Apoptosis signals in atopy and asthma measured with cDNA arrays

A variety of studies have stressed the importance of the control of inflammatory cell longevity and the balance of pro-survival and pro-apoptotic signalling. Recently, asthma was found to be associated with reduced apoptosis of inflammatory cells in lung tissue. The aim of the study was to investigate the systemic activation of apoptosis pathways using cDNA array technology in atopy and asthma. Eighteen atopic asthmatics (AA), eight atopic non-asthmatic (AN) and 14 healthy control subjects (C) were included in the study. Peripheral blood mononuclear cells were separated with gradient centrifugation, mRNA purified and the reverse-transcribed probes hybridized to cDNA arrays. The signals were compared by standardizing to the 100 most expressed genes and group differences assessed with the Mann-Whitney U-test. We found a concerted up-regulation of several pro-survival cytokines and growth factors in AN and AA. FAS and FASL were not differentially expressed, but FAST kinase was over-expressed in AN and AA. The tumour necrosis factor pathway was activated in AN and AA with increased cytokine and receptor levels and increased TRAF2, an intracellular signalling product. There were indications of a down-regulated p53 system. In contrast, the Bcl-2 family of genes showed a net pro-apoptotic profile in AN and AA. The group of caspases showed a constant gene expression pattern in all groups. In conclusion, significant differences in the expression of apoptosis-related genes were found in peripheral blood of atopic individuals with and without asthma. cDNA array technology proved to be useful and may be complementary to DNA-based studies in order to analyse interactive and multidimensional pathways as shown here for apoptosis.

Views of young people using augmentative and alternative communication systems

Children with physical impairments who cannot use intelligible speech are often recommended augmentative and alternative communication (AAC) systems. In England and Wales, it is usually the job of speech and language therapists to support development in AAC skills. This paper reports findings from discussion with children and young people who use AAC systems concerning their attitudes and opinions towards the organization of speech and language therapy, the role of the speech and language therapist in school and issues concerned with AAC systems themselves. Six young adults and 17 children from London education authorities were interviewed on a one-to-one basis and in focus groups. Children were interviewed who had a communication aid incorporating at least 20 symbols and/or pictures and/or written words, language understanding at the two-word level and above, i.e. they demonstrated understanding of adult requests with at least two information carrying words. For children using communication aids, it is conceivable that their communication systems do not contain appropriate symbol vocabulary to express complex ideas, opinions and feelings. Consequently, a symbol-based interview tool was designed to allow children to express complex issues through visual means. Most children interviewed reported that their AAC system was useful to them. Further analysis of opinions revealed that negative attitudes towards AAC systems were primarily associated with operational issues (technical skills required to operate an AAC system) and issues of self-image/identity, and to some degree, with a lack of perceived benefit in interaction. In apparent contrast to therapists' preferred models of working, children and young people identified a preference for therapy organized on a one-to-one basis targeting linguistic and operational skills. It is suggested that more acceptable and individualized design of AAC systems could have implications for their use in school and other contexts. The value of service users' views in service planning and evaluation are discussed.

A collaborative effort to enhance HIV/STI screening in five county jails

Funding from the Centers for Disease Control and Prevention and the Health Resources and Services Administration (HRSA) supports collaborations among health departments (CA, FL, GA, IL, MA, NJ, NY), correctional facilities, and community-based organizations to improve services to HIV-infected inmates, particularly as they return to the community. Additionally, HRSA funded the Evaluation and Program Support Center to guide the implementation of a multi-site evaluation of the Corrections Demonstration Project (CDP). The authors present a model approach to the problem of health disparities that involves forging collaborations among federal funders, public health departments, corrections, community-based organizations, and the scientific research community. They show how such collaboration can promote the reduction of racial/ethnic health disparities. The authors examined disease screening activities in five county jails. Screening for HIV and other sexually transmitted infections (STIs) was offered during the medical intake process and during HIV prevention education sessions. One thousand twenty inmates were tested from July 1, 2000, through December 31, 2000, for HIV infection, and 171 (17%) positive cases were identified (largely due to confirmatory testing). Of HIV-positive inmates, 83 (49%) were started on antiretroviral treatment. Additionally, 2,160 were tested for chlamydia, 1,327 for gonorrhea (largely duplicated), and 937 (duplicated) for syphilis. Across all three STIs, 78% of those who tested positive were treated. The remaining 22% either declined treatment, were released prior to notification of results, or were released prior to starting treatment. The CDP offers a model approach for addressing the poor health status of members of racial/ethnic minority groups by developing collaborations between corrections, public health departments, community-based organizations, and academia. An outgrowth of this collaboration is the improved capacity to detect and treat disease, which is a necessary component of a comprehensive HIV risk reduction program.

Industrial scale-up of countercurrent chromatography: predictive scale-up

This study describes how scale-up in countercurrent chromatography (CCC) can be simply predicted on a process scale CCC device by running a preliminary analytical-sized sample and having knowledge of the stationary-phase retention at scale-up conditions. Results have shown that simple experimentation can lead within a day to a process with the capability of several kilograms per day (tons per year) compound yield, and that this is feasible with benchtop CCC units.

An unusual case of furcation external resorption

AIM

To describe the presentation and management of an unusual external root resorption.

SUMMARY

An unusual external inflammatory root resorption presented in the furcation of a mandibular first molar. Review of earlier radiographs suggested that the lesion was non-progressive. Occlusal trauma associated with anterior open bite was the most likely aetiological factor. No active treatment was prescribed.

KEY LEARNING POINTS

External resorption may occur following loss of the external root surface. Occlusal trauma may be a propagating stimulus for progressive resorption. Lesions may sometimes be non-progressive, and treatment may therefore be more damaging than observation.

Investigation of the comparative toxicity of 5-FU bolus versus 5-FU continuous infusion circadian chemotherapy with concurrent radiation therapy in locally advanced rectal cancer

PURPOSE

To compare the relative toxicities of bolus versus infusional 5-FU chemotherapy administrated concurrently during external beam irradiation in patients with locally advanced rectal cancer following surgical extirpation.

METHODS

A total of 26 eligible patients were retrospectively identified as having been treated for rectal adenocarcinoma at the Stratton VAMC between 1989 and 1997. A comparative analysis of treatment dose intensities, treatment delays and toxicities in these patients was performed.

RESULTS

Significantly less WBC toxicity was observed in the patients receiving infusional 5-FU chemotherapy. The other toxicities, with the exception of skin toxicity, were generally less frequent in the 5-FU infusional group. When the toxicities were corrected for 5-FU dose intensity, to yield toxicity per mg of 5-FU, statistically significant differences were found for hematological toxicity (WBC and platelets), and for gastrointestinal toxicity (frequency and severity of diarrhea and weight loss). The majority of patients receiving infusional 5-FU therapy were treated using a circadian pattern of treatment peaking around the time of the radiation therapy. Patients receiving infusional 5-FU were able to tolerate over twice the dose intensity as those receiving bolus administration. Local recurrence rate in all patients was 3.8% comparing favorably to other reported studies. Distant recurrence frequency was also acceptable at 34.6% for the group.

CONCLUSION

Infusional 5-FU chemotherapy compared with bolus therapy during pelvic radiation minimizes toxicity to the patient while maximizing the dose of 5-FU that can be delivered. As infusional 5-FU therapy during radiation has previously been shown to increase disease free duration and survival, infusional 5-FU should be considered as an acceptable standard of care to prevent local recurrence of rectal adenocarcinoma following its resection. Shaping this infusional 5-FU chemotherapy within the day so that most of the daily dose is delivered around the time of the radiation therapy may further modify the toxic therapeutic ratio of combined modality therapy.

Determination of LY295501 in human plasma by reverse phase HPLC with UV detection

A high performance liquid chromatographic (HPLC) assay was developed and validated for the quantitative determination of LY295501 in human plasma. A structural analog, LY186641, was selected as the internal standard. The samples were processed by protein precipitation with acetonitrile followed by concentration of the supernatants and reconstitution. Chromatographic resolution of LY295501 from endogenous plasma components was accomplished with a Waters Novapak C18 HPLC column (3.9 x 150 mm, d(p) 4 mm). Detection was by absorbance at 260 nm. The linear dynamic range was from 5 to 400 microg ml(-1) of human plasma using a 0.25 ml aliquot. The inter-day precision (%RSD) and accuracy (%RE) in plasma ranged from 2.4 to 4.7, and -4.9 to 1.4, respectively. This assay is both simple and rapid, and has been used to successfully analyze over 1500 samples from human clinical trials.

Osteoblastic differentiation and mRNA analysis of STRO-1-positive human bone marrow stromal cells using primary in vitro culture and poly (A) PCR

Investigation of osteoblast dysfunction in osteoporosis has been hampered by a poor understanding of normal early osteoblast differentiation, due to a relative lack of markers for the earliest cells in the lineage. Attempts to identify such markers have used cultures of animal or immortalized human cells, of uncertain relevance to human biology, or heterogeneous cultures in which genetic variability precludes the isolation of stage-specific genotypic markers. Primary in vitro generation of clonal populations of human bone marrow stromal cells was used in order to overcome these problems. Fibroblast-like stromal cells were isolated from human sternal bone marrow. They showed differentiation to an osteoblastic phenotype when stimulated with dexamethasone (10(-7) M) and fluorescence activated cell analysis demonstrated immunopositivity for STRO-1 (an antibody that recognizes osteoprogenitor stem cells of the colony-forming unit-fibroblastic) in from 8 to 40 per cent of the cells, dependent on time post-harvest. Cells positive for STRO-1 were immunoselected using magnetic activated cell sorting and seeded at low density (10 cells/cm2) to produce clones. Each clone was subpassaged, osteoblastic differentiation stimulated with dexamethasone, and mRMA-extracted at time points post-stimulation (0 h and 1-14 days). A novel poly (A) reverse transcriptase-polymerase chain reaction (RT-PCR) was used to amplify cDNA representative of all transcripts expressed at each time point. Differential gene expression within the amplified cDNA was assessed using 3' end cDNA probes to osteocalcin, osteopontin, and collagen type I (positive), demonstrating the acquisition of an osteoblastic phenotype. Time-specific gene products for early osteoblast differentiation have been generated from primary human cultures, utilizing very low density seeding and poly (A) RT-PCR. These products overcome the problems associated with animal, immortalized or heterogeneous culture and can be used to study normal and altered early osteoblast differentiation, indicating the possibility of using the same system to study other disease states.

Cellular distribution of secretin receptor expression in rat pancreas

Secretin is an important regulator of pancreatic function, but the molecular basis of its actions is not well understood. We have, therefore, used in situ autoradiography, photoaffinity labeling, and RNase protection assays with healthy rat pancreas, dispersed acinar cells, and pancreas depleted of acinar cells to explore the cellular distribution and molecular identity of high-affinity secretin receptors in this complex organ. The autoradiographic examination of 125I-labeled [Tyr10]rat secretin-27 binding to normal pancreas demonstrated saturable and specific high-affinity binding sites on both acinar and duct cells, with a uniform lobular distribution, but with no binding above background over islets or vascular structures. Photoaffinity labeling demonstrated that the ductular binding site in acinar cell-depleted copper-deficient rat pancreas represented the same glycoprotein with a molecular weight of 50,000-62,000 that was present on acinar cells. RNase protection assays confirmed the molecular identity of the secretin receptors expressed on these distinct cells. The apparent absence or extreme low density of similar secretin receptors on islets and pancreatic vascular structures suggests that the pharmacological effects of secretin on those cells may either be indirect or mediated by another secretin family receptor that recognizes this hormone with lower affinity.

The use of poloxamer hydrogels for the assessment of biofilm susceptibility towards biocide treatments

Poloxamer F127 is a non-toxic, di-block copolymer of polyoxyethylene and polyoxypropylene. Aqueous solutions (30% w/v) show thermoreversible gelation, being liquid at temperatures < 15 degrees C and robust gels at temperatures > 15 degrees C. Chilled poloxamer (30% in tryptone soya broth) was mixed with an inoculum of Pseudomonas aeruginosa (10(4) cfu ml-1) and placed as 100 microliters drops onto separate glass cover-slips. These were placed into sealed Petri dishes containing moistened cotton wool and incubated at 35 degrees C. Viable counts could be performed on the poloxamer gels by transfer of the coverslips to diluents at < 15 degrees C. Growth curves in the gels and in liquid batch cultures were indistinguishable from one another with stationary phase cell densities, being approximately 5 x 10(10) cfu ml-1 in each at 16 h. SDS-PAGE of cell envelope preparations showed the poloxamer-grown cells to exhibit a biofilm rather than planktonic phenotype. Susceptibility towards various concentrations of chlorhexidine, iodine and hydrogen peroxide was assessed for 10 min at 35 degrees C for suspensions of broth-grown cells and for incubated poloxamer-gels (1 and 16 h). The gels were immersed in biocide, on their glass supports, before transfer to neutralizer at 10 degrees C where dissolution was complete within 5 min. Further serial dilutions and plate counts were made. While modest decreases in susceptibility towards all biocides were associated with incorporation of the inoculum with the gel (1 h incubation), substantial changes were noted after prolonged incubation and adaptation to a biofilm phenotype (16 h incubation). The gel populations mimic the localized high cell densities observed in biofilms and will also be subject to the same nutrient and chemical gradients as found within natural biofilms. Thermoreversible gelation enables complete recovery of the test inoculum without further trauma. They therefore provide an effective model for assessing biofilm susceptibility towards biocides and would be suitable for screening programmes.

Outpatient assessment of residual growth hormone secretion in treated acromegaly with overnight urinary growth hormone excretion, random serum growth hormone and insulin like growth factor-1

OBJECTIVE

To assess the outpatient investigations, overnight urinary growth hormone (uGH) excretion, random serum GH and insulin like growth factor 1 (IGF-1), and GH indices from the oral glucose tolerance test (OGTT) (fasting, nadir and mean GH), as measures of mean GH secretion in treated acromegaly, in comparison with a GH day series, which served as a gold standard.

DESIGN

Prospective cross-sectional study, with patients admitted to a metabolic ward for the following investigations: random GH, IGF-1, 6 point GH day series (day 1), 9 h timed overnight uGH excretion, OGTT with GH response (day 2). Agreements between the mean GH during the day series and the other outcome measures, and the diagnostic performance of the latter, for the presence or absence of active acromegaly (mean GH during day series > or = 5 or < 5 mU/l, respectively) were determined.

PATIENTS

26 patients with treated acromegaly (11 with inactive acromegaly off drug therapy).

MEASUREMENTS

Serum GH and uGH were measured by immunoradiometric assays and IGF-1 by radioimmunoassay.

RESULTS

Agreements with the mean GH during the day series were perfect for the nadir GH during the OGTT with a 2 mU/l cutoff (Cohen's kappa (kappa) = 1, P < 0.00001), almost perfect for the fasting and mean GH throughout the OGTT (both kappa = 0.92, P < 0.0001) and random GH (kappa = 0.85, P < 0.0001), and substantial for the nadir GH with a 5 mU/l cutoff (kappa = 0.77, P < 0.0001), IGF-1 (kappa = 0.62, P < 0.001) and overnight uGH excretion (kappa = 0.61, P = 0.002). Nadir GH with a 2 mU/l cutoff was completely accurate for diagnosing the presence or absence of active acromegaly (positive and negative predictive values (% +/- standard error percentage) 100 +/- 8% and 100 +/- 10%). None of the outpatient tests used alone was an adequate diagnostic test (positive and negative predictive values: overnight uGH excretion -86 +/- 10% and 75 +/- 13%; random GH -100 +/- 11% and 85 +/- 11%; IGF-1 -92 +/- 10% and 71 +/- 13%) and so combinations of tests were assessed. The best was overnight uGH excretion plus random GH (positive and negative predictive values 88 +/- 9% and 100 +/- 12%). Using all three outpatient investigations, the positive predictive value of three raised results was 100 +/- 13%.

CONCLUSIONS

In treated acromegaly, residual GH secretion can be reliably assessed with the OGTT, using standard diagnostic criteria. It can also be assessed on an outpatient basis with overnight uGH excretion and random GH, as direct measures, and IGF-1. If these are all normal, active acromegaly is excluded. Three raised results denote active acromegaly, and one or two raised results would need further investigation with a GH day series.

The effect of sodium balance on sweat sodium secretion and plasma aldosterone concentration

The effect of manipulating sodium intake upon sweat sodium secretion was investigated during heat acclimation. Twenty-five male subjects were confined to an environmental chamber at a temperature of 25 degrees C for 3 days, and then acclimated to heat by a further 5 days at 40 degrees C. The subjects' daily sodium intake was controlled throughout as follows: high (HNa), 348.4 (0.8) mmol x day(-1), n=7; moderate (MNa), 174.1 (0.6) mmol x day(-1), n=9; or low (LNa), 66.3 mmol x day(-1), n=9. Sodium losses were estimated from urinary, faecal and sweat collections using a whole-body washdown method. Plasma aldosterone concentration was also measured from venous blood sampled each morning. Measurements of body temperature and heart rate during the heat exposure phase indicated a degree of heat acclimation. During this heat phase there was a reduction (P < 0.01) in sweat sodium secretion for all three conditions which was greatest for the LNa condition, although this finding was not significant (P < 0.1). In the LNa condition, plasma aldosterone concentration increased (P < 0.05) prior to heat exposure, and the secretion of aldosterone was potentiated (P < 0.01) during the heat exposure in comparison with the MNa condition. In contrast, the HNa diet produced a fall (P < 0.05) in plasma aldosterone concentration prior to heat exposure and an attenuation of aldosterone secretion thereafter. These findings are inconsistent with the hypothesis that retention of sweat sodium is dependent upon a net body sodium deficit, but demonstrate that aldosterone secretion is potentiated under such conditions.

The meaning and management of neuroleptic medication: a study of patients with a diagnosis of schizophrenia

The meaning of medication and the way in which people use medicines has been the focus of a number of studies in recent years. However, there has been little attention directed to the meaning and management of neuroleptic medication by people who have received a diagnosis of schizophrenia. This topic is highly relevant to policy because of the central role given to neuroleptics in contemporary mental health and community care services. Using data from in-depth interviews with people with a diagnosis of schizophrenia we explore patients reasons for taking neuroleptics and the ways in which patients self-regulate their medication. The data suggest that the main utility of taking neuroleptic medication is to control specific symptoms and to gain personal control over managing symptoms. The costs of taking medication were side-effects which at times equalised or outweighed the positive gains of the neuroleptic medication. Patient accounts suggest that everyday medication practices are to a significant degree related to a policy context which stresses the need to survey and control the behaviour of people living in the community and the wider meaning and symbolic significance that schizophrenia has for patients in their everyday lives. For this reason, self regulatory action in this group of patients tends to be less evident and the threat of external social control greater than patients taking medication for other chronic conditions. The findings suggest the need to develop a collaborative patient-centred model of medication management for patients diagnosed with schizophrenia.

Ruffling membrane, stress fiber, cell spreading and proliferation abnormalities in human Schwannoma cells

Schwannomas are peripheral nerve tumors that typically have mutations in the NF2 tumor suppressor gene. We compared cultured schwannoma cells with Schwann cells from normal human peripheral nerves (NHSC). Both cell types expressed specific antigenic markers, interacted with neurons, and proliferated in response to glial growth factor, confirming their identity as Schwann cells. Schwannoma cells frequently had elevated basal proliferation compared to NHSC. Schwannoma cells also showed spread areas 5-7-fold greater than NHSC, aberrant membrane ruffling and numerous, frequently disorganized stress fibers. Dominant negative Rac inhibited schwannoma cell ruffling but had no apparent effect on NHSC. Schwannoma cell stress fibers were inhibited by C3 transferase, tyrphostin A25, or dominant negative RhoA. These data suggest that the Rho and Rac pathways are abnormally activated in schwannoma cells. Levels of ezrin and moesin, proteins related to the NF2 gene product, merlin, were unchanged in schwannoma cells compared to NHSC. Our findings demonstrate for the first time that cell proliferation and actin organization are aberrant in schwannoma cells. Because NF2 is mutant in most or all human schwannomas, we postulate that loss of NF2 contributes to the cell growth and cytoskeletal dysfunction reported here.

Glycan-regulated antigen processing of a protein in the endoplasmic reticulum can uncover cryptic cytotoxic T cell epitopes

We and others have shown that influenza A nucleoprotein (NP) targeted to the secretory pathway cannot be processed to yield several cytotoxic T lymphocyte (CTL) epitopes in cell lines that lack the transporter associated with antigen processing (TAP). However, a large COOH-terminal fragment of NP is processed and presented in these cells. Full-length NP is cotranslationally glycosylated in the lumen of the endoplasmic reticulum at two sites distal to the major H2-Kk and H2-Db restricted CTL epitopes, and we show here that pharmacological or genetic inhibition of N-linked glycosylation, leads to the processing and presentation of both these epitopes in a TAP-independent way.

Feeding the anorectic client: comfort foods and happy hour

The anorectic patient presents a dilemma to the health care provider. As the patient refuses oral intake, quality of life diminishes, and health care costs increase. This article describes two approaches that have demonstrated effectiveness: comfort food and happy hour. "Comfort foods" describe foods associated with bygone years, intended to trigger recollections of pleasant childhood experiences and feelings of caring and healing. A second alternative described is the offering of a "happy hour" beverage, presented in a social milieu. These treatments are reproducible in a variety of clinical care settings and stimulate oral intake in the failure-to-thrive patient.

Changes in MIC alter responses of Pseudomonas aeruginosa to tobramycin exposure

The pharmacokinetic parameters determining antibiotic efficacy are peak concentrations (Cmax), minimum (trough) concentrations (Cmin), and area under the concentration-time curve (AUC). There is general agreement about the importance of Cmax and AUC for aminoglycosides, but this is not so for maintenance of Cmin. With in vitro exposures modelling in vivo administration, Pseudomonas aeruginosa reference strain ATCC 27853 (MIC, 1 mg/liter) and a higher-MIC (relatively resistant) clinical isolate (MIC, 4 mg/liter) were used to explore bacteriostatic and bactericidal outcomes. With P. aeruginosa ATCC 27853, kill followed a complete bolus profile with a 30-min postdistribution peak (Cpeak30) of 10 mg/liter. The clinical isolate required a Cpeak30 bolus profile of 20 mg/liter for kill, and there was no difference between the efficacies of the bolus and infusion exposures. Bolus profiles that were truncated at 8.5 h and producing sublethal effects were then combined with a wide range of Cmins. With a Cpeak30 profile of 8 mg/liter, P. aeruginosa ATCC 27853 showed a graded bacteriostatic response until a Cmin of > or = 0.8 mg/liter, when complete kill resulted. In contrast, bactericidal effects on the clinical isolate required a Cpeak30 profile of 18 mg/liter with a Cmin of > or = 1.0 mg/liter. Therefore, Cmin also contributes to the bactericidal effect of tobramycin, with requirements showing minor variation with change in MIC. Dosing principles for relatively resistant (higher-MIC) organisms are suggested from the data. Relatively higher aminoglycoside doses via infusion regimens are likely to be needed to generate higher peak concentrations and higher AUC values necessary for bactericidal effect in resistant organisms. Maintenance of trough concentrations on the order of 1.0 mg/liter during the interdose interval will tend to guard against the possibility of inadequate peak and AUC exposures for kill.

Surface-catalysed disinfection of thick Pseudomonas aeruginosa biofilms

Transition metal catalysts were incorporated into polymers which formed the surface for bacterial attachment and biofilm formation in a constant depth film fermenter (100 microns thickness), flow chamber (about 30 microns thickness) and in batch culture (< 30 microns thickness). The catalysts drive the breakdown of persulphates to reactive oxygen species. When Pseudomonas aeruginosa biofilms were exposed to dilute solutions of potassium monopersulphate (20 micrograms ml-1-1 mg ml-1), significant enhancement of killing was notable for catalyst-containing surfaces over that of controls. The degree of enhancement was greatest for thin films, but was nevertheless significant for the 100 microns thick biofilms. Fluorescence probes and viability staining, in conjunction with laser confocal microscopy, showed that reactive species were generated at the biofilm-substratum interface and killed the biofilm from the inside. Reaction-diffusion limitation now concentrates the active species within the biofilm rather than protecting it, and a diffusion bump is established whereby further treatment agent is drawn to the substratum enabling relatively thick biofilms to be disinfected.

Pathogenicity of the entomopathogenic fungi paecilomyces spp. and Beauveria bassiana against the silverleaf whitefly, Bemisia argentifolii

Pathogenicities of three species of entomopathogenic fungi against preimaginal Bemisia argentifolii were measured and compared. Third-instar nymphs on excised leaves of Hibiscus rosa-sinensis were exposed to spray applications of 14 isolates of Beauveria bassiana, 22 isolates of Paecilomyces fumosoroseus, and five isolates of Paecilomyces farinosus. B. bassiana and P. fumosoroseus isolates of diverse origins were highly pathogenic to the whitefly nymphs; median lethal doses of 14 of the 22 P. fumosoroseus and four of the 13 B. bassiana isolates ranged between 50 and 150 conidia/mm2. Five isolates of P. farinosus were also pathogenic; however, LC50s were relatively high, ranging between 350 and 4000 conidia/mm2. Nymphs infected with all but one isolate of B. bassiana displayed a pronounced red pigmentation. Postmortem hyphal growth and sporulation of B. bassiana was relatively slow and usually confined to the region immediately surrounding the dead host. Whitefly nymphs patently infected with P. fumosoroseus and P. farinosus were lightly pigmented yellow or orange. Postmortem hyphal growth and sporulation of P. fumosoroseus rapidly covered the dead host and extended several millimeters onto the surrounding leaf surface. The results indicate that highly virulent strains of P. fumosoroseus and B. bassiana with considerable whitefly control potential are widespread and numerous.

Gin and tonic and reactive hypoglycemia: what is important-the gin, the tonic, or both?

The objectives of this study were to test the hypothesis that alcohol can cause reactive hypoglycemia by attenuating the release of counterregulatory hormones. The subjects were eight healthy volunteers (five men and three women, aged 20-40 yr). Each subject drank, using a randomized, double blind design 1) three large gin with regular tonics (0.5 g/kg alcohol and 60 g carbohydrate, mainly sucrose (G+T); 2) the same amount of alcohol with Slim-line tonic (0.5 g carbohydrate; G alone); and 3) regular tonic without alcohol (T alone). Glucose, insulin, and counterregulatory hormone levels and middle cerebral artery velocity (MCAV), an index of cerebral blood flow, were measured. Alcohol levels averaged 60-70 mg/dL. Peak insulin levels were similar in both studies in which regular tonic was consumed (95% confidence interval for difference, -6 to 22 microU/mL). After the ingestion of G+T, the blood glucose nadir was lower compared to that with T alone (3.35 vs. 3.87 mmol/L; P < 0.02) or G alone (3.35 vs. 3.95 mmol/L; P < 0.01). After drinking gin, subjects reported typical hypoglycemic warning symptoms unrelated to the prevailing glucose level. In both alcohol studies, there was marked blunting of GH release (P < 0.01). Despite a blood glucose nadir of 3.35 mmol/L, plasma epinephrine levels rose only slightly from 267 to 455 pmol/L (P = NS) after G+T. Ingestion of alcohol also caused a transient rise in right MCAV (P < 0.05) followed by a late drop in velocity in both cerebral hemispheres in the G+T study (P < 0.05). In otherwise healthy individuals a combination of gin and regular tonic can induce reactive hypoglycemia. Acute ingestion of alcohol impairs the epinephrine response and markedly suppresses the release of GH in response to a fall in blood glucose levels.

Dysphagia: a screening tool for stroke patients

Initiating safe oral nutrition and hydration immediately following stroke had become a critical concern for health care professionals at our facility. The Examine Ability to Swallow (EATS) dysphagia screening protocol, administered by nurses, was developed to solve this clinical dilemma. The dysphagia screening process for the acute stroke patient has successfully met the facilities' needs and more importantly has increased patients' satisfaction. No formal data were collected. This proactive approach is beneficial to the patient's physiological status as a means of preventing adverse complications; which impacts the recovery time frame for the patient. In addition it promotes the emotional well being of patients, and is economically prudent. This is an asset in today's healthcare environment.