Empiric flap coverage for the pneumonectomy stump: How protective is it? A single-institution cohort study

OBJECTIVE

To evaluate the impact of empiric tissue flaps on bronchopleural fistula (BPF) rates after pneumonectomy.

METHODS

Patients who underwent pneumonectomy between January 2001 and December 2019 were included. Primary end point was development of BPF. Secondary end points were impact of flap type on BPF rates, time to BPF development, and perioperative mortality.

RESULTS

During the study period, 383 pneumonectomies were performed; 93 were extrapleural pneumonectomy. Most pneumonectomy cases had empiric flap coverage, with greater use in right-sided operations (right: 97%, 154/159; left: 80%, 179/224, P < .001). Empiric flaps harvested included intercostal, latissimus dorsi, serratus anterior, omentum, pectoralis major, pericardial fat/thymus, pericardium, and pleura. BPF occurred in 10.4% of the entire cohort but decreased to 6.6% when extrapleural pneumonectomy cases were excluded; 90% (36/40) of BPFs occurred on the right side (P < .001). Median time to develop BPF was 63 days, and 90-day mortality was greater in patients with BPF (12.5% BPF vs 7.4% non-BPF, P < .0001). Intercostal muscle had the lowest rate of BPF (4.5%), even in right-sided operations (8.7%). In contrast, larger muscle flaps such as latissimus dorsi (21%) and serratus anterior (33%) had greater rates of BPF, but the sample size was small in these cohorts.

CONCLUSIONS

Empiric bronchial stump coverage should be performed in all right pneumonectomy cases due to greater risk of BPF. In our series, intercostal muscle flaps had low BPF rates, even in right-sided operations. Coverage of the left pneumonectomy stump is unnecessary due to low incidence of BPF in these cases.

The mitigated carbon emissions of transitioning to virtual medical school and residency interviews: A survey-based study

PURPOSE

Prior to COVID, thousands of medical school and residency applicants traversed their countries for in-person interviews each year. However, data on the greenhouse gas emissions from in-person interviews is limited. This study estimated greenhouse gas emissions associated with in-person medical school and residency interviews and explored applicant interview structure preferences.

METHODS

From March to June 2022, we developed and distributed a nine-question, website-based survey to collect information on applicant virtual interview schedule, demographics and preference for future interview format. We calculated theoretical emissions for all interviews requiring air travel and performed a content analysis of interview preference explanations.

RESULTS

We received responses from 258 first-year and 253 fourth-year medical students at 26 allopathic US medical schools who interviewed virtually in 2020-2021 and 2021-2022, respectively. Residency applicants participating in the study were interviewed at a mean of 15.3 programs (SD 5.4) and had mean theoretical emissions of 4.31 tons CO2 eq. Medical school applicants participating in the study were interviewed at a mean of 6.9 programs and had mean theoretical emissions of 2.19 tons CO2 eq. Ninety percent of medical school applicants and 91% of residency applicants participating in the study expressed a preference for hybrid or virtual interviews going forward.

CONCLUSION

In-person medical training interviews have significant greenhouse gas emissions. Virtual and hybrid alternatives have a high degree of acceptability among applicants.

Extramural US Federal Research Grants For Health Outcomes Associated With Climate Change Inadequate, Too Narrow In Focus

Climate change causes and exacerbates disease, creates and worsens health disparities, disrupts health care delivery, and imposes a significant disease burden in the US and globally. Critical knowledge gaps hinder an evidence-based response and are perpetuated by scarce federal research funds. We identified and described extramural US federal research funding (that is, grants provided to organizations and institutions outside of federal agencies) that both addressed health outcomes associated with climate change and was awarded between 2010 and 2020. During this eleven-year period, 102 grants met our criteria, totaling approximately $58.7 million, or approximately $5.3 million per year (2020 adjusted US dollars). Federal investments in climate change and health research during this period failed to address the breadth of climate-sensitive exposures, health outcomes, and impacts on vulnerable populations. Moving forward, in addition to increasing investment in climate and health research across all known hazards, critical attention should be placed on vulnerable populations and health equity. To achieve this, increased federal research coordination and cooperation are needed, as well as a mechanism to track this funding.

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

BACKGROUND

Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.

METHODS

This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries.

RESULTS

In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.

CONCLUSION

This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.

How Should We Respond to Health Sector Emissions That Exacerbate Climate Change and Inequity?

A warming climate poses substantial risk to public health and worsens existing health inequity. As a contributor to greenhouse gas emissions and air pollution, the health sector has obligations and ample opportunities to protect health by decreasing waste and motivating more system-wide sustainable clinical practices. Such efforts will have important ethical implications for health equity.

Examining the mental health of siblings of children with a mental disorder: A scoping review protocol

Introduction

Mental disorders affect 1 in 5 children having consequences for both the child and their family. Indeed, the siblings of these children are not insulated from these consequences and may experience elevated levels of psychological distress, placing them at increased risk for developing mental disorders. This protocol describes the methodology for a scoping review that will examine how mental disorders in children impact the mental health of their sibling(s). Further, we aim to examine the role of sex, gender, birth order, age of each child, and familial factors (e.g., parent mental illness, family structure), in sibling mental health. The proposed review will also identify resources that aim to support the needs of siblings of children with mental disorders. Taken together, this proposed review aims to take a fundamental step towards determining intervention targets to reduce the transmission of risk between siblings.

Aim

The proposed scoping review aims to address the following questions: i) how do mental disorders (in children <18 years of age) impact the mental health of their sibling(s) (also <18 years of age)? ii) Can we identify resources designed to address the needs of siblings of children with mental disorders?

Methods

We will conduct the proposed scoping review in keeping with the six-stage Arksey and O’Malley Framework and the scoping review methodology provided by the Joanna Briggs Institute. In section i) we outline our research questions. In section ii) we describe our process for identifying studies that examine the mental health of siblings of a child with a mental disorder and studies that provide evidence on resources directed specifically at these siblings. We will search peer-review and grey literature published between 2011 and 2022 from OVID MEDLINE, OVID EMBASE, CINAHL Complete, Proquest Nursing and Allied Health, PsycINFO (via APA platform), Proquest Sociology Collection and Web of Science Core Collection and Proquest Theses and Dissertations. Section iii) describes our process for selecting relevant studies. In sections iv and v, we describe our methods for charting and summarizing relevant data. Finally, in section vi) we describe our integrative knowledge translation plan that aims to include knowledge users in interpretating and translating evidence gathered from the proposed review.

Mining of Ebola virus entry inhibitors identifies approved drugs as two-pore channel pore blockers

Two-pore channels (TPCs) are Ca2+-permeable ion channels localised to the endo-lysosomal system where they regulate trafficking of various cargoes including viruses. As a result, TPCs are emerging as important drug targets. However, their pharmacology is ill-defined. There are no approved drugs to target them. And their mechanism of ligand activation is largely unknown. Here, we identify a number of FDA-approved drugs as TPC pore blockers. Using a model of the pore of human TPC2 based on recent structures of mammalian TPCs, we virtually screened a database of ~1500 approved drugs. Because TPCs have recently emerged as novel host factors for Ebola virus entry, we reasoned that Ebola virus entry inhibitors may exert their effects through inhibition of TPCs. Cross-referencing hits from the TPC virtual screen with two recent high throughput anti-Ebola screens yielded approved drugs targeting dopamine and estrogen receptors as common hits. These compounds inhibited endogenous NAADP-evoked Ca2+ release from sea urchin egg homogenates, NAADP-mediated channel activity of TPC2 re-routed to the plasma membrane, and PI(3,5)P2-mediated channel activity of TPC2 expressed in enlarged lysosomes. Mechanistically, single channel analyses showed that the drugs reduced mean open time consistent with a direct action on the pore. Functionally, drug potency in blocking TPC2 activity correlated with inhibition of Ebola virus-like particle entry. Our results expand TPC pharmacology through the identification of approved drugs as novel blockers, support a role for TPCs in Ebola virus entry, and provide insight into the mechanisms underlying channel regulation. This article is part of a Special Issue entitled: ECS Meeting edited by Claus Heizmann, Joachim Krebs and Jacques Haiech.

Exploring the Impact Factor: Medical Students Mentoring High School Students and Cultivating Cultural Humility

Purpose: Diversity at all levels of medical training remains relatively stagnant, despite efforts to address equity in medical schools. Early career-specific mentoring may address barriers to the pursuit of medical education for students underrepresented in medicine (URiM). By surveying a program that engages medical students as drivers of career-specific mentorship for URiM high school students, this study evaluates medical student mentors' experiences mentoring and seeks to develop a mentorship curriculum.

Methods: The authors describe a medical student-led pipeline program, which connects medical students with URiM high school students. Medical student mentors participated in focus groups and gave written responses evaluating reasons for involvement, sociocultural attitudes, and skills needed for mentoring. Thematic analysis was applied.

Results: Themes that emerged in this analysis include motivation to mentor, skills used to approach the mentoring relationship, and benefits to the mentor. Mentors felt their experiences had a high impact factor, and they employed dynamic discovery. It provided personal reward and a deeper understanding of disparities.

Conclusion: Bringing medical school mentors together for peer to peer idea sharing, creating communities of practice, will help these students develop effective mentorship skills. A curriculum based on appreciative inquiry of mentors' strengths will enrich idea sharing, fostering cultural humility and avoiding burnout. Medical students involved in this program believe they gained benefits, including improving their mentorship skills, expanding their cultural humility, increasing their comfort with caring for underserved populations, and improving their ability to recognize health disparities.

Should prospective dental students be screened for colour vision deficits?

A perennial question in dental education is: what skills and aptitudes should be assessed in prospective dental students? Intellectual capacity and manual dexterity understandably rank highly, but are there minimum thresholds for visual perception that applicants need be able to demonstrate before they enter the profession? We have recently flagged this issue with regard to the thresholds of stereoscopic acuity required for a dentist when operating on teeth. In the present article, we highlight the issue of identifying a minimum acceptable level of colour vision.

In vitro investigations on the effects of semi-synthetic, sulphated carbohydrates on the immune status of cultured common carp (Cyprinus carpio) leucocytes

The rapid emergence of drug resistance, unfavourable immunosuppression and mounting evidence to suggest the deleterious accumulation of drug breakdown residues within animal tissues has driven a strong desire to move away from these current methods of disease control. Some natural products such as β-glucan, which are extracted from, for example, plants and fungi, are able to modulate the immune system and increase protection against diseases. However, these products are heterogeneous and their effects can be variable thus limiting their applicability and reliability. Carbohydrates were modified via chemical sulphation and these semi-synthetic, sulphated carbohydrates analysed for their immunological activity utilising carp pronephric cells and a carp leucocyte cell line (CLC). A sulphated β(1,4)-glucan, methyl hydroxyethyl cellulose sulphate (MHCS), demonstrated a stimulatory effect on fish immune cells. MHCS induced a range of bioactive effects in carp leucocyte cells whilst not affecting cell viability when cells were exposed for 24 h at concentrations of 1-150 μgml^-1. MHCS stimulated the innate immune system where a significant increase in respiratory burst activity was observed at concentrations 25-250 μgml^-1 in comparison to control (sterile water), cellulose ether, MacroGard^® and zymosan. Also, under in mock bacterial and viral infection conditions i.e. Lipopolysaccharide (LPS) and polyinosinic:polycytidylic acid (Poly(I:C)), MHCS enhanced the immune responses of pronephric cells by stimulating the respiratory burst activity at concentrations 50 and 150 μgml^-1. MHCS also enhanced the expression of cytokines including interleukin 1 beta (IL1β), tumor necrosis factor alpha 1 and 2 (TNFα 1,2), interferons alpha 2 (IFN α2) and inducible nitric oxide synthase (iNOS) in carp pronephric cells. It is proposed that this new semi-synthetic carbohydrate is a potential candidate for the development of a new generation of immunostimulants and adjuvants for use in vaccination strategies in aquaculture.

An Endosomal NAADP-Sensitive Two-Pore Ca2+ Channel Regulates ER-Endosome Membrane Contact Sites to Control Growth Factor Signaling

Membrane contact sites are regions of close apposition between organelles that facilitate information transfer. Here, we reveal an essential role for Ca²⁺ derived from the endo-lysosomal system in maintaining contact between endosomes and the endoplasmic reticulum (ER). Antagonizing action of the Ca²⁺-mobilizing messenger NAADP, inhibiting its target endo-lysosomal ion channel, TPC1, and buffering local Ca²⁺ fluxes all clustered and enlarged late endosomes/lysosomes. We show that TPC1 localizes to ER-endosome contact sites and is required for their formation. Reducing NAADP-dependent contacts delayed EGF receptor de-phosphorylation consistent with close apposition of endocytosed receptors with the ER-localized phosphatase PTP1B. In accord, downstream MAP kinase activation and mobilization of ER Ca²⁺ stores by EGF were exaggerated upon NAADP blockade. Membrane contact sites between endosomes and the ER thus emerge as Ca²⁺-dependent hubs for signaling.

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NAADP/TPC1 signaling maintains endo-lysosomal morphology

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TPC1 localizes to contacts between late endosomes and the endoplasmic reticulum

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NAADP/TPC1 signaling regulates contact site formation

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NAADP tempers EGF receptor-mediated signaling

Feedback and motor skill acquisition using a haptic dental simulator

AIM

To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator.

METHODS

Sixty-three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device-only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post-test.

RESULTS

Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks.

CONCLUSION

These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education.

An Exploration of Faculty Experiences With Open Access Journal Publishing at Two Canadian Comprehensive Universities

INTRODUCTION: This exploratory study was intended to shed light on Canadian academics’ participation in, knowledge of and attitudes towards Open Access (OA) journal publishing. The primary aim of the study was to inform the authors’ schools’ educational and outreach efforts to faculty regarding OA publishing. The survey was conducted at two Canadian comprehensive universities: Brock University (St. Catharines, Ontario) and Wilfrid Laurier University (Waterloo, Ontario) in 2014. METHODS: A Web-based survey was distributed to faculty at each university. The data was analyzed using descriptive statistics. LIMITATIONS: Despite the excellent response rates, the results are not generalizable beyond these two institutions. RESULTS: The Brock response rate was 38 percent; the Laurier response rate was 23 percent from full-time faculty and five percent from part-time faculty. Brock and Laurier faculty members share common characteristics in both their publishing practices and attitudes towards OA. Science/health science researchers were the most positive about OA journal publishing; arts and humanities and social sciences respondents were more mixed in their perceptions; business participants were the least positive. Their concerns focused on OA journal quality and associated costs. CONCLUSION: While most survey respondents agreed that publicly available research is generally a good thing, this study has clearly identified obstacles that prevent faculty’s positive attitudes towards OA from translating into open publishing practices. INTRODUCTION : Cette étude exploratoire tente de mieux comprendre la participation, les connaissances et les attitudes des universitaires canadiens envers la publication en libre accès. Le but premier de cette étude est d’éclairer les campagnes éducatives et de sensibilisation concernant la publication en libre accès auprès des institutions des auteurs. Un sondage a été mené en 2014 à deux universités à vocation générale canadiennes : Brock University (St. Catherine, Ontario) et Wilfrid Laurier University (Waterloo, Ontario). MÉTHODES : Un sondage en ligne a été envoyé au corps professoral de chaque université. Les données ont été analysées à l’aide de statistiques descriptives. LIMITES : Malgré l’excellent taux de réponse, les résultats ne peuvent être généralisés au-delà des deux universités. RÉSULTATS : Le taux de réponse de Brock était de 38%; celui de Laurier était de 23% pour les professeurs à temps plein et 5% pour les professeurs à temps partiel. Les professeurs des deux universités partagent quelques caractéristiques quant à leurs pratiques et attitudes envers le libre accès. Les chercheurs en médecine et en sciences de la santé étaient les plus positifs envers la publication dans des revues en libre accès; les répondants des arts, sciences humaines et sciences sociales avaient des opinions mixtes; les participants en gestion étaient les moins positifs. Leurs inquiétudes portaient sur la qualité des revues en libre accès et les coûts associés. CONCLUSION : Malgré le fait que la plupart des répondants croient qu’il est bon que la recherche soit disponible au grand public, cette étude identifie clairement des obstacles qui empêchent les professeurs de passer d’attitudes positives envers le libre accès à des pratiques concrètes de publication ouverte.

Subscapularis and deltoid preserving anterior approach for reverse shoulder arthroplasty

HYPOTHESIS

We hypothesize that performing a RSA using an anterior approach without cutting the subscapularis tendon and the deltoid muscle could provide patients with superior short-term clinical outcomes and immediate active range of motion (ROM) without immobilization.

METHODS

Between August 2013 and June 2015, all patients who had a primary RSA were considered potentially eligible for inclusion in this prospective study.

RESULTS

No immediate intra- or postoperative complications were noted. A statistically significant improvement of VAS (from 6.7 to 1; P<.001), SANE (from 34 to 80; P<.001), and elevation (from 103° to 128°; P=.02) was observed. In some cases, patients who had pseudoparalysis preoperative were able to achieve full anterior elevation few days after the operation.

DISCUSSION

Using a subscapularis and deltoid preserving anterior approach is an option for patients requiring RSA. Leaving this tendon intact and preserving the deltoid minimize the need for immediate postoperative immobilization and allow for faster recovery of shoulder ROM, without risking the concern of humeral anterior dislocation. Overall duration of hospital stay as well as length of postoperative physical therapy may be minimized, with substantial long-term economic gain. Longer follow-up and comparison with standard approaches is necessary in the future.

LEVEL OF EVIDENCE OF THE STUDY

Level IV, case series with no comparative group.

Endo-lysosomal TRP mucolipin-1 channels trigger global ER Ca2+ release and Ca2+ influx

Transient receptor potential (TRP) mucolipins (TRPMLs), encoded by the MCOLN genes, are patho-physiologically relevant endo-lysosomal ion channels crucial for membrane trafficking. Several lines of evidence suggest that TRPMLs mediate localised Ca²⁺ release but their role in Ca²⁺ signalling is not clear. Here, we show that activation of endogenous and recombinant TRPMLs with synthetic agonists evoked global Ca²⁺ signals in human cells. These signals were blocked by a dominant-negative TRPML1 construct and a TRPML antagonist. We further show that, despite a predominant lysosomal localisation, TRPML1 supports both Ca²⁺ release and Ca²⁺ entry. Ca²⁺ release required lysosomal and ER Ca²⁺ stores suggesting that TRPMLs, like other endo-lysosomal Ca²⁺ channels, are capable of ‘chatter’ with ER Ca²⁺ channels. Our data identify new modalities for TRPML1 action.

Summary: The endolysosomal ion channel TRP mucolipin 1 was thought to mediate local Ca²⁺ signals. However, as reported here, it can also mediate global elevations in Ca²⁺.

Interventions Associated With the Management of Suspected Infections in Advanced Dementia

CONTEXT

Nursing home (NH) residents with advanced dementia are commonly suspected of having infections. Most episodes are treated with antimicrobials, although evidence supporting bacterial infections is often lacking. The extent to which other interventions are used in managing suspected infections is unknown.

OBJECTIVES

To describe interventions used to manage suspected infections in advanced dementia and identify factors associated with greater intervention use.

METHODS

Residents with advanced dementia who experienced suspected infections in 35 Boston NHs were followed for 12 months. Data describing interventions used in managing each episode were ascertained, including blood draws, chest radiographs, procurement of urine samples, and hospital transfers. Resident and episode characteristics associated with greater intervention use were identified using mixed model regression.

RESULTS

A total of 240 residents experienced 496 suspected infections involving the following interventions: any, n = 360 (72.6%); hospital transfer, n = 51 (10.3%); blood draw, n = 215 (43.3%); chest radiograph, n = 120 (24.2%); and urine sample, n = 222 (44.8%). Factors associated with greater intervention use included black race (adjusted odds ratio [AOR] 3.19; 95% CI, 1.37-7.44); no do not hospitalize order (AOR, 1.83; 95% CI, 1.16-2.90); not on hospice (AOR, 5.41; 95% CI, 2.14-13.70); and suspected source being respiratory (AOR, 10.67; 95% CI, 4.99-22.80), urine (AOR, 15.79; 95% CI, 7.41-33.66) or fever of unknown source (AOR, 20.26; 95% CI, 8.42-48.73) vs. skin/soft tissue.

CONCLUSION

NH residents with advanced dementia frequently experience potentially burdensome interventions when suspected of having an infection. Advance directives to limit such interventions may be appropriate for residents whose goal of care is comfort.

A critical evaluation of the Incapacity Status Scale

The Incapacity State Scale (ISS) of the research version of the Minimal Record of Disability in Multiple Sclerosis has been tested in parallel with Assessment of the Activities of Daily Living (ADL) Index. Reliance of the ISS scoring on the use of aids and adaptive devices was found to be a major source of variation. It is suggested that the general scoring of the proposed ISS scale should be modified so that it employs that of the ADL method, i.e. measuring only independence (irrespective of the use of side and adaptive devices), partial and total dependence.

In a medium containing glucose, lactate carbon is incorporated by gonococci predominantly into fatty acids and glucose carbon incorporation is increased: implications regarding lactate stimulation of metabolism

The reason for stimulation by lactate of metabolism of gonococci growing in a medium containing glucose, which enhances pathogenicity by increasing growth rate, lipopolysaccharide (LPS) synthesis and protein formation, has been investigated. Tricine dodecylpolyacrylamide gel electrophoresis (SDS-PAGE) and thin layer chromatography (TLC) on homogenates of gonococci grown in this medium with [14C]lactate showed that lactate carbon was preferentially incorporated into lipid and LPS. Nuclear magnetic resonance (NMR) spectroscopy on lipid extracted from gonococci grown in the glucose containing medium with [13C]lactate showed that lactate carbon was incorporated into fatty acid moieties and not into ethanolamine or glycerol moieties. In contrast, NMR on lipid from gonococci grown with [13C]glucose indicated glucose carbon in both moieties. When unlabelled lactate was added, lipid synthesis from [l3C]glucose was stimulated and small amounts of different fatty acids were formed. The NMR data shows that gluconeogenesis from lactate carbon does not occur in the presence of glucose, suggesting that lactate is used solely for rapid production, via pyruvate, of acetyl CoA, the precursor not only for fatty acid synthesis but also for the constituents and products of the citric acid cycle, including ATP. The rapid formation of a high level of acetyl CoA is the probable reason for the stimulation of metabolism and oxygen uptake by lactate. 14C label on LPS was detected in its fatty acids. Most proteins that stained with silver in tricine SDS-PAGE were not significantly labelled by [14C]lactate in the glucose-containing medium. Two of three appreciably labelled proteins were identified by N-terminal sequencing as GroEL and porin 1B, and one of the two less labelled proteins was similar to peroxiredoxin type proteins. There were no signs of specific induction of these proteins by lactate and their labelling was consistent with fatty acids in attached lipid.

Child and adolescent nortriptyline single dose kinetics predict steady state plasma levels and suggested dose: preliminary data

The use of nortriptyline single dose kinetics to predict steady state plasma levels and suggested dose was investigated in 33 pediatric subjects who were diagnosed as having major depressive disorder. The data were analyzed separately for the 11 subjects 5 to 9 years old who received a single dose of 25 mg and a fixed daily dose of 20 mg of nortriptyline, and for the 22 subjects 10 to 16 years old who received a single dose of 50 mg and a fixed daily dose of 50 mg of nortriptyline (N = 17) or a fixed daily dose of 20 mg (N = 5) because of a very slow rate of metabolism of the drug. Correlations within the group of 5 to 9 years olds between the steady state plasma levels and the five sampling points after the single dose were all highly significant. Correlations between the steady state plasma levels within the group of 10 to 16 year olds and the five sampling points after the single dose and a fixed daily dose of 50 mg (N = 17) were also highly significant. Similar correlations for the total group of 10 to 16 year olds (N = 22) were performed (prorating the steady state plasma levels of the slow metabolizers), and these too were highly significant. Suggested dose schedules for each age group were developed from the regression equations of nortriptyline steady state plasma levels versus 24-hour nortriptyline plasma levels after the single dose. The regression equation for the group of 5 to 9 year olds was highly significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary data on DSM-III associated features of major depressive disorder in children and adolescents

Fifty-nine subjects 5-16 years old with major depressive disorder were assessed for the presence of separation anxiety and antisocial behavior, mentioned in DSM-III as associated features of the disorder in children and adolescents. The findings of the study support the existence of these associated features.

Symposium--forensic psychiatry. Civil commitment and the danger mandate

This paper examines the practice of involuntary mental hospitalization from the viewpoint of factors constituting effective, operating definitions of ‘dangerous’ mental disorder, as contrasted with the more narrow criteria which sanction commitment under Canadian law.

A sorting and analysis of a large sample of commitment certificates indicated that few contained evidence of involuntarily hospitalized patients as being dangerous, nor did the present sample of certificates indicate clearly that operating commitment criteria have been altered with the new and liberalized legislative formulations of such criteria. Independent of the need to commit certain people in society, possible incongruities between ideal and operating criteria for civil commitment deserve to be scrutinized by responsible professionals in mental health and law.