Psychiatric Aspects of Air Pollution

Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well-being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Manifestations are often insidious or delayed, but they can provide a more sensitive indicator of toxic effects than cancer rates or mortality data. Other medical effects of air pollution, such as asthma, can indirectly affect psychological health. The sick building syndrome and multiple chemical sensitivity are conditions with toxicologic and psychiatric aspects. Psychosocial stress can cause symptoms similar to those of organic mental disorders. Reactions to stress depend on cultural, individual, and situational variables. We must understand these factors to be able to alleviate and prevent the consequences of environmental trauma. Expanded research is recommended in three main areas: (1) how people perceive and cope with environmental health risks, (2) the effects of air pollution on behavior and neuropsychological functioning, and (3) neurotoxicologic evaluation of air pollutants with both behavioral and in Vitro Studies.

Psychiatric aspects of air pollution

Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well-being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Manifestations are often insidious or delayed, but they can provide a more sensitive indicator of toxic effects than cancer rates or mortality data. Other medical effects of air pollution, such as asthma, can indirectly affect psychological health. The sick building syndrome and multiple chemical sensitivity are conditions with toxicologic and psychiatric aspects. Psychosocial stress can cause symptoms similar to those of organic mental disorders. Reactions to stress depend on cultural, individual, and situational variables. We must understand these factors to be able to alleviate and prevent the consequences of environmental trauma. Expanded research is recommended in three main areas: (1) how people perceive and cope with environmental health risks, (2) the effects of air pollution on behavior and neuropsychological functioning, and (3) neurotoxicologic evaluation of air pollutants with both behavioral and in vitro studies.

Localization of a gene for autosomal dominant Larsen syndrome to chromosome region 3p21.1-14.1 in the proximity of, but distinct from, the COL7A1 locus

Larsen syndrome (LS) is a skeletal dysplasia (osteochondrodysplasia) in which multiple dislocations of the large joints are the major feature. Nosology in this group of diseases, which constitutes 8% of Mendelian disorders in man, is primarily based on clinical and radiographic features. Hopes for more accurate classification grounds are currently being met by progress in elucidation of underlying genetic defects. We have performed linkage analysis in a large Swedish kindred with autosomal dominant LS and found the gene (LAR1) to be strongly linked to chromosome 3p markers (Zmax = 13.4 at (theta = .00). Recombination analysis indicates that the LAR1 locus is located in a region defined distally by D3S1581 and proximally by D3S1600, which cytogenetically maps to chromosome region 3p21.1-14.1. Linkage and recombination analysis of a COL7A1 PvuII intragenic polymorphism versus LS and chromosome 3 markers indicate that COL7A1 is located close to, but distinct from, the LAR1 locus.

Late results of the Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. 6/19 implants loose after 5 years

We performed total elbow replacement, using the Souter-Strathclyde prosthesis in 19 elbows of 18 patients with rheumatoid arthritis and followed the patients for 5 (1-11) years. Pain relief was achieved initially in all patients. The average range of flexion-extension was increased by 12 degrees and pronation-supination by 40 degrees. There were no infections. 1 patient sustained an intraoperative fracture of the medial epicondyle, 3 patients developed neuropathies and 1 patient had an immediate postoperative dislocation of the joint. At follow-up, 6 prostheses had radiographic loosening, with sagittal titling and migration of 4 humeral components. 2 patients had clinical symptoms of loosening.

Kinematics of the normal arch of the foot and ankle under physiologic loading

We studied 15 cadaver feet to determine three-dimensional motion of selected tarsal bones under axial loading at three different loading levels. We determined the motion of individual joints and also the rotation of the tarsal bones in relation to the tibia. Joint rotations increased consistently with higher loads. The naviculartalar joint had the greatest total screw axis rotation, which averaged 9.4 degrees +/- 2.2 degrees at 667 N of load, followed by the first metatarsal-navicular (mean, 7.2 degrees +/- 1.5 degrees), talartibial (mean, 5.2 degrees +/- 1.6 degrees), and calcaneal-talar (mean, 4.4 degrees +/- 1.7 degrees) joints. The observed changes indicate the need for assessment of foot and ankle alignment clinically and radiologically while the patient is weightbearing.

Biodegradable fixation of ankle fractures. A roentgen stereophotogrammetric study of 32 cases

We performed a prospective randomized study comparing fixation with biodegradable polyglycolic acid (PGA) rods (n 15) or screws (n 17) in 32 selected displaced supination-eversion fractures. Immediate postoperative weight bearing in a walking cast was encouraged. An exact reconstruction of the ankle mortise was achieved in 26/32 ankles. Roentgen stereophotogrammetric analysis (RSA) revealed rather small movements in the ankle mortise during fracture healing. A better stability was achieved by using screws. After 6 months the clinical results did not differ. One case of sinus formation and one with local effusion occurred; both healed without impairing the clinical result. To compare the results with a nondegradable osteosynthesis technique, a reference group of supination-eversion fractures previously operated on with cerclage-wires, staples and pins was used. RSA showed better fracture stability with nondegradable fixation. The clinical results, however, did not differ.

Knee motion after tibial osteotomy for arthrosis. Kinematic analysis of 7 patients

The in vivo kinematics of the knee in 7 patients with moderate medial gonarthrosis was analyzed before and 6 months after high tibial osteotomy using roentgen stereophotogrammetric analysis. The inclination of the femorotibial helical axis of rotation did not change with knee flexion or after surgery. The femorotibial rotation increased after surgery. No consistent change in patellar position after surgery was found. Patella translated laterally as the knee was flexed with a maximum patellar translation of about 15 mm and rotated internally with a maximum patellar internal rotation of about 15 degrees. There was no significant change in patellar translation or rotation after surgery. There was a good concordance regarding the size of the tibial wedge removed during surgery, calculated from the Hip-Knee-Ankle radiographs and from the roentgen stereophotogrammetric measurements.

Characteristics of target-reaching in cats. II. Reaching to targets at different locations

Trajectory formation of unrestrained forelimb target-reaching was investigated in relation to the effect of a change in target location. Sagittal displacement of the target (6 cm in each direction) gave a selective change of velocity in the x direction (protraction) with an increase or decrease at larger and shorter distances, respectively. In the case of a double-peaked x velocity profile, the change was mainly with respect to the first major component. The shape of the y (sideways) and of the z (lifting) velocity profiles were both almost unchanged, but the onset of the movement in the z direction changed with the x distance. Vertical displacement (4 cm up or 5 cm down) gave increased velocity in the z direction (lifting) when the target was above the normal mid-position and decreased velocity when the target was lower. The velocity was changed with constant rate of rise, so that the rise time increased when the target was elevated and shortened when the target was lowered (pulse width control policy). The change in the z velocity was not selective. In cats with a double-peaked x velocity profile, the second component decreased when the target was elevated and increased when it was lowered. With excessive lowering of the target (14 cm down), the first x velocity component was very much reduced in amplitude so that protraction depended mainly on the second x velocity component. In the cat with a unimodal x velocity profile, a second component appeared in the x and net velocity profiles when the target was excessively lowered.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of target-reaching in cats. I. Individual differences and intra-individual constancy

Trajectory formation of unrestrained forelimb target-reaching was investigated in six cats. A Selspot-like recording system was used for three-dimensional recording of the position of the wrist every 3 ms with the aid of two cameras detecting infrared light emitted from diodes taped to the wrist. These measurements allowed reconstruction of movement paths in the horizontal and sagittal planes and velocity profiles in the direction of the cartesian x, y and z co-ordinates. Horizontal movement paths were smoothly curved, segmented or almost linear. Sagittal movement paths were sigmoid. The net velocity profile was usually bell-shaped with longer deceleration than acceleration, but for some slow movements the velocity profile had a plateau. When the net velocity profile was bell-shaped, the averaged sagittal movement paths and normalized x (protraction) and z (lifting) velocity profiles were virtually superimposable for fast and slow movements: thus, movement speed was changed by parallel scaling of protraction and lifting. Comparison of movement paths and velocity profiles amongst the different cats revealed considerable differences. The x profile was unimodal in one cat and double peaked in five cats: the second component was pronounced in two cats and small in the other three. The z profile was unimodal and, except for one cat, it had later onset and summit than the first component of the x profile. In contrast to the interindividual differences, there was a high degree of intraindividual constancy over 6-12 months. It is postulated that the interindividual variability depends on chance differences established early during learning of the task and that the imprinted pattern remains, resulting in intra-individual constancy.

Early mobilization of operated on ankle fractures. Prospective, controlled study of 40 bimalleolar cases

40 patients with dislocated bimalleolar and trimalleolar ankle fractures took part in this randomized study. All ankles were operated on using cerclage, staples and pins. Active ankle movement with weight bearing in an orthosis was compared with active ankle movement without weight bearing using a dorsal splint. Stereophotogrammetric analysis showed small movements in the ankle mortise in both groups but conventional radiography revealed no fracture redislocation. The clinical results did not differ. This study was designed as the second part of a consecutive project. In the first part, early and late weight bearing in a cast without ankle movements was compared (Ahl et al. 1987b). In comparing the first and the second parts of the study, a small but significant increase in fracture instability was observed in the early motion group. No lasting superior clinical result was achieved by early ankle movement. After operation on dislocated bimalleolar ankle fractures, early postoperative weight bearing in a walking cast is recommended.

Staging of soft-tissue sarcomas. Prognostic analysis of clinical and pathological features

In a retrospective study of all 137 patients with soft-tissue sarcoma treated by surgery between 1972 and 1984, the clinical course was related to several host and tumour features, including the Surgical Staging System of Enneking, Spanier and Goodman (1980). Only patients free from metastasis with untreated primary lesions on admission were included. According to the Surgical Staging System, nine tumours were IA, 18 IB, 38 IIA and 72 IIB. Only 12 patients underwent amputation; 125 were treated by local surgery. The mean follow-up time was ten years (minimum five). For the whole series the probability of seven-year survival was 0.65; 42 patients (31%) died from tumour disease. All these had metastases and 24 also had local recurrence. The local recurrence rate was 36%. Multivariate analysis identified large tumour size and high histological grade as significant risk factors for metastatic disease and tumour-related death. Sex, age, tumour site, surgical margin and local recurrence showed no correlation with survival. The prognostic contribution of compartmentality was virtually nil. Histological grade combined with tumour size was found to give better prognostic information than that obtained by the Surgical Staging System.

Subsidence of porous coated noncemented femoral components in total hip arthroplasty. A roentgen stereophotogrammetric analysis

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in nine noncemented femoral components of the Biomet Taperloc prosthesis. After 2 years three components had subsided 0.7-0.9 mm. No distinct symptoms related to the micromotion appeared. The subsidence in this investigation was smaller than the reported subsidence of other noncemented prostheses.

Neurodevelopment in late infancy after prenatal exposure to benzodiazepines--a prospective study

Growth and neurodevelopment at 6, 10 and 18 months of age have been studied prospectively and longitudinally in a series of 17 children born to mothers who used benzodiazepines (BZD) in therapeutic doses as their only psychotropic drug throughout pregnancy. The results were compared with a group of 29 children born to mothers without any known use of psychotropic drugs. The BZD-exposed children caught up their low mean birth-weight, at an early stage, whereas the slightly decreased head circumference at birth remained at the same low level. In five infants, a pattern of craniofacial anomalies was found. Deviating neurodevelopmental and clinical symptoms and signs were common. The gross motor development was retarded at 6 and 10 months, but was nearly normal at 18 months. Impaired fine motor functions were found on all follow-up occasions. At 18 months, the most prominent finding was a delayed development of pincer grasp. The BZD-exposed children showed deviations in muscle tone and pattern of movements more frequently than children in the reference group. The study suggests that the use of BZD in therapeutic doses throughout pregnancy can have negative effects on the development of children up to 18 months of age. The long-term hazards cannot be evaluated from these results. A further follow-up at early school age is needed and is in progress.

The effect of benzodiazepines on the fetus and the newborn

The effect of the maternal use of benzodiazepines (BZD) on the fetus and the newborn infant has been studied in a representative series of 17 newborn infants (BZD group). The pregnancy and the perinatal period were characterized by 20 items. On the 2nd day of life, a neurologic investigation was performed and comprised a total of 38 items, subgrouped into items of reflexes/reactions, tonus, and other symptoms and signs. An optimum finding for each item was selected. The results were compared with a group of 21 newborns fetally exposed to psychotropic drugs other than BZD (drug group) and a reference group of 29 newborns with no known fetal exposure to drugs. Infants in the BZD group had a lower birth weight for birth length, as compared to both the drug group and the reference group. Significant differences in frequency of pre- and perinatal complications and in neuro-behavior between the BZD group and the reference group were found in all groups of items. We conclude that the use of BZD during pregnancy is associated with impaired intrauterine growth and an increased frequency of pre- and perinatal events. It affects the newborn infant neurologically mainly in the form of intoxication and withdrawal symptoms.

The effect of a low pyramidal transection following previous transection of the dorsal column in cats

In order to test the working hypothesis that motor deficits after low pyramidotomy may be due to transection of the cortico-cuneate pathway, a low pyramidotomy was made 2-4 months after a C2 dorsal column (DC) transection and tested on forelimb target-reaching and food-taking. Since food-taking recovered faster than after pyramidotomy alone, it is inferred that the loss of food-taking after pyramidotomy without previous DC transection is due mainly to transection of the cortico-cuneate pathway which controls transmission from forelimb Ia afferents to the motor cortex. The dysmetria and dyscoordination of target-reaching, on the other hand, was similar whether or not the low pyramidotomy was made after a previous C2 DC transection. It is tentatively suggested that dysmetria and dyscoordination of target-reaching after pyramidotomy may be due to transection of the pathway from the motor cortex which controls spinocerebellar transmission by its effect on the lateral reticular nucleus.

The pathway from Ia forelimb afferents to the motor cortex: a new hypothesis

Forelimb target-reaching and food-taking in cats depend on different interneuronal circuitry in the spinal cord. On the basis of previous findings regarding the effect of transection of the corticospinal tract in the spinal cord, of high dorsal column (DC) transection, of low pyramidotomy and of pyramidotomy after previous DC transection, it is proposed that the food-taking movement is temporally linked to target-reaching as follows: During target-reaching, the position of the paw is signalled by the pathway from forelimb proprioceptors (mainly Ia) to the motor cortex with a relay in the main cuneate nucleus. The command for food-taking is issued by the motor cortex only when the pathway from the forelimb signals that the paw approaches the target correctly, as may be determined by a comparison of the information from the forelimb with an efference copy of the motor program for target-reaching. The hypothesis is based on previous results regarding the organization of the pathway from the forelimb to area 3a and the motor cortex, and regarding the cortico-cuneate pathway with selective projection from area 3a and motor cortex to the basal caudal part of the cuneate nucleus, where the proprioceptive information from the forelimb is relayed. Results relevant to the present hypothesis regarding responses of precentral neurones during active and passive movements in awake animals are briefly discussed.

Order and dynamics in mixtures of membrane glucolipids from Acholeplasma laidlawii studied by 2H NMR

The two dominant glucolipids in Acholeplasma laidlawii, viz., 1,2-diacyl-3-O-(alpha-D-glucopyranosyl)-sn-glycerol (MGlcDG) and 1,2-diacyl-3-O-[alpha-D-glucopyranosyl-(1----2)-O-alpha-D-glucopyranosyl ]- sn-glycerol (DGlcDG), have markedly different phase behavior. MGlcDG has an ability to form nonlamellar phases, whereas DGlcDG only forms lamellar phases. For maintenance of a stable lipid bilayer, the polar headgroup composition in A. laidlawii is metabolically regulated in vivo, in response to changes in the growth conditions [Wieslander et al. (1980) Biochemistry 19, 3650; Lindblom et al. (1986) Biochemistry 25, 7502]. To investigate the mechanism behind the lipid regulation, we have here studied bilayers of mixtures of unsaturated MGlcDG and DGlcDG, containing a small fraction of biosynthetically incorporated perdeuterated palmitic acid, with 2H NMR. The order-parameter profile of the acyl chains and an apparent transverse spin relaxation rate (R2) were determined from dePaked quadrupole-echo spectra. The order of the acyl chains in DGlcDG-d31 increases upon addition of protonated MGlcDG, whereas the order of MGlcDG-d31 decreases when DGlcDG is added. The variation of order with lipid composition is rationalized from simple packing constraints. R2 increases linearly with the square of the order parameter (S2) up to S approximately 0.14; then, R2 goes through a maximum and decreases. The increase in R2 with S2, as well as the magnitude of R2, is largest for pure MGlcDG-d31, smallest for DGlcDG-d31, and similar for mixtures with the same molar ratio of MGlcDG/DGlcDG but with the deuterium label on different lipids.(ABSTRACT TRUNCATED AT 250 WORDS)

Integration in descending motor pathways controlling the forelimb in the cat. 16. Visually guided switching of target-reaching

A task has been developed to investigate the ability of cats to switch the direction of an ongoing target-reaching forelimb movement with the aid of a visual cue. The cats were standing in front of two horizontal tubes (internal diameter 30 mm; shoulder level) with food. The entrances of the tubes were closed with opaque trap doors but during illumination inside a tube its trap door was unlocked allowing the cat to retrieve food with the paw. When the cats had learnt to select the illuminated tube for insertion the next step was to switch the illumination to the other tube during ongoing target-reaching. Limb lifting was performed when the light was switched on in one of the tubes and time was measured from breaking electrical contact between the paw and the floor. After 25-75 ms, illumination was shifted to the other tube and the latency to the earliest change in movement trajectory was measured. The trajectory was recorded with the aid of cameras detecting the position of infrared light emitting diodes fixed to the dorsal part of the wrist. Every 3 ms the position was fed into a computer, and the movement trajectory (horizontal and sagittal planes) was displayed graphically. The velocities in the direction of cartesian coordinates x, y and z (protraction, adduction-abduction, lifting) were also computed. Single tube trials and switching trials from either tube were made in a random series. In order to switch, the cats used a combination of braking the protraction and a sideways movement. Initially there was often some retraction of the paw to avoid hitting the trap door of the first illuminated tube, but with more proficiency braking decreased and the movement path became smoothly curved. During braking of protraction there was also deceleration of lifting but not enough to maintain a constant movement path in the sagittal plane. In sessions with single tube trials, the movement paths in the horizontal plane were reasonably straight. In sessions with intermixed switching trials the single tube paths became segmented or curved, seemingly in order to facilitate switching. The mean switching latency in four cats ranged from 83 to 118 ms. In the fastest cat the switching latency ranged from 70-106 ms.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term sequelae after pediatric brain tumors: their effect on disability and quality of life

In an unselected series of pediatric brain tumors, 56 of 60 long-term survivors--craniopharyngiomas and pituitary tumors excluded--were investigated and interviewed mean X = 10 (5-16) years after diagnosis. After this time, sequelae were stable and included cognitive (38%), motor (25%), visual (20%), hormonal (20%), and psychological-emotional (14%) dysfunction. Memory dysfunction was found in 22% of patients with normal intelligence. Moderate or severe disability, from combinations of these impairments, was found in 34%. Sixty-six percent had no or mild disability compatible with active life and employment. However, these patients less often were married or had children compared with a control group of healthy subjects. Moderate and severe disability was found in 48% of supra- and in 21% of infratentorial tumors, after radiotherapy (RT) in 55% vs. without RT in 18%. RT before 6 years of age caused subnormal IQ in all cases. The self-reported quality of life was not related to degree of disability. Patients with psychological-emotional sequelae self-evaluated their quality of life lower than did patients with other types of long-term sequelae.

The effect of low pyramidal lesions on forelimb movements in the cat

Complete transection of the pyramid just rostral to the crossing gave defects in forelimb target-reaching and food-taking tested with retrieval of food from a cylinder. The most marked symptoms were dysmetria, dyscoordination of movement and almost total loss of the food-taking movement. Gradual recovery occurred, but even after 3-4 months the food-taking movement was deficient. The symptoms were less severe than those previously found after a high pyramidotomy but much more pronounced than those observed after complete transection of the corticospinal tract in the spinal cord. The motor defects after a low pyramidotomy closely resemble those found after a high dorsal column transection. It is tentatively proposed that the motor defects after low pyramidotomy are largely due to transection of corticocuneate fibers which regulate the feedback pathway from forelimb afferents to the motor cortex.

Kinematics of the ankle/foot complex--Part 3: Influence of leg rotation

In an in vivo kinematical investigation, the movements of the ankle/food complex induced by external rotation of the leg from an internally rotated position were analyzed by roentgen stereophotogrammetry. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones of eight healthy volunteers. Rotations occurring between these bones after 10 degrees increments of leg rotation were calculated in three dimensions. Movement of the leg from an internally rotated position to the neutral was found to induce motion mainly as internal rotation of the talus in relation to the tibia. Further external rotation induced motion mainly in the talonavicular and talocalcaneal joints, whereas a smaller amount of motion was seen in the joint between the navicular and the medial cuneiform.