Gene for von Recklinghausen neurofibromatosis is in the pericentromeric region of chromosome 17

Linkage analysis of 15 Utah kindreds demonstrated that a gene responsible for von Recklinghausen neurofibromatosis (NF) is located near the centromere on chromosome 17. The families also gave no evidence for heterogeneity, indicating that a significant proportion of NF cases are due to mutations at a single locus. Further genetic analysis can now refine this localization and may lead to the eventual identification and cloning of the defective gene responsible for this disorder.

Cell-free translation of the mRNAs for the heavy and light chains of HLA-A and HLA-B antigens

Cell-free translation of poly(A)-containing RNA from the JY lymphoblastoid cell line followed by immunoprecipitation has indicated the presence of mRNAs for both the heavy and light chains of HLA-A and HLA-B antigens in these preparations. Both chains are synthesized with an NH2-terminal extension, approximately 20 residues in length for the light chain, and 20 or 24 residues for the heavy chains. The precursors can be processed by dog pancreatic microsomes to products similar to those obtained in vivo. Immunoprecipitation of the cell-free products has been employed as an assay for partial purification of the mRNAs. Investigation of the Daudi cell line, which cannot synthesize the small subunit, beta 2-microglobin, has indicated that the heavy chains of HLA-A and HLA-B antigens are synthesized intracellularly in vivo and can also be translated from their cognate RNAs in vitro. The implications of these findings for biosynthesis of membrane proteins in general and multimeric membrane proteins in particular, as well as the role of beta 2-microglobulin in expression of HLA-A and HLA-B antigens, are discussed.

Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study

OBJECTIVE--To characterise the natural history of sexually transmitted HIV-I infection in homosexual and bisexual men. DESIGN--Cohort study. SETTING--San Francisco municipal sexually transmitted disease clinic. PATIENTS--Cohort included 6705 homosexual and bisexual men originally recruited from 1978 to 1980 for studies of sexually transmitted hepatitis B. This analysis is of 489 cohort members who were either HIV-I seropositive on entry into the cohort (n = 312) or seroconverted during the study period and had less than or equal to 24 months between the dates of their last seronegative and first seropositive specimens (n = 177). A subset of 442 of these men was examined in 1988 or 1989 or had been reported to have developed AIDS. MAIN OUTCOME MEASURES--Development of clinical signs and symptoms of HIV-I infection, including AIDS, AIDS related complex, asymptomatic generalised lymphadenopathy, and no signs or symptoms of infection. MEASUREMENTS AND MAIN RESULTS--Of the 422 men examined in 1988 or 1989 or reported as having AIDS, 341 had been infected from 1977 to 1980; 49% (167) of these men had died of AIDS, 10% (34) were alive with AIDS, 19% (65) had AIDS related complex, 3% (10) had asymptomatic generalised lymphadenopathy, and 19% (34) had no clinical signs or symptoms of HIV-I infection. Cumulative risk of AIDS by duration of HIV-I infection was analysed for all 489 men by the Kaplan-Meier method. Of these 489 men, 226 (46%) had been diagnosed as having AIDS. We estimated that 13% of cohort members will have developed AIDS within five years of seroconversion, 51% within 10 years, and 54% within 11.1 years. CONCLUSION--Our analysis confirming the importance of duration of infection to clinical state and the high risk of AIDS after infection underscores the importance of continuing efforts both to prevent transmission of HIV-I and to develop further treatments to slow or stall the progression of HIV-I infection to AIDS.

Neurological and neuropsychological manifestations of HIV-1 infection: association with AIDS-related complex but not asymptomatic HIV-1 infection

To determine whether neurological and neuropsychological abnormalities are associated with clinical manifestations of human immunodeficiency virus type 1 (HIV-1) infection in men who do not have acquired immunodeficiency syndrome (AIDS), we performed a historical prospective and cross-sectional study. One hundred HIV-1 seropositive homosexual or bisexual men, of whom 26 had AIDS-related complex, 31 had generalized lymphadenopathy, and 43 had no signs or symptoms of HIV-1 infection, and 157 HIV-1 seronegative men were enrolled from a cohort of 6,701 men who were originally recruited between 1978 and 1980 for studies of hepatitis B virus infection. Evaluation included medical history, physical examination, and neuropsychological tests. Of 26 HIV-1 seropositive subjects with AIDS-related complex, 11 (42%) reported neurological, cognitive, or affective symptoms compared with 30 (19%) of 157 HIV-1 seronegative subjects (relative risk = 2.2, p = 0.02). On neuropsychological testing, subjects with AIDS-related complex performed at a significantly lower level than the HIV-1 seronegative group (p = 0.001). A significantly higher percentage of subjects with AIDS-related complex (8[31%]of 26) than HIV-1 seronegative subjects (19 [12%] of 157) had abnormal results on two or more neuropsychological tests (rate ratio = 2.5, p = 0.03). Symptoms and impairment on neuropsychological tests were correlated only within the group who had AIDS-related complex. Subjects with generalized lymphadenopathy and subjects who had no signs or symptoms of HIV-1 infection were not different from HIV-1 seronegative subjects with respect to symptoms or performance on neuropsychological tests.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro synthesis of repressible yeast acid phosphatase: identification of multiple mRNAs and products

Antibodies to repressible nonspecific acid phosphatase [APase; orthophosphoric-monoester phosphohydrolase (acid optimum), EC 3.1.3.2] purified from Saccharomyces cerevisiae were used to detect the in vitro products of APase mRNA. Immunoprecipitation of cell-free synthesized protein and of in vivo enzyme from cell extracts has shown that derepression of enzyme synthesis in situ is the result of de novo appearance of functional mRNA followed by de novo protein synthesis. At least three unique APase polypeptides are synthesized in vitro from separate mRNAs and appear to be glycosylated in vivo to form secreted enzyme.

Presecretory and cytoplasmic invertase polypeptides encoded by distinct mRNAs derived from the same structural gene differ by a signal sequence

Saccharomyces cerevisiae strain FH4C carries a single invertase structural gene, SUC2, but produces distinct invertase mRNAs and polypeptides for the secreted and cytoplasmic forms of the enzyme. The two major invertase cell-free translation products are polypeptides of 60,000 daltons (p60) and 62,000 daltons (p62) and correspond to the nonglycosylated cytoplasmic form of invertase and the precursor of glycosylated secreted invertase, respectively. This paper describes amino acid sequence and peptide map analyses of invertase polypeptides. The peptide maps demonstrate that p62, p60, and the in vivo secreted polypeptide have significant structural homology. Sequence analysis, however, revealed differences between p62 and p60 at their amino termini. p62 contains an amino-terminal signal sequence of 19 amino acid residues that is specifically cleaved during secretion in a cell-free system to generate the secreted 87,000-dalton invertase glycopeptide gp87. This signal sequence is not present in p60. p60 synthesis begins with a methionine which can be aligned with a methionine at residue 21 in p 62. During translation, the p60 initiator methionine is removed and the newly generated amino terminus is acetylated. Based on peptide map similarities, partial amino-terminal sequence data, and common genetic origin, it is suggested that p60 and p62 have identical amino acid sequences carboxy-terminal to the p60 initiator methionine (residue 21 of p62). The reciprocal correlations of signal sequence with secretion and absence of signal sequence with cytoplasmic localization provide proof of the signal hypothesis for secreted proteins. Two mechanisms are proposed for the derivation of p60 and p62 from a single structural gene: alternative promoter sites, and differential processing of a single primary transcript.

The StarClose® vascular closure system: Interventional results from the CLIP study

BACKGROUND

The StarClose Vascular Closure System is a femoral access site closure technology that uses a flexible nitinol clip to complete a circumferential, extravascular arteriotomy close. The Clip CLosure In Percutaneous Procedures study was initiated to study the safety and efficacy of the StarClose device in subjects undergoing diagnostic and interventional catheterization procedures.

METHODS

A total of 17 U.S. sites enrolled 596 subjects, with 483 subjects randomized at a 2:1 ratio to receive StarClose or standard compression of the arteriotomy after the percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis.

RESULTS

The results of the diagnostic StarClose cohort have been reported separately. Results for the interventional arm revealed major vascular complications occurring in 1.1% of StarClose subjects (2/184) and 1.1% in manual compression subjects (1/91; P = 1.00). No infections were seen in either cohort. Minor complications in the StarClose interventional group occurred at a rate of 4.3% (8/184) and with compression at 9.9% (9/91; P = 0.107). Pseudoaneurysm or arteriovenous fistula was not seen with StarClose. With StarClose, procedural success was 100% (136/136) for the diagnostic group and 98.9% (181/183) in the interventional group. Device success for the treatment group was 86.8%. In the interventional cohort, 87.3% (158/181) of StarClose subjects reported a pain scale of 0-3 compared with 93.3% (84/90) in the compression group, which was not statistically different.

CONCLUSIONS

The clinical results of this study demonstrate that the StarClose Vascular Closure System is noninferior to manual compression with respect to the primary safety endpoint of major vascular events in subjects who undergo percutaneous interventional procedures. StarClose significantly reduced time to hemostasis, ambulation, and dischargeability when compared with compression.

HIV seroconversion in two homosexual men after receptive oral intercourse with ejaculation: implications for counseling concerning safe sexual practices

Seroconversion for HIV antibody occurred in two homosexual men who reported no anal intercourse for greater than or equal to 5 years and multiple episodes of receptive oral intercourse with ejaculation. Neither man reported intravenous drug use or receipt of blood products. The last antibody-negative specimen was also negative by the polymerase chain reaction and p24 antigen assays. All sexually active persons should be clearly counselled that receptive oral intercourse with ejaculation carries a potential risk of HIV transmission.

Behind armour blunt trauma--an emerging problem

Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel. In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall. Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings-TABs). The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described.

Clinical trials of WR-2721 and cis-platinum

WR-2721 is an aminothiol compound; in the animal model it protects against the nephrotoxicity, neurotoxicity, and hematologic toxicity of cis-platinum. We initiated Phase I trials of WR-2721 and cis-platinum to determine toxicity when WR-2721 was given prior to escalating doses of cis-platinum. With mannitol diuresis and WR-2721, transient nephrotoxicity occurred in 9 of 30 (27%) patients treated with cis-platinum 150 mg/m2 and 7% of patients given with cis-platinum 120 mg/m2. Bone marrow suppression was mild and infrequent. Mild to moderate peripheral neuropathies occurred in 26% of patients courses following a mean cumulative cis-platinum dose of 725 mg/m2. Objective partial responses were observed in 53 of 118 (45%) patients with measurable disease. Antitumor responses were observed in 25 of 53 patients with metastatic melanoma, 12 of 22 patients with locally recurrent or metastatic head and neck cancer, and 7 of 13 patients with metastatic breast cancer refractory to conventional chemotherapy. Controlled studies of WR-2721 and cis-platinum will be performed in the Eastern Cooperative Oncology Group in these disease sites to better define the activity of this regimen and its toxicity.

Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention

OBJECTIVES

The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention.

BACKGROUND

The ideal dose and duration of heparin infusion after successful coronary intervention is unknown.

METHODS

Patients were randomized to one of three heparin strategies after coronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patients) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any further heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome.

RESULTS

After successful coronary intervention, 414 patients were randomized. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overall incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all three groups.

CONCLUSIONS

Heparin infusion after successful coronary intervention is associated with more minor bleeding and vascular injury, prolonged length of stay and increased cost. In-hospital and one-month ischemic events rarely occur after successful intervention, irrespective of heparin use. Routine postprocedure heparin is not recommended, even in patients who present with unstable ischemic syndromes.

Continuous monitoring of mixed venous oxygen saturation in septic shock

Fiberoptic pulmonary artery catheters provide a practical method for continuously measuring the amount of oxygen in mixed venous blood. To characterize the usefulness of mixed venous oxygen saturation in managing patients with sepsis, we performed serial hemodynamic measurements on 20 patients with documented septic shock. There was a highly significant positive correlation between increases or decreases of 5% or more in mixed venous oxygen saturation and corresponding changes in oxygen delivery (r = 0.95) and oxygen consumption (r = 0.96). Mixed venous oxygen saturation less than 65% was clinically unacceptable in patients with sepsis and was associated with a poor prognosis. In this study, measurement of mixed venous oxygen saturation was a valuable predictor of survival in patients with septic shock and provided a means of continuously monitoring the status of tissue oxygenation.

Continuous emergency department monitoring of arterial saturation in adult patients with respiratory distress

Continuous measurement of arterial oxygen saturation (SaO2) using pulse oximetry has become a common monitoring and management technique in critically ill hospitalized patients. To determine the impact of SaO2 monitoring on emergency patient management, we conducted a prospective uncontrolled clinical trial on 40 adult patients presenting to the emergency department with acute respiratory illness, such as emphysema, asthma, or pulmonary edema. Recorded data included hemograms, arterial blood gases, subsequent therapy, and response to treatment. Additionally, the "early warning" capability of SaO2 monitoring was analyzed by recording the severity and outcome of hypoxemic events during treatment. Mean duration of usage for the 40 oximeters in the ED was 1.8 hours; all probes functioned reliably over a wide range of systolic pressures (80 to 206 mm Hg), heart rates (40 to 180 beats per minute), and hematocrits (20% to 58%). There was good correlation between simultaneous pulse oximeter values and both directly measured SaO2 (r = 0.95) and saturations derived from measured arterial PaO2 (r = 0.94). The device detected several otherwise unrecognized drops in arterial saturation that were confirmed by laboratory analysis. Other clinical situations in which the pulse oximeter was found useful in the ED are reviewed. We conclude that continuous measurement of SaO2 can improve the monitoring of ED patients, increase the precision of therapy, detect hypoxemia during intubation, suctioning, and other treatments, and detect clinically unsuspected changes in arterial oxygenation.

The safety and efficacy of the StarClose® vascular closure system: The ultrasound substudy of the CLIP study

BACKGROUND

The StarClose Vascular Closure System (Abbott Vascular, Redwood City, CA) features a nitinol clip that is designed to achieve closure of the femoral arteriotomy access site. The CLIP Study was performed to assess the safety and efficacy of StarClose when compared with standard manual compression following 5-6 French diagnostic or interventional percutaneous procedures. A substudy of this trial was designed to assess the utility of duplex ultrasonography to assess patency of the femoral artery and to determine access site complications (pseudoaneurysm, arteriovenous fistula, hematoma, deep vein thrombosis) in a multicenter prospective trial. This is the report of the duplex ultrasound (DUS) substudy of the CLIP trial.

METHODS

A total of 17 U.S. sites enrolled 596 subjects with 483 subjects randomized at a 2:1 ratio to receive StarClose or manual compression of the arteriotomy after a percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis. A substudy of the CLIP interventional arm evaluated DUS images of the closure site at five study sites, targeting 100 subjects at day 30 following hemostasis. The DUS protocol was devised and implemented by an independent vascular ultrasound core laboratory with extensive experience in vascular device trials. DUS inguinal region from 6 cm proximal to 6 cm distal to the arteriotomy puncture was performed. A qualitative examination was performed to determine the presence of iatrogenic vascular injuries: hematoma, pseudoaneurysm (PSA), arteriovenous fistula (AVF), and arterial/venous thrombosis or stenosis using 2-dimensional gray scale, color, and focused Doppler images.

RESULTS

DUS of 96 subjects randomized to StarClose (n = 71) and compression (n = 25) were performed and evaluated. There was no evidence of hematoma, PSA, or AVF observed in the StarClose group. No StarClose subjects in the substudy had a PSA or AVF. All patients in the substudy demonstrated patency of the access site artery and vein without thrombosis or stenosis. Finally, in the entire study cohort, no clinically-driven DUS studies demonstrated iatrogenic vascular injury or vessel thrombosis in the StarClose treated patients.

CONCLUSION

DUS, a safe and reliable method for determining the safety and efficacy of access site closure devices, is a reliable, safe, inexpensive and accurate method of assessing vascular access site complications in multicenter trials. In this substudy of the CLIP study, DUS found no statistical difference in access site complications between the StarClose and manual compression groups. Both groups maintained vessel patency without stenosis, thrombosis, hematoma, pseudoaneurysm, or AV fistula.

Diversity of light chain variable region sequences among rabbit antibodies elicited by the same antigens

We report the complete variable region sequences of three homogeneous rabbit antibody light chains and the partial sequences of five others. Wehn these are compared to other published rabbit light chain sequences, two regions of markedly increased variability are revealed, which are homologous in position to the first and third hypervariable regions of murine and human myeloma light chains. In addition, there is increased variability among the first three residues at the aminoterminal end. A hypervariable region homologous to that identified at positions 50 to 56 in myeloma light chains is not present in these rabbit antibody light chains. The available three-dimensional models of Fab fragments based on x-ray crystallography indicate that neither the amino-terminal portion of the light chain nor the region homologous to positions 50 to 56 forms a part of the combining site. Comparison of the hypervariable regions among six light chains from antibodies to Type III pneumococcal polysaccharide and among four from antibodies to Type VIII pneumococcal polysaccharide suggests that a large number of different sequences may be found in antibodies specific for these relatively simple antigens. Certain residues outside of the hypervariable regions are invariant in the rabbit light chains and correspond to residues that are required for proper chain folding in human and murine myeloma light chains, indicating that the general conformation of myeloma light chains is the same as that of light chains of elicited antibodies.

Diphenhydramine-induced toxic psychosis

A 24-year-old man presented to the emergency department with acute anticholinergic symptoms, hallucinations, and bizarre behavior following a large ingestion of diphenhydramine (Benadryl). Because of the large number of nonprescription preparations containing this antihistamine, similar ingestions are becoming increasingly frequent. Minor anticholinergic side effects associated with diphenhydramine are general medical knowledge. The effects of overdosage are less well known. The clinical presentation of toxic psychosis, its differential diagnosis, and its subsequent treatment are discussed.

Repetitive doses of activated charcoal in the treatment of poisoning

Activated charcoal has found a renewed role in the management of overdosed patients. Routinely administered to reduce the gastrointestinal (GI) absorption of many drugs, growing evidence indicates that repeated doses of charcoal also may enhance drug elimination. Some drugs are excreted into the bile or gastric fluids (phencyclidine, digoxin) and are reabsorbed. Other drugs (theophylline, phenobarbital) can diffuse from the plasma into the lumen of the GI tract. Activated charcoal is administered at regular intervals to sequester these toxins in the GI tract, eventually causing their excretion in feces. This article reviews the evidence for the safety and efficacy of repetitive charcoal therapy. While supportive management remains the mainstay of therapy in poisoned patients, activated charcoal is inexpensive, effective, simple to administer, and may obviate the need for more invasive methods of toxin removal.

The professional role for nurses in clinical trials

This article has examined the role of the nurse in clinical trials, particularly the clinical, administrative, and research roles. Components of each role and characteristics essential for the implementation of each role have been examined. The nursing role in clinical trials research is undergoing major transformation from the perception of the nurse as a data collector for medical research to the recognition of the nurse as an essential member of the research team with a multifaceted role. Miaskowski identifies two factors influencing the development of oncology nursing practice; scientific and technological advances and societal factors relating to the perception of cancer as a disease and changes in the nursing profession. Certainly it is recognized that progress in basic science research will lead to an increase in the complexity and number of clinical trials. Nurses have clearly implemented the roles necessary to be vital participants and have contributed to answering questions leading to improved treatments for the patients with cancer.

Prevalence of recreational drug use reported by men who have sex with men attending sexual health clinics in Manchester, UK

Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.

Unique V kappa group associated with two mouse L chain genetic markers

The C.C58 and C.AKR congeneic strains of mice differ from BALB/c at loci on chromosome 6 which govern kappa light chain variable region (V kappa) polymorphisms and the Lyt-2 and Lyt-3 alloantigens. Amino acid sequence analysis of light chains of myelomas induced in these strains revealed one light chain, C.C58 M75, that had an NH2-terminal serine and differed sufficiently from published V kappa sequences to define a new V kappa group, V kappa (Ser), apparently not expressed by BALB/c mice. Peptide map analysis indicated that the M75 light chain contained the IB-peptide marker, a V kappa polymorphism expressed by C.C58 but not BALB/c mice, which is determined by the IgK-Trpa allele present on chromosome 6. This same light chain was found by isoelectric focussing to correspond to IgK-Ef1a, another V kappa genetic marker of C.C58 and C.AKR. Isoelectric focussing of approximately 200 C.C58 and C.AKR myeloma light chains revealed three additional C.C58 and four C.AKR light chains that corresponded to IgK-Ef1a-specific light chains. All three additional C.C58 light chains belonged to the V kappa (Ser) group and contained the IB-peptide marker. Thus, the differences in V kappa repertoires represented by the IB-peptide and IgK-Ef1a markers and controlled by genes on chromosome 6 appear to reflect expression (or failure of expression) of a distinct group of V kappa regions.

Teaching research in the emergency medicine residency curriculum

Research in emergency medicine is a necessary component for the growth and development of the academic discipline. Although the need exists for competent physician investigators, most graduates of emergency medicine residencies have had little structured education in research design or methodology. This is particularly true in community hospital programs with little funding allocated to research, limited facilities, and few staff members actively involved in research. Our purpose is to describe a research curriculum designed to operate within a community-based residency program. This curriculum identifies a detailed set of educational objectives in research techniques with the expectation that on completion of the residency program, the resident will be able to critically evaluate medical literature and independently design a research project. We have developed a specific plan for meeting these objectives with coordinated seminars, readings, journal clubs, research projects or exhibits, and professional conferences. We suggest some practical methods of motivating residents and attending staff to pursue clinical investigation.

Further linkage data on Norrie disease

We obtained a LOD score of +1.61 using DNA marker L1.28 in 5 generations of a family with Norrie disease, raising the total LOD score to +5.42. There have been no recombinations between the 2 loci in any family to date, making the marker useful for genetic counseling.