Biotypes of Haemophilus parainfluenzae from the respiratory secretions in chronic bronchitis

A total of 2401 isolates of Haemophilus parainfluenzae was isolated from respiratory secretions of 36 healthy adults and 128 patients with chronic bronchitis over a period of 1 year. The isolates were allocated to eight biotypes, by their production of indole, urease and ornithine decarboxylase. Biotypes I and II constituted most of the isolates of H. parainfluenzae from the oropharynx of controls (75%) and chronic bronchitics (c. 90%). Among the patients, there was no difference in the isolation rate between oropharyngeal swabs and sputum specimens. Biotypes III, IV, VI, VII and VIII were isolated less frequently, as was a new taxon defined here as biotype V which does not produce indole, urease or ornithine decarboxylase. Biotype III was isolated significantly less frequently from cases of chronic bronchitis than from controls, whereas biotype II was isolated somewhat more frequently from the patients, especially during acute episodes.

Evaluation of the operating room as a surgical teaching venue

Surgical educators are facing changes in residency training that have a direct impact on the opportunity that surgeons and residents have for clinical teaching and learning. The knowledge required of residents continues to escalate. Further, as resident positions are reduced, the opportunity for inter-resident education is decreased. Increased service-to-education ratios may result in resident discontent unless surgeons take an active role in the resident's educational experience. The purpose of this study was to examine the educational activities that occur during the operating-room experience. Technical training in the procedure being done was the primary educational activity, but there were long periods when no form of education was taking place. The operating room provides the teacher and learner with uninterrupted time together, and this time can and should be used for clinical teaching and learning.

Syndesmosis sprains of the ankle. The influence of heterotopic ossification

A retrospective study of 50 syndesmosis sprains in 44 football players was performed. Five patients (6 ankles) were lost to follow-up, allowing review of 44 injuries. Average follow-up was 47 months. The patients were evaluated for recurrent injury, overall ankle function, and for persistent ankle symptoms, including stiffness, pain, limping, and swelling. Follow-up radiographs of the injured ankle were obtained in 22 patients. The average return time to full activity was 31 days. Pain with pushing-off was a major factor preventing return to activity. At final followup, 36% of the patients complained of persistent mild to moderate stiffness of the ankle. Twenty-three percent had mild to moderate pain, usually with activity. One patient had a mild limp with activity, and 18% of the ankles had persistent mild to moderate swelling. Ankle function was rated as good to excellent in 86%. All patients with fair results had recurrent ankle sprains. There were no poor results. Eleven of the 22 patients with follow-up radiographs developed heterotopic ossification within the interosseous membrane, but no patient developed a frank synostosis. The patients with heterotopic ossification required an average of 11 days more recovery time than those without ossification. There was no significant difference between the 2 groups' ultimate ratings of ankle function or ankle symptoms, but the ankles with heterotopic ossification were associated with more recurrent lateral ankle sprains. We conclude that syndesmosis sprains require a longer recovery period than other types of ankle sprains. Most of these injuries showed good to excellent ankle function after recovery, unless there was a recurrent ankle sprain.2+ formation of heterotopic ossification.

Measurement of lysozyme by an enzyme-linked immunosorbent assay

In this study an enzyme-linked immunosorbent assay has been developed for the determination of lysozyme in saliva, serum and urine. The assay relies on the detection of specific protein rather than lytic activity, a property which has been shown to be most suitable for the quantitation of lysozyme in mucin containing substances. Our results indicate that no pretreatment is necessary for the immunochemical method. The assay is sensitive to concentrations as low as 1 microgram lysozyme/l. The intra-assay and inter-assay coefficients of variation were 5.9% and 15.8% respectively. The lysozyme level in whole saliva was 55.53 +/- 30.35 mg/l, in serum the level was 0.64 +/- 0.15 mg/l and in urine it was 0.17 +/- 0.22 mg/l. Comparisons between immunochemical determination and lytic assays showed a good correlation (serum, r = 0.79, P less than 0.01; saliva, r = 0.85, P less than 0.005; treated saliva, r = 0.96, P less than 0.001).

Psychophysiological anomalies in children with emotional and conduct disorders

We studied patterns of psychophysiological (skin conductance, heart rate) reactivity to sounds and to situations with varying emotional and alerting connotations in child psychiatric outpatients and in healthy controls. Children with emotional disorders were particularly reactive to situations with aversive components, while conduct disorder subjects showed increased reactivity to pleasant situations and decreased responses to neutral but high-intensity stimulation and to withdrawal of stimulation in silence periods. The results indicate patterns of biological reactivity which may underlie different psychiatric disturbances in children.

Triacylglycerol Bioassembly in Microspore-Derived Embryos of Brassica napus L. cv Reston

Erucic acid (22:1) was chosen as a marker to study triacylglycerol (TAG) biosynthesis in a Brassica napus L. cv Reston microspore-derived (MD) embryo culture system. TAGs accumulating during embryo development exhibited changes in acyl composition similar to those observed in developing zygotic embryos of the same cv, particularly with respect to erucic and eicosenoic acids. However, MD embryos showed a much higher rate of incorporation of (14)C-erucoyl moieties into TAGs in vitro than zygotic embryos. Homogenates of early-late cotyledonary stage MD embryos (14-29 days in culture) were assessed for the ability to incorporate 22:1 and 18:1 (oleoyl) moieties into glycerolipids. In the presence of [1-(14)C]22:1-coenzyme A (CoA) and various acyl acceptors, including glycerol-3-phosphate (G-3-P), radiolabeled erucoyl moieties were rapidly incorporated into the TAG fraction, but virtually excluded from other Kennedy Pathway intermediates as well as complex polar lipids. This pattern of erucoyl incorporation was unchanged during time course experiments or upon incubation of homogenates with chemicals known to inhibit Kennedy Pathway enzymes. In marked contrast, parallel experiments conducted using [1-(14)C]18:1-CoA and G-3-P indicated that (14)C oleoyl moieties were incorporated into lyso-phosphatidic acids, phosphatidic acids, diacylglycerols, and TAGs of the Kennedy Pathway, as well as other complex polar lipids, such as phosphatidylcholines and phosphatidylethanolamines. When supplied with l-[2-(3)H(N)]G-3-P and [1-(14)C]22:1-CoA, the radiolabeled TAG pool contained both isotopes, indicating G-3-P to be a true acceptor of erucoyl moieties. Radio-high-performance liquid chromatography, argentation thin-layer chromatography/gas chromatography-mass spectrometry, and stereospecific analyses of radiolabeled TAGs indicated that 22:1 was selectively incorporated into the sn-3 position by a highly active diacylglycerol acyltransferase (DGAT; EC 2.3.1.20), while oleoyl moieties were inserted into the sn-1 and sn-2 positions. In the presence of sn-1,2-dierucin and [1-(14)C]22:1-CoA, homogenates and microsomal preparations were able to produce radiolabeled trierucin, a TAG not found endogenously in this species. A 105,000g pellet fraction contained 22:1-CoA:DGAT exhibiting the highest specific activity. The rate of 22:1-CoA:DGAT activity in vitro could more than account for the maximal rate of TAG biosynthesis observed in vivo during embryo development. In double label experiments, G-3-P was shown to stimulate the conversion of [(3)H]phosphatidylcholines to [(3)H]diacylglycerols, which subsequently acted as acceptors for (14)C erucoyl moieties. In vitro, 22:1 moieties did not enter the sn-1 position of TAGs by a postsynthetic modification or transacylation of preformed TAGs.

Steric stabilization of microspheres with grafted polyethylene oxide reduces phagocytosis by rat Kupffer cells in vitro

Sterically stabilized polyethylene oxide-polystyrene copolymer microspheres, (PS-PEO) and charge stabilized polystyrene (PS) microspheres of similar size (1 micron) were prepared in order to compare their uptake by cultured rat Kupffer cells isolated by centrifugal elutriation. The uptake of the sterically stabilized particles was found to be much less than that for the charge stabilized control. The uptake of microspheres stabilized with covalently grafted PEO was lower or equivalent to that of control microspheres stabilized by the adsorption of the non-ionic PEO-polypropylene oxide (PPO-PEO) surfactant Poloxamer 238 or Methoxy-PEO. Phagocytic uptake by Kupffer cells at low and body temperature (8 degrees C and 37 degrees C) demonstrated that PS-PEO particles showed both low adherence and low metabolic uptake. The adsorption of PEO, as Poloxamer 238, to particles with covalently attached or grafted PEO resulted in a synergistic reduction in uptake that was greater than the individual effects of grafting and adsorption alone (P less than or equal to 0.001). It is suggested that this combination produces a more effective steric barrier on the particle surface with the Poloxamer adsorbing to the surface between the grafted PEO chains. The relevance to drug targeting/carrier systems is discussed.

Psychological disturbance and its associations in the children of the Gujarati community

The infrequent referral of Asian children to child psychiatry clinics was noted. By administering Rutter's scale A2 to samples of Gujarati and English parents with children between the ages of 4 and 7 years a lower rate of disturbance was demonstrated among the Asian sample providing an explanation for the original observation. Family and child-rearing factors associated with disturbance were identified.

Duplex ultrasound in the assessment of vascular disease in clinical hypertension

Duplex ultrasound combines B-mode imaging and pulsed Doppler flow analysis and is rapidly becoming the most useful and widely applied method for the evaluation of atherosclerotic arterial disease. Recent technical improvements including color flow Doppler allow its application to practically all vascular beds in the body. Duplex is noninvasive and in many areas its accuracy in the detection of arterial stenosis and occlusion rivals angiography. Duplex ultrasound has become the preferred method of evaluation of patients with cerebrovascular disease. It provides information about the degree of stenosis, location of disease, and plaque characterization, and in many cases replaces standard cerebral arteriography. Duplex ultrasound has been used to detect renal artery stenosis in patients suspected of having renovascular hypertension with an accuracy of 93% in the diagnosis of hemodynamically significant stenosis. It also has important applications in the assessment of mesenteric artery stenosis, peripheral vascular disease, and venous disease. Because it is accurate, reasonably inexpensive, and noninvasive, duplex ultrasound can be used to follow the progression of untreated atherosclerotic lesions throughout the body. Used in this fashion, it provides important information about the natural history of atherosclerotic lesions, their clinical prognosis, and the effect of interventions, either medical or surgical, on lesions.

Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia

There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

Inhibition of adhesion of Haemophilus influenzae to buccal cells by respiratory secretions

The ability of salivary secretions and sputum sol from patients with chronic bronchitis to inhibit the adhesion of non-serotypable Haemophilus influenzae to human buccal epithelial cells has been examined. Specific H. influenzae antibodies were measured by an enzyme-linked immunosorbent assay (ELISA). Saliva and sputum levels of anti-H. influenzae immunoglobulin A (IgA) antibody were related inversely to buccal cell adherence (r = -0.92). Absorption of saliva and sputum sol with H. influenzae removed antibody detected by ELISA but only partially removed inhibition of attachment of bacteria. In patients with a history of recurrent bronchitis significantly more inhibitory activity remained after absorption of the secretory IgA (sIgA) specific antibody compared with patients who were resistant to acute episodes of infection (P less than 0.05). These observations suggest that factors, other than sIgA, are present in respiratory secretions and are capable of modulating H. influenzae attachment to buccal epithelial cells.

Evaluation of a selective medium for the isolation and differentiation of Haemophilus influenzae and Haemophilus parainfluenzae from the respiratory tract of chronic bronchitics

Respiratory tract specimens from chronic bronchitic patients were cultured for Haemophilus species on conventional chocolate agar and a modified sucrose medium in order to determine the accuracy of the new medium in differentiating Haemophilus influenzae from Haemophilus parainfluenzae strains. Haemophilus influenzae biotypes II and III and Haemophilus parainfluenzae biotypes I and II were found to be the predominant strains isolated from the respiratory tract. The modified sucrose medium was found to be a rapid and reliable means of differentiating Haemophilus influenzae from Haemophilus parainfluenzae by sucrose fermentation, on initial isolation.

Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching

Most muscle stretching studies have focused on defining the biomechanical properties of isolated elements of the muscle-tendon unit or on comparing different stretching techniques. We developed an experimental model that was designed to evaluate clinically relevant biomechanical stretching properties in an entire muscle-tendon unit. Our objectives were to characterize the viscoelastic behavior of the muscle-tendon unit and to consider the clinical applications of these viscoelastic properties. Rabbit extensor digitorum longus and tibialis anterior muscle-tendon units were evaluated using methods designed to simulate widely used stretching techniques. Additionally, the effects of varying stretch rates and of reflex influences were evaluated. We found that muscle-tendon units respond viscoelastically to tensile loads. Reflex activity did not influence the biomechanical characteristics of the muscle-tendon unit in this model. Experimental techniques simulating cyclic stretching and static stretching resulted in sustained muscle-tendon unit elongations, suggesting that greater flexibility can result if these techniques are used in the clinical setting. With repetitive stretching, we found that after four stretches there was little alteration of the muscle-tendon unit, implying that a minimum number of stretches will lead to most of the elongation in repetitive stretching. Also, greater peak tensions and greater energy absorptions occurred at faster stretch rates, suggesting that the risk of injury in a stretching regimen may be related to the stretch rate, and not to the actual technique. All of these clinically important considerations can be related to the viscoelastic characteristics of the muscle-tendon unit.

Storage-protein regulation and lipid accumulation in microspore embryos of Brassica napus L

Embryos derived in vitro from isolated microspores of Brassica napus L. were compared with their zygotic counterparts. Parameters investigated included storage-protein accumulation and gene expression, fattyacid composition, storage-lipid biosynthesis, and the appearance of oil-body proteins. The microspore embryos accumulate storage-protein and show increases in levels of their transcripts during the torpedo stage. These embryos were sensitive to abscisic acid (ABA) with respect to accumulation of storage-protein mRNA and oil-body proteins. Post-transcriptional regulation of cruciferin accumulation is indicated by a disparity between ABA-enhanced transcript accumulation and a less marked effect at the level of protein accumulation. To investigate storage-lipid profiles, two cultivars of Brassica napus, Reston and Topas, were used. The former accumulates major quantities of C20 (11.2%) and C22 (39.9%) fatty acids in its seeds, the latter predominantly C18 fatty acids. The higher-molecular-weight fatty acids (>C18) normally occur only in seeds and were used as biochemical markers for seed-specific metabolism in microspore embryos. Microspore embryos from Reston were found to accumulate C20 (10.6%) and C22 (31.2%) fatty acids after 35 d in culture at levels and proportions comparable to those found in seeds. Similarly, microspore embryos of Topas had a fatty-acid profile similar to that of mature Topas seed. Activities of enzymes involved in the accumulation of storage lipids (erucoyl-CoA synthetase [EC 6.2.1.3], erucoyl-CoA thioesterase [EC 3.1.2.2] and erucoyl-CoA acyltransferase [EC 2.3.1.15 or EC 2.3.1.20]) were detected in torpedostage microspore embryos. Their specific activities were higher than have been reported to date for analogous preparations from zygotic embryos of B. napus. The similarities in storage-lipid and protein composition of these embryos to their zygotic counterparts, along with their sensitivity to ABA, indicate that microspore embryos might be exploited to facilitate studies of biochemistry and gene regulation in oilseeds.

A simple enzymatic method for the preparation of radiolabeled erucoyl-CoA and other long-chain fatty acyl-CoAs and their characterization by mass spectrometry

A simple two-step method for the biosynthesis of radiolabeled erucoyl-coenzyme A of high specific activity and other long-chain fatty acyl-coenzyme A (acyl-CoA) thioesters is reported. 1-14C-labeled erucic and oleic acids, as well as unlabeled ricinoleic and nervonic acids, were incubated at 35 degrees C with coenzyme A in the presence of ATP, MgCl2, and acyl-CoA synthetase (EC 6.2.1.3) from Pseudomonas spp. to yield the corresponding CoA thioesters. Following incubation, each thioester was purified by rapid passage through a disposable reverse-phase C18 extraction column. The overall yields were greater than 90% and the purities greater than 95%, based on the distribution of radioactivity, and chromatographic and spectral properties. Fast ion bombardment-mass spectrometry was employed to confirm the structures of the various acyl-CoAs.

Peripheral psychophysiological reactivity to mental tasks in children with psychiatric disorders

Peripheral psychophysiological reactivity (skin conductance and heart rate changes) to mental activity tasks (imagery and listening to music) was examined in child psychiatric day or in-patients with conduct and emotional disorders. Children with predominant antisocial symptomatology showed higher electrodermal than cardiovascular reactivity to the experimental tasks, whilst children with predominant neurotic symptoms showed more marked cardiovascular reactivity. No statistical differences between the groups emerged in response to listening to music, but antisocials were more responsive (with higher skin conductance level increases) to imaging pleasant situations, whereas neurotics were more reactive (increased heart rate levels and decreases in skin conductance) to imaging unpleasant situations. The results are compatible with an enhanced biological responsiveness by antisocials to reward and with neurotics experiencing an unusually marked sense of threat and withdrawal to aversive stimuli.

Asymptomatic high-grade internal carotid artery stenosis: is stratification according to risk factors or duplex spectral analysis possible?

High-grade (80% to 99% diameter reduction) asymptomatic internal carotid artery stenoses are associated with an increased neurologic event rate (transient ischemic attack, stroke, asymptomatic internal carotid artery occlusion) compared to less severe asymptomatic lesions. However, many do remain free of associated events. To determine which are most dangerous, we compared risk factors and duplex scan results in two groups with asymptomatic high-grade internal carotid artery stenoses. Group A included 31 patients with 33 unoperated high-grade lesions that remained asymptomatic for at least 12 months (mean 30 months). Group B included 25 patients with 26 initially asymptomatic lesions that subsequently were associated with a neurologic event (mean time to event 7.4 months). The groups did not differ significantly in average age, sex, aspirin use, smoking, or prevalence of hypertension, diabetes, or cardiac disease. With respect to the index high-grade lesion, there was no difference in the frequency of a greater than 50% contralateral internal carotid artery stenosis or greater than 50% ipsilateral external carotid stenosis. However, on duplex scanning, high-grade stenoses with greater than 6.5 kHz end-diastolic frequencies were more frequently associated with an event than high-grade lesions with lower end-diastolic frequency (p = 0.0004). Similarly, seven of 23 lesions (30%) with end-diastolic frequency greater than 6.0 kHz were associated with subsequent internal carotid artery occlusion compared to only one of 29 (3.5%) with end-diastolic frequency less than or equal to 6.0 kHz (p = 0.025). Analysis of internal carotid artery end-diastolic frequency may help select a subgroup of patients with asymptomatic high-grade lesions who are at greatest risk for subsequent neurologic symptoms or ICA occlusion or both.

Hysteria, belief, and magic

“We cannot command nature except by obeying her” (Bacon)

Follow-up of renal artery stenosis by duplex ultrasound

We have previously shown that duplex ultrasound is an accurate method of diagnosing renal artery stenosis (93% accuracy compared with angiography in the diagnosis of less than 60% stenosis, 60% to 99% stenosis, or occlusion). With this method we have now serially observed 35 renal arteries with 60% to 99% renal artery stenosis in 27 patients. Nineteen stenotic renal arteries in 15 patients were observed without intervention. There was a significant decrease in kidney size (mean difference - 1.0 cm; p less than 0.01; mean follow-up 13 months) but all 19 renal arteries remained patent. Percutaneous transluminal angioplasty (PTA) was performed in five patients (six renal arteries) for renovascular hypertension. Renal duplex scanning documented relief of renal artery stenosis in two patients whose hypertension improved after PTA and confirmed residual 60% to 99% renal artery stenosis in three patients whose hypertension did not improve after PTA (mean follow-up 6.5 months). Aortorenal bypass was performed for 10 stenotic renal arteries in seven patients. At a mean follow-up of 9 months duplex ultrasound documented eight patent and two occluded aortorenal bypass grafts. Duplex ultrasound is useful both for defining the natural history of untreated renal artery stenosis and assessing the results of renal artery angioplasty or bypass.

Overflow movements and cognitive, motor and behavioural disturbance: a normative study of girls

This study established norms for overflow movements of girls on the Modified Fog Test (MFT) of neurological function and investigated the relationship between high levels of overflow and behavioural and cognitive measures. 193 girls aged seven to 10 years, from suburban and inner-city areas, were examined for overflow, co-ordination and handedness, and completed cognitive and reading tests. Teachers' assessments of performance and behaviour at school were obtained and the parents of 147 girls were interviewed about developmental history, psychosocial situation and current behaviour. As predicted, there was a highly significant reduction in the amount of overflow with increasing age. Left-handed girls showed more overflow on the right side, in contrast to right- and mixed-handed girls. Girls in a combined group of 'poor performers' on the MFT were significantly more likely to show behaviour problems at school, and to be judged poor scholastically. They had significantly lower reading scores, were judged poor at handwriting and school sport, and scored lower on the Gubbay clap and catch task.

Duplex ultrasound measurement of postprandial intestinal blood flow: effect of meal composition

Duplex ultrasound was used to evaluate the effects of 350-cal, 300-ml protein, fat, carbohydrate, and mixed (Ensure-Plus) liquid meals on celiac, superior mesenteric, and femoral artery blood flow in 7 healthy volunteers. Ingestion of separate water and mannitol solutions served as controls for volume and osmolarity. Duplex parameters of peak systolic velocity, end-diastolic velocity, mean velocity, and volume flow were determined before, and serially for 90 min after, ingestion of each test meal. Maximal changes were compared with baseline values. There were no significant changes in any of the blood flow parameters derived from the celiac or femoral arteries after any test meal ingested. In contrast, maximal changes in all superior mesenteric artery parameters were increased significantly over baseline (p less than 0.05) after each of the test meals except water, with end-diastolic velocity showing proportionally the greatest increase. The study demonstrates that duplex ultrasound can provide a noninvasive means of studying the reactivity of the splanchnic arterial circulation to different stimuli and documents differing blood flow responses to variation of nutrients.