Meta-analysis of correlates of diabetes patients' compliance with prescribed medications

This study quantitatively integrated the results of independent research papers containing correlates of objectively measured diabetes patients' compliance with prescribed medications. A total of 183 correlations were extracted from 26 studies. Separate meta-analytic syntheses were conducted to calculate average correlations for different subsets of studies, each of which represented homogeneous results. In general, emotional stability, internal and external motivations, perceived benefit, and supportive structure were positively associated with patients' compliance; perceived barriers and negative social environment were correlated with poor compliance. The directions of relationships of knowledge and age with compliance varied, depending on other study characteristics.

Pulmonary hamartoma and multiple cardiac anomalies in a Finn-Dorset cross lamb

A case of pulmonary hamartoma was diagnosed in a neonatal, male, Finn-Dorset cross lamb with concurrent cardiac anomalies and palatoschisis. On gross examination, the lungs were markedly enlarged and spongy. Histologically, pulmonary lobules were composed of severely dilated and hyperplastic terminal bronchioles, separated by an abundant connective tissue stroma. Alveoli were generally absent. Other bronchi were hypoplastic and lacked both cartilage and smooth muscle. Both the cranial and caudal vena cavae and the pulmonary veins entered the right atrium. This anomaly has not been previously reported in lambs.

The corticospinal tracts in man. Course and location of fibres at different segmental levels

The course, location and relations of the corticospinal tracts within the spinal cord of man are demonstrated on the basis of cases with lesions above the spinal cord restricted to the corticospinal tracts, of motor neuron disease, and of anterolateral cordotomies; control cases were of normal spinal cords. The following features of the lateral corticospinal tract are emphasized in the cervical cord: (1) the large extent of the white matter of the cord covered by the tract, and the anterior extent of the tract, the border being anterior to the central canal; (2) in the lower cervical cord, the separation of fibres from the main mass of the tract, which reach the periphery of the cord in the anterolateral sector; (3) the presence in many cords of the ventral crossed bundle; and (4) the relationship of the denticulate ligament to the tracts in the cervical segments. The following features of the anterior corticospinal tracts are emphasized: (1) their location, caudal extent and asymmetry; and (2) the changes in location in relation to the median fissure as the tract descends and its relationship to other tracts of the anterior column. Three-quarters of spinal cords are asymmetric and in three-quarters of asymmetric cords the right side is the larger. The asymmetry is due to a greater number of corticospinal fibres crossing to the right side. As more fibres have crossed in the decussation, the anterior tract opposite the large lateral tract is smaller than the ipsilateral anterior tract: that accounts for the asymmetry of the two halves of the cord. The greater number of corticospinal fibres in the right side of the cord is unrelated to handedness, but correlates with the fact that in three-quarters of corticospinal decussations, the crossing from left to right occurs at a more cranial level than the opposite crossing. A group of short peripheral ascending fibres is described running along the sides of the median fissure in the thoracic cord.

Streptomyces griseus streptomycin phosphotransferase: expression of its gene in Escherichia coli and sequence homology with other antibiotic phosphotransferases and with eukaryotic protein kinases

The aphD gene of Streptomyces griseus, encoding a streptomycin 6-phosphotransferase (SPH), was sub-cloned in the pBR322-based expression vector pRK9 (which contains the Serratia marcescens trp promoter) with selection for expression of streptomycin resistance in Escherichia coli. Two hybrid plasmids, pCKL631 and pCKL711, were isolated which conferred resistance. Both contained a approximately 2 kbp fragment already suspected to include aphD. The properties of in vitro deletion derivatives of these plasmids were consistent with the presumed location of aphD. In vitro deletion of a sequence including most of the trp promoter largely, but not quite completely, abolished the ability of the plasmid to confer streptomycin resistance, confirming that expression was indeed principally from the trp promoter. A polypeptide of approximately 34.5 kDa was present in minicells containing plasmids that conferred streptomycin resistance, but was absent when the plasmids contained in vitro deletions removing streptomycin resistance. Part of the fragment was sequenced and an open reading frame corresponding to aphD identified. A computer-assisted comparison of the deduced SPH sequence with those of other antibiotic phosphotransferases suggested a common structure A-B-C-D-E, where B and D were conserved between all sequences compared while A, C and E divided between the streptomycin and hygromycin B phosphotransferases on one hand and kanamycin/neomycin ones on the other. A composite sequence data base was searched for homologues to consensus matrices constructed from five approximately 12-residue subsequences within blocks B and D. For one subsequence, corresponding to the N-terminal portion of block D, those sequences from the database that yielded the highest homology scores comprised almost entirely either antibiotic phosphotransferases or eukaryotic protein kinases. Possible evolutionary implications of this homology, previously described by other groups, are discussed.

Recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase

Three cases of left recurrent laryngeal nerve palsy following heart-lung transplantation are described. In each case, within twelve hours of extubation, the left vocal cord was injected with Teflon, and the paralyzed vocal cord thus displaced to the midline. Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration. Augmentation under general anaesthesia as soon as possible after discovery of vocal cord dysfunction is advocated. Suitable materials for injection are discussed. To our knowledge, this is the first reported series of vocal cord augmentation in the acute phase following heart-lung transplantation.

Laryngeal compression and stridor as the presenting feature of ruptured thoracic aortic aneurysm. Report of two cases

Two patients are reported in whom rupture of a thoracic aortic aneurysm presented with neck swelling and progressive stridor. Stridor occurred due to compression of the larynx by haematoma tracking up from the mediastinum. The presentation of thoracic aortic aneurysms and of rupture of thoracic aortic aneurysms are discussed with particular reference to mechanisms of cardiovascular and respiratory manifestations. The importance of early control of the airway is emphasised if there is to be any hope of survival from acute rupture.

S-methylation in motorneuron disease and Parkinson's disease

Thiolmethyltransferase activity has been measured in newly diagnosed, untreated patients with idiopathic Parkinson's disease and motorneuron disease, and in normal volunteers. In Parkinsonian patients, mean thiolmethyltransferase activity was low (300 U/mg protein [SD 96]) compared with that in controls (947 [409]), whereas activity was high in patients with motorneuron disease (2077 [825]).

Nucleotide sequence of a Bacillus subtilis arginine regulatory gene and homology of its product to the Escherichia coli arginine repressor

In Bacillus subtilis, arginine represses its biosynthetic enzymes and activates its catabolic ones via a regulator gene ahrC. A 6.2-kb EcoRI fragment of B. subtilis chromosomal DNA that includes the ahrC gene has previously been cloned. Gene ahrC was localised in a 0.8-kb HindIII sub-fragment whose nucleotide sequence was determined. An open reading frame (ORF) was present whose translated amino acid sequence showed homology to that of the Escherichia coli arginine repressor encoded by that organism's argR gene. That this ORF corresponded to ahrC was confirmed by (i) the location of the transposon in an ahrC::Tn917 insertion mutant within the ORF; and (ii) by the appearance of an AhrC- phenotype when plasmids carrying restriction fragments lying wholly within this ORF were permitted to integrate by Campbell-type recombination into the B. subtilis chromosome. This represents the first description of a repressor in a 'housekeeping' biosynthetic system in a Bacillus, and indeed of homology between regulatory proteins for any 'housekeeping' system across such a wide taxonomic barrier among prokaryotes.

Effect of gonadotropin-releasing hormone on clinical response and fertility in cows with cystic ovaries, as related to milk progesterone concentration and days after parturition

We gave gonadotropin-releasing hormone (GnRH) or an analog of GnRH to 264 lactating cows with cystic ovaries. The effects of milk progesterone concentration (MPC) and days after parturition (DAP) at diagnosis on clinical response 30 days after treatment and on subsequent fertility were examined. Palpation per rectum revealed ovarian cysts in 264 cows; 118 had true follicular cysts (MPC less than 1 ng/ml). Clinicians with more than 3 years of experience reported significantly more true cysts than did less experienced clinicians. Clinical response 30 days after treatment did not differ in 3 groups of cows (divided on the basis of MPC at treatment), but fewer cows with MPC less than 1 ng/ml were bred or conceived than were cows with MPC greater than or equal to 33 ng/ml. Days after parturition at diagnosis did not affect 30-day clinical response rate, but cows treated less than 35 DAP had significantly more days to first estrus and to conception than did cows treated greater than 90 DAP. Significantly more cows treated less than 35 DAP had MPC less than 1 ng/ml at treatment.

Fibrosarcoma of the ethmoid

Fibrosarcoma may involve the ethmoid sinus by extension from the maxillary antrum or, more rarely, arise as a primary neoplasm. A case of a well differentiated primary fibrosarcoma of the ethmoid sinuses is reported which presented in a 24-year-old male. The tumour was treated by wide local resection. From a review of similar cases in the literature together with their treatment modalities and outcome, it is concluded that wide local resection is the treatment of choice.

Structure and activity dependence of recombinant human insulin-like growth factor II on disulfide bond pairing

The complete peptide map of purified folded recombinant human insulin-like growth factor II (rhIGF-II) was determined to verify its sequence and disulfide bonding scheme. Each peptide generated by digestion with pepsin was purified and characterized by amino acid analysis, amino acid sequence analysis, and fast atom bombardment/mass spectrometry. Some peptides were also sequenced using tandem mass spectrometry. The rhIGF-II peptide map was compared to that of rat insulin-like growth factor II and to that of a disulfide-bonded isomer of rhIGF-II. The data obtained in these studies are consistent with the conclusion that the rhIGF-II obtained from Escherichia coli has the correct amino acid composition, sequence, and the native disulfide-bonded structure. The binding affinities of these forms of recombinant IGF-II for IGF carrier proteins were measured in an IGF binding protein assay. The disulfide isomer of rhIGF-II was 160-fold less potent than native rhIGF-II in the competitive protein binding assay. These studies illustrate the need to characterize recombinant polypeptides containing disulfide bonds to allow the native structure to be verified before characterizing the biological properties of such molecules in hopes of elucidating their physiologic functions.

Pain interventions with children: a meta-analysis of research

A meta-analysis of 27 studies on pain management interventions with children was conducted using two decades of research reported in five disciplines. One-fifth of these studies were in the nursing literature and 78% were published since 1979. Two complementary methods of calculating the effectiveness of pain management interventions were used for each of three outcome categories. Fisher's Combined test procedure was used to combine the results of the independent studies, to determine if a significant relationship existed between pain management programs and children's response. An overall effect size (r) was also calculated. Significant relationships of small magnitude were found between pain management interventions and child's response for behavioral (r = .41, chi 2 = 181.97, p less than .0001), self-report (r = .34, chi 2 = 122.06, p less than .0001), and physiologic (r = .30, chi 2 = 88.29, p less than .0001) measures.

Effect of large palpable ovarian follicles on response to prostaglandin administration in dairy cows with corpora lutea

We examined the response to exogenous prostaglandin F2alpha in cattle with or without palpable structures believed to be ovarian follicles. All animals had ovarian structures diagnosed by palpation as corpora lutea. The cows were placed into two groups: those with follicles which were estimated by the palpators to be </=13 mm diameter (n=60); and cows with no palpable follicles or with follicles <13 mm diameter (n=133). Comparisons of proportion in estrus within five days, days to estrus, and milk progesterone levels failed to show significant differences between the groups.

Control of IgE responses

Peyer's patches (PP) in germ-free rats (GF) and in the hyper-IgE syndrome patient (HIES) differ from their conventional rat (C) and healthy human (HH) counterparts in that GF rats contained fewer (two-fold) PP and none was detected in HIES. Existing PP in GF rats had reduced cellularity (three-fold) and different B and T cell subsets: high numbers of IgE-bearing (sIgE+) B cells (approximately 15% of total cells), one-half of which also expressed sIgA, were present in GF rat PP while none was detected in C rat PP (less than 1%). GF rat PP also contained elevated numbers of sIgA+ cells and decreased sIgM+ cells, with elevated numbers of sThy 1+ RT 7.1+ Ig- T cells (suppressor phenotype) and reduced sThy 1- RT 7.1+ Ig- T cells (helper phenotype). The cellular composition of GF rat PP was converted to that resembling a C rat within 18 hr after (a) use of standard (unautoclaved) chow; (b) feeding with certain bacteria or "working" bacterial cell wall components (BCWC) and synthetic derivatives, murein, MTP-PE, and norMDP, but not with LPS, core lipid A, or lipoprotein; BCWC had no effect if injected intravenously; or (c) thymectomy. Each procedure resulted in (i) elimination of sIgE+ B cells and normalization of the other isotypes, and (ii) loss of T suppressor cells and normalization of T helper cells. After treatments, no sIgE+ cells were detected in bone marrow (BM), thymus, other lymphoid organs, or blood. PP were not detected in HIES, although they were present in HH (approximately 10/individual). P blood contained two distinct sIgE+ B cell subpopulations, the apparent source of which was mesenteric lymph node (MLN), the only organ in which high numbers of these cells (35%) (five nodes examined) were detected; far fewer IgE+ cells were found in spleen (less than 5%), and none was detected in BM, thymus, other LN, or appendix, which was virtually acellular. Virtually no IgE secreting plasma cells were detected in MLN, spleen, appendix, other lymphoid organs, or in gut lamina propria. IgE+ B cells in MLN were not detected in follicles (classical B cell areas); instead, they were found in high numbers in the thymus-dependent area and in medulla. Most follicles (greater than 98%) in MLN and spleen contained intercellular IgE complexed to bacterial antigen and/or CD23 (IgE-binding factor? antigen?), but contained no germinal centers.(ABSTRACT TRUNCATED AT 400 WORDS)

Recombinant DNA-derived human insulin-like growth factor II (hIGF-II) stimulates growth in hypophysectomized rats

Sustained subcutaneous administration of recombinant DNA-derived insulin-like growth factor II to immature female hypophysectomized rats stimulated significant increases in body weight gain, tibial epiphyseal cartilage width, femur hydroxyproline concentrations and a significant decrease in serum urea nitrogen concentrations. Recombinant DNA-derived human growth hormone (Humatrope), administered in the same manner produced similar biological effects. The data support the contention that hIGF-II has anabolic effects when administered to hypophysectomized rats and may be a locally acting mediator of pituitary hormone actions.

Sequences required for regulation of arginine biosynthesis promoters are conserved between Bacillus subtilis and Escherichia coli

The region required for regulation of a previously characterized arginine-regulatable promoter upstream from the argC gene in the argCAEBD-cpa-argF cluster of Bacillus subtilis was defined by integration of argC-lacZ translational fusions into the chromosome at a site distant from the arginine loci. Some sequence similarity was detected between the argC regulatory region and the well-characterized Escherichia coli arginine operators (ARG boxes). This similarity was shown to be functional in vivo in that the B. subtilis repressor regulated the E. coli arginine genes, but the E. coli repressor, even when encoded by a multicopy plasmid, could not repress the B. subtilis argC promoter. In vitro binding studies using purified repressors on DNA fragments encoding operators from both E. coli and B. subtilis demonstrated interactions by both proteins.

The arginine repressor is essential for plasmid-stabilizing site-specific recombination at the ColE1 cer locus

The heritable stability in Escherichia coli of the multicopy plasmid ColE1 and its natural relatives requires that the plasmids be maintained in the monomeric state. Plasmid multimers, that arise through recA-dependent homologous recombination, are normally converted to monomers by a site-specific recombination system that acts at a specific plasmid site (cer in ColE1). No plasmid functions that act at this site have been identified. In contrast, two unlinked E.coli genes that encode functions required for cer-mediated site-specific recombination have been identified. Here we describe the isolation and characterization of one such gene (xerA) and show it to be identical to the gene encoding the repressor of the arginine biosynthetic genes (argR). The argR protein binds to cer DNA both in vivo and in vitro in the presence of arginine. We believe this binding is required to generate a higher order protein-DNA complex within the recombinational synapse. The argR gene of Bacillus subtilis complements an E.coli argR deficiency for cer-mediated recombination despite the two proteins having only 27% amino acid identity.