Nutritional screening - Evaluation and implementation of a simple Nutrition Risk Score

Development of a simple, validated Nutrition Risk Score for identification of patients at risk of undernutrition is described. The score is easy to use, applicable to all patient categories and ages, and correlated well with a validated Nutrition Risk Index (r = 0.68, p < 0.001) and clinical impression (r = 0.83, p < 0.001). Reproducible scores were obtained between dietitians (r = 0.91, p < 0.001) and between dietitians and nursing staff (r = 0.80, p < 0.001). The score was used to assess risk of undernutrition in 153 consecutive admissions to medical and surgical specialties. Patients were categorised as low (50%), moderate (24%) or high risk (26%). Evaluation of measures to prevent nutritional depletion revealed that no action was taken in 64% (23/36) of moderate risk and 30% (12/40) of high risk patients. Implementation of routine, hospital-wide nutritional screening, to identify patients in need of nutritional support, has been achieved by inclusion of the score in the standard nursing assessment process.

Levels of lipoprotein(a), apolipoprotein B, and lipoprotein cholesterol distribution in IDDM. Results from follow-up in the Diabetes Control and Complications Trial

Levels of lipoprotein(a) [Lp(a)], apolipoprotein (apo) B, and lipoprotein cholesterol distribution using density-gradient ultracentrifugation were measured as part of a cross-sectional study at the final follow-up examination (mean 6.2 years) in the Diabetes Control and Complications Trial. Compared with the subjects in the conventionally treated group (n = 680), those subjects receiving intensive diabetes therapy (n = 667) had a lower level of Lp(a) (Caucasian subjects only, median 10.7 vs 12.5 mg/dl, respectively; P = 0.03), lower apo B (mean 83 vs. 86 mg/dl, respectively; P = 0.01), and a more favorable distribution of cholesterol in the lipoprotein fractions as measured by density-gradient ultracentrifugation with less cholesterol in the very-low-density lipoprotein and the dense low-density lipoprotein fractions and greater cholesterol content of the more buoyant low-density lipoprotein. Compared with a nondiabetic Caucasian control group (n = 2,158), Lp(a) levels were not different in the intensive treatment group (median 9.6 vs. 10.7 mg/dl, respectively; NS) and higher in the conventional treatment group (9.6 vs. 12.5 mg/dl, respectively; P < 0.01). No effect of renal dysfunction as measured by increasing albuminuria or reduced creatinine clearance on Lp(a) levels could be demonstrated in the diabetic subjects. Prospective follow-up of these subjects will determine whether these favorable lipoprotein differences in the intensive treatment group persist and whether they influence the onset of atherosclerosis in insulin-dependent diabetes.

Spatial reciprocity of connections between areas 17 and 18 in the cat

We examined whether the interconnections between areas 17 and 18 are spatially reciprocal, i.e., whether a column of cells in area 17 receives from the same region of area 18 as it sends projections to, and vice versa. We addressed this question by making side by side injections of retrograde fluorescent tracers in area 18, calculating the convergence and divergence of the connections from area 17 to 18. We compared these values with previously reported values of divergence and convergence of the projections from area 18 to area 17. The results demonstrate that there is a good match between the convergence and divergence of the area 17 to area 18 connection and, respectively, the divergence and convergence of the reverse connection. We confirmed directly the spatial reciprocity by injecting simultaneously in area 17 a retrograde and an anterograde tracer and by analyzing quantitatively the density of anterograde and retrograde labeling across the surface of area 18. There was an excellent match between the density maps of retrogradely labeled cells and anterogradely labeled axon terminals in area 18. Connections between areas 17 and 18 therefore exhibit large degrees of convergence and divergence and are spatially reciprocal. Thus, a given column of cells within one of these two areas is reciprocally interconnected with a large region of the opposite area. Such an organization may provide the basis for synchronization of firing of neurons across these two areas, as revealed by cross-correlation studies.

Influence of the physical form of barley grain on the digestion of its starch in the human small intestine and implications for health

It has been suggested that incomplete digestion of cereal starch explains the low energy values of certain cereals of large particle size. We used human subjects with ileostomies to investigate the digestion of barley and to determine whether the physical form of barley affects stomal excretion of starch, glucooligosaccharides, nitrogen, fat, and calculated energy. Only 2 +/- 1% of starch remained undigested after finely milled barley was eaten, but after flaked barley was eaten 17 +/- 1% resisted digestion, partly as oligosaccharides (G1-G10) but largely as intact unpitted starch granules bound by intact cell walls. The calculated energy excretion from the stoma was three times higher after flaked than after milled barley [51.5 decreasing to 15.3 kJ/g nonstarch polysaccharide (NSP, P < 0.001]. NSP, starch, and fat made almost equal contributions to the higher energy excretion. It is concluded that possibly the botanical source of cereals and certainly processing, other than retrogradation of the starch, are important determinants of starch digestibility and energy value. Possible clinical implications are introduced.

Johann Baptist von Schweitzer: the queer Marx loved to hate

Despite his conviction on a morals charge involving a boy, the early German Social Democrat Johann Baptist von Schweitzer went on to have a successful political career. His life furnishes the context to present remarks by his political opponents Marx and Engels, which reveal their deep-seated homophobia. It is pointed out that this has been glossed over by the translations of the recently published Marx/Engels Collected Works. Some remarks on boy-love and anarchism are appended.

Developmental remodeling of primate visual cortical pathways

The pre- and postnatal developmental changes of the cortical afferents to area 17 were studied in the macaque monkey. Paired injections of the retrograde tracers fast blue and diamidino yellow were made in area 17. Quantitative techniques were used to examine the spatial patterns of labeling in three distinct locations of the extrastriate cortex that correspond to known visual areas. In the adult, each cortical region has a characteristic laminar distribution. In the fetus the proportion of supragranular layer neurons in all cortical regions was much higher than in the adult. The present study shows that despite the very high levels of labeled supragranular layer neurons, there is some early areal specialization so that the adult configuration does not emerge from a uniform distribution. The developmental decline in the proportion of labeled supragranular neurons is complete by 1 month after birth. Each injection of tracer gave rise in each cortical area to dense labeling in a restricted region (projection zone). Areal measurements of projection zones in the supra- and infragranular layers showed that the developmental decrease in the proportion of labeled supragranular layer neurons is accompanied by a relative change of the dimensions of supra- and infragranular projection zones: the supragranular projection zone in the fetus is larger than the infragranular projection zone and vice versa in the adult. In the fetus, the two projection zones corresponding to each of the two tracers overlap in the supragranular layers whereas they are largely separated in the infragranular layers. During development there is a progressive decrease in the overlap of the supragranular projection zones and an increase in the overlap in the infragranular layers. Again, the adult configuration is achieved 1 month after birth. This developmental inversion of the areal dimensions of the projection zones in supra- and infragranular layers is accompanied by a drastic decrease in the proportion of double-labeled neurons located in supragranular layers. These results clearly show that early in development, axonal projections to area V1 are modified in very different ways according to whether they originate from supra- or infragranular layers. This developmental process lasts for about 80 d. These findings show that in the primate there is a prolonged remodeling of axonal projections that is a highly characteristic feature of this species.

Topography of developing thalamic and cortical pathways in the visual system of the cat

Adult patterns of connectivity could emerge during development by a process of selective elimination from an earlier, more widespread, connectivity. We have addressed this issue by examining the topography of developing projections to area 17 in the cat. At different postnatal ages, paired injections of the retrograde tracers diamidino yellow and fast blue were made in area 17. Interinjection separations were carefully controlled and the spatial distribution of the two populations of labelled neurones investigated. Projections to the striate cortex from the lateral geniculate nucleus, area 18, as well as connections intrinsic to area 17 were analysed quantitatively with a graphic method that uses a two-dimensional model of the projection. This allows two parameters of the projection to be calculated: the divergence (the spatial extent of area 17 contacted by an infinitely small region of an afferent structure) and the convergence (the extent of an afferent structure that projects to an infinitely small region of area 17). During postnatal development, the bulk of the connections making up the geniculostriate and corticocortical pathways showed no variation either in their convergence and divergence. However, the projection of area 18 to area 17 and the intrinsic area 17 connections (but not the geniculostriate projection) in the 3-15-day-old kittens were each found to contain a small subpopulation of widely scattered neurones with widespread axonal trajectories. These results, showing that many initially formed connections display a high degree of topographical order, are discussed in terms of the control mechanisms specifying axonal trajectories during development.

International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. IV. Comparability of apolipoprotein B values by use of International Reference Material

We performed temporal and thermal stability studies on SP3-07, a liquid-stabilized reference material for apolipoprotein (apo) B, selected during the previous phase of the International Federation of Clinical Chemistry project on standardization of apolipoprotein measurements. Results indicate that SP3-07 stored at -70 degrees C has the long-term stability required for a reference material. We assigned an accuracy-based apo B value of 1.22 g/L to SP3-07, using a nephelometric method that was calibrated with freshly isolated low-density lipoprotein for which the apo B mass value was determined by a standardized sodium dodecyl sulfate-Lowry procedure. Using a common protocol, the study participants transferred the assigned mass value from SP3-07 to the individual calibrators of the analytical systems and measured the apo B concentration of 20 fresh-frozen samples obtained from individual donors and covering a clinically relevant range of apo B values. The among-laboratory CV on these samples, analyzed by 25 analytical systems, ranged from 3.1% to 6.7%. These results demonstrate the lack of matrix effects of SP3-07 and its ability to provide accurate and comparable apo B values in a variety of immunochemical methods. On the basis of the outcome of these studies, the World Health Organization has endorsed SP3-07 as the International Reference Material for Apolipoprotein B.

International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. IV. Comparability of apolipoprotein B values by use of International Reference Material

We performed temporal and thermal stability studies on SP3-07, a liquid-stabilized reference material for apolipoprotein (apo) B, selected during the previous phase of the International Federation of Clinical Chemistry project on standardization of apolipoprotein measurements. Results indicate that SP3-07 stored at -70 degrees C has the long-term stability required for a reference material. We assigned an accuracy-based apo B value of 1.22 g/L to SP3-07, using a nephelometric method that was calibrated with freshly isolated low-density lipoprotein for which the apo B mass value was determined by a standardized sodium dodecyl sulfate-Lowry procedure. Using a common protocol, the study participants transferred the assigned mass value from SP3-07 to the individual calibrators of the analytical systems and measured the apo B concentration of 20 fresh-frozen samples obtained from individual donors and covering a clinically relevant range of apo B values. The among-laboratory CV on these samples, analyzed by 25 analytical systems, ranged from 3.1% to 6.7%. These results demonstrate the lack of matrix effects of SP3-07 and its ability to provide accurate and comparable apo B values in a variety of immunochemical methods. On the basis of the outcome of these studies, the World Health Organization has endorsed SP3-07 as the International Reference Material for Apolipoprotein B.

cDNA cloning, expression and primary structure of Par jI, a major allergen of Parietaria judaica pollen

A 659 bp cDNA clone** coding for an allergen of Pj pollen has been isolated from a lambda gt11 library, and its DNA sequence determined. The cDNA insert showed an open reading frame of 429 bp coding for an allergenic protein of 14,866 Da and a deduced amino acid sequence containing 143 residues. The expressed recombinant protein represented the major allergen Par jI since it reacted with 95% of the sera from Pj-allergic patients (n = 22) and with two Par jI-specific monoclonal antibodies. No similarity with other known DNA and protein sequences has been detected.

Developmental changes in the distribution of acetylcholinesterase in the extrastriate visual cortex of the monkey

In the fetal and neonatal monkey, periodically organized regions of high activity of acetylcholinesterase were found in the visual cortical area V2 (Area 18). The acetylcholinesterase bands, like the thin and thick stripes of cytochrome oxidase, were found to run orthogonal to the area 17/18 border. During neonatal development these bands progressively narrow and finally disappear shortly after four months of age.

Transient cortical pathways in the pyramidal tract of the neonatal ferret

Anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) was used to study transient axons from the visual cortex in the pyramidal tract. Injections at birth restricted to the visual cortex labeled axons in the vicinity of the pontine nuclei. Two to eight days after birth, axons from the occipital cortex were found posterior to the pontine nucleus, their caudalmost stable target. Transient corticospinal axons from the presumptive primary visual cortex did not grow caudal to the pyramidal decussation. Innervation of more distal targets preceded innervation of proximal targets. Innervation of the pontine nucleus is initiated around 68 hours after birth, when the transient extension in the medullary pyramidal tract has attained its maximum caudal extent. Innervation of the superior colliculus begins 9 days after birth. Retrograde tracers were used to follow the developmental changes in the cortical distribution of the parent neurons giving rise to axons in the pyramidal tract. In the adult, labeled neurons following injection of retrograde tracer in the pyramidal tract occupied less than a third of the neocortex and were centred on the anterior part of the coronal and spleniocruciate gyri. In the immature brain, labeled neurons covered more than two-thirds of the neocortex. Areal density measurements in the neonate showed that peak labeling was centred in the anterior coronal and spleniocruciate gyri, where corticospinal cells in the adult are located. There was a marked rostral-caudal gradient so that labeled neurons were very scarce towards the occipital pole. These results, showing transient neocortical axons in the pyramidal tract in a carnivore, suggest that this may be a common feature of mammalian development. The finding that the adult pattern of corticospinal projections does not emerge from a uniform distribution is discussed with respect to the areal specification of cortical connectivity.

Modulation of the cell cycle contributes to the parcellation of the primate visual cortex

An as-yet unresolved issue in developmental neurobiology is whether the discrete areas that form the mammalian cortex emerge from a uniform cortical plate or whether they are already specified in the germinal zone. A feature of the primate striate cortex is that the number of neurons per unit area is twice that of anywhere else in the cerebral cortex. Here we take advantage of this unique structural feature to investigate whether the extra striate cortical cells are due to increased neuron production during neurogenesis. We labelled precursors undergoing terminal cell division with 3H-thymidine and allowed them to migrate to the cortical plate. Cell counts revealed that their rate of production in the germinal zone of striate cortex is higher than in that given rise to extrastriate cortex. Also, we used 3H-thymidine pulse injections to investigate cell cycle dynamics and found that this phase of increased production of striate cortical cells is associated with changes in the parameters of the cell cycle. These results show that cortical area identity is at least partially determined at the level of the ventricular zone.

Cortical specification of mice and men

The developmental basis for the localization of function in the mammalian cortex remains a controversial issue. The newly formed rodent cortex displays a considerable uniformity in terms of its connectivity. This contrasts with the primate, where even the first formed connections can show a high degree of areal specificity. An important clue to understanding these species differences can be obtained by examining how and when the sensory periphery exerts its organizing influence on the developing cortex. In rodents the developmental timetable ensures that the organizational control of the periphery persists late in development, when neurons are forming their first connections. By contrast, in primates the late onset and prolonged duration of corticogenesis result in the periphery being able to exert its influence much earlier, during the phase of precursor proliferation. Differences and similarities between primate and rodent corticogenesis are highly informative. In rodents, recent results with molecular markers show that regional differences in developmental potential exist in the cerebral cortex before innervation from the periphery. Similar findings are predicted in primates. It is to be expected that a more complete understanding of the rules governing the emergence of distinct cortical areas will come from resolving how afferent specification acts within the confines of such regional specializations.

Twilight of the gods: John Henry Mackay's Der Unschuldige

The writings of the Scotch-German John Henry Mackay are important for the early cultural history of the modern gay movement. This article recalls this unjustly neglected anarchist writer and advocate of man/boy love by tracing his biography and pointing out his contacts with others in the movement. His late novella Der Unschuldige is analyzed to show that Mackay has encoded homosexuality there in a unique and individual way.

The roles of mental representations and mental processes in therapeutic action

In this paper we describe two models of the psychoanalytic treatment of mental disturbance. The first describes the mechanism by which the patient is helped to recover threatening ideas and feelings which have been repudiated or distorted as a result of conflict and defense. The second points to the therapeutic effects of engaging previously inhibited mental processes within the psychoanalytic encounter. The two forms of therapeutic action imply two distinct means available to the individual to deal with psychological conflict. They highlight different aspects of the psychoanalytic process and technique in child and adult psychoanalysis.

Visuotopic organization of corticocortical connections in the visual system of the cat

It has recently been demonstrated that, in contrast with the retinogeniculocortical projection, the corticocortical connections in the cat present a high degree of convergence and divergence. This suggests that some corticocortical connections link nonvisuotopically corresponding regions. Using fine-grain electrophysiological mapping and anatomical tracing, we have set out to test this possibility by placing a small injection of retrograde tracer in area 17 and by comparing the extent of visual field encoded in the region of area 18 containing labeled cells and that represented in the uptake zone. The results demonstrate that the size of the labeled region on the surface of area 18 is independent of eccentricity and that, despite its anisotrophy, this region of labeling encodes a broadly circular region of visual field that is larger than that encoded in the uptake zone of the tracer in area 17. For example, in the representation of lower visual field, a virtual point in area 17 that encodes a visual field region 4 degrees in diameter receives afferents from a region of area 18 encoding a region 11 degrees wide. Examination of the density of labeled cells in the labeled zone in area 18 reveals that the highest density is observed in a region in visuotopic correspondence with the injection site. However, high labeling density is also occasionally found in patches that do not represent the same visual field region as the injection site. Many receptive fields of neurons recorded in the labeled zone in area 18 only partially overlap or fail to overlap the visual field region encoded by the injection site. The results also demonstrate that the extent of visual field encoded in the labeled zone in area 18 is the same as that represented in the region of intrinsic labeling in area 17. It is suggested that cortical afferents coming from several cortical areas and converging on a column of cells in area 17 cover the same extent of visual field and that this cortical network constitutes the structural basis for the modulatory regions of the receptive field as well as the synchronization of neurons in different cortical areas.

Zinc absorption in adult men from a chicken sandwich made with white or wholemeal bread, measured by a double-label stable-isotope technique

Eleven fasted adult men consumed a chicken meat sandwich made with white or wholemeal bread, extrinsically labelled with 2 mg 67Zn, on two different occasions. Immediately after eating the sandwich they were given an intravenous injection of 1.5 mg 70Zn. True Zn absorption (which was approximately 7% higher than apparent absorption) was determined by the faecal balance technique by making an allowance for endogenous excretion from measurements of faecal excretion of 70Zn. There was no significant difference in mean true Zn absorption from the white or wholemeal bread sandwich, 33.6 and 25.4% respectively. It was concluded that the substitution of wholemeal for white bread does not reduce Zn absorption from meat-based sandwiches.

International Federation of Clinical Chemistry Standardization Project for Measurements of Apolipoproteins A-I and B. II. Evaluation and Selection of Candidate Reference Materials

The first phase of an international collaborative study for standardization of test systems for measuring apolipoprotein (apo) A-I and apo B demonstrated that uniformity of apo A-I and apo B measurements can be achieved if suitable common reference materials are used to calibrate the different systems. The objective of the second phase was to evaluate the linearity and parallelism or proportionality of the candidate reference materials selected in phase one and to determine whether any of them could be proposed as international reference materials. We evaluated the proposed reference materials with 37 test systems for apo A-I and 38 for apo B, involving 23 manufacturers and five research laboratories. Two lyophilized preparations were proposed for apo A-I, SP1 from Behringwerke AG and SP2 from Daiichi Pure Chemicals Co., and two liquid preparations were proposed for apo B, SP3 from Behringwerke AG and SP4 from Reagents Applications. The linearity of the candidate reference materials was compared with the linearity of a frozen serum pool or interim serum reference material distributed to all the participants and with that of a fresh serum pool prepared by each participant. SP1 and SP3 exhibited linearity and parallelism similar to that of the fresh frozen serum pool and had among-laboratory CVs less than or similar to those obtained on normolipidemic serum samples (approximately 6% for apo A-I and approximately 7% for apo B).

International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. II. Evaluation and selection of candidate reference materials

The first phase of an international collaborative study for standardization of test systems for measuring apolipoprotein (apo) A-I and apo B demonstrated that uniformity of apo A-I and apo B measurements can be achieved if suitable common reference materials are used to calibrate the different systems. The objective of the second phase was to evaluate the linearity and parallelism or proportionality of the candidate reference materials selected in phase one and to determine whether any of them could be proposed as international reference materials. We evaluated the proposed reference materials with 37 test systems for apo A-I and 38 for apo B, involving 23 manufacturers and five research laboratories. Two lyophilized preparations were proposed for apo A-I, SP1 from Behringwerke AG and SP2 from Daiichi Pure Chemicals Co., and two liquid preparations were proposed for apo B, SP3 from Behringwerke AG and SP4 from Reagents Applications. The linearity of the candidate reference materials was compared with the linearity of a frozen serum pool or interim serum reference material distributed to all the participants and with that of a fresh serum pool prepared by each participant. SP1 and SP3 exhibited linearity and parallelism similar to that of the fresh frozen serum pool and had among-laboratory CVs less than or similar to those obtained on normolipidemic serum samples (approximately 6% for apo A-I and approximately 7% for apo B).

Segregation of callosal and association pathways during development in the visual cortex of the primate

The segregation of callosal and association pathways in the developing visual cortex of the monkey was studied using the retrograde tracers fast blue and diamidino yellow. Quantitative analysis of the laminar distribution of labeled callosal and association neurons made it possible to reveal the shifting pattern of connections that characterizes the development of these two pathways. In the adult, callosal neurons are restricted to supragranular layers, where they are concentrated at the bottom of layer 3. Association neurons are located both in infra- and supragranular layers. Supragranular layer association neurons are concentrated in layer 2, with limited spread into layer 3 so that there is little overlap with callosal neurons. In the immature brain, callosal neurons are characterized by a tangential distribution that is more widespread than in the adult, while their laminar distribution undergoes little developmental change. Association neurons show two types of changes in their laminar distribution: (1) in the early fetus, there is a large excess of association neurons in supragranular layers, the adult distribution being achieved some time after birth; and (2) during maturation there is a selective elimination of at least 50% of the projections originating from the lower part of layers 2/3. Hence, the adult radial segregation of association and callosal pathways is achieved in part by regressive phenomena. The developmental reduction of bihemispheric projections is largely independent of changes in the organization of association neurons. Quantitative analysis of the morphology and spatial location of neurons sending axon collaterals to both hemispheres suggests that they constitute a subset of callosal neurons and that their frequency is determined by factors that regulate directly this population. These results are discussed with respect to the specification of visual cortical pathways during ontogenesis.

The effects of bilateral enucleation in the primate fetus on the parcellation of visual cortex

Bilateral enucleation in the macaque fetus causes an areal reduction of an otherwise normal striate cortex. Here we show that in early operated animals this reduction is accompanied by a separation of striate and prostriate cortices which are normally contiguous. However this induced separation does not correspond to the areal reduction of striate cortex, indicating that extrinsic signals regulate either the proliferation and/or survival of striate cortical neurons.

Cost efficiency of bone scans in breast cancer

A total of 110 consecutive females who presented in 1987 with primary carcinoma of the breast were staged according to the UICC TNM staging system. Of these, 90 patients had bone scans at presentation, of which seven were positive. The rate of positive initial scans for Stages I-II was 3.5%. Of these only one patient subsequently had bone metastases confirmed, to diagnose which by bone scan, the estimated cost was pounds 1300. Follow-up information was obtained for 95 patients, repeat scans being performed in 22 who had symptoms suggestive of bone metastases. Ten patients with negative initial scans converted to scan-positive within a mean time of 15 months. Only four of these had radiological confirmation of bone metastases. The cost of detecting bone metastases by follow-up scan was approximately pounds 80 per patient. The false-positive rate and the false-negative rate were both calculated as 10%. The specificity of the test was calculated as 90%. It is recommended that bone scanning should be reserved for patients with Stages III and IV disease and to evaluate symptoms suggesting bone metastases.