The D2 Dopamine Receptor Gene as a Determinant of Reward Deficiency Syndrome

The dopaminergic system, and in particular the dopamine D2 receptor, has been profoundly implicated in reward mechanisms in the brain. Dysfunction of the D2 dopamine receptors leads to aberrant substance seeking behaviour (alcohol, drug, tobacco, and food) and other related behaviours (pathological gambling, Tourette's syndrome, and attention deficit hyperactivity disorder). We propose that variants of the D2 dopamine receptor gene are important common genetic determinants of the ‘reward deficiency syndrome’.

Case discussion: large volume blood loss and delirium in a patient with subtrochanteric fracture, dementia, and multiple comorbidities

This case presents a discussion of a 92-year-old man with multiple comorbidities, who presents with a subtrochanteric fracture. His course is complicated by large volume blood loss intraoperatively, requiring intensive care unit (ICU) monitoring postoperatively. His course is also complicated by delirium.

Inoculative freezing promotes winter survival in hatchling diamondback terrapin,Malaclemys terrapin

We investigated the hibernation ecology and cold hardiness of hatchling diamondback terrapins, Malaclemys terrapin (Schoepf, 1793), an estuarine species that reaches 42°N along the Atlantic Ocean. During 3 years of study, about 50% of the nests we monitored harboured hatchlings during winter, and the majority (87%) of these individuals survived despite being intermittently exposed to subfreezing temperatures. Most such exposures were brief (ca. 12 h) and mild (minimum temperature: ca. –1.2 °C); however, turtles were occasionally subjected to longer chilling episodes and lower temperatures. In laboratory experiments, hatchlings supercooled extensively, attaining ca. –15 °C before spontaneously freezing. However, they were highly susceptible to inoculative freezing through contact with external ice and (or) ice-nucleating agents, which occur in nesting soil. Therefore, freeze avoidance through supercooling does not appear to be a viable cold-hardiness strategy in these turtles. Hatchlings subjected to experimental freezing survived exposure to temperatures as low as –3.0 °C, suggesting that freeze tolerance may account for the high winter survival observed in natural nests. We conclude that freeze tolerance in hatchling M. terrapin is promoted by high susceptibility to inoculation, which is known to moderate freezing, allowing cells time to adapt to the attendant physical and osmotic stresses.

Spectral broadening of sound scattered by advecting atmospheric turbulence

Scattering and spectral broadening of a monochromatic sound wave by atmospheric turbulence that is flowing with a uniform constant horizontal wind is considered. The acoustic source and a detector are at rest and at different positions in a ground-fixed frame. Analytic expressions are derived for the sound pressure scattered to the detector by a single eddy. Since distances and the scattering angle change with time as the eddy flows through the scattering volume, the detector signal has time-dependent amplitude and frequency, for which general formulas are derived. A computer code is developed that calculates the scattered signal and its Fourier transform from a single eddy, or from a steady-state collection of eddies of many different scale lengths that represents isotropic homogeneous turbulence flowing with the wind. The code utilizes a time-shift algorithm that reduces the calculation time substantially. Several numerical results from this code are presented, including simulations of a recent experiment. The predicted spectral shape, including peak width and jaggedness, are in good agreement with experiment.

Prevalence, incidence, and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish Population for the Epidemiologic Study for the Elderly

OBJECTIVES

To determine the rates and risk factors associated with hip fractures in the community-dwelling older Mexican-American population.

DESIGN

A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over.

SETTING

The 1993-1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

In 1993-1994 and in 1995-1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US.

MEASUREMENTS

Self-reported hip fracture and functional measures by in home interviews.

RESULTS

Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person-years. The incidence rate for men was 4.8 fractures/1000 person-years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture.

CONCLUSIONS

This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.

The maximum motor fusion test: a parameter for surgery for acquired esotropia

PURPOSE

The purpose of this study was to determine whether surgery for acquired esotropia based on the maximum capacity for motor fusion measured with a prism bar could be used to increase the number of millimeters of bilateral medial rectus recession that could be performed without producing an early overcorrection or a late consecutive exotropia, as a way safely to reduce the need for postoperative wear of glasses or a bifocal.

METHODS

Category I patients had residual deviations of esotropia (ET) of 12 PD or more with distance fixation, measured after a full hyperopic correction of +1.50 to +3.25 was placed, and had no significant anisometropia or astigmatism. Category II patients had residual deviations of esotropia of less than 11 PD with distance fixation and had residual deviations of esotropia with near fixation (ET') of at least 10 PD more than esotropia with distance fixation ("clinical high AC/A"). Category III patients had had previous bilateral medial rectus muscle recessions and had recurrent esotropia with near fixation of more than 10 PD. For patients in categories I and II, bilateral medial rectus muscle recessions were performed by using a published dose-response table from the national Prism Adaptation Study but with the maximum capacity for motor fusion as the input parameter instead of the prism-adapted angle. Patients in category III received re-recessions of one or both medial rectus muscles, according to a previously published system, with the distance fusional amplitude as the input parameter.

RESULTS

In category I, 24 of 30 (80%) patients needed no glasses after surgery, 1 of 30 had esotropia, and 2 of 30 had exotropia (XT) (10% reoperation rate). In category II, 35 of 36 (98%) patients needed no bifocals after surgery, and 3 of 36 had exotropia (9% reoperation rate). In category III, 10 of 10 patients needed no bifocals, and 2 of 10 had exotropia (20% reoperation rate).

CONCLUSIONS

When a postoperative reduction in dependence on continuous wear of an optical appliance is a reasonable goal, the maximum motor fusional capacity, measured with a prism bar, is a good parameter for surgical design.

A three dimensional surgical dose-response schedule for lateral rectus resections for residual congenital/infantile esotropia after large bilateral medial rectus recessions

PROBLEM

A series of overcorrections after this surgical sequence.

SUBJECTS & METHODS

Forward stepwise multiple regression analysis of the effect of bilateral lateral rectus resections, retrieved and tabulated retrospectively from the clinical charts of 50 children with infantile esotropia who had significant residual non- accommodative esotropia after bilateral medial rectus recessions. Analysis allowed for selection among linear and quadratic forms of two relevant predictor variables: the mm of previous bilateral medial rectus recession and the prism diopters of residual esotropia.

RESULTS

We found a correlation between the effect of the second surgery (bilateral LR resections) and the two variables. This relation could be expressed by a surgical dose-response schedule-surface with the formula: [2.39 + 0.26 (mm MR recession) Squared + 0.41 (mm LR Resection) Squared = prism diopters of effect]. A corresponding schedule (table) with these two parameters was developed to facilitate clinical application. To test and prove this schedule, we re-studied 19 of the 50 original cases who had had surgery, fortuitously, +/-0.3 mm of our new surgical dose- response surface-schedule plus 10 new cases performed according to the new surface-schedule. For these 29 cases there was only one "failure" at 6 months postop' (3%). As a control, for the 31 cases of the original 50 whose surgery had not been within +/- 0.3 mm of the new schedule, 7/31 (23%) were "failures", all overcorrections. ("Failure" vs. "success" - there were only two categories of outcome - was defined as an esotropia over 8 PD or exophoria over 6 PD.)

CONCLUSION

This difference in results, expressed as "successes" of 28/29 vs 24/31, or 97% vs 77% gave, on statistical analysis, a p=0. 053 of rejecting the null hypothesis, which is considered a valid "trend" or marginally "statistically significant" and definitely "clinically-medically significant". We have adopted the regular application of our new surgical dose- response schedule in these cases and recommend it for all such cases. binocular vision; complications, surgical; dose-response surgical schedule; esotropia, congenital/infantile; lateral rectus muscle, resection; outcomes; overcorrections; strabismus surgery; study, retrospective, clinical; surgery, strabismus.

Antielevation syndrome after bilateral anterior transposition of the inferior oblique muscles: incidence and prevention

BACKGROUND

Unilateral and bilateral anterior transpositions of the inferior oblique muscle (ATIOs) for primary inferior oblique (IO) muscle overaction may produce apparent new or recurrent overaction of the contralateral IO muscle. This effect has been termed "antielevating" and can produce overaction of the contralateral elevators in adduction that mimics recurrent or new overaction of the IO muscle of the other eye. This phenomenon may be termed the antielevation syndrome (AES). Kushner has hypothesized that this complication of the ATIO is produced primarily by the posterior fibers of the IO muscle. The purpose of this study is to correlate the frequency of this syndrome in a large series of patients with the mm of lateral displacement (spreading) of the IO muscle reattachment site.

METHODS

There was a combination of 123 patients who received ATIO from Mims and 77 patients who received ATIO from Kushner. ATIO was performed according to a previously published technique.

RESULTS

All 16 patients (14 from Mims and 2 from Kushner) with AES had received bilateral anterior transposition of the posterior fibers of the IO muscle to at least 2 mm anterior to the lateral end of the inferior rectus (IR) muscle with spreading laterally 3 to 5 mm. Among children who had the posterior fibers of their IO muscles placed 2 to 4 mm anterior to a line drawn laterally from the insertion of the IR muscle, the incidence of AES was significantly larger with more spreading out of the new IO muscle insertion.

CONCLUSIONS

AES may be prevented by attaching the posterior fibers of the IO muscle no more than 2 mm lateral to the IR muscle insertion site. This complication responds to bilateral nasal IO muscle myectomy in many cases.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly

OBJECTIVES

To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans.

DESIGN

Cross-sectional survey of a regional probability sample of older Mexican Americans.

SETTING

The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates.

OUTCOME MEASURES

Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers.

RESULTS

Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage.

CONCLUSIONS

These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.

Increased prevalence of the Taq I A1 allele of the dopamine receptor gene (DRD2) in obesity with comorbid substance use disorder: a preliminary report

In order to investigate the prevalence of the Taq I A1 allele of the dopamine receptor gene (DRD2) in obesity with and without comorbid substance use disorder, a total of 40 patients, from an outpatient neuropsychiatric clinic in Princeton, New Jersey, were genotyped for presence or absence of the Taq I DRD2 A1 allele. The primary inclusion criterion for 40 obese subjects was a body mass index (BMI) equal to or over 25 (uncharacterized); 11 obese subjects had severe substance use disorder; 20 controls had a BMI below 25; and, 33 substance use disorder (less severe) patients had a BMI below 25. The data were statistically compared with three different sets of controls divided into three separate groups (Group I, n = 20; Group II, n = 286; Group III, n = 714). They differed according to screening criteria (drug, alcohol, nicotine abuse/dependence, BMI below 25 and other related behaviours including parental history of alcoholism or drug abuse and DSM IV, Axis I and Axis II diagnoses). Groups II and III were population controls derived from the literature. The prevalence of the Taq I A1D2 dopamine receptor (DRD2) alleles was determined in 40 Caucasian obese females and males. In this sample with a mean BMI of 32.35 +/- 1.02, the A1 allele of the DRD2 gene was present in 52.5% of these obese subjects. Furthermore, we found that in the 23 obese subjects possessing comorbid substance use disorder, the prevalence of the DRD2 A1 allele significantly increased compared to the 17 obese subjects without comorbid substance use disorder. The DRD2 A1 allele was present in 73.9% of the obese subjects with comorbid substance use disorder compared to 23.5% in obese subjects without comorbid substance use disorder. Moreover, when we assessed severity of substance usage (alcoholism, cocaine dependence, etc.) increasing severity of drug use increased the prevalence of the Taq I DRD2 A1 allele; where 66.67% (8/12) of less severe probands possessed the A1 allele compared to 82% (9/11) of the most severe cases. Linear trend analyses showed that increasing use of drugs was positively and significantly associated with A1 allelic classification (p < 0.00001). These preliminary data suggest that the presence of the DRD2 A1 allele confirms increased risk not only for obesity, but also for other related addictive behaviours (previously referred to as the Reward Deficiency Syndrome) and that a BMI over 25 by itself (without characterization of macroselection or comorbid substance use disorders) is not a sufficient criterion for association with the DRD2 A1 allele.

Involvement of methionine in the synthesis of certain membrane-associated nucleotide sugars by human amnion (WISH) cells

A plasma membrane preparation from human amnion (WISH) cells contained uridine diphosphate sugars and methyl-uridine diphosphate (mUDP) sugars. The synthesis of mUDP-glucose, mUDP-mannose, and mUDP-fucose by the membrane preparation occurred when supplemented with uridine-5'-diphosphate-glucose and S-adenosyl-L-methionine. It is suggested that this newly recognized route for fucose biosynthesis might be employed by certain transformed cells, and may partly account for the methionine dependence of certain human tumors. Additionally, it is suggested that, in colon cancer, a deficiency of folic acid and methionine might affect mUDP-sugar biosynthesis rather than the methylation of DNA.

Involvement of folic acid in the synthesis of membrane-associated nucleotide sugars by normal and transformed mouse fibroblasts

A plasma-membrane-containing fraction isolated from Swiss mouse (3T3) fibroblasts was found to contain uridine diphosphate sugars and methyl-uridine diphosphate (mUDP) sugars. The synthesis of the mUDP sugars by membrane preparations of normal and transformed 3T3 cells occurred from the intrinsic membrane uridine-diphosphate sugars + methylenetetrahydrofolic acid. Compared to the normal 3T3 cells, the synthesis of mUDP sugars by the transformed 3T3 cells was reduced by 49%. It is proposed that the plasma-membrane-associated mUDP sugars may be essential for normal cell growth.

Assessment of a model for measuring drug diffusion through implant-generated fibrous capsule membranes

Fibrous tissue, which encapsulates subcutaneously implanted silastic, vinyl, polyurethane and Teflon discs in rats, has been isolated, characterized and tested for drug permeability in order to develop an in vitro model for determining the effect of this tissue on drug disposition from implant sites. With all materials, capsule tissue thickness and collagen content (approximately 59%) was consistent from 2 to 4 months after implantation. Silastic implants afforded the most consistent and usable tissue in terms of thickness and lack of vascularity, and these capsule membranes were used for determining the transport of three model compounds in an in vitro diffusion cell model. The rank ordering of permeability through these membranes was estrone (60.2 x 10(-6) cm s-1) > 3-O-methylglucose (18.7 x 10(-6) cm s-1) > dextran of molecular weight 70 000 (5.6 x 10(-6) cm s-1), which is consistent with expectations based on the molecular weights and partitioning behaviour of the model compounds. The results of these studies indicate that implant-generated encapsulating membranes can be successfully isolated and employed to study drug diffusion in an in vitro model, providing a direct assessment of the barrier properties of encapsulating membranes.

Dopamine D2 receptor gene variants: association and linkage studies in impulsive-addictive-compulsive behaviour

Drug and alcohol seeking behaviour has become a great global problem affecting millions of inhabitants with a cost to society in the billions. Dopaminergic reward pathways have frequently been implicated in the etiology of addictive behaviour. While other neurotransmitters have also been implicated, to date the only molecular genetic defect which has been found to associate with alcoholism, drug dependency, obesity, smoking, pathological gambling, attention-deficit-hyperactivity disorder (ADHD), Tourette syndrome, as well as other related compulsive behaviours, are the variants of the dopamine D2 receptor gene (DRD2). In this review of the available data on the subject, we report a number of independent meta-analyses that confirm an association of DRD2 polymorphisms and impulsive-additive-compulsive behaviour (IACB), which we have termed "Reward Deficiency Syndrome". While we agree that Meta-analyses of all exant studies support an association of variants of DRD2 and IACB, correct negative findings with alcoholism may be due to differences in assessing controls and inclusion/exclusion criteria for selection of diseased probands.

The D2 dopamine receptor gene as a predictor of compulsive disease: Bayes' theorem

The dopaminergic system, and in particular the dopamine D2 receptor, has been profoundly implicated in reward mechanisms in the meso-limbic circuitry of the brain. Dysfunction of the D2 dopamine receptors leads to aberrant substance (alcohol, drug, tobacco and food) seeking behavior. Decades of research indicate that genetics play an important role in vulnerability to severe substance seeking behavior. We propose that variants of the D2 dopamine receptor gene are important common genetic determinants in predicting compulsive disease.

Prolonged P300 latency in a neuropsychiatric population with the D2 dopamine receptor A1 allele

The role of the dopaminergic system in P300 has been implicated and previous studies have suggested the presence of a heritable component in the genesis of P300 or P3, a late positive component of the event-related potential. In the present investigation, 155 Caucasian male and female diagnosed neuropsychiatrically-ill patients with and without comorbid drug and alcohol abuse/dependence were genotyped for the presence or absence of the A1 allele of the D2 dopamine receptor gene (DRD2). The relationship of the A1 and A2 alleles to P3 amplitude and latency was also determined. The results showed no significant difference in P3 amplitude between all groups studied with A1 and A2 allele carriers. However, we now report prolonged P3 latency in neuropsychiatrically-ill patients (with or without polysubstance abuse) with those carrying two copies of the A1 allele (homozygote) of the DRD2 gene (quadratic trend, p = 0.01). Moreover, the age-adjusted mean P3 latency in the D2A2/A2 allele group was 327.8 +/- 3.08 ms compared by ANOVA, to 360.04 +/- 4.86 ms in the D2A1/A1 group. Our work suggests an association of polymorphisms of the DRD2 gene and a biological marker previously indicated to have predictive value in vulnerability to substance abuse.

Mechanism of irrigation effects on gingivitis

Although gingivitis is initiated by plaque and plaque removal controls gingivitis, gingival irrigation with water has been shown to reduce gingivitis without reducing plaque. This study attempted to explore possible mechanisms involved in the treatment of gingivitis by water irrigation. Patients (n = 125) with more than 20 teeth, less than 4 sites with probing depth (PD) deeper than 6 mm, bleeding on probing (BOP) frequency of 30% or higher, and no systemic disease were randomized to one of four treatment groups: toothbrushing alone (brush), toothbrushing plus chlorhexidine 0.12% rinse 2x/day (CHX), toothbrushing plus water irrigation 1x/day (irr+H2O), or toothbrushing plus chlorhexidine 0.04% irrigation 1x/day (irr+CHX). Six sites/tooth were examined at baseline, and at 3 and 6 months for BOP and PD using an automated probe, and for gingival index (GI) and plaque index (PI) by standard means. A prophylaxis and oral hygiene instructions were provided after baseline and 6 month measurements. Subgingival microbial samples and crevicular fluid (GCF) were collected from 2 teeth/subject at each time point. Microbial samples were processed for anaerobic culture and the predominant cultivable flora was determined. CHX and irr+CHX had a 30 to 35% decrease in mean PI, while brush and irr+H2O had only a 12 to 16% decrease. BOP was reduced by 14% in the brush group and 23 to 24% in the other groups. GI was significantly correlated with PI in the brush, CHX, and irr+CHX groups, but not in the irr+H2O group. Prevotella intermedia was significantly reduced in both irrigation groups, but not CHX or brush groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of folic acid and methionine in the synthesis of certain membrane-associated nucleotide sugars by Enterococcus hirae

A membrane preparation from Enterococcus hirae contained UDP and methyl-UDP (mUDP) monosaccharides. This preparation, when incubated with combinations of folic acid, L-serine, and S-adenosyl-L-methionine in a reaction system containing UDP-glucose, promoted synthesis of certain mUDP sugars. Folic acid and serine produced mUDP-glucose and mUDP-rhamnose; S-adenosylmethionine produced mUDP-glucose, mUDP-mannose, and mUDP-fucose.

Occupational exposure to human immunodeficiency virus (HIV)-infected blood in Denver, Colorado, police officers

The authors undertook a study of Denver, Colorado, police department officers to measure their risk of exposure to blood and human immunodeficiency virus (HIV) by type of work assignment and to document how exposures occurred. From December 1989 through March 1991, 137 officers reported an exposure to either blood or saliva, and 42 exposures to blood were independently documented. The overall rate of exposure to HIV-infected blood for medium and high risk assignments was 0.10 per 10,000 person-days. Thirty-two source persons underwent voluntary testing for HIV antibodies, and five (15.6%) were seropositive. Two thirds of the 42 blood exposures occurred in circumstances in which 1) there was little or no time for the officer to put on protective gloves and clothing because the officer was restraining or being assaulted by a suspect or 2) gloves would have not been protective because of penetration by needles. The authors conclude that Denver police officers rarely have percutaneous or mucosal exposures to blood, but when they do, the risk of exposure to HIV-infected blood is quite high. A health department can provide to police officers a number of services: evaluation of an incident involving contact with blood or body fluids to determine whether there was potential for disease transmission; information about modes of transmission and prevention of bloodborne diseases; serologic testing of source persons; HIV counseling for exposed officers and source persons; documentation for worker's compensation claims; and consultation regarding the use of zidovudine for postexposure prophylaxis.

Evaluation of clinical and laboratory aspects of antibody tests for detection of hepatitis C virus infection in blood donors and recipients from a low-risk population

BACKGROUND

When the first-generation enzyme immunoassay (EIA) for detection of antibody to hepatitis C virus (anti-HCV) was approved in May 1990, blood banking agencies recommended testing of all components in inventory. In many cases, one or more components from these units had already been transfused.

STUDY DESIGN AND METHODS

Donors that reacted in first-generation EIAs and recipients of their components were identified, and anti-HCV test methods (including first-generation EIA, second-generation EIA, and recombinant immunoblot assay [RIBA]) were evaluated.

RESULTS

Of 66 donors identified as anti-HCV-positive by first-generation EIA, 17 were positive in second-generation EIA. Of these 17, 9 reacted in RIBA; 6 of these showed evidence of HCV infection in polymerase chain reaction (4) and/or probable transmission of HCV to a transfusion recipient (3). Of the 48 specimens that were positive in first-generation EIA and negative in second-generation EIA, only 1 was positive in RIBA; serum was not available for polymerase chain reaction testing, and there were no living transfusion recipients in whom to assess evidence of transmission of HCV.

CONCLUSION

This study documents the low predictive value of EIAs for anti-HCV in a low-prevalence blood donor population and emphasizes the need for additional testing to confirm the specificity of samples that react in the screening tests.

Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers

OBJECTIVE

To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination.

DESIGN

Retrospective cohort study.

SETTING

Ten acute care hospitals in Minnesota.

PARTICIPANTS

A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine.

MAIN OUTCOME MEASURE

Presence or absence of anti-HBs following hepatitis B vaccination.

RESULTS

Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P = .01), body mass index (P < .01), and smoking status (P < .01) were associated with lacking anti-HBs only for Recombivax HB recipients; and gender (P = .03) was associated with lacking anti-HBs only for Engerix-B recipients. After controlling for smoking status, age, gender, and body mass index, recipients of Recombivax HB were more likely to lack anti-HBs than recipients of Engerix-B (relative risk, 2.3; 95% confidence interval, 1.1 to 4.7; P = .02).

CONCLUSIONS

Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed.

The role of nonionic myelography in the diagnosis of lumbar disc herniation

RATIONALE AND OBJECTIVES

The accuracy and safety of nonionic myelography, unenhanced computed tomography (CT), and magnetic resonance (MR) in the diagnosis of lumbar disc herniation are reviewed. The comparative costs of these tests are also considered.

METHODS

The accuracy of imaging tests that diagnose disc herniations was established by conducting a Medline search between 1985 and 1992. The morbidity associated with these tests are less formally established from selected articles. Finally, the mediocre reimbursement rates of these tests are reviewed.

RESULTS AND CONCLUSIONS

The evolution of nonionic contrast media from the first to the second generation has been accompanied by a notable decrease in adverse reactions. Although nonionic myelograms are now better tolerated by patients, noninvasive imaging with CT and MR imaging has become as accurate as or more accurate than lumbar myelography, and should replace it as a screening test. Computed tomography may have advantages over MR imaging when issues of availability and cost are considered. In contrast to lumbar myelography, CT myelography may continue to be a useful method for clarifying ambiguous results of noninvasive tests. The morbidity associated with CT myelography can be minimized by using low doses of a nonionic agent, keeping the patient well hydrated, and using a small lumbar puncture needle. The incidence of adverse reactions can be expected to decrease further as new nonionic dimers become clinically available.

Allelic association of the D2 dopamine receptor gene with cocaine dependence

The objective of the present study was to examine allelic prevalence of the D2 dopamine receptor (DRD2) gene in male cocaine-dependent (CD) Caucasian (non-Hispanic) subjects and to determine the relationship of DRD2 alleles to family history and selected behavioral measures. The prevalence of the A1 allele in CD subjects (n = 53) was 50.9%. It was significantly higher than either the 16.0% prevalence (P < 10(-4)) in non-substance abusing controls (n = 100) or the 30.9% prevalence (P < 10(-2)) in population controls (n = 265) wherein substance abusers were not excluded. Similarly, a significantly higher prevalence (P < 10(-2)) of the B1 allele was found in CD subjects (n = 52) compared with non-substance abusing controls (n = 53); 38.5% vs. 13.2%. Logistic regression analysis of CD subjects identified potent routes of cocaine use and the interaction of early deviant behaviors and parental alcoholism as significant risk factors associated with the A1 allele. The cumulative number of these three risk factors in CD subjects was positively and significantly (P < 10(-3)) related to A1 allelic prevalence. The data showing a strong association of the minor alleles (A1 and B1) of the DRD2 with cocaine dependence suggest that a gene, located on the q22-q23 region of chromosome 11, confers susceptibility to this drug disorder.

Women defining health: food, diet and body image

This article explores the relationship between gender and food through analysing data obtained from a series of women-only discussion groups, the participants of which explored self definitions of the term 'health'. What is distinct about this data, collected in the North East of England, is the clear link respondents perceive between food, diet and health. However, due to a number of factors such a knowledge may not result in dietary and ultimately bodily change. The many implications of such findings for health education are outlined in the discussion section of the paper.

Relationship of "bleeding on probing" and "gingival index bleeding" as clinical parameters of gingival inflammation

Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E. = 1.36) BOP sites and 35.3% (S.E. = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with < 4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PD. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1-2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Building-related asthma in Denver office workers

OBJECTIVES

Reported cases of building-related asthma and hypersensitivity pneumonitis among workers in a Denver office building prompted an epidemiologic investigation.

METHODS

A cross-sectional, self-administered survey of employees in the office building of the reported cases was compared with that of employees in a comparison building.

RESULTS

A significant excess of respiratory disease existed among 512 Denver workers (case building) compared with 281 office workers in a suburban agency (control building). Denver employees had a higher prevalence of respiratory symptoms, and the prevalence of physician-diagnosed asthma with onset or exacerbation since building occupancy was 4.9 times greater for Denver employees than for suburban employees. Asthma was not associated with any particular ventilation system in the building. Water incursion from a below-grade wall may have contributed to the problem, but the etiology is unknown.

CONCLUSIONS

This investigation provided evidence of office building-related asthma. Individual cases may be sentinel events for other cases of work-related asthma or hypersensitivity pneumonitis and may indicate a need for public health investigation of remediable causes.

Campylobacter enteritis outbreaks associated with drinking raw milk during youth activities. A 10-year review of outbreaks in the United States

OBJECTIVE

To determine the incidence of recognized outbreaks of Campylobacter enteritis associated with drinking raw milk during youth activities.

DESIGN

Retrospective survey of 51 state and territorial health departments.

SETTING

The 50 United States and the Territory of Puerto Rico.

POPULATIONS

Persons in preschool through college.

MEASUREMENT

Information was obtained for all Campylobacter outbreaks associated with consumption of raw milk during youth activities from 1981 through 1990 that were investigated by state and territorial health departments.

RESULTS

Twenty outbreaks were identified in 11 states. Four hundred fifty-eight outbreak-associated cases occurred among 1013 persons who drank raw milk, with an overall attack rate of 45%. At least one outbreak was reported for each year of the 10-year period. Fourteen outbreaks (70%) occurred among children in kindergarten through third grade, compared with one outbreak (5%) among fourth through sixth graders. The remaining five outbreaks (25%) occurred in mixed groups of children and teenagers. Only nine (60%) of 15 outbreaks identified from 1981 through 1988 were reported to the Campylobacter national surveillance system maintained by the Centers for Disease Control and Prevention.

CONCLUSION

Drinking raw milk on school field trips or other youth activities continues despite the occurrence of multiple Campylobacter outbreaks documented from this practice. Such illnesses can be prevented by educating dairy farmers and officials of schools and youth organizations about the hazards of drinking raw milk. Public health organizations need to develop and implement such educational programs.

What is twin birthweight discordance?

The purpose of this study was to define the level of twin birthweight discordance across gestational age at which perinatal morbidity, neonatal death, or congenital anomalies were more likely to occur. One hundred ninety-four sets of twins (1982-1985) were retrospectively studied. Discordance was defined as (birthweight of larger-birthweight of smaller/birthweight of larger) x 100. The mean discordance was 10.3 +/- 8.5% (26 to 32 weeks = 7.6 +/- 5.9%; 33 to 36 weeks = 9.5 +/- 9.5%; 37 to 42 weeks = 11.4 +/- 8.5%) (p = 0.07). The occurrence of morbidity, neonatal death, and anomalies was increased with prematurity or the occurrence of small for gestational age in both twins. However, neither morbidity, neonatal death, nor anomalies were significantly related to level of discordance. These data demonstrate that prematurity and birthweight below the tenth percentile may present a greater threat to twins than does birthweight discordance. These findings should be given due consideration in planning antepartum management.

Presentation of antigen to suppressor cells by a dimethylbenz (a) anthracene-resistant, Ia-positive, Thy-1-negative, I-J-restricted epidermal cell

The epidermal layer of the skin contains class II major histocompatibility (MHC)-positive antigen-presenting cells (APC), the most well characterized population being Langerhans' cells (LC). The chemical carcinogen 7,12 dimethylbenz (a) anthracene (DMBA) depletes about two-thirds of these cells from murine epidermis, and contact sensitizers applied to DMBA-treated skin induce specific immunological tolerance. This tolerance results from epidermal cells migrating to local lymph nodes within 3-6 hr after contact with antigen where they present the antigen to suppressor cells. Here we demonstrate that this epidermal cell which activates suppressor cells is a class II MHC-positive. Thy-1-negative, I-J-restricted APC. Hence at least two types of class II MHC-positive epidermal cells migrate to local lymph nodes and present antigen to lymphocytes; LC, which are sensitive to the effects of DMBA and activate helper lymphocytes, and another, which is resistant to DMBA and activates suppressor cells in an I-J-restricted manner. During the early stages of carcinogenesis any antigen present in the epidermis would be presented only by the cells which activate suppressor lymphocytes, resulting in tolerance induction. This may enable neoplastic cells to avoid the initiation of anti-tumour immunity.

Correction of density changes caused by methodological errors in CADIA

Quantitative evaluation of radiographic changes by computer-assisted densitometric image analysis (CADIA) requires exact knowledge about method errors. In the present study, density change errors were determined from pairs of films with "no change". From this distribution of error values, a series of threshold values for correction of changes due to method errors was selected. The threshold values were then applied to results from analysis of densitometric changes in sites with "known loss" or "no change" of the alveolar bone among films from cynomolgus monkeys. The density errors formed non-normal distributions with no difference in magnitudes between the absolute values expressing density decreases and density increases in the same areas. Calculation of sensitivity, specificity, type 1 and type 2 errors showed that these variables were clearly influenced by selection of different threshold values for correction of the density change errors. It is therefore recommended that threshold values be determined for each analytical system initially as well as following any equipment or computer program modification. Before selecting the threshold value for a specific radiographic analysis, the desired level of sensitivity and specificity should be evaluated.

Therapeutic ultrasound for refractory glaucoma: a three-center study

We present the results of therapeutic ultrasound for refractory glaucoma in a three-center study over 1 year. One hundred fifty-eight eyes were treated, with a mean follow-up of 8.0 months. The mean fall in intraocular pressure was 38.4%. Life table analysis for three success criteria are presented. Success varied between 66% and 72% at the mean follow-up time. Complications occurred in 11.4%, including phthisis bulbi in 0.6% and persistent hypotony in 2.5%. There was a mean loss of less than one line of visual acuity. Therapeutic ultrasound appears to be safe and effective for treatment of refractory glaucoma.

Bilateral anterior transposition of the inferior obliques

Sixty-one children with bilateral overaction of the inferior oblique muscle with concurrent or previous infantile esotropia received bilateral inferior oblique recessions with anteriorization to a point 2 to 4 mm anterior to the lateral end of the inferior rectus insertion. Subsequent reoperation for recurrent overaction of the inferior obliques was needed in only one case. Also, substantial reduction in dissociated vertical deviation (DVD), when present, and almost complete absence of subsequent need for surgery for DVD among the 61 children of this series were new findings. Only one of the 61 required subsequent surgery for manifest DVD. In another series of 60 infantile esotropes of similar ages drawn from the same practice who had previously had no inferior oblique surgery, nine needed surgery for DVD. This difference (one of 61 vs nine of 60) was significant.

Variability of strabismus surgery for acquired esotropia

We developed a mathematical model to predict the probable success rate of the first surgery to correct acquired esotropia with normal accommodative convergence-accommodation ratio in children. A computer-averaged dose-response curve of the effect of 68 bilateral medial rectus recessions was combined with various assumptions regarding likely errors in surgical performance and likely errors in measurement of the preoperative deviation. Fifteen different sets of reasonable assumptions were tested, giving a range of theoretical success rates from 72% to 96%. The results of this study clearly indicate that a certain proportion of failures is to be expected when this or other forms of strabismus are treated surgically by a fully competent ophthalmic surgeon performing as accurately as is practically possible.

Birth weight percentile and perinatal outcome: recurrence of intrauterine growth retardation

In 9596 patients followed throughout two pregnancies, recurrence of intrauterine growth retardation (IUGR) was evaluated as a function of previous birth weight percentile and attendant complications of pregnancy. Among 4623 patients with two uncomplicated pregnancies, the prevalence of recurrent IUGR was significantly related to the severity of growth retardation in the first pregnancy (P less than .0001). Those patients with both medical complications and IUGR in the first pregnancy remained at significantly increased risk for recurrent IUGR, even when the second pregnancy was uncomplicated. In second pregnancies, the combination of a previous history of an IUGR neonate and an additional current complication of pregnancy acted synergistically to increase the risk of recurrent IUGR to a level higher than that attributable to either risk factor alone.

Analysis of birth weight percentile as a predictor of perinatal outcome

Birth weight-gestational age tables are convenient methods for the neonatal evaluation of intrauterine growth, however, the limits of acceptable birth weight for gestational age are controversial. The purpose of this study was to identify the birth weight percentiles that accurately predicted poor perinatal outcome from 28 through 41 weeks' gestational age. In a homogeneous population of 44,811 patients, the birth weight percentile that predicted poor perinatal outcome varied with gestational age. The birth weight percentile that predicted normal outcome in 80% of normal patients declined from the 55th percentile at 28 to 29 weeks to the 24th percentile at 34 to 35 weeks. From 28 through 35 weeks' gestational age, possibly owing to the confounding effects of prematurity, patients classified as normal by birth weight criteria still had a significant risk of poor outcome. After 36 weeks' gestational age, poor perinatal outcome occurred in 3.9% of patients and tended to occur at the extremes of birth weight. Classification by birth weights approximating the tenth and 90th percentiles identified a population in which the majority of the poor perinatal outcome occurred. However, poor outcome occurred in only 10% of patients with birth weights below the tenth or above the 90th percentiles. Among those with birth weights between the tenth and 90th percentiles, outcome was normal in 98%. Therefore, from 36 through 41 weeks' gestational age, the prevalence of poor perinatal outcome was low, and birth weight percentile was a weak predictor of outcome in the individual patient.