South Africa's male homicide epidemic hiding in plain sight: exploring sex differences and patterns in homicide risk in a retrospective descriptive study of postmortem investigations

Background

South Africa has homicide rates six times the global average, predominantly among men, but little is known about male victims. As part of the country's first ever study of male homicide we compared 2017 male and female victim profiles for selected covariates, against global averages and previous estimates for 2009.

Methods

We conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, stabs and blunt force) within and between years.

Findings

87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge the most common external causes. Rates were higher among males than females at all ages, and up to eight times higher among males aged 15-44 years. Provincial rates varied overall and by sex, with the highest comparative risk for men vs. women in the Western Cape Province (11.4 males for every 1 female). Male homicides peaked during December and were highest on weekends, underscoring the prominent role of alcohol as a risk factor. Significantly more males tested positive for alcohol than females.

Interpretation

The massive, disproportionate and enduring homicide risk borne by adult South African men highlights the negligible prevention response. Only through challenging the normative perception of male invulnerability can we begin to address the enormous burden of violence impacting men. There is an urgent need to address the insidious effect of such societal norms alongside implementing structural interventions to overcome the root causes of poverty and inequality and better control alcohol and firearms.

Funding

South African Medical Research Council and Ford Foundation.

The cost of harmful alcohol use in South Africa: A reply to Murray and Barr (2022)

Letter by Matzopoulos et al. on article by Murray and Barr (Murray M, Barr GDI. The cost of harmful alcohol use in South Africa: A commentary. S Afr Med J 2022;112(3):187-188. https://doi.org/10.7196/SAMJ.2022.v112i3.16354).

Mechanical-tactile stimulation (MTS) intervention in a neonatal stress model improves long-term outcomes on bone

OBJECTIVES

Neonatal stress impairs postnatal bone mineralization. Evidence suggests that mechanical tactile stimulation (MTS) in early life decreases stress hormones and improves bone mineralization. Insulin-like growth factor (IGF1) is impacted by stress and essential to bone development. We hypothesized that MTS administered during neonatal stress would improve bone phenotype in later life. We also predicted an increase in bone specific mRNA expression of IGF1 related pathways.

METHODS

Neonatal stress (STRESS) and MTS (STRESS+10 min of MTS) were given from D6 to D10 of rat life and tissue was harvested on D60 of life. Dual energy x-ray absorptiometry (DXA), bone morphometry, serum osteocalcin, type I procollagen N-terminal propeptide (PINP), tartrate-resistant acid phosphatase (TRAP), and bone and liver mRNA levels of IGF1, IGF1 receptor (IGF1R), and growth hormone receptor (GHR) were measured.

RESULTS

Stress resulted in reduced bone area and bone mineral content (BMC) compared to naive control (CTL). MTS intervention increased BMC and tibial growth plate width compared to STRESS. MTS also resulted in higher osteocalcin, and, in males, lower TRAP (p<0.05). MTS resulted in three-fold, two-fold, and six-fold higher bone specific IGF1, IGF1R, and GHR, respectively (p ≤ 0.001) compared to STRESS.

CONCLUSIONS

MTS in early postnatal life improves long-term bone mineralization. IGF1 and related pathways may explain improved BMC.

Injuries in the Victorian thoroughbred racing industry

There is increasing concern in Australia about safety in the thoroughbred racing industry, but there has been no reported analysis of injury data. This review analyses injury and workers' compensation data recorded in Victoria. On the basis of the results, it is recommended that the injury and incident data collection systems are improved such that they are not only more complete but also accumulate more detailed information about the location of an incident or injury event, the activity at the time of the incident or injury event, and factors that may have influenced the occurrence.

Recommending calcium to reduce lead toxicity in children: a critical review

Assertions that adequate or supplemental calcium intake can reduce lead absorption in children are based on liberal extrapolation from animal studies, experiments with human adults, and cross-sectional studies of children that have a variety of methodologic weaknesses. Without stronger supporting evidence, statements that diet can ameliorate the deleterious effects of environmental lead could provide a false sense of efficacy and divert efforts from lead abatement and from behavioral modifications that might have more impact.

Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996

OBJECTIVES

This study examined trends in fruit and vegetable consumption among adults in 16 US states.

METHODS

Data from telephone surveys were used to stratify respondents by sociodemographic and health-related characteristics.

RESULTS

The proportion of adults who consumed fruits and vegetables at least 5 times daily was 19%, 22%, and 23% in 1990, 1994, and 1996, respectively. While the proportion increased among those with active leisure-time physical activities and normal weight, it remained almost the same among inactive people and dropped among the obese.

CONCLUSIONS

Progress in fruit and vegetable intake from 1990 to 1994 was encouraging, but it changed little between 1994 and 1996.

Negative pressure ventilation via chest cuirass to decrease ventilator-associated complications in infants with acute respiratory failure: a case series

Pulmonary and nonpulmonary complications of invasive positive pressure ventilation are well documented in the medical literature. Many of these complications may be minimized by the use of noninvasive ventilation. During various periods of medical history, negative pressure ventilation, a form of noninvasive ventilation, has been used successfully. We report the use of negative pressure ventilation with a chest cuirass to avoid or decrease the complications of invasive positive pressure ventilation in three critically ill infants at two institutions. In each of these cases, chest cuirass ventilation improved the patient's clinical condition and decreased the requirement for more invasive therapy. These cases illustrate the need for further clinical evaluation of the use of negative pressure ventilation utilizing a chest cuirass.

Mycobacterium Keratitis After Laser in situ Keratomileusis

PURPOSE

The authors report two cases of Mycobacterium keratitis following LASIK.

METHODS

The case reports are based on a retrospective review of clinical history and associated findings.

RESULTS

Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated Mycobacterium fortuitum from case #1 and Mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second.

CONCLUSIONS

Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.

Nutrient intakes and dietary patterns of young children by dietary fat intakes

OBJECTIVE

To determine whether low fat intake is associated with increased risk of nutritional inadequacy in children 2 to 8 years old and to identify eating patterns associated with differences in fat intake.

STUDY DESIGN

Using 2 days of recall from the Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, we classified 2802 children into quartiles of energy intake from fat (<29%, 29% to 31.9% [defined as moderate fat], 32% to 34.9%, and > or =35%) and compared nutrient intakes, the proportion of children at risk for inadequate intakes, Food Pyramid servings, and fat content per serving across quartiles.

RESULTS

More children in quartile 2 were at risk for inadequate intakes of vitamin E, calcium, and zinc than children in higher quartiles (P <.0001); more children in quartiles 3 and 4 were at risk for inadequate intakes of vitamins A and C and folate (P <.001). Fruit intake decreased across quartiles (P <.0001); whereas vegetable, meat, and fat-based condiment intakes increased (P <.0001). Fat per serving of grain, vegetables, dairy, and meat increased across quartiles (P <.0001).

CONCLUSIONS

Moderate-fat diets were not consistently associated with an increased proportion of children at risk for nutritional inadequacy, and higher-fat diets were not consistently protective against inadequacy. Dietary fat could be reduced by judicious selection of lower-fat foods without compromising nutritional adequacy.

Molecular phylogeny and taxonomy of medically important fungi

Some recent advances in study of molecular evolution and taxonomy of human pathogens are discussed. In systemic Onygenales as well as in Chaetothyriales, pathogenic species are phylogenetically intermingled with non-pathogenic taxa. When a teleomorph of Coccidioides immitis is eventually found, it is predicted to resemble Uncinocarpus, a genus otherwise comprising environmental species. In the dermatophytes, Trichophyton and Microsporum are paraphyletic, whereas Epidermophyton is polyphyletic. On the basis of 18S and ITS rDNA sequencing data, Exophiala anamorphs (black yeasts) are confirmed to be closely related to the ascomycete genus Capronia. The related neurotropic species Cladophialophora bantiana is remarkable in consistently having introns in its 18S rDNA gene.

Predictors of injury among adult recreational in-line skaters: a multicity study

OBJECTIVES

This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in-line skaters.

METHODS

Randomly selected in-line skaters in 6 major US cities were interviewed.

RESULTS

Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury.

CONCLUSION

More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use in alarmingly low in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population.

In vitro verification of myocardial motion tracking from phase-contrast velocity data

The ability to track motion from cine phase-contrast (PC) magnetic resonance (MR) velocity measurements was investigated using an in vitro model. A computer-controlled deformable phantom was used for the characterization of the accuracy and precision of the forward-backward and the compensated Fourier integration techniques. Trajectory accuracy is limited by temporal resolution when the forward-backward technique is used. With this technique the extent of the calculated trajectories is underestimated by an amount related to the motion period and the sequence repetition time, because of the band-limiting caused in the cine interpolation step. When the compensated Fourier integration technique is used, trajectory accuracy is independent of temporal resolution and is better than 1 mm for excursions of less than 15 mm, which are comparable to those observed in the myocardium. Measurement precision is dominated by the artifact level in the phase-contrast images. If no artifacts are present precision is limited by the inherent signal-to-noise ratio of the images. In the presence of artifacts, similar in magnitude to those observed in vivo, the reproducibility of tracking a 2.2 x 2.2 mm2 region of interest is better than 0.5 mm. When the Fourier integration technique is used, the improved accuracy is accompanied by a reduction in precision. We verified that tracking three-dimensional (3D) motion from velocity measurements of a single slice can lead to underestimations of the trajectory if there is a through-plane component of the motion that is not truly represented by the measured velocities. This underestimation can be overcome if volumetric cine phase-contrast velocity data are acquired and full three-dimensional analysis is performed.

Controlled delivery of vascular endothelial growth factor promotes neovascularization and maintains limb function in a rabbit model of ischemia

PURPOSE

Vascular endothelial growth factor (VEGF) modulates new blood vessel development and growth and has been suggested as a potential therapeutic agent that could alleviate debilitating claudication in patients. The objective of this study was to determine whether controlled, local delivery of a low dose of VEGF from an osmotic pump could promote neovascularization, limb perfusion, and functional improvements in the hind limbs of rabbits rendered partially ischemic by surgery. The effects of VEGF were compared with those of the vasodilator nitroglycerin (NTG) and to saline administered similarly.

METHODS

Thirty rabbits were randomly assigned to either VEGF (n = 10), NTG (n = 10), or saline (n = 10) treatment groups. Partial ischemia was induced in each left hind limb by surgical ligation of the common and superficial femoral arteries, leaving the internal iliac artery intact. The right limb of each animal served as a nonischemic control. Immediately after vessel ligations, a 28-day osmotic pump was implanted to deliver VEGF (0.22 microg/kg/day), NTG (17.8 microg/kg/day), or saline solution into the common iliac artery just proximal to the ligation site. Comparative vascularity between ischemic and nonischemic limbs within treatment groups and between groups was evaluated by (1) capillary counts from representative fields of hematoxylin and eosin stained muscle tissue taken from hind limbs at day 40; (2) digitized arteriograms of ischemic legs at day 40, which were used to quantify the complexity of vascular branching (fractal dimension index) and the total extent of vascularization (vascular density index); (3) measuring capillary refill times in ischemic limbs; and (4) observations of functional and trophic changes in ischemic limbs. Statistical differences between treatment groups were evaluated by one-way ANOVA.

RESULTS

Complexity of vascular branching and vascular density were significantly greater (p < 0.001) in VEGF-treated ischemic limbs compared with NTG- and saline-treated ischemic limbs. By postoperation day 14, all VEGF-treated ischemic limbs had restored capillary refill (p < 0.001), new hair growth, and greatly improved limb function and appearance. Saline-treated limbs exhibited ischemic changes, with poor capillary refill and negligible limb function. Capillary refill in NTG-treated ischemic limbs did not differ significantly from saline-treated limbs. Ischemic VEGF-treated limbs had significantly more capillaries compared with both ischemic and nonischemic limbs in saline-treated animals (p < 0.05). Ischemic NTG-treated limbs also had significantly more capillaries compared with ischemic limbs in saline-treated animals (p < 0.05). Because of high variability, however, capillary counts in VEGF-treated ischemic limbs did not differ significantly from those of contralateral nonischemic limbs, or from capillary counts in either ischemic or nonischemic limbs of NTG-treated rabbits.

CONCLUSIONS

Controlled release of microgram quantities of VEGF significantly enhanced neovascularization and vascular perfusion in ischemic limbs compared with controls in this rabbit model of partial ischemia. In addition, VEGF-treated ischemic limbs demonstrated near-normal function and appearance, whereas NTG- and saline-treated ischemic controls remained noticeably impaired. This novel approach of VEGF delivery may prove clinically useful either alone or combined with revascularization procedures.

Granulocyte colony-stimulating factor upregulates the vacuolar proton ATPase in human neutrophils

We have previously shown that granulocyte colony-stimulating factor (G-CSF ) delays spontaneous neutrophil apoptosis through activation of the vacuolar proton ATPase (v-ATPase). We have now examined the regulation of the v-ATPase in neutrophils exposed to G-CSF in vitro. When neutrophils were cultivated in the absence of G-CSF, the 57-kD cytosolic B subunit of the v-ATPase disappeared within 1 to 2 hours, its loss preceding the nuclear changes of apoptosis and coinciding with the onset of acidification. By contrast, in neutrophils cultured for 2 hours in the presence of G-CSF, the amount of the 57-kD subunit was similar to that in freshly isolated neutrophils. However, inhibition of protein synthesis with cycloheximide and actinomycin D led to loss of the 57-kD subunit even in the presence of G-CSF. These results indicated that ongoing protein synthesis was required to maintain the v-ATPase, and further suggested that G-CSF acted, at least in part, by maintaining synthesis of the 57-kD cytosolic subunit. G-CSF also promoted the translocation of the 57-and 33-kD cytosolic v-ATPase subunits to the membrane. Our findings suggested two coordinate mechanisms by which the activity of the v-ATPase could be increased by G-CSF: the synthesis of cytosolic v-ATPase subunits and their translocation to the membrane.

The 1997 Lindberg Award. Effects of burn injury on bone and growth in a mouse model

Bone growth and remodeling are inhibited by severe burns in adult and pediatric patients, resulting in alterations in linear growth, bone mass, osteoporosis, and increased risk for pathologic fractures. This study of a mouse model of burn injury showed skeletal changes similar to those reported in patients with burn injuries. Baseline, control, sham, and burned mice were injected with fluorescent markers calcein and tetracycline for histomorphometric analysis. Total femur dry and ash weights and total calcium content were significantly lower 10 days after burn injury compared with sham and control animals. There also were decreases in the percentage of fluorochrome-labeled bone surfaces and bone formation rates in the burn-injured mice compared with control and sham mice; however, there were no differences in the mineral apposition rates. This model now provides an opportunity to examine cellular and molecular mechanisms contributing to skeletal pathology in a well-defined burn injury model.

Curriculum model for associate degree programs in HIM, Part III: Focus on educational outcomes and curricular content

This is the last in a series of three articles that discuss curriculum models for associate and baccalaureate degree programs in health information management (HIM). Part I discussed the development of the models and presented a composite summary of key sections within the models. Part II focused on the baccalaureate degree curriculum model sections, which addressed educational outcomes, curricular content, and clinical experience expectations. Part III addresses these same sections, but in regard to the associate degree curriculum model.

Migraine-related visual-field loss with prolonged recovery

BACKGROUND

Migraine is a complex neurologic syndrome that commonly causes visual disturbances. Although migraine visual disturbances are usually transient in nature, persistent or permanent visual field defects may occur. When persistent visual-field loss is found-even if migraine is suspected-appropriate workup must be performed to rule out other causes of vision loss.

CASE REPORTS

Two patients went to the eye clinic for comprehensive examination. One patient with symptomatic visual loss and one patient with asymptomatic visual loss were evaluated by serial ophthalmic examinations, neurologic/medical evaluations, computed tomography of the head, and laboratory results. Each patient reported a history consistent with migraine, and each demonstrated resolution of persistent visual-field defects that had been present longer than 10 days. Since ophthalmic, medical, laboratory, and imaging results did not identify and etiology other than migraine as the cause of the vision loss, it is likely that each case represents a specific form of complicated migraine.

CONCLUSIONS

Previous reports suggest that migraine-related visual deficits usually become permanent if persistent for more than 7 days. These reports demonstrate that visual recovery may still occur when field defects are present for 10 days or more.

Curriculum model for baccalaureate degrees programs in HIM, Part II: Focus on educational outcomes and curriculum content

This the second in a series of three articles discussing curriculum models for associate and baccalaureate degree programs in health information management (HIM). Part I discussed the development of the models and presented a composite summary of selected key sections within the models. Part II focuses on the educational outcomes, curriculum content, and clinical experience expectations for the baccalaureate degree curriculum model. Part III will do the same for the associate degree curriculum model.

Serum ferritin iron, a new test, measures human body iron stores unconfounded by inflammation

Serum ferritin protein is an acute phase reactant. We hypothesized that serum ferritin protein generated in response to an inflammatory process would have much less iron (Fe) in it than would "normal" ferritin protein, and therefore measuring serum ferritin iron would assess human body iron status unconfounded by inflammation.

BASIC METHODS

We measured serum ferritin iron in 140 clinical samples obtained from the serum banks of Bronx VA Medical Center Hematology and Nutrition Laboratory (Bronx, NY), the CDC Nutritional Biochemistry serum sample bank (Atlanta, GA), and the sample bank from patients with thalassemia and iron overload treated at New York Hospital (New York, NY). Each was analyzed for three conventional criteria of iron status: serum iron, percentage of transferrin saturation and ferritin protein. In addition, tests for inflammation were also performed: C-reactive protein, WBC and transaminases. Seventy-seven patients' sera from 140 screened met each of three consistent criteria for stages of iron status. Serum ferritin was immobilized by immunoprecipitation with rabbit antihuman polyclonal antibody bound to agarose and separated from other iron-containing proteins, digested with 0.2 ml of 3N nitric acid and analyzed for iron content by atomic absorption spectroscopy.

RESULTS

Serum ferritin iron ranged in normal controls from 10 ng to 35 ng Fe/ml. The patients with iron deficiency (4/4) and those in negative iron balance (5/6) had values < or = 10 ng. Positive iron balance (8/9) and iron overload (22/22) values were > 35 ng/ml, in contrast to 11/19 with inflammation. Seventeen of twenty-two with overload had values > 100 ng/ml while only 1/19 with inflammation had such a value. Ferritin iron in ferritin protein was > 15% by weight in 14/22 with iron overload but in 0/19 with inflammation.

IMPLICATIONS OF THE WORK

Serum ferritin iron is a simple, direct measure of iron stores that we propose, in conjunction with measuring serum ferritin protein, as a minimally invasive screening procedure for accurately assessing the whole range of human body iron status, unconfounded by inflammation.

The ABCs of physician billing compliance plans

As it evolves, an organization's compliance plan will become an effective risk-management tool. As the price for noncompliance becomes ever higher, the development and implementation of a corporate compliance plan makes both common and fiscal sense. A compliance plan should not be a program that is rolled out and then allowed to sit on the shelf and gather dust. The only thing worse than not having a compliance plan is having one and not following it.

Physiologic motion phantom for MRI applications

To address the need for a complex physiologic motion phantom for use in MR applications, such as the verification of techniques for measuring myocardial motion dynamics and motion insensitive pulse sequences, a computer-controlled motion phantom has been designed. The phantom, which consists of a deformable silicone gel annulus mounted on a translation stage, can undergo a range of bulk motions and deformations. Available motions include bulk rotation and translation, rotational shear, axial shear, and combinations of some or all of these motions. In this paper, the capability of the phantom to produce accurate constant and time-varying waveforms is demonstrated. In the current implementation, peak linear translation and rotation rates are 175 mm s-1 and 10 rad s-1, respectively. Cycle-to-cycle reproducibility is excellent, with variations of less than .003 radians over the period of hours while undergoing rotational shear. The phantom has been designed in a flexible fashion so that various test objects can be scanned while undergoing bulk translation and can be adapted to produce different deformations.

Pediatric emergency medicine fellow clinical work requirements

A wide range of clinical requirements exists among PEM fellowship programs. Programs are equally split concerning the question of whether fellows should work with supervision or independently in the first year; a significant number of fellowship programs require continued supervision of fellows in subsequent years. Orientation for first year fellows and requirements for completion of PALS, advanced pediatric life support (APLS), ACLS, or ATLS courses prior to their first independent shift varied greatly. In particular, a minority of programs required ATLS completion even though a majority of overall fellowship programs operate in a hospital designated as a Level 1 Trauma Center. Programs in which first-year fellows worked independently had fewer attendings and were less likely to provide 24-hour coverage. Fellows appear to work a similar or less demanding schedule than PEM attendings in most fellowship programs, and most fellowship directors feel that their fellows should continue with their current schedule.

The effect of electrical stimulation on obstructive sleep apnea syndrome

Patients with severe obstructive sleep apnea polygraphically documented underwent electrical stimulation treatment trials. Submental and intraoral stimulations were applied during waking and during nocturnal sleep. The stimulation was applied using a custom-designed neuromuscular electrical stimulator (EdenTec Corp) providing symmetric biphasic constant voltage pulses. Pulse duration of each phase was set to 80 microseconds based on a subjective evaluation of pulse durations from 80 to 300 microseconds to minimize sensation while generating equivalent motor responses. Pulse repetition rate was set to 50 pulses per second. Cephalometric radiographs and endoscopies were obtained with and without stimulations during waking. Most commonly, stimulations induced alpha EEG arousals. Submental subcutaneous stimulation induced good contractions of platysmal muscles but had no impact on the upper airway. Intraoral stimulation induced clear tongue muscle movements but with change of shape of the upper airway and posterior movements of the tongue. Each time a breakage of apnea was noted, it was associated with a time-linked alpha EEG arousal. The results obtained by us and others do not, at this time, give convincing support for the use of electrical stimulation using submental surface or intraoral electrodes as a viable approach for effective control of obstructive sleep apnea syndrome symptoms.

Vitamin E supplements and coronary heart disease

Although two new epidemiologic studies on the association between vitamin E and heart disease do not resolve important issues related to dose-response, mechanisms of action, or specificity, they do provide important evidence that supports the development of new strategies for preventing heart disease.

Pre-operative staging of colorectal carcinoma using positron emission tomography

Positron emission tomography (PET) is a unique technique for imaging functional metabolism of normal and diseased tissue. Accelerated rate of glucose metabolism typical of malignant tumor cells can be detected by using fluorine-18 deoxyglucose. In this pilot study, PET FDG imaging was compared to computerized tomography for the pre-operative staging of colorectal carcinoma. We prospectively evaluated 16 patients by simultaneously performing PET FDG and CT imaging for lesions in the liver, colon and rectum. The results were compared to the operative findings in all patients. Twenty tumor sites (lymph nodes 5, colon and rectum 13, liver 2) were found on histology in 16 patients. On comparison with histology, sensitivity, specificity and predictive accuracy for detection of tumor sites were 90%, 66% and 87% with PET as compared to 60%, 100%, and 65% with CT. These findings represent increased sensitivity and predictive accuracy for staging of colorectal carcinoma with PET FDG imaging as compared to CT scanning.

Characterization of the ilv-2 gene from Neurospora crassa encoding alpha-keto-beta-hydroxylacyl reductoisomerase

We have isolated the cDNA and corresponding genomic DNA for the ilv-2 locus of Neurospora crassa. This gene encodes alpha-keto-beta-hydroxylacyl reductoisomerase (Ilv-2), required for the synthesis of isoleucine and valine. The gene contains four introns, maps to the right arm of chromosome V, and encodes a protein of 400 amino acids (aa). Alignment of the aa sequence of Ilv-2 with the two other known eukaryotic sequences encoding this enzyme reveals two conserved regions.

The pigtail probe protected by silicone intubation: a combined approach to canalicular reconstruction

We have devised a method of single-eyelid canalicular reconstruction using the pigtail probe to facilitate identification of the proximal canalicular segment following silicone stent intubation of the normal, uninjured canaliculus. A series of seven acute and two long-standing canalicular lacerations were successfully reconstructed using this technique, which minimizes the risks associated with the use of the pigtail probe.

Altered fractional excretion of uric acid during total parenteral nutrition

The presence of crystal proven podagra coincident with a 52% decrease in plasma urate after a 3-day course of total parenteral nutrition (TPN) prompted a study of urate excretion in 9 patients with Crohn's disease. By Day 9 in those receiving TPN, plasma urate decreased 58% (p less than 0.001), while fractional urate excretion increased 94% (p less than 0.005). Twenty-four hour urate excretion and serum creatinine were not significantly altered. These findings persisted for the duration of TPN. In 2 patients with ileocolitis, the addition or deletion of either lipid emulsion or multivitamin infusions during TPN had no effect on urate values. Rather, the amino acid load or a specific constituent appears to be the causal factor. These data suggest that hypouricemia due to extensive net urate excretion is common during TPN therapy. Finally, patients with established gout may be at risk for acute gouty attacks during TPN therapy.

DNA sequences from the quagga, an extinct member of the horse family

To determine whether DNA survives and can be recovered from the remains of extinct creatures, we have examined dried muscle from a museum specimen of the quagga, a zebra-like species (Equus quagga) that became extinct in 1883 (ref. 1). We report that DNA was extracted from this tissue in amounts approaching 1% of that expected from fresh muscle, and that the DNA was of relatively low molecular weight. Among the many clones obtained from the quagga DNA, two containing pieces of mitochondrial DNA (mtDNA) were sequenced. These sequences, comprising 229 nucleotide pairs, differ by 12 base substitutions from the corresponding sequences of mtDNA from a mountain zebra, an extant member of the genus Equus. The number, nature and locations of the substitutions imply that there has been little or no postmortem modification of the quagga DNA sequences, and that the two species had a common ancestor 3-4 Myr ago, consistent with fossil evidence concerning the age of the genus Equus.

Effects of feedback stimulation training and cyclical electrical stimulation on knee extension in hemiparetic patients

Positional feedback stimulation training and cyclical electrical stimulation were used in combination as a treatment for facilitating knee extension in hemiparetic patients. Forty adult hemiparetic patients who demonstrated minimal active control of their quadriceps femoris muscles were randomly assigned to control or study groups. The control patients received a program of physical therapy, and the study patients received the positional feedback stimulation training in addition to their therapy program. The stimulation training provided the patient with immediate auditory and visual feedback of his changing joint angle while he voluntarily extended his knee. When the patient reached a near maximal extension effort, electrical stimulation of the quadriceps femoris muscle was automatically triggered, completing the patient's available range of motion in extension. The stimulation training was supplemented with two hours of cyclical electrical stimulation daily. At the end of four weeks, analysis revealed a statistically significant increase in knee extension torque and active synergistic range of motion in the study group. No change was noted in their ability to extend their knees using isolated quadriceps femoris muscle control. This study suggests that positional feedback stimulation training is effective when used to augment a facilitation program for improving knee extension control in hemiparetic patients.

Testing and modelling of spasticity

The aim of this investigation was to develop a clinically applicable method for quantitative evaluation of spasticity about the knee and to determine the minimum instrumentation necessary for a quick and simple estimation of spasticity. Skeletal muscle spasticity is assessed by physical therapists as increased resistance of a particular muscle group to manually induced passive movement. In this study the passive movement was produced by the force of gravity while the resistance was observed from the joint goniogram. Spasticity of the knee extensors was measured on patients with spinal cord injuries. Records of severe, moderate, and slight spasticity are presented in the paper. A mathematical model has been developed describing the behaviour of healthy and spastic extremity.