Inhibition of acetylcholinesterase from electric eel by (-)-and (+)-physostigmine and related compounds

Unnatural (+)-physostigmine (2) inhibited acetylcholinesterase (AChE) from electric eel considerably less than natural (-)-physostigmine (1), but 2 may because of its possible lower toxicity still be an interesting anticholinesterase agent. (-)-Eseroline (3), a major metabolite of (-)-physostigmine (1) and a potent narcotic analgetic, and its unnatural (+)-antipode (4), were both poor inhibitors of the enzyme. (-)-Dihydrosecophysostigmine (5), a ring-open analog of (-)-physostigmine was less, but (-)-N-methylphysostigmine (6) much more potent than the natural alkaloid. The availability of compounds related to (-)- and (+)-physostigmine by improved chemical synthesis suggests that further structural variation may well lead to other biologically interesting AChE inhibitors.

Factors influencing survival after out-of-hospital cardiac arrest

Survival to hospital discharge was related to the clinical history and emergency care system factors in 285 patients with witnessed cardiac arrest due to ventricular fibrillation. Only the emergency care factors were associated with differences in outcome. Both the period from collapse until initiation of basic life support and the duration of basic life support before delivery of the first defibrillatory shock were shorter in patients who survived compared with those who died (3.6 +/- 2.5 versus 6.1 +/- 3.3 minutes and 4.3 +/- 3.3 versus 7.3 +/- 4.2 minutes; p less than 0.05). A linear regression model based on emergency response times for 942 patients discovered in ventricular fibrillation was used to estimate expected survival rates if the first-responding rescuers, in addition to paramedics, had been equipped and trained to defibrillate. Expected survival rates were higher with early defibrillation (38 +/- 3%; 95% confidence limits) than the observed rate (28 +/- 3%). Because outcome from cardiac arrest is primarily influenced by delays in providing cardiopulmonary resuscitation and defibrillation, factors affecting response time should be carefully examined by all emergency care systems.

Smoking as a risk factor for recurrence of sudden cardiac arrest

We obtained information about cessation of smoking in 310 survivors of out-of-hospital cardiac arrest who had been habitual cigarette smokers at the time of their arrest. Patients with coronary heart disease were stratified according to mortality risk on the basis of recognized criteria. The expected first-year rate of recurrent arrest ranged from 2 to 40 percent among the strata. Life-table analyses showed that reformed smokers had a lower incidence of recurrent arrest than patients who continued to smoke (19 vs. 27 percent at three years; P = 0.038 by one-sided test adjusted across strata). This effect occurred to varying degrees in all but the highest risk stratum. No differences in survival were observed for mortality due to other causes. It is possible that continued smoking in these patients led to acceleration of an ongoing atherosclerotic process, but the differences in early survival suggest that smoking may also act in the short term to enhance vulnerability to cardiac arrest.

Monoclonal antibodies reveal extensive antigenic differences between the hemagglutinin-neuraminidase glycoproteins of human and bovine parainfluenza 3 viruses

A panel of twenty monoclonal antibodies to the hemagglutinin-neuraminidase (HN) glycoprotein of human parainfluenza 3 (PI3) virus has been obtained and tentatively classified into four different groups based on reactivity in hemagglutination inhibition (HI), neuraminidase inhibition (NI), and plaque neutralization (NT) tests. The antibodies were tested for cross-reactivity with bovine PI3 virus, Sendai virus, and simian virus 5 (SV5). Only two of these antibodies showed similar reactivities with human and bovine PI3 viruses in HI and NT tests; a few other antibodies showed low levels of reactivity with the heterologous viruses in HI tests. A competitive binding assay further suggested that the two cross-reactive antibodies are directed against the same domain of the HN molecule. Therefore, the HN glycoproteins of human and bovine PI3 viruses appear to be antigenically dissimilar, although they share at least one common epitope.

Glycoproteins of human parainfluenza virus type 3: characterization and evaluation as a subunit vaccine

The envelope glycoproteins of human parainfluenza type 3 virus were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and reactivity with specific monoclonal antibodies. The molecular weight of the hemagglutinin-neuraminidase (HN) glycoprotein was found to be 72,000, and the fusion (F) glycoprotein appeared to consist of 74,000 (F0) or 56,000 (F1) species. Envelope glycoproteins were solubilized with octyl-glucoside and, after removal of the detergent by dialysis, were used for immunization of hamsters. Other animals were immunized with a formalin-inactivated preparation of whole virus. A single subcutaneous immunization with these antigen preparations induced a serum antibody response to the HN and F glycoproteins, as determined by plaque neutralization, hemagglutination inhibition, inhibition of virus-induced cell fusion, and immune precipitation tests. An IgG antibody response to both glycoproteins was also observed in bronchial washings. Animals immunized with the highest dose of envelope glycoproteins showed complete protection from challenge infection, whereas immunization with inactivated virus did not completely protect animals.

Evaluation of a photolabile derivative of 1,25-dihydroxyvitamin D3 as a photoaffinity probe for 1,25-dihydroxyvitamin-D3 receptor in chick intestinal cytosol

We evaluated the viability of 1 alpha, 25-dihydroxyvitamin D3-3 beta-[N-(4-azido-2-nitrophenyl)glycinate] (1,25-(OH)2-D3-ANG), an analog of 1 alpha, 25-dihydroxyvitamin D3 (1,25-(OH)2-D3) as a photoaffinity probe for 1,25-(OH)2-D3 receptor in chick intestinal cytosol. A competitive-binding assay revealed that chick intestinal cytosolic 1,25-(OH)2- D3 receptor bound to 1,25-(OH)2-D3-ANG approximately 20-times less effectively than it did to 1,25-(OH)2-D3. Irradiation of 1,25-(OH)2-D3- ANG in the presence of chick intestinal cytosolic preparation significantly diminished subsequent binding to 3H-1,25-(OH)2-D3, suggesting that the photoaffinity analog was covalently attached to the receptor. Therefore the nitroarylazide derivative of 1,25-(OH)2-D3 may be a valuable photoaffinity probe for the characterization of the 1,25-(OH)2-D3 receptor.

Unipolar mania - a separate entity?

Twelve unipolar manics satisfying the inclusion criteria of having had three episodes of mania without a depressive episode were compared against bipolar manics on clinical psychopathology, demographic variables and family history of psychiatric morbidity. We Found no differences between the two groups on any of the variables studied and concluded that unipolar mania is clinically homogenous with bipolar manic depressive illness.

The influence of halothane and isoflurane on pulmonary collateral ventilation

The effects of halothane and isoflurane on hypocapnic increases in pulmonary collateral resistance were studied in dogs. A bronchoscope with a double lumen catheter in the suction port obstructed a peripheral airway and allowed gas to flow out of the isolated segment of lung only via collateral channels. The collateral gas flow (Vcoll) was measured with a flowmeter and delivered through one lumen of the catheter, while the other lumen measured distal pressure (Pb). At FRC, the resistance to collateral ventilation (Rcoll) was calculated as Rcoll = Pb/Vcoll. The rest of the lung was ventilated with air, while air (hypocapnia), 10% CO2 in air, or air and halothane or isoflurane were delivered to the isolated segment. A measurement of resistance was made after 4 min of test gas flow. For each segment, when air replaced 10% CO2, the average increase in Rcoll was calculated and called Rmax. When 10% CO2 in air was infused into segments the mean Rcoll (n = 50) was 0.0196 +/- 0.0022 cmH2O X ml-1 X min. This increased to 0.0285 +/- 0.0031 cmH2O X ml-1 X min (mean +/- E) when air was infused, a mean increase in resistance of 52 +/- 3%. When halothane or isoflurane was added to air the hypocapnic increase in Rcoll was attenuated with a 50% decrease at 1.3% (1.4 MAC and 0.8 MAC, respectively). These two inhalational anesthetics reduce active changes in the flow resistance to collateral ventilation. When collateral resistance acts to adjust ventilation perfusion deviations, this action of halothane and isoflurane may make this regulation less effective.

Amplitude of ventricular fibrillation waveform and outcome after cardiac arrest

The amplitude of ventricular fibrillation found initially in 394 patients was compared to clinical and logistical findings at the time of cardiac arrest. Peak-to-peak amplitude averaged 0.55 +/- 0.25 mV; a very low amplitude (0.2 mV or less) or "fine" fibrillation was present in 66 patients (17%). The amplitude was not found to be related to clinical histories, but depended on the length of the period from collapse until start of basic life support (p = 0.004) and the delay until assessment by paramedics (p = 0.001). Survival rates were strongly associated with amplitude: only 4 patients (6%) with fine ventricular fibrillation survived, compared to 117 or 328 patients (36%) in whom the initial amplitude was higher (p less than 0.001). Patient outcome related to amplitude even after adjusting for clinical history and logistical delays (p less than 0.005). We conclude that fine ventricular fibrillation is in part the result of delay in initiation of treatment, and that fibrillation amplitude is a powerful indicator of outcome after cardiac arrest.

Personality characteristics of alcoholics dropping out of treatment

Twenty seven male alcoholics were prospectively studied to find out the characteristics of those who drop out soon after discharge from the hospital. Seven persons, failed to make a single visit over a six-month period, and were termed 'dropouts'.On admission, after detoxification, all 27 patients were individually administered, the following tests:(1) Bhatia's Performance Test of Intelligence(2) Multiphasic Questionnaire(3) Internal-External Locus of Control Scale and(4) 16 P. F. Questionnaire (Form C).Dropouts did not differ from the completers on any of the socio-demographic or clinical variables. Two personality characteristics significantly differentiated the dropouts from the completers.

Oral contraceptive use: prospective follow-up of women with suspected glucose intolerance

593 women from a cohort of 8,652 healthy women failed a 1-hr glucose screening test. These 593 women with suspected glucose intolerance were classified as normal or as having impaired glucose tolerance (IGT) or diabetes mellitus (DM) after an oral standard glucose tolerance test (SGTT) and were followed over a mean 8.55 years. No permanent change in glucose status as a result of oral contraceptive use was found in an analysis for impaired glucose tolerance, diabetes mellitus, diabetic symptoms, or use of oral agents and/or insulin. Increased glucose intolerance was observed for women who were older, had a positive family history of diabetes, or were of greater relative weight. Diabetic symptoms correlated most closely with the onset of persistent fasting hyperglycemia.

A possible mechanism for diisopropylfluorophosphate-induced memory loss in rats

Passive avoidance retention and cortical [H3]-quinuclidinyl benzilate (QNB) binding were examined in rats that were chronically treated with diisopropylfluorophosphate (DFP), an irreversible acetylcholinersterase inhibitor. Retention of a passive avoidance response in DFP-treated rats was significantly lower when compared to vehicle-treated controls. Passive-avoidance retention decreased from 93% in control animals to 68% in DFP-treated rats. QNB binding studies revealed the density of muscarinic receptors in cortical homogenates was significantly reduced from 0.95 +/- 0.04 pmole/mg protein in controls to 0.72 +/- 0.04 pmole/m protein in DFP-treated rats. Scatchard analysis of QNB binding curves did not reveal a decrease in affinity of muscarinic receptors for QNB. Based on data that DFP causes a reduction in cholinergic receptors, this study supports the hypothesis that central cholinergic receptors are associated with mechanisms involved in memory storage.

Improved neurologic recovery and survival after early defibrillation

Eighty-seven patients who had out-of-hospital cardiac arrests received defibrillating shocks delivered by minimally trained first responders before the arrival of paramedics in a city with short emergency response times. Their outcomes were compared with those of 370 other victims who received only basic life support by first responders until paramedics arrived. Survival was improved by early defibrillation in cases in which there was a delay in initiating cardiopulmonary resuscitation and in which paramedic response times exceeded 9 min; there was 62% survival after early defibrillation by first responders and 27% if first responders provided only basic life support (p less than .02). Neurologic recovery was also improved after early defibrillation. Eighteen of 46 resuscitated patients (39%) receiving early defibrillation were awake at 24 hr compared with 49 of 204 patients (24%) who received only basic life support while awaiting paramedics (p less than .02). Incorporating defibrillation as part of basic life support can reduce both mortality and morbidity from cardiac arrest, even in cities with established, rapidly responding emergency care systems.

Stability of psychiatric diagnosis

Eighty five charts of patients whose diagnoses have changed at least once between 1977 and 1981 (unstable) were compared with another randomly chosen charts where diagnosis during the subsequent admissions remained unchanged (stable). Seventy six percent of the changes occurred from one to the other diagnostic category and remained so. Seventy three percent of Schizophrenics, 77.5% of Manics, 45% of Depressives and only 31% the Neurotics retained their original diagnosis. More Schizophrenics became Manics rather than the reverse. No statistically significant differences were found regarding changes between the other diagnostic categories. Unstable group had lesser frequency of admissions before the index admission and were more often readmitted.

Modulation of synapse formation by cyclic adenosine monophosphate

Synapses between neuroblastoma-hybrid cells and myotubes exhibit a high degree of plasticity. Increase of cyclic adenosine monophosphate (AMP) levels of the hybrid cells for several days results in the appearance of functional voltage-sensitive Ca2+ channels, which are required for evoked secretion of acetylcholine. The results show that cyclic AMP regulates synaptogenesis by regulating the expression of voltage-sensitive Ca2+ channels, and suggest that cyclic AMP affects posttranslational modifications of some glycoproteins and cellular levels of certain proteins.

Evaluation of continuous ambulatory peritoneal dialysis

This study was undertaken to ascertain whether 19 patients maintained on continuous ambulatory peritoneal dialysis (CAPD) for at least 1 year experienced any deterioration in peritoneal membrane function. Selected serum chemistries and skinfold measurements were also evaluated to determine whether patients dialyzed by CAPD could maintain a normal nutritional status. This study demonstrates that patients maintained on CAPD had stable dialysate protein losses, glucose absorption from the dialysate, and constant urea, creatinine, and sodium removal. When these patients were subdivided by incidence of peritonitis, the group with a lower incidence of peritonitis (one episode every 349 +/- 155 SEM days) showed stable serum protein concentration and improvement in upper arm area whereas the group with a high incidence of peritonitis (one episode every 95 +/- 7 SEM days) showed a reduction in upper arm muscle area. Thus, our data suggest that over a 1-year period, there is no deterioration in peritoneal membrane characteristics and CAPD is effective in maintaining the nutritional status of the patient. However, both membrane function and nutritional status may be impaired by frequent episodes of infection.

Measuring the costs of children: an alternative approach

Problems related to the concept of the "cost of a child", more commonly known as the general equivalence scale, are reviewed. The importance of this concept is noted with regard to both theoretical and empirical studies relating to taxation, poverty, income distribution, dietary needs, income maintenance programs, supplementary and child benefits, and other social security payments. "This paper proposes a new methodology for calculating the scale using a framework which is consistent with utility theory and which overcomes the identification problem without having to enforce the arbitrary prior assumptions of recent studies. The proposed method allows easy calculation of not only the basic 'scale' parameter but also how it varies with price and reference utility. [The author illustrates] the usefulness of the procedure by estimating on U.K. budget data at two different levels of aggregation and employing two sets of quite different functional forms. The results are plausible, compare favourably with one another and, hence, confirm the robustness and usefulness of the proposed procedure."

Error analysis of surface normals determined by radiometry

Surface normals can be computed from three images of a workpiece taken under three distinct lighting conditions without requiring surface continuity. Radiometric methods are susceptible to systematic errors such as: errors in the measurement of light source orientations; mismatched light source irradiance; detector nonlinearity; the presence of specular reflection or shadows; the spatial and spectral distribution of incident light; surface size, material, and microstructure; and the length and properties of the light source to target path. Typically, a 1° error in surface orientation of a Lambertian workpiece is caused by a 1 percent change in image intensity due to variations in incident light intensity or a 1° change in orientation of a collimated light source. Tests on a white nylon sphere indicate that by using modest error prevention and calibration schemes, surface angles off the camera axis can be computed within 5°, except at edge pixels. Equations for the sensitivity of surface normals to major error sources have been derived. Results of surface normal estimation and edge extraction experiments on various non-Lambertian and textured workpieces are also presented.

Peritonitis in continuous ambulatory peritoneal dialysis patients

Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD). We reviewed our experience with peritonitis over a 2 1/2-year period. Our patients spent 4% of their total time on dialysis in hospital due to peritonitis. Thirty-eight percent of the episodes of peritonitis were treated without hospitalization. We evaluated the dialysate bag change technique as commonly performed with currently available devices (extension tubing and titanium Luerlock Tenckhoff catheter adapter). The aseptic techniques described for dialysis extension tubing changes appear adequate (with no increased incidence of peritonitis demonstrated shortly after an extension tubing set change). Long-term sterility is maintained at the dialysate bag puncture port and at the orifice of the dialysis catheter adapter (no positive cultures from the bag port and orifice of the titanium adapter). Etiologic diagnosis of uremia was not a risk factor predisposing to peritonitis. The incidence of peritonitis was greater among patients with less formal education and lower income. Out data suggest that patients with less formal education and of lower economic status be carefully evaluated before commencing CAPD.

Comparison of home hemodialysis to continuous ambulatory peritoneal dialysis

We evaluated prospectively various outcome measurements of patients assigned initially to continuous ambulatory peritoneal dialysis (CAPD) and home hemodialysis (HHD) from February 1979 to August 1981 and the causes for failures of the techniques. Morbidity was assessed by time in hospital/time on dialysis. Fifty-six patients were trained for CAPD and 37 for HHD. Those assigned to CAPD experienced an increased frequency of hospitalization (7.5% CAPD, 2.8% HHD, respectively) primarily due to episodes of peritonitis. There was also a higher modality failure rate (43% vs. 16%). However, the groups were not comparable in all respects. For example, the CAPD population included 21 patients with major cardiovascular diseases versus only three in the HHD group. The demographic characteristics of both populations including race, sex, age, income, place of residence, marital status, and education were similar. At the time of this study there is no direct evidence showing that healthy patients otherwise able to perform HHD may be maintained with less morbidity for a prolonged period utilizing CAPD. Therefore, we suggest that HHD is the home method of choice for patients able to proceed with this technique. CAPD may be indicated for patients in whom the period of home dialysis is expected to be relatively short and who would be otherwise unable to carry out home dialysis, for example, patients awaiting transplantation and those unable to be maintained on hemodialysis because of impaired cardiac function. To fully evaluate CAPD as a long-term maintenance therapy, a prospective trial must be performed.

Clinical assessment and follow-up of functional capacity in patients with chronic congestive cardiomyopathy

The presumption that the results of left ventricular systolic function tests performed at rest are related to the symptoms of chronic congestive heart failure or to exercise capacity is unproved. Thirty-three patients with chronic congestive cardiomyopathy underwent serial exercise tests, determinations of ejection fraction and systolic time intervals, echocardiograms, assessment of symptom score, chest roentgenogram, and physical examination over a mean ( +/- standard deviation) of 24.8 +/- 14.1 months. Maximal exercise performance achieved correlation with symptoms (r = 0.66) but not with indexes of left ventricular function. Edema, elevated jugular venous pressure, rales and radiologic evidence of pulmonary venous hypertension were more common in patients with severe limitation of exercise capacity. in 17 patients whose functional capacity changed during the follow-up period, congruent changes in left ventricular function measured at rest were not consistently observed. Thus the findings on history, physical examination and radiologic examination correlate with exercise capacity, but indexes of left ventricular performance at rest do not and therefore are of limited use in assessing treatment. The clinical course of patients with chronic congestive cardiomyopathy can be followed up safely, effectively and economically by simple clinical observations. Serial laboratory testing of left ventricular function can be reserved for specific indications, research and patients with valvular heart disease.

Walk-in clinic drop-outs

Data were collected among 159 consecutive new patients in a walk-in clinic. Patients were given an appointment for a subsequent visit after the initial clinical diagnostic interview, and 61% completed their referral. A long waiting list and a diagnosis of depressive neurosis were significantly associated with drop-out. Possible forms of follow-up are suggested.

Continuous ambulatory peritoneal dialysis. Treatment of dialysis-related ascites

Continuous ambulatory peritoneal dialysis is a new dialysis technique. It is unknown at this time which patient would be served best by this therapy. Two cases of dialysis-related ascites were successfully treated by this technique. We suggest that the continuous control of salt and water balance possible with this technique, as well as frequent drainage of the peritoneal cavity to prevent fluid reaccumulations, contributed to successful treatment. Continuous ambulatory peritoneal dialysis may be used to treat dialysis-related ascites.

Peritoneal abnormalities during infectious episodes of continuous ambulatory peritoneal dialysis

Exchanges were performed in 1-hour and 3- to 5-hour cycles when patients were noninfected and during episodes of peritonitis. The hourly exchange dialysate effluent volume decreased with the occurrence of peritonitis. These exchanges were associated with increased glucose absorption from dialysate, diminished sodium removal and augmented clearances of urea and creatinine. Protein losses were increased in the dialysate effluent of patients during an episode of peritonitis during the hourly exchanges. In the long-dwell exchanges obtained after clinical improvements of peritonitis, only protein losses were increased over control. Clearances, sodium loss in dialysate and glucose absorption were not altered from control.

Lower limb anomalies in the thrombocytopenia absent-radius (TAR) syndrome

We report a case of the TAR syndrome with severe abnormalities of the lower limbs. The syndrome of thrombocytopenia and radial deformities occasionally presents diagnostic difficulties when severe limb anomalies are present. Based on this case and 2 additional cases from the literature, reduction anomalies of the lower limbs should be considered part of the TAR syndrome.

Failure of serology in diagnosing chlamydial infections of the female genital tract

Chlamydia trachomatis was recoved from 20% (36/180) of women attending a venereal disease clinic. All infected women had chlamydial antibodies in their serum and cervical secretions. However, the background rates of chlamydial antibody in chlamydia-negative women were very high. Measurement of antibodies in serum (complement fixation or immunoglobulin G [IgG] and IgM by microimmunofluorescence) or cervical secretion (IgG, IgM, IgA or secretory IgA classes) did not result in predictive values of greater than 32%. It is concluded that the detection of chlamydial antibodies in serum or cervical secretions cannot be substituted for agent isolation in diagnosing these infections.

Psychosocial correlates of chronic cannabis use

The psychosocial effects of chronic heavy use of cannabis were studied in a rural population of males in north India. The user group comprised thirty persons who had been taking only cannabis at least 11 times a month over a period of five years or more. The controls were fifty subjects selected from among the general population to which the users belonged. The controls had not been using any drugs. The subjects had similar age distribution, occupation, socioeconomic status, and educational background. Psychosocial adaptation was assessed by enquiries into such areas as self-aspiration, present occupation, occupational satisfaction, marital status, marital relationships, sexual behaviour, self-reported deviant behaviour, and future planning for children. On no variable were the present users found to be different from the non-user control group.

The incidence of cervical cancer and duration of oral contraceptive use

In a prospective study carried out on a cohort of 17,942 women belonging to the Kaiser Foundation Health Plan and living in suburban communities of the San Francisco Bay Area, a positive association was found between the incidence of cervical carcinoma and total duration of oral contraceptive use. The association was established while controlling for the effects of age, education, and selected infections. The association persists when incident cases of dysplasia are added to those of carcinoma. A further study, in which covariates relating to sexual behavior will also be taken into account, is in progress.