The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

"I had no choice": A mixed-methods study on access to care for vaginal breech birth

INTRODUCTION

Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision-making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth.

METHODS

We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty-five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi-structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care.

RESULTS

Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision-making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system.

CONCLUSION

Some service users believe that home birth is their only option when they cannot access hospital-based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.

American College of Nurse-Midwives Clinical Bulletin Number 18: Induction of Labor

Induction of labor is an increasingly common component of intrapartum care in the United States. This rise is fueled by a nationwide escalation in both medically indicated and elective inductions at or beyond term, supported by recent research showing some benefits of induction over expectant management. However, induction of labor medicalizes the birth experience and may lead to a complex cascade of interventions. The purpose of this Clinical Bulletin is twofold: (1) to guide clinicians on the use of person-centered decision-making when discussing induction of labor and (2) to review evidence-based practice recommendations for intrapartum midwifery care during labor induction.

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence-Based, Patient-Centered Approach to Care

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.

Abnormal Typical Pattern of Platelet Function and Thromboxane Generation in Unstable Angina

Platelet aggregation (PA), platelet thromboxane B2 (TXB2) generation and 14C 5-hydroxytryptamine (5HT) release were studied in 13 patients with unstable angina, and compared to 14 patients with stable angina and 16 healthy controls. A typical pattern, distinct in 4 aspects from stable angina patients or controls, was observed in the unstable angina patients. ADP or collagen induced shape change was 3-4 times greater, the extent of epinephrine induced PA was nil or very low, the extent of collagen induced 14C 5HT release was also reduced while collagen induced platelet TXB2 generation was increased in spite of a reduced extent of PA. The extent of ADP or collagen induced PA was also significantly reduced. These results indicate a platelet membrane abnormality occurring presumably during contact of the circulating platelets with a non-occlusive thrombus observed at sites of ruptured plaques in unstable angina patients. Since also the pattern (20-30% overlap with control values) was distinct from that of stable angina patients, it might indicate an active thrombotic process.

Plasma β-thromboglobulin (βTG) and TXB2 levels and serum TXB2 generation were also studied in the cardiac patients and controls and in another 10 patients with advanced peripheral occlusive arterial disease (POAD). Plasma βTG and TXB2 levels were slightly elevated in the unstable angina patients and markedly elevated in the POAD patients. Serum TXB2 generation was, however, elevated in the stable angina patients (p <0.002) and more so in the unstable angina patients (p <0.001) compared to controls or to POAD patients. This was presumably mediated through enhanced thrombin generation. These results suggest that the measured plasma βTG variable in the unstable angina patients is not useful in the assessment of in vivo platelet activation. It is presumably reflecting the sum of local enhanced platelet activation (at sites of ruptured plaques) and of reduced function of the “defective” circulating platelets. The ability of the platelets of unstable angina patients to generate large amounts of TXB2 if occurring in vivo might induce an intense coronary vasospasm.

Mutational analysis of the tumor-suppressor gene wt1 - detection of a novel homozygous point mutation in sporadic unilateral wilms-tumor

The WT1 gene located on chromosome 11p13, has been identified as the first Wilms' tumor suppressor gene and has been implicated in the development of Wilms' tumor. About 10% of Wilms' tumors analyzed to date carry a mutation and only 6 different point mutations affecting the zinc finger region have been reported. We analyzed the zinc finger coding exons of 38 sporadic Wilms' tumor by SSCP and detected 2 point mutations. One homo/hemizygous mutation, already described in the literature, replaced an arginine in zinc finger II by a stop codon. The other mutation, a replacement of an arginine by a stop codon in zinc finger I, represents a novel mutation.

Production of macrophage IL-1beta was inhibited both at the levels of transcription and maturation by caspase-1 following inhalation exposure to isobutyl nitrite

Epidemiological studies have identified abuse of nitrite inhalants as an independent co-factor in HIV infection and in Kaposi's sarcoma (KS) in AIDS patients. In the present study we investigated the ability of macrophages from mice exposed to isobutyl nitrite to produce the inflammatory cytokine IL-1beta, upon stimulation with IFN-gamma and LPS. The production of IL-1beta was inhibited up to 55%. IL-1beta mRNA transcription was reduced by 35% following nitrite inhalant exposure, consistent with inhibition of activation-induced phosphorylation of macrophage mitogen-activated protein kinase p38. However, synthesis of the 31 kDa IL-1beta precursor protein was only marginally inhibited. Caspase-1, which cleaves the precursor IL-1beta into mature 17 kDa IL-1beta, was examined. Nitrite inhalant exposure blocked activation-induced increases in caspase-1 activity, consistent with a 50% reduction in 17 kDa IL-1beta shown in Western blots. Thus, exposure to nitrite inhalants reduced macrophage production of IL-1beta by reducing transcription, as well as post-translational processing mediated by caspase-1.

Altered AP-1 (activating protein-1) activity and c-jun activation in T cells exposed to the amide class herbicide 3,4-dichloropropionanilide (DCPA)

3,4-Dichloropropionanilide (DCPA), the active ingredient of some postemergence herbicides, has been demonstrated to inhibit several immune system functions including cytokine production by T cells. The central role of cytokines in regulating the immune response suggests a possible mechanism by which DCPA inhibits the immune system. Since interleukin (IL)-2 is critical in regulating many immune functions, we chose to investigate the effect of DCPA on this cytokine. Using the human T lymphoma line, Jurkat, stimulated with phorbol-12-myristate acetate (PMA) and the calcium ionophore A23187 (Io), we determined that DCPA exposure decreased IL-2 secretion and mRNA levels in a dose dependent manner. We hypothesized that DCPA affected one or more of the transcription factors that regulate IL-2 gene transcription. Activating protein 1(AP-1) is a transcription factor that has been demonstrated to be required for optimal IL-2 gene transcription. Electrophoretic mobility shift assays (EMSAs) demonstrated a decreased level of AP-1 DNA binding activity in DCPA-exposed Jurkat cells compared to control cells from 30 min to 2 h after stimulation. The altered AP-1 DNA binding kinetics was associated with a decrease in c-jun protein in these cells at 1 and 2 h after exposure and a decreased level of phosphorylated c-jun at 1-4 h after exposure. These results suggest a possible mechanism for DCPA-induced IL-2 inhibition; alteration in the activation of the c-jun component of AP-1.

Ubiquinone (Coenzyme Q10) and Mitochondria in Oxidative Stress of Parkinson’s Disease

Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease affecting approximately1% of the population older than 50 years. There is a worldwide increase in disease prevalence due to the increasing age of human populations. A definitive neuropathological diagnosis of Parkinson's disease requires loss of dopaminergic neurons in the substantia nigra and related brain stem nuclei, and the presence of Lewy bodies in remaining nerve cells. The contribution of genetic factors to the pathogenesis of Parkinson's disease is increasingly being recognized. A point mutation which is sufficient to cause a rare autosomal dominant form of the disorder has been recently identified in the alpha-synuclein gene on chromosome 4 in the much more common sporadic, or 'idiopathic' form of Parkinson's disease, and a defect of complex I of the mitochondrial respiratory chain was confirmed at the biochemical level. Disease specificity of this defect has been demonstrated for the parkinsonian substantia nigra. These findings and the observation that the neurotoxin 1-methyl-4-phenyl-1,2,3, 6-tetrahydropyridine (MPTP), which causes a Parkinson-like syndrome in humans, acts via inhibition of complex I have triggered research interest in the mitochondrial genetics of Parkinson's disease. Oxidative phosphorylation consists of five protein-lipid enzyme complexes located in the mitochondrial inner membrane that contain flavins (FMN, FAD), quinoid compounds (coenzyme Q10, CoQ10) and transition metal compounds (iron-sulfur clusters, hemes, protein-bound copper). These enzymes are designated complex I (NADH:ubiquinone oxidoreductase, EC 1.6. 5.3), complex II (succinate:ubiquinone oxidoreductase, EC 1.3.5.1), complex III (ubiquinol:ferrocytochrome c oxidoreductase, EC 1.10.2.2), complex IV (ferrocytochrome c:oxygen oxidoreductase or cytochrome c oxidase, EC 1.9.3.1), and complex V (ATP synthase, EC 3.6.1.34). A defect in mitochondrial oxidative phosphorylation, in terms of a reduction in the activity of NADH CoQ reductase (complex I) has been reported in the striatum of patients with Parkinson's disease. The reduction in the activity of complex I is found in the substantia nigra, but not in other areas of the brain, such as globus pallidus or cerebral cortex. Therefore, the specificity of mitochondrial impairment may play a role in the degeneration of nigrostriatal dopaminergic neurons. This view is supported by the fact that MPTP generating 1-methyl-4-phenylpyridine (MPP(+)) destroys dopaminergic neurons in the substantia nigra. Although the serum levels of CoQ10 is normal in patients with Parkinson's disease, CoQ10 is able to attenuate the MPTP-induced loss of striatal dopaminergic neurons.

Propanil inhibits tumor necrosis factor-alpha production by reducing nuclear levels of the transcription factor nuclear factor-kappab in the macrophage cell line ic-21

Tumor necrosis factor-alpha (TNF-alpha) is an essential proinflammatory cytokine whose production is normally stimulated by bacterial cell wall components, such as lipopolysaccharide (LPS), during an infection. Macrophages stimulated with LPS in vitro produce several cytokines, including TNF-alpha. LPS-stimulated primary mouse macrophages produced less TNF-alpha protein and message after treatment with the herbicide propanil (Xie et al., Toxicol. Appl. Pharmacol. 145, 184-191, 1997). Nuclear factor-kappaB (NF-kappaB) tightly regulates TNF-alpha transcription. Therefore, as a step toward understanding the mechanism of the effect of propanil on TNF-alpha transcription, IC-21 cells were transfected with a TNF-alpha promoter-luciferase construct, and the effect of propanil on luciferase activity was measured. Cells transfected with promoter constructs containing a kappaB site showed decreased luciferase activity relative to controls after propanil treatment. These observations implicated NF-kappaB binding as an intracellular target of propanil. Further studies demonstrated a marked reduction in the nuclear levels of the stimulatory p65 subunit of NF-kappaB after propanil treatment, as measured by fluorescence confocal microscopy and Western blot analysis. The p50 subunit of NF-kappaB was not found to be reduced after propanil exposure by Western blot. Electrophoretic mobility gel shift assays showed decreased DNA binding of both p65/p50 heterodimers and p50/p50 homodimers to the kappaB3 site of the TNF-alpha promoter of propanil-treated cells. The marked reduction in nuclear p65/p50 NF-kappaB levels and diminished binding to the TNF-alpha promoter in propanil-treated cells are consistent with reduced TNF-alpha levels induced by LPS.

Melting of isolated tin nanoparticles

The melting of isolated neutral tin cluster distributions with mean sizes of about 500 atoms has been investigated in a molecular beam experiment by calorimetrically measuring the clusters' formation energies as a function of their internal temperature. For this purpose the possibility to adjust the temperature of the clusters' internal degrees of freedom by means of the temperature of the cluster source's nozzle was exploited. The melting point of the investigated tin clusters was found to be lowered by 125 K and the latent heat of fusion per atom is reduced by 35% compared to bulk tin. The melting behavior of the isolated tin clusters is discussed with respect to the occurrence of surface premelting.

In vivo cytokine production and resistance to infection after acute exposure to 3,4-dichloropropionaniline

3,4-Dichloropropionaniline (propanil) is an extensively used postemergent herbicide that has been shown to produce toxic and immunotoxic effects. The present report examined if acute exposure to propanil altered in vitro or in vivo cytokine production in response to antigenic stimulation. Studies to determine resistance to infection by the intracellular bacterium Listeria monocytogenes after exposure to propanil were also conducted. Our experiments demonstrate that in vivo exposure to propanil during bacterial infection reduced the subsequent in vitro production of interferon-gamma (IFN-gamma) by splenocytes and liver nonparenchymal cells in response to antigenic and mitogenic stimulation. Additional experiments examined the production of cytokines in vivo after propanil exposure alone or combined propanil exposure and L. monocytogenes infection. It was found that the endogenous levels of cytokines in the liver, spleen, and blood were similar in control and propanil-treated mice. The levels of cytokines were also similar in control and exposed mice that were infected with L. monocytogenes. Initial resistance to the infection was not affected by exposure to propanil. These results demonstrate that in vivo exposure to propanil during a bacterial infection suppresses the subsequent in vitro production of cytokines but that the endogenous levels are not affected during the initial stages of infection.

Dependence of formation energies of tin nanoclusters on their size and shape

In a novel molecular beam experiment we have calorimetrically investigated the dependence of the formation energies of isolated Sn(N) clusters on their size. The experimentally determined size dependence of the formation energy for Sn(N) clusters consisting of between 95 and 975 atoms can be explained by the existence of two different types of cluster isomers: One class of isomers is characterized by formation energies proportional to N(-1/3), indicating compact spherical-like shapes. The other class has constant formation energies for the investigated size range, which is consistent with quasi-one-dimensional geometries.

Reflections on 'thinking in the presence of the other'

The author argues that as analysis progresses, mutual processes of projective and introjective identification result in an interpretation of analyst and patient such that the contributions that each participant makes to the analytic dialogue are to a significant degree imbued with the prior contributions of the other. This consideration renders the concepts of evidence and confirmation ambiguous and applicable only with a certain amount of caution. Further complexity is added to analytic protocols by the limited regulation of interpretation by the general guidelines of the theoretical orientation in play. This understanding of the analytic process contrasts sharply with that put forward by those who place particular emphasis on the centrality of the so-called real relationship in bringing about change.

Disappointment and disappointedness

The author argues that the widespread affective experience of disappointment has not received the analytic attention it deserves, and that this is particularly the case for disappointedness as an outstanding feature of a way of life. Disappointedness is presented as a pathological organisation or character disorder that expresses specific unconscious fantasies and gives rise to disruptive transference-countertransference manifestations. The author singles out disappointedness as a special problem rather than, in the usual way, subsuming it under depressiveness or masochism and then assigning it a subsidiary or merely descriptive role. With the help of a case example, he attempts to illustrate the benefits of heightened clinical awareness of disappointment and disappointedness. These benefits include increased access to the compromise formations that can stand in the way of effective analytic work.

Propanil affects transcriptional and posttranscriptional regulation of IL-2 expression in activated EL-4 cells

The amide-class herbicide, propanil, causes numerous immunomodulary effects in animal models. In the present study, we investigated the effect of propanil on IL-2 expression and production in the murine lymphoma T cell line, EL-4. When supernatants of cells stimulated with phorbol 12-myristate 13-acetate in the presence of propanil were assessed by enzyme-linked immunosorbent assay, IL-2 levels were dose-dependently decreased by 20 and 50 microM of propanil but not at 10 microM. Quantitative Northern blot analysis of peak IL-2 message levels also showed a dose-dependent decrease. The kinetic pattern of message production, however, was unaffected. To determine if the reduced message production was due to reduced signaling or message stability, nuclear run-on and mRNA stability assays were performed. Nuclear run-on assays determined that the transcription rate of the IL-2 gene was decreased approximately 50% in the presence of 20 microM propanil, indicating that it was able to interfere with signal transduction. IL-2 message stability assays also demonstrated a reduction in message stability. Thus, propanil appears to reduce IL-2 production by affecting the signal transduction pathway and IL-2 message stability.

Cytokine production by C57BL/6 mouse spleen cells is selectively reduced by exposure to propanil

Numerous immunomodulatory effects are caused by propanil, an extensively used postemergent herbicide. The T-dependent antibody response is suppressed after exposure to propanil, raising the question of propanil's effect on T-helper-cell populations. In the present study, we show that the production of several T-cell cytokines is affected by propanil after in vivo or in vitro exposure. In vivo exposure to propanil caused the reduction of interleukin (IL)-2, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interferon (IFN)-gamma production in concanavalin A-stimulated spleen cell cultures established 2 d after exposure. IFN-gamma and GM-CSF production had recovered by d 4 postexposure; however, IL-2 and IL-6 levels continued to be depressed through d 7 postexposure. Continuous in vitro treatment of normal spleen cells with propanil decreased IL-2, IL-6, GM-CSF, and IFN-gamma production after concanavalin A activation. Pulsing normal spleen cell cultures with propanil for up to 8 h before T-cell activation resulted in reduced IL-6 but not IL-2 or IFN-gamma production. These data indicate that propanil can selectively inhibit spleen cell cytokine production, which could contribute to the immunomodulatory effects previously described.

Vicissitudes of remembering in the countertransference. Fervent failure, colonisation and remembering otherwise

The author argues that certain kinds of transference can have great impact on the analyst's ego functioning. One such effect is impairment of ready recall of the analytic material, such as life historical data, the analytic process itself, and his or her role as analyst. The analyst strives to remember otherwise by analysing the patient's projective identifications and other defensive, manipulative strategies. When successful, these strategies may be said to colonise the analyst's mind. Although other ego functions are often affected by colonisation, remembering is of particular interest owing to its importance in building up and keeping ready at hand the contexts within which balanced and timely interpretations can be formulated with some hope that they will be heard and used effectively and progressively by the threatened, phantasy-ridden patient. Special attention will be paid to themes of failure; other themes, such as omnipotence and erotised transferences will be considered later on. Clinical illustrations are included.

The immunomodulatory effects of the herbicide propanil on murine macrophage interleukin-6 and tumor necrosis factor-alpha production

Intraperitoneal (i.p.) exposure to propanil (3,4-dichloropropionanilide) has previously been shown to affect macrophage cytotoxicity. In this study, we compared the immunotoxic effects of propanil, after different routes of in vivo administration, on cytokine production by thioglycollate-elicited peritoneal macrophages. C57B1/6 mice were treated with either vehicle or 200 mg/kg propanil i.p., or with vehicle, 40, or 400 mg/kg propanil orally. Three or 7 days later, ex vivo production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) by macrophages after lipopolysaccharide (LPS) stimulation was determined. Both oral and i.p. propanil exposure resulted in up to a 60-70% reduction in IL-6 and TNF-alpha production by the LPS-stimulated macrophages, depending on the route, postexposure time, and dose of propanil administered. Oral exposure to propanil also caused splenomegaly and thymic atrophy in animals in much the same manner as animals exposed via the i.p. route. In vitro exposure to propanil also significantly reduced macrophage cytokine production. Thioglycollate-elicited macrophages from normal mice were cultured in the continuous presence of 0, 10, or 20 microM propanil plus LPS. This exposure caused a significant reduction in IL-6 and TNF protein production by these macrophages in a concentration-dependent manner. Northern blot analysis demonstrated that the message levels of these cytokines were reduced by approximately the same percentage as the protein levels in propanil-treated macrophages, indicating a possible transcriptional or pretranscriptional target(s) for propanil.

Inhibitory effect of 3,4-dichloro-propionaniline on cytokine production by macrophages is associated with LPS-mediated signal transduction

Our previous studies demonstrated that both in vivo and in vitro 3,4-dichloro-propionanilide (propanil) exposure inhibited interleukin-6 (IL-6) and tumor necrosis factor (TNF) production by adherent thioglycollate-elicited peritoneal cells (macrophages) after lipopolysaccharide (LPS) stimulation. In this study, we report that IL-6 and TNF-alpha message is reduced by propanil in a concentration-dependent pattern, yet the stability of cytokine mRNA is not affected. In addition, exposure of macrophages to propanil after a relatively short period of LPS stimulation significantly reduced the production of IL-6 and TNF. Determination of the intracellular Ca2+ levels demonstrates that LPS-induced Ca2+ release is abrogated in propanil-treated macrophages. However, the binding of LPS to macrophages is not affected. Measurement of inositol 1,4,5-triphosphate (IP3) demonstrates that propanil significantly increases the level and the duration of IP3 in macrophages. These results suggest that the inhibitory effect of propanil on macrophage cytokine production is associated with the early stages of LPS-mediated signal transduction in macrophages.

3,4-Dichloropropionanilide-induced atrophy of the thymus: mechanisms of toxicity and recovery

The herbicide 3,4-dichloropropionanilide (propanil) has several well-documented neurotoxic and immunotoxic effects on mice. We report here a detailed characterization of the effects of propanil exposure on the thymus. We found that at doses of 100-200 mg/kg, propanil induces significant thymic atrophy between 2 and 7 days postexposure. This atrophy is characterized by a decrease in thymus/body ratio and a decrease in cellularity. Flow cytometric analyses of thymuses from propanil- and vehicle-treated mice indicate that the CD4(+) CD8(+) population of immature cells, is most significantly decreased in propanil-exposed mice. We performed cell cycle analysis of thymocyte populations using two-color surface staining and the DNA binding dye 7-aminoactinomycin D to determine whether thymic atrophy was associated with changes in the percentages of cells in the S, G2, and M phases of the cell cycle. We found a high percentage of proliferating CD4(+)CD8(+) thymocytes 4 days after exposure. Thus, recovery of the thymus occurs following increases in thymocyte proliferation, most notably the immature CD4(+) CD8(+) thymocytes. We tested the hypothesis that glucocorticoids play a role in the observed atrophy by examining thymuses in adrenalectomized, propanil-treated mice. No atrophy was observed in those animals. These results suggest that propanil has an immunotoxic effect on the thymus that appears to be mediated, in part, by endogenous glucocorticoids.

Effects of amiodarone-induced phospholipidosis on pulmonary host defense functions in rats

The effect of the induction of pulmonary phospholipidosis by amiodarone on selected pulmonary host defense functions was studied in male Fischer-344 rats. One week of daily amiodarone treatment resulted in a 4.5-fold increase in total phospholipid in alveolar macrophages recovered from the lungs by bronchoalveolar lavage. The presence of the phospholipidosis had no effect on the phagocytosis of heat-killed yeast cells, the induction of luminol-dependent chemiluminescence, or the spontaneous release of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), or spontaneous and LPS-stimulated release of IL-1 by alveolar macrophages in vitro. In contrast, the LPS-stimulated release of IL-6 and TNF-alpha by phospholipidotic alveolar macrophages was enhanced compared with control cells. The pulmonary clearance of Listeria monocytogenes following intratracheal administration of the bacteria was not affected by the phospholipidotic condition. It appears that, in the context of the functions studied, the induction of pulmonary phospholipidosis by amiodarone does not impair pulmonary host defense processes in rats, and may actually be associated with the augmentation of some activities.

Changes in primary and secondary lymphoid organ T-cell subpopulations resulting from acute in vivo exposure to propanil

Acute exposure to the herbicide propanil is immunotoxic for selected immune functions, as well as causing changes in the weights of the thymus and spleen. Although spleen cellularity and weight increase with propanil exposure, the thymus: body weight ratio decreases with increasing doses of propanil. The present study analyzes the thymocyte subpopulations in the thymus, spleen, and mesenteric lymph nodes. C57Bl/6 mice were treated with either 0, 100, 150, or 200 mg/kg propanil, and 7 d later thymocyte populations were analyzed by flow cytometry. In the thymus, propanil exposure resulted in a dose-dependent decrease in total numbers of T cells, as would be expected with its reduced weight. Determination of the thymocyte subpopulation distribution in the thymus showed a significant reduction in the number of CD3+CD4+CD8- (CD3+4+8-), CD3+CD4-CD8+ (CD3+4-8+), and CD3+CD4+CD8+ (CD3+4+8+) cells. Percent distribution of these thymic cell subpopulations showed similar decreases only with the highest dose. Apparent dose-related decreases in the numbers of CD3-CD4+CD8+ (CD3-4+8+) cells were also noted and were attributed to the general decrease in total thymus cells. The percentage of CD3- subpopulations showed an increasing trend with dose, which suggests that at 7 d postpropanil exposure there may be a specific effect on this most immature population. Although the size and cellularity of the spleen were increased, no change in CD4+ or CD8+ cell distribution was observed. Similarly, mesenteric lymph nodes showed no changes in the cell subpopulation distribution between propanil-treated and control animals.

Aloneness in the countertransference

This survey of a variety of ways in which analysands induce a feeling of aloneness in the analyst includes reference to the developmental origins, unconscious dynamics, and characterological settings of these ways. An account is presented of the role of narrative choice in defining the phenomena of an analysis not just in reporting pre-existing phenomena. Also included are some technical suggestions.

Immunotherapy of a plasmacytoma with attenuated salmonella

An attenuated strain of Salmonella typhimurium, SL3235, developed as a prototypic typhoid vaccine, is shown to retard growth of a murine plasmacytoma, TEPC-183, and to prolong survival of tumor-bearing mice. Live salmonella, but not acetone-killed organisms, had antitumor activity. The immunotherapeutic effect was demonstrable when the tumor was injected intralesionally or intraperitoneally. Increased survival, longer mean time to death, and retardation of tumor growth were found when the salmonella were given intralesionally as late as the sixth day post-tumor injection. Timing of salmonella inoculation, as well as the salmonella dose, had an effect on treatment efficacy. Injection of salmonella intraperitoneally exerted a strong antitumor effect when given as late as the third day post-tumor inoculation. The highest dose (2 x 10(6)) of salmonella was less effective than doses 10- or 100-fold lower. TEPC-183 plasmacytoma is rapidly growing and highly immunosuppressive, so the ability of the salmonella to exert therapeutic activity against it is a measure of the potency of the vaccine. These observations are of interest, as they show that a genetically engineered, avirulent strain of Salmonella has immunotherapeutic properties similar to those of BCG and other biological response modifiers, and might have clinical potential as an antitumor agent.

In the wake of Heinz Hartmann

This study of Heinz Hartmann's contributions emphasises change within continuity. Specifically, it is argued that he both integrated and changed significantly Freud's structural theory--his 'ego psychology'. This he did through his then-modern concept of adaptation. In turn, adaptation paved the way towards further change in the direction of current emphases on dialogue and intersubjectivity. These new developments have contributed beneficially to theory and clinical practice, but, like all new developments, they have introduced new problems, among them unreflective and undisciplined eclecticism. Consideration is given to the incompleteness inherent in theory construction. In psychoanalysis, the new, object-related developments require as a complement some version of the type of structural theorising initiated by Freud and developed to its highest point by Hartmann and his close collaborators particularly; in meeting that requirement, some version of an objectivist stance is also required to complement the subjectivism and pluralism of the newer developments. Throughout this appreciation of Hartmann's role in the history of psychoanalytic thought, an effort is made to undo the negative effects of misreadings that took his ideas on adaptation and ego psychology to mean an endorsement of superficial adjustment or conformity and an overvaluation of conscious mental processes.

Functional characterization of the human neurokinin receptors NK1, NK2, and NK3 based on a cellular assay system

The neurokinin receptor family is known to modulate phospholipase C activity. In order to find new compounds modulating the activity of these receptors we have developed a cellular screening system that measures the biological activity of receptors coupled to the IP3/DAG signal transduction pathway via the transcriptional activation of a reporter gene. For the establishment of neurokinin test cell lines the reporter cell line A20, stably transformed with the luciferase gene under the control of a promoter containing TPA response elements (TRE), which did not respond to neurokinin agonists, was used. Stable test cell lines were developed by transfecting the reporter cell line A20 with the genes for the human neurokinin receptors NK1, NK2 or NK3, respectively. In these cell lines, expression of luciferase was inducible by substance P, neurokinin A and neurokinin B, respectively. The order of potency of the three neurokinins substance P, neurokinin A and neurokinin B was consistent with published data and results from ligand binding studies performed with the NK1 and NK2 test cell lines. The agonistic effect of the neurokinins could be inhibited in a dose-dependent manner by simultaneous addition of neurokininspecific antagonists like the non-peptide antagonists CP-99,994 and SR 48968.

The conceptualisation of clinical facts

There has never been a fact that has not already been conceptualised. To enter into discourse as a fact, whatever the case may be in the world that is of immediate concern must always already be symbolically mediated, that is, already a specialised version of that aspect of the world. To become a 'clinical' fact, however, 're'conceptualisation is required; before then the clinician has only details. Details become clinically significant when, implicitly or explicitly, they are situated and redefined in a context of interrelated clinical narratives. These narratives are based partly on dialogue and partly on the general theories or metanarratives provided by one or another school of psychoanalytic thought. During psychoanalysis, new clinical facts continue to be conceptualised, and these often alter their own formative contexts, for they include the consequences of previous conceptualisations. Consequently, facticity is always in flux as, over time, understanding alters meaning and emphasis. Even the apparently brute fact of corporeality changes with changes of age, culture, historical epoch, gender of patient, and phase of analysis. In analysis, a central role is played by insight into the functions served by the analysand's uses of 'fact' in the course of devising, unconsciously, transferenceAcountertransference enactments. Illustrated case material is provided.

Morphological characteristics of cultured olfactory bulb cells

Cultured olfactory bulb cells from embryonic mice had ultrastructural characteristics similar to those of many cell types in the intact adult mouse olfactory bulb. Identified cultured cells included mitral/tufted cells, granule cells, short-axon cells, and fibrous and protoplasmic astrocytes. Cultured neurons were found as individual cells, clusters or aggregates. Clusters consisted of a loose array of neurons that appeared to be densely interconnected by neurites. However, few neurites or fascicles emanated from clusters to adjoining areas. Aggregates consisted of many small, usually rounded, neurons piled on top of one larger neuron, or on more than one, with typically many neurites and fascicles projecting to adjacent aggregates, clusters or individual neurons. Neurites of cultured olfactory bulb cells were well developed, and some were several millimeters long. Synapses were very prominent in these cultures, especially in aggregates, clusters, and fascicles. Electron-lucent, dense-core, and coated vesicles were present. Polarity, shape, and length of the long axis (size) of 815 cultured neurons, identified by positive anti-microtubule-associated protein 2 staining, were documented. Cultured neurons varied in size from 9 to 27 microns, with an average size of 16 microns. Elliptical bipolar (35%), triangular multipolar (21%), and round unipolar (15%) were the most common polarity/shape combinations found in culture. Multipolar, triangular, triangular multipolar, and elliptical bipolar cells increased in size with increasing age of culture. The relative proportions of triangular, multipolar, elliptical multipolar, and triangular multipolar cells decreased, whereas the relative proportions of round, unipolar, and round unipolar cells increased with increasing age of culture. These changes in population subtypes and cell size may indicate continued differentiation and maturation of cultured neurons.

A classic revisited: Kurt Eissler's 'the effect of the structure of the ego on psychoanalytic technique'

Eissler's influential contribution, which introduced the idea of the parameter of technique, extended Freud's later contributions so that they would apply to thoughtful analytic work with hard-to-treat patients. Aimed at sharpening the baseline of psychoanalytic technique-interpretation--and differentiating ego-psychological work from Franz Alexander's modifications in particular, Eissler's 'parameter' was progressively and perversely made into a coercive, if not punitive, concept. Looking back on it now, one can see that, in addition to its merits, the paper advocates an orientation that is no longer beyond dispute. In contrast to the present pluralistic state of psychoanalytic approaches to treatment, certain aspects of Eissler's paper seem unacceptably finalistic, restrictive and uncritically committed both to assumptions about continua in development and pathological states and to an operational approach to diagnosis.

The contemporary Kleinians of London

A review of the modern British modifications of Melanie Klein's approach. While featuring its advantages along with its systematic problems, this review also argues for its recognition by all analysts as a true branch of Freudian analysis. It points up egopsychological aspects of this approach, showing that it includes some elements that are distinctive and others that overlap standard Freudian practice. Mention is made of some incompleteness of theorizing and some seemingly avoidable tendency toward interpretive imbalance, both of which are seen to be signs of the times in contemporary analytic thinking.

Food labeling

In June 1990, the American Diabetes Association approved a food labeling position statement (1) that emphasized the following four general points: 1) food labeling must be truthful, meaningful, understandable, and complete; 2) no food should be designated or promoted as nutritionally good, bad, healthful, or unhealthful for people with diabetes; 3) education, based on principles of good nutrition and use of food labels, is essential for people with diabetes; and 4) specific recommendations for label inclusions.

Selective myelotoxicity of propanil

Propanil, a commonly used herbicide, has been previously shown to be immunotoxic for selected immune functions as well as specific cell types, such as the macrophage. Propanil has also been shown to cause a methemoglobulinemia and anemia through direct action on the erythrocyte. Demonstrated toxicity to both macrophages and erythrocytes raised concern for the possible myelotoxicity of propanil which could contribute to the observed effects of exposure. Therefore, the effect of propanil on several stem and progenitor cell types was assessed 7 days after acute propanil exposure. The results described herein show that propanil, at doses of 50-200 mg/kg body wt, resulted in reduction in the number of myeloid stem cells and early myeloid and erythroid progenitor cells. No reduction in the numbers of more differentiated myeloid and erythroid progenitor cells was noted at even the highest dose used (200 mg/kg). In addition, no statistically significant difference in number of leukocytes per femur was noted. These data suggest that propanil is myelotoxic to early hemapoietic stem cells, but that this reduction is apparently compensated by proliferation of more differentiated progenitor cells for the myeloid and erythroid lineages. It remains unknown whether chronic exposure leads to progressive depletion of additional myeloid and erythroid cells.

Synaptology of cultured olfactory bulb cells

Cultured embryonic mouse olfactory bulb cells formed asymmetric, symmetric, axodendritic, and dendrodendritic synapses. These neurons contained electron lucent, dense core, and coated vesicles. Dense core and coated vesicles had an average diameter of 71 and 80 nm, respectively. Two statistically different populations of electron lucent vesicles were found, based on synaptic symmetry: electron lucent vesicles from asymmetric synapses had an average diameter of 46 nm with an estimated volume of 49,000 nm3, whereas those from symmetric synapses had an average diameter of 44 nm and an estimated volume of 42,000 nm3. Because these values are similar to those found for intact olfactory bulb, the synapses of these cultured cells have some of the same morphological characteristics as those in the intact olfactory bulb.

One perspective on the Freud-Klein controversies 1941-45

Comments on the complex relations obtaining between, on the one hand, tradition, innovations and existential perspective and, on the other, presuppositions about method, evidence and truth are prefaced by a review of the helpful and hindering attitudes and conduct of the three parties to these controversial discussions, the third group being the indigenous ('independent') British group. This group directed the process into productive channels against great odds. The subsequent history of psychoanalysis shows, in addition to increased organisational stability and tolerance in times of crisis, an evolving enrichment and refinement of theory and practice in all three groups. Those following Melanie Klein have developed further their own kind of ego-psychological emphasis, while those following Anna Freud and 'the Viennese' around her have developed a more inclusive theoretical and clinical perspective, one that makes more salient the influence of the very first years of life and early infantile aggression as well as accepting a broadening of the idea of transference to include child analysis. This history supports the view that pluralism in psychoanalysis has been of much benefit.

Forcing expression of a soybean root glutamine synthetase gene in tobacco leaves induces a native gene encoding cytosolic enzyme

Glutamine synthetase (GS; EC 6.3.1.2) is present in different subcellular compartments in plants. It is located in the cytoplasm in root and root nodules while generally present in the chloroplasts in leaves. The expression of GS gene(s) is enhanced in root nodules and in soybean roots treated with ammonia. We have isolated four genes encoding subunits of cytosolic GS from soybean (Glycine max L. cv. Prize). Promoter analysis of one of these genes (GS15) showed that it is expressed in a root-specific manner in transgenic tobacco and Lotus corniculatus, but is induced by ammonia only in the legume background. Making the GS15 gene expression constitutive by fusion with the CaMV-35S promoter led to the expression of GS in the leaves of transgenic tobacco plants. The soybean GS was functional and was located in the cytoplasm in tobacco leaves where this enzyme is not normally present. Forcing this change in the location of GS caused concomitant induction of the mRNA for a native cytosolic GS in the leaves of transgenic tobacco. Shifting the subcellular location of GS in transgenic plants apparently altered the nitrogen metabolism and forced the induction in leaves of a native GS gene encoding a cytosolic enzyme. The latter is normally expressed only in the root tissue of tobacco. This phenomenon may suggest a hitherto uncharacterized metabolic control on the expression of certain genes in plants.

Induction of a cellular immune response to a foreign antigen by a recombinant Listeria monocytogenes vaccine

A recombinant strain of Listeria monocytogenes that stably and constitutively expresses Escherichia coli beta-galactosidase was used as a live vaccine vector. BALB/c mice were immunized orally or parenterally with the recombinant L. monocytogenes, and their cellular and humoral immune responses to beta-galactosidase were measured. Spleen cells taken 1 week after oral inoculation or 5 weeks after oral or parenteral inoculation (with a boost at 4 weeks) showed beta-galactosidase-specific CTL responses. The CTL line derived from mice immunized i.p. was also shown to be class I restricted and Thy-1.2+, CD8+, and TCR alpha beta+. All mice immunized with the recombinant L. monocytogenes had positive delayed-type hypersensitivity responses to heat-killed L. monocytogenes, but only 15% had a positive delayed-type hypersensitivity reaction to beta-galactosidase. Individual serum samples from mice immunized i.p. or i.v. were tested for antibody to beta-galactosidase. Approximately 11% had low positive titers for beta-galactosidase antibodies. These results demonstrate that both oral and parenteral immunization with recombinant L. monocytogenes results in a cellular immune response to the foreign protein, which is primarily a specific CD8+ CTL response.