Association of indicators of hygiene behavior with persistent diarrhea of young children. We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration > or = 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty-four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti-hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicators were also strongly correlated with each other. In individual logistic regression models, which included overall rate of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicators maintained significant association with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, the hands of the mother being dirty, presence of a fecally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicators, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose-response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea.


Deaths due to dysentery, acute and persistent diarrhoea among Brazilian infants. In a population-based study, all infant deaths occurring in a one-year period in the metropolitan areas of Porto Alegre and Pelotas, in southern Brazil, were studied. There were 227 infants who presented diarrhoea during the fatal illness, and in 75% of these diarrhoea was considered to be the underlying cause of death. Acute diarrhoea (< 14 days' duration) accounted for 28% of the deaths, persistent diarrhoea for 62% and dysentery for a further 10%. Approximately one-half of the children with persistent diarrhoea were admitted to a hospital in the first two weeks of the episode. Hospital-acquired infections were likely to have contributed to one- to two-thirds of deaths due to dysentery and persistent diarrhoea. A comparison with neighbourhood controls showed that breast milk provided substantial protection against deaths due to either acute or persistent diarrhoea.


Small intestinal mucosal histology in the syndrome of persistent diarrhoea and malnutrition: a review. Prolonged injury to the small intestinal mucosa is probably the final common pathway by which a variety of noxious influences--nutritional, infective and possibly allergic--perpetuate the syndrome of persistent diarrhoea in children in developing countries. Animal studies have helped to separate the individual effects of malnutrition and diarrhoea on the gut in a way that is not possible in the clinical situation. Early studies in children provided somewhat subjective or semi-quantitative data on intestinal morphology. More recently, the application of computer-assisted quantitative morphological techniques to intestinal mucosae from children with persistent diarrhoea have revealed a spectrum of changes consistent with a cell-mediated immune form of damage. The nature of the antigens that provoke these responses remains to be elucidated. Several reports indicate that in children with persistent diarrhoea clinical severity and prognosis do not necessarily correlate with the degree of small intestinal mucosal damage. Nutritional rehabilitation can be shown to produce a demonstrable improvement in small intestinal crypt cell proliferative activity in children with persistent diarrhoea. It is not yet known for how long nutritional rehabilitation should be continued to ensure complete recovery of the intestinal damage following persistent diarrhoea.


Dietary protein sensitivity: is it an important risk factor for persistent diarrhea? Although the causes of persistent diarrhea are largely unknown, dietary protein sensitivity has been identified as one possible mechanism. Since nutritional therapy appears to be an essential component of treatment for persistent diarrhea, a clearer understanding of the importance of dietary protein allergy is needed to provide optimal dietary recommendations. This paper reviews the current concepts of the pathophysiology, clinical features and criteria for diagnosis of dietary protein sensitivity. Evaluation of the results of several clinical studies indicates that dietary protein sensitivity does occur especially in young infants fed cows' milk but that it is an uncommon event, especially in older infants and children.


Zinc and diarrhea.

Zinc and diarrhea. Malnutrition is a major factor in the etiology, management and prognosis of persistent diarrhea in young children. Apart from inadequate energy intake, deficiencies of several specific nutrients have been implicated. Zinc is a micronutrient that appears to be of special interest, at least in some communities. Zinc deficiency has been documented in otherwise normal children. The risk of deficiency, however, is enhanced by diarrhea which is associated with variable but sometimes gross increases in zinc losses in the feces. These losses could contribute to a vicious circle, as there is now evidence that mild as well as severe zinc deficiency states can contribute to the duration and severity of diarrheal disease. During rehabilitation, impaired zinc nutriture could be responsible for slow growth, especially if the rehabilitation diet is high in phytate, a recognized inhibitor of zinc absorption. Research should be directed to a better understanding of zinc metabolism and homeostasis during diarrhea disease, to the consequences of zinc deficiency and to the benefits to be derived from zinc supplementation programs.


Effect of milk-containing diets on the severity and duration of childhood diarrhea. Individual components of milk from humans and other mammalian species may influence the severity, duration, and nutritional outcome of childhood diarrhea in different ways. Nonetheless, empirical data from clinical trials can be used to assess children's responses to specific milk-containing diets. Factors modifying the response to milk include its source, amount, frequency of feeding, type of processing, and accompanying foods, as well as the type and severity of enteric infection and specific characteristics of the host. Whereas breast-fed infants have less severe diarrhea when breast milk is continued rather than interrupted, infants and children fed with non-human milks tend to have more severe illness than those receiving milk-free or lactose-limited formulas or milk-cereal mixtures. Fermentation of milk may reduce the severity of lactose malabsorption, but additional information regarding the efficacy of yogurt in acute, childhood diarrhea is still needed.


Type of milk feeding during acute diarrhoea and the risk of persistent diarrhoea: a case control study. The role of feeding breast milk, unmodified bovine milk or adapted infant formula during acute diarrhoea in protecting against or causing persistence of the episodes was investigated in a population-based case control study in an urban area of north India. After adjustment for confounding variables, exclusive breast-feeding was associated with an odds ratio of 0.06 (95% CI 0.002-2.1), a 16.5 times lower odds in favour of developing persistence of an episode. Infants fed unmodified bovine milk in addition to breast milk had an odds of 2.5 times (95% CI 1.0-9.9) in favour of developing persistence of acute diarrhoea (p = 0.04). In infants receiving unmodified bovine milk and no breast milk, this odds ratio was 11.1 (95% CI 1.0-228.8) (p = 0.05). This study indicates that promoting exclusive breastfeeding may reduce the persistence of diarrhoea over and above its effect in decreasing the incidence of acute diarrhoea. In urban areas of the developing countries where working mothers often use milk supplementation beyond the age of three months, our findings suggest that use of adapted spray dried formula may be safer than unmodified bovine milk with respect to the risk of developing persistent diarrhoea.


Feeding during acute diarrhea as a risk factor for persistent diarrhea. Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community-based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (> 14 days' duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p < 0.02 Kaplan-Meier log-rank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non-maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.


Management of extremely low-birth-weight infants. Better health care of women during pregnancy and delivery, improvement in neonatal intensive therapy and technology have led to a decrease in neonatal mortality and morbidity and to lower limits of birth weight and gestational age for survival. This paper refers to the management protocol used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan for extremely low-birth-weight (ELBW) infants (birth weight < 1000 g). In this hospital, all newborn infants presenting evidence of life, irrespective of birth weight and gestational age, are resuscitated and transferred to the Neonatal Intensive Care Unit (NICU) for clinical management. After the introduction of this protocol the mortality rate of ELBW infants dropped from 71.4% in 1977-78 to 48% in 1987-88. In a group of 72 ELBW infants with a mean birth weight of 850 g and a mean gestational age of 27 weeks, 80% presented a normal outcome, 12% presented a mild neurological impairment and 8% were affected by severe cerebral palsy at the age of two years. The intact survival of a newborn infant of 450 g at birth is also reported.


Hospital care techniques resulting in intact survival of a 380-g infant. Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well known phenomenon. We recently cared for an infant whose birth weight was 380 g, making her one of the smallest survivors in the United States. Her hospitalization (including expenses), the techniques of our minimal intervention protocol and her 20-month (corrected) follow-up are presented together with a discussion of the moral, economic and social implications involved in the care of such an infant.


Intact survival of a 280-g infant: an extreme case of growth retardation with normal cognitive development at two years of age. The care of infants born weighing less then 500 g is not only controversial but is also associated with medical uncertainties. We report the management of a growth retarded infant who weighed 280 g at birth after 26.9 weeks' gestation. The child not only survived but appears developmentally normal at two years of age. Although the infant is the smallest survivor reported, the case demonstrates the importance of gestational assessment in deciding delivery room management.


The care of fetal babies: survival of a 390-g infant. Infants with birth weight 750 g or less usually have a poor survival rate, and those who live have poor neurologic and intellectual outcome. With significant advances in perinatal care and meticulous neonatal support, the survival of these babies has improved in recent years and the long-term outcome can be as good as that of larger low-birth-weight infants. It is likely that the reported increase in survival of ELBW infants reflects a changing obstetrical approach to the extremely premature fetus along with an increased attitude among pediatricians and neonatologists to treating such babies. This posture is motivated and supported by a number of factors, including regional systems of perinatal care that encourage early maternal transport to tertiary centers, an increasing ability of neonatal intensive care technology to achieve survival, and more optimistic long-term neurodevelopmental outcome reports. Our experience is encouraging in this regard. This presentation reports the survival of an ELBW infant delivered in Switzerland before the completion of the 26th week of gestation and weighing 390 g at birth.


The most important needs of parents of critically ill children: parents' perceptions. Research studies have identified the needs of relatives when they have had an adult family member in the intensive care unit. However little similar work has been done within the paediatric setting. Therefore the aim of this study was to examine what parents considered to be their most important needs, when they have a child ill in the intensive care environment (PICU). A questionnaire was designed, and was distributed to parents of 30 children admitted into a PICU. The questionnaire identified needs items which may be important to parents of sick children. The parents were required to indicate how important each need was to them during the time of the child's stay in the PICU. Results obtained indicate that parents have a strong need for information and relief of anxieties that they may have about their child's condition. A conclusion reached in this study is that if the critical care staff can go some way to assess and meet the needs of parents of critically ill children, then these parents may be more able to become effective partners in care, which may have therapeutic effects upon the child's health recovery.


The nurse's role in organ donation from a brainstem dead patient: management of the family. This paper suggests ways in which the nurse in charge of a brainstem dead patient can help in the management of the patient's family so that they can more easily and effectively come to terms with his or her death and consider the possibility of organ donation. Many nurses, in spite of their basic training, are unprepared to assume such a role successfully, and three areas are preliminarily identified for closer study, i.e. 1) the preparation of the family for brainstem death, 2) the approach to the family for possible organ donation, and 3) the care of the family throughout the process of organ donation. Certain recommendations are suggested which might help to promote the necessary caring approach to the problem. Review of literature on the nurse's role in such a situation shows how important that role is thought to be. Guidelines are tentatively laid down for explaining brainstem death and preparing the family for it; and the importance of their acceptance of the finality of death is stressed, so that they can begin the essential grieving process. Emphasis is also laid on the need for the nurse to adopt a sensitive, caring and supportive attitude which will help the family in their bereavement and encourage them to accept the possibility of organ donation. In conclusion, it is recommended that nurses be provided with more detailed advice and guidance on managing the family in the many aspects of such a situation.


The applicability of a new sedation scale for intensive care. Experience of the sedation scale, which was in use for the assessment of ventilated patients, in an intensive care unit revealed a number of deficiencies. Discussion suggested that an ideal scale should be more straightforward and easily understood by all levels of staff. It should also relate closely to the behaviour of the ventilated patient, and allow an optimal level of sedation; where the patient receives the minimum level of medication to allow pain and stress-free ventilation. A scale was devised with explanations of each level, and was incorporated in a revised sedation policy. In practice this was found to be an improvement over the scale that had been used previously.


Tissue distribution of adoptively transferred adherent LAK cells: role of the route of administration. The ability of LAK and adherent LAK (A-LAK) cells to migrate to and localize into tumors might be a limiting factor for the efficacy of adoptive immunotherapy. Employing different routes of inoculation of A-LAK cells labeled with 125IUdR, we have investigated how murine A-LAK cells circulate in the bloodstream and localize into various tissues. After intravenous injection, most of the A-LAK cells migrated to the lungs with less than 15% redistributing to other organs. Following left ventricular inoculation, after which the injected cells do not have to pass the lung capillaries before reaching other organs, higher numbers of A-LAK cells were found in liver, carcass, kidney and gut compared to intravenous injection. However, most of the A-LAK cells were cleared from these organs within 24 h, and surprisingly at this time the overall survival of the injected A-LAK cells was not more than 10-20% regardless of the route of injection. We found that a substantial accumulation of A-LAK cells in the liver could be achieved only when the cells were injected directly into the portal vein. Following this route of administration, more than 40% of the injected A-LAK cells were still in the liver at 24 h, whereas only 3-5% had redistributed to other organs. Our data suggest that A-LAK cells circulate inefficiently and survive poorly following systemic administration. However, enhanced accumulation of these cells in a particular organ might be achieved by direct administration of the A-LAK cells into the vessels feeding the organ.


Pain following coronary artery bypass grafting: an exploration of contributing factors. Patients suffer pain and discomfort in ICU following coronary artery bypass grafting (CABG). While the surgical procedure causes pain, it is the psychological state of the individual which influences his perception of the pain. For the patient undergoing cardiac surgery, several stressors may influence his psychological state, including coronary heart disease (CHD) itself, impending surgery and the intensive care unit (ICU) environment. The types of pain caused by the surgical procedure are discussed. Each of these aspects are brought together in an attempt to gain a better understanding of the patient's perspective of cardiac surgery, and any pain experienced as a result. Given the major influence of the patient's mind in pain perception, there is a need for nurses to consider alternative methods of pain relief in addition to drug therapy.


Window of vulnerability of vaccinia virus-infected cells to natural killer (NK) cell-mediated cytolysis correlates with enhanced NK cell triggering and is concomitant with a decrease in H-2 class I antigen expression. A time course study was performed in order to determine if vaccinia virus (VV)-infected targets were more susceptible to murine natural killer (NK) cell-mediated lysis during a discrete period of time postinfection. Activated NK cells were used in short-term (e.g. 4 h) assays in order to avoid a further in vitro activation of the NK cells by interferon (IFN) and to test the innate susceptibility of target cells to lysis. The sensitivity of VV-infected L929 cells to lysis by NK cells increased as the infection progressed, reached a peak at approximately 24 h postinfection, and subsequently declined to levels lower than that of uninfected cells. This window of vulnerability was not due to an increase in the number of effector/target cell conjugates, which continually decreased as the VV infection progressed. Triggering of NK cells was measured by the influx of 45Ca2+. Target cells treated with IFN induced less 45Ca2+ uptake, whereas cycloheximide treatment of targets caused a greater influx of 45Ca2+ into the effector cells. When L929 cells were infected with VV for various time intervals and used in the triggering assays, an enhanced triggering of the effectors corresponding to the time of enhanced susceptibility of the target cells to lysis was detected. Quantitative decreases in H-2Kk and Dk class I antigens were observed following VV infection of target cells as measured by FACS analysis using alloantibodies. Qualitative changes in H-2 class I antigens were also observed, as detected by a loss in VV-infected target cell susceptibility to lysis by allospecific cytotoxic T lymphocytes (CTL) at a time when they were highly sensitive to killing by NK cells and VV-specific CTL. These results show that virus-infected targets may become innately more sensitive to lysis by NK cells at discrete time points after infection and that the susceptibility to lysis correlates with enhanced triggering of NK cells and reduced H-2 class I antigen expression.


Inotropes--an overview.

Inotropes--an overview. It is essential that nurses understand the drugs they are using, and the measurements they are monitoring. Inotropes are powerful drugs with immediate action. The aim of this article is to give an overview of the inotropes used commonly in intensive care environments, plus some of those currently undergoing investigation.


Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses. The teaching and reinforcing of advanced cardiopulmonary resuscitation (ACPR) is an important part of the role of an intensive care nurse manager. This study highlights the need for a structured training programme, as well as regular updates in ACPR. Current research shows poor retention of CPR skills amongst nursing staff. A small study was undertaken amongst intensive care trained nurses at The Middlesex Hospital intensive care unit (ICU). 18 nurses took part in the study, and were each interviewed with regard to their knowledge of ACPR in December 1990. The period of time since last trained in ACPR ranged from 2 months-4 years. Those who had been recently updated in ACPR (up to 4 months prior to interview) scored higher than those who were updated more than 2 years ago. The results showed that most nurses interviewed were only able to answer correctly half the questions asked. These results indicate that the nurses in the study generally demonstrated a severe lack of knowledge of ACPR. This indicates the need for a structured training package in ACPR, followed by frequent reinforcement of ACPR knowledge and skills for nurses practising in an ICU environment.


A literature review of recent advances in enteral feeding and the increased understanding of the gut. This literature review focuses on recent advances in enteral feeding and increased understanding of the role of the gut. The gut is beginning to be seen as a reservoir for bacteria and a source which contributes to multi-organ failure (MOF) due to translocation of bacteria, in addition to its usual functions. Enteral feeding as discussed in this article is a method of feeding which frequently involves nurses at the bedside, yet so many seem unfamiliar with recent research on the topic. A simple change to intermittent enteral feeding could be more beneficial for patients than continuous feeding. Indeed, continuous feeding may even be harmful, and as Florence Nightingale stated in her book Notes on Hospitals in 1858, hospitals should do no harm to patients.


An iron-sulfur cluster plays a novel regulatory role in the iron-responsive element binding protein. Post-transcriptional regulation of genes important in iron metabolism, ferritin and the transferrin receptor (TfR), is achieved through regulated binding of a cytosolic protein, the iron-responsive element binding protein (IRE-BP), to RNA stem-loop motifs known as iron-responsive elements (IREs). Binding of the IRE-BP represses ferritin translation and represses degradation of the TfR mRNA. The IRE-BP senses iron levels and accordingly modifies binding to IREs through a novel sensing mechanism. An iron-sulfur cluster of the IRE-BP reversibly binds iron; when cytosolic iron levels are depleted, the cluster becomes depleted of iron and the IRE-BP acquires the capacity to bind IREs. When cytosolic iron levels are replete, the IRE-BP loses RNA binding capacity, but acquires enzymatic activity as a functional aconitase. RNA binding and aconitase activity are mutually exclusive activities of the IRE-BP, and the state of the iron-sulfur cluster determines how the IRE-BP will function.


Mutagenic activity of copper(II) chromate and dichromate complexes with polypyridines. Copper(II) chromate and dichromate complexes with 2,2'-bipyridyl and 1,10-phenathroline were tested for their mutagenic activity in the standard Ames test. All of six tested complexes exhibited markedly lower mutagenic activity than the reference compounds--potassium dichromate and sodium chromate. The blockage of Cr(VI) reduction capability in the presence of the complex Cu2+ ion and the competition between copper and chromium ions in the interaction with cellular components are discussed in the light of the results of our previous chemical study.


Modulation of chromium(VI) toxicity by organic and inorganic sulfur species in yeasts from industrial wastes. Two chromium(VI) resistant yeast strains (Candida sp. and Rhodosporidium sp.) were isolated from industrial wastes. Four different yeasts, three from the Industrial Yeast Collection and one of pharmaceutical origin, were also studied in relation to chromate toxicity and its alleviation by sulfur species. The growth of yeasts from industrial wastes was inhibited by 50% by high concentrations of Cr(VI): Candida sp. by 4 mM Cr(VI) and Rhodosporidium sp. by 10 mM Cr(VI) in Sabouraud Broth medium. The other Cr(VI)-sensitive yeasts were inhibited by 0.1 mM Cr(VI). The general mechanism of chromium resistance in Candida sp. and Rhodosporidium sp. was due to reduced uptake of chromium, but not to biological reduction from Cr(VI) to Cr(III). In Cr(VI)-sensitive yeasts, chromium was accumulated as much as 10-fold, as in Saccharomyces cerevisiae. Cr(VI) toxicity in Candida sp. was modulated from Cr(VI)-resistance to Cr(VI)-hypersensitivity depending on the addition of methionine, cysteine, sulfate and djenkolic acid. If Candida sp. was grown in the presence of S-amino acids, especially methionine, it was more resistant than if the sulfur source was sulfate. When sulfate transport was enhanced by addition of djenkolic acid, Candida sp. became hypersensitive. Rhosporidium sp. was always resistant to Cr(VI) because sulfate transport was inefficient and it assimilated sulfur as S-amino acids. Cr(VI)-sensitive yeasts required larger amounts of S-amino acids, especially methionine, to tolerate Cr(VI) toxicity. Cysteine was toxic for C.famata 6016 above 50 microM.


Analogous copper(I) coordination in metallothionein from yeast and the separate domains of the mammalian protein. The three-dimensional structures of both vertebrate Cu12-metallothionein (class 1) and yeast Cu8-thionein (class 2) are still unknown. The different copper:protein stoichiometry compared with that of the (ZnCd)7-metallothioneins was expected to alter the metal-thiolate cluster structure considerably. In order to avoid possible domain interactions in the hepatic rat metallothionein, separate chemically synthesized alpha- and beta-domains were used rather than the apoprotein. Apo yeast thionein, and the alpha- and beta-domains of rat liver metallothionein-2 were reconstituted by Cu(I) titration. Reconstitution steps were monitored using spectroscopic methods including luminescence emission and circular dichroism. Upon UV irradiation a linear increase in intensity of the orange-red luminescence was observed near 600 nm up to 6 Cu eq using either compound regardless of the different cysteine sulfer content (yeast thionein 12S, alpha-domain 11S, beta-domain 9S). The characteristic dichroic properties of the yeast copper-protein between 240 and 400 nm were in good agreement with those of the respective class 1 metallothionein domains. All observed Cotton bands were of similar shape and appeared in the same wavelength regions. However, the molar ellipticities were less pronounced in the alpha- and beta-fragments employed. There appears to be a striking similarity between the oligonuclear Cu(I) binding centers in all metallothionein species.


[Clinical study of yi shen ning for treatment of kidney-yang deficiency after hormone withdrawal of primary nephrotic syndrome--clinical analysis of 100 cases]. This paper reports that Yi Shen Ning (YSN) which acts as warming and tonifying Kidney-Yang was administrated on 100 cases of primary nephrotic syndrome (PNS) while adrenocortical hormone (ACTH) was diminished to half dosage. The results showed that to apply the integrated TCM and WM according to the different stage of PNS was quite effective to treat deficient syndrome of Kidney-Yang appeared after withdrawal of ACTH. This recipe not only could improve the symptoms, but also pick plasma cortisol up earlier than expected, which was inhibited by exogenous hormone. The total remission rate of YSN group was 68.75%, higher than that of ACTH group (P < 0.05), especially for the cases dependent on exogenous hormone, the re-acquired remission rate reached to 58.3%.


[Preliminary experimental and clinical study of the treatment of chronic renal insufficiency by granule of yi-qi bu-shen]. The effects of the granule of Yi-Qi Bu-Shen on the chronic renal insufficiency (CRI) was studied. 30 cases of CRI patients using the granule was compared with other 23 CRI patients by using Aldehyde-coating Oxidated Starch in same conditions. The effective rate of these 2 groups were 53, 3% and 42.9% respectively (P > 0.05). According to laboratory observation, the granule had the ability to reduce BUN, Scr, Ch, TG and increase Ccr, Hb. The granule also could relieve symptom of Kidney-deficiency. Animal experimental research suggested the granule had the function of reducing BUN, Scr and could improve pathological changes in rat kidneys. The conclusion were that the granule was effective on treating CRI and could postpone the progress of CRI.


[Effect of Cordyceps sinesis on T-lymphocyte subsets in chronic renal failure]. Synchronous measurements of renal function and T-cell subsets were taken in 51 cases of chronic renal failure (CRF) patients. Cordyceps sinesis 3-5 g/d was given to 28 out of these 51 patients, which was considered as follow-up group. The results were stated as follows: (1) Obvious decrease of OKT3, OKT4, OKT4/OKT8 was found in CRF (P < 0.01). (2) OKT4 and OKT4/OKT8 were proportional to plasma albumin and Hb levels (P < 0.05). (3) After administration of Cordyceps sinesis, improvement of renal function and OKT4, OKT4/OKT8 were confirmed. This study indicated that cellular immune function was decreased in CRF. Administration of Cordyceps sinesis might improve their renal function and as the same time enhance the cellular immune function in CRF.


[Long-term effect of Schonlein-Henoch nephritis with nephritic-nephrotic syndrome in children by traditional Chinese medicine and Western medicine]. 21 cases are fully agreed with the diagnosis standard of Schonlein-Henoch nephritis. Biopsy on the kidney of 5 cases with resistant duration was made and all were diagnosed as mesenteric hyperplastic glomerular nephritis, among them, one with segmental sclerosis, one with segmental sclerosis and crescents in some glomerulus. 13 cases were treated with prednisone, cyclophosphamide and Traditional Chinese herbs. 8 cases with wilfordine adding and/or traditional Chinese herbs. The results showed that 15 of 21 cases were cured, one case perfect remission, 4 cases part remission. All of the cases were followed-up from 2 years and 10 months to 12 years and 4 months, average 7.34 years. The late results: Group A, 16 cases with symptom, physical exam, urine routine normal. Group B, 4 cases with microscopic hematuria and/or "a little-(+)" urinary protein. Group C, one case with "+2" urinary protein and/or hypertension, urinary creatinine clearance rate normal. Of 5 cases, whose biopsies of kidney were made, one with glomerular segmental sclerosis belonged to Group B. 13 of 21 cases had recurrence for 1-6 times, which was closed related with up respiratory tract infection.


[Treatment of purpuric nephritis in children with Tripterygium wilfordii and radix Salviae miltiorrhizae]. This paper dealt with the data of Tripterygium wilfordii polyoglucoside (1 mg/kg.d) combined with Radix Salvaie multiorrhizae (6-15 g/d) for treating purpuric nephritis (group-A), compared with the control group of using Tripterygium wilfordii polyoglucoside treatment only (group-B). The average time of edema-disappearing and blood pressure-resuming to normal range were 8.72 +/- 3.07 and 7.44 +/- 5.17 days in group-A, which were much better than those in group-B (P < 0.05). The average time of blood urine-disappearing in group-A and group-B were 36.37 +/- 11.50 and 47.73 +/- 14.03 days respectively. The average time on C3 in the urine resumed to normal in groups A and B were 40.33 +/- 4.51 and 50.00 +/- 5.30 days respectively (P < 0.01). The time of microcirculation of nail fold returned to normal after treatment in group-A and group-B were 39.00 +/- 11.03 and 66.00 +/- 9.01 days respectively (P < 0.001). These results indicated that the effect of group-A was much better than that of group-B.


[Salvia miltiorrhizae in the treatment of the viral myocarditis]. In Order to evaluate the effect of Salvia miltiorrhizae (SM) on the acute viral myocarditis (AVM), 60 children with AVM were studied. The patients were divided in random into two groups, group 1 treated with vit. C, ATP, CoA (n = 30), group II with SM plus vit. C, ATP, CoA (n = 30). The levels of plasma lipid peroxide (LPO), erythrocyte membrane microviscosity (EMMV), LDH, CPK, GOT and ECG in each patient were determined before and after one course of treatments respectively. The results revealed that before treatment the levels of plasma LPO and EMMV in both groups increased significantly compared with those of normal controls (n = 30, P < 0.01) respectively. There was a close correlation between LPO and EMMV (r = 0.6774, P < 0.01) and a close correlation between LPO and LDH (r = 0.5703, P < 0.01). After one course, the levels of plasma LPO and EMMV in both groups decreased significantly (compared with those before treatment, P < 0.01, respectively). But the LPO level and EMMV in group I were much higher than those in normal controls yet (P < 0.05, respectively). And LDH, GOT and ECG in nearly half of the patients in group I did not recover after one course while most patients in group II recovered. The results suggested that free radical plays an important role in the pathogenesis of AVM. SM as a good antioxidant, could protect myocardium from repairing membrane damage and clearing away free radical. This provided a new approach to treatment of viral myocarditis.


[Reduction of genotoxic damage in oral mucosa with myasthenia gravis by traditional Chinese medicine]. Micronucleated exfoliated cell (MEC) of oral mucosa of 40 patients with myasthenia gravis (MG) and 54 normal controls were observed by means of micronucleus test. The frequency of MEC of two groups were 9.56/1000 and 2.55/1000 respectively, and their difference was remarkably significant (P < 0.001). 22 cases were treated by TCM Qiang Ji Jian Li Capsule. The frequency of MEC after treatment fell from 14.38/1000 to 6.00/1000. The difference was significant (P < 0.002). The frequency of Spleen-asthenia group higher than that of non-Spleen-asthenia (P < 0.05). The results revealed that. The patients with MG had genotoxic damage. (2) The constitution with the Spleen-asthenia and the genotoxic damage was related. (3) Qiang Ji Jian Li Capsule of invigorating the Spleen and benefiting Qi could reduce the genotoxic damage.


[Couch-netting operation for dislocation of adult lens]. Clinical data of 12 adult cases of dislocation of lens treated with couching-netting operating were analysed, including cases of traumatic cataracts with complications of glaucoma and cataract couching surgical complication of phacolysis. The result was rather satisfactory. Eye sight was corrected, most of the corrective vision was over 0.5 level, intraocular pressure was controlled and no serious complication was found. According to the authors experience, couching-netting was recommended as a simple and effective method for treating dislocation of adult lens.


[Effect of radix Salviae miltiorrhizae on calcium, zinc, copper content in serum, callus and bony tissue in early stage of healing process in rat closed tibial fracture]. Changes of calcium, zinc, copper contents in serum, callus and bony tissue in the early stage of the healing process of rat closed tibial fracture, also the changes of them with radix Salviae miltiorrhizae (RSM) treatment were studied. It was found that calcium, zinc contents and Zn/Cu ratio increased significantly and the rise of serum copper content was inhibited by the administration of RSM after fracture. Zn/Cu ratio in fracture callus was correlated to the calcium content in fracture callus. These findings suggested that the effect of the promotion of RSM on fracture healing was related to the increased zinc content in serum, also related to the acceleration of mobilization of zinc in fractured bone, and to the acceleration of fracture callus formation and mineralization process by the increased zinc and Zn/Cu ratio in the callus of the fracture.


[Experimental study of preventing liver cirrhosis by using four kinds of Chinese herbs]. 55 rats were divided into six groups; (1) normal control, (2) cirrhosis control, (3-6) Chinese herbs groups, 2-6 groups were liver cirrhosis model caused by combined factor dominated by CCl4, and 3-6 groups were given Chinese herbs simultaneously until the end of sixth week. Radix Salviae miltlorrhizae (RSM) were used in group 3, Flos Carthami (FC) in group 4, Radix Angelicae sinensis (RAS) in group 5, Semen persicae (SP) in group 6. in group 2, 7 out of 9 rats developed into cirrhosis, the degree of fibrosis was 2.55+ and collagen protein content was 35.3 mg/g.liver, SGPT 387u. In group 3(RSM), no cirrhosis was found, the degree of the fibrosis was 0.43+ (compared with group 2, P < 0.01, collagen protein content was 16.7 mg/g.liver (P < 0.01), SGPT 132u (P < 0.01). In group 4(FC), 8 out of 9 rats did not develop into cirrhosis, collagen content 21.1 mg/g.liver, compared with group 2, P < 0.05. In the group of 5 and 6, some rats were developed into cirrhosis. The result showed that RSM and FC possessed an inhibitory effect on fibrogenesis. The effect of RSM was remarkable. It could prevent experimental cirrhosis. The effect of RAS and SP were uncertain. This experiment predicted that RAM would become the promising drug to restrain chronic hepatic disease from developing into cirrhosis clinically.


[Experimental study of anisodamine on therapeutic effect of pulmonary edema in rats]. The pulmonary edema (PE) induced by adrenaline (AD) is similar to neurogenic pulmonary edema. Anisodamine (654-2) showed an apparent therapeutic effect on it. The pulmonary wedge arterial pressure (PAWP), carotid arterial pressure (CAP) and blood gases were measured. It was found that in PE group, PAWP was increased to four-fold compared with those from before AD administration (from 0.98 +/- 0.24 to 4.04 +/- 0.53 kPa, mean +/- SD) rapidly. CAP was increased to one fold. The changes of PaO2,O2Sat and PaCO2 showed progressive hypoxia. The PaO2(kPa) was 11.0 +/- 1.3, 6.1 +/- 1.7, 4.4 +/- 1.9 and 3.8 +/- 1.9, PaCO2(kPa) was 4.1 +/- 2.1, 5.4 +/- 0.8, 9.7 +/- 2.9 and 10.3 +/- 3.4, O2 Sat(%) was 95.6 +/- 16.0, 69.2 +/- 15.1, 48.9 +/- 22.0, and 33.7 +/- 25.9 in order before AD injection, 1, 5 min after AD injection and before death respectively. Blood pH value also decreased in apparent way. All of animal died within 15 min. While in 654-2 therapeutic group, the significant increased PAWP and CAP were decreased gradually to normal within 30 min. The abnormal blood gases and pH were approached to repair within 20 min. All of animals survived.


Suction therapy in the critically ill patient. Caring for patients with inefficient airway function who need suctioning requires a great deal of nursing skill. This article outlines the methods of suction therapy currently available, the role of research in improving clinical practice and the way in which new technology may be used to benefit both patient and nurse.


Minitracheostomy: the benefits for patient care. Sputum retention is a potential complication following thoracic surgery. This article describes minitracheostomy, a technique that is commonly used in thoracic units to clear secretions, examines its advantages and disadvantages and recommends its more widespread use in district general hospitals.


Caring for patients with enterocutaneous fistulae. Fistulae are distressing for both patients and staff. The management of fistulae presents a challenge to the nurse in terms of providing care for the psychological and physiological needs of the patient. This article describes the causes of fistulae and examines the nursing priorities and how to achieve them.


MRI of the shoulder.

MRI of the shoulder. MR imaging of the shoulder has become an important imaging modality for that joint. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsules, fat, bursae and bone marrow. The most common indications for shoulder MRI are suspected rotator cuff tear, shoulder instability, osteonecrosis, neoplasm and infection. In this article we describe MR technique, special anatomy of the shoulder, and diagnostic MR criteria of common pathologic conditions.


Rights to healthcare and the role of the nurse practitioner. With the recent developments in healthcare now coming into effect, it is necessary to consider rights to healthcare, the balance of supply and demand and the role of the nurse practitioner as patient advocate.


Implications of the theory/practice gap for Project 2000 students. Nursing has frequently attempted to address the gap between theory and practice. This article explores their relationship and the implications of any theory/practice gap for emergent Project 2000 students.


[MRT of epiphyseolysis capitis femoris]. MR imaging provides exact measurement of the epiphyseal angle by drawing a ventral tangent to the femoral neck in parasagittal images along the femoral neck. The average MR imaging angle was 49.7 degrees in SCFE. Important information is provided about the activity of the slipping process (reattachment) and the contralateral epiphysis.


Career development in intensive care: 2. In part 1 of this article, intensive care nursing and the career opportunities that are available were discussed. Part 2 will examine postregistration intensive care training and career progressions from grade D level to senior/specialist posts.


The lumbar spine: postoperative magnetic resonance imaging. Persistent low back pain after surgery can be a severe diagnostic and therapeutic problem. By using MRI many causes of this failed back surgery syndrome (FBSS) can be disclosed. MRI is superior to other imaging modalities in this concern. In this article we describe the MR technique, normal and abnormal findings of the postoperative lumbar spine, such as persistent or recurrent disc herniation, epidural scar, spinal stenosis, pseudomeningocele, arachnoiditis, pseudarthrosis, hematoma, and infection.


MRI of spondylitis.

MRI of spondylitis. MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous administration of Gd-DTPA, enhancement of the marrow and disc was seen. With progressive healing an increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. As healing progressed, the T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA administration. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.


[MRT in osteomyelitis: detection of bone sequestration with Gd-DTPA]. In 4/12 patients with subacute or chronic osteomyelitis MRI was able to detect bone sequestrae by use of gadolinium DTPA. This method is of great advantage in cases of infections not originating from osteosynthetic material. In patients in whom osteosynthetic material was removed completely, invisible metallic residuals may lead to signal deterioration.


MRI and MRS of the skeletal muscle.

MRI and MRS of the skeletal muscle. Magnetic resonance imaging and spectroscopy were performed in several types of muscular disorders. In acute stages, 31P spectra showed remarkable changes compared with normals, and T2-weighted MR images were most sensitive in delineating the pathology. Fatty degeneration of muscle in chronic diseases yielded high contrast in T1-weighted MRI and could be quantified by 1H-MRS including the chemically selective determination of proton T1 values. In order to evaluate true abundance rations of phosphorus metabolites, 31P relaxation times T1 of muscle were measured by localized inversion recovery.


Consumer satisfaction surveys in mental health. Treating clients of mental health services as consumers is a relatively new concept in Britain. This article seeks to explain the development of consumer satisfaction surveys, reviews the literature, and identifies ways in which the approach can be used to improve services.


Atrial natriuretic peptide (ANP), aldosterone, angiotensin II and renin in the 'low T3 syndrome' in organ donors. The present prospective study was conducted in order to investigate the effect of an acute decrease in serum T3 levels on ANP, aldosterone, angiotensin II, renin and ADH. All patients showed a pathologic TRH stimulation test prior to organ harvesting. Our patients developed secondary T3 hypothyroidism of different severity dependent on intensive care unit (ICU) stay. T3 values in group 1 (ICU stay > or = 77 h) were smaller than 70 ng/dl, those of group 2 (ICU stay < or = 53 h) were greater than 70 ng/dl. In both groups a severe elevation of plasma renin activity was measured, with almost high-normal values for ANP in group 1 and slightly elevated values in group 2 [not significant (n.s.)]. Results demonstrate that, contrary to patients who are not critically ill, brain-dead patients develop a dissociation of the renin-angiotensin-aldosterone mechanism. No statistical significant difference was found between the groups in serum levels of ADH and aldosterone. This endocrine dissociation, however, seems to have no clinical significance with regard to organ function after transplantation in kidney recipients.


Application of an automated plasma filtration device and a blood monitoring system for LDL apheresis. This study describes the adaptation of a filtration separation device (AK 10 from Gambro, München, FRG) and a blood monitor system (BTS 100 from Diamed, Köln, FRG) to the automated adsorption/desorption device for LDL apheresis. Plasma separation by filtration was performed by a hollow-fiber filter (OP5, Asahi Corp., Japan). In order to evaluate the quality of the plasma obtained by filtration, the platelet contamination, the activity of factors V and VIII and the concentration of the immunoglobulins IgG and IgM were determined. The following results were found: Platelet contamination of the plasma was 2,740/microliters. As compared to the patient's pretreatment values, activity of factor V was 94%, activity of factor VIII was 104%, concentration of IgG was 96%, concentration of IgM was 94%. Ten LDL aphereses were evaluated: red cell counts, platelet counts, hemoglobin concentration and hematocrit were not changed significantly. Thus, this new combination system represents an improved alternative to previously performed centrifugation methods.


Bedside monitoring of anti-coagulation under LDL apheresis by means of aPTT testing with a coagulation monitor. Optimally adjusted anticoagulation under LDL apheresis is essential for successful treatment: Excessive anticoagulation exposes the outpatient to the risk of uncontrolled hemorrhage, insufficient anticoagulation may shorten the duration of utilization of the immune-adsorption columns. A new device (coagulation monitor 512, Ciba Corning) allows individual adaptation of dosage and timing of heparin application by modifying the standard schedule (5,000 IU intravenously before treatment, 2,000 IU/h continuously). APTT was measured before and after application of heparin and then at 30-min intervals both by the coagulation monitor and by conventional laboratory methods; the respective heparin concentration was determined in addition. The correlation coefficient between the heparin concentration and both the monitor-derived and the laboratory-derived aPTT was 0.811 and 0.590, respectively. An explanation for this finding might be that the monitor avoids the influences induced by subsequent collection and testing of samples associated with laboratory procedures.


[LDL cholesterol apheresis by adsorption to dextran sulfate]. Extracorporeal LDL cholesterol elimination may be the sole successful treatment in familial hypercholesterolemia. By treatment of 41 plasma both total cholesterol and LDL cholesterol were lowered by 69 +/- 1% and 78 +/- 1%, respectively. HDL cholesterol was decreased by 24 +/- 3%. This could be explained both by hemodilution (hematocrit was decreased by 9.3 +/- 2.8%) and unspecific adsorption of various plasma proteins (-15.3 +/- 3.7 g/l, i.e. -22 +/- 4%). Protein electrophoresis showed different affinities of the protein fractions. These data suggest that LDL apheresis by dextran sulfate is an effective method for the elimination of LDL cholesterol. However, other proteins besides apolipoprotein B are adsorbed to dextran sulfate.


Platelet loss during plasma exchange is unaffected by in-line filters. 15 patients underwent plasma exchange using a standard 170-microns in-line filter with or without an additional 40-microns microaggregate filter in the return circuit. The mean platelet count fall immediately after plasma exchange in 15 patients was (54 +/- 6) x 10(9)/l and 48 h later was (23 +/- 8) x 10(9)/l representing a mean total platelet loss immediately after plasma exchange of (253 +/- 31) x 10(9) with no difference in the 40-microns filtered procedures. The mean platelet loss in the discarded plasma was (60 +/- 8) x 10(9), and a mean of 52 x 10(9) platelets were recovered from machine harness washings. The platelet loss in the removed plasma and in the harness therefore accounted for only 42-44% of the total loss of platelets. The inclusion of 40-microns microaggregate filters did not reduce platelet loss, and it is therefore unlikely that the thrombocytopenia is induced by reinfused microaggregates. It is likely that platelets are activated in the machine and sequestered in the spleen.


The role of lipoproteins in the inactivation of endotoxin by serum. The lipopolysaccharide (LPS)-induced release of cytokines from human monocytes can be prevented by previous interaction of serum with LPS. This inactivation is a function of lipoproteins. Here we show that LPS can be inactivated by low-density lipoproteins (LDL) as well as by high-density lipoproteins (HDL). The effects of heparin and EDTA on LPS inactivation by serum are also described.


Screening of blood donors and recipients for Borrelia burgdorferi antibodies: no evidence of B. burgdorferi infection transmitted by transfusion. In the study presented here, the prevalence of antibodies against Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was determined in a group of blood donors from the Würzburg area (Southern Germany). 13 of 472 donors (2.7%) tested were positive by immunoblotting (IB). These 13 donors were examined in more detail by physical examination, anamnesis and determination of inflammation parameters of the blood. All persons were asymptomatic for Lyme borreliosis. One of 5 who remembered a tick bite actually had suffered from an erythema chronicum migrans 5 years ago. Another one had been affected by fever, headaches and pain in the limbs, arthralgia and motoric disorder in both hands 6 months before examination. Analysis of the blood did not provide any evidence of an acute infection. Moreover, each of the 472 serum samples was analyzed by a hemagglutination test (HAT). 26 (5.5%) showed a positive test result. In order to investigate whether a seroconversion of the recipients by transfusion of B. burgdorferi antibody-positive blood had taken place, 9 recipients of blood products originating from the 13 IB-positive donors were serologically reexamined. All samples taken proved to be antibody-negative. Consequently, the transfusion did not produce any seroconversion in the patients thus treated.


[New possibilities in diagnosis of hemolytic diseases in newborns]. The diagnosis and management of the hemolytic disease of the newborn (HDN) rely on measurement of maternal anti-D, amniotic fluid analysis, and fetal blood sampling by cordocentesis. However, amniocentesis and cordocentesis have substantial risks of fetomaternal hemorrhage and subsequent increase in maternal anti-D potency. In addition to quantitation, the functional activity of maternal anti-D has been determined by measuring the interaction of red blood cells sensitized by maternal serum in monocyte-monolayer assays. We assessed the functional activity of anti-D by titration of the sensitized red blood cells using selected sera with rheumatoid factor (RF) as human anti-IgG. First experiments using monoclonal anti-D showed a good correlation between erythrophagocytosis and RF titers. The bilirubin/protein ratio in amniotic fluid may be of great value in predicting the severity of HDN, as shown in 94 cases with severe and 39 cases with moderate disease. Amniotic fluid analysis is complicated by the presence of hemoglobin; we developed a computer program to solve this problem. To improve the serological diagnosis of ABO incompatibility, we measured IgG-anti-A,B in 1,392 maternal and newborn sera applying a sensitive gel test with Coombs serum. Furthermore, we determined the hemolytic activity of anti-A,B by microscopic observation of the morphological changes of red blood cells.


Analysis of oligonucleotide binding, internalization, and intracellular trafficking utilizing a novel radiolabeled crosslinker. Although antisense oligonucleotides have been widely used to inhibit gene expression, their mechanism of entry into cells and their site of action are still in some doubt. In this report, we describe a novel technique for kinetically analyzing oligonucleotide association with living cells as well as intracellular compartmentalization. The technique utilizes a photoactivatable, radiolabeled crosslinker, the Denny-Jaffe reagent. Oligonucleotides containing pendant amine groups were conjugated to this reagent, added to HL60 cells in culture, and photocrosslinked to associated proteins, which were analyzed electrophoretically. We find that several proteins are labeled, predominantly a 75 kD one that appears to be membrane-associated. Our results suggest that the majority of intracellular oligonucleotide is associated in vesicles with the same protein to which it bound on the cell surface, but only a small percentage of non-protein-bound cytosolic oligonucleotide can be detected. Additionally, oligonucleotides are readily accumulated by nuclei, and by treating whole nuclei, a unique set of nuclear binding proteins is detected.


Oligodeoxyribonucleotide phosphorothioate fluxes and localization in hematopoietic cells. An antisense oligonucleotide phosphorothioate, previously shown to inhibit HIV-1 viral expression in chronically infected H9 cells, was fluorescently labeled to study oligonucleotide fluxes and localization within living cells. Observations based on flow cytometry and fluorescence microscopy show the following: within around 0.5-2 h, an apparent steady-state distribution of the oligonucleotide is achieved in which the intracellular oligonucleotide concentration is less than that present in the external medium; following oligonucleotide uptake and resuspension of the cells in oligonucleotide-free medium, an oligonucleotide efflux, with a time constant similar to that for uptake, is observed (although a significant fraction of the phosphorothioate remains within the cell); cellular uptake as a function of the external oligonucleotide concentration is nonlinear, being more efficient at lower concentrations (less than 2 microM); and a predominant oligonucleotide localization within the cell nucleus and perinuclear organelles is observed.


Reversal of the malignant phenotype by an anti-ras ribozyme. In this study a ribozyme (catalytic RNA) was designed to site specifically cleave the mRNA of the activated H-ras gene expressed in human bladder carcinoma EJ cells. The optimal conditions for catalytic cleavage by the ribozyme were demonstrated in vitro. A synthetic DNA encoding the ribozyme was cloned into a mammalian expression vector (pH beta APr-1) and transfected into EJ cells. The expressed ribozyme significantly altered the morphology and suppressed the growth of EJ cells in vitro. These cell lines were examined for their malignant potential in athymic (nude) mice by an orthotopic (transurethral) implantation model, which recapitulates the invasive potential of various bladder carcinomas. EJ tumors expressing the H-ras ribozyme were characterized by a marked reduction in tumor take and invasion compared to those formed by control EJ cells. These differences resulted in almost a twofold increase in survival of mice implanted with ribozyme-containing EJ cells. These results further elucidate the role of ras genes in tumorigenicity and invasion, as well as introduce ribozymes as a new class of anticancer agents.


Lipofectin enhances cellular uptake of antisense DNA while inhibiting tumor cell growth. A natural DNA oligomer (15-mer) was synthesized with a sequence complementary to the translation initiation codon region of the human TGF-alpha mRNA and mixed with Lipofectin to form unilamellar complexes. It was found that tumor cell growth was inhibited when HCT116 cells were treated with Lipofectin-DNA oligomer complexes or with Lipofectin alone. Uptake of 32P-labeled 15-mers into colon tumor cells was compared in the presence and absence of Lipofectin. The amount of labeled oligomer found in cells that received optimal ratios of Lipofectin to DNA was 4- to 10-fold higher than the amount found in cells that received 32P-labeled DNA alone. Although Lipofectin-antisense DNA oligomer treatment of HCT116 cells caused a dose-dependent inhibition of cell growth, there was a subsequent rise in target mRNA product. Because the mechanism of growth inhibition could not involve an inhibition of TGF-alpha expression, it was concluded that Lipofectin probably exerts a nonspecific, detergent-like effect upon the cell membrane, producing an enhancement of TGF-alpha processing and release.


Selective output-discriminative signals in the motor cortex of waking monkeys. Monkeys and humans have similar capacities to discriminate between the frequencies of mechanical sinusoids delivered to the glabrous skin of their hands. Combined psychophysical-electrophysiological experiments in monkeys discriminating in the range of flutter provided evidence that this capacity depends upon differences in the cycle lengths in the sets of periodically entrained activity, evoked by the stimuli discriminated, in neurons of areas 3b and 1 of the (sensory) hemisphere opposite the stimulated hand. Identical experiments have now been made, in similarly trained and discriminating monkeys, in the motor cortex (area 4) of the hemisphere opposite the arm projecting selectively to one of two targets, to indicate discrimination (five hemispheres, 1137 neurons studied). We observed a selective signal of the upcoming correct discrimination in about 25% of the neurons of area 4 active in the task. The neuronal discharge occurs selectively for stimuli either lower or higher in frequency than that of the base stimulus, and commonly begins within 200-300 msec after onset of the comparison stimulus. These neuronal discharges are aperiodic, with no sign of the stimulus frequencies. EMG recording during performance of the discrimination showed that the muscles of the arm opposite the side of recording were silent during the period of stimulus presentations. Recordings during trials in which the animal made errors showed most commonly that the output of the discrimination operation was itself in error, followed by an appropriate arm projection to the wrong target. We interpret the selective response during the comparison stimulus to be a postdiscrimination signal projected transcallosally from the sensory hemisphere to the motor area of the hemisphere controlling the responding arm. We obtained no evidence that the discrimination operation is localized to any particular area, and we surmise it to occur in the dynamic activity within the distributed system linking the sensory cortex of one hemisphere and the motor cortex of the other. One-third of the neurons of the motor cortex responded to indentation of the skin of the ipsilateral hand, at trial onset. These responses varied from those closely linked to that sensory stimulus to those linked to the upcoming movement of the contralateral hand. These onset responses did not occur when similar sequences of mechanical stimuli were delivered to alert but idling monkeys.


Internal representations of movement in the cerebral cortex as revealed by the analysis of reaching. Reaching movements have the well-defined goal of bringing the hand to the location of an object of interest. For neuroscientists a basic problem to be solved is how the nervous system transforms the visual information concerning the location of the object in space into a pattern of muscle activity necessary to bring the hand to it. According to Descartes, spirits passing from the eyes impinge on the pineal gland, causing it to lean in one direction or another; this leaning of the gland pulls on filaments (nerves) attached to the muscles. Modern treatments, instead, tend to decompose this process into sequences of transformations between informational representations. Such transformations lead from a description of the target in visual coordinates to an expression of the movement in muscle space by way of various internal representations. The organization of such internal representations has implications for the types of transformations actually performed in the brain. Recent psychophysical, neurophysiological, and computational approaches to study the cortical representations of reaching movements are yielding complementary data on this issue.


Reentry and the problem of integrating multiple cortical areas: simulation of dynamic integration in the visual system. Studies of the cerebral cortex, particularly those of the visual system, demonstrate the existence of multiple, anatomically segregated and functionally specialized cortical areas. There is no evidence that these areas, which are linked by a network of reciprocal connections, are coordinated by a higher-order center. The visual image that we perceive, however, seems to be unified and coherent. In this article, we address the problem of integration posed by these observations. In an extension of our previous work, we develop a dynamic model of reentry. Reentry is a process of parallel and recursive signaling along ordered anatomical connections that achieves integration by giving rise to constructive and correlative properties within and among maps. We present and test a computer model simulating nine functionally segregated visual areas organized into three streams for form, color, and motion. The model receives visual input consisting of camera images of objects of different shapes and colors. We show the specialized response properties of the areas in the three streams. A computational strategy involving a phase variable is introduced to represent explicitly the dynamics of short-term temporal correlations among thousands of units distributed across different areas. We then illustrate constructive and correlative consequences of reentry within a system of reciprocal intra- and interareal connections by two examples taken from psychophysics: generation of form from motion and motion capture. The model solves the so-called "binding problem" through short-term correlations, which serve to link similar object features within a simulated cortical area and to bind multiple attributes of one or more objects across several areas, including a nontopographic one. Integration emerges from cooperative effects within and among the specialized areas. These effects lead to a simple output, a simulated foveation response, that is used as a basis for conditioning. Reward is mediated by the activation of a saliency system that is modeled on diffuse projection systems in the brain. As a result, the visual cortical model carries out foveation responses to input stimuli that require the dynamic conjunction and discrimination of form, color, and location for successful performance.


Varieties of functional deficits in prosopagnosia. Prosopagnosia is a neurologically based deficit characterized by the inability to recognize faces of known individuals in the absence of severe intellectual, perceptual, and memory impairments. The nature of the underlying disturbance was investigated in three patients in an attempt to identify the structural and functional levels at which the processing of faces breaks down, the relation between prosopagnosia and associated deficits, and the specificity of the prosopagnosic disturbance. The breakdown of face processing resulted from unilateral damage in different cerebral structures of the right hemisphere in the three patients, and it involved different functional levels of face processing, but all three patients displayed perceptual impairments of unequal severity. In one patient (R.M.), the deficit encompassed all perceptual operations on faces, including matching identical views of the same faces, but it did not extend to all categories of objects characterized by a close similarity among their instances; the second patient (P.M.) exhibited a less severe perceptual impairment but was unable to derive the configurational properties from a facial representation and to extract its physiognomic invariants; the third patient (P.C.) had not lost the capacity to differentiate faces on the basis of their configurations but could not associate a facial representation with its pertinent memories. Associated deficits were present in each patient but differed depending on the anatomofunctional locus of the breakdown, although all patients were impaired at recognizing noncanonical views of objects that they readily recognized when shown from a conventional viewpoint. However, performance dissociation within patients and double dissociation between patients suggest that these associated deficits are not necessary concomitants of prosopagnosia.


Increased gut parasympathetic activity and chronic diarrhoea in a patient with the acquired immunodeficiency syndrome. A 25-year-old homosexual man with a 2-year history of watery diarrhoea and a 20 kg weight loss is described. He had been diagnosed HIV-1 antibody positive 6 years previously. Investigations excluded opportunist pathogens and other known causes of diarrhoea. A range of anti-diarrhoeal medication had been unsuccessful. Plasma levels of gastrointestinal and pancreatic peptides were normal and treatment with the somatostatin analogue, octreotide, which inhibits release of pancreatic/gut peptides, did not provide any benefit. Cardiovascular autonomic function tests revealed blunted pressor responses but no other abnormalities. Gastric emptying studies with a technetium labelled meal indicated rapid gastric emptying time. This was slowed by the anticholinergic drug, atropine. This suggested increased parasympathetic activity to the gut. He was, therefore, treated with the anti-cholinergic agent, propantheline bromide, which reduced the frequency and volume of stools. He put on weight and has remained well since. This case highlights the diagnostic challenge in HIV-associated chronic diarrhoea, the case for investigations of autonomic function, and the need for a therapeutic trial of anticholinergic drugs, when other measures have failed.


Emergence of connectivity in the embryonic rat parietal cortex. In order to understand how cortical circuitry is put together, we examined the emergence of corticofugal projection cells and the arrival of subcortical afferents in the presumptive parietal cortex of the embryonic rat cerebrum. Afferent and efferent projections were selectively labeled by applications of the lipophilic tracers DiI and DiA in aldehyde-fixed brains of 12-18-d-old rat embryos (E12-E18; gestation: 21 d). On E12 and E13, the neocortical anlage consists of a ventricular zone and a preplate, with no extracortical connections. By E14, just prior to the appearance of the cortical plate, polymorphic cells located in the ventrolateral preplate of the telencephalic vesicle send out the first group of corticofugal axons toward the ganglionic eminence. Shortly thereafter, the cortical plate emerges as a dense band of radially oriented cells that also contribute to the corticofugal projection. By E15, axons of the early cortical projection cells cascade through the striatal primordium, the future site of the internal capsule. At the time of cortical plate formation and initial corticofugal axon outgrowth, ascending corticopetal axon systems have not yet arrived in the neocortex. Double-labeling experiments in which one dye is placed in the neocortex and the other in the ipsilateral dorsal thalamus reveal that cortical efferents encounter the first ascending wave of thalamofugal axons at the level of the striatum. Collectively, these two axonal systems bridge the necortex and the diencephalon. Upon their arrival in the neocortex on E16, thalamic axons follow a ventrolateral to dorsomedial course within the intermediate zone. Thalamic axons are the first subcortical afferent system to arrive in the neocortex. Other ascending afferent systems arising from the midbrain tegmentum enter the neocortex after E17. Comparison of thalamocortical and tegmentocortical projections in two halves of the same brain and across various embryonic ages clearly reveals that the two projection systems differ in their trajectories as well as in their time of arrival. Present observations challenge the view that the precocious arrival of subcortical axons provides the impetus for cortical maturation, and suggest that cortical plate differentiation and the initial organization of corticofugal projection patterns occur independent of ascending pathways.


Implicit access to knowledge derived from unrecognized faces in prosopagnosia. Prosopagnosia is an acquired neurological impairment characterized by an inability to experience a feeling of familiarity at the view of faces of known individuals and to identify these individuals. The inability of prosopagnosic patients to recognize faces does not entail that perceived faces go unprocessed in their brains, and there are indications that cognitive operations are still performed whereby a perceived face reactivates pertinent memories, but either these operations cannot be completed or their outcome fails to reach consciousness. A series of experiments were conducted on three severe prosopagnosic patients in an attempt to understand better this phenomenon known as covert face recognition, the conditions for its occurrence, and its functional locus. The capacity of the patients implicitly to access pertinent knowledge related to overtly unrecognized faces was inversely related to the severity of their perceptual deficit, suggesting that some preserved ability to extract the physiognomic invariants of a face is a necessary condition for the occurrence of the phenomenon. However, the results indicated that covert recognition does not take place at a perceptual or structural level although it is initiated at such a level, that it may have more than one underlying mechanism, and that it is achieved through the reactivation of specific information related to the individual's identity. Under special conditions that restricted the relevant knowledge that needed to be activated, transient overt recognition of faces was experienced by one of the prosopagnosic patients.


Effects of plasmapheresis on short-term variability of blood pressure in healthy donors. The acute effect of mild central hypovolaemia induced by plasmapheresis on the short-term variability of blood pressure and heart rate was evaluated in ten healthy donors. Indirect finger blood pressure was measured by a non-invasive device (Finapres). Analogue-to-digital conversion of the blood pressure was used to determine systolic, diastolic and mean blood pressure and heart rate every second. The equidistant sampling allowed a direct spectral analysis using a fast Fourier transform algorithm. Blood pressure and heart rate were maintained while an increased overall variability of blood pressure was observed after plasmapheresis. The increased total area under the curve of the systolic and diastolic blood pressure spectra was documented with the selective analysis of the three main components of the spectra: the increase in the oscillations of blood pressure following plasmapheresis predominated in the 66-129 mHz region, corresponding to Mayer waves. The spectral profile of HR was unaffected by plasmapheresis. The significant increase in the 10-s period oscillations of blood pressure after the mild central hypovolaemia could result from the unloading of cardiopulmonary (and arterial) baroreceptors which in turn could buffer the arterial pressure through sympathetic activation, detected on the systolic and diastolic pressure spectra in the low-frequency range.


In vivo myeloarchitectonic analysis of human striate and extrastriate cortex using magnetic resonance imaging. A primary goal of investigations into the organization of human cerebral cortex is to determine the functional specificity of architectonic regions. This includes the correlation of neurobehavioral deficits with neuropathological data for clinical diagnosis and treatment, and the identification of active brain regions using functional neural imaging techniques, such as positron emission tomography, electroencephalographic and magnetoencephalographic (EEG and MEG) source localization algorithms, and direct cortical stimulation. Currently, the architectonic classification of a cortical region identified by these methods is inferred from the comparison of its cerebral topographic position to cytoarchitectonic brain atlases. However, substantial intersubject variability in the position of cytoarchitectonic regions with respect to cerebral topographic landmarks may lead to errors in this procedure. An alternative method is presented here, which uses magnetic resonance (MR) imaging to identify myeloarchitectonic regions of isocortex directly by estimating the relative concentration of myelin within cortical laminae. This high-resolution MR protocol is used to identify striate cortex (Brodmann's area 17) and extrastriate cortex in vivo. Correspondence of MR signal intensity with myeloarchitectonic data from a postmortem brain confirms this identification. As MR imaging technology improves, this noninvasive method has the potential to identify and discriminate among at least 50 cortical regions in the living human brain.


Elevation of plasma atrial natriuretic peptide occurs during adrenaline infusion in hypertensive but not normotensive subjects. The levels of plasma atrial natriuretic peptide in response to graded adrenaline infusion were determined in six patients with essential hypertension and six healthy normotensive subjects (controls). Basal plasma adrenaline concentration was similar in both groups and rose progressively and to a similar level during adrenaline infusion. Plasma noradrenaline rose in both groups and to the same extent during the 26 and 39 ng/kg/min adrenaline infusion rates. Basal plasma atrial natriuretic peptide levels were higher in the hypertensives than in the controls. Graded adrenaline infusion had no effect on atrial natriuretic peptide levels in the controls but significantly raised atrial natriuretic peptide levels in the hypertensives. Systolic blood pressure rose progressively during adrenaline infusion at a lower infusion rate in the hypertensives than in the controls. Similarly, while heart rate rose during adrenaline infusion in both groups, there was a greater rise in the hypertensives. The increased cardiovascular responsiveness to adrenaline infusion in patients with essential hypertension may explain why plasma atrial natriuretic peptide levels rose only in this group and not the normotensive subjects.


Multiplicity of inputs in the afferent path to cat auditory cortex neurons revealed by tone-on-tone masking. This report presents preliminary evidence on the effect of continuous tonal maskers on the responses of single primary auditory cortical neurons in anesthetized cats to tonal signals across their effective frequency ranges 10 dB above characteristic frequency threshold. Tonal maskers had three kinds of effects. In many cells, the masker produced a generalized suppression of responses to tones across the response area. In some neurons, typically those with monotonic intensity profiles, tonal maskers on one side of the response area produced a selective suppression of responses to tone signals on the same side as the masker. This differential sensitivity to the masker is evidence of independent inputs to those neurons on the high- and low-frequency sides of their excitatory response areas. Finally, in non-monotonic neurons, tonal maskers at the high-frequency edge of the excitatory response area produced enhanced responses to tonal signals on the same side of the response area as the masker. We interpret this as a release from the effect of an inhibitory input located at the high-frequency edge of the response area.


Autonomic responses to carbohydrate ingestion and head-up tilt in elderly subjects with orthostatic hypotension. To investigate the role of glucose and insulin in the development of hypotension following glucose ingestion in elderly subjects with orthostatic hypotension, the autonomic responses to glucose and xylose ingestion were studied in five elderly subjects with age related orthostatic hypotension (without autonomic failure), five elderly control subjects and three elderly subjects with evidence of autonomic failure. Heart rate, blood pressure, plasma noradrenaline and plasma arginine vasopressin responses to glucose ingestion and to xylose ingestion were investigated. All subjects were supine for 90 min following ingestion of each carbohydrate and were then tilted 45 degrees head-up for 10 min. Blood pressure was maintained in elderly control subjects following ingestion of both carbohydrates and during tilting. The elderly group with orthostatic hypotension, while supine had a fall in systolic blood pressure 60-90 min following both glucose and xylose ingestion. Diastolic blood pressure was lowered 60-90 min after glucose but not xylose. During tilting, blood pressure fell by similar levels following both carbohydrate ingestions; plasma noradrenaline levels after 2 min and plasma arginine vasopressin levels after 10 min tilting were significantly less following glucose ingestion compared to xylose ingestion. The autonomic failure group while supine had a fall in systolic blood pressure 60-90 min following both glucose and xylose ingestion. Diastolic blood pressure was lowered 60-90 min after glucose but not xylose. During tilting, blood pressure fell by similar levels following both carbohydrate ingestion. Plasma noradrenaline and arginine vasopressin levels were unchanged after ingestion of either carbohydrate, and during tilting.(ABSTRACT TRUNCATED AT 250 WORDS)


Time-frequency dynamics in neurally mediated syncope. In this study, the responses during syncope were determined by noninvasive beat-to-beat analysis during passive orthostasis. Twenty patients with recurrent unexplained syncope (13 men and seven women) and ten healthy aged-matched control subjects were studied during 80 degrees head-up tilt for 25 min. Time-frequency mapping of R-R intervals, systolic and diastolic pressures and respiration was used to determine the responses to tilt. The spectral estimation was based on a modified Wigner distribution and the frequency content was evaluated on a beat-to-beat basis. Ten patients developed syncope (tilt-positive group) during tilt, while the remaining ten were asymptomatic (tilt-negative group). Control subjects reacted to tilt by the immediate shortening of R-R intervals to a plateau with an accompanying moderate increase in diastolic pressure. In the tilt-negative group the responses to tilt were similar, but of greater amplitude. In contrast, in the tilt-positive group, R-R intervals gradually and continuously decreased with tilt while systolic and diastolic pressures increased until shortly before syncope, when an abrupt fall in blood pressure followed by R-R intervals lengthening occurred. Furthermore, the R-R intervals fluctuations at both respiratory and nonrespiratory frequencies were the highest at rest as well as during tilt in the tilt-positive group. Nonrespiratory fluctuations in blood pressure increased more during tilt in both tilt-positive and negative groups compared to the control group. The nonrespiratory fluctuations in R-R intervals and blood pressure reached a maximum at syncope, simultaneously with hypotension and bradycardia. Time-frequency mapping has demonstrated that an elevated parasympathetic tone at rest which persists during orthostasis identifies patients prone to vasodepressor syncope. The counteracting sympathetic activation is not sustained and results in hypotension followed by cardioinhibition and loss of consciousness.


Portable infrared pupillometry using Pupilscan: relation to somatic and autonomic nerve function in diabetes mellitus. The relationship between dynamic pupillary function and peripheral nerve function was studied in 85 randomly-selected diabetic patients and 67 age-matched normals using a portable infrared pupillometer (Pupilscan Version 5). Seven measurements were chosen to represent different components of the pupillary constriction-redilatation curve after a standardized light stimulus. Constriction latency was significantly prolonged in diabetic patients (p = 0.05), as was time to 63% redilatation (p = 0.001). Thermal thresholds at the feet weakly correlated with relative reflex amplitude (warm: r = -0.22, p = 0.05; cool: r = -0.23, p = 0.05), but vibration perception thresholds were more strongly associated with constriction and redilatation velocity (r = -0.42, p = 0.001; r = -0.28, p = 0.03). Among the cardiovascular autonomic function tests, only respiratory R-R variation correlated with constriction velocity (r = 0.47, p < 0.001), and Valsalva ratio with redilatation velocity (r = 0.25, p = 0.04), but postural systolic blood pressure change was also correlated with reflex amplitude and latency time (r = -0.42, p < 0.001; r = 0.41, p = 0.001). There were no significant associations with three measures of sweating function in the feet. Pupil measurements were abnormal in 4-11% of diabetic patients, while other neurological tests were abnormal in 8-35%, consistent with the length-dependence of diabetic neuropathy. Median coefficients of variation were 2.0-7.2% in diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Suprasensitivity to calcitonin gene-related peptide but not vasoactive intestinal peptide in women with chronic pelvic pain. Chronic pelvic pain in women is associated with radiological evidence of pelvic venous dilatation and reduced flow, termed 'pelvic congestion'. The aim of this study was to elucidate a possible role in this condition for vasoactive intestinal peptide and calcitonin gene-related peptide, both localized in perivascular nerves in the ovaries and uterus. Healthy volunteers and women with chronic pelvic pain and venous congestion received intravenous infusions of vasoactive intestinal peptide (n = 15), calcitonin gene-related peptide (n = 15) or a bland infusate (n = 7). Changes in the uterovaginal and skin blood flow were assessed by continuous measurement of vaginal, axillary, cheek and hand temperature. During calcitonin gene-related peptide infusion median hand temperature changes were +0.97 degrees C in women with pelvic pain and -0.03 degrees C in healthy volunteers (p < 0.05). There were no differences between groups in hand and cheek temperature responses to vasoactive intestinal peptide infusion. Vasoactive intestinal peptide and calcitonin gene-related peptide appeared to dilate the uterovaginal vasculature in healthy subjects but not in those with pelvic pain. Vasoactive intestinal peptide and calcitonin gene-related peptide did not provoke pain in healthy subjects but in those with pelvic pain, symptoms were significantly exacerbated during calcitonin gene-related peptide infusion but not by vasoactive intestinal peptide. Changes in plasma follicle stimulating hormone, luteinizing hormone and oestradiol during either infusion were not significant. These findings indicate greater sensitivity to calcitonin gene-related peptide in women with pelvic pain and suggest a possible underlying neurovascular disorder.


Endoscopic transthoracic sympathectomy for idiopathic upper limb hyperhidrosis. A 5-year experience of 51 endoscopic transthoracic dorsal sympathectomies for idiopathic palmar hyperhidrosis in 26 patients is presented. Fifty-two percent complained of excessive sweating over their hands, 28% of axillary sweating and 20% over both areas, with a mean duration of 10 years. The second, third and fourth thoracic ganglia and their interconnecting fibres on the affected side were ablated using diathermy cautery. Over a mean follow up time of 26 months, this procedure was successful in curing or improving intractable sweating in 92%. However, axillary sweating was less well controlled than in the palms with 20% of patients describing residual wetness in the axilla. Compensatory sweating (75%) and gustatory sweating (48%) were the commonest side effects; despite this, most patients were satisfied with the functional and cosmetic outcome. Other complications included a temporary Horner's syndrome in one patient, a pneumothorax in the immediate post-operative period in another and a unilateral non-infective reactionary pleural effusion in a third. Two patients developed recurrence of palmar hyperhidrosis within 6 months of surgery. One has been successfully treated by re-operation on the affected side. All patients complained of mild to moderate interscapular chest pain which was easily controlled by non-steroidal anti-inflammatory agents, and resolved within 7-10 days post-operatively. The technique of endoscope transthoracic sympathectomy is effective, relatively simple to perform and usually requires only an overnight stay. It is recommended as the surgical treatment of choice for upper limb hyperhidrosis unresponsive to conservative measures.


Temazepam misuse in a group of injecting drug users. It is well recognized that many injecting drug users are poly-drug users. The intravenous use of Temazepam has become popular recently. In response to the ease of misuse, the pharmaceutical industry produced a formulation that would be as 'resistant' as possible to injecting. The preparation is a gel-filled formulation, one proprietary name being Temazepam Gelthix. General Practitioners have been encouraged to prescribe gel-filled capsules to potential drug misusers in order to reduce the harm Temazepam can cause by its misuse. This study of 23 Temazepam injectors shows that the group still find the gel-filled preparation readily injectable. It appears to be more problematic in causing medical complications including superficial thrombophlebitis, abscesses and deep venous thrombosis. Temazepam misuse can cause drug users to become more chaotic. The study group recognize this and suggest there should be stricter control on the supply of Temazepam to drug dependents. General Practitioners, who are the main source of Temazepam prescribing, require additional training in prescribing to drug users.


The prices of alcoholic beverages in the Nordic countries. Apart from Denmark, all the Nordic countries have state-owned monopolies which handle all of the off-premise retail sales of wine and spirits. In some of the countries, the state monopoly also distributes strong and medium-strong beer. This paper discusses how the prices of beer, wine and spirits are set in the Nordic countries and compares the setting of prices in each. The paper shows that there are great differences both between the prices of alcoholic beverages in the Nordic countries and between the price-fixing mechanisms. The main part of the price differential is due to differences in taxation, but substantial discrepancies still exist when we look at prices exclusive of alcohol taxes. The reason for this is to be found in differences in profits and in the efficiency of producing and distributing alcoholic beverages. According to our data, it seems that some of the state monopolies are more effective than firms in the Danish market.


Legislating responsible alcohol service: an inside view of the new Liquor Licence Act of Ontario. The Ontario Government has recently passed a new Liquor Licence Act, based on the recommendations of a special advisory committee. This paper describes how the advisory committee framed the issues and arrived at a lengthy document detailing 73 recommendations on issues such as licence classification, the control of special permit functions, days and hours of operation, legal drinking age, alcohol advertising, the civil liabilities of alcohol providers and server training. The key actors and considerations are discussed, as well as the subsequent Cabinet action on the report and the implementation process currently underway. The paper concludes with an assessment from both an administrative and a public health perspective, with particular attention to the limited role which research played in these policy decisions.


The difference context makes: Americans' views on abstinence and impairment. While it is acknowledged that social norms play a role in determining acceptable drinking levels, there has been little research on the factors that determine approved or prohibited consumption levels in particular social contexts. This paper investigates the factors that influence the choice of abstention or impairment (as compared to 'social drinking') through an analysis of the 1984 survey of American drinking patterns using logistic regression, a method that allows the separate identification of social and demographic factors that encourage abstention or impairment. Results show that although the effects of drinking status variables (such as lifelong abstainer) are contextually neutral, most social and demographic characteristics have differential effects depending on the specific context and the choice of abstention or impairment.


Tobacco smoking in Moscow school students. A cross-sectional study on tobacco smoking prevalence and related socio-psychological parameters in Moscow school students aged 10-17 was performed. Data from an anonymous self-report (n = 4802) on smoking prevalence was confirmed by special technique--expert assessment. Widespread smoking was found: among male 5th graders (the youngest group) 14.4% are smokers (those who smoked at least 1 cigarette over the past 3 months); among male 10th graders (oldest group) 53.2% smoke; among females these figures were 0.8% for the youngest students and 28.2% for the oldest ones. A significant difference in awareness of smoking health hazards and attitudes towards the habit was shown among school students with various smoking statuses. Complaints about cough and shortness of breath after light physical stress were significantly more prevalent in regular smokers as compared to non-smokers. The possible causal role of some psychological factors in early formation of smoking habit is discussed.


Alcohol placebos: you can only fool some of the people all of the time. Some data from three studies of the acute psychological effects of alcohol are presented. After blind administration subjects could often tell that they had consumed alcohol, presumably because of its physiological effects. About 50% of subjects who received placebo alcohol felt slightly drunk and guessed that they had received alcohol. But, subjects who had actually received alcohol rated themselves as more drunk and were much more likely to guess that they had received alcohol. Subjects could also approximately estimate how much alcohol they had drunk. These findings suggest that the effects of unblinding should be considered when alcohol is administered in placebo designs. True blind placebo administration may only be possible when achieved BAL is < 40 mg/100 ml.


The prevalence of illicit drug use in six metropolitan areas in the United States: results from the 1991 National Household Survey on Drug Abuse. National levels and trends of illicit drug use in the general population are well documented. However, little is known about how this phenomenon is distributed among various subnational areas such as state, metropolitan area, and other local areas. The sample design from the National Household Survey on Drug Abuse (NHSDA) was recently expanded such that estimates from several large metropolitan areas could be produced with reasonable precision. The prevalence of illicit drug use is examined in six large metropolitan areas of the United States. These findings indicate that, in some cases, drug use varies considerably by metropolitan area.


Schwann cells: early lineage, regulation of proliferation and control of myelin formation. This article reviews selected topics of particular relevance for understanding the process of Schwann cell development. It will discuss early commitment to the Schwann cell lineage and Schwann cell precursors, regulation of Schwann cell proliferation, and regulation of myelin formation.


Reconstituting animals from immortal precursors. Several recent experiments have shown that immortal neural and muscle cells retain the specific temporal and spatial properties of their precursor cells in the animal. In addition, the immortal cells retain the ability to differentiate in vitro and, after transplantation, in vivo. The results of these experiments suggest that the use of precursor cell lines may lead to powerful approaches for understanding the mechanisms that generate the ordered distribution of cell types in mammals.


Cell adhesion molecules, second messengers and axonal growth. Recent studies on NCAM-related molecules suggest that individual cell adhesion molecules might function to both promote axonal growth during development and maintain synaptic structure in the adult. Evidence that differential alternative splicing contributes to this apparent bifunctionality of cell adhesion molecules is discussed.


Neuronal polarity.

Neuronal polarity. The axonal and somatodendritic domains of neurons differ in their cytoskeletal and membrane composition, complement of organelles, and capacity for macromolecular synthesis. Recently there has been progress in elucidating the cellular mechanisms that underlie the establishment and maintenance of neuronal polarity, including microtubule organization and the sorting, transport, and anchoring of membrane proteins.


Membrane trafficking in neurons.

Membrane trafficking in neurons. Neurons possess an unusually extensive Golgi apparatus and exhibit a variety of active endocytic-like processes. The Golgi apparatus and the endocytic phenomena both contribute, probably in multiple overlapping ways, to the genesis and fate of the membrane systems in axons and terminals.


Neuronal cytoskeleton and growth.

Neuronal cytoskeleton and growth. The involvement of the cytoskeleton in the expression of neuronal morphology is most obvious in its support of neurite extension and the motile activity of growth cones. Techniques permitting direct observation of the dynamics of proteins in living cells, along with attempts to assay protein function in vivo, are testing existing models for cytoskeletal function in neurons, as well as generating more detailed models at the molecular level.


Phototransduction in Drosophila: a paradigm for the genetic dissection of sensory transduction cascades. A combination of molecular, genetic and physiological studies is providing fundamental insight into the function and regulation of the phototransduction cascade. The availability of Drosophila mutants with defects in visual physiology allows for an in vivo dissection of this complex sensory signal transduction process.


Natural and experimental prion diseases of humans and animals. Prions cause transmissible and genetic neurodegenerative diseases. Infectious prion particles are composed largely, if not entirely, of an abnormal isoform of the prion protein (PrPSc), which is encoded by a chromosomal gene. Although the PrP gene is single copy, transgenic mice with both alleles of the PrP gene ablated develop normally. A post-translational process, as yet unidentified, converts the cellular prion protein (PrPC) into PrPSc. Scrapie incubation times, neuropathology and prion synthesis in transgenic mice are controlled by the PrP gene. Mutations in this gene are genetically linked to the development of neurodegeneration. Transgenic mice expressing mutant PrP spontaneously develop neurological dysfunction and spongiform neuropathology. Future investigations of prion diseases using molecular biological and genetic approaches promise to yield much new information about these once enigmatic disorders.