Different ventilation strategies affect lung function but do not increase tumor necrosis factor-alpha and prostacyclin production in lavaged rat lungs in vivo

BACKGROUND

Using an in vivo animal model of surfactant deficiency, the authors compared the effect of different ventilation strategies on oxygenation and inflammatory mediator release from the lung parenchyma.

METHODS

In adult rats that were mechanically ventilated with 100% oxygen, acute lung injury was induced by repeated lung lavage to obtain an arterial oxygen partial pressure < 85 mmHg (peak pressure/positive end-expiratory pressure [PEEP] = 26/6 cm H2O). Animals were then randomly assigned to receive either exogenous surfactant therapy, partial liquid ventilation, ventilation with high PEEP (16 cm H2O), ventilation with low PEEP (8 cm H2O), or ventilation with an increase in peak inspiratory pressure (to 32 cm H2O; PEEP = 6 cm H2O). Two groups of healthy nonlavaged rats were ventilated at a peak pressure/PEEP of 32/6 and 32/0 cm H2O, respectively. Blood gases were measured. Prostacyclin (PGI2) and tumor necrosis factor-alpha (TNF-alpha) concentrations in serum and bronchoalveolar lavage fluid (BALF) as well as protein concentration in BALF were determined after 90 and 240 min and compared with mechanically ventilated and spontaneously breathing controls.

RESULTS

Surfactant, partial liquid ventilation, and high PEEP improved oxygenation and reduced BALF protein levels. Ventilation with high PEEP at high mean airway pressure levels increased BALF PGI2 levels, whereas there was no difference in BALF TNF-alpha levels between groups. Serum PGI2 and TNF-alpha levels did not increase as a result of mechanical ventilation when compared with those of spontaneously breathing controls.

CONCLUSIONS

Although alveolar protein concentration and oxygenation markedly differed with different ventilation strategies in this model of acute lung injury, there were no indications of ventilation-induced systemic PGI2 and TNF-alpha release, nor of pulmonary TNF-alpha release. Mechanical ventilation at high mean airway pressure levels increased PGI2 levels in the bronchoalveolar lavage-accessible space.

Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein

OBJECTIVE

To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.

DESIGN

Prospective, controlled study.

SETTING

Tertiary care university center.

PATIENTS

Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein.

INTERVENTIONS

Single-lumen, silicone elastomer or polyurethane catheters were inserted for a mean duration of 14.7+/-7.4 days (range, 4-33 days). On catheter removal, bilateral upper-extremity phlebographic examination was performed in each patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms.

MEASUREMENTS AND MAIN RESULTS

Of the 60 patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, but no patient had clinical sign of pulmonary embolism. There were 35 patients (58.3%) who developed positive phlebographic examinations homolateral to the catheter. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis: nonobstructive clots adherent to the vessel wall and/or the catheter. Two patients (3.3%) had phlebographic signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting < or =6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of > or =15 days (p < .01). In the seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10+/-2.5 min) was not different from that of patients with no axillary vein thrombosis (14+/-9 min).

CONCLUSIONS

Based on the data from the present study, we conclude that axillary vein catheterization is associated with a 11.6% frequency of upper-extremity deep vein thrombosis. This rate of vein thrombosis is similar to that observed after internal jugular or subclavian vein cannulation. Given the acceptable rate of this clinically important complication, axillary vein cannulation offers an attractive alternative site for catheter insertion to the internal jugular or subclavian vein in the critically ill. Because thrombosis is rare or absent in catheterizations lasting <15 days, it seems wise to withdraw axillary catheters after a maximum of 2 wks.

Specificity of starch synthase isoforms from potato

In higher plants several isoforms of starch synthase contribute to the extension of glucan chains in the synthesis of starch. Different isoforms are responsible for the synthesis of essentially linear amylose chains and branched, amylopectin chains. The activity of granule-bound starch synthase I from potato has been compared with that of starch synthase II from potato following expression of both isoforms in Escherichia coli. Significant differences in their activities are apparent which may be important in determining their specificities in vivo. These differences include affinities for ADPglucose and glucan substrates, activation by amylopectin, response to citrate, thermosensitivity and the processivity of glucan chain extension. To define regions of the isoforms determining these characteristic traits, chimeric proteins have been produced by expression in E. coli. These experiments reveal that the C-terminal region of granule-bound starch synthase I confers most of the specific properties of this isoform, except its processive elongation of glucan chains. This region of granule-bound starch synthase I is distinct from the C-terminal region of other starch synthases. The specific properties it confers may be important in defining the specificity of granule-bound starch synthase I in producing amylose in vivo.

Changing a hydrophobic heat and moisture exchanger after 48 hours rather than 24 hours: a clinical and microbiological evaluation

OBJECTIVE

Complications following ventilation with dry and cold gases may be prevented by the use of artificial noses or heat and moisture exchangers, which are a solution to both the problems of humidification and heat preservation. The aim of the present study was to determine whether changing hydrophobic heat and moisture exchangers (HMEs) every 48 h rather than 24 h would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed.

DESIGN

Prospective observational study.

SETTING

ICU of a university hospital.

PATIENTS

Twelve patients requiring controlled mechanical ventilation for more than 2 days were evaluated.

INTERVENTIONS

The patients were ventilated with a heat and moisture exchanger (HME) (Maxipleat Filter, Europe Medical, France). The hydrophobic HME was placed between the Y-piece and the connecting tube and changed after 48 h of continuous use. Temperature (degree C), relative humidity (%) and absolute humidity (mgH2O/l) were obtained using the capacitive sensor principle. Bacterial colonization (tracheal secretions and ventilator side of the HME) were obtained on days 1 and 2.

MEASUREMENTS AND RESULTS

After 48 h of ventilation with the same HME, tracheal tube occlusion was never observed. Using the same hydrophobic HME for 48 h rather than 24 h did not affect its technical performance: temperature at 24 h: 32.5 +/- 1.3 degrees C, at 48 h: 32.7 +/- 1.8 degrees C; relative humidity (RH) at 24 h: 99.0 +/- 1.4%, at 48 h: 99.0 +/- 1.4%; absolute humidity (AH) at 24 h: 34.0 +/- 2.4 mgH2O/l, at 48 h: 34.4 +/- 3.5 mgH2O/l. Peak and mean airway pressures did not change over the 48-h study period, with identical tidal and minute volumes in the study patients. Total respiratory heat losses were not modified during the 48-h study period (at 24 h: 152 +/- 47 cal/min, at 48 h: 149 +/- 65 cal/min). Evaporative and convective heat losses were not modified either. On day 1, eight patients had positive cultures of their tracheal secretions at a colony count of 10(3) or higher cfu/ml. After 48 h of use of the same HME, only six patients had a positive culture of their tracheal secretions. Cultures from the ventilator sides of the HMEs were all sterile (12/12) after 48 h of use.

CONCLUSIONS

Changing the hydrophobic HME after 48 h rather than 24 h did not affect its technical performance in terms of heat and water preservation of ventilatory gases. There is also some indirect evidence of very little, if any, change in HME resistance. No bacterial colonization of the ventilator sides of the HMEs was observed after 48 h of use. However, other large clinical trials should be undertaken to confirm the safety of extending the time between HME changes.

Multifunctionality and diversity within the plant MYB-gene family

MYB proteins constitute a diverse class of DNA-binding proteins of particular importance in transcriptional regulation in plants. Members are characterised by having a structurally conserved DNA-binding domain, the MYB domain. Different categories of MYB proteins can be identified depending on the number of imperfect repeats of the MYB domain they contain. It is likely that single MYB-domain proteins, a class of expanding importance in plants, bind DNA in a different way than two-repeat or three-repeat MYB proteins, and these groups are therefore likely to have different functions. The two-repeat (R2R3) MYB family is the largest family characterised in plants, and there are estimated to be over 100 members in Arabidopsis. Functions of MYB proteins in plants include regulation of secondary metabolism, control of cellular morphogenesis and regulation of meristem formation and the cell cycle. Although functional similarities exist between R2R3 MYB proteins that are closely related structurally, there are significant differences in the ways very similar proteins function in different species and also within the same organism. Therefore, despite the large number of R2R3 MYB proteins in plants, it is unlikely that many are precisely redundant in their functions, but more likely that they share overlapping functions.

Strength of discourse context as a determinant of the subordinate bias effect

Two experiments examined the influence of strength of discourse bias on lexical ambiguity resolution. Short passages were constructed to bias polarized ambiguous words (homonymous) strongly or weakly toward the dominant or subordinate meanings. Using a self-paced reading task in Experiment 1, it was demonstrated that in strongly biased discourse, reading times for homonyms in dominant discourse did not differ from those in subordinate discourse. However, when the discourse was weakly biased, homonyms were read faster in dominant discourse than in subordinate discourse. Experiment 2 combined the reading paradigm with a naming task in order to provide an assessment of specific word-meaning activation. Reading times on ambiguous words replicated the results of Experiment 1. In addition, naming latencies for probe words revealed that only the contextually appropriate sense of a homonym was activated in strongly biased discourse. In contrast, both contextually appropriate and inappropriate senses were activated following a weakly biased subordinate discourse, whereas only the dominant sense was activated following weakly biased dominant discourse. The results demonstrate (1) an immediate influence of prior discourse information on lexical processing; and (2) that the strength of discourse constraints can play a governing role in lexical ambiguity resolution. The results were interpreted within the framework of a context-sensitive model of lexical ambiguity resolution.

Passive expiratory flow-volume curve is not an accurate method to measure the respiratory time constant in rabbits

BACKGROUND

In mechanically ventilated patients, inspiration is forced by an externally applied positive pressure whereas expiration remains passive and depends on the time constant of the total respiratory system (tau), which constitutes an important determinant of mechanical ventilation. The end-inspiratory occlusion technique is one of the easiest methods to obtain tau values in ventilated patients, especially infants, but its accuracy is not well established. The aim of this study was to compare in anesthetized, paralyzed rabbits tau values given by the end-inspiratory occlusion technique (tau(rs)) to tau values obtained by references methods for measurements (i.e. the product of static lung compliance by airway resistance: tau(ref)) during carbachol-induced bronchospasm eliciting marked modifications of the respiratory mechanics.

METHODS

Comparisons were made in the basal state and after carbachol-induced bronchoconstriction in seven New Zealand adult rabbits. This procedure resulted in a wide range of expiratory time constants. A pneumotachograph was used to measure expiratory flow and volume before and after end-inspiratory occlusion. The slope of the flow volume curve gave tau(rs). Then tau(rs) was compared with tau(ref) (which ranged from 0.30 to 1.96 s).

RESULTS

Statistical analysis revealed a weak correlation between the two methods, and a size-dependent bias of tau(rs) measurements.

CONCLUSIONS

The end-inspiratory occlusion technique leads to a systemic bias in measurements of respiratory time constant, especially when the resistance of the respiratory system is elevated.

NOS2-derived nitric oxide regulates the size, quantity and quality of granuloma formation in Mycobacterium avium-infected mice without affecting bacterial loads

Granuloma formation in response to mycobacterial infections is associated with increased expression of inducible nitric oxide synthase (NOS2) within granuloma macrophages and increased levels of nitrate/nitrite in the sera of infected mice. Continuous treatment with 5 mm or 10 mm l-N6-(1-imino-ethyl)-lysine (L-NIL), a selective NOS2-inhibitor, in acidified drinking water for up to 7 weeks consistently reduced infection-induced nitrate/nitrite to background levels in mycobacteria-infected BALB/c mice. Oral treatment with 5 mm L-NIL initiated at the time of infection significantly exacerbated growth of Mycobacterium tuberculosis, but had no effect on Mycobacterium avium colony-forming unit development in the liver, spleen and lungs of intravenously infected mice. In order to examine the role of nitric oxide in mycobacteria-induced granulomatous inflammation in the absence of any effect on the bacterial load, M. avium-infected mice were treated with 5 mm L-NIL from day 1 through 38 and the development of granulomatous lesions in the liver was assessed by histology, immunohistology and reverse-transcription-polymerase chain reaction (RT-PCR). Computer- and video-assisted morphometry performed at 4 and 7 weeks post-infection showed that treatment with L-NIL led to markedly increased number, cellularity and size of granulomatous lesions in infected mice regardless of the virulence of the M. avium isolate used for infection. Immunohistology of the liver revealed that in mice treated with L-NIL, the numbers of CD3+ T cells, CD21/35+ B cells, CD11b+ macrophages and RB6-8C5+ granulocytes associated with granulomatous lesions was increased. RT-PCR of the liver showed that in L-NIL-treated mice infected with M. avium, mRNA levels of tumour necrosis factor, interleukin-12p40, interferon-gamma, interleukin-10 and interferon-gamma-inducible protein-10 (IP-10) were up-regulated, while mRNA levels of interleukin-4, monocyte chemotactic protein-1 (MCP-1) and MCP-5 were similar to those in untreated control infected mice. When M. avium-infected mice were treated with 5 mm L-NIL between the 5th and 12th weeks of infection, similar changes in granuloma number and size were found in the absence of any effect on the bacterial load. These findings demonstrate that nitric oxide regulates the number, size and cellular composition of M. avium-induced granulomas independently of antibacterial effects by modulating the cytokine profile within infected tissues.

Characterization of a periplasmic ATP-binding cassette iron import system of Brachyspira (Serpulina) hyodysenteriae

The nucleotide sequence of the pathogenic spirochete Brachyspira hyodysenteriae bit (for "Brachyspira iron transport") genomic region has been determined. The bit region is likely to encode an iron ATP-binding cassette transport system with some homology to those encountered in gram-negative bacteria. Six open reading frames oriented in the same direction and physically linked have been identified. This system possesses a protein containing ATP-binding motifs (BitD), two hydrophobic cytoplasmic membrane permeases (BitE and BitF), and at least three lipoproteins (BitA, BitB, and BitC) with homology to iron periplasmic binding proteins. These periplasmic binding proteins exhibit lipoprotein features. They are labeled by [(3)H]palmitate when tested in recombinant Escherichia coli, and their signal peptides are typical for substrates of the type II secretory peptidase. The FURTA system and Congo red assay indicate that BitB and BitC are involved in iron binding. The Bit system is detected only in B. hyodysenteriae and is absent from B. innocens and B. pilosicoli.

Primary association of a TNF gene polymorphism with susceptibility to multiple sclerosis

The associations of three promoter polymorphisms in the tumor necrosis factor (TNFA) gene have been studied in 238 patients and 324 control subjects. A significant correlation was found between MS susceptibility and the TNFA-376 polymorphism. This association was independent of the human leukocyte antigen (HLA) class II association and the combined inheritance of HLA-DRB1*1501 and the TNFA-376A allele more than additively increased susceptibility to MS.

Posttraumatic subgaleal hematoma: a case report and review of the literature

INTRODUCTION

A subgaleal hematoma or subaponeurotic hemorrhage occurs infrequently and is usually seen in pediatric patients, especially in the neonatal period. It may be associated with coagulation disorders.

CASE REPORT

We report on a previously healthy 19-month-old patient who presented with an extensive subgaleal hematoma and significant anemia secondary to a fall.

DISCUSSION

A literature review was conducted, and the etiology, diagnosis, and treatment of the subgaleal hematoma are discussed.

CONCLUSION

Conservative treatment, except in select severe cases, is recommended for this condition.

Function search in a large transcription factor gene family in Arabidopsis: assessing the potential of reverse genetics to identify insertional mutations in R2R3 MYB genes

More than 92 genes encoding MYB transcription factors of the R2R3 class have been described in Arabidopsis. The functions of a few members of this large gene family have been described, indicating important roles for R2R3 MYB transcription factors in the regulation of secondary metabolism, cell shape, and disease resistance, and in responses to growth regulators and stresses. For the majority of the genes in this family, however, little functional information is available. As the first step to characterizing these genes functionally, the sequences of >90 family members, and the map positions and expression profiles of >60 members, have been determined previously. An important second step in the functional analysis of the MYB family, through a process of reverse genetics that entails the isolation of insertion mutants, is described here. For this purpose, a variety of gene disruption resources has been used, including T-DNA-insertion populations and three distinct populations that harbor transposon insertions. We report the isolation of 47 insertions into 36 distinct MYB genes by screening a total of 73 genes. These defined insertion lines will provide the foundation for subsequent detailed functional analyses for the assignment of specific functions to individual members of the R2R3 MYB gene family.

Office ergonomics. Measurements for success

The successful implementation of an ergonomics program requires collecting data on worksite history repetitive motion injuries and assessing the corporate ergonomic needs. It is important to solicit management, department, and employee support. Program success depends on creating process, training program, skilled assessors, and an accountability method. A thorough understanding and application of neutral posture and the three seated chair positions is essential. Evaluation of the entire individual work-space is essential. Precise measurements of the individual, the office chair, and the work surfaces should be completed, and heights adjusted to meet individual needs. Functional, totally adjustable office chairs are a necessity. Vendor selection criteria and vendor contracts for chairs and office equipment assure consistent specifications and cost control.

What guides the selection of alternate foot placement during locomotion in humans

Our goal was to understand the bases for selection of alternate foot placement during locomotion when the normal landing area is undesirable. In this study, a light spot of different shapes and sizes simulated an undesirable landing area. Participants were required to avoid stepping on this spot under different time constraints. Alternate chosen foot placements were categorised into one of eight choices. Results showed that selection of alternate foot placement is systematic. There is a single dominant choice for each combination of light spot and normal landing spot. The dominant choice minimises the displacement of the foot from its normal landing spot (less than half a foot length). If several response choices satisfy this criterion, three selection strategies are used to guide foot placement: placing the foot in the plane of progression, choosing to take a longer step over a shorter step and selecting a medial rather than lateral foot placement. All these alternate foot-placement choices require minimal changes to the ongoing locomotor muscle activity, pose minimal threat to dynamic stability, allow for quick initiation of change in ongoing movement and ensure that the locomotor task runs without interruption. Thus, alternate foot-placement choices are dependent not only on visual input about the location, size and shape of the undesirable surface, but also on the relationship between the characteristics of the undesirable surface and the normal landing area.

Project DARE: no effects at 10-year follow-up

The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 individuals who in 6th grade had either received DARE or a standard drug-education curriculum, were reevaluated at age 20. Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Possible reasons why DARE remains so popular, despite the lack of documented efficacy, are offered.

Changes in the expression of myometrial ryanodine receptor mRNAs during human pregnancy

Uterine contraction is triggered by a rise in intracellular free Ca(2+) concentration ([Ca2+]i), and although ryanodine-sensitive Ca(2+) release channels (RyRs) play a key role in the regulation of [Ca(2+)](i) in skeletal and cardiac muscle, much less is known about their role in smooth muscle. In this study, we investigated the expression of RyR mRNAs (ryr1-3) during human pregnancy by examining myometrial samples (n=18) taken, with informed consent and ethical approval, from non-pregnant patients undergoing hysterectomy, and patients undergoing elective caesarean section (at term, prior to or following the onset of labour). Ca(2+) release channel expression was determined both qualitatively and quantitatively, using reverse transcription-polymerase chain reaction (RT-PCR) analysis, RNase protection assays, and in situ mRNA hybridisation. RT-PCR analysis demonstrated that all three ryr genes, as well as the gene encoding the type I inositol 1,4,5-trisphosphate receptor (InsP(3)RI), are expressed in human myometrium. Quantitation by RNase protection assays showed that ryr3 and InsP(3)RI mRNAs are the most abundant, while ryr2 mRNA is barely detectable. In situ mRNA hybridisation confirmed that ryr3 and InsP(3)RI mRNAs are both localised to myometrial smooth muscle cells. The expression of ryr2 and ryr3 mRNA is down-regulated at the end of pregnancy compared to non-pregnant myometrium, indicating that ryanodine-sensitive Ca(2+) release channels are differentially expressed. The relative conservation of ryr1 expression is consistent with a role for Ca(2+) release from ryanodine-sensitive stores in the mechanism of uterine contractility during labour.

[When and how to research anxiety disorders in children?]

From the epidemiological evidence, anxiety disorders appear frequent in childhood and adolescence. Because anxiety has normal adaptative forms through development, the identification of pathology may sometimes pose difficulty. Child and adolescent anxiety disorders are defined in modern classifications with diagnostic criteria nearby of those used for adulthood. Behavioural symptoms of anxiety often alert relatives or teachers of the children. This paper reviews the main behavioural signs found in anxiety disorders (shyness, school refusal, sleep disorders, somatic distress, slowness, domestic tyranny).

Interaction with amylopectin influences the ability of granule-bound starch synthase I to elongate malto-oligosaccharides

This paper examines the properties in soluble form of two isoforms of starch synthase. One of these, granule-bound starch synthase I (GBSSI), is responsible for the synthesis of amylose inside the amylopectin matrix of the starch granule in vivo. The other, starch synthase II (SSII), is involved in amylopectin synthesis. Both isoforms can use amylopectin and malto-oligosaccharide as substrates in vitro. As well as acting as a substrate for GBSSI, amylopectin acts as an effector of this isoform, increasing the rate at which it elongates malto-oligosaccharides and promoting a processive rather than distributive mode of elongation of these compounds. The affinity of GBSSI for amylopectin as an effector is greater than its affinity for amylopectin as a substrate. The rate and mode of elongation of malto-oligosaccharides by SSII are not influenced by amylopectin. These results suggest that specific interaction with amylopectin in the matrix of the starch granule is a unique property of GBSSI and is critical in determining the nature of its products.

Effects of norepinephrine plus dobutamine or norepinephrine alone on left ventricular performance of septic shock patients

OBJECTIVE

To determine the hemodynamic effects of the combination of norepinephrine-dobutamine in adult patients with septic shock. Specifically, we tested the hypothesis that norepinephrine in addition to dobutamine would improve cardiac index (CI) and stroke volume index (SVI) and increase left-ventricular afterload.

DESIGN

Prospective, descriptive, interventional study with no control group.

SETTING

Intensive care unit of a university hospital.

PATIENTS

Fourteen patients (group 1) were transferred to the intensive care unit from other wards with septic shock not responsive to dobutamine infusion, low blood pressure (systolic blood pressure of <90 mm Hg), clinical and laboratory signs of infection, clinical signs of poor organ perfusion, and blood lactate of >2.0 mmol/L. They were enrolled and treated by the addition of norepinephrine, while the dose of dobutamine remained constant. Three of these patients required additional fluid loading to achieve adequate ventricular filling (pulmonary capillary wedge pressure [PCWP], 12-15 mm Hg). These patients were compared with 12 patients with septic shock with high CI (CI > 5/min/m2, and other signs as outlined previously) who were treated with norepinephrine alone (group 2).

INTERVENTIONS

Patients in group 1 were maintained with the same dobutamine dose, and norepinephrine was added (initial dose, 0.5 microg/kg/min, and increments of 0.3 microg/kg/min) until the correction of mean arterial blood pressure (MAP > or =75 mm Hg). Patients in group 2 received norepinephrine following the same protocol.

MEASUREMENTS AND MAIN RESULTS

At study entry, group 1 patients receiving dobutamine had similar MAPs but were significantly older and had significantly lower CIs and SVIs and higher systemic vascular resistance than group 2 patients. In group 1 norepinephrine, in addition to dobutamine, significantly increased MAP, CI, SVI, left ventricular stroke work index (LVSWI), and systemic vascular resistance (SVR). No change in heart rate or PCWP was observed. In group 2, norepinephrine used alone did not modify CI or SVI and it significantly improved MAP, LVSWI, and SVR. No changes in heart rate or PCWP were observed. Blood lactate was significantly decreased in both groups. Comparing the two groups, in response to norepinephrine titrated to increase MAP to a similar concentration, patients with dobutamine-resistant septic shock had a statistically significantly greater increase in CI and SVI than patients treated with norepinephrine alone. There were no other significant differences in hemodynamic and metabolic responses to norepinephrine between groups 1 and 2.

CONCLUSION

The addition of norepinephrine to treatment of patients with septic shock unresponsive to dobutamine significantly improves MAP, CI, SVI, and LVSWI. A different pattern of evolution was observed if norepinephrine was used alone in younger patients with higher CI at study entry, increases in MAP and LVSWI, and no concomitant change in CI or SVI. The use of norepinephrine in dobutamine-resistant septic shock may have some beneficial implications for the treatment of patients with inadequate myocardial performance associated with low SVR.

Early-onset autosomal dominant Alzheimer disease: prevalence, genetic heterogeneity, and mutation spectrum

To determine the prevalence of early-onset Alzheimer disease (EOAD) and of autosomal dominant forms of EOAD (ADEOAD), we performed a population-based study in the city of Rouen (426,710 residents). EOAD was defined as onset of disease at age <61 years, and ADEOAD was defined as the occurrence of at least three EOAD cases in three generations. Using these stringent criteria, we calculated that the EOAD and ADEOAD prevalences per 100,000 persons at risk were 41.2 and 5.3, respectively. We then performed a mutational analysis of the genes for amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2) in 34 families with ADEOAD ascertained in France. In 19 (56%) of these families, we identified 16 distinct PSEN1 missense mutations, including 4 (Thr147Ile, Trp165Cys, Leu173Trp, and Ser390Ile) not reported elsewhere. APP mutations, including a novel mutation located at codon 715, were identified in 5 (15%) of the families. In the 10 remaining ADEOAD families and in 9 additional autosomal dominant Alzheimer disease families that did not fulfill the strict criteria for ADEOAD, no PSEN1, PSEN2, or APP mutation was identified. These results show that (1) PSEN1 and APP mutations account for 71% of ADEOAD families and (2) nonpenetrance at age <61 years is probably infrequent for PSEN1 or APP mutations.

Utilization of alcohol, drug, and mental health treatment services among American Indian adolescent detainees

OBJECTIVE

To describe the relationship between psychiatric status and the use of alcohol, drug, and mental health (ADM) services among a sample of American Indian (AI) juvenile detainees.

METHOD

A structured diagnostic and service use interview was administered to 150 AI youths detained in a juvenile detention center located on a Northern Plains reservation.

RESULTS

Forty percent of AI youths with a diagnosed substance use disorder and 34.1% with a diagnosed anxiety, mood, or disruptive behavior disorder reported lifetime use of services for substance use and emotional problems, respectively. While services for substance use problems were most commonly provided in residential settings, services for emotional problems were most commonly provided in outpatient settings. Traditional healers and pastoral counselors provided services to 23.7% and 29.6% of youths who received services for substance use and emotional problems, respectively. Detained youths were more likely to receive ADM services than AI adolescents living at--large in another, comparable Northern Plains reservation community. Still, the vast majority of youths in detention who suffered from psychiatric disorders did not report use of ADM services.

CONCLUSIONS

Detention facilities serving AI adolescents need to screen carefully for the presence of psychiatric disorders and facilitate the use of ADM services.

Molecular characterization of mycobacteria isolated from seals

Tuberculosis (TB) was diagnosed in 10 seals from three species (Arctocephalus australis, Arctocephalus tropicalis and Otaria flavescens) found in South America. The mycobacteria isolated from these cases belonged to the Mycobacterium tuberculosis complex, as determined by RFLP using an IS6110 probe, spoligotyping, analysis of the 16S rRNA gene sequence and by PCR-restriction analysis of hsp65. Polymorphisms in gyrA, katG, oxyR and pncA were investigated in some of the isolates, as well as the presence of the MPB70 antigen. The insertion sequence IS6110 was present in three to seven copies in the genome of the mycobacteria isolated from seals. Using the IS6110 probe, six patterns (designated A, B, C, D, E and F) were identified from 10 different isolates. Patterns A and B were found for the mycobacteria isolated from two and four seals, respectively, indicating an epidemiological relationship between isolates grouped according to their IS6110 RFLP. The mycobacteria isolated from seals shared the majority of their IS6110 DNA-containing restriction fragments, and nine isolates had an identical spoligotype; only one isolate showed a minor difference in its spoligotype. In addition, none of these spoligotypes were found in other M. tuberculosis complex strains. These results suggest that the isolates from seals constitute a unique group of closely related strains. The mycobacteria isolated from seals showed polymorphisms at gyrA codon 95 and katG codon 463, as do group 1 M. tuberculosis, and M. bovis. Group 1 mycobacteria are associated with cluster cases. The spoligotypes found in the mycobacteria isolated from seals lack spacers 39-43, as does M. bovis, but the MPB70 antigen, which is highly expressed in M. bovis and minimally expressed in M. tuberculosis, was not detected in these mycobacteria. The mycobacteria isolated from seals also showed oxyR and pncA polymorphisms specific to M. tuberculosis. In conclusion, the mycobacteria that cause TB in seals in the South-Western Atlantic are a related group, and based on the combination of genetic characteristics, belong to a unique genotypic group within the M. tuberculosis complex.