Recombinant tissue plasminogen activator to restore catheter patency: efficacy and safety analysis from a multihospital NICU system

OBJECTIVE

In 2001, the US Food and Drug Administration approved recombinant tissue plasminogen activator (alteplase, Cathflo Activase) to reestablish patency of central catheters occluded, presumably, by a fibrin clot. We conducted a multicenter quality improvement study to determine the value of this procedure in our Neonatal Intensive Care Unit (NICUs), including analyses of efficacy, safety and costs.

STUDY DESIGN

We conducted a retrospective quality analysis of neonates in level III NICUs, who received alteplase for the purpose of reestablishing patency of occluded central catheters.

RESULTS

Alteplase was administered to 169 neonates, each given one to four doses, totaling 205 episodes of administration. The most common type of catheter where alteplase was used was percutaneously inserted central catheter (PICC) lines (78% of uses), 8% were umbilical venous catheters (UVCs), 6% arterial lines, 5% chest tubes and 3% other catheters. Postnatal age at first dose ranged from 0 to 132 days (median, 12); dosed patients were 22 to 41 weeks gestation at birth (median, 31). Fifty-eight percentage of administrations restored catheter function. Success was more likely at younger postnatal age (10±2 days old in successful vs 14±1 days in unsuccessful treatments; P=0.023). Seventy-two percentage of the re-canalized catheters remained functional until they were no longer needed (2 to 30 days later). Nine percentage of episodes were treated with a second dose 1 to 17 days later for re-occlusion and 50% of those were successful. Bleeding consequences were identified in only one case, where three separate lines were treated (chest tube, PICC and UVC) within a 6-h period. Costs to the health system of doses, minus savings to the system by not needing to replace lines, averaged a net of $34 per dose.

CONCLUSIONS

The apparent safety and favorable value analysis prompted us to develop a consistent approach to alteplase usage in the Intermountain Healthcare NICUs, using the data in this report to standardize the guidelines across our health system.

The menstrual bleeding questionnaire: development and validation of a comprehensive patient-reported outcome instrument for heavy menstrual bleeding

OBJECTIVE

To develop and validate a patient-reported outcome measure for women with heavy menstrual bleeding (HMB).

STUDY DESIGN

Prospective cohort and cross-sectional studies.

SETTING

Outpatient women's health facility.

POPULATION

Women aged between 18 and 55 years with and without self-reported HMB.

METHODS

Using data from patients and clinicians, we developed a patient-reported outcome measure for HMB; the Menstrual Bleeding Questionnaire (MBQ). Participants in the validation studies completed demographic and general health questionnaires and either (1) bleeding and quality of life data collected daily on handheld computers and the MBQ after 1 month or (2) the MBQ at enrolment only. A subset of women also completed the Short-form-36 (SF-36) generic quality of life questionnaire. We performed psychometric analyses of the MBQ to assess its internal consistency as well as its content and concurrent validity and ability to discriminate between women with and without HMB.

MAIN OUTCOME MEASURES

Psychometric properties of the questionnaire.

RESULTS

Overall, 182 women participated in the MBQ validation studies. We found that the MBQ domains were internally consistent (Cronbach's α = 0.87-0.94). There was excellent correlation between daily bleeding-related symptom data and the MBQ completed at 1 month (ρ > 0.7 for all domains). We found low to moderate correlation between the MBQ scores and SF-36 scores (ρ = -0.15 to -0.45). The MBQ clearly discriminated between women with and without HMB (mean MBQ score = 10.6 versus 30.8, P < 0.0001).

CONCLUSIONS

The MBQ is a valid patient-reported outcome measure for HMB that has the potential to improve the evaluation of women with self-reported HMB in research and clinical practice.

Axial transport within bidisperse granular media in horizontal rotating cylinders

The discrete element method has been used to examine axial dispersion within rotating cylinders containing two sizes of particle. Two bed configurations are considered: initially segregated, which consists of a pulse (narrow axial band) of small particles within a bed of large particles, and initially mixed, in which the cylinder is loaded with a homogeneous mixture of the two particle sizes. The dispersion of the small particles within initially segregated beds is found to depend strongly on the initial length of the pulse of small particles. Initially mixed beds are found to undergo a transient period in which the small particles disperse rapidly. Following this transient, axial dispersion of both particles sizes is found to follow Fick's second law, in that the mean squared deviation of the axial position of the particles is proportional to time. Axial dispersion coefficients have been calculated for initially mixed beds that have reached steady state; the axial dispersion coefficients of both particle sizes decrease as the volume fraction of small particles is increased.

Metal-Germanium Contacts and Germanide Formation

In this study, we survey germanide formation and characterize Schottky- barrier properties for a number of representative metals on Ge (Al, Ag, Au, Er, Ni, Pd, Pt, Ta and Ti). It is found that the germanide formation characteristics (sequence of phase formation, kinetics, moving species) are similar to those of the corresponding silicides. The Schottky-barrier heights, however, are all similar and centered around 0.59 eV arida re relatively insensitive to the metallization.

Pt and Pd Silicides and Pd Germanide as Contact Metallizations for GaAs

Refractory metal silicides have been shown to form stable Schottky barriers on GaAs up to an annealing temperature of ∼850°C. In this study, the metallurgical and electrical stability of near noble metal (Pd and Pt) silicide contacts to GaAs have been investigated. It is observed that Pd and Pt silicides are metallurgically more stable than Pd and Pt alone on GaAs. A correlation between the stability of silicide contacts and the heat of formation of the silicides normalized to per metal atom is found, thus allowing the prediction of contact stability of other silicides on GaAs. We have also investigated the feasibility of using solid-phase epitaxy (SPE) to grow a highly doped Ge epitaxial layer on GaAs to form a non-alloyed ohmic contact. This approach of forming a Ge/GaAs heterojunction alleviates the high vacuum requirement of MBE techniques. Our preliminary results indicate that relatively low contact resistivities can be obtained by SPE using the Ge-Sb-Pd system.

Regional Anaesthesia and Analgesia on the Front Line

Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier.

Untangling the roles of fire, grazing and rainfall on small mammal communities in grassland ecosystems

In grassland systems across the globe, ecologists have been attempting to understand the complex role of fire, grazing and rainfall in creating habitat heterogeneity and the consequences of anthropogenic control of these factors on ecosystem integrity and functioning. Using a South African grassland ecosystem as a model, we investigated the impact of fire and grazing pressure on small mammal communities during three differing periods of a rainfall cycle. Over 2 years, 15,203 trap nights revealed 1598 captures of 11 species (nine rodents, one macroscelid and one insectivore). Results highlighted the importance of the interplay between factors and showed that the role of fire, grazing and rainfall in determining small mammal abundance was species-dependant. While no two species were affected by the same environmental variables, grass cover or height was important to 56% of species. Considered independently, high rainfall had a positive influence on small mammal abundance and diversity, although the lag period in population response was species-specific. High grazing negatively affected overall abundance, but specifically in Mastomys coucha; fire alone had little immediate impact on small mammal diversity. Six months after the fire, vegetation cover had recovered to similar levels as unburned areas, although small mammal diversity and richness were higher in burned areas than unburned areas. Grazing levels influenced the rate of vegetation recovery. In conclusion, low-level grazing and burning can help to maintain small mammal biodiversity, if conducted under appropriate rainfall levels. A too high grazing pressure, combined with fire, and/or fire conducted under drought conditions can have a negative impact on small mammal biodiversity. To maintain small mammal diversity in grassland ecosystems, the combined effects of the previous year's rainfall and existing population level as well as the inhibition of vegetation recovery via grazing pressure need to be taken into consideration before fire management is applied.

Design, synthesis, and analysis of a polyethelene glycol-modified (PEGylated) small molecule inhibitor of integrin {alpha}4{beta}1 with improved pharmaceutical properties

Integrin alpha4beta1 plays an important role in inflammatory processes by regulating the migration of leukocytes into inflamed tissues. Previously, we identified BIO5192 [2(S)-{[1-(3,5-dichloro-benzenesulfonyl)-pyrrolidine-2(S)-carbonyl]-amino}-4-[4-methyl-2(S)-(methyl-{2-[4-(3-o-tolyl-ureido)-phenyl]-acetyl}-amino)-pentanoylamino]-butyric acid], a highly selective and potent (K(D) of 9 pM) small molecule inhibitor of alpha4beta1. Although BIO5192 is efficacious in various animal models of inflammatory disease, high doses and daily treatment of the compound are needed to achieve a therapeutic effect because of its relatively short serum half-life. To address this issue, polyethylene glycol modification (PEGylation) was used as an approach to improve systemic exposure. BIO5192 was PEGylated by a targeted approach in which derivatizable amino groups were incorporated into the molecule. Two sites were identified that could be modified, and from these, five PEGylated compounds were synthesized and characterized. One compound, 2a-PEG (K(D) of 19 pM), was selected for in vivo studies. The pharmacokinetic and pharmacodynamic properties of 2a-PEG were dramatically improved relative to the unmodified compound. The PEGylated compound was efficacious in a rat model of experimental autoimmune encephalomyelitis at a 30-fold lower molar dose than the parent compound and required only a once-a-week dosing regimen compared with a daily treatment for BIO5192. Compound 2a-PEG was highly selective for alpha4beta1. These studies demonstrate the feasibility of PEGylation of alpha4beta1-targeted small molecules with retention of activity in vitro and in vivo. 2a-PEG, and related compounds, will be valuable reagents for assessing alpha4beta1 biology and may provide a new therapeutic approach to treatment of human inflammatory diseases.

An assessment of the mechanistic differences between two integrin alpha 4 beta 1 inhibitors, the monoclonal antibody TA-2 and the small molecule BIO5192, in rat experimental autoimmune encephalomyelitis

Integrin alpha 4 beta 1 plays an important role in inflammatory processes by regulating the migration of lymphocytes into inflamed tissues. Here we evaluated the biochemical, pharmacological, and pharmacodynamic properties and efficacy in experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis, of two types of alpha 4 beta 1 inhibitors, the anti-rat alpha 4 monoclonal antibody TA-2 and the small molecule inhibitor BIO5192 [2(S)-[[1-(3,5-dichloro-benzenesulfonyl)-pyrrolidine-2(S)-carbonyl]-amino]-4-[4-methyl-2(S)-(methyl-[2-[4-(3-o-tolyl-ureido)-phenyl]-acetyl]-amino)-pentanoylamino]-butyric acid]. TA-2 has been extensively studied in rats and provides a benchmark for assessing function. BIO5192 is a highly selective and potent (KD of <10 pM) inhibitor of alpha 4 beta 1. Dosing regimens were identified for both inhibitors, which provided full receptor occupancy during the duration of the study. Both inhibitors induced leukocytosis, an effect that was used as a pharmacodynamic marker of activity, and both were efficacious in the EAE model. Treatment with TA-2 caused a decrease in alpha 4 integrin expression on the cell surface, which resulted from internalization of alpha 4 integrin/TA-2 complexes. In contrast, BIO5192 did not modulate cell surface alpha 4 beta 1. Our results with BIO5192 indicate that alpha 4 beta 7 does not play a role in this model and that blockade of alpha 4 beta 1/ligand interactions without down-modulation is sufficient for efficacy in rat EAE. BIO5192 is highly selective and binds with high affinity to alpha 4 beta 1 from four of four species tested. These studies demonstrate that BIO5192, a novel, potent, and selective inhibitor of alpha 4 beta 1 integrin, will be a valuable reagent for assessing alpha 4 beta 1 biology and may provide a new therapeutic for treatment of human inflammatory diseases.

Lymphangioma-like Kaposi's sarcoma: etiology and literature review

Much confusion surrounds a rare and occasionally described variant of Kaposi's sarcoma (KS) known as lymphangioma-like or bullous KS. We describe the typical clinical and histologic features and elucidate the etiologic cell in lymphangioma-like KS. A computer-based review of the English-language literature was performed. Routine histologic and immunoperoxidase techniques were performed on formalin-fixed tissue. Immunoperoxidase staining for anti-CD31, anti-CD34, and anti-factor VIII-related antigen suggests that the etiologic cell of origin is the vascular endothelial cell. Lymphangioma-like KS has been described for more than a century and given various names. Dilated vascular spaces correlate with the clinically bullous lesions, which are veritable KS and not a secondary reaction to it.

Timing Noise in SGR 1806-20

We have phase-connected a sequence of Rossi X-Ray Timing Explorer Proportional Counter Array observations of SGR 1806-20 covering 178 days. We find that a simple secular spin-down model does not adequately fit the data. The period derivative varies gradually during the observations between 8.1x10-11 and 11.7x10-11 s s(-1) (at its highest, approximately 40% larger than the long-term trend), while the average burst rate as seen with the Burst and Transient Source Experiment drops throughout the time interval. The phase residuals give no compelling evidence for periodicity, but more closely resemble timing noise as seen in radio pulsars. The magnitude of the timing noise, however, is large relative to the noise level typically found in radio pulsars (Delta8=4.8; frequency derivative average power approximately 7x10-20 cycles(2) s(-3)). Combining these results with the noise levels measured for some anomalous X-ray pulsars, we find that all magnetar candidates have Delta(8) values larger than those expected from a simple extrapolation of the correlation found in radio pulsars. We find that the timing noise in SGR 1806-20 is greater than or equal to the levels found in some accreting systems (e.g., Vela X-1, 4U 1538-52, and 4U 1626-67), but the spin-down of SGR 1806-20 has thus far maintained coherence over 6 yr. Alternatively, an orbital model with a period Porb=733 days provides a statistically acceptable fit to the data. If the phase residuals are created by Doppler shifts from a gravitationally bound companion, then the allowed parameter space for the mass function (small) and orbital separation (large) rule out the possibility of accretion from the companion sufficient to power the persistent emission from the SGR.

Crystal structures of Toxoplasma gondii adenosine kinase reveal a novel catalytic mechanism and prodrug binding

Adenosine kinase (AK) is a key purine metabolic enzyme from the opportunistic parasitic protozoan Toxoplasma gondii and belongs to the family of carbohydrate kinases that includes ribokinase. To understand the catalytic mechanism of AK, we determined the structures of the T. gondii apo AK, AK:adenosine complex and the AK:adenosine:AMP-PCP complex to 2.55 A, 2.50 A and 1.71 A resolution, respectively. These structures reveal a novel catalytic mechanism that involves an adenosine-induced domain rotation of 30 degrees and a newly described anion hole (DTXGAGD), requiring a helix-to-coil conformational change that is induced by ATP binding. Nucleotide binding also evokes a coil-to-helix transition that completes the formation of the ATP binding pocket. A conserved dipeptide, Gly68-Gly69, which is located at the bottom of the adenosine-binding site, functions as the switch for domain rotation. The synergistic structural changes that occur upon substrate binding sequester the adenosine and the ATP gamma phosphate from solvent and optimally position the substrates for catalysis. Finally, the 1.84 A resolution structure of an AK:7-iodotubercidin:AMP-PCP complex reveals the basis for the higher affinity binding of this prodrug over adenosine and thus provides a scaffold for the design of new inhibitors and subversive substrates that target the T. gondii AK.

Anaesthetic management of a parturient with a colloid cyst of the third ventricle

A colloid cyst in the third ventricle near the foramen of Monroe can obstruct cerebrospinal fluid (CSF) flow from the lateral ventricles. Any change in the CSF pressure on either side of the cyst can lead to displacement and thus precipitate acute hydrocephalus. Management of the confinement of a patient with a colloid cyst must therefore aim to minimize changes in CSF pressure. We describe our management of a patient with a small colloid cyst who was permitted to labour with the assistance of patient-controlled epidural analgesia. The available alternatives are discussed.

Crystal structures of Toxoplasma gondii adenosine kinase reveal a novel catalytic mechanism and prodrug binding

Adenosine kinase (AK) is a key purine metabolic enzyme from the opportunistic parasitic protozoan Toxoplasma gondii and belongs to the family of carbohydrate kinases that includes ribokinase. To understand the catalytic mechanism of AK, we determined the structures of the T. gondii apo AK, AK:adenosine complex and the AK:adenosine:AMP-PCP complex to 2.55 A, 2.50 A and 1.71 A resolution, respectively. These structures reveal a novel catalytic mechanism that involves an adenosine-induced domain rotation of 30 degrees and a newly described anion hole (DTXGAGD), requiring a helix-to-coil conformational change that is induced by ATP binding. Nucleotide binding also evokes a coil-to-helix transition that completes the formation of the ATP binding pocket. A conserved dipeptide, Gly68-Gly69, which is located at the bottom of the adenosine-binding site, functions as the switch for domain rotation. The synergistic structural changes that occur upon substrate binding sequester the adenosine and the ATP gi phosphate from solvent and optimally position the substrates for catalysis. Finally, the 1.84 A resolution structure of an AK:7-iodotubercidin:AMP-PCP complex reveals the basis for the higher affinity binding of this prodrug over adenosine and thus provides a scaffold for the design of new inhibitors and subversive substrates that target the T. gondii AK.

Peer-Led Alcohol Education program: a pharmacy student-led program for seventh-graders

OBJECTIVE

To delay or discourage the use of alcohol by seventh-grade students through peer-led education. Peer-Led Alcohol Education (PLAE) program objectives were to: (1) educate students about alcohol use and (2) assess the differences between pharmacy student presenters and high school student (peer) presenters.

SETTING

Middle schools in rural Nebraska.

DESIGN

PLAE focuses on normative beliefs, personal values, and pledging. Pharmacy students and high school students were trained to deliver alcohol education presentations to seventh-grade students. Evaluation results were compared among groups of seventh-grade students who received PLAE presentations from peer presenters and from pharmacy student presenters.

RESULTS

PLAE presentations were made to 342 seventh-grade students at 11 schools. Evaluation results suggest that pharmacy students projected more confidence in their presentations, used more creative prop selections, and were more effective communicators. High-school presenters had a greater ability to "relate" to the seventh-graders and thus were deemed more on-target with the information.

CONCLUSION

Evaluation findings suggest that rural seventh-grade students in Nebraska perceived that the PLAE program provides useful information to aid them in their decisions regarding alcohol use.

Fibrous hamartoma of infancy

Fibrous harmartoma of infancy is a benign soft tissue tumor that occurs in the first few years of life. Although the lesion is not distinctive clinically, it has a characteristic microscopic appearance. Only 12 cases of fibrous hamartoma of infancy have been reported in the dermatology literature.

Effectiveness of student assistance programs in Nebraska schools

BACKGROUND

This study investigated whether Nebraska schools with Student Assistance Programs (SAP) are associated with reduced adolescent alcohol use and a higher level of academic achievement than students from schools without a SAP.

METHODS

In 1992, the Toward a Drug Free Nebraska (TDFN) survey was administered to 3,454 students in grades seven to twelve at eighty-three Nebraska schools. A second survey, the TDFN "team activity report" collected from each school's team, the presence of a SAP (n = 34 schools) or absence of a SAP (n = 49 schools). Student responses for alcohol use and academic achievements were linked with the presence of a SAP through use of a school identification number on both surveys.

RESULTS

Students from schools with a SAP reported a lower use of alcohol in the last thirty days, compared with students from schools without a SAP program (p < 0.05), and they also reported a significant difference in academic achievement (p < 0.05).

CONCLUSIONS

While this study used post hoc analysis of data, the results suggest lower alcohol use and higher academic achievement among students from SAP schools. Given SAPs' popularity, these trends suggest that further research should be conducted to demonstrate the effectiveness of student assistance programs.

Characterization of genes encoding translation initiation factor eIF-2gamma in mouse and human: sex chromosome localization, escape from X-inactivation and evolution

The Delta Sxrb interval of the mouse Y chromosome is critical for spermatogenesis and expression of the male-specific minor transplantation antigen H-Y. Several genes have been mapped to this interval and each has a homologue on the X chromosome. Four, Zfy1 , Zfy2 , Ube1y and Dffry , are expressed specifically in the testis and their X homologues are not transcribed from the inactive X chromosome. A further two, Smcy and Uty , are ubiquitously expressed and their X homologues escape X-inactivation. Here we report the identification of another gene from this region of the mouse Y chromosome. It encodes the highly conserved eukaryotic translation initiation factor eIF-2gamma. In the mouse this gene is ubiquitously expressed, has an X chromosome homologue which maps close to Dmd and escapes X-inactivation. The coding regions of the X and Y genes show 86% nucleotide identity and encode putative products with 98% amino acid identity. In humans, the eIF-2gamma structural gene is located on the X chromosome at Xp21 and this also escapes X-inactivation. However, there is no evidence of a Y copy of this gene in humans. We have identified autosomal retroposons of eIF-2gamma in both humans and mice and an additional retroposon on the X chromosome in some mouse strains. Ark blot analysis of eutherian and metatherian genomic DNA indicates that X-Y homologues are present in all species tested except simian primates and kangaroo and that retroposons are common to a wide range of mammals. These results shed light on the evolution of X-Y homologous genes.

Cytologic-pathologic correlations: fine needle aspiration of three cases of steatocystoma multiplex

Steatocystoma multiplex is a rare condition characterized by multiple subcutaneous nodules classically located on the anterior chest. Diagnosis usually is made clinically or by biopsy. The lesions may be numerous, and surgical treatment may not be practical or the results may be unsatisfactory. Three patients with multiple subcutaneous nodules underwent fine needle aspiration, which produced smears with acellular debris. A diagnosis was possible in the first patient because of close collaboration with a dermatologist. The lesions in the other patients were recognized clinically and were confirmed cytologically by fine needle aspiration. A syringe holder allows the use of thin needles (22-gauge) to aspirate very small lesions (4 to 5 mm). Fine needle aspiration may provide a useful alternative to surgical methods in the treatment of these lesions because it is inexpensive, well-tolerated by the patients, and has no associated morbidity.

A preliminary study of immunologic and hematologic profiles of peripheral blood from Nebraska farmers who apply pesticides to their fields

OBJECTIVE

Laboratory studies have documented a wide range of pesticide-induced changes in the hematopoietic and lymphoreticular systems. Some of these are expressed as altered serum values, blood cell counts, and leucocyte functions. The goal of the present study was to determine whether these alterations were evident in peripheral blood of Nebraska farmers who applied pesticides to their fields.

METHODS

An invitation to participate was mailed to 100 residents (70 farmers; 30 controls) of Butler County, Nebraska. All respondents (51 farmers and 21 controls) were enrolled and surveyed by written questionnaire for health status and pesticide use. Our analysis included 45 farmers and 18 controls. The farmers were divided into a high (n = 23) and a low (n = 22) pesticide use group. Statistical correlations of ten blood values with both pesticide use and age were evaluated, since pesticide use correlated with age.

RESULTS

Four of the ten blood values correlated with pesticide use and age (Spearman Rho). In a multiple regression model, pesticide use (not age) proved to be a predictor of red blood cell count and hematocrit. In the same model, pesticide use was not a predictor of mean red cell volume or candida antigen-induced T-lymphocyte proliferation. Serum complement activity did not correlate with pesticide use among the farmers (n = 45) but was significantly reduced (ANOVA) in the high pesticide use group, compared to controls.

CONCLUSIONS

A preliminary study of blood values in a small cohort of Nebraska farmers found no pesticide-associated effects on 1) leucocyte count, 2) antigen- and mitogen-stimulated T-cell proliferation, 3) mitogen-stimulated B-cell proliferation, and 4) concentrations of serum IgG and IgM. The study found small but statistically significant pesticide-associated effects on red blood cells and serum complement.

Crystal structures of Toxoplasma gondii uracil phosphoribosyltransferase reveal the atomic basis of pyrimidine discrimination and prodrug binding

Uracil phosphoribosyltransferase (UPRTase) catalyzes the transfer of a ribosyl phosphate group from alpha-D-5-phosphoribosyl-1-pyrophosphate to the N1 nitrogen of uracil. The UPRTase from the opportunistic pathogen Toxoplasma gondii is a rational target for antiparasitic drug design. To aid in structure-based drug design studies against toxoplasmosis, the crystal structures of the T.gondii apo UPRTase (1.93 A resolution), the UPRTase bound to its substrate, uracil (2.2 A resolution), its product, UMP (2.5 A resolution), and the prodrug, 5-fluorouracil (2.3 A resolution), have been determined. These structures reveal that UPRTase recognizes uracil through polypeptide backbone hydrogen bonds to the uracil exocyclic O2 and endocyclic N3 atoms and a backbone-water-exocyclic O4 oxygen hydrogen bond. This stereochemical arrangement and the architecture of the uracil-binding pocket reveal why cytosine and pyrimidines with exocyclic substituents at ring position 5 larger than fluorine, including thymine, cannot bind to the enzyme. Strikingly, the T. gondii UPRTase contains a 22 residue insertion within the conserved PRTase fold that forms an extended antiparallel beta-arm. Leu92, at the tip of this arm, functions to cap the active site of its dimer mate, thereby inhibiting the escape of the substrate-binding water molecule.

Impact of OBRA '90 on pharmacists' patient counseling practices

OBJECTIVE

To assess the impact of OBRA '90 regulations on the counseling practices of community pharmacists in Nebraska.

METHODS

A telephone survey was conducted of 80 randomly selected community pharmacies throughout Nebraska. A modified written survey was mailed to the 34 telephone nonrespondents and to another 86 randomly selected community pharmacists. A composite response rate (combining both survey methods) of 67.5% (112 of 166) was obtained, and responses were sorted into an independent community pharmacy group (n = 80) and a chain pharmacy group (n = 32).

RESULTS

Only 44.6% of respondents reported that time devoted to patient counseling had increased as a result of OBRA '90. Chain pharmacists generally devoted more time to counseling after OBRA '90 became effective than did independent community pharmacists.

CONCLUSION

While more than three out of four pharmacists felt adequately prepared for mandated patient counseling, fewer than half reported that time devoted to counseling had increased. Although the profession is moving toward the standard of pharmaceutical care, many pharmacists are not yet counseling as the law requires.

Why do some females reject males? The molecular basis for male-specific graft rejection

The male-specific minor histocompatibility antigen H-Y plays an important role in both graft rejection and graft-versus-host disease following transplantation of male tissue into females that are completely matched at the major histocompatibility loci. The recent identification of two peptides that, in association with the mouse H-2Kk or human HLA B7 major histocompatibility class I molecules, are recognised by H-Y-specific T cells, has provided evidence for the molecular basis for such anti-H-Y responses. These peptides are encoded by the mouse and human homologues of a ubiquitously expressed Y chromosome gene, Smcy, whilst the equivalent peptides encoded by the X chromosome homologues of this gene fail to be recognised. Genetic studies have demonstrated that, as is the case for other minor histocompatibility antigens, peptide epitopes from several closely linked genes may be required to interact in order to elicit a response against H-Y. Definition of the peptides and the genes that encode these epitopes will allow the development of tolerogenic protocols that could specifically down-modulate the response to H-Y and perhaps even other minor histocompatibility antigens.

Anabolic steroid use among adolescents in Nebraska schools

The extent of anabolic steroid use among adolescent sports participants and nonparticipants in Nebraska schools was studied. The Nebraska Secondary School Survey administered in 1991 contained 19 new items designed to determine rates of use of anabolic steroids and to measure participation in school sports. Schools participating in the survey are part of the Toward a Drug Free Nebraska training project; when the 1991 survey was conducted, training did not address ergogenic drug use. The survey was administered on a voluntary and confidential basis to Nebraska students in grades 7 through 12. A total of 4722 students in 62 secondary schools were surveyed; 3183 (67.4%) identified themselves as participants in school-sponsored sports. Of all the respondents, 117 (2.5%) reported having used anabolic steroids in the preceding 30 days. Some 4.5% of all the male respondents were steroid users, versus 0.8% of all the females. Of the students who reported using anabolic steroids, 72.6% were sports participants. Steroid users, whether they participated in sports or not, were more likely to use alcohol, tobacco, and other drugs than were nonusers of steroids. Among sports participants and nonparticipants, anabolic steroid users were more likely than nonusers to report acting violently. Nebraska students (grades 7 through 12) who participated in school-sponsored sports were more likely than non-participants to use anabolic steroids. Steroid-using athletes were more likely to use alcohol, tobacco, and other drugs than athletes who did not use steroids.

Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate

BACKGROUND

There is some evidence that the perception of bronchoconstriction may very according to the nature of the provoking stimulus. The aims of this study were, firstly, to develop a method for measuring dyspnoea during induced bronchoconstriction in patients with asthma and, secondly, to apply this method to testing differences between directly and indirectly acting bronchoconstricting stimuli.

METHODS

Descriptive terms suitable for quantifying respiratory discomfort due to bronchoconstriction in patients with asthma were identified in a preliminary investigation. The relation between reduction in forced expiratory volume in one second (FEV1) and respiratory discomfort, measured using a visual analogue scale (VAS), was then studied during challenges with three different inhaled stimuli: methacholine (MCH), sodium metabisulphite (MBS), and adenosine monophosphate (AMP). Three indices were calculated to describe the relation: the VAS value associated with a 20% fall in FEV1 (FEV20 VAS); the ratio of the final VAS value to the final percentage fall in FEV1 (VAS-FEV1 ratio); and the regression coefficient for predicting VAS from the percentage fall in FEV1 within each challenge (beta VAS FEV1).

RESULTS

"Difficulty in breathing" and "chest tightness" were selected as suitable terms for quantifying respiratory discomfort. There were no differences between the three agonists in the qualitative aspects of the respiratory sensation. In paired challenges with the same agonist the three indices were all found to be reproducible for both sensations measured. MCH induced less intense difficulty in breathing and chest tightness for a given fall in FEV1 than did AMP. There was a trend in the same direction for the comparison between MCH and MBS. There were no differences between AMP and MBS. FEV20 VAS was less powerful in discriminating between agonists than the two slope indices.

CONCLUSIONS

The relation between induced reduction in FEV1 and the intensity of respiratory discomfort can be measured reliably. The indirectly acting bronchoconstricting agonists AMP and MBS induced more intense respiratory discomfort for a given fall in FEV1 than the direct agonist MCH. This may be due to differences in unmeasured mechanical changes in the lungs or to an additional action on airway sensory nerves.

Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma

Asthma and chronic obstructive pulmonary disease are characterized by chronic airway inflammation. Studies using bronchoalveolar lavage (BAL) have shown an increased proportion of eosinophils in the BAL fluid from asthmatics compared with that from normal subjects, whereas studies of chronic obstructive pulmonary disease (COPD) have shown increased numbers of neutrophils. Induced sputum allows sampling of respiratory tract secretions from patients and control subjects, providing a noninvasive method of studying airway secretions and allowing characterization of cells and measurement of soluble markers. We investigated whether induced sputum was a useful method of studying airway fluid from patients with moderate to severe COPD and whether it could be used to compare inflammation in this condition with that in asthma. An initial reproducibility study was undertaken. Sputum was induced twice in 13 patients with severe COPD at a 14-d interval. Total and differential cell counts were carried out and were found to be reproducible over this period. Sputum was then induced in 14 patients with COPD, 23 patients with asthma, 12 healthy cigarette smokers, and 16 normal nonsmoking control subjects. We found a significant increase in neutrophils and increased concentrations of tumor necrosis factor-alpha (TNF alpha) and interleukin-8 (IL-8) in the patients with COPD compared with the smoking and nonsmoking control subjects. Interleukin-8, but not TNF alpha, was significantly higher in the COPD group than in the asthmatic group. We conclude that the cytokines TNF alpha and IL-8 may be involved in the inflammation in COPD.

Identification of a mouse male-specific transplantation antigen, H-Y

The male-specific transplantation antigen, H-Y, causes rejection of male tissue grafts by genotypically identical female mice and contributes to the rejection of human leukocyte antigen-matched male organ grafts by human females. Although first recognized 40 years ago, the identity of H-Y has remained elusive. T cells detect several distinct H-Y epitopes, and these are probably peptides, derived from intracellular proteins, that are presented at the cell surface with major histocompatibility complex (MHC) molecules. In the mouse, the gene(s) controlling H-Y expression (Hya) are located on the short arm of the Y chromosome between the zinc-finger genes Zfy-1 and Zfy-2. We have recently identified Smcy, a ubiquitously expressed gene, in this region and its X-chromosome homologue, Smcx. Here we report that Smcy encodes an H-YKk epitope that is defined by the octamer peptide TENSGKDI: no similar peptide is found in Smcx. These findings provide a genetic basis for the antigenic difference between males and females that contributes towards a tissue transplant rejection response.

Pharmacists as nonprescription drug advisors

This field study tested the ability of pharmacists to counsel patients with diabetes mellitus on the contraindicated use of a decongestant. The study was modeled after a 1969 study conducted by Knapp et al. Our simulation used a patient with diabetes who questioned pharmacists initially about proper insulin storage and then asked about the use of Contac (phenylpropanolamine) capsules, which carry a prominent label warning against use by diabetic patients. A research assistant, posing as the patient, interviewed pharmacists at 36 community pharmacies in a midwestern metropolitan area. Eleven of the pharmacists (30.5%) failed to warn the patient about the contraindication, compared with 83% in the earlier study.

A survey of alcohol and other drug use behaviors and risk factors in health profession students

This survey assessed the alcohol and other drug (AOD) use habits and risk factors of health profession students at a midwestern university health science center. The authors administered a 75-item survey to 1,707 students in selected classrooms: 984 students responded for a return rate of 57.6%. In 1990, they found, alcohol use among the health profession students in the past year was comparable to that of undergraduate college students nationally (86%), although significantly fewer health profession students drank heavily (27% had five or more drinks in the past 2 weeks, compared with 41% of college students). The percentage of health profession students who reported using tobacco or illicit drugs was lower than the percentage of undergraduate students who used these substances. At the time of the study, 16% of the respondents may have had a potential current alcohol problem and 3.5% a potential drug problem. Pharmacy students most often reported negative consequences from their AOD use. Peer pressure influenced the drinking decisions of 55% of the respondents; students in dentistry and pharmacy experienced the least support from peers for their decisions to abstain from drinking. Family histories of alcohol problems were reported by 38% of the respondents, and family histories of drug use by 14.8%. Male health profession students, when compared with the female professional students, drank more and experienced more consequences of their drinking or drug use and were also more influenced by peers.

Process evaluation of Nebraska's Team Training Project

BACKGROUND

A process evaluation of the Nebraska Drug Free School/Community Residential Team Training Project is described. This training project utilizes a "system approach" in the formation and implementation of localized strategic (action) plans targeting alcohol and other drug (AOD) abuse prevention.

METHODS

In June of 1990, training participants completed a pre-post survey in conjunction with the four-day training. The majority of the participants (51.2%) were teachers, 19.2 percent were parents, 13.6 percent administrators, and 9.6 percent were counselors.

RESULTS

Although the overall attitudes of the participants (N = 125) were positive initially, they became even more so by the end of the training (N = 121). Prior to training participants felt they could have a significant impact on their local AOD abuse problem, and this attitude became more positive by the completion of training (p < 0.05).

CONCLUSIONS

The Nebraska team training process immerses team members in an active planning process allowing teams to develop a plan of action for their school and community. During this process, participants experience a positive growth in attitudes reflecting not only the training experience itself, but even more importantly their ability to meaningfully affect AOD abuse and related destructive behaviors in their homes, schools, and community.

Prevention of substance use problems: models, factors, and processes

The use of substances for medical or nonmedical reasons occurs in most cultures. Regardless of the reason for use, however, most types of substance use (or drug-taking behaviors) have their associated problem states. The prevention of substance use problems is an important issue and need in every society. In this review we present and discuss various models and factors that purport to describe and predict patterns of drug use, and we discuss various strategies to prevent the occurrence of substance use problems.

The use of Ender nails in femoral shaft fractures: what are the remaining indications?

The use of Ender nails for the treatment of femoral shaft fractures has been described as technically easier and less time consuming than current intramedullary nailing techniques. We reviewed our results with unlocked Ender nails in 26 stable and 17 unstable fracture patterns an average of 3-4 years after injury. Because of continued instability, 42% of the stable and 76% of the unstable groups required adjunctive stabilization in the form of skeletal traction, a cast, or an external fixator. Additionally, nail migration and shortening and loss of motion at the knee were seen in 14 fractures in each group. Although two thirds of the patients with stable fracture patterns obtained good or excellent results, no outcome in the unstable group was rated excellent and only 19% were considered good. We therefore recommend that rigid locked intramedullary nails be used in femoral diaphyseal injuries. The use of Ender nails should be limited to stable fracture patterns and locked with screws or wires. They may be particularly useful for fractures in femora with small medullary canals (less than or equal to 8 mm), fractures below noncemented femoral prostheses, and fractures in young children requiring intramedullary stabilization without injuring the physeal plates.

Factors affecting pharmacists' selection of rural or urban practice sites in Nebraska

A questionnaire was used to determine why pharmacists in Nebraska chose urban or rural practice sites and to help the University of Nebraska College of Pharmacy encourage students to consider rural practice. Questionnaires were mailed to 1427 Nebraska pharmacists to gather data about their practice, job satisfaction, location of rearing, location of spouse's rearing, and prepharmacy and clerkship training. Usable responses were sorted into those from urban pharmacists (residing in Omaha and Lincoln and their suburban areas) and those from rural pharmacists (all others). Of the 689 usable responses, 315 (45.7%) were from urban pharmacists and 374 (54.3%) were from rural pharmacists. Of the rural pharmacists, 93% [corrected] grew up in communities of fewer than 100,000 people and 60% grew up in communities of fewer than 5,000 people. Respondents cited income potential, desirability of practice site, influence of spouse and family, and quality of children's schools as factors that most influenced their choice of practice site. Based on the survey results, the University of Nebraska College of Pharmacy took actions to recruit students from rural communities and increase students' exposure to rural practice settings. Pharmacists who were reared or trained in rural areas were more likely to practice in rural Nebraska than pharmacists who had only urban experience.

A new approach to the cloning of genes encoding T-cell epitopes

The molecular structure of antigens recognized exclusively by T cells, such as minor histocompatibility antigens and some antigens that provoke autoimmune responses, has proved difficult to determine. Recently, several antigens induced on tumor cells by mutagen treatment have been cloned by transfection of genomic DNA libraries into P1.HTR cells, screening for antigen expression using T-cell clones, and subsequent recovery of the integrated DNA by cosmid rescue. We have modified this technique and have stably transfected P1.HTR cell lines with polyoma T antigen, which allows episomal replication of the shuttle vector, pCDM8. Using pCDM8-CAT constructs, we have determined the frequency of transfection and plasmid copies taken up per cell under optimal transfection conditions. Using a pCDM8 construct which expresses the tumor-specific antigen, P91A (pCDM8-tum-), that is recognized by a T-cell clone, we have found that cells transfected with this antigen can be recognized by the T-cell clone when they are present at only 1%-3% of a mixed population. Progeny of a single cell transfected with pCDM8-tum-: pCDM8-CAT at proportions of 1:10, 1:25, and 1:50 are recognized by the T-cell clone. Furthermore, Hirt extracted plasmid DNA from transfectants expressing the tum- antigen can be amplified in bacteria, transfected back into P1.HTR recipients, and recognized by the T-cell clone. This approach should enable reasonably rapid screening of cDNA libraries for even relatively low abundance messages encoding, for example, minor histocompatibility and alloantigens, and allow their subsequent cloning.

Studies on the phenotype and karyotype of immortalized rabbit kidney epithelial cell lines

Differentiated mammalian cell lines can be isolated by immortalizing primary cells by transfection with DNA from plasmids containing sequences from SV40 early region. These cell lines show cytogenetic abnormalities but the degree of aneuploidy is considerably less than that observed in other established cell lines. No correlation was observed between the degree of differentiation of a clone and the extent of chromosomal damage.

Performance of BOC Ohmeda Tec 3 and Tec 4 vaporisers following tipping

The introduction of systems to facilitate the changing of vaporisers on the back bar of the anaesthetic machine has increased the risk of a vaporiser being tipped or inverted prior to attachment. The performance of three Ohmeda Tec 3 and three Ohmeda Tec 4 vaporisers following tipping to 30 degrees, 90 degrees and inversion to 180 degrees was measured using a calibrated Datex Capnomac AGM-103 analyser. Both types of vaporiser when switched off tolerated tipping and inversion without alteration of the anaesthetic concentration subsequently delivered. The same was true for the Tec 3 after tipping to 30 degrees and 90 degrees with the dial set at zero or above. However, after inversion of the Tec 3 vaporiser with the dial at zero or higher, the anaesthetic concentration delivered was much greater than shown on the dial, initially exceeding 12% for all agents. Should a Tec 3 vaporiser be inverted with the dial at any setting other than OFF, it is necessary to adequately flush it with fresh gas and check its output prior to use.