Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Follow-up care for survivors of lymphoma who have received curative-intent treatment

OBJECTIVE

This evidence summary set out to assess the available evidence about the follow-up of asymptomatic survivors of lymphoma who have received curative-intent treatment.

METHODS

The medline and embase databases and the Cochrane Database of Systematic Reviews were searched for evidence published between 2000 and August 2015 relating to lymphoma survivorship follow-up. The evidence summary was developed by a Working Group at the request of the Cancer Care Ontario Survivorship and Cancer Imaging programs because of the absence of evidence-based practice documents in Ontario for the follow-up and surveillance of asymptomatic patients with lymphoma in complete remission.

RESULTS

Eleven retrospective studies met the inclusion criteria. The proportion of relapses initially detected by clinical manifestations ranged from 13% to 78%; for relapses initially detected by imaging, the proportion ranged from 8% to 46%. Median time for relapse detection ranged from 8.6 to 19 months for patients initially suspected because of imaging and from 8.6 to 33 months for those initially suspected because of clinical manifestations. Only one study reported significantly earlier relapse detection for patients initially suspected because of clinical manifestations (mean: 4.5 months vs. 6.0 months, p = 0.042). No benefit in terms of overall survival was observed for patients depending on whether their relapse was initially detected because of clinical manifestations or surveillance imaging.

SUMMARY

Findings in the present study support the importance of improving awareness on the part of survivors and clinicians about the symptoms that might be associated with recurrence. The evidence does not support routine imaging for improving outcomes in this patient population.

Lenalidomide in multiple myeloma-a practice guideline

BACKGROUND

Promising new drugs such as lenalidomide, an immunomodulatory agent, are available for the treatment of multiple myeloma. We describe the process of creating a provincial guideline for the use of lenalidomide, alone or in combination with other drugs, in relapsed, refractory, or newly diagnosed disease (including smoldering and symptomatic patients, and candidates and non-candidates for transplant) and in maintenance treatment (after transplant or non-transplant therapy); and for strategies to manage lenalidomide-related toxicities.

METHODS

Outcomes of interest included overall survival, event-free survival, progression-free survival, time to progression, time to next treatment, response rate, and incidence of serious toxicity. The medline, embase, and Cochrane Library databases, as well as meeting abstracts and the Web sites of relevant organizations, were systematically searched for relevant literature.

RESULTS

Recommendations were developed using the evidence from published studies and the clinical expertise of the working group and of the Cancer Care Ontario Hematology Disease Site Group.

CONCLUSIONS

Lenalidomide in combination with dexamethasone can be recommended for both previously untreated and treated patients with multiple myeloma. Guidelines for the management of cytopenias, venous thromboembolism, and second primary malignancies are discussed.

The California Pertussis Epidemic 2010: A Review of 986 Pediatric Case Reports From San Diego County

BACKGROUND

The California Department of Public Health (CDPH) declared a pertussis epidemic on 23 June 2010. More cases were reported in 2010 (9146) than in any year since 1947. We describe the characteristics of pertussis epidemiology and disease from 986 reported cases in children in San Diego County (population 3.2 million).

METHODS

Descriptive statistics were abstracted from CDPH pertussis case report forms that were completed by public health nurses investigating reports of positive laboratory results for pertussis and reports of illnesses compatible with pertussis.

RESULTS

Of 1144 reported adult and pediatric cases, 753 (66%) were confirmed and 391 were probable/suspect. Children aged <19 years comprised 86% of all reported cases in San Diego County; of these, 22% were aged 11-18 years, 29% were aged 6-10 years, 27% were aged 1-5 years, and 22% were aged <1 year (with 70% aged <6 months). Case rates were highest in infants aged <6 months (651 per 100 000 population). Of those aged >1 year, the highest attack rates were in preschool children aged 1-5 years (114 per 100 000) and elementary school children aged 6-10 years (141 per 100 000). Of 51 children hospitalized, 82% were aged <6 months; 2 deaths occurred in these young infants. Paroxysmal cough was noted in over 70% of children in all age groups; post-tussive vomiting occurred in 36% (aged 11-18 years) to 57% (aged <6 months) of children.

CONCLUSIONS

Pertussis vaccine efficacy may decrease more rapidly than previously believed, facilitating spread of pertussis in elementary school-aged children. The highest case rates and the only mortality occurred in infants aged <6 months.

Is age-dependent, ketamine-induced apoptosis in the rat somatosensory cortex influenced by temperature?

General anesthetics have long been thought to be relatively safe but recent clinical studies have revealed that exposure of very young children (4 years or less) to agents that act by blocking the N-methyl-D-aspartate receptor (NMDAR) can lead to cognitive deficits as they mature. In rodent and non-human primate studies, blockade of this receptor during the perinatal period leads to a number of molecular, cellular and behavioral pathologies. Despite the overwhelming evidence from such studies, doubt remains as to their clinical relevance. A key issue is whether the primary injury (apoptotic cell death) is specific to receptor blockade or due to non-specific, patho-physiological changes. Principal to this argument is that loss of core body temperature following NMDAR blockade could explain why injury is observed hours later. We therefore examined the neurotoxicity of the general anesthetic ketamine in P7, P14 and P21 rats while monitoring core body temperature. We found that, at P7, ketamine induced the pro-apoptotic enzyme activated caspase-3 in a dose-dependent manner. As expected, injury was greatly diminished by P14 and absent by P21. However, contrary to expectations, we found that core body temperature was not a factor in determining injury. Our data imply that injury is directly related to receptor blockade and is unlikely to be overcome by artificially changing core body temperature.

Are patients with Parkinson's disease suicidal?

Using the National Center of Health Statistics' mortality statistics databases for 1991 through 1996 (12,430,473 deaths), we isolated 144,364 individuals 40 years of age or older with a primary diagnosis of Parkinson's disease (PD). Of these, 122 died by suicide. The rate of suicide in the general population was about 10 times higher than in patients with PD (0.8% compared with only 0.08%, respectively). These different rates of suicide cannot be attributed to differences in age, gender, race, education, or marital status. Compared with patients with suicidal PD, patients with PD who died from other causes manifested significantly lower rates of affective disorders. The referent population exhibited a higher rate of malignancy and a lower rate of depression. The findings suggest that marital status, mood disorder, and somatic comorbidity provide only a limited understanding of completed suicide.

Spatial convergence and divergence between cutaneous afferent axons and dorsal horn cells are not constant

We have proposed a quantitative model of the development of dorsal horn cell receptive fields (RFs) and somatotopic organization (Brown et al. [1997] Somatosens. Motor Res. 14:93-106). One component of that model is a hypothesis that convergence and divergence of connections between low-threshold primary afferent mechanoreceptive axons and dorsal horn cells are invariant over skin location and dorsal horn location. The more limited, and more easily tested, hypothesis that spatial convergence and divergence between cutaneous mechanoreceptors and dorsal horn cell are constant was examined. Spatial divergence is the number of dorsal horn cells whose RFs overlap the RF center of a primary afferent, and spatial convergence is the number of afferent RF centers that lie within the RF of a dorsal horn cell. Innervation density was determined as a function of location on the hindlimb by using peripheral nerve recording and axon counting. A descriptive model of dorsal horn cell receptive fields (Brown et al. [1998] J. Neurophysiol. 31:833-848) was used to simulate RFs of the entire dorsal horn cell population in order to estimate RF area and map scale as a function of location on the hindlimb. Previously reported correlations among innervation density, map scale, and RF size were confirmed. However, these correlations were not linear. The hypothesis that spatial convergence and divergence are constant was rejected. The previously proposed model of development of dorsal horn cell somatotopy and RF geometries must be revised to take variable spatial convergence and divergence into account.

Australian isolates of Legionella longbeachae are not a clonal population

Legionella longbeachae is almost as frequent a cause of legionellosis in Australia as Legionella pneumophila, but epidemiological investigation of possible environmental sources and clinical cases has been limited by the lack of a discriminatory subtyping method. The purpose of this study was to examine the genetic variability among Australian isolates of L. longbeachae serogroup 1. Pulsed-field gel electrophoresis (PFGE) of SfiI fragments revealed three distinct pulsotypes among 57 clinical and 11 environmental isolates and the ATCC control strains of L. longbeachae serogroups 1 and 2. Each pulsotype differed by four bands, corresponding to <65% similarity. A clonal subgroup within each pulsotype was characterized by >88% similarity. The largest major cluster was pulsotype A, which included 43 clinical isolates and 9 environmental isolates and was divided into five subgroups. Pulsotypes B and C comprised smaller numbers of clinical and environmental isolates, which could each be further divided into three subgroups. The ATCC type strain of L. longbeachae serogroup 1 was classified as pulsotype B, subtype B3, while the ATCC type strain of L. longbeachae serogroup 2 was identified as a different pulsotype, LL2. SfiI macrorestriction analysis followed by PFGE showed that the Australian L. longbeachae strains are not a single clonal population as previously reported.

The relative positions of alanine residues in the hydrophobic core control the formation of two-stranded or four-stranded alpha-helical coiled-coils

The objective of this study was to investigate the positional effect of hydrophobic interactions in the alpha-helical interface in controlling the formation of two-stranded and four-stranded coiled-coils. Two disulfide-bridged antiparallel coiled-coils were designed which differ only in the position of a single Ala residue in the middle heptad: in peptide 2H the Ala residues are in register (in the same rung), while in peptide 4H they are not. Data from size-exclusion chromatography and sedimentation equilibrium experiments showed that under benign conditions peptides 2H and 4H were two-stranded and four-stranded coiled-coils respectively. These results, in conjunction with molecular modeling studies, suggests that when four Ala residues are in the same plane of a potential four-stranded coiled-coil, the small side chains of Ala would create a large cavity in the hydrophobic interface of the potential four-stranded structure which is destabilizing and favors the two-stranded, disulfide-bridged coiled-coil. In contrast, an alternating Leu-Ala hydrophobic packing in the two planes distributes the potential cavity over a larger region, which may be partially filled by minor adjustments of the neighboring Leu side chains. As a result, there is still sufficient hydrophobic contact to maintain the four stranded structure.

Serological cross-reaction between Legionella spp. and Capnocytophaga ochracea by using latex agglutination test

Cross-reactivity between Legionella spp. and Capnocytophaga ochracea was noted by latex agglutination tests (Serobact Legionella; Disposable Products, Adelaide, Australia). Four of 11 (36%) C. ochracea isolates agglutinated with latex reagents designed to identify Legionella pneumophila serogroups. C. ochracea isolated on buffered charcoal yeast extract media may give false-positive results in this Legionella latex agglutination assay.

Evaluating low-speed rear-end impact severity and resultant occupant stress parameters

Automotive Systems Analysis, Inc. (ASA) and Lowell Hicks, Inc. (LHI) have developed a ground-up set of sensor instrumentation and recording method to document vehicle-artifact/occupant-stress parameters occurring from a continuing series of low-speed rear-end multi-vehicle impact tests (approximately 2 to 8 MPH). This work has four goal areas: 1) calculate impacted vehicle (TARGET) barrier equivalent velocity (BEV) from isolator Artifacts; 2) correlate calculated BEV' to occupant stress; 3) calibrate injury potential of occupant stress impulse; 4) compare occupant stress with everyday volunteer activities. The test collision series now includes several different vehicle pairs with varying impact/escape speeds, weight ratios, and parallel parameters from a driver side manikin and passenger side volunteer. Observable physical vehicle isolator artifacts (piston stroke scrapes) were compared with computer-recorded linear sensor time traces, and these data were fitted to a 'calculated BEV' worksheet/algorithm. The worksheet/algorithm method shown here was found to be reasonably repeatable, per vehicle model and series tested. Next, manikin and volunteer occupant stress data, measured along with TARGET vehicle BEVs, were charted and compared with injury-threshold-impulse criteria referenced in the literature. Lastly, the occupant-stress impulses were compared with sample stress impulses for various volunteer physical activities, as a practical calibration of vehicle occupant stress.

Plasma lipid effects of three common vegetable oils in reduced-fat diets of free-living adults

We compared plasma lipid changes due to the polyunsaturated fatty acids (PUFAs) in partially hydrogenated soybean oil, corn oil, and sunflower oil fed in reduced-fat diets (22-26% of total energy). Each oil was the dominant fat in isoenergetic diets of centrally prepared foods consumed by 26 male and 35 female normolipidemic, free-living individuals. Test diets were consumed double-blind, alternating with self-selected diets for 5 wk each. The ranges of proportions of total fat were: 4.7-9.7% polyunsaturated fat, 8.9-14.2% monounsaturated fat and 5.4-7.4% saturated fat. All three diets lowered (P < 0.0001) total cholesterol (11%), LDL cholesterol (13%), and HDL cholesterol (10%), without triglyceride changes. We conclude that PUFAs at approximately 6% of total energy result in clinically relevant plasma cholesterol-lowering and that the proportion of polyunsaturated fat must be an important consideration when planning reduced-fat, reduced-saturated-fat diets.

Structural properties of the myelin-associated glycoprotein ectodomain

Myelin-associated glycoprotein (MAG) has been proposed to mediate adhesive interactions during myelin development. We have used the baculovirus expression system to produce a truncated form of this molecule [soluble extracellular domain of MAG (sMAG)] consisting of the complete extracellular ectodomain. Spectroscopic studies indicate a high beta-sheet content, consistent with the prediction of Ig-like structure. Hydrodynamic studies indicate an asymmetric monomer, with a Stokes radius of 4.1-4.6 nm, a sedimentation coefficient of 3.6S, and a frictional ratio of approximately 1.6. We postulate that the outer two Ig-like domains form a unit that folds back over the rest of the molecule. Fluorescence quenching studies indicate that sMAG interacts with divalent cations and may have a functional lectin domain.

Gastroschisis wringer clamp: a safe, simplified method for delayed primary closure

When primary abdominal wall closure in a newborn with gastroschisis cannot be accomplished safely, placement of a reinforced Silastic silo facilitates delayed primary closure (DPC). In this report we describe our experience with the gastroschisis wringer clamp (GWC). The GWC is an autoclavable, 140-g, aluminum alloy device reminiscent of an old wringer washing machine. It consists of two apposing serrated rollers that pull the Silastic silo through a slotted base plate. This protects the intestine and converts the circular defect into a vertical slit to ease DPC. The GWC is adjusted daily on the awake newborn in the nursery and the magnitude of each adjustment is gauged by the infant's cardiac and pulmonary status. For the past 10 years we have cared for 116 newborns with gastroschisis. The average birth weight was 2,530 g (range, 1,380 to 3,300 g). Eighty-six infants (74.1%) have undergone primary closure. The remaining 30 infants (25.9%) were treated by placement of a Silastic silo and application of the GWC, forming the basis of this report. The DPC operation was performed an average of 6.7 days (range, 3 to 23 days) following the application of the silo. Extubation was usually possible prior to the DPC, with the mean length of mechanical ventilation being 3.8 days. Three patients developed serious complications including two dehiscences of the silo-fascia interface. There were no deaths in this group of 30 patients. The GWC offers many technical advantages and can be easily reversed when the infant's cardiopulmonary status deteriorates. We advocate its adoption as a method of choice in the newborn with gastroschisis who requires DPC.

Nursing challenges in managed care

The emergence of managed care organizations offers many opportunities, challenges, and threats for nursing and nurses. The goal of these organizations (ensuring maximum value from resources used) is congruent with the basic philosophy of nursing, which focuses on the total needs of the patient, not just disease, and on maintaining the health of the individual to minimize the need for expensive health care services. Within the structure of managed care, however, there is also a need for strong professional advocacy to ensure that the needs of the members are adequately met as the organization strives to maintain costs. In meeting the needs of the organization and of the members, the nurse also plays an important role in managing the resources used in producing health care services.

Lipreading in patients with schizophrenia

This study was designed to explore whether schizophrenic patients who are able to maintain their gaze with adequate persistence could competently lip-read. Four lipreading tests, designed to assess recognition of syllables, words, and overlearned sentences, were administered to 15 schizophrenic and 15 normal subjects matched for age, sex, and educational level. The patients proved to be competent lip-readers susceptible to the blend illusion and were inferior only in lipreading of overlearned sentences. The latter difficulty may tentatively be attributed to the inadequacy of the patient's premorbid social network for establishing contextual cues that aid in the recognition of overlearned sentences.

Cellular pharmacology of cyclopentenyl cytosine in Molt-4 lymphoblasts

The toxicity, uptake, and metabolism of the oncolytic nucleoside cyclopentenyl cytosine (CPEC) have been examined in the Molt-4 line of human lymphoblasts. This compound is known to be converted to its 5'-triphosphate, which inhibits CTP synthetase and depletes the pools of cytidine nucleotides. In the Molt-4 system, the concentration of drug reducing proliferation by 50% in a 24-h incubation was between 50 and 100 nM. Cytidine, uridine, and nitrobenzylthioinosine almost fully prevented the cytotoxicity of CPEC when introduced shortly before or together with the drug, but only cytidine was effective as an antidote when added 12 h after 200 nM CPEC. Studies of the cellular entry of CPEC revealed that nitrobenzylthioinosine fully blocked this process over a 60-s interval and for as long as 2 h, suggesting that the initial interiorization was mediated by facilitated diffusion. In Molt-4 cells incubated with tritiated CPEC, 9 metabolites could be distinguished: prominent among these was cyclopentenyl uridine (CPEU), the deamination product of CPEC; other major metabolites included the 5'-mono-, di-, and triphosphates of CPEC, and of CPEU, along with two phosphodiesters provisionally identified as CPEC-diphosphate choline and CPEC-diphosphate ethanolamine. When the accumulation of CPEC-5'-triphosphate was measured as a function of concentration of the drug in the medium, the process was found not to be saturable by levels of CPEC up to 1000 nM. In cells incubated with 200 nM drug, CPEC-5'-triphosphate accumulated rapidly and linearly for approximately 4 h, the time for doubling of the concentration being 2 h. After a 16-h incubation with 100 nM CPEC, the concentration of CPEC-5'-triphosphate was 50-fold that of the parent drug in the medium and could be readily monitored spectrophotometrically in high-pressure liquid chromatography effluents without recourse to radiolabeled nucleoside. In 2-h incubations, the concentration of free CPEC required to reduce CTP by 50% was 150 nM; this corresponded to a CPEC-5'-triphosphate level of 750 nM. After washout of extracellular CPEC, CPEC-5'-triphosphate decayed with a half-life that ranged from 9 to 14 h. Twenty-four h after washout of 200 nM CPEC (the concentration of drug reducing proliferation by 80%), cells had not resumed proliferation, and CTP pools were still depressed by 90%. Cytidine, uridine, and nitrobenzylthioinosine all strongly repressed the anabolic phosphorylation of CPEC when added to Molt-4 cells along with the drug.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuropsychological studies of blacks with cerebrovascular disorders: a preliminary investigation

Very few studies have been conducted that examine brain behavior functions in blacks and other ethnic minorities. Recognizing that measures of higher cortical functions have cultural, experiential, and organic determinants, the present investigation was designed to ascertain whether findings reported in neuropsychologic studies of white patients with lateralized cerebral lesions are applicable to groups of black patients with lesions in similar locations. Thirty-seven patients with left (n = 15) and right (n = 22) cerebrovascular lesions were administered the Michigan Neuropsychological Battery (MNB). This battery is comprised of a number of objective standardized measures of higher and lower-level cerebral functions. With one exception, the performance of patients in the brain-injured groups was not systematically different on tests of higher brain functions. As expected, tests of lower-level somatosensory and motor functions showed a pattern of greater impairment on the side of the body contralateral to the lesion. But, in contrast to neuropsychological studies of white patients, a pattern of laterality specific deficits on verbal IQ and performance IQ was not observed. Methodological and theoretical implications of these findings are discussed.

A comparison of circulating immune complexes, pregnancy associated beta 1-macroglobulin and galactosyltransferase as tumour markers for ovarian cancer

Serial blood samples have been obtained from 12 patients with ovarian cancer who were treated by surgery and, generally, chemotherapy or radiotherapy. Some achieved clinical remission, but the majority relapsed after variable time interval. Three potential tumour markers (Circulating Immune Complexes, Pregnancy Associated beta 1-Macroglobulin and Galactosyltransferase) have been studied longitudinally in serum for clinical correlation, predictive value, and biochemical 'lead time' to clinically detectable progression. None of the 3 offered any signal advantage over the others, and each showed an inconsistent relationship to observed disease status, with high levels indicating a poor outlook and the converse not true. Thus, since the 'lead time' is short, and reliability low, none of the compounds can be strongly commended as individual markers for ovarian cancer.

A temperature-dependent block in spore differentiation is transduced intercellularly by Dictyostelium discoideum

Strain HH31 of Dictyostelium discoideum is abnormal in the sense that at 27 degrees C it fails to produce spores and all or nearly all of the cells become stalk cells. In interstrain chimeras produced at the restrictive temperature, this strain shares with strains A3 or M28 the potential to control spore differentiation in neighboring cells. If HH31 is in numerical excess in slugs, then spore formation by A3 or M28 is suppressed by a factor of 20 or more. In contrast, an excess of A3 cells stimulates the formation of spores by HH31; the rescue affects fewer than one in 1000 HH31 cells though this represents a rescue coefficient of up to 2 X 10(3). The transcellular influence mediated by HH31 is rendered locally since it cannot traverse a thin membrane. It is not an artifact of unfavorable positioning of the test cells because in the slug they accumulate in the prespore region. The temperature-dependence of the self-differentiation of HH31 and its effect on A3 or M28 are altered coordinately in a spontaneous variant of HH31. We suggest that HH31 exerts, and is receptive to, a local effect on and by neighboring cells. This may be mediated by plasma membrane wheat germ agglutinin receptors, since their expression is also found to be under coordinate temperature control in HH31 and its variant.

Below-knee amputations for vascular insufficiency

In the case of below-knee amputations for vascular insufficiency, divisions of the tibia and fibula in the proximal one-third followed by coverage by a long posterior soft tissue flap gives the best results. Emphasis must be placed on sharp division of structures, perfect hemostasis, and accurate skin approximation. The use of suction drainage and gentle compression dressing is demonstrated.

Increased myocardial catalase in rats fed ethanol

The effects of chronic intake of dietary ethanol upon catalase, an enzyme capable of metabolizing ethanol, as well as upon myocardial morphology and hemodynamics, were studied in the rat. Ethanol, comprising 36% of dietary calories, administered to rats for 5 weeks, was associated with increased myocardial catalase of 45.9 +/- 3.7 IU/mg protein, compared to 21.0 +/- 1.8 IU/mg protein in pair-fed controls. The enzyme activity remained significantly elevated after 18 weeks of ethanol. Hepatic catalase did not differ in these groups. Parallel cytochemical studies confirmed the increase in myocardial catalase by demonstrating an increase in peroxisomes. Gross and light-microscopic examinations revealed no abnormalities at either 5 or 18 weeks. Remarkably few ultrastructural abnormalities were seen in this material fixed by vascular perfusion. Hemodynamic studies after 5 weeks of ethanol revealed decreased left ventricle systolic pressure and decreased mean arterial pressure but no change in ventricular filling pressure. The possibility of catalase playing a metabolic and potentially protective role in rat myocardium chronically exposed to ethanol is discussed.

Visual proprioception and postural stability in infancy. A developmental study

The effect of conflicting visual, and mechanical proprioceptive information on postural stability was compared in two groups of infants. The older group could sit or stand unsupported, while the younger group could sit but could not yet stand. The results suggest that visual proprioception functions to maintain postural stability before infants have learned to stand.

Peroxisomes (microbodies) in the myocardium of rodents and primates. A comparative Ultrastructural cytochemical study

The occurrence of peroxisomes (microbodies), their cytochemical characteristics and their ultrastructural relationship to the neighboring organelles were investigated in the ventricular myocardium of four rodent (rat, rabbit, gerbil, and guinea pig) and two primate (Macaca java and Tupaya) species. The hearts were fixed by vascular perfusion with glutaraldehyde and incubated in alkaline diaminobenzidine media for visualization of catalase. The electron-dense reaction product of catalase was found in the myocardium of all examined species and was localized in 0.2--0.5 mum oval particles, surrounded by a single limiting membrane and located usually at the junction of I and A bands. The peroxisomes in the hearts of gerbil and Macaca java were especially long and tortuous. A close spatial association was found between the myocardial peroxisomes and mitochondria, lipid droplets, and the membranes of sarcoplasmic reticulum, especially the so-called junctional sarcoplasmic reticulum. These observations demonstrate the consistent occurrence of peroxisomes in the heart of various mammalian species and suggest that peroxisomes have important metabolic and physiological functions in myocardium.