Neuropathological changes in the substantia nigra in schizophrenia but not depression

Schizophrenia is a chronic, disabling neuropsychiatric disorder characterised by positive, negative and cognitive symptoms. The aetiology is not known, although genetic, imaging and pathological studies have implicated both neurodevelopmental and neurodegenerative processes. The substantia nigra is a basal ganglia nucleus responsible for the production of dopamine and projection of dopaminergic neurons to the striatum. The substantia nigra is implicated in schizophrenia as dopamine has been heavily implicated in the dopamine hypothesis of schizophrenia and the prevalent psychotic symptoms and the monoamine theory of depression, and is a target for the development of new therapies. Studies into the major dopamine delivery pathways in the brain will therefore provide a strong base in improving knowledge of these psychiatric disorders. This post-mortem study examines the cytoarchitecture of dopaminergic neurons of the substantia nigra in schizophrenia (n = 12) and depression (n = 13) compared to matched controls (n = 13). Measures of nucleolar volume, nuclear length and nuclear area were taken in patients with chronic schizophrenia and major depressive disorder against matched controls. Astrocyte density was decreased in schizophrenia compared to controls (p = 0.030), with no change in oligodendrocyte density observed. Significantly increased nuclear cross-sectional area (p = 0.017) and length (p = 0.021), and increased nucleolar volume (p = 0.037) in dopaminergic neurons were observed in schizophrenia patients compared with controls, suggesting nuclear pleomorphic changes. No changes were observed in depression cases compared to control group. These changes may reflect pathological alterations in gene expression, neuronal structure and function in schizophrenia.

Energy extraction and use in a nomadic pastoral ecosystem

An analysis of annual energy flows in an arid tropical ecosystem inhabited by nomadic pastoralists provides insight into a subsistence life-style that has persisted in droughted environments for hundreds to thousands of years. Although a large fraction of the total energy consumed by the Ngisonyoka of Kenya followed a single pathway from plant to animal to human, they also harvested solar energy from a relatively diverse assemblage of energy flow channels. Energy utilization and conversion efficiencies were generally low, as the system is maintenance-rather than production-oriented. Energy flow to maintenance must be relatively high to support biotic responses that enable tolerance of abiotic variability and to stabilize energy flow under the stress of severe droughts. Energy utilization by the Ngisonyoka is therefore consistent with ecological patterns that promote rather than diminish ecological stability under stress.

Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis

OBJECTIVES

(i) To develop a group-based intervention for the management of multiple sclerosis (MS) fatigue incorporating energy effectiveness and cognitive behavioural approaches and (ii) to undertake a process and preliminary evaluation.

METHODS

Drawing upon a literature search, a local model of good practice and the views of service users and health professionals, a manualised group-based fatigue management programme was developed, designed to be delivered by health professionals. A process and preliminary outcome evaluation was undertaken. Sixteen participants attended across two iterations. Participant feedback, obtained via a focus group and evaluation questionnaires, was used to refine the programme. Outcomes were collected pre- and post-programme (including fatigue severity, quality of life, self-efficacy).

RESULTS

Focus group feedback suggested the programme was well received, reflected in high attendance and positive ratings on evaluation questionnaires. At follow-up, despite the small sample size, there were significant improvements in perceived self-efficacy for managing fatigue.

CONCLUSION

An evidence-based fatigue management intervention has been developed and preliminary findings look promising. In the next phase we will examine whether the programme transfers satisfactorily to other centres and collect data in preparation for a randomised controlled trial (RCT).

PRACTICE IMPLICATIONS

Implications for practice will emerge when the results of our RCT are published.

Fatty acid profile, tocopherol, squalene and phytosterol content of brazil, pecan, pine, pistachio and cashew nuts

Nuts contain bioactive constituents that elicit cardio-protective effects including phytosterols, tocopherols and squalene. The objective of the present study was to determine the total oil content, peroxide value, fatty acid composition and levels of tocopherols, squalene and phytosterols in oil extracted from freshly ground brazil, pecan, pine, pistachio and cashew nuts. The total oil content of the nuts ranged from 40.4 to 60.8% (w/w) while the peroxide values ranged from 0.14 to 0.22 mEq O2/kg oil. The most abundant monounsaturated fatty acid was oleic acid (C18:1), while linoleic acid (C18:2) was the most prevalent polyunsaturated fatty acid. The levels of total tocopherols ranged from 60.8 to 291.0 mg/g. Squalene ranged from 39.5 mg/g oil in the pine nut to 1377.8 mg/g oil in the brazil nut. beta-Sitosterol was the most prevalent phytosterol, ranging in concentration from 1325.4 to 4685.9 mg/g oil. In conclusion, the present data indicate that nuts are a good dietary source of unsaturated fatty acids, tocopherols, squalene and phytosterols.

Phytosterol, squalene, tocopherol content and fatty acid profile of selected seeds, grains, and legumes

The unsaponifiable lipid fraction of plant-based foods is a potential source of bioactive components such as phytosterols, squalene, and tocopherols. The objective of the present study was to determine the levels of phytosterols, and squalene, as well as tocopherols (alpha and beta + gamma) in selected grains, seeds, and legumes. The method comprised acid hydrolysis and lipid extraction followed by alkaline saponification, prior to analysis by HPLC. In addition, the fatty acid profile of the foods was determined via total lipid extraction, fatty acid derivitisation and GC analysis. In general, beta-sitosterol was the most prevalent phytosterol, ranging in concentration from 24.9 mg/100 g in pumpkin seed to 191.4 mg/100 g in peas. Squalene identified in all foods examined in this study, was particularly abundant in pumpkin seed (89.0 mg/100 g). The sum of alpha- and beta+ gamma-tocopherols ranged from 0.1 mg/100 g in rye to 15.9 mg/100 g in pumpkin seeds. Total oil content ranged from 0.9% (w/w) in butter beans to 42.3% (w/w) in pumpkin seed and the type of fat, in all foods examined, was predominantly unsaturated. In conclusion, seeds, grains, and legumes are a rich natural source of phytosterols. Additionally, they contain noticeable amounts of squalene and tocopherols, and in general, their fatty acid profile is favorable.

Phase I study of ON-01910.Na, a novel cell cycle inhibitor in adult patients with solid tumors

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Background: ON-1910.Na is a new chemical entity, novel cell cycle inhibitor which arrests cells in G2/M, affects phosphorylation of several regulatory kinases and lacks cross resistance to other standard chemotherapy agents. This is a first-in-man Phase I dose escalation study to determine the dose limiting toxicities, recommended Phase II dose, and pharmacokinetic (PK) profile, and to document any antitumor activity of ON-01910.Na. Methods: Patients had histologically confirmed solid tumors refractory to standard therapy. ON-1910.Na, formulated as a solution in PEG400, was administered as a 2-hour infusion on days 1, 4, 8, 11, 15, and 18 followed by a 10 day observation period for a total of 28 days per cycle. The initial dose was 80 mg and was escalated using an accelerated titration schedule; one patient was treated per cohort until grade 2 toxicity was documented. A dose confirmation cohort of up to 12 patients will be treated at the maximun tolerated dose (MTD). A comprehensive PK study was performed on days 1 and 15 of the first cycle, plus trough samples were collected. Results: Thirteen patients (7F, 6M; ages 46–73) have received 20 cycles. Dose levels of 80, 160, 320, 480, 800, 1280, 2080, and 3120 mg were evaluated in 8 patients, and a further dose of 4370 mg has been evaluated in 5 patients. Toxicities have been anemia (2 G1, 1 G2), leucopenia (1 G1, 1 G2), hyperglycemia (2 G1), elevated AST/ALT (1 G1, 1 G2), nausea (3 G1), diarrhea (3 G1), skeletal pain (5 G1, 1 G2), abdominal pain (2 G1), tumor pain (1 G2), and fatigue (3 G1, 1 G2), and have clustered at the latter 3 dose levels. PK analysis shows increasing ON-1910.Na exposure with increasing doses. ON-1910.Na has a low clearance (13 L/h), long half-life (20 h), distribution in excess of blood volume (58 L) and PK parameters are similar on days 1 and 15. Approximately 3-fold and 5-fold inter-subject variation in ON-1910.Na clearance was observed on days 1 and 15, respectively. No antitumor activity has been documented by standard criteria. Conclusions: Dose escalation is continuing.

[Table: see text]

Psychological interventions for multiple sclerosis

BACKGROUND

The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences.

OBJECTIVES

To assess the effectiveness of psychological interventions for people with MS.

SEARCH STRATEGY

We searched 19 databases up to December 2004; Cochrane MS Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsychINFO, CINAHL and 14 others. We searched reference lists of articles, wrote to corresponding authors of the 13 papers identified by June 2004, and searched for trials in progress using 3 research registers.

SELECTION CRITERIA

Randomised controlled trials of interventions described as wholly or mostly based on psychological theory and practice, in people with MS. Primary outcome measures were disease specific and general quality of life, psychiatric symptoms, psychological functioning, disability, and cognitive outcomes. Secondary outcome measures were number of relapses, pain, fatigue, health care utilisation, changes in medication, and adherence to other therapies.

DATA COLLECTION AND ANALYSIS

Pertinent studies were identified from abstracts by one author. Full papers were independently compared to selection criteria by four authors. Key details were extracted from relevant papers using a standard format, and studies scored on three dimensions of quality. The review is organised into four mini-reviews (MR) dependent on the intervention's target population; people with cognitive impairments (MR1), people with moderate to severe disability (MR2), people with MS (no other criteria) (MR3), and people with depression (MR4).

MAIN RESULTS

Overall 16 studies were identified and included. MR1: three trials (n=145). Some evidence of effectiveness of cognitive rehabilitation on cognitive outcomes, although this was difficult to interpret because of the large number of outcome measures used. MR2: three trials (n=80). One small trial suggesting psychotherapy may help with depression. MR3: seven studies (n=688). Some evidence that cognitive behavioural therapy may help people adjust to, and cope with, having MS (three trials). The other trials were diverse in nature and some difficult to interpret because of multiple outcome measures. MR4: three trials (n=93). Two small studies of cognitive behavioural therapy showed significant improvements in depression.

AUTHORS' CONCLUSIONS

The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.

Fatty acid profile, tocopherol, squalene and phytosterol content of walnuts, almonds, peanuts, hazelnuts and the macadamia nut

Nuts are high in fat but have a fatty acid profile that may be beneficial in relation to risk of coronary heart disease. Nuts also contain other potentially cardioprotective constituents including phytosterols, tocopherols and squalene. In the present study, the total oil content, peroxide value, composition of fatty acids, tocopherols, phytosterols and squalene content were determined in the oil extracted from freshly ground walnuts, almonds, peanuts, hazelnuts and the macadamia nut. The total oil content of the nuts ranged from 37.9 to 59.2%, while the peroxide values ranged from 0.19 to 0.43 meq O2/kg oil. The main monounsaturated fatty acid was oleic acid (C18:1) with substantial levels of palmitoleic acid (C16:1) present in the macadamia nut. The main polyunsaturated fatty acids present were linoleic acid (C18:2) and linolenic acid (C18:3). alpha-Tocopherol was the most prevalent tocopherol except in walnuts. The levels of squalene detected ranged from 9.4 to 186.4 microg/g. beta-Sitosterol was the most abundant sterol, ranging in concentration from 991.2 to 2071.7 microg/g oil. Campesterol and stigmasterol were also present in significant concentrations. Our data indicate that all five nuts are a good source of monounsaturated fatty acid, tocopherols, squalene and phytosterols.

Influence of concentrate composition and forage type on retail packaged beef quality

The objective of this study was to determine the effect of type of conserved forage and concentrate composition on the quality of beef held in overwrapped (aerobic) or modified atmosphere packaging under simulated retail display for 17 d. Friesian steers (n = 45) were assigned randomly to one of five dietary treatments: 1) extensively fermented grass silage plus silage concentrate (EFS); 2) restricted fermented grass silage plus silage concentrate (RFS); 3) starch-based concentrate plus wheat straw (SC); 4) nonstarch-based concentrate plus wheat straw (NSC); or 5) zero-grazed perennial ryegrass plus grass concentrate (RYE). Meat quality was determined by measuring color, lipid oxidation (TBARS), alpha-tocopherol concentrations, and fatty acid composition. In aerobically packaged beef, there was a display x diet interactive effect (P < 0.001) on Hunter a* values, with steaks from the EFS group having higher (P < 0.05) a* values than all other dietary groups from d 6 through d 17. Moreover, during the last 12 d of display, beef from the EFS group had the lowest (P < 0.01) proportion of metmyoglobin (display day x diet; P < 0.001). Under aerobic packaging, the SC and NSC groups produced steaks with higher (P < 0.05) TBARS values than RFS, EFS, and RYE groups, which did not differ from each other (display day x diet; P < 0.01). The SC and NSC groups had higher (P < 0.05) oxidation levels than RFS, EFS, and RYE groups, which did not differ from each other. Beef from the EFS group had (P < 0.05) higher concentrations of alpha-tocopherol than from the SC, NSC, and RYE groups. Beef from EFS-fed steers had a higher (P < 0.05) proportion of saturated fatty acids than the SC and NSC groups. It was concluded that the method of grass conservation influenced beef color, whereas concentrate composition did not. Color of aerobically packaged beef was improved by feeding animals silage that had undergone extensive fermentation. Conversely, oxidative stability was decreased by feeding animals starch- and nonstarch-based concentrate diets.

Grass silage versus maize silage effects on retail packaged beef quality

The effects of three preslaughter diets on heifer beef quality were investigated. Heifers (n = 45) were divided into three groups and fed for ad libitum consumption either maize silage, grass silage, or a 50:50 mixture of maize silage and grass silage. Meat quality was determined by measuring color, lipid oxidation, alpha-tocopherol levels, and fatty acid composition. Beef from the maize silage group had poorest color stability (P < 0.05), whereas beef from the grass silage diet had best (P < 0.05) color stability. The visual panel least preferred the maize silage group after 2 or more days of display, and lipid oxidation was significantly (P < 0.001) higher in this group compared to the 50:50 maize:grass silage and grass silage groups. There was a significant (P < 0.001) difference in the alpha-tocopherol levels detected in the meat from the three dietary groups. Alpha-tocopherol levels increased in the order: maize silage < 50:50 maize:grass silage < grass silage, at levels of 2.08, 2.95, and 3.84 microg/g meat, respectively. Fatty acid analysis indicated 18:3 was significantly (P < 0.001) lower in the maize silage-fed group than in the maize:grass silage and grass silage groups. However, 18:3 was significantly (P < 0.001) higher in the grass silage group than in the other two groups. There were no significant differences in all other fatty acids among the three dietary groups. It was concluded that beef from grass silage-fed animals had better overall quality in terms of color, lipid oxidation, and alpha-tocopherol levels than beef from maize silage fed animals.

Brain injury: the uncertainties of using complementary therapies

The use of complementary therapies is fast growing in the UK, but their place within health care is still unclear. This study explored the views of families using a specific complementary therapy in the care of their brain-injured children, and of professionals involved in the care of the children. The findings revealed an interesting comparison of views about the use of complementary therapies and attitudes towards their use.

Interprofessional working and learning in a UK operating department

This study explores the issues of working and training together for nurses and operating department assistants and practitioners (ODAs/ODPs), based on experiences in an operating department. Interviews and focus groups with nurses, ODAs/ODPs and medical staff were the means of collecting data.

Assessing the impact of a nurse-led health education intervention for people with peripheral vascular disease who smoke: the use of physiological markers, nicotine dependence and withdrawal

This study evaluated the impact of a nurse-led health education programme on the behaviour, nicotine dependence and nicotine withdrawal in patients who smoke and suffer from peripheral vascular disease, based in a large teaching hospital in the north of England. Smoking behaviour was measured by self report, end-expired carbon monoxide and urinary cotinine. Nicotine dependence and withdrawal were measured using a nicotine dependence scale and a nicotine withdrawal scale. The findings demonstrated that the programme did have some impact on behaviour. The study raised issues concerning the measurement of physiological markers for smoking as nursing outcomes. Issues about the measurement of nicotine dependence and withdrawal are highlighted.

Health care support workers in the critical care setting

The 1999/2000 winter demands on the NHS have once again highlighted deficits in UK critical care provision (Daily Telegraph, 2000; London Evening Standard, 2000) Recent years have seen the development of the role of health care support workers in the NHS; some critical care units now employ health care support workers This research examined the views of critical care unit staff on the introduction of health care support workers into the critical care unit It is concluded that the role is viable within the setting of this study A framework is outlined that could form the basis for a critical care health care support worker training programme

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.

Exploring the expanded role of nurses in critical care

This paper reports on a small research study that explored the perceptions of staff in an intensive/coronary/high-dependency care unit on the expanded role of nurses in critical care. The research was undertaken in two phases. In the first phase, focus groups and interviews of nursing and medical staff were used as methods to explore their perceptions. Data were analysed by thematic content analysis and generated four categories: specialized skills; maintaining competence; how far nurses can go; and training and education. Using verbatim examples from the participants, these categories are described. In summary, it was found that both doctors and nurses were in favour of nursing role developments, and for the nurses this was driven by their desire to meet the patients' needs. In a smaller second phase, a questionnaire was developed based on information gained in the first phase. It was utilized to seek the views of all the nursing staff on specific role-expansion activities. Findings revealed substantial support for developing the role of critical care nurses in a number of activities: cannulation; venepuncture; ordering blood tests and X-rays; performing physiotherapy; inserting arterial lines; performing elective cardioversion; thrombolysis treatment and intubation. This research study has yielded important information. However, it is recognized that, whilst these roles may be new to this particular critical care unit, there are many other units where they may already be common practice. Whenever new roles are developed, it is important to evaluate their effectiveness in measurable terms and regular audit is advisable. Further research is therefore recommended on both the development and evaluation of new roles in critical care.

Comparison of effects of dietary olive oil, tallow and vitamin E on the quality of broiler meat and meat products

1. The effect of dietary fat and vitamin E supplementation on quality attributes (drip loss, oxidative stability, sensory quality) in chicken meat and meat products was investigated. Broiler chicks were fed on diets containing tallow (60 g/kg) or olive oil (60 g/kg) at a basal (30 mg/kg diet) or supplemental (200 mg/kg diet) concentration of alpha-tocopheryl acetate for 8 weeks. The alpha-tocopherol content and fatty acid composition of breast and thigh meat was determined. Drip loss was determined in breast fillets. Lipid oxidation (thiobarbituric acid-reacting substances/TBARS) and sensory quality (warmed-over flavour development/WOF) were assessed in minced thigh meat during storage. 2. Dietary olive oil increased the ratio of monounsaturated to saturated fatty acids (MUFA/SFA) in the diets. In breast and thigh, this resulted in approximately a two-fold increase in the MUFA/SFA ratio. Supplemental alpha-tocopherol increased the alpha-tocopherol content of muscles. 3. Dietary fat not influence drip loss in thawed breast fillets during refrigerated storage, but supplemental alpha-tocopherol reduced drip loss. 4. TBARS and WOF development in minced thigh meat patties were also reduced by supplemental alpha-tocopherol following frozen storage, or cooking and refrigerated storage. Storage stability was not adversely affected by dietary fat. 5. Overall, the results showed that increasing the monounsaturated profile of chicken meat lipids did not adversely affect quality characteristics. Dietary alpha-tocopherol supplementation was a more important factor in the determination of broiler meat quality.

Lipid stability in meat and meat products

Lipid oxidation is one of the main factors limiting the quality and acceptability of meats and meat products. Oxidative damage to lipids occurs in the living animal because of an imbalance between the production of reactive oxygen species and the animal's defence mechanisms. This may be brought about by a high intake of oxidized lipids or poly-unsaturated fatty acids, or a low intake of nutrients involved in the antioxidant defence system. Damage to lipids may be accentuated in the immediate post-slaughter period and, in particular, during handling, processing, storage and cooking. In recent years, pressure to reduce artificial additive use in foods has led to attempts to increase meat stability by dietary strategies. These include supplementation of animal diets with vitamin E, ascorbic acid, or carotenoids, or withdrawal of trace mineral supplements. Dietary vitamin E supplementation reduces lipid and myoglobin oxidation, and, in certain situations, drip losses in meats. However, vitamin C supplementation appears to have little, if any, beneficial effects on meat stability. The effect of feeding higher levels of carotenoids on meat stability requires further study. Some studies have demonstrated that reducing the iron and copper content of feeds improves meat stability. Post-slaughter carnosine addition may be an effective means of improving lipid stability in processed meats, perhaps in combination with dietary vitamin E supplementation.

Influence of dietary vitamin E and oxidised sunflower oil on the storage stability of cooked chicken muscle

1. The effects of oxidised dietary sunflower oil and dietary alpha-tocopheryl acetate supplementation on alpha-tocopherol concentrations in broiler muscle and on the storage stability of refrigerated, cooked, minced muscle were determined. Broiler chicks were fed on diets containing fresh sunflower oil and 30 (FS30) or 200 (FS200) mg alpha-tocopheryl acetate/kg, or oxidised sunflower oil and 0 (OS0), 30 (OS30) or 200 (OS200) mg alpha-tocopheryl acetate/kg. 2. Inclusion of oxidised sunflower oil significantly reduced dietary and hence, muscle alpha-tocopherol concentrations. 3. Oxidised oil increased oxidation in raw and cooked muscle, and reduced the oxidative stability of muscle during refrigerated and frozen storage. 4. Supplementation with alpha-tocopheryl acetate improved the stability of muscle, with stability increasing as muscle alpha-tocopherol concentrations increased, when fresh or oxidised oil was fed. Supplementation with 200 mg alpha-tocopheryl acetate/kg offset the effects of oxidised oil in breast, but not in thigh. 5. The results show that the prooxidising effects of oxidised oils in muscle foods can be overcome, but alpha-tocopherol content needs to be adequately adjusted to compensate for increased oxidative stress. Supplementation with 200 to 400 mg alpha-tocopheryl acetate/kg may be necessary to achieve an optimum muscle alpha-tocopherol concentration.

Efficacy of a high and accelerated dose of hepatitis B vaccine in alcoholic patients: a randomized clinical trial

PURPOSE

A randomized, double-blind trial was conducted to compare the efficacy of a high-dose versus standard-dose hepatitis B vaccine in alcoholic patients.

PATIENTS AND METHODS

One hundred ten alcoholic patients were randomized to either receive the standard dose (20 micrograms at 0.1, and 6 months) or a high dose (40 micrograms at 0, 1, 2, and 6 months) of recombinant hepatitis B vaccine (Engerix-B). Patients were monitored for relapse of drinking using self-report, serial serum carbohydrate deficient transferrin, and collateral verification. The final titer of antibody to hepatitis B surface antigen (anti-HBs) was obtained 12 months after the first vaccine dose; a seroconversion was defined as a titer greater than 10 mlU/ml.

RESULTS

One hundred subjects completed the study; 10 of these had clinical or pathological evidence of cirrhosis. Thirty-six out of 48 (75%) of patients administered the high-dose regimen seroconverted compared with 24 of 52 (46%) in the standard dose group (P < 0.005). The mean anti-HBs titer of the high dose group was significantly greater than of the standard dose group (76.4 versus 39.4 mlU/ml, P < 0.01). Logistic regression demonstrated a significant effect on seroconversion for the vaccine dose (P < 0.005) and serum albumin (P = 0.05) but not for the other variables such as race, age, drinking during the study, serum creatinine, arm muscle circumference, and cirrhosis.

CONCLUSIONS

A high- and accelerated-dose regimen of hepatitis B improves the serological response in alcoholic patients. This regimen (currently recommended for hemodialysis patients) should now also be considered for patients with a history of alcoholism.

Suppression of grp78 core promoter element-mediated stress induction by the dbpA and dbpB (YB-1) cold shock domain proteins

The highly conserved grp78 core promoter element plays an important role in the induction of grp78 under diverse stress signals. Previous studies have established a functional region in the 3' half of the core (stress-inducible change region [SICR]) which exhibits stress-inducible changes in stressed nuclei. The human transcription factor YY1 is shown to bind the SICR and transactivate the core element under stress conditions. Here we report that expression library screening with the core element has identified two new core binding proteins, YB-1 and dbpA. Both proteins belong to the Y-box family of proteins characterized by an evolutionarily conserved DNA binding motif, the cold shock domain (CSD). In contrast to YY1, which binds only double-stranded SICR, the Y-box/CSD proteins much prefer the lower strand of the SICR. The Y-box proteins can repress the inducibility of the grp78 core element mediated by treatment of cells with A23187, thapsigargin, and tunicamycin. In gel shift assays, YY1 binding to the core element is inhibited by either YB-1 or dbpA. A yeast interaction trap screen using LexA-YY1 as a bait and a HeLa cell cDNA-acid patch fusion library identified YB-1 as a YY1-interacting protein. In cotransfection experiments, the Y-box proteins antagonize the YY1-mediated enhancement of transcription directed by the grp78 core in stressed cells. Thus, the CSD proteins may be part of the stress signal transduction mechanism in the mammalian system.

Within-subject comparison of speech perception benefits for congenitally deaf adolescents with an electrotactile speech processor and a cochlear implant

This study assessed speech perception benefits for three congenitally deaf adolescents who used an electrotactile speech processor (Tickle Talker(TM)) and subsequently went on to use a Nucleus Minisystem 22 cochlear implant. Both devices provided significant and comparable benefits for all children in the device plus lipreading condition. All children benefited from the additional information provided by either the Tickle Talker(TM) or the cochlear implant, and were able to perceive speech information with these devices that was not available through either aided residual hearing or lipreading. None of the three children were able to understand open-set words or sentences using either hearing aids alone or Tickle Talker(TM) alone, without the aid of lipreading. Two of the children showed significant open-set speech perception benefits while using their cochlear implant alone.

Alcoholism is associated with hepatitis C but not hepatitis B in an urban population

OBJECTIVES

Previous studies have suggested an association of viral hepatitis with alcoholism, although the role of confounding risk factors (e.g. i.v. drug use) has not been adequately excluded. We therefore compared the seroprevalences of hepatitis B and C in alcoholic patients to that of a nonalcoholic control group.

METHODS

Hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody, and hepatitis C virus antibody testing (second generation ELISA and a confirmatory recombinant immunoblot assay) was performed in 150 consecutive alcoholics admitted for detoxification and in 166 randomly selected patients attending a general medical clinic who were screened for alcoholism.

RESULTS

Hepatitis B and C seropositivities in actively drinking alcoholics are 49.3 and 35.3%, respectively, and were significantly associated with a history of i.v. drug abuse. Out of 166 general medicine clinics patients, 93 were classified as nonalcoholic (by both self-report and collateral verification), 46 patients had a history of alcoholism , and 27 were indeterminate. In the subgroup of patients without known viral hepatitis risk factors, there was no significant difference in hepatitis B seropositivity among nonalcoholic general medicine clinic patients, alcoholic general medicine clinic patients, and alcoholic patients admitted for detoxification (22.1%, 30.3%, and 27.6%, respectively). In contrast, anti-HCV recombinant immunoblot assay seropositivity in alcohol patients admitted for detoxification without risk factors was significantly greater than in nonalcoholic general medicine patients without risk factors (10 vs 0%, p >0.01). Stepwise logistic regression analysis revealed that alcoholism requiring detoxification was a significant risk factor for hepatitis C but not for hepatitis B seropositivity.

CONCLUSIONS

The increased seroprevalence of hepatitis C in actively drinking alcoholic patients without known risk factors suggests that alcoholism, in some way, is a predisposing factor for HCV infection.

Utility of carbohydrate-deficient transferrin as a marker of relapse in alcoholic patients

Carbohydrate-deficient transferrin (CDT) has been proposed as a marker of alcoholism. However, its role in monitoring alcoholic patients for relapse has not been extensively studied. We therefore performed sequential serum CDT measurements using a microcolumn/radioimmunoassay method (Kabi Pharmacia, Piscataway, NJ) in 86 male alcoholics participating in a hepatitis vaccination program who were monitored for relapse using self-report and collateral history (when available). The maximum serum CDT was significantly higher in patients who relapsed (n = 38) (33.1 +/- 3.1 mg/liter), as compared with abstinent subjects with collateral verification (n = 39) (18.8 +/- 1.3, p < 0.001) and abstinent patients without collateral verification (n = 9) (17.4 +/- 1.3, p < 0.01). Using the manufacturer's currently recommended threshold of 20 mg/liter for males, serum CDT was elevated in 29 of 38 patients who relapsed (sensitivity 76.3%). In 16 (42.1%) of the relapsed patients, a serum CDT above this threshold preceded the patient's self-report by at least 28 days. However, serum CDT exceeded 20 mg/liter in 10 of 48 patients who remained sober (specificity 79.2%); three of these patients had clinical and/or pathological evidence of cirrhosis. Using a threshold of 25 mg/liter, 21 of 38 patients who relapsed had an elevated serum CDT (sensitivity 55.3%); 12 (31.6%) of these patients had elevated serum CDT before self-report. Only 4 of 48 subjects who remained sober had serum CDT levels that exceeded 25 mg/liter (specificity 91.7%); three of these patients had clinical and/or pathological evidence of cirrhosis. In conclusion, serial serum CDT testing detects relapses before self-report in male subjects. Values between 20-25 mg/liter suggest relapse, but call for collateral verification, whereas CDT values above 25 mg/liter are usually diagnostic of relapse in the absence of cirrhosis.

Retinoblastoma and p53 tumor suppressor genes in human hepatoma cell lines

We analyzed the status of retinoblastoma and p53 genes in 10 human hepatoma cell lines. Polyclonal anti-peptide antibodies generated against peptides homologous to COOH-terminal and leucine-zipper domains of the retinoblastoma protein allowed us to identify two cell lines (Hep 3B and FOCUS) with abnormal expression. The same cell lines have both lacked p53 expression. In contrast to the retinoblastoma gene, the expression of the p53 gene was abnormal in six additional cell lines. Indeed, only the Hep G2 hepatoblastoma cell line (and its derivative Hep G2/2215) appeared to have normal p53 and retinoblastoma gene expression. Our studies indicate that p53 abnormalities are common but retinoblastoma gene aberrations are rare in human hepatoma cell lines.

Hepatitis C virus antibody in alcoholic patients. Association with the presence of portal and/or lobular hepatitis

OBJECTIVE

To evaluate the relationship between hepatitis C viral infection and alcoholic liver disease.

DESIGN

Case-comparison study.

SETTING

Bronx (NY) Veterans Affairs Medical Center.

PARTICIPANTS

Forty-seven consecutive alcoholic patients undergoing diagnostic liver biopsy.

MAIN OUTCOME MEASURES

Serum was obtained at the time of liver biopsy and assayed for antibodies to hepatitis C virus using enzyme-linked immunosorbent assay, recombinant immunoblot assay, and hepatitis C virus neutralization methods.

RESULTS

Antibody to hepatitis C virus, as confirmed by the recombinant immunoblot assay, was strongly associated with the presence of portal and/or lobular inflammation (91% seropositivity) but was only present in 16% of patients without this histologic finding (P < .001). In patients without portal or lobular hepatitis, recombinant immunoblot assay seropositivity was seen in 27% of patients with cirrhosis and 20% of patients with alcoholic hepatitis and was absent in patients with steatosis and/or perivenular fibrosis. In the subgroup of alcoholic patients who were without known risk factors for hepatitis C virus infection (ie, no history of intravenous drug use or blood transfusions), antibody to hepatitis C virus was present in 78% of subjects with portal and/or lobular hepatitis but was absent in those with other types of alcoholic liver disease. Finally, anti-hepatitis C virus-seropositive patients had a significantly greater mean necroinflammatory score as compared with anti-hepatitis C virus-seronegative alcoholic patients (2.1 vs 1.2; P < .001). In contrast, there was no significant difference in the mean fibrosis score between the two groups.

CONCLUSIONS

The presence of portal and/or lobular inflammation is strongly associated with antibodies to hepatitis C virus in alcoholic patients, even in the absence of known risk factors. This association indicates that hepatitis C virus is responsible, at least in part, for the portal and/or lobular hepatitis associated with alcoholic liver disease.

Hepatitis C virus antibody in alcoholic patients. Association with the presence of portal and/or lobular hepatitis

OBJECTIVE

To evaluate the relationship between hepatitis C viral infection and alcoholic liver disease.

DESIGN

Case-comparison study.

SETTING

Bronx (NY) Veterans Affairs Medical Center.

PARTICIPANTS

Forty-seven consecutive alcoholic patients undergoing diagnostic liver biopsy.

MAIN OUTCOME MEASURES

Serum was obtained at the time of liver biopsy and assayed for antibodies to hepatitis C virus using enzyme-linked immunosorbent assay, recombinant immunoblot assay, and hepatitis C virus neutralization methods.

RESULTS

Antibody to hepatitis C virus, as confirmed by the recombinant immunoblot assay, was strongly associated with the presence of portal and/or lobular inflammation (91% seropositivity) but was only present in 16% of patients without this histologic finding (P < .001). In patients without portal or lobular hepatitis, recombinant immunoblot assay seropositivity was seen in 27% of patients with cirrhosis and 20% of patients with alcoholic hepatitis and was absent in patients with steatosis and/or perivenular fibrosis. In the subgroup of alcoholic patients who were without known risk factors for hepatitis C virus infection (ie, no history of intravenous drug use or blood transfusions), antibody to hepatitis C virus was present in 78% of subjects with portal and/or lobular hepatitis but was absent in those with other types of alcoholic liver disease. Finally, anti-hepatitis C virus-seropositive patients had a significantly greater mean necroinflammatory score as compared with anti-hepatitis C virus-seronegative alcoholic patients (2.1 vs 1.2; P < .001). In contrast, there was no significant difference in the mean fibrosis score between the two groups.

CONCLUSIONS

The presence of portal and/or lobular inflammation is strongly associated with antibodies to hepatitis C virus in alcoholic patients, even in the absence of known risk factors. This association indicates that hepatitis C virus is responsible, at least in part, for the portal and/or lobular hepatitis associated with alcoholic liver disease.

The major histocompatibility complex class I antigen-binding protein p88 is the product of the calnexin gene

A 90-kDa phosphoprotein (p90) of the endoplasmic reticulum was identified by a monoclonal antibody generated against human hepatoma cells. Pulse-chase experiments with [32P]phosphate and [35S]methionine demonstrated that p90 formed both stable and transient complexes with other cellular proteins, suggesting its role as a molecular chaperone. This protein associates with heavy chains of major histocompatibility complex class I proteins, suggesting that it is the human homolog of the recently described 88-kDa protein that transiently associates with murine class I molecules in the endoplasmic reticulum. The p90 protein also associates in B lymphocytes with membrane immunoglobulin mu heavy chains and may serve as a chaperone for many membrane-bound polypeptides. A partial human p90 cDNA was cloned from a lambda gt11 expression library and identified as the human homolog of calnexin, a major canine calcium-binding protein found to be associated with the signal-sequence receptor in endoplasmic reticulum membranes.

Identification of polymorphic simple sequence repeats in the genome of the zebrafish

The zebrafish has drawn a great deal of attention as a developmental system because it offers the ability to combine excellent embryology and genetics. Here, we report that simple sequence repeats are abundant in the zebrafish genome and are highly polymorphic between two outbred lines, making them useful markers for the construction of a genetic map of this organism.

Variability in protection afforded by half-mask respirators against styrene exposure in the field

Concentrations of styrene were measured in the breathing zone and inside the facepiece of air-purifying half-mask respirators of 13 workers for three to six 1-hr periods while they were engaged in the production of fiberglass-reinforced products. These data were used to estimate the protection afforded by the respirators. In arriving at these estimates, it was necessary to correct the concentration measured inside the mask for pulmonary retention of styrene by the workers. Workers were classified as sprayers or as other production line workers not directly carrying out spraying operations. An analysis of variance showed no evidence of differences in the level of protection afforded by the respirators between the two job classes. A second analysis of variance showed that protection varied between workers as well as for a single worker during different wearing periods. The geometric standard deviation (GSD) between workers was 1.92, the common within-worker GSD was 2.93, and the total GSD was 3.51. One-half of a population of wearers with similar protection would be expected to experience long-term average workplace protection factors in excess of 44 and one-half below that value. The observation of between-worker and within-worker variability in protection indicates that both sources of variability have to be taken into account in the specification of maximum use concentrations.

Enhanced expression of the protein kinase substrate p36 in human hepatocellular carcinoma

A basic phosphoprotein defined by a monoclonal antibody named AF5 was found to be highly abundant in human hepatocellular carcinoma by Western immunoblotting. Under the same conditions, the levels of this phosphoprotein were low or undetectable in normal liver extracts. The AF5 antibody was used to screen a cDNA expression library of a human hepatoma cell line named FOCUS. A 960-base-pair cDNA was isolated and found to be a partial cDNA encoding the human protein-tyrosine kinase substrate p36, also known as lipocortin II. p36 expression was highly abundant in hepatocellular carcinomas at both the transcript and protein levels. Its expression was not induced significantly during rat liver regeneration following a partial hepatectomy. These results suggest that the induction of p36 expression is associated with malignant transformation of hepatocytes. p36 was previously shown to be phosphorylated upon transformation of normal fibroblasts by retroviral oncogenes without significant modulation of expression. We report here the initial description of the association of increased p36 expression with malignant transformation.

Urine toxicology as a predictor of continuation in outpatient alcoholism treatment

Urine for toxicology was obtained from 93% of 62 alcoholics (60 males, 2 females) applying for alcoholism treatment. Fourteen urines were positive, with cocaine (35%) and minor tranquilizers (35%) being most common. History of drug use did not correlate with toxicology results nor was there an association with simultaneously obtained alcohol levels. Treatment outcome was analyzed retrospectively at 4 months. Subjects were more likely to remain in outpatient therapy if the screening urine toxicology was negative.