Precipitating causes of acid reflux episodes in ambulant patients with gastro-oesophageal reflux disease

Previous studies of the mechanisms that precipitate acid reflux episodes have used short term hospital based measurements. A 24 hour pH and motility recording system, incorporating a sphincter monitoring device, has been developed to study naturally occurring acid reflux episodes in control subjects and patient groups with different grades of oesophagitis. Lower oesophageal sphincter relaxations related to episodes of acid reflux were common in control subjects (67% of episodes) but became more difficult to detect as the grade of oesophagitis increased (grade 0/1 - 67%, grade 2/3 - 35%, grade 4 - 13%). A variety of events that produced recognisable transdiaphragmatic pressure patterns were associated with acid reflux episodes. In control subjects 74% of acid reflux episodes were precipitated by belching but this mechanism became less evident as the grade of oesophagitis increased (grade 0/1 - 43%, grade 2/3 - 40%, grade 4 - 29%). Activities that produced a pressure gradient across the diaphragm became increasingly important as events precipitating acid reflux as oesophagitis became more severe (controls--2%, grade 0/1 - 15%, grade 2/3 - 11%, grade 4 - 22%). This study has shown the pressure events surrounding acid reflux in fully ambulant patients with gastro-oesophageal reflux disease.

What is the relationship between perineal descent and anal mucosal electrosensitivity?

PURPOSE

Perineal descent is found in many patients with anorectal disorders. There is now substantial evidence against perineal descent causing damage to the motor axons in the pudendal nerves, but the sensory sequelae of perineal descent have been neglected. The purpose of this study was to establish the relationship between perineal descent and anal sensation.

METHODS

Perineal position was determined in relation to the bony pelvis by means of defecating proctography. Anal mucosal electrosensitivity was determined by using a constant current generator.

RESULTS

This study demonstrated significant correlations between perineal position at rest and sensitivity in each third of the anal canal in the study group overall. In women studied alone, there were significant correlations between perineal position at rest and at squeeze and anal mucosal electrosensitivity in each third of the anal canal.

CONCLUSIONS

We propose that perineal descent traumatizes the pudendal nerves, damaging the large diameter sensory axons. This may be a precursor of motor axon damage or may correlate with the global pelvic sensory loss found in patients with perineal descent and fecal incontinence.

Oesophageal acid clearance in patients with severe reflux oesophagitis

Previous studies examining oesophageal acid clearance have employed a variety of techniques to induce or simulate acid reflux. Clearance abnormalities have been deduced from abnormal standard motility studies, barium radiology or from 24-h pH recordings. In this study a 24-h pH and oesophageal motility recording system was used to study naturally occurring acid reflux episodes in control subjects and in two groups of patients with severe acid reflux disease (erosive oesophagitis and oesophageal stricture). Acid clearance was compared between the subject groups. Patients with oesophageal stricture were found to have poor oesophageal peristaltic ability and particularly poor oesophageal acid clearance. Those with erosive oesophagitis had normal peristaltic swallowing but abnormal acid clearance. This study has characterized, for the first time, the abnormalities in acid clearance during naturally occurring acid reflux episodes in patients with severe reflux disease. A more complete understanding of these clearance abnormalities could influence future medical and surgical strategies in the management of severe gastro-oesophageal reflux disease.

Reporting simplified colonic transit studies using radionuclides: clinician friendly reports

This study describes a graphic presentation of the results of a simplified segmental colonic transit model. This study requires three sets of images on three consecutive days after intake of indium-111 resin capsule at each time point. The per cent of ingested activity is calculated in each region of the colon and in the faeces. The program uses standard PC compatible graphic package, CorelDRAW (Corel Corporation). The report for the patients' notes consists of three schematic diagrams of colon with regions identified and a pot representing the faecal activity. The per cent of administered activity in each region and pot is both printed and represented by shades of grey (white representing 0% and black 100% activity), for each region and the pot. The distribution of activity is clearly seen at each time point and the report is presented on single A4 size sheet of paper. Using a simplified colonic study protocol it is possible to produce clinician friendly reports on a single sheet of paper.

High-level expression of G protein-coupled receptors with the aid of the Semliki Forest virus expression system

The expression of two G protein-coupled receptors was studied in several cell lines using the Semliki Forest virus expression system. Human neurokinin-2 and dopamine D3 receptor cDNAs were introduced into the pSFV1 vector. In vitro transcribed RNAs were coelectroporated with pSFV-Helper RNA into BHK cells resulting in in vivo packaging of high titer SFV-NK-2 and SFV-D3 virus stocks, respectively. Infection of BHK, HOS and CHO cells with the recombinant NK-2 virus resulted in high levels of receptor expression as detected by metabolic labelling with [35S]-methionine. The expression of the NK-2 receptors in the cell membrane was demonstrated by Flow cytometry experiments on infected BHK and CHO cells with fluoresceinyl-NKA as the ligand. Saturation binding assays on membranes prepared from SFV-NK-2 infected CHO cells with [3H] GR100679 showed maximum receptor densities of 6.5 pmol receptor/mg protein. Additionally, the expressed NK-2 receptors were able to stimulate Ca2+ mobilization in CHO cells indicating functional coupling to G proteins. CHO cells infected with SFV-D3 also produced high levels of receptor as evidenced by both [35S]methionine labelling and [3H]spiperone binding.

Financing mechanisms for village activities in The Gambia and their implications for financing insecticide for bednet impregnation

The recent enthusiasm for impregnated bednets as a malaria control measure leaves unresolved the question of how to finance them. The National Impregnated Bednet Programme in The Gambia faced the question of how to obtain funds from villages to finance the cost of insecticide, but knew very little about current village fundraising for development purposes. A survey was conducted of such fundraising, and questions also asked about willingness to pay for insecticide and preferred means of paying. All 53 villages surveyed paid taxes/rates, but 34% of villages reported no voluntary fundraising. The most common reason for collecting money was for the maintenance of wells (40% of villages). Collective farming was used as a means of raising money in 32% of villages. There was some variation in the type and extent of fundraising by region and also by the predominant ethnic groups of the village. Villages with voluntary fundraising activities seemed to have well established collective mechanisms for agreeing on sums to be collected and their use, and for collecting and recording income and expenditure. Non-payment was rare, and misuse of funds was not reported. Respondents were asked how much compounds might be willing to pay for insecticide impregnantion: the most frequently cited maximum amounts were D5 and 10, and minimum D1 and 5 (D15 = 1 pound). The paper discusses payment options for insecticide, such as whether the village should be allowed to decide itself how to raise funds, and whether the payment should be made only by households with nets or by a village-wide mechanism such as collective farming.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent right umbilical vein: sonographic detection and subsequent neonatal outcome

OBJECTIVE

To review our experience with antenatal detection and subsequent neonatal outcome of fetuses with a persistent right umbilical vein.

METHODS

In a prospective observational study, 33 cases of persistent right umbilical vein were detected during 15,237 obstetric ultrasound examinations performed after 15 weeks' gestation.

RESULTS

Persistent right umbilical vein was detected at a rate of one per 476 obstetric ultrasound examinations. Six of 33 (18.2%) fetuses with a persistent right umbilical vein had additional important congenital malformations.

CONCLUSIONS

Careful second- and third-trimester ultrasound examinations can detect a persistent right umbilical vein. When this particular anomaly is detected, a thorough fetal anatomic survey, including echocardiography, should be performed to rule out more serious congenital malformations.

High-level expression of the human neurokinin-1 receptor in mammalian cell lines using the Semliki Forest virus expression system

Human neurokinin-1 receptor cDNA was introduced into the pSFV1 Semliki Forest virus (SFV) vector and the in vitro transcribed RNA was electroporated into BHK cells with pSFV-Helper RNA. This procedure resulted in the packaging of a high-titer SFV-NK-1 virus stock containing approximately 5 x 10(9) infective units/ml. Infection of baby hamster kidney, COS-7, Chinese hamster ovary and human osteosarcoma cells yielded high levels of human neurokinin-1 receptor expression as assessed by [3H]substance P binding. The maximal receptor expression level obtained was 4 x 10(6) receptors/cell and studies of the post-infection time indicated that a high level of receptor expression was observed 10-24 h post-infection. The human neurokinin-1 receptor expressed in infected baby hamster kidney, COS-7 and Chinese hamster ovary cells was able to stimulate Ca2+ mobilization indicating functional coupling to guanine-nucleotide-binding proteins. The application of the Semliki Forest virus expression system will permit the rapid and efficient production of large quantities of receptor protein for both pharmacological and structural studies.

The economic consequences of malaria for households: a case-study in Nepal

Increased attention has recently been paid to the impact of illness on the well-being of households in developing countries. This has been a particular theme in the case of malaria, but relatively little evidence is available on how households react to malaria and on its impact on expenditure and time allocation patterns. This paper reports the results of a study designed to investigate the economic consequences of malaria for households in Nepal. A household survey of malaria cases in two districts provided information on use of various sources of treatment, their cost to households, time lost by the person with malaria, the extent to which others inside or outside the household provided assistance with the normal work of the malaria patient, the time spent caring for a child with malaria and any financial losses associated with the malaria episode. Out-of-pocket expenditure on treatment differed greatly between the two districts, for reasons associated with the choice of public or private sources of treatment and the number of visits made per episode. The majority of households appeared to cope without great difficulty with the reduction in labour supply caused by a malaria episode, by drawing largely on the time of adult family members. Caution is advised in extrapolating the results to other situations, given the extent to which local factors are likely to influence the impact on households. Moreover, the findings relate to a situation where a malaria control programme is in place: a relatively greater impact per household would occur in the absence of control. However, it is argued that such surveys have value in informing health policy, particularly in relation to setting priorities and treatment policy.

Characterization of the functional activity of dopamine ligands at human recombinant dopamine D4 receptors

The human D4 dopamine receptor has been expressed in Sf9 insect cells where it appears to couple to endogenous G proteins. Increased guanine nucleotide exchange to G proteins is a reflection of receptor activation and can be followed using a [35S]GTP gamma S binding assay. By measuring D4 receptor stimulation of [35S]-GTP gamma S binding we have been able to characterize several dopaminergic compounds for their functional activity at this receptor. In Sf9 cells expressing the D4 receptor, dopamine, quinpirole, and dp-2-aminodihydroxy-1,2,3,4-tetrahydronaphthalene were all full agonists, whereas (-)-apomorphine appeared to be a partial agonist. No increase in [35S]GTP gamma S binding was observed for noninfected cells or cells infected with an unrelated sequence. The quinpirole-stimulated [35S]GTP gamma S binding could be inhibited by the antagonists clozapine, eticlopride, and haloperidol, and a Schild analysis of these data showed that all three compounds were acting as competitive antagonists of D4 receptors. The rank order of affinities derived from the Schild analysis correlated with that obtained from [3H]spiperone competition binding assays. In conclusion, we have shown that, using this assay system, it is possible to investigate functionally the pharmacology of a recombinant G protein-coupled receptor in the absence of any information regarding the eventual second messenger pathways involved.

Total energy expenditure and energy intake in the pre-school child: a comparison

In a cohort (n 81) of healthy children aged 1.5-4.5 years, measurements of energy intake and energy expenditure were compared. Energy intake was calculated following a 4 d weighed record completed by the mother or guardian of the child. Total energy expenditure was measured using the doubly-labelled water technique. Mean energy intake and expenditure in the cohort were 4773 kJ/d and 4928 kJ/d respectively. The mean relative bias between the techniques was 154 kJ/d. In the older children (3.5-4.5 years) the mean relative bias was only 37 kJ/d. At the population level the measurements of energy intake and energy expenditure were extremely close, and the study has provided sufficient confidence in weighed intake methodology for it to be used in a major nationwide study of dietary intake and nutritional status of children aged 1.5-4.5 years.

Antenatal diagnosis of fetal pelvic kidneys

OBJECTIVE

To review our experience with the antenatal detection and subsequent neonatal outcome of fetuses with a pelvic kidney.

METHODS

A retrospective review of 25,551 obstetric ultrasound examinations performed after 16 weeks' gestation identified 13 cases of fetal pelvic kidneys (one per 1965 examinations).

RESULTS

Three pelvic kidneys were dysplastic; the remainder appeared sonographically normal. Seven pelvic kidneys were measured; five were smaller than expected for gestational age. Associated anomalies were detected in three cases.

CONCLUSIONS

Careful second- and third-trimester ultrasound examinations can detect an absence of the kidney in the renal fossa. Evaluating the migratory path of the kidney from the pelvis to the renal fossa will frequently result in detection of an ectopic kidney.

Actin filament bundles are associated with fiber gap junctions in the primate lens

A unique association between actin filament bundles and gap junctions in cortical fiber cells of human and monkey lenses was studied with thin-section electron microscopy and immunocytochemistry. Thin-section electron microscopy showed that distinct layers of filament bundles (approximately 55 nm thick) were consistently associated with fiber gap junctions (approximately 16 nm thick) from intermediate to deep cortical regions in both species studied. The filament bundle was composed of 6-8 nm microfilaments which lay along both cytoplasmic surfaces of the junction. Fluorescence microscopy revealed a patchy pattern of F-actin labeling along the fiber cell membranes in the intermediate and deep cortical regions of the lens. The size and distribution pattern of F-actin labeling appear to correlate well with those of filament bundles/gap junctions seen in thin-section electron microscopy. By immunoelectron microscopy, the anti-actin antibody was shown to be localized to filament bundles/gap junctions in the intermediate cortical fibers of human lens, indicating that filament bundles are F-actin in nature. The identical filament bundle/gap junction association was not found in other species examined, including rodent, bird and fish, by the same procedure, suggesting that an association between actin bundles and gap junctions has a special functional role in the primate lens. It is proposed that gap junction-associated actin bundles may provide added structural stability for the primate lens.

Orphan seven transmembrane domain receptors: reversing pharmacology

The application of molecular genetic approaches to the study of seven transmembrane domain receptors has allowed the cloning of many receptors for which the ligand is initially unknown. These are commonly referred to as 'orphan receptors', and several have subsequently proved to be important pharmacological targets. This article discusses how these receptor sequences were isolated, and presents some of the methods by which the corresponding ligands were identified. These examples are used to propose a rational approach for the study of further orphan receptors.

Recombinant protein expression in a Drosophila cell line: comparison with the baculovirus system

In this report, we compare two different expression systems: baculovirus/Sf9 and stable recombinant Drosophila Schneider 2 (S2) cell lines. The construction of a recombinant S2 cell line is simple and quick, and in batch fermentations the cells have a doubling time of 20 hours until reaching a plateau density of 20 million cells/ml. Protein expression is driven by the Drosophila Metallothionein promoter which is tightly regulated. When expressed in S2 cells, the extracellular domain of human VCAM, an adhesion molecule, is indistinguishable from the same protein produced by baculovirus-infected Sf9 cells. Additionally, we present data on the expression of a seven trans-membrane protein, the dopamine D4 receptor, which has been successfully expressed in both systems. The receptor integrates correctly in the S2 membrane, binds [3H]spiperone with high affinity and exhibits pharmacological characteristics identical to that of the receptor expressed in Sf9 and mammalian cells. The general implications for large scale production of recombinant proteins are discussed.

The economics of vector control strategies for controlling tropical diseases

This paper describes the techniques of economic evaluation and how they can help improve the efficiency of vector control strategies for controlling tropical diseases. The differences among the techniques are clarified, and the main components of each analytical approach are presented, as well as some of the major problems in their application. The historic evolution of the application of economics to vector control in developing countries is summarized, before analyzing some more recent studies that have explored some of the choices concerning vector control. The paper concludes with some recommendations for improving the quality and, therefore, the usefulness of studies.

Is malaria control a priority? Evidence from Nepal

The research reported here assessed the value of malaria control through a cost-effectiveness study of the vertically-organized malaria control programme in Nepal. It presents a methodological framework for analysing cost-effectiveness which includes resource-saving consequences as well as health consequences. The methods used to collect data on control costs, cases and deaths prevented, treatment costs averted and production gains are described and the assumptions required by the analysis are made explicit. A variety of cost-effectiveness ratios are calculated, sensitivity analysis applied and the policy implications of the results considered. The results from Nepal are compared to estimates for parasitic disease and other health programmes in other countries: it is concluded that the Nepalese programme appears no less cost-effective than many other health interventions. It can also be justified by reference to the population groups benefiting from malaria control.

Characterization of a novel exon within the D3 receptor gene giving rise to an mRNA isoform expressed in rat brain

A novel D3 receptor cDNA containing an insertion of 84 bp has been isolated from a series of alternatively spliced D3 receptor cDNAs by polymerase chain reaction on RNA isolated from rat basal forebrain. Sequence analysis of both subcloned cDNAs and genomic DNA clones, has identified a 84 bp insertion resulting in a 28 amino acid insertion in the first extracellular loop. A comparison of the cDNA sequence of the novel D3 cDNA and the isolated genomic sequence indicates that the novel insertion corresponds to a new exon and arises via an alternative splicing event. The mRNA for the novel insertion could be detected by PCR in several areas of the brain co-localized with the wild type form of the D3 receptor. Moreover, genomic Southern blot analyses suggest that the D3-receptor exon giving rise to this novel D3 mRNA variant might exist in other species.

Helping male victims of sexual abuse

The author recounts his experience of working in an extra care psychiatric unit in which a proportion of the male attenders had been subject to sexual abuse as children. While there is a paucity of literature on the subject of male sexual abuse, his experience of looking after victims suggests that many commonalities with female sexual abuse survivors exist. A model is presented as guidance for practitioners in helping men who have suffered sexual abuse as children.

Community financing of health care in Africa: an evaluation of the Bamako initiative

The Bamako Initiative, a controversial attempt to strengthen Primary Health Care using community financing and community participation and management was launched at a meeting of African Ministers of Health in 1987. This evaluation focuses particularly on the community financing aspects of the Initiative. Previous experiences of community financing highlight particular lessons for the development of the Initiative and issues likely to be encountered in implementation attempts. Four country case studies of the Initiative at its early stages of implementation (in June, July and August 1991) were conducted in Burundi, Guinea, Kenya, and Nigeria. Similar activities in Uganda were also studied. These were short studies of one month each and utilised methods of rapid evaluation. The studies aimed to direct implementers quickly to issues requiring attention rather than to reach overall conclusions regarding the success of the Initiative which would be premature at this stage. Price structures used by the Initiative need to consider the access of marginalised groups more than is the case at present. In addition, there is a need to ensure against over-prescription and commercialisation and to ensure that incentives for utilising most appropriate levels of care are maintained. The evidence suggests that most people do find amounts of money to pay for health services which are large in relation to their income. This is probably a tribute to extensive community support mechanisms. Nevertheless, it highlights the plight of those who fall through this safety net for whom even charges for very basic care may be prohibitive. On the other hand, it appears that in most cases, the Initiative's activities provide a service which is cheaper when all costs to the household are taken into account, than was available before. The quality of services included in the Initiative's activities in the five countries was highly variable. Success in raising substantial revenues has also been mixed. In some countries however, substantial funds have been generated and used to achieve real improvements in health services. Overall, the experiences of the five countries appear to have been highly dependent on a number of 'environmental' characteristics: a tradition or not of 'free' services; the adequacy of current resource availability and that immediately preceding the introduction of the Initiative; the existing stage and nature of decentralisation within the country; and the competition the Initiative's activities face with alternatives.

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 8. Cost-effectiveness of bed net impregnation alone or combined with chemoprophylaxis in preventing mortality and morbidity from malaria in Gambian children

In The Gambia, insecticide impregnation of bed nets, used alone or combined with Maloprim, reduced morbidity and mortality from malaria amongst children between one and 4 years of age. Taking expenditure of both time and money by public authorities and village volunteers into account, the costs and cost-effectiveness of each intervention were estimated. Bed net impregnation alone and the combined strategy cost US $5.65 and US $7.49 per child-year protected respectively (1990 figures). Insecticide (and drugs) accounted for more than 80% of the costs of each intervention strategy. They were both highly cost-effective. Estimated costs per death and per clinical episode of malaria averted were US $188 and US $28 for bed net impregnation and $257 and $19 for impregnation combined with chemoprophylaxis. Estimated costs per healthy year of life saved, discounted at 3%, were US $7.90 and US $10.84.