A time course study of the protective effect of mesenteric lymph duct ligation on hemorrhagic shock-induced pulmonary injury and the toxic effects of lymph from shocked rats on endothelial cell monolayer permeability

BACKGROUND

We have previously documented that lymphatic duct division protects against shock-induced lung injury when tested 3 hours post-shock and that lymph collected at 3 hours post-shock increases endothelial cell monolayer permeability. However, whether lymph collected at other time points post-shock also increases endothelial cell permeability is not known. We tested the protective effects of lymphatic division on lung permeability at 6, 12, and 24 hours post-shock and the ability of lymph collected before, during, and hourly (up to 6 hours) after shock to increase endothelial cell monolayer permeability.

METHODS

At 3, 6, 12, or 24 hours after sham or actual shock (30 mm Hg for 90 min), lung permeability was measured by using Evans blue dye in rats subjected to sham or actual mesenteric duct ligation. In separate experiments, the ability of lymph collected from rats subjected to shock or sham shock to increase human umbilical vein endothelial cell (HUVEC) monolayer permeability to a 40 kd dextran rhodamine permeability probe. Lymph was tested at 10% and 1% concentrations.

RESULTS

Hemorrhagic shock induced a 3- to 4-fold increase in lung permeability compared with sham-shock rats when tested at 3, 6, 12, or 24 hours post-shock. Lymphatic division prevented this increase in lung permeability at each of these time points. Sham shock lymph did not increase HUVEC permeability, while lymph from the shocked rats did, whether tested at 1% or 10%. Lymph samples collected during the shock period and hourly for 6 hours post-shock all increased HUVEC permeability; however, the greatest relative increase in HUVEC permeability was observed in the 3- and 6- hour post-shock samples.

CONCLUSIONS

Lung injury after hemorrhagic shock appears to be caused by toxic factors carried in the mesenteric lymph, and factors capable of increasing HUVEC permeability initially appear in the lymph during the shock period and increase over time.

Severe infantile axonal neuropathy with respiratory failure

We describe 5 infants (4 male, 1 female) with a severe intractable form of motor-sensory axonal neuropathy. All became ventilator-dependent, 4 have since died and 1 remains static. Diaphragmatic paralysis was an early feature with generalized neuropathy evolving rapidly. Nerve conduction studies and biopsies were consistent with axonal disease. This disorder could be a new condition or part of the spectrum of inherited neuropathies of the axonal degenerative type. It may be that there is a "switching-off" in the infant's Schwann cell-axonal interactions in utero or in the early postnatal period, resulting in severe progressive deterioration and then a static period without recovery.

Child'sTalk--for children with autism and pervasive developmental disorder

A research assessment protocol and early intervention approach designed for use by multi-disciplinary professionals with children who have the severe social communication deficits of early autism and pervasive developmental disorder (PDD) are described. The assessment analyses the specific pattern of social communication impairment in each child and defines the characteristics of the dyadic communication between parent and child. The intervention aims to identify facilitative strategies, using video feedback, which lead to close interpersonal interaction between the child and their parents. Parents can reflect on their own interaction and identify which strategies successfully engage their child. Child'sTalk aims to facilitate adaptations to the child's level of communication by sensitively and finely tuning the interaction and mutual sharing of intentions as a fundamental agent for the emergence of communication.

Zuclopenthixol acetate in psychiatric emergencies: looking for evidence from clinical trials

BACKGROUND

Case series and reviews have suggested the effectiveness of zuclopenthixol acetate in the acute management of disturbed behaviour caused by serious mental illnesses. This review investigates the trial-based evidence for these suggestions.

METHODS

All randomized clinical trials comparing zuclopenthixol acetate to other 'standard' treatments for the acute management of those with serious mental illnesses were identified and, if possible, their results summated.

RESULTS

Six trials were identified. All had methodological problems and one did not meet the minimal methodological inclusion criteria. The summary data do not demonstrate that zuclopenthixol acetate is better than 'standard care' for altering behaviour, decreasing the need for supplementary medication, avoiding side-effects, or postponing early discharge against medical advice. One trial, however, presented data that suggested an earlier, more intense level of sedation.

CONCLUSIONS

Recommendations of reviews and open studies for the use of zuclopenthixol acetate in preference to 'standard' treatments in the psychiatric emergency are not supported by evidence from randomized controlled trials.

The MN1-TEL fusion protein, encoded by the translocation (12;22)(p13;q11) in myeloid leukemia, is a transcription factor with transforming activity

The Tel gene (or ETV6) is the target of the translocation (12;22)(p13;q11) in myeloid leukemia. TEL is a member of the ETS family of transcription factors and contains the pointed protein interaction (PNT) domain and an ETS DNA binding domain (DBD). By contrast to other chimeric proteins that contain TEL's PNT domain, such as TEL-platelet-derived growth factor beta receptor in t(5;12)(q33;p13), MN1-TEL contains the DBD of TEL. The N-terminal MN1 moiety is rich in proline residues and contains two polyglutamine stretches, suggesting that MN1-TEL may act as a deregulated transcription factor. We now show that MN1-TEL type I, unlike TEL and MN1, transforms NIH 3T3 cells. The transforming potential depends on both N-terminal MN1 sequences and a functional TEL DBD. Furthermore, we demonstrate that MN1 has transcription activity and that MN1-TEL acts as a chimeric transcription factor on the Moloney sarcoma virus long terminal repeat and a synthetic promoter containing TEL binding sites. The transactivating capacity of MN1-TEL depended on both the DBD of TEL and sequences in MN1. MN1-TEL contributes to leukemogenesis by a mechanism distinct from that of other chimeric proteins containing TEL.

Tel induces a G1 arrest and suppresses Ras-induced transformation

The Tel gene is a major target of translocations in leukemia and loss of heterozygosity is regularly observed for the non-translocated allele, thus supporting the notion that Tel is a tumor suppressor. Most tumor suppressors influence cellular proliferation, differentiation and cell death and thereby prevent oncogenic transformation and genetic instability. We found that overexpression of Tel retards proliferation of many cell types, primary cells and immortalized cells, by inducing a G1 arrest. Tel's block of cellular proliferation is rescued by high seeding densities. Furthermore, Tel suppressed Ras-mediated colony growth in soft agar and tumor formation in nude mice. The Pointed and DNA binding (DB) domains of Tel were required for all Tel-induced phenotypes.

Autoantibodies in childhood post-varicella acute cerebellar ataxia

BACKGROUND

Anti-Purkinje cell antibodies have been reported in cerebellar ataxia following Epstein-Barr virus (EBV) infection. We investigated autoantibody responses, including anti-Purkinje cell antibodies, and the clinical course in eight children who developed post-varicella ataxia, five of their siblings with uncomplicated varicella, one child with post-EBV ataxia, two children with acute disseminated encephalomyelitis (ADEM) and one with neuroblastoma associated ataxia, and in age and gender matched controls.

METHODS

Autoantibodies were tested by indirect immunofluorescence (IIF) on cryopreserved cerebrum and cerebellum sections. Other autoantibodies were measured by conventional IIF protocols using HEp-2 cells as a substrate. Antibodies to myelin associated glycoprotein (MAG), asialo-GM1, beta2 glycoprotein 1, cardiolipin and myelin basic protein (MBP) were measured by ELISA.

RESULTS

Three of eight children with acute post-varicella ataxia, one child with post-EBV ataxia, one child with ADEM and one child with uncomplicated varicella, had high titer autoantibodies (>1/160) that reacted with cerebrum and cerebellar tissue. This reactivity was not seen in one child with ADEM, in one with neuroblastoma and ataxia, in the remainder of the children with uncomplicated varicella or age and gender matched controls. Autoantibodies were not seen in CSF from two children with post-varicella ataxia. The punctate staining seen on cerebrum and cerebellum sections co-localized with rabbit antibodies to the centrosome protein pericentrin. All patients with strong reactivity with cerebrum and cerebellar tissue by IIF had elevated levels of anti-MAG that was not confirmed by absorption assay. No reactivity was seen with asialo-GM1, MBP, beta2 glycoprotein 1 or cardiolipin. None of the sera had autoantibodies directed against endosomes, the Golgi complex, or the paraneoplastic autoantigens Hu and Yo.

CONCLUSION

Some children with post-viral ataxia develop antibodies that have strong reactivity with cerebral and cerebellar tissue. Some of the antigenic reactivity co-localized with the centrosome protein pericentrin.

Conversational responsiveness in specific language impairment: evidence of disproportionate pragmatic difficulties in a subset of children

Eighteen children with specific language impairment (SLI), from 6 to 8 years of age, were compared with 9 control children matched on age and nonverbal ability (CA controls) and with 9 younger control children of comparable language level (LA controls). Half of the SLI group were rated on a teacher checklist as having pragmatic difficulties: these were referred to as the pragmatic language impairment (PLI) group; the remainder were the typical (SLI-T) group. Children's responses to adult soliciting utterances were compared. All children usually responded to conversational solicitations, but children in the PLI group were more likely than control children to give no response, and they also made very little use of nonverbal responses, such as nodding. Nonverbal responding was closely related to the quality of children's responses. Children who failed to use nonverbal responses also had a relatively high level of pragmatically inappropriate responses that were not readily accounted for in terms of limited grammar or vocabulary. This study lends support to the notion that there is a subset of the language-impaired population who have broader communicative impairments, extending beyond basic difficulties in mastering language form, reflecting difficulty in responding to and expressing communicative intents. The analytic methods developed for this project have promise for the study of pragmatic difficulties in other clinical groups.

Pol kappa: A DNA polymerase required for sister chromatid cohesion

Establishment of cohesion between sister chromatids is coupled to replication fork passage through an unknown mechanism. Here we report that TRF4, an evolutionarily conserved gene necessary for chromosome segregation, encodes a DNA polymerase with beta-polymerase-like properties. A double mutant in the redundant homologs, TRF4 and TRF5, is unable to complete S phase, whereas a trf4 single mutant completes a presumably defective S phase that results in a failure of cohesion between the replicated sister chromatids. This suggests that TRFs are a key link in the coordination between DNA replication and sister chromatid cohesion. Trf4 and Trf5 represent the fourth class of essential nuclear DNA polymerases (designated DNA polymerase kappa) in Saccharomyces cerevisiae and probably in all eukaryotes.

Smoking. Baccy to front

The government is making 60m pounds available to develop smoking cessation services over three years. This year's funding is concentrated on health action zones where progress has been slow. The cost of nicotine replacement patches is significantly more than many smokers spend on cigarettes.

Memory functioning among midlife women: observations from the Seattle Midlife Women's Health Study

OBJECTIVE

As the number of midlife women increases, there is an increased interest in women's experiences of the perimenopause. Because of the evidence linking estrogen with cholinergic and serotonergic activity in the brain and with central nervous system development of dendritic arborization, and mixed evidence of estrogen use with incidence of Alzheimer's disease, the effects of the perimenopause on memory functioning are of interest. The purpose of these analyses, part of the Seattle Midlife Women's Health Study, was to describe changes in women's perceived memory functioning according to their perimenopausal group, age, perceived stress, health status, and mood.

DESIGN

Memory functioning was assessed with the Memory Functioning Questionnaire as part of a questionnaire mailed to study participants annually. Perimenopausal group was assessed using Mitchell's rating schema.

RESULTS

Age was unrelated to any of the Memory Functioning Questionnaire indicators except for retrospective memory; younger women reported more memory problems than older women. Perimenopausal groups were unrelated to most memory functioning ratings with few exceptions. Memory functioning ratings of current memory compared with the past were worse for women who were in early and middle transition and for those who were using hormone therapy than for those who were in late transition and postmenopause. Women reported more current memory problems compared with 10 and 20 years ago and at age 18. Health ratings were negatively correlated with memory functioning ratings, and depressed mood positively correlated with nearly every indicator of memory functioning (frequency of memory problems, ratings of current memory, past memory, and memory change). Greater perceived stress levels were associated with more memory problems.

CONCLUSIONS

Perceived memory functioning seems more closely related to perceived health, depressed mood, and perceived stress than to perimenopausal stage or age. Further work is needed to determine whether these ratings provided by the Seattle cohort will change over time as women age and as they make the transition to menopause and beyond.

A regulatory RNA (PrrB RNA) modulates expression of secondary metabolite genes in Pseudomonas fluorescens F113

The GacS-GacA two-component signal transduction system, which is highly conserved in gram-negative bacteria, is required for the production of exoenzymes and secondary metabolites in Pseudomonas spp. Screening of a Pseudomonas fluorescens F113 gene bank led to the isolation of a previously undefined locus which could restore secondary metabolite production to both gacS and gacA mutants of F113. Sequence analysis of this locus demonstrated that it did not contain any obvious Pseudomonas protein-coding open reading frames or homologues within available databases. Northern analysis indicated that the locus encodes an RNA (PrrB RNA) which is able to phenotypically complement gacS and gacA mutants and is itself regulated by the GacS-GacA two-component signal transduction system. Primer extension analysis of the 132-base transcript identified the transcription start site located downstream of a sigma(70) promoter sequence from positions -10 to -35. Inactivation of the prrB gene in F113 resulted in a significant reduction of 2, 4-diacetylphloroglucinol (Phl) and hydrogen cyanide (HCN) production, while increased metabolite production was observed when prrB was overexpressed. The prrB gene sequence contains a number of imperfect repeats of the consensus sequence 5'-AGGA-3', and sequence analysis predicted a complex secondary structure featuring multiple putative stem-loops with the consensus sequences predominantly positioned at the single-stranded regions at the ends of the stem-loops. This structure is similar to the CsrB and RsmB regulatory RNAs in Escherichia coli and Erwinia carotovora, respectively. Results suggest that a regulatory RNA molecule is involved in GacA-GacS-mediated regulation of Phl and HCN production in P. fluorescens F113.

Phonological awareness therapy and articulatory training approaches for children with phonological disorders: a comparative outcome study

Sixty-one children, aged 3.6-5.0, with developmental phonological disorders (PD) participated in a study comparing the effects of metaphonologically (MET) or articulation-based (ART) therapy. Maturational effects were controlled for by the inclusion of 59 normally speaking control children of the same age range. Measures of phonological (speech) output and phonological awareness were taken before and after therapy for all subjects and at 3 months post-therapy for PD children. Results showed that PD children improved significantly in both phonological output and awareness skills across the intervention period compared with control children, but that there was no significant difference on the awareness measure between ART and MET groups. ART and MET groups differed from each other on one measure of speech improvement only, with the ART group making more change than the MET group on individual probe scores. Follow-up measures for both therapy groups indicated that there was little difference between the groups on phonological awareness change or speech development 3 months after intervention, though there was a trend for MET children to continue to make more long-term change than the ART group on one output measure. Additional analysis showed that there were generally few significant implications for outcome between PD children with good initial phonological awareness skills and those who initially had poor phonological awareness skills.

Preservation of the brainstem auditory evoked potential in non-convulsive status epilepticus

Brainstem auditory evoked potentials (BAEPs) were recorded from a patient simultaneously experiencing non-convulsive generalized status epilepticus (NGSE). Waves I, III and V were normal but all subsequent waves were absent. This finding indicates that structures within the brainstem adjacent to the generators for the BAEP are likely not affected by NGSE and also illustrates the resilient nature of the BAEP. This is the first report of the recording of an evoked potential during a naturally occurring generalized seizure.

Modelling the major histocompatibility complex susceptibility to RA using the MASC method

To explain the association between HLA-DRB1 gene and rheumatoid arthritis (RA), two main hypotheses have been proposed. The first, the shared epitope hypothesis, assumes a direct role of DRB1 in RA susceptibility. The second hypothesis assumes a recessive disease susceptibility gene in linkage disequilibrium with DRB1. To investigate these two hypotheses, we analysed data on the HLA-DRB1 and TNF-LT loci in 49 affected sib-pairs. We used the Marker Association Segregation Chi-square (MASC) method in which the genotype distribution of markers among index cases and the haplotype sharing in affected sib-pairs are jointly taken into account. With DRB1 data alone, both hypotheses were shown to fit but with analysis of TNF data, both hypotheses were strongly rejected. Thus the TNF data provided additional information for a better understanding of genetic susceptibility to RA than was previously possible using only HLA-DR data. A theoretical standpoint is addressed here on the advisability of using different linked markers in a candidate region for modelling the contribution of this region in disease susceptibility.

R1 region of P97 mediates adherence of Mycoplasma hyopneumoniae to swine cilia

Adherence of Mycoplasma hyopneumoniae to the swine respiratory tract is mediated by the membrane protein P97. This protein is located on the outer membrane surface, and its role in adherence has been firmly established. The general region of P97 that mediates adherence to swine cilia is thought to be the R1 region near the carboxy terminus of the protein, but it was not clear if this region could mediate adherence to swine cilia independently of other P97 sequences. To examine this in more detail, a series of R1 repeat sequences containing different numbers of repeating units cloned in frame with lacZ was used to produce R1-beta-galactosidase fusion proteins. These proteins were then tested for adherence to swine cilia and for reactivity to the adherence-blocking monoclonal antibody F2G5 and convalescent-phase swine sera. In this way it was possible to accurately define the cilium binding epitope of P97 and the minimal epitope recognized by antibody. Our results indicate that eight R1 repeating units are required for cilium binding and that three repeating units are needed for antibody recognition. These results could lead to more effective therapeutic measures against this important swine pathogen.

Evaluation of a single seizure: guidelines for advance practice nurses

Deciding whether or not to treat a client after a single seizure can be challenging for the clinician. The risk of seizure recurrence is greatest in the first six months after the initial episode. The decision to treat a single seizure should be based on diagnostic and clinical findings that assess the client's risk for recurrence. When making treatment decisions, the clinician must consider the benefits and risks of single-seizure therapy. Careful consideration should be given to differential diagnosis, factors that induce symptomatic seizures and risk factors for epilepsy.

Frequent codon 12 Ki-ras mutations in mouse skin tumors initiated by N-methyl-N'-nitro-N-nitrosoguanidine and promoted by mezerein

The skin tumor initiators N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and 7,12-dimethylbenz[a]anthracene (DMBA) differ in effectiveness when tumor formation is promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA). Even at high doses, MNNG is less effective, producing fewer benign and malignant tumors with a longer latent period. In DMBA-initiated skin, 10 wk of TPA promotion produced a maximal tumor response. With MNNG, 20 wk of TPA promotion was required, producing nearly four times as many papillomas as 10 wk of promotion. Promotion of MNNG-initiated skin with mezerein induced the appearance of very rapidly-growing papillomas within 5 wk, 3 wk earlier than the first TPA-promoted papillomas. Thus, MNNG may induce a novel mutation resulting in a population of initiated cells that respond especially well to mezerein. Since ras mutations are common in experimental tumors in many tissues, we determined the frequency of activating mutations in the Ha-ras, Ki-ras, and N-ras oncogenes. Activating Ha-ras mutations were present in essentially all DMBA-initiated tumors and about 70% of MNNG-initiated tumors. No N-ras mutations were found in tumors lacking other ras mutations. Surprisingly, 41% of the papillomas arising in the first 11 wk in MNNG-initiated, mezerein-promoted mice bore mutations in codon 12 of the Ki-ras oncogene. Activating Ki-ras mutations were also found in more than 60% of squamous cell carcinomas and 40% of keratoacanthomas. Although mutations in Ha-ras are frequently detected in mouse skin tumors, mutations in Ki-ras are rare. This is the first report of mutated Ki-ras in skin tumors from mice initiated by MNNG.

Smoking and schizophrenia: abnormal nicotinic receptor expression

Biological and genetic evidence suggests a role for the neuronal nicotinic receptors in the neuropathophysiology of schizophrenia. Nicotine normalizes an auditory evoked potential deficit seen in subjects who suffer from the disease. Nicotinic receptors with both high and low affinity for nicotine are decreased in postmortem brain of schizophrenics compared to control subjects. The chromosomal locus of the human alpha-7 gene (15q14) is linked to the gating deficit with a lod of 5.3, and antagonists of the alpha-7 receptor (alpha-bungarotoxin and methyllycaconitine) induce a loss of gating in rodents. We have cloned the human alpha-7 gene and found it to be partially duplicated proximal to the full-length gene. The duplication is expressed in both the brain and in peripheral blood cells of normal subjects, but is missing in some schizophrenic subjects. The results of these studies suggest the presence of abnormal expression and function of the neuronal nicotinic receptor gene family in schizophrenia.

Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia

BACKGROUND

A recent review suggested an association between using unpublished scales in clinical trials and finding significant results.

AIMS

To determine whether such an association existed in schizophrenia trials.

METHOD

Three hundred trials were randomly selected from the Cochrane Schizophrenia Group's Register. All comparisons between treatment groups and control groups using rating scales were identified. The publication status of each scale was determined and claims of a significant treatment effect were recorded.

RESULTS

Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison (relative risk 1.37 (95% CI 1.12-1.68)). This effect increased when a 'gold-standard' definition of treatment superiority was applied (RR 1.94 (95% CI 1.35-2.79)). In non-pharmacological trials, one-third of 'gold-standard' claims of treatment superiority would not have been made if published scales had been used.

CONCLUSIONS

Unpublished scales are a source of bias in schizophrenia trials.

Sleep-disordered breathing in Duchenne muscular dystrophy: a preliminary study of the role of portable monitoring

Although Duchenne muscular dystrophy (DMD) is often associated with sleep disordered breathing (SDB), it is not standard clinical practice to routinely test this population for SDB, and the optimal timing and methodology for such testing has not been established. Our objectives were: 1) to examine the concordance between laboratory polysomnography (PSG) and two portable monitoring systems, and 2) to identify clinical factors associated with the onset of SDB. We performed a cross-sectional pilot study of patients with DMD who were 6 years of age or older, and who were registered at the Alberta Children's and Calgary General Hospitals. Patient symptom and functional rating scores were calculated, and pulmonary function tests, awake oxygen saturation, and capillary blood gases were obtained. PSG was performed according to standard methods, and results were compared with Snoresat(R) (Saga Tech Electronics, Inc.) and EdenTec(R) (Nellcor Puritan Bennett) portable home monitors. Eleven boys were studied. Ten of 11 subjects had normal awake oxygen saturation and capillary blood gases. Median forced vital capacity (FVC) was 70% of predicted values (15-104%). PSG identified 3 boys with severe hypoventilation occurring throughout REM sleep. Reported symptom severity did not predict the patients with significant SDB. All 3 boys with SDB had a severe functional disability and severely reduced FVCs. Portable monitoring in the home identified all patients with abnormal PSG. One additional patient was falsely identified by the EdenTec(R) monitor. We conclude that initial results using Snoresat(R) or EdenTec(R) monitoring equipment for the identification of SDB are promising, but further validation of portable home monitoring is required in this group of patients.

Use of phage display for the generation of human antibodies that neutralize factor IXa function

The use of libraries of phage-displayed human single-chain antibody fragments (scFv) has become a new, powerful tool in rapidly obtaining therapeutically useful antibodies. Here, we describe the generation of human scFv and F(ab')2 directed against the gamma-carboxyglutamic acid (Gla) domain of coagulation factor IX. A large library of human scFv, displayed either on M13 phage or expressed as soluble proteins, was screened for binding to human Gla-domain peptide (Tyr1-Lys43). Among a panel of scFv that bound to the factor IX-Gla domain, six scFv clones recognized full-length factor IX and exhibited strong inhibitory activity of factor IX in vitro. After reformatting as F(ab')2, the affinity for factor IX of three selected clones was determined: 10C12 Kd = 1.6 nmol/l, 13D1 Kd = 2.9 nmol/l, and 13H6 Kd = 0.46 nmol/l. The antibodies specifically bound to factor IX and not to other coagulation factors, as assessed by enzyme-linked immunosorbent-type and human plasma clotting assays. The complementarity determining region amino acid sequences of clones 10C12 and 13D1 only differed at a single residue, whereas 13H6 showed little homology, suggesting that 13H6 binds to a different epitope within the factor IX-Gla domain. Despite the slightly lower affinity of 10C12 F(ab')2 versus 13H6 F(ab')2, 10C12 was consistently more potent than 13H6 in prolonging the activated partial thromboplastin time (APTT), in inhibiting platelet-mediated plasma clotting, and in inhibiting factor X activation by the intrinsic Xase complex. Finally, 10C12 F(ab')2 also recognized and neutralized factor IX/factor IXa of different species, as demonstrated by the specific APTT prolongation of dog, mouse, baboon and rabbit plasma. In summary, the results validate the usefulness of scFv phage-displayed libraries to rapidly generate fully human antibodies as potential new therapeutics for thrombotic disorders.

Acute melioidosis outbreak in Western Australia

A cluster of acute melioidosis cases occurred in a remote, coastal community in tropical Western Australia. Molecular typing of Burkholderia pseudomallei isolates from culture-confirmed cases and suspected environmental sources by pulsed-field gel electrophoresis (PFGE) of XbaI chromosomal DNA digests showed that a single PFGE type was responsible for five cases of acute infection in a community of around 300 during a 5 week period. This temporal and geographical clustering of acute melioidosis cases provided a unique opportunity to investigate the environmental factors contributing to this disease. B. pseudomallei isolated from a domestic tap at the home of an asymptomatic seroconverter was indistinguishable by PFGE. Possible contributing environmental factors included an unusually acid communal water supply, unrecordable chlorine levels during the probable exposure period, a nearby earth tremor, and gusting winds during the installation of new water and electricity supplies. The possible role of the potable water supply as a source of B. pseudomallei was investigated further.

Smokers' sex and the effects of tobacco cigarettes: subject-rated and physiological measures

Smoking tobacco cigarettes results in characteristic subject-rated and physiological effects in regular tobacco smokers. Few reports have investigated potential sex differences in the physiological and subjective effects produced by tobacco smoking, though previous reports indicate that men and women differ in their tobacco smoking behavior. Sex differences in the subjective and/or physiological effects of smoking may help determine why women find quitting smoking more difficult than men and may help guide gender-specific treatment when planning smoking cessation. This laboratory study investigated sex differences in the subjective and physiological effects of cigarette smoking and smoking behavior in men (n = 38) and women (n = 30) before, during, and after they smoked two of their usual brand of cigarettes through a flowmeter-type puff topography measurement device. Results showed that the reduction in 'desire to smoke' produced by cigarette smoking was greater in women than in men, that the physiological effects of smoking were independent of smokers' sex, and that women take smaller and shorter puffs than men. These results suggest that women may be more sensitive than men to some of the subjective but not the physiological effects of smoking.

[Appetite suppressants and heart valve disorders]

Serotoninergic appetite-suppressant drugs, fenfluramine and dexfenfluramine, were withdrawn from the market in September 1997 on account of two major cardiopulmonary complications: primary pulmonary hypertension and valvular regurgitation. The valvular heart diseases involve mainly left-sided valves, and contrary to physiological valvular regurgitations, they appear mostly on the aortic valve. Prolonged exposure (> 3 months) appears to confer a higher risk of cardiac valve involvement. Pathological features are similar to carcinoid or ergot alkaloid-induced valve diseases, and suggest a common pathophysiological mechanism which would also explain pulmonary hypertension by the toxic effect of high levels of circulating serotonin. After the first reports documenting a dramatically high prevalence of valvular side effects (up to 33% according to the Food and Drug Administration), recent studies reported a lower prevalence and severity. The long-term outcome and the real incidence are unknown and require further research and epidemiological data. A clinical survey of the patients exposed to serotoninergic appetite-suppressants is necessary, to be repeated 6 to 8 months later in the absence of an initial cardiac murmur. Doppler echocardiographic examination should be performed after prolonged exposure (> 3 months) or a high dosage of these drugs, in circumstances such as the presence of cardiovascular symptoms, a cardiac murmur, or an uncertain cardiac examination because of weight of patients.

Searching the right database. A comparison of four databases for psychiatry journals

Journal coverage is one factor that affects the retrieval of relevant information from bibliographic databases. The aims of this study were to investigate the coverage of databases for psychiatry journals, and to assess the overlap between databases. Psychiatry journals were identified using Ulrich's International Periodicals Directory and then analysed to see which bibliographic databases indexed the most journals. A total of 213 abstracting and indexing services were listed as indexing at least one of the 977 psychiatry journals identified. The four most frequently cited databases (PSYCLIT, EMBASE, BIOSIS and MEDLINE) indexed 506 (52%) of the psychiatry journals. Of these 506 journals, PSYCLIT indexed 367 (73%), EMBASE 337 (67%), BIOSIS 243 (48%) and MEDLINE 236 (47%). Combining the databases with the highest yields (PSYCLIT and EMBASE) increased the number of journals indexed to 461 (91%). The four databases combined accounted for 90% of all psychiatry journals found to be indexed by at least one abstracting and indexing service. More than 400 journals were not indexed at all. Variations in the overlap between PSYCLIT, EMBASE, BIOSIS and MEDLINE, and the high proportion (35%) of journals indexed in only one of these four databases emphasize the importance of searching more than one or even two databases to ensure optimal coverage of the literature.

Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta-analysis of randomized trials

OBJECTIVE

The purpose of this study was to evaluate all available trial-based evidence on the effectiveness of clozapine in schizophrenia as compared with conventional neuroleptics.

METHOD

All randomized, controlled trials comparing clozapine with a conventional neuroleptic in which there was satisfactory concealment of patients' treatment allocation were located through electronic searches in all languages of several databases and through contacting authors of recent trials as well as the manufacturer of clozapine. At least two independent reviewers assessed trials for inclusion in the study and extracted data for meta-analysis.

RESULTS

The review included 2,530 randomly assigned participants in 30 trials, most of them short-term. Clozapine-treated patients showed more clinical improvement and experienced significantly fewer relapses during treatment, although the risk of blood dyscrasias in long-term treatment may be as high as 7%. Scores on symptom rating scales showed greater improvement among clozapine-treated patients, who were also more satisfied with their treatment. However, there was no evidence that the superior clinical effect of clozapine is reflected in levels of functioning; on the other hand, global functional and pragmatic outcomes were frequently not reported. Clinical improvement was most pronounced in patients with treatment-resistant illness.

CONCLUSIONS

This meta-analysis confirms that clozapine is more effective than conventional neuroleptics in reducing symptoms of patients with both treatment-resistant and nonresistant schizophrenia. Future trials should be long-term pragmatic community trials or should address the effectiveness of clozapine in special patient populations. An international standard set of outcomes, including pragmatic assessments of functioning, would greatly enhance the comparison and summation of trials and future assessments of effectiveness.

Congenital trismus secondary to masseteric fibrous bands: endoscopically assisted exploration

The authors present an 18-month-old female infant with congenital trismus. Computed tomography and magnetic resonance imaging were not helpful in determining the cause. A surgical endoscope was used to explore her temporomandibular joints and temporal fossae, thus avoiding the morbidity of a bicoronal incision. The cause was bilateral fibrous bands on the anterior border of the masseter muscles. Incision of these fibrous bands led to relief of the trismus. This finding is consistent with a previously described variant of the Hect-Beals-Wilson trismus-pseudocamptodactyly syndrome. This patient, however, had no evidence of the autosomal dominant inheritance pattern nor did she exhibit pseudocamptodactyly, both of which are generally ascribed to this syndrome. Unfortunately the trismus recurred 3 months postoperatively.

Genetic analysis of the 3' untranslated region of the tumour necrosis factor shows a highly conserved region in rheumatoid arthritis affected and unaffected subjects

Tumour necrosis factor (TNF) is a key proinflammatory mediator in rheumatoid arthritis (RA). The TNF locus, situated in the class III region of the MHC, is flanked by five microsatellite markers. It has previously been shown that this region influences susceptibility to RA; two TNF microsatellite haplotypes were found to be associated with RA. Evidence from murine studies has indicated that variation in the TNF 3' untranslated region (UTR) could be associated with altered regulation of TNF biosynthesis. In order to identify possible RA associated polymorphisms, more than 800 bp of the TNF 3' UTR was genetically analysed in RA affected and unaffected subjects possessing specific RA and non-RA associated TNF microsatellite haplotypes. The TNF 3' UTR region was analysed using two mutation detection methods, PCR-SSCP and NIRCA analysis and DNA sequencing. No genetic differences were observed in the human TNF 3' UTR between subjects, that is, irrespective of RA status or TNF haplotype, and also compared with previously published TNF sequences from human sources. Therefore it can be concluded that the TNF 3' UTR in this population was highly conserved and did not influence susceptibility to RA.

Intercessory Prayer for ill Health: A Systematic Review

OBJECTIVES: To review the effectiveness of prayer as an additional intervention for those with health problems already receiving standard medical care. SEARCH STRATEGY: Electronic Searches of Biological Abstracts, CINAHL, The Cochrane Controlled Trials Register, EM-BASE, MEDLINE, PsycLIT, and Sociofile were undertaken. All references of articles selected were searched for further relevant trials. SELECTION CRITERIA: Randomised and quasi-randomised trials of personal, focused, committed and organised intercessory prayer on behalf of anyone with a health problem were considered. Outcomes such as achievement of desired goals, death, illness, quality of life and well-being for the recipients of prayer, those praying and the caregivers were sought. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and assessed for methodological quality. Data were extracted by 4 reviewers working independently. Dichotomous data were analysed on an intention-to-treat basis, and continuous data with over 50% completion rate are presented. MAIN RESULTS: There was no evidence that prayer affected the numbers of people dying from leukaemia or heart disease (OR 0.64, CI 0.32-1.27), or that it decreased coronary care complications (OR 1.05, CI 0.49-2.26) or the time participants stayed in hospital. There were significantly fewer 'intermediat//poor outcomes' for those with heart disease in the prayed-for group (OR 0.49, CI 0.30-0.80), and this finding was robust to some changes in definition. CONCLUSIONS: This review provides no guidance for those wishing to uphold or refute the effect of intercessory prayer on the outcomes studied in the available trials. Therefore, in the light of the best available data, there are no grounds to change current practices. There are very few completed trials of the value of intercessory prayer. The evidence presented so far is interesting enough to justify further study. If prayer is seen as a human endeavour it may or may not be beneficial, and further trials could uncover this. It could be the case that any effects are due to elements beyond present scientific understanding that will, in time, be understood. If any benefit derives from God's response to prayer it may be beyond any such trials to prove or disprove.

Inhibition of N'-nitrosonornicotine-induced esophageal tumorigenesis by 3-phenylpropyl isothiocyanate

The ability of dietary isothiocyanates to inhibit the esophageal metabolism of N'-nitrosonornicotine (NNN) was examined in F344 rats. Following feeding of benzyl isothiocyanate (BITC), phenethyl isothiocyanate (PEITC), 3-phenylpropyl isothiocyanate (PPITC), 4-phenylbutyl isothiocyanate (PBITC) or 6-phenylhexyl isothiocyanate for 2 weeks, rats were killed and the esophagi were incubated in vitro with [5-3H]NNN. While dietary BITC, PEITC and PBITC all decreased NNN metabolism, dietary PPITC had the greatest effect, yielding inhibition ranging from 55 to 91% of the control production of various NNN metabolites. To determine the chemopreventive efficacy of PPITC on NNN-induced esophageal tumorigenesis, rats were fed AIN-76A diets containing 0, 1.0 or 2.5 micromol/g PPITC and were given untreated drinking water or drinking water containing 5 p.p.m. NNN. After 87 weeks, the experiment was terminated and the esophageal tumors were counted. Rats that were given untreated drinking water developed no tumors. Rats that were given 5 p.p.m. NNN and unadulterated AIN-76A diet had an esophageal tumor incidence of 71% and a multiplicity of 1.57 tumors/animal. The two dietary concentrations of PPITC reduced the incidence and multiplicity of NNN-induced esophageal tumors by >95%. These results demonstrate the remarkable chemopreventive efficacy of PPITC in the NNN-induced esophageal tumor model.

Effect of a commercially available nonspecific immunomodulating biologic product on health of neonatal calves

OBJECTIVE

To determine whether treatment with a commercially available nonspecific immunomodulating biologic product would alter the clinical course of disease in neonatal calves.

DESIGN

Systematically randomized, controlled cohort study.

ANIMALS

200 Holstein bull calves 1 to 5 days old.

PROCEDURE

Assessments were performed that included evaluation of fecal consistency, attitude, appetite, and hydration status. Calves with abnormal results were enrolled in the study. Calves were systematically assigned to control or treatment groups (100 calves/group). Calves in the treatment group were given a single i.v. injection of the biologic product at the time of enrollment, whereas control calves were not given the product. Calves were assessed daily for 5 days to evaluate fecal consistency, attitude, appetite, hydration status, and rectal temperature. Assessments were made without knowledge of group assignment.

RESULTS

Treatment with the immunomodulating product was not associated with a decrease in the number of calves that had moderate or severe departures from clinically normal conditions for attitude, appetite, or hydration on days 1 though 5, compared with control calves. Fecal consistency scores were significantly greater for treated calves on days 1 (P = 0.03) and 5 (P = 0.02), compared with scores for control calves.

CLINICAL IMPLICATIONS

Administration of the nonspecific immunomodulating biologic product did not significantly affect outcome of clinical disease for calves in the treated group, compared with calves in the control group. On the basis of results of this study, we cannot recommend use of the nonspecific immunomodulating biologic product for the treatment of undifferentiated diarrheal disease in neonatal calves.

Cartilage formation in a hollow fiber bioreactor studied by proton magnetic resonance microscopy

The ideal in vitro system for investigating the regulation of cartilage formation and maintenance would allow for three-dimensional tissue growth, a wide range of biochemical interventions, and non-destructive evaluation. We have developed a hollow fiber bioreactor (HFBR) system which meets these criteria. After injection with embryonic chick sternal chondrocytes, neocartilage is elaborated around the hollow fibers, reaching a thickness of up to a millimeter after four weeks of growth. This process was monitored over time with nuclear magnetic resonance (NMR) microimaging and correlative biochemical and histologic analyses. Tissue volume and cellularity increased greatly during development. This was accompanied by changes in magnetic resonance properties consistent with increased macromolecular content. Further, tissue heterogeneity, observed as regional variations in cell size in histologic sections, was also observed in quantitative NMR images.

Content and quality of 2000 controlled trials in schizophrenia over 50 years

OBJECTIVE

To provide a comprehensive survey of the content and quality of intervention studies relevant to the treatment of schizophrenia.

DESIGN

Data were extracted from 2000 trials on the Cochrane Schizophrenia Group's register.

MAIN OUTCOME MEASURES

Type and date of publication, country of origin, language, size of study, treatment setting, participant group, interventions, outcomes, and quality of study.

RESULTS

Hospital based drug trials undertaken in the United States were dominant in the sample (54%). Generally, studies were short (54%<6 weeks), small (mean number of patients 65), and poorly reported (64% had a quality score of <=2 (maximum score 5)). Over 600 different interventions were studied in these trials, and 640 different rating scales were used to measure outcome.

CONCLUSIONS

Half a century of studies of limited quality, duration, and clinical utility leave much scope for well planned, conducted, and reported trials. The drug regulatory authorities should stipulate that the results of both explanatory and pragmatic trials are necessary before a compound is given a licence for everyday use.

Effect of exercise training on passive stiffness in locomotor skeletal muscle: role of extracellular matrix

The purpose of this study was to evaluate the effect of endurance exercise training on both locomotor skeletal muscle collagen characteristics and passive stiffness properties in the young adult and old rat. Young (3-mo-old) and senescent (23-mo-old) male Fischer 344 rats were randomly assigned to either a control or exercise training group [young control (YC), old control (OC), young trained (YT), old trained (OT)]. Exercise training consisted of treadmill running at approximately 70% of maximal oxygen consumption (45 min/day, 5 days/wk, for 10 wk). Passive stiffness (stress/strain) of the soleus (Sol) muscle from all four groups was subsequently measured in vitro at 26 degreesC. Stiffness was significantly greater for Sol muscles in OC rats compared with YC rats, but in OT rats exercise training resulted in muscles with stiffness characteristics not different from those in YC rats. Sol muscle collagen concentration and the level of the nonreducible collagen cross-link hydroxylysylpyridinoline (HP) significantly increased from young adulthood to senescence. Although training had no effect on Sol muscle collagen concentration in either age group, it resulted in a significant reduction in the level of Sol muscle HP in OT rats. In contrast, exercise had no effect on HP in the YT animals. These findings indicate that 10 wk of endurance exercise significantly alter the passive viscoelastic properties of Sol muscle in old but not in young adult rats. The coincidental reduction in the principal collagen cross-link HP also observed in response to training in OT muscle highlights the potential role of collagen in influencing passive muscle viscoelastic properties.

Epidemiology and clinical impact of Pseudomonas aeruginosa infection in cystic fibrosis using AP-PCR fingerprinting

Arbitrarily primed PCR (AP-PCR) was utilized to genetically fingerprint 252 Pseudomonas aeruginosa strains isolated from the sputa of 50 cystic fibrosis (CF) patients attending the Cork CF clinic over a period of 3 years. Ten distinct P. aeruginosa strains were identified and the distribution, temporal trends and clinical impact of colonization with these individual P. aeruginosa clones was studied. A number of random isolates from each AP-PCR group were analysed using pulsed field gel electrophoresis (PFGE) in order to confirm the discriminatory power of the AP-PCR technique. The majority of patients were colonized with a single strain over the time period of the study, but it was also possible to harbour two or more strains transiently or simultaneously. Four main strains were relatively evenly distributed throughout the CF population, and it was noted that patients from the same family or attending the same school tended to harbour the same P. aeruginosa clone. Disease severity was significantly associated with the age of the patient (P < 0.001), clearly indicating an increase in severity with increase in age. The general clinical status of the CF patients was not significantly associated with the P. aeruginosa variant isolated from their sputa. Lung status was defined by FEV1 measurement and chest X-ray score (CXR). The non parametric Kruskal-Wallis significance test of FEV1, CXR and age by colonizing P. aeruginosa clone indicated that FEV1 (P = 0.017), but not CXR (P = 0.19) or age (P = 0.842), differed significantly across the clones of P. aeruginosa isolated. Patients harbouring P. aeruginosa strains B, F or G clearly had lower FEV1 scores while those harbouring clones A, C, D or H generally had higher FEV1 scores. Thus, the sub-species variant of P. aeruginosa colonizing CF patients may be associated with the severity of progressive lung disease.

Assessment of the role and reliability of sonographic post-prandial flow response in grading Crohn's disease activity

PURPOSE

To investigate the value of pre and post prandial Duplex colour Doppler sonographic (DCDS) measurement of superior mesenteric artery (SMA) flow in the assessment of Crohn's disease activity, and its response to treatment.

MATERIALS AND METHODS

SMA volume flow rates before and after a food challenge (200 ml of Ensure Plus) were recorded over 60 min in 11 controls, and 25 patients with proven Crohn's disease. Peak flow rates and the time interval to peak flow were recorded. Eleven patients with active disease were monitored longitudinally and their response following the introduction of systemic steroids was assessed.

RESULTS

The time interval from food challenge to peak SMA flow rate was significantly lower in patients with untreated active disease (median 20 min, range 14.5-21.25) compared to inactive patients (median 33 mins, range 28.75-40.5, P = 0.0006). Longitudinal follow-up of active disease demonstrated prolongation of time to peak flow following clinical remission (P = 0.0024)

CONCLUSIONS

This technique is useful in offering an immediate, noninvasive means of assessing disease activity. Further longitudinal follow up data is necessary to determine its utility in assessing response to treatment.

Congenital autosomal dominant distal spinal muscular atrophy

We present a father and son with congenital foot deformity. The father at age 41 years used crutches and the son at 7 years walked unaided. Both had atrophy and weakness of lower leg muscles and mild proximal and hand intrinsic weakness. Knee and ankle myotactic reflexes were absent and sensation was intact. Creatine kinase level was normal, nerve conduction studies wer normal and electromyography showed chronic neurogenic change. In both, nerve biopsies were normal and muscle biopsies showed type 1 predominance. The boy's serum hexosaminidase, spinal MRI and SMN gene were normal. This may be the first well documented example of congenital autosomal dominant distal spinal muscular atrophy affecting legs and arms.