Gait and heart rate: do they measure trait or state physical fatigue in people with multiple sclerosis?

BACKGROUND

Trait and state physical fatigue (trait-PF and state-PF) negatively impact many people with multiple sclerosis (pwMS) but are challenging symptoms to measure. In this observational study, we explored the role of specific gait and autonomic nervous system (ANS) measures (i.e., heart rate, HR, r-r interval, R-R, HR variability, HRV) in trait-PF and state-PF.

METHODS

Forty-eight pwMS [42 ± 1.9 years, 65% female, EDSS 2 (IQR: 0-5.5)] completed the Timed Up and Go test (simple and with dual task, TUG-DT) and the 6-min walk test (6MWT). ANS measures were measured via a POLAR H10 strap. Gait was measured using inertial-measurement units (OPALs, APDM Inc). Trait-PF was evaluated via the Modified Fatigue Impact Scale (MFIS) motor component. State-PF was evaluated via a Visual Analog Scale (VAS) scale before and after the completion of the 6MWT. Multiple linear regression models identified trait-PF and state-PF predictors.

RESULTS

Both HR and gait metrics were associated with trait-PF and state-PF. HRV at rest was associated only with state-PF. In models based on the first 3 min of the 6MWT, double support (%) and cadence explained 47% of the trait-PF variance; % change in R-R explained 43% of the state-PF variance. Models based on resting R-R and TUG-DT explained 39% of the state-PF.

DISCUSSION

These findings demonstrate that specific gait measures better capture trait-PF, while ANS metrics better capture state-PF. To capture both physical fatigue aspects, the first 3 min of the 6MWT are sufficient. Alternatively, TUG-DT and ANS rest metrics can be used for state-PF prediction in pwMS when the 6MWT is not feasible.

Light pollution alters the skeletal morphology of coral juveniles and impairs their light capture capacity

Urbanization and infrastructure development have changed the night-time light regime of many coastal marine habitats. Consequently, Artificial Light at Night (ALAN) is becoming a global ecological concern, particularly in nearshore coral reef ecosystems. However, the effects of ALAN on coral architecture and their optical properties are unexplored. Here, we conducted a long-term ex situ experiment (30 months from settlement) on juvenile Stylophora pistillata corals grown under ALAN conditions using light-emitting diodes (LEDs) and fluorescent lamps, mimicking light-polluted habitats. We found that corals exposed to ALAN exhibited altered skeletal morphology that subsequently resulted in reduced light capture capacity, while also gaining better structural and optical modifications to increased light levels than their ambient-light counterparts. Additionally, light-polluted corals developed a more porous skeleton compared to the control corals. We suggest that ALAN induces light stress in corals, leading to a decrease in the solar energy available for photosynthesis during daytime illumination.

Selective deep water coral bleaching occurs through depth isolation

Climate change is degrading coral reefs around the world. Mass coral bleaching events have become more frequent in recent decades, leading to dramatic declines in coral cover. Mesophotic coral ecosystems (30-150 m depth) comprise an estimated 50-80 % of global coral reef area. The potential for these to act as refuges from climate change is unresolved. Here, we report three mesophotic-specific coral bleaching events in the northern Red Sea over the course of eight years. Over the last decade, faster temperature increases at mesophotic depths resulted in ~50 % decline in coral populations, while the adjacent shallow coral reefs remained intact. Further, community structure shifted from hard coral dominated to turf algae dominated throughout these recurrent bleaching events. Our results do not falsify the notion of the northern Red Sea as a thermal refuge for shallow coral reefs, but question the capacity of mesophotic ecosystems to act as a universal tropical refuge.

Untangling the molecular basis of coral response to sedimentation

Urbanized coral reefs are often chronically affected by sedimentation and reduced light levels, yet many species of corals appear to be able to thrive under these highly disturbed conditions. Recently, these marginal ecosystems have gained attention as potential climate change refugia due to the shading effect of suspended sediment, as well as potential reservoirs for stress-tolerant species. However, little research exists on the impact of sedimentation on coral physiology, particularly at the molecular level. Here, we investigated the transcriptomic response to sediment stress in corals of the family Merulinidae from a chronically turbid reef (one genet each of Goniastrea pectinata and Mycedium elephantotus from Singapore) and a clear-water reef (multiple genets of G. pectinata from the Gulf of Aqaba/Eilat). In two ex-situ experiments, we exposed corals to either natural sediment or artificial sediment enriched with organic matter and used whole-transcriptome sequencing (RNA sequencing) to quantify gene expression. Analysis revealed a shared basis for the coral transcriptomic response to sediment stress, which involves the expression of genes broadly related to energy metabolism and immune response. In particular, sediment exposure induced upregulation of anaerobic glycolysis and glyoxylate bypass enzymes, as well as genes involved in hydrogen sulphide metabolism and in pathogen pattern recognition. Our results point towards hypoxia as a probable driver of this transcriptomic response, providing a molecular basis to previous work that identified hypoxia as a primary cause of tissue necrosis in sediment-stressed corals. Potential metabolic and immunity trade-offs of corals living under chronic sedimentation should be considered in future studies on the ecology and conservation of turbid reefs.

Reciprocal-transplantation between shallow and mesophotic stony corals

Most studies to date on the various life-history aspects of scleractinian corals (e.g. reproduction, connectivity, and physiology) have focused on their innate habitats. However, comprehensive data on the ability of both shallow and mesophotic corals to contend in the coming decades with the different environmental conditions they may encounter due to new habitats or environmental changes (e.g. eutrophication), are scarce. Long-term cross-transplantation experiments assessing the potential responses and acclimatization ability of corals are thus needed in order to expand our knowledge. Here we examined the survivorship and changes in the photobiological acclimatization of corals following their cross-transplantation between two different depths (5-10 m and 45 m) and two sites characterized by different abiotic conditions (i.e. light, nutrient, and sedimentation regime). This year-long in-situ experiment was performed on five depth-generalist coral species. Depth of origin and the species' particular morphology were found to be the strongest predictors of survivorship. Physiological responses occurred mainly among those corals that had been translocated from deep-to-shallow water, and were expressed in a significant reduction in chlorophyll-a concentration and algal density, as well as changes in photosynthetic parameters (e.g. minimal/maximal saturating points, E_k and E_m, and rETR_max). Our study contributes to a better assessment of the physiological and ecological consequences of corals under acute and long-term environmental perturbations and their endurance abilities. Furthermore, it contributes to the information necessary for effective management intervention aimed at supporting the possible acclimation or rehabilitation of coral species.

Effects of Light Pollution on the Early Life Stages of the Most Abundant Northern Red Sea Coral

The growth in human population along coastal areas is exposing marine environments to increasing anthropogenic light sources. Despite the potential effects of this modern phenomenon, very few studies have examined its implications for corals. Here, we present a long-term study of coral early life stages under light pollution conditions at night. Coral larvae were collected from Stylophora pistillata colonies, and then settled and grown under experimental conditions of two different common city lighting methods (fluorescent or LED). Effects of the artificial lighting on the coral settlement success, survivorship, growth rate, photosynthetic efficiency, and calcification rate were examined over a period of one year. The control exhibited ~30% higher settlement success compared to the two light treatments, while under the light treatments corals showed higher survivorship, growth, and calcification rates. In addition, an indication of damage to the photosynthetic system was found in the light-polluted corals, which was reflected in their photosynthesis efficiency parameters: i.e., lower maximum light utilization coefficient (α), lower maximum potential photosynthetic rate (P_max), and lower photosynthetic maximal quantum yield (F_v/F_m). Our findings provide evidence of the potential adverse effects of artificial lighting methods on the natural environment of coral reefs. We conclude that the use of the LED lighting method has high interference potential for the early life stages of corals.

A pilot study of a novel specs for chronic dizziness

OBJECTIVE

A pilot study to assess the efficacy and safety of a novel specs device developed to alleviate chronic dizziness using eyeglasses with referential marks fixed on the lenses.

MATERIALS AND METHODS

Forty patients with stable symptoms of chronic dizziness for more than 3 months participated in a 4-week, double-blind, randomized treatment with Active-Specs or Sham-Specs. Efficacy was assessed using validated semiquantitative scales and questionnaires of vertigo, dizziness and anxiety. Safety evaluation included monitoring of any adverse event.

RESULTS

Thirty-six participants were included in the efficacy analysis, 18 in each group. Twelve of 18 subjects (67%) treated with Active-Specs reported substantial improvement of symptoms compared to six (33%) with Sham-Specs showing a significant improvement on Clinical Global Impressions scale (P = .017). The Active-Specs group showed significant reduction in the Vertigo Visual Analogue Scale (P = .017) and a nonsignificant but consistent trend of improvement measured by the Dizziness Handicap Inventory and Beck Anxiety Inventory. There were no adverse events related to the treatment.

CONCLUSIONS

This novel specs device seems to be a safe and promising novel treatment for chronic dizziness. We hypothesize that marks in specific zones of the peripheral visual field could strengthen information of real head motion counteracting the mismatch sensory and locomotor information causing chronic dizziness. The results of this pilot study should be followed up by additional studies aimed at confirming the present encouraging findings.

Reproductive strategies of the coral Turbinaria reniformis in the northern Gulf of Aqaba (Red Sea)

Here we describe for the first time the reproductive biology of the scleractinian coral Turbinaria reniformis studied during three years at the coral reefs of Eilat and Aqaba. We also investigated the possibility of sex change in individually tagged colonies followed over a period of 12 years. T. reniformis was found to be a stable gonochorist (no detected sex change) that reproduces by broadcast spawning 5-6 nights after the full moon of June and July. Spawning was highly synchronized between individuals in the field and in the lab. Reproduction of T. reniformis is temporally isolated from the times at which most other corals reproduce in Eilat. Its relatively long reproductive cycle compared to other hermaphroditic corals may be due to the high reproductive effort associated with the production of eggs by gonochoristic females. Sex ratio in both the Aqaba and Eilat coral populations deviated significantly from a 1:1 ratio. The larger number of males than of females may provide a compensation for sperm limitation due to its dilution in the water column. We posit that such sex allocation would facilitate adaptation within gonochoristic species by increasing fertilization success in low density populations, constituting a phenomenon possibly regulated by chemical communication.

Spectral Diversity and Regulation of Coral Fluorescence in a Mesophotic Reef Habitat in the Red Sea

The phenomenon of coral fluorescence in mesophotic reefs, although well described for shallow waters, remains largely unstudied. We found that representatives of many scleractinian species are brightly fluorescent at depths of 50–60 m at the Interuniversity Institute for Marine Sciences (IUI) reef in Eilat, Israel. Some of these fluorescent species have distribution maxima at mesophotic depths (40–100 m). Several individuals from these depths displayed yellow or orange-red fluorescence, the latter being essentially absent in corals from the shallowest parts of this reef. We demonstrate experimentally that in some cases the production of fluorescent pigments is independent of the exposure to light; while in others, the fluorescence signature is altered or lost when the animals are kept in darkness. Furthermore, we show that green-to-red photoconversion of fluorescent pigments mediated by short-wavelength light can occur also at depths where ultraviolet wavelengths are absent from the underwater light field. Intraspecific colour polymorphisms regarding the colour of the tissue fluorescence, common among shallow water corals, were also observed for mesophotic species. Our results suggest that fluorescent pigments in mesophotic reefs fulfil a distinct biological function and offer promising application potential for coral-reef monitoring and biomedical imaging.

Do oncologists engage in bereavement practices? A survey of the Israeli Society of Clinical Oncology and Radiation Therapy (ISCORT)

e20588

Background: What happens to the patient-physician relationship after the patient succumbs to the illness? To begin answering this question, we determined the extent to which oncologists are involved in bereavement rituals for their patients. Methods: An e-mail survey was sent to ISCORT oncologists querying them as to their involvement in bereavement rituals including funerals, visitations (e.g., shiva), condolence phone calls, and condolence letters. Results were described using summary statistics, Wilcoxon, and Fisher's exact test. Results: The survey response rate was 69% (126/182). Median age of respondents was 49 y and the male:female ratio was 2:1. Generally, only 2% of oncologists attend funeral services and 1% visit the family. A higher number telephoned the surviving family members (27%) or sent written condolences (18%). When a ‘special bond‘ developed between doctor and patient, there was a significant increase in those who attended the funeral (8%), participated in a visitation (18%), or made phone calls (54%), p < .0001 for all three rituals. There was no higher likelihood to participate in bereavement practices as a function of subspecialty (Medical v. Radiation v. Surgical Oncologist), gender, religiosity, or personal death anxiety. The rank ordered reasons for not participating in bereavement activities are lack of time, fear of burnout, need to maintain boundaries, and death anxiety. Males, more often than females, indicated that time constraints were the most important factor in determining their participation (P = .025). There was a weakly significant association between the physician's spirituality and participation in specific bereavement rituals. Interestingly, 11% of oncologists indicated that they would participate in bereavement visits if compensated for their time. Conclusions: Most oncologists do not engage in bereavement rituals for their deceased patients. When they do, they are less likely to attend a funeral or visit the family, and more likely to send a condolence card or call.

No significant financial relationships to disclose.

Skin test results and self-reported symptom severity in allergic rhinitis: the role of psychological factors

BACKGROUND

In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity.

OBJECTIVES

To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors.

METHODS

One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism.

CONCLUSIONS

The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.

Prevalence of asthma in 13-14 yr-old schoolchildren across Israel

There is evidence that the incidence and severity of asthma are increasing worldwide, but there are limited data on asthma in Israel. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in 13-14 yr-old schoolchildren in Israel. The self-completed questionnaire used was a modified version of that developed by the International Study of Asthma and Allergies in Childhood (ISAAC), and was administered to a national sample of 12,918 children. The prevalence of asthma ever, wheezing ever and wheezing in the last 12 months were 13.7, 23.8 and 17.9% respectively. Significantly higher rates of a history of asthma and asthma symptoms were observed in Jews compared with Arabs. Although asthma ever was more prevalent in males than in females, asthma symptoms were significantly more common in females. The type of area of residence had no effect on the prevalence of wheezing. The ethnic differences in the prevalence of asthma persisted after controlling for sex, district of residence and level of urbanization. The prevalence of both asthma and asthma symptoms in Israel are slightly above the mean reported from 10 other countries in Europe and the Far-East.

The impact of Hymenoptera venom allergy on occupational activities

The objective of this study was to investigate the impact of allergy to hymenoptera venom on the occupational activities of patients undergoing immunologic treatment for insect sting anaphylaxis. The design was a cross-sectional study conducted in a sample of 500 out of 1,500 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. A self-administered questionnaire was used to collect data about demographic characteristics of patients, severity of the allergic reaction and adverse effects on occupational activities. Of the 204 respondents who were part of the labour force, 48.5% reported adverse effects on routine occupational activities. The factors with a significant influence on the probability of adverse occupational effects were: (1) patient's type of work (blue collar vs. white collar: OR = 3.22, p < 0.001: army vs. white collar: OR = 5.28, p = 0.001); (2) severity of the allergic reaction (severe reaction vs. mild/moderate reaction: OR = 2.34, p = 0.007). Our findings suggest that severe insect sting allergy has an adverse impact on patients' occupational activities. This factor requires special attention by the medical community. Social workers and occupational physicians should collaborate in the assessment and management of these patients.

Allergenicity of the pollen of Pistacia

Differences in IgE binding and skin responses to pollen extracts of four species of Pistacia, and some immunochemical characteristics of this pollen were investigated. The incidence of positive SPT among atopic patients varied between 31.5% to the pollen extracts of P. vera and 24.6% to P. palaestina. The antigens are located on the exine of the grains as well as in their cytoplasm. Some of the antigens are common to all four species, whereas others seem to be specific. Cross-reactivity was found among the four species of Pistacia and between them and Schinus terebintifolious. Five conspicuous IgE-binding bands were observed in the immunoblots of the four examined species, the bands of 49, 57, 64, 68, and 79 kDa. The 36-37-kDa band of P. lentiscus and the 60- and 84-kDa bands of P. atlantica and P. vera were also noticeable. As the flowering seasons of Pistacia and Schinus do not overlap, the patients are exposed to such pollen for more than 4 months a year. Apparently, Pistacia pollen is a major source of allergy.

Risk factors associated with the severity of systemic insect sting reactions

To evaluate risk factors associated with the severity of systemic insect sting reaction and to determine the type of insect responsible for systemic anaphylaxis, we conducted a cross-sectional study of 498 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. Data were collected by questionnaire and review of patient records. Eighty percent of the patients were treated with honeybee venom, which was used as a single therapy in 60% of the group. In a multivariate logistic model the major factors identified as significantly influencing the probability of a more severe systemic reaction were short time of onset of reaction after stinging (<30 min), high number of prior stings (> or = 4), and age (> or = 18 years). A total of 79.3% of the patients had been stung outdoors, and 50% had lived all their lives in rural areas as compared to 10% in the general Israeli population. This study reports clinically valuable risk factors for the severity of systemic sting reaction. A practical finding was that the honeybee is the insect mostly responsible for sting reactions in Israel, but the type of insect is not a significant predictor of the severity of the reaction.

GDNF-induced activation of the ret protein tyrosine kinase is mediated by GDNFR-alpha, a novel receptor for GDNF

We report the expression cloning and characterization of GDNFR-alpha, a novel glycosylphosphatidylinositol-linked cell surface receptor for glial cell line-derived neurotrophic factor (GDNF). GDNFR-alpha binds GDNF specifically and mediates activation of the Ret protein-tyrosine kinase (PTK). Treatment of Neuro-2a cells expressing GDNFR-alpha with GDNF rapidly stimulates Ret autophosphorylation. Ret is also activated by treatment with a combination of GDNF and soluble GDNFR-alpha in cells lacking GDNFR-alpha, and this effect is blocked by a soluble Ret-Fc fusion protein. Ret activation by GDNF was also observed in cultured embryonic rat spinal cord motor neurons, a cell type that responds to GDNF in vivo. A model for the stepwise formation of a GDNF signal-transducing complex including GDNF, GDNFR-alpha, and the Ret PTK is proposed.

Podocarpus gracilior and Callitris verrucosa--newly identified allergens that crossreact with Cupressus sempervirens

Thirty-six symptomatic patients, with positive skin reactions to Cupressus sempervirens pollen extract were skin-tested with pollen extracts of Podocarpus gracilior and Callitris verrucosa, of these 17 (47%) had positive responses to P. gracilior, nine (25%) to C. verrucosa, and six (17%) to both. None of the non-atopic healthy controls had positive reactions to either of the extracts. Radioallergosorbent test (RAST)-inhibition studies were performed with pooled sera from three patients. Fifty per cent inhibition was obtained with 11 micrograms protein of C. sempervirens, 54 micrograms of P. gracilior, and 71 micrograms of C. verrucosa; however, when pollen extract of Olea europaea, an unrelated allergen, was tested, 265 micrograms protein were needed to obtain 50% inhibition. One-dimension sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis of pollen extracts from the three species revealed that they had several very similar protein bands. Using Western blot analysis, several closely related IgE binding proteins were identified in the three species. It was concluded that the pollen grains of P. gracilior and of C. verrucosa are potentially allergenic. The presence of common allergenic proteins indicate partial crossreactivity with C. sempervirens.

Serum IgE concentrations, disease activity, and atopic disorders in systemic lupus erythematosus

We investigated the relationship between disease activity and total IgE concentration in the sera of patients with active systemic lupus erythematosus (SLE). In addition, the prevalence of personal and family history of allergic rhinitis and asthma were examined with a questionnaire and immediate skin tests for common inhalant allergens in 24 patients in remission. In the 20 patients with active disease, we found that IgE concentration was significantly higher during the periods of active disease than the periods of remission. This elevation was not associated with an elevation in total serum IgG concentrations. The increase in IgE concentration during disease activity in patients with active nephritis was significantly higher than in patients without nephritis. Of the 24 patients in remission, only one reported allergic rhinitis, and two had positive skin tests for inhalant allergens. We concluded that, although patients with SLE do not have an increased rate of atopic disorders, serum IgE rises during disease activity and is associated with active nephritis. This phenomenon suggests that IgE may be involved in the pathogenesis of SLE, particularly in patients with nephritis.

[Allergic responses to date palm and pecan pollen in Israel]

Date palm (Phoenix dactylifera) and pecan (Carya illinoensis) trees are commonly planted in Israel for fruit, for shade, or as ornamental plants. Pollen grains of both species are allergenic; however, the extent of exposure to such pollen and the incidence of allergic response have not been studied here. We therefore investigated skin-test responses to pollen extracts of 12 varieties of palm and 9 of pecan in 705 allergic patients living in 3 cities and 19 rural settlements. Sensitivity to the pollen extracts of both species was much higher among residents of rural than of urban communities. Moreover, there was a definite relationship between the abundance of these trees in a region and the incidence of skin responders to their pollen. Sensitivity was frequent in settlements rich in these 2 species, such as those with nearby commercial date or pecan plantations. In general, sensitivity to date pollen extracts was lower than to pecan. However, differences in skin responses to pollen extracts of various clones were substantiated. Air sampling revealed that pollen pollution decreased considerably with distance from the trees. At approximately 100 m from a source concentrations of airborne pollen were low. Since planting of male palm and pecan trees in population centers would increase pollen pollution, it should be avoided.

IgE response in multiple myeloma

IgE levels in sera of patients with multiple myeloma (MM) were found to be similar to those of patients with monoclonal gammopathy of unknown significance (MGUS) and to normal controls. This is in contrast to the significant depression in the level of the other polyclonal isotypes in patients with MM. Immediate skin test response to common environmental allergens was also preserved in patients with MM as compared with normal nonatopic controls. One-year treatment of MM patients with alkylating agents caused a significant decrease in the monoclonal immunoglobulin level and induced a tendency toward decreasing IgE level but had no effect on the polyclonal immunoglobulin concentrations. These findings suggest that IgE production and immediate skin test response is not impaired by the pathologic process in MM patients, in contrast to the production of other polyclonal immunoglobulins. This demonstrates the dissociation between the response of the IgE antibody and the other isotypes.

Immediate adverse reactions to immunotherapy in allergy

We report our experience of adverse reactions to immunotherapy (IT) in patients with insect venom allergy and inhalant respiratory allergy. Adverse reactions included large local reactions, generalized cutaneous reactions or systemic reactions. Among 87 patients treated for venom allergy, 43% had adverse reactions during the course of IT, averaging 2.5 reactions per patient and per course of IT. Nine had systemic reactions, of which 7 required adrenaline administration. Among 52 patients treated with inhalant allergen extracts, 40% had adverse reactions averaging 3 reactions per patient per course of treatment. Ten patients had systemic reactions but only 2 required adrenaline administration. There was no difference between the rate of adverse reactions in the venom and the inhalant treatment groups. IT has an inherent risk which has to be weighed against its benefits.

[Falls in elderly patients in an institution]

Falls among the elderly are a major concern of those caring for them. We studied the incidence of falls in institutionalized elderly, as well as the characteristics of those who fell and the causes of the falls, to determine how to prevent falling. A 2-month survey was conducted in Mishan, an institution in Raanana, and included 144 falls in 108 patients (447 women and 162 men, mean age 84) out of a total of 609 elderly. The prevalence of falls was 1426 per 1000 per year. Most cases of falls were first seen in the emergency room or wards for demented patients. The prevalence of falls among those receiving physiotherapy was only 1/3 that of those who did not. Old institutionalized patients tend to fall mainly while getting in and out of bed. Falls may result from medication such as sleeping pills and psychotropic drugs, but not diuretics. Falls are not inevitable, and measures can be applied to prevent them and thus reduce their frequency.

Olive pollen induces asthmatic response

We provide evidence that olive pollen extract can induce asthmatic response. The pattern of airway response to olive pollen is investigated. Nineteen patients with seasonal allergic rhinitis and asthma, suspected to be due to olive pollen, all of whom had positive skin-prick test, were investigated. Bronchial challenge with olive pollen extract were performed and the peak flow rate was followed for 20 hr. Eight patients developed dual asthmatic response (DAR), six patients developed early asthmatic response (EAR) and five patients had no asthmatic response. The early maximal fall in FEV1 and the PD15 were not different between the group with DAR and the group with EAR only. We conclude that olive pollen can induce dual asthmatic response.

1,25-Dihydroxyvitamin D3 potentiates the decreased response of lymphocytes from atopic subjects to agents that increase intracellular cyclic adenosine monophosphate

The inhibitory effect of prostaglandin E2, histamine, isobutylmethylxanthine, and 1,25-dihydroxyvitamin D3 (1,25-[OH]2D3) on the mitogenic stimulation of peripheral blood lymphocytes from normal and atopic subjects was studied. We found that lymphocytes from atopic patients were less susceptible to inhibition by the three agents that elevate intracellular cyclic adenosine monophosphate (cAMP) concentrations and by the active metabolite of vitamin D (inhibition of 27%, 14%, 12%, and 36% for the atopic patients as compared with 40%, 20%, 22%, and 46% for the normal donors, by the four agents, respectively; p less than 0.02). The inhibitory effect of the cAMP-elevating agents was potentiated by the addition of 1,25-(OH)2D3 to the lymphocyte cultures. The potentiation was more pronounced on lymphocytes from the atopic donors, increasing their responsiveness to levels comparable to levels of lymphocytes from normal donors. The synthetic corticosteroid, dexamethasone, had a similar potentiating effect on the inhibitory action of prostaglandin E2. In view of the beneficial action of beta-agonists, phosphodiesterase inhibitors, and corticosteroids in the treatment of allergy, the potentiating effect of 1,25-(OH)2D3 on the action of cAMP-elevating agents may be of therapeutic interest.

[Prognostic factors in multiple myeloma]

There have been major advances in the treatment of multiple myeloma in the past 20 years, but for the individual patient the prognosis still remains uncertain. As the length of survival varies from several months to over 10 years, definition of prognostic parameters at the time of diagnosis, and early detection of disease activity are most important. In our study, median survival was 42 months with very good quality of life. Factors not helpful in prognosis were sex, WBC and platelet counts, BUN, serum M protein type, extent of osteolytic lesions, percentage of plasma cells in bone marrow and plasma cell asynchrony. However, age, hemoglobin, calcium, uric acid, Bence-Jones proteinuria and polyclonal Ig concentrations had a certain degree of prognostic importance. Due to more sensitive and more specific laboratory methods, peripheral blood findings are lately gaining in importance. With new "salvage" protocols, the detection of additional prognostic parameters and sensitive indicators of disease activity may be most important for further improvement in the survival of patients with multiple myeloma.

Forecasting pollen pollution: correlation with floral development

Variations in the time course of flowering and in its intensity were recorded for regions in Israel along with variable climatic conditions. Such variations had an effect on pollen release into the air and on pollen counts. Two approaches for forecasting allergenic pollen dispersion were compared: (1) a survey of floral development and flowering intensity and (2) a survey of airborne pollen. There was a positive correlation between the survey of flowering and airborne pollen counts, although pollen was occasionally found after the flowering season. Further, it predicted fairly accurately the beginning of the flowering time of each species in each regio, the expected flowering duration, and intensity. Conducting a survey of flowering is a simple, easy and inexpensive operation. It is highly recommended for regions with variable climates.

Constrictive pericarditis complicating dermatomyositis

Chronic constrictive pericarditis may complicate both rheumatoid arthritis and systemic lupus erythematosus. To our knowledge, however, this is the first time it has been described in a patient with dermatomyositis. This association should be kept in mind as constrictive pericarditis should be considered in the differential diagnosis of liver cirrhosis and Budd-Chiari syndrome in rheumatic diseases.

Immunological response to immunotherapy for immediate hypersensitivity: clinical relevance

Immunotherapy, also called desensitization, is effective in treating allergic rhinitis, insect sting venom hypersensitivity and probably allergic asthma. Administration of gradually increasing doses of the sensitizing antigen induces several immunological changes. The humoral responses include an increase in specific IgG titer, a decrease in specific IgE titer with blunting of its seasonal rise, and an increase in the specific anti-idiotype antibody titer. Cellular changes include diminished responsiveness of the patient's lymphocytes to stimulation by allergen as measured by thymidine incorporation. This is accounted for by the generation of suppressor cells specific for the allergen. These suppressor cells also induce suppression of IgE production by mononuclear cells. An additional effect that is attributed to IT is a decrease in basophil sensitivity to the allergen as measured by histamine release. The clinical correlates of these changes are not clear. Currently, none of the responses can be used as a tool for assessing the response in the treated individual patient. Although the increase in specific IgG was shown to correlate with the clinical response in patient groups, it is not applicable to the individual patient. Currently the best parameter for assessing clinical response is probably the increase in the ratio between the specific IgG and the specific IgE. However further studies are warranted to evaluate the significance of the change in anti-idiotype antibodies, basophil histamine release and perhaps immunological changes yet to be discovered.

Intravenous desensitization to beta-lactam antibiotics

Patients allergic to penicillin (PCN) often require treatment with beta-lactam antibiotics for life-threatening bacterial infections. In this article, we review our experience with rapid intravenous desensitization for patients who gave a history of PCN allergy and who had hypersensitivity demonstrated by skin tests. Skin testing was performed with both prick and intradermal techniques and with the recommended antibiotic as well as PCN G, penicilloyl polylysine, and a minor determinant mixture. Patients were transferred to the intensive care unit, and desensitization was performed with a buret technique that required minimal preparation and was easily applied to any antibiotic. Fifteen desensitizations in 12 patients were associated with no immediate reactions. One patient developed a delayed reaction consisting of a pruritic rash and angioedema. A second patient developed a more serious delayed serum sickness-like illness with fever, rash, eosinophilia, abnormal liver function tests, and urinary abnormalities. These reactions did not necessitate stopping the antibiotic, although the latter patient required corticosteroids to suppress his symptoms. Rapid intravenous desensitization is a rapid, safe, and effective technique for patients demonstrating hypersensitivity to beta-lactam antibiotics who require therapy with these medications.

Positive skin tests to pollen extracts of four species of Pistacia in Israel

Fifty-eight atopic and nine non-atopic volunteers, all residents of the Tel Aviv metropolitan area, Israel, were skin tested with extracts made from filtered pollen of Pistacia atlantica, P. lentiscus, P. palaestina and P. vera. Twenty-four out of the fifty-eight patients examined (41.4%) had positive skin reactions to at least one of the four examined species of Pistacia: seven of the patients reacted to all the examined extracts, whereas the other seventeen reacted to only some of them. Fifteen patients reacted to extracts of P. atlantica, sixteen patients reacted to extracts of P. lentiscus, ten patients reacted to extracts of P. palaestina and seven patients reacted to extracts of pollen of P. vera. None of the healthy, non-atopic volunteers reacted to any of the extracts. To the best of our knowledge, this is the first report of immunological reactions to pollen extracts of the genus Pistacia.

Generation of suppressor cells in atopic patients during immunotherapy that modulate IgE synthesis

We prospectively studied the effect of ragweed immunotherapy on the generation of suppressor T cells that modulate total and antiragweed IgE production in five patients with seasonal allergic rhinitis. Suppressor T cell depletion was accomplished by treating mononuclear cells (MNCs) with the monoclonal antibody Leu 2b followed by the addition of complement. Treated and untreated MNCs were obtained before and during (6 to 24 months) immunotherapy and were cultured at 1 X 10(6) cells per milliliter for 7 days in RPM1-1640 containing 10% fetal calf serum. In order to determine the effect of ragweed antigen on IgE production, untreated or Leu 2b-depleted MNCs were incubated with short ragweed extract (SRW) (1.0 to 10 micrograms/ml) for 20 hours, washed three times, and incubated for a further 6 days. The cell-free supernatants from each were harvested and assayed for total IgE by use of a modified PRIST assay. To determine specific IgE, a modified RAST procedure was used. Total or antiragweed IgE production was calculated by subtracting preformed IgE from the total or specific IgE content in the supernatant. Depletion of Leu 2-positive cells did not affect total IgE production before immunotherapy. In contrast, a statistically significant increase was observed in total IgE 6 months (p less than 0.05) and 13 months (p = 0.005) after immunotherapy. Specific antiragweed IgE production at these times was also enhanced, but this increase did not reach statistical significance. Before immunotherapy was begun, preincubation of MNCs with SRW did not change the amount of total IgE produced.(ABSTRACT TRUNCATED AT 250 WORDS)

High-output cardiac failure as a presenting symptom of plasma cell leukemia

A patient presented with high-output cardiac failure and was found to have plasma-cell leukemia. No cause for the cardiac failure was found, and there was no response to treatment with diuretics and thiamine. Chemotherapy for the leukemia resulted in resolution of the cardiac failure, suggesting that the latter was caused by the leukemia--a hitherto unreported association.

Retinal manifestations of acquired immunodeficiency syndrome (AIDS). Report of a case

The syndrome of acquired immunodeficiency (AIDS) has previously been described. Originally thought to affect homosexuals and drug abusers exclusively, the disorder has also been observed in women associated with drug abuse, hemophiliacs, Haitians and, rarely, in heterosexual men. Several hundred cases have been reported in the United States whereas only a small number have been reported elsewhere. We report the first case of AIDS in Israel in a heterosexual male who developed the opportunistic infections of esophageal candidiasis and pneumocystis caranii pneumonia as well as the ischemic retinopathy which has come to be associated with the syndrome.

Comparison of the sensitivity of 99mTc-methyl diphosphonate bone scan with the skeletal X-ray survey in multiple myeloma

In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using 85Sr and 99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.