Inhibition of early and late events of the HIV-1 replication cycle by cytoplasmic Fab intrabodies against the matrix protein, p17

BACKGROUND

The HIV-1 matrix (MA) protein, p17, contains two subcellular localization signals that facilitate both nuclear import of the viral preintegration complex early during infection and virus particle assembly late in infection. The dual role of MA in both the afferent and efferent arms of the HIV-1 life cycle makes it an important target for intracellular immunization-based gene therapy strategies.

MATERIALS AND METHODS

Here we report, using a new bicistronic vector, that an intracellular Fab antibody, or Fab intrabody, directed against a carboxy-terminal epitope of MA from the Clade B HIV-1 genotype, can inhibit HIV-1 infection when expressed in the cytoplasm of actively dividing CD4+ T cells.

RESULTS

Marked inhibition of proviral gene expression occurred when single-round HIV-1 CAT virus was used for infections. In challenge experiments using both laboratory strains and syncytium-inducing primary isolates of HIV-1, a substantial reduction in the infectivity of virions released from the cells was also observed.

CONCLUSIONS

This novel strategy of simultaneously blocking early and late events of the HIV-1 life cycle may prove useful in clinical gene therapy approaches for the treatment of HIV-1 infection and AIDS, particularly when combined with genetic or pharmacologic-based strategies that inhibit other HIV-1 target molecules simultaneously.

Protein kinase C induced calcium influx and sustained enhancement of ciliary beating by extracellular ATP

The major purpose of this work was to determine protein kinase C (PKC) influence on ciliary beat frequency (CBF) and to assess participation of PKC in purinergic ciliary stimulation. The experiments were performed by simultaneous measurement of [Ca2+]i and CBF on tissue culture of frog esophagus epithelium. The PKC activators TPA and DiC8 produced significant elevation of [Ca2+]i and strong frequency enhancement. The calcium elevation was inhibited by lowering the extracellular calcium level, or by La3+, but was unaffected by verapamil and the phospholipase C inhibitor U-73122, suggesting that Ca2+ influx was via non-voltage-operated calcium channels. The inhibition of [Ca2+]i elevation resulted in corresponding inhibition of CBF enhancement. The effect of TPA was blocked by the selective PKC inhibitors chelerythrine, calphostin C, and GF109203X, and by the enzyme downregulation. The downregulation of PKC, or the enzyme inhibitors did not affect the immediate response to extracellular ATP but caused rapid decay of initially stimulated [Ca2+]i and CBF to the basal level. These results suggest that PKC produces CBF enhancement via activation of calcium influx through non-voltage-operated calcium channels. This calcium influx seems to be responsible for the duration of ciliary stimulation produced by the extracellular ATP.

The impact of thiazide diuretics on the initiation of lipid-reducing agents in older people: a population-based analysis

OBJECTIVE

The objective of this study was to examine how often treatment for hyperlipidemia followed the use of thiazides, compared with the use of other antihypertensive drugs, in older patients.

DESIGN

Retrospective follow-up of all health claims filed over a 12-month period.

SETTING

New Jersey Medicaid and Medicare programs.

PARTICIPANTS

A total of 9274 enrollees, aged 65 to 99, who were newly initiated on antihypertensive medications from 1981-1989.

MEASUREMENTS

We measured rates of lipid-reducing agent (LRA) initiation among patients in the 2 years following antihypertensive initiation (thiazide, non-thiazide drug, or combinations of the two) compared with rates among patients not currently taking antihypertensive agents. We used Cox regression analyses to estimate relative risks (RR), accounting for switching in antihypertensive therapy and for time when drug therapy was not currently available according to pharmacy refill records.

RESULTS

There were 226 patients (2.4%) in the cohort who were started on LRA during the follow-up period. After adjusting for potential confounders, we found no significant relationship between LRA initiation and overall thiazide use (RR 1.47, 95% CI 0.89-2.40), or other antihypertensive use, relative to no current exposure. However, use of high-dose thiazides (> or = 50 mg) was associated significantly with LRA initiation (RR 1.97, 95% CI 1.12-3.45). Factors associated with decreased incidence of LRA use included age > or = 85 (RR 0.59, 95% CI 0.36-0.96), black race (RR 0.58, 95% CI 0.37-0.91), and nursing home residency (RR 0.20, 95% CI 0.11-0.35).

CONCLUSION

Use of low-cost and effective thiazide diuretics in older hypertensives was not associated with more common initiation of lipid-reducing agents, except with high-dose use of thiazides currently seen as inappropriate in most cases. Age and race were important determinants of LRA use.

Actions of lidocaine on reentrant ventricular rhythms in the subacute myocardial infarction period in dogs

The actions of lidocaine were studied in 18 dogs, 4 days after ligation of the left anterior descending artery, by computerized mapping. Lidocaine only occasionally suppressed the induction of reentry. At fast heart rates, lidocaine actually facilitated the induction of reentry. The effects on conduction and refractoriness of normal and ischemic myocardium were measured using high-resolution techniques. Lidocaine promoted reentry by a rate-dependent increase in refractory gradient, resulting in additional block, and a selective decrease in conduction velocity in ischemic tissue, resulting in additional conduction delay. Lidocaine could prevent reentry through a rate-independent differential increase in refractory period gradient at the entrance to the common pathway of the circuit, causing block of the reentrant impulse. We conclude that the proarrhythmic effect of lidocaine is due to increased conduction delay and block while the antiarrhythmic effect is due to block of the reentrant impulse by prolonged refractoriness in the common pathway.

Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender, and race

OBJECTIVES

This study measured compliance and related demographic factors in a retrospective cohort of 4068 elderly outpatients newly starting antihypertensive therapy from 1982 through 1988.

METHODS

Logistic regression modeling of data from the New Jersey Medicaid program was used.

RESULTS

These patients filled antihypertensive prescriptions covering an average of only 179 days in the 365-day follow-up period (49%) Good compliance (> or = 80%) was associated with advanced age (odds ratio [OR] = 2.12, for patients 85 or older) and White race (OR = 0.55 for Blacks). There was no relationship between compliance and gender.

CONCLUSIONS

Despite the efficacy of antihypertensive therapy in preventing cardiovascular morbidity, such high rates of noncompliance may contribute to suboptimal patient outcomes.

Meckel's diverticulum. Internal hernia and adhesions without gastrointestinal bleeding--ultrasound and scintigraphic findings

The results from an ultrasound study performed on an 11-year-old boy, who had several weeks of intermittent abdominal pain, showed a nonperistaltic loop of bowel near the umbilicus, which suggested either an internal hernia or a diverticulum. Tc-99m pertechnetate imaging showed a focal collection near the umbilicus, which was consistent with a Meckel's diverticulum. No evidence was found of gastrointestinal bleeding. Exploratory laparotomy showed a Meckel's diverticulum near the terminal ileum and attached to the anterior abdominal wall close to the umbilicus. Small bowel had herniated through the loop formed by the terminal ileum and the diverticulum.

A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty

OBJECTIVES

The purpose of this study was to determine prospectively whether the differences in anticoagulant and antiplatelet effects of ionic and nonionic contrast media after angiographic or clinical outcomes in patients with unstable ischemic syndromes undergoing percutaneous transluminal coronary angioplasty.

BACKGROUND

The interaction of platelets and thrombin with the endothelium of injured vessels contributes to thrombosis and restenosis after coronary angioplasty. Case reports and retrospective observations have reported an increased risk of thrombosis with the use of nonionic contrast media.

METHODS

A total of 211 patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty were randomized to receive nonionic or ionic low osmolar contrast media. Coronary angiograms were assessed by a technician blinded to the study contrast media, and clinical events were monitored by an independent nurse for 1 month.

RESULTS

Patients receiving the ionic media were significantly less likely to experience decreased blood flow during the procedure (8.1% vs. 17.8%, p = 0.04). After the angioplasty, residual stenosis, vessel patency, the incidence of moderate to large thrombi and use of adjunctive thrombolytic therapy were similar between the two groups. However, patients receiving ionic media had fewer recurrent ischemic events requiring repeat catheterization (3.0% vs. 11.4%, p = 0.02) and repeat angioplasty during the initial hospital stay (1.0% vs. 5.8%, p = 0.06). One month after angioplasty, patients receiving ionic contrast media reported significantly fewer symptoms of any angina (8.5 vs. 20.0%, p = 0.04) or of angina at rest (1.4% vs. 11.8%, p = 0.01) and a reduced need for subsequent bypass surgery (0% vs. 5.9%, p = 0.04), compared with patients receiving the nonionic media.

CONCLUSIONS

These findings demonstrate that in patients with unstable ischemic syndromes undergoing coronary angioplasty, the use of ionic low osmolar contrast media reduces the risk of ischemic complications acutely and at 1 month after the procedure. Therefore, low osmolar ionic contrast media should be strongly considered when performing interventions in patients with unstable angina or myocardial infarction.

Temporal variation in drinking water turbidity and diagnosed gastroenteritis in Milwaukee

Daily counts of diagnosed gastroenteritis (gastrointestinal events) in Milwaukee County, Wisconsin, from January 1992 through April 1993 were compared with reported daily turbidity from the two drinking water treatment plants serving the county. Turbidity in both plants was associated with an increased number of gastrointestinal events even after exclusion of a major documented outbreak of cryptosporidiosis. During the 434-day period prior to the outbreak, an increase in turbidity of 0.5 nephelometric turbidity units at one of the plants was associated with relative risks for gastrointestinal events of 2.35 among children (95% confidence interval [CI] = 1.34, 4.12) and 1.17 among adults (95% CI = 0.91, 1.52).

Altered contractility of rabbit penile corpus cavernosum smooth muscle by hypoxia

PURPOSE

To investigate the effects of severe hypoxia on trabecular smooth muscle contractility.

MATERIALS AND METHODS

Strips of rabbit corpus cavernosum were mounted in organ chambers to measure isometric tension. In some experiments intracellular free Ca2+ concentration and tension were measured by the intracellular fluorescent dye FURA-2 and isometric tension recording simultaneously.

RESULTS

Contractions elicited by norepinephrine, endothelin-1 or potassium were attenuated under hypoxic conditions (pO2 approximately 10 mm. Hg). Strips contracted with 20 mM. K+ under normoxic conditions and then exposed to hypoxia consistently lost the potassium-induced tone. The hypoxia-induced relaxation was not affected by the removal of the endothelium, by treatment with the cyclooxygenase blocker, indomethacin, or with the guanylate cyclase blocker, methylene blue. The potassium channel opener, cromakalim, and adenosine relaxed potassium contracted strips; however, the potassium channel blockers glibenclamide, apamin, barium chloride and charybdotoxin or the adenosine receptor antagonist 8-(p-sulfonyl)theophylline were unable to prevent hypoxia-induced relaxation. Tetraethylammonium, a potassium channel blocker, and the depolarizing agents ouabain and high potassium (80 mM.), partially prevented hypoxia-induced relaxation. The calcium ionophore, ionomycin, had no effect on hypoxia-induced relaxations. Hypoxia, within 2 to 6 minutes, caused a large accumulation in intracellular calcium, concomitant with a loss of trabecular smooth muscle tone. Both these effects could be reproduced by inhibiting oxidative phosphorylation with 2,4,dinitrophenol. Reoxygenation resulted in an immediate recovery of both tone and intracellular calcium levels. Tissues under hypoxic conditions for 30 minutes had a 24% and 67% decrease in the ATP/ADP ratio and in creatine phosphate concentrations, respectively.

CONCLUSION

Hypoxia causes a simultaneous increase in intracellular calcium and relaxation which, we propose, is the consequence of inhibition of oxidative phosphorylation with loss of high energy phosphates, necessary for the homeostasis of Ca2+ and the contractile mechanism of the cavernosal smooth muscle.

The advocacy role in hospital social work

Hospital social workers were asked to describe their roles and functions, with particular emphasis on the amount of time spent doing traditional advocacy on behalf of patients. The results indicated that workers spent the least amount of time on advocacy as compared with other traditional social work roles. A case is made for emphasizing the advocacy role as a strategy to counteract the potentially negative effects on social work of organizational changes in Canadian hospitals. The implications of the findings for schools of social work, professional associations and employers of social workers are discussed.

Communicating with the schizophrenic superego

The procedure reported here, which I have called "conversations with superegos," raises a number of important questions, both about ordinary versus psychopathological psychic structure, and about technique. There is no space to enter into a lengthy discussion, but a few brief points may be in order. First, let us consider the issue of psychic structure. I have argued that the superego is a hostile agency within the mind whose operations are essentially inimical to the patient's growth and well-being. (As an element of psychic structure, the superego can be distinguished from the ego ideal on the basis of the associated affect, that is, guilt rather than shame. Similarly, it is possible that the superego may be constructed on the basis of identifications that are different than those that may form the basis of the ego ideal). Further, I have argued that the superego is neither a force for true moral development nor a platform for the voice of the patient's "better" nature, (although it purports to be until challenged). A structure that lies, manipulates, threatens, and appears to be motivated in the end solely by its own continued existence, must certainly be considered suspect as an authority on morality. On the contrary, I see true morality originating in the patient's ego, because in that structure lies the ability to identify with others. One could object, however, that this way of viewing the matter is an artifact of working with a particular patient population. That is to say, it might be the case that in psychotic and borderline psychotic conditions, the superego does function this way, whereas in healthy or neurotic conditions it does not. In a similar vein, it could be argued that a pattern of development that was sufficiently skewed so as to result in psychosis would be more than likely to have been peopled by hostile, punitive, and essentially destructive identification figures, such as could form the basis for a pathological superego, whereas in normal or neurotic development this might not be the case. I would disagree on the following basis: I believe that the course of development is laid out by nature; that is, events like the separation-individuation phase, the oral, anal, phallic, and oedipal phases occur in all of us. It is what happens in the course of that development that will lead either to normalcy or various degrees of pathology. For example, we all project. But it is whether we project an expectation that the next person we meet is a decent, civilized human being or a monster out to destroy us that causes us happiness or pain. That said, my own view of the matter is that the general principal holds for conditions other than the patients reported here, with the difference being one of degree. Where identification figures are essentially benign and foster the development of the self, then their strictures, whether moral or merely practical, would be likely to become assimilated into the ego, without the telltale restriction of reflection and autonomy together with the accompanying guilt that characterize the superego's activity, in which case, we are not talking about superegos at all. What distinguishes psychotic and neurotic development, in my view, is not the issue of whether superego operations are benign or not, but the degree to which the ego is compromised with the resulting formation of fantasy-introjects. I have found, as if it were a principal of physics, that the stronger the ego, the weaker the superego and vice versa. And when some energy of the superego is released, it appears to go directly into the ego without my intervention, though I sometimes ask the "brain's" opinion. The second issue concerns technique. In psychosis, the voice of the superego is very loud, so much so that there are times when I have had to shout to be heard. On the other hand, my patients report that the voice of the ego may be so quiet that the patient hasn't heard it at all, or hears it as a whisper. (ABSTRACT TRUN

The use of heated citric acid for dialyzer reprocessing

Dialyzer reprocessing with heated water (100 to 105 degrees C) for 20 h can be used safely in lieu of chemical methods for disinfection. All infective agents including spores are destroyed and depyrogenation may occur. However, these temperatures may result in structural damage to the dialyzer, limiting reuse. Dialyzer reprocessing by using 1.5% citric acid heated to 95 degrees C for 20 h is an alternative method that produces equivalent microbiologic effects. Citric acid is well known as a disinfecting agent used for dialysis equipment. Because there is little structural damage to dialyzer components at 95 degrees C, reuse statistics are improved (mean reuse increased to 12.8). Both small and large molecule clearances and the sieving coefficient for protein are insignificantly altered by the process. Whereas the procedure is relatively simple, quality-assurance indicators are essential. The method has appeal because it avoids the use of chemical germicides. However, at present it has only been tested thoroughly in polysulfone dialyzers with heat-resistant polycarbonate casings and polyurethane resin. The clinical experience is favorable.

Relations of oral imagery to thought disorder in subjects with frequent nightmares

Oral imagery was examined in the Rorschach protocols of 60 female subjects, 30 who experienced at least one nightmare per week and 30 who had no more than one nightmare in the past year. Mean number of oral responses did not differ between the groups. In subjects with nightmares, Rorschach orality was significantly related to many personality measures, including state and trait anxiety, Beck Depression Inventory scores, five subscales of a schizotypy inventory, the Rorschach penetration score, and two measures of pathological thinking on the Rorschach. In the 30 subjects without nightmares, the number of significant correlations did not exceed that expected by chance. The results are discussed within the context of empirical and theoretical reports about the links between the oral personality and pathological behavior.

Use of patient-controlled analgesia with alfentanil for extracorporeal shock wave lithotripsy

STUDY OBJECTIVE

To compare the efficacy of patient-controlled analgesia (PCA) to physician-controlled analgesia in patients undergoing extracorporeal shock wave lithotripsy (ESWL).

DESIGN

Prospective, randomized trial.

SETTING

New Jersey Kidney Stone Treatment Center at Robert Wood Johnson University Hospital, New Brunswick, NJ.

PATIENTS

62 ASA I, II, and III patients undergoing ESWL.

INTERVENTIONS

The control group (n = 29) received physician-controlled analgesia with continuous infusions (0.75 mcg/kg/min) and intermittent boluses (5 mcg/kg) of alfentanil. PCA patients (n = 33) initially received alfentanil 0.5 mcg/kg followed by a continuous background infusion (0.2 to 0.5 mcg/kg/min) and self-administered alfentanil (3 to 5 mcg/kg) with a 5-minute lockout period. Bolus doses and infusion rates were determined by patient comfort and cardiorespiratory response to alfentanil.

MEASUREMENTS AND MAIN RESULTS

Prior to the procedure, the patients completed two questionnaires (State-Trait Anxiety Inventory and Multidimensional Health Locus of Control Scales). During ESWL, blood pressure, heart rate, respiratory rate, oxygen saturation, end-tidal CO2, and pain and sedation levels were measured at 0, 800, 1,600, 2,400, and 3,000 shock waves. The total doses of alfentanil administered were calculated. PCA patients received 31% less alfentanil than control group patients (p < 0.0001). Patients with more preoperative anxiety required larger doses of alfentanil (p < 0.05). The pain level was slightly higher in the patients receiving PCA (p > 0.05) but most patients reported either no or only mild pain. Side effects from the therapy, such as nausea and vomiting, were either not present or were mild in both groups, with one patient (3% to 4%) in each group reporting mild nausea. Both patients and urologists were very satisfied with the pain management in both groups.

CONCLUSIONS

PCA is a useful alternative to physician-controlled analgesia during ESWL since it provides equivalent pain control while using less alfentanil.

Prevalence of antibodies against hepatitis A virus among new immigrants in Israel

Israel, located in a region endemic for hepatitis A virus (HAV), recently absorbed a large population of immigrants who came from the former USSR. To assess the risk of high morbidity in this population a serosurvey of HAV antibodies was undertaken. Serum samples were collected from 965 new immigrants, of whom 664 came from the European, non-endemic region, and 301 from the Asian and Caucasian endemic regions of the former Soviet Union. They were compared to 240 Israelis. Each population was divided into six age groups: 1-9, 10-19, 20-29, 30-39, 40-49, and 50 years of age and older. The Asian/Caucasian immigrants and the Israeli population were found to share similar characteristics. In both groups, antibodies to HAV (anti-HAV) were present in the 1-9-year-old age group and reached maximum prevalence (90% and 86.7%, respectively) in the 20-29-year-old age group. In contrast, among the European immigrants anti-HAV was first found in the 10-19-year-olds and peaked (93%) in the age group of 50 years and older. It is concluded that immigrants originating from the European part of the former USSR may require vaccination against hepatitis A.

Trends in medication choices for hypertension in the elderly. The decline of the thiazides

We studied the evolution in choice of antihypertensive therapy in the elderly over a seven-year period and defined factors associated with such prescribing. To accomplish this, we performed a retrospective analysis of 8428 enrollees older than 65 years of age in the New Jersey Medicaid and Medicare programs newly begun on antihypertensive therapy between 1982 and 1988. Diuretics were the most common agents prescribed (51%), followed by calcium channel blockers (14%), beta-blockers (13%), central adrenergic antagonists (11%), and angiotensin-converting enzyme inhibitors (5%). However, the use of diuretics declined sharply during the latter part of the time interval studied. Using logistic regression modeling, we determined that the odds of a subject being started on a diuretic compared with any other antihypertensive drug decreased from 1.0 during the referent years 1982 to 1984 to 0.75 in 1985 to 1986 and to 0.41 in 1987 to 1988, after controlling for demographics, comorbidity, and hospital and physician visits (P < .001). The relative odds of diuretic use were significantly increased (P < .05) for the oldest subjects (odds ratio, 1.28 for age 85 and older versus ages 65 to 74 odds), women (odds ratio, 1.15), and blacks (odds ratio, 1.14). Despite the growing evidence during the study interval of the efficacy of diuretics in treating hypertension in the elderly, diuretic use diminished throughout this period in relation to other antihypertensive drugs. Subject characteristics (oldest subjects, women, and blacks) were important determinants of physicians' choice of antihypertensive therapy.

Differential work assignments of social work practitioners in hospitals

This article reports the results of a survey concerning the differential assignment of tasks to social workers with bachelor of social work (BSW) and master of social work (MSW) degrees by social work directors in Canadian hospitals. It also provides data relative to the variation in amount of supervision provided to workers in those settings where both BSW-level and MSW-level workers perform the same tasks. It is intended that this study will yield useful information to assist the profession in defining the appropriate assignment of tasks to hospital social workers.

Effect of cromakalim and pinacidil on 86Rb efflux from guinea pig urinary bladder smooth muscle

86Rb efflux assay was used to investigate the effect of cromakalim, pinacidil and P1075 in guinea pig urinary bladder strips. The type of K channel opened by cromakalim and pinacidil was determined using specific K channel blockers through 86Rb efflux assay in detrusor strips. Cromakalim, pinacidil and P1075 all three potassium channel openers (PCOs) evoked a concentration-dependent increase in 86Rb efflux in bladder strips. This increase in isotope release was inhibited by pretreatment of bladder with 10 and 30 microM glibenclamide suggesting that both cromakalim and pinacidil interact with ATP-sensitive K channels (KATP). Further, an increase in basal 86Rb efflux was observed when 2-deoxy-D-glucose was substituted for glucose together with 0.24 micrograms/ml of oligomycin (known to lower intracellular ATP) indicating the presence of KATP channels in bladder smooth muscle. Charybdotoxin and apamin, blockers of large and small conductance Ca(2+)-dependent K channels, were found not to be involved in the action of these PCOs in bladder strips. alpha-Dendrotoxin, known to block voltage-dependent K channels, slightly reduced pinacidil-induced 86Rb release without affecting cromakalim-induced 86Rb efflux. The present studies show that ATP-sensitive K channels are present in guinea pig urinary bladder and that cromakalim and pinacidil act by opening these ATP-sensitive K channels in detrusor strips.

Unusual immunocytochemical and ultrastructural features of synovial fluid cells in multicentric reticulohistiocytosis. A case report

We present the first report in which cells in synovial fluid from a patient with multicentric reticulohistiocytosis (MRH) were studied by immunocytochemistry for correlation with routine light and electron microscopy. MRH cells stained predominantly for lymphocyte-related surface antigens and not for the monocyte marker LEU M3 (CD14). These findings suggest a lymphocytic origin of MRH cells and not a histiocytic origin, as previously suggested. In addition, large numbers of membrane-bound, electron-dense, secretory-type granules were found ultrastructurally in the cytoplasm of these cells.

The VNA (visiting nurse association) and SCP (senior companion program) program: a natural partnership

Senior companions can be the eyes and ears of a visiting nurse association, with companions turning into friends and offering the nurturing and emotional support that VNAs may not have time to provide with the ever-increasing demand for home care.

Optimal design of clinical outcome studies in nutrition and cancer: future directions

Many studies have assessed the benefits of nutrition support in cancer patients. Except for studies directed at the treatment of severe malnutrition, most clinical trials have failed. Although prospective randomized controlled clinical trials (Phase III) remain the most reliable means of evaluating the efficacy of therapy, the available literature reports only results from small trials (Phase II to III), most of which appear to be contradictory and none of which conclusively answer the question being considered. To address this gap in knowledge, tools such as meta-analysis have been adapted from the field of statistics. Meta-analysis involves pooling results across several studies and provides a more precise estimate of treatment effect than can each individual study. However, clinical trials selected for meta-analysis, although broadly similar, can differ significantly in terms of therapies used and clinical populations studied. Major cancer types with differing effects on food intake and malnutrition (eg, the mechanical obstruction in head and neck cancer vs the cytokine-induced metastases associated with lung, ovarian, colon, and breast cancer) cannot be subject to the same analytic criteria. In this paper, the current state of clinical outcome trials in nutrition and cancer is examined, and the desired design for future studies is proposed. Research priorities include the conduct of Phase II clinical trials that use as outcome measures quality of life, performance status, and survival to identify optimal cancer-specific and patient-specific nutrition support. The next round of Phase III efficacy studies should establish the appropriate use of nutrition support in cancer therapy.

Concordance between two measures of dream bizarreness

To assess the level of concordance between two published measures of dream bizarreness, 100 randomly selected dreams from 93 college students were scored for primary process using the Auld, Goldenberg, and Weiss scale and for dream distortion using Zepelin's scale. This analysis yielded a strong relationship between these measures, indicating adequate concurrent validity for the content analysis of the construct of dream bizarreness.

A non-bronchoconstrictor, bacteriostatic preservative for nebuliser solutions

We have studied the bacteriostatic and airways effects of the preservatives chlorocresol and chlorbutol, to assess if they may be safely used in nebuliser solutions. The bacteriostatic study was carried out according to standard techniques, and the preservatives were able to inhibit the growth of a range of bacteria and yeasts for a period of 28 days. The airways effects were studied in eight asthmatic subjects, who were challenged with either the preservatives or saline (as placebo). Pulmonary function was followed as FEV1 for 60 min after inhalation, and there was no change in FEV1 following inhalation. We conclude that these preservatives may be used safely in nebuliser solutions.

Spinal cord slices with attached dorsal root ganglia: a culture model for the study of pathogenicity of encephalitic viruses

We describe here a culture system for long-term growth of organotypic slices of spinal cord, with attached dorsal root ganglia (DRG) derived from 13-14 day mouse fetuses. This is a unique in vitro tool in which both central and peripheral nervous tissue grow and differentiate in culture to become heavily myelinated. During cultivation the slices and the ganglia become flattened so as to allow microscopical and immunocytochemical staining. When both central and peripheral myelin had been formed (usually around the third week of cultivation), cultures were infected with 5 x 10(6) PFU of West Nile Virus (WNV). Progeny virions appeared first in about 10% of the neurons and were subsequently observed between lamellae in the central myelin sheath of several axons. Such viral arrangement in relation to myelin membranes, might provide a novel concept for a possible mechanism underlying slow viral infection.

West Nile virions aligned along myelin lamellae in organotypic spinal cord cultures

Organotypic spinal cord cultures infected with West Nile Virus (WNV) exhibited a remarkable arrangement of virions among lamellae of the myelin sheath. Virions were first observed in neurons and only at day 4 after infection appeared within the myelin lamellae. Virions were observed only in the central myelin, aligned along the interperiod lines and therefore attached to the outer side of the oligodendrocyte membrane. In spite of this peculiar location of the virions, their presence was not associated with severe damage to the axon or to the myelin sheath. The causes of the formation of this viral pattern, its morphological features, and the role which it might have in viral infection in vivo are considered.

Osteoblastoma of the distal phalanx of the hallux

Osteoblastoma is a very rare bone tumor infrequently reported in the podiatric literature. The authors present a review of this tumor and the types of modalities that may be used to detect and diagnose these tumors. They also present a surgical approach to the resection of these bone tumors.

The distribution and utilization of CNSs on Long Island

The present study provides a data base concerning the professional characteristics and various roles and functions of the CNS. Data for this survey research were collected by questionnaire and compared to the literature and ANA's National Survey of Clinical Nurse Specialists which was done in 1984. Results obtained from this research should serve as a springboard for further study of this essential role.

Effect of specific amino acid groups on renal hemodynamics in humans

The effect of specific amino acid groups on renal hemodynamics was examined in seven healthy young volunteers. Each subject received a 3-h intravenous infusion according to one of the following protocols: study 1, gluconeogenic amino acids (Arg, Gly, Pro, Cys, Met, Ser); study 2, alanine alone; study 3, branched-chain amino acids (BCAA, Leu, Ile, Val); or study 4, 0.9% saline. The rise (40-60% above base line) in total plasma amino acid concentration was similar in studies 1-3; no change was observed in study 4. During study 1, glomerular filtration rate (GFR) rose by 16% (from 98 +/- 6 to 114 +/- 8 ml.1.73 m-2.min-1, P less than 0.01), and renal plasma flow (RPF) rose by 28% (from 496 +/- 47 to 638 +/- 70 ml.1.73 m-2.min-1, P less than 0.01). After alanine (study 2) and BCAA (study 3) infusion, there was a slight, although not significant, rise in GFR and RPF; during saline infusion (study 4), GFR and RPF remained unchanged. Plasma insulin and growth hormone did not change significantly in any study protocol. Plasma glucagon rose significantly by 30% in study 1 (from 117 +/- 10 to 151 +/- 13 pg/ml, P less than 0.05) but did not change in studies 2-4. In summary, infusion of mixed gluconeogenic amino acids increases both GFR and RPF, and neither alanine nor BCAA infusion caused a consistent alteration in renal hemodynamics.

Different pathogenicity of encephalitic togaviruses in organotypic cultures of spinal cord slices

The pathogenicity of two encephalitic Togaviruses, Sindbis virus (SV), an alphavirus, and West Nile virus (WNV), a flavivirus, was studied in organotypic cultures of fetal mouse spinal cord slices grown in roller tubes. After about 3 weeks in vitro, during which time the cultures became abundantly myelinated, they were infected either by 5 X 10(5) PFU SV or by 5 X 10(6) PFU WNV per culture. The viruses caused different patterns of cytopathogenicity: SV induced severe cytotoxicity in all glia cells and neurons with concomitant demyelination within 48 hr. In contrast, WNV, even 4 days after infection, caused only mild cytopathic effects mainly to neurons and astrocytes and a slight degree of damage to the myelin sheath. A most remarkable finding was the entrapment of WNV particles in the interperiod lines of the myelin sheaths. Treatment of cultures with mouse alpha and beta interferon prior to their infection with either virus protected the cultures from any viral damage. Long-term exposure of non-infected control organotypic cultures of fetal spinal cord slices to mouse interferons had no significant effect on neuronal and glial differentiation, and myelin formation.

Serologically defined linear epitopes in the E2 envelope glycoprotein of Semliki Forest virus

A set of 41 overlapping peptides, representing the complete sequence of SFV-E2 protein were synthesized and analyzed in the ELISA test against murine anti-SFV sera. No single peptide was recognized by all antisera. Eight peptides were found to be highly reactive with hyperimmune anti-SFV sera. Six out of the eight peptide sequences coincide with the most hydrophilic regions of SFV-E2. Out of these, four peptides (amino acid positions 16-35, 61-80, 166-185, 286-305) that contain the least number of alphavirus conserved residues were selected. This panel constitutes the minimal number of peptides necessary and sufficient for specific recognition of hyperimmune mouse anti-SFV sera.

Relations among nightmare frequency and ego strength, death anxiety, and sex of college students

The present study was designed to investigate empirically the relationship between self-reports of nightmare frequency and ego strength and death anxiety in both men and women. In addition, the interrelations among these variables were assessed. 20 undergraduates with high frequencies of nightmares and 20 with low frequencies (10 men and 10 women per group) were administered the Barron Ego Strength Scale and a death anxiety scale. Significant differences were found between nightmare groups on the Barron scale for men and women but none on the death anxiety scale either by nightmare frequency or sex. A significant negative correlation of -.47 between death anxiety and ego strength was found for women and in one high frequency group. Women with high frequencies of nightmares showed the highest correlation, -.83. These data suggest that nightmare frequency may be a mediating factor in the relationship between ego strength, death anxiety, and sex of subject.

Local anesthesia prevents hypertension following application of the Mayfield skull-pin head holder

A marked hypertensive response is often seen when the Mayfield skull-pin device is applied to stabilize the head of the anesthetized patient for neurosurgery. In a prospective, blinded and randomized trial, 10 patients received an infiltration block of 0.5% mepivacaine with epinephrine 5 micrograms/ml (3 ml at each pin site) 1 min before the Mayfield holder was applied. Ten patients received normal saline and served as controls. All patients were under general anesthesia induced with sodium pentothal, fentanyl and pancuronium, and maintained with isoflurane in nitrous oxide/oxygen and increments of fentanyl. In the control group, there were significant increases in mean arterial pressure (mean increase 43%, P less than 0.001) and heart rate (15%, P less than 0.01) at 0.5, 1 and 2 min after application. In the mepivacaine group, no significant changes occurred. Infiltration of local anesthetic with epinephrine can thus safely protect against potentially dangerous increases in arterial pressure when the Mayfield holder is used.

[Role perception of medical residents in relation to hospital size and specialty]

The resident's perception of the nature of the socialization process during specialization in relation to hospital size and field of specialization was studied. A closed-type questionnaire was administered to 258 residents who in 1984 registered for Phase One of the National Board Examination during their training. The results indicate considerable homogeneity in their perception of the norms and rewards of the practice of medicine. No significant differences were found by field of specialization or size of hospital. However, there were significant differences in the nature of the actual training in relation to the size of the hospital. A great deal of direct training and a large routine workload was reported by residents in medium-sized hospitals as compared with large and small hospitals. Surprisingly, achievements of residents were not congruent with the pattern of training: the highest rate of success in the examination was achieved by residents in large hospitals, a lower rate in small hospitals, while the lowest was in medium-sized hospitals.

Psychosocial dimensions of epilepsy: a review of the literature

The literature on psychosocial dimensions of epilepsy has been reviewed utilizing the framework developed by Dodrill et al. (Epilepsia 1980; 21:123-35). Factors considered were family background, emotional adjustment, interpersonal adjustment, vocational adjustment, financial status, adjustment to seizures, and medicine and medical management. The published studies highlighted a number of issues and sometimes rendered varying and contradictory conclusions. In general, epilepsy fosters certain reactions in family members. If negative, these reactions may be detrimental to the person with epilepsy. The association between specific emotional adjustment factors and epilepsy is not conclusive. Studies have been published which support as well as refute this association. Studies indicate that persons with epilepsy experience lower rates of marriage and more sexual difficulties than do nonepileptic persons. Studies report greater unemployment and underemployment in epileptic persons than in the population at large. Studies suggest that some persons with epilepsy manifest an attitude of nonacceptance of self. Some are reluctant to disclose their disability to others. The studies also indicate the presence of a discriminatory attitude by some nonepileptic persons toward epileptic persons. Several factors are associated with successful medical management of epilepsy. The emphasis in research studies with regard to psychosocial aspects of epilepsy focuses predominantly on individual deficiencies rather than on strengths and abilities.

Beyond "the men of steel". The origins and significance of house staff training stress

Stress is a common and significant component of house staff training. It has a dual capacity to support and hinder the trainee's education and well-being. However, there has been infrequent attention to the purpose and significance of training stress in the medical literature. The myths and traditions of medicine that foster sayings such as "in the days of the giants" or "the men of steel" do not sufficiently explain the dynamics of house staff stress. This article examines the origins, effects, and meaning of house officer stress. Stress seems to originate from as well as influence: the psychology of physicians, patient care, hospital economics, and the relationship between trainees and educators. Adaptations to stress acquired in training influence the house officer's future professional and personal well-being. Evaluation of training stress can help clarify related issues such as physician impairment and mentoring in medical education.