Evidence that IgE receptor stimulation increases adenosine release from rat basophilic leukaemia (RBL-2H3) cells

Adenosine may play a role in asthma by enhancing inflammatory mediator release from lung mast cells. In this study, we investigated whether adenosine is released from cultured rat basophilic leukaemia (RBL-2H3) cells in response to antigen challenge and whether released adenosine enhances mediator release. RBL-2H3 cells closely resemble mucosal mast cells, the most common type of mast cell in lung tissue, and they express adenosine A3 receptors (which have been associated with asthma). Measurement of adenosine in RBL-2H3 cell incubation medium was possible if adenosine metabolism was inhibited by EHNA (10 microM; an adenosine deaminase inhibitor) and 5-iodotubericidin (5-IT; 10 microM; an adenosine kinase inhibitor). Basal adenosine concentration increased up to 1.0 microM during a 90 min incubation; after antigen challenge, adenosine concentration was increased by 0.3-0.4 microM above basal. Antigen-induced adenosine release ranged from 30-70 nmol/1.25x10(6) cells. Antigen-induced mediator release (beta-hexosaminidase and [3H]5-hydroxytryptamine) was increased by APNEA, an adenosine A3 receptor agonist (EC50 approximately 20 nm) but inhibited by EHNA and 5-IT, despite increased adenosine levels. This inhibition was not blocked by the adenosine A1/A2 receptor antagonist DPSPX (5 microM). Therefore, it is unlikely to be related to adenosine receptor activation. In conclusion, although our data provide no direct support for a positive feedback effect of adenosine on mast cell mediator release, the observation that IgE receptor stimulation increases adenosine production in cells which express stimulatory A3 receptors is consistent with this hypothesis.

Motivation underlying career choice for internal medicine and surgery

Self-determination theory (Deci and Ryan, 1985) was used to predict medical students' career choices for internal medicine or surgery based on their experiences of the autonomy support provided by the instructors in the two corresponding third-year clerkships. Fourth-year medical students (n = 210) at three medical schools completed questionnaires that assessed (1) retrospective prior likelihood (as of the end of second year) of their going into internal medicine and surgery, (2) their perceived competence with respect to these two medical specialties, (3) their interest in the problems treated in each specialty, (4) the autonomy support of the instructors on the two corresponding rotations, (5) the current likelihood (late in the fourth year) of going into each of the two specialties, and (6) their actual residency choices. For a subset (n = 64), actual prior likelihoods of going into the two careers had also been assessed at the end of their second year. Structural equation modeling confirmed, as hypothesized, (a) that perceived autonomy support of the corresponding clerkship would predict students' choices of internal medicine or surgery, even after the effects of retrospective (and actual) prior likelihood had been removed, and (b) that this relationship between perceived autonomy support and career choice was mediated by perceived competence and interest. The present study suggests that students' experiences on clerkships do affect the likelihood that they will select particular specialties, and that students' interest in the areas are good indicators of the selections they will make.

Hedonic consequences of social comparison: a contrast of happy and unhappy people

Two studies tested the hypothesis that self-rated unhappy individuals would be more sensitive to social comparison information than would happy ones. Study 1 showed that whereas unhappy students' affect and self-assessments were heavily affected by a peer who solved anagrams either faster or slower, happy students' responses were affected by the presence of a slower peer only. These between-group differences proved to be largely independent of 2 factors associated with happiness, i.e., self-esteem and optimism. Study 2 showed that whereas the unhappy group's responses to feedback about their own teaching performance were heavily influenced by a peer who performed even better or even worse, happy students' responses again were moderated only by information about inferior peer performance. Implications for our appreciation of the link between cognitive processes and "hedonic" consequences are discussed.

Morphologic and molecular changes induced by recombinant human leptin in the white and brown adipose tissues of C57BL/6 mice

Leptin is a 16-kd protein synthesized and secreted by adipose tissue, which regulates adiposity and body weight. To investigate the peripheral effects of recombinant human leptin, lean C57BL/6 mice were treated with subcutaneous injections of vehicle or 20 mg/kg/day leptin for 1 to 14 days. Groups of animals were killed on Days 1, 2, 3, 4, 7, or 8 and 15 to evaluate the time course of clinical chemistry, morphologic, and molecular changes in white (WAT) and brown adipose tissue (BAT) depots. There was a progressive daily reduction in the body weight of mice receiving leptin. By Day 15, the body weight of leptin-treated groups decreased by 6% to 8% relative to base-line weight. Clinical chemistry changes in treated mice included decreased cholesterol and triglyceride levels. At necropsy, the mice had rapidly progressive atrophy of subcutaneous, intra-abdominal, and retroperitoneal WAT and interscapular BAT depots, with complete depletion of fat stores by Days 3 to 4 in most females and by Days 7 to 14 in male mice. Histologically, white and brown adipocytes underwent marked atrophy with loss of lipid droplets and activation of BAT cells in WAT depots. Ultrastructurally, white and brown adipocytes contained numerous, enlarged mitochondria. Molecular analysis of key adipose tissue genes in brown and white fat depots revealed a rapid, selective increase in the mRNA expression of thermogenic proteins and lipolytic enzymes, including uncoupling proteins 1 and 2, lipoprotein lipase, and hormone-sensitive lipase, with decreases in the lipogenic enzyme fatty acid synthase, endogenous leptin, and cytochrome c oxidase. These data suggest that the peripheral effects of leptin include increased thermogenesis and lipid oxidation in brown fat coupled with increased lipolysis and decreased fat synthesis in white and brown fat, which lead to a rapid reduction in the body weight and adiposity of mice.

Self-interest and fairness in problems of resource allocation: allocators versus recipients

Two studies explored the tension between self-interest and the equality norm in problems of resource allocation. Study 1 presented graduate business students with a hypothetical task requiring them to make a series of managerial decisions. On learning the outcome of those decisions, they were asked to divide a bonus pool between self and a rival manager (who had opted for very different decisions and achieved either the same results as self on 2 criteria or a better result on 1 criterion and a worse result on the other criterion). Study 2 required Stanford and San Jose State undergraduates to consider the division of a hypothetical scholarship fund between candidates from their 2 schools. Data from both studies contrasted the apparent evenhandedness and lack of self-interest manifested by allocators with the self-serving responses of evaluators. Furthermore, when faced with different claims, participants were inclined to justify an unequal allocation of resources--provided that they, or a representative of their group, received the larger share--that few personally would have recommended, demanded, or imposed.

Cycloheximide inhibition of delayed early gene expression in baculovirus-infected cells

The baculovirus protein IE1 is required for the transactivation of many early viral genes in transient expression assays. However, cycloheximide inhibition studies have failed to reveal a dependence of early gene transcription on expression of IE1 in infected cells. We show here that synthesis of IE1 was not effectively inhibited by the addition of 100 microg/ml cycloheximide, the concentration routinely used in these studies. However, when cycloheximide was added at 250 microg/ml, IE1 synthesis was repressed to less than 5% of control levels. These more stringent conditions were used to discriminate between immediate early and delayed early genes. Transcription of three immediate early genes (ie1, ie2, and ie0) was increased by the addition of high concentrations of cycloheximide. However, transcription of three other early genes (39k, p35, and lef-3), which are known to be dependent on IE1 transactivation, was significantly reduced by the addition of 250 microg/ml cycloheximide. Immunoblot analyses also revealed a difference between the immediate and delayed early class of viral genes. Synthesis of IE1, IE2, and IE0 was resistant to cycloheximide treatment, while translation of SSB/LEF-3 and pp31 was strongly inhibited even at the lower concentration of cycloheximide. Although cycloheximide was shown to be useful in defining early temporal classes, it induced apoptosis in both uninfected and infected Sf9 cells when used at the inhibitory concentration.

Self-interest and fairness in problems of resource allocation: allocators versus recipients

Two studies explored the tension between self-interest and the equality norm in problems of resource allocation. Study 1 presented graduate business students with a hypothetical task requiring them to make a series of managerial decisions. On learning the outcome of those decisions, they were asked to divide a bonus pool between self and a rival manager (who had opted for very different decisions and achieved either the same results as self on 2 criteria or a better result on 1 criterion and a worse result on the other criterion). Study 2 required Stanford and San Jose State undergraduates to consider the division of a hypothetical scholarship fund between candidates from their 2 schools. Data from both studies contrasted the apparent evenhandedness and lack of self-interest manifested by allocators with the self-serving responses of evaluators. Furthermore, when faced with different claims, participants were inclined to justify an unequal allocation of resources--provided that they, or a representative of their group, received the larger share--that few personally would have recommended, demanded, or imposed.

Evolution of a role to enhance care coordination

The recent trend toward shorter hospital stays has prompted health care personnel in acute care settings to reevaluate models of coordinating patient care. In whatever model is adopted, there must be someone whose role is to focus on achieving quality patient outcomes in a shorter time frame. Our institution has piloted several different models with various job classes to fulfill the role. However, the primary focus of the models-to enhance care coordination-remained unchanged. The initial care coordination model was the development of patient care coordinator role by converting the charge nurse position on the unit. The second model our institution developed occurred during a management restructuring. This model created a new position, a nursing practice coordinator, who had previously been a management support person with supervisory responsibilities. We now envision the role to be assumed by a nurse practitioner. The nurse practitioner's broader scope of practice potentially can further enhance coordination of care. In this article, the authors describe the development process, issues and interventions, and lessons learned during each step of redesigning a case management model.

Identification of pesticide poisoning in wildlife

The Wildlife Incident Investigation Scheme investigates incidents of suspected poisoning of wildlife (also honey bees and companion animals) by pesticides in the United Kingdom. The approach to these investigations has evolved over the past 30 years. Field investigations, post-mortem examinations, toxicological data and experience of previous poisoning incidents assist in the selection and interpretation of appropriate chemical analyses. Several 'multi-residue' and several 'individual compound' analytical methods for pesticides in wildlife are currently in use; these are described.

Meiotic recombination initiated by a double-strand break in rad50 delta yeast cells otherwise unable to initiate meiotic recombination

Meiotic recombination in Saccharomyces cerevisiae is initiated by double- strand breaks (DSBs). We have developed a system to compare the properties of meiotic DSBs with those created by the site-specific HO endonuclease. HO endonuclease was expressed under the control of the meiotic-specific SPO13 promoter, creating a DSB at a single site on one of yeast's 16 chromosomes. In Rad+ strains the times of appearance of the HO-induced DSBs and of subsequent recombinants are coincident with those induced by normal meiotic DSBs. Physical monitoring of DNA showed that SPO13: : HO induced gene conversions both in Rad+ and in rad50 delta cells that cannot initiate normal meiotic DSBs. We find that the RAD50 gene is important, but not essential, for recombination even after a DSB has been created in a meiotic cell. In rad50 delta cells, some DSBs are not repaired until a broken chromosome has been packaged into a spore and is subsequently germinated. This suggests that a broken chromosome does not signal an arrest of progression through meiosis. The recombination defect in rad50 delta diploids is not, however, meiotic specific, as mitotic rad50 diploids, experiencing an HO-induced DSB, exhibit similar departures from wild-type recombination.

The value of skin testing in patients with chronic rhinitis

The value of skin prick testing in the management of patients with chronic rhinitis has still to be established. The aim of the study was to determine how accurately atopic status could be predicted from the clinical history of allergy. We carried out a prospective audit of 103 patients undergoing skin tests in three ORL departments over a three-month period. Of 73 patients with a history of allergy or an atopic family history, 44 (60%) had a positive skin test. Twenty-one out of 30 (70%) with no history had a negative skin test. In subjects where a negative atopic history to inhaled allergens is combined with a negative family history, the incidence of negative skin test results was 79%. Skin prick testing is of questionable clinical value in the absence of positive atopic feature in the personal or family history of the patient.

Congenital anomalies in two infants born after gestational gamma-globulin prophylaxis

The offspring of two women given prophylactic gamma-globulin 50 and 54 days after their last menstrual periods had congenital duodenal stenosis and a paraoesophageal hiatus hernia, respectively. The possibility that gamma-globulin may have contributed to these malformations is discussed.

The spiritual dimension: its importance to patients' health, well-being and quality of life and its implications for nursing practice

The spiritual dimension is described and is interpreted as the need for: meaning, purpose and fulfillment in life; hope/will to live; belief and faith. As the spiritual dimension is important for the attainment of an overall sense of health, well-being and quality of life (referred to as the health potential) and as illness and hospitalisation can precipitate spiritual distress, patients' spiritual needs should be addressed. The nurse's role in spiritual care is discussed with reference to the nursing literature.

Psychometric characteristics of revised Sociotropy and Autonomy Scales in college students

Beck, Epstein, Harrison and Emery (unpublished manuscript, 1983) developed the Sociotropy-Autonomy Scale (SAS) to assess personality constructs that were considered possible vulnerability factors to reactive depression. Principal components and factor analyses of an expanded 93-item version of the SAS were performed with successive samples of undergraduates totalling 2041 Ss. Only 59 items were needed to establish the generalizabilities of one dimension of Sociotropy and two dimensions of Autonomy. Three subscales reflecting Sociotropy, Solitude and Independence were constructed from these items. The convergent and discriminant validities of the three subscales were assessed with respect to a variety of other psychological tests. The overall pattern of relationships indicated that Solitude was positively correlated with dysphoria, perfectionism, self-criticalness, and loneliness. In contrast, Independence was positively correlated with perfectionism and self-efficacy, but inversely related to concern about approval from others. Sociotropy was correlated with dependency, self criticalness, and affiliation motivation. The findings supported the construct validity of the three revised SAS subscales.

Dexamethasone therapy for children with bacterial meningitis. Meningitis Study Group

OBJECTIVE

To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae.

DESIGN

This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year.

SETTING

The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio.

PATIENTS

Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year.

INTERVENTIONS

Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission.

MAIN OUTCOME MEASURES

Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later.

MAIN RESULTS

One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups.

CONCLUSION

All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.

A truncated recombinant intercellular adhesion molecule-1 inhibits adhesion of leukemic cell lines to upregulated endothelial cells

Intercellular adhesion molecule-1, a member of the immunoglobulin supergene family, is the ligand for the integrin lymphocyte function associated antigen-1. Intercellular adhesion molecule-1 and lymphocyte function associated antigen-1 binding interactions mediate leukocyte adherence and migration. Previous work has shown that the adherence of lymphocyte function associated antigen-1 is directed to the first immunoglobulinlike domain of the endothelial cell surface protein intracellular adhesion molecule-1. We have constructed a truncated intercellular adhesion molecule-1 gene encoding the first 185 amino acids from the amino terminus and overexpressed it in Escherichia coli. The recombinant protein was purified from insoluble inclusion bodies and refolded into an active conformation by a denaturation/renaturation cycle. The identity of the protein was confirmed by microsequencing and by Western blot analysis using a polyclonal antibody to ICAM-1. We have demonstrated that this soluble region of the otherwise membrane-bound ligand is an inhibitor of Molt or HL-60 cell adhesion to cytokine-stimulated endothelial cells.

Prevalence of sperm bound antibodies in infertile men with varicocele: the effect of varicocele ligation on antibody levels and semen response

An increased level of antisperm antibodies has been demonstrated in infertile men with varicocele compared with normal fertile men, suggesting a possible cause and effect relationship. To evaluate the possible etiological role of antisperm antibodies in varicocele patients, we performed a prospective study of 32 infertile men undergoing varicocele ligation. Semen analyses and antisperm antibodies as measured by the immunobead test were performed preoperatively and postoperatively at 3 and 6 months. Of the infertile men with varicocele 28% had a positive immunobead test compared with 0% of normal fertile men. The average total motile sperm count was significantly different (p < 0.05, 2-tailed t test) for 9 varicocele patients with sperm-bound antibody (3.2 x 10(6)) compared with 23 without antibody (8.4 x 10(6)). Postoperatively, 68% of all patients exhibited improved semen parameters, with no change in antibody status in either group. Among the antibody positive group 71% showed an increase in motile sperm per ml. of 2.8 x 10(6) to 17.2 x 10(6) (525% increase, p < 0.05), while in the antibody negative group 67% showed an increase of 3.8 x 10(6) to 24.9 x 10(6) (553% increase, p < 0.05). Our study suggests that there is an increased incidence of sperm-bound immunoglobulin in infertile varicocele patients and an apparent adverse effect on semen parameters in these patients. However, the presence of sperm-bound immunoglobulin did not affect the percentage response to surgical correction, nor can we postulate an immunological mechanism as a major etiological factor in varicocele induced infertility.

Spiritual care: the nurse's role

This article presents part of a doctoral study which explored some spiritual aspects of nursing care. It reports how a sample of nurses perceived and reported how they gave spiritual care, and identifies possible influencing factors. The implications of these findings are discussed and suggestions for practice made.

Depressive disorders and suicidal intent in adolescent suicide attempters

This study describes the relationships between the presence of a depressive disorder, suicidal intent, and the medical seriousness of a suicide attempt in an adolescent sample. Consecutive adolescents who attempted suicide were evaluated for the presence or absence of current DSM-III-R depressive disorders (DD). Adolescent suicide attempters with DD were compared with those without DD regarding the level of their suicide intent and the medical seriousness of their suicide attempt. Adolescent suicide attempters with a diagnosis of DD were found to have a higher level of suicidal intent than were those without depressive illness. There was no relationship between the medical seriousness of the suicide attempt and the presence of DD. Clinicians should specifically assess for DSM-III-R DD as a means of determining suicidal intent in adolescent suicide attempters.