[Statins and stroke]

The role of cholesterol in the pathogenesis of stroke, the role of the treatment of hypercholesterolemia in the prevention of stroke have been controversed. The explanation was based on the heterogenous characteristics of stroke, on the relationship between several risk factors, and on the role of the age, in the evaluation of these 2 questions. The discovery of statins induced major therapeutic trials whose aim was the impact on coronary events. These trials demonstrated that statins were accompanied with a major reduction of cholesterol levels and stroke events similar to the one observed with coronary events. Even prospective, placebo controlled, randomized specific trials for stroke are necessary, we can state that cholesterol reduction is the most important mechanism accounting for a decrease in stroke occurrence with statins.

Studies on polyurethane potting compound based on HDI-TMP adduct for fabrication of haemodialyzer

Polyurethane potting compounds based on hexamethylene diisocyanate-trimethylol propane (HDI-TMP) adduct (Component "A") and polypropylene glycol, polyethylene glycol and castor oil (Component "B") were prepared as potential compounds for the fabrication of haemodialyzer. The setting characteristics of the potting compounds having isocyanate index 2.0 are better than those compounds having 1.35. The aging stability of PEG and PPG based potting compounds are poorer than those of castor oil based potting compounds. Appreciable hydrolytic, oxidative and chemical stability could be observed with castor oil based potting compounds of HDI-TMP adduct.

Methods of feminist family therapy supervision

Although feminist family therapy has been studied and practiced for more than 20 years, writing about feminist supervision in family therapy has been limited. Three supervision methods emerged from a qualitative study of the experiences of feminist family therapy supervisors and the therapists they supervised: The supervision contract, collaborative methods, and hierarchical methods. In addition to a description of the participants' experiences of these methods, we discuss their fit with previous theoretical descriptions of feminist supervision and offer suggestions for future research.

Necrotising fasciitis of the breast

Necrotising fasciitis is a rare condition and to the best of our knowledge has never been reported in the breast. We report the first case in the literature of necrotising fasciitis involving the breast.

Cognitive behavioural therapy in pain management for sickle cell disease

It is well established that the treatment of pain is improved by the incorporation of psychological, social and behavioural components in that treatment (Rosenthiel and Keefe), 1983). However, until very recently, the management of sickle cell disease (SCD) in British hospitals has focused exclusively on the physical dimension of pain (Thomas et al, 1998). Although pain is wrong (vaso-occlusive crisis), every individual reacts in a different way. This reaction is influenced in part by immediate role models, usually within the family, and by a person's cognition (thought patterns, beliefs and expectations) in relation to the pain. This paper presents research that has shown that cognitive behavioural therapy (CBT) in SCD is an effective aid in the treatment of chronic pain, reducing psychological distress and boosting confidence.

Is acute appendicitis another inflammatory condition associated with highly active antiretroviral therapy (HAART)?

OBJECTIVE

To report the occurrence of acute appendicitis as a possible manifestation of the immune restoration inflammatory syndrome (IRIS) following the commencement of highly active antiretroviral therapy (HAART) in HIV patients.

DESIGN

Case-note review of HIV patients on HAART with acute appendicitis.

METHODS

Review of HIV markers, antiretroviral therapy and abdominal ultrasound results of four HIV patients with acute appendicitis and the histopathology reports on the appendix in two of the patients.

RESULTS

From a population of approximately 350 HIV patients on HAART, we found four patients who developed acute appendicitis within 6 months of commencing or changing HAART.

CONCLUSION

Acute appendicitis occurring in HIV patients on HAART may represent a variant of IRIS. Further immunohistopathological and epidemiological evaluation will be needed to define this relationship fully.

A test of the Circumplex Model of Marital and Family Systems using the Clinical Rating Scale

Most studies of the Olson Circumplex Model of Marital and Family Systems have utilized a version of the Family Adaptability and Cohesion Evaluation Scales (FACES). Because FACES does not appear to operationalize the curvilinear dimension of the Circumplex Model, researchers have been pessimistic about the model's validity. However, the Clinical Rating Scale (CRS) has received some support as a curvilinear measure of the Circumplex Model. Therefore, we used the CRS rather than FACES to test the validity of the Circumplex Model hypotheses. Using a structural equation-modeling analytical approach, we found support for the hypotheses pertaining to the effects of cohesion and communication on family functioning. However, we found no support for the hypotheses pertaining to the concept of adaptability. We discuss these results in the context of previous studies of the Circumplex Model using FACES. Based on the collective findings, we propose a preliminary reformulation of the Circumplex Model.

Studies on polyurethane potting compound based on isocyanurate of aliphatic diisocyanate for fabrication of a haemodialyser

Polyurethane potting compounds based on multifunctional isocyanurate of aliphatic diisocyanate, hexamethylene diisocyanate (HDI-IC) as Component A and polypropylene glycol, polyethylene glycol and castor oil (Component B) were prepared as potential potting compounds for the fabrication of a haemodialyser. The setting characteristics of the potting compounds having isocyanate index 2.54 are better than those of the compounds having 1.77. The ageing stability of castor oil and PPG-based potting compounds having isocyanate index 2.54 is better than that of PEG oil-based potting compounds. Appreciable hydrolytic, oxidative and chemical stability could be observed with HDI-IC/PPG/2.54 potting compounds for development of haemodialyser, oxygenator, etc.

CD52 antibodies for prevention of graft-versus-host disease and graft rejection following transplantation of allogeneic peripheral blood stem cells

Graft-versus-host disease (GVHD) is a major cause of mortality and morbidity after allogeneic bone marrow transplantation, but can be avoided by removing T lymphocytes from the donor bone marrow. However, T cell depletion increases the risk of graft rejection. In this study, two strategies are used to overcome rejection: (1) use of high doses of stem cells obtained from peripheral blood (PBSC), (2) admixture with a CD52 monoclonal antibody in order to deplete both donor and residual recipient lymphocytes. Two antibodies are compared: CAMPATH-1G (rat IgG2b) and its humanized equivalent CAMPATH-1H (human IgG1). A total of 187 consecutive patients at six centers received PBSC transplants from HLA-matched siblings between 1997 and 1999. A wide spectrum of diseases, both malignant and non-malignant, was included. The recovery of CD34+ cells after antibody treatment was close to 100%. The risk of acute GVHD (grade 2 to 4) was 11% in the CAMPATH-1G group and 4% in the CAMPATH-1H group (P = NS). The risk of chronic GVHD (any grade) was 11% in the CAMPATH-1G group and 24% in the CAMPATH-1H group (P = 0.03) but the risk of extensive chronic GVHD was only 2%. The overall risk of graft failure/rejection was 2%, not significantly different between the two antibodies. Antibody treatment was equally effective at concentrations between 10 microg/ml and 120 microg/ml and it made no significant difference to the outcome whether the patients received post-transplant immunosuppression or not (87% did not). Transplant-related mortality in this heterogenous group of patients (including high-risk and advanced disease) was 22% at 12 months. It is proposed that treatment of peripheral blood stem cells with CAMPATH-1H is a simple and effective method for depleting T cells which may be applicable to both autologous and allogeneic transplants from related or unrelated donors. Special advantages of this approach are the simultaneous depletion of donor B cells (which reduces the risk of EBV-associated lymphoproliferative disease) and the concomitant infusion of CAMPATH-1H to deplete residual recipient T cells and thus prevent graft rejection.

Prior BCG vaccination improves survival of Gambian patients treated for pulmonary tuberculosis

The protection provided by BCG against pulmonary tuberculosis ranges from nil to over 90%. While BCG protects against the more serious forms of tuberculosis, it is not known whether or not it protects patients with pulmonary tuberculosis from death. In a study designed to look at the effects of immunotherapy with M. vaccae as an adjunct to chemotherapy in 285 adult Gambian patients treated for proven pulmonary tuberculosis, we examined the association between the presence or absence of a BCG scar and mortality. The data showed that subjects who had a BCG scar were significantly younger than those who did not, and were less likely to have nutritional oedema. During the course of treatment, none of the 85 patients who had a BCG scar died compared to 35 of 200 patients (17.5%) who did not (P < 0.001). In these Gambian patients with pulmonary tuberculosis, prior vaccination with BCG may have provided substantial protection against death. However, there is the possibility that this finding is the result of confounding by other factors or has arisen from bias. Researchers with similar data need to investigate this question as this association, if true, could have major implications for BCG vaccination.

Immune reconstitution after allogeneic bone marrow transplantation depleted of T cells

BACKGROUND

Immune reconstitution following transplantation in individuals who had received T-cell-depleted marrow from HLA identical siblings was serially documented and correlated with the clinical recovery.

METHODS

Patients were preconditioned with radiation containing programs. GvHD prophylaxis was by T-cell depletion with CAMPATH 1G (ex vivo; median dose 20 mg). After transplantation lymphoid development was studied by flow cytometry and serum Ig concentrations were determined. Charts were reviewed to determine the effects of the immune reconstitution on the clinical performance.

RESULTS

The mean donor mononuclear cell number infused was 0.89x10(8)/kg. Within 6 months all the patients recovered their blood parameters and only one required therapy for GvHD. However, despite normal blood counts, 15 suffered life-threatening opportunistic infections, developing at a median of 24 weeks post grafting, but occurring even after 11 months. At 8 weeks from marrow infusion when leukocyte values had normalized in 15/20, compared to normal, immunophenotyping of blood cells from BMT revealed a significantly reduced mean lymphocyte count (1.06, SD 0.83x10(9)/l; P = 0.01), cells expressing CD3 (0.7x10(9)/l, SD 0.68; P = 0.05), CD4 (0.13x10(9)/l, SD 0.21; P = 0.0001) and CD19 (0.04x10(9)/l, SD 0.05; P = 0.001). Populations expressing CD8 and CD56 remained within normal range throughout the study. Normalization of cell numbers displaying CD2, CD3 and CD19 was delayed until 52, 52 and 24 weeks respectively, while CD4 counts persisted subnormal even at 72 weeks. Serum IgA levels were significantly decreased for the entire study period.

CONCLUSIONS

T-cell depletion with CAMPATH 1G while effectively preventing GvHD, also causes clinically significant and prolonged immunosuppression with apparently important clinical implications.

The efficacy of bilingual health advocacy in ethnic minority patients with cancer

AIM

This research aims to establish the efficacy of introducing trained bilingual health advocates to non-English speaking cancer patients.

METHOD

Male and female Bengali advocates received appropriate training. They were then given a group of patients to manage, while a control group received no such intervention. Outcomes were determined at the baseline and after three months. The study finally concludes in April 2000.

RESULTS

The progress so far shows that the advocates had only recruited half of the expected number of Bengali cancer patients. Focus groups showed, however, that healthcare professionals felt that their training was inadequate to overcome the language and cultural barriers, and many were distressed that they were not meeting the needs of minority ethnic patients.

CONCLUSION

The authors anticipate that this study will concur with research in other health sectors where bilingual health advocacy has been beneficial, and that future care will be better informed as a result.

The role of the haemoglobinopathy nurse counsellor: an exploratory study

The haemoglobin disorders are among the most common genetically inherited conditions within the United Kingdom. Individuals who are fully affected have severely impaired health while carriers may be faced with difficult reproductive decisions although generally they are well. Policy makers agree that counselling for families at risk should be undertaken in primary care settings and since the early 1980s this service has been undertaken mainly by specialist haemoglobinopathy nurse counsellors. Despite a number of government reports and recommendations for best practice, problems with service provision continue to be highlighted. However, there is little documented information about the work undertaken by the counsellors or how they perceive their role. A descriptive study was therefore conducted to fill this gap. It took the form of a questionnaire survey undertaken with 26 counsellors. The results were analysed by content and used to develop an interview schedule which was employed to obtain more detailed information from staff in four centres. The counsellors suggested that most of their time was spent in client-centred activities and most clients were first seen antenatally. However, there were significant barriers which prevented optimal service provision. These included: problems of communication with other health professionals, obtaining laboratory results crucial to the early identification of couples at risk, late referral from general practitioners and poor facilities for administration, especially maintaining computer databases essential for record keeping. Developing and obtaining written information suitable for families was particularly time-consuming.

How to organize a study day: a practical account

Organizing a memorable study day is a great challenge. A good study day has the potential to stimulate innovative ideas and improve nursing practice. It is therefore imperative that study days are of high quality, are relevant and well organized. This article highlights some valuable lessons that were learnt from the experience of organizing a study day at a London hospital. It discusses the processes involved including brainstorming, programme preparation, advertising and the provision of care for delegates. The areas that could have been improved are also highlighted.

A computerized method of identifying potentially preventable heart failure admissions

Heart failure (HF) is both highly prevalent and costly to society. Successful self-care is essential to effective HF management. This study sought to develop a method to identify, via medical records (International Classification of Diseases, 9th Revision, Clinical Modification) coding, HF admissions attributable to ineffective self-care. Expert panels completed an iterative series of mailed surveys to generate and validate a list of coded diagnoses that represent HF sequelae modifiable through self-care. Sixteen diagnoses resulted. Chart review at one hospital revealed that these modifiable sequelae were frequently present but not coded. A computerized method of identifying self-care deficits would allow nurses to identify patients in need of patient education.

Beyond the clinic: in-home therapy with Head Start families

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.

The AAMFT-Head Start Training Partnership Project: enhancing MFT capacities beyond the family system

This paper summarizes the experience of a two-year project to promote partnerships between 12 graduate Marriage and Family Therapy (MFT) training programs and their 12 local Head Start partners. The American Association for Marriage and Family Therapy (AAMFT) awarded 9 grants to MFT-Head Start partnerships that had established relationships with each other prior to the project. Three MFT-Head Start pairs that had no preexisting relationship but wanted to develop one received planning grants. The partnership project provided an exciting opportunity for MFT faculty and interns to integrate family systems theory into larger organizational settings and to enhance the capacity of MFTs to serve disadvantaged, low-income, culturally diverse families and the community agencies that work with them. Preparing MFT students to intervene and respond systemically both in organizations and with the families they serve represents a viable alternative to more traditional approaches to MFT that limit the focus to the family system. Survey results and interview data reflect the rich experiences of MFT faculty and supervisors, MFT interns, and Head Start staff. Implementation issues are discussed and recommendations are made to improve the collaboration between MFTs and community-based agencies such as Head Start.

Ex vivo depletion of T cells from bone marrow grafts with CAMPATH-1 in acute leukemia: graft-versus-host disease and graft-versus-leukemia effect

BACKGROUND

Preventing graft-versus-host disease (GVHD) by depletion of T lymphocytes from the stem cell graft for transplantation remains controversial, mainly because of the perceived increase in disease recurrence.

METHODS

We retrospectively analyzed the outcome of 50 consecutive individuals in remission of acute lymphoblastic leukemia (n=13; 8 in complete remission [CR]1) or acute myeloblastic leukemia (n=37; 33 in CR1), who had received marrow grafts from HLA-identical siblings. The conditioning regimen included six 2-Gy fractions of total body irradiation, succeeded by cyclophosphamide at 120 mg/kg (with mesna) followed by four fractions of 1.5 Gy to lymphoid areas. Bone marrow (n=38) or peripheral blood mobilized donor mononuclear cells (n=12) were exposed ex vivo to CAMPATH-1 (IgM and complement, or IgG; antiCD52) antibodies, without any further posttransplantation immunosuppression.

RESULTS

Median patient age was 31 (range 14-51) years; 12 patients were 40 or older. Thirty-two patients were male. One patient died of pulmonary hemorrhage on day 10; another died on day 29 of interstitial pneumonitis. Except for one early death, all patients engrafted. Ten (21%) of the remaining 48 who were at risk, developed GVHD. In none was it greater than grade II. Eight patients developed serious viral infections. Four died of cytomegalovirus pneumonia, adenovirus hepatitis, and human immunodeficiency. Overall, 11 patients (22%) relapsed (4 of 33 acute myeloblastic leukemia in CR1) at a median of 235 (range 46-528) days. Mean posttransplantation follow-up was 1062 (median 560; range 10-4177) days. Thirty-three patients (66%) remained disease free at a mean of 1,118 (median 1439; range 159-4,177) days. For all patients, the performance status was between 82% and 100% (median 100).

CONCLUSION

T-cell depletion with CAMPATH-1 effectively prevents GVHD, particularly the severe acute forms, without leading to excessive risk of relapse in acute leukemia.

Apolipoprotein E genotype does not affect the age of onset of dementia in families with defined tau mutations

We have assessed whether apolipoprotein E (ApoE) genotype influences the age of onset of dementia in a series of families with frontal temporal dementia with defined mutations in the tau gene. In contrast to the situation in Alzheimer's disease (AD), we could find no evidence that the age of onset of disease was influenced by the ApoE genotype.

Influences on the inclusion of children in family therapy

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs. two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two-parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.

Ultrasonographically-guided fine-needle aspiration cytology in the diagnosis of colonic lesions

BACKGROUND

The use of fine-needle aspiration cytology (FNAC) in the diagnosis of colonic lesions was investigated.

METHODS

Some 22 patients (median age 71 years) with a colonic lesion identified on abdominal ultrasonography underwent ultrasonographically-guided FNAC using a 21-G needle. The sample was checked immediately by a cytopathologist for adequacy.

RESULTS

Eighteen patients had colonic carcinoma; aspiration cytology detected malignant epithelial cells consistent with colonic carcinoma in 17 patients and severely dysplastic cells in one patient. The sensitivity and specificity of ultrasonographically-guided FNAC in the diagnosis of colonic carcinoma was 94 and 100 per cent respectively. The remaining four patients had a diagnosis of ileocaecal tuberculosis, ileocaecal Crohn's disease, and metastatic adenocarcinoma in the liver with no identifiable primary (two patients). One demonstrated granulomata, grew acid-fast bacilli and the patient was treated for tuberculosis. One had inflammatory cells and the patient was found to have Crohn's disease on histology. The remaining two patients had confirmed metastatic adenocarcinoma in the liver on aspiration cytology but suspected colonic lesions were found to be benign on cytological examination and no primary lesion was subsequently demonstrated. There were no complications of FNAC and patients complained of minimal discomfort. There has been no evidence of tumour recurrence with a median follow-up of 12 (range 1-25) months.

CONCLUSION

Ultrasonographically-guided FNAC is a valid method for the diagnosis of colonic tumours.

Cutaneous meningioma of the scalp: a case report and review of literature

Ectopic meningioma outside the skull and spinal column is uncommon. We report a cutaneous meningioma of the scalp in a 77-year-old man. A review of types and their management options are discussed. We also highlight that in certain carefully selected cases, these lesions can be treated conservatively.

Self issues for family therapy educators

Family therapy educators frequently encourage self-reflection in their students and clients. However, little attention has been paid to the challenges and processes of the educators themselves. In this piece, four faculty members reflect individually and collectively on their lives and roles as educators. They describe family-of-origin influences, the intersections of their personal and academic lives, systemic factors in the professional setting, balancing work and family, hierarchy, gender, and coping strategies to increase support and reduce competition. They recommend a deliberate process of self-reflection to other family therapy educators and offer suggestions for improving the organizational dynamics of family therapy training programs.

Participatory evaluation research: an introduction for family therapists

Participatory evaluation research empowers the consumers of services to become leaders in evaluation and change. Participatory research methods have been used widely in developing countries and are consistent with family therapy's recent emphasis on non-hierarchical, empowering, collaborative therapies. In this paper, the authors present several examples of participatory evaluation methods and discuss their applicability to the work of family therapists.

Development of an instrument to measure cardiac illness dependency

OBJECTIVE

Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health.

DESIGN

Instrument development study.

SAMPLE

Convenience sample of 311 patients with cardiac disease.

RESULTS

The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal.

CONCLUSION

Internal consistency reliability, content validity, and discriminant validity of the Illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Effect of normal aging and of Alzheimer's disease on, episodic memory

Performances of 12 patients with Alzheimer's disease (AD), 15 healthy elderly subjects and 20 young healthy volunteers were compared on two episodic memory tests. The first, a learning test of semantically related words, enabled an assessment of the effect of semantic relationships on word learning by controlling the encoding and retrieval processes. The second, a dual coding test, is about the assessment of automatic processes operating during drawings encoding. The results obtained demonstrated quantitative and qualitative differences between the population. Manifestations of episodic memory deficit in AD patients were shown not only by lower performance scores than in elderly controls, but also by the lack of any effect of semantic cues and the production of a large number of extra-list intrusions. Automatic processes underlying dual coding appear to be spared in AD, although more time is needed to process information than in young or elderly subjects. These findings confirm former data and emphasize the preservation of certain memory processes (dual coding) in AD which could be used in future therapeutic approaches.

Prevention of acute emesis in cancer patients following high-dose cisplatin with the combination of oral dolasetron and dexamethasone

PURPOSE

Dolasetron is a 5-HT3 antagonist antiemetic with active oral and intravenous formulations. The effects of this class are enhanced when combined with dexamethasone. This study tested the ability of the combination of oral dolasetron 200 mg and oral dexamethasone 20 mg to prevent acute emesis in cancer patients receiving initial cisplatin at doses > or = 70 mg/m2. Additionally, patients were randomly assigned to receive a second dosage of the regimen 16 hours later to improve control of acute symptoms.

PATIENTS AND METHODS

A total of 75 patients were entered, with 38 randomized to the two-dose regimen. Thirty-five percent were women and 77% had lung cancer.

RESULTS

Overall, the regimen prevented acute vomiting in 76% (95% confidence interval, 65% to 85%), including 74% of 35 patients who received cisplatin at doses > or = 100 mg/m2. There was no observed difference in emesis prevention between the one-dose (76%) and two-dose (76%) regimens (95% confidence interval for the difference, -20% to 19%). The median time to the onset of emesis was 19 hours for the one-dose regimen and 17 hours for the two-dose regimen in those patients with emesis. Headache occurred in 11% who received one dose and 16% who received two doses.

CONCLUSION

The combination of oral dolasetron 200 mg and dexamethasone 20 mg given only once prevented acute emesis in 76% of patients who received cisplatin > or = 70 mg/m2. Administration of a second dose of the regimen did not improve the observed prevention rate or delay the time to emesis. This one-dose oral regimen has comparable or better effectiveness than reported results of intravenous combination regimens in preventing cisplatin-induced vomiting and merits further study and use.

Multi-facial anomalies in mandibulofacial dysostosis. A report of three cases

Mandibulofacial dysostosis is readily recognized on the basis of a characteristic facial appearance caused by hard and soft tissue abnormalities of the face, including malformations of the ear. Generally, the abnormality is symmetrical. The psychological and social stigma associated with severe facial deformity makes this syndrome one of the most challenging reconstructive problems presented to the craniomaxillofacial surgeon.

Effect of chronic cold exposure on Na-dependent D-glucose transport along small intestine in ducklings

In conditions of chronic cold exposure, ducklings develop a nonshivering thermogenesis that requires a high energy expenditure. Therefore, energy supply becomes essential to cold-acclimated ducklings, which increase their intake of carbohydrate-rich food. The aim of this work was to investigate the effect of cold acclimation on the activity of the intestinal brush-border Na(+)-D-glucose cotransport, which is the first major step controlling glucose entrance into an organism. Cotransport activity was determined by measuring D-glucose uptake in brush-border membrane vesicles isolated from different parts of the small intestine of thermoneutral control (25 degrees C) or cold-acclimated (4 degrees C) ducklings (Cairina moschata). Two D-glucose transport sites were described in ducklings: a high-affinity/low-capacity site and a low-affinity/high-capacity site. The former was mainly located in the ileum and the latter in the duodenum. These two transport sites were altered differently by cold exposure. Major alterations occur in the ileum where 1) a reduction in the Michaelis-Menten constant and maximal transport rate of the high-affinity site was observed, and 2) the occurrence of low-affinity site activity was noted in cold-acclimated ducklings, although it was not detected in the thermoneutral control group. Cold effect on the high-affinity site could be related to the changes in the ileal brush-border membrane vesicle lipids, whereas cold effect on the low-affinity site could be due, at least in part, to the higher glycosyl content found in this segment. The small intestine appears then able to react to cold exposure by increasing both its mucosa mass in proximal segments and D-glucose uptake capacity in ileum to respond to the higher energy demand induced by thermoregulatory requirements.

Intracellular signaling of tumor necrosis factor-alpha in brain microvascular endothelial cells is mediated by a protein tyrosine kinase and protein kinase C-dependent pathway

The intracellular signaling pathways responsible for tumor necrosis factor (TNF)-alpha stimulation of lymphocyte adhesion to brain microvascular endothelial cells (BMEC) were studied using inhibitors of protein kinase C (bisindolylmaleimide HCl, H-7, or staurosporine), or protein tyrosine kinase (genistein). Each of these blocked the ability of BMEC to respond to TNF-alpha. In contrast, BMEC treated with H-89, an inhibitor of protein kinase A, or the adenylate cyclase inhibitor, dideoxyadenosine, responded normally to TNF-alpha. Forskolin, an adenylate cyclase agonist, significantly increased lymphocyte adhesion to BMEC. These data indicate that intracellular signaling by TNF-alpha in BMEC is mediated through a protein kinase C and tyrosine kinase dependent pathway.

Activation of transcription at divergent urea-dependent promoters by the urease gene regulator UreR

The Proteus mirabilis and plasmid-encoded urease loci contain seven contiguous structural and accessory genes (ureDABCEFG) and the divergently transcribed ureR, which codes for an AraC-like transcriptional activator. Previously, it was shown that the plasmid-encoded ureR to ureD intergenic region contained divergent promoters (ureRp and ureDp). Transcription from these promoters required both the effector molecule urea and the activator protein UreR. In this report, we demonstrate that the P. mirabilis urease gene cluster contains similar divergent urea- and UreR-dependent promoters. The ureR gene products from either urease locus were able to activate transcription at both the plasmid-encoded and P. mirabilis promoters. The minimal concentration of urea required to activate transcription at ureRp or ureDp from either gene cluster was approximately 4 mM. The transcriptional start sites for the plasmid-encoded and P. mirabilis divergent promoters were similar in an Escherichia coli DH5 alpha background, as determined by primer-extension analysis. However, in P. mirabilis HI4320, transcription of ureR initiated predominately at an alternative site. Physical mapping and inhibition studies were used to localize the UreR-binding sites within the plasmid-encoded ureRp and ureDp intergenic sequences to regions of 68 bp and 86 bp, respectively. Gel shift analysis demonstrated that UreR bound to a 135 bp fragment in the approximate centre of the plasmid-encoded ureR to ureD intergenic region. The results presented here suggest that the P. mirabilis and plasmid-encoded urease gene clusters utilize similar mechanisms of transcriptional activation in response to urea.

Molecular requirements for polyamines binding to the antispermine monoclonal antibody Spm8-2

The monoclonal antispermine antibody Spm8-2 was obtained by immunizing mice with a thyroglobulin-spermine conjugate. The molecular requirements for polyamines binding to this antibody were investigated by ELISA binding and inhibition tests, using a variety of natural polyamines and synthetic polyamine analogs. Four major structural determinants are important for the binding of polyamines by the antibody: (1) terminal amino groups: N-alkylation of both terminal amino groups of the polyamines leads to an important drop in the affinity for the antibody; (2) number of methylene groups spacing the amino groups: the four carbon chains appear to present the optimum length since the antibody binds polyamines with repeats of the aminobutyl moiety more actively than their homologues with shorter or longer carbon chains; (3) number of amino groups: the affinity of Spm8-2 for free homologous polyamines varied in the following order: pentamines > tetramines > triamines > diamines, showing the importance of the number of positive charges of the polyamines in the antibody-antigen reaction; the importance of charges is further emphasized by the dependence of antibody binding on the ionic strength of the medium; (4) N-acylation of one terminal amino group: the antibody binds more actively N1-acetylspermidine than spermidine or spermine. The binding properties of Spm8-2 suggest the presence of two recognition sequences, one selective for N-acylaminopropyl moieties, the second for the aminobutyl moiety.

Assessment of procedural memory in Parkinson's disease

1. Findings in cognitive psychology and neuropsychology have led to consider the existence of several mnestic systems. This study focuses on a now clearly established distinction between the procedural and the declarative memories. 2. The aim of the present study was to try and determine which of the two acquisition steps (learning and automation) is affected by Parkinsonians' mnestic difficulties, and to verify if these difficulties are linked to the skill content (declarative or motor). 3. To answer these questions, 20 Parkinsonians under treatment underwent specific tests: the maze test and the arithmetic alphabet test. 4. Results show that, by comparison with 20 matched healthy individuals, the deficiencies observed in Parkinson's disease affect both the declarative and the motor skills. In addition, Parkinsonians suffer difficulties in both acquisition steps: learning and automation. 5. These results could account for the cognitive and motor disturbances observed in Parkinson's disease; these abnormalities should be among the pharmacological targets in future.

Pharmacokinetics of marbofloxacin in dogs after oral and parenteral administration

Six dogs were treated with a single intravenous (i.v.) dose (2 mg/kg) of marbofloxacin, followed by single oral (p.o.) doses of marbofloxacin at 1, 2 and 4 mg/kg, according to a three-way crossover design. The same experimental design was used for the subcutaneous (s.c.) route. In addition, a long-term trial involving eight dogs given oral doses of marbofloxacin at 2, 4 and 6 mg/kg/day for thirteen weeks was carried out. Plasma and urine samples were collected during the first two trials, plasma and skin samples were collected after the second of these trials. Plasma, urine and skin concentrations of marbofloxacin were determined by a reverse phase liquid chromatographic method. Mean pharmacokinetic parameters after i.v. administration were the following: t1/2 beta = 12.4 h; ClB = 0.10 L/h.kg; Varea = 1.9 L/kg. The oral bioavailability of marbofloxacin was close to 100% for the three doses. At 2 mg/kg, Cmax of 1.4 micrograms/mliter was reached at tmax of 2.5 h. Mean AUC and Cmax values had a statistically significant linear relationship with the doses administered. About 40% of the administered dose was excreted in urine as unchanged parent drug. After s.c. administration, the calculated parameters were close to those obtained after oral administration, except tmax (about 1 h) which was shorter. The mean skin to plasma concentration ratio after the long-term trial was 1.6, suggesting good tissue penetration of marbofloxacin.

Effects of Hydrophilization and Immobilization on the Interfacial Behavior of Immunoglobulins

The adsorption and immobilization of rabbit anti-human immunoglobulin (rabbit IgG), as well as the effects of rinsing with buffer and addition of bovine serum albumin (BSA) or human IgG on the amount and reactivity of bound rabbit IgG, were investigated with ellipsometry, total internal reflection fluorescence spectroscopy (TIRF), and enzyme immuno assay (EIA). It was found that although rabbit IgG readily adsorbs at hydrophobic hexamethyldisiloxane (HMDSO) plasma polymer surfaces, a substantial fraction of the adsorbed protein molecules is desorbed upon rinsing with buffer. BSA was found to adsorb readily at the surfaces obtained after rinsing, although also this protein desorbed to a large extent (about 60%) upon further rinsing with buffer. The adsorption of BSA causes a further reduction in the amount of rabbit IgG adsorbed. Immobilization of rabbit IgG to acrylic acid (AA) plasma polymer surfaces, achieved by covalent coupling via a strongly adsorbed PEG-PEI copolymer, was found to overcome the problem of the desorption of rabbit IgG upon rinsing with buffer or addition of BSA. Furthermore, nonspecific adsorption was virtually absent after immobilization. However, covalently bound rabbit IgG reacted strongly with human IgG, as observed by ellipsometry, TIRF, and EIA. The immobilization of rabbit IgG to hydrophilized surfaces was found to facilitate the interpretation of EIA results.

The rectus sheath block in paediatric anaesthesia: new indications for an old technique?

The rectus sheath block has been used with success for postoperative analgesia in adults. This paper reviews the anatomy of the rectus sheath, and presents our initial experience of using the block to provide intra- and postoperative analgesia in children having repair of umbilical and paraumbilical hernia. The rectus sheath block appears to be a useful technique in children, particularly for paediatric day-cases surgery.

Differential recognition of free and covalently bound polyamines by the monoclonal anti-spermine antibody SPM8-2

The reactivity of an anti-spermine MAb (SPM8-2) toward polyamines either free or bound to a solid surface was investigated using equilibrium dialysis and ELISA methods. When polyamines were covalently linked to hydrophilized microtiter plates using carbodiimide, the MAb SPM8-2 reacted both with spermine and spermidine, with a higher affinity for the latter, but did not show any reactivity towards bound putrescine. In contrast, the MAb SPM8-2 reacted with all three polyamines bound to the microtiter plates with glutaraldehyde, with an affinity in the order: putrescine > spermidine > spermine. Equilibrium dialysis and competitive ELISA tests showed that the MAb SPM8-2 exhibited high affinity for free spermine and 50% and 5% cross-reactivity with free spermidine and putrescine respectively. The affinity of the MAb SPM8-2 for putrescine, spermidine and spermine appears to depend on whether the polyamine is free or bound. The antigenicity of the polyamines differs according to the nature of their link to the solid phase. These observations are discussed in the light of the structural modification produced by covalent binding of the polyamines. It is also concluded that when antibodies are used, due care has to be exercised in choosing the appropriate immunoassay for determining the specificity of antibodies directed against small haptens such as the polyamines.

Antibacterial activity of marbofloxacin. A new fluoroquinolone for veterinary use against canine and feline isolates

Marbofloxacin is a new fluoroquinolone developed exclusively for veterinary use. Minimum inhibitory concentrations of marbofloxacin were assessed for 816 recent isolates associated with canine or feline diseases. Marbofloxacin showed a broad spectrum of activity against gram-negative and gram-positive bacteria. In vitro rates of killing of marbofloxacin and enrofloxacin were compared against strains of Staphylococcus intermedius and Pasteurella multocida, and the results showed no marked difference between the two antibiotics. The duration of bactericidal activity was evaluated ex vivo in the urine of dogs and cats treated with marbofloxacin and lasted from 2 to 5 days after a single administration according to the dosages. Post-antibiotic effect durations were determined with Escherichia coli, Pasteurella multocida, Staphylococcus aureus and Staphylococcus intermedius and were found almost equal to those of enrofloxacin or ciprofloxacin. These results predict a great potential for marbofloxacin in the treatment of a wide range of diseases in dogs and cats.

Procedural memory and Parkinson's disease

A detailed analysis of the mnestic deficits associated with Parkinson's disease (PD) contributes to explaining the cognitive disorders and their well documented consequences. This study was designed to show that, in PD declarative as well as procedural memory is severely impaired. Three tests designed to explore this aspect of mnestic functioning were proposed to a group of 16 parkinsonian patients whose motoricity was controlled: inverted reading, braille reading, sound form association. The results obtained, compared with those of young and aged controls, show that PD is associated with marked deficits in both declarative and procedural memory. Declarative memory impairment was similar to that observed in the control population (healthy elderly subjects, age-matched with the PD patients) but more marked in PD subjects. The procedural memory deficit was linked with age and pathology. Procedural memory involves a variety of processing modules dedicated to the type of information (visual, auditive, tactile codes). The deficits observed were more like a loss of automatism than procedural impairment stricto sensu ('knowing how'). It would be worth pursuing research by studying akinesia and motor disorders from the angle of automatic memory impairment.

Pain from sickle-cell crisis

A qualitative questionnaire survey was carried out to identify the perceptions and expectations of pain management of patients with sickle-cell disease, and of nurses. The study illustrates that the present sample of nurses contributed to the poor pain control of sickle-cell patients because of their misconceptions about narcotic addiction, inadequate formal pain assessment and their neglect of attention to the psychosocial implications of this chronic disease.

Psychological characteristics and the effectiveness of patient-controlled analgesia

We have evaluated the level of state and trait anxiety, neuroticism, extroversion and coping style as predictors of the effectiveness of patient-controlled analgesia (PCA) in 110 patients undergoing total abdominal hysterectomy. After operation patients were allocated to receive pain control with either PCA or i.m. injections (IMI). Pain was assessed using the short form McGill pain questionnaire at 6, 18 and 24 h after operation, and by recording the amount of analgesic consumed in the first 24 h after surgery. Both state anxiety and coping style were significant predictors of postoperative pain, irrespective of the method of analgesia used. Patients using PCA experienced significantly better pain control than those receiving IMI. However, it was those with high levels of state anxiety who experienced the greatest reduction in pain with PCA. In addition to achieving better pain control, patients who received PCA used significantly less analgesia and were discharged earlier than patients who received IMI.

Explicit and procedural memory in Parkinson's disease

One of the aims of cognitive psychology is to breakdown complex tasks into their most basic components. The components of explicit (declarative) and implicit (procedural) memory were thus analyzed in undemented, non-depressed Parkinsonian patients under anti-Parkinsonian treatment, and compared with young and elderly healthy subjects. Three series of experiments were conducted in 61 patients in total. Statistically significant results revealed an impairment of explicit memory (verbal recall of words and drawings) with preserved recall of faces, in Parkinsonians. Implicit memory was also deficient, only in association tests (sound-form; arithmetical alphabet) and maze tests. Braille reading tests and Toronto tower tests did not discriminate between Parkinsonians and elderly subjects. Lastly, analyzing learning and automation revealed a dysfunctioning in Parkinsonian patients. All these data indicate a dysregulation of the cortical-sub-cortical systems, not essentially pre-frontal, and not necessarily dopaminergic. Cognitively, it appears that procedural and implicit memories should be dissociated conceptually.

National survey of pediatric fever management practices among emergency department nurses

INTRODUCTION

Management of pediatric fever is controversial. Although many nursing texts advocate aggressive fever management, research provides evidence that fever is a normal physiologic process with beneficial effects. We sought to describe emergency nurses' pediatric fever management practices, their rationales for practice, and their practice consistency.

METHODS

A researcher-developed tool was mailed to a systematic random sample of approximately 5% of ENA members. Surveys were mailed to 1136 nurses nationally; 731 surveys were returned (64% response rate).

RESULTS

Temperature at which nurses initiate fever interventions varied from 37.8 degrees C (100 degrees F) to 40.6 degrees C (105 degrees F). Most frequently identified rationales for intervention were prevention of fever increase (83.3%), fever reduction (76.9%), comfort (74.7%), and seizure prevention (65.3%). Most nurses (79.8%) employ tepid sponging to reduce fever; 31% sponge routinely. Nurses reported sponging for temperatures higher than 38.9 degrees C (102 degrees F) to 40.6 degrees C (105 degrees F). Rationales for sponging included seizure prevention (58%), rapid cooling (56.8%), and treatment of fevers unresponsive to antipyretics (45.6%). Factors influencing rationales for practice included departmental standards of care (67.2%), physician practices (65.8%), and common sense (64.2%).

DISCUSSION

The results of this nationwide survey demonstrate that fever management practices vary. ED nurses are practicing in a manner consistent with that advocated in many nursing texts but not necessarily the research literature. We believe that clinical trials of commonly used fever treatments are indicated. Standards of care could then be revised to reflect the research literature.

The health care needs of ethnic minority groups: are nurses and individuals playing their part?

The UKCC Code of Professional Conduct for nurses, midwives and health visitors stresses the need to have an understanding of the social and cultural determinants of health and illness. There is as yet little evidence of what might constitute good practice in this area and it is difficult to ascertain why this basic philosophy is not translated into action. Indeed, the nursing and midwifery professions' ability to deliver adequate and appropriate health care more generally to Britain's multiracial, multicultural population has been questioned. This literature review presents evidence which strongly suggests that although we are living in a multicultural society patients from minority ethnic groups are additionally disadvantaged because the initiatives by nurses, and others working in the National Health Service, to meet their health care needs are inadequate and often inappropriate.