Reducing cervical cancer among First Nations women

First Nations women in British Columbia have a four to six times higher mortality rate from cancer of the cervix than do women in the general population. Their participation in the provincial Cervical Cytology Screening Program (CCSP) is less regular and less frequent than other women in B.C. Likewise, they have more difficulty in obtaining culturally suitable health care services from respectful and consistent professionals. These issues should be of critical concern to nurses, as nurses provide the majority of health services to First Nations people.

Nutritional quality of lactic fermented bitter gourd and fenugreek leaves

Pediococcus pentosaceus was selected from isolates obtained from the naturally fermenting bitter gourd and fenugreek leaves based on its high titre and broad spectrum of inhibitory activity against spoilage organisms. This strain was then employed for fermentation of bitter gourd and fenugreek which resulted in a more acceptable product having enhanced fat, pyridoxine and ascorbic acid levels. It was of interest to note that vitamin B12 was formed in the fenugreek as a result of the fermentation.

Genetic variability and diversity for protein and calcium contents in finger millet (Eleusine coracana (L.) Gaertn) in relation to grain color

Analysis of 36 genotypes of finger millet (Eleusine coracana (L.) Gaertn) with varying seed colors revealed a wide range of protein and calcium contents. White seeded genotypes had higher protein contents, while brown seeded types had a wide range of values. The brown seeded genotype GE 2500 had the highest protein content. Although protein content had significant negative association with calcium content, white seeded types had moderate levels of calcium. The genotypic coefficients of variability were moderate and high for protein and calcium, respectively. High heritability coupled with high genetic advance indicated their governance by additive gene action. A negative significant correlation was observed between protein content and grain yield. Mahalanobis D2 analysis grouped the 36 genotypes into eight clusters. Clustering pattern failed to indicate any relationship between genetic diversity and geographic diversity. Based on genetic diversity and performance, the genotypes MS 1168, MS 174 and CO 13 were found to be suitable for use as parents in a hybridization program for improving yield; the genotypes MS 1168, MS 174 and MS 2869 for protein and Malawi 1915 and CO 11 for calcium. Protein and calcium contents contributed less to genetic divergence.

Effects of aspirin on platelet aggregation in smokers and nonsmokers

OBJECTIVE

To assess the relative antiaggregatory ability of aspirin on platelets of smoking and nonsmoking healthy volunteers.

DESIGN

Prospective, randomized, crossover study.

SETTING

Tertiary-care teaching institution.

SUBJECTS

Eighteen healthy smoking and nonsmoking male volunteers.

INTERVENTIONS

Each subject received aspirin 325 mg or ticlopidine 250 mg bid as an active control for 7 days in a crossover manner separated by a 1-month washout period. Whole blood platelet aggregation was measured on four occasions, twice at baseline and once after each drug treatment.

OUTCOME MEASUREMENT

Whole blood ex vivo platelet aggregation in terms of impedance (omega) and adenosine triphosphate (ATP) release (nmol), as assessed using Lumi-aggregometry.

RESULTS

Aspirin was associated with significantly less ATP release in both smokers (p = 0.01) and nonsmokers (p = 0.003). No significant differences in platelet aggregation were found between smokers and nonsmokers at baseline or with any treatment phases. Sixty-seven percent and 17% of volunteers receiving ticlopidine and aspirin, respectively, reported adverse effects.

CONCLUSIONS

Twice-daily administration of aspirin for 7 days to healthy volunteers was well tolerated and also reduced platelet aggregation significantly regardless of smoking status.

Recognition and treatment of reactions to contrast media: a model for resident and faculty education employing lectures and case scenario workshops

RATIONALE AND OBJECTIVES

The effectiveness of an interactive course on the recognition and treatment of contrast media reactions was studied.

METHODS

An instructional course on contrast media reactions was organized for the radiology staff, residents, and nurses. Before the beginning of the 3-day course, a 25-point pretest was administered to determine the ability of each participant to recognize and treat contrast material reactions. An identical posttest was administered after the course, and the pre- and posttest results were compared.

RESULTS

There was a statistically significant improvement on the posttest scores for all subjects tested (P < .05). There was also a substantial improvement in the participants' confidence levels in dealing with contrast media reactions.

CONCLUSIONS

A short course on contrast material reactions is a worthwhile learning aid that is simple to conduct and educates and instills confidence in both residents and staff.

Effect of amine activators on the properties of chemical cured dental composites

The purpose of this study was to evaluate the reactivity and the effect of concentration of three tertiary amines upon the mechanical properties of a chemical curing dental composite. Chemical cured composite pastes were prepared by keeping peroxide concentration constant at 1 wt% (by weight of resin mixture) and by varying the amine/peroxide molar ratio from 0.25 to 1.5. Composite samples were prepared for all three amine pastes aged for 1, 15, 30, 45, and 60 d stored at 8, 22, and 37 degrees C. The loss in activity of the tertiary amine with time was measured. Changes in compressive strength, diametral tensile strength, and microhardness were also measured. A sharp decrease in working and setting times corresponding to increased activity was noticed with an increased amine content. The activity was found to vary in the order N,N-dimethyl p-toluidine (DMPT) > 2-(4-dimethylaminophenyl)ethanol (DMAPEA) > N,Ndiethanol p-toluidine (DEPT). DMPT is found to be more temperature sensitive than DMAPEA and DEPT. However, DEPT is found to provide better storage stability out of all three amines tested. Each amine was found to possess optimum concentrations at which the mechanical properties showed maximum values. DEPT is preferred for long-term storage stability in chemical-cured dental composites where aging tends to reduce the activity of the amine.

Effect of phototherapy on thyroid stimulatory hormone and free thyroxine levels

OBJECTIVE

To study the effect of phototherapy for neonatal hyperbilirubinaemia on thyroid function as neonatal thyroid screening is sometimes performed during exposure to phototherapy.

METHODOLOGY

Infants with non-haemolytic hyperbilirubinaemia were sequentially allocated to fibre-optic phototherapy, conventional daylight phototherapy, or a combination of both. Bilirubin concentration was monitored 12 hourly by capillary blood sampling; venous blood was sampled for thyroid stimulating hormone (TSH) and free thyroxine (fT4) determinations, at start of exposure, at 24 h, end of exposure and 1 day later. Comparable unexposed infants served as controls.

RESULTS

All 123 study infants and 25 controls remained well during the study. Bilirubin levels declined during phototherapy, being most rapid in the combination group. The TSH and fT4 values at start of exposure were 3.86 +/- 0.41 mU/L (mean +/- SEM) and 33.20 +/- 1.16 pmol/L, respectively, in the fibre-optic group, 3.62 +/- 0.38 mU/L and 37.22 +/- 1.76 pmol/L in the daylight group, and 4.40 +/- 0.48 mU/L and 29.91 +/- 1.13 pmol/L in the combined group, compared with 5.77 +/- 0.40 mU/L and 34.46 +/- 1.68 pmol/L in the control group. The TSH and fT4 values declined with increasing age in the phototherapy and control groups with end of exposure values of 2.90 +/- 0.28 mU/L and 27.71 +/- 0.71 pmol/L, 2.77 +/- 0.31 mU/L and 33.52 +/- 1.22 pmol/L, and 3.44 +/- 0.30 mU/L and 27.54 +/- 0.88 pmol/L, respectively, compared with 4.21 +/- 0.61 mU/L and 27.19 +/- 2.33 pmol/L (at 72 h) in the control group. The pattern of TSH and fT4 decline in the exposed and control groups was similar, being related to increasing age.

CONCLUSIONS

The validity of neonatal thyroid screening is not affected by fibre-optic or conventional phototherapy or by both combined.

Neuronatin mRNA in PC12 cells: downregulation by nerve growth factor

Neuronatin was recently cloned from neonatal rat brain (Biochem, Biophys. Res. Commun., 201 (1994) 1227-1234). In subsequent studies, we noted neuronatin mRNA was brain-specific and that there were two alternatively spliced forms, alpha and beta (Brain Res., 690 (1995) 92-98). Furthermore, on sequencing the human neuronatin gene, it was determined that the alpha-form was encoded by three exons, and the beta-form was encoded by the first and third exons only (Genomics, 33 (1996) 292-297). The middle exon was spliced out in the beta-form. The human neuronatin gene is located in single copy of chromosome 20q 11.2-12 (Brain Res., 723 (1996) 8-22). These studies called for an understanding of the function of this gene. Therefore, we studied the expression of neuronatin in PC12 cells, an established model of neuronal growth and differentiation. Neuronatin mRNA expression was found to be abundant in undifferentiated PC12 cells. Treatment with nerve growth factor (NGF), resulting in neuronal differentiation, was associated with a downregulation of neuronatin mRNA expression. Removal of NGF was associated with a return of neuronatin mRNA levels towards baseline. These effects appear to be specific for NGF as they were not seen with transforming growth factor, epidermal growth factor, 12-O-tetradecanoylphorbol-13-acetate or dexamethasone. Although, basic fibroblast growth factor also reduced neuronatin mRNA levels, the effect was less pronounced than with NGF. The NGF-induced decreased in neuronatin mRNA occurred even in the presence of protein and RNA syntheses inhibitors. Of the two spliced forms, only the alpha-form was expressed in PC12 cells. In conclusion, we report the presence of neuronatin mRNA in PC12 cells, and that NGF downregulates its expressions. These findings provide a basis for investigating the role of neuronatin in neuronal growth and differentiation.

Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbia?

OBJECTIVE

To determine Pap smear screening rates among urban First Nations women in British Columbia; to identify facilitators and barriers; and to develop, implement, and evaluate specific interventions to improve Pap smear screening in Vancouver.

DESIGN

Computer records of band membership lists and the Cervical Cytology Screening Program registry were compared to determine screening rates; personal interviews and community meetings identified facilitators and barriers to urban screening programs. A community advisory committee and the project team collaborated on developing specific interventions.

SETTING AND PARTICIPANTS

Purposive sample of British Columbia First Nations women, focusing on women living in Vancouver.

INTERVENTIONS

Poster, art card, and follow-up pamphlet campaign; articles in First Nations community papers; community meetings; and Pap smear screening clinics for First Nations women.

MAIN OUTCOME MEASURES

Pap smear screening rates among BC First Nations women according to residence and reasons for not receiving Pap smears.

RESULTS

Pap smear screening rates were substantially lower among First Nations women than among other British Columbia women; older women had even lower rates. No clear differences were found among First Nations women residing on reserves, residing in Vancouver, or residing off reserves elsewhere in British Columbia. Facilitators and barriers to screening were similar among women residing on reserves and in Vancouver. Many First Nations women are greatly affected by health care providers' attitudes, abilities to provide clear information, and abilities to establish trusting relationships.

CONCLUSIONS

Family physicians are an important source of information and motivation for Pap smear screening among First Nations women.

Cloning of human neuronatin gene and its localization to chromosome-20q 11.2-12: the deduced protein is a novel "proteolipid'

Human brain development is a continuum governed by differential gene expression. Therefore, we proceeded to identify genes selectively expressed in the developing brain. Using differential display and library screening, a novel rat cDNA, neuronatin, was identified and used to screen a human fetal brain cDNA library. Human neuronatin cDNA was isolated and sequenced. The cDNA was 1159 bp long and corresponded in size to the 1.25 kb message detected on Northern analysis. Neuronatin mRNA was selectively expressed in human brain during fetal development, but became repressed in adulthood. When studied in the rat, neuronatin mRNA first appeared at mid-gestation in association with the onset of neurogenesis, becoming most pronounced later in development when neuroepithelial proliferation and neuroblast commitment are manifest, and declined postnatally coinciding with the completion of neurogenesis. The deduced protein has two distinct domains, a hydrophobic N-terminal and basic C-terminal rich in arginine residues. Both the amino acid sequence and secondary structure of this amphipathic polypeptide exhibited homology to PMP1 and phospholamban, members of the "proteolipid' class of proteins which function as regulatory subunits of membrane channels. The neuronatin gene, 3973 bases long, contains in its 5'-flanking region a neural restrictive silencer element which may govern neuron-specific expression. Based on screening a somatic cell hybrid panel, neuronatin gene was assigned to chromosome-20. And, using deletion constructs of chromosome-20 and fluorescence in situ hybridization, neuronatin was localized to chromosome-20q11.2-12. In conclusion, neuronatin is a novel human gene that is developmentally regulated and expressed in the brain. The deduced protein is a proteolipid that may function as a unique regulator of ion channels during brain development. The definitive localization of neuronatin to human chromosome 20q11.2-12 provides the basis to investigate this gene as a candidate in neuro-developmental diseases that may also map to this region.

Structure and organization of the human neuronatin gene

Neuronatin is a brain-specific human gene that we recently isolated and observed to be selectively expressed during brain development. In this report, the genomic structure and organization of human neuronatin is described. The human gene spans 3973 bases and contains three exons and two introns. Based on primer extension analysis, a single cap site is located 124 bases upstream from the methionine (ATG) initiation codon, in good context, GAACCATGG. The promoter contains a modified TATA box, CATAAA (-27), and a modified CAAT box, GGCGAAT (-59). The 5'-flanking region contains putative transcription factor binding sites for SP-1, AP-2 (two sites), delta-subunit, SRE-2, NF-A1, and ETS. In addition, a 21-base sequence highly homologous to the neural restrictive silence element that governs neuron-specific gene expression is observed at -421. Furthermore, SP-1 and AP-3 binding sites are present in intron 1. All splice donor and acceptor sites conformed to the GT/AG rule. Exon 1 encodes 24 amino acids, exon 2 encodes 27 amino acids, and exon 3 encodes 30 amino acids. At the 3'-end of the gene, the poly(A) signal, AATAAA, poly(A) site, and GT cluster are observed. The neuronatin gene is expressed as two mRNA species, alpha and beta, generated by alternative splicing. The alpha-form contains all three exons, whereas in the beta-form, the middle exon has been spliced out. The third nucleotide of all frequently used codons, except threonine, of neuronatin is either G or C, consistent with codon usage expected for Homo sapiens. This information about the structure of the human neuronatin gene will help in understanding the significance of this gene in brain development and human disease.

Comparison of methods for measuring albumin in peritoneal dialysis and hemodialysis patients

Serum albumin levels have been used extensively as an indicator of morbidity in patients with end-stage renal disease. Recent evidence suggests that albumin levels vary considerably in hemodialysis patients depending on the laboratory method used, but formulas for comparing albumin values by different methods have not been developed. We prospectively evaluated the effects of measuring albumin by three different methods on paired plasma and serum from 23 patients on continuous ambulatory peritoneal dialysis (CAPD) and 53 patients on chronic maintenance hemodialysis. Plasma and serum gave virtually identical results independent of method used. In CAPD patients, bromcresol green and nephelometry gave nearly identical albumin measurements through the entire range of plasma levels. In contrast, bromcresol purple gave values that were 9.9 percent +/- 1.3 percent lower (P < 0.05). Hemodialysis patients showed a similar pattern with close agreement between bromcresol green and nephelometry, but bromcresol purple gave lower albumin levels by 19.1 percent +/- 1.2 percent (P < 0.05). The discrepancy in albumin in CAPD patients was significantly less than in the hemodialysis patients (P < 0.05), suggesting that there were fewer interfering substances in the blood of CAPD patients than in hemodialysis patients. Linear regression analysis was used to develop simple formulas for comparing albumin values obtained by the different methods in CAPD and hemodialysis patients. These studies show that values for albumin in blood vary significantly by method of analysis in CAPD and hemodialysis patients. By the use of these formulas, it becomes possible to compare albumin values between centers using different methods for the purpose of quality management.

Fetal and neonatal haemodilution associated with multiple placental chorioangioma: case report

A pregnancy with polyhydramnios and abnormal antepartum fetal heart rate pattern was found to have multiple placental haemangiomas. Multiple placental haemangiomas can give rise to fetal cardiac failure due to a hyperdynamic circulation or fetal anaemia either due to haemodilution or possibly destruction of blood cells in the chorioangioma. Whether fluid restriction with or without diuretics or blood transfusion is the correct form of treatment of neonatal cardiac failure in such a case is discussed.

Neuronatin mRNA: alternatively spliced forms of a novel brain-specific mammalian developmental gene

Neurogenesis begins with the closure of the neural tube around mid gestation and continues in the rat for about two weeks postnatally. Therefore, we investigated the role of neuronatin, a novel cDNA that we cloned from neonatal rat brain (Joseph et al., Biochem. Biophys. Res. Commun., 201 (1994) 1227-1234), in brain development. Further studies described in the present manuscript, lead to the identification of two alternatively spliced forms of neuronatin mRNA, alpha and beta, with the same open reading frame. Neuronatin-alpha encoded a novel protein of 81 aa, and the beta-form encoded 54 aa. Both forms were identical, except that the alpha-form had an additional 81 bp sequence inserted into the middle of the coding region. On Northern analyses, neuronatin mRNA was relatively selective for the brain. It first appeared at E11-14, a time when the neural tube has closed and neuroepithelial proliferation initiated, became pronounced at E16-19 with a surge in neurogenesis, and declined postnatally to adult levels with the completion of neurogenesis. In order to determine whether there were other forms of neuronatin mRNA, and to study the expression of the alpha and beta forms separately during development, reverse transcriptase-polymerase chain reaction was carried out using primers flanking the coding region of the alpha and beta forms. The RT-PCR results clearly indicated that there were only two forms of neuronatin. The beta-form first appeared at E11-14, whereas the alpha-form was present even earlier at E7-10. Together, these findings indicate that the two forms of neuronatin mRNA are regulated differently during brain development.(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual biphasic melting behaviour of Rhodotorula gracilis DNA

Ultraviolet, fluorescence and CD spectral analysis suggested unusual structural features of Rhodotorula gracilis ATCC 90950 DNA. R. gracilis DNA exhibited 13% hyperchromicity at 260 nm as against 26% shown by calf thymus DNA. The biphasic melting curve, one phase between 88-92 degrees C and the other between 92-97 degrees C, was attributed to different unwinding pattern of R. gracilis DNA as a function of rise in temperature. The binding affinity of ethidium bromide to R. gracilis DNA determined was almost the same as that of calf thymus DNA. Fluorescence spectra with rise in temperature showed decrease in the quanta of fluorescence intensity after transition temperature, suggesting the quenching due to variation in structure. The CD spectra of R. gracilis DNA did not resemble the spectra of any of the known DNA forms and it showed increase in the magnitude of negative band with rise in temperature suggesting a B-C transition. Disruption of intermolecular and higher order structures by sonication and salt concentration did not change this behaviour implicating the influence of sequence and base composition of R. gracilis DNA on thermal melting transition.

p23 transplantation antigen mRNA is differentially expressed in human fetal brain

As gene expression governs development, we attempted to isolate differentially expressed genes in fetal and adult human brain. RNA samples extracted from adult and 18-24-week-old fetal human brain were reverse transcribed, amplified using twenty combinations of 3'-anchored primers and degenerate 5'-primers, and the resulting cDNA fragments separated on denaturing polyacrylamide gels. Thereafter, 45 (H1-H45) differentially displayed cDNA bands were extracted from the gels, amplified by polymerase chain reaction, and used as probes to detect their mRNA by northern blotting. One of these fragments, H8, confirmed on northern blotting to be highly expressed in fetal brain, was cloned and sequenced. This fragment was homologous to wild type p23 human transplantation antigen. This is phylogenetically a well conserved gene and appears to play an important role in cell growth. Even a single point mutation in the mouse gene results in cell destruction secondary to a cytotoxic T-lymphocyte response. Therefore, our finding that normal human fetal brain expresses high levels of wild type p23 transplantation antigen may have importance in maintaining cell growth during human brain development.

Prospects for the secondary prevention of colorectal cancer: screening by flexible sigmoidoscopy?

It may be useful to draw an analogy between the proposed screening programme for colorectal cancer and the cervical cancer screening programme. Both tumours show a spectrum of histological abnormalities consistent with a premalignant phase. The natural history of these premalignant lesions is poorly understood and although some will progress, if untreated, to invasive disease, most will not. Light microscopy cannot confidently distinguish which cases will progress and which will regress, and clinicians are therefore obliged to treat all. This will result in the destruction of many lesions of uncertain malignant potential. The secondary prevention of cervical cancer, although therapeutically efficacious, is inefficient. A lack of understanding of the natural history of intraepithelial neoplasia has frustrated attempts to develop rational referral criteria, and it is only now that the appropriate trials are being undertaken. The development of outpatient investigative and therapeutic procedures has resulted in many more women being referred for investigation and treatment, with predictable pressure on other services offered by gynaecologists, but no demonstrable saving of life. Similar uncertainties surround a screening programme for colorectal cancer. The principal concerns are not about the efficacy of polypectomy in interrupting the polyp cancer sequence, although uncertainties about the frequency with which cancer arises de novo do require that the effectiveness of this intervention is formally tested. Our major concerns are with compliance, and the management of the individual who tests positive--that is, who is found to have a distal polyp. Technological advances and operator enthusiasm may, as has happened with the cervical screening programme, lead to a relaxation in the indications for further investigation and treatment. Such a development would affect resources substantially if a population screening programme were in place. Nevertheless, there are grounds for believing that a screening programme for colorectal cancer, using sigmoidoscopy, might be successful in certain age groups if compliance was satisfactory. The scale of benefits may be comparable with those achieved by the breast screening programme. Our limited cost analysis, which relates to only to specific items of clinical activity, suggest that the mean cost for each case of cancer prevented will be about 8000 pounds sterling. These conclusions suggest that screening by flexible sigmoidoscopy merits serious consideration. It is also imperative, however, that consideration should be given to resolving some of the uncertainties about the clinical management and surveillance of those found to have distal polyps.

The normal preterm foetal heart rate pattern

A longitudinal study was carried out on 38 women with low risk pregnancies. These women had cardiotocography at 27-28 wk initially, at fortnightly intervals thereafter until 36 wk and at weekly intervals thereafter until delivery. All cardiotocographs were analyzed by one investigator who was not aware of the individual clinical situation. Of the 232 cardiotocographs, 12 (0.5%) of poor quality were excluded from analyses. The mean base-line heart rate decreased from 142.5 (SD 6.03) beats per min at 27-30 wk to 138.2 (SD 7.4) at term. Analysis of variance for repeated measures showed that the decrease in foetal heart rate with gestation was statistically significant (P < 0.001). The number of accelerations increased with gestation (P = 0.002). There were no significant changes in variability and decelerations with increasing gestation.