Understanding cell culture dynamics: a tool for defining protocol parameters for improved processes and efficient manufacturing using human embryonic stem cells

Standardization is crucial when culturing cells including human embryonic stem cells (hESCs) which are valuable for therapy development and disease modeling. Inherent issues regarding reproducibility of protocols are problematic as they hinder translation to good manufacturing practice (GMP), thus reducing clinical efficacy and uptake. Pluripotent cultures require standardization to ensure that input material is consistent prior to differentiation, as inconsistency of input cells creates end-product variation. To improve protocols, developers first must understand the cells they are working with and their related culture dynamics. This innovative work highlights key conditions required for optimized and cost-effective bioprocesses compared to generic protocols typically implemented. This entailed investigating conditions affecting growth, metabolism, and phenotype dynamics to ensure cell quality is appropriate for use. Results revealed critical process parameters (CPPs) including feeding regime and seeding density impact critical quality attributes (CQAs) including specific metabolic rate (SMR) and specific growth rate (SGR). This implied that process understanding, and control is essential to maintain key cell characteristics, reduce process variation and retain CQAs. Examination of cell dynamics and CPPs permitted the formation of a defined protocol for culturing H9 hESCs. The authors recommend that H9 seeding densities of 20,000 cells/cm2, four-day cultures or three-day cultures following a recovery passage from cryopreservation and 100% medium exchange after 48 hours are optimal. These parameters gave ~SGR of 0.018 hour-1 ± 1.5x10-3 over three days and cell viabilities ≥95%±0.4, while producing cells which highly expressed pluripotent and proliferation markers, Oct3/4 (>99% positive) and Ki-67 (>99% positive).

Detecting somatic mosaicism: considerations and clinical implications

Human disease is rarely a matter of all or nothing; variable expressivity is generally observed. Part of this variability is explained by somatic mosaicism, which can arise by a myriad of genetic alterations. These can take place at any stage of development, possibly leading to unusual features visible at birth, but can also occur later in life, conceivably leading to cancer. Previously, detection of somatic mosaicism was extremely challenging, as many gold standard tests lacked the necessary resolution. However, with the advances in high-throughput sequencing, mosaicism is being detected more frequently and at lower levels. This raises the issue of normal variation within each individual vs mosaicism leading to disease, and how to distinguish between the two. In this article, we will define somatic mosaicism with a brief overview of its main mechanisms in concrete clinical examples, discuss the impact of next-generation sequencing technologies in its detection, and expand on the clinical implications associated with a discovery of somatic mosaicism in the clinic.

Nutritional status and socio-ecological factors associated with overweight/obesity at a rural-serving US-Mexico border university

INTRODUCTION

Globesity (the global epidemic of obesity), like undernutrition at the opposite end of the malnutrition spectrum, affects virtually all age and socioeconomic groups in developed and developing countries. Genetics, comorbid diseases and lifestyle factors have been associated with obesity and weight gain for college students. Little is known about obesity and lifestyle factors of campus students and employees located in rural areas. The purpose of this study was to examine the prevalence of overweight/obesity and socioecological elements of the obesogenic environment at a rural-serving US-Mexico border university.

METHODS

Data were collected using a cross-sectional, convenience sample by anasynchronous electronic survey submitted to approximately 23 000 students, faculty and staff on the main campus of New Mexico State University. Self-reported anthropometric indicators were used as proxy measures of nutritional status. Factors analyzed include the prevalence overweight/obesity from calculated body mass index (BMI) and self-identified body image in the contexts of sex, age, ethnicity, role at the university (student or employee) and residence. Body mass index categories were analyzed for associations with reported prevalence of stress indicators such as clinically diagnosed anxiety or depression, and major diseases such as diabetes, hypertension, heart disease, cancer and stroke.

RESULTS

A total of 3962 completed surveys were analyzed. Self-reported respondent rates (n = 3962) of overweight and obese individuals (47.2%) were less than those reported for the state (60.7%) in a 2010 national survey. When BMI was analyzed by sex, there was a significant difference (p = 0.003) between males and females. More males were overweight and obese than females. When BMI and BMI categories were assessed by age, ethnicity, role at the university and residence, each variable was found to have statistically significant differences.

CONCLUSION

No one demographic or socioecological factor appears to have a predominant role in predicting obesity in the participants studied at this rural-serving university. The authors conclude that levels of overweight and obesity are multifactorial and should be addressed with more holistic actions. These findings suggest that future studies should look more closely at stressors in the environment as well as culturally acceptable versus ideal notions of weight and corpulence. Study findings also suggest that early intervention will be critical to reducing levels of overweight/obesity and associated complications as the population ages. Finally, this study provides evidence for health educators and policy makers to go beyond exercise and calories in/out to develop educational materials that can cross many barriers of culture, age, ethnicity, educational level, residence and body image.

Predictors of access to healthcare: what matters to rural Appalachians?

Objective:

Lack of access to healthcare is frequently cited as a primary reason for health disparities globally, especially in poor, rural areas such as Appalachia in the U.S. This study examined predictors of perceived access to healthcare among residents in a poor, medically underserved, rural Appalachian community.

Methods:

The study was guided by the revised behavioral model of healthcare services utilization. Self-reported survey data were obtained from a convenience sample of 921 residents in rural Tennessee.

Results:

The majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Financial factors, health status, and associated social factors negatively affected only a small number respondents’ perceptions of access to healthcare.

Conclusions:

Despite the presence of multiple factors previously shown to affect access to healthcare, the majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Results of this study suggest that to understand an individual’s passage through the healthcare system, the contextual aspects of healthcare utilization, should be added to coverage, services, timeliness, and workforce as a fifth component of access to healthcare. Assessing perceived need and associated cultural factors that affect individuals’ concepts of health and wellness represent important areas for future exploration to explain observed health disparities. Additionally, findings showed that having sufficient quality and quantity of healthcare professionals and services in a community or region may be necessary, but not sufficient to explain health disparities and the underlying reasons why individuals choose or choose not to seek health services.

Diabetes and stress: an anthropological review for study of modernizing populations in the US-Mexico border region

INTRODUCTION

Diabetes is a growing worldwide problem, characterized by considerable ethnic variation and being particularly common in modernizing populations. Modernization is accompanied by a variety of stressful sociocultural changes that are believed to increase the risk of diabetes. Unfortunately, there is little accurate knowledge about impact of stress on the risk of diabetes in the US-Mexico border area.

METHODS

Literature searches were performed in PubMed and Google Scholar to identify anthropological studies on stress and diabetes. Snowball and opportunistic sampling were used to expand the identified literature. In total, 30 anthropological studies were identified concerning the role of stress and modernization on diabetes among Indigenous peoples. This article reviews the available information regarding stress and diabetes in different populations from various anthropological perspectives.

RESULTS

Four different concepts of stress were indentified: physiological, psychological, psychosocial and nutritional stress. Unlike physiological and nutritional theories of diabetes, psychological and psychosocial theories of stress and disease lack etiological specificity. No study addressed all four concepts of stress and few studies addressed more than two concepts. Most studies concerned nutritional stress and the developmental origins of diabetes. Most studies were conducted on the Pima Indians of Arizona and Mexico. All four stress concepts have some evidence as determinants of diabetes.

CONCLUSION

These theoretical concepts and ethnographic results can provide the basis for developing comprehensive research protocols and public health intervention targeted at diabetes. A comprehensive view of stress can potentially explain the high prevalence of diabetes in developing countries and among Indigenous peoples. These results can be used to inform public health interventions aimed at reducing diabetes in the US-Mexico border region or similar areas, help identify at-risk individuals, and guide health education and promotion.

Pandemic flu knowledge among dormitory housed university students: a need for informal social support and social networking strategies

INTRODUCTION

The declaration of a Phase 6 pandemic of influenza A (H1N1) by the World Health Organization in June 2009, triggered the activation of preparedness responses worldwide. During 2009 spring and fall, many US universities actuated their emergency pandemic preparedness plans. This article describes a research study that used a modified community based participatory research (CBPR) approach between August and November 2009 at New Mexico State University's main Las Cruces campus to determine influenza (pandemic influenza A (H1N1) 2009 and seasonal influenza knowledge, attitudes, and health communication (informal support networks and social networking) strategies specifically related to influenza among dormitory housed (on-campus living) undergraduate students. The goal was to produce data for use in the university's pandemic illness/disaster preparedness and response plans.

METHODS

Following activation of the university's campus-wide efforts to educate students about pandemic flu, university community partners were asked for input regarding information for flu preparedness for the university's undergraduate students. Student participants were recruited for the present study from those housed in four campus dormitories. A purposive convenience sample was used to collect survey data from 175 students during the peak week of reported flu cases on campus. Each participant was given an anonymous, face-to-face, self-administered survey and 167 surveys were able to be analyzed. A χ² goodness of fit test was used to determine whether observed proportions of categorical variables differed from hypothesized proportions.

RESULTS

Four categorical data were analyzed by topics: (1) demographics; (2) flu awareness; (3) flu immunization knowledge and practices; and (4) communication and health information practices. The average age was 19.6 years (SD = 1.8), with no significant differences by sex (86 males and 76 females, 5 undisclosed) or race/ethnicity (57 White, 43 Hispanic, 44 Other). All questions were tested with χ² against sex, race, and dormitory; however, only three questions revealed statistically significant differences by any of these demographic categories.

CONCLUSIONS

Sex, race, age, and dormitory were demonstrated to have little impact on H1N1 health practices and knowledge. Three-quarters of students surveyed demonstrated awareness of the pandemic 2009 H1N1 flu. Despite public health and university health education campaigns, approximately 25% were not aware of the virus. Most students stated that they knew someone who had flu during the year, even if they had not. Students did not perceive (60%) dormitory living to be a greater health risk, even though the proximal distance among students diminishes by sharing bathrooms and sleeping quarters. Three main factors affected the students' knowledge, attitudes and behaviors: faculty attitudes and influenza knowledge; low levels of flu like illnesses at the university; and the utilization of health education strategies inconsistent with the mechanisms students use to gain health information (informal support networks and electronic social networking). Failure to utilize these student information mechanisms may result in less than optimal health education effectiveness. Health educators should ensure that identifiable intermediaries (eg faculty) understand and assist in health education efforts. However, the incidence of H1N1 at this university was relatively low, which may have affected the research results.

Psychotherapy with brain injury survivors: An investigation of the challenges encountered by clinicians and their modifications to therapeutic practice

OBJECTIVE

The aim of this study is to elicit practitioners' views and experiences of the challenges to forming a therapeutic alliance with brain injury survivors, with a view to informing current psychotherapeutic practice.

METHODS

The present research utilised the data-display method, a qualitative technique, to examine the questionnaire responses of 21 psychologists who provide forms of psychotherapy for brain injury survivors at rehabilitation units in the UK. An anonymous postal return questionnaire was used for data collection.

RESULTS

The main challenges to forming a working alliance comprised a range of cognitive, behavioural and emotional sequelae. A combination of educational, psychosocial and cognitive strategies were identified as being most effective in addressing the challenges encountered.

CONCLUSIONS

A qualitative research approach has proved useful in identifying challenges to the formation of a working alliance and also the modifications to psychotherapeutic practice these challenges have engendered.

Effects of HIV status and antiretroviral therapy on blood pressure

OBJECTIVE

High blood pressure is a major risk factor for cardiovascular disease and concerns have been raised over its possible association with antiretroviral drugs. The objective of this study was to explore the associations among blood pressure, HIV status and two predefined highly active antiretroviral therapy (HAART) regimens: treatment with and without nonnucleoside reverse transcriptase inhibitors (NNRTIs) (NNRTI- and non-NNRTI-based HAART).

METHOD

A cross-sectional survey was conducted among 612 adults attending the Sexual Health Outpatient Department at St Mary's NHS Hospital Trust, London.

RESULTS

HIV-infected patients treated with NNRTIs had a blood pressure that was 4.6/4.2 mmHg higher than those who were HIV positive but treatment naïve. The diastolic difference remained statistically significant after adjusting for potential confounders of this association (2.4 mmHg; P=0.03). There was no difference in blood pressure between those treated with non-NNRTI-based regimens and those who were HIV positive but treatment naïve.

CONCLUSION

NNRTIs may be associated with an increase in blood pressure. Pending further more robust evidence from randomized clinical trials it would be prudent for clinicians to monitor blood pressure in all HIV-infected patients, particularly after initiating treatment with NNRTIs, and to commence antihypertensive therapy whenever appropriate.

Cardiovascular risk: its assessment in clinical practice

Cardiovascular disease is one of the major causes of mortality and morbidity in Western industrialised countries. Many factors impact on the likelihood of an individual suffering a stroke or heart attack. One of the greatest challenges facing clinicians today is how best to identify those individuals at increased risk, to prevent them becoming tomorrow's patients. Risk assessment tools can provide useful frameworks to support the identification of individuals who may benefit from therapeutic intervention; however, such tools should be used with care, as they do not include all the factors that contribute to future disease risk, and they are subject to an age bias. Nonetheless, they provide a systematic, evidence-based approach to the delivery of preventative healthcare services.

Differences in attitudes regarding teaching and research orientations between allied health faculty and administrators in academic health centers

The congruence between faculty's and administrators' attitudes toward teaching, research, and the rewards associated with them has implications for the practices the groups follow and for the decisions they make related to promotion, tenure, and merit. This article reports the findings from a national study of allied health faculty and administrators at public academic health centers regarding their attitudes toward teaching, research, and the reward systems related to both. The administrators and faculty at the participating academic health centers did not differ in their views regarding research orientation and rewards related to research. The faculty, including tenured and tenure-track, and department chairs indicated a higher teaching orientation than did the deans, while tenure-track faculty expressed less belief that rewards influence teaching than did tenured faculty, department chairs, and deans.

In vitro and In vivo inhibition of LPS-stimulated tumor necrosis factor-alpha secretion by the gallotannin beta-D-pentagalloylglucose

The naturally occurring gallotannin beta-D-pentagalloylglucose (beta-PGG) decreases tumor necrosis factor-alpha (TNF-alpha) output from human peripheral blood mononucleocytes exposed to lipopolysaccharide (LPS) by as much as 90% (vs control) at approximately 5 microM concentration. A qualitatively similar but less pronounced effect ( approximately 50% decrease) was observed in the serum of rats dosed with both LPS and beta-PGG. These results may have relevance to therapies that target disease states characterized by an overproduction of TNF-alpha.

Representation: a call to action for allied health professionals

The Coalition of Allied Health Leadership (CAHL) Representation Project committee examined the representation of allied health professionals in political and other policy-making groups and found it both fragmented and lacking. The benefits to individuals participating in such groups, as well as to the allied health profession as a whole and to the groups themselves, are described. Individuals are urged to participate, and the means to do so are presented.

Misconceptions about brain injury among the general public and non-expert health professionals: an exploratory study

The purpose of this pilot study was to investigate the lack of knowledge and misconceptions concerning brain injury, as perceived by those with experience of the condition. Using a qualitative research method, 19 semi-structured interviews were conducted with brain-injured individuals, caregivers and professionals who provide social rehabilitation after brain injury. Interviews were analysed using Interpretative Phenomenological Analysis. According to participants, inaccurate and inadequate knowledge about brain injury is common among the general public and among health professionals without expertise in the field of brain injury. The major themes that emerged from the analysis were: inaccurate beliefs about recovery time and possible extent of recovery from brain injury; lack of awareness of the diversity ofproblems it can cause, particularly the existence of behavioural and cognitive sequelae; misconceptions about the capabilities of brain-injured people depending on the visibility or invisibility of their disability: and misidentification of brain-injured individuals as mentally ill or learning disabled. Results are discussed in terms of a theory of illness cognition. Posibilities for further research are discussed, and it is concluded that the results of this study could help guide future information provision to all who may come into contact with brain injury.

Attachment disorders: review and current status

Developmental research on attachment has flourished in the past 15 years (C. H. Zeanah, 1996). However, there has been relatively scant empirical investigation of disorders in attachment. In this article, the pertinent developmental research on the attachment cycle is delineated and the current status of disordered attachment is examined. A particular focus is given to the conceptualization of the most severe form of disordered attachment, Reactive Attachment Disorder.

Hypertension awareness, detection and treatment in a university community: results of a worksite screening

This study aimed to assess knowledge levels, explore the extent of undiagnosed hypertension, record previous screening activity and monitor the outcomes of previous hypertension treatment. To this end, information was collected from volunteer members of a university community, by means of a self-report questionnaire, about their personal characteristics, knowledge and experience of hypertension and stroke, and previous blood pressure measurements. In addition, their current blood pressure was recorded. A total of 653 staff and students completed the questionnaire and had their blood pressure measured. Analysis revealed that 82% were normotensive (diastolic blood pressure <90 mmHg). Hypertension was significantly associated with age, self-reported excess weight P<0.001) and marginally with self-reported non-healthy eating (P=0.06). Of the volunteers, 57% could not provide an accurate definition of a stroke. Knowledge levels were significantly and positively related to experience of stroke, healthy eating, not smoking and a recent blood pressure check. Of the respondents, 30% stated that they had not had their blood pressure measured in the previous two years. 51% of known hypertensives were not controlled. 68% of volunteers with diastolic blood pressure >89 mmHg were previously unaware of a potential hypertension problem. Hypertension rates amongst the university volunteers are higher than those recently recorded from a population sample. Scope exists for increasing knowledge and awareness, and for raising both screening rates and treatment outcomes. Improvements in these areas are required if current public health targets for heart disease and stroke are to be achieved. Worksite screening programmes can contribute to this endeavour.

Early indication of emergence from vegetative state derived from assessments with the SMART--a preliminary report

An explanatory analysis of data from serial assessments of 30 patients with a diagnosis of vegetative state (persistent vegetative state) was carried out. The data were gathered using the Sensory Modality Assessment and Rehabilitation Technique (SMART) and the Western Neuro Sensory Stimulation Profile (WNSSP) on the same day in the week post-admission and, thereafter, at 2 monthly intervals. Seven patients emerged from vegetative state during the study, a further six emerged later (by time of the analysis) and the rest remained in vegetative state. Recovery scores were calculated for each measure by subtracting the total score at any one assessment from the total score for the subsequent assessment; the largest recovery scores, shown by each patient, were noted. It was found that those who emerged later could be differentiated mathematically from those who did not emerge, using largest recovery score data from the SMART. This research supports previous

Chromobacteriosis in a Chinese red panda (Ailurus fulgens styani)

An adult Chinese red panda (Ailurus fulgens styani) transported by airplane from Florida to a North Dakota zoo died 1 week after arrival. Grossly, an interscapular abscess, subcutaneous inflammation, lymphadenitis, and pulmonary abscesses were observed. Microscopic findings included necrotizing inflammation in liver, lung, lymph node, and spleen. Chromobacterium violaceum was cultured from the interscapular abscess, liver, lung, and spleen and was injected into Swiss Webster mice. These mice died 18 hours postinoculation, and C. violaceum was cultured from liver, lung, and spleen. Chromobacterium violaceum is a sporadically reported but highly virulent pathogenic bacterium of both animals and humans typically found as a soil and water inhabitant of tropical and subtropical regions.

Scholarship and research of allied health deans and directors

In 1997, a questionnaire was sent to 141 allied health deans or directors to: 1) determine current research and scholarship, 2) ascertain institutional expectations regarding scholarly activities, 3) characterize the institution's research environment, 4) quantitate scholarship productivity by point assessment, and 5) compare scholarship of administrators from research universities with that of those at non-research four-year colleges and universities. Seventy-three (52%) responded. Measures of research productivity included time spent in research, numbers of publications and presentations, and grantsmanship. While spending two thirds of their time in administrative duties, many deans and directors were actively involved in scholarship. Since 1990, they had, as a group, produced 855 publications, made 1,348 presentations, and been awarded $38.3 million in total funding. They did not differ significantly by employing institution (a research institution or a non-research institution).

Listeria monocytogenes infection and activation of human brain microvascular endothelial cells

Listeria monocytogenes invasion of human brain microvascular endothelial cells (BMEC) and its role as a stimulus for endothelial cell activation were studied. Binding and invasion of intact BMEC monolayers were independent of the L. monocytogenes inlAB invasion locus. Cytochalasin D abrogated invasion of BMEC, whereas genistein effected only a 53% decrease in invasion, indicating a requirement for rearrangement of actin microfilaments but less dependence on tyrosine kinase activity. L. monocytogenes stimulated surface expression of E-selectin, ICAM-1, and to a lesser extent, VCAM-1, whereas L. monocytogenes prfA- and Deltahly mutants were severely compromised in this respect. Other experiments showed that BMEC infection stimulated monocyte and neutrophil adhesion and that CD18-mediated binding was the predominant mechanism for neutrophil adhesion to infected BMEC under static conditions. These data suggest that invasion of BMEC is a mechanism for triggering inflammation and leukocyte recruitment into the central nervous system during bacterial meningitis.

Cardiac pacing in Canada in 1998: working towards optimal pacing therapy. Canadian Working Group on Cardiac Pacing

The Canadian Working Group on Cardiac Pacing (CWGCP) was formed in 1996 with the primary goal of promoting optimal pacing therapy in Canada. In 1997, the CWGCP conducted a survey of pacing practices across Canada. Ninety-two of 125 implanting programs (74%) responded. Implant rates vary by province--from 39 per 100,00 population in Ontario to 63 per 100,000 population in Nova Scotia and Prince Edward Island. Variations in regional implant rates persist even after correcting for the age of the population. Physiological pacing was used for 35% of all implants in Canada in 1996/97. There were marked differences across Canada in the mode of pacing selected. In western Canada, 39.5% of pacing systems implanted were physiological compared with 18.2% in Atlantic Canada and 29% in Quebec. There were also differences in follow-up practices. Approximately 40% of centres follow patients with single chamber pacemakers annually, whereas most other centres still follow these patients every six months. Economic constraints, the size of pacing programs and the involvement of committed pacing physicians are factors that may influence the regional differences in cardiac pacing across Canada.

Vegetative state and responses to sensory stimulation: an analysis of 24 cases

A meta-analysis was performed on data from 24 single-case experimental studies evaluating the immediate effects of sensory stimulation treatment on patients in vegetative state following traumatic brain injury. Response to treatment was evaluated by time sampling behaviour pre- and post-treatment, and examining for changes in behaviour that suggested increased arousal. In this analysis the relative effectiveness of different treatment protocols was examined. The effects of variables such as age, gender and time since injury on magnitude of behaviour change was examined; also whether there was a relationship between response to treatment and outcome in terms of whether patients emerged from vegetative state or not. Analyses showed that multimodal stimulation produced greater behavioural changes than unimodal stimulation, and the use of personally salient stimuli in multimodal stimulation the greatest changes of all. Age and gender both showed effects on the magnitude of the behaviour change, but time since injury did not. Patients who did not emerge from the vegetative state were no less likely that those who did to produce statistically significant changes in behaviour in response to treatment. The paper includes a discussion of general issues concerning vegetative state.

Behavioural differences between patients who emerged from vegetative state and those who did not

This paper reports on a meta-analysis of behavioural data gathered using single case research methodology, while evaluating the immediate effects of a treatment (sensory stimulation) on 24 individuals diagnosed as being in vegetative state following trauma. The data derived from time sampling have been used to compile measures of behavioural change in response to environmental events, which are referred to as arousal profiles. In addition to this, interviews were conducted regularly to elicit structured observations from the nursing staff concerning behavioural changes that they had observed. The subjects were divided into two groups according to whether they had emerged from vegetative state or not at the time the meta-analysis commenced. Statistically significant differences were found between the outcome groups in terms of modal arousal profile characteristics; one profile type was characteristic only of those that emerged. The two groups could also be differentiated by the mean recovery curves derived from the interview data. Behavioural differences between the outcome groups have been found which are detectable while the patients are in vegetative state. These findings have prognostic potential.

Constructing arousal profiles for vegetative state patients--a preliminary report

Arousal profiles are a method that we have developed for using data derived from time sampling to examine how behaviours such as the frequency with which the eyes are observed open, and the frequency of spontaneous movements, vary in the periods immediately before and immediately after sensory stimulation treatment. We believe changes in such behaviours reflect changes in arousal. The use of this new technique is illustrated with examples from a pilot study using data from 15-day treatment blocks, gathered for 10-minute periods immediately before and after sensory stimulation treatment from three patients using single-case research methods. The patients were diagnosed as being in vegetative state following traumatic brain injury. The possible significance of the differing characteristics of the profiles is discussed.

A venous thrombosis technique for experimental thrombolytic therapy

A technique for the experimental creation of a venous thrombus in the rat is described. This technique involves a circumferential stretching of the intima, which maximizes intraluminal collagen exposure without complete separation of the vessel wall. This thrombotic method was 94.4% effective at complete vessel occlusion after 24 hours in 40 treated veins. This model is of particular interest in the in vivo evaluation of thrombolytic agents in the laboratory setting and as an adjunct to thrombotic complications in microsurgery.

Giant leiomyoma of the small intestine with free perforation into the peritoneal cavity

Leiomyomas involving the small bowel are rare benign tumors comprising 0.2% to 1.8% of all gastrointestinal tumors. We have presented a case with the rare complication of a free perforation between the tumor and the peritoneal cavity, causing an acute abdomen.

Problems in magnetic resonance imaging of patients with severe brain injury and a solution to one of them

A number of difficulties have been encountered in carrying out MRI scans with severely brain-injured subjects. One of the problems is maintenance of head position for the 30 minutes' duration of the scan. The use of a vacuum cushion has proved a low-cost solution to this problem.

Sensory stimulation in prolonged coma: four single case studies

Patients diagnosed as being in prolonged coma (vegetative state) in this hospital are routinely treated according to a sensory stimulation protocol. This paper reports an evaluation of the efficacy of this procedure using the comparison of behavioural measures taken immediately prior to and post-stimulation. Four single cases produced significant behavioural changes suggesting increased arousal as a result of stimulation. The results and implications for further evaluation studies are discussed.

Flexible sigmoidoscopy screening for asymptomatic colorectal disease in patients with and without inguinal hernia

Several studies have evaluated the diagnostic value of flexible sigmoidoscopy for screening asymptomatic patients before hernia repair. All have shown a 16% to 28% incidence of neoplastic (malignant or premalignant) lesions. None of these studies compared a similar group of asymptomatic patients without hernia to determine whether the incidence is increased in patients with hernias. We reviewed 87 consecutive cases of male surgical patients without hernia or any anorectal disease who had flexible sigmoidoscopy between June 1986 and December 1989 (group 1) and compared them with a group of hernia patients that we previously reported (group 2). Patients with stool positive for occult blood were excluded from this study. Examinations in both groups were done under the direct supervision of an attending surgeon (W.W., C.S.C., or J.K.). No significant difference was noted between group 1 and group 2 in mean age (mean 65.6 vs 59.7 years), rate of normal findings (68% vs 63%), and incidence of neoplastic lesions (14% vs 22%). All patients tolerated the procedure well, and there were no complications.

Comparison of free and liposome encapsulated doxorubicin tumor drug uptake and antitumor efficacy in the SC115 murine mammary tumor

Tumor drug uptake and antitumor efficacy of free and liposomal doxorubicin (DOX) were determined in the SC115 Shionogi mouse mammary tumor. Liposomal DOX systems were prepared by pH gradient-driven drug encapsulation in 170 nm egg phosphatidylcholine/cholesterol (55:45, mol ratio) vesicles. Intravenous injection of free DOX at 6.5 mg/kg, the maximum tolerated dose for free drug in the multiple dose therapy regimen, resulted in tumor-associated drug levels of 2.0 micrograms/g tissue at 1 h which remained constant over 24 h. Liposomal DOX injected at 6.5 mg/kg led to an accumulation of drug in the tumor from 2.6 micrograms/g tissue to 5.5 micrograms/g tissue between 1 h and 24 h, respectively. Increasing the dose of liposomal DOX to 13.0 mg/kg increased tumor drug uptake levels to 5.7 micrograms/g and 10.2 micrograms/g tissue at 1 h and 24 h, respectively. Administration of free or liposome encapsulated DOX every 7 days for 3 weeks resulted in a dose-dependent decrease in tumor growth rate. However, liposomal DOX injected at 6.5 mg/kg exhibited enhanced tumor growth inhibition compared to an equivalent dose of free drug. Further, the ability to administer increased doses of the less toxic liposomal DOX not only resulted in a greater inhibition of tumor growth but also significantly reduced tumor weight. Tumors weighing as much as 5 g were diminished to less than 0.5 g upon treatment with liposomal DOX at a dose of 13 mg/kg. In addition, groups receiving the highest liposomal DOX dose exhibited 25% complete tumor regression which persisted over the 50-day study period. These results demonstrate the ability of appropriately designed liposomal DOX systems to significantly enhance the delivery and retention of drug at solid tumor sites, resulting in increased therapeutic activity.

Identification of a 150-kilodalton polypeptide that copurifies with yeast TFIIIC and binds specifically to tRNA genes

The transcription in vitro of eucaryotic tRNA genes by RNA polymerase III requires two transcription factors, designated TFIIIB and TFIIIC. One of the critical functions of TFIIIC in the transcription of tRNA genes is that it interacts directly and specifically with the two internal promoter elements of these genes. We have partially purified Saccharomyces cerevisiae TFIIIC by chromatography on Bio-Rex 70, DEAE-cellulose, and phosphocellulose resins. A 150-kilodalton (kDa) DNA-binding polypeptide copurified with TFIIIC activity. This 150-kDa protein coeluted with the DNA-binding activity of TFIIIC after rechromatography of TFIIIC on phosphocellulose and its elution with a linear salt gradient. The stable and high-affinity interaction of this protein with tRNA genes was demonstrated by the maintenance of a protein-DNA complex under conditions of high ionic strength. Finally, we showed by two criteria that the interaction of this protein with tRNA genes was specific. First, the protein-DNA complex was competed with only by DNA-containing tRNA genes; second, the protein preferentially bound to DNA fragments containing a tRNA gene. These results strongly suggest that the DNA-binding domain of the yeast TFIIIC is contained within this 150-kDa polypeptide.

Health educators in HMOs: a study of utilization and effectiveness

This study examined the status of health educators in Health Maintenance Organizations (HMOs). Specifically, the investigation described the utilization of health education personnel in HMOs, the way in which health education services were provided, and the effectiveness of health educators in HMOs as perceived by HMO administrators. Data from a national study showed that health educators were employed by all HMO types except Independent Practice Associations. Health education services tended to be provided in-house rather than through contractual services. HMO administrators were generally favorable toward the presence of health educators in their organizations and were satisfied with their performances, believing that they were cost effective and well educated for their position. The belief that health educators could be better utilized if they possessed additional skills apparently existed.

Brain stem evoked response in the assessment of learning disabilities

Evidence has accumulated rapidly to support the hypothesis that neurological anomalies underlie specific forms of learning disability (LD). This article reviews recent studies directed at the electrophysiological assessment of LD children, with emphasis on the brain stem evoked response(BSER) methodology. Child studies appear to indicate that there are significant differences in BSERs between LD and age-matched normal controls. The methodological and statistical differences among these studies, which have clouded the findings and made replication difficult, are reviewed. Improvements in sampling and empirical procedures are suggested, including the use of discriminant analysis to explore BSER asymmetries in LD children. Future inquiry into the measurement and analysis of BSER activity in LD populations is warranted on the basis of these preliminary findings. New information may bring professionals closer to an understanding of the neurological causes of specific subtypes of LD and permit earlier identification of these "at risk" populations.