mproved pregnancy outcome in a patient with renal allograft nephropathy undergoing temporary hemodialysis

We report a case of a woman with a poorly functioning renal allograft and a positive anti-cardiolipin antibody who was dialysis-independent and conceived 18 months following her transplant. She was electively maintained on hemodialysis during the pregnancy and delivered a live infant at 31 weeks gestation. Her renal function returned to prepregnancy levels post partum and she remained dialysis-independent.

Genetic test for involvement of intervening sequences in transport of nuclear RNA

The construction of a recombinant virus in the late region of simian virus 40 is presented. The small intervening sequence of late 19S RNA (0.760 to 0.765 map unit) was cloned and inserted into the EcoRI site (1.0 map unit) in the late region of simian virus 40. This is a mutant virus that now has two intervening sequences, one at the normal position (0.760 map unit) and another out of the context of its flanking sequence and now at 1.0 map unit. The recombinant appears poisonous, as repeated attempts to plaque it as a virus with a standard helper virus were unsuccessful. The transcription of this recombinant was, therefore, studied after direct DNA transfection onto CV-1 cells. Nuclease S1 analysis of mutant RNA indicates that the major nuclear transcript was a spliced but nuclear 16S RNA species. Normally, 16S RNA is not found in the nucleus. This result was shown to be an artifact of the DNA transfection protocol. When the glycerol shock was done after infection with virus, a similar alteration in the makeup of nuclear RNA was seen. A transient stock of this double-intron mutant was finally obtained, using a nonrevertable helper virus. The transcriptional analysis of this mutant showed that unspliced 19S RNA was not transported and remained within the nucleus, whereas spliced 19S and 16S RNAs were transported. We conclude that the retention of nuclear transcripts within the nucleus is not simply due to the presence of intronic sequences, as spliced 19S and 16S RNAs which contain the second intron were efficiently transported.

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services

OBJECTIVE

To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services.

METHODS

Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data.

RESULTS

The integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities. There were increased numbers of referrals between clinical services in the Sandyford Initiative.

CONCLUSIONS

Sexual, reproductive and women's services can be integrated to provide improved facilities for clients.

Secretary's advisory committee on genetic testing: its emerging role in public policy deliberation on genetic tests

The Secretary's Advisory Committee on Genetic Testing (SACGT) was established by the U.S. Secretary of Health and Human Services, Donna E. Shalala, to provide a public forum for the formulation of policy advice in the complex and growing area of genetic testing. After a careful nomination and selection process, the Secretary announced the appointment of thirteen advisors to the SACGT in June 1999. The first meeting of the SACGT was held June 30, 1999. This article describes the purpose, formation, and function of the SACGT. Before addressing these questions about the role of the SACGT, we first will explain what genetic testing is, how it is currently used, and what new uses it may be put to in the future.

Detection and consequences of recombinant protein isoforms: implications for biological potency

Various types of structural variants have been observed in recombinant DNA - derived products. These isoforms include variations in post translational carbohydrate modifications where variations in site occupancy or unoccupied sites may occur. In addition, varying degrees of C-terminal processing and N-terminal substitutions have been observed. Isoforms may also be generated during processing and can include aggregated and/or chemically modified forms of the protein. Sophisticated analytical techniques exist for the identification and characterization of these structural variants. Several strategies have been used to isolate or enrich the isoform before molecular characterization. However, the effect these structural variations have on the biological activity of the product is less well understood. This may, in part, be due to the specificity and variability of the bioassay employed. This presentation describes the isolation and characterization of specific molecular isoforms for a monoclonal antibody product as well as an assessment of effects on biological activity.

The effects of maternal depression on fetal heart rate response to vibroacoustic stimulation

To better understand the effects of untreated maternal depression on the fetus, this study examined fetal heart rate (FHR) and FHR reactivity to vibroacoustic stimulation in pregnant women with untreated depression. The 20 participants were 32- to 36-week pregnant women divided into groups with depression (N = 10) and without depression (N = 10) based on the Beck Depression Inventory (BDI; Beck, 1977; Beck & Steer, 1987). Participants were attached to a fetal heart monitor, and 10 min of baseline FHR were recorded. A vibroacoustic stimulus (VAS) was presented, and an additional 10 min of FHR were recorded. Fetuses of mothers with depression had an elevated baseline FHR and a 3.5-fold delay in return to baseline FHR after VAS presentation. Additionally, mothers with depression had significantly higher anxiety levels and took fewer prenatal vitamins during pregnancy. Delayed habituation of FHR in the fetuses of mothers with depression may be due to alterations in the internal hormonal environment and could have implications for postnatal information processing.

The 'real-world' impact of improved diagnostic techniques for Chlamydia trachomatis infection in Glasgow

In April 1997, the main chlamydia laboratory in Glasgow introduced ligase chain reaction (LCR) as its standard diagnostic test. The diagnostic effectiveness and health economic impact of introduction of LCR testing was assessed. Between April 1996 to March 2000, results of all chlamydia detection tests on genital specimens sent from general practitioners and the two main sexual healthcare providers (Genitourinary Medicine and Family Planning services) were reviewed. A preliminary economic assessment, inclusive of staff, reagents, consumables and laboratory overheads was conducted. Overall, testing activity increased four and a half times between 1996-97 and 1999-2000; the proportionate rise was greatest in general practice. Although chlamydia testing in both genders increased over the review period, testing activity rose disproportionately in women (59%, compared with a 31% increase in men). The overall Chlamydia trachomatis detection rate rose from 4.8% in 1996-97 to 7.8% in 1999-2000. Following introduction of LCR testing, an estimated additional 331 men and 844 women were diagnosed during the study period. The cost per additional diagnosis made was estimated at 162 Pounds for men and 263 Pounds for women. Substantial health gains are likely to be achieved, at both an individual and public health level, as a result of introduction of LCR testing for genital chlamydial infection.

Bronchoconstriction following nebulised colistin in cystic fibrosis

Nebulised colistin is regularly used as antipseudomonal therapy in children with cystic fibrosis. We assessed bronchoconstriction in response to nebulised colistin in 58 children. Nebulised colistin significantly reduced FEV(1), MEF(25%), and SaO(2) for 15 minutes. In 20 children the reduction was greater than 10% from baseline FEV(1), and was still at that level in five at 30 minutes. Subjective assessment, baseline FEV(1), and serum IgE were unable to identify susceptible children. It is recommended that children receiving colistin should be carefully assessed for bronchoconstriction.

Biochemical markers evaluation of RAW transformed cells during treatment with various biomaterials

Upon introduction into the human body, biomaterials initially trigger a foreign-body inflammatory response. Furthermore, the wear debris associated with such materials as those used for orthopedic implants, artificial heart valves, and dental implants can cause the body to mount an inflammatory response. This involves the production of phagocytic macrophages that ingest the foreign material while simultaneously producing cytokines that serve as chemotactic agents for an amplified immune response. Currently titanium (Ti), polyethylene (PE), tricalcium phosphate (TCP) and hydroxyapatite (HA) are widely used as biomaterials in medical implants, and particle size is an important factor in the development of orthopedic, dental, and medical implants. The objective of this study was to investigate the effect of various biomaterials (Ti, mixed particle size polyethylene (MPE), ultra high molecular weight polyethylene (UHMWPE), mixed particle size TCP (MTCP), < 0.38 micron TCP (S-TCP), and hydroxyapatite (HA)) on the inflammatory reactions expressed by transformed RAW macrophages. RAW transformed monocytes were obtained from the American Cell Culture Line, (Rockville, MD). The cells were allowed to incubate in contact with the materials for intervals of 24, 48, and 72 hours. Biochemical tests and morphological evaluations were performed after each time point, including screening for cell number, cell protein levels, supernatant protein levels, lactate dehydrogenase (LDH), Maliondialdehyde (MDA), catalase by following standard lab protocols.

Morphological and biochemical modifications of human macrophages treated with various biomaterials

Although tissue culture techniques are used extensively to explore the biocompatibility of various biomaterials used in orthopaedic, dental and pharmaceutical fields, the role of these materials towards human monocytes/macrophages has not been fully elucidated. The specific objectives of this investigation were: (1) to determine the biochemical markers resulting from exposure of the human monocytes/macrophages to titanium (TI), large size polyethylene (LSP), submicron polyethylene (SPE), hydroxyapatite (HA), large particle size tricalcium phosphate (LTCP), and small particle size tricalcium phosphate (STCP), and (2) to morphologically evaluate the viability of the cells treated with the aforementioned biomaterials. Approximately 15 volunteers donated blood for each phase (24, 48, and 72 hours) of the experiment. The monocytes were isolated by following established lab procedures (Histopaque 1077 and 1119). Aseptic techniques were followed throughout each phase. Each phase contained four experimental groups (TI, LSP, SPE, HA). Each group was comprised of six wells. The total protein, catalase, LDH, MDA, and cell count were measured using established lab protocols. Data obtained suggests that: (I) regardless of the biomaterial being used all experimental groups experienced remarkable phagocytosis in the first two phases (24, 48 hours), (II) during the 24 hour phase MDA activities were increased in TI, LTCP, and STCP treated wells when compared to the control and other experimental groups, (III) in the 48 hour phase the MDA level increased in LPE and STCP treated cells, (IV) there were significant differences in LDH levels in LPE, STCP, and SPE at 24 hours compared to the control and other experimental groups, (V) LDH activities were increased in LPE, STCP, SPE, and LTCP at 48 hours, and (VI) at 72 hours there were significant increases in catalase activity in HA, TI, SPE and LPE when compared to the control group and other experimental groups. Information obtained from this study provided new ideas about the interrelationship of various biomaterials, the effect of size and cell response to the various biomaterials.

Iga nephropathy, antineutrophil cytoplasmic antibodies and crescentic glomerulonephritis in a patient with the Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome is an uncommon cause of renal dysfunction. Because of the risk of bleeding in this condition, few patients have undergone a renal biopsy. Renal dysfunction has been attributed to the deposition of ceroid pigment in the tubules and interstitial fibrosis. We report a case with renal biopsy findings of ceroid deposition and interstitial fibrosis, but also of mesangial IgA deposition, crescentic glomerulonephritis, and an interstitial lymphocytic infiltrate. Furthermore, perinuclear antineutrophil cytoplasmic antibodies of the IgG subclass were detected in a blood sample. It is well known that ceroid pigment in this syndrome accumulates in monocytes, macrophages and T lymphocytes and it has been suggested that this may affect their function. We suggest that this novel combination of renal changes might be explained on the basis of alterations in immune mechanisms in the Hermansky-Pudlak syndrome.

Zygotic expression of the caudal homolog pal-1 is required for posterior patterning in Caenorhabditis elegans embryogenesis

Previous work has shown that the Caenorhabditis elegans gene pal-1, a homolog of Drosophila caudal, is required maternally for blastomere specification in the early embryo and postembryonically for tail development in males. We show here that embryonic (zygotic) transcription of pal-1 is also required for posterior patterning during later embryogenesis. Embryos homozygous for strong loss-of-function mutations arrest as nonviable L1 larvae with gross posterior defects. PAL-1 protein produced from zygotic transcripts is expressed dynamically during gastrulation and morphogenesis in specific cells of all major lineages except the germ line. Most expressing cells are undergoing cell movements or forming midline structures or both. Mutant embryos exhibit defects involving most of the expressing cells. Aberrant early cell positions are observed in posterior hypodermis, both in the C-lineage cells that express pal-1 and in the neighboring hypodermal seam cell precursors, which do not, as well as in posterior muscle derived from the C and D lineages. Defects in late gastrulation, ventral hypodermal enclosure, and formation of the rectum result from failures of cell movements of ABp and MS descendants. Limited mosaic analysis supports the view that most of the required pal-1 functions are cell autonomous.

Crystallization of the cytotoxic domain of a ribosome-inactivating colicin in complex with its immunity protein

The complex between the ribonuclease domain of the ribosome-inactivating colicin E3 and its protein inhibitor, the cognate immunity Im3, has been crystallized and preliminary X-ray characterization has been performed. Single crystals of the 1:1 complex were grown from hanging-drop vapour-diffusion experiments using 2-propanol as a precipitant. The space group is P3(1)21 or P3(2)21, with unit-cell parameters a = b = 93.7, c = 76.2 A. When cryocooled, these crystals diffract to a resolution of 2.4 A. A search for suitable conventional heavy-atom derivatives was unsuccessful and so Im3 mutants containing engineered cysteine or methionine residues have been produced for mercury soaks and selenomethionine-labelling experiments, respectively.

Inhibition of a ribosome-inactivating ribonuclease: the crystal structure of the cytotoxic domain of colicin E3 in complex with its immunity protein

BACKGROUND

The cytotoxicity of most ribonuclease E colicins towards Escherichia coli arises from their ability to specifically cleave between bases 1493 and 1494 of 16S ribosomal RNA. This activity is carried by the C-terminal domain of the colicin, an activity which if left unneutralised would lead to destruction of the producing cell. To combat this the host E. coli cell produces an inhibitor protein, the immunity protein, which forms a complex with the ribonuclease domain effectively suppressing its activity.

RESULTS

We have solved the crystal structure of the cytotoxic domain of the ribonuclease colicin E3 in complex with its immunity protein, Im3. The structure of the ribonuclease domain, the first of its class, reveals a highly twisted central beta-sheet elaborated with a short N-terminal helix, the residues of which form a well-packed interface with the immunity protein.

CONCLUSIONS

The structure of the ribonuclease domain of colicin E3 is novel and forms an interface with its inhibitor which is significantly different in character to that reported for the DNase colicin complexes with their immunity proteins. The structure also gives insight into the mode of action of this class of enzymatic colicins by allowing the identification of potentially catalytic residues. This in turn reveals that the inhibitor does not bind at the active site but rather at an adjacent site, leaving the catalytic centre exposed in a fashion similar to that observed for the DNase colicins. Thus, E. coli appears to have evolved similar methods for ensuring efficient inhibition of the potentially destructive effects of the two classes of enzymatic colicins.

The structure of TolB, an essential component of the tol-dependent translocation system, and its protein-protein interaction with the translocation domain of colicin E9

BACKGROUND

E colicin proteins have three functional domains, each of which is implicated in one of the stages of killing Escherichia coli cells: receptor binding, translocation and cytotoxicity. The central (R) domain is responsible for receptor-binding activity whereas the N-terminal (T) domain mediates translocation, the process by which the C-terminal cytotoxic domain is transported from the receptor to the site of its cytotoxicity. The translocation of enzymatic E colicins like colicin E9 is dependent upon TolB but the details of the process are not known.

RESULTS

We have demonstrated a protein-protein interaction between the T domain of colicin E9 and TolB, an essential component of the tol-dependent translocation system in E. coli, using the yeast two-hybrid system. The crystal structure of TolB, a procaryotic tryptophan-aspartate (WD) repeat protein, reveals an N-terminal alpha + beta domain based on a five-stranded mixed beta sheet and a C-terminal six-bladed beta-propeller domain.

CONCLUSIONS

The results suggest that the TolB-box residues of the T domain of colicin E9 interact with the beta-propeller domain of TolB. The protein-protein interactions of other beta-propeller-containing proteins, the yeast yPrp4 protein and G proteins, are mediated by the loops or outer sheets of the propeller blades. The determination of the three-dimensional structure of the T domain-TolB complex and the isolation of mutations in TolB that abolish the interaction with the T domain will reveal fine details of the protein-protein interaction of TolB and the T domain of E colicins.

The prevalence of gender dysphoria in Scotland: a primary care study

A questionnaire was sent to senior partners in all general practices in Scotland designed to elicit experience of patients with gender dysphoria: a subjective experience of incongruity between genital anatomy and gender identity. Responses were received from 73% of practices. The prevalence of gender dysphoria among patients aged over 15 years was calculated as 8.18 per 100,000, with an approximate sex ratio of 4:1 in favour of male-to-female patients. One-third of gender-dysphoric patients known to practices had registered in the preceding 12 months, suggesting that patients with this condition are increasingly likely to present for medical care.

The utilisation of shared governance to improve vascular access catheter care

This article looks at the implementation of shared governance at directorate level and its role in improving vascular access catheter care.

Expression of a recombinant form of the V antigen of Yersinia pestis, using three different expression systems

Yersinia pestis, the causative organism of plague, produces V antigen (LcrV), a bifunctional protein with regulatory and virulence roles that has been shown to be highly protective against a plague challenge. A combined sub-unit vaccine, comprising recombinant V and Fraction 1 antigens is currently being developed. We report here the expression and purification of recombinant V antigen (rV) using three different expression systems: the N-terminal GST fusion pGEX-5X-2 and pGEX-6P-2 systems from Pharmacia Biotech, and the C-terminal CBD fusion (IMPACT I) system from New England Biolabs. After cleavage from the carrier protein, the yields of rV were 25 mg l(-1) (pGEX-5X-2), 31 mg l(-1) (pGEX-6P-2) and 0.75 mg l(-1) (IMPACT I). All of the recombinant proteins were immunogenic in mice, although there were some differences in their protective efficacy against subcutaneous challenge with Y. pestis. Whilst rV antigen derived from the IMPACT I and pGEX-6P-2 systems and given in two immunising doses protected fully against challenge with 1 x 10(7) colony forming units (cfu) of Y. pestis, there was breakthrough in protection against 1 x 10(5) cfu of Y. pestis in animals immunised twice with rV from the pGEX-5X-2 system. From this study, the pGEX-6P-2 has been selected for the production of rV as a vaccine component. The pGEX-6P-2 system utilises a GST tagged PreScission Protease (a recombinant human rhinovirus 3C protease) to cleave the fusion protein, thereby allowing efficient removal of the enzyme from the final product. In addition, the enzyme is not of animal origin, therefore making it suitable for vaccine production.

Crystal structures of MMP-1 and -13 reveal the structural basis for selectivity of collagenase inhibitors

The X-ray crystal structures of the catalytic domain of human collagenase-3 (MMP-13) and collagenase-1 (MMP-1) with bound inhibitors provides a basis for understanding the selectivity profile of a novel series of matrix metalloprotease (MMP) inhibitors. Differences in the relative size and shape of the MMP S1' pockets suggest that this pocket is a critical determinant of MMP inhibitor selectivity. The collagenase-3 S1' pocket is long and open, easily accommodating large P1' groups, such as diphenylether. In contrast, the collagenase-1 S1' pocket must undergo a conformational change to accommodate comparable P1' groups. The selectivity of the diphenylether series of inhibitors for collagenase-3 is largely determined by their affinity for the preformed S1' pocket of collagenase-3, as compared to the induced fit in collagenase-1.

Assessment of costs and benefits of management of gestational diabetes mellitus

The purpose of this pilot study was to perform a cost-identification analysis of care for gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs) and the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby, and newborn care (outcome costs). Reimbursed average charges in the Northern California (NoCal) managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in NoCal, Southern California (SoCal), and New England (NewEng), using prospectively collected data. Reimbursed amounts for the detailed elements of GDM management (program input costs) are presented in the categories of diagnosis of GDM, diabetes treatment supplies, doctor's office visits, office visits to ancillary providers, and fetal surveillance. Program input costs per patient were $817 for diet-treated and $1,838 for insulin-treated women in NoCal, and were estimated to be $882 for diet-treated and $1,425 for insulin-treated women in NewEng. Program input costs for women requiring insulin treatment who were randomized to premeal or postprandial blood glucose testing (N Engl J Med 333:1237, 1995) in SoCal were estimated to be $3,596 per patient for the premeal group and $3,770 per patient for the postprandial group. Reimbursed amounts for health care expenditures related to pregnancy outcomes are detailed in the categories of hospital and physician charges for maternal antepartum hospitalization ($1,864 for 2 days), vaginal delivery with 50% use of epidural anesthesia ($4,050), cesarean section ($5,932), and neonatal intensive care ($9,130 for 4 days). Outcome costs per patient were $5,792 for diet-treated and $6,462 for insulin-treated women in NoCal. Outcome costs per patient were estimated to be $6,096 for diet-treated and $11,216 for insulin-treated women in NewEng, and $8,013 for the premeal blood glucose group and $7,495 for the postprandial blood glucose group in SoCal (both groups required insulin treatment). Incremental cost-effectiveness of postprandial monitoring in the SoCal controlled trial was $35 per patient in input costs per cesarean section averted and $25 per patient in input costs per neonatal intensive care unit day prevented. The benefit-to-cost ratio of the difference in input and outcome costs was 2.98 in favor of postprandial monitoring in the SoCal study. Cost analysis should be included in clinical trials of the management of GDM.

Discharged Residents' Satisfaction With Transitional Housing for the Homeless

One year following discharge from a transitional residential program, homeless women, some of whom were chemically dependent or mentally ill, indicated that they were satisfied with the program and that it had met their needs. Suggestions for improvement related primarily to greater flexibility of rules in the transitional residence. Most of the women had improved their housing situation since discharge; all of the women continued to maintain a home for their children.

Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study

OBJECTIVE

To test the hypotheses that children with abdominal pain have anxious parents and come from families with high rates of physical illness and that they grow up to suffer from high rates of medically unexplained symptoms and psychiatric disorders.

DESIGN

Population based birth cohort study.

SETTING

General population.

SUBJECTS

Participants in the Medical Research Council (MRC) national survey of health and development, a population based birth cohort study established in 1946.

MAIN OUTCOME MEASURES

Abdominal pain present throughout childhood in the absence of defined organic disease, and measures of physical symptoms and psychiatric disorder at age 36 years.

RESULTS

There were high rates of complaints about physical health among the parents of children with persistent abdominal pain, and the mothers had higher neuroticism scores. Children with persistent abdominal pain were more likely to suffer from psychiatric disorders in adulthood (odds ratio 2.72 (95% confidence interval 1.65 to 4.49)) but were not especially prone to physical symptoms once psychiatric disorder was controlled for (odds ratio 1. 39 (0.83 to 2.36)).

CONCLUSIONS

Persistent abdominal pain is associated with poor health and emotional disorder in the parents. Children with abdominal pain do not necessarily continue to experience physical symptoms into adulthood but are at increased risk of adult psychiatric disorders.

Primary care. Associated benefits

Results from an associate physician scheme for one region showed improved services for patients, benefits in organisation and management and high retention of doctors in inner cities. The scheme also caused early retirement of two poorly performing principals and uncovered instances of possible fraud. Success depended on the health authorities' commitment and support.

HIV infection among family planning clinic attenders in Glasgow: why prevalence has remained low in this general population group

OBJECTIVE

During 1991-2, unlinked anonymous testing of dried blood spots from neonatal metabolic screening cards showed the prevalence of HIV among childbearing women from Glasgow to be extremely low at 0.01%. A study was conducted to determine if non-pregnant sexually active women who engaged in unprotected sexual intercourse were more likely to be infected than those who were pregnant.

METHODS

Unlinked anonymous HIV testing of urine specimens submitted by attenders of the family planning clinic in Glasgow for pregnancy testing.

RESULTS

Of 11,990 urine specimens tested, 7664 were from women with a negative pregnancy test and two of these were HIV positive (0.026%); none of the remainder from those with a positive pregnancy test had HIV antibodies.

CONCLUSION

No hidden epidemic was unearthed among a population which had engaged in unprotected sexual intercourse and was not pregnant. Other data from Glasgow strongly suggest that the control of HIV transmission among the city's population of current injectors (HIV prevalence, 1% of 8500) has prevented the spread of infection into its wider heterosexual population. It is essential that preventive measures which have been responsible for this public health success should be maintained.

Hypopigmented common blue nevus

Blue nevus is a benign pigmented lesion of dermal melanocytes with a number of histologic and clinical variants, of which the major types are the common blue nevus, cellular blue nevus and combined nevus. This study describes 9 cases of hypopigmented blue nevus (HBN), a variant of common blue nevus in which there is minimal identifiable melanin pigment. We also discuss the usefulness of the immunoperoxidase stain HMB-45 in relation to the diagnosis of HBN and the lesions with which it may be histologically confused, namely common intradermal nevus, dermatofibroma, neurofibroma, dermal scar and desmoplastic malignant melanoma. The HMB-45 stain was found to be uniformly positive in all 9 cases of HBN, in contrast to the other dermal lesions which have been reported as either negative or showing only focal positivity. The physical distribution and age range of the patients in this study was similar to the age and sites for common BN, supporting the relationship between the 2 lesions. The occurrence of HBN in predominantly young adults indicates that this lesion is not a phenomenon due to ageing or degenerative change, and should be regarded as a variant of common blue nevus.

Prenatal ultrasound diagnosis of abdominal aortic aneurysm with fibrotic occlusion in aortic branch vessels

In a 35-year-old multiparous patient, an ultrasound scan performed at 32 weeks' gestational age for size less than dates revealed an appropriately grown fetus with a two-vessel umbilical cord. Also noted were dilated, tortuous abdominal and pelvic vessels. A scan at 33.5 weeks confirmed the two-vessel cord and noted a widely dilated abdominal aorta and a left foot 2 cm shorter than the right. Delivery at 36 weeks was followed by a neonatal course complicated by thromboses, renovascular hypertension, and a newly patent ductus with pulmonary hypertension. Successful ligation was followed by acute pulmonary hypertension, cardiac dysfunction and death. Autopsy findings included aneurysmal dilation of the abdominal aorta without evidence of arterial wall pathology.

A patient's guide to safer sex. Reducing the risk of HIV and other sexually transmitted diseases

In summary, each person must be responsible for his or her own sexual health and, unfortunately, there are some deadly infections in the population these days. We hope this frank discussion of options will help you make smart decisions about your sex life.

A primary health care service for Glasgow street sex workers--6 years experience of the "drop-in centre', 1989-1994

In Glasgow, a health and social care centre opened in 1988 principally to facilitate HIV prevention among street prostitutes, most of whom are injecting drug users. During 1992 to 1994, 551 women made 17,554 visits to the medical room which is functional 5 nights per week. The mean age of the sex workers was 26 years (range 15 to 62) and 89% injected drugs. Fifty-five per cent of the attendances were for needle/syringe exchange only whilst the remainder involved other health care provision. Common presenting problems included abscesses, burns and venous thromboses, reflecting the high proportion of sex workers who injected drugs. Most women always used condoms for penetrative commercial sex and symptomatic sexually transmitted disease was seen infrequently. In addition to the provision of injecting equipment and condoms, other key prevention activities included Hepatitis B vaccination and cervical screening. The prevalence of HIV infection amongst the women remains under 5% and most seropositives were known to be infected before the Centre opened. This initiative shows that if multidisciplinary health and social services are provided to street sex workers at a time and place convenient to their work, the benefits are considerable.

Glucose and lactate kinetics during a short exercise bout in pregnancy

Pregnancy is considered diabetogenic. Although exercise has been advocated to assist in metabolic control of the nonpregnant diabetic individual, there is a paucity of data about the metabolic effects of exercise during pregnancy. To examine whether moderate exertion may be beneficial in the maintenance of maternal carbohydrate homeostasis, glucose and lactate kinetics were measured in the third trimester in five pregnant nondiabetic women (gestational age, 34.2 +/- 0.1 weeks [mean +/- SE]) by infusion of 45 microg x kg(-1) x min(-1) [6,6-2H2]glucose and 70 microg x kg(-1) x min(-1) [U-13C]lactate tracers. Subjects were observed at rest for determination of baseline steady-state kinetics over a 30-minute period, and then they exercised for 30 minutes at 60% maximum oxygen consumption (VO2max) and were evaluated for 30 minutes postexercise. Glucose and lactate kinetics and lactate oxidation were measured throughout the exercise protocol. This study was repeated postpartum in all individuals at least 6 weeks after delivery. Compared with the steady-state preinfusion period, plasma glucose concentration was not elevated during exercise in either group, nor was plasma lactate concentration significantly different in either group. Glucose kinetics did not change during exercise, but lactate kinetics increased in both groups. V02 and percent of lactate C contribution to CO2, an indication of lactate oxidation, increased proportionally in both groups during exercise. Metabolic perturbations, as measured by glucose and lactate kinetics, do not appear to be different during the third trimester of pregnancy during a relatively short bout of exercise compared with the nonpregnant state.

Atherosclerotic plaque rupture in symptomatic carotid artery stenosis

PURPOSE

Plaque rupture is often the precipitating event in acute coronary syndromes. We hypothesized that a similar process occurs in stenotic carotid plaques in association with ischemic neurologic symptoms. Our purpose was to examine several morphologic features of stenotic carotid plaques and to determine which characteristics are more commonly associated with plaques obtained from patients with symptomatic carotid artery disease than with those from patients with asymptomatic carotid artery disease.

METHODS

Forty-four carotid endarterectomy specimens (from 25 asymptomatic and 19 symptomatic patients) were analyzed with pentachrome staining and light microscopy. The asymptomatic patients and symptomatic patients had similar mean percent stenosis (77% vs 74%). Other risk factors, including hypertension, diabetes mellitus, coronary artery disease, smoking history, serum cholesterol, and triglyceride levels, were similar between groups.

RESULTS

Patients with symptomatic carotid artery disease were found to have more frequent plaque rupture, fibrous cap thinning, and fibrous cap foam-cell infiltration when compared with the asymptomatic group. Plaque rupture was seen in 74% of symptomatic plaques and in only 32% of plaques from asymptomatic patients (p = 0.004). Fibrous cap thinning was noted in 95% of symptomatic plaques and in 48% of asymptomatic plaques (p = 0.003). Infiltration of the fibrous cap with foam cells was also significantly more common in the symptomatic plaques (84% vs 44% of asymptomatic plaques; p = 0.006). In addition, intraplaque fibrin was more common in symptomatic plaques than in asymptomatic (100% vs 68%; p = 0.008). No significant differences were found between the two groups with respect to plaque hemorrhage, the presence of a necrotic core, luminal thrombus, smooth muscle cell infiltration, eccentric shape, and plaque type (fibrous, necrotic, or calcified).

CONCLUSIONS

As in the coronary artery system, rupture of the atherosclerotic plaque may play an important role in the pathogenesis of ischemic stroke caused by carotid artery stenosis. The process of inflammation, involving foam-cell infiltration of the fibrous cap, may contribute to rupture of the atherosclerotic plaque.

Bryostatin 1 activates splenic lymphocytes and induces sustained depletion of splenocyte protein kinase C activity in vivo after a single intravenous administration

Bryostatin 1 activates and subsequently down-regulates protein kinase C (PKC) in vitro and has potential use as an immunomodulator and as an anti-cancer agent. Despite extensive examination of its activities in vitro and anti-tumor effects in vivo, previous studies have failed to document that bryostatin 1 modulates total cellular PKC activity in tumor or normal tissues when administered in vivo. After a single bolus injection of bryostatin 1 (1.0 microgram) in normal C57BI/6 mice, blood was drawn at various intervals and assayed for bryostatin 1 levels. In addition, spleens from bryostatin-treated mice were harvested 10 min to 10 days after treatment, weighed and analyzed for cell numbers, PKC activity and cell surface phenotypes. Bryostatin 1 levels in plasma rose rapidly, reaching peak levels of 56.5 nM less than 1 min after injection, and then declined to undetectable levels by 1 h. A similar pattern was observed when bryostatin 1 was incubated with leukemia cells in vitro, raising the possibility that the rapid fall in plasma levels results from intracellular uptake and binding. Bryostatin 1 induced marked depletion of total splenocyte PKC activity (as much as 69% relative to control values) at 24-96 h after drug administration, but not at earlier times (i.e. 1 h). A single injection of bryostatin 1 also induced expression of the T cell activation marker CD69, leading to positivity in 53% of cells at 3-24 h versus 11% in control mice, and resulted in marked splenomegaly, associated with increased numbers of nucleated cells at 48-96 h. Together, these studies demonstrate that despite rapid disappearance of the drug from plasma, a single i.v. dose of bryostatin 1 exhibits significant and sustained effects on normal murine spleen cells, including early lymphocyte activation, prolonged depletion of PKC activity, splenocyte proliferation and splenomegaly. These findings may have implications for attempts to understand the in vivo effects of bryostatin 1 in normal host tissues.

Blunt-trauma carotid artery injury: mild symptoms may disguise serious trouble

Injury to the carotid artery can occur in athletes by direct blow to the neck or by hyperextension of the neck. After such injury, symptoms may be mild or transient. Catastrophic complications such as stroke can occur if the injury is not recognized and treated. Neurologic changes such as transient weakness or transient unilateral blurred vision that occur after a hyperextension injury or a direct blow to the neck may indicate a carotid artery injury. A careful neurologic examination can help identify most carotid artery injuries, but because the symptoms of injury may not appear immediately, follow-up may be necessary. Treatment may consist of anticoagulation therapy or operative repair.

Activation of phospholipase A2 by the human endothelin receptor in Chinese hamster ovary cells involves Gi protein-mediated calcium influx

The signalling pathways used by the human endothelin A receptor to activate phospholipase A2 in Chinese hamster ovary cells were investigated. Pertussis toxin caused a partial but significant reduction in endothelin-1-induced arachidonic acid release although cAMP-dependent kinase inhibitors did not mimic its action. Extracellular calcium and its entry into the cell was essential for activation of phospholipase A2 as its removal from media or incubation with an intracellular calcium chelator-reduced activation. Nifedipine had no effect on endothelin-1-induced arachidonic acid release while divalent cations caused a significant reduction indicating the possible role of CRAC. Thapsigargin caused an increase in arachidonic acid release which was completely inhibited by pertussis toxin treatment. This further supports the involvement of CRAC in calcium influx and activation of phospholipase A2 by the human endothelin A receptor.

Intrauterine therapy for homozygous alpha-thalassemia

BACKGROUND

Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life.

CASE

A Filipino woman with a prior loss due to hemoglobin Bart's underwent prenatal diagnosis that confirmed recurrence in the index pregnancy. Intravascular intrauterine exchange transfusions maintained appropriate fetal growth. A cesarean delivery yielded a 2190-g male infant with minor malformations. The postnatal course was characterized by mild respiratory insufficiency. Postnatal chronic transfusion therapy is underway pending consideration for bone marrow transplantation.

CONCLUSION

Antenatal diagnosis and therapy of homozygous alpha-thalassemia can prevent the prenatal consequences of hydrops and fetal death. New technologies such as stem cell transplantation may help to avert both prenatal and postnatal consequences.

Binding interactions of human interleukin 5 with its receptor alpha subunit. Large scale production, structural, and functional studies of Drosophila-expressed recombinant proteins

Human interleukin 5 (hIL5) and soluble forms of its receptor alpha subunit were expressed in Drosophila cells and purified to homogeneity, allowing a detailed structural and functional analysis. B cell proliferation confirmed that the hIL5 was biologically active. Deglycosylated hIL5 remained active, while similarly deglycosylated receptor alpha subunit lost activity. The crystal structure of the deglycosylated hIL5 was determined to 2.6-A resolution and found to be similar to that of the protein produced in Escherichia coli. Human IL5 was shown by analytical ultracentrifugation to form a 1:1 complex with the soluble domain of the hIL5 receptor alpha subunit (shIL5R alpha). Additionally, the relative abundance of ligand and receptor in the hIL5.shIL5R alpha complex was determined to be 1:1 by both titration calorimetry and SDS-polyacrylamide gel electrophoresis analysis of dissolved cocrystals of the complex. Titration microcalorimetry yielded equilibrium dissociation constants of 3.1 and 2.0 nM, respectively, for the binding of hIL5 to shIL5R alpha and to a chimeric form of the receptor containing shIL5R alpha fused to the immunoglobulin Fc domain (shIL5R alpha-Fc). Analysis of the binding thermodynamics of IL5 and its soluble receptor indicates that conformational changes are coupled to the binding reaction. Kinetic analysis using surface plasmon resonance yielded data consistent with the Kd values from calorimetry and also with the possibility of conformational isomerization in the interaction of hIL5 with the receptor alpha subunit. Using a radioligand binding assay, the affinity of hIL5 with full-length hIL5R alpha in Drosophila membranes was found to be 6 nM, in accord with the affinities measured for the soluble receptor forms. Hence, most of the binding energy of the alpha receptor is supplied by the soluble domain. Taken with other aspects of hIL5 structure and biological activity, the data obtained allow a prediction for how 1:1 stoichiometry and conformational change can lead to the formation of hIL5.receptor alpha beta complex and signal transduction.

Sonographic Analysis of Vocalisations in Captive Dunnarts, Sminthopsis crassicaudata

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The impact of caring upon the health of older women

Much community care relies upon the provision of unpaid care by family members. The short- and longer-term effects of providing care upon older women were researched in an interview survey of 286 women aged over 50 in urban and rural areas of Queensland. The findings were validated by reports from the women's general practitioners. The results suggest that providing care has both short- and long-term negative effects upon the physical health and emotional wellbeing of older women. The major predictor of a range of self-reported health problems was the level of self-reported stress. Implications are drawn for both community care policy, which needs to focus upon the impact on the carer of continuing to provide care at home, and for health research relating to older women, which has ignored the demands of caring among older people.

A comparison of chamba (marijuana) abusers and general psychiatric admissions in Malawi

The study aimed to provide the first general description of chamba-related admissions to Zomba Mental Hospital, the major psychiatric facility in Malawi, and to analyse the distinctiveness of this patient group from other admissions. A questionnaire was verbally administered to 50 chamba abusers and 50 other patients matched by gender, age, and admission date. The typical chamba abusing patient is: 27, male, a subsistence farmer, takes the drug because it is the cheapest form of intoxication, reports 'seeing things clearly' (immediate effect), and general apathy (long-term); and compared to other patients is more likely to originate from a chamba-growing area, less likely to have been raised by his natural parents, and has had more schooling.