Immunoblotting of multiple antigenic peptides

Multiple antigenic peptides (MAPs) can be efficiently separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and transferred to a nitrocellulose membrane for subsequent use in immunoblot (IgG and IgM). MAPs can be stained by Coomassie and silver on SDS-PAGE as well as by Fast Green on an immunoblot. Affinity immunoblotting for analysis of antibody clonotype distribution has also been carried out using MAPs. High performance liquid chromatography purification of the MAPs is mainly responsible for their migration as sharp bands in SDS-PAGE and immunoblotting.

Regulation of decidual cell and chorion cell production of interleukin-10 by purified bacterial products

PROBLEM

To determine whether cultured human decidual cells and chorion cells produce interleukin-10 (IL-10) after incubation with purified bacterial products.

METHOD OF STUDY

Decidual cell cultures and chorion cell cultures were established by standard techniques. With confluence, monolayers of each culture were incubated with purified bacterial products, including various concentrations of lipopolysaccharide (LPS), lipid A, and lipoteichoic acid (LTA) for 16 hr in quadruplicate. Culture supernatants were collected and assayed for immunodetectable IL-10 by enzyme-linked immunoadsorbent assay (ELISA).

RESULTS

Both decidual cell cultures and chorion cell cultures produced significant quantities of IL-10 after stimulation with LPS, lipid A, and LTA. Cultures of decidual cells produced more IL-10 than did chorion cell cultures.

CONCLUSIONS

Our data indicate that both maternal decidual cells and fetally derived chorion cells can produce IL-10 after incubation with bacterial virulence factors. This finding contrasts with our previous findings in which chorion cells did not produce IL-10 after stimulation with IL-1 beta, suggesting that chorion cell production after incubation with bacterial products is independent of IL-1 beta. We speculate that the contribution of anti-inflammatory IL-10 production by human gestational tissues to the inflammatory process in these tissues may be overcome or abrogated by the pro-inflammatory process.

Cochlear implants in children: what constitutes a complication?

The surgeon must ultimately accept the responsibility for any complications that occur as the result of a cochlear implant. Listening to the cochlear implant team members and responding to their needs may enhance the child's progress. Surgical complications, (i.e., skinflap problems, infection, and facial paralysis) are indeed infrequent, but nonsurgical problems are not. Surgical and nonsurgical experiences were reviewed in 55 children. Ages ranged from 23 months to 18 years at the time of cochlear implantation, which occurred from 1984 to 1995. There were no surgical complications. However, the most common surgical obstacle was ossification, which was present in 40% and undetected by computed tomographic scanning in 16.3% of children. Ossification occurred at the round window and scala tympani in 32.7% and involved the cochlea more extensively in 7.3% of children. In only one child was the cochlea entirely ossified. There were, however, many nonsurgical problems that were viewed as complications in patient management. The single most important complication was device failure. This occurred in 10.9% (5/46) of children with the Cochlear Corporation multichannel implant. Head banging and other temper tantrums, parental interference with rehabilitation, socioeconomic factors, poor compliance by the family unit, equipment problems, educational deficiencies, and impatience with habilitative training were some of the other problems.

Using nursing standards to evaluate competency

A competency evaluation program uses nursing standards to link performance management, quality improvement and education to patient care outcomes. This program enables nurse managers to capitalize on the data already available to them and helps meet the Joint Commission on Accreditation of Healthcare Organizations standards. An orientation competency assessment and an annual competency evaluation are provided.

Understanding and enhancing compliance with the second dose of hepatitis B vaccine: a cohort analysis and a randomized controlled trial

OBJECTIVE

To determine the predictors and extent of noncompliance with a second dose of hepatitis B vaccine and the effectiveness of a compliance enhancement strategy.

DESIGN

Cohort analysis and randomized clinical trial.

SUBJECTS

A total of 256 consecutive adults attending a sexually transmitted diseases clinic from October 1992 to July 1993 who were seronegative for hepatitis B virus and agreed to receive hepatitis B vaccination.

SETTING

Hamilton, Ont.

INTERVENTION

Subjects were followed up for 4 months. Those who did not return for the second dose of vaccine by 6 weeks after the first (2 weeks overdue) were randomly assigned to the enhanced intervention group (telephone and mail reminders) or the regular intervention group (mail reminder only). Subjects were considered noncompliant if they did not return for the second dose by 4 months after the first.

RESULTS

The risk of not returning for the second dose of vaccine within 4 months after the first was strongly and linearly associated with level of education (p = 0.004). The noncompliance rate among those with less than a grade 10 education was 50%, grade 10-13 education 34%, some college education 15% and some university education 9%. In the randomized controlled trial the enhanced intervention group had twice the compliance rate of the regular intervention group (48% v. 25%; p = 0.008). Subjects with no postsecondary education were highly responsive to the enhanced intervention (relative risk 2.1; p = 0.02) compared with those with a higher level of education (relative risk 1.0; p = 1.0).

CONCLUSION

Hepatitis B vaccine recipients with lower educational levels are at increased risk of noncompliance with the second dose of vaccine but are highly responsive to telephone reminders.

Growth hormone, gonad development, and steroid levels in female carp

The pituitary and plasma growth hormone (GH) levels of female carp (Cyprinus carpio L.) were measured in fish of various sizes and degrees of maturity, and were matched against the levels of 17 beta-estradiol (E2), testosterone (T), 17 alpha-hydroxyprogesterone (17-P), and progesterone (P) in the ovary and plasma. The short-term action of the above hormones and 17 alpha, 20 beta-dihydroxy-4-pregnen-3-one (17,20-P) on the release of GH was examined in vitro in primary culture pituitary cells. The gonadosomatic index (%GSI) increased rapidly in specimens when they had attained 900 +/- 50 g body weight (BW). The pituitary and plasma GH levels increased between 150 and 600 g BW (when oocytes reached the stage at which lipoprotein appeared in the cytoplasm), but at 900 g BW (with oocytes in vitellogenesis) the plasma GH dropped, while pituitary GH remained high. E2 increased with BW, reaching its maximum at 600 and 900 g BW in the ovary and plasma, respectively. Similar patterns were found in the levels of T and P, both hormones reaching their maximum levels at 900 g BW. The level of 17-P was very low and did not increase in proportion to BW. The application of various concentrations of different steroids on a primary culture of pituitary cells led to release of GH. The highest degrees of release were obtained from 10(-6) and 10(-7) M E2, 10(-6) M T, 10(-7) M 17-P and 10(-8) M 17,20-P. In all these cases, hormone treatment effected higher release of GH than was found in the control. A model of the relationship between GH and the steroids associated with maturation is proposed.

Use of data from a hospital online medical records system by physicians during preanesthetic evaluation

OBJECTIVE

There is no data on the use of hospital-wide online medical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied.

METHODS

In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patient's record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of how much data was copied, the number of characters was also recorded.

RESULTS

Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfully retrieved data from the patient's record. Data was copied for 170 patients - 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied-an average of 1,543 characters per instance of copying.

CONCLUSION

We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR data-base, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.

Token reinforcement, choice, and self-control in pigeons

Pigeons were exposed to self-control procedures that involved illumination of light-emitting diodes (LEDs) as a form of token reinforcement. In a discrete-trials arrangement, subjects chose between one and three LEDs; each LED was exchangeable for 2-s access to food during distinct posttrial exchange periods. In Experiment 1, subjects generally preferred the immediate presentation of a single LED over the delayed presentation of three LEDs, but differences in the delay to the exchange period between the two options prevented a clear assessment of the relative influence of LED delay and exchange-period delay as determinants of choice. In Experiment 2, in which delays to the exchange period from either alternative were equal in most conditions, all subjects preferred the delayed three LEDs more often than in Experiment-1. In Experiment 3, subjects preferred the option that resulted in a greater amount of food more often if the choices also produced LEDs than if they did not. In Experiment 4, preference for the delayed three LEDs was obtained when delays to the exchange period were equal, but reversed in favor of an immediate single LED when the latter choice also resulted in quicker access to exchange periods. The overall pattern of results suggests that (a) delay to the exchange period is a more critical determinant of choice than is delay to token presentation; (b) tokens may function as conditioned reinforcers, although their discriminative properties may be responsible for the self-control that occurs under token reinforcer arrangements; and (c) previously reported differences in the self-control choices of humans and pigeons may have resulted at least in part from the procedural conventions of using token reinforcers with human subjects and food reinforcers with pigeon subjects.

Circadian blood pressure variation versus renal function

Several published reports describe an abnormal circadian blood pressure profile in chronic renal failure subjects. Factors other than renal failure, including age, diagnosis of diabetes mellitus, autonomic dysfunction, and race, also may affect circadian blood pressure profiles. To further elucidate the relationship between renal function and circadian blood pressure variation, we compared day/night circadian blood pressure changes in three groups of male veteran hypertensive patients: group A, creatinine clearance (CC) > 80 mL/min, n = 20; group B, CC 20 to 80 mL/min, n = 19; and group C, CC < 20 mL/min, n = 14. We use postural changes in catecholamines, renin, and aldosterone as a measure of autonomic function. No significant difference in day/night percent change in systolic, diastolic, mean arterial pressure (MAP), or heart rate was seen by renal function group. Regression analysis using age, diagnosis of diabetes mellitus, postural hormonal changes, and creatinine clearance found race to be the only significant predictor of the day/night percent change in MAP (P < 0.05). Compared with whites, black subjects had higher nocturnal heart rates (P = 0.01); smaller day/night heart rate changes (P = 0.03); significantly higher diastolic blood pressure (P = 0.01); and a trend toward smaller day/night change in diastolic blood pressure (P = 0.06). In conclusion, renal function level does not influence day/night blood pressure changes. The blunting or reversal of the normal circadian blood pressure pattern seen in some chronic renal failure hypertensive subjects may be attributable to the association between chronic renal failure and cofactors associated with abnormal circadian blood pressure, including black race and possibly severity of atherosclerosis.

Retroviral-like sequences specifically expressed in the rat ovary detect genetic differences between normal and transformed rat ovarian surface epithelial cells

We have identified a repetitive DNA element in the rat genome that we demonstrate to be suitable to detect molecular genetic differences between normal and malignantly transformed rat ovarian surface epithelial cells by genome scanning. With fluorescence in situ hybridization, we show that these elements are widely distributed in the rat genome, and that a member of this family is present within a homogeneously staining chromosomal region of tumorigenic rat ovarian surface epithelial cells. The homogeneously staining chromosomal region infers the presence of an amplified DNA sequence in the tumor cells, and we provide molecular evidence for an amplicon in this DNA by genome scanning using a probe related to these elements. Sequence analysis revealed that these elements have the structural features of retroviral DNA. We show that they are transcriptionally active in the rat ovary, but not in a wide range of other normal rat tissues. In situ hybridization to ovarian tissue sections revealed that the elements are expressed in granulosa and theca interna cells and in the surface epithelial cells adjacent to preovulatory follicles. Based on this property, we refer to these retroviral-like elements as ovary-specific transcribed sequences. Partial sequence analysis of multiple members of this family and the range in transcript sizes strongly suggest that multiple members of this retrovirus-like family are transcriptionally active. We speculate that binding by one or a combination of ovary-specific transcription factors to regulatory sequences within the genomic ovary-specific transcribed sequences units contributes to the tissue specificity of their expression.

Molecular method for typing Mycobacterium ulcerans

A cluster of Mycobacterium ulcerans infections has recently occurred on Phillip Island, Victoria, Australia. Previous cases of infection have generally been located around Bairnsdale in southeast Gippsland. The aim of this study was to determine the epidemiological relationship between these strains and other strains originating in Australia and Africa. The previously described plasmid pTBN12 was used as a probe with restriction enzyme-digested chromosomal DNA to differentiate the strains of M. ulcerans. The probe was able to distinguish 11 restriction fragment length polymorphisms (RFLPs). Forty-three strains originating in Victoria were divided into three types, i.e., V1, V2, and V3. The majority of strains (40) yielded a type V1 pattern, including strains from southeast Gippsland. Fourteen strains from Queensland yielded three additional RFLP types, i.e., Q1, Q2, and Q3. Five strains from Benin and seven strains from Zaire yielded five additional RFLP types. It is envisaged that molecular typing of M. ulcerans strains from around the world may have a great impact on understanding of the epidemiology of infection with this organism.

RGDFAP: platelet aggregation inhibitory and profibrinolytic hybrid peptide (RGDF coupled with the carboxy terminal part of alpha 2-antiplasmin) enhances plasminogen binding to platelets

As published in a recent issue of Blood Coagulation and Fibrinolysis, the hybrid peptide RGDFAP, composed of RGDF (Arg-Gly-Asp-Phe) coupled to a synthetic peptide residue of the carboxy terminal part of antiplasmin (AP26) inhibited platelet activation and augmented plasmin generation and in vitro fibrin clot lysis. This peptide contains an RGD motif which provides linkage to platelet GP IIb-IIIa. The antiplasmin part of the molecule may attach free plasminogen, which in turn increases the amount of platelet surface bound plasminogen, probably yielding enhanced lytic action at the site of thrombus formation. This hypothesis was investigated and confirmed by the results of platelet-plasminogen binding assays, using FITC-labelled antiplasmin antibodies and radioligand binding analysis. Increased platelet-linked plasminogen was detected by a chromogenic method, along with the acceleration of in vitro lysis of platelet-rich clots in the presence of RGDFAP peptide.

The effect of sleep intervals on analysis of 24-h ambulatory blood pressure data

Twenty-four hour blood pressure exposure and circadian blood pressure variability may be important predictors of hypertensive end-organ damage. Since sleep is a major determinant of circadian blood pressure decline, day/night blood pressure changes may be affected by sleep intervals. The current study compares 24-h blood pressure results with and without adjustment for patient-specific sleep intervals. Forty male hypertensive patients (22 with renal insufficiency and 18 with normal renal function) underwent 24-h blood pressure study with SpaceLabs 90207 monitors. They also filled out sleep questionnaires to evaluate time awake and asleep during the day and night intervals. Data was analyzed with and without adjustment for daytime asleep and nighttime awake intervals. The percent change in systolic, diastolic, and mean arterial pressure as well as heart rate was not different statistically or clinically with or without adjustment for sleep intervals. Nevertheless, there was a progressive increase in the day versus night percent change in these hemodynamic parameters with adjustment for sleep intervals. When we used arbitrary cut-offs to define "non-dipper", ie, less than 10% drop in a given hemodynamic parameter, and used patient-specific sleep intervals, clinically and statistically different numbers of "non-dippers" were seen versus sleep unadjusted data (19 v 12, using diastolic BP, P < .01). In conclusion, it may not be necessary to adjust for sleep intervals when relating 24-h blood pressure and day/night blood pressure variability to hypertensive end-organ damage. However, arbitrary cut-offs to define "non-dippers" may be greatly and capriciously affected by sleep/awake intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocturnal blood pressure measurement: can it be predicted by self-monitoring and is 24-hr BP monitoring clinically important in the treatment of hypertension

We predict that 24-hour blood pressure data will be required prior to starting treatment in order to receive third-party payment. We are currently performing a cost benefit analysis in patients with mild to moderate hypertension to see the prevalence of inappropriate treatment of hypertension (diagnosed by normal 24-hour BP results) in an outpatient clinic population. We will compare the cost of treating that segment of the population that is inappropriately on treatment to the cost of 24-hour BP monitoring for the entire study population. As a result of this type of analysis, health care payors may require 24-hour BP documentation prior to hypertension treatment for all cases of mild to moderate hypertension.

Hybrid peptide containing RGDF (Arg-Gly-Asp-Phe) coupled with the carboxy terminal part of alpha 2-antiplasmin capable of inhibiting platelet aggregation and promoting fibrinolysis

The aim of this study was to synthesize and investigate hybrid peptides which contain the RGD (Arg-Gly-Asp) sequence coupled with lysine residues in special arrangements (antiplasmin carboxyterminal peptide) in an effort to simultaneously inhibit platelet aggregation and promote fibrinolysis. The in vitro haemostatic modifying properties of the synthesized peptides were tested by ADP-induced platelet aggregation, plasmin-generation tests and fibrin-clot lysis assays. The hybrid peptide RGDFAP, composed of RGDF (Arg-Gly-Asp-Phe) coupled to a synthetic peptide residue of the carboxyterminal part of antiplasmin (AP26) inhibited platelet activation and increased plasmin generation and in vitro fibrin-clot lysis.

[A new thrombocyte aggregation-inhibiting and fibrinolysis-promoting synthetic molecule: RGDF (Arg-Gly-Asp-Phe) coupled with the carboxyterminal antiplasmin peptide]

OBJECTIVE

Synthesize such hybrid peptides, which contain the RGD (Arg-Gly-Asp) sequence coupled with another peptide containing lysine residues in special positions, to inhibit simultaneously platelet activation and promote fibrinolytic processes.

DESIGN

The in vitro haemostasis modifying properties of the synthesized peptides were tested with ADP induced platelet aggregation, in vitro plasmin generation tests and fibrin-clot lysis assays.

RESULTS AND CONCLUSIONS

RGDF (Arg-Gly-Asp-Phe) coupled with the carboxyterminal antiplasmin peptide (RGDFAP hybrid molecule) has a common concentration range for inhibiting platelet activation and increase plasmin generation along with accelerated in vitro fibrin-clot lysis.

Parenting and childrearing attitudes among high school students

A descriptive study to assess parenting and childrearing attitudes was conducted among 502 high school students in a greater metropolitan area in the Southeast. The Adult-Adolescent Parenting Inventory (Bavolek, 1984) was used to identify students' scores on four constructs associated with abusive parenting: inappropriate parental expectations, lack of empathy toward the child, value of physical punishment, and parent-child role reversal. Several group differences were found by sex, race, grade, and birth order. Ten percent of students scored consistently low and could be targeted for education programs to increase parenting knowledge and skill.

Effects of raclopride treatment on plasma and CSF HVA: relationships with clinical improvement in male schizophrenics

Thirty-two acutely psychotic, male schizophrenic patients received raclopride, at 2, 6, or 12 mg/day, or haloperidol, 15 mg/day for 4 weeks after randomized, double-blind assignment. Twenty-six patients, including 19 who had been assigned one of the three doses of raclopride, completed the study. Raclopride, particularly at 12 mg/day, increased CSF homovanillic acid (HVA) at 4 weeks, and plasma HVA at 2 days, of treatment. The clinical response to raclopride was significantly correlated with plasma raclopride concentrations and baseline plasma HVA concentrations. Although raclopride is a substituted benzamide with atypical properties in animals, these results suggest that the doses of raclopride required for clinical efficacy and elevation of clinical indices of brain dopamine turnover are similar.

The Homeless Prenatal Program: a model for empowering homeless pregnant women

The Homeless Prenatal Program (HPP) is one of the first programs in the country to provide comprehensive prenatal services to homeless pregnant women. A formative evaluation was conducted in 1992, indicating that HPP is achieving its program goals of improving birth outcomes and transforming the lives of its clients. Results of the qualitative evaluation are presented, including HPP's service model and approach to empowerment. In this model, empowerment has two central tenets, derived from the special needs of women who are pregnant and homeless: the "mother-child connection," and the principle of "giving back."

Analysis of intrabolus forces in patients with Zenker's diverticulum

This report presents 10 patients with Zenker's diverticulum who were evaluated with simultaneous solid-state manometry and fluoroscopy. With this method, intrabolus forces are determined. Each patient had abnormal intrabolus forces regardless of the size of the diverticulum and cricopharyngeal muscle dysfunction. In the literature, there has been conflicting manometry results when studying Zenker's diverticulum. The use of analysis of intrabolus forces increases the sensitivity of manometric evaluation. This study establishes pressure abnormality in the pharyngoesophageal segment of patients with Zenker's diverticulum. The pathogenesis of Zenker's is presented based on these findings.

Undulator radiation for at-wavelength interferometry of optics for extreme-ultraviolet lithography

Techniques are described for at-wavelength interferometry of multilayer coated optics designed for use in extreme-ultraviolet lithography. Broadly tunable undulator radiation, which covers the spectral region from 45 to 400 A, is described. The coherent power available at these wavelengths is described, and several types of interferometer that might be suitable at these short wavelengths are also described.

Epidural clonidine treatment for refractory reflex sympathetic dystrophy

BACKGROUND

Intraspinally administered alpha 2-adrenergic agonists may relieve pain in sympathetically maintained pain (SMP) syndromes, such as reflex sympathetically dystrophy (RSD), by spinal, peripheral, and central nervous system actions. This study examined analgesic efficacy and side effects of epidurally administered clonidine in patients with severe, refractory RSD.

METHODS

Twenty-six patients with severe chronic pain consistent with RSD were studied in a randomized, blinded, placebo-controlled design. Cervical or lumbar epidural catheters were inserted for patients with upper or lower extremity RSD, respectively, and patients received, in random order on three consecutive days, epidural injection of clonidine, 300 or 700 micrograms, or placebo. Pain (by visual analog score (VAS) and McGill Pain Questionnaire), sedation, blood pressure, and heart rate were monitored at specified intervals for 6 h after injection. Patients who responded to clonidine, but not placebo, then entered a trial of open-label, continuous epidural infusion of clonidine (10-50 micrograms/h).

RESULTS

Clonidine, but not placebo, caused pain relief, sedation, and decreased blood pressure and heart rate after bolus epidural injection. The smaller clonidine dose (300 micrograms), produced pain relief and decreases in blood pressure and heart rate similar to those of the 700 micrograms dose, but with less sedation. Epidural clonidine was infused for a mean of 43 days in 19 patients at a mean rate of 32 micrograms/h for sustained analgesia.

CONCLUSIONS

Transdermal clonidine has been demonstrated to produce analgesia in the area surrounding its application site in patients with SMP. The current study indicates that extensive analgesia may be obtained by epidural administration. Sedation and hypotension may limit bolus epidural clonidine administration for RSD. The role for chronic epidural infusion of clonidine has not yet been established.

Safety of lumbar puncture in patients with hemophilia

STUDY OBJECTIVE

To determine the safety of lumbar puncture in patients with hemophilia who are pretreated with clotting factor.

DESIGN

Retrospective analysis of medical records between 1980 and 1990.

SETTING

Three hospitals, each serving as a regional hemophilia center.

PARTICIPANTS

Thirty-three patients with hemophilia A or B who received one or more lumbar puncture.

INTERVENTION

All patients received replacement of deficient factor before the lumbar puncture. Serious post-lumbar puncture complications were defined as motor or sensory deficits, incontinence, or documented intraspinal hemorrhage.

RESULTS

Thirty-three patients with hemophilia A or B received a total of 52 lumbar punctures during the study period. Thirty of 33 patients (91%) had severe baseline factor deficiency, two (6%) had moderate deficiency, and one (3%) had mild deficiency. There were no serious complications reported as a result of the lumbar puncture. The 95% confidence interval for the risk of a serious complication was 0% to 5.8%.

CONCLUSION

With adequate factor replacement, a lumbar puncture can be done safely in patients with hemophilia.

Delayed desensitization of alpha 2-adrenoceptor-mediated platelet aggregation in depressed patients

After prolonged exposure to epinephrine, platelets are observed to desensitize alpha 2-adrenoceptor-mediated aggregation responses in vitro. Herein, this phenomenon was studied as a possible in vitro model for alpha 2-adrenoceptor dysregulation in depression. Platelet-rich plasmas obtained from 22 unipolar depressed patients and 25 healthy subjects were preincubated with 20 mumol/L of epinephrine for various lengths of time prior to stirring. By comparing the subsequent extents of aggregation, we observed significantly less desensitization at 4, 20, 30, or 60 minutes postepinephrine exposure (p < or = .05) in depressed patients as compared to healthy controls. This blunted desensitization appeared to be due to a delayed onset of desensitization during the first 0.5 to 2 minutes after epinephrine exposure, since thereafter, the monoexponential desensitization rate did not differ in depressed patients, but the extent of desensitization remained less as compared to healthy subjects. The extent of desensitization was correlated (r = -0.48, p = .02) with the density (Bmax) of the alpha 2-adrenoceptor high-affinity state, as detected in undesensitized platelet membranes by p125I-clonidine binding. An elevation was also observed in the density of nonadrenergic p125I-clonidine-binding sites (putative imidazoline I1 sites) in platelet membranes from depressed patients compared to healthy control subjects. Following treatment with desipramines, the patients (n = 15) displayed more normal (nonblunted) extents of desensitization of aggregation, and the Bmax values for the putative I1 sites were at the levels of healthy controls. If similar aberrations exist in neurons of depressed patients, this may explain a dysregulation of the noradrenergic system believed to underlie depression.

Mycobacteria in stool specimens: the nonvalue of smears for predicting culture results

A previous recommendation suggests that stool be cultured for mycobacteria only if the smear is positive. We have correlated smear and culture results of 2,176 stool specimens submitted for mycobacterial culture. The sensitivity, specificity, and positive and negative predictive values for smears to predict culture results are 34, 99, 90, and 87%, respectively. We recommend that the stool smear not be used as a screening technique to decide which specimens from at-risk patients should be cultured because it lacks the necessary sensitivity.

DNA restriction fragment analysis to define an extended cluster of tuberculosis in homeless men and their associates

A cluster of tuberculosis in men associated with shelters for the homeless in Melbourne, diagnosed between April 1984 and July 1991, was reviewed with respect to the genetic relatedness of the infecting strains. Relatedness was determined by examination of Southern blot analyses of restriction enzyme-digested genomic DNA, using probes for repetitive sequences. From the initial 24 cases selected, isolates were available from 19, and 18 were identical. A total of 571 other Australian and Solomon Islands strains were examined for relatedness to these strains. Nine additional case strains were found to be identical; all were from recent Melbourne residents and at least 7 were epidemiologically related to the original case cluster. The identification of a single infecting strain of Mycobacterium tuberculosis in these 27 cases suggests that reactivation disease in this group may not be as important as infection or reinfection from another case or cases.

Identification of a genetically distinct subspecies of Mycobacterium kansasii

To assess the usefulness of a specific DNA probe for Mycobacterium kansasii, 105 isolates from Australia, Belgium, Japan, South Africa, and Switzerland were collected and analyzed. Twenty of these isolates were probe negative, of which 18 were from Belgium and Switzerland. Analysis of all isolates by Southern blot hybridization indicated a lack of variability among probe-positive isolates, while probe-negative isolates were clearly distinct and showed greater diversity. Sequence analysis of the 250 nucleotides at the 5' end of the 16S rRNA gene revealed that 19 of the 20 probe-negative isolates had a sequence different from that of M. kansasii. A total of five nucleotide differences were present in a cluster consisting of two nucleotide deletions and three nucleotide substitutions. These results suggest the existence of a genetic subspecies of M. kansasii.

Isolation of a fastidious Mycobacterium species from two AIDS patients

Two strains of fastidious mycobacteria were isolated from two patients with AIDS and clinical disease suggestive of Mycobacterium avium complex infection. Acid-fast bacilli were isolated from blood and bone marrow of both patients in BACTEC 12B and/or 13A media. The acid-fast bacilli failed to grow on subculture to routine Löwenstein-Jensen medium containing pyruvate and egg yolk agar. After several attempts, the strain from one patient was finally cultured on Middlebrook 7H9 medium with agar, charcoal, and yeast extract 13 months after the initial specimens were received in the laboratory. The second patient's strain was cultured on the same medium 6 weeks postinoculation with fresh BACTEC fluid and 5 months after specimen collection. Routine biochemical and growth tests were performed on these isolates but failed to give definitive identifications. 16S rRNA gene sequencing suggested that the organisms share at least 98.9% homology with M. simiae. Even greater homology (99.86%) was found with the recently described species "M. genavense." Recognition of the fastidious nature of some mycobacteria that infect AIDS patients is important in the treatment of infections in these patients and in understanding the epidemiology of atypical mycobacterial infections. It is suggested that a liquid culture medium such as BACTEC be employed for primary isolation of mycobacteria from AIDS patients and that subculture to the charcoal medium described here be carried out for those organisms that fail to grow on subculture to routine media.

Rate of change of end-stage renal disease treatment incidence 1978-1987--has there been selection?

End-stage renal disease (ESRD) treatment rates in the United States have increased steadily since 1973. Decreasing selection against elderly patients with a poor prognostic primary cause of ESRD (i.e., diabetic nephropathy) may partly account for this increase in rates. To test this hypothesis, we calculated log ESRD treatment incidence (ESRDI) rates by four major primary causes of ESRD (diabetic nephropathy (DN), hypertensive nephropathy (HN), glomerulonephritis (GN), and cystic kidney disease (PC); two age groups (old (O), greater than 65 and young (Y), 15 to 44 yr of age) for black and white, male and female, new ESRD patients from 1978 to 1987. As predicted, summary log ESRDI slopes (produced by analysis of covariance) occurred in the following decreasing order, ODN (0.19), OGN = OHN = YDN (0.134). YHN = YPC = YGN (in white patients) = slope not significantly different from 0. Log ESRDI slopes for young black males and females with GN increased significantly between 1978 and 1987, possibly as a result of an increased incidence of GN. In conclusion, decreasing selection may be a factor in the continuing increase in the U.S. ESRD population.

Molecular cloning of a highly repeated DNA element from Mycobacterium tuberculosis and its use as an epidemiological tool

In order to develop a technique for distinguishing between isolates of Mycobacterium tuberculosis, we cloned two hypervariable DNA fragments from NdeII-digested genomic DNA. The cloned DNA fragments of 3.8 and 4.7 kb were found to contain the same repetitive element, which was different from previously characterized repetitive elements. It is present in at least 30 copies per genome and is distributed among mycobacterial species other than those of the tuberculosis complex, including M. kansaii, M. gastri, and M. szulgai. When used as a probe on restriction enzyme-digested DNA, it can distinguish between strains from unrelated cases of tuberculosis while demonstrating identical banding patterns for isolates from epidemiologically related cases.

Safety and immunogenicity in volunteers of a recombinant Plasmodium falciparum circumsporozoite protein malaria vaccine produced in Lepidopteran cells

A recombinant Plasmodium falciparum circumsporozoite (CS) antigen (rPfCSA) was produced in insect cells using a baculovirus expression vector containing the entire CS gene. This near full-length CS antigen was adsorbed onto aluminium phosphate for use as a malaria vaccine. In a study of safety and immunogenicity, 20 volunteers were divided into four groups of five each and inoculated intramuscularly with 10, 100, 500 or 1000 micrograms of vaccine. Primary vaccinations were followed by two booster immunizations at 2 and 6 months. Three volunteers developed prominent local reactions manifested as tenderness, redness and swelling at the injection site following the second or third vaccination. All symptoms resolved spontaneously within 72 h. Postimmunization sera from six of 20 volunteers showed seroconversions as measured by Western blot, using rPfCSA as antigen. However, specific anti-CS protein antibody could not be detected by indirect immunoflourescence against intact sporozoites or by ELISA using rPfCSA or peptide to the repeat region. In addition, 18 of 20 volunteers developed antibody to baculovirus proteins as determined by ELISA and/or Western blot. Antigen-driven replication studies using peripheral blood mononuclear cells from vaccinees failed to detect proliferative responses specific to CS protein. This recombinant CS protein vaccine, as formulated, was minimally immunogenic in humans.

Using the health belief model to predict safer sex intentions among adolescents

The purpose of this study was to use Health Belief Model (HBM) concepts to predict adolescents intentions to adopt safer sex behaviors. A stratified, random sampling technique was used to generate a sample of seventh-, ninth-, and eleventh-grade students representative of a southeastern state. A predictive model was constructed of the HBM variables. The model accounted for 43% of the variance in safer sex intentions among the seventh grade, 27% of the variance for the ninth grade and 17% of the variance for the eleventh grade. For the eleventh grade sample gender was the only significant predictor. The results of this study suggest that educational programs to promote safer sex intentions should focus on health related motivations among younger students. With older adolescents it may be more effective to expand education efforts to address factors directly relevant to their motivational schema and social environment. This study underscores the importance of using theory-based models in conducting health education research.

Operative mortality with implantation of the automatic cardioverter-defibrillator

Operative mortality was studied in 939 consecutive patients undergoing initial implantation of an automatic implantable cardioverter-defibrillator (AICD) at 15 hospitals. Twenty-nine (3.1%) patients died during the first 30 days after surgery. Among patients who survived beyond the first 30 postoperative days, ejection fraction data were available in 219; compared with the mortality group, these survivors had a significantly higher ejection fraction (34 +/- 15 vs 26 +/- 10%, respectively, p less than 0.001), despite similar age, sex, underlying heart disease, type of presenting arrhythmia and prevalence of concomitant surgery. The causes of perioperative death were sudden in 7 (24%), tachyarrhythmic/nonsudden in 5 (17%), cardiac nonarrhythmic in 9 (31%), and noncardiac in 8 (28%). Twenty-four (83%) of the deaths occurred before hospital discharge, and in all 9 instances of in-hospital sudden and tachyarrhythmic/nonsudden death, the initial recorded rhythm was sustained ventricular tachycardia or fibrillation; in 5 (56%) of these 9 patients the AICD had been in a deactivated state since implantation. Other possible contributory factors in the 12 sudden or tachyarrhythmic/nonsudden deaths included acute myocardial ischemia or infarction in 2 (17%), and "device proarrhythmia" in 3 (25%) that were AICD-related in 2 and secondary to an antitachycardia pacemaker in another; defibrillation threshold testing was not performed in 3 patients (1 of whom had terminal ventricular fibrillation). Thus, in this multicenter experience with thoracotomy requiring AICD implantation, operative (30-day) mortality was 3.1% and correlated inversely with left ventricular ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

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Predictors of risk perceptions of childhood injury among parents of preschoolers

This article assesses the relationship between parents' perceived risk of childhood injuries and familial, sociocultural, and situational variables. Data were obtained through a random digit dial telephone survey of 1,200 households with a preschool child in a southeastern metropolitan area. Perceived risks of childhood injury measures were based on social science theory and childhood injury epidemiology. Multiple item measures included dimensions of seriousness and likelihood for both injuries and hazards. When risk perceptions were viewed as individual items, parents underestimated the risk of some hazards and injuries and overestimated the risks of others, and parents whose children have sustained a recent injury had higher risk perception overall. When risk perceptions were viewed as summed scales, sociodemographic variables and parental safety behaviors were not significant predictors. Sociocultural factors of having a child previously injured, the parent reporting stress, having a household with self-reported risk factors, and the perception of the child as active and hard to manage are related to summed scales of risk perceptions, with some interactions by race of the parent. Findings illustrate the role of situational and sociocultural characteristics of respondents in risk perception research.

Effect of agitation of BACTEC 13A blood cultures on recovery of Mycobacterium avium complex

The effect of agitation of BACTEC 13A bottles (Becton Dickinson) on the recovery of Mycobacterium avium complex (MAC) from blood was compared with that of static incubation. A total of 265 blood specimens was inoculated in duplicate into BACTEC 13A bottles. One specimen was statically incubated at 35 degrees C, and the other was incubated with agitation on a Gyrotory shaker at 35 degrees C for the first 2 weeks and thereafter without shaking for up to 12 weeks. Of the 265 specimens, 77 (29.1%) were positive in either one or both of the paired bottles. The average detection times for the shaken and nonshaken bottles were 12.7 and 15.9 days, respectively. A total of 10.4% of the specimens in the shaken bottles became positive 1 week before those in the nonshaken bottles, and 16.9% of the shaken cultures were positive more than 2 weeks before their counterparts. A further 46.8% of the agitated specimens became positive while the corresponding nonagitated cultures remained negative. When both specimens became positive at the same time, 88% of the shaken cultures had higher growth indices than their nonshaken counterparts. A further 11 paired blood cultures were taken from patients known to be infected with MAC to assess the effect of agitation of bottles on the utility of making twice-weekly readings during the first 2 weeks of incubation. Ten of the 11 sets of specimens in the shaken bottles were positive 1 or more weeks before those in the corresponding nonshaken bottles. In the remaining set, both specimens became positive on the same day; however, the growth index of the agitated culture was higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculosis in Australia: an analysis of cases identified in reference laboratories in 1986-88

The Special Interest Group in Mycobacteria within the Australian Society for Microbiology has carried out a collaborative study of cases of tuberculosis diagnosed in Australian reference laboratories in the years 1986, 1987 and 1988. Annual totals of 574, 584 and 613 respectively, suggest that the incidence of bacteriologically-positive tuberculosis is continuing at 3-4 cases per 100,000 population. The highest rates were detected in males over 50 and females over 65 years of age. Three-quarters of the total cases relate to pulmonary disease. Resistance to at least 1 anti-tuberculosis drug was detected in 78 (12.7%) of isolates tested in 1988. The negligible decline in incidence of tuberculosis in Australia, the high prevalence in S.E. Asian countries, and the fact that HIV-infection is an important risk factor, make it imperative that Australia's diagnostic and management programmes be maintained.

Differentiation of Mycobacterium tuberculosis strains by use of a nonradioactive Southern blot hybridization method

The only means of dividing strains of Mycobacterium tuberculosis is by phage typing. Attempts at developing a convenient method based on differences in chromosomal DNA by detecting restriction fragment length polymorphisms (RFLP) have had limited success. This report describes the development of a nonradioactive RFLP technique that differs from most methods by using enzymes that have four base recognition sites rather than six. The restriction enzymes AluI, DdeI, HinfI, NdeII, RsaI, and TaqI were used to digest genomic DNA, and high-molecular-weight fragments were visualized after Southern blotting with digoxigenin-labeled M. tuberculosis DNA. Digestion with AluI resulted in different banding patterns among all eight clinical isolates of M. tuberculosis and three type strains from the tuberculosis complex. NdeII distinguished all but two strains, while HinfI and RsaI were unable to distinguish two pairs of strains. Digestion with the enzymes DdeI and TaqI failed to result in clearly discernible bands. These preliminary results suggest that this method provides a fine differentiation of M. tuberculosis strains and may be useful as an epidemiologic tool.