Faculty openings and recruitment in dental hygiene education.

The purpose of this study was to obtain information on the availability of full-time teaching positions, job qualifications, and methods of recruitment in dental hygiene education. A questionnaire was mailed in 1990 to 198 dental hygiene program directors to acquire data on faculty positions and recruitment. The initial and follow-up mailings produced an 86% response rate. Data were analyzed using frequency distributions and chi-square analyses. Seventy-seven authorized openings for full-time faculty were reported: 60 were vacancies resulting from the departure of a faculty member. The minimum educational qualification was the baccalaureate degree for faculty positions in associate degree programs, and the master's degree or higher for teaching positions in baccalaureate degree programs. The type of experience required was primarily clinical, although teaching and research were preferred. The majority of positions available were at the entry levels of instructor and assistant professor. The recruitment method reported to be most successful in locating prospective faculty candidates was placement of a notice in a professional journal.


Aerosol generation by two ultrasonic scalers and one sonic scaler. A comparative study.

The purposes of this study were to compare the amount of aerosols generated from ultrasonic and sonic scalers and to measure the potential depth of respiratory tract penetration. Forty subjects were randomly assigned to receive instrumentation with the magnetostrictive, piezoelectric, or air turbine scaler. The Anderson Air Sampler collected total baseline airborne microbes for 20 minutes prior to treatment and for 20 minutes during instrumentation. This cascade impactor system measures the degree of microbial penetration in a simulated respiratory system. Blood agar plates from the sampler were incubated for 24 hours at 37 degrees C. Colony forming units per cubic foot of air (CFUs/cu. ft.) were enumerated by one blind examiner using a Lab Line Colony Counter. Data for total microbial CFUs/cu.ft. and CFUs/cu.ft. by sampler level were analyzed on the log-transformed data using ANCOVA. Baseline values of airborne bacteria served as the covariate. Results showed no significant difference in mean combined total CFUs/cu.ft. for the magnetostrictive, piezoelectric, or air turbine sonic scalers. The magnetostrictive scaler generated the lowest CFUs/cu.ft. at the deepest level of penetration; however, no significant difference in level of penetration was found among the three scalers.


Effects of vitamin B12-deficiency on testes tissue in rats.

The state of vitamin B12-deficiency in rats was evaluated by determination of hepatic vitamin B12-dependent enzyme activities after the animals had fed on a vitamin B12-deficient soybean protein diet for 150 days. The effect of vitamin B12-deficiency on testicular tissue was also studied by morphological observations. Growth of vitamin B12-deficient rats was retarded and marked increase in urinary methylmalonic acid was observed. Vitamin B12 contents in the organs were depressed distinctly by the deficiency, especially in testes, vitamin B12 content decreased to 2.5 ng/g. Hepatic methionine synthase and methylmalonyl-CoA mutase activities showed striking depression to 5% of the control rats and extreme vitamin B12-deficiency was confirmed. Testes weight also showed marked decrease together with their relative weight per 100 g body weight. Morphological observations of testes of vitamin B12-deficient rats revealed atrophy of the seminiferous tubules and aplasia of sperms and spermatids. The above results proved that vitamin B12-deficiency affected rat testes, and suggested that the rat could be the animal model for elucidation of the mechanism of B12 action on testicular functions.


Isolation of plasma cholesterol-lowering components from ningyotake (Polyporus confluens) mushroom.

The present study was undertaken to isolate component(s) which contributes to the hypocholesterolemic action of Ningyotake (Polyporus confluens) mushroom. The mushroom powder was extracted with 80% ethanol, and the extract and residue were fractionated into five fractions according to the solubility to solvents. When each fraction was added to a diet containing 1% cholesterol and 0.25% sodium cholate and fed to rats, the plasma cholesterol level was significantly decreased only by ethyl acetate-soluble fraction. Therefore, ethyl acetate-soluble fraction was further fractionated by silica gel column chromatography. Two major compounds, which comprised 45.0% and 28.5% of the ethyl acetate-soluble fraction, were obtained in a pure form by the chromatography, and the compounds were identified as grifolin (2-trans, trans-farnesyl-5-methylresorcinol) and neogrifolin (4-trans, trans-farnesyl-5-methylresorcinol), respectively. The addition of grifolin and neogrifolin to the high cholesterol diet was found to lower plasma cholesterol level significantly.


Effects of cultured milk products by Lactobacillus and Bifidobacterium species on the secretion of bile acids in hepatocytes and in rats.

Whey preparations prepared from cultured milk by 19 Lactobacillus (2 species) and 20 Bifidobacterium (5 species) strains were examined for the effects of secretion and synthesis of bile acids in primary cultured rat hepatocytes. The stimulating effect of whey preparation on bile acid secretion depended on the species as well as the strains used for milk fermentation. Two strains belonging to L. casei SBT 2230 (LC2230) and B. longum SBT 2912 (BL2912) produced the whey which stimulates both the secretion of bile acid and the activity of cholesterol 7 alpha-hydroxylase, a rate-limiting enzyme for bile acid synthesis. When the cultured products by these two strains were given to rats for 14 days, the products from L. casei (LC2230) were found to stimulate the biliary secretion of bile acids. These results suggest that primary cultured hepatocytes were a useful experimental system as an initial screening for an active principle modulating cholesterol metabolism.


Effects of sesamin and curcumin on delta 5-desaturation and chain elongation of polyunsaturated fatty acid metabolism in primary cultured rat hepatocytes.

Effects of sesamin and curcumin on delta 5-desaturation and chain elongation of polyunsaturated fatty acid (PUFA) were studied in rat primary cultured hepatocytes. When sesamin was added to culture medium containing 20:4 (n-3), rat hepatocytes after 24 h of incubation produced 20:5 (n-3) from 20:4 (n-3), whereas when incubated with 20:3 (n-6), the metabolite by delta 5-desaturation did not accumulate, and consequently, the ratio of 20:3 (n-6)/20:4 (n-6) increased with the amount of sesamin added. Curcumin was more effective than sesamin in this respect. Both sesamin and curcumin interfered with chain elongation of PUFAs. An addition of 18:3 (n-6) or 18:4 (n-3) increased the cellular concentrations of 20:3 (n-6) or 20:4 (n-3), respectively, but the simultaneous addition of sesamin or curcumin inhibited the chain elongation of C18 acids (the fatty acids with 18 carbons) into corresponding C20 and C18 acids. Similarly, the elongation from C20 of n-3 and n-6 families to C22 was also inhibited with sesamin and curcumin. These results suggested that: 1) sesamin and curcumin inhibited delta 5-desaturation of n-6 fatty acid, but not n-3 fatty acid in rat hepatocytes; 2) curcumin was more effective than sesamin; 3) chain elongation was also inhibited by sesamin and curcumin.


Decrease of lactase activity in the small intestine of jejunum-bypassed rats.

The effect of jejunum-bypass operation on lactase in rat small intestine was examined. Three groups of four or five rats were designated as jejunum-bypassed, sham-operated and normal rats. All animals including normal rats received by pair-feeding 5% glucose/1% NaCl for 5 days following the operation; thereafter they were fed ad libitum the laboratory chow diet. Three weeks after the jejunal bypass operation, the proximal ileum exhibited a hyperplasia as evidenced by a concomitant increase in mucosal contents of both total proteins and DNA. The specific activity of lactase in this segment was significantly lower in the operated rats than sham-operated controls, whereas the specific activity of sucrase in this segment was significantly elevated. The reduction of lactase activity was also evident in the proximal jejunal segment as well as in the distal jejunum which was deprived of luminal nutrition, suggesting that some hormonal factor(s) might be involved in the decrease of lactase activity in jejunum-bypassed animals. Electroimmunoassay revealed that the amount of immunoreactive lactase also declined in the operated rats relative to the sham-operated controls. Our results thus suggest that lactase activity in residual ileum is not only unable to compensate for the loss of digestive-absorptive surface of jejunum, but lactase activity even decreases following jejunum-bypass operation.


An improved high-performance liquid chromatographic assay for the determination of pyridinoline in connective tissues.

A high-performance liquid chromatographic (HPLC) method for determination of pyridinoline and its application to connective tissues are described. The chromatographic separation was accomplished by using Inertsil ODS-2 column and a mixture of 0.1 M sodium phosphate and acetonitrile (75:25, v/v) containing sodium dodecyl sulfate (SDS) and ethylenediamine tetraacetic acid (EDTA) as eluent. The chromatogram was developed isocratically and the eluted components were monitored with excitation at 295 nm and emission at 395 nm. The pyridinoline in crude hydrolysate of connective tissues can be determined in 5 min, with as little as 1 pmol of sample. The present method is rapid, simple and can be used for the routine analysis of connective tissues such as cartilage, bone, Achilles tendon and aorta.


Lipid peroxidation of liposome induced by glucosone.

Lipid peroxidation of liposome made of egg lecithin was induced by glucosone (D-arabino-hexos-2-ulose), a secondary product of Maillard reaction or glycation of protein. Lipid peroxidation was assessed with measurement of TBARS (thiobarbituric acid reacting substances), POV (peroxide value), and HPLC measurement of MDA (malondialdehyde). EDTA and DTPA (diethylenetriamine-pentaacetic acid) inhibited the lipid peroxidation assessed by each method described above, indicating involvement of metal ions. The observed reduction of Fe3+ to Fe2+ by glucosone might be a critical step of the lipid peroxidation. Our findings suggest a possible role of lipid peroxidation of low-density lipoproteins (LDL) induced by glucosone in atherosis caused by diabetes mellitus.


Inhibitory effect of oligosaccharides derived from plant xyloglucan on intestinal glucose absorption in rat.

We studied the effects of oligosaccharides which were obtained from tamarind xyloglucan by cellulase digestion on absorption of 3-O-methyl-D-glucose using the everted sacs from rat small intestine. Among oligosaccharides tested, octasaccharide and nonasaccharide, which contain D-galactose residue at non-reducing terminals, inhibited effectively absorption of 3-O-methyl-D-glucose, and their inhibitory effects were concentration-dependent. On the other hand, heptasaccharide not having D-galactose residue at its non-reducing terminal showed no inhibitory effect on absorption of 3-O-methyl-D-glucose. These results indicate that the octasaccharide and nonasaccharide may not only serve as a soluble dietary fiber with small molecular weight but also lower the blood sugar level.


Correlation between plasma alpha-cysteine proteinase inhibitor level and pyruvate kinase activity in vitamin E-deficient rats.

Weaning rats were divided into two groups, one group being fed a vitamin E-deficient diet, and the other an alpha-tocopherol-containing (50 mg/kg) control diet. Rats were killed at 1, 2, 3 and 4 months of feeding. The following results were obtained. 1. Both plasma and liver alpha-tocopherol levels decreased greatly by feeding vitamin E-deficient diet for 1 month, and thereafter decreased gradually by continued feeding. 2. Somehow different results were obtained concerning liver peroxidation value by the method of analysis. In the case of chemiluminescence, the value increased by vitamin E deficiency during the first 2 months, but thereafter, the value was almost unchanged. On the contrary, in the case of TBA-RS, the value increased gradually throughout the entire 4 months of feeding period. 3. Both plasma alpha-CPI level and pyruvate kinase activity increased by vitamin E deficiency, showing similar pattern of change with feeding period. Especially, marked increase of these values was observed in vitamin E-deficient rats fed for longer than 2 months, and differences from control groups were highly significant (in both cases, at 2 months, p < 0.005, and at 3 and 4 months, p < 0.001). And, in vitamin E-deficient group, including all the rats fed on test diet for 1 to 4 months, correlation between both values was very high, and was highly significant (r = 0.9060, p < 0.001).


The kidney as a sensor: functional evidence.

To evaluate the effects of afferent renal nerve activity on reflex control of the cardiovascular system and volume balance. In the kidney, receptors sensitive to mechanical and chemical stimuli have been identified. Afferent fibres from the kidney have been shown to travel along renal nerves and dorsal roots, mainly from T9 to L4, and to project to the central nervous system at spinal and supraspinal levels. Most of the brainstem regions involved in cardiovascular control and several regions of the anterior hypothalamus (including vasopressin-secreting neurons) receive inputs from renal afferents. The electrical stimulation of afferent renal nerve fibres can either increase or decrease systemic arterial pressure. The hypertensive response to electrical stimulation of renal afferents is the result of widespread activation of the sympathetic nervous system, leading to an increase in peripheral vascular resistance. Activation of afferent renal nerve fibres by an intrarenal artery infusion of adenosine elicits sustained increases in arterial pressure, heart rate and cardiac output without changing total peripheral resistance, indicating reflex activation of the sympathetic nervous system, predominantly restricted to the heart. An increase in the plasma vasopressin concentration, observed during the electrical stimulation of renal afferents, might help to mediate the hypertensive response to afferent renal nerve stimulation. The existence of neural renorenal reflexes, by which one kidney can influence the functioning of the opposite kidney, is well established. Contralateral renorenal reflexes, which are inhibitory in nature, are tonically active and mainly control the secretion of renin from juxtaglomerular cells and the tubular reabsorption of sodium and water. The evidence suggests that sensory information from the kidney contributes to the overall regulation of cardiovascular homeostasis and volume balance.


Peptides as targets for antihypertensive drug development.

To assess the potential for development of new classes of pharmacological drugs in the treatment of hypertension and cardiovascular disease. Basis of pharmacological blood pressure reduction: Since the discovery of the renin-angiotensin system by Tigerstedt almost 100 years ago, a large number of vasoactive peptides have been discovered. By interaction with such peptides of endocrine, perivascular or endothelial origin, blood pressure may be modulated. BLOCKADE OF THE RENIN-ANGIOTENSIN SYSTEM: The success of the angiotensin converting enzyme (ACE) inhibitors in hypertension and congestive heart failure is generally attributed to reduced generation of angiotensin II. The recent development of specific and highly potent Ang II type 1 subtype receptor antagonists such as losartan (DuP753, MK954) have provided a new opportunity to inhibit the renin-angiotensin system, and this is currently being explored in hypertensive patients. In addition, blockade of the first and rate-limiting reaction of the renin-angiotensin system, inhibition of renin activity, is also a target for the development of antihypertensive drugs. However, this development is hampered at present by a compensatory increase in active renin that clinically offsets the antihypertensive action of renin inhibitors. PHARMACOLOGICALLY INDUCED INCREASE IN ATRIAL NATRIURETIC PEPTIDE (ANP): The availability of circulating or tissue ANP may be increased by inhibiting its metabolic clearance by NEP-24.11 inhibitor drugs. These agents induce a reduction in blood pressure and diuretic effects in animal models, and may become a new class of drugs for the clinical management of patients with hypertension and congestive heart failure. OTHER POTENTIAL PHARMACOLOGICAL TARGETS IN THE MANAGEMENT OF HYPERTENSION: There are several potential pharmacological targets that may lead to the development of novel antihypertensive agents in the future. These include the interaction or blockade of vasopressor peptides. Routes of development include neuropeptide Y1 receptor antagonists, which block the postjunctional vasopressor effect of neuropeptide Y, or endothelin antagonists, which block endothelin pressor actions at the endothelin A receptor site. The cardiovascular actions of the functional neuropeptide Y inhibitor alpha-trinositol (PP 56) provide a potential new mechanism for reducing blood pressure in hypertension. In addition, the recent discovery of small molecular agents with high potency and specificity for the endothelin A receptor subtype may also be of value in specific vascular disease states. Future development is likely to provide us with novel drugs based on interactions with vasoactive peptides that may improve the management of specific cardiovascular disease states.


Adrenergic receptors and their signal transduction mechanisms in hypertension.

Recent years have witnessed an astonishing proliferation in the number of known adrenoceptor subtypes and related signaling pathways, all of which can potentially be altered in hypertension. Although numerous reports have suggested altered adrenoceptors, guanine nucleotide binding regulatory proteins (G proteins) or effector mechanisms in hypertensive animals or patients, only few clear trends have emerged. Cardiac beta-adrenoceptor function is desensitized in various forms of hypertension but it is not clear whether alterations in signaling contribute to this desensitization in addition to the well documented decrease in beta 1-adrenoceptor numbers. Vascular alpha- and beta-adrenoceptor responsiveness are increased and decreased, respectively, in hypertensive animals and patients but the molecular site underlying these alterations has not unequivocally been established. Renal alpha 1- and alpha 2B-adrenoceptor numbers are frequently increased in genetically hypertensive rats but alpha 1-adrenoceptor-stimulated inositol phosphate formation is unchanged or decreased and alpha 2-adrenoceptor functions remain unclear. Renal beta-adrenoceptor numbers are elevated in many forms of hypertension but it is not clear whether this is accompanied by alterations in receptor function.


The microcirculation and hypertension.

To review published evidence on the effects of arteriolar changes in primary and secondary hypertension. Pressure profile analyses have shown that the microcirculation is a major site of vascular resistance. With the recent refinement of intravital microscopy techniques detailed information has become available on mechanisms of the microvascular resistance increase in hypertension. Three mechanisms play an important role: (1) a decrease in arteriolar diameter; (2) arteriolar vessel wall hypertrophy; and (3) small arteriolar and capillary rarefaction. The evidence was synthesized into a hypothesis on the role of the microcirculation in primary forms of hypertension. The hypothesis formulated contains two important elements in that (1) diminished outgrowth of the microvascular bed in different tissues is seen as an important early pathogenic mechanism; and (2) the decreases in arteriolar diameter and vessel wall hypertrophy are seen as adaptive mechanisms that maintain a constant wall stress. The three factors together maintain the increase in vascular resistance that is common to all established forms of primary hypertension.


Renin inhibitors, angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists: relationships between blood pressure responses and effects on the renin-angiotensin system.

To compare the effects of angiotensin converting enzyme (ACE) inhibitors, renin inhibitors and angiotensin II (Ang II) antagonists. Survey of data from recent studies. DISCREPANCY BETWEEN BLOOD PRESSURE REDUCTION INDUCED BY ACE INHIBITORS AND PLASMA ANG II LEVELS: Studies on the effects of ACE inhibition in hypertensive subjects have suggested that with chronic ACE inhibitor treatment, blood pressure remains lowered even when plasma Ang II returns to normal. However, this discrepancy may be largely an artefact related to difficulties in measuring low Ang II levels in the presence of high angiotensin I (Ang I) levels. Even with modern sensitive and specific Ang II assays it can be difficult to monitor in vivo ACE inhibition (Ang II:I ratio in plasma) because of ex vivo Ang II formation. Recently, in measuring 24-h blood pressure responses to ACE inhibitor treatment, we have obtained good correlations between the time-course of the blood pressure response and the change in circulating Ang II. PROBLEMS IN MEASURING RENIN ACTIVITY: Routine assays of renin activity in plasma can lead to an overestimate of the degree of in vivo inhibition during renin inhibitor treatment, because some protease inhibitors that are used in these assays can cause an ex vivo displacement of protein-bound renin inhibitor, thereby increasing its free concentration. This must be taken into account when using the ratio of enzymatically active renin to immunoreactive renin as an index of in vivo renin inhibition. BLOOD PRESSURE RESPONSE AND ANG II LEVELS WITH RENIN INHIBITORS AND ANG II ANTAGONISTS: Results published so far seem to indicate that with these drugs, as with the ACE inhibitors, the magnitude of the blood pressure effect is correlated with the decrease in the 'effective' Ang II concentration at the receptor sites. However, the time-course of the two effects may be different; with the renin inhibitors, the maximum effect on pressure was delayed compared with the effect on Ang II. Further studies are needed to establish the exact time-course of renin and Ang II changes and their relationship to blood pressure. Only with rigorously controlled assays will it be possible to answer the question whether, for a given change in 'effective' Ang II concentration at the receptor sites, the effect on blood pressure is different with the three classes of anti-renin-angiotensin drugs.


Deficient production of nitric oxide induces volume-dependent hypertension.

To study the influence of nitric oxide on renal function. Nitric oxide synthesis was inhibited and the effects on renal parameters were determined. Nitric oxide synthesis was progressively blocked by the intravenous administration of increasing doses of NG-nitro-arginine methylester (L-NAME) and then (c)GMP was administered. The blockade of nitric oxide synthesis first induced a marked fall in urinary sodium excretion, and later, a sustained increase in mean arterial pressure. These effects were reversed by 8-bromide cGMP. Nitric oxide-dependent cGMP formation was higher in the inner medulla than in any other part of the renal parenchyma, and the inhibition of nitric oxide synthesis significantly decreased both pressure- and volume expansion-induced natriuresis. Both the natriuretic and vasodilator tone maintained by nitric oxide are ultimately due to the production of cGMP. Nitric oxide-induced formation of cGMP appears to be the major factor that links changes in renal medullary circulation to those of sodium excretion. Sufficient inhibition of nitric oxide synthesis to decrease sodium excretion without altering blood pressure induces volume-dependent hypertension because blood pressure is elevated by an increased sodium intake.


Interpretation of the acetylcholine test of endothelial cell dysfunction in hypertension.

In the hypertensive circulation, endothelial cells may release less nitric oxide or more endothelin-1, both powerful vasoactive substances, suggesting an attractive hypothesis for the initiation or reinforcement of hypertension. These substances, however, are not the only way that endothelial dysfunction could be involved in hypertension. In this work we examine the role of the endothelium as a diffusion barrier to vasoconstrictor substances, as a metabolic barrier and as a secretory source of paracrine hormones. The evidence that endothelial cell dysfunction occurs in different forms of hypertension comes mainly from the loss of relaxation revealed by the 'acetylcholine test' in a variety of preparations. We examined the strength of this evidence in terms of the stability of the agonist, equilibrium between agonist and receptor, and variations in acetylcholine and other receptor populations on endothelial and smooth muscle cells. The range (Emax) and sensitivity (EC50) of the acetylcholine test was considered in a novel approach to determine the full range by in vitro assay. Using conscious rabbits, we showed that the vascular amplifier of resistance in the hypertensive bed can lead to misinterpretation of changes in reactivity. The question of endothelial dysfunction in hypertension as determined by the acetylcholine test is far from proven.


Effect of renal medullary circulation on arterial pressure.

PRESSURE-NATRIURESIS EFFECTS IN HYPERTENSION: Considerable advances have been made in our understanding of pressure-natriuresis and the effects of this mechanism in hypertension. We have shown that in the absence of changes in neural and endocrine factors, sodium and water excretion doubled when arterial pressure was increased by only 10 mmHg. These responses were greatly blunted or obscured by elevations in renal sympathetic tone, infusion of the vasoconstrictors angiotensin and vasopressin or by inhibition of paracrine factors such as eicosanoids and nitric oxide. The pressure-natriuresis response is closely associated with changes in papillary blood flow as determined by laser-Doppler flowmetry. In volume-expanded rats, papillary blood flow is not well autoregulated, which results in elevations of vasa recta capillary pressure and renal interstitial fluid pressure. The increased interstitial fluid pressure is transmitted from the medulla to the cortex in the encapsulated organ and is associated with inhibition of sodium transport in the proximal tubule and/or the thin descending loop of Henle of deep nephrons. Selective reductions in medullary blood flow by infusion of the nitric oxide inhibitor N6-nitro-L-arginine methylester (L-NAME) into the renal medullary interstitial space resulted in decreased interstitial fluid pressure and reduced sodium excretion. The mechanisms by which small elevations in renal interstitial fluid pressure alter tubular sodium reabsorption remain to be determined. PRESSURE-NATRIURESIS EFFECTS IN HYPERTENSIVE RATS: Our studies have also shown that the pressure-natriuresis response is blunted in spontaneously hypertensive rats (SHR) compared to normotensive Wistar-Kyoto (WKY) rats. This abnormality is associated with shifts in the relationships among papillary flow, renal interstitial pressure and renal perfusion pressure towards higher pressures. The calcium antagonist nisoldipine corrected the defect in vasa recta hemodynamics in SHR and normalized relationships among sodium excretion, renal interstitial pressure and renal perfusion pressure. These studies indicate that sodium and water excretion is very sensitive to small changes in renal perfusion pressure due to associated changes in papillary blood flow, and that alterations in medullary hemodynamics can have an important effect on the relationship between arterial pressure and sodium and water excretion.


Obesity and hypertension: experimental data.

BACKGROUND TO DATA REVIEW: Epidemiologic surveys have demonstrated that hypertension is associated with obesity in a substantial proportion of cases, particularly in young and middle-aged adults. Despite the clinical importance of this association the nature of the relationship between body weight and blood pressure remains obscure. CONCLUSION OF DATA REVIEW: The data reviewed here indicate that obesity-related hypertension involves insulin and the sympathetic nervous system, and may be part of a metabolic adaptation to the obese state.


The fetal origins of adult hypertension.

To elucidate the fetal origins of hypertension. A systematic search was made for records of early growth, comprising measurements taken either at birth and/or during infancy, for groups of men and women now in middle-late life. Over 25,000 men and women born before 1931 were successfully traced. Retarded growth in fetal life was strongly related to high blood pressure in adult life. Hypertension is programmed by an adverse environment in utero. It is linked to impaired development in both early and late gestation.


Aging, blood pressure and mortality.

POPULATION STUDIES: We reviewed population studies that relate mortality to blood pressure in the elderly. A positive relationship between blood pressure and mortality at the age of 60-69 years was weaker over the age of 75 and became a negative relationship over the age of 85, with hypertensive subjects living longer. This negative relationship probably reflects cardiac, respiratory and neoplastic disease in very elderly subjects with low blood pressure. Therefore, in very elderly hypertensive subjects we cannot conclude that a reduction in blood pressure will not be beneficial, for example in reducing stroke events. The results of clinical trials of antihypertensive treatment in the elderly provide inadequate evidence to assess the benefit of treating hypertensive subjects over the age of 80 years. A randomly allocated controlled trial is required in this age group.


Advances in the community control of hypertension: from epidemiology to primary care practice.

To review the progress in hypertension control in the United States since 1972, to examine the factors that contributed to that progress and to consider areas in which further improvement is required. A review of epidemiological, clinical and health services research related to hypertension control was conducted. We report our experience in evaluating hypertension control in a multi-ethnic community clinic population as an illustration of the challenges of hypertension management in primary care practice. Hypertension prevalence in the United States population has remained relatively stable, whereas actual blood pressure levels in the population have declined slightly. Most Americans (approximately 80%) have had a blood pressure check within the past year, but the rate of blood pressure control in treated hypertensives has been disappointing. The current diagnostic and therapeutic criterion of blood pressure < or = 140/90 mmHg, regardless of individual patient characteristics (e.g. age, race), should be re-evaluated.


Blood pressure disturbance in diabetes mellitus.

Arterial hypertension and, less often, postural hypotension are frequently associated with diabetes mellitus, and with diabetic complications and death. To review data on the relationship between hypertension and nephropathy in diabetes mellitus. We reviewed data on both retinopathy and nephropathy in hypertensive diabetic patients. Data suggesting that vasopressin levels might affect blood pressure in upright patients with postural hypotension due to cardiocirculatory diabetic neuropathy were also examined. Antihypertensive treatment during different phases of diabetic nephropathy in insulin-dependent diabetes was reviewed. The data showed that hydrochlorothiazide and nitrendipine reduce urinary protein excretion in parallel with a reduction in blood pressure. However, the decreases in urinary protein excretion induced by captopril are not correlated with a reduction in blood pressure and may be related to decreases in intraglomerular pressure found in patients with mild renal failure taking furosemide. Domperidone, a peripherally acting dopaminergic antagonist is an additional therapeutic option for the treatment of diabetic postural hypotension.


Cerebral vascular changes during chronic hypertension: good guys and bad guys.

To examine new concepts concerning structural changes in cerebral blood vessels during chronic hypertension, and to examine mechanisms that lead to cerebral vascular complications, in light of the hypothesis that hypertensive vascular hypertrophy may be harmful. Literature review. The evidence suggests that the current view is not correct in relation to the cerebral circulation. Vascular hypertrophy and remodeling appear to protect cerebral vessels during hypertension, instead of being harmful. Major cerebral vascular complications during hypertension may be largely due to endothelial dysfunction. One function of the cerebral endothelium is to serve as the blood-brain barrier. Disruption of the blood-brain barrier appears to mediate hypertensive encephalopathy. A second endothelial function is to modulate vascular tone. Abnormalities in vasoactive factors that are released by the endothelium (impaired vasodilator mechanisms and augmented vasoconstrictor mechanisms) may make an important contribution to the pathophysiology of transient ischemic episodes, and perhaps stroke, in chronic hypertension.


Epidemiology and prevention of blood pressure-related renal disease.

To examine the relationship between blood pressure and end-stage renal disease. Review of recent reports on blood pressure in relation to renal function. The incidence and prevalence of treated end-stage renal disease are increasing progressively in economically developed countries. To combat this problem, the treatment of established end-stage renal disease must be complemented by strategies to treat and prevent risk factors for the development of renal failure. Severe hypertension and malignant hypertension are well accepted as risk factors for renal insufficiency. Recent reports suggest a strong relationship between blood pressure and renal function, throughout the entire range of blood pressure. Most blood pressure-related renal disease can probably be attributed to mild hypertension or a high normal blood pressure. Additional clinical trials are needed to assess the value of different antihypertensive drugs and different levels of blood pressure control in preserving renal function in subjects at risk of blood pressure-related renal disease. Primary prevention of hypertension may be an important complement to the treatment of established hypertension in reducing the burden of renal disease in the community.


Renal consequences of arterial hypertension.

To seek ways of improving the prognosis for renal function in the presence of arterial hypertension. Nephrosclerosis is a term used to define the renal damage induced by arterial hypertension. The renal vasculature can participate in the genesis of essential hypertension and can suffer the consequences of elevated blood pressure. There is no doubt that antihypertensive therapy has dramatically improved the prognosis for renal function in the presence of arterial hypertension. There appears to be a need for a further improvement in the prognosis for renal hypertension. At present, the prevalence of nephrosclerosis as a cause of terminal renal failure may be increasing and a progressive fall in renal function in treated hypertensive patients compared to normotensives has been described. It is not yet clear whether improvements in renal hypertension depend merely on the effectiveness of antihypertensive therapy in reducing arterial blood pressure or whether it will be necessary to improve the metabolic disturbances that accompany hypertension or the renal hemodynamic effects of different drugs before the prognosis for nephrosclerosis can be improved.


Glomerular hypertension: cause and consequence of renal injury.

Glomerular capillary hyperfiltration and hypertension occur in certain disease states and also in response to a reduction in the number of functional nephrons. Experimental studies have shown that these glomerular hemodynamic changes are maladaptive, and ultimately damaging to the kidney. Amelioration of glomerular hyperfunction by dietary protein restriction or antihypertensive therapy lessens glomerular injury in several experimental models of chronic renal disease. Hyperfiltration may similarly occur in humans with diabetes mellitus, a solitary or remnant kidney, or acquired renal disease. There is evidence to suggest that these people may therefore be at increased risk for the development of renal injury. Clinical studies have shown that dietary protein restriction and antihypertensive therapy may beneficially affect the course of chronic renal failure in humans. Large multicenter trials are currently underway on the effects of these therapeutic maneuvers on the progression of chronic renal disease.


Children at risk: latex allergy and spina bifida.

A collaborative study conducted by nurse coordinators at five centers for children with spina bifida (myelodysplasia) identifies the increased incidence of allergies to latex products--gloves, balloons, and catheters--in this population. Reports from 185 families or adult patients with spina bifida on a questionnaire developed by the nurse coordinators describe the sample characteristics and history to allergies. Statistical analysis concludes that children with spina bifida have a higher incidence of allergies to latex products at 20.4% than the controls at 1.1%. Patient age and the presence of shunted hydrocephalus also correlated positively with latex allergy. The increased risk in this population for latex allergy and the life-threatening reactions (anaphylaxis) have implications for patient, family, and professional education.


Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication.

The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in a vital role that is therapeutic to them and their critically ill child. Although many interventions have been recommended to help parents decrease their stress, only the Nursing Mutual Participation Model of Care (NMPMC) has been tested in the clinical setting. This article reports a study that expands on Curley's original work by investigating the effects of the NMPMC on parental stress when implemented by PICU staff nurses. Fifty-six parents participated in the study, which used a quasi-experimental design. Sequential sampling placed the first 31 subjects into the control group and the next 25 subjects in the experimental group. The experimental group received care from staff nurses instructed in the NMPMC. The dependent measure was the Parental Stressor Scale:Pediatric Intensive Care Unit (PSS:PICU) administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicated that parents in the experimental group perceived less stress than the control group, specifically the stress related to alterations in parental role in the PICU setting. Implications for nursing care are discussed.


On the nature of social support for families of critically ill children.

The purpose of this study was to explore the nature of family social support during an acute life-threatening health crisis of a child. A convenience sample of 10 families was obtained from two pediatric intensive care units (PICUs) in a major midwestern metropolitan area. Tape-recorded interviews of parents took place in the hospital 2 to 13 days after admission to the PICU. The Family Crisis Support Interview (FCSI) was developed from existing literature on social support with content selected for specificity to this population. Qualitative analysis was used to reduce verbatim interview transcription data into four major categories with related themes. Results suggest that for these families (a) costs of support received sometimes outweighed the perceived benefits; (b) the benefit of the social network to parents was influenced by its density and level of connectedness; (c) mothers received more network support than fathers; and (d) dyadic cohesion was a central factor in perceptions of overall support. Interpretation of the data include general applications to family nursing management in pediatric critical care.


A case illustration of family management style.

Chronic illness management is a way of life for many children and their families. For these chronically ill children, the ability of the family to respond to the daily relentless demands of management dictates the quality of the child's and family's life. In an effort to better understand how a family responds to a chronic illness, Knafl and Deatrick's Family Management Style (FMS) model is applied to a family with a child with type I diabetes using a case-study analysis. Gallo derived dimensions of the model's components in an earlier application. These dimensions are applied to interview data obtained on the same family 1 year later to address the dynamic nature of family management style.


Strategies for consoling the infant with colic: fact or fiction?

"Persistent" crying has been labeled a developmental crises of parenthood, given the feelings of inadequacy it engenders in new parents. Nearly one of five infants has colic, or more than 700,000 infants in the United States each year. Because there is no "cure" for colic, therapeutic approaches are generally aimed at "containment" of the crying. Such approaches can be classified as feeding/formula modifications, pharmacological agents, and sensory stimulation approaches. This report examines the evidence supporting or refuting the utility of each approach.


A patch-clamp study of the Ca2+ mobilization from internal stores in bovine aortic endothelial cells. I. Effects of caffeine on intracellular Ca2+ stores.

The effects of agents known to interfere with Ca2+ release processes of endoplasmic reticulum were investigated in bradykinin (BK)-stimulated bovine aortic endothelial cells (BAE cells), via the activation of Ca(2+)-activated potassium channels [K(Ca2+) channels]. In cell-attached patch experiments, the external application of caffeine (1 mM) caused a brief activation of K(Ca2+) channels in Ca(2+)-free and Ca(2+)-containing external solutions. The application of BK (10 nM) during cell stimulation by caffeine (1-20 mM) invariably led to a drastic channel activation which was maintained during a recording period longer than that observed in caffeine-free conditions. In addition, the cell exposure to caffeine (20 mM) during the BK stimulation enhanced systematically the channel activation process. Since a rapid inhibition of BK-evoked channel activity was also produced by removing caffeine from the bath medium, it is proposed that the sustained single-channel response recorded in the concomitant presence of both agents was due to their synergic action on internal stores and/or the external Ca2+ entry pathway resulting in an increased [Ca2+]i. In addition, the local anesthetic, procaine, depressed the initial BK-induced K(Ca2+) channel activity and completely blocked the secondary phase of the channel activation process related to the external Ca2+ influx into stimulated cells. In contrast, this blocking effect of procaine was not observed on the initial caffeine-elicited channel activity and could not suppress the external Ca(2+)-dependent phase of this channel activation process. Our results confirm the existence of at least two pharmacologically distinct types of Ca(2+)-release from internal stores in BAE cells: an inositol 1,4,5-triphosphate (InsP3)-dependent and a caffeine-induced Ca(2+)-release process.


A patch-clamp study of the Ca2+ mobilization from internal stores in bovine aortic endothelial cells. II. Effects of thapsigargin on the cellular Ca2+ homeostasis.

Evidence was provided, in the preceding paper (Thuringer & Sauvé, 1992), that the external Ca(2+)-dependent phase of the Ca2+ signals evoked by bradykinin (BK) or caffeine in bovine aortic endothelial cells (BAE), differ in their respective sensitivity to procaine. To examine whether the emptying of the InsP3-sensitive Ca2+ store is the signal for activating the agonist-evoked Ca2+ entry, we have investigated the effects of thapsigargin (TSG), a known inhibitor of the microsomal Ca(2+)-ATPase activity in a variety of cell types, via the activity of calcium-activated potassium channels [K(Ca2+) channels]. In cell-attached experiments, the external application of TSG caused a sustained or oscillatory activation of K(Ca2+) channels depending on both the cells and doses tested. The TSG-evoked channel activity could be reversibly blocked by removing extracellular Ca2+, and strongly decreased by adding 10 mM procaine to the bath medium. In Ca(2+)-free external conditions, TSG did not promote an apparent Ca2+ discharge from internal stores but prevented in a dose- and time-dependent manner the subsequent agonist-evoked channel activity related to the release of internally sequestered Ca2+. These results confirm that TSG and BK release Ca2+ from the same internal stores but with different kinetics. Because the channel response to caffeine was found to be poorly sensitive to procaine, in contrast to that evoked by BK and TSG, it may be concluded that both BK and TSG activate the same Ca2+ entry pathway. Therefore, the emptying of the InsP3-sensitive Ca2+ store is likely to be the main signal for activating the agonist-evoked Ca2+ entry in BAE cells.


A TEA-insensitive flickering potassium channel active around the resting potential in myelinated nerve.

A novel potassium-selective channel which is active at membrane potentials between -100 mV and +40 mV has been identified in peripheral myelinated axons of Xenopus laevis using the patch-clamp technique. At negative potentials with 105 mM-K on both sides of the membrane, the channel at 1 kHz resolution showed a series of brief openings and closings interrupted by longer closings, resulting in a flickery bursting activity. Measurements with resolution up to 10 kHz revealed a single-channel conductance of 49 pS with 105 mM-K and 17 pS with 2.5 mM-K on the outer side of the membrane. The channel was selective for K ions over Na ions (PNa/PK = 0.033). The probability of being within a burst in outside-out patches varied from patch to patch (> 0.2, but often > 0.9), and was independent of membrane potential. Open-time histograms were satisfactorily described with a single exponential (tau o = 0.09 msec), closed times with the sum of three exponentials (tau c = 0.13, 5.9, and 36.6 msec). Sensitivity to external tetraethylammonium was comparatively low (IC50 = 19.0 mM). External Cs ions reduced the apparent unitary conductance for inward currents at Em = -90 mV (IC50 = 1.1 mM). Ba and, more potently, Zn ions lowered not only the apparent single-channel conductance but also open probability. The local anesthetic bupivacaine with high potency reduced probability of being within a burst (IC50 = 165 nM). The flickering K channel is clearly different from the other five types of K channels identified so far in the same preparation. We suggest that this channel may form the molecular basis of the resting potential in vertebrate myelinated axons.


Human responses to the diagnosis of choroidal melanoma.

Patient responses to the diagnosis of choroidal melanoma are individual and sometimes unexpected. Nurses are in a perfect position to ascertain a cancer patient's feelings, to listen, and to provide emotional support. Patient reactions to the diagnosis of choroidal melanoma can range from fear of blindness to concern for their children.


Blindness in the world: nursing experience in Nepal.

According to statistical data from the World Health Organization, 41 to 52 million people have a vision of 20/200 (6/60) or less; 85% of these blind live in Asia and Africa. Cataract is the leading cause of blindness in underdeveloped countries. Glaucoma and infections are the other main causes. Half of the blind could be helped by surgery and 25% of blindness could be prevented. Strategies for prevention of blindness include an accurate estimation of the number of blind, an evaluation of the main causes of blindness, and behavioral changes in hygiene, nutrition, and seeking eye care. Although Nepal is one of the poorest countries in the world, their eye care system is well-organized. The ophthalmic assistants constitute the backbone of the prevention program. They are trained to screen for diseases, give primary eye care, and assist in surgery.


Inflammatory orbital pseudotumor.

1. Inflammatory orbital pseudotumor, a term used to describe any idiopathic inflammatory lesion of orbital tissue that simulates a neoplasm of the orbit, is a definite clinical entity masquerading in various forms and covering a wide spectrum of periocular lesions. 2. Inflammatory orbital pseudotumor has a good prognosis with steroid therapy. Once it is suspected, prompt and effective treatment must be given as soon as possible, even before laboratory work-up has been completed. 3. A great deal of investigative study must be done to rule out any other life-threatening diseases. Long-term follow-up is mandatory because malignant or monoclonal transformation is possible.


The excimer laser: program implementation and nursing implications.

The excimer laser is a low energy level laser used in the correction of myopia and removal of corneal scars. The technique, known as photoablation, produces a new kind of laser-tissue exchange where the corneal tissue is transferred into a gaseous state that is expelled from the surface. Predetermined layers of corneal tissue are removed without injury to surrounding tissue. Reshaping the cornea's central optic zone is visually equivalent to placing a contact lens on the eye.


Biomechanical aspects of a fluid percussion model of brain injury.

The fluid percussion model is in widespread use for the study of brain injury. However, the tissue deformation characteristics of the model have not been determined. Studies have suggested that at high levels of fluid percussion, the fluid percussion model is primarily a model of brainstem injury. It was proposed that this occurs as a direct result of the volume influx to the cranial vault at the moment of impact. This study examines the biomechanical deformation produced by the fluid percussion model. The purpose of this investigation was to describe the regional strain distribution in brain tissue at the moment of impact and to determine the effect of volume efflux produced by the percussion device. A cat skull was sectioned parasagittally and filled with an optically transparent gel. A grid pattern was painted in the midsagittal plane and was used to record the surrogate brain tissue deformation in response to fluid percussion loading. Motion of the grid pattern at low and high levels of fluid percussion loading was recorded using a high-speed camera, and a series of photographs developed from the high-speed film were analyzed to determine the intracranial strain distribution at these loading levels. The results of these studies indicated that the maximum site of strain was located in the region of the lower brainstem and that deformations were negligible in other regions of the brain. These studies provide an explanation for the pathophysiologic results obtained in a parallel series of experiments from which it was concluded that high-level fluid percussion is predominantly a model of lower brainstem injury.


Expression of c-fos in the hippocampus following mild and moderate fluid percussion brain injury.

An oncoprotein mediator of gene expression, c-fos, was evaluated in the central fluid percussion model of traumatic brain injury (TBI). Since hippocampal CA1 neurons are particularly vulnerable to TBI, we hypothesized that TBI may produce pathobiologic changes in CA1, in part, by alterations in gene expression through c-fos. Sprague-Dawley rats were subjected to mild (1.0 atm) or moderate (2.1 atm) fluid percussion TBI or sham injury. At 15 min, 1 h, and 24 h after injury (or sham injury), sections from middorsal hippocampus were immunostained with antibodies to c-fos, and c-fos-positive CA1 neurons were counted. As predicted, c-fos was localized in the nuclei of CA1 pyramidal neurons. However, the intensity of label was not equal over all CA1 neurons. Cells with high-intensity c-fos label were more prevalent after mild TBI. The number of c-fos-labeled CA1 neurons was increased at 15 min after both mild and moderate TBI relative to paired sham controls. Counts of c-fos-positive neurons remained significantly elevated at 1 h postinjury only after mild TBI. By 24 h postinjury, the number of c-fos-positive cells at both injury levels was not different from sham controls. No difference was observed between the number of c-fos-positive cells in naive and sham controls. However, label intensity was slightly less in the naive cases. These results suggest that the pathobiologic changes at early intervals following mild or moderate TBI may involve c-fos alteration of gene expression and that c-fos expression may be differentially regulated as a function of injury level.


Breakdown of the blood-brain barrier after fluid percussion brain injury in the rat: Part 2: Effect of hypoxia on permeability to plasma proteins.

Clinical studies have demonstrated that hypoxia after severe brain injury is common and significantly worsens neurologic outcome. We have, therefore, developed a rat model of posttraumatic hypoxic injury in order to identify the pathophysiologic responses after head injury that are worsened by this secondary insult. We examined the effect of hypoxia after brain injury on permeability of the blood-brain barrier to plasma proteins. Animals were divided into two experimental groups: group I (impact alone) and group IH (impact plus hypoxia). Rats were subjected to a lateral fluid percussive brain injury (4.8-5.2 atm). Animals in group IH were exposed to hypoxic conditions (10% O2) for 45 min immediately after injury. In each group, vascular permeability to endogenous immunoglobulins (IgG) and to horseradish peroxidase (HRP) was examined at the light microscopic level. IgG was immunolocalized in brain sections at 1-24 h after injury. In other studies, HRP was given i.v. either before impact or 10 min before killing. Permeability to this protein was assessed at 1-72 h after injury. The distribution of extravasated proteins was similar between the experimental groups at 1 h postinjury. Pronounced abnormal permeability to IgG and HRP (given before impact) occurred in discrete regions throughout both the ipsilateral and contralateral hemispheres. By 6 h after injury, a differential response of the blood-brain barrier was noted between groups I and IH. Widespread leakage of proteins was observed in the injured hemisphere in group IH. This finding was in sharp contrast to group I, in which extravasated proteins remained more localized in the injured hemisphere. The time course for reestablishment of the blood-brain barrier to HRP (given before killing) was determined. The impact site remained permeable to HRP up to at least 72 h postinjury within groups I and IH. In group I, the blood-brain barrier was reestablished in the parasagittal cortex and deep cortical layer by 6 h postinjury. In contrast, the blood-brain barrier in group IH was not restored in similar brain regions until 24 h postinjury. These studies demonstrate that (1) hypoxia after brain injury exacerbates the regional breakdown of the blood-brain barrier to circulating proteins, (2) this influence of hypoxia on permeability is not apparent immediately after injury but rather is expressed at 6 h after injury, and (3) hypoxia after traumatic brain injury delays recovery of the blood-brain barrier. These findings suggest that secondary posttraumatic hypoxia contributes to the vascular pathogenesis of brain injury.


Endothelium-dependent responses after experimental brain injury.

We examined the effect of fluid percussion brain injury on the responses to topical application of acetylcholine and serotonin, two vasoactive agents that have endothelium-dependent effects, in anesthetized cats equipped with cranial windows. Before brain injury, topical acetylcholine dilated both small and large arterioles. Thirty minutes after brain injury, acetylcholine constricted small arterioles, and the vasodilator response of large vessels was abolished. Subsequent application either of superoxide dismutase plus catalase to eliminate superoxide and hydrogen peroxide or of deferoxamine, an agent that scavenges iron and inhibits the production of hydroxyl radical via the Haber-Weiss reaction, restored the normal vasodilator responses to acetylcholine. Serotonin constricted both large and small arterioles before brain injury. After brain injury, small arterioles responded with a small vasodilation, and the response of large arterioles was abolished. After application of superoxide dismutase and catalase, the normal vasoconstrictor response to serotonin was restored. The results show that endothelium-dependent vasodilation from acetylcholine is eliminated by brain injury by a mechanism that involves the generation of oxygen radicals, and, more specifically, the production of hydroxyl radical. The results with serotonin are explained by the elimination by oxygen radicals of a vasoconstrictor agent generated by this agent, perhaps an endothelium-derived contracting factor.


Continuous monitoring of posttraumatic cerebral blood flow using laser-Doppler flowmetry.

Traumatic brain injury causes alterations in cerebral blood flow that are thought to influence secondary pathophysiology and neurologic outcome in humans. Since it is difficult to study early changes in blood flow in head-injured patients, animal models of brain injury must be employed. However, techniques to monitor brain blood flow in animals are labor intensive and generally provide discontinuous flow measurements. The present study examines the application of laser-Doppler flowmetry for measurement of cerebral blood flow following experimental brain injury. This method allows continuous monitoring of local cerebral blood flow before, during, and after injury. Rats (n = 9) were prepared for lateral fluid percussion injury under barbiturate anesthesia. Injury (2.10 +/- 0.02 atm) was induced over the right parietal cortex, and blood flow was monitored in the contralateral cortex. Seconds after the peak hypertension after injury, blood flow in the left parietal cortex increased 226% +/- 18% (means +/- SEM). This increase was transient, with blood flow falling below control values within minutes. Five minutes after injury, blood flow was 83% +/- 8% of control, and at 1 h, this value had fallen to 56% +/- 6%. Blood flow at 60 min was 93% +/- 5% of control in the sham-injured group (n = 10). The reduction in cerebral blood flow in our laser-Doppler study was of similar magnitude as previously reported in rats injured at a similar intensity when blood flow was examined with radiolabeled microspheres. Given these results, we believe laser-Doppler flowmetry can be used to continuously monitor posttraumatic blood flow following experimental brain injury.


Motor power differences within the first two weeks post-SCI in cervical spinal cord-injured quadriplegic subjects.

The purpose of this study was to confirm the clinical impression that motor power significantly changed within the first 2 weeks after a spinal cord injury (SCI) and to determine the time for motor power assessment within the first 2 weeks post injury that best correlated with motor power determined 6 months post-SCI. Our hypothesis was that within the first 2 weeks postinjury, the manual muscle test (MMT) scores would change significantly from the < or = 24 h examination and that the post-24 h evaluations of strength would have a higher correlation with the 6 month measure of motor outcome than the evaluation of strength performed < or = 24 h after SCI. The biceps, extensor carpi radialis, triceps, flexor digitorum profundus, and interosseous muscle strength was measured in 40 subjects using the MMT (muscles graded 0/5 to 5/5) at < or = 24 h, 72 h, 1 week, 2 weeks, 3 months, and 6 months post-SCI. Upper extremity motor index scores (MIS) obtained at the four testing periods within 2 weeks of injury were analyzed using a Friedman analysis of variance with Duncan's post-hoc tests to identify significant differences. Separate analyses were performed on subgroupings of the total sample based on the strength of the most rostral key muscle having less than antigravity strength. There were three groups evaluated: initial MMT 0/5 (n = 22), initial MMT 1-1.5/5 (n = 17), and initial MMT 2-2.5/5 (n = 13).(ABSTRACT TRUNCATED AT 250 WORDS)


An empirical evaluation of behavioral and cognitive-behavioral group marital treatments with discordant couples.

Previous research has revealed that group behavioral therapy for distressed couples provides an effective and efficient form of marital treatment. However, research comparing alternative group approaches is lacking. The current investigation evaluated group behavioral and cognitive-behavioral marital treatments across a variety of relationship dimensions and measures of individual functioning. Dysfunctional couples were randomly assigned to experimental conditions and demonstrated statistically and clinically significant improvement as contrasted with the waiting list control group. These results are discussed in terms of the differences between treatment conditions, potential advances in the field of marital therapy, and recommendations for further inquiry.


Stress, sexual satisfaction, and marital adjustment in infertile couples.

A longitudinal study was designed to assess the effects of infertility as well as the influence of the subsequent medical investigation on marital functioning. During their initial visit at a fertility clinic, 165 couples underwent psychological assessment. Questionnaires were completed to assess stress, sexual satisfaction, and marital adjustment. Participants were categorized into those who became pregnant during the 12 months of the study (n = 48 couples) and those for whom treatment was not successful (n = 117 couples). Significant increases in stress and decreases in marital functioning were experienced by subjects as the treatment investigation progressed. Furthermore, greater levels of marital distress were observed in couples that did not conceive. Significant gender differences were observed.


Does the CAT technique enhance female orgasm?

The following is a report of The Human Sexuality Program of the New York Hospital-Cornell Medical Center to personally replicate Edward W. Eichel's claims that his Coital Alignment Technique (CAT) enhances and increases female coital orgasms and mutual orgasms. We failed to replicate these claims. However, it was the consensus of the group that within the context of sex therapy, the CAT technique may have merit in certain clinical situations, and as such deserves to be further evaluated.


The long-term use of cyproterone acetate in pedophilia: a case study.

This investigation reports the long-term use of the antiandrogen cyproterone acetate (CPA) in a pedophile, who was studied continuously over 38 months. Measures of sexual arousal, serum testosterone, and gonadotropin levels were significantly reduced by the drug as compared with placebo and no treatment; prolactin levels were significantly elevated. Some workers have observed that long-term administration of CPA (more than one year, which was then discontinued) produced enduring (in some cases apparently permanent) anti-libidinal effects; however, in the case described, within three weeks of stopping the drug, all measures had returned to pretrial levels. The importance of continuous long-term monitoring in sex offenders receiving an antiandrogen is discussed.


Sexual addiction: designation and treatment.

While there is general agreement that the pattern of behavior described as "sexual compulsivity" or "sexual dependency" or "sexual addiction" does exist, considerable controversy surrounds the issue of how this syndrome should be designated. The principle candidates--compulsivity, dependency, and addiction--are examined, and addiction is found to be the most suitable term. Addiction is then clearly defined, and diagnostic criteria for addictive disorder are specified. After the definition of and diagnostic criteria for sexual addiction are presented, arguments against the concept of sexual addiction are reviewed and answered. Implications of this concept for treatment are then explored.


The female sensation seeker and marital sexuality.

To examine the role of sensation seeking in female sexuality, the Zuckerman's Sensation Seeking Scale was administered to a nonclinical population of married women. Comparative assessments were made between two matched samples of high and low sensation seekers on frequency of sexual intercourse, marital satisfaction, sexual desire, sexual arousal, sexual assertiveness, sexual attitudes, and sexual satisfaction. Although the high sensation seekers demonstrated significantly greater sexual desire, sexual arousability, and a more positive attitude toward sex, there were surprisingly no differences between the groups on frequency of sexual intercourse and sexual assertiveness. Also, the women classed as low sensation seekers reported greater marital and sexual satisfaction.


Bisoprolol and hypertension: effects on sexual functioning in men.

To investigate prospectively the effects of the selective beta 1 adrenoceptor blocker bisoprolol on sexuality of men with hypertension. In newly diagnosed patients (group I): double-blind, crossover, placebo controlled. In men with hypertension on antihypertensive treatment (group II): crossover design. Large area in and around Rotterdam, The Netherlands. Twenty-six men (criteria: between 25 and 70; no disease etc. known to affect sexual functioning) were recruited through their general practitioners. Group I (n = 13) fulfilled the selection criteria, sitting blood pressure systolic > or = 160 mm Hg and/or diastolic > or = 95 mm Hg, measured on 3 different days. Group II (n = 13) patients already on antihypertensive treatment. Data on blood pressure. Qualitative and quantitative data on sexuality through questionnaires, including personal and sexual history, sexual functioning, sexual satisfaction and erectile difficulties. Bisoprolol is an effective antihypertensive drug with no detrimental effects on sexuality in newly diagnosed men with hypertension. In men already on antihypertensive medication bisoprolol improved sexuality in some parameters, i.e. firmness of erection during coitus, contentedness with sexual functioning and satisfaction with own sexuality. Bisoprolol is an effective antihypertensive agent with no sexual side effects.


Evaluation of an improved dot-immunobinding assay for carcinoembryonic antigen determination in nipple discharge in early breast cancer: results of a multicenter study.

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. We have now developed a "microdot-immunobinding assay" using a specially constructed device to screen efficiently large numbers of patients with nipple discharge for non-palpable breast cancer. The method is as follows: a sample of nipple discharge is placed on a solid phase monoclonal anti-CEA antibody and, if CEA is present in the discharge, it will be detected by a second monoclonal anti-CEA antibody conjugated with alkaline phosphatase. The use of bromochloroindolyl phosphate as a chromogen results in a stable color reaction that can be semiquantitatively analyzed with the naked eye. CEA levels determined by this microdot assay correlated well with those determined using the earlier Elmotec assay. To determine the accuracy of the method, a collaborative study involving 11 institutes in Japan was organized. The CEA levels in nipple discharges from 77 patients undergoing surgery, 44 of whom were diagnosed as having breast cancer, were assayed. The results were that 17 of the 23 patients with palpable breast cancer, and 16 of the 21 patients with non-palpable breast cancer exhibited CEA values > 400 ng/ml, a cut-off value determined in a previous study. The overall accuracy (78%) of this test for diagnosing non-palpable breast cancer was higher than that obtained from ductography or cytology. The system may thus be of use in the screening of early breast cancer.


Microcarcinoma of the endometrium: a mapping study with special reference to cytologic atypia in the endometrium.

In order to elucidate the basis for the development of an endometrial carcinoma, we looked for microcarcinomas measuring < 5 mm in greatest diameter, and studied their histologic characteristics and those of the neighboring endometrium. Using serial step section methods, two microcarcinomas were detected. A microcarcinoma was found in one of 14 uteri resected for atypical hyperplasia and the other was found in one of 114 uteri resected for endometrial carcinoma. The neighboring endometrium of the former was adenomatous and had atypical hyperplasia and that of the latter was atrophic and contained atypical glands characterized by cytologic atypia and not by architectural changes. The findings may suggest endometrial carcinomas to have two pathogenetic forms: a carcinoma associated with hyperplasia and occurring in premenopausal women, a second carcinoma associated with atrophic endometrium and occurring in postmenopausal women. Atypical glands in atrophic endometria may indicate that endometrial specimens from postmenopausal women should be carefully screened for cytologic atypia.


Treatment of hairy cell leukemia with deoxycoformycin (YK-176). The Deoxycoformycin (YK-176) Study Group.

Eleven patients with hairy cell leukemia (HCL) were treated with YK-176 (2'-deoxycoformycin) at a dose of 5 mg/m2 by intravenous injection every week or every other week. Patients received a median of eight (range 4-19) injections of YK-176. Five patients had previously been untreated, four of whom had massive splenomegaly. Six patients had previously been treated, four with interferon-alpha (IFN-alpha) or IFN-alpha and chemotherapy and two with prednisolone. Two patients had had splenectomies. Five patients achieved complete remission (CR) and six, partial remission (PR) according to WHO criteria (remission rate 100%, 95% confidence interval (CI) 74-100%). All six neutropenic patients recovered > 1,500/microliters neutrophils, six of seven anemic patients recovered > 12.0 g/dl hemoglobin and five of nine thrombocytopenic patients recovered > 100,000/microliters platelets following the treatment. According to the response criteria for HLC, five patients achieved CR, two PR and four minor response. The overall remission (CR + PR) rate was 64% (95% CI 35-85%). The CR and PR have lasted from > 30 to > 718 days (median, > 281 days) so far with no relapses. Of four patients previously treated with IFN-alpha, two achieved CR and one, PR. All patients were alive with a median survival time of > 290 days from treatment (range > 50- > 763 days). The treatment was generally well tolerated. Mild to moderate nausea, vomiting, appetite loss and general fatigue were experienced in two patients, skin rash in one and a transient fever in three. YK-176 was a highly active agent in the treatment of HCL.


Cardiac tamponade in chronic myelomonocytic leukemia: a case report.

Serous effusion is a rare complication of chronic myelomonocytic leukemia. We present a patient with chronic myelomonocytic leukemia who developed a massive pericardial effusion with cardiac tamponade as early manifestations. Numerous clumps of monocytes were observed in the effusion. The patient obtained rapid relief following the intravenous administration of etoposide (100 mg daily for 5 days). Few reports have documented details of such a case.


A case of hypersensitivity syndrome resembling Langerhans cell histiocytosis during phenobarbital prophylaxis for convulsion.

The case of a two-year-old girl with generalized histiocytosis, probably induced by phenobarbital, is reported. Symptoms, including intermittent fever, systemic lymphadenopathy, maculopapular skin eruption and hepatosplenomegaly, suggested Langerhans cell histiocytosis. Laboratory examinations revealed leukocytosis with lymphocytosis and eosinophilia and a high LDH serum level, while GOT and GPT were within normal ranges. Cytological studies of lymph node and pleural effusion specimens revealed proliferation and infiltration of Langerhans cell histiocytes with eosinophilia. No histiocyte proliferation was observed in the bone marrow or skin. The clinical manifestations shown by the patient were, however, transient, and improved spontaneously after the discontinuation of phenobarbital. The case was considered to be one of phenobarbital hypersensitivity syndrome based on clinical course and laboratory findings. The mechanism and differential diagnosis of the syndrome are discussed.


A vertically transmitted HIV-1 gag-subtype variant detected in Taiwan.

We used polymerase chain reaction (PCR) to amplify a segment, about 560 base pairs (bp), of HIV-1 gag DNA prepared from peripheral blood mononuclear cells of a seropositive Taiwanese pair of mother and infant. TM-1 and TC-1 clones of PCR-amplified DNA derived from the mother and infant, respectively, showed a 94.5% homology with each other. However, the TM-1 and TC-1 sequences exhibited lower degrees of homology, i.e. only 85.1% and 85.8%, respectively, with the corresponding gag segment of a North American HIV-1 subtype (HXB2), and 86.4% and 87.0%, respectively, with that of a Zairean HIV-1 subtype (Z2Z6). The divergence of TM-1 and TC-1 sequences from those of HXB2 and Z2Z6 is particularly prominent in the first (5' proximal) 200 bp of the cloned DNA segment, involving transitions more frequently than transversions. Two additional clones TM-2 and TC-2 derived from the mother and infant were sequenced for the first 200 bp. These four clones showed a high degree of homology (94.7-97.5%) among themselves, providing an evidence for transmission of the virus from the mother to the infant. These findings show the epidemiological value of PCR, and indicate the presence of a gag subtype of HIV-1 which is distinct from both the North American and Zairean subtypes according to the phylogenetic tree constructed.


Mitochondrial malate dehydrogenase and malic enzyme of a filarial worm Setaria digitata: some properties and effects of drugs and herbal extracts.

Mitochondrial malate dehydrogenase (mMDH) and malic enzyme (mME) of a filarial worm Setaria digitata were studied. mMDH exhibited the highest activities in the oxidation and reduction reactions at pH 9.5 and pH 6.2, respectively, while mME did so in the malate decarboxylation reaction at pH 6.8. mME showed no detectable activity on the pyruvate carboxylation direction. The Km values for malate (1.7 mM) and oxaloacetate (0.17 mM) and the ratio of Vmax oxidation: Vmax reduction (2.73) tend to favor the oxaloacetate reduction by mMDH. mME showed a relatively high Km value of 8.3 mM, for malate decarboxylation. A drug, diethylcarbamazine citrate (DEC-C), did not change appreciably the activity of either mMDH or mME, while filarin (a drug of herbal origin) effectively inhibited mMDH. The leaf extracts of Ocimum sanctum, Lawsonia inermis and Calotropis gigantea and leaf and flower extracts of Azadirachta indica were, however, found to inhibit both mMDH and mME.


[The use of the contact periodic-pulse laser and microwave scalpels in liver surgery].

In use of the laser (CPPLS) and microwave (MWS) scalpels, the reliability of arrest of bleeding and bile leakage has been proved not only at studies on the intact liver but on the models of jaundice with impaired coagulative blood properties as well. After hepatic resection by means of CPPLS and MWS, the impairement in its functional state lasts for a short time. In use of CPPLS, disturbance in tissue blood flow is less than in use of MWS. Healing of the wounds inflicted by CPPLS and MWS occurs in absence of pronounced exudative and inflammatory reactions. In a wound inflicted by a laser scalpel, the necrotic layer is not pronounced. It is expedient to use the CPPLS and MWS in patients with hepatic masses in technically difficult cholecystectomy as they contribute to decrease in intraoperative blood loss and prevention of the development of complications after the operation.


[The use of the zonal electrophoresis of antibiotics in acute destructive cholecystitis complicated by suppurative cholangitis].

At experimental investigations on 38 adult dogs for studying pharmacokinetics of kanamycin in the bile and liver tissue under the influence of the electric field of constant current, the increase in concentration of the preparation as compared with that in the control group was established. Optimal concentration of kanamycin retained for 14-16 h. Clinical study has shown the high effectiveness of the method for treatment of acute cholangitis suggested.


[The use of the neodymium-YAG laser in thoracic surgery].

The technique of use of a neodymium YAG-laser for surgical treatment of diseases of the lungs and pleura in 25 patients is described. The experience accumulated is indicative of good aero- and hemostatic properties of the laser, which permit to reduce the incidence of postoperative complications.


[The characteristics of the adaptive-recovery reactions of children after lung resection in chronic respiratory organ diseases].

The results of examination of 80 children at the late postoperative period are indicative of gradual progression of the reparative-restorative processes 1 year after the operation already. Diffuse purulent endobronchitis preserves for one year, purulent endobronchitis on the non-operated side-up to 3 years, at a zone of the operative intervention, local inflammatory process is defined more than 3 years later. In half of the children operated on, exacerbations of the bronchial tree disease with formation in some of them of the combined changes in hemodynamics and external respiration were revealed.


[The clinical picture and diagnosis of the pharyngofacial form of myasthenia].

In the clinic, 564 patients with the different forms of myasthenia were operated on. A pharyngo-facial form of myasthenia was revealed in 65 (11.5%) of them. There are the following clinical peculiarities of a pharyngo-facial form of myasthenia: involvement of the pharyngeal and facial muscles, impaired phonation, jerky speech, sensation of the tongue heaviness. The direction of process generalization is commonly from the centre towards periphery, towards the skeletal muscles. Involvement of the muscles of the soft palate, epiglottis causes saliva and pharyngeal secret flowing into the bronchi which leads to asphyxia.


[The correction of functional disorders of the hemostatic system and of the rheological properties of the blood in dogs in the late period of hemorrhagic shock by the intravenous transfusion of lactoprotein].

In 9 dogs with severe hemorrhagic shock, the effect of hemocorrector "Lactoprotein" on the indices of coagulative hemostasis and rheologic blood properties was studied. It was established that in intravenous transfusion of lactoprotein at a dose of 10 ml/kg permitting to lead the animals out from the state of shock, the syndromes of disseminated intravascular coagulation and high viscosity of the blood were cupped off. However, by the end of 48 hours of observation, fibrinogen level in the blood of the animals increased sharply, while antithrombin-III concentration and hematocrit decreased. Together with recommendation to use lactoprotein in the complex of shock therapy at all the stages of medical evacuation, the conclusion about necessity to perform at the early postshock period the differential component hemo- and anticoagulative therapy has been made.


[The use of biosporin in treating an experimental suppurative wound].

The effect of biosporin biopreparation on the agents of suppurative wound infection in the experiment on rabbits was studied. A positive effect of the preparation on healing of a suppurative wound was noted.


[Lymphosorption in the combined treatment of jaundice].

Drainage of the thoracic lymph duct and lymphosorption were used in 63 patients with obstructive jaundice of different etiology and cholestatic hepatitis. Lymph was returned into the umbilical vein with transfusion of proteins, glucose, steroid hormones and other preparations.


[The surgical procedure and treatment of paravesical abscesses in acute cholecystitis in middle-aged and elderly patients].

The results of 238 operations performed for acute cholecystitis within 1985-1990 have been analysed. Of them in 11 (4.6%), paravesical (8 cases) and intrahepatic (3) abscesses were revealed. In 8 patients, the presence of an abscess at the preoperative period was supposed. All the patients were admitted to the hospital later than 24 h from the onset of the disease and operated on within 1 to 5 days. Perforation of the gallbladder was revealed in 5 patients, gangrene with destruction of its wall--in 3. Abscess location near the gallbladder fundus was noted in 4 patients, near its neck--in 2, along the medial surface--in 2. A unicameral abscess was revealed in 5 cases, a multicameral one--in 3. The operative treatment presents technical difficulties and consists in performance of cholecystectomy (sometimes--Pribram's mucoclasis), external drainage of the common bile duct and abscess cavity, drainage of the subhepatic and subphrenic space. One 82-year old patient died.


[The use of cholesorption in the treatment of patients with acute cholecystitis complicated by cholangitis].

The results of treatment of 137 patients with acute cholecystitis complicated by cholangitis are presented. The causes and clinical signs, and tactics for operative treatment of the disease are described. Progressive hepatic failure is one of the causes of lethality. Use of the developed method of cholesorption permitted to reduce the incidence of hepatic failure development, decrease postoperative lethality to 9.5%.


[The diagnostic characteristics and surgical treatment of acute cholecystitis in middle-aged and elderly patients].

From 1980 to 1990, 340 elderly and senile patients underwent treatment for acute cholecystitis. Of them, 109 were operated on. To diagnose the disease, immunologic reactivity of an organism was considered. Diagnostic errors were made in 10.2% of cases. Three patients died.


[The dissolution via the drain of "forgotten" calculi in the common bile duct after surgery].

The results of dissolution of the "lost" concrements in the common bile duct in 12 patients, who underwent urgent operations for acute complicated cholecystitis, with the use of transdrain administration of miscleron, chloroform, novocaine are analysed. A positive result was obtained in 10 patients.


[The optimal drainage of the bile ducts and subhepatic recess in the surgical treatment of complicated cholecystitis].

On the basis of the analysis of the results of surgical treatment of 478 patients with complicated cholecystitis, it was established that the Robson-Vishnevsky method (95 cases) was the optimal one for drainage of the bile ducts after diagnostic (19) or therapeutic (115) choledochotomy, and that of Halsted-Pikovsky (9)--in manipulations through the cystic duct. Drainage of the subhepatic space by means of a rubber tube drain is effective. The methods for active decompression and transdrain therapeutic measures used in presence of purulent-inflammatory process in the bile ducts, or subhepatic space are presented.


[Changes in the microflora of the suppurative cavities resulting from the treatment of acute bacterial destruction of the lungs].

The results of complex bacteriologic examination of 62 patients with acute bacterial destruction of the lungs during the process of treatment were analysed. The complex of investigations included the express methods (bacterioscopy, studies in the ultraviolet light, chromatography-mass spectrometry), inoculation under aerobic and anaerobic conditions. A role of anaerobic non-clostridial infection in the development of acute pulmonary destruction, polymicrobial character of microflora are shown. It was established that complex conservative therapy with inclusion of the methods for drainage of the cavities of destruction, prolonged intraarterial infusion, aimed antibacterial therapy permitted to achieve rapid suppression of microflora, its anaerobic component in particular. In chronization of the disease, the gram-negative aerobic flora is playing the leading part in its pathogenesis.


[Kasten's syndrome].

The associated hiatal hernia, chronic cholecystitis and duodenal ulcer disease were diagnosed in 12 patients. Combined surgical operations were performed in 9 patients with a good long-term result.


[Selective proximal vagotomy and esophagofundoplication by Nissen's method in treating reflux esophagitis of ulcerous etiology].

In this article, the results of the use of selective proximal vagotomy and Nissen fundoplication in the surgery of reflux esophagitis in patients with ulcer disease of the pyloric gastric portion and duodenum are analysed. Characteristics of a state of acid producing function of the stomach at different periods after the operation is given. The causes of development of the post-fundoplication complications, methods for their treatment are presented.


[Exploratory laparotomy in stomach cancer].

The results of performance of exploratory laparotomy in 333 patients with gastric cancer have been analysed. The main reason of the use of laparotomy consists in seldom use of the special methods for diagnosis of tumor spreading. Complex use of laparoscopy and radionuclide methods for diagnosis permits to reduce the number of unsubstantiated laparotomies by 45-50% and bring down the frequency of its performance to 12-15% of the total number of operative interventions in gastric cancer.


[Ultrasonic scanning and duodenoscopy in the diagnosis and treatment of obstructive jaundice].

In 186 patients with obstructive jaundice admitted to the clinic for diagnosis of its cause, the ultrasound scanning with duodenoscopy was employed. This permitted to establish the cause of jaundice in 84.9% of the patients and to choose proper therapeutic tactics at the shortest time after hospitalization. In 80% of the patients, an obstacle for bile outflow was liquidated by means of endoscopy. When it was not possible to established the cause of jaundice by the findings of ultrasound scanning and duodenoscopy, percutaneous transhepatic cholangiography was performed, which has proved to be successful in 5.9% of cases. Use of the given methods for diagnosis permitted to define the optimal therapeutic tactics in patients with obstructive jaundice, to reduce the lethality.


[Endovascular regional infusion therapy in the combined treatment of liver abscess].

The comparative assessment of the effectiveness of endovascular regional infusion therapy (ERIT) in the complex of treatment of a hepatic abscess in 16 patients was carried out. In 12 patients, it was performed in combination with surgical intervention, in 4--as an independent method of treatment. In patients with a solitary hepatic abscess, it is expedient to include ERIT into the complex of therapeutic measures in combination with abscess puncture under ultrasound guidance. In presence of multiple abscesses of the liver, ERIT is a method of choice.


Deciduous tooth size standards for American blacks.

Normative standards for tooth sizes are valuable for assessing a given patient's status, both clinically and for evaluating intrinsic (e.g., genetic, chromosomal aberrations) and acquired conditions. There are, however, very few published standards for American Blacks and none for the deciduous teeth. Mesiodistal and buccolingual crown diameters are reported here for a series of 100 Black children. As with the permanent dentition, the primary teeth of Blacks are appreciably larger than Whites, though the amount differs by tooth type. In general, while all teeth are larger than norms for Whites, the posterior teeth (m1, m2) are preferentially larger. Applications of these standards are discussed.


Macroevolution of plasmids: a model for plasmid speciation.

A new evolutionary model for diversification in plasmid incompatibility groups (plasmid speciation) is suggested. The model is based on the formation of plasmid cointegrates from two compatible plasmids. The existence of plasmid cointegrates is well known, however, their potential key role in plasmid macroevolution has not yet been recognized. In a hypothesis presented here, one of the rep genes is supposed to be relaxed from selection in plasmid cointegrates and thus becomes free to accumulate mutations. These mutations can lead to a change in incompatibility specificity. Evidence supporting this hypothesis comes from the common occurrence of multi-replicon plasmids in nature as well as from experimental studies on plasmid cointegrate formation. A more speculative extension of this model hypothesizes an evolutionary scenario for origin of the eubacterial single-replicon genome and the eukaryotic multi-replicon genome, as well as the place of plasmids and viruses in this picture.


The cellular toxicity of aluminium.

Aluminium is a serious environmental toxicant and is inimical to biota. Omnipresent, it is linked with a number of disorders in man including Alzheimer's disease, Parkinson's dementia and osteomalacia. Evidence supporting aluminium as an aetiological agent in such disorders is not conclusive and suffers principally from a lack of consensus with respect to aluminium's toxic mode of action. Obligatory to the elucidation of toxic mechanisms is an understanding of the biological availability of aluminium. This describes the fate of and response to aluminium in any biological system and is thus an important influence of the toxicity of aluminium. A general theme in much aluminium toxicity is an accelerated cell death. Herein mechanisms are described to account for cell death from both acute and chronic aluminium challenges. Aluminium associations with both extracellular surfaces and intracellular ligands are implicated. The cellular response to aluminium is found to be biphasic having both stimulatory and inhibitory components. In either case the disruption of second messenger systems is observed and GTPase cycles are potential target sites. Specific ligands for aluminium at these sites are unknown though are likely to be proteins upon which oxygen-based functional groups are orientated to give exceptionally strong binding with the free aluminium ion.


Viral sex, levels of selection, and the origin of life.

Several issues in Chao's related paper J. theor. Biol. (1991, 153, 229-246) are revisited. It is argued that mixes of segments from different viral coinfection groups cannot be regarded as sex, unless one is willing to accept that these groups are replicators and individuals. But, because selection in coinfection groups is dynamically analogous to that in trait groups in structured demes, one should also regard these latter groups as replicators. This approach is unacceptable since the groups in question have irregular ploidies, an unfixed number of parents, and no rules analogous to those of meiosis. It is emphasized, however, that the effective presence of neighbour-modulated fitness can ensure dynamical coexistence of covirus segments, even if the equal net reproduction rate within groups is not warranted. It seems that during the origin of coviruses from complete viruses, a higher-level evolutionary unit has become disintegrated, whereas during the origin of life a higher-level unit, the protocell, has emerged from lower-level ones, i.e. unlinked, replicating genes. These two gene-level systems are not homologous, but analogous. Although it is true that the resistance to parasites and the need to avoid a mutational collapse of the genome are likely to have called for some compartmentation in precellular stages of evolution, no clear demonstration, that the proposed mechanisms (the compartmentalized hypercycle and the stochastic corrector model) do in fact solve the error threshold problem, exists. Neither has a plausible mode of protocellular sex been suggested.


Treatment of 100 cases of nerve deafness with injectio radix salviae miltiorrhizae.

100 cases of nerve deafness were treated with Injectio Radix Salviae Miltiorrhizae by i.v. drip, and additional drugs that promoted blood circulation were used according to symptom differentiation. Results were 28 cases cured, 45 cases improved, and 27 cases failed, for a total effective rate of 73%.


Treatment of fever due to exopathic wind-cold by rapid acupuncture.

57 cases of common cold, influenza, acute tonsillitis and acute bronchitis were treated by rapid needling with filiform needles at Dazhui (Du 14), Fengchi (GB 13), and Quchi (LI 11). The indices for observation were first determined, and the 19 cases that manifested an axilla temperature drop of over 1 degree C after treatment and a ratio of < 0.3 of the main symptom scores after treatment were regarded as markedly effective; the 27 cases that manifested an axilla temperature drop of 0.5-1.0 degree C and a symptom score ratio of 0.3-0.6 were regarded as effective, and the 11 cases that manifested an axilla temperature drop of < 0.5 degrees C and a symptom score ratio of > 0.7 were regarded as failures. The total effective rate was 80.7%. Analysis of the individual patients indicated that the peripheral blood leucocyte and lymphocyte counts differed insignificantly after needling, while the body temperature, rate of respiration, pulse, blood pressure and acupoint temperature all dropped, with a simultaneous increase in the percentage of T-lymphocytes. The immediate effects were especially marked in fevers due to exogenous wind and cold.


Computerized plotting of low skin impedance points.

The distribution of low skin impedance points (LSIP) was studied on 68 subjects with a computer system designed for the measurement of skin impedance. The results demonstrated that LSIPs were basically distributed along the 14 channels, the overwhelming majority located right on or within 5 mm bilaterally to their courses. LSIPs were found in the area between every two channels only in a few cases. Moreover, there was no marked natural fluctuation of skin impedance in the human body and the distribution of LSIPs was considerably stable, which could be plotted on any day in the experiment. It is clear that such particular distribution of LSIPs along channels was really a biological phenomenon, not an experimental error. However, the distribution of low skin impedance was not an uninterrupted solid line but a series of LSIPs basically along the channel course. The method used in this work was accurate, reliable and repeatable which has upgraded the measurement of LSIPs to a new level. Under certain conditions, skin impedance can be used as an objective index in channel research.


Studies on the luminescence of channels in rats and its law of changes with "syndromes" and treatment of acupuncture and moxibustion.

We previously reported the discovery of 14 channels in the human body, which possessed the biophysical property of high emission of light. In this study we found the same property on the Ren and Du channels in healthy rats. Additionally, we discovered that the luminance of the related channels in rat models with different "syndromes" varied greatly. For instance, a markedly low luminance appeared on the Du channel in animals with experimental syndrome of Yang deficiency induced by hydrocortisone; while in animals with experimental syndrome of blood deficiency caused by bleeding, an apparently low luminance occurred on the Ren channel. The intensity of the emitted light on Du and Ren channels increased after acupuncture treatment, but not significantly. This phenomenon conforms to the theory in traditional Chinese medicine that the Du channel is the "sea of Yang channels", while the Ren channel is the "sea of Yin channels".


Influence of a 70 kilobase virulence plasmid on the ability of Yersinia enterocolitica to survive phagocytosis in vitro.

During the course of infection, Yersinia enterocolitica invades tissues where macrophages and polymorphonuclear leucocytes (PMNs) constitute the first line of defence. As expression of virulence in Y. enterocolitica is governed in part by a c. 70 kilobase virulence plasmid (pYV), we investigated the influence of this plasmid on the interaction between Y. enterocolitica and phagocytes in vitro. The results showed that, irrespective of plasmid-carriage, yersiniae survived phagocytosis by macrophages and PMNs. Plasmidless Y. enterocolitica that had grown intracellularly in macrophages, however, were susceptible to killing by PMNs, whereas plasmid-bearing bacteria were resistant. In vitro cultivation of Y. enterocolitica in a Ca(2+)-deficient medium resembling that found within macrophages, did not influence the susceptibility of plasmid-bearing and plasmidless strains to killing by PMNs. These results indicate that passage through macrophages renders plasmidless strains of Y. enterocolitica susceptible to killing by PMNs. This finding may explain some of the differences in the behaviour of plasmid-bearing and plasmidless strains of Yersinia species in vivo.