Non Hepatitis viruses in causation of acute sporadic non-A, non-B viral hepatitis

Viruses other than Hepatitis viruses i.e. Cytomegalovirus, Epstein-Barr Rubella etc., can cause a clinical picture resembling that of viral hepatitis. Consequently, these viruses can falsely contribute to the diagnosis of Non-A, Non-B hepatitis amongst of sporadic jaundice. This study attempts to find out the possibility of occurrence of such an event.

Diabetes Management During Glucocorticoid Therapy for Nonendocrine Disease

OBJECTIVE

To determine current attitudes about management of diabetes during glucocorticoid therapy for nonendocrine disease, as assessed by a pilot survey.

METHODS

A 27-item questionnaire was designed to determine areas of consensus and of disagreement on diabetes management during glucocorticoid therapy for nonendocrine disease and was mailed to 84 Chicago-area academic general internists, endocrinologists, pulmonologists or allergists, rheumatologists, and certified diabetes nurse-educators.

RESULTS

The response rate was 55%. For new-onset "steroid diabetes," 43% of respondents agreed with use of insulin and 44% with use of sulfonylurea therapy. Respondents indicated 91 to 95% agreement on the desirability of self-monitoring of blood glucose on initiation of glucocorticoid therapy. For a fasting plasma venous glucose level of 150 mg/dL at the time of initiation of long-term glucocorticoid therapy, 54% of respondents disagreed with immediate increase of insulin in the case of a patient already taking insulin, and 80% disagreed with immediate substitution of insulin in the case of a patient on maximal glyburide therapy (P = 0.0053 for mean change of position). During tapering of glucocorticoid therapy, 75% of respondents approved close observation without immediate insulin reduction. Two anticipatory management plans, opposed by 54% and 45% of respondents, respectively, elicited strongly correlated attitudes: immediate increase of NPH insulin dosage during initiation of glucocorticoid therapy and immediate reduction of NPH insulin dose during tapering of glucocorticoids (r = 0.6296; P<0.0001). Finally, 78% perceived a paucity of objective information about diabetes management during glucocorticoid therapy for nonendocrine disease.

CONCLUSION

The surveyed sample of practitioners reported a paucity of objective data about management of diabetes during glucocorticoid therapy for nonendocrine disease and conservatism in adjusting diabetes management during initiation and tapering of glucocorticoid therapy.

The Cbp2 protein suppresses splice site mutations in a group I intron

The Cbp2 protein facilitates the folding of a group I intron in the COB pre-mRNA of yeast mitochondria. Based on its ability to suppress mutations affecting the auto-catalytic reaction, the protein appears to play a role in the selection of splice sites. Adding Cbp2 did not overcome the effects of mutations in P1 whose primary effect was on the first step of splicing. In contrast, most mutations affecting the ligation of exons were suppressed in vitro by Cbp2. These included mutations in P1, P9.0 and P10. In fact, a mutant transcript lacking both P9.0 and P10 ligated efficiently in the presence of Cbp2. P9.0 and P10 mutations also reduced the rate of cleavage at the 5' splice junction, and this effect was only partially mitigated by adding Cbp2. A competitive secondary structure near the 3' splice junction blocked Cbp2-stimulated splicing, but this mutation could be suppressed by co-transcriptional splicing in the presence of Cbp2. Our data underscore the importance of the interaction between the 5' and 3' splice junctions in group I introns and suggest that nucleotide-nucleotide interactions that stabilize the structure of group I introns can be superceded by protein-RNA interactions.

Mapping of a gene for type 2 diabetes associated with an insulin secretion defect by a genome scan in Finnish families

Non-insulin dependent diabetes mellitus (NIDDM) affects more than 100 million people worldwide and is associated with severe metabolic defects, including peripheral insulin resistance, elevated hepatic glucose production, and inappropriate insulin secretion. Family studies point to a major genetic component, but specific susceptibility genes have not yet been identified-except for rare early-onset forms with monogenic or mitochondrial inheritance. We have screened over 4,000 individuals from a population isolate in western Finland, identified 26 families (comprising 217 individuals) enriched for NIDDM and performed a genome-wide scan using non-parametric linkage analysis. We found no significant evidence for linkage when the families were analysed together, but strong evidence for linkage when families were classified according to mean insulin levels in affecteds (in oral glucose tolerance tests). Specifically, families with the lowest insulin levels showed linkage (P = 2 x 10(-6)) to chromosome 12 near D12S1349. Interestingly, this region contains the gene causing the rare, dominant, early-onset form of diabetes MODY3. Unlike MODY3 families, the Finnish families with low insulin have an age-of-onset typical for NIDDM (mean = 58 years). We infer the existence of a gene NIDDM2 causing NIDDM associated with low insulin secretion, and suggest that NIDDM2 and MODY3 may represent different alleles of the same gene.

Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects

To validate the use of pulsed Doppler tissue imaging that measures myocardial wall velocities and to define the characteristics of these velocities in normal subjects, we obtained and compared the anteroseptal and posterior wall velocities in 24 volunteers with pulsed Doppler tissue imaging and digitized M-mode echocardiography. We also studied the relation between velocity components and hemodynamic events timed by standard Doppler flows. There was an excellent correlation between Doppler and M-mode-derived velocities (r = 0.95, p < 0.001), with higher reproducibility for Doppler (r = 0.99) than for M-mode (r = 0.95, p < 0.001). Biphasic velocities that were uniformly present during isovolumic contraction and relaxation were attributed to geometric changes due to asynchronous contraction and ventricular interdependence. We conclude that wall velocities obtained by pulsed Doppler tissue imaging are accurate and reproducible. This method may prove useful for studying the contractile and elastic properties of the myocardium.

Failure to induce resistance to cytotoxic drugs in normal lymphocytes

Lymphocytes from patients who had received chemotherapy for lung cancer were examined for evidence of drug resistance using an in vitro assay for sensitivity to the effects of chlorambucil and etoposide. There was no evidence of induced resistance to the effects of chlorambucil or etoposide in the patients' lymphocytes when compared to the sensitivity of the normal control subjects' lymphocytes. In four patients, in whose lymphocytes sensitivity to chlorambucil was measured before and after a course of treatment, there was no significant change in the in vitro drug sensitivity. These findings are in contrast to those made previously using the lymphocytes of patients with chronic lymphocytic leukaemia and indicate that acquired drug resistance is a property of malignant cells and is not inducible in normal lymphocytes.

Characterization of left atrial appendage Doppler flow in atrial fibrillation and flutter by Fourier analysis

The aim of this study was to characterize left atrial appendage mechanical function in atrial fibrillation and flutter by Fourier analysis to analyze frequency and regularity of flow. Left atrial appendage function is central to a patient's risk for thromboembolism. Although the function of the appendage can be analyzed by Doppler echocardiography in sinus rhythm, its mechanical function in atrial fibrillation and flutter has not been well characterized. This lack of adequate definition is caused by the complexity and temporal variability of the Doppler flow profiles. We assessed left atrial appendage function in 21 cases of atrial fibrillation (n - 11) and flutter (n = 10) and five in sinus rhythm with transesophageal Doppler echocardiography. Doppler profiles were examined by Fourier analysis, and the power spectra compared and analyzed between patients with atrial fibrillation and flutter. Left atrial appendage Doppler flow in atrial fibrillation produced Fourier spectra over a narrow band of frequencies with a peak frequency of 6.2 +/- 1.0 Hz, significantly higher than in atrial flutter (3.9 +/- 0.6 Hz, p < 0.00001). Additionally, a significant difference in subharmonic modulation (spectral power below the peak frequency) was observed between atrial appendage flow in atrial fibrillation and flutter, because 37% +/- 16% of the total spectral power was achieved before the dominant frequency in atrial fibrillation compared with 20% +/- 14% in atrial flutter (p = 0.02). Conversely, patients in sinus rhythm exhibited broad-banded Fourier spectra with most of the power in discrete frequency spikes at harmonics above the fundamental frequency with very little subharmonic modulation (1% +/- 0.05%). Left atrial appendage function in atrial fibrillation and flutter can be well characterized by Fourier analysis of Doppler flow. Atrial fibrillation has higher dominant frequencies and greater subharmonic modulation compared with flutter. Moreover, atrial fibrillation demonstrated quasiperiodic contraction patterns typically found in chaotic systems. Fourier analysis of left atrial appendage contraction patterns may therefore have significant promise in providing insights into mechanisms of atrial fibrillation and thromboembolism.

Gender and referral for coronary angiography after treadmill thallium testing

Considerable controversy exists regarding whether women are less likely than men to be referred to coronary angiography after an abnormal noninvasive test. This prospective cohort study analyzed consecutive subjects (2,351 men and 1,318 women) with no prior history of invasive cardiac procedures who were referred for treadmill thallium testing at the Cleveland Clinic Foundation. The primary end point was performance of coronary angiography within 90 days of treadmill thallium testing. A secondary end point was all-cause mortality during 1.8 years of follow-up. Women were less likely than men to undergo coronary angiography (6% vs 14%, odds ratio [OR] 0.42, 95% confidence interval [Cl] 0.33 to 0.54, p < 0.001), but were also less likely to have an abnormal thallium scan (8% vs 29%, p < 0.001). In logistic regression analyses with adjustment for thallium result and age, women were as likely as men to be referred for coronary angiography (adjusted OR 1.00, 95% Cl 0.75 to 1.34, p > 0.9). Women were less likely to have severe coronary disease on angiography (15% vs 30%, p = 0.006). During 1.8 years of follow-up there were 26 deaths (2%) among women and 84 deaths (4%) among men. After adjusting for age, thallium abnormalities, and clinical characteristics in Cox regression analyses, women had a lower mortality rate than men (relative risk 0.58, 95% Cl 0.36 to 0.94, p = 0.03). Thus, gender-related differences in referral for coronary angiography after treadmill thallium testing can be explained by a higher rate of abnormal tests in men. No evidence of a post-test gender bias was detected, but a pretest bias affecting referral to nuclear testing cannot be excluded. Furthermore, women have a lower prevalence of severe coronary disease and a lower adjusted mortality rate.

Behavioral deficits induced by bingelike exposure to alcohol in neonatal rats: importance of developmental timing and number of episodes

The importance of the timing and number of episodes of bingelike alcohol exposure in neonatal rats on subsequent behavioral outcomes was evaluated with a parallel bar task and a spatial conditional alternation task. Different groups of Sprague-Dawley rat pups were exposed to alcohol delivered via artificial rearing procedures either on postnatal Days (PD) 4 and 5, on PD 8 and 9, or on both PD 4/5 and 8/9 (Combined), producing daily peak blood alcohol concentrations around 400 mg/dl. Controls included an artificially reared group and a normally reared group. Exposure during PD 4/5 produced significantly more severe motor deficits and significantly more severe reductions in cerebellar and brainstem weights than did exposure on PD 8/9. Combined exposure produced greater deficits on these measures than either of the limited exposures. Significant deficits in the acquisition rates for conditional alternation were found only with the Combined exposure, although both the PD 8/9 and Combined groups committed significantly more within-trial errors. All three alcohol treatments produced significant and comparable reductions in forebrain weight. The type and severity of behavioral and neural deficits induced by neonatal bingelike alcohol exposure depend on the timing and number of exposures.

Integrated backscatter for quantification of left atrial spontaneous echo contrast

OBJECTIVES

This study was designed to develop a quantitative method of spontaneous echo contrast (SEC) assessment using integrated backscatter and to compare integrated backscatter SEC measurement with independent qualitative grades of SEC and clinical and echocardiographic predictors of thromboembolism.

BACKGROUND

Left atrial SEC refers to dynamic swirling smokelike echoes that are associated with low flow states and embolic events and have been graded qualitatively as mild or severe.

METHODS

We performed transesophageal echocardiography in 43 patients and acquired digital integrated backscatter image sequences of the interatrial septum to internally calibrate the left ventricular cavity and left atrial cavity under different gain settings. Patients were independently assessed as having no, mild or severe SEC. We compared intensity of integrated backscatter in the left atrial cavity relative to that in the left ventricular as well as to the independently assessed qualitative grades of SEC. Fourier analysis characterized the temporal variability of SEC. The integrated backscatter was compared with clinical and echocardiographic predictors of thromboembolism.

RESULTS

The left atrial cavity integrated backscatter intensity of the mild SEC subgroup was 4.7 dB higher than that from the left ventricular cavity, and the left atrial intensity of the severe SEC subgroup was 12.5 dB higher than that from the left ventricular cavity. The left atrial cavity integrated backscatter intensity correlated well with the qualitative grade. Fourier transforms of SEC integrated backscatter sequences revealed a characteristic dominant low frequency/high amplitude spectrum, distinctive from no SEC. There was a close relationship between integrated backscatter values and atrial fibrillation, left atrial size, left atrial appendage flow velocities and thrombus.

CONCLUSIONS

Integrated backscatter provides an objective quantitative measure of SEC that correlates well with qualitative grade and is closely associated with clinical and echocardiographic predictors of thromboembolism. The relationship between integrated backscatter measures and cardioembolic risk will be defined in future multicenter studies.

Rapid microscopic detection of cytomegalovirus and PCP in bronchoalveolar lavage specimens

This article describes how bronchoalveolar lavage specimens can be screened rapidly and inexpensively for Pneumocystis carinii and cytomegalovirus infections with materials available in any hospital laboratory.

Climate Change During the Last Deglaciation in Antarctica

Greenland ice core records provide clear evidence of rapid changes in climate in a variety of climate indicators. In this work, rapid climate change events in the Northern and Southern hemispheres are compared on the basis of an examination of changes in atmospheric circulation developed from two ice cores. High-resolution glaciochemical series, covering the period 10,000 to 16,000 years ago, from a central Greenland ice core and a new site in east Antarctica display similar variability. These findings suggest that rapid climate change events occur more frequently in Antarctica than previously demonstrated.

The effect of anoxia on cardiomyocyte glucose transport does not involve an adenosine release or a change in energy state

The action of anoxia on glucose transport was investigated in isolated resting rat cardiomyocytes. Incubation of these cells in the absence of oxygen for 30 min resulted in a 4- to 5-fold increase in glucose transport (with a lag period of 5-10 min). Up to 40 min of anoxia failed to alter the cellular concentrations of ATP, phosphocreatine, and creatine. Adenosine deaminase (1.5 U/ml), the A1-adenosine receptor antagonist 1,3-diethyl-8-phenylxanthine (1 microM), or the A2-selective antagonist 3,7-dimethyl-1-propargylxanthine (20 microM) had no effect on anoxia-dependent glucose transport. Moreover, adenosine (10-300 microM, added under normoxia) did not stimulate glucose transport. Wortmannin (1 microM) did not influence the effect of anoxia, but completely suppressed that of insulin. On the other hand, the effects of anoxia and insulin were not additive. These results indicate (i) that the effect of anoxia on cardiomyocyte glucose transport is not mediated by a change in energy metabolism, nor by an adenosine release; (ii) that it probably does not involve a phosphatidylinositol 3-kinase, in contrast to the effect of insulin, and (iii) that the signal chains triggered by anoxia or insulin may converge downstream of this enzyme, or, alternatively, that anoxic conditions may impair the action of the hormone.

Community nurses and health promotion: ethical and political perspectives

This paper brings together ideas from two perspectives on ethics and health promotion. A discussion of the ethical dimension of the health promotion practice of community nurses is set in the wider context of health policy, with particular reference to health gain and individual responsibility. It is widely held that nurses have a key role to play in health promotion and that this is particularly the case for nurses working in primary health care. This assumption is reinforced by policy documents from the World Health Organization, the Department of Health and statutory bodies such as the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The approach of many nurses to health promotion has tended on the one hand to be somewhat naive and on the other to be authoritarian and didactic; there has been little discussion in the nursing literature of the ethical aspects of health promotion. However, recent developments in nurse education, such as Project 2000 and the consequent changes to preregistration programmes, have resulted in increased attention to both ethics and health promotion within the curriculum.

A practical guide to assessment of ventricular diastolic function using Doppler echocardiography

Doppler assessment of diastolic function has become a standard part of routine echocardiographic examination and imparts information relevant to a patient's functional class, management and prognosis. This review describes the Doppler patterns of diastolic function relative to physical signs and physiology. A continuum of doppler patterns of diastolic function exists, including normal diastolic function, impaired relaxation, pseudonormal filling, restriction, constriction and tamponade. These patterns evolve from one to another in a single individual, with changes in disease evolution, treatment and loading conditions. New applications of continuous wave Doppler, color Doppler M-mode and Doppler tissue imaging are refining our understanding of diastolic function.

Clinical analysis of 670 cases in two trials of the European Organization for the Research and Treatment of Cancer Lymphoma Cooperative Group subtyped according to the Revised European-American Classification of Lymphoid Neoplasms: a comparison with the Working Formulation

In the Working Formulation (WF), non-Hodgkin's lymphomas (NHL) are grouped according to their clinical behavior. These disorders are listed as entities defined by morphology, phenotype, and cytogenetics in the proposed Revised European-American Classification of Lymphoid Neoplasms (REAL), the clinical relevance of which is still debated. We analyzed 670 NHL cases included in two randomized clinical trials (EORTC 20855 WF-intermediate/high-grade and 20856 WF-low-grade malignancy) with histologic material available for review. Based on hematoxylin-eosin-stained sections, 77% of cases could be subtyped. Immunophenotyping was considered to be mandatory only in diagnosing T-cell lymphoma and anaplastic large-cell lymphoma. Of 522 cases subtyped, 11% were mantle cell lymphoma (MCL), 5% were marginal zone B-cell lymphoma (MZBCL), 46% were follicle center lymphoma, and 32% were diffuse large B-cell lymphoma. Statistical analysis and comparisons between classifications were made only within each trial and treatment group. MCL and MZBCL were characterized by a shorter median survival (3.4 and 4.1 years, respectively) in comparison with low- and intermediate-grade WF groups (> 9.3 and 5.8 years, respectively). In terms of progression-free survival, MCL showed a behavior similar to the low-grade group, with frequent relapses. Follicle center cell lymphomas behaved as low-grade lymphomas as defined by the WF and diffuse large B-cell lymphomas as the WF-intermediate grade group. Because several NHL entities have a clinical behavior of their own, their recognition by the REAL classification offers clinicians additional information that is not obtained when the WF is used.

Factors Influencing Pyrethroid Resistance in a Permethrin-Selected Strain of the Soybean Looper, Pseudoplusia includens (Walker)

Cytochrome P450 monooxgenase activity toward p-nitroanisole was measured in larvae of three strains of soybean looper, Pseudoplusia includens (Walker), including a laboratory susceptible (S) strain, a resistant (R) strain selected for several generations with permethrin, and a nonselected (NS) strain from the same field collections as the R strain. Activity was significantly higher in R strain larvae than in the S and NS strains (1.8- and 1.4-fold, respectively), and there was no significant difference between activity in the S and NS strains. Resistance to the alpha-cyano pyrethroids deltamethrin and cypermethrin was similar to or higher than that observed with permethrin (RR = 70.0, 62.4, 145.3 and 12.1, 32.3, and 27.0 for permethrin, deltamethrin, and cypermethrin in R and NS strains, respectively). The R strain was less resistant (RR = 4.3) to tefluthrin, a pyrethroid with a fluorinated-phenyl alcohol moiety, and a nonester (ether) pyrethroid, BRC 429 (RR = 17.7). Piperonyl butoxide (PB) significantly increased the toxicity of each insecticide tested in the R and NS strains. In addition, penetration of 14C-cypermethrin was decreased significantly at 24 hr after treatment when R strain larvae were pretreated with PB, with 21.1% of the applied dose unpenetrated in PB-treated larvae and 7.6% unpenetrated in larvae not treated with PB.

Blunt traumatic rupture of a mitral papillary muscle head

Severe mitral regurgitation developed in a patient after a lateral-impact motor vehicle accident. The papillary muscle head was disrupted without evidence of other myocardial injury. We hypothesize that a dramatic and sudden increase in intrathoracic pressure may have produced the injury. The patient experienced progressive heart failure and underwent successful mitral valve repair 9 days after the accident.