Optimising the performance of intermittent pneumatic compression devices

OBJECTIVES

this study was designed to determine whether an intermittent pneumatic compression device (IPC) with an increased maximal inflation pressure, a decreased time to maximal pressure and a longer duration of compression would improve venous return compared to a standard IPC device.

METHODS

thirty limbs in 15 volunteers without evidence of venous disease were studied using duplex scanning at rest and during the application of two different IPC devices with different compression parameters. The first device IPC-1 (SCD 5325, Kendall) has a six-chambered cuff applying 45 mmHg after 12 s, sequentially from ankle to thigh followed by 60 s of non-compression. The second device IPC-2 (Vena-Assist(R), ACI Medical) has a foot, ankle and calf cuff, applies a pressure of 80 mmHg, has a pressure rise time of 0.3 s, maintains inflation for 5.5 s, and has a cycling time of 1 min. Peak venous velocity and acceleration time were measured at rest and during the IPC application. Measurements were obtained in supine position from the common femoral vein 1 cm above the saphenofemoral junction to include the entire venous outflow from the limb.

RESULTS

peak venous velocity at rest was significantly higher in the right limb than in the left limb (26+/-7.2 vs. 22+/-5.7 cm/s, p<0.01). Peak venous velocity was significantly increased by both IPC devices (p <0.0001). IPC-2 achieved significantly higher peak venous velocity than IPC-1 (55.1+/-17.8 vs. 37.4+/-6.9 cm/s, p<0.0001). Acceleration time was also found to be significantly shorter (370+/-93.4 vs. 560+/-83.5 ms, p<0.0001) in IPC-2 than in IPC-1, respectively.

CONCLUSIONS

we have demonstrated that progressive inflation at the foot, ankle and calf, increasing maximal inflation pressure and decreasing time to maximal pressure result in increased venous return. These changes may improve the efficacy of IPC devices in the prevention of deep-venous thrombosis (DVT) formation.

Maturation of the mismatch negativity: effects of profound deafness and cochlear implant use

The use of cochlear implants to restore auditory sensation in deaf children is increasing, with a trend toward earlier implantation. However, little is known about how auditory deprivation and subsequent cochlear implant use affect the maturing human central auditory system. Our previous studies have demonstrated that the obligatory auditory evoked potentials (AEPs) of implanted children are very different from those of normal-hearing children. Unlike the obligatory potentials, which primarily reflect neural responses to stimulus onset, the mismatch negativity (MMN) provides a neurophysiological measure of auditory short-term memory and discrimination processes. The purpose of this investigation is to review our studies of the effects of auditory deprivation due to profound deafness and cochlear implant use on the maturation of the MMN in children, placed in the context of overall age-related changes in the AEPs. The development and application of a statistical technique to assess the MMN in individuals is also reviewed. Results show that although the morphology of the obligatory AEPs is substantially altered by the absence of a normal N(1) peak, the MMN is robustly present in a group of implanted children who have good spoken language perception through their device. Differences exist in the scalp distribution of the MMN between implanted and normal-hearing children. Specifically, the MMN appears to be more symmetrical in amplitude over both hemispheres, whereas it is initially much larger over the contralateral hemisphere in normal-hearing children. These findings suggest that, compared to N(1), the MMN is a better measure of basic auditory processes necessary for the development of spoken language perception skills in profoundly deaf children and adults who use a cochlear implant.

Consequences of neural asynchrony: a case of auditory neuropathy

The neural representation of sensory events depends upon neural synchrony. Auditory neuropathy, a disorder of stimulus-timing-related neural synchrony, provides a model for studying the role of synchrony in auditory perception. This article presents electrophysiological and behavioral data from a rare case of auditory neuropathy in a woman with normal hearing thresholds, making it possible to separate audibility from neuropathy. The experimental results, which encompass a wide range of auditory perceptual abilities and neurophysiologic responses to sound, provide new information linking neural synchrony with auditory perception. Findings illustrate that optimal eighth nerve and auditory brainstem synchrony do not appear to be essential for understanding speech in quiet listening situations. However, synchrony is critical for understanding speech in the presence of noise.

Pamidronate therapy as prevention of bone loss following renal transplantation

BACKGROUND

Very rapid bone loss, osteopenia and skeletal morbidity after renal transplantation have been well documented and found to occur in a sex dependent fashion. Glucocorticoids, cyclosporine and pre-existing uremic osteodystrophy have been implicated in the pathogenesis of the skeletal lesions. Glucocorticoid induced osteopenia is also a serious clinical problem in patients with various nonrenal diseases and can be prevented, or at least attenuated, by pamidronate and other bisphosphonates.

METHOD

We prospectively studied 26 male patients undergoing renal transplantation, and randomized them to receive either placebo or intravenous pamidronate (0.5 mg/kg) at the time of transplantation and again one month later. All patients received immunosuppression comprising prednisolone, cyclosporine and azathioprine. The bone mineral density (BMD) of the second, third and fourth lumbar vertebrae and of the femoral neck was measured at the time of transplantation and at three months and 12 months after transplantation using dual energy X-ray absorptiometry (DXA).

RESULTS

Twelve months after transplantation, the mean (+/- SEM) BMD of the lumbar vertebrae in patients who received placebo had decreased 6.4% (P < 0.05). In contrast, patients who received pamidronate experienced no significant reduction of BMD at the lumbar vertebrae. At the femoral neck, placebo-treated patients showed a reduction of BMD of 9% (P < 0.005), whereas there was no significant change in the pamidronate treated group. The two study groups had similar patient profiles, serum parathyroid hormone (PTH) and aluminium concentrations. After transplantation, comparable falls in the serum creatinine and PTH concentration were found in the two groups. Apart from transient hypocalcemia in two patients, no significant adverse effects of pamidronate were noted.

CONCLUSION

This study has shown that the early rapid bone loss that occurs in men during the first 12 months after renal transplantation can be prevented by two intravenous doses of pamidronate given at transplantation and one month later. The regimen was simple to administer, well tolerated and potentially applicable to other clinical groups of glucocorticoid treatment patients.

Comparative evaluation of the speed of flea kill of imidacloprid and selamectin on dogs

Imidacloprid (Advantage, Bayer Corporation, Shawnee Mission, KS) and selamectin (Revolution [United States], Pfizer Animal Health, Exton, PA 19341; Stronghold [European Union], Pfizer Animal Health Ltd, Sandwich, Kent CT 13 9NJ, UK) were tested to assess the speed of flea kill achieved against existing flea infestations and subsequent reinfestations. Thirty-six dogs were infested with 100 unfed adult fleas on day-1. On day 0, 12 dogs (group 1) were treated with imidacloprid at the minimum label dose of 10 mg/kg body weight. Twelve dogs (group 2) were treated with selamectin at the minimum label dose of 6 mg/kg body weight. Twelve dogs (group 3) remained as untreated controls. Four sub-groups (A through D) of three dogs each were designated within each group. All dogs were subsequently reinfested with fleas on days 6, 13, 20, 27, 34, and 41. Live flea counts were performed for subgroups A through D at 6, 12, 24, and 36 hours after treatment/reinfestation. Imidacloprid provided significantly and consistently greater flea kill than selamectin at 6, 12, and 24 hours after treatment and at 6 and 12 hours after each reinfestation. Although both products are commercially labeled for monthly topical use, imidacloprid provided significantly greater 36-hour flea kill at 34 and 41 days after treatment.

What is the optimal regimen for vitamin D?

The past 30 years have seen substantial advances in our understanding of the pathogenesis of the mineral, hormonal and skeletal disorders that comprise renal osteodystrophy. The introduction of calcitriol and alfacalcidol as treatments for this disorder in the early 1970s represented an enormous step forward in clinical practice, but unfortunately, the subsequent refinement of these therapies still leaves us well short of the ideal: hyperphosphatemia and hypercalcemia induced by the vitamin D metabolites, and failure to control parathyroid hyperplasia, all remain problematic. Novel pulsed regimens using alfacalcidol and calcitriol, while clearly effective, have not fulfilled initial high expectations of superiority in the context of comparative studies. New vitamin D metabolites, some of which have exhibited desirable selectivity in experimental settings with reduced tendency to raise phosphate and/or calcium while maintaining good control of the parathyroid glands, are now being evaluated. Of these, 22-oxacalcitriol, paricalcitol (19 nor-1,25 dihydroxyvitamin D2) and doxercalciferol (1 alpha-hydroxyvitamin D2) have all shown high efficacy when compared with placebo, but so also did alfacalcidol and calcitriol in similar studies in the 1970s and 1980s. The results of randomized studies comparing the new vitamin D metabolites with current standard therapy (alfacalcidol or calcitriol) are either not yet available or show uncertain benefits in relation to hypercalcemia, hyperphosphatemia and hyperparathyroidism. The impact of these new metabolites on the increasing prevalence of low turnover bone disease is unknown, although experimentally there is evidence of potentially important differences at the level of the skeleton.

Comparison of the persistent efficacy of the injectable and pour-on formulations of doramectin against artificially-induced infection with Dictyocaulus viviparus in cattle

The persistent efficacy of the injectable and topical formulations of doramectin was compared against experimental challenges with infective larvae of Dictyocaulus viviparus in two separate studies. Four groups of 10 randomly-assigned calves, negative for lungworm larvae by the Baermann technique, were used in each study. Calves were treated subcutaneously in the midline of the neck or poured down the midline of the back with saline (1 ml/50 kg. injection: 1 ml/10 kg. pour-on) on Day 0 or doramectin (200 microg/kg = 1 ml/50 kg. injection: 500 microg/kg = 1 ml/10 kg. pour-on) on Day 0, 7, or 14. Two additional calves from the same pool of animals were randomly assigned as larval-viability monitors and received no treatment. Calves were inoculated daily with a gavage of approximately 100 larvae of D. viviparus from days 35 to 49 for the injectable study and days 28 to 42 for the pour-on study. The two larval viability monitor calves received approximately 3000 infective larvae in the same manner on Day 49 or 42 for the injectable and pour-on studies, respectively. Equal numbers of calves from each treatment group as well as the larval viability monitor calves were necropsied on days 14 and 15 after the last lungworm inoculation to enumerate the worm burden. The worms recovered were quantified and identified. For each study, geometric mean worm recoveries for each treatment group were back transformed from the natural log-transformed data (worm count +1) and were used to estimate percentage reduction. Doramectin injectable solution was 100.0% efficacious against lungworms for up to 49 days and the pour-on formulation was 100.0%, 93.1% and 81.5% effective in reducing lungworm infection resulting from challenge infection for up to 28, 35, and 42 days post-treatment, respectively.

Coexpression of factor VIII heavy and light chain adeno-associated viral vectors produces biologically active protein

We are interested in using recombinant adeno-associated viral vectors in the treatment of hemophilia A. Because of the size constraints of recombinant adeno-associated viral vectors, we delivered the heavy and light chains of the human factor 8 (hFVIII) cDNA independently by using two separate vectors. Recombinant AAV vectors were constructed that utilized the human elongation factor 1alpha promoter, a human growth factor polyadenylation signal, and the cDNA sequences encoding either the heavy or light chain of hFVIII. Portal vein injections of each vector alone, a combination of both vectors, or a hFIX control vector were performed in C57BL/6 mice. An ELISA specific for the light chain of hFVIII demonstrated very high levels (2-10 microgram/ml) of protein expression in animals injected with the light chain vector alone or with both vectors. We utilized a chromogenic assay in combination with an antibody specific to hFVIII to determine the amount of biologically active hFVIII in mouse plasma. In animals injected with both the heavy and light chain vectors, greater than physiological levels (200-400 ng/ml) of biologically active hFVIII were produced. This suggests that coexpression of the heavy and light chains of hFVIII may be a feasible approach for treatment of hemophilia A.

Effects of lengthened formant transition duration on discrimination and neural representation of synthetic CV syllables by normal and learning-disabled children

In order to investigate the precise acoustic features of stop consonants that pose perceptual difficulties for some children with learning problems, discrimination thresholds along two separate synthetic /da-ga/ continua were compared in a group of children with learning problems (LP) and a group of normal children. The continua differed only in the duration of the formant transitions. Results showed that simply lengthening the formant transition duration from 40 to 80 ms did not result in improved discrimination thresholds for the LP group relative to the normal group. Consistent with previous findings, an electrophysiologic response that is known to reflect the brain's representation of a change from one auditory stimulus to another--the mismatch negativity (MMN)--indicated diminished responses in the LP group relative to the normal group to /da/ versus /ga/ when the transition duration was 40 ms. In the lengthened transition duration condition the MMN responses from the LP group were more similar to those from the normal group, and were enhanced relative to the short transition duration condition. These data suggest that extending the duration of the critical portion of the acoustic stimulus can result in enhanced encoding at a preattentive neural level; however, this stimulus manipulation on its own is not a sufficient acoustic enhancement to facilitate increased perceptual discrimination of this place-of-articulation contrast.

Speech-sound discrimination in school-age children: psychophysical and neurophysiologic measures

This study measured behavioral speech-sound discrimination and a neurophysiologic correlate of discrimination in normal school-age children (ages 6 to 15) to determine if developmental effects exist. Just noticeable differences (JNDs) and mismatch responses (MMNs) were assessed for synthetic syllables that differed in third-formant onset frequency (/da-ga/) and formant transition duration (/ba-wa/). These stimuli were selected because children with learning problems often find it difficult to discriminate rapid spectrotemporal changes like /da-ga/, whereas the ability to distinguish /ba-wa/ is relatively unimpaired. Results indicate that JNDs for /da-ga/ show no developmental effects and that JNDs for /ba-wa/ decrease slightly with age (although likely for task-related reasons). MMNs elicited by two /da-ga/ stimulus pairs (onset frequency differences = 20 Hz, 280 Hz) and three /ba-wa/ stimulus pairs (transition duration differences = 3, 5, 15 ms) showed no systematic or significant differences for onset latency, duration, or area as a function of age. Normative JND and MMN data are provided. These norms provide a metric against which children with suspected central auditory processing difficulties or auditory-based language disorders can be compared.

Non-invasive RNA-based determination of fetal Rhesus D type: a prospective study based on 96 pregnancies

OBJECTIVES

To develop a non-invasive method for determining fetal RhD status in order to provide improved care for women most at risk.

DESIGN

A prospective study.

METHODS

Fetal erythroblasts were enriched from the peripheral circulation of 96 RhD negative women with pregnancies at various stages in gestation using discontinuous density gradients. Amplification of RhD-specific mRNAs was carried out by reverse transcription-polymerase chain reaction assay. RNA, rather than DNA, was selected for amplification because it rarely contaminates samples, thus resulting in fewer false positives; moreover, its presence in multiple copies per cell should enhance the sensitivity of the assay, resulting in fewer false negatives. The study was prospective, relying on postnatal serological confirmation of RhD phenotype.

RESULTS

The assay was 75% accurate at predicting fetal RhD status, comparing favourably with standard genomic DNA-based assays. However, we found that accuracy dropped from 85% (29/34) in the third trimester of pregnancy, to 82% (32/39) in the second and 48% (11/23) in the first trimester. Discordant data were due to false negatives in the majority (78%) of cases.

CONCLUSIONS

We suggest that reverse transcription may be a useful and perhaps more sensitive alternative to standard genomic polymerase chain reaction in the majority of cases. However, under certain circumstances the absence or reduction of fetal erythroblasts or possibly RhD mRNA in some preparations may compromise the accuracy of the assay.

Disturbance of cerebral function in people exposed to drinking water contaminated with aluminium sulphate: retrospective study of the Camelford water incident

OBJECTIVE

To establish whether people exposed to drinking water contaminated with 20 tonnes of aluminium sulphate in the Camelford area of Cornwall in the south west of England in July 1988 had suffered organic brain damage as opposed to psychological trauma only.

DESIGN

Retrospective study of affected people.

PARTICIPANTS

55 affected people and 15 siblings nearest in age to one of the group but who had not been exposed to the contaminated water were studied.

MAIN OUTCOME MEASURES

Various clinical and psychological tests to determine medical condition and anxiety levels in affected people. Assessment of premorbid IQ (pFSIQ) with the national adult reading test, a computerised battery of psychomotor testing, and measurement of the difference in latencies between the flash and pattern visual evoked potentials in all participants.

RESULTS

The mean (SE) pFSIQ was above average at 114.4 (1.1). The most sensitive of the psychomotor tests for organic brain disease was the symbol digit coding (SDC) test (normal score 100, abnormal <85). PARTICIPANTS performed less well on this test (54.5 (6.0)) than expected from their pFSIQ (P<0.0001) and a little less poorly on the averaged less discriminating tests within the battery (86.1 (2.5), P<0.0001). In a comparison with the 15 sibling pairs (affected people's age 41.0 (3.3) years v sibling age of 42.7 (3.1) years (P=0.36) the exposed people had similar pFSIQ (114.7 (2.1)) to their siblings (116.3 (2.1), (P=0.59) but performed badly on the symbol digit coding test (51.8 (16.6)) v (87.5 (4.9) for siblings, P=0.03). The flash-pattern differences in exposed people were greater than in 42 unrelated control subjects of similar age (27.33 (1.64) ms v 18. 57 (1.47) ms, P=0.0002). The 15 unexposed siblings had significantly better flash-pattern differences than their affected siblings (13.4 (2.4) ms v 29.6 (2.9) ms, P=0.0002). No effect of anxiety could be shown on these measurements from the analysis of the anxiety scores of exposed people.

CONCLUSION

People who were exposed to the contaminated water at Camelford suffered considerable damage to cerebral function, which was not related to anxiety. Follow up studies would be required to determine the longer term prognosis for affected individuals.

Nurses' attitudes to the extension and expansion of their clinical roles

Nurses are increasingly being asked to extend or expand their traditional roles, often for reasons other than their own professional development. This study, across three specialties in one hospital, examines whether or not nurses view such change in a positive light.

Teaching and assessing ethics and law in the dental curriculum

The General Dental Council's recommendations on dental education places a new emphasis on the importance of ethics and law in the dental curriculum, stating that students should have an awareness of moral and ethical responsibilities involved in the provision of care to individual patients and to populations. The duties of care to protect a patient's life and health at all times, to respect their autonomy to make informed choices about what happens to them, and to do this fairly and without prejudice, are widely accepted as the fundamental ethical principles governing all health care. The specifics of these duties of care are detailed in Maintaining Standards: guidance to dentists on professional and personal conduct, published by the GDC.

Mental health service use: a comparison of treated and untreated individuals with substance use disorders in Ontario

OBJECTIVE

To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults.

METHOD

Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15-64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses.

RESULTS

Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use.

CONCLUSIONS

The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.

Effects of red blood cell transfusion on resting energy expenditure in adolescents with sickle cell anemia

BACKGROUND

Previous studies indicate that resting energy expenditure is elevated in children with sickle cell anemia, possibly caused in part by hemolysis and increased erythropoietic activity. The purpose of the present investigation was to determine whether erythrocyte transfusion normalizes resting energy expenditure in sickle cell anemia.

METHODS

Five adolescents with sickle cell anemia (12-16 years old; 4 boys, 1 girl) were studied before and 1 week after erythrocyte transfusion before elective surgery or at the initial transfusion for growth failure. Resting energy expenditure was measured by indirect calorimetry, and laboratory measures were determined by routine, validated methods. Data comparisons were by nonparametric analysis.

RESULTS

After erythrocyte transfusion, total hemoglobin levels increased (difference (D) = 15 g/l; p < 0.05), whereas hemoglobin S (D = -0.36; p < 0.05) and reticulocyte count (D = -0.12; p < 0.05) decreased. Mean pretransfusion resting energy expenditure was elevated to 124% above predicted levels (p < 0.05) and increased further to 134% above prediction (p < 0.05 vs. pretransfusion levels). Plasma triiodothyronine (T3) levels increased (D = 0.17 nmol/l; p < 0.05), reverse T3 (rT3) levels tended to decline (D = -0.04 nmol/l; p = 0.14), and rT3/T3 decreased (D = -0.03; p < 0.05). Plasma insulin-like growth factor-I (IGF-I) levels were low-normal before transfusion and did not change, despite the change in resting energy expenditure.

CONCLUSIONS

The results confirm that resting energy expenditure is elevated in patients with sickle cell anemia. However, resting energy expenditure further increased after transfusion, despite decreased erythropoietic activity. A posttransfusion decrease in rT3/T3 may contribute to the increased resting energy expenditure. That there was no change in IGF-I implies that the growth hormone-IGF system is not involved in posttransfusion regulation of resting energy expenditure. Therefore, our data are not consistent with the hypothesis that increased resting energy expenditure in sickle cell anemia is directly related to erythropoietic activity. The mechanisms by which resting energy expenditure increases after transfusion in sickle cell anemia require additional investigation.

Isolation and characterization of microsatellite loci in black rhinoceros (Diceros bicornis)

The black rhinoceros (Diceros bicornis) is currently one of the most endangered African mammals as a direct result o habitat destruction and intensive poaching. A microsatellite library was constructed to address a number of population genetic questions. This paper describes the isolation of five black rhinoceros microsatellite loci. Three of these loci were found to be polymorphic. In addition, the paper demonstrates the utility for cross-hybridization of these primers in other species of rhinoceros.

The failed gastrointestinal anastomosis: an inevitable catastrophe?

BACKGROUND

There is a great deal of conflicting data regarding risk factors for anastomotic leakage, with most studies being small and looking only at anastomoses performed at one level of the gastrointestinal (GI) tract. Surgeons have looked at patient and technical variables with inconsistent findings. The purpose of this study was to evaluate the incidence, possible predictive factors, and results of treatment of anastomotic dehiscence in patients undergoing operations at all levels of the GI tract.

STUDY DESIGN

We evaluated the records of 2,842 patients undergoing esophagogastrectomy, total or partial gastrectomy, enterectomy, and partial or subtotal colectomy over a 12-year period. Complete demographic data, comorbidity, and details regarding anastomotic technique were collected on all patients sustaining leaks along with diagnostic methods used, treatment modalities, and outcomes data. Using age and gender-matched case control methodology, we compared patients sustaining an anastomotic leak to those undergoing successful anastomoses.

RESULTS

Fifty-one of 2,842 patients (1.8%), ranging from 1.1% of enterectomy patients to 4.8% of total gastrectomy patients, sustained an anastomotic dehiscence. Foregut procedures were accompanied by a significantly increased rate of leakage, and depending on location, diagnosis was made between the 6th and 9th postoperative day. For each procedure, deaths from factors other than leakage far exceeded deaths from leaks. Standard risk stratifiers did not predict occurrence of leakage. Overall, 24% of patients sustaining a leak died, and this complication necessitated multiple reoperations and significantly increased length of hospital stay.

CONCLUSIONS

In view of these findings, standard preoperative strategies to prepare these patients for operation may prove unsuccessful, because minimizing the incidence of anastomotic leaks will have little overall impact on survival. In addition, efforts to accomplish early hospital discharge may prove hazardous, because many of these patients manifest their leaks later in the postoperative period than is generally assumed. Improved management of GI tract disruption, including aggressive attempts at diagnosis, ICU care, antibiotics, and nutritional support may further increase survival in these patients.

A case report: recognizing factitious injuries secondary to multiple eating disorders

This report describes the uncommon problem of a female patient diagnosed with an eating disorder, bulimia nervosa, who reported self-mutilating dental factitious behavior. The case presents a serious diagnostic and management problem. Notwithstanding the clinical appearance of the dentition, a thorough medical-dental history was essential for this uncommon diagnosis.

Effects of new analogues of vitamin D on bone cells: implications for treatment of uremic bone disease

BACKGROUND

The use of calcitriol in the treatment of uremic hyperparathyroidism and renal osteodystrophy is limited in many patients by hypercalcemic side-effects. New less calcemic analogues of calcitriol are being developed, and some are under clinical evaluation. To investigate whether these compounds possess important differences in their action on bone cells, we have studied their effects [with and without parathyroid hormone (PTH)] on the release and synthesis of the resorptive osteotropic cytokine, interleukin-6 (IL-6).

METHODS

MG 63 and SaOS-2 human osteoblastic cell lines were cultured for 6 or 24 hours in media containing calcitriol, the sterols of interest, or 1-34 synthetic PTH. IL-6 release was assayed by commercially available enzyme-linked immunosorbent assay. IL-6 mRNA levels were assessed by reverse transcriptase-polymerase chain reaction.

RESULTS

We found that calcitriol and paricalcitol behaved in a similar fashion, resulting in increased IL-6 release only at higher concentrations (10(-7) to 10(-9) M). In contrast, 22-oxacalcitriol and 1,25-dihydroxydihydrotachysterol2 stimulated release to a similar extent but at concentrations three to four orders of magnitude lower (10(-11) to 10(-13) M), despite being less potent as suppressers of parathyroid function than calcitriol. Studies of IL-6 mRNA showed a similar pattern of concentration and cell line-dependent transcription.

CONCLUSIONS

Compounds stimulating IL-6 release at concentrations achievable during the treatment of uremic hyperparathyroidism might favor continuing linked bone formation and resorption and thereby avoid adynamic bone disease while still allowing profound suppression of PTH.

Ier5, a novel member of the slow-kinetics immediate-early genes

We describe here a novel member of the slow-kinetics immediate-early gene family. Ier5 is an intronless gene, encoding a serum- and growth factor-inducible message of 2123 nucleotides that is present in a wide variety of tissues. The predicted open reading frame encodes a 308-amino-acid, highly proline-rich protein with homology to the amino terminus of the immediate-early gene pip92/Ier2/ETR101. Ier5 is predicted to be a nuclear protein and contains a PEST-like sequence, suggesting rapid protein degradation. Multiple phosphorylation sites are present. Ier5 shows growth factor induction kinetics similar to that of pip92/Ier2/ETR101, but unlike pip92/Ier2/ETR101 does not appear to require phosphokinase C activity for transcriptional activation. The sequence of the promoter region of Ier5 was determined and examined for transcription factor binding sites thought to mediate serum and growth factor response. Multiple AP-1 sites and an Ets-1 site were observed, but the CArG and CArG-like boxes of the serum response element were absent. The predicted nuclear localization of Ier5, coupled with the potential for rapid regulation by phosphorylation and/or degradation, suggests that Ier5 may play an important role in mediating the cellular response to mitogenic signals.

Roles for laminin in embryogenesis: exencephaly, syndactyly, and placentopathy in mice lacking the laminin alpha5 chain

Laminins are the major noncollagenous glycoproteins of all basal laminae (BLs). They are alpha/beta/gamma heterotrimers assembled from 10 known chains, and they subserve both structural and signaling roles. Previously described mutations in laminin chain genes result in diverse disorders that are manifested postnatally and therefore provide little insight into laminin's roles in embryonic development. Here, we show that the laminin alpha5 chain is required during embryogenesis. The alpha5 chain is present in virtually all BLs of early somite stage embryos and then becomes restricted to specific BLs as development proceeds, including those of the surface ectoderm and placental vasculature. BLs that lose alpha5 retain or acquire other alpha chains. Embryos lacking laminin alpha5 die late in embryogenesis. They exhibit multiple developmental defects, including failure of anterior neural tube closure (exencephaly), failure of digit septation (syndactyly), and dysmorphogenesis of the placental labyrinth. These defects are all attributable to defects in BLs that are alpha5 positive in controls and that appear ultrastructurally abnormal in its absence. Other laminin alpha chains accumulate in these BLs, but this compensation is apparently functionally inadequate. Our results identify new roles for laminins and BLs in diverse developmental processes.

cDNA cloning, in vitro expression, and biochemical characterization of cholinesterase 1 and cholinesterase 2 from amphioxus--comparison with cholinesterase 1 and cholinesterase 2 produced in vivo

We have isolated cDNAs coding for the complete amino acid sequences of cholinesterase 1 (ChE1) and cholinesterase 2 (ChE2) from amphioxus. Both ChE transcripts have the characteristics of H-type catalytic subunits, which are inserted in the membrane via an ethanolamine-glycan-phosphatidylinositol anchor. The members of the catalytic triad of ChEs, the three pairs of cysteine residues involved in intrachain disulfide bonding, a cysteine near the carboxy terminal of both sequences, which could mediate interchain disulfide bonding, and 11 of the 14 aromatic amino acids that line the catalytic gorge of AChE are conserved. A remarkable difference between the two enzymes is in the region of the acyl-binding pocket, which plays an important role in determining substrate specificity in cholinesterases. ChE2 contains a sequence that resembles the acyl pocket of invertebrate ChE, while the acyl-binding site of ChE1 is novel. There are also differences between the two enzymes in the peripheral anionic site, which mediates inhibition by certain ligands. In vitro expression in COS-7 cells demonstrates that ChE2 hydrolyzes acetylthiocholine almost exclusively, while ChE1 hydrolyzes both acetylthiocholine and butyrylthiocholine. Both enzymes are inhibited comparably by BW284c51, but ChE1 is considerably more resistant to inhibition by propidium, ethopropazine, and eserine than is ChE2. Velocity sedimentation indicates that ChE1 and ChE2 are present as amphiphilic and nonamphiphilic G2 forms in vivo and in vitro. Another molecular form, which sediments at 17 S, is also present in vivo. Nondenaturing gel electrophoresis in conjunction with digestion by phosphatidylinositol-specific phospholipase C demonstrates that the vast majority of ChE1 and ChE2 is present as ethanolamine-glycan-phosphatidylinositol-anchored G2 forms in vivo. ChE1 also possesses an ethanolamine-glycan-phosphatidylinositol-anchor in vitro; however, ChE2 produced in vitro could not be detected on nondenaturing gels.

The importance of clinical experience in aboriginal communities

The importance of preparing nurses adequately to meet the health needs of Aboriginal people cannot be understated. Much of the reason for negative attitudes among nurses is a lack of knowledge and understanding of cultural differences. Clinical practice in an Aboriginal community can assist in the development of cross-cultural skills among student nurses. In recent times it has been accepted that nursing curricula in Australia must reflect an understanding and awareness of cultural perspectives, diversity and sensitivity. Exposing students to Aboriginal health workers has been found to result in a positive change in attitude among students (Hayes et al. 1994). Providing clinical experiences in Aboriginal communities can increase students' awareness of Aboriginal health status, the socio-cultural and historical influences involved, and the nurse's role in relation to Aboriginal health. Nurses are a major provider of health care within Aboriginal communities throughout Australia. Culturally diverse clinical placements challenge students to become aware of their own health beliefs, attitudes, and values, which can facilitate bridging cross-cultural gaps with clients and also facilitate the delivery of quality nursing care.

Selective release of nitric oxide from retinal amacrine and bipolar cells

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Hospital-acquired blood stream infections in New Zealand

AIM

To determine the number and rates of hospital-acquired blood stream infections in New Zealand public hospitals.

METHOD

From October 1994 to December 1996 each of the 23 Crown Health Enterprises (CHEs) provided the Crown Company Monitoring Advisory Unit with data on the number of episodes of hospital-acquired blood stream infection (HA-BSI) and the number of inpatient admissions.

RESULTS

During the 27 month study period, 3049 episodes of HA-BSI occurred in an inpatient population of 1 300 892 giving a national average rate of 0.23%. HA-BSI rates were highest for the six tertiary level, metropolitan CHEs (range 0.19% - 0.56%) in which 79% of all HA-BSIs occurred.

CONCLUSION

The HA-BSI rate for New Zealand is within the range that would be expected for a developed country with a comprehensive health service. The variability between CHEs in terms of the clinical services provided and case mix differences invalidates direct comparison of HA-BSI rates. Surveillance for HA-BSI should continue with the collection of data which would allow meaningful comparison of similar tertiary level services.

BOOK REVIEW: AN ENCYCLOPEDIA TO ACHIEVE AN HOLISTIC APPROACH

Psychology and Sociology both deal with a huge range of concepts and methodologies. Information from other disciplines is integrated into Psychology and Sociology, and vice versa. This reciprocal intellectual relationship must be enhanced so that the social and behavioral sciences can assist in solving the many present and future local and international problems. Such a highly demanding integration among disciplines can be systemised using an invaluable research tool - the Encyclopedia of World Problems and Human Potential.

Peer mentorship in clinical education: outcomes of a pilot programme for first year students

Identifying effective strategies for promoting learning in the clinical setting continues to pose challenges for nurse educators. The aim of the present paper is to examine the potential that peer mentorship may have in helping nursing students to improve clinical learning outcomes. An example of a peer mentorship programme for nursing students undertaking their first clinical practicum is described, and preliminary findings from an evaluation of this pilot programme are presented. The results suggest that peer mentorship may be of some benefit to students, particularly in relation to reducing anxiety and improving confidence with clinical practice experiences, and is therefore a strategy which is worthy of further investigation.

Efficacy of imidacloprid for removal and control of fleas (Ctenocephalides felis) on dogs

OBJECTIVE

To evaluate efficacy of a 9.1% (w/w) imidacloprid solution, applied topically, to remove fleas from dogs and the duration of residual flea control when dogs were exposed to continuing flea infestation.

ANIMALS

32 adult mixed-breed dogs.

PROCEDURE

Dogs were allocated to 4 groups of 8 dogs each; dogs of 3 groups received a single dose of imidacloprid, and those of the fourth group received excipient. Each dog was infested with 100 adult fleas on study days -3, -1, 6, 13, 20, 27, and 33. Treatments were applied on day 0. Each dog was examined for live fleas on days -2, 1, 7, 14, 21, 28, and 34. Posttreatment efficacy was determined by comparing the mean number of live fleas remaining on the treated dogs with the mean number of live fleas remaining on the control dogs.

RESULTS

All 3 imidacloprid dosages provided flea control > or = 96.9% one day after treatment. Maximal efficacy of all 3 dosages (99.1 to 100%) was observed at 7 days after treatment. Flea control with 3.75 mg of imidacloprid/kg of body weight ranged from 94.4 to 96.9% for days 14 to 28 and decreased to 91.6% by 34 days after treatment. Flea control with 7.5 and 10.0 mg of imidacloprid/kg was 97.8 to 100% through day 28. At day 34, dosages of 7.5 and 10.0 mg of imidacloprid/kg were 97.6 and 96.9% efficacious, respectively.

CONCLUSION

7.5 or 10.0 mg of imidacloprid/kg are equivalent and superior to 3.75 mg/kg for flea control over the course of a 34 day posttreatment period.

CLINICAL RELEVANCE

Monthly imidacloprid application of 7.5 to 10 mg/kg will rapidly kill existing and reinfesting flea infestations on dogs and break the flea life cycle by killing adult fleas before egg production begins.

Human cationic amino acid transporter gene hCAT-2 is assigned to 8p22 but is not the causative gene in lysinuric protein intolerance

Lysinuric protein intolerance (LPI) is a recessively inherited amino acid disorder characterized by defective efflux of cationic amino acids at the basolateral membrane of the intestinal and renal tubular epithelium. Recently, cDNAs encoding the related proteins hCAT-2A and hCAT-2B have been cloned. These two carrier proteins are most likely to product of the same gene, hCAT-2. Using the hCAT-2B cDNA, we assigned the hCAT-2 gene to chromosome 8p22. Furthermore, by linkage analysis in Finnish LPI families, we ruled out that hCAT-2B is involved in LPI disease.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Reduced calcium dialysate in CAPD patients: efficacy and limitations

BACKGROUND

The increasing use of 'reduced calcium' dialysate in CAPD patients treated with calcium-based phosphate binders has raised concerns that this could lead to negative calcium balance, worsening hyperparathyroidism, and osteopenia.

METHODS

The present study was conducted to examine the possibilities (a) that 1.25 mM calcium dialysate leads to negative calcium balance and worsening hyperparathyroidism, and (b) that conversely 1.25 mM calcium dialysate is still too high for some patients. We studied 22 patients who, after a 2-month run in using 1.75 mM calcium dialysate and aluminium hydroxide binders, entered a 3-month phase of 1.25 mM calcium dialysate with continuation of aluminium hydroxide as the sole phosphate binder. The patients then entered a final 9-month phase in which dialysate calcium remained at 1.25 mM and calcium carbonate was substituted for aluminium hydroxide and progressively titrated to achieve optimum phosphate control.

RESULTS

During the initial 3-month period, parathyroid hormone increased from 259, range 11-1149 to 405, range 16-1318 pg/ml (P = 0.0001) and ionized calcium decreased from 1.17 +/- 0.06 to 1.11 +/- 0.08 mM (P = 0.0004). The subsequent 9-month phase was associated with return of parathyroid hormone to baseline levels. Further dialysate calcium reduction to 0.6 mM was implemented in the four patients who became hypercalcaemic.

CONCLUSION

This study has clearly shown that reduction of dialysate calcium to 1.25 mM can be harmful to CAPD patients if oral calcium availability is inadequate. It has also shown that dialysate calcium at 1.25 mM is a compromise, with increased risk of hyperparathyroidism if calcium intake is too low and, conversely, risk of hypercalcaemia and unacceptable increases of the Ca x Pi product in a minority of patients. At these extremes there is a need for a high-calcium dialysate (1.75 mM) and a very low-calcium dialysate (0.6 mM or less), to optimize management.

Reduced expression of mismatch repair genes measured by multiplex reverse transcription-polymerase chain reaction in human gliomas

Microsatellite instability (MIN) is frequently observed in hereditary nonpolyposis colon cancer and in other sporadic cancers including gliomas. Abnormalities in at least one of five mismatch repair (MMR) genes are implicated in the development of cancers in hereditary nonpolyposis colon cancer and the associated MIN. Using a newly developed multiplex reverse transcription-PCR assay, we evaluated the expression of the five known human MMR genes (hMSH2, hMLH1, hPMS1, hPMS2, and GTBP) in human gliomas by measuring simultaneously the relative levels of the transcripts. The beta-actin gene was used as an internal control for RNA degradation and DNA contamination and as a reference for quantifying the levels of their transcripts. Of the 33 gliomas examined, 42% (14) had low expression of hMSH2 (at least 4-5-fold lower than normal mean), 21% (7) had low expression of hMLH1, and 18% (6) had low expression of hPMS1 compared with the expression in the lymphocytes from 13 normal individuals. Furthermore, six of the 33 (18%) tumor samples had decreased expression of more than one MMR gene. Two of these six patients with multiple gene abnormalities had second primary cancers, and an additional patient had multifocal gliomas. Further molecular analysis of available DNA samples indicated that one of five of those tumors with aberrant expression of MMR genes had MIN, as compared with none of five tumors with normal expression. These data suggest that reduced expression of MMR genes is frequent in human gliomas and that aberrant expression of more than one MMR gene may be associated with increased risk of second primary malignancies in glioma patients.

Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis

BACKGROUND AND STUDY AIMS

The reason for the increased risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of Oddi dysfunction is not known. This study sought to determine whether pancreatic sphincter hypertension might explain some of the increased risk.

PATIENTS AND METHODS

The incidence of pancreatitis was determined from a cohort of patients who underwent pancreatic sphincter manometry. Additional data collected included: pancreatic and biliary sphincter manometry results, distal bile duct diameter, chronic pancreatitis grade by pancreatography, and endoscopic treatments.

RESULTS

Ten of 32 patients (31%) with pancreatic sphincter hypertension developed post-ERCP pancreatitis, compared to one of 33 (3%) with normal pancreatic manometry (P = 0.002). Patients with pancreatic sphincter hypertension were more likely to undergo endoscopic treatments (88%) compared to those with normal manometry (27%) (P = 0.001). The distal bile duct diameter was significantly smaller (4.5 +/- 0.5 mm) in patients who developed post-ERCP pancreatitis than in those who did not (6.2 +/- 0.3) (P = 0.025). Patients with small distal bile duct diameters (< 5 mm) were three times more likely to develop post-ERCP pancreatitis than those with larger ducts (relative risk [RR] 3.1, 95% confidence interval [CI] 0.9, 10.7). Patients with pancreatic sphincter hypertension were ten times more likely to develop post-ERCP pancreatitis than those with normal pancreatic manometry (RR 10.3, 95% CI 1.5, 76.0). In patients with a small bile duct size, pancreatic sphincter hypertension substantially increased the risk compared to those with normal manometry (RR 18.1, 95% CI 1.1, 287.6).

CONCLUSIONS

Pancreatic sphincter hypertension greatly increases the risk of post-ERCP pancreatitis in patients undergoing treatment or evaluation, or both, for sphincter of Oddi dysfunction.

Transactional Analysis of Communication Styles in HIV/AIDS Advertisements

Television advertising has been an important medium for health promotion campaigns addressing HIV/AIDS. This study sought to evaluate the 'Grim Reaper' and 'Multiple Beds' advertisements frequently broadcasted throughout Australia. Our model for evaluation was based on a theoretical synthesis of television advertising, transactional analysis (TA) and recall congruence. Eighty-three participants viewed each advertisement and rated which ego state the source of the message was attempting to 'hook' in the audience. They also predicted their own ego state during sexual intercourse and rated the effectiveness of the advertisements. As predicted by TA theory, a crossed transaction was associated with significantly less psychological impact than a parallel transaction for the 'Grim Reaper' advertisement. A similar trend was apparent for the 'Multiple Beds' advertisement. Important issues which warrant further research in order to evaluate whether transactional analysis could be a useful tool in promoting health are discussed.