Development of child-centered disease-specific questionnaires for living with asthma

Contemporary developments in the management of chronic diseases such as diabetes and asthma offer possibilities for optimal control, but patients increasingly need to take on responsibilities for self care. Health professionals require comprehensive assessments of outcome that include data reflecting patients' perceptions of their disorder and its management. Disease-specific, patient-centered questionnaires for evaluation of adults' health-related quality of life are available for diabetes and asthma. Little progress is evident in relation to pediatric instruments. This paper describes the development of such an instrument for measurement of 8- to 11-year-olds' perceptions of their asthma--the CAQ-B Psychometric characteristics of the CAQ-B are reported: principal axis factor analysis resulted in the derivation of four subscales reflecting children's perceptions of both active and passive aspects of living with asthma, together with their perceptions of its severity and any associated distress. Preliminary explorations with CAQ-B included comparisons of parents', doctors', and children's ratings of severity; comparisons of data from asthmatic and nonasthmatic children; comparisons of data from boys and girls.

Direct observation of driving, self reports of driver behaviour, and accident involvement

Forty-eight drivers answered a set of written questions about their driving style and drove a pre-defined, mixed urban and motorway route under observation. For 20 drivers there was a second observer in the car to check on inter-observer reliability. Relationships were examined between self-reports of driver behaviour and observers' reports, and between both of these and the number of accidents in which the drivers had been involved in the past three years. The results indicated that there was good inter-observer agreement on a number of important variables including speed, calmness, and attentiveness. Inter-observer reliability for other variables was less good; among these were preferred distance to car in front, use of indicators, and aggressiveness. Observers also showed good agreement on overall ratings of driver skill and safety. Observed speed on the motorway correlated well with drivers' self reports of normal driving speed. Observer ratings of calmness correlated significantly with self-reports of calmness. Also observer ratings of attentiveness and carefulness correlated significantly with self-reports of deviant driving behaviour. Observed speed on the motorway showed a clear positive correlation with self-reported accident involvement. The results indicate that self-reports of certain aspects of driver behaviour can be used as surrogates for observational measures, thus providing a convenient extension to the researcher's methodological armoury. One such aspect is speed which appears to play an important role in accident involvement.

Mild social deviance, Type-A behaviour pattern and decision-making style as predictors of self-reported driving style and traffic accident risk

A 10-item self-report scale for mild social deviance (the Social Motivation Questionnaire) was developed and used in a study examining the role of social deviance in traffic accident risk. The scale focused on self-serving behaviours which might directly or indirectly harm the interests of others. Data were obtained from 108 drivers taking part in a research programme examining a range of factors underlying traffic accident risk. Apart from social deviance scores, measures were taken of Type-A behaviour pattern, decision-making style, self-reported driving style, age, sex, annual mileage, and accidents over a three-year period. The results indicated that the social deviance scale yielded a good spread of values and had adequate intra-scale reliability. Social deviance was positively correlated with accident rates independently of age, sex and annual mileage. The association between social deviance and accident rates appeared to be partly mediated by faster driving speed. The results indicate that, even within the general population, social deviance can show measurable variation and that this variation is predictive of traffic accident risk.

Integrin beta 4 expression in the neoplastic progression of cervical epithelium

Integrin alpha 6 beta 4, a putative laminin receptor, is expressed in normal squamous epithelium and in squamous cell carcinomas. We evaluated by immunohistochemistry the topography of the beta 4 subunit in 35 biopsy samples representative of the sequence from normal exocervical epithelium to invasive squamous cell carcinoma. In normal and metaplastic squamous cervical epithelium, in condylomas, and in squamous epithelium with low-grade dysplasia (CIN 1), beta 4 was detected in basal and parabasal cells. In high-grade CIN (2-3) there was enhanced beta 4 expression and upward shift of beta 4 topography to the whole epithelial thickness. The beta 4 chain was diffusely expressed in most invasive squamous cell carcinomas. These observations suggest that profound alterations in the expression of the alpha 6 beta 4 adhesion glycoprotein occur in the intraepithelial phase of cervical carcinogenesis.

Effect of low and moderate doses of alcohol on driving hazard perception latency and driving speed

Both driving speed and speed of detection of potentially hazardous events while driving have been found to correlate positively with accident rates across individuals. Alcohol ingestion is also known to increase risk of a traffic accident. This paper reports two double-blind, placebo-controlled studies: one on the effect of alcohol on driving speed and the other on the effect of alcohol on time taken to detect potential traffic hazards. Moderate drinkers aged between 30 and 55 took part. Each subject underwent three experimental conditions on separate days: no alcohol, low alcohol (0.025% BAC) and moderate alcohol (0.05% BAC). The order of conditions was counterbalanced. The moderate alcohol dose increased mean time taken to respond to hazards (2.5 s in no alcohol condition compared with 3.2 s in moderate alcohol condition) but did not affect mean driving speed (indexed by time taken to travel sections of a fixed route; 19.3 s in no alcohol compared with 19.0 s in moderate alcohol). The results support the view that at least part of the excess risk of accident associated with alcohol ingestion is attributable to an increase in the time taken to respond to traffic hazards.

Behavioral correlates of individual differences in road-traffic crash risk: an examination method and findings

This article considers methodological issues relevant to the study of differential crash involvement and reviews the findings of research in this area. Aspects of both driving skill and driving style appear to contribute to crash risk. Of the former, hazard-perception latency appears to play an important role, and this may be attributable to generalized abilities to identify visual targets in a complex background and to switch attention rapidly. Of the latter, faster driving speed and willingness to commit driving violations increase crash risk, and these factors may be explicable in terms of personality and antisocial motivation. The article concludes with an examination of the practical implications and of the ways in which research in this area might usefully proceed.

Evidence for nuclear internalization of exogenous DNA into mammalian sperm cells

Mature sperm cells have the spontaneous capacity to take up exogenous DNA. Such DNA specifically interacts with the subacrosomal segment of the sperm head corresponding to the nuclear area. Part of the sperm-bound foreign DNA is further internalized into nuclei. Using end-labelled plasmid DNA we have found that 15-22% of the total sperm bound DNA is associated with nuclei as determined on isolated nuclei. On the basis of autoradiographic analysis, nuclear permeability to exogenous DNA seems to be a wide phenomenon involving the majority of the sperm nuclei. In fact, the foreign DNA, incubated with sperm cells for different lengths of time, is found in 45% (10 min) to 65% (2 hr) of the sperm nuclei. Ultrastructural autoradiography on thin sections of mammalian spermatozoa, preincubated with end-labelled plasmid DNA, shows that the exogenous DNA is internalized into the nucleus. This conclusion is further supported by ultrastructural autoradiographic analysis on thin sections of nuclei isolated from spermatozoa preincubated with end-labelled DNA.

Healing rituals and sacred serpents

Votive tablets found during the excavation of shrines of the Graeco-Roman god of medicine (Asklepios or Aesculapius) associate the healing of superficial lesions with contact with the oral cavity of non-poisonous serpents. We suggest that this may have been the empirical exploitation of the healing properties of salivary growth factors. By immunohistochemistry and immunoblotting we demonstrate the expression of the epidermal growth factor and its receptor in the oral, upper digestive, and salivary epithelia of Elaphe quatuorlineata, a species probably used in healing rituals.

The interaction between exogenous DNA and sperm cells

Epididymal sperm cells, incubated with plasmid DNA, showed a spontaneous tendency to interact with the exogenous nucleic acid. We have investigated the molecular basis of such interaction. Exogenous DNA is taken up by sperm cells over a 15- to 20-min period and is specifically localized on the nuclear area of the sperm head. DNA was reversibly bound to spermatozoa since it can be competed out by excess of cold competitor DNA or by other polyanions as heparin and dextran sulphate. By contrast, poly-L-lysine, a polycation, favours the uptake. DNA molecules of large size (7 kb) were preferentially taken up as compared to smaller ones (150-750 bp). Acidic proteins were also taken up and concentrated, as for DNA, at the nuclear level. These data strongly suggested that ionic interactions may occur between foreign molecules and a substrate located in the sperm head. On the basis of Southwestern analysis, a sperm head protein(s) of 30-35 KD is identified as potential substrate for exogenous DNA binding. Moreover, we have found that seminal plasma contains factor(s) which abolish sperm permeability, exerting a powerful inhibitor effect on DNA uptake. The presence of a specific binding protein for the DNA and of a factor inhibiting such interaction support the existence of a mechanism controlling, through specific factors, the sperm-DNA interaction.

Regional heterogeneity and complementation in the expression of the tumor-associated glycoprotein 72 epitopes in colorectal cancer

We analyzed the immunohistochemical expression of three epitopes of the tumor-associated glycoprotein 72 (TAG-72) in whole cross-sections of primary colorectal carcinomas and in regional lymph node metastases using monoclonal antibodies (MAbs) B72.3, CC-49, and CC-83, which recognize distinct carbohydrate antigenic determinants. B72.3, CC-49, and CC-83 reacted with 13 of 27 (48%), 25 of 27 (92%), and 21 of 27 (77%) carcinomas, respectively. The immunoreactivity with lymph node metastases followed a similar pattern; MAb CC-49 was again the most reactive of the three antibodies, since it labeled 13 of 15 metastatic lesions. Positive reactions of the MAbs with the primary tumors were not always predictive of the immunorecognition of their metastases. Distinct areas within whole cross-sections of TAG-72-positive primary carcinomas demonstrated marked differences in the expression of the three epitopes. CC-49 tended to react with the highest number of areas and with the highest percentages of carcinoma cells within each area. In no instances did B72.3 demonstrate reactivity superior to that of either CC-49 or CC-83. Tumors negative for the CC-49 epitope in any area also did not express the other two TAG-72 epitopes. However, the comparison of the immunostaining obtained with each MAb in TAG-72-positive primary lesions revealed areas where CC-83 was clearly more reactive than CC-49. Moreover, one lymph node metastasis, negative for CC-49, was recognized by CC-83. Thus, the combined use of MAbs CC-49 and CC-83 resulted in additive immunostaining of primary and metastatic colorectal carcinoma cells. The study provides evidence of intratumoral heterogeneity in the glycosylation pattern of the TAG-72 antigen in colorectal cancer and emphasizes the advantages of cocktails of anti-tumor-associated antigen MAbs in the immunodetection of colorectal tumor cells.

HTLV-1-associated myeloneuropathy in an Italian

A 58-year old man presented with slowly progressive spastic paraparesis, ataxia, absent ankle jerks, bladder disturbances, impairment of vibration sense and mental deterioration. Electrophysiological studies documented axonal sensory neuropathy, posterior column and optic nerve involvement. Serum tests for anti-HTLV-1 antibodies were negative but HTLV-1 proviral sequences were consistently demonstrated in white blood cell genomic DNA using the polymerase chain reaction technique. Western blot and polymerase chain reaction assays of sera and DNA from family members were negative for HTLV-1. The most likely cause of infection in this patient was a blood transfusion received 2 years before onset of symptoms. This is the second Italian case of HTLV-1 associated myelopathy and the fourth reported in white subjects living in Europe.

Amplifications of multiple regions of the HTLV-I genome from DNA of an Italian spastic paraparesis patient but not from DNA of multiple sclerosis patients

We searched for evidence of infection by the human T-cell lymphoma/leukemia virus type I (HTLV-I) in patients with multiple sclerosis (40 cases); brainstem encephalitis (1 case); Friedreich's ataxia (1 case); spastic paraparesis of unknown etiology (1 case). All patients were from the region of Abruzzo, Italy. Sera were all negative for anti-HTLV-I reactivity by the Western blotting (WB) analysis. DNAs from peripheral blood mononuclear cells were amplified using the polymerase chain reaction (PCR) technique with primers specific for the HTLV-I gag, pol, and env proviral regions. HTLV-I sequences were amplified only in the patient with spastic paraparesis of unknown etiology. In this case, HTLV-I infection might have been related to blood transfusions received 2 years prior to the onset of the neurologic symptoms. Members of the patient's family were negative for HTLV-I by PCR and WB. These data indicate that HTLV-I associated myelopathy is present also in Italy, but fail to substantiate an association of HTLV-I with multiple sclerosis.

Complementary reactivities of anti-carcinoembryonic antigen and antitumor-associated glycoprotein 72 monoclonal antibodies in lung carcinomas

Monoclonal antibodies (MAbs) COL-4 and COL-12, to the carcinoembryonic antigen (CEA), and B72.3, CC-49, CC-83, to the tumor-associated glycoprotein 72 (TAG-72), were used to study the expression of distinct epitopes of the two molecules in 71 cases of lung carcinoma of differing histotype. These MAbs reacted with the majority of adenocarcinomas by immunoperoxidase on tissue sections, but demonstrated a more restricted reactivity with squamous carcinomas. MAb CC-49 detected the highest percentages of adenocarcinoma cells while the B72.3 epitope was expressed more in squamous carcinoma cells. No significant reactivity with any of these MAbs was observed in small cell carcinomas. The expression of the CEA and TAG-72 epitopes in non-small cell lung cancers was highly heterogeneous: a distinct epitopes in non-small cell lung cancers was highly heterogeneous: a distinct epitope could be expressed by the majority of cells, whereas another of the same antigenic molecule was either poorly or not expressed. In adenocarcinomas, mixtures of anti-CEA, anti-TAG-72, and anti-(TAG-72 plus CEA) MAbs resulted in additive reactivity with an increase of the immunopositive tumors and of the percentages of immunostained cells. This was particularly evident for the anti-(TAG-72 plus CEA) mixture. In squamous cell carcinomas the increase was modest and was mainly related to anti-TAG-72 reactivity. These studies suggest variability in the antigenic structure of tumor-associated antigens expressed by carcinomas and indicate that anti-(TAG-72 plus CEA) mixtures may represent an immunological adjunct for clinical application in adenocarcinoma patients. On the other hand, TAG-72 should be considered a better target antigen, as compared to CEA, in the detection of squamous cell carcinomas.

A molecular and structural analysis of the VH and VK regions of monoclonal antibodies bearing the A48 regulatory idiotype

The results presented in this paper explore the molecular basis for expression of the A48 regulatory Id (RI). A48 RI+ mAb derived from idiotypically manipulated mice molecularly resembled the A48 and UPC 10 prototypes of this system by utilizing a VHX24-Vk10 combination. Id expression by these antibodies was not restricted by a particular D region sequence, JH, or JK segment, but quantitative differences in Id expression were associated with utilization of different members of the VK10 germ-line gene families. The VL sequences of these A48 RI+ mAb has identified amino acid residues lying in four different idiotope-determining regions which may contribute to the structural correlate of this Id. A comparative sequence analysis of the VH regions of these VHX24 utilizing A48 RI+ mAb with several A48 RI+ mAb utilizing VHJ558 or VH7183 VH genes as well as a hybrid transfectoma antibody derived from two A48 RI-, VHJ558 utilizing hybridomas, all suggested that four nonconsecutive positions which lie outside the idiotope-determining regions may contribute structural elements toward expression of this Id. The VH and VL regions of the A48RI+, VHX24-Vk 10+ mAb showed low to moderate levels of somatic mutation which showed different patterns of distribution between the complementary determining region (CDR) and framework regions in the H and L chains. Although the VK sequences contained 50% of the replacement mutations in the CDR, with a replacement/silent mutation ratio of 10, the CDR of the VH sequences contained only 31% of the replacement mutations with a replacement/silent mutation ratio of 0.69.

A molecular and structural analysis of the VH and VK regions of monoclonal antibodies bearing the A48 regulatory idiotype

The results presented in this paper explore the molecular basis for expression of the A48 regulatory Id (RI). A48 RI+ mAb derived from idiotypically manipulated mice molecularly resembled the A48 and UPC 10 prototypes of this system by utilizing a VHX24-Vk10 combination. Id expression by these antibodies was not restricted by a particular D region sequence, JH, or JK segment, but quantitative differences in Id expression were associated with utilization of different members of the VK10 germ-line gene families. The VL sequences of these A48 RI+ mAb has identified amino acid residues lying in four different idiotope-determining regions which may contribute to the structural correlate of this Id. A comparative sequence analysis of the VH regions of these VHX24 utilizing A48 RI+ mAb with several A48 RI+ mAb utilizing VHJ558 or VH7183 VH genes as well as a hybrid transfectoma antibody derived from two A48 RI-, VHJ558 utilizing hybridomas, all suggested that four nonconsecutive positions which lie outside the idiotope-determining regions may contribute structural elements toward expression of this Id. The VH and VL regions of the A48RI+, VHX24-Vk 10+ mAb showed low to moderate levels of somatic mutation which showed different patterns of distribution between the complementary determining region (CDR) and framework regions in the H and L chains. Although the VK sequences contained 50% of the replacement mutations in the CDR, with a replacement/silent mutation ratio of 10, the CDR of the VH sequences contained only 31% of the replacement mutations with a replacement/silent mutation ratio of 0.69.

Expression of int-2 mRNA in human tumors amplified at the int-2 locus

Gene amplification is a relatively frequent event in human malignant tumors and is believed to have an important function in neoplastic transformation and tumor progression. Our attention has been focused on the amplification and the expression of the int-2 gene for several reasons: (1) In the mouse mammary tumorigenesis int-2 is frequently activated by MMTV proviral integration. (2) The human homolog of int-2, located on chromosome 11q13, is frequently amplified in human primary tumors and is comprised in an amplification unit encompassing the hst gene, which is often coamplified; the amplification at the 11q13 locus in breast carcinomas correlates with a poor outcome of the disease. (3) int-2 and hst belong to the basic FGF gene family. All these observations raise the possibility that the human int-2 gene plays an active role in the neoplastic process, but this will prove to be true only if int-2 is expressed in human tumors. In the present study we used RNA:RNA in situ hybridization and Northern blot analysis to show that int-2 gene is expressed in a number of human carcinomas amplified at the same locus.