Does prophylactic decompression of distal nerves following nerve repair improve functional recovery? A systematic review

BACKGROUND

Peripheral nerve injuries are burdensome on healthcare systems, individuals and society as a whole. The current standard of treatment for neurotmesis is primary neurorrhaphy or nerve grafting. However, several patients do not recover their full function. There has been a suggestion that primary distal neurolysis at common entrapment sites maximises surgical outcomes; however, no guidelines exist on this practice. This scoping review aims to ascertain the existing evidence on prophylactic distal decompression of peripheral nerves following repair.

METHODS

A literature search was performed using Ovid Medline, PubMed, Embase and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews for studies published in the past 50 years. Studies were screened using a selection criteria and study quality was assessed using standardised tools. Furthermore, thematic content analysis was performed.

RESULTS

Six studies were eligible for inclusion after screening; all studies were retrospective and at most level 3 evidence. No studies were designed specifically to assess the efficacy of distal neurolysis following proximal repair, thus no comparative data with control cohorts are available. All studies that recommended distal decompression of proximally repaired nerves based their conclusions on cases observed by the authors in practice or from theories on nerve regeneration.

CONCLUSIONS

This systematic review suggests that the evidence on the role of immediate distal neurolysis in primary neurorrhaphy is inadequate. Recommendations are limited by the lack of large-scale and generalisable data. Further research is needed with definitive objective outcomes and patient-related outcome measures.

Development of optimised tissue-equivalent materials for proton therapy

Objective. In proton therapy there is a need for proton optimised tissue-equivalent materials as existing phantom materials can produce large uncertainties in the determination of absorbed dose and range measurements. The aim of this work is to develop and characterise optimised tissue-equivalent materials for proton therapy.Approach. A mathematical model was developed to enable the formulation of epoxy-resin based tissue-equivalent materials that are optimised for all relevant interactions of protons with matter, as well as photon interactions, which play a role in the acquisition of CT numbers. This model developed formulations for vertebra bone- and skeletal muscle-equivalent plastic materials. The tissue equivalence of these new materials and commercial bone- and muscle-equivalent plastic materials were theoretical compared against biological tissue compositions. The new materials were manufactured and characterised by their mass density, relative stopping power (RSP) measurements, and CT scans to evaluate their tissue-equivalence.Main results. Results showed that existing tissue-equivalent materials can produce large uncertainties in proton therapy dosimetry. In particular commercial bone materials showed to have a relative difference up to 8% for range. On the contrary, the best optimised formulations were shown to mimic their target human tissues within 1%-2% for the mass density and RSP. Furthermore, their CT-predicted RSP agreed within 1%-2% of the experimental RSP, confirming their suitability as clinical phantom materials.Significance. We have developed a tool for the formulation of tissue-equivalent materials optimised for proton dosimetry. Our model has enabled the development of proton optimised tissue-equivalent materials which perform better than existing tissue-equivalent materials. These new materials will enable the advancement of clinical proton phantoms for accurate proton dosimetry.

Development of a heterogeneous phantom to measure range in clinical proton therapy beams

PURPOSE

In particle therapy, determination of range by measurement or calculation can be a significant source of uncertainty. This work investigates the development of a bespoke Range Length Phantom (RaLPh) to allow independent determination of proton range in tissue. This phantom is intended to be used as an audit device.

METHOD

RaLPh was designed to be compact and allows different configurations of tissue substitute slabs, to facilitate measurement of range using radiochromic film. Fourteen RaLPh configurations were tested, using two types of proton fluence optimised water substitutes, two types of bone substitute, and one lung substitute slabs. These were designed to mimic different complex tissue interfaces. Experiments were performed using a 115 MeV mono-energetic scanning proton beam to investigate the proton range for each configuration. Validation of the measured film ranges was performed via Monte Carlo simulations and ionisation chamber measurements. The phantom was then assessed as an audit device, by comparing film measurements with Treatment Planning System (TPS) predicted ranges.

RESULTS

Varying the phantom slab configurations allowed for measurable range differences, and the best combinations of heterogeneous material gave agreement between film and Monte Carlo on average within 0.2% and on average within 0.3% of ionisation chamber measurements. Results against the TPS suggest a material density override is currently required to enable the phantom to be an audit device.

CONCLUSION

This study found that a heterogeneous phantom with radiochromic film can provide range verification as part of a dedicated audit for clinical proton therapy beams.

Palmitoylethanolamide and Cannabidiol Prevent Inflammation-induced Hyperpermeability of the Human Gut In Vitro and In Vivo-A Randomized, Placebo-controlled, Double-blind Controlled Trial

BACKGROUND AND AIMS

We aimed to examine, for the first time, the effect of cannabidiol (CBD) and palmitoylethanolamide (PEA) on the permeability of the human gastrointestinal tract in vitro, ex vivo, and in vivo.

METHODS

Flux measurements of fluorescein-labeled dextrans 10 (FD10) and fluorescein-labeled dextrans 4 (FD4) dextran across Caco-2 cultures treated for 24 hours with interferon gamma (IFNγ) and tumour necrosis factor alpha (TNFα) (10 ng·mL-1) were measured, with or without the presence of CBD and PEA. Mechanisms were investigated using cannabinoid receptor 1 (CB1), cannabinoid receptor 2 (CB2), transient receptor potential vanilloid 1 (TRPV1), and proliferator activated receptors (PPAR) antagonists and protein kinase A (PKA), nitric oxide synthase, phosphoinositide 3-kinases, extracellular signal-regulated kinases (MEK/ERK), adenylyl cyclase, and protein kinase C (PKC) inhibitors. Human colonic mucosal samples collected from bowel resections were treated as previously stated. The receptors TRPV1, PPARα, PPARδ, PPARγ, CB1, CB2, G-coupled protein receptor 55 (GPR55), G-coupled protein receptor 119 (GPR119), and claudins-1, -2, -3, -4, -5, -7, and -8 mRNA were measured using multiplex. Aquaporin 3 and 4 were measured using enzyme-linked immunosorbent assay (ELISA). A randomized, double-blind, controlled-trial assessed the effect of PEA or CBD on the absorption of lactulose and mannitol in humans taking 600 mg of aspirin. Urinary concentrations of these sugars were measured using liquid chromatography mass spectrometry.

RESULTS

In vitro, PEA, and CBD decreased the inflammation-induced flux of dextrans (P < 0.0001), sensitive to PPARα and CB1 antagonism, respectively. Both PEA and CBD were prevented by PKA, MEK/ERK, and adenylyl cyclase inhibition (P < 0.001). In human mucosa, inflammation decreased claudin-5 mRNA, which was prevented by CBD (P < 0.05). Palmitoylethanolamide and cannabidiol prevented an inflammation-induced fall in TRPV1 and increase in PPARα transcription (P < 0.0001). In vivo, aspirin caused an increase in the absorption of lactulose and mannitol, which were reduced by PEA or CBD (P < 0.001).

CONCLUSION

Cannabidiol and palmitoylethanolamide reduce permeability in the human colon. These findings have implications in disorders associated with increased gut permeability, such as inflammatory bowel disease.

Measurement of the proton-air cross section at √s=57 TeV with the Pierre Auger Observatory

We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505±22(stat)(-36)(+28)(syst)] mb is found.

Successful establishment of Wolbachia in Aedes populations to suppress dengue transmission

Genetic manipulations of insect populations for pest control have been advocated for some time, but there are few cases where manipulated individuals have been released in the field and no cases where they have successfully invaded target populations. Population transformation using the intracellular bacterium Wolbachia is particularly attractive because this maternally-inherited agent provides a powerful mechanism to invade natural populations through cytoplasmic incompatibility. When Wolbachia are introduced into mosquitoes, they interfere with pathogen transmission and influence key life history traits such as lifespan. Here we describe how the wMel Wolbachia infection, introduced into the dengue vector Aedes aegypti from Drosophila melanogaster, successfully invaded two natural A. aegypti populations in Australia, reaching near-fixation in a few months following releases of wMel-infected A. aegypti adults. Models with plausible parameter values indicate that Wolbachia-infected mosquitoes suffered relatively small fitness costs, leading to an unstable equilibrium frequency <30% that must be exceeded for invasion. These findings demonstrate that Wolbachia-based strategies can be deployed as a practical approach to dengue suppression with potential for area-wide implementation.

The impact of uterine leiomyomas on reproductive outcomes

Uterine leiomyomas (fibroids, myomas) are a common benign disease of the uterus with a prevalence of 8-18%. Prevalence rates vary with race, and fibroids are most common in African American women. Uterine leiomyomas can also be present during pregnancy, which may occur more frequently than previously suspected, with prevalence rates reported of up to 10%. Recent evidence has emerged to clarify the relationship of uterine fibroids on fertility and obstetrical outcomes. In this paper we review evidence that uterine fibroids, specifically submucosal and intramural myomas, negatively impact fertility and are associated with adverse obstetrical outcomes such as: pain, preterm labor, placental abruption, malpresentation, postpartum hemorrhage, and cesarean section. Myomectomy performed for submucosal and intramural fibroids significantly improves fertility outcome, and current evidence suggests myomectomy is the treatment of choice in women desiring to conceive. For women that do not desire surgery, medical management of myomas is available. Treatment with GnRH agonists may be considered, however newer medications with fewer side effects give practitioners and patients more options. Progesterone antagonists, selective progesterone receptor modulators, and aromatase inhibitors have all shown promise as effective therapies. Non-pharmacologic treatments such as uterine artery embolization and MRI-guided ultrasound have also emerged as effective treatments for uterine fibroids. With such a wide range of new and emerging treatment options, it is important for providers to understand which fibroids are likely to respond optimally to a specific treatment, in order to individualize appropriate and effective management for patients.

Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

High-pressure freezing in the study of animal pathogens

High-pressure freezing is applicable to both morphological and immunocytochemical studies. We are investigating the morphogenesis of foot-and-mouth disease virus and African swine fever virus by the use of high-pressure freezing of infected cells. Foot-and-mouth disease virus particles are not detected in sections of conventionally immersion-fixed infected cells, but when the cells are prepared by high-pressure freezing, newly formed virions are readily seen throughout the cell. We report two methods for high-pressure freezing of virally infected cells: first, two sapphire discs frozen 'face to face' with a narrow spacer to prevent cell damage and, second, a fibrous filter substrate that can be easily cut into discs to fit into the freezing planchettes. Cells readily adhere to the fibres in vitro, and the complete disc can be rapidly transferred to the planchettes for freezing. Immunolabelling studies of the microneme proteins of the parasite Eimeria tenella indicate that high-pressure freezing followed by freeze-substitution in acetone with uranyl acetate allows high-sensitivity immunolabelling for these proteins.

An improved method for preparing thick sections for immuno/histochemistry and confocal microscopy and its use to identify rare events

Detection of rare events within solid tissues by immunocytochemistry is aided by imaging thick sections. Sections of 40--100 microm thickness of paraformaldehyde-fixed solid tissue can be prepared by use of a vibrating microtome and when immunolabelled these sections can be imaged in a confocal microscope. This approach provides excellent preservation of the structure of the sample and imposes minimal antigenic damage. In studies of the invasion of the bovine intestinal epithelium by Salmonella, this method has allowed detection of individual invading bacteria within large samples. The thick vibrating microtome sections were also used for the detection of rare apoptotic cell nuclei identified by TUNEL staining.

Manipulation of separation selectivity of inorganic anions in electrostatic ion chromatography by the use of mixed cationic-zwitterionic micelles as the column coating solution

This paper describes an electrostatic ion chromatographic system in which the separation selectivity for inorganic anions, especially for sulfate and phosphate, could be manipulated by altering the molar ratio of the zwitterionic and cationic surfactants in the column coating solution used to prepare the stationary phase. The zwitterionic surfactant used for this study was 3-(N,N-dimethyltetradecylammonio)propanesulfonate (Zwittergent-3-14) and the cationic surfactant was tetradecyltrimethylammonium (TTA). Using a reversed-phase C18 column (250x4.6 mm I.D.) coated with 10/10 (mM/mM) of TTA/Zwittergent-3-14 mixed micelles as the stationary phase and either NaHCO3 or Na2CO3 aqueous solution as the eluent, together with suppressed conductivity detection, baseline separation of seven model inorganic anions was obtained. The elution order for those anions was found to be F+ < HPO4(2-) < Cl- < SO4(2-) < NO2- < Br- < NO3-. Under the same conditions but using 1/10 (mM/mM) of TTA/Zwittergent-3-14 mixed micelles as the column coating solution, the elution order for these model ions was F- < HPO4(2-) < SO4(2-) < Cl- < NO2- < Br- < NO3-. The early elution of phosphate and sulfate is a unique attribute of this system. Detection limits for F-, HPO4(2-), Cl-, SO4(2-), NO2-, Br- and NO3- (S/N=3, sample injection volume 100 microl) were 0.11, 0.12, 0.12, 0.18, 0.49, 0.49, 0.52 microM, respectively.

Differences in susceptibility to colonic stem cell somatic mutation in three strains of mice

Different species and different strains of animals commonly show very different sensitivities to carcinogenic regimes, which are often unexplained. A major possible contributory factor is variation in susceptibility to mutation, but this has not been directly demonstrated. This study therefore quantified the colonic stem cell mutation frequency in three strains of mice using two carcinogens. Stem cell mutations were identified using loss of function of glucose 6-phosphate dehydrogenase (G6PD) in individual crypts, a technique validated by several previous studies. The carcinogens dimethylhydrazine (DMH) and ethyl nitrosurea (ENU) were given to Balb/C, C57BL/6J, and C3H mice. In response to DMH, Balb/C mice were most susceptible, with approximately double the stem cell mutation frequency found in C3H and more than ten-fold that found in C57BL/6J (3.3+/-0.71 vs. 1.5+/-0.52 vs. 0.28+/-0.8x10(-4)). In response to ENU, Balb/C mice and C3H mice were equally susceptible, showing a stem cell mutation frequency approximately twice that of C57BL/6J (3.1+/-0.4 vs. 3.1+/-0.65 vs. 1.63+/-0.28x10(-4)). The observed differences among the strains with respect to somatic mutation following DMH treatment are likely to be due to the previously documented differences in metabolic conversion to the active metabolite. However, as ENU is a directly acting, rapidly inactivated mutagen, strain differences in response to ENU are unlikely to be due to strain-dependent metabolism of the mutagen and are likely to reflect differences in DNA repair efficiency, or possibly in stem cell kinetics among the strains studied. Susceptibility to the induction of colonic stem cell mutation is an important factor in susceptibility to carcinogens, whether due to differences in DNA repair or to other factors. Direct quantification of stem cell mutation frequency allows the separate identification of this component of the carcinogenic cascade and shows that it can make a major contribution to the differing susceptibility of different mouse strains.

Phenotypic variation in the production of bioactive hepatocyte growth factor/scatter factor by oral mucosal and skin fibroblasts

Hepatocyte growth factor/scatter factor (HGF/SF) is a pleiotropic growth factor produced principally by cells of mesenchymal origin. HGF/SF is an important mitogen, morphogen, and motogen and plays an important role in wound healing, tumorigenesis and particularly fetal development. Oral mucosal fibroblasts exhibit a fetal phenotype, including an increased extracellular matrix reorganizational ability, cellular migration and experimental wound repopulation in comparison to skin fibroblasts. In this study the expression, production, and bioactivity of HGF/SF by oral mucosal and skin fibroblasts was investigated. Although both oral mucosal and skin fibroblasts expressed HGF/SF, the oral mucosal fibroblasts produced significantly increased amounts of total HGF/SF (p < 0.01) as measured by enzyme-linked immunosorbent assay and bioactive HGF/SF as measured by cell scatter and cell-dissociation techniques (p < 0.01). The possible effect of increased HGF/SF in production mediating the previously described preferential responses of oral mucosal fibroblasts was studied in vitro. Reverse transcriptase-polymerase chain reaction-Western blotting and immunocytochemistry methods all showed that both oral mucosal and skin fibroblasts expressed and produced the c-Met receptor. Recombinant HGF (20-40 ng/mL) however, failed to affect fibroblast repopulation of monolayer wounds or cellular proliferation. In contrast, recombinant HGF significantly increased ECV304 wound repopulation. These studies provide direct evidence of another mechanism by which site-specific variations in fibroblast phenotype may contribute in a paracrine fashion to the rapid reepithelialization and revascularization of oral wounds.

Defective extracellular matrix reorganization by chronic wound fibroblasts is associated with alterations in TIMP-1, TIMP-2, and MMP-2 activity

Chronic leg wounds are characterized by defective remodeling of the extracellular matrix, failure of reepithelialization, and prolonged inflammation. The hypothesis that this defective extracellular matrix remodeling is associated with phenotypic differences in the activity of the matrix metalloproteinases and tissue inhibitors of metalloproteinases was studied in chronic wound and patient-matched normal fibroblasts in three-dimensional collagen lattice systems. Chronic wound fibroblasts exhibited no differences in morphology or proliferation (p > 0.1) compared with patient-matched uninvolved dermal fibroblasts. The ability of chronic wound fibroblasts to reorganize extracellular matrix was significantly impaired, however, in comparison to the uninvolved dermal fibroblasts (p < 0.01). This difference in extracellular matrix reorganization was not related to differences in proliferation within the collagen lattices (p > 0.05) or attachment to type I collagen (p > 0.1). Marked differences were evident in matrix metalloproteinase-2 activity between chronic wound and patient-matched normal fibroblasts. Whereas levels of pro-matrix metalloproteinase-2 were similar between the two fibroblast populations (p > 0.1), the chronic wound fibroblasts exhibited significantly decreased levels of the 62 kDa active form of matrix metalloproteinase-2 (p < 0.01). Reverse zymography and enzyme-linked immunosorbent assay demonstrated that the decreased matrix metalloproteinase-2 activity was associated with increased production of tissue inhibitors of metalloproteinase-1 and -2 by the chronic wound fibroblasts (p < 0.05). Increased production of tissue inhibitors of metalloproteinases in chronic wound fibroblasts was also reflected in decreased levels of matrix metalloproteinase-1 (p < 0.005). These data suggest that the impaired ability of chronic wound fibroblasts to reorganize extracellular matrix in vitro is related to decreased levels of active matrix metalloproteinase-2 and matrix metalloproteinase-1 resulting from increased production of tissue inhibitors of metalloproteinase-1 and -2 by chronic wound fibroblasts. These findings provide a mechanism to explain the impaired cellular responses and extracellular matrix reorganization observed in chronic leg wounds in vivo.

Feeding value of an enzymatically digested protein for early-weaned pigs

Weanling pigs were used in a series of studies to determine the feeding value of an enzymatically digested protein product developed from a blend of swine and poultry abattoir by-products. The initial study used 156 pigs weaned at approximately 22 d of age to compare the product with menhaden fish meal in Phase II diets. The product supported equal growth rate, and there was no preference for diet exhibited based on inclusion level of the enzymatically digested protein product. The second study used 100 pigs weaned at approximately 21 d of age to compare the product with spray-dried animal blood cells in Phase II diets. The product supported a growth rate equal to that with the blood cells, and the combination of products enhanced growth rate (P<.05). The third study used 265 pigs to compare the product with spray-dried porcine plasma in a slope ratio growth assay. Results demonstrated a relative feeding value of 91% for the product over a 4-wk feeding period. The fourth study used 290 pigs to compare the product with spray-dried porcine plasma in Phase II diets; results demonstrated comparable growth performance. The final study used 180 pigs to compare the product with spray-dried porcine plasma in Phase I diets; results demonstrated comparable growth performance. These data indicate that the enzymatically digested abattoir by-product is a high-quality protein source for weanling pigs.

Primary health care for people with learning disabilities

Health screening and education for people with learning disabilities is often given low priority by service providers, but the input of community nurses can make a great difference. Helen Cook charts the success of two teams.

Gender differences in premorbid social adjustment and intimacy motivation in schizophrenia

The present study compared the relationship between motivation for intimacy and level of premorbid adjustment for men and women with schizophrenia. A sample of 34 schizophrenic patients (14 male and 20 female) were studied. Stories told in response to six TAT cards were scored for Intimacy Motivation (IM). Levels of Premorbid adjustment (PA) and Asociality (ASOC) were assessed. A statistically significant interaction between gender and level of PA indicated that males with good PA had higher IM than those with poorer whereas females with good PA had lower IM than females with poor PA. The same interaction was obtained for the measure of ASOC. Findings are discussed in relation to sociocultural expectations for women. Some implications for differential treatment needs of male and female schizophrenics are suggested.

Cloning and chromosomal localization of a gene (GPR18) encoding a novel seven transmembrane receptor highly expressed in spleen and testis

Using the techniques of relaxed stringency polymerase chain reaction and genomic library screening, we have isolated homologous canine and human genes that encode a novel putative seven transmembrane G-protein-linked receptor. The gene encodes an open reading frame (ORF) of 993 bp. The sequences of the canine and human ORFs are highly conserved, sharing 89% nucleotide identity and 92% amino acid similarity between the two species. Northern blot analysis demonstrates that mRNA transcripts of the gene are abundantly expressed in testis and spleen with a lesser degree of expression observed in several other tissues associated with endocrine and immunologic/hematologic function. The gene, designated GPR18, was localized to human chromosome 13q32 using fluorescence in situ hybridization.

Postoperative nausea and vomiting. 2: Management and treatment

The management and nursing care of patients experiencing postoperative nausea and vomiting (PONV) are discussed, together with the various types of pharmacological and complementary approaches to treatment. These treatments are examined in relation to the causes of PONV and a scientific approach to the use of antiemetics which links causation and treatment is suggested. It is argued that by adopting this approach PONV could be minimized, drug bills reduced, patient choice encouraged and postoperative recovery enhanced.

Postoperative nausea and vomiting. 1: Physiology and aetiology

There is a vast amount of research available relating to postoperative nausea and vomiting (PONV). This research has been analyzed and summarized in a series of two articles which draw out the main factors influencing the incidence and affecting the treatment of the condition. This, the first article, will describe the physiological processes that result in PONV. An analysis will then follow of the many factors that contribute to the complex multifactorial aetiology of PONV. These factors include personal, preoperative, intraoperative and postoperative variables which affect differing neurotransmitter centres in the chemoreceptor trigger zone (CTZ) which is situated in the brainstem. These variables will then be related to the appropriate neurotransmitter centre allowing a greater understanding of the most likely physiological pathways involved in specific cases of PONV. The second article will explore the management and treatment of PONV.

Sexual dimorphism of galanin-like immunoreactivity in the brain and pituitary of goldfish, Carassius auratus

A sexually dimorphic distribution of galanin (GAL)-like immunoreactive (ir) neurons and fibers was found in the brain and pituitary of goldfish. The rostralmost GAL-ir perikarya were found in the area ventralis telencephali pars supracommissuralis dorsal to the anterior commissure. In the diencephalon, there was several GAL-ir perikarya in the nucleus preopticus periventricularis (NPP). Males had many GAL-ir perikarya in the nucleus preopticus pars parvocellularis (NPOpp) and isolated GAL-ir perikarya in the NPO pars magnocellularis, and lateral to the NPO; in females GAL-ir perikarya were not found in these sites. A large GAL-ir neuronal aggregation was observed in the nucleus lateralis tuberis pars posterioris (NLTp). Several ir perikarya were present in the nucleus posterioris tuberis; however, unlike in other regions the males revealed fewer neurons than females. Besides the established innervation of the pituitary gland by the NPP, NPO and NLT, the present study revealed GAL-ir perikarya of these nuclei apparently also innervating the telencephalon, thalamus, optic tectum, tegmentum and even some areas of the rhombencephalon. Isolated perikarya were found in the nucleus posterioris periventricularis, the dorsal vicinities of the nucleus recessus lateralis (NRL), nucleus recessus posterioris, and nucleus saccus vasculosus, and in the medulla oblongata ventral to the vagal lobes. In the pituitary gland, GAL-ir fibers ramify and terminate among the pars distalis cells. A small percentage of growth hormone-secreting cells colocalize GAL. In males, most GAL-ir cells of the proximal pars distalis (PPD) showed granular ir product in the entire cell, and some had one or two large granules; in females the ir PPD cells showed clusters of a few fine ir granules of uniform size in each. Sexual dimorphism was also found in the olfactory bulb, telencephalon, infundibulum, mesencephalic tegmentum, optic tectum and medulla oblongata, the males having a more extensive GAL-ir fiber system than the females. Galanin may play a role in both hypophysiotropic and motor functions.

Effect of positive heel inclination on posture

Millions of women wear high heels on a daily basis; however, few studies have analyzed the changes high heels (positive heel inclination) have on posture. The purpose of this study was to determine whether positive heel inclination changed the postural alignment of the head, spine, pelvis, and knees. Fifteen female college students ((mean age = 22.7, SD = 3.7 years) had sagittal plane angles measured for the cervical spine, thoracic spine, lumbar spine, sacral spine, and knee joints in addition to anterior/posterior displacements of the head and pelvis. All variables were assessed by a Metrecom Skeletal Analysis System, a three-dimensional electrogoniometer. Six randomized trials, three at zero heel inclination and three at 5 cm positive heel inclination, were measured. Analysis of variance results indicated positive heel inclination of subjects brought about significantly lower anterior pelvic tilt, lumbar lordosis, and sacral base angles when compared with zero heel inclination (p < .01). Clinically, patients with low back pain may be affected by high heel usage because of the reduction of the normal lumbar lordosis.

Immunocytochemical evidence for the presence of inhibin and activin-like proteins and their localization in goldfish gonads

In previous studies, we have demonstrated that inhibin and activin are stimulatory to goldfish gonadotropin release. In the present study, the distribution of immunoreactive inhibin and activin subunits (alpha, beta A, and beta B) in goldfish gonads was examined with domain-specific antibodies against mammalian inhibin and activin subunits, using the avidin-biotin-peroxidase complex method. In the ovary, follicle cells surrounding the oocyte were heavily stained with anti-porcine beta A and human beta B subunits. The cytoplasm of previtellogenic oocytes, at all stages of the ovarian cycle, also showed strong reactions with anti-beta A and beta B. As ovarian recrudescence progressed, oocytes that started to accumulate cortical vesicles gradually lost their immunoreactivity, with the reaction intensity inversely proportional to the amount of cortical vesicles in the oocyte; when oocytes became full of cortical vesicles, the oocytoplasm was no longer immunoreactive to anti-beta A and beta B. The staining with antiporcine alpha subunit was similar to that with anti-beta A and beta B but the reaction intensity was weaker than that with anti-beta A and beta B. In the testis, the mature sperm in the tubular lumen exhibited a strong immunoreaction to anti-alpha antibody, while the interstitial tissue was completely negative. However, the immunoreactivities with anti-beta A and beta B in the testis were exclusively restricted to the interstitial tissues. These results provide evidence for the presence of inhibin and activin-like molecules in the goldfish and reveal the distribution of these molecules in the goldfish gonads.

A future for clinical management

The NHS has been moving rapidly towards establishing clinical directorates in all specialties. It has been part of an attempt, along with the resource management initiative, to involve doctors in management, and to encourage them to take responsibility for the managerial and resource dimensions to clinical activity. Haydn Cook identifies a problem.

Effects of diet containing extruded full-fat soybeans or butter on the growth, composition, and sensory characteristics of pork

Ninety-six crossbred barrows were randomly allotted to five replications of four treatments to determine the effects of diets containing 20% extruded full-fat soybeans (FFS) or 4% butter (B) on the growth, composition, and sensory characteristics of finishing pigs. Pigs were housed five per pen, except for one replication that had four pigs per pen, in environmentally regulated barns. Pigs were given ad libitum access to a corn-soybean meal diet for 11 wk (control); a corn-extruded soybeans and soft wheat midds diet for 11 wk (FFS-11); a corn-soybean meal diet for 6 wk, changed to a corn-extruded soybeans and soft wheat midds diet for 5 wk (FFS-5); or a corn-soybean meal diet for 6 wk, changed to a corn-soybean meal, soft wheat midds, and 4% butter diet for 5 wk (B). Feed intake and weight gain were measured once every 2 wk. Pigs were slaughtered and carcass data were collected. Sensory characteristics (tenderness, juiciness, pork flavor intensity, off-flavor intensity, and overall acceptability), shear force, moisture, and fat content were determined for the longissimus muscle. Sensory characteristics (pork flavor, off-flavor, rubbery, cohesiveness, and juiciness) and 2- thiobarbituric acid values were determined for ground pork (30% fat) after 1, 4, and 7 d for control, FFS-11, and B treatments. No differences (P > .05) in ADG were observed between diets. Feed efficiency of the FFS-11 group was better (P < .05) than that of the control or B groups. No consistent differences were observed for carcass, sensory, or shear-force characteristics of the longissimus muscle or ground pork.(ABSTRACT TRUNCATED AT 250 WORDS)

Demonstration of gonadotropin releasing-hormone receptors on gonadotrophs and somatotrophs of the goldfish: an electron microscope study

Dispersed pituitary cells of the goldfish were incubated with biotinylated [D-Lys6, Pro9-N-ethylamide] salmon gonadotropin-releasing hormone (sGnRH-A) then avidingold (10 nm), and were fixed, embedded and sectioned. Cells were identified as gonadotrophs, somatotrophs, or prolactin cells using specific hormone antisera and protein-A gold (20 nm) as a marker. Attachment of the biotinylated sGnRH-A to the pituitary cell sections was determined by scanning cell surfaces for the smaller gold particles using the transmission electron microscope. Attachment was observed on gonadotrophs and somatotrophs, but was negligible on prolactin cells. Preincubation with unlabelled salmon gonadotropin-releasing hormone or chicken II gonadotropin-releasing hormone, or omission of the salmon gonadotropin-releasing hormone analog, prevented the reaction. The direct visualization of specific gonadotropin-releasing hormone receptors on gonadotrophs and somatotrophs supports the existence of direct stimulatory actions of gonadotropin-releasing hormone on gonadotropin and somatotropin release in gold-fish.

Central arteriovenous malformations of the maxillofacial skeleton: case report

Central arteriovenous malformation of the maxillofacial skeleton, though rare, is a well-documented entity. Past treatments have usually included some form of surgical intervention. Surgical resection as an attempt to cure has been effective but costly, ie, in relationship to patient morbidity and hospital expenditures. A case of vascular malformation is presented in which selective angiography and embolization as a primary treatment were used rather than ablative surgery. The patient tolerated the procedures well, with complete resolution of bleeding.