Cerebral Aβ deposition in an Aβ-precursor protein-transgenic rhesus monkey

With the ultimate goal of developing a more representative animal model of Alzheimer's disease (AD), two female amyloid-β-(Aβ) precursor protein-transgenic (APPtg) rhesus monkeys were generated by lentiviral transduction of the APP gene into rhesus oocytes, followed by in vitro fertilization and embryo transfer. The APP-transgene included the AD-associated Swedish K670N/M671L and Indiana V717F mutations (APPSWE/IND) regulated by the human polyubiquitin-C promoter. Overexpression of APP was confirmed in lymphocytes and brain tissue. Upon sacrifice at 10 years of age, one of the monkeys had developed Aβ plaques and cerebral Aβ-amyloid angiopathy in the occipital, parietal, and caudal temporal neocortices. The induction of Aβ deposition more than a decade prior to its usual emergence in the rhesus monkey supports the feasibility of creating a transgenic nonhuman primate model for mechanistic analyses and preclinical testing of treatments for Alzheimer's disease and cerebrovascular amyloidosis.

Fetal teratogenicity in a rhesus macaque (Macaca mulatta): Association with the chronic maternal treatment of amitriptyline

Amitriptyline is a tricyclic antidepressant commonly prescribed in humans for pain and sleep disorders and in non-human primates for self-injurious behaviors. Here, we report a clinical case on the teratogenic effect of maternal-fetal amitriptyline exposure.

Longitudinal Anthropometric Assessment of Rhesus Macaque (Macaca mulatta) Model of Huntington Disease

The neurodegeneration associated with Huntington disease (HD) leads to the onset of motor and cognitive impairment and their advancement with increased age in humans. In children at risk for HD, body measurement growth abnormalities include a reduction in BMI, weight, height, and head circumference. The transgenic HD NHP model was first reported in 2008, and progressive decline in cognitive behaviors and motor impairment have been reported. This study focuses on longitudinal body measurements in HD macaques from infancy through adulthood. The growth of HD macaques was assessed through head circumference, sagittal and transverse head, and crown-to-rump ('height') measurements and BMI. The animals were measured monthly from 0 to 72 mo of age and every 3 mo from 72 mo of age onward. A mixed-effect model was used to assess subject-specific effects in our nonlinear serial data. Compared with WT controls, HD macaques displayed different developmental trajectories characterized by increased BMI, head circumference, and sagittal head measurements beginning around 40 mo of age. The physiologic comparability between NHP and humans underscores the translational utility of our HD macaques to evaluate growth and developmental patterns associated with HD.

Asbestos disease in Australia: looking forward and looking back

This article provides an overview and analysis of recent developments in policy and practice in relation to asbestos disease in Australia. It complements three other concurrent publications in this issue representing important contributions of people and organizations toward addressing the health and social impacts of Australia's asbestos disease epidemic. The campaign to "Make James Hardie Pay" as well as the efforts of workers and advocates are profiled in this article as well as in this issue's Documents and Voices sections. Discussion of recent developments in asbestos-related disease research and mesothelioma surveillance is followed by articulation of the comprehensive public and social health response that is needed to fully engage and address the asbestos disease legacy and to apply lessons learned to help revive the currently waning societal commitment to occupational health and safety in Australia and elsewhere.

The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part i: the prevalence of drug use in drive the drug-positive group

Blood samples from 2,500 injured drivers were analysed for alcohol, cannabinnoids, benzodiazepines and stimulants. Overall, three-quarters of drivers tested negative for drugs. Alcohol was the most frequently detected drug. Cannabinoids were also detected at high rates, but the majority of drivers tested positive for THC-acid, the inactive metabolite of THC. Benzodiazepines and stimulants were detected at low rates, and detection rates for combinations of drugs were also low. Males were more likely to test positive for drugs, especially alcohol and THC, whereas females were more likely to test positive for benzodiazepines. A similar proportion of car drivers and motorcycle riders tested positive for drugs, although riders were more likely to test positive for THC. Single-vehicle crashes were particularly associated with alcohol for both car driver and riders, and for riders, multiple-vehicle crashes were particularly associated with THC.

The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability: part ii: the relationship between drug prevalence and drug concentration, and driver culpability

Blood samples from 2,500 injured drivers were analysed for alcohol, cannabinoids (measured by the presence of THC), benzodiazepines and stimulants. The relationship between the prevalence and concentration of drugs and the culpability of the driver was examined using an objective method for assessing culpability. There were no significant differences between males and females with respect to culpability. However, there was a relationship between age and culpability: drivers under 26 years and over 60 years were more likely to be culpable. Drivers who tested positive for alcohol only, benzodiazepines only and the combinations of alcohol and THC and alcohol and benzodiazepines were significantly more likely to be culpable for the crash compared with the drug-free group. Conversely, a lower percentage of drivers who only tested positive for THC were culpable for the crash compared with drug-free drivers. This difference was not statistically significant. For car drivers in single-vehicle crashes, the majority of drivers were judged culpable irrespective of drug use. In multiple-vehicle crashes, car drivers testing positive for alcohol only or benzodiazepines only were more likely to be culpable for the crash compared with drug-free drivers. For motorcycle riders in both single- and multiple-vehicle crashes, there were no significant differences between the drug-positive and drug-free groups. A higher percentage of drug-free riders in multiple-vehicle crashes were culpable compared with riders who only tested positive for THC, but this difference was not statistically significant. There was a significant concentration-dependent relationship between alcohol and culpability: as blood alcohol concentration increased, so did the percentage of culpable drivers. When THC was used alone, there was no significant increase in culpability. For those drivers with benzodiazepines at therapeutic concentrations and above, there was a significant increase in culpability. The relationship between stimulants and culpability was not significant, although a higher proportion of stimulant-positive drivers were culpable compared with drug-free drivers. The combinations of alcohol and THC, and alcohol and benzodiazepines also produced a significant increase in culpability, but this increase was not significantly greater than that produced by alcohol alone.

The Mental Adjustment to HIV scale: measurement and dimensions of response to AIDS/HIV disease

Attitudes of people with HIV disease towards HIV have seldom been measured. However, a well-established scale to measure attitudes toward cancer in those with the disease, the 38-item Mental Adjustment to Cancer (MAC) scale was modified to assess adjustment to HIV disease. We administered the scale to 107 Australian men with HIV infection, of whom 36 had an AIDS-defining condition, who were patients at an ambulatory care facility and in a research study. The data were factor analyzed using a method identical to that used in the development of the MAC scale to determine the latent dimensions of attitudes toward HIV/AIDS. The Mental Adjustment to HIV scale (MAH) factor analysis revealed five factors: Helplessness-Hopelessness, Fighting Spirit, and Denial-Avoidance as in the original MAC scale, plus a Fatalism subscale which also measured Preoccupation, and a new subscale, which measured Belief in Influencing the Course of the Disease. Together, these five factors accounted for half of the variance. These data suggest that while there are similarities between mental attitude to cancer and mental attitude to HIV in the latent dimensions of the questionnaire items, there are also some differences. Most significant is the belief in people with HIV disease in being able to personally influence the course of the illness, and the combination of Preoccupation with Fatalism. The five subscales of the MAH scale had Cronbach's alpha reliabilities between 0.80 and 0.55. The MAH appears to be a useful way to measure total attitudes and subscale scores of people with HIV infection, including AIDS, to their disease.

DRGs and Australian psychiatry

The introduction of diagnosis related groups (DRGs) as a basis for funding in the United States has revealed several shortcomings in current DRG systems. Overall, DRGs have proven to be poor predictors of cost, accounting for approximately one third of the variation in cost and length of stay for surgical DRGs and falling to less than 10% for medical DRGs. Their ability to contain costs also remains uncertain, with savings associated with reductions in length of stay being offset by increased readmission rates. Given the increasing commitment of government to casemix approaches to funding it is suggested that psychiatry should participate in the process of solving the problems so far identified with DRG systems. Participation would, it is hoped, create a focussed debate about the provision of a "gold standard" of care for all patients. The evaluation and refinement of existing DRGs is urgently needed and could utilise a number of comprehensive data bases which already exist across the country. Alternatives to diagnosis such as functional status and treatment needs should also be explored.

Undiagnosed post-traumatic stress disorder following motor vehicle accidents

OBJECTIVES

To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability.

DESIGN

A longitudinal study of motor vehicle accident victims one month and 18 months after the accident.

SUBJECTS

Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved.

MAIN OUTCOME MEASURES

Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile.

RESULTS

Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap.

CONCLUSION

The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.

Determinants of Health-Care Workers' Attitudes Toward People with AIDS

One hundred and thirty-four health professionals read one of 12 fictional case histories in which the patient was diagnosed as being either HIV- or Hepatitis B-positive. For each diagnosis infection was attributed to sexual contact, IV drug use, or a transfusion of contaminated blood. Within each diagnostic category, and for each source of infection, the patient was identified as either heterosexual or homosexual. Although homophobia has been suggested as a major contributor to negative attitudes toward people with AIDS, the present results remained significant even after homophobia, as measured by Hudson and Ricketts (1980), had been controlled for statistically. Regardless of disease, patients infected through IV drug use or sexual contact were seen as equally culpable and more responsible for their condition than those infected by transfusion. HIV, but not Hepatitis B, patients infected by sex or IV drug use were perceived as having less moral integrity than those infected by transfusion. Source of infection also influenced respondents' desire for close personal interaction. Negativity toward particular patient groups based merely on information about patient lifestyles was clearly demonstrated and it is suggested that negative attitudes toward people with AIDS may be a reflection of negative attitudes toward sexuality generally, rather than homosexuality.

Dimensions, content and validation of the fear of AIDS schedule in health professionals

We examined the structure of the Fear of AIDS Schedule (FAIDSS) in a sample of 134 health care workers. Factor analysis indicated that there were five discrete dimension of fear of AIDS: fears of loss of control, of sex, of HIV infection through blood and illness, of death and medical interventions, and of contact with outsiders. These dimensions had low to moderate intercorrelations. The dimensions of fear of HIV infection through blood or illness, was significantly correlated with desired personal social distance from people with AIDS, and this dimension along with fear of death and medical interventions were correlated with desired public social distance. Fear of infection through blood and illness were predictors of both desired personal social distance and public social distance from people with HIV infection. The data suggest greater discrimination of AIDS fears with greater closeness of interaction with people with HIV disease, and that these dimensions of the FAIDSS are both reliable and valid measures of AIDS fears.

Relative efficacy of intensive and spaced behavioral treatment of stuttering

Twenty adult and adolescent stutterers were randomly assigned to two treatment formats consisting of either 16 two-hour sessions of fluency training administered within a concentrated period of four consecutive days (intensive treatment), or two two-hour sessions per week for eight weeks (spaced treatment). Frequency of stuttering and rate of speaking were repeatedly assessed from speech samples obtained in six different clinic and extra-clinic speech settings. The efficiency of treatment, subject compliance, and communication "attitudes" were also measured. Fluency training produced significant reductions in stuttering frequency, and significant improvements in speaking rate and communication attitudes for both treatment formats. Both formats were found equivalent on all measures. In addition, generalization of treatment effects was observed in all settings. However, maintenance of generalization effects was uneven across settings, suggesting the possible need for differential levels of training for different speaking situations.

A comparison of methods for limiting myocardial infarct expansion during acute reperfusion--primary role of unloading

Current use of angioplasty, thrombolysis, and surgical techniques for prompt reperfusion of an acute myocardial infarction raises questions concerning the optimum reperfusion technique for maximum myocardial salvage. Alterations in the conditions of reperfusion and/or the composition of the initial reperfusate can exert a significant effect on the extent of myocardial salvage. In an effort to define an optimum reperfusion technique, we used 40 dogs in a series of experiments in which the left anterior descending coronary artery (LAD) was snared for 2 hr followed by reperfusion by one of five methods for 4 hr. In addition, in a control group(group I, n = 6) the LAD was occluded for 6 hr without any reperfusion. In group 2 (n = 12), simulating medical reperfusion, reperfusion was achieved by simply releasing the snare for 4 hr. Group 3 dogs (n = 6) were placed on pulsatile left atrial-femoral bypass throughout 4 hr of reperfusion. Group 4 dogs (n = 9) were placed on percutaneous, synchronized pulsatile cardiopulmonary bypass during reperfusion. The procedure in group 5 (n = 7) dogs simulated coronary artery bypass grafting with cardiopulmonary bypass and cold blood, low-Ca++ cardioplegia during reperfusion. Group 6 (n = 6) was treated similarly except that during reperfusion amino acid-enriched cardioplegia was administered by warm induction techniques. At the end of 4 hr of reperfusion, the left ventricular area of infarction was determined by triphenyltetrazolium chloride staining and expressed as a percentage of the left ventricular area at risk for infarction (area of infarction [AI]/area at risk [AR]).(ABSTRACT TRUNCATED AT 250 WORDS)

Time course of effective interventional left heart assist for limitation of evolving myocardial infarction

Previous work has shown that if pulsatile left atrial-femoral artery bypass is instituted after occlusion of the left anterior descending coronary artery for from 15 minutes to 2 hours, it can significantly limit the size of the infarct resulting 4 hours later. This study investigated whether pulsatile left atrial-femoral artery bypass begun after more clinically pertinent periods of initial ischemia can still significantly limit infarct expansion. After baseline measurements of hemodynamics, tension-time index, and regional myocardial blood flow in 73 open-chest, adult dogs, the left anterior descending coronary artery was ligated for 15 minutes or 1, 2, 4, or 6 hours of unprotected ischemia. In the five control groups, the initial ischemic period was merely extended for another 4 hours. In the five experimental groups, the animals were placed on pulsatile left atrial-femoral artery bypass for another 4 hours after the initial ischemic period. At the end of each procedure, gentian violet was used to identify the area at risk of infarction, and triphenyltetrazolium chloride was used to delineate the area of infarct. The results showed a significant reduction in the area of infarct as a percentage of the area at risk in each bypass group compared with its control group for all ischemic periods of less than 6 hours. These findings suggest that the maximum permissible ischemic time delay for myocardial salvage by pulsatile left atrial-femoral artery bypass is one which is pertinent in a clinical setting. The results justify continued attempts to develop appropriate techniques for percutaneous application of this modality to patients with an evolving myocardial infarction.

Quantification of pulsatile flow during cardiopulmonary bypass to permit direct comparison of the effectiveness of various types of "pulsatile" and "nonpulsatile" flow

The relative merits of adding a "pulsatile" component to flow during cardiopulmonary bypass (CPB) has long generated controversy, the resolution of which has been hampered by lack of quantification of the "pulsatility" delivered by different devices. The present experimental series had two goals: to quantify the "pulsatility" of blood flow during CPB in terms of pulse rate and pulsatility index (PI) and to examine which aspects of a "pulsed flow" provide clinical benefits. A flow waveform can be expressed in terms of its baseline rate and its PI, the sum of the square of its harmonics components divided by the square of the mean flow. We used PI to quantify the pulsatility of blood flow in the descending thoracic aorta and used changes in the serum lactate level as an indication of end organ flow. In one experimental series seven adult mongrel dogs were placed on roller pump CPB at a constant flow of 100 ml/kg/min. After a 20-minute stabilization period a roller pump wave and three different pulse shapes (generated by a computer-controlled hydraulic pump) were evaluated for 15 minutes each. The pulse wave shapes were graded, with C being the sharpest and A the least sharp. In a second series six other dogs were placed on CPB and were subjected to roller pump perfusion and three pulse waves of identical shape but at different rates. The results indicated that a combination of a minimum PI of 1.88 and a minimum rate of 80 bpm were necessary to significantly reduce lactate production as compared with roller pump perfusion. Thus the same mean flow can have very different physiologic effects depending on how it is delivered. This quantification method permits direct comparison of different "pulsatile waveforms" and provides a means for identification of optimal pulsatile flow.

Intracystic papillary carcinoma of the breast

The occurrence of a breast carcinoma within a breast cyst is rare. These tumors are usually papillary adenocarcinomas arising from the wall of macrocysts of the breast. The clinicopathologic course in seven patients is reviewed. Modified radical mastectomy has provided satisfactory surgical management and is the recommended therapy.

The use of bactericidal concentrations of antibiotics in hypothermic pulsatile perfusion and the effects on canine renal autograft function

Although cadaver allograft contamination occurs frequently, the potential danger to the transplant recipient varies. Usually the results of culture from the donor and kidney perfusates are not available at the time of transplantation. A positive culture result often necessitates the use of prophylactic antibiotics. The antibiotic may be potentially nephrotoxic, and in the setting of minimal or changing renal function this effect may be potentiated. If significant contamination with virulent organisms is found prior to transplantation, clinical judgment often dictates that the graft be discarded. Perfusion and storage with solutions containing broad-spectrum antibiotics would substantially reduce the incidence of contamination in perfused kidneys. This would in turn reduce the requirement for potentially nephrotoxic antimicrobial therapy in the transplant recipient. Since the antibiotics tested are effective against a wide range of contaminants and apparently cause no detrimental effects, it would seem reasonable to add them routinely to the perfusate solution.