ARAX: a graph-based modular reasoning tool for translational biomedicine

MOTIVATION

With the rapidly growing volume of knowledge and data in biomedical databases, improved methods for knowledge-graph-based computational reasoning are needed in order to answer translational questions. Previous efforts to solve such challenging computational reasoning problems have contributed tools and approaches, but progress has been hindered by the lack of an expressive analysis workflow language for translational reasoning and by the lack of a reasoning engine-supporting that language-that federates semantically integrated knowledge-bases.

RESULTS

We introduce ARAX, a new reasoning system for translational biomedicine that provides a web browser user interface and an application programming interface (API). ARAX enables users to encode translational biomedical questions and to integrate knowledge across sources to answer the user's query and facilitate exploration of results. For ARAX, we developed new approaches to query planning, knowledge-gathering, reasoning and result ranking and dynamically integrate knowledge providers for answering biomedical questions. To illustrate ARAX's application and utility in specific disease contexts, we present several use-case examples.

AVAILABILITY AND IMPLEMENTATION

The source code and technical documentation for building the ARAX server-side software and its built-in knowledge database are freely available online (https://github.com/RTXteam/RTX). We provide a hosted ARAX service with a web browser interface at arax.rtx.ai and a web API endpoint at arax.rtx.ai/api/arax/v1.3/ui/.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

RTX-KG2: a system for building a semantically standardized knowledge graph for translational biomedicine

BACKGROUND

Biomedical translational science is increasingly using computational reasoning on repositories of structured knowledge (such as UMLS, SemMedDB, ChEMBL, Reactome, DrugBank, and SMPDB in order to facilitate discovery of new therapeutic targets and modalities. The NCATS Biomedical Data Translator project is working to federate autonomous reasoning agents and knowledge providers within a distributed system for answering translational questions. Within that project and the broader field, there is a need for a framework that can efficiently and reproducibly build an integrated, standards-compliant, and comprehensive biomedical knowledge graph that can be downloaded in standard serialized form or queried via a public application programming interface (API).

RESULTS

To create a knowledge provider system within the Translator project, we have developed RTX-KG2, an open-source software system for building-and hosting a web API for querying-a biomedical knowledge graph that uses an Extract-Transform-Load approach to integrate 70 knowledge sources (including the aforementioned core six sources) into a knowledge graph with provenance information including (where available) citations. The semantic layer and schema for RTX-KG2 follow the standard Biolink model to maximize interoperability. RTX-KG2 is currently being used by multiple Translator reasoning agents, both in its downloadable form and via its SmartAPI-registered interface. Serializations of RTX-KG2 are available for download in both the pre-canonicalized form and in canonicalized form (in which synonyms are merged). The current canonicalized version (KG2.7.3) of RTX-KG2 contains 6.4M nodes and 39.3M edges with a hierarchy of 77 relationship types from Biolink.

CONCLUSION

RTX-KG2 is the first knowledge graph that integrates UMLS, SemMedDB, ChEMBL, DrugBank, Reactome, SMPDB, and 64 additional knowledge sources within a knowledge graph that conforms to the Biolink standard for its semantic layer and schema. RTX-KG2 is publicly available for querying via its API at arax.rtx.ai/api/rtxkg2/v1.2/openapi.json . The code to build RTX-KG2 is publicly available at github:RTXteam/RTX-KG2 .

Vehicle emissions of radical precursors and related species observed in the 2009 SHARP campaign

The 2009 Study of Houston Atmospheric Radical Precursors (SHARP) field campaign had several components that yielded information on the primary vehicular emissions of formaldehyde (HCHO) and nitrous acid (HONO), in addition to many other species. Analysis of HONO measurements at the Moody Tower site in Houston, TX, yielded emission ratios of HONO to the vehicle exhaust tracer species NOx and CO of 14 pptv/ppbv and 2.3 pptv/ppbv, somewhat smaller than recently published results from the Galleria site, although evidence is presented that the Moody Tower values should be upper limits to the true ratios of directly emitted HONO, and are consistent with ratios used in current standard emissions models. Several other Moody Tower emission ratios are presented, in particular a value for HCHO/CO of 2.4 pptv/ppbv. Considering only estimates of random errors, this would be significantly lower than a previous value, though the small sample size and possible systematic differences should be taken into account. Emission factors for CO, NOx, and HCHO, as well as various volatile organic compounds (VOCs), were derived from mobile laboratory measurements both in the Washburn Tunnel and in on-road exhaust plume observations. These two sets of results and others reported in the literature all agree well, and are substantially larger than the CO, NOx, and HCHO emission factors derived from the emission ratios reported from the Galleria site.

IMPLICATIONS

Emission factors for the species measured in the various components of the 2009 SHARP campaign in Houston, TX, including HCHO, HONO, CO, CO2, nitrogen oxides, and VOCs, are needed to support regional air quality monitoring. Components of the SHARP campaign measured these species in several different ways, each with their own potential for systematic errors and differences in vehicle fleets sampled. Comparisons between data sets suggest that differences in sampling place and time may result in quite different emission factors, while also showing that different vehicle mixes can yield surprisingly similar emission factors.

Short-term variation in near-highway air pollutant gradients on a winter morning

Quantification of exposure to traffic-related air pollutants near highways is hampered by incomplete knowledge of the scales of temporal variation of pollutant gradients. The goal of this study was to characterize short-term temporal variation of vehicular pollutant gradients within 200-400 m of a major highway (>150 000 vehicles/d). Monitoring was done near Interstate 93 in Somerville (Massachusetts) from 06:00 to 11:00 on 16 January 2008 using a mobile monitoring platform equipped with instruments that measured ultrafine and fine particles (6-1000 nm, particle number concentration (PNC)); particle-phase (>30 nm) [Formula: see text], [Formula: see text], and organic compounds; volatile organic compounds (VOCs); and CO(2), NO, NO(2), and O(3). We observed rapid changes in pollutant gradients due to variations in highway traffic flow rate, wind speed, and surface boundary layer height. Before sunrise and peak traffic flow rates, downwind concentrations of particles, CO(2), NO, and NO(2) were highest within 100-250 m of the highway. After sunrise pollutant levels declined sharply (e.g., PNC and NO were more than halved) and the gradients became less pronounced as wind speed increased and the surface boundary layer rose allowing mixing with cleaner air aloft. The levels of aromatic VOCs and [Formula: see text], [Formula: see text] and organic aerosols were generally low throughout the morning, and their spatial and temporal variations were less pronounced compared to PNC and NO. O(3) levels increased throughout the morning due to mixing with O(3)-enriched air aloft and were generally lowest near the highway reflecting reaction with NO. There was little if any evolution in the size distribution of 6-225 nm particles with distance from the highway. These results suggest that to improve the accuracy of exposure estimates to near-highway pollutants, short-term (e.g., hourly) temporal variations in pollutant gradients must be measured to reflect changes in traffic patterns and local meteorology.

Adaptation of a proton transfer reaction mass spectrometer instrument to employ NO+ as reagent ion for the detection of 1,3-butadiene in the ambient atmosphere

A proton transfer reaction mass spectrometer (PTR-MS) instrument was adapted to employ NO+ as a chemical reagent ion without any hardware changes by switching the reagent ion source gas from water vapor to dry air. Ionization of dry air within the hollow cathode ion source generates a very intense source of NO+ with only a minor impurity of NO2+. The intensities of the primary NO+ reagent ion and the unwanted impurity NO2+ are controllable and dependent on the operational conditions of the hollow cathode ion source. Ion source tuning parameters are described, which maintain an intense source of NO+ while keeping the impurity NO2+ signal to less than 2% of the total reagent ion intensity. This method is applied to the detection of 1,3-butadiene. NO+ reacts efficiently with 1,3-butadiene via a charge exchange reaction to produce only the molecular ion, which is detected at m/z 54. Detection sensitivities of the order of 45 pptv for a 1-s measurement of 1,3-butadiene are demonstrated. We present the first real-time on-line sub parts per billion measurement of 1,3-butadiene in the ambient atmosphere. The only likely interference is from 1,2-butadiene. Concurrent measurements of benzene are provided and suggest that the vehicular emissions are the predominant source of 1,3-butadiene in a suburban Boston area monitoring location.

Lost surgical specimens

It is an unfortunate fact that surgical specimens can become lost in the peritoneal cavity. Several reparative actions may be required, including laparotomy. The preferred method to avoid this complication, however, is to prevent it from occurring.

Fresh and cryopreserved ovarian tissue samples from donors with lymphoma transmit the cancer to graft recipients

Girls and young women who require ovariectomy or cancer therapy may consider having their own eggs, embryos or ovarian tissue stored (cryopreserved) for their own future use. Ovarian tissue is simple to collect and contains large numbers of germ cells. Transplantation of fresh and frozen-thawed ovarian tissue in healthy sheep and mice has resulted in normal live young. Similar techniques may be effective in the human but it is unclear whether ovarian tissue cryopreservation and grafting is suitable for ovaries from individuals with cancer or infections. If cancer cells were present in an ovary at the time of collection and survived cryopreservation and grafting they could establish cancer in the recipient. We therefore performed ovarian cryopreservation and transplantation trials using a mouse lymphoma model. This established that the lymphoma was transmitted by grafts of both fresh and frozen ovarian tissue. The normal healthy recipient mice died 9-43 days after receiving a small piece (1 mm3) of ovarian tissue from a donor with lymphoma. We conclude that ovarian tissue which is collected, cryopreserved and grafted while it contains cancer cells has the potential to spread the cancer to the graft recipient.

Routine use of ureteric catheters at laparoscopic hysterectomy may cause unnecessary complications

STUDY OBJECTIVE

To test the use of ureteric catheters in preventing ureteric trauma during laparoscopic hysterectomy.

DESIGN

Prospective study of 492 consecutive women.

SETTING

Pelosi Women's Medical Center, New Jersey, and Cliveden Hill Private Hospital, Melbourne, Australia.

PATIENTS

Four hundred ninety-two consecutive women.

INTERVENTIONS

Laparoscopic hysterectomy was performed in all women. Because of the reported increased risk of ureteric trauma during laparoscopic hysterectomy, we passed ureteric catheters in 92 such procedures and ceased the practice with the last 400 when further reports suggested lack of increased risk.

MEASUREMENTS AND MAIN RESULTS

Oliguria and anuria occurred in 7 of 92 patients having ureteric catheterization. No ureteric trauma occurred in 400 patients without ureteric catheterization. The injury rate in this series was significantly lower than in three other series of abdominal hysterectomy.

CONCLUSIONS

As long as surgical techniques incorporate various procedures to avoid ureteric injury, routine ureteric catheterization during laparoscopic hysterectomy is not indicated and may result in unnecessary complications.

Evolutions of an orientation concerning the nature of the male homosexualities

None of the adults I have treated have had major disturbances in their sexual identity except for the selection of the sex of the person with whom they express their sexual feelings. Only one lives out a role that is ambisexual. All the men I have seen have been able to relate sexually to women with varying degrees of comfort. Six have had sexual intercourse with women and can function physiologically but without a sense of closeness or satisfaction, and five have been able to achieve climax. Some decided not to stay in their marriages, divorced, and adopted an overtly homosexual lifestyle. Some felt increasing ability to relate to women and decided to marry. Still others resolved current conflicts with their gay partners and felt no need for further therapy. All but one were actively employed and functioning well by external observation in demanding jobs requiring postgraduate college education. In terms of the detailed analytic work, there were no sets of insights that resulted in a major sexual partner reorientation. Those who decided to marry did so when they felt more able to resolve their narcissistic needs and make a relationship with a caring tolerant woman. They maintained their homosexual fantasies though the fantasies were more acceptable and less disruptive. It was not always the partner's penis that determined the sexual interest of these men. More often, it was the contour of the male body, the firmness of the musculature, the masculine bodily movements, the very identity and role of the father in the family. I did not see these foci of interest only as displacements from the genitals but rather as primary erotogenic stimuli. It is the seeking of a narcissistic object, the self in the other. This very orientation may be the innate variable. This position is spelled out in some detail by Leavy (1985). To varying degrees, the families of all these men were experienced as being composed of vigorous, active, articulate, determined, aspiring mothers and rather quiet, removed, passive fathers. The reported presence of this general pattern is impressive though the prominence of these characteristics differed from family to family. I have not postulated that these parental-child relations are causative in the boy's development of a homosexual life. However, they may be crucial if the genetic and/or constitutional factors discussed above are also present.(ABSTRACT TRUNCATED AT 400 WORDS)

Endoscopic minilaparotomy

In a preliminary study the principles of standard gynaecological surgery, new operative laparoscopic techniques and mechanical elevation of the abdominal wall are combined. These early results indicate an advantage to both patient and hospitals from this approach. Further studies are required to verify our impressions that minilaparotomy combined with no insufflation laparoendoscopy will open up the concept of operative laparoscopic surgery to most gynaecologists.

Decreased natural killer cell activity in endometriosis patients: relationship to disease pathogenesis

A number of reports have measured NK cell activity in patients with endometriosis with varied results. Therefore we have examined the NK activity of PBL from 44 gynecological patients undergoing laparoscopy. This analysis has demonstrated a significant reduction in NK activity only in more severe stages of endometriosis (stages III and IV) relative to patients with milder disease and controls. These data indicate that decreased NK activity is unlikely to be a primary etiological factor in the development of endometriosis but may indicate that decreased NK activity is related to the development of the more frequent and/or larger lesions characteristic of severe endometriosis. These data could indicate potential for immunotherapy of patients with advanced endometriosis by the upregulation of NK activity in vivo.

Gasless laparoscopy--useless or useful?

Carbon dioxide (CO2) pneumoperitoneum for advanced operative laparoscopy has well-documented inherent pathophysiologic risks. Problems are associated with creating and maintaining the pneumoperitoneum, lowering body temperature, infective particles in the insufflation gas, and ensuring hemostasis of port entry sites after intraabdominal pressure is reduced. When the vagina is opened to remove surgical specimens or at the time of hysterectomy, loss of vision occurs. In some patients general anesthesia and CO2 pneumoperitoneum are contraindicated, and in them such problems could be avoided by gasless laparoscopy. Three types of mechanical anterior abdominal wall elevators have been used at the Melbourne Gynoscopy Centre for a variety of laparoscopic procedures, all of which have their advantages and disadvantages.

Evaluation of a unique mechanical client lift: efficiency and perspectives of nursing staff

This study evaluated the acceptability of a mechanical client lift based on the design employed for helicopter rescue lifts. Twenty-three nursing personnel completed questionnaires which explored their preferences, intentions to use the lift, perceptions of helpfulness, and exertion. Sixteen clients in a long term care setting consented to participate. One hundred manual lifts and 100 belt lifts were observed for comparative time and staff measures. The findings suggest that: 1) nursing staff will prefer the belt lift device for changing incontinent briefs; 2) nursing staff will prefer the belt lift device for toileting; 3) nursing staff will prefer the belt lift device to the currently used lift (in cases where either lift is appropriate) for bed/chair transfer; and, 5) the time required to utilize the belt lift as compared to manual lifting methods will not increase significantly.

Laparoscopically assisted hysterectomy

OBJECTIVE

To determine the feasibility and effectiveness of laparoscopically assisted hysterectomy.

DESIGN

A prospective study of the planned surgical procedure was carried out by two teams, each with two gynaecologists, who were experienced in operative laparoscopy.

SETTING

The operations were carried out in a private hospital, where advanced operative laparoscopy equipment was available.

PATIENTS

Seventeen patients were selected for the procedure, all of whom required hysterectomy for symptoms of pain or menorrhagia in association with uterine or other pelvic disease. Patients with carcinoma or uterine enlargement beyond 12 cm were excluded.

PROCEDURE

Laparoscopically assisted hysterectomy was carried out by means of a video monitor, uterine manipulation by vaginal instrumentation, three or four abdominal punctures of less than 1 cm, and bipolar diathermy to secure vascular pedicles. The uterus was removed from the vagina by cutting vaginal skin and the cardinal ligaments.

RESULTS

The operating time was 90-220 min, the blood loss was 30-200 mL, and the hospital stay lasted two to five days and convalescence two to four weeks. No serious complications occurred.

CONCLUSIONS

Laparoscopically assisted hysterectomy may be valuable when adnexal or uterine abnormalities are present and vaginal hysterectomy is either contraindicated or more difficult. The procedure requires special equipment and may only be carried out by experienced gynaecological operative laparoscopists. Its acceptance will depend upon reducing the operating time to less than 90 min. It has the advantage of reducing the duration of hospital stay and the duration of convalescence when compared with abdominal hysterectomy.

Pregnancy following intra-fallopian insemination of spermatozoa from a male with obstructive azoospermia

A pregnancy obtained after intratubal insemination with epididymal spermatozoa recovered from a patient with obstructive azoospermia is reported. The successful outcome of the case emphasizes the beneficial nature of the intra-Fallopian environment.

A comparison of vaginal ultrasonic-guided and laparoscopic retrieval of oocytes for in vitro fertilization

A retrospective analysis was undertaken to compare the less invasive technique of vaginal ultrasonic-guided oocyte retrieval with the standard laparoscopic technique. We have shown that the outcome of the transvaginal technique with respect to oocytes harvested, fertilization rate, and pregnancy rate is comparable with the laparoscopy technique. We have also shown that 9 clinicians with little previous expertise in ultrasound have been able to incorporate this technique into a busy and successful in vitro fertilization unit.

Referral issues in psychotherapy and psychoanalysis

The authors consider the complex decisions involved in the initial consultation of a person looking for treatment when this person must be referred to a professional colleague. They explore the way decisions are made in the referral processes and the complex practical and transference-countertransference issues that arise at the outset and whenever second opinions are sought during an ongoing psychotherapy. They present four clinical examples in varying detail to emphasize how readily misunderstandings can develop when even experienced consultants are not sufficiently alert to the complex conscious and unconscious motives and messages being expressed in the exchanges. They make recommendations on how to conceptualize and respond to them.

A prospective study of prognostic factors in in vitro fertilization and embryo transfer

Multiple factors influence the outcome of in vitro fertilization and embryo transfer (IVF-ET). This prospective study was designed to assess their relative importance, in order to improve prognostic ability and treatment success. Prior to IVF-ET, couples were divided into "good" (GP) and "poor" (PP) prognosis groups according to female age, semen quality, previous response to stimulation, and embryo quality. The data obtained from 716 consecutive treatment cycles then were evaluated using univariate statistics and logistic regression, a technique designed to assess the relative contribution of significant factors. The pregnancy rate per GP cycle was 14.7%, compared with 5.4% per PP cycle (chi 1(2) = 12.7, P less than 0.001). The most important prognostic factors were female age, the pregnancy rate showing a linear decline after the age of 25, and previous failed fertilization due to abnormal sperm. The rate of pregnancy also declined after 14 or more follicles were aspirated and/or nine oocytes were retrieved. A formula for the probability of pregnancy, derived from the logistic regression, provides patients with a more accurate prognosis before treatment.

Antenatal serum levels of relaxin in patients having preterm labour

This study is the first report of antenatal levels of relaxin measured by homologous radioimmunoassay in peripheral serum from patients who subsequently had a preterm delivery. Serial blood samples were collected antenatally from a group of subjects known to be at increased risk of preterm labour because of a past history of shortened pregnancy. Serum relaxin was measured using an homologous radioimmunoassay based on a synthetic bioactive analogue of the native hormone. In women whose pregnancies ended preterm most measurements were within the range of values previously established in normal antenatal patients although some measurements early in pregnancy were above the normal range. These findings suggest that low serum levels of relaxin are not causatively related to the onset of labour before term.

Relaxin in human pregnancy serum measured with an homologous radioimmunoassay

This study reports serum levels of relaxin in normal and special-interest pregnancies using an homologous radioimmunoassay for human relaxin. The mean levels in uncomplicated antenatal patients were lower than those reported in studies using heterologous assays, but the trend in serum levels was similar. Serum levels peaked at ten weeks' gestation and decreased progressively to term. Relaxin was detectable in all pregnant subjects assessed at the time of the first missed menses. The mean relaxin levels in patients having in vitro fertilization and embryo transfer who subsequently delivered a single infant were significantly higher than those in normal antenatal patients at an equivalent gestational age. Patients with twin pregnancies after in vitro fertilization and embryo transfer generally had higher levels than patients with single pregnancies. Some pregnant patients who aborted after in vitro fertilization and embryo transfer had declining levels of relaxin before 40 days postlaparoscopy.

Predictive value of plasma human chorionic gonadotrophin beta subunit in diagnosing ectopic pregnancy after in vitro fertilisation and embryo transfer

A study was conducted aimed at establishing a range of plasma concentrations of the beta subunit of human chorionic gonadotrophin that might predict ectopic pregnancy after in vitro fertilisation and embryo transfer. From May 1984 to February 1986, 161 consecutive pregnancies at the Monash University in vitro fertilisation unit were analysed by determining plasma beta human chorionic gonadotrophin concentrations between two and 10 weeks after oocyte collection. Eighty eight ongoing singleton pregnancies, 25 multiple pregnancies, 27 first trimester spontaneous abortions, 12 anembryonic pregnancies, and nine ectopic pregnancies resulted from these conception cycles. When compared with values for ongoing singleton pregnancies two weeks after oocyte collection plasma beta human chorionic gonadotrophin concentrations in ectopic pregnancies were significantly lower (p less than 0.05; Wilcoxon rank sum test). Two weeks after oocyte collection all plasma beta human chorionic gonadotrophin concentrations in the set of ectopic pregnancies were below 30.6 IU/l, which corresponded to the lower quartile (25th percentile) of beta human chorionic gonadotrophin concentrations in ongoing singleton pregnancies. The beta human chorionic gonadotrophin concentration corresponding to the lower quartile of ongoing singleton pregnancies at each week of gestation was used to derive the predictive value of various statistics in detecting ectopic pregnancy in patients after in vitro fertilisation. The sensitivity, specificity, predictive value of a positive result, predictive value of a negative result, and efficiency of a single plasma beta human chorionic gonadotrophin concentration in predicting ectopic pregnancy were 100%, 68.1%, 16.7%, 100%, and 70%, respectively, two weeks after oocyte collection. These results suggest that a single determination of the plasma beta human chorionic gonadotrophin concentration beginning 14 days after oocyte collection is clinically useful in predicting the outcome of pregnancy achieved by in vitro fertilisation. Ectopic pregnancy after in vitro fertilisation is more likely when beta human chorionic gonadotrophin concentration is below the lower quartile of values in ongoing singleton pregnancies achieved by the technique.

Attitudes towards oocyte and embryo donation and disposal

The attitudes of In Vitro Fertilization (IVF) patients, their relatives, and their friends towards oocyte and embryo donation and disposal of frozen embryos were determined by questionnaire. The results obtained from a group of patients undergoing IVF treatment in the hospital were compared and some differences in attitudes were detected. Most respondents find embryo research and the creation of embryos, especially for research, acceptable under some circumstances and this contrasts with current Victorian legislation.

An analysis of plasma estradiol concentrations during clomiphene citrate-human menopausal gonadotropin stimulation in an in vitro fertilization-embryo transfer program

We report here a range of plasma estradiol (E2) concentrations suitable for use in an in vitro fertilization (IVF) program. This range was derived from nonparametric analysis of plasma E2 levels using plasma E2 measurements beginning 10 days before the anticipated day of the midcycle LH surge (midpoint), as calculated from each patient's six previous menstrual cycles, during which time the patients all received the same ovarian stimulation regimen. The regimen consisted of 100 mg clomiphene citrate/day for 5 days, beginning 10 days before the anticipated midpoint, plus 150 IU human menopausal gonadotropin, commencing the day after clomiphene. A consecutive series of 102 IVF conception cycles induced in this standardized fashion were analyzed in this study. The 5th-95 percentile envelope of plasma E2 concentrations was derived as a valid clinical indicator of satisfactory folliculogenesis during IVF treatment. Five women had plasma E2 concentrations below the 5th percentile of the E2 range on at least 3 consecutive days of ovarian stimulation, while six women had E2 levels above the 95th percentile of this range on at least 3 consecutive days. This plasma E2 range defined objectively the diagnoses of ovarian hyperstimulation and inadequate stimulation in an IVF program. These criteria should help clinicians in managing ovarian responses during IVF superovulation stimulation treatment.

Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole

Ten healthy volunteers were studied before, during, and after treatment with omeprazole 30 mg daily for two weeks. On the 14th night mean nocturnal (2100-0700) intragastric acidity was significantly decreased by 75% (p less than 0.001). At 0700, 22 hours after the last dose of omeprazole, there were significant increases in the bacterial count and the nitrite and N-nitrosamine concentrations in the gastric juice (p less than 0.001). Three days later these changes had resolved. Short term treatment of healthy volunteers with omeprazole is associated with a short lived increase in the gastric bacterial flora, with endogenous production of N-nitroso compounds.

Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity

In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients.

Tearfulness: a psychoanalytic interpretation

In our view, the tearful feeling state is occasioned by the ego temporarily threatened with being inundated by complex memories and affects. For the moment, the ego cannot provide appropriate satisfying and integrated verbal expression. Words and verbal thinking are delayed. In this brief period, a controlled regression occurs during which the ego relates the current "precipitating experience" to temporally older conflictual experiences in the presence of the current object as a transference object and with a series of relationships so closely connected to that experience that they are interchanged in whole or part by the less selective, regressed, ego operations. The conscious experience may be sadness, gratitude, love, pride, or joy. But beneath these, there is the controlled regression, which interrupts verbal expression while the ego works through the earlier related conflicts,now remembered. The tearful feeling, a step in the direction of overt weeping, primitively expresses the frustration of an early wish for relief from pain, the pain of the imbalance of a complex conflict. The tearful feeling both expresses the wish for relief of pain and, at the same time, interrupts current verbal expression until the needed defense operations reduce the threat of ego disruption by working through old conflicts once again. Our thesis, then, is that within the analytic or psychotherapeutic hour the patient's feeling of tearfulness is a "too much" ego phenomenon that leads to a psychophysiological outlet.

Effect of daily oral omeprazole on 24 hour intragastric acidity

Twenty four hour intragastric acidity was measured in nine patients with duodenal ulcer before and after one week of treatment with oral omeprazole 30 mg daily, a drug that inhibits gastric secretion by inhibition of parietal cell H+K+ adenosinetriphosphatase (ATPase). Omeprazole virtually eliminated intragastric acidity in all patients: the median 24 hour intragastric pH rose from 1.4 to 5.3 and the mean hourly hydrogen ion activity fell from 38.50 to 1.95 mmol(mEq)/1 (p less than 0.001). This inhibition of 24 hour intragastric acidity is more profound than that previously reported with either cimetidine 1 g daily or ranitidine 300 mg daily.

T helper lymphocyte depression in early human pregnancy

Peripheral blood lymphocyte subclasses were determined in 60 women with normal pregnancies, 20 from each trimester, and in 20 controls using automated flow cytofluorimetry. The cells were stained with the monoclonal antibodies OKT3, OKT4 and OKT8 to stain total T cells, T helper and T suppressor-cytotoxic lymphocytes, respectively. A polyvalent rabbit anti-human Ig serum was used to stain B lymphocytes. Absolute numbers of T lymphocytes were significantly reduced in both the first and second trimesters. This was due to a significant decrease in T helper lymphocytes and a smaller, statistically not significant, reduction in the number of T suppressor lymphocytes. There was no significant change in lymphocyte subclasses during the third trimester. Total lymphocyte numbers were normal throughout pregnancy.

Responses of Australian patients with gynaecological disorders to the General Health Questionnaire: a factor analytic study

One hundred and twenty-seven out-patients attending a gynaecology clinic completed the General Health Questionnaire (GHQ, 60-item version) and a role problems checklist (RPCL). Principal factors analysis of the GHQ yielded 8 factors which were named: poor performance (which accounted for 63.3% of total variance), depression-anxiety, sleep-disturbance, anhedonia anergia, loss of confidence, general illness, social dysfunction and headache. These results were compared with previous principal components analyses of the GHQ (Goldberg, 1972; Goldberg et al. 1976). A multiple regression analysis indicated that age and 7 of the 8 factors were significantly related to the number of role problems reported by the patients. However, it appears that psychiatric distress (as measured by the GHQ) and role problems were only related to a small degree (multiple R2 = 12.69% only).

The morphological basis of embryonic movements in the light brown apple moth, Epiphyas postvittana (Walk) (Lepidoptera : Tortricidae)

A description is given of the morphological basis of the embryonic movements revealed in E. postvittana by time-lapse cinematography. The blastoderm gives rise to a broad germ band and serosal rudiment. The serosa spreads over the germ band, followed by the amnion. The germ band becomes cup-shaped, elongates, and turns on its side in the flattened egg before gastrulation begins. Only a small amount of the yolk of the egg is enclosed in the germ band. The remainder fills the amnioserosal space. As elongation continues, mainly through growth in the length of the abdomen, and segmentation takes place, the germ band becomes spirally coiled and convoluted within the flattened egg space. At the completion of elongation, the nervous system is well developed, segmental myoblasts are present, and the tubular stomodaeum and proctodaeum are linked by paired midgut strands. Shortening and dorsal closure eliminate the spiralling and convolution of the germ band and result in a tubular embryo with a large ganglionated nerve cord and large stomodaeum and proctodaeum, but with musculature still at the myoblast stage and midgut strands unchanged. Paired sheets of cardioblasts extending from the body wall to the midgut strands divide the ventral haemocoele from the dorsal haemocoele in the middle region of the body. A mesodermal sac covers the inner end of the stomodaeum and opens in the dorsal haemocoele. The tubular embryo now elongates, doubling its volume, reverses its position in the egg, and tucks the tail in beside the head. During elongation, the segmental myoblasts differentiate as muscle fibres. Towards the end of elongation and reversal, the midgut strands give rise to the midgut tube and the cardioblast sheets to the middorsal heart. When elongation and reversal are complete, the stomodaeal mesodermal sac is transformed into proventricular mesoderm. After further differentiation of striated muscle and secretion of the cuticle, the embryo ingests the yolk in the surrounding amnioserosal space and digests it before hatching takes place. Comparison of morphological structure with the movements displayed in the time-lapse record show that all elongation, rotation, spiralling, and convolution of the embryo before the onset of shortening is due to growth by cell proliferation and to accommodation of this growth within a fixed egg space of specific shape. In contrast, controlled muscular activity plays a major role in shortening and dorsal closure, in elongation and reversal of position, and in ingestion of excluded yolk. During shortening and dorsal closure, slow, generalized, possibly myogenic contractions are produced by the somatic myoblasts and appear to be responsible for the shape changes observed. During elongation and reversal, contractions are confined to the stomodaeal myoblast layer and result in rhythmic filling and emptying of the terminal stomodaeal sac. By this activity, fluid is transferred from the excluded yolk to the embryo and pumped along the dorsal haemocoelic channel, bringing about controlled elongation and reversal. In view of the coordination exhibited, and of the precocious development of the nervous system, it seems likely that this activity is neurogenic, even though the contractile units are still myoblasts. The final movement of reversal, tucking in of the tail, is due to somatic musculature, now differentiated as muscle fibres and showing twitches of probably neurogenic causation. Ingestion of excluded yolk is a precocious feeding activity, brought about by coordinated action of the larval feeding apparatus, and occurs only when the appropriate musculature has become differentiated as striated muscle. Although the morphogenetic movements of E. postvittana show modifications associated with the flattened form of the egg, they and their structural basis are, on comparative evidence, common to all lepidopteran embryos.