Increased NaV1.8 expression in patients with sleep-disordered breathing induces pro-arrhythmic activity

Background

Sleep-disordered breathing (SDB) is often associated with atrial fibrillation, but detailed mechanisms remain elusive. Interestingly, late Na current (late INa) has been shown to be increased in patients with SDB, while expression of cardiac Na channel NaV1.5 and peak Na current were decreased. Indeed, recent data demonstrated that enhanced NaV1.8-dependent late INa may also induce pro-arrhythmic activity.

Purpose

We tested whether Na-V1.8 expression and subsequent NaV1.8-dependent pro-arrhythmic activity are increased in patients with SDB.

Methods

We prospectively analysed 29 right atrial appendage biopsies of patients undergoing elective coronary artery bypass grafting. SDB was assessed using polygraphy in the preoperative night and an apnoea-hypopnea index (AHI) ≥15/h defined SDB. Micro-dissected atrial trabeculae were electrically field stimulated (at 1 Hz, 5 V for 50 ms, at 37°C) to elicit regular contractions. Trabecular arrhythmias were induced using 100 nM isoproterenol at [Ca]o of 3.5 mmol/L and pro-arrhythmic activity was scored from 0 (no arrhythmias) to 5 (salve). Sarcoplasmic reticulum Ca leak was estimated by the contractility after paused stimulation (at 2 Hz, normalized to before pause). To correlate functional and expression data for each individual patient, NaV1.8 mRNA expression was quantified in each trabeculum using qPCR.

Results

NaV1.8 mRNA expression was increased in patients with SDB, leading to a significant positive correlation with the severity of SDB (i.e. AHI, p=0.02, r2=0.22, Fig. 1A). Multivariate regression analysis revealed that this association was independent from age, sex, atrial fibrillation, heart failure, diabetes mellitus, and renal function (p=0.03, r2=0.35). Accordingly, selective NaV1.8 blockade with PF-01247324 (PF, 1 μM, 30 min) significantly improved post-pause contractility of isolated trabeculae from 1.69±0.31 to 2.95±0.54 in patients with SDB (p=0.001), whereas no significant improvement was observed in patients without SDB. This resulted in significant positive correlations between the PF-dependent improvement of post-pause contractility and both AHI (p=0.047, r2=0.19) and NaV1.8 mRNA expression (p=0.03, r2=0.17). Most importantly, we also observed a significant increase in arrhythmia severity in patients with SDB of 2.21±0.52 (vs. 1.00±0.49, p=0.03) that could be significantly reduced by selective NaV1.8 inhibition with PF to 0.25±0.18 (p=0.0008, Fig. 1B). In accordance, there was a significant positive correlation between arrhythmia severity and AHI (p=0.01, r2=0.28) that was abolished in the presence of PF (interaction analysis: p=0.ehab724.33141, r2=0.46).

Conclusion

In patients with SDB, enhanced NaV1.8 expression contribute to atrial pro-arrhythmic activity independent from comorbidities. Selective NaV1.8 inhibition may have therapeutic implications for patients with SDB.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Part of the study was supported by grants from Philips Respironics (Murrysville, PA 15668) and the Medical Faculty at the University of Regensburg. Figure 1

Validation of an antimicrobial susceptibility testing protocol for Brachyspira hyodysenteriae and Brachyspira pilosicoli in an international ring trial

Brachyspira hyodysenteriae and Brachyspira pilosicoli cause economically important enteric disease in pigs. Treatment of these infections often includes antimicrobial administration, which can be most effective when therapeutic options are informed by antimicrobial susceptibility testing data. Here we describe a method for broth dilution antimicrobial susceptibility testing of these bacteria, both of which are difficult to culture in vitro. The protocol was evaluated for its fitness for use in an inter-laboratory ring trial involving eight laboratories from seven countries, and employing eleven test strains (5 Brachyspira hyodysenteriae including the type strain B78^T and 6 Brachyspira pilosicoli) and six antibiotics. Overall intra- and inter-laboratory reproducibility of this method was very good (>90 % MICs at mode +/- 1 log₂). Whole genome sequencing revealed good correspondence between reduced susceptibility and the presence of previously defined antimicrobial resistance determinants. Interestingly, lnu(C) was identified in B. pilosicoli isolates with elevated MICs of lincomycin, whilst tva(B) was associated with elevated MICs of pleuromutilins in this species. We designated two new control strains with MICs lying within currently tested ranges, including for the pleuromutilins, in contrast to the control strain B. hyodysenteriae B78^T. These were deposited at the DSMZ-German Collection of Microorganisms and Cell Cultures GmbH. The validation of a standard protocol and identification of new control strains facilitates comparisons between studies, establishment of robust interpretative criteria, and ultimately contributes to rational antimicrobial use when treating infected livestock.

Bacteraemia before, during and after tooth extraction in horses in the absence of antimicrobial administration

BACKGROUND

Transient bacteraemia can occur during tooth extraction in humans, and dogs and can lead to severe infectious sequelae. Several case reports describe distant site infections following equine tooth extraction, but the occurrence of bacteraemia during dental surgery has not been evaluated in the horse.

OBJECTIVES

To determine if transient bacteraemia occurs during tooth extraction in horses, describe isolated organisms and compare these with those found in the diseased teeth.

STUDY DESIGN

Prospective, observational study.

METHODS

Blood was collected aseptically for blood culture before, during and after oral extraction of incisor, canine or cheek teeth from 20 adult horses undergoing dental extraction that had not received antimicrobial agents for at least 4 weeks prior to surgery. Bacteria found in blood cultures were compared with those found in swab samples obtained from the extracted teeth.

RESULTS

Eighteen of 20 horses had positive blood cultures at one or more time points. Streptococcus spp., Actinomyces spp., Fusobacterium spp. and Prevotella spp. were most commonly found. Bacterial genera isolated from swab samples of extracted teeth largely corresponded with those identified in blood cultures.

MAIN LIMITATIONS

This study was limited by its use of only conventional bacterial culture, the lack of statistical analysis to explore associations between gingiva score and the occurrence of bacteraemia, and the lack of an age-matched control group of horses not undergoing exodontia.

CONCLUSIONS

Transient bacteraemia of oral origin commonly occurs during dental extraction in horses. As none of the horses developed complications associated with bacteraemia during the observation period after surgery, the significance of this bacteraemia remains uncertain. The Summary is available in Chinese - see Supporting Information.

The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia

BACKGROUND

Health care-associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community-acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug-resistant organisms, and appropriate initial antibiotic therapy is associated with reduced mortality.

METHODS

An online survey was distributed to faculty and housestaff at 4 academic medical centers. The survey required respondents to choose initial antibiotic therapy for 9 hypothetical pneumonia cases (7 cases of HCAP and 2 cases of CAP). Answers were considered correct if the antibiotic regimen chosen was consistent with published guidelines. In addition, physicians rated their knowledge of current guidelines, as well as their level of agreement with guideline recommendations.

RESULTS

Surveys were sent to 1313 physicians with a response rate of 65% (n = 855). Respondents included physicians in the following categories: hospital medicine/internal medicine, 60%; emergency medicine, 25%; and critical care, 13%. Respondents selected guideline-concordant antibiotic regimens 78% of the time for CAP, but only 9% of the time for HCAP. Because mean scores for HCAP questions were extremely low (mean, 0.63 correct answers out of 7), differences in performance between groups were too small to be meaningful. Despite their poor performance, 71% of the respondents stated that they are aware of published guidelines for HCAP, and 79% stated that they agree with and practice according to the guidelines.

CONCLUSIONS

In this survey, physicians reported they were aware of, agreed with, and practiced according to published pneumonia guidelines; however, the overwhelming majority did not choose guideline-concordant therapy when tested.

An evaluation of the District Health Information System in rural South Africa

BACKGROUND

Since reliable health information is essential for the planning and management of health services, we investigated the functioning of the District Health Information System (DHIS) in 10 rural clinics.

DESIGN AND SUBJECTS

Semi-structured key informant interviews were conducted with clinic managers, supervisors and district information staff. Data collected over a 12-month period for each clinic were assessed for missing data, data out of minimum and maximum ranges, and validation rule violations.

SETTING

Our investigation was part of a larger study on improving information systems for primary care in rural KwaZulu-Natal.

OUTCOMES

We assessed data quality, the utilisation for facility management, perceptions of work burden, and usefulness of the system to clinic staff.

RESULTS

A high perceived work burden associated with data collection and collation was found. Some data collation tools were not used as intended. There was good understanding of the data collection and collation process but little analysis, interpretation or utilisation of data. Feedback to clinics occurred rarely. In the 10 clinics, 2.5% of data values were missing, and 25% of data were outside expected ranges without an explanation provided.

CONCLUSIONS

The culture of information use essential to an information system having an impact at the local level is weak in these clinics or at the sub-district level. Further training and support is required for the DHIS to function as intended.

Role of the Vam3p Transmembrane Segment in Homodimerization and SNARE Complex Formation

Intracellular membrane fusion in eukaryotic cells is mediated by SNARE (soluble N-ethylmaleimide sensitive factor (NSF) attachment protein receptor) proteins and is known to involve assembly of cognate subunits to heterooligomeric complexes. For synaptic SNAREs, it has previously been shown that the transmembrane segments drive homotypic and support heterotypic interactions. Here, we demonstrate that a significant fraction of the yeast vacuolar SNARE Vam3p is a homodimer in detergent extracts of vacuolar membranes. This homodimer exists in parallel to the heterooligomeric SNARE complex. A Vam3p homodimer also formed from the isolated recombinant protein. Interestingly, homodimerization depended on the transmembrane segment. In contrast, formation of the quaternary SNARE complex from recombinant Vam3p, Nyv1p, Vti1p, and Vam7p subunits did not depend on the transmembrane segment of Vam3p nor on the transmembrane segments of its partner proteins. We conclude that Vam3p homodimerization, but not quaternary SNARE complex formation, is promoted by TMS-TMS interaction. As the transmembrane segments of Vam3p and other SNARE homologues were previously shown to be critical for membrane fusion downstream of membrane apposition, our results may shed light on the functional significance of SNARE TMS-TMS interactions.

Synthesis and evaluation of 3-aryl piperidine analogs as potent and efficacious dopamine D4 receptor agonists

A series of 3-aryl piperidine analogs with 2-piperidinoalkylamino or 2-piperidinoalkyloxy fused bicyclic rings were prepared and found to be potent and efficacious human dopamine D4 agonists. The synthesis and structure-activity relationship (SAR) studies that led to the identification of these compounds are discussed.

Discovery of 2-(4-Pyridin-2-ylpiperazin-1-ylmethyl)-1H-benzimidazole (ABT-724), a Dopaminergic Agent with a Novel Mode of Action for the Potential Treatment of Erectile Dysfunction

A new class of agents with potential utility for the treatment of erectile dysfunction has been discovered, guided by the hypothesis that selective D4 agonists are erectogenic but devoid of the side effects typically associated with dopaminergic agents. The lead agent 2-(4-pyridin-2-ylpiperazin-1-ylmethyl)-1H-benzimidazole (1, ABT-724) was discovered by optimization of a series of benzimidazole arylpiperazines. This highly selective D4 agonist was found to be very potent and efficacious in vivo, eliciting penile erections in rats at a dose of 0.03 micromol/kg, with a positive response rate of 77% erectile incidence. Even at high doses, it was devoid of side effects in animal models of central nervous system behaviors, emesis, or nausea. The structure-activity relationship of the parent benzimidazole series leading to 1 is described, with the detailed in vitro and in vivo profiles described. Distinctive structural features were discovered that are associated with D4 selective agonism in this series of analogues.

[The vitality of obese patients after a weight reduction by fasting]

INTRODUCTION

The objective documentation of the positive results of natural medicine or physiotherapy gains raising importance in medicine.

OBJECTIVE

The aim of the study was to investigate the application of the vitality test according to Pöthig in the objective holistic evaluation of treatment by natural and physical medicine.

SUBJECTS AND METHODS

In 48 obese patients (28 males and 20 females) with a body mass index of 32.1 to 56.5 kg/m(2) a weight reduction therapy was carried out for 21 days (16-25 days) by means of fasting according to Buchinger, accompanied by physiotherapeutic treatments. At the beginning and at the end all patients underwent a multidisciplinary functional diagnosis by means of the vitality test according to Pöthig and a bioelectrical impedance analysis. On the basis of the 47 measured parameters of the entire body function (physical, mental and emotional/social) the Vitality Index and the Functional Age Index (FAI) were calculated.

RESULTS

The reduction of body weight was 9.1 +/- 2.4 (5.1-15.0) kg, the reduction of body fat 5.5 +/- 1.3 (3.3-8.5) kg. At the beginning 31% of the patients showed a reduced vitality, i.e. the FAI was at least 5 years (maximum 16 years) higher then the real age. 56% of the patients matched the real age and in 13% of the patients the FAI was better with respect to the corresponding age group. During the treatment 94% of the patients showed an improvement of their FAI by 5 +/- 3 years on average (maximum 12 years).

CONCLUSIONS

With the help of the presented multidisciplinary vitality test it is possible to objectively document the positive results of natural medicine and physical medicine on the whole human organism.

[New findings about Priessnitz from the unknown Vinzenz Priessnitz Familien-Wasserbuch from 1847]

The large scope of therapies that Priessnitz used for his cure treatments in Gräfenberg completely fell into oblivion. More than 50 different applications of water, partly created by Priessnitz, dietary therapy for every patient, a lot of physical exercise, air as well as sun baths, improvement of fitness, and a regular life style were included in Priessnitz' treatments. He treated a variety of indications, not only chronic but also severe acute ones. The Vinzenz Priessnitz'sche Familien-Wasserbuch is a real treasury of forgotten facts about the genius who was the first to rediscover and remodel hydrotherapy before Kneipp.

The TOR kinases link nutrient sensing to cell growth

Rapamycin is an immunosuppressive natural product that inhibits the proliferation of T-cells in response to nutrients and growth factors. Rapamycin binds to the peptidyl-prolyl isomerase FKBP12 and forms protein-drug complexes that inhibit signal transduction by the TOR kinases. The FKBP12 and TOR proteins are conserved from fungi to humans, and in both organisms the TOR signaling pathway plays a role in nutrient sensing. In response to nitrogen sources or amino acids, TOR regulates both transcription and translation, enabling cells to appropriately respond to growth-promoting signals. Rapamycin is having a profound impact on clinical medicine and was approved as an immunosuppressant for transplant recipients in 1999. Ongoing clinical studies address new clinical applications for rapamycin as an antiproliferative drug for chemotherapy and invasive cardiology.

Thyroid cancer: patients' experiences of receiving iodine-131 therapy

PURPOSE/OBJECTIVES

To enhance understanding of the experiences and educational needs of patients receiving iodine-131 (131I) therapy for the treatment of thyroid cancer.

DESIGN

Qualitative design using interpretive description.

SETTING

A 24-bed oncology/acute-care medical unit in a large tertiary hospital in western Canada.

SAMPLE

5 men and 22 women (18-80 years of age) who have received 131I therapy in the past two years.

METHODS

Unstructured focus group and telephone interviews and field notes. Interviews were tape-recorded, transcribed verbatim, and subjected to thematic analysis.

FINDINGS

Researchers elicited four major themes from the analysis: (a) recognizing the totality of the cancer experience, (b) being isolated, (c) recognizing the totality of the treatment experience, and (d) understanding barriers to treatment.

CONCLUSIONS

Healthcare providers require a better understanding of thyroid disease and the treatment and side effects of 131I therapy. Furthermore, educational programs are required to adequately prepare nurses and patients for future care.

IMPLICATIONS FOR NURSING PRACTICE

A need exists to improve the care and education provided to patients receiving 131I therapy. In particular, recognition of the totality of the cancer experience and the need for both staff and patient education were illustrated. If nurses are to provide comprehensive cancer care, both psychosocial and physical needs must be addressed and fulfilling these needs requires a collaborative approach among patients, nurses, and other healthcare professionals.

A conserved membrane-spanning amino acid motif drives homomeric and supports heteromeric assembly of presynaptic SNARE proteins

Assembly of the SNARE proteins synaptobrevin/VAMP, syntaxin, and SNAP-25 to binary and ternary complexes is important for docking and/or fusion of presynaptic vesicles to the neuronal plasma membrane prior to regulated neurotransmitter release. Despite the well characterized structure of their cytoplasmic assembly domains, little is known about the role of the transmembrane segments in SNARE protein assembly and function. Here, we identified conserved amino acid motifs within the transmembrane segments that are required for homodimerization of synaptobrevin II and syntaxin 1A. Minimal motifs of 6-8 residues grafted onto an otherwise monomeric oligoalanine host sequence were sufficient for self-interaction of both transmembrane segments in detergent solution or membranes. These motifs constitute contiguous areas of interfacial residues assuming alpha-helical secondary structures. Since the motifs are conserved, they also contributed to heterodimerization of synaptobrevin II and syntaxin 1A and therefore appear to constitute interaction domains independent of the cytoplasmic coiled coil regions. Interactions between the transmembrane segments may stabilize the SNARE complex, cause its multimerization to previously observed multimeric superstructures, and/or be required for the fusogenic activity of SNARE proteins.

[Sensitivity of bovine and equine streptococci to beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime) in the agar diffusion and E-test]

368 streptococcal strains from udder secretions of cattle (Sc. agalactiae, Sc. dysgalactiae, Sc. uberis) and 191 streptococcal isolates from horse specimens (Sc. equi ssp. zooepidemicus, Sc. equi ssp. equi) originating from different agricultural regions in Germany (Lower Saxony, in particular the region of Weser-Ems, Bavaria, Altmark) were investigated for their sensitivity to 4 beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime). Two different test methods were applied: the agar diffusion test for determination of the diameter of the zone of inhibition and the E-test for determination of the minimal inhibitory concentration (MIC). According to the evaluation code of DIN 58,940, 98% to 100% of the isolates from the cow udder as well as of the Streptococcus strains from horses were sensitive to the four antibiotics tested. Only Sc. uberis was less sensitive to benzylpenicillin (79.7%) and Oxacillin (83.2%). The strains from different agricultural regions did not differ from each other concerning their sensitivity to beta-lactams. The results of the two methods of sensitivity testing were in satisfactory agreement: Compared to the MIC reference values, misclassifications occurred in the agar diffusion test only at an error rate of between 1.62% (for ampicillin) and 5.21% (for benzylpenicillin).

First chromosomal restriction map of Actinobacillus pleuropneumoniae and localization of putative virulence-associated genes

Combined physical and genetic maps of the genomes of Actinobacillus pleuropneumoniae AP76 (serotype 7 clinical isolate) and of A. pleuropneumoniae ATCC 27088 (serotype 1 reference strain) were constructed by using the restriction endonucleases ApaI, AscI, NotI, and SalI. The chromosome sizes as determined by the addition of estimated fragment sizes were 2.4 Mbp, and both maps had a resolution of approximately 100 kbp. The linkages between the ApaI, AscI, NotI, and SalI fragments and their relative positions were determined by (i) fragment excision and redigestion and (ii) partial digests of defined fragments and Southern blot using end-standing probes. The single SalI site within the chromosome of strain A. pleuropneumoniae AP76 was defined as position 1 of the map; for the map of A. pleuropneumoniae ATCC 27088, the corresponding SalI site was chosen. Putative virulence-associated genes (apx, omlA, sodA, tbpBA, ureC, and a repeat element) and housekeeping genes (glyA, metJ, recA, and rhoAP) were positioned on the physical maps and located on the ApaI and NotI fragments of A. pleuropneumoniae serotype reference strains.

[Diagnosis of swine dysentery and spirochaetal diarrhea. 2. Effort of macrorestriction analysis for differentiation of intestinal Serpulina relative to determination by culture-biochemical markers following species classification]

Genotypic differentiation by means of macrorestriction fragment profile analysis using Mlul restriction enzyme was carried out differentiating 41 Serpulina field strains from swine (38), dog (2) and a rat as well as ten type and reference strains into 40 electrophoretic types. A dendrogram was created using the average linkage between groups method. At a level of 50% similarity the patterns could be divided into six groups that roughly corresponded to the results yielded by cultural and biochemical methods formerly (FELTRUP et al. 1999). Five of these clusters corresponded to the five known porcine Serpulina species, one cluster contained the S. pilosicoli isolates from dog and rat included in this study. Interestingly all nine investigated indole negative, strongly haemolytic isolates were clustered together in one group with the S. hyodysenteriae strains, so that incidence of indole negative variants of S. hyodysenteriae was confirmed. Because of being grouped together with two S. intermedia isolates, the suitability of B 256 as S. innocens type strain is--in accord to investigations carried out by PETTERSSON et al (1996)--called in question.

[Investigations into the occurrence and the antibiotic susceptibility of gram negative anaerobes of the genera Bacteroides, Prevotella, Porphyromonas and Fusobacterium in specimens obtained from diseased animals]

From different samples of 247 diseased animals (cattle, sheep, goat, horse, pig, dog, cat, rodent, zoo-animals), 410 strains of gram-negative anaerobes were cultured. 297 isolates (72.4%) could be differentiated to the species level by using cultural-biochemical methods, gaschromatography and cell-wall-lipidanalysis. They belonged to 29 different species. For an additional 113 strains (27.6%) only the genus could be determined. Bacteria belonging to the genus Fusobacterium occurred with the highest isolation rates (36% of all strains) in the samples examined, followed by Bacteroides spp. (26.1%), Prevotella spp. (19.9%) and Prophyromonas spp. (17.8%). Fusobacterium necrophorum was the single species isolated most frequently. Antibiotic susceptibility tests by E-test were performed on 100 strains belonging to the the above mentioned genera. Of these strains 18% were resistant to penicillin and 20% to tetracycline. The resistant strains belonged mainly to the Bacteroides fragilis-group. Resistant rates to most other antimicrobial agents tested were Amoxicillin in combination with clavulanic acid: 1%, Chloramphenicol: 3%, Clindamycin:8%. All 100 selected strains proved to be susceptible to Metronidazol.

Health screening for people with Down's syndrome

All adults over the age of 18 years with Down's syndrome living in a borough of London, England, were identified through a case register. A questionnaire seeking information on health status and screening was sent to their carers. The reply rate was 70%. The attendance for general health care is reasonable, but there are some gaps in screening. The implications for primary health care and health promotion are discussed.

Towards the development of a multi-axial classification of people with learning difficulties

The complexity of need experienced by people with learning disabilities might best be described by a multi-axial classification. The data routinely collected for a register of people with learning disabilities were analysed to see whether factors that might discriminate between individuals could be identified. Three factors were identified. The factor scores were used in a cluster analysis. A ten-cluster model formed from these factors made empirical sense. The present investigation indicates that a multi-axial classification is feasible and may be useful. However, the results cannot be applied beyond the data set used for its development at the present time. Ultimately, it will be necessary to collect additional information in order to calibrate the factor scores.

Is the money following the clients with learning disabilities?

For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.

Identification of neutral endopeptidase mRNA in human nasal mucosa

Neutral endopeptidase (NEP) may regulate peptide-induced inflammation in the upper respiratory tract. NEP mRNA was detected by Northern blotting in poly(A)+ mRNA prepared from human turbinates. NEP mRNA bands were detected at 3.9 and 1.8 kb. In situ hybridization identified NEP mRNA in epithelial cells, serous cells of submucosal glands, and vessel walls. The vacuoles of goblet and mucous cells were not stained, but it is likely that the cytoplasm of these cells contained some NEP mRNA. Radioactive in situ hybridization with 35S-UTP appeared to be more sensitive than nonradioactive in situ hybridization with biotin-UTP and immunogold detection. The NEP mRNA-containing cells identified by in situ hybridization were the same as those identified by immunohistochemistry to contain immunoreactive NEP. These NEP-containing cells have been previously shown to possess peptide receptors. This is consistent with the hypothesis that NEP on cells bearing peptide receptors may regulate neuropeptide-induced inflammation in human nasal mucosa.

Localization of beta pre-protachykinin mRNA in nodose ganglion

The neurons which synthesize tachykinins in the capsaicin-sensitive afferent nerves of the respiratory tract are largely localized to the nodose ganglia. Using a radiolabelled antisense cRNA probe constructed from cDNA for the major precursor of substance P and neurokinin A (beta-preprotachykinin: beta-PPT), we have localized specific mRNA for this peptide in neurons of the nodose ganglion of rat using in situ hybridization. 26% of neurons gave a positive hybridization signal, which was in agreement with the same proportion of cell bodies showing substance P-like immunoreactivity. The specificity of the hybridization was confirmed by the absence of labelling using RNase pre-treatment and a sense probe having the same sequence as beta-PPT mRNA. This approach may now allow the investigation of factors which regulate synthesis of tachykinins at a gene transcriptional level.

Turning off the diarrhea: the role of food and ORS

Ninety-three boys aged 5 years or less who had diarrhea due to Vibrio cholerae were randomly assigned to treatment with glucose oral rehydration salt (ORS) or rice-based ORS. For the first 24 h, ORS only was given to all the patients. During the next 24 h, ORS and normal food were given. The efficacy of the two types of ORS was compared in terms of ORS intake, stool output, change in hematocrit reading, serum specific gravity, and increase in body weight. At the end of the first 24 h of treatment, a 50% reduction in ORS intake and stool output was observed in the 47 patients randomly assigned to receive rice ORS as compared with the 46 patients who received glucose ORS. During the second 24 h of treatment, a significant reduction in the stool output was noticed in the glucose ORS group, making the efficacy of glucose ORS equal to that of rice ORS. The study suggests that normal food can impart some of the superiority of "super" ORS to standard glucose ORS with regard to reduction of stool volume.

Response to measles vaccine in Haitian infants 6 to 12 months old. Influence of maternal antibodies, malnutrition, and concurrent illnesses

To study the factors affecting the serologic response to measles vaccination, we evaluated 595 Haitian infants from 6 through 12 months of age, and their mothers, at the beginning of an immunization program. Thirty-four per cent of the infants had preexisting serologic evidence of measles infections by 11 months of age. Among infants more than nine months of age, those who had had measles had a significantly lower nutritional status than those who had not (P less than 0.01). After vaccination, seroconversion rates increased from 45 per cent at 6 months to 100 per cent at 12 months. The lowest rate of vaccine failure compatible with acceptably low rates of natural infections could be achieved by vaccination after eight months of age. Infants born to mothers with low levels of antibody to measles (hemagglutination-inhibition antibody titers less than 1:40) were significantly more likely to have had natural measles (P less than 0.01) or to have seroconversion after vaccination (P less than 0.001) at 6 to 10 months of age than were infants born to mothers with higher of age than were infants born to mothers with higher titers. Malnutrition and acute infections did not affect seroconversion rates. These data support the World Health Organization recommendation to administer measles vaccine in under-developed countries as soon after nine months of age as possible, regardless of nutritional status or the presence of minor illnesses.

A register of mentally handicapped individuals using a microcomputer

The Kensington and Chelsea and Westminster Mental Handicap Register described in this paper was commissioned by the Area Planning Team for the Mentally Handicapped, on behalf of the two local authorities and the Area Health Authority. The register was designed and implemented for the authorities by the Kensington and Chelsea and Westminster Health Information Unit, which forms part of the Department of Community Medicine of Westminster Medical School.

[Treatment of rheumatoid arthritis. Open parallel study with the non-steroidal antirheumatics piroxicam and diclofenac]

Piroxicam and diclofenac were compared for 4 weeks in an open parallel study in 20 rheumatoid arthritis patients each. Both preparations showed good efficacy and were well tolerated, piroxicam appearing to be slightly superior in both respects. Piroxicam exercised a significant action on the inflammation-specific parameters (reduction of BSR by 6.15 mm maximum and of the alpha 2-globulin fraction by 0.75%), whereas diclofenac did not. Another advantage of piroxicam is its low effective dosage level achieved by a single daily dose.

Effect of availability and acceptability of lethal instruments on suicide mortality. An analysis of some international data

Suicide mortality in the 5 years 1969-73 in 11 countries is examined in relation to the methods used. Some countries have substantially high suicide rates for each method, others have increased mortality for certain specific methods. In this latter group it is suggested that some of the variations in total suicide mortality can be explained by variations in either the availability or the acceptability of certain specific instruments for causing death, particularly domestic gas, firearms and hanging.

Diagnosis and treatment of anorexia nervosa

Anorexia nervosa is much like other psychogenic or psychosomatic disorders in that it tends to run a chronic, relapsing course, with a proportion of patients never fully recovering. It is unlike them, however, in that significant mortality rates have been reported. With epidemiological studies now suggesting an increased incidence of the disorder, and follow-up studies indicating the importance of early treatment to favorable outcome, the vital role of family physicians in diagnosis and treatment becomes evident. This paper draws on both published accounts and original case material to summarize the primary diagnostic criteria and secondary signs of anorexia nervosa. An illustrative history of a young woman with chronic anorexia nervosa is followed by a discussion of treatment alternatives. Although still in the experimental stage, behavior therapy is presented for its apparent efficacy and adaptability to the outpatient family practice setting.

Concurrence of anorexia nervosa and yellow mutant albinism

A review of published clinical reports shows that anorexia nervosa has been found in association with several genetic anomalies, principally gonosomal aneuploidy. An additional, and unique, association is described here: a case of anorexia nervosa in a patient with the yellow mutant form of oculocutaneous albinism and no other apparent chromosomal abnormalities. While the concurrence of these two disorders in a single person is apparently a chance phenomenon, our review of experimental publications shows that feeding disturbances also occur in yellow mutant mice. Such complementary findings suggest the need for continuing investigation of the genetic foundations of eating behaviour.