Variables which distinguish patients fulfilling clinical criteria for dementia with Lewy bodies from those with Alzheimer's disease

OBJECTIVES

To compare patients fulfilling clinical criteria for Lewy body dementia with those meeting clinical criteria for Alzheimer's disease.

DESIGN

Prospective cohort study.

SETTING

Psychiatric services and a memory clinic.

SAMPLE

124 patients with DSM-III-R dementia.

MEASURES

The assessment included the GMS/HAS/SDS package, the CAMCOG, the Cornell Depression scale and the Burns Symptom Checklist. Dementia was diagnosed according to DSM-III-R, NINCDS ADRDA, McKeith, Byrne, Hachinski and HAS AGECAT criteria.

RESULTS

Patients meeting McKeith et al. criteria for senile dementia of Lewy body type were significantly more likely to have clouding of consciousness, significant Parkinsonian symptoms and less severely impaired recent memory than patients with NINCDS ADRDA Alzheimer's disease. Each of these variables also distinguished patients meeting Byrne et al.'s criteria for dementia with Lewy bodies from those with a diagnosis of Alzheimer's disease.

CONCLUSIONS

It is suggested that one set of criteria could encompass those overlapping groups of patients. Work is needed to further develop the diagnostic criteria for Lewy body dementia.

Automated fed-batch fermentation with feed-back controls based on dissolved oxygen (DO) and pH for production of DNA vaccines

A fermentation process in Escherichia coli for production of supercoiled plasmid DNA for use as a DNA vaccine was developed using an automated feed-back control nutrient feeding strategy based on dissolved oxygen (DO) and pH. The process was further automated through a computer-aided data processing system to regulate the cell growth rate by controlling interactively both the nutrient feed rate and agitation speed based on DO. The process increased the total yield of the plasmid DNA by approximately 10-fold as compared to a manual fed-batch culture. The final cell yield from the automated process reached 60 g L-1 of dry cell weight (OD600 = 120) within 24 h. A plasmid DNA yield of 100 mg L-1 (1.7 mg g-1 cell weight) was achieved by using an alkaline cell lysis method. Plasmid yield was confirmed using High Performance Liquid Chromatography (HPLC) analysis. Because cells had been grown under carbon-limiting conditions in the automated process, acetic acid production was minimal (below 0.01 g L-1) throughout the fed-batch stage. In contrast, in the manual process, an acid accumulation rate as high as 0.36 g L-1 was observed, presumably due to the high nutrient feed rates used to maintain a maximum growth rate. The manual fed-batch process produced a low cell density averaging 10-12 g L-1 (OD600 = 25-30) and plasmid yields of 5-8 mg L-1 (approximately 0.7 mg g-1 cells). The improved plasmid DNA yields in the DO- and pH-based feed-back controlled process were assumed to be a result of a combination of increased cell density, reduced growth rate (mu) from 0.69 h-1 to 0.13 h-1 and the carbon/nitrogen limitation in the fed-batch stage. The DO- and pH-based feed-back control, fed-batch process has proven itself to be advantageous in regulating cell growth rate to achieve both high cell density and plasmid yield without having to use pure oxygen. The process was reproducible in triplicate fermentations at both 7-L and 80-L scales.

Do rehabilitation patients continue prescribed bowel medications after discharge?

An exploratory descriptive study was conducted to address the use of bowel medications 1 month after discharge from an inpatient rehabilitation center and the rationale for making changes from bowel medications prescribed at discharge. At discharge, 66% of the 114 participants took bowel medications, but 1 month later, 42% did. Stimulant laxatives accounted for nearly half the medications taken at each point. Most of the patients who made medication changes reduced the prescribed dose or altogether discontinued taking the prescribed medication. In response to open-ended questions about changes, participants gave reasons related to physiology and personal preference. Anticipating that many patients will change their bowel medications after discharge, practitioners need to consider patients' preferences and teach patients how to adjust their medications correctly.

Fatal bone marrow embolism in a patient with sickle cell beta + thalassaemia

Sickle cell beta + thalassaemia is regarded as the mildest of the sickle cell haemoglobinopathy syndromes with a benign natural course. In contrast to sickle cell disease, severe life threatening complications are not usually associated with this genotype. A case of a 30 year old West Indian man who, previously asymptomatic for 10 years, sustained a fatal pulmonary bone marrow embolism, is reported. This case report illustrates that serious, even fatal, complications may occur in patients with this 'benign' condition and bone marrow embolism should be included in the differential diagnosis of acute crisis in these patients.

The determination of radioisotope levels in municipal sewage sludge

Sludge samples from 25 municipal waste water treatment plants have been analyzed to determine the level of environmentally present, man-made, gamma-ray emitting radioisotopes. Samples were freeze dried and separated into dried sludge, liquid-soluble and liquid-insoluble components. These were counted in the low background level, whole body counter at Missouri University using a standard intrinsic-Germanium spectrometer. After freeze drying, the liquid effluents from the samples were not found to have statistically significant levels of radioactivity. Using log-normal analysis, the dried sludge was found to have 0.0016 +/- 0.0022 Bq g-1 (0.04 +/- 0.06 pCi g-1) of 137Cs and 0.001 +/- 0.003 Bq g-1 (0.03 +/- 0.08 pCi g-1) of 60Co. These data can be used to determine if sewage effluents from nuclear facilities have levels of radioactivity above that expected from the environment.

Structure-activity relationships and computer-assisted analysis of respiratory sensitization potential

The mechanism(s) underlying respiratory sensitivity to chemicals is uncertain but is assumed to involve immunologic components with pharmacologic and neurologic involvement. Predictive testing would be valuable to prevent occurrence of hypersensitivity. Several in vitro and in vivo approaches have been used for predictive purposes. In vitro methods have included assessment of the ability of the chemical to undergo reaction with proteins. Computational methods have investigated the relationship between structure and electrophilic potential of chemical allergens. We have initiated a structure-activity evaluation of chemicals associated with elicitation of respiratory sensitization and have utilized a computer-based expert system, MultiCASE. A preliminary database of 39 active chemicals has been established from a literature search of clinical case reports and animal test results. Evaluation of the model has indicated structural alerts for activity which consist of structural fragments as well as physicochemical properties. Further development of the model and evaluation of findings should enable mechanistic insight into the process of respiratory sensitization and recognition of factors which distinguish respiratory sensitizers mechanistically from other chemical allergens such as contact sensitizing chemicals.

A retinaldehyde dehydrogenase as a structural protein in a mammalian eye lens. Gene recruitment of eta-crystallin

eta-Crystallin is a taxon-specific crystallin, a major component of the eye lens in elephant shrews (Macroscelidea). Sequence analysis of eta-crystallin from two genera of elephant shrews and expression of recombinant eta-crystallin show that the protein is a cytoplasmic (class 1) aldehyde dehydrogenase (ALDH1, EC 1.2.1.3) with activity for the oxidation of retinaldehyde to retinoic acid. Unlike many other mammals, elephant shrews have two ALDH1 genes. One encodes ALDH1/eta-crystallin which, in addition to its very high expression in lens, is also the predominant form of ALDH1 expressed in other parts of the eye. The second gene encodes a "non-lens" ALDH1 (ALDH1-nl) which is the predominant form expressed in liver. This pattern of tissue preference contrasts with other mammals which make use of the same major ALDH1 transcript in both ocular and non-ocular tissues. Thus the gene recruitment of ALDH1/eta-crystallin as a structural protein in elephant shrew lenses is associated with its collateral recruitment as the major form of ALDH1 expressed in other parts of the eye.

Evaluating clinical case report data for SAR modeling of allergic contact dermatitis

Clinical case reports can be important sources of information for alerting health professionals to the existence of possible health hazards. Isolated case reports, however, are weak evidence of causal relationships between exposure and disease because they do not provide an indication of the frequency of a particular exposure leading to a disease event. A database of chemicals causing allergic contact dermatitis (ACD) was compiled to discern structure-activity relationships. Clinical reports represented a considerable fraction of the data. Multiple Computer Automated Structure Evaluation (MultiCASE) was used to create a structure-activity model to be used in predicting the ACD activity of untested chemicals. We examined how the predictive ability of the model was influenced by including the case report data in the model. In addition, the model was used to predict the activity of chemicals identified from clinical case reports. The following results were obtained: When chemicals which were identified as dermal sensitizers by only one or two case reports were included in the model, the specificity of the model was reduced. Less than one half of these chemicals were predicted to be active by the most highly evidenced model. These chemicals possessed substructures not previously encountered by any of the models. We conclude that chemicals classified as sensitizers based on isolated clinical case reports be excluded from our model of ACD. The approach described here for evaluating activity of chemicals based on sparse evidence should be considered for use with other endpoints of toxicity when data are correspondingly limited.

Child life programs in the pediatric emergency department

Child life (CL) programs have long been utilized in the inpatient setting to help in relieving the stress and anxiety associated with hospitalization. The objective of this study was to determine the current availability of such programs in pediatric emergency departments (ED) and what interventions were provided in one ED with a CL program. We conducted a telephone survey of EDs in 44 large children's hospitals in the United States as to their use of child life specialists (CLS). Also, a retrospective review was performed of the CL intervention in one large pediatric ED over a two-year period. Only 6/44 EDs (14%) had at least one full-time CLS, with three of those having two full-time workers. In these EDs the CLS prepared children for painful or anxiety-provoking procedures and provided developmentally appropriate activities in the ED. Another 6/44 (14%) had CL services available by consult. There were no CLS available in 32/44 (72%) EDs, where nursing staff prepared children for painful procedures. EDs with a higher census were more likely to have a full-time CLS (P = 0.02). Hospitals with certified pediatric trauma centers were less likely to have any CL services available in the ED (P = 0.04). A review of the records of the ED at Arkansas Children's Hospital revealed that 32% of patient contacts by the CLS were for invasive procedure teaching and support. Another 22% of interventions were for developmental stimulation. Family support (21.5%) and therapeutic intervention (17.5%) were the next most common contacts. Admission teaching accounted for 4%, while preoperative teaching and support accounted for only 3% of the total. There were more patient contacts made by the worker on evening shift. CL programs, while common in the inpatient setting, are currently underutilized in most pediatric EDs. CLS can provide a variety of services in the pediatric ED.

Nocturnal melatonin levels in human volunteers exposed to intermittent 60 Hz magnetic fields

Two double-blind laboratory-based studies were performed to determine whether a suppression of nocturnal melatonin similar to that observed in rodents occurs when humans are exposed to magnetic fields at night. In study 1, 33 men were exposed to sham, 10 mG, or 200 mG intermittent, circularly polarized magnetic fields from 2300 to 0700 h under controlled environmental and exposure test conditions. Overall, exposure had no effect on melatonin levels. Men with preexisting low levels of melatonin, however, showed significantly greater suppression of melatonin when they were exposed to light and also when they were exposed to the 200 mG magnetic-field condition. Study 2 directly tested the hypothesis that low-melatonin subjects show enhanced sensitivity when exposed to light and to 200 mG magnetic fields. After preexposure screening, each of 40 men slept in the exposure facility on two nights. On one night, the men were sham exposed. On the other night, they were exposed to the 200 mG field condition used previously. Again, exposure had no overall effect on melatonin levels. The original finding of enhanced sensitivity in low-melatonin subjects was not replicated in this study. We conclude that the intermittent exposure conditions used in these two studies were not effective in altering nocturnal melatonin release patterns in human volunteers. Further research is underway with regard to exposure parameters, hormonal and immune system measures, and individual differences.

Fluorescent multiplex microsatellites used to define haplotypes associated with 75 CFTR mutations from the UK on 437 CF chromosomes

The cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene contains three highly informative microsatellites: IVS8CA, IVS17bTA, and IVS17bCA. Their analysis improves prenatal/ carrier diagnosis and generates haplotypes from CF chromosomes that are strongly associated with specific mutations. Microsatellite haplotypes were defined for 75 CFTR mutations carried on 437 CF chromosomes (220 for delta F508, 217 for other mutations) from Northern Ireland and three English regions: the North-West, East Anglia, and the South. Fluorescently labelled microsatellites were amplified in a triplex PCR reaction and typed using an ABI 373A fluorescent fragment analyser. These mutations cover all the common and most of the rare CF defects found in the UK, and their corresponding haplotypes and geographic region are tabulated here. Ancient mutations, delta F508, G542X, N1303K, were associated with several related haplotypes due to slippage during replication, whereas other common mutations were associated with the one respective haplotype (e.g., G551D and R560T with 16-7-17, R117H with 16-30-13, 621 + 1G > T with 21-31-13, 3659delC with 16-35-13). This simple, fast, and automated method for fluorescent typing of these haplotypes will help to direct mutation screening for uncharacterised CF chromosomes.

Temporal distribution of rotavirus G-serotypes in the West Midlands region of the United Kingdom, 1983-1994

Samples of rotavirus from cases of acute gastroenteritis, occurring in the West Midlands region of the United Kingdom during the winter months of 1983 to 1994, were tested by enzyme-immunoassay for G-serotype (VP7). Statistically significant changes in the relative prevalence of serotypes occurred each year (p-values in chi-square tests were: p < 0.05 or p < 0.01). No consistent pattern was associated with these changes. G1, G2, G3, and G4 were the most common serotypes detected throughout the study period, accounting for 93.2%. Serotypes G5, G8, and G10 were detected in 0.4% samples, and serotypes other than G1 to G4 were detected in 6.8% samples. Thus, the rotavirus serotypes are less diverse here compared to other locations. These data are important for the development of an appropriate rotavirus vaccine.

Coping by the carers of dementia sufferers

One hundred and nine of 125 patients from consecutive referrals to a clinical service had an informal carer in contact at least once a week. Thirty-two of the carers had major or minor depression. The active management strategy 'being firm in directing behaviour' was significantly inversely associated with depression amongst carers living with the dementia sufferers, whilst carers who prioritized their daily routines were significantly more likely to be depressed. The active psychological coping strategy 'constructing a larger sense of the illness' was also significantly inversely associated with depression amongst carers living with the patients and 'reduction of expectations' showed a trend in the same direction. There were no significant differences between the coping strategies used by men and women. The type of coping strategy used by carers has an important relationship with depression. Active practical and psychological strategies were of benefit to carers and this has important treatment implications.

The aetiology of depression in the carers of dementia sufferers

OBJECTIVE

To examine the associations of depression in the carers of dementia sufferers, diagnosed on the basis of a semistructured interview.

DESIGN

Case control study.

SETTING

Referrals to clinical services.

SUBJECTS

The informal carers of 109 dementia sufferers, 32 with depression and 77 without.

MEASURES

Carers were interviewed using the Geriatric Mental State Schedule. The diagnosis of depression was made according to Research Diagnostic Criteria. Instruments used to assess associations included Carers' Stress Scale, Marital Intimacy Scale, Cornell Depression Scale and CAMCOG Schedule.

RESULTS

Only increasing age was significantly associated with depression in the overall group of carers. The severity of cognitive impairment was significantly associated with depression in carers who lived with a dementia sufferer and a low level of premorbid marital intimacy was significantly associated with depression amongst carers who were marital partners.

CONCLUSION

Few factors are clearly associated with depression in the carers of dementia sufferers. The pattern of associations was, however, different for carers in different situations.

Associations of psychotic symptoms in dementia sufferers

BACKGROUND

Psychotic symptoms in dementia have been considered as a single category which may have masked important associations. An exploratory analysis was undertaken to look separately at delusions, visual hallucinations and delusional misidentification.

METHOD

Psychotic symptoms were assessed with the Burns' Symptom Checklist in 124 patients with DSM-III-R dementia.

RESULTS

Eighty-three (66.9%) patients had psychotic symptoms. Deafness and life events were associated with delusions and visual impairment was associated with visual hallucinations, while senile dementia of Lewy body type and older age were associated with both.

CONCLUSIONS

Differences are evident in the associations of delusions and visual hallucinations. Sensory impairments were associated with both symptoms.

The duck gene for alpha B-crystallin shows evolutionary conservation of discrete promoter elements but lacks heat and osmotic shock response

The gene for alpha Beta-crystallin from a bird (the domestic duck, Anas platyrhynchos) has been cloned and sequenced to allow comparison with its mammalian homologues. The duck gene has the same general structure as those of humans and rodents although, unlike those of mammals, the duck gene has two polyadenylation signals at the 3' end. The most interesting comparisons are in the 5'flanking promoter regions. In contrast to the broad conservation of promoter sequence among mammals, only two significant blocks and a few smaller elements have been conserved during evolution in the more distantly related avian gene. Block 1 (-350/-308) corresponds to alpha BE-2, a functional element defined in the mouse gene. Further downstream, block 2 (-98/-65) shows 27/33 identity among all three species but does not correspond to any previously defined element. Other regions are less well-conserved. In particular, putative heat-shock response elements of the mammalian alpha B-crystallin genes are absent from the duck gene. In contrast to the heat and osmotic stress-inducibility of mouse alpha B-crystallin in NIH 3T3 cells, duck alpha B-crystallin showed no inducibility in duck cells in culture. Thus, although high expression in lens is common to alpha B-crystallin genes in birds and mammals, other modes of expression appear to be taxon-specific.

Classification of psychotic symptoms in dementia sufferers

Little attention has been payed to the classification of psychotic symptoms in dementia sufferers. This article compares the etiology of delusions, visual hallucinations and delusional misidentification and examines the value of factors generated from principal components analysis as a possible classificatory system in a group of 125 patients with DSM-III-R dementia in contact with clinical services who were prospectively evaluated using standardized instruments to describe in detail individual psychotic symptoms. The assessment also included the Geriatric Mental State Schedule, the History and Aetiology Schedule and the CAMCOG. Delusions and visual hallucinations had a distinct cognitive profile as did delusions and delusional misidentification, although there was an overlap between visual hallucinations and delusional misidentification. Four factors were generated from principal components analysis. Three of these closely mirrored the 3 symptom groups delusions, visual hallucinations and delusional misidentification, although the phantom-boarder delusion was correlated with the visual hallucination factor and not delusional misidentification. The fourth factor included visual hallucinations of relatives and delusions that relatives were in the house. This factor was strongly inversely associated with emotional distress and could perhaps best be seen as a comfort phenomena. The pattern of cognitive deficits and etiological associations of each of the factors were independent of one another, supporting the notion that it is useful to consider them as separate entities.

Fluorescent multiplex microsatellites used to identify haplotype associations with 15 CFTR mutations in 124 Northern Irish CF families

The cystic fibrosis transmembrane conductance regulator gene contains three highly informative microsatellites; IVS8CA, IVS17BTA and IVS17BCA. Fluorescent multiplexes of these microsatellites were assayed in 124 CF families carrying 15 different CFTR mutations, from N. Ireland.

Carotid body tumor associated with hyperparathyroidism

Hyperparathyroidism in association with carotid body tumor is a rare combination. A common embryologic cellular origin was postulated previously to explain this unusual occurrence. We report a case of left carotid body tumor and left inferior parathyroid adenoma. We believe this to be the sixth reported case in the literature with this combination.

Discriminating translation of insulin-like growth factor-II (IGF-II) during mouse embryogenesis

The problem is to discover which of the promoters of the insulin-like growth factor-II gene stimulate the transcription of mRNA which is translated into protein. Three alternative leader exons are attached to the coding sequences in RNA transcribed from this gene in other systems, and it is mainly the paternal allele which is expressed in mouse development. Transcripts bearing each of the three leader exons were found in the RNA from the chorio-allantoic placenta, visceral yolk sac, and embryo, starting at 9.5 days. A varying proportion of one abundant transcript was disengaged from the polysomes at different days of development. This transcript was prefixed by the longest of the three alternative untranslated 5' leader exons (exon 2), and it was consistently associated with polysomes in the choroid plexus and leptomeninges of the brain. Many exon 2 transcripts were abbreviated by endonucleolytic cleavage and lacked a poly(A) tail. In contrast, the transcripts with the shortest leader (exon 3) were mainly displayed on polysomes at all the stages of development which were examined. During mouse development, the production of IGF-II protein must be partly controlled by the mechanisms which regulate translation.

Effects of sodium monensin on reproductive performance of dairy cattle. II. Effects on metabolites in plasma, resumption of ovarian cyclicity and oestrus in lactating cows

A randomised trial was conducted to determine the effects of sodium monensin on plasma metabolite concentrations, resumption of cyclicity and oestrus and milk production and milk composition of postparturient dairy cows. Cows treated with sodium monensin in a controlled-release capsule had significantly lower plasma beta-hydroxybutyrate (BHB) concentrations (P = 0.006) and tended (P = 0.07) to have significantly higher plasma glucose concentrations than untreated cows. Treatment did not significantly influence plasma free fatty acid, urea nitrogen or cholesterol concentrations. Despite higher plasma glucose concentrations and lower plasma BHB concentrations, periods from calving to first ovulation and oestrus were not reduced by treatment. This observation, with limited numbers of cows, is not consistent with a hypothesis that glucose or ketones are important metabolic regulators of pulsatile release of luteinising hormone and consequent resumption of cyclicity. While milk production and milk protein concentration did not significantly differ between groups, milk fat concentration was significantly lower for treated cows. Treated cows probably had lower dry matter intake than untreated cows as they produced 67 litres less milk per head and lost more weight than untreated cows during the study period, although weight and body condition score were not significantly affected by treatment. The lack of significance of these latter observations probably reflects the low statistical power of the study.

Conservative treatment of plantar heel pain: long-term follow-up

In order to evaluate the long-term results of patients treated conservatively for plantar heel pain, a telephone follow-up survey was conducted. After eliminating those patients with worker's compensation-related complaints and those with documented inflammatory arthritides, data on 100 patients (58 females and 42 males) were available for review. The average patients was 48 years old (range 20-85 years). The average follow-up was 47 months (24-132 months). Clinical results were classified as good (resolution of symptoms) for 82 patients, fair (continued symptoms but no limitation of activity or work) for 15 patients, and poor (continued symptoms limiting activity or changing work status) in 3 patients. The average duration of symptoms before medical attention was sought was 6.1, 18.9, and 10 months for the three groups, respectively. The three patients with poor results all had bilateral complaints, but had no other obvious risk factors predictive of their poor result. Thirty-one patients stated that, even with the understanding that surgical treatment carries significant risk, they would have seriously considered it at the time medical attention was sought; twenty-two of these patients eventually had resolution of symptoms. Although the treatment of heel pain can be frustrating due to its indolent course, a given patient with plantar fasciitis has a very good chance of complete resolution of symptoms. There is a higher risk for continued symptoms in over-weight patients, patients with bilateral symptoms, and those who have symptoms for a prolonged period before seeking medical attention.

Commentary: recent reforms in the British National Health Service--lessons for the United States

President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance.

Dose response study of human exposure to 60 Hz electric and magnetic fields

This human exposure study examined the relationship between field strength and biological response and tested whether the exposure levels at which the greatest effects occur differ for different endpoints. Three matched groups of 18 men each participated in two 6 h exposure test sessions. All subjects were sham exposed in one session. In the other session, each group of subjects was exposed at a different level of combined electric and magnetic field strength (low group:6 kV/m, 10 microT; medium group:9 kV/m, 20 microT; and high group: 12 kV/m, 30 microT). The study was performed double blind, with exposure order counterbalanced. Significant slowing of heart rate, as well as alternations in the latency and amplitude of event-related brain potential measures derived from the electro encephalogram (EEG), occurred in the group exposed to the 9 kV/m, 20 microT combined field (medium group). Exposure at the other field strength levels had no influence on cardiac measures and differential effects on EEG activity. Significant decrements in reaction time and in performance accuracy on a time estimation task were observed only in the low group. These results provide support for the hypothesis that humans may be more responsive to some combinations or levels of field strength than to others and that such differences in responsivity may depend, in part, on the endpoint of interest.

The adenovirus E1A-associated 130-kD protein is encoded by a member of the retinoblastoma gene family and physically interacts with cyclins A and E

The adenovirus E1A proteins form complexes with a group of cellular proteins, including a protein of 130 kD. E1A-associated p130 was purified through coimmunoprecipitation with E1A, and sequence data from four tryptic peptides was obtained. Oligonucleotides derived from the peptide sequences were used to clone a 4.85-kb cDNA. The cDNA contained an 1139-amino-acid open reading frame with homology to the retinoblastoma protein and E1A-associated p107 but was more closely related to p107. In vitro-translated p130 bound to E1A, and anti-p130 antibodies detected p130 in immunoblots of E1A immunoprecipitates. p130 was also detected in immunoprecipitates of cyclins A and E and was an efficient substrate in vitro for kinase activities associated with these cyclins. The p130 gene mapped to chromosome 16q12.2-13, a region that undergoes allelic loss in several types of tumors, including hepatocellular, prostate, and breast carcinomas.

A mutation in CFTR produces different phenotypes depending on chromosomal background

Cystic fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene but the association between mutation (genotype) and disease presentation (phenotype) is not straightforward. We have been investigating whether variants in the CFTR gene that alter splicing efficiency of exon 9 can affect the phenotype produced by a mutation. A missense mutation, R117H, which has been observed in three phenotypes, was found to occur on two chromosome backgrounds with intron 8 variants that have profoundly different effects upon splicing efficiency. A close association is shown between chromosome background of the R117H mutation and phenotype. These findings demonstrate that the genetic context in which a mutation occurs can play a significant role in determining the type of illness produced.

Detection of antitrophoblast antibodies in the sera of patients with anticardiolipin antibodies and fetal loss

Women with anticardiolipin antibodies (ACLA) are at increased risk for fetal loss. One potential explanation for this outcome is that sera from these individuals contain antibodies reactive with trophoblast cells, which are involved in the establishment of the uteroplacental vasculature and maintenance of placental blood fluidity. To examine this hypothesis, we compared the incidence of trophoblast-reactive antibodies in 27 patients with ACLA and a history of fetal loss with that in 29 normal pregnant women. Sera from 20 patients, but only one control, contained trophoblast-reactive antibodies (P < .001). These antibodies were not directed against major histocompatibility class I antigens, and reacted with both term and first-trimester trophoblast cells. In most cases, sera from which ACLA were adsorbed by cardiolipin-containing liposomes maintained reactivity against cells. In addition, patient Ig fractions immunoprecipitated an approximately 62-kD protein from the trophoblast cell surface, stimulated the release of arachidonic acid and thromboxane A2 by trophoblasts, and inhibited the binding of prourokinase to trophoblast urokinase receptors. These observations show that sera from women with ACLA and a history of fetal loss contain antitrophoblast antibodies. These antibodies may be serologically distinct from ACLA, and may contribute to the pathogenesis of fetal demise.

Influences of exogenous epinephrine on two reproductive parameters in female mice: disruption of receptivity but not implantation

Diverse stressors impede female receptivity and fertility. Since epinephrine is released from the adrenal during stress, it might play a role in stress-induced disruptions of female reproductive parameters. Experiment 1 examined whether exogenous epinephrine would disrupt lordosis behavior in estrogen- and progesterone-treated ovariectomized female mice. Single dosages of 20 and 40 micrograms almost eliminated sexual receptivity. Experiments 2 and 3 examined whether chronic dosages of epinephrine shortly after insemination would lead to a failure of implantation of mouse embryos. Results indicated that epinephrine had little effect on the number of dams delivering pups, the number of pups born, litter weight, or the number of stillbirths.

Analysis of four diverse population groups indicates that a subset of cystic fibrosis mutations occur in common among Caucasians

To determine the nature and frequency of non-delta F508 cystic fibrosis (CF) mutations among diverse populations, we have sequenced exons 9-12 and 19-23 of the CF transmembrane conductance regulator (CFTR) gene from 128 CF chromosomes (39 U.S. Caucasian, 27 African-American, 42 Northern Irish, and 20 Israeli chromosomes). These regions were chosen because they encode the two putative ATP-binding folds of CFTR, domains which appear to have functional significance. In addition, CFTR exons 1 and 2 were analyzed in the American patients. Mutations were found on 49 of the 128 CF chromosomes. Nineteen different mutations were observed; six were novel, while the remaining 13 had been reported previously by our group or by other investigators. Six of nine different mutations found in African-American patients were unique to that population. However, the vast majority of the mutations found in U.S. Caucasians (eight of nine), Northern Irish (four of five), and Israelis (three of three) also occurred in other Caucasian groups. The preponderance of previously reported mutations in these three groups suggested that a subset of the non-delta F508 mutations occur in common among Caucasians. A survey of mutation frequencies in other Caucasian groups confirmed this observation. Unfortunately, this subset accounts for less than half of non-delta F508 CF mutations in most groups. These data suggest that screening for delta F508 and this select group of mutations will efficiently and economically maximize the number of CF mutations identified in Caucasian groups. However, it will be difficult to detect more than 90% of mutant CFTR alleles except in ethnically and geographically discrete populations where CF is the result of founder effect.

Pulmonary artery dissection: MR findings

We report a case of pulmonary artery dissection imaged by MR. Dissection of a markedly dilated pulmonary artery is a rare and usually fatal complication of chronic pulmonary arterial hypertension. The diagnosis is made at autopsy, with only two cases having previously been documented (by Doppler echocardiography) during life. The hallmark of an arterial dissection is the finding of an intimal flap and a false lumen. In our case, spin echo MR imaging failed to show either the intimal flap or any intraluminal signal defects. The dissection was presumably obscured by nonhomogeneous intraluminal signal caused by the slow blood flow associated with severe pulmonary arterial hypertension. Cine MR imaging, however, demonstrated different signal intensity within the true and false lumens of the dissection, thereby outlining the intimal flap between the two channels.

A study of coroner's records of suicide in young people, 1986-88 in Western Australia

Coroner's records of 25 consecutive suicides aged 15-19 years and 43 aged 20-24 years were compared with 68 suicides aged 45-59 years to identify associated clinical and psychosocial factors. Male: female ratios were 2.6:1, 5.1:1 and 3.5:1 respectively. The most common method of suicide in males in all three age groups was CO poisoning using motor vehicles. In females the teenage group used mainly active methods, whilst in the 20-24 and 45-49 years age groups the most common method was overdosage. Over 90% of each age group had some identifiable psychiatric symptomatology. In each age group the commonest symptoms were minor affective symptoms. In each group the pattern was mainly of associated multiple rather than single psychosocial factors. In each group disruption of interpersonal relationships (boy-girlfriend, de facto, marital, family) was the predominant stressor. Compared with the 45-59 year group the following associated factors were significantly greater in (a) 15-19 years: personality/conduct disorders, unemployment and legal/disciplinary problems, and (b) 20-24 years: drug abuse and unemployment. Although the two younger groups had significantly more unemployment than the older group, only the 20-24 years group had significantly more unemployment compared with community age norms. Preventive implications of the findings are discussed.

ELF exposure facility for human testing

A laboratory facility specifically designed for controlled human exposure to 60-Hz electric (0 to 16 kV/m) and magnetic (0 to 32 A/m, B = 0 to 40 microT) fields has been constructed. The facility presents uniform fields under controlled temperature and humidity. Special control systems allow collection of physiological data during, as well as before and after, exposure to electric fields at strengths to 16 kV/m under verified double-blind control. Exposure to continuous or intermittent fields is possible in the facility. The capability of obtaining physiological data during actual exposure to constant or intermittent, 60-Hz fields, and of doing so without either the subject or the experimenter being aware of actual field conditions, is a critical factor in valid experimentation.

A replication study of human exposure to 60-Hz fields: effects on neurobehavioral measures

The purpose of this study was to reproduce and extend an earlier investigation of the effects of human exposure to combined, 60-Hz electric and magnetic fields. This paper presents the neurobehavioral results. Thirty men participated in one training session and four testing sessions. Subjects were randomly assigned to two groups. The 18 subjects in Group I were exposed (9 kV/m, 20 microT) and sham exposed in two counterbalanced orders. In Group II, half of 12 subjects were exposed (9 kV/m, 20 microT) every session, and the remaining half were sham exposed every session. The study was doubly blinded. Measures of cardiac interbeat interval, event-related brain potentials, and performance were obtained before, during, and after exposures. As in the earlier study, exposure to the combined field resulted in a statistically significant slowing of heart rate, in changes in late components of event-related brain potentials, and in decreased errors on a choice reaction-time task. In addition, field effects on several other measures approached statistical significance. The physiological measures obtained during exposure indicated that effects were greatest soon after the field was switched on, and again when it was switched off. The data indicate that changes in exposure level may be more important than duration of exposure for producing effects in human beings.

Characterization of the aldose reductase-encoding gene family in rat

Although the enzyme aldose reductase (AR) is implicated in the development of tissue pathology in diabetes, the exact mechanism of this involvement remains unclear. To better understand the role that expression of the aldose reductase-encoding gene (ALR) may play in diabetic complications, we have begun to analyze the gene and its regulatory regions, and we present here the sequence of four ALR genes in the rat. The putative functional gene is 14.1 kb long, has ten exons which show perfect sequence identity to the rat lens AR RNA sequence, and nine introns with classical splice-site consensus sequences. Potential regulatory elements in the 5'-flanking region of this gene include a TATA box and two CCAAT boxes. Probing rat genomic Southern blots with a fragment from the first intron indicates that there is probably only one copy of this gene in the rat genome. The other three genes are processed pseudogenes which show approx. 90% identity to the rat lens AR RNA sequence, contain no introns, and have poly(A) regions at their 3' ends. Chromosomal localization studies show the presence of ALR genes on chromosomes 3, 4 and 6 in the rat with the putative functional gene mapped on chromosome 4.

Effects of methanol vapor on human neurobehavioral measures

Methanol could become an important motor fuel. The objective of this exploratory study was to provide preliminary information about whether or not acute exposure to methanol at 250 mg/m3 for 75 minutes would have adverse effects on human neurobehavioral functions important in everyday life. This concentration level was selected because it is at the upper limit of the traffic scenario estimates provided by the U.S. Environmental Protection Agency (EPA)2 (86 to 240 mg/m3), but is below the maximum concentrations for eight-hour average exposures currently recommended by the National Institute of Occupational Safety and Health (NIOSH) and the American Conference of Government and Industrial Hygienists (ACGIH) (260 mg/m3). Although traffic scenario exposure estimates suggest that such high levels of exposure last less than 15 minutes, we used a 75-minute exposure to increase the probability of identifying dependent measures that should be studied in more detail in a future confirmatory study. Twelve healthy young men, each serving as his own control, participated in two sham exposures and two methanol exposures under counterbalanced, double-blind control conditions. Because methanol is present in many foods, and because high preexposure levels of methanol or formate might obscure exposure effects, subjects were required to strictly limit their diets for 12 hours before each experimental session. The following endpoints were examined before, during, and after exposure to methanol and sham vapors: blood and urinary methanol; plasma formate; oral temperature; blood pressure; subjective mood, alertness, fatigue, workload, and symptom scales; spectral analysis of the electroencephalogram; visual- and auditory-event-related potentials; contingent negative variation; respiration; cardiac interbeat interval; Symbol Digit substitution task; three-choice reaction time; Stroop color-word test; simple reaction time; visual function; critical flicker fusion frequency; hand steadiness; visual search task; Gamberale reaction time task; visual tracking task; Sternberg memory task; interval production task; and speeded addition task. Two dual tasks were also included in the task batteries. These endpoints were selected from those indicated in the literature to be sensitive to solvents, and from those that are widely used in other neurobehavioral test batteries to identify the effects of environmental pollutants. Because the number of endpoints examined was large and the number of subjects was small, procedures designed to reduce the number of statistical tests performed were used. Mean methanol concentration in the exposure room during methanol exposures was 249 mg/m3 (SD +/- 7 mg/m3). Exposure produced significant increases in blood and urine methanol concentration. As expected, no changes in plasma formate were observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Exercise and aging: implications for persons with diabetes

Physiological systems decline with age. Such declines may be the result of aging itself or physical deconditioning. Evidence suggests that the degree to which decrements occur with aging may be modifiable with physical activity. The elderly adapt to exercise programs at a generally reduced rate. Thus reduced activity, coupled with diabetes, may present unique clinical needs. In the design of exercise programs for the elderly person with diabetes, special attention needs to be given to medical screenings, potential risks, exercise goals, and implementation.

Rehabilitation of a paraplegic prisoner: conflicts for patient and nurses

The most frequent outcome of a physical rehabilitation program is discharge to an independent or assisted-living environment in the community. When a patient remains incarcerated throughout a rehabilitation stay and is returned to a prison at discharge, both patient and nurse can experience conflicts caused by differences in the two settings. This article presents a case study in which conflicts that occurred and strategies for their resolution are discussed.