Optic neuropathy endemic in secondary school children in Dar es Salaam, Tanzania

AIM

To investigate the prevalence and causes of optic neuropathy, reported as epidemic in 1997, among secondary school students in Dar es Salaam, Tanzania.

PATIENTS AND METHODS

First year students (n = 10,892) from 63 secondary schools located within 30 km from the base hospital were interviewed and had a visual acuity (VA) screening test. Students failing the 6/12-line in either eye were defined as having "poor eyesight" and referred to the base hospital where an optometrist re-tested VA and refracted them. An ophthalmologist examined students with VA of 6/12 or worse in either eye and visual impairment was defined as VA of worse than 6/12 with best correction. Associations between optic neuropathy, socioeconomic status and educational results were investigated.

RESULTS

Students' ages ranged from 12 to 22 (mean 15.2) years; 50.6% were male. The prevalence of optic neuropathy was 0.3 (SD 0.051)%. The condition affected older students and was associated with the family having fewer economic possessions (car, computer, television). Optic neuropathy accounted for 19/33 (58%) of bilateral visual impairment cases. No effect of the disease on educational performance was identified.

CONCLUSION

Optic neuropathy remains a significant problem in this population and can now be termed endemic rather than epidemic. Further research into its causes is required.

Influence of irrigation method on water use and production of perennial pastures in northern Victoria

The irrigation of pasture for the dairy industry accounts for a large proportion of Australia’s total irrigation water use, particularly in the Murray–Darling Basin. Most pasture is irrigated using the border-check method. The dairy industry is under increasing pressure to use water more efficiently in response to water market reforms and restrictions on future irrigation water availability, creating interest in the potential of alternative irrigation methods. A field experiment was conducted at Tatura, Victoria, Australia between July 2000 and July 2002 to quantify the differences in water use, perennial pasture production and pasture composition under border-check, surge, sprinkler and subsurface drip irrigation. The experiment aimed to assess each irrigation method as it would perform under farm best management practices. Measurements included applied water, tailwater runoff, soil water status, dry matter production and botanical composition. This experiment found that sprinkler and subsurface drip irrigation used on average 2 ML/ha.year (17–23%) less water than border-check irrigation while maintaining or increasing pasture production, consequently having a significantly higher water use efficiency. Surface runoff was significantly reduced under sprinkler and subsurface drip irrigation. Surge irrigation had no advantages over border-check. Although some differences in pasture composition were observed between irrigation treatments, the trends were inconsistent from one season to the next. The high water use by gravity fed irrigation methods is attributed to a combination of higher evaporation and groundwater accessions.

Therapeutic effects of cysteine protease inhibition in allergic lung inflammation: inhibition of allergen-specific T lymphocyte migration

OBJECTIVE AND DESIGN

We have evaluated the effects of the broad-spectrum cysteine protease inhibitor E64 on allergic lung inflammation in the mouse ovalbumin model of human asthma. We have also characterised membrane-associated cathepsin enzyme activity on a range of cell types.

MATERIALS

Balb/C mice, E64 and CA074, various cell lines.

TREATMENT

E64 was administered by subcutaneous minipump into ovalbumin-sensitised mice prior to intranasal ovalbumin challenge. The effect of E64 on ovalbumin-induced inflammation in vivo and ovalbumin-specific T cell proliferation in vitro and ex vivo was examined. Membrane-associated cathepsin activity on various cell types was measured.

RESULTS

E64 treatment (0.36-0.48 mg/day) led to a significant reduction in eosinophil numbers and lung weights in the mouse model. Histological examination of lungs confirmed the anti-inflammatory effect. E64 greatly reduced ovalbumin-specific T cell numbers in the lymph nodes draining the lung following intranasal challenge whilst an accumulation of these T cells was found in the 'priming' lymph nodes. An analysis of various cells involved in lymphocyte priming and migration revealed that monocytes, dendritic cells and endothelial cells express high levels of membrane-associated cathepsin B activity.

CONCLUSIONS

Since E64 is not cell permeable and does not inhibit antigen-induced T cell proliferation in vitro or in vivo, the data indicate that membrane-associated cysteine proteases, possibly cathepsin B, may regulate T lymphocyte migration in vivo.

1,6-interactions between dimethylamino and aldehyde groups in two biphenyl derivatives

The title compounds, 2-(dimethylamino)biphenyl-2'-carboxaldehyde, C15H15NO, and 2-(dimethylamino)biphenyl-2',6'-dicarboxaldehyde, C16H15NO2, show similar 1,6-interactions [N...C=O 2.929 (3) to 3.029 (3) A] between the dimethylamino and aldehyde groups located in the ortho positions of the two rings, which lie at 58.1 (1)-62.4 (1) degrees to each other.

Statistical analysis of spatial pattern: a comparison of grid and hierarchical sampling approaches

Previous studies have combined random-site hierarchical sampling designs with analysis of variance techniques, and grid sampling with spatial autocorrelation analysis. We illustrate that analysis techniques and sampling designs are interchangeable using densities of an infaunal bivalve from a study in Poverty Bay, New Zealand. Hierarchical designs allow the estimation of variances associated with each level, but high-level factors are imprecisely estimated, and they are inefficient for describing spatial pattern. Grid designs are efficient for describing spatial pattern, and are amenable to conventional analysis. Our example deals with a continuous spatial habitat, but our conclusions also apply in disjunct or patchy habitats. The influence of errors in positioning is also assessed. The advantages of systematic sampling are reviewed, and more efficient hierarchical approaches are identified. The distinction between biological and statistical significance in all analyses is emphasised.

Fast measurements of the motion and velocity spectrum of blood using MR tagging

A new method is presented for tracking the motion of blood and determining its velocity spectrum from magnetic resonance data collected within a single heartbeat. The method begins by tagging a column of blood in a vessel by combining a 1D SPAMM excitation with a 2D cylindrical excitation. A series of 1D projections of the tagging pattern is acquired from a train of gradient echoes. The influence of specific excitation profiles and velocity profiles on the motion of the tags is explored for steady flow. It is shown mathematically, and confirmed with phantom experiments, that the velocity of a tag equals the mean velocity of the excited fluid when the velocity spectrum is symmetric about its mean velocity. The velocity spectrum is derived by analyzing the interference between tags moving at different velocities. This appears to be the first use of magnitude tagging to obtain velocity spectra. Representative measurements in a human aorta are presented to assess feasibility in vivo. Magn Reson Med 45:461-469, 2001.

Partial discrete Fourier transform (PDFT) multiband encoding

For conventional multiband encoding techniques such as Hadamard encoding, scan time scales linearly with the number of slices encoded simultaneously. In this work, a new multiband encoding technique called partial discrete Fourier transform (PDFT) encoding is introduced, which overcomes this restriction. This technique incorporates the principle of partial Fourier imaging, allowing the tradeoff of SNR and imaging time without changing the number of slices. The theory behind PDFT encoding and its inherent sensitivity to phase errors are outlined. The theory was validated through simulations, showing that phase errors result in degraded slice localization. The feasibility of PDFT encoding of 12 slices was tested with experimental excitation profile measurements and heart images of a human subject using commercial MRI equipment. Imaging time was reduced to 66% with SNR reduced to 82%. Magn Reson Med 45:118-127, 2001.

Comparison of the nucleic acid-based crosslinking hybridization assay and the branched DNA signal amplification assay in the quantitative measurement of serum hepatitis B virus DNA

Quantitative measurement of hepatitis B virus (HBV) DNA has become important in the clinical diagnosis of patients with chronic hepatitis B, especially in patients with hepatitis B e antigen (HBeAg)-negative precore mutant and in patients who received treatment with interferon or antiviral agents. Two different hybridization assays for quantitative measurement of HBV DNA: Naxcor crosslinking assays and Chiron branched DNA signal amplification (bDNA) assay, were applied to 158 serum samples which were positive for HBV DNA by polymerase chain reaction. Among 158 serum samples, 135 samples (85.4%) were positive by the crosslinking assay and 129 samples (81.6%) were positive by the bDNA assay in the quantification of serum HBV DNA (P > 0.05). Serum HBV DNA levels obtained from both assays showed a good linear correlation (r = 0.91, P < 0.001). The sensitivity of both assays in HBeAg-positive samples was 90.5%, significantly higher than in HBeAg-negative samples (69.6% for the crosslinking assay and 56.5% for the bDNA assay, P < 0.05). In HBeAg-negative patients with elevated serum alanine transaminase levels, the so-called precore HBV mutant, the detection sensitivity for HBV DNA was better in the crosslinking assay (83%) than in the bDNA assay (61%). The crosslinking assay was less time consuming than the bDNA assay in performing the measurement of serum HBV DNA (6 hours vs. 20 hours). In conclusion, Naxcor crosslinking hybridization assay was equally as sensitive as Chiron bDNA assay in the quantitative measurement of serum HBV DNA. Less time-consuming procedures and better sensitivity in the detection of HBeAg-negative samples with elevated serum alanine transaminase levels may favor the clinical use of the crosslinking assay.

Photo-cross-linkable oligonucleotide probes for in situ hybridization assays

In situ hybridization techniques have been an important research tool since first introduced 30 years ago, and more recently clinical applications have been expanding greatly. Still, further improvements in the assay sensitivity and protocols that are amenable to routine clinical use are desired. We use a novel photo-cross-linking technology to irreversibly bind short oligonucleotide probes to the target sequence following a hybridization period. The cross-linking agent is incorporated into the backbone of the probe and is activated to react with pyrimidines in the opposite strand by near-UV (300-370 nm) irradiation. By locking the probe to the target, very stringent wash conditions can be used that would otherwise completely remove probes that are hybridized but not cross-linked to the target. Consequently, the probe-specific signal is maximized, while the background signal is minimized to the greatest extent possible with the stringency of the wash. The use of short, photo-cross-linkable probes presents a new strategy for maximizing the sensitivity of probe hybridization or signal amplification-based in situ techniques.

Open reduction and cementation for femoral head fracture secondary to avascular necrosis: preliminary report

Current treatment for femoral head avascular necrosis has shown good results in early stages of disease, but are not as impressive after progression to collapse. We treated 19 patients (20 hips) with Stage III avascular necrosis (AVN) by open reduction augmented by methylmethacrylate cementation. Follow up ranges from 6 months to 2 years (average = 8.7 months). We followed patient progress with pre- and post-operative Harris Hip Scores, Womac Osteoarthritis Index and a Health Status Questionnaire (SF36). All patients realized immediate post-operative pain relief and improvement in function. Harris Hip, Womac Osteoarthritis Index and SF36 physical health scores improved significantly from 54.0 to 79.5 (p < 0.05), 54.3 to 29.8 (p < 0.05) and 28.4 to 42.4 (p < 0.05), respectively. Three patients had a conversion to total hip arthroplasty. Cementation is technically simple, burns no bridges and enables patients a rapid recovery. The long term results, in regards to progression of disease and secondary arthritis, are unknown.

Comparison of the nucleic acid-based crosslinking hybridization assay and the branched DNA signal amplification assay in the quantitative measurement of serum hepatitis B virus DNA

Quantitative measurement of hepatitis B virus (HBV) DNA has become important in the clinical diagnosis of patients with chronic hepatitis B, especially in patients with hepatitis B e antigen (HBeAg)-negative precore mutant and in patients who received treatment with interferon or antiviral agents. Two different hybridization assays for quantitative measurement of HBV DNA: Naxcor crosslinking assays and Chiron branched DNA signal amplification (bDNA) assay, were applied to 158 serum samples which were positive for HBV DNA by polymerase chain reaction. Among 158 serum samples, 135 samples (85.4%) were positive by the crosslinking assay and 129 samples (81.6%) were positive by the bDNA assay in the quantification of serum HBV DNA (P > 0.05). Serum HBV DNA levels obtained from both assays showed a good linear correlation (r = 0.91, P < 0.001). The sensitivity of both assays in HBeAg-positive samples was 90.5%, significantly higher than in HBeAg-negative samples (69.6% for the crosslinking assay and 56.5% for the bDNA assay, P < 0.05). In HBeAg-negative patients with elevated serum alanine transaminase levels, the so-called precore HBV mutant, the detection sensitivity for HBV DNA was better in the crosslinking assay (83%) than in the bDNA assay (61%). The crosslinking assay was less time consuming than the bDNA assay in performing the measurement of serum HBV DNA (6 hours vs. 20 hours). In conclusion, Naxcor crosslinking hybridization assay was equally as sensitive as Chiron bDNA assay in the quantitative measurement of serum HBV DNA. Less time-consuming procedures and better sensitivity in the detection of HBeAg-negative samples with elevated serum alanine transaminase levels may favor the clinical use of the crosslinking assay.

Repetitive high G exposure is associated with increased occurrence of cardiac valvular regurgitation

BACKGROUND

Exposure to repeated high +Gz loads and the methods to prevent loss of consciousness cause unique stresses on the cardiovascular system. The purpose of this study was to determine if the +Gz environment is associated with an increased occurrence of valvular regurgitation in pilots of high performance aircraft.

METHODS

There were 247 subjects who were divided into pilot (n = 46) and non-pilot (n = 201) groups. Pilots were defined as those individuals who had flown at least 1000 h in high performance aircraft. The echocardiographic data of these subjects were examined retrospectively.

RESULTS

We found a statistically significant association between pulmonic insufficiency and exposure to high +Gz stress in pilots vs. non-pilots (chi2 = 13.09, p = 0.0002). In addition, there was a greater incidence of tricuspid regurgitation (chi2 = 4.97, p = 0.025) and concurrent pulmonic insufficiency and tricuspid regurgitation (chi2 = 14.1, p = 0.0002) in the pilot group.

CONCLUSIONS

There is a direct relationship between repetitive exposure to a +Gz environment and pulmonic insufficiency, tricuspid regurgitation, or concurrent pulmonic insufficiency and tricuspid regurgitation. This may be secondary to the transient increase in right ventricular pressure due to acceleration forces or straining maneuvers utilized to prevent or postpone +Gz induced loss of consciousness (G-LOC).

Behavioral sensitization following repeated intravenous nicotine administration: gender differences and gonadal hormones

Repeated intermittent administration of stimulants is well known to produce behavioral sensitization in male animals. The present studies explored whether 1) behavioral sensitization occurred with the i.v. route of administration, 2) sensitization was greater in females than in males, 3) sensitization was modulated by gonadectomy, 4) intact adult female rats maintained normal estrous cytology patterns in response to repeated nicotine administration, and 5) the pharmacokinetics of i.v. nicotine dosing. Adult male, female, castrated, and ovariectomized Sprague-Dawley rats (n = 48) were surgically implanted with an intravenous access port. Animals received 50 microg/kg i.v. nicotine once/day for 14 days. Immediately after the initial nicotine injection and the final day 14 nicotine injection, animals were placed in IR photocell activity chambers for 60 min. Observational time sampling of behavior was also simultaneously performed by an observer blind to treatment condition. An increase in behavioral activity of greater than 120% occurred across the 14-day time course of i.v. nicotine injections. The magnitude of the increase, however, varied as a function of component of activity, gender, and gonadectomy. The behavioral observation data further suggested that the females demonstrated an increased sensitivity to repeated nicotine, as evidenced in a more rapid response, for example, grooming. These behavioral observations were associated with peak arterial levels of nicotine (approximately 25 ng/ml) no greater than the average venous levels of nicotine commonly maintained by cigarette smokers. Repeated i.v. nicotine, at a dose of 50 microg/kg, did not interfere with intact female vaginal cytology or body weight; the failure to detect such alterations were not due to inadequate statistical power. Moreover, no nicotine-treated animals displayed persistent vaginal estrous or were acyclic. Collectively, these data suggest that the i.v. nicotine model may be particularly useful in exploring the gender-dependent effects of nicotine.

Estrous cyclicity and behavioral sensitization in female rats following repeated intravenous cocaine administration

Repeated intermittent administration of cocaine is well known to produce behavioral sensitization in male animals. The present studies explored whether intact adult female rats maintained normal estrous patterns in response to repeated IV cocaine administration and whether behavioral sensitization occurred with this route of administration. Adult female Sprague-Dawley rats (N = 48) were surgically implanted with an intravenous access port. Animals received 3.0 mg/kg IV cocaine once/day for 14 days. Daily vaginal lavages indicated that female rats continued to cycle normally throughout the experiment. Estimates of statistical power for detecting alterations in estrous cycle length ranged from 0.61-0.95 for small (0.1) to large (0.4) effect sizes. Moreover, no cocaine-treated animals displayed persistent vaginal estrus or were acyclic and cocaine treatment did not decrease body weight. Immediately after the cocaine injection, animals were placed in IR photocell activity chambers for 60 min. Female rats displayed a significant 75% increase in locomotor activity across the 14-day time course of IV cocaine injections. These data indicate that 3.0 mg/kg of IV cocaine does not interfere with normal estrous cyclicity, and that behavioral sensitization occurs in female rats following repeated daily IV cocaine dosing. Collectively, these data suggest that the IV cocaine-dosing model may be particularly useful in exploring the gender-dependent effects of cocaine using intact female rats.

Aorta wall motion monitoring by 1-d MRI of perpendicular diameters

A method for monitoring the cross-sectional size of blood vessels rapidly is introduced. The method creates a one-dimensional (1-D) profile of a strip along the diameter of a vessel using magnetic resonance imaging (MRI). The strips can be much wider than pixels in a typical two-dimensional (2-D) image to increase the signal-to-noise ratio. A second strip perpendicular to the first is also imaged sequentially to allow the detection, estimation, and correction of errors in diameter measurements resulting from the strip inadvertently covering a chord, rather than a diameter. Diameter measurements derived from 1-D profiles agree with measurements derived from 2-D images. This method is nearly an order of magnitude faster than 2-D MRI and has the potential for real-time implementation. J. Magn. Reson. Imaging 1999;10:833-840.

Method for improved multiband excitation profiles using the Shinnar-Le Roux transform

A method to design multiband RF pulses for magnetic resonance imaging is described. The method is based on the Shinnar-Le Roux transform and involves a phase correction that provides control over the phase of the excited bands. The theory behind the method and this phase correction is outlined. The method is demonstrated with the design of RF pulses for Hadamard encoding and Haar wavelet encoding. Experimentally measured excitation profiles and images for RF pulses designed with the new method are compared to those designed by the conventional method. The conventional method is shown to result in distortion of the excitation profile when the bands are closely spaced. A 78% reduction in this distortion is attributed to the new method. This translates into a 52% reduction of out-of-slice signal in Haar wavelet encoding. Magn Reson Med 42:577-584, 1999.

Motion measurements from individual MR signals using volume localization

A novel method is presented for measuring motion using individual magnetic resonance (MR) signals. This method uses a volume-localized excitation with reduced spatial encoding to measure displacement with a temporal resolution of several milliseconds. The trajectory of the excited volume is derived from the time-dependent frequency of the MR signal, which changes as the volume moves through a magnetic-field gradient. Phantom and in vivo experiments confirm that this method can monitor the trajectory of plug-like structures accurately, with T2* decay limiting the measurement period. The displacement of flowing blood in a human aorta has been measured for 65 msec from one MR signal, with a theoretical accuracy of 0.25 mm and an effective time resolution of 2 msec. The high temporal resolution of this method is useful for capturing rapid motions. An interesting property of this method is that it measures motion from the reference frame of the moving anatomy.

Community health nurses' knowledge of Lyme disease: implications for surveillance and community education

A statewide assessment was conducted to determine the general knowledge and professional practices about Lyme disease (LD) of local health department nurses. The study sample included 226 nurses practicing in 80 health departments in Indiana. Data were collected using a self-administered questionnaire and analyzed using group independent t tests. Findings showed that nurses were most knowledgeable about personal protection against LD and least knowledgeable about symptoms, case definition, and reporting criteria. Nonbaccalaureate degreed nurses scored significantly higher on questions about LD than the baccalaureate or master's prepared nurses. Results point to the need for better dissemination of LD information among public health nurses, expanded LD education for the public, and further development of LD surveillance activities.

Nucleic acid-based cross-linking assay for detection and quantification of hepatitis B virus DNA

A nucleic acid photo-cross-linking technology was used to develop a direct assay for the quantification of hepatitis B virus (HBV) DNA levels in serum. Cross-linker-modified DNA probes complementary to the viral genomes of the major HBV subtypes were synthesized and used in an assay that could be completed in less than 6 h. The quantification range of the assay, as determined by testing serial dilutions of Eurohep HBV reference standards and cloned HBV DNA, was 5 x 10(5) to 3 x 10(9) molecules of HBV DNA/ml of serum. Within-run and between-run coefficients of variation (CVs) for the assay were 4. 3 and 4.0%, respectively. The assay was used to determine HBV DNA levels in 302 serum samples, and the results were compared to those obtained after testing the same samples with the Chiron branched-DNA (bDNA) assay for HBV DNA. Of the samples tested, 218 were positive for HBV DNA by both assays and 72 gave results below the cutoff for both assays. Of the remaining 12 samples, 10 were positive for HBV DNA by the cross-linking assay only; the 2 other samples were positive by the bDNA assay only. Twenty-eight samples had to be retested by the bDNA assay (CV, >20% between the results obtained from the testing of each sample in duplicate), whereas only three samples required retesting by the cross-linking assay. The correlation between the HBV DNA levels, as measured by the two tests, was very high (r = 0.902; P = 0.01). We conclude that the cross-linking assay is a sensitive and reproducible method for the detection and quantification of HBV DNA levels in serum.

Collagen fiber sliding during ligament growth and contracture

It is hypothesized that the sliding of collagen fibers past one another plays an important role in changes of ligament length during growth or contracture. To explore this possibility, we used the fluorescent dye dichlorotriazinyl fluorescein to stain collagen fibers perpendicular to their orientation in a rat medial collateral ligament model. Growth, contracture, and control models (with rats weighing 50-75 g in the first and 500-600 g in the latter two groups) were studied. In the contracture model, the medial collateral ligament was transected distally. Marking sutures were used to verify the presence of growth or contracture in each medial collateral ligament. Fluorescence photomicrography after 2 weeks demonstrated stained collagen fibers protruding from either side of the original mark as one would expect, in either growth or contracture, if the fibers slid past one another and away from their initial location during changes in length. By measuring the initial and final widths of the growth and contracture model marks and correlating them to controls that had minimal growth (rats grow throughout their life) and were free of contracture, we have provided evidence that collagen sliding plays a significant role in changes in ligament length.

An episode of ventricular tachycardia during long-duration spaceflight

An episode of nonsustained ventricular tachycardia was recorded from a crew member during the second month aboard the MIR space station. Although asymptomatic, this cardiac event increases the concern that serious cardiac dysrhythmias may be a limiting factor during long-duration spaceflight.

Wavelet encoding for improved SNR and retrospective slice thickness adjustment

A method to encode the slice-select direction in magnetic resonance imaging through the use of a discrete wavelet transform is presented. The paper reports the first implementation of wavelet encoding using the Haar basis. Theoretically, the signal-to-noise ratio (SNR) for two levels of wavelet encoding is expected to be approximately 1.6 times higher than for conventional multislice imaging in which each slice is excited separately. A slightly lower SNR is encountered experimentally because of slice interference. The design of radiofrequency (RF) pulses to excite slices approximating Haar wavelet basis functions is discussed. Wavelet encoding also provides an efficient method for balancing slice thickness and SNR after an image has been acquired. The experiments have been conducted at 1.5 Tesla. Wavelet encoding of slices should be especially suitable for low-field MRI, in which the SNR is lower and the characteristically lower T1 values favor the use of shorter TR, which sometimes forces the slices to be acquired in multiple passes.

A focal zone of thalamic plasticity

In this study, sensory maps in the thalamus were investigated by examining their volume and shape. We determined the forelimb representation in adult rats after the removal of hindlimb input by nucleus gracilis lesions. Three-dimensional reconstructions of thalamic sensory maps were obtained from a grid of electrode penetrations. We found that the volume of the shoulder sensory map contracted >50% at an acute time interval (n = 6), followed by a robust volumetric sensory map expansion of 25% at 1 week (n = 8) and 1 month (n = 8) after lesion relative to controls (n = 8). The topology of the volumetric increase was scrutinized by slicing functional maps in the coronal, sagittal, and horizontal planes. The equivalence of such slices from each animal was established by virtue of their distance from either a functional or neuroanatomical landmark. Surprisingly, all of the volumetric increase unequivocally occurred in a circumscribed coronal slice 300 micron thick. This focal zone was located toward the rostral pole of the thalamic tactile relay, the ventroposterolateral nucleus. Analysis in the sagittal plane revealed that, unexpectedly, the shoulder map volume expanded by superimposing its representation on that of the forepaw, via an advancement of the shoulder representation by 0.6 mm medially. We propose a "hot spot" hypothesis in which focal zones of plasticity may not be specific to the thalamus but may have manifestations elsewhere in the nervous system, such as the cerebral cortex or dorsal column nuclei.

Preventable blindness in the east African elderly

The epidemiology and delivery of eye care for East Africa are outlined. The common causes of blindness in the elderly (> 60 years old) are discussed individually. Cataract causes (50%), trachoma (16%) and glaucoma (12%) of blindness in the East Africa Region.

Functional magnetic resonance imaging: a potential tool for the evaluation of spinal cord stimulation: technical case report

OBJECTIVE AND IMPORTANCE

The management of chronic pain of spinal origin continues to represent a challenge for neurosurgeons. Spinal cord stimulation for chronic intractable pain is an effective therapy in approximately 50% of patients. The present study uses a novel imaging approach, functional magnetic resonance imaging (fMRI), to examine the central effects of spinal cord stimulation.

CLINICAL PRESENTATION

Three patients, each with a chronic history of intractable pain, were treated at the Toronto Hospital with a trial of dorsal column stimulation (DCS). For all patients, significant improvement in pain symptoms was achieved with DCS.

INTERVENTION

fMRI on a 1.5-T conventional magnetic resonance system was used to study the effects of DCS in these patients. Images were collected while the stimulator was activated and deactivated.

CONCLUSION

This report is the first to describe the cerebral effects of exogenous spinal cord stimulation with fMRI. fMRI allows for the objective examination of the effects of DCS and may provide an objective means of evaluating the efficacy of DCS as a therapy for intractable pain of spinal origin.

Functional MRI of pain- and attention-related activations in the human cingulate cortex

The aims of the study were to use functional magnetic resonance imaging (fMRI) to 1) locate pain-related regions in the anterior cingulate cortex (ACC) of normal human subjects and 2) determine whether each subject's pain-related activation is congruent with ACC regions involved in attention-demanding cognitive processes. Ten normal subjects underwent fMRI with a 1.5-T standard commercial MRI scanner. A conventional gradient echo technique was used to obtain data from a single 4-mm sagittal slice of the left ACC, approximately 3.5 mm from midline. For each subject, interleaved sets of 6 images were obtained during a pain task, an attention-demanding task, and at rest, for a total of 36 images per task. Pain of different intensities was evoked via electrical stimulation of the right median nerve. The attention-demanding task consisted of silent word generation (verbal fluency). Additional experiments obtained data from the right ACC. A pixel-by-pixel statistical analysis of task versus rest images was used to determine task-related activated regions. The pain task resulted in a 1.6-4.0% increase in mean signal intensity within a small region of the ACC. The exact location of this activation varied from subject to subject, but was typically in the posterior part of area 24. The signal intensity changes within this region correlated with pain intensity reported by the subject. The attention-demanding tasks increased the mean signal intensity by 1.3-3.3% in a region anterior and/or superior to the pain-related activation in each subject. The activated region was typically larger than the pain-related activation. In some cases this activation was at or superior to the ACC border, near the supplementary motor area. These regions did not show any pain-intensity-related activation. In one subject both right and left ACC were imaged, revealing bilateral ACC activation during the attention task but only contralateral pain-related activation. These findings shed light on pain- and attention-related cognitive processes. The results provide evidence for a region in the posterior part of the ACC that is involved in pain and a more anterior region involved in other attention-demanding cognitive tasks.

Evaluation of cardiac rhythm disturbances during extravehicular activity

This study represents the first systematic evaluation of dysrhythmias before, during, and after spaceflight including extravehicular activity (EVA). The data, based on 7 Shuttle crew members, revealed a nonsignificant decrease in ventricular and supraventricular ectopy during EVA, suggesting that the incidence of dysrhythmias is no greater during EVA than with any other phase of a mission or preflight.

Superiority of sirolimus (rapamycin) over cyclosporine in augmenting allograft and xenograft survival in mice treated with antilymphocyte serum and donor-specific bone marrow

BACKGROUND

Sirolimus is a potent immunosuppressive agent with great therapeutic potential. The objective of our study was to evaluate the efficacy of sirolimus versus cyclosporine in augmenting the unresponsiveness induced by an antilymphocyte serum (ALS)/donor-specific bone marrow (BM)-based regimen across three levels of histoincompatibility: class I and II disparate (DBA/2 to B6AF1), complete mismatch (AKR to C57BL/6), and xenograft (ACI rat to B6AF1).

METHODS

Full-thickness skin grafts were taken from donors and placed on recipients in standard fashion. Seven groups of recipient mice (n=10-28) received various combinations of the following treatment protocols: sirolimus, 1.5 mg/kg (3.0 mg/kg for xenografts) every other day from day 0 to day 12; cyclosporine, 50 mg/kg every other day from day 10 through 22; ALS, 0.5 ml on days -1 and 2 for allografts and days -1, 2, and 4 for xenografts; and BM, 25 million donor-specific cells IV on day 7.

RESULTS

The administration of ALS or ALS/BM resulted in modest but significant prolongation of skin graft survival in all combinations tested. Cyclosporine combined with ALS or ALS/BM significantly extended allograft survival compared with ALS or ALS/BM alone (P<0.05) but had no effect on xenograft survival. In contrast, the combination of sirolimus with ALS or ALS/BM resulted in a two- to threefold increase in allograft survival and over a fourfold increase in xenograft survival when compared with the comparable cyclosporine-based regimen. Additionally, lymphocytes isolated from class I and II incompatible mice with skin grafts surviving >100 days demonstrated markedly reduced interleukin 2 and interferon-gamma secretion in response to irradiated donor-specific lymphocytes in culture.

CONCLUSIONS

In the regimens tested, sirolimus was superior to cyclosporine in augmenting donor BM-induced skin graft prolongation in ALS-treated mice across all levels of histoincompatibility.

Case management at work for SSA disability beneficiaries: process results of the Project NetWork return-to-work demonstration

This article presents the results of the process analysis of the evaluation of the Project NetWork demonstration, a Federal demonstration undertaken by the Social Security Administration (SSA) in 1991 to test alternative methods of providing rehabilitation and employment services to SSA's Disability Insurance beneficiaries and Supplemental Security Income disabled and blind applicants and recipients. The major findings are: (1) from an operational standpoint, it is feasible to expand access to vocational rehabilitation (VR) services to a broad spectrum of SSA beneficiaries, and (2) roughly similar results are achieved, in terms of client intake and provision of services, when case management services are provided by SSA staff, contracted out to State VR agencies, or contracted with private VR providers. Later evaluation reports will trace demonstration impacts on earnings and disability benefits and report the overall benefits and costs of return-to-work services for this population.

Fourier registration of three-dimensional brain MR images: exploiting the axis of rotation

We have developed a novel algorithm to register three-dimensional MR images that have undergone rigid body motion. The most interesting feature of the algorithm is that it reduces a general three-dimensional rotation to a simple planar rotation by finding the axis of rotation. The algorithm, which is a nontrivial three-dimensional extension of existing Fourier registration algorithms, has been tested on 30 artificially misaligned MR images of a phantom, four artificially misaligned MR images of a brain, and one case of actual patient motion. The algorithm successfully registered every image. The registration error for a voxel 10 cm from the origin for the artificially misaligned phantom images was 2.8 mm at most and had a mean of 1.2 mm and standard deviation of .7 mm. The registration parameters for the images contaminated by actual patient motion were similar to that from an established image registration algorithm. The results indicate that the algorithm is accurate, reliable, and fast. The rigid body model requires the brain to be segmented from MR images of the head before registration.

Wavelet encoding for 3D gradient-echo MR imaging

An implementation of wavelet encoding to resolve one spatial direction of a three-dimensional gradient-echo magnetic resonance image is described. This is the first report of the use of wavelet encoding with a relatively short repetition time for rapid image acquisition. An important feature of this implementation is that it allows wavelet-encoded images to be reconstructed without phase correction. The images show no discernible degradation compared with images acquired with phase encoding or scaling-function encoding instead of wavelet encoding. In addition to describing the implementation, typical sources of phase errors are investigated both theoretically and experimentally.

Cancer in remission. Challenge in collaboration for family physicians and oncologists

OBJECTIVE

To explore oncologists' perspectives on the process of cancer patient follow up and to identify what oncologists need from family physicians during the remission stage of cancer disease.

DESIGN

Qualitative study with in-depth interviews.

SETTING

Regional cancer centre serving a catchment area of 1.4 million people.

PARTICIPANTS

A purposive sample of 10 oncologists. One was unable to participate because of sabbatical leave. The nine who participated represented both radiation and medical oncology. Oncologists who had practised at the cancer centre for less than 2 years were excluded from the study.

MAIN OUTCOME MEASURES

Existing barriers to communication and collaboration between oncologists and family physicians in cancer patient follow up.

RESULTS

Oncologists described roles for themselves in reassuring patients, detecting recurrence, monitoring toxicity of treatment, and gathering data for clinical trials. Collaboration with family physicians in the remission phase was identified as desirable but inhibited by variable and unpredictable interest, poor communication with family physicians, and patients' own preferences for follow up. Oncologists perceived the cancer system structure as a "black box" within which multidisciplinary teams worked well but seldom included family physicians. Oncologists expressed a need to see healthy patients and to have more understanding and support from family physicians, preferably through sharing follow-up care. Developing dialogue and a more collaborative approach were suggested.

CONCLUSIONS

Family physicians should maintain a role in remission follow-up. However, a more collaborative approach with oncologists is warranted. Communication barriers, patient preferences, and misperceptions between groups must be addressed before roles are redefined.

Multilevel wavelet-transform encoding in MRI

This paper explores an alternative to standard Fourier MRI called wavelet-transform encoding. Spatially selective radiofrequency (RF) pulses are used to excite slice profiles in the shape of the wavelet-basis functions of a discrete wavelet transform. Our implementation on a standard commercial whole body MRI system resolves one spatial dimension through wavelet encoding and orthogonal directions through conventional frequency encoding and rectangular-slice selection. The wavelet transform is described as a method for multiresolution analysis, and we show how a high resolution MR image can be constructed from lower resolution images, representing the approximation and detail structures of the object. A multiple level architecture of the wavelet reconstruction is described, thereby allowing wavelet-encoded images to be reconstructed through several modes. Multilevel wavelet-encoded images of a gel phantom are presented that show comparable image quality to Fourier-encoded images of similar signal-to-noise ratio. However, a chemical-shift artifact is identified with this particular implementation.

Microgravity decreases heart rate and arterial pressure in humans

Spaceflight causes adaptive changes in cardiovascular physiology, such as postflight orthostatic intolerance, that can have deleterious effects on astronauts. In-flight cardiovascular data are difficult to obtain, and results have been inconsistent. To determine normative in-flight changes in Shuttle astronauts, we measured heart rate, arterial pressure, and cardiac rhythm disturbances for 24-h periods before, during, and after spaceflight on Shuttle astronauts performing their normal routines. We found that heart rate, diastolic pressure, variability of heart rate and diastolic pressure, and premature ventricular contractions all were significantly reduced in flight. Systolic pressure and premature atrial contractions also tended to be reduced in flight. These data constitute the first systematic evaluation of in-flight changes in basic cardiovascular variables in Shuttle astronauts and suggest that a microgravity environment itself does not present a chronic stress to the cardiovascular system.

Phase-encode reordering to minimize errors caused by motion

A new method for suppressing the effects of motion in MR images by reordering the acquisition of k space has been developed. Existing reordering methods suffer from image blurring. The method presented here applies specifically to translation along the phase-encoding direction, in which case it reduces both ghosting and blurring. The method is conceptually similar to a linear phase shift of k space, except that it has the advantage of not corrupting stationary structures inadvertently. The method is intended for anatomic sites in which substantial translational motion occurs along the phase-encoding direction, such as the cranial-caudal motion of the liver and kidneys. The reordering method is motivated from an analysis of factors affecting the severity of motion artifacts. The theory behind the reordering method is described and validated experimentally by imaging a moving phantom.

Willingness to follow breast cancer. Survey of family physicians

OBJECTIVE

To identify the experience and willingness of family physicians to accept follow-up care of patients treated for stage I breast cancer.

DESIGN

Mailed questionnaire.

PARTICIPANTS

One hundred eighty-nine family physicians in southwestern Ontario with oversampling of female physicians and physicians practising more than 20 km from a cancer clinic.

MAIN OUTCOME MEASURE

Willingness to follow breast cancer patients and time after treatment family physicians would be willing to begin follow-up care.

RESULTS

We had an 81.5% response rate. Of the 154 respondents, 53% had been involved previously in the 5-year, follow-up care of a patient with breast cancer and 77.1% believed it appropriate for family physicians to assume responsibility for follow-up care in all or most cases. If asked by a patient, the family, or an oncologist to provide follow-up care, 90.1% of family physicians reported they would accept this responsibility. Willingness to follow breast cancer patients was not associated with sex, years in practice, proximity to a cancer clinic, or certification status but was associated with having previously provided such care (P = .043). Of those willing to care for these patients, almost 90% would prefer to start within 1 year of treatment.

CONCLUSION

Although only half the respondents had experience in providing follow-up care to breast cancer patients, most were willing to take on this role, especially if asked.

fMRI of human somatosensory and cingulate cortex during painful electrical nerve stimulation

Functional MRI (fMRI) can detect changes from resting levels of blood flow and oxygenation during task performance (i.e. activation). We used a simple electrical nerve stimulation technique together with fMRI to study pain process in the human cortex. Images of the primary somatosensory (SI) and cingulate cortex (Cg) were obtained from subjects during stimulation at painful and non-painful intensities. Stimuli that evoked non-painful tingling sensations activated the contralateral SI but not Cg. Stimuli that evoked painful sensations activated both the contralateral SI and Cg. These data indicate that fMRI can detect pain-related changes in SI and Cg evoked by electrical stimulation of peripheral nerves. These findings add to the evidence for a role of SI and Cg in human pain processes and provide a simple method of stimulus delivery for its study.

Induction of tolerance to skin allografts by intrathymic injection of donor splenocytes. Effect of donor-recipient strain combination and supplemental rapamycin

The effect of donor-recipient strain combination and supplemental rapamycin (Rapa) on tolerance induction by intrathymic (IT) injection of donor splenocytes was examined in a mouse skin allograft model. In an MHC class I-mismatched C3H/He skin to (C57BL/6 x A)F1 (B6AF1) mouse combination, IT injection of 50 x 10(6) donor splenocytes with transient immunosuppression by rabbit anti-mouse lymphocyte serum (ALS) induced significant prolongation of skin allograft survival with a median survival time (MST) of 115 days versus an MST of 24.5 days in controls given ALS alone. With an additional short course of supplemental Rapa treatment at a dose of 1.5 mg/kg i.p. every other day from day 0 to 12, all C3H/He skin allografts survived indefinitely (> 350 days) in ALS-treated, donor splenocyte intrathymically injected B6AF1 recipient mice. Tolerance was antigen-specific, since the second donor-type skin allografts were accepted while third-party skin allografts were acutely rejected in these mice bearing long-term C3H/He skin allografts. In MHC class I- and II-disparate (DBA/2 to B6AF1) and fully MHC-incompatible (AKR to B6) strain combinations, IT injection of donor splenocytes and ALS treatment failed to prolong skin allograft survival over ALS controls. When supplemental Rapa was used, long-term skin allograft acceptance was observed with an MST of 127 days for the DBA/2 to B6AF1 combination and 70 days for the AKR to B6 combination. In contrast, supplemental treatment with cyclosporine was not effective in these combinations, which suggests that supplemental Rapa may have a unique effect in augmenting IT tolerance induction. Thymectomy within 7 days after IT injection significantly shortened the allograft survival, which suggests that interaction of the host thymus and the injected donor splenocytes, which takes place early after IT injection, plays an important role in the induction of allograft tolerance in this model.