Symptoms of Posttraumatic Stress Disorder are Associated with Altered Glucose Parameters in Early and Late Gestation

OBJECTIVE

 Posttraumatic stress disorder (PTSD) is associated with increased risk for insulin resistance and the development of diabetes outside of pregnancy. In pregnancy, emerging evidence suggests that PTSD is associated with increased risk for gestational diabetes; however, it is not yet known how PTSD is associated with disruptions in glucose processing across gestation. Therefore, the aim of the current study was to test associations between PTSD symptoms and glucose parameters in early and late gestation among pregnant people without a history of pregestational diabetes.

STUDY DESIGN

 Two 34 participants were included in these analyses. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5) in early gestation. Fasting blood samples were collected at approximately 12 and 32 gestational weeks and were used to calculate β-cell function and insulin sensitivity.

RESULTS

 Participants were 31 years old (standard deviation [SD] = 6) with body mass index (BMI) of 36 kg/m2 (SD = 7) at enrollment, 26% reported their ethnicity as Hispanic, 62% reported their race as White, 17% Black, 2% Asian, 3% Native American, 9% more than one race, and 11% unknown/not reported. Hierarchical linear regression analyses revealed that, after adjusting for several covariates including maternal age, race, ethnicity, BMI, apnea hypopnea index, and depressive symptoms, PTSD symptoms were positively associated with β-cell function in early (β = 0.230, p = 0.016) and late gestation (β = 0.238, p = 0.037).

CONCLUSION

 Higher PTSD symptoms were associated with greater insulin secretion over pregnancy in this sample. More research is needed to replicate these findings and evaluate the effects of treatment of PTSD on mitigating the risk for gestational diabetes.

KEY POINTS

· We examined associations among symptoms of PTSD and glucose parameters over pregnancy.. · Symptoms of PTSD were positively associated with β-cell function over pregnancy.. · Symptoms of PTSD were not associated with insulin resistance over pregnancy..

Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

Religious and Existential Determinants of Affective Response to a Brief Mindfulness Intervention

Mindfulness-based interventions (MBIs) are often promoted in the Western world as being "secular" in nature, despite the religious/spiritual (R/S) roots of mindfulness itself. Relevant individual characteristics such as R/S, however, have yet to be examined thoroughly in relation to treatment response. Using pre-post experimental designs, we examined the interaction of participant religiosity and different religious framings (Buddhist, secular, spiritual) of a brief MBI as determinants of affective responses to the MBI using regression in two online samples (Study 1: N=677; Study 2: N= 157). Aspects of religiosity (existential quest, scriptural literalism) had differential effects on affective responses to MBIs dependent on the framing of the condition. Participants' R/S, as well as the R/S attributes of an MBI, may impact affective responses to MBIs. Further research is needed to ascertain how, and to what extent, MBIs might be optimized in order to maximize benefits for participants with diverse religious and existential commitments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00139-0.

Psychiatric comorbidities among undergraduate and graduate students attending spiritual-mind-body interventions

OBJECTIVE

This study examined rates of positive screens for depression and posttraumatic stress and their comorbidity among undergraduate (N = 77) and graduate (N = 136) students who participated in on-campus Spiritual-Mind-Body (SMB) wellness interventions.

METHODS

Participants completed the PHQ-9 and the PCL-C before starting an 8-week in-person SMB wellness intervention. Elevated depression was indicated by a score of ≥10 on the PHQ-9; elevated posttraumatic stress (PTS) was indicated by a score of ≥30 on the PCL-C.

RESULTS

There were unexpectedly high rates of posttraumatic stress among both undergraduate (39%) and graduate (32%) students without the presence of comorbid depression. A small minority of students experienced depression apart from elevated PTS symptoms. Overall, students reported high levels of clinically relevant psychopathology.

CONCLUSION

On-campus wellness centers may offer an appropriate setting for the screening of trauma-related distress and depression and their comorbidity to address the psychiatric concerns of SMB wellness-seeking students.

Inner Peace in a Global Crisis: A Case Study of Supported Spiritual Individuation in Acute Onset Phase of COVID-19

Emerging-adult undergraduates (ages 18-25) are at increased risk for mental illness, exacerbated by the COVID-19 pandemic. Simultaneously, emerging adults face developmental tasks including identity development, finding meaning and purpose, and spiritual individuation. A case study approach is used to elucidate processes of undergraduates coping with collective trauma as a potential pathway to trauma-related spiritual growth via Awakened Awareness for Adolescents (AA-A) and emerging adults, a spiritual-mind-body wellness intervention. Awakened Awareness for Adolescents fosters enhanced spiritual perception to support spiritual individuation for improved mental health and well-being. Processes of spiritual individuation supported by AA-A during the COVID-19 pandemic from February to May 2020 are presented using students' qualitative data and self-report measures of psychopathology, spiritual well-being, emotional regulation, and cognition. Shared cohort (N = 15) themes and one in-depth case (1) reveal ideographic processes of personal transformation and spiritual growth, (2) generate hypotheses around pathways of trauma-related spiritual growth and spiritual individuation for future research.

Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Stress, coping and silver linings: How depressed perinatal women experienced the COVID-19 pandemic

BACKGROUND

Research on perinatal mental health during the COVID-19 pandemic has largely focused on data from community samples. This study sought to understand the experiences of pregnant and postpartum women with histories of clinically elevated symptoms of depression.

METHODS

Participants included 60 perinatal women who participated in wellness intervention trials for women with antenatal depression. We used a mixed methods approach, assessing depression, anxiety, stressors and coping behaviors, along with narrative responses to questions regarding COVID-specific effects on mental health.

RESULTS

Over three-fourths of the sample indicated a worsening of mental health during the pandemic, with 31.7% of women endorsing clinically elevated depression symptoms and 36.7% screening positive for anxiety. Women reported negative impacts on their emotional wellbeing, especially a resurgence of mental health symptoms. Participants also articulated positive experiences during the pandemic, including an appreciation for increased time with family, especially infants. Women detailed numerous, mostly adaptive, coping strategies they had used to mitigate stress; self-isolation and spending time outdoors were associated with having depression above or below the clinical cut off, respectively.

LIMITATIONS

The study had a small sample, and the generalizability of findings may be limited, given that participants were clinical trial completers.

CONCLUSIONS

Although the pandemic upended many aspects of life for perinatal women and raised mental health concerns, many also reported adaptive means of coping and positive experiences or 'silver linings' related to pandemic restrictions. Some coping strategies that were utilized, including wellness-based behaviors, may have helped to mitigate the impact of COVID-19 related stress.

Religiosity and Depression at Midlife: A Prospective Study

Objectives:

Previously, authors found high personal importance of religion/spirituality (R/S) in early adulthood to predict a 75% decreased risk of recurrence of major depression in middle adulthood. Here, the authors follow up the original study sample to examine the association between R/S and major depression from middle adulthood into midlife.

Method:

Participants were 79 of 114 original adult offspring of depressed and non-depressed parents. Using logistic regression analysis, three measures of R/S from middle adulthood (personal importance, frequency of religious service attendance, and denomination) were used to predict Major Depressive Disorder (MDD) in midlife.

Results:

High R/S importance in middle adulthood was prospectively associated with risk for an initial onset of depression during the period of midlife. Frequency of attendance in middle adulthood was associated with recurrence of depression at midlife in the high-risk group for depression, as compared to the low-risk group.

Conclusion:

Findings suggest that the relation between R/S and depression may vary across adult development, with risk for depression associated with R/S at midlife potentially revealing a developmental process.

Genetic Correlates of Spirituality/Religion and Depression: A Study in Offspring and Grandchildren at High and Low Familial Risk for Depression

RATIONALE

Possible genetic correlates of spirituality and depression have been identified in community samples. We investigate some of the previously identified candidates in a sample of families at both high and low-risk for depression.

METHOD

Offspring and grandchildren of individuals at high and low-risk for depression, participating in a multi-wave thirty-year longitudinal study, were assessed for seven SNPS drawn from four single gene candidates associated with systems implicated in both depression and spirituality: Serotonin (5-HT1B and 5-HT2A), Dopamine (DRD2), Oxytocin (OT) and Monoamine Vesicular Transporter (VMAT1).

RESULTS

Dopamine (DRD2) Serotonin (5-HT1B), their Transporter (VMAT1) and Oxytocin (OXTR) were positively associated with a high level of importance of spirituality or religion (S/R) in the group at low familial risk for depression. DRD2 minor allele was associated with both lifetime major depressive disorder (MDD) and spirituality in the low-risk group for depression. No SNPs were related to S/R in the group at high familial risk for depression. OXTR was associated with lifetime MDD in the full sample.

CONCLUSION

Genes for dopamine, serotonin, their vesicular transporter, and oxytocin may be associated with S/R in people at low familial risk for depression. Genes for dopamine may be associated both with S/R and increased risk for depression in people at low-risk for depression, suggesting a common pathway or physiology to mild to moderate depression. MDD is associated with oxytocin across risk groups. In the high-risk group, phenotypic expression of S/R may be suppressed.

IMPLICATIONS

The shared association of DRD2 by S/R and depression, generally found to be inversely related, calls for further research on their common physiological pathways, and the phenotypic expression of these pathways based upon use and environment. Prevention for offspring at high familial risk for depression might include support for the development of child spirituality.

Review article: proton pump inhibitors with clopidogrel--evidence for and against a clinically-important interaction

BACKGROUND

The treatment of acute coronary syndromes involves a combination of antiplatelet therapies. Proton pump inhibitors are frequently recommended for patients receiving clopidogrel in addition to aspirin, to minimise the risk of bleeding. Several studies have shown that proton pump inhibitors can affect the platelet inhibitory effects of clopidogrel. However, the data on whether this has an effect on clinical outcomes are conflicting and a definitive answer is still awaited.

AIM

To provide an overview of the evidence for the pharmacological interaction between proton pump inhibitors and clopidogrel and to discuss whether this interaction translates into adverse clinical outcomes. Despite recent developments, clear consensus is lacking.

METHODS

A search of the published literature combined with the authors' knowledge of the field.

RESULTS

There is evidence to show that proton pump inhibitors can influence the pharmacodynamics of clopidogrel, but the data suggesting clinical effects are weak and conflicting. Supporting a clinically important interaction are four retrospective studies including over 11,000 patients prescribed both clopidogrel and a proton pump inhibitor. Evidence against a clinically important interaction is derived from over 18,000 patients from seven studies, including the only prospective trial to examine the potential interaction. Confounding variables are relevant and prospective clinical evidence is lacking.

CONCLUSIONS

Proton pump inhibitors offer clear protection and the concern over clinically relevant interactions with clopidogrel is biologically plausible, but not yet proven.

Enhanced cellular responses and environmental sampling within inner foreskin explants: implications for the foreskin's role in HIV transmission

The decrease in HIV acquisition after circumcision suggests a role for the foreskin in HIV transmission. However, the mechanism leading to protection remains undefined. Using tissue explant cultures we found that Langerhans cells (LCs) in foreskin alter their cellular protein expression in response to external stimuli. Furthermore, we observe that upon treatment with TNF-alpha, tissue-resident LCs became activated and that stimulatory cytokines can specifically cause an influx of CD4+ T-cells into the epithelial layer. Importantly, both of these changes are significant in the inner, but not outer, foreskin. In addition, we find that LCs in the inner foreskin have increased ability to sample environmental proteins. These results suggest differences in permeability between the inner and outer foreskin and indicate that HIV target cells in the inner foreskin have increased interaction with external factors. This increased responsiveness and sampling provides novel insights into the underlying mechanism of how circumcision can decrease HIV transmission.

Effects of prasterone (dehydroepiandrosterone) on markers of cardiovascular risk and bone turnover in premenopausal women with systemic lupus erythematosus: a pilot study

DHEA (dehydroepiandrosterone) is a weak androgen with proposed efficacy in the treatment of mild to moderate lupus, and possible beneficial effects on cardiovascular risk and bone mineral density. We hypothesized that treatment with 200 mg a day of Prasterone (DHEA) would improve pre-clinical measures of atherosclerosis: flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NMD), and circulating apoptotic endothelial cells (CD 146(AnnV +)), as well markers of bone metabolism. Thirteen premenopausal female patients with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) <or=8 were enrolled in a double-blind placebo-controlled crossover trial for 22 weeks with a 6-week washout between treatment periods. Results reveal high-density lipoprotein (HDL) levels significantly decreased with Prasterone (48.5 versus 56.3 with placebo, p <or= 0.001), and there was a trend towards impairment of endothelial function with Prasterone (brachial artery FMD 3.4% versus 4.4% with placebo, mean difference -1.07, NMD 19.5% versus 24.4% with placebo, mean difference -4.9, p = NS). There were no differences between groups in SLEDAI, CD146( AnnV+) cells, or receptor activator for nuclear factor kB ligand (RANKL)/osteoprotegerin, although RANKL was higher after treatment with Prasterone (mean difference -29.5 units; p = 0.097). This pilot study does not support the use of Prasterone in mild lupus for prevention of atherosclerosis or osteoporosis, and confirms other findings of potentially harmful effects on lipids.

Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala

The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection.

PCB concentrations in lake trout (Salvelinus namaycush) are correlated to habitat use and lake characteristics

This study considers the importance of lake trout habitat as a factor determining persistent organochlorine (OC) concentration. Lake trout is a stenothermal, cold water species and sensitive to hypoxia. Thus, factors such as lake depth, thermal stratification, and phosphorus enrichment may determine not only which lakes can support lake trout but may also influence among-lake variability in lake trout population characteristics including bioaccumulation of OCs. A survey of 23 lakes spanning much of the natural latitudinal distribution of lake trout provided a range of lake trout habitat to test the hypothesis that lake trout with greater access to littoral habitat for feeding will have lower concentrations of OCs than lake trout that are more restricted to pelagic habitat. Using the delta13C stable isotope signature in lake trout as an indicator of influence of benthic littoral feeding, we found a negative correlation between lipid-corrected delta13C and sigmaPCB concentrations supporting the hypothesis that increasing accessto littoral habitat results in lower OCs in lake trout. The prominence of mixotrophic phytoplankton in lakes with more contaminated lake trout indicated the pelagic microbial food web may exacerbate the biomagnification of OCs when lake trout are restricted to pelagic feeding. A model that predicted sigmaPCB in lake trout based on lake area and latitude (used as proximate variables for proportion of littoral versus pelagic habitat and accessibility to littoral habitat respectively) explained 73% of the variability in sigmaPCBs in lake trout in the 23 lakes surveyed.

The metabolic marker tumour pyruvate kinase type M2 (tumour M2-PK) shows increased expression along the metaplasia-dysplasia-adenocarcinoma sequence in Barrett's oesophagus

BACKGROUND

Proliferating and tumour cells express the glycolytic isoenzyme, pyruvate kinase type M2 (M2-PK). In tumours cells, M2-PK usually exists in dimeric form (tumour M2-PK), causing the accumulation of glycolytic phosphometabolites, which allows cells to invade areas with low oxygen and glucose concentrations.

AIMS

To investigate the expression of tumour M2-PK during the metaplasia-dysplasia-adenocarcinoma sequence of Barrett's oesophagus, and to assess the prognostic usefulness of tumour M2-PK in oesophageal cancer.

MATERIALS/METHODS

One hundred and ninety cases selected from the histopathology archives as follows: 17 reflux oesophagitis, 37 Barrett's oesophagus, 21 high grade dysplasia, 112 adenocarcinomas, and three control tumours. Sections were stained immunohistochemically with antibody to tumour M2-PK.

RESULTS

Tumour M2-PK was expressed in all cases, and increased cytoplasmic expression was seen with progression along the metaplasia-dysplasia-adenocarcinoma sequence. All cases of adenocarcinoma showed 100% staining so that tumour M2-PK was not a useful prognostic marker.

CONCLUSIONS

Tumour M2-PK is not a specific marker of Barrett's adenocarcinoma, but may be important as a marker of transformed and highly proliferating clones during progression along the metaplasia-dysplasia-adenocarcinoma sequence.

The role of receptor tyrosine kinase inhibition in treating gastrointestinal malignancy

Tyrosine kinase receptors are proteins that transduce the signal from many growth factor and cytokine ligands to produce intracellular responses. As such they can activate multiple signalling cascade pathways and influence cell division, migration and survival. Many show upregulation in certain malignancies, including those of the gastrointestinal tract, and are thought to play key roles in carcinogenesis. This makes them attractive targets for drug therapy and in recent years many inhibitors have been developed. This review discusses the current situation regarding the development of inhibitors with particular reference to the erbB family, the insulin-like growth factor receptor, the Met receptor, the receptor for vascular endothelial growth factor and the Kit receptor. The evidence will be related back to cancers of the gut lumen. Clinical effectiveness in this area seems to lie in using a combinatorial approach that inhibits multiple key signalling points, and the reasons for this will be discussed.

The treatment, management and prevention of oesophageal cancer

The combination of a rising incidence and a poor survival rate makes oesophageal cancer a major health issue. Adenocarcinoma of the oesophagus is associated with one of the commonest pre-malignant lesions recognised, Barrett's metaplasia. This provides a focus for early detection and intervention. The subjects of acid suppression, bile reflux, COX-2 inhibition and ablation therapy will be discussed herewith. Established carcinoma is now rarely treated by surgery alone and this review discusses the benefits of multimodality therapy combined with more accurate staging techniques. Finally an emerging understanding of the molecular events that characterise the transition to carcinoma may provide novel targets in cancer therapy such as epidermal growth factor receptor (EGFR) and TNF-alpha. This review will focus on some of the future developments in the treatment of oesophageal cancer.

Direct comparison of the impact of head tracking, reverberation, and individualized head-related transfer functions on the spatial perception of a virtual speech source

A study of sound localization performance was conducted using headphone-delivered virtual speech stimuli, rendered via HRTF-based acoustic auralization software and hardware, and blocked-meatus HRTF measurements. The independent variables were chosen to evaluate commonly held assumptions in the literature regarding improved localization: inclusion of head tracking, individualized HRTFs, and early and diffuse reflections. Significant effects were found for azimuth and elevation error, reversal rates, and externalization.

The role of race in the clinical presentation

What role, if any, should race play in clinical presentations? While race is widely used as a way of identifying patients, this practice has been challenged as conceptually flawed, potentially misleading, and possibly prejudicial to the patient. There are, however; important reasons for not excluding information about race. This article includes a set of guidelines for the inclusion of racial data in presentations: (1) Race is a social construct and, if used, should be recorded in the social history, not the opening sentence of the presentation. (2) Patients should self-identity their race or races. (3) Race should not be used as a proxy for genetic variation, social class, or other elements of the social history. (4) Clinicians should be mindful of the potential influence of racism in the clinical encounter.

Sex-role strain in alcoholic women

We investigated sources of sex-role strain between alcoholic and non-alcoholic women. We compared alcoholic (n = 55) and non-alcoholic (n = 51) women on the presence of strain in their sex-role identity and strain between sex-role identity, attitudes, and behaviors in 1996. One source of sex-role strain for alcoholic women was the discrepancy between their perceived femininity when intoxicated versus when sober. A second source of strain for alcoholic women was the discrepancy between their traditionally feminine sex-role identity as well as attitudes toward marital, parental, and educational roles and their participation in male-valued activities. We offer suggestions for future research.

Respiratory support of the head-injured child

Meticulous care of the head-injured child revolves around the prevention of secondary injury. In no arena is this more crucial than in the respiratory support of the pediatric traumatic brain-injured patient. Careful attention to intubation techniques, maintenance of adequate oxygen delivery, avoidance of hypoxia, and judicious use of PEEP and other respiratory therapeutics all can be invaluable in the care of the pediatric traumatic brain-injured patient and may ultimately enhance outcome in this sometimes devastating disease.

Baseline metal concentrations in coastal Labrador sediments

Levels of Cr, Cu, Fe, Pb, Ni, and Zn in surface sediment from the Voisey's Bay area of coastal Labrador showed no evidence of recent anthropogenic input of metals. Metal concentrations in surface sediments, normalized to Li, fell within the 95% confidence limits of the background levels. Further analysis showed that the Li-metal regression lines from the surface sediments and sediments from 30-cm depth had the same slope and intercepts, suggesting that there was no difference in the metal content of the sediments at the two depths. Li-metal relationships can be used as a measure of the natural variability of the metal concentrations for the region and will serve as a baseline against which future anthropogenic affects may be assessed.

Staphylococcal enterotoxin-B-induced lethal shock in mice is T-cell-dependent, but disease susceptibility is defined by the non-T-cell compartment

Here we introduce a murine model for SEB-induced lethal shock that relies on the administration of SEB alone and does not involve hepatotoxicity by avoiding pretreatment with the hepatotoxin D-galactosamine. In the absence of D-gal, we first identified SEB-susceptible and -resistant H-2(k)-congenic mouse strains. In contrast with what is well established for the classic D-gal-dependent model and what therefore is anticipated for the human disease, the levels of TNF produced did not define susceptibility in our model. The SEB-induced TNF response in vitro and in vivo was stronger in resistant B10.BR mice than in susceptible C3H/HeJ mice. Neither the magnitude nor the quality of the T cell response induced by SEB defined susceptibility. Adoptive transfer experiments in C3H-SCID recipient mice demonstrated that induction of the disease is T-cell-dependent. T cells from resistant and susceptible mice both transferred disease susceptibility to H-2(k)-congenic C3H-SCID mice, indicating that disease susceptibility is downstream from T cell activation, at the level of the target organ itself, which responds differently to T-cell-induced inflammation.

Tight junction protein ZO-2 is differentially expressed in normal pancreatic ducts compared to human pancreatic adenocarcinoma

Differential display of hamster mRNA identified a fragment present in normal pancreatic duct cells that is not expressed in pancreatic duct carcinoma cells. Sequence analysis showed an 88% and 82% identity, respectively, to the cDNA of the canine and human tight junction zo-2 gene. Semi-quantitative RT-PCR analysis of human ZO-2 revealed a striking difference in the expression of various regions of the ZO-2 transcript in normal and neoplastic cells and the presence of an abnormality at the 5'-end of mRNA. RACE analysis identified 2 human ZO-2 mRNAs that encode proteins of different lengths, designated as ZO-2A and ZO-2C. The difference between the 2 forms of ZO-2 is the absence of 23 amino acid residues at the N terminus of ZO-2C compared with ZO-2A. Although ZO-2C was expressed in normal pancreatic cells and a majority of neoplastic tissues analyzed, ZO-2A was undetectable except in one case in all of the pancreatic adenocarcinomas analyzed. This suggests the presence of a yet to be identified motif important for cell-growth regulation within the 23-amino acid residue N-terminal peptide of ZO-2A, MPVRGDRGFPPRRELSGWLRAPG.

A screening method for beta-lactams in tissues hydrolyzed with penicillinase I and lactamase II

Antibiotic residues above tolerance levels are not allowed in foods derived from farm animals. Microbial inhibition assays are used to screen antibiotics in U.S. regulatory laboratories. We developed a screening approach to classify beta-lactams through selective hydrolysis of the beta-lactam ring with Penase or lactamase II, thereby inactivating the beta-lactam activity. Optimum conditions for hydrolysis of beta-lactams with Penase and lactamase II were determined. beta-Lactams were detected by a microbial inhibition assay and with enzyme-linked immunosorbent assays before and after hydrolysis. beta-Lactams (10-100 ppb) were spiked in kidney extracts and hydrolyzed. Results indicate a pattern that tentatively classified the beta-lactams into 3 subgroups. Desfuroyl-ceftiofur-cysteine, a major metabolite of ceftiofur, was clearly detected. Penicillin G, ampicillin, amoxicillin, and cloxacillin were distinguishable from cephapirin, ceftiofur metabolite, and high levels of hetacillin. Liver and kidney tissue samples were analyzed with the combined enzyme hydrolysis and screening assays, which tentatively identified the residues. This approach can speed up screening analysis of beta-lactam residues prior to identification and quantitation by chromatographic analysis, thus enhancing positive identification of residues to provide a safer food supply.

Race and ethnicity in research on infant mortality

BACKGROUND AND OBJECTIVES

Race and ethnicity are variables frequently used in medical research. However, researchers employ race and ethnicity in different ways and with differing intent. This leads to confusion over the interpretation of racial or ethnic differences. This study sought to determine how race and ethnicity are used in research on infant mortality.

METHODS

We did a structured literature review of original research related to infant mortality published between January 1995 and June 1996 and indexed in the Core Contents section of MEDLINE.

RESULTS

The majority of articles (54%) mentioned race and ethnicity. US studies mentioned race or ethnicity more than non-US studies (80% versus 22%). Only one study defined the method used to determine the ethnicity of patients; no study defined race or the methodology used in determining patients' race. Researchers primarily used race and ethnicity to describe study populations. Some racial and ethnic identifiers may have been stigmatizing to the subjects studied. The second most common use of race or ethnicity was as a potential confounder. Only one article discussed racism as a contributing factor in infant mortality.

CONCLUSIONS

There are several problems and ambiguities in the use of race and ethnicity in clinical research. Researchers who use racial or ethnic categories should do so for specified reasons and adopt clear definitions of the categories used.

Survey of commercial airline pilots' hearing loss

64 commercial airline pilots (ages 35-64 yr, Mdn: 53) were surveyed regarding hearing loss and tinnitus. Within specific age groups, the proportions responding positively exceed the corresponding proportions in the general population reported by the National Center for Health Statistics.

Medical options for early pregnancy termination

Newly developed protocols using methotrexate and misoprostol are more than 90 percent effective in terminating pregnancies of less than seven weeks of gestation. Major side effects include cramping and bleeding. In a significant minority of women, the abortion is completed only after a prolonged wait. Nonetheless, abortions completed with methotrexate and misoprostol have been well tolerated and acceptable to patients. Mifepristone (formerly called RU 486) will soon be available in the United States. When used with misoprostol, mifepristone successfully terminates 94 to 99 percent of early pregnancies.

Advances in the therapy for sepsis in children

Sepsis remains a major clinical problem in children, with a high mortality rate. Recent discoveries have identified the major cytokines involved in sepsis and several anticytokine strategies have been used in clinical trials. Antiendotoxin, anticytokine, and even steroid therapy have been studied in humans, with limited success. Several of the clinical trials of immunotherapy in sepsis are reviewed, and the inherent pitfalls in the varied clinical approaches investigated are analyzed.

Vertical Flux of Biogenic Carbon in the Ocean: Is There Food Web Control?

Models of biogenic carbon (BC) flux assume that short herbivorous food chains lead to high export, whereas complex microbial or omnivorous food webs lead to recycling and low export, and that export of BC from the euphotic zone equals new production (NP). In the Gulf of St. Lawrence, particulate organic carbon fluxes were similar during the spring phytoplankton bloom, when herbivory dominated, and during nonbloom conditions, when microbial and omnivorous food webs dominated. In contrast, NP was 1.2 to 161 times greater during the bloom than after it. Thus, neither food web structure nor NP can predict the magnitude or patterns of BC export, particularly on time scales over which the ocean is in nonequilibrium conditions.

Antihistamines and the common cold. A review and critique of the literature

OBJECTIVE

To determine if antihistamines provided clinically significant relief from the symptoms of the common cold.

METHODS

Structured literature review following standardized guidelines of primary studies published after 1975.

MEASUREMENTS

Improvements in symptom scores for total symptoms and nasal symptoms over the first three days of a common cold.

RESULTS

Three of five studies reporting on sneezing found a statistically significant improvement in the antihistamine group; similarly, three of seven studies reporting on nasal discharge found a statistically significant improvement with therapy. No study reported improvement in total symptom score at the level of p < .05. The validity of these findings was weakened by several flaws in the literature such as inattention to clinical significance and functional impact, inappropriate use of statistical tests, and poorly described methodology. The clinical significance of these improvements was not demonstrated.

CONCLUSIONS

The primary literature offers little support for the use of antihistamines in the common cold.

Predictive factors of short-term neurologic outcome in children with encephalitis

When a child is admitted to the hospital with presumed encephalitis, the physician must use clinical criteria to gauge the appropriate level of hospital care and to give a preliminary assessment of outcome to the family because the etiology is unknown. This study attempted to determine which clinical factors gathered on hospital admission would be most helpful to the physician. The records of 106 children (ages 1 month to 20 years), admitted to Rainbow Babies and Childrens Hospital between 1978-1989 who had discharge diagnoses of encephalitis, were reviewed. Seventy-five met the case definition of presumed viral encephalitis, with viral etiology established in 23% of patients. Poor short-term outcome was defined as the presence of an abnormal neurologic examination at hospital discharge, and was present in 32% of patients. Focal signs on neurologic examination (odds risk: 16.30, P < .05) and abnormal neuroimaging studies (odds risk: 5.66, P < .05) were the only 2 factors present at admission that predicted a poor short-term outcome. Glasgow coma scale at admission was predictive of an abnormal neurologic examination at discharge only when profoundly depressed (6 or less); otherwise, this scale was not useful as a prognostic tool. Factors that were not correlated with adverse outcomes included age younger than 1 year, any type of seizure occurrence, status epilepticus, diffuse or focal electroencephalographic abnormalities, or abnormal cerebrospinal fluid findings.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro activity of CP-99,219, a novel 7-(3-azabicyclo[3.1.0]hexyl) naphthyridone antimicrobial

The in vitro activity of CP-99,219 was compared with that of ciprofloxacin and sparfloxacin against 814 clinical bacterial isolates using a microdilution method with brain-heart infusion broth. CP-99,219 was the most potent agent tested against methicillin-resistant, ciprofloxacin-susceptible staphylocci (minimum inhibitory concentration [MIC]90 < or = 0.25 microgram/ml). CP-99,219 was 32-fold and fourfold more potent than ciprofloxacin and sparfloxacin, respectively, against Streptococcus pneumoniae, including strains resistant to penicillin G and erythromycin (MIC90 < or = 0.25 microgram/ml). CP-99,219 was also the most potent agent tested against S. pyogenes and Enterococcus faecalis (MIC90 < or = 0.5 microgram/ml). The activity of CP-99,219 against Enterobacteriaceae was comparable to that of sparfloxacin, with 90% of Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, Citrobacter freundii, C. diversus, Helicobacter pylori, and K. oxytoca being inhibited by < or = 0.5 microgram/ml. Serratia marcescens, Morganella morganii, and Pseudomonas aeruginosa were less susceptible, with MIC90 values to CP-99,219 of 4, 2, and 2 micrograms/ml, respectively. The MIC90 for Bacteroides fragilis was 0.39 microgram/ml for CP-99,219 compared with 12.5 micrograms/ml for ciprofloxacin. CP-99,219 was highly bactericidal at 1 x to 4 x MIC against both Gram-positive and Gram-negative organisms; its activity was similar in nutrient, trypticase soy, and cation-supplemented Mueller-Hinton broths. The spectrum and potency observed with CP-99,219 warrant further testing with this novel quinolone.

Detection of internal carotid artery stenosis: comparison of MR angiography, color Doppler sonography, and arteriography

Findings of two-dimensional time-of-flight magnetic resonance (MR) angiography projection angiograms were prospectively compared with those of color Doppler sonography by using angiography as a standard in 23 consecutive patients (42 carotid bifurcations) to evaluate their utility in determining the presence of carotid artery stenosis. MR angiography helped detect 50% or greater lumen diameter stenosis (sensitivity, 0.96; specificity, 0.64). Color Doppler sonography with 1.25 m/sec peak systolic velocity as a threshold had a sensitivity of 0.96 and a specificity of 0.71. Statistical analysis showed a correlation between percentage of lumen diameter narrowing and the length of the zone of signal intensity loss with MR angiography (r = .69; P less than .0001). A stronger relationship was obtained between angiographic narrowing and peak systolic velocity derived from color Doppler sonography (r = .80; P less than .0001). Two-dimensional time-of-flight MR angiography displayed as projection angiograms and combined with carotid artery and combined with carotid artery sonography is a useful approach for helping detect and potentially grade the severity of stenoses of the carotid artery.

Conjugated Polymer Films for Gas Separations

Permeabilities for a series of gases through free-standing films of the conjugated polymer polyaniline are reported. A remarkable selectivity has been achieved for important gas pairs incuding hydrogen-nitrogen, oxygen-nitrogen, and carbon dioxide-methane. The selectivity values of 3590 for H(2)/N(2), 30 for O(2)/N(2), and 336 for CO(2)/CH(4) surpass the highest previously reported values of 313, 16, and 60 for the nonconjugated polymers poly(trifluorochloroethylene), cellulose nitrate, and a fluorinated polyimide, respectively. The process for tailoring gas selectivity of a polyaniline membrane involves first enhancing the permeabilities of gases with small diameters [<3.5 angstroms (A)] by doping and undoping the polymer film with counterions of an appropriate size. High selectivities are then achieved by decreasing the permeabilities of larger gases (>3.5 A diameter) through controlled redoping of the polymer. The permanent morphological changes induced in this conjugated polymer system and others indicate the potential for development of universal membranes for gas separations.

The Pyrolysis of Phenylnaphthalenedicarboxylic Anhydrides: Products of Ring Contraction and of Radical Cyclization

Naphthalene-1,2,-dicarboxylic anhydrides with neighbouring phenyl substituents give on flash vacuum pyrolysis (850-900°/0.02-0.04 mm) ring-contracted carbenes which insert into the phenyl groups. The 8- phenyl anhydride (7) gives acephenanthrylene (10) as the major product, and the 3-phenyl anhydride (15) gives 1,2 : 4,5-dibenzopentalene (indeno [2,1-a]indene) (18). The anhydrides (7) and (15) were � synthesized by pyrolysis of the corresponding 1-naphthylmethyl propynoates (2) and (13) through a new one-step process of intramolecular Diels -Alder addition/retro-Diels -Alder elimination of acetylene. 1-Phenylnaphthalene-2,3-dicarboxylic anhydride (19) on pyrolysis at 960°/0.02 mm gives fluoranthene (11) as the major product. The behaviour of the 1-C6D5 compound (24) suggests involvement of a radical cyclization process.

The Pyrolysis of Butatrienone Precursors: 3,4-Diazatricyclo[5.2.1.02,6]deca-3,8-diene-endo-cis-2,6-dicarboxylic anhydride and Its 5,5-Diphenyl Derivative

Flash vacuum pyrolysis of the title anhydride (4) gave a poor yield of butatrienone , detected by argon matrix isolation infrared spectroscopy. Similar pyrolysis of the 5,5-diphenyl derivative (8) failed to give diphenylbutatrienone ; the red product (16) is considered to have been formed by dimerization of an intermediate 2H-indenylidenemethanone (15). The crystal structure of (16) has been determined.

Left ventricular adaptation to volume overload from large aortocaval fistula

The manner in which the left ventricle responds to an acute volume overload has not been well defined. Left ventricular performance was studied in six chronically instrumented resting awake dogs in the control state and serially after creation of a large abdominal aortocaval shunt. Ultrasonic transducers measured minor and major axis diameters and equatorial wall thickness. Left ventricular pressure was obtained with micromanometers. Cardiac contractility was evaluated by the load-independent contractility index, EMAXsc (slope of the normalized end-systolic equatorial midwall circumferential stress-equatorial midwall circumference relationship). By 1 week postshunt, the dog had clinical signs of congestive heart failure (ascites, dyspnea, limb edema); although systolic aortic pressure remained stable, heart rate, end-diastolic volume, pulse pressure (systolic minus diastolic pressure), cardiac output, minute work and dp/dtmax were significantly increased. At 1 week the calculated left ventricular mass was increased by 10.1% +/- 4.0% above control. EMAXsc was significantly increased immediately after shunting but returned to control at 1 day and was less than control at 1 week. Thus adaptation of the left ventricle to acute volume overload is characterized by use of inotropic, chronotropic, and Starling reserves. However, chronic volume overload is characterized by decreased inotropic state and an apparent increase in hemodynamic performance (dp/dtmax, cardiac output, minute work), which appears to be maintained by an increase in cardiac mass and by chronotropic and Starling reserves.

Absolute Cross Sections of Proton Induced Reactions on 65Cu, 64Ni and 63Cu

Absolute cross sections have been measured for (p, y) reactions on 63CU, 64Ni and 63CU over proton energy ranges of 1,05-3 '25, 1�00-3 �45 and 1�05-4� 70 MeV respectively, for (p, n) reactions over proton energy ranges from threshold to 3� 25,3' 80 and 4�86 MeV respectively, and for 63CU(p, p')63CU over a proton energy range of 1�05-4'00 MeV. All the data are compared with global statistical model calculations. The agreement, to within a factor of 2, between theory and experiment is regarded as satisfactory for a global code, but the 64Ni data are suggestive of a closed shell effect at Z = 28.

Pyloric stenosis--a report of triplet females and notes on its inheritance

Pyloric stenosis has been reported in multiple sibs and multiple births, A case of the disease affecting triplets is reported, the second in the literature. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Descendants of affected females are the most likely to develop pyloric stenosis.