Effectiveness of transnasal butorphanol for the treatment of musculoskeletal pain

A prospective, open-label study of the effectiveness of transnasal butorphanol in the treatment of pain resulting from musculoskeletal injuries. Twenty-eight patients with strains (n = 20), fractures (n = 6), contusions (n = 1), and stab wounds (n = 1) were included. All patients were examined by an attending level emergency medicine physician and deemed to have pain severe enough to warrant parenteral narcotic analgesia. All patients received an initial 1-mg dose of transnasal butorphanol. Subsequent dosing was flexible depending on response to the initial dose. All patients received pain relief from transnasal butorphanol, and only one requested alternative analgesic medication. Fifty-seven percent (n = 16) of patients noticed at least a little relief of pain within 5 minutes of administration and 93% (n = 26) received at least a little relief within 15 minutes. Seventy-one percent of the patients received a 50% reduction of pain within 60 minutes. No serious side effects were noted, but drowsiness occurred in 82% (n = 23) and dizziness in 54% (n = 15) of the patients. One patient discontinued participation in the study because of nausea. In this limited trial transnasal butorphanol proved to be a rapidly effective opioid analgesic. Further controlled studies comparing transnasal butorphanol with standard parenteral narcotics are needed.

Osmotic inhibition of prolactin secretion in rats

Chronic hyponatremia is known to cause inhibition of pituitary vasopressin (AVP) and oxytocin (OT) secretion in response to most physiological stimuli, as well as a marked inhibition of synthesis of these peptides. Because many studies have implicated neurohypophyseal peptides in the regulation of pituitary prolactin (PRL) secretion, we investigated the effects of chronic hyponatremia on basal and stimulus-induced PRL secretion in rats. Hyponatremia was induced by subcutaneous infusion of 1-deamino-[8-D-arginine]-vasopressin (dDAVP) (5 ng/h) to rats fed a nutritionally balanced liquid diet, and plasma [Na+] was maintained < or = 115 mmol/l for 10-12 days. After this period, hyponatremic rats and normonatremic controls fed the same diet without dDAVP were subjected to one of the following stimuli known to stimulate PRL release in rats: 3 min exposure to ether, hemorrhage (20 ml/kg), intravenous injection of 5-hydroxytryptophane (5-HTP, 10 mg/kg), or intravenous injection of estradiol (5 micrograms/kg). A baseline blood sample was collected before each stimulus, and 3-6 additional blood samples were collected at selected intervals after the stimulus. Baseline levels of plasma PRL were not different between normonatremic and hyponatremic rats. However, PRL responses induced by either or estradiol, but not those induced by hemorrhage or 5-HTP, were very significantly blunted in the chronically hyponatremic rats. Plasma AVP and OT responses were measured as an index of magnocellular secretion, but did not correlate with the PRL responses for any of the stimuli tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Childhood epilepsy and asthma: comparison of quality of life

We report results from the first data collection on an ongoing longitudinal study aimed at describing the natural history of adaptation to childhood epilepsy and asthma in children and their families. We studied 136 children with epilepsy and 134 children with asthma aged 8-12 years. Data were collected from the children, their mothers, and their school teachers through interviews, school records, and questionnaires. The two samples were compared on four domains of quality of life: physical, psychological, social, and school. Data were analyzed by a 2 x 2 between-subjects multivariate analysis of covariance with type of illness (epilepsy or asthma) as the independent variable and length of time since onset of illness as a covariate. A significant main effect was noted for illness [multivariate F (15, 236) = 11.36, p < 0.001]. Our major finding was that children with epilepsy had a relatively more compromised quality of life in the psychological, social, and school domains. In contrast, children with asthma had a more compromised quality of life in the physical domain. Our findings suggest that attention simply to seizure control in the clinical setting will not address the full range of quality-of-life problems of children with epilepsy.

Long-term persistence of AZT-resistance mutations in the plasma HIV-1 of patients removed from AZT therapy

Zidovudine (3'-azido-2',3'-dideoxythymidine) resistant isolates of human immunodeficiency virus type I (HIV-1) were previously demonstrated in zidovudine-treated AIDS patients. The genetic linkage of multiple mutations characteristic of zidovudine-resistance as well as dideoxyinosine-resistance were demonstrated by examining clones of viral reverse transcriptase after polymerase chain reaction (PCR) amplification of plasma culture DNA. The zidovudine-resistance mutations persisted in seven timepoints from four patients for 5 to 22 months despite cessation of zidovudine therapy (and while patients underwent ddI therapy). One patient's plasma virus isolate at 14 months possessed a genotype doubly resistant to ZDV and ddI. Virus recovered from four timepoints showed Intermediate to high levels of zidovudine-resistance. As these genotypes were mainly derived from plasma culture, the zidovudine resistant virus appears to persist and replicate well in vivo after cessation of zidovudine therapy.

Crohn's disease: ancient and modern

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Long-term persistence of zidovudine resistance mutations in plasma isolates of human immunodeficiency virus type 1 of dideoxyinosine-treated patients removed from zidovudine therapy

Zidovudine (3'-azido-2',3'-dideoxythymidine)-resistant isolates of human immunodeficiency virus type 1 (HIV-1) were previously demonstrated in zidovudine-treated AIDS patients. The genetic linkage of multiple mutations characteristic of zidovudine resistance as well as dideoxyinosine resistance were demonstrated by examining clones of viral reverse transcriptase after polymerase chain reaction amplification of plasma culture DNA. The zidovudine resistance mutations persisted at seven time points from 4 patients for 5-22 months despite cessation of zidovudine therapy (and while patients underwent dideoxyinosine therapy). One patient's plasma virus isolate at 14 months possessed a genotype doubly resistant to zidovudine and dideoxyinosine. Virus recovered from four time points showed intermediate to high levels of zidovudine resistance. As these genotypes were mainly derived from plasma culture, the zidovudine-resistant virus appears to persist and replicate well in vivo after cessation of zidovudine therapy.

Viral association with Crohn's disease

Crohn's disease is an inflammatory disorder of the gastrointestinal tract, the cause of which remains unknown. Since the first description by Dalziel in 1913 (1), similarities between Crohn's disease and intestinal mycobacterial infection, particularly Johne's disease in ruminants, have been widely recognized (2, 3). After Mitchell and Rees demonstrated the transmission of granulomata from Crohn's disease by injecting intestinal homogenates into the footpads of mice (4), there followed many studies attempting to identify infective agents within the bowel of patients with Crohn's disease. Although Mycobacterium paratuberculosis has been identified in intestinal tissue from a proportion of patients with Crohn's disease, a convincing role for this agent in the aetiology of Crohn's disease has not been established (5). Likewise, extensive studies into bacterial (6-9) and viral (10) agents potentially associated with Crohn's disease have been inconclusive, although recent ultrastructural observations of viral particles within submucosal granulomata have added a new impetus to the search (11, 12). This review examines the evidence for an association between Crohn's disease and viral infection from epidemiological studies, transmission and cell culture, specific immunological responses, ultrastructure and from molecular biological techniques.

The regulation of regional hemodynamics by alpha-1 adrenoceptor subtypes in the conscious rat

The role of alpha-1 adrenoceptors sensitive and resistant to chloroethylclonidine (CEC) in the regulation of peripheral hemodynamics in the conscious rat has been examined. CEC treatment (15, 25 or 30 mg/kg i.p.) resulted in a sustained decrease in systemic arterial blood pressure and heart rate. These same concentrations reduced, but did not eliminate, [3H]prazosin binding sites in vascular smooth muscle homogenates. The effect of CEC administration on blood flow and regional vascular resistance was assessed using pulsed-Doppler flow probes implanted around the superior mesenteric and iliac arteries. CEC treatment resulted in a significant decrease in mesenteric and hindlimb resistance. Prazosin (3 or 5 mg/kg) reduced systemic arterial blood pressure and vascular resistance to a greater degree than did CEC. The dose-response curve for phenylephrine-induced increases in mesenteric or hindlimb vascular resistance was shifted only 2- to 10-fold to the right by CEC. Prazosin, by contrast, shifted the phenylephrine dose-response curve over 100-fold to the right. These data indicate that multiple alpha-1 adrenoceptor subtypes, both CEC sensitive and insensitive, participate in the regulation of blood flow to the gut and the hindlimb. Finally, CEC sensitive sites do not appear to play as prominent a role as insensitive sites in mediating the pressor response to phenylephrine.

Changes in pituitary gonadotropin-releasing hormone receptor messenger ribonucleic acid content during lactation and after pup removal

Lactation is associated with a reduction in pituitary GnRH receptor content (GnRH-R) when compared with diestrus of the estrous cycle. These studies examined whether the changes in GnRH-R during lactation involved alterations in GnRH-R gene expression. GnRH-R messenger RNA (mRNA) levels were assessed by in situ hybridization, using a 35S-labeled antisense riboprobe coding for the transmembrane region of the mouse GnRH-R gene. The area occupied by grains in 20-microns sections of the pituitary was assessed with an image analysis program. The specificity of the probe for GnRH-R mRNA was demonstrated by the presence of only background grains over the pituitary when a sense riboprobe to GnRH-R mRNA was used. Also, there was an absence of clusters of grains over the posterior pituitary, an area devoid of gonadotropes. In lactating rats suckling eight pups on day 10 postpartum, GnRH-R mRNA levels in the anterior pituitary were suppressed by 60% when compared with the levels observed during diestrus. Removal of the eight-pup suckling stimulus for 24 h reestablished the diestrous pattern of GnRH-R mRNA expression. These results demonstrate that the suckling stimulus results in a significant suppression of GnRH-R mRNA levels that is reversed by removal of the stimulus. These changes in GnRH-R mRNA most likely contribute to the changes in GnRH-R content observed in response to the suckling stimulus.

Effects of N-methyl-D-aspartate receptor activation on cFos expression in luteinizing hormone-releasing hormone neurons in female rats

N-Methyl-D,L-aspartic acid (NMA), an agonist of N-methyl-D-aspartate (NMDA) excitatory amino acid receptors, stimulates the secretion of LH by increasing the release of LHRH. During proestrus, LHRH neurons express cFos in association with the LH surge. To determine the involvement of NMDA receptors in the activation of LHRH neurons on proestrus, we treated animals with an NMDA receptor blocker, MK-801. Treatment with MK-801 (0.3 mg/kg, sc) at 1130 h blocked both the LH and PRL surges and cFos expression in LHRH neurons. These data suggest that NMDA receptors are involved in the regulation of LHRH neuronal activation during the LH surge. We then determined whether NMA treatment could restore LH secretion and cFos expression in LHRH neurons in animals whose endogenous proestrous LH surges were blocked with pentobarbital. In the pentobarbital-blocked rats, NMA failed to induce cFos expression in LHRH neurons and increase LH secretion, but it did result in an increase in PRL secretion. To determine if NMA treatment alone could induce cFos expression in LHRH neurons, diestrous rats were treated with NMA by either systemic (40 mg/kg BW; four injections, 10 min apart) or third ventricular (2 micrograms in 2 microliters; four injections, 10 min apart) injections. NMA administration (regardless of the route of administration) caused an increase in LH secretion and significant cFos expression in many regions of the brain, including sites where the LHRH perikarya are concentrated. However, neither systemic nor intraventricular administration of NMA induced cFos expression in LHRH neurons. Thus, even though NMA results in increased activity of LHRH neurons, as evidenced by increased LH secretion, NMDA receptor activation alone appears to be insufficient to induce cFos expression in the LHRH neurons.

Altered luteinizing hormone and prolactin responses to excitatory amino acids during lactation

We have used excitatory amino acids as tools to elucidate changes in hypothalamic function associated with lactation, focusing on the regulation of luteinizing hormone (LH) and prolactin secretion. In these studies, we have compared the responsiveness to NMA (N-methyl-D,L-aspartate), an agonist for the N-methyl-D-aspartate (NMDA) receptor, with that of kainate, an agonist for another type of glutamate receptor, the kainate receptor. To address the issue of the permeability of the blood-brain barrier to either NMA or kainate, systemic and central administration of the drugs were compared. Four injections of either drug were administered at 10-min intervals to cycling or lactating rats suckling 8 pups. All of these treatment significantly stimulated LH secretion in cycling rats. However, neither systemic injections of NMA (40 mg/kg) or kainate (2.5-3.5 mg/kg), nor third-ventricular administration of NMA (2 micrograms/2 microliters) or kainate (0.2-0.3 micrograms/2 microliters) stimulated LH secretion during lactation. In contrast, LH responses to NMA were observed in lactating animals suckling 2 pups. These data demonstrate that the intensity of the suckling stimulus determines the degree of gonadotropin-releasing hormone (GnRH) neuronal inhibition during lactation. Recovery of the LH response to NMA in animals suckling 8 pups was not observed after treatment with RU 486 to block the effects of progesterone. Thus, the elevated levels of progesterone during lactation do not appear to play a role in inhibiting GnRH neuronal responsiveness. Removal of the 8-pup suckling stimulus for 24 h also did not restore the LH response to NMA. However, treatment with RU 486 and removal of the suckling stimulus for 24 h did restore LH responses to NMA, suggesting that progesterone may play a role in prolonging the recovery of GnRH neuronal responsiveness. The prolactin responses to NMA and kainate changed with the reproductive state of the animal and the site of administration. Central injections of either drug stimulated prolactin release in both cycling and lactating animals. In contrast, whereas systemic administration of NMA stimulated prolactin secretion in cycling animals, kainate had no effect. In the lactating animals, systemic administration of either drug inhibited prolactin secretion. Thus, the difference in the prolactin responses to systemic administration of the drugs may not only be due to a difference in the distribution of kainate and NMDA receptors but also to the steady state level of activity of the prolactin-releasing and -inhibiting factors which is determined by the reproductive state of the animal.(ABSTRACT TRUNCATED AT 400 WORDS)

Suppressed tyrosine hydroxylase gene expression in the tuberoinfundibular dopaminergic system during lactation

Suckling-induced PRL secretion is regulated in part by a reduction in tuberoinfundibular dopamine (TIDA) neuronal activity. We have examined the effects of suckling on TIDA activity in the arcuate nucleus by measuring changes in gene expression of tyrosine hydroxylase (TH), the rate-limiting enzyme in catecholamine synthesis. TH gene expression was assessed by performing in situ hybridization, using a 35S-labeled antisense riboprobe for quantitating TH mRNA and analyzing grain density with the aid of an Optimas Bioscan image analysis system. Lactating rats suckled by eight pups were studied on postpartum day 10, and diestrous day 1 rats were used as controls. The results showed that lactation suppressed TH mRNA content throughout the arcuate nucleus to about 10% of diestrous levels. The dramatic reduction in TH mRNA during lactation was specific to the arcuate nucleus, as TH mRNA levels in the zona incerta were similar during lactation and diestrus. The suckling stimulus was the primary signal responsible for the suppression of TH mRNA in the arcuate nucleus, as removal of the pups for 6 h restored TH mRNA content to diestrous levels. By 24 h after pup removal, TH mRNA had reached almost twice diestrous levels. In view of the dramatic reduction in TH mRNA levels during lactation, we examined whether TH protein in the arcuate nucleus was similarly diminished. TH protein was detected by immunocytochemistry using a monoclonal antibody to TH. Qualitatively, TH staining was heavier in cell bodies, nerve fibers, and median eminence during diestrus. There was a small, but significant, decrease in TH-positive cell numbers during lactation (14% reduction) compared to those on diestrus. These data provide clear evidence that TH expression is suppressed during lactation, as evidenced by the decrease in TH mRNA and TH protein. The reduction in TH expression most likely contributes to the decrease in dopaminergic tone during lactation.

Rabies and bats in a rabies-endemic area of southern Africa: application of two commercial test kits for antigen and antibody detection

In southern Africa, isolates of rabies-related viruses (i.e. Duvenhage virus and Lagos bat virus) have been made from insectivorous and frugivorous bats. As no recent formal bat virus survey has been reported in southern Africa, a survey of bats in rabies-endemic areas was undertaken. Five hundred and forty-seven bats (13 species) were collected from 21 localities in the Orange Free State, Lesotho and the northern Cape Province. None of the 190 bat sera tested using the "Trousse Platelia Rage" ELISA kit (Diagnostic Pasteur), had antibodies to rabies virus glycoprotein G. Rabies virus nucleocapsid antigen was also sought for in the brains of 530 bats (13 species) by means of the "Rapid rabies enzyme immunodiagnosis" (RREID) test (Diagnostics Pasteur). No positive results were obtained. These results show that bats are unlikely to play an important role as hosts of rabies in these parts of Africa, although a low rate of infection cannot be excluded.

Regulation of gonadotropin-releasing hormone (GnRH) and galanin gene expression in GnRH neurons during lactation in the rat

Galanin is colocalized with GnRH, and its expression in these neurons is enhanced at proestrus, a time of activation of GnRH neurons. We tested the hypothesis that the expression of both the GnRH and galanin mRNAs in GnRH neurons decrease during lactation in the rat, a reproductive state characterized by reduced gonadotropin secretion. For double label in situ hybridization, GnRH mRNA was detected with an antisense cRNA probe labeled with the hapten digoxigenin, whereas galanin mRNA was detected with a cRNA probe labeled with 35S. The number of silver grains deposited over a digoxigenin-labeled cell body provided an index of galanin mRNA levels in GnRH cells. We observed a 60% reduction in signal (grains per cell) for galanin mRNA in GnRH neurons of lactating animals compared with those of diestrus animals (P < 0.004), with no difference in the number of GnRH neurons between groups. To compare cellular GnRH mRNA content between groups, we used single label in situ hybridization and image analysis. Signal levels (grains per cell) for GnRH mRNA were not different between diestrus and lactating animals in either an initial (diestrus, 121.4 +/- 5.9; lactation, 117.3 +/- 8.0; P > 0.7) or in a subsequent trial (diestrus, 184.0 +/- 10.4; lactation, 197.5 +/- 13.0; P > 0.7). To confirm and extend these findings, we used a RNAse protection assay to measure and compare the content of GnRH mRNA in hypothalamic fragments between diestrus and lactating animals. The concentration of GnRH mRNA (picograms of mRNA per 25 micrograms total RNA) was not different between the two groups (diestrus, 1.21 +/- 0.25; lactation, 1.25 +/- 0.13; P > 0.7). A determination of the total GnRH peptide content by RIA in a separate set of hypothalamic dissections revealed no difference between groups in the level of GnRH content (nanograms) per hypothalamus (diestrus, 6.0 +/- 0.6; lactation, 5.7 +/- 0.4; P > 0.4). We conclude that galanin mRNA expression in GnRH neurons of the rat is diminished during lactation, whereas GnRH expression continues unabated. This decrease in galanin gene expression associated with lactation may lead to decreased synthesis and secretion of galanin, which, in turn, could diminish the pulsatile secretion of GnRH or reduce its activity at the pituitary.

Lactation alters neuropeptide-Y and proopiomelanocortin gene expression in the arcuate nucleus of the rat

To identify possible factors associated with lactation that may be involved in the suppression of GnRH neuronal function, we have examined whether lactation induces changes in arcuate nucleus neuronal function, focusing on changes in neuropeptide-Y (NPY) and POMC neuronal activity. Animals were studied during diestrous day 1 of the estrous cycle or during day 10 postpartum. Lactating animals had their litters adjusted to eight pups on day 2 postpartum. Brain tissue was removed to measure NPY peptide content in the median eminence (ME) or the ME-arcuate nucleus (ME-ARC) and to quantify NPY or POMC mRNA by in situ hybridization, using 35S-labeled antisense riboprobes. The NPY peptide content was significantly increased in the ME (1.8-fold) and ME-ARC (1.5-fold) during lactation compared to those on diestrus. The NPY mRNA content throughout the ARC did not differ between diestrous and lactating animals. However, if specific subdivisions of the ARC were examined, a significant increase (1.8-fold) in NPY mRNA in the ARC-C region of the ARC (at the plane of the dorsal medial hypothalamic nucleus) was observed during lactation. Dorsal to the ARC in this same plane, there was also an induction of NPY expression in cells lateral to the dorsal medial hypothalamic nucleus. The increases in NPY mRNA in the ARC-C region of the arcuate nucleus persisted for at least 24 h after removal of the suckling stimulus. The other subdivisions of the ARC did not show any differences in NPY mRNA between diestrus and lactation. The POMC mRNA content was decreased by 20-30% during lactation compared with that on diestrus. The effects of lactation to decrease POMC mRNA content were not specific to any subdivision of the ARC, but were observed throughout the entire ARC. Given that lactation is an estrogen-deficient state, the increase in NPY neuronal activity, as indicated by increased gene expression in the caudal portion of the ARC and increased content in the ME, could play an inhibitory role in the regulation of GnRH secretion. However, the decrease in POMC neuronal activity, as suggested by the decrease in gene expression throughout the ARC, would not appear to be involved in the suppression of GnRH neuronal activity. These changes in ARC neuronal function could be related to hormonal changes or metabolic signals regulating food intake during lactation.

Analysis of human immunodeficiency virus type 1 nef gene sequences present in vivo

The nef genes of the human immunodeficiency viruses type 1 and 2 (HIV-1 and HIV-2) and the related simian immunodeficiency viruses (SIVs) encode a protein (Nef) whose role in virus replication and cytopathicity remains uncertain. As an attempt to elucidate the function of nef, we characterized the nucleotide and corresponding protein sequences of naturally occurring nef genes obtained from several HIV-1-infected individuals. A consensus Nef sequence was derived and used to identify several features that were highly conserved among the Nef sequences. These features included a nearly invariant myristylation signal, regions of sequence polymorphism and variable duplication, a region with an acidic charge, a (Pxx)4 repeat sequence, and a potential protein kinase C phosphorylation site. Clustering of premature stop codons at position 124 was noted in 6 of the 54 Nef sequences. Further analysis revealed four stretches of residues that were highly conserved not only among the patient-derived HIV-1 Nef sequences, but also among the Nef sequences of HIV-2 and the SIVs, suggesting that Nef proteins expressed by these retroviruses are functionally equivalent. The "Nef-defining" sequences were used to evaluate the sequence alignments of known proteins reported to share sequence similarity with Nef sequences and to conduct additional computer-based searches for similar protein sequences. A gene encoding the consensus Nef sequence was also generated. This gene encodes a full-length Nef protein that should be a valuable tool in further studies of Nef function.

c-Fos and related immediate early gene products as markers of activity in neuroendocrine systems

Expression of c-Fos, or other immediate early gene products, by individual neurons can be used as a marker of cell activation, making staining of these proteins an extremely useful technique for functional anatomical mapping of neuroendocrine systems. Because these proteins are located in the nucleus, identification of the phenotype of the activated neuron using substances located within the cytoplasm can be accomplished with standard double-labeling immunocytochemical techniques. Although it is clear that neurons have the capacity to express a number of immediate early gene products, what remains to be established is whether there is a different pattern of expression following various stimuli. In our studies, we focus primarily on expression of one immediate early gene product, the c-Fos protein. We also include some experiments using expression of other members of the Fos family and Jun proteins as markers for neuronal activation. Our studies describe uses of c-Fos expression in both parvocellular and magnocellular hypothalamic systems to address the following issues: (a) identification of neuroendocrine cells activated by specific treatments and conditions, (b) ascertainment of functional differences in subpopulations activated by specific stimuli, (c) evaluation of neuronal activity in complex areas containing multiple neuroendocrine systems, (d) identification of other brain areas activated in conjunction with neuroendocrine systems following specific stimuli, (e) analysis of connectivity of activated neuroendocrine systems with other parts of the brain, and (f) identification of stimuli that decrease neuronal activity. The neuroendocrine systems studied include those that secrete arginine vasopressin (AVP), oxytocin (OT), corticotropin-releasing hormone (CRH), luteinizing hormone-releasing hormone (LHRH), and dopamine (DA). The use of c-Fos expression has permitted functional neuroanatomical mapping of these systems in response to specific stimuli such as cholecystokinin (CCK), hyperosmolality, and volume depletion, or during various physiological states such as the proestrous ovulatory luteinizing hormone (LH) surge and lactation. Although the use of c-Fos as a marker of neuronal activation will continue to be an extremely powerful technique, future studies will also be directed at relating immediate early gene expression to changes in neuroendocrine gene expression. To this end, we have shown that both c-Fos and c-Jun are expressed in neuroendocrine neurons in response to a number of stimuli, setting the stage for potential regulatory drive to genes containing AP-1 binding sites.

Validation of smoking abstinence in newly diagnosed cardiovascular patients

Three methods of assessing smoking status among newly diagnosed cardiovascular (CV) patients were compared: self-reports, collateral reports (spouse, friend, etc.), and saliva cotinine assays. Self-reported smoking status was assessed as the average number of cigarettes smoked per day at baseline, 3, 6, 9, and 12 months into treatment, and at a 6-month posttreatment follow-up. The majority of patients had quit smoking within 6 months prior to participating in the program. All participants were informed at the onset of the study and at the time of each assessment that their self-reports of smoking abstinence would be validated through collateral reports and possibly saliva cotinine analyses. Less than 5% (13 of 274) of the subjects' self-reports showed discrepancies with collateral reports. Analyses of saliva cotinine assays in a subsample of subjects, however, indicated that 16% (13 of 81) of the saliva cotinine tests were discrepant with the collateral reports. Thus, the saliva cotinine analyses picked up an additional 11% false negatives, as compared to collateral reports. It is concluded that the use of collateral reports as an index of smoking status may be an overestimate of actual quit rates. The overall discrepancy rate for this study, however, was fairly low and suggests that patients' self-reports may be reliable when they have already quit on their own and/or are notified in advance of verification procedures.

Regulation of galanin gene expression in gonadotropin-releasing hormone neurons during the estrous cycle of the rat

Galanin is colocalized with GnRH in neurons of the hypothalamus and basal forebrain of female rats, and this neuropeptide may play a role in the generation of the midcycle surge of gonadotropin secretion. We tested the hypothesis that galanin gene expression in GnRH cells increases during proestrus. To accomplish this, we killed groups of adult female rats at 1200 and 1800 h on the day of proestrus as well as at 1800 h on the day of estrus and used double labeling in situ hybridization and image analysis to estimate and compare the levels of galanin mRNA in cells coexpressing GnRH mRNA. GnRH mRNA was detected with an antisense cRNA probe labeled with the hapten digoxigenin, while the galanin cRNA probe was labeled with 35S and detected by autoradiography. There was no significant difference in the total number of GnRH cells identified in each animal in any of the different groups in any experiment. The relative number of silver grains over these cells, reflecting galanin mRNA content in GnRH neurons (identified by their purple color), was counted with a computerized image analysis system. In an initial experiment, we observed a 2-fold (P < 0.03) higher galanin mRNA signal level in the animals killed at 1800 h than in those killed at 1200 h on the day of proestrus. Animals killed at 1800 h on the day of estrus had galanin mRNA signal levels that were not statistically different from those in the proestrous 1800 h group, indicating that the increase in galanin mRNA at proestrus is maintained for at least 24 h. Galanin mRNA levels in GnRH neurons returned to basal levels equivalent to those in the proestrous 1200 h group by 1000 h on diestrous day 1. In conjunction with the studies of galanin gene expression in GnRH neurons, we compared the relative cellular contents of GnRH mRNA among the same groups. Here, we used single labeling isotopic in situ hybridization for GnRH mRNA and computerized image analysis to count the resulting silver grains. We could detect no difference in GnRH mRNA signal levels (proestrus, 1200 h vs. proestrus, 1800 h vs. estrus, 1800 h). In a final experiment, we investigated the possible role of estrogen in the induction of galanin mRNA expression at proestrus by comparing relative galanin mRNA contents in GnRH neurons among groups of ovariectomized, intact (diestrous day 1), and ovariectomized 17 beta-estradiol-replaced female rats.(ABSTRACT TRUNCATED AT 400 WORDS)

Cortical refractoriness to N-methyl-D,L-aspartic acid (NMA) stimulation in the lactating rat: recovery after pup removal and blockade of progesterone receptors

We have previously reported that lactating rats, unlike cycling rats, are refractory to N-methyl-D,L-aspartic acid (NMA), but not kainate, in terms of behavioral responses and activation of cFos expression in the neocortex and hippocampus. To study the factors involved in the suppression of cortical activation in lactating rats in response to NMA, we examined the effects of removing either the suckling stimulus and/or progesterone. The degree of cFos expression was used as a marker for cortical activation. Whereas control suckled animals exhibited little or no cFos activation in the piriform cortex in response to NMA, cycling rats showed a high degree of activation. Blockade of the effects of progesterone or removal of the pups for 24 h, resulted in a moderate level of cFos intensity in response to NMA. Total recovery was observed only in animals who had their pups removed for 24 h and the effects of progesterone were blocked. In general, similar results were obtained in the hippocampus except that the total recovery of hippocampal activation took longer than the cortex. Thus, the deficits in cortical activation depend on the presence of both the suckling stimulus and progesterone. However, progesterone alone cannot induce these cortical deficits since pregnant rats showed no deficits in cortical activation in response to NMA when compared to cycling rats. Therefore, the suckling stimulus is required for the inhibition of NMDA-receptor mediated activation of the cortex and hippocampus. The effects of progesterone appear to act synergistically with the effects of suckling.

Ranitidine has no effect on postbreakfast ethanol absorption

The effect of ranitidine, the H2-receptor antagonist, on the systemic bioavailability of ethanol (0.3 g/kg body weight) taken orally 1 h after breakfast, was investigated in a randomized, placebo-controlled, double-blind cross-over study. Twenty normal male subjects (age, 19-26 yr) were studied on the morning of the 8th day of twice-daily dosing with either 150 mg ranitidine or placebo. Plasma ethanol concentration was measured by the alcohol dehydrogenase method from 0 to 240 min after oral ingestion of ethanol (100% ethanol made up to 200 ml orange juice). Compared with placebo, dosing with ranitidine resulted in nonsignificant changes in either the mean integrated 4-h plasma ethanol concentration (27.8 vs. 32.4 mg.h/dl), the peak plasma ethanol concentration (18.0 vs. 21.1 mg/dl), or the time to peak (43 vs. 40 min). There is no clinically important interaction between ranitidine and a low dose of ethanol taken orally 1 h after breakfast.

Zidovudine-resistant human immunodeficiency virus type 1 genomes detected in plasma distinct from viral genomes in peripheral blood mononuclear cells

The emergence of zidovudine (3'-azido-2',3'-deoxythymidine)-resistant strains of human immunodeficiency virus type 1 (HIV-1) from AIDS patients treated with zidovudine has been linked to six amino acid substitutions localized within the viral polymerase gene. Here, in 2 patients, three resistance mutations were detected by polymerase chain reaction amplification of HIV-1 polymerase (reverse transcriptase) sequences from cultures of patient plasma only and not from the same patients' uncultured leukocytes. The differences in distribution of the mutant genotypes from the two sources were highly significant. Both plasma- and peripheral blood mononuclear cell (PBMC)-derived virus (and/or RNA genomes) should be studied in additional subjects to confirm the hypothesis raised by these data that zidovudine-resistant virus may be more frequent in plasma than in uncultured PBMC.

Neural tube defects in the parietal region of human embryos: failure to close or closure-reopening?

This is a follow-up study to earlier investigations on neural tube defects (NTD) in the Kyoto collection of human embryos. It includes an extensive examination of abnormal embryos which have been photographed and serially sectioned following routine histological preparation. Two new types of NTD are described in the parietal region (the roof of the third ventricle) which had previously been overlooked. These anomalies were found most commonly in embryos at the developmental period. Carnegie stage [CS] 16-23 (embryonic days 38-52). Hypotheses are advanced regarding the genesis of NTD and whether encephaloceles and NTD are part of a spectrum of malformation. This study also reinforces evidence that the occurrence of NTD is significantly higher in the embryonic period than at birth. Animal studies, using the guinea-pig are discussed with regard to the investigation of hypotheses put forward to explain the genesis of NTD.

Evaluation of synergy between carbovir and 3'-azido-2',3'-deoxythymidine for inhibition of human immunodeficiency virus type 1

3'-Azido-2',3'-deoxythymidine and carbovir [racemic and (-) enantiomer] were evaluated individually and in combination for antiviral activity against human immunodeficiency virus type 1 replication and cytotoxicity in vitro. The combination of these drugs synergistically inhibited human immunodeficiency virus type 1 replication in C3 and Jurkat cells and in human peripheral blood mononuclear cells, although the same combination also produced synergistic cytotoxicity in human peripheral blood mononuclear cells.

Subclinical central nervous system infection with JC virus in patients with AIDS

Immunocompromised patients, particularly those with AIDS, develop progressive multifocal leukoencephalopathy (PML) due to central nervous system infection with JC virus (JCV). It is unknown whether JCV infection in the central nervous system can occur in the absence of PML symptoms. To address this question, autopsy specimens from patients with AIDS were examined. The brains of a group of patients without AIDS or central nervous system disease were also examined. JCV DNA was detected by the polymerase chain reaction in brain tissue from 4 (31%) of 13 human immunodeficiency virus (HIV)-positive patients. JCV was also detected in 1 elderly HIV-negative patient but not in the 11 other control brains. JCV was not detected in 22 myocardial specimens obtained at autopsy from HIV-negative patients nor 10 peripheral blood specimens from HIV-positive patients. The presence of JCV in brains of patients without clinically evident PML suggests that JCV may be present in the central nervous system without clinical disease.

Tissue-specific expression of kallikrein family transgenes in mice and rats

To define the regulatory strategy for the transcriptional control of the kallikrein multigene family, we analyzed the expression of several kallikrein/SV40 T-antigen (TAg) fusion genes in transgenic mice and rats. Kallikrein family members are normally expressed at a high level in the submandibular gland and are expressed in a wide range of tissues that vary among individual family members. A total of 1.7 kb of proximal 5'-flanking DNA from the tissue kallikrein gene (rKlk1) was sufficient to confer much of the correct tissue-specific pattern on a TAg reporter gene. TAg mRNA was detectable in tissues that normally express rKlk1 and TAg-induced tumors arose in brain and pancreas. However, absolute levels of transgene mRNA were very low relative to the expression of the normal endogenous tissue kallikrein gene. In particular, expression in the salivary glands, normally very high for endogenous rKlk1, was either low or absent. An intact rKlk1 transgene with extensive flanking DNA (4.5 kb 5' and 4.7 kb 3') and complete intragenic (4 kb) sequences was expressed similarly to the fusion transgene, demonstrating that regulatory elements necessary for comprehensively correct expression are not contained within these additional gene regions. Two additional kallikrein/SV40 fusion transgenes were derived from other family members, one from the rKlk2 gene, which encodes tonin, and another from the rKlk8 gene, which encodes a prostate kallikrein. Whereas the endogenous rKlk2 and rKlk8 genes normally are expressed at high levels in rat salivary glands, they were not expressed in the salivary glands as transgenes. The results for these transgenes of three different family members indicate that control elements that direct the particular nonsalivary gland expression pattern characteristic of each family member may be present within the proximal 5'-flanking region of each gene, whereas regulatory sequences necessary for normal levels of expression in these tissues and for maximal salivary gland expression are not. We propose that the gene-associated regulatory sequences are complemented by a dominant control region that imposes salivary gland expression on the extended kallikrein family locus.

Ganglionic and arterial release of neuropeptide Y by bullfrog sympathetic neurons

Sympathetic C neurons in lumbar paravertebral ganglia of the bullfrog have previously been shown to be vasomotor in function and to express neuropeptide Y (NPY). In the present experiments, a sensitive radioimmunoassay was used to measure the NPY content of ganglia and the descending abdominal aorta and to measure the overflow of NPY evoked by depolarizing concentrations of K+. Paravertebral ganglia 9 and 10 contain 3.1 pg NPY/micrograms protein and the aorta contains 0.18 pg NPY/micrograms protein. During 20-min depolarizations in high K+ (58 mM) Ringer, the ganglia released approximately 5% of their NPY content and the aorta released approximately 2% of its NPY content. Pretreatment of the tissues with Ringer containing 0.18 mM Ca2+, 8 mM Mg2+, and 1 mM Co2+ blocked the NPY release elicited by high K+. These findings provide further evidence that NPY is a postganglionic co-transmitter in sympathetic C neurons of the bullfrog.

Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: serial CK-MB sampling in the emergency department. The Emergency Medicine Cardiac Research Group

STUDY OBJECTIVES

This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs.

DESIGN

Patients more than 30 years old who were evaluated initially in the ED and hospitalized for chest pain were studied. Serial CK-MB levels were analyzed prospectively using a rapid serum immunochemical assay for identification of AMI patients in the ED. Presenting ECGs showing new, greater than 1-mm ST elevation in two or more contiguous leads were considered diagnostic for AMI. All other ECGs were considered nondiagnostic ECGs. CK-MB levels were determined at ED presentation and hourly for three hours (total of four levels). Patients with at least one level of more than 7 ng/mL were considered to have a positive enzyme study. The in-hospital diagnosis of AMI was determined by the development of typical serial ECG changes or separate standard cardiac enzyme changes after admission.

SETTING

Eight tertiary-care medical center hospitals.

METHODS AND MAIN RESULTS

Of the 616 study patients, 108 (17.5%) were diagnosed in the hospital as AMI; 69 of these AMI patients (63.9%) had nondiagnostic ECGs in the ED. Of the patients with nondiagnostic ECGs, 55 (sensitivity, 79.7%) had a positive ED serial CK-MB enzyme study within three hours after presentation. Combining serial ED CK-MB assay results with diagnostic ECGs yielded an 88.4% sensitivity for AMI detection within three hours of ED presentation. The predictive value of a negative serial ED enzyme study for no AMI was 96.2% (specificity, 93.7%).

CONCLUSION

Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.

LHRH neurons express cJun protein during the proestrous surge of luteinizing hormone

LHRH neurons express cFos on the afternoon of proestrus in association with the ovulatory LH surge. This study determined whether LHRH neurons express another proto-oncogene product, Jun, during the estrous cycle. By using immunocytochemical double staining techniques, localization of Jun proteins and LHRH was compared with expression of cFos in LHRH neurons. LHRH neurons expressed Jun proteins on the afternoon of proestrus with detection of Jun through the morning of estrus. The time course of Jun expression in LHRH neurons during proestrus suggests a common stimulus for both Jun and cFos expression in LHRH neurons, with Jun proteins persisting somewhat longer than cFos. Pentobarbital, which blocks the preovulatory LH surge and cFos expression in LHRH neurons, blocked Jun expression in LHRH neurons; the LHRH neurons similarly expressed Jun and cFos on the following afternoon at the time of the expected delayed LH surge. There was a similarity in the patterns (in terms of numbers and distribution) of Jun-positive and cFos-positive LHRH neurons. Both were localized in the preoptic area and anterior hypothalamus; LHRH neurons above the anterior commissure or rostral to the OVLT did not express Jun or cFos. For the first time, these data provide direct evidence that both proto-oncogene products, Jun and cFos, are expressed in LHRH neurons in association with the proestrous LH surge. Taken together, these results suggest that changes in gene expression mediated by Jun-cFos heterodimers may accompany LHRH activation on the afternoon of proestrus.

cFos Activity Identifies Recruitment of Luteinizing Hormone-Releasing Hormone Neurons During the Ascending Phase of the Proestrous Luteinizing Hormone Surge

The proto-oncogene product of the c-fos gene, cFos, is a useful marker for luteinizing hormone-releasing hormone (LHRH) neuronal activation. While recent data indicate that in the rat, an LHRH surge plays an active role in stimulating the proestrous luteinizing hormone (LH) surge, the mechanics of the LHRH surge remain unknown. The aim of this study was to determine whether LHRH neuronal activation occurs entirely at the beginning of the LH surge or whether the number of LHRH neurons activated increases during the ascending phase of the surge. To accomplish this aim, we determined the relationship between the number of LHRH neurons expressing cFos and LH concentrations during the ascending limb of the proestrous LH surge. During the estrous cycle in the rat, on the afternoon of proestrus, the number of LHRH neurons expressing cFos increased as plasma LH levels increased to reach peak concentrations. The regression line describing these two variables had a very highly significant correlation coefficient, indicating a linear relationship. Treatment with RU486 to block progesterone's action on the afternoon of proestrus significantly reduced both the number of LHRH neurons expressing cFos and the magnitude of LH secretion during the entire ascending phase of the LH surge. An analysis of covariance with comparison of regression lines from untreated and RU486-treated animals revealed that while both sets of data established significant linear relationships between the degree of activation of LHRH neurons and plasma LH values, the slopes of the two lines were different (P = 0.031) with no statistical difference in the two intercepts. These data, together with the demonstration of an overall reduction of cFos intensity following removal of progesterone's actions, suggest progesterone alters the dynamics of LHRH neuronal activation by significantly reducing the recruitment of LHRH neurons and suppressing the level of activation of individual LHRH neurons. The results of our study support the hypothesis that the ascending phase of the LH surge results from the gradual recruitment of LHRH neurons into the active state.

Functional neurolobectomy induced by controlled compression of the pituitary stalk

Degeneration of magnocellular nerve terminals in the neurohypophysis was induced by compressing the pituitary stalk of anesthetized rats for 30 s using a triangle-shaped wire. Immediately after stalk compression (SC), rats exhibited markedly increased water intake characteristic of diabetes insipidus, followed by a triphasic pattern of fluid intake. In SC rats, arginine vasopressin (AVP) and oxytocin (OT) contents of the neurointermediate lobe (NIL) of the pituitary gland were significantly reduced to approximately 2.5% and approximately 10% of sham-operated controls, respectively. In contrast, OT, but not AVP, content of the stalk-median eminence (SME) of SC rats was significantly increased. Histological examination of the pituitaries showed substantial degeneration of the neural lobe with very scarce AVP-neurophysin and OT-neurophysin immunoreactivity, while both the anterior and the intermediate lobes appeared to be intact. Plasma AVP and OT responses to infusion of hypertonic NaCl were significantly blunted in SC rats compared to sham-operated controls. However, two days after surgery the secretory patterns of LH in SC rats were similar to those in the controls. These results indicate that controlled compression of the pituitary stalk results in selective degeneration of the neural lobe without causing permanent ischemic damage to the anterior pituitary, and produces marked sustained functional deficits in pituitary AVP and OT secretion. Consequently, SC provides an alternative means to achieve selective neurolobectomy in rats.

The induction of neural tube defects by maternal hyperthermia: a comparison of the guinea-pig and human

In our recent studies on the effects of maternal hyperthermia on the embryonic guinea-pig, we have demonstrated two 'teratogenic windows' at embryonic days 13 and 21 (E13 and E21). E13 encompasses the period of the closure of the neural groove and anterior neuropore, and E21 the commencement of the cortical plate. The approximate equivalent developmental times in the human are E23-E25 and E49-E56 respectively. In the guinea-pig, maternal hyperthermia at E13 results in a high incidence of neural tube defects (NTD), many open, and associated with other defects such as microphthalmia, and scoliosis or kyphosis. The NTD were most common in the developing hindbrain and all demonstrated considerable infoldings of neural tissue, rosettes of neuroepithelial cells, outpocketings of neural tissue and large cystic cavities beneath the defect. In human examples from the Kyoto Human Embryo Collection, 16 had verified hyperthermic insults at E23-E25 and all had NTD which showed similar deformities to the guinea-pig. Most embryos with such gross defects are aborted in the early fetal period in both species.

Studies of the role of the N-methyl-D-aspartate (NMDA) receptor in the hypothalamic control of prolactin secretion

To further examine the role of excitatory amino acids in the control of prolactin (PRL) secretion, the effects of administering a specific agonist and an antagonist of the N-methyl-D-aspartate (NMDA) receptor on plasma PRL concentrations were examined in the adult male rat. Animals of the Sprague-Dawley strain weighing 250-300 g were implanted with an indwelling cardiac catheter via the right jugular vein. Blood samples were collected through the catheter at 5 min intervals for 40 min, beginning 5 min before the iv administration of drug or the saline vehicle (V). Plasma PRL and luteinizing hormone (LH) concentrations were estimated using RIAs. Groups of animals (n = 5-7) received N-methyl-D,L-aspartate (NMA), D,L-2-amino-5-phosphonopentanoic acid (AP5), AP5 and NMA, norvaline (NOR), or V. The effects of administering the NMDA receptor antagonist alone were studied on two separate occasions. Injection of NMA (4.5 mg/rat) resulted in unambiguous PRL and LH discharges. Treatment with AP5 (9 mg/rat) 1 min prior to NMA administration completely blocked the LH releasing action of NMA, but did not significantly alter the discharge of PRL. Injection of AP5, alone, generally elicited a distinct and robust discharge of PRL, although plasma LH levels in these animals remained unchanged. NOR, an amino acid structurally related to AP5, administered at a dose (5.3 mg/animal) isomolar to that of AP5, was without effect on PRL and LH secretion, as was injection of V alone. These findings suggest that neuroexcitatory amino acids acting at the NMDA receptor may play a role in modulating the activity of neuronal systems that govern the release of both PRL releasing factor (PRF) and PRL inhibiting factor (PIF) into hypophysial portal blood.

Differences in the luteinizing hormone and prolactin responses to multiple injections of kainate, as compared to N-methyl-D,L-aspartate, in cycling rats

We have previously reported that repetitive iv injections of NMA [N-methyl-D,L-aspartate, the mixed analog acting on the N-methyl-D-aspartate (NMDA) receptor] can induce a consistent increase in LH and PRL secretion in cycling rats, but not in lactating rats. To further explore the use of excitatory amino acids (EAAs) as tools for understanding the regulation of the neuroendocrine reproductive axis, we have examined the effects of multiple injections of kainate, an agonist to another subclass of EAA receptor, on LH and PRL secretion in cycling rats. Recent studies suggest that kainate receptors may be more abundant than NMDA receptors in the hypothalamus. Five iv injections of kainate were administered at 50-min intervals to diestrous or estrous rats. Blood samples were collected every 10 min and assayed for LH and PRL. LH, but not PRL secretion, was stimulated by this regimen of kainate treatment. Surprisingly, the LH response to kainate, unlike NMA, decreased with repetitive injections of the drug. The response to the last pulse of kainate was approximately 30-40% of the first pulse. This decline in LH responsiveness to kainate was not due to desensitization at the level of the pituitary or to refractoriness of GnRH neurons, since further stimulation of LH release could be obtained by the administration of GnRH or NMA. The mechanisms responsible for the diminishing GnRH response to kainate remain unclear. However, we speculate that it might be due to the delayed activation of inhibitory inputs to GnRH neurons or to the desensitization of kainate receptors. On the other hand, the absence of a PRL response to kainate, in contrast to the stimulatory effect of NMA, most likely reflects differences in the distribution of kainate and NMDA receptors on dopamine neurons and neurons containing PRL-releasing factors, or on extrahypothalamic afferent neuronal populations projecting to the hypothalamus. In conclusion, the effects of systemic injections of kainate on LH and PRL secretion differed from NMA in that the LH response could not be sustained with multiple injections and PRL was unresponsive to kainate stimulation.

Immunity to rabies after administration of prophylactic human diploid-cell vaccine

The immune status to rabies of 14 volunteers was determined using the commercially available Trousse Platelia Rage (Diagnostics Pasteur) enzyme immunoassay test system. Twelve subjects were evaluated before and between 6 months and 60 months after prophylactic intramuscular (deltoid) administration of rabies human diploid-cell vaccine, while the effect of booster doses on a further 2 volunteers was evaluated over an 11-year period. Optical density values were converted to international units to allow correlation with World Health Organisation seroneutralisation references. Values of greater than or equal to 0.5 IU are considered protective. The results showed that most individuals were still immune 2 years after vaccination; there was a tendency for serum antibody levels to decrease over a 5-year post-vaccination period. Antibody levels rose sharply after booster immunisation, after which they decreased at a much slower rate. In general, results revealed that after the first booster, additional booster vaccinations at 5-yearly intervals would provide adequate prophylactic immunity. There was, however, much individual variation, which emphasises the need to evaluate each individual at regular and shorter intervals to determine the need for booster vaccine doses. The test method employed is economical and well suited to such evaluations.

Chronic fatigue in adolescents

Nine female and 6 male adolescents (mean age 14.5 +/- 1.7 [SD] years) were evaluated for chronic fatigue associated with at least three additional symptoms present for 18.4 +/- 8.4 months. Eleven subjects experienced the onset of symptoms with an acute illness (seven Monospot-positive). Medical history, physical examination, and laboratory testing yielded little helpful information. Serologic testing for Coxsackie B viruses 1 through 6, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and Toxoplasma gondii in subjects and healthy controls provided little evidence for an infectious cause of persistent fatigue. Children's Depression Inventory scores and psychiatric interviews with the Schedule for Affective Disorders and Schizophrenia-Children's Version (K-SADS) identified five subjects with major depression. On the K-SADS, the 10 fatigued subjects without major depression endorsed many secondary symptoms of depression but were less likely than depressed psychiatric clinic patients to endorse primary symptoms such as depressed mood, guilt, and suicidality. At telephone follow-up 13 to 32 months after intake, 4 subjects were completely well, 4 markedly improved, and 7 unimproved or worse. Further research is necessary to determine whether chronic fatigue in adolescents is prodromal depression, a discrete psychosomatic condition, or an infectious or immunologic disorder that mimics depression.

A prospective study of physical trauma and multiple sclerosis

During an eight year period 170 multiple sclerosis (MS) patients and 134 controls without physical impairment were followed closely to record all episodes of physical trauma and to measure their effect on exacerbation rate and progression of MS. There was a total of 1407 instances of trauma, which were sorted into various categories. Overall there was no significant correlation between all-traumas and disease activity. There was, however, a statistically significant negative correlation between traumatic episodes and exacerbations in 95 patients who had exacerbations during the programme, due primarily to less activity of the disease during a three month period following surgical procedures and fractures. Electrical injury had a significant positive association with exacerbation using a three month at-risk period, but there were no other significant positive correlations in any other category of trauma, including minor head injuries; there were no cases of head injury with prolonged unconsciousness. There was no linkage between the frequency of trauma and progression of disability. MS patients had two to three times more trauma than controls.

Interference with neural crest migration by maternal hyperthermia as a cause of embryonic death due to heart failure

Maternal hyperthermia has been demonstrated to be a teratogen in every animal species studied, and a minimum core temperature rise of 2.5 degrees C can produce a number of developmental defects. However, numerous embryos fail to survive to term. In the guinea-pig, heating the embryos prior to neural tube closure induces significant neural tube defects, but all embryos die within 20 days of heating. A number have aberrant cardiac development and many show spectacular pericardial effusions and congestion in the peripheral circulation. We suggest that maternal hyperthermia has interfered with neural crest migration which is a major component in the induction of these changes.

Porcine relaxin affects the release of luteinizing hormone in rats

Abstract The effects of intravenous injection of porcine relaxin on the pulsatile secretion of luteinizing hormone (LH) were investigated in conscious rats. In untreated, ovariectomized animals, relaxin at doses 2.5 to 10/mug/rat caused a dose-dependent suppression of pulsatile release of LH. At 5mug relaxin, pulses were suppressed for approximately 60 min and there was a significant (P<0.05) fall in mean plasma LH levels. Pulses returned with the same frequency as the pretreatment period but amplitude and nadir of these pulses were significantly (P<0.05) reduced at doses >2.5mug/rat. In ovariectomized rats pretreated with either estradiol or progesterone alone, relaxin did not alter plasma LH levels. In contrast, injection of 5mug relaxin in rats primed with a combination of estradiol and progesterone caused a 90% increase in circulating LH levels. Intracerebroventricular infusion of a specific angiotensin II antagonist blocked the inhibitory effect of relaxin on LH release in untreated, ovariectomized rats and negated the stimulatory effect of relaxin on LH release in estradiol-progesterone-primed, ovariectomized rats. The results demonstrate that acute injections of porcine relaxin in ovariectomized rats suppress the pulsatile release of LH. This effect is blocked when the central angiotensinergic system is compromised suggesting that relaxin might act through the central angiotensin system. The findings are in agreement with other studies that indicate relaxin activates the central angiotensin system. It is also possible that relaxin may act at the level of the adenohypophysis to alter secretion of LH but data in the present study suggest that this may not be a significant site of relaxin action.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

Mexiletine versus quinidine as first-line antiarrhythmia therapy: results from consecutive trials

The efficacy of mexiletine and quinidine in controlling ventricular couplets (VC) and ventricular tachycardia (VT) was compared in 156 trials (78 for each drug) in 114 consecutive patients. Forty-two patients received both drugs, whereas 36 patients were given mexiletine, and 36 patients received quinidine only. During acute drug testing, mexiletine was more effective than quinidine in controlling VC and VT (54 vs. 32 patients, respectively, P less than .001) and resulted in fewer proarrhythmic events (4 vs. 13, respectively, P less than .05). Mean duration of follow-up for mexiletine (27 +/- 14 mo) and quinidine (21 +/- 14 mo) did not differ. Long-term success was more frequent with mexiletine administration than quinidine administration (33/47 vs. 10/30 patients, respectively, P less than .01). The incidence of sudden death during follow-up with the two drugs did not differ overall, but more patients with ejection fraction greater than or equal to 40% died suddenly while taking quinidine than while receiving mexiletine (4/17 vs. 0/24, P less than .02). Mexiletine is as effective as quinidine for treating VC and VT and appears to be less proarrhythmic. It should be considered as an initial choice in the management of VC and VT.