Accuracy of orthognathic evaluation using telemedicine technology

OBJECTIVE

Telemedicine technology has the ability to project highly specialized medical and dental expertise anywhere in the world. This is particularly important to many small, isolated communities that do not have access to medical and dental specialists. Telemedicine also has the potential to reduce unnecessary travel, time away from work, and unneeded hospital admissions. For this technology to be successful, however, clinicians need to have confidence in its capabilities. This study was conducted to determine the accuracy of an orthognathic evaluation using telemedicine.

MATERIALS AND METHODS

Thirteen patients were randomly selected for review by two surgeons each using telemedicine and clinical examinations. Clinically acceptable differences were established, and the results of the two examination methods were compared.

RESULTS

A main effect of the examination method was observed in 7 of the 18 continuous measurements taken. Examination of the absolute value of the within-subject difference between the two examination methods demonstrated that the mean absolute difference was statistically different from zero for 13 of 18 measurements taken.

CONCLUSIONS

These data demonstrate that a relatively accurate orthognathic examination can be performed with this technology. With this in mind, clinicians may feel comfortable using this technology for other clinical applications.

The association between telomerase, p53, and clinical staging in colorectal cancer

BACKGROUND

A proposed etiology of tumor activation involves p53 mutations while telomerase may serve as a key enzyme for maintenance of tumor cell proliferation.

METHODS

Telomerase activity levels were measured in colorectal adenocarcinomas and corresponding normal tissue using a modified telomeric repeat amplification protocol, and p53 mutations were identified using immunohistochemical staining. Results were compared with staging data using regression analysis.

RESULTS

Telomerase activity was present in 23 of 23 (100%) of the tumors and only 2 (9%) of normal specimens (P <0.0001). The p53 mutations were present in 18 of 23 (78%) of the tumors. No significant correlation between p53 mutations, telomerase activity levels, and staging was found.

CONCLUSIONS

Telomerase activity in 100% of the tumors suggests telomerase activation is a universal event in colorectal tumor progression; however, telomerase activity appears to be independent of p53 mutations and clinical staging.

Pharmacologic hemoglobin reversal: the importance of lipid intermediaries and the proposed involvement of the cAMP and phosphatidylinositol second messenger systems

Humoral and microenvironmental influences have played a major role in recent research into reversing the Hb F to Hb A switch. Early research in this area focused on hormonal influences and showed both thyroid hormone and prolactin could induce small but statistically significant reversals in hemoglobin phenotype. Recent research has focused on the effect of certain lipids in this process. The current study shows a synergy between thyroid hormone and prolactin in inducing a significant switch in adult rat hemoglobin patterns toward the neonatal pattern. Further, it is hypothesized that this synergy is due to the hormones' effect on lipid intermediaries whose effect in turn are proposed to be mediated by the cAMP and phosphatidylinositol second messenger systems.

Prevalence of prostatic cysts in adult, large-breed dogs

The prevalence of prostatic cysts was evaluated in 85 adult, male dogs weighing more than 16 kg which were admitted for problems unrelated to the prostate gland. Urine culture and prostatic evaluation by ultrasonography were performed in all dogs. Prostatic cysts were identified in 12 (14%) of the 85 dogs. Cultures of prostatic cysts were positive in five (42%) of the 12 dogs. Nonclinical, aerobic bacteriuria was documented in 9% of the study population. Urine cultures correlated with prostatic cyst cultures in four of the five dogs that had positive prostatic cyst cultures. Results of this study indicate that the prevalence of prostatic cysts in adult, intact male dogs is approximately 14% and that approximately 42% are infected with bacteria.

Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research

CONTEXT

The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers.

OBJECTIVE

To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline.

DESIGN

The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness.

PATIENTS

The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time.

INTERVENTION

Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum.

MAIN OUTCOME MEASURE

Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%.

RESULTS

The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention.

CONCLUSIONS

Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.

Long-acting diltiazem CD is safe and effective in a hypertensive Mexican-American population

STUDY OBJECTIVE

To evaluate the safety and effectiveness of diltiazem CD for reducing blood pressure in Mexican-American patients with mild to moderate hypertension.

DESIGN

Randomized, double-blind, placebo-controlled trial.

SETTING

Twelve clinical sites in the United States.

PATIENTS

Patients with baseline diastolic blood pressures between 95 and 115 mm Hg.

INTERVENTIONS

Patients were treated with an average daily dose of diltiazem CD 246 mg (60 patients) or placebo (58 patients) to achieve a trough diastolic blood pressure below 90 mm Hg.

MEASUREMENTS AND MAIN RESULTS

Diltiazem CD significantly reduced mean diastolic blood pressure compared with placebo, -8.2 versus -4.1 mm Hg, respectively (p=0.0025). Diastolic blood pressure below 90 mm Hg or a reduction of 10 mm Hg or more was achieved by 57% of diltiazem CD versus 28% of placebo recipients. Systolic blood pressure and heart rate were also reduced with diltiazem CD. Adverse events were mild, with similar frequency for diltiazem CD (15%) and placebo (19%).

CONCLUSION

Diltiazem CD is safe and effective in hypertensive Mexican-Americans, and diastolic blood pressure reductions compare with those in non-Hispanic white patients.

Comparison of the biological properties of two anti-mucin-1 antibodies prepared for imaging and therapy

A comparison was made between the murine anti-MUC1 antibody BC2 (which reacts with the peptide epitope APDTR) and the "humanised" antibody hCTMO1 from CellTech, which reacts with the MUC1 epitope RPAP. Preliminary studies demonstrated that hCTMO1 was a "good" antibody whereas BC2 was not. Various parameters were determined and conclusions reached. (a) Affinity: the affinity of hCTMO1 was 2.60 x 10(7) M(-1) and that of BC2 was 1.36 x 10(7) M(-1); we did not consider these numbers to be substantially different, although hCTMO1 was clearly of higher affinity than BC2. (b) On/off rate at 4 degrees C: both antibodies bound effectively to the MUC-1 transfectant MOR5-CF2; the association rate for hCTMO1 was 3.8 times that of BC2 and the dissociation rate for BC2 was twice as fast as that of hCTMO1. (c) On/off rates at 37 degrees C: at 37 degrees C the association rate for hCTMO1 was greater than that of BC2. (d) Internalization: hCTMO1 was also more efficient at internalising bound antibody; 70% of bound hCTMO1 was internalised, whilst 6% of bound BC2 was internalised. From these studies it was clear that, while hCTMO1 was of similar affinity to BC2, the faster uptake and internalisation and lower off rate indicated that it was likely to be a superior antibody; this was proven in vivo. (e) Localisation: hCTMO1 bound much better in vivo than BC2 (68% compared to 28%). (f) Therapeutic experiments: BC2-idarubicin conjugates were essentially ineffective in eradicating tumours in mice whereas hCTMO1-idarubicin had a dramatic effect on breast cancer tumour cells growing in mice. We conclude that the simple measurements on/off rates and internalisation at 37 degrees C are the most important parameters to use to determine antibody effectiveness, prior to embarking on clinical studies.

Hospital Communication Threats and Intervention

1. Threats are indirect acts of criminal behavior designed to weaken or injure individuals, institutions, or property. 2. All threats should be analyzed and investigated quickly and with high priority. 3. An interdisciplinary hospital team should conduct periodic reviews of threats received, threat management, and case outcome.

Challenges to identifying actual diabetes case-mix complexity and total treatment charges

Patient management programs are being used to improve the quality of care and decrease charges for both high-cost and potential high-cost claimants. Adequate information is key to program development, planning, and implementation. Claims-based data are a ready source of valuable information, but without proper processing, true case-mix complexity and total charges for patients will not be identified.

Effects of histamine and 5-hydroxytryptamine on the growth rate of xenografted human bronchogenic carcinomas

1. The influence of histamine and 5-hydroxytryptamine (5-HT) antagonists and agonists on the volume doubling times (Td) of human bronchogenic carcinomas propagated as s.c. xenografts in immunosuppressed mice was examined. 2. The H2-receptor antagonists, cimetidine and ranitidine, increased Td. 3. Treatment with the H2-receptor agonist, 4-methyl histamine, had no effect on Td. 4. Co-administration of 4-methyl histamine and cimetidine abolished the effects of cimetidine. 5. The 5-HT2-receptor antagonists, cinanserin and ketanserin, both increased Td. 6. Treatment with the 5-HT1/2-receptor agonist quipazine (0.1 mg/kg, reflecting 5-HT2 agonist activity) decreased Td, while a higher dose (10.0 mg/kg) had no effect. 7. The 5-HT1/2-receptor antagonist, methiothepin, decreased Td. 8. The 5-HT uptake inhibitor, fluoxetine, increased Td in one tumour line but not in another, while the 5-HT releaser/depletor, fenfluramine, increased Td. 9. Histamine may stimulate tumour growth through the histamine H2-receptor, while the dominant effect of 5-HT is 5-HT1-receptor inhibition. 10. Tumour growth in some bronchogenic carcinomas may involve 5-HT uptake mechanisms.

An effect of magnesium on neuromuscular function in parturients

STUDY OBJECTIVE

To determine the effects of magnesium sulfate on neuromuscular transmission in parturients.

DESIGN

Open-label, clinical study.

SETTING

Preeclamptic patients at a university-affiliated hospital.

PATIENTS

12 pregnant patients, ages 18 to 40 years, with preeclampsia or entering preterm labor.

INTERVENTIONS

Patients were treated with magnesium sulfate. Train-of-four (TOF) recordings of the adductor pollicis muscle were obtained before and 30 minutes after the magnesium sulfate infusion.

MEASUREMENTS AND MAIN RESULTS

Each contractile response in the control TOF showed an increase in the tension developed in response to supramaximal stimulation. The TOF responses after magnesium sulfate did not demonstrate this phenomenon, but rather developed fade. The T4/T1 ratios ranged from 0.72 to 0.92.

CONCLUSIONS

In this patient population, clinically relevant infusions of magnesium sulfate produced significant changes in neuromuscular transmission as manifested by loss of treppe phenomenon and diminished TOF response to ulnar nerve stimulation.

Familial myeloid leukemia associated with loss of the long arm of chromosome 5

A 24-member kindred is described in which four cases of acute myeloid leukemia (AML), and one case of myelodysplastic syndrome (MDS) occurred over three generations. The proband was diagnosed with AML at age 47; within 6 months, her sister, age 41, was diagnosed with MDS. The proband's father, grandfather and a paternal uncle all died of AML, preceded by a pre-leukemic phase. The five cases had several clinical features in common. In the two sisters and their paternal uncle, cytogenetic analyses of bone marrow cells revealed a common abnormality characterized by loss of the long arm of chromosome 5, del(5q). No constitutional cytogenetic abnormality was detected in mitogen-stimulated peripheral blood lymphocytes from the proband. In addition, there was no history of common environmental or occupational exposure in the family. The occurrence of AML and MDS in three generations of this family most likely resulted from a single gene defect with an autosomal dominant pattern of inheritance. The association with the somatic loss of 5q material in the leukemia cells of affected members suggests that a germline mutation of a leukemia suppressor gene located on 5q might be the primary event responsible for hereditary susceptibility to leukemia in this family.

Matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 expression and synthetic matrix metalloproteinase-2 inhibitor binding in ovarian carcinomas and tumor cell lines

Enhanced matrix metalloproteinase-2 (MMP-2/72-kd type IV collagenase) action correlates with invasion in neoplasia. MMP-2 is inhibited in vivo by tissue inhibitors of metalloproteinases (TIMPs)-TIMP-1 and, especially, TIMP-2. A synthetic, biotinylated inhibitor specific for activated MMP-2 in solution phase, and immunohistochemistry were used to detect MMP-2 and TIMP-2 expression in cell lines and ovarian tumors and to analyze the surface-binding capacity of the inhibitors, which are potential therapeutic agents. Characterization of novel monoclonal antibodies to MMP-2 and TIMP-2 is described together with immunocytochemical staining of 83 paraffin-embedded ovarian tumors (67 malignant, 7 borderline, 9 benign) and 9 cell lines. Synthetic MMP-2 inhibitor binding under controlled conditions was visualized by immunofluorescence and avidin-biotin complex immunoperoxidase methods in cell lines and cryostat sections of ovarian tumors. MMP-2 and TIMP-2 showed heterogenous immunoreactivity, with enhanced staining on high-grade tumors, specifically at the invasive front and in vascular invasion. TIMP-2 immunoreactivity was maximal in malignant cell cytoplasm and less intense in desmoplastic fibroblasts. One monoclonal antibody to MMP-2 showed membrane immunoreactivity, apically polarized in benign and low-grade tumors but depolarized and strong in 37 of 44 cases of high-grade invasive tumors. Eleven of eighteen ovarian carcinomas and six of nine cell lines showed membrane localization of the synthetic inhibitor. Maximal binding occurred in the ovarian cell line OVCA 432 and the breast cell lines MCF 7 and MDA MB 435, all of which were immunoreactive for MMP-2. Cell lines propagated on type I collagen showed no enhancement in inhibitor binding. This study demonstrates cell surface binding of a synthetic MMP-2 inhibitor and provides new evidence of MMP-2 and TIMP-2 immunoreactivity in ovarian carcinomas and cell lines.

Memory Presentations of Childhood Sexual Abuse

Questions are continually raised about the accuracy and validity of very young children's memories of traumatic events. Out of 19 children, where the median age was 2 1/2 at time of disclosure, 11 had full verbal memory, five had fragmented verbal memory traces, and three had no memory 5 to 10 years following day care sexual abuse. Data from this clinical study suggest the nature of children's memory is four-dimensional: somatic, behavioral, verbal, and visual. Efforts need to continue to document the nonverbal components for assessment and treatment purposes.

Speed and ease of tracheal intubation: priming with mivacurium compared with succinylcholine

This study examined the efficacy of mivacurium priming (0.015 mg.kg-1) with five minutes between the priming and intubating doses by comparing the effects of one, two and three times the ED95 dose (0.075 mg.kg-1) of mivacurium after priming (Groups 1, 2 and 3, respectively), with a saline prime and 2 x ED95 mivacurium (Group 4) or 1 mg.kg-1 dose of succinylcholine (Group 5). The time from the intubating dose injection to intubation was measured and intubating conditions were rated on a five-point scale with 4 being optimal and 0 being failure. Mean times (+/- SEM) in seconds between the administration of the intubating dose and tracheal intubation were: 106.4 +/- 5.1, 89.6 +/- 6.7, 81.9 +/- 2.7, 169.9 +/- 7.8 and 82.9 +/- 3.5 for Groups 1-5 respectively. The times for Group 2 (2 x ED95 with priming), Group 3 (3 x ED95 with priming) and Group 5 (succinylcholine with saline) were shorter than the times of Groups 1 (1 x ED95 with priming) and 4 (2 x ED95 with saline) P < 0.05. Mean intubating condition scores (+/- SD) for the five groups respectively were 3.1 +/- 0.6, 3.4 +/- 0.6, 3.5 +/- 0.5, 3.2 +/- 0.6 and 3.8 +/- 0.4. Scores for Groups 2, 3 and 5 were higher than those of Group 1 (P < 0.05). The data demonstrated that (1) priming with mivacurium shortens the intubation time and is accompanied by good intubating conditions with doses 2x and 3x ED95, and (2) intubating times and conditions similar to those achieved with succinylcholine can be obtained using mivacurium 2x (total dose 0.150 mg.kg-1) or 3 x ED95 (total dose 0.215 mg.kg-1) with a five-minute priming interval. Priming provides an alternative technique in those clinical circumstances where succinylcholine is contraindicated.

Health problems of Maryland's migrant farm laborers

The health problems of Maryland's agricultural migrant labor force are presented for the information of Maryland's health care providers. Maryland's problems are placed in the context of U.S. and worldwide migrant labor practices.

Structural and functional analyses of the transcription-translation proteins NusB and NusE

The NusB and NusE (ribosomal protein S10) proteins function in transcription and translation. The two proteins form a complex that binds to the boxA sequence found in the leader RNA of rrn operons; boxA is required for transcription antitermination in rrn operons. Although binding of these two proteins to the boxA RNA of the bacteriophage lambda nut site has not been observed, both NusB and NusE as well as the RNA boxA sequence are required for lambda N-mediated antitermination. Studies identifying the amino acid changes caused by mutations in nusB and nusE and relating these changes to altered function are reported. It is concluded that boxA is essential for an effective NusB contribution to N-mediated antitermination and that by mutation NusB may be changed to allow more-effective binding to boxA variants.

The minor issue of electroconvulsive therapy

ECT can be life-saving for patients with certain mental illnesses, such as severe depression, but that is no reason to allow ECT without informed consent. Nor is there general medical justification for the use of ECT on children, a practice in the United Kingdom that is out of control.

Cardiac enzymes in patients undergoing caesarean section

Some of the changes reported in the ECG of parturients undergoing Caesarean section are suggestive of myocardial ischaemia. This study determined serum CK total and the isoenzyme CK-MB levels in 21 patients during and after Caesarean section under epidural anaesthesia. Twenty patients complained of chest pain, discomfort and pressure, while 12 had ST segmental depression. Although the total CK activity in ten patients was elevated, CK-MB activity in all patients was negative. The electrocardiographic changes were rate-related and occurred at the time pressure was placed upon the upper abdomen and lower thoracic cage by the surgeon to facilitate Caesarean delivery. The data from this study demonstrate that no myocardial injury as measured by CK-MB activity occurs in parturients undergoing Caesarean delivery despite the complaint of chest pain, discomfort and pressure, and ST changes in the ECG.

Music reduces stress and anxiety of patients in the surgical holding area

Many patients in the Surgical Holding Area become stressed and anxious. In a hospital setting music reduces patients' anxiety. This study determined that music can reduce the anxiety and stress of patients in the Surgical Holding Area. In this study, one group of subjects listed to music while a second group did not. Subjects who listened to music while in the Surgical Holding Area had significantly less stress and anxiety than did those who did not listen to music. Both groups spent similar lengths of time in the Surgical Holding Area. The results strongly suggest that if music were available to all patients in the Surgical Holding Area, most would select this option, and they would experience less anxiety.

A rodent model for hemoglobin switching utilizing high performance liquid chromatography

It has long been recognized that a treatment for beta hemoglobin chain anomalies could result if a way to reverse the Hb F to Hb A switch in humans were found. Studies of hemoglobin switching have been hampered by the fact that small animals normally used in the laboratory do not have a true Hb F. However, several small animal models which take advantage of a switch in minor beta chain proportions in certain strains of inbred mice and rats have been proposed and used. The use of these models has suffered from what, until now, could be considered technically demanding, time-consuming methodologies. In this study we report an effective, rapid and technically streamlined model of hemoglobin switching utilizing Fisher 344 rats and high performance liquid chromatography with a weakly cationic column.

Serum metalloproteinases and their inhibitors: markers for malignant potential

Death from cancer results from the development of metastases or local progression of tumour. Metastasis and local progression may result from the inappropriate activity of metalloproteinases released by tumour cells or of their regulatory peptides. We have developed quantitative assays for interstitial collagenase, stromelysin 1 and tissue inhibitors of metalloproteinase (TIMP) 1 and 2, which have allowed the study of serum levels of these proteins. Sera from 40 patients with prostatic cancer, stored prior to and after 6 and 12 months' treatment with a gonadotrophin-releasing hormone agonist and an anti-androgen were analysed. Levels were compared with two control groups, comprising 21 patients with active rheumatoid arthritis and 56 age-matched hospital attenders without arthritis or cancer. Contrasting levels have been found in patients with prostatic cancer as compared with hospital controls without cancer and patients with rheumatoid arthritis. Patients with prostatic cancer had higher levels of TIMP-1 and collagenase (P = 0.0001) and lower levels of TIMP-2 (P = 0.003) than controls. Patients with metastatic cancer had significantly higher levels of collagenase than those without metastases (P = 0.02). Patients with rheumatoid arthritis had significantly higher levels of stromelysin than either controls (P = 0.002) or patients with cancer (P = 0.008). Serum tissue inhibitor of metalloproteinase 1 in combination with collagenase levels was as sensitive as prostate-specific antigen as a marker of metastatic disease. These findings provide a basis for the investigation of the role of metalloproteinases and their inhibitors in other malignancies.

Comparison of Ifosfamide versus cyclophosphamide in combination with Cisplatin and Doxorubicin (adriamycin), as first-line therapy for advanced epithelial ovarian-cancer - report of a pilot-study

Cisplatin induction therapy followed by combination chemotherapy employing cisplatin, doxorubicin, and ifosfamide was administered to 25 consecutive patients with FIGO stage III:or IV epithelial ovarian cancer as first-line therapy following cytoreductive surgery. A median of seven (3-10) courses of combination chemotherapy were administered. Myelotoxicity necessitated dose attenuation in 20 (80%) patients. Microscopic hematuria was observed in one (4%) patient. Serious central neurotoxicity occurred in two (8%) patients. A surgically documentable response to therapy was observed in 16 of 19 (84%) patients who underwent second-look laparotomy. Thirteen (68%) patients had a surgical complete response, three (12%) patients had a surgical partial response, and three (12%) patients demonstrated progression of disease. The estimated two-year survival for the study population was 81%. The results observed in the current study were compared to those reported for a population of 40 patients with advanced ovarian cancer treated with cisplatin, doxorubicin, and cyclophosphamide (PAC). Patients treated with PAI had significantly (p=0.04) fewer episodes of sepsis, a significantly (p=0.02) greater percentage of patients requiring dose reduction secondary to myelotoxicity, and a significantly (p=0.02) higher surgical complete response rate. The two-year survival for patients treated with PAI of 81% and that for patients treated with PAC of 68%, do not differ significantly (p=0.39). The two-year disease-free survival for patients treated with PAI of 34% and the two-year disease-free survival of 55% for patients treated with PAC do not differ significantly (p=0.99). The combination of cisplatin, doxorubicin, and ifosfamide is effective as first-line therapy in the treatment of advanced epithelial ovarian cancer, but a significant advantage over the less costly standard regimen which employs cisplatin, doxorubicin and cyclophosphamide is not demonstrable in the current study.

Bacteriophage lambda N-dependent transcription antitermination. Competition for an RNA site may regulate antitermination

Bacteriophage lambda controls the expression of its early genes in a temporal manner by a series of transcription termination and antitermination events. This antitermination requires the lambda N protein as well as host proteins called Nus, and cis-acting sites called nut. Following transcription of the nut site, N and Nus proteins bind to the nut RNA and modify the transcription complex to a termination-resistant form. The nut site is a composite of at least two components; one is the boxB hairpin structure which interacts with N. The other is boxA, a nine-nucleotide sequence upstream of boxB. To understand more about the formation of the antitermination complex, we have characterized the effect of point mutations in and deletions of boxA on antitermination. Point mutations in boxA were found to either enhance or reduce N-mediated antitermination. Several boxA deletions, on the other hand, had little effect on antitermination other than to eliminate the requirement for the NusB host protein. To explain these observations, we propose that at least two factors compete to interact with boxA, NusB and an inhibitor of the antitermination reaction. In addition, we propose that NusB is required to prevent the inhibitor from binding at boxA. The results with various nusB and boxA mutations can be explained by this model of competition between NusB and an inhibitor for boxA RNA.

Impact of motor vehicle injury in Taiwan using potential productive years of life lost

Motor vehicle injuries are a major harmful side effect of industrialization. We examine this relationship in a rapidly industrializing country, Taiwan, using Potential Productive Years of Life Lost (PPYLL) analysis, and suggest ways that the injury toll of industrialization might be mitigated. We also compare Taiwan to the US, Hungary, Korea, and Chile. Taiwan has a higher PPYLL per 100,000 population due to motor vehicle injury (530/100,000) than cardiac disease, cancer, or strokes. Twenty-five years ago, more PPYLL was due to cancer, strokes, cardiac disease, and tuberculosis than to motor vehicle injuries (106/100,000). Taiwan's PPYLL rate is much greater than three other industrializing countries--Chile, Korea, and Hungary--and twice that of the US. Explanations for the dramatic rise in motor vehicle injury deaths in Taiwan may be high use of motorcycles, lack of motorcycle helmets, increase in alcohol use, high care density, and road and vehicle safety design problems.

A comparison of the incidence of nausea after laparoscopic cholecystectomy and diagnostic laparoscopy

Thirty-four patients undergoing gynecologic diagnostic laparoscopy and 30 patients undergoing laparoscopic cholecystectomies were followed prospectively for nausea and vomiting 24 hours postoperatively. Diagnostic laparoscopy patients had a significantly higher incidence of nausea and vomiting than laparoscopic cholecystectomy patients with similar anesthetic techniques, duration of surgery, and population parameters. All patients had their stomach contents suctioned after induction. While both procedures involve bowel manipulation, patient position and organ manipulation differ: diagnostic laparoscopy involves the Trendelenburg position and laparoscopic cholecystectomy involves the reverse Trendelenburg; diagnostic laparoscopy involves the uterus, ovaries, and fallopian tubes while laparoscopic cholecystectomy involves mainly the gall-bladder and its appendages. These factors may contribute to the differences found in this study.

Intercomparison of dosimetry measurements at the alternating gradient synchrotron from 1986-1988

The responses of several types of high-energy personnel neutron dosimeters were studied in the operational radiation fields at the Alternating Gradient Synchrotron. Included in the study are intercomparisons of polycarbonate, type A neutron track emulsion, allyl diglycol carbonate, electrochemical etch allyl diglycol carbonate, TLD-600, and TLD-700. Some of the passive measurements were compared with active tissue-equivalent instruments. The trend for many but not all of the measurements was for type A neutron track emulsion to report the highest neutron dose equivalent. The polycarbonate returned intermediate values while allyl diglycol carbonate usually reported the smallest values. Quality assurance data from calibration sources through 1990 are also provided.

The effects of smoking on postoperative recovery

Two recent studies have implicated smoking as a principal risk factor for increasing the time patients spend in the postanesthesia care unit (PACU) following a wide range of surgical procedures. Hospitals are performing an increasing number of surgical procedures, with growing pressure to do more on an outpatient basis. With more internal and external pressures to streamline the rising costs of medical care, increased focus is being placed on the length of stay in the PACU. More than 300 patients were examined in each study. PACU time varied from 15 minutes to 5 hours, with a median of 75 minutes. Anesthesia duration correlated most closely with the length of stay in the PACU. All other variables were found to be unrelated to the length of time in the PACU or secondary to anesthesia time. The only independent factor was a history of smoking. While there were comparable ratios of smokers in all tested groups, there was a marked difference between smokers and nonsmokers in length of PACU stay. Of the nonsmokers, 38% were found to have PACU stays of less than 1 hour, compared with 23% of the smokers. Only 7% of the nonsmokers required longer PACU stays, compared with 19% of the smokers. Among the various smoking groups, however, there were no significant differences. While previous studies have suggested that smokers may have higher rates of various perioperative complications, these two studies are significant in that they have identified a population previously overlooked. These people who stay longer in the PACU would not otherwise be identified as having complications, and their eventual outcome was good. But it suggests that even these patients, who may view themselves as "healthy smokers," are significantly different from their nonsmoking counterparts. Further, varying the degree of smoking from heavy to light does not negate the increased PACU time. Therefore, any degree of smoking must now be viewed as having serious consequences in the immediate postoperative period and must be discouraged.

Locating essential Escherichia coli genes by using mini-Tn10 transposons: the pdxJ operon

The mini-Tn10 transposon (delta 16 delta 17Tn10) confers tetracycline resistance. When inserted between a gene and its promoter, it blocks transcription and prevents expression of that gene. Tetracycline in the medium induces divergent transcription of the tetA and tetR genes within the transposon, and this transcription extends beyond the transposon in both directions into the bacterial genes. If the mini-Tn10 inserts between an essential bacterial gene and its promoter, the insertion mutation can cause conditional growth which is dependent on the presence of tetracycline. Two essential genes in adjacent operons of Escherichia coli have been detected by screening for tetracycline dependence among tetracycline-resistant insertion mutants. These essential genes are the era gene in the rnc operon and the dpj gene in the adjacent pdxJ operon. The pdxJ operon has not been described previously. It consists of two genes, pdxJ and dpj. Whereas the dpj gene is essential for E. coli growth in all media tested, pdxJ is not essential. The pdxJ gene encodes a protein required in the biosynthesis of pyridoxine (vitamin B6).

Effects of oral phosphocysteamine and rectal cysteamine in cystinosis

Diurnal variation in leucocyte cystine and the effects of equimolar single doses of oral phosphocysteamine and rectal cysteamine were studied in eight patients with cystinosis, aged 1.8-16.5 years. No significant diurnal variation in leucocyte cystine was found. Absorption of cysteamine was reduced after rectal administration compared with the oral dose: mean (SD) peak concentration 17.2 (6.3) mumol/l v 36.4 (5.5) mumol/l at 40 min and mean (SD) area under the curve 22.3 (14.3) v 59.4 (33.1) mumol/h/l. Oral phosphocysteamine significantly reduced the mean (SD) leucocyte cystine from 8.09 (0.47) to 3.26 (1.48) nmol 1/2 cystine/mg protein at three hours. At 12 hours the mean leucocyte cystine was significantly lower than the pretreatment concentration. Rectal cysteamine did not significantly reduce the mean leucocyte cystine concentration. In conclusion, phosphocysteamine suspension may be administered every 12 hours. Rectal cysteamine administration is feasible but higher doses are required before efficacy can be judged.

Smoking prevention: towards a process approach

Current studies of smoking prevention treat the adolescent as a target of influence, they emphasize the acquisition of skills for resisting peer pressure and give too little attention to motivation for resistance. Studies consistent with this social learning framework show moderate reductions in the incidence of smoking for the short term; recent, long-term follow-ups show no reduction in experimental over control conditions. We propose a re-examination of the influence framework and suggest that adolescents use smoking and dress, to project an image of self that will increase the likelihood of success in the formation of relationships in which participants share feelings and attitudes toward each other and the adult world. We also suggest that adults focus upon external, perceptible, and remote threats, e.g. smoking is seen as evil, a response to peer pressure, and a long term threat to health, and ignore discourse about proximal, subjective feelings respecting the changing sexual urges and feelings of social anxiety that accompany adolescence. The socialization of these affects is left to the peer group. It is suggested that future programs intensify their focus on motivation for resisting smoking based upon a revised view of the adolescents objectives in self definition, and combine this with the best of the current skills approaches.

Postpartum cardiovascular complications after bromocriptine and cocaine use

A case is presented of a postpartum woman in whom hypertension and pulmonary edema developed after administration of bromocriptine mesylate. Caution is advised when there is additional recent use of cocaine because of a suggested potentiating action of cocaine on the development of adverse cardiovascular and cerebral sequelae in postpartum patients who take bromocriptine.