Misleading results with the 14-3-3 assay for the diagnosis of Creutzfeldt-Jakob disease

The definitive diagnosis of Creutzfeldt-Jakob disease (CJD) requires brain tissue analysis. A positive assay for the 14-3-3 protein in CSF has been suggested to be highly sensitive and specific in patients with CJD. The authors describe three patients for whom CSF 14-3-3 assays were falsely positive or falsely negative. Caution against overreliance on this putative biomarker is suggested in the diagnosis of CJD.

Behavioral risk reduction in a declining HIV epidemic: injection drug users in New York City, 1990-1997

OBJECTIVES

This study assessed trends in HIV risk behaviors among injection drug users in New York City from 1990 to 1997.

METHODS

Injection drug users were recruited continuously from a large drug detoxification treatment program (N = 2588) and a research storefront located in a high-drug-use area (N = 2701). Informed consent was obtained, and a trained interviewer administered a structured interview covering sociodemographics, drug use history, HIV risk behavior, and participation in syringe exchange.

RESULTS

Trends were assessed for 5 risk behaviors in the 6-month period before the interview. The 3 injection risk behaviors declined significantly over time at each site (all P < .01). When data were pooled across sites, all 5 risk behaviors declined significantly over time (all P < .01). Participation in syringe exchange programs and in HIV counseling and testing increased greatly from 1990 to 1997.

CONCLUSIONS

The continuing risk reduction among injection drug users indicates a "declining phase" in the large HIV epidemic in New York City. HIV prevention programs appear to be making an important contribution to the declining phase.

The role of male accessory gland protein Acp36DE in sperm competition in Drosophila melanogaster

A crucial factor determining sperm fertilization success in multiply mated Drosophila melanogaster females is the efficiency with which sperm are stored. This process is modulated by the accessory gland protein Acp36DE. In this study, we show that the effect of Acp36DE on sperm storage itself alters the outcome of sperm competition. As second-mating males, Acp36DE1 (null) males had significantly lower P2-values than Acp36DE2 (truncation) or Acp36DE+ (control) males, as might be expected as the null males' sperm are poorly stored. We used spermless males, which are null for Acp36DE, to show that, in the absence of sperm co-transfer, Acp36DE itself could not displace first-male sperm. The results therefore suggest that males null for Acp36DE suffer in sperm displacement because fewer sperm are stored or retained, not because Acp36DE itself displaces sperm. Acp36DE1 (null) males also gained significantly fewer fertilizations than controls when they were the first males to mate. Using spermless males, we also showed that significantly more second-male offspring were produced following the transfer of Acp36DE by spermless first-mating males. This implies that the transfer of Acp36DE itself by the first male facilitated the storage or use of the second male's sperm and that co-transfer with sperm is not necessary for Acp36DE effects on second-male sperm storage. Acp36DE may persist in the reproductive tract and aid the storage of any sperm including those of later-mating males or prime the female for future efficient sperm storage. Our results indicate that mutations in genes that affect sperm storage can drastically affect the outcome of sperm competition.

Mating-induced inhibition of remating in female Mediterranean fruit flies Ceratitis capitata

Mechanisms producing inhibition of remating in mated female Mediterranean fruit flies Ceratitis capitata, were investigated by matings with surgically altered males. Comparison of remating by females mated with either intact control males or males with a shortened penis, showed that ejaculate or a physical stimulus of penis insertion caused remating inhibition for at least 10 days after first mating. Remating frequency at two days after mating was significantly higher in females mated to castrated (spermless) males than in females mated to sham-operated control males. This difference disappeared by day four after mating, indicating that sperm cause a shorter-term inhibition of remating than does a normal first mating. Other factors in addition to sperm must therefore play a role in inhibition of remating.

A neuromorphic hair sensor model of wind-mediated escape in the cricket

Crickets are able to extract directional information about a wind stimulus through the filiform hairs located on their cerci. This paper describes the design and testing of a neuromorphic sensor that aims to achieve a close correlation with both the physical and functional properties of these hairs. An integrate and fire neural network is used to process the sensory information in real time. The resulting system is shown to be capable of extracting directional information from a wind stimulus and producing an appropriate motor control pattern.

Declining seroprevalence in a very large HIV epidemic: injecting drug users in New York City, 1991 to 1996

OBJECTIVES

This study assessed recent trends in HIV seroprevalence among injecting drug users in New York City.

METHODS

We analyzed temporal trends in HIV seroprevalence from 1991 through 1996 in 5 studies of injecting drug users recruited from a detoxification program, a methadone maintenance program, research storefronts in the Lower East Side and Harlem areas, and a citywide network of sexually transmitted disease clinics. A total of 11,334 serum samples were tested.

RESULTS

From 1991 through 1996, HIV seroprevalence declined substantially among subjects in all 5 studies: from 53% to 36% in the detoxification program, from 45% to 29% in the methadone program, from 44% to 22% at the Lower East Side storefront, from 48% to 21% at the Harlem storefront, and from 30% to 21% in the sexually transmitted disease clinics (all P < .002 by chi 2 tests for trend).

CONCLUSIONS

The reductions in HIV seroprevalence seen among injecting drug users in New York City from 1991 through 1996 indicate a new phase in this large HIV epidemic. Potential explanatory factors include the loss of HIV-seropositive individuals through disability and death and lower rates of risk behavior leading to low HIV incidence.

Some reflections on cultural and social considerations in mental health nursing

This article critiques the contribution of two main theoretical perspectives on mental health care and ethnicity, with particular reference to Asian women. It considers the work of those who highlight the impact of culture on the health and illness experience (Kleinman 1980, Rack 1982, Fernando 1989) and the work of authors who argue that the impact of broader socio-economic structures must be considered (Donovan 1989, Pearson 1989, Ahmad 1993). It is posited that the emphasis on cultural difference results in crude monolithic generalizations about Asian culture and operates as a smokescreen for the impact of poverty and racism. The backdrop to this article is provided by an assessment of the problematic conceptual framework of Western mental health and the role it plays in perpetuating stereotypes. It is concluded that mental health nurses need a thorough understanding of the complexity of the cultural and social factors that influence health and illness; an understanding which falls somewhere between these two theoretical perspectives. Such an approach needs to be grounded in the experience of mental health clients themselves if it is to be appropriate.

Sex-specific selection on time to remate in Drosophila melanogaster

Female Drosophila melanogaster were artificially selected for fast and slow time to remate (denoted 'high' and 'low' selection regimes, respectively). Both selection regimes and a control were replicated three times. Correlated responses to selection in females and in males were measured. A significant direct response to selection for time to remating was found in females from both selection regimes. Remating frequency of females showed a correlated response only in the females from the lines selected for faster time to remating. Time to first mating of virgin females showed no correlated response in either selection regime. No correlated response was found in males for time to remate, remating frequency or time to first mating of virgins, indicating that genetic correlations between the sexes do not influence the evolution of these traits in this population of D. melanogaster. There was no direct response to artificial selection for the ability of first males to deter females from remating. However, we found that the genotype of the first male to mate with a female could influence her time to remate; base stock males were better at deterring females from remating than were males from any of the selection lines. Copyright 1998 The Association for the Study of Animal Behaviour.

Interactions of mating, egg production and death rates in females of the Mediterranean fruit fly, Ceratitis capitata

Costs of reproduction include costs of producing eggs and of mating itself. In the present study, we made an experimental investigation of costs of reproduction in the Mediterranean fruit fly (medfly, Ceratitis capitata). We demonstrated that virgins live longer than non-virgin females. However, in strong contrast to most findings within the Diptera, non-virginity had no detectable effect on egg production. Therefore the increased longevity of the virgin females cannot be attributed to an increase in egg production in non-virgin females, and instead indicates a cost of mating. A comparison of the life spans of normal females and those sterilized by low doses of X-irradiation, revealed an additional cost of egg production. There were no significant differences in remating levels between females that did and did not lay eggs, showing that the cost of producing eggs is independent of mating frequency. Medfly females therefore suffer a decrease in survival as a result of egg production and of mating, and these costs are independent of one another. To put our results into context, we reviewed the existing literature on the effects of mating on longevity, egg production and sexual receptivity for 64 species of Diptera, and examined the pattern of mating effects that emerged.

Mating and hormonal triggers regulate accessory gland gene expression in male Drosophila

Drosophila melanogaster males transfer accessory gland proteins, as part of their seminal fluid, to females during each mating. Since accessory gland proteins are important for male reproductive success, it is important that the male replenish the proteins he transferred during mating. Previous studies had shown that mating induces the resynthesis of accessory gland proteins, but since mating includes a set of stereotyped behavior patterns as well as the act of copulation, it was not known which aspect of the mating process induces accessory gland protein synthesis. By exposing males to females whose ovipositors had been sealed shut, we have shown that resynthesis of accessory gland proteins occurs only when seminal fluid is transferred to females. By applying juvenile hormone or 20-hydroxyecdysone topically to the cuticle of male flies, we showed that these hormones can act in vivo to stimulate the synthesis of accessory gland proteins to levels similar to those observed after mating.

Panic disorder and quality of life: variables predictive of functional impairment

OBJECTIVE

The authors sought to characterize the functional impairment in patients with panic disorder, specifically the variance in impairment explained by demographic and clinical variables.

METHOD

Sixty-two patients with panic disorder and 61 comparison subjects from three primary care clinic sites were assessed with an adapted form of the Structured Clinical Interview for DSM-III-R. Impairment was assessed according to three measures from the 36-item Short-Form Health Survey (general health perception, mental health, and physical functioning) as well as a principal component factor of the survey. Subjects were also compared with respect to personality variables, presence and severity of chronic medical illness, and demographic characteristics. Stepwise multiple regressions with and without pairwise interactions were used to construct models of disability in the patients with panic disorder.

RESULTS

The patients with panic disorder were more impaired than comparison subjects on each measure of the Short-Form Health Survey. The panic disorder diagnosis combined with major depression, increasing neuroticism and age, less education, and an interaction between panic disorder and age accounted for 48%-77% of the variance in impairment scores. Gender and ethnicity contributed modestly to the variance in impairment in physical functioning, whereas no contribution was demonstrated for chronic medical illness or city of residence.

CONCLUSIONS

Factors in addition to panic phenomena contribute to the severe impairment seen in patients with panic disorder. Further research about factors that affect impairment may help improve clinical approaches to this illness.

Female fitness in Drosophila melanogaster: an interaction between the effect of nutrition and of encounter rate with males

Female Drosophila melanogaster were maintained at five levels of nutrition, with either continuous or intermittent exposure to males. Remaining frequency increased with nutrition and was higher with continuous exposure to males. Age-specific and lifetime egg production increased with increasing nutrition, but lifespan peaked at intermediate nutrition. Females on the three highest nutritional levels showed a cost of mating in reduced survival, but only at the highest food level did this reduced lifespan lead to a significant cost of mating for lifetime egg production. The data suggest that remating frequencies in laboratory cultures may evolve to a low enough level for the cost of mating to be only weakly expressed, if at all. Further data are required to assess the importance of the cost of mating in natural populations, where the evolution of low remating frequencies might be expected to be opposed by other costs.

The respiratory chain of Helicobacter pylori: identification of cytochromes and the effects of oxygen on cytochrome and menaquinone levels

The quinone and cytochrome components of the respiratory chain of the microaerophilic bacterium Helicobacter pylori have been investigated. The major isoprenoid quinone was menaquinone-6, with traces of menaquinone-4; no methyl-substituted or unusual menaquinone species were found. Cell yield was highest after growth at 10% (v/v) oxygen and menaquinone levels (per dry cell mass) were maximal at 5-10% (v/v) oxygen. Helicobacter pylori cells and membranes contained b- and c-type cytochromes, but not terminal oxidases of the a- or d-types, as judged by reduced minus oxidised difference spectra. Spectra consistent with the presence of a CO-binding terminal oxidase of the cytochrome b- or o-type were obtained. The soluble fraction from disrupted cells also contained cytochrome c. There were no significant qualitative differences in the cytochrome complements of cells grown at oxygen concentrations in the range 2-15% (v/v) but putative oxidases were highest in cells grown at 5-10% (v/v) oxygen.

New segregation analysis of panic disorder

We performed simple segregation analyses of panic disorder using 126 families of probands with DSM-III-R panic disorder who were ascertained for a family study of anxiety disorders at an anxiety disorders research clinic. We present parameter estimates for dominant, recessive, and arbitrary single major locus models without sex effects, as well as for a nongenetic transmission model, and compare these models to each other and to models obtained by other investigators. We rejected the nongenetic transmission model when comparing it to the recessive model. Consistent with some previous reports, we find comparable support for dominant and recessive models, and in both cases estimate nonzero phenocopy rates. The effect of restricting the analysis to families of probands without any lifetime history of comorbid major depression (MDD) was also examined. No notable differences in parameter estimates were found in that subsample, although the power of that analysis was low. Consistency between the findings in our sample and in another independently collected sample suggests the possibility of pooling such samples in the future in order to achieve the necessary power for more complex analyses.

CFTR chloride channels in human and simian heart

OBJECTIVES

The cAMP-dependent Cl- conductance in heart is believed to be due to cardiac expression of the cystic fibrosis transmembrane conductance regulator (CFTR). While CFTR expressed in rabbit and guinea-pig heart (CFTRcardiac) is an alternatively spliced isoform of the epithelial gene product, little information is known regarding possible expression of CFTR in primate heart. In this study, we examined molecular expression of CFTR in human and simian atrium and ventricle and functional expression of cAMP-dependent Cl- currents in isolated human atrial and simian ventricular cells.

METHODS

The reverse transcription polymerase chain reaction (RT-PCR) was performed on human and simian atrial and ventricular mRNA using primers designed to border regions of the CFTR gene product corresponding to transmembrane segments I-VI (TSI-VI), the first nucleotide binding domain (NBD1), transmembrane segments VII-XII (TSVII-XII), and the large cytoplasmic domain which includes the regulatory (R) domain and NBD1. Functional expression of CFTR Cl- channels in human atrial and simian ventricular myocytes was determined using whole-cell and giant inside-out patch-clamp techniques.

RESULTS

Southern blot analysis of these RT-PCR products demonstrated expression of CFTR transcripts in human and simian atrial and ventricular tissue and revealed a novel pattern of expression compared to most animal species studies: both the exon 5 plus (unspliced) and exon 5 minus (spliced) CFTR transcripts are co-expressed in human and simian atrium and ventricle. Whole-cell experiments demonstrated a Cl- sensitive time-independent background conductance in both human atrial and simian ventricular myocytes that was activated by forskolin (FSK) and insensitive to 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS). In inside-out patches utilizing the giant patch technique on human atrial myocytes, unitary Cl- sensitive channels resembling CFTR Cl- channels (approximately 14 pS conductance) were activated by the catalytic subunit of protein kinase A (PKA) in 3/12 patches examined.

CONCLUSIONS

These results clearly demonstrate the molecular expression of CFTR Cl- channels and provide electrophysiological evidence consistent with functional expression of these channels in human atrial and simian ventricular myocardium.

How is lean body mass conserved with the very-low protein diet regimen?

Eight CRF patients (GFR = 18.8 +/- 2.7 ml/min) underwent a crossover comparison of a very-low-protein diet (VLPD) providing 0.28 g protein and 35 kcal/kg/day, plus an isomolar mixture of ketoacids (KA) or essential amino acids (EAA). During each dietary period, a 5-day nitrogen balance (BN) was performed and whole-body protein turnover (WBPT) was measured during fasting and feeding using intravenous [1-13C]leucine and intragastric [5,5,5-2H3]leucine. Although the VLPD/KA regimen contained 15% less nitrogen, BN was neutral and did not differ between the regimens. Similarly, rates of WBPT did not differ between the KA or EAA regimens, and neutral BN was achieved by a marked suppression of amino acid oxidation and postprandial inhibition of protein degradation (PD). Participants were then discharged on the VLPD/KA regimen and monitored as outpatients for > or = 1 year. Repeat BN was neutral and rates of WBPT did not differ from baseline values. Thus, the adaptive responses to dietary protein restriction are sustained during long-term therapy.

The DSM-IV panic disorder field trial: panic attack frequency and functional disability

The goal of the DSM-IV panic disorder field trial was to provide an empirical basis for choosing between alternate proposals (DSM-III-R and proposed DSM-IV) for the diagnostic threshold for panic disorder, in particular the number and frequency of panic attacks required for diagnosis. The two criteria sets were compared with respect to their ability to identify individuals whose panic attacks were associated with distress, impairment, or help-seeking. Subjects were a convenience sample screened in three geographically diverse primary care clinics for presence (past 6 months) or absence (lifetime) of panic attacks. Each underwent a clinician-administered semistructured interview which included assessment of panic frequency, panic-related impairment, psychiatric diagnosis, health services utilization, and medical illness. Self-perceived health-related quality of life was assessed using the Medical Outcome Study SF-36 Health Survey Questionnaire. Although both proposals diagnosed the same proportion of panic-impaired individuals, they were not completely overlapping. Twenty percent of subjects diagnosed by each criteria set were excluded by the other. Subjects who had been excluded by the DSM-III-R but included by the DSM-IV proposal were those with fewer than 4 attacks in 4 weeks who also denied worry about the "next" attack. Broadening the worry criterion to include concerns about the health implications of attacks enabled diagnosis of this group. Subjects who met DSM-III-R, but not the proposed DSM-IV criteria, had 4 attacks in 4 weeks but denied any panic related worry. Modification of the DSM-IV proposal to include a month of worry or "a significant change in behavior related to the attacks" allowed inclusion of this group in the diagnostic category. These data suggest that the finalized DSM-IV panic disorder criteria will diagnose a greater proportion of individuals whose panic attacks are associated with impairment without inflating the diagnostic category or significantly reducing specificity.

Long-term adaptive responses to dietary protein restriction in chronic renal failure

Six patients with chronic renal failure (glomerular filtration rate 18 +/- 2 ml/min) underwent two 10-day admissions separated by at least 1 yr of outpatient therapy with a very low-protein diet (VLPD) providing 0.28 g protein.kg-1.day-1 plus an amino acid-ketoacid supplement. During each Clinical Research Center admission, subjects completed a 5-day nitrogen balance (BN), and whole body protein turnover was measured during fasting and feeding using intravenous [1-13C]leucine and intragastric [5,5,5-2H3]leucine. Outpatient dietary protein compliance was very good (25 vs. 20 g protein/day or 125% goal), whereas energy intake was only 69% of goal (24 vs. 35 kcal.kg-1.day-1). During the 16 +/- 2 mo of dietary therapy, there were no changes in serum proteins or anthropometrics. BN after > or = 1 yr of dietary therapy was neutral and did not differ from initial values (+0.46 +/- 0.20 vs. +0.55 +/- 0.19 g N/day). Similarly, rates of whole body protein synthesis, degradation, and leucine oxidation after long-term therapy with the VLPD regimen did not differ from baseline values, and neutral BN was maintained by a marked suppression of amino acid oxidation and postprandial inhibition of protein degradation. This is the first evidence that the compensatory changes in whole body protein turnover activated in response to dietary protein restriction are sustained during long-term therapy.

Infrequent panic attacks: psychiatric comorbidity, personality characteristics and functional disability

Primary care patients with infrequent panic attacks were found to have similar levels of disability in their social, family and vocational functioning to patients who met DSM-III-R criteria for panic disorder. Both panic subgroups had significantly more functional disability than controls. Patients with panic and infrequent panic had significantly more Axis I psychiatric comorbidity than primary care controls but similar levels of medical comorbidity. Patients with panic disorder had a significantly higher prevalence of one or more other lifetime psychiatric diagnoses, current major depression, and current DSM-III-R depressive symptoms compared to patients with infrequent panic. Patients with infrequent panic scored as high on the NEO personality measure of neuroticism as patients with panic disorder, and both panic subgroups had significantly higher neuroticism levels than controls.

Cost of mating in Drosophila melanogaster females is mediated by male accessory gland products

Female Drosophila melanogaster with environmentally or genetically elevated rates of mating die younger than controls. This cost of mating is not attributable to receipt of sperm. We demonstrate here that seminal fluid products from the main cells of the male accessory gland are responsible for the cost of mating in females, and that increasing exposure to these products increases female death rate. Main-cell products are also involved in elevating the rate of female egg-laying, in reducing female receptivity to further matings and in removing or destroying sperm of previous mates. The cost of mating to females may therefore represent a side-effect of evolutionary conflict between males.

Replacement of the conserved G.U with a G-C pair at the cleavage site of the Tetrahymena ribozyme decreases binding, reactivity, and fidelity

There is a phylogenetically conserved G.U pair at the 5'-splice site of group I introns. When this is mutagenized to a G-C pair, splicing of these introns is greatly reduced. We have used a ribozyme derived from the Tetrahymena group I intron to compare the binding and reactivity of oligonucleotides that form either a G.U or a G-C pair at this position. Ribozyme binding of oligonucleotides at 42 degrees C was measured by native gel electrophoresis and equilibrium dialysis. Binding of GGCCCUCC (C(-1)P), which base-pairs with the ribozyme guide sequence to form a G-C at the cleavage site, was 10-fold weaker than the binding of GGCCCUCU (U(-1)P), which maintains the conserved G.U pair at the cleavage site. This is surprising since a terminal G-C enhances the binding between oligonucleotides by 20-fold relative to a terminal G.U. Thermal denaturation studies indicate that C(-1)P and several analogs with deoxy substitutions bind the guide-sequence oligonucleotide, GGAGGGAAA, as strongly as they bind the ribozyme. In contrast, U(-1)P binds 240-fold more strongly to the ribozyme than to GGAGGGAAA, a difference that is decreased by deoxy substitutions. Thus, while U(-1)P binds the ribozyme through a combination of base-pairing and specific 2-OH and other tertiary interactions, C(-1)P may bind by base-pairing alone. The substrate GGCCCUCCAAAAA (C(-1)S) is cleaved 100-fold more slowly than GGCCCUCUAAAAA (U(-1)S) and also has a higher propensity to be cleaved at the wrong nucleotide position.(ABSTRACT TRUNCATED AT 250 WORDS)

A hyphal-specific chitin synthase gene (CHS2) is not essential for growth, dimorphism, or virulence of Candida albicans

In the dimorphic fungus Candida albicans, the CHS2 gene encodes a chitin synthase that is expressed preferentially in the hyphal form. Gene disruption of CHS2 in this diploid asexual fungus was achieved by the "ura-blaster" protocol described for Saccharomyces [Alani, E., Cao, L. & Kleckner, N. (1987) Genetics 116, 541-545]. This involves the sequential disruption of multiple alleles by integrative transformation with URA3 as a single selectable marker. After disrupting the first CHS2 allele, the Ura- phenotype was recovered through cis recombination between repeated hisG sequences that flanked the URA3 marker in the disruption cassette, which was then used again to disrupt further CHS2 alleles. This method of gene disruption is well suited to the mutational analysis of this genetically recalcitrant human pathogen. Three rounds of disruption were required, suggesting that the strain SGY243 is triploid for the CHS2 locus. The resulting homozygous delta chs2::hisG null mutants were viable and made germ tubes with a normal morphology. The germ tubes were formed more slowly than parental strains in serum-containing medium and the germinating cells had a 40% reduction in their chitin content compared to germ tubes of the parent strain. The chitin content of the yeast form was not affected. A prototrophic strain of the chs2 null mutant was not attenuated significantly in its virulence when tested in normal and immunosuppressed mice.

Adaptive responses to very low protein diets: the first comparison of ketoacids to essential amino acids

Eight patients with chronic renal failure (GFR 18.8 +/- 2.7 ml/min) were randomized to a crossover comparison of a very low protein diet (VLPD) containing 0.28 g protein and 35 kcal per kg per day, plus an isosmolar mixture of either ketoacids (KA) or essential amino acids (EAA). Subjects initiated the diets 14 days before hospital admission and following a four-day equilibration, a five-day nitrogen balance (BN) was performed. Whole-body protein turnover (WBPT) was measured during fasting and feeding using intravenous [1-13C]leucine and intragastric [5,5,5-2H3]leucine. Even though the VLPD/KA regimen contained 15% less nitrogen, BN was neutral and did not differ between the regimens. Nitrogen conservation with KA was due to a reduction in urea nitrogen appearance. Rates of WBPT measured during fasting and feeding did not differ between the KA or EAA regimens. During both regimens, feeding decreased protein degradation, whereas protein synthesis was unchanged. Although feeding stimulated leucine oxidation, rates were 50 to 100% lower than reported in CRF patients consuming 0.6 or 1.0 g protein/kg/day. Thus, neutral Bn with the VLPD regimen is achieved by a marked reduction in amino acid oxidation and a postprandial inhibition of protein degradation.

No reduction in the cost of mating for Drosophila melanogaster females mating with spermless males

Drosophila melanogaster females can incur a cost of mating, manifested as a decrease in longevity and lifetime reproductive success. We investigated whether the cost of mating was a cost of storing and/or receiving sperm by using two types of males that do not transfer sperm (transformer pseudomales and the male offspring of homozygous tudor mothers). Females that were intermittently exposed to males that did and did not transfer sperm did not differ in lifespan, in the absence of any differences in other costly aspects of reproduction, showing that there was no cost to receiving sperm. There was a cost of mating with spermless males; this suggested a potential cost of receiving accessory fluid. However, it was not possible to distinguish this possibility from other explanations, e.g. female injury at mating and the transfer of parasites. The reasons why females continuously exposed to males remated more than was in their reproductive interests is discussed.

Profits with a purpose: an interview with Tom Chapman. Interview by Nancy A. Nichols

Greater Southeast Community Hospital is located in the center of one of Washington, D.C.'s most troubled and isolated neighborhoods. Like so many inner-city hospitals, it serves a population struggling with high rates of poverty, crime, and illiteracy. As a result, the area suffers from the highest rates of infant mortality, cancer, and coronary disease in the D.C. area. When Tom Chapman joined the hospital in 1984, it was giving away roughly 11% of its care-or about $11.5 million worth of medical services to indigent residents. If things continued at that rate, the hospital would soon go out of business. His challenge: to keep Greater Southeast solvent while shoring up the community that surrounds it. Chapman, who grew up in a housing project himself, understands the problems of inner cities innately. Working in tandem with community residents, Greater Southeast has developed a broad range of preventive and supportive programs, such as housing, day care for children and the elderly, nursing home services, and literacy training. Last year, Chapman was promoted to CEO of Greater Southeast Health Care, a broad network comprising two hospitals, three nursing homes, a physician care network, and over 50 community programs. He remains true to his original mission: "I want to create a network of participants, stringing together various organizations and players, each of whom have something special to contribute to urban problems.... What we are really doing is creating a community."

Chitin biosynthesis in Candida albicans grown in vitro and in vivo and its inhibition by nikkomycin Z

An N-acetyl-D-[14C]glucosamine radiolabel incorporation assay has been used to monitor chitin biosynthesis in whole cells of Candida albicans both in vitro and in vivo in two different mouse infection models, one using the peritoneal cavity as a chamber in which to add and retrieve cells and the other using infected kidneys. Specific labeling of chitin in alkali-insoluble material was confirmed by chitinase digestion, analysis of acid hydrolysates, and the use of nikkomycin Z as a probe. Nikkomycin Z was shown to strongly inhibit chitin biosynthesis in C. albicans grown in vitro and in vivo in both models. This demonstrates that nikkomycin Z-susceptible chitin synthase activity is present in C. albicans when the fungus is in its pathogenic state in vivo. The limited use of nikkomycin as a therapeutic agent is discussed.

Early prenatal diagnosis of type II cystic adenomatoid malformation of the lung: sonographic and histological findings

Cystic adenomatoid malformation is a rare abnormality of the fetal lung. Depending on the size and histology of the cyst, it is classified as type I, II or III. With improving ultrasound technology, prenatal diagnosis during the mid-trimester is now possible; however, the earliest previous reports of type II cases have been at 23-24 weeks' gestation. We here report cases diagnosed at 19.5 and 20.5 weeks. In contrast to the appearance of multiple small cysts seen later in pregnancy, these cases showed a predominance of marked hyperechogenicity, usually associated with type III malformations, with small areas of lung involved by sonographically detectable cysts. Both families chose pregnancy termination. Sonographic findings, counselling, and histology are presented and discussed.

Child panic revisited

Childhood panic attacks and panic disorder were assessed retrospectively in adult anxiety clinic patients (N = 343) and their adult relatives (N = 560). Only nine (1%) of the 903 subjects were judged to have experienced spontaneous panic attacks before age 13 by clinically trained interviewers. The narrative summaries of these cases were reviewed, and only three of nine provided convincing descriptions of spontaneous panic attacks in childhood. The authors conclude that prepubertal spontaneous panic attacks are rare, and that retrospective assessments of panic phenomena are difficult, even among adequately trained mental health professionals.

The Nurse's Role in NEUROLEPTIC MEDICATIONS

1. A questionnaire study of schizophrenia sufferers' (N = 132) views on medication, contrary to expectations, revealed generally favorable attitudes. Clients seemed to understand the fine balance between costs and benefits better than many health-care professionals imagine. 2. Because nurses spend more time communicating with clients than physicians, they are ideally placed to find out how patients perceive neuroleptic therapy, and to provide information, advice, and counseling support. 3. There is a strong case for asserting that mental health nurses should extend their role in monitoring the effects of medication on their clients.

Colonoscopic removal of a gallstone obstructing the sigmoid colon

For the patient with a single gallstone obstructing the colon, this technique offers nonoperative relief of the obstruction, allowing definitive operative therapy to be accomplished at a later time on a more elective basis. The patient should be carefully observed during the interval for intervening recurrent gallstone ileus.

Do the right thing for the community. Interview by Howard Larkin

When the area surrounding Greater Southeast Community Hospital, Washington, DC, changed from a middle-class commuter neighborhood to one populated mainly by the poor and elderly in the early 1970s, hospital officials decided to stay and serve where they were needed most. The 450-bed hospital now sponsors a wide variety of health and community development programs. In recognition of its commitment to community service, Greater Southeast Community Hospital was awarded this year's Foster G. McGaw Prize by the American Hospital Association, Chicago, and the Baxter Foundation, Deerfield, IL. Thomas Chapman, president of Greater Southeast Community Hospital, recently talked about the importance of community service with Hospitals finance coordinator Howard Larkin.

An imbalance in sex chromosomes alters cell survival of human skin fibroblasts exposed to ionizing radiation in vitro

We report that a cell clone with a 45,X(-Y) karyotype, obtained from a male individual who is a gene carrier for hereditary adenomatosis of the colon and rectum (ACR), was considerably more resistent to gamma-ray irradiation (D0 range 184-240) than were diploid ACR skin fibroblasts (SF) obtained from sister biopsies of the same individual or of normal controls (D0 range 90-125). In addition, cell clones obtained from a Turner's syndrome female patient and from a female patient with focal endometrial hyperplasia, each with a 45,X(-X) karyotype, were abnormally resistent to gamma-ray irradiation (D0 range 168-195). These results may suggest an association between the status of the sex chromosomes and an altered response to gamma-ray-induced cytotoxicity of human SF.

Cystic adventitial disease of the popliteal artery

Cystic adventitial disease of the popliteal artery is a rare but well recognized cause of arterial occlusive changes producing disabling symptoms in young patients. We have described a 37-year-old long-distance runner who noticed progressive decrease in the function of his right leg over a period of several months. The presence of an arterial occlusive lesion was difficult to define on clinical grounds, but was confirmed with noninvasive vascular studies and angiography. Surgical treatment by resection of the diseased segment and end-to-end saphenous vein interposition graft yielded excellent results.

Phytotoxicity tests with the molluscicide N-tritylmorpholine

N-Tritylmorpholine (Frescon, WL 8008) has been applied as an emulsifiable concentrate (FX 28) to cotton and rice in glasshouse experiments without any adverse effects. The compound was applied in the irrigation water at 5 and 10 times the rates used for snail control. The experiment on cotton was terminated after 60 days, when the plants became pot-bound. The treatments did not affect the leaf area or the fresh weight of plants. The rice (Oryza sativa ssp. japonica) was harvested and no differences in growth, time of ear emergence or total plant weight were noted.A further experiment using the same formulation of N-tritylmorpholine in an overhead spray on young cotton and rice, at rates up to 48.5 kg/ha of FX 28, resulted in no adverse effects.