Investigation of patients' understanding of fibromyalgia: Results from an online qualitative survey

OBJECTIVE

An important component to effective fibromyalgia treatment is patient education about the condition. While previous educational interventions have been developed, these have not incorporated the lived experiences of patients and may not address common misunderstandings among those who may benefit from these interventions. This study aimed to explore understanding, confusion, and gaps in knowledge about fibromyalgia among those who report a fibromyalgia diagnosis.

METHODS

Participants were recruited via clinic flyers and the social media page of a chronic pain research laboratory. Participants completed an online survey that assessed their knowledge of fibromyalgia via open-ended questions. Responses were analyzed via thematic analysis to identify, analyze, and report themes.

RESULTS

Thirty-eight participants completed the survey (63% female, ages 18-68). Common themes that arose from patients included being unsure of the cause of their fibromyalgia, frustration and confusion about the random/variable nature of symptoms and flares, feeling that their condition was invisible, and desiring more information on available treatments.

CONCLUSION

Participants in this study expressed confusion about many aspects of fibromyalgia and a desire for more understanding from others in their life about this condition.

PRACTICE IMPLICATIONS

Future interventions would benefit from tailoring fibromyalgia education to the specific knowledge and lived experiences of patients.

Farmworker Mobility and COVID-19 Vaccination Strategies: Yuma County, Arizona, 2021

Farmworkers, a group of essential workers, experience a disproportionately high burden of COVID-19 due to their living and working conditions. This project characterized farmworker mobility in and around Yuma County, Arizona, to identify opportunities to improve farmworker access to COVID-19 vaccination. We collected qualitative and geospatial data through a series of in-person and virtual focus group discussions, key informant interviews, and intercept interviews with participatory mapping. Participants included farmworkers, employers, and representatives of local institutions who serve or interact with farmworkers. We identified participants through purposive and referential sampling and grouped people by sociodemographic characteristics for interviews. We used qualitative and geospatial analyses to identify common themes and mobility patterns. The team interviewed 136 people from February 26 to April 2, 2021. Common themes emerged about how farmworkers have little or no access to COVID-19 vaccination unless offered at their workplaces or at locations where they congregate at convenient times. Further, farmworkers described how their demanding work schedules, long commute times, and caretaker commitments make it challenging to access vaccination services. Geospatial analyses identified three geographic areas in Yuma County where farmworkers reported living and working that did not have a COVID-19 vaccine clinic within walking distance. Coordination between local public health authorities and key partners, including employers and trusted representatives from local community-based organizations or the Mexican consulate, to offer vaccination at worksites or other locations where farmworkers congregate can help improve access to COVID-19 vaccines and booster doses for this population.

Survey of selected pathogens in free-ranging pinnipeds in Uruguay

Marine mammals, regarded as sentinels of aquatic ecosystem health, are exposed to different pathogens and parasites under natural conditions. We surveyed live South American fur seals Arctocephalus australis and South American sea lions Otaria flavescens in Uruguay for Leptospira spp., canine distemper virus (CDV), Mycobacterium spp., Toxoplasma gondii, and Neospora caninum. Samples were collected from 2007 to 2013. The seroprevalence of Leptospira spp. was 37.6% positive, 50.9% negative, and 11.5% suspect for A. australis (n = 61) while for O. flavescens (n = 12) it was 67% positive, 25% negative, and 8% suspect. CDV RNA was not detected in any of the analyzed samples. Most animals tested seropositive to tuberculosis antigens by WiZo ELISA (A. australis: 29/30; O. flavescens: 20/20); reactivity varied with a novel ELISA test (antigens MPB70, MPB83, ESAT6 and MPB59). Seroprevalence against N. caninum and T. gondii was 6.7 and 13.3% positive for O. flavescens and 0 and 2.2% positive for A. australis respectively. To evaluate possible sources of infection for pinnipeds, wild rats Rattus rattus and semi-feral cats Felis catus were also tested for Leptospira spp. and T. gondii respectively. Water samples tested for Leptospira revealed saprofitic L. bioflexa. Pathogenic Leptospira were detected in the kidneys of 2 rats, and cats tested positive for T. gondii (100%). These results represent a substantial contribution to the study of the health status of wild pinnipeds in Uruguay.

Burnout and Compassion Satisfaction: Survey Findings of Healthcare Employee Wellness During COVID-19 Pandemic using ProQOL

Introduction

Healthcare systems are being bombarded during the COVID-19 pandemic. Understanding burnout, compassion fatigue, and potential protective factors, such as compassion satisfaction, will be important in supporting the vital healthcare workforce. The goal of the current study was to understand the key factors of burnout, compassion fatigue, and compassion satisfaction among healthcare employees during the pandemic within the U.S. in April 2020.

Methods

The authors conducted a single-center, cross-sectional online survey using the Professional Quality of Life (ProQOL) Questionnaire and three open-ended questions around stress and responses to stress during COVID-19 at a large Midwestern academic medical center with nearly 16,000 employees.

Results

Healthcare employees (613) representing over 25 professions or roles and 30 different departments within the health system were surveyed. Participants reported low levels of compassion fatigue and burnout, but moderate levels of compassion satisfaction. Compassion satisfaction was notably higher than prior literature. Key areas of stress outside of work included family, finances and housing, childcare and homeschooling, and personal health.

Conclusions

This was a cross-sectional survey, limiting causal analyses. Also, based on the qualitative responses, the ProQOL was somewhat insufficient in assessing the breadth of stressors, particularly outside of work, that healthcare employees faced due to the pandemic. Although compassion satisfaction was elevated during the initial phases of the pandemic, providing some possible protection against burnout, this may change as COVID-19 continues to surge. Healthcare systems are encouraged to assess and address the broad range of work and non-work-related stressors to best serve their vital workforce.

Histomorphology of prepuberal ovaries in the South American fur seal (Arctocephalus australis Zimmerman, 1783)

The South American fur seal reproductive histophysiology is scarcely described. This study provides a histological description of prepuberal South American fur seal (Arctocephalus australis) ovaries as well as three-dimensional reconstructions of subcapsular crypts and primordial follicles. Ovaries from fresh dead animals were processed for histology and sliced into serial sections. A portion of the superficial cortex was photographed, and the images were processed using BioVis3d software in order to generate 3-dimensional reconstructions. A. australis prepuberal ovaries conform to the basic structure of pinnipedian species, with a subcapsular crypts system made up of interconnecting cisternae and tubules with multiple openings to the surface. Generally, the primordial follicles were arranged in a monolayer beneath the tunica albuginea and were closely associated with subcapsular crypts. The large number of interstitial cells distributed throughout the cortex was the main histological feature in comparison with previous reports in other seals. Three-dimensional reconstructions modelled the subcapsular crypts microarchitecture and showed the close spatial relationship between the crypts and the primordial follicles. Despite the fact that the general ovarian histological structure was similar to that of other pinnipeds, the large number of interstitial cells is a distinctive feature that raises the question about the origin and function in A. australis with regard to the steroidogenic activity reported in other seal species.

Histology of lamb epididymal development

To describe the distribution of the histological regions and their morphometry during epididymal development, 10 Corriedale lambs were castrated monthly from 90 to 180 days of age (n = 24), and their testes and epididymides were weighed. All animals were weighed monthly. Epididymides were divided into caput, corpus and cauda, and cut sagitally so that sections included all the length of the organ. The diameter of the epididymal duct, the smooth muscle depth and the epididymal epithelium height were measured. The quantitative histology of the ovine epididymal development was described. Epididymal development advanced from caput to cauda. The distribution of the histological regions varied according to epididymal weight. Transient histological regions were found during epididymal development. The present results indicate a new way of epididymal development in sheep, which courses from caput to cauda with transient histological regions appearing, varying in location and disappearing during ovine epididymis development.

Hodgkin's disease involving the large bowel

Hodgkin's disease (HD) is a malignancy that rarely affects the gastrointestinal tract. We describe a patient with disseminated, relapsed HD, in whom HD was found in a colorectal polyp. We also review the literature regarding HD involving the colon. To our knowledge, this is the first reported case of colonic HD presenting as a polyp.

Paper-like electronic displays: large-area rubber-stamped plastic sheets of electronics and microencapsulated electrophoretic inks

Electronic systems that use rugged lightweight plastics potentially offer attractive characteristics (low-cost processing, mechanical flexibility, large area coverage, etc.) that are not easily achieved with established silicon technologies. This paper summarizes work that demonstrates many of these characteristics in a realistic system: organic active matrix backplane circuits (256 transistors) for large ( approximately 5 x 5-inch) mechanically flexible sheets of electronic paper, an emerging type of display. The success of this effort relies on new or improved processing techniques and materials for plastic electronics, including methods for (i) rubber stamping (microcontact printing) high-resolution ( approximately 1 microm) circuits with low levels of defects and good registration over large areas, (ii) achieving low leakage with thin dielectrics deposited onto surfaces with relief, (iii) constructing high-performance organic transistors with bottom contact geometries, (iv) encapsulating these transistors, (v) depositing, in a repeatable way, organic semiconductors with uniform electrical characteristics over large areas, and (vi) low-temperature ( approximately 100 degrees C) annealing to increase the on/off ratios of the transistors and to improve the uniformity of their characteristics. The sophistication and flexibility of the patterning procedures, high level of integration on plastic substrates, large area coverage, and good performance of the transistors are all important features of this work. We successfully integrate these circuits with microencapsulated electrophoretic "inks" to form sheets of electronic paper.

Nutritional management during fetal and postnatal life, and the influence on testicular stereology and Sertoli cell numbers in Corriedale ram lambs

The aim of the experiment was to determine whether supplementation of the lamb-ewe unit during intra-uterine and postnatal life affects testicular stereology, particularly Sertoli cell numbers, in 120 pregnant Corriedale ewes grazed either native pastures (control group) or improved pastures+grain supplement (treated group). Ewes bearing single ram lambs were maintained under the same feeding regime until lambs were castrated (99 days of age). Body weight, testosterone and FSH blood serum levels were recorded at 45, 75 and 99 days of age. Body weight was higher (P<0.01) in the treated group from birth on. Serum testosterone values did not differ between groups. Serum FSH values tended to differ at 45 days of age (P<0.06). Testicular weight and testes histology showed earlier pubertal development and a tendency for higher Sertoli cell numbers in the treated (supplemented) group. This tendency may indicate that extensively reared lambs supplemented during fetal and postnatal life have higher testicular growth and sperm production in later life.

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience

STUDY DESIGN

Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP.

SETTING

Sexual rehabilitation clinic, Neuro-Rehabilitation department, Sheba Medical Center, Israel.

METHODS

Between June 1992 and May 1998, a total of 84 consecutive SCIP were treated in our clinic with electro-ejaculation (EEJ), representing a sample of the SCIP population, composed mostly of young men traumatically injured. The patients have sustained different levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3%), while the rest were interested in determining fertility potential for family. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determination or for fertilization.

RESULTS

Eighty-four patients were treated by EEJ. Mean age was 31.3 and mean age at injury was 21.7. There were 29 cervical, 50 thoracic and five lumbar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (ASIA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sperm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility and morphology of spermatozoa were low in most cases. A significant difference in sperm count, motility and morphology was noted between antegrade and retrograde samples. No significant improvement in sperm quality after four repeated consecutive stimulations was noted in 38 SCIP. Side effects were minor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of In-Uterine-Insemination (pregnancy rate 28.6% per couple), and 15 after 68 cycles of In-Vitro-Fertilization (micromanipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and accounting for an overall pregnancy rate of 70% per couple.

CONCLUSION

The high percentage of pregnancies imply that, despite the typically poor sperm motility noted in EEJ, rectal probe EEJ combined with assisted reproductive techniques, and performed by a team approach, is an efficient and safe technique for treating infertility among SCIP.

Boundary tracking in 3-D binary images to produce rhombic faces for a dodecahedral model

An algorithm is presented for tracking boundaries in three-dimensional binary images based on rhombic dodecahedral voxels. The algorithm produces a list of all the rhombic voxel faces in such a boundary.

The course after cataract extraction, intraocular lens implantation, and trabeculectomy for patients with diabetes

BACKGROUND AND OBJECTIVE

To evaluate the postoperative recovery of the anterior segment and the course of diabetic retinopathy following a combined procedure of an extracapsular cataract extraction with posterior chamber intraocular lens implantation and trabeculectomy in diabetic patients with glaucoma.

PATIENTS AND METHODS

The records of diabetic patients with uncontrolled glaucoma and cataract, who underwent a combined procedure in one eye, were retrospectively reviewed.

RESULTS

Eleven patients were included. The mean intraocular pressure and the amount of antiglaucomatous medications required to control it were both reduced postoperatively. Anterior segment complications included hyphema in 4 eyes (37%), fibrin formation in 4 eyes (37%), and posterior synechia in 3 eyes (27%). The hyphema resolved spontaneously and the fibrin disappeared following increased administration of steroids. Development of diabetic retinopathy occurred in 1 eye (9%). Cystoid macular edema without other evidence of diabetic retinopathy was observed in 1 eye (9%).

CONCLUSION

The control of intraocular pressure is improved in diabetic patients who have undergone this combined procedure. The postoperative course in these diabetic patients is similar to that previously described in the general population.

Mouse Eotaxin expression parallels eosinophil accumulation during lung allergic inflammation but it is not restricted to a Th2-type response

A model of lung eosinophilia based on the repeated exposure of mice to aerosolized OVA has been used to identify C-C chemokine genes expressed at stages of massive eosinophil infiltration. We describe the identification and cloning of a cDNA that encodes a mouse C-C chemokine with 68% amino acid identity to guinea pig Eotaxin. The recombinant protein encoded by this gene displays potent and specific chemotactic activity for eosinophils, both in vivo and in vitro. Its mRNA levels parallel the kinetics of eosinophil accumulation in the lung during the experimentally induced eosinophilia and it is mainly produced by type I alveolar epithelial cells. The mRNA expression of mouse Eotaxin is not restricted to Th2 T cells in vitro and is independent of the development of a Th2-type response during N. brasiliensis infection, in vivo.

Glucose turnover in presence of changing glucose concentrations: error analysis for glucose disappearance

The present studies were undertaken to determine whether 1) the cold- and hot-GINF techniques used with Steele's model provide equivalent estimates of the rates of glucose appearance (R(a)) and disappearance (R(d)) in the presence of physiological changes in glucose and insulin concentrations, 2) the conditions for the best estimation of R(a) are the same as those for R(d), 3) the magnitude of error (if present) differs in diabetic and nondiabetic subjects, and 4) situations exist in which the knowledge of R(d) allows inferences to be made on whole body glucose uptake. To do so we performed experiments in non-insulin-dependent diabetes mellitus and nondiabetic subjects using simultaneous infusions of [6-3H]glucose and [6-14C]glucose; glucose and insulin were infused to mimic normal postprandial glucose and insulin profiles; the infused glucose contained [6-14C]glucose but not [6-3H]glucose. Compared with the hot-GINF method, the traditional cold-GINF method underestimated (P < 0.05) R(a) and R(d) by 10-15% and hepatic glucose release by 25-50% during the 1st h of the study, with the magnitude of error being the same in both diabetic and nondiabetic subjects. Error analysis demonstrated that errors in R(a) and R(d) have different analytic expressions containing common structural but different volume errors. Both R(a) and R(d) can be accurately measured in diabetic and nondiabetic subjects if glucose specific activity is kept constant and the volume of the accessible pool is used to calculate glucose disappearance. The relationship between R(d) and whole body glucose uptake was also derived. Although R(d) can be determined by relying on measurements in the accessible pool only, the assessment of whole body glucose uptake requires a model of the nonaccessible portion of the glucose system. However, knowledge of R(d) can provide useful insights into the behavior of whole body glucose uptake.

Antiulcer action and toxicity of Styrax camporum and Caesalpinia ferrea

Oral administration of Styrax camporum Pohl and Caesalpinia ferrea Martius stem extracts, atropine, and cimetidine, during 15 days, decreased the ulceration size, gastric secretion volume, and increased collagen fibre number of chronic ulcer induced by acetic acid in rats. The pH increased and the concentration of hydrochloric acid decreased after administration of atropine and cimetidine. The ethyl acetate fraction, obtained by chromatography from Styrax camporum Pohl extracts, showed antiulcer activity. The subchronic toxicity was studied during 30 days, through weight variation, water and food consumption and spleen, lung, kidney and liver relative weights. No difference to the control-lot was observed.

RAPT1, a mammalian homolog of yeast Tor, interacts with the FKBP12/rapamycin complex

Rapamycin is a potent immunosuppressant that blocks the G1/S transition in antigen-activated T cells and in yeast. The similar effects of rapamycin in animal cells and yeast suggest that the biochemical steps affected by rapamycin are conserved. Using a two-hybrid system we isolated mammalian clones that interact with the human FK506/rapamycin-binding protein (FKBP12) in the presence of rapamycin. Specific interactors, designated RAPT1, encode overlapping sequences homologous to yeast Tor, a putative novel phosphatidylinositol 3-kinase. A region of 133 amino acids of RAPT1 is sufficient for binding to the FKBP12/rapamycin complex. The corresponding region in yeast Tor contains the serine residue that when mutated to arginine confers resistance to rapamycin. Introduction of this mutation into RAPT1 abolishes its interaction with the FKBP12/rapamycin complex.

Assessment of insulin action in NIDDM in the presence of dynamic changes in insulin and glucose concentration

Both glucose and insulin are important regulators of glucose uptake and hepatic glucose release. Because insulin concentrations rarely if ever increase under daily living conditions, unless glucose concentrations also increase, we sought to determine whether hepatic and extrahepatic responses to changes in insulin and glucose concentration are impaired in patients with non-insulin-dependent diabetes mellitus (NIDDM). To address this question, glucose metabolism was measured in diabetic and nondiabetic subjects. A computer-driven infusion system was used to produce a nondiabetic postprandial insulin profile in both groups while sufficient exogenous glucose was infused to mimic nondiabetic postprandial glucose concentrations. Although NIDDM was associated with greater (P < 0.05) hepatic glucose release both before and during the prandial insulin infusion, suppression did not differ in the diabetic and nondiabetic subjects (-1.06 +/- 0.20 vs. -0.86 +/- 0.15 mmol/kg every 4 h). In contrast, stimulation of both glucose disappearance (0.77 +/- 0.27 vs. 1.68 +/- 0.27 mmol/kg every 4 h) and forearm glucose uptake (187 +/- 81 vs. 550 +/- 149 mumol/dl every 4 h) was lower (P < 0.05) in diabetic than in nondiabetic subjects. Thus, despite increased basal rates of glucose production, obese individuals with NIDDM had decreased stimulation of glucose disappearance but normal suppression of hepatic glucose release in response to nondiabetic prandial glucose and insulin concentrations. These data indicate that the increase in glucose that occurs with carbohydrate ingestion is likely to compensate for hepatic but not extrahepatic insulin resistance.

Retention of a co-translational translocated mutant protein of carboxypeptidase Y of Saccharomyces cerevisiae in endoplasmic reticulum

Co-translational translocation of Saccharomyces cerevisiae vacuolar glycoprotein carboxypeptidase Y (CpY) was highly efficient when studied with an in vivo and in vitro homologous system, comparison of limited proteolytic cleavage of immunoprecipitated translational products of CpY and subcellular localisation of a mutant CpY. The efficient segregation of CpY mRNA in highly purified fractions of rough microsomes was characterised. CpY1 mutant showed retention of core glycosylated material (proCpY1) in the rough and smooth endoplasmic reticulum fractions. It is suggested that the presence of structures that are incompatible with intercompartmental transport of vacuolar protein leads to retention of the mutated CpY by the endoplasmic reticulum.

Hepatic and extrahepatic insulin action in humans: measurement in the absence of non-steady-state error

The isotope dilution technique has been extensively used to assess insulin action in humans. To determine if nonsteady state (NSS) has led to erroneous estimates of hepatic and extrahepatic insulin sensitivity, we measured glucose turnover in healthy subjects during infusion of insulin at rates of 0.25, 0.6, and 2.0 mU.kg-1.min-1. Turnover was calculated using Steele's traditional NSS equations [fixed-effective volume (pV) method] as well as with methods [radioactive infused glucose (hot-GINF) or variable pV] designed to minimize NSS error. In contrast to the fixed-pV method, both the hot-GINF and variable-pV methods indicated that several hours were required for suppression of hepatic glucose release at all insulin concentrations and that small increases in plasma insulin (approximately 100 pmol/l) had comparable effects on glucose disappearance and hepatic glucose release. Nevertheless, despite these differences, when turnover during the final hour of the insulin infusions was plotted vs. the prevailing insulin concentration, all three methods yielded similar insulin dose-response curves for suppression of hepatic glucose release. Thus despite previous errors in measurement of glucose turnover, the widely accepted belief that the human liver is exquisitely sensitive to small changes in insulin is correct.

Structure of a thymine-thymine adduct formed by menadione photosensitization

The structure of one of the dithymine adducts formed by near-UV photosensitization of aqueous oxygenated thymine in the presence of 2-methyl-1,4-naphthoquinone is reported. The compound, 6' beta-hydroxy-5' beta-1-[5-methylpyrimidinyl-2,4-dione]-5'- 6'-dihydrothymine, has one thymine ring (ring I) linked through the 1-nitrogen atom to the C5' atom of a second thymine, which has been hydroxylated at C6' (ring II). Crystals are monoclinic, space group I2/c, and the structure was refined to R(obs) = 0.036 for 2072 unique reflections with intensities I greater than 2.33 sigma(I). Ring I is planar, whereas ring II is not. Ring I and the OH group on ring II are cis to ring II. The planar ring I and the OH group are attached, respectively, in an equatorial and axial manner to ring II (which is in the sofa conformation). The planar rings I of close-lying pairs of molecules stack parallel to each other. The structure is held together by a hydrogen-bonding system consisting of the water molecules, the NH groups, two of the C = O groups and the OH group. The chemical formula and relative configurations at C5' and C6' are established by this analysis.

Molecular dimensions and properties of N-[1-(2-hydroxyethyl)-2-nitro-1H-imidazol-1-yl]acetamide (SR2508)

Hypoxic cells in tumors are resistant to radiation and chemotherapy treatment. To decrease this resistance, 2-nitroimidazoles are used as radiation and chemical sensitizers in the treatment of tumors. Their use is marred by their toxicity. Therefore, the compound SR2508, a new 2-nitroimidazole derivative, was introduced in an attempt to obtain a less toxic nitroimidazole than those used thus far. The molecular structure and conformation of SR2508, determined from X-ray diffraction studies, is reported. The compound, formula C7H10N4O4, molecular weight 214.18, crystallizes in the monoclinic system, space group P2(1)/c, unit cell dimensions a = 12.052(3), b = 11.116(4), c = 7.330(2) A, beta = 106.94(2) degrees, V = 939.4(5) A3, Z = 4. The crystal structure was refined to Robs = 0.041. The imidazole and C-NO2 groups are each planar and inclined at 6.6 degrees to each other. The side chain, which contains an amide group, is also planar. There are hydrogen bonds between different molecules and they involve O(11) and O(15), as well as N(12) and O(15). When compared to other 2-nitroimidazoles that have been clinically tested, the hydrogen bonds in SR2508 account for the increased hydrophilic character of the compound. Based on the crystal structure data, models for a possible interaction between SR2508 and DNA have been proposed.

Identification of polymorphic simple sequence repeats in the genome of the zebrafish

The zebrafish has drawn a great deal of attention as a developmental system because it offers the ability to combine excellent embryology and genetics. Here, we report that simple sequence repeats are abundant in the zebrafish genome and are highly polymorphic between two outbred lines, making them useful markers for the construction of a genetic map of this organism.

Use of [3-3H]glucose and [6-14C]glucose to measure glucose turnover and glucose metabolism in humans

[3-3H]glucose is frequently used to measure glucose turnover in humans. If fructose 6-phosphate-fructose 1,6-diphosphate cycling (Fpc) is negligible in both liver and muscle, then [3-3H]- and [6-14C]glucose (corrected for Cori cycle activity) should provide equivalent measures of glucose turnover. In addition, if glycogenolysis is fully suppressed, then [14C]lactate specific activity should equal that of [6-14C]glucose from which it was derived, and oxidation of [6-14C]glucose, as measured by rate of generation of 14CO2, should equal total glucose oxidation (i.e., that derived from intra- and extracellular pools) as measured by indirect calorimetry. To address these questions, glucose turnover was measured simultaneously with [3-3H]- and [6-14C]glucose in the basal state and in presence of low (approximately 200 pM) and high (approximately 750 pM) insulin concentrations. Glucose turnover rates measured with [3-3H]- and [6-14C]glucose were equivalent at all insulin concentrations, indicating that Fpc had no detectable effect on measurement of glucose appearance. [14C]lactate specific activity was lower (P less than 0.01) than that of [6-14C]glucose in the basal state but not during either low- or high-dose insulin infusion, implying that all lactate was derived from extracellular glucose. On the other hand, glucose oxidation as measured by rate of generation of 14CO2 was lower (P less than 0.05) than glucose oxidation as measured by indirect calorimetry during both insulin infusions, implying either that suppression of glycogenolysis was not complete in all tissues or that one or both of these techniques do not accurately measure glucose oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)

A genetic map of the mouse suitable for typing intraspecific crosses

We report the construction of a genetic linkage map of the mouse, consisting entirely of genetic markers that can be rapidly typed by polymerase chain reaction and that show a high degree of polymorphism among inbred laboratory strains. Specifically, the map contains 317 simple sequence length polymorphisms at an average spacing of 4.3 cM and is detectably linked to approximately 99% of the mouse genome. In typical crosses between inbred laboratory strains, about 50% of the markers are polymorphic, making it straightforward to follow inheritance in almost any cross.

Golgi-like staining of visual cortex cells obtained by extracellular biocytin application in vitro

We report here the application of biocytin (a biotin-lysine complex) as an extracellular tracer in vitro. Biocytin was applied extracellularly, revealing Golgi-like staining of cells in the adult in vitro rat visual cortex. Micropipettes were filled with a solution of 2.3-2.6% biocytin dissolved in 0.05 M Tris buffer, pH 7.4. Biocytin was applied by one of 3 methods: diffusion, pressure injection or drop application. Cell bodies and dendrites around the application site and their efferent axonal processes were stained; dendritic spines were often visible. The injection sites varied in size from a single cell to a diameter of 400 microns. When applied in layer I-III, few filled cells were also seen in layers IV and V, outside the application site. The drop application (5-10 microliters) of biocytin resulted in filling of cells throughout the cortex. The combination of biocytin and the slice preparation was found to be very useful in revealing cell morphology and tracing interlaminar connections in the visual cortex. The advantages of this technique are its ease of application, the precise and restricted injection sites, and Golgi-like morphological detail.

A research-based reconsideration of the psychoanalytic theory of dreaming

We present a brief review of sleep research which, when combined with psychoanalytic experience, has led to the hypothesis that REM sleep and dreaming serve the function of adaptation by the process of integration of information. We then report the results of a study of dreams, based on this hypothesis. We studied dreams and their relation to waking mental activity and found a correlation between problems in manifest dreams and those in pre- and postsleep waking life. Dreams can be understood on the basis of problems that appear in them. We also found evidence for a relation between the solution of problems in dreams and the fate of those problems the next day. We discuss these findings in relation to some of the controversies about dreaming, and then present suggestions for future research.

Effects of pancreas transplantation on postprandial glucose metabolism

BACKGROUND

Because a pancreas allograft is placed in the pelvis, pancreas transplantation abolishes the normal gradient between portal-vein and peripheral-vein insulin concentrations and causes systemic hyperinsulinemia. Whether pancreas transplantation restores carbohydrate metabolism to normal is not known.

METHODS

We studied seven patients with insulin-dependent diabetes mellitus after pancreas-kidney transplantation, seven nondiabetic patients after kidney transplantation (to control for immunosuppression), and eight normal subjects. Measurements were made after an overnight fast and after ingestion of a mixed meal.

RESULTS

Although plasma glucose concentrations did not differ in the two transplant groups, plasma insulin concentrations were significantly higher in the diabetic pancreas-kidney recipients than in the nondiabetic kidney recipients, both before the meal (mean +/- SE, 102 +/- 15 vs. 53 +/- 6 pmol per liter; P less than 0.05) and afterward (123 +/- 22 vs. 61 +/- 6 nmol per liter per six hours; P less than 0.05). Plasma C-peptide concentrations were the same in both groups, indicating that hyperinsulinemia was due to decreased insulin clearance rather than increased insulin secretion. Despite drainage of the venous effluent from the transplanted pancreas into the systemic circulation, the values for splanchnic clearance of ingested glucose, suppression of hepatic glucose release, incorporation of carbon dioxide into glucose, stimulation of glucose oxidation, glucose uptake, and forearm glucose clearance were all similar in the transplant groups and differed minimally from the values in the normal group. The similar rates of glucose uptake in the presence of higher systemic insulin concentrations indicated that the extrahepatic tissues of the diabetic pancreas-kidney recipients were insulin-resistant.

CONCLUSIONS

Despite systemic delivery of insulin, pancreas-kidney transplantation in patients with diabetes results in carbohydrate metabolism similar to that in nondiabetic subjects receiving the same immunosuppressive agents after kidney transplantation.

Effects of chronic systemic insulin delivery on insulin action in dogs

The metabolic consequences of the prolonged systemic insulin delivery associated with human pancreas transplantation have not been precisely defined. To determine if systemic insulin delivery in the absence of immunosuppressive agents results in alterations in hepatic or extrahepatic insulin action, three groups of dogs were studied 2 months after either a sham operation or after their pancreatic venous drainage was severed and anastomosed to the inferior vena cava or portal vein (sham, peripheral and portal groups, respectively). The pattern of venous drainage was documented by measuring vena cava and portal insulin concentrations before and after glucose injection. Systemic insulin concentrations were higher (p less than 0.05) in the peripheral group than in the portal group both following a 14-h fast and after intravenous glucose. During a hyperinsulinaemic euglycaemic clamp (1 mU.kg-1.min-1), glucose utilization (measured using [6(3)H]glucose) was slightly lower (p = 0.07) in the peripheral than in the portal group. Hepatic glucose release was equal in all groups. Carbon dioxide incorporation into glucose (an estimate of gluconeogenesis) was higher in the portal than peripheral group in the fasted state but not during insulin infusion. Plasma concentrations and flux rates of fatty acids and amino acids did not differ between groups. We conclude that chronic systemic insulin delivery results in a) systemic but not portal hyperinsulinaemia, b) a minimal impairment in insulin-stimulated glucose uptake, without altering insulin-induced suppression of hepatic glucose release, and c) no effect on fatty acid or amino acid turnover.(ABSTRACT TRUNCATED AT 250 WORDS)

Coordination of the contractile activity of bile canaliculi. Evidence from spontaneous contractions in vitro

Rat hepatocytes, when isolated and maintained in primary culture, are capable of producing forceful contractions of their bile canaliculi, with contractions occurring on a regular basis once every 5.5 minutes. To determine whether the contraction of one bile canaliculus affected the contraction of a neighboring canaliculus, cinephotomicrographic studies of pairs of contiguous canaliculi were undertaken. The activity of 10 pairs of contiguous canaliculi, and 10 pairs of noncontiguous canaliculi which served as a control group, was recorded for a period of 12.5 hours at the rate of 1 frame every 15 seconds. Using frame-by-frame analysis of this period of observation, we determined the time of contraction of each of the canaliculi in the pairs. Cross-correlations were obtained for the contraction times of each of the 10 pairs of contiguous canaliculi and 10 control pairs. A peak in activity was found, with that peak occurring five frames or 75 seconds from the midline, whereas the noncontiguous controls showed no correlation in contractile activity. This finding indicates that, when one bile canaliculus contracts, a neighboring canaliculus is likely to contract after an interval of 1.25 minutes. That there is coordination of contractile activity of bile canaliculi suggests that, within the intact liver lobule, ordered motility function of the bile canaliculi may facilitate bile flow.

Sex roles, gender, and fear

Male and female college students classified as masculine, feminine, androgynous, or undifferentiated on the Bem (1974) Sex Role Inventory (N = 199) were given the Wolpe (1969) Fear Inventory. Significant differences in average fear scores were seen between men and women and between the four sex-role categories, with sex role and gender contributing equally to the variability. The argument is raised here that excessive fearfulness or fearlessness might be as much a product of sex-role conditioning as a product of gender.

Oxygen tension in human tumors: in vivo mapping using CT-guided probes

The role of oxygen in tumor response to therapy has been studied for several decades. We describe a technique that allows in vivo measurement of oxygen in tumors using computed tomography to guide probes. In the evaluation of 16 tumors, oxygen tensions were found to be substantially lower than surrounding tissue and varied nonrandomly. This technique has allowed construction of detailed tumor oxygen level maps.

Utilization and morbidity: random or tandem?

Earlier studies have shown that one in eight children persist in being high users of health care services over long periods of time and, conversely, about the same proportion of children are consistently low users. As these studies failed to discover reasons for these persistent deviations from average, this study explored three possible explanations: persistent morbidity, mental health problem, and familial patterns of use. Although all three phenomena were associated with both persistence of high utilization of services as well as an overall large number of visits, the number of types of morbidity was the most significant correlate of high use. Children who were constantly low users of services were much more likely to have only a few types of morbidity whereas children who were constantly high users were much more likely to experience a wide variety of types of problems. These findings suggest that an understanding of the demand for health services requires an understanding of the interrelationships of illnesses within individuals rather than a focus on particular illnesses or particular types of illnesses.

Morbidity in childhood--a longitudinal view

We examined all the morbidity experienced in a six-year period by a total of 2591 children who were continuously enrolled in a prepaid medical plan. The children had received 19,291 diagnoses, each of which was assigned to one of 14 types of morbidity, and the frequency of each type was determined. Although the typical child had at least one problem in 5 of the 14 types of morbidity in the six-year period, over 20 per cent of children had at least 8 different types of problems during that time. Children with a greater variety of acute problems and more frequent acute problems were also more likely to have nonacute problems during the six-year period. Conversely, children with nonacute problems had more acute problems than other children. Our findings indicate that morbidity, like use of health services, occurred in clusters in this population of children. Therefore, an understanding of the cause and projected outcome of morbidity among children will be incomplete if the focus is only on specific diseases or specific types of illnesses.

Preventive care and overall use of services. Are they related?

The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. Teenage children who were low users were at some risk of not receiving their tetanus-diphtheria immunization on time. The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.

A study of bile canalicular contractions in isolated hepatocytes

Living hepatocytes observed under standard methods of cell isolation and culture show frequent active contractions of bile canaliculi when viewed by time-lapse cinephotomicrography. This report gives details of the methods used to show the contractions. In addition, the characteristics of the contraction pattern are defined and analyzed. The contractions are regular, canalicular contraction time (systole) lasts 60 sec, and the most probably interval between contractions is 5 1/2 min. The finding of a regular pattern of contraction suggests an ordered, programmed, and integrated mechanism which entails a high degree of communication and functional coordination between neighboring hepatocytes.

Episode-based efficiency comparisons for physicians and nurse practitioners

Most previous studies comparing the efficiency of new health practitioners with that of physicians have used the visit as the basic unit of output. Several researchers have noted, though, that the episode is a conceptually superior output unit in several respects, although it is more complex to deal with methodologically. This study demonstrates the application of episode-based methods for comparing the efficiency of physicians with that of nurse practitioners. Data are drawn from the information system of the Columbia Medical Plan and from observations of provider time inputs. The analysis is confined to care episodes for otitis media and sore throat in the Department of Pediatrics. Results indicate that per episode costs with nurse practitioners as the initial provider are approximately 20 per cent below the costs of episodes in which physicians are the initial provider. Examination of a limited amount of data on patient-reported measures of effectiveness indicates that while nurse practitioners' care is less costly, it is not less effective. These findings are particularly interesting in light of recent doubts expressed about cost-savings from using new health practitioners, and particularly nurse practitioners, in group practice settings.

Subcutaneous facial emphysema complicating dental anaesthesia

A 20 year-old female developed swelling and protrusions of the tongue and marked facial swelling while under general anaesthesia for dental restoration and gigivectomy. The initial diagnosis was angioedema; however x-rays showed marked subcutaneous emphysema more extensive in the perimandibular area with a minimal amount in the neck. There was no evidence of pneumomediastinum or pneumothorax. The iatrogenic subcutaneous emphysema was felt to be due to air-driven dental equipment. Tracheal intubation was maintained for 21 hours to prevent airway obstruction. The patient was treated with oxygen and antibiotics. Subcutaneous emphysema may occur following root canal therapy, tooth extraction, periodontal surgery and operative dentistry, due to the use of air-driven dental equipment. It has the potential to cause obstruction.