The effects of EMLA and a topical formulation of 4% amethocaine (Ametop) on pain associated with retrobulbar injection

Retrobulbar block is commonly performed to provide anaesthesia for cataract extraction. This technique can cause significant discomfort. A prospective, randomised, placebo-controlled trial was carried out to investigate the efficacy of a eutectic mixture of local anaesthetics (EMLA) and a 4% amethocaine topical formulation (Ametop) in reducing the pain of retrobulbar injection. Ametop and EMLA proved to be of similar efficacy, both being superior to a placebo in alleviating the discomfort of retrobulbar block. No significant side-effects were observed with the use of either formulation.

Characterization of the murine A1 adenosine receptor promoter, potent regulation by GATA-4 and Nkx2.5

Adenosine acts via A1 adenosine receptors (A1ARs) in the heart and brain to potently influence mammalian physiology. A1ARs are expressed very early in embryonic development, and A1ARs are among the earliest expressed G protein coupled receptors in the heart and brain. To understand the biologic basis of A1AR expression, a genomic fragment containing the murine A1AR promoter was cloned. Reporter assay studies using DDT1 MF2 cells that express A1ARs revealed that 500 base pairs of the proximal A1AR promoter contained essential elements for A1AR gene expression. Transgenic mice with A1AR proximal promoter coupled with the beta-galactosidase reporter gene had heavy labeling of the brain and atria, consistent with normal patterns of A1AR expression. Within the proximal A1AR promoter, putative binding sites for cardiac transcription factors GATA and Nkx2.5 were identified. Co-expression studies revealed that GATA-4 and Nkx2.5 could individually drive A1AR promoter activity and act synergistically to activate A1AR expression. These observations suggest that embryonic A1AR expression involves activation of the A1AR promoter by GATA-4 and Nkx2.5.

A radiation hybrid map of the rat genome containing 5,255 markers

A whole-genome radiation hybrid (RH) panel was used to construct a high-resolution map of the rat genome based on microsatellite and gene markers. These include 3,019 new microsatellite markers described here for the first time and 1,714 microsatellite markers with known genetic locations, allowing comparison and integration of maps from different sources. A robust RH framework map containing 1,030 positions ordered with odds of at least 1,000:1 has been defined as a tool for mapping these markers, and for future RH mapping in the rat. More than 500 genes which have been mapped in mouse and/or human were localized with respect to the rat RH framework, allowing the construction of detailed rat-mouse and rat-human comparative maps and illustrating the power of the RH approach for comparative mapping.

Effective treatment of localized Darier's disease with adapalene 0.1% gel

Darier's disease is an autosomal dominant disorder of keratinization that can produce unique clinical manifestations. Oral and topical retinoid products have been the mainstay therapy for this population, but local as well as systemic side effects often limit their effectiveness. A case of localized Darier's disease is presented that responded promptly and with no side effects to the topical application of adapalene 0.1% gel. A review of treatments for Darier's disease is presented.

The transfer of two embryos instead of three to reduce the risk of multiple pregnancy: a retrospective analysis

PURPOSE

Our purpose was to investigate whether a reduction in the number of embryos transferred from three to two would help reduce the incidence of multiple pregnancies and yet leave the pregnancy rate unaffected.

METHODS

Women were treated in a routine clinical in vitro fertilization program and the results analyzed retrospectively.

RESULTS

There was no reduction in the pregnancy rate when two embryos were transferred compared with three. Indeed, there was actually an increase in pregnancy rate after the transfer of two embryos in those cases with one or more embryos remaining after the transfer.

CONCLUSIONS

The transfer of only two embryos compared to three in women younger than 40 years of age does not compromise the chance of pregnancy. Triplets were not seen in the limited series of patients when only two embryos were transferred, but the incidence of twins remained the same. Further consideration should be given to strategies that enable the transfer of single embryos without compromising the pregnancy rate.

A physical map of 30,000 human genes

A map of 30,181 human gene-based markers was assembled and integrated with the current genetic map by radiation hybrid mapping. The new gene map contains nearly twice as many genes as the previous release, includes most genes that encode proteins of known function, and is twofold to threefold more accurate than the previous version. A redesigned, more informative and functional World Wide Web site (www.ncbi.nlm.nih.gov/genemap) provides the mapping information and associated data and annotations. This resource constitutes an important infrastructure and tool for the study of complex genetic traits, the positional cloning of disease genes, the cross-referencing of mammalian genomes, and validated human transcribed sequences for large-scale studies of gene expression.

Quality of life of elderly patients with isolated systolic hypertension: baseline data from the Syst-Eur trial. Syst-Eur Trial Investigators

OBJECTIVE

To describe measures of quality of life of elderly patients with isolated systolic hypertension at entry to a placebo-controlled randomized trial of antihypertensive treatment and to investigate factors associated with these.

DESIGN

Cross-sectional analyses at entry to a randomized controlled trial.

SETTING

Patients attending hypertension clinics or general practitioners' surgeries at 30 centres in 10 European countries.

PATIENTS

Six hundred and thirty-one patients aged 60 years or more, with a sitting systolic blood pressure during the run-in phase of 160-219 mmHg, a sitting diastolic blood pressure below 95 mmHg and a standing systolic blood pressure of 140 mmHg or more.

MAIN OUTCOME MEASURES

Cognitive function tests (Reitan Trail Making A and B), Brief Assessment Index (a measure of depressed mood) and four subscales from the Sickness Impact Profile (Ambulation, Social Interaction, Sleep and Rest and Housework).

RESULTS

Poor quality of life was generally associated with increasing age, previous treatment with antihypertensive drugs, presence of cardiovascular complications and, among women, high diastolic blood pressure, higher consumption of alcohol and high body mass index.

CONCLUSIONS

At entry to the trial there was considerable heterogeneity of patients in terms of measures of quality of life and cognitive performance. It remains to be determined whether these influence subsequent quality of life during randomized treatment.

Identification of a major susceptibility locus on chromosome 6p and evidence for further disease loci revealed by a two stage genome-wide search in psoriasis

Psoriasis is a common chronic inflammatory disorder of the skin. To further understand the pathogenesis of psoriasis we have chosen to investigate the molecular genetic basis of the disorder. We have used a two-stage approach to search the human genome for the location of genes conferring susceptibility to psoriasis, using a total of 106 affected sibling pairs identified from 68 independent families. As over a third of the extended kindreds included affected relatives besides siblings, in addition to an analysis of allele sharing between affected sibling pairs, a novel linkage strategy was applied that extracts full non-parametric information. Four principal regions of possible linkage were identified on chromosomes 2, 8, 20 (p <0.005) and markers from the MHC region at 6p21 (p <0.0000006) for which significant evidence of linkage disequilibrium was also observed (p <0.00002). Whilst data from limited case control associations exist to implicate the MHC, the results of this genome wide analysis demonstrate that, at least in the population studied, a gene or genes located within the MHC and close to the class 1 HLA loci, represent the major determinant of the genetic basis of psoriasis.

Location of the first genetic locus, PKDr1, controlling autosomal dominant polycystic kidney disease in Han:SPRD cy/+ rat

The Han:SPRD cy/+ strain develops a form of slowly progressive disease that appears similar in many respects to that seen in the autosomal dominant polycystic kidney disease (ADPKD) in humans. We have performed a total genome scan in an experimental backcross population derived from affected Han:SPRD cy/+ rat (PKD) and non-affected Wistar Ottawa Karlsburg rat (WOK) using 117 microsatellite markers. The genetic dissection of PKD allowed us to map on rat chromosome 5, a quantitative trait locus (QTL) controlling PKD, kidney mass and plasma urea concentration. The homology region is likely to reside on human chromosome 8. The gene responsible for PKD in Han:SPRD cy/+ rat is neither PKD1, localised on human chromosome 16, nor PKD2, localised on human chromosome 4. Therefore, we propose that this new locus be denoted PKDr1. The detection of the PKDr1 locus and associated QTL should accelerate research into the genetic causes of ADPKD.

Research directions in male sex work

This paper provides a critical review of the literature relating to male sex work and outlines approaches to theorizing about and researching male sex work. The adequacy of these models to explain the male sex work industry is discussed. The literature reveals that earlier studies conceptualized male sex work as deviance and focused on the individual sex worker and his reasons for engaging in sex work. Although the research agenda has recently moved away from the individual sex worker towards the sex work industry, the focus of the investigation continues to be from a deviance rather than a work perspective. A number of aspects of male sex work have received little attention in the literature. These include the interpersonal dialogues and power relations that constitute the commercial sexual negotiation, the role of political and economic forces, and expressions of male sexuality within the practice of commercial sex. The paper suggests future research directions and argues that researchers need to draw on the strengths of the male sex work community in order to promote safe sex practices in commercial researchers need to draw on the strengths of the male sex work community in order to promote safe sex practices in commercial sexual settings.

A row-action alternative to the EM algorithm for maximizing likelihood in emission tomography

The maximum likelihood (ML) approach to estimating the radioactive distribution in the body cross section has become very popular among researchers in emission computed tomography (ECT) since it has been shown to provide very good images compared to those produced with the conventional filtered backprojection (FBP) algorithm. The expectation maximization (EM) algorithm is an often-used iterative approach for maximizing the Poisson likelihood in ECT because of its attractive theoretical and practical properties. Its major disadvantage is that, due to its slow rate of convergence, a large amount of computation is often required to achieve an acceptable image. Here, the authors present a row-action maximum likelihood algorithm (RAMLA) as an alternative to the EM algorithm for maximizing the Poisson likelihood in ECT. The authors deduce the convergence properties of this algorithm and demonstrate by way of computer simulations that the early iterates of RAMLA increase the Poisson likelihood in ECT at an order of magnitude faster that the standard EM algorithm. Specifically, the authors show that, from the point of view of measuring total radionuclide uptake in simulated brain phantoms, iterations 1, 2, 3, and 4 of RAMLA perform at least as well as iterations 45, 60, 70, and 80, respectively, of EM. Moreover, the authors show that iterations 1, 2, 3, and 4 of RAMLA achieve comparable likelihood values as iterations 45, 60, 70, and 80, respectively, of EM. The authors also present a modified version of a recent fast ordered subsets EM (OS-EM) algorithm and show that RAMLA is a special case of this modified OS-EM. Furthermore, the authors show that their modification converges to a ML solution whereas the standard OS-EM does not.

Preparation of antisera to recombinant, soluble N-acetylglucosaminyltransferase V and its visualization in situ

N-Acetylglucosaminyltransferase V (GlcNAc-T V) is a glycosyltransferase which transfers N-acetylglucosamine in beta(1,6) linkage to the alpha(1,6)-linked mannose residue of Asn-linked oligosaccharides. This enzyme is characterized by several unusual properties: GlcNAc-T V is the largest lumenal Golgi glycosyltransferase described thus far, and its multiple mRNA transcripts range from 4.5 to about 9.5 kb; GlcNAc-T V mRNA and activity are regulated by the src tyrosine kinase signalling pathway; in brain tissue, large levels of GlcNAc-T V mRNA are present, but only relatively low levels of catalytic activity can be detected; a lectin-resistant cell line, Lec4A, expresses active GlcNAc-T V which is mislocalized intracellularly. In addition, the cell surface oligosaccharide products of this enzyme have been hypothesized to regulate intercellular adhesion. In order to devise specific inhibitors of this enzyme it is necessary to understand its physical structure and how structural changes can influence its activity and localization. We have expressed milligram amounts of a soluble form of recombinant rat GlcNAc-T V, purified it from CHO cell-conditioned media, and used it to prepare specific antisera. This antisera binds selectively to GlcNAc-T V and has been used to visualize B-16 mouse melanoma cell GlcNAc-T V on immunoblots after SDS-PAGE. When the antisera was used in immunofluorescence microscopy experiments on permeabilized B-16 and baby hamster kidney cells, intense, specific staining was observed in intracellular structures which appear to correspond to the Golgi apparatus.

The social meanings behind male sex work: implications for sexual interactions

This qualitative study explores the meanings of the commercial sexual encounter between male sex workers and their clients. The study highlights the various social meanings male sex workers attribute to having sex, their typologies of clients, the psychic contexts of male commercial sex, safer sex interactions, and how these issues inform sexual behaviour. The data shows that the meaning attached to the act of having sex is an important aspect of the way in which participants perceive their partners, conduct themselves during sexual encounters, and engage in safe sex practices. Clients are categorized by sex workers according to their perceptions of 'them', which include 'marrieds', 'easy trade', 'undesirables', 'sugar daddies' and 'heaven trade'. Different types of clients pose alternate levels of risk to the safe sex practices of sex workers. The sex worker's definition of commercial sex as work enables him to separate work and personal sex and define work sex as 'not real sex', in which safe sex practices symbolize both the degree of self that is shared and protective work equipment. It was also found that this sample of sex workers do not negotiate safe sex. Rather they use 'modes of interaction' which direct the encounter either towards safe sex, or they refuse to continue with the transaction. The interactive modes identified are 'natural', 'educative', 'challenge', 'other options' and 'walk-out'. These modes of interaction are effective strategies for ensuring safe sex, and can be used by the broader community to gain partner compliance in safe sex practices.

Anaesthesia for thyroplasty

The purpose of this report is to describe the anaesthetic considerations for layngoplastic procedures. Thyroplasty is a procedure which restores the voice in unilateral vocal cord paralysis. The procedure employs an external approach via a window cut at the appropriate level in the thyroid ala. A wedge of silastic is inserted against the inner perichondrium, thereby displacing the vocal cord medially and permitting voice production. Correct placement of the implant is assessed by asking the patient to phonate; patient cooperation is therefore necessary at certain times during the procedure. We describe our management of a patient undergoing thyroplasty. The use of a benzodiazepine agonist-antagonist combination provided both optimal operating conditions and patient comfort.

Onchocerca volvulus: a comparative study of in vitro neutrophil killing of microfilariae and humoral responses in infected and endemic normals

In vitro neutrophil-mediated microfilarial killing, humoral responses to crude adult worm antigens (OVAg) and to four recombinant Onchocerca antigens (GST-OV7, GST-OV103, GST-OV3.6, and MBP-OV16), as well as Western blot analysis to stage-specific Onchocerca proteins were studied in individuals from Bassa County, Liberia, infected with onchocerciasis and in endemic normals, defined as individuals without microfilaridermia. Both groups exhibited high levels of specific serum-dependent killing of microfilariae but could not be differentiated on the basis of these results. However, infected individuals had a significantly higher frequency of antibody response to OVAg (P = 0.0001) except GST-OV103. Based on the pattern of response to the different antigens, 17 categories of specific recognition were observed. Nine of these categories were common to both the infected individuals and the endemic normals, 2 were unique to the infected individuals, and 6 were unique to the endemic normals. Among the endemic normals, we identified a subcategory of individuals who had nondetectable levels of total IgG to OVAg by ELISA and had significantly lower IgG4 responses to OVAg. These same individuals demonstrated evidence of past infection, based on serum antibodies detectable by Western blot analysis to male and female adult worms and skin microfilariae, and had a positive response to two or less of the recombinant antigens. We believe that this subcategory may represent individuals with a unique status of immunity.

Onchocerca volvulus: in vitro cytotoxic effects of human neutrophils and serum on third-stage larvae

The cytotoxic effects of neutrophils co-cultured with infective third-stage larvae (L3) and autologous serum from three groups of individuals: infected (INF), non-patent endemic normals (EN) and non-endemic controls (NEC), were compared using a MTT (3-(4,5 dimethylthiazol-2yl)-2,5 diphenyl tetrazolium bromide) reduction assay as a biochemical parameter of larval viability. The MTT assay permitted the detection of L3 which had suffered varying levels of necrosis. The observations from this study indicate that infected individuals and endemic normals are capable of mounting a specific immune response against the infective L3. This is based on our findings of i) significantly greater numbers of L3 showed necrosis in neutrophil cultures of the INF and EN compared to those from the NEC, ii) a superior ability of cultures from these individuals to inhibit the molting of L3 to fourth-stage larvae, iii) IgG antibodies reactive with the surface of L3, detected by immunofluorescence in the serum of the INF and the EN and iv) recognition of specific antigens in extracts of L3 detected by Western blot analysis. The specific immune response directed against L3 is probably a significant immunological defense mechanism used to limit infection in endemic areas.