Frequency of spinocerebellar ataxia type 1, dentatorubropallidoluysian atrophy, and Machado-Joseph disease mutations in a large group of spinocerebellar ataxia patients

The spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative disorders varying in both clinical manifestations and mode of inheritance. Six different genes causing autosomal dominant SCA are mapped: SCA1, SCA2, Machado-Joseph disease (MJD)/SCA3, SCA4, SCA5, and dentatorubropallidoluysian atrophy (DRPLA). Expansions of an unstable trinucleotide CAG repeat cause three of these disorders: SCA type 1 (SCA1), MJD, and DRPLA. We determine the frequency of the SCA1, DRPLA, and MJD mutations in a large group of unrelated SCA patients with various patterns of inheritance and different ethnic backgrounds. We studied 92 unrelated SCA patients. The frequency of the SCA1 mutation was 3% in the overall patient group and 10% in the non-Portuguese dominantly inherited SCA subgroup. We found that DRPLA mutation in only one Japanese patient, who was previously diagnosed with this disease. We identified the MJD mutation in 41% of the overall patient group, which included 38 autosomal dominant kindreds of Portuguese origin; the frequency of the MJD mutation among the non-Portuguese dominantly inherited cases was 17%. These results suggest that SCA may be occasionally caused by the SCA1 mutation and rarely caused by the DRPLA mutation and that, to date, the MJD mutation seems to be the most common cause of dominantly inherited SCA. Finally, our results suggest that recessively inherited cases of SCA are not caused by the known trinucleotide repeat expansions.

High level monocyte chemoattractant protein-1 expression in transgenic mice increases their susceptibility to intracellular pathogens

We have constructed transgenic mice in which the mouse mammary tumor virus long terminal repeat controls the expression of murine monocyte chemoattractant protein-1 (MCP-1). Several independently derived lines of transgenic mice constitutively expressed MCP-1 protein in a variety of organs. Protein extracts from these organs had substantial in vitro monocyte chemoattractant activity that was neutralized by an anti-MCP-1 Ab, indicating that transgenic MCP-1 protein is biologically active. However, no transgenic mouse at any age displayed monocyte infiltrates in MCP-1-expressing organs. Two transgenic lines had circulating MCP-1 levels of 13 to 26 ng/ml, which is a concentration sufficient to induce maximal monocyte chemotaxis in vitro. These transgenic lines showed a 1 to 1.5 log greater sensitivity to infection with Listeria monocytogenes and Mycobacterium tuberculosis. A third transgenic line had lower serum levels of MCP-1 and was resistant to L. monocytogenes. The results suggest that this transgenic model is one of monocyte nonresponsiveness to locally produced MCP-1 due to either receptor desensitization or neutralization of a chemoattractant gradient by high systemic concentrations of MCP-1. Regardless of the mechanism, the data indicate that constitutively high levels of MCP-1 expression do not induce monocytic infiltrates, and that MCP-1 is involved in the host response to intracellular pathogens.

High level monocyte chemoattractant protein-1 expression in transgenic mice increases their susceptibility to intracellular pathogens

We have constructed transgenic mice in which the mouse mammary tumor virus long terminal repeat controls the expression of murine monocyte chemoattractant protein-1 (MCP-1). Several independently derived lines of transgenic mice constitutively expressed MCP-1 protein in a variety of organs. Protein extracts from these organs had substantial in vitro monocyte chemoattractant activity that was neutralized by an anti-MCP-1 Ab, indicating that transgenic MCP-1 protein is biologically active. However, no transgenic mouse at any age displayed monocyte infiltrates in MCP-1-expressing organs. Two transgenic lines had circulating MCP-1 levels of 13 to 26 ng/ml, which is a concentration sufficient to induce maximal monocyte chemotaxis in vitro. These transgenic lines showed a 1 to 1.5 log greater sensitivity to infection with Listeria monocytogenes and Mycobacterium tuberculosis. A third transgenic line had lower serum levels of MCP-1 and was resistant to L. monocytogenes. The results suggest that this transgenic model is one of monocyte nonresponsiveness to locally produced MCP-1 due to either receptor desensitization or neutralization of a chemoattractant gradient by high systemic concentrations of MCP-1. Regardless of the mechanism, the data indicate that constitutively high levels of MCP-1 expression do not induce monocytic infiltrates, and that MCP-1 is involved in the host response to intracellular pathogens.

Phenotype and genotype diversity in the circumsporozoite proteins of Plasmodium vivax in Thailand

Two phenotypes of the circumsporozoite (CS) protein of the human malaria parasite Plasmodium vivax occur in Thailand, each of which has a characteristic nonamer repeat: GDRA(A/D)GQPA for VK210-type and ANGAG-NQPG for VK247-type. We have sequenced the repetitive domains and flanking regions from 17 specimens collected from a small area, some of which had given ambiguous results in allele-specific hybridization or enzyme-linked immunosorbent assays (ELISA). Base substitutions occurred in non-random, limited patterns that suggest the dissemination of mutations by both unequal crossing-over and gene conversion; most substitutions were silent and phenotypic variation was relatively minor. Sequence variation and number of repeat units were much more variable in VK210-type clones than in those of VK247-type. Each VK210-type isolate with a poor ELISA response contained at least one clone with one of five residue substitutions not found in normally responsive isolates. The absence of obvious hybrid sequences between the two alleles suggests that most successful recombination may have been between sister chromatids, and the limited phenotypic variation suggests that CS antibody does not exert selective pressure on evolution.

Health-related quality of life between naturalism and hermeneutics

Interest in measuring Quality of life (QOL) in modern medicine has increased considerably in recent years. However, there is no generally agreed definition of QOL, but the term encompasses several constructs, including physical, functional, emotional, social and cognitive domains. A psychometric approach is typically applied, but major problems conceptual confront this tradition. It is argued that QOL research follows a naturalistic tradition in medicine, and that the theoretical status of the QOL concept remains ambiguous. Hence, the more neutral term multidimensional evaluation is suggested as more appropriate than QOL. Hermeneutic thinking with its focus on meaning, understanding and interpretation of the individual placed in a historical and social context is briefly introduced and its role for QOL discussed. A radical hermeneutic position focusing solely on the subjectivity of the individual is rejected, and a balanced view is suggested. Such a view should not ignore that man is a biological organism which can be subjected to naturalistic studies, but it should also take into account those features which constitutes man as a person, e.g. understanding and interpretation. Future QOL research may benefit from an integration of philosophical reflection on health and disease issues and a psychometric tradition.

[The magnetic resonance tomographic optimization of hip joint cartilage visualization by the selection of a T1-volume gradient-echo sequence and the use of hip-joint traction]

PURPOSE

The purpose of this study was to examine the accuracy of MR imaging of the healthy and the arthrotically altered articular hip cartilage with in vivo and in vitro separation of femoral head cartilage and acetabular cartilage.

MATERIAL AND METHODS

Images of three animal cadaver hips, 8 dissected patient femoral heads and 18 hip joints of human corpses, all either with arthrosis stage I-III or artificial cartilage defects, were compared with their corresponding anatomic sections. Additional histomorphologic examinations of the arthrotic cartilages were conducted, and MR-Imaging of 20 healthy and 21 arthrotic patient hips was performed using a specific traction method.

RESULTS

Using a T1-weighted 3-dimensional gradient-echo sequence and a traction of the hip joint, it was possible due to the low-signal imaging of the joint space to separate in vivo the high-signal femoral head cartilage from the high-signal acetabular cartilage. In horizontal position of the phase-encoding parameter, minimisation of the chemical-shift artifact, mainly in the ventro-lateral areas, was accomplished. MRI measurements of the articular cartilage widths showed significant correlations (p < 0.001) with the corresponding anatomic sections. At the same time the T1 3-dimensional gradient-echo sequence of the lateral femoral head with r = 0.94 showed the lowest deviations of the measurements. It was possible with MR imaging to distinguish four cartilage qualities.

CONCLUSIONS

Using these MR-examinations, an improved imaging of early stage arthrotic cartilage defects is possible, and the status of the arthrotic hip cartilage with regard to intertrochanteric osteotomy can also be assessed.

[Incidence of alcohol abuse among patients with emergency admissions to a psychiatric department. Evaluation based on clinical and biochemical markers]

Alcoholism and drug abuse were investigated in psychiatric patients, who were acutely admitted to a general psychiatric ward at Silkeborg Hospital in Denmark during a six month period. Several standardized diagnostic systems and assessment instruments were applied: ICD-8 and DSM-III diagnoses and the WHO Alcohol Use Disorder Identification Test (AUDIT) and Short Michigan Alcoholism Screening Test (SMAST). Furthermore, several biochemical markers were studied, including carbohydrate-deficient-transferrin (CDT), gamma-glutamyltransferase (GGT), and S-ethanol. Finally, thin layer chromatography of the urine was used to detect drugs abuse. A diagnosis of Alcoholism (code 303) was obtained in 39% of the included patients, while 13% were considered drug abusers (main and subsidiary diagnosis). These findings are in accordance with several previously published Danish studies and illustrate that alcohol abuse is a common diagnosis among acutely admitted patients to a psychiatric department situated outside the metropolitan areas in Denmark. When comparing alcohol abuse as assessed by clinical information and by biochemical markers, only CDT and GGT gave estimates similar to clinical evaluations. CDT was positive in 41% of the patients. Taking ICD-8 diagnoses of alcoholism as "golden standards" the sensitivity and specificity of the marker was 0.67 and 0.74, respectively. Although this is not as high as previously found values, these figures suggest CDT to be a useful biological marker in the delineation of alcohol related problems in psychiatric patients.

[Results of urinary control analyses of narcotic addicts on methadone therapy. An evaluation in the county of ]rhus in 1993]

Urinary control results were evaluated for 230 drug addicts in methadone therapy in the county of Arhus for 1993. Nine point nine percent of the initial samples were positive for opiates, dropping to 5.9% for subsequent samples, suggesting that urinary control has consequences. Two point four percent of the initial samples were negative for methadone decreasing to 1.3% for later samples. Fifty percent were positive for cannabinols and 15-20% for benzodiazepines, whereas only 1.4% was positive for amphetamine. Looking at the serial pattern for the patients, it turned out that 41% had one or more samples positive for opiates during the methadone treatment period, and 14% were occasionally negative for methadone. For comparison, urine samples from 461 clients not in methadone treatment were also studied. A similar abuse pattern was recorded for these samples.

Clozapine serum levels and side effects during steady state treatment of schizophrenic patients: a cross-sectional study

Serum clozapine (S-Cloza) and serum desmethyl-clozapine concentrations (S-Descloza) were measured in 30 chronic schizophrenic in- and out-patients on a variable dose regimen. All patients were in steady state with respect to clozapine therapy and in a stable condition with respect to psychotic illness. The 24-h clozapine dose (median with interquartile range in parenthesis) was 350 (228-425) mg/24 h (range 100-700). There was a weak positive correlation between doses and the BPRS total score (r = 0.44, P < 0.05). The median S-Cloza was 1076 (706-1882) nmol/l (range 196-5581 corresponding to 64-1824 ng/ml). The S-Cloza was linearly correlated to dose but with a high interindividual variation at equal doses, e.g. a factor of 8 at 400 mg/24 h, but a low intraindividual variability of 20%. The S-Descloza averaged 77% of the S-Cloza and was highly correlated to S-Cloza (r = 0.90; P < 0.001). The S-Descloza/dose ratio increased with age and duration of treatment. The side effects registered were EEG abnormalities (83%), tachycardia (23%), increased liver enzyme activity (60%), orthostatic hypotension (17%), and moderate leucocytosis (17%). Only EEG changes were correlated to S-Cloza (r = 0.43; P < 0.05). The score values of the UKU Side Effect Scale were weakly (r = 0.36) correlated to S-Cloza. No side effects were correlated to S-Descloza, doses, or treatment duration. The frequency of side effects was higher than in studies using lower mean doses indicating a correlation between doses or S-Cloza and the frequency of side effects. It is concluded that clozapine fulfils the criteria for therapeutic drug monitoring. TDM may contribute to finding the lowest effective dose with the fewest possible side effects.

Oral vinorelbine (Navelbine) in the treatment of advanced non-small cell lung cancer: a preliminary report

Vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) is a novel semisynthetic vinca alkaloid with antitumor activity in non-small cell lung cancer. An oral preparation of this drug is under investigation and was tested in a multicenter phase II study in patients with stage IV measurable or evaluable non-small cell lung cancer. The initial vinorelbine dose was 100 mg/m2/wk (80 mg/m2/wk for patients with prior radiotherapy). Following an initial 37% incidence of grade 3 or 4 neutropenia, the dose was reduced by 40 mg/dose. Nausea, vomiting, diarrhea, and mucositis were other frequently observed toxicities. A preliminary analysis indicated a response rate of 14%, suggesting activity of this drug when administered orally.

Three years follow-up of panic disorder patients: a naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.

Effect of flunarizine and calcium on serotonin uptake in human and rat blood platelets and rat synaptosomes

Calcium and the calcium overload blocker flunarizine exert profound effects on mood. We therefore studied the effect of calcium and flunarizine on serotonin uptake in human and rat blood platelets and in rat synaptosomes. Calcium (1.3 mmol/L) had a weak inhibiting effect on serotonin uptake in blood platelets, whereas no effect was observed in synaptosomes. Flunarizine inhibited serotonin uptake in a concentration dependent manner with an IC50 value of 1 mumol/L in blood platelets and 5 mumol/L in synaptosomes. The inhibition did not depend on the presence of extracellular calcium indicating that the effect is not coupled to a blockade of cellular calcium influx. In human blood platelets, the inhibition was of the noncompetitive type. These results indicate that flunarizine interacts directly with the 5-HT uptake site. The relatively high concentration of flunarizine required to inhibit 5-HT uptake may question the clinical importance of this effect.

A test of alternative supervision strategies for family planning services in Guatemala

This report presents results of an operations research project that tested the impact and cost-effectiveness of alternative supervision schemes of reproductive health services in Guatemala. The strategies tested were (1) indirect supervision, in which one of the two annual supervised visits to each health unit was replaced by a one-day meeting at the district level with the supervisor; and (2) self-assessment, in which one supervised visit was replaced by a two-day workshop where participants filled out self-assessment checklists identifying quality of care problems and made a plan to solve identified problems during the following months. Health units in the two experimental groups showed greater increases in productivity than units receiving traditional supervision. In both alternative strategies, supervisors were able to reach a larger proportion of health units and service providers than through the traditional supervision system. The supervised cost per unit was also lower in the two experimental groups than in the control group. Few differences were observed between the experimental and control groups in terms of the satisfaction of service providers with their jobs and of clients with services received.

The epidemiology of Plasmodium vivax circumsporozoite protein polymorphs in Thailand

Enzyme-linked immunosorbent assays (ELISAs) highly specific for the characteristic repeat units of the circumsporozoite proteins of the VK 247 and VK 210 polymorphs of Plasmodium vivax were used to test sporozoites produced by feeding mosquitoes on 1,711 human volunteers presenting at four locations in Thailand over five years. There was no evidence for the existence of any polymorph other than the two already described. Based on the ELISAs, the overall prevalence of the VK 247 type was 29.5%, including those found mixed with VK 210. Relative proportions of VK 210 and VK 247 differed between collection sites. At all places, the ratio of VK 210 to VK 247 was significantly higher at the end of the nontransmission season than it was later during the annual monsoon, suggesting that there may be intrinsic biological differences between the polymorphs that affect their survival.

Borderline states: pharmacotherapy and psychobiology of personality. A discussion of Soloff's article

The question of the existence of rational drug treatment of borderline personality disorder is discussed from two different positions. To the empiricists, the answer must rely on rigorous analysis of controlled drug trials, while to the realists theoretical conceptions of borderline personality disorder must also be seriously addressed. A rational pharmacotherapy can be claimed even when the nosological status of the disorder is not clarified but must be based on a dimensional analysis of psychopathology. Current psychotropic drugs have some but not any too impressive efficacy in the treatment of borderline personality disorder. It is argued that future drug treatment may benefit from the progress in neuroscience, especially within the area of psychobiology of personality.

Comparative test of DNA probes for detection of Plasmodium vivax circumsporozoite protein polymorphs VK 247 and VK 210

Oligonucleotide probes specific to the characteristic repeat sequences of two alleles of the circumsporozoite protein gene of Plasmodium vivax (VK 210 and VK 247) were selected, synthesized, and tested on matched blood and sporozoite DNA amplified by polymerase chain reaction from 182 cases naturally acquired in Thailand. Probe results were compared to those of circumsporozoite phenotype-specific ELISAs used to evaluate sporozoites from the same cases. There was a 96% agreement between probe results for blood and for sporozoites. Although there was also a nearly complete agreement between probe and ELISA results for cases producing only VK 210 or VK 247 sporozoites, the probes detected 45% more mixed infections than did the ELISAs when used to test specimens from western and southern Thailand; there was no discrepancy when mixed cases from Cambodia were tested. Examination of Southern blots from ambiguous mixed cases demonstrated the presence of both genes, suggesting suppression of VK 247 in some mixed cases to numbers below those detectable by the ELISA.

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.

Determination of free polyamines in human bile by high-performance liquid chromatography

1. Polyamines are widely distributed in the body and may have cholesterol-nucleating activity in model bile and human bile. There are only partial and scant data available on the type of polyamines in human bile. 2. In this study methods for extraction of free polyamines, benzoylation and an h.p.l.c.-based method for the quantitative determination of putrescine, cadaverine, spermidine and spermine in bile are described. The h.p.l.c. methodology was validated and compared with separation on t.l.c. after dansylation. 3. The polyamine content of 11 gallbladder bile samples and 11 T-tube bile samples was analysed, all from patients with gallstones. Polyamines were found in three out of 11 gallbladder bile samples and eight out of 11 T-tube bile samples. Putrescine levels were 0.5-287 mumol/l and cadaverine levels were 2.4-645.4 mumol/l; these were considerably higher than spermine and spermidine levels. 4. As many of these gallstones bile samples were devoid of polyamines, it is questionable whether polyamines play an important role in cholesterol nucleation in human bile.

Chronic pain: intrusion and accommodation

Cognitive-behavioral and self-management perspectives on chronic pain emphasize the central role that patient's appraisals of their pain problems may have in determining aspects of the pain experience. This paper reports the development of a self-report instrument measuring two aspects of patients' appraisals of their pain and its impact on their lives. Two reliable and meaningful scales were derived via factor analysis, and a second sample was submitted to confirmatory factor analysis. Further analyses offered support for the internal consistency and stability of the scales. Pain Intrusion is related to greater depressive symptom severity and pain behaviors reflecting affective distress. Pain Accommodation is related to self-reports of greater self-control, viewing oneself as a problem-solver, fewer depressive symptoms, and fewer pain behaviors reflecting affective distress. This report introduces these constructs and the Chronic Pain Intrusion and Accommodation Scales that measure them, and discusses their theoretical and clinical relevance.