Water desalination using capacitive deionization with microporous carbon electrodes

Capacitive deionization (CDI) is a water desalination technology in which salt ions are removed from brackish water by flowing through a spacer channel with porous electrodes on each side. Upon applying a voltage difference between the two electrodes, cations move to and are accumulated in electrostatic double layers inside the negatively charged cathode and the anions are removed by the positively charged anode. One of the key parameters for commercial realization of CDI is the salt adsorption capacity of the electrodes. State-of-the-art electrode materials are based on porous activated carbon particles or carbon aerogels. Here we report the use for CDI of carbide-derived carbon (CDC), a porous material with well-defined and tunable pore sizes in the sub-nanometer range. When comparing electrodes made with CDC with electrodes based on activated carbon, we find a significantly higher salt adsorption capacity in the relevant cell voltage window of 1.2-1.4 V. The measured adsorption capacity for four materials tested negatively correlates with known metrics for pore structure of the carbon powders such as total pore volume and BET-area, but is positively correlated with the volume of pores of sizes <1 nm, suggesting the relevance of these sub-nanometer pores for ion adsorption. The charge efficiency, being the ratio of equilibrium salt adsorption over charge, does not depend much on the type of material, indicating that materials that have been identified for high charge storage capacity can also be highly suitable for CDI. This work shows the potential of materials with well-defined sub-nanometer pore sizes for energy-efficient water desalination.

Playing well with others: The Discipline in a pediatric hospital

This article contains a personal reflection on the way it feels, in fact and in theory, to move from a chaplaincy position in a clinical setting, to one where clinical chaplaincy is relatively new. The article presents the ways a clinically trained chaplain can introduce herself to a new setting, and how she must continually reevaluate her approach.

Identification of at-risk women for osteoporosis screening

A total of 1610 women completed a questionnaire that evaluated their risk factors for osteoporosis. A dual-energy x-ray absorptiometry scan followed. Analysis of data was performed by the 2-tailed chi(2) test and multivariate logistic regression. Age was directly related to osteoporosis, whereas weight was inversely related. Also, the lack of use of any estrogen was significantly related to the presence of osteoporosis.

Radiation and intra-arterial cisplatin: effects on arteries and free tissue transfer

OBJECTIVES

To determine the histopathologic effect of combined intra-arterial cisplatin administration and hyperfractionated external beam radiation treatment (HYPERRADPLAT) on potential recipient arteries in the neck and to analyze the efficacy of free tissue transfer (FTT) in patients undergoing HYPERRADPLAT.

DESIGN

Cisplatin-perfused and nonperfused artery segments were harvested during planned interval neck dissection performed 6 to 10 weeks after HYPERRADPLAT. These segments were evaluated by light microscopy and transmission electron microscopy. All patients undergoing FTT after HYPERRADPLAT were reviewed retrospectively.

SETTING

Academic medical center.

PATIENTS AND INTERVENTION

Eight patients undergoing HYPERRADPLAT for head and neck squamous cell carcinoma and planned interval neck dissection were prospectively studied. All patients had a perfused artery sampled, and 3 also had a nonperfused (control) artery sampled. Five patients undergoing FTT after HYPERRADPLAT were retrospectively analyzed for outcome of FTT.

RESULTS

No consistent histological or ultrastructural differences were detected between injected and noninjected arteries. Both demonstrated intimal thickening, collagen and elastin deposition in the intimal layer, and, occasionally, intimal smooth muscle proliferation. A smaller fraction of the injected and noninjected arteries demonstrated smooth muscle cell vacuolation, elastic fiber degeneration, and calcific deposits. Four of 5 FTTs in patients undergoing HYPERRADPLAT were successful.

CONCLUSIONS

The changes seen in the injected and noninjected arteries were characteristic of ionizing radiation. Arteries treated with HYPERRADPLAT had no observable difference from vessels treated with radiation alone. These vessels can be used with caution as recipient vessels for FTT. Further clinical experience is needed to establish the expected results of FTT using these arteries.

UCMP and the Internet help hospital libraries share resources

The Medical Library Center of New York (MLCNY), a medical library consortium founded in 1959, has specialized in supporting resource sharing and fostering technological advances. In 1961, MLCNY developed and continues to maintain the Union Catalog of Medical Periodicals (UCMP), a resource tool including detailed data about the collections of more than 720 medical library participants. UCMP was one of the first library tools to capitalize on the benefits of computer technology and, from the beginning, invited hospital libraries to play a substantial role in its development. UCMP, beginning with products in print and later in microfiche, helped to create a new resource sharing environment. Today, UCMP continues to capitalize on new technology by providing access via the Internet and an Oracle-based search system providing subscribers with the benefits of: a database that contains serial holdings information on an issue specific level, a database that can be updated in real time, a system that provides multi-type searching and allows users to define how the results will be sorted, and an ordering function that can more precisely target libraries that have a specific issue of a medical journal. Current development of a Web-based system will ensure that UCMP continues to provide cost effective and efficient resource sharing in future years.

A simple system to determine who needs osteoporosis screening

OBJECTIVE

To define factors that identify patients at highest risk for osteoporosis who should be screened.

METHODS

We gave a questionnaire we developed for osteoporosis risk factors to 1346 menopausal women who were being screened by bone densitometry at the spine, hip, and femoral neck. Chi-square analysis using the one-tailed test was done on all categoric variables to determine differences or patterns in bone mineral density at specific sites. Multivariate logistic regression analysis was done on each of the three sites scanned to determine which combination of independent variables was a significant predictor of the presence or absence of osteoporosis.

RESULTS

Factors identified that were significant for the presence of osteoporosis were age 61 years or older, weight 165 pounds or less, or lack of any use of estrogen, either oral contraceptives or estrogen replacement therapy.

CONCLUSION

We devised a simple system to identify which patients should be screened for osteoporosis.

Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery?

OBJECTIVE

To determine if the scientific literature supports the practice of electronic monitoring of the fetal heart rate (FHR) during nonobstetric surgery.

STUDY DESIGN

A search of the literature from 1966 to 1995 was performed using MEDLINE.

RESULTS

No fetal hypoxic mortality or morbidity has been documented from nonobstetric surgery without occurrence of a maternal hypoxic complication regardless of the use of FHR monitoring or whether alterations of the FHR occurred.

CONCLUSIONS

Fetal monitoring is an indirect assessment of maternal anesthetic and surgical management that is not as specific or effective as direct assessment of the maternal parameters to detect respiratory compromise. Current clinical evidence obtained does not substantiate the need for obstetric personnel to monitor FHR changes during surgical procedures because no change in fetal outcome has been documented.

Stimulatory guanine nucleotide binding protein subunit 1 mutation in two siblings with pseudohypoparathyroidism type 1a and mother with pseudopseudohypoparathyroidism

Pseudohypoparathyroidism (PHP) type la is characterized by multihormone resistance and a constellation of somatic features referred to as Albright hereditary osteodystrophy. Several mutations in the gene coding for the Gs alpha subunit (GNAS1) have been described. Clinical symptoms are heterogeneous and initially laboratory parameters may be normal. We identified a 4 base pair deletion within GNAS1 in two affected siblings with PHP type la and their mother with presumed pseudo PHP. The female proband was diagnosed after an episode of apnoea and seizures. The younger brother was asymptomatic during infancy and had normal plasma parameters. PHP was diagnosed at the age of 4.4 years. Regular check-ups of siblings in families with index cases are therefore important. Molecular genetic analyses or biochemical screening for stimulatory guanine nucleotide binding protein defects should be performed.

CONCLUSION

Different symptoms may be seen in patients with the same mutation causing pseudohypoparathyroidism or pseudopseudohypoparathyroidism. Therefore, clinical and biochemical investigations should be performed in all family members with an index patient.

A review of HELLP syndrome

HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a variant of severe preeclampsia which is associated with substantial maternal and perinatal morbidity and mortality. As with preeclampsia, the etiology and pathogenesis of HELLP syndrome is not completely understood. An increase in vascular thrombosis and activation of the coagulation system may be important in the clinical presentation of this disorder. Laboratory criteria for the diagnosis of HELLP syndrome have been classically described but lack uniformity among different institutions. Aggressive management of HELLP syndrome with expeditious delivery appears to yield the lowest perinatal mortality rates. Conservative or expectant management has been associated with higher stillbirth rates with antenatal corticosteroids not causing resolution of the laboratory abnormalities. Resolution of laboratory abnormalities in HELLP syndrome runs a protracted course over several days after delivery. Despite nearly two decades since HELLP syndrome has been defined as a clinical entity, treatment for the disorder still remains delivery of the patient.

Stability of Magnesium Sulfate in 0.9% Sodium Chloride and Lactated Ringers solutions

Storage stability test were peformed on two extemporaneous formulation alternatives to the commercially available magnesium sulfate injection solutions that are in 5% dextrose or in water. Preparations of the commercial water for injection formulation and two alternative formulations in lactated Ringers and in 0.9% sodium chloride were stored at room temperature in glass bottles and in polyvinyl chloride bags over a three-month period. Solutions were monitored for gross precipitation and for changes in magnesium, sulfur and calcium levels as measured by elemental analysis using atomic absorption spectroscopy and inductively coupled plasma atomic emission spectroscopy. The results demonstrate no consistent decreases in measured elemental concentrations or gross signs of precipitation for any formulation tested.

Catalase-peroxidase of Caulobacter crescentus: function and role in stationary-phase survival

Caulobacter crescentus is an obligate aerobe which is exposed to high concentrations of photosynthetic oxygen and low levels of nutrients in its aquatic environment. Physiological studies of oxidative and starvation stresses in C. crescentus were undertaken through a study of lacZ fusion and null mutant strains constructed from the cloned 5' end of katG, encoding a catalase-peroxidase. The katG gene was shown to be solely responsible for catalase and peroxidase activity in C. crescentus. Like the katG of Escherichia coli, C. crescentus katG is induced by hydrogen peroxide and is important in sustaining the exponential growth rate. However, dramatic differences are seen in growth stage induction. E. coli KatE catalase and KatG catalase-peroxidase activities are induced 15- to 20-fold during exponential growth and then approximately halved in the stationary phase. In contrast, C. crescentus KatG activity is constant throughout exponential growth and is induced 50-fold in the stationary phase. Moreover, the survival of a C. crescentus katG null mutant is reduced by more than 3 orders of magnitude after 24 h in stationary phase and more than 6 orders of magnitude after 48 h, a phenotype not seen for E. coli katE and katG null mutants. These results indicate a major role for C. crescentus catalase-peroxidase in stationary-phase survival and raise questions about whether the peroxidatic activity as well as the protective catalatic activity of the dual-function enzyme is important in the response to starvation stress.

Unexpected second trimester pregnancy loss due to maternal parvovirus B19 infection

Five unexplained second trimester fetal deaths occurring in a 3-month interval were evaluated to determine whether the fetal demise was associated with maternal infection due to parvovirus B19. One fetus was markedly hydropic, a classic finding of fetal infection; no gross anomalies were present in the other four. Liver specimens from all five fetuses showed viral inclusions by light microscopy, supporting the presence of fetal parvovirus B19 infection. None of the five women had a history of parvovirus infection, but serum samples from all of them were positive for IgG to parvovirus. We conclude that maternal parvovirus B19 infection is associated with fetal demise during the second trimester and that hydropic changes may be absent, necessitating careful evaluation of tissue from the dead fetus.

No abnormality in the gene for the G protein stimulatory alpha subunit in patients with bipolar disorder

BACKGROUND

The available evidence for an involvement of the heterotrimeric guanine-nucleotide-binding proteins (G proteins) in bipolar disorder relies primarily on the effects of lithium salts on G protein function and on alterations in the concentration or function of G proteins (most notably Gs-alpha) in peripheral leukocytes and in postmortem tissues of patients with bipolar disorder.

METHODS

The hypothesis that a mutation in Gs-alpha gene confers an increased susceptibility to bipolar disorder was tested by the following strategies: (1) mutational screening of the Gs-alpha subunit gene coding sequences and promoter sequences by denaturing gradient gel electrophoresis in unrelated individuals with bipolar disorder and (2) association and linkage analyses with a common silent exonic polymorphism, using genetic allelic information from American families with at least 1 affected child. For association analysis, the transmission test for linkage disequilibrium was used; for linkage analysis, nonparametric methods were used.

RESULTS

No structural or regulatory mutations in this gene were found in bipolar disorder; the results of association and genetic linkage were negative.

CONCLUSION

Our results do not support the speculation that the Gs-alpha protein gene has a role in the genetic predisposition to bipolar disorder.

The substance abuse subtle screening inventory is more cost effective and has better selectivity than urine toxicology for the detection of substance abuse in pregnancy

OBJECTIVE

To compare the SASSI as a screen for substance abuse in pregnancy with the patient history and toxicology screening.

STUDY DESIGN

On 560 patients the substance abuse history and urine toxicology was obtained at registration in the prenatal clinic. Each patient also completed the SASSI questionnaire. The SASSI was compared with each screen individually and the result of the SASSI and the patient's history were combined for comparison with the toxicology results.

RESULTS

SASSI was found to be more selective as a screen for substance abuse than urine toxicology and it gave a profile of alcohol use which was absent on the toxicology screen.

CONCLUSIONS

The SASSI is a more effective clinical tool for identifying substance abuse and more cost effective than toxicology screening.

Hotline in China: one way to help Chinese people

Due to lack of sufficient professional counselors and psychologists, telephone hotlines were established as a way to reach Chinese people.

The transference and the zone of proximal development

The Zone of Proximal Development (ZPD) is discussed, a construct that, when introduced into psychoanalysis, advances understanding of the key clinical relationship between the intrapsychic and the interpersonal. Strands from several psychoanalytic formulations are brought together and forged into a coherent construct, which is then contrasted with the transference. It is shown how the ZPD provides the transference with its mutative potential. Just as the transference provides the motivation for the recruitment of objects to accomplish its purposes (repetition), the ZPD leads to the recruitment of objects in order to accomplish its purposes (to learn by ushering individuals into a speech and internalization community). Under the sway of the transference objects are sought so that early disregulating experiences can be repeated and an opportunity provided for a better resolution. The ZPD works in tandem with the transference, capitalizing on the impetus provided, allowing for the possibility of internalization, a beneficial outcome to transference repetition which otherwise would have no agent of conflict resolution. In analysis, when the transference and the ZPD enjoin smoothly, the potential outcome is "insight" in a broad sense. The processes of the ZPD define the optimal interpersonal context of psychoanalysis, one that allows the intrapsychic to be best reached by analytic interventions. Given the inevitability of mutual influences between analyst and analysand, the analyst strives simultaneously to be in the ZPD yet outside the transference with the analysand, a crucial tension that is a constant, precarious technical factor. This useful tension casts light on such procedural guides as optimal frustration and abstinence.

The CLIPED procedure: an attempt to improve perinatal outcome in hopeless situations

The purpose of this study was to prevent delivery in women who at < 23 weeks' gestation were in premature labor with excessive cervical dilation and membranes prolapsed into the vagina. Six patients were seen at gestational ages of 17 to 22.5 weeks in premature labor with cervical dilatation of 2 to 8 cm and membranes prolapsed into the vagina. There were three singleton pregnancies, two sets of twins, and one set of triplets. Cerclage placement was successful in five of six patients and one patient had ruptured membranes at operation. One fetus died the day after successful cerclage. The average prolongation of gestation was 33 days in the remaining four patients. It is our opinion that the poor prognosis of a patient at < 23 weeks' gestation in premature labor with excessive cervical dilatation and membranes prolapsed into the vagina may be altered with cerclage placement. We suggest that patients at > or = 21 weeks' gestation with prolapsed membranes whose contractions have been stopped be considered for cerclage late in pregnancy with excessive dilation (CLIPED procedure). The average amount of time a gestation is prolonged may preclude the procedure before 21 weeks.

Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern

PURPOSE

To measure changes and predictors of change in mammograms obtained in postmenopausal women undergoing continuous combined hormonal replacement therapy (HRT).

MATERIALS AND METHODS

Mammograms of 41 postmenopausal women obtained before and 1 year after the initiation of HRT were evaluated blindly according to the quantitative density percentage method and the Wolfe classification system.

RESULTS

Mammographic densities increased compared with baseline values in 73% of subjects (mean increase, 6.7%; 95% confidence interval, 2.5%, 11.0%; P = .003). A shift in Wolfe classification from lower to greater parenchymal density was noted in 24% of subjects (P = .016). Multivariate analysis results indicated that the lower the tissue density percentage before treatment, the greater the increase in density percentage after treatment.

CONCLUSION

An increase in mammographic density was demonstrated in most subjects undergoing continuous combined HRT and was most pronounced in subjects with a lower baseline density percentage.

Single oral dose fluconazole compared with conventional clotrimazole topical therapy of Candida vaginitis. Fluconazole Vaginitis Study Group

OBJECTIVES

Candida vaginitis is currently treated with a wide range of intravaginal preparations usually prescribed over several days. Fluconazole with its marked activity against Candida species and favorable pharmacokinetics offered a safe, effective, and convenient alternative to topical therapy in a single-dose regimen.

STUDY DESIGN

We conducted a multicenter, randomized, prospective, single-blinded study of 429 patients with acute Candida vaginitis, comparing the efficacy and safety of a single oral 150 mg dose of fluconazole with 7-day clotrimazole 100 mg vaginal treatment. Posttherapy evaluations and mycologic eradication rates were conducted.

RESULTS

No statistically significant differences were seen between fluconazole and clotrimazole in the clinical, mycologic, or therapeutic responses. At the 14-day evaluation clinical cure or improvement was seen in 94% of fluconazole-treated patients and 97% of clotrimazole-treated patients. Mycologic and therapeutic cures were seen in 77% and 76% of the fluconazole and 72% of the clotrimazole groups, respectively. At the 35-day evaluation 75% of both groups remained clinically cured, and 56% of the fluconazole and 52% of the clotrimazole group were considered therapeutic cures. In both treatment groups patients with a history of recurrent vaginitis (33/84) compared with those without a history of recurrent vaginitis (177/266) were significantly less likely to respond clinically and mycologically (p < 0.001). Twenty-seven percent of the fluconazole-treated patients and 17% of the clotrimazole-treated patients reported mild side effects only.

CONCLUSION

Fluconazole administered as a single 150 mg oral dose proved to be as safe and effective as 7 days of intravaginal clotrimazole therapy for Candida vaginitis. Therapy of vaginitis should be individualized, taking into consideration severity of disease, history of recurrent vaginitis, and patient preference.

Purpose in life, boredom, and volunteerism in a group of retirees

In a pilot study of 40 retirees, those who volunteered more than 10 hours per week scored significantly higher on the Purpose In Life test than those who volunteered 10 or fewer hours per week. A significant negative correlation of -.75 was obtained between scores on purpose in life and boredom proneness.

RFLP analysis of human chromosome 11 region q13 in multiple symmetric lipomatosis and multiple endocrine neoplasia type 1-associated lipomas

Six lipomas from patients affected by Multiple Symmetric Lipomatosis (MSL) and by Multiple Endocrine Neoplasia Type 1 (MEN 1) were analyzed for loss of heterozygosity on chromosome 11 region q12-13 using four RFLPs. Allelic loss for the D11S146 locus was found only in one visceral MEN 1-associated lipoma. Lipomas that exhibited a lack of allelic lesions were analyzed for an eventual abnormal amount or a defective function of the Gs protein by studying the Gs alpha subunit gene, codons 201 and 207, by PCR and TGGE techniques. All the samples were negative for activating mutations.

Developing a research unit within a hospital social work department

This article describes the establishment of a research unit as an integral part of a hospital social work department on the basis of the authors' experience in a cancer center over a 13-year period. Methods are described for building support within the institution, for the process of initiating the unit, for deciding on study topics, and finally for bridging the gap between clinical and research staff. The evolution of the relationship between clinical and research staff was characterized by four different phases: curiosity, competitiveness, cooperation, and collaboration. A childhood bereavement project is used to exemplify the developmental processes and the ongoing interaction of research and clinical staff. The professional practice of all staff benefited from the increased academic rigor and productivity, although some staff remained unconvinced of the value of such a major research effort. The benefits and costs of the unit are also discussed.

The process of resident selection: a view from the residency director's desk

In 1992, the Executive Council of the Association of American Medical Colleges recommended that a computerized application system be investigated. Under this system, the application package would include: 1) a standardized application form, 2) a personal statement, 3) a dean's letter, 4) transcripts, 5) a chairman's letter, and 6) United States Medical Licensing Examination (USMLE) scores. To investigate the value residency directors placed on these items, all directors from Accreditation Council for Graduate Medical Education--approved residency programs in obstetrics and gynecology and family practice residency programs were surveyed. The directors were asked to prioritize the usefulness of the proposed components of the Electronic Residency Application Service application package. Transcripts, the dean's letter, and USMLE scores ranked highest (in descending order) for the obstetrics and gynecology residency directors for making decisions about "inviting a student for an interview," whereas the dean's letter, personal statement, and transcripts ranked highest for the family practice residency directors. Both ranked the interview as most valuable in ranking a student in the residency match. Although these two disciplines do not represent all fields, our study indicates that residency programs are not homogeneous in their value systems and that certain characteristics may predict those values.

LIFENET/INTERNET and the health science librarian

The Medical Library Center of New York, a cooperative library agency for the health sciences, developed a program to offer an electronic communications system (LIFENET) with access to the Internet for its members. Information on documentation and training as well as statistics on the subsequent use of the system and of the Internet are discussed in the article. Specific examples of how health science librarians are using the system include bibliographic verification, reference, research on integrated library systems, production of duplicate journal lists, and professional activities such as electronic mail and discussion groups (listservs).

The manganese superoxide dismutase of Escherichia coli K-12 associates with DNA

Superoxide dismutases (SODs) are vital components in the resistance of aerobic organisms to the toxicity of oxygen. Escherichia coli contains two highly homologous cytoplasmic SODs, a manganese- and an iron-containing enzyme (MnSOD, FeSOD). We previously demonstrated that MnSOD and FeSOD have different physiological functions and that MnSOD is more effective in preventing oxidative damage to DNA. In this report, purified E. coli MnSOD was shown to bind nonspecifically to DNA by electrophoretic mobility shift assay and nitrocellulose-filter binding methodologies. From electrophoretic mobility shift assay, the equilibrium dissociation constants for interaction with a variety of double-stranded and single-stranded oligonucleotides ranged from 1.5 +/- 0.2 to 8.4 +/- 1.3 microM at 20 degrees C. This range of concentrations corresponds to MnSOD concentrations in aerobically grown E. coli. In vivo binding of MnSOD to DNA was supported by colocalization of MnSOD and the E. coli nucleoid in immunoelectron microscopy. Both MnSOD and DNA were inhomogeneously distributed in the cytosol, the concentration of each being higher in the center of the cell and relatively low near the inner membrane. In contrast, there was no evidence for physiologically relevant interaction of FeSOD with DNA. Binding to DNA in vitro was weak, Kd > 40-220 microM, concentrations 7-40 times higher than found in vivo. In addition, the cytoplasmic distribution of FeSOD did not correlate with DNA. FeSOD concentration was higher near the inner membrane and lower in the center of the cytosol. These results demonstrate that E. coli MnSOD associates with DNA in vitro and in vivo. Combined with prior data demonstrating that MnSOD preferentially protects DNA in vivo while an equal enzymatic activity of FeSOD does not (Hopkin, K. A., Papazian, M. A., and Steinman, H. M. (1992) J. Biol. Chem. 267, 24253-24258), our data suggest that E. coli MnSOD acts as a "tethered antioxidant"; association of MnSOD with DNA localizes dismutase activity near a target of oxidative stress and increases protection of DNA from oxidative damage. This model has implications for the therapeutic use of SODs as antioxidants.

Vaginal retention of 2% butoconazole nitrate cream: comparison of a standard and a sustained-release preparation

The purpose of this study was to establish the length of time that butoconazole nitrate 2% standard cream and sustained-release cream could be detected in the vagina after a single administration of 5 g of cream that contained 100 mg of butoconazole. Sixteen healthy subjects received a single vaginal dose of either the standard (8 patients) or the sustained-release preparation (8 patients). Participants returned daily for vaginal examination and collection of specimens to determine the presence of the drug. The specimens were analyzed for butoconazole content using high-performance liquid chromatography. All subjects in both groups had detectable levels of butoconazole present in the vagina for the first 2 days of the study. The sustained-release cream was demonstrated to be present in the vagina in 7 subjects on the third day, 5 on the fourth day, and 1 on the seventh day, while only 1 subject who received standard cream retained it on the third day and none did so thereafter. Analysis of these data demonstrated a median vaginal retention time of 2.57 days with the standard cream and 4.20 days for the sustained-release preparation (P = 0.0024).

A case study: massage, relaxation, and reward for treatment of alopecia areata

Alopecia areata, a common cause of hair loss, is generally considered the consequence of an autoimmune process. Both physiological and psychological factors have been implicated. Previous studies have not incorporated behavior modification in their treatment designs. In this study, three treatment techniques (hair massage, relaxation procedures, and monetary reward) were applied to a 16-year-old male with a five-year history of alopecia areata. Comparison for seven months without treatment versus seven months with treatment showed that loss of hair was markedly reduced after three months of treatment. During the last four months of the study, new hair growth was evidenced.

Residency directors' responses to the concept of a proposed electronic residency application service

BACKGROUND

In 1992, the Executive Council of the Association of American Medical Colleges (AAMC) recommended that the feasibility of the proposed Electronic Residency Application Service (ERAS) be investigated. This action was based on concerns that the current system was inefficient, costly, and disruptive to students, medical schools, and residency programs. The purpose of this study was to explore residency directors' opinions about the benefits and barriers to the introduction of such a system.

METHOD

All directors from family practice and obstetrics-gynecology residency programs were surveyed in early 1993. Three forced-choice and three open-ended questions elicited opinions concerning benefits and potential barriers to the implementation of ERAS. T-tests and chi-square tests for independence were used to examine differences for continuous and categorical variables.

RESULTS

Overall, 544 residency directors (81%) responded to the questionnaire: 339 (86%) in family practice, and 205 (75%) in obstetrics-gynecology. Eighty percent of the respondents in family practice and 75% of those in obstetrics-gynecology were in favor of the initiation of ERAS. Perceived benefits included increased "efficiency," "simplicity," "standardization," and "completeness." Concerns included "technical problems," "loss of flexibility," "lack of a personal touch," "costs," and "lack of security."

CONCLUSIONS

It is appropriate for the AAMC to take the lead in investigating the computerization of this important process. It is essential, however, to gather data from all three consumers of this potentially valuable service as an important step in the project's development.

Particle digestibility is required for induction of the phosphatidylserine recognition mechanism used by murine macrophages to phagocytose apoptotic cells

One of the characteristic features of programmed cell death in vivo is the rapid recognition and removal of apoptotic cells by macrophages. Although there are several potential mechanisms by which the macrophage can identify a cell as apoptotic, it has been shown recently that murine-elicited macrophages stereospecifically recognize phosphatidylserine (PS) exposed on the surface of apoptotic cells. The particulate stimulus, beta-1, 3-glucan, stimulates bone marrow-derived macrophages to express several characteristics of inflammatory macrophages, and induced these cells to recognize PS on apoptotic cells; this activity was correlated with the ability to form rosettes with PS-expressing RBC. Induction of PS recognition in bone marrow-derived macrophages was associated with digestibility of the stimulus, because L, but not D amino acid particles or latex, were able to stimulate macrophage recognition of PS. The requirement for digestibility could be bypassed by the addition of exogenous TGF-beta, which induced macrophage recognition of PS after stimulation with either latex or D amino acid particles. That endogenously produced TGF-beta played a role in the glucan-stimulated response was indicated by the ability of anti-TGF-beta antibodies to inhibit digestible particle-induced recognition of PS. The induction of the PS recognition mechanism correlated well with the expression of other markers for the inflammatory phenotype. These studies indicate that the PS receptor may be a marker for the inflammatory phenotype, which appears to be induced by the phagocytosis of particulate digestible stimuli. Endogenously produced TGF-beta is suggested to play an autocrine or paracrine priming role in the induction of the PS receptor.

Particle digestibility is required for induction of the phosphatidylserine recognition mechanism used by murine macrophages to phagocytose apoptotic cells

One of the characteristic features of programmed cell death in vivo is the rapid recognition and removal of apoptotic cells by macrophages. Although there are several potential mechanisms by which the macrophage can identify a cell as apoptotic, it has been shown recently that murine-elicited macrophages stereospecifically recognize phosphatidylserine (PS) exposed on the surface of apoptotic cells. The particulate stimulus, beta-1, 3-glucan, stimulates bone marrow-derived macrophages to express several characteristics of inflammatory macrophages, and induced these cells to recognize PS on apoptotic cells; this activity was correlated with the ability to form rosettes with PS-expressing RBC. Induction of PS recognition in bone marrow-derived macrophages was associated with digestibility of the stimulus, because L, but not D amino acid particles or latex, were able to stimulate macrophage recognition of PS. The requirement for digestibility could be bypassed by the addition of exogenous TGF-beta, which induced macrophage recognition of PS after stimulation with either latex or D amino acid particles. That endogenously produced TGF-beta played a role in the glucan-stimulated response was indicated by the ability of anti-TGF-beta antibodies to inhibit digestible particle-induced recognition of PS. The induction of the PS recognition mechanism correlated well with the expression of other markers for the inflammatory phenotype. These studies indicate that the PS receptor may be a marker for the inflammatory phenotype, which appears to be induced by the phagocytosis of particulate digestible stimuli. Endogenously produced TGF-beta is suggested to play an autocrine or paracrine priming role in the induction of the PS receptor.

Development of functional diversity in mouse macrophages. Mutual exclusion of two phenotypic states

The objective of this study was to investigate the mechanisms that contribute to the generation of macrophage functional diversity. Exposure of mouse bone marrow-derived macrophages to beta-1,3-glucan, a particulate inflammatory stimulus, or polyinosinate-polycytidylate (poly[I:C]), a stimulus of macrophage cytocidal activation, induced distinct and stimulus-specific patterns of gene expression. These changes were characterized by an up-regulation of the expression of the acid hydrolase beta-glucuronidase and platelet-derived growth factor B following incubation with beta-1,3-glucan and a stimulation of the expression of the complement component Bf, beta-interferon, and the reactive nitrogen intermediates NO2/NO3 during incubation with poly[I:C]. The induction of Bf expression by poly[I:C] could not be explained on the basis of distinct subpopulations of cells since in situ hybridization with a mouse Bf cRNA probe revealed a uniform and substantial increase in Bf expression by the entire population of cells. Incubation of macrophages with beta-1,3-glucan before stimulation with poly[I:C] was found to strongly attenuate the expression of Bf and beta-interferon. Conversely, incubation with poly[I:C] prior to exposure to beta-1,3-glucan substantially blocked the stimulation of beta-glucuronidase and platelet-derived growth factor B expression, indicating that these two responses were expressed in a mutually antagonistic fashion. However, after removal of either stimulus and following a period in which the primary response was allowed to decay, the cells regained their capacity to subsequently respond to either the same stimulus or to a different stimulus. Collectively, these findings indicate, first, that the heterogeneity of gene expression seen in response to poly[I:C] represents an adaptive response of the entire macrophage population rather than the restricted responses of distinct subpopulations of cells. Second, macrophages respond to these stimuli in a sequential fashion. These findings thus have a significant bearing on our understanding of the regulation of macrophage heterogeneity in host defense.

Impact of parental terminal cancer on latency-age children

The underlying psychological and emotional components of distress were examined in 87 children with a parent in the terminal phase of cancer. Common fears, concerns, misperceptions, and behavioral consequences are analyzed, as are more severe psychological and behavioral reactions. Implications for psychoeducational parent-guidance intervention are discussed.

Pulmonary sporotrichosis treated with itraconazole

A 62-year-old woman had chronic cavitary pulmonary sporotrichosis refractory to medical management over an 8-year period. She was treated with oral itraconazole and had an apparent microbiologic and clinical response; however, the patient succumbed to progressive pulmonary hypertension. The early use of oral itraconazole for treatment of pulmonary sporotrichosis is advocated.

The PROEF diet--a new postoperative regimen for oral early feeding

OBJECTIVE

The purpose of this study was to determine if immediate postoperative feeding of a new oral elemental diet (PROEF diet) would be tolerated by patients and to determine its effect on gastrointestinal function after cesarean section.

STUDY DESIGN

One hundred eighteen patients undergoing cesarean section were randomly assigned by a computer-generated list of numbers to receive either the PROEF diet (60 patients) or routine postoperative dietary management (58 patients). Gastrointestinal morbidity was analyzed by an independent-samples t test.

RESULTS

The PROEF diet group has a more rapid return of normal bowel sounds, 10.3 versus 14.5 hours (p = 0.001), and earlier acceptance of a regular diet, 2.0 versus 2.3 days (p = 0.008).

CONCLUSION

The PROEF diet was well tolerated in cesarean section patients with no increase in gastrointestinal morbidity when compared with a control group of patients. This dispels the classic teaching that postoperative patients may not have oral intake until the return of normal bowel function. Further study is necessary to support the theoretic benefits that may accrue from early feeding of an elemental diet.

Language and the psychoanalytic process: psychoanalysis and Vygotskian psychology. II

This paper follows our previous one, where we described a psychoanalytic conception of language, thought, and internalization that is informed by the thinking of Lev Vygotsky. Here, several aspects of the analytic process which allow for the understanding of ineffable experiences in the analysand's history and the analytic situation are investigated: specifically, primal repression, metaphor, and the role of speech in free association. It is suggested that Freud's notion of primal repression be revived and redefined as one aspect of the descriptive unconscious. Some implications of primal repression for transference and resistance are explored. The metaphoric in its broad sense is examined as one example of how early dynamic experiences embedded in the process of language acquisition can be reached within the clinical situation. It is proposed that an understanding of free association is enhanced by awareness of distinctions between inner, egocentric, and social speech. The basic rule can be interpreted as an invitation for the analysand to use inner speech in collaboration with the analyst as best he or she can. Further, the aliveness and degree of superficiality of the analysis can be seen as a function of the analyst's ability to appreciate the properties of inner speech and foster the conditions in the analysis that allow for its unfolding.

Right internal mammary artery graft angioplasty through a right brachial artery approach using a new custom guide catheter: A case report

Angioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.

An investigation into some implications of a Vygotskian perspective on the origins of mind: psychoanalysis and Vygotskian psychology, Part I

The Russian psychologist Lev Vygotsky proposed an analysis of language, thought, and internalization that has direct relevance to the current concerns of psychoanalysts. Striking methodological and conceptual similarities and useful complementarities with psychoanalysis are discovered when one peers beneath the surface of Vygotskian psychology. Our adaptation of Vygostsky's views expands upon Freud's assigned role to language in the topographic model. We suggest that the analysand's speech offers several windows into the history of the individual, through prosody, tropes, word meaning, and word sense. We particularly emphasize Vygotsky's views on the genesis and utilization of word meanings. The acquisition of word meanings will contain key elements of the internal climate present when the word meaning was forged. Bearing this in mind, crucial theoretical questions follow, such as how psychoanalysis is to understand the unconscious fantasies, identifications, anxieties, and defenses associated with the psychodynamics of language acquisition and later language usage. We propose that the clinical situation is an ideal place to test these hypotheses.