FP2-3 Ten years of paediatric neuro-oncology surgery: quantifying and predicting complications after surgery for intracranial tumour excision

Objectives

To measure complications of paediatric neurooncology surgery using the Clavien Dindo grading scale, and identify predictors of surgical morbidity.

Design

Retrospective review of prospectively collected data.

Subjects

All paediatric patients treated with craniotomy for excision of intracranial tumour between 2008 and 2017 in a single tertiary paediatric neurosurgery centre.

Methods

Demographics, surgical details and perioperative complications were prospectively recorded between 0 and 30 days post operatively. These were retrospectively graded using the CD scale. Data analysis was done in R using logistic regression. Significance was defined as p<0.05

Results

Between 3/1/2008 and 21/12/2017 there were 322 operations, on 254 patients (142 Male). Median age at surgery was 9 years (IQR 4–13 years). 48% were without complication on the CD scale. Maximum CD grade complication for each procedure was 1 in 11%, 2 in 19%, 3A in 2%, 3B in 14%, and 4 in 0.6% of operations. 30 day mortality was 0.9%. CD grade of 3B or over was associated with infratentorial tumours (OR 2.24; CI 1.10–4.68; p=0.004) and WHO grade III tumours (OR 4.12; CI 1.56–10.86; p=0.028).

Conclusions

Complications in paediatric neurooncology surgery are common overall, but our results are favourable in comparison to the literature. The CD scale has limitations in neurosurgery but gives insight into the health economic impact of complications. Infratentorial tumours, and WHO grade III tumours were associated with increased morbidity.

TP1-10 Non tumour brain biopsies in alder hey paediatric neurosurgery

Objectives

To review the utility of non-tumour brain biopsies in Alder Hey Children’s NHS Foundation Trust Paediatric Neurosurgery Department.

Methods

Operative records were searched for ‘biopsy’. Case notes were reviewed for referral source, histology, surgical complication and outcome. Tumour, epilepsy and non-brain biopsy cases were excluded.

Results

83 ‘biopsy’ cases were identified between 2008 and 2017. 31 tumour, 5 epilepsy, 2 infections and 28 non brain/other biopsies were excluded. 17 brain biopsies for non-tumour causes were seen. 15 patients were referred by neurology, 2 by rheumatology. 14 underwent a craniotomy/mini-craniotomy, 3 had burrholes.4 biopsies were non diagnostic, 2 were abnormal but inconclusive for diagnosis. Diagnoses included: 3 demyelinating lesions, 2 normal brain tissue, 1 neurosarcoidosis, 1 autoimmune encephalitis, 1 definite Rasmussen’s Encephalitis, 1 possible Rasmussen’s Encephalitis, 1 systemic lupus erythematosus associated CNS vasculitis, 1 inflammatory infiltrate (secondary to hydrocephalus/ventriculitis), 1 patient developed a late wound infection. No other surgical morbidities/mortalities were recorded. 11 of these cases had a change in management or the treating team were reassured due to the result of the biopsy (i.e. were able to start immunomodulatory drugs in the absence of infection).

Conclusions

65% of brain biopsies were diagnostic. 71% of biopsies either changed management or reassured the treating team about a line of management. The procedure is low risk with 0.06% morbidity and 0% mortality.

P98 A decade of primary tumours of the spine in the paediatric population

Objectives

Primary spinal tumours in children are rare and poorly understood; we review 10 years of surgical experience.

Design

Retrospective review of prospectively maintained database.

Subjects

Children receiving surgical management of primary spinal tumours in a single, tertiary paediatric neurosurgery centre.

Methods

Operations for primary spinal tumours were abstracted from our prospectively maintained surgical database and supplemented with data from case notes, operative records, and imaging studies.

Results

Between 2008 and 2017, 37 procedures were performed on 29 patients (19 male; Median age 7.5 years, IQR 2–11.25). 28 had their primary procedure in our unit: 21 excisions, and 7 biopsies (of which 5 proceeded to further surgery). Tumours were classified as extradural (10), intradural extramedullary (3), intradural intramedullary (11) or bony (4). Tumours were found at the following levels: Cervical (8; 29%), Cervicothoracic (2; 7.1%), Thoracic (10; 36%), Thoracolumbar (3; 11%), Lumbar (2; 7.1%), Lumbosacral (2; 7.1%) and Sacral (1; 3.6%). Histology comprised: Pilocytic Astrocytoma (6), Other Astrocytoma (4), Schwannoma (3), Ewing Sarcoma (2), Langerhans cell histiocytosis (2), Lymphoma (2), Neurofibroma (2), and others (7) including one Myxopapillary Ependymoma.

Conclusions

The rarity and heterogeneity of paediatric spinal tumours makes treatment challenging. We propose a national online registry including a tissue bank, and invite collaboration with other units.

Cerebellopontine angle oligodendroglioma in a child: first case report

The reported incidence of oligodendrogliomas in the paediatric population is less than 1 %. The posterior fossa is a rare location, with the vast majority arising in the cerebral hemispheres. We report the first paediatric case of a WHO grade II oligodendroglioma arising in the cerebellopontine angle (CPA). CPA oligodendrogliomas in children appear to behave aggressively and adjuvant therapy must be considered early; especially when complete resection cannot be achieved.

Costs and outcomes associated with hospitalizations for venous thromboembolic disease in patients with malignant neoplasm

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Background: Venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common occurrence in oncology, as patients with cancer have a greatly increased risk of VTE. Costs of VTE treatment are significant, including direct costs (expenditures for procedures, tests, medications, and services), indirect morbidity costs (lost income from work due to the condition or disability), and indirect mortality costs (lost income due to early mortality). Costs associated with VTE contribute to the overall cost of cancer care, however studies that examine the cost of care for oncology patients that develop VTEs are limited. Methods: A retrospective cohort study identified patients with cancer hospitalized during January 2006 through May 2008 using a large US healthcare database (>342 inpatient facilities across all US regions, ∼ 11 million patients and > 300 million charge- detail records). Patients with an ICD-9-CM code for malignant neoplasm (140.xx-208.xx) in combination with DVT or PE (415.11,415.19, 453.4,453.41,453.42) were included. Using Aspen's charge cost model, the hospital's clinical, utilization and billing, and cost accounting records healthcare cost, LOS, and mortality rates associated with these hospitalizations were calculated. Results: Data from 74 facilities with a mean bed size of 349 was utilized. A total of 77% of these facilities were not classified as teaching hospitals. Overall 1136 inpatients were identified with a diagnosis of malignant neoplasm and either DVT or PE. Table 1 shows the results. Conclusions: DVT/PE contributes to the cost of cancer treatment and is a considerable cost driver. Additionally, human costs are high. Aggressive practices to prevent these complications can result in a lower healthcare burden. In an era of restricted resources and value based purchasing, these data can be used to prioritize resource utilization.

[Table: see text]

[Table: see text]

Costs and outcomes associated with febrile neutropenia-related hospitalizations across patients with varying cancer types: A retrospective analysis

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Background: Neutropenia, the major dose-limiting toxicity of chemotherapy, is a frequent, often serious, and sometimes fatal complication of myelosuppressive chemotherapy. Its economic and clinical impact is often under-appreciated, and thus this study evaluates the contribution of febrile neutropenia (FN) by tumor type as related to healthcare cost and mortality. Methods: FN patients in this study were identified as having cancer (ICD-9-CM: 140.xx - 208.xx), neutropenia (288.0x) and either opportunistic infections (110 total codes) or fever of unknown origin (780.6) who were hospitalized between 1/05 and 6/08 in a retrospective cohort study from the Aspen US healthcare database (∼11 million pts, >342 inpatient facilities, and >300 million charge-detail records). Unadjusted mean healthcare cost of hospitalization, length of hospital stay (LOS), and mortality rates were calculated, stratifying by cancer type (breast, metastatic breast, and lung cancers, non-Hodgkin lymphoma (NHL), or other hematologic tumors). Results: Among 598 hospitalized patients (mean age 63 years; 53% female) with cancer experiencing FN, the mean cost of hospitalization, LOS and mortality varied significantly by tumor type ( Table ). Conclusions: FN hospitalizations are costly and may be associated with significant mortality. Considerable variations exist across cancer types for hospitalization costs, LOS and mortality. The tumor type is important in assessing the economic and clinical impact of FN hospitalizations.

[Table: see text]

[Table: see text]

First Report of Arceuthobium hondurense in Mexico

Honduran dwarf mistletoe (Arceuthobium hondurense Hawksw. & Wiens) is a rare dwarf mistletoe previously known only from Honduras (1,2). In March 2000 we collected a dwarf mistletoe from approximately 7 km west of San Cristobal de las Casas, Chiapas, Mexico near Route 190 (elevation 2,440 m), which was morphologically similar to A. hondurense (1). This population had initially been classified as A. nigrumHawksw. & Wiens (1). However, our morphological measurements and analysis of nuclear rDNA ITS sequences of A. hondurense plants from Honduras (GenBank No. AF325969) and the plants from Chiapas (AF325970) have confirmed that the Chiapan population is A. hondurense and not A. nigrum. An additional population of A. hondurense was discovered in Chiapas approximately 11 km west of Oxchuc near Route 186 (elevation 2160 m). Both of the Chiapan populations of A. hondurense were parasitizing Pinus tecunumanii(Schw.) Eguiluz et Perry. Specimens of A. hondurense from Chiapas were deposited at the Deaver Herbarium, Northern Arizona University, Flagstaff. This is the first report of A. hondurense in Mexico and extends its known distribution from northwestern Honduras (3) by approximately 500 km. Although A. hondurense has not been observed in the pine forests of Guatemala, it is probable that it also occurs there (1). References: (1) F. G. Hawksworth and D. Wiens. 1996. Dwarf Mistletoes: Biology, Pathology, and Systematics. USDA Agric. Handb. 709. (2) R. Mathiasen et al. Phytologia 36:211, 1998. (3) R. Mathiasen et al. Plant Dis. 84:372, 2000.

Performance of older depressed patients on two cognitive malingering tests: false positive rates for the Rey 15-item memorization and dot counting tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.

First Report of Psittacanthus angustifolius on Pines in Mexico and Guatemala

The mistletoe Psittacanthus angustifolius Kuijt (Loranthaceae) is a common parasite of pines in Honduras (2). In March we observed this mistletoe parasitizing a pine that Farjon and Styles (1) have classified as Pinus tecunumanii Eguiluz & J. P. Perry 4 km south of Jitotol, Chiapas, Mexico. The taxonomy of this host in Chiapas is controversial as Perry (3) classifies the Chiapas populations of this pine as Pinus oocarpa var. ochoterenai Martinez. We also observed P. angustifolius on P. oocarpa Schiede 4 km north of Jitotol. In addition, we found this mistletoe parasitizing Pinus maximinoi H. E. Moore approximately 15 km west of Ocosingo, Chiapas. In Guatemala, we observed P. angustifolius on P. oocarpa at several locations north and south of La Cumbre, Department Baja Verapaz. This mistletoe appears to be less common in Chiapas and Guatemala than it is in Honduras. We did not observe this mistletoe damaging its pine hosts in Mexico or Guatemala. This is the first report of P. angustifolius in both Mexico and Guatemala and the first report of this mistletoe on Pinus tecunumanii (or Pinus oocarpa var. ochoterenai). Specimens of P. angustifolius from the above pine hosts have been deposited at the Deaver Herbarium, Northern Arizona University, Flagstaff. References: (1) A. Farjon and B. Styles. Pinus (Pinaceae), Flora Neotropica, Monogr. 75, New York Botanical Garden, 1997. (2) Mathiasen et al. Plant Dis. 84:203, 2000. (3) J. Perry. The Pines of Mexico and Central America, Timber Press, Portland, Oregon, 1991.

First Report of Psittacanthus angustifolius on Pinus oocarpa and Pinus maximinoi

The mistletoe Psittacanthus angustifolius Kuijt (Loranthaceae) was first described in 1987 on Pinus from Nicaragua near the Honduran border, but the species of pine was not designated (1). Kuijt (1) speculated that this mistletoe probably also occurs in Honduras. During March and October 1999 we observed P. angustifolius parasitizing Pinus oocarpa Schiede in the departments of Choluteca, Francisco Morazan, El Paraiso, Intibuca, Lempira, and Olancho in Honduras. This mistletoe appears to be a very common parasitic plant on pines in Honduras and is associated with host mortality. We also observed P. angustifolius parasitizing Pinus maximinoi H.E. Moore at two locations in the department of Lempira: one infection on a single tree 1.5 km east of El Matazano (elevation 1,400 m) and six and eight infections on two trees 0.5 km west of the main entrance to Celaque National Park east of Gracias (elevation 1,200 m). This is the first report of P. angustifolius in Honduras and the first report of this mistletoe on Pinus oocarpa and Pinus maximinoi. Specimens of P. angustifolius from Pinus oocarpa and Pinus maximinoi have been deposited at the Herbario, Escuela Nacional de Ciencias Forestales, Siguatepeque, Honduras, and at the Deaver Herbarium, Northern Arizona University, Flagstaff. Reference: (1) J. Kuijt. Ann. Mo. Bot. Gard. 74:511, 1987.

Effects of aging on efficiency of task switching in a variant of the trail making test

The Trail Making Test (TMT; R. M. Reitan, 1958, 1992) is extensively used in research in neuropsychology and in aging, in part because it has been postulated to reflect executive processes, such as planning and switching. However, neurocognitive and individual-difference-based analyses of this test are complicated because of different spatial arrangements of targets, the use of letters only in Version B, and potential order effects when Version A is administered prior to Version B. The present article examines a variant of a TMT (called the Connections Test) that attempts to remedy these deficiencies. A structural equation model suggested that there were no direct effects of age on either the nonalternating or alternating versions of the Connections Test (analogous to TMT Versions A and B, respectively); rather, all age-related effects were mediated through effects on perceptual speed. Moreover, although the nonalternating and alternating versions were strongly related to one another, only the latter had significant independent relations with measures of higher order cognition.

Complications and outcome after acute stroke. Does dysphagia matter?

BACKGROUND AND PURPOSE

The published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside assessment and videofluoroscopic examination.

METHODS

We prospectively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We performed videofluoroscopy blinded to this assessment within 3 days of stroke onset and within a median time of 24 hours of the bedside evaluations. The presence of aspiration was recorded. Mortality, functional outcome, lengthy of stay, place of discharge, occurrence of chest infection, nutritional status, and hydration were the main outcome measures.

RESULTS

Patients with an abnormal swallow (dysphagia) on bedside assessment had a higher risk of chest infection (P=.05) and a poor nutritional state (P=.001). The presence of dysphagia was associated with an increased risk of death (P=.001), disability (P=.02), length of hospital stay (P<.001), and institutional care (P<.05). When other factors were taken into account, dysphagia remained as an independent predictor of outcome only with regard to mortality. The use of videofluoroscopy in detecting aspiration did not add to the value of bedside assessment.

CONCLUSIONS

Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.

Genomic characterization of hepatitis C virus isolates from Argentina

Thirty-three Argentinian patients infected with hepatitis C virus (HCV) were studied for viral genotyping. The patients included 10 hemophiliac and 4 polytransfused children and 19 adults: 3 polytransfused, 7 dialyzed and 9 sporadic cases. Core-based genotyping permitted the classification of 31 samples. Genotypes II, I and V were the most frequent: 21 (63.6%), 16 (48.4%) and 10 (30.3%) of the 33 patients, respectively. Only one polytransfused patient carried genotype IV. Genotype II was detected in 7 out of 9 sporadic cases. Thirteen patients (39.3%) were coinfected with two genotypes, and 2 others were coinfected with three genotypes. The remaining 2 samples which could not be typed were characterized following the restriction fragment length polymorphism (RFLP) method, and were classified as type 1. One of these had two consecutive transitional mutations in the 5' untranslated region (5' UTR).

Glial cell-specific expression of the serotonin 2 receptor gene: selective reactivation of a repressed promoter

The 5' flanking region of the 5-HT2 receptor gene has been cloned, sequenced and its transcriptional regulatory functions analyzed. The promoter lacks an identifiable TATA motif, and utilizes at least 11 clustered start sites. Promoter function was analyzed by transient assays in rat C6 glioma cells, which were shown to express the endogenous 5-HT2 receptor gene, as well as in rat CREF and human HeLa cells which do not express the endogenous gene. The basal promoter functioned equally well in all three cell lines; and a repression domain, located upstream of the basal promoter, inhibited activity of the promoter in all three cell lines. A far upstream cell specific activator domain restored promoter activity in C6 glioma cells, but did not reactivate the silenced promoter in CREF or HeLa cells. The upstream activator domain, repressor domain and basal promoter functioned in concert to achieve cell type specific expression. The activator domain did not direct C6 glioma cell specific expression in the absence of the repressor domain or in constructs carrying a heterologous basal promoter. These results indicate that glial cell expression of the 5-HT2 receptor gene is achieved through a cell type specific reactivation of a repressed promoter.

Pediatric sedation: short-term effects

A prospective investigation on the short-term effects of various sedation regimens on 549 nonhospitalized magnetic resonance (MR) patients was performed. The drugs evaluated were chloral hydrate, pentobarbital, midazolam, and diazepam (fentanyl was used for enhancement after any of these drugs). The overall safety and efficacy were quite good with all the regimens. Overall, 84% of children slept less than 8 h after the examination, 90% were drowsy and/or unsteady for less than 8 h after they awoke, and 97% resumed their usual activities by 24 h. Significant hyperactivity was seen only with pentobarbital and occurred in 8.4% of children over 8 years of age. The multiple-dose regimen of pentobarbital and fentanyl had a significant short-term effect on the children less than 8 years of age, with 35% sleeping longer than 8 h after the MR. Ten children who had needed the multiple-dose pentobarbital regimen or who had failed prior pentobarbital sedation presented for repeat sedation. Midazolam was effective in 9 of these 10 children.

The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice

We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasi-experimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch. During the baseline year, patients who would join the independent practice association plan already had 19% more acute-illness visits than control patients. During the second year, patients in the independent practice association plan averaged 42% more acute-illness visits, 22% more well child-care visits, 93% more chronic-illness visits, 27% more after-hours visits, 53% more weekend visits, 185% more laboratory studies, and 70% more referrals. The shift toward independent practice association plans in this open-market setting increased use of ambulatory medical care for pediatric patients.

Modulation of the blood-aqueous barrier by gram positive and gram negative bacterial cell wall components in the rat and rabbit

Acute anterior uveitis in man is related to Gram negative bacterial infection occurring at sites distant to the eye. This could involve intraocular localization of inflammatory bacterial cell wall constituents. Modulation of the blood-aqueous barrier in rabbit and rat, by muramyl dipeptide (the monomer of peptidoglycan) and lipopolysaccharide (and its monomer lipid A) was studied. The rabbit eye was found to be highly susceptible to MDP and LPS, although without cellular infiltration. In contrast the rat eye was demonstrated to be totally refractory to MDP. The response to LPS in the rat was modest, required high dosages and ocular changes were slow to occur, but cellular infiltration was readily apparent. Since MDP is found in Gram positive (as well as Gram negative) bacterial cell walls it is hypothesized that Gram positive bacteria might also play a role in causing uveitis in man.

Systemic injection of group A streptococcal peptidoglycan-polysaccharide complexes elicits persistent neutrophilia and monocytosis associated with polyarthritis in rats

The perpetuation of inflammatory changes within joints elicited by persisting, poorly biodegradable group A streptococcal cell walls (peptidoglycan-polysaccharide complexes [PG-PS]) is well documented. Chronic changes in the bloodstream induced by PG-PS have not been described previously. We demonstrated that leukocytosis occurs within 3 days after intraperitoneal injection of PG-PS and remains elevated 20 weeks later. Chronic neutrophilia, monocytosis, and lymphocytosis were observed in all experiments. Chronic changes in platelet, erythrocyte, and reticulocyte counts were not seen. The newly documented leukocytosis, lasting for months after PG-PS administration, provided a circulating pool of leukocytes that may participate in chronic inflammatory events in the joint. Although the central role of the macrophage in PG-PS-mediated inflammation has been emphasized (F. G. Dalldorf, W. J. Cromartie, S. K. Anderle, R. L. Clark, and J. H. Schwab, Am. J. Pathol. 100:383-402, 1980), the polymorphonuclear cell may be involved in periods of exacerbation of streptococcal cell wall-mediated polyarthritis. This was supported by our observations that neutrophilia and monocytosis correlate well with the degree of chronic joint inflammation.

Analysis of the amino acid and sugar composition of streptococcal cell walls by gas chromatography-mass spectrometry

A procedure for determining the amino acid and sugar composition of streptococcal peptidoglycan-polysaccharide complexes by capillary gas chromatography-mass spectrometry (GC-MS) was established. Amino acids are analysed as butyl heptafluorobutyl derivatives and sugars as alditol acetates. These two different groups of compounds are derivatized independently but chromatography in both cases utilizes the same OV-1701 fused-silica capillary column which simplifies GC-MS analysis. The butyl heptafluorobutyl procedure incorporates new pre- and post-derivatization clean-up steps. Additionally, selected-ion monitoring MS allows amino acids to be readily analysed without interference from background noise.

Analysis of the amino acid and sugar composition of streptococcal cell walls by gas chromatography-mass spectrometry

A procedure for determining the amino acid and sugar composition of streptococcal peptidoglycan-polysaccharide complexes by capillary gas chromatography-mass spectrometry (GC-MS) was established. Amino acids are analysed as butyl heptafluorobutyl derivatives and sugars as alditol acetates. These two different groups of compounds are derivatized independently but chromatography in both cases utilizes the same OV-1701 fused-silica capillary column which simplifies GC-MS analysis. The butyl heptafluorobutyl procedure incorporates new pre- and post-derivatization clean-up steps. Additionally, selected-ion monitoring MS allows amino acids to be readily analysed without interference from background noise.

Cyclic nucleotide function in trachealis muscle of dogs with and without airway hyperresponsiveness

We examined basal adenosine 3',5'-cyclic monophosphate (cAMP) levels, isoproterenol (ISO)-stimulated cAMP responses, basal cAMP, and guanosine 3',5'-cyclic monophosphate (cGMP) phosphodiesterase (PDE) activities and protein-kinase (PK) activities in trachealis muscle from five Basenji-greyhound (BG) and four greyhound dogs to determine whether the inverse relationship between in vivo and in vitro airway responsiveness could be due to altered cyclic nucleotide metabolism. Basal cAMP levels were not significantly different (PNS) in muscle from BG (11.6 +/- 0.53 pmol/mg protein) and greyhound dogs (10.30 +/- 1.60 pmol/mg protein). The cAMP responses to stimulation with ISO were enhanced in BG compared with greyhound dogs. The low Michaelis constant (1) for Km-cAMP PDE activity (Km = 0.63 microM) was significantly less (P less than 0.005) in BG dogs (1.54 +/- 0.28 pmol.min-1.mg protein-1) than greyhounds (11.76 +/- 2.48). Endogenously active PK activity was significantly greater (P less than 0.005) in BG (54.74 +/- 5.39 pmol.min-1.mg protein-1) than in greyhound dogs (15.50 +/0 2.20). Increases in PK activity with 5 microM cAMP added were not significantly different between BG (14.79 +/- 6.00) and greyhound dogs (7.04 +/- 2.14). Approximately 90% of both endogenous PK activity and cAMP-activated PK activity in BG and greyhound dogs was inhibited by a cAMP-dependent PK inhibitor (PKI'). These data suggest that decreased cyclic nucleotide degradation due to decreased cyclic nucleotide PDE activity with increased PK could account for the in vitro hyporesponsiveness of airway smooth muscle in BG dogs as a protective adaptive mechanism.

Type A behavior as a function of reversed computer activity

Four consecutive trials involving a computer activity were presented to 110 students categorized as Type A+, A-, B+, or B- personalities. A fifth trial presented the same computer activity with controls in reversed position, and Type A groups had more difficulty than Type B groups.

The use of promoter fusions in Drosophila genetics: isolation of mutations affecting the heat shock response

We have constructed a gene fusion using the promoter of Drosophila hsp70 and the structural gene for Drosophila alcohol dehydrogenase (Adh) and used this construct to transform Adh-deficient flies. In these transformants, Adh is expressed only after heat shock. Like hsp70 itself, this heat-shock-inducible Adh (Adhhs) is induced in a wide variety of tissues. It fails to be induced in primary spermatocytes. Although the tissue distribution of Adh activity is very different from wild type, this does not appear to be deleterious. Indeed, the induction of Adhhs allows flies to survive exposure to ethanol. We have used this latter characteristic to select dominant, trans-acting mutations that alter the response of flies to heat shock.