in their homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that conduct-disordered children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The depressed children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness in their own behavior. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of depressed children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior, and were exposed to similar patterns of parental behavior, as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology.

Partial purification and characterization of Ral8I, a class-IIS restriction endonuclease from Ruminococcus albus 8 which recognizes 5'-GGATC

Heparin-agarose chromatography was used to isolate a restriction endonuclease (ENase) from the cellulolytic Gram+ anaerobe, Ruminococcus albus 8. The enzyme, Ral8I, was eluted from the column using 230-310 mM Na+. However, the preparation was active only with DNA substrates that were not Dam-methylated. Moreover, the restriction fragment pattern generated from simian virus 40 (SV40) DNA was not consistent with the expected number of Dam-methylation sites. Alignment of the Dam-methylation sites in SV40 DNA indicated that Ral8I may actually recognize the asymmetric sequence, GGATC. This was confirmed by nucleotide (nt) sequence analysis and, further, Ral8I was found to cause cleavage of the DNA approx. 5 nt downstream from the recognition sequence. Ral8I can therefore be classified as a type-IIS restriction endonuclease and is an isoschizomer of AlwI, BinI and BthII.

Partial characterization of a DNA restriction endonuclease from Ruminococcus flavefaciens FD-1 and its inhibition by site-specific adenine methylation

The principal DNA restriction-modification system of the cellulolytic ruminal bacterium Ruminococcus flavefaciens FD-1 is described. The restriction endonuclease RflFI could be separated from cell extracts by phosphocellulose and heparin-sepharose chromatography. Restriction enzyme digests utilizing RflFI alone or in combination with SalI, a restriction enzyme isolated from Streptomyces albus G, showed that the DNA sequence recognized by RflFI either overlapped or was the same as that recognized by SalI. DNA sequence analysis confirmed that RflFI was identical in activity to SalI, with the recognition sequence being 5'-GTCGAC-3' and cleavage occurring between G and T. Adenine methylation within this sequence can be catalyzed in vitro by TaqI methylase, and this inhibited the cleavage of plasmid DNA molecules by RflFI and SalI. Chromosomal DNA from R. flavefaciens FD-1 is also methylated within this DNA sequence because neither restriction endonuclease could degrade this DNA substrate. These findings provide a means to protect plasmid molecules from degradation prior to gene transfer experiments with R. flavefaciens FD-1.

Cyclosporine monitoring by fluorescence polarization immunoassay

The monitoring of cyclosporine levels in whole blood and serum has become a routine procedure for the post-transplant management of immunosuppression. We have developed fluorescence polarization immunoassays for cyclosporine in whole blood and in serum using a monoclonal antibody. These assays are fast (20 determinations in less than 22 min), sensitive (25 micrograms/L for whole blood samples and 10 micrograms/L for serum samples), and precise (CV less than 7% in both assays). Cross-reactivities with AM1 (Metabolite 17) and AM4N (Metabolite 21) are less than 8.5 and 2.5%, respectively, for both assays.

Evidence that Cellulolysis by an Anaerobic Ruminal Fungus Is Catabolite Regulated by Glucose, Cellobiose, and Soluble Starch

A Piromyces -like ruminal fungus was used to study preferential carbohydrate utilization of [U- 14 C]cellulose, both alone and in combination with several soluble sugars. For cells grown on cellulose alone, cellulolytic activity was immediate and, initially, greater than that observed in the presence of added carbohydrate. Cellulolytic activity remained minimal in cultures containing cellulose plus glucose or cellobiose until the soluble sugar was depleted. Soluble starch also regulated cellulose activity but to a lesser extent. The results presented suggest that some fungal cellulases are susceptible to catabolite regulatory mechanisms.